ABSTRACT
Objective This study reconstructed 4D-CBCT for fully automatic compensated sliding motion by incorporating the bilateral filtering into the Deformable Vector Field (DVF). Methods First, a motion compensated simultaneous algebraic reconstruction technique (Modified Simultaneous Algebra Reconstruction Technique, mSART) was used to generate a high quality reference phase by using all phase projection stogether with the initial 4D-DVFs, which were generated via Demons registration between 0% phase and each other phaseimage. The 4D-DVF was optimized by matching the forward projection of the deformed 0% phase with the measured projection of the target phase. The loss function’s DVF smoothing constrain term contained bilateral filtering kernel that contained: 1) an spatial domain Guassian kernel; 2) animage intensity domain Guassian kernel; and 3) a DVF domain Guassian kernel. By choosing suitable kernel variances, the sliding motion can be extracted. A non-linear conjugate gradient optimizer wasused. We validated the algorithm on a Non-Uniform Rotational B- spline based Cardiac-Torso (NCAT) phantom. Quantification was evaluated by: 1) the Root-Mean-Square-Error (RMSE) together with the Maximum-Error (MaxE); 2) the Dice coefficient of the extracted lung contour from the final reconstructed images and 3) the relative reconstruction error (RE) to evaluate the algorithm's performance. Results The motion trajectory's RMSE/MaxEare 0.796/1.02 mm for bilateral filtering reconstruction; and 2.704/4.08 mm for original reconstruction. Image content such a stherib position, the hearted gedefinition, the fibrous structures all had been better corrected with bilateral filtering. Conclusion We developed a bilateral filtering based fully automatic sliding motion compensated 4D-CBCT scheme. Digital phantom study confirmed the improved motion estimation and image reconstruction ability. It can be used as a 4D-CBCT image guidance tool for lung SBRTtreatment.
ABSTRACT
Objective: To analyze the efficacy of enamel matrix derivative (EMD) combined with bone grafts in the treatment of periodontal osseous defects comparied with that of bone grafts alone by Meta-analysis. Methods: The randomized controlled trials(RCTs) about the efficacy of enamel matrix derivative and bone grafts for the treatment of periodontal osseous defects were collected from Cochrane Library,EMBASE,PubMed,CNKI,Wanfang databases and Google scholar from inception may,2016 by electronic search,scored literatures with the methodological index for non-randomized studies(MINORS) evaluation tool. Revman 5. 3 was used for the Meta-analysis. Results: 5 RCTs articles with 145 cases were included. Meta-analysis showed that: at 6 months of follow-up, PD reduction and CAL gain was found more in test group than in control group(WMD = 0. 40,95％ CI =[0. 01,0. 79],P ＜ 0. 05) and (WMD = 0. 50,95％ CI =[0. 12,0. 88],P ＜ 0. 05) respectively. At 12 months of follow-up,there was no statistical significant difference in PD reduction and CAL gain respectively between the 2 treatments. Conclusion: The combined use of EMD and bone grafts may improve PD reduction and CAL gain in the early stage of convalescence following treatment of periodontal osseous deffects.
ABSTRACT
Objective To investigate the clinical effect of anterior controllable antedisplacement and fusion (ACAF) for the treatment of ossification of the posterior longitudinal ligament (OPLL) of the cervical spine.Methods The data of 45 cases with cervical posterior longitudinal ligament ossification treated by ACAF from March 2017 to October 2017 were retrospectively analyzed,including 25 males and 20 females,age 45-68 years,average 57.5 years.There were 18 cases involving C3 vertebral body,30 cases involving C4 vertebral body,40 cases involving C5 vertebral body,34 cases involving C6 vertebral body,and 7 cases involving C7 vertebral body.The function of the neural function was evaluated by the Japanese Orthopaedic Association (JOA) scoring system at preoperation and latest follow-up.The curvature of the cervical spine was measured on the lateral X-ray film of the cervical spine,the maximum occupying ratio of the spinal canal was measured on the cross section of the CT scan,and compression of the cervical spinal cord was evaluated by the cervical MRI.Results Patients were followed up for 3 to 6 months (average,3.9 months).The improvement of neurological function was obtained in all the patients.The JOA score improvement rate at the latest follow-up was 71.3％±9.6％.The cervical lordosis was improved from preoperative 4.5°±3.8° to 10.3°±4.8° at the latest follow-up.The canal stenosis ratio was decreased from preoperative 54.3％±8.2％ to 12.5％±5.3％ at the latest follow-up.MRI showed that the cervical spinal cord was adequately decompressed in situ.No specific complications were identified that were associated with this technique.Conclusion The present study elaborates the surgical tips and demonstrates the satisfactory outcome of ACAF for the treatment of OPLL.This novel technique has the potential to serve as an alternative surgical technique for the treatment of cervical OPLL.
ABSTRACT
BACKGROUND: Anterior subtotal vertebrectomy and fusion using titanium mesh cage (TMC) is an effective surgical treatment for cervical spondylosis, while TMC subsidence usually occurs. The risk factors for TMC subsidence and its effect on the treatment outcomes remain controversial. OBJECTIVE: To investigate the TMC subsidence after anterior subtotal vertebrectomy and TMC fusion and its effect on the treatment outcomes, thereby understanding the underlying mechanism and related risk factors. METHODS: Clinical data of 34 patients undergoing anterior subtotal vertebrectomy and TMC fusion in the Second Department of Spine, Shanghai Changzheng Hospital Affiliated to the Second Military Medical University from March to September 2015 were analyzed retrospectively. After 12-month follow-up, the height of the fused segments was measured, and the neurologic outcomes were evaluated using the Japanese Orthopedic Association scores. The loss of the fused segments subsided more than 3 mm compared with that at 1 day postoperatively was considered as TMC subsidence, and all patients were allotted to TMC subsidence and control (without TMC subsidence) groups.RESULTS AND CONCLUSION: (1) Totally 19 patients (56%) experienced TMC subsidence that occurred in postoperative (6.00±3.73) months averagely. (2) No significant differences were found in the age, sex or the level of fused segments between two groups (P=0.731, 0.672, 0.053). (3) The Japanese Orthopedic Association recovery ratio in the control group was significantly higher than that in the TMC subsidence group (P=0.01), suggesting that TMC subsidence might be correlated with the poor improvement of neurologic function after surgery. (4) To conclude, TMC subsidence is a common complication after anterior subtotal vertebrectomy, which does harm to the treatment outcomes.Moreover, age, sex or the level of fused segments are not independent risk factors for TMC subsidence.
ABSTRACT
Objective To report a novel technique named anterior controllable antedisplacement and fusion (ACAF) for the treatment of severe ossification of the posterior longitudinal ligament of the cervical spine,which allows for direct decompression of the nerve without resection of the ossification,making up for deficiencies in traditional anterior or posterior decompression.Methods The main surgical procedures of the ACAF included treatment of intervertebral space,removal of the anterior part of vertebrae,installation of titanium plate and interbody fusion cages,bilateral osteotomies of the vertebrae,and antedisplacement of the vertebrae ossification complex.The clinical data of two patients undergoing this surgery for severe ossification of the posterior longitudinal ligament of cervical spine were collected and analyzed.Results ACAF enabled direct decompression of spinal cord and nerve root through antedisplacement of the vertebrae ossification complex.The two patients who underwent ACAF gained satisfactory restoration with decompression of spinal cord and good recovery of neurological function,with no specific complications.Conclusion ACAF surgery takes into account the effectiveness of anterior direct decompression and the safety of posterior indirect decompression.Preliminary results shows that it can be used for severe cervical ossification of the posterior longitudinal ligament.
ABSTRACT
Objective:To evaluate volumetric changes in the upper airway after orthodontic-bimaxillary surgery for the treatment of skeletal class Ⅲ malocclusion.Methods:Literatures about volumetric changes in the upper airway after orthodontic-bimaxillary surgery for the treatment of skeletal class Ⅲ malocclusion were searched from the database:Cochrane library,Embase,PubMed,Web of Science,Wangfang,China Science and Technology Journal Database (VIP),Chinese Biomedical Medicine Database (CBM) and China National Knowledge Infrastructure(CNKI).All the literatures were evaluated by Newcastle-Ottawa Scale(NOS) and analyzed by RevMan 5.3.Results:9 studies with 204 cases about volumetric changes in the upper airway after orthodontic-bimaxillary surgery for the treatment of skeletal Ⅲ malocclusion were included.Meta-analysis showed that after treatment there was no statistical difference about the nasopharyngeal volume change and the total volume change(P＞0.05);there was statistically significant difference about oropharyngeal volume change (P＜0.05).Conclusion:It might be better to consider orthodontic-bimaxillary surgery for skeletal class Ⅲ malocclusion with certain risk factors about OSAHS,but there was still a risk of airway narrow after orthodontic-bimaxillary surgery for skeletal class Ⅲ malocclusion.
ABSTRACT
Objective To study the expression and clinical significance of miR-183-5p, TβRⅠ and TβRⅡ in esophageal squamous cell carcinoma (ESCC). Methods The mRNA and protein expression of miR-183-5p, TβRⅠ and TβRⅡ were examined in ESCC cell lines ECA-109, TE-1, normal esophageal epithelial cells, tumor tissues and tumor-free tissues from 72 ESCC patients. Their clinical significance and the relationship between miR-183-5p and the latter two were analyzed. The effects of miR-183-5p on the expression of TβRⅠand TβRⅡ in ECA-109 cells and the cell functions of ECA-109 were also investigated. Results Compared with the normal esophageal epithelia cells, ESCC cell lines TE-1 and ECA-109 were statistically characterized by a high expression of miR-183-5p (all P<0.05) and low expression of TβRⅠand TβRⅡ(all P<0.05). The expression of miR-183-5p in ESCC tissues was higher than that in adjacent normal tissues, while the expressions of TβRⅠ and TβRⅡ were lower (all P< 0.05). The expression of miR-183-5p was closely related to sex, tumor differentiation, tumor staging, distant metastasis, lymphatic metastasis, and tumor location (all P<0.05). TβRⅠlevel was associated with sex, lymph node metastasis and tumor size (all P<0.05). Experimental data showed the negative correlation between the expression of miR-183-5p and TβRⅠin ESCC tissues (r= -0.521, P< 0.05). Over expression of miR-183-5p significantly inhibited the expression of TβRⅠ in ECA-109 cells (P< 0.05) and promoted the growth, invasion and metastasis of ECA-109 cells (P< 0.05). Low expression of miR-183-5p significantly promoted the expression of TβRⅠ in ECA-109 cells (P< 0.05), and suppressed the growth, invasion and metastasis of ECA-109 cells (P< 0.05). There was no significant change in the expression of TβRⅡ in the transfection experiments. Conclusion MiR-183-5p is closely related to the abnormal expression of TβRⅠ, which may exert an important role in the progression of lymphatic metastasis.
ABSTRACT
BACKGROUND:Preliminary studies of our research group have confirmed that bone morphogenetic protein-4 can stimulate the development of mandible in the growth period, but whether bone morphogenetic protein-4 can interact with bone morphogenetic protein-2 to promote the growth of mandible has not been reported. OBJECTIVE:To detect the expression of bone morphogenetic protein-2 and bone morphogenetic protein-4 in skeletal class II malocclusion during growth peak, and to explore the relationship of the expression of bone morphogenetic protein-2 and bone morphogenetic protein-4 with mandibular growth. METHODS: Patients with skeletal class I malocclusion in growth peak served as group I, and those with skeletal class II malocclusion in growth peak characterized as mandibular retrognathia acted as group II. There were 18 cases in each group. Expression of bone morphogenetic protein-2 and bone morphogenetic protein-4 in serum was detected by real-time fluorescent quantitative PCR. RESULTS AND CONCLUSION:The mRNA expression of bone morphogenetic protein-2 and bone morphogenetic protein-4 in the group II was significantly lower than that in the group I (P < 0.05). In the group II, there was a significant correlation between the expression of bone morphogenetic protein-2 and bone morphogenetic protein-4. These experimental findings confirm that the reduced expression of bone morphogenetic protein-2 and bone morphogenetic protein-4 in skeletal class II malocclusion during growth peak has a certain relationship with mandibular deficiency, and moreover, bone morphogenetic protein-2 interacts with bone morphogenetic protein-4 to promote the growth of mandible.
ABSTRACT
ObjectiveTo compare the incidence of C5 nerve palsy after laminoplasty and laminectomy with internal fixation for treating multilevel cervical spondylotic myelopathy (MCSM).MethodsFrom January 2005 to June 2010,68 patients with MCSM were treated with laminoplasty (27 patients,group A) or laminectomy with internal fixation(41 patients,group B).There were 21 males and 6 females in group A,aged 33-80 years(average,60.4 years),31 males and 10 females in group B,aged 22-77 years (average,58.7 years).All the patients were followed up for 12-48 months (average,22 months).In both groups,Cobb's method was applied to measure cervical lordotic angle,and Ishihara's method was conducted to measure cervical curvature index(CCI) before and after operation.The incidence of C5 nerve palsy was recorded and compared.Then we further compared preoperative and postoperative the cervical lordosis angle and CCI of 9 patients with C5 nerve palsy (group B1) and 32 patients without C5 nerve palsy (group B2) in group B.ResultsThe incidence of C5 nerve palsy in group A was 3.7％(1/27),while 22.0％(9/41) in group B (x2=4.32,P＜0.05).For all ten patients with C5 nerve palsy,the muscle strengths of paralyzed muscles were recovered to grade 4 or better after being treated with conservative treatment for an average of 14 months.The change rate of preoperative and postoperative CCI in group B1 was 38.07％±18.03％,while 22.81％±12.71％ in group B2.There was a statistical difference between group B1 and group B2 (t=2.88,P＜0.05).Conclusion Compared with laminoplasty,laminectomy with internal fixation has a higher incidence of C5 nerve palsy.The C5 nerve palsy may be associated with postoperative increase of cervical lordosis angle.Moreover,tethering of the C5 root may be one of its important pathomechanisms.
ABSTRACT
Objective To investigate the expression and clinical significance of UL16 binding protein 3 (ULBP3) in human esophageal squamous cell carcinoma (ESCC) and its correlation with nature killer (NK) cells.Methods The relative expression of ULBP3 in the ESCC tissues and corresponding carcinoma adjacent tissues of 40 patients was detected by realtime-poly merase chain reaction (PCR),immunohistochemical staining and Western blot methods.The percentage of NK cells in peripheral blood of same patients was examined by flow cytometry.The correlation between ULBP3 and the percentage of NK cells was analyzed with Pearson method.Results The expression of ULBP3 at mRNA level in the tumor tissues ([4.96 ±-6.11]×10-3) was significantly higher than that of corresponding carcinoma adjacent tissues ([1.64 ± 2.96]× 10-3,t =3.656,P＜ 0.01).The immunohistochemical staining results indicated that the positive rate of ULBP3 in the tumor tissues was 60％ (24/40),however that of corresponding carcinoma adjacent tissues was only 32.5％(13/40,t=3.921,P＜0.01).The Western blot results indicated that the expression of ULBP3 at protein level in the tumor tissues was significantly higher than that in the corresponding carcinoma adjacent tissues.The relative expresssion ULBP3 at mRNA level in carcinoma tissues of ESCC patients with lymph node metastasis and at TNM stage Ⅲ was higher than that of ESCC patients without metastasis and at TNM stage Ⅰand Ⅱ (t=4.839,4.192,P＜0.05).There was no significant correlation between the expression and ages,gender,location of tumors and the differentiation degree of tumor (P＞0.05).At early and mid stage of the tumor,the expression of ULBP3 at mRNA level was positively correlated with the percentage of NK cells in peripheral blood (r=0.5233,P＜0.05),however there was no correlation at advanced stage.Conclusion ULBP3 was highly expressed in ESCC and may be involved in the immune regulation of NK cells.
ABSTRACT
ObjectiveTo study the effect of anterior decompression and autograft fusion under video-assisted thoracoscopic to treat lower thoracic vertebrae bursting fracture complicated with intervertebral disc injury.MethodsEleven patients who suffered from lower thoracic vertebrae bursting fracture complicated with intervertebral disc injury were treated with anterior decompression and autograft fusion under video-assisted thoracoscopic from December 2005 to May 2008.The involved vertebrae included T12 in 5cases,T11 in 4 cases,T10 in 1 case and Ts in 1 case.According to the AO classification,4 patients were A2.2and 7 were A3.According to the Frankel classification,5 patients were rated as grade A,2 as grade C,2 as grade D and 2 as grade E.ResultsEvery patient underwent successful operation.The operation time was 3.5-8 h(average,5.2±1.6).The blood loss was 600-3800 ml(average,1195±576).One patient got intercostal neuralgia after operation,which disappeared after treating with analgesic drugs for 7 days.All patients were followed up for 36-65 months (average,49.5±5.9).All patients got bony fusion according to the CT scans 24month after operation.There were no neurological function deterioration and other instrument complications happened.At the last follow-up,5 patients were rated as grade A,2 as grade D and 4 as grade E,according to the Frankel classification.ConclusionAnterior decompression and autograft fusion under video-assisted thoracoscopic is an effective method to treat lower thoracic vertebrae bursting fracture complicated with intervertebral disc injury.However,this method needs higher technology and has a long study-curve.
ABSTRACT
Objective To review the relevant causes for and treatment of nerve injuries in the anterior cervical surgery. Methods From January 2008 to December 2009,859 cages of cervical spondylosis,ossification of cervical posterior longitudinal ligament and cervical spine trauma were treated by anterior cervical surgery.This study retrospectively analyzed the clinical data of seven cases who were with worsened symptoms of spinal cord injury and related nerve injury. Results Of 859 cases,five cases(0.58%)were with spinal cord injury,one(0.12%)with recurrent laryngeal nerve injury and one (0.12%)with laryngeal nerve injury.Hematoma occurred in four cases after surgery caused spinal cord injury and all the four patients recovered to normal after removal of the hematoma and timely treatment with mythylprednisolone and hyperbaric oxygen.Cervical spine trauma was worsened in one patient after the anterior cervical surgery.The patient restored to its original level of spinal cord gradually through some measures such as tracheotomy,ventilator support,hormone therapy and hyperbaric oxygen treatment.Laryngeal nerve injuries in two cases recovered to normal after conservative treatment with hormone,dehydration and other drugs within three months after surgery. Conclusions Anterior cervical surgery of cervical spondylosis,ossification of cervical posterior longitudinal ligament and cervical spine trauma are likely to induce the related nerve damage.The good prognosis can be obtained under timely prevention and treatment.
ABSTRACT
Objective To investigate and analyze the postoperative progression of ossification of the patients with ossification of the posterior longitudinal ligament (OPLL) on cervical spine. Methods From Jaunary 2001 to December 2007, 95 postoperative patients with cervical OPLL were followed and analyzed retrospectively. There are 72 males, 23 females, with the average age of 56.3 years (range, 40-73years). The follow-up time was from 1 to 6 years, average 3.1 years. Among them 36 patients were performed with anterior cervical corpectomy, fusion with titanium mesh and fixed with cervical plates, others treated with posterior cervical laminectomy and fixation. 2 of the 95 cases were performed anterior and posterior combined operation. Clinical data, X-rays, CT and MR images and progression of ossification, were measured and analyzed in details .The relationships between the progression of ossification and relative factors, as gender, age, C3 ossified involved, T-OPLL, OPLL-type, time of follow-up, surgical approach, Japanese Orthopaedic Association (JOA) scores and improvement rate of JOA scores, were analyzed. Results Progression of ossification in 39 cases among the 95 followed postoperative OPLL patients, 28 men and 11 women, average age 55.9 years, range 41-71 years. The age of progressed patients included 12 cases of ≤49 years, 12of 50-59 years, 12 of 60-69 years and 3 of ≥70 years. 35 patients were operated by posterior approach and only 4 treated with anterior operation. According to the standard of the progression of ossification that 2 mm in the length or/and thickness, there are 4 cases progressed only in length, 2 only in thickness, other 33 patients both the length and thickness. Progression of length is from 2mm to 20mm (average 7.74±4.71). But thickness is progressed from 2 mm to 6 mm (average 2.67±1.51). From 1 to 3 years follow-up time it appeard as a downtrend about the progression of ossification. But it may appear an uptrend from the 4th year. JOA score and improvement rate of the JOA score were almost improved to the high-point in three years. And according to the statistic data there are obvious relationship between progression of ossification with age, surgical approach and C3 ossified involved. Conclusion There is a high rate of postoperative ossification progression in cervical OPLL patients. Cervical OPLL patients with C3 ossification involved, performed with posterior laminectomy and those young at surgery may have higher rate of progression of the ossification. The JOA score and improvement rate of the JOA score were little influenced by the progression of the OPLL during the short and intermediate-term follow-up.
ABSTRACT
Objective To analyze the expression and regulation of HES1 in sperms with low motility.Methods Thirty semen samples from asthenospermia patients and 20 semen samples from healthy and fertile adults were collected,total RNAs were extracted to produce cDNAs probes.Hybridization with Phalanx OneArray~(TM) containing 30 968 probes was carried out after the labeled cDNAs were purified by PCR product purification kit.Realtime RT-PCR was used to analyze the expression of hsa-miR-487a and hsa-miR-193b;the expression of the target genes of hsa-miR-487a and hsa-miR-193b were searched from gene-expression profiles in asthenospermia patients' sperms.Results The expression level of HES1 in low motility sperms was up-regulated.The expression level of hsamiR-193b in low motility sperms was 2.19 times higher than that in high motility sperms,hsa-miR-487a was 0.43% of that in high motility sperms.Conclusion The expression level of HES1 in low motility sperms was up-regulated.Hsa-miR-487a and hsa-miR-193b may affect the expression of HES1 and so regulate sperm motility.
ABSTRACT
Objective To investigate the role of TROP2 in migration and invasion of human gastric cancer cells. Methods Small interfering RNA(siRNA) targeting TROP2 gene was constructed by gene cloning and transfection into gastric cancer cell line BGC-823. The expression of mRNA and protein were detected by Real-time quantitative PCR and Western blot assay after RNA interference. The proliferation was determined by MTT assay. Transwell assay was performed to assess the effect of TROP2 targeted RNA interference on the migratory and invasive properties of gastric cancer in vitro. Results Enzyme digestion analysis and DNA sequencing showed that TROP2 targeted RNA interference recombinant plasmids were successfully constructed. The most effective recombinant plasmid was selected. After transfection, knockdown of TROP2 significantly inhibited the proliferation, migration and invasion of BGC-823 cells in vitro(P <0. 05). Conclusion Interfering and down-regulating TROP2 gene can inhibit migration and invasion of gastric cancer cell line BGC-823 in vitro, indicating that TROP2 gene is a potential target for gastric cancer gene therapy.
ABSTRACT
Objective To compare the dinical outcome of posterior Gallie method with cable fixation and Harms technique with C1,2 pedicle screw fixation in treatment of odontoid fractures. Methods From July 2003 to July 2008, 26 patients with types Ⅱ and Ⅲ odontoid fractures were treated surgically. There were 18 males and 8 femalses, at age range of 22-65 years ( average 43 years). The patients were divided into Gallie titanium cable fixation group (Gallie group, n = 14) and C1 -C2 posterior screw fixation group using Harms technique (Harms group, n = 12) according to treatment methods to compare blood loss, operation duration, costs, hospital stay, bone fusion time, complications and secondary operation. Results The patients were followed up for 18-84 months ( average 37.3 months). The average blood loss and costs in Gallie group were significantly less than that in Harms group (P<0.05), while the time for back to work in Gallie group was significantly longer than that in Harms group ( P < 0. 05 ). There was no statistical difference upon operation duration, hospital stay and bone fusion time in two groups (P > 0. 05 ). There was one patient with nonunion and two with delayed union in Gallie group and one with secondary operation due to implant failure in Gallie group, and one with secondary debridement due to wound infection and one with delayed wound healing in Harms group, with no statistical difference (P > 0. 05). Conclusions Both Gallie technique with titanium cable fixation and Harms C1,2 screw fixation have advantages of early walk and short hospital stay. Compared with the former, the latter technique costs more but can help early back to work.
ABSTRACT
BACKGROUND: Ossification of intervertebral disc, and ossification of spinal ligament and fibrous tissues are still uncertain.OBJECTIVE: To observe osteogenic potential of fibrous ring in the cervical intervertebral disc during bone fusion.DESIGN, TIME AND SETTING: The comparative observation was performed at the Experimental Animal Center of Second Military Medical University and Shanghai Institute of Orthopedics in October 2006.MATERIALS: Ten healthy goats, including 6 males and 4 females; titanium alloy cervical hollow threaded columnar internal fixator (CHTF) for goat, simulated human used internal fixator by Kanghui Medical Innovation Co., Ltd., Changzhou.METHODS: Every goat underwent conventional anterior cervical decompression and internal fixation. Two adjacent intervertebral spaces among C2-6 were selected and implanted with 2 CHTFs for each space. Of the 4 CHTFs, 3 were filled with cancellous bone alone, cancellous bone plus fibrous ring, and fibrous ring alone, respectively; the other one filled with nothing served as blank control.MAIN OUTCOME MEASURES: Implant location and fusion condition on anteroposterior and lateral radiographs and CT plain scanning at 6 and 12 weeks postoperatively; bone graft fusion and regional tissue reaction by histology.RESULTS: Radiographs and CT showed that CHTF was in the position during the whole experimental procedure with no loosening, displacement or dislocation. At 6 weeks, bone tissue was found surrounding CHTF and the vertebral body, and bone bridge formed in the connection site of CHTF and the vertebral body. New cartilage and bone trabecula formation were found in the CHTF filled with cancellous bone alone, accompanied by necrotic original bone graft; in the CHTF filled with cancellous bone and fibrous ring, necrotic fibrous tissue and newly formed cartilage accumulation surrounding original bone trabecula and fibrous ring were found; 6 weeks after surgery, there were fibrocartilage in fibrous tissue of CHTF filled with fibrous ring alone, and at 12 weeks postoperatively, newly formed cartilage was observed. In blank control group, only few newly formed cartilages were found at 12 weeks postoperatively. CONCLUSION: Enchondral ossification of fibroblast may be the osteogenic pattern of fibrous ring of cervical intervertebral disc.
ABSTRACT
Objective To summarize the clinical results of posterior fusion plus pedicle screw fixation in treatment of dens fracture combined with recoverable atlantoaxial dislocation. Methods Twenty-seven patients with dens fractures combined with recoverable atlantoaxial dislocation were treated with posterior pedicle screw fixation, reduction and fusion. In this series of patients, skull traction was made to restore the normal atlantoaxial joint before the operation. Results Atlantoaxial alignment or stability were restored, without complication due to instrumentation. A follow-up for 12-48 months (average 24 months) showed osseous union. Conclusion Posterior aflantoaxial pedicle screw and rod fixation provides immediate three-dimensional rigid fixation of aflantoaxial joint and is a more effective technique compared with previously reported techniques.
ABSTRACT
Objective To observe the changes of the peripheral blood T lymphocyte subsets following acute spinal cord injury and investigate the possible mechanism of these changes. Methods The SCI models of rats were made by Allen's method. Forty SD rats were divided into four groups, ie,normal control group, sham operation group, 100 g·cm group and 200 g·cm group. The expressions of CD4 and CD8 subsets of the peripheral blood T lymphocyte of the injured rats were determined by immunofluorescence labelling and flow cytometry at different times after injury. Results It was found that the expression of CD4 was significantly reduced to (30.40±4.76)% in 100 g·cm group and to (26.54± 9.34) % in 200 g·cm group, which were significantly lower than that of normal control group ( P ＜0.01 ). At 36 hours after injury, the ratio of CD4/CD8 was significantly reduced to 1.81 ± 0.55 in 100 g·cm group and and 1.29 ± 0.50 in 200 g·cm group, with statistical difference (P ＜ 0.05).Conclusions The immunoreaction is significantly depressed at the early stage of acute spinal cord injury. The severer injury results in more significant decrease of CD4 and ratio of CD4/CD8. The changes of CD4 and CD4/CD8 ratio can be used to indicate the severity of spinal cord injury.
ABSTRACT
[Objective]To explore the optimal time for the surgical operation on patients with ossification of the posterior longitudinal ligament of the cervical spine. [Methods]The clinical symptoms,the persistent time of the symptoms and the interval from exacerbation to operation in 168 patients with OPLL were analyzed.[Results]The average time was 27.6 months from the onset of myelopathy to the operation on patients with OPLL,and 17.4 months from the decrease of muscle strength in extremities to the operation,and 5.3 months from the symptomatic exacerbation of the extremities especially the decrease of muscle strength in lower extremities to the operation.[Conclusion]The patient should be treated earlier by surgical operation after his/her illness has been diagnozed as OPLL.It is the optimal time for surgical operation when the patient has imaging change of hypertrophy or ossification of the posterior longitudinal ligament and severe compression of spinal cord(more than 60% spinal canal stenosis),or the decrease of muscle strength in extremities especially in lower extremities.