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Infectious diseases of spine (IDS) refer to a series of infectious diseases in different parts of the spine (vertebral body, intervertebral disc, appendix of vertebra, spinal canal, and adjacent paravertebral tissues) caused by various pathogenic microorganisms, accounting for about 2%~7% of systemic musculoskeletal system infections. According to the classic classification IDS can be divided into two types: specific infection and non-specific infection. IDS often has an insidious onset, atypical clinical manifestations, and less-specific imaging and laboratory tests, which causes great difficulties for the accurate diagnosis and treatment, often leading to missed diagnosis, misdiagnosis, and even mistreatment. Problems such as disordered clinical diagnosis and treatment procedures, diverse treatment methods, and non-standard medication and course of treatment still affect the prognosis of IDS. This article reviews the current research progress of the diagnosis and treatment process of IDS, in order to further standardize the diagnosis and treatment process of IDS.
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Objective:To determine the clinical efficacy of posterior intervertebral surgery for single-segment thoracolumbar spinal tuberculosis.Methods:Clinical data were retrospectively analyzed in 62 patients with thoracolumbar spinal tuberculosis who underwent posterior intervertebral surgery (A group) or posterior and anterior combined intervertebral surgery (B group) from January 2010 to January 2015 in Department of Spinal Surgery,General Hospital,Ningxia Medical University.The operative time,blood loss,length of hospital stay,erythrocyte sedimentation rate (ESR),C-reactive protein (CRP) level,neurological function,VAS score,vertebral Cobb angle,bone healing,and postoperative complications were compared between the 2 groups.Results:All patients were followed up for 10 to 30 (average 22) months after the operation.In the A group,operative time,blood loss,and hospital stay were less than those in the B group (P＜0.05).In the follow-up,the pain of patients was alleviated and nervous function was improved obviously in the 2 groups compared with pre-operation.The ESR and CRP at the 6 months after operation returned to the normal range in patients of the 2 groups.There were significant differences in the ESR and CRP among the pre-operation,the 6 months after operation,and the end of follow-up within the group (P＜0.05),while there were no significant differences in ESR and CRP between the 6 months after operation and the end of follow-up (P＞0.05).There were no significant differences in the ESR and CRP among the pre-operation,the 6 months after operation,and the end of follow-up in the 2 group (P＞0.05).The Cobb angles after the operation and the end of follow-up were significanthy smaller than those before the operation (P＜0.01),while there were no significant differences in Cobb angle before operation,after the operation,and the end of follow-up between the 2 groups (P＞0.05).There were no significant differences in the bone healing rate at 6 months or 1 year after operation between the A group and B group (P＞0.05) and the complication rate of the A group was lower than the B group (P＜0.01).Conclusion:Clinical efficacy of posterior intervertebral surgery is satisfatory in treating single-segment thoracolumbar spinal tuberculosis with less complications.
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Objective To study the in vitro cytotoxicity of HRZ (isoniazid + rifampin + pyrazinamide) / transforming growth factor (TGF) β1 siRNA nanoliposomes on human macrophages and the underlying mechanism. Methods Self-made nanoliposomes were used to study with the cultured human macrophages in vitro. MTT assay was used to detect cell proliferation. Flow cytometry was used to analyze apoptosis and cell cycle. Electron microscopy was used to observe autophagy. RT-PCR and Western blot were employed to analyze the silenced expression of target gene TGF-β1. Results HRZ/TGF-β1 siRNA nanoliposomes (triple liposome) inhibited macrophage proliferation within certain range of concentration, and cell cycle was captured in G2 phase. The HRZ / TGF-β1 SiRNA nanoliposomes could significantly inhibit the expression of target gene TGF-β1 in human macrophages. Conclusions The self-made triple liposome has evident effect in silencing the target gene. It is a promising biomaterial, which meets the required specifications in terms of cytotoxicity.
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Objective To explore the effect of posterior debridement, grafting and internal fixation for treatment of non-specific lumbar intervertebral infection. Methods Clinical data of 20 patients with non-specific lumbar intervertebral infection treated in General Hospital of Ningxia Medical University from October 2013 to June 2013 were retrospectively analyzed. There were 15 males and 5 females with an average age of 41 years (range, 36-51 years). All patients suffered from single lumbar inter-vertebral infection, including 3 cases at L2/3,4 at L3/4,10 at L4/5 and 3 at L5/S1. All 20 cases underwent one-stage posterior debride-ment, autogenous bone grafting and internal fixation, tissue samples in focus were collected for bacterial culture and pathological examination. The disease controlling statues were evaluated based on laboratory results of ESR and CRP. Imaging examinations were taken to evaluate the fusion of vertebral body. Clinical effects were evaluated using the visual analog scale (VAS) and the Jap-anese Orthopaedic Association scores (JOA) score of lumbar fumction. Results All patients underwent the surgery successfully. The surgery duration time was 90-160 min, average 125 min, and the blood loss was 200-700 ml, average 360 ml. Cerebrospinal fluid leakage occurred in one case. Postoperatively, all patients experienced significant reliefof back pain, improving in the func-tion of movement, and no fever. The lower back VAS score: average (5.35 ± 1.15) points before operation , average (2.76 ± 0.34) points one week after operation, and an average score of (0.85±0.65) points by the last follow-up time. JOA lumbar function score:all patients were effective after operation, the improvement rate was excellent in 65%(13cases), good in 25%(5 cases), and pass-able in 10%(2cases). Comparing with preoperation, the excellent and good rate was 90%. All patients ESR and CRP returned to normal levels at the last follow-up. Ordinary bacterial culture was positive in 8 cases and negative in 12 cases. The pathogens iden-tified were staphylococcus aureus (6 cases), Escherichia coli (2 cases) and staphylococcus epidermidis (2cases). All incisions achieved primary healing. All patients were followed up from 6-18 months (average,12 months), and the symptom of pain relieved significantly. No recurrent infection had happened. A solid bony fusion was found in all patients at 6-14 months (average, 8.5 months) after the surgery. Conclusion Posterior debridement, grafting and internal fixation are effective treatments for non-spe-cific lumbar intervertebral infection, can reduce the time of staying in hospital, this operation is safe and reliable.
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Objective To explore the clinical significance of blood flow reserve fraction in the treatment of coronary stent implantation.Methods A total of 46 patients with positive coronary angiography were included.Criteria for positive coronary angiography:coronary angiography confirmed at least a coronary artery stenosis was more than or equal to 50%.According to the results,the patients were divided into the control group(24 cases) and observation group(22 cases).Results 1.There was no significant difference in baseline level(P>0.05);2.The operation time,number of stents and the contrast agent dosage of the observation group were (63.20±9.92)min,(0.50±0.65) and (182.94±39.30)mL,which were significantly less than those of the control group,the differences were statistically significant(operation time t=2.69,P=0.01;number of stents t=2.56,P=0.02;contrast agent dosage t=6.98,P=0.00).There was no significant difference between the control group and the observation group in angina pectoris and MACE attack.Conclusion Blood flow reserve score is an important guiding parameter for PCI treatment of coronary artery stenosis.
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Purpose MRI is one of the most effective methods in examining anterior cruciate ligament (ACL),but probability of misdiagnose and missed diagnosis still might exist.This research aims to investigate the effect of oblique coronal MRI views in individualized bent-knee position on the imaging findings of ACL.Materials and Methods Seventy healthy volunteers recruited by the Third Xiangya Hospital,Central South University from September 2016 to March 2017 were involved in this prospective study.3-T MRI combined with independently designed knee joint dynamic imaging auxiliary instrument was employed to perform a dynamic scan in the sagittal plane;the optimal bentknee angle with ACL basically in straight layers (angle of the individualized bent-knee position) was measured.Afterwards,oblique coronal MRI views (PDWI+FS) in both regular extended-knee position and individualized bent-knee position were conducted.And their separate effects on ACL imaging findings in oblique coronal MRI views were compared.Results Oblique coronal MRI scan in extended-knee position and individualized bent-knee position were 92.9％ (65/70) and 45.7％ (32/70) respectively in displaying the imaging of the whole ACL.The former outperformed the latter,and the difference was statistically significant (P＜0.001).Conclusion In contrast to oblique coronal MRI scan in extended-knee position,the scan in individualized bent-knee position elevates the performance of whole ACL imaging.
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BACKGROUND: Calcium sulfate/poly amino acid compound materials carrying triple anti-tuberculosis drugs have been proved to have excellent slow release performance based on our preliminary studies on the physical and chemical properties and the release properties of the compound materials.OBJECTIVE: To observe the slow release performance of the calcium sulfate/poly(amino acid) compound material carrying triple anti-tuberculosis drugs in a rabbit model of spinal tuberculosis.METHODS: Twenty-four New Zealand white rabbits were used to make L4-5 spinal tuberculosis models and divided into two groups in a random way following removal of tuberculosis lesions. Calcium sulfate/poly amino acid compound material carrying isoniazide, rifampicin, pyrazinamide or calcium sulfate/poly(amino acid)compound material with no drugs was implanted into the defect in the experimental or control group,respectively. At 2, 4, 6 and 8 weeks after implantation, the concentrations of isoniazid, rifampicin and pyrazinamide in the defect region, including the bone tissue, adjacent psoas major and inferior vena cava,were measured.RESULTS AND CONCLUSION: In the experimental group, the isoniazid levels in the damaged bone tissue and psoas major were kept in minimum bactericidal concentration (MBC) at 8 weeks after implantation and in the minimum inhibitory concentration (MIC) at the end of 12 weeks after implantation, while its level in the vein was kept in MBC at 2 weeks and in MIC at 8 weeks. The rifampicin levels in the bone tissue and psoas major were kept in MBC at 4 weeks after implantation and in the MIC at 8 weeks after implantation, while its level in the vein was kept MIC at 4 weeks.The pyrazinamide levels in the damaged bone tissue and psoas major were kept in MBC at 8 weeks after implantation and in the MIC until 8 weeks after implantation, while its level in the vein was kept MIC at 8 weeks. In the control group,there were no levels of isoniazid, rifampicin and pyrazinamide in the damaged bone tissue, adjacent psoas major and inferior vena cava in comparison with the baseline. These results show that isoniazid, rifampicin and pyrazinamide in the defect region can achieve sustained slow release in the rabbit model of spinal tuberculosis after implantation of the calcium sulfate/poly(amino acid) compound material carrying triple anti-tuberculosis drugs. In addition, the local drug concentration and duration in the defect region are better than those in the blood.
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BACKGROUND:Stem cel transplantation has gained considerable support recently. It provides new opportunities for treating diabetic neurogenic bladder. OBJECTIVE:To summarize the research progress in bone marrow mesenchymal stem cel s (BMSCs)transplantation in the treatment of diabetic neurogenic bladder. METHODS:The first author retrieved Sciencedirect, PubMed, Embase, Wangfang and CNKI databases, for relevant articles of BMSCs transplantation in the treatment of diabetic neurogenic bladder, published from 2000 to 2016. The key words were“bone marrow mesenchymal stem cel s, diabetic neurogenic bladder, differentiation, transplantation”in Chinese and English, respectively. RESULTS AND CONCLUSION:In patients with diabetic neurogenic bladder, the transplantation of BMSCs may provide safer and longer-lasting outcomes by repairing the damaged bladder and urethra. And it can produce various bioactive substances, which wil have nutritional paracrine effects on the bladder microenvironment, including anti-inflammation, promoting cel proliferation and improving cel survival. On the one hand, the BMSCs have the ability to migrate to the injury site via the blood circulation. On the other hand, BMSCs can produce various growth factors, as wel as the cytokines that can inhibit the inflammatory response. While the current clinical studies are lacking, its efficacy and safety needs further verification.
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Objective To investigate clinical efficacy of transforaminal approach debridement with fusion,thoracolumbar single segment of Brucella spondylitis pedicle screw fixation (TLIF surgery).Methods We analyzed retrospectively the clinical data of 28 patients with Brucella spondylitis treated in our department between January 2009 and January 2014 with TLIF surgery (Group A) and internal fixation with a simple posterior anterior interbody disease debridement,autogenous bone graft (Group B).The two groups were compared in operation time,blood loss,postoperative ambulation time,hospitalization days,erythrocyte sedimentation rate (ESR),Creactive protein (CRP),American Spinal Injury Association (ASIA) classification,visual analogue scale (VAS),Oswestry Disability Index (ODI),Cobb angle of vertebral bone graft healing,and complications.Results All the patients were followed up for an average of 20.2 months (18 to 27 months).They were all cured.Compared with those in Group B,patients in Group A had shorter operation time (164.60±59.19)min,significantly reduced blood loss (346.00±108.90)mL and complications (1 case);significantly shorter postoperative ambulation time (3.36±1.11 days),hospitalization days (17.36 ± 4.19) days and duration (13.16 ± 3.94) months (P ＜ 0.05).The two groups did not significantly differ in VAS scores,ODI,ESR CRP,or Cobb angle (P＞0.05).Conclusion On the basis of norms of anti-drug treatment for brucellosis,TLIF surgery on Brucella spondylitis has the advantages including less trauma,shorter operation time,easier operation,less bleeding,earlier postoperative ambulation,and lower complication rate.
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Objective To explore the effect of posterior debridement, grafting and internal fixation for treatment of non-specific lumbar intervertebral infection. Methods Clinical data of 20 patients with non-specific lumbar intervertebral infection treated in General Hospital of Ningxia Medical University from October 2013 to June 2013 were retrospectively analyzed. There were 15 males and 5 females with an average age of 41 years (range, 36-51 years). All patients suffered from single lumbar inter-vertebral infection, including 3 cases at L2/3,4 at L3/4,10 at L4/5 and 3 at L5/S1. All 20 cases underwent one-stage posterior debride-ment, autogenous bone grafting and internal fixation, tissue samples in focus were collected for bacterial culture and pathological examination. The disease controlling statues were evaluated based on laboratory results of ESR and CRP. Imaging examinations were taken to evaluate the fusion of vertebral body. Clinical effects were evaluated using the visual analog scale (VAS) and the Jap-anese Orthopaedic Association scores (JOA) score of lumbar fumction. Results All patients underwent the surgery successfully. The surgery duration time was 90-160 min, average 125 min, and the blood loss was 200-700 ml, average 360 ml. Cerebrospinal fluid leakage occurred in one case. Postoperatively, all patients experienced significant reliefof back pain, improving in the func-tion of movement, and no fever. The lower back VAS score: average (5.35 ± 1.15) points before operation , average (2.76 ± 0.34) points one week after operation, and an average score of (0.85±0.65) points by the last follow-up time. JOA lumbar function score:all patients were effective after operation, the improvement rate was excellent in 65%(13cases), good in 25%(5 cases), and pass-able in 10%(2cases). Comparing with preoperation, the excellent and good rate was 90%. All patients ESR and CRP returned to normal levels at the last follow-up. Ordinary bacterial culture was positive in 8 cases and negative in 12 cases. The pathogens iden-tified were staphylococcus aureus (6 cases), Escherichia coli (2 cases) and staphylococcus epidermidis (2cases). All incisions achieved primary healing. All patients were followed up from 6-18 months (average,12 months), and the symptom of pain relieved significantly. No recurrent infection had happened. A solid bony fusion was found in all patients at 6-14 months (average, 8.5 months) after the surgery. Conclusion Posterior debridement, grafting and internal fixation are effective treatments for non-spe-cific lumbar intervertebral infection, can reduce the time of staying in hospital, this operation is safe and reliable.
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Objective To investigate the feasibility of Antituberculotic?loaded bone cement (ATLBC) prepared by mix?ing the anti?TB drugs Rifampicin (RFP), Isoniazid (INH), Pyrazinamid (PZA), Moxifloxacin (MFX) with Palacos R PMMA bone cement in Total Joint Arthroplasty treatment for Joint Tuberculosis. Methods Forty grams of Palacos R bone cement powder without antibiotics was mixed with 1 or 2 grams of RFP, INH, PZA and MFX respectively. According to ISO 5833:2002 stan?dard, 8 groups of ATLBC standard test specimen were prepared as experiment group and Palacos R PMMA bone cement with?out antibiotics was prepared as control group. Physical properties (such as the average dough time, curing time, maximum tem?perature), mechanical strength (such as the compressive strength, the bending resistance strength, the modulus of elasticity) and the concentrations of eluant drug in different time points of ATLBC were detected. Results In RFP (1 g), RFP (2 g), INH (1 g) and INH (2 g) group, the average dough time and curing time were longer than those in control group, which exceeded the standard scope of ISO, while the average maximum temperature was significantly lower than that in control group. The INH ( 1 g) group and INH (2 g) group hardened after mixing for 14 days. The RFP (1 g) group and RFP (2 g) group hardened after mixing for 30 days. Twenty minutes after mixing and hardening, the compressive strength, bending resistance strength and modulus of elastic?ity were significantly lower than the specified values of ISO standard. The physical properties and mechanical strength in PZA ( 1 g) group, PZA (2 g) group, MFX (1 g) group, MFX (2 g) group and control group were in accordance with the specified values of ISO standard, and they hardened after 20 minutes. In RFP (1 g) group, RFP (2 g) group, INH (1 g) group, INH (2 g) group, PZA (1 g) group, PZA (2 g) group, MFX (1 g) group and MFX (2 g) group, the concentration of eluant could maintain for 3 days, 7 days, 90 days, 90 days, 45 days, 60 days, 60 days and 60 days respectively. Conclusion RFP and INH mixing with Palacos R PMMA bone cement can hinder the aggregation of bone cement so they are unsuitable for preparing ATLBC. PZA and MFX mixing with Palacos R PMMA bone cement do not affect the physical properties of bone cement, with excellent mechanical strength and elu?tion properties. Because the minimal inhibitory concentration of PZA is higher and its antimicrobial activity maintains shorter time, while MFX maintains longer time in antimicrobial activity, it's more suitable for the preparation of ATLBC.
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Objective To discuss the clinical efficacy of surgical treatment of pathologic vertebral surgery for thoracic and lumbar tuberculosis. Methods All of 322 cases of thoracic and lumbar spinal tuberculosis patients from December 2003 to June 2014 were retrospectively analyzed in our department. All patients were underwent debridement, fusion and nerve decompres?sion surgery. According to different fixed methods, patients were divided into pathologic vertebral surgery group (fixation complet?ed within lesions invaded motion unit) including 91 males and 100 females, with an average age of 41.53 years, and non?pathologic vertebral surgery group (long segments or short segment fixation) including 61 males and 70 females, with an average age of 42.72 years. We observed the tuberculosis cure rate, degrees of deformity, pain and neurological recovery, operative time, blood loss and complications by follow?up. Results The average follow?up time was 75.52 months in pathologic vertebral surgery group and 76.21 months in non?pathologic vertebral surgery group. The total number of pathologic vertebras in pathologic vertebral surgery group and non?pathologic vertebral surgery group were 277 and 218 respectively, and the average was 1.45 and 1.66. The total number of fixed segments was 277 in pathologic vertebral surgery group and 485 in non?pathologic vertebral surgery group, and the average fixed segments was 1.45 and 3.70. The cure rate was 85.86%in pathologic vertebral surgery group and 85.49%in non?pathologic vertebral surgery group at 6 months postoperatively, and 98.95%and 98.47%at the last follow?up time, with no signifi?cant difference between groups. Graft fusion rate was 89.00%in pathologic vertebral surgery group and 89.31%in non?pathologic vertebral surgery group 6 months postoperatively, 98.38%and 98.47%at the last follow?up time, without significant difference. In lumbar spine, the average correction of Cobb's angle was 12.4° in pathologic vertebral surgery group and 13.1° in non?pathologic vertebral surgery group, and the average angle loss was 1.3 and 1.4°, with no significant difference. In thoracolumbar, the average correction of Cobb’s angle was 10.9°in pathologic vertebral surgery group and 11.1°in non?pathologic vertebral surgery group, and the average angle loss was 1.7°and 1.5° respectively, without significant difference. However, in thoracic, the average correction of Cobb's angle was 10.2° in pathologic vertebral surgery group and 12.7° in non?pathologic vertebral surgery group, and the average angle loss was 3.6° and 2.5°respectively, with significant difference. The mean operation time was 210.45 min in pathologic verte?bral surgery group and 210.45 min in non?pathologic vertebral surgery group, with significant difference. The average blood loss was 726.12 ml in pathologic vertebral surgery group and 726.12 ml in non?pathologic vertebral surgery group, with significant dif?ference. The complication rate was 11.51%in pathologic vertebral surgery group and 11.45%in non?pathologic vertebral surgery group, with no significant difference. Conclusion Pathologic vertebral surgery surgery is a safe, effective and feasible method of operation for treatment of thoracic and lumbar tuberculosis, which can effectively preserve adjacent normal vertebral motion unit features. The thoracic surgery was less satisfactory than the lumbar and thoracolumbar surgery.
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Objective To explore the compare of complete and incomplete radical debridement for thoracolumbar spinal tuberculosis.Methods Data of 296 patients with spinal tuberculosis from January 2000 to January 2011 were retrospectively analyzed.All patients were divided into two groups according to completeness of debridement:complete debridement group (group A) and incomplete debridement group (group B).There were 162 cases in group A including 86 males and 76 females,with an average age of 38.74± 17.26 years.There were 134 cases in group B including 73 males and 61 females,with an average age of 35.64± 18.21 years.All paticnts had undergone anterior debridement,focal graft implantation,anterior or posterior deformity correction,and internal fixation.Regular follow-up was required in the two groups.Results Residual sclerotic walls (36.54％),multipie cavities (34.62％),affected bony bridges (13.46％),sequestmm (3.37％),abscess (7.21％) and other lesionses (4.81％) were found in the group B.The first three factors were made up 84.62％ of the total.The mean follow-up time was 76.13±8.32 months in the group A and 79.24±5.49 months in the group B.The symptoms,C-reactive protein and erythrocyte sedimentation rate were improved more obviously in group A than those in group B.Six months after operation,tuberculosis healing rate in group A and group B was 29.01％ (47 patients) and 4.48％ (6 patients),respectively.The mean healing time was 4.36± 1.27 months in the group A and 9.15±2.53 months in the group B,with significant differences.The mean the time of chemotherapy was 5.21± 1.38 months in the group A and (10.45±2.15) months in the group B,with significant differences.Reoperation rate in group A and group B was 0.62％ (1/162) and 4.48％ (6/134),respectively.Conclusion Sclerotic bone,multiple cavities,and bony bridges are parts of foci in spinal tuberculosis.Clearing tuberculous foci with sclerotic bone,multiple cavities,and bony bridges can increase the curative effect,shorten the time of chemotherapy and reduce the side effects of drug,thus early resumption can be achieved.
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Objective:To investigate the results of surgical treatment for multi-level spinal tuberculosis with focal debridement ,bone grafting and primary internal fixation.Method:27 cases of multi-level spinal tuberculosis treated by operation from January 1999 to January 2007 were reviewed retrospectively.3 vertebral bodies involved in 15 cases,4 vertebral bodies involved in 7 cases,5 vertebral bodies involved at least in 5 cases.Of these,there were 5 cases in thoracic vertebra,7 cases in lumbar vertebra,11 cases in thoracolumbar vertebra,4 cases in lumbosacral vertebra.11 cases showed neurological deficit before surgery,According to the Frankel classification,Frankel B in 1 case,Frankel C in 2,Frankel D in 8.The preoperative average Cobb angle of kyphosis was 35°±7° (range,26°-43°).The focal debridement,bone grafting and primary internal fixation were performed for all patients.Among these protocols, 16 cases underwent one staged posterior spinal internal fixation and anterior focal debridement,bone grafting.11 cases had anterior spinal internal fixation with focal debridement and bone grafting.All patients received anti-TB chemotherapy before and after operation.Anti-TB chemotherapy protocols consisting of combinations of rifampin,isoniazid,ethambutol and streptomycin were administered for 3 months which including 3 weeks before the operation and 3 months after the operation,followed by rifampin,isoniazid and ethambutol for a total of 9 months.The clinical outcomes were evaluated according to the criteria designed by WU Qiqiu et al.Result:The average surgical time was 240 minutes (range,150-300min),with the average intraoperative blood loss of 1000ml (range,600-1400ml),There was no complication such as nerve injury and cerebrospinal fluid leakage.The incision in 1 case presented sinus which had a secondary healing later on,others obtained primary healing.The average postoperative Cobb angle of kyphosis was 15°±5°(range,12°-20°).All cases were followed up for an average of 18 months(range, 14-48 months).The patients with paraplegia recovered to the normal in 8 months.Bony fusion was achieved in all cases with mean fusion period of 7 months(range,5-14 months) with no incidence of hardware failure.At the final follow-up,all patients had evidence of clinical heal and the solid bony fusion.Conclusion:Focal debridement,bone grafting and primary internal fixation is reliable in dealing with multi -level spinal tuberculosis.
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OBJECTIVE: To evaluate the clinical outcomes of single-balloon kyphoplasty in the treatment of thoracic osteoporotic compression fractures via extrapedicular approach METHODS: From July 2004 to May 2008, 38 cases (52 vertebra) of thoracic osteoporotic fractures were treated by balloon kyphoplasty via unilateral extrapedicular approach, including 12 males and 26 females with an average age of 60.3 years (range 55-72 years). There were 34 cases of primary osteoporosis, and 4 had administrated hormone due to other diseases for over 6 months. Symptomatic levels ranged from T_4 to T_(12) confirmed by physical examination, MRI and X-ray. The pain relief, restoration of vertebral height and kyphosis correction were compared before and after operation by using visual analogue scale (VAS) and radiograph, respectively. In addition, bone cement leakage location and complications were recorded. RESULTS: Operation were successfully performed in 38 cases with an average injection of bone cement volume of (3.2+ 1.4) mL (2.25-4.60 mL in unilateral infusion). The mean time of surgery was 25-55 minutes, and that of follow-up was 9.5 months (6-24 months). Back pain of 36 cases was improved, and the VAS 3 days postoperatively and the final follow-up was significantly reduced (P < 0.05). The vertebral anterior margin and median height following surgery were significantly improved detected by X-ray (P < 0.05), and average median height restoration was (50.90+34.60)%, but no significant change was found in posterior height (P > 0.05). No lateral wedging or changes in the coronal alignment was found. Three cases (5 vertebra) had cement leakage: the bone cement of 1 case leaked to posterior margin through the puncture channel, and 2 cases leaked to lateral vertebra through vertebral venous system without any adverse event. The patients could move the second day after surgery, discharged from the hospital at days 3-4, and restored to normal life at 1 month postoperatively. No blood vessel or spinal cord puncture injury or pulmonary embolism, or blood vessel embolism was found. CONCLUSION: Unilateral extrapedicular kyphoplasty is safe and effective in treating thoracic osteoporotic fractures. It rapidly releases backache, restores the body height of fractured thoracic vertebrae and improves quality of life of the patients.
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[Objective] To investigate the changes of urinary deoxypyridinoline(DPD)in patients with spinal tuberculosis(STB)and evaluate their clinical significance.[Method] All subjects were divided into three groups:group 1,STB patients;group 2,Pulmonary TB patients:group 3,healthy controls.Their DPD was detected by ACS:180 automated chemiluminescence system.The values for urinary DPD were adjusted for urinary creatinine to overcome confounding variables such as body mass index and urine dilution.The results were analyzed.[Result]The mean urinary concentrations of DPD in spinal tuberculosis,pulmonary tuberculosis and healthy controls were 1(4.9?9.8)?mol/mol Cr.,(6.4?2.6)?mol/mol Cr,and(6.3? 2.0)?mol/mol Cr.,respectively(P value=0.001,0.000).Patients with spinal tuberculosis had a higher urinary excretion of DPD than those without spinal tuberculosis.There was no difference in groups of pulmonary tuberculosis and healthy controls(P=0.751).DPD had a better receiver operating characteristic(ROC)curve and the area under the ROC curve was 0.83.For DPD,the sensitivity(87%)and specificity(73%)were seen at the cut-off level of 8.4 ?mol/mol creatinine.[Conclusion]Change of bone matabolic activities can be found in patients with STB.Bone resorption can increase sharply by DPD.The determination of urinary DPD may provide an important reference value for the assessment of STB from Pulmonary TB.
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Objective To investigate the relation between TCM syndromes of upper gastrointestinal hemorrhage and solar terms change in different years. Methods Data of upper gastrointestinal hemorrhage in-patients in seven districts of TCM hospital of Gansu province in twelve years were filled in investigative statistical forms and analyzed by computer. Results There was obvious difference in TCM syndromes among different solar terms and different years. Conclusion Atmospheric pressure, atmospheric temperature, air humidity, diurnal temperature range of solar terms change in different years directly effect TCM syndromes of upper gastrointestinal hemorrhage.
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Objective To investigate the relation of morbidity law of upper gastronintestinal hemo rrhage and cycle of Heavenly Stems and Earthly Branches in Gansu province. Methods Investigative statistical forms were set up and analyzed by computer about twelve years in-patient of upper gastronintestinal hemorrhage in TCM hospital of these district. Results High morbidity corresponded with theory of YUNQI, in 1988 (year of the fifth of ten Hevenly Stems and the fifth of the twelve Earthly Branches, HUOYUN is high sufficient), 1995 (year of the second of ten Hevenly Stems and the last of the twelve Earthly Branches, JINYUN is insufficient), and Baiyin district in 1994 (year of the first of ten Hevenly Stems and the eleventh of the twelve Earthly Branches TUYUN is high sufficient), Cheng district in 1996 (year of the third of ten Hevenly Stems and the first of the twelve Earthly Branches, SHUIYUN is high sufficient), YUNQI was high sufficient or insufficient, which causing diseases conform to five internal organs and geographical position. Conclusion Morbidity law of upper gastronintestinal hemorrhage corresponds with cycle of Heavenly Stems and Earthly Branches.
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0.05). After operation, in the pedicle screw fixation group the indexes were restored, but the restoration was lost gradually at later follow- up stage. Their superior- inferior endplate angle before operation averaged 19.5? , but 8.6? after operation, and 20.0? at the latest follow- up. Their wedged angle before operation averaged 20.7? , but 9.1? after operation, and 15.9? at the latest follow- up. In the non- pedicle- screw fixation group, the indexes decreased gradually at the later follow- up. Their average superior- inferior endplate angle before operation was 16.6? , 14.6? after operation, and 23.0? at the latest follow- up. Their average wedged angle before operation was 15.6? , 16.6? after operation, and 22? at the latest follow- ups. Conclusions The height of the fractured vertebra may be lost and the wedged vertebra may occur again after surgery but conditions may become stable in 2 years. The spinal kyphosis deformity, however, may go on. Its possible causes are structural changes of the vertebra after surgery, the early degenerative changes of the adjacent intervertebral discs, and osteoporosis.
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Medical universities and colleges have to strengthen and develop teaching affairs of health law in accordance with requirements of time. They must deepen teaching reform by paying attention to the practical teaching sectors,optimize teaching resources from teachers, teaching materials, teaching content,and explore ways to enhance teaching effectiveness from the case teaching,teaching clinics,targeted teaching methods,so as to train medical and health personnel with good quality of law knowledge.