The surgical nutrition puts emphasis on the regulation of postoperative patients recently.The artical reviewed the effects of recombinant human growth hormone on metabolism, defence and wound healing of postoperative patients.

Objective To compare dynamic hip screw (DHS),InterTan and proximal femoral nail antirotation-Ⅱ (PFNA-Ⅱ) in the treatment of femoral intertrochanteric fracture in terms of their effects on postoperative hidden blood loss (HBL) and deep venous thrombosis (DVT).Methods We retrospectively analyzed the 133 patients with femoral intertrochanteric fracture who had been treated in our hospital from November 2011 to November 2015.Of them,42 received DHS treatment,including 22 males and 20 females;43 underwent InterTan fixation,including 21 males and 22 females;48 had PFNA-]Ⅱtreatment,including 25 males and 23 females.At preoperation,1,3 and 7 days postoperation,all of them had tests of hemoglobin (Hb),hematocrit value (Hct),blood platelet (PLT),thrombin time (TT),activated partial thromboplastin time (APTT),prothrombin time (PT),human fibrinogen (FIB) and D-dimer.DVT was detected using color Doppler ultrasound at 7 days postoperation.Results At 1,3 and 7 days postoperation,the DHS patients had the smallest values of Hb,Hct,TT,PT and APTT while the PFNA-Ⅱ patients the largest.The DHS patients had the largest values of intraoperative bleeding,PLT,FIB and D-dimer while the PFNA-Ⅱ patients the smallest.There were significant differences between the 3 groups in all the indexes (P ＜ 0.05) except in TT at 7 days postoperation and APTT at 1 and 7 days postoperation between the InterTan and PFNA-Ⅱ groups (P ＞ 0.05).The incidence of DVT in the InterTan group (2.3％,1/43) and in the PFNA-Ⅱ group (0) was significantly lower than in the DHS group(7.1％,3/42) (P ＜ 0.05).Conclusion In the treatment of femoral intertrochanteric fracture,PFNA-Ⅱ may be superior to InterTan and DHS in reducing postoperative HBL and control of DVT.

ObjectiveTo evaluate the clinical effects of transforaminal lumbar interbody fusion (TLIF) or posterior lumbar interbody fusion(PLIF) using microendoscopic discectomy under X-Tube system in treatment of lumbar degenerative disc diseases.MethodsFrom December 2007 to April 2008,32 patients with low back disorders were treated by microendoscopic discectomy TLIF or PLIF under X-Tube system,including 19 cases in TLIF and 13 in PLIF.Etiologies including lumbar disc herniation combined with segmental instability in 21 cases,and spondylolisthesis in 11 cases.All patients were under regular postoperative follow-up and radiological examination.The clinical functional outcomes were evaluated according to Oswestry disability questionnaire.ResultsThe mean operation time was 120 min(range,90-180),and the average blood loss was 190 ml (range,100-400).There were no complications,such as infection and internal fixation failure.Bony fusion was achieved in all patients.The follow-up was from 14 months to 41 months with 21 months in the average.The average 0swestry scores decreased from preoperative 40.1％±4.1％ to 9.5％±3.7％ three months after the operation.The outcomes of this operation were rated as excellent.ConclusionMicroendoscopic discectomy TLIF or PLIF under X-Tube system in treatment of lumbar degenerative disc diseases has the characteristics of less blood loss,tissue trauma and quick recovery.

Objective To identify the feasibility and the anatomical parameters of posterior transarticular pedicle screw fixation in the thoracic spine, provide a reference for clinical applications. Methods Twenty human cadaveric thoracic spine segments were dissected posteriorly and anteriorly, with care taken to expose the laminas and pedicles. The entrance point of transarticular pedicle screws was located in the 7 mm away from the above at the inferior margin of the lamina and the inside at the exterior margin, respectively. Posterior transarticular pedicle screws implantation was performed under direct visualization into T1,2,T5,6 and T9,10 Under direct abservation, the feasibility of posterior transarticular pedicle screw fixation was assessed. Then a CT was done. On the morphologic CT scan, the angle and length of the transarticular pedicle crew trajectory were measured. Results The thoracic transarticular pedicle screw trajectory were caudal tilting in the sagittal plane and lateral tilting in the axial plane with successful placement. Screws were placed across the facet joint, and from the inferior articular process of upper thoracic vertebra into the pedicle of lower thoracic vertebra. There was little difference between different number of thoracic vertebrae of the angle, but without significance. The average angles of the screws were 41.4°+3.2°caudal tilting in the sagittal plane and 2.1°±0.7° lateral tilting in the axial plane. The average trajectory lengths were (40.6±4.9)mm, and the lengths increased gradually from upper thoracic vertebra to middle and lower. There were significant differences statistically among T1,2, T5,6 and T9.10 (F=74.09, P＜0.01 ). Conclusion Posterior transarticular pedicle screw fixation is feasible, and there are some directions for implantating the screws. Transarticular pedicle fixation in the thoracic spine affords an alternative to standard pedicle screw placement for thoracic stabilization.

Objective To report the clinical results of surgical treatment of fracture of the anteromedial facet of the coronoid process in terrible triad injury.Methods Of the 59 patients with terrible triad injury of the elbow,17 were surgically treated for fracture of the anteromedial facet of the coronoid process from July 2010 to July 2014.They were 12 men and 5 women,from 29 to 70 years of age (average,50 years).By the Mason classification for the radial head fractures,2 cases were type Ⅰ,13 type Ⅱ and 2 type Ⅲ;by the O'Driscoll classification for coronoid process fractures,one was type Ⅰ,14 were type Ⅱ and 2 type Ⅲ.All patients were treated through combined approaches.The lateral Kocher approach was used to fixate or replace the radial head and to repair the lateral ligament complex;the anteromedial approach was used to fixate the coronoid process fracture and to explore and repair the medial collateral ligament if necessary.Fracture union,implant loosening,ectopic ossification,regression and articular alignment were assessed on the postoperative X-rays.At final follow-ups,the elbow function was evaluated using Mayo elbow performance score (MEPS) and Broberg & Morrey grading system for traumatic arthritis.Results The average follow-up duration for the 17 patients was 32 months (range,from 24 to 60 months).Final follow-ups showed that the mean arc of flexion-extension was 97° (from 70° to 120°),the mean extension limitation 23° (from 0 to 40°),the mean arc of forearm rotation 139° (from 90° to 145°),the mean pronation 71° (from 60° to 90°)and the mean supination 67° (from 60° to 85°).The MEPT scores averaged 87 points (from 80 to 100 points),yielding 7 excellent,8 good and 2 fair cases.By the Broberg & Morrey grading,there were 4 cases of grade 1 and one of grade 2.No evidence of elbow instability,nonunion or implant failure was found.Ectopic ossification around the elbow happened in 4 cases,transient ulnar nerve palsy was found in one,and the Kirschner wire was removed operatively in 2 because it had loosened after fracture union.Conclusion The treatment of anteromedial coronoid fractures in terrible triad injury should be anatomically reduced through direct exposure and fixated rigidly.

Japanese gastric cancer treatment guidelines list options for treatment of each stage of early gastric cancer (EGC).The treatment of EGC is closely related to the lymph node metastasis, and the accurate prediction of lymph node metastasis is related to the choice of the treatment options and the prognosis of the patients.The lymph node metastasis of EGC is evaluated according to the clinicopathological factors, imaging,molecular markers and sentinel lymph node (SLN) tracer biopsy.A two-step method for the management of EGC treated with endoscopic mucosal resection/endoscopic submucosal dissection (EMR/ESD) is recommended.While for those EGC patients not suitable to receive EMR/ESD, imaging or molecular marker and SLN tracer biopsy technology are applied to determine lymph node status.

Objective To discuss the strategies for treatment of lower cervical distractive flexion injuries. Methods Sixty-eight patients including 43 males and 25 females at age range of 18-72 years (average 43 years) suffered from lower cervical distractive flexion injuries were operated from January 2002 to June 2007. According to Allen's classification, there were 7 patients at grade Ⅰ, 19 at grade Ⅱ,29 at grade Ⅲ and 13 at grade Ⅳ. Temporary skull traction was used for each subject before surgery. Only posterior approach was performed in 26 patients who were fixated by pedicle screw system,lateral mass screw system or transarticular screw system. Combined anterior and posterior approach was applied for the other 42 patients at one stage. The curative effect was followed up for all patients after the procedures. Results All patients were followed up for 6-65 months ( average 34 months), which showed posterior incision infection in 2 patients who were cured after debridement or change dressing. Two patients with aggravated neural symptome were cured following treatment with methylprednisolone. Neural function was improved at least for one level in all patients except for 18 patients (Frankel A). Of 11 patients at grade B, there were 4 patients improved to grade C and 5 to grade D. Of 10 patients at grade C, there were 6 patients recovered to grade D and 4 to grade E. All 15 patients at grade D reached grade E. It was not found loosening, breakage or defuxion. The graft bone was fused within 3-4 months, with no any complications related to surgical fixation. Conclusions The strategies for lower cervical distractive flexion injuries should be taken according to Allen' s classification. Single posterior procedure is suitable for grade Ⅰ and Ⅱ injuries. While combined posterior and anterior procedure can be used for grade Ⅲ and Ⅳ injuries.

Objective To explore the clinical outcomes of anterior plate fixation through transoral approach in the treatment of unstable atlas fractures.Methods From March 2004 to May 2010,20 patients with unstable atlas fractures were treated by anterior plate fixation through transoral approach,including 12 males and 8 females,aged from 23 to 68 years (average,47.7±13.9 years).Of the 20 cases of unstable atlas fractures,4 cases were classified as anterior 1/2 Jefferson fracture,8 cases as 1/2 ring Jefferson fracture,and 8 cases as anterior 3/4 ring Jefferson fracture.The preoperative average VAS scores were 6.0±1.3 points,ranged from 4 to 8 points.Clinical and imaging examinations were performed during follow-up period to evaluate the outcomes.Results All patients were followed up for 12 to 81 months,with an average of 48.5±20.0 months.There were no screw loosing and breakage,no plate displacement,and no spinal cord and vertebral artery injury during operation.A total of 20 plates were placed and all 40 screws were inserted into atlas lateral mass.Computed tomography scans demonstrated 2 screws were placed too close to the vertebral artery canal,but without clinical consequences.The postoperative VAS scores were from 0 to 3 points with an average of 1.3±1.0 points.Static and dynamic films 6 months after surgery demonstrated that fusion was achieved in all cases.Atlantoaxial rotational function was restored satisfactorily.No plate-related complication was observed in all patients in the whole follow-up period.Conclusion Anterior plate fixation through transoral approach is an effective method for management of unstable atlas fractures,which has advantages such as solid bony fusion and low incidence of complication.

Objective To investigate the preliminary clinical application of anterior pedicle screws in treatment of the lower cervical spine injuries. Methods The study involved 22 patients with lower cervical spine injuries treated with anterior pedicle screw technique from January 2009 to December 2011.X-ray and CT images of the patients were taken postoperatively to evaluate whether the position,orientation and length of the screws were appropriate and whether there involved pedicle cortex perforation,transverse foramen or spinal canal invasion.MRI was also performed to ascertain the situation of decompression,the formation of epidural hematoma and the degeneration of cervical spinal cord.The improvement of JOA score was compared statistically. Results All the patients were followed up for 3-36 months ( mean,15.5 months).A total of 44 anterior lower cervical screws were implanted and all screws were inserted smoothly.All the patients had bone healing after average 4.5 months,which showed no loosening,prolapse or breakage of the screws or no loosening of the plate.One patient showed hoarseness postoperatively,which was probably due to the long-term distraction of recurrent laryngeal nerve.The symptom disappeared at around three weeks after neurotrophic support.Two patients complained of dysphagia postoperatively,and were informed of keeping a soft diet.The symptom was remarkably alleviated after three months or so.The X-ray films indicated satisfactory position of the implanted screws.Before discharge,the transaxial CT images showed that two screws perforated the medial pedicle cortex ( 1 ° ) and that two screws perforated the lateral cortex (1 °) and affected the medial margin of the transverse foramen.Before discharge,the MRI indicated obvious alleviation of the anterior spinal cord compression in all patients and a small amount of anterior epidural hematoma in four patients,with no obvious spinal cord compression.At 12 months after operation,the MRI showed significant improvement of spinal cord degeneration in three patients.JOA score was increased from preoperative (8.5 ± 0.7) to ( 14.5 ± 0.8 ) before discharge (P ＜0.01 ).JOA score was (15.7 ±0.7) at six months postoperatively,which was significantly improved as compared with that before discharge. Conclusions Anterior pedicle screw fixation is a reliable and safe method for reconstruction of the anterior lower cervical injuries.Surgical indications should be strictly controlled in its clinical application.

Objective:To compare the effects of 3 spatial locations of the screw at the injured vertebra on the vertebral height in AO type A thoracolumbar fracture.Methods:A retrospective analysis was performed of the 156 patients with type A thoracolumbar fracture who had been hospitalized at Department of Spine Surgery, The Sixth Hospital of Ningbo from January 2016 to June 2019. They were divided into 3 groups according to the spatial location of the screw at the injured vertebra. In group A of 55 cases, the screws were located in the vertebral body between the longitudinal axis bisector of the vertebral pedicle and the upper endplate; in group B of 52 cases, the screws were located in the vertebral body between the vertical axis bisector of the vertebral pedicle and the horizontal line of the apex of the inferior pedicle notch; in group C of 49 cases, the screws were located in the vertebral body between the horizontal line at the apex of the inferior pedicle notch and the inferior endplate. The anterior, middle and posterior heights of the injured vertebra, Beck index and angulation of the injured vertebra at preoperation, one week postoperation and the last follow-up were compared between the 3 groups and within the same group.Results:There was no significant difference in preoperative general data between the 3 groups, showing comparability ( P>0.05). In all the 3 groups, the anterior and middle heights of the injured vertebra and Beck indexes at one week postoperation and at the last follow-up were significantly larger than those before operation while the angulations of the injured vertebra at one week postoperation and at the last follow-up were significantly smaller than the preoperative values (all P<0.05), but there was no significant difference between one week postoperation and the last follow-up in any of the above indexes ( P>0.05). In all the patients, the posterior height of the injured vertebra at one week postoperation was significantly larger than those before operation and at the last follow-up ( P<0.05), but there was no such a significant difference in comparison between preoperation and the last follow-up ( P>0.05). At the last follow-up, groups A and B had significantly larger anterior and middle heights of the injured vertebra and Beck indexes but significantly smaller angulations of the injured vertebra than group C, but such significant differences did not exist when the above indexes were compared between groups A and B ( P>0.05). Conclusions:In insertion into an injured vertebra, the screw should be parallel and close to the upper endplate, and located in the middle and upper part of the vertebra corresponding to the longitudinal axis of the vertebral pedicle, because this spatial position is conducive to intraoperative reduction, maintaining the postoperative height of the injured vertebra, and decreasing loss of the vertebral height.