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Methods@#This study enrolled 51 patients with LDK out of 382 patients with adult degenerative spinal deformity. Baseline information was reviewed including demographic data and complications. Sagittal spinopelvic alignments and global imbalance parameters were assessed on full-length X-ray images of the spine. Muscularity and the fatty infiltration area of the ES and multifidus (MF) were measured at the L4/5 level on preoperative magnetic resonance image to evaluate the lumbar erector muscle atrophy. Stratification by sagittal vertical axis (SVA) was performed: group 1 with SVA 100 mm, and these groups were compared. Spearman correlation and multivariable logistic regression analyses were performed to analyze and define risk factors of postoperative proximal junctional kyphosis (PJK). @*Results@#Group 2 had lower ES and MF muscularity than group 1. ES muscularity correlated with SVA (r=−0.510, p<0.003), lumbar lordosis (r=−0.415, p<0.018), and postoperative PJK (r=−0.508, p<0.022). MF muscularity did not correlate with the above parameters. Multivariable logistic regression analysis verified ES muscularity (odds ratio [OR], 0.001; p<0.039) and SVA (OR, 1.034; p<0.048) as the risk factors for postoperative PJK. @*Conclusions@#ES atrophy, besides the MF, is an important predictor in distinguishing decompensated LDK from well-compensated ones. It plays an important role in compensatory mechanism, not only correlates with global sagittal imbalance but also ties to PJK after deformity corrective surgery.
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Methods@#A cohort of 54 consecutive patients with DLS and RO was included in the study. All the included patients underwent selective RO fusion and at least 2 years of follow-up. They were divided into two groups: group 1 with a curve 30° because of a higher complication rate and a worse clinical outcome at the final follow-up.
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OBJECTIVE@#To evaluate the effectiveness of neurovascular staghorn flap for repairing defects in fingertips.@*METHODS@#Between August 2019 and October 2021, a total of 15 fingertips defects were repaired with neurovascular staghorn flap. There were 8 males and 7 females with an average age of 44 years (range, 28-65 years). The causes of injury included 8 cases of machine crush injury, 4 cases of heavy object crush injury, and 3 cases of cutting injury. There were 1 case of thumb, 5 cases of index finger, 6 cases of middle finger, 2 cases of ring finger, and 1 case of little finger. There were 12 cases in emergency, and 3 cases with finger tip necrosis after trauma suture. Bone and tendon exposed in all cases. The range of fingertip defect was 1.2 cm×0.8 cm to 1.8 cm×1.5 cm, and the range of skin flap was 2.0 cm×1.5 cm to 2.5 cm×2.0 cm. The donor site was sutured directly.@*RESULTS@#All flaps survived without infection or necrosis, and the incisions healed by first intention. All patients were followed up 6-12 months, with an average of 10 months. At last follow-up, the appearance of the flap was satisfactory, the wear resistance was good, the color was similar to the skin of the finger pulp, and there was no swelling; the two-point discrimination of the flap was 3-5 mm. One patient had linear scar contracture on the palmar side with slight limitation of flexion and extension, which had little effect on the function; the other patients had no obvious scar contracture, good flexion and extension of the fingers, and no dysfunction. The finger function was evaluated according to the total range of motion (TAM) system of the Hand Surgery Society of Chinese Medical Association, and excellent results were obtained in 13 cases and good results in 2 cases.@*CONCLUSION@#The neurovascular staghorn flap is a simple and reliable method to repair fingertip defect. The flap has a good fit with the wound without wasting skin. The appearance and function of the finger are satisfactory after operation.
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Adult , Female , Humans , Male , Middle Aged , Aged , Cicatrix/surgery , Contracture/surgery , Crush Injuries/surgery , Finger Injuries/surgery , Plastic Surgery Procedures , Skin Transplantation/methods , Soft Tissue Injuries/surgery , Treatment OutcomeABSTRACT
Methods@#This study included 60 patients with Lenke 1 AIS who underwent selective thoracic fusion surgery. Coronal spinal alignment parameters were analyzed preoperatively, postoperatively, and at the final follow-up. The postoperative FMS was divided into two groups: the balanced group (FMS ≤20 mm) and the unbalanced group (FMS >20 mm). An independent t-test was used to compare quantitative data between groups, and a chi-square test was used for qualitative data. Furthermore, binary logistic regression and receiver operating characteristics curve analyses were used to identify the risk factors for postoperative distal adding-on in AIS. @*Results@#At 2-year follow-up, the unbalanced group was more likely to have adding-on (17 of 24 patients) than the balanced group (six of 36 patients; p<0.001). Twenty-three patients with distal adding-on had significantly greater preoperative and postoperative lower instrumented vertebrae (LIV) rotation, FMS, and FMS angle (FMSA) than those without postoperative distal adding-on. Binary logistic regression analysis selected three independent risk factors for adding-on incidence after surgery: FMS (odds ratio [OR], 1.115; 95% confidence interval [CI], 1.049–1.185; p<0.001), FMSA (OR, 1.590; 95% CI, 1.225–2.064; p<0.001), and postoperative LIV rotation (OR, 6.581; 95% CI, 2.280–19.000; p<0.001). @*Conclusions@#Achieving a balanced fusion mass intraoperatively is important to avoid postoperative distal adding-on, with FMS of <20 mm and FMS angle of <4.5°. Furthermore, correcting LIV rotation helps to decrease the incidence of postoperative distal addingon.
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BACKGROUND:Previous studies have shown that nerve function may achieve different degrees of recovery in most patients after transvertebral transposition of the spinal cord for repair of spinal cord nerve compression and kyphoscoliosis. However, the effective mechanism of the proposed method to improve postoperative nerve function is stil not clear. OBJECTIVE:To investigate the improvement in neurological outcomes after transvertebral transposition of the spinal cord and posterior correction in patients suffering from neurologic deficit secondary to angular kyphoscoliosis. METHODS:Eighteen patients suffering from neurologic deficit secondary to angular kyphoscoliosis underwent transvertebral transposition of the spinal cord and posterior correction. Preoperatively and 1 week postoperatively, al patients were subjected to somatosensory evoked potential detection. During operation, motor evoked potentials and somatosensory evoked potentials were monitored. Using MRI, the distance from the inner edge of the spinal canal to the outer edge of the convex side of the spinal cord at apical region was measured, and the distance of spinal cord transposition was calculated. RESULTS AND CONCLUSION:(1) There were no significant differences in terms of the latency and amplitude of posterior tibial nerve P40 (preoperatively versus intraoperatively:amplitude:(1.66±0.29)μV vs. (1.68±0.28)μV, P>0.05;latency:(39.25±3.02) ms vs. (38.68±2.67) ms, P>0.05). (2) After surgery, the major curve was improved with (51.1±21.2)%correction rate, and the mean kyphosis was improved with (38.9±18.1)%. The distance between spinal cord and canal on the convex side at the apex was decreased by (2.4±1.7) mm on average. (3) The amplitude and latency of posterior tibial nerve P40 at 1 week postoperatively were (2.21±0.40)μV and (34.98±2.83) ms, respectively (P<0.05). (4) These results suggest that posterior correction and internal fixation can remarkably improve neurophysiological index and nerve function in patients with neurologic deficit secondary to angular kyphoscoliosis.
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Objective To investigate the relevance between relapse and course of treatment in genotype 1 chronic hepatitis C (CHC)pa-tients with slow virologic response.Methods Totally 157 genotype 1 CHC inpatients or outpatients were selected from the Third People′s Hospital of Jiaozuo and the People′s Hospital of Jiaozuo from April 2010 to March 2013.The patients were treated with interferon α-1b in conjunction with ribavirin.At 6 months of the initial treatment,5 1 patients with slow virologic response were randomly divided into groups A (24 cases)and B (27 cases),which received continued treatment for another 6 and 12 months,respectively.A 1 -year follow-up of pa-tients was performed after withdrawal of treatment.Adverse reactions in patients receiving the antiviral therapy were assessed.Furthermore, group comparisons were performed on the clearance rate of hepatitis C virus (HCV)RNA and normalization rate of alanine aminotransferase (ALT)at withdrawal of treatment,as well as the CHC relapse rate and ALT normalization rate at 6 months and 1 year after withdrawal of treatment.Continuous data were compared using t test,and categorical data were compared usingχ2 test.Results The rate of adverse reac-tions in patients receiving antiviral therapy had no significant difference between groups A and B (P>0.05 ).At withdrawal of treatment, there were no significant differences between groups in terms of HCV RNA clearance rate (95.65%vs 92.59%)and ALT normalization rate (95.65% vs 88.89%)(χ2 =0.02 and 0.13,respectively,both P>0.05).At 6 months and 1 year after withdrawal of treatment,the CHC relapse rate in group B was significantly lower than that in group A (20.00% vs 50.00%,χ2 =4.69,P 0.05;72.00% vs 50.00%,χ2 =2.40,P>0.05).Conclusion To extend the 6 -month course of treatment can significantly reduce the relapse following slow virologic response in patients with genotype 1 CHC.
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Objective To explore the influence of renal insufficiency with microwave therapy in the treatment of liver cancer .Methods A retrospective clinical analysis with 80 patients who underwent microwave therapy of liver cancer ,was performed from June 2012 to March 2014 in the department of hepatobiliary and pan-creatic surgery ,the Affiliated Tumor Hospital of Harbin Medical University .According to perioperative presence of renal insufficiency,we divided the patients into renal dysfunction group (A)(n=44)and normal renal function group(B)(n=36);Preoperative ALT,TBIL,BUN,intraoperative hypotension,intraoperative urinary volume,age, the distance between the tumor and the main vessels in the liver ,postoperative microwave ablation time the differ-ences of the risk factors ,such as microwave ablation range and sex of the two groups were compared during micro -wave therapy .Results There was no statistical significant difference between the two groups on intraoperative u -rinary volume(P>0.05);The preoperative ALT,TBIL,BUN,intraoperative hypotension,age,microwave ablation time,the distance between the tumor and the main vessels in the liver ,scular microwave ablation range ,sex of two groups showed statistical differences (P<0.05).BUN with preoperative ALT,TBIL,preoperative BUN,intraoper-ative hypotension,age,the distance between the tumor and the main vessels in the liver ,time of microwave abla-tion,microwave ablation range,sex influence factors were positively correlated (r=0.63,0.60,0.58,0.49,0.45, 0.40,0.35,0.46,0.52,P<0.05).Strength and influencing factors of BUN are the distance between the tumor and the main vessels in the liver,microwave ablation range,intraoperative hypotension,preoperative ALT,sex,pre-operative TBIL,microwave ablation time,age,preoperative BUN(β=0.52,0.42,0.37,0.31,0.29,0.25,0.20, 0.18,0.16,P<0.05).Conclusion Microwave therapy leads to renal insufficiency in the treatment of liver cancer performs many aspects , including preoperative ALT , TBIL, preoperative preoperative BUN , intraoperative hypotension ,age,the distance between the tumor and the main vessels in the liver ,time of microwave ablation ,mi-crowave ablation range ,sex,which is closely related to the factors affecting the risk of kidney .
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BACKGROUND:The infection after spinal internal fixation was its serious complications. A number of studies have shown that erythrocyte sedimentation rate and C-reactive protein are of great importance in judging infections. OBJECTIVE:To analyze the trend of change of erythrocyte sedimentation rate and C-reactive protein for patients without infection after the cervical fixation. METHODS:Total y 56 patients, who underwent cervical fixation from October 2013 to July 2014, were retrospectively analyzed, and then divided into anterior cervical group (n=29) and posterior cervical group (n=27). Patients in the anterior cervical group underwent anterior cervical decompression bone graft internal fixation. Patients in the posterior cervical group underwent posterior cervical unilateral open door decompression internal fixation. The peripheral blood was col ected before fixation and at the early morning of the 1, 3, 6, 9 days after fixation. Erythrocyte sedimentation rate and C-reactive protein values were determined. The fol ow-up of patients was more than one year. Signs of infection did not appear. RESULTS AND CONCLUSION:(1) General rule:After the cervical fixation, the erythrocyte sedimentation rate was increased significantly and reached a peak on postoperative day 6. The peak level gradual y decreased but has not returned to normal at the 9 postoperative days. The C-reactive protein increased significantly on the first postoperative day and reached a peak on postoperative day 3. The peak level rapidly decreased but has not returned to normal at the 9 postoperative days. The level of erythrocyte sedimentation rate of patients in the posterior cervical group was significantly higher than that in the anterior cervical group at 3, 6 and 9 days after internal fixation (P0.05). (2) These results demonstrate that C-reactive protein is an important indicator of monitoring the inflammatory response of patients after cervical internal fixation, which was conductive to the judgment of early infection after internal fixation. The abnormal inflammatory indices of erythrocyte sedimentation rate and C-reactive protein do not suggest a presence of blade infection after internal fixation. C-reactive protein can reach the peak at 3 days after fixation. It is recommended to check blood at 2 and 3 days. If there is no apparent rebound, then the possibility of infection is smal . It may indicate the presence of infection if the inflammatory indices increased again or decreased slowly after the decrease.
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ObjectiveTo study the efficacy of thymosin α1 in the treatment of chronic hepatitis B virus (HBV) infection with low viral load. MethodSeventy-six patients with low-viral load chronic HBV infection admitted to our hospital from June 2011 to June 2013 were randomly assigned to treatment group, and forty-one patients were assigned to control group. The treatment group received subcutaneous injection of 1.6 mg thymosin α1 twice a week, and the treatment stopped at 3 months if the patients were negative for serum HBV DNA; otherwise, the treatment was extended to 6 months. The control group did not receive any treatment. The serum HBV DNA clearance rates at months 3 and 6 of treatment were measured in both groups. Comparison of continuous data between two groups was made by t test, and comparison of categorical data was made by χ2 test. ResultsThe treatment group showed significantly higher HBV DNA clearance rates than the control group at months 3 and 6 of treatment (χ2=10.61, P＜0.01; χ2=13.09, P＜0.01). At month 6 in the treatment group, the HBV DNA clearance rate in patients who had HBV DNA ＜104 copies/ml and were positive for HBeAg showed no significant difference from that in those who were negative for HBeAg (χ2=0.02, P＞0.05), but was significantly higher than that in patients with HBV DNA ≥104 copies/ml (χ2=7.52, P＜0.01). ConclusionThymosin α1 significantly promotes HBV DNA clearance in patients with low-viral load chronic HBV infection. The clearance rate is negatively correlated with the DNA load, but shows no correlation with the HBeAg status.
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BACKGROUND:Pathological examination and MRI have been widely used in clinic, but their combination is rarely reported in discrimination of early spine infections. OBJECTIVE:To determine the accuracy of pathology and MRI for discrimination between early pyogenic spondylitis and brucella spondylitis. METHODS:Twenty-two patients with pyogenic spondylitis and 20 patients with brucella spondylitis who had CT-guided percutaneous biopsy and MRI of the spine were retrospectively reviewed. Pathological observations included structure and activity of bone lesions, tissue cells and their main components;MRI observations included signal and sign changes at lesion sites. Statistical analysis was performed with the chi-square test. RESULTS AND CONCLUSION:The patients with pyogenic spondylitis had a significantly higher incidence of pathological and MRI findings as fol ows (P<0.05):neutrophil infiltration;intervertebral disc abnormal signal, location of vertebral body lesions anterior+posterior, obviously shape change in the vertebral body, paraspinal abnormal signal, presence of intraosseous or paraspinal abscess. Pathological and MRI examination was accurate for early differentiation of pyogenic spondylitis from brucella spondylitis.
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BACKGROUND:The reasons for spinal imbalance include spinal deformity, spinal degenerative disease osteoporotic vertebral compression fractures. We believe that the power factor (back muscle) plays a key role in spinal sagittal imbalance. OBJECTIVE:To analyze the reasons for spinal sagittal imbalance by observing clinical manifestations and therapeutic outcomes in patients with osteoporotic vertebral compression fractures. METHODS:A total of 41 patients with osteoporotic compression fractures combined with spinal sagittal imbalance were retrospectively analyzed from January 2012 to May 2013. Al patients were subjected to percutaneous bal oon vertebroplasty under local anesthesia. Before treatment, they received bone density, standing ful-spine lateral X-ray, CT and MR imaging with injured vertebrae as the center. Using standing ful-spine radiographs, the height of anterior border of the injured vertebrae, Cobb angle of kyphosis and improved angle, wedging angle of the injured vertebrae and improved angle were measured. The patients underwent weight loading test and walking test. Preoperative and postoperative data were compared. RESULTS AND CONCLUSION:The patients affected spinal sagittal imbalance symptoms, so the walking distance was significantly shorter than that postoperatively (P<0.05). Moreover, the time of weight loading test was significantly shorter than that postoperatively (P<0.05). In standing ful-spine radiographs, the average difference of Cobb angle was (10.01±0.76)°. The mean difference of vertebral wedging improvement was (4.84±0.40)° (P<0.05). Al patients were fol owed up. Low back pain and sagittal imbalance symptoms were relieved. No severe complications appeared after percutaneous bal oon vertebroplasty. Results indicated that patients with osteoporosis compression fractures can affect the symptoms of spinal sagittal imbalance, which is not only induced by wedging of the injured vertebra. In addition, after percutaneous bal oon vertebroplasty, imbalance symptoms are apparently improved, suggesting that back pain after spinal fracture limits back muscle strength and is an important cause for spinal sagittal imbalance.
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Objective To investigate the application of real-time quantitative PCR in quantification of cell-free fetal DNA maternal plasma in patients bearing fetuses affected with DOWN syndrome. Methods Cell-free fetal DNA in maternal serum was isolated from 30 samples(7 male DOWN syndrome fetal ,3 female DOWN syndrome fe-tal,14 male euploid fetal,6 female euploid fetal). Cell-free fetal DNA levels in maternal serum were measured using real-time quantitative PCR using SRY as marker. Results The median cell-free fetal DNA levels in pregnant carry-ing male fetuses(n=7) and the controls (pregnant carrying male euploid fetuses,n=14)were 318.03±96.74 ge-nome-equivalents/ml and 154.40±39.43 genome-equivalents/ml of maternal serum,respectively (t=3.33,P=0.004 ),which was o in women with female fetuses. Conclusion The cell-free fetal DNA levels in pregnant women with DOWN syndrome fetuses are higher than that in pregnant women with normal fetuses.
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[Objective] To evaluate the value of Fulcrum-bending radiograph and new treatment strategy to the scoliosis with Chiari malformation and/or syringomyelia,and to analyze the effect of operation.[Methods]Eighteen cases suffering from scoliosis with Chiari malformation and/or syringomyelia were divided into 2 groups for surgical treatment.(1)Group 1:six cases had scoliosis with Chiari malformation and/or syringomyelia without obvious neurological impairment.Their scoliosis was corrected with anteroposterior instrumentation afer one week of Halo's traction.(2)Group 2:another 12 patients having similar scoliosis underwent posterior orthopedic operation according to the result of preoperative suboccipital Fulcrum-bending radiograph.[Results]In 6 patients who underwent opration after traction,the average frontal correction rate was 61%.In another 6 cases having soft scoliosis with only posterior operation,the average frontal correction rate was 60%,and the result of opration came close to the Fulcrum-bending radiograph's.But in 6 cases having rigid scoliosis with only posterior operation,the average frontal correction rate was 52%.One patient had nervous lesion and gradually recovered.There existed excessive rectification.[Conclusion]Patients with soft scoliosis with Chiari malformation and/or syringomyelia without obvious neurological impairment can be operated on according to Fulcrum-bending radiograph without preoperative traction,and the therapeutic effect is similar to classic operative result.
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Objective To investigate the gene expression of interleukin-1 alpha (IL-1?) in degenerative cervical intervertebral discs and its significance. Methods The specimens of the cervical intervertebral discs were harvested from 12 patients with cervical disc herniation (CDH) and 16 patients with cervical spondylotic myelopathy (CSM) in surgical operations, and categorized according to the MRI disc degeneration classification. The specimens of 8 normal cervical intervertebral discs from fresh corpses were harvested as control group. The expression of IL-1? mRNA was detected by in situ hybridization histochemistry (ISHH) and the difference and change characteristics of IL-1? mRNA expression were compared among groups and each grades. Results The expression of IL-1? mRNA was obviously stronger in CDH and CSM groups than in the control group and stronger in discs of grades Ⅲ and Ⅳ than gradesⅠ and Ⅱ. Conclusion The gene expression of IL-1? was strengthened in degenerative cervical intevertebral discs and the more serious the degeneration, the stronger the gene expression. IL-1? may play an important role in the degeneration of cervical intervertebral discs.
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Objective To study the influence of the surgical glue on anastomosis scar formation after bilioenterostomy Methods Seventy-two hybrid canines were randomly assigned into group A (OB glue plus persistent T tube stent ), group B (OB glue plus T tube drawn out at different postoperative time), group C ( FG plus persistent T tube stent ) and group D (FG plus T tube drawn out at different postoperative time). The surgical glue (OB glue or FG) was used instead of silk thread in biliointestinal Roux-en-Y anastomosis, and T tube was placed as indwelling stent. The collagen content (BCC) of anastomotic specimen was measured in 3 weeks and 3 , 6 , 9 ,12 months after the operation. Results Three months after the operation, BCC in group B was significantly higher than that in group A (P0.05). Conclusions The surgical glue can promote anastomosis healing with less scar formation, and accelerate scar softening and maturation, which suggests that surgical glue should be effective in the prevention of anastomotic stricture.
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Objective To investigate the feasibility of sentinel lymph node (SLN) detection in patients with cervical cancer undergoing radical hysterectomy Methods Twenty patients with cervical cancer at stage Ⅰb ( n =3), stage Ⅱa ( n =12) and stage Ⅱb ( n =5) underwent SLNs detection by using blue dye Four ml of methlene blue or lymphazurin was injected into the cervix at 4 points around the tumor at the time of radical hysterectomy and bilateral pelvic lymphadenectomy Tumor characteristics, surgical findings, and specific locations of lymphatic dye uptake were recorded and correlated with final pathology results Results Among 20 patients underwent this detection, dye uptake was seen in 18 patients Total number of SLNs were 33 Eighteen SLNs identified located in right pelvic and 15 SLNs located in left The SLNs were successfully detected in 78% patients (14/18) Six patients (33%) were diagnosed with lymph node metastases and there were 5 patients with positive nodes in the group of SLN Two patients had both positive SLNs and pelvic lymph nodes Three patients had positive SLNs only The predictive rate was 100% and the false negative rate was zero Conclusion SLN detection undergoing radical hysterectomy is feasible and safe, however, the detection rate of SLN needs improvement
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Purpose:To explore the clinical feature,and treatment of primary cervical lymphoma. Methods:Clinical data and follow-up survey data of 26 cases were retrospectively analyzed with SSPS software. Results:Primary cervical lymphoma could occur in any age group of women. The misdiagnosis rate was as high as 57.69% (15/26 case).Three of 26 patients died,the five years survival rate was 88.46%.Conclusions:Primary cervical lymphoma is rare,which was very often misdiagnosised. The treatment consisted of an combination of chemotherapy,operation and radiotherapy,which could improve curative results and reduce relapse.
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Purpose:To investigate the feasibility of detecting intraoperatively blue sentinel lymph node (BSLN) in patients with cervical cancer and to evaluate the accuracy of predicting pelvic lymph node disease. Methods:Between May 2002 and Jun 2003,29 patients with cervical cancer FIGO stage Ⅰb ( n =3),stage Ⅱa ( n =21),stage Ⅱb ( n =5) underwent BSLNs detection. During operation 4ml of methlene blue or lymphazurin was injected into the cervical tissue around the tumor or 3′,6′,9′,12′ of normal appearance of cervix about 0.5cm deep. Blue lymph duct and BSLNs were observed and located carefully for 10 minutes. Tumor characteristics,surgical findings,and location and number of BSLNs were recorded and correlated with pathologic results to get the accuracy and false-negative rate.Results:Among 29 patients underwent this technique,BSLNs were seen in 24 patients. Total detection rate was 83%(24/29). Location of BSLNs was mainly in obturator and internal iliac group. BSLNs located in left internal iliac group in 11 patients and 13 patients in right internal iliac group,10 patients in left obturator group,and 14 patients in right obturator group. 3 patients had BSLNs in both iliac and internal iliac group. Among 24 patients with BSLNs,there were 6 patients with lymph node metastases. 5 patients had only SLN metastases and one patient had both SLN and other lymph node disease. 18 patients had neither SLNs nor other pelvic lymph nodes metastases. The false-negative rate was 0.Conclusions:Intraoperatively BSLN detection was feasible and safe. Sentinel lymph node was representative of the lymphatic basin.