Qiu Gx

Dynamic Radiographic Analysis of Sympathetic Cervical Spondylosis Instability

OBJECTIVEnTo investigate the correlation between subaxial cervical spine instability and cervical spondylotic sympathetic symptoms as well as the difference of cervical spondylotic subaxial instability between male and female patients.nnnMETHODSnWe analyzed retrospectively 318 surgical cases of cervical spondylosis treated at Department of Orthopedic Surgery of Peking Union Medical College Hospital between July 2003 and December 2007. All cases were divided into group A without sympathetic symptoms (n=284) and group B with sympathetic symptoms (n=34). Angular and horizontal translation values between two adjacent vertebral bodies from C2 to C7 were measured separately on hyperflexion and hyperextension lateral cervical spine radiographs. Fishers exact test was used to evaluate the correlation between subaxial cervical instability and sympathetic symptoms. Intragroup correlation between patient gender and subaxial cervical instability was also evaluated.nnnRESULTSnSubaxial instability incidences in groups A and B were 21.8% (62/284) and 55.9% (19/34), respectively. Statistical analysis indicated a definite correlation between subaxial cervical instability and sympathetic symptoms (P=0.000). Among patients without sympathetic symptoms, subaxial instability incidences were 21.4% (37/173) in males and 22.5% (25/111) in females, respectively (P=0.883). While among patients with sympathetic symptoms, subaxial instability incidences were 27.3% (3/11) in males and 69.6% (16/23) in females, respectively, indicating significant difference (P=0.030). Subaxial instability was most commonly seen at C4-C5 intervertebral space in sympathetic cervical spondylosis patients.nnnCONCLUSIONSnHigh correlation exists between subaxial cervical spine instability and cervical spondylotic sympathetic symptoms, especially in female patients. Hyperextension and hyperflexion radiographs of cervical spine are important to assess sympathetic cervical spondylotic subaxial instability.

Effect of Osteoarthritis Patients＇ Gender on Rehabilitation after Total Knee Arthroplasty

OBJECTIVEnTo investigate the influence of gender on osteoarthritic knee rehabilitation outcome of osteoarthritis patient undergoing total knee arthroplasty (TKA).nnnMETHODSnWe prospectively studied thirty male and thirty female knee primary osteoarthritis patients receiving unilateral TKA with posterior stable-fixed plateau prosthesis at our hospital from March 2003 to March 2008. The age and body mass index of male and female patients were matched. The surgical and rehabilitation clinical factors were compared between two groups.nnnRESULTSnThere was no significant difference in postoperative hospitalization time, surgical tourniquet time, and wound drainage volume between two groups (P>0.05). The extension/flexion degrees of knee joint before operation, 1-week, 2-week and 1-year after operation for male patients were 6.0 +/- 3.3 degrees/114.0 +/- 10.0 degrees, 2.0 +/- 1.6 degrees/93.0 +/- 7.4 degrees, 0.6 +/- 0.6 degrees/104.0 +/- 9.9 degrees and 0.3 +/- 0.5 degrees/125.0 +/- 8.8 degrees, for female patients were 7.0 +/- 3.4 degrees/112.0 +/- 14.0 degrees, 2.0 +/- 1.3 degrees/89.0 +/- 10.9 degrees, 0.9 +/- 0.8 degrees/101.0 +/- 11.8 degrees, 0.4 +/- 0.5 degrees/124.0 +/- 7.1 degrees. The range of motion before operation, 1-week, 2-week, and 1-year after operation for male patients was 108.0 +/- 9.5 degrees, 91.0 +/- 7.1 degrees, 103.0 +/- 9.9 degrees, and 125.0 +/- 8.9 degrees, for female patients was 105.0 +/- 14.1 degrees, 87.0 +/- 11.4 degrees, 100.0 +/- 11.9 degrees, and 124.0 +/- 7.0 degrees. The preoperative and 1-year postoperative HSS scores were 55.8 +/- 13.3 and 89.6 +/- 6.7 for males and 54.5 +/- 13.8 and 89.2 +/- 4.1 for females. No significant statistical difference was observed between two gender groups in regards to degree of extension and flexion, range of motion and HSS score (P>0.05).nnnCONCLUSIONSnGender does not influence postoperative knee function of osteoarthritis patients. TKA significantly improves knee joint function and relieve osteoarthritis-related pain.

Management of Cerebrospinal Fluid Leakage Following Cervical Spine Surgery

OBJECTIVEnTo investigate the management and outcome of cerebrospinal fluid leakage (CSFL) after cervical surgery.nnnMETHODSnMedical records of 642 patients who underwent cervical surgery between December 1999 and December 2005 at our hospital were retrospectively reviewed. Five patients complicated by CSFL after surgery were enrolled, of which 4 cases were complicated after ossified posterior longitudinal ligament or posterior vertebral osteophyte resection directly injuring the dura, and 1 case after posterior cervical double-door laminoplasty without observed dural injury during surgery. Of the 5 CSFL cases, 4 cases occurred at 1-3 days after operation and 1 case at 9 days after operation. All 5 postoperative CSFL cases were treated through wound drainage removal, wound sutures, prophylactic antibiotics, and continuous subarachnoid drainage in the elevated head position.nnnRESULTSnAll 5 CSFL cases experienced leakage cessation within 1-3 days and wound healing within 4-8 days, and subarachnoid drainage lasted 11-16 days with an average volume of 320 mL (range, 150-410 mL). Four cases experienced headache, nausea and vomiting, 1 case suffered from somnolence and hyponatremia, and symptoms subsided after symptomatic treatment and intravenous fluid administration. All patients were followed up for an average of 32 months (range, 22-50 months). No occurrence of cerebrospinal fluid cyst or wound infection was observed. CSFL produced no significant negative effects upon neuromuscular function recovery.nnnCONCLUSIONnContinuous subarachnoid cavity drainage in combination with elevated head position is a simple and safe non-surgical method in treatment of CSFL following cervical surgery.