Objective To study the efficiacy and safety of transfacet approach decompression to treat thoracic spinal stenosis caused by anterior compression.Methods Thirty-three patients with thoracic spinal stenosis caused by anterior compression were treated in our institution from April 2005 to April 2009.Nineteen patients with more than 12 months follow-up were included in this study.Among of them,10 were male and 9 were female,with the age ranged from 33 to 77 years(mean,55.9 years).The causes of compression for spinal stenosis included ossification of posterior longitudinal ligament(OPLL)in 5 cases,thoracic disc herniation(TDH)in 11 cases,OPLL with ossification of ligamentum flavum(OLF)in 2 cases and TDH with OLF in 1 case.All patients underwent anterior decompression via a transfacet approach combined with anterior fusion and posterior fixation.The modified Japanese Orthopaedic Association(JOA)score system and Nurick Myelopathy grade were used to evaluate the outcomes.Results The operation time ranged from 180 to 480 min,with an average of 299.5 min and the blood loss was varied from 250 to 2200 ml,with an average of 918.5 ml.Among 7 cases with OPLL(including combined with OLF),2 patients developed neurologic deterioration and 1 patient developed cerebrospinal fluid leakage.There were no neurologic deterioration,cerebrospinal fluid leakage and other complications occurred in 12 cases with TDH(including combined with OLF).The follow-up ranged from 12 to 54 months(mean,28.6 months).The preoperative JOA score ranged from 2 to 11(mean,6.3).The JOA score in the last follow-up ranged from 5 to 11(mean,8.6).According to Nurick Myelopathy grade,the preoperative grade was 0 in 2 cases,1 in 2,2 in 4,3 in 5,4 in 2,and 5 in 4.The number of postoperative grade was 6,6,3,3,1 and 0 respectively.Conclusion Satisfactory decompression could be achieved by using transfacet approach for thoracic spinal stenosis caused by anterior compression.The approach is a safe and promising alternative for thoracic spinal anterior decompression.

The purpose of this study was to investigate and discuss imaging methods and management strategies for congenital choledochal cyst with co-existing intrahepatic dilation and aberrant bile duct as well as other complicated biliary anomalies. In this study we reviewed and analyzed 72 patients with congenital choledochal cyst, ranging in age from 15 days to 12 years old and who were seen at our hospital during the past 12 years, from January 1993 to October 2005. The image manifestation and clinical significance of patients with co- xisting intrahepatic biliary dilation and aberrant bile duct were carefully examined during operation via MRCP, cholangiography and choledochoscope. Twenty-two cases (30.1%) presented with intrahepatic bile duct dilation and 12 of these were of the cystic type. That is, the orifice of the dilated intrahepatic tract that converged into the common hepatic duct showed membrane or septum-like stenosis. In 10 cases the dilation tapered off from the porta hepatis to the initiating terminals of the intra-hepatic bile ducts and was not accompanied by stenosis. An aberrant bile duct was observed in 2 of the cases. In 3 cases, the right and left hepatic ducts converged at the choledochal cyst. In conclusion, the imaging methods for intrahepatic bile duct dilation possess important clinical significance. Further, for hepatojejunostomy with radical excision of a choledochal cyst, additional operative procedures for intrahepatic stenosis, possible bile duct malformation and pancreaticobiliary common duct calculi can potentially reduce postoperative complications.
Tomography, X-Ray Computed ; Postoperative Complications/ultrasonography ; Male ; Liver Diseases/complications/*radiography/surgery ; Infant, Newborn ; Infant ; Humans ; Female ; Choledochal Cyst/complications/*radiography/surgery ; Cholangiography ; Child, Preschool ; Child ; Bile Ducts/*abnormalities/pathology/surgery

The purpose of this study was to investigate and discuss imaging methods and management strategies for congenital choledochal cyst with co-existing intrahepatic dilation and aberrant bile duct as well as other complicated biliary anomalies. In this study we reviewed and analyzed 72 patients with congenital choledochal cyst, ranging in age from 15 days to 12 years old and who were seen at our hospital during the past 12 years, from January 1993 to October 2005. The image manifestation and clinical significance of patients with co- xisting intrahepatic biliary dilation and aberrant bile duct were carefully examined during operation via MRCP, cholangiography and choledochoscope. Twenty-two cases (30.1%) presented with intrahepatic bile duct dilation and 12 of these were of the cystic type. That is, the orifice of the dilated intrahepatic tract that converged into the common hepatic duct showed membrane or septum-like stenosis. In 10 cases the dilation tapered off from the porta hepatis to the initiating terminals of the intra-hepatic bile ducts and was not accompanied by stenosis. An aberrant bile duct was observed in 2 of the cases. In 3 cases, the right and left hepatic ducts converged at the choledochal cyst. In conclusion, the imaging methods for intrahepatic bile duct dilation possess important clinical significance. Further, for hepatojejunostomy with radical excision of a choledochal cyst, additional operative procedures for intrahepatic stenosis, possible bile duct malformation and pancreaticobiliary common duct calculi can potentially reduce postoperative complications.
Tomography, X-Ray Computed ; Postoperative Complications/ultrasonography ; Male ; Liver Diseases/complications/*radiography/surgery ; Infant, Newborn ; Infant ; Humans ; Female ; Choledochal Cyst/complications/*radiography/surgery ; Cholangiography ; Child, Preschool ; Child ; Bile Ducts/*abnormalities/pathology/surgery

Objective To observe the early clinical outcomes of iliotibial band with Gerdy's tubercle transplantation for irreparable rotator cuff tears (IRCT).Methods A total of 16 patients with IRCT who underwent iliotibial band with Gerdy's tubercle transplantation from June 2014 to June 2015 and with a minimum follow-up of 2 years were retrospectively analyzed.There were 4 male and 12 female with a mean age of 56.1±6.6 years old (range 44-67 years old).The X-ray and MRI were used to evaluate the improvement of acromiohumeral interval (AHI),rotator cuff healing and final outcome of bone graft postoperatively.Functional outcomes were assessed by visual analogue scale (VAS),American Shoulder and Elbow Surgeon (ASES) and Constant-Murley score.Results The average follow-up duration was 25.3±1.5 months (range 24-48 months).At the final follow-up,the forward flexion,external rotation and internal rotation were 159.37°±8.51°,35.31°±8.26° and 11.00°±2.52°,respectively.There was statistically significant difference between preoperative and postoperative joint range of motion (P ＜ 0.05).At the 3 months postoperatively,all patients had complete bone union between the Gerdy's tubercle and the greater tubercle.However,at the final followup,partial or complete bone absorption was observed in 6 patients.Twelve patients had complete rotator cuff healing,and 4 patients had partial healing.No patient had rotator cuff retear.The AHI increased significantly from 3.63±1.25 mm preoperatively to 8.37± 1.02 mm postoperatively (P ＜ 0.05).The postoperative VAS,ASES and Constant-Murley score were 1.06±0.93,81.75±6.80 and 77.12± 6.72,respectively.The differences between preoperative and postoperative VAS,ASES and Constant-Murley score were statistically significant (P ＜ 0.05).There was significant difference in postoperative VAS between bone absorption group and non-absorption group (P ＜ 0.05),while no significant difference was found in ASES or Constant-Murley score (P ＞ 0.05).Conclusion All patients had complete or partial rotator cuff healing.However,37.5％ of the patients had bone absorption and obtained a worse VAS score.The iliotibial band with Gerdy's tubercle transplantation for IRCT could significantly restore the joint function at 2 years postoperatively.

Objective:To investigate the application value of Hisense computer-assisted surgery system (CAS) three-dimensional reconstruction in the precision treatment of pediatric liver tumors.Methods:The retrospective and descriptive study was conducted. The clinicopathological data of 82 children with liver tumors who were admitted to Affiliated Hospital of Qingdao University from January 2013 to September 2021 were collected. There were 39 males and 43 females, aged 13(19)months. Children underwent upper abdominal dynamic enhanced computed tomography (CT) examination, and three-dimensional reconstruction was performed on CT images of arterial, equili-brium and venous phases with Hisense CAS. Surgical feasibility and scheme were evaluated and conducted based on the results of upper abdominal dynamic enhanced CT examination, and then revised according to three-dimensional reconstruction results of Hisense CAS. Observation indicators: (1) comparison of surgical scheme between two-dimensional enhanced CT images and three-dimensional reconstruction results of Hisense CAS; (2) intraoperative and postoperative situations; (3) follow-up. Follow-up was conducted by outpatient examination to detect postoperative compli-cations and residual liver compensation up to November 2021. Measurement data with normal distribution were represented as Mean± SD. Measurement data with skewed distribution were represented as M(IQR) or M(range). Count data were described as absolute numbers or percentages. Results:(1) Comparison of surgical scheme between two-dimensional CT images and three-dimensional reconstruction results of Hisense CAS. ① Based on the two-dimensional CT images, 42 cases of 82 children could undergo one-stage resection and 40 children could not. However, based on the three-dimensional reconstruction results of Hisense CAS, 48 cases of 82 children could undergo one-stage resection and 34 children could not. There were 6 children with one-stage resection feasibility based on the three-dimensional reconstruction results of Hisense CAS rather than the two-dimensional CT images. For the 34 children undergoing chemotherapy firstly, 31 cases had surgical feasibility after chemotherapy based on the two-dimensional CT images and 3 cases could not undergo surgery because of unapparent tumor regression or tumor surrounding impor-tant vessels. However, the 34 children had surgical feasibility after chemotherapy based on the three-dimensional reconstruction results of Hisense CAS. The revision rate of surgical feasibility was 11.0%(9/82) for the 82 children. ② Based on the two-dimensional CT images, 15 cases of 82 children underwent liver left lobectomy, 21 cases underwent liver right lobectomy, 7 cases underwent mesohepatectomy, 13 cases underwent extended left hemihepatectomy, 23 cases underwent extended right hemihepatectomy, 3 cases underwent segmental hepatectomy. However, based on the three-dimensional reconstruction results of Hisense CAS, 20 cases of 82 children underwent liver left lobectomy, 29 cases underwent liver right lobectomy, 7 cases underwent mesohepatectomy, 7 cases underwent extended left hemihepatectomy, 14 cases underwent extended right hemihepatectomy, 5 cases underwent segmental hepatectomy. The revision rate of surgical scheme was 36.6%(30/82) for the 82 children. (2) Intraoperative and postoperative situations. The operation time, volume of intraoperative blood loss, duration of postoperative hospital stay of the 82 children were (182±18)minutes, 20(10)mL, (10.2±1.9)days, respectively. (3) Follow-up. All the 82 children were followed up for 10 (range, 2?18)months. There was no obvious complication occurred to the 82 children after surgery, and the residual liver can satisfy the liver compensation of body. All the children survived well.Conclusion:Three-dimensional reconstruction of Hisense CAS is conducive to judging the surgical feasibility and formulation of accurate surgical plan of children with liver tumors.