基于计算机辅助技术的肱骨近端微创手术术前设计

Background: Accurate and precise preoperative planning can provide information instrumental for performing less invasive articular fracture surgery. The purpose of this study was to determine that computer-assisted preoperative planning (CAPP) has the potential to improve efficiency and time in the operating room. Patients and methods: Sixty-four patients with proximal humeral fractures were treated using locking plates by MIPO with CAPP. Total time needed and total cost for virtual segmentation, reduction and fixation of the fracture fragments were recorded. Intra- and interobserver reliability were analyzed with intraclass correlation coefficient. Clinical function was analyzed with Constant Score and radiology. Results: The mean total time required for CAPP of two-part, three-part, and four-part proximal humeral fractures were 13.63 ± 1.38 min, 23.14 ± 2.18 min and 39.61 ± 3.01 min, respectively. The intra- and interobserver reliabilities for all variables were high, ranging from 0.785 to 0.992. The mean operation time was 50.1 ± 6.7 minutes. Fifty-two cases were followed with an average follow-up of 34.2 months. The mean Constant Score of the injury side was 82.5 ± 9.9. Three (3/52) patients had 4 complications. Conclusions: The application of CAPP was efficient and reliable, and provided excellent clinical and radiographic outcome for the treatment of proximal humerus fractures by MIPO.     

A recommended technique of renal vein anastomosis in rat kidney transplantation for trainee

Background Various rat kidney transplantation models have been introduced over the decades and the study on the models seems to lack novelty and necessity.However,vascular anastomosis,especially renal vein,is still very difficult for trainees.The aim of this study was to provide the modified renal venous anastomosis of rat kidney transplantation to substitute the currant method for trainees.Methods Male Wistar rats were used as donors and recipients,respectively.Left orthotopic transplantation was performed with a modified technique of renal vein anastomosis,combining the end-to-end sutures with epidural catheter.Meanwhile,the survival rate,warm ischemia time,renal venous anastomosis time,and complications were recorded to evaluate the merits of the modified technique compared with the current recommended technique of rat renal vein.Two trainees took part in the learning of the models in two methods for performing 30 operations,respectively.Results The difference in warm ischemia time （from （57.25±7.30） minutes in the first 10 operations to （30.05±1.85）minutes in the third 10 operations） and renal vein anastomosis time （from （32.80±3.80） minutes in the first 10 operations to （19.30±0.98） minutes in the third 10 operations） was significantly short （P＜0.01） and the survival rate was statistically high （from （25±7）％ in the first 10 operations to 70％ in the third 10 operations） in equal number of operations （P＜0.01） by comparing with the current recommended method （（47.60±7.19） minutes to （22.8±1.85） minutes,（22.40±3.10） minutes to （9.95±1.50） minutes,45％±7％ to 80％±0,respectively）.The intraoperative complications and postoperative complications of renal venous anastomosis were also significantly decreased （P＜0.01）.Conclusions The technique with epidural catheter can shorten the learning curve of the trainee learning rat kidney transplantation.It may replace the currently recommended technique of rat renal vein for trainees.     

Proficiency of virtual reality simulator training in flexible retrograde ureteroscopy renal stone management

Background Minimally invasive flexible ureteroscopy techniques have widely adopted in the management of patients with renal stones. We performed this study to investigate the value of virtual reality simulator training in retrograde flexible ureteroscopy renal stone treatment for catechumen.     

Pulmonary vein antrum isolation of pre-excited atrial fibrillation

Background Pulmonary vein antrum isolation (PVAI) of pre-excited atrial fibrillation (AF) is controversial. This study aimed to observe the therapeutic effects of PVAI on pre-excited AF.

Methods Twenty-nine patients with pre-excited AF were prospectively divided into a PVAI group (group I, 19 cases) and a control group (group II, 10 cases). To each case in group I, PVAI was performed, and then electroanatomical mapping of accessory pathways (AP) and ablation were constructed on a three-dimensional (3D) map of the valve annulus. Only AP ablation was performed in each case of group II.

Results Of the 29 cases, three were found to have dual APs, two had intermittent APs, and the remaining 24 had single APs. All APs were successfully ablated after the procedure. There were no significant statistical differences in the AP procedure duration ((77.4±21.3) minutes vs. (85.3±13.1) minutes), the AP ablation time ((204±34) seconds vs. (223±62) seconds) and the AP X-ray exposure time ((18.6±4.4) minutes vs. (19.1±4.5) minutes) respectively between groups I and II. As compared with the control group (5 of 10 cases, 50%), the PVAI group had a significantly lower AF recurrence rate (2 of 19 cases, 11%; P <0.05) during follow-up of (20.5±10.0) months. All seven patients who recurred were successfully abolished by a second ablation.

Conclusions In patients with pre-excited AF, PVAI is an effective therapeutic approach with a low AF recurrence rate. 3D electroanatomical maps of AP contributed to the high success rate of ablation without significantly prolonging of operational duration and X-ray exposure time.

     

Retroperitoneal laparoendoscopic single-site ureterolithotomy versus conventional laparoscopic ureterolithotomy

Background Laparoendoscopic single-site （LESS） surgery through the retroperitoneal approach has been seldom reported.We aimed to evaluate the outcomes of LESS and conventional laparoscopic surgery via the retroperitoneal approach in the management of large,impacted ureteral calculi.Methods Between November 2011 and July 2013,retroperitoneal LESS ureterolithotomy was performed in 12 patients using a homemade single-port device comprising a surgical glove and several strips of tape.Another 16 patients underwent conventional retroperitoneal laparoscopic ureterolithotomy.We compared the operative time,complications,and surgical outcomes,retrospectively.Results All patients were completed without conversion to conventional laparoscopic or open surgery.The operative time of the LESS group and of the conventional laparoscopic group were （125.3±12.8） minutes and （116.9±14.4）minutes,respectively （P=0.119）.The intraoperative blood loss was （42.9±8.9） and （43.4±14.7） ml,respectively （P=0.914）.Postoperative radiologic evaluation revealed that the stones had been removed completely.Cosmetic results were superior in the LESS group （P=0.001）.Conclusion Retroperitoneal LESS ureterolithotomy using a homemade single-port device can be considered a feasible and safe alternative to conventional laparoscopic ureterolithotomy.     

PHILOS接骨板治疗47例NeerⅡ、Ⅲ型肱骨近端骨折的临床研究

目的 探讨肱骨近端内固定锁定系统(PHILOS)治疗NeerⅡ、Ⅲ型肱骨近端骨折的临床疗效.方法 回顾性分析2013年1月至2015年12月在该院因NeerⅡ、Ⅲ型肱骨近端骨折行PHILOS接骨板固定的47倒患者的手术时间、术中出血量、住院时间、并发症、Constant评分等临床资料,并对患者的影像学资料进行评估.结果 47例患者均获随访,平均随访(19.2±9.6)个月,平均手术时间(95.6士43.1)min,平均术中出血量(108.0±41.6)mL,平均住院时间(11.3±3.2)d,并发症发生率为14.7％;Constant评分术前为(21.74±8.24)分,末次随访为(82.83±7.21)分,两者比较差异有统计学意义(t=-36.57,P＜0.01).结论 PHILOS接骨板是治疗NeerⅡ、Ⅲ型肱骨近端骨折的一种安全有效的方法.     

附加钢板在治疗股骨干骨折髓内钉固定后肥大性骨不连中的应用：与更换钢板的比较

Background Augmentation plating has been used successfully to treat hypertrophic non-union after nail fixation.This study compared the efficacy of augmentation plating and exchange plating for treating hypertrophic non-union of femoral shaft fracture after intramedullary nail fixation.Methods A total of 12 patients received augmentation plating and 15 patients received exchange plating as treatment for femoral shaft hypertrophic non-union.The procedures were conducted at our medical centre between January 2005and January 2012.Clinical follow-up was conducted at 2 weeks,1 month and then monthly until union was achieved to compare union time,operation time,bleeding and complications between the two groups.Results All patients underwent follow-up examinations until fracture union was achieved.The average length of followup time after the second treatment was （18.37±3.28） months.The time needed for union was （4.17±0.94） months in the augmentation plating group and （5.33±1.72） months in the exchange plating group.The operation time was （90.00±17.58） minutes in the augmentation plating group and （160.00±25.35） minutes in the exchange plating group.The amount of blood loss during the operation was （270.00±43.32） ml in the augmentation plating group and （530.00±103.65） ml in the exchange plating group.Both groups showed significant difference （P 〈0.05） in their results.No complications were reported after the second operation.Conclusions Augmentation plating after nail fixation could remove local rotation instability,facilitate simple operation,create minimal damage and enable exercise for early functional recovery.Therefore,augmentation plating is excellent for treating hypertrophic non-union after nail fixation in femoral shaft fracture.     

微创锁定接骨板与传统切开复位内固定术治疗肱骨近端骨折的临床疗效研究

目的 比较微创锁定接骨板(MIPO)与传统切开复位内固定术(ORIF)治疗肱骨近端骨折的疗效.方法 收集2011年2月至2013年1月接受手术治疗的65例肱骨近端骨折患者的临床资料,根据手术方式将患者分为MIPO组(26例)和ORIF组(39倒).比较两组患者手术和住院情况,术后通过电话和门诊的方式对患者进行随访.采用Neer评分和欧洲五维健康量表(EQ-5D)评估患者肩关节功能和生活质量,采用视觉疼痛模拟评分(VAS)评估患者疼痛程度.结果 与ORIF组相比,MI-PO组手术时间短、出血少、住院时间短,但两组并发症发生率差异无统计学意义(P＞0.05).所有患者术后均完成3年以上的随访,平均随访时间(47.2±6.1)个月.末次随访时MIPO组和ORIF组患者肩关节功能评分为(84.1±9.3)、(82.8±11.5)分,生活质量评分为(0.91±0.09)、(0.89±0.10)分,VAS评分为(0.9±0.8)、(1.2±0.7)分,两组患者各项评分差异均无统计学意义(P＞0.05).结论 MIPO与ORIF治疗肱骨近端骨折均可取得良好的临床疗效,MIPO技术具有创伤小、恢复快等特点.     

Efficacy of multimodal cocktail periarticular injection with or without steroid in total knee arthroplasty

Background Multimodal cocktail periarticular injection （MCPI） with a large volume of low concentration local anesthetics, adrenaline, and anti-inflammatory agents such as non-steroidal anti-inflammatory drug or steroids have shown good pain control and improvement in range of motion after surgery. This study compares the efficacy of pain control after total knee arthroplasty, using multimodal cocktail periarticular injection with steroid or without steroid.     

Impairment of recovery of muscle function by residual rocuronium after re-transfusion of intraoperative salvaged blood

Background Recurarization has previously been described in the context of acute normovolemic hemodilution.The aim of this study was to investigate the impairment of recovery of neuromuscular function after re-transfusion of intraoperative salvaged blood in patients treated with rocuronium.Methods We enrolled 50 patients undergoing general anesthesia for lumbar surgery.Intraoperative blood salvage （IBS） was used in 30 patients （group Ⅰ）; the remaining 20 comprised a control group （group C）.Anesthesia was induced with fentanyl,midazolam,propofol and rocuronium.Rocuronium was infused to maintain neuromuscular blockade during surgery.Blood was collected from the operative field and re-transfused in the post-anesthesia care unit （PACU）.Neuromuscular function was monitored using the train-of-four ratio （TOFr）.Once the train-of-four ratio exceeded 90 in the PACU,neuromuscular function was evaluated every 5 minutes for 30 minutes.The TOFr and incremental recovery of TOFr from baseline were recorded.Salvaged blood was re-transfused at the beginning of the evaluation for patients in group Ⅰ,and afterwards for patients in group C.Blood gas analysis was assessed before anesthesia and in the PACU.Results Incremental recovery of TOFr from baseline was significantly less in group Ⅰ than controls at 25 minutes （6.1±3.2vs.9.1±3.2,respectively; P=0.001） and 30 minutes （7.1±3.2 vs.10.0±2.2,respectively; P=-0.001）.There were no significant differences in gas exchange between the groups.Conclusions In patients who had received a rocuronium infusion during anesthesia,re-transfusion of salvaged blood significantly impaired recovery of neuromuscular function recovery in the PACU,but without significant impairment of respiratory function.     

锁定钢板治疗非骨质疏松性复杂肱骨近端骨折的中期临床及影像学随访研究

目的 回顾性分析采用锁定钢板治疗非骨质疏松性三部分和四部分肱骨近端骨折的临床效果。方法 回顾性评估锁定钢板治疗非骨质疏松性三部分和四部分肱骨近端骨折的临床效果,统计患肢的肩关节活动度、临床评分、视觉模拟评分(visual analogue scale,VAS)和影像学检查的结果。结果 自2007年1月至2014年10月,采用锁定钢板共治疗107例新鲜非骨质疏松性三部分和四部分肱骨近端骨折,其中67例患者完成至少2年的随访,平均随访时间(43.9±23.3)个月(24~108个月)。在最终随访时,Constant评分平均为(87.1±11.7)分(51~100分),加州大学肩关节评分(the University of California at Los Angeles shoulder score, UCLA)平均为(30.5±3.9)分(18~35分),VAS疼痛评分为(1±2)分(0~7分);主动前屈上举为159.0°±19.3°(80°~180°),体侧外旋为36.8°±19.5°(0°~80°),体侧内旋为T11水平(T2~LS水平)。术后11例患者出现并发症,包括5例螺钉穿出(7.5%),9例肱骨头缺血坏死(13.4%)及5例创伤性骨性关节炎(7.5%),6例合并两种或两种以上并发症。三部分骨折和四部分骨折术后患者的肩关节活动度、临床评分和VAS疼痛评分差异无统计学意义。四部分骨折的术后并发症率及术后肱骨头缺血坏死概率显著高于三部分骨折。结论 应用肱骨近端锁定钢板治疗非骨质疏松性三、四部分复杂肱骨近端骨折可得到满意的术后肩关节功能恢复,严格的适应证选择与精细的手术操作是取得手术成功的关键,骨折的复杂程度亦对术后结果产生影响,四部分骨折的并发症发生率以及术后肱骨头缺血坏死率高于三部分骨折。     

Distinct properties and metabolic mechanisms of postresuscitation myocardial injuries in ventricular fibrillation cardiac arrest versus asphyxiation cardiac arrest in a porcine model

Background The two most prevalent causes of sudden cardiac death are ventricular fibrillation cardiac arrest （VFCA） and asphyxiation cardiac arrest （ACA）. Profound postresuscitation myocardial dysfunction has been demonstrated in both VFCA and ACA animal models. Our study aimed to characterize the two porcine models of cardiac arrest and postresuscitation myocardial metabolism dysfunction. Methods Thirty-two pigs were randomized into two groups. The VFCA group （n=16） were subject to programmed electrical stimulation and the ACA group （n=16） underwent endotracheal tube clamping to induce cardiac arrest （CA）. Once induced, CA remained untreated for a period of 8 minutes. Two minutes following initiation of cardiopulmonary resuscitation （CPR）, defibrillation was attempted until return of spontaneous circulation （ROSC） was achieved or animals died. To assess myocardial metabolism, 18F-FluoroDeoxyGlucose Positron Emission Tomography was performed at baseline and 4 hours after ROSC. Results ROSC was 100% successful in VFCA and 50% successful in ACA. VFCA had better mean arterial pressure and cardiac output after ROSC than ACA. Arterial blood gas analysis indicated more detrimental metabolic disturbances in ACA compared with VFCA after ROSC （ROSC 0.5 hours, pH： 7.01±0.06 vs. 7.21±0.03, P〈0.01; HCO3： （15.83±2.31 vs. 20.11±1.83） mmol/L, P〈0.01; lactate： （16.22±1.76 vs. 5.84±1.44） mmol/L, P〈0.01）. Myocardial metabolism imaging using Positron Emission Tomography demonstrated that myocardial injuries after ACA were more severe and widespread than after VFCA at 4 hours after ROSC （the maximum standardized uptake value of the whole left ventricular： 1.00±0.17 vs. 1.93±0.27, P〈0.01）. Lower contents of myocardial energy metabolism enzymes （Na＊-K＊-ATPase enzyme activity, Ca2＊- ATPase enzyme activity, superoxide dismutase and phosphodiesterase） were found in ACA relative to VFCA. Conclusions Compared with VFCA, ACA causes more severe myocardium injury an     

Radioactive probe-guided parathyroidectomy for secondary hyperparathyroidism

Background The value of gamma probes in the surgical treatment of secondary hyperparathyroidism （sHPT） was determined.The aim of this study was to enhance the rate of successful total parathyroidectomy in patients with sHPT using intraoperative gamma probe investigations.Methods We retrospectively analyzed the clinical data of 48 sHPT patients between May 2007 and September 2011.Preoperative 99Tcm-methoxyisobutyl isonitrile （MIBI） scintigraphy and high-frequency ultrasonography were used for parathyroid localization.Thirty-five patients （group Ⅰ） underwent conventional neck exploration and open parathyroidectomy.Thirteen patients （group Ⅱ） underwent gamma probe-guided total parathyroidectomy and parathyroid transplantation.The two groups were compared in terms of the number of parathyroid resections,operative time,and postoperative changes in the blood levels of parathyroid hormone （PTH）,calcium,and phosphate.Results The clinical manifestations,PTH and calcium levels,age distribution,and clinical characteristics did not differ between the two groups.The accuracy of preoperative 99Tcm-MIBI scintigraphy （89.74％） for the diagnosis of hyperparathyroidism did not differ from that of ultrasonography （81.25％）.However,the accuracy of 99TcmMIBI scintigraphy （66.67％） for localizing hyperfunctioning parathyroids was significantly lower than that of ultrasonography （76.86％）.The operation time was significantly longer in group Ⅰ （（120±25） minutes） than in group Ⅱ （（90±30） minutes）.The accuracy of parathyroid identification was significantly higher in group Ⅱ （92.59％） than in group Ⅰ （80.39％）.On average,significantly fewer parathyroid specimens were obtained in group Ⅰ （2.5±0.5） than in group Ⅱ （3.5±0.5）.Compared with group Ⅰ,group Ⅱ showed a significant increase （15.4％） in the number of parathyroid resections.The PTH,calcium,and phosphate levels significantly decreased postoperatively in all patients.Conclusions Intra     

A novel method of defective vascular reconstruction using 2-octyl-cyanoacrylate and homemade prosthetic component

Background Currently,adhesive technique is popular in vascular repair but not widely used for defective vessels.This study aimed to determine the feasibility and effectiveness of repairing defective vessels with 2-octyl-cyanoacrylate and a homemade prosthetic component.Methods Homemade prosthetic component consisting of expanded polytetrofluoroethylene （ePTFE）,terylene film,and homemade soluble hollow stent mixed with adhesive can replace autologous graft and suture in repairing defective vessels,can fix vessels better using the stent without occlusive bleeding.Forty male mongrel dogs were used,20 for biomechanical tests and 20 for animal experiments.In the biomechanical test,dogs were randomly divided into two groups （n=10 each）,one group repaired on the two sides of the carotid arteries with 2-octyl-cyanoacrylate and homemade component and another group repaired with suture and ePTFE.Of the 40 specimens,10 were used for adhesive and 10 for suture specimens for tension strength test,whereas the remaining specimens were used for bursting pressure test.In animal experiments,dogs were also divided into adhesive and suture groups （n=10）,only of the left carotid artery.Recording the operational time,bleeding or not.Vessels were tested using color Doppler ultrasound,the inner diameter was measured,and the degree of stenosis at 8 weeks was evaluated digital subtraction angiography （DSA） were also performed.Specimens were then analyzed histologically.Results In the adhesive and suture groups,the specimens could afford atension strength of （23.80±1.51） N versus （24.60±1.08） N （P ＞0.05）,the bursting pressure was （52.03±.2.43） kPa versus （50.04±3.51） kPa （P ＞0.05）,and the mean time of anastomosis was （15.20±0.55） minutes versus （25.97±0.58） minutes （P ＜0.05）.One dog in the adhesive group was bleeding from the suture.One dog from each group presented with thrombosis at 1 week.After measuring using ultrasound,the stenosis degree of all dogs were no more than 30％ except the two thromboses.DSA and histological observation showed no obvious difference between the two groups.Conclusion Defective vascular anastomosis with 2-octyl-cyanoacrylate and our homemade prosthetic component is feasible,effective,timesaving,and easy to master.     

Fourth-generation ceramic-on-ceramic total hip arthroplasty in patients of 55 years or younger: short-term results and complications analysis

Background The incidence of total hip replacement in the younger and more active patients is ever increasing.The ceramic-on-ceramic （COC） bearing was developed to reduce wear debris-induced osteolysis and loosening and to improve the longevity of hip arthroplasties.Few studies have reported the clinical results and complications of the new zirconia-toughened ceramic total hip arthroplasty （THA）.Methods A consecutive series of 132 young patients （177 hips） that underwent primary cementless THAs between January 2010 and December 2012 were included in this study.These arthroplasties all had fourth-generation COC bearings performed through a posterolateral approach.The average age was （41.8±8.3） years （ranging from 22 to 55 years）,and the mean follow-up period was （24.5±9.4） months （ranging from 12 to 47 months）.The results were evaluated both clinically and radiographically.Harris hip score （HHS） was determined before surgery and at the time of each follow-up.Presence of postoperative groin or thigh pain and squeaking were recorded.Other complications such as dislocations,periprosthetic fractures,and ceramic components fractures were diagnosed and treated in emergency.Results The average HHSs improved from preoperative 60.3±10.7 （ranging from 29 to 76） to 91.0±5.1 （ranging from 74 to 100） at the final follow-up （t=-45.064,P ＜0.05）,and 97.7％ of cases were scored as excellent and good results.At the last follow-up,incidental inguinal pain was found in three hips （1.7％） and thigh pain in 11 hips （6.2％）.Radiographs showed a high rate of new bone formation around the acetabular and stem components.No obvious osteolysis or prosthesis loosening was detected.Complications occurred in six hips （3.4％）：posterior dislocation in two hips （1.1％）,periprosthetic femoral fracture in one hip （0.6％）,asymptomatic squeaking in two hips （1.1％）,and ceramic liner fracture in one hip （0.6％）.Conclusions The fourth-generation COC THA showed excelle     

Transradial artery intervention: an alternative approach for renal artery stent implantation?

Background  Transfemoral artery access is the main approach for the interventional treatment of renal artery stenosis (RAS). This study aimed to investigate the technical feasibility of a transradial interventional (TRI) treatment of renal artery stenosis.

Methods  A series of 23 patients who underwent transradial renal artery stenting from October 2010 to October 2011 were studied. Radial sheath system (Terumo, Japan) was used to get access to the radial artery. Radial tourniquet (Terumo) was used to stop bleeding. A 5Fr MPA (COOK, USA) was used to perform selective renal arteriography. Percutaneous renal artery stent systems were used to perform renal artery stenting. 

Results  Renal artery angiography showed that 15 patients had unilateral renal artery stenosis and eight patients had bilateral renal artery stenosis. The descending aorta could not be catheterized in one patient because of the type III aortic arch. Twenty-two patients successfully underwent transradial renal artery angiography and the technical success rate was 95.7%. There was no puncture site hematoma or pseudoaneurysm. Mean procedure time was (38.4±7.2) minutes, the mean amount of contrast agent used was (93.2±6.3) ml, and the mean postprocedure bleeding time was (3.2±1.9) minutes.

Conclusion  Transradial renal artery intervention is technically reliable with less invasion, rapid recovery, fewer complications and may become an alternative intervention approach for the treatment of renal artery stenosis.

     

Differential diagnosis of isolated calf muscle vein thrombosis and gastrocnemius hematoma by high-frequency ultrasound

Background Differential diagnosis of isolated calf muscle vein thrombosis （ICMVT） and gastrocnemius hematoma is essential for early identification of deep vein thrombosis （DVT）.This study aimed to investigate the diagnostic value of high-frequency color Doppler ultrasound for differential diagnosis of ICMVT and gastrocnemius hematoma.Methods A retrospective case series of 35 ICMVT （M∶F,21∶14; mean age （64.5±10.6） years） and 23 gastrocnemius hematoma （M∶F,16∶7; mean age （75.4±11.8） years） patients with bilateral/unilateral lower limb pain was conducted between January 2006 and September 2012.Characteristics and the morphology of high-frequency color Doppler ultrasonography of the lower limb deep vein,great saphenous vein,calf muscles,skin,and soft tissue were examined.Results ICMVT hypoechoic signals were characterized by long,tube-like masses on longitudinal sections and oval masses on transverse sections,with apparent muscle thrombosis boundaries,distal and proximal venous connections,and,often,lower limb DVT.Gastrocnemius hematoma hypoechoic signals were characterized by large volumes,enhanced posterior hematoma echo,hyperechoic muscle boundaries,no hematoma blood flow,and no DVT,and clear differences in trauma/exercise-and oral anticoagulant-induced hematomas were readily apparent.According to the measurement,the ratio of long diameter/transverse diameter （D/T） in ICMVT patients was about less than 2.0,whereas in gastrocnemius hematoma patients the ratio was more than 2.0.Early stage isoechoic and hypoechoic signals were detected with gradually increasing ovular anechoic areas.Partial muscle fibers in the hematoma due to muscle fractures were apparent.Conclusion High-frequency color Doppler ultrasound was found to be a sensitive and reliable method for differential diagnosis of ICMVT and gastrocnemius hematoma due to trauma and exercise or prolonged oral anticoagulant use.     

Comparison on colonoscopic parameters according to length of adult-colonoscope

Background High success rate of intubation and short intubation time have been needed to endoscopists for a complete and comfortable coolonoscopy,if possible.The purpose of present study was to compare procedure efficiencies according to adult-colonoscope length.Methods This was a prospective,randomized,single-blinded controlled trial.A total of 239 healthy Korean subjects were randomly assigned to two groups：one group receiving intermediate-length adult-colonoscope （n=119）,and the other group receiving long-length adult-colonoscope （n=120）.Cecal intubation time and rate,and terminal ileal intubation time and rate as well as other procedure-related outcomes （adenoma detection rate,withdrawal time,and total procedure time） were evaluated.Results There were significant differences in cecal intubation time and terminal ileal intubation rate according to colonoscope length.The time of cecal intubation was shorter in the intermediate-scope group than that in the long-scope group （（222.13±101.67） s vs.（253.85±109.40） s,P=-0.014）.However,the rate of terminal ileal intubation was higher in the long-scope group than that in the intermediate-scope group （94.2％ vs.83.2％,P=-0.007）.In addition,terminal ileal intubation time was also shorter in the long-scope group than that in the intermediate-scope group （（35.21±38.89） s vs.（44.09±33.87） s,P ＜0.001）.There were no significant differences in other procedure-related outcomes between the two groups.Conclusions The intermediate-length adult-colonoscope had an advantage over the long-length adult-colonoscope regarding cecal intubation time,whereas the long-scope had an advantage over the intermediate-scope regarding the rate and time of terminal ileal intubation.These results suggest that it is rational to prepare and use these two types of colonoscope properly,instead of employing only one type of colonoscope.     

Kyphoplasty versus vertebroplasty for the treatment of malignant vertebral compression fractures caused by metastases: a retrospective study

Background There are few comparative studies regarding kyphoplasty (KP) and vertebroplasty (VP) for the treatment of painful vertebral compression fractures (VCF) in patients with cancer. The purpose of this study is to retrospectively compare KP with VP in pain improvement, cement leakage incidence, and the cost of treatment of malignant VCF.

Methods We performed a retrospective study of clinical data for 80 patients with multiple spinal metastases, treated with KP in 42 cases and VP in 38. Visual analog scale (VAS) scores were collected pre-operatively, post-operatively, at 1 month, 6 months, and 1 year after treatment. Cement leakage was identified using fluoroscopy and CT scan. Total cost per patient was also collected.

Results There was a significant difference between the pre- and post-operative VAS scores (7.4±2.0 to 3.8±1.6, P <0.001 in the KP group; 6.7±2.4 to 3.7±1.4, P <0.001 in the VP group), and was maintained at 1-year follow-up (3.2±1.4 in the KP group, 3.1±1.3 in the VP group). However, the difference in VAS score between these two groups was insignificant at baseline and every follow-up assessment post-operatively (P >0.05). The incidence of cement leakage in the KP group was lower than that of the VP group (16.9% (14/83) vs 30.3% (23/76), P <0.05). However, none of the patients developed any symptoms. The length of postoperative hospital stay in the VP group was shorter than that of the KP group ((2.4±1.3) vs (5.3±1.9) days, P <0.05). Total hospital cost in the KP group was much higher than that of the VP group (RMB Yuan 8 492±3 332 vs RMB Yuan 3 173±1 341, P <0.01).

Conclusions VP and KP are both effective in providing pain relief for patients with cancer-related VCF. KP provides no greater degree of pain improvement. KP is associated with a lower rate of cement leakage compared with VP. VP is associated with lower cost and shorter postoperative hospital stay in China.

     

Clinical results and intramedullary signal changes of posterior decompression with transforaminal interbody fusion for thoracic myelopathy caused by combined ossification of the posterior longitudinal ligament and ligamentum flavum

Background Surgical treatment of thoracic myelopathy caused by ossification of the posterior longitudinal ligament （OPLL） and ossification of the ligamentum flavum （OLF） is technically demanding, and the results tend to be unfavorable. Various operative approaches and treatment strategies have been attempted, and posterior decompression with transforaminal thoracic interbody fusion （PTTIF） may be the optimal method with which the anterior-posterior compression was removed in one step. It is comparatively less traumatic with fewer serious complications.