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Objective To study the curative effect and safety of senile osteoporotic vertebral compression fractures with balloon ky-phoplasty. Methods The clinical data of 80 patients in our hospital during July 2008 to July 2012 with senile osteoporotic vertebral compres-sion fractures were analysed retrospectively. And the clinical effect was evaluated by observing the charges of visual analog scale (VAS), height of vertebral bodies and Cobb’ s angle, the quality of life score in patients respectively before and after operation. Results The pain of the patients were controlled effectively after operation, and the patients had significant and sustained improvement in anterior and midline ver-tebral body height after operation, with (56. 02 ± 12. 08) % and (58. 19 ± 13. 11) % before preoperation respectively, and (72. 10 ± 16. 19) % and (78. 33 ± 19. 02) % after surgery respectively. VAS score reduced from (8. 31 ± 1. 22) to (1. 65 ± 0. 33) after surgery;Cobb’s angle reduced from (24. 12 ± 3. 28)° to (13. 56 ± 2. 05)° after operation. The differences of the frontal height and flange height, VAS scores, and Cobb’s angle before and after operation were statistically significant (P<0. 05). The incidence of complications reduced from 23. 75% to 1. 25% after operation, which indicates significant difference (P<0. 01). According to QLQC-30 quality of life score, the postoperative life of patients were much better than that of the preoperative life, and the difference of all statistical index were of statistical significance (P<0. 05). Conclusion Balloon kyphoplasty in the treatment of senile osteoporotic vertebral compression fractures has signifi-cant effect and high safety, it should be popularized and applied in clinical.
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BACKGROUND:Artificial Lumbar disc replacement as a new choice for the treatment of degenerative disc disease has aroused widespread concern by clinicians because of the preservation of lumbar vertebra’s biomechanical characteristics during pain eliminating. While the design of the prosthesis structure and material needs further study and validation. OBJECTIVE:To review the structure and material types of several newly designed artificial lumbar discs, then to discuss the trends in the optimization design of prosthesis, in order to provide instruction for the design and assessment of new lumbar artificial disc prosthesis. METHODS:The PubMed database, CNKI database and SinoMed database were searched for related articles. New articles related to artificial lumbar disc structure, material, in vivo and in vitro biomechanics were included. Repetitive studies and stale perspectives were excluded. A total of 46 articles were summarized and discussed in the end. RESULTS AND CONCLUSION:Artificial lumbar disc has developed for nearly 30 years, the design of structure and biological material has been in continuous improvement. At first, we summarized the principle and current situation in the design of movement reservation, movement constraint, instant fixation, base material, weight-bearing material and coating material of artificial lumbar disc prosthesis, then combined with the exist newly in vivo and in vitro biomechanical results to evaluate different kinds of design with the recent research trend to prospect the development of biomimetic design, material improvement, the optimization design of prosthesis and assisted devices.
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BACKGROUND:The basic idea of artificial disc replacement is the intension to minimize the impact on adjacent segments based on the premise of stabilizing index segment, then prevent and reduce the incidence of adjacent segment degeneration. OBJECTIVE:To explore the indications and contraindications of artificial disc replacement, peri-operative economics considerations, long-term complications, as wel as the effect of artificial lumbar disc replacement combined with fusion surgery. METHODS:The PubMed database, CNKI database and SinoMed database over the past decade were searched for the related articles. The retrospective and prospective clinical trials of artificial lumbar disc replacement were included. Repetitive studies and stale perspectives were excluded. A total of 34 articles were summarized and analyzed in the end. RESULTS AND CONCLUSION:Since the first artificial lumbar disc prosthesis designed to be commercial y distributed in 1982, there have been a plenty of clinical trials on lumbar disc replacement. However, there is no answer to many problems that encountered in clinical trials. The effect of the number of replaced segment on the clinical outcomes, the effect of facet joint degeneration on the clinical outcomes, selection of the patients with the history of lumbar disc surgery, age of the patients and the rest time before disc replacement should be taken into consideration in the researches on indications and contraindications of artificial disc replacement. The intraoperative blood loss, operation time and hospital stay after replacement can be used to evaluate whether lumbar disc replacement is better than the traditional lumbar fusion surgery or not. The complications after lumbar disc replacement include heterotopic ossification, implants mechanical failure, and facet joint and adjacent segment degeneration. The combination of lumbar disc replacement and fusion surgery for the treatment of multi-segmental lumbar disc diseases can achieve complement and thus obtaining the efficacy that better than the application of one surgery alone.
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BACKGROUND: Studies demonstrated that vertebral endplate can be remodeled during intervertebral disc degeneration.However,the relationship between morphology of the vertebral endplate and intervertebral disc degeneration remains poorly understood.OBJECTIVE: To explore the relationship between the morphology of the vertebral endplate and the lumbar disc herniation.METHODS: Forty cases without previous spine disorder and sixty-two cases symptomatic lumbar disc herinations lumbar vertebral were scanned by using spiral CT.Scan range was from superior L4 to superior S2.Scan protocols as below: 140 kV,345 mAs,FOV 160 mm,layer of thick 1 mm,pitch 1.0.Original images were carried through three-dimensional reconstructions using O2 image work station,W300,C80,ZOOM=1.5,Expand 1.Intervertebral disc maximum anteroposterior,transverse diameter,circumference,area and shape were measured based on curve planar reconstruction.RESULTS AND CONCLUSION: Endplate shape was strongly related to disc herniation(all the P value < 0.01).Endplate area was a less significant factor L4/5 in men and L5/S1 in men and females(P < 0.05).The shape of the intervertebral body endplate margin is an important factor contributing to the development of disc herniation at L4/5 and L5/S1.
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Objective To explore operation method,skills,and curative effect of orthophofia microscope discectomy(OMD)for the treatment of lumber disc herniation.Method Retrospective analysis of the 64 patients(74 herniated discs)of lumbar disc herniation heated by OMD,which included 38 segments posterior-lateral extrusion,32 segments central type herniated,and 4 segments extra-lateral extrusion.Resuits All patients were followed-up 6 to 8 months,average 7 months,54 cases were good and 4 cases were fair and no case was bad according to the Nakai scale.The choiceness rate was 93.75%,and no serious complications.Conclusions Orthophoria microscope discectomy has a better third dimension,good operation field of vision,less invasion and best clinical curative effect.Orthophoria microscope discectomy may be the best way of discectomy for the treatment of lumber disc hemiation.
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BACKGROUND: Pathophysiological mechanism of local microenvironment is complex after central nerve injury; especially,both inflammatory reaction at an acute phase and formation of secondary glial scar have tremendous effects on effective regeneration of axon, regeneration and arrangement of local nerve cells, proliferation and migration of local stem cells;therefore, it becomes a basic reason for blocking nerve repair in an early period. Thus, how to effectively resist inflammatory factors in injured region at an acute phase and how to optimize microenvironment of neural regeneration are the most important strategies for repairing spinal cord injury in recent years.OBJECTIVE: To design, establish and screen the best expression of interleukin-6 receptor (IL-6R) α to inhibit shRNA adenovirus expression vector by using spinal cord injury models.DESIGN: Duplicative measurement study.SETTING: Department of Spine Surgery, the Second People's Hospital of Shenzhen.MATERIALS: A total of 40 healthy Wistar rats, either gender, 8-10 weeks old, were selected in this study. Rabbit-anti-rat glial fibrillary acidic protein (GFAP) antibody Ⅰ was provided by Santa Cruz Compan; siRNA eukaryon expression plasmid pGenesil (cohtaining green fluorescent expression system) was provided by Wuhan Jingsai Bioengineering Company.METHODS: The experiment was carried out in ImmuneOpening Laboratory, Basic Medical Faulty, Tongji Medical College, Huazhong University of Science and Technology, and Medica Laboratory Center, the Second People's Hospital of Shenzhen in November 2006. Three pairs of shRNA template which composed of 19 bp reverse repeated motif of IL-6 receptor (IL-6R) α target sequence with 9 bp spacer were designed and synthesized, then the recombinant adenovirus expression vectors with green fluorescence protein were constructed in vitro respectively. The acute spinal cord injury models were completed, and the adenovirus recombinants were regionally injected post 12 hours after spinal cord injury;in addition, the inhibitory effect of RNA interference (RNAi) on expression of IL-6R in local region after spinal cord injury were detected by using real-time fluorescence quantitative reverse transcription polymerase chain reaction (RT-PCR) and Western blot so as to screen adenovirus expression vector which had the best inhibitory effect on expression of IL-6R.MAIN OUTCOME MEASURES: Inhibitory effect of RNAi on expressions of IL-6R RNA and protein in local region after spinal cord injury.RESULTS: Sequence analysis showed that IL-6R-shRNA recombinant adenovirus expression vector was successfully constructed, and optimal IL-6R-shRNA recombinant adenovirus expression vector was screened by using real-time fluorescence quantitative RT-PCR and Western blot. The IL-6R expressions were 49% and 56% at the levels of mRNA and protein, respectively.CONCLUSION: The IL-6R--shRNA recombinant adenovirus expression vector is successfully constructed and screened.The gene expression of IL-6R can be highly inhibited after acute spinal cord injury.
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Objective To investigate the clinical effects of surgical treatment of acute deep vein thrombosis (DVT) in the lower limbs. Methods Twenty four cases with DVT were treated with a 2～3cm incision at the cross of superficial and deep femoral veins to take the thrombasis out. Moulding thrombasis were pulled up with ova circular tongs, and fragmented thrombi were spilled out of the incision with the prelum arteriol winding from foot to thigh. The artery was rinsed with heparinized saline for three minuets till the femoral vein was completely unobstructed. The vein was sutured, and the wound was drained under negative pressure. Results The near future effects: Limb swelling and pain disappeared in seventeen cases, conditions turned for the better in six cases, and there was no improvement in one case. The long term effects: Twenty one were followed up for an average of one year and three months. All patients had excellent walking and standing except two cases who suffered lower limb swelling and pain occasionally. Conclusions The operation of vein thrombectomy is a simple, easy and excellent approach to treat DVT, especially within six days after the the condition.