Analysis of the correlation between bone cement distribution and vertebral refracture after lumbar percutaneous vertebroplasty kyphoplasty / 中国基层医药

Objective To research the risk of osteopo'rotic vertebral fractures with PKP after the PMMA injected location and dose of occurrence of vertebral refracture.Methods 78 cases of vertebral osteoporotic thoracolumbar vertebral compression fracture patients with PKP treatmentin were selected.According to position of postoperative PMMA in the vertebral body,they were divided into the side of the group of 35 patients and a median group of 43 patients.Compared two groups of patients before and after surgery,VAS,ODI score,the SI and Cobb angle and analyzed the PMMA leakage occur with the relationship of the amount of bone cement injected.Results There were significant differences in visual analogue pain scale(VAS),Oswestry disability index(ODI),sagittal index(SI) and Cobb angle of each group preoperatively versuspostoperatively (all P ＜ 0.05).No statistical difference was noted in the VAS,ODI,SI and Cobb angle between two groups preoperatively versus postoperatively(all P ＞ 0.05).PMMA injection volume between the the leakage group and the non-leakage patients had statistically significant difference (P ＜ 0.05).Conclusion PKP could obtain better clinical therapeutic effect in osteoporotic vertebral fractures treatment.Different PMMA positions had no significant influence on the therapeutic results.PMMA injected dose is a risk factor for bone cement leakage,which will increase the risk of vertebral fractures again.

Total arch replacement combined with stented elephant trunk implantation for Stanford type A aorticdissection / 中国医师杂志

ObjectiveTo improve the long term outcomes of the surgery for Stafford type A aorticdissection, we performed ascending aorta and total aortic arch replacement combined with transaorticstented graft implantation into the descending aorta for acute type A aortic dissection.MethodsFrom May 2005 to February 2011,36 consecutive patients with acute Stanford type A aorticdissection underwent this procedure.Right axillary artery cannulation was routinely used forcardiopulmonary bypass and selected cerebral perfusion.The stented elephant trunk was implanted through the aortic arch under hypothermic circulatory arrest.The stented elephant trunk was a 10 cm long selfexpandable graft.34 patients were followed up for 2 ～36 months.ResultsCardiopulmonary bypass time was (160 ± 31)min, average cross clamp time was (101 ±26)min, and average selective cerebral perfusion and lower body arrest time was (31 ± 16)min.The in-hospital mortality was 5.5％ (2/36).One patient died of multi-organ failure postoperatively and another died of cerebral infarction 9 day after surgery.No one suffered from spinal cord injury perioperatively.There was no late death during follow up.ConclusionsAscendingaorta and total aortic arch replacement combined with transaortic stented graft implantation into the descending aorta is an effective way in closing the residual false lumen of the descending aorta and might contribute to better long term outcomes of type A aortic dissection.