Atlantoaxial dislocation with high spinal cord compression is a common disease, which endangers people's health and is difficult to treat. Transoropharyngeal surgery is a very important method for the treatment of this disease. The author briefly reviews various operations of decompression and internal fixation through anterior transoropharyngeal approach and some correlative treatments conducted over the past few years. Although transoropharyngeal surgery has not been widely adopted at present, with increasing understanding of physiology and anatomy of the cranio-cervical junction, and development of microsurgical technic, and improvement in pre-vention and treatment of amplications, it has rapidly become a more acceptable approach for the treatment of atlantoaxial dislocation with cord compression. And with the application of new techniques, its treatment result will be conspicuously improved.

External fixators have been widely u sed in treatment of war trauma due to t heir small size,light weight,easy application,and convenience in transport.There are several types of military external fixato r,such as FESSA(Fixateur Externe du Service de Sant?des Arm?es),CMC(Croatian Medical Corps),Synthes and Hoffman-Ⅱ.All of these have been used on the battlefields of Rwandese War,Croatia Wa r and the first Persian Gulf War.Most of military external fixators are unilateral connectable-joint.For temp orary fixation,one bar is enough;by adding another parallel bar,the fixation can be use d for long-time fixing.Facing with a great demand of war trauma treatment ,we should develop new types of military external fixator with more simplicity and less size or weight. [

Objective To prepare recombinant human bone morphogenetic protein-2(rhBMP-2)loaded chitosan nanospheres and to evaluate their ectopic bone formation activity in vivo. Methods The rhBMP-2 loaded chitosan nanospheres were prepaid using the ionic crosslinking method with TPP as a crosslinking agent.The morphological properties and particle size distribution were evaluated by transmission electron microcopy(TEM) and particle size analyzer.An intramuscular ectopic bone formation test was carried out to compare the ectopic bone formation activity in 24 SD rabbits that were randomized into 4 even groups.rhBMP-2 loaded chitosan nanospheres (1 mg),rhBMP-2 (1 mg),chitosan nanospheres and nothing were implanted into the muscle pouch at the left thigh,respectively,in groups A,B,C and D. Results The rhBMP-2 loaded chitosan nanospheres were well distributed and spherical in shape.The average particle diameter was 230.0 nm,the entrapment efficiency was 66.87％ ± 4.58％,and the loading rate was 33.44 ± 2.29 μg/mg.The mean ALP activity was respectively 1.94 ± 0.35 kat/g,1.48 ± 0.56 kat/g,0.20 ±0.07 kat/g and 0.18 ±0.06 kat/g in groups A,B,C and D,with a significant difference between the 4 groups( F =42.959,P =0.000).The mean Ca2 + content was respectively 5.20 ± 1.42 μg/mg,3.80 ± 1.40 μg/mg,0.19 ± 0.08 μg/mgand 0.20 ± 0.08 μg/mg in groups A,B,C and D,with a significant difference between the 4 groups ( F =39.242,P =0.000).Groups A and B were obviously higher than groups C and D and group A was obviously higher than group B in terms of ALP activity and Ca2+ content. Conclusion The rhBMP-2 loaded chitosan nanospheres prepared by ionic crosslinking method show a good property and obvious ectopic bone formation activity.

Objective To study the repair of great vessels injured by firearm in extremities. Methods From May 2002 to Sep. 2005, 15 cryopreserved homologous arteries were transplanted to repair the defects of great vessels of extremities in 14 patients, including 5 cases of defect of brachial arteries, 1 case of defect of axillary artery, 1 case of popliteal artery damage and 7 cases of defect of femoral arteries. The average length of homologous arterial transplants was 9.5 cm. After operation, all the 14 patients were monitored and treated according to principles of microsurgery. Result No early reject reaction was found in all the 14 cases, and all the wounds healed after Ⅱ stage treatment. With Doppler ultrasonic examination 2-3 weeks after healing, it was proved that 100% of the vessels were patent. In 4 to 8 month follow up, the function of the extremities recovered well, and no delayed reject reaction was observed. Conclusion The vessels after cryopreservation is a suitable biomaterial in homologous transplantation for repairing the defect of great vessels of the extremities as a result of firearm injury.

Objective To summarize the experience of preventing infection in atlanto-axial operations via transoropharyngeal approach. Methods The methods and experiences of prevention of infection in 80 cases of atlanto-axial dislocation operated on via transoropharyngeal approach were retrospectively summarized and analyzed. Result There was no infection in all the 80 cases. Conclusion As long as preventive measures were perfectly taken, the post-operative infection could be effectively prevented and the transoropharyngeal operation would be safe.

Objective To evaluate the clinical results of subtotal vertebrectomy of the axis for spinal canal decompression by transoral anterior approach in the treatment of atlanto-axial dislocation with spinal cord compression. Method fifteen cases of atlanto-axial dislocation with spinal cord compression caused by congenital deformity or trauma were subjected to subtotal vertebrectomy of the axis via transoral anterior approach . Results After an average follow-up of 20 months, curative effect was evaluated according to Symon and Lavender. Vertebral canal vector diameters in MRI were measured. The total clinical effective rate was 100%, and the remarkable effective rate reached 60%. The average improvement rate of vertebral canal decompression was 79.8%. No sign of spinal cord and arteries injury and infection were observed. Conclusion Subtotal vertebrectomy of the axis via transoral anterior approach is proved to be feasible to treat cervical spinal cord compression on C 2 vertebra level.

Objective To evaluate transoropharyngeal atlantoaxial reduction plate system (TARP) and its preliminary clinical effect. Methods The TARP system was designed to consist of a butterfly titanium alloy plate, self-locking screws, atlantoaxial reductor and other surgical instruments. The system was applied clinically to five irreducible atlantoaxial dislocations as a result of injury or congenital disorders. During the operation, the reduction was achieved through the combination of the plate and the atlantoaxial reductor after the transoropharyngeal brisement and decompression. Bone graft was implanted between the lateral atlantoaxial joints. Results The reduction mechanism of the TARP system was well designed. Its clinical application to five cases of irreducible atlantoaxial dislocation proved that TARP had the function of instant reduction and that the operation was feasible and had laudable effect. Conclusion TARP design is a novel strategy. Its operative procedure is simple and feasible. Both the instant reduction and stable fixation can be obtained during the operation. TARP is creative and has excellent prospect.

0.05). The ROM of flexion-extension, lateral bending and axial rotation of these two groups was smaller than that of the other three fixators(P0.05). Conclusion Experimentally, the effect of TARP was equal to that of Magerl+Brooks, but it was proved to be more stable than the other three clinically widely used atlantoaxial fixators: Magerl, Brooks and anterior transarticular screw fixation through C 2 vertebral body. TARP's C 1 and C 2 screws were strong enough for atlanto-axial arthrodesis. TARP's biomechanical performance was excellent.

Objective To provide anatomical profile of the cranio-cervical region for the surgical treatment of ventral atlantoaxial lesions through transoropharyngeal approach.Methods Ten fresh specimens of craniocervical region were dissected layer by layer with microsurgical technic in accordance with the transoropharyngeal approach for the surgical treatment of atlantoaxial lesion, with special attention to anatomical stratification of pharyngeal posterior wall, the course of the vertebral artery, anatomical relation between the atlas and the axis, and anatomical parameters pertaining to internal fixation for the atlantoaxial joint. Results Pharyngeal posterior wall consisted of two layers (mucosa and prevertebral fascia) and two spaces (posterior interspace of pharynx and anterior interspace of vertebrae). Through anterior transoropharyngeal approach, the region between the anterior rim of the foramen magnum down to C 3 could be exposed. The distance between the vertebral artery and midline of the atlar and axis was 25.2?2.3mm(20.4-29.7mm) and 18.4?2.6mm(13.1-23.0mm) respectively. The exposed areas of the atlas and axis were 39.4?2.2mm(36.2-42.7mm) and midline was 39.0?2.1mm(35.8-42.3mm), respectively. The distance(a) between the two screw inserting points on the atlas (middle point of C 1 lateral mass) was 31.4?3.3mm(25.4-36.6mm). The vertical distance(b) between the connecting line of two screw inserting points on the atlas and that of two screw inserting points on the axis (3-4mm lateral to the midline of C 2 vertebra) was 18.7?2.7mm(14.9-23.2mm). The odds of a/b ranged from 1.5 to 1.7. Conclusion Atlantoaxial surgery through transoropharygeal approach is safe and feasible. The approach is suitable for internal fixation of anterior atlantoaxial joint, and the design of the plate should be based on the above data.

Objective To study the feasibility and clinical results of C2, 3 pedicle-lateral mass plate fixation in the treatment of unstable Hangman's fractures. Methods From March 1999 to July 2005, 25 cases of unstable Hangman's fracture were treated surgically using the C2, 3 pedicle-lateral mass plate. All the cases were followed up for the healing of bone and function of the cervical vertebrate. Results The average follow-up period was 38 months. Twenty-three cases had a perfect reduction. Three cases had kyphosis deformity. There were no other complications related to the operation. AH the cases had a perfect early fusion of the C2 pedicle isthmus and long-term stability of C2, 3 intervertebral space. The clinic results were good. Conclusion Since the C2, 3 pedicle-lateral mass fixation can provide immediate reduction and satisfactory biomechanical stability, it is a good device for unstable Hangman s fractures.