Paraspinal muscle approach with winglike working channel in the treatment of thoracic and lumbar spine fracture / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate the clinical and radiological efficacy of paraspinal muscle approach with winglike working channel in the treatment of thoracic and lumbar spine fracture.</p><p><b>METHODS</b>From October 2010 to August 2012, a total of 51 patients with thoracic and lumbar spine fractures without neurological symptoms were enrolled in the study, including 32 males and 19 females. All patients were divided into two groups: 26 patients were treated through posterior paraspinal muscle approach with winglike working channel, and 25 patients were treated through traditional posterior approach. In all patients, the interval between injury and operation was less than two weeks; the vertebral canal blocked area was less than 1/3 in sagittal diameter; the compression of the fractured vertebra height was less than 2/3. And the patients with pathological fracture and severe osteoporosis were excluded. The perioperative index including operative blood loss, draining loss, operative time, postoperative bed time were recorded. The clinical results were evaluated by visual analogue scale (VAS) for back pain preoperatively, at 3 days, 3 months, the last follow-up postoperatively and modified Macnab criteria at the last follow-up. The radiological results were evaluated by sagittal Cobb angle and the anterior height of the fractured vertebra. The data of two groups were compared statistically with paired and independent t test, χ² test, Mann-Whitney U test and Wilcoxon test.</p><p><b>RESULTS</b>All patients were followed up with average of 16.6 months. In the two groups, the operative blood loss was respectively (91.5 ± 36.6) ml and (209.2 ± 38.3) ml (t=-11.216, P=0.000), draining loss was (13.7±4.4) ml and (162.3 ± 56.6) ml (t=-13.352, P=0.000), postoperative bed time was (87.3 ± 11.5) hours and (118.4 ± 20.4) hours (t=-6.727, P=0.000), VAS for back pain at 3 days postoperatively was 5.5 ± 1.0 and 6.4 ± 0.8 (t=-3.304, P=0.002), also VAS at the last follow-up was 1.0 (1.0) and 2.0 (1.0) (U=191.0, P=0.008). Data above showed significant differences between the two groups.No significant differences were found in operative time, (109.0 ± 29.7) min vs. (119.2 ± 26.8) min (t=-1.283, P=0.206), and modified Macnab criteria (χ²=0.513, P=0.774) between the two groups. The anterior height of the fractured vertebra preoperatively, at 1 week and the last follow-up postoperatively of the two groups were respectively (57.2 ± 11.8)% and (55.2 ± 10.9)% (t=0.685, P=0.496), (95.2 ± 8.3)% and (95.3 ± 5.8%) (t=-0.068, P=0.946), (92.9 ± 6.7)% and (92.1 ± 5.6)% (t=0.505, P=0.615). The sagittal Cobb angles preoperatively, at 1 week and the last follow-up postoperatively of the two groups were respectively 21.0° (12.5°) and 23.0° (12.0°) (U=316.0, P=0.544), 3.0° (5.5°) and 4.0° (4.5°) (U=342.5, P=0.893), 4.0° (5.5°) and 6.0° (6.0°) (U=328.5, P=0.701). There were no significant differences of these radiological results between the two groups in the same time point.</p><p><b>CONCLUSION</b>The paraspinal muscle approach with winglike working channel in the treatment of thoracic and lumbar spine fracture is an efficient surgical option which can acquire satisfactory clinical and radiological results.</p>

Relation between angiogenesis and cell proliferative poten tial in human meningiomas / 吉林大学学报(医学版)

Objective:To study the relation of angiogenesis with cell proliferative postenti al in human meningiomas.Methods:Expression of factor Ⅷ-related antigen (FⅧRAg) and proliferating cell nuclear antigen (PCNA) was detected by immunohistochemistry in 38 specimens of human meningiomas,including 14 benign,12 atypical and 12 anaplastic (malignant) menningiomas and the correlation of microvessel density (MVD) with PCNA labellin g index (PCNA LI) was analyzed.Results:There was no significant difference in MVD between benign and atypical m eningiomas (P>0.05).MVD was higher in analplastic meningiomas than in both benign and atypical tumors (P<0.01).PCNA LI was markedly higher in anaplast ic meningiomas than in benign and atypical tumors (P<0.01). A significant c orrelation between MVD and PCNA LI was not detected in benign tumors;whereas,MVD positively correlated with PCNA LI in both atypical (r=0.518,P<0.01) and a naplastic (r=0.358,P<0.01) meningiomas. Conclusion:Angiogenesis is linked to cell proliferative potential in both atypic al and anaplastic meningiomas.