[Objective]To evaluate clinical results of videoassisted thoracoscopic anterior spine release combined with anterior or posterior correction of adolescent idiopathic scoliosis(AIS).[Method]Eleven cases of received video-assisted thoracoscopic anterior spine release followed by anterior or posterior instrumentation from July 2003 to December 2005 were reviewed.The average age at surgery was 14.6 years(ranged from 12 to 16 years).There were nine cases of Lenke type Ⅰ with average preoperative Cobb's angle of 59.7?(ranged from 54? to 68?),and two cases of Lenke type Ⅲ,with average preoperative Cobb's angle of 64.5?(ranged from 58?to 71?).The correction rate of thoracic curves in bending film averaged 26.4%(ranged from 21.8% to 32.4%).All 11 patients underwent release via endoscopic anterior resection of intervertebra disc through radiofrequency,and anterior or posterior correction.The coronal and sagittal Cobb's angle after surgery,and at follow-up were measured.The operative time,intraoperational blood loss,peri-operative complications and loss of carrection were analyzed.[Result]The average operation time was 4 hours and 50 min.The blood loss during surgery averaged 171 ml.The average number of released levels was 4.4(ranged from 5 to 7).The average postoperative Cobb's angle of 9 cases of Lenke type Ⅰ was 20.4? with curve correction rate of 65.5%.Postoperative Cobb's angles of 2 cases of Lenke type Ⅲ were 20? and 25?,the correction rate of thoracic curve averaged 65.1%.One patient developed thoracic effusion.The average follow-up period was 18.6 months,only one of them with loss correction of 14?.No neurologic or vascular complication occurred.[Conclusion]Compared to the open anterior surgery,video-assisted thoracoscopic anterior spinal release is a safe and effective treatment for idiopathic scoliosis.It can avoid complications incurred by traditional thoracic surgery.It has satisfactory clinical results compared to conventional thoracotomic release for AlS.

Purpose:To study prognostic factors of younger women's eptihelial ovarian neoplasms.Methods: From Jan. 1980 to Dec. 1992, there were 86 cases of younger women's epithelial ovarian carcinoma in our hospital. We studied serveral prognostic factors retrospectively.Results:In this setting, 2 year survival rate were 79.07%, 5 year survival rate were 54.65%. There were 49 cases with stage Ⅰ and 41 cases with grade Ⅰ. No recurrence was found in 4 patients who preserved ovarian function. Cox model multifactor results showed that grade, residual tumor size and the method of surgery were prognostic factors( P 0 05). The pathological type, FIGO staging, grade, residual tumor size, the method of surgery were important factors according to unifactor analyze ( P

Objective To discuss the clinical outcomes of two-stage anterior osteotomy and posterior correction to serious congenital scoliosis in children. Methods 14 patients with serious congenital scoliosis was typeⅠin 2 cases, type Ⅱin 6 cases, and combination of type Ⅰ and Ⅱ in 6 cases according to MacEwen's classification. There were 4 boys and 10 girls, and the age was ranged from 8 to 13 years with a mean of 11.2 years. The preoperative coronal Cobb's angle was ranged from 63? to 95? with an average of 72.1?. The hemivertebra ranging from T2 to L4. All cases were treated by anterior osteotomy, resection of hemivertebrae, and release of unilateral unsegmented bar, combined with posterior correction, and fusion with bone graft. The average range of osteotomy was 5.5 segments in anterior procedure, and all the patients were instrumented with pedicle screws in posterior procedure. Results In this group, the blood loss was 300 to 500 ml in first stage and 700 to 1200 ml in second stage respectively. After the first-stage surgery, the coronal Cobb's angle was ranged from 48? to 60? with a mean of 51.5?, and the correction rate ranged from 19.6% to 37.8% with an average of 28.6%. After the second-stage surgery, the Cobb's angle was ranged from 5? to 45? with a mean of 30.5? and the correction rate was from 52.6% to 87.5% with an average of 62.5%. All cases were followed up for 8 to 30 months (mean, 12.1 months). There were no loss of correction and major complications of the fixations, and the spinal fusions were excellent. Complications were observed in 2 cases, one was the loosening of the screw cap, and another was the T1 radicular pain after operations. Conclusion The combined anterior and posterior approach is an effective technique for serious congenital scoliosis in children of 8 to 12 years.

Objective To investigate the effect of corpectomy decompression by subtotal vertebrectomy and fusion of adjacent segmental artificial disc replacement through anterior intervertenral spance (Hybrid Surgery) in the anteriorcervical spondylotic myelopathy treatment . Methods Hybrid Surgery were operated on 18 patients who suffered from anterior cervi?cal spondylotic myelopathy . Follow up of 1-50 months. Patient’s conditions were assessed according to the Japanese Associ?ation for Department of orthopedics assessment score (JOA score) before and after operation. Effects of Hybrid operation were assessed by the improvement of JOA score, Odom’s follow-up grade and cervical mobility . Results The JOA scores of all 18 operated patients were improved from 10.6 ± 1.7 before operation to 13.5 ± 2.4 after operation. And the difference is statistically significant (t=1.314, P < 0.05). Among all the operated patients, 16 were cured and 2 were effective. As to Odom’s follow up grades, 6 cases were excellent, 11 cases were good and 1 case was acceptable. The postoperative move?ment range of cervical spine (40.1° ± 8.4°) show no statistically difference compared with that in preoperation (42.6° ± 11.9°) (t=0.68, P > 0.05). Conclusion Hybrid Surgery of anterior cervical decompression and fusion can both improve the nerve function and preserve cervical mobility.

Objective To study the clinical efficacy of Akin combined Scarf osteotomies for moderate and severe hal?lux valgus. Methods Thirty-nine (58 feet) patients received Akin combined Scarf osteotomies, in which 12 patients (16 feet) with moderate hallux valgus received the single scarf osteotomy. Hallux valgus angle (HVA), intermetatarsal angle (IMA), tibial sesamoid position and American orthopedic foot and ankle society score (AOFAS) were measured and compared before and after operation respectively. Results All operations were successfully completed patients were followed up for 8-22 months. The mean operation time was (55.0±6.8) min. The amount of intraoperative bleeding was 3-20 mL with an aver?age of (11.0±5.4) mL. All patients were healed except for a delayed union of Akin on a severe hallux valgus patient. Two cas?es (2 feet) were found inflammation in surgical incision. Two cases (2 feet) were found numbness in dorsal medial side of hal?lux, which was considered nerve damage and improved in 3-5 months. There was no recurrence of hallux valgus in the peri?od of following up. After surgery, HVA (14.1°±5.3°), IMA (7.7°±3.8°) and tibial sesamoid position (2.58±0.61) were signifi?cantly decreased compared with those before operation (39.6° ± 6.8° , 18.7° ± 5.4° and 4.87 ± 0.59, P<0.05). AOFAS score (84.4±8.7) was significantly higher after surgery than that before surgery (37.3±9.5, P<0.05). Conclusion Akin combined Scarf osteotomies can achieve a excellent therapeutic effect for moderate and severe hallux valgus with very few complica?tions and recurrence, which is worth for clinical application.

10.3969/j.issn.1000-3606.2013.06.018

Objective To evaluate the effect of percutaneous transforaminal endoscopic discectomy (PTED) using tar?get puncture and 2-stage procedures in treating lumbar disc hernia. Methods Patients present in our clinic from January 2014 to June 2014 with lumbar disc hernia who were treated with PTED were collected (n=36). Lower back and leg pain were evaluated by visual analog scale (VAS) while clinic outcome were assessed by Oswestry disability index (ODI) and modified Macnab criteria. Results All surgeries were carried out successfully. On average, operation time was(125±31)min, blood loss was(8.5±2.9)mL in each operation. The average length in hospital stay was(7.6±3.5)day. Compared with the preoper?ative VAS scores,the postoperative and last follow-up scores for lower back and leg pain decreased significantly (P<0.01). The ODI of pre-operation and last follow-up were (18.90 ± 7.78)%and (73.30 ± 18.21)%respectively with statistic differ?ence. As to the modified Macnab criteria,theexcellent and goodratio was 94.4%. One case present hyperalgesia in L4 der?matome which recovered through conservative treatment. No complications such as permanent nerve root injury ,cerebrospi?nal fluid leakage,or infection were found during or after operations. All patients are in stable conditions during follow-up pe?riod without recurrence. Conclusion PTED using target puncture and 2-stage procedures is an effective method with mini?mal trauma, less bleeding, quick recovery, high security, short hospitalization time. what′s more, it can remove protruded disc and broken nucleus from the intervertebral space. It ensure efficacy and avoid recurrence.

Objective To investigate short?term clinical outcomes of XLIF through small incision approach combined with percutaneous pedicle screw fixation for degenerative lumbar scoliosis. Methods From December 2011 to June 2013, 15 pa?tients with degenerative lumbar scoliosis were treated by XLIF combined with percutaneous pedicle screw fixation (XLIF group). There were 6 males and 9 females, with an average age of 68.27±5.70 (ranging from 58 to 75) years old and Cobb angle of scoliosis 22.20°±6.66° (ranging from 14° to 35°). Meanwhile, 23 patients were treated with posterior lumber inter?body fusion (PLIF) com?bined with pedicle screw fixation (PLIF group). There were 9 males and 14 females, with an average age of 63.26 ± 6.03 (ranging from 49 to 73) years old and Cobb angle of scoliosis 23.17°±6.95° (ranging from 13° to 36°). The efficacy was assessed through cor?rection rate of Cobb angle, VAS and lumbar JOA score at the time of the latest follow?up. Results The operation time was 224.35 ± 51.53 min in the PLIF group and 197.47 ± 31.84 min in the XLIF group. No significant differences were found, but there was significantly difference in the intraoperative blood loss (PLIF group: 576.52 ± 227.89 ml, XLIF group: 181.33 ± 47.37 ml, t=-8.054, P<0.001). No patient accepted blood transfusion in the XLIF group, but in the PLIF group, 11 patients accepted blood transfusion. The Cobb angle, VAS and JOA score in two groups were improved compared with the preoperative. 38 patients were followed up for 12 to 32 months, with an average of 23 months. The correction rate of Cobb angle, VAS and JOA scores were 56.90%±11.51%, 87.97%±12.07%, 84.00%±5.59%in the XLIF group, and 62.88%±8.28%, 83.68%±12.33%, 84.79%±6.76%in the PLIF group. No significant differences were found between the two groups (P>0.05). Conclusion Treatment of degenerative lumbar scoliosis with XLIF through small incision approach combined with percutaneous pedicle screw fixation is a kind of safe and effective minimally invasive spine surgery with small trauma and less bleeding, and the recent surgery efficacy was close to PILF.

Adult ; Hand Injuries ; epidemiology ; Humans ; Occupational Injuries ; epidemiology ; Surveys and Questionnaires

Background and purpose:Single drug of docetaxel and pemetrexed as second line treatment is standard treatment of advanced non-small cell lung cancer (NSCLC). Whether combined with platinum can increase the response and survival is still not elucidated. This study was designed to investigate the treatment response, overall survival (OS) and the safety of combined with oxaliplatin or cisplatin regimens as second line in treating NSCLC patients. Methods:Advanced NSCLC inpatients, failure of cisplatin or carboplatin in initial treatment, were divided into three groups at random in 3∶2∶1 rate. Control group:who received docetaxel, 75 mg/m2 (for all patients), d1 or pemetrexed 500 mg/m2 (for non-squamous carcinoma);Cisplatin group:who received cisplatin 25 mg/m2, d1-3 and docetaxel/pemetrexed; Oxaliplatin group: who received oxaliplatin 130 mg/m2 d1 and docetaxel/pemetrexed. Every 3 weeks were repeated as one cycle. The side effect was assessed every cycle and treatment efifcacy was investigated every two cycles. Follow-up examination was taken every 3 months after treatment. Results:There were no differences in treatment response, progress free survival (PFS), OS and toxicity among the three groups (P>0.05). Old patients (≥60 years) had a better PFS than that of patients less than 60 years (HR=0.56, 95%CI:0.35-0.90, P=0.015). Patients with performance score 0-1 had a better PFS and OS (HR=1.52, 95%CI:1.01-2.30, P=0.048;HR=1.90, 95%CI:1.17-3.09, P=0.009). Treatment response had relation to PFS and OS (HR=2.93, 95%CI:2.01-4.26, P=0.000;HR=2.03, 95%CI:1.37-3.01, P=0.000). Patients with anemia after treatment tended to have a worse PFS and OS (HR=1.59, 95%CI:0.97-2.61, P=0.066;HR=1.60, 95%CI:0.94-2.75, P=0.085). Patients with thrombocytopenia after therapy had a worse OS (HR=2.97, 95%CI:1.01-8.78, P=0.049). Patients with neural toxicity after chemotherapy tended to have a worse PFS (HR=3.36, 95%CI:0.92-12.25, P=0.066). Patients received post treatment after second line therapy had a better OS (HR=0.36, 95%CI:0.22-0.61, P=0.000). Conclusion:Combined with oxaliplatin or cisplatin as second line treatment can’t improve the response and survival in NSCLC patient. Treatment response and PS are prognostic factors to NSCLC patients’ PFS and OS. Patients with treatment related anemia might have a worse survival. Post therapy after failure to second line chemotherapy can prolong the survival.