Health Conditions and Health Service for People with Intellectual Disability / 中国康复理论与实践

Objective To analyze the health conditions, related factors and development of health services for people with intellectual disability, to provide evidence-based support for the development of health services.Methods The functioning of people with intellectual disability had been analyzed using ICF. Health conditions and related factors for people with intellectual disability had been analyzed using epidemiologic approach.Results The prevalence of intellectual disability is about 1.1％ reported by US and 0.75％ by China. The main health conditions for people with intellectual disability were overweight, obesity, malnutrition, oral problems and digestive diseases. The main functioning included cognitive impairment, autism spectrum disorder, visual or auditory impairment, learning disability, movement limitation, generalized developmental disorder, etc. Secondary disorders caused by intellectual disability worsened the functioning of conceptual skills, social skills and practical skills.People with intellectual disability faced health risks from biological and environmental domains.Conclusion It is important to tailor to the unmet needs and health behaviors of people with intellectual disability. It is proposed to conduct capacity building for health professionals and institutions and improve the health of people with intellectual disability.

Contrast study of full-endoscopic interlaminar approach for the surgical treatment of lumbar disc herniation / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate the minimally invasive efficacy and surgical outcome of full-endoscopic discectomy via interlaminar approach for lumbar disc herniation (LDH).</p><p><b>METHODS</b>From August 2008 to February 2009, 56 patients with lumbar disc herniation were retrospectively studied. The patients were divided into two groups according to the surgical methods. Full endoscopic discectomy (FED) group included 16 males and 12 females, the age was 20 - 51 years with a mean (36 ± 8) years, and the course of disease was 18 - 120 d with a mean (68 ± 26) days. There was L(5)-S(1) LDH in 22 and L(4-5) LDH in 6. Headlamp-assisted mini-open discectomy (HAMOD) group, there were 17 males and 11 females. The age was 17-53 years with an average age of (35 ± 9) years, the course of disease was 19 - 110 d with an average (66 ± 24) days, and the herniated disc located at L(5)-S(1) in 15 cases, and L(4-5) in 13 cases. Perioperative parameters (operation time, bleeding volume and length of hospital stay), complications and VAS of leg and back pain (preoperatively, 3 months postoperatively and final follow-up) were statistically analyzed.</p><p><b>RESULTS</b>All patients were followed up in both groups, and the average follow-up time of full endoscopic was 1.8 years, and headlamp assisted mini-open was 1.7 years. The average operation time in full endoscopic group was (71 ± 30) min and the headlamp group was (60 ± 12) min, which there was no statistical difference (P > 0.05). There was no measurable bleeding in full endoscopic group, and the headlamp group was (59 ± 10) ml. The average hospital days in full endoscopic group was (5.7 ± 1.4) days, and the headlamp group was (12.3 ± 3.0) days, there was statistically significant difference in both groups (P < 0.01). The complication rate in full endoscopic group was 7.1%, and in headlamp group was 10.7%, without statistical difference (P > 0.05). There was no recurrent case in either group. With regard to VAS of back pain and leg pain, statistically significant difference was found in each group between preoperatively and 3 months postoperatively, but not between 3 months postoperatively and at final follow-up. With regard to the final follow-up VAS, there was no statistical difference in leg pain between full endoscopic and headlamp group (P > 0.05). However, there was statistical significance in VAS back pain between the two groups (P < 0.01).</p><p><b>CONCLUSIONS</b>Compared to the headlamp assisted mini-open technique, the full-endoscopic interlaminar approach for the surgical treatment of lumbar disc herniation can achieve similar clinical outcomes with advantage of less iatrogenic trauma and sooner rehabilitation.</p>

Complications of one stage posterior vertebral column resection for the treatment of severe rigid spinal deformities / 中华外科杂志

<p><b>OBJECTIVE</b>to summarize the complications of posterior vertebral column resection (pVCR) and pedicle screw fixation for the treatment of rigid thoracic and lumber spinal deformity.</p><p><b>METHODS</b>fifty four patients from a single center from February 2000 to February 2009 were included in this study. There were 23 males and 31 females with an average age of 28.3 years (range, 16-58 years). Patients were divided into 4 diagnostic categories: severe scoliosis (n = 9, mean Cobb angle, 91.7°), kyphoscoliosis (n = 22, mean scoliosis, 101.5°, and mean kyphosis, 69.4°), angular kyphosis (n = 21, mean kyphosis, 72.2°), global kyphosis (n = 2, mean kyphosis, 93.6°). All of the patients received one stage pVCR combined correction with pedicle screws and circumferential fusion. Radiographs and hospital charts were reviewed to analyze the outcomes of correction.</p><p><b>RESULTS</b>a mean of 1.4 vertebral levels were resected, the mean operative time was 470 min, and the mean blood loss was 4180 ml. All the patients were followed-up for an average time of 26 months (range, 12 - 66 months). At the latest follow-up, the major curve correction averaged: severe scoliosis 61.4° (67%), kyphoscoliosis 59.7° (56%)/kyphosis 42.3° (59%), angular kyphosis 48.5° (71%), global kyphosis 62.7° (67%). A total of 21 complications (38.9%) occurred in 17 patients, including 5 (9.3%) neurological complications happened in early stage and one case of delayed complete paraplegic. There were 11 (20.4%) non-neurological complications happened in early stage and 5 (9.3%) cases in late stage.</p><p><b>CONCLUSIONS</b>one stage posterior-only vertebral column resection can achieve satisfactory correction of severe deformities with limited flexibility. Given its technically demanding and exhausting features, its potential risk of significant complications should be paid more attention.</p>

One-stage combined anterior and posterior strategy in treating active tuberculosis of thoracic and lumbar spine complicated with severe kyphotic deformity / 中华外科杂志

<p><b>OBJECTIVE</b>To explore an effective and reasonable surgical strategy for active spinal tuberculosis with severe kyphotic deformity (kyphotic angle >or= 45 degrees).</p><p><b>METHODS</b>From January 2004 to January 2008, 30 consecutive patients of active spinal tuberculosis complicated with significant angulation were enrolled in this study, including 8 male and 22 female. The average age was 35 years (range, 7 - 60 years), with average angle of kyphosis of 58 degrees (range, 45 degrees - 70 degrees). There were 28 patients complicated with intraspinal abscess, of which 10 patients presented with incomplete paraplegia. According to the Frankel's scoring system, there were 2 patients with Frankel Grade B, 6 with Grade C, 2 with Grade D. After antituberculous chemotherapy (HREZ) for at least 2 weeks, all patients underwent posterior multiple-level pedicle screw instrumentation and kyphotic correction, and then received anterior debridement, decompression and supportive bone grafting, all of which were completed in the same day. The postoperative standardized chemotherapy was 6HREZ/6-12HRE. The angle of kyphosis, curve correction after surgery, and recovery of paraplegia were analyzed. Fusion status and erythrocyte sedimentation rate were recorded to determine the presence of active disease.</p><p><b>RESULTS</b>Operative time was 4 to 6 hours (average 5.2 h), blood loss was 600 to 900 ml (average 760 ml). No perioperative severe complications occurred. The kyphotic angle was corrected to 0 degrees - 10 degrees, and the maximum corrected angle was 65 degrees . The average follow-up duration was 18 months (range, 12 - 48 m). All patients showed evidence of solid fusion and healing of the active disease at 6 months follow-up. Neurologic deficits were improved: 2 patients from B to D, 6 patients from C to E, 2 patients from D to E. No recurrence of the tuberculosis infection or instrumentation failure happened at final follow-up.</p><p><b>CONCLUSION</b>Combined posterior instrumentation and anterior debridement, fusion surgery in one stage is proved to be successful in treating spinal tuberculosis, correcting the kyphosis, and providing solid fusion.</p>

Correlation of the expression of III β-tubulin and MDR1 protein with biological features of non-small cell lung cancer / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To explore the expression of III β-tubulin and MDR1 protein in patients with non-small cell lung cancer (NSCLC), and to clarify its clinical significance.</p><p><b>METHODS</b>Paraffin embedded tissues from 158 primary non-small cell lung cancers and para-cancerous lung tissues were investigated for the expression of III β-tubulin and MDR1 protein by immunohistochemistry, as well as in freshly-taken NSCLC tissues by Western blot. The relationship between the expression of III β-tubulin and MDR1 and the biological features of lung cancer was analyzed.</p><p><b>RESULTS</b>The positive rate of III β-tubulin and MDR1 protein expression in lung cancer tissues was 65.19% and 51.27%, respectively. Western blot analysis showed that the level of of III β-tubulin and MDR1 protein in NSCLC tissues was remarkably higher than that in normal tissues (P < 0.01). The expression of III β-tubulin in stage III-IV cases was significantly higher than that in stage I-II cases (P < 0.05), while the expression of MDR1 protein showed no significant difference (P > 0.05). The positive rate of III β-tubulin expression in well-moderate pathological grades was lower than that in poor ones. The positive rate of MDR1 expression in adenocarcinoma was higher than that in squamous cell carcinoma and large cell undifferentiated cancers (P < 0.01). The positive rate of expression of MDR1 protein and III β-tubulin was not correlated with sex, age, tumor size and lymph node metastasis (P > 0.05).</p><p><b>CONCLUSION</b>The expression of III β-tubulin and MDR1 may play an important role in the development and progression of human non-small cell lung cancer, and could be looked as an important index for judging the prognosis of lung cancer.</p>

Expression of alpha-tubulin and MDR1 and their correlation with the biological features of non-small cell lung carcinoma / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To detect the expression of alpha-tubulin and MDR1 in human non-small cell lung carcinoma (NSCLC), and to clarify their clinical significance.</p><p><b>METHODS</b>Paraffin embedded tissues from 158 primary non-small lung carcinomas and 30 paracancerous lung tissues were examined for expression of alpha-tubulin and MDR1 by immunohistochemistry (SP method). 30 freshly taken NSCLC tissues were examined by Western blot analysis. The relationship between alpha-tubulin and MDR1 expression and the biological features of lung carcinoma was analyzed.</p><p><b>RESULTS</b>The positive rate of alpha-tubulin and MDR1 expressions in the lung carcinomas was 65.2% and 51.3%, respectively. There was no expression of either of them in 30 paracancerous lung tissues. Western blot analysis showed that the level of alpha-tubulin and MDR1 expressions in NSCLC tissues were 0.49 +/- 0.06 and 0.56 +/- 0.04, respectively, significantly higher than that in paracancerous tissues (0.07 +/- 0.01) (t = 3.693 and t = 6.769, P < 0.01). The positive rate of alpha-tubulin expression was gradually increased with tumor progression, significantly higher in III-IV stage cancers and in poorly differentiated carcinomas (both P < 0.01). There was a distinct statistically significant difference between stage I, stage II and III, and stage IV. The positive rate of alpha-tubulin in well-moderately differentiated carcinomas was lower than that in poorly differentiated ones. There was no significant correlation with age, sex, tumor size, histological type, clinical TNM system and lymph node metastasis. The positive rate of MDR1 was not correlated with sex, age, tumor size, pathological grading, clinical TNM stages and lymph node metastasis. But the positive rate of MDR1 in adenocarcinoma was significantly higher than that in squamous carcinoma and undifferentiated large cell carcinomas (P < 0.01). alpha-tubulin and MDR1 expression had no impact on the outcome of chemotherapy (chi(2) = 0.69 and 1.30, P > 0.05, respectively). Univariate analysis showed that the 5-year survival rate of patients with negative alpha-tubulin and MDR1 expression was 30.7% and 28.5%, respectively, significantly higher than that of patients with positive alpha-tubulin and MDR1 expression (13.5% and 11.8%, respectively) (chi(2) = 20.69 and 15.52, P < 0.01, respectively), and multivariate Cox regression analysis showed that alpha-tubulin (RR = 3.287, P = 0.006) and clinical TNM stage (RR = 1.954, P = 0.025) were significantly independent predictive factor for patients with lung cancer, MDR1 and other factors could not be used as an independent predicitive factors. However, there was no significant correlation between the expression of alpha-tubulin and MDR1 in lung carcinoma(r = 0.093, P > 0.05).</p><p><b>CONCLUSION</b>The expression of alpha-tubulin and MDR1 may play an important role in the development and progression of human non-small cell lung carcinoma. Combined detection could be considered as an important index for predicting prognosis of lung carcinoma.</p>

Activated changes of platelet ultra microstructure and plasma granule membrane protein 140 in patients with non-small cell lung cancer / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Non-small cell lung cancer (NSCLC) is the leading cause of cancer mortality worldwide. Platelet activation may play an important role in pathologic progress in lung cancer. In this study, we aimed to clarify the influence of activated platelets on lung cancer generation and growth, and the relationship among these functional and ultrastructural changes of platelets and the severity of pathogenetic condition in these patients with NSCLC.</p><p><b>METHODS</b>One hundred and thirty-six cases of patients with pathologically confirmed NSCLC were included in this study. Fifty-four healthy people were enrolled as controls. The change of ultra microstructure and activity of blood platelets were observed under the transmission and scanning electron microscope. Simultaneous determination of plasma granule membrane protein 140 (GMP-140) was made.</p><p><b>RESULTS</b>Transmission electron microscopy showed remarkable changes of ultra microstructure of platelets in patients with NSCLC, including swelling, increase of a-granules, vesicles, and glycogenosome. Scanning electron microscopy showed many more surface processes and wrinkles on platelets in patients with NSCLC. The reference plasma levels of GMP-140 of healthy controls were (18.2 +/- 2.7) microg/L. The plasma levels of GMP-140 in patients with NSCLC were (47.8 +/- 12.3) microg/L, which were much higher than those of the controls. There was a medium positive correlation between plasma levels of GMP-140 and amount of a-granules (r = 0.514, P < 0.01) and a high positive correlation between plasma levels of GMP-140 and area of platelet (r = 0.84, P < 0.01) in patients with NSCLC. The Kaplan-Meier survival curve analysis showed significant shift to the left in patients with NSCLC whose a-granules per platelet were 19 or more compared to those 18 or less (Log rank statistic, chi(2) = 17.38, P < 0.01).</p><p><b>CONCLUSIONS</b>There are significant activated changes of ultra microstructure and increased activity of blood platelets in patients with NSCLC. These activated platelets may play an important role in the generation and growth of lung cancer. These changes can be used as a diagnostic index of severity, progression, and prognosis of NSCLC.</p>

The assessment of accuracy and safety of thoracic pedicle screws placement with interlaminar fenestration technique in severe kyphoscoliosis treatment / 中华外科杂志

<p><b>OBJECTIVE</b>To analyze the accuracy and safety of thoracic pedicle screws placement with interlaminar fenestration technique in severe kyphoscoliosis treatment.</p><p><b>METHODS</b>Twenty-three cases of severe kyphoscoliosis between June 1996 and December 2007 underwent pedicle screw placement of thoracic vertebrae by interlaminar fenestration technique. Postoperative CT scan was performed in all cases; there were 9 males and 14 females with the averaging age 17.8 years old. The preoperative Cobb angle of the main thoracic curve was 97.3 degrees in average. The average kyphotic angle in main curve was 67.4 degrees . Patients who underwent screw placement by closing technique and postoperative CT scan in the same stage with severe kyphoscoliosis were selected as control group (B): there were 22 patients with the averaging age 17.2 years old. The preoperative Cobb angle of the main thoracic curve was 96.6 degrees in average. The average kyphotic angle in main curve was 62.1 degrees . The screw-related complications were analyzed and online measure and analyze the degree of screw penetration according to CT by statistics.</p><p><b>RESULTS</b>There were 209 thoracic pedicle screws being inserted in group A, no spinal cord and large blood vessel injury occurred, 5 patients occurred intraoperative pedicle fracture, dura lesion had 4 patients. Screws misplacement ratio was 8.6%, there were 11 screws located in the thoracic pedicle laterally, 6 screws located in medially, 1 screw presented a moderate anterior cortical perforation. The number of screws misplacement in upper and mild thoracic vertebrae were 15, occupied 83.3%; the number of screws misplacement in lower thoracic vertebrae were 3, occupied 16.7%. There was statistics difference (P < 0.05). Of the total 116 thoracic pedicle screws inserted on the convex side, the ratio of screw misplacement was 5.2%; 93 screws on the concave side, the ratio of screw misplacement was 12.9%, there was statistics difference (P < 0.05). There were 201 thoracic pedicle screws being inserted in group B, no spinal cord and large blood vessel injury occurred, 16 patients occurred intraoperative pedicle fracture, dura lesion had 7 patients. The ratio of screw misplacement was 22.4%, there were 24 screws located in the thoracic pedicle laterally, 11 screws located in medially, 10 screw presented a moderate anterior cortical perforation. The ratio of screw misplacement in Group B was higher than Group A (P < 0.05). All cases received 3.2 years and 3.4 years follow-up. There was no obvious loss of correction in coronal and sagittal plane at the latest follow-up.</p><p><b>CONCLUSIONS</b>It is technically demanding for placement of thoracic screw in the severe kyphoscoliosis treatment. The interlaminar fenestration technique can increase the accuracy and safety of thoracic pedicle screw placement.</p>

Expression of glucose transporter in non-small cell lung carcinoma and its clinical significance / 浙江大学学报·医学版

<p><b>OBJECTIVE</b>To investigate the expression of glucose transporter (Glut)1, Glut3, and hypoxia inducible factor (HIF)-1 alpha in human non-small cell lung carcinoma (NSCLC), and its clinical significance.</p><p><b>METHODS</b>Specimens of cancer tissues and paracancerous lung tissues from 34 cases of NSCLC and 17 specimens of benign lung lesions were collected. The expressions of Glut1, Glut3, and HIF-1 alpha were detected with immunohistochemical staining, RT-PCR, and Western blot.</p><p><b>RESULT</b>The relative mRNA expressions of Glut1 and HIF-1 alpha were 0.689 +/-0.245, 0.693 +/-0.248 in cancer tissues; and 0.338 +/-0.157, 0.351 +/-0.184 in paracancerous lung tissues (P <0.001); while those of Glut3 were 0.506 +/-0.246 in cancer tissues and 0.482 +/-0.238 in paracancerous tissues (P >0.05). The relative protein expressions of Glut1 and HIF-1 alpha were 0.582 +/-0.247, 0.525 +/-0.246 in cancer tissues and 0.288 +/-0.151, 0.261 +/-0.135 in paracancerous lung tissues (P<0.001), but the protein expressions of Glut3 were 0.551 +/-0.251 and 0.436 +/-0.224 respectively (P>0.05). Glut1 and HIF-1 alpha expressions were higher in poor differentiation group and in stage III group, than those in medium and well differentiation group and stage I and II group. Moreover, there was a significant correlation between the expression of Glut1 and HIF-1 alpha (r=0.854, P<0.01).</p><p><b>CONCLUSION</b>Glut1 and HIF-1 alpha are highly expressed in NSCLC, and their expressions are associated with tumor differentiation and clinical stage.</p>

Development and verification of a 3-dimensional finite element model of the human neck based on CT images / 中南大学学报(医学版)

OBJECTIVE@#To establish a 3-dimensional finite element model.@*METHODS@#The coordinate data of the vertebras were obtained from the CT scan images of Chinese 50th percentile healthy male adult volunteers' cervical spine, converted into point cloud data, and stored as ASCII file using Mimics software. CATIA software was used to preprocess and Geomagic software was used to establish the geometry model of the C0 approximately C7 cervical spine. The geometry model was meshed by Hypermesh software. Mapped mesh method was used to mesh cortical bone, trabecular bone, intervertebral disk, ligaments, etc. Some material parameters were defined from other available material parameters using proportion and function scale method.@*RESULTS@#The model had 22 512 solid elements and 14 180 shell/membrane elements. The model was validated by the cervical spine drop test.@*CONCLUSION@#The model has good biofidelity and can be used to study the dynamic response and injury mechanism of the cervical spine in the car accidents.

One stage posterior vertebral column resection for the treatment of thorciclumbar tuberculosis with kyphotic deformity / 中南大学学报(医学版)

OBJECTIVE@#To evaluate the clinical outcome of one stage posterior vertebral column resection in patients with spinal tuberculosis combined with kyphotic deformity.@*METHODS@#Thirty-six patients with spinal tuberculosis combined with kyphotic deformity underwent posterior one-stage vertebral column resection reducing tension on the spinal cord from 1998 to 2006. The patients were mobilized with a thoracolumbar orthosis for 3 months. All patients had a minimum of a 2-year follow-up, and clinical examinations and radiographs were obtained at 6-month intervals.@*RESULTS@#No perioperative mortality occurred. The average duration of surgery was 208 (145 approximately 385) min. The kyphotic Cobb angle improved from the preoperative average of 57.2 degree(17 degree approximately 86 degree) to a postoperative average of 8.9 degree(-6 degree approximately 27 degree). The average horizontal distance between C(7) and S(1) was 13.6 (8 approximately 19) mm preoperatively and 3.6 (-11 approximately 9) mm postoperatively. Nineteen patients had preoperative neurological deficits. Of them, 89.5% (17/19) showed a postoperative neurologic improvement. Perioperative complications occurred in 3(8.5%) of the 36 patients with pneumonias and superficial infections. Twenty-five patients (69.4%) showed radiographic evidence of solid fusion in the follow-up examinations. In the follow-up, 25% (9/36) patients rated their results as excellent, 66.7% (24/36) as good, 2 as fair, and 1 as poor.@*CONCLUSION@#One stage posterior vertebral column resection for the treatment of spinal tuberculosis with kyphotic deformity is safe and effective. Because this procedure is highly technical, the surgeon must be familiar with the pathoanatomy and the operation must be carefully done.

Combined anterior and posterior approach for cervical fracture-dislocation with ankylosing spondylitis / 中华外科杂志

<p><b>OBJECTIVE</b>To discuss the pathological characteristics of cervical spinal fracture of ankylosing spondylitis (AS), and surgical effect by combined anterior and posterior operation.</p><p><b>METHODS</b>Eighteen AS patients with traumatic cervical fracture-dislocation were treated from January 2000 to January 2006. The symptom duration of AS was 14.5 years in average. Three cases had undergone osteotomy in lumbar spine. There were 4 cases of Grade A, 3 cases of Grade B, 9 cases of Grade C and 2 cases of Grade D in Frankel's score. All patients underwent surgical procedures by combined anterior and posterior approach.</p><p><b>RESULTS</b>There were 4 anterior-posterior procedures, 8 anterior-posterior-anterior procedures and 6 posterior-anterior procedures. Seven patients had one stage operation and 11 cases underwent two stage. There were some extent neurological improvement in 14 incompletely paraplegic patients, no improvement in 4 complete paraplegia patients. The follow-up period was 21.2 months in average and the bone fusion was 3.6 months. There were 4 complications during perioperative period and 1 in long term follow-up.</p><p><b>CONCLUSIONS</b>The study suggests that anterior combined with posterior approach makes the spine stable and relieves the pressure immediately. It is the reasonable surgical strategy in the treatment of cervical spinal fracture-dislocation with AS.</p>

Operative strategy of the thoracolumbar fracture dislocation / 中南大学学报(医学版)

OBJECTIVE@#To explore the operative strategy and clinical outcome of the thoracolumbar fracture dislocation.@*METHODS@#Forty-two patients with the thoracolumbar fracture dislocation were treated with anterior approach (10 patients), posterior approach (28 patients), and anterior combined with posterior approach (4 patients) in order to construct the stabilities of the spine. The ASIA grades were used to evaluate the recovery of the neurological function, and the improvement of the kyphosis deformities was evaluated by the cobb's angle post-operation.@*RESULTS@#All the patients had no complications of injury in the vascular and neurological system. The ASIA grades after the operation were superior to those of pre-operation, and the cobb's angle was rectified distinctly.@*CONCLUSION@#When appropriate operative strategies are adopted, thoracolumbar fracture dislocation can be treated with satisfactory outcome.

Pedicle screws in the posterior reconstructive operation of the lower cervical vertebra / 中南大学学报(医学版)

OBJECTIVE@#To explore the efficiency of the cervical pedicle screws in the posterior reconstructive operation of the lower cervical diseases.@*METHODS@#From November 2001 to July 2003, 31 patients suffering from the lower cervical diseases were treated with the posterior pedicle screws fixation. We put the screws in the inferior articular process of the upper centrum, the lateral of the intervertebral facet center (3 - 5 mm the medial edge of lateral mass). The angles of toe-in sagittal plane varied from 30 degrees to 45 degrees, and the screws were from 18 to 26 mm (22.3 mm) in average.@*RESULTS@#There were 193 pedicle screws in this group, and no one had spinal cord injury or vertebral artery injury. The improvement rate was 84.5%. Follow-up was from 9 to 28 months (17 months in average). The screws were fixed properly without being loose and broken, and the bone graft fusions within 9 to 12 months in the X-ray and CT scan examination were satisfactory. The Japanese orthopaedics association score (JOA) was 9.7 preoperatively, but it was raised to 16.3 postoperatively.@*CONCLUSION@#The posterior reconstructive operation with cervical pedicle screws is a good choice for patients with lower cervical diseases.

Research on complications of thoracoscopic assisted thoracic spine surgery / 中华外科杂志

<p><b>OBJECTIVE</b>To analyze occurrence, prevention and treatment of the complications of thoracoscopic assisted spine surgery.</p><p><b>METHODS</b>Retrospective review of 182 patients who underwent standard thoracoscopic technique or video-assisted thoracic surgical procedure from October 1998 to August 2004. The treatment of thoracic diseases included debridement, decompression with (or) reconstruction. The total number of complications were recorded, and its mechanism, prevention and treatment were analyzed.</p><p><b>RESULTS</b>Complications occurred in 16 patients, 12 cases of perioperative complications included 3 patients suffered from pneumonia, 3 pulmonary atelectasis, 2 patients' lung injured by trocar, 1 patient obtained transient monoplegia, 2 suffered from transient intercostal nerve pain and 1 had superficial incision infection. Long-term complications occurred in 4 cases: spinal tuberculosis relapsed 2 cases (one who had diabetes obtained relapse in 8 months of post-operation and another relapsed with complex spinal tuberculosis in 4 weeks postoperation), 2 patients suffered from kyphosis deformity and pain.</p><p><b>CONCLUSIONS</b>The type and incidence of complications with thoracoscopic spine surgery mainly depend on indication, operation procedures and anesthesia, only by limit surgical indication, ameliorate technique, obey surgical principle and consummate perioperative treatment can we obtain mini-invasive effect by thoracoscopic assisted spine surgery.</p>

Screw-rod technique in treating cervical spinal cord injury without fracture and dislocation / 中南大学学报(医学版)

OBJECTIVE@#To evaluate the efficacy of screw-rod technique in treating cervical spinal cord injury without fracture and dislocation.@*METHODS@#The screw-rod technique was used to treat 38 patients with cervical spinal cord injury without fracture and dislocation. The JOA scores before and after the surgery were evaluated.@*RESULTS@#No severe complication occurred. The JOA scores were increased by 4.1, 6.7, 7.8, and 8.1 respectively at 0 th, 4 th, 12 th and 24 th weeks after the operation. Neurological deficits were improved one year after the operation in 1 patient.@*CONCLUSION@#Treating cervical spinal cord injury without fracture and dislocation with screw-rod technique can achive an efficient and safe clinical outcome.

Treatment of spinal metastases by posterolateral approach / 中南大学学报(医学版)

OBJECTIVE@#To evaluate the value of spondylectomy, circumferential decompression, and spinal reconstruction for the treatment of spinal metastases using posterolater approach.@*METHODS@#Thirteen patients with spinal metastases were treated by spondylectomy, circumferential spinal cord decompression, and spinal reconstruction with pedicle fixation and polymethyl methacrylate. The outcome was assessed by pain relief and the improvement in neurologic symptoms.@*RESULTS@#Pain relief was obvious in all patients. Neurologic symptoms improved to various degrees in 6 patients.@*CONCLUSION@#Spondylectomy, spinal cord circumferential decompression and spinal reconstruction with pedicle fixation and polymethyl methacrylate using posterolateral approach are effective surgical method for spinal metastases.

Diagnosis and treatment of cauda equina syndrome secondary to lumbar disc herniation / 中南大学学报(医学版)

OBJECTIVE@#To discuss the diagnosis and treatment of cauda equina syndrome.@*METHODS@#Thirty-four cases of cauda equina syndrome from 1993 to 2005 were analysed retrospectively. Its clinical representation, pathology character and clinical outcome were observed.@*RESULTS@#At follow-ups of 3 to 102 months after the treatment (averagely 43 months), the muscle strength and function of the constrictor began to resume to different degrees. Muscle strength resumed gradually one week after the operation, resumed faster 3 months after the operation, and resumed completely more one year later. Function of the constrictor began to resume 3 days after the operation, and resumed mostly six months or so after the operation. Sense resumed slowly.@*CONCLUSION@#Clinical outcome of cauda equina syndrome is good. Resumption after the operation obviously correlates to the time of operation. One week after the operation, the kinetic function resumes best, function of the constrictor resumes well and the sense function of the saddle area resumes not very well.

The treatment of deep wound infection after posterior thoracic and lumbar instrumentation / 中华外科杂志

<p><b>OBJECTIVE</b>To study the characteristics and treatment of the deep wound infection after thoracic and lumbar instrumentation.</p><p><b>METHODS</b>Thirty-six cases of deep wound infection after thoracic and lumbar instrumentation were retrospectively reviewed. There were acute deep wound infection in 14 cases and delayed infection in 22 cases. The patients with acute infection were treated with debridement and continuous irrigation and suction. Internal fixators were removed in 3 cases for repeated infection. The patients with delayed infection were treated with internal fixator removal, debridement and continuous irrigation and suction.</p><p><b>RESULTS</b>At follow-up evaluation, only 1 patient had recurrence of infection because of his complicating vertebral osteomyelitis. The most common organisms cultured in acute deep wound infection were staphylococcus aureus and colibacillus while staphylococcus epidermis, micrococcus and diphtheria bacillus in delayed infection. The white cell count and ESR were elevated in the acute deep wound infection while only the ESR elevated and the white cell count remained normal in the delayed deep wound infection.</p><p><b>CONCLUSIONS</b>There may be different between the acute and delayed deep wound infection's pathology. The internal fixator could be remained in the acute deep wound infection which need be removed in the delayed deep wound infection.</p>

Surgical treatment of thoracic vertebral angioma with extraosseous extension causing spinal cord compression / 中南大学学报(医学版)

OBJECTIVE@#To evaluate the therapeutical effect of surgical treatment for thoracic angioma with extraosseous extension which causes spinal cord compression and neurological dysfunction.@*METHODS@#We retrospectively analyzed 5 cases of thoracic vertebral body angioma with extraosseous extension and spinal cord compression. The operation were performed through anterior approach to resect the involved vertebral body and intracanal angioma in 5 patients. Bone graft and internal fixation were also completed in the meantime. Two patients accepted radiotherapy for 2 periods of treatment postoperatively, and the other 3 patients didn't accept the other supportive therapy.@*RESULTS@#The blood loss during the operation was 1000 mL to 1500 mL. All the patients recovered their neurological function rapidly after the operation. The patients were followed up for 1 to 4 years, and no patient recurred. The bone graft was solidly fused in all patients. No hardware failure occurred.@*CONCLUSION@#The surgical treatment for thoracic vertebral body and extraosseous angioma with spinal cord compression is effective, reliable, and workable. Good long-term result can be obtained.