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Objective To evaluate neurofunctional and radiographic results of transpedicular screw fixation reduction and anterior column fixation with use of screw-red system in treatment of multiple segment lumbar pedicle and vertebral body fractures combined with spondylolisthesis. Methods A consecutive series of 12 patients with unstable multiple segment lumbar pedicle fracture, vertebral body fracture, spondylolisthesis and neurologic deficit were managed with posterior transpedicular screw fixation including fractured pedicle and anterior screw-rod fixation instrumentation from January 2002 to December 2007. Results Patients were followed up for 24-30 months (mean 26 months). All the patients with incomplete neurologic deficits got improvement by at least one Frankel grade. Transpedicular screw brought satisfactory reduction. At the time of the latest follow-up, no screw breakage occurred. Con-clusions Excellent reduction of unstable multiple segment lumbar pedicle fractures combined with spon-dylolisthesis can attain better reduction and maintenance by means of selective pedicle screw fixation via fractured pedicle and anterior screw-rod instrument.
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[Objective]To study the neurologic criterion and curative effect facts of cervical spondylotic myelopathy.[Method]A prospective study was carried out and 21 cases of cervical spondylotic myelopathy were involved in this investigation to be classified by Nurick grade,JOA score and 40 cent classification.The possibility curative effect facts were analysed.[Result]The patients were followed up for average 11 months.Spinal cord function score were improved by 2~3 grades according to Nurick grade;1～6 cent to JOA score and 7~12 cent to 40 cent postoperation.Height of vertebral,cervical lordosis,centrum posterior decompression being unenough,excess height of centrum were curative effect facts of cervical spondylotic myelopathy.[Conclusion]Nurick classify allow even more contrast,but unsuit to some Cervical spondylotic myelopathy,JOA is simple and convenit,efficienf and across-the-aboard;40 cent assess measure is impersonality but cockamamie.Height of vertebral and centrum posterior decompression being unenough are most important facts about surgery.
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[Objective]To evaluate the long-term results of recurrent lumbar disc herniation between different kinds of reoperation.[Method]Seventy-four patients of recurrent lumbar disc herniation after discectomy alone were treated surgically from May 2001 to Augest 2005.They were divided into three groups:nonfusion,posterolateral fusion and intervertebral fusion.After a long term follow-up(≥2y),their clinical data were reviewed to compared their improvement rate of lower back pain,JOA score,subside rate of disc height and chang rate of superior intervertebral space angle.[Result]The long-term results revealed that the improvement rates of lower back pain JOA score in the three groups were increased in sequence.The differences in subside rate of disc height and change rate of superior intervertebral space angle between discectomy and posterolateral fusion groups were insignificant,but much higher than those of posterior lumbar interbody fusion group.[Conclusion]Posterior lumbar interbody fusion is effective in increasing the improvement rates of lower back pain JOA score and maintaining the disc height and the superior intervertebral space angle.
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Objectives:To study the enzymatic changes and protective effects of ciliary neurotrophic factor (CNTF) on neurons in spinal cord injury (SCI).Methods:SD rats were subjected to incomplete SCI with modified Allen methods.Activities of acetylcholinesterase (AChE) and acid phosphatase (ACP) in spinal cord were quantitatively measured preoperatively,and 3,7,14 days after SCI.Results:AChE activity decreased gradually after injury.ACP activity increased 3 days after injury,and reached peak on the 7th day,then recovered gradually.The rats treated with CNTF showed relatively smooth change of the 2 kinds of enzymes.Conclusions:CNTF plays a role in protecting the spinal cord neurons against injury.
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Objective: To study the biocompatibility of CFR/PEEK composite in bone tissue after implanted in lumbar intervertebral space and to evaluate its role in the interbody fusion compared to the allograft bone. Methods: Thirteen beagles were chosen among which 7 were implanted with the disk-like CFR/PEEK composite in the lumbar intervertebral space and the other 6 were implanted with allograft bone. X-ray, QCT and histological examination were employed at 6, 12 and 24 months postoperatively. Results: The X-ray results of fusion segment were in conformity with the QCT's as well as that of histological results. All animals obtained a complete fusion at 24 months. Histological examination revealed that the anterior soft tissue to the implant exhibited a nonspecific foreign body reaction with connective tissue embed the biomaterials. Carbon fragment were seen in the surrounding tissue and some of the debric were phagocytosed by foreign body giant cell. Histological examination of bone and material revealed that new bone grew along the hole of CFR/PEEK implant. Conclusion: CFR/PEEK has an excellent biocompatibility to bone tissue.
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0.05). X ray film revealed that there was no loosening and displacement of internal fixation device in the test group 3 days after operation. In control group, there were 2 cases of slight graft bone displacement. Both groups exhibited a stiff bone fusion at operative level 3 months later. The intervertebral disc height of fusion level increased by (1.2?0.7) mm in the test group while decreased by (1.5?0.8) mm in the control group. CT scan revealed that there was tight contact between the internal fixation device and bone 3 days after operation. Both groups had obtained bone fusion in CT image 3 months later. Conclusion:Threaded cervical interbody fusion device made from carbon fiber reinforced PEEK has an excellent biocompatibility and can restore the intervertebral disc hight effectively with satisfactory fusion rate.
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Objective:To study the relationship between dynamic Hoffmann's sign(DHS) and the early diagnosis of cervical spondylotic myelopathy. Methods:Patients with neck, shoulder and back pain (218 cases) were employed in this investigation. Among them, 96 cases had positive reaction to DHS test and they received 3 7 years follow up as study group. The other 122 cases negative to DHS test were taken as control group. The clinical data included the patient's symptoms and signs, sagittal diameter of cervical spinal canal, Pavlov rate, angular displacement and horizontal displacement between cervical vertebral, etc . Results:There were 72 cases in study group developed cervical spondylotic myelopathy and needed operation during follow up. Meanwhile, 11 cases in control group received surgical treatment. The incidence of stenosis of cervical spinal canal, herniation of cervical intervertebral disc and instability of cervical spine in DHS group were significantly higher than that of the control group. Conclusion:DHS is closely related to the onset of cervical spondylotic myelopathy. The patients should be followed up closely if they present positive reaction to DHS, and should be operated on early when their neurological symptom is progressing.
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Objective:To investigate the biological mechanism of the degeneration of cervical spine in cervical spondylosis(CS) by analyzing the alteration of bone matrix components.Methods:Twenty five degenerative cervical vertebra and 8 blood samples from CS cases were collected.The contents of hyaluronic acid(HA),laminin(LN),pro collagen Ⅲ,collagen Ⅳ were detected by radioimmunoassay.Calcium,phosphate and total protein levels were detected by automatic biochemical analyzer.Results:Ruling out the inference of blood, the contents of HA, LN, pro collagen Ⅲ and collagen Ⅳ were significantly lower in degenerated CS vertebra than in the control, so as the levels of calcium and phosphate. Conclusion:Bone matrix components are obviously decreased during the degeneration of cervical vertebra, resulting in the alleviation of bone tenacity and hardness. This may be one of the biological mechanisms of cervical vertebra degeneration and deterioration of cervical spine biomechanics.
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Objective: To investigate the gene expresssion changes in normal and degeneration cervical intervertebral disc in rats, providing information for clinical diagnosis and treatment of cervical intervertebral disease.Methods: The models of cervical intervertebral disc degeneration in rats caused by imbalance between the dynamic and static forces was established.cDNA microarray chips containing 512 cDNAs were used to investigate the gene expression pattern in cervical intervertebral disc of rat.The results were scanned and analyzed by computer image analysis,and then subjected to standardization,ratio and clustering analysis.Results: Eighteen genes expressed in cervical intervertebral disc were screened out,comprising 11 up regulated and 7 down regulated ones,respectively.This genes expression in cervical spondylosis was similar to other reports.Conclusion: Signal transduction pathways plays an important role in the process of cervical intervertebral disc degeneration.Investigation on the gene expression pattern is helpful for studying degeneration of cervical intervertebral disc pathogenesis.
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Sixty-eight patients with a surgically proven lumbar stenosis associated with disc protrusion were studied retrospectively. According to the essential clinical feature the patients were divided into three groups: Group 1, intermittent claudication (n=21), Group 2, low back pain associated with unilateral aciatic pain (n=42), and Group 3, intermittent claudication coexisting with bilateral or unilateral leg pain (n=5). The final diagnosis prior to operation was difficult to make. Surgical decompression of the spinal canal required removal of the portion of hypertrophied superior articular faced and prolapsed disc. Fifty-eight patients were followed up from 6 months to 6 years and 3 months. In 41 patients preoperative neurogenic symptoms completely disappeared, 14 still an occasinal bachache, existed and 3 moderate symptoms persisted postoperatively.
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Under the operating microscope an experiment of epineurium suture by comparison with perineurium suture was performed in sciatic nerves of 20 rabbits. "Strength-duration curve" of tibialis posterior muscle and axons growth rate of distal myelinated fiber were used as the viewing indexes. The end result was showed that there were no obvious differences between both methods in restoring peripheral nerves function. Funicular orientation by direct stimulation was advocated. A new instrument of measuring "Strength-duration curve" was produced.
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Craniocervical unstability may cause severe motor and respiratory compromise due to recurrent upper spinal cord and/or brain stem impingement.In recent years,by improving internal fixation materials and surgical techniques,the methods of surgical treatment of craniocervical unstability has made great progress.With the appearance of these new surgery and internal fixation methods,the successful rate and safety of the operation obviously increased and the complications was reduced greatly.We reviewed the surgery methods for craniocervical unstability in this article.
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Pelvic fractures are high energy injuries involving severe trauma and potential intra pelvic bleeding. Immediate control of hemorrhage, fixation of pelvic fractures and inter department cooperation are important for their treatment. Transcatheter angiographic embolization can be used to identify bleeding sites, control hemorrhage and improve mortality and complications, and it has been proved to be a valuable technique in the diagnosis and treatment of pelvic vascular injuries. Still there is a considerable controversy on the fracture patterns, the sequence and the timing of emergency angiography and possible embolization in these patients. In this paper, we reviewed the role of angiographic embolization and we thought more attention should be paid on angiographic embolization in the control of hemorrhage.