With the development of medical science, the level of minimally invasive spinal surgery is becoming higher and higher. Comparing to the traditional operation, the postoperative effect is equal to it or slightly better than it, with the higher patient satisfaction. The minimally invasive spine surgery is gradually accepted by the majority of patients. However, compared with the traditional operation, minimally invasive spinal surgery requires that spine surgeon must be familiar with principles and related concepts of minimally invasive surgery of the spine, due to its higher degree of fine operating, long learning curve. Only by following these principles and ideas, can the minimally invasive spine surgery be healthy sustainable and rapid developed.

Objective:To explore the relationship of Syk and VEGF-C expression in breast cancer with lymph node metastasis . Methods:The expression of Syk and VEGF-C in 40 cases of breast cancer were determined using immunohistochemistry assay .Then, the positive rates of Syk and VEGF-C were compared with lymph node metastasis .Results:The expression rate of VEGF-C and Syk in breast cancer was respectively 77.5%(31/40), 37.5%(15/40).VEGF-C protein expression was not significant related with the tumor diameter (P>0.05) and histological grade (P>0.05), but was significantly associated with lymph node metastasis (P<0.05).Syk protein expression was not significant related with tumor diameter (P>0.05) and the histological grade(P>0.05), and was associated with lymph node metastasis (P<0.05).The difference of Syk and VEGF-C had statistics significance(P<0.05).Con-clusion:Syk and VEGF-C involved in the lymphatic invasion and metastasis , may be an important indicator of prognosis .

Characteristics found in CT and MRI of osseous hydatidosis were analyzed. The incidence of osseous hydatidosis in China, and its diagnosis and treatment were discussed. The results showed that most of osseous hydatid disease was polycystic. On CT and MRI scanning, it was shown that there were many little cysts constituting a big lesion. Scolex and cyst wall were not clearly shown. Expansive growth was its main feature. The cystic wall was shown as a linear shadow. Recurrent signs of spinal cord compression called for reoperation. The patients led an acceptable life with the disease. Surgical eradication was the main treatment,but recurrence rate was high after the operation.

To observe the clinical outcome of degenerative lumbar spondylolisthesis treated by TFC, transpedicle instrument and bone graft, transpedicle instrument and TFC, respectively, from May 1995 to Aug. 2000, 106 patients with degenerative lumbar spondylolisthesis were conservatively treated. According to Meyerding classification system of lumbar spondylolisthesis, 56 cases were classified as degree 1, 47 cases as degree 2, 3 cases as degree 3. The patients were followed up from 6 months to 10 years and 2 months, averaged 38 months. According to different operative methods, the patients were divided into 3 groups: TFC group, transpedicle instrument and bone graft group, transpedicle instrument and TFC group. Among the 31 cases in TFC group, 22 cases were followed up, the excellent rate was 95 5%. Among the 42 cases in transpedicle instrument and bone graft group, 35 cases were followed up, the anatomical reduction rate was 83%, the excellent rate was 94 8%. Among the 33 cases in transpedicle instrument and TFC group, 28 cases were followed up, the anatomical reduction rate was 81%, the excellent rate was 96 4%. According different indications, TFC and pedicle screw systems were all effective for spondylolisthesis. They had a lower complication rate. The use of spinal instrumentation is a valuable adjunct to achieve lumbosacral fusion in patients having undergone decompressive surgery for the spine.

To evaluate the diagnosis and treatment of epidural neurilemmoma in the spinal canal, the diagnostic characteritics shown by X ray, MRI and CT were analyzed in 42 patients. Furthermore, peri operative conditions, operative time, blood loss and amount of blood transfusion during the operation, operative technique, changes in functions of the spinal cord before and after the operation were also analyzed. The results showed that there was marked recovery of nerve functions after the operation. MRI together with X ray and CT were in the diagnosis of the nature and site of the lesion. Excision of the tumor was done in all the patients. Among them, in 12 patients internal fixation was done at the same time. Follow up showed that the operation achieved good results. While radiologic examinations contributed greatly to the diagnosis, the final diagnosis depended on pathological examination. Internal fixation was optional depending on different situations.

head and neck region. Postoperative recurrence rate was 42 10%, five year survival rate was 8 33%. Not a single case was found to be malignant degeneration of neurolemmoma or neurofibromatosis, nor as a result of radiotherapy. It is suggested that MNST is a primary soft tissue malignant tumor, and early complete excision is the key treatment. The biological characteristics of this tumor as revealed in this study suggest that it is different from what was reported in the foreign literature.

Objective To study the effect of fibrin gel delivered with CT g ui ded trans-laminar injection on sacral nerve root sheath cysts. Methods From Apri l 1998 to February 2001, thirty-eight cases of sacral nerve root sheath cysts we re treated by fibrin gel injection. The location of cysts consisted of 12 L5 S1, 15 S1,2, 11 S2,3. All the fibrin gel was delivered by CT guided trans-laminar i njection. Results Thirty-eight cases were followed up for 3 to 37 months (averag e 9 months). Most of the patients obtained lower back and sacral pain and sacral nerve symptom alleviation. No infection, nerve injury, recurrence and cerebrosp inal fluid(CSF) leaking occurred. According to the critia of the clinic symptom releasing and the radiographic signs, there were 17 cases (44.7%) rated as excel lent, 18 (47.4%) good and 3 (7.9%) fair, the excellent and good rate was 92.1%. Conclusion CT-guided trans-laminar fibrin gel injection is an effective economic al and mini-invasive way to treat sacral nerve root sheath cysts.

OBJECTIVE:To investigate the effects of different doses of sufentanil citrate on hemodynamic indexes and stress response indexes of Crouzon syndrome children with craniofacial reconstruction. METHODS:60 cases of Crouzon syndrome under-going craniofacial reconstruction were selected from our hospital during Jan. 2010-Jan. 2016,and then randomly divided into group A,group B and group C,with 20 cases in each group. 3 groups were given pump injection of Propofol injection 4-8 mg/(kg·h)for anesthesia induction+Sufentanil citrate injection [group A 0.3 μg/(kg·h),pump injection;group B 0.6 μg/(kg·h),pump injection;group C 1.0 μg/kg,iv,0.5 h/time] for anesthesia maintenance, Cisatracurium besilate for injection 0.1 mg/kg,iv,every 40 min, drug withdrawal 5 min before the end of surgery. The hemodynamic indexes(MAP,HR)and stress response indexes(ACTH,cor-tisol)were observed in 3 groups at different time points as well as the occurrence of ADR. RESULTS:MAP levels of group C at 5 min after skin incision,1 h after operation and immediately at the end of surgery were significantly higher than before anesthesia, while those of group B were significantly higher than group C at same time points. HR of group A at 1 h after surgery and that of group B at 5 min after skin incision and 1 h after surgery were significantly higher than before anesthesias;HR of group B at 1 h after surgery was significantly lower than that of group A,and its HR at 5 min after skin incision and 1 h after surgery were signifi-cantly lower than those of group C. ACTH levels of 3 groups at 5 min after skin incision,1 h after surgery and immediately after the end of surgery were significantly higher than before anesthesia. ACTH levels of group B at 5 min after skin incision,1 h after surgery and immediately after the end of surgery were significantly lower than those of group A and C,and the group A was signifi-cantly lower than the group C at same time points. Cortisol levels of group A at 1 h after surgery,and those of group C at 5 min af-ter skin incision,1 h after surgery and immediately after the end of surgery were significantly higher than before anesthesia. Corti-sol levels of group B at 1 h after surgery were significantly lower than those of group A;cortisol levels of group A at 5 min after skin incision and immediately after the end of surgery and those of group B at 5 min after skin incision,1 h after surgery and imme-diately after the end of surgery were all significantly lower than those of group C. There were statistical significance all above(P<0.05). No obvious ADR was found in 3 groups. CONCLU-SIONS:Pump injection of sufentanil citrate 0.6 μg/(kg·h) can maintain analgesic effect of Crouzon syndrome children with craniofacial reconstruction,can keep hemodynamics sta-ble and effectively inhibit stress response during surgery with good safety.

BACKGROUND: Homocysteine(HCY) is emerging as an independent risk factor for atherosclerosis. Its damage to the structure and function of endothelial cell(EC) is seemingly an important mechanism that leads to atherosclerosis.OBJECTIVE: To investigate the effect of HCY on fibrinolysis in elderly patients with coronary heart disease(CHD).DESIGN: A case-controlled study based on CHD patients and normal people as control group.SETTING: Department of general internal medicine and department of cardiology in a university hospital.PARTICIPANTS: The study was completed in the Department of Gerontology Internal Medicine and Department of Cardiology, Beijing Chaoyang Hospital, Capital University of Medical Science. Altogether 177 inpatients and outpatients from this hospital during December 2001 to August 2003 were selected and divided into three groups according to the results of coronary angiography(CAG): CHD group( n = 91 ) with 50 males and 41 females with the mean age of(66 ± 6) years, negative CAG group( n = 86) with 43 males and 43 females with the mean age of(60 ± 6) years, and normal control group( n = 85) with 43 healthy males and 42 healthy females with the mean age of(55± 5) years.METHODS: Peripheral blood samples were collected. ELISA double antibody method was applied to test tissue-type plasminogen activator(t-PA), plasminogen activator inhibitor-1 (PAI-1) and yon Willebrand factor(vWF). HCY was assayed with EIA method and the ratio of PAI-1 to t-PA was calculated.MAIN OUTCOME MEASURES: HCY level, t-PA, PAI-1 and vWF activities, and the ratio of PAI-1 to t-PA.RESULTS: The levels of HCY, PAI-1, PAI-1/t-PA and vWF in CHD group were significantly higher than those in negative CAG group and normal control group( P ＜ 0.01 ); however, the level of t-PA was significantly lower than that in control group( P ＜ 0. 01) . HCY was positively correlated with PAI-1,PAI-1 / t-PA and vWF, while it was negatively correlated with t-PA.CONCLUSION: The increase of serum HCY is accompanied with fibrinolytic dysfunction. HCY is positively correlated with PAI-1 and vWF but negatively correlated with t-PA. Therefore, HCY is a predictor for early coronary lesions,and can provide related laboratory data for the primary prevention and early treatment of CHD.

Objective To investigate the clinical value of multiband mucosectomy (MBM) for the treatment of early esophageal cancer and precancerous lesions.Methods The clinical data of 43 patients with early esophageal cancer or precancerous lesions (including 13 cases of early esophageal cancer and 30 cases of precancerous lesion) who were admitted to the Tengzhou Central People's Hospital from January 2010 to January 2011 were retrospectively analyzed.A total of 51 lesions were confirmed by preoperative endoscopy and mucosal biopsy,and then were treated by MBM.Results A total of 52 MBM procedures were carried out,and 180 lesions were resected.The sizes of the lesions ranged from 10 mm × 8 mm to 25 mm × 23 mm,and the mean operation time was (37 ± 5)minutes.The complete resection rate was 92.2％ (47/51).The submucosal layer of 1 patient was invaded by squamous cell carcinoma postoperatively,and the patient was treated by operation;1 patient wth squamous epithelium carcinoma was treated by radiotherapy at 2 weeks after MBM ; the other 2 lesions were treated by argon plasma coagulation (APC).Four lesions with bleeding were detected during 52 MBM procedures,and no esophageal perforation was detected during MBM.Early complications consisted of delayed bleeding (1 patient,cured by APC) and slight esophageal stenosis (1 patient,recovered at postoperative month 6).The accurate rate of pathological examinations was 51.0％ (26/51).Forty-three patients were followed up for 1 year,3 patients with tumor recurrence were treated by MBM or APC.No death occurred during the followup.Conclusion MBM is a safe and effective technique for the treatment of early esophageal cancer and precancerous lesions.