[Objective]To evaluate the outcome on patients with primary infection of intervertebral space of the thoracolumbar spine following combined one-stage debridement,strut grafting and internal fixation.[Method] From May 1999 to February 2006,18 patients with spontaneous infection of intervertebral space were analyzed retrospectively.These infections occurred at thoracic spine in 3 cases(16.7%),thoracolumbar junction in 2 cases(11.1%),lumbar spine in 10 cases(55.5%),and lumbosacral junction in 3 cases (16.7%).Their clinical data and outcome were studied.None of all had previous spinal surgery or spinal injection,and their diagnosis were confirmed by histopathology after surgery.All patients were treated by one-stage debridement,strut grafting and internal fixation after failure of nonsurgical treatment.Antibiotics was used following debridement in the infection sites,and was continued to be administered after surgery.Patients were evaluated before and after surgery in terms of pain,neurologic level,sagittal spinal balance,and radiologic fusion.[Result]Postoperatively,all patients experienced significant relief of symptoms,and no fever.Six patients showed improved neurological status(at least one grade improvement on Frankel's functional classification).Only 3 of 18 cases had a positive culture result that pathogen identified Staphylococcus aureus.Histological examination of the specimen after surgery revealed that inflammation occurred in all patients,but no evidence of tuberculosis.The period of follow-up ranged 13 to 45 months with a mean of 26 months.No evidence of recurrence or residual infection was observed in any patient.Postoperative radiological evaluation revealed that implants were stable,there was no phenomena of prosthesis subsidence,hook dislodgment and failure restoration of spinal segments height.Solid bony fusion was obtained in all patients.Eight patients were misdiagnosed for spinal tuberculosis.[Conclusion] One-stage eradication of the infection,strut grafting and internal fixation are effective treatments for primary infection of intervertebral space.The presence of the instrumentations at the site of infection has no negative influence on the course of infection healing.

[Objective] A retrospective study was performed to evaluate the outcome of three-dimensional correction for adolescent idiopathic scoliosis(AIS)and discuss biomechanics of posterior three-dimensional correction surgery and measures for the prevention of spinal imbalance.[Methods]Thirty-one patients with AIS were classified and treated with three-dimensional correction surgery from 2005 to 2007.There were 18 male and 13 female with the average age of 15.2 years(range,11 to 18 years).The cases were classified according to the Lenke surgical classification,including type I 8 cases,type Ⅱ 4 cases,type Ⅲ 8 cases,type Ⅳ 2 case,type Ⅴ 5 cases,type Ⅵ 4 cases.The major curve Cobb's angles,the distance of apical vertebra shift and trunk shift,were measured and analyzed in the reoperative,postoperative and final follow-up radiographies.The average preoperative coronal Cobb's angle was 54?,the distance of both apical vertebra shift and trunk shift was 5.8 cm and 2.6 cm respectively.[Results]The mean time of follow-up was 16 months(range 1 to 3 years).The average postoperative coronal Cobb's angle was 21?,as the correction was 61%,the lost angle at the last follow-up was 4.0?.The postoperative distance of apical vertebra shift was 2.5cm,as the correction was 56%,the lost distance at the last follow-up was 0.5 cm.The distance of trunk shift at the last follow-up was 1.0 cm.[Conclusion]Posterior three-dimensional correction surgery is a good corrective method in the treatment of AIS.The spinal mechanical balance should be noticed during the operaion.

0.05).One case developed hemorrhage of venous plexus in the posterior pedicle screw fixation group.And complications occurred in 6 cases(4 of superior nerve injury,1 of intra-incision hematoma and 1 of esophageal injury).There were significant differences between 2 groups(P

Objective To assess the benefit of intraoperatively placed nasointestinal feeding tubes for early postoperative enteral nutrition.Methods The retrospective study was carried out on 19 cases of in-fants with long gap esophageal atresia who underwent one-stage operation in Xinhua Hospital from January 2006 to December 2013.Patients were divided into two groups according to whether the transanastomotic na-sointestinal feeding tubes(TNFT)were placed.Demographics,associated anomalies,operative findings,com-plications,duration of enteral nutrition(EN),length of stay were analyzed.Results Thirty-seven patients had long gap esophageal atresia and nineteen underwent one-stage operation.Eight patients were identified as TNFT group while eleven patients were identified as nonfeeding tube(NFT)group.There was no significant differences between the two groups in gestational age,birth weight,associated anomalies,anastomotic leak, weight gain,ICU-free days and length of stay(P>0.05).But the ventilator-free days(23.5 d vs.19.3 d), first EN time(0.8 d vs.9.1 d)and total EN feeding time(15.9 d vs.21.4 d)between the two groups were significantly different(P<0.05 ).Conclusion Intraoperatively placed TNFT may lead to earlier EN feeding and shorter parenteral nutrition duration,but a larger prospective study would be required to prove the benefits and ensure the safety.

Objective To explore the expression of CD133 and nestin in human glioma cell of patients with neuroglioeytoma and to see whether CD133 and nestin expression associate with the differentiation and pathologic grading.Methods The expression of CD133 and nesfin was detected by immunohistochemistry staining in 65 cases of human glioma and 19 specimens of normal brain tissues.Results The rate of the CD133 positive ceUs was 18.46%in human glioma and 0 in the control group(P＜0.01),and that of nesfin was 23.79%and 5.16%respectively.The positive cell rates of CD133 or nestin varied accordingly to different pathological grades.There were significant difference between grade Ⅰ and grade Ⅲ or grade Ⅳ (P＜0.01).There were difference between grade Ⅱ and grade Ⅲor grade Ⅳ (P＜0.01).The same significance were also found between grade Ⅲ and grade Ⅳ(P＜0.01).The higher pathological grades had higher positive cell rates.There was a significant corl~lation between the rate of CD133 positive cells and that of nestin in experimental group (r=0.408,P＜0.01).Conclusion Detecting CD133 and nestin in the human glioma can be used in diagnosing,judging the malignancy degree and the prognosis.

Objective To discuss the surgical effect of adult lipomatous tethered cord syndrome (TCS). Methods The clinical data of 29 patients with adult lipomatous TCS were systematically analyzed. Eleven of male and 18 of female,who ranged from 20 to 59 years. All patients were performed filum terminale release and lipoma excision, the clinical outcome after operation was analyzed according to Hoffman grading criteria and visual analog scale (VAS). Results According to Hoffman grading criteria, 9 cases were obviously improved in leg muscle weakness, including 1 case with urination disturbance improved significantly. Also the lower back pain of patients were improved obviously: (2.63 ± 1.30) scores vs. (8.67±0.30) scores, there was significant difference (P<0.05). Conclusions Filum terminale release and lipoma excision can effectively improve the symptom of lower back pain of adult lipomatous TCS patients, meanwhile the symptom of paraparesis can improve appropriate postoperatively. But urinary deficits do not show a significant change.

Objective To perform the epidemiological analysis of the developmental dysplasia hip(DDH) in Shigatse of Tibet in order to explore the correlation between the onset of DDH with some risk factors such as altitude and take targeted intervention measures to reduce the disability rate of DDH.Methods A total of 5900 children aged 0 to 14 year-old from different altitudes in Shigatse of Tibet were surveyed randomly from June 2013 to June 2014.SPSS 18.0 statistical software was used to analyze the correlation of the onset of DDH with residence altitude,production and living ways,binding method of the lower limbs,delivery situation and genetic factor.Results One hundred and ninety-one DDH cases were screened out,and the average incidence of DDH in Shigatse of Tibet was about 32.4‰,and unilateral was higher than bilateral,fight side(33 cases)∶left side(68 cases) =1.00∶ 2.06.The result of Pearson correlation analysis of the onset of DDH with residence altitude showed that there was significant correlation (r=0.820,P=0.046).The result of Spearman correlation analysis of the onset of DDH with production and living ways showed that there was significant correlation(r=0.530,P =0.048).The result of x2 test analysis of the onset of DDH with binding method of the double lower limbs and breech delivery showed that there was statistical significance (P=0.0017,0.0082).Conclusions The DDH incidence of children living in high altitude areas in Tibet has certain regional characteristics indicating that it has clear correlation with some environmental risk factors such as altitude,methods of the lower limbs binding,production and living ways and breech delivery,especially the bundled package of lower limbs is the main environmental risk factor of DDH.

Objective To investigate the diagnostic value of prostate specific antigen (PSA) (fPSA, fPSA/tPSA, PSAD) combined with value of apparent diffusion coefficient (ADC) in diffusion weighted imaging (DWI) and magnetic resonance spectroscopy (MRS) in the diagnosis of prostate cancer (PCa) between total PSA (tPSA) 4- 10 μg/L. Methods From December 2013 to 2015 February , 56 elderly male patients with serum tPSA 4-10μg/L were enrolled. Pathological examination confirmed 26 patients with PCa and 30 patients with benign prostatic hyperplasia (BPH). The levels of tPSA and free PSA(fPSA) , fPSA/tPSA, Prostate specific antigen density(PSAD), ADC value according to the DWI, choline(Cho), creatine(Cre) and citrate(Cit) in MRS were analyzed, and ADC, (Cho+Cre)/Cit combined with PSAD and fPSA/tPSA in PCa diagnosis was analyzed by receiver operating characteristic curve (ROC). Results The level of tPSA in PCa group and BPH group had no significant difference (P >0.05), but the levels of fPSA、fPSA/tPSA、prostate volume, PSAD, (Cho+Cre)/Cit, ADC had significant difference:(1.04 ± 0.14) μg/L vs. (1.22 ± 0.34) μg/L, 0.15(0.14- 0.16) vs. 0.17(0.15-0.18), (41.45 ± 5.70) cm3 vs. (48.70 ± 9.97) cm3, 0.17(0.15-0.18) ng/(ml·cm3) vs. 0.16(0.14-0.17) ng/(ml·cm3), 2.22 ± 0.59 vs. 1.17 ± 0.52, 0.98 ± 0.28 vs. 1.39 ± 0.24, P < 0.01 or < 0.05. The area under the curve of (AUC) fPSA/tPSA+PSAD+(Cho+Cre)/Cit、fPSA/tPSA+PSAD+ADC、fPSA/tPSA+PSAD+(Cho+Cre)/Cit+ADC were 0.932, 0.941 and 0.977, and the AUC of fPSA/tPSA+PSAD+(Cho+Cre)/Cit+ADC was the highest. Conclusions PSAD and fPSA/tPSA and the value of ADC in DWI and MRS can be used in diagnosis of PCa.

Objective To explore the effect of using pedicle skin flaps for treatment of skin and soft tissue defects.Methods From January 2004 to September 2010,87 patients with skin and soft tissue injury which had been treated by using pedicle skin flaps without vessel anastomosis were retrospectively analyzed,including 61 males and 26 females with an average age of 40 years (range,14-61).The pedicle skin flaps selected were known vessel skin flaps or unknown vessel random skin flaps.The reconstruction treatment increased multiple selections of skin flaps for patients.Skin and soft tissue defects were located at the hand in 21 cases,at the lower extremities in 66.The kinds of skin flaps included adjacent transposition flaps in 50 cases,distal skin flaps in 37.The areas of the skin flaps were 2.0 cm×1.5 cm-18 cm×12 cm.Donor sites were as follows:lower leg in 61 cases,abdomen in 18,and hand in 8.Results Three patients appeared skin flaps hematoma after operation,which were removed immediately with no effect on flaps survival.Pedicle skin flap was compressed due to unstable fixation in 1 case,which made distal flap tissue necrosis approximately 2 cm in width.After dressing change for 6 weeks,the flaps got survival.Thirty seven patients underwent the second stage operation for breaking the perdicle 3 weeks after the first operation.All 87 patients were obtained follow-up for an average of 13 months (range,3-60).The total of 90.80％ patients treated with pedicle skin flaps were satisfied with the results.Conclusion Pedicle skin flap surgery can be performed more easily with less limitations of surgical designs.The survival rate of the flap is high,and the treatment of pedicle skin flaps could be well applied for soft tissue defects.

Objective To explore the value of intraoperative contrast-enhanced ultrasonography in radiofrequency ablation completeness evaluation in patients with hepatic carcinoma of differently sized nodules.Methods Fifty five patients (69 lesions) with hepatic carcinoma were included and were divided into the experimental group (20 cases,30 lesions in whom CEUS were used) and the control group (35 cases,39 lesions,conventional ultrasound was used).After RAF,the treatment effect of the two groups were evaluated by enhanced CT regularly.Differences between conventional ultrasound and CEUS were compared and their judgement on ablation residual tumor tissue was analyzed.Results After 1 to 24 months of follow-up,the total residual rate of the experimental group and the control group was 13.3％ (4/30) and 35.9％ (14/39) respectively.The significant difference was found in the residual rate between the experimental group and the control group (x2 =5.366,P ＜ 0.05).For the two groups (＞ 5 cm and ＜3-5 cm),the residual rate of the experimental group was 30.0％ and 10.0％,the residual rate of the control group was 87.5％ and 46.2％,there were statistically significant difference (respectively x2 =5.951,4.790,all P ＜ 0.05).The significant difference was found in the recurrence rate (the experimental group:20.0％ (4/30),the experimental group:75.0％ (6/8)),when the lesion was larger than 5 cm in diameter(x2 =5.445,P ＜ 0.05).Conclusions CEUS has advantage over conventional ultrasound for the detection of residual tumor tissues after radiofrequency ablation for hepatic carcinoma,it reduces after ablation tumor recurrence especially in large tumors.