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Hu Y.,Ningbo No6 Hospital | Xu R.-M.,Ningbo No6 Hospital | Albert T.J.,Thomas Jefferson University | Vaccoro A.R.,Thomas Jefferson University | And 4 more authors.
Journal of Spinal Disorders and Techniques | Year: 2014

Study Design: This is a retrospective, clinical, and radiologic study of posterior reduction and fusion of the C1 arch in the treatment of unstable Jefferson fractures. OBJECTIVE: The aim of the study was to describe a new motion-preserving surgical technique in the treatment of unstable Jefferson fracture. Summary of Background Data: The management of unstable Jefferson fractures remains controversial. The majority of C1 fractures can be effectively treated nonoperatively with external immobilization unless there is an injury to the transverse atlantal ligament (TAL). Conservative treatment usually involves immobilization for a long time in Halo vest, whereas surgical intervention generally involves C1-C2 fusion, eliminating the range of motion of the upper cervical spine. We propose a novel method for the treatment of unstable Jefferson fractures without restricting the range of motion. METHODS: A retrospective review of 12 patients with unstable C1 fractures between April 2008 and October 2011 was performed. They were treated by inserting bilateral posterior C1 pedicle screws or lateral mass screws interconnected by a transversal rod to achieve internal fixation. There were 8 men and 4 women, with an average age of 35.6 years (range, 20-60 y). Presenting symptoms included neck pain, stiffness, and decreased range of motion but none had neurological injury. Seven patients had bilateral posterior arch fractures associated with unilateral anterior arch fractures (posterior 3/4 Jefferson fracture, Landells type II), and 5 had unilateral anterior and posterior arch fractures (half-ring Jefferson fracture, Landells type II). Seven patients had intact TAL, and 5 patients had fractures and avulsion of the attachment of TAL (Dickman type II). Results: A total of 24 screws were inserted. Five cases had screws placed in the lateral mass: 3 because of posterior arch breakage, and 2 because the height of the posterior arch at the entry point was <4 mm. The remaining 7 cases had pedicle screw fixation. One patient had venous plexus injury during exposure of lower margin of the posterior arch; however, successful hemostasis was achieved with Gelfoam. Postoperative x-ray and computed tomography scan showed partial breach of the transverse foramen caused by a screw in 1 case, and breach of the inner cortex of the pedicle caused by screw displacement in 1 case; however, no spinal cord injury or vertebral artery injury was found. The remaining screws were in good position. Patients were followed up for 6-40 months (average, 22 mo). All cases had recovery of range of motion of the cervical spine to the preinjury level by 3-6 months after surgery, with resolution of pain. At 6 months follow-up, plain radiographs and computed tomography scans revealed satisfactory cervical alignment, no implant failure, and satisfactory bony fusion of the fractures; no C1-C2 instability was observed on the flexion-extension radiographs. CONCLUSIONS: C1 posterior limited construct is a valid technique and a feasible method for treating unstable Jefferson fractures, which allows preservation of the function of the craniocervical junction, without significant morbidity. © 2013 by Lippincott Williams & Wilkins.


PubMed | University of Ulsan, Nantong University, Korea Institute of Science and Technology and Ningbo No6 Hospital
Type: | Journal: Orthopaedics & traumatology, surgery & research : OTSR | Year: 2017

Restoration of native head-shaft angle (HSA) is critical for treatment of proximal humerus fracture. However, HSA has not been properly investigated according to the humeral rotation. This study was designed to analyze the relationship between the humeral rotation and the HSA at 1 increments, and clarify its serial changing pattern according to the humeral rotation.The angulation of HSA would be undervalued when the humerus is being rotated externally and it would be overvalued when it is being rotated internally.Eight dried cadaveric normal humeri were CT scanned. They were analyzed using Computer-aided design with a standardized neutral position. HSA was the angle between the humeral shaft axis (SA) and the humeral head axis (HA). SA and HA were the best-fit lines through center of all the best-fitting circles in every cross section along the humeral shaft and within the humeral head, respectively. Each 3D model was rotated 30 internally and 45 externally relatives to the SA at 1 increments with the camera was fixed at antero-posterior view of neutral position. Angulation of HSA in every rotational degree was documented as ratio relatives to the angulation of HSA in neutral position.The average HSA at neutral position was 1331.93. HSA was underestimated by 81.9% and it was overestimated by 205.1% at the maximum external rotation (ER) and internal rotation (IR), respectively. HSA was underestimated by 1% in every 5.8 of ER and overestimated by 1% in every 1.5of IR. Rotational misalignments within 10 of IR and 18 of ER could be tolerated (P>.05).HSA was underestimated at ER and was overestimated at IR. This information could be useful for surgeons in restoring the native HSA for treatment of proximal humerus fracture.basic research study.


Jiang W.Y.,Ningbo No6 Hospital
Zhongguo gu shang = China journal of orthopaedics and traumatology | Year: 2011

To retrospectively analyze the surgical effect of anterior approach bone graft and internal fixation methods for treating old thoracolumbar fracture without neurological symptom, so as to provide references for surgical treatment of such kind of fracture. From April 2004 to April 2009, 22 cases of old thoracolumbar fractures were treated, including 15 males and 7 females with an average age of 38 years ranging from 21 to 56 years. The time from injured to operation was from 4 months to 2 years (average 8 months). Anterior approach surporting bone graft and internal fixation were performed. All patients were followed up for at least 12 months, the Cobb angle depending on lateral radiographs and VAS scores were compared between pre-operative and post-operative. Complication was observed. The average preoperative Cobb angle of kyphosis was (15.0 +/- 2.4) degrees (8.0 degrees to 28.0 degrees), VAS score was 7.0 +/- 0.7. The average two weeks after operation was (3.0 +/- 1.6) degrees (-2.0 degrees to 9.0 degrees), VAS score was 1.0 +/- 0.6. The average Cobb angle at one year after operation was (3.5 +/- 1.4) degrees (0.0 degrees to 12.0 degrees), VAS score was 1.2 +/- 0.6. There were statistically significant differences in the above indexes between preoperation and two weeks after operation (P<0.05), while no statistically significant difference was found between 2 weeks and 1 year after operation (P>0.05). Bony fusion were achieved in 21 patients, nounion were occurred in 1 patient, but without correction loss. According to Cobb angle of kyphosis, anterior approach surporting bone graft and internal fixation is a reasonable strategy to treat old thoracolumbar fracture without neurological symptom.


Zhou L.J.,Ningbo No6 Hospital
Zhongguo gu shang = China journal of orthopaedics and traumatology | Year: 2010

OBJECTIVE: To summarize the therapeutic experience of Bryan prosthetic cervical disc replacement at the 3rd years after operation and to analyze the clinical effect, incidence rate of heterotopic ossification, conditions of prosthetic fusion in order to investigate the countermeasures. METHODS: From December 2005 to December 2008, 54 patients with cervical syndrome (34 males and 20 females, the age was from 39 to 69 years with an average of 50.5) were treated with single level Bryan prosthetic cervical disc replacement. The patients were followed for 24-36 months with an average of 30 months. The symptoms and nerve function were evaluated according to JOA and Odom's scoring. The anterior-posterior and lateral cervical X-ray films were also taken regularly every three months for the observation of heterotopic ossification and prosthetic fusion. Meanwhile, the X-ray films of the forward bending, extending, left and right lateriflection were taken before operation and at the 1st years after operation for the measurement of the stability and rang (ROM) of replaced levels. RESULTS: The pain symptom and neurological function of all 54 patients were improved obviously. JOA score increased with an average of 76.1%, and ROM of replaced levels also improved obviously. The incidence rate of heterotopic ossification and prosthetic fusion went up year by year, 3.7% (2/54) for the first year, 16.7% (9/54) for the second year and 22.2% (12/54) for the nearly third year. CONCLUSION: Bryan prosthetic cervical disc replacement has better mid-stage results than conventional methods. Modified surgical methods and early rehabilitation exercise may reduce the relatively high incidence rate of heterotopic ossification and prosthetic fusion.


Wu Y.,Ningbo No6 Hospital | Guo X.-H.,Ningbo No6 Hospital
International Eye Science | Year: 2016

AIM: To evaluate the efficacy and safety of Ahmed glaucoma valve(AGV) implantation surgery using different methods. METHODS: This was a retrospective study of patients with refractory glaucoma in whom AGV implantation was performed between June 2011 and September 2014. According to the method of tube insertion into the anterior chamber, the sample was divided into two groups, needle-generated scleral tunnel and scleral flap. The surgical success rate, intraocular pressure(IOP), number of antiglaucoma medications used, best correct visual acuity, postoperative complications, and operation duration were analyzed between the two groups. RESULTS: Compared with preoperative data, the two groups showed statistically significant decrease on IOP and the number of antiglaucoma medication used at all follow-up points(P<0.01). Differences on mean postoperative IOP, mean number of postoperative antiglaucoma medications, and best correct visual acuity were not significant between the two groups at all follow-up intervals. Kaplan-Meier survival curves showed that the success rate was 79% for the needle-generated scleral tunnel group and 80% for the scleral flap group at the follow-up endpoint of 1a. There was no significant difference between the two groups(P=0.932); however, statistically significant differences were detected when flat anterior chamber complications between the needle-generated scleral tunnel group (6%)and the scleral flap group (24%) were compared(P=0.032). CONCLUSION: AGV implantation may be an effective method in managing refractory glaucoma, since the two methods have similar efficacy. However, the needle-generated scleral tunnel technique application could greatly decrease the incidence of flat anterior chamber complications and decrease the duration of the operation. Copyright 2016 by the IJO Press.


Yuan J.-S.,Ningbo No6 Hospital | Wu Y.,Ningbo No6 Hospital | Wang Y.-W.,Ningbo No6 Hospital
International Eye Science | Year: 2016

AIM:To observe the change of subfoveal choroidal thickness(SFCT) after intravitreal injections of anti-vascular endothelial growth factor monoclonal antibody Ranibizumab in patients with choroidal neovascularization(CNV) secondary to pathologic myopia(PM) and to research the relation between visual acuity and SFCT. METHODS:This was a prospective, contrast, open-label study.Fifty pathologic myopia patients with CNV (50 eyes) were recruited in this study. Before the injection, best-corrected visual acuity detected by visual chart from Early Treatment of Diabetic Retinopathy Study(ETDRS), non-contact tonometer, ophthalmoscope, fundus photography, fundus fluorescein angiograph(FFA)and optical coherence tomography(OCT)examination were necessary. All affected eye were treated with intravitreal ranibizumab 0.05mL. Following up for 12mo, the changes of visual acuity and SFCT were compared before and after treatment, also the relation between them. RESULTS:All eyes received an average of 2.47±2.23 injections, the final vision of follow-up increased by 13.62±8.98 letters than that before(t=6.69, P<0.05). The SFCT before therapy, 1, 6 and 12mo after treatment were 81.48±61.62, 79.63±60.98, 77.92±61.26 and 78.34±59.48μm and respectively decreased by 2.09±8.93, 3.68±7.42, 3.16±6.95μm compare to pre-treatment. The difference on SFCT at 1mo was not significant compared to before treatment(t=0.95, P>0.05).While after 6 and 12mo, the differences were significant(t=2.34, 2.61; P<0.05). Twenty-four eyes (48%) were with recurrence, mean recurrence times were 1.39±1.23. The SFCT increased from 75.7±51.6μm at 1mo to 84.4±55.9μm(by 11.5%) when recurred, there were significant differences(P<0.05). Twenty-six eyes (52%) were not with recurrence. The SFCT at 1, 6 and 12mo after treatment were 85.3±52.7, 83.6±50.5 and 84.2±54.2μm, there were no significant differences with multiple comparison(P>0.05). There were no serious systemic or local side effects during the follow up. CONCLUSION:Intravitreal ranibizumab for CNV secondary to pathologic myopia is safe and can improve the visual acuity. Intravitreal injections of ranibizumab can induce SFCT reduction for CNV secondary to pathologic myopia. We hypothesized that increase of SFCT may be one of evaluation index for CNV activity. Copyright 2016 by the IJO Press.


Fu D.,Huazhong University of Science and Technology | He X.,Ningbo No6 Hospital | Yang S.,Huazhong University of Science and Technology | Xu W.,Huazhong University of Science and Technology | And 2 more authors.
BMC Musculoskeletal Disorders | Year: 2011

Background: To study the effects of zoledronic acid (ZA) on the vasculogenic mimicry of osteosarcoma cells in vitro. Methods. A Three-dimensional culture of LM8 osteosarcoma cells on a type I collagen matrix was used to investigate whether osteosarcoma cells can develop vasculogenic mimicry, and to determine the effects of ZA on this process. In addition, the cellular ultrastructural changes were observed using scanning electron microscopy and laser confocal microscopy. The effects of ZA on the translocation of RhoA protein from the cytosol to the membrane in LM8 cells were measured via immunoblotting. Results: ZA inhibited the development of vasculogenic mimicry by the LM8 osteosarcoma cells, decreased microvilli formation on the cell surface, and disrupted the F-actin cytoskeleton. ZA prevented translocation of RhoA protein from the cytosol to the membrane in LM8 cells. Conclusions: ZA can impair RhoA membrane localization in LM8 cells, causing obvious changes in the ultrastructure of osteosarcoma cells and induce cell apoptosis, which may be one of the underlying mechanisms by which the agent inhibits the development of vasculogenic mimicry by the LM8 cells. © 2011 Fu et al; licensee BioMed Central Ltd.


Zhang J.H.,Ningbo No6 Hospital
Zhongguo gu shang = China journal of orthopaedics and traumatology | Year: 2011

To investigate the incidence, predisposing factors and therapeutic modalities of acute colonic pseudo-obstruction (ACPO) in patients after total hip arthroplasties (THA) and total knee arthroplasties (TKA). From January 2006 to December 2009, 12 patients with ACPO after THA and TKA operation were investigated retrospectively,who were viewed as the ACPO group. There were 10 males and 2 females with an average age of (78 +/- 12) years in the ACPO group. Other 853 patients without ACPO after THA and TKA operation were viewed as the control group treated at the same period. The incidence of ACPO was calculated. The clinical data were collected and compared between the two groups including patient age, gender, procedure, anesthetic class, clinical presentation, radiographic findings, duration from index surgery to diagnosis of ACPO, treatment, postoperative mobilization time, and length of hospital stay. The incidence of ACPO was 1.4%. The incidence of primary THA (1.3%) was higher than that of primary TKA (0.4%); the incidence of hip and knee revisions (5.0%) was higher than that of primary THA and TKA (1.0%); there was no difference in incidence between hip revisions (5.5%) and knee revisions (4.0%). The mean age was (78 +/- 12) years old in ACPO group and (71 +/- 13) in the control group. The male/female ratio was 5:1 in ACPO group and 2:3 in control group. There were statistical differences in mean age and gender ratio between the two groups. No association was found with respect to anesthetic class. On average, ACPO occurred at 2.5 days after index surgery. The abdominal distention occurred in all 12 cases, nausea or vomiting in 8 cases and abdominal pain in 3 cases. Radiographically cecal dilation occurred in all cases and intestinal dilation in 3 cases. All patients initially were treated conservatively with immediate cessation of oral intake,a nasogastric tube and oral mineral oil. Three patients received a rectal tube. Only 1 patient required endoscopic decompression. There were no deaths after ACPO in the series. Mean mobilization time after surgery averaged (5.0 +/- 2.2) days in ACPO group compared with (2.5 +/- 1.1) days in the control group. Mean hospital stay averaged (16.5 +/- 6.4) days in ACPO group compared with (10.5 +/- 4.5) days in the control group. There were statistical differences in mean mobilization time after surgery and mean hospital stay between two groups. ACPO mainly happened in old male patients. The majority cases response to conservative treatment and their prognoses are good. But ACPO will delay mobilization time after surgery and increase hospital stay.


Gu Y.J.,Ningbo No6 Hospital
Zhongguo gu shang = China journal of orthopaedics and traumatology | Year: 2012

To explore the clinical application of Centerpiece titanium plate fixation in open door laminoplasty. From January 2009 to December 2010,25 patients with cervical spinal stenosis were treated by open door laminoplasty with Centerpiece titanium plate fixation. There were 16 males and 9 females,with a mean age of (57.2 +/- 6.7) years (ranged, 44 to75 years). There were multilevel cervical myelopathy in 8 cases, posterior longitudinal ligament ossification in 12 cases and congenital cervical spinal stenosis in 5 cases. According to Japanese Orthopedic Association (JOA) score to evaluate nerve function and calculate improvement rate. X-ray and CT were used to evaluate postoperative spinal canal enlargement and bone fusion at the hinge side. The sagittal diameter of C5 spinal canal on the lateral X-ray was measured before operation and 6 months after operation respectively, and the expansion rate of spinal canal was calculated [(postoperative sagittal diameter-preoperative sagittal diameter)/(preoperative sagittal diameter) x 100%]. The operative time and intraoperative blood loss were respectively (165.5 +/- 35.6) min and (325.0 +/- 75.1) ml. All patients were followed up from 6 to 18 months with an average of (7.3 +/- 3.8) months. The JOA score increased from 9.3 +/- 1.1 before operation to 14.7 +/- 2.1 at 6 months after operation (t = 4.12, P < 0.05), and the improvement rate was (64.5 +/- 10.2)%. Radiographic data showed spinal canal enlarged perfectly, bone fusion at hinge side and no cervical spinal stenosis was found. The sagittal diameter of C5 spinal canal improved from (9.0 +/- 1.5) mm before operation to (14.3 +/- 2.0) mm at 6 months after operation (t = 7.61, P < 0.05), and the expansion rate was (67.6 +/- 11.8)%. Clinical application of Centerpiece titanium plate fixation in open door laminoplasty is safe and effective. While vertebral plate is elevated to obtain instantly stability, at the same time, the integrity of spinal canal is also recovered.


PubMed | Ningbo No6 Hospital and Zhejiang University
Type: | Journal: The Journal of arthroplasty | Year: 2016

With the introduction of new fixation systems and designs, there has been a recent reemergence of interest in cementless fixation of the tibial component in total knee arthroplasty. However, little is known regarding the clinical features and survivorship of the cementless porous tantalum monoblock tibial component compared to the conventional cemented modular tibial component.We conducted a literature search of multiple databases for comparative studies published before June 2015 that investigated the outcomes of cementless porous tantalum monoblock tibia vs conventional cemented modular tibia. A pooled analysis was performed. The outcomes of interest were postoperative functional score, range of motion, Western Ontario and McMaster University Osteoarthritis Index, total complications, reoperation, radiolucent lines, loosening of the tibial component, and length of operation.Six studies involving 977 patients were eligible for the meta-analysis. The use of a cementless porous tantalum monoblock tibial component may associate with a slightly higher functional score, fewer radiolucent lines, and shorter operation. No significant difference was seen in regard to the range of motion, Western Ontario and McMaster University Osteoarthritis Index, total complications, reoperation, and loosening of the component between the 2 groups.However, due to variation among the included studies, the use of cementless porous tantalum monoblock tibia seems to achieve no substantial superiority over that of the conventional cemented modular tibia at 5-year follow-up. Data concerning the long-term prognosis of this novel implant should continue to be collected and analyzed.

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