目的:观察脊柱侧凸矫形术后发生严重冠状面失衡进行再次手术翻修的效果及并发症.方法:回顾性分析我院2013年1月～2021年8月手术治疗的7例脊柱侧凸矫形术后严重冠状面失衡患者的临床资料,其中男性3例,女性4例;本次手术年龄21.3±7.5岁(14～32岁).随访16.3±4.2个月(12～25个月).统计初次手术年龄、既往手术次数、本次手术时间、出血量和固定节段.在本次手术前、术后即刻及末次随访时在全脊柱正侧位X线片上测量主胸弯及腰弯Cobb角、最下固定椎倾斜角、冠状面平衡距离(coronal balance distance,CBD)、冠状面骨盆倾斜角等,计算CBD的矫正率.术前、术后即刻及末次随访时使用SF-36量表评估患者生活质量.记录本次手术后各类并发症发生及转归情况.结果:初次手术年龄8.86±4.14岁(3～15岁);手术次数5.29±3.55次(2～13次);本次手术时间为346.14±64.65min,术中出血量1342.86±687.65ml;6例患者行不对称性PSO截骨,1例患者行多节段Ponte截骨、延长内固定融合节段.术前CBD为77.23±33.28mm,术后即刻为36.11±15.14mm,较术前改善(P＜0.05),矫正率为(53±3)％,末次随访为35.91±14.45mm,与术后即刻相比无明显差异(P＞0.05).主胸弯、最下固定椎倾斜角及冠状位骨盆倾斜角术后即刻均较术前明显减少(P＜0.05),末次随访与术后即刻无显著性差异(P＞0.05).术前腰弯21.29°±17.77°,术后即刻30.14°±8.86°,较术前有统计学差异(P＜0.05),末次随访腰弯30.14°±8.13°,与术后无显著性差异(P＞0.05);术前SF-36综合评分27.29±1.98分,术后即刻 36.86±2.27分(P＜0.05),末次随访时50.14±3.24分(P＜0.05).5例患者术后出现胸腔积液、脑脊液漏、下肢神经痛等并发症,均在住院期间完全治愈.结论:脊柱侧凸矫形术后出现严重冠状面失衡的患者,再次翻修截骨手术可取得较好的矫正效果并提高生活质量,但手术风险大,围丰术期需密切关注并发症.

目的 探讨经椎间孔腰椎间融合术(TLIF)治疗腰椎融合术后邻近节段病变的中长期疗效及并发症发生情况.方法 采用TLIF治疗30例腰椎融合术后邻近节段病变患者.分析术后并发症发生情况.术后1周、末次随访时采用腰痛及下肢痛VAS评分、腰椎JOA评分评定临床症状改善情况.结果 患者均获得随访,时间4.3～9.0(6.0±1.9)年.下肢痛VAS评分、腰椎JOA评分:术后1周、末次随访时较术前明显改善(P<0.05);末次随访时与术后1周比较差异均无统计学意义(P>0.05).腰痛VAS评分:术后1周较术前明显改善(P<0.05);末次随访时与术前比较差异无统计学意义(P>0.05).术后15例(50％)出现18例次并发症:肺部感染1例次,切口愈合不良1例次,切口深部感染1例次,残留一侧下肢神经疼痛2例次,融合椎板骨折1例次,远隔椎体骨折1例次,腰骶部反复疼痛2例次,再次出现相邻节段病变(包括相邻椎体骨折和近端交界性后凸)9例次.结论 采用TLIF治疗腰椎融合术后邻近节段病变疗效满意,但随着随访时间的延长,临床疗效逐渐下降,且继发邻近节段病变的风险高.

背景:融合后脊柱侧凸翻修原因复杂,手术难度较高,围手术期及随访并发症发生率较高.目的:探讨融合后脊柱侧凸截骨翻修的原因、疗效、安全性及并发症.方法:回顾性分析2014年3月至2017年1月于我院行截骨翻修的50例融合后脊柱侧凸患者,男16例,女34例,年龄18～41岁,平均(27.5±6.4)岁.根据病因分成特发性脊柱侧凸(idiopathic scoliosis,IS)组(26例)和先天性脊柱侧凸(congenital scoliosis, CS)组(24例).对比整体及各组手术效果,并统计分析围手术期和随访期间并发症.应用简体中文版SRS-22问卷进行患者生活质量评估.结果:本组病例随访24～65个月,平均(36.5±10.1)个月.IS组和CS组的截骨术式、手术时间、出血量、住院时间及随访时间均无显著性差异,IS组固定节段明显多于CS组(P＜ 0.05).50例患者的主弯侧凸角、节段性后凸角、顶椎偏移、T1倾斜角、矢状位平衡、腰椎前凸角及骨盆入射角与腰椎前凸角差值在术后即刻及末次随访时,与术前相比,均有显著性差异(P＜0.05),而冠状位躯干偏移及锁骨角仅在末次随访时与术前相比有显著性差异(P＜0.05).IS组手术前后及末次随访时的主弯侧凸角与CS组相比均有显著性差异(P＜0.05).IS组术前及术后即刻的顶椎偏移与CS组相比有显著性差异(P＜0.05).本组20例(40％)患者出现并发症共23次,后路全脊椎切除术出现脊髓损伤次数明显增加.简体中文版SRS-22问卷5项指标在末次随访时均较术前有明显改善.结论:应用截骨术翻修融合后脊柱侧凸可以达到满意的临床效果,但整体并发症发生率较高,其中后路全脊椎切除术是脊髓损伤的高危因素.

目的:研究腰椎退行性疾病患者首次行单节段腰椎手术后功能恢复的影响因素.方法:以北京市9家三级甲等医院收治的因腰椎退行性疾病首次行单节段椎管减压内固定手术的患者为研究对象,搜集人口学资料及诊疗、随访评定记录,获得病例资料共1152例.于术前、术后24周±7天分别用日本骨科学会(Japanese Orthopedic Association,JOA)腰椎评分量表评定腰椎功能,按照功能情况分为优、良、可、差;将年龄、性别、体质指数(BMI)、手术节段、术前功能、术前疼痛、是否进行一体化康复、有无术后并发症共8个因素纳入分析,使用有序多分类logistic回归分析的方法对腰椎退行性疾病术后患者功能恢复的影响因素进行分析.结果:经过有序多分类Logistic回归分析,进行围手术期骨科康复一体化治疗的患者术后24周时腰椎JOA评分显著优于接受现行骨科诊疗的患者,差异有显著性意义(P＜0.05)(OR=1.589,95％ CI [0.193,0.733]);术后无并发症的患者术后24周时腰椎JOA评分显著优于术后发生并发症的患者,差异有显著性意义(P＜0.05) (OR=2.300,95％ CI[0.112,1.555]).结论:围手术期骨科康复一体化治疗和是否发生术后并发症这两个因素是首次行腰椎管减压内固定术的患者功能预后的独立影响因素.采取骨科康复一体化模式、不伴发术后并发症的患者获得更良好的腰椎功能恢复.

目的 探讨学龄儿童脊柱侧凸矫形手术中,自体血回输技术是否可节约用血和医疗费用.方法 收集107例行脊柱侧凸矫形手术的7～12岁学龄儿童资料.根据是否采用cell saver 5自体血回输机,分为对照组和自体血回输组(cell saver组).采用卡钳法进行倾向值匹配后,52例患者的资料匹配成功,观察其围术期各项指标并进行输血相关费用评价.结果 与对照组相比,cellsaver组的异体红细胞及血浆输注量在术中、术后和整个围术期差异均无统计学意义(均P＞0.05);ICU入住时间和术后住院日等其余指标及医疗费用差异也均无统计学意义(均P ＞0.05).结论 在学龄儿童脊柱侧凸术中,自体血回输不能减少异体红细胞和血浆的需求,也并不经济合算.

生理性囊肿会随着月经周期而发生不同的变化,一般情况下,3～6个月会自行消退或缩小.如果是病理性囊肿采用手术以及激素药物治疗,可考虑配合中药调理来避免复发. 复查非常重要 偶然B超检查发现卵巢囊肿,不要紧张,如果没有任何症状,且B超提示为纯囊性,建议复查.可以换家医院复查,更重要的是,在1个月后,月经干净的时候再次复查.

目的:探讨后路三柱截骨矫形术治疗先天性颈胸段脊柱畸形的疗效、安全性及并发症.方法:回顾性分析2009年1月～2017年3月于我院应用后路一期三柱截骨矫形术治疗的25例先天性颈胸段脊柱畸形患者的病历资料,其中男11例,女14例,年龄3～32岁(12.1±7.1岁).术前合并神经功能损害6例,其中Frankel分级C级4例,D级2例.测量手术前后及末次随访时的颈胸段主弯Cobb角、局部后凸角、远端代偿弯Cobb角、双肩高度等参数,并观察神经功能转归及并发症.结果:行SRS(Scoliosis Research Society)3级截骨6例,SRS 4级截骨3例,SRS 5级截骨16例.手术时间306.1±101.5min(147～550min),术中失血量1108.0±1000.9ml(150～4500ml).随访时间37.8±14.0(20～69)个月.颈胸段主弯Cobb角由术前59.5°±28.5°矫正到术后的28.8°±16.9°(P＜0.001),末次随访时为31.6°±16.4°,无明显丢失(P=-0.574).局部后凸由术前39.2°±28.2°矫正到术后的21.1°±14.4°(P＜0.001),末次随访时为24.0°±14.3°,无明显丢失(P=0.478).远端代偿弯由术前的35.4°±19.5°减少为术后的18.4°±11.3°(P＜0.001),末次随访时为26.1°±16.9°,较术后无统计学差异(P=0.073).双肩高度差由术前的2.6±0.9cm减少到术后的1.2±0.6cm(P＜0.001),末次随访时进一步改善为0.9±0.6cm,但较术后无统计学差异(P=0.093).术前合并神经功能损害的6例患者中5例随访期间恢复至Frankel E级,1例C级恢复至FrankelD级.术后神经系统并发症6例:5例凸侧上肢麻木;1例因双下肢肌力持续下降行再次手术探查清除血肿后恢复,6例末次随访时神经功能均恢复正常.其他包括脑脊液漏1例,胸腔积液3例,伤口积液1例,肺部感染1例,远期融合远端侧凸加重行翻修手术2例,均通过对症处理后恢复.结论:对于先天性颈胸段脊柱畸形患者应用后路一期三柱截骨矫形手术治疗,能够获得良好的矫形效果,但存在较高的并发症发生率.

Objective To explore the postoperative efficacy in preschoolers after single hemivertebrectomy and to make comparison among different surgical timings.Methods A retrospective study was performed for a total of 33 preschoolers with spinal deformity due to hemivertebra from January 2009 to August 2015.There were 13 boys and 20 girls with a mean age of 57.6 (26-94) months.All children underwent posterior hemivertebra resection with pedicle screw fixation and interbody fusion.The concurrent conditions were cardiac malformations (n=4) and spinal deformities (n =4).Complete clinical and radiological data were reviewed and long-cassette-standing spinal radiographs measured at preoperation,postoperation and final follow up for comparing the corrections and complications of two groups (group A,n=20,age:26-60 months;group B,n =13,age:61-94 months).Results No inter-group statistical differences existed in percentage of blood loss of total blood volume,length of hospital stay or postoperative follow-up period.Operative duration was longer in group B than that in group ＞A (P＜0.05).Cobb's angles of major curves,sagittal balance,proximal compensatory Cobb's and sagittal segmental Cobb's angles before and after operation were significanly different (P＜ 0.05).However,there were no inter-group statistical differences (P＞0.05).The Cobb's angles of major curves pre-operation (°):41.37 ± 12.51 (A∶ B =41.25 ± 13.11 ∶ 41.54 ± 12.05),post-operaion:16.18 ± 10.68 (A∶ B =15.85 ± 11.78 ∶ 16.69 ± 9.18),segmental kyphosis pre-operation (°):33 ± 17.20(A∶ B =26 ± 17.13 ∶ 41 ± 14.42) and post-operation:18.93 ± 16.73 (A∶ B =15.63 ± 15.69 ∶ 22.71 ± 18.30).Coronal balance,distal compensatory curve and thoracic kyphosis,differences between before and after operation and comparison among groups were insignificant.The immediate correction rate of Cobb's angles of major coronal curves was (62.30 ± 19.18) ％ (group A∶group B=64.29± 18.58∶59.23±20.43)％ and the final follow-up correction rate (41.41 ±33.32)％ (group A∶ group B =47.35 ± 37.90∶32.28 ± 23.19)％;The immediate correction rate of segmental kyphosis was (46.73 ± 30)％(group A∶ group B =45.88 ± 33.15∶47.71 ± 28.57)％ and the final followup correction rate (50.05 ± 33.36) ％ (group A∶ group B =47.31 ± 39.54 ∶ 53.17 ± 27.42) ％.During perioperative period and follow-ups,complications occurred in 4 patients (12.12％),including 3 cases in group A,hematoma 4 years post-operation (n =1),rod breakage (n =1) and poor wound healing (n =1);1 case in Group B had a decrease of muscle strength,yet recovered after 2-month follow-ups.Conclusions Posterior hemivertebral resection is both safe and effective for preschoolers with congenital scoliosis.Short-segment fusion is feasible.Immediate and ＞2 years follow-up outcomes between before and after vertebral endplate forming have no significant difference.For neonates with single hemivertebra,the progress of Cobb's may be tracked until an age of 5 years old.Fixation-related complications and perioperative risks can be lowered without effect on operative outcomes or fusion segments.

[目的]评估联合体感诱发电位(somatosensory evoked potential,SSEP)和经颅运动诱发电位(transcranial motor evoked potential,TcMEP)监测在重度脊柱畸形翻修截骨矫形手术中的应用价值,探讨术中出现神经监测变化的危险因素.[方法]回顾性分析2015年1月～2017年1月于本科全麻下进行重度脊柱畸形翻修截骨矫形手术54例患者,男19例,女35例.术中均应用SSEP和TcMEP联合监测.统计比较单模式SSEP、单模式TcMEP及双模式联合监测的阳性预测值和阴性预测值、敏感性及特异性.分析术中出现真阳性电生理监测变化的原因和危险因素,并提出相应的管理措施.[结果]联合SSEP及TcMEP监测成功率、阳性预测值、阴性预测值、敏感性及特异性均为最高.54例患者中共有14例(25.93％)出现阳性电生理监测变化.经术中干预后,随访时最终2例(3.70％)未恢复至术前神经功能状态.术前合并胸椎管狭窄、主弯Cobb角＞130°为出现真阳性电生理变化的危险因素.[结论]在重度脊柱畸形翻修截骨矫形手术中,联合SSEP及TcMEP监测能有效地检测早期脊髓损伤,有更好地进行预警的价值.积极进行干预能扭转电生理变化并可以避免严重脊髓损伤并发症发生.翻修术中截骨矫形过程出现电生理变化概率较高.术前合并胸椎管狭窄以及主弯Cobb角＞130°的患者更易导致真阳性监测变化发生.

Objective To study the clinical efficacy of percutanous kyphoplasty(PKP) in vertebral compression fractures of acute and subacute phases.Methods The clinical data of 45 patients with osteoporotic vertebral compression fractures(OVCF) receiving PKP were analyzed retrospectively,among whom 23 patients in group A,had been injured in less than 2 weeks and 22 patients in group B,had been injured in more than 2 weeks but less than 2 months.Relevant data were recorded before and after operations including Visual Analogue Scale(VAS) scores,anterior and middle vertebral heights,Cobb angles and bone cement leakage.Results The average follow-up time lasted for 10.5 months.VAS scores in two groups were in decline.Differences at points in time had statistical significance(P＜0.05) There was no significant difference in the inter-group,inter-group and inter-point interaction (P＞0.05).Cobb angles before and after treatments in group B were both much bigger than those of group A,either group A or group B saw a great increase in its Cobb angles after operations (P＜ 0.05).Differences in the recovery of Cobb angles after operations for two groups showed no statistical significance(P＞0.05).For group B,before operations,both anterior and middle vertebral heights were lower than those of group A(P＜0.05) and the two figures for either group became higher compared with preoperative period(P＜0.05).There was no significant difference in the height recovery between the anterior and central vertebral bodies in group A and group B(P＞0.05).Follow-up re-examinations had found 1 case of cement leakage in anterior vertebral and 1 in intervertebral disc,with no other symptoms in group A.Hospital stays ranged from 3 to 7 days and primary healing of operative incision occurred in all patients.During our visits after surgery,no patients have had a relapse of fractures.Conclusion PKP can alleviate the pain of patients with thoracic lumbar segment OVCF effectively.Subacute patients can recover to the same level of vertebral body height and Cobb angles as acute patients after operations.

Objective To identify the predictors of intraoperative blood loss in pedicle subtraction osteotomy(PSO) surgery for rigid scoliosis.Methods Data of 103 patients treated with PSO surgery for rigid scoliois by a single surgeon from January 2010 to September 2016 were retrospectively analyzed.Sex,age,preoperative height,preoperative weight,BMI,scoliosis type,preoperative Cobb angle,correction rate on Cobb angle,rib resection,intraspinal anomalies,fused levels,surgical procedures,the number of pedicle screws,preoperative laboratory examination (hemoglobin,platelet count,PT,APTT,and INR) were recorded and analyzed with a multivariable linear stepwise regression to develop a predictive model of blood loss.Pearson's correlation was also calculated between operation time and blood loss.Results Intraoperative blood loss was (2 311.1 ± 1 123.1) mL(range,700 to 6 500 mL),operation time was positively correlated to blood loss(Pearson's correlation 0.463,P＜0.000 1).Multivariate linear regression identified age,scoliosis type,the number of pedicle screws,preoperative Cobb angle as predictors of increased blood loss.The following formula was developed to predict blood loss during PSO surgery for rigid scoliosis:t =-1 562.8 + 42.6 A + 629.0B + 78.8C + 9.9D.T was Blood loss(mL),A wasage(year),B was scoliosis type(AIS=0,congenital scoliosi 1),C was number of pedicle screws,D waspreoperative Cobb angle of main coronal curve(degree).Conclusion Age,scoliosis type,the number of pedicle screws,preoperative Cobb angle of main coronal curve are the predictors of blood loss,and a formula has been developed to predict the blood loss.Surgeons can use this model to predict blood loss while making small adjustments.Operation time is positively correlated with blood loss,measures should be taken to reduce the operation time,then avoid massive blood loss in PSO surgery for rigid scoliosis.

Objective To evaluate the safety and clinical outcomes of posterior vertebral column resection (PVCR) combined with stepwise correction technique in the treatment of patients with severe angular kyphosis .Methods A prospective study was designed on patients .From January 2015 to December 2016 ,37 patients with severe angular ky-phosis underwent PVCR combined with stepwise correction technique ,including16 males and 21 females with an aver-age age of 28 .6 years old (range 11～58 years).Relevant radiographic parameters were recorded pre-operatively ,post-operatively and at last follow-up ,included Cobb angle ,global kyphosis(GK) ,Trunk shift(TS) and sagittal vertical axis (SVA).The clinical outcomes were evaluated by MOS item short-form health survey (SF-36) ,visual analogue scale (VAS) and Oswestry disability index(ODI) ,while neurological function was evaluated by Frankel classification .Periop-erative complications were analyzed as well .Results The average operation time was (468 .9 ± 108 .3)min (range 312～723 min)with an average blood loss of (2 173 .7 ± 1 226 .6)mL (range 800～5 100 mL).The average follow-up time was 22 .5 months (12～40 months).The pre-operative average GK angle and Cobb angle were (124 ± 20 .4)°(range 91°～160°)and (87 .2 ± 45 .2)°(range 0°～156°).The post-operative average GK angle and Cobb angle were (46 .8 ± 21 .5)° (range 10°～120°)and (49 .1 ± 26 .9)°(range 0°～109°).The correction rate of GK angle and Cobb angle were 62 .3% and 45 .2%,respectively .At last follow-up ,no significant loss of correction was observed in the GK angle and Cobb’s angle. The pre-operative and post-operative TS were (38 .6 ± 17 .2)mm ,(11 .5 ± 11 .2)mm ,respectively ,SVA decreased from pre-operative (33 .5 ± 11 .4)mm to (9 .6 ± 7 .2)mm post-operatively ,significant improvement of TS and SVA were ob-served .In addition ,compared with SF-36 ,VAS ,ODI values in pre-operation ,the values in both post-operation and the last follow-up have significant improvement .The incidence of perioperative complications was 37 .8%(n＝14)including complete paralysis (n＝1) ,transient neurological deficit (n＝3) ,hemothorax (n＝2) ,poor wound healing (n＝3) ,the digestive system complications (n＝3) ,screw pull-out (n＝1)and screw cap dislodgement(n＝1).Conclusion Posteri-or vertebral column resection combined with stepwise correction technique can achieve satisfactory correction for severe angular kyphosis .However ,more blood loss ,longer operative time needed in these procedures ,and high incidence of perioperative complications must be attentioned .

小张自18岁时开始就出现腰背部僵硬、疼痛不适,伴双膝、双踝关节疼痛等症状,几年来,一直未得到明确诊治.其间,他自行间断服用了布洛芬、中成药等药物.近1个月来,小张的不适症状加重,双髋及右膝关节疼痛明显,行走困难,明显影响了正常的工作和生活.为了进一步诊治,他在家人的陪伴下前去医院就诊.医生对小张进行了全面的检查,根据病程、症状和检查结果,医生诊断小张患了强直性脊柱炎.

Objective To analyze the clinical results and perioperative complications of the dual rod distraction tech-nique in the concave side for severe early onset scoliosis(EOS)by mid-term follow-up.Methods 52 patients undergoing dual rod distraction technique in the concave side for severe EOS in our hospital from June 2007 to December 2013 were retrospectively studied.The pedicle screws provided anchors at the end of the rods.The patients'records were reviewed. The parameters included age at initial surgery and the final follow-up,number and frequency of lengthening and compli-cations.Radiographic evaluation included scoliosis Cobb angle,thoracic kyphosis and length of T1 ~S1 .Results Accord-ing to the average frequency of lengthening,the patients were divided into two groups.There were 32 patients(9 males and 23 females)in Group 1.The average age was (7.4±1.1)years(range,4~10 years)at initial surgery.There was a total of 148 surgeries.The average interval between lengthenings was 12.6(range,4~ 18)months.The mean follow-up was 60.7 (range,30~102)months.Cobb angle decreased from a mean value of (109±23)°preoperatively to (55±16)° after the primary implantation,at final follow-up,the mean Cobb angle was (46±12)°.The average increase of T1 ~S1 lengthwas 1 .9 cm per year .There were 20 patients (6 males and 14 females )in Group 2 .The average age was (7 .7 ± 1.3)years (range,5~10 years)at initial surgery.There was a total of 54surgeries,The average interval between length-enings was 26.4(range,12~72)months.The mean follow-up was 61.5(range,29~ 108)months.Cobb angle decreased from a mean value of (104±19)°preoperatively to (51±13)°after the primary implantation,at final follow-up,the mean Cobb angle was (62±17)°.The average T1 ~S1 length was 1.19 cm per year.At final follow-up,the correction of Cobb angle,thoracic kyphosis and trunk shift was better in Group 1 than in Group 2(P <0.05).As to the T1 ~ S1 length, there was no significant difference between the two Groups at final follow-up (P >0.05).There were 9 complications occurred in 7 patients(21.9%)in Group 1 and 15 complications occurred in 12 patients(60%)in Group 2.Conclusion For patients with severe EOS,dual rod distraction technique in the concave side was an effective treatment option. Shortening the interval of lengthening,it can decrease the complications rate and gain better deformity correction while allowing spinal growth.

Objective To investigate the causes of 30-day unplanned revision surgery following one-stage posterior vertebral column resection (PVCR) for severe spinal deformity and the methods of prevention and management.Methods A total of 112 severe deformity patients underwent one-stage PVCR for surgical treatment in the 306th Hospital of People' s Liberation Army from May 2010 to December 2015 were retrospectively reviewed.Six patients required reoperation within 30 days after PVCR,including 2 males and 4 females with average age of 21 years (ranging from 12 to 38 years).Four cases were congenital kyphoscoliosis,1 was post-laminectomy kyphoscoliosis and 1 was post-tuberculous angular kyphosis.Three cases associated with preoperative neurologic deficit (Frankel C in 1 patient and D in 2 patients).The causes,management and outcomes of unplanned revision surgery within 30 days after PVCR were recorded.Results The total incidence of unplanned revision surgery within 30 days following PVCR was 5.4％ (6/112).There was 1 case due to cerebrospinal fluid leak,5 cases with varying degrees of new neurologic deficits,the causes were as followed:dural buckling in 1 case,residual bone compression in 1 case,epidural hematoma compression in 2 cases,spinal subdural hematoma in 1 case.All the 6 cases underwent surgical exploration again,including further dural repair,decompression and hematoma clearance.After unplanned reoperation,6 cases recovered completely.The average follow-up time after surgery was 30.8 months (ranging from 10 to 60 months).The major curve at coronal plane was improved from preoperative 87.7° to 34.2°,with a mean correction of 61.0％ at final follow-up;the sagittal kyphosis curve was improved from preoperative 119.5° to 45.5°,with a mean correction of 61.9％ at final follow-up.Two patients' neurological status improved from Frankel D to Frankel E,one patient's neurological status improved from Frankel C to Frankel E.Conclusions One-stage PVCR could be an effective method for treatment of severe spinal deformity.The causes of 30-day unplanned reoperation after PVCR are as followed:cerebrospinal fluid leak,dural buckling,residual bone compression and hematoma compression.Timely surgical exploration can gain good clinical outcomes.

Objective To evaluate the clinical value of transcranial electric motor evoked potentials (TCeMEP) and somatosensory evoked potentials(SSEP) monitoring in spinal kyphoscoliosis osteotomy revision surgery.Methods A retrospective study was performed in 176 Kyphoscoliosis patients who were takenosteotomyrevision surgery under total anesthesia from March 2011 to March 2016.Intraoperative neurophysiological monitoring data including SSEP and TCeMEP were collected.SSEP was attempted in 176 patients,meanwhile TCeMEPwas attempted in 134 patients.The monitoring results are identified andanalyzed.The true and false positive rate,true and false negative rate,positive predictive value,negative predictive value,sensitivity and specifi-city of SSEP and TCeMEP and combined use of SSEP and TCeMEP were calculated,respectively.Results SSEP was successful attempted in 162 patients(92.0%),and TCeMEP was successful attempted in 109 patients(81.3%).By combined using SSEP and TCeMEP,the successful rate increased to 92.5%(124/134).The overall incidence of significant alerts was 8.6%(14/162) and overall permanent neurological deficit was 1.9%(3/162).The sensitivity and specificity were 72.7% and 98.7% for SSEP,90.9% and 98.0% for TCeMEP,respectively.The sensitivity and specificity were 100% and 98.2% by combined using.The positive and negative predictive values of SSEP&TCeMEP were 85.7% and 100%,higher than SSEP alone(80.0% & 98.0%) and TceMEP alone(83.3% & 99.0%).Conclusion Kyphoscoliosis revision surgery is complex,but it can greatly decrease the risk of operation by usingSSEP and TCeMEP.We suggest intraoperative neurophysiological monitoring is the current gold standard for kyphoscoliosis osteotomy revision surgery.

Objective To investigate the safety and efficacy of three column osteotomy (3-CO) procedures through previous spinal fusion site for the revision surgical treatment in severe spinal deformity patients.Methods From Oct.2010 to May 2014 in our hospital,a total of 12 severe spinal deformity patients underwent 3-CO for the revision surgical treatment.There were 7 males and 5 females with the average age of (21.8±3.8) years,ranging from 18 to 30 years.The mean time from the initial operation to the revision surgery was (10.2±4.8) years (ranging from 3 to 17 years).The reasons for revision were:curve progression in 7 patients,neurologic deficit in 2 cases,implant failure in 1 patient and pseudarthrosis in 2 patients.The coronal parameters including major Cobb angle and distance between C7 plumb line and center sacral vertical line (C7PL-CSVL),and the sagittal parameters including global kyphosis curve and sagittal vertical axis (SVA) were measured pre-operatively,post-operatively and at last followup,respectively.The operation time,intraoperative blood loss and complications were recorded.The paired t test was used to evaluate the difference among pre-revision,post-revision and last follow-up.Results The average operation time was (451.7±83.1) min (range,320-600 min) and the average blood loss was (4 016.7± 1 080.0) ml (range,2 700-6 000 ml).The average follow-up time after revision operation was (35.4±9.8) months (range,24-49 months).The coronal Cobb angles of pre-revision and post-revision were 83.8°±23.3°and 34.6°± 13.7°.The average correction rate was 60.1％ ±8.8％.At last follow-up,the average coronal Cobb angle was 34.9°±13.8°,there was no significant loss of correction.The pre-revision and post-revision values of global kyphosis were 99.1°±13.3°and 38.7°±7.8° with a mean correction rate of 60.8％ ±6.7％.At the last follow-up,the average global kyphosis was 39.3°±7.5°and no loss of correction was found.For the C7PL-CSVL and SVA,pre-revision (30.3± 17.1) mm and (40.1±31.1) mm were corrected to (14.3 ±7.6) mm and (19.1± 12.3) mm immediately after revision operation,respectively.At final follow-up,the average C7PL-CSVL and SVA were(14.1 ± 7.6) mm and (19.6± 12.1) mm,the correction was well maintained.Obviously,two patient's neurological status improved from Frankel C before revision surgery to Frankel E.Complications were encountered in five patients (41.7％),including SEP signal changed in 1 patient (8.3％),transient neurologic deficit after revision surgery in 1 patient (8.3％),cerebrospinal fluid leak in 1 patient (8.3％),and pleural effusion in 2 patients (16.7％).During the follow-up time,there was no patient experienced pseudarthrosis,implant failure,infection or significant loss of correction.Conclusion Based on results of this study,it was concluded that 3-CO procedures through previous spinal fusion sites could obtain satisfactory and safety results in severe spinal deformity revision surgery.However,it is a technique-demanding procedure with more blood loss,longer operative time and higher risk of perioperative complications.

Objective To discuss the value of routine Doppler ultrasound screening for patients underwent total hip arthroplasty. Methods Forty- three patients who received total hip arthroplasty (THA) in our hospital from April 2014 to April 2015 were included and their Doppler ultrasound screening results were analyzed. Results Of the 43 cases, two patients were diagnosed as deep venous thrombosis (DVT) by Doppler ultrasonography screening and received corresponding intervention promptly. Conclusion Routine Doppler ultrasound screening has important significance for patients underwent total hip arthroplasty.

Catalpol, an iridoidglucoside found in the root of RehmanniaglutinosaLibosch. This study was designed to investigate the effects of catalpol on the proliferation and osteogenic differentiation of rat BMSCs in vitro. When rat BMSCs cultivated in the basal medium or the osteogenic induction medium (OS with or without catalpol), cell proliferation was analyzed using an MTT and BrdU assay; and the osteogenic differentiation was assessed by alkaline phosphatase activity detection, mineralization and determination of osteogenic marker genes expression. Here, we demonstrated that rat BMSCs cultured in the basal medium with low dose catalpol (lower than 50 mu g/ml) caused a significant increase in proliferation. Furthermore, Catalpol treatment increased the ALP activity, mineralization (Alizarin red S staining) and mRNA levels of ALP, OC, and BSP genes (as osteogenic makers), whereas decreased protein expression of PPAR gamma 2 (as an adipogenic marker) during osteogenic induction. In conclusion, catalpol could stimulate BMSCs proliferation and promote their osteogenic differentiation by upregulating expression of osteogenic marker genes in a dose-dependent manner. Thus, catalpol may play an important therapeutic role in osteoporosis patients by improving osteogenic differentiation of BMSCs.

RATIONALE:Severe post-laminectomy spinal deformity associated with late-onset paraplegia is a complex and rare disorder. Little is known about revision surgery in post-laminectomy rotokyphoscoliosis associated with late-onset paraplegia treated by the single stage posterior-only vertebral column resection (VCR) procedure.PATIENT CONCERNS AND DIAGNOSES:The patient was a 14-year-old male diagnosed as post-laminectomy rotokyphoscoliosis associated with late-onset paraplegia. He underwent posterior total laminectomy through the thoracic spine for intramedullary spinal cord tumors at the age of 3 years in another hospital. He then developed kyphosis deformity 1 year after laminectomy, and underwent posterior spinal fusion without instrumentation at 9 years of age. However, the deformity gradually progressed over the years. Seven months before admission to our hospital, he developed a significant progression of neurological deficits, including weakness of strength and sensation in lower extremities bilaterally, with no bladder or bowel dysfunction. There was no improvement of spinal cord function with conservative measures, and he required a wheelchair for movement.INTERVENTIONS:The patient underwent posterior-only VCR by single stage with the purposes of spinal cord decompression and spinal deformity correction.OUTCOMES:Postoperatively, he was transferred to the intensive care unit (ICU) and required positive pressure ventilation support to improve his respiratory condition. The child experienced cerebrospinal fluid leak (CSF) which resulted in an unplanned return to the operating room. The neurological function improved from preoperative Frankel C to Frankel D within 12 months of surgery, and recovered completely to Frankel E by 18 months. At the 24 month follow-up, the good neurological function was maintained; pulmonary function tests (PFTs) revealed improved forced vital capacity (FVC) and forced expiratory volume for 1 second (FEV1). The patient's coronal major curve and sagittal kyphosis were corrected from 70° to 21°, and 170° to 75°, respectively.LESSONS:These findings demonstrated that single-stage posterior-only VCR is efficacious but challenging for revision surgery in post-laminectomy rotokyphoscoliosis associated with late-onset paraplegia.