BACKGROUND:Deep vein thrombosis is a common postoperative complication after spinal surgery in clinical department of neurosurgery anddepartment of orthopedics. Deep vein thrombosis is mostly related to vein intima injury, stasis and activation of blood coagulation factor. Early effective prediction can effectively avoid the adverse effects on the prognosis of patients with deep vein thrombosis. D-dimer used in the prediction of deep venous thrombosis has high sensitivity and specificity, andcan be used as a sensitive predictor for deep vein thrombosis. OBJECTIVE:To explore the relationship between plasma D-dimer mass concentration and deep vein thrombosis after spinal surgery. METHODS:A total of 83 patients treated with spinal surgery colected fromDepartment of Neurosurgery, First Affiliated Hospital of Xinjiang Medical University from April 2014 to August 2015 were retrospectively analyzed. They were divided into two groups according to postoperative plasma D-dimer mass concentration:D-dimer positive group (n=48) and D-dimer negative group (n=35). We monitored D-dimer mass concentration in both groups preoperatively and postoperatively 1, 3, 5, 9 and 14 days, and analyzed the relationship between D-dimer mass concentration and deep vein thrombosis. RESULTS AND CONCLUSION:(1) No significant difference in D-dimer mass concentration was determined between the two groups (P> 0.05). D-dimer mass concentration was significantly higher in the D-dimer positive group than in the D-dimer negative group 1, 3, 5, 9, and 14 days postoperatively (P<0.05). (2) After operation, plasma D-dimer of 28 cases was positive, with persistent increasing. Double lower limb deep vein color Doppler ultrasound demonstrated that seven patients experienced deep vein thrombosis and four patients suffered from pulmonary embolism in D-dimer positive group. There was no deep vein thrombosis and pulmonary embolism in the D-dimer negative group. (3) These results indicate that positive D-dimer concentration of patientsafter spinal surgery suggests the possibility of deep vein thrombosis. If the concentration of D-dimer is persistently high, we should highly alert to the occurrence of deep vein thrombosis.

Objective:To investigate the efficacy of free superficial circumflex iliac artery perforator flap (SCIAPF) in reconstruction of the donor site of hallux nail flap.Methods:From December 2015 to December 2022, Section Ⅲ of Department of Hand Surgery of Hangzhou Plastic Surgery Hospital conducted thumb reconstruction surgery with free hallax nail flaps for 12 patients with traumatic defects of thumbs. Six patients had degloving injuries of thumb with intact bone scaffold and extensor-flexor tendon. Among the other 6 patients with thumb defects, 3 had grade I defect, 2 had grade II defect and 1 had grade Ⅲ defect, according to Gu Yudong's classification. Free SCIAPFs were used to reconstruct the donor sites of hallux nail flaps. Sizes of the flaps were 3.0 cm× 6.5 cm-9.0 cm ×7.0 cm. All donor sites in the abdomen were directly sutured. After surgery, functional evaluations of the reconstructed thumb were conducted through follow-ups at outpatient clinics and(or) by WeChat interviews, according to the Evaluation Trial Standards of Upper Limb Partial Functional of Hand Surgery of Chinese Medical Association, and the functional evaluation of donor feet was conducted according to the Maryland foot function evaluation standard.Results:Successful survival of the 9 cases of flap in the donor site of hallux nail flap. One patient had venous occlusion of flap and survived after timely surgical exploration. One flap had partial necrosis at the tip of flap, and the wound was eliminated with local transfer of a flap. One patient had necrosis over most of the flap with the base of the flap survived, and the wound was repaired by a stage-II skin grafting. The donor sites at groin healed in stage-I in all of 11 patients with a linear scar. One patient who had haematoma at the donor site was cured by removal of the haematoma and a re-suture. All the patients received a 3 to 24 months of postoperative follow-up. According to the Evaluation Trial Standards of Upper Limb Partial Functional of Hand Surgery of Chinese Medical Association, 10 patients were in excellent and 2 in good. All of the great toes remained with original length and recovered normal flexion and extension. No patient suffered pain while walking and running. According to the Maryland foot function evaluation standard, 10 patients were in excellent and 2 in good. All SCIAPFs were satisfactory in colour and texture. Five patients had bloated flaps and underwent Hacks in the stage-Ⅱ.Conclusion:Application of a free SCIAPF in reconstruction of the donor site for hallux nail flap can effectively preserve the appearance and function of the donor site. Meanwhile, the scar in the donor site of groin is concealed with little damage, therefore the groin meets the requirements as a donor site of a flap.

Objective To explore the clinical characteristics and clinical treatments strategies of ependymoma in the spinal cord.Methods The clinical and follow-up data of 34 patients with ependymoma in the spinal cord,admitted to our hospital from July 2011 to September 2016,were analyzed retrospectively.All patients were operated under nerve electrophysiological monitoring,and several patients with less than 95％ tumor resection accepted adjuvant radiotherapy.Results Postoperative pathological results indicated ependymoma in all patients,including one with WHO Ⅰ,30 with WHO Ⅱ,and 3 with WHO Ⅲ.Total tumor removal was achieved in 20 patients,subtotal removal (more than 95％) in 10 and big partial removal (80％-95％) in 4.Seven patients occurred postoperative complications,including 3 with cerebrospinal fluid infection,2 with paraplegia and 2 with rectal bladder dysfunction;5 occurred in patients with total tumor removal and 2 occurred in patients with subtotal removal.Spinal cord functions were significantly improved in 20 patients,unchanged in 7 and deteriorated in 7 when they left hospital.In the follow up of (30.5±18) months,4 patients with subtotal removal were recurrent,and 4 big partial removal patients received radiotherapy after a month were without recurrence at present.Conclusions Total tumor removal with capsule or pseudocapsule by microsurgery is the most effective treatment for ependymoma in the spinal cord.For a small number of tumors whose margins are not clear,better neurological functions could be preserved and postoperative quality of life could be improved by undergoing subtotal removal and adjunctive radiotherapy.

Objective To explore the etiology,clinical manifestations,diagnoses,treatments and prognoses of spontaneous spinal epidural and subdural hematomas.Methods Medical records of 10 patients with spontaneous spinal epidural hemorrhage and 4 patients with subdural hemorrhage,collected in our hospital from September 2013 to January 2016,were analyzed retrospectively.Evacuation of the hematoma was carried out in 12 patients and the other two patients were treated conservatively.The functions of spinal cords were assessed by American Spinal Injury Association impairment scale (ASIA) before and after the treatment.Results Spontaneous spinal epidural and subdural hematomas appeared mostly in young patients with sudden onset.Spinal epidural hematomas were much more common than subdural ones.The pathological examination showed that one suffered from arteriovenous malformation,one suffered from perimedually artriovenous fistula,and 12 had intracranial hematomas which were resulted from undefined causes.The ASIA before the operation was as follows:5 were in grade A,2 in grade B,4 in grade C and 3 in grade D.The ASIA after the operation was as follows:4 were in grade A,one in grade C,3 in grade D and 4 in grade E.The two patients received conservative treatments achieved total recovery of the neurological functions (grade E).Conclusions It should be stressed that early diagnosis and prompt surgical intervention are of great importance for prompt of spontaneous spinal epidural.The better the preoperative neurological status,the better the neurological outcome after the surgical operation.

Objective To discuss the efficacy and safety of endoscopic endonasal transsphenoidal surgery for sympatomatic Rathke' s cleft cysts.Methods The clinical manifestations, imaging features, surgical methods, pathology features, postoperative complications, postoperative recurrence and outcomes of 24 patients with Rathke's cleft cysts, admitted to our hospital from January 2007 to December 2014, were reviewed retrospectively.Results Total resection was achieved in 0 patient and subtotal resection was achieved in 24 patients.In the 16 patients with headache, 4 got relief and 12 achieved cure.In the 9 patients with hypopsia, 3 recovered to normal, 5 got improvement and one enjoyed no obvious changes.In the 21 patients with endocrine function disorder, 2 recovered to normal, 2 got improvement and one had transient diabetes insipidus.One patient appeared transient diabetes insipidus.Nine patients had transient decreased thyroid hormones, and those patients with progesterone, follicle stimulating hormone, luteinizing hormone, growth hormone and prolactin disorders recovered to normal;one patient got postoperative recurrence and accepted surgery for the second time.Conclusion Endoscopic endonasal transsphenoidal surgery is a rational choice for sympatomatic Rathke' s cleft cysts, which can effectively perform the cyst drainage and resection of the capsule wall, enjoying small trauma, safety and low postoperative recurrence rate.