Objective To evaluate the mid-term cl inical outcome of instrumented sl ip reduction combined with 360° circumferencial fusion and restoration laminae for symptomatic adult isthmic spondylol isthesis. Methods Between October 2004 and March 2008, 44 patients with symptomatic isthmic spondylol isthesis underwent instrumented sl ip reduction combined with 360° circumferencial fusion and restoration laminae. There were 15 males and 29 females with an average age of38.4 years (range, 28-45 years). The disease duration was 14 months to 7 years (38 months on average). The affected vertebrae was L4-5 in 18 patients and L5, S1 in 26 patients. According to Meyerding’s grade for spondylol isthesis, 28 cases were rated as grade II and 16 as grade III. The visual analogae scale (VAS), Oswestry disabil ity index (ODI), and the short form 36 health survey (SF-36) scores were evaluated before operation and at last follow-up; the radiographical outcome was evaluated by measuring sl i pping percentage, heights of intervertebral space and foramen, and fusion rate. Results All patients were followed up 20-60 months (42 months on average). The VAS, ODI, and SF-36 scores were all significantly improved at last follow-up when compared with those before operation (P lt; 0.05). According to Morelos criteria, the cl inical results were excellent in 32 patients, good in 9, and fair in 3; the excellent and good rate was 93.2%. The preoperative average percentage of sl ip was 47.5%, which was improved to 2.6% 3 days after operation; the total average reduction rate was 97.4%, and it was maintained at last followup. The heights of intervertebral space and foramen were all improved significantly after operation (P lt; 0.05), and there was no significant difference between at 3 days after operation and at last follow-up (P gt; 0.05). X-ray and CT showed bony fusion 1 year after operation in all patients with a fusion rate of 100%. Compl ications included pain at donor site of il iac bone in 4 cases, superficial infection in 2 cases, dural tear in 1 case, and degeneration of adjacent vertebrae in 2 cases; no nerve root injury, pseudoarthrosis, failure of internal fixation, and acquired spinal canal stenosis occurred. Conclusion Instrumented sl ip reduction combined with 360° circumferencial fusion and restoration laminae is a rel iable procedure for adult isthmic spondylol isthesis with satisfactory mid-term results, a high fusion rate and low compl ication rate. The long-term outcomesshould be verified by follow-up in the future.
Objective To approach a new procedure of microsurgery to repair thumb fingertip amputation with forward homodigital ulnaris artery flap coverage for bone and nail bed graft. Methods From March 2005 to October 2007, 6 cases of amputated thumb fingertip (6 fingers) were treated, including 4 males and 2 females and aging 23-63 years. Six patients’ (3 crush injuries, 2 cut injuries and 1 other injury) amputated level was at nail root (2 cases), mid-nail (3 cases), and the distalone third of nai bed (1 case). The time from injury to surgery was 3-10 hours, they were treated with forward homodigital ulnaris artery flap coverage for bone and nail bed graft. The flaps size ranged from 1.5 cm × 1.4 cm to 2.0 cm × 1.4 cm. Results All flaps survived. Wound healed in one-stage in 5 cases, and healed in second stage in 1 case because of swell ing. All skin grafting at donor site survived in one-stage. All patients were followed up for 6-8 months. The appearance of flaps were good, and the two-point discrimination was 5-6 mm. Bone graft were healed, the heal ing time was 4-5 weeks. All finger nails were smooth and flat without pain. Conclusion When there was no indication of replantation in thumb fingertip amputation, establ ishing the functional and esthetic construction can be retained with forward homodigital ulnaris artery flap coverage for bone and nail bed graf
ObjectiveTo investigate the effectiveness of delayed replantation of degloving skin preserved at 4℃ in treatment of limb degloving injuries. Methods Between October 2020 and October 2023, 12 patients with limb degloving injuries were admitted. All patients had severe associated injuries or poor wound conditions that prevented primary replantation. There were 7 males and 5 females; age ranged from 29 to 46 years, with an average of 39.2 years. The causes of injury included machine entanglement in 6 cases, traffic accidents in 5 cases, and sharp instrument cuts in 1 case. Time from injury to hospital admission was 0.5-3.0 hours, with an average of 1.3 hours. Injury sites included upper limbs in 7 cases and lower limbs in 5 cases. The range of degloving skin was from 5 cm×4 cm to 15 cm×8 cm, and all degloving skins were intact. The degloving skin was preserved at 4℃. After the patient’s vital signs became stable and the wound conditions improved, it was trimmed into medium-thickness skin grafts for replantation. The degloving skin was preserved for 3 to 7 days. At 4 weeks after replantation, the viability of the degloving skin grafts was assessed, including color, elasticity, and sensation of pain. The Vancouver Scar Scale (VSS) was used to assess the scars of the skin grafts during follow-up. Results At 4 weeks after replantation, 8 cases of skin grafts completely survived and the color was similar with normal skin, with a survival rate of 66.67%. The elasticity of skin grafts (R0 value) ranged from 0.09 to 0.85, with an average of 0.55; moderate pain was reported in 4 cases, mild pain in 3 cases, and no pain in 5 cases. All patients were followed up 12 months. Over time, the VSS scores of all 12 patients gradually decreased, with a range of 4-11 at 12 months (mean, 6.8). Conclusion For limb degloving injuries that cannot be replanted immediately and do not have the conditions for deep low-temperature freezing preservation, the method of preserving the degloving skin at 4℃ for delayed replantation can be chosen.
Objective To investigate the survival effect and reaction mechanismsof motor neurons after reimplantation of the avulsed root into the spinal cord,and to observe the survival and differentiation in the spinal cord after brachial plexus roots avulsion. Methods Thirty adult Wistar rats were randomly devided into the control group and the experimental group (n=15). Laminectomy of C4-6 was performed via a posterior approach. The ventral and dorsal roots of C5，6 were both avulsed from the spinal cord outside the dura mater and within the vertebral canal.For the experimental group, the ventral root of C6 wasreimplanted into the ventralhorn under microscope. The dorsal root was left. The ventral and dorsal roots of C5 were placed inside the nearby muscles. For the control group, the ventral and dorsal roots of both C5 and C6 were placed inside the nearby muscles. At 2, 4, 6, 8, 12 weeks postoperatively, the C6 spinal cord was stained with HE. The changes of the number and morphology of motor neurons were observed onHEstained sections. The C6 spinal nerve root was stained with silver nitrate, andthe regeneration of nerve fiber was observed. Results All rats were recovered well and their wounds were healed at primary stage. The gross observation showed that the avulsed nerve roots in control group adhered to adjacent muscles, however the one in experimental groups which had been implanted into spinal cord adhered to scar tissues and were not separated from spinal cord. At each time point postoperatively, the HEstained transverse sections showed that the number of motor neurons decreased significantly with soma swollen and atrophied, Nissle bodies decreased or disappeared. The survival rates of motor neurons in the control group were 60.9％±5.8%,42.3％±3.5％,30.6％±6.1％27.5％±7.9％ and 20.4％±6.8％ respectively；in the experimental group,the survival rates were 67.1％±7.4％,56.3％±4.6％,48.7％±8.8％,44.2％±5.5％ and 42.5％±8.3％ respectively. The survival rates of motor neurons in the experimental group was higher than those in the control group at all time points,showing statistically significant difference（Plt;0.01）.At 12 weeks postoperatively, thesilver nitrate stained specimen from the C6 nerve root showed regeneration of the motor neurons in the ventral horn into the reimplanted nerve root through axon in the experimental group,but the degeneration of the nerve fiber appeared and the number of the myelinated nerve fiber decreased in the control group. Conclusion Through reimplantationof the avulsed ventral nerve root into the ventral horn, degeneration of the motor neurons in the ventral horn can be reduced. After reimplantation of avulsed nerve root, there is axonal regrowth of motor neurons into the spinal nerve root and regeneration of the myelinated nerve fiber also appears.
摘要:目的:进行深低温贮存回植自体颅骨瓣的临床应用效果研究。方法:将74例患者术后骨瓣深低温(零下80℃)贮存,2～12月后予以原位回植,术中取骨标本病检,随诊1～36月。结果:74例中72例伤口Ⅰ期愈合,颅骨复位良好。病检示回植骨有正常骨细胞,与新鲜颅骨对照无骨母细胞。2例患者回植骨吸收明显,失去支撑作用而再次行修补钛网,2例感染,余下70例患者2～4月后骨缝不同程度增宽1～2 mm,6月后骨缝不再增宽,12～36月后骨缝部分变窄,达骨性愈合,而颅骨钻孔处及颞下骨缝较宽区未见骨性结构,为纤维疤痕愈合。结论:深低温贮存的自体颅骨部分骨细胞能长时间存活,回植后无免疫排异性。回植手术简便,患者容易接受,临床应用效果较好。