Objective To simplify surgical technique andincrease postoperative survival rate, sleeve anastomosis technique combined cuff technique was used in developing the model of cervical heart transplantation in rats. Methods In this model, the hearts from 25 male SD rats were transplanted into the neck of Wistar rats by anastomosing the donor innominate artery to the recipient right common carotid artery by use of sleeve technique, and the donor pulmonary artery to the recipient right external jugular vein by use of cuff technique. After operation,the rats were treated with cyclosporine A (1.5mg/kg, q.d.), transplanted hearts were followed by daily inspection or palpation and the allograft survival time was more than 3 days as the standard of successful operation. Results The mean operative time was (48.7±3.4) min, with a successful rate of 88%(22/25). Complications were anastomotic hemorrhage( 1 case) and thrombosis(2 cases). During the followup period, 6 rats died of pulmonary infection, abscess in the neck,liver or bladder tumor. The remaining 16 transplanted hearts survived more than3 months. Conclusion The modified operation have advantages ofless operative procedure, shorter operation and ischemia time and easier monitoring of graft function.
ObjectiveTo analyze the relative factors of lymph-nodes metastasis (LM) in patients with cervical cancer.
MethodsThe clinico-pathological data of 136 patients with stageⅠ A-Ⅱ A of cervical cancer who underwent surgical therapy from January 2005 to December 2010 were retrospectively analyzed. The correlation between clinico-pathological parameters and LM was analyzed by univariable χ2 analysis and multivariable logistic analysis.
ResultsThe total LM rate (LMR) was 14.0% (19/136). The rate of LM in obturator was the highest (63.2%), and then the rate between the external and internal iliac was 42.1%. The rate of deep inguinal lymph nodes and para-aortic lymph node was 0.0%. There was correlation between the clinic staging, depth of stromal invasion, histologic subtype, parametrial invasion, vaginal invasion and LM in univariable analysis (P<0.05). While in multivariable analysis, the correlation with LM was only existed between the clinic staging, histologic subtype, depth of stromal invasion and LM.
ConclusionClinic staging, histologic subtype, depth of stromal invasion are high risk factors of LM.
Objective To develop a high-accuracy, better-safety and low-cost cervical pedicle locator system for guiding cervical pedicle screw placement. Methods Cervical pedicle screw locator system was made of stainless steel. Ten cervical specimens from voluntary donation were divided into two groups according to compatibil ity design: control group inwhich 60 screws were planted into C2-7 by free hand; and experimental group in which 60 screws were planted into C2-7 under the guidance of three-dimensional locator system. The condition of screw insertion was observed and the accuracy was evaluated by the integrity of pedicle walls. Results In the control group, 32 screws (53.33%) were placed inside the pedicles and 28 (46.67%) were outside; 9 screws (15.00%) led to nerve root injury, 5 screws (8.33%) caused vertebral artery injury and no spinal cord injury occurred; and the qual ification ratio of screw insertion was 76.67% (excellent 32, fair 14, poor 14). While in the experimental group, 54 screws (90.00%) were placed inside the pedicles and 6 (10.00%) were outside; 1 screw (1.67%) caused vertebral artery injury and no nerve root injury and spinal cord injury occurred; and the qual ification ratio of screw insertion was 98.33% (excellent 54, fair 5, poor 1). There was significant difference between the two groups (P lt; 0.05). Conclusion Cervical pedicle screw locator system has the advantages of easy manipulation, high accuracy of screw placement and low cost. With further study, it can be appl ied to the cl inical.
ObjectiveTo compare the clinical and radiographic outcomes between laminoplasty and laminectomy compression and fusion with internal fixation to treat cervical spondylotic myelopathy. MethodsBetween September 2006 and September 2009, 143 cases of multilevel cervical myelopathy (the affected segments were more than 3) were treated by laminoplasty in 87 cases (group A) and by laminectomy decompression and fusion with lateral mass screw fixation in 56 cases (group B). There was no significant difference in gender, age, disease duration, pathological type, and affected segments between 2 groups (P gt; 0.05). The operation time, intraoperative blood loss, improvement of neurological function [Japanese Orthopaedic Association (JOA) 17 score], and the incidences of complications were observed; the cervical curvature index (CCI), range of motion (ROM), and symptoms of neck and shoulder pain [visual analogue scale (VAS) and neck disability index (NDI) scores] were recorded and compared. ResultsThere was no significant difference in operation time and intraoperative blood loss between 2 groups (P gt; 0.05). All patients were followed up 18-30 months (mean, 24 months). C5 nerve root palsy occurred in 4 cases (4.60%) of group A and in 5 cases (8.93%) of group B, showing no significant difference (χ2=0.475, P=0.482). No complication of deep infection, pseudarthrosis, or screw loosening occurred. No closure of opened laminae was observed in group A; and no screw extrusion, breakage, or nerve injury was observed in group B. At last follow-up, neck axial symptoms appeared in 35 cases (40.23%) of group A and in 11 cases (19.64%) of group B, showing significant difference (χ2=6.612, P=0.009). No significant difference was found in JOA score, CCI, ROM, or VAS scores between 2 groups at preoperation (P gt; 0.05); the JOA score, ROM, and VAS scores of groups A and B and CCI of group A at last follow-up were significantly improved when compared with preoperative ones (P lt; 0.05). No significant difference was found in the JOA score, improvement rate, and VAS score between 2 groups (P gt; 0.05); however, significant differences were found in ROM and CCI between 2 groups (P lt; 0.05). There were significant differences (P lt; 0.05) in pain intensity, lifting, work, reaction, driving, and total score between 2 groups at last follow-up. ConclusionLaminectomy decompression and fusion with internal fixation can effectively relieve pain, but it will greatly reduce the ROM; laminoplasty has less complications and satisfactory outcome. The two methods have similar effectiveness in the improvement of neurological function.
Objective To explore the feasibility and safety of removal of benign substernal goiter through cervical approach and summarize the operation skill. Methods The clinical data of 85 cases diagnosed as benign substernal goiter from August 2002 to October 2011 in this hospital were analyzed retrospectively. Results The removal of benign substernal goiters in all 85 cases were performed through cervical approach without perioperative death，respiratory tract obstruction，massive haemorrhage，pneumothorax，hemothorax，chylus leakage，permanent impairment of recurrent laryngeal nerve，and permanent hypoparathyroidism. Three cases of hoarseness were found on 1-3d after operation，which returned to normal after symptomatic treatment. Four cases of numbness in the extremities and one case of mild convulsion happened，the symptoms were relieved through intravenous and oral administration of calcium treatment in 3-7d. The drainage volume was 35-220ml with （68±4.9） ml. The drainage tube was removed on postoperative 2-6d with an average 4.2d. Eighty-two patients were followed-up in 2 years after operation，no low calcium，low parathyroid hormone，hoarseness，and local goiter recurrence occurred. Two cases of hypothyroidism returned to normal after oral thyroxine dose adjustment. Conclusions Removal of the downward benign substernal goiter through cervical approach is safe and feasible. Sufficient exposure，stepwise procedure，blunt dissection in the precise gap，and combination of lifting with upbearing are the surgical skills for success.
Objective To evaluate the clinical effect of percutaneous laser disc decompression (PLDD) in the treatment of cervical disc herniation. Methods From March 2003 to December 2005, 47 patients with cervical disc herniation(96 cervical disc) were treated with PLDD. There were 25 males and 22 females with an average age of 56 years, ranging from 37 to72 years. The lesion were located at the levels of C3,4 in 20 discs, C4,5 in 27 discs, C5,6 in 31 discs, C6,7 in 18 discs. The laser fiber was introduced into the center of the herniated disc space by percutaneous puncture from anterior neck surface under fluoroscopic guidance. Laser reduced the intradisc pressure through the vaporization of disc nucleu. The adopted laser was semiconducted with a wavelength of 810 nm. Each laser output power was15 W with 1 s emission and 2 s interval. The total laser output power was decided depending on the degenerative degree of the disc and the reactive process of heat, ranging from 300 to 1 000 J.Results Of 47 patients,42 were followed up for 3 to 31 months (mean 13 months). The clinical evaluation was classified as excellent in 18 cases (42.9%), good in 14 cases (33.3%), fair in 6 cases (14.3%) and poor in 4 cases (9.5%). The general response rate was 90.5%. The excellent and good rate was 76.2%. No complications occurred. Conclusion PLDD can relieve the symptoms and signs of patients suffering from cervical disc herniation with less complication. The manipulation of PLDD is easy, safe and mini-invasive.
Objective To summarize the clinical experience of surgical treatment for cervical and upper thoracic esophageal cancer (the distance between the upper margin of tumor and the inlet of chest is/or less than 3cm), so as to enhance the surgery curative effect and reduce the occurrence of complications. Methods Clinical material of 142 patients with esophageal carcinoma in the neck and upper thorax in this hospital were retrospectively analyzed. Radical excision were taken for 122 patients, palliative excision were taken for 15 patients and exploration were taken for 5 patients, total excision rate was 96.5%. The main type of surgical reconstruction technique includes: simple replacement of esophagus with stomach, colon replacement of esophagus technique, jejunum replacement of esophagus, pectoral major muscleskin flap reconstruction; the right chestupper abdomenneck three incisions for the stomach replacement of esophagus technique, an entire throat excision+stomach replacement of esophagus, a tube stomach replacement of esophagus, left chestneck two incisions, stomach replacement of esophagus technique. Results There were 5 postoperative deaths, two of which died of pulmonary infection, one died of serious infection due to colon necrosis, one died of pulmonary infection due to esophagealtracheal fistula after palliative excision, one died of suffocation due to massive regurgitations. Tumor cells were discovered on the cancer edge of esophagus by pathology in 9 patients. Eight patients with carcinoma of the cervical and 21 patients with carcinoma of the upper thoracic esophagus were suffered from one or more kind of postoperative complications. Mainly complications consisted of the jejunum necrosis, the colon necrosis, the recurrent nerve damage, the lungs infection, the swallow function barrier, esophageal regurgitation. The total of 117(85.4%) survivals were followed up from 1 to 5 years, 20 patients were missed followup. The 1, 3, 5 years survival rate after surgical treatment were 72%,48% and 31% respectively. The 5 year survival rate of the patients in Ⅰ,Ⅱ,Ⅲ,Ⅳa stage were 82.3%, 61.2%, 25.0% and 5.0% respectively. Conclusion Further studies about operation mode, excision area, prevention for postoperative complication, preservation and reconstruction of normal function for patients suffering from the cervical and upper thoracic esophageal cancer (the distance between the upper margin of tumor and the inlet of chest is/or less than 3cm) is still expected.
ObjectiveTo evaluate the effectiveness of cervical single open-door laminoplasty with the unilateral C4,5 foraminotomy for cervical myelopathy in preventing postoperative C5 palsy.
MethodsBetween January 2008 and June 2012, 200 consecutive patients with cervical myelopathy and unilateral C4,5 foraminal stenosis were treated, and the clinical data were retrospectively analyzed. Of them, 89 patients underwent cervical single open-door laminoplasty combined with unilateral C4,5 foraminotomy (group A), and 111 patients underwent simple cervical single open-door laminoplasty (group B). There was no significant difference in gender, age, disease duration, segmental lesions, and diagnosis distribution between 2 groups (P>0.05). The operation time, intraoperative bleeding volume, and the incidence of C5 palsy were recorded. The Japanese Orthopaedic Association (JOA) score before and after operation was used for neurological assessment, and the JOA recovery rate was calculated.
ResultsThe operation time was (122±29) minutes and the intraoperative bleeding volume was (165±50) mL in group A, which were significantly higher than those in group B[(109±31) minutes and (145±32) mL] (t=3.033, P=0.010;t=3.429, P=0.003). All patients were followed up; the follow-up time was 3-48 months (mean, 25 months) in group A, and was 4-50 months (mean, 27 months) in group B. C5 palsy occurred in 1 patient of group A (1.12%), and in 9 patients of group B (8.11%), showing significant difference between 2 groups (χ2=3.709, P=0.045). The JOA score was significantly improved at 2 weeks and last follow-up after operation when compared with preoperative JOA scores in 2 groups (P<0.05), but no significant was found between at 2 weeks and at last follow-up (P>0.05) in each group. Between group A and group B, no significant difference was found in JOA score and the recovery rate (P>0.05). During follow-up, no persistent axial pain for a long time and obvious spinal instability occurred in 2 groups.
ConclusionCervical single open-door laminoplasty with unilateral C4,5 foraminotomy can reduce the incidence of the C5 palsy for patients with cervical myelopathy combined with unilateral C4,5 foraminal stenosis.
Objective There is few report on dynamic stabil ization for posterior cervical reconstruction. To investigate the biomechanical properties of a novel cervical spine posterior fixation using the bio-derived freeze-dried tendon in posterior cervical spine reconstruction. Methods The palmaris longus flexor tendon and metacarpal extensor tendon were collected from the death donors’ stump to prepare bio-derived tendon. Twenty fresh cervical vertebrae (C1-7) were harvested from goats and were randomly divided into 4 groups (n=5): intact group (group A); injury control group (group B); screwrods fixation group, fixed with screw-rods on C3，4 (group C); tendon reconstruction group, cross-fixed with bio-derived freezedried tendon on C3，4 bilatera facet joints (group D). The range of motion (ROM) values in flexion, extension, lateral bending, and axial rotation were measured. Results In flexion, the ROM values of group C were significantly lower than those of the other 3 groups (P lt; 0.05), and the ROM values of group B were significantly higher than those of groups A and D (P lt; 0.05). In extension, lateral bending, and axial rotation, the ROM values of group C were significantly lower than those of groups A, B, and D (P lt; 0.05), and no significant difference was found within the other 3 groups (P gt; 0.05). Conclusion The novel cervical spine posterior fixation using the bio-derived frozen-dried tendon can provide enough stabil ity in flexion motion, but it can not limit the lateral bending and axial rotation motion, which can provide dynamic stabil ization in animal model.
Objective To analyze the biomechanical changes of the adjacent cervical facet joints when the angled cervical prosthesis is replaced. Methods A total of 400 northwestern people were involved, with an age of 40 years or older.The cervical vertebra lateral X-ray films were taken, and the cervical angles were measured by professional computer aided design software, then the cervical intervertebral disc prosthesis with 10° angle was designed. The finite element models of C4，5and C4-6 segments with intact cervical discs were developed; the C4，5 disc was replaced by the cervical prosthesis with 0° and 10° angle respectively; and then all models were subjected to axial loading, flexion/extension, lateral bending, and torsion loading conditions; the stress effects on adjacent facet joints after replacement were observed by comparing with that of the intact model. Results The cervical angles were (9.97 ± 3.64)° in C3，4, (9.95 ± 4.34)° in C4，5, (8.59 ± 3.75)° in C5，6, and (8.49 ± 3.39)° in C6，7, showing no significant difference between C3，4 and C4，5, C5，6 and C6，7 (P gt; 0.05) and showing significant differences between the other cervical angles (P lt; 0.05). When C4，5 model was axially loaded, no significant difference in equivalent shearing stress were observed in intact, 0°, and 10° groups; at flexion/extension loading, the stress was biggest in intact group, and was smallest in 10° group; at lateral bending, the stress got the high rank in intact group, and was minimum in 10° group; at torsion loading, the stress state of 10° group approached to the intact one condition. When C4-6 model was loaded, the facet joint stress of the replaced segment (C4，5) decreased significantly at axial loading, flexion/extension, and lateral bending; while no obvious decrease was observed at torsion loading; the stress of the adjacent inferior disc (C5，6) decreased significantly at axial loadingand lateral bending condition, while less decrease was observed at torsion loading, no significant change at flexion/extension condition, it approached to that of the intact one. Conclusion The finite element analysis reveals that the biomechanical properties of 10° designed prosthesis is approximate to that of the intact cervical disc, thus the 10° designed prosthesis can meet the requirements of biomechanical function reconstruction of the cervical spine.
