Objective To explore clinical value of the therapeutic effect of subscapularis transthoracic approach for upper thoracic tuberculosis. Methods A total of 21 patients with upper thoracic tuberculosis underwent the subscap-ularis transthoracic,debridement,bony fusion and internal fixation. Results The operation time was ranged 152 ~238 (192 ± 10) min. The blood loss was ranged 600 ~1 800 (1 150 ± 235) ml. The follow-up time was 6 ~48 months. 2 cases were complicated with shoulder joint dysfunction after rehabilitation treatment,and returned to normal shoulder joint activity after follow-up about 6 months. 2 cases were complicated with lung infection. It had been cured after 10 days by anti-infection therapy. At last follow-up, there were 17 patients with spinal cord injury,Frankel scale improved by 1 case,16 cases of nerve function were recovered to normal. The kyphosis Cobb angles were 19° ~30° (24. 8° ± 5. 6°) after operation,with an average correction rate of 30. 9%. Conclusions Posterior debridement,bony graft and instrumentation is reliable and safe for upper thoracic tuberculosis underwent the subscapularis transthorac-ic,which has higher clinical value.

Objective To investigate the clinical efficacy of spinal vertebrae tuberculosis treated by posterior debridement,bone grafting,interbody fusion and posterior internal fixation. Methods 42 patients who diagnosed with spinal tuberculosis were performed posterior debridement,bone grafting,interbody fusion and internal fixation via posterior single approach. Following parameters including Cobb angle,neurological function,fusion ratio,erythrocyte sedimentation rate and C reactive protein. Results The operation time was 75 ~ 140 minutes and blood loss was 500 ~ 1 000 ml. All cases were followed up for 17 ~ 41 months. The postoperative correction rate was 85. 5%,at the last follow-up visit,the correction rate was 79. 8%. Neurologic status of the 21 patients with preoperative neurologic deficit was: 2 with grade A,1 recovered to grade B and 1 recovered to D; 5 with grade B,2 recovered to grade C and 1 recovered to D,2 did not recover; 6 with grade C,4 recovered to grade D and 1 recovered to E,1 did not recover; 8 with grade D,6 recovered to grade E and 2 did not recover. The 3 months after operation,ESR was 5. 0 ~ 14. 0 mm /1 h and CRP was 4. 0 ~ 9. 0 mg / L. All patients got bone fusion after 1 year. Conclusions Surgical treatment by posterior debridement,bone grafting,interbody fusion and posterior internal fixation for spinal tuberculosis is a safe,effective and feasible technique.

Objective To compare the therapeutic effect of debridement,bony fusion and internal fixation through subscapularis transthoracic and posterolateral approach in treating upper thoracic tuberculosis.Methods Between January 2002 to February 2014,a total of 43 patients with upper thoracic tuberculosis were analyzed retrospectively.There were 21 patients in subscapularis transthoracic approach group and 22 patients in posterolateral approach group.Several parameters of the two groups were compared,including gender,age,segmental tuberculosis,intraoperative blood loss,operative time,complications of operation,hospital stay,the cure rate,the Cobb angle,Frankel scale and so on.Results There was no significant difference in gender,age,segmental tuberculosis,ESR,Frankel scale,Cobb angle between the two groups before surgery.The operative time was 196± 10 min in subscapularis transthoracic approach group,whereas it was 142±13 min in posterolateral approach group.The operative time of subscapularis transthoracic approach group was significantly longer than posterolateral approach group.There was no significant difference in intraoperative blood loss,complications of operation,hospital stay and the cure rate.The followed up of subscapularis transthoracic approach group and posterolateral approach group was 28.0± 14.7 months and 27.3± 15.5 months respectively.The preoperative Cobb angle was 36.5°±4.8° and the postoperative Cobb angle was 24.8°±5.6° in subscapularis transthoracic approach group.The correction rate was 30.9％.The preoperative Cobb angle was 34.5°±5.2° and the postoperative Cobb angle was 10.2°±2.6° in posterolateral approach group.The correction rate was 68.5％.Thus,the correction rate of posterolateral approach group was significant better than subscapularis transthoracic approach group.The neurological score of Frankel scale was significantly restored in two groups after operation,and there was no significant difference between two groups.Conclusion For upper thoracic tuberculosis,the therapeutic effect of debridement,bony fusion and internal fixation through subscapularis transthoracic and posterolateral approach could achieve the same good clinical results.However,the posterolateral approach was better than subscapularis transthoracic approach in surgical trauma,surgical duration and kyphosis correction.Therefore,it is recommended to use the posterolateral approach in treating upper thoracic tuberculosis.

Objective To investigate the curative outcomes of total en bloc spondylectomy ( TES ) in the treatment of primary thoracolumbar tumors. Methods From January 2005 to January 2013, 15 patients with primary thoracolumbar tumors underwent TES. Posterior TES was performed on 12 cases, including 2 cases of plasma cell myeloma in T11, osteosarcoma in Ll, plasma cell myeloma in Ll and histiocytic sarcoma in L3 and 1 case of giant cell tumor of bone in L2, solitary plasmacytoma in L2, chondrosarcoma in L2 and osteosarcoma in T7. TES via combined anterior and posterior approaches was performed on 3 cases, including 2 cases of giant cell tumors of bone and paraspinal huge masses in L4 and 1 case of ifbrosarcoma in L4. According to Tomita surgical classiifcation system, all the 15 patients belonged to type III-VI, among whom the TES operative indications were correct. One-stage spinal reconstruction was performed after the tumor resection. The preoperative and postoperative neurological function was evaluated, and the postoperative survival, complications and recurrence were monitored. Results Tumors were resected completely in the 15 patients. The mean operation time was 365 min, and the mean intraoperative blood loss was 3500 ml. All the patients were followed up for a mean period of 29 months ( range;12-60 months ). No local recurrence or distant metastasis was found but in 1 case. The clinical symptoms were signiifcantly improved after the surgery in all the patients. The patient had recurrence died at 1 year after the operation, and the other 14 patients were alive without tumors. The total survival rate was 93.33%. The neurological function scores were improved from ( 3.81±0.98 ) points preoperatively to ( 4.89±0.19 ) points postoperatively, and the differences between them were statistically signiifcant ( t=-5.619, P<0.05 ). Lymphatic ifstula was detected during the operation in 1 patient with plasma cell myeloma in Ll, and rod fracture and spinal instability occurred to this patient at 1 year after the operation. No cerebrospinal lfuid ifstula or incision infection was found in all the patients. Conclusions TES is a reliable technique in the treatment of primary thoracolumbar tumors of surgical indications, with the advantages of satisfactory outcomes and low recurrence rate. In order to reduce complications, the patients should be followed up for a longer period and the technique should be further improved.

Objective To probe the clinical effect of the vertebral column decancellation(VCD)osteotomy for the management of the spinal kyphotic deformity due to ankylosing spondylitis.Methods Twenty-eight patients with spi-nal kyphotic deformity due to ankylosing spondylitis underwent VCD osteotomy.Preoperative and postoperative height,brow-chin angle,distance of sagittal balance loss and Cobb angle of the osteotomy sites were measured to e-valuate the curative effect.Results The operation time was 128~226 minutes,and the intraoperative blood loss was 960~4 580 ml.Dural rupture encountered in operation in 9 patients,and they healed on time by tight suture and drainage.Three patients encountered postoperative pulmonary infection,and recovered by positive anti-inflammatory therapy treatment.Four patients encountered stress gastric ulcer after operation,and recovered through the proton pump inhibitor treatment.The height was corrected from preoperative 1 10.6~135.4(122.6 ±1 1.2)cm to postopera-tive 150.6~175.8(160.8 ±9.66)cm.The brow-chin angle was corrected from preoperative 62°~112°(66°± 26.3°)to postoperative 5.2~21.4°(12.3°±6.2°).The distance of sagittal balance loss was corrected from preop-erative 12~28(16.6 ±4.6)cm to postoperative 4.5 ~13.8(8.6 ±3.2)cm.Cobb angle was corrected from preoper-ative 40°~145°(86.2°±20.3°)with kyphosis to postoperative -19.2°~21.4°(-2.6°±16.1°)with lordosis. The differences were statistically significant(P<0.05).All patients were followed up for 1 ~4(2.6 ±0.5)years. At final follow-up,all the spinal kyphotic deformities of the patients were corrected obviously.Conclusions VCD osteotomy can effectively correct spinal kyphotic deformity due to ankylosing spondylitis,and significantly improve the appearance and quality of life of patients.

脊髓损伤（spinal cord injury,SCI）是医学领域致死率、致残率最高的创伤之一,可直接引起神经轴突中断、神经元坏死、脊髓结构严重破坏导致严重功能缺陷。脊髓损伤后小胶质细胞激活、星形胶质细胞（astrocytes,AS）增殖和胶质瘢痕的形成等[1]是阻碍损伤脊髓轴突有效再生和生长的主要因素。国内外学者先后利用药物治疗、体外诱导及基因技术等