Anterior cervical decompression and fusion (ACDF) treatment for cervical spondylosis has been more than half a century, and achieved good clinical results. However, with the continuous extension of follow-up time, the fusion segment-associated postoperative complications emerged gradually. Reserved cervical stability and activity, the concept of non-fusion was born. As a non-fusion technique, cervical artificial disc replacement (CADR) developed rapidly. With the continuous development of artificial prosthesis materials and design concepts, and specification and proficiency of surgical procedures, CADR has achieved better short- and mid-term clinical efficacy than ACDF. Compared with ACDF, the main advantages of CADR are that the postoperative recovery is quick, the activity and stability of cervical vertebra are maintained, the height of cervical intervertebral space is restored, and the stress of adjacent segments and the rate of surgical renovation are reduced. In clinical work, as an emerging technology, CADR requires spine surgeons to control the surgical indications, contraindications, and patients’ conditions strictly. This article reviews the research progress of CADR in order to provide new ideas for clinical treatment of cervical spondylosis.
目的 通過對連枷胸兩種不同治療方法的比較，探討該病的優化治療方案。 方法 將2005年1月－2012年11月收治的80例枷胸患者按入選標準分為：保守組40例，通過胸部外固定和（或）呼吸機內固定等方法治療；手術組40例，采用鎳鈦記憶合金環抱式接骨器手術內固定骨折的肋骨，比較兩種治療方法和療效及并發癥情況。 結果 保守組和手術組各死亡3例，原因為呼吸道感染致呼吸衰竭，兩組無差異，但ICU停留和住院天數、機械通氣時間、呼吸道感染等并發癥手術組明顯低于保守組（P＜0.01）。手術組無胸壁畸形，而保守組有18例，兩組比較差異有統計學意義（P＜0.01）。出院3個月后，手術組患者部分肺功能指標顯著優于保守組（P＜0.01）。 結論 手術治療連枷胸可迅速穩定胸壁，消除反常呼吸和激烈疼痛對呼吸的影響，還可減輕連枷胸對患者遠期肺功能的影響，具有較高的臨床應用價值。
【摘要】 目的 探討活動期感染性心內膜炎（infectiue endocarditis，IE）患者心臟手術的最佳時期。 方法 回顧分析1999年9月-2009年9月行外科治療的92例IE患者的臨床資料。IE診斷標準為修訂的Duke標準。采用SPSS 12.0軟件包，分析了年齡、性別、是否是院內感染IE、合并癥（糖尿病、慢性阻塞性腫疾病、癌癥）、病原菌、手術時間等因素與手術并發癥及6個月病死率的關系。 結果 56例患者在確診為IE后7 d內手術，36例患者在確診7 d后，并抗生素治療完成后手術。葡萄球菌為主要感染菌株，與栓塞、膿腫及感染性休克顯著相關。最常見的手術指征是重度的瓣膜關閉不全合并心功能不全。6個月的病死率為12%。早期手術與晚期手術比較，病死率增高。單因素分析顯示，與6個月病死率相關的因素包括葡萄球菌感染和感染性休克。多因素分析顯示感染性休克為6個月內死亡的預測因子。感染性休克的患者盡管行了早期手術，病死率仍為67%。嚴重瓣膜關閉不全的患者，若未出現心衰，無手術（早期或晚期）死亡。 結論 手術患者的預后由是否發生過感染性休克決定。晚期手術組患者結果好于早期手術組，但結果的差異可能并不是手術的時期不同，而是感染性心內膜炎的嚴重程度不同造成的。對于有重度瓣膜返流但無心衰的患者，早期手術可能在縮短住院時間，預防心衰發生上有幫助。【Abstract】 Objective To discuss the optimal time of cardiac operations in patients with infective endocarditis (IE). Methods We analyzed the clinical data of 92 patients with IE diagnosed by the modified Duke criteria between September 1999 and September 2009. SPSS 12.0 was used to analyze predictors of 6-month mortality, including age, sex, nosocomial origin of infection, comorbid conditions (diabetes, chromic obstructive pulmonary disease, cancer), the causative microorganisms, the timing of cardiac operation, and the complications. Results Fifty-six patients underwent operation within the first 7 days after diagnosis of infective endocarditis, and 36 received operation at the completion of antibiotic treatment 7 days after the diagnosis. Staphylococci predominated and were significantly associated with embolism, abscess, and septic shock. The most frequent indication for operation was severe regurgitation with heart failure. The 6-month mortality was 12%. Early operation showed an increased mortality compared with late operation. Univariate analysis showed that factors associated with 6-month mortality included staphylococci infection and septic shock. Multivariate analysis revealed that septic shock was a predictor of 6-month mortality. Despite early operation for patients with septic shock, 67% of them died. No death occurred to patients with severe regurgitation but without heart failure after undergoing (early or late) operations. Conclusions The prognosis for surgically treated patients is determined by the occurrence of septic shock. The outcome in patients undergoing late operations is favorable compared with patients undergoing early operations. This difference is probably not due to the timing of the surgical intervention but to the severity of infective endocarditis. In patients with severe regurgitation without heart failure, early operation may offer benefits in shortening the length of hospitalization and preventing development of heart failure.
To study the effect of the repair of rabbit articular cartilage defects by the composite of chondrogenic induction of autologous MSCs and autologous “two-phase” bone matrix gelatin (BMG). Methods Twentyfour healthy adult New Zealand rabbits weighing 2 to 3 kg were divided into group A, B and C with 8 in each. Autologous MSCsderived from group A were cultured in vitro and observed under inverted phase contrast microscope when enough cells through trypsinization transferring in vitro were obtained. Then the growth curves of 1, 3 and 5 passage culture of MSCs were drawn. The 3rd passage MSCs were induced into chondrogenic differentiation by adding TGF-β1 (10 ng/mL), IGF-1 (10 ng/mL) and vitamin C (50 ng/mL) in vitro. At 8 days after induction, the features of chondrocytes were observed under inverted phase contrast microscope, and immunohistochemical staining and Mallory staining were made. Getting out part of the il ium of group A and B, according to the method of Urist, the “two-phase” BMG was acquired. Chondrogenic induction of autologous MSCs was inoculated into the corresponding BMG to set up a composite of cell-carrier, and then it was observed through scanning electric microscope after 3 days of culture. The model of articular cartilage defects of rabbits was made: in group A, autologous cell-carriers were implanted; in group B, there only existed autologous BMG; in group C, there was nothing. At 8, 12 weeks after operation, the gross, HE staining and immunohistochemical staining were made, and grading scales were evaluated according to Wakitani histological grading method. Results Features of MSCs were as follows: the shape of primary cells was shotspindled and of passage cells was long. As to the growth curves of 1, 3 and 5 passage culture of MSCs, passage cells grew slowly for 3 days after being passaged and went into log-growth during the 3rd and the 7th days and into plateau later, but the 3rd passage cells grew best. Observation of MSCs after chondrogenic induction was performed: the shape of cells was ell iptical and the effect of induction was verified by the positive results of collagen type II, S-100 and Mallory staining. Under scanning electricmicroscope, the structure of BMG was good and cells were observed growing in it well. As far as repair of articular cartilage defects are concerned at 8, 12 weeks after transplantation, the defects in group A were repaired by the hyl ine-l ike tissue and the structures of the cartilage surface and normal cartilage were in integrity, and immunohistochemical staining of collagen type II was positive, while those in group B and C were repaired by the fibrous-l ike tissues and the surfaces were irregular. In Wakitanni histological score, at 8 weeks after operation, group A was (3.50 ± 1.51) points, group B was (10.00 ± 1.41) points and group C was (12.00 ± 0.93) points; at 12 weeks, group A was (1.13 ± 0.99) points, group B was (8.38±1.30) points, and group C was (10.13 ± 1.64) points. At different time points, group A was significantly better than group B and C, showing significant differences (P lt; 0.05). Conclusion Induced autologous MSCs and the composite with autologous “two-phase” BMG have the function to repair articular cartilage defects, and they are better than autologous BMG transplanted only or nothing transplanted.
目的 總結68例二尖瓣成形術的臨床經驗，評估其術后臨床效果。 方法 回顧分析2001年12月－2011年12月進行二尖瓣成形術治療的68例二尖瓣關閉不全患者的臨床資料。成形術的方法為：人工瓣環植入、雙孔成形、后瓣矩形切除、贅生物切除及心包補片修復、腱索轉移等。術中采用注水實驗和經食管超聲心動圖檢查評估成形效果。 結果 68例患者中手術死亡2例，二次開胸止血1例，肺部感染3例。全部患者術中注水實驗和食管超聲心動圖檢查顯示成形效果滿意。存活66例患者隨訪6個月，術后10 d、6個月彩色多普勒超聲心動圖檢查：左心房內徑、左心室舒張末內徑縮小。術后6個月彩色多普勒超聲心動圖檢查：無或微量反流33例，輕度反流27例，輕～中度反流5例，中度反流1例。 結論 根據二尖瓣關閉不全的特征，選擇相應的二尖瓣成形技術，可以取的較好的臨床效果。
Objective To explore the effectiveness of two-stage operation on free latissimus dorsi myocutaneous flap transplantation and skull contour reconstruction in the treatment of head titanium mesh exposure complicated with soft tissue infection. Methods Between January 2015 and December 2021, 13 patients with head titanium mesh exposure complicated with soft tissue infection were admitted. There were 9 males and 4 females with a mean age of 42.9 years (range, 23-64 years). The duration of titanium mesh exposure was 22-609 days (median, 102 days). The wound site located at the frontal part in 3 cases, the parietal part in 1 case, the occipital part in 2 cases, the frontal-parietal part in 1 case, the temporal-parietal part in 4 cases, and the frontotemporal part in 2 cases. The titanium mesh had been taken out in 5 patients before admission, leaving skull defect and shape collapse, with signs of infection. The bacterial culture was positive in 7 cases and negative in 6 cases. The imaging examination revealed that the size of the skull defect ranged from 6 cm×5 cm to 21 cm×17 cm and the scalp defect ranged from 1 cm×1 cm to 15 cm×10 cm. The soft tissue infection did not reach dura in 5 cases, reached dura in 6 cases, and reached frontal sinus in 2 cases. The two-stage surgical protocol was used in all patients. In the first-stage operation, the latissimus dorsi myocutaneous flap was designed to repair the skull and scalp defects after removing the titanium mesh and thorough debridement. The size of muscle flap ranged from 13.5 cm×4.0 cm to 21.0 cm×17.0 cm, and the skin flap ranged from 7.0 cm×4.0 cm to 15.0 cm×10.0 cm. After the flap survived and stabilized, the second-stage operation was performed. The titanium mesh was implanted to reconstruct the skull contour. The size of titanium mesh ranged from 7.0 cm×6.0 cm to 21.5 cm×17.5 cm. The interval between the first- and second-stage operations was 3.7-17.8 months, with an average of 11.4 months. The survival of the skin flap, the appearance of the head, and the presence of re-exposed titanium mesh and infection were observed after operation. Results At the first-stage operation, venous embolism occurred in 1 case, and no obvious abnormality was observed after treatment. All the flaps survived and the incisions healed by first intention. Besides, the incisions of the second-stage operation healed by first intention. All patients were followed up 1-96 months (median, 14 months). During follow-up, no exposure to titanium mesh, infection, or other complications occurred. The appearance satisfaction rate of the patients was 92.31% (11/13). There was no significant difference in the skull contour between the affected side and the healthy side in all patients. Conclusion For the head titanium mesh exposure with soft tissue infection, the application of two-stage operation on free latissimus dorsi myocutaneous flap transplantation and skull contour reconstruction can reduce the risks of implant exposure and infection again by increasing the thickness of the scalp and blood supply, filling the wound cavity, and obtain good effectiveness.