Objective To introduce a modified Sakakibara classification system for a ruptured sinus of Valsalva aneurysm （RSVA），and suggest different surgical approaches for corresponding types of RSVA. Methods Clinical data of 159 patients undergoing surgical repair for RSVA in Fu Wai Hospital between February 2006 and January 2012 were retrospectively analyzed. There were 105 male and 54 female patients with their age of 2-71 （33.4±10.7） years. All these patients were divided into 5 types as a modified Sakakibara classification system. Type I: rupture into the right ventricle just beneath the pulmonary valve （n=66），including 84.8% patients with ventricular septal defect （VSD） and 53.8% patients with aortic valve insufficiency （AI）. TypeⅡ：rupture into or just beneath the crista supraventricularis of the right ventricle （n=17），including 88.2% patients with VSD and 23.5% patients with AI. Type Ⅲ：rupture into the right atrium （typeⅢ a，n=21） or the right ventricle （typeⅢv，n=6） near or at the tricuspid annulus，including 18.5% patients with VSD and 25.9% patients with AI. TypeⅣ：rupture into the right atrium （n=46），including 23.9% patients with AI but no patient with VSD. TypeⅤ：other rare conditions，such as rupture into the left atrium，left ventricle or pulmonary artery （n=3），including 100% patients with AI and 33.3% patients with VSD. Most RSVA originated in the right coronary sinus （n=122），and others originated in the noncoronary sinus （n=35） or left coronary sinus （n=2）. Results All the type V patients （100%） and 50% patients with typeⅢv received RSVA repair through aortotomy. In most patients of typeⅠ，II andⅣ，repair was achieved through the cardiac chamber of the fistula exit （71.2%，64.7% and 69.6% respectively）. Both routes of repair were used in 76.2% patients with typeⅢ a. The cardiopulmonary bypass time （92.4±37.8 minutes） and aortic cross-clamp time （61.2±30.7 minutes） was the shortest to repair typeⅣRSVA. There was no in-hospital death in this group. Two patients （type I andⅡrespectively） underwent reoperation during the early postoperative period because of restenosis of the right ventricular outflow tract. Most patients received reinforcement patch for RSVA repair （n=149），and only 10 patients received simple suture repair （including 5 patients with typeⅣ，4 patients with typeⅢ a and 1 patient with typeⅡ）. Aortic valve replacement was performed for 33 patients （66.7% of those with typeⅠ）. A total of 147 patients （92.5%） were followed up after discharge. Two patients （type I andⅢ a respectively） developed atrial fibrillation and received radiofrequency ablation treatment，1 patient （typeⅣ） underwent reoperation for residual shunt，and there was no late death during follow-up. Conclusion Modified Sakakibara classification system for RVSA provides a guidance to choose an appropriate surgical approach，and satisfactory clinical outcomes can be achieved for all types of RSVA.
Objective To recognize and reevaluate the pathologic anatomic classification of ventricular septal defect （VSD）. Methods From January,2002 to October,2004,119 patients less than 10kg of body weight with simple VSD whose pathologic anatomic classification was determined by preoperative echocardiography and ascertained during surgery were choosed randomly. Results （1） There were fihy-one patients with perimembranous VSD （diameter 0. 6±1.0 cm）, 8 VSD situated in the membranous septum （diameter 0. 5±0.4 cm）, 21 VSD extending to inlet （diameter 0.8±0.5 cm）, 14 extending to outlet （diameter 1.0±0. 6 cm） and 8 extending to trabecula （diameter 0. 8±0.6 cm）. In this group, accessory tricuspid valve tissue was formed in 14 patients（diameter 0. 5±0.3 cm）. （2） Twenty-one patients had conoventricular VSD （diameter 1.2±0. 8 cm）, among them 13 VSD had muscle margins, 8 extending to membranous septum, 14 had septal band hypertrophy, and 5 had subaortic stenosis. （3） Twenty-six patients had subpulmonary VSD（diameter 0.8±0.8 cm）, 18 VSD lay immediately below pulmonary valve, 8 had muscle distant from pulmonary valve, 20 lay completely below pulmonary valve, and 6 lay below pulmonary valve and aortic valve. （4） Ten patients were atrioventricular canal type or inlet VSD （diameter 1.2±0.8 cm）. （5）Eleven patients had muscular VSD, among them 3 were single ,and 8 multiple （diameter 0. 4±0.3 cm）. Conclusion It will be more clinically significant that VSD is classified into perimembranous, conoventricular, atrioventricular canal or inlet, muscular and subpulmonary artery or conical types.
Objective To review the research progress of the risk factors for slip progression and the pathogenesis of lumbosacral spondylolisthesis, and to discuss the value of Spinal Deformity Study Group (SDSG) classification system for lumbosacral spondylolisthesis. Methods Recent articles about the risk factors for slip progression and the pathogenesis of lumbosacral spondylolisthesis were reviewed and comprehensively analyzed with SDSG classification system of lumbosacral spondylolisthesis. Results Pelvic incidence (PI) is the key pathogenic factor of lumbosacral spondylolisthesis. The Meyerding grade of slip, PI, sacro-pelvic balance, and spino-pelvic balance not only are the fundamental risk factors of slip progression, but also are the key factors to determine how to treat and influence the prognosis. Therefore, compared with Wiltse, Marchetti-Bartolozzi, and Mac-Thiong-Labelle classification systems of lumbosacral spondylolisthesis, SDSG classification based on these factors mentioned above, has better homogeneity between the subjects of subgroup, and better reliability, moreover, could better guide operative plan and judge the prognosis. Conclusion It is suggested that the SDSG classification system should be the standard classification for lumbosacral spondylolisthesis for the clinical and research work.
Objective To summarize the injury characteristics of the whole hand degloving injury and to explore its classification and treatment. Methods Between December 1999 and May 2010, 41 cases of the whole hand degloving injury were admitted for treatment. There were 28 males and 13 females with an average age of 35 years (range, 18-58 years). The causesof injury included mangled injury in 28 cases and crush injury in 13 cases. The interval between injury and surgery was 1-10 hours (mean, 3 hours). According to self-made classification standard for whole hand degloving injury, 11 cases were rated as type I, 5 cases as type II, 4 cases as type III, 8 cases as type IV, and 13 cases as type V. Type I injury was treated by replantation surgery with vascular anastomosis, type II by reconstruction with thumb flap and the second toe containing dorsal skin flap, type III by reconstruction with the second toe containing dorsal skin flap of both feet, type IV by replantation surgery with vascular anastomosis, and type V by reconstruction with thumb flap containing dorsal skin flap (8 cases) or repairing with abdominal flap (5 cases). The size of the dorsal flap was between 9 cm × 6 cm and 17 cm × 11 cm and the dorsal donor site was covered with free skin grafting. Results After surgery, partial necrosis occurred at fingers in 6 patients with type I injury, and at fingers and palm skin in 6 patients with type IV injury; the flaps, the reconstructed fingers, and replanted skin all survived in the others. The grafted skin at donor sites successfully healed. Forty cases were followed up from 6 months to 7 years (mean, 14 months). The skin color and texture were close to normal hand in the cases undergoing replantation, who had the best function restoration with S2-S4 sensory recovery; the hand function was basically restored with S2-S3 sensory recovery in the cases undergoing finger reconstruction with thumb and toe flaps; and the restoration of the hand function was not satisfactory with S1-S2 sensory recovery in the cases undergoing abdominal flaps. Conclusion Whole hand degloving injury can be classified into different types according to injury degree and this will help choose the cl inical treatment plan. The appropriate treatment based on these types can obtain better cl inical effectiveness.
Objective To evaluate the characteristics, classification, treatment methods, and cl inical outcomes of the spoke heel injuries in children. Methods From June 2001 to June 2008, 289 children with bicycle or motorcycle spoke heel injuries were treated, including 179 males and 110 females aged 2-12 years old (average 3.9 years old). There were 179 cases of skin contusion and laceration (type I), 83 cases of skin and soft tissue defect with Achilles tendon exposure (type II), and 27 cases of wide skin and soft tissue defect with the Achilles tendon defect and rupture (type III). The defect size of the skin or the soft tissues ranged from 3 cm × 2 cm to 11 cm × 7 cm in type II and type III injury. The time between injury and hospital admission was 1-53 days (average 14.5 days). Child patients with type I injury were managed with dressing or suturing after debridement. For the child patients with type II injury, the wound was repaired with the regional fascia flap in 53 cases, the reverse sural neurocutaneous vascular flap in 19 cases, the reverse saphenous neurocutaneous vascular flap in 9 cases, and the lateral supramalleolar flap in 2 cases. For the child patients with type III injury, 6 cases underwent primary repair of the Achilles tendon followed by the transposition of the reverse sural neurocutaneous vascular flap, 3 cases received primary repair of the wound with the reverse sural neurocutaneous vascular flap and secondary reconstruction of the Achilles tendon with the upturned fascia strip or the ipsilateral il iotibial tract transplant, and 18 cases underwent primary repair of the wound and the Achilles tendon with the sl iding bi-pedicled gastrocnemius musculocutaneous flap. The flap size ranged from 4 cm × 2 cm to 30 cm × 12 cm. All the donor sites were closed bypartial suture and spl it-thickness skins graft. The lower l imbs were immobil ized with plaster spl ints after operation. Results All the flaps survived except for 1 case of type II suffering from distal flap venous crisis 3 days after operation and 6 cases of type III suffering from distal flap necrosis 3-5 days after operation. All those flaps survived after symptomatic treatment. All the skin grafts at the donor site survived uneventfully. All the wounds healed by first intention. All child patients were followed up for 15-820 days (average 42 days). Child patients with type I and type II injury had a full recovery of ankle functions. While 25 cases of type III injury had ankle dorsal extension degree loss (10-30°) and unilateral plantar flexion strength decrease 3 months after operationwithout influence on walking, and 2 cases recovered well. Conclusion Spoke heel injury in children has special mec hanisms of injury, and the choice of proper treatment method should be based on the types of injury.
Objective To review the latest progress in classification system of thoracolumbar fractures and its surgical treatment with posterior approaches. Methods Recent l iterature about classification system of thoracolumbar fractures and its surgical treatment was reviewed. Results For the treatment of thoracolumbar fracture, the surgeon first should decide whether the surgical treatment was necessary. Recently, a new classification system had been developed to help the surgeon make the right decision. The surgical methods included short segment internal fixation and long segment internalfixation with or without fusion, and minimally invasive internal fixation. Conclusion The progress in the surgical treatmentof thoracolumbar fracture will help spinal surgeon decide the necessary surgery beneficial for the patients. The most appropriate and effective surgical method with the minimum damage should be used to treat the fracture. The advantages of non-fusion surgical treatment still need a further study.
Objective To investigate new classification and repair methods for the traverse amputated fingertip. Methods From March 2000 to October 2006, 20 cases of 20 fingers with traverse amputated fingertip, including 13 males and 7 females aged 17-47 years, were treated. Twenty patients (9 crush injuries, 5 cutting injuries and 6 sawing injuries) were classified into 4 types, namely type I (the distal one third of nail bed), type II (the middle of nail bed), type III (the poximal one third of nail bed), and type IV (the root of nail bed). There were 3 patients (2 index fingers and 1 l ittle finger) of type I, 8 patients (2 thumbs, 3 index fingers and 3 middle fingers) of type II, 5 patients (3 index fingers, 1 ring finger and 1 l ittle finger)of type III, and 4 patients (2 thumbs, 1 middle finger and 1 l ittle finger) of type IV. The soft tissue defect ranged from 1.2 cm × 1.2 cm to 1.5 cm × 1.2 cm. The time from injury to surgery was 3-10 hours. Fingers of type I and type II were treated with forward flow axial flap and modified nail bed lengthening. Fingers of type III and type IV were treated with forward flow axial flap and partial nail bed replantation as well as modified nail bed lengthening. The flaps ranged in size from 1.5 cm × 1.2 cm to 2.0 cm × 1.4 cm. Results Twenty patients incisions healed by first intention and the flaps, nails and skin grafting survived. All donor sites healed by first intention. All patients were followed up for 2-6 months (4 months on average). The appearances of fingertips were good. The texture of the flap was soft, and the fingers had no tenderness and motor disturbance. The two-point discrimination was 4.5-6.5 mm．The finger nails of type I and type II extended 3-4 mm after operation, while the finger nails of type III and type IV extended 8-10 mm after operation. All finger nails were smooth and flat without pain. Hook nail happened in 1 case 6 months after operation. Conclusion Classification of the injured fingers according to the condition of the amputation base is helpful in choosing repair methods, and is conducive to maximize the recovery of the function and shape of fingertips.
Objective To discuss the concept of ulnar tunnel at thewrist, the types, causes, traits of compression, diagnosis, and clinical significance of ulnar tunnel syndrome(UTS). Methods Thirty-nine cases diagnosed as having UTS from 1986 were retrospectively reviewed combined with previous relevant literature. Results Ulnar tunnel included Guyon’s canal, pisohamate tunnel and hypothenar segment. There were 8 types andmany causes of UTS. Some patients had compression in more than one zones and might be associated with carpal tunnel syndrome or cubital tunnel syndrome. UTS could be diagnosed through clinical manifestations and electrophysiological examination. Conclusion Defining the concept of ulnar tunnel and the knowledge of the complexity and rarity of UTS can effectively guide diagnosis and treatment.
Purpose To analyse the maculopathy in 597 eyes of 317 cases with diabetic retinopathy,and to explore the classification and visual prognosis. Methods Using fluorescein angiography to examine the extend of capillary leakage and foveal avascular zone as well as the extent of the capillary closure in macular area. Results ①Diabetic maculopathy was divided into 5 types,among 597 eyes,no leakage type 154 eyes (25.8%),focal edema type 188 eyes(31.5%),diffuse edema type (including cystoid edema)231 eyes(40.0%),ischemic type 12 eyes(2.0%) and proli ferative type was 4 eyes(0.7%).② There is close relationship between the classification and visual prognosis.such as when visual acuity was ge;0.5,no leakage type was 99.4%, focal edema type was 83.0%,diffuse edema type was 28.4%,ischemic type was 8.4%,and proliferative type was 0.5%.the visual acuity of cystoid edema was worse than diffuse edema only 20.3%.③The stage and visual prognosis:The higher the stage the worse the visual prognosis.if visual acuityge;0.5, 1 stage in 96.2% eyes,2 stage in 84.8%,3 stage in 53.2%,4 stage in 37.2%,5 stage in 12.5%. Conclusion Diabetic maculopathy is the main cause of visual impairment in diabetic retinopathy. Different type has different visual prognosis.macular edema and cystoid edema are the main factors to decrease visual acuity and could be treated by focal and grid laser photocoagulation to prevent visual loss. (Chin J Ocul Fundus Dis,2000,16:144-146)
One hundred and thirty patients with uveitis in north-western zone of our country were analyzed based on anatomical classification and their causes. It was found that anterior uveitis was the commonest type in uveitis,accounting for 86.15% of total patients. Intermediate uveitis, pan-uveitis and posterior uveitis accounted repectively for 6.92%, 3.85%and3.08% of the total patients. Rheumatic arthritis was the most frequently accompanied systemic disease in patients with uveitis,showing a possibly causative link between them in their pathogenesis. （Chin J Ocul Fundus Dis,1994,10:156-158）