Clinical application of advanced percutaneous vertebroplasty in treating of senile osteoporotic vertebral compression fracture / 中国骨伤

<p><b>OBJECTIVE</b>To compare the differences between advanced percutaneous vertebroplasty and routine percutaneous vertebroplasty,and evaluate the clinical application of advanced percutaneous vertebroplasty in treating senile osteoporotic vertebral compression fracture.</p><p><b>METHODS</b>From January 2010 to January 2011,28 patients with senile osteoporotic vertebral compression fracture were concealed random allocated to advanced percutaneous vertebroplasty and routine percutaneous vertebroplasty group according to whether using advanced percutaneous pedicle puncture. Of them,there were 5 males and 23 females with an average age of (70.50 +/- 9.33) years old (ranged, 53 to 85). Course of disease was from 2 to 28 days with an average of (7.62 +/- 4.52). The fracture involved 34 vertebral bodies (19 segments of thoracic vertebrae and 15 segments of lumbar vertebra), 3 day's antibiotics were applied to prevent infections. The opreation time, X-ray fluoroscopy times were compared, and pain relief effect were evaluated by VAS (visual analogue scales) score.</p><p><b>RESULTS</b>For operation time, there were significant meaning between routine group (49.00 +/- 7.74) min and advanced group (32.36 +/- 4.81) min (t = 6.828,P = 0.000 < 0.05); X-ray fluoroscopy times in advanced group (4.28 +/- 1.38) times was shorter than routine group (8.78 +/- 2.33) times, and had statistical significance (t = 6.222, P = 0.000 < 0.05); while there were no meaning in VAS scores between routine group (2.85 +/- 0.94) and advanced group (2.57 +/- 1.08) (t = 0.740, P = 0.456 > 0.05).</p><p><b>CONCLUSION</b>Compared with routine group, advanced group can shorten opreration time, reduce radiological hazard, further reduce image monitoring costs and surgical risk, and benefit from the application of advanced percutaneous vertebroplasty in treating senile osteoporotic vertebral compression fracture. Furthmore, it can provide reference to vertebral body biopsy and minimally invasive of pedicle screw fixation.</p>

Combined procedure for the treatment of ankle and foot deformities secondary to spina bifida / 中国骨伤

<p><b>OBJECTIVE</b>To study surgical strategies for ankle and foot deformities secondary to spina bifida and treatment methods for different types of deformities.</p><p><b>METHODS</b>From January 1990 and July 2009, 107 patients with ankle and foot deformities secondary to spina bifida were retrospectively analyzed. There were 44 males and 63 females, with an average age of 17.7 years (rangd from 1.3 to 52 years). Among the patients, 58 patients had double ankle deformities, 49 patients had unilateral deformities (22 cases on the left side, 27 cases on the right). Ninety-nine patients with equinus deformities were treated by achilles tendon lengthening and tendon transfering; 25 patients with talipes were treated by release of anterior tendon of ankle and tendon transfer; 17 patients with valgus and varus deformities were treated by tendon transfer and calcaneal osteotomy; 15 patients with flail deformities were managed treated by bone fusion between calcaneus and talus and shortening of achilles tendon; 9 patients with claw toe deformities were treated by bone fusion of interphalangeal joint or Ilizarovs distraction. AOFAS (American Orthopaedic Foot & Ankle Society) comprehensive scoring system was used to evaluate subjective pain and objective functional.</p><p><b>RESULTS</b>Seventy-nine (127 feet) of 107 patients were followed up, and the duration ranged from 48 to 180 months (averaged, 64 months). According to AOFAS scoring system, the results were rated as excellent in 89 feet, good in 26 feet, moderate in 9 feet and poor in 3 feet.</p><p><b>CONCLUSION</b>Treatment strategies for ankle-foot deformities mainly included four principles, deformity correction, muscular balance, joint stability and reservation of foot elasticity. Different combined procedure was applied for different foot deformities and received good therapeutic effects.</p>

Clinical analysis of CT guided unilateral PVP for the treatment of osteoporotic vertebral compression fracture in senile patients / 中国骨伤

<p><b>OBJECTIVE</b>To evaluate the therapeutic effect and security of CT guided unilateral percutaneous vertebroplasty (PVP) for the treatment of osteoporotic vertebral compression fracture (OVCF) in senile patients.</p><p><b>METHODS</b>From April 2009 to June 2010, 26 patients undergoing CT guided unilateral percutaneous vertebroplasty were analyzed retrospectively. There were 9 males and 17 females,ranging in age from 60 to 85 years with an average of (67.50+/-6.76) years, ranging in course of disease from 2 to 30 days with an average of (8.92+/-4.36) d. The affected segments involved 35 vertebras. The major clinical manifestations of OVCF were lumbar-back pain (especially when turning over or stooping down) and unable to bear. The needle was punctured into vertebral of lesions through unilateral puncture under the CT guidance; and then 3-5 ml bone cement was injected into vertebral. Antibiotic was used 3 days to prevent postoperative infections. Postoperative complications were observed after operation, such as local leakage of bone cement, penetrating spinal cord and/or segmental spinal nerve injuries and pulmonary embolism. X-ray was used to measure the height of anterior, middle and exterior of vertebral before and after treatment. A visual analog scale (VAS) scoring was applied to evaluate pain score preoperative, 48 hours postoperative and the terminal follow-up.</p><p><b>RESULTS</b>Twenty-six patients achieved success in punctuation without serious complications. Local leakage of bone cement occurred in 6 cases, but without clinical symptoms or signs. One patient suffered from acute intraoperative reactions to bone cement and relieved by 5 mg dexamethasone and oxygen. All patients were followed up for 6 to 12 months [averaged (8.4+/-1.6) months]. The postoperative vertebrae height was higher than preoperative,but there was no statistical difference between postoperative and preoperative (P>0.05). Preoperative VAS scores was 7.63+/-0.92, postoperative score was 3.00+/-1.09, the final follow-up score was 2.38+/-1.17; there was significant difference between preoperative and postoperative at 48 hours (P<0.05), but there was no statistical difference between final follow-up and postoperative at 48 hours (P>0.05).</p><p><b>CONCLUSION</b>Unilateral PVP under CT guided can increase the vertebral strength and stabilize vertebral body,and the procedure is a safe and effective method for OVCF in elderly patients.</p>

Clinical analysis of 107 patients with foot and ankle deformities caused by spinal bifida / 中华外科杂志

<p><b>OBJECTIVE</b>To analyze the incidence, clinical features, deformity categories and orthopedic treatment of foot and ankle deformities caused by spinal bifida.</p><p><b>METHODS</b>The charts of the patients received surgical treatment between January 1990 and July 2009 were studied retrospectively, and the data were analyzed.</p><p><b>RESULTS</b>One hundred and seven cases of foot and ankle deformities caused by spinal bifida received surgical treatment and were included. There were 44 male and 63 female patients. The average age was 17.7 years (range, 1.3 - 52.0 years). And 50.5% (54/107) of cases were over 18 years old and had spinal bifida occulta, and the other 49.5% had spinal bifida manifesta. There was only one case of thoracic spinal bifida (T(3-8)), while the other 106 cases had lumbosacral vertebrae cleft (mainly L(3) to Sacrum). Among a total of 165 feet, unilateral involvement was found in 49 cases (22 cases on the left side, 27 cases on the right side), bilateral involvement in 58 cases. Combined ankle-foot deformities included 76 varus talipes, 23 talipes valgus, 15 flail feet, and 51 other foot deformities. Other site deformities, as a result of spinal bifida, included knee flexion or hyperextension deformity in 4 cases, hip deformity (hip adduction, flexion, or hip dislocation, pelvic tilt, lower extremity discrepancy, etc.) in 17 cases, and urinatory dysfunction and defecation in 30 cases. Twenty-nine of 54 cases with spinal bifida occulta failed to be diagnosed in other hospitals and the misdiagnosed rate reached 53.7% (29/54). Corrective surgery was performed in only 26 patients. And 50.5% (54/107) of patients (over 18 years old) had severe foot and ankle deformities due to a failure of prior surgical treatment.</p><p><b>CONCLUSIONS</b>Spinal bifida is the most commonly found in the lumbosacral vertebrae. Although the main pathogenesis is developmental abnormalities of spinal cord and nerve, the secondary deformity is usually located on the foot and ankle. Some young orthopedic surgeons may not have enough awareness and treatment experience about this disease due to over-specialty of the orthopaedics, so the delay of early diagnosis and treatment is often found and many severe foot and ankle deformities occur.</p>

Application of traditional Chinese drug soaking, continual irrigation and focus elimination for the treatment of foot osteomyelitis complicated with massive skin defect and denervation / 中国骨伤

<p><b>OBJECTIVE</b>To evaluate therapeutic effects of traditional Chinese drug soaking,continual irrigation and focus elimination for foot osteomyelitis complicated with massive skin defect and denervation.</p><p><b>METHODS</b>There were 25 males and 28 females in the study. All the patients suffering from foot osteomyelitis complicated with massive skin defect and denervation were treated with comprehensive therapy including preoperative traditional Chinese drug soaking, skin release, focus elimination,continual irrigation, and two-stage suture if necessary. Among the patients, there were 42 cases of left foot and 11 cases of right one. Fifty-one patients complicated with skin defect and sinus tract,only 2 patients complicated with skin defect. There were 48 patients with denervation caused by spina bifida, 5 patients by other causes.</p><p><b>RESULTS</b>The follow-up duration was from 1 to 12 years,the mean time was about 5 years. Osteomyelitis recurred in 3 cases and skin defect reoccurred in original position in 9 cases.</p><p><b>CONCLUSION</b>The methods of traditional Chinese drug soaking, continual irrigation and elimination of focus have good effects for foot osteomyelitis complicated with massive skin defect and denervation. To some degree,this therapy may avoid skin flap transplantation, bone graft and amputation. It deserves further studies and promotion.</p>

Cohort study on the effect of a combined treatment of traditional Chinese medicine and Western medicine on the relapse and metastasis of 222 patients with stage II and III colorectal cancer after radical operation / 中国结合医学杂志

<p><b>OBJECTIVE</b>To evaluate the effectiveness of a comprehensive therapy of traditional Chinese medicine (TCM) in reducing the relapse and metastasis of stage II and III colorectal cancer based on conventional Western medicine (WM) therapy.</p><p><b>METHODS</b>Two hundred and twenty-two patients in total, diagnosed as stage II and III colorectal cancer from February 2000 to March 2006, were recruited from Xiyuan Hospital, China Academy of Chinese Medical Sciences and the General Hospital of Beijing Military Area. They were followed-up once every 3-6 months. Twenty cases dropped out from the cohort. The remaining 202 patients were all treated with routine WM treatment [including R0 radical operation, or chemotherapy or/and radiotherapy according to national comprehensive cancer network (NCCN) clinical guidelines]. These patients were assigned to two groups based on whether or not they were additionally treated with TCM comprehensive therapy (orally administered with a decoction according to syndrome differentiation, combined with a traditional patent drug over one year). Ninety-eight patients from Xiyuan Hospital were treated with WM and TCM (combined group), and 104 patients from the General Hospital of Beijing Military Area were treated with WM alone (WM group). The demographic data at baseline were comparable, including the operation times, age, sex, TNM staging, and pathological types. The patients were followed-up for one to five years. Up to now, there are 98, 98, 77, 64, and 47 patients with 1, 2, 3, 4, and 5 years of follow-up in the combined group, respectively; and 104, 104, 97, 81, and 55 patients in the WM group, respectively. The results of the 5-year follow-up of all the patients will be available in 2011.</p><p><b>RESULTS</b>The relapse/metastasis rate of 1-, 2-, 3-, 4-, and 5-year were 0 (0/98), 2.04% (2/98), 11.69% (9/77), 14.06% (9/64), and 21.28% (10/47) in the combined group, and were 4.80%(5/104), 16.35% (17/104), 21.65% (21/97), 25.93% (21/81), and 38.18%(21/55) in the WM group, respectively. A significant difference was found in the second year between the two groups (chi (2)=12.117, P=0.000). Median relapse/metastasis time was 26.5 months in the combined group and 16.0 months in the WM group.</p><p><b>CONCLUSION</b>The combined therapy of TCM and WM may have great clinical value and a potential for decreasing the relapse or metastasis rate in stage II and III colorectal cancer after conventional WM therapy.</p>