Experimental study on the repair of peripheral nerve injuries via simultaneously coapting the proximal and distal ends of peripheral nerves to the side of nearby intact nerves.

Introduction: Peripheral nerve defect is a difficult disease to treat in clinical practice. End-to-side anastomosis is a useful method to treat it. At present, the end-to-side anastomosis method does not involve the proximal nerve, which results in a waste of proximal donor nerves, and even the formation of traumatic neuromas at the proximal end. The patients suffer from traumatic neuralgia and the curative effect is unsatisfactory. Methods: In this study, an improved end-to-side anastomosis technique was proposed in this study: both the proximal and distal ends of the damaged common peroneal nerve were sutured to an adjacent normal tibial nerve. Moreover, the possible role and mechanism of the proposed technique were explained at the physiological and anatomical levels. In this study, a 10 mm common peroneal nerve defect was made in SD rats, and the rats were randomly divided into three groups. In Group I, the distal end of the common peroneal nerve was attached end-to-side to the fenestrated tibial nerve adventitia, and the proximal end was ligated and fixed in the nearby muscle. In Group II, the tibial nerve adventitia was fenestrated and the epineurial end-to-end anastomosis surgery was performed to suture the proximal and distal ends of the common peroneal nerve. Rats in Group III were taken as control and received sham operation. Twelve weeks after the operation, the recovery of the repaired nerve and distal effector functions were examined by the sciatic functional index, electrophysiology, osmic acid staining, the muscle wet weight ratio, and the muscle fiber cross-sectional area. Results: It was found that these results in Group II were similar to those in Group III, but better than those in Group I. Through retrograde tracing of neurons and Electrophysiological examination in Group II, the study also found that the proximal common peroneal nerve also could establish a connection with tibialis anterior, even gastrocnemius. Discussion: Therefore, it is inferred that fostering both the proximal and distal ends of defective peripheral nerves on normal peripheral nerves using the end-to-side anastomosis technique is a more effective approach to repairing injured nerves.

Balloon kyphoplasty: an experience of 38 patients with painful osteoporotic vertebral compressive fractures.

OBJECTIVE: To evaluate the efficacy and safety of percutaneous balloon kyphoplasty as a new therapy for patients with painful osteoporotic vertebral compressive fractures of the lumbar and thoracic spine. METHODS: A retrospective analysis was conducted in 38 consecutive patients (28 females, 10 males), whose ages ranged from 56 to 82 years (mean age 72 years). The symptom- and sign-positive spinal segment was identified by MRI. The time between onset of symptoms and surgical intervention ranged from 2 days to 1 year. 62 segments (36 thoracic, 26 lumbar) were treated in this cohort. The pain score estimated by Visual Analog Scale and activity degree were assessed immediately after operation and at 1-, 6-, and 12-month postoperative follow-up. Preoperative and postoperative anterior, midline vertebral heights in fractured vertebrae were measured on lateral radiographs to evaluate the effect of the procedure. RESULTS: The method achieved a swift pain relief associated with an evidently increased weight-bearing ability. The pain score was reduced from 8.2 to 2.4 points. The anterior and midline vertebral heights in 62 fractured vertebral bodies increased up to 82.76%+/-26.84%, 88.82%+/-21.75% and the wedge decreased from 15 to 8 degrees. This effect persisted at least over a period of two years. The procedure did not induce narrowing of the spinal canal and no severe complications occurred. CONCLUSIONS: Balloon kyphoplasty can result in immediate clinical improvement of mobility and pain relief, increase vertebral body height, and quickly return patient's activity. The short-term results are approved excellent, and the long-term results need further judgment.

[Selection of surgical procedure for the treatment of idiopathic scoliosis].

OBJECTIVES: To discuss and evaluate the selection of surgical procedure for the treatment of idiopathic scoliosis according to the location and degree of the deformity. METHODS: 175 patients with idiopathic scoliosis underwent surgical treatment with correction and fusion. The patients were divided into four groups according to the location and degree of the deformity and four different procedures were used for each group. For each group, the blood loss, surgery time, correction rate, loss of correction at final follow up and complications were compared and analyzed. RESULTS: All patients underwent surgery safely and no neurological complication occurred. The correction rate was 81% for Group I, 86% for Group II, 68% for Group III and 72% for Group IV. All patients were followed up at least 2 years and the average time was 38 months (24 approximately 52). CONCLUSION: Proper selection of surgical procedure according to the location and degree of the scoliotic deformity, satisfactory results can be achieved in the treatment of idiopathic scoliosis.