Objective:To evaluate the limbs shortening and re-lengthening in the treatment of tibial infectious bone defect and chronic osteomyelitis.Methods:Between January 2011 and April 2016, 19 cases of tibial infectious bone defect and chronic osteomyelitis were treated with the limbs shortening and re-lengthening technique. There were 13 males and 6 females, aged from 22 to 62 years (mean, 44 years). The causes of injury included traffic accident injury in 16 cases, crush injury in 1 case, and falling from height in 2 cases. One patient was infected after plate internal fixation of closed tibial fracture and 18 patients after external fixation of open tibial fractures (Gustilo type IIIB). The mean previous operation times was 3 times (range, 2-5 times). The time from injury to bone transport operation was 3-11 months (mean, 6.5 months). The bone defect length was 2.0-5.5 cm (mean, 4.3 cm) after debridement. After tibial shortening, limb peripheral blood supply should be checked after release of the tourniquet. Seven wounds were closed directly, 5 were repaired with adjacent skin flap, 5 were repaired with sural neurovascular flap, 1 was repaired with medial head of gastrocnemius muscle flap, and 1 underwent skin grafting. Single arm external fixator or ring type external fixator were used, and completely sawed off between 2 sets of external fixation screws at proximal and distal metaphysis of the tibia. Limb lengthening was performed after 1 week with the speed of 1 mm/d.Results:All patients were followed up 10-36 months with an average of 14 months. Two cases delayed healing of the wound after operation, and the other wounds healed primarily. Natural healing of the opposite end of the bone were found in 18 cases, and 1 case had nonunion in the opposite end of the bone because of incomplete removal of lesion bone. There were 5 cases of slow growth of the callus, and healed smoothly by "accordion" technology and injecting red bone marrow in 4 cases, and by bone grafting and internal fixation in 1 case. The time of bone lengthening was 1-3 months, the prolongation index was 1.6-2.7 cm/month (2.20 cm/month). The bone healing time was 7-13 months (mean, 11.1 months). According to tibial stem diagnostic criteria Johner-Wruhs score, 9 cases were excellent, 8 cases were good, 2 cases were fair, with an excellent and good rate of 89.5%.Conclusion:Limbs shortening and re-lengthening is an effective method for the treatment of tibial infectious bone defect and chronic osteomyelitis, with the advantages of improving the immediate alignment of the osteotomy ends, significantly shortening the bone healing time of opposite ends of bone.

Objective To explore the perioperative management and surgical outcomes of fracture-dislocation of the upper cervical spine complicated with vertebral artery injury.Methods We retrospectively analyzed the clinical data of 19 patients diagnosed with fracture-dislocation of the upper cervical spine complicated with vertebral artery injury who had been treated at our department from January 2008 through December 2012.They were 14 males and 5 females,aged from 22 to 53 years (mean,35.2 years).All the patients had fractures of the atlas and/or axis,and disordered atlanto-axial relationship as well.According to Frankel grading system,8 cases were Grade D and 11 Grade E.The cervical posterior fixation with pedicle screws was adopted for all and hemostasis was conducted for those with bleeding from the broken vertebral artery.Their Frankel grade,Japanese Orthopedic Association (JOA) score and visual analogue scale (VAS) score were compared between preoperation and final follow-up.Results Intraoperative hemorrhage occurred in 2 patients from the injured vertebral artery.Hemostasis was achieved through direct tamponade with bone wax and gelatin sponge in one and through endovascular intervention after bleeding control by direct tamponade in another.Neither of them presented with symptoms of posterior circulation ischemia after operation.The mean operation time was 153.5 min,and the mean blood loss was 542.1 mL.All the patients were followed up for an average time of 28 months.Bony union was obtained in all after an average time of 13.5 weeks.Follow-ups revealed no ischemic stroke in this series.Symptoms of transient ischemic attack,like transient dizziness and blurred vision,appeared in 2 patients.At the final follow-up,all the patients were assessed as Frankel Grade E.Their mean JOA and VAS scores were significantly improved from 8.1 ± 1.2 and 7.0 ± 1.7 preoperatively to 12.7 ± 1.6 and 1.3 ± 1.2,respectively (P ＜ 0.05).Conclusions Angiography examination is routinely indicated for the patients with fracture-dislocation of the upper cervical spine perioperatively.Preoperative evaluation of the vertebral artery and its adjacent structures and effective intraoperative hemostasis can avoid uncontrollable bleeding during operation,reduce postoperative complications,and improve surgical outcomes.

Objective: To explore the expression of ether à go-go 1 (Eag1) in human osteosarcoma and its molecular mechanisms of regulating the malignant phenotype of osteosarcoma. Methods: The expression levels of Eag1 in osteosarcoma cell lines and human osteosarcoma tissues were detected by reverse transcription polymerase chain reaction (RT-PCR), western blot analysis and immunohistochemistry. The small interfering RNA (siRNA) was used to inhibit the expression of Eag1. The abilities of proliferation and invasion in osteosarcoma cells transfected with Eag1 siRNA were determined by CCK-8, colony formation assay, transwell assay and wound healing assay. The osteosarcoma xenograft model of nude mouse was established and tumor growth curve was drawn. Western blot analysis was performed to detect the expression of vascular endothelial growth factor (VEGF) and signal transducer and activator of transcription 3 (STAT3) in osteosarcoma cells transfected with Eag1 siRNAs. Results: Eag1 was overexpressed in the osteosarcoma cells and tissues. Compared with the scrambled siRNA group, the cell survival rates of Eag1 siRNA1 and Eag1 siRNA2 groups of the two cell lines were significantly lower. [MG-63 cells: scrambled siRNA group (100.0±4.65)%, Eag1 siRNA1 group (63.57±3.89)%, and Eag1 siRNA2 group (54.13±3.70)%; Saos-2 cells: scrambled siRNA group (100.00±5.46)%, Eag1 siRNA1 group (56.70±5.34)%, and Eag1 siRNA2 group (40.27±5.28)% (P<0.001 for all)]. Similar results were obtained from colony formation assay. The colony formation rates of MG-63 cells: the scrambled siRNA group was (92.00±3.46)%, Eag1 siRNA1 group (60.00±3.06)%, and Eag1 siRNA2 group (53.67±2.40)%; the colony formation rates of Saos-2 cells: the scrambled siRNA group was (92.00±5.57)%, Eag1 siRNA1 group (52.33±5.13)%, and Eag1 siRNA2 group (41.67±2.73)%. Compared with the scrambled siRNA group, P<0.001 for all. The tumor volumes of osteosarcoma xenograft in the Eag1 siRNA1 and Eag1 siRNA2 groups were significantly smaller than that in the scrambled siRNA group after 10 days treatment (P<0.01 for all). The invasion assay data showed that MG-63 and Saos-2 cells transfected with Eag1 siRNAs exhibited the ability of cell invasion, when compared with the cells transfected with scrambled siRNA. (Invasive cell number of MG-63 cells: the scrambled siRNA group was 134.00±3.61, Eag1 siRNA1 group 105.20±2.52, and Eag1 siRNA2 group 91.00±3.01; Invasive cell number of Saos-2 cells: the scrambled siRNA group was 132.30±3.23, Eag1 siRNA1 group 114.30±3.48, and Eag1 siRNA2 group 82.67±6.33. Compared with the scrambled siRNA group, P<0.01 for all. The migration rates were (62.48±1.83)%, (35.98±1.23)% and (32.30±1.20)% in the three groups of MG-63 cells, and (70.15±1.42)%, (41.38±1.34)% and (32.40±1.92)% in the three groups of Saos-2 cells, respectively. Compared with the scrambled siRNA group, P<0.001 for all. Notably, the expression levels of VEGF decreased evidently after Eag1 siRNAs transfection, paralleled with reduction in the expression levels of STAT3. Conclusions: Eag1 may promote osteosarcoma cell proliferation and invasion by targeting STAT3-VEGF pathway and may be a potential therapeutic target for osteosarcoma.

This study aims to evaluate clinical efficacy of short segment pedicle screw fixation without bone fusion for unstable thoracolumbar burst fracture. Nineteen patients younger than 40 years old with unstable thoracolumbar burst fractures were included. The surgical procedure included postural reduction for 3 days and screw fixations at one level above, one level below and at the fractured level itself. The implants were removed 12 months after initial operation. Imaging and clinical findings were analyzed at preoperative, 12 months after surgery, just before implant removal, and at six months after implant removal. Results indicated that difference was statistically significant between preoperative period or postoperative 1 year follow-up, just before implant removal and 6 months after implant removal (P < 0.05). Results at postoperative 1 year follow-up, just before implant removal and 6 months after implant removal were better than preoperative period. There were no significant complications or neurological deterioration after screws insert and removal in any patient. The rate of clinical outcome with excellent and good was 94.7%. In conclusion, short segment pedicle screw fixation without bone fusion can be an effective and safe operative srategytechnique in the management of young patients suffering from unstable burst fracture.

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.

To investigate the short and medium term outcomes of bone defect reconstruction with bone cement prosthesis after clavicle malignancies resection.

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

Objectives: To observe the effect of resveratrol on the expression of TNF-α and IL-1 in dorsal root ganglion(DRG) neuron after auto-transplantation of nuclear pulposus in rat model.Methods: Forty-eight Sprague-Dawley rats were divided randomly into 4 groups: fat+normal saline group(group A),nucleus pulposus+normal saline group(group B),nucleus pulposus+dexamethasone(group C) and nucleus pulposus+resveratrol group(group D),with 12 rats in each group.All rats underwent laminectomy,which exposed the dorsal nerve root of left L4 and L5,and then in group B,C and D,autologous nucleus pulposus was transplanted around the nerve root,while in group A,autologous adipose tissue was transplanted instead.Sevens days after operation,six rats in each group were killed randomly and the left dorsal nerve roots were obtained,while the other rats in group D,resveratrol was given by intraperitoneal injection once a day and lasted for 5 days.In group C dexamethason was given,and in group A and B,saline was given in the same way.Then,at the 14th day,dorsal nerve roots of left L4 and L5 obtained from the other rats experienced HE staining,immunohistochemical staining(IHC) for TNF-α and IL-1,the TNF-α positive cells and the IL-1 apoptosis cells were measured under light microscope.The experimental data were analyzed by SPSS 17.0 statistical software.Results: There was no significant inflammatory reaction in group A.At 7 days,in group B,C,D,the arrangement between cells in DRG were loose and presented hyperemia and edema,ganglion cells Nissl bodies disappeared,vacuolar degeneration,nucleus disappearance,inflammatory cells infiltration,capillary dilatation,vacuolar degeneration in some myelin were evidenced.At 14 days,the inflammatory reaction was still evidenced in group B,while the pathological changes in the DRG were lighter in group C and D compared with group B,which included fewer disappearance of nissl bodies,just fewer vacuoles degeneration in nissl bodies and fewer inflammatory cell infiltration,and also the myelin vacuolar degeneration was lighter.The expressions of TNF-α and IL-1 in group B,C and D were apparently higher than group A at 7 and 14 days(P0.01).The expressions of TNF-α and IL-1 in group C and D were apparently lower compared with group B(P0.01) at 14 days,but there was no difference between group C and D(P0.05).Conclusions: Autologous nucleus pulposus can induce inflammatory reaction in the DRGs.Resveratrol can alleviate the reaction through reducing the expression of TNF-α and IL-1 in DRGs.

PURPOSE:Our goal was to observe the midterm results of a case series of Denis type B thoracolumbar burst fracture treated with anterior decompression with single segmental spinal Interbody fusion. METHODS:Twenty patients with Denis type B thoracolumbar burst fractures underwent anterior decompression with single segmental spinal Interbody fusion. They underwent clinical and radiologic follow-up for at least three years after the surgery. RESULTS:The mean follow-up period lasted 57 months. To the last follow-up, there were no cases of internal fixation loosening, failure and other complications. Titanium mesh or interbody bone grafts were in good position. Spinal kyphosis was not observed. Interbody fusion was achieved for all cases. The average fusion time was 4.5 months. Based on visual analogue scale (VAS) pain scores, percentage of vertebral body height loss and Cobb angle, the difference was statistically significant between the preoperative period and postoperative one year or final follow-up (P < 0.05). Results at postoperative one year and final follow-up were better than the preoperative period. However, the difference was not significant between postoperative one year and final follow-up (P > 0.05). CONCLUSIONS:Good midterm results on clinical and radiologic evaluation of anterior decompression with single segmental spinal Interbody fusion for suitable patients with Denis type B thoracolumbar burst fracture can be achieved. The incident rate of relative complications is low.

Objective To investigate the clinical effect of portable bracket of lower limb and revolving self-lock nail fixation for tibia fracture.Methods 47 patients of tibia fracture were treated with closed reduction and fixation with tibia revolving self-lock nail applied with the portable bracket of lower limb.Results The time of the operation varied from 20 ～ 40 mintues.45 cases were followed up for 12 ～ 30 months with good bone union(Only 1 case of multiple trauma was delayed healed 8 months after the operation).The results were evaluated by Johner-Wruh scoring system,which were excellent in 37 patients,and good in 8.Conclusions Revolving self-lock nail applied with the portable bracket of lower limb for tibia fracture is convenient,minimally invasive and satisfactory in therapeutic effect.

Objective To explore the treatment of transpedicular decompression and pedicle screw fixation for the treatment of kyphosis after thoracolumbar fractures.Methods 18 cases of kyphosis after thoracolumbar fractures were treated through transpedicular decompression and pedicle screw fixation.Results All the patients were followed up 24 ～ 62(47.7 ± 9.5) months.Preoperative ASIA score was 34.6 ± 7.2(range: 25 to 44).The ASIA motor scores of the patients were 47.7 ± 9.5(range: 35 to 50) and the patients improved their neurologic function by about 13.1 ± 3.1 ASIA motor scores at final follow-up.The preoperative kyphotic angle was 27.89° ± 4.63°(range: 21°to 35°).The mean postoperative kyphotic angle was 4.13° ± 0.87°(range: 2°to 8°) and the kyphotic angle of correction was 23.7° ± 3.3°,there was only about 1.3° ± 0.2° of Cobb angle lost at final follow-up.Complications were not found including deep infection,pedicle screw breakage and spine injury increased.Conclusions The treatment of transpedicular decompression and pedicle fixation is significant for kyphosis after thoracolumbar fractures.The technique is a recommended treatment for kyphosis after thoracolumbar fractures.

Objective To observe the expression level of vascular endothelial growth factor(VEGF) and cells apoptosis at different time points after rats suffering acute spinal cord injury,further in-depth understanding of the pathological changes after spinal cord injury.Methods Female SD rats,which were randomly divided into control group(A group),spinal cord injury group(B group),with 30 animals in each group.The 60 rats were surgically removed the vertebral lamina of T12 segment to expose the spinal cord.And then in A group,the spinal cord was untouched;in B group,the spinal cord was hit by power of 10 g×6 cm according to the improved Allen′s method to establish rat acute spinal cord injury model,then 5 randomly selected rats were sacrificed at 1,3,5,7,14,28 d after injury,materials were obtained from the injury locations following by immunohistochemical staining(IHC) of cell apoptosis and VEGF,observation and calculation of the VEGF positive cells and the positive apoptosis cells under light microscope.Results Except that a few VEGF expressed around central canal and soft meninges of spinal cord,it seldomly expressed in other locations in sham group;In control group,after spinal cord injury VEGF highly expressed in the injured area and its periphery,which reached the peak at 5 d,decreased after 5 d,obviously expressed at 7,14 d and still expressed at 28 d.The expression of VEGF significantly increased at 1,3,5,7,14,28 d compared to control group,and the difference was significant(P<0.05).A little TUNEL labeled positive cells were observed at every time point in sham group,while those cells could be observed obviously after spinal cord injury in the control and intervention groups.Apoptotic cells gradually increased after injury,reached the peak at 1 d,decreased after that.At 5,7 d time points there were still many apoptotic cells and still existed at 14,28 d.The apoptotic cells increased at 1,3,5,7,14,28 d compared to control group,and the difference was significant(P<0.05).Conclusions VEGF plays a part in the pathological change after spinal cord injury,and it persists a long time.Secondary neuron apoptosis exist for a long time after SCI.

Objective To investigate the effects of methylprednisolone(MP) on patients with cervical spondylotic myelopathy(CSM) underwent anterior decompression.Methods Fifty patients scheduled for elective anterior decompression were randomly divided into two groups of 25 each: control group(C) and methylprednisolone group(MP).Group MP received methylprednisolone 30 mg / kg and group C received same volume of normal saline instead of methylprednisolone as control.Blood samples were taken from vein for determination of plasma TNF-α,IL-6 and SOD concentrations before induction of anesthesia(T1),1 h after(T2),6 h after(T3) and 24 h(T4) after termination of operation.All of these was estimated by enzyme-linked immunosorbent assay(ELISA).Results There was no significant difference between two groups in plasma TNF-α,IL-6 and SOD level at T1.The level of TNF-α,IL-6 at T2-T4 and SOD at T2-T3 was significantly increased compared with that before operation in both groups.However,the plasma concentrations of TNF-α and IL-6 were significantly lower at T2-T4 while the concentration of SOD was significantly higher at T2-T3 in group MP than those in group C.Conclusion Methylprednisolone can reduce the increased amplitude of plasma levels of TNF-α and IL-6,whereas enhance the increased amplitude of the plasma SOD levels in anterior cervical decompression operation.In other words,Methylprednisolone posseses the effect to decrease ischemical reperfusion injury and down-regulate inflammatory response during operation.

Objective To observe the effect of defibrase on the expression of VEGF and the apoptosis after spinal cord injury.Methods Ninty SD rats were randomly divided into sham operation group,control group,intervention group,with 30 in each group.Motor function assessment(BBB) was performed at each time-point post-injury,and 5 rats were selected randomly for sacrifice.HE staining and immunohistochemical staining were performed.VEGF-positive cells and the apoptotic cells under light microscope were counted.Results BBB scores was 21 in sham group.The scores of control group and intervention group at each time-point were significantly decreased,while the score of intervention group was higher than that of control group at all time points after 5 d(P0.05).The scores of two groups were significantly different at 7 d,14 d,28 d(P0.01).In control group,after spinal cord injury VEGF was highly expressed in and around the injured area,which peaked at 5 d,was obviously expressed at 7 d,14 d and was little expressed at 28 d.In intervention group,the expressions of VEGF were significantly increased at each time-point compared to control group(P0.05).The expressions of VEGF in two groups were significantly different at 3 d,5 d,7 d,14 d(P0.01).The number of apoptotic cells was gradually increased after injury,peaked at 1 d,and then was decreased gradually.In intervention group the number of apoptotic cells was less at each time-point compared to control group(P0.05),with 3 d,5 d,7 d the most significant(P0.01).The correlation between VEGF-positive cells and apoptosis cells at 1 d,3 d,5 d was analyzed.The expression of VEGF in control group was negatively correlated with the number of apoptotic cells at 1~5 d(r=-0.90052,P0.05).Conclusion Defibrase performed a therapeutic effect on spinal cord injury by promoting the expression of VEGF,which reduces the cell apoptosis in injury.

OBJECTIVE:To investigate the effectiveness of portable bracket of lower limb in the reconstruction of anterior cruciate ligament (ACL) by the long fibular muscle tendon under arthroscopy.METHODS:Between March 2008 and September 2010, 22 patients with ACL injury were treated. The limb position was maintained by portable bracket of lower limb and ACL was reconstructed with the long fibular muscle tendon under arthroscopy. There were 15 males and 7 females with an average age of 33.8 years (range, 19-64 years). The causes of ACL injury were traffic accident injury in 14 cases, sport trauma in 5 cases, and falling injury in 3 cases. The locations were the left knee in 10 cases and the right knee in 12 cases, including 12 fresh injuries and 10 old injuries. Of 22 patients, 17 had positive anterior drawer test, 19 had positive pivot shift test, and 20 had positive Lachman test. According to International Knee Documentation Committee (IKDC) criteria, there were 6 abnormal and 16 severely abnormal. The subjective IKDC score was 57.64 +/- 6.11. The Lysholm score was 55.45 +/- 4.37.RESULTS:All incisions healed by first intention, and no complication was found. All patients were followed up 9-38 months (mean, 15 months). At last follow-up, the flexion of the knee ranged from 120 to 135 degrees (mean, 127 degrees). One patient had positive anterior drawer test, 1 patient had positive pivot shift test, and 2 patients had positive Lachman test. No ligament loosening and breakage occurred. According to the IKDC criteria, 10 patients rated as normal, 11 patients as nearly normal, and 1 patient as abnormal. The subjective IKDC score was 90.44 +/- 6.11, showing significant difference when compared with preoperative one (t=4.653, P=0.021). The Lysholm score was 90.12 +/- 5.78, showing significant difference when compared with preoperative one (t=4.231, P=0.028).CONCLUSION:Portable bracket of lower limb in the reconstruction of ACL has the advantages of saving manpower and easy operation. The long fibular muscle tendon is enough long and strong to reconstruct the ACL, which can increase the contact surface between the tendon and bone and is beneficial to tendon-bone healing.

<正>胸骨骨折常合并有胸腹部严重并发症和其它部位骨折,病情凶险,如诊治不当,可引起严重后果[1]。2006年5月～2011年9月,我们采用锁定型颈椎前路钢板系统治疗9例严重胸骨骨折患者,取得了较好效果,报道如下1材料与方法

Objective To discuss the effect of treatment of distal or supracondylar fractures of femur with retrograde intramedullary nail under portable bracket of lower limb.Methods 55 patients of distal or supracondylar fractures of femur were fixed with femoral retrograde intramedullary nail,application of minimally invasive method such as portable bracket,AO large distractor and Schanz screw.Results The average operative time was 50～110(78±22) min,the average blood loss was 100～600(260±110) ml;All cases were followed up for 12～35 months.According to assessment systems of Karlstrom and Olerud,the clinical results were excellent in 27 cases,good in 24 and fair in 4,and the excellent and good rate was 92.7%.Conclusions Retrograde intramedullary nail under portable bracket of lower limb on combined AO large distractor and Schanz screw used in distal or supracondylar fractures of femur is one of effective methods,and convenient for operation.

Objective To research the influences of local intradural infusion with Methylprednisolone(MP) on the Malondialdehyde(MDA) and Superoxide Dismutase(SOD) in serum in acute spinal cord injuried rabbits.Methods Fifty-four rabbits were randomly divided into three groups:GroupⅠwas made into the incomplete spinal cord injury by the method of Allen and treated by local intradural infusion MP.Group Ⅱ got the same injure,but was treated by normal saline as contrast.Group Ⅲ performed the operation of total laminectomy.The levels of SOD,MDA in serum were observed with colorimetric methods at the postoperative different time point,and the rabbits were evaluated the motor function as the advanced Tarlov method at preoperative and postoperative different time.The change of pathological in injured spinal cord was observed with hematoxylin and eosin staining and Tunel staining.Results In the groupⅡ,MDA in serum increased while SOD decresed,compared with those in the groupⅢ(P0.05).In the group Ⅰ MDA in serum reduced significantly while SOD increased after SCI,compraed with those in the group Ⅱ(P0.05).Conclusions Local intradural infusion with MP can lower the MDA level but increase SOD concentration in serum,which may inhibit progression of secondary injuries to some extent.

STUDY DESIGN:A randomized, controlled follow-up study.OBJECTIVE:The objective of this study was to compare the results of anterior approach versus posterior approach with subtotal corpectomy, decompression, and reconstruction of spine in the treatment of thoracolumbar burst fractures.SUMMARY OF BACKGROUND DATA:Burst fractures are frequently associated with instability or neurological deficit. Anterior subtotal corpectomy, decompression, and reconstruction with instrumentation are an established method for a highly unstable burst fracture. In the past few years, subtotal corpectomy, decompression, and reconstruction of spine could be completed by posterior approach. Posterior segmental pedicle screw instrumentation, with its more rigid fixation and less technically demanding, could offer potential advantages.METHODS:A total of 64 patients with thoracolumbar burst fractures were divided into 2 groups randomly. Group A was treated by anterior approach and group B was treated by posterior approach with subtotal corpectomy, decompression, and reconstruction of spine. During the minimum 24 months (range, 24 to 72 mo) follow-up period, all patients were prospectively evaluated for clinical and radiologic outcomes. The intraoperative blood loss, operative time, complications of operation, pulmonary function, Frankel scale, and the American Spinal Injury Association (ASIA) motor score were used for clinical evaluation, whereas the heights of anterior edge of vertebral body and the Cobb angle were examined for radiologic outcome. RESULTS: All patients in this study achieved solid fusion, with significant neurological improvement. The intraoperative blood loss (P<0.05) and complications of operation were less, the operative time was shorter (P<0.05), and the pulmonary function after operation was better in the group B (P<0.05). The Frankel scale, the ASIA motor score, and the radiologic results were not significantly different (P<0.05) at all time points between the 2 groups A and B. But the 2 groups improved in their neurological function by approximately 1.3 Frankel grade and 15.6 ASIA motor scores at final follow-up.CONCLUSION:Anterior approach and posterior approach with subtotal corpectomy, decompression, and reconstruction of spine are sufficient for surgical treatment of thoracolumbar burst fractures. Less intraoperative blood loss and complications, shorter operative time, and better pulmonary function after operation are the significant advantages of posterior surgery.

[Objective]To compare the clinical outcome of posterior pedicle screw fixation and iliac crest or granular bone grafting lumbar interbody fusion for the treatment of degenerative lumbar instability.[Methods]There were 75 patients with degenerative lumbar disease.They were 41 males and 34 females,aged from 27 to 68 years with an average of 55.6 years.Clinical manifestation:there were 72 cases with lower back pain and 47 cases with intermittent claudication.All of 75 cases had leg pain,including 37 cases of unilateral leg pain,23 cases of bilateral leg pain and 15 cases of alternative leg pain.Fifty-seven cases were positive with straight leg raising test,66 cases had sensory disturbance,58 cases had movement disorders,and 45 cases had abnormal achilles tendon reflex and knee jerk reflex,and 45 cases had injuries of cauda equina.There were 32 cases with degeneration of L4、5,26 cases with degeneration of L5S1,6 cases with degeneration of L3、4,and 11 cases with degeneration more than 2 segments.They were divided into two groups randomly:iliac bone group and granular bone group.The iliac bone group were treated with decompression,internal fixation for degenerative lumbar instability with pedicle screw and interbody fusion with iliac crest grafting.The granular bone group were treated with decompression,internal fixation and with granular bone grafting fusion.All of the cases had X-ray in routine and oblique view,CT and MRI preoperatively.The Japanese Orthopedic Association(JOA) score,Oswestry Disability Index(ODI) were evaluated before and 3,6,12 months after surgery.And fusion situation was evaluated by reviewing the roentgenographic film.[Results](1)Significant difference of JOA score and ODI were founded in each group before and after surgery.But it was no significant different between two groups.(2)The loss of intervertebral height was significant different between two group before and after surgery.The loss of intervertebral height was significantly more in the granular bone group.(3)In each group,angle of interbody movement appeared significant change comparision before and after surgery,it wasn't significant different between two groups.(4)In each group,there were no transparent region at the interface between the vertebral body and bone graft.The radiographic views showed good fusion,no shift again and no srew breaking and loasening,no signs were found for that bone graft dropped into the spinal canal in each group.[Conclusion]The time of fusion,fusion rate and clinical results are not significant different between two groups.Granular bone group were better than iliac crest group in operative duration and blood loss,and no complication such as pain of donor site.Pedical screw fixation and spinal process and partial laminae decortication granular bone grafting interbody fusion is a recommended surgical procedure for the treatment on degenerative low lumbar spinal instability.