Objective To discuss the operative efficacy of anterior- and postero-decompression plus pedicle screw instrumentation through posterior approach in the treatment of thoracolumbar burst fractures. MethodsFrom February 2006 to November 2009,28 patients with thoracolumbar burst fracture and spinal cord injury were treated with anterior-and postero-decompression plus pedicle screw instrumenattion through posterior approach.They were 19 men and 9 women,21 to 52 years of age (average,35.6 years).The fractures happened at T11 in 3 cases,at T12 in 11 cases,at L1 in 9 cases and at L2 in 5 cases.By AO classification,there were 16 cases of type A3,7 cases of type B and 5 cases of type C.By the ASIA(American Spinal Injury Association) system,6 cases were rated as grade A,12 cases as grade B and 10 cases as grade C. Bone grafting was performed according to different conditions of the patients.Results The patients were followed for 12 months to 24 months,with an average of 14 months.The X-ray examinations showed that the mean anterior border height of the injured vertebrae recovered from46.8％ ± 18.3％ of the normal height before operation to 90.3％ ± 14.2％ postoperatively; the mean posterior border height recovered from preoperative 80.4％ ± 12.4％ to postoperative 94.2％ ± 15.1％ ; and the mean cobb angle decreased from preoperative 20.1°± 11.5° to postoperative 2.7°± 2.4°. The differences between preoperation and postoperation were significant(P ＜ 0.05).According to the ASIA evaluation system,neurofunctional recovery was achieved in the cases of incomplete paralysis except in the 6 eases who had had complete spinal cord injury of Grade A. Conclusion Anterior- and posterro-decompression plus pediclescrew instrumentation through posterior approach is an effective method of treating thoracolumbar burst fractures.

Objective To ratiocinate the formula of relationship between opening size of laminoplasty and the increment of sagittal canal diameter following double-door cervical laminoplasty and to predict the increment of sagittal canal diameter and the cross sectional area of canal according to the opening size of laminoplasty.Methods Twenty patients (12 males and 8 females) with multilevel cervical spondylotic myelopathy had undergone double-door cervical laminoplasty (C3-C7 in 9 patients and C3-C6 in 11 patients,89 segments) in our institution between September 2010 and January 2013.The formula describing the relationship between the opening size of laminoplasty and the increment of sagittal diameter was deduced.The parameters of pre-and post-operative computed tomography scans of 20 patients who had undergone laminoplasty surgery were measured by picture archiving and communication system (PACS) software,and the increment of sagittal canal diameter and the cross sectional area of canal were predicted when the opening size of laminoplasty were 6 mm,8 mm,10 mm,12 mm,14 mm and 16 mm according to the formula.Results Increment of sagittal canal diameter and canal area respectively showed significant difference in the same segment laminoplasty.Increment of sagittal canal diameter between various groups in the same segment (C3-C6) showed significant difference.Increment of sagittal canal diameter between the opening size of 14 mm and 16 mm in C7 laminoplasty showed no significant difference.Increment of sagittal canal diameter was increased steadily following C3-C7 double-door laminoplasty with opening sizes of 6 mm,8 mm,10 mm,12 mm,14mm and 16mm,but the increasing trend in sagittal canal diameter diminished gradually.Conclusion Increment of sagittal canal diameter and canal area following C3-C7 laminoplasty can be accurately predicted according to the opening size of laminoplasty by this formula.The formula can help operator to perform double-door cervical laminoplasty based on accurate individual laminoplasty opening size,which prevents inadequate or excessive opening.

Objective:To investigate the risk factors for early complications after laparoscopy-assisted gastrectomy in patients with gastric cancer.Methods:The retrospective case-control study was conducted. The clinicopathological data of 196 patients who underwent laparos-copy-assisted radical gastrectomy at Peking Union Medical College Hospital from March 2016 to March 2019 were collected. There were 144 males and 52 females, aged (61±10)years. Observation indicators: (1) early complications after laparoscopy-assisted radical gastrectomy and treatment; (2) analysis of risk factors for early complications after laparoscopy-assisted radical gastrectomy.Measurement data with normal distribution were represented as Mean± SD, and measurement data with skewed distribution were represented as M( P25,P75). Count data were represented as absolute numbers. Univariate analysis was conducted using the t test, Mann-Whitney U test or chi-square test. Multivariate analysis was conducted using the Logistic regressional model. Results:(1) Early complications after laparoscopy-assisted radical gastrectomy and treatment: 51 of 196 patients had early postoperative complications, including 7 cases of grade Ⅰ according to Clavien-Dindo classi-fication system, 32 cases of grade Ⅱ, 9 cases of grade Ⅲa, 3 cases of grade Ⅲb. There was no grade Ⅳ or Ⅴ complication. There were 25 cases with abdominal complications, 7 cases with thoracic complications, 3 cases with internal/catheter related complications and 16 cases with other unclassified complications. All patients with complications were improved after symptomatic and supportive treatments. (2) Analysis of risk factors for early complications after laparoscopy-assisted radical gastrectomy: results of univariate analysis showed that the lymphocyte count, neutrophil-to-lymphocyte ratio, radiotherapy, operation time, volume of intraoperative blood loss, T stage, lymph node metastasis were related factors for early complications after laparoscopy-assisted radical gastrectomy in patients with gastric cancer ( Z=?2.048, χ2=6.385, 4.168, 8.068, 6.336, 12.497, 7.522, P<0.05). Results of multivariate analysis showed that the neutrophil/lymphocyte ratio ≥1.96, operation time ≥222 minutes, and lymph node metastasis were independent risk factors for early complica-tions after laparoscopy-assisted radical gastrectomy in patients with gastric cancer ( odds ratio=2.279, 2.245, 2.226, 95% confidence interval as 1.149-4.519, 1.116-4.517, 1.125-4.402, P<0.05). Conclusions:The abdominal complications are the most common early complications after laparoscopy-assisted radical gastrectomy. The neutrophil-to-lymphocyte ratio ≥1.96, operation time ≥222 minutes, and lymph node metastasis are independent risk factors for early complications after laparoscopy-assisted radical gastrectomy in patients with gastric cancer.