Objective To investigate the cl inical effect of cervical artificial disc replacement (CADR) on twosegment cervical spondylosis and to research its influences on the range of motion (ROM) of the diseased segments and theadjacent superior and inferior segments. Methods From September 2004 to February 2007, 7 cases with cervical spondylosis at C4,5 and C5,6 were treated with CADR using Bryan artificial disc prosthesis, including 4 males and 3 females aged 30-45 years old (average 38.5 years old). All the patients had cervicodynia in various degrees, pain and numbness of l imbs and decreased muscle strength, including 3 cases of cervical spondylotic radiculopathy, 3 of cervical spondylotic myelopathy and 1 of mixed cervical spondylosis. The course of disease was 12-54 months (average 27 months). Preoperatively, X-ray films revealed the intervertebral space of C4, 5 and C5,6 was narrowed and the cervical curve became straight, CT or MRI showed the intervertebral disk hernia of C4, 5 and C5,6, and the hyperostosis of vertebral margin compressed nerve root or spinal cord. All the patients had no response to the preopratively conservative treatment. JOA score and ROM of the diseased segments and the adjacent superior and inferior segments were compared before and after operation. Results All the patients survived the perioperative period, without hoarse voice, muscle spasm, dysphagia and cervicodynia. X-ray films showed the implanted prosthesis was well located, the height of intervertebral space was normal, and no prosthesis loosening, prosthesis migration and infection occurred 12 months after operation. All the 7 cases were followed up for 12-41 months (average 26.7 months). Cervicodynia and l imbs’pain and numbness disappeared, and muscle strength was improved obviously. The JOA score before and during the followup period was (8.35 ± 1.27) and (14.65 ± 1.61) points, respectively, indicating there was a significant difference (P lt; 0.05). For the ROM of C4,5 and C5,6, it was (8.38 ± 0.48)° and (9.16 ± 0.54)° before operation, respectively, and it increased to (11.15 ± 0.65)° and (12.75 ± 0.73)° after operation, respectively, showing there was a significant difference (P lt; 0.05). The ROM at C3,4 and C6,7 before operation was (9.71 ± 0.76)° and (12.39 ± 0.58)°, espectively, while it was improved to (10.26 ± 0.47)° and (13.67 ± 0.71)° after operation, respectively, indicating there were no significant differences between before and after operation (P gt; 0.05). Conclusion The appl ication of Bryan Disc CADR for two-segment cervical spondylosis has satisfying therapeutic effects, can improve the ROM of diseased segments obviously, and has minor influences on the ROM of adjacent superior and inferior segment.
Objective To investigate the method and effectiveness of V-U-shaped flaps in repairing soft tissue defect of the fingertip. Methods Between January 2006 and February 2011, 47 patients (55 fingers) with soft tissue defect of fingertip were treated by using the V-U-shaped flaps. There were 25 males and 22 females, aged 18 to 35 years (mean, 26 years). The injury was caused by cuts in 21 cases and avulsion in 26 cases. The time between injury and admission was 1 to 6hours with an average of 2.6 hours. The injured fingers included thumb (18 fingers), index finger (10 fingers), middle finger (10 fingers), ring finger (9 fingers), and l ittle finger (8 fingers). Forty-one fingers had skin avulsion of the distal interphalangeal joint with phalanx exposure, and 14 fingers had distal dactylopodite defect and second phalanx exposure. The size of wound ranged from 1.1 cm × 1.0 cm to 1.9 cm × 1.7 cm. The time between injury and first-stage operation was 2 to 7 hours with an average of 5 hours. In the first-stage operation, the pedicled flap was used to repair the defect of dactylopodite. Then at 3 weeks after the first-stage operation, one U-shaped flap and two V-shaped flaps were prepared to cover defect of the fingertips in the second-stage operation. Results At 2 days after the second-stage operation, congestion and bl isters occurred in 5 fingers, and were improved after symptomatic treatment. The other flaps survived, and wounds healed by first intention. Incisions at the donor site healed primarily. After the second-stage operation, 42 cases (50 fingers) were followed up 6 to 12 months (mean, 8.9 months). The appearance, texture, and color of the flaps were similar to normal skin. Injured fingers had tactile, pain, and thalposis, and the two point discrimination was 5-8 mm. At last follow-up, according to the functional assessment standards by the Chinese Medical Association Society of Hand Surgery of the upper l imbs, the results were excellent in 46 fingers and good in 4 fingers. Conclusion V-U-shaped flaps can be considered as an ideal method to repair soft tissue defect of the fingertip because of good appearance and function recovery.