Volume 86  ·   Issue 27  ·  2006

The deepening of the basic theory of spinal surgery, the progress of surgical technique and internal fixation technique have promoted the rapid development of spinal surgery in China, including trauma, degeneration, deformity, tumor and inflammation, etc. However, the failure and complications of surgery also occur from time to time, and there is an obvious upward tendency. Therefore, the analysis and evaluation of the mistakes and lessons of spinal surgery, especially the factors affecting the curative effect of spinal surgery, will help to improve the curative effect, reduce or avoid the surgical mistakes and complications.

As a new technique in the field of minimally invasive spinal surgery, percutaneous vertebroplasty (PVP) and percutaneous kyphoplasty (PKP) have attracted widespread attention. The key words "vertebroplasty" and "kyphoplasty" were used in PUBMED database. As of December 2001, there were 115 articles of PVP and only 6 articles of PKP. By March 2006, there were 606 PVP articles and 188 PKP articles. The key words "vertebroplasty" and "kyphoplasty" were used in the Chinese Journal Full Text Database (CNKI). By December 2001, there were 10 PVP articles, but no PKP articles were found. By March 2006, there were 398 PVP articles and 68 PKP articles. The authors covered almost all famous medical institutions in Europe, America and Asia. The doctors who performed surgery included spinal surgeons, interventional radiologists and pain surgeons, etc. The related research involved biomechanics, materials engineering, radiographic imaging, clinical anatomy and other subjects. It can be seen that the rapid development, high attention and wide popularity of PVP and PKP are rare in the history of spinal surgery.

With the aging of the population and the increase of lumbar degenerative diseases, the influence of lower limb joint lesions on its surgical efficacy cannot be ignored. Many patients with lumbar degeneration have lower limb joint degenerative diseases at the same time, and some foreign scholars have put forward the views of "knee joint-spine syndrome" and "hip joint-spine syndrome". Now, the influencing factors of lower limb joint lesions on the curative effect of lumbar spine surgery are analyzed.

Objective to investigate the repair method of abdominal wall fascial defect during abdominal wall endometriosis (AWE) surgery. Methods the case data of 55 patients with abdominal wall endometriosis were retrospectively analyzed. 55 patients were divided into two groups: (1) abdominal wall fascial defect group, 29 cases, the area of abdominal wall fascial defect during operation exceeded 2 cm2; the abdominal wall fascial defect group was treated according to the area of abdominal wall fascial defect (from small to large) as follows: 11 patients were routinely sutured abdominal wall; The abdominal wall was reconstructed by tension line, PDS-Ⅱ or fascia/skin tension reduction suture in 7 patients. Fascial patch was applied in 4 cases during operation; Seven patients with large abdominal wall fascial layer and skin defects were assisted by plastic surgery. (2) In the group without abdominal wall fascial layer defects, the area of abdominal wall fascial layer defects was less than 2 cm2 during operation, and the abdominal wall was routinely sutured in the group without abdominal wall fascial layer defects. Results the incision healed in stage I. The maximum diameter, operation time and bleeding amount of AWE measured by B-ultrasound and resection were significantly larger in the group without fascial defects than in the group without fascial defects, and the differences were statistically significant. One case of disease recurred in each group. Conclusion B-ultrasound examination is helpful to accurately evaluate the lesion before operation.

Objective to investigate the levels of serum endostatin in patients with lung cancer at different clinical stages and histological types and their changes before and after chemotherapy, so as to judge the value of serum endostatin level in early diagnosis and prognosis of lung cancer. Methods 40 patients with lung cancer, 20 patients with benign lung disease and 20 normal subjects were detected by ELISA. The levels of serum endostatin in different clinical stages, pathological types and before and after chemotherapy were analyzed. Results (1) The serum endostatin level in lung cancer group (10.71±9.99) ng/ml was higher than that in benign lung disease group (4.79±1.23) ng/ml and normal control group (4.51±1.14) ng/ml, and the difference was statistically significant (P<0.01); (2) The level of serum endostatin in patients with stage Ⅰ and Ⅱ lung cancer was higher than that in stage Ⅲ, and the difference was statistically significant (P<0.05). (3) The difference of serum endostatin in patients with lung cancer was not statistically significant. (4) The level of serum endostatin in patients with lung cancer after chemotherapy was significantly higher than that before chemotherapy, and the difference was statistically significant (P<0.05). Conclusion (1) Serum endostatin may be a reference index for early diagnosis of lung cancer; (2) The dynamic changes of serum endostatin level can be used as the evaluation index of chemotherapy efficacy and prognosis.

Objective to investigate the immunopathological changes of microvessels in skeletal muscle of patients with dermatomyositis. Methods Muscle biopsy was performed in 12 patients with dermatomyositis. 10 patients without dermatomyositis were selected as controls. The primary antibodies included anti-von Willebrand factor (vWF) antibody, anti-thrombomodulin (TM) antibody and anti-endothelial nitric oxide synthase (eNOS) antibody. Results All patients showed perifascicular myofibrosis and different degrees of inflammatory cell infiltration around small blood vessels in the muscle fascicle coating. Non-specific esterase staining showed deep staining of capillaries between muscle fibers. Immunohistochemical staining showed that the distribution of vWF, TM and eNOS in capillaries in the perifascicular region was significantly reduced, and the distribution of TM and eNOS in micro arteries and veins at the muscle fascicle coating was also reduced. Conclusion Besides capillaries, vascular endothelial cell damage in dermatomyositis, Can appear in other microvasculars.TM and eNOS decrease in vascular endothelial cells suggests decreased anticoagulant and diastolic function of blood vessels.Dermatomyositis is a diffuse inflammatory vascular endothelial cell disease.

Objective to evaluate the clinical value of intradermal test and serum specific IgE (sIgE) detection in the diagnosis of humulus pollen fever. Methods 1150 patients (5~75 years old) with allergic rhinitis and asthma in summer and autumn were subjected to intradermal test of 20 kinds of inhaled allergens, including humulus pollen, and serum sIgE of humulus pollen. The concentration of humulus pollen allergen infusion used in intradermal test was 1:100 (w/v), and the concentration of other allergens except Artemisia pollen and ragweed pollen was 1:1000 (w/v) was 1:100 (w/v). All patients were subjected to humulus pollen sIgE test (Phadia Uni CAP). According to the typical medical history, intradermal test and sIgE test results, clinical comprehensive diagnostic criteria were established and the clinical value of intradermal test and sIgE test was evaluated. Results The sensitivity (89.0%), positive expectancy (77.9%), negative expectancy (90.6%) and diagnostic accuracy (80.4%) of humulus pollen intradermal test were higher than those of humulus pollen with sIgE ≥0.35 kUa/L as reference standard The sensitivity (97.6%), specificity (97.5%), positive expectancy (98.8%), negative expectancy (88.0%) and diagnostic accuracy (92.0%) of sIgE detection of humulus pollen were higher than those of in vitro test when intradermal test ≥5 mm was used as the reference standard. When intradermal test ≥10 mm was used as the positive standard, the false positive rate of intradermal test decreased from 59.9% to 17.4%. Among 288 patients with positive sIgE pollen intradermal test and negative sIgE, 84 patients had intradermal test ≥10 mm. Conclusion There is a good correlation between intradermal test and sIgE detection, but the false positive rate of sIgE detection in the diagnosis of humulus pollen allergy is higher than that of humulus detection. When using intradermal test or sIgE detection alone to diagnose humulus pollen fever, immunotherapy with low positive results should be avoided.

Objective to understand the decision-making of domestic doctors in diagnosis and treatment of gout and analyze the related factors.Methods A field questionnaire survey was conducted among 197 doctors on the decision-making of diagnosis and treatment of gout, and the personal data of the respondents were collected.The related factors affecting the decision-making were analyzed by bivariate analysis and multiple Logistic regression analysis.Results A total of 120 valid answers were collected.When diagnosing gout, 94 doctors (78.3%) thought that the synovial fluid of patients should be examined.In the treatment of acute gout attack, if the renal function of patients is good, 83 doctors (69.2%) preferred oral colchicine; For patients with renal insufficiency, 50 doctors (41.7%) preferred corticosteroids or corticosteroids. 99 doctors (82.5%) selected the indication incorrectly, 107 doctors (89.2%) started the treatment too early, and 92 doctors (76.7%) did not take the medication long enough. In addition, only 17 doctors (14.2%) prevented the onset of acute gout at the same time as starting the blood uric acid lowering therapy. Multiple Logistic regression analysis found that continuing education of gout is the relevant factor for doctors to adopt the correct diagnosis method. Conclusion The decision-making of domestic doctors in diagnosis and treatment of gout is not consistent with the current international opinion, and high-quality medical continuing education may improve the decision-making level of doctors in diagnosis and treatment of gout.

Objective to study Sa antigen recognized by anti-SA antibody specific for rheumatoid arthritis (RA) and to explore the related proteins of Sa antigen.Methods Sa antigen was purified from human placental tissue by anion exchange column chromatography, and the serum anti-SA antibody was detected by immunoblotting in 155 patients with various rheumatic diseases.Among 155 patients, 71 cases were rheumatoid arthritis,11 cases of ankylosing spondylitis,7 cases of psoriatic arthritis,7 cases of reactive arthritis,4 cases of juvenile idiopathic arthritis,5 cases of osteoarthritis,6 cases of polymyalgia rheumatica,6 cases of gout, 7 cases of systemic lupus erythematosus,10 cases of Sjogren's syndrome,8 cases of inflammatory myopathy,4 cases of mixed connective tissue disease,6 cases of Behcet's disease and 3 cases of adult Still disease.The in-gel band corresponding to the positive band by immunoblotting was cut out, and the in-gel band was enzymatically hydrolyzed by trypsin. The target protein was identified by high performance liquid chromatography-electrospray-ion trap mass spectrometry.The target protein was recombinantly expressed by E. coli as the antigen, Results Anti-SA antibody showed positive blot bands with relative molecular mass of 50 000 (and 55 000). The sensitivity and specificity for diagnosis of RA were 47.9% and 95.2%, respectively, in 155 cases of rheumatism. Vimentin was identified by mass spectrometry. The positive rate of anti-vimentin antibody was statistically significant (P =0.005). The sensitivity and specificity for diagnosis of RA were 36.6% and 83.3%, respectively, but the agreement with anti-SA antibody was poor (Kappa =0.316). The positive rate of anti-citrullinated Vimentin antibody was higher in RA group than in other rheumatism groups (P<0.01), the sensitivity and specificity for diagnosis of RA were 49.3% and 86.9%, respectively, and the agreement with anti-SA antibody was higher (Kappa =0.746). Conclusion The Sa antigen-related protein Vimentin identified by mass spectrometry,

Objective to investigate the accuracy of cortical somatosensory evoked potential (CSEP) monitoring in cervical spondylotic myelopathy (CSM) and the influencing factors related to surgical operation.Methods CSEP of ulnar nerve in 68 cases of CSM was monitored, and the influence and degree of CSEP in various periods and operations were recorded, as well as the postoperative spinal cord function were analyzed and evaluated.Results All 68 cases were successfully monitored by CSEP, and 24 cases had 44 early warnings of CSEP due to various operations, including 31 general early warnings, and all of them could recover automatically after observation; Conclusion CSEP can immediately sensitively and accurately monitor the sensory nerve conduction function of spinal cord, and it is proved that the main operation factors causing CSEP early warning include: cervical hyperextension or hyperflexion position, excessive distraction of intervertebral space, complete anterior intraspinal decompression, and too wide or too deep bone graft insertion.

Objective to evaluate the value and safety of Yunnan Baiyao capsule in the perioperative period of posterior cervical surgery for cervical spondylotic myelopathy. Methods A multicenter, randomized, double-blind, placebo-controlled clinical study was conducted. 197 patients who met the inclusion criteria were randomized to receive Yunnan Baiyao capsule 500mg or placebo 4 times a day for 5 days. The intraoperative blood loss and postoperative drainage volume of the two groups were compared, and the safety was evaluated. Results The intraoperative blood loss of Yunnan Baiyao group was 350 ml ± 190ml, and the intraoperative blood loss of placebo group was 443 ml ± 266 ml (P<0.05). There was no difference in postoperative drainage volume and adverse reactions after taking the drug between the two groups. Conclusion Oral administration of Yunnan Baiyao capsule can significantly reduce the blood loss in posterior cervical surgery for cervical spondylotic myelopathy, which is safe and effective.

Objective to investigate the reasonable surgical methods after cervical spinal cord injury of hyperextension. Methods 67 cases of cervical spinal cord injury of hyperextension underwent surgery were retrospectively analyzed. According to different surgical methods, the patients were divided into 3 groups: anterior approach, posterior approach and combined anterior and posterior approach, and the differences in curative effects were compared. Results After 6~12 months of follow-up, the changes of Frankel's grade and ASIA score before and after surgery were compared between the 3 groups. Anterior decompression, bone graft internal fixation and anterior-posterior combined decompression and bone graft internal fixation were better than posterior decompression and bone graft internal fixation, and the difference between the two groups was obvious; Conclusion Anterior decompression and internal fixation is the first choice for cervical spinal cord injury of hyperextension, and posterior approach is the second choice. The combined approach should be according to the specific condition and strictly control the surgical indications.

Objective to evaluate the safety and efficacy of simple posterior resection of thoracolumbar hemivertebrae in the treatment of juvenile congenital kyphosis without surgical complication.Methods Twenty-eight cases of juvenile congenital kyphosis were treated with simple posterior resection of thoracolumbar hemivertebrae, of which 12 hemivertebrae were located in T12, 10 hemivertebrae were located in L1, and 6 hemivertebrae were located in T11. The average kyphosis angle was 75° and the average scoliosis angle was 48° as measured by Cobb angle.The average age of the patients was 14 years old, including 19 males and 9 female.All cases were fixed with simple posterior hemivertebrae resection and pedicle internal fixation system.The feasibility of intraoperative operation, operation time, bleeding volume, intraoperative and postoperative complications and correction of deformity were analyzed.Results The average operation time was 3.7 h, and the average blood loss was 900ml. Hemopneumothorax occurred in 2 cases, 1 case healed by wound drainage, and 1 case healed by thoracic tube drainage for 1 week after operation. 1 case had cerebrospinal fluid leakage during operation, which healed naturally after operation. 1 case had transient unilateral intercostal neuralgia after operation, which disappeared after 1 week without any treatment; The incidence of complications was 14%.All cases showed no early or late spinal cord injury symptoms and wound infections. All cases obtained bone fusion after an average follow-up of 3.5 years. At the last follow-up, the average kyphosis angle measured by Cobb angle was 19°, the average scoliosis angle was 14°, and the trunk was balanced in all cases. Conclusion Simple posterior resection of thoracolumbar hemispinal vertebra is highly operative in the treatment of congenital kyphosis. Compared with anterior and posterior combined surgery, the operation time is shortened, the surgical trauma is significantly reduced, the orthopedic effect is good, and there is no serious nerve injury or other serious complications.

A 36-year-old female was admitted to the hospital on November 11, 2004 due to intermittent fever for 6 years, edema for 4 months and multiple abscesses for more than 1 month. The patient had fever after catching cold in March 1998, with the highest body temperature of 39.7℃, accompanied by multiple joint pain, but no swelling. The examination showed "pancytopenia" and multiple lymph nodes in the abdominal cavity (pathology showed necrotizing lymphadenitis). After 2 courses of CHOP chemotherapy and prednisone (40 mg/d, gradually decreasing for half a year), the fever subsided, and the blood routine returned to normal. In November 2003, she had no induced fever, and the highest body temperature was 40℃. The blood routine showed that white blood cells (WBC) were 2.06×109/L, hemoglobin (HGB) was 95g/L, and platelets were normal. Urinary routine, liver and kidney function normal; Erythrocyte sedimentation rate (ESR) 58~118 mm/h; Antinuclear antibody (ANA) and anti-SSA antibody were positive.

Macrophage activation syndrome (MAS) is a fatal complication of chronic rheumatic diseases in children, which is more common in systemic juvenile idiopathic arthritis (JIA). It is characterized by hepatosplenomegaly, lymphadenomegaly, pancytopenia, abnormal liver function, disseminated intravascular coagulation (DIC) and central nervous system disorders. Bone marrow pathology shows that a large number of well-differentiated macrophages engulf blood cells [1]. Recent studies have shown that the pathogenesis of MAS is related to the uncontrolled proliferation and activation of T lymphocytes and macrophages and the decline of cytotoxic function caused by mutations of NK cell perforin encoding gene [2]. A deep understanding of the pathogenesis of MAS can help to determine better treatment plan and improve the prognosis of patients.

Clinical data: A 65-year-old female, retired worker, began to have repeated cough, expectoration and wheezing 10 days before admission, and her condition could improve after anti-inflammatory and anti-asthmatic treatment. Five years ago, she began to have edema of lower limbs and shortness of breath after activity. Two weeks before admission, she appeared again after catching cold, accompanied by visual hallucinations, sleep inversion and edema of both lower limbs. She was admitted to the hospital on June 17, 2005. On the same day, she was found to be unable to respond to her calls, without vomiting or convulsions. Blood gas was checked in the emergency department: pH 7.16, PaCO2 111 mm Hg (1 mm Hg =0.133kPa), PaO2 44 mm Hg, and was admitted to the respiratory intensive care unit (RICU) of our hospital after tracheal intubation. She had a history of hypertension for 15 years, with a maximum of 199/101 mm Hg. She took medication regularly and could be controlled. Has been diagnosed as obstructive sleep apnea syndrome; History of fractures of right upper limb and ribs.

At present, recombinant tissue plasminogen activator (rt-PA) is administered within 3 hours of onset in intravenous thrombolytic therapy of acute ischemic stroke. Because most stroke patients cannot arrive at the hospital within 3 hours, the opportunity of rt-PA thrombolytic therapy is lost. New neuroimaging techniques have found that the ischemic penumbra can last for several hours in most acute stroke patients, so it is promising to perform thrombolytic therapy in a longer time range. desmoteplase is a new plasminogen activator, which has the advantages of high fibrin specificity, long half-life, no neurotoxicity and inactivation of beta amyloid protein compared with other plasminogen activators.

The mortality rate of ovarian cancer is the highest among gynecological malignant tumors. The main reasons are the difficulty of early diagnosis, late clinical diagnosis and chemotherapy (chemotherapy) resistance. Cisplatin-based combined chemotherapy is still the main adjuvant treatment after ovarian cancer surgery. How to overcome or prevent drug resistance has become a hot spot in tumor treatment research. With the advent of post-genome era and the rapid development and perfection of proteomics theory and technology, it is possible to explore the mechanism of cisplatin resistance in ovarian cancer from a brand-new perspective of protein. In this study, the differential protein of cisplatin-sensitive strain (COC1) and drug-resistant strain (COC1/DDP) of ovarian cancer was compared and analyzed by differential gel electrophoresis (DIGE) technique, hoping to find the key molecules related to cisplatin resistance.

MRKHR's syndrome is the main cause of congenital absence of vaginal deformity [1]. Traditional vaginoplasty methods mainly include vaginal model pressing, open sigmoid colon replacement vaginal surgery or peritoneal vaginal replacement surgery, but after laparotomy, there is a large scar in the abdomen, and the surgical trauma is greater, and it also causes some psychological trauma to patients. We used laparoscopic sigmoid colon autograft vaginoplasty and laparoscopic autologous peritoneal vaginal replacement surgery to treat MRKH syndrome, respectively, and obtained satisfactory results.

atrial fibrillation is a common clinical arrhythmia, but there is no unified view on the specific mechanism of atrial fibrillation [1, 2]. Although it has been found that intracellular calcium overload leads to electrophysiological remodeling of atrial muscle, which causes the occurrence and maintenance of atrial fibrillation, there is still no direct evidence on whether there is calcium overload in atrial myocytes in the early stage of atrial fibrillation [3, 4]. In this paper, a rabbit rapid atrial pacing (RAP) model was established to detect the changes of free calcium ion concentration and L-type calcium ion channel gene expression in atrial myocytes at different time points, which provided experimental basis for revealing the electrophysiological mechanism in the early stage of atrial fibrillation.

The increased permeability of blood-brain barrier (BBB) plays an important role in the development of angiogenic cerebral edema in infectious brain injury. Therefore, it is of great clinical significance to elucidate the changes of BBB permeability and its regulatory mechanism in infectious brain injury. In this study, astrocytes (AS) and bain microvascular endothelial cells (BMEC) of the same species were co-cultured to establish a BBB model in vitro, and to investigate the changes of BBB tight junction protein and cytoskeletal actin in the increase of BBB permeability induced by endotoxin lipopolysaccharide (LPS) and its relationship with the signal transduction pathway of Rho/Rho kinase cells.

Placental site trophoblastic tumor (PSTT) is the least common type of gestational trophoblastic tumor (GTN), accounting for 1% ~2% of all GTNs. It can be secondary to various types of pregnancy or coexists with various pregnancies. Kurman et al. [1] first described this disease with "placental site pseudotumor" in 1976, which was considered as a benign disease at that time. In 1981, Scully et al. [2] proposed that the disease has malignant potential and renamed it PSTT. Most PSTT has no metastasis and good prognosis, but about 15% ~30% of cases [3] have metastasis and bad prognosis. Therefore, we summarized and analyzed the clinical and pathological characteristics of 11 patients with PSTT, aiming at exploring the diagnosis and treatment of PSTT and the adverse prognostic factors.

A 31-year-old woman was admitted to the hospital because she was found to have a gradually enlarging aneurysm of the right internal iliac artery for 8 years and was accompanied by dull pain and discomfort in the right lower abdomen for 2 years. Physical examination showed that there was a longitudinal surgical incision scar about 10 cm in the middle of the lower abdomen (cesarean section 7 years ago). Mild tenderness in the right lower abdomen, no obvious mass was palpable, and vascular murmur was heard during auscultation. Anal examination showed that a pulsatile mass could be palpable in the right rectal wall about 6 cm away from the anus. No abnormalities were found in laboratory examination. Enhanced CT scan and three-dimensional reconstruction showed that the right internal iliac artery aneurysm was irregular in shape, with a total expansion length of 84 mm and a maximum inner diameter of 30 mm. Discontinuous calcified scar was seen in the tumor wall, and tortuous and thickened blood vessels were seen running to the left at the posterior edge of the pubic symphysis. The left internal iliac vein was obviously developed early, but the right internal iliac vein was not developed early (Figure 1). Diagnosis: Right internal iliac artery aneurysm combined with right internal iliac artery-left internal iliac vein fistula. Treatment: Through left femoral artery cannulation, right common iliac artery angiography showed that the tumor body and arteriovenous fistula were the same as the results of preoperative CT examination.