Randomized controlled trials of proximal femoral nail antirotation in lateral decubitus and supine position on treatment of intertrochanteric fractures.

The objective of this study was to compare the clinical results and complications of proximal femoral nail antirotation (PFNA) on treatment of intertrochanteric fractures in 120 elderly Chinese patients using Randomized Controlled Trials (RCTs). Totaly 120 cases enrolled were randomly assigned to a lateral decubitus position group and supine position group. The hospital stay, operating time, intraoperative blood loss, length of incision, X-ray fluoroscopy time, and out-of-bed activity time in the lateral decubitus position group were significantly lower than those in the supine position group. There was not statistical significance on union time and Harris values in the two position groups. Moreover, only complications of superficial wound infection were observed in the lateral decubitus position group, but two complications of deep venous thrombosis and wound deep infection were found in the supine position group. The present findings suggested that PFNA applied in elderly patients with intertrochanteric fracture can get satisfactory effects, and the treatment of intertrochanteric fractures using lateral decubitus position showed a satisfactory clinical outcome and a lower radiological complication rate.

[Long-term effectiveness of percutaneous laser disc decompression in treatment of cervical spondylosis].

OBJECTIVE: To retrospectively analyze the long-term effectiveness of percutaneous laser disc decompression (PLDD) in treatment of cervical spondylosis. METHODS: Between March 2003 and June 2005, 156 patients with cervical spondylosis were treated with PLDD. There were 74 males and 82 females with an average age of 55.4 years (range, 31-74 years). The disease duration varied from 2 months to 15 years. Fifty-nine patients were classified as cervical spondylotic radiculopathy, 48 as vertebral-artery-type cervical spondylosis, 19 as cervical spondylotic myelopathy, and 30 as mixed type spondylosis. The lesions were located at the levels of C3, 4 in 32 discs, C4, 5 in 66 discs, C5, 6 in 89 discs, and C6, 7 in 69 discs, and including 71 one-level lesion and 85 multi-level lesions. All cases were followed up to study the long-term effectiveness and correlative factors. RESULTS: A total of 117 (75%) patients' symptoms were lightened or eased up immediately after operation. Discitis occurred in 1 case at 3 days after operation and was cured after 3 weeks of antibiotic use. All patients were followed up 5 years to 7 years and 3 months (5 years and 6 months on average). According to Macnab criteria, the long-term effectiveness was excellent in 60 cases (38.46%), good in 65 cases (41.67%), fair in 19 cases (12.18%), and poor in 12 cases (7.69%); the excellent and good rate was 80.13%. No significant difference was observed in the wedge angels and displacements of the intervertebral discs between before and after operations (P > 0.05). Multiple-factors logistic regression showed that the disease duration and patient's age had obvious relationship with the effectiveness of treatment (P < 0.05), while the type of cervical spondylosis, disc protrusion degree, mild cervical instability, and lesion scope had no correlation with the effectiveness of treatment (P > 0.05). CONCLUSION: PLDD is safe and effective in treatment of cervical spondylosis with less complication. There is no impact on the stability in cervical spinal constructs. The disease duration and patient's age have obvious impact on the long-term effectiveness of treatment. The type of cervical spondylosis, disc protrusion degree, cervical instability, and lesion scope are not the correlative factors.

[New surgical approach for presacral lesion by double door via S(3-5)].

OBJECTIVE: To investigate a new surgical approach for presacral lesion by double door via S(3-5). METHODS: From June 2007 to January 2008, 5 female patients (56-84 years old) with presacral lesion were treated. One patient had straining feeling in anus, 2 patients had difficult defecation and bloody stool and 2 patients had no symptoms. Digital rectal examination revealed rectal tumor in 2 cases and anus examination of presacral tumor showed no abnormality in 3 cases. B-ultrasound, CT and MRI examination displayed presacral tumor in 3 cases and rectumal tumor in 2 cases. The size of the lesions was 4 cm x 3 cm x 3 cm - 20 cm x 15 cm x 13 cm. The disease course was 12-50 days (average 18 days). All 5 patients received total resection of tumor through the surgical approach featured by double door via S(3-5). RESULTS: The operations were successful in all the 5 patients, and no severe presacral venous hemorrhage, rectal injury, direct injury of pelvic nerve and structure damage of pelvic bottom occurred during operation. The approach exposure time was 12-28 minutes (average 20 minutes) and the blood loss for approach was 30-130 mL (average 80 mL); and the operation time was 80-120 minutes (average 105 minutes) and the blood loss during operation was 100-350 mL (average 280 mL). All incision healed by first intention. Pathological examination of resected tissue after operation revealed presacral teratoma in 1 case, dermoid cyst in 1 case, spindle cell tumor in 1 case and rectal tubiform villus adenoma in 2 cases. All the patients suffered from perineal hypoesthesia to various degrees after operation, which were recovered to the normal 6 months later, and X-ray films showed bone union occurred in all the cases. No gatism occurred. During the followed-up period of 6-13 months, no sacrum defect, pelvic instability and sacroiliitis was observed in the 5 cases. B-ultrasound, CT and MRI examination showed no recurrence of tumor. CONCLUSION: The approach of double door via S(3-5) is a simple and safe surgical procedure featured by a good surgical exposure with less bleeding, short operative time, no sacrum defect, no severe sacral nerve damage, and early postoperative convalescence.

[Clinical application of percutaneous laser disc decompression in the treatment of cervical disc herniation].

OBJECTIVE: To evaluate the clinical effect of percutaneous laser disc decompression (PLDD) in the treatment of cervical disc herniation. METHODS: From March 2003 to December 2005, 47 patients with cervical disc herniation (96 cervical disc) were treated with PLDD. There were 25 males and 22 females with an average age of 56 years, ranging from 37 to 72 years. The lesion were located at the levels of C3,4 in 20 discs, C4,5 in 27 discs, C5,6 in 31 discs, C6,7 in 18 discs. The laser fiber was introduced into the center of the herniated disc space by percutaneous puncture from anterior neck surface under fluoroscopic guidance. Laser reduced the intra-disc pressure through the vaporization of disc nucleu. The adopted laser was semi-conducted with a wavelength of 810 nm. Each laser output power was 15 W with 1 s emission and 2 s interval. The total laser output power was decided depending on the degenerative degree of the disc and the reactive process of heat, ranging from 300 to 1 000 J. RESULTS: Of 47 patients, 42 were followed up for 3 to 31 months (mean 13 months). The clinical evaluation was classified as excellent in 18 cases (42.9%), good in 14 cases (33.3%), fair in 6 cases (14.3%) and poor in 4 cases (9.5%). The general response rate was 90.5%. The excellent and good rate was 76.2%. No complications occurred. CONCLUSION: PLDD can relieve the symptoms and signs of patients suffering from cervical disc herniation with less complication. The manipulation of PLDD is easy, safe and mini-invasive.