Effects from deep-freezing, freeze-drying or radiation on mechanical properties of cortical bone for spinal fusion / 医用生物力学

Objective To study the effects on compressive strength and rigidity of tibia cortical bone from deep-freezing, freeze-drying or radiation treatments, and to discuss the appropriate method for tibia cortical bone treatment. Methods The cortical bone were collected from the middle part in tibial diaphysis from amputated limbs of trauma patients and made into bone plates with the size of 10 mm×10 mm×5 mm each. The bone plates were then divided into seven groups evenly and randomly: control group (Group A), deep-freezing group (Group B), freeze-drying group(Group C), deep-freezing plus 60Co (25 J/g) radiation group(Group D), deep-freezing plus 60Co (50 J/g) radiation group(Group E), freeze-drying plus 60Co (25 J/g) radiation group(Group F), freeze-drying plus 60Co (50 J/g) radiation group(Group G). The compressive strength and rigidity of allograft cortical bone were tested by mechanical testing machine. Results The largest compressive strength of the tibia cortical bone was in the range of 6.089-9.089 kN. Compared with Group A, the strength in Group B, C, D and F showed no significant difference, and the rigidity in Group B and C showed no significant difference, while the rigidity in Group D and F was decreased by 9.6% (P<0.05) and 8.7% (P<0.05), respectively. Compared with Group A, the strength in Group E and G was reduced by 29.6% (P<0.05) and 33.1% (P<0.05), respectively, and the rigidity was reduced by 16.7% (P<0.05) and 14.8% (P<0.05), respectively. Conclusions The strength and rigidity of tibia cortical bone are not changed significantly after deep-freezing or freeze-drying treatment. Compared with the untreated group, the strength of tibial cortical bone with the small dosage of 60Co treatment is not significantly changed after deep-freezing or freeze-drying, but the rigidity is decreased; the strength and rigidity with the large dosage of 60Co treatment are decreased obviously. For application of cortical bone used in spinal fusion, radiation sterilization dosage should be controlled in the range of 15-25 J/g.

Changes in autophagy proteins in a rat model of spinal cord injury / 中华创伤杂志(英文版)

<p><b>OBJECTIVE</b>Autophagy is involved in several neurodegenerative diseases and recently its role in acute brain injury has won increasing interest. Spinal cord injuries (SCIs) often lead to permanent neurological deficit. Therefore, in this study, we examined the pro?les of autophagy-linked proteins (MAP-LC3) after SCI to investigate whether the expression of autophagy contributes to neurological deficit after SCI.</p><p><b>METHODS</b>Adult female Sprague-Dawley rats were used and randomly divided into control and SCI groups. All the rates received laminectomy at T8-T10 level. Those in the SCI group received additional exposure of the dorsal surface of the spinal cord, followed by a weight- drop injury. Thereafter we investigated the expression levels of MAP-LC3, beclin-1, Cathepsin D and the beclin-1-binding protein bcl-2 by western blot analysis at 12 h, 24 h, 3 d, 7 d, 21 d and 28 d. One-way ANOVA with Tukey post hoc test was used to compare data between groups.</p><p><b>RESULTS</b>We observed significant increase in the level of LC3 (LC3-II/LC3-I) at 3 d and 7 d after SCI when compared with the sham group. While the level of beclin-1 and ratio of beclin-1/bcl-2 was found to have increased from 12 h to 24 h after injury. Cathepsin D expression was also elevated at 7 d (P<0.01).</p><p><b>CONCLUSION</b>Based on the above mentioned data, we proposed that autophagy plays a role in the manifestation of cell injury following SCI.</p>

Balloon kyphoplasty for osteoporotic vertebral compression fractures with osteonecrosis / 中华外科杂志

<p><b>OBJECTIVE</b>To explore the clinical efficacy of the percutaneous balloon kyphoplasty for osteoporotic vertebral compression fractures with osteonecrosis.</p><p><b>METHODS</b>The clinical data of 31 patients with osteoporotic vertebral compression fractures associated with osteonecrosis from January 2005 to January 2008 were analyzed retrospectively. There were 13 male and 18 female in this study. The mean age of the patients was 71 years (range from 57 to 84 years). The back pain lasted for 4.2 months (from 1 month to 10 years). Radiography, MRI and CT examination were performed. The patients were treated by percutaneous balloon kyphoplasty and the vertebral body tissue was extracted to perform common pathological examination. The anterior vertebral height was measured on a standing lateral radiograph before operation, after operation (one day after operation) and at the final follow-up. A Visual Analog Scale (VAS) and the Oswestry Disability Index (ODI) were chosen to evaluate pain status and functional activity.</p><p><b>RESULTS</b>The mean follow-up was for 27 months (range, 18 to 48 months). The anterior vertebral body height of fracture vertebra was restored from (34.7 +/- 3.1)% preoperatively to (71.4 +/- 2.3)% postoperatively, and to (70.2 +/- 2.5)% at the final follow-up. There was a significant improvement between preoperative and postoperative values (P < 0.05) and no difference between postoperatively and at the final follow-up (P > 0.05). The VAS was 8.7 +/- 0.4 preoperatively, 2.3 +/- 0.7 postoperatively, and 1.9 +/- 0.2 at the final follow-up; and the ODI was 89.1 +/- 2.7 preoperatively, 31.7 +/- 3.1 postoperatively, and 29.1 +/- 2.7 at the final follow-up. There was statistically significant increment in the VAS and ODI postoperatively compared with preoperatively (P < 0.05), while there was no statistically significant differences between postoperatively and at the final follow-up (P > 0.05). There was a significant increment between preoperative and final follow-up values (P < 0.05). Asymptomatic cement leakage occurred in two cases. New vertebral fracture occurred in one case.</p><p><b>CONCLUSION</b>Balloon kyphoplasty is a safe and effective procedure for osteoporotic vertebral compression fractures with osteonecrosis.</p>

Open-door laminoplasty for the treatment of failed anterior cervical spine surgery / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate the outcome of open-door laminoplasty for the treatment of failed anterior cervical spine surgery.</p><p><b>METHODS</b>From February 2003 to June 2009, 15 patients underwent open-door laminoplasty for the failed anterior cervical spine surgery. The causes of revision and the progression of disease were analyzed. Japanese Orthopedic Association (JOA) scores and Nurick grade were adopted to record the improvement of neurological status and walking ability.</p><p><b>RESULTS</b>Two patients were excluded for analysis because of lost follow-up and follow-up less than 12 months. The mean follow-up period after revision surgery for the other 13 patients was 26 months (ranged 13-52 months). The mean interval between the initial and revision surgery was 24 months (ranged 5 months to 6 years). The causes of revision were as following: degeneration of the adjacent segment in 2 cases, inadequate decompression in 5 cases, mis-diagnosis of ossification of posterior longitudinal ligament (OPLL) as myelopathy in 4 cases, and progression of OPLL in 2 cases. Posterior laminoplasty was recommended for each patient. After the operation, 13 patients improved neurologically with respect to JOA score, 12 patients improved their walking ability while 1 remained unchanged. The mean modified JOA scores improved from 10.5 to 13.8 (P<0.05), the average recovery rate was 53.0% after the revision operation. The mean overall Nurick grade was 3.1 preoperatively and 1.9 at the final follow-up (P<0.05), the mean improvement of the Nurick grade was 1.2. Complications included cerebrospinal fluid leakage in 1 case, new axial neck pain in 1 case, and transient C5 nerve root palsy in 1 case.</p><p><b>CONCLUSIONS</b>Open-door laminoplasty is a straightforward and effective treatment for failed anterior cervical spine surgery due to inadequate decompression, progressive OPLL or degeneration of the adjacent segment. The merit of the open-door laminoplasty for failed anterior spine fusion is able to avoid high risk from initial anterior cervical spine surgery.</p>

Preliminary experiences in minimally invasive transforaminal lumbar interbody fusion / 中华外科杂志

<p><b>OBJECTIVE</b>To explore clinical application of minimally invasive transforaminal lumbar interbody fusion (TLIF) for the management of lumbar disorders and discuss its indications, surgical techniques and clinical effectiveness.</p><p><b>METHODS</b>From Jan 2005 to Dec 2006, 31 selected patients (22 males and 9 females, aged from 41 to 63 years) with degenerative lumbar diseases were treated with minimally invasive TLIF assisted by METRx X-Tube micro-endoscopy system. The index diagnosis was lumbar disc herniation with Lumbar spinal stenosis in 7, lumbar disc herniation with segmental instability in 16, grade 1 to 2 of lumbar spondylolisthesis in 8. The surgical methods was performed with bilateral or unilateral pedicle screws insertion and a single rectangle cage posterolateral placement. The operating time, blood loss, blood transfusion, drainage, visual analogue scale (VAS), preoperative and postoperative JOA scores were observed as well as radiographic evaluation. The results were compared with standard TLIF group respectively.</p><p><b>RESULTS</b>A total of 116 pedicle screws and 31 cages were implanted of which 4 patients were treated with unilateral pedicle screws fixation. Four pedicle screws were found misplaced in CT scans after surgery. The average operating time was 199 min, blood loss 359 ml, volume of transfusion 32 ml drainage 81 ml, and VAS was 2.37 about 72 hours after surgery, which had statistic difference compared with control group. There was no statistic difference on postoperative improvement rate and JOA scores in two groups.</p><p><b>CONCLUSIONS</b>Minimally invasive TLIF minimizes paraspinal muscle trauma and blood loss, shortens the operating and recovery time. A good long-term outcome can be gained compared with standard procedures.</p>

Classification and management of the tandem ossification of the posterior longitudinal ligament and flaval ligament / 中华医学杂志(英文版)

<p><b>OBJECTIVE</b>To provide appropriate guidelines for treatment of tandem ossification of the posterior longitudinal ligament (OPLL) and flaval ligament (OFL). Data sources Published articles about OPLL and OFL were selected using Medline and Embase electronic databases. Study selection An English literature search from January 1980 to December 2006 was conducted. Because many reported cases were incorporated in OFL studies, the key words for search were OFL or OFL and OPLL. The first step revealed 93 studies of which 13 reports of tandem OPLL and OFL (tandem ossification) were selected.</p><p><b>RESULTS</b>All studies were case series or case report and advocated that the primary therapy for tandem ossification should be operative. The clinical outcomes of surgery were evaluated in most reports, predominantly using the JOA scores. Gender is the only factor which has prognostic value. A higher proportion of women was found in the failure group. A two-stage classification of tandem ossification was developed to relate diagnosis to outcome.</p><p><b>CONCLUSIONS</b>All patients with suspected ossification of the spinal ligaments should undergo routine MRI screening of the whole spine. The correlation of the classification with surgical treatments needs further studies to validate its usefulness.</p>

Unilateral versus bilateral balloon kyphoplasty in the treatment of multi-vertebral osteoporotic compression fractures / 中华外科杂志

<p><b>OBJECTIVE</b>To comparatively study the efficacy and safety of unilateral and bilateral balloon kyphoplasty in the treatment of painful multi-vertebral osteoporotic compression fractures.</p><p><b>METHODS</b>From May 2002 to June 2007, 41 consecutive patients with painful multi-vertebral osteoporotic compression fractures underwent unilateral or bilateral kyphoplasty. The unilateral group included 3 male and 14 female with an average age of 70.4 (range 52 to 91 years old). The bilateral group included 4 men and 20 women with an average age of 72.4 (range 61 to 87 years old). Each procedure included insertion of inflatable balloon, fracture reduction and cement filling under "C"-arm monitoring. Preoperative and postoperative pain level, SF-36 score, radiographs and complications were recorded and analyzed.</p><p><b>RESULTS</b>All 41 patients tolerated the operation well. The mean operation time were (86 +/- 32) min and (120 +/- 26) min for unilateral and bilateral groups respectively; the mean volume of cement injected into one level were (3.9 +/- 1.6) ml and (5.4 +/- 2.1) ml for unilateral and bilateral groups respectively. The mean follow-up were (32.5 +/- 17.2) months and (30.7 +/- 14.3) months for unilateral and bilateral groups respectively. The mean VAS pain score of unilateral group decreased significantly from 7.4 +/- 2.1 preoperatively to 2.7 +/- 1.9 postoperatively (t = 2.50, P < 0.05) and 3.1 +/- 2.2 at final follow-up, the mean VAS pain score of bilateral group decreased significantly from 7.9 +/- 2.1 preoperatively to 2.3 +/- 2.5 postoperatively (t = 2.41, P < 0.05) and 2.7 +/- 2.2 at final follow-up, no significant difference was found between two groups. Significant increase of the mean height of anterior and medial vertebral body were recorded after the operation and maintained at final follow-up. The mean correction of local kyphosis was 7.2 degrees +/- 4.9 degrees for unilateral group and 7.3 degrees +/- 5.9 degrees for bilateral group, no significant difference was found between two groups. Postoperatively, 6 of 8 subscales measured by SF-36 were significantly improved for both groups. Complications were found in 7 patients including 6 cases of cement leakage and 1 case of pulmonary embolization.</p><p><b>CONCLUSION</b>As a minimally invasive procedure, unilateral or bilateral kyphoplasty is effective and relatively safe for multi-vertebral osteoporotic compression fracture.</p>

Determination of painful vertebrae treated by kyphoplasty in multiple-level vertebral compression fractures / 中华外科杂志

<p><b>OBJECTIVE</b>To explore how to determine painful vertebrae treated by kyphoplasty in multiple-level osteoporotic vertebral compression fractures and clinical outcome.</p><p><b>METHODS</b>From October 2002 to June 2005, 51 consecutive procedures with kyphoplasty were performed on 35 patients with multiple-level osteoporotic vertebral compression fractures. There were 51 painful vertebrae among 120 vertebral compression fractures. The painful vertebra was determined by the signal intensity changes in MR images, combined with radiography and local percussion pain before operation. Only painful vertebrae were treated by kyphoplasty. Preoperative, postoperative and final follow-up visual analog scale (VAS) and radiographic findings such as vertebral height and Cobb angle were recorded and analyzed.</p><p><b>RESULTS</b>All patients tolerated the procedure well with immediate relief of their back pain after kyphoplasty and they can walk at 1-3 days after the procedure. There were 3 vertebrae (3/51) occurred asymptomatic extravasation of cement. 31 cases were followed up for mean 16.2 months (range 6-44 months). VAS reduced from preoperative 8.7 to final follow-up 2.1 (P <0. 01). At final follow-up the vertebral height had a recovery rate of 59.17%, and the mean Cobb angle was improved 10.1 degrees. There was a significant improvement between preoperative and final follow-up values (P < 0.01).</p><p><b>CONCLUSIONS</b>The painful vertebra can be determined by signal intensity changes in MR series images in multiple-level osteoporotic vertebral compression fractures. Selecting painful vertebrae to be treated by kyphoplasty can make patients with multiple-level VCFs gain an excellent result.</p>

Diagnosis and surgical treatment of thoracolumbar vertebral Chance fractures caused by a fall / 中华外科杂志

<p><b>OBJECTIVE</b>To explore the diagnosis of Chance fractures of thoracolumbar spine and the clinical efficacy of segmental pedicle screw instrumentation in the treatment.</p><p><b>METHODS</b>The clinical data of 16 patients with Chance fractures from January 2000 to January 2007 were retrospectively analyzed. All patients were treated with segmental pedicle screw instrumentation. Radiology and the Oswestry Disability Index (ODI) were used to evaluate the efficacy.</p><p><b>RESULTS</b>One case associated with open dislocation of ankle and craniocerebral injury, 3 cases with calcaneus fracture and 1 with kidney contusion. All cases were followed up from 7 months to 6 years, with a mean of 2.6 years. There were no operation complications. The anterior vertebral body height of fracture vertebra was restored from preoperative (63.3 +/- 6.8)% to postoperative (92.1 +/- 4.0)%, at the follow-up (90.7 +/- 3.6)%. There was a significant improvement between preoperative and postoperative values (P < 0.01) and no difference between initial postoperative and final follow-up (P > 0.05). The mean ODI was 4.9.</p><p><b>CONCLUSIONS</b>The injuries associated with Chance fracture caused by a fall and its mechanism are different from those with the safety belt injury. The segmental pedicle screw instrumentation can rebuild spinal stabilization and restore spinal alignment in treatment of Chance fractures.</p>

Cement vertebroplasty combined with ethanol injection in the treatment of vertebral hemangioma / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>A number of methods have been used in the treatment of symptomatic and aggressive vertebral hemangioma, but none of them is optimal. Vertebral hemangioma treated with cement vertebroplasty or ethanol injection alone showed relatively good results despite their limitations.</p><p><b>METHODS</b>Between February 2002 and May 2004, twelve patients with vertebral hemangioma were subjected to combined cement vertebroplasty and ethanol injection, five of them were men and seven women, and aged from 26 to 54 years (mean, 41 years). The following levels of the spine were involved: T9: 1, T10: 3, T12: 2, L1: 1, L2: 2, L3: 2 and L4: 1. The clinical results and radiographic records of the patients were assessed after 2 years and 5 months of follow-up.</p><p><b>RESULTS</b>The average score of back pain significantly decreased from 6.5 before operation to 1.7 one month after operation. No severe complications occurred during and after operation. During the period of follow-up, symptoms were not deteriorated. At the end of follow-up, neither radiographic sign of aggressive destruction nor collapse of the involved vertebra was observed. Significant improvement in the 12 patients was demonstrated on 7 of 8 SF-36 Health Scale except for mental health.</p><p><b>CONCLUSIONS</b>Cement vertebroplasty combined with ethanol injection as a safe and effective technique is an alternative to the treatment of patients with vertebral hemangioma.</p>

Early diagnosis and treatment of acute or subacute spinal epidural hematoma / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Despite low morbidity, acute or subacute spinal epidural hematoma may develop quickly with a high tendency to paralysis. The delay of diagnosis and therapy often leads to serious consequences. In this study we evaluated the effects of a series of methods for the diagnosis and treatment of the hematoma in 11 patients seen in our hospital.</p><p><b>METHODS</b>Of the 11 patients (8 males and 3 females), 2 had the hematoma involving cervical segments, 2 cervico-thoracic, 4 thoracic, 1 thoraco-lumbar, and 2 lumbar. Three patients had quadriplegia, including one with central cord syndrome; another had Brown-Sequard's syndrome; and the other seven had paraplegia. Five patients were diagnosed at our hospitals within 3 - 48 hours after appearance of symptoms, and 6 patients were transferred from community hospitals within 21 - 106 hours after development of symptoms. Key dermal points, key muscles and the rectal sphincter were determined according to the American Spinal Injury Society Impairment Scales as scale A in two patients, B in 5 and C in 4. Emergency MRI in each patient confirmed that the dura mater was compressed in the spinal canal, with equal intensity or hyperintensity on T(1) weighted image and mixed hyperintensity on T(2) weighted image. Preventive and curative measures were taken preoperatively and emergency operation was performed in all patients. Open laminoplasty was done at the cervical and cervico-thoracic segments, laminectomy at the thoracic segments, laminectomy with pedicle screw fixation at the thoraco-lumbar and lumbar segments involving multiple levels, and double-sided laminectomy with the integrity of articular processes at the lumbar segments involving only a single level. During the operation, special attention was given to hematoma evacuation, hemostasis and drainage tube placement.</p><p><b>RESULTS</b>Neither uncontrollable hemorrhage nor postoperative complications occurred. All patients were followed up for 1 - 6 years. A marked difference was noted between postoperative and preoperative scales (u = 3.66, P < 0.01). Most patients recovered after therapy, but the recovery of patients treated at our hospitals was superior to that of those transferred from community hospitals (t = 2.95, P < 0.05). Of the patients treated at our hospitals, 4 were cured and 1 was upgraded with scale from A to D, whereas none of those transferred from community hospitals recovered completely, even one remained scale C.</p><p><b>CONCLUSIONS</b>Physical examination plus MRI is essential to early diagnosis of acute or subacute spinal epidural hematoma. Preventive and curative measures including emergency operation are helpful to the recovery of patients' nerve function.</p>

Antioxidation of quercetin against spinal cord injury in rats / 中华创伤杂志(英文版)

<p><b>OBJECTIVE</b>To observe the effect of quercetin on experimental spinal cord injury (SCI) in rats.</p><p><b>METHODS</b>Sixty Sprague-Dawley rats were randomly divided into four groups: Group A only for laminectomy, Group B for laminectomy with SCI, Group C for SCI and intraperitoneal injection with a bolus of 200 mg/kg quercetin and Group D for SCI and intraperitoneal injection of saline. SCI model was made by using modified Allen's method on T(12). Six rats of each group were killed at 4 h after injury and the levels of free iron and malondialdehyde (MDA) of the involved spinal cord segments were measured by bleomycin and thiobarbituric acid (TBA) assays separately. The recovery of hind limb function was assessed by Modified Tarlov's scale and inclined plane method at 7 d, 14 d and 21 d after SCI. The histological changes of the damaged spinal cord were also examined at 7 d after SCI.</p><p><b>RESULTS</b>After SCI, the levels of free iron and MDA were significantly increased in Groups B and D, while not in Group C. The Modified Tarlov's score and the inclined plane angles were significantly decreased in Groups B, C and D. The histological findings were not improved.</p><p><b>CONCLUSIONS</b>After SCI, quercetin can reduce the level of lipid peroxidation, but not improve recovery of function.</p>

Selectivity and individualization of transpedicular balloon kyphoplasty for aged osteoporotic spinal fractures / 中国医学科学院学报

<p><b>OBJECTIVE</b>To investigate the selectivity and individualization of transpedicular balloon kyphoplasty for aged osteoporotic spinal fracture.</p><p><b>METHODS</b>Twenty-two consecutive procedures were performed in 17 aged patients with osteoporotic spinal compression fractures from April 2002 to June 2004. The signal changes in different sequences were confirmed by magnetic resonance imaging before the procedures. This operation involved the percutaneous insertion of two inflatable bone tamps into a fractured vertebral body transpedicularly under fluoroscopic guidance. Every patient was treated individually, according to the results of radiography and CT scan before operation. Preoperative and postoperative complications, visual analogue scale, and radiographic findings such as vertebral height and Cobb angle were recorded and analyzed.</p><p><b>RESULTS</b>All patients tolerated the procedure well with immediate relief of their back pain in 24 hours. There was no leakage of cement into the epidura. The mean loss percent of the anterior and middle vertebral heights were (35.32 +/- 13.15)% and (27.53 +/- 12.61)% before operation, and (14.21 +/- 12.43)% and (16.2 +/- 7.5)% after operation. The height restoration of vertebra was confirmed by X-ray after the procedure (P < 0.01). The mean kyphosis was improved from (25.3 +/- 4.2) degrees to (8.6 +/- 5.1) degrees. No complications occurred. No patient had nerve injury. The patients were allowed to walk next day after the procedure.</p><p><b>CONCLUSION</b>The selectivity and individualization of transpedicular balloon kyphoplasty for aged osteoporotic spinal fractures has satisfactory short-term clinical efficacy. It is also an effective way to prevent complications.</p>

The mitosis and immunocytochemistry of olfactory ensheathing cells from nasal olfactory mucosa / 中华创伤杂志(英文版)

<p><b>OBJECTIVE</b>To culture olfactory ensheathing cells (OECs) of rats in vitro and to investigate its morphology, mitosis and immunocytochemistry, and to explore if the OECs could be a new donation for transplantation.</p><p><b>METHODS</b>OECs were harvested from olfactory mucosa of Sprague Dawley rats based on the differing rates of attachment of the various cell types, followed by glial fibrillary acidic protein (GFAP), nerve growth factor (NGF), anti-low affinity receptor for NGF (NGFRp75), brain-derived neurotrophic factor (BDNF), neurotrophin-3 (NT-3) and S-100 immunocytochemistry. The morphological changes and mitosis were observed under a phase contrast microscope at different culture time.</p><p><b>RESULTS</b>Three morphologically distinct types of cells, bipolar, multipolar and flat morphology were present in the primary culture of adult rat olfactory mucosa. Mitosis was characterized by a retraction of all processes, forming a sphere that divided into spherical daughter cells, the daughter cells sent out their processes. The OECs were immunoreactive for GFAP, NGFRp75, S-100, NGF, BDNF and NT-3.</p><p><b>CONCLUSIONS</b>The OECs from nasal olfactory mucosa cultivated in the medium with fetal bovine serum could survive, divide, differentiate, and express the neurotrophin. It may become an accessible source for autologous grafting in spinal cord injury.</p>

Long-term outcomes of the revision open lumbar discectomy by fenestration: a follow-up study of more than 10 years / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate the long-term clinical results and the factors that influences the outcomes of the revision open lumbar discectomy by fenestration.</p><p><b>METHODS</b>Fifty-one patients, who underwent the second open discectomy by fenestration from January 1 1988 to December 31 1994, were followed for an average of 146.8 months (range, 120 to 203 months). The long-term follow-up results were evaluated by using the MacNab classification and the Japanese Orthopaedic Association (JOA) scoring system through direct examinations and questionnaires. Radiography was also used in patients who agreed to visit the hospital, and findings were compared with those on preoperative radiographs.</p><p><b>RESULTS</b>At the final follow-up, with the MacNab classification an excellent and good outcome was achieved in 70.6% of the cases, 78.4% were satisfied with their results. The failure rate was 15.7% (8 patients). Excluding those 8 failed cases who needed another reoperation, the average improvement calculated by JOA scores was (64.6 +/- 18.2)%. The disc height of the operation site significantly decreased after surgery, nevertheless, this did not affect the long-term clinical outcome. Factors that were associated with a fair and bad outcome included smoking, isolated trauma or injury, fibrosis and the length of the remaining or recurrent primary postoperative symptoms history. Psychosociological signs were probably known as negative predictors of lumbar disc surgery outcome.</p><p><b>CONCLUSION</b>The long-term outcome of the revision open lumbar discectomy by fenestration in this series was favorable. Because the revision operation is typically associated with a higher complexity, selection of suitable surgical candidates and determination of valid indications for operative treatment are very important. JOA scores have proved to be easy to perform for patients and clinicians and standardize subjective data.</p>

The contrast study between single and double balloon bilateral dilatation of kyphoplasty / 中华外科杂志

<p><b>OBJECTIVE</b>To contrast single and double balloon-inflated kyphoplasty for vertebral compression fractures (VCFs) and evaluate its clinical efficacy.</p><p><b>METHODS</b>From May 2000 to May 2004, 90 consecutive procedures were performed in 58 patients who suffered from painful vertebral compression fractures, transferring tumour and angioma. Ninety vertebrae were inflated while 62 as A group were double balloon and 28 as B group were single balloon, fracture reduction and bone cement augmentation. Preoperative and postoperative symptom levels, variables, complications were recorded and the vertebral height and Cobb angle were measured and analyzed.</p><p><b>RESULTS</b>All patients' pain was alleviated or disappeared without syndrome, and the vertebral height and Cobb angle of both groups were improved. The average recovery rate was 72.6% (22.9% approximately 100%), Cobb angle from 17.9 degrees (3.1 degrees approximately 31.6 degrees ) were corrected to 9.6 degrees (0.6 degrees approximately 28.2 degrees ), the average angle was 8.7 degrees (0.3 degrees approximately 27.2 degrees ), and the contrast between preoperative and postoperative showed obvious differences (P <0.001). The average recovery rate of A group was 77.6% (55.3% approximately 100%), B group was 64.3% (22.9% approximately 100%). The average postoperative Cobb angle of A group was 9.9 degrees (0.3 degrees approximately 27.2 degrees ), B group was 8.6 degrees (0.6 degrees approximately 19.8 degrees ) (P >0.05).</p><p><b>CONCLUSIONS</b>As a promising minimally invasive surgery, balloon kyphoplasty can provide early relief of pain and improve the function as well as spinal alignment in treatment of painful compression fracture owing to recovering the vertebral height and Cobb angle of the vertebral body. Single balloon-inflated kyphoplasty can improve VCFs as double balloon.</p>

Antioxidation of melatonin against spinal cord injury in rats / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>The iron catalyzed lipid peroxidation plays an important role in the autodestruction of the injured spinal cord. This study was to detect the antioxidation of melatonin against spinal cord injury (SCI) in rats.</p><p><b>METHODS</b>Sity Sprague-Dawley rats were randomly divided into four groups: group A (n = 15) for laminectomyanly, group B (n = 15) for laminectomy with SCI, group C (n = 15) for SCI and intraperitoneal injection of a bolus of 100 mg/kg melatonin, and group D (n = 15) for SCI and intraperitoneal injection of saline containing 5% ethanol. The SCI of animal model was made using modified Allen's method on T12. Six rats of each group were sacrificed 4 hours after injury, and the levels of free iron and malondialdehyde (MDA) of the involved spinal cord segments were measured by the bleomycin assay and thiobarbituric acid (TBA) separately. Functional recovery of the spinal cord was assessed by Modified Tarlov's scale and the inclined plane method at 1, 3, 7, 14, 21 days after SCI. The histologic changes of the damaged spinal cord were also examined at 7 days after SCI.</p><p><b>RESULTS</b>After SCI, the levels of free iron and MDA were increased significantly and the modified Tarlov's score and inclined plane angle decreased significantly in groups B and D. In group C, the Tarlov's score and inclined plane angle were increased significantly at 7, 14 and 21 days, with histological improvement.</p><p><b>CONCLUSION</b>Melatonin can reduce the level of lipid peroxidation and prevent damage to the spinal cord of rat.</p>

Changes of free iron contents and its correlation with lipid peroxidation after experimental spinal cord injury / 中华创伤杂志(英文版)

<p><b>OBJECTIVE</b>To observe the dynamic changes of free iron contents and its relationship to the changes of lipid peroxidation after experimental spinal cord injury (SCI).</p><p><b>METHODS</b>Sprague Dawley rats were randomly divided into three groups: Group A (n=6) received no operation; Group B (n=48) received only laminectomy (sham); and Group C (n=48) received both laminectomy and traumatic injury (SCI model). The SCI animal models were made by using an modified Allen's weight-drop device (50 g.cm) on T(12). Rats were sacrificed at 0.5, 1, 3, 6, 12, 24 hours after injury. The levels of free iron involved in spinal cord segments at different time points were measured by bleomycin assay. The malondialdehyde (MDA) was also measured by the thiobarbituric acid (TBA).</p><p><b>RESULTS</b>After SCI in Group C, the level of free iron showed a significant increase at 0.5 hour compared to Groups B and A, restored to the control level at 6 h; the level of MDA was increased at 0.5 hour, peaked at 3 hours, returned to the control level at 12 hours; the concentrations of free iron and lipid peroxidation in injured rats were significantly and positively correlated at 0.5-3 hours.</p><p><b>CONCLUSIONS</b>After SCI the levels of free iron are increased quickly and might be a major contributor to lipid peroxidation in injured spinal cord.</p>

Current status and perspective of diagnosis and treatment of thoracolumbar fracture in China / 中华创伤杂志(英文版)

Since the late 20th century owing to the improvement of spinal surgery techniques, the diagnosis and treatment of thoracolumbar fracture have been perfected more and more. Although the advent of modern spinal surgery in China was late, we have gained some advanced achievements owing to various international communications benefited from the open policy. Therefore, it is essential to evaluate the current status and perspective of diagnosis and treatment of thoracolumbar fracture. There are several issues we would like to discuss here.

The experimental study of histology and apoptosis after the bone cement leakage into the intervertebral disc / 中华放射学杂志

Objective To discuss the histology change,apoptosis state and Bcl-2,Bax expression after the bone cement leakage into the intervertebral disc in vertebroplasty.Methods Eight majority canis familiaris were studied.Three lumbar intervertebral discs(L2 to L5)in each dog were randomly classified into three groups(control group,PMMA group,and CPC group),the canine discs were stabbed by 18-gauge needle,and 0.1 ml cement was injected into them.Control discs were only stabbed and injected with nothing.Histology of all discs was studied 24 weeks after the operation.Terminal-deoxynucleotidyl transferase mediated nick end labeling(TUNEL)and immunohistochemisty were used to detect apoptosis and Bcl-2,Bax expression in the discs.The data were statistically analyzed by SPSS 12.0.Results Intervertebral disc degeneration was not found in control groups.In bone cement groups,however,ruptured or serpentine patterned fibers,decreased cellularity of the nucleus pulposus and condensed matrix of the nucleus pulposus were found in histologic results.The Bax protein decreased in the order of control group, CPC group,and PMMA group.However,the Bcl-2 protein increased in the order of control group,CPC group,and PMMA group.The histology grade was significantly different among the three groups under ANOVA analysis(P