The preliminary clinical study about the effectiveness of selective treatment for traumatic cervical disc herniation with stand alone RIO-C / 中国骨伤

<p><b>OBJECTIVE</b>To discuss the efficacy of a new double plate self locking interbody fusion device(ROI-C) in the anterior cervical discectomy and fusion(ACDF) to treat traumatic cervical disc herniation(TCDH) without segmental instability, fracture or dislocation.</p><p><b>METHODS</b>ACDF with stand alone ROI-C was performed in 17 selective TCDH patients between December 2011 and December 2013. There were 12 males and 5 females, aged from 24 to 41 years old with a mean of 32.9 years, including 11 patients with single segment, 4 patients with double segments and 2 patients with three segments. Japanese Orthopaedics Assiciation (JOA), visual analogue scale(VAS) score and the Neck Disability Index(NDI) were recorded before and after operation in order to evaluate the clinical outcome, meanwhile, the preoperative and postoperative X ray films were collected to measure the intervertebral space height and whole cervical curvature. According to Vaccraro criteria to observe the bone fusion. The clinical effects were assessed according to Odom criteria.</p><p><b>RESULTS</b>All patients were followed up from 12 to 33 months with an average of 18.5 months. JOA score was increased significantly from preoperative 4.3±3.8 to 13.9±2.5 at final follow up (<0.05). VAS, NDI were decreased from preoperative (6.5±2.2) scores and (38.2±11.7) % to (1.0±0.9) scores and (8.7±3.4) % in final follow up, respectively (<0.05). Intervertebral space height and cervical curvature were increased from preoperative (5.2±1.7) mm and (5.1±7.5) ° to (7.8±0.6) mm and (10.5±5.1) °, respectively(<0.05). Hoarseness occurred in one patient and dysphagia occurred in 2 patients and they recovered spontaneously in 2 weeks and 3 months after operation, respectively. All the segments (25 levels) of the 17 cases achieved bony fusion in 6 months after operation. No displacement, subsidence and failure of ROI-C were found during follow up. According to Odom's criteria to evaluate clinical effects at the last follow up, 13 cases got excellent results, 3 good, and 1 fair.</p><p><b>CONCLUSIONS</b>ACDF with stand alone ROI-C is an effective, minimally invasive and reliable method in treating TCDH without segmental instability, fracture or dislocation, it can obtain satisfactory clinical outcomes and has advantage of less complications, high fusion rate.</p>

Comparison of two approaches for the treatment of distal radius fractures / 中国骨伤

<p><b>OBJECTIVE</b>To discuss the effective operative approach for the treatment of distal radius fractures.</p><p><b>METHODS</b>From March 2003 to April 2010,107 patients with distal radius fractures suffered internal fixation with locking compression plate (LCP). There were 48 males and 59 females with an average age of 51.27 years (ranged, 23 to 79). Of them, with directed volar approach was in 55 cases and Henry approach was in 52 cases. Surgical feature, fractured exposure time, operative time, median nerve complication, repair rate of the musculus pronator quadratus were compared between the two groups. Gartland-Werley wrist score (GW score), range of motion of wrist joint, grasp force and imageology score were observed in two groups at the first year after operation.</p><p><b>RESULTS</b>The average fractured exposure time in directed volar approach group and Henry approach group was (21.18 +/- 1.69) min and (12.56 +/- 1.35) min,operative time was (89.90 +/- 4.86) min and (61.58 +/- 4.37) min, postoperative median nerve irritation rate was 34.55% and 5.77%, and repair rate of the musculus pronator quadratus was 52.73% and 100%,respectively;there was statistical difference between two groups (P < 0.01). At the one-year after operation, GW score was 3.25 +/- 2.29,and with rate of excellent and good of 90.91% in directed volar approach group;in Henry approach group that was 2.92 +/- 2.13 and 92.31%, respectively; there was no statistical difference between two groups (P > 0.05). There was no statistical difference in range of motion of wrist joint, grasp force and imageology score between two groups (P > 0.05).</p><p><b>CONCLUSION</b>Henry approach can obtain the same operative result compared with directed volar approach in treating distal radius fractures. Henry approach has advantage of simple anatomy,easy operation,better repair rate of the the musculus pronator quadratus and lower postoperative median nerve complication,which should be used preferentially to treat distal radius fractures.</p>

[Forensic application of brainstem auditory evoked potential in patients with brain concussion].

OBJECTIVE: To investigate changes of brainstem auditory evoked potential (BAEP) in patients with brain concussion. METHODS: Nineteen patients with brain concussion were studied with BAEP examination. The data was compared to the healthy persons reported in literatures. RESULTS: The abnormal rate of BAEP for patients with brain concussion was 89.5%. There was a statistically significant difference between the abnormal rate of patients and that of healthy persons (P<0.05). The abnormal rate of BAEP in the brainstem pathway for patients with brain concussion was 73.7%, indicating dysfunction of the brainstem in those patients. CONCLUSION: BAEP might be helpful in forensic diagnosis of brain concussion.

Treatment by limited-incision for posterior edge separation of lumbar vertebral body / 中国骨伤

<p><b>OBJECTIVE</b>To discuss effective operative method for posterior edge separation of lumbar vertebral body.</p><p><b>METHODS</b>Twelve cases of posterior edge separation of lumbar vertebral body were categorized as lateral type and central type, and were operated upon with limited-incision using lamina retractor. All patients were male and with an average age of 30 years (range, 23 to 40 years). The average history of disease was 17.9 months. In lateral type cases, separation bone was in the posterolateral lower edge of L4 vertebral body in 1 case, in the posterolateral upper edge of L5 vertebral body in 3 cases and in the posterolateral upper border of S1 vertebral body in 6 cases, all with ipsilateral disc herniation. Lateral type cases were treated with unilateral fenestration and removal of disc nucleus and posterior bony edge. Separation bone was in the central upper edge of S1 vertebral body with central disc herniation in 2 central type cases. Two central type cases were treated with bilateral fenestration and removal of disc nucleus and posterior bony edge.</p><p><b>RESULTS</b>All patients were followed up for 12 to 36 months, and the average follow-up was 22.5 months. According to Macnab postoperative evaluation criterion, the results were excellent in 10 cases, good in 2 cases.</p><p><b>CONCLUSION</b>Limited-incision for posterior edge separation of lumbar vertebral body has characteristic of less trauma and convenience. It is an effective method for removal posterior bony edge.</p>

[Epidemiological research and analysis on the impaired person in road traffic accident in Chengdu area].

OBJECTIVE: To analyze epidemiological characteristics of road traffic accidents that resulted in injuries in Chengdu area, to find out the cause and to provide scientific a base for accident prevention. METHODS: Appraisal data of the injured in road traffic accident from January 2003 to October 2006 were re-examined. Detailed statistics were made which include gender, age, transportation mode, person types, the accident date and day, and location. RESULTS: Six thousand three hundred and sixty four cases involving road traffic accident were analyzed. Among the injured, male to female ratio was 1.84:1, and the age group of 18-50 were the largest proportion (66.34%). Bicyclists, motorcyclists and pedestrians made up 80.90% of the injured persons. Different age groups, different genders and those who were injured in different regions varied greatly in terms of transport modes they employed. In terms of injured parts, lower limb injury took up the highest proportion (39.49%), with cranium & cerebrum ranking second (22.77%). CONCLUSION: Different approaches and measures shall be taken in regard to different age groups, different regions, different times and different transport modes, and corresponding policies shall be adopted.

[Analysis on body impairment assessment upon 447 thoracolumbar, spinal injury cases in traffic accidents].

OBJECTIVE: To discuss the relation between degree of body impairment and that of thoracolumbar spinal injuries resulting from road traffic accidents, and sum up the experiences in body impairment assessment and its regularity. METHODS: For comprehensive body impairment assessment, 477 cases of thoracolumbar spinal injuries in road accidents have been sorted out, reassessed and rediagnosed. In addition, analyses have been undertaken about their treatment, the assessment of the degree of their thoracolumbar dysfunction,nerve dysfunction and the relations between injuries and sequelaes. RESULTS: The analyses show that the degree of thoracolumbar dysfunction and that of the post-injury nerve dysfunction don't necessarily depend on the quantity and degree of spinal injuries. However, the position suffering from the thoracolumbar spinal injuries has an immense impact on the thoracolumbar dysfunction, and the nerve impairment result mainly from the T1-1L spinal injuries. The research also shows that there has been a high misdiagnosis rate in hospital about the spinal injuries. CONCLUSION: In body impairment assessment, the cause and effect relations between the injury and degree of injury extent should be analyzed, the injury extent should be employed as principal evidence, and the degree of spinal dysfunction should be taken into greater consideration.