Objective
To observe the clinical outcomes of Hangman fracture treated by anterior cervical discectomy and fusion.
Methods
A total of 41 patients with Hangman fracture were retrospectively analyzed, who underwent anterior cervical discectomy and fusion from May 2010 to May 2016. Intervertebral bone graft fusion was observed through postoperative radiographic images, and improvement of symptoms was evaluated by Visual Analogue Scale (VAS), Neck Disability Index (NDI) and Modified Japanese Orthopaedic Association Scale (m-JOA). Surgical complications were evaluated as well.
Results
No severe complications occurred after surgery, but 5 patients had a transient dysphagia, which relieved spontaneously. Thirty-five patients had a fusion of intervertebral bone graft 3 months after surgery, and the remaining 6 patients did at the last follow-up. The VAS score was improved from 4.5±1.6 pre-operatively to 2.4±1.7 immediately post-operatively (P>0.05), and was further improved to 0.7±0.9 at the last follow-up (P<0.05). The NDI score was improved from 29.3±10.9 pre-operatively to 13.2±5.4 immediately post-operatively (P<0.05), and was further improved to 4.6±3.1 at the last follow-up (P<0.05). The m-JOA score was improved from 8.4±2.3 pre-operatively to 11.6±3.5 immediately post-operatively (P<0.05), and was further improved to 14.3±2.0 at the last follow-up (P<0.05).
Conclusion
Anterior cervical discectomy and fusion can be used in Hangman fracture, which is safe and reliable.
Objective To investigate the possible mechanism and fracture stability of subtypes of type B Hangman’s fracture by using imaging observation. Methods Patients with type B Hangman’s fractures admitted to multiple centers between January 2008 and October 2023 were selected as the research objects. The clinical data and imaging data of patients who met the selection criteria were extracted. The patients’ age, gender, cause of fracture, disease duration, visual analogue scale (VAS) score of neck pain, neck disability index (NDI), and American Spinal Injury Association (ASIA) classification of spinal cord function were collected. Based on the imaging data, the anatomical structure of the contralateral superior articular process fracture, the relationship between the superior articular process fracture line and the position of the odontoid process, the associated posterior vertebral wall fracture and its classification, the incidence of vertebral arch floating and C2, 3 instability were observed. The superior articular fracture angle (SAFA), superior articular fracture displacement distance (SAFD), and C2 vertebral body rotation (VBRA) were measured. According to the anatomical structure of the contralateral superior articular process fracture, the patients were divided into a pedicle fracture group (POA group), a inferior articular process fracture group (IAP group), and a laminar fracture group (CSL group). The baseline data and imaging indexes were analyzed between groups, and the imaging anatomical characteristics of each subtype of fracture were observed to explore its possible mechanism and fracture stability.Results A total of 86 cases of type B Hangman’s fractures were collected. There were 67 males and 19 females. The mean age was 51.0 years (range, 21-78 years). There were 48 cases of pedicle fracture (POA group), 25 cases of inferior articular process fracture (IAP group), and 13 cases of laminar fracture (CSL group). There was no significant difference in age, gender, cause of fracture, disease duration, VAS score of neck pain, and NDI between groups (P>0.05). However, the incidence of spinal cord injury in POA group was the highest (P<0.05). The incidences of superior articular process fracture line posterior to the odontoid process and posterior vertebral wall fracture in POA group were the highest (P<0.05). The incidences of vertebral arch floating and C2, 3 instability in IAP group were the highest (P<0.05). There were significant differences in SAFA and VBRA between groups (P<0.05). There was no significant difference in SAFD between groups (P>0.05). The differences in the incidences of fracture displacement>3 mm and VBRA>5° between groups were significant (P<0.05). There were 78 cases of unstable Hangman’s fracture, including 2 cases of simple C2、3 instability, 22 cases of simple axis rotation and displacement instability, 8 cases of simple vertebral arch floating instability, and the rest of the patients had two or more types of instability. Conclusion The mechanism of different subtypes of type B Hangman’s fracture may be that the lateral mass of the rotation of the atlas applied the overextension compression force to the unilateral superior articular process of the axis vertebra, and the contralateral pedicle, inferior articular process and lamina fractures were caused by direct violence or/and rotational violence to different degrees. The decomposition of this type of fracture into C2, 3 intervertebral, axis vertebra body displacement and rotation and vertebral arch floating instability is beneficial to the treatment and surgical approach selection.
ObjectiveTo review the research progress of the diagnosis and treatment of Hangman fracture.
MethodsThe original articles about the diagnosis and treatment of Hangman fracture were extensively reviewed and analyzed.
ResultsNot only X-ray, but also MRI and CT scans are necessory for the diagnosis and assessment of Hangman fractures. The treatment of unstable Hangman fracture included posterior C2, C3 fixation, anterior C2, C3 fixation, and anterior C2, C3 fixation combined with posterior C2 pedicle screw fixation. The anterior surgical fixation is used by the anterior retropharyngeal approach or subaxial anterior approach, and it has the advantages of directly resecting the injured C2, C3 discs, getting a satisfactory cervical spine alignment, and avoiding the postoperative axial pain. However, posterior surgical fixation using C2 pedicle screw has the risks of neurovascular injuries.
ConclusionThe surgical technique of Hangman fracture should be determined based on the patient's injury and surgeon's experience. Randomized control trials of different surgical techniques should be performed.
ObjectiveTo explore the effectiveness of anterior cervical plate internal fixation in the treatment of unstable Hangman fracture.
MethodsBetween May 2006 and May 2010, 42 patients with unstable Hangman fracture were treated by anterior cervical plate internal fixation. There were 30 males and 12 females with an average age of 36.5 years (range, 22-64 years). According to the Levine-Edwards classification, 25 cases were rated as type Ⅱ, 15 cases as type Ⅱ A, and 2 cases as type Ⅲ. Eight patients had spinal cord injury. The average interval between injury and operation was 5 days (range, 3-14 days). The X-ray, CT, and MRI were done pre-and post-operatively to evaluate the cervical physiological curvature, the intervertebral disc height of C2,3, the fracture-healing, and bone fusion. The effectiveness was evaluated using visual analogue scale (VAS) for occipito-cervical pain, Neck Disability Index (NDI) for cervical spine function, and the Japanese Orthopaedic Association (JOA) score for neurological functional recovery.
ResultsAll incisions healed by first intention. No neurological deterioration or internal fixation failure was observed. All of the patients were followed up 2-5 years (mean, 3.5 years). The complications were dysdipsia in 3 cases and dysphagia in 4 cases, which alleviated spontaneously after 1 week. All the patients were almost free from occipito-cervical pain and the limited cervical spine motion. Neurological function was improved in 8 cases of spinal cord injury, and complete decompression was observed in 6 cases who had spinal cord compression. The bone fusion was observed at 6.5 months on average (range, 6-8 months); the mean fracture-healing time was 10.5 months (range, 9-12 months). The VAS, NDI, and JOA scores were significantly improved at 3 months after operation and last follow-up when compared with preoperative scores (P<0.05), significant improvement scores were achieved at last follow-up when compared with the scores at 3 months (P<0.05). The intervertebral disc height of C2,3, the reconstructed curvature and stability of the cervical spine, and the spine movement were good.
ConclusionThe method of anterior cervical plate internal fixation can achieve satisfactory reduction and fusion, less complications, negligible impact on the cervical movement. So it is an ideal method to treat unstable Hangman fracture.
Forty-eight cases of multi-structural defects of hands were primarily repaired or reconstructed from July 1989 to 1997. The structural defects included: the defects of radial or ulnar aspect of hands involving fingers and skin, multiple fingers defects and the fingers and skin defects of whole hand. In this series, there were 32 males and 16 females with age ranged from 17 to 46 years old. The composite tissue grafts were obtained from wrap-around flap or 2nd toe skin flap of the foot. The result showed that composite 108 tissues transplantations, or 48 cases, were all survived. After a follow-up of 38.5 months (ranged from 5 months to 6 years), the grasp, pinch and opposition function of the reconstructed finger were restored, the two-point discrimination sensation was 4 mm-12 mm. Most of the patients had resumed their original works. So that the primary repair of multi-structural defects of hands by composite tissues transplantation was feasible and valuable, but thorough debridement and skilled microsurgecal technique were required.
ObjectiveTo comparatively analyze risk factors that influence the postoperative recurrence and distant metastasis between Xinjiang Uygur and Han women with breast cancer.
MethodsThe clinical data of Han and Uyghur women with diagnosis of breast cancer at Ⅰ-Ⅲ period were completely collected for retrospective analysis. Then logistic regression (univariate and multivariate) was performed for analyzing the risk factors that influenced recurrence and metastasis.
ResultsA total of 728 patients were included. The recurrence and metastasis rates among Uyghur and Han patients 3 years after surgery were 28.4%, 9.8%, respectively, including local recurrence[11 Uyghur cases (6.5%) and 9 Han cases (1.6%)] and distant metastasis[37 Uyghur cases (21.8%) and 45 Han cases (8.0%)]. Significant differences were found between the two groups in tumour size and time from symptom occurrence to clinical visits (P<0.05). Pathological type, tumour size, axillary lymph node metastasis, clinical stage, ER and PR expression, and whether to accept a regular postoperative adjuvant therapy were associated with the recurrence and metastasis rate among the patients with breast cancer at Ⅰ-Ⅲ period (P<0.05). The results of multivariate logistic regression analysis showed that, the recurrence and metastasis rate of Uyghur patients was higher than that of Han patients with a significant difference (P<0.01). Pathological type, tumour size, and axillary lymph node metastasis number were the risk factors used to predict postoperative recurrence and metastasis among Uygur and Han patients; while ER positive expression, adjuvant radiation and postoperative chemotherapy were protective factors.
ConclusionThe recurrence and metastasis rate of Uyghur patients with breast cancer is higher than that of Han patients. Pathological type, tumour size, and axillary lymph node metastasis number are the risk factors of postoperative recurrence and distant metastasis; while ER positive expression, adjuvant radiation and postoperative chemotherapy may inhibit the recurrence and distant metastasis of breast cancer.
OBJECTIVE: To explore a new surgical approach to repair skin and soft tissue defect of hands. METHODS: Based on the anatomical study of the origin, course, branch, distribution, and anastomosis of the posterior interosseous artery and its recurrent branches in 40 upper limbs of cadavers, the posterior forearm serial flap, pedicled with the posterior interosseous artery and its recurrent branches, was designed and applied clinically in 17 cases to repair the skin and soft tissue defect of hands from August 1998 to July 2000. The size of flaps ranged from 7 cm x 5 cm to 15 cm x 10 cm. All of the cases were followed up for 3 weeks to 6 months. RESULTS: The anatomy study showed that the posterior forearm serial flap had long vascular pedicle, suitable thickness and large skin area. The clinical application indicated that the flaps survived in 16 cases. But flap necrosis at the distal end, sized 2 cm x 3 cm, was observed in one case, in which the defect was repaired by delayed skin grafting, CONCLUSION: The posterior forearm serial flap pedicled with the posterior interosseous artery and its recurrent branch have the character of avoidance of sacrificing the major arteries of the extremity, longer vascular pedicle, larger area and suitable thickness. The posterior forearm serial flap is a safe and easily manipulated surgical approach to repair the skin and soft tissue defect of the hands, especially of the thumb, palm, and proximal part of the fingers.
Objective To discuss the safety and feasibil ity of treating complex renal aneurysm with ex vivo aneurysmectomy and renal revascularization and renal autotransplantation after hand-assisted retroperitoneoscopic nephrectomy. Methods In October 2006, one male patient with complex renal aneurysm was treated. The preoperative color Doppler ultrasonograph, CT and DSA showed that there was an aneurysm (3.4 cm × 4.3 cm × 4.5 cm) located in the main renalartery bifurcation and its five branches of the left kidney. The patient had a history of hypertension with no response to treatment. After successful hand-assisted retroperitoneoscopic nephrectomy, the kidney off-body was perfused by the renal irrigating solution immediately to protect the kidney. Then ex vivo aneurysmectomy and renal artery revascularization were performed, the renal artery was reconstructed with an autologous right internal il iac artery. The reconstructed left kidney was re-implanted into the right il iac fossa. Results The operation was successful and the patient recovered without perioperative complications. The postoperative renal function was normal and the color Doppler ultrasonograph showed that the blood circulation in the transferred renal artery of the right il iac fossa and its branches was smooth, the blood circulation of the renal venous was smooth and no stenosis in the ureter 2 weeks after operation. Thirteen months follow-up showed the blood pressure was recovered to normal and the renal function was normal. Conclusion The method of ex vivo aneurysmectomy and autotransplantation is safe, feasible and minimally invasive for treating complex hilar renal artery aneurysms.
ObjectiveTo systematically review the safety of hand disinfectants. MethodsPubMed, EMbase, The Cochrane Library, INAHTA, WanFang Data, CNKI and VIP databases were electronically searched to collect studies on the safety of hand disinfectants from inception to February 1st, 2021. Two reviewers independently screened the literature, extracted data and assessed the risk of bias of the included studies; then, a systematic review was conducted. ResultsA total of 50 studies were included. The reported adverse events were eye and nasal mucosal irritation, hand adverse events with skin itching, rash, erythema, edema and so on. A total of 29 brands such as 3M Avagard and 26 ingredients such as ethanol were reported to be related to the above adverse events. Hand disinfectants containing glycerin, silicone oil, vitamin B, plant extracts and other emollients could reduce the incidence of adverse events. ConclusionCurrent evidence shows that hand disinfectants containing emollients and free from ethanol, chlorhexidine and other ingredients are related to fewer adverse events. Due to the limited quality and quantity of the included studies, more high-quality studies are needed to verify the above conclusion.
Since Swanson designed the silicone small joint prosthesis, the material and design of the small joint prosthesis have been constantly innovating. The number of small joint reconstruction and arthroplasty has gradually increased in the past decade. The numerous studies have focused on design and application of new material prosthesis and its long-term effectiveness analysis, in order to overcome prosthesis loosening, shift, dislocation, and poor function problem, at the same time to challenge the difficulty of the small joints revision procedures. Although the small joint prosthesis which has got the overall performance of the Swanson joints and been mature and stable like a knee joints prosthesis has not been obtained, but the small joint development has made revolutionary changes in the treatment of joint diseases, and the prosthesis selection criterion and surgical technique tendency solution have been established. In the future, digital three-dimensional printing, regenerative medicine, and translational medicine will contribute to the development of small joint reconstruction and replacement.
