Objective To prevent wrong diagnosis and treatment of chronic inflammatory demyelinating polyneuritis(CIDP) by analyzing the clinical characteristics of CIDP and spine degeneration disorders. Methods In order to distinguish CIDP from spine degeneration diseases, we retrospectively reviewed 16 CIDP patients from December 2000 to December 2003 (male 10, female 6; range 38-58 years old, mean 49.1 years old) who were misdiagnosed as spine degeneration diseases. The duration of the disease was 2 months to 2 years and 8 months, with an everage of 106 months. All clinical data of the 16 patients were analyzed. The data included clinical manifestation, physical examination, protein content of cerebrospinal fluid (CSF) and upper-lower extremity electrophysiologic study(EPS). Comparing the clinical charateristics of CIDP with those of spine degeneration disease. Results All 16 patients of CIDP sufferred limbs sensory disturbance or abnormality, walking difficulty. Upper or lower extremity were involved at equal pace and symmetry; limb tendon reflexes weakened or dissappeared, but limbs muscular atrophy were not significant. X-ray showed degeneration of cervical or thoracic and lumbar spine; MRI showed that there were disc herniation in different intervertebral. The content of protein of CSF remarkably increased(mean 479.9 mg/L). There were significant deviation compare to normal. Electrophysiology study found that sensory nerve action potential(SNAP) wave amplitude were descending; motor nerve conduction velocity(MNCV) were slower. Conclusion We could rightly diagnose and distingnish CIDP from spine degeneration diseases by analyzing clinical manifestation, physical examination, cerebrospinal fluid and electrophysiological study. [

Among all the road traffic injuries(RTI ),limb and spine fractures have a very high inci-dence.They can be caused by a variety of traumatogenic mechanisms,of whi ch crash is the most common.The distribution of types of fracture in RTI assumes a centrifugation-like p attern.Multiple fractures,homola teral limb injuries and violence-conducted in juries are common.The priority in RTI emergency is to treat serious concu rrent injuries and life-threatening comp lications.Only after the overall condition of the victim get stabilized can open injuries and fractures be treated ac tively.To treat victims of fracture s caused by RTI,especially those with a poor overall condition or an old age,appl ication of external fixation,espec ially a unilateral one,is a good consider-ation.And application of lockable i ntramedullary nailing to treat long tubular bone fractures has proved ve ry satisfactory.As for pelvis fractur es caused by RTI,external fixation c an be used initially while massive hemor-rhage resulted from the injury shoul d be treated vigorously.Internal fixation should be adopted as soon as th e vital signs get stabilized.To treat spine and spinal cord injuries,titanium a lloy is the first choice for fixation material.In most cases,anterior cervical fix ation and fusion with steel plate and screw is advisable for treatment of f ractures of cervical spine,while posterior i mmobilization with screw through pedicle of vertebra is usually suggested for treatment of fracture-dislocation of thoracolumbar vertebrae.

0.05). Conclusion Our finding suggests that it is reasonable to operate on elderly patients with lumbar stenosis who are different in body mass index, because little relation has been found between body mass and surgery outcome.

Objective To study the short-term outcome of transforaminal posterolateral endoscopic discectomy and radiofrequency annuloplasty in patients with discogenic low back pain. Methods A total of 25 patients with discogenic low back pain,who were diagnosed by provocative discography,received transforaminal posterolateral endoscopic discectomy and radiofrequency annuloplasty in our hospital. The VAS scores determined before and 6 months after the operation were compared in the patients. Their MacNab scores were also evaluated at 6 months postoperation. Results After the surgery,2 patients who had ruptured intervertebral discs (L5-S1) developed sunburn syndrome,and then was relieved by pulsed electrical stimulation for one week. The patients were followed up for 6-10 months,during which no other postoperative complications occurred. The mean VAS score of this series decreased significantly after the treatment,and kept being reduced in 6 months [preoperation:6.24?0.97,1,3,6 months after the operation:0(0~2); Kruskal-Wallis rank-sum test,H=61.680,P=0.000]. Four patients showed lower limbs pain before the treatment and were relieved after the surgery. The evaluation of MacNab score showed excellent in 11 pateints,good in 12,and fair in 2,suggesting an effective rate of 92.0%(23/25). Conclusions Transforaminal posterolateral endoscopic discectomy plus radiofrequency annuloplasty is effective for discogenic low back pain in a short term.

Objective To evaluate the clinical effectiveness of minimally invasive external fixation in the treatment of intertrochanteric fractures of the femur in high-risk patients. Methods By using a monolateral external fixator with oblique pin-insertion, we treated 77 consecutive elderly patients (mean age, 71.3) with intertrochanteric fractures of the femur associated with at least one kind of severe systemic diseases from June 1996 to June 2004. Fractures included 70 cases of anterograde intertrochanteric fracture (According to the Evans classification, there were 5 cases of type Ⅰ fracture, 11 cases of type Ⅱ, 34 type ⅢA, 9 type ⅢB, and 11 type Ⅳ.) and 7 cases of retrograde intertrochanteric fracture. A total of 8 patients were combined with multiple injuries. Results A follow-up was made for 5~60 months (mean, 24.3 months). Complete bone union was achieved in all the patients within a period of 8~20 weeks (mean, 12 weeks). Postoperatively, no non-union or coxa vara occurred. According to the Harris hip scores, 49 patients were classified as “excellent” results, 21 as “good”, and 7 as “poor” (all of which were fatal cases), the “excellent-and-good” rate being 91%. Conclusions Minimally invasive external fixation is an alternative to open internal fixation in the management of intertrochanteric fractures in high-risk elderly patients, especially suitable to those with multiple injuries.

Objective To investigate the pathological changes of bone in situ lengthening for the gunshot bone defect, and to discuss the practical feasibility and biological basis of bone lengthening in the conditions of periosteum damage. Methods The 38 canines were randomly distributed into two groups and sustained the same gunshot bone defect in the mid femoral diaphysis. In one group, the femur were stabilized with Bastiani external fixator and 2 weeks later the fractured limb with fixation were lengthened 2-4 times per day at a speed of 0.5-1 mm/d until the normal length was reached. The control group only had external fixation without lengthening. 3, 6 and 12 weeks after injury, the canines were given 99mTc MDP and got radionuclide examination under SPECT (ADAC company, USA.). Pathological and X ray observation were carried out at 1, 2 ,3 ,6 and 12 weeks respectively after injury for comparison between two groups. Results The X ray measurement showed that the length of callus distraction in the bone lengthening group increased by (2.82?0.94)cm and the relative lengthening of bone is 19.3% (15.8%-21.4% ), compared with normal femur on the same X ray film. The count of radionuclide increased gradually at the region of bone defect in the lengthening group. While in the fracture ends, no significant difference was found in the development pattern through each radionuclide observation phase between two groups. The main mode of osteogenesis was endochondral ossification and the bone defect area was enriched by chondrocyte in the bone lengthening group. Conclusion There are no obvious negative influence on bone turnover and local blood flow in the bone lengthening for gunshot bone defect. The remained periosteum and bone fragment under gunshot injury may have important role in the progression of osteogenesis. The neogenetic capillary provided not only blood supply for healing of bone but also source of osteocyte for bone lengthening in the case of the periosteum and blood circulation damaged with gunshot wound.

To observe the local microcirculation changes in primary bone lengthening for gunshot bone defect treated by external fixators, the experimental study was carried out by using canine model of gunshot bone defect of extremities. 16 mongrel dogs were randomly divided into 2 groups, external fixators were used to distract early callus in one group and plaster was used for immobilization in the other group. The local microcirculation in the two groups was measured. The results showed: (1) Different from the normal fractures, the local blood flow of gunshot fractures was reduced in the first 3 days and then increased, at the 6th week it was close to the normal level. (2) There was no significant difference in the restoration of blood flow between the groups of external fixation and plaster immobilization. It is suggested that primary bone lengthening for gunshot bone defect by external fixators has no adverse effect on the restoration of the local blood flow.

Purpose: Through the analysis of 202 cases of spondylolisthesis treated with surgery, the different types of surgical procedures were reevaluated. Material and Method: Patients with spondylolisthesis were divided into 3 groups based upon their pathology and different surgical procedures were used accordingly. The results were evaluated after follow-up of more than one year. Group Ⅰ consisted of 38 patients with degenerative spondylolisthesis with back pain and isthmic spondylolisthesis of less than 33%; they were treated with anterior intervertebral body fusion. Group Ⅱ consisted of 99 cases of mild isthmic spondylolisthesis with unilateral sciatica, and were treated with semi-laminectomy and decompression of symptomatic side; interlaminar and interspinous process fusion of the opposite side was performed for 99 cases of mild isthmic spondylolisthesis with unilateral sciatica. Group Ⅲ consisted of 65 cases of spondylolisthesis more than 33% with sciatica and they were treated with decompression, reduction of sliding vertebra and posterior intervertebral body fusion. Result: In group Ⅰ, solid fusion was in 20 cases giving a fusion rate of 91%. In group Ⅱ, the satisfactory rate was as high as 91.5%. In group Ⅲ, the satisfactory rate and fusion rate reached 91.8% and 95.9% respectively. Conclusion: Reduction of spondylolisthesis could increase the fusion contact area, restore normal mechanics and saggital curve of the lumbar spine, relieve neural compression and improve the extemal appearance and function. For the surgical treatment of spondylolisthesis, the major goal should toward a solid fusion between the sliding vertebra and its adjacent vertebrae and laminectomy alone is not a procedure of choice.

Objective To describe the structure and clinical application of the single arm suspended reduction fixation device(HOIST device) for spondylolisthesis. Methods HOIST device is composed of the hauling screw, open angle screw(upholding screw), blocker, angle connective bar and blocking ring. Through the different assembly of the angle screws and the connective bar, to increase or decrease the fixation angle of the angle screw which as an upholding arm and the connective bar to meet the needs of different lumbosacral angles and hauling screw reducing distance. Twenty three patients with an average slipping rate of 25％－ 50％ , were treated with the device, and among them, intervertebral implantation of BAK was done in 5 patients and intervertebral fusion was performed in 18 patients. Results The mean duration of follow up was 10.3 months. Olisthy was reduced completely, clinical symptoms disappeared and there was no serious complications. Conclusion This device only required fixation of the slipped and its inferior adjacent vertebral body, and then it causes little influence to the movement of the lumbar spine. The arm of force of the reduction is short, so it is especially indicated for mild and moderate spondylolisthesis.

Objective To Introduce the principle, structure and observe the effects of clinical application of Scofix instrumentation. Methods Scofix instrumentation consists of different size of open up pedicle screws, open up pedicle hooks, connecting rods, blockers and devices of transverse connection. The open up pedicle screws can be inserted continuously or intermittently, fixed by the connecting rods in the scoliotic segments, and then distraction, compression and derotation manipulation can be performed to correct the spinal deformity. Thirty three patients were treated with this methods. The average age at surgery was 14.4 years. The mean preoperative Cobb angle in idiopathic and congenital scoliosis was 70 and 68 degrees,respectively. According to the degree of deformity and spinal flexibility, the correction was done at one setting or in stages. Results Postoperative Cobb angle and the corrective rate in 19 cases of idiopathic scoliosis were 29.4?and 59.1%, respectively while in 14 cases of congenital scoliosis the figures were 33.3?and 52.3%, respectively. No severe complications occurred. Conclusion Scofix instrumentation which is designed by the principle of CD instrumentation and in conformity with the spinal structural features of Chinese adolescence has the function of distraction, compression and derotation and can be used for internal fixation of scoliosis in different ages. Because of the high risk and the great difficulty, the thoracic pedicel screws should be used carefully, and can be replaced by pedicle hooks if necessary.