ObjectiveTo explore the long-term effectiveness of expandable Cage in treatment of degenerative lumbar disease. MethodsBetween January 2005 and January 2008, 72 patients with degenerative lumbar disease were treated by expandable Cage and followed up for 5 years. Of 72 cases, 41 were male and 31 were female with an average age of 40.5 years (mean, 35-65 years), including 35 cases of lumbar spinal stenosis, 20 cases of degenerative lumbar instability, and 17 cases of serious lumbar intervertebral disc protrusion combined with lumbar instability. The disease duration was 6-28 months (mean, 9 months). The affected lumbar segments were L3, 4 in 6 patients, L4, 5 in 37 patients, and L5, S1 in 29 patients. The Oswestry disability index (ODI) was used to evaluate the effectiveness before and after operation and to calculate the improvement rate. During the follow-up, the anteroposterior, lateral, and dynamic X-ray films were taken to evaluate the operated segment fusion rate. The intervertebral lordosis angle was measured, and adjacent segment degeneration was observed. ResultsThe operation time was 35-90 minutes (mean, 65 minutes); the intraoperative blood loss was 200-450 mL (mean, 280 mL), and all the patients received intraoperative autologous blood transfusion; the postoperative bedridden time was 3-7 days (mean, 4.5 days); the hospitalization days were 10-18 days (mean, 12 days). No complications of nerve root injury, cauda equina injury, or cerebrospinal fluid leakage occurred during operation. All patients achieved primary healing of the incisions. All 72 patients were followed up for 5 years. At 3 months, 1 year, and 5 years after operation, the ODI were 8.2±2.6, 6.9±1.9, and 6.4±1.3 respectively, showing significant differences when compared with preoperative value (41.5±3.5) (P<0.05); the improvement rates were 87.3%±1.2%, 90.1%±0.8%, and 91.6%±1.3% respectively, showing no significant difference (F=0.492, P=0.375); the intervertebral lordosis angles were (5.1±1.2), (5.0±0.5), and (5.4±0.8)°respectively, showing no significant difference (F=0.570, P=0.453). At 5 years after operation, the intervertebral fusion rate was 100%, with no adjacent segment degeneration. ConclusionUsing expandable Cage to treat degenerative lumbar disease can get stabilization without pedicle screw fixation, the good effectiveness is shown after long-term follow-up.
ObjectiveTo investigate the clinical characteristics of primary mass of the hepatoduodenal ligament (HDL) and present some thoughts in the diagnosis and treatment of this disease. MethodsSixteen consecutive patients diagnosed as having a primary mass of the HDL in the West China Hospital of Sichuan University from September 2004 to May 2013 were retrospectively investigated. ResultsThe symptoms and blood testing both lacked specificity. In this group, fourteen patients were examined by ultrasound and fifteen by contrast-enhanced computed tomography, with 3/14 (21.43%) and 5/15(33.33%) respectively defining the location of the lesions and characteristic of benign/malignant. When combining the ultrasound and contrast-enhanced computed tomography, six of twelve(50.00%) defined the location and characteristic of benign/malignant. When combined with contrast-enhanced magnetic resonance, ten of sixteen (62.5%) defined the location and characteristic of benign/malignant. All cases underwent abdominal exploration, 11 cases (68.8%) were porformed mass resected, 2 cases(12.5%) were porformed the simple HDL mass biopsy combined with biliary drainage with T tube, 1 case(6.2%) was porformed drainage for abscess of HDL, and 2 cases(12.5%) were porformed simple frozen biopsy. All cases recovered and discharged. ConclusionsThe diagnosis of a primary mass of the HDL is difficult. The united usage of multiple imageological examinations can increase the accuracy rate of the noninvasive preoperative diagnosis. Surgery and other active treatment can produce good prognosis.