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Objective:To investigate the safety and clinical efficacy of primary anterior lesion removal and bone graft fusion combined with secondary posterior fixation in the treatment of cervical suppurative spondylitis.Methods:Retrospective analysis was performed on the data of twenty cervical suppurative spondylitis patients treated with primary anterior lesion removal and bone graft fusion combinedwith secondary posterior fixation in our hospital from May 2016 to December 2020, including 14 males and 6 females. Aging from 40 to 87 years, with an average of 60.2±12.6 years. The laboratory tests of preoperative blood culture, such as white blood cell count (WBC), erythrocyte sedimentation rate (ESR), and hypersensitive C-reactive protein (CRP) were performed.The selection and duration of antibiotic usewere guided according to bacterial culture and laboratory test results. visual analogue scale (VAS) score, Japanese Orthopeadic Association (JOA) score and Frankle classification of neurological function were evaluated before surgery, 3 months after surgery, and 12 months after surgery, so were the Cobb angle and segmental angle of cervical lordosis. Single factor repeated measure ANOVA was used for statistical analysis of data.Results:Surgeries were performed successfully for all the 20 patients. 9 cases of Staphylococcus aureus, 4 cases of Streptococcus and 2 case of Escherichia coli were detected by pathogen examination. The remaining 5 cases were negative in bacterial culture. All 20 patients were followed up for 18.3±6.7 months. WBC, ESR and CRP at 3 and 12 months after surgery were significantly lower than those before surgery ( F value: 17.90, 30.65, 18.64, P<0.001). The VAS at 3 months after surgery 1.35±0.49 and 12 months after surgery 1.15±0.48 were significantly lower than that before surgery 4.95±1.10 ( F=176.12, P<0.001). The JOA score at 3 months after surgery 15.40±1.93 and 12 months after surgery 16.06±1.36 were significantly better than that before surgery 11.45±2.78 ( F=65.33, P<0.001). The Cobb Angle of C 2-C 7 cervical lordosis after surgery 14.45°±4.36° and 12 months after surgery (13.70°±3.15°) were significantly larger than that before surgery (8.25°±4.36°) ( F=72.54, P<0.001). Cobb angle of the lesion segment after surgery (3.60°±1.90°) and 12 months after surgery (2.90°±1.44°) were significantly better than that before surgery (-3.55°±5.74°) (negative value indicated kyphosis) ( F=42.49, P<0.001). Bone fusion was observed in all graft areas at 12 months of follow-up. Conclusion:The treatment of cervical suppurative spondylitis with primary anterior lesion removal and bone graft fusion combined with secondary posterior fixation can effectively obtain intraspinal decompression, improve pain and nerve function, as well as restore cervical stability and correct kyphosis, with satisfactory clinical efficacy.
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Objective:To summarize the status and trends of papers published by Chinese scholars on the combination teaching model in the area of medical education in China.Methods:Literature retrieval was performed on CNKI, WanFang, and VIP database, and studies regarding to combination teaching model in medical education were selected and analyzed. BICOMS-2 analysis software was used to extract and sort out keywords, provinces, authors and their organizations and generate co-occurrence matrix and/or word matrix. NetDraw and gCLUTO software were used to draw the network relationship diagram and cluster analysis respectively.Results:Totally 99 articles were included this study, and the number of articles published each year showed an increasing trend. Authors from 15 provinces contributed to these articles, with uneven development and limited cooperation across regions. The authors were divided into 4 main groups, but the communication among these groups was not enough. And there were 3 main research topics.Conclusion:The number of articles on combination teaching model in medical education in China is increasing, covering many authors, teams, institutions and regions. However, the communication and cooperation among these authors and institutions needs to be strengthened; and the research topics should be expanded.
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OBJECTIVE： To investigate the effects of different polar parts of 5 kinds of Alpinia on the function of sympathetic-adrenal system in gastric ulcer model rats with cold syndrome， such as the root of Alpinia officinarum， the rhizome and fruit of Alpinia galangal， the seed of Alpinia katsumadai， and the fruit of Alpinia oxyphylla. METHODS： SD rats were given Anemarrhena asphodeloides decoction at 4 ℃ and Glacial acetic acid solution intragastrically to induce gastric ulcer model with cold syndrome； the model rats were randomly divided into model group， Fuzi lizhong pills group （positive control， 9.0 g/kg）， cimetidine group （positive control， 0.003 3 g/kg）， low-dose and high-dose groups of petroleum ether， ethyl acetate， n-butanol and water extraction parts from 5 medicinal materials （hereinafter referred to as “gaoshidi” “gaoshigao” “dashidi” “dashigao” “hongshidi” “hongshigao” “caoshidi” “caoshigao” “yishidi” “yishigao” “gaoyidi” “gaoyigao” “dayidi” “dayigao” “hongyidi” “hongyigao” “caoyidi” “caoyigao” “yiyidi” “yiyigao” “gaozhengdi” “gaozhenggao” “dazhengdi” “dazhenggao” “hongzhengdi” “hongzhenggao” “caozhengdi” “caozhenggao” “yizhengdi” “yizhenggao” “gaoshuidi” “gaoshuigao” “dashuidi” “dashuigao” “hongshuidi” “hongshuigao” “caoshuidi” “caoshuigao” “yishuidi” “yishuigao”， 0.064/0.256， 0.032/ 0.128， 0.008/0.032， 0.075/0.3， 0.1/0.4， 0.064/0.256， 0.108/0.432， 0.16/0.64， 0.064/0.25， 0.125/0.5， 0.056/0.224， 0.108/0.432， 0.08/0.32， 0.2/0.8， 0.3/1.2， 0.14/0.56， 0.032/0.128， 0.028/0.112， 0.05/0.2， 0.087/0.348 g/kg， by mass of extraction parts）， with 10 rats in each group； and the blank group （normal temperature water） was set up. Next day after modeling， blank group and model group were given constant volume of normal temperature water intragastrically； administration group was given relevant solution 2 mL/100 g intragastrically， q12 h， 4 times in total. After last medication， urine contents of 17-OHCS， CAs substances （A， NE， DA） and serum contents of ACTH and D-β-H were determined by ELISA. RESULTS： Compared with blank group， the contents of 17-OHCS， A， NE and DA in urine， the contents of ACTH and D-β-H in serum were decreased significantly in model group （P＜0.01）. Compared with model group， the contents of 17-OHCS （Fuzi lizhong pills group， cimetidine group， gaoshidi， gaoshigao， dashigao， hongshigao， caoshigao and yishigao groups， ethyl acetate part groups of 5 medicinal materials， dazhenggao， hongzhenggao， caozhenggao and yizhenggao groups， gaoshuigao， dashuigao and hongshuigao groups）， A （Fuzi lizhong pills group， cimetidine group， gaoshigao， dashigao， hongshidi， hongshigao， caoshidi， caoshigao and yishigao groups， ethyl acetate part groups of 5 medicinal materials， gaozhenggao， dazhenggao， hongzhengdi， hongzhenggao， caozhenggao and yizhenggao groups， hongshuigao group）， NE （Fuzi lizhong pills group， cimetidine group， petroleum ether part， ethyl acetate part and n-butanol part groups of 5 medicinal materials， gaoshuigao， dashuigao and hongshuigao groups）， DA [Fuzi lizhong pills group， cimetidine group， petroleum ether part （except for gaoshidi group） and ethyl acetate part groups of 5 medicinal materials， gaozhenggao， dazhenggao， hongzhenggao， caozhenggao and yizhenggao groups， hongshuigao group] in urine， serum contents of ACTH [Fuzi lizhong pills group， petroleum ether part （except for gaoshidi， dashidi and caoshidi groups） and ethyl acetate part （except for dayidi and hongyidi groups） groups of 5 medicinal materials， hongzhenggao group， dashuigao group]， and D-β-H [Fuzi lizhong pills group， gaoshigao， dashigao， hongshidi， hongshigao and yishigao groups， ethyl acetate part groups of 5 medicinal materials （except for dayidi， hongyidi and yiyidi groups）， dazhenggao and hongzhenggao groups， hongshuigao group] were increased significantly （P＜0.05 or P＜0.01）. The contents of 17-OHCS and D-β-H in dashigao group， the contents of ACTH and D-β-H in caoshigao group and the contents of D-β-H in gaoshigao and yishigao groups were significantly lower than hongshigao group. The contents of DA in gaoyigao， caoyigao and yiyigao groups as well as the contents of D-β-H in gaoyigao， hongyigao， caoyigao and yiyigao groups were significantly lower than dayigao group； the contents of DA in gaoyigao and caoyigao groups were significantly lower than hongyigao group， the contents of ACTH in gaoyigao， dayigao， caoyigao and yiyigao groups were significantly higher than hongyigao group. The contents of 17-OHCS， DA and ACTH in gaozhenggao， dazhenggao， caozhenggao and yizhenggao groups， the contents of A in dazhenggao， caozhenggao and yizhenggao groups as well as the contents of D-β-H in gaozhenggao， caozhenggao and yizhenggao groups were significantly lower than hongzhenggao group. The contents of 17-OHCS and D-β-H in caoshuigao and yishuigao groups were significantly lower than dashuigao group. The contents of 17-OHCS， DA and D-β-H in caoshuigao and yishuigao groups as well as the contents of DA and D-β-H in gaoshuigao groups were significantly lower than hongshuigao group （P＜0.05 or P＜0.01）. CONCLUSIONS： Different polar parts of 5 kinds of Alpinia can improve gastric ulcer model rats with cold syndrome to different extents； among them， the fruit of A. galangal is the best， followed by the root of A. officinarum. Above medicinal materials can regulate the function of sympathetic-adrenal system by increasing the contents of 17-OHCS， CAs and D-β-H.
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Objective To investigate the clinical effectiveness of anterior cervical discectomy and fusion (ACDF)plus plating in the treatment of unstable Hangman's fractures.Methods A retrospective case series study was carried out to analyze 12 patients who received ACDF plus plate internal fixation for unstable Hangman's fracture admitted to Sir Run Run Shaw Hospital affiliated to Zhejiang University School of Medicine from July 2014 to July 2018.There were nine males and three females,aged 24-70 years with an average of 46.2 years.According to Levine-Edwards typing,there were seven patients of type Ⅱ,four patients of type Ⅱ A and one patient of type Ⅲ.There were two patients of grade D and 10 patients of grade E according to the American Spinal Injury Association (ASIA) classification.The operation time,intraoperative blood loss and the operational complications were recorded.At 3 days,1,3,6,12 and 24 months after operation,the height of intervertebral disc,physiological curvature of cervical spine,fracture healing and bone graft fusion were evaluated.The recovery of neurological function was assessed by ASIA,and the neck pain relief and function improvement was assessed by visual analogue scale (VAS) and the neck disability index (NDI).Results All patients were followed for 6-48 months(mean,27.7 months).The operation time ranged from 50-100 minutes,with an average of 72.5 minutes.The intraoperative blood loss was 30-120 ml (mean,65.8 ml).No serious complications occurred during and after operation.Two patients had dysphagia after operation,and the symptoms were relieved at the follow-up of 3 months.All patients achieved bony fusion of C2-3 within the 6 month follow-up.No subsidence or migration of cages and significant loss of intervertebral space height were observed.The patient's neck and occipital pain was relieved obviously,and the flexion,extension and rotation of cervical spine were good.The neurologic dysfunction of two patients of ASIA Grade D recovered after surgery,and the final ASIA grade was E.The VAS score was decreased from 5.0 (4.0,6.0)points preoperatively to 1.0(0,1.0)points at the last follow-up (P ＜0.01).The NDI score was improved from (28.5 ± 6.4) points preoperatively to (5.3 ± 2.7) points at the last follow-up (P＜0.01).Conclusion ACDF combined with plate internal fixation can provide immediate postoperative stability,high fusion rate,less complications,less pain,and satisfactory function recovery.
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Objective@#To investigate the clinical effectiveness of anterior cervical discectomy and fusion (ACDF)plus plating in the treatment of unstable Hangman's fractures.@*Methods@#A retrospective case series study was carried out to analyze 12 patients who received ACDF plus plate internal fixation for unstable Hangman's fracture admitted to Sir Run Run Shaw Hospital affiliated to Zhejiang University School of Medicine from July 2014 to July 2018. There were nine males and three females, aged 24-70 years with an average of 46.2 years. According to Levine-Edwards typing, there were seven patients of type Ⅱ, four patients of type Ⅱ A and one patient of type Ⅲ. There were two patients of grade D and 10 patients of grade E according to the American Spinal Injury Association (ASIA) classification. The operation time, intraoperative blood loss and the operational complications were recorded. At 3 days, 1, 3, 6, 12 and 24 months after operation, the height of intervertebral disc, physiological curvature of cervical spine, fracture healing and bone graft fusion were evaluated. The recovery of neurological function was assessed by ASIA, and the neck pain relief and function improvement was assessed by visual analogue scale (VAS) and the neck disability index (NDI).@*Results@#All patients were followed for 6-48 months(mean, 27.7 months). The operation time ranged from 50-100 minutes, with an average of 72.5 minutes. The intraoperative blood loss was 30-120 ml (mean, 65.8 ml). No serious complications occurred during and after operation. Two patients had dysphagia after operation, and the symptoms were relieved at the follow-up of 3 months. All patients achieved bony fusion of C2-3 within the 6 month follow-up. No subsidence or migration of cages and significant loss of intervertebral space height were observed. The patient's neck and occipital pain was relieved obviously, and the flexion, extension and rotation of cervical spine were good. The neurologic dysfunction of two patients of ASIA Grade D recovered after surgery, and the final ASIA grade was E. The VAS score was decreased from 5.0 (4.0, 6.0)points preoperatively to 1.0(0, 1.0)points at the last follow-up (P<0.01). The NDI score was improved from (28.5±6.4)points preoperatively to (5.3±2.7)points at the last follow-up (P<0.01).@*Conclusion@#ACDF combined with plate internal fixation can provide immediate postoperative stability, high fusion rate, less complications, less pain, and satisfactory function recovery.
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Objective To discuss the clinical value of IL-6 combined with CA125 and HE4 as a new association marker in the diagnosis of early ovarian cancer.Methods The expression of IL-6, CA125 and HE4 in 21 cases of early ovarian cancer (stageⅠ-Ⅱ), 36 cases of advanced ovarian cancer (stageⅢ-Ⅳ), 40 cases of benign ovarian tumor and 40 healthy women were measured by the Roche automatic chemiluminescence analyzer (electrochemiluminescence).The sensitⅣity, specificity, positive predictive value, negative predictive value and ROC curves were used to evaluate the diagnostic value.Results The serum levels of IL-6, CA125 and HE4 in patients with ovarian cancer were significantly higher than those in the benign ovarian tumor and the healthy control (P＜0.05).The sensitⅣity, specificity, positive predictive value and negative predictive value of IL-6 combined with CA125 and HE4 were respectively 85.7％, 90％, 81.8％, 92.3％in the diagnosis of early ovarian cancer (stageⅠ-Ⅱ) patients and respectively 94.4％, 97.5％, 97.1％and 95.1％for advanced ovarian cancer (stageⅢ-Ⅳ) patients.For IL-6 combined with CA125 and HE4, the ROC AUC was respectively 0.955 4 and 0.974 0 for early ovarian cancer (stageⅠ-Ⅱ) patients and advanced ovarian cancer (stageⅢ-Ⅳ) patients.It performed significantly better than any single test of IL-6, CA125 and HE4 and the 2-marker combination of CA125+HE4.Conclusion The marker panel, IL-6, CA125 and HE4, shows higher sensitⅣity, positive predictive value and ROC AUC.It is an ideal serum marker combination for the diagnosis of early ovarian cancer (stageⅠ-Ⅱ) patients, which can improve the diagnostic efficiency of early ovarian cancer.
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Objective To investigate the indirect decompression effect of oblique lateral interbody fusion (OLIF) in the treatment of mild to moderate degenerative lumbar stenosis.Methods From October 2014 to November 2016,23 patients with mild to moderate lumbar spinal stenosis underwent OLIF combined with or without posterior pedicle screw fixation;9 males and 14 females with average age of 59.2±11.6 years old;8 cases at L3,4 segment and 15 cases at L4,5 segment.All cases were followed up for more than 6 months.Thin layer scanning of CT and two-dimensional reconstruction images were used to measure the vertical diameter and area of intervertebral foramen.Intervertebral disc height and spinal canal anteroposterior diameter were measured on median sagittal MRI sequence,and the anteroposterior diameter and the cross-sectional area of the spinal canal were measured on cross-sectional MRI sequence.The clinical effects were assessed by the visual analogue score (VAS) and the Oswestry disability index (ODI) for low back pain,lower limb pain and lower limb numbness.Results Compared with those measurements pre-operatively,the post-operative intervertebral disc height increased by 78.6％±13.4％.The post-operative left vertical diameter of intervertebral foramen increased by 36.7％±7.8％,and the post-operative left area of intervertebral foramen increased by 36.6％± 8.7％,and the post-operative right vertical diameter of intervertebral foramen increased by 40.7％±9.6％,and the post-operative right area of intervertebral foramen increased by 40.0％±8.9％.The post-operative anteroposterior diameter of sagittal spinal canal were increased 32.6％ ± 5.9％,and the post-operative anteroposterior diameter of cross-sectional spinal canal were increased 34.4％±6.8％,and the post-operative cross-sectional area of the spinal canal were increased 47.5％±7.2％.All of the differences were statistically significant between pre-operative and post-operative measurements.The VAS score for low back pain was 6.2± 1.7 pre-operatively,and 1.1±0.5 post-operatively.The ODI for low back pain was 81.2％± 18.2％ pre-operatively,and 6.1％±2.0％ post-operatively.The VAS score for lower limb pain was 5.6±1.4 pre-operatively,and 0.8±0.3 post-operatively.And the VAS score for lower limb numbness was 6.6±2.0 pre-operatively,and 3.4± 1.2 post-operatively.All of the differences were statistically significant between pre-operative and post-operative evaluations.Conclusion There were obvious radiological evidences and remarkable clinical effect of indirect decompression using OLIF technique in treatment of mild to moderate lumbar spinal stenosis at early post-operative stage.However further long-term follow-up studies with multicenter large sample were still needed.
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Objective To evaluate the early clinical outcomes and complications of oblique lateral interbody fusion (OLIF) in the treatment of degenerative lumbar diseases.Methods All of 83 patients,29 males and 54 females with ages from 32 to 83 (average 60.8± 13.7 y),underwent OLIF with or without posterior pedicle screw-rod instrumentations from October 2014 to February 2017.The index diagnosis was discogenic back pain in 17 cases,spondylolisthesis in 23,lumbar spinal canal stenosis in 25,and degenerative lumbar spinal kyphoscoliosis in 18 cases.The distribution of operative level was 5 at L1,2,13 at L2,3,38 at L3,4,and 69 at L4,5.The mean number of fusion level for each case was 1.5 segments.The operative duration,blood loss during operation,intra-operative and post-operative complications,the length of post-operative hospital stay were recorded.Clinical outcomes were evaluated using visual analogue scale (VAS) and Oswestry disability index (ODI).All patients were followed up for at least 3 months.Lumbar X-ray and CT scans were taken and the clinical outcomes were re-assessed during follow-up.Results Fifty-one in the 83 patients underwent supplementary posterior pedicle screw-rod instrumentation with OLIF procedures.The operation lasted for 43-295 min,with a mean duration of (153 ± 72) min.Mean operation time for each OLIF segment was 43± 12 min.Blood loss during the operation was 30-800 ml,with a mean of 125±74 ml.Mean blood loss for each OLIF segment was 27±13 min.Average length of stay was 5.6 ± 3.2 d,ranging from 3-15 d.The VAS for back pain and leg pain and ODI scores were decreased apparently for each patient.The total incidence of complications was 22.9％ (19/83),including 6.0％ (5/83) of intra-operative complications (4 cases of cage subsidence,1 case of segmental artery injury) and 16.9％ (14/83) of post-operative ones.The latter consisted of ipsilateral hip flexor weakness in 6,ipsilateral anterolateral thigh pain in 2,ipsilateral lateral thigh numbness in 1,contralateral pain in flexion of hip in 1,ipsilateral sympathetic chain injury in 2,and pain in area of iliac bone donor site in 2.All symptoms were released or disappeared during follow-up.Conclusion OLIF as a novel minimally invasive technique can act as a safe and effective treatment for degenerative lumbar diseases,which can also reduce approach-related complications.
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Objective To investigate the effect of over-expression of ROBO4 on permeability of human renal glomerular endothelial cells (HRGECs) in high glucose medium.Methods HRGECs infected with recombinant lentiviral vector ROBO4 were cultured in high glucose or low glucose medium in vitro.The protein levels of ROBO4 and ARF6 in each group were detected by Western blotting.The endothelial permeability was measured by the effiux of fluorescein isothiocyanate-dextran (FITC-Dextran)permeated through the monolayer endothelial cells using Transwell cell model system.The cell viability after lentivirus transfection was measured by CCK8 assay.Results The transfection rate of lentiviruses in HRGECs reached 80％ 72h after,and obvious overexpression of ROBO4 protein was in transformed cells compared with the empty vector group (P＜0.05).The lentivirus-mediated ROBO4 transfection did not affect cell viability of HRGECs.Compared with the low glucose group,the expression of ROBO4 increased obviously after 12h,but declined after 24h (P＜0.05),and reached to minimun after 72h (P＜0.05).On the contrary,the expression of ARF6 increased after 12h,and the increase reached to the maximum after 72h (P＜0.05).Furthermore,the vascular permeability increased gradually after 24h,and reached to the maximum after 72h (P＜0.05) in high glucose group.Compared with the empty vector group,the over-expression of ROBO4 inhibited the expression of ARF6 significantly,and the FITC-Dextran permeability reduced obviously.Conclusion Over-expression of ROBO4 may significantly enhance the barrier functions of HRGEC in high glucose medium,and ROBO4 activation may be a potential therapeutic approach in diabetic nephropathy.
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Objective To evaluate the clinical outcomes of oblique lateral interbody fusion (OLIF) in the treatment of adult degenerative scoliosis (ADS).Methods From January 2015 to May 2016,17 ADS patients,4 males and 13 females were enrolled with ages from 46 to 80 (average 69.5±9.2 years).The Cobb angle of all was greater than 10°.According to Lenke-Silva classification systems:Ⅰ level,2 cases,decompression alone;Ⅱ level,2 cases,decompression and limited instrumented spinal fusion;Ⅲ levels,4 cases,decompression and lumbar curve instrumented fusion;Ⅳ levels,5 cases,decompression with anterior and posterior spinal instrumented fusion;Ⅴ level,4 cases,thoracic instrumentation and fusion extension.The operation time,blood loss,blood transfusion,and preoperative and postoperative complications were recorded.Clinical and radiological outcomes were evaluated using visual analogue scale (VAS),Oswestry disability questionnaire (ODI) scores,sagittal vertical axis (SVA) and coronal Cobb.All cases were followed up in 3,6,12 and 24 months.Results All of 17 cases underwent OLIF,one level 4 cases,two levels 2 cases,three levels 7 cases and four levels 4 cases.Alone OLIF was 5 cases (2 case of Ⅰ level,1 case of Ⅱ level,1 case of Ⅲ level and 1 case of Ⅳ level).OLIF combined with posterior approach was 12 cases and the interval time were 1-2 weeks,the mean were 1.7±0.5 weeks.Among these 12 cases,posterior fixation was 6 cases,posterior fixation and decompression was 2 cases,and L5/S1 interbody fusion was 4 cases.The operation lasted for 50-460 min,with a mean duration of 230.6± 132.0 min.Blood loss during the operation was 30-640 ml,with a mean of 306.5±213.8 ml.No patient had blood transfusion.The follow-up was 12-28 months and the mean was 17.9±4.5 months.The preoperative Cobb angles were 16.2°-37.7°,the mean was 29.1°±6.4°.The postoperative Cobb angle were 1.5°-10.2°,and the mean were 5.6°±2.4°.The Cobb of all cases improved significantly.The SVA was returned to the normal level in 4 cases of Lenke-Silva V level.The VAS and ODI score decreased from 7.1 ±0.7 preoperatively to 2.4±0.9 at last follow-up,and from 37.9±2.5 to 10.9±3.0,respectively,and both of them were improved significantly.2 cases of OLIF had cage malposition.Left hip flexor weakness occurred in 5 cases and recovered completely within 2 weeks.Left anterior thigh pain occurred in 1 case and disappeared within 2 weeks.Left sympathetic chain injury happened in 1 case and recovered at last follow-up.Conclusion OLIF as a management of ADS showed excellent short-term outcomes.Clinical and radiological results,such as VAS,ODI and Cobb angle,were improved in all cases.OLIF will be a good choice for the treatment of ADS.
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Objective To investigate the radiographic characteristics of posterosuperior fracture fragment of the injured vertebral body and its effects on the results of surgical treatment in thoracolumbar burst fractures.Methods A total of 45 patients with acute thoracolumbar burst treated by either anterior or posterior surgery from January 2014 to December 2015 were analyzed by retrospective casecontrol study.There were 24 males and 21 females with a mean age of 33.6 years (range,23-52 years).Fractured segments included T12 in six cases,L1 in 15,L2 in 14,L3 in 5,and L4 in 5.Based on AO classification,there were ten cases of A3 fractures and 35 cases of Ag fractures,among which four cases of A4 were combined with B2 injuries.Eleven patients underwent anterior surgery and 34 patients posterior surgery.The operation time and intraoperative blood loss were recorded.The following parameters were also measured pre-and post-operatively,namely the displacement and inversion angle of posterosuperior fracture fragment,Cobb angle,anteroposterior diameter (APD) of spinal canal,and American spinal injury association (ASIA) neurological scale.Results All patients were followed up for 11-24 months (mean,17 months).There were no complications except for one case of implant loosening at three months after anterior surgery.The average operation time was 138.3 minutes and intraoperative blood loss was 293.7 ml in anterior surgery while the average operation time was 77.5 minutes and intraoperative blood loss was 54.7 ml in posterior surgery (P ＜ 0.05).Compared with postoperative situation,the canal APD was increased by 55.5％ in anterior surgery and the corresponding increase was 14.9％ in posterior surgery (P ＜ 0.01).There was no significant difference between two groups in Cobb angle correction.Compared with situation before surgery,the postoperative ASIA grading was improved in 73％ of the patients in anterior surgery and while it was enhanced in 24％ of the patients in posterior surgery (P ＜ 0.05).On the aspect of spinal canal decompression,anterior surgery had obvious decompression effects.The canal APD of anterior surgery was 94.4％,which was larger than 88.5％ in posterior surgery,although the difference was not significant.Notably,when the fragment displacement was ≤ 8 mm,posterior surgery could achieve 97.4％ APD which was comparable with that of anterior surgery.In contrast,when the fragment displacement was ＞ 8 mm,the APD was much smaller in posterior surgery with only 78.5％ (P ＜ 0.05).Similarly,when the fragment inversion was ≤25° or ＞ 25°,the APD was significantly different in anterior surgery and posterior surgery (95.4％ vs.80.8％) (P ＜ 0.05).Conclusions Although posterior surgery for thoracolumbar burst fractures is easy to perform and has short operation time and little intraoperative blood loss,it cannot always guarantee adequate decompression of spinal canal.When the posterosuperior fragment displacement is ＞ 8 mm or when its inversion is ＞ 25°,stand-alone posterior indirect reduction technique is likely to lead to inadequacy of canal restoration.In this case,anterior surgery should be considered in order to achieve more complete canal decompression.Therefore,this radiographic characteristic of the posterosuperior fragment could serve as an approach reference for thoracolumbar burst fractures.
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Objective To investigate a reliable and practicable model of intraoperative neurophysiological monitoring (IONM) in oblique lateral interbody fusion (OLIF) combined with posterior transpedicle internal fixation.Methods A total of 34 consecutive patients who underwent OLIF combined with posterior transpedicle internal fixation with IONM at the SRRSH from November 2014 to July 2016 were collected and follow-up at least for 3 months postoperative.The intraoperative somatosensory evoked potentials (SEP),motor evoked potentials (MEP),dermatomal somatosensory evoked potential (DSEP) and spontaneous electromyography (sEMG) were used and evaluated,besides,triggered electromyography (tEMG) was used to monitor the implantation of pedicle screws,the possible reasons and treating procedures of monitoring alerts were summarized.Results A total of 34 cases of patients were effectively monitored during OLIF combined with posterior transpedicle internal fixation.SEP monitoring was successful in all patients,and no abnormal SEPs were observed in all cases.DSEP monitoring was successful in 20 cases (58.8％),and no abnormal DSEPs were observed in these patients.MEP was successfully monitored in all cases,eliminating the anesthesia factor,no abnormal MEPs were observed in all cases.The sensitivity and positive predictive value of SEP,MEP,DSEP were 0％.3 cases had abnormal sEMG reactions during the channel establishment which disappeared after adjustment of channel,and 2 cases which appeared abnormal wave recovered after brief observation.Among the 5 patients with abnormal wave,one case got numbness,one patient felt pain in front of the thigh postoperative.Among the other 29 patients without abnormal wave during channel establishment,one case appeared numbness.These 3 patients with neurologic symptoms recovered in 3 months after conservative treatment.The sensitivity and specificity of sEMG was 66.7％ and 90.3％ respectively,negative predictive value and positive predictive value were 96.6％ and 40％ respectively.6 screws got tEMG response after tapping even the intensity was less than 10mA,which showed broken codex of pedicle according to postoperative CT scan.Cornclusion Intraoperative application of sEMG monitoring in OLIF can obviously reduce the incidence of the neurological deficit,which was an effective method,tEMG monitoring during lumbar pedicle screw fixation can detect the mal-positioned screws and protect the nerve roots.SEP,MEP and DSEP did not seem well suited for OLIF.
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Objective To analyze the influence of Wiltse approach and conventional transmuscular approach on the mul?tifidus muscle by imageology, histology and electrophysiology assessment following short?segment pedicle fixation on thoracolum?bar fractures. Methods 76 patients with thoracolumbar fractures without neurological deficits who had undergone short?segment pedicle fixation between June 2010 and August 2012. Wiltse approach 36 cases, conventional transmuscular approach 40 cases. The perioperative parameters, Visual Analogue Scale scores (VAS), and radiologic parameters, esp the imageology, histology and electrophysiology changes of multifidus muscle were compared. Results 20 cases were fellowed up over 1 year in the Wiltse ap?proach group (20/36, 56%). 25 cases were fellowed up over 1 year in the conventional transmuscular approach group (25/40, 62.5%). No significant differences were found in terms of gender, age, fracture type, injured segment and follow?up period. Till the last follow?up, all patients with vertebral fractures were healed. No loosening or breaking of internal fixation was observed. Com?pared to the conventional transmuscular approach, the Wiltse approach was significantly advantageous in terms of operation time, the amount of bleeding, hospital stays and VAS scores after the surgery but the length of incision, besides, the Wiltse approach group had less incidence of multifidus atrophy and less fatty infiltration, and in conventional transmuscular approach group electro?myography demonstrated that the multifidus muscles median frequency values and average amplitude value were significantly low?er than Wiltse approach group. Conclusion The Wiltse approach for thoracolumbar fractures, retaining the posterior ligament complex, is an effective and minimally invasive treatment, with less trauma, less bleeding, less operation time, the advantages of re?liable clinical results. Especially less incidence of multifidus atrophy and less fatty infiltration.
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Objective To explore the diagnostic value of cerebrospinal fluid(CSF) biochemical indexes in central nervous system (CNS) infection .Methods The results of CSF culturing and detection of biochemical indexes including glucose(Glu) ,lactate dehy‐drogenase(LDH) ,chloride ion(Cl) and protein(PRO) were collected from the First Affiliated Hospital of Xi′an Jiaotong University from September to December 2013 .Taking the results of CSF culturing as golden standard ,the biochemical indexes were analyzed by using receiver‐operating characteristic(ROC) curve for single index and combined indexes .Results A total of 157 CSF speci‐mens were collected ,including 39 culture‐positive specimens and 118 culture‐negative specimens .Areas under ROC curve(AUC) of Glu ,LDH ,Cl and PRO were 0 .653 ,0 .633 ,0 .626 ,0 .671 ,respectively .The AUCs of combined detection of these biochemical inde‐xes were higher than those of single index ,and the AUC of combined detection of these four indexes was the largest ,up to 0 .694 , but all were less than 0 .7 .Conclusion Glu ,LDH ,Cl and PRO all could be independent biochemical indexes for diagnosing CNS in‐fection ,among which PRO has the highest diagnostic value .And combined detections of these indexes are better than single detec‐tions ,especially combination of four indexes ,which is the strongest indicator ,but accuracy is low whether single or combined detec‐tion .More sensitive and specific biomarkers of CSF should be explored for rapid diagnosis of CNS infection .
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Objective To assess incidence rate of different types of cement leakage in percutaneous kyphoplasty (PKP) with or without intravertebral clefts and to determine whether basivertebral foramen could be connected with intravertebral cleft.Methods 270 vertebrae in 224 consecutive patients who underwent percutaneous kyphoplasty for treatment of osteoporotic vertebral compression fractures were classified into two groups on preoperative radiographs,computed tomography scans,and/or magnetic resonance images of the treated levels:Cleft group with an intravertebral cleft in vertebral body and trabecular group without intravertebral clefts.On direct postoperative images,the patterns of cement leakage were classified as 5 types:through a cortical defect into paraspinal soft tissues (type A),through the basivertebral foramen (type B),via the needle channel (type C),through a cortical defect into the disc space (type D),via the paravertebral vein (type E).The incidence of different types of cement leakage between two groups was analyzed.Results In 72 of 270 vertebrae,an intravertebral cleft was confirmed on preoperative images.Leaks through basivertebral foramen as type B (42,15.5％) and through cortical defects into the disc space as type D leaks (21,7.8％) were more common than other types.The incidence of type B leakage in the cleft group (23.6％) was higher than the incidence in the trabecular group (12.6％),which made a statistical significance (P=0.028).There was no statistical difference between the trabecular pattern and the cleft pattern on other types of leaks.Conclusion Type B leaks were more common in vertebrae with the presence of an intravertebral cleft,which support the presence of the connection between an intravertebral cleft and the basivertebral foramen.Thus,care must be taken when PKP was performed in these patients to avoid cement leakage into spinal canal through basivertebral foramen directly.
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Objective To explore the possible pathological essence of HIZ in lumbar intervertebral disc by means of CT,MRI and histomorphology analysis.Methods All of 41 patients of low back pain with the HIZ in the lumbar disc on MRI were identified.There is 23 males and 18 females with mean age of 38 years (range 33-50 years).All the patients were divided into 2 groups according to the characteristics of HIZ on MRI:group A,29 patients with high intensity on MRI T2WI and low intensity on MRI T1WI; group B,12 patients with high intensity both on T2WI and T1WI.All these patients underwent X-rays and CT scan on the targeted level.26 patients in group A were performed discography and pain provocative test.15 patients in group A and 7 patients in group B underwent operation and those samples of HIZ region were excised for HE staining and immunohistochemical analysis.Results All the patients in group A were proved intervertebral disc degeneration on CT and MRI.21 patients in 26 who underwent discography and pain provocative test were proved positive and 15 of them underwent operation(Transforaminal lumbar interbody fusion or posterior lumbar interbody fusion).Histomorphology examination showed annular tear combined with granulation tissue in the samples of HIZ region which were excised in operation.Neoformative blood capillary could be seen through CD34 staining.Macrophage could be found in CD68 staining,but the regions off the HIZ were less stained.In group B,all those targeted discs showed calcified or ossified lesion on the posterior annular on CT scan,HE staining showed calcification or ossification of the posterior annulus fibrosus with frontier line.Conclusion The HIZ on MRI T2WI with low intensity zone on T1WI possibly refers to annular tear combined with granulation in-growth.But the HIZ both on MRI T2WI and T1WI might be calcification or ossification.The conventional concept of HIZ might be modified as HIZ on MRI T2WI,but low intensity zone on MRI T1WI.In addition,CT scan might be helpful in the distinguished diagnosis.
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Objective To investigate characteristics of cage migration after transforaminal lumbar interbody fusion (TLIF) and related risk factors.Methods A retrospective study was conducted to review cage migration in 512 patients who had undergone TLIF procedure from January 2010 to June 2011 in 5 spinal research centers.There were 255 males and 257 females,aged from 37 to 77 years (average,54.7 years).All patients were followed up at 3,6,12 months after operation.The clinical outcomes were evaluated using the visual analogue scores (VAS) and Oswestry disability index (ODI).X-rays and 3D CT scans were used to analyze the incidence and related risks factors of cage migration in these patients.Results Cage migration was found in 6 of 512 patients,the total incidence was 1.17％.Significant difference was found between each center.Cages with different shapes had different incidence.The analysis showed that the incidence of migration of rectangular-shaped cage (3.11％,5/161) was significantly higher than that of kidney-shaped cage (0.28％,1/351).The cage in double-segment TLIF (5.75％,5/87) was easier to migrate than that in monosegment TLIF (0.24％,1/425); furthermore,linear type endplate(3.50％,5/143) was remarkably easier to migrate than concave-concave one (0.27％,1/369).Conclusion Difference in operative skills,cage shape,number of fused segments,adjacent endplate shape,and lumbar spondylolisthesis might be risk factors for cage migration after TLIF.