Atlantoaxial pedicle screw system for treatment of unstable atlantoaxial dislocation post traction / 中华创伤杂志

Objective To explore the technique and clinical outcome of the atlantoaxial pedicle screw system in the treatment of the unstable atlantoaxial dislocation post traction.Methods The study involved 32 patients with atlantoaxial dislocation(type T2 of TOI classification)admitted from March 2005 to September 2009.There were 17 patients with fresh odontoid fracture and two with old odontoid fracture,five with traumatic disruption of the transverse atlantal ligament and eight with congenital odontoid dysplasia.JOA scores of neurological function before operation was at a range of 5-13(average 8.38).The average of space available for the cord(SAC)was 9.15 mm.Before the atlantoaxial pedicle screw system was carried out,the skull traction was performed in all the patients preoperatively.Results A total of 128 pedicle screws were inserted safely,with mean operation time and perioperative blood loss for 1.5 hours and 300 ml,respectively.No injury to the vertebral artery or spinal cord was observed.All the patients were followed up for 12-24 months,which showed that JOA scores one year after operation was increased to 10-17(average 14.56),with the improvement rate of 71.70%,and that the SAC was average 14.86 mm.The X-ray and SCT scans verified the proper position of the screws,with no internal fixation failure or atlantoaxial redislocation.After 3-6 months,all the patients except for one patient achieved a solid bone fusion.One year after operation,the one patient with no bone graft fusion was removed of the internal fixation system and obtained satisfactory restoration of the rotational function.Conclusions Atlantoaxial pedicle screw system is an effective method for the treatment of the unstable atlantoaxial dislocation post traction,for it has the advantages of stable three-dimension fixation,direct screw placement,intraoperative reduction and high fusion rate.

Treatment options for Grauer type Ⅱ odontoid fractures and clinical outcome / 中华创伤杂志

ObjectiveTo explore the treatment options for fresh Grauer type Ⅱ odontoid fractures and discuss corresponding clinical outcome.Methods The study involved 40 patients with fresh odontoid fractures including seven with type Ⅱ A fractures, 18 with type Ⅱ B and 15 with type ⅡC according to Grauer classification.There were five patients with incomplete cervical cord injuries.Type Ⅱ A fractures were treated by traction of occipital-jaw band or skull for 1-2 weeks and then fixed with head-neck-chest plaster or brace.Type Ⅱ B fractures were treated with anterior odontoid screw system fixation.Fifteen patients with type Ⅱ C fractures and three patients with type Ⅱ B fractures combined with severe fracture displacement were managed with posterior atlantoaxial pedicle screw fixation.Results All the patients were followed up for 6-24 months.Seven patients with type Ⅱ A fractures showed union after fixation with head-neck-chest plaster or brace for 3-6 months.Fifteen patients treated with odontoid screw fixation had good positions of screws, with no injury to the spinal cord, of which 14 patients obtained bone union, with union rate of 93.3％.Eighteen patients (including 15 patients with type Ⅱ C fractures and three with type Ⅱ B fractures combined with severe displacement) managed with atlantoaxial pedicle screw system showed no injury to the vertebral artery and spinal cord.Solid bone fusion was achieved.in 31 patients after 3 to 6 months.The X-ray and SCT scans verified proper fixation of the screws, with no deformation, loosening or breakage of the screws.Five patients with incomplete cervical cord injuries obtained neural function recovery at various degrees after surgery.ConclusionsConservative treatment cau be alternative to type ⅡA fractures.Anterior odontoid hollow screw fixation is better for type ⅡB fractures (non-displaced or reducible) and has advantages of minor trauma, fast postoperative recovery and high union rate.However, posterior atlantoaxial pedicle screw system fixation and fusion is suitable to type Ⅱ C and ⅡB fractures with severe displacement and has the advantages of stable three-dimension fixation, direct screw placement, intraoperative reduction, short-segment fixation and high fusion rate.

A Clinical Study on the Minor Myocardial Injury Associated with Percutaneous Coronary Intervention / 中国医师杂志

0 05). In PCI group,the balloon inflation time, the highest inflation pressure and the number of placed stents in the patients with the increased level of cTnI had not significant difference compared with those in the patients without the increased level of cTnI. There were 2 patients with side branch occlusion, whose cTnI level obviously elevated. Conclusion PCI could lead to minor myocardial injury in some patients, the reason of which might be side branch occlusion. The number of placed stents and balloon inflation time were not associated with the minor myocardial injury.

Alteration of serum interleukin-6 and tumor necrosis factor-? after ischemic stimulation of coronary artery in PTCA / 中国病理生理杂志

AIM: Inflammatory responses play an important role in the post- percutaneous transluminal coronary angioplasty (PTCA) restenosis and has been demonstrated occuring immediately after PTCA. Interleukin-6(IL-6) and tumor necrosis factor-?(TNF-?) are the main inflammatory cytokines. We try to compare the changes in interleukin-6(IL-6) and TNF-? after PTCA in the patients with and without collateral circulation to probe into the pathogenesis of early inflammatory response. METHODS: The extent of myocardial ischemia induced by balloon inflation was quantified by a scoring system referring to the Leaman coronary score. The IL-6?TNF-? levels of coronary heart disease group and control group before and after PTCA are calculated. RESULTS: The concentrations of IL-6 and TNF-? were (9.592?1.847) ng/L and (26.959?1.967) ng/L, respectively, and were significantly increased [(27.423?1.882) ng/L and (78.542?1.573) ng/L)] 4 hours after PTCA. CONCLUSION: IL-6 and TNF-? are sensitive indicators of the early inflammatory response after PTCA. Ischemia scores reflected the extent of ischemia reperfusion injury during PTCA. Collateral circulation decreased the early inflammatory response after PTCA.