Comparison of the diagnostic value of four tests for superior labrum anterior and posterior lesions of the shoulde

To compare the diagnostic value of four signs for superior labrum anterior and posterior (SLAP) lesions of the shoulder.Methods The physical examination was performed randomly on 81 cases with abnormalities of the shoulder.There were four tests,including Kibler anterior sliding test,Liu crank test,O’Brien active compression test and Kim biceps load test Ⅱ.The arthroscopic examination were also performed.The result of the arthroscopic examination was considered as a golden standard,so that we could estimate the diagnosis value of the four tests according to the method of evaluation of diagnosis test on clinical epidemiology,their sensitivity,specificity,positive and negative predictive value,accuracy.Results There were 21 cases diagnosed as SLAP lesions by arthroscopy.The diagnosis value of Kim biceps load test Ⅱ was the highest among the four tests,in which 19 of true positive,59 of true negative,1 of false positive,only 2 of false negative cases;while the sensitivity was 90.48%,specificity was 98.33%,positive predictive value was 95.00%,negative predictive value was 96.72%,and accuracy was 96.30%.However the sensitivity,specificity,positive predicitive value,negative predictive vale and accuracy of Kibler anterior sliding test were 76.19%,96.67%,88.89%,92.06%,91.33%;and those of Liu crank test were 85.71%,93.33%,81.82%,94.92%,91.35%;those of O’Brien active compression test were 80.95%,91.66%,77.27%,93.22%,88.89%.Conclusion Kim Biceps load test Ⅱ may be the best for clinical diagnosis of SLAP lesions of the shoulder.9 refs,4 figs,2 tabs.

Surgical treatment of cervicothoracic junction spinal tuberculosis via combined anterior and posterior approaches in children

Background Cervicothoracic junction spinal tuberculosis （CJST） in children is uncommon, especially when accompanied by a huge abscess. However, its consequences can be severe. Because of the special anatomic location of the cervicothoracic junction, surgical treatment is difficult and rarely reported. The aim of this clinical study was to assess the effectiveness of combined anterior and posterior approaches for focal debridement, decompression, allografting and anterior instrumentation in the treatment of CJST in children. Methods Ten pediatric CJST patients underwent focal debridement and cord decompression through combined anterior and posterior approaches. Then an appropriate allograft and titanium plate were applied to reconstruct the spine. The patients were asked to wear head-neck-chest braces for six months and received regular anti-tubercular drugs therapy for 12 months. Results The patients were followed-up for an average of 26 months （range, 15-32 months）. There was no recurrent tuberculous infection. The bone grafts incorporated well and the instrumentation was stable. Cervical and thoracic kyphosis was successfully corrected from 40° （range, 30-52°） before the operation to 18° （range, 12-26°） post-operation. Neurological function was improved in all patients. Conclusions Combined anterior and posterior approaches for focal debridement, decompression, bone allografting and anterior instrumentation provided an effective means of treatment in children of CJST with a huge abscess in the posterior part of the vertebral body.

One stage anterior release and posterior fusion for the treatment of irreducible atlantoaxial dislocation secondary to os odontoideum

Objective To evaluate clinical effect of the ventral release through high anterior cervical retropharyngeal approach and one stage posterior fusion for the treatment ofirreducible atlantoaxial dislocation (IAAD) secondary

SURGICAL TREATMENT OF SCOLIOSIS CAUSED BY NEUROFIBROMATOSIS TYPE 1

Objective To retrospectively analyze the relationship between curve types and clinical results in surgical treatment of scoliosis in patients with neurofibromatosis type 1 (NF-1). Methods Forty-five patients with scoliosis resulting from NF-1 were treated surgically from 1984 to 2002. Mean age at operation was 14.2 years. There were 6 nondystrophic curves and 39 dystrophic curves depended on their radiographic featu- res. According to their apical vertebrae location, the dystrophic curves were divided into three subgroups: thoracic curve (apical vertebra at T8 or above), thoracolumbar curve (apical vertebra below T8 and above L1), and lumber curve (apical vertebra at L1 and below). Posterior spine fusion, combined anterior and posterior spine fusion were administrated based on the type and location of the curves. Mean follow-up was 6.8 years. Clinical and radiological manifestations were investigated and results were assessed. Results Three patients with muscle weakness of low extremities recovered entirely. Two patients with dystrophic lum- bar curve maintained their low back pain the same as preoperatively. The mean coronal and sagittal Cobb’s angle in nondy- strophic curves was 80.3o and 61.7o before operation, 30.7o and 36.9o after operation, and 32.9o and 42.1o at follow-up, respectively. In dystrophic thoracic curves, preoperative Cobb’s angle in coronal and sagittal plane was 96.5o and 79.8o, postoperative 49.3o and 41.7o, follow-up 54.1o and 45.3o, respectively. In thoracolumbar curves, preoperative Cobb’s angle in coronal and sagittal plane was 75.0o and 47.5o, postoperative 31.2o and 22.8o, follow-up 37.5o and 27.8o, respectively. In lumbar curves preoperative Cobb’s angle in coronal plane was 55.3o, postoperative 19.3o, and follow-up 32.1o. Six patients with dystrophic curves had his or her curve deteriorated more than 10 degrees at follow-up. Three of them were in the thoracic subgroup and their kyphosis was larger than 95 degrees, and three in lumbar subgroup. Hardware failure occurred in 3 cases. Six patients had 7 revision procedures totally. Conclusions Posterior spinal fusion is effective for most dystrophic thoracic curves in patients whose kyphosis is less than 95 degrees. Combined anterior and posterior spinal fusion is stronger recommended for patients whose kyphosis is larger than 95 degrees and those whose apical vertebra is located below T8. Patients should be informed that repeated spine fusion might be necessary even after combined anterior and posterior spine fusion.