Objective To investigate the influence of spinal cord decompression on posterior surgical treatment of thoracolumbar fracture, and to provide the practical basis for the indications of posterior spinal cord decompression Methods The cl inical data were retrospectively analyzed from 170 cases of thoracolumbar fracture treated with posterior surgical treatment between January 2005 and January 2009. There were 119 males and 51 females with an average age of42.7 years (range, 17-68 years). The fracture locations included T11 in 22 cases, T12 in 30 cases, L1 in 57 cases, and L2 in 61 cases. According to Denis classification system, there were 65 cases of compression fractures, 44 cases of burst fractures, 25 cases of flexion-distraction injuries, and 36 cases of fracture-dislocations. The time from injury to operation was 3-8 days (mean, 4.4 days). All the cases were divided into 4 groups according to space-occupying rates of spinal cord: group A, ≤20% (n=32); group B, 21%-40% (n=68); group C, 41%-60% (n=37); and group D, ≥ 61% (n=33). Through statistical analysis, the correlation between space-occupying rates and spinal cord function (Frankel grade) was evaluated, and the necessities of spinal cord decompression was studied in the patients who had neurological symptoms with space-occupying rates under 40%. Results There was no positive correlation between the degree of spinal cord injury and the space-occupying rates of bone fragments broken into the spinal canal. All patients were followed up 13-41 months (mean, 23.5 months). During the follow-up period, no secondary neurological damage occurred in the patients who were not given posterior spinal cord decompression with space-occupying rates under 40% (28 cases). And also in the cohort of patients with neurological symptoms whose space-occupying rates were under 40%, the posterior spinal cord decompression (65 cases) could improve the spinal cord function significantly when compared with no decompression cohort (7 cases), (P lt; 0.05). Conclusion The relative indications of posterior spinal cord decompression for thoracolumbar fracture are as follows: the cases having neurological symptoms with space-occupying rates under 40% and the ones having the neurological symptoms or not with space-occupying rates above 40%.
Objective To investigate the operative procedure and the short-term therapeutic effects of medial plantar venous flaps for estoration of soft-tissue defects on the volar aspect of fingers. Methods From May 2007 to July 2009, 13 cases (15 fingers) of volar soft tissue defects were treated with medial plantar venous flaps, including 7 males (9 fingers) and 6 females(6 fingers) with an average age of 30 years (range, 17-55 years). Soft tissue defects were caused by electric saws in 4 cases (5 fingers), by crush injury in 6 cases (6 fingers), and by burned scar removal in 3 cases (4 fingers). The size of soft tissue defects ranged from 1.0 cm × 0.9 cm to 5.8 cm × 3.3 cm, included 5 thumbs, 3 index fingers, 3 l ittle fingers, 2 ring fingers, and 2 middle fingers. The emergency surgical treatment was performed in 10 traumatic cases after 2 to 12 hours (4 hours on average); and the elective surgical treatment was performed in the other 3 cases of scar after burn. The 15 medial plantar venous flaps, with size of 1.0 cm × 1.0 cm to 6.0 cm × 3.5 cm, were harvested to restore defects. Of them, 12 venous flaps had 1 superficial vein and the other 3 had 2 veins; and the veins of 13 venous flaps bridged a single digital artery and the veins of the other 2 flaps bridged both arteries. The donor sites were sutured directly or were covered with skin graft. Results All 15 venous flaps survived completely, and the donor and reci pient sites healed by first intention. Eleven cases (11 fingers) were followed up for 2 to 12 months. The texture and color of the flaps were similar to those of adjacent normal skin with a satisfactory appearance. The two-point discrimination was 6-9 mm. According to criterion for joint junction of total active range of motion/total active range of flexion, the results were excellent in 10 cases and good in 1 case; the excellent and good rate was 100%. Conclusion The medial plantar venous flap has advantages of easy-to-operate, rich blood supply and high survival rate. So it is an ideal and rel iable choice for volar soft tissue defects of fingers.
Objective To explore the effects of Neurogenesin 1 (Ng1) gene on functional recovery after spinal cord injury (SCI) and its mechanism. Methods Thirty-six rats (aging 4 months, weighing 230 g and being male or female), were randomly divided into two groups: experimental group (n=18) and control group (n=18). After spinal cord contusive injury at T10 level was made in all these rats using modified Allen’s method, Ng1 recombinant plasmid and blank plasmid were transfectedinto the damaged areas of exprimental group and control group respectively by Alzet pumps. At 1 day, 1 week, 2 weeks, 3 weeks, and 4 weeks after SCI, Basso-Beattle-Bresnahan (BBB) Rating Scale was used to observe the recovery of motor function. At 1 week after injury, the expressions of Ng1 mRNA and protein in injured spinal cord were detected by RT-PCR and Western blot techniques. And at 2 and 4 weeks, double immunofluorescence and histopathologic examinations were performed to study the prol iferation of the adult endogenous neural stem cells and pathological change after SCI. Results At 1-4 weeks after SCI, the BBB scores in the exprimental group was significantly higher than that in control group (P lt; 0.05), and at 4 weeks the BBB score of the experimental group (16.80 ± 1.79) was significantly higher than that of the control group (9.60 ± 1.67), (P lt; 0.01). RTPCR and Western blot showed that the mRNA and protein expressions of Ng1 were observed in the exprimental group and no expression was seen in the control group. Histologic observation showed that the morphology of spinal cord and neurons in the exprimental group was better than that in the control group and was close to the normal tissue. The mean number of Nestin+/ BrdU+ newborn endogenous neural stem cells in the exprimental group was significantly more than that in control group (P lt; 0.05). Conclusion Ng1 gene could promote the prol iferation of endogenous neural stem cells and protect the injured neurons, which enhances the repair of the motor function after SCI.
目的 探讨缝合治疗在膝关节内侧半月板桶柄状撕裂中的应用及效果。 方法 对2010年6月－2012年7月18例膝关节内侧半月板桶柄状撕裂患者，采用多种缝合材料、缝合方式相结合的方法予以救治。 结果 18例患者术后即时MRI均显示内侧半月板位置、形态恢复良好。随访12～26个月，所有患者膝关节活动度均正常，Lysholm评分术前（45.0 ± 3.5）分，术后末次随访（93.0 ± 5.1）分，差异有统计学意义（t=2.064，P＜0.05）；国际膝关节文献委员会膝关节评估表评分，术前（49.0 ± 1.5）分，术后（92.0 ± 3.6）分，差异有统计学意义（t=2.205，P＜0.05）；无膝关节疼痛，麦氏试验阴性，术后MRI显示内侧半月板愈合良好。 结论 采用缝合方法可挽救内侧半月板桶柄状撕裂，恢复半月板稳定性及正常功能。
Objective To evaluate the effect of laparoscopic splenectomy （LS） and open splenectomy （OS） forhypersplenism secondary to liver cirrhosis with portal hypertension. Methods Cochrane Central Register of Controlled Trials， Cochrane Database of Systematic Reviews， Medline， Embase， CINAHL， CBM， CNKI， VIP and WanFang database were searched for randomized control trials or retrospective studies related to the effect of LS and OS for hyper-splenism secondary to liver cirrhosis with portal hypertension. Then studies were screened according to the inclusion and exclusion criterias， data were collected， and quality of studies were evaluated. RevMan 5.1.0 software was used for meta-analysis. Results Seventeen retrospective studies and one randomized control trial were enrolled. The results of meta analysis showed that， the estimated blood loss， postoperative hospital stay， rate of postoperative complication， and WBC level on 1 day after operation of LS group were significantly lower or shorter than those of OS group （P＜0.05）. However， there were no significant differences on operative time， WBC level on 7 days after operation， postoperative platelets （1 day and 7 days after operation）， alanine aminotransferase （1 day and 7 days after operation）， and total bilirubin （1 day and 7 days after operation） between LS group and OS group （P＞0.05）. Conclusions LS may be more effective to reduce blood loss， postoperative hospital stay， and rate of postoperative complication in patients with hypersplenism secondary to liver cirrhosis with portal hypertension in comparison to OS. However， the effectiveness of LS on liver function is not clear.
ObjectiveTo investigate the effects of telomerase reverse transcriptase (TERT) promoter mutation and TERT mRNA expression on the prognosis of patients with hepatocellular carcinoma (HCC) after radical resection, and the clinicopathological factors affecting the prognosis of patients with HCC after radical resection were explored.MethodsClinical data of 212 HCC patients underwent radical resection from Jan. 2009 to Jan. 2016 in The Affiliated Cancer Hospital of University of Electronic Science and Technology of China were selected and analyzed. The mutations of TERT, TP53, and catenin beta 1 (CTNNB1) were detected by Sanger sequencing, and the expression of TERT mRNA was detected by SYBR. Patients were followed up routinely and their overall survival (OS) and disease-free survival (DFS) were recorded.ResultsThe mutation rates of the TERT promoter, TP53, and CTNNB1 gene were 17.9% (38/212), 40.1% (85/212), and 13.7% (29/212), respectively. The TERT promoter mutation had significant correlation with Child-Pugh classification and preoperative albumin value (P<0.05). Expression level of TERT mRNA had significant correlation with HBV infection, Child-Pugh classification, preoperative AST value and ALT value (P<0.05). Cox proportional hazards regression result showed that anatomical hepatectomy, tumor diameter>5 cm, and high expression of TERT mRNA were significant prognostic factors of OS (P<0.05); preoperative platelets count≤100×109/L, tumor diameter>5 cm, and high expression of TERT mRNA were significant prognostic factors of DFS (P<0.05).ConclusionFor patients after HCC surgery, high expression of TERT mRNA may be a key factor affecting the prognosis of HCC patients.