Fracture of the thoracic spine with paralysis and esophageal perforation

A 17-year-old young man presented with a highly unstable fracture dislocation of the third and fourth thoracic vertebrae with neurological deficit, in which the fractured spine had perforated the thoracic esophagus. Open reduction and internal fixation of the spinal fractures in combination with aggressive treatment of the mediastinitis caused by esophageal perforation, consisting of two re-thoracotomies, was performed. Two years after the accident, the patient had recovered well. The neurological deficit had recovered, and there were no difficulties with swallowing.     

The lumbar and lumbosacral facet-syndrome. Diagnostic measures,surgical treatment and results in 119 patients

Summary The authors present their diagnostic and therapeutic protocol as well as the surgical outcome in a series of 119 patients with the lumbar facet syndrome.By use of different surgical techniques such as translaminar screw fixation (n=56), Louis plate fixation (n=36), Cotrel-Dubousset instrumentation (n=11) and soft system stabilization according to Graf (n=14) excellent, good, satisfactory, moderate and poor results were obtained in 78 (67%), 20 (17%), 14 (12%), 4 (3%), and 1 (1%) instances, respectively.     

Labman and Linkman: A data management system specifically designed for genome searches of complex diseases

Two programs have been developed to manage linkage analysis data. The first program, LABMAN, is a comprehensive laboratory data management system organizing pedigrees, blood DNA samples, DNA markers, Southern blot or polyacrylamide gels, autoradiographs, and marker-allele typings generated from these samples. Output includes mendelization checks for genetic incompatibilities in typings and formatted files ready for linkage analysis. LABMAN can also compress highly polymorphic allele systems into smaller allele systems facilitating analysis of large systems. The second program, LINKMAN, provides data management for lod score output from linkage analyses. It reads linkage analysis output files, calculates lod scores by family, associates lod scores with specific marker and family identifiers, and stores these data in a database where they can be combined with lod scores from previous analyses. LINKMAN easily incorporates any of a wide variety of genetic models. It produces formatted output of lod scores by user-specified criteria for reports or as ASCII files for input to other programs. If desired, tests of homogeneity of linkage across families can be run via the HOMOG program [Ott, 1991] and their output included in reports. The programs include features critical for conducting genome searches of complex diseases: They are easy-to-use, well-tested, and reliable. Data from multi-center investigations can be easily combined for analysis. Moreover, they include extensive error-checking capabilities, and they are specifically set up to protect blindness between laboratory workers and data analysts. LABMAN and LINKMAN are currently available free of charge under DOS. © 1994 Wiley-Liss, Inc.     

颈前路Interfix与Syncage-C的临床应用比较

目的比较两种颈椎椎间融合器前路减压融合术后椎体颈前柱高度、生理曲度及融合时间。方法采用Interfix及Syncage-C两种颈椎椎间融合器行颈椎病及颈椎间盘突出症前路减压后椎体间融合141例,其中Interfix38例,Syncage-C103例。术后摄X线片,观察手术节段的稳定性、颈前柱高度、生理曲度,以及融合时间。结果随访6~12个月,手术节段稳定,两种椎间融合器骨融合时间无显著性差异;术后颈前柱高度,除单节段外,多节段Interfix与Syncage-C有显著性差异。结论Syncage-C在术后颈前柱高度恢复及恢复生理曲度等方面均优于Interfix。     

Anterior lumbar fusion using a hybrid interbody graft

Summary This is a radiographic report of 40 patients (20 men, 20 women) who underwent anterior lumbar interbody fusions (73 levels) utilizing a “hybrid” interbody graft composed of femoral cortical allograft (FCA) bone and iliac crest cancellous autograft bone. The average age at surgery was 38 years (range 17–64 years), and follow-up averaged 1.4 years (range 1.0–2.4 years). Nineteen of the patients had undergone previous lumbar surgery. Thirty-two patients (63 levels) underwent anterior fusion combined with some type of posterior fixation, and eight patients (10 levels) had no posterior fixation. Types of posterior fixation included: for 20 patients (36 levels) Steffee variable screw placement fixation, for 10 patients (23 levels) translaminar facet screws (TFS), for 1 patient (3 levels) Knodt rods and for 1 patient (1 level) facet screws. Based on the persistence of lucent lines at the graft-host interface, three patients (one level each) were felt to have non-unions at their latest follow-ups at 1.4, 1.5 and 2.0 years, respectively. Two of these patients had no posterior fixation, and the other had TFS fixation. The overall fusion rate was 96% (70 of 73 levels). The fusion rate for all levels treated with posterior fixation was 98% compared with 75% for those without fixation. Intervertebral disc heights (IVDH) were measured on all films and corrected for magnification with computer assistance. On average, the IVDH was increased postoperatively but returned to preoperative values at follow-up. IVDH loss was independent of the type of instrumentation used. No complications arose from the use of the hybrid graft. Incorporation of the allograft portion of the graft is slow and was felt to be complete in only 7 of the 73 levels at follow-up. We conclude that the hybrid interbody graft technique is a safe and reliable method for performing anterior lumbar interbody fusions and should be combined with some type of posterior fixation. Long-term follow-up will be required to assess the behaviour of the allograft until incorporation is complete.     

The uses of a patient-based dietetic data-collection systern

The F.I.P. (Financial Information Project) dietetic package allows the collection of basic patient data, which then can be processed to give valuable clinical and management information for use by all dietitians in a dietetic department. The advent of the Korner Reports (DHSS, 1984a) and their implementation highlighted the need to computerize certain aspects of data collection in dietetic departments. Within the West Midlands Regional Health Authority a group of dietitians worked with the Regional Management Services Department to adapt a community nursing system, F.I.P., for use by dietitians. The system was piloted for all paramedical services in 1987 with one health district (North Warwickshire) piloting the dietetic package. It is now used by a range of dietetic and paramedical departments. This paper outlines the system and its uses.     

老年髋部骨折术后患者康复需求程度与康复状况调查

目的了解老年髋部骨折术后患者康复需求程度、需求满足度与康复状况的关系.方法上门随访82例老年髋部骨折术后患者家庭康复现状和康复需求情况.结果康复需求10个维度中他人支持、康复信息及功能训练指导位居前3位;需求程度与生理功能、躯体功能和社会功能有关(P＜0.05,P＜0.01);与髋关节功能评分中的疼痛程度、上楼梯、穿鞋袜和行走距离4个方面有关(P＜0.05,P＜0.01).结论出院后定期给予针对性的康复训练指导和健康教育是患者迫切的需求;康复需求程度高者,相应需求满足率低,其生活质量及髋关节功能恢复应成为干预的重点.     

Array compression for MRI with large coil arrays.

Arrays with large numbers of independent coil elements are becoming increasingly available as they provide increased signal-to-noise ratios (SNRs) and improved parallel imaging performance. Processing of data from a large set of independent receive channels is, however, associated with an increased memory and computational load in reconstruction. This work addresses this problem by introducing coil array compression. The method allows one to reduce the number of datasets from independent channels by combining all or partial sets in the time domain prior to image reconstruction. It is demonstrated that array compression can be very effective depending on the size of the region of interest (ROI). Based on 2D in vivo data obtained with a 32-element phased-array coil in the heart, it is shown that the number of channels can be compressed to as few as four with only 0.3% SNR loss in an ROI encompassing the heart. With twofold parallel imaging, only a 2% loss in SNR occurred using the same compression factor.     

重建钛板枢椎椎弓根螺钉及颗粒状植骨枕颈融合术

目的 探讨重建钛板螺钉及颗粒状自体松质骨植骨在枕颈融合中的应用。方法 2002年4月～2005年1月，选择枕颈区不稳定患者19例，年龄31～67岁；病程3个月～2年。其中枕寰枢椎复合畸形8例，陈旧性寰枢椎骨折脱位8例，类风湿性关节炎所致寰椎前脱位2例，枢椎齿状突肿瘤1例。JOA脊髓功能评分平均9．8分。使用重建钛板和枢椎椎弓根螺钉固定枕颈部，同时枕骨与枢椎后弓间颗粒状自体松质骨植骨。结果 术中、术后无并发症发生，切口Ⅰ期愈合。19例均获随访6个月～2年8个月，平均16个月，均获得了骨性融合。无神经血管损伤，无断钉、断板及内固定松脱。JOA脊髓功能评分平均达14．4分。结论 重建钛板枢椎椎弓根螺钉固定可靠，置入方便，自体颗粒状松质骨具有较高的融合率，在枕颈融合中效果满意。