Analysis of safety and effect of reconstructing anterior and middle columns by single posterior approach in treating lumbar burst fractures.
ABSTRACT To explore the safety and effect of the technique of reconstructing anterior and middle columns by posterior approach in treating lumbar burst fractures.
From July 2005 to January 2007, 22 cases (18 males and 4 females, aged 28-57 years, 42.7 years on average) of lumbar burst fractures were treated with surgical procedures in our hospital. Based on the routine posterior approach, one of the transverse processes of the injured vertebra was incised to get access to the lateral side of the injured vetebral body. After all the displaced fracture fragments were cleared away and the spinal canal was decompressed, the titanium mesh packed with autografts was implanted from the lateral side to reconstruct the anterior and middle columns. The adjacent above and below segments of the vetebral body were fixed with transpedicular screws. The operation time, intraoperative blood loss, vertebral height, degree of kyphotic deformity and comprised spinal canal were documented.
The average operation time was 3.5 hours (ranging 2.8-5.8 hours) and the average blood loss was 820 ml (ranging 650-2 100 ml). All the cases were followed up for 17.2 months on average ( ranging 12-28 months). The height of the injured vetebral body was restored from 24 % (12%- 45%) preoperatively to 96% (95%-99%) postoperatively (P less than 0.05). The natural spinal curvatures and spinal canal were restored. Three cases were involved in transient iatrogenic nerve root injury and 1 case was involved in the loosening of the connected rod of the pedicle screw system 3 months postoperatively.
The technique of implanting the titanium mesh by posterior approach is effective and safe enough to reconstruct the anterior and middle columns in treating lumbar burst fractures.
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ABSTRACT: The use of the Mokum system for correctly designing Information Systems (in the old days called Data Base Systems) and how these designs can automatically be translated into implementations, is one theme of this paper. Theoretical considerations will not be avoided. Similarities and differences with tools from the field of Model Driven Architecture, such as UML, will be demonstrated. How to deal with Mokum in a situation with many sites, as in real Cyberspace is demonstrated as a second theme. Special attention is given to a protocol: MAP, which guarantees that a certain access constraint is being maintained. The constraint being that for an object in one site to obtain access to an attribute of an object in another, a third site must give permission. The technique is based on a new notion: the Triple, to be used in a Knowledge based Engineering environment.Data & Knowledge Engineering 01/2008; 67(2):293-329. · 1.52 Impact Factor
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ABSTRACT: From the Book:In the spring of 1999 I flew to Chicago to consult on a project being done by ThoughtWorks, a small but rapidly growing application development company. The project was one of those ambitious enterprise application projects: a back-end leasing system. Essentially what this system does is to deal with everything that happens to a lease after you've signed on the dotted line. It has to deal with sending out bills, handling someone upgrading one of the assets on the lease, chasing people who don't pay their bills on time, and figuring out what happens when someone returns the assets early. That doesn't sound too bad until you realize that leasing agreements are infinitely varied and horrendously complicated. The business "logic" rarely fits any logical pattern, because after all its written by business people to capture business, where odd small variations can make all the difference in winning a deal. Each of those little victories is yet more complexity to the system. That's the kind of thing that gets me excited: how to take all that complexity and come up with system of objects that can make more tractable. Indeed I belive that the primary benefit of objects is in making complex logic tractable. Developing a good Domain Model (133) for a complex business problem is difficult, but wonderfully satisfying. Yet that's not the end of the problem. Such a domain model has to persisted to a database, and like many projects we were using a relational database. We also had to connect this model to a user interface, provide support to allow remote applications to use our software, and integrate our software with third party packages. All of this on a newtechnology called J2EE which nobody in the world had any real experience in using. Even though this technology was new, we did have the benefit of experience. I'd been doing this kind of thing for ages now with C++, Smalltalk, and CORBA. Many of the ThoughtWorkers had a lot of experience with Forte. We already had the key architectural ideas in our heads, we just had to figure out how to apply them to J2EE. Looking back on it three years later the design is not perfect, but it's stood the test of time pretty damn well. That's the kind of situation that is where this book comes in. Over the years I've seen many enterprise application projects. These projects often contain similar design ideas which have proven to be effective ways to deal with the inevitable complexity that enterprise applications possess. This book is a starting point to capture these design ideas as patterns. The book is organized in two parts. The first part is a set of narrative chapters on a number of important topics in the design of enterprise applications. They introduce various problems in the architecture of enterprise applications and their solutions. However the narrative chapters don't go into much detail on these solutions. The details of the solutions are in the second part, organized as patterns. These patterns are a reference and I don't expect you to read them cover to cover. My intention is that you can read the narrative chapters in part one from start to finish to get a broad picture of what the book covers, then you can dip into the patterns chapters of part two as your interest and needs drive you. So this book is a short narrative book and a longer reference book combined into one. This is a book on enterprise application design. Enterprise applications are about the display, manipulation and storage of large amounts of often complex data and the support or automation of business processes with that data. Examples include reservation systems, financial systems, supply chain systems, and many of the systems that run modern business. Enterprise applications have their own particular challenges and solutions. They are a different animal to embedded systems, control systems, telecoms, or desktop productivity software. So if you work in of these other fields, there's nothing really in this book for you (unless you want to get a feel for what enterprise applications are like.) For a general book on software architecture I'd recommend POSA. There are many architectural issues in building enterprise applications. I'm afraid this book can't be a comprehensive guide to them. In building software I'm a great believer in iterative development. At the heart of iterative development is the notion that you should deliver software as soon as you have something useful to the user, even if it's not complete. Although there are many differences between writing a book and writing software, this notion is one that I think the two share. So this book is an incomplete but (I trust) useful compendium of advice on enterprise application architecture. The primary topics I talk about are: layering of enterprise applications how to structure domain (business) logic the structure of a web user interface how to link in-memory modules (particularly objects) to a relational database how to handle session state in stateless environments some principles of distributionThe list of things I don't talk about is rather longer. I really fancied writing about organizing validation, incorporating messaging and asynchronous communication, security, error handling, clustering, application integration, architectural refactoring, structuring rich-client user interfaces, amongst others. I can only hope to see some patterns appear for this work in the near future. However due to space, time, and lack of cogitation you won't find them in this book. Perhaps I'll do a second volume someday and get into these topics, or maybe someone else will fill these, and other, gaps. Of these, dealing with message based communication is a particularly big issue. Increasingly people who are integrating multiple applications are making use of asynchronous message based communication approaches. There's much to said for using them within an application as well. This book is not intended to be specific for any particular software platform. I first came across these patterns while working with Smalltalk, C++, and CORBA in the late 80's and early 90's. In the late 90's I started to do extensive work in Java and found these patterns applied well both to early Java/CORBA systems and later J2EE based work. More recently I've been doing some initial work with Microsoft's .NET platform and find the patterns apply again. My ThoughtWorks colleagues have also introduced their experiences, particularly with Forte. I can't claim generality across all platforms that ever have been or will be used for enterprise applications, but so far these patterns have shown enough recurrence to be useful. I have provided code exampl for most of these patterns. My choice of language for the code examples is based on what I think most readers are likely to be able to read and understand. Java's a good choice here. Anyone who can read C or C++ can read Java, yet Java is much less complex than C++. Essentially most C++ programmers can read Java but not vice versa. I'm an object bigot, so inevitably lean to an OO language. As a result most of the code examples are in Java. As I was working on the book Microsoft started stabilizing their .NET environment, and their C# language has most of the same properties as Java for an author. So I did some of the code examples in C# as well, although that does introduce some risk since developers don't have much experience with .NET yet and so the idioms for using it well are less mature. Both are C-based languages so if you can read one you should be able to read both, even if you aren't deeply into that language or platform. My aim was to use a language that the largest amount of software developers can read, even if it's not their primary or preferred language. (My apologies to those who like Smalltalk, Delphi, Visual Basic, Perl, Python, Ruby, COBOL or any other language. I know you think you know a better language than Java or C#, all I can say is I do too!) The examples are there for inspiration and explanation of the ideas in the patterns. They are not canned solutions, in all cases you'll need to do a fair bit of work to fit them into your application. Patterns are useful starting points, but they are not destinations. Who This book Is ForI've written this book for programmers, designers, and architects who are building enterprise applications and who want to either improve their understanding of these architectural issues or improve their communication about them. I'm assuming that most of my readers will fall into two groups: either those with modest needs who are looking to build their own software to handle these issues, or readers with more demanding needs who will be using a tool. For those of modest needs, my intention is that these patters should get you started. In many areas you'll need more than the patterns will give you, but my intention is to provide more of a head start in this field than I got. For tool users I hope this book will be useful to give you some idea of what's happening under the hood, but also help you in making choices between which of the tool supported patterns to use. Using, say, an object-relational mapping tool still means you have to make decisions about how to map certain situations. Reading the patterns should give you some guidance in making the choices. There is a third category, those with demanding needs who want to build their own software for these problems. The first thing I'd say here is look carefully at using tools. I've seen more than one project get sucked into a long exercise at building frameworks which weren't what project was really about. If you're still convinced, go ahead. Remember in this case that many of the code examples in this book are deliberately simplified to help understanding, and you'll find you'll need to do a lot tweaking to handle the greater demands that you'll face. Since patterns are common solutions to recurring problems, there's a good chance that you'll have already come across some of them. If you've been working in enterprise applicat while, you may well know most of them. I'm not claiming to have anything new in this book. Indeed I claim the oppositethis is a book of (for our industry) old ideas. If you're new to this field I hope you'll like this book to help you learn about these techniques. If you're more familiar with the techniques I hope you'll like this book because it helps you communicate and teach these ideas to others. An important part of patterns is trying to build a common vocabulary, so you can say that this class is a Remote Facade (413) and other designers know what you mean. Martin Fowler, Melrose MA, May 2002 http://martinfowler.com