Analysis of early and middle stage efficacy and complications of oblique lumbar interbody fusion in treating degenerative lumbar diseases / 中国骨伤

OBJECTIVE@#To investigate the early and middle stage efficacy and complications of minimally invasive extraperitoneal oblique lumbar interbody fusion (OLIF) in the treatment of degenerative lumbar diseases.@*METHODS@#The clinical data of 22 patients with degenerative lumbar diseases underwent OLIF from October 2017 to March 2019 were retrospectively analyzed, including 14 males and 8 females, aged from 51 to 72 years with an average of (63.15±7.22) years. There were 6 cases of lumbar spinal stenosis, 5 cases of lumbar spondylolisthesis, 4 cases of adjacent vertebral disease, 3 cases of degenerative lumbar scoliosis, 3 cases of discogenic low back pain, and 1 case of recurrence after posterior lumbar decompression. Posterior minimally invasive pedicle screw fixation was performed in 13 cases and Stand-alone fixation in 9 cases. Intraoperative blood loss, operation time, postoperative drainage volume, landing time were recorded. The intervertebral disc height(IDH), intervertebral foramen height(IFH), intervertebral foramen area( IFA), canal diameter(CD), canal area(CA) were measured before and after operation. The imaging changes (including location of fusion cage, interbody fusion, and cage subsidence) and complications were observed. Oswestry Disability Index (ODI), numerical rating scales (NRS) and Japanese Orthopaedic Association (JOA) scores were compared before and 3, 6, 12 months after operation.@*RESULTS@#All 22 patients successfully completed the operation. The intraoperative blood loss was 25 to 280 ml with an average of (95.45±79.07) ml and that of simple anterior approach was 25 to 70 ml with an average of (45.71±15.42) ml. The operation time was 75 to 210 min with an average of (137.72±37.66) min, and the simple anterior operation time was 75 to 105 min with an average of (91.40±15.96) min. The total drainage volume was 10 to 110 ml with an average of (56.23±31.15) ml, and the time to go down to the ground was 24 to 72 hours (54.48±18.24) hours after operation. Postoperative IDH improved (6.63±2.61)mm(P<0.05), the IFH improved (5.35±2.47)mm (P<0.05), the IFA improved (97.67±33.58)mm2(P<0.05), the CD improved (3.31±1.61) mm(P<0.05), the CA improved (57.52±31.39) mm2(P<0.05). Five patients got interbody fusion at 6 months after operation and all 22 patients got interbody fusion at 12 months after operation. There was 5 cases of fusion cage subsidence, all of which occurred in the cases without posterior fixation(using Stand-alone fixation). There was no serious complication such as big blood vessel injury, ureter injury, dural sac injury and nerve root injury. Peritoneal injury occurred in 1 case, postoperative transient thigh pain, decrease of quadriceps femoris muscle strength in 4 cases and sympathetic nerve injury in 1 case. The symptoms of lumbago and radicular pain of lower extremities were alleviated obviously 3 days after operation. The ODI, NRS and JOA scores at 6, 12 months after operation were significantly improved(P<0.05).@*CONCLUSION@#The treatment of lumbar degenerative diseases with definite indications by OLIF can achieve satisfactory clinical results, and it has advantages of less intraoperative bleeding, fast time to land, less complications, good imaging improvement and indirect decompression. But the operation time and fluoroscopy time are longer in the early stage, and complications such as peritoneal injury and lumbar plexus over traction may occur. The long-term incidence of settlement of fusion cage with Stand-alone technology is higher.

Effect of different bone cement dispersion types in the treatment of osteoporotic vertebral compression fracture / 中国骨伤

<p><b>OBJECTIVE</b>To observe different bone cement dispersion types of PVP, PKP and manipulative reduction PVP and their effects in the treatment of senile osteoporotic vertebral compression fractures and the bone cement leakage rate.</p><p><b>METHODS</b>The clinical data of patients with osteoporotic vertebral compression fractures who underwent unilateral vertebroplasty from January 2012 to January 2015 was retrospectively analyzed. Of them, 56 cases including 22 males and 34 females aged from 60 to 78 years old were treated by PVP operation; Fouty-eight cases including 17 males and 31 females aged from 61 to 79 years old were treated by PKP operation; Forty-three cases including 15 males and 28 females aged from 60 to 76 years old were treated by manipulative reduction PVP operation. AP and lateral DR films were taken after the operation; the vertebral bone cement diffusion district area and mass district area were calculated with AutoCAD graphics processing software by AP and lateral DR picture, then ratio(K) of average diffusion area and mass area were calculated, defining K<50% as mass type, 50%<=K<=100% as mixed type and K>100% as diffusion type. Different bone cement dispersion types of PVP, PKP and manipulative reduction PVP operation were analyzed. According to bone cement dispersion types, patients were divided into diffusion type, mixed type and mass type groups.Visual analogue scale (VAS), vertebral body compression rate, JOA score and bone cement leakage rate were observed.</p><p><b>RESULTS</b>All patients were followed up for 12-24 months with an average of 17.2 months. There was significant difference in bone cement dispersion type among three groups (<0.05). The constituent ratio of diffusion type, mixed type and mass type in PVP operation was 46.43%, 35.71%, 17.86%, in PKP was 16.67%, 37.50% , 45.83%, and in manipulative reduction PVP was 37.21%, 44.19% and 18.60%, respectively. PVP operation and manipulative reduction PVP were mainly composed of diffusion type and mixed type, while PKP was mainly composed of mass type and mixed type. There was no significant difference in VAS score, JOA score and bone cement leakage rate among three groups. There was statistically significant difference in postoperative vertebral body compression rate among three bone cement dispersion types(<0.05), postoperative vertebral body compression rate in diffusion type group at 24 h postoperatively and final follow-up was (17.31±5.06)% and(18.58±4.91)%, respectively. In mixed type group, it was(14.21±5.15)% and(14.59±5.07)%, respectively. In mass type group, it was(13.89±5.02)% and(14.28±4.94)%, respectively.</p><p><b>CONCLUSIONS</b>Bone cement dispersion type is different in PVP, PKP and manipulative reduction PVP operation. The bone cement dispersion of mass type and mixed type to recovery of compressed vertebral body is better than diffusion type, and there is no obvious difference in clinical effect in different bone cement dispersion type early and middle term.</p>

Treatment of odontoid process fracture with pedicle screws by location through inferior and inner wall of atlas and superior and inner wall of axis / 中国骨伤

<p><b>OBJECTIVE</b>To evaluate the therapeutic effects of atlantoaxial pedicle screw in treating odontoid process fracture by location through inferior and inner wall of atlas and superior and inner wall of axis.</p><p><b>METHODS</b>From June 2006 to September 2010, 12 patients with odontoid process fracture were treated with the atlantoaxial pedicle screw fixation by location through inferior and inner wall of atlas and superior and inner wall of axis. There were 8 males and 4 females, ranging in age from 18 to 62 years, with an average of 37.9 years. According to classification of Anderson, type II was in 10 cases and type III was in 2 cases. Fresh fracture was in 9 cases and old fracture was in 3 cases. All patients had symptoms such as cervical pain, stiffness and limitation of activity and 9 cases with symptoms were found physical signs of cervical spinal injury. According to grade of ASIA, grade C was in 4 cases and grade D was in 5 cases.</p><p><b>RESULTS</b>There were no severe complications such as injuries of vertebral artery, nerve root and spinal cord during operation. The mean time of follow-up was 14 months (6 to 24 months). The X-ray film and CT scanning showed that all patients had steady bony union and all screws were in the proper position, no screws loosening or breaking were found. Clinical symptoms of all patients improved significantly. Nine patients with spinal injury before operation, of which nerve function obtained improvement, grade C was in 1 case, grade D was in 2 cases and grade E was in 6 cases according to grade of ASIA.</p><p><b>CONCLUSION</b>Location through inferior and inner wall of atlas and superior and inner wall of axis is an effective method for the atlantoaxial pedicle screw implantation; atlantoaxial pedicle screw could be accurately and safely implanted thought this way.</p>

Clinical analysis of vertebral laminae reconstruction after laminectomy and pedicle screw fixation in treating lumbar spinal stenosis / 中国骨伤

<p><b>OBJECTIVE</b>To observe the curative effects of vertebral laminae reconstruction after laminectomy and pedicle screw fixation for the treatment of lumbar spinal stenosis in early (at the 3rd months after operation) and metaphase (at the more than 1 year after operation).</p><p><b>METHODS</b>Twenty-two patients with lumbar spinal stenosis were treated by vertebral laminae reconstruction after laminectomy and pedicle screw fixation, there were 12 males and 10 females, the age was from 55 to 76 years with an average of 65.8 years, including single segment (6 cases), double segments (13 cases) and three segments (3 cases) of L3-S1. The follow-up period was for 1-3 years, preoperative and postoperative (at the 3rd months after operation and last follow-up) to assess the subjective symptoms, physical signs, the limit of daily activities and bladder function according to JOA scoring; and observe saggital diameter measurement and radiological changes through X-ray and CT.</p><p><b>RESULTS</b>All the patients were followed up, the JOA scoring were respectively 5.3 +/- 1.6, 23.2 +/- 2.0, 22.9 +/- 2.4 before operation and after operation (at the 3rd after operation and last follow-up); at the 3rd months after operation, 18 cases obtain excellent results, 3 good, fair 1, and at the last follow-up, 17 cases obtain excellent results, 3 good, fair 2, there was no significant difference between two postoperative periods (u = 0.413, P < 0.05). The mean sagittal diameter of narrow segment was respectively (6.8 +/- 0.9), (17.6 +/- 2.5), (16.9 +/- 1.8) mm before operation, at the 3rd months after operation and the last follow-up. Through statistics processing, there was significant different comparing JOA scoring at 3 months after operation, last follow-up with preoperative (P < 0.05). There was significant difference of vertebral canal sagittal diameter between at the 3rd months after operation and before operation (t = 35.116, P < 0.01); there was no significant difference between at the 3rd months after operation and last follow-up (t = 1.814, P > 0.05). The CT examination of last follow-up showed the vertebral canal have no stenosis, the dural sac and nerve roots have no compression, the rebuilt vertebral laminae have fused well, the graft bone are no absorbed and the fixation have no failure.</p><p><b>CONCLUSION</b>Treatment of lumbar spinal stenosis with vertebral lamina reconstruction after vertebral laminectomy and pedicle screw fixation can obtain satisfactory results in early and metaphase. The method had advantages of decompression thoroughly and fixation solidly, and could prevent vertebral canal restenosis causing by nerve oppression of the postoperative scar and nerve adhesion.</p>

Inhibitory effects of immunotargeting of Chinese cobra cytotoxin and iodine-131 against nasopharyngeal carcinoma cells in vitro / 南方医科大学学报

<p><b>OBJECTIVE</b>To explore a new specific therapy of nasopharyngeal carcinoma (NPC) using an anti-nasopharyngeal carcinoma (NPC) monoclonal antibody BAC5 conjugate with Chinese cobra (CT) and iodine-131(131I).</p><p><b>METHODS</b>BAC5 was labeled with 131I by chloramine-T method, CT was labeled with 125I using iodogen method, and BAC5 and 125I-CT were conjugated by SPDP method. The inhibitory effect of the conjugate on cultured human NPC CNE2 cells was observed using MTT assay.</p><p><b>RESULTS</b>The IC50 of 125I-CT-BAC5 conjugate was 9.17x10(-8) mol/L, and that of 131I-BAC5 was 5.83x10(8) Bq/L, and their combined administration showed obvious inhibitory effect on the NPC cells.</p><p><b>CONCLUSION</b>Both 125I-CT-BAC5 and 131I-BAC5 have obvious inhibition effects against NPC cells, but their combined use shows stronger effects.</p>

Capability of three types of biodegradable intravascular stent / 中华放射学杂志

Objective To develop and evaluate three types of biodegradable intravascular stent (BIS)with biodegradable materials of poly-L-acid(PLLA)or Poly](1-lactide-co-glycol ide)(PLLGA). Methods Forty-five spiral BISs(15 BISs for each type)were prepared with PLLA(153 kDa,type A), PLLGA(141 kDa,type B),and PLLGA(contains paclitaxel,141 kDa,type C).The physical and mechanical properties of the BIS were tested,including radial force,overlay rate,longitudinal shrinkage rate,and rate of expansion.Results The radial force of three types BIS was 15.7%/0.006 Mpa(type A), 16.3%/0.006 Mpa(type B),and 16.4%/0.006 Mpa(type C).The radial force of type A was greater than that of type B and C(P