Imageology classification and treatment option for atypical Hangman fractures / 中华骨科杂志

Objective The purpose of the retrospective study was to introduce a treatment option for atypical Hangman fractures (AHF) based on a new classification.Methods Sixty-seven patients with Hangman fractures were treated with a comprehensive treatment strategy.Firstly,Hangman fractures were classified as typical or atypical (AHF) lesions using computed tomography scans of the cervical spine.Secondly,AHF was divided into 1 of 4 types (type A1,A2,B1,and B2) devised by us to clarify the feature of injury.Thirdly,the injury status of disco-ligamentous complex (intact/indeterminate/ruptured) was evaluated using magnetic resonance imaging.If it was a stable lesion,conservative treatment was recommended.If not surgical treatment using anterior or/and posterior stabilization and fusion at C2-C3 level was used.Results Fifty-one patients were identified with AHF.According to our classification,thirty patients were classified as type A1,14 cases as typeA2,5 cases as type B1,and 2 cases as type B2 lesions.Thirteen AHF without C2-C3 instability (12 as type A1 and 1 as type B1) were treated with non-operative treatment,and 38 AHF with C2-C3 instability (18 as type A1,14 as type A2,4 as type B1,and 2 as type B2) were treated with operative treatment.Three patients (all with type A1 lesions) with slightly displacement of C2-3 underwent isolated direct screw osteosynthesis.The remaining 35 underwent posterior stabilization and fusion at C2-C3 level:24 patients with posterior approach with C2 lag screws and C3 non-lag screws fixation and fusion (11 as type A1,10 as type A2,2 as type B1,and 1 as type B2);3 patients with posterior approach with C1 and C3 screw-rod fixation and fusion (1 as type A1 and 1 as type B1);7 with anterior approach by C2-3 discectomy and fusion (3 as type A1 and 4 as type A2);and 2 with anterior and posterior approach (1 as type B1 and 1 as type B2).The average follow-up period was 26 months (range,12-86 months).Neck pain improved significantly at 3-month follow-up,and neurologic status improved at least 1 grade in 12 patients with neurologic deficits at final follow-up.Radiological evaluation showed bony fusion in all patients at 12-month follow-up.Radiological evaluation showed that all 13 AHF without C2-C3 instability treated with non-operative treatment gained fractures fusion at 3-6 month follow-up.Posterior approaches with C1 or C2 and C3 screw-rod fixation and fusion were found to obtain a better alignment of C2-C3 and satisfactory fusion of C2 pedicle factures than anterior approach.Conclusion The treatment option for AHF based on a new classification is helpful in managing such fractures,resulting in good clinical and radiological outcomes.C2 lag screws with or without C3 pedicle screws fixation via posterior approach may not only reduce fractures but also obtain alignment of C2-C3 effectively.

Chordomas of the upper cervical spine: clinical characteristics and surgical management of a series of 21 patients / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Chordomas of the upper cervical spine are rare and present unique surgical challenge. This study aimed to describe the clinical characteristics and surgical management of patients with chordomas of the upper cervical spine.</p><p><b>METHODS</b>Twenty-one patients with chordomas of the upper cervical spine who were treated in Peking University Third Hospital from January 1999 to October 2012 were retrospectively analyzed. Survival was calculated by the Kaplan-Meier method and was compared between groups using the log-rank test.</p><p><b>RESULTS</b>The postoperative diagnosis was classical chordoma in 20 cases and chondroid chordoma in one case. The mean operative time was 9.5 hours (range 6-17 hours), and the mean blood loss was 2 812 ml (range 700-4 800 ml). There were two postoperative deaths. Unilateral vertebral artery ligation was performed in six patients, cervical nerve roots were cut in six patients, and the external branch of the superior laryngeal nerve was repaired after being cut in one case. Two patients developed postoperative velopharyngeal incompetence, and loosening of the occipitocervical screws was observed in one patient. The recurrence rate was 66.7% (10/15) after a mean follow-up period of 46.8 months (range 14-150 months). The 5- and 10- year overall survival rates were (39.8±13.1)% and (31.9±12.7)%, respectively. There was a significant difference in survival rate between patients who underwent surgery and those who did not.</p><p><b>CONCLUSION</b>In spite of the high rates of recurrence and complications after surgical treatment of chordomas of the upper cervical spine, intralesional resection combined with adjuvant radiotherapy remains the optimal treatment to prolong survival.</p>

Circumferential decompression via the posterior approach for the surgical treatment of multilevel thoracic ossification of the posterior longitudinal ligaments: a single institution comparative study / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>The treatment strategies for multilevel thoracic ossification of the posterior longitudinal ligaments (T-OPLL) were rarely reported. The aim of this study was to investigate the clinical outcomes and complications of circumferential decompression for multilevel T-OPLL and compare two different methods in the management of the OPLL (resection or floating).</p><p><b>METHODS</b>Data of sequentially treated patients who received surgical treatment for thoracic spinal stenosis caused by multilevel T-OPLL from January 2005 to February 2012 were retrospectively reviewed. Based on the surgical approaches applied, the patients were divided into two groups. Group A consisted the patients who received posterior decompression and group B consisted the patients who received circumferential decompression via the posterior approach. Group B was further divided into two subgroups: subgroup 1 (the resection group) where the OPLL was completely resected and subgroup 2 (the floating group) where the OPLL was floated.</p><p><b>RESULTS</b>A total of 49 patients were included in the study. Fourteen patients with single posterior decompression were included in group A and 35 patients who received circumferential decompression were included in group B. In group B, 29 patients had complete resection of the ossified posterior longitudinal ligaments, while the other six underwent a flotation procedure. The follow-up data were available in 39 patients. Mean JOA scores improved from 5.4 ± 1.8 to 7.5 ± 2.8 in group A and from 3.7 ± 1.8 to 7.9 ± 2.4 in group B. The main complications included cerebrospinal fluid (CSF) leakage and postoperative neurologic deterioration (ND). Twenty-three of the 25 cases with postoperative CSF leakage achieved a complete recovery at the last follow-up and 12 of the 15 cases with ND achieved some neurological improvement at the last follow-up.</p><p><b>CONCLUSIONS</b>Circumferential decompression via the posterior approach is an effective surgical method for thoracic spinal stenosis caused by multilevel OPLL of the thoracic spine. Patients who receive complete resection of the ossified posterior longitudinal ligaments may have better recovery rate than the "floating" group.</p>

Surgical outcome and strategy for cervical metastasis / 中华骨科杂志

Objective To investigate surgical strategy and outcome for cervical metastasis in different anatomical segments.Methods Data of 31 patients,who had undergone surgical treatment for cervical metastasis from 2001 to 2009,were retrospectively analyzed.Two anatomical regions were defined:upper cervical spine (C1 and C2)and subaxial cervical spine plus cervicothoracic junction (C3-T1).VAS score,Frankel grade,Tomita score and Karnofsky performance scale were used to evaluate pain,neurological status,expected survival time and general health.The improvement of symptoms,survival time and characteristics of surgical strategies for different anatomical regions were analyzed.Results Twenty-four patients were followed up successfully.An effective recovery in neck pain and quality of life was found after operation.The median survival time was 45.0 months.In upper cervical spine group,the surgical strategies included posterior occipitocervical fixation combined with 125I seed brachytherapy and other surgical methods,and the median survival time 48.0 months) of patients who underwent 125I seed brachytherapy was longer than that 22.0 of patients treated with other surgical methods.In C3-T1 metastasis group,patients who underwent combined anterior-posterior approach total spondylectomy had a longer survival time than those treated with anterior corpectomy.Conclusion Surgical treatment can effectively relief neck pain,maintain or improve neurological function and improve quality of life.Doctors should choose different surgical strategies according to anatomical region of cervical metastasis.For upper cervical spine,the main purpose of surgery is to stabilize the cervical spine; the posterior occipitocervical fixation is usually chosen,and the 125I seed brachytherapy is useful in local control of metastasis.For subaxial cervical spine and cervicothoracic junction,the anterior corpectomy is usually chosen,and a combined anterior-posterior approach total spondylectomy can be used for patients with corresponding conditions.

Bone augmentation in an osteoporosis rat model via a single local injection of simvastatin / 中华骨科杂志

ObjectiveTo explore the bone anabolic effects after a single local injection of simvastatin into femoral cavities of osteoporotic rats.MethodsThirty-six female SD rats(3 months old,body weight 250-300 g) were ovariectomized(OVX) and low-calcium-diet fed for 3 months,OVX rats were randomized into 3 groups(n=12).Left femurs of group A,B and C were injected with 0,5 and 10 mg simvastatin,respectively.Half of the rats in each group were randomly euthanized separately 1 and 5 months after simvastatin injection.Left femurs were taken out for bone mineral density (BMD) assessment with dual energy X-ray absorptiometry,bone histomorphometic changes were analysized by Micro-CT,and two kinds of biomechanical tests were used to evaluate the osteogenic effects.ResultsOne and five months after injection,BMD in mid-diaphysis significantly increased in simvastatin-injected groups compared to the control group.For Micro-CT analysis,significant increase in total bone volume/total tissue volume,cortical wall thickness,trabecular thickness,trabecular number,and a significant decrease in trabecular spacing were observed in simvastatin-injected groups compared to the control group.For both biomechanics (the three-pointbreaking test of condyles and axial compressive testing of proximal femur),the values were significantly higher in simvastatin-injected groups than the control group.ConclusionLocal simvastatin treatment showed a positive effect on improving mechanical strength,structure of osteopenic femurs and BMD.Our findings may provide a new strategy for the prevention and treatment of osteoporosis,especially for osteoporotic fractures.

Diagnosis and treatment of spinal primitive neuroectodermal tumor / 中华骨科杂志

Objective To sum up the clinical experience in diagnosis and treatment of spinal primitive neuroectodermal tumor (PNET). Methods Thirteen patients with spinal PNET were included in the study from 1999 to 2009. There were 8 males and 5 females with the mean age of 26.9 years. The lesions involved the cervical spine in 6 cases, the thoracic segment in 1 case, the lumbar segment in 5 cases and the sacrum in 1 case. The diagnosis of PNETs was made in nine patients by postoperative pathological examination. Among them, 6 patients received a preoperative CT-guided percutaneous biopsy. The other four patients were diagnosed only by CT-guided percutaneous biopsy. Osteolytic bony lesions and obvious neurological deficit were found in ten patients, while the other 3 had complained of local pain only. Nine patients had received operation followed by chemotherapy and radiotherapy. The other 4 underwent only chemotherapy and radiotherapy. The changes of symptoms and time of survival were recorded. Results Eleven patients were followed up with the mean of 21.8 months. The back pain in 7 patients who underwent operation relieved one month after the operation. The bladder and bowel function returned to normal condition after the operation. Among them, four patients died postoperatively. The mean survival time was 11.3 months. The otherthree patients survived with an average of 36 months. Three patients who had only received chemotherapy and radiotherapy died with an average of 7 months, while the other patient survived for 5 months. Conclusion The diagnoses of spine PNET mainly depend on pathological examination. Percutaneous CT-guided biopsy is a reliable method to confirm diagnose of tumor before surgery. The mortality rate of spinal PNET which is a highly malignant tumor is high. Operation can relieve clinical symptoms and improve patients' life quality, but not prolong the survive time.

A single posterior surgical procedure for cervical spinal fracture combined with ankylosing spondylitis / 中华创伤杂志

Objective To summarize the clinical outcome of single posterior fixation and fusion in treatment of cervical spinal fracture combined with ankylosing spondylitis.Methods A total of 26 patients with cervical spinal fracture combined with ankylosing spondylitis admitted for surgical treatment from June 2003 to June 2008 were reviewed to analyze parameters including injury mechanism,injury severity,treatment course,operation records,postoperative follow-up and rehabilitation and evaluate neurologic recovery and fracture healing by using American Spinal Injury Association(ASIA)classification.Results A single posterior surgical procedure was performed in six patients,of whom the spinal cord function were rated at grade A in two patients,at grade B in one,at grade C in two and at grade D in one according to ASIA classification criteria.All patients were treated with posterior reduction and lateral mass fixation plus fusion.Two patients at grade ASIA A died of respiratory failure at 2 and 3 months respectively after operation.The other four patients were followed up for 12-54 months(mean 37 months),which showed solid fusion at average 3.8 months after operation and significant improvement of neural function.One patient with aggravated symptoms of spinal epidural hematoma at grade ASIA B was improved to grade D postoperatively.The patients at grades C and D recovered to normal.Hyponatremia occurred in two patients at grade ASIA A.There was no instrumentation related complications in all patients.Conclusions For cervical spinal fractures combined with ankylosing spondylitis without bone defect at fracture end,lateral mass fixation and autologous bone graft through a single posterior approach can attain stable fracture healing after sound reduction.

Classification and treatment of cervical spinal cord injuries without fracture or dislocation / 中华创伤骨科杂志

Objective To evaluate retrospectively the causative factors and corresponding surgical treatments of cervical spinal cord injuries without fracture or dislocation. Methods 29 cases of cervical spinal cord injury without fracture or dislocation were studied to analyze their imaging manifestation, features and causative factors of the injury, and pathological elements. Different surgical operations were performed accordingly, and their short-term outcomes were evaluated. Results The analysis indicated that there were chiefly 3 groups of causative factors. About 24% of the patients were typical cervical disc protrusion or prolapse, about 52% of them suffered from obvious decrease or even disappearance of the storing space of spinal canal, and about 24% suffered from decrease of the storing space of spinal canal combined with segmental instability among the vertebras, or with cervical disc prolapse. The postoperative short follow-ups (a mean period of 8.5 months) for the 29 surgical treatments showed that their spinal cord functions had been improved significantly, with the recovery rate being 52.8% by Japanese Orthopaedic Association (JOA) scoring. Conclusions Despite some common features, the causative factors for the cervical spinal cord injury without fracture or dislocation are quite different. Consequently, in order to achieve satisfactory outcomes, corresponding surgical operations with different approaches should be performed, and proper internal fixation should be applied according to the specific indications.

Simvastatin induces osteoblastic differentiation of bone marrow stromal cells / 北京大学学报(医学版)

Objective: To observe the effect of simvastatin on osteoblastic cell differentiation of bone marrow stromal cells in vitro, and to elucidate the mechanisms of anabolic effect of simvastatin on bone formation. Methods: Bone marrow stromal cells from femur and tibia of adult female BALB C mice were cultured in vitro , after being treated with different concentrations of simvastatin for 72 h, changes of mRNA level of osteocalcin (OCN) were detected by RT PCR, change of OCN, and osteopontin (OPN) expression were examined by Western blot, and the changes of cellular alkaline phosphatase activity (ALP) were examined by histochemistry and enzymologic measurement. Results: After bone marrow stromal cells were treated with different concentration of simvastatin for 72 h, level of OCN mRNA increased, and expression of OCN and OPN also increased in a concentration dependent manner, and cellular ALP activity significantly increased in a concentration dependent manner. Conclusion: Simvastatin can stimulate osteoblastic differentiation,and improve cellular ALPase activity with high expression of osteocalcin and osteopontin in vitro. These may be parts of the mechanism of anabolic effect of simvastatin on bone formation.

Upper thoracic short angular kyphosis: a clinical analysis of 15 cases / 中华外科杂志

<p><b>OBJECTIVE</b>To provide reference for correct clinical treatment by summarizing the characteristics and surgical experience in spinal deformity of the upper thoracic (T(1)-T(4)) short angular kyphosis.</p><p><b>METHODS</b>Medical history was taken in 15 cases are reviewed. The results of X-ray and MRI examinations were analyzed. The kyphotic angles were measured using the Cobb technique. All cases underwent the anterior spinal cord decompression, by posterolateral approach in 4 cases and posterior in 11 cases.</p><p><b>RESULTS</b>Kyphosis was congenital in 7 cases and due to tuberculosis approach in 8 was. The average age at deformity was first noted was 3.6 years in 7 congenital cases and 9.0 years in 8 tuberculosis cases. All cases had neurologic deficits. The mean kyphosis was 86.5 degrees (range, 45 - 100 degrees). The delay between first observation of the deformity and subsequent neurologic loss was 16.5 years and 18.1 years respectively. The operation failed in 1 case. 13 cases were followed up, with an average 42 months. Seven cases showed improvement, 2 no change and 4 deterioration in neurologic deficit.</p><p><b>CONCLUSIONS</b>In cases of or tuberculosis kyphosis, the usual time for kyphosis to occur is during the preadolescent growth spurt. Neurologic deficits may occur without treatment and will be always progressive. The result of operation is not satisfactory. Early diagnosis and adequate management of kyphosis will prevent progression and thus any possible spinal cord compression. Early fusion is usually necessary to control the kyphosis.</p>

Construction of adenoviral vector encoding human VEGF(121) cDNA and its expression in vitro / 中华外科杂志

<p><b>OBJECTIVE</b>To construct the adenoviral vector bringing hVEGF(121) cDNA for evaluation of the possibility of VEGF gene therapy in ischemic bone disease.</p><p><b>METHODS</b>Human vascular endothelial growth factor (hVEGF(121)) cDNA obtained from the plasmid pCDI/VEGF(121) was cloned into plasmid pshuttle and further cloned to Adeno-X Viral DNA. The recombinant adenoviral plasmid was identified and then transferred to the adenoviral packaging cell HEK293 by lipofectamine mediated gene transfer method to pack the virus. After titilating the virus, the mouse bone marrow stromal cells (MSC) were transfected by the adenovirus and the expression of VEGF gene was detected.</p><p><b>RESULTS</b>The recombinant Adeno-VEGF(121) was correctly constructed and confirmed by restriction endonuclease analysis and DNA sequencing analysis. After MSCs were tranfected by the virus, RT-PCR showed that hVEGF(121) mRNA was transcripted from the hVEGF(121) gene. Western blot and immune histochemistry showed VEGF(121) protein was expressed in transgene MSCs.</p><p><b>CONCLUSION</b>The recombinant adenoviral vector bringing hVEGF(121) cDNA was successfully constructed and the transgene MSC expressed hVEGF gene in vitro, it provided the further foundation of VEGF gene therapy for bone ischemic diseases.</p>

Expression of human VEGF(121) cDNA in mouse bone marrow stromal cells / 中华医学杂志(英文版)

<p><b>OBJECTIVE</b>To construct a retroviral vector carrying human vascular endothelial growth factor (hVEGF (121)) cDNA for evaluation of the possibility of VEGF gene therapy in ischemic bone disease.</p><p><b>METHODS</b>hVEGF(121) cDNA was obtained from the plasmid pCDI/VEGF(121) and cloned into retroviral plasmid pLXSN. Recombinant plasmid was transferred to the retro virus packaging cell, PT-67, by lipofectamine mediated gene transfer. Mouse bone marrow stromal cells (MSCs) were transfected by the retrovirus. The integration of the hVEGF(121) cDNA into MSC genomic DNA and expression of the VEGF gene was detected. Proliferation assays of human umbilical vein endothelial cells (HUVECs) by VEGF(121) in culture medium were performed.</p><p><b>RESULTS</b>Recombinant pLXSN/VEGF(121) was correctly constructed and confirmed by restriction endonuclease analysis and DNA sequencing analysis. hVEGF(121) gene was integrated into MSC genomic DNA after transfection, and the VEGF(121) protein was expressed. Proliferation assays showed VEGF(121) in culture medium was a biologically active protein and had a mitogenic effect on HUVEC.</p><p><b>CONCLUSIONS</b>Recombinant retroviral vector carrying hVEGF(121) cDNA was successfully constructed. VEGF (121) protein expressed by MSCs had mitogenic effect biologically. This provides a further foundation for VEGF gene therapy for bone ischemic disease and bone tissue engineering.</p>

Effect of cervical instability in sympathetic cervical spondylosis / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the etiology and treatment of sympathetic cervical spondylosis (SCS).</p><p><b>METHODS</b>Twenty patients who with SCS had undergone operations for sympathetic cervical spondylosis were reviewed retrospectively from 1988 to 2000. Lateral views in flexion and extension of pre- and postoperative cervical X-ray were analyzed to quantify cervical instability.</p><p><b>RESULTS</b>Cervical instability was detected at one level in seven patients, two levels in ten patients, three levels in three. Cervical instability mainly occurred at C(3)-C(4) and C(4)-C(5). Cervical epidural block had a short time effect in the greater part of patients. Cervical discectomy and fusion at unstable segment was carried out in all 20 cases. The effective rate was 90%.</p><p><b>CONCLUSIONS</b>Cervical instability at C(3)-C(4) or C(4)-C(5) maybe an important factor in the etiology of sympathetic cervical spondylosis. Cervical epidural block may provide diagnostic information. Anterior cervical fusion were effective to treat sympathetic cervical spondylosis.</p>

Clinical analysis of 388 cases of atlanto-axial instability / 中华骨科杂志

Objective To study the clinical characteristics of atlanto-axial dislocation and instability caused by different reasons. Methods 388 cases of atlanto-axial dislocation and instability admitted between Jan 1975 and Apr 2000 were reviewed retrospectively. Results 262 cases were caused by anomaly, 71 by trauma and 55 by other reasons. 238/262 had bony deformity, including anomaly of odontoid process, atlanto-occipital assimilation, skull basilar invagination and some others. Simple anomaly of odontoid was the most commonly seen etiology. Myelopathy occurred at similar morbidity among each kind of patients. But patients who presented symptoms for longer time were more likely to have myelopathy. It is difficult to reduce chronic fractures of the odontoid process compared with the fresh fractures. 19 cases with chronic fracture suffered from severe myelopathy. Patients with chronic atlanto-axial fracture over 1 year were more likely to have secondary damage of spinal cord than those within 1 year. Conclusion Atlanto-axial dislocation and instability is more commonly caused by anomaly than trauma. Once the patients with atlanto-axial anomaly present clinical signs, they should be treated as soon as possible. Traumatic atlanto-axial instability should be treated at the early stage to avoid myelopathy.

THE PRELIMINARY RESULT OF OSTEOID CALLUS ALLOGRAFT FOR BONE HEALING / 中国修复重建外科杂志

Objective　To investigate the feasibility of osteoid callus allograft as a kind of bone healing promoting materials. Methods　The osteoid callus was obtained at one week after bilateral femoral fracture of a SD rat, then was kept at -196℃ for 2 weeks. The bone defect model which bone repair was in intra-membranous osteogenesis was made at bilateral tibial shaft in 5 rats, and filled with the osteoid callus in the left defect area, the right side was filled with allogenous cancellous as control group. The specimen were processed with undecalcified technique and the sections were staining with light blue and sofranin T. Results　After 2 weeks ,there were cartilage and bone formation in the defect area of osteoid callus graft group(3/4), medullary cavity formation in bone tissue with cartilage arround it, fibrous tissues between new bone and host bone. While there were no cartilage or bone formation in the control group. Conclusion　The allograft osteoid callus is not absorbed by immunological rejection, but changed into bone tissue through endochondral osteogenesis. It is inspiring to develop osteoid callus allograft as a kind of material for bone healing.

The matched control study between medical imaging and pathologic findings in ossification of the ligamentum flavum of the thoracic spine / 中华骨科杂志

Objective To analyze and classify the characteristic of plain X-ray, CT scan, MRI and pathologic findings in ossification of the ligamentum flavum of the thoracic spine. Providing the clinic criterion to verify the extent and progression of ossification of ligaments based on medical imaging findings. Methods Twenty-four patients with thoracic myelopathy due to ossification of the ligamentum flavum underwent surgical decompression posteriorly. There were 18 males and 6 females with age ranging from 42-76 years (mean, 57.9 years). The morphology of ossification on the CT scan was divided into isotype and non-isotype. The signal intensity of ossification was compared with that of spinal cord on T2 stage in MRI, whose results were divided into four types, such as no signal, low signal, iso signal and high signal. There were two types of ossification in pathologic findings, the mature and immature ossification. 73 segments of ossified ligaments removed from surgery were evaluated and classified individually on the base of their X-ray, CT scan, MRI and pathologic findings. 27 segments of ossified ligaments were examined immunohistochemically by use of TGF-?1 antibody. The relationship between classification of X-ray, CT scan, MRI and pathology of the ossified ligaments were compared on the basis of individual segment, to determine whether there was correlation between these findings. Results The relationship between the pathologic findings of the 73 ossified fragments and the manifestation for the CT classification and MRI signal showed: 18 isotype ossification on CT scan turn out to be mature; and among the 55 non-isotype ossification, 51 were immature and 4 were mature. 22 no signal ossifications on MRI were confirmed as mature type; all the 50 low signal ossifications were immature type; and 1 iso signal ossification was immature type. 100% were matched between MRI and pathological findings, 94.5% matched between CT and pathological findings. Conclusion The extent and progression of ossification of ligaments may be verified and predicted clinically on the base of CT scan and MRI findings, which provide the clinic criterion to guide the extent and timing of decompression.

Study on the potential and the effect of simvastatin on adipocytic differentiation of bone marrow stromal cells / 中华老年医学杂志

Objective To observe the adipocytic differentiation potential of bone marrow stromal cells (BMS), and the effect of simvastatin on adipocytic differentiation of bone marrow stromal cells in vitro, and to elucidate the mechanisms of anabolic effect of simvastatin on bone formation. Methods BMS from femur and tibia of adult female BALB C mice were cultured in vitro. Changes of alkaline phosphatase (ALP) activity were determined after treatment with adipogenetic agonist (hydrocortisone 0 5 ?mol/L and indomethacin 60 ?mol/L, HI) for 6 days. Thenexpression of lipoprotein lipase (LPL) mRNA was detected by RT PCR after treatment with HI and different concentration of simvastatin for 72 h. Adipogenetic differentiation were also observed with Oil Red O staining and fluorescence activated cell sorting (FACS) after treatment with HI and different concentration of simvastatin or 100 ?g/L rhBMP 2 for 12 days. Results After BMS were treated with HI for 6 days, ALP activity was significantly decreased ( P

Spinal tumors treated with total spondylectomy and spinal stability reconstruction / 中华骨科杂志

Objective To evaluate the possibility and clinical value of total spondylectomy for the treatment of spinal tumors and to investigate a reliable method of spinal reconstruction after total spondylectomy. Methods Twenty seven cases of spinal tumors which eroded both vertebral body and its attachments were treated with total spondylectomy and internal fixation as reconstruction techniques. There were benign, malignant and metastatic tumors, which involved different levels from upper cervical to lower lumbar spines. One to 3 spinal vertebrae were removed. Results Twenty three cases were followed up for 7 to 96 months (with an average of 25 months). Among them, 1 case of L 5 malignant neurofibroma and 1 case of C6,7 giant cells tumor recurred in 10 and 12 months after operation, but the patients refused further treatment. One case of C2-4 chordoma recurred 1 year after operation, after second surgery, the result was satisfactory. No recurrent signs were found in the rest of 20 cases. Among 25 cases with neurological lesions, obvious improvement were obtained in 23 after operation. Conclusion For patients with involvement of spinal vertebra eroded by tumors, total spondylectomy is an effective procedure. After total spondylectomy, spinal stability can be reconstructed by stable internal fixation system.

CT-guided percutaneous puncture for atlantoaxial lateral mass arthrodesis with bone graft / 中华骨科杂志

Objective To report a new designed technique of CT-guided percutaneous puncture for atlantoaxial lateral mass arthrodesis with bone graft and discuss its clinical usefulness and effect. Methods From March 1999 to March 2001, on the base of anatomical investigation of 56 adult cadaversatlas and axis bone specimens, 9 cases with instability of atlantoaxial were treated after reduction by traction, 4 of 9 cases underwent Halo-Vest immobilization, and the other 5 cases underwent transarticular screw fixation through C2 vertebral body for atlantoaxial instability. Of all nine cases, the articular cartilage and capsule of post lateral part of atlantoaxial joints were removed by using home made surgical instruments under CT guidance. Iliac cancellous bones obtained by puncture were implanted into the joint space. Results All cases were followed up from 2 to 17 months (average 12.7 months) and 8 cases more than 6 months. Generally, at the third to fourth month after operation, CT scan showed bony union of the grafted bone and the excessive extension and flexion X-ray films showed stable movement of the atlantoaxial joints, and then the Halo-Vest stock were removed. Conclusion This technique has obvious advantages of less trauma and hemorrhage, high union rate, easy, safe and efficiencies.

The diagnosis and surgical treatment of sacral fracture (Denis Ⅱ fracture) with sacral neurological damage / 中华骨科杂志

5 mm. Oblique coronal MR of secrum could show the full length of sacral never. There were some primiral espression of MR of sacral neurological dam-age -- the variation of sacral never canal, the fatty disappearance of peri-never, the route alteration of never. 14 patients were followed up from 6 to 12 months with an average of 7.1 months. According to the BMRC score system the excellent result was obtained in 9 cases, good in 1 case, no change in 1 case. Con-clusion Clinic history and neurological examination associated with X-ray, CT and MRI was the important of the diagnosis of sacral neurological damage, the new surgical approach may be a ideal approach to treat sacral neurological damage in the sacral nerve canal region.