[Objective]To discuss the relationship between partial upper limb edema in the cervical spondylosis patients and the decompression operation.[Method]Ten cervical spondylosis cases with partial upper limb edema were reviewed,including 7 cases of cervical spondylotic myelopathy,2 cases of cervical radiculopathy and 1 case of OPLL(ossification of the posterior longitudinal ligament).Seven cases were treated with subtotal vertebrectomy and anterior internal fixation,one with subtotal vertebrectomy and anterior discectomy,2 cases with posterior decompression and fusion.All the patients were available for follow-up to evaluate the decay of the edema.[Result]All the 10 patients' edema disappeared with the duration from one day to over half a year.The treatment of anterior surgery made patients' edema disappear quicker than that of posterior surgery.[Conclusion]The occurrence of the upper limb edema in the cervical spondylosis patients is related to do with the irritated sympathetic nerve.The edema can be reduced in short term after the decompression operation.

According to the concept of sagittal spinal balance, the alternating curves of cervical and lumbar lordosis and thoracic and sacral kyphosis enable the head to be positioned over the trunk and pelvis. But the sagittal imbalance represents departure from this ideal form. Cervical kyphosis may represent the most disabling of these imbalances, for it can cause pain, postural difficulties, or neurologic deficit. A summary and discussion is reviewed regarding the anatomy, biomechanics, etiology, clinical presentation, laboratory examination and treatment of this condition.

Objective: To discuss the clinical effect of the treatment of metaphyseal cancellous bone fracture with fragment fixation system implants(FFS).Methods:Thirty patients treated with FFS were reviewed.Results:The patients were followed up for 7～　24 months (8.7 months in average).The fractures in all cases were healed in 6 months and the function recovered or nearly reeovered. Conclusion:By traction with FFS to treat this kind of fracture,the fractures and joint function recovered.The operation is simple and trauma is little.

Objective To evaluate the clinical outcome of lumbopelvic reconstruction in treatment of unstable sacral fractures.Methods A retrospective study was performed on 17 cases (12 males and 5 females； at 23-55 years of age,mean 35.5 years) of unstable sacral fractures treated from January 2007 to June 2012.There were 11 cases of zone Ⅱ fracture and six zone Ⅲ fracture according to Denis classification and nine cases of type B fracture and eight type C fracture according to Tile classification.Sacral nerve injury assessed by Gibbons criteria was 3 points in seven cases and 4 points in 10 cases.Lumbar-pelvic ring stability of the patients was restored by posterior decompression and lumbar pedicle screw fixation combined with sacral pedicle screw or iliac screw fixation.Fracture reduction and healing were measured by X-ray film or CT scan； functional outcomes by Majeed scale； neurological outcome by Gibbons criteria.Results All the cases were followed up for mean 16 months (range,8-24 months).X-ray and CT follow-up revealed all fractures had bone union at average 6 months in the absence of remnant sacrum malformation,pseudarthrosis and fracture redisplacement.Iliac screw loosening not yet breakage happened to one case.In total,12 cases had full recovery of neurological function； four significant improvement,but experienced different degree of footdrop and hypoesthesia of lower extremities； one poor improvement and experienced not only lower extremity dysfunction but also bladder and bowel dysfunction.According to Majeed scale in the final follow-up,clinical functional outcome was excellent in 12 cases,good in three,fair in one and poor in one,with excellent-good rate of 88％.Gibbons score improved from preoperative (3.29 ±0.47) points to postoperative (1.53±0.94) points (t=12.94,P＜0.01).Conclusion Posterior decompression plus lumbar pedicle screw fixation combined with sacral pedicle screw and/or iliac screw fixation is an effective method for treatment of unstable sacral fracture,for it can restore general stability of spine-pelvis,facilitate neurological function recovery and allow early weight-bearing.

[Objective]To investigate the efficacy of treatment of C_(1～C) instability with 3D-fixation techniques.[Method]From July 2002 to July 2005,thirteen patients were treated with atlantal lateral mass screw associating with axoid pedicle screw;twelve patients were treated with axoid transarticular screw associating with posterior atlantal arch hook;sixteen patients were treated with Vertex and nine patients with Summit among them.[Result]There were 26 lateral mass screws,26 axoid transarticular screws,24 atlantoaxial transarticular screws and 24 posterior atlantal arch hooks were applied in the 25 patients.All patients were followed up.The follow up duration time was ranging from 10 to 36 months with the mean time of 16.7 months.No spinal injury and vertical artery injury was found. The postoperative JOA score was ranging from 13.6 to 15.9 with the mean score of 14.8 and the improvement rate of 89.5%.All fractures of odontoid process and all bone grafts had solid bone union.No failure and loosening of internal instrument was found.[Conclusion]The two 3D-fixation techniques are effective and reliable.

Objective This study assessed whether the best overall response rate(ORR) of cetuximab combined with oxaliplatin,leucovorin and fluorouracil/Xeloda was superior to that of this method alone as first-line treatment for metastatic colorectal cancer.The influence of KRAS mutation status was investigated.Methods Patients received cetuximab(400mg/m2 initial dose followed by 250mg/m2,wk thereafter)less than 2 times plus chemotherapy(oxaliplatin 130mg/m2 on day 1,plus leucovorin 200mg/m2 and fluorouracil as a 400mg/m2 bolus followed by a 600mg/m2 infusion during 22 hours on days 1 and 2) or chemotherapy alone.Treatment was continued until disease progression or unacceptable toxicity.KRAS mutation status was assessed in the subset of patients with assessable tumor samples.Results The confirmed ORR for cetuximab plus oxaliplatin,leucovorin and fluorouracil/Xeloda was higher than that with alone(42.86% vs 21.74%).A statistically significant increase in the odds for a response with the addition of cetuximab to oxaliplatin,leucovorin and fluorouracil/Xeloda could be established.In patients with KRAS wild-type tumors,the addition of cetuximab to oxaliplatin,leucovorin and fluorouracil/Xeloda was associated with a clinically significant increased chance of response(ORR 54.55% vs 21.74%) and a lower risk as compared with chemothrapy alone.Cetuximab plus oxaliplatin,leucovorin and fluorouracil/Xeloda was generally well tolerated.Conclusion The clinical effcacy of chemothrapy(oxaliplatin,leucovorin and fluorouracil/Xeloda) plus cetuximab is better than only chemothrapy.KRAS mutational status was shown to be a highly predictive selection criterion in the treatment decision regarding the addition of cetuximab to oxaliplatin,leucovorin and fluorouracil/Xeloda for previously untreated patients with metastatic colorectal cancer.

[Objective] To explore the surgery protocol of the serious dislocation of acromio-clavieular joint,and compare the outcome of ORIF with AO/ASIF clavicle hook plate only to ORIF with eoraco-clavieular ligament reconstruction.[Method]Fity-two cases of the dislocation of acromio-clavicular joint were reviewed,Group A was ORIF only including 29 cases(male 20,female 9,mean age 45),according to the system of Rockwood,as TypeⅢ in 12 patients,TypeⅣ in 15 patients and TypeⅤ in 2 patients,the other 23 cases ORIF with eoraeo-clavieular l ligament reconstruction was Group B(male 15,female 8,mean age 50.6),according to the system of Rockwood,as TypeⅢ in 9 patients,TypeⅣ in 13 patients and TypeⅤ in 1 patients,AO/ASIF claviadar hook plates were used for all of the ORIF,and modified Weaver's method was used to reconstruct eoraco-clavieular ligament.Outcome was evaluated by Lazzcano scale after 8~12 months,and data was analyzed by SPSS 10.0.[Result]Good outcome was achieved in all of the patients,there was no significanty statistical difference between the two groups.[Conclusion]Clavicle hook plate is a kind of perfect internal fixation.Reconstruction of eoraco-clavleular ligament is not necessary if the AO/ASIF plate is used,unless serious avulsion of deltoid and trapezius muscle involved.

[Objective]To Probe the causes of significant operatiive complications of ossification of posterior longitudinal ligament as well as the treatment outcomes in order to reduce the surgical morbidities and to suggest preventive measures of complications.[Method]The surgical data of 85 cases with ossification of posterior longitudinal ligament were reviewed form March 2002 to May 2006.In continuous long segment OPLL which were treated by bilaminectomy with internal fixation system;short segment OPLL which were treated by corpectomy of anterior cervical approach with bone of autograft and anterior cervical spine locking plates.[Result]Totally 66 cases were followed-up from 3 to 25 months with an average of 13 months.Complication of posteior cervical approach:8 cases with the pain of neck-shoulder,which resulted from postoperative radiculopathy and nerve root irritation or injury.Most of 8 cases were recovered in 2 to 20 weeks by conservative treatment such as antalgica,dehydration and physiotherapy.Four cases with quadriparesis or symptom deteriorate,which resulted from reperfusion injury of spine cord.Two cases were recovered by hyperbaric oxygen and medication and 1 cases recovered not enough.Two cases with posterior cervical hemotoma were caused by bleeding of smaller blood vessels and obstruction of drainage.One case of CSF leakage were cured in 3 days with cervical spinal immobilization and moderate local compressiom.Two cases of local infection were cured during 20 days with antibiotics or combined with debridement and suturing.Complications of anterior cervical approach:a cases with quadriparesis or symptom deteriorate;1 case of CSF leakage.Complications related to instruments included 1 case of titanium net subsidence and 1 case of single lateral mass screw back-out.[Conclusion]Many kinds of operative complications could occur in either anterior or posterior approach of surgery of ossification of posterior longitudinal ligament.Preoperative good preparation,intraoperative carefull operation and postoperative strengthened management are the key points to decrease and prevent operative related complications.

[Objective]The purpose of this study was to determine the treatment odontoid fractures complicated by significant C2、3 displacement.[Method]Sixteen patients with odontoid fractures(12 type Ⅱ and 4 type Ⅲ,according to Anderson-D'Alonzo standard)were treated in this study.There were 11 male and 5 female with an average of 36 years(range 19-54 years).Group A included 9 cases of odontoid fracture with Hangman fracture and group B includcd 7 cases of odontoid fractures with C2、3 anterior fusion and 6 underwent dens screw with C2、3 posterior fusion.Postoperatively,neck collars were applied for 3 months.[Result]Successfully closed reduction of C1～2 was achieved in 16 patients.No complication occurred in the two groups.[Conclusion]Postoperatively there was no motion restriction in the neck or residual neck pain.Direct osteosynthesis of the fractured dens with screws is an effective procedure for unstable type Ⅱ fracture of the dens.Postoperative external immobilization with a neck collar seems to contribute much to the treatment.

[Objective]To evaluate the surgical results of spinal scoliosis in the elderly and to investigate the indications,surgical techniques and factors which may contribute to the outcome. [Methods]A retrospective study was held.Sixty-four patients≥65 years undergoing different kinds of operation for lumbar spinal scoliosis from Sep.2004 to Apr.2008 were recruited.The mean patient age at surgery was 69.2 years(61~75 years).[Results]There were a variety of treatment methods of degenerative scoliosis based on symptomatology and radiologic measurements of scoliosis and stenosis.Sixty-four patients were followed up for an average of 37 months.The average correction rate of scoliosis was 51.2% after operation.No case was found spinal cord injury.Clinical symptoms and functional tolerance for daily activities improved after surgery.Radiographic evaluation showed a reduction in the deformity on the frontal and sagittal planes.There were no infections,pseudoarthrosis,instrument related failures or reoperations in this series.[Conclusion]The surgical results of lumbar scoliosis in the elderly are better than to those reported for the general population.Carefully perioperative preparation is very important in the treatment of elderly patients with lumbar spinal scoliosis.