Wang J.-Y.,Xinjiang Medical University |
Deng Q.,Xinjiang Medical University |
Sheng W.-B.,Xinjiang Medical University |
Lu Y.-J.,The 474 Hospital of Chinese PLA
Chinese Journal of Tissue Engineering Research | Year: 2015
BACKGROUND: The treatment of lower cervical spine fracture and dislocation is aimed to improve neurological functions of patients, the selection of surgical approach is conductive to the reduction and spinal decompression, also maintain strong fixation and bone graft fusion. OBJECTIVE: To explore the restoration approach of lower cervical spine fracture and dislocation, and investigate the effect on bone graft fusion and cervical stability. METHODS: A total of 126 patients with lower cervical spine fracture and dislocation were treated surgically from January 2009 to September 2013 in the First Affiliated Hospital of Xinjiang Medical University. Based on Frankel system, 7 cases were grade A, 48 were grade B, 54 were grade C, and 17 were grade D before surgery. Based on SLIC system, 15 cases were 4 points, 23 were 5 points, 25 were 6 points, 22 were 7 points, 18 were 8 points, 16 were 9 points, and 6 were 10 points. Surgical approaches were determined based on the SLIC system, with a combination of sub-axial injury classification system, the type of fracture, spinal cord compression, and cervical spine injury degree. Anterior surgery (single gap or cervical corpectomy and fusion, bone graft internal fixation) was performed on 91 cases; Posterior treatment (posterior decompression, reduction and internal fixation) was performed on 6 cases; Combined posterior and anterior approach was performed in 29 cases. The neurological function improvement was evaluated at follow-ups; fracture healing, bone graft fusion and cervical stability were determined with imaging findings. RESULTS AND CONCLUSION: All the 126 patients underwent surgery safely without severe complications such as tracheal or esophageal injury. Four patients appeared spinal cord injury and cerebrospinal fluid leakage, which were healed after corresponsive intervention. All patients were immobilized in a hard collar for 3 months postoperatively and were followed up for 6-18 moths. At postoperative 6 months, 5 cases of grade A were not recovered, one case of grade B was not recovered, 1-2 degree of neurological function recovery was achieved in the remaining cases by Frankel system. X-ray finding showed the good recovery of cervical vertebrae sequence after operation. Fusion was achieved in all cases within 12 months (mean 8.5 months) except non-fusion in one case and delayed fusion in two cases. There was no pseudarthrosis or nonunion occurred. The interbody height, physiological curvature and cervical stability maintained well. The SLIC system, with a combination of sub-axial injury classification system, the type of fracture, spinal cord compression, and cervical spine injury degree should be considered before surgery. Reasonable selection of surgical approach can reconstruct spinal stability and achieve anatomical reduction and complete decompression, which is conducive to the recovery of neurological function. © 2015, Journal of Clinical Rehabilitative Tissue Engineering Research. All rights reserved.
Xiang H.,The 474 Hospital of Chinese PLA |
Xu X.-q.,The 474 Hospital of Chinese PLA |
Zhao D.-q.,The 474 Hospital of Chinese PLA |
Zhang H.,The 474 Hospital of Chinese PLA |
And 6 more authors.
Chinese Journal of Tissue Engineering Research | Year: 2012
BACKGROUND: Whether a high specificity, no wound and safety examination method can be used in the diagnosis of transplant renal artery stenosis after kidney transplantation. OBJECTIVE: To evaluate the diagnostic value of multi-slice spiral CT angiography in the diagnosis of transplant renal artery stenosis. METHODS: Eleven patients who were doubtful with transplant renal artery stenosis received the transplant renal artery phase enhanced multi-slice spiral CT scanning before operation. The data obtained after scanning was used to process the image after volume rendering, maximum intensity projection, surface reconstruction and multi-planar reconstruction imaging. RESULTS AND CONCLUSION: All the 11 patients were diagnosed with transplant renal artery stenosis. Multi-slice spiral CT angiography showed that the stenosis degree of 10 patients was 54%-75%, one patients had the stenosis degree that less than 50%. Ten patients had anastomotic stenosis, two patients had truncal stenosis of the renal artery and one patient had transplant renal artery branch stenosis. Multi-slice spiral CT angiography of nine patients showed that the stenosis degree was 75%-95%, and eight patients received stent implantation, one patient had balloon dilatation. One patient was treated with drug therapy and follow-up for 2 years, and 2 years later, the patient suffered renal function further deterioration and refractory hypertension and received stent implantation. One patient was normal in clinical symptoms, and the stenosis degree was less than 50%, and 4-year follow-up results indicated the normal blood pressure and renal function. Among the patients received stent implantation, one patient received balloon dilatation, and the color Doppler flow after 2 years showed the transplant renal artery stenosis, and the multi-slice spiral CT angiography showed the stenosis degree was less than 50%. After followed-up for 51 months, the renal function and the blood pressure were returned to normal level. Multi-slice spiral CT angiography can be used as the basis for the diagnosis of transplant renal artery stenosis, and has some clinical reference value for distinguish the clinically suspected cases, design the treatment options for stent implantation and postoperative follow-up observation.