>脊柱融合的理念源始于关节融合技术，即用不动的关节来替代随活动而疼痛的关节。脊柱融合与骨折愈合不同，前者是通过特定的外科技术和材料来实现骨组织终身生物性连接，让“链条式脊柱“变成“柱式脊柱”（并非理想的生理模式脊柱），达到治疗部分脊柱疾病的目的。
目的:通过脊柱单侧双通道内镜技术(UBE)治疗椎间孔型腰椎间盘突出(ILDH)的临床研究,设计了一种基于椎间孔区三维解剖结构的超远外侧入路(FFLB)并评价其临床应用价值.方法:回顾性分析2020年1月至2022年1月收治的12例ILDH患者的临床资料.男4例,女8例;年龄26～68岁,平均(46.5±11.8)岁;体重指数21.1～27.8 kg/m2,平均(25.04±1.94)kg/m2;记录手术时间、住院时间,对比分析手术前后的疼痛视觉模拟评分(VAS)、日本骨科协会(JOA)评分、直腿抬高角度、MRI矢状位和轴位椎间孔距离.结果:所有患者手术顺利完成,手术时间40～90 min,平均(67±15)min.术后随访时间6～13个月,平均(7.5±2.2)个月.术后即刻、术后3个月和术后6个月的腰腿痛VAS评分均低于术前,JOA评分高于术前,差异有统计学意义(P＜0.05);直腿抬高角度大于术前,差异有统计学意义(P＜0.05);MRI轴位椎间孔内孔、正中央、外孔前后距离均大于术前,差异有统计学意义(P＜0.05);MRI矢状位椎间孔上区和下区的椎间孔内孔、正中央、外孔前后距离均大于术前,差异有统计学意义(P＜0.05).结论:FFLB增加了操作器械的外展角,方便椎间孔内外操作.准确的初始定位和清晰的三维解剖结构为治疗ILDH提供了新选择.
Objective:To explore the clinical diagnostic features and the causes of misdiagnosis of Keegan′s disease.Methods:3 patients with Keegan's disease treated in Orthopedics Department of Air Force Medical Center Affiliated to Air Force Medical University from March 2018 to December 2020 were selected. Their diagnosis, differential diagnosis and outcomes were analyzed, and the relevant literatures were reviewed.Results:There were 3 patients, 1 male and 2 females, aged 36, 36 and 47 years old, respectively. All the patients had restricted abduction of the right shoulder without obvious inducement, and lateral soreness when lifting the right upper arm. The muscle strength of deltoid muscle and biceps brachii of the right upper limb was significantly reduced, with no symptoms and signs of spinal cord damage and paresthesia. There were typical selective "high spots" in MRI T2WI, and clear neurological damage of the deltoid and biceps in electrophysiology, in line with all the clinical features of Keegan′s disease. With conservation treatment, all patients began to get better 2 to 3 weeks and recovered 11 to 13 weeks after onset.Conclusion:Shoulder abductor dysfunction without paresthesia is a typical clinical feature of Keegan′s disease.
Objective:To discuss the influence of high load and weightlessness environment on intervertebral disc by observing and analyzing the imaging changes of the spines in New Zealand white rabbits and the content changes of matrix metalloproteinase (MMP) and tissue inhibitor of metalloproteinase (TIMP) in the intervertebral disc under high load and weightlessness environment, and to provide theoretical basis for prevention and delay of lumbar intervertebral disc degeneration under high load and weightlessness environment.Methods:A total of 120 New Zealand white rabbits with balanced age and body weight were randomly and averagely divided into control groups (further grouped by 30 d, 60 d and 90 d) and high load/weightlessness groups (further grouped by 30 d, 60 d and 90 d) with residual single-blind method. High load was simulated by animal centrifuge and weightlessness was simulated by tail suspension. The imaging changes and the positive expression rates of MMP1, MMP3 and TIMP1 in intervertebral disc were detected, and the statistical differences between the high load/weightlessness group and the control group in different time periods were compared, as well as among the different exposure time in load/weightlessness groups.Results:From the imaging observation, the T2-weighted images of lumbar 6 sacral 1 intervertebral disc in experimental animals decreased to some extent. The positive rates of MMP1 and MMP3 in each high load/weightlessness group were higher than those in the control group for the same exposure time, and the differences were statistically significant ( t=22.97-145.51,all P<0.001). The positive rates of MMP1 and MMP3 increased with the extension of exposure time, and there were statistically differences among the groups with different exposure time in high load/weightlessness group ( F=2531.10, 1758.80, both P<0.001). The positive rate of TIMP1 in each high load/weightlessness group was higher than that in the control group for the same exposure time, and the difference was statistically significant ( t=29.34-65.05, all P<0.001). There was statistically difference on TIMP1 positive rate among different load/weightlessness exposure time groups ( F=462.20, P<0.001). Conclusions:High load/weightlessness can cause the MMP1, MMP3 and TIMP1 content changes in animal lumbar disc. The changes of TIMP1 are obvious in the early stage and the sensitivity is decreased in the late stage. High load/weightlessness may lead to changes in the contents of MMP and TIMP in intervertebral discs, which may accelerate intervertebral disc degeneration.
目的 研究自噬在结核菌素纯化蛋白洐生物(PPD)诱导破骨细胞形成中的作用及机制.方法 培养小鼠单核巨噬细胞(RAW264.7细胞),用不同浓度(1.0、2.5、5.0、10.0 IU/mL)PPD及自噬激动剂雷帕霉素、自噬抑制剂3-甲基腺苷(3-MA)处理.处理24 h后,检测细胞活力;处理7 d后,检测破骨细胞数量、抗酒石酸酸性磷酸酶(TRAP)活力、自噬小体数目及自噬标志基因Beclin-1、LC3-Ⅱ/LC3-Ⅰ的表达水平.结果 与对照组相比,10.0 IU/mL PPD组细胞活力降低,差异有统计学意义(P<0.05),1.0、2.5、5.0 IU/mL PPD组细胞活力无明显变化.与对照组相比,2.5、5.0、10.0 IU/mL PPD组破骨细胞数量、TRAP活力、自噬小体数目及Beclin-1、LC3-Ⅱ/LC-Ⅰ的表达水平均明显增加,差异有统计学意义(P<0.05).与5.0 IU/mL PPD组相比,5.0 IU/mL PPD+激动剂组破骨细胞数量、TRAP活力、自噬小体数目及Beclin-1、LC3-Ⅱ/LC-Ⅰ的表达水平均明显增加,差异有统计学意义(P<0.05);细胞活力无明显变化.与5.0 IU/mL PPD组相比,5.0 IU/mL PPD+抑制剂组破骨细胞数量、TRAP活力、自噬小体数目及Beclin-1、LC3-Ⅱ/LC-Ⅰ的表达水平均明显降低,差异有统计学意义(P<0.05);细胞活力无明显变化.结论 PPD能够诱导破骨细胞形成,其机制与自噬激活有关.
目的 通过脊柱单侧双通道内镜技术(unilateral biportal endoscopy,UBE)与脊柱显微内镜手术(microendoscopic disectomy,MED)治疗腰椎间盘突出的临床比较,对手术路径进行改良,评价UBE在脊柱内镜手术中的优势及"三角技术"在UBE手术中的应用价值.方法 根据纳入排除标准选取2019年1月—2020年4月单纯腰椎间盘突出的患者38例(40个节段).分为2组,UBE组手术18例,MED组手术20例.手术相关指标包括年龄、平均住院时间、术后平均住院时间、平均随访时间.效果评价包括下肢疼痛VAS评分、下腰痛JOA评分和直腿抬高试验角度(angle of lasegue sign,ALS).并发症包括硬膜撕裂、神经根损伤、关节突切除、术后复发、软组织水肿等.结果 UBE组手术时间大于MED组,差异有统计学意义(P<0.05);2组下肢疼痛VAS评分、下腰痛JOA评分和直腿抬高试验角度终末随访、出院与术前比较差异有统计学意义(P<0.05);2组出院时下腰痛JOA评分比较,差异有统计学意义(P>0.05).结论 尽管UBE与MED技术在治疗椎间盘突出的术后效果一致,但手术并发症明显少于MED.UBE具有放大倍数高、优质的照明、扩大的视野、三维立体物像、良好的器械操控性等特点."三角技术"在UBE手术中能够发挥其特有的技术优势.
随着全球人口老龄化的加速,退变性脊柱疾病的发生率和致残率不断升高,已成为老年社会面临的健康、卫生、经济及社会问题.同时,由于医学认知的提高和医疗技术的进步,越来越多老年退变性脊柱矢状问题得到诊断和治疗.然而,在获得部分临床效果的同时,由于对退变性脊柱矢状位平衡与失衡的科学认识尚不完全清晰,在此基础上实施的手术治疗尚有部分效果不佳,并发症较多,翻修手术率高,存在过多医疗依赖,经济负担重.目前,国际上越来越多的学者强调:务必正确认识老年退变性脊柱矢状位平衡与失衡,严格把握手术指征,慎重选择手术,努力降低各种并发症,提高卫生经济品质,使临床效果和社会效益最大化,最终让患者和社会获益.
Objective:To compare the clinical effects between Dynesys dynamic stabilization with microendoscopic discectomy (MED) and posterior lumbar interbody fusion (PLIF) treatment for the degenerative lumbar spinal stenosis in the elder, and to evaluate clinical advantages of Dynesys with MED according to enhanced recovery after surgery (ERAS).Methods:All of 79 cases (male 31, female 48) who suffered from the degenerative lumbar spinal stenosis were include mean age 67.32±5.88 years (from 60 to 81 years) during January 2012 to December 2017. Thirty-nine patients received Dynesys dynamic stabilization with MED (Dynesys group) and 40 cases undergone PLIF (fusion group). The operative time, blood loss, drainage, length of hospital stay, and complications were compared between the two groups. The visual analog scale (VAS), Oswestry disability index (ODI) were used to assess efficacy. The range of motion (ROM) of the lumbar spine and the adjacent segment by dynamic radiographs between two groups were reviewed to evaluate radiological results.Results:The fusion group was larger than Dynesys group in operation time (271.00±57.19 min vs. 193.85±32.17 min), blood loss (458.25±136.85 ml vs. 316.41±87.64 ml), drainage (143.12±47.46 ml vs. 101.67±31.23 ml) and length of hospital stay (15.70±3.01 d vs. 13.38±2.72 d) with statistics differences ( P<0.05). There was a significant difference in VAS and ODI between the two groups at the final follow-up, and Dynesys group was superior to the fusion group (VAS: 1.51±1.21 vs. 2.40±1.48, t=2.910, P=0.005; ODI: 11.90%±6.15% vs. 17.73%±6.85%, t=3.974, P<0.001). The lumbar ROM of Dynesys group increased comparing with the fusion group at post-operation one year (19.21°±6.08° vs. 14.08°±5.80°, t=0.425, P<0.001) and final follow-up (20.56°±6.37° vs. 16.33°±6.94°, t=2.828, P=0.006). ROM of the adjacent segment increased in fusion group at final follow-up (7.45°±2.45°) compared to pre-operation (4.68°±1.98°) and post-operation one year (4.83±1.43°) with significant difference ( F=24.437, P<0.001). The rate of epidural damage, delayed union, surface infection, internal fixation loose, thrombus, pulmonary infection, bedsore, reoperation of the fusion group were all higher than Dynesys group. Conclusion:The Dynesys with MED demonstrated better clinical and radiological results than fusion for degenerative lumbar spinal stenosis. As a method of safety and efficiency, the Dynesys and MED can speed up postoperative recovery of elderly patients in line with ERAS.
介绍了几种国内外足底压力分布测量装置,阐述了足底压力分布测量装置在空降兵跳伞训练中足底压力测量、士兵行走或跑步时足底压力测量中的应用,分析了该装置应用中存在的问题并给出了改进建议,指出了其在预防军事训练伤、指导军事训练中异常步态的矫正和预防军事训练伤护具的研发方面具有良好的应用前景.
Objective:To analyze the kinematics of causing spine injury by calculating the force and torque applied on spine with reverse kinematics method upon the simulated parachute landing test, and to provide theory base for the guidance of parachuting training.Methods:Twenty-three male active paratroopers without extremity trauma or spinal diseases volunteered to participate in this study. Their average height was (175.78±2.34) cm and average weight was (71.05±4.73) kg. All subjects respectively jumped from 40 cm- and 120 cm-platforms with a standard half-squat posture to the land point. The Vicon 3D motion capture system was used to record the jump process and the AMTI 3D force measuring platform was used to measure the ground reaction force. The biomechanical simulation model of spine and lower limbs was established by AnyBody Modeling System. All the experimental data were introduced into the model with the C3D format for kinematics and kinetics analysis. The measurements included the upper and lower spine torque and joint reaction force of lumbar segments. The maximum torque was compared between different height jumps and between the upper and lower spine ends in same height jumps.Results:The torques measured from the upper and lower spine ends had no statistical significance in both height jumps ( P>0.05 ). The maximum rotational torque and lateral torque of lower spine were significantly larger than those of upper spine in same height jumps ( Z=2.972-4.107, P<0.01), while the flexion and extension torques were not statistically different between two height jumps ( P>0.05). Compared to 40 cm jump, the vertical and the shearing forces on the lumbar segments (excluding L 3-4) significantly increased in 120 cm jump ( t=3.525-4.873, P<0.01), and the lateral force significantly increased at T 12-L 1 segment ( t=2.293, P<0.05). In the same height jumps, the vertical reaction forces on bottom-up lumbar segments decreased gradually. The anteroposterior shearing forces were in opposite directions at upper and lower spine ends and symmetrical distributed, and showed statistical significance among segments ( F=70.651, 85.101, P<0.01). The right and left lateral forces of spine were weak and showed insignificance among segments ( P>0.05). Conclusions:①Maintaining the stability of head, cervical spine, lumbar spine and pelvis would be helpful to avoid injuries. It's necessary to improve the strength of the muscles surrounded spine. ②The vertical and anteroposterior shearing forces would be the main reason led to low back pain. ③The ground training method should be more scientific to improve the impact tolerance and spatial perception.
椎间融合器(interbody fusion cage)联合椎弓根钉棒系统实施腰椎后路减压融合内固定术是治疗腰椎退变性疾病如腰椎管狭窄症、腰椎滑脱症、腰椎间盘突出症合并腰椎不稳等的常用手术方法,包括后路腰椎椎间融合术(posterior lumbar interbody fusion,PLIF)和经椎间孔入路腰椎椎间融合术(trans-foraminal interbody fusion,TLIF),取得了良好的效果.但是有0.9％～4.7％的腰椎后路手术患者由于椎间融合器应用不规范,术后出现椎间融合器相关并发症,给后续治疗带来困难[1～5].为了正确规范地应用椎间融合器,减少椎间融合器相关并发症的发生,《中国脊柱脊髓杂志》编辑部组织的国脊沙龙邀请20余位脊柱外科专家,在循证医学的基础上,经多轮专家讨论,形成以下共识,供脊柱外科医师参考.
目的 通过逆向动力学测定半蹲式跳伞着陆(half-squatparachute landing,HSPL)过程中髋周肌组织的肌肉激活度,研究不同高度和水平距离对髋周肌肉激活度的影响.方法 选取22名健康空降兵,受试者分别从40 cm和120 cm 2种高度以半蹲式着陆姿势跳落(120 cm高度增加水平距离80 cm),利用三维运动捕捉系统记录运动数据并导入AnyBody分析软件,建立下肢数据模型.测定髋周五组肌肉的最大肌肉激活度,包括髂腰肌、股直肌、缝匠肌、股二头肌、臀大肌.结果 不同高度:随着高度增加,5组肌肉激活度增加,差异具有统计学意义(P<0.05).2种高度下,髂腰肌、股直肌和缝匠肌峰值较高.臀大肌的激活度始终维持在15％,其曲线较为平缓,波动幅度小.不同水平距离比较:随着水平距离增加,5组肌肉激活度增加,差异具有统计学意义(P<0.05).不同水平距离时髋周肌肉激活度曲线中5组肌肉都具有2个波峰,髂腰肌、缝匠肌的波峰最大.120-80 cm臀大肌幅度波动较大,而在120-0 cm并未出现.结论 髂腰肌、股直肌是髋部受力缓冲的主要肌肉,缝匠肌、股二头肌、臀大肌维持冠状位的髋部稳定.水平距离可增加关节屈曲度,使髋部损伤的风险增加.
目的 在佩戴不同腰部护具条件下,模拟空降平台半蹲式跳伞着陆(half-squat parachute landing,HSPL),分析腰部护具对脊柱屈曲活动的影响.方法 我科于2016年8月招募空降兵集训队共30名战士,男性,平均年龄(22.79±3.73)岁.分别进行不佩戴护腰(对照)、佩戴弹性护腰和半钢性护腰测试,每种防护测试分别从40 cm和120 cm平台跳下,以半蹲式着陆姿势着陆,双足落在测力台有效区域内.测试过程中使用Vicon动态捕捉系统记录脊柱-骨盆夹角(spine-pelvic angle,S-PA)和屈曲角速度(spine flexion angular velocity,SFAV).同一高度及防护状态下重复测试3次,每次测试间隔2 min,取有效数据记录.结果 1)防护方式维度:40 cm高度,受试者佩戴半钢性护腰和弹性护腰与无护腰比较,脊柱-骨盆夹角增大,差异有统计学意义[(158.78±12.49)°、(155.45±15.13)°vs(146.01±16.19)°,P均<0.05],三组间脊柱屈曲角速度差异无统计学意义[(211.68±13.29)°/s vs(193.29±10.67)°/s vs(222.53±11.75)°/s,P均>0.05].120 cm高度,受试者佩带半钢性护腰、弹性护腰、无护腰时,脊柱-骨盆夹角依次降低,组间比较差异均有统计学意义[(153.66±8.79)°vs(143.76±17.43)°vs(133.84±13.73)°,P均<0.05],前两组与无护腰比较,屈曲角速度均显著减小[(311.85±17.26)°/s、(290.12±14.73)°/s vs(389.94±23.40)°/s,P均<0.05],但这两种护腰间差异无统计学意义(P>0.05).2)高度维度120 cm较之于40 cm,无论是否佩戴护腰,脊柱-骨盆夹角均减小,脊柱屈曲角速度均增加,组间差异均有统计学意义(P<0.05).结论 地面平台训练,护腰可以减少脊柱屈曲角度,降低脊柱屈曲角速度,半刚性护腰与弹性护腰相比,未显示出明显优势,弹性护腰可能更适合于空降部队训练防护.
从临床角度看,狭义的“骨质疏松性脊柱骨折”特指的是“骨质疏松性椎体压缩骨折”(osteoporotic vertebral compression fractures,OVCFs),而广义的是指伴有骨质疏松(osteoporosis,OP)的各种类型的脊柱骨折(osteoporotic spine fractures,OSFs).本刊于2016年曾刊登过孙常太教授的述评[1],重点就OVCFs现代治疗,即经皮椎体成形术(percutaneous vertebroplasty,PVP)和经皮椎体后凸成形术(percutaneous kyphoplasty,PKP)的发生、发展、临床特点及适应证进行了述评.随着PVP和PKP等椎体加强术的开展、经验积累、技术提升、器械改进,在临床疗效普遍得到认可的同时,有关其他类型OSFs的内固定理念和技术也迅速得到改进.结合贵刊本期中发表的数篇有关OVCFs和OSFs临床研[2-11],笔者就如何再度认识OVCFs和OSFs治疗中存在问题、理念提升、技术改进等浅谈一下个人的经验和体会,希望对读者有所借鉴.
[Objective] To evaluate the clinical outcomes of flexible stabilization (dynamic stabilization system) combined with accurate decompression for treatment of symptomatic degenerative lumbar spondylolisthesis.[Methods] From January 2014 to December 2015,27 patients with symptomatic degenerative lumbar spondylolisthesis underwent the flexible stabilization using Dynesys system combined with accurate decompression.Clinical outcomes were evaluated by using Oswestry disability index (ODI) and visual analogue scale (VAS),and the imaging measurements.[Results] All the patients had operation successfully performed with operative time of (106.96±8.89) min and blood loss of (112.96±23.99) ml on average.Only a patient got dural tear during the procedure.The follow-up lasted for an average of 30.53 months ranged from18 to 39 months.The ODI significantly decreased from (51.22±9.47) ％ preoperatively to (14.04±3.43) ％ at the latest follow-up (P ＜ 0.001).In addition,the back pain and leg pain VAS remarkably decreased from (5.74±1.10) and (5.26±1.29) preoperatively to (1.33±0.68) and (1.22±0.64) at the latest follow-up (P＜ 0.001).Regarding to the image measuring,cross-sectional area of the dural sac significantly increased from (70.03±17.61) mm2 before operation to (134.11±22.53) mm2 at the final follow-up (P＜ 0.001).Although extent of spondylolisthesis did not increased (P ＞ 0.05),the disc height significantly increased at the latest follow-up compared with that preoperatively (P ＜ 0.001).At the final follow-up,the ROM of stabilized segments was preserved (4.25±1.18)°,by comparison,the ROM of upper adjacent segments significantly increased (P ＜ 0.001).[Conclusions] The flexible stabilization combined with accurate decompression for treatment of symptomatic degenerative lumbar spondylolisthesis leads significantly improved clinical outcomes,with advantages of minimized trauma,less blood loss,quicker recovery and less complication.
Objective To study the protective effect of a new protection device for ankle joints of airborne troops and recommend an effective method for reducing ankle injury during landing among airborne troops.Methods One hundred airborne soldiers were equally divided into experiment group and control group.All the subjects jumped off a standard airborne training platform 1.5 m high in training uniforms and paratroopers' shoes while the experiment group additionally wore ankle-protecting devices.Using the telemetering electromyography and FlexiForce(R)'s Economical Load & Force (ELF) system,the stress and respone of ankle joints and the muscle around them were tested and analyzed to confirm the practicability and reliability of protective devices.Results The ankle joint protection devices significantly enhanced the average EMG amplitude of the tibialis anterior muscle and the peroneus longus and brevis muscles before and after touchdown(P＜0.05),but failed to have significant influence on the gastrocnemius(P＞0.05).The experimental group with ankle joint protection apparatus reduced the varus and valgus stress of the ankle joint by more than 50％,and there was statistically significant diference between the two groups(P＜0.05).Conclusion The ankle joint protection device can effectively improve the myoelectricity activity of ankle extensors and limit the range of the varus and valgus of ankle joints,so the new ankle-protecting device has a significant protective effect on ankle joints of airborne troops during landing.
Objective To evaluate the short-term effectiveness of Dynesys stabilization and transforaminal lumbar interbody fusion(TLIF) through Wiltse approach for treatment of lumbar spinal stenosis in elderly patients. Methods The clinical data of 35 elderly patients with lumbar spinal stenosis operated in our hospital from January 2013 to January 2015 were retrospectively analyzed. Fifteen patients were treated using Dynesys internal fixation(Dynesys group),and 20 using TLIF through Wiltse approach(TLIF group). The follow-up period was 12 - 18 months with an average of 16 months. The perioperative indicators (operation time,intraoperative blood loss and volume of drainage),visual analogue scale(VAS) scores,Oswestry disability index(ODI) and the range of motion(ROM) of operative segments and adjacent segments were compared between the 2 groups. Results The operation time,intraoperative blood loss,postoperative drainage volume in Dynesys group were less than those in TLIF group,and the difference was statistically significant(P<0.05). The VAS score of low back pain and ODI at the postoperative 5 d were lower in Dynesys group than those in TLIF group,and the difference was statistically significant(P<0.05). The difference in VAS score of leg pain at the postoperative 5 d was not statistically significant between the 2 groups(P>0.05). At the final follow-up,low back/leg pain VAS scores and ODI significantly improved compared with those at pre-operation in the 2 groups,and the difference was statistically significant(P<0.05),but there was no significant difference between the 2 groups (P > 0.05). The ROM of stabilized segments in Dynesys group was decreased,and the ROM of TLIF group decreased to 0°;compared with preoperation,the difference was statistically significant(P < 0.05). In Dynesys group,there was no significant change in ROM of the adjacent segment at the final follow-up time,while the ROM in the TLIF group was higher than that of preroperation,the difference was statistically significant(P<0.05);there was significant difference between 2 groups(P<0.05). Conclusion The Wiltse approach has advantages of less bleeding,less injury and quick recovery. The Dynesys system does not need support of external fixation,allows the patient to earlyambulate,and can avoid the formation of pseudarthrosis after lumbar interbody fution,remain ROM of the operation segment,and limit hypermobility of the adjacent segment,thus being of unique advantages in the treatment of lumbar spinal stenosis in elderly patients.
Objective To analyze the clinical outcomes of one-stage anterior debridement , dura splitting decompression , one-stage kyphosis correction , bone grafting and internal fixation in the treatment of thoracolumbar tuberculosis .Methods Clinical data of 32 cases with thoracolumbar tuberculosis who underwent above surgeries in our hospital from January 2007 to January 2015 were collected retrospectively.The time of bone graft fusion, and the changes of erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), kyphotic angle ( Cobb angle ) and American Spine Injury Association ( ASIA ) grade before and after treatment were collected and analyzed.Results The average operation time was (177.3 ±14.5) min, and the mean amount of intraoperative blood loss was (492.5 ±170.1)ml.During the postoperative follow-up of (36.9 ±12.7)months (ranging from 18 to 72 months), no recurrence of thoracolumbar tuberculosis was found in all the patients .The time of bone graft fusion was (5.5 ±1.1)months (3-8 months).The levels of ESR and CRP were gradually declined to normal levels at 3 months after operation .Their ASIA grades also went back to normal at the last follow-up.The average angle of kyphosis was decreased from (17.6°±6.4°) preoperatively to (2.5°±1.3°) post-operatively, and then to (3.8°±1.5°) at the last follow-up.No significant loss of correction angle (1.3°±0.6°) was observed, but the angle was greatly improved postoperatively and at the last follow-up when compared with that before operation (P<0.5).At the last follow-up, all patients got solid bony fusion and had no evidences of internal fixation and fracture .Conclusion Anterior operation is suitable to one-stage anterior debridement , dura splitting decompression , one-stage kyphosis correction , bone grafting and internal fixation and reconstruction of spinal stability for thoracolumbar tuberculosis , with satisfying clinical outcomes .
Objective To evaluate mid-term efficacy of unicompartmental knee arthroplasty (UKA) for isolated compartmental osteoarthritis in the elderly.Methods A retrospective study was conducted on 23 patients (24 knees) suffered from isolated compart-mental osteoarthritis admitted in our department from January 2007 to January 2009.They were 4 males and 19 females, at mean age of 61.3 years (52-71 years), and weighted 62.4 kg (55-69 kg).All the patients were treated with endo-model sledge UKA by same surgeon.Preoperative and postoperative knee range of motion (ROM), knee society score (KSS) and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) were compared to evaluate mid-term clinical outcomes.SPSS 17.0 software was used to analyze the data.The measurement data were expressed as mean±standard deviation (±s).Preoperative and postoperative knee ROM, KSS and WOMAC were compared by paired t test.P<0.05 was defined as statistical difference.Results All patients had no contraindication for UKA, none of them turned to suffer knee arthroplasty, and all successfully completed surgery.The operation time was (93.8±11.6)min and the blood loss volume was recorded as (196.7±40.1) ml.No infection or deep vein thrombosis occurred in any patient.All surgical incisions healed well.These patients were followed up for 5-7 years (mean 6.3 years).The ROM, KSS and WOMAC were significantly increased when compared with the values preoperatively (P<0.001).During the follow-up, no prosthesis loosening or revision was found in the patients.Conclusion Under strict control of surgical indications, UKA achieves satisfactory mid-term clinical outcome in treatment of isolated compartmental osteoarthritis, with the advantages of minimal incision and quick recovery.But long-term efficacy needs further research.
