Objective:To analyze the effects of rational intervention on prophylactic antibiotics use in typeⅠIncision. Methods:A retrospective investigation method was used. Totally 170 cases with typeⅠIncision undergone in the hospital from April to Decem-ber 2013 were selected as the non-intervention group, and 173 cases with typeⅠIncision undergone in the hospital from April to De-cember 2014 were selected as the intervention group. The prophylactic antibiotics use, medication time, drug selection and duration of drug treatment were analyzed. Results:After intervention, the use rate of antibiotics was decreased from 67. 65% to 26. 59%, the ir-rational rate of use time was decreased from 15. 88% to 4. 63%, the irrational rate of treatment course was decreased from 30. 58% to 8. 09%, and the combination rate was declined from 10. 59% to 5. 20%. Conclusion:The rational prophylactic use of antimicrobial in type Ⅰ incision is improved through the intervention, and further efforts are still needed to improve the reasonable use.

Objective To understand the basic situation and the influencing factors of medical expenses of the inpatients in Haikou city for the government to developing a scientific control policy of medical expense or improving the existing measures for controlling the medical expense.Methods Totally 463 inpatients from 10 hospitals were conducted the questionnaire survey and the survey data were analyzed.Results The difference of medical costs constituent existed in different medical institutions and the me-dian of drug costs to the total medical costs in general hospital was 42.13%.30.02% (139/463)of the surveyed inpatients thought that the use of “new techniques,new drugs and new equipments”was the primary cause of medical costs rising.51.19%(237/463) of patients thought that the primary considered factor is “cure”when seeing a doctor.24.84%(115/463)of patients did not known the modification of medical insurance policy.46.00%(213/463)and 28.51%(132/463)of patients thought that the main responsi-bility main body for controlling the medical costs rising is government and hospital respectively.Conclusion Increasing the medical insurance policy advocacy,promoting the reform of medical insurance payment methods,strengthening the dominant position of gov-ernment control medical costs and rationally allocating the medical resources conduce to reduce the medical costs rising.

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 explore the clinical effect of posterior indirect reduction and internal fixation and laminectomy in the treatment of thoracolumbar vertebrae burst fracture complicated with spinal cord injury.Methods Eighty patients with thoracolumbar vertebrae burst fracture and spinal cord injury treated in our hospital from March 2014 to March 2015 were selected as the objects,and they were divided into reset group and laminectomy group with forty cases in each group according to surgical method.All the patients were followed up for 1 year,the lumbar function of two groups at 1 week and 1 year after operation were observed respectively,and the pain degree was observed in 1month,3 months and 6 months after operation.The amount of bleeding,operation time,hospitalization time and fracture healing time were observed.Neurological function was assessed by classification criteria of the American Spinal Cord Injury Association(ASIA),and incidence of complications was figured in the two groups.Results The anterior heights of the injured vertebra were higher than those before the operation,and the Cobb's angles were lower than those before the operation,the differences were significant(P ＜ 0.05);while there was no significant differences in the anterior heights of the injured vertebra between the two groups at 1 week and 1 year after operation(P ＞ 0.05).VAS scores of the two groups after 1 month,3 months and 6 months decreased significantly when compared with the preoperative scores(P ＜ 0.05),and VAS scores of each time in the reset group were significantly lower than those in the laminectomy group(P ＜ 0.05).The amount of bleeding,operation time,hospitalization time and fracture healing time in the reset group were less than those in the laminectomy group (P ＜ 0.05).The neurological function recovery of the two groups were significantly improved when compared with that before the operation(P ＜0.05).There was no significant difference in recovery of neurological function between the two groups(P ＞ 0.05).The complication rate was 7.50％ in the reset group,lower than 12.50％ of the laminectomy group,the difference was significant (P ＜ 0.05).Conclusion Posterior indirect reduction and internal fixation of lamina both have a certain effect in the treatment of thoracolumbar vertebrae burst fracture complicated with spinal cord injury.But posterior indirect reduction has less complications and less amount of bleeding,which is beneficial to postoperative recovery.

OBJECTIVE:To observe the protective effect of ketamine and dexamethasone on lung injury in esophageal cancer thoracotomy. METHODS:60 patients with one-lung ventilation thoracotomy were randomly divided into 4 groups:blank group (group S),ketamine group(group K),dexamethasone group(group D)and ketamine and dexamethasone group(group KD)by number. After surgery,the patient-controlled epidural anaigesia (PCEA) was used to record the concentrations of IL-6,IL-8, TNF-α with the time point of preoperative 30 min (T0),60 min after one-lung ventilation (OLV)(T1),120 min after the OLV (T2),2 h after restore double-lung ventilation(T3),the changes of respiratory index(RI)in blood gas analysis and the analgesic effect and adverse reactions in 48 h after treatment. RESULTS:There was no obvious difference between the blood pressure and heart rate in 4 groups. Compared with T0,the RI values in T1,T2 and T3 were increased;compared with group KD,the RI values in T2 and T3 in group K,group D and group S were increased;compared with T0,the concentrations of IL-6 and IL-8 in T1,T2 and T3 were increased(P<0.05);compared with group S,the concentrations of IL-6 and IL-8 in T1,T2 and T3 in group D,group F and group KD were decreased(P<0.05);compared with group KD,the concentrations of IL-6 and IL-8 in T2 and T3 in group D and group K were higher(P<0.05),there was no significant difference between group D and group K(P>0.05)and the con-centration of TNF-α in 4 groups was lower than minimum detectable concentrations;compared with group KD,the scores of anal-gesia visual analogue scale(VAS)and Prince-Henry in postoperative 48 h in group K and group S were higher(P<0.05);com-pared with group D,group S and group K,the total number of press PCEA and the total amount of analgesic in group KD were de-creased (P<0.05) and the incidence of postoperative nausea was low (P<0.05);there was no significant difference in the inci-dence of postoperative delirium in 4 groups (P>0.05). CONCLUSIONS:Ketamine and dexamethasone can reduce the release of inflammatory mediators,decrease the RI values,increase the analgesia effect and has certain protective effect on lung injury.

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 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 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 the depression of patients with Meniere disease after surgery ,and the relationships to vertigo and the improvement of the quality of life .Methods A total of 46 patients with Meniere dis-ease and 95 patients with other diseases of otorhinolaryngology (as control) were enrolled in this retrospective stud-y .They underwent operations between 2013 and 2015 .They finished self -rating depression scales ,Meniere dis-ease outcomes questionaire by snail mail .They were asked about the frequencies of vertigo before and after surgery . The gender ,age and postoperative course in the control group were matched to those of in the Meniere group .The relationships among vertigo ,the improvement of the quality of life and postoperative depression were compared .Re-sults In the Meniere group ,69 .77％ of patients did not have depression ,while 13 .95％ were with mild depres-sion ,16 .28％ with moderate ,none with severe .Depression was more severe in the Meniere group than in the con-trol group .There were no obvious linear relationships between vertigo and depression or between quality of life and depression .There was no statistical difference in depression of patients with different vertigo frequencies .Conclusion There is still a certain degree of postoperative depression in near 30％ of patients with Meniere disease after sur-gery .This may not be related to vertigo nor the quality of life .