Objective To introduce the mini-open anterior correction under video assisted thoracosco- py for thoracic idiopathic scoliosis and report its clinical results.Methods From July 2001 to 2006,37 ca- ses of right thoracic idiopathic seoliosis were surgically corrected with mini-open anterior instrumentation. There were 4 males and 33 females with average age of 14.1 years and average Cobb angle of 56?.Fourteen cases with Lenke I A 14 cases,IB ++-++++ 14 cases,IC 9 cases.The Risser sign was ++-++++. The operative time,blood loss,instrumented levels,correction rate and loss of correction were analyzed. Results The operative time averaged 220 miu.The intraoperative blood loss averaged 320 ml.The average number of instrumented levels was 7.8.The postoperative Cobb angle was 16.8?on average with correction rate of 70%.With a follow-up of 18-36 months,the loss of correction averaged 4.6%,but no hardware complications.Conclusion The clinical results of mini-open anterior correction under thoracoscopy for tho- racic idiopathic scoliosis were satisfactory.It may minimize the complications of classical thoracotomic anterior correcion and mav reduce the high requirement for anesthesia,long operative time and high cost of thoraco- scopic anterior instrumentation.

OBJECTIVETo analyze thoracic complications related to the convex thoracoplasty for the treatment of rib hump deformity in patients with thoracic scoliosis.

METHODSBetween December 2003 and September 2007, 548 patients with thoracic scoliosis underwent posterior spinal correction and the convex thoracoplasty. There were 167 male and 381 female, with an average age of 16.1 years (range, 12 to 38 years). The mean preoperative rib prominence was 35 degrees (range, 16 degrees to 50 degrees).

RESULTSThe mean number of resected ribs was 4.1. The mean rib prominence was 7 degrees (range 2 degrees to 17 degrees) after operation. No death happened. Thoracic complications related to the thoracoplasty consisted of respiratory insufficiency in 1 (0.2%) patient,intraoperative tear of parietal pleura in 29 (5.3%), with a subsequent pleural effusion in 6 and pneumothorax in 3. In the other patients, no obvious tear of parietal pleura was found during operation. However, 6 (1.1%) patients had pleural effusion after operati on.

CONCLUSIONThe thoracic complications related to convex thoracoplasty can be decreased by improving the surgical skill and using respiratory function monitoring.

Adolescent ; Adult ; Child ; Female ; Humans ; Male ; Postoperative Complications ; prevention & control ; Scoliosis ; surgery ; Thoracic Vertebrae ; surgery ; Thoracoplasty ; adverse effects

OBJECTIVETo explore the clinical features and treatment results of brachial plexus palsy caused by halo traction before posterior correction in patients with severe scoliosis.

METHODSA total of 300 cases of severe scoliosis received halo traction before posterior correction in our department from July 1997 to November 2004. Among them, 7 cases were complicated with brachial plexus palsy. The average Cobb angle was 110 degree (range, 90 degree-135 degree). Diagnoses were made as idiopathic scoliosis in 1 case, congenital scoliosis in 3 cases, and neuromuscular scoliosis in 3 cases. Additionally, diastematomyelia and tethered cord syndrome were found in 3 cases and thoracolumbar kyphosis in 2 cases. Weight of traction was immediately reduced when the patient developed any abnormal neurological symptoms in the upper extremity, and rehabilitation training was undertaken. Simultaneously, neurotrophic pharmacotherapy was applied, and the neurological function restoration of the upper limbs and the recovery time were documented.

RESULTSTraction was used for an average of 3.5 weeks (range, 2-6 weeks) before spinal fusion for these 7 patients. The average traction weight was 8 kg, which was 19% on average (range, 13%-26%) of the average body weight (40.2 kg). These 7 patients had long and thin body configuration with a mean height of 175 cm. The duration between symptoms of brachial plexus paralysis and the diagnosis was 1-3 hours. All of these 7 patients presented various degrees of numbness in the ulnar side of the hand and forearm. Median nerve paresis was found in 3 cases and ulnar nerve paresis in 4 cases. Complete recovery of the neurological function had been achieved by the end of three months.

CONCLUSIONSThe clinical features of brachial plexus palsy caused by halo traction include median nerve paresis, ulnar nerve paralysis, and numbness in the ulnar side of the hand and forearm, which may be due to the injury of the inferior part of the brachial plexus, i.e., damage of C8 and T1 nerve roots. Complete recovery of neurological function can be expected when the patient is kept under careful observation for recognizing this complication as soon as possible, then immediately reducing or removing the traction weight, and adopting rehabilitation training and neurotrophic pharmaceutical treatment.

Adolescent ; Adult ; Brachial Plexus Neuropathies ; etiology ; therapy ; Child ; Female ; Humans ; Male ; Paralysis ; etiology ; therapy ; Prognosis ; Scoliosis ; therapy ; Traction ; adverse effects

OBJECTIVETo compare the early clinical results of thoracoscopic and mini-open thoracotomic anterior correction for idiopathic thoracic scoliosis.

METHODSTwenty-three cases with idiopathic right thoracic scoliosis were divided into 2 groups. Group A includes 8 females with average age of 14.8 years and average Cobb angle of 54 degrees . The Risser sign was +++ approximately ++++. These patients were operated on with thoracoscopic Eclipse instrumentation. Group B covers 2 males and 13 females with average age of 13.8 years and average Cobb angle of 57 degrees . The Risser sign was ++ approximately ++++. These patients were operated on with mini-open thoracotomic anterior instrumentation. The operative time, blood loss, postoperative drainage, instrumented levels, curve correction and early loss of correction of both groups were analyzed.

RESULTSThe patients of group A had average operative time of (360 +/- 72) min, (629 +/- 145) ml of intra-operative blood loss, (7.4 +/- 1.1) of instrumented levels, (500 +/- 150) ml of post operative drainage, 74 +/- 14% of curve correction rate and (8.6 +/- 2.7)% of early loss of correction after 6 approximately 18 m follow-up. The patients of group B had average operative time of (246 +/- 64) min, (300 +/- 110) ml of intra-operative blood loss, (7.8 +/- 0.9) of instrumented levels, (210 +/- 90) ml of post operative drainage, (70 +/- 12)% of curve correction rate and (4.6 +/- 1.9)% of early loss of correction. The curve correction rates of thoracoscopic and mini-open thoracoscopic anterior correction were not significantly different (P >0.05). But the operative time, blood loss, postoperative drainage, and early loss of correction showed significant difference (P <0.05).

CONCLUSIONSThoracoscopic and mini-open thoracotomic anterior correction for idiopathic thoracic scoliosis have their own indications. Both techniques are safe and effective to correct the idiopathic thoracic scoliosis with satisfied early results. But the early loss of correction of mini-open thoracotomic anterior correction is significantly less than that of thoracoscopic anterior correction.

Adolescent ; Adult ; Female ; Follow-Up Studies ; Humans ; Male ; Minimally Invasive Surgical Procedures ; Scoliosis ; surgery ; Spinal Fusion ; methods ; Thoracic Vertebrae ; surgery ; Thoracoscopy ; Thoracotomy ; methods ; Treatment Outcome

Recent years, the development of medical devices kits is rapid. How to make the technical evaluation of medical devices kits more perfect bases on the two major principles of safe and effective, and to make kits in the market more normative and orderly, these issues for technical evaluation have to be considered. This article makes a study on current situation of production, classification of management and registration status, combined with existing regulations and related standards, and discusses technical evaluation related issues.
Equipment and Supplies ; standards

OBJECTIVETo evaluate the efficacy and significance of posterolateral fusion in preventing failure of short-segment stabilization for the treatment of thoracolumbar burst fractures.

METHODSSixty patients with thoracolumbar burst fractures were included in the study. The patients were classified into two groups (n equal to 30 in each group). In Group A, patients were treated in our hospital with short-segment instrumentation via posterolateral fusion with iliac bone. In Group B, patients were treated in other hospital with short-segment fixation without fusion. All cases came to our hospital for reexamination. There were 18 males and 12 females in Group A with a mean age of 42.3 years (range, 24 to 52 years) and 16 males and 14 females in Group B with a mean age of 41.5 years (range, 19 to 54 years). Radiographic (Cobb angle, kyphosis of the vertebral body, and sagittal index) and clinical outcomes (Low Back Outcome Score ) were analyzed after an average follow-up of 16 months.

RESULTSAfter operation, Cobb angle was reduced from 19.3 degrees to 3.1 degrees in Group A and from 19.1 degrees to 3.3 degrees in Group B (P>0.05). It was 5.9 degrees in Group A and 11. 9 degrees in Group B at the final follow-up (P<0.01). Its average loss of correction was 2.8 degree in Group A and 8.6 degrees in Group B. Average kyphosis of the vertebral body was reduced from 21.3 degrees to 6.2 degrees in Group A and from 21.7 degrees to 7.4 degrees in Group B (P>0.05). It was decreased to 7.9 degrees in Group A and 13.5 degrees in Group B at the final follow-up (P<0.01). Its average loss of correction was 1.7 degrees in Group A and 6.1 degrees in Group B. Sagittal index was reduced from 21.3 degrees to 3.6 degrees in Group A and from 20.5 degrees to 3.8 degrees in Group B (P<0.05). It was decreased to 5.1 degrees in Group A and 9.8 degrees in Group B at the final follow-up (P<0.01). Its average loss was 1.5 degrees in Group A and 6.0 degrees in Group B. In Group A, 73.3% of patients had an excellent result based on Low Back Outcome Score system, while that in Group B was only 43.3%.

CONCLUSIONSPosterolateral fusion is an effective measure to prevent implant failure, and decrease loss of correction, posttraumatic kyphosis and neurological deficit during the treatment of thoracolumbar burst fractures. Short-segment fixation of thoracolumbar burst fractures without fusion obviously increases failure rate and it is not an optional procedure.

Adult ; Bone Screws ; Female ; Fracture Fixation ; adverse effects ; Fractures, Bone ; diagnostic imaging ; surgery ; Humans ; Lumbar Vertebrae ; diagnostic imaging ; injuries ; Male ; Middle Aged ; Radiography ; Spinal Fusion ; adverse effects ; methods ; Thoracic Vertebrae ; diagnostic imaging ; injuries

OBJECTIVETo investigate the feasibility and therapeutic results of multiple organ resection in patients with tumor of the body and tail of pancreas.

METHODSThe clinical and pathological data were analysed in 16 consecutive patients with neoplasm of the body and tail of pancreas from 1999 to 2004 retrospectively.

RESULTSMultiple organ resection was performed in 6 cases of primary pancreatic adenocarcinoma of the body and tail (3 cases of pancreatic cancer, 2 cases of malignant glucagonoma, and 1 case of well-differentiated pancreatic stromal sarcoma) and 10 cases of extrapancreatic malignancy (4 cases of gastric cancer, 2 cases of gastric leiomyosarcoma, 1 case of duodenal cancer, and 3 cases of colon cancer of hepatic flexure). Distal pancreatectomy with splenectomy was performed in all cases. In addition, 10 patients received splenic flexure colectomy, 6 patients received distal gastrectomy, 3 patients received left nephrectomy, left colectomy, total gastrectomy, liver lobe resection, left adrenalectomy, and local diaphragma resection, and 2 patients received transverse colectomy, subtotal colectomy, proximal proctectomy, proximal gastrectomy, and duodenectomy. No perioperative death and severe complications were observed. Patients with primary pancreatic cancer or pancreatic stromal sarcoma died within 1 year. Two patients with malignant glucagonoma died 51 and 39 months later. The 3-year survival rate was 70% in 10 patients with extrapancreatic malignancy, among which 2 patients with enteric cancer have survived 37 and 48 months.

CONCLUSIONRadical combined multiple organ resection may be performed actively in appropriately selected patients.

Adenocarcinoma ; mortality ; pathology ; surgery ; Adult ; Aged ; Colectomy ; Female ; Gastrectomy ; Humans ; Male ; Middle Aged ; Pancreatectomy ; methods ; Pancreatic Neoplasms ; mortality ; pathology ; surgery ; Pancreaticoduodenectomy ; Retrospective Studies ; Splenectomy ; Survival Rate ; Treatment Outcome

OBJECTIVETo evaluate the clinical importance of titanium mesh cage (TMC) in anterior instrumentation for scoliosis.

METHODSThirty-six consecutive patients with thoracolumbar/lumbar adolescent idiopathic scoliosis were treated with anterior derotation and instrumentation using autologous bone grafting and TMC for interbody fusion. The average age of patients was 17 years (ranged from 14 to 22 years), in which 5 cases were male and 31 cases were female.

RESULTSThe coronal Cobb angle before surgery, 2 weeks after surgery, and 13 months at the follow-up was measured as 56 degrees , 15 degrees , and 18 degrees respectively, while the thoracic kyphosis from T(5) to T(12) was 30 degrees , 33 degrees , and 37 degrees respectively, and the lumbar lordosis from L(1) to S(1) was 46 degrees , 56 degrees , 51 degrees . There were no death, infection, implant failures or collapse of intervertebral space. Intraoperative injury of lacteal occurred in one patient, but no postoperative complications happened. One of two patients who had pleural effusion was managed with close drainage. Exudative pleurisy occurred in one patient, the sympathectomy effect occurred in three patients who presented asymmetry of skin temperature and resolved in short term.

CONCLUSIONSCoronal and sagittal alignment can be well corrected and maintained with TMC in anterior scoliosis surgery, collapse of intervertebral space and lumbar kyphosis can be prevented.

Adolescent ; Adult ; Female ; Follow-Up Studies ; Humans ; Lumbar Vertebrae ; surgery ; Male ; Orthopedic Fixation Devices ; Retrospective Studies ; Scoliosis ; surgery ; Spinal Fusion ; instrumentation ; methods ; Thoracic Vertebrae ; surgery ; Titanium

OBJECTIVETo compare the precision of the vertebral screw insertion in treating idiopathic thoracic scoliosis by thoracoscopy with that by mini anterior thoracotomy.

METHODSTen patients with an average Cobb angle of 52.9 degrees were operated thoracoscopically (group A), and twenty-one patients with an average Cobb angle of 45.4 degrees were operated by mini anterior thoracotomy (group B). In order to determine the accuracy of screw placement, several parameters were measured postoperatively on each instrumented level of CT scan, including the entry point and entry direction of screw, the relationships between the screw tip and aorta as well as spinal canal. The safety of screw placement was determined at the position of screw to the vertebral canal and the aorta, and the results of CT analysis were designated as; D, the screw tip was distant from the aorta (> or = 1 mm); A, the screw tip was adjacent to the aorta (< 1 mm); C, the screw tip was felt to be against the aorta and creating contour deformity. The screw which had a bi-cortical purchase but was distant from the aorta and vertebral canal was defined as a satisfied screw.

RESULTS73 screws were inserted into patients of Group A, and 162 into patients in Group B. Parameters measured on CT image and X-ray showed no difference between these two groups (P > 0.05). There is no difference (P > 0.05) between A and B group of percentages in D (89.0% vs. 80.2%), in bi-cortical purchase (89.0% vs. 87.0%), and in satisfaction of screw placement (74.0% vs. 66.0%).

CONCLUSIONThoracoscopic and mini-open thoracotomic anterior correction are safe and effective to correct idiopathic right thoracic scoliosis with satisfied correction. Vertebral screws placed by both techniques have the same satisfied accuracy, safety, bi-cortical purchase and the satisfaction rate either in total screws or in the corresponding area.

Adolescent ; Bone Screws ; Child ; Female ; Humans ; Male ; Minimally Invasive Surgical Procedures ; instrumentation ; methods ; Reproducibility of Results ; Scoliosis ; surgery ; Thoracic Vertebrae ; pathology ; surgery ; Thoracoscopy ; methods

OBJECTIVESTo evaluate the correlation between preoperative pulmonary function tests, surgical approach and postoperative time of tracheal extubation in patients with scoliosis.

METHODSThe case records of 115 patients, who underwent anterior or posterior fusion, were reviewed. And we studied the relative factors on postoperative time of tracheal extubation by multiple linear regression analysis.

RESULTSMultiple linear regression showed that the time of tracheal extubation had negative correlation with the VC%, MVV%, FEV1%, FEF25% and thoracoplasty. On the other hand, the time of extubation in patients with thoracoplasty was larger than those without thoracoplasty, but the time of extubation in patients with or without thoracotomy had no statistical significance.

CONCLUSIONSVC%, MVV%, FEV1%, FEF25% and thoracoplasty are the main determinants of the time of extubation in patients with scoliosis. Preoperative pulmonary function evaluation and surgical approach selection may play an important role in determining the time of tracheal extubation in patients with scoliosis.

Adolescent ; Adult ; Child ; Female ; Humans ; Intubation, Intratracheal ; Lung ; physiopathology ; Male ; Postoperative Period ; Respiratory Function Tests ; Retrospective Studies ; Scoliosis ; physiopathology ; surgery ; Thoracoplasty ; Thoracotomy ; Time Factors