Analysis of the clinical efficacy of tumor resection methods used in 20 patients with clavicular tumor.

BACKGROUND: To retrospectively analyze the tumor resection method used in 20 patients with clavicular tumors and evaluate its clinical efficacy. METHODS: A total of 9 patients with clavicular benign tumors underwent intracapsular resection, and 11 patients with clavicular malignant tumors underwent tumor resection from May 2012 to May 2017. Of the 11 patients, 5 underwent clavicular reconstruction using the plate-cement complex. Surgical efficacy was assessed using the Musculoskeletal Tumor Society, Constant-Murley, and American Shoulder and Elbow Surgeons shoulder outcome scores preoperatively until 12 months postoperatively. RESULTS: The average duration of follow-up care was 33.7 (12-71) months. Of the 20 patients, 3 patients died, 3 survived with tumor recurrence or metastasis, and 14 survived with no tumor recurrence. Among the 5 patients who underwent resection of malignant clavicular tumors and reconstruction, 2 underwent a re-operation because of a loose screw and plate displacement. In the functional assessment of the shoulder joint, patients with benign and malignant clavicular tumors showed significantly higher scores postoperatively compared with preoperative scores. For malignant clavicular tumors, no significant improvement was observed when comparing the non-reconstruction and reconstruction groups. CONCLUSIONS: Surgery is an optimal treatment for clavicular tumors. In patients with benign clavicular tumors, simple intracapsular resection can achieve a satisfactory prognosis. Reconstruction of a clavicular defect after resection of a clavicular malignant tumor is not recommended.

Anterior cervical discectomy versus corpectomy for multilevel cervical spondylotic myelopathy: a meta-analysis.

PURPOSE: This is a meta-analysis to compare the results between anterior cervical discectomy fusion (ACDF) and anterior cervical corpectomy fusion (ACCF) for the patients with multilevel cervical spondylotic myelopathy (MCSM). METHODS: Systematic review and meta-analysis of cohort studies between ACDF with plate fixation and ACCF with plate fixation for the treatment of MCSM. An extensive search of literature was performed in PubMed, Mediline, Embase and the Cochrane library. The following outcome measures were extracted: JOA scores, fusion rate, cervical lordosis (C2-7), complications, blood loss and operation time. Data analysis was conducted with RevMan 5.0. RESULTS: Four cohorts (six studies) involving 258 patients were included in this study. The pooled analysis showed that there was no significant difference in the postoperative JOA score [WMD = -0.14 (-1.37, 1.10), P = 0.83], fusion rate [OR = 0.84 (0.15, 4.86), P = 0.85] between two group. However, there was significant difference in the cervical lordosis [WMD = 3.38 (2.52, 4.23), P < 0.00001], surgical complication rate and instrument related complication rate (P = 0.01, 0.005 respectively), blood loss [WMD = -52.53 (-73.53, -31.52), P < 0.00001], and operation time [WMD = -14.10 (-20.27, -7.93), P < 0.00001]. CONCLUSIONS: As compared with ACCF with plate fixation, ACDF with plate fixation showed no significant differences in terms of postoperative JOA score, fusion rate, but better improved cervical lordosis, lower complication and smaller surgical trauma. As the limitations of small sample and short follow-up in this study, it still could not be identified whether ACDF with plate fixation is more effective and safer than ACCF with plate fixation.

Comparison of unilateral versus bilateral pedicle screw fixation with cage fusion in degenerative lumbar diseases: a meta-analysis.

PURPOSE: To compare the results between unilateral and bilateral pedicle screw (PS) fixation for the patients with degenerative lumbar diseases. METHODS: A systematic review and meta-analysis of cohort studies were conducted between unilateral PS fixation with cage fusion (unilateral group) and bilateral PS fixation with cage fusion (bilateral group) for the treatment of degenerative lumbar diseases from 1990 to June 2014. An extensive search of studies was performed in PubMed, Mediline, Embase and the Cochrane library. The following outcome measures were extracted: visual analogue scale (VAS), Oswestry disability index (ODI), Short-Form health survey (SF-36), fusion rate, complications, blood loss and operation time. Data analysis was conducted with RevMan 5.0. RESULTS: Eight RCTs involving 545 patients were included in this meta-analysis. The pooled analysis showed that there was no statistically significant difference in terms of the VAS, ODI and SF-36 scores, fusion rate [OR = 0.49 (0.23, 1.04), P = 0.06], complication rate(implant-related complication: P = 0.35, general complication rate: P = 0.71) and blood loss between two groups. However, there was less operation time in the unilateral group compared with bilateral group. Four patients (1.48 %) in unilateral group and one patient (0.36 %) in bilateral group were found cage migration, the difference did not achieve statistical significance (P = 0.213). CONCLUSIONS: As compared to bilateral PS fixation with cage fusion, unilateral PS fixation with cage fusion achieves a similar VAS, ODI and SF-36 scores, fusion rate, complications and smaller surgical trauma. However, it is still uncertain whether unilateral pedicle screw fixation with cage fusion is as effective and safe as bilateral pedicle screw fixation with cage fusion.

Different types of intermittent pneumatic compression devices for preventing venous thromboembolism in patients after total hip replacement.

BACKGROUND: Total hip replacement (THR) is an effective treatment for reducing pain and improving function and quality of life in patients with hip disorders. While this operation is very successful, deep vein thrombosis (DVT) and pulmonary embolism (PE) are significant complications after THR. Different types of intermittent pneumatic compression (IPC) devices have been used for thrombosis prophylaxis in patients following THR. Available devices differ in compression garments, location of air bladders, patterns of pump pressure cycles, compression profiles, cycle length, duration of inflation time and deflation time, or cycling mode such as automatic or constant cycling devices. Despite the widely accepted use of IPC for the treatment of arterial and venous diseases, the relative effectiveness of different types of IPC systems as prophylaxis against thrombosis after THR is still unclear. OBJECTIVES: To assess the comparative effectiveness and safety of different IPC devices with respect to the prevention of venous thromboembolism in patients after THR. SEARCH METHODS: For this update the Cochrane Peripheral Vascular Diseases Group Trials Search Coordinator searched the Specialised Register (November 2014), CENTRAL (2014, Issue 10). Clinical trial databases were searched for details of ongoing and unpublished studies. Reference lists of relevant articles were also screened. There were no limits imposed on language or publication status. SELECTION CRITERIA: Randomized and quasi-randomized controlled studies were eligible for inclusion. DATA COLLECTION AND ANALYSIS: Two review authors independently selected trials, assessed trials for eligibility and methodological quality, and extracted data. Disagreement was resolved by discussion or, if necessary, referred to a third review author. MAIN RESULTS: Only one quasi-randomized controlled study with 121 study participants comparing two types of IPC devices met the inclusion criteria. The authors found no cases of symptomatic DVT or PE in either the calf-thigh compression group or the plantar compression group during the first three weeks after the THR. The calf-thigh pneumatic compression was more effective than plantar compression for reducing thigh swelling during the early postoperative stage. The strength of the evidence in this review is weak as only one trial was included and it was classified as having a high risk of bias. AUTHORS' CONCLUSIONS: There is a lack of evidence from randomized controlled trials to make an informed choice of IPC device for preventing venous thromboembolism (VTE) following total hip replacement. More research is urgently required, ideally a multicenter, properly designed RCT including a sufficient number of participants. Clinically relevant outcomes such as mortality, imaging-diagnosed asymptomatic VTE and major complications must be considered.

Continuous passive motion for preventing venous thromboembolism after total knee arthroplasty.

BACKGROUND: Total knee arthroplasty (TKA) is a common form of orthopaedic surgery. Venous thromboembolism (VTE), which consists of deep venous thrombosis (DVT) and pulmonary embolism (PE), is a major and potentially fatal complication after TKA. The incidence of DVT after TKA is 40% to 80% and the incidence of PE is approximately 2%. It is generally agreed that thromboprophylaxis should be used in patients who undergo TKA. Both pharmacological and mechanical methods are used in the prevention of DVT. Pharmacological methods alter the blood coagulation profile and may increase the risk of bleeding complications. When pharmacological methods cannot be used the mechanical methods become crucial for VTE prophylaxis. Continuous passive motion (CPM) is provided through an external motorised device which enables a joint to move passively throughout a preset arc of motion. Despite the theoretical effectiveness and widespread use of CPM, there are still differing views on the effectiveness of CPM as prophylaxis against thrombosis after TKA. This is an update of the review first published in 2012. OBJECTIVES: The aim of this review was to determine the effectiveness of continuous passive motion (CPM) therapy for preventing venous thromboembolism (VTE) in patients after total knee arthroplasty (TKA). SEARCH METHODS: For this update the Cochrane Peripheral Vascular Diseases Group Trials Search Co-ordinator searched the Specialised Register (last searched February 2014), CENTRAL (2014, Issue 1), Ovid MEDLINE (to week 1 February 2014) and EMBASE (to Week 07 2014). SELECTION CRITERIA: Randomised controlled trials (RCTs) comparing the use of CPM with control in preventing DVT or PE after TKA. People aged 18 years and older who had undergone TKA were included in this review. We excluded studies of patients who presented with DVT at baseline. The experimental and control groups received similar postoperative care and therapy other than the CPM. DATA COLLECTION AND ANALYSIS: Two review authors independently assessed the citations retrieved by the search strategies for reports of relevant RCTs. They independently selected trials that satisfied the inclusion criteria, extracted data and undertook quality assessment. Effects were estimated as risk ratios (RRs), mean differences or standardised mean differences with 95% confidence intervals (CIs). Meta-analyses were performed using a fixed-effect model for continuous variables. Where heterogeneity existed (determined by the I(2) statistic) a random-effects model was used. MAIN RESULTS: Eleven RCTs involving 808 participants met the inclusion criteria. The methodological quality of the included studies was variable and most of the predefined outcomes were reported by only one or two studies, therefore the quality of the evidence was low. Five studies with a total of 405 patients reported the incidence of DVT. In the CPM group (205 patients) 36 developed DVT (18%) compared to 29 (15%) in the control group (200 patients). The results of the meta-analysis showed no evidence that CPM had any effect on preventing VTE after TKA (RR 1.22, 95% CI 0.84 to 1.79). One trial (150 participants) did not find PE in any of the patients during hospitalisation or in the subsequent three months. PE was not reported in the other included studies. None of the trials reported deaths among the included participants. AUTHORS' CONCLUSIONS: There is not enough evidence from the available RCTs to conclude that CPM reduces VTE after TKA. We cannot assess the effect of CPM on mortality because no such events occurred amongst the participants of these trials. The quality of the evidence was low. The results are supported by only a small number of studies, most of which are of low to moderate quality.

Different types of intermittent pneumatic compression devices for preventing venous thromboembolism in patients after total hip replacement.

BACKGROUND: Total hip replacement (THR) is an effective treatment for reducing pain and improving function and quality of life in patients with hip disorders. While this operation is very successful, deep vein thrombosis (DVT) and pulmonary embolism (PE) are significant complications after THR. Different types of intermittent pneumatic compression (IPC) devices have been used for thrombosis prophylaxis in patients following THR. Available devices differ in compression garments, location of air bladders, patterns of pump pressure cycles, compression profiles, cycle length, duration of inflation time and deflation time, or cycling mode such as automatic or constant cycling devices. Despite the widely accepted use of IPC for the treatment of arterial and venous diseases, the relative effectiveness of different types of IPC systems as prophylaxis against thrombosis after THR is still unclear. OBJECTIVES: To assess the comparative effectiveness and safety of different IPC devices with respect to the prevention of venous thromboembolism in patients after THR. SEARCH METHODS: The Cochrane Peripheral Vascular Diseases Group Trials Search Coordinator searched the Specialised Register (May 2012), CENTRAL (2012, Issue 4), MEDLINE (April Week 3 2012) and EMBASE (Week 17 2012). Clinical trial databases were searched for details of ongoing and unpublished studies. Reference lists of obtained articles were also screened. There were no limits imposed on language or publication status. SELECTION CRITERIA: Randomized and quasi-randomized controlled studies were eligible for inclusion. DATA COLLECTION AND ANALYSIS: Two review authors independently selected trials, assessed trials for eligibility and methodological quality, and extracted data. Disagreement was resolved by discussion or, if necessary, referred to a third review author. MAIN RESULTS: Only one quasi-randomized controlled study with 121 study participants comparing two types of IPC devices met the inclusion criteria. The authors found no cases of symptomatic DVT or PE in either the calf-thigh compression group or the plantar compression group during the first three weeks after the THR. The calf-thigh pneumatic compression was more effective than plantar compression for reducing thigh swelling during the early postoperative stage. The strength of the evidence in this review is weak as only one trial was included and it was classified as having a high risk of bias. AUTHORS' CONCLUSIONS: There is a lack of evidence from randomized controlled trials to make an informed choice of IPC device for preventing venous thromboembolism (VTE) following total hip replacement. More research is urgently required, ideally a multicenter, properly designed RCT including a sufficient number of participants. Clinically relevant outcomes such as mortality, imaging-diagnosed asymptomatic VTE and major complications must be considered.

Continuous passive motion for preventing venous thromboembolism after total knee arthroplasty.

BACKGROUND: Total knee arthroplasty (TKA) is a common form of orthopedic surgery. Venous thromboembolism (VTE), which consists of deep venous thrombosis (DVT) and pulmonary embolism (PE), is a major and potentially fatal complication after TKA. The incidence of DVT after TKA is 40% to 80% and the incidence of PE is approximately 2%. It is generally agreed that thromboprophylaxis should be used in patients who undergo TKA. Both pharmacological and mechanical methods are used in the prevention of DVT. Pharmacological methods alter the blood coagulation profile and may increase the risk of bleeding complications. When pharmacological methods cannot be used, the mechanical methods become crucial for VTE prophylaxis. Continuous passive motion (CPM) is through an external motorised device which enables a joint to move passively throughout a preset arc of motion. Despite the theoretical effectiveness and widespread use of CPM, there are still differing views on the effectiveness of CPM as prophylaxis against thrombosis after TKA. OBJECTIVES: The aim of this review is to determine the effectiveness of continuous passive motion therapy for preventing thrombosis in patients after total knee arthroplasty (TKA). SEARCH METHODS: The Cochrane Peripheral Vascular Diseases Group searched their Specialised Register (last searched January 2011), CENTRAL (2011, Issue 1), MEDLINE (1948 to Week 2 January 2011) and EMBASE (1980 to Week 3 January 2011). In addition, the authors searched the reference lists of identified trials. SELECTION CRITERIA: Randomised controlled trials (RCTs) comparing the use of CPM with control in preventing DVT or PE after TKA. People aged 18 years and older who have undergone TKA were included in this review. We excluded studies of patients who presented with DVT at baseline. Both the experimental and control groups received similar postoperative care and therapy other than the CPM. DATA COLLECTION AND ANALYSIS: Two review authors independently assessed the citations retrieved by the search strategies for reports of relevant RCTs. They independently selected trials that satisfied the inclusion criteria, extracted data and undertook quality assessment. Effects were estimated as risk ratios (RRs) or mean differences or standardised mean differences with 95% confidence intervals (CI). Meta-analyses were performed using a fixed-effect model for continuous variables. Where heterogeneity existed (determined by the I(2) statistic), a random-effects model was used. MAIN RESULTS: Ten randomised controlled trials involving 764 participants met the inclusion criteria. Four studies with a total of 361 patients reported the incidence of DVT. In the CPM group (182 patients) 36 developed DVT (20%) compared to 28 (16%) the control group of 179 patients. The meta-analysis result showed no evidence that CPM had any effect on preventing VTE after TKA (RR 1.27, 95% CI 0.87 to 1.86). One trial (150 participants) did not find PE in any of the patients during hospitalisation or in the subsequent three months. None of the trials reported any deaths of the included participants. AUTHORS' CONCLUSIONS: There is not enough evidence from the available RCTs to conclude that CPM reduces VTE after TKA. We cannot assess the effect of CPM on death because no such events occurred amongst the participants of these trials.

Posterior screw-plate system for treating old fracture of the odontoid process.

OBJECTIVE: To assess the efficacy of a screw-plate system for the treatment of old fracture of the odontoid process. METHODS: Twenty-six patients with old fracture of the odontoid process were treated by a posterior screw-plate system. There were 17 men and 9 women ranging in age from 17 to 58 years (mean, 32.8 years). According to the Anderson-D'Alonzo classification, 19 patients were classified as type II, and 7 as type III. According to the Frankel classification, there were 3 patients of grade C, 21 of grade D and 2 of grade E. RESULTS: All operations were successfully performed. The operation time was 75-120 min (mean, 90 min) and the intraoperative blood loss 50-200 ml (mean, 125 ml). There were no postoperative complications. All patients were followed up for 24-36 months. At the final follow-up, one patient had improved from grade C to grade D, two from grade C to grade E, and 15 from grade D to grade E. The other cases had remained stable. There was no breakage of nails or failure of internal fixation during follow-up. Stable bone union was observed in all cases, the average healing time being 7.8 months. CONCLUSION: Posterior screw-plate system is a safe and effective method for treating old fracture of the odontoid process.

Anterior transsternal approach for treatment of upper thoracic vertebral tuberculosis.

OBJECTIVE: To study an anterior transsternal approach for treatment of upper thoracic vertebral (T(l)-T(4)) tuberculosis (TB). METHODS: Sixteen patients with upper thoracic vertebral TB underwent anterior decompression and fusion through an anterior transsternal approach. There were nine men and seven women with a mean age of 48.6 ± 2.3 years (range, 37 to 72 years). The involved area included T(l) in three patients, T(2) in one, T(2) and T(3) in four, T(3) in two, T(3) and T(4) in four, and T(4) in two. The "inside window of the brachiocephalic artery" was used to access T(1) and T(2) lesions, and the "outside window of the brachiocephalic artery" for T(3) and T(4) lesions, for T2 and T3, both "windows" were used. According to the Frankel grading system, two patients were of Grade A, one Grade B, two Grade C, six Grade D and five Grade E. The kyphosis Cobb's angle ranged from 15°-40° (mean, 22° ± 2.5°) preoperatively. RESULTS: All patients tolerated surgery wel1. The operation time was 120-150 minutes and bleeding during operation 300-600 ml. The kyphosis Cobb's angle ranged from 10°-25° (mean, 17° ± 2.5°) postoperatively. Eight patients with preoperative neurologic deficit had improved. During the follow-up period, all cases healed without any recurrence. There was no failure of internal fixation. Spinal bone fusion occurred after 3-6 months (mean, 4.2 months) after bone graft in all patients. CONCLUSION: The anterior transsternal approach provides safe and effective access for surgical treatment of upper thoracic TB.

C2 pedicle screw and plate combined with C1 titanium cable fixation for the treatment of atlantoaxial instability not suitable for placement of C1 screw.

STUDY DESIGN: A method of atlantoaxial stabilization using individual fixation of the C1 posterior arch and the C2 pedicle with C2 pedicle screws and plates combined with C1 titanium cables is described. In addition, the clinical results of this method on 8 patients are described. OBJECTIVE: To describe the method and the clinical and radiographic results for posterior C1-C2 fixation with a combined implant system. SUMMARY OF BACKGROUND DATA: Stabilization of the atlantoaxial complex is a challenging procedure because of the unique anatomy of this region. Fixation by plate or rod and C1 and C2 screw and structural bone grafting leads to excellent fusion rates. The technique is technically demanding and has a potential risk of the injuries to the vertebral artery, the internal carotid artery, spinal cord, and hypoglossal nerves. In addition, how to stabilize the atlantoaxial complex in the cases not suitable for placement of C1 screw is not described in the literature. To address these limitations, a method of C1-C2 fixation has been developed: bilateral insertion of C2 pedicle screws and rolling of C1 titanium cable through the posterior arch of atlas and the cranial hole of the plate, followed by C1-C2 plate fixation. METHODS: From February 2003 to March 2006, 8 patients with atlantoaxial instability and not suitable for placement of C1 screw were included in this study: 5 cases of broken C1 pedicle screw trajectory and 3 cases of C1 anatomic anomalies. Skull traction was performed in each patient preoperatively. The pedicle screws were inserted into C2 pedicles in the direction as its axis. C1 titanium cable was rolled superior to lower through posterior arch of atlas in the cases not suitable for placement of C1 screw. The C1-C2 plate was slightly bent to fit the upper cervical contour. Hyperflexion alignment of the atlantoaxial complex was corrected by application of extension force created by tightening of the nut on the pedicle screws and the C1 titanium cable, which was passed through the cranial hole of the plate. Morselized autogenous cancellous iliac grafts were placed on the surface of the posterior arches of both atlas and axis. All patients were assessed clinically for neurologic recovery by Odom's method. RESULTS: There were 5 males and 3 females with a mean age of 37.8 years (range, 17 to 59 y). There were 2 cases of old odontoid fracture, 2 cases fresh odontoid fracture (Aderson II C), 2 cases atlas transverse ligament laxation, 2 cases atlas transverse ligament rupture, and in these cases, 5 cases had failed placement of C1 screw because of broken C1 pedicle screw trajectory and 3 cases not suitable for placement of C1 screw because of anatomic anomalies. There were no spinal cord and vertebral artery and nerve injury after surgery. Follow-up duration was from 18 to 55 months with the average of 29 months. The plant bones all fused and there were no internal fixation rupture and mobility. All the patients showed improvement. CONCLUSIONS: C2 pedicle screw and plate combined with C1 titanium cable could be used to treat atlantoaxial instability in the cases not suitable for placement of C1 screw.

[Etiologic fraction and interaction of risk factors for primary hepatic carcinoma in Guangxi, China].

OBJECTIVE: To explore etiologic fraction (EF) and interaction of hepatitis B virus (HBV) infection and other risk factors for primary hepatocellular carcinoma (PHC) in Guangxi, China. METHODS: A hospital-based case-control study including 500 PHC patients and 500 nontumorous patients was carried out in Guangxi. EF and interactions of HBV infection and other risk factors for PHC were analyzed by crossover analysis and nonconditional multiple logistic regression. RESULTS: HBV infection, family history of PHC, diabetes mellitus, eating raw fish, heavy alcohol consumption, frequently used drug, low income, mental oppression and blood type B all were risk factors for PHC. With EFs of 0.725, 0.186, 0.119, 0.486, 0.385, 0.438, 0.277, 0.607, 0.299, respectively and with etiologic fractions attributable to interaction [EF(A xB)] of 0.736, 0.643, 0.849, 0.551, 0.592, 0.618, 0.902, 0.577; and indices of interaction of 0.743, 0.651, 0.853, 0.560, 0.600, 0.626, 0.907, 0.586, respectively. CONCLUSION: Main risk factors for PHC might include HBV infection, family history of PHC, diabetes mellitus, eating raw fish, heavy alcohol consumption, frequently used drug, low income, mental oppression and blood type B. HBV infection with other risk factors might exert synergistic action on developing PHC and increase the risk of PHC.

Treatment of osteonecrosis of femoral head with BMSCs-seeded bio-derived bone materials combined with rhBMP-2 in rabbits.

OBJECTIVE: To evaluate the effect of autologous bone marrow mesenchymal stem cells (BMSCs) seeded bio-derived bone materials (BBM) combined with recombinant human bone morphogenetic protein-2 (rhBMP-2) in repairing defect of osteonecrosis of femoral head (ONFH). METHODS: Early-stage osteonecrosis in the left hip was induced in 36 adult New Zealand white rabbits (provided by the Animal Center of Guangxi Medical University, Nanning, China) after core decompression and delivery of liquid nitrogen into the femoral head. Then the animals were divided into three groups according to the type of implants for bone repair: 12 rabbits with nothing (Group I, the blank control group), 12 with BBM combined with rhBMP-2 (Group II), and 12 with BMSCs-seeded BBM combined with rhBMP-2 (Group III). At 4, 8, and 12 weeks after surgery, X-ray of the femoral head of every 4 rabbits in each group was taken, and then they were killed and the femoral heads were collected at each time point, respectively. Gross observation was made on the femoral heads. After hematoxylin and eosin staining, Lane-sandhu scores of X-ray and bone densitometry were calculated and the histomorphometric measurements were made for the new bone trabeculae. RESULTS: At 12 weeks after surgery, two femoral heads collapsed in Group I, but none in Group II or Group III. X-ray examination showed that the femoral heads in Group I had defect shadow or collapsed while those in Group II had a low density and those in Group III presented with a normal density. Histologically, the defects of femoral heads were primarily filled with no new bone but fibrous tissues in Group I. In contrast, new bone regeneration and fibrous tissues occurred in Group II and only new bone regeneration occurrd in Group III. Lane-sandhu scores of X-ray, bone mineral density and rate of new bone in trabecular area in Group III were higher significantly than those of the other two groups. CONCLUSIONS: Our findings indicate a superior choice of repairing the experimental defect of ONFH with BMSCs- seeded BBM combined with rhBMP-2.

Surgical management for upper thoracic spine tumors by a transmanubrium approach and a new space.

The anterior aspect of the upper thoracic spine is a difficult region to approach in spinal surgery. Many vital structures including osseus, articular, vascular and nervous ones hinder the exposure. With increasing frequency, spine surgeons are being asked to provide decompression and stabilization in patients with spinal tumors. The traditional exposure is between the esophagus and trachea medially and the left common carotid or the brachiocephalic artery (BCA) laterally, and the disadvantages were that the ligation and section of the left innominate vein is proposed to reach T4 and the injury of the thoracic duct could occur. The right space of the BCA or the ascending aorta (AA) (the exposure between the right brachiocephalic vein and the BCA or between the AA and superior caval vein) is recommended in exposing the upper thoracic vertebrae; this new space is technically feasible; the exposure is sufficient for vertebral body resection and reconstruction and fixation. Twenty-eight patients with upper thoracic spine tumors underwent surgery by the use of this new space between June 2000 and October 2005. A strut graft was fixed anteriorly after decompression of the spinal cord. Levels C7-T5 can be well exposed through this new space, allowing complete vertebral body removal at level T1-T4. After body removal, the posterior longitudinal ligament is well exposed, allowing complete release of the spinal cord. Curettage was performed in one case of aneurysmal bone cyst and three cases of bone giant cell tumors. For other tumors, vertebrectomies or sagittal resections were performed. Four patients underwent surgery by a combination of anterior and posterior approach.

[Precision-fit surface hemiarthroplasty of the hip for the treatment of the femoral head osteonecrosis].

OBJECTIVE: To evaluate the outcome of precision-fit surface hemiarthroplasty in the treatment of femoral head osteonecrosis. METHODS: The clinical data of 41 patients (48 hip joints) with femoral head osteonecrosis were reviewed. Of them, 30 were male and 11 were female, average age was 37 years old (ranging from 29 - 49). Thirty-five patients were at Ficat stage III and 13 at Ficat stage IV, their acetabula were relatively normal. The 41 patients (48 hip joints) underwent precision-fit surface hemiarthroplasties. RESULTS: The mean duration of follow-up was 5.2 years. The average UCLA hip score at follow-up was improved significantly from 3.1 to 9.1 points for pain, 4.4 to 9.2 points for walking, and 5.5 to 7.1 points for activity (P = 0.001). The satisfaction rate was 88.6% for 35 at Ficat stage III, 69.2% for 13 at stage IV (P = 0.25). Eight hips failed; the UCLA hip score was not improved significantly; the postoperative X-ray examination showed that 7 femoral prostheses were implanted in a varus orientation (the angle between the femoral prosthesis stem and the anatomic axis of the femoral shaft was lower than angle of 130 degrees). Five-year survival rate was 83.0%. CONCLUSIONS: Precision-fit surface hemiarthroplasty of the hip has the satisfactory result in treatment of the femoral head osteonecrosis on the basis of observing strictly operative indications and improving operative technique.