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Objective:To investigate the feasibility and early clinical effect of lumbar lateral anterior interbody fusion in the treatment of degenerative lumbar scoliosis.Methods:Forty patients with degenerative lumbar scoliosis who underwent lumbar lateral anterior interbody fusion combined with posterior percutaneous pedicle screw and rod internal fixation from January 2018 to January 2020 were selected. There were 17 males and 23 females; The age was 65.4±7.2 years (range 51-84 years). All patients had obvious low back pain, of which 22 patients (55.0%) had lower limb pain, numbness or intermittent claudication. 16 patients (40.0%) had scoliosis and the main curve protruded to the right, and 24 patients (60.0%) had scoliosis and the main curve protruded to the left. The operation time and intraoperative bleeding were recorded. The main outcome measures were visual analogue scale (VAS), Oswestry disability index (ODI), the MOS item short from health survey (SF-36), deformity correction, bone graft fusion time and complications.Results:The left approach was used in 16 cases of scoliosis with the main curve protruding to the right; In 24 cases, the main curve of scoliosis protruded to the left, of which 6 cases showed osteophyte on the concave side (right side) of coronal CT and the right approach was adopted, while the rest were adopted the left approach. Single segment fusion was performed in 8 cases (20.0%), double segment fusion in 12 cases (30.0%), three segment fusion in 16 cases (40.0%), and four segment fusion in 4 cases (10%). Among the 22 patients with symptoms of lower limb nerve damage, 6 needed secondary unilateral laminectomy. All 40 patients completed the operation successfully, the operation time was 255±37 min (range 130-345 min) and the amount of intraoperative bleeding was 100±16.2 ml (range 10-505 ml). All patients were followed up for 12.8±4.5 months (range 6-24 months). The preoperative VAS score was 5.7±1.0, improved to 3.5±0.7 on the first day after operation, and 1.4±0.3 at the last follow-up. The difference was statistically significant ( F=2322.229, P <0.001). The preoperative ODI was 79.9%±9.3%, the first day after operation was 51.6%±8.9%, and the last follow-up was 11.7%±2.2%. The difference was statistically significant ( F=3770.411, P <0.001). SF-36 was 68.6±5.3 before operation and 78.4±5.5 on the first day after operation, which increased to 109.9 ± 4.9 at the last follow-up. The difference was statistically significant ( F=21736.486, P <0.001). The Cobb angle of lumbar scoliosis was 27.8°±14.1° before operation and 7.5°±3.5° on the first day after operation, the difference was statistically significant ( t=3.551, P <0.001); The height of intervertebral space was 10.9±2.1 mm before operation and 15.3±3.4 mm on the first day after operation, the difference was statistically significant ( t=2.106, P <0.001). 24 patients (60.0%) had pain or numbness in the front of the thigh, and 4 patients (10.0%) had quadriceps femoris weakness; These symptoms disappeared within 3 months after operation in 26 patients, except that the numbness in the front of the thigh was only reduced in 2 patients 3 months after operation. All patients achieved satisfactory fusion in all segments at the last follow-up, and there was no non-fusion. Conclusion:Lumbar lateral anterior interbody fusion is a safe and feasible method for the treatment of degenerative lumbar scoliosis.
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BACKGROUND: Pedicle screw fixation is the preferred surgical treatment for clinical treatment of lumbar degenerative disease currently. The stability of pedicle screw fixation system can be evaluated from the perspective of biomechanics and finite element method is more and more popular in analyzing stress of pedicle screw fixation of vertebral body for researchers. OBJECTIVE: To analyze the stress and displacement changes of human lumbar spine in bending movement from the biomechanical point of view when unilateral and bilateral pedicle screws are fixed, providing theoretical reference for practical clinical application. METHODS: Three-dimensional models were established based on CT data of the volunteers. The volunteers signed the informed consent. This study was approved by the Hospital Ethics Committee. Abaqus software was used to simulate the actual stress conditions. Finite element analysis of lumbar spine flexion was performed during unilateral and bilateral pedicle screw fixation. The stress and displacement of lumbar vertebra, disc and pedicle screw were observed under two fixation methods. RESULTS AND CONCLUSION: (1) Under bilateral fixation, the stress on the left screw was 22.2 MPa, and the stress on the right screw was 21.14 MPa, which was far less than the stress of the screw under unilateral fixation (79.19 MPa). The stress of intervertebral disc in unilateral fixation was 87% larger than that in bilateral fixation; the stress of vertebral body in bilateral fixation was 72% smaller than that in unilateral fixation. (2) From the perspective of displacement, the displacement of screw, lumbar disc and centrum under bilateral fixation were 53%, 55% and 62% smaller than that under unilateral fixation, respectively. (3) Therefore, from the mechanical point of view, bilateral pedicle screw fixation has less stress level, which is friendlier to the human body than unilateral fixation and thus more conducive to the recovery of patients.
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Objective@#To develop a new type of triple-leaf-enhanced cervical spine plate system, to study its biomechanical properties, perform clinical preliminary applications, and observe clinical effects.@*Methods@#Twelve fresh goat specimens were used, and the high-precision digital display grating displacement sensor system was used to compare the stability, fatigue strength and tensile strength of the fixation of the anterior nailing of the new type of triple-leaf-enhanced cervical spine plate system. All of 92 patients with cervical spondylosis who underwent cervical anterior decompression, cage or titanium mesh fusion, with new PRUNUS spine plate system or Atlantis spine plate system internal fixation were selected from January 2015 to January 2018. Comparative study recorded intraoperative blood loss, operative time, preoperative cervical Cobb angle, pain visual analogue scale (VAS), and Japanese Orthopaedic Association (JOA) spinal function score, and neurological improvement ratewas calculated. Frankel grading was used to evaluate pre and postoperative functional status of the anterior and posterior nerves, so as to comprehensively evaluate the initial clinical efficacy of the new PRUNUS spine plate system.@*Results@#The biomechanical tests showed that: 1) The flexion, extension, left bending, right bending, left rotation and right rotation ROM after fixing with the new PRUNUS spine plate system were 1.02°±0.13°, 1.32°±0.11°, 0.96°±0.23°, 1.03°±0.19°, 1.37°±0.17° and 1.05°±0.08°. ROM after fixation of Atlantis spine plate system were 0.99°±0.11°, 1.08°±0.23°, 0.83°±0.21°, 0.82°±0.13°, 1.18°±0.43°, 1.17°±0.17°, respectively. There was no significant statistical difference between the two groups; 2) The fatigue life of the new PRUNUS spine plate system and Atlantis spine plate system were 6.3×105 and 6.1×105, and the fatigue strengths were 512.12 Mpa and 502.85 Mpa respectively. There was no statistical difference between the two groups. 3) The maximum pull-out force of the new PRUNUS spine plate system was 483.62±39.14 N, and the maximum pull-out force of the Atlantis spine plate system was 396.55±22.79 N. The difference between the two groups was statistically significant. In the clinical application, the new PRUNUS spine plate system was used, the average operation time was 102.8±13.6 min, and the average blood loss was 56.8±14.1 ml. Using the Atlantis spine plate system, the average operation time was 132.8±15.7 min, and the average blood loss was 76.8±19.1 ml. The difference between the two groups was statistically significant; Using the new PRUNUS spine plate system, the VAS score was reduced from 5.42±1.17 before surgery to 1.58±0.44, the preoperative JOA score was 8.13±1.26, and the JOA score was 14.71±1.16 at the last follow-up. Using the Atlantis spine plate system, the VAS score was 6.94±1.06 before surgery. dropped to 1.75±0.35, the preoperative JOA score was 9.26±1.32, and the JOA score was 14.96±1.56 at the last follow-up. There was no significant difference between the two groups.@*Conclusion@#The new PRUNUS spine plate system has good biomechanical properties and has a good effect on the stability of the cervical vertebra, especially for the postoperative renovations and osteoporosis patients. The operation is simple and convenient, safe and effective, and worthy of clinical promotion.
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Objective@#To analyze the mid-term clinical efficacy of extended to C1, 2 posterior single-door laminoplasty for the treatment of ossification of the posterior longitudinal ligament combined the upper cervical spine.@*Methods@#From February 2013 to December 2015, 32 patients with cervical OPLL who were extended to C1, 2 posterior open-door laminoplasty were enrolled in our hospital (complete follow-up of 25 patients). There were 19 males and 6 females, aged 48-76 years (mean 60.1±7.0 years). Cervical spinal cord function was assessed using the Japanese Orthopaedic Association (JOA) spinal cord function score, and the rate of improvement in neurological function was calculated. The quality of life of patients was assessed using the neck disability index (NDI). Axial symptoms were assessed and indexed using the visual analog scale (VAS). The C0-2 angle of the cervical spine was measured by X-ray preoperative and at the last follow-up. The cervical curvature was evaluated by the C2-7 angle, and the cervical vertebra activity was observed by the dynamic X-ray of the cervical spine.@*Results@#25 patients were followed up for a period of 26-64 months (mean 35.9±8.1 months). At the last follow-up, the JOA score was 14.32±3.24, the NDI score was 7.61±1.23, and the VAS score was 1.42±0.78. The differences between the three scores were statistically significant compared with the preoperative scores. The neurological improvement rate at the last follow-up was 79.61%±13.23%. The preoperative C0-2 angle was 26.04°±6.28°, and the last follow-up was 24.92°±5.51°; the C2-7 angle was 19.55°±9.42° before surgery, and the C2-7 angle at last follow-up was 17.97°±8.80°. The C2-7 angle at last follow-up was slightly reduced compared with that preoperative, but the difference was not statistically significant. The preoperative cervical vertebra ROM was 35.31°±12.24°, and at the last follow-up it was 32.23°±9.65°. The ROM of cervical vertebrae at the last follow-up was slightly lower than that before surgery, but the difference was not statistically significant. Among them, the reduction of the ROM of overflexion was greater than that of the over-extension, which was the main reason for the decrease of ROM. The OPLL bone mass continued to grow at the last follow-up of 11 patients.@*Conclusion@#The extended to C1, 2 posterior single-door laminoplasty for the treatment of ossification of the posterior longitudinal ligament combined the upper cervical spine can achieve adequate spinal cord decompression, satisfactory neurological improvement, and improve the postoperative cervical curvature and activity. There was no obvious change in the curvature and activity of the cervical spine, and the axial symptoms did not increase significantly, and the clinical efficacy was positive.
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Objective@#To explore the relationship between the compression depth and compressive stress of the anterior and posterior cervical spinal cord in different sports positions.@*Methods@#Specimens of ten intact fresh cervical spine (C1-T1) from adult cadaver were collected. In order to simulate cervical disc degeneration and abnormal ligamentum flavum, we placed two hemispherical steel balls into the anterior and posterior side of the cervical spinal cord through the bone window of the C4, 5. The measurement was conducted in 10%, 20%, 30%, 40%, 50%, and 60% of the sagittal diameter for the compressive stress of the anterior and posterior cervical spinal cord under different compression depths of flexion, neutral, and posterior extension.@*Results@#The anterior depth of a certain pressure with the posterior pressure depth was increasing in neutral position, the stress on the anterior of the cervical cord-meningeal complex (CCMC) had no significant change, while the stress on the posterior of the CCMC increased greatly with the increasing of the degree of canal occlusion. The stress on the posterior of the CCMC varied insignificantly between 10% and 20% depth of canal occlusion (P>0.05). However, there was remarkable significance among 30% and 60% (P<0.05). In extension or flexion position, the stress on the anterior of the CCMC had no significant change, while the stress on the posterior of the CCMC increased greatly with the increasing of the degree of canal occlusion. The stress on the posterior of the CCMC varied insignificantly between neighboring depths of canal occlusion from 10% (P>0.05). However, there was remarkable significance among 20% and 60% (P<0.05). The posterior depth of a certain pressure with the anterior pressure depth was increasing in neutral position. The stress on the anterior of the CCMC increased greatly with the increasing of the degree of canal occlusion. The stress on the anterior of the CCMC varied insignificantly between 10% and 20% depth of canal occlusion(P>0.05). However, there was remarkable significance among 30% and 60% (P<0.05). The stress on the posterior of the CCMC had no significant change. In extension or flexion position, the stress on the anterior of the CCMC increased greatly with the increasing of the degree of canal occlusion. The stress on the anterior of the CCMC varied insignificantly between neighboring depths of canal occlusion from 10% (P>0.05). However, there was remarkable significance among 20% and 60% (P<0.05). The stress on the posterior of the CCMC had no significant change. Compared with the neutral position, the anterior flexion position and the posterior extension position had different trends in the compressive stress in the anterior and posterior aspect of the cervical spinal cord.@*Conclusion@#The stress on the anterior and the posterior of the CCMC has a closely nonlinear relationship with the depth of canal occlusion. With the increase of the depth of canal occlusion, the stress is increasing, especially running over the 30% depress of canal occlusion under neutral position. However, the stress is increased, especially running over the 20% depress of canal occlusion under the flexion and extension position.
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0bjective@#To explore the feasibility and clinical efficacy of cervical vertebral dome expansion laminoplasty..@*Methods@#Our hospital from February 2017 to 2018 Sep 16 cases with cervical spinal canal dome of cervical spinal stenosis angioplasty in treatment of cervical spinal cord due to the medical records of patients, including 14 males and 2 females; Aged 49- 76 years old, average age 57.3±1.7 years old. The course of disease was 7-48 months, with an average disease duration 17.75±1.90 months. Of the 16 patients, 5 had multi-segment cervical disc herniation and 11 had long segmental ossification of the posterior longitudinal ligament. All the 16 patients underwent cervical C3-7 dome-type spinal canal enlargement; the position, stability and spinal cord compression of the internal fixation were evaluated according to the patient's imaging data (X-ray, CT and MRI). The neck and upper extremity pain was evaluated by visual analogue scale (VAS) before and after operation. The cervical spinal cord function was evaluated by the Japanese Orthopaedic Association (JOA) spinal cord function score, and the rate of improvement of neurological function was calculated. The Frankel grading was used to evaluate the neurological function of patients before and after surgery.@*Results@#Cervical X-ray, CT and MRI were performed in all patients before and after surgery. Operation time 55-110 min, mean 65±12 min, bleeding 100-220 ml, mean 110±20 ml. The cross-sectional area of the spinal canal and the median sagittal diameter of the spinal canal were significantly increased compared with the preoperative. All patients were followed up for an average of 10.9±1.4 months (3-20 months). Imaging examination showed that 16 patients had no loosening and fracture after internal fixation, and no re-closure occurred. MRI T2WI images showed continuous recovery of cerebrospinal fluid signal in the spinal cord of C3-7 range. The preoperative VAS score was 7.3±0.9 points, the average VAS score at the last follow-up was 1.6±0.4 points, the preoperative JOA score was 6.9±1.1 points, and the last follow-up JOA score was 13.4±1.3 points. The improvement rate was 87.23%±3.81%; Frankel grade D before surgery, and Frankel grade E after surgery.@*Conclusion@#Cervical spinal canal domed simple angioplasty operation, spinal canal full, satisfactory clinical efficacy, and can effectively reduce the incidence of related complications, it is a safe and feasible method for the treatment of cervical spinal stenosis.
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Objective To develop a new type of triple-leaf-enhanced cervical spine plate system,to study its biomechanical properties,perform clinical preliminary applications,and observe clinical effects.Methods Twelve fresh goat specimens were used,and the high-precision digital display grating displacement sensor system was used to compare the stability,fatigue strength and tensile strength of the fixation of the anterior nailing of the new type of triple-leaf-enhanced cervical spine plate system.All of 92 patients with cervical spondylosis who underwent cervical anterior decompression,cage or titanium mesh fusion,with new PRUNUS spine plate system or Atlantis spine plate system internal fixation were selected from January 2015 to January 2018.Comparative study recorded intraoperative blood loss,operative time,preoperative cervical Cobb angle,pain visual analogue scale (VAS),and Japanese Orthopaedic Association (JOA) spinal function score,and neurological improvement ratewas calculated.Frankel grading was used to evaluate pre and postoperative functional status of the anterior and posterior nerves,so as to comprehensively evaluate the initial clinical efficacy of the new PRUNUS spine plate system.Results The biomechanical tests showed that:1) The flexion,extension,left bending,right bending,left rotation and right rotation ROM after fixing with the new PRUNUS spine plate system were 1.02°±0.13°,1.32°±0.11 °,0.96°±0.23°,1.03°±0.19°,1.37°±0.17° and 1.05°±0.08°.ROM after fixation of Atlantis spine plate system were 0.99°±0.11°,1.08°±0.23°,0.83°±0.21°,0.82°±0.13°,1.18°±0.43°,1.17°±0.17°,respectively.There was no significant statistical difference between the two groups;2) The fatigue life of the new PRUNUS spine plate system and Atlantis spine plate system were 6.3×105 and 6.1×105,and the fatigue strengths were 512.12 Mpa and 502.85 Mpa respectively.There was no statistical difference between the two groups.3) The maximum pull-out force of the new PRUNUS spine plate system was 483.62±39.14 N,and the maximum pull-out force of the Atlantis spine plate system was 396.55±22.79 N.The difference between the two groups was statistically significant.In the clinical application,the new PRUNUS spine plate system was used,the average operation time was 102.8±13.6 min,and the average blood loss was 56.8±14.1 ml.Using the Atlantis spine plate system,the average operation time was 132.8±15.7 min,and the average blood loss was 76.8±19.1 ml.The difference between the two groups was statistically significant;Using the new PRUNUS spine plate system,the VAS score was reduced from 5.42±1.17 before surgery to 1.58±0.44,the preoperative JOA score was 8.13±1.26,and the JOA score was 14.71±1.16 at the last follow-up.Using the Atlantis spine plate system,the VAS score was 6.94±1.06 before surgery.dropped to 1.75±0.35,the preoperative JOA score was 9.26± 1.32,and the JOA score was 14.96±1.56 at the last follow-up.There was no significant difference between the two groups.Conclusion The new PRUNUS spine plate system has good biomechanical properties and has a good effect on the stability of the cervical vertebra,especially for the postoperative renovations and osteoporosis patients.The operation is simple and convenient,safe and effective,and worthy of clinical promotion.
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Objective To explore the feasibility and clinical efficacy of cervical vertebral dome expansion laminoplasty..Methods Our hospital from February 2017 to 2018 Sep 16 cases with cervical spinal canal dome of cervical spinal stenosis angioplasty in treatment of cervical spinal cord due to the medical records of patients,including 14 males and 2 females;Aged 49-76 years old,average age 57.3± 1.7 years old.The course of disease was 7-48 months,with an average disease duration 17.75± 1.90 months.Of the 16 patients,5 had multi-segment cervical disc herniation and 11 had long segmental ossification of the posterior longitudinal ligament.All the 16 patients underwent cervical C3-7 dome-type spinal canal enlargement;the position,stability and spinal cord compression of the internal fixation were evaluated according to the patient's imaging data (X-ray,CT and MRI).The neck and upper extremity pain was evaluated by visual analogue scale (VAS) before and after operation.The cervical spinal cord function was evaluated by the Japanese Orthopaedic Association (JOA) spinal cord function score,and the rate of improvement of neurological function was calculated.The Frankel grading was used to evaluate the neurological function of patients before and after surgery.Results Cervical X-ray,CT and MRI were performed in all patients before and after surgery.Operation time 55-110 min,mean 65±12 min,bleeding 100-220 ml,mean 110±20 ml.The cross-sectional area of the spinal canal and the median sagittal diameter of the spinal canal were significantly increased compared with the preoperative.All patients were followed up for an average of 10.9±1.4 months (3-20 months).Imaging examination showed that 16 patients had no loosening and fracture after internal fixation,and no re-closure occurred.MRI T2WI images showed continuous recovery of cerebrospinal fluid signal in the spinal cord of C3-7 range.The preoperative VAS score was 7.3±0.9 points,the average VAS score at the last follow-up was 1.6±0.4 points,the preoperative JOA score was 6.9± 1.1 points,and the last follow-up JOA score was 13.4± 1.3 points.The improvement rate was 87.23％±3.81％;Frankel grade D before surgery,and Frankel grade E after surgery.Conclusion Cervical spinal canal domed simple angioplasty operation,spinal canal full,satisfactory clinical efficacy,and caneffectively reduce the incidence of related complications,it is a safe and feasible method for the treatment of cervical spinal stenosis.
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Objective To explore the safety,efficacy and outcomes of posterior transforaminal spinal cord reduction in the treatment of severe thoracic ossification of the posterior longitudinal ligament.Methods Since May 2010 to May 2016,21 patients with thoracic spinal stenosis with ossification of the posterior longitudinal ligament and embedding rate of more than 50％ underwent posterior circular decompression,12 males and 9 females;age 42-71 years old,with an average of 63.3±1.6 years old.There were severe spinal cord compression symptoms before surgery.The operation was from the posterior median approach.First,the pedicle screw tract was preset in the upper and lower segments where decompression was required,and then the posterior wall of the spinal canal was removed by the "uncovering method" to complete the posterior decompression.Through the superior and inferior articular joints,the joints were removed,the intercostal nerves were pushed outward,the extracorporeal intervertebral space and intervertebral disc tissue were revealed,and the vertebral cancellous bone of the lower vertebral body was removed.Separate the adhesion of the dura mater,use the special tool to cut the upper and lower edges of the posterior longitudinal ligament,collapse,remove the posterior longitudinal ligament ossification block,and complete the decompression of the front of the spinal cord through one or both sides.Finally,the pedicle screw fixation and the intervertebral bone graft were completed.Postoperative follow-up (mean 38.5 months) CT and MRI scans were performed to observe the patency of the spinal canal and the state of the internal fixation.The Frankel graded evaluation function was restored,the JOA score was used to evaluate the neurological function,the Otani evaluation system was used to evaluate the surgical outcome,the clinical excellent rate was calculated,and the treatment effect was evaluated.Results Nineteen cases recovered after operation,and 1 case showed a transient decrease in unilateral lower extremity motor function on the second day after surgery.It returned to normal after dehydration and neurotrophic support treatment,and 1 case had bilateral lower limbs on the day after surgery.Muscle strength was transiently lost,feeling recovered after 6 hours,and exercise resumed after 48 hours.The operation time was 180-300 min,with an average of 240±23 min.The intraoperative blood loss was 168±12 ml.Postoperative spinal cord function recovered significantly.At the last follow-up,Frankel graded F in 8 cases and grade E in 13 cases.Preoperative average JOA score was 3.5,and the JOA score of the follow-up was increased from 3.5±0.98 points to 9.0±0.9 points.The improvement rate of JOA score was excellent in 14 cases,good in 5 cases,and fair in 2 cases.According to Otani system there was excellent in 14 cases,good in 6 cases,and fair in 1 case.The excellent and good rate was 95.24％.Cerebrospinal fluid leakage occurred in 3 cases and healed after symptomatic treatment.No chest occurred during the follow-up period.The vertebral instability,internal fixation loose,broken.Conclusion Posterior transforaminal spinal decompression of posterior longitudinal ligament ossification of thoracic spine can be finished using self-developed special surgical tools,which is safe,effective and can achieve full decompression of spinal cord.
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Objective To investigate the clinical outcome of cervical expensive open-door laminoplasty combined with vitamin B12 treatment for patients of cervical spondylotic myelopathy with subacute combined degeneration of the spinal cord.Methods Data of 10 patients with cervical spondylotic myelopathy with subacute combined degeneration of the spinal cord in February 2013 to August 2013 were retrospectively analyzed.There were 7 males and 3 females with an average age of 46 years (range,32-73 years).Eight patients' history was in six months,and others' was beyond six months.All patients had undergone cervical expansive open-door laminoplasty with mini-plate fixation combined with intramuscular injection or pre os vitamin B 12.Patient imaging data were used to assess the stability of the cervical spine,and spinal cord compression in the fixed position before and after their surgery.Japanese Orthopaedic Association (JOA) score was used to evaluate function,and the rate of neurological improvement was calculated.The American Spinal Injury Association was used to evaluate the neurological function inpatients before and after surgery.The preoperative and postoperative numerical changes of SEP and vitamin B 12 were compared using correlation analysis.Each dimension of preoperative and postoperative scores change was compared by Life quality evaluation F-36 scale.Results All patients were followed up for an average period of 15 months (range,6-26 months).There were no complications related to the internal fixation,such as fixation loosened or broken.Cerebrospinal fluid surrounding the spinal cord within the C3-7 range of the signal on MRI T2WI of the continuous had been recovered.JOA score increased from preoperative 9.6±2.04 to postoperative 14.7±2.04,and postoperative neurological improvement rate was 20％-80％.The excellent and good rate was 90％ (9/10) including 4 excellent and 5 good.Vitamin B12 level before operation:78.30±42.82 pg/ml,postoperative:176.50±85.77 pg/ml.Electromyography and SEP had been all recovered.There was correlation between preoperative and postoperative vitamin B 12 levels with spinal cord function score.According to ASIA score,there were 4 cases in C level,6 in D level preoperatively,while 2 in C level,5 in D level,3 in E level postoperatively.Conclusion Cervical spondylotic myelopathy with subacute combined degeneration of the spinal cord could be treated by surgery.Vitamin B 12 by per os or intramuscular injection with removal of the cervical spinal cord compression which creates a space for recovery of spinal cord could improve the surgical curative effect.
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Objective To investigate the clinical outcome and complications of different types of expansive open door laminoplasty in cervical spondylotic myelopathy.Methods From December 2008 to June 2012,221 patients with cervical spondylotic myelopathy treated with expansive open-door laminoplasty were divided into micro-titanium plate fixed group (96 cases),wire hanging fixed group(66 cases),anchor suspension fixed group (59 cases).The clinical outcome was evaluated including JOA score,operation time,bleeding volume,spinal cord pressure (a/M),cervical range of motion (ROM),open door angle,posterior shift distance of spinal cord and postoperative complications.Results All patients were followed up for more than 2 years.There were no significant differences in general condition,operation time,intraoperative blood loss,preoperative and postoperative 2 years JOA score,JOA score improvement rate,spinal cord shift distance,spinal cord compression among three groups;In the incidence of C5 nerve root paralysis,there was no significant difference between the silk suspension fixation group (12.1％) and the anchored suspension group (11.9％).The incidence of C5 nerve root paralysis for microplate fixation group (2.1％) was significantly lower than that of the silk suspension fixation group and anchored suspension fixation group,and the difference was statistically significant.There was no significant difference in the fusion rate between the 3-month and 6-month portal arteries in the group of silk suspension fixation group(65％,82％) and anchor fixation group(61％,82％).The fusion rate of the microtiter plate fixation group(90％,98％) was significantly higher than that of the silk suspension group and the anchorage group at 3 months and 6 months after operation.There were no significant differences in the incidence of recurrence,the total amount of cervical spine loss and the incidence of axial symptoms after 6 months of operation in the suspension group and the anchor suspension group.The incidence of occlusion,the total amount of cervical spine loss and the incidence of axial symptoms were significantly lower in the micro titanium plate fixation group than those in the silk suspension group and the anchorage fixation group,the difference was statistically significant.Conclusion Using micro-titanium plate to fix the side of open door could achieve full spinal cord decompression and access to satisfactory neurological improvement rate.At the same time,compared with the traditional silk or anchor suspension,the use of micro-titanium plate is more conducive to the door axis bone healing,prevent the occurrence of reclosing,significantly reduce the loss of postoperative cervical range of motion,and reduce the incidence of axial symptoms with the satisfaction of the clinical outcome.
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Objective To explore the surgical method and effects of posterior expansive open-door laminoplasty extended to C1,2 levels.Methods 16 cervical spinal stenosis patients with cervical myelopathy were posterior cervical surgery in our hospital from February 2013 to September 2015,including 11 males and 5 females;aged 51-76,average 62.8.4 cases merged C1spinal stenosis,the line which operated by C1～7 spinal posterior open-door expansion of the forming with mini titanium fixation;12 cases merged C2 spinal stenosis,which had the operation of C2～7 posterior open-door laminoplasty with Micro Titanium fixation plate.According to the patient imaging data to assess the stability of the cervical spine,and spinal cord compression fixation position before and after their surgery evaluated;the preoperative and postoperative pain using visual analog scale (VAS);application Japanese Orthopaedic Association (JOA) score spinal cord score was used to evaluated spinal cord function,and calculates the rate of improvement of neurological function;surgery patients before and after application Frankel grading was used to evaluate neurological function.Results All patients were followed up,for an average of 11.58 months (2-33 months).16 patients showed no loosening,fracture fixation and related complications,C1,2 showed no instability;cerebrospinal fluid surrounding the spinal cord with in the C1-7 range of the signal on MRI T2WI showed continuous recovery;preoperative VAS score was 6.7 points,postoperative VAS score was 1.8 points;the first 16 cases of patients with preoperative JOA score average (8.3± 1.6) points,postoperative JOA score was (14.6±1.4) points,postoperative neurological improvement rate was 91.6％;Frankel grade C before operation and grade E in postoperation;postoperative follow-up neurological improvement rate excellent 7 cases,good 7 cases,general 2 cases.Conclusion Treatment of cervical spinal stenosis combined with cervical myelopathy may use a C 1-7 posterior spinal expand within the single door molding fixation with mini titanium plate,which can release the compression of the cervical spinal cord nerve and reconstruct a stable structure of posterior of cervical spine.
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Objective To investigate the clinical efficacy and safety of the cytokine-induced killer cells (CIK) treated in patients with advanced pancreatic cancer. Methods 74 cases (hospitalized from January 2012 to December 2013) with advanced pancreatic cancer (Ⅲ ~ Ⅳ stage) were selected. The patients were randomly divided into two groups: CIK cells treated group (38 patients) and chemotherapy group (36 cases). Patients in CIK cells group received CIK cell infusion therapy , and patients in chemotherapy group received only gemcitabine. The efficacy and safety of all patients were observed. Results The efficacy rate of CIK cells group was 29.0%, with no statistical significance compared to chemotherapy alone group (16.7%). Disease control rate was 63.2%, with statistical significance compared to the chemotherapy group (38.9%). The PFS was 3 months (95%CI:2.5 ~ 3.5), OS 6.8 months (95%CI:6.1 ~ 7.5). 6-month survival rate 41.7%, with statistically significance compared to chemotherapy group. Conclusion CIK cells treated in patients with advanced pancreatic cancer is feasible and safe , and can improve disease control rate , improve immunity and produce clinical benefit in patients.
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The clinical data of 186 patients with acute gout attack during upper gastrointestinal bleeding were analyzed retrospectively.The ratio of male to female was 1.7∶1, smokers and alcohol drinkers accounted for 66.1% ( 123/186 ) and 62.4% ( 116/186 ) of patients were had underlying diseases.All patients had different degree of joint painful and fever , the blood uric acid levels were higher.Gastroscopic examinations were performed in 166 patients , of whom 88 cases received endoscopic intervention.The symptoms of gout were improved after treatment with dexamethasone and celecoxib ; and the medication did not induce or increase gastrointestinal bleeding.
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We describe a 58-years-old man with a primary nasopharyngeal carcinoma accompanying erythroderma. His first symptoms were systemic scattered erythema and itching for six months. Lower right cervical lymphadenectasis was found by physical examination. A neoplasm in nasopharynx could be seen with nasal endoscope. The pathology of the neoplasm was non-keratinizing carcinoma. This case illustrates that "erythroderma" could be a paraneoplastic effect of nasopharyngeal carcinoma.
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Humans , Male , Middle Aged , Carcinoma , Dermatitis, Exfoliative , Nasopharyngeal Carcinoma , Nasopharyngeal Neoplasms , Paraneoplastic Endocrine SyndromesABSTRACT
Objective To evaluate the processing line and the range of thoracolumbar (T10-L2) vertebral pedicle channel for vertebral reconstruction.Methods The thoracolumbar vertebrae (T10-L2) of thirty fresh specimens were performed CT scan,slice thickness of 1 mm without interval.Each vertebral body was reconstructed using the software Mimics 10.0 and measured each vertebral body pedicle axis length (L),pedicle length (L0),width (W) and height (H0),vertebral height (H),pedicle entry point in the sagittal plane angle (α) and the pedicle entry point in the cross-section angle (β),and further calculated the volume through vertebral pedicle channel for vertebral reconstruction.Results The average thoracolumbar (T10,T11,T12,L1,and L2) vertebral pedicle axis length was 32.64±5.66,31.80±6.41,38.46±3.52,40.31±4.39,and 42.72±3.36 mm prospectively.The average vertebral pedicle length was 12.38±2.06,11.77±2.15,14.63±2.34,15.46±3.04 and 14.37±1.64 mm.The average pedicle width was 5.09±0.26,5.79±1.10,7.35±1.87,7.17±0.69 and 7.14±0.84 mm.The average pedicle height was 9.76±1.43,10.83±0.77,11.16±0.78,11.33±1.26 and 11.16±0.96 mm.The average vertebral height was 18.12±0.88,19.48±1.02,21.25±1.27,22.88±0.68 and 23.20±0.93 mm.The average α angle was 25.06°±3.84°,30.87°±7.28°,25.12°±5.18°,20.55°±1.54° and 21.74°±2.58°.The average β angle was 43.60°±4.52°,49.48°±10.30°,41.97°±5.19°,40.29°±6.49° and 42.85°±6.47°.The average volume of one side of vertebral body after vertebral reconstruction respectively was 1.02±0.36,1.30±0.43,1.96±0.67,1.84±0.48 and 1.94±0.41 cm3,the corresponding percentage of total vertebral volume was 53.95％,55.68％,52.67％,49.53％ and 48.14％.Conclusion It is possible to use the pedicle channels for vertebral body reconstruction,reduction the end-plates and filling bone graft inside vertebral body.
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This report presented a case of 62-year-old woman who was admitted to our hospital for cirrosis, but she had a variety of clinical manifestations,such as abdominal distension,diarrhea,ascites, hepatosplenomegaly,anemia, palpitation, flushing, low blood pressure, arrhythmia and so on. Upper gastrointestinal endoscopy showed thicken mucosa at gastric fundus. Colonoscopy revealed nodular, pseudopolypoid. Ascitic fluid test suggested a transudate. Endoscopic abnormal mucosa biopsy showed chronic inflammation. Many mast cells were seen in bone marrow and liver biopsies,and liver tissue immunophenotype was CD117, and CD68. Thus the patient's diagnosis was systemic mastocytosis. It is rare that a patient only has the gastrointestinal tract symptoms complicated with ascites without skin lesion. The goal for treatment was to reduce hypersecretion of mast cells.
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Objective To explore the clinical features of ischemic colitis (IC) in elderly patients for improving diagnosis and treatment. Methods The clinical symptoms, physical signs,underlying diseases, colonoscopic features, pathology features, laboratory examination and medical imageology data and prognosis were analyzed retrospectively in 12 patients with IC. Results (91.7%) had underlying diseases. They all had different degrees of abdominal pain, and experienced bloody stools after abdominal pain. Majority of them showed symptoms of nausea, vomiting and diarrhea. Colonoscopy showed that the most common lesions were located in the left colon (91.7%).Endoscopic appearances were edema, congestion and erosion of mucous membrane in colon,submucosal bleeding as well, and the lesion was longitudinal and demarcated with normal areas. The detection of plasma D-dimer and the imageology in all patients were normal. Conclusions IC should be suspected in elderly patients who have related underlying diseases accompanied by acute abdominal pain, hematochezia and gastric emptying symptoms. The early endoscopy is the first choice in the diagnosis of IC. Abdominal CT scan as well as the detection of plasma D-dimer have an important negative predictive value for IC.
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Objective To study the state, feature and risk factors of bacterial infection in patients with liver cirrhosis, find out the influence of infection on prognosis, and provide scientific basis for its prevention and treatment. Methods Three hundred and twenty-three patients with liver cirrhosis were analyzed. The number of the patients with infection, the location of infection, clinical feature as well as the kind of pathogenic bacteria were analyzed. Unconditional Logistic regression analysis was used to assess the risk factors of bacterial infection. Results The overall infection rate was 39.94% (129/323),of which community acquired infection rate and nosocomial infection rate were 22.60% (73/323) and 17.34%(56/323) respectively. The most common location of infection in turn were respiratory tract,gastrointestinal tract, urinary tract,biliary tract and abdominal cavity. The main pathogenic bacteria was Gram-negative bacillus, most of which had drug resistance for cefquinome and quinolones. The risk factors related with bacterial infection included liver cancer, Child-Pugh class B and C grade of liver function, gastrointestinal tract bleeding, diabetes mellitus,invasive operations and the length of staying in hospital. Conclusions The incidence rate of infection in patients with liver cirrhosis is higher. Multiple factors are likely to affect the incidence rate of infection in patients with liver cirrhosis.