Mid-term efficacy of Waveflex semi-rigid internal fixation system in the treatment of lumbar degenerative diseases / 中华骨科杂志

Objective:To investigate the mid-term clinical efficacy and imaging changes of Waveflex semi-rigid internal fixation system combined with posterior lumbar interbody fusion (PLIF) in the treatment of double segmental lumbar degenerative diseases.Methods:The data of 51 patients with lumbar degenerative diseases who underwent surgery from September 2014 to September 2015 were retrospectively analyzed, including 29 males and 22 females, aged 65.5±5.6 years (range 58-73 years). Preoperative intervertebral space degeneration grade by University of California at Los Angeles (UCLA) and Pfirrmann intervertebral disc degeneration grade were recorded. 23 cases of primary responsible segments were treated with decompression, fixation and fusion, and adjacent secondary responsible or degenerative segments were treated with Waveflex semi-rigid internal fixation (combined group); 28 cases of double segments were treated with decompression, fixation and fusion (fusion group). Disc height index (DHI) and intervertebral foramina height (IFH) of the semi-rigid fixation segments, DHI and IFH of the upper adjacent intervertebral space, and horizontal displacement of the upper adjacent vertebral body (HD) were measured on lateral X-ray films of lumbar spine; In the fusion group, DHI and IFH adjacent to the upper vertebral space and HD adjacent to the upper vertebral body were measured. The efficacy was evaluated by short-form McGill Pain Questionnaire (SF-MPQ) and Oswestry disability index (ODI).Results:51 cases were followed up for 5.4±0.3 years (range 5.2-6.3 years). The low back and leg pain and function in the combined group and fusion group were significantly improved compared with those before operation. SF-MPQ and ODI at 3 months, 1 year, 5 years after operation were significantly different from those before operation ( P<0.05). In the combined group, the DHI of semi-rigid internal fixation segments before operation and 3 months, 1 year, 5 years after operation were 37.8%±7.6%, 37.9%±7.4%, 36.5%±6.9% and 36.0%±7.1% respectively ( P>0.05); The IFH of semi-rigid internal fixation segments before operation and 3 months, 1 year, 5 years after operation were 21.5±2.8, 21.4±2.8, 20.4±2.7, 19.4±2.4 mm respectively ( P<0.05); The DHI of the upper segment adjacent to semi-rigid internal fixation before operation and 3 months, 1 year, 5 years after operation were 37.1%±9.3%, 36.8%±9.1%, 35.2%±9.1%, 33.9%±8.8% respectively ( P>0.05); The IFH of the upper segment adjacent to semi-rigid internal fixation before operation and 3 months, 1 year, 5 years after operation were 21.9±3.0, 21.4±3.0, 20.4±2.9, 19.5±2.7 mm, respectively ( P<0.05). The HD of upper vertebral body adjacent to semi-rigid internal fixation before operation and 3 months, 1 year, 5 years after operation were 2.2±0.7, 2.3±0.5, 2.5±0.5, 2.8±0.5 mm respectively ( P<0.05). At the last follow-up, one case of semi-rigid titanium rod fracture, one case of screw loosening at semi-rigid internal fixation segment, three cases with unsatisfied numbness relief, and 2 cases of facet joint spontaneous fusion at semi-rigid fixation segment occurred in the combined group. Conclusion:Waveflex semi-rigid internal fixation can protect the degenerative lumbar intervertebral disc, and delay the degeneration of semi-rigid internal fixation segment and adjacent upper segment after interbody fusion, but long-term follow-up and study are needed.

Influencing factors on the survival time in recurrent glioma after reoperation / 中国生化药物杂志

Objective To investigate the factors influencing the survival time of patients with recurrent glioma after reoperation.Methods 45 cases in our hospital due to recurrence cerebral glioma undergoing reoperation were selected, whose general data were retrospective analyzed, and the surgery conditions, postoperative complications, survival time and its influencing factors were analyzed.Results In 45 cases of recurrent cerebral glioma patients undergoing surgical treatment, 25 cases with total resection, 20 cases with subtotal resection, 3 cases with postoperative brain edema, 3 cases with pulmonary infection; and compared with pre-surgery, the Karnovsky performance status (KPS) score increased significantly (P <0.05); and postoperative survival time was ( 10.62 ±3.25 ) months, multi-factor regression analysis showed that recurrence lesion resection, preoperative KPS score, recurrent interval time and preoperative grading is the independent risk factors related to survival time(P<0.05).Conclusion Surgical treatment of recurrent cerebral glioma is of great significance, and aggressive surgical treatment could improve the quality of life, prolong the survival time and improve the quality of life.

Intravascular stent implantation in treating patients with symptomatic vertebral artery kinking / 中国医师进修杂志

Objective To evaluate the feasibility and safety of stent implantation in treating patients with symptomatic vertebral artery kinking. Methods Forty-two patients with vertebral artery kinking confirmed by digital subtraction angiography and accorded with the stent implantation indications were chosen in our study; these patients were performed stent implantation. The stenosis and haemodynamics changes, and recent and postoperative complications were observed; Malek scale was adopted to evaluate the clinical efficacy during the 1-year follow-up. Results The success rate of stent implantation for patients with symptomatic vertebral artery kinking was 100%(42/42). The percentage of stenosis was significantly reduced from (75.6 ± 13.5)%to (8.3 ± 3.1)%after stenting, and the mean flow velocity of kinking lesion was obviously decreased from (49.5 ± 12.4) cm/s to (31.7 ± 15.0) cm/s, and there were statistical differences (P<0.01). The cerebellum hematoma was noted in 1 patient , subcutaneous hematoma of puncture point appeared in 2 and femoral artery pseudoaneurysm after the stenting in 1;all these complications did not cause serious consequences. Malek scale indicated that 36 cases got 1 point,4 cases got 2 points, 1 case got 3 points, 1 case got 4 points and no one got 5 points;36 patients (85.7%, 36/42) were asymptomatic during the 1-year follow-up;no significant in-stent restenosis was found. Conclusions Symptomatic vertebral artery kinking can be treated safely and effectively with stent implantation.

Clinical significance of acute-phase proteins in the recurrence of gastric cancer / 中国普通外科杂志

Objective To determine the value of acute phase protein in the early diagnosis of recurrence after curative gastric cancer surgery. Methods Acute phase serum protein level was measured before and after the gastric cancer surgery in 120 patients,and was compared with that of the control group. At 1, 3, 6, 9, 12 months after the operation in 87 patients undergoing curative gastric cancer surgery, the levels of acute phase proteins were measured. They were followed up for at least 12 months or until death. Results The levels of serum C reactive protein(CRP), ?1 antitrypsin (?1 AT) and ? acid glycoprotein (? AG) in gastric cancer group were significantly higher than those in the control group (P0.05). In patients who underwent curative gastric cancer surgery in a certain period after the operation, the serum levels of CRP, ?1 AT and ? AG were significantly lower than those before the surgery(P0.05).There were significant difference in CRP,?1 AT and ? AG between the recurrence groups and nonrecurrence group before and after the operation (P