Analysis of delayed infection of proximal junctional zone after posterior spinal internal fixation and its treatment strategy / 中国骨伤

<p><b>OBJECTIVE</b>To explore the features and treatment strategy of delayed infection of proximal junctional zone after posterior spinal internal fixation.</p><p><b>METHODS</b>The clinical data of 1325 patients underwent posterior spinal internal fixation were retrospectively analyzed. Delayed infection occurred in 10 patients, among which 4 infections occurred at the proximal junction (non-operative site). And these 4 patients were treated with combined broad-spectrum antibiotics. Their clinical symptoms and signs, lab tests, MRI findings, pathology findings, and clinical effects were analyzed.</p><p><b>RESULTS</b>All four patients were followed up from 6 months to 4 years. No infection recurrence was found. All patients obtained satisfactory results after hospital discharge. No nerve injury was found. One patient developed kyphosis in the proximal junctional zone 2 years after the operation. According to the criteria of N.Nakano and T.Nakano, 3 cases obtained excellent results, while 1 poor.</p><p><b>CONCLUSIONS</b>The incidence rate of delayed infections was rare after spinal operation. Delayed infections occurred in proximal junctional zone may be attributed to the stress concentration of adjacent segments after fixation and the degeneration of adjacent segments, thus forming inflammation areas. For refractory lumbar and back pains, an elevated blood sedimentation rate, C-reactive protein level, MRI manifestation and focal pathology would be helpful for establishing a definite diagnosis. Full course of combined broad-spectrum antibiotics in treating the infection can lead to satisfactory clinical results.</p>

Analysis of postoperative complication and its preventive measure of cervical open-door expansive laminoplasty with lateral mass screw fixation / 中国骨伤

<p><b>OBJECTIVE</b>To explore the postoperative complication and its preventive measure of cervical open-door expansive laminoplasty with lateral mass screw fixation in treating cervical canal stenosis.</p><p><b>METHODS</b>From February 2008 to July 2011, 33 patients with cervical canal stenosis underwent cervical open-door expansive laminoplasty with lateral mass screw fixation. JOA score was used to evaluate clinical effects before and after operation. Of them, complications occurred in 6 cases, male in 2 cases and female in 4 cases. The reason of complications were analyzed.</p><p><b>RESULTS</b>All the patients were followed up from 6 months to 2 years with an average of 10.3 months. The improvement rate of JOA was 78.8% and incidence rate of complication was 18.2% (6 cases). There were 2 cases of axiality symptoms, 1 case of lateral mass screw pulled-out, 2 cases of cerebrospinal fluid leakage with wound dehiscence, 1 case of nerve root parlysis. These complications correlated with operative design, manipulation,improved degree of cervical curvature,postoperative management and cooperation of patient.</p><p><b>CONCLUSION</b>As an effective treatment, cervical open-door expansive laminoplasty with lateral mass screw fixation has lower incidence of axiality pain. Preoperative examination ,postoperative management ,meticulous surgical skill are very important to avoid complications.</p>

Video-assisted thoracoscopic extended thymectomy for myasthenia gravis: analysis of 107 cases / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate the results of video-assisted thoracoscopic extended thymectomy for myasthenia gravis.</p><p><b>METHODS</b>We retrospectively reviewed data from 107 patients received thoracoscopic extended thymectomy from June 1995 to June 2004. All patients had confirmed diagnosis of myasthenia gravis by clinical manifestation and electromyogram. Thoracoscopic extended thymectomy as well as dissection of all fatty tissue anterior to the pericardium was performed.</p><p><b>RESULTS</b>During a follow-up of 1-98 months, symptom was significantly improved in 83% of patients, including 34 patients experienced complete remission. There was no postoperative mortality.</p><p><b>CONCLUSION</b>Favorable results of video-assisted thoracoscopic extended thymectomy can be achieved in patients with myasthenia gravis. The technique is safe and minimally invasive.</p>