Preliminary curative effect of interspinous blocking injection guiding by X-ray for the diagnosis and treatment of lumbar Baastrup's disease / 中国骨伤

<p><b>OBJECTIVE</b>To evaluate the preliminary curative effect of interspinous injections for the diagnosis and treatment of back pain caused by lumbar kissing spine (Baastrup's disease) under fluoroscopically guiding.</p><p><b>METHODS</b>From November 2011 to March 2013,17 patients with back pain caused by Baastrup's disease were treated with fluoroscopically-guided interspinous injections, including 7 males and 10 females with an average age of 49.6 years old ranging from 40 to 71 years old; the duration of the disease ranged from 2 to 5 years with a mean of 3.7 years. The visual analogue scale (VAS) and the lumbar segments range of motion (ROM) was analyzed at pre-operation, 2 days, 3 months and final followed-up after operation, the effects were evaluated with modified Macnab standard.</p><p><b>RESULTS</b>All patients were follow-up from 6 to 10 months with an average of 7.6 months. The pre-operative VAS was 6.41 +/- 0.94, the postoperative VAS at different time points improved significantly comparing with pre-operation,and the differences were statistically significant (P < 0.01). There was no significant difference in VAS at different time points after operation (P > 0.05). The ROM of operated segment and adjacent segment was (4.88 +/- 0.86) degrees and (6.82 +/- 0.73) degrees respectively at pre-operation. The postoperative operated segment ROM at different time points improved significantly comparing with pre-operation, and the differences were statistically significant (P < 0.05). Compared with pre-operation, there was no significant difference in adjacent segment ROM at different time points after operation (P > 0.05). According to modified Macnab, the result was excellent in 6 cases, good in 7 cases, fair in 3 cases and poor in 1 case.</p><p><b>CONCLUSION</b>Fluoroscopically-guided interspinous injections is an effective method for the diagnosis and treatment of Baastrup's disease. The method has advantages of simple operation, minimal invasion and safety, satisfactory short-term and medium-term therapeutic effect; it can also effectively lessen the pain of lumbar and back.</p>

Laminectomy and extraction of nucleus pulposus for treatment of lumbar disc herniation: effect evaluation of over 10-year-followed-up / 中国骨伤

<p><b>OBJECTIVE</b>To investigate retrospectively the clinical effects and recurrence rate of 143 cases who underwent one level discectomy and followed up more than 10 years. To evaluate the outcome of patients in groups of different operating age and extents of disc herniation, and analyse whether difference exists in each group.</p><p><b>METHODS</b>There were 143 patients (operation time from January 1996 to December 2000) including 80 males and 63 females, aged from 18 to 66 years old with an average of 37.85 years. The followed-up time was 10 to 15 years with an average of 12.7 years. Patients were divided into 3 groups depends on operating age: < 30 years old, 30 to 50 years old and > 50 years old; 87 patients who's pre-operative CT scan could be collected among 143 cases were divided into 3 groups depends on extents of disc herniation: I degree, II degrees, and III degrees. The final followed-up was obtained in 2011, to evaluate each group and the holistic clincal outcome with JOA scores and ODI scores, and observe whether there were difference between every groups; to judge the effects by patient himself with modified Macnab Criteria.</p><p><b>RESULTS</b>(1) JOA scores pre-operation and final followed-up was 5.11 +/- 2.02 and 12.51 +/- 2.35 respectively; ODI scores pre-operation and final followed-up was 33.98 +/- 7.42 and 13.39 +/- 6.79 respectively. There were significant differences between pre-operative and final followed-up in JOA and ODI (P < 0.01). The excellent-good rate was 83.2% (119/143 ) according to modified Macnab Classification with recurrence rate of 6.3% at final follow-up. (2) Obvious difference was found in JOA scores in group who's age at operation less than 30 years old compared with other 2 groups at followed-up time, and no significant difference was found in JOA scores between other two groups ; no significant difference was found in ODI scores among the three groups. (3) Significant difference was found in JOA and ODI scores in group with III degrees lumbar disc herniation group compared with other 2 groups, and no statistical difference was found in clincal scores between other 2 groups.</p><p><b>CONCLUSION</b>(1) Long-term followed-up of 143 cases prove mono-level lumbar discectomy is an option for disc herniation with good curative effect and lower recurrent rate, the technique should be the prior selection in dealing with patients with lumbar disc herniation. (2) 51% patients (19/37) in group under 30 years old endure persistent low back pain. (3) The long-term clinical effects in patients with severe disc protrution who underwent lumbar discectomy is worse than those patients with mild lumbar disc herniation.</p>

Comparison of the grafting technique in treatment of thoracolumbar burst fractures:transpedicular intracorporeal versus posterolateral / 中华外科杂志

<p><b>OBJECTIVES</b>To retrospectively investigate the outcome of transpedicular intracorporeal grafting and posterolateral grafting in treatment of thoracolumbar burst fractures.</p><p><b>METHODS</b>Forty-six patients treated with transpedicular intracorporeal grafting from January 1999 to December 2009 and followed up for 19-119 months (average 67 ± 13 months) were reviewed retrospectively, and were compared with 18 patients who had underwent posterolateral fusion during the same period through radiographic analysis. Radiographic measurements included Cobb angle, vertebral wedge angle (VWA), ratio between anterior and posterior vertebral height (APHR), upper inter-vertebral angle, lower inter-vertebral angle on X-ray, CT and MRI.</p><p><b>RESULTS</b>In transpedicular intracorporeal grafting group, the VWA was corrected from 27.2° ± 6.5° to 7.0° ± 3.0° and the APHR from (53.3 ± 11.8)% to (92.3 ± 2.4)%. In posterolateral fusion group, the VWA was corrected from 23.9° ± 4.4° to 8.8° ± 2.1° and the APHR from (60.7 ± 10.0)% to (88.5 ± 3.3)%. Transpedicular intracorporeal grafting group showed better postoperative correction results than posterolateral fusion group (P < 0.05), and had less loss of correction of Cobb angle, VWA and APHR at final follow-up (P < 0.05).</p><p><b>CONCLUSIONS</b>The transpedicular intracorporeal grafting can improve injured vertebral body morphology recovery better than posterolateral bone grafting, but can not prevent the late loss of correction after implant removal.</p>

Diagnosis and surgical treatment of back pain originating from endplate / 中华外科杂志

<p><b>OBJECTIVE</b>To explore the methods of diagnosis and surgical treatment for patients with back pain originating from endplate.</p><p><b>METHODS</b>All patients received examinations of radiography, CT, and MR imaging. Pain level of disc was decided by discography in each patient. The principal outcome judgment were pain and disability, and the efficacy of surgical treatment was assessed by visual analog scale (VAS) for pain, and the Oswestry disability index (ODI) for functional recovery.</p><p><b>RESULTS</b>All patients with a diagnosis of back pain originating from endplate according to discography were treated with anterior or posterior fusion surgery. The mean follow-up period was three years and five months (from 2 to 6 years). Among of the 21 patients, 20 (95%) reported a disappearance or marked alleviation of low back pain, and experienced a definite improvement in physical function. A statistically significant and clinically meaningful improvement on the ODI and the VAS scores were obtained in the patients with chronic low back pain originating from endplate (P = 0.0001) after treatment.</p><p><b>CONCLUSIONS</b>The study suggests that the discography and fusion surgery may be very effective methods for the diagnosis and treatment of chronic back pain originating from endplate respectively.</p>

Vascularized pedicle iliac crest for the repair of bone and soft tissue defect of lower extremity / 中华外科杂志

<p><b>OBJECTIVE</b>To study the role of transplantation of the vascularized pedicle iliac crest for the repair of bone and soft tissue defect of lower extremity.</p><p><b>METHODS</b>The vascularized pedicle iliac crest was designed for the repair of bone and soft tissue defect of lower extremity according to anatomic feature of leg and foot. Skin graft was used for coverage of the iliac flap.</p><p><b>RESULTS</b>Skin survival could demonstrate the survival of the vascularized pedicle iliac crest indirectly one week postoperatively. Skin survived completely in 4 cases and partly in 3 cases. Callus was seen at the transplantation site one month postoperatively, and K-wires were removed 4 months later in the cases of metatarsal defect. The external fixators were removed in the cases of tibia defect 6 to 8 months postoperatively. The functions of lower extremities were restored in 2 to 4 months. The bone and soft tissue defects were repaired, and ultimate function and cosmetic effects were satisfied after the mean follow up of 10 months (ranged from 6 to 15 months).</p><p><b>CONCLUSION</b>Transplantation of the vascularized pedicle iliac crest is an ideal method for the repair of bone and soft tissue defect of lower extremity. The operation can be performed in one stage. The functions and cosmetic effects are better than the traditional methods.</p>

The protective effects of melatonin on global cerebral ischemia-reperfusion injury in gerbils / 药学学报

<p><b>AIM</b>To investigate the effects of melatonin (MT) on histology and behavioral tests during global cerebral ischemia-reperfusion in gerbils.</p><p><b>METHODS</b>Global cerebral ischemia was induced by occluding the bilateral common carotid arteries for 10 min in gerbils. Three doses of MT were administrated intraperitoneally 30 min prior to the onset of ischemia. Locomotor activity was measured by using the open field method 3 and 7 days after the ischemic episode. T maze test was carried out 4, 5 and 6 days after ischemia to assess the working memory of gerbils. Neuronal damage was assessed in CA1 pyramidal layer of gerbil hippocampus and evaluated 7 days after ischemia.</p><p><b>RESULTS</b>MT significantly reversed the locomotor activity increases, ameliorated learning and working memory deficit, and reduced the extent of CA1 hippocampal pyramidal cells injury after transient global cerebral ischemia in the Mongolian gerbil.</p><p><b>CONCLUSION</b>MT provides significantly protective effect against both histological and behavioral consequences of global cerebral ischemia-reperfusion injury in gerbils.</p>