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Objective To explore the clinical outcome with anterior debridement,bone graft and posterior internal fixation with short nail of treating intervertebral infection.Methods Ninteen cases (11 male and 8 female,aged from 34 to 63,46 on average) of lumbar intervertebral space infection treated in our hospital from June 2008 to June 2013 were retrospectively analyzed.These infections occurred at L2-L3 in 2 cases,L3-L4 in 5 cases,L4-L5 in 8 cases and L5-S1 in 4 cases.All patients had history of disc surgery or puncture.The clinical outcome after operation was analyzed according to the low back paine after operation which analyzed by visual analog scale (VAS),and the bone fusion.Erythrocyte sedimentation rata and C-reactionprotein were aslo recorded before and after surgery.Results All cases were followed up,average 24 months.The lower back pain was improved obviously between preoperation and postoperation (P ＜0.05).Also erythrocyte sedimentation rata and C-reactionprotein returned to normal after the operation and all cases had complete bone union at the end of follow-up with no instrument failure noted.Conclusion Anterior debridement,bone graft and posterior internal fixation with short nail in of treating intervertebral infection not only can effectively reconstruct the stability of the spine,but also retain range of motion segment of spine.
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Objective To observe the efficacy of posterior atlantoaxial fusion for C1/C2 fractures combined with ponticulus posticus.Methods A retrospective case series review was performed on data of 12 cases of C1/C2 fractures combined with ponticulus posticus treated from January 2008 to January 2014.There were 7 males and 5 females,aged 35.5 (23.5-49.25) years.Three cases were diagnosed with C1 lateral mass fractures combined with other injury,seven type Ⅱ odontoid fractures,and two type Ⅲ odontoid fractures.Nine cases whose C1 pedicle height ≥4 mm in both sides underwent posterior C1-C2 screw-rod fixation and fusion,and three cases whose C1 pedicle height was ＜ 4 mm underwent posterior C1-C2 hook-screw fixation and fusion.Operation time,blood loss and complications were recorded.Variations in American Spinal Injury Association (ASIA) grade and Visual Analogue Scale (VAS) were compared before operation and at final follow-up.Position of internal implant,fracture healing and fusion were observed.Results Surgery was successful in all cases.Operation time was 145 (120-160) min,and blood loss was 200 (200-300)ml.No intraoperative injury to the vertebral artery injury,venous plexus,spine and nerve root occurred,and no cases showed ponticulus posticus after operation.Follow-up period was 24 (12-33) months.Postoperative imaging demonstrated satisfactory implant placement in all eases.Before operation,one case was rated as ASIA grade A,two as grade D and nine as grade E.One case was rated as ASIA grade A and 11 as grade E at the final follow-up.VAS was improved from preoperative 7 (6-8) points to 0(0-1) points at the final follow-up (P ＜ 0.05).Fracture healing and fusion were observed in all cases at the final follow-up.Conclusion Posterior atlantoaxial fusion for C1/C2 fractures combined with ponticulus posticus is a safe and effective procedure that can promote fracture union without increasing the risk of vertebral artery injury.
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Objective To explore the clinical efficacy of minimally invasive transforaminal lumbar interbody fusion (MIS TLIF) for bilateral isthmic spondylolisthesis on lumbar spine in adolescents. Methods Twentyone patients with bilateral isthmic spondylolisthesis on lumbar spine who received MIS TLIF from February 2012 to April 2014 were enrolled. Fourteen male, aged from 15 to 20 years, 16.3 years on average and 7 female, aged from 14 to 20 years, 15.6 years on average. The clinical outcome after operation was analyzed according to the low back pain and leg pain after operation which analyzed by visual analog scale (VAS) and Oswestry dysfunction index (ODI). The bone fusion were also recorded after surgery by using CT scan reconstruction. Results All cases were followed up 23.7 months on average. The VAS scores of lower back pain preoperative and at the last followup was (8.4 ± 1.2) scores and (2.3 ± 0.8) scores, the scores of ODI preoperative and at the last followup was (72.6 ± 7.4) scores and (29.7 ± 5.3) scores, there were significant differences (P < 0.05). At the last followup, there was no instrument failure noted in all patients,18 patients had complete bone union, while nonfusion were 3 patients. Conclusions MIS TLIF not only have the characteristic of less invasive, but can significantly release clinical symptom and can obtain higher rate of bone union.
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Objective To explore the clinical efficacy of polymethyl methacrylate (PMMA) augmented pedicle screw instrumentation and fusion for old osteoporotic vertebral compression fractures complicated with spinal instability. Methods The clinic data of 26 old patients with osteoporotic vertebral compression fractures complicated with spinal instability treated from June 2011 to June 2015 were retrospectively analyzed. Among them, there were 5 male patients aged from 61 to 72 years and 21 female patients aged from 56 to 75 years. All patients had history of chronic low back pain. The clinical outcome after operation was analyzed according to visual analog scale (VAS) and Oswestry dysfunction index (ODI). The status of bone fusion were aslo recorded before and after surgery. Results There were no pulmonary embolism, infection, toxic reaction of PMMA, and no nerve root compression and damage occurred in patients. The operation time was (105.0 ± 20.5) min, and bleeding volume was (200 ± 55) ml. The operative incision was healed in Ⅰ stage. All patients were followed up for 12-27 months, and average was 14 months. The levels of VAS scores and ODI scores after operation and 1, 3, 6, and 12 months after operation were significantly increased compared with those before operation (P<0.05). Conclusions PMMA augmented pedicle screw instrumentation and fusion is an effective method for old osteoporotic vertebral compression fractures complicated with spinal instability.
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Objective To determine the relation between the graduation and type of Modic change and low back pain. Methods Ninety-seven patients with low back pain associated with Modic change were enrolled, and the data of clinical were analyzed. The degree of back pain was evaluated by visual analog score (VAS) and Oswestry disability index (ODI). The relation between Modic change and the degree of low back pain was evaluated. Results In 97 patients, the type of Modic change:28 cases (28.9%) were type Ⅰ, 37 cases (38.1%) were type Ⅱ, 11 cases (11.3%) were Ⅱ/Ⅲ, and 21 cases (21.6%) were type Ⅲ. The graduation of Modic change:39 cases (40.2%) were minimal, 34 cases (35.1%) were moderate, and 24 cases (24.7%) were severe. The VAS of type Ⅰ, type Ⅱ, typeⅡ/Ⅲand typeⅢin patients with Modic change were (3.8 ± 0.4), (2.6 ± 0.2), (1.7 ± 0.5) and (1.0 ± 0.6) scores, and there were statistical differences (P0.05). Spearman correlation analysis result showed that the graduation of Modic change had no correlation with the intensity of low back pain (r = 0.351, P>0.05). Conclusions The graduation of Modic change does not directly correlate with the low back pain, but the type of Modic lesion is more important.
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Objective To discuss the treatment efficacy and radiotherapy side effects of the preoperative long-course radiochemotherapy and preoperative short-course radiotherapy.Methods 64 patients with local advanced middle and low rectal cancer who got the treatment from April 2004 to April 2010 were analyzed retrospectively.40 patients got the preoperative long-course radiochemotherapy under the dose of DT 45-50 Gy/25 F,1.8-2.0 Gy/F,5 F/W,combining with the synchronous capecitabine chemotherapy (1 650 mg/m2,2 F/d,d1-14/d21-35),and accepted operation 4-6 weeks after the radiotherapy.The rest 24 patients underwent the preoperative short-course radiotherapy under the dose of DT 25 Gy/5 F,5 Gy/F,5 F/W,and got the operation in 2 weeks after the radiotherapy.Results The radical and anus reservation rates in preoperative long-course radiochemotherapy group [85.0 ％ (34/40),65.0 ％ (26/40)] were higher than those in preoperative short-course radiotherapy group [58.3 ％ (14/24),33.3 ％ (8/24)] (x2 =5.689,P =0.019;x2 =6.040,P =0.041).There were no significant differences between the two groups on the index of remission rates,radiation injury,surgical complications,and overall survival rate of 1,3,5 years (all P ＞ 0.05).Conclusions The remission rate and overall survival time between the preoperative long-course radiochemotherapy group and preoperative short-course radiotherapy have no significant difference.But the preoperative long-course radiochemotherapy may improve the anus reservation rate and the radical resection rate,without increasing the radiation injury and surgical complications.
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Objective To discuss the surgical effect of adult lipomatous tethered cord syndrome (TCS). Methods The clinical data of 29 patients with adult lipomatous TCS were systematically analyzed. Eleven of male and 18 of female,who ranged from 20 to 59 years. All patients were performed filum terminale release and lipoma excision, the clinical outcome after operation was analyzed according to Hoffman grading criteria and visual analog scale (VAS). Results According to Hoffman grading criteria, 9 cases were obviously improved in leg muscle weakness, including 1 case with urination disturbance improved significantly. Also the lower back pain of patients were improved obviously: (2.63 ± 1.30) scores vs. (8.67±0.30) scores, there was significant difference (P<0.05). Conclusions Filum terminale release and lipoma excision can effectively improve the symptom of lower back pain of adult lipomatous TCS patients, meanwhile the symptom of paraparesis can improve appropriate postoperatively. But urinary deficits do not show a significant change.
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Objective To investigate the protective effects of erythropoietin (EPO) on myocardium injury after sepsis in rats in order to clarify the mechanisms.Methods The rat models of sepsis were produced by cecal ligation and perforation method (CLP).Ninty-six healthy SD rats were randomly (random number) divided into 3 groups:the sham operation group (Sham group,n =32),the sepsis group (CLP group,n =32),and the EPO treatment group (EPO group,n =32) treated with EPO 1000 IU/kg intraperitoneal injection after the CLP.The observation intervals were set at 3 h,6 h,12 h and 24 h after the surgery.The cardiac hemodynamics of the CLP group were measured.Plasma levels of inflammatory factors and myocardial enzyme indicators were determined by enzyme-linked immunosorbent assay (ELISA) ; Membrane potential levels of chondriosome of myocardial cells,cell apoptosis rates and expressions of nuclear factor-κB p65 of myocardium tissue were detected by flow cytometer; Then the pathological change of myocardium with HE staining was observed under light microscopy.Results (1) Compared with the CLP group,left ventricle systolic pressure (LVSP),left ventricle diastolic end pressure (LVEDP),the maximum rate of left ventricle rise and fall (+ dp/dtmax and-dp/dtmax) in the EPO group improved (P ＜0.05,P＜0.01); (2) Compared with the Sham operation group,plasma levels of tumor necrosis factoralpha (TNF-α),interleukin-6 (IL-6),C-reactive protein (CRP),cardiac troponin-I (cTNI),creatine kinase (CK),lactate dehydrogenase (LDH) and glutamine-oxaloacetic transaminase (GOT) in the CLP group increased at each interval (P ＜ 0.05),and those biomarkers in the EPO group were lower than those in the CLP group (P ＜ 0.05) ; On the contrary,plasma level of anti-inflammatory factor IL-10 in EPO group was higher than that in the CLP group (P ＜ 0.01) ; (3) Compared with the Sham operation group,the cell apoptosis rates in the CLP group increased significantly (P ＜ 0.01),and it decreased obviously in the EPO group (P ＜ 0.01); (4) Compared with the Sham group,membrane potential levels of chondriosome of myocardial cell in the CLP group decreased (P ＜0.01),while it increased in the EPO group in comparison with the CLP group (P ＜ 0.01) ; (5) Pathological changes of myocardium after the CLP could be lessened by the EPO treatment.Conclusions EPO may increase membrane potential levels of chondriosome and decrease the apoptosis rates of myocardial cell in rats after sepsis,and it may reduced the production of inflammatory factors to protect the myocardial cell by down-regulating NF-κB p65.Both increased membrane potential level of chonriosome and decreased inflammatory factor may implicate in myocardium protection thereby improving cardiac function after sepsis.
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Objective To compare the clinical outcomes of cervical vertebral reconstruction using titanium mesh and nano-hydroxyapatite and polyamide 66 (n-HA/PA66) mesh as two different kinds of artificial vertebrae. Methods From January 2008 to June 2009 had surgically treated 37 cases of cervical spondylosis with anterior corpectomy for decompression, and artificial vertebrae implanted combined platescrews fixation for cervical reconstruction and fusion. As a vertebral substitution, titanium mesh were implanted in 25 cases ( group A ), and the others (12 cases, group B) were implanted with n-HA/PA66 mesh. The height of fusion space immediately postoperatively and the implanted condition were observed. The fusion rate and the JOA score were recorded to compare the clinical outcomes. Results Two groups received 6-20 ( 15.4 ±4.2 )months follow-up. When follow-up to the end grafts were already fusion. The preoperative JOA score in group A,B [(8.40 ±0.96) scores vs. (8.33 ±1.07) scores(P ＞ 0.05)] were increased to (14.36 ±0.86)scores and (14.83 ±0.71) scores after postoperatively (P＞ 0.05),but there were statistically significant differences between preoperative and postoperative each group (P＜0.05). There were 6 cases artificial vertebrae in group A and 1 case in group B subsided asymptomaticly with 100% choiceness rate. Conclusion These two kinds of artificial vertebrae could show similar outcomes in cervical vertebral reconstruction, but the n-HA/PA66 mesh has a lower subsidence rate.
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Objective To discuss the effects of Modic II changes on clinical outcomes of discectomy for lumbar disc herniation (LDH) with low back pain associated with unilateral sciatica. Methods Sixty-five cases of LDH with low back pain associated with unilateral sciatica received single segment discectomy during January 2007 to January 2009.There were 30 cases with Modic Ⅱ changes in group A, 35 cases without Modic Ⅱ changes in group B. Assessed the clinical outcomes by using MacNab analyzing system and visual analog scale (VAS). Results Two groups of the postoperative clinical symptoms had significant relief, the follow-up of 12 - 36 months, average (20.6 ± 7.5) months. MacNab efficacy evaluation by group A of optimal 10 cases (33.33%), good 17 cases (56.67%), general 3 cases (10.00%). Group B optimal 28 cases (80.00%), good 5 cases (14.29%), general 2 cases (5.71%), there was significant difference in fine rate (P<0.05). Preoperative group A VAS was ( 8.67 ± 0.30) scores, group B was (8.60± 0.32 ) scores (P>0.05). Postoperative group A VAS was (2.63 ± 1.30) scores,group B was (1.09 ±0.50) scores (P< 0.05). Conclusion Modic Ⅱ changes may be one of the reasons which cause the residual low back pain after the discectomy for LDH.
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Objective To evaluate the effectiveness of tobacco control interventions among employees in centers for disease control and prevention (CDC) in Hebei Province. Methods Tobacoo control interventions, including health education, Quit and Win competition, and founding smokeless CDC, were carried out in CDC system in Hebei Province from May 2006 to June 2008. Surveys on smoking rate of employees and on average cigarette quantity consumed by male employee smokers were conducted at the beginning and the end of the interventions. Results In 2006, 9 931 employees in 174 centers at provincial, city, county level in Hebei Province participated in this study. The overall smoking rate was 25.69%. Male employees had a higher smoking rate (51.28%) than the females (0.68%). The smoking rate of male employees was 50.92%, 49.48% and 51.72% for provincial, city and county CDC levels, respectively. The average cigarettes consumed by one smoker in one day were 15.0. In 2008, 9 139 employees in 189 centers participated in this study. The overall current smoking rate was 25.07%. The smoking rate was 52.26% and 0.43% for males and females, respectively. The smoking rates of male employees in provincial and city CDCs were 43.93% and 46.18%, significantly lower than those in 2006. The smoking rate of male employees in county CDCs was 53.98%, much higher than that in 2006. The average cigarettes consumed by one smoker in one day in 2008 were 12.4, significantly less than that in 2006. The current smoking rate of male employees in smokeless CDCs was 48.0% , significantly lower than 56.9% in non smokeless CDCs. Conclusion Male employees in Hebei Province CDC system had a high smoking rate. Tobacco control interventions play a role in reducing smoking rate and cigarettes consumption.