AIM: To determine the effect of phacoemulsification and intraocular lens (IOL) implantation for angle closure glaucoma previously treated by laser iridotomy.METHODS: Thirty-nine patients(39 eyes )with angle closure glaucoma previously treated by laser iridotomy and cataract were divided into two groups according need for anti-glaucoma medications for controlling intraocular pressure (IOP) or not. All the patients underwent phacoemulsification and foldable IOL implantation and were followed up 3 months postoperatively.RESULTS: The best-corrected visual acuity(BCVA) of both groups improved significantly (P<0.05). The post-operative IOP of group I at 3 months was 15.72±3.02mmHg,and that of group Ⅱwas 16.30±3.81mmHg. The IOP of both group decreased significantly(P<0.05). The central anterior chamber depth of group I was deepened from 1.64±0.45mm preoperatively to 3.21±0.41mm at 3 months postoperatively,group Ⅱ was deepened from 1.92±0.52mm preoperatively to 3.18±0.39mm at 3 months postoperatively. The postoperative central anterior chamber depth of both groups increased significantly(P<0.05).Anterior chamber angle was much wider postoperatively.CONCLUSION: Phacoemulsification and IOL implantation was effective for angle closure glaucoma previously treated by laser iridotomy,and can improve visual acuity and completely relieve the pupillary block of angle closure glaucoma.

Objective To discuss the value and experience of the percutaneous vertebroplasty (PVP)in the treatment of vertebral body compression fracture(VCF)in aged osteoperosis.Methods PVP was performed in 44 cases with VCF including 28 with single vertebral compressed fracture,12 with double compressed fracture and four with triple compressed fracture,with 67 vertebrae,for clinical and radiologieal evaluation.Results The mean follow-up was 15 months(4-23 months).There could be seen immediate relief of pain in 40 cases,out-of-bed activities at operation day in 19 and out-of-bed activ- ities at second day after operation in 25.Postoperative X-ray showed uniformly distributed bone cement in the vertebral,without leakage.Conclusion PVP is a recommendable method for VCF,for it has ad- vantages of pain relief,vertebrae stabilization,minimal invasion and minor complications.

OBJECTIVETo investigate the treatment for traumatic intervertebrae disk herniation in cervical thoracic junction.

METHODSFrom 2003 to 2008, there were 10 patients with trautimatic intervertebral disk herniation in cervical thoracic junction, which included 6 males and 4 females, aged from 23 to 66 years (means 41.5 years). All of them were performed through the transforminal approach combined with internal fixation. After operation all patient underwent hyperbaric oxygen treatment. The function of spine was evaluated by JOA score system.

RESULTSAll patients were followed up for 8 to 16 months(means 13 months). All patients got recovery of spine function to some extent except one case with complete spine damaged. The JOA scores was improved from (8 +/- 3) before operation to (15 +/- 2) after operation.

CONCLUSIONEarly and effective treatment by transforminal operation could be helpful for the recovery of spine function.

Adult ; Aged ; Cervical Vertebrae ; injuries ; surgery ; Female ; Fracture Fixation, Internal ; methods ; Humans ; Intervertebral Disc Displacement ; surgery ; Male ; Middle Aged ; Thoracic Vertebrae ; injuries ; surgery

OBJECTIVETo discuss the reasons for the operation performed on 13 patients with upper cervical disease and to explore the management and prevention of upper cervical disease.

METHODSThirteen patients with upper cervical disease were retrospectively reviewed. The reason for of reoperations on these patients were analyzed. The measures to reduce upper cervical operational complication and bad prognosis were discussed to avoid reoperations.

RESULTSThe reasons for reoperations included 9 cases with unstable or re-dislocated atlantoaxial joint, 10 cases with residual spinal cord compression, 1 case with malposition of odontoid screw, 1 case with adjacent cervical spine regression, 1 case with occipital-cervical fusion failure, 1 case with spinal cord injury during operation, 1 case with bone-plant slipped into canales spinalis, and 1 case with demand to take out internal fixation for aggravated symptom.

CONCLUSIONSThe common reasons for upper cervical reoperations were due to instability or redislocation of atlantoaxial joint and residual of spinal cord compression. Some measures such as reducing operate miss, using firm internal fixation and decompressing were advisable to decrease the incidence of reoperations.

Adolescent ; Adult ; Atlanto-Axial Joint ; Cervical Vertebrae ; surgery ; Decompression, Surgical ; Female ; Humans ; Joint Instability ; etiology ; prevention & control ; surgery ; Male ; Middle Aged ; Postoperative Complications ; etiology ; prevention & control ; surgery ; Reoperation ; statistics & numerical data ; Spinal Cord Compression ; etiology ; prevention & control ; surgery ; Spinal Fusion ; Young Adult

OBJECTIVETo provide anatomical data for transoral atlantoaxial reduction plate internal fixation.

METHODMicrosurgical dissecting was performed on 10 fresh craniocervical specimens layer by layer according to transoral approach. Stratification of posterior pharyngeal wall, course of vertebral artery, adjacent relationships of atlas and axis and correlative anatomical parameters of internal fixation to atlantoaxial joint were observed.

RESULT(1) Posterior pharyngeal wall consisted of 2 layers and 2 interspace: mucosa, anterior fascia of vertebrae, posterior interspace of pharynx and anterior interspace of vertebrae. (2) The range from anterior rim of foramen magnum to C3 could be exposed by this approach. (3) The distance between the vertebral artery at atlas and midline was (25.2 +/- 2.3) mm and that between the vertebral artery at axis and midline was (18.4 +/- 2.6) mm. (4) The width of atlas and that of axis could be exposed respectively to (39.4 +/- 2.2) mm and (39.0 +/- 2.1) mm. The distance (a) between 2 atlas screw inserting points (center of anterior aspect of C-1 lateral mass) was (31.4 +/- 3.3) mm. The vertical distance (b) between the connecting line of 2 atlas screw inserting points and that of 2 axis screw inserting points (at the central part of the vertebrae which was 3 - 4 mm lateral to the midline of C-2 vertebrae) was (18.7 +/- 2.7) mm. The odds of a/b was 1.5 approximately 1.7.

CONCLUSIONSAnterior atlantoaxial plate internal fixation through transoral approach is suitable and feasible. The design of the plate should be based on the above data.

Atlanto-Occipital Joint ; anatomy & histology ; surgery ; Bone Plates ; Cervical Vertebrae ; anatomy & histology ; surgery ; Equipment Design ; Humans ; Microsurgery ; Oropharynx ; anatomy & histology ; Spinal Fusion ; instrumentation ; methods

Adult ; Female ; Hepatitis B, Chronic ; complications ; physiopathology ; Humans ; Liver ; physiopathology ; Liver Function Tests ; Male ; Retrospective Studies ; Severe Acute Respiratory Syndrome ; complications ; physiopathology

OBJECTIVEto evaluate the risk factors for postoperative pulmonary complications following transoral operation for the atlanta-axis disorders.

METHODStotal 104 cases were collected from January 2005 to June 2009. Twelve variables among patients with PPCs and without PPCs were analyzed by logistic regression analysis.

RESULTSthe incidence of postoperative pulmonary complications following transoral operation for the atlanta-axis disorders was 22.1% (23/104). There was significantly difference in 9 variables between patients with PPCs and without PPCs, and 5 variables as serum albumin < 35 g/L (OR = 15.185, P = 0.003), tracheotomy (OR = 32.254, P = 0.015), Frankle grade (OR = 8.866, P = 0.001), the duration of intubation > 4 d (OR = 7.934, P = 0.002), the duration of surgery > 6 h (OR = 16.889, P = 0.006) were found to be significantly related to the development to postoperative pulmonary complications by multivariate analysis.

CONCLUSIONserum albumin < 35 g/L, tracheotomy, Frankle grade, the duration of intubation > 4 d, the duration of surgery > 6 h are the risk factors for postoperative pulmonary complications following transoral operation for the atlanta-axis disorders.

Adolescent ; Adult ; Aged ; Axis, Cervical Vertebra ; surgery ; Cervical Atlas ; surgery ; Female ; Humans ; Logistic Models ; Lung Diseases ; etiology ; Male ; Middle Aged ; Mouth ; surgery ; Multivariate Analysis ; Postoperative Complications ; etiology ; Risk Factors ; Young Adult

OBJECTIVETo study the relevant position of C(2) pedicle to C(2) inferior articular process, set up a technique of C(2) pedicle screw placement with the inferior articular process of axis as an anatomic landmark.

METHODSFifty C(2) bone specimens were used to measure the distance from the sagittal midline to the medial border, the midpoint and the lateral border of C(2) inferior articular process or C(2) pedicle; the width and the height of the C(2) pedicle were also evaluated. The anatomic relation between the measurements data of C(2) pedicle and that of C(2) inferior articular process were analyzed, and the technique of C(2) pedicle screw fixation was established.

RESULTSThe medial border of C(2) inferior articular process was averaged (3.67 +/- 0.41) mm lateral to that of C(2) pedicle, and the midpoint C(2) inferior articular process was averaged (1.15 +/- 0.44) mm lateral to the lateral border of C(2) pedicle, respectively. Using the C(2) inferior articular process as landmark, two techniques was established for C(2) pedicle screw placement. The entry point of method A was located in 2 mm medial and superior to the central point of C(2) inferior articular process; the entry point of method B was at the crossing point of the medial border C(2) inferior articular process with the superior quarter of C(2) inferior articular process.

CONCLUSIONSThere is a steady anatomic relation between C(2) pedicle and C(2) inferior articular process, the C(2) inferior articular process could be as a convenient key anatomic landmark to determine the location of C(2) pedicle and the position of C(2) pedicle screw entry point.

Axis, Cervical Vertebra ; anatomy & histology ; surgery ; Humans ; Spinal Fusion ; methods

OBJECTIVETo design a clinically applicable transoralpharyngeal atlantoaxial reduction plate (TARP), introduce the operation procedure, and evaluate its preliminary clinical effects.

METHODSA novel TARP system, including butterfly titanium alloy plate, self-locking screws, atlantoaxial reductor and other operational instruments was developed. This system was applied clinically on five patients with irreducible atlantoaxial dislocation of congenital or traumatic origin. During operation, the reduction was completed by the combined action of the plate and the atlantoaxial reductor after transoral joint release and cord decompression. Bone graft granules were implanted between the bilateral atlantoaxial joints and TARP was used to immobilize subsequently the atlas and axis.

RESULTSClinical application demonstrated that TARP could induce instant reduction and that the method was operationally feasible and its postoperational effect was satisfactory.

CONCLUSIONSThe design of TARP is novel. The operational procedure is simple and easy to use. Furthermore, instant reduction can be completed during the operation and the fixation is relatively stable. TARP is an ideal alternative for irreducible atlantoaxial dislocation and may have excellent prospects for further clinical applications.

Adolescent ; Adult ; Atlanto-Axial Joint ; surgery ; Bone Plates ; Bone Screws ; Decompression, Surgical ; methods ; Equipment Design ; Female ; Humans ; Internal Fixators ; Joint Dislocations ; surgery ; Male ; Mouth ; surgery ; Spinal Fusion ; methods

OBJECTIVETo study relevant anatomical features of the structures involved in transoral atlanto-axial reduction plate (TARP) internal fixation through transoral approach for treating irreducible atlanto-axial dislocation and providing anatomical basis for the clinical application of TARP.

METHODSTen fresh craniocervical specimens were microsurgically dissected layer by layer through transoral approach. The stratification of the posterior pharyngeal wall, the course of the vertebral artery, anatomical relationships of the adjacent structures of the atlas and axis, and the closely relevant anatomical parameters for TARP internal fixation were measured.

RESULTSThe posterior pharyngeal wall consisted of two layers and two interspaces: the mucosa, prevertebral fascia, retropharyngeal space, and prevertebral space. The range from the anterior edge of the foramen magnum to C(3) could be exposed by this approach. The thickness of the posterior pharyngeal wall was (3.6+/-0.3) mm (ranging 2.9-4.3 mm) at the anterior tubercle of C1, (6.1+/-0.4) mm (ranging 5.2-7.1 mm) at the lateral mass of C(1) and (5.5+/-0.4) mm (ranging 4.3-6.5 mm) at the central part of C(2), respectively. The distance from the incisor tooth to the anterior tubercle of C(1), C(1) screw entry point, and C(2)screw entry point was (82.5+/-7.8) mm (ranging 71.4-96.2 mm), (90.1+/-3.8) mm (ranging 82.2-96.3 mm), and (89.0+/-4.1) mm (ranging 81.3-95.3 mm), respectively. The distance between the vertebral artery at the atlas and the midline was (25.2+/- 2.3) mm (ranging 20.4-29.7 mm) and that between the vertebral artery at the axis and the midline was (18.4+/- 2.6) mm (ranging 13.1-23.0 mm). The allowed width of the atlas and axis for exposure was (39.4+/-2.2) mm (ranging 36.2-42.7 mm) and (39.0+/-2.1) mm (ranging 35.8-42.3 mm), respectively. The distance (a) between the two atlas screw insertion points (center of anterior aspect of C(1) lateral mass) was (31.4+/-3.3) mm (ranging 25.4-36.6 mm). The vertical distance (b) between the line connecting the two C(1) screw entry points and that connecting the two C(2) screw entry points (at the central part of the vertebrae, namely 3-4 mm lateral to the midline of C(2) vertebrae) was (21.3+/-2.7) mm (ranging 19.4-24.3 mm), with an a/b ratio of 1.3-1.5. The screws of TARP had a lateral tilt of 12.2 degrees+/-0.4 degrees(ranging 10.2 degrees-14.6 degrees) at C(1) and a medial tilt of 7.3 degrees+/-0.3 degrees (ranging 5.1 degrees-9.4 degrees) at C(2) relative to the coronal plane.

CONCLUSIONSAn atlanto-axial surgery through transoral approach is safe and feasible. This approach is suitable for an anterior TARP internal fixation, and the design of the internal fixation system should be based on the above anatomical data.

Atlanto-Axial Joint ; anatomy & histology ; surgery ; Bone Plates ; Bone Screws ; Cadaver ; Decompression, Surgical ; methods ; Humans ; Internal Fixators ; Joint Dislocations ; surgery ; Mouth ; surgery ; Spinal Fusion ; methods ; Vertebral Artery ; anatomy & histology