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. [

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.

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). However, there was significant difference between the "open-window" or hemilaminectomy group and total laminectomy group. The time of returning to work and the rate of returning to previous work were 4.3 months and 84.6% in "open-window" group, 4.6 months and 86.4% in hemilaminectomy group and 4.4 months and 77.8% in total laminectomy group respectively. The height loss of involved disc spaces was discovered in the postoperative radiographs in all the patients. However, no segmental instability was found in the majority of these patients. Conclusion 1) "Open-window" or hemilaminectomy may achieve satisfactory long-term results for treatment of lumbar disc herniation. 2) No definite correlation exists between the height loss of involved disc space and segmental instability or nerve root entrapment. 3) Discectomy is still a reliable and effective surgical procedure for the treatment of lumbar disc herniation before the reliability of any disc replacement is confirmed in the long-term follow-up survey.

Objective To introduce the indications and surgical technique of pedicle subtraction osteotomy (PSO) for patients with rigid kyphotic scoliosis. Methods Fifty-eight consecutive patients (21 males, 37 females) with rigid kyphotic scoliosis were operated with PSO at the apical vertebra. The average age was 14.1 years (ranged from 4 to 27 years). Among them, 31 were congenital deformity while 26 with idiopathic scoliosis and 1 with neurofibromatosis scoliosis. 9 had previous surgery history. The average preoperative Cobb's angle of scoliosis and kyphosis was measured as 83.7? and 78.2? on standing films and as 71.1? and 76.3? on the distraction films. On the bending films, scoliosis and kyphosis were corrected by 12.4% and 23.8% respectively. The associated neurologic deficits were observed in 14 patients, bony or fibrous septum in the canal was found in 6 patients on the preoperative CT or MRI. All patients underwent pedicle subtraction osteotomy at the convex side of the apical vertebra with segmental pedicle screw fixation or Luque instrumentation. The level of osteotomy varied from T8 through L1. Results Most patients were improved in terms of pain and radiographic examinations. The average follow-up period were 26.7 months in 49 cases (ranged from 5 to 69 months). The average residual angle of scoliosis and kyphosis was 30.0? and 21.3? respectively. The average correction rate of scoliosis and kyphosis was 64.2% and 63.5% respectively. The complete neurologic recovery was obtained in 11 and partial recovery in 2 at three months postoperatively. One case showed no improvement 12 months after surgery. No patients developed severe complications while 2 had pneumonia(3.4%), 2 had superior mesenteric artery syndrome (3.4%) and 5 had temporary dysfunction of one or both lower extremity (8.6%). The loss of correction was 1.8% at one-year follow-up. Conclusion Pedicle subtraction osteotomy is a reliable technique for severe and rigid kyphotic scoliosis both in adolescents and adults, and for severe congenital deformities and revision surgery. With pedicle subtraction osteotomy at the apical vertebra and segmental pedicle screw fixation, the rigid deformities can be corrected in one-stage, neurovascular complications can be greatly reduced, both the spinal balance and stability can be restored. The patients is able to ambulate with a brace as early as three weeks after surgery.

Objective To analyze retrospectively the results of closed reduction and static transarticular fixation with unilateral external fixators in the treatment of severely comminuted distal radius fractures caused by high-energy injuries. Methods From June 2000 to June 2003, 20 patients with 24 severely comminuted distal radius fractures were treated with closed reduction and static transarticular fixation with unilateral external fixator. The injuries involved 16 males and 4 females, the age of the patients was from 15 to 48 years (average 33.4 years). All fractures were classified as Frykman's type Ⅷ or AO type C3. The operative technique consisted of reduction of the fractures by manipulation or assisted with the external fixator, then fixed them statically. The mean duration of the union was 7.4 weeks (ranged from 6-8 weeks). After the fixator removal, the patients were encouraged to proceed for the rehabilitations, such as the elbow flexion-extension, radial abduction, ulnar adduction, and the pronation as well as the supination of the forearm. Results All patients were available at the final follow-up, the mean duration was 16 months (range, 6-42 months). At the last examination, the radiological manifestations revealed excellent in 21 fractures (17 patients) and good in 3 (3 patients) according to the Sarmiento scoring system (modified by Stewart); and the functional results displaied excellent in 16 (13 patients), good in 6 (5 patients) and fair in 2 (2 patients) according to Gartland-Werley functional assessment system. There were only 2 cases of superficial pin site infection cured with oral antibiotics and local care with mild disinfectants. 7 obvious defect of mataphysis occurred in 5 patients, but the fractures united simultaneously without any additional treatment. And there was no any complication, such as pin tract infection, fixator loosening, iatrogenic fracture and injury of the superficial radial nerve. Conclusion The technique of closed reduction by manipulations or external fixators combined with static transarticular fixation plus unilateral external fixators is an effective method for the treatment of severely comminuted distal radius fracture caused by high-energy injuries, such as falling from the height. It is unnecessary to apply supplementary bone grafts to promote bone healing. The complications can be avoided by selecting the right sites for the insertion of the pins, which is beneficial for the hand to mobilize earlier after operation.

objective To analyze the causes of early complications following posterior lumbar spinal operations and to find out about the way for prevention and treatment of those complications. Methods From 1998 to 2002, 903 patients underwent posterior lumbar spinal operations ,there were 587 males and 316 females , with an average age of 36.7years (range, 18 to 78 years ). The diagnosis of patients included lumbar disc prolapse in 483, lumbar stenosis in 145, lumbar spondylolisthesis in 96, lumbar fracture in 94, lumbar instability in 27, lumbar tuberculosis in 15 spinal tumors in 24 and reoperation in 19. All patients were evaluated by the medical history, clinical examination and review of the imaging data, and then the surgical plan was made respectively according to clinical evaluation. Results Early complications of 78 complications within 2 weeks post-operatively occurred in 76 cases with the incidence of 8.6%(78/903), in-cluding of 49 males and 27 females with an average age of 44.6 years. The complications consisted of 50 nerve root irritations(64.1%, 50/78), most of which relieved at 4 to 30 days after treatment, 9 gastrointesti-nal symptoms(11.5%, 9/78), all of which disappeared at 3 to 10 days but 2 cases needed enema, 4 hematomas of incisional wound(5.1%, 4/78), 4 cerebrospinal fluid leakages(5.1%, 4/78), 3 urinary reten-tions(3.9%, 3/78), 2 deep infections(2.6%, 2/78), 2 deep vein thrombosis(2.6%, 2/78), 2 pulmonary em-bolisms(2.6%, 2/78),1 infection of urinary tract(1.3%) and 1 fatty liquidization(1.3%, 1/78). The opera-tional procedure possible leading to surgical complication were laminectomy, nerve root dissection and in-strumentation. Conclusion Early complications may determine the clinical result of the posterior lumbar spinal operations. Besides the skilled technique, thorough pre-operative planning, close observation and proper management after operation, and early post-operative rehabilitations are of great benefit to the pre-vention and treatment of the complications.

Objective To study the pathologic characteristics and clinical significance of high intensity zone (HIZ) of lumbar intervertebral disc in the patients with discogenic low back pain. Methods 52 patients with low back pain without disc herniation underwent MRI and following discography of lumbar vertebrae. All patients previously were treated conservatively without relief of their symptoms for more than 6 months. Specimens of lumbar intervertebral discs containing HIZ in the posterior annulus from 11 patients with discogenic low back pain during posterior lumbar interbody fusion (PLIF) were collected to investigate the morphologic patterns and clinical significance. Results In all of 142 discs in 52 patients at discography, 17 discs in 17 patients presented HIZ, all showed painful reproduction and abnormal morphology with annular tears extending either well into or through the outer third of the annulus fibrosus. The histologic study of the consecutive sagittal slices in the HIZ lesions revealed that the normal lamellar structure was replaced by disorganized, vascularized granulation tissue that consisted of small round cells, fibroblasts, and newly formed blood vessels around the tears extending from the nucleus pulposus to the outer region of the annulus fibrosus. Blood vessel proliferation and inflammatory cell infiltration were seen extending along the margins of the tears into the middle and inner annulus, and sometimes the tears were bridged with granulation tissue. Ingrowth of vascularized tissue was sometimes observed to end abruptly at the junction between the inner third of the annulus and the nucleus pulposus. There was also matured scarring collagenous tissue. Conclusion The HIZ in the lumbar disc in the patients with symptomatic low back pain can be considered as a reliable marker of painful outer annular disruption.

Objective To determine the cause, prevention and management of failed spinal deformity surgery, and evaluate the indication of spinal revision. Methods Thirty-one cases of failed spinal deformity surgery were treated surgically. There were 18 males and 13 females with an average age of 14.7 years(ranged from 4 to 35 years) at the present procedures. The average number of previous surgeries for this group of patients was 1.5 times. The duration between the first surgery and revision was 13-114 months, with an average of 47.9 months. There were 16 patients with consistent back pain which became worse after movement, 5 patients with implant complication (broken, loosing, explosing), 21 patients with failure of instrumentation and deterioration of deformity, 5 patients with decreased sensory and motor function. The average preoperative angel of deformity was 75.3 degrees for scoliosis and 76 degrees for kyphosis and the flexibility was 9.8% and 25.2%, respectively. All patients underwent reconstructive surgery with segmental vertebral osteotomy and trans-pedicular fixation and fusion in one or two stages according to the location and degree of the deformity. Results The average follow-up period for this group of patients was 31.8 months in 20 cases. The postoperative correction rate for scoliosis and kyphosis was 55.2% and 67.5%, respectively. There were 4 cases (12.9%) developed temporary neural dysfunction postoperatively and were recovered within 1-3 weeks after appropriate treatment. Instrumentation failure was occurred in two cases and there was no other complication in this group. Conclusion It is might be benefit to follow the principle of spinal deformity correction, fuse with adequate bone grafting and combine with proper pedicle fixation, especially for the congenital scoliosis patients, which are the efficial methods to prevent the failure of spinal deformation surgery. The management for the patients suffered from long-time back pain, spinal pseudarthrosis or progressive aggravated deformity postoperatively should be individuated depending on the degree of deformity, flexibility of the spine and the age of patients.

[Objective]To discuss the clinical problems of meniscal transplantation based on 2 cases clinical practical results including the harvest and preserved methods of meniscal allograft,operative procedure,rehabilitation plan and side-effect,combining with literature review,so as to provide reference for further clinical practice and research.[Method]The meniscal allograft were perfumed with arthroscopic technique on 2 patients,younger than 50 years,suffering from severe meniscus tear or defect at the time of other procedures.The initial clinical results about relieving of symptoms,recovery of functions were evaluated after short time rehabilitations.[Result]There was no operative side-injury and signs of knee instability.The incisions healed well without exudation.The knee joint swelling disappeared in 6 weeks.Rejection reaction was not observed in all of laboratory tests.The VAS were 8,6 preoperatively and 3,2 postoperatively.The processes of rehabilitation were normal.[Conclusion]Considering the difficult in maintaining severe tear meniscus and the characteristics of immune evasion of meniscus,meniscal allograft may be expectable option in the future.Very many researches have provided theoretical base.The results of long-time following-up should be further observed and wany clinical problems need to be further solved.