To evaluate the safety and efficacy of one-level posterior lumbar interbody fusion(PLIF) combined with Prospace and facet fusion using local autograft. Methods Clinical and radiographic data of 76 patients treated by this technique was reviewed from May 2002 to December 2004. Of them, there were 52 males and 24 females, with an average age of 53.2 years (2381 years), including 60 cases of degenerative disc disease, 9 cases of failed back surgery syndrome and 3 cases of spondylolysis. The disese courses were 1.2-8.7 years (mean 3.6 years). The levels of PLIF were:L 2,3 in 2 cases, L 3,4 in 7, L 4,5 in 54, L 5/S 1 in 10, L 4/S 1 in 1 and L 5,6 in 2. After decompression，Prospace was inserted into interbody space bilaterally，and located in disc space 4 mm beyond the rear edge ofthe vertebral body. Local laminectomy autograft was packed both laterally into and between 2 implants. Then the remanent local autograft was placed over facet bed. Pedicle screws were used after insertion of Prospace. Clinical results wereevaluated by the JOA score. Disc height ratio and lumbar lordosis angles were measured on lateral radiographs. Fusion status was determined by evidence of bridge trabeculae across facet joint and interbody space on CT scan without mobility in lateral dynamic X-rays, and no radiolucent gap between Prospace and endplate. Paired t test was used for statistical analysis. Results Mean blood loss and operative time was 384 ml and 178 minutes, respectively. The average JOA score at final follow-up (26.1±2.7) was significantly improved when compared with that of preoperation (14.5±4.0, P＜0.05), with a mean recovery rate of JOA score 81.1% (37.5%-100.0%). The fusion rate was 974%(74/76). Mean disc height ratio and the involved segmental lordosis angle were increased from preoperative 0.27± 0.07 and 5.8±2.2° to 0.33±0.06 and 11.3±2.0° respectively at the final followup, and the differences were significant (P＜0.05). There were no devicerelated complications. Conclusion This surgical technique combined with Prospace interbody device is a safe and effective surgical option for patients with onelevel lumbar disorders when PLIF is warranted.
Objective To review the research progress of midfacial fat compartments, and to thoroughly understand its current state of the anatomy and the aging morphologic characters of midfacial fat compartments, as well as the current status of clinical applications. Methods The recent literature concerning the midfacial fat compartments and related clinical applications were extensively reviewed and analyzed. Results Midfacial fat layer has been considered as a fusion and a continuous layer, experiencing a global atrophy when aging. As more anatomical researches have done, recent studies have shown that midfacial fat layer is broadly divided into superficial and deep layers, which are both divided into different fat compartments by fascia, ligaments, or muscles. Midfacial fat compartments tend to atrophy with age, specifically in the deep fat compartments while hypertrophy in the superficial fat compartments. Clinical applications show that fat volumetric restoration with deep medial cheek fat and Ristow’s space can restore the appearance of midface effectively. Conclusion In recent years, the researches of midfacial fat compartments have achieved obvious progress, which will provide new ideas and basis for fat volumetric restoration. Corresponding treatments are selected based on different sites and different layers with different aging changes, reshaping a more youthful midface.
ObjectiveTo realize the current status and hot issues in the field of gastric cancer imaging research, and to provide references for radiologists and gastrointestinal surgeons to grasp the overall overview of gastric cancer imaging.MethodWe downloaded the relevant literatures of gastric cancer imaging published in 2010–2020 in the Web of Science database, and used Citespace 5.7.R3 software for related visual analysis.ResultsA total of 726 articles in the field of gastric cancer imaging research were retrieved and screened. The number of gastric cancer imaging studies published from 2010 to 2020 was on the rise, with the top three countries published in China, Japan, and the United States. The clusters of co-cited literature on gastric cancer imaging: confocal laser microendoscopy, gastric cancer, gastric mucosal intestinal metaplasia, preoperative T staging, convolutional neural network, deep learning, advanced gastric cancer, in vivo differentiation, early stage gastric cancer, surgical treatment, perigastric lymph nodes, nearest neighbor algorithm, and so on. Hot words in recent research fields included: risk factors, characteristics, deep learning, chemotherapy, and neural networks.ConclusionThe imaging diagnosis of early gastric cancer and the application of artificial intelligence are the research hotspots in this field.
【Abstract】ObjectiveBy using multidetectorrow spiral CT (MDCT), to investigate the CT imaging features of inflammatory diseases in retroperitoneal space with correlation of radiological anatomy.MethodsThe clinical and laboratory dada of 30 patients with proven inflammatory diseases of retroperitoneal space were collected. All patients underwent MDCT plain scanning and portal venous acquisition. CT imaging data generated at portal venous phase were processed with coronal, sagittal and oblique multiplanar reformation (MPR) technique.ResultsAcute pancreatitis and various types of renal infection were the two main sources of retroperitoneal inflammation. Depending on the specific anatomic locations, retroperitoneal inflammation of different subspaces demonstrated characteristic imaging features. Spreading of inflammatory process across subspaces was also quite common.ConclusionMDCT is the imaging method of choice to depict comprehensively and clearly the inflammatory diseases of various retroperitoneal spaces.
Objective To evaluate the effects of different inspiratory flow waveforms on the respiratory function of patients with severe exacerbation of asthma during mechanical ventilation. Methods Twenty-one patients with severe exacerbation of asthma were ventilated with square waveform and decelerating waveform respectively for 30 minutes when the tidal volume was set at 6 mL/ kg, 8 mL/ kg and 10 mL/ kg in ICUof Zhejiang Hospital of Integrated Traditional Chinese and Western Medicine fromJanuary 2006 to December 2007. Meanwhile shunt fraction ( Q·S /Q·T ) , dead space value ( VD/VT ) , airway peak pressure ( Ppeak ) , plateau pressure ( Pplat) ,intrinsic positive end-expiratory pressure( PEEPi) and arterial blood gas analysis were measured. Results The Q ·S /Q·T in the decelerating waveformgroup was less than that of the square waveform group( P lt;0. 05) when tidal volume was set at 6 mL/ kg. When tidal volume was set at 10 mL/ kg, PEEPi and VD /VT in the decelerating waveform group were higher than those of the square waveform group. On the contrary, the Ppeak was lower than that of square waveform group( P lt; 0. 05) . Conclusion For patients with severe exacerbation of asthma treated with mechanical ventilation, decelerating waveform is preferable at low tidal volume( 6 mL/ kg) , and square waveform is preferable at high tidal volume( 10 mL/kg) .
Objective To assess the predictive value of alveolar dead space fraction ( ADSF) for severity and reperfusion of acute pulmonary embolism( APE) . Methods 39 consecutive patients with APE were enrolled in a perspective study from July 2004 to March 2007. All patients were divided into a large pulmonary embolism group ( LPE) and a small pulmonary embolism group ( SPE) based to the mass and location of the embolus. The patients of the LPE group received thrombolytic therapy and anticoagulation,while the patients of the SPE group received anticoagulation only. CTPA or lung scintigraphy was performed before and after treatment to confirm the resolve condition of the embolism after treatment. Pressure of endexpired carbon dioxide ( PETCO2 ) and blood gas analysis ( including PaCO2 ) were measured at the time of run-in and 30 days after treatment by bedside. ADSF was calculated by PET CO2 and PaCO2 . Results Among 39 APE patients, there were 18 patients in the LPE group, while 21 in the SPE group. The ADSF of the LPE group before treatment were higher than that of the SPE group ( 0. 34 ±0. 078 vs. 0. 18 ±0. 027,P lt;0. 05) . The ADSF decreased significantly after treatment in the patients with full reperfusion ( 0. 09 ±0. 04 vs. 0. 28 ±0. 11, P lt;0. 01) . Conclusion As a bedside test, ADSF can reflect the mass of embolism and the reperfusion condition, and is useful in monitoring the disease.
Abstract： Objective To investigate the change of tissue structure and epithelial barrier function of excluded esophagus after esophageal exclusion surgery for tracheoesophageal fistula (TEF). Methods Twentyeight hybrid dogs were divided into 3 groups with random number method. For group A (n=12), fistula was excluded; for group B (n=12), only the esophagus was excluded; and group C (n=4) was the control group. The normal and excluded esophagus of the three groups were observed through general sampling, HE staining, transmission electron microscope (TEM), scanning electron microscope (SEM) and Lanthanum trace labeling. The interstitial space dilation (ISD) of the cells on the esophageal mucosa was measured and the number of desmosome in the intercellular space was calculated. Results The changes of tissue structure and epithelial barrier function of the excluded esophagus were similar between group A and group B. Compared with group C, group A and B showed the following changes: esophageal structure changed, submucous glandular tissues reduced or disappeared; the interstitial space increased, the number of desmosome decreased, and the epithelial barrier function attenuated, but the basal lamina did not changed and lanthanum did not break through it. For the dogs in group C, esophageal mucosa could be observed, submucosa was complete and a large number of gland tissues and micrangiums could be seen in it. The number of desmosome for group A, B and C was 0.21±0.03 entries/μm2, 0.22±0.05 entries/μm2, and 0.32±0.03 entries/μm2 respectively, which showed a significant difference between group A, B and group C (Plt;0.05), while there was no significant difference between group A and group B (Plt;0.05). The average interstitial space for group A, B and C was 2.11±0.56 μm, 2.04±0.77 μm, and 1.84±0.49 μm respectively. There was no significant difference between group A and B, while there was significant difference between group A, B and group C. Conclusion The esophageal exclusion surgery for refractory TEF is safe, feasible, and effective with few complications, and deserved to be popularized.
Objective To investigate the effectiveness of two-stage revision of infected total knee arthroplasty (TKA) using an antibiotic-impregnated articulating cement spacer. Methods The clinical data were analyzed from 23 patients (23 knees) undergoing two-stage revision for late infection after primary TKA between January 2007 and December 2009. There were 15 males and 8 females, aged from 43 to 75 years (mean, 65.2 years). Infection occurred at 13-52 months (mean, 17.3 months) after TKA. The time interval between infection and admission ranged from 15 days to 7 months (mean, 2.1 months). One-stage operation included surgical debridement and removal of all knee prosthesis and cement, then an antibiotic-impregnated articulating cement spacer was implanted. The re-implantation of prosthesis was performed after 8-10 weeks when infections were controlled. The American Hospital for Special Surgery (HSS) score and Knee Society Score (KSS) were used to compare the function of the knee between pre- and post-revision. The rate of infection control and complication were analyzed. Results All incisions healed primarily. Re-infection occurred in 2 cases after two-stage revision, and infection was controlled in the other 21 cases, with an infection control rate of 91.3%. The patients were followed up 2-5 years (mean, 3.6 years). The HSS score was increased from 60.6 ± 9.8 at pre-revision to 82.3 ± 7.4 at last follow-up, the KSS score was increased from 110.7 ± 9.6 at pre-revision to 134.0 ± 10.5 at last follow-up, all showing significant differences (P lt; 0.01). Radiographs showed that prosthesis had good position with no loosening, fracture, or periprosthetic radiolucent. Conclusion Two-stage revision using an antibiotic-impregnated articulating cement spacer is an effective method to control infected TKA and to restore the function of affected knee.
Objective To investigate the effectiveness of repairing severe cicatricial contracture deformity in the web-space by kite-like incision combined with full-thickness skin grafting. Methods Between June 2008 and September 2011, 31 patients (87 web-spaces) with severe cicatricial contracture deformities in the web-spaces were treated. There were 24 males and 7 females, aged 5-43 years (median, 22 years). The causes of injuries were flame burn (26 cases), scald (3 cases), electric arc burn (1 case), and chemical burn (1 case). The degree of burn was deep second degree (14 cases) and third degree (17 cases). The interval time from injury to operation was 10 months to 17 years (median, 2.2 years). The kite-like incision was marked on the scar in the web-space. The rhombic scar between the adjacent metacarpophalangeal joints was excised, and cicatricial contracture was released completely. The secondary wound in the web-space was repaired with full-thickness autogeneic skin grafting. The secondary wound at donor site was directly sutured. Results All full-thickness skin grafts survived well. The incisions at donor sites healed primarily. Of 31 patients, 29 (82 web-spaces) were followed up 6-18 months (mean, 13 months). The sizes and depths of reconstructed web-spaces were similar to those of normal ones. No secondary cicatricial contracture was observed, and the function of fingers recovered well. Conclusion The short-term effectiveness is satisfactory by kite-like incision combined with full-thickness skin grafting for repairing severe cicatricial contracture deformities in the web-space, while the long-term effectiveness needs further observation.
Objective To investigate the effectiveness of spinal canal decompression with microendoscopic disectomy (MED) and pillar vertebral space insertion through pedicle of vertebral arch for thoracolumbar neglected fracture. Methods Between February 2006 and November 2009, 30 patients with thoracolumbar neglected fracture were treated by spinal canal decompression with MED and pillar vertebral space insertion through pedicle of vertebral arch. There were 22 males and 8 females with an average age of 36.2 years (range, 17-58 years). The disease duration was 6 weeks to 14 months with an average of 5.3 months. All patients had single vertebral compression fracture, including T9 in 1 case, T11 in 2 cases, T12 in 5 cases, L1 in 11 cases, L2 in 5 cases, L3 in 5 cases, and L4 in 1 case. The preoperative Cobb angle was (27.5 ± 7.5) ° . The preoperative height of vertebrae was (26.67 ± 5.34) mm. The visual analogue score (VAS) was 5.8 ± 1.4. According to Wolter classification for spinal canal stenosis, there were 17 cases of grade 1, 10 cases of grade 2, and 3 cases of grade 3. According to Frankel grade, 3 cases were in grade A, 8 cases in grade B, 13 cases in grade C, and 6 cases in grade D. Results The average operation time was 70 minutes (range, 40-120 minutes) and the average blood loss was 180 mL (range, 100-400 mL). The hematoma occurred in 1 case, and other incisions healed by first intension. No deep vein thrombosis of the lower extremity occurred. All patients were followed up 26 months on average (range, 24-46 months). The Cobb angle and vertebral height at 3 days and last follow-up were significantly improved when compared with ones before operation (P lt; 0.01). At last follow-up, the spinal canal stenosis was grade 0 in 27 cases and grade 1 in 3 cases according to Wolter classification. At 24 months after operation, the spinal function was obviously improved; 1 case was in grade A, 1 case in grade B, 3 cases in grade C, 9 cases in grade D, and 16 cases in grade E according to Frankle grade, showing significant differences when compared with preoperative ones (P lt; 0.05). The VAS score at 1 month after operation was significantly higher than that before operation (P lt; 0.01), then the score showed downtrend along with time, and it was significantly lower at 24 months after operation than before operation (P lt; 0.01). Conclusion Spinal canal decompression with MED and pillar vertebral space insertion for thoracolumbar neglected fracture has short surgical time, less blood loss, and satisfactory reduction, but higher technical requirement is necessary for MED.