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Infectious diseases of spine (IDS) refer to a series of infectious diseases in different parts of the spine (vertebral body, intervertebral disc, appendix of vertebra, spinal canal, and adjacent paravertebral tissues) caused by various pathogenic microorganisms, accounting for about 2%~7% of systemic musculoskeletal system infections. According to the classic classification IDS can be divided into two types: specific infection and non-specific infection. IDS often has an insidious onset, atypical clinical manifestations, and less-specific imaging and laboratory tests, which causes great difficulties for the accurate diagnosis and treatment, often leading to missed diagnosis, misdiagnosis, and even mistreatment. Problems such as disordered clinical diagnosis and treatment procedures, diverse treatment methods, and non-standard medication and course of treatment still affect the prognosis of IDS. This article reviews the current research progress of the diagnosis and treatment process of IDS, in order to further standardize the diagnosis and treatment process of IDS.
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Objective:To investigate the efficacy of 3D printed navigation template in posterior atlantoaxial surgery.Methods:A retrospective study was conducted of the 22 patients who had received posterior atlantoaxial surgery for atlantoaxial diseases at The Second Department of Orthopedics, The Second Hospital Affiliated to Xi'an Jiao Tong University from September 2017 through February 2020. They were divided into a control group ( n=11) and an experimental group ( n=11) according to whether a 3D printed navigation template had been used to assist the posterior atlantoaxial surgery. In the control group, there were 6 males and 5 females, with an age of 63.6 years ± 4.6 years. In the experimental group, there were 7 males and 4 females, with an age of 57.6 years ± 4.8 years. In the control group, the pedicle screws were inserted with the help of conventional X-ray; in the experimental group, the pedicle screws were implanted with the assistance of a 3D printed navigation template and a 3D printed 3D model of cervical spine based on the preoperative CT data. Recorded were surgery time, times of intraoperative fluoroscopy, blood loss and success rate of pedicle screw insertion. Results:There were no significant differences between the 2 groups in the preoperative general data, showing comparability ( P>0.05). A total of 44 pedicle screws were inserted in the control group, including 12 ones of level-Ⅰ, 20 ones of level-Ⅱ and 12 ones of level-Ⅲ, giving a success rate of 72.7%; a total of 44 pedicle screws were inserted in the experimental group, including 21 ones of level-Ⅰ, 19 ones of level-Ⅱ and 4 ones of level-Ⅲ, giving a success rate of 90.9%. The success rate in the experimental group was significantly higher than in the control group ( P< 0.05). The surgery time (120.0 min± 5.0 min), times of tntraoperative fluoroscopy (9.9 times ±0.5 times), and blood loss (96.6 mL ± 4.2 mL) in the experimental group were significantly lower than those in the control group (153.1 min ± 5.3 min, 12.2 times ± 0.7 times and 128.5 mL ± 5.1 mL) ( P<0.05). Conclusion:Application of a 3D printing template can effectively reduce surgery time, intraoperative blood loss and intraoperative fluoroscopy but increase the success rate of pedicle screw implantation, showing excellent application prospects in posterior atlantoaxial surgery.
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Objective To develop a new type of lumbar prosthesis,movable artificial lumbar vertebral body (MALV) and evaluate the stability and activity of the prosthesis by in vitro biomechanical test.Methods Fifteen adult fresh lumbar spine specimens were randomly divided into three groups:intact group,fusion group and non-fusion group.The anatomical parameters of L2 vertebral body and adjacent intervertebral discs were collected by software (Mimics 16.0,Materialise Company,USA) and the new prosthesis was personalized by 3D printing and mechanical processing.All specimens in fusion group and in non-fusion group were implanted with titanium cage,titanium plate and MALV respectively after partial resection of L2 vertebra and adjacent intervertebral disc.No other intervention was conducted on physiological specimens.All specimens were examined by imaging to determine the position of the prosthesis and the condition of the spinal cord.Specimens in all groups were subjected to a 7.5 N · m load biomechanical test in flexion,extension,left and right lateral bending,left and right rotation aiming to evaluate the mobility of operative site and adjacent discs.Results The new prosthesis consists of three parts,vertebral body,intervertebral disc and composite material ball.All 15 cadavers were free of spinal deformity,fracture and osteoporosis.Postoperative radiographic examination indicated no prosthesis displacement and spinal compression without adverse phenomena.The results in vitro mechanical test were as followed.There was no statistical difference in ROM of the T12L1 intervertebral in non-fusion group (3.68°±0.86°,3.52°± 0.86°,2.64°±0.93°,2.58°±0.76° respectively) and in intact group (3.98°±0.90°,3.74°±0.91°,2.94°±1.10°,2.96°±0.86° respectively) in flexion,extension,left and right lateral bending (P＞0.05).The ROM of the T12L1 intervertebral in fusion group (5.28°±0.83°,5.32°±0.42°,4.72°±1.10°,4.94°±1.17° respectively) was significantly larger than that in intact group and non-fusion group (P＜0.05).There was no statistically significant difference between the ROM of L1.2 and L2.3 intervertebral in flexion,extension and left and rightlateral bending in the non-fusion group (ROM of L1.2 were 4.62°±0.51 °,4.34°±0.67°,3.16°±0.55°,3.28°±0.41 ° respectively;ROM of L2.3 were 4.54°±0.58°,4.36°±0.65°,3.26°±0.21°,3.42°±0.37° respectively) and the intact group (ROM of L1.2 were 4.10°±0.53°,3.72°±0.42°,2.74°±0.50°,3.04°±0.40° respectively;ROM of L2.3 were 4.26°±0.72°,4.08°±0.77°,3.00°±0.36°,3.20°±0.31° respectively) (P＞0.05).The ROM of L1.2 and L2.3 in intact group and in non-fusion group were significantly greater than those in the fusion group (ROM of L1.2 were 1.10°± 0.35°,1.28°±0.31°,0.84°±0.34°,0.80°± 0.43° respectively;ROM of L2.3 were 1.14°±0.30°,1.18°±0.28°,0.94°± 0.36°,1.06°±0.32°) (P＜0.05).There was no statistically significant difference in the ROM of the T12-L3 full segment in the left and right rotation of the three groups (Intact group:4.47°± 0.99°,4.40°±0.70°;Non-fusion group:4.60°±0.90°,4.50°±0.77°;Fusion group:3.85°±0.50°,3.72°±0.70°)(P＞0.05).Conclusion The MALV can retain the mobility of the operative site in flexion,extension,lateral bending and rotation.Furthermore,it can effectively avoid the increased mobility of adjacent segment intervertebral.After implantation,the prosthesis can obtain satisfied immediate stability.
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Objective To compare the effects of movable artificial lumbar vertebra implantation and traditional vertebral excision and fusion on the stress of adjacent intervertebral discs,so as to provide reference for the biomechanical safety of new prosthesis implantation.Methods The total lumbar vertebra CT scan data of a healthy adult were imported into the compute r-aided software Mimics 16.0 for three dimensional reconstruction.The reconstructed three dimensional model was smoothed using computer-aided software Geomagic Studio 12.0.Subsequently,meshing,parameter setting and ligaments reconstructing were completed using computer-aided software Hypermesh 13.0 and Solidworks 2013,successfully constructing the finite element model of lumbar vertebral physiology group.On the basis of the finite element model of physiological group,three vertebral bodies and two intervertebral spaces were fused and fixed,and a simplified finite element model of fusion group was constructed.The partitioned prosthesis model was inserted into the established finite element model of physiological group,replacing the L 3 vertebral body and the adjacent two intervertebral discs in the model,constructing the finite element model of non fusion group.Three finite element models were imported into computer-aided software Abaqus/Explict and loaded under six motion modes including anteflexion,dorsiflexion,left and right rotation,and left and right bending.The stress changes of adjacent intervertebral discs were calculated.Results The maximum Mises stress of the adjacent intervertebral disc in the direction of forward flexure,dorsal extension,left and right rotation and left and right lateral bending of the three finite element models was located at the site of loading and increased with the increase of loading.Under the maximum loading,the Mises stress of adjacent intervertebral discs in the above directions in the fusion group (L1-2 respectively were 0.79,0.96,1.26,1.92,1.34,1.57 MPa while L4-5 respectively were 0.52,1.13,1.50,1.74,0.94,0.87 MPa) was significantly higher than that in the physiological group (L1-2 respectively were 0.42,0.53,0.57,0.66,0.64,0.72 MPa while L4-5 respectively were 0.23,0.29,0.68,0.63,0.37,0.34 MPa).The Mises stress of adjacent intervertebral disc in the non-fusion group (L1-2 respectively were 0.38,0.57,0.75,1.02,0.87,0.90 MPa while L4-5 respectively were 0.18,0.26,0.81,0.98,0.30,0.27 MPa) was similar to that in the physiological group,although there was some difference.Conclusion Movable artificial lumbar disc prosthesis implantation can better avoid the stress increase of adjacent intervertebral discs,and its long-term implantation in the human body is expected to reduce the incidence of degeneration of adjacent intervertebral discs.
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OBJECTIVE@#To assess the geometrical matching of a new anatomical adaptive titanium mesh cage (AA-TMC) with the endplate and its effect on cervical segmental alignment reconstruction in single- and two-level anterior cervical corpectomy and fusion (ACCF) and compare the compressive load at the endplate between the AA-TMC and the conventional titanium mesh cage (TMC).@*METHODS@#Twelve cervical cadaveric specimens were used to perform single- and two-level ACCF. The interbody angle (IBA), interbody height (IBH) and the interval between the AA-TMC and the endplate were evaluated by comparison of the pre- and postoperative X-ray images. The maximum load at the endplate was compared between the AA-TMC and TMC based on American Society for Testing and Materials (ASTM) F2267 standard.@*RESULTS@#No significant differences were found between the preoperative and postoperative IBA and IBH in either single-level ACCF (11.62°±2.67° 12.13°±0.69° and 23.90±2.18 mm 24.23±1.13 mm, respectively; > 0.05) or two-level ACCF (15.63°±5.06° 16.16°±1.05°and 42.93±3.51 mm 43.04±1.70 mm, respectively; > 0.05). The mean interval between the AA-TMC and the endplate was 0.37 ± 0.3 mm. Compared to the conventional TMC, the use of AA-TMC significantly increased the maximum load at the endplate in both single-level ACCF (719.7±5.5 N 875.8±5.2 N, < 0.05) and two-level ACCF (634.3±5.9 N 873±6.1 N, < 0.05).@*CONCLUSIONS@#The use of AA-TMC in single-level and two-level ACCF can significantly increase the maximum load at the endplate to lower the possibility of implant subsidence and allows effective reconstruction of the cervical alignment.
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Humans , Biomechanical Phenomena , Cervical Vertebrae , Prostheses and Implants , Spinal Fusion , Surgical Mesh , Titanium , Treatment OutcomeABSTRACT
Objective To evaluate the preliminary clinical effect of anterior anatomical reduction plate fixation on the treatment of atlantoaxial dislocation. Methods A retrospective case series study was conducted to analyze the 13 patients with atlantoaxial dislocation admitted to the second affiliated hospital of Xi'an Jiaotong University from January 2016 to December 2017. There were eight males and five females, aged 20-57 years, with an average age of 42 years. All patients received transoropharyngeal reconstruction and atlantoaxial anterior anatomical reduction plate fixation, 12 of which underwent the surgery for the first time but one had the revision surgery. The operation time and intraoperative bleeding were recorded. The angle of the clivus axis was measured, and the reduction of the atlantoaxial spine and the fusion of bone graft were observed. The neurological function was evaluated by Japanese Orthopedic Association ( JOA ) score and the improvement rate of spinal cord function was calculated. The complications were also recorded. Results All patients were followed up for 10-30 months [(14. 2 ± 5. 0)months]. The operation time was 150-285 minutes [(216. 8 ± 36. 7)minutes]. The intraoperative blood loss was 50-130 ml [(80. 5 ± 19. 7)ml]. The slope axis angle was (113. 2 ± 9. 1)° before operation and (145. 8 ± 6. 7)° after operation, with an average increase of 32. 6° (P<0. 01). Anatomical reduction was obtained in nine patients, and partial reduction in four patients. At the last follow-up, the atlantoaxial fusion was obtained in all patients, and the healing time was ( 4. 6 ± 1. 1 ) months. Postoperative neurological symptoms were improved compared with those before operation. The JOA score was improved from preoperative (8. 7 ± 1. 7) points to postoperative (14. 3 ± 1. 2) points, with an average increase of 5. 6 points (P<0. 01). The average improvement rate of spinal cord function was 69％. Except for one patient with cerebrospinal fluid leakage, there were no complications such as spinal cord, nerve, blood vessel injury or wound infection after operation. Conclusions Anterior atlantoaxial anatomical reduction plate fixation can effectively restore the dislocated atlantoaxial joint, restore slope axis angle, improve bone fusion rate, and improve nerve function. It can be used as an alternative or supplement to posterior fixation.
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Objective To conduct the biomechanical evaluation of the effect of the new operative method,one stageanterior debridement and fusion combined withtitanium cage and dual screw-rod anterior instrumentation inter-fixation on the reconstruction of lumbosacral spine stability and provide biomechanical support for its further promotion in clinical practice.Methods Fifteen lumbosacral spine specimens were obtained from the department of anatomy,Xi'an Jiaotong University Health Science Center.Fracture,deformity and osteoporosis were removed by CT and bone density examination.The remaining specimens were randomly divided into intact group,anterior fixation group and posterior fixation group.L5 vertebral body and adjacent intervertebraldisc subtotal resection were performed on all specimens in the anterior fixation group and the posterior fixation group.The specimens in the anterior fixation group were fixed through titanium cage and dual screw-rod from front approach and the specimens inthe posterior group were fixed by dual screw-rod from posterior approach.Specimens in the intact group were not treated.All specimens were examined by X-ray and thin-slice CT after surgery to determine whether implant placement was appropriate andwhether there was spinal cord compression or not.Three groups of lumbosacral spine specimens were subjected to mechanical testsunder the conditions of flexion and extension,lateral bending,axial torsion and axial compression to evaluate the mechanical effect of anterior dual screw-rod system combined with titanium cage on the fixation of lumbosacral spine.Results All lumbosacralspine specimens were free of fractures,deformities,osteoporosis and other diseases.Postoperative imaging examination showed thatthe implant was in normal position and no adverse phenomena such as pedicle screw insertion into the spinal canal and spinalcord compression were observed.Mechanical test results in vitro showed that the load required for maximum loading displacement (5 mm) or rotation angle (5°) of the specimens in the intact group was less than that of the specimens in anterior and posterior fixation group in flexion,lateral bending and axial compression and torsion direction (Fflexion=1335.989,Pflexion=0.000;Fextenxion=166.688,Pextenxion=0.000;Fleft latebending=258.872,Pleft lateral bending=0.000;Fright lateral bending=335.766,Pright lateral bending=0.000;Faxial compression=481.444,Paxial compression =0.000;Fleft rotation=21.682,Pleft totation=0.000;Fright rolation=34.990,Pright rotation=0.000).When the maximum loading displacement (5 mm) was reached,the load required for the specimens in anterior fixation group was significantly greater than that for specimens in posterior fixation groupin the direction of flexion,left and right lateral bending and axial compression (Pflexion=0.000;Pleft lateral bending=0.006;Pright lateral bending=0.016;Paxial compression=0.000).However,the load required to reach the maximum loading displacement (5 mm) in the anterior fixation group in the direction of extension was significantly lower than that in the posterior fixation group (P=0.000).When the maximum load angle (5°) was reached intorsion direction,the required load of the specimens in both anterior and posterior fixation groups was similar (Pleft rotation=0.820;Pright rotation=0.259).Conclusion The anterior fixation of lumbosacral spine specimens with titanium cage combined with dualscrew rod can provide better immediate stability and its stability in flexion,lateral bending and axial compression is better than that of back double nailing rodfixed.
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BACKGROUND:We have designed and manufactured a novel artificial cervical vertebra and intervertebral complex (ACVC) which combines the cervical titanium cage with the artificial cervical disc, and also developed the ACVC with a hydroxyapatite biocoating (ACVC-HA). OBJECTIVE:To evaluate biomechanical properties of the joint system, and the role of HA coating in promoting osseointegration and long-term stability. METHODS:Twenty-four goats were randomly divided into three groups and underwent the anterior C2/3 and C3/4 discectomy, and C3 subtotal corpectomy, fol owed by ACVC implantation (group 1) and ACVC-HA implantation (group 2), and given no intervention (black control group), respectively. group. At 12 weeks after surgery, C1-5 samples were col ected to undergo biomechanical tests and histological staining. RESULTS AND CONCLUSION:Prior to the fatigue test, compared with the blank control group, the range of motion and neural zone of groups 1 and 2 in the directions of flexion-extension and lateral bending showed no significant differences, but the above indicators were significantly increased in the direction of rotation (P<0.05). Additional y, the stiffness in al three directions was significantly lower than that in the blank control group (P<0.05). There were no significant differences in the range of motion and neural zone in al directions between groups 1 and 2. Similar results were found after the fatigue test. The histological staining showed that both two implants had good biocompatibility and abradability, but more new bone formed on the ACVC-HA. These results suggest that ACVC can effectively reconstruct the motor function of the cervical spine after decompression. Furthermore, HA coating can markedly improve bone-implant interface to promote osseointegration.
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BACKGROUND:Cauda equina syndrome often induces skin hypoesthesia in the perineal area, poor urine-stool control, and impairs male function. After peripheral nerve fiber injury, apoptosis of neurons appeared. This is associated with the nature of the injury, the types of neurons, the species of animals, the age, and the distance between neurons. OBJECTIVE:To explore the motor neuron apoptosis and expression of apoptosis-associated protein in the anterior horn of the spinal cord after acute cauda equina compression. METHODS:A total of 27 canines were randomly divided into three groups. In the compression and control groups, models of cauda equina compression were established. In the normal group, no models were established. Compression group received water sac compression for 4, 8, 12, 24, 48, 72 and 168 hours, with three models in each group. In the control group, only water sac was implanted, but water was not injected. Terminal deoxynucleotidyl transferase TdT-mediated biotin dUTP nick end-labeling assay was used to detect the apoptosis of neurons in the anterior horn of the spinal cord. Bcl-2, Bax and Caspase-3 protein expressions were measured by immunohistochemical staining (strept avidin-biotin complex). Gray values of positive cels of Bax, Bcl-2 and Caspase-3 protein expressions were detected using Qwin550Cw image colection and analysis system. RESULTS AND CONCLUSION:The apoptosis of motor neuron occurred in the compression groups. At 12 hours of compression, positive cels were detected, and the number of positive cels reached a peak at 72 hours. Bax and Bcl-2 protein expression was smal in the normal group. Caspase-3 protein expression was not detected in the normal and control groups. Bax and Bcl-2 protein expression was significantly increased at 8 hours, peaked at 72 hours and reduced to a normal level at 168 hours. The increased range of Bax protein expression was bigger than that of Bcl-2. Caspase-3 protein began to express at 12 hours, peaked at 72 hours and reduced to a low level at 168 hours. Bax and Caspase-3 protein expression peaked at 72 hours, and Bcl-2 protein expression was not obviously increased. These findings verified that after acute cauda equina compression, the apoptosis of neurons occurred in the anterior horn of the spinal cord. Bax and Bcl-2 protein expression showed an antagonistic action. In the Bax/Bcl-2 complex, Bax protein in a high expression promoted apoptosis, induced Caspase-3 protein expression, and neuronal apoptosis.
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Objective To explore a surgical method for the treatment of lumbosacral spinal tuberculosis by combination of one-stage focus debridement with anterolateral incision, bone graft fusion with titanium mesh cage and internal fixation with double pedicle crew system.Methods From Sep.2009 to Dec.2012, a total of 8 patients with lumbosacral spinal tuberculosis which included 5 cases of male, 3 cases of female.The age ranged from 20 to 65 years, with a mean of 51.6 years.All patients presented with persistent back pain, 4 patients with radiating pain of unilateral lower limb, 3 with weakness and numbness and 5 with constitutional symptoms including low-grade fever and weight loss.All patients were not associated with active tuberculosis in oth er parts of the body.The patients were given regular anti-TB treatment for at least 4 weeks.By anterolateral incision, common iliac and iliac arteries and veins were dissociated extraperitoneally.The focus was completely debrided through the inferior part of vessels.Then the bone graft fusion was performed with the titanium mesh cage and the internal fixation with a double pedicle crew system was accomplished.After the surgery, patients were treated with continuous anti-TB drugs and with antibiotics to prevent infection.Patients were allowed to move with the protection of waist early and regular follow-up.Results Operation time was 180-360 min, with an average of 225 min.Operative blood loss was 624 ml and drainage volume was 150 ml on average.All cases were cured after surgery.No severe complications were observed during the surgeries.After follow-up of 8 to 30 months (averaged 12months), no recurrence of the tuberculosis was found.The lumbocrural pain improved in all the patients.Complications such as migration, loosening and breaking of the implants were not observed.The vertebral bodies were fused in all patients with an average time of 8.3 months.No case occurred angiemphraxis or internal bleeding.Conclusion The method debrids the focus of lumbosacral spinal tuberculosis thoroughly and implements titanium mesh cage and double pedicle crew system simultaneously.The pedicle screw system is implemented in anterior lumbosacral vertebrae through the inferior part of iliac arteries and veins, which will not lead to angiemphraxis or vascular injuries.The early term outcome is encouraging.This technique is safe and effective to treat severe lumbosacral spinal tuberculosis.
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BACKGROUND:Animal studies have shown that cauda equina compression can induce apoptosis of lumbosacral spinal cord anterior horn motor neurons. OBJECTIVE:To explore the pathological change in lumbosacral spinal cord after acute cauda equina compression in dogs. METHODS:A total of 27 dogs were randomly divided into nine groups, with three dogs in each group. There were one normal control group, seven experimental groups and one sham surgery group. In the experimental group, an empty water sac was implanted above epidural fat below L6 vertebral plate. Compression was given by injecting water at 4, 8, 12, 24, 48, 72 and 168 hours. In the sham surgery group, an empty water sac was implanted, but compression was not given. At the time of compression, the spinal cord sent out by cauda equina nerve and adjacent to the head end was subjected to histopathological examination. RESULTS AND CONCLUSION:(1) Results of light microscope:at 4-48 hours of compression, spinal cord anterior horn motor neurons did not alter. At 72 hours, motor neurons became smal , cel membrane shrank and separated from surrounding tissues. Cel s were homogenous and darkly stained. At 168 hours, motor neurons disappeared, but spinal cord sections of the adjacent head end did not shown abnormal motor neurons in the spinal cord anterior horn. (2) Results of electron microscope:at 12 hours, spinal cord tissue began to swel , and the swel ing aggravated with prolonged time of compression. The swel ing of glial cel s was apparent. At 168 hours, myelin sheath structure dissolved;axons showed vacuolization;axoplasm spil ed, and exhibited inflammatory injury-like changes. (3) Apoptotic results of spinal cord anterior horn motor neurons:apoptosis appeared at 12 hours of compression, became increased, and showed an increased trend at 168 hours.
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BACKGROUND:Previous study has found that hsa-miR-182 is probably related to the apoptosis-related genes such as cytochrome C (Cycs C) and calcineurin subunit CnB (PPP3R1) in nucleus pulposus cells. OBJECTIVE:To determine whether miR-182 plays a regulatory role in nucleus pulposus cel apoptosis by detecting the relative gene expression levels after transfecting miR-182 with Cycs C and PPP3R1 into nucleus pulposus cel s via plasmid delivery. METHODS:After a bioinformatics prediction about miR-182, miR-182 and target genes were transfected into the nucleus pulposus cel s, and at the same time, blank control group was established. Then the expression levels of the target genes were detected through cel lysis. RESULTS AND CONCLUSION:miR-182 significantly inhibited the expression of Cycs C in nucleus pulposus cel s compared with the blank control group (P<0.05). Compared with the blank control group, miR-182 made no inhibitory effect on the expression of PPP3R1. These findings suggest that miR-182 may play a regulatory part in nucleus pulposus cel apoptosis by inhibiting the expression of Cycs C.
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BACKGROUND:Knee osteoarthritis can be treated by total knee arthroplasty. To improve therapeutic effect and promote postoperative recovery, we should take effective measures to improve the joint space and postoperative range of motion. OBJECTIVE:To explore the effectiveness and feasibility of posterior composite release of the knee joint after total knee arthroplasty. METHODS:118 knee osteoarthritis patients undergoing unilateral total knee arthroplasty in two hospitals from December 2009 to December 2013 were selected, and were randomly divided into control group (59 cases) and observation group (59 cases). After osteotomy during operation, the control group underwent bone removal of conventional condylar hyperplasia. Observation group underwent posterior composite release of the knee joint. Postoperative extension, flexion gap and the time required for postoperative active flexion 90° and 120° were observed in the two groups. Hospital for Special Surgery Knee Score and maximum flexion angle were recorded in 3 months of fol ow up, and compared between the two groups. RESULTS AND CONCLUSION:Through the statistics and comparison, no significant difference in flexion gap was found between the two groups (P>0.05). However, significant differences in extension gap, the time for active flexion 90° and 120°and the maximum flexion angle were detectable between the two groups, and above indexes were better in the observation group than in the control group (P<0.05). Hospital for Special Surgery Knee Score of each index and total score were significantly higher in the observation group than in the control group (P<0.05). These results suggest that rear joint composite release after total knee arthroplasty has certain validity and feasibility, can effectively improve knee extensor gap and the postoperative range of motion during replacement, but does not impact flexion gap during replacement.
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Objective:To explore the effectiveness of humanism concept in the management of patients with spi-nal cord injury care.Methods:Choose between January 2011 and February 2011 hospitalized in our hospital 112 cases of spinal cord injury patients, randomly divided into control group and observation group ( 56 cases) , com-pared two groups of nursing effect.Control group routine nursing management, observation group will humanistic nursing management idea runs through in the routine nursing management.Results:Aware of knowledge about health education group is significantly higher than the control group, patients satisfaction survey in nursing, be-tween the two groups statistically significant depression levels lower than the control group.Conclusions:In the nursing management of patients with spinal cord injury in the application of humanistic nursing concept effect is good, not only improve the effect of the nursing, and obviously improve the patient′s satisfaction, promote the pa-tient′s psychological adaptability.
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ObjectiveTo investigate the preventive strategy of early post-operative complications of closed spinal dysraphisms in children.MethodsOne hundred and nine children with closed spinal dysraphisms underwent surgery from January 2004 to December 2008,were enrolled in this study.After dural closure,the wound was washed completely with saline to clear the tissue debris to prevent postoperative infection. We routinely made a horizontal incision to prevent postoperative infection. Results After operation,all patients were recovered and were discharged from hospitalNo post-operative complications,including cerebrospinal fluid leakage, wound infection and flap necrosis, were encountered. ConclusionThe sophisticated microsurgical technique and the delicate surgical manipulation is the prerequisite for the prevention of early operational complication of closed spinal dysraphisms in children.
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Objective To study the mRNA and protein expressions of the neurofilament in the region of acute spinal cord injury (SCI) of rats after olfactory ensheating cells (OECs) transplantation combined with methyprednisolone administration and investigate the molecular mechanisms of OECs transplantation combined with methyprednisolone administration in promoting the recovery of the spinal cord.Methods Acute spinal cord injury was established in SD rats ( T10 ) by using NYU instrument. The rats were randomly divided into control group, SCI group, DF12 group, OECs transplantation group,methyprednisolone administration group and OECs + methyprcdnisolone group. The mRNA and protein expressions of the neurofilament in the SCI regions of rats in different groups at different time points were detected by using immunohistochemistry, RT-PCR and Western blotting. Results A significant increase of mRNA and protein expressions of the neurofilament could be found in the other five groups compared with the control group at days 7, 14 and 28 after SCI. The mRNA and protein expressions of the neurofilament in the injury region of the OECs group, the methyprednisolone group and the OECs + MP group were more significantly increased than that of the SCI group and the DF12 group. The expression of the neurofilament in the injury region of the OECs + MP group was more significantly increased than that of the OECs group and the MP group ( P ＜ 0. 05). Conclusions OECs transplantation or methyprednisolone administration can induce the mRNA and protein expressions of the neurofilament. Meanwhile, OECs transplantation combined with methyprednisolone administration can significantly increase the mRNA and protein expressions of the neurofilament, as may be one of mechanisms promoting spinal cord repair.
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Objective To explore the law of apoptosis of lumbar spinal cord neurons in cauda equina syndrome (CES). Methods Cauda equina of rats was compressed by a piece of silica gel stick. From day 1 to day 28, the lumbar spinal cord specimens were harvested and assessed by Nissl's staining and TUNEL staining. Results Compression of cauda equina caused lesion and apoptosis of neurons in lumbar spinal cord, and the extent of apoptosis reached the peak on 7th day after compression. Conclusion Apoptosis of neurons in lumbar spinal cord might be one of the reasons why patients with CES get poor prognosis.
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Objective To investigate the effects of erigeron breviscapus (Vant.) Hand-Mazz (erigeron breviscapus) pretreatment on pathology and oxyradical level in the spinal cord after ischemia-reperfusion (I/R) injury in rabbits. Methods A total of 40 New Zealand white rabbits were randomly divided into three groups: sham-operation group with 10 rabbits treated with only abdominal aorta exposure without occlusion, control group with 15 rabbits that underwent ischemia for 50 minutes and treated with matched saline, and experimental group with 15 rabbits that underwent ischemia for 50 minutes and treated with erigeron breviscapus (9mg/kg) injection before ischemia. Malondialdehyde (MDA) level and superoxide dismutase (SOD) activity in the spinal cord were examined at 6 and 24 hours after I/R, respectively. The morphological changes and the number of the spinal cord anterior horn motor neurons were observed and counted under the light microscope and electron microscope, respectively. Results The level of MDA was markedly decreased and SOD activity was increased in the experimental group compared with those in the control group (P<0.01). Compared with that in the control group, the number of motor neurons in the experimental group significantly increased at 24h after I/R (P<0.01) and the morphous of the motor neurons improved. Conclusion Erigeron breviscapus can reduce oxyradical production and the apoptosis of nerve cells, and protect nerve tissue structure and function after spinal cord I/R.
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Objective To analyze proliferation and differentiation of glial fibrillary acid protein (GFAP)- and nestin-positive (GFAP+/nestin+) cells isolated from the subventricular zone following fluid percussion brain injury to determine whether GFAP+/nestin+ cells exhibit characteristics of neural stem cells. Methods Male Sprague-Dawley rats, aged 12 weeks and weighing 200-250 g, were randomly and evenly assigned to normal control group and model group. In the model group, a rat model of fluid percussion brain injury was established. Five days later, subventricular zone tissue was resected from each group and made into single cell suspension. After serum-free neural stem cell medium culture and subsequent serum-induced differentiation, cell type, proliferation and differentiation capacities were determined by immunofluorescence staining and flow cytometry. Results At 3-7 days after fluid percussion brain injury, nestin+/GFAP+ cells in the single cell suspension from the model group significantly outnumbered those from the normal control group (P<0.01). In the model group, an increased number of small neurospheres with smooth cell edge and bulged center formed after primary culture, and were clearly visible with the increase of culture time and medium replacement. After several passages, many clonal spheres were obtained, suggesting strong self-proliferatiing capacity. Neurospheres from the model group differentiated into astrocytes, neurons and oligodendrocytes. Conclusion GFAP+/nestin+ cells isolated from the adult rat subventricular zone after fluid percussion brain injury are thought to be neural stem cells because of their self-renewal and multi-differentiation capacities.
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Objective To explore the expression and effect of transforming growth factors-β1 (TGF-β1) and heat shock protein (HSP47) on gluteal muscle contracture (GMC). Methods We collected contraction band and adjacent muscle from GMC patients and explored the expression of TGF-β1 and HSP47 using immunohistohemistry, reverse transcription and polymerase chain reaction (RT-PCR), and Western blot analysis. Results TGF-β1 and HSP47 were intensely expressed in fibroblast cells and vascular endothelial cells. The expression of them increased 8.1-fold and 3.6-fold at the mRNA level, respectively (P<0.05). The same changes were found at the protein level, which increased 11.2-fold and 7.6-fold, respectively (P<0.05). Conclusion Up-regulation of TGF-β1 and HSP47 may initiate fibrotic cascade in the gluteal muscles of GMC patients.