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Objective To explore the impact of the ratio between pelvic tilt (PT) and sacral slope (SS) on the life quality of patients with ankylosing spndylitis (AS) after kyphosis correction. Methods From November 2008 to May 2011, 33 AS pa?tients were reviewed, including 31 males and 2 females, aged from 19 to 58 years old (average, 36 years old). The thoracolumbar kyphosis angle was 35.23° ± 13.98° (range, 15.12°-74.37° ) and the lumbar lordosis angle was 8.68° ± 18.27° (range,-23.70°-62.15°). The Scoliosis Research Society (SRS)?22 questionnaire was used to evaluate the quality of life and the Oswestry disability index (ODI) was used to evaluate the condition of pain. The pelvic incidence (PI), PT, SS, sagittal vertical axis (SVA) and osteoto?my angle were obtained from standing lateral full?spine radiographs. The correlations were analyzed from the subjective grading and the sagittal parameters in AS patients. Results The osteotomy site was in L1 (5 cases, 21.00°-54.59° , average 32.59° ± 13.44° ), L2 (19 cases, 28.63°-66.24° , average 37.89° ± 9.26° ), L3 (9 cases, 31.78°-60.90° , average 47.05° ± 9.20° ), respectively. The range of osteotomy angle was 39.59°±10.82° (range, 21.00°-66.24°). The subjective grading and spino?pelvic parameters were improved significantly after operation except PI, only postoperative PT/SS (0.93±0.65) and ODI standing (0.60±0.75)(r=0.681, P<0.05), osteotomy angle (39.59°±10.82°) and satisfaction of management (3.33±0.49)(r=0.478, P<0.05)had correlation with the subjective grading. Conclusion Compared with the change of PT, SS and SVA, the change of PT/SS is more closely related to the quality of life after operation in AS patients with kyphosis, which should be pay attention to by surgeon when designing operative schemes.
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BACKGROUND:Fibrin glue introduced into calcium phosphate cement has not been confirmed whether this way could overcome the compressive limits and the low degradation of calcium phosphate cement and to modify the biological properties of calcium phosphate cement. OBJECTIVE:To explore the mechanical and biological properties of calcium phosphate cement/fibrin glue at different powder/liquid ratio for bone regeneration in vitro. METHODS:Calcium phosphate cement and fibrin glue were mixed at ratios of 1:1, 3:1, 5:1 (mL/g), and the pure calcium phosphate cement served as controls. Setting time, scanning electron microscope and the biomechanical test were used to analyze the composite scaffold structure, physical performance and the mechanical properties. Passage 3 osteoblasts were respectively inoculated on the material surface of the four groups, and pure cells served as blank controls. celladhesion, proliferation and alkaline phosphatase activity were observed. RESULTS AND CONCLUSION:The initial and final setting time of calcium phosphate cement/fibrin glue at 1:1 and 3:1 (mL/g) was higher than that in the control group (P<0.05), while the initial and final setting time of calcium phosphate cement/fibrin glue at 5:1 (mL/g) was lower than that of the control group (P<0.05). Scanning electron microscope showed smoother and denser surface of composite scaffolds compared with the pure calcium phosphate cement. The aperture of the composite scaffolds was decreased with the increasing concentration of fibrin glue. The compressive strength of composite scaffolds at 3:1 and 5:1 was higher than that of the control group (P<0.05), while the modulus of the composite scaffolds at 1:1, 3:1, 5:1 was higher than that of the control group (P<0.05). celladhesion, proliferation and alkaline phosphatase activity showed no difference among the three composite scaffold and control groups, but al higher than the blank control group (P<0.05). These findings indicate that fibrin glue introduced into calcium phosphate cement can overcome the low-strength limits of calcium phosphate cement, and maintain the good biological properties of calcium phosphate cement for bone regeneration.
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<p><b>OBJECTIVE</b>To study the clinical effects and application value of intraoperative CT in treatment of severe scoliosis with posterior total pedicle screws.</p><p><b>METHODS</b>Thirty-two cases of severe scoliosis were retrospectively analysed in our hospital from June 2009 to June 2011,which were treated by posterior total pedicle screws with intraoperative CT including 12 males and 20 females with an average age of 16.8 years ranging from 10 to 38 years. There were 19 cases combined with thoracic kyphosis among 32 cases. Multiple planar reconstruction technology of intraoperative CT was applied to assess screw position. The numbers (rates) of pedicle screws were calculated and evaluated as different grades in upper thoracic vertebra (T1-T4) ,middle thoracic vertebra (T5-T8), lower thoracic vertebra (T9-T12) and lumbar vertebra. The pedicle screws of 2 grade and 3 grade were defined as malpositioned screws. Times of applicating intraoperative CT were calculated. Cobb angle of all cases and kyphosis angle of the cases combined with thoracic kyphosis were measured before and after surgery. Scoliosis correction rates and kyphosis correction rates were calculated.</p><p><b>RESULTS</b>There were 686 pedicle screws placed in thoracolumbar of 32 patients (including 544 thoracic pedicle screws,142 lumbar pedicle screws) and 14 patients underwent osteotomy. The rate of malpositioned screws in thoracolumbar was 7.3% by evaluating with intraoperative CT,and it respectively was 5.6%,11.1%, 6.7% and 4.3% in upper thoracic vertebra, middle thoracic vertebra,lower thoracic vertebra and lumbar vertebra. The malpositioned screws were amended in surgery. The mean times of intraoperative CT was 2.6 times (ranged from 2 times to 4 times). The mean preoperative Cobb angle was 95 degrees (ranged from 78 degrees to 123 degrees) and the mean postoperative Cobb angle was 340 (ranged from 19 degrees to 53 degrees). The mean correction rate of Cobb angle was 64%. The mean preoperative kyphosis angle of the patients combined with thoracic kyphosis was 69 degrees (ranged from 46 degrees to 82 degrees) and the mean postoperative kyphosis angle was 32 degrees (ranged from 22 degrees to 45 degrees). The mean correction rate of kyphosis angle was 54%. Four patients suffered cerebrospinal fluid leak after surgery. No infection, vascular lesion and nervous lesion were found. All patients had an average 18-month follow-up (ranged from 12 to 26 months). No broken nails, broken rods and pseudarthrosis were founded.</p><p><b>CONCLUSION</b>Application of in traoperative CT in severe scoliosis with posterior total pedicle screws can detect and amend malpositioned screws timely in surgery, to avoid secondary surgery for malpositioned screws and protect the safety of surgery. The effects of surgery is satisfactory.</p>
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Adolescent , Adult , Child , Female , Humans , Male , Bone Screws , Monitoring, Intraoperative , Retrospective Studies , Scoliosis , Diagnostic Imaging , General Surgery , Tomography, X-Ray Computed , MethodsABSTRACT
<p><b>OBJECTIVE</b>To investigate the feasibility of minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) using hybrid internal fixation of pedicle screws and a translaminar facet screw for recurrent lumbar disc herniation.</p><p><b>METHODS</b>From January 2010 to December 2011, 16 recurrent lumbar disc herniation patients, 10 male and 6 female patients with an average age of 45 years (35-68 years) were treated with unilateral incision MIS-TLIF through working channel. After decompression, interbody fusion and fixation using unilateral pedicle screws, a translaminar facet screw was inserted from the same incision through spinous process and laminar to the other side facet joint. The results of perioperative parameters, radiographic images and clinical outcomes were assessed. The repeated measure analysis of variance was applied in the scores of visual analogue scale (VAS) and Oswestry disablity index (ODI).</p><p><b>RESULTS</b>All patients MIS-TLIF were accomplished under working channel including decompression, interbody fusion and hybrid fixation without any neural complication. The average operative time was (148 ± 75) minutes, the average operative blood loss was (186 ± 226) ml, the average postoperative ambulation time was (32 ± 15) hours, and the average hospitalization time was (6 ± 4) days. The average length of incision was (29 ± 4) mm, and the average length of translaminar facets screw was (52 ± 6) mm. The mean follow-up was 16.5 months with a range of 12-24 months. The postoperative X-ray and CT images showed good position of the hybrid internal fixation, and all facets screws penetrate through facets joint. The significant improvement could be found in back pain VAS, leg pain VAS and ODI scores between preoperative 1 day and postoperative follow-up at all time-points (back pain VAS:F = 52.845, P = 0.000;leg pain VAS:F = 113.480, P = 0.000;ODI:F = 36.665, P = 0.000).</p><p><b>CONCLUSION</b>Recurrent lumbar disc herniation could be treated with MIS-TLIF using hybrid fixation through unilateral incision, and the advantage including less invasion and quickly recovery.</p>
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Adult , Aged , Female , Humans , Male , Middle Aged , Bone Screws , Feasibility Studies , Fracture Fixation, Internal , Methods , Intervertebral Disc Displacement , General Surgery , Lumbar Vertebrae , General Surgery , Minimally Invasive Surgical Procedures , Spinal FusionABSTRACT
<p><b>OBJECTIVE</b>To investigate the feasibility and safety of unilateral incision hybrid fixation using pedicle screws and a translaminar screw in minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF).</p><p><b>METHODS</b>From January to June 2010, 18 patients with single-level lumbar disc disease were treated with MIS-TLIF under METRx(TM) X-tube. After decompression and fixation using unilateral pedicle screws, a translaminar screw was inserted from the same incision to the other side. The results of perioperative parameters, radiographic images and clinical outcomes were assessed.</p><p><b>RESULTS</b>All patients underwent MIS-TLIF were accomplished unilateral hybrid fixation without any neural complication. The average operative time was (107 ± 19) min, the average operative blood loss was (62 ± 21) ml, and the average postoperative ambulation time was (21 ± 5) h. The average length of translaminar facets screw was (52 ± 2) mm, and the postoperative images showed all screws penetrate through facets joint. During the follow-up the visual analogue scale and Oswestry disability index scores were significant improved compared with preoperative (F = 42.221 - 259.833, P < 0.01).</p><p><b>CONCLUSIONS</b>Bilateral hybrid fixation could be completed through unilateral incision by pedicle screws and a translaminar screw in MIS-TLIF, and the advantage including less invasion, quickly recovery, short operative time, and saving fixation cost.</p>
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Adult , Female , Humans , Male , Middle Aged , Young Adult , Bone Screws , Feasibility Studies , Follow-Up Studies , Lumbar Vertebrae , General Surgery , Minimally Invasive Surgical Procedures , Spinal Fusion , Methods , Treatment Outcome , Visual Analog ScaleABSTRACT
<p><b>OBJECTIVE</b>To evaluate the outcome of posterior trans-pedicle + disc osteotomy in patients with post-traumatic thoracolumbar kyphosis.</p><p><b>METHODS</b>Between June 2000 and June 2003, 26 adult patients, 16 male and 10 female, average 30.6 years old (21 - 42 y), of post-traumatic thoracolumbar kyphosis were corrected by means of single posterior trans-pedicle + disc osteotomy technique. Operation time, blood loss, and surgical complication were counted. Back pain Visual Analog Scale (VAS) Oswestry score and Frankel neurological grade were used to for clinical evaluation. All the radiographic and clinical data were requested at 3 time points (before operation, directly postoperatively, and at final follow-up).</p><p><b>RESULTS</b>No severe complications were found in this group. Local kyphosis (T(10)-L(2) Cobb angle) was corrected from average 22.3 degrees +/- 3.5 degrees to 2.2 degrees +/- 2.1 degrees (corrective rate 90.1%). Intraoperative average blood loss was (680.0 +/- 31.5) ml and average operational time was (186.0 +/- 22.8) min. All the patients finished at least 3 - 5 years follow-up, Neural improvement achieved in this group (before operation Frankel D 12 cases, Frankel C 6 cases and Frankel B2 cases; 3 years postoperation Frankel E 14 cases, Frankel D 2 cases Frankel C1 case and Frankel B 1 case), postoperative back pain was reduced from preoperative 8.6 +/- 1.3 to 2.2 +/- 0.5 in VAS and Oswestry score improved from (62.5 +/- 8.6)% to (16.2 +/- 4.3)% at last follow up.</p><p><b>CONCLUSION</b>Single posterior trans-pedicle + disc osteotomy technique is suitable to thoracolumbar post-traumatic kyphosis.</p>
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Adult , Female , Humans , Male , Young Adult , Kyphosis , General Surgery , Lumbar Vertebrae , Wounds and Injuries , Osteotomy , Methods , Spinal Fractures , Thoracic Vertebrae , Wounds and Injuries , Treatment OutcomeABSTRACT
BACKGROUND: The active component in recombinant human bone morphogenetic protein-2/poly(lactide-co-glycolide) (rhBMP-2/PLGA) microsphere prone to be absorbed or lost during solution with physiological saline, and the setting time is uncontrollable using blood solution, so it is necessary to explore an sustained-release carrier that can control the setting time.OBJECTIVE: To construct an injectable BMP release system by combing rhBMP-2/PLGA microsphere with fibrin glue. DESIGN, TIME AND SETTING: An experimental comparative study was performed at the Department of Othopaedics, General Hospital of Chinese PLA from January 2005 to April 2008.MATERIALS: PLGA (polylactic acid/polyglycolic acid 75/25, M_r=3 000, with 0.025 L/g viscosity) was supplied by Shandong Institute of Medical Instruments; rhBMP-2 was offered by The Academy of Military Medical Sciences; and fibrin glue was supplied by Hangzhou Puji Medicine Technology Development Co., Ltd.METHODS:The rhBMP-2/PLGA microsphere was prepared using W/O/W solvent evaporation methods. rhBMP-2 loaded PLGA microsphere were incorporated in fibrin glue to establish injectable BMP release system.MAIN OUTCOME MEASURES: The setting time,release behaviors, electron spectroscopy for chemical analysis (ESCA) as well as pH values of composites were measured.RESULTS:①Compared with fibrin glue, the setting time of composites were slightly increased.②Initial burst release of the composites occurred, the drug release exceeded 16.76% within 2 days, and 76.75% of the drug was release within 42 days. ③ESCA showed that composites prolonged release times.④The PH value of composites was between microsphere and fibrin glue.CONCLUSION: RhBMP-2/PLGA microsphere/fibrin glue composite has satisfactory slow-release effect and syringeability, which not only degrade partial acid environment but also maintain the biological effect of higher density. Therefore, it forms a promising synthetic bone graft.
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Objective To investigate the effectiveness of femoral troehanter reconstruction and artificial femoral head replacement in treatment of unstable intertrochanterie fractures in the elderly pa- tients. Methods Femoral trochanter reconstruction and artificial femoral head replacement was done on 106 patients with unstable intertrochanterie fractures. There were 45 males and 61 females, at age range of 80-105 years (average 88 years). Most of patients slipt in the room and got fractured. According to the Evans classification, there were 31 patients with type ⅢA fractures, 45 with type ⅢB and 30 with type IV. We used 4 kinds of methods to reconstruct the fracturad imertrochanters : (1) shape of" ∞ " ten- sion band fixation after intertrochanterie fracture reduction;(2) wire loop fixation of the lesser troehanter around proximal femur;(3)defect within the femoral ealear was filled with bone cement and remodeled; (4) for patients with relative intact base of femoral neck, the intertrochanterie fracture was transformed in- to femoral neck fracture and the femoral ealear was fixed with femoral prosthesis stem. Results All the operations continued successfully, with duration of the operation for 45-70 minutes (average 55 minutes). No artificial femoral head dislocation occurred during hospitalization. Of all, 79 patients were followed up for 6-48 months (average 16 months). No Late loosening, dislocation or infections occurred, with total excellence rate of 87.3%. Conclusions For elderly patient with unstable intertrochanterie fractures, reconstruction of femoral intertrochant and artificial femoral head replacement can restore the proximal femoral anatomy, maintain stability of the hip joint and help early functional exeereise, as can reduce ease fatality rate and improve the quality of life.
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@#Objective To explore the mechanism of percutaneous laser disc decompression (PLDD) for treating prolapse of intervertebral disc. Methods 15 rabbits were divided into 3 groups randomly: sham group, model group with PLDD treatment, model group without PLDD treatment. The nerve conduction velocity (NCV) of L6 nerve root and the activity of phospholipase A2 (PLA2) in the intervertebral disc of L5-6 were determined 2 weeks after the initial surgery. Results NCV in the group with PLDD was significantly faster than that in the group without PLDD (P<0.001); NCV in the group without PLDD was significantly lower than that in the sham group (P<0.001). The activity of PLA2 in the group with PLDD was significantly lower than that in the group without PLDD (P<0.001); The activity of PLA2 in the group without PLDD was significantly higher than that in the sham group (P<0.001). Conclusion The activity of PLA2 in the herniated discs is higher than that in normal discs, which result in NCV falls remarkably. The PLDD can reduces chemical factors such as PLA2.
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[Objective]To evaluate a preliminary outcome of volar surgical treatment of dorsally displaced fractures of distal radius with open reduction and internal fixation with T shape locking compression plate(TLCP).[Method]From Sept.2003 to Nov.2005,9 cases with dorsally unstable distal radius fractures were treated with open reduction and internal fixation with T-LCP.This study involved 3 males and 6 femals with an average age of 63.5 years(ranged from 52 to 74 years old).According to AO classification: 2 cases of types B2;1 case of type B3;2 cases of type C1;3 cases of type C2;1 case of type C3,all of them were closed fractures of distal radius.The fractures of 9 cases were fixated with T-LCP by volar approach and dorsal soft tissues were not dissected during the operation.The Osteosets and the artificial bone substitute were implanted into bone defects if they were large enough.[Result]Nine cases were followed up for 6 to 17 months and the average time was 10.7 months.The X-ray pictures showed that unions have been achieved in all patients and a mean healing time was 7 weeks.The Osteosets were implanted into large bone defects in one case.No complication was found as infection,non-union,loosing of nails,syndrome of wrist,and medium neuritis.The functional recovery was achieved from 6 to 29 weeks with an average time of 12.5 weeks after operation.Passive wrist motion,active finger motion and forearm rotation were encouraged immediately after surgery.Active wrist motion was suggested in 7 days postoperatively.The clinical outcomes were evaluated according to modified Mcbide grading system.There were 7 excellent,1 good and 1 fair,the satisfactory rate was 88.9%.[Conclusion]The volar fixation of T-LCP for dorsally displaced fractures of distal radius has a good clinical outcome.It allows the patients to begin early exercise.
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@#ObjectiveTo compare the effect and prognosis of two kinds of internal fixation (improved Giebel blade plate and traditional straddle nail) after high tibial osteotomy (HTO) on osteoarthritis of knee with genu varus deformity. Methods37 knees of 32 cases were treated with straddle nail (25 knees) or Giebel blade plate (12 knees). All the cases were followed up for 6～28 months. ResultsThe clinical bone healing time of osteotomy was 8～12 weeks. There was no significant differences between 2 groups in the increased score in HSS Standard and in the clinical bone healing time. ConclusionBoth internal fixation with improved Giebel blade plate and traditional straddle nail get similarly satisfactory prognosis, while the former shows more advantages to allow early functional exercises.
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Objective To investigate the efficacy of injectable osteoinductive material with fibrin sealant(FS) as a carrier compounded with bovine bone morphogenetic protein(bBMP) and bovine fibroblast growth factor(bFGF) for radial defect in dogs.Methods A total of 12 dogs were used in this study.The animals were randomly divided into treatment and control groups with 6 in each.We created a 20-mm bone defect at the upper radius of each dog,and then sutured the subcutaneous tissues and skin around the lesion.After the operation,FS(control) and FS+bFGF+bBMP were given to the two groups respectively by percutaneous injection.To compare the efficacy of the injections,we examined the animals by radiography in 4,8,16,and 24 weeks.The dogs were sacrificed in 24 weeks to obtain the specimens of the bone defect for histological examination and bone mineral density(BMD) determination.Results Radiography showed callus formation in 4 weeks and then osteoneogenesis in 24 weeks in the treatment group;whereas,in the control group,no callus was found around the defect in 24 weeks.In the treatment group,the mean BMD of the diseased radius was significantly higher than that of the healthy leg and that in the control group [(456.33?13.74) mg/cm2 vs(433.33?6.77) mg/cm2(t=2.57,P=0.00) and 0 mg/cm2].By histological examination,the new-formed bone in the treatment group was confirmed integral and dense with intact cortex and continuous marrow cavities in 24 weeks,while the bone defect of the controls were repaired with connective tissues without remodeling of the bone.Conclusion It is effective to repair bone defect in dogs by using injectable osteoinductive material with FS as a carrier compounded with bBMP and bFGF.
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0.05). The expression of IL－ 1, IL－ 6, TNF－? in fibromatosis and the periosteum of CPT was higher than that in normal periosteum and traumatic pseudarthrosis (P
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Objective To investigate the variation of the chromosomal karyotype of patients with congenital pseudarthrosis of the tibia(CPT) and its relation with the neurofibromatosis. Methods Ten patients with complete follow up records in 28 cases of CPT treated between 1982 and 1999 were included in this study. There were 7 males and 3 females. The age of the patients at the surgery ranged 4 to 17 years. Seven patients had skin caf?-au-lait spots. Peripheral venous blood (1-2 ml) of 10 patients was cultured in 1640 culture medium with 10%(v/v) fetal calf serum and phytahematoagglutinin(PHA) for 70-72 hours, and then colchicines was added (10 ?g/ml) in culture medium 4 hours before finishing the culture. The specimens were harvested and the chromosomal karyotype was analysed. Results The karyotype of the chromosomes were normal(46XY or 46XX) in all of the speciments, there were no chromosome aberration, chromosome loss and polyploid. Conclusion Neurofibromatosis has no relation with CPT, the genic location of the CPT may have some relation with the neurofibromatosis.
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Objective To study the effect of injectable osteoinductive materials with fibrin sealant as the vehicle on the reconstruction of segmental radius defect in dog, and to provide an experimental foundation for its clinical application in the future. Methods 20mm bone defects were created in the radius 18 dogs, and in the experiment group b [FS+bFGF+bBMP (bovine BMP)] composite, and in experiment group r (FS+bFGF+rhBMP-2) were injected percutaneously into the defects. A control group (FS) with bone defect only was also included. The reconstruction effect on the segmental dog radius defects was evaluated by radiography, histology, bone mineral density (BMD) at 4, 8, 12, 16, 20 and 24 weeks after operation. Results In the experimental groups with bovine BMP as osteoinductive agent, higher repairing capability and osteogenesis rate were observed in experiment group b (FS+bFGF+bBMP) compared with that of control group (P
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Objective To investigate the effect of the injectable osteoinductive material with fibrin glue(FG)as carrier compounded with rhBMP-2 and bFGF on the proliferation and differentiation of marrow matrix cells(MMCs)of rabbit,in order to lay an experimental foundation for clinical application in the future.Method MMCs were isolated and cultured from bone marrow of a 3-day-old rabbit.The effects of the material were investigated in experiment group(group A:FG+bFGF+rhBMP-2),with control groups consisting of control group 1(group B:FG),control group 2(group C:FG+bFGF),control group 3(group D:FG+rhBMP-2)and single control group(group E:free of material).The observation objects included proliferation rate,adhesive rates,expression of type I collagen and alkaline phosphatase,cell growth condition in the material and the ultrastructure of rabbit MMCs with the aid of electron microscopy,histochemistry and cell culturing.The concentration of rhBMP-2 and bFGF in all groups was uniform(1?g/ml).Results The proliferation rates and the adhesive rates of rabbit MMCs in group A was significantly higher than that in group B,group D and group E,but was lower than in group C(P