Surgical options and clinical outcomes of cervical ossification of the posterior longitudinal ligament / 中华外科杂志

<p><b>OBJECTIVE</b>To discuss the options and clinical outcomes of surgical treatment of cervical ossification of the posterior longitudinal ligament (OPLL).</p><p><b>METHODS</b>From January 2006 to December 2010, 63 patients of cervical OPLL treated surgically by same team were retrospectively analyzed. There were 49 males, 14 females, with a mean age of 56.2 years (from 38 to 76 years). The duration of symptoms ranged from 2 months to 20 years (mean 3.2 years). The ossified ligament was classified via sagittal and coronal images on CT scan. The cervical curvature was measured. Choice of surgical methods was determined according to the type of ossified ligament and cervical curvature. All complications occurred was recorded. The Japanese Orthopedic Association (JOA) scoring system was used to evaluate the neurological status. The severity of cervical pain was assessed with visual analogue scale (VAS) method. The results of preoperative, postoperative and follow-up were statistically compared with student t test.</p><p><b>RESULTS</b>The JOA scores of 35 patients performed with anterior approach improved from 9.8 ± 2.3 preoperatively to 11.7 ± 2.1 at final follow-up (t = 3.28, P < 0.05). The VAS sore was significantly decreased at final follow-up compared with preoperative (t = 3.15, P < 0.05). While the JOA scores improved from 10.4 ± 2.7 preoperatively to 12.5 ± 2.3 at final follow-up (t = 3.81, P < 0.05) in 12 patients with laminectomy and from 9.7 ± 2.5 to 11.6 ± 2.6 in 14 patients with laminoplasty (t = 3.56, P < 0.05). The VAS score either in laminectomy or in laminoplasty has not significantly difference between preoperative, 3 month postoperative and final follow-up (P > 0.05). Two patients underwent a combined anterior-posterior approach procedure. Complications in patients included 1 patient of postoperative neurologic deterioration and 2 cases of cerebrospinal fluid leakage in patients with anterior approach, and 2 cases of C(5) nerve palsy in patients with laminectomy.</p><p><b>CONCLUSIONS</b>Surgical options of cervical OPLL should be determined by detailed study of type and range of ossified ligament, as well as the cervical curvature of patients. Good neurological function can be expected in case of appropriate choosing the method for treating the cervical OPLL.</p>

Effect of Aidi injection on peripheral blood expression of Th1/Th2 transcription factors and cytokines in patients with esophageal squamous cell carcinoma during radiotherapy / 中国中西医结合杂志

<p><b>OBJECTIVE</b>To investigate the expression of Th1/Th2 transcription factors and cytokines in peripheral blood of patients with esophageal squamous cell carcinoma (ESCC) during radiotherapy to provide an evidence for using traditional Chinese medicine in anti-tumor immunotherapy.</p><p><b>METHODS</b>Sixty patients with ESCC undergoing radiotherapy were randomly and equally assigned to the tested group (treated with combined treatment of Aidi Injection) and the control group (treated with radiotherapy alone). A group consisted of 20 healthy persons was set up meanwhile as the normal control. Patients' expressions of Th1 and Th2 type transcription factors and cytokines were detected before and after radiotherapy, the expression of T-bet and GATA-3 in peripheral blood monoclear cells (PBMCs) were detected by Real-time quantitative PCR (RT-PCR), and plasma expressions of interferon gamma (IFN-gamma), interleukin 2, 4 and 10 (IL-2, IL-4, IL-10) were detected by enzyme-linked immunosorbent assay (ELISA).</p><p><b>RESULTS</b>Compared with the healthy control group, the expressions of Th1 type transcription factor T-bet and cytokines IFN-gamma, IL-2 in ESCC patients were significantly lower (P < 0.01), while expressions of Th2 type transcription factor GATA-3 and cytokines IL-4, IL-10 were significantly higher (P < 0.01). These changes were exacerbated significantly after radiotherapy in the control group (P < 0.01), but only showed a slight change in the tested group with statistical insignificance (P > 0.05).</p><p><b>CONCLUSIONS</b>Radiotherapy can not reverse the Th1/Th2 shift presented in ESCC patients, while the combined intravenous dripping of Aidi Injection during radiotherapy can inhibit it effectively. The combined therapy could elevate the immune function in organism, enhance the radiosensitivity, and attenuate the toxic-adverse effect of radiotherapy.</p>

Key sperm membrane proteins in sperm-egg fusion / 中华男科学杂志

Fertilization is a complex process involving multiple steps, of which sperm-egg fusion is most important. This article presents a detailed review of some of the key sperm membrane proteins closely related with fertilization, such as the Izumo, the ADAMs gene family and the Crisp gene family proteins, which is of practical significance for deeper insights into the mechanisms of sperm-egg fusion, as well as for the improvement of clinical diagnosis of male infertility and development of novel contraceptive drugs.

Expression of transcription factor T-bet and GATA-3 in peripheral blood mononuclear cells and its correlation with immune status in esophageal cancer patients / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To investigate the expression of transcription factors (TF) T-bet and GATA-3 mRNA in peripheral blood mononuclear cells and its correlation with immune status in esophageal cancer patients.</p><p><b>METHODS</b>Sixty patients were divided into two groups according to the clinical data: group A consisting of stage I and II, group B including stage III and IV. The gene expression of T-bet and GATA-3 in 60 esophageal cancer patients and 30 healthy controls was detected by reverse transcription-polymerase chain reaction (RT-PCR). The expression of IFN-gamma and IL-4 was measured by enzyme linked immunosorbent assay (ELISA).</p><p><b>RESULTS</b>Expression of T-bet mRNA in esophageal cancer patients (stage I and II: 0.27 +/- 0.05 ng/L, stage III and IV: 0.12 +/- 0.02 ng/L) was significantly lower than that in the healthy controls (1.35 +/- 0.14 ng/L), but the expression of GATA-3 mRNA in esophageal cancer patients (stage I and II: 0.45 +/- 0.06, stage III and IV: 0.55 +/- 0.03) was significantly higher than that in the healthy controls (0.09 +/- 0.10). The plasma level of Th1 cytokine IFN-gamma in the patients [stage I and II: (12.12 +/- 1.48) ng/L, stage III and IV: (8.44 +/- 0.90) ng/L] was significantly lower than that in the healthy controls, while the level of Th2 cytokine IL-4 in the patients [stage I and II: (18.64 +/- 0.77) ng/L, stage III and IV: (25.28 +/- 2.02) ng/L] was significantly higher than that in the healthy controls. However, neither in the expression of T-bet and GATA-3, nor in the plasma level of IFN-gamma and IL-4, showed a significant difference between group A and B.</p><p><b>CONCLUSION</b>In the peripheral blood of esophageal cancer patients, the expression of T-bet decreased, while GATA-3 increased, Th1/Th2 balance is broken, and the Th2 is dominant. T-bet and GATA-3 play a part role in the regulation of Th1/Th2 balance.</p>

Anterior decompression for the treatment of cervical spondylotic myelopathy associated with ossification of posterior longitudinal ligament / 中华外科杂志

<p><b>OBJECTIVE</b>To study the technique and effect of anterior decompression for the treatment of cervical spondylotic myelopathy associated with ossification of posterior longitudinal ligament (OPLL).</p><p><b>METHOD</b>Sixty-one patients (42 male and 19 female, 45 - 74 years with mean age of 57 years old) underwent anterior decompression for the treatment of cervical spondylotic myelopathy associated with OPLL. Among them, OPLL was definitely diagnosed in 49 patients preoperatively, and was found during the operation in the other 12 patients. The occupying rate of OPLL ranged 32%-70% with an average of 52%. The preoperative JOA scores ranged 4 - 14 points with an average of 9.6 points. In additional to conventional decompression, the ossification was removed completely after discectomy and corpectomy.</p><p><b>RESULTS</b>Corpectomy was performed in 41 cases, discectomy in 6 cases and combination of corpectomy and discectomy in 14 cases. The follow-up of all patients ranged from 6 to 36 months (mean 16 months). The postoperative JOA scores ranged 8-16 points with an average of 12.8 points. The neurological improvement rate ranged from 25.0% to 87.5% with an average of 65.2%. The transient leakage of cerebrospinal fluid (CSF) occurred in 5 cases, and stopped after conservational treatment. No neurological deterioration developed.</p><p><b>CONCLUSIONS</b>The difficulty and risk of anterior decompression are significantly increased in the patients with cervical spondylotic myelopathy associated with OPLL. Remove of ossification after corpectomy and discectomy could provide complete decompression and better results.</p>

Anterior radical decompression for severe ossification of the posterior longitudinal ligament in the cervical spine / 中华外科杂志

<p><b>OBJECTIVE</b>To report the outcome of anterior radical decompression for the treatment of severe ossification of the posterior longitudinal ligament (OPLL) with an average occupying ratio exceeding 50% in the cervical spine.</p><p><b>METHODS</b>From July 2002 to February 2006, 26 patients with cervical OPLL occupying ratio of the spinal cord exceeding 50% underwent anterior decompression and fusion. There were 18 males and 8 females. The average age was 59 years (ranged from 43 to 73 years) and the mean occupying ratio was (65 +/- 20)%; Before operation, the JOA score was 8.7 +/- 2.8, and the sagittal diameter of spinal cord was (25 +/- 7)%. The ossified ligament was classified into two groups, the base-open group and the base-closed group. The occupying ratio was measured on 3-D CT scans, and the sagittal diameter of the deformed spinal cord was measured at the narrowest level on sagittal T2-weighted MRI. All patients received anterior decompression with the ossified ligament removed completely. Among them, 10 cases underwent one level corpectomy combined with one level diskectomy, 3 cases underwent 2 level corpectomy, and the other 13 patients underwent one level corpectomy. The decompressed segments were reconstructed either with a iliac crest strut or a titanium cage, and an anterior locking plate was implanted to prevent graft extrusion in every patient. All patients were monitored with ECP during decompression.</p><p><b>RESULTS</b>The occupying ratio decreased to (10 +/- 5)%, the sagittal diameter of spinal cord increased to (75 +/- 15)%, and the average diameter of spinal cord at the narrowest site increased 3 times after operation. The JOA score was 14.2 +/- 2.5, with an average improvement ratio of (61 +/- 24)%. Three patients accompanied with diabetes presented with temporarily neurological deterioration. There were two cases complicated with cerebrospinal fluid leaks but cured within 2 weeks after surgery. One case accompanied with diabetes underwent a second emergency reexploration for hematoma in the spinal canal which caused a dyspnea.</p><p><b>CONCLUSIONS</b>Anterior radical decompression is an optimal method for the management of severe OPLL in the cervical spine. Higher rate of neuro-function recovery can be anticipated.</p>

Combined anterior C2,3 reduction and fusion with posterior compressive C2 pedicle screw fixation for the treatment of unstable Hangman's fractures: 16 cases review / 中华外科杂志

<p><b>OBJECTIVE</b>To determine the outcome of combined anterior C2,3 reduction and fusion with posterior compressive C2 pedicle screw fixation for the management of unstable Hangman's fractures.</p><p><b>METHODS</b>Sixteen cases of unstable Hangman's fractures were retrospectively reviewed through X-ray, MRI and three dimensional CT scans. Pre- and postoperative radiographs were measured for translation and angulation of C2,3. Skull traction under extension poison was conducted in all the patients right after their admission. Then anterior C2,3 discectomy followed by interbody fusion, either with iliac autograft or with box cage, and locking plate fixation were performed in each case. Because dissatisfied reduction, mainly residual large fracture gap or kyphosis, was found by the C-arm fluoroscopy during operations, posterior compressive C2 pedicle screw fixation was performed in one stage. According to the Levine-Edwards classification, there were 12 cases of type II, 2 of type I a and 2 of type III in this group.</p><p><b>RESULTS</b>Follow-up ranged 6-38 months, averaged 26 months. Fracture union and bone graft fusion were completed in an average of 4 months after operation. Complaints of neck pain and numbness of limbs disappeared in all patients after surgery, but range of neck motion decreased compared with normal people. Translation of C2 decreased from (4.2 +/- 1.4) mm preoperatively to (2.3 +/- 1.1) mm postoperatively, while angulation of C2,3 decreased from 8.6 degrees +/- 2.1 degrees preoperatively to 2.6 degrees +/- 1.0 degrees postoperatively. Both have statistical significance (P < 0.05). No implant failure or infection was observed.</p><p><b>CONCLUSIONS</b>The classification of Hangman's fracture should be modified in combination with MRI and CT scans to determine the stability of the fracture. Combined anterior C2,3 reduction and fusion with posterior compressive C2 pedicle screw fixation is the treatment of choice for patients with unstable Hangman's fractures.</p>

Detection of fungi in liquor workers with tinea corporis and tinea cruris using arbitrarily primed polymerase chain reaction / 中华劳动卫生职业病杂志

<p><b>OBJECTIVE</b>To explore the method of rapid detection of skin fungi and the significance of conventional diagnosis liquor worker tinea corporis and tinea cruris using arbitrarily primed polymerase chain reaction AP-PCR.</p><p><b>METHODS</b>Among liquor workers who were 50 tinea corporis patients, 58 tinea cruris patients and 50 health persons, we amplified the DNAs of the dermatophytes were amplified using AP-PCR and random primers OPD18 5'-GAGAGCCAAC-3' and OPAA11 5'-ACCCGACCTG-3', at the same time, the dermatophytes with microscope were detected and cultured.</p><p><b>RESULTS</b>AP-PCR analysis detected fungal DNA in 45 patients(90.00%) among 50 liquor worker patients with tinea corporis, 31 patients(62.00%) had the positive results of microscope detection, and 41 patients(82.00%) had the positive results of standard culture. Among these workers who suffered from tinea corporis, T.rubrum, T.mentagrophyte, M. canis and E.floccosum were detected by AP-PCR. T.rubrum, T.mentagrophyte and M.canis were detected by standard culture. AP-PCR analysis detected fungal DNA in 53 patients(91.38%) among 58 liquor worker patients with tinea cruris, 37 patients(63.79%) had the positive results of microscope detection, and 48(82.76%) had the positive results of standard culture. Among the 58 workers who had tinea cruris, T.rubrum, E.floccosum and T.mentagrophyte were detected by AP-PCR and standard culture. Among 50 health persons, AP-PCR analysis detected fungal DNA in 3 persons(6.00%). The detection result with AP-PCR indicated that the kinds of fungi were T.rubrum and T.mentagrophyte. No one health person had the positive result in detection of fungi using microscope detection. Only one(2.00%) health person was detected to be infected by fungus with cultural way. The kind of fungus was T.rubrum.</p><p><b>CONCLUSION</b>AP-PCR is a rapid, sensitive and specific detection method for occupational dermatophyte patients. It can be used to detect and diagnose professional dermatophytosis.</p>

Clinical characteristics and results of cervical spinal cord injury in the patients with ossification of the posterior longitudinal ligament / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the clinical characteristics and results of cervical spinal cord injury (SCI) in the patients with ossification of the posterior longitudinal ligament (OPLL).</p><p><b>METHODS</b>Nineteen patients with cervical SCI associated with OPLL were retrospectively analyzed. Data collection included: pre- and postoperative neurological function, OPLL-type, MRI signal changes and surgical approaches.</p><p><b>RESULTS</b>Spinal cord associated with OPLL was injured severely by mild trauma. Methylprednisolone sodium succinate was used within 8 h after trauma in 12 cases. Two of them died of complications. The neurological functions were markedly improved in the other 10 cases. Seventeen cases had surgical treatment. The neurological functions (Frankel grade) were improved significantly in the operated patients except for one, who died 27 d after operation.</p><p><b>CONCLUSIONS</b>The patients with OPLL are prone to have severe SCI, which directly associates with the preexisting OPLL-type and hyper-intensity signal change in the spinal cord on MRI. Both of using methylprednisolone sodium succinate administration within 8 h after trauma and surgical decompression may improve the neurological outcomes.</p>

Surgical strategy for severe cervical spine dislocations / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate the rate of open reduction and surgical strategy of severe cervical dislocation.</p><p><b>METHODS</b>From March 2001 to March 2006, the data of 92 cases of cervical dislocation over 1/2 were retrospectively studied. Garden Well traction with 1 - 3 kg weight were performed before operation. The patients were performed with diskectomy and reduction with anterior approach initially, for those that can not be reduced, corpectomy were performed and reduction procedures were repeated. The posterior reduction and fixation were followed when reduction can not be reached with anterior approach only. The succeed rate of reduction, rate of tracheotomy were recorded and fusion rate, Frankel score and visual analog scale (VAS) were evaluated.</p><p><b>RESULTS</b>Reduction succeed in 38 cases after diskectomy, 44 after corpectomy and 7 after combined anterior-posterior-anterior procedure. Three cases got incompleteness reduction. Tracheotomy was done in 29 cases. The Frankel score increased 0.5 degree and VAS was 2 averagely at the last follow-up.</p><p><b>CONCLUSIONS</b>The succeed rate of anterior open reduction was 89.2%, and only 10.8% patients needs an additional combined posterior and anterior approach. For patients with completed spinal cord injury with dislocation above C(4), or with dislocation below C(5) but the edema on MRI T2 image are above C(4) level need tracheotomy. The operation be done until respiratory function stable. For patients with completed spinal cord injury with dislocation below C(4) and uncompleted spinal cord injury with dislocation above C(4), the rate of tracheotomy is relatively lower and early operation is recommended.</p>

Surgical treatment and its related factors of cervical spondylotic myelopathy / 中国医学科学院学报

<p><b>OBJECTIVE</b>To observe the results and its related factors of surgical treatment of cervical spondylotic myelopathy (CSM).</p><p><b>METHODS</b>Totally 365 CSM patients were reviewed. All patients were treated with anterior cervical decompression and fusion with autogenous iliac bone or titanium mesh cages with local bone graft. Anterior locking plates were used for fixation. Five patients received revision surgery 3 to 6 months after the initial operation.</p><p><b>RESULTS</b>Clinical function was excellent in 175 patients (47.94%), good in 129 patients (35.34%), fair in 44 patients (12.05%), and poor in 17 patients (4.66%).</p><p><b>CONCLUSION</b>Anterior cervical decompresion of CSM has good clinical efficacy. The timing of operation, disease severity, and surgical technique are the important factors affecting the outcome of treatment.</p>

Diagnosis and surgical management of Hangman's fracture combined with intervertebral disc injury / 中华外科杂志

<p><b>OBJECTIVE</b>To study the pathology characteristics and management of Hangman's fracture combined with intervertebral disc injury.</p><p><b>METHODS</b>Twenty-one patients suffered from this special injury were converged in this study. All patients underwent anterior C(2 - 3) discectomy and fusion, 18 cases were fixed by anterior cervical plate. The type of fractures, radiology characteristics, and clinical outcomes were investigated.</p><p><b>RESULTS</b>No graft displacement or absorption, infection and neurologic deterioration occurred. All fresh dislocation of axis and C(2 - 3) angulation were corrected. Fusion of C(2 - 3) intervertebral space and pedicle fracture were acquired in all of the patients. After a mean follow-up of 31 months, ranging from 8 to 48 months, nearly all of the complains disappeared after operation.</p><p><b>CONCLUSIONS</b>Hangman's fracture is not restricted at pedicle of the axis. Fracture combined with intervertebral disc injury is a special type of Hangman's fracture. Anterior discectomy and fusion of C(2 - 3) intervertebral disc is an effective operation method in accord with the pathophysiology of this special injury.</p>

Key points about atlanto-axial internal-fixation and fusion using Gallie's technique / 中华外科杂志

<p><b>OBJECTIVE</b>To study the clinical problems about posterior atlanto-axial internal-fixation and fusion for atlanto-axial instability or dislocation.</p><p><b>METHODS</b>Surgical treatments of 138 cases with atlanto-axial instability or dislocation were reviewed. There were 62 cases of odentoid malformation, 54 cases of odentoid fracture or rupture of transverse ligament, 22 cases of subluxation and rotation. All cases were treated using Gallie's technique. Six cases were also fixed with transarticular screws, and protected with Philadelphia collar. Other patients were fixed with plaster paris brackets. The followed-up period was 1 to 12 years with an average of 3 year and 5 months.</p><p><b>RESULTS</b>According to Sumi's criteria, excellent 70 cases (50.7%), good 40 cases (29.0%), fair 15 cases (10.9%), poor 13 cases (9.4%). 9 cases with bone graft postponed fusion were cured by enhance external-fixation. 2 cases with nonunion were treated with revision surgery. Complication of cord injury happened in 1 case.</p><p><b>CONCLUSION</b>Gallie's fusion technique is an effective method to manage the atlanto-axial instability or dislocation. Skull distraction before operation and reliable external-fixation post operative are important assistant measures. Key points for successful operation are careful wiring or cable traversing, decortication of posterior arc of C1, and maintaining the physiological height between C1 and C2 posterior arc. Indications and objectives should be conformed before revision surgery for failure cases.</p>

Investigation of resection and reconstruction procedure of high-sacrum tumors / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the way of resection of high-sacrum tumors and the way and duration of the spinal-pelvic TSRH or ISOLA internal fixation.</p><p><b>METHOD</b>From October 1998 through April 2002, 35 patients with sacral tumor were enrolled in our hospital, including 4 cases in L(5)-S(1), 2 in L(5)-S(2), 4 in S(1), 8 in S(1 - 2), 6 in S(1 - 3), 6 in S(1 - 4), 5 in S(1 - 5). 35 patients were followed by lumbo-pelvic TSRH or ISOLA internal fixation and corresponding chemotherapy and radiotherapy.</p><p><b>RESULTS</b>In the follow-up period of 6 - 42 months, the short-term results were satisfactory with the lumbosacral pain reduced and the neurological function improved in different degrees, however dysuria occurred in 1 case and skin necrobiosis at coccygeal incision occurred in 1 case; two cases experienced cerebrospinal fluid leakage and 1 case experienced postoperative infection and delayed healing, 1 case with chordoma and 2 cases with malignant fibrous histiocytoma recurred 1 year after postoperation, one of these 2 cases with malignant fibrous histiocytoma suffered from lung metastasis and died of system failure 19 months after postoperation. No fractured rod occurred.</p><p><b>CONCLUSION</b>Surgical procedure and postoperative comprehensive treatment have important effects on the prognosis. High-sacral tumor resection and reconstruction are effective means of achieving stabilization, providing significant pain relief and preserving ambulatory capacity.</p>

Comparison of fixation strength of the locking and non-locking anterior cervical plate systems / 第二军医大学学报

Objective: To compare the prompt fixation strength and antifatigue strength of the locking and non-locking anterior cervical plating systems. Methods:AO Cervical Spine Locking Plate (CSLP), Danek Orion plate and AcroMed Acroplate were used on the lamb cervical spines. The CSLP and Orion were tested with screws locked and unlocked, and the Acroplate with unicortical and bicortical purchase. The fixation strength and pull-off strength of the screw-plate constructs were performed initially and after fatigue. Results: Locked CSLP and Orion constructs were more rigid than all unlocked unicortical systems initially and after cyclic loading. After fatigue testing, the strength of all unlocked constructs decreased significantly. There was no significant difference in pull-off strength between the CSLP, the Orion and the unicortical Acroplate. Conclusion: The locking mechanism significantly increases the prompt fixation strength and antifatigue strength of the tested screw-plate systems.

Evaluation of long-term outcome of surgical treatment for cervical spondylotic myelopathy / 第二军医大学学报

Objective: To investigate the long-term outcome of anterior decompression and bone graft fusion for cervical spondylotic myelopathy(CSM) and factors affecting the outcome. Methods: Two hundred and forty-five patients with CSM were treated with anterior cervical decompression and auto iliac bone graft fusion, of whom 31 had a second operation between 4 months and 2 years after operation. Follow-up studies were carried out within 5 to 15 years after operation, averaging 6.8 years. Results: Function evaluation: excellent in 118 cases (48.16%), good in 71 (28.98%), passable in 35 (14.29%) and poor in 21 (8.57%). According to the 40 points score method, there was an average of 8 point increase in all cases, of which 101 were between 36 to 40 points, 54 between 31 to 35 points. Conclusion: The long-term outcome of surgical treatment for CSM is definite. Significant factors affecting the outcome include timing of operation, degree of pathology and technique of surgery.

Comparison of fixation strength of the locking and non-locking anterior cervical plate systems / 第二军医大学学报

Objective: To compare the prompt fixation strength and antifatigue strength of the locking and non-locking anterior cervical plating systems. Methods:AO Cervical Spine Locking Plate (CSLP), Danek Orion plate and AcroMed Acroplate were used on the lamb cervical spines. The CSLP and Orion were tested with screws locked and unlocked, and the Acroplate with unicortical and bicortical purchase. The fixation strength and pull-off strength of the screw-plate constructs were performed initially and after fatigue. Results: Locked CSLP and Orion constructs were more rigid than all unlocked unicortical systems initially and after cyclic loading. After fatigue testing, the strength of all unlocked constructs decreased significantly. There was no significant difference in pull-off strength between the CSLP, the Orion and the unicortical Acroplate. Conclusion: The locking mechanism significantly increases the prompt fixation strength and antifatigue strength of the tested screw-plate systems.

Evaluation of long-term outcome of surgical treatment for cervical spondylotic myelopathy / 第二军医大学学报

Objective: To investigate the long-term outcome of anterior decompression and bone graft fusion for cervical spondylotic myelopathy(CSM) and factors affecting the outcome. Methods: Two hundred and forty-five patients with CSM were treated with anterior cervical decompression and auto iliac bone graft fusion, of whom 31 had a second operation between 4 months and 2 years after operation. Follow-up studies were carried out within 5 to 15 years after operation, averaging 6.8 years. Results: Function evaluation: excellent in 118 cases (48.16%), good in 71 (28.98%), passable in 35 (14.29%) and poor in 21 (8.57%). According to the 40 points score method, there was an average of 8 point increase in all cases, of which 101 were between 36 to 40 points, 54 between 31 to 35 points. Conclusion: The long-term outcome of surgical treatment for CSM is definite. Significant factors affecting the outcome include timing of operation, degree of pathology and technique of surgery.