Seed oil of Brucea javanica induces apoptosis through the PI3K/Akt signaling pathway in acute lymphocytic leukemia Jurkat cells / 中国天然药物

Brucea javanica oil emulsion (BJOE) has been used to treat tumor in China for more than 40 years. However, its components and effectiveness in the treatment of acute lymphocytic leukemia (ALL) and its mechanism of anti-cancer activity remain unknown. In the current study, high-performance liquid chromatography-evaporative light scattering detector (HPLC-ELSD) was used to analyze the components of BJOE. Then, the anti-leukemia effects of BJOE were examined both in vitro and in vivo using ALL Jurkat cells and the p388 mouse leukemia transplant model, respectively. The primary ALL leukemia cells were also used to confirm the anti-leukemia effects of BJOE. The apoptotic-related results indicated that BJOE induced apoptosis in Jurkat cells and were suggestive of intrinsic apoptotic induction. Moreover, BJOE inhibited Akt (protein kinase B) activation and upregulated its downstream targets p53 and FoxO1 (forkhead box gene, group O-1) to initiate apoptosis. The activation of GSK3β was also involved. Our findings demonstrate that BJOE has anti-leukemia effects on ALL cells and can induce apoptosis in Jurkat cells through the phosphoinositide3-kinase (PI3K) /Akt signaling pathway.

Lumbar Scoliosis Induction in Juvenile Dogs by Three-dimensional Modulation of Spinal Growth Using Nickel-Titanium Coil Springs / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Current treatments for scoliosis have some defects and complications. To study spinal deformities and test novel scoliosis treatments, many animal models of scoliosis have been developed. These models applied a single load to the spine and could not precisely modulate the spinal growth in different dimensions. In this study, we applied posterior tethering in various directions with the application of nickel-titanium (NT) coil springs in dog's spine to modulate spinal growth in the coronal, sagittal, and transverse planes and create a scoliosis model possess curves that mimic adolescent idiopathic scoliosis (AIS) three dimensionally.</p><p><b>METHODS</b>Scoliosis was surgically induced in eight 8-week-old female dogs (weight: 1.95-2.30 kg) using bone screws and NT coil springs. The deformity was induced through the placement of posterior NT coil springs that tethered the spine by bone screw fixation. All dogs were monitored with serial radiographs to document changes in deformities.</p><p><b>RESULTS</b>All experimental animals developed scoliotic curves convex to the left in the lumbar segment. The mean coronal Cobb angle was 18.0° immediately postoperatively and 54.5° at 22 weeks. The mean lordosis increased from 6.2° postoperatively to 35.0° at final follow-up. Apical axial rotation increased from 4.5° postoperatively to 31.2° at 22 weeks.</p><p><b>CONCLUSIONS</b>With the application of NT springs in dogs that allowed posterior tethering in various directions, lumbar spinal deformity was achieved in three planes: coronal, sagittal, and transverse planes. Notably, the lumbar spine in surgically treated dogs developed lordoscoliosis with obvious rotation and the curves mimic AIS three dimensionally well. This method allows lumbar scoliosis to develop without deep dissection of muscle and maintains the essential anatomical elements along the spinal curve. Moreover, the spinal growth modulation technique could yield information that would provide a basis for developing novel early-stage treatments for children with scoliosis.</p>

Recent Advances in Technique and Clinical Outcomes of Minimally Invasive Spine Surgery in Adult Scoliosis / 中华医学杂志(英文版)

<p><b>OBJECTIVE</b>Conventional open spinal surgery of adult scoliosis can be performed from anterior, posterior, or combined approach. Minimally invasive spine surgery (MISS) was developed for the purpose of reducing the undesirable effects and complications. This review aimed to make a brief summary of recent studies of the approach and clinical outcomes of MISS in adult scoliosis.</p><p><b>DATA SOURCES</b>We conducted a systematic search from PubMed, Medline, EMBASE, and other literature databases to collect reports of surgical methods and clinical outcomes of MISS in treatment of adult scoliosis. Those reports were published up to March 2017 with the following key terms: "minimally invasive," "spine," "surgery," and "scoliosis."</p><p><b>STUDY SELECTION</b>The inclusion criteria of the articles were as followings: diagnosed with adult degenerative scoliosis (DS) or adult idiopathic scoliosis; underwent MISS or open surgery; with follow-up data. The articles involving patients with congenital scoliosis or unknown type were excluded and those without any follow-up data were also excluded from the study. The initial search yielded 233 articles. After title and abstract extraction, 29 English articles were selected for full-text review. Of those, 20 studies with 831 patients diagnosed with adult DS or adult idiopathic scoliosis were reviewed. Seventeen were retrospective studies, and three were prospective studies.</p><p><b>RESULTS</b>The surgical technique reported in these articles was direct or extreme lateral interbody fusion, axial lumbar interbody fusion, and transforaminal lumbar interbody fusion. Among the clinical outcomes of these studies, the operated levels was 3-7, operative time was 2.3-8.5 h. Both the Cobb angle of coronal major curve and evaluation of Oswestry Disability Index and Visual Analog Scale decreased after surgery. There were 323 complications reported in the 831 (38.9%) patients, including 150 (18.1%) motor or sensory deficits, and 111 (13.4%) implant-related complications.</p><p><b>CONCLUSIONS</b>MISS can provide good radiological and self-evaluation improvement in treatment of adult scoliosis. More prospective studies will be needed before it is widely used.</p>

Advances in minimally invasive spine surgery in treatment of adolescent idiopathic scoliosis and adult scoliosis / 中国医学科学院学报

The traditional treatment of scoliosis is mainly based on open surgeries that use the anterior approach, the posterior approach, or both. These surgical procedures often lead to complications including massive blood loss, infections, and pain of incision.The minimally invasive spine surgery (MISS) was introduced in the 1990s and has shown many advantages including less blood loss, less pain, and lower infection incidences.Today MISS is mainly used in the treatment of adolescent idiopathic scoliosis and adult scoliosis. However, due to some inevitable complications, it still can not be routinely applied.This review will briefly summarize the advances in the application of MISS in surgical treatment of adolescent idiopathic scoliosis and adult scoliosis.

Effects of guanxinping tablet containing serum on H2O2-induced apoptosis and NF-kappaB expressions in vascular endothelial cells / 中国中西医结合杂志

<p><b>OBJECTIVE</b>To study the effects of Guanxinping Tablet (GT) containing serum on H2O2-induced apoptosis and the nuclear factor kappa B (NF-kappaB) expression in vascular endothelial cells (VECs).</p><p><b>METHODS</b>Rabbits were randomly divided into the normal control group (treated with normal saline, 10 mL/kg), the verapamil group (0. 02 g/kg, 10 mL/kg), the small dose GT group (2; 8 g/kg, 10 mL/kg), the middle dose GT group (5.6 g/kg, 10 mL/kg), and the large dose GT group (11.2 g/kg, 10 mL/kg), 3 in each group. The medication was given to rabbits by gastrogavage for 3 successive days. The gastrogavage was performed twice on the last day with an interval of 2 h. One h after the last medication the peripheral blood was sampled from the vein of the ear edge. The blood was put for 1 h and centrifuged at 2 500 r/min for 30 min. The serum was extracted and deactivated at 56 degrees C for 30 min to prepare the drug containing serum. The apoptosis injury model was established using 100 micromol/L H2O2 induced VECs in the log phase growth. After modeling they were divided into 6 groups, 5 samples in each group, i. e., the normal group (10% vehicle serum culture solution), the model group (10% vehicle serum culture solution +100 micromol/L H2O2), the verapamil group (10% verapamil serum culture solution +100 micromol/L H2O2), the low dose GT group (10% low dose GT culture solution +100 micromol/L H2O2), the middle dose GT group (10% middle dose GT culture solution + 100 micromol/L H2O2), and the high dose GT group (10% high dose GT culture solution + 100 micromol/L H2O2). THE VEC apoptotic rate was detected using flow cytometry. The protein expression of NF-kappaB was detected using Western blot.</p><p><b>RESULTS</b>The VEC apoptosis rate (9.00% +/- 1.18%) and the protein expression of NF-kappaB (0.39% +/- 0.06%) increased more in the model group than in the normal control group (P<0.01). Compared with the model group, the VEC apoptosis rate of the verapamil group (6.00% +/- 0.18%), the large dose GT group (5.30% +/- 0.08%), and the middle dose GT group (6.83% +/- 0.51%) were obviously lower. The expression of NF-kappaB of each treatment group significantly decreased (the verapamil group: 0.28% +/- 0.03%; the small dose GT group: 0.33% +/- 0.03%; the middle dose GT group: 0.30% +/- 0.03%; the large dose GT group: 0.28% +/- 0.04%, P<0.01, P<0.05).</p><p><b>CONCLUSIONS</b>GT could fight against H2O2-induced VEC cell apoptosis. Its mechanism might be correlated with regulating the expression of NF-kappaB protein.</p>

Treadmill exercise test in patients with coronary artery myocardial bridging / 中华心血管病杂志

<p><b>OBJECTIVE</b>To observe treadmill exercise test (TET) characteristics in patients with myocardial bridging (MB).</p><p><b>METHODS</b>TET results from January 2003 to December 2010 were retrospectively analyzed in 156 patients with confirmed MB diagnosis. MB patients were divided into smoking group (68 cases) and non-smoking group (88 cases). Coronary angiography results were used to analyze the relations between MB length, myocardial ischemia and exercising duration.</p><p><b>RESULTS</b>(1) MB was documented on two coronary arteries in 2 patients (1%), MB was detected in single artery in 154 patients (99%), of whom 146 cases were located at left anterior descending artery, 8 cases were located at right coronary artery. The degree of narrowing of MB was graded 1 (less than 50%) in 16 patients (10%), grade 2 (50% to 75%) in 108 patients (69%) and grade 3 (greater than 75%) in 32 patients (21%). The length of MB ranged between 4 to 40 mm, MB length was less than 10 mm in 40 patients (26%), between 11 to 20 mm in 48 patients (31%), between 21 to 30 mm in 44 patients (28%), greater than 31 mm in 24 patients (15%). (2) TET positive rate was 41% (64/156) and the TET positive rate was significantly higher in smoking group than in non-smoking group [57% (39/68) vs. 28% (25/88, P < 0.01)]. (3) The length of MB was positively related to the ST-segment depression (r = 0.723, P < 0.01) and negatively related to exercising duration (r = -0.828, P < 0.01). Heart rate was positively related to the ST-segment depression (r = 0.368, P < 0.01).</p><p><b>CONCLUSIONS</b>TET may serve as a good test to assess myocardial ischemia in patients with MB. The length of MB is positively related with myocardial ischemia and negatively related with exercising duration. Smoking might increase myocardial ischemic incidence in MB patients, MB patients should be advised to stop smoking.</p>

Primary clinical evaluation of the joint replacement for the treatment of the first metatarsophalangeal arthritis / 中国医学科学杂志(英文版)

<p><b>OBJECTIVE</b>To retrospectively assess the primary clinical results of a cohort of the first metatarsophalangeal joint replacement with double-stemmed hinge silicone implant.</p><p><b>METHODS</b>A total of 12 patients (15 feet) received the joint replacement with double-stemmed hinge silicone implant. There were 2 males and 10 females with a mean age of 61.4 (range, 56-75) years old. Of them, 9 cases (11 feet) were hallux valgus with osteoarthritis; 1 case (2 feet) was rheumatic arthritis; 2 cases (2 feet) were traumatic arthritis. The subjective and objective results were evaluated during follow-up.</p><p><b>RESULTS</b>All of the patients were followed up regularly with an average of 24.7 months, ranging from 12 to 38 months. Ten patients were completely satisfied with the operation; 1 patient showed partial satisfaction, and 1 patient was not satisfied because of the first matatarsophalangeal joint pain due to severe hyperosteogeny surrounding the cut bone surface 3 years after the operation. Osteolysis around the implant occurred in 2 cases without clinical symptoms, and no special treatment was given.</p><p><b>CONCLUSION</b>The joint replacement is a preferable method in alleviating pain and improving walking function with proper indication.</p>

Postoperative disc wedging in adolescent idiopathic thoracolumbar/lumbar scoliosis: a comparison of anterior and posterior approaches / 中国医学科学杂志(英文版)

<p><b>OBJECTIVE</b>To evaluate the different influences of anterior and posterior correction and fusion approaches upon disc wedging in adolescent idiopathic thoracolumbar/lumbar scoliosis.</p><p><b>METHODS</b>The retrospective study was conducted with the medical records and radiographs of adolescent idiopathic thoracolumbar/lumbar scoliosis patients that underwent anterior (group A) or posterior (group B) correction and fusion surgery from December 1998 to May 2008. The correction of the main curve and changes of the disc wedging were analyzed.</p><p><b>RESULTS</b>Fifty-three patients were included, 26 in group A and 27 in group B. The mean coronal Cobb angles of the main curve in group A and group B were significantly corrected after surgery (P < 0.05), with an average correction rate of 75.2% and 88.2%, respectively. Upon final follow-up, the coronal Cobb angles of the two groups were 18.90 +/- 11.1 degrees and 7.70 +/- 5.6 degrees, respectively, with an average correction loss of 6.8 degrees +/- 6.5 degrees and 2.7 degrees +/- 3.3 degrees, respectively. The coronal Cobb angle after operation and at final follow-up, and the correction rate were significantly better in group B than those in group A (P < 0.05), while the coronal Cobb angle loss in group A was greater than that in group B (P < 0.05). The disc wedging before operation, after operation, and at final follow-up were 3.2 degrees +/- 3.0 degrees, 5.7 degrees +/- 3.0 degrees, and 8.6 degrees +/- 4.4 degrees in group A, and 2.4 degrees +/- 3.2 degrees, 3.3 degrees +/- 3.4 degrees, and 3.7 degrees +/- 3.6 degrees in group B, respectively. Postoperative disc wedging was significantly larger compared with preoperative measurements in group A (P < 0.05), but not in group B (P > 0.05). The difference between disc wedging at final follow-up and that after surgery was significant in group A (P < 0.05), but not in group B (P > 0.05). Between the two groups, group A had larger disc angles after operation and at final follow-up (P < 0.05), and a greater loss of disc angle (P < 0.05).</p><p><b>CONCLUSION</b>For adolescent idiopathic thoracolumbar/lumbar scoliosis, posterior approach using all pedicle screws might produce a better result in terms of disc wedging compared with anterior approach.</p>

Primary effect of dual growing rod technique for the treatment of severe scoliosis in young children / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Treatment of rapidly progressing scoliosis in young children is a challenge for spine surgeons. Some surgeons had begun to use dual growing rod technique for treatment of rapidly progressing scoliosis in young children and had achieved acceptable results. The aim of this study was to determine the primary results and complications of this new technique in China.</p><p><b>METHODS</b>Eleven children suffering from rapidly progressing scoliosis were treated with dual growing rod technique between November 2004 and March 2009 at Peking Union Medical College Hospital (PUMCH). There were 10 females and 1 male in the group with Risser sign of 0 grade. The mean age at initial surgery was 6.1 years (range, 2.1-10.9 years). Ten patients were diagnosed as congenital scoliosis and 1 patient neuromuscular scoliosis. All the patients had 1-4 lengthening procedures (mean, 1.8 procedures) after the initial surgeries. The radiographic results of all the patients were investigated.</p><p><b>RESULTS</b>The coronal Cobb angle of scoliosis improved from (67.64+/-11.43) degrees to (34.64+/-8.26) degrees after initial surgery with the correction rate observed at (47.15+/-16.48)%. The coronal trunk shift improved from (2.00+/-1.73) cm to (1.49+/-1.31) cm after initial surgery. The T1-S1 height increased from (25.47+/-6.16) cm to (28.84+/-5.69) cm after initial surgery. The coronal Cobb angle of scoliosis was (36.82+/-11.76) degrees and the coronal trunk shift was (1.11+/-1.29) cm after the most recent lengthening procedure with the most recent correction rate observed at (44.73+/-19.43)%. The T1-S1 height was (31.29+/-4.50) cm after the most recent lengthening procedure with an average T1-S1 length increase of 1.6 (range, 1.0-2.7) cm per year during the lengthening period. The sagittal balance was maintained. Five of the total patients (45.5%) had complications including: hook displacement, pedical screw loosening, and broken rod. We performed revision surgeries with simultaneous lengthening procedures in all 5 cases with satisfactory results.</p><p><b>CONCLUSIONS</b>The dual growing rod technique was useful in the management of rapidly progressing scoliosis in young children. This technique could control severe scoliosis, allow for spinal growth, and maintain the coronal and sagittal balance. But the technique has high complications requiring strict and regular follow-up.</p>

Selective anterior thoracolumbar/lumbar fusion and instrumentation in adolescent idiopathic scoliosis patients / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Selective anterior thoracolumbar/lumbar (TL/L) fusion and instrumentation in adolescent idiopathic scoliosis (AIS) patients with a structural major TL/L curve and a nonstructural minor thoracic curve is rarely reported. We investigate the correction results of these patients.</p><p><b>METHODS</b>By reviewing the medical records and roentgenograms of AIS patients undergone selective anterior TL/L fusion and instrumentation, Cobb angle, correction rate of the major and minor curves, coronal balance, lowest instrumented vertebra (LIV) tilt, coronal disc angle immediately below the LIV (LIVDA) and radiographic shoulder height (RSH) were measured and analyzed.</p><p><b>RESULTS</b>Forty patients were included. For the major TL/L curve, the mean coronal Cobb angle before and after operation were 43.9° and 8.7°, respectively, with an average correction rate of 80.2% (P = 0.000). While for the minor thoracic curve, the mean coronal Cobb angle before and after operation were 27.2° and 14.3°, respectively, with an average spontaneous correction rate of 47.4% (P = 0.000). At final follow-up, the coronal Cobb angles of the major and minor curves were 13.7° and 17.1°, respectively, with a mean correction loss of 5.0° and 2.9°, respectively. The coronal balance before and after operations was 13.2 mm and 11.5 mm, respectively. At the final follow-up, it turned to 5.6 mm, which was much better than that after operation (P = 0.001). The mean LIV tilt was 23.5° before operation, and was significantly improved after operation (8.3°, P = 0.000). At final follow-up, it was well maintained (10.6°). The LIVDA averaged 3.5° before operation, and aggravated to 5.5° after operation (P = 0.100) and 7.4° at final follow-up (P = 0.012), respectively. The RSH was 7.3 mm before operation, 5.6 mm after operation, and 2.2 mm at the final follow-up. The RSH at the final follow-up was significantly improved compared with that after operation (P = 0.002).</p><p><b>CONCLUSIONS</b>Selective anterior TL/L fusion and instrumentation can get good correction results of both curves, with good results of the coronal balance and RSH in AIS patients, while a larger LIVDA.</p>

Ultrastructural changes of duodenal mucosas and their significance in patients with liver cirrhosis / 中华肝脏病杂志

<p><b>OBJECTIVE</b>To investigate the ultrastructural changes of duodenal mucosas and their significance in patients with liver cirrhosis (PLC).</p><p><b>METHODS</b>Endoscopic biopsy duodenal mucosa specimens of 60 PLC and 18 healthy volunteers as controls were obtained. Ultrastructural changes of them were studied with transmission electron microscopy. These PLC were divided into groups A, B and C according to the Child-Pugh classification. The ultrastructural changes in the duodenal mucosas of each group were rated and compared with those of the other groups. PLC with and without ultrastructural changes of duodenal mucosas were divided into a positive group and a negative group. Levels of plasma Alb, TBil, PT, plasma endotoxin, and blood ammonia of the PLC were detected and compared.</p><p><b>RESULTS</b>There were 20 PLC each in groups A, B, and C. Ultrastructural changes of duodenal mucosas were found in 5 PLC of group A, 9 in group B and 17 in group C. Among the 60 PLC, 52% had some changes in their duodenal mucosas. The changes included decrease and rupture of the microvilli; also karyopyknosis, karyorrhexis, widening of the gaps of the tight junction and tumefactions of mitochodrion of duodenal mucosa epithelial cells. No ultrastructural changes of duodenal mucosas were found in the control group. The rate of changes in the three Child-Pugh class groups and in the control group were 25%, 45%, 85%, 0% respectively (P < 0.01). The level of Alb of the positive group was significantly lower than that of the negative group (P < 0.01). Levels of plasma TBil, PT, endotoxin and blood ammonia of the positive group were significantly higher or longer than those of the negative group (P < 0.01). Levels of plasma Alb of the positive and negative groups were significantly lower than those of the control group (P < 0.01). Levels of TBil, PT, plasma endotoxin and blood ammonia of the positive and negative groups were significantly higher or longer than those of the control group (P < 0.01).</p><p><b>CONCLUSION</b>There were ultrastructural changes of duodenal mucosas in PLC, especially in end-stage PLC. Ultrastructural changes of intestinal mucosas in the PLC may have important pathophysiological and clinical significance.</p>

Analysis of the correction results of the adolescent idiopathic scoliosis patients with a proximal thoracic curve / 中华外科杂志

<p><b>OBJECTIVE</b>To analyze the correction results of the adolescent idiopathic scoliosis patients with a proximal thoracic (PT) curve.</p><p><b>METHODS</b>There were 13 cases of double thoracic curve (PUMC IIa) and 13 cases of triple curve (PUMC IIIa 11 cases, IIIb 2 case). The upper instrumented vertebra were at T(3) or above (fusion level including PT curve, Group A) in 18 cases, and at T(4) or T(5) (PT curve not fused, Group B) in 8 cases. Reviewing the medical records and radiographs of 26 adolescent idiopathic scoliosis patients with a proximal thoracic curve that underwent corrective surgery, the changes of the curve and the shoulder balance were analyzed.</p><p><b>RESULTS</b>The coronal Cobb angles of the PT curve and the main thoracic (MT) curve before operation were 45.3 degrees and 61.2 degrees in group A, 35.6 degrees and 58.9 degrees in group B. After operation, they were corrected to 24.2 degrees and 20.1 degrees , 26.4 degrees and 20.3 degrees , respectively. The correction rates of the PT curve and MT curve were 48.2% and 68.7%, 24.5% and 66.3%, respectively. The correction rates of the PT curve of group A was significantly better than group B (P = 0.006), but for the MT curve, the difference was not significant (P = 0.694). The incidence of radiographic shoulder height (RSH) over than 10 mm (shoulder imbalance) after operation in group B was higher than group A significantly (P = 0.038). The incidence rate of shoulder imbalance after operation of the patients with a left higher shoulder or balance shoulder was significantly higher than that of the patients with a right higher shoulder (P = 0.015).</p><p><b>CONCLUSIONS</b>Fusing the PT in patients with a left shoulder not lower than right side will make better coronal correction results of the PT curve and reduce the incidence of postoperative shoulder imbalance.</p>

Distribution and expression of collagen type II, transforming growth factor beta1 and basic fibroblast growth factor in articular process cartilages of scoliosis / 中华外科杂志

<p><b>OBJECTIVE</b>To look into the character of the expression of collagen type II and transforming growth factor beta1 (TGF-beta1), basic fibroblast growth factor (bFGF) in the apical articular process cartilages of adolescent idiopathic scoliosis (AIS) and congenital scoliosis (CS) patients.</p><p><b>METHODS</b>The articular processes of 22 AIS and 18 CS were collected. The techniques of HE staining, immunohistochemistry and in situ hybridization were adopted in this research. By comparing the apical processes with the end processes, the convex processes with the concave processes, the AIS processes with CS processes, the pathological changes of the articular process cartilages of these patients and the distribution of collagen type II and TGF-beta1, bFGF in them were studied. The images of immunohistochemistry and in situ hybridization were input into the image analysis system and were analyzed semi-quantitatively. The SAS software (8.01) was adopted, and P < 0.05 was defined as the significant level.</p><p><b>RESULTS</b>The expression of collagen type II and TGF-beta1, bFGF in AIS was similar to CS: the concave sides of apexes were higher than the convex sides. The comparisons had statistical significance. There was no statistical significance between upper and lower end vertebrae in convex and concave sides, between convex and concave sides in upper and lower end vertebrae. The apical vertebrae were significantly higher than the ipsilateral sides of upper or lower end vertebrae for collagen type II. There was no statistical difference of the expression at the concave, convex, upper, lower end vertebrae between AIS and CS.</p><p><b>CONCLUSIONS</b>The cartilages of the apical processes show some signs of regression and hypoplasia in scoliosis. The concave side is more severe than the convex side. Increase of collagen type II and TGF-beta1, bFGF in the concave sides of apical processes in scoliosis may be the results of reconstruction of extracellular matrix and the compensation reactions which are caused by abnormal biomechanical forces such as compressive stresses. Compressive stress on the concave sides has more influences on the expression of collagen type II than tensile stress on the convex sides.</p>

Evaluation and treatment of congenital scoliosis with split cord malformation / 中华外科杂志

<p><b>OBJECTIVE</b>To discuss the diagnosis and surgical treatment of congenital scoliosis (CS) with split cord malformation (SCM).</p><p><b>METHODS</b>From May 1999 to June 2004, 353 cases of CS were admitted, and 58 cases were diagnosed CS combined with SCM via myelography and (or) CTM. According to Pang's classification for SCM, patients were divided into type I SCM and type II SCM. Two cases gave up operation, and surgeries were performed in 56 patients. Except that one case with arachnoid cyst underwent intraspinal exploration, all other 55 cases underwent spinal correction without dealing with the intraspinal abnormalities. Clinical manifestation, radiological findings, operative methods and results were retrospectively analyzed in this paper.</p><p><b>RESULTS</b>There were 11 patients (19%) with type I SCM and 47 patients (81%) with type II SCM. In the 56 cases who had surgical treatment, the Cobb angle in the patients with type I SCM (11 cases) was (60 +/- 25) degrees, and in type II SCM (45 cases) was (67 +/- 21) degrees pre-operation. The Cobb angle in type I SCM was (29 +/- 13) degrees and in type II SCM was (39 +/- 19) degrees post-operation, with the correction rate (51 +/- 17)% and (41 +/- 24)% respectively. No statistic differences were found between both types. And there were no new neurological deficits in both groups after the spinal correction operation. After average 17.3 months (4-59 months) follow-up, the correction loss was (6 +/- 10) degrees, (5 +/- 8) degrees in 7 patients with type I SCM and (6 +/- 10) degrees in 19 patients with type II SCM. There was no statistic difference in correction loss between both types. In the follow-up, the neurological symptoms and signs of the patients were stable.</p><p><b>CONCLUSION</b>Considering the incidence of intraspinal anomalies in patients with congenital scoliosis, intraspinal examination via myelography, CTM or MRI should be performed prior to spinal correction surgery. For congenital scoliosis with type I SCM, the bone spur need not be excised before spinal correction if there is no signs of spinal cord tethered and the bone spur locate in the middle of the split cord where there are much space to accommodate it. For congenital scoliosis with type II SCM, if there are no progressive neurological manifestations, the split cord in the single tubular can tolerate the manipulation of spinal correction as the normal spinal cord.</p>