Predictive value of post-operative neutrophil/lymphocyte count ratio for surgical site infection in patients following posterior lumbar spinal surgery.

OBJECTIVE: Surgical site infection (SSI) is a common complication in patients following posterior lumbar spinal surgery. Various laboratory data such as laboratory parameters derived neutrophil/lymphocyte count ratio (NLR), have been applied for the prediction of SSI, but more studies are necessary to evaluate the significance of these indicators. Here, our study aims to investigate the predictive value of total white blood cells (WBCs), count and percentages of neutrophils and leukocytes, NLR, and C-reactive protein (CRP) for surgical site infection (SSI) in patients after posterior lumbar spinal surgery. METHODS: A total of 293 patients who underwent posterior lumbar spinal surgery were enrolled in this study. Each patient's medical history was retrospectively reviewed, and patients were divided into the deep SSI group (n = 13) and the non-SSI group (n = 280). Laboratory data including total WBC, count and percentages of neutrophils and leukocytes, NLR at 1 week before the operation and the 4 and 7 days post-operation, and CRP at 4 and 7 days post-operation were analysed between the SSI and non-SSI groups. Moreover, predictive power and cut-off of NLR for SSI were determined by receiver operating characteristic curve (ROC) results. RESULTS: Data revealed that the medians of NLR were markedly increased in the SSI group as compared to that in non-SSI group at 4 days (p = 0.011) and 7 days (p = 0.047) post-operation. Moreover, the neutrophil percentage was also dramatically increased in the SSI group at both 4 and 7 days post-operation (p = 0.010 and p = 0.030) respectively compared to the non-SSI group. However, no significant difference was observed between the groups 1 week before the operation. ROC results showed that NLR at 4 days (cut-off >5.19; sensitivity: 61.5%; specificity: 77.6%; AUC = 0.708) and 7 days (cut-off >3.85; sensitivity: 69.2%; specificity: 62.7%; AUC = 0.663) post-operation could significantly discriminate the SSI and non-SSI groups. Logistic regression analysis showed that NLR at both post-operative time points (OR = 1.218; p = 0.003 and OR = 1.296; p = 0.048) could be valuable predictors for SSI. CONCLUSION: NLR at 4 and 7 days post-operation are valuable laboratory predictors for SSI in patients with posterior lumbar spinal surgery.

[Progress in diagnosis and therapy of thoracic outlet syndrome].

Thoracic outlet syndrome(TOS) are constellation of symptoms caused by compression of the neurovascular bundle including the brachial plexus, the subclavian artery and the subclavian vein at the thoracic outlet region. It includes neurogenic TOS, venus TOS, arterial TOS, and neurogenic TOS is the most common type. TOS has varied manifestations and lack of confirmatory testing, therefore, the diagnosis should be conbination with thorough history, physical examination and associated supplementary examinations. Conservative and surgical treatment can be choosed for TOS and the outcomes are generally good. Conservative management is the initial treatment strategy for neurogenic TOS. In cases of symptomatic vascular TOS and neurovascular TOS, which has been failed by conservative treatment, surgery should be considered more promptly.

A reduction clamp for an aiming component in associated acetabular fractures.

BACKGROUND: The treatment of acetabular fractures is complex and requires specialized equipment. However, all currently available instruments have some disadvantages. A new reduction clamp that can firmly enable reduction and not hinder subsequent fixation procedures for some special fracture types is needed. MATERIALS AND METHODS: In this study, we introduce a new acetabular clamp and its preliminary clinical application in three T-shaped acetabular fractures. RESULTS: This new clamp can successfully pull the posterior column back to the anterior column and firmly maintain the reduction. This clamp's aiming plate can facilitate the insertion of long lag screws. The clamp is also easy to assemble and use. CONCLUSION: This reduction clamp is a useful instrument that can facilitate open reduction and internal fixation of acetabular fractures.

[Comparative study of two operation methods on complicated fractures of the distal radius and ulna].

OBJECTIVE: To compare the differences between external fixator and volar T-shaped plate in the treatment of complicated fractures of the distal radius and ulna, and evaluate the appropriate operation method for the fractures. METHODS: From July 2005 to July 2007, forty-eight cases of complicated fractures of the distal radius and ulna were treated with operation. There were 21 males and 9 females in the internal fixator group, ranged from 22 to 52 years old (with an average of 38.4 +/- 1.5 years). There were 10 mals and 8 femals in the external fixator group,ranged from 25 to 56 years old (with an average of 40.5 +/- 2.3 years). The X-ray films were measured to acquire radial length, palmar tilt and radial inclination after operations. The functional evaluation were scored with a modified Gartland and Werley's (GW) scoring system at 6 and 12 months after operation. RESULTS: The patients were followed up for 12 to 18 months with an average of 14.2 months. The radial length was (8.82 +/- 0.55) mm, palmar tilt (9.23 +/- 0.86) degrees, radial inclination (19.66 +/- 1.38) degrees in the internal fixator group, while those were (8.25 +/- 0.36) mm, (8.56 +/- 0.72) degrees, (18.82 +/- 1.42) degrees in the external fixator group. The film parameter of internal fixator group was better than the external fixator group, but with no statistical significance (P > 0.05). In the internal fixator group, 16 cases obtained excellent, 7 good, 5 fair, 2 poor, while in the external fixator group, 4 cases obtained excellent, 2 good, 8 fair, 4 poor in 6 months. The GW scores of internal fixator group were lower than that of the external fixator group (P < 0.05). At 12 months after surgery, in the internal fixator group, 17 cases obtained excellent, 7 good, 5 fair, 1 poor; while in the external fixator group, 5 cases obtained excellent, 9 good, 2 fair, 2 poor. The GW score was similar between the two groups (P > 0.05). CONCLUSION: The volar T-shaped plate fixation may offer effective stability,the short-term outcome is better than the external fixator group,and there are relatively fewer complications. But the treatment outcome of the two operation methods are similar for the long time follow up.

[Study on expression of mkp-1 and P-ERK in acutecontusive spinal cord injury rat's model].

To observe the expression of mitogen activated protein kinase phosphatase-1 (MKP-1) and phosphorylation of extracellular signal-regulated kinases (P-ERK) of spinal cord in acute contusive spinal cord injury model, 20 Sprague Dawley rats were divided into two groups at random, Ten rats' spinal cord contusive injuries were produced by using modified Allen's method (using a weight-drop device) after the T10 spinous process and the corresponding vertebral lamina were removed as experimental group. The rest 10 rats received only T10 laminectomies and didn't injury the spinal cord as Sham-operated control group. The injury spinal cord was carried out respectively in two groups at 12h after injury. Pathological alterations were detected by H-E stain. The expression of MKP-1 and P-ERK were analyzed by immunohistochemistry and Western blot analysis. In Sham-operated control group, the micro structure of spinal cord was normal. The pathological alterations were very apparent in the damaged spinal cord area in the experiment group. We also found MKP-1 expression of spinal cord was decreased while P-ERK was increased in experimental group when compared with Sham-operated control group (P<0.01). The results suggested that acute contusive spinal cord injury down-regulated the expression of MKP-1 and up-regulated the PERK, which might play a role in the pathophysiological of spinal cord injury.