Cases Of Protrusion Research Articles

Short‐term clinical observation of the Dynesys neutralization system for the treatment of degenerative disease of the lumbar vertebrae

To explore the safety and short-term efficacy of the posterior approach of the Dynesys dynamic neutralization system for degenerative disease of the lumbar vertebrae. From March 2008 to March 2010, 32 cases of degenerative lumbar vertebral disease, 19 men and 13 women, (mean age 58 ± 5.2, range, 43-78 years), were treated with posterior laminectomy and Dynesys internal fixation. All patients had a history of over 3 months waist or leg pain that had not been relieved by conservative treatment. There were 10 cases of single lumbar intervertebral disc protrusion, 14 of degenerative lumbar spinal stenosis, 5 of degenerative lumbar isthmic spondylolisthesis, and 3 of recurrent lumbar disc protrusion after surgery. A visual analogue score (VAS) was used for pain assessment, and the Oswestry disability index (ODI) for functional evaluation of clinical outcomes. All patients were followed up for 6-23 months (mean, 16.4 ± 5.5 months). Forty-one segments in 32 patients were stabilized; 23 cases (71.9%) underwent single-segmental stabilization, and 9 (28.1%) two-segmental stabilization. VAS of leg pain, root and low back pain was significantly improved postoperatively. The ODI improved from preoperative 69% ± 12.6% to postoperative 28% ± 15.7% (P < 0.001). On the stabilized segment and adjacent segments above and below, the range of movement showed no statistical difference; no loosening of screws, cord and polyester spacer occurred. The Dynesys dynamic neutralization system combined with decompression can achieve satisfactory short-term clinical results in lumbar degenerative disease. This procedure system not only reduces back and leg pain, but also preserves the mobility of fixed segments, minimizes tissue injury and avoids taking bone for spinal fusion.

Radiotherapy induced hip joint avascular necrosis—Two cases report

Background Avascular necrosis (AVN) refers to the death of osteocytes and osteoblasts. Sites such as the femoral head, the head of the humerus and the mandibula with restricted access to local blood supply are particularly vulnerable to osteonecrosis. A combination of several factors is responsible for ischaemia and is associated with AVN: corticosteroids, alcohol abuse, Cushing's syndrome, SLE, systemic vasculitis, RA, scleroderma, haemoglobinopathies, radiotherapy. Management is based on proper diagnosis and treatment – conservative, pharmacological or surgical. Radiotherapy has become an integral part of the therapeutic programme of cancer patients. However, early and late after-effects of irradiation still constitute a significant issue in clinical practice. Aim The aim of this report is to present two cases of acetabular protrusion and femoral head deformities after a therapeutic pelvic irradiation and draw physicians’ attention to that clinical problem which continues to be underestimated. Materials and methods This report documents two cases of acetabular protrusion and femoral head deformities after a therapeutic pelvic radiation. Results Avascular necrosis (AVN) constitutes a severe and challenging long-term complication in radiation oncology. Conclusion It is necessary to take into account bone structures among organ at risk (OAR) involved in irradiation fields. The detailed analysis of the dose distribution and the use of collimators allow to decrease the total dose to OAR. An adequate management, early diagnosis and prompt, proper treatment may protect patients from long-term morbidities.

Treatment of 100 cases of lubar intervertebral disc protrusion with quick bone manipulation

Objective To investigate the effect of lubar intervertebral disc protrusion(LIDP)treated with quick bone manipulation.Methods 200 patients with LIDP were randomly recurited into a treatment group(n=100)and a control group(n=100).The treatment group was treated by quick bone manipulations,and the control group was treated with Ibupmfen PO.Results The total effective rate in the treatment group(95.5%)was significantly better as compared to the control group(73.0%).Conclusion Ouick bone manipulation is effective in treating LIDP. Key words: LIDP; Quick bone manipulation

Effectiveness of canalicular laceration repair using monocanalicular intubation with Monoka tubes

This study aimed to evaluate the clinical efficacy of canalicular laceration repair using monocanalicular intubation with Monoka tubes. A total of 36 single lacerated canaliculi were repaired using monocanalicular intubation with Monoka tubes, without mucosal anastomosis of the canaliculi, and were retrospectively reviewed. Demographic information, injury locations, associated ocular injuries, complications and outcomes were analysed. Mean patient age was 34 years (range 1-64 years). Tubes were removed at a mean of 4.2 months (range 3-6 months). There were 26 lower canalicular lacerations (72%) and 10 upper canalicular lacerations (28%). Overall, 34 of 36 cases (92%) showed improvement in symptoms and exhibited positivity on the dye disappearance test at 4-12 months after the procedure (mean 7.8 months). In total, 21 patients (58%) achieved complete success, 13 patients (36%) achieved partial success and two patients (6%) suffered surgical failure. Complications were seen in five cases and included two early tube protrusions, two punctal slits and one punctal granuloma. Monocanalicular intubation with Monoka tubes leads to successful outcomes without significant complications and offers an alternative to bicanalicular intubation in the treatment of monocanalicular lacerations.

Investigation of the shear flows over a sunroof opening based on a linear inviscid instability analysis

The large-scale shear flows over the sunroof opening of a mid-sized SUV measured using a PIV system were investigated. The shear flows were measured for five different cases of deflector protrusion (one case was the baseline test without deflector) at two different free stream flow velocities below the critical velocity where the buffeting noise level reached a maximum. The structures of the shear flows were observed to differ, apparently depending on whether the radiated buffeting noise is relatively strong or not. For strongly buffeting experimental cases, the momentum thicknesses of the shear layers were observed to grow rapidly and saturated at a station near the downstream edge of the sunroof opening, where the saturation of the transverse velocity fluctuations was also observed, and where the vortex coalescence process was presumably completed. On the other hand, no discrete large-scale vortex structures were observed for none-buffeting or weakly buffeting cases. Streamwise growth of the velocity fluctuations was found to be well predicted by a linear hydrodynamic instability analysis for the strongly buffeting cases. Numerical results obtained from a linear inviscid instability analysis using a hyperbolic tangent mean velocity profile were used to calculate the amplification factors with the initial momentum thickness and the streamwise fluctuation wavenumber. The shear flows were found to form large-scale discrete vortices when the linear inviscid amplification factors exceeded a threshold amplification factor.

Duokopfprothesenimplantation bei medialer Schenkelhalsfraktur im hohen Lebensalter – Klinische und radiologische Ergebnisse

In our study, we retrospectively evaluated 203 patients with medial or lateral femoral neck fractures who received 210 bipolar prosthesis (7 bilateral implantations) at our institution. 204 patients underwent cemented bipolar hemiarthroplasty. These included 149 females and 54 males with a median age of 82 (46-97) years. At the time of surgery 144 patients (71%) suffered from more than 3 medical conditions. We conducted our follow-up examination at a median of 27.9 months after the operation, at which time 97 patients (48%) had already died. On examination, 17% of our 76 patients had a Harris hip score between 90 and 100 and 20% between 80 and 89 or 70 and 79, respectively. 43% had a score of less than 70. In 20 patients (57%) we found radiographic evidence of periarticular ossification. Signs of loosening according to Gruen were found in 7 out of 35 patients, with no apparent clinical correlation. Surgery-related complications were noted in 15% of our 203 patients--mostly, with 10 cases each, wound infections and postoperative haematomas. In 3 cases of deep wound infection, a removal of the prosthesis was necessary, leading to a Girdlestone hip in one case. Postoperative hip dislocations occurred in 3.4% and intraoperative femur fissures were encountered in 1% of our patients. There were no cases of nerve damage or protrusion of the acetabulum reported. 43% of our patients developed a general complication--mainly cardiological or vascular problems, nephrological or urinary tract diseases, pulmonary or neurological complications. Hip arthroplasty is predominantly applied in older patients, most of them suffering from at least one medical condition at the time of surgery that influences their hospital course. This is why especially the overall physical condition of elderly patients has to be taken seriously into account when planning surgical treatment of femoral neck fractures. In our retrospective study, we have shown that implantation of a bipolar hip prosthesis constitutes an adequate treatment for these patients.

Visualization of periodic flows over a sunroof opening by using a phase-marked PIV measurement

Flows over cavity openings are known to be highly structured and periodic due to the strong sound pressures emitted by the cavities. This article is concerned with the measurement of flow fields over the sunroof opening of an SUV. Since the PIV system used in the present work is not capable of taking phase-locked velocity fields during the measurement stage, phase-marked PIV measurements are performed and the phase-locked velocity fields are retrieved during a post-processing stage. The new PIV measurement method is shown to yield fairly accurate results with a proper choice of a phase-bandwidth. By using the phase-marked PIV measurement method, the evolution of large-scale structures in shear flow over the sunroof opening as phase changes is revealed. The detached shear layer is shown to fluctuate and then form a discrete large vortex convecting and impinging on the rear roof edge of the SUV. The average convection velocity of the vortex is calculated to be 0.45 of the nominal free stream flow velocity. Flow fields are compared for four different cases of deflector protrusion and a case without a deflector. Installation of a deflector can significantly change the flow field. For a deflector that reduces the buffeting noise by more than 10 dB, it is shown that turbulent fluctuations are initiated by the deflector but do not grow in amplitude as they convect downstream. As the deflector protrusion is increased, the amount of flow under the deflector increases in general. The flow exiting from the channel formed by the deflector and an A-frame is shown to increase the thickness of the shear layer near the leading edge of the sunroof opening.

Treatment of 116 cases of cervical intervertebral disc protrusion by tuina

To observe the clinical efficacy of uplifting massage therapy in the treatment of cervical intervertebral disc protrusion and study the effectiveness of this massage therapy for cervical intervertebral disc protrusion. 116 subjects were randomized into two groups: treatment group in which 60 cases were treated by uplifting massage therapy and conventional massage, and control group in which 56 cases were treated by simple conventional massage. After 1–2 courses of treatment, the total effective rate was 95.0% in treatment group and 80.4% in control group; the former rate was higher than the latter one(P<0.05). The uplifting massage therapy combined with conventional massage has better effects than simple conventional massage in the treatment of cervical intervertebral disc protrusion.

A clinical study of Ender nails fixation in femoral shaft fractures in children

Background : Fracture of femoral shaft is fairly common in children and should be considered serious because of blood loss and potential shock that accompany the primary trauma. Surgical procedure allows early mobilization, rapid callus formation and rapid restoration of continuity of bone. Method : We studied 24 children with 24 femoral shaft fractures in age group 6-14 year (average 9.67 years). Eighteen fractures were in middle third, 4 in distal third and 2 in proximal third. Fifteen fractures were transverse, 4 oblique and 5 were spiral. Twenty-three cases were closed and one grade I compound. The injury surgery interval was 6 day. Mean hospital stay was 10.4 days. They were treated by closed reduction and Ender's nail fixation. Result : The minimum follow up was 6 months. The average time to clinical union and full weight bearing was 6.6 week (5 to 12 week); full movement was achieved in 9 weeks (6 to 15 weeks). One case of intraoperative perforation occurred. Two cases of nail protrusion and infection occurred. No cases of deep infection, delayed union, nonunion were seen. Seven cases had no limb length discrepancy. Thirteen cases had lengthening (max 9 mm mean 4.23mm), 4 cases had shorting (max 7mm mean 4.25mm). On the Flynn criteria 20 denoted excellent and 4 had satisfactory results. No poor results were seen. Conclusion : Healing in cases treated with Ender's nail can be with abundant callus attributed to non rigid fixation. This resulted in rapid fracture union and early return to few weight bearing while reducing hospital stay. Advantages that Ender nailing offers over other treatment modalities both consecutive as well as operative convinces us to recommend ender nailing in isolated femoral shaft fracture in children between 6-14 years.

Protrusion of the Valvular Intestine in Captive Smalltooth Sawfish and Comments on Pristid Gastrointestinal Anatomy and Intestinal Valve Types

AbstractWe report on three separate instances of protrusion of the valvular intestine in the smalltooth sawfish Pristis pectinata, compare pristid gastrointestinal anatomy and intestinal valve structure with those of other elasmobranchs, and discuss the relevance of anatomy and valve structure to the husbandry of captive specimens. Protrusion of the valvular intestine, or intestinal eversion, has been documented in carcharhinid sharks with scroll‐type intestines. All three cases of protrusion in smalltooth sawfish in this report involved specimens in multispecies display facilities and ultimately resulted in mortality. These are the first documented cases of intestinal eversion in any species of elasmobranch with a conicospiral valvular intestine. The valvular intestine of sawfishes (family Pristidae) is of the conicospiral type, which is similar to that described in other batoid species. However, unlike many other sharks and batoids, which possess short, stout pyloric stomachs, the pyloric stomachs in the pristids we examined were long and similar to those of carcharhinid sharks. The ability to protrude the valvular intestine in elasmobranchs may depend upon both valve morphology and the length of the pyloric stomach. The details of the gastrointestinal anatomy may be useful for systematics but also may be relevant to the captive husbandry of carcharhinids and sawfishes.

Endovenous laser therapy and radiofrequency ablation of the great saphenous vein: Analysis of early efficacy and complications

Endovenous laser therapy (EVLT) and radiofrequency ablation (RFA) are new, minimally invasive percutaneous endovenous techniques for ablation of the incompetent great saphenous vein (GSV). We have performed both procedures at the Mayo Clinic during two different consecutive periods. At the time of this report, no single-institution report has compared RFA with EVLT in the management of saphenous reflux. To evaluate early results, we reviewed saphenous closure rates and complications of both procedures. Between June 1, 2001, and June 25, 2004, endovenous GSV ablation was performed on 130 limbs in 92 patients. RFA was the procedure of choice in 53 limbs over the first 24-month period of the study. This technique was subsequently replaced by EVLT, which was performed on the successive 77 limbs. The institutional review board approved the retrospective chart review of patients who underwent saphenous ablation. According to the CEAP classification, 124 limbs were C2-C4, and six were C5-C6. Concomitant procedures included avulsion phlebectomy in 126 limbs, subfascial endoscopic perforator surgery in 10, and small saphenous vein ablation in 4 (EVLT in 1, ligation in 1, stripping in 2). Routine postoperative duplex scanning was initiated at our institution only after recent publications reported thrombotic complications following RFA. This was obtained in 65 limbs (50%) (54/77 [70%] of the EVLT group and 11/53 [20.8%] of the RFA group) between 1 and 23 days (median, 7 days). Occlusion of the GSV was confirmed in 93.9% of limbs studied (94.4% in the EVLT [51/54] and 90.9% in the RFA group [10/11]). The distance between the GSV thrombus and the common femoral vein (CFV) ranged from -20 mm (protrusion in the CFV) to +50 mm (median, 9.5 mm) and was similar between the two groups (median, 9.5 mm vs 10 mm). Thrombus protruded into the lumen of the CFV in three limbs (2.3%) after EVLT. All three patients were treated with anticoagulation. One received a temporary inferior vena cava filter because of a floating thrombus in the CFV. Duplex follow-up scans of these three patients performed at 12, 14, and 95 days, respectively, showed that the thrombus previously identified at duplex scan was no longer protruding into the CFV. No cases of pulmonary embolism occurred. The distance between GSV thrombus and the saphenofemoral junction after EVLT was shorter in older patients (P = .006, r(2) = 0.13). The overall complication rate was 15.4% (20.8% in the EVLT and 7.6% in the RFA group, P =.049) and included superficial thrombophlebitis in 4, excessive pain in 6 (3 in the RFA group), hematoma in 1, edema in 3 (1 in the RFA group), and cellulitis in 2. Except for two of the three patients with thrombus extension into the CFV, none of these adverse effects required hospitalization. GSV occlusion was achieved in >90% of cases after both EVLT and RFA at 1 month. We observed three cases of thrombus protrusion into the CFV after EVLT and recommend early duplex scanning in all patients after endovenous saphenous ablations. DVT prophylaxis may be considered in patients >50 years old. Long-term follow-up and comparison with standard GSV stripping are required to confirm the durability of these endovenous procedures.

Clinical observation on the treatment of lumbar intervertebral disc protrusion with electroacupuncture, TDP plus Tuina

One hundred and twenty-eight cases of lumbar intervertebral disc protrusion were randomly divided into treatment group, in which 70 cases were treated with electroacupuncture, TDP plus Tuina, and control group, in which 58 cases were treated with electroacupuncture plus TDP. The curative rate in the treatment group was higher than that in the control group (64.3% vs 31.0%,P<0.01). The total effective rate was 100% in the treatment group, 91.3% in the control group; the effect of the former was better than that of the latter (P<0.05).

Clinical study on cervical spinal cord injury related to intervertebral dick injury

目的 探讨与椎间盘损伤相关颈脊髓损伤的诊断和治疗方法. 方法 1997年1月～ 2003年1月,我院共收治创伤性颈脊髓损伤患者 1274例,对 275例临床资料完整的患者进行回顾和分析. 结果 275例影像学资料完整的患者中颈椎间盘突(脱)出 213例,占 77.5%. 213例颈椎间盘突(脱)出患者中, 82.2%的患者椎间盘突出 MRI图像显示有脊髓信号改变, 94.4%的患者神经损伤平面与椎间盘突出平面一致.手术结果行统计学分析显示椎间盘损伤相关颈脊髓损伤手术治疗疗效较为明确,手术时间距受伤时间越短疗效越好. 结论对椎间盘损伤相关颈脊髓损伤诊断要明确,一旦明确诊断应手术治疗,且应尽早手术。

ガンマネイルにおけるＯｎｅＳｈｏｔ Ｇｕｉｄｅの有用性

The purpose of this study was to investigate the effects of utilizing the OneShot Guide (OSG) during gamma nail surgery.From 1998, we performed 104 gamma nail surgeries (84 trochanteric fractures, eight subtrochanteric fractures and 12 basal neck fractures) utilizing the OSG (OSG group). The average ageat surgery was 82.0 years, and the average follow-up was 5.5 months. To evaluate the position of the lag screw, 121 proximal femoral fractures for which the OSG was not used were assigned to the control group. The position of the lag screw and rate of complications (postoperative varus deformity, cut out, protrusion of nail head, ectopic ossification, and pseudarthrotis) were compared between these two groups.In the OSG group, 96 of 104 cases (92.3%) had ideal setting of the lag screw. In the control group, only 57 of 121 cases (47.0%) had ideal insertion of the lag screw, indicating statistical difference between the two groups. There were seven post-operative varus deformities in the control group, and only one in the OSG group. Regarding other complications, there was a case of cut out, seven cases of protrusion of the nail head, four cases of ectopic ossification and no case of pseudoarthrosis in the control. On the other hand, there were no cases of cut out, three cases of protrusion of the nail head, five cases of ectopic ossification, and no cases of pseudoarthrosis in the OSG.The OSG is an effective tool for facilitating insertion of the lag screw at the ideal position, reducing the complication rate when using the OSG during gamma nail surgery.

Treatment of protrusion of cervical intervertebral disc by Tuina

Twenty-five cases of protrusion of cervical intervertebral disc were treated by the manipulations of rolling, pressing, pushing with one-finger, traction, obliquely pulling, grasping of five channels, sweeping, etc. The result showed that 10 cases were cured, 14 cases got marked effectiveness and 1 case was improved.

Treatment of protrusion of cervical intervertebral disc with Tuina therapy plus acupuncture

In application of the bone-setting Tuina therapy plus acupuncture on Jiaji (Ex-B 2), Tianzong (SI 11). Jianyu (LU 15), Quchi (LI 11), Waiguan (TE 5) and Hegu (LI 4) in the treatment of 8 cases of protrusion of cervical intervertebral disc, all the symptoms disappeared and the movements were free after treatments in the patients.

Acupuncture treatment of 32 cases of lumbar intervertebral disc protrusion

Yaoyangguan (GV 3), Shiqizhui (Ex-B 8) and Yanglingquan (GB 34) were selected as main points and a three-part needle insertion technique was used to treat 32 cases of lumbar intervertebral disc protrusion. The curative rate was 96.9%. Deep puncture is the key to the treatment.

Relationship between clinical data and urodynamic findings in patients with lumbar intervertebral disk protrusion.

The relationship between voiding disturbances and urodynamic diagnosis in patients with lumbar intervertebral disk protrusion is controversial. The objective of this study was to determine the association between clinical data and urodynamic diagnosis, in order to reveal whether bladder dysfunction can be assessed on the basis of urological symptoms and signs. We prospectively studied 122 patients with lumbar intervertebral disk protrusion. Detrusor areflexia was found in 32 of these patients, while in the remaining 90 detrusor activity was normal. All patients with detrusor areflexia reported difficulty voiding by abdominal straining. The patients with normal urodynamic findings were either free of voiding disturbances (77 patients) or complained of frequent voiding (13 patients). In conclusion, there are cases of lumbar intervertebral disk protrusion in which the presence of bladder dysfunction can be predicted on the basis of clinical urodynamic testing, i.e. clinical neurological alterations, decreased bladder sensation, voiding by straining, increased bladder capacity, residual volume, and intermittent or continuous low flow curve on free uroflowmetry.

腰椎椎間板ヘルニアの自然経過 ＭＲＩ複数回撮像例の検討

32 cases of lumbar disc herniation were sequentially followed by MR imagings in order to ascertain its natural course. Herniation consisted of protrusion in 6 cases, extrusion in 13 cases, and sequestration in 13 cases. We analysed the durations until the herniation regressed more than 50% of its A-P diameter. The mean duration was 8.2 months for extrusion, and 5.3 months for sequestration. Only 2 cases of protrusion regressed within 12 months. Huge disc herniations with central protrusion in particular showed slight spontaneous regression.

Spinal Gas Collection Demonstrated at CT

In 234 consecutive CT examinations of the lumbar spine, gas collection was observed in 4 cases with disk herniation, and in 6 cases of disk protrusion. In 3 cases free gas was found in the epidural space, and one patient presented an intraspinal gas-filled "bleb". Gas collection in intervertebral disk spaces and facet joints was found in a total of 60 patients. The CT findings and surgical results were compared to determine whether gas collection contributes to clinical symptoms. In most cases the presence of gas was not clinically important, but in one patient it presented as a spinal mass, causing pain and radiculopathy.