Role of high temperature denervation in pain relief during percutaneous kyphoplasty / 中华创伤杂志

Objective To determine the effect of high temperature denervation in back pain relief during percutaneous kyphoplasty (PKP) for vertebral osteoporotic fracture.Methods Fifty-six patients undergone PKP for single vertebral osteoporotic fracture were randomly divided into cooling group and normal group with 28 patients per group according to whether the temperature reducing measures were provided during the polymerization process of polymethyl methacrylate (PMMA).Data recorded were operation time, amount of PMMA injected into each vertebral body, visual analogue scale (VAS), Oswestry disability index (ODI), and anterior vertebral height.Results All the data revealed no significant differences between cooling and normal groups: operation time [(45.6 ± 7.3)min vs (43.6 ± 5.8)min], PMMA injected into each vertebral body [(2.8 ±0.3)ml vs (2.7 ±0.4)ml], VAS [(3.8 ± 0.7) points vs (3.2 ± 0.7) points], ODI [(36.6 ± 8.2) points vs (30.4 ± 6.0) points] and height restoration of anterior vertebral body [(85.3 ± 6.1)％ vs (83.9 ± 7.3)％] (P ＞ 0.05).Conclusion High temperature denervation contributes a little to the relief of back pain during PKP, as may be due to the vertebral augmentation and stabilization.

Change regularity of intervertebral contact areas during lumbar spondylolisthesis and its value in clinical application / 中国组织工程研究

BACKGROUND: Lumbar spondylolisthesis directly reduces contact areas between dislocated vertebral body and subjacent vertebral body, which is an important factor that decides intervertebral stress and lumbar degeneration. The cross section of lumbar is irregular reniform shaped and there is no mathematical formula to calculate changing regularity of intervertebral contact areas of lumbar spondylolisthesis directly.OBJECTIVE: To study changing regularity of intervertebral contact areas during lumbar spondylolisthesis and to analyze its clinical significance. METHODS: Super-surface of L5 vertebra and sub-surface of L4 from 25 cases were taken by a digital camera and computer simulation spondylolisthesis process and every intervertebral contact areas (Sn) were measured by Image-Pro Plus software. The mean value was obtained and converted into percentage area according to Sn%=Sn/S×100%. The change rules of vertebral bodies were observed from 0 to 100% spondylolisthesis. Based on this regularity, a new clinical stage of lumbar spondylolisthesis was proposed and guided for treatment of 56 cases with lumbar spondylolisthesis. RESULTS AND CONCLUSION: During lumbar spondylolisthesis process, Sn% changes like a hyperbola. Sn% lost slowly during spondylolisthesis rate at 0-23% and quickly during 23%-44%, and then it become slowly once again after spondylolisthesis rate at 44%-100%, the inflection points appeared at (23±2)% and (44±2)%. Totally 48 patients were followed up, according to Staufee standard rate, the clinical curative effect reached approximately 90%. It suggests that the intervertebral contact areas present with a non-linear change, which is helpful to judge the stability of lumbar spine and guide the treatment of lumbar spondylolisthesis.

Treatment of unstable intertrochanteric fracture with augmentation technique injected with PMMA through lateral holes of dynamical hip screw / 中华创伤杂志

Objective To observe curative effects of augmentation fixation technique injected with PMMA through lateral holes of dynamical hip screw (DHS) in treatment of unstable intertrochanteric fracture of senile osteoporotic patients. Methods From January 2006 to December 2007,15 senile osteoporotic inpatients with unstable femoral intertrochanteric fracture were treated with augmentation technique injected with PMMA to the femoral head through central channel and lateral holes of DHS. Clinical data about function of hip joint and complications early after operation were observed. All patients were followed up till fractures were healed, when the hip joint function was evaluated according to Harris standarch. Results Surgical trauma indices such as operation time and bleeding volume of augmentation technique were the same as those of merely DHS fixation. All the patients could safely do hip flexion and extension exercises in the bed and completely sit up by bedside 2-3 days after operation. Six patients could do walking exercise with aid one week after operation, with no complications relating to staying in bed or to PMMA during per-operation period. All fractures were healed 3-6 months after operation, without complications like fixation loosening, cut or destruction of femoral head during postoperative follow-up period. Six months after operation, 14 patients recovered viability to normal. According to Harris standards, the results were excellent in four patients, good in 10 and fair in one, with average Harris score of 83 points. Conclusions The augmentation fixation technique injected with PMMA through lateral holes of DHS has advantages of better DHS anchoring ability in femoral heads, less surgical trauma, reliable fixation and early functional exercise and is suitable for senile osteoporotic patients with unstable intertrochanteric fractures.

Animal experimental study on incorporation of silk fibroin reducing the risk of cardiovascular complication during vertebroplasty / 中国矫形外科杂志

[Objective]To develop an animal pulmonary cement embolism model,by which the effect of polymethylmethacrylate(PMMA),calcium phosphate cement(CPC) and silk fibroin/calcium phosphate cement composite(SF/CPC) on the hemodynamic change,respiratory function and the antithrombin activity were measured after the pulmonary embolism caused by cement injection.The efficiency of SF reducing the risk of cardiovascular complication was evaluated.[Method]Twenty-four pigs were assigned to 3 groups randomly,with 8 pigs in each group.After general anesthesia,animals were endotracheal intubated and mechanically ventilated by a respirator.The pulmonary trunk was exposed via sternotomy and each kind of cement was injected into the main pulmonary artery.Hemodynamic parameters were continuously monitored.Blood samples were drawn at certain time points for blood gases analyzing and measurement of AT Ⅲ.Postmortem lungs were subject to computer tomography(CT) examination along with three-dimensional reconstructions of cement casts.[Result]The injection of CPC caused severe pulmonary hypertension and arterial hypotension,with a maximum elevation of 20.93?5.04 mmHg in PAP(20 min post-injection) and a maximum decrease of-26.59?6.8 mmHg in MABP(50 min post-injection).The changes in SF/CPC group were relatively slighter,which is similar with PMMA group,having a statistically significant difference from CPC groups(P

Anatomical study on bladder functional reconstruction with Achilles tendon reflex / 中国组织工程研究

BACKGROUND: In recent years, the method of bladder reconstruction is still at the experimental stage. Therefore, anatomical study is necessary for its clinical application.OBJECTIVE: To provide anatomical bases for the selection of proper spinal roots, the ideal level for cross anastomosis, and the identification of anterior roots of spinal nerves during bladder functional reconstruction with Achilles tendon reflexes.DESIGN: It was a single sample study with anatomical specimen as subjects.SETTING: The experiment was conducted in the department of orthopaedics of a municipal hospital.PARTICIPANTS: The experiment was completed in the Department of Anatomy, Second Military Medical University of Chinese PLA, from May 1999 to January 2000. Altogether 20 adult corpse specimens (14 males and 6females, 40 sides) were involved.INTERVENTION: The origin of spinal roots of the sacral plexus and sciatic nerve, the distribution of corresponding spinal root between the sciatic nerve and other nerves were followed up.MAIN OUTCOME MEASURES: Overlapping length, horizontal area, and relative position of anterior roots of L4-S4 spinal nerves in the dura mater.of S2 -4 anterior spinal roots originating from the spinal cord was higher than that of L4, L5 and S1 anterior spinal roots running through the dura; the cross-sectional area of L4(2. 19 ±0.39) mm2, L5(2.58 ±0.58) mm2 and S1(2.19 ± 0.42) mm2 anterior spinal roots was more than that of S2-4 anterior dentify their sequence at the terminal cone level than under this level.should be taken during bladder functional reconstruction with Achilles tendon level.

Bladder controller in bladder function reconstruction of paraplegic dogs / 中华外科杂志

<p><b>OBJECTIVE</b>To observe whether bladder controller can restore bladder function in paraplegic dogs.</p><p><b>METHODS</b>Four dogs were studied after their T(10) spinal cord was transected. Electrodes implanted around S(2) bilaterally were connected to subcutaneous recievers. Microsurgical techniques were employed in dorsal rhizotomy at S(1 - 3) intradural segment. After daily stimulation, the results of bladder controller were evaluated by micturition and vesicography.</p><p><b>RESULTS</b>Micturition was given under electrical stimulation with a urine volume of 80 - 140 ml per time. The mode of micturition was post-stimulus voiding. Vesicography showed that the bladder was filled and bladder neck was open in the micturition course of electric stimulation. Residual urine volume was 15 - 20 ml.</p><p><b>CONCLUSION</b>Bladder controller together with a sacral deafferentation procedure can restore bladder function of paraplegic dogs.</p>

Comparison of different dynamic anterior roots on bladder functional reconstruction / 中华骨科杂志

Objective To compare L 5 anterior roots which is mostly composed of somatic motor nerve fibers and S2 anterior roots which is mostly composed of parasympathetic nerve fibers as dynamic nerve on bladder reinnervation and functional reconstruction after spinal cord injury. Methods Randomly select one side as experimental side and the other side as control, then L 5-S2 anterior roots cross extrameningeal anastomosis in the experimental side and S2-S2 self extrameningeal anastomosis in the control side were performed in 5 dogs. The changes of bladder pressure, urethral pressure responsed to electrical stimulation of the anastomosis roots on each side were recorded in the mean time and the two groups data were compared after one year. Results There were no significant difference between the changes of bladder pressure, urethral pressure responded to the stimulation of left side and right sides anterior roots as the anastomosis operation performed. After one year, both of experimental sides L 5 and control sides S2 anterior roots established neural relationship with bladder detrusor and urethral sphincter. There were no significant difference in the change of bladder pressure responded to electrical stimulation of the anastomosis roots between experimental side (5.0?2.1) kPa and control side (4.6?1.8) kPa(P=0.17) as well. The change of urethral pressure responded to electrical stimulation of the anastomosis roots between experimental side (4.2?1.7)kPa and control side (4.4?1.6)kPa also has no significant difference(P=0.31). Conclusion In the treatment of bladder dysfunction after spinal cord injury, L 5 anterior root can serve a similar role as S2 on bladder functional reconstruction as a dynamic nerve.