[Objective]Toevaluatetheclinicaloutcomesofanterolaterallumbarinterbodyfusion(ALLIF)formildsingle-segmentdegenerativelumbarspondylolisthesis(DLS).[Methods]Atotalof 115 patientsunderwentsurgicaltreatmentsformild(degreeⅠor Ⅱ) single-segment DLSinour hospital from January 2018 to January 2019. Based on the consequences of patient-doctor communication, 54 patients received ALLIF, while the remaining 61 patients underwent conventional transforaminal lumbar interbody fusion(TLIF). The perioperative, follow-up and radiographic documents were compared between the two groups. [Results] The ALLIF group proved significantly superior to the TLIF group in operation time, intraoperative blood loss, postoperative drainage volume, time to return ambulation and hospital stay(P 0.05). In term of radiographic assessment, the disc height(DH) and sarolumbar angle(SLA) significantly increased, whereas the % slippage(%SP) significantly decreased at all the time points postoperatively compared with those before operation in both groups(P 0.05). [Conclusion]The ALLIF is safe and effective treatment for mild single-segment DLS, with advantages of less iatrogenic trauma than TLIF.
Charcot arthropathy is a rare clinical disease that can be caused by a variety of pathogenic factors. It is more easily to attack large joints,especially the knee and result in joint bone damage,which could seriously affect the patient's quality of life. The main pathogenic factor was replaced gradually by diabetes from syphilis and showed a trend of increase with the development of the society. In this paper,based on the awareness of the disease,we review this disease systematically in many ways,just like pathogenic factors,pathogenesis,diagnosis and treatment.
Malignant fibrous histiocytoma( MFH) has features with high malignant degree,fast transfer,easy recurrence and poor prognostic,its incidence is in the first place among the soft tissue. MFH can be accurately diagnosed combined with the pathological,histological characteristics,expression of markers,X- ray,CT and MRI imaging. The metastasis and recurrence was high only with surgery alone. Universality,radical resection,radiotherapy and chemotherapy have achieved satisfactory results. The continuous development of molecular techniques for the diagnosis of malignant fibrous histiocytoma( MFH) can put forward the treatment,diagnosis and prognosis.
Cancer stem cells( CSCs) is a minority population within tumors possesses stem cell properties of self- renewal,unlimited proliferation and multi- directional differentiation. The CSC theory states that tumor is difficult to eradicate because of the existence of cancer stem cells. Malignant fibrous histiocytoma( MFH) is a common malignant tumor,its treatment is still a problem for the extremely high rate of postoperative recurrence. People have successfully isolated cancer stem cells from MFH which has brought us the hope of eradicating the cancer.
Recent years,as the rapidly developing of tissue engineering,tissue engineering of bone and cartilage shows great supriority in the repairment of tissue defection and treatment of orthopedic diseases.Op-1(Osteogentic protein-1) has been well known as inducing osteogenesis and chondrogenesis since it was discovered,which makes the deep application of Op-1 in tissue engineering of bone and cartilage and treatment of orthopedic diseases.The Op-1 has played an important role in estensive terms.Lots of studies confirmed that it has been closely related with the treatment of bone and cartilage related diseases,such as the nonunion of bone fracture,bone defection,cartilage defection and intervertebral disc degeneration etc.This paper focuses on the op-1 in the application of bone and cartilage tissue engineering.
As patient with cancer live longer,spine metastasis is a growing problem. Untreated,it can cause pain,instability and neurologic deficit,which can severely alter the patient's ability and quality of life. When the diagnosis is established,Grading and scoring systems help the physician to best define the objective of treatment by evaluating the life expectancy. The traditional treatment for spine metastasis is palliative. Remarkable evolution in surgical techniques provided to patients valuable therapeutic options to perform decompression and stabilization of the affected level. More recently,minimally invasive techniques allowed a significant reduction of morbidity. The parallel development of stereotactic radiotherapy offers new therapeutic options in particular for patients ineligible for surgery.
[Objective] To evaluate the efficacy of total hip arthroplasty with the S- ROM femoral stem prosthesis( De Puy Synthes,Warsaw,IN,USA) in treatment of Crowe type IV developmental hip dysplasia. [Methods] Twenty- six patients with Crowe type IV developmental hip dysplasia were treated by total hip arthroplasty with S- ROM prosthesis,combined with subtrochanteric osteotomy,from January 2011 to June 2013,with 12 cases being bilateral and 14 unilateral for a total of 38 hips treated. Pain in the femoral region was evaluated with a visual analog scale( VAS) before and after the operation. Preoperative limb shortening,osteotomy length,and postoperative limb lengthening were recorded. Hip joint function was evaluated according to the Harris hip score. A radiograph and CT scan of the pelvis were obtained before the operation to evaluate the hip and acetabular bone. Postoperatively,radiography was used to determine prosthesis position and check for complications.[Results] Patients were followed up for an average of 34 months( range 18 to 48). No infection,prosthesis loosening,or symptomatic deep venous thrombosis occurred. VAS score in the femoral region improved significantly after the operation( P 0. 05). Mean preoperative limb shortening,osteotomy length,and postoperative limb lengthening were 6. 5 cm,2. 5 cm,and4. 0 cm,respectively. Harris score improved from( 43. 2 ± 7. 4) preoperatively to( 84. 8 ± 8. 1) postoperatively. Radiographs showed that the femoral stem prosthesis was in good position,with the metal acetabular cup located in the true acetabulum. No loosening,subsidence,screw breakage,or osteolysis occurred. Six months after the operation,bone union was observed at the osteotomy site on the side of the femur. [Conclusion] Total hip arthroplasty using the S- ROM prosthesis,combined with subtrochanteric osteotomy,appears to be effective for Crowe type IV developmental hip dysplasia. However,further follow- up is required to confirm long- term efficacy.
Ankylosing spondylitis( AS) is a chronic inflammatory autoimmune disease,which primarily involves the axial skeleton,characterized by pathological new bone formation. AS is the secondary most popular inflammatory arthritis. As AS mainly affects young and middle-aged males and has high rate of disabling,it brought heavy burden to both the patient'sfamily and the society,and now the international hot spot of research. Typically,Based on clinical study and research on animal models,there has been some new recognition in the relationship between inflammation and new bone formation. However,because of the specific molecule mechanisms between inflammation and new bone formation have not been clarified,their relationship is still in controversial. This review explore the relationship between inflammation and new bone formation based on the signal pathway of ossification and hopes to provide a reference for further research.
[Objective] To analyze the efficacy and safety of Coflex versus traditional instrumented spinal fusion in the treatment of lumbar spinal degenerative disease and discuss the potential effects of the Coflex on lumbar spine. [Methods] Databases such as Pub Med and CBM were searched for literatures on Coflex and traditional instrumented spinal fusion for lumbar spinal degenerative disease,meanwhile manual search of related journals were performed. Rev Man 5. 2 software was used for Meta analysis. [Results] The Meta- analysis showed no differences between groups for clinical outcomes of VAS( leg and back) and ODI at last follow up( P 0. 05); statistically significance were noted between two procedures for blood loss( P 0. 000 1),operation time( P 0. 000 01),ROM of superior adjacent levels at last follow up( P = 0. 000 7) and ROM of inferior adjacent levels at last follow up( P = 0. 007). [Conclusion] Coflex provides similar clinical outcomes over the short and medium term and can obviously decrease blood loss and operation time in comparison with the traditional instrumented spinal fusion. Similarly,Coflex has a protective effect for physiological functions which reflected at the segment levels of lumbar spine( especially at the superior segment levels).
Neurotization,or nerve transfer,is most commonly used to treat brachial plexus injury by connecting a donor nerve,such as the spinal accessory or intercostal nerves,to a denervated peripheral nerve target.After the transfer,axons grow from the donor nerve into the recipient nerve,innervating previously denervated muscles.In recent years,anastomosis of the donor nerve originating above the level of spinal injury to the spinal accessory nerve seems to be a promising surgery procedure reconstructing diaphragmatic function after cervical spinal cord injury.In this article we make a review of application of nerve transfer in diaphragmatic function reconstruction.
[Objective]The purpose of this study was to evaluate the related factors that affect the different types of new vertebral compression fractures( NVCFs) after percutaneous kyphoplasty( PKP) in the treatment of osteoporotic vertebral compression fractures( OVCFs). [Method]From April 2006 to April 2012,a total of 458 patients who underwent PKP for the treatment of OVCFs were retrospectively analyzed. According to the different types of NVCFs,patients were divided into those NVCFs including the recompression of operated vertebrae( operated fractures group,n = 36),subsequent fracture in the adjacent vertebral bodies( adjacent fractures group,n = 33),subsequent fracture in the remote vertebral bodies( remote fractures group,n =35) and those without NVCFs( maintained group,n = 354). The clinical parameters,spine radiographs and operation technique were evaluated to analyze the incidence and risk factors of the three types of NVCFs. [Result]1. One hundred and four patients( 22. 71%) subsequently suffered from NVCFs. 66. 7% of the NVCFs in operated fractures group and 54. 5% of the NVCFs in adjacent fractures group developed within 6 months of the procedures. 2. For the three types of NVCFs,multivariable analysisshowed that a higher risk of NVCFs after PKP was associated with a larger number of VCFs at baseline,lower T- score and lower body mass index( BMI)( P 0. 05). 3. The risk of NVCFs in operated fractures group and adjacent fractures group after PKP was correlated with the extent of bone cement. The cement mass in the trabecula level of the vertebrae was an important factor related to inducing the subsidence of the lower endplate in operated fractures group( OR,0. 311; P= 0. 016). The cement mass in the endplate level and disclevel of the upper endplate caused NVCFs in adjacent fractures group( OR,4. 831; P = 0. 018). 4. The lack of the back brace were related to the occurrence of NVCFs in adjacent fractures group( OR,0. 425; P = 0. 001) and remote fractures group( OR,0. 601; P = 0. 009). [Conclusion]The recurrent NVCFs of the three types are all associated with the osteoporosis. The risk of NVCFs after PKP is correlated with the extent of bone cement and the use of the back brace and treating osteoporosis could prevent the NVCFs.
High mobility group box protein- 1( HMGB- 1),a nuclear ubiquitous protein,is a DNA- binding protein with functions of stabilizing nucleolar structure and regulating gene expression. Under pathologic conditions,HMGB- 1 can be released into the extracellular milieu actively or passively. Extracellular HMGB- 1 is an important pro- inflammatory cytokines,which correlates with the pathogenesis of many diseases. Recently,the role of HMGB- 1 in trauma has attracted more and more attentions. And HMGB- 1 has been demonstrated to be an important mediator of the secondary injury after traumatic brain injury,acute spinal cord injury,burn,hemorrhagic shock,pulmonary contusion,and fracture by a series of basic and clinical studies.Therefore,it is expected that inhibition of HMGB- 1 release may be a novel therapeutic strategy for treating trauma.
[Objective] To study the ultrasonic scanning methods of normal infant hip and to determine whether there is a relationship among the multiple evaluation parameters. [Methods] Two- hundred and ten hips of 105 infants were examined with ultrasound. The morphology and structure information of hips were observed,and multiple parameters( angle α,angle β,femoral head percentage of cover,acetabular index,L parameter) were measured. [Results] 1 The normal values of angleα,angle β,femoral head percentage of cover,acetabular index,L parameter were( 67. 24 ± 4. 21) °,( 62. 92 ± 6. 40) °,( 61. 92 ± 5. 52) %,( 23. 04 ± 2. 56) °,0. 44 ± 0. 05,respectively. 2There was no statistical significance between boys and girls in angle α,angle β,femoral head percentage of cover,acetabular index,L parameter. There were not statistical significant difference between the parameters of Hui nationality and the Han nationality normal infants. 3For normal infant hips,angleα had positive correlation with FHC and had negative correlation with angle β,AI,L parameter. [Conclusion] Different measurement have different meanings. Graf's method could be an early definite and screening method of choice in early diagnosis of developmental dysplasia of the hip( DDH). FHC,AI,L parameter could help the diagnose of DDH.
[Objective] To explore the incidence of malposition of prosthesis following cervical disc replacement and the influencing factors on the malposition. [Methods] A retrospective analysis 56 patients( 32 males,24 females) with a mean age of( 41. 2 ± 5. 6) years was made,all patients were treated by cervical disc replacement from March 2009 to March 2012 in our hospital. The incidence of postoperative malposition of prosthesis was calculated,which was defined as a displacement of the prosthesis 1. 5 mm,or the angle of prosthetic piece 1. 5 °. According to the presence or absence of malposition of prosthesis,the patients were divided into two groups- with and without malposition of prosthesis. The preoperative characteristics in both groups,were compared,and influencing on factors postoperative malposition of prosthesis were analyzed. [Results] All patients were followed- up and the average follow- up time was( 34. 3 ± 5. 6) months. All patients were satisfied with the clinical outcome. Seventy- four prostheses were implanted in 56 patients. There was single segment in 38 cases and double segment in 18 patients. There were 7 cases( 7 prostheses) with malposition of prosthesis; the incidence of malposition of prosthesis was9. 5%( 7 /74). During March 2009- March 2010,March 2010- March 2011,and March 2011- March 2012,the incidence of malposition of prosthesis were 21. 4%( 3 /14),8. 0%( 2 /25),and 5. 7%( 2 /35),respectively,which indicated that a higher incidence of malposition of prosthesis at the early period. Compared to the patients without malposition of prosthesis,patients with that had a higher incidence of preoperative straight or anti- flexion of the cervical spine( 87. 7% vs. 38. 8%,P =0. 037),a higher preoperative ROM( 11. 0 ± 3. 8 ° vs. 9. 1 ± 2. 5 °,P = 0. 040.),and a higher preoperative disc- facet angle( 127. 9 ± 6. 9 ° vs. 121. 1 ± 4. 8 °,P = 0. 000). [Conclusion] The cervical disc replacement is a capacity surgeryand need a learning curve. A poor preoperative flexion of the cervical spine,a large ROM of surgical segment,and a large disc- facet angle,are important influenceing factors on postoperative position of prosthesis.
Intertrochanteric fracture of femur are common in elderly patients. Since elderly patients have osteoporosis,the fracture usually is severely comminuted. In addition,elderly patients often being with other medical diseases,therefore the treatment of fracture is still more difficult. Currently,open reduction and internal fixation is the first choice of treatment for intertrochanteric fracture in elderly patients. In 1974,hip arthroplasty for the treatment of intertrochanteric fracture of femur in elderly patients had been reported. In recent years,the literatures reported increasedly year by year,but there remains to be controversial in some aspects. In present paper,we review the advances in surgical indications,surgical technique,postoperative effects,complications,biomechanics and cost research of hip arthroplasty for the treatment of intertrochanteric fracture of femur in elderly patients.
[Objective]To investigate the morphological characteristics of the bone channel of the atlas pedicle with three-dimensional imaging,and to provide recommendations for screw placement. [Method]Sixty patients with a lesion- free atlas,who had undergone computed tomography angiography( CTA) and magnetic resonance imaging( MRI) screening,were randomly selected from the Shengjing Hospital PACS system. We measured the relative anatomical information including the distance between the spinal cord and inner wall of the atlas pedicle,distance between the vertebral artery and outer wall of the atlas pedicle,thickness of the medial cortical bone of the atlas pedicle,thickness of the lateral cortical bone of the atlas pedicle,and thickness of the atlas pedicle. The above measurements were statistically analyzed with SPSS 12. 0 software. [Result]The differences in the anatomical measurements between the two sides were not statistically significant. The distance between the spinal cord and inner wall of the atlas pedicle was 10. 45 ± 2. 35 mm and 9. 98 ± 2. 30 mm,the distance between the vertebral artery and outer wall of the atlas pedicle was 1. 03 ± 0. 41 mm and 1. 34 ± 0. 52 mm,and the thickness of the medial cortical bone of the atlas pedicle was 3. 03 ± 0. 41 mm and 3. 18 ± 0. 72 mm,in men and women,respectively. The thickness of the lateral cortical bone of the atlas pedicle was 1. 43 ± 0. 31 mm and 1. 63 ± 0. 48 mm and the thickness of the atlas pedicle was 8. 25 ± 1. 58 mm and 7.94 ± 1. 42 mm,in men and women,respectively. The distance between the spinal cord and inner wall of the atlas pedicle was larger than that between the vertebral artery and outer wall of the atlas pedicle,and the thickness of the medial cortical bone of the atlas pedicle was greater than that of the lateral cortical bone of the atlas pedicle. [Conclusion]The thickness of the medial cortical bone of the atlas pedicle is greater than the optimal thickness. This is the morphological basis for more damage to the vertebral artery during pedicle screw placement. Therefore,attempting to grind the medial cortical bone interoperatively is an effectiveway of preventing damage to the vertebral artery. Meanwhile,there is a larger buffer space between the spinal cord and inner wall of the atlas pedicle,the more media screw channel is still security enough.
[Objective]To analyze the anatomic parameters of the anatomic study of anterior cervical vertebral screw insertion and observe the feasibility,and to compare the corresponding parameters through the literatures.[Method]Forty-two cervical vertebral specimens of human adult cadavers were measured by hand and CT scan to study the height and width of pedicle,the screw point,the direction of trajectory,the length of vertebral body and at the direction of trajectory and the axis length. The statistical methods were used to study the difference of the parameters of hand and CT scan. The key words cervical vertebral, anterior, pedicle were used to search CNKI,PubMed,Scopus,the literatures including the above parameters were used to compare. [Result]There was no statistical difference between hand and CT scan. The average height and width of were more than 4 mm except the 6. 3% C 3 pedicle. The screw point: C 3- C 4 lay on the opposite and 2- 3 mm with the middle sagittal plane of the vertebral body,C 5- C 7 lay on the same side and C 5 was 1. 38 and C 6- C 7 were 4- 5 mm with the middle. The distance of screw point of C 3- C 7 and upper end- plate was 5- 8 mm. the direction of trajectory: the angle of the trajectory and the sagittal plane: C 2,C 5,C6 were 38°-40°,C 3- C 4 were 43°- 47°. the angle of the trajectory and the transverse plane: C 2- C 4 was caudal,the average angle was19. 43°,10. 58°,5. 93° separately,C 5- C 7 was uptip,the average angle was 1. 94°,6. 29°,7. 50°. The total length of axis was 29- 32 mm,the length of the vertebral body along the axis was 14 mm. the literatures showed that there were differences in the length and width of the pedicel and the screw point.[Conclusion]In our study,the large sample was measured by hand and CT scan,the study introduced the anatomic parameters for clinic anterior cervical vertebral screw insertion. In addition,we compared the different literatures using different sample and measurements,in order to provide anatomic evidence for further statistical study.
As an age- related disease,disc degeneration is the most common in spine surgery. Currently the clinical treatment of disc degeneration remains committed to the end- stage( such as disc herniation,spinal stenosis,vertebral spondylolisthesis et al),but it can not slow down the progress of disc degeneration. In recent years,with deeper research on intervertebral disc degeneration,the treatment of intervertebral disc degeneration also has new discovery. Gene therapy provides a new method to retard disc degeneration. Now we do a review about it.
[Objective]To study the repair material of rotator cuff injury. [Method]To review the related articles of the repair material of rotator cuff injury in the database of Pub Med and Sino Med,summarize and analyze those data. [Result]Currently,the repair materials which is used in the rotator cuff injury mainly include extracellular matrix materials and non- biodegradable synthetic materials and degradable synthetic material,at the same time of material repair,we also can add different growth factors and seed cells to promote repair process. [Conclusion]Under the influence of various factors,it may cause the higher failure rate through traditional repair methods in rotator cuff injury. With the development of tissue engineering and materials science,the use of new materials may get the better results.
