Diagnosis and treatment status of spinal cavernous hemangioma / 中华骨科杂志

Spinal cavernous hemangiomas (SCH) represent a rare subtype of cavernous hemangiomas (CH). Existing literature predominantly indicates a higher prevalence of SCH in the thoracic region, although a comprehensive explanation for segmental distribution variations remains elusive. Current investigations suggest that the etiology of SCH may be linked to mutations in genes such as TEK, KRIT1, MGC4607, and PDCD10, and can also be precipitated by external factors including radiation, trauma, and infection. However, the specific impact of radiation dosage and modality on the incidence and severity of SCH warrants further in-depth study. The onset of this disease is concealed, but it can cause serious motor and sensory disorders. The symptoms mostly progress slowly or disappear gradually, but there are also cases of acute onset or sudden exacerbation. Recent research emphasizes the more prevalent magnetic resonance imaging (MRI) features of "flame-like" or "linear" intramedullary hemorrhages over the formerly identified "popcorn" or "mulberry-like" heterogeneous signals. Surgical intervention is generally recommended for patients with severe or progressively worsening symptoms, large lesion volumes, high risk of hemorrhage, or those with rapid increase in lesion size upon follow-up. Optimal outcomes are achieved when surgery is performed within three months of symptom onset. Surgical strategies typically involve laminectomy or laminoplasty via a posterior approach to achieve maximal lesion resection, although deep-seated lesions still pose considerable surgical challenges and risks. Ongoing clinical innovations are focusing on optimizing surgical approaches and techniques, such as employing anterior or dorsolateral approaches into the spinal cord via dorsal root entry zones and utilizing orthopedic robotic systems. Intraoperative monitoring technologies like neurophysiological monitoring and intraoperative ultrasound have been widely implemented, yet uniform warning criteria are yet to be established. A limited array of pharmacotherapies, including propranolol and sirolimus, have been clinically deployed, but their efficacy awaits validation from multicenter studies. In terms of disease management, patients with a history of spinal lesions, subarachnoid hemorrhages, or large lesions generally have poorer prognoses, while the impact of underlying comorbidities like hypertension and diabetes on hemorrhage risk remains unclear. The likelihood of re-hemorrhage in SCH patients increases over time, and tailored conservative treatment plans for diverse clinical scenarios are yet to be refined.

Analysis of the complications of percutaneous vertebroplasty / 中国矫形外科杂志

[Objective]To analyze the causes of complication following percutaneous vertebroplasty and to find out the methods on its prevention and treatment.[Method]Complications of 140 patients (233 vertebral bodies) performed percutaneous vertebroplasty from August 2002 to July 2006 and long-term complications and its correlative prognosis after followed-up 7-52 months (average 28.4 months were observed and analyzed.[Result]Sixty-one patients of 140 cases showed complications (43.6%).Forty-five of the 61 patients with complications revealed with leakage of bone cement,2 with transient low blood pressure or lethargy,3 with dyspneic respiration or slight cough or chest discomfort,1 with subcutaneous herniation.In 12 patients complicated with leakage of bone cement,10 complained aggravation of pain,1 of radiating pain of back and low limb,1 with incomplete paraplegia. The 11 patients complicated with various postoperative pain induced by bone-cement leakage were complete recovery after treatment with anti-imflamatory analgetics orally for 3-7 days.One patient with incomplete paraplagia caused by leakage of bone cement demonstrated satisfactory walking function recovery but still remained slight disability of lower limbs after 26 months by treatment of laminectomy decompression,with drawing of bone cement combined with anti-biotics,dehydration agent,hormone,nerve-nourisling agent and 3-month acupuncture. Two patients with transient low blood pressure or lethargy were treated and recovery after fluid infusion and 30-60 oxygen taking. Three patients with dypneic respiration or slight cough or chest discomfort but without abnormality on radiographs were convalesced after treatment of fluid infusion,taking oxygen and anti-biotics for 3-5 days.The subcutaneous homotoma of 1 patient was absorbed 7 days later.Ten patients complicated with new adjacent vertebral body fracture 1-12 months postoperatively were healed after conservative treatment of PVP operation.[Conclusion]Complications after percutaneous vertebroplasty are not uncommon(43.6%).Leakage of bone cement is most common complication. Strict pre-operation plan and improving operation skill are the most important preventive measures.

An Analysis on the Clinical Therapeutic Effect of the Chinese Medical Herb Washing Matched with Small Needle Scaple for Treatment of Osteoarthritis of the Knee / 浙江中医药大学学报

[Objective] To explore the method for knee joint osteoarthritis. [Method] 97 patients take the said method above, observe its effect. [Result] 41 cases were excellent, 29 good, 22 just so so, 5 bad, the total effective rate was 94.85%. [Conclusion] TCM external cleansing coordinated with small needle-knife has good clinical effect.