The Value of T-SPOT.TB in Evaluating Treatment Effect of Tuberculous Vertebral Osteomyelitis / 昆明医科大学学报

Objective To investigate the treatment evaluating value of ESAT－6 and CFP－10 in T－SPOT.TB kit for tuberculous vertebral osteomyelitis.Medthods This retrospective study analyzed 29 cases diagnosed as TVO in the First Affiliated Hospital of Kunming Medical University from January 2013 to January 2016. All cases were the first－time consultancy. The Wilcoxon－singed－rank－test and chi－square test were used to analyze the changes of ESAT－6 and CFP－10 in the procedure of treatment. The linear－regression analysis was used to analyze the relationship between ESR, CRP, VAS and two specific antigens.Results The pretherapeutic spot counts of ESAT－6 and CFP－10 were compared with the first and the last follow－up respectively. The results of two antigenic spots change showed a higher consistency (P＜0.05) .The positive rates of CFP－10 at the prior treatment, the first follow－up and the last follow－up were 86.20% , 79.31% and 58.62% respectively. The result of chi－square test showed a higher consistency (P＜0.05) . ESAT－6 only correlated with VAS. CFP－10 had the relationship with VAS and ESR. But all of these relativities were weak.Conclusion The decrease in the spot counts of ESAT－6 and CFP－10 suggest that the treatment is effective,and CFP－10 may be one available index to evaluate the treatment effect.

Treatment of Gustilo grade III leg fractures by external fixation associated with limited internal fixation / 中华创伤杂志(英文版)

<p><b>OBJECTIVE</b>To explore the clinical effects of external fixation associated with limited internal fixation on treatment of Gustilo grade III leg fractures.</p><p><b>METHODS</b>From July 2006 to December 2008, 40 cases of Gustilo grade III leg fractures were emergently treated in our unit with external fixation frames. Soft tissue injuries were grouped according to the Gustilo classification as IIIA in 17 cases, IIIB in 13 cases, and IIIC in 10 cases. All the patients were debrided within 8 hours, and then fracture reposition was preformed to reestablish the leg alignment. Limited internal fixation with plates and screws were performed on all the Gustilo IIIA cases and 10 Gustilo IIIB cases at the first operation. But all the Gustilo IIIC cases and 3 Gustilo IIIB cases who had severe soft tissue injuries and bone loss only received Vacuum-sealing drainage (VSD). Broad-spectrum antibiotics were regularly used and VSD must be especially maintained easy and smooth for one week or more after operation. Limited internal fixation and transplanted free skin flaps or adjacent musculocutaneous flaps were not used to close wounds until the conditions of the wounds had been improved.</p><p><b>RESULTS</b>The first operations were completed within 90-210 minutes (170 minutes on average). The blood transfusions were from 400 ml to 1500 ml (those used for anti-shock preoperatively not included). All the 40 patients in this study were followed up for 6-28 months, 20.5 months on average. The lower limb function was evaluated according to the comprehensive evaluation standards of leg function one year after operation and the results of 28 cases were excellent, 9 were good and 3 were poor.</p><p><b>CONCLUSION</b>External fixation associated with limited internal fixation to treat Gustilo grade III leg fractures can get satisfactory early clinical therapeutic effects.</p>

Multi-slice spiral CT 3-dimensional reconstruction technique to treat multi-segmental degenerative spinal stenosis with traumatic instability of lower cervical spine / 中华创伤杂志(英文版)

<p><b>OBJECTIVE</b>To study the feasibility of multi-slice spiral computed tomography (MSCT) 3-dimensional reconstruction technique in assisting cervical pedicle screw fixation (PSF) and double-door laminoplasty to treat multi-segmental degenerative spinal stenosis with traumatic instability (MDSTI) of lower cervical spine.</p><p><b>METHODS</b>From September 2006 to August 2007, PSF combined with double-door laminoplasty was performed in 9 patients with MDSTI of lower cervical spine. MSCT 3-dimensional reconstruction techniques, including volume rendering (VR) and multi-planar reconstruction (MPR), were used to assist preoperative diagnosis and measurement to guide the procedure. MPR was performed after operation. In coronal view, the degree of screw perforation was measured precisely and the different positions of pedicle screws were divided into three grades according to Richter's method. In axial view, the canal sagittal diameter and transverse area of every laminoplasty level were measured.</p><p><b>RESULTS</b>Nine patients with MDSTI of lower cervical spine underwent PSF (total 44 screws). According to the classification of Richter, 72.7% (32/44) was in Grade 1 and 27.3% (12/44) was in Grade 2. No screw perforation occurred in Grade 3 and no screw revision was done for misplacement. No iatrogenic damage was observed. Double-door laminoplasty was performed in total 42 volumes. The postoperative sagittal diameter and transverse area of cervical spinal canal were significantly increased (P<0.05). The confidence intervals of mean increased ratio were 23.43%-40.65% in sagittal diameter and 23.18%-42.07% in transverse area. Six months after laminoplasty, based on MSCT axial view, complete union between "open door" and allograft bone was obtained in 76.19% of volumes (32/42), and allograft bone was absorbed partly in 23.81% (10/42). A solid union in bilateral gutters was achieved in all cases. They were followed up from 6 months to 1 year (mean 7.8 months). Postoperative neural function recovery in two cases improved 2 ASIA grade, 5 cases improved 1 grade and 2 cases remained the same as preoperative grade. No cases had lower ASIA grade.</p><p><b>CONCLUSION</b>Assisted with MSCT 3-dimensional reconstruction technique, PSF combined with double-door laminoplasty can be performed more safely and effectively to treat patients with MDSTI of lower cervical spine.</p>

Application of spiral CT image 3D reconstruction in severe talar neck fracture / 中华创伤杂志(英文版)

<p><b>OBJECTIVE</b>To explore the application of the spiral computerized tomography (CT) image three-dimensional (3D) reconstruction technique associated with the conventional radiography in the diagnosis and treatment of severe talar neck fracture.</p><p><b>METHODS</b>Using the multi-slice spiral CT image 3D reconstruction technique, we analysed 11 cases of talar neck fracture. The fractures were reduced and fixed through a minimal incision and internal fixation with titanium cannulated lag screws.</p><p><b>RESULTS</b>In the 11 cases, the results of CT image 3D reconstruction were in concordance with plain radiograph in 6 case of Hawkins type II. And the remaining 5 cases of Hawkins types III and IV could not be classified exactly only by radiographs, one of whom was misdiagnosed. After using the CT image 3D reconstruction, the 5 cases were classified exactly before osteosynthesis. The classifications of these 11 cases were confirmed finally by surgical findings. The duration of operation were 45-140 min, averaging 81 min (including the duration of C-arm fluoroscopy). X-ray exposure time was 6-58 seconds, averaging 22 seconds. The blood loss was less than 100 ml. The fracture union was achieved in 3 months. No nonunion, talus avascular necrosis or joint surface collapse occurred. Postoperative follow-up was from 1 to 25 months. According to Hawkins score, excellent result was found in 6 type II cases and 1 type III case; good result in 1 type III case with both medial and lateral malleolar fracture, 1 type III with medial malleolus fractures and 1 open type III; fair result in 1 open type IV with lateral malleolus fracture.</p><p><b>CONCLUSIONS</b>By using the multi-slice spiral CT image 3D reconstruction associated with radiography to diagnose and treat severe talar neck fractures, the accuracy of diagnosis can be improved obviously. Based on this technique, more consummate operational plan can be designed and performed so as to achieve a better therapeutic effect.</p>

Gene expression profile related to inflammation in rat model of traumatic deep vein thrombosis / 中华创伤杂志(英文版)

<p><b>OBJECTIVE</b>To study the relationship between inflammation and traumatic deep vein thrombosis (TDVT).</p><p><b>METHODS</b>A rat model of deep venous thrombosis was established by directly clamping femoral vein. Based on the different biological situations of femoral vein thrombosis and observation phases, 150 SD rats were divided into 7 groups. Inflammatory cells in vein wall of each group were counted. The fold change and cluster analysis were applied to study the change of gene expression during the development of venous thrombosis. Especially, the genes related to inflammation, fibrinolysis, coagulation of endothelium were analyzed in detail.</p><p><b>RESULTS</b>The inflammation cells in femoral vein wall were mostly neutrophilic granulocytes in Groups B, C and D, while they were lymphocytes in Groups E, F and G. Compared with Groups A, B, E and G, the inflammation cell counts in Groups C, D and F were much higher (P less than 0.05). The results of fold-change analysis showed that 2 504 genes (Log 2 ratio > or = 1 or < or = 1) presented different expressions in the process of TDVT. Most of these genes'functions were not clarified so far and the genes with known functions were involved in inflammation, DNA-dependent transcription regulation, blood coagulation, fibrinolysis, etc. Among them, 23 genes related to inflammation had different expressions during TDVT. The cluster analysis showed that the expression changes of several genes, such as IL-1 alpha, IL-1 beta, IL-6, Cinc2, corresponded with the development of femoral vein thrombosis.</p><p><b>CONCLUSION</b>There is a close relationship between the genes related to inflammation and deep vein thrombosis induced by direct vascular trauma.</p>

Lower cervical spine injury treated with lateral mass plates and pedicle screws through posterior approach / 中华创伤杂志(英文版)

<p><b>OBJECTIVE</b>To treat injury of the lower cervical spine C6 to C7 with cervical lateral mass plates and T1 pedicle screws through posterior approach.</p><p><b>METHODS</b>The data of 8 patients with lower cervical spine C6 or C7 injury (6 patients with fracture and dislocation in C6 and C7 and 2 with fracture in C7) were analyzed retrospectively in this study. For the preoperative American Spinal Injury Association (ASIA) classification, Grade C was found in 3 cases and Grade D in 5 cases. Screws were placed on the lateral masses and the first thoracic pedicle with Margerl technique. Lamina or facet bone allografting was used to achieve a long-term stability.</p><p><b>RESULTS</b>All the 8 patients were followed up for 5-37 months (mean: 15 months). No operative death occurred. There were no examples of aggravation of spinal cord injury or vertebral artery injury, cerebrospinal fluid leak, nerve roots injury, screw malposition or back-out, loose of alignment or implant failure. Clinical symptoms and ASIA classification were improved in all the patients. Postoperative MRI scanning confirmed the satisfactory screw placement in all the cases.</p><p><b>CONCLUSIONS</b>Lateral mass plates and pedicle screws through posterior approach are safe and beneficial for patients with lower cervical spine C6 or C7 injury.</p>

The use of lateral mass screws and pedicle screws for the treatment of injury of lower cervical spine / 中华外科杂志

<p><b>OBJECTIVE</b>To discuss the effect of the use of the cervical lateral mass plates screws and T(1) pedicle screws for the treatment of C(6) to C(7) injury through posterior approach.</p><p><b>METHODS</b>There were 8 patients in the study group; Each of them had been injured with low cervical spine C(6) or C(7). There were 6 cases with C(6)-C(7) injury and 2 cases with C(7) injury. According to ASIA classification, 3 cases were in grade C and 5 cases in D. The lateral mass screws were placed on the lateral masses using Margel technique. Lamina or facet bone allografting were used to achieve a long-term stability.</p><p><b>RESULTS</b>All 8 patients were followed up from 5 to 37 months (mean 15 months). No operative death occurred. There were no cord or vertebral artery injury, cerebrospinal fluid leak, nerve roots injury, screw malposition or back out, loose of alignment or implant failure. Clinical symptom and ASIA classification were improved in all patients. Postoperative MRI scanning confirmed satisfactory screw placement in all cases.</p><p><b>CONCLUSION</b>This technique is safe and benefit to patients with low cervical spine C(6) or C(7) injury.</p>