Objective: We examined the cause、level of pathology、onset of symptoms、time taken to treatment and outcome of 14 patients with cauda equina syndrome(CES) to determine how these factors influenced the eventual outcome.Methods:14 patients with CES treated at our hospital between 1991 and 1997 underwent laminectomy followed by bilateral decompression.The mean time of followup was 35 months(range 22～48months).Logistical regression analysis was used to manage the data.Results:Out of 14 patients,11 had satisfactory recovery at 2 years postdecompression;3 patients were left with some residual dysfunction.Conclusion:There was a clear correlation between delayed decompression and the poor overall outcome,as well as the presence of perineal anaesthesia and significant sphicter dysfuncation.

[Objective]A new device of gear-distraction plate (GDP) for spine reduction and fixation was designed and its biomechanical characteristics was evaluated.[Method]The GDP implants were made of titanium alloy (TC4,Ti6AL4V) and the instruments were made of stainless steel after design.Eighteen fresh calf lumbar specimens were randomly divided into three groups, the GDP group had a biomechanical test contrast to control group(CD, Steffee) in load-responsive change, load-displacement, strength, stiffness, torsion intensity and ultimate strength.[Result]Results It is better than control group in load-responsive change, load-displacement, strength, stiffness, torsion intensity and ultimate strength, there was a significant difference between them (P

[Objective]To investigate results of surgical treatment of intradural tumors of the cervical spinal cord.[Method]Twenty-one cases with cervical intradural tumor were treated surgically under posterior approach from 1999 to 2005,all patients were performed cervical laminae resection before tumor resection,and some received internal fixation.All patients were followed up for 8 months to 38 months respectively.All the clinical materials were analyzed retrospectively.[Result]All patients survived the operation,symptoms disappeared 13,relieved 7 and deteriorated 1.Total resection in 15 cases,subtotal 4 cases and partial 2 cases.[Conclusion]To succeed the operation,it is very important to make clear the location and size of the tumor and the relationship between the tumor and spinal cord;in order to gain total resection of tumor,both careful protection of spinal cord and vertebral artery and intraspinal cannal veins are essence.

BACKGROUND: The most commonly used rod-screw posterior spinal fixation system has some biomechanical drawbacks. The screw-plate system is more preferred for patients.OBJECTIVE: To prepare a new posterior spinal fixation system based on imaging results of distance between two pedicles,radian of spine flexion, extension and the height of intervertebral space of Chinese population.METHODS: The thoracolumbar data of 129 normal people were measured. According to the imaging measurements and relative documents, a device of gear-distraction plate (GDP) for spine reduction and fixation was designed. Eighteen fresh calf lumbar specimens were randomly divided into 3 groups, the test group was fixed by GDP and the other groups were fixed by CD and Steffee plate, respectively. The results of the displacement, strain, strength, stiffness and ultimate strength were measured under the states of vertical compression, flexion, extension and lateral bending respectively, and the results were statistically analyzed.RESULTS AND CONCLUSION: GDP could meet the need of strength and stiffness of human bodies. It showed superior to the CD and Steffee plate groups in strength and stiffness (P ＜ 0.05), with 13% or 14% torsion intensity greater than that of the CD or Steffee plate groups. The ultimate mechanical performance test showed that, the load bearing of the GDP group was greater than that of the CD and Steffee plate groups (P ＜ 0.05). The findings demonstrated that GDP for Chinese human presented with good biomechanical stability, which can promote vertebrae fracture union and prevent kyphosis relapses or vertebral height loses.

Objective To evaluate the technique and clinical effect of arthroscopic treatment of anterior cruciate ligament tibial eminence avulsion fracture with suture bridge fixation technique. Methods From May 2013 to July 2015, 18 patients with anterior cruciate ligament tibial eminence avulsion fracture were treated with arthroscopic re﹣duction and fixation by suture bridge technique. There were 12 males and 6 females with an average age of 29.8 years old (range, 9~45 years). The right knees were involved in 10 cases and left knees in 8 cases. The injury caus﹣es included traffic accident injury in 10 cases, sports injury in 5 cases and other reasons in 3 cases. 2 patients had old fracture, the others had fresh fracture. The results of Lachman and anterior drawer test were both positive. The International Knee Documentation Committee (IKDC) subject score was (53.8 ± 4.2). Based on Meyers-Mckeaver classification, there were 5 cases in typeⅡ, 10 cases in type Ⅲ and 3 cases in type Ⅳ. Results The operation time was 50~80 minutes (mean, 60.5 minutes), X-ray showed satisfactory fracture reduction after surgery. Primary healing of incision were obtained with no infection, all 18 patients were followed up for 6 ~ 31 months (mean, 18.6 months). The results of Lachman and anterior drawer test were both negative in 17 cases, the result was negative for anterior drawer test and was weakly positive for Lachamn test in 1 case. The IKDC subject score were significantly improved to (95.2 ± 3.8) at last follow-up (P< 0.05). Conclusion It could achieve early restoration of knee joint function to treat the anterior cruciate ligament tibial eminence avulsion fracture with suture bridge fixation technique because of satisfactory reduction, reliable fixation, minor trauma, and quick recovery.

Objective To study the expression of suppressor gene PTEN in gastric cancer tissues and its relationship with tumor biologic characteristics. Methods Using EnVision immunohistochemical methods, we examined the suppressor gene PTEN expression in 116 cases of gastric cancer, 35 cases dysplasia and 56 cases normal gastric mucosa specimens. Results The positive rate of PTEN (53.4 %, 62/116) was lower in gastric cancer tissue than in dysplasia (71.4 %, 25/35) and normal gastric mucosa specimens(100 %, 56/56) (P

OBJECTIVE: To explore the clinical effects of using custom-made tumor prosthesis replacement to treat malignant tumor located in the distal femur or proximal tibia. METHODS: A retrospective study of 29 cases malignant tumors around knee treated surgically from June 2001 to October 2008. In the study there were 19 males and 10 females, aging from 17 to 65 years, with an average of 38.5 years. The location of tumors was at distal femur in 22 cases and 7 cases at proximal tibia. After the tumor was extensively resected or radically resected, custom-made tumor prosthesis replacement was performed for reconstruction, simultaneously, neoadjuvant chemotherapy and radioactive-therapy were used in treating the tumor according the pathology. RESULTS: All patients were followed-up for 18-84 months, with average follow-up period of 54.2 months. The 3 year survival rate was 79.8%, and the 5 year survival rate was 63%. As for the complications, prosthesis breakage occurred in 2 patients, aseptic loosening in 1 patients, 2 had a recurrence of the soft tissue tumor for which the diseased limb amputation was performed. The mean MSTS score showed excellent limb function in 15 patients, good in 8 patients, fair in 5 patients and poor in 1 patient. The overall excellent and good function was obtained in 79% of the patients. No superficial or deep infection occurred. Two patients suffered common peroneal nerve injury, but were cured by symptomatic treatments. CONCLUSION: Application of tumor prosthesis can give a satisfactory functional outcome, which is an effect method in limb salvage treatment of malignant tumor around the knee.

Objective To investigate audiological characteristics of patients with intact tympanic membranes and conductive or mixed hearing loss .Methods A retrospective study was carried out among 30 patients (42 ears) with intact tympanic membranes and conductive or mixed hearing loss who underwent exploratory tympanotomy . The preoperative outcomes of pure tone audiometry ,tympanometry ,resonant frequency of middle ear and temporal bone CT scan were analyzed .Results Among 42 ears ,30 ears with otosclerosis and 12 ears with ossicular chain dis-ruption were confirmed in exploratory tympanotomy ,but only 5 ears showed positive findings in CT scan .The mean thresholds of bone conduction ,air conduction and air -bone gap at frequencies of 0 .5 ,1 and 2 kHz were 27 .5 ± 1 .3 dB HL ,67 .0 ± 1 .8 dB HL ,39 .5 ± 1 .1 dB HL ,respectively .An analysis of tympanometric data of all patients re-vealed that 50% of all ears (21/42) were type A tympanograms ,42 .9% (18/42) were type As tympanograms ,and 7 .1% (3/42) were type Ad tympanograms .The mean of the resonant frequency of the middle ear in otosclerositic patients (1 079 .0 ± 67 .4 Hz) was significantly higher than ossicular chain disruption patients (633 .3 ± 43 .6 Hz) . Conclusion Otosclerosis is the most common in the patients with intact tympanic membranes and conductive or mixed hearing loss .The middle ear resonant frequency of otosclerositic patients is significantly higher than that of ossicular chain disruption patients .

BACKGROUND:Once lumbar degenerative diseases merge with lumbar spinal stenosis, lumbar instability and degenerative scoliosis, surgical therapy is required for corresponding clinical symptoms, and the usage of internal fixators cannot be inevitable. Osteoporosis is rather common in the elderly. Therefore, how to implant stable pedicle screw fixation system in serious osteoporosis patients wil be a big difficulty. In recent years, some studies have proven the biomechanical stability of polymethylmethacrylate augmentation of a cannulated and fenestrated pedicle screw in the vertebral body, so it becomes very hot in the spine surgery. OBJECTIVE: To explore the clinical efficacy of the use of polymethylmethacrylate augmentation of a cannulated and fenestrated pedicle screw fixation for the treatment of lumbar degenerative disease accompanied with osteoporosis. METHODS:Thirty-one patients with lumbar degenerative disease accompanied with osteoporosis from Jun 2008 to Jan 2013 were selected, including 11 males and 20 females with an average age of 73.5 years (range, 65-86 years). There were 14 cases of lumbar degenerative stenosis, 9 of lumbar intervertebral disc herniation combined with segmental instability, 6 of lumbar degenerative spondylolisthesis, and 2 of lumbar degenerative scoliosis. The patients were treated with lumbar canal decompression, fusion and polymethylmethacrylate augmentation of a cannulated and fenestrated pedicle screw fixation according to their clinical features and imaging data. Visual analog scale for pain evaluation was used before and after fixation, the Japanese Orthopaedic Association (JOA) scale was used for assessment of neurological function and life skils before internal fixation and during folow-up. RESULTS AND CONCLUSION:Al cases were folowed up for 40 months (range, 36-48months). No screw breakage, rod breakage, screw extraction, loosening, pseudoarticulation formation, or incision infection was found. The postoperative visual analog scale score and the JOA score was remarkably improved (P < 0.05). For patients suffering from lumbar degenerative disease accompanied with osteoporosis, polymethylmethacrylate augmentation of a cannulated and fenestrated pedicle screw fixation is helpful for increasing the stabilization of screw and preventing from loosening and dislocation of the screws, and thereby beneficial for improvement and maintenance of clinical efficacy.

Objective To investigate the characteristics of auditory brainstem response (ABR) in autistic children of 6 years or younger .Methods A total of 98 children with normal hearing and 22 autistic children were en‐rolled in this study .They were divided into 3 groups :1~2 years age group ,2< ~3 years age group ,and 3< ~6 years age group .The thresholds ,wave latencies and interpeak intervals of ABR were statistically analyzed .Results The ABR thresholds in normal hearing children (and autistic children) in 1~2 years age group ,2< ~3 years age group ,and 3< ~6 years age group were 15 .64 ± 5 .02 (17 .50 ± 5 .35) ,14 .73 ± 4 .85 (17 .81 ± 6 .58) ,and 15 .57 ± 5 .62 (17 .25 ± 6 .97) dB nHL ,respectively .There were no significantly statistical difference between the normal hearing children and autistic children (P>0 .05) .In 80 dB nHL click sound stimulus ,there was also no statistical difference in the values of peak latencies or interpeak intervals of ABR between normal hearing children and autistic children (P> 0 .05) ,whereas ,prolongation of peak latencies or interpeak intervals of ABR occurred in 36 .36%(25 .00% ears) autistic children .The ratio of prolongation of peak latencies of I ,III ,V waves and interpeak inter‐vals of I-III ,III-V ,I-V occurred in 4 .54% ,6 .82% ,13 .64% ,18 .18% ,6 .83% and 15 .91% ,respectively . Conclusion The ABR in some autistic children present abnormality and occur in various forms with the prolongation of interpeak intervals of I -III as the most common .