Comparison of curative effect between elective nodal irradiation and involved field irradiation combined with nedaplatin for cervical and upper thoracic esophageal cancer / 肿瘤研究与临床

Objective:To compare the efficacy and prognosis of elective nodal irradiation (ENI) combined with nedaplatin chemotherapy and involved field irradiation (IFI) combined with nedaplatin chemotherapy in the radical radiotherapy treatment of patients with cervical or upper thoracic esophageal cancer.Methods:Seventy-eight patients with cervical or upper thoracic esophageal cancer in Hai'an Traditional Chinese Medicine Hospital from February 2017 to February 2020 were selected and divided into ENI group and IFI group according to random number table method, with 39 cases in each group. The ENI group was treated with ENI combined with nedaplatin chemotherapy, while the IFI group was treated with IFI combined with nedaplatin chemotherapy. After 2 months of treatment, the therapeutic effect and the dose of lung irradiation were compared between the two groups, and the occurrence of adverse reactions and prognosis were compared.Results:The total effective rate and disease control rate were 69.23% (27/39) and 82.05% (32/39) in IFI group, and 64.10% (25/39) and 74.36% (29/39) in ENI group, there was no significant difference between the two groups ( χ2 = 0.23, P = 0.631; χ2 = 0.68, P = 0.411). The lung irradiation doses of V 5 Gy and V 20 Gy in IFI group were lower than those in ENI group (both P < 0.05). The incidence rates of bone marrow suppression and radiation lung injury in IFI group were lower than those in ENI group (all P < 0.05). By the end of follow-up, the survival rates of IFI group and ENI group were 76.92% (30/39) and 66.67% (26/39), respectively. There was no significant difference in overall survival between the two groups ( χ2 = 1.06, P = 0.300). Conclusions:ENI and IFI combined with nedaplatin chemotherapy in the radical radiotherapy treatment of cervical and upper thoracic esophageal cancer have similar efficacy and prognosis, but IFI can reduce the lung radiation dose and the incidence of adverse reactions.

Prognostic value of postoperative adjuvant chemotherapy in patients with cervical and upper thoracic esophageal squamous cell carcinoma / 中国胸心血管外科临床杂志

@#Objective    To explore whether surgery combined with adjuvant chemotherapy can bring survival benefits to patients with cervical and upper thoracic esophageal squamous cell carcinoma (ESCC). Methods    The clinical data of patients with cervical and upper thoracic ESCC who underwent R0 resection and neck anastomosis in our department from 2006 to 2010 were retrospectively analyzed. Patients received neoadjuvant therapy or adjuvant radiotherapy were excluded. The adjuvant chemotherapy group was given a combination of taxanes and platinum based chemotherapy after surgery; the surgery alone group did not receive adjuvant chemotherapy. The Kaplan-Meier method was used to analyze the survival difference between the adjuvant chemotherapy group and the surgery alone group. Results    A total of 181 patients were enrolled, including 141 (77.9%) males and 40 (22.1%) females, with an average age of 61.0±8.2 years (80 patients aged≤61 years, 101 patients aged>61 years). There were 70 (38.7%) patients of cervical ESCC, and 111 (61.3%) patients of upper thoracic ESCC. Eighty-seven (48.1%) patients underwent postoperative adjuvant chemotherapy, and 94 (51.9%) patients underwent surgery alone, and the basic clinical characteristics were well balanced between the two groups (P>0.05). The median survival time of patients in the adjuvant chemotherapy group and the surgery alone group was 31.93 months and 26.07 months, and the 5-year survival rate was 35.0% and 32.0%, respectively (P=0.227). There was no statistical difference in median survival time between the cervical ESCC and upper thoracic ESCC group (31.83 months vs. 29.76 months, P=0.763). For cervical ESCC patients, the median survival time was 45.07 months in the adjuvant chemotherapy group and 14.70 months in the surgery alone group (P=0.074). Further analysis showed that the median survival time of lymph node negative group was 32.53 months, and the lymph node positive group was 24.57 months (P=0.356). The median survival time was 30.43 months in the lymph-node positive group with adjuvant chemotherapy and 17.77 months in the lymph-node positive group with surgery alone. The survival curve showed a trend of difference, but the difference was not statistically significant (P=0.557). Conclusion    There is no statistical difference in the long-term survival of cervical and upper thoracic ESCC patients after R0 resection. Postoperative adjuvant chemotherapy may have survival benefits for patients with cervical ESCC and upper ESCC with postoperative positive lymph nodes, but the differences are not statistically significant in this setting.

Preliminary analysis of recurrence-free survival after radical intensity-modulated radiotherapy combined with/without chemotherapy for upper cervical and thoracic esophageal cancer / 中华放射肿瘤学杂志

Objective:To investigate the recurrence-free survival (RFS) and influencing factors of intensity-modulated radiotherapy±chemotherapy (IMRT±C) for the upper thoracic esophageal cancer.Methods:The medical records of 168 patients with cervical and upper thoracic esophageal cancer who met the inclusion criteria from January 2011 to December 2015 were retrospectively analyzed. The RFS was calculated by the Kaplan-Meier method. Multivariate prognostic analysis was performed by Cox models. The recurrence factors were identified by the Logistics model. Results:The 1-, 3-, and 5-year RFS rates were 67.8%, 38.0%, and 20.4%, respectively, and the median RFS was 21.9 months. The locoregional recurrence rate was 47.6%(80/168). The recurrence sites were local esophagus ( n=63), regional lymph nodes ( n=7), and local esophagus+ regional lymph node recurrence ( n=10). Multivariate analysis showed that hoarseness, cTstaging, combined with chemotherapy, 95%PTV 1 exposure dose and GTV average exposure dose were the influencing factors of RFS ( P=0.029, <0.001, 0.031, 0.038, 0.020). Logistics model showed that cTstaging, cNstaging, short-term efficacy, irradiationmethod, GTV maximum transverse diameter and PTV average exposure dose were the influencing factors of recurrence ( P=0.046, 0.022, 0.001, <0.001, 0.012, 0.001). Conclusions:Patients with cervical and upper thoracic esophageal cancer treated with radical IMRT combined with/without chemotherapy have a higher locoregional recurrence rate, and the recurrence rate is mainly the esophagus. The independent factors that affect RFS are different from the risk factors of recurrence.

Analysis of the long-term prognosis of patients with cervical and upper thoracic esophageal cancer treated with simultaneous integrated boost intensity-modulated radical radiotherapy / 中华放射医学与防护杂志

Objective:To evaluate the effects of simultaneous integrated boost intensity-modulated radical radiotherapy (SIB-IMRT) on the long-term prognosis of patients with cervical and upper thoracic esophageal cancer.Methods:From January 2011 to December 2014, a retrospective analysis was performed in 172 patients with cervical and upper thoracic esophageal cancer who were eligible for IMRT. First, the prognosis of all the patients was evaluated using single factor and multivariate analyses. According to the different irradiation method of the patients, the patients were divided into two groups, one of which received conventional IMRT (C-IMRT) and the other of which received SIB-IMRT. Propensity score matching (PSM) analysis was applied to match the two groups of patients and to determine the treatment efficacy of patients after PSM, prognostic factors, failure modes, and side effects. SPSS19.0 statistical software was used to conduct statistical analysis.Results:The median overall survival (OS) and progression-free survival (PFS) times of all the patients were 30 months and 20 months, respectively. The fact whether the surrounding tissues and organs of esophageal lesions were invaded, clinical node staging (cN staging), chemotherapy, and GTV-maximum transverse diameter were observed to be independent influencing factors of OS and PFS in all the patients ( P<0.001, P=0.013, 0.005, 0.002; P<0.001, P=0.017, 0.034, 0.002). In addition, the independent influencing factors of PFS showed short-term efficacy ( P=0.036). After PSM, there were 54 patients in each of the two groups. The result of multivariate analysis showed that the fact whether the surrounding tissues and organs of esophageal lesions were invaded, cN staging, cTNM staging, prescribed dose, GTV-maximum transverse diameter, and irradiation method were independent factors affecting the OS ( P<0.001, P=0.008, 0.014, 0.021, 0.010, 0.008). Similarly, the fact whether the surrounding tissues and organs of esophageal lesions were invaded, cN staging, and GTV-maximum transverse diameter were observed to be independent factors that affect the PFS of patients ( P<0.001, P=0.044, 0.013). The difference in the total failure rate (70.4% vs. 50.0%) and the local regional recurrence rate (61.1% vs. 31.5%) between the C-IMRT and SIB-IMRT groups after treatment was significant ( χ2=4.68, 9.53, P=0.031, 0.002). The incidence of radiation pneumonitis of grade ≥ 1 in the C-IMRT group was significantly higher than that of the SIB-IMRT group ( χ2=6.16, P=0.046), whereas the leukocyte suppression of grade ≥ 2 in the C-IMRT group was significantly lower than that in the SIB-IMRT group ( χ2=12.77, P=0.005). Conclusions:As shown by the result of this study, compared with C-IMRT, SIB-IMRT can improve the OS of patients with cervical and upper thoracic esophageal cancer to a certain extent. Whether SIB-IMRT can improve the PFS of patients requires further research.

Comparison of surgical treatment for cervical esophageal squamous cell carcinoma and upper thoracic esophageal squamous cell carcinoma: A propensity score matching analysis / 中国胸心血管外科临床杂志

@#Objective    To evaluate the clinical outcomes of larynx-preserving limited resection with total thoracic esophagectomy and gastric pull-up reconstruction for the treatment of cervical esophageal squamous cell carcinoma (ESCC) without tumor involvement of the larynx and hypopharynx compared with the upper thoracic ESCC. Methods    Retrospective and comparative analysis of consecutive patients with cervical and upper thoracic ESCC who underwent R0 surgical resection from 2006 to 2011 in our center was performed. Kaplan-Meier method was used to calculate the patients’ survival. Results    In total, 44 pairs of patients, including 71 males and 17 females with an average age of 60.66±8.49 years were enrolled in the study after propensity score matching. The baseline characteristics of the two groups of patients were well balanced. There was no statistical difference in the operation time (P=0.100), blood loss (P=0.685), mortality rate in 30 days (P=1.000), total complication rate (P=0.829), cervical anastomosis leakage (P=0.816), mechanical ventilation (P=1.000), normal oral diet within 15 days (P=0.822) and anastomosis recurrence rate (P=0.676) between the two groups. Survival analysis showed that there was no statistical difference in survival time between the cervical group [31.83 (95%CI 8.65-55.02) months] and upper thoracic group [37.73 (95%CI 25.29-50.18) months, P=0.533]. The 5-year survival rates were 32.6% and 42.1%, respectively. Conclusion    Larynx-preserving limited resection  with total thoracic esophagectomy and gastric pull-up reconstruction for the treatment of cervical ESCC without involvement of the larynx and hypopharynx may result in a similar clinical outcome to upper thoracic ESCC.

Computer navigation-assisted surgical treatment with osteotomy for upper thoracic kyphosis / 中国组织工程研究

BACKGROUND: The biomechanical characteristics of kyphosis of the upper thoracic vertebra are unique. Decompression and internal fixation are relatively difficult. Previous relevant studies and case reports are few, and there is a lack of research on correction of kyphosis of the upper thoracic section with the assistance of computer navigation. OBJECTIVE: To explore the clinical effect of computer navigation-assisted surgical treatment of upper thoracic kyphosis by screws and osteotomy. METHODS: Totally 18 patients with kyphotic deformity of the spine (T1-T4) were admitted in Beijing Jishuitan Hospital from June 2011 to June 2018, including 11 males and 7 females, aged 12 to 59 years. They were all treated with computer-assisted surgical treatment with PSO osteotomy. Local Cobb angle of the upper thoracic kyphosis was determined during final follow-up. Cervical visual analogue scale, Nurick grades, EMS scores and satisfaction of the surgery were evaluated. This study was approved by the Ethics Committee of Beijing Jishuitan Hospital (approval No. 201709-23). RESULTS AND CONCLUSION: (1) A total of 18 patients were followed up for 6-90 months at an average time of (33. 73±35. 33) months. (2) The local Cobb angle of 18 patients at the last follow-up was significantly improved [(47. 32±9. 92)°, (24. 01 ±7. 64)°, P < 0. 001]. Cervical visual analogue scale score at the last follow-up was significantly lower than that before surgery (3. 64±2. 16, 0. 73±1. 01, P< 0. 001). Nurick score at the last follow-up was significantly lower than that before surgery (2. 91 ±0. 94, 0. 82±1. 47, P < 0. 001). EMS score at the last follow-up was significantly higher than that before surgery (14. 45±0. 93), 17. 09±1. 45, P< 0. 001). (3) Surgical satisfaction was excellent (n=16) or good (n=2). (4) At the last follow-up, 18 patients had no adverse reactions related to implants, and the wound healed well without screw loosening. (5) The results showed that reasonable osteotomy correction with computer-assisted surgery and PSO osteotomy could effectively treat kyphosis of upper thoracic segment.

Comparative analysis on biomechanical stability of the lateral fixation of the upper thoracic vertebrae through the middle Axillary approach and the traditional anterior plate fixation / 中国组织工程研究

BACKGROUND: With the comprehensive promotion of spinal internal fixation technology, the remodeling of spinal mechanical stability has attracted more and more attention. Lateral internal fixation via axillary midline transthoracic approach for the treatment of upper thoracic vertebra lesion is a new surgical approach. Currently, the research on the biomechanics of upper thoracic vertebra after fixation is relatively rare. OBJECTIVE: To evaluate whether the reconstruction of upper thoracic vertebrae via axillary midline transthoracic approach can achieve the requirements of biomechanical stability by biomechanical analysis of three-dimensional motion stability and load-bearing strength of upper thoracic vertebrae in lateral and anterior internal fixation models. METHODS: The C7-T6 spine and bilateral rib cage joint specimens were obtained from 12 human cadaveric bodies, and the three-dimensional motion stability test of the complete upper thoracic vertebrae model was performed and recorded as a complete vertebral body group. Subsequently, the specimens were randomly divided into two groups, and the traditional front plate internal fixation (front internal fixation group) and the axillary line into the thoracic cavity side plate internal fixation models (lateral internal fixation group) were established, respectively, with six specimens in each group. Three-dimensional motion test, vertical pressure test and vertical pressure failure test were performed. This study was approved by the Ethics Committee of Second Affiliated Hospital of Guangxi Medical University (approval No. 2017(KY-0080)). RESULTS AND CONCLUSION: (1) The load of left vertebral body group under left/right flexion, flexion/posterior extension and left/right rotational motion was smaller than that of lateral internal fixation group and anterior internal fixation group (P 0.05). (2) When the load reached 600 N, the vertebral body sinking displacement of the front internal fixation group was smaller than in the lateral internal fixation group [(1.39±0.20), (2.15±0.17) mm, P< 0.01]. (3) There was no significant difference in the maximum intensity load between the anterior internal fixation group and the lateral internal fixation group [(1 839.70±122.45), (1 798.65±120.21) N, P=0.571], (4) Results showed that the axillary midline transthoracic approach was in the lateral steel plate. The fixation is stable and meets the biomechanical needs of spinal reconstruction.

Application value of information-motivation-behavioral skill model nursing in adjuvant chemotherapy for patients with upper thoracic esophageal squamous cell carcinoma / 中国实用护理杂志

Objective@#To investigate the effect of nursing intervention on information-motivation-behavioral skill (IMB) model in patients with adjuvant chemotherapy after radical resection of upper thoracic esophageal squamous cell carcinoma.@*Methods@#A total of 128 patients with adjuvant chemotherapy after radical resection of esophageal squamous cell carcinoma from December 2016 to June 2018 were enrolled. The random number table method was used to divide them into control group (64 cases) and study group (64 cases). The control group received routine nursing, and the study group took the IMB model of nursing intervention on the basis of the control group. The intervention time was 2 months. Postoperative rehabilitation (feeding time, time to get out of bed, and length of hospital stay), pre-intervention self-efficacy score (Strategies Used by People to Promote Health, SUPPH), European Organization for Research and Treatment of Cancer-Quality of Life-Core 30 Questionnaire (EORTC-QLQ-C30), complications (reflux esophagitis, chest cavity), the incidence of effusion, infection, anastomotic leakage, and satisfaction of nursing work were compared.@*Results@#The feeding time of the study group was (3.39±0.72) d, the time of getting out of bed (2.26±1.02) d, the length of hospital stay (9.19±1.68) d, which was shorter than that of the control group (4.48±0.81), (4.07±1.55), (12.26±2.35) d, the difference was statistically significant (t=8.046, 7.804, 8.502, P<0.05). After intervention, the self-decision, self-decompression, and positive attitude scores of the two groups were higher than those before the intervention, and the study group was (11.19±1.28), (28.37±2.79), (39.98±5.01), respectively, higher than the control group. The differences were statistically significant (t= 7.239, 5.036, 5.057, P < 0.05). After intervention, the social function, emotional function, role function and physical function score of the two groups were higher than those before the intervention, and the study group were (69.02±6.87), (70.61±7.65), (69.68±6.80), (72.55±6.51). The scores were higher than those of the control group (61.13±7.03), (63.64±7.44), (60.22±7.05), and (65.86±6.08), and the difference was statistically significant (t=5.225-6.422, P<0.05). The complication rate was 7.81% (5/64) in the study group and 20.31% (13/64) in the control group. The difference was statistically significant (χ2=4.137, P <0.05). The nursing job satisfaction of the study group was 92.19% (59/64), which was higher than that of the control group 79.69% (51/64). The difference was statistically significant (χ2=4.137, P<0.05).@*Conclusions@#The intervention of IMB model in the treatment of patients with adjuvant chemotherapy after radical resection of upper esophageal squamous cell carcinoma can effectively improve their self-efficacy, reduce postoperative complications, shorten the postoperative rehabilitation time, and improve the quality of life of patients and improve the satisfaction of their nursing work.

Application value of information- motivation- behavioral skill model nursing in adjuvant chemotherapy for patients with upper thoracic esophageal squamous cell carcinoma / 中国实用护理杂志

Objective To investigate the effect of nursing intervention on information-motivation-behavioral skill (IMB) model in patients with adjuvant chemotherapy after radical resection of upper thoracic esophageal squamous cell carcinoma. Methods A total of 128 patients with adjuvant chemotherapy after radical resection of esophageal squamous cell carcinoma from December 2016 to June 2018 were enrolled. The random number table method was used to divide them into control group (64 cases) and study group (64 cases). The control group received routine nursing, and the study group took the IMB model of nursing intervention on the basis of the control group. The intervention time was 2 months. Postoperative rehabilitation (feeding time, time to get out of bed, and length of hospital stay), pre-intervention self-efficacy score (Strategies Used by People to Promote Health, SUPPH), European Organization for Research and Treatment of Cancer-Quality of Life-Core 30 Questionnaire (EORTC-QLQ-C30), complications (reflux esophagitis, chest cavity), the incidence of effusion, infection, anastomotic leakage, and satisfaction of nursing work were compared. Results The feeding time of the study group was (3.39±0.72) d, the time of getting out of bed (2.26±1.02) d, the length of hospital stay (9.19±1.68) d, which was shorter than that of the control group (4.48±0.81), (4.07±1.55), (12.26±2.35) d, the difference was statistically significant (t=8.046, 7.804, 8.502, P<0.05). After intervention, the self-decision, self-decompression, and positive attitude scores of the two groups were higher than those before the intervention, and the study group was (11.19±1.28), (28.37±2.79), (39.98±5.01), respectively, higher than the control group. The differences were statistically significant (t=7.239, 5.036, 5.057, P<0.05). After intervention, the social function, emotional function, role function and physical function score of the two groups were higher than those before the intervention, and the study group were (69.02 ± 6.87), (70.61 ± 7.65), (69.68±6.80), (72.55±6.51). The scores were higher than those of the control group (61.13±7.03), (63.64±7.44), (60.22±7.05), and (65.86±6.08), and the difference was statistically significant (t=5.225-6.422, P<0.05). The complication rate was 7.81% (5/64) in the study group and 20.31% (13/64) in the control group. The difference was statistically significant (χ2=4.137, P<0.05). The nursing job satisfaction of the study group was 92.19% (59/64), which was higher than that of the control group 79.69% (51/64). The difference was statistically significant (χ2=4.137, P<0.05). Conclusions The intervention of IMB model in the treatment of patients with adjuvant chemotherapy after radical resection of upper esophageal squamous cell carcinoma can effectively improve their self-efficacy, reduce postoperative complications, shorten the postoperative rehabilitation time, and improve the quality of life of patients and improve the satisfaction of their nursing work.

Clinical and radiographic outcomes of upper thoracic versus lower thoracic upper instrumented vertebrae for adult scoliosis: a meta-analysis

The aim of this study was to evaluate the clinical and radiographic outcomes of upper thoracic (UT) versus lower thoracic (LT) upper instrumented vertebrae (UIV) for adult scoliosis by meta-analysis. We conducted a literature search in three databases to retrieve related studies up to March 15, 2017. The preliminary screened studies were assessed by two reviewers according to the selection criteria. All analyses were carried out using the statistical software package R version 2.31. Odds ratios (OR) with 95% confidence intervals (CI) were used to describe the results. The I2 statistic and Q statistic test were used for heterogeneity assessment. Egger's test was performed to detect publication bias. To assess the effect of each study on the overall pooled OR or standardized mean difference (SMD), sensitive analysis was conducted. Ten trials published between 2007 and 2015 were eligible and included in our study. Meta-analysis revealed that the UT group was associated with more blood loss (SMD=0.4779, 95%CI=0.3349-0.6209, Z=6.55, P<0.0001) and longer operating time (SMD=0.5780, 95%CI=0.1971-0.958, Z=2.97, P=0.0029) than the LT group. However, there was no significant difference in Oswestry Disability Index, Scoliosis Research Society (SRS) function subscores, radiographic outcomes including sagittal vertical axis, lumbar lordosis, and thoracic kyphosis, length of hospital stay, and revision rates between the two groups. No evidence of publication bias was found between the two groups. Fusion from the lower thoracic spine (below T10) has as advantages a shorter operation time and less blood loss than upper thoracic spine (above T10) in posterior long-segment fixation for degenerative lumbar scoliosis.

Experimental study on rigidity effect of 3 kinds of different internal fixation at upper thoracic spine / 重庆医学

Objective To compare the rigidity at upper thoracic spine among the anterior transpedicular screw-plate system (ATPSPS),posterior transpedicle screw-rod system (PTPSRS) and anterior vertebral body screw-plate system (AVBSPS).Methods Twelve embalmed cadaver specimens were divided into three groups.The specimens in each group were randomly allocated to use the above 3 different internal fixation devices for conducting fixation.The stiffness of each specimen on the directions of axial compression,flexion and extension,and left and right lateral bending was detected under original status.All specimens conducted the simulated corpectomy of T2 (damage status).Then the rigidity on various directions was re-detected on the damage status.The corresponding internal fixation system was selected for conducting the install and fixation according to the grouping results.The intra-group and inter-group rigiditieson different directions were compared amongoriginal status,damage status and after internal fixation.Results The rigidities on different directions under original and damage statushad no statistical difference among various groups (P＜0.05).After conducting fixation in each group,the rigidity after fixation on different directions had statistically significant difference among groups(P＜0.05).The stiffness of anterior flexion in the ATPSPS group was greater than that in the other two groups (P＜0.05).The rigidity of axial compression and extension in the PTPSRS group was greater than that in the other two groups,the difference among groups was statistically significant (P＜0.05).The stiffness of lateral bending in the AVBSPS group was smaller than that in the other two groups,the difference was significant (P＜0.05),but the difference between the other two groups had no statistical significance (P＞0.05).Conclusion The rigidity of ATPSPS in all directions is higher than that of AVBSPS.The anterior flexion rigidity is greater than PTPSRS,and the axial compression and extension rigidity are less than PTPSRS,but the lateral bending rigidity is equivalent to PTPSRS.

Efficacy of postoperative chemoradiotherapy after radical resection of squamous cell carcinoma of upper thoracic esophagus / 中华放射医学与防护杂志

Objective To compare the prognosis of patients with squamous cell carcinona of the upper thoracic esophagus after radical resection with and without postoperative chemoradiotherapy (POCRT).Methods From January 2007 to December 2011,168 patients with upper thoracic esophageal carcinoma who were treated in the Fourth Hospital of Hebei Medical University were retrospectively included in this study.According to the different treatment method,they were divided into simple surgery group (86 cases) and POCRT group (82 cases) respectively.Based on SPSS statistical software,the group data composition,prognostic analysis and multivariate prognostic analysis were performed by x2 test,Log-rank method and Cox regression model,respectively.Results The 1,3,5 year-survival rate,recurrence rate and distant metastasis rate were 83.9％,52.4％,43.5％,26.5％,40.8％,43.4％ and 5.3％,11.4％,16.9％,respectively.The result of multivariate analysis showed that gender,T stage,N stage and treatment method were independent prognostic factors of overall survival (P =0.020,0.008,0.005,0.000);N staging and treatment method were the independent prognostic factors of local/regional recurrence (P =0.001,0.003);differentiation and T staging were the independent prognostic factors of distant metastasis (P =0.045,0.020).The intrathoracic regional recurrence rate of operation only group and POCRT group patients were 44.2％ (38/86) and 29.3％ (24/82) respectively,where the difference was statistically significant (x2 =7.110,P ＜ 0.05).The rate of metastasis were 19.8％ (17/86) and 13.4％ (11/82) respectively without significant difference (P ＞0.05).Conclusions The recurrence rate of patients with upper thoracic esophageal squamous cell carcinoma after radical resection was still high.Postoperative chemoradiotherapy can improve the overall survival rate and reduce the recurrence rate,but whether it can reduce the patient's distant metastasis rate needs further study.

Radiographic measurement for orientation relationships and changing regulations of pedicle screw entry point and posterior bony landmarks in middle-upper thoracic vertebrae of adults / 第二军医大学学报

Objective To explore the orientation relationships and changing rules of pedicle screw entry point (PSEP) on the posterior bony landmarks in middle-upper thoracic vertebrae in adults by measuring parameters of 3-D reconstruction CT images. Methods CT images of the middle-upper thoracic vertebrae from 30 healthy adults were used for 3-D reconstruction to observe the anatomical characteristics of posterior bony landmarks, including transverse process-lamina concave, superior ridge of transverse process and outer edge of the lamina. The following basic parameters, including PSEP-to-midline distance (PMD), transverse process-lamina concave-to-midline distance (CMD) and half lamina width (HLW), and target parameters, including PSEP-to-transverse process-lamina concave distance (PCD), entry point location ratio (EPLR) and PSEP-to-superior ridge of transverse process distance (PRD) were determined on reconstructed CT images from T1 to T10. The differences of bilateral measurements of all parameters and the differences of basic parameters were analyzed, and the changing rules of target parameters measurements from T1 to T10 were summarized. Results The transverse process-lamina concave, superior ridge of transverse process and outer edge of the lamina of middle-upper thoracic vertebral characterized by obvious and constant anatomical marks with less proliferative. The left and right PMD, CMD, HLW, PCD, EPLR, and PRD were (14.14±2.63) mm and (14.59±2.58) mm, (10.45±2.12) mm and (10.51±2.02) mm, (16.30±1.48) mm and (16.39±1.61) mm, (4.56±1.03) mm and (4.47±0.94) mm, 0.35±0.26 and 0.33±0.30, and (-1.62±1.90) mm and (-1.63±1.44) mm, respectively. There was no significant difference in the measured values between the two sides of the above parameters (P>0.05). Except that the difference between PMD and HLW in T2 was not significant (P>0.05), the differences between basic parameters in the other segments were statistically significant (P<0.05). PCD of T1 to T10 showed a trend of decrease first and then significant increases in T1, T2, T9, and T10 compared with in T3-T8 (P<0.05). EPLR of T1-T10 showed a trend of increase first and then decrease, in which EPLR in T1, T2 and T3 were significantly lower than in the following any segments (P<0.01), and in the T4-T6 and T10 were significantly lower than in T7-T9 (P<0.01). PRD of T1-T10 showed a trend of increase first and then decrease, in which the PRD in T1, T2 and T3 were significantly lower than in the following any segments, and in the T4-T6 were lower than T7-T10 (P<0.01). Conclusion There is constant orientation relationship and changing rules of PSEP in the middle-upper thoracic vertebrae on the posterior bony landmarks, such as transverse process-lamina concave, superior ridge of transverse process and outer edge of the lamina, and it can serve as a new clinical choice.

BIOMECHANICAL STUDY ON UPPER THORACIC SPINE BASED ON PRESSURE SENSITIVE FILM MATERIALS IN CHINESE MINI PIGS / 中国修复重建外科杂志

OBJECTIVE: To analyze the pressure change and distribution of the intervertebral disc of upper thoracic spine in vertical pressure and 5° flexion, extension, or lateral bending.

The feasibility of the anterior reverse transpedicular screw (ARTPS) fixation at upper thoracic spine / 中国脊柱脊髓杂志

Objectives: To verify the feasibility and safety of the anterior transpedicular screw(ATPS) fixation of the upper thoracic spine (T1-T4) through the radiological anatomy study on the cadaveric specimens. Methods: The upper thoracic spine thin-section CT data of 40 cases were collected from the radiology de-partment′s database(20 males and 20 females, aged from 18 to 68 years, the mean age was 39.7 years). The data of OPW(outer pedicle width), OPH(outer pedicle height), PAL(pedicle axis length), TPA(transverse section angle), SPA(sagittal section angle), DTIP(distance of transverse intersection point) and DSIP(distance of sagittal intersection point) of each pedicle were measured on the transverse and sagittal sections through the axis of each pedicle. The data were recorded and statistically analyzed. 10 upper thoracic spine(C7-T6) specimens of adults(5 males and 5 females, with unknown ages), with no damage to their appearance, the costovertebral joints and paravertebral soft tissue were completely retained. Then simulate surgical operations were done on the cadaveric specimens based on the obtained data. Screws were implanted anteriorly by free hand. After that, the specimens accepted X-ray fluoroscopy and CT scan. At last, the screws were removed, the speci-mens were sawed along the transaction and sagittal section of the screw channel. Then the success rate of the screw placement was evaluated according to Rao′s worn out classification standard of pedicle screws. Results: From T1 to T4, the OPW decreased from 8.14mm to 3.47mm; the OPH increased from 6.89mm to 10.29mm; the TPA decreased from 32.96° to 11.64°; the DTIP increased from 1.80mm to 5.50mm; the SPA increased from 104.95° to 115.74°; the DSIP increased from 5.95 to 8.76mm; the PAL changed irregularly, from 32.95 to 35.96mm. The pedicle diameters of T3 and T4 were too small to implant ATPS, but the ARTPS can be implanted successfully. The diameter of ATPS was about 4.0mm; the length of ATPS was about 35mm. The diameter of ARTPS was about 5.0mm; the length of ARTPS was about 35mm. 80 pedicle screws were implanted anteriorly, according to Rao′s worn out classification standard of pedicle screws, the fine rate was 90%. The internal walls of 7 pedicles were broken by screws of less than 2mm and no compression to the spinal cord. The internal walls of 5 pedicles were broken of 2 to 4mm, 1 at T1, 1 at T3 and 3 at T4, with varying degrees of spinal cord compression. The internal walls of 2 pedicles were broken of greater than 4mm, 1 at T2 and 1 at T4, with serious spinal cord compression. The external wall of 1 pedicle was broken at T2. Conclusions: The ATPS techniques at T1, T2 and the ARTPS techniques at T3, T4 are feasible, but the safety and clinical practice and further research is needed.

Inferiorly Migrated Disc Fragment at T1 Body Treated by T1 Transcorporeal Approach

Upper thoracic vertebral bodies are difficult to access using standard anterior approaches. It may require sternotomy and claviculectomy, which carries significant possibility of morbidities. We report a case of inferiorly migrated cervicothoracic junction disc treated successfully by anterior upper-vertebral transcorporeal approach. This specific technique obviated the need of sternotomy, created favorable working space and saved the motion segment at cervicothoracic junction. This report is the first transcorporeal approach to a disc fragment at T1-2 space without fusion.

A Case of Upper Thoracic Spinal Tuberculosis(T2-8) with T5,6 Compression Fracture in Pulmonary Tuberculosis Patient / 결핵및호흡기질환

Tuberculous spondylitis is the most common manifestation of musculoskeletal tuberculosis (TB). The progression of the disease is usually slow and insidious. The main symptom, back pain, is not specific, which frequently results in a delayed diagnosis resulting in neurologic deficits and more advanced vertebral destruction. It is more difficult to diagnose the disease if the involved area is an uncommon sites, such as the upper thoracic, cervical or sacral region. It is important to make an early diagnosis and treatment to achieve a better treatment outcome. We reported a 29 year old female with upper thoracic TB spondylitis(T2-8) and pulmonary TB complaining of back pain that persisted for 5 months and fever. TB spondylitis was not suspected to be due to upper thoracic involvement despite her pulmonary tuberculosis. Chest CT for the evaluation of pulmonary TB found T5 destruction and the paravertebral abscess that was consistent with TB spondylitis. Her spine was examined by MRI, which made an early diagnosis before the neurologic deficit had developed. She was treated with surgical intervention due to the spinal instability and anti-TB medication for 1 year with excellent results.

Study of the operative approach of the upper thoracic vertebrae (report of 21 cases) / 中国矫形外科杂志

[Objective] To investigate the anatomical relation between manubrium sternum incisure(MSI)with the level of upper thoracic vertebrae(UTV)and to find out the basis of operative approach of UTV.[Method]Standing pan chest radiographs of 400 male and 400 female were equally divided into 4 year groups:≤19 years,20～39 years,40～59 years and ≥60 years and were used to observe the relationship between MSI with the level of UTV.On the basis of this relationship,a suitable UTV approach was advocated.There were fracture and dislocation of UTV 7 cases,UTV tumor 9 cases,tuberculosis of UTV 3 cases;OPLL ossification of UTV 2 cases.Diseases located at T1 6 cases,T2 7 cases,T3 2 cases,T4 3 cases,T1、2 2 cases,T2、3 1 case.Lower anterior cervical approach was performed for 7 cases including T1、2 one case and T2 one case,improved T3 1 case,and right subscapular transthoracic posterolateral approach was used for 5 cases.[Result]The number of UTV in relationship with the level of MSI was successively increased from T1 to T3 and was gradually decreased on T4,i.e.rate of cases of level of MST in relationship with T1、2 level was 1%,to T2 level 5.5%,to T2、3 level 15.87%,to T3 level 43.5%,to T3、4 level 20.75%,to T4 13.375%.No relationship was found in trend of distribution with the age and gender.The operative approach of UTV according its relationship with MSI was performed with the advantages of satisfactory exposure easily manipulation and satisfactory clinic results in most follow-up cases.One case died of metastasis of tumor in 9 months,3 cases were complicated with cerebrospinal fluid leakage and 3 cases with injury of recurrent laryngeal nerve.[Conclusion]Approach to UTV should be selected according to its relationship between MSI and diseased UTV preoperatively.The operative approach of UTV according to its relationship with MST has the advantages of satisfactory exposure,easily manipulation and satisfactory clinic results.

Operation of upper thoracic spine diseases through anterior transsternal approach / 中国矫形外科杂志

[Objective]To investigate the method of anterior transsternal approach for the patients with upper thoracic spine diseases and the clinic results.[Method]Six cases upper thoracic spinal diseases,1 case of C7/T1 grade V dislocation,1 case of T1、2 TB,2 cases of upper thoracic tumor,1 case of T2 fracture and 1 case of T2、3 disc prolapse,were treated with the anterior transsternal approach operation since Oct.2001.The lesions areas were exposed via partial or complete sternotomy.The relative articles were reviewed.[Result]The average follow-up was 12.4 months(range from 6 to 22 months,except the died one).The case of C7/T1 grade V dislocation died of respiratory tract obstruction and one case of malignant schwannoma recurred 6 months post-operation.Good results were obtained in the other 4 cases.No operative complication happened in all cases.[Conclusion]While the transthoracic lateral approach cannot expose the upper thoracic spine clearly,the anterior cervical approach cannot expose the T2、3 clearly also.The anterior transsternal approach can provide a safe access to the lesions located on the upper thoracic spine above T4.

Treatment of Upper Thoracic Disc Herniation Using Transthoracic Approach without Division of Latissimus Dorsi: Technical Note / 대한척추외과학회지

Thoracic disc herniation is a rare condition in which a posterior approach, extrapleural approach, posterolateral approach, or transthoracic approach is currently used. The posterior approach is not recommended in thoracic disc herniation surgery because of the risk of spinal cord injury. The transthoracic approach makes it possible to remove the intervertebral disc and is considered a standard method. However, due to an extensive transverse skin incision, division of the latissimus dorsi muscles, and rib resection, the conventional open approaches involve a risk of complications, such as infection and post-thoracotomy pain syndrome; and a long period of rehabilitation and recovery is required. Excision of the intervertebral disc under thoracoscopic guidance can reduce the damage to the skin and muscles, but the equipment and surgical materials are expensive and a long learning curve is required. Therefore, we report a case and a new muscle splitting transthoracic approach that can be performed by incising 10 cm of skin longitudinally and preserving the serratus anterior and latissimus dorsi muscles.