Objective To evaluate the clinical efficacy of anterior C2-3 discectomy and fusion in treatment of type Ⅱ traumatic spondylolisthesis of the axis. Methods A total of 27 patients with type Ⅱ traumatic spondylolisthesis of the axis were treated with anterior C2-3 discectomy, fusion and plate fixa-tion. There were 19 males and 8 females, at average age of 38 years (22-67 years). The spinal cord function was at Fraukel D in four patients. Results Operation lasted for 75-95 minutes (mean 86 mi-nutes), with blood loss of 100-160 ml (mean 135 ml). Hospital stay was 9-12 days ( mean 10.8 days). Follow-up for 9-24 months (mean 14 months) showed that all patients achieved bony fusion within three months postoperatively, with no anterior displacement or kyphosis. The range of cervical movement was normal, with no chronic neck pain ocurred. Conclusions Anterior approach can minimize surgical trauma, shorten recovery time and hospital stay. Anterior C2-3 discectomy and fusion is a feasible and safe surgical technique and can get satisfactory therapeutic effect in treating type Ⅱ traumatic spondylolisthesis of the axis.

Objective To analyze the perioperative complications of posterior transpedicular osteotomy (wedge osteotomy and total vertebral osteotomy) for patients with spinal deformity.Methods From January 2007 to December 2011,73 patients with spinal deformity underwent posterior transpedicular spinal osteotomy (wedge osteotomy and total vertebral osteotomy).Among them,30 patients,including 8 males and 22females,aged from 8 to 68 years (average,40.7 years),presented with at least one perioperative complication.There were 10 cases of scoliosis,9 cases of kyphoscoliosis and 11 cases of kyphosis.Twenty two patients underwent total vertebral osteotomy,and 8 patients underwent wedge osteotomy.A retrospective analysis on perioperative complications of 30 patients was performed.Results Except 1 patient dying of hemorrhagic shock after operation,29 patients were followed up for 6 to 61 months (average,17.2 months).The total perioperative complication rate was 41.1％.Neurological complications occurred in 16 patients (21.9％),bleeding complications in 2 patients (2.7％),dural injury in 6 patients (8.2％),postoperative cerebrospinal fluid leakage in 4 patients (5.5％),wound infection in 4 patients (5.5％) and pleural effusion in 4 patients (5.5％).Conclusion Posterior transpedicular osteotomy is an effective surgical technique for spinal deformity.However,perioperative complications are common,including nerve injury,bleeding,dural injury,wound infection and so on.Among them,nerve injury and bleeding are most common.

Objective To compare the safety and efficacy of posterolateral lumbar fusion (PLF) and transforaminal lumbar interbody fusion (TLIF) in the treatment of degenerative lumbar scoliosis (DLS).Methods Forty DLS patients with Cobb angles of 20 to 60 degrees were divided randomly into PLF and TLIF groups.Operative time,intraoperative blood loss,imaging results,and clinical outcomes were compared.Results Complete information was available in 37 patients,including 18 patients in the PLF group and 19 in the TLIF group.There were significant differences between two groups with regard to the operative time (P=0.002) and the intraoperative blood loss (P=0.048).The incidence of early complications in the 2 groups was 11.1％ and 26.3％.There was no significant difference in the recovery rates of the Cobb angle and the spinal coronal balance between two groups.However,the recovery rates of the lumbar lordotic angle and spinal sagittal balance were significantly different between two groups (36.7％ vs.62.5％ and 44.8％ vs.64.1％,respectively).In various domains of SRS-22,the scores for pain and satisfaction with treatment in TLIF was better that those in PLF groups.There was no significant difference in ODI score between two groups.Conclusion TLIF helps to improve lumbar lordosis and sagittal balance,which leads to better clinical outcomes.For patients without significant loss of lumbar lordosis and with good spinal sagittal balance preoperatively,PLF is still an option.

Objective To investigate different surgical procedures for treatment of thoracic ossification of ligamentum flavum.Methods From January 1994 to June 2008,56 cases of thoracic ossification of ligamentum flavum underwent different surgical procedures.There were 40 males and 16 females,aged from 43 to 76 years(average 58.1 years).The courses of disease were 3 months to 5 years,average 13.4 months.CT and MRI examinations were used to observe ossification involving levels,distributions,ossification nest shapes,spinal canal stenosis and spinal cord compression and so on.All patients were treated with en bloc or dissolved laminectomy combining with posterolateral fusion.Japanese Orthopaedic Association(JOA)score was used to evaluate postoperative outcomes.Results The patients were followed up for 18 to 70 months,with an average of 25 months.The mean JOA score increased from 6.25±2.47 preoperatively to 7.53±3.20 at the final follow-up.According to CT scans,the ossifications were divided into lateral type in 6 cases,diffuse type in 17 and thickened nodular type in 33 cases.Patients of lateral type was treated with en bloc laminectomy,and the excellent and good rate was 83.3%.In the patients of diffuse type,11 were treated with en bloc laminectomy and 6 with dissolved laminectomy,and the excellent and good rate was and 81.8% and 83.3% respectively.For patients of thickened nodular type,4 were treated with en bloc laminectomy and 29 with dissolved laminectomy,the excellent and good rate was 50% and 82.8% respectively,and 2 cases presented spinal cord injury aggravation.Conclusion En bloc laminectomy combining with lateral fusion is ideal surgical procedure for lateral type and diffuse type,dissolved laminectomy combining with laeral fusion is suitable for thickened nodular type.

Objective To study the diagnosis and treatment for distractive extension injuries of the cervical vertebrae.Method From 2000 to 2005.the clinical and image data of fifty-six patients in the Second Affiliated Hospital of Zhejiang University College of Medicine with distractive extension injuries of the cervical vertebrae were studied and treated with anterior discectomy or subtotal vertebrectomy in the second affiliated Hospital of zhejiang university collegeof medicine,bone grafting and internal fixation with plate.Results The follow-up period was six to seventeen months in fourty-eight patients.The neurological recovery was found after operation in five of nine case with complete spinal cord injuries and thirteen patient had complete recovery.Neck pain completely disappeared in 6 patients with oboslete injury and neurological recovery was improved in 4 patients.Condusions MRI examination is the essential approach to diagnoze distractive extension injuries of the cervical vertebran,and early operation,including anterior discectomy,bone graftillg and internal fixiation with plate,is a best choice of surgical interrention to achieve cervical stabilization and neurological improvement.

Objective:To assess the safety and efficacy of induction chemotherapy with cisplatin and docetaxel followed by radia-tion concurrent with weekly cisplatin for unresectable, locally advanced esophageal cancer. Methods: Thirty-three patients with T3N0M0 to T4N2M0 thoracic esophageal squamous cell carcinoma without celiac lymph node metastasis were included in the study. They were treated with cisplatin (75 mg/m2 d1, d22) and docetaxel (75 mg/m2 d1, d22) neoadjuvant chemotherapy followed by three-dimensional conformal radiotherapy (60Gy/30F/6w) concurrent with cisplatin (30 mg/m2 d1, 8, 15, 22, 29, 36 from the beginning of radiation). Results:Grade 4 hematological toxicities were observed in 13.33%(4/33) of the patients after the neoadjuvant chemother-apy. No grade 3 or above hepatic or renal toxicities were found. During concurrent chemoradiation, the highest grade 3 hematological toxicities were observed in the erythrocyte, granulocyte, and macrophage at 21.21%(7/33), 15.15%(5/33), and 3.01%(1/33), respec-tively. No grade 2 or above hepatic or renal toxicities were observed. Grade 3 radiation esophagitis was observed in 9.1%(3/33) of the patients, whereas grade 3 and above radiation esophagitis or grade 1 and above acute radiation pneumonitis did not occur. The evalua-tion results after treatment completion were 84.85%(28/33), 12.12%(4/33), and 3.03%(1/33) for CR+PR, SD, and PD , respectively. Two months after treatment completion, the results changed to 75.76%(25/33), 9.10%(3/33), and 15.15%(5/33), respectively. Overall, 15 patients died. The one-year survival rate was 66.4%. Local failure was approximately 46.67%(7/15), whereas the local+distant fail-ure was approximately 26.67%(4/15). Therefore, local failure is the main pattern of failure in esophageal cancer. Conclusion:The re-sults indicate that neoadjuvant chemotherapy with cisplatin and docetaxel followed by radiotherapy concurrent with weekly cisplatin for locally advanced esophageal cancer is safe. Local failure remains the main pattern of failure in esophageal cancer.

Objective To explore the clinical effects of C2 dome-like expansive laminoplasty and C2 expansive opendoor laminoplasty in upper cervical(involve or above C2 segment) ossification of the posterior longitudinal ligament.Methods All of 39 patients (22 males and 17 females) withcervical ossification of the posterior longitudinal ligament up to C2 which causedcompression symptoms were operated with posterior cervical surgery in ourhospital from January 2013 to June 2017.The average age was 55.74+7.91 years old,ranging from 39 to 71 years.Among these patients,21 patients underwent C2 domelike expansive laminoplasty and 18 underwent C2 expansive open-door laminoplasty,the patients in both groups underwent the C3-C7 expansive open-door laminoplasty.The preoperative and postoperative Neck Disability Index (NDI),Japanese Orthopedic Association (JOA) score,the xisual analog scale(VAS) and the space available for the spinal cord (SAC) of C2 segment in X-ray were measured and statistically analyzed.Results All patients were followed up,the follow-up time was from 15 to 63 months (mean 42.3±17.7 months).There was no significant difference in the general condition,NDI,JOA score and JOA score improvement rate between preoperative and postoperative follow-up in 2 groups.There were significant differences in the NDI,JOA,VAS and SAC between preoperative and postoperative follow-up in 2 groups.The VAS score in C2 dome-like expansive laminoplasty group 1.52± 1.2 was significantly lower than that in C2 expansive open-door laminoplasty group 2.06±0.87(t=-2.23,P＜0.05),while the SAC in C2 expansive open-door laminoplasty group 14.11±1.023 was significantly higher than that in C2 dome-like expansive laminoplasty group 1 L86± 1.014(t=-6.89,P＜0.05).No failure of internal fixation or recurrent compression was found during follow-up.Conclusion For patients with ossification of posterior longitudinal ligament up to C2 or higher level,both C2 dome-like expansive laminoplasty and C2 expansive open-door laminoplasty can achieve good results.The SAC in C2 expansive open-door laminoplastygroup was superior to that in C2 dome-like expansive laminoplasty group,while the postoperative pain was more obvious.There was no significant difference in postoperative neurological recovery between the two groups.Using C2 dome-like expansive laminoplasty could reduce postoperative axial pain than the C2 expansive open-door laminoplasty surgery.For patients withossified tissue in the spinal canal,which occupies more than 50％ of the sagittal diameter of the spinal canal,or with developmental spinal stenosis,C2 expansive open-door laminoplasty may berecommend to get more adequate decompression.

Objective:To explore the role of insulin-like growth factor binding protein 1 (IGFBP1) in the diagnosis and prognosis of nasopharyngeal carcinoma (NPC), and to search for molecular markers that can be used for the diagnosis of NPC.Methods:A retrospective analysis was conducted on 150 NPC patients (treated from April 2014 to May 2015) at the Cancer Hospital Affiliated to Shantou University Medical School, and clinical baseline data were collected from 143 healthy individuals (normal control group) during the same period. The serum IGFBP1 concentration was detected using enzyme-linked immunosorbent assay (ELISA) in 112 nasopharyngeal carcinoma patients and 109 normal controls in the training cohort, and was validated in the validation cohort (38 nasopharyngeal carcinoma patients and 34 normal controls). The diagnostic value of serum IGFBP1 in nasopharyngeal carcinoma was evaluated using the receiver operating characteristic curve (ROC).Results:Compared to the normal control group, the expression level of serum IGFBP1 in nasopharyngeal carcinoma patients was higher in the training and validation queues (all P<0.05). In the training queue, the area under the ROC curve was 0.768 (95% CI: 0.706-0.830), with diagnostic specificity and sensitivity of 90.83% and 48.21%, respectively. In the validation queue, the area under the ROC curve was 0.798 (95% CI: 0.697-0.899), with diagnostic specificity and sensitivity of 97.06% and 31.58%, respectively. The predictive values for positive cases in both cohorts were greater than 80%, while the predictive values for negative cases were greater than 50%. The diagnostic threshold for serum IGFBP1 in both cohorts was 1 077 ng/ml. Conclusions:IGFBP1 has practical value as a molecular marker for the diagnosis of nasopharyngeal carcinoma.

【Objective】 To investigate the relationship between ABO blood types and the risk of malignant tumors in Chaoshan area, Guangdong. 【Methods】 Chi-square test was used to analyze the distribution of ABO blood types between 45 890 patients with malignant tumors from the Cancer Hospital of Shantou University Medical College and 42 465 healthy blood donors from Shantou Central Blood Bank. 【Results】 Among the main types of malignant tumors, the distributions of ABO blood types in patients with esophageal cancer or head and neck cancer were significantly different from that in the normal population (χ²=11.16, P<0.05; χ²=74.36, P<0.05; respectively). People with type B were identified with high risk of esophageal cancer and head and neck cancer (OR=1.09, 95% CI=1.03-1.15, P<0.05; OR=1.46, 95% CI=1.34-1.60, P<0.05), whereas those with type A or O were identified with low risk of head and neck cancer (OR=0.87, 95% CI=0.79-0.96, P<0.05; OR=0.83, 95% CI=0.76-0.90, P<0.05). 【Conclusion】 ABO blood type distribution in patients with esophageal cancer or head and neck cancer in Chaoshan area may be different from that in normal population, suggesting that different ABO blood types may be associated with the risk of esophageal cancer and head and neck cancer.