MSCT evaluates the correlation between epicardial adipose tissue volume and coronary atherosclerosis in patients with type 2 diabetes mellitus / 医学研究生学报

ObjectiveEpicardial adipose tissue directly affects coronary arteries and myocardium due to its special anatomical position and physiological function, but its exact effects in patients with type 2 diabetes mellitus (T2DM) have yet to be confirmed. In this paper, the epicardial adipose tissue volume (EATV) was quantitatively measured by Multi-slice spiral computed tomography (MSCT) to evaluate the correlation between EATV and coronary atherosclerosis in patients with T2DM.MethodsThe clinical data of 172 patients with coronary heart disease and coronary artery computed tomographic angiography (CCTA) were retrospectively analyzed in the first affiliated hospital of Anhui medical university from December 2015 to March 2018. According to the diagnostic criteria for CHD and T2DM, the patients included in the study were divided into the CHD group (45 cases), the T2DM group (44 cases), the T2DM group (42 cases) and the control group (41 cases). The clinical data was measured and recorded such as gender, age, blood pressure, body mass index (BMI), total cholesterol (TC), triglyceride (TG), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C) and other relevant clinical data in each group. EATV was measured by CT post-processing workstation. Compared the differences of related data between groups, it was analyzed the risk factors of diabetes mellitus complicated with coronary heart disease by Logistic regression. The degree of coronary artery stenosis was quantified by Gensini, and analyzed its correlation with EATV. The receiver operating characteristic (ROC) curve was used to determine the suspicious value range of EATV.ResultsIn the CHD group, the diabetes group and the diabetic CHD group, EATV, LDL-C and TC were all higher than those in the control group respectively [(150.10±31.64)cm3, (145.56±37.89)cm3, (167.07±40.00)cm3 vs (115.44±27.95）cm3;（2.44±0.88) mmol/L, (2.47±0.86）mmol/L, （2.50±0.97) mmol/L vs (1.90±0.59) mmol/L; (4.19±0.99) mmol/L, (4.43±0.95）mmol/L,（4.32±1.57）mmol/L vs （3.70±0.59）mmol/L], with statistically significant differences (P<0.05). TG level in the diabetes group was higher than that in the control group [（2.18±1.54）mmol/L vs （1.32±0.61）mmol/L] (P<0.05). Multivariate Logistic regression analysis showed that EATV, age and BMI were independent risk factors for diabetes mellitus with coronary heart disease. The Gensini integral of coronary artery stenosis was positively correlated with EATV (r=0.528, P=0.000). The ROC curve showed that EATV had a high predictive value for coronary heart disease in diabetic patients (AUC=0.767).ConclusionEATV was positively correlated with the severity of coronary heart disease in diabetic patients. The determination of EATV by MSCT has good repeatability and is worthy of clinical promotion.

MSCT evaluates the correlation between epicardial adipose tissue volume and coronary atherosclerosis in patients with type 2 diabetes mellitus / 医学研究生学报

ObjectiveEpicardial adipose tissue directly affects coronary arteries and myocardium due to its special anatomical position and physiological function, but its exact effects in patients with type 2 diabetes mellitus (T2DM) have yet to be confirmed. In this paper, the epicardial adipose tissue volume (EATV) was quantitatively measured by Multi-slice spiral computed tomography (MSCT) to evaluate the correlation between EATV and coronary atherosclerosis in patients with T2DM.MethodsThe clinical data of 172 patients with coronary heart disease and coronary artery computed tomographic angiography (CCTA) were retrospectively analyzed in the first affiliated hospital of Anhui medical university from December 2015 to March 2018. According to the diagnostic criteria for CHD and T2DM, the patients included in the study were divided into the CHD group (45 cases), the T2DM group (44 cases), the T2DM group (42 cases) and the control group (41 cases). The clinical data was measured and recorded such as gender, age, blood pressure, body mass index (BMI), total cholesterol (TC), triglyceride (TG), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C) and other relevant clinical data in each group. EATV was measured by CT post-processing workstation. Compared the differences of related data between groups, it was analyzed the risk factors of diabetes mellitus complicated with coronary heart disease by Logistic regression. The degree of coronary artery stenosis was quantified by Gensini, and analyzed its correlation with EATV. The receiver operating characteristic (ROC) curve was used to determine the suspicious value range of EATV.ResultsIn the CHD group, the diabetes group and the diabetic CHD group, EATV, LDL-C and TC were all higher than those in the control group respectively [(150.10±31.64)cm3, (145.56±37.89)cm3, (167.07±40.00)cm3 vs (115.44±27.95）cm3;（2.44±0.88) mmol/L, (2.47±0.86）mmol/L, （2.50±0.97) mmol/L vs (1.90±0.59) mmol/L; (4.19±0.99) mmol/L, (4.43±0.95）mmol/L,（4.32±1.57）mmol/L vs （3.70±0.59）mmol/L], with statistically significant differences (P<0.05). TG level in the diabetes group was higher than that in the control group [（2.18±1.54）mmol/L vs （1.32±0.61）mmol/L] (P<0.05). Multivariate Logistic regression analysis showed that EATV, age and BMI were independent risk factors for diabetes mellitus with coronary heart disease. The Gensini integral of coronary artery stenosis was positively correlated with EATV (r=0.528, P=0.000). The ROC curve showed that EATV had a high predictive value for coronary heart disease in diabetic patients (AUC=0.767).ConclusionEATV was positively correlated with the severity of coronary heart disease in diabetic patients. The determination of EATV by MSCT has good repeatability and is worthy of clinical promotion.

Pedicle Subtraction Osteotomy with a Cage Prevents Sagittal Translation in the Correction of Kyphosis in Ankylosing Spondylitis / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Sagittal translation (ST) is an accidental event that surgeons commonly encounter during a spinal osteotomy in the correction of kyphosis in ankylosing spondylitis (AS). However, there is a paucity of effective techniques to prevent ST. The purpose of this study was to propose a pedicle subtraction osteotomy (PSO) with a cage as a method to prevent ST and to explore the efficacy and feasibility of this method in the treatment of kyphosis in AS.</p><p><b>METHODS</b>We retrospectively reviewed 89 consecutive patients with AS kyphosis who underwent a PSO (Group B, 46 patients) or a PSO with a cage (Group A, 43 patients) from February 2009 to December 2013. Pre- and post-operative radiographic results were reviewed. ST and complications were analyzed in both groups. Clinical assessment was performed using the Scoliosis Research Society-22 (SRS-22) outcomes metric. The patients were followed up for at least 2 years.</p><p><b>RESULTS</b>Group A achieved the same re-alignment of the kyphotic spine as Group B. Two (4.7%) of the 43 patients in Group A and 14 (30.4%) of the 46 patients in Group B had intraoperative ST (χ2 = 10.020, P = 0.002). Significant differences were identified between the two groups in the height change of the osteotomized column. SRS-22 scores improved significantly in both groups. Seven patients experienced neurologic complications (1 in Group A and 6 in Group B). Eight patients had cerebrospinal fluid leakage (2 in Group A and 6 in Group B).</p><p><b>CONCLUSION</b>PSO with a cage significantly avoided ST during the osteotomy procedure and might represent a new, safe, and feasible choice for treating patients with AS kyphosis.</p>

Autotoxic effect of ginsenoside extrats on growth of American ginseng in different medium / 中国中药杂志

Ginsenosides are the abundant secondary metabolites in American ginseng (Panax quinquefolium), it could be released into soil through root exudation and decomposition during plant growth. This study determined ginsenoside contents in American ginseng cultivated soil by HPLC. Three ginsenosides, Rb1, Rb2 and Rd, were detected in the rhizosphere soil of 3-4 years old American ginseng cultivated in Huairou District, Beijing, and their contents were 0.80-3.19 mg x kg(-1). Correspondingly, the contents of the three ginsenosides in soil solution were 4-16 mg x L(-1) at field water-holding capacity of 20%. According to the field soil test data, we designed the concentration of ginsenosides for bioassays (0.2-125 mg x L(-1) in solution or 0.2-125 mg x kg(-1) in soil). The results showed that radicle lengths of American ginseng were reduced by 6%-23% in solution containing 0.2-125 mg x L(-1) ginsenoside extract, and a significant difference was observed at concentration of 125 mg x L(-1) (P < 0.05). The shoot lengths of American ginseng were not significantly inhibited by 0.2-125 mg x L(-1) ginsenosides extractions. After 20 days of growth in nutrient solution amended with 25 mg x L(-1) ginsenosides extraction, plant height of 3-year-old American ginseng seedling was decreased by 28% compared to the control, and the biomass of aerial parts was also reduced by 50% (P < 0.05). However, the growth of newly-grown fibrous root was not significantly inhibited. Comparatively, when American ginseng embryos were cultivated into sterile or non-sterile soil, neither radicle lengths nor shoot lengths were significantly affected by 0.2-125 mg x kg(-1) ginsenoside extracts. In conclusion, ginsenosides showed autotoxic effect on growth of American ginseng radicle and adult seedling, however, this effect was weakened in field soil.

Surgical strategy for the treatment of thoracolumbar metastatic tumor and its clinical outcomes / 中国骨伤

<p><b>OBJECTIVE</b>To evaluate surgical strategy and clinical outcomes for the treatment of thoracolumbar metastatic tumor.</p><p><b>METHODS</b>From January 2009 to December 2010,42 patients with thoracolumbar metastatic tumor were treated surgically. Among the patients, 30 patients were male, and 12 patients were female, ranging in age from 28 to 76 years old, with an average age of 56.8 years old. Twenty-five patients had metastatic tumor in thoracic vertebraes, and 17 patients had metastatic tumor in lumbar vertebraes. Thirty-four patients had metastatic tumor in 1 segment, 6 patients had metastatic tumor in 2 segments and 2 patients had metastatic tumor in 3 segments. Two patients had no symptoms and 40 patients had back or leg pain. Eighteen patients had neurologic deficits, and 5 patients had injuries of A degree, 3 patients had injuries of B degree, 4 patients had injuries of C degree, 6 patients had injuries of D degree according to ASIA grading system. The operation goal was made according to Tomita evaluation. The surgical procedures included pallative decompression, tumor curettage and total vertebrectomy, which were decided based on Tomita classification. The pain, spinal cord function,part control of tumor,survival rate and conditions of internal fixation were evaluated at 1 week, 3 months, 6 months, 1 year and 2 years after operation.</p><p><b>RESULTS</b>One patient died in the operation. Pain relief was obtained in 38 patients after operation. Among 18 patients suffering from spinal cord compromise, 17 patients improved 1 to 4 grades after surgery according to the ASIA grading system. All the patients were followed up and the duration ranged from 24 to 48 months, with a mean time of 34.2 months. Five patients got recurrence. The postoperative survival rates at 3 months, 6 months, 1 year and 2 years were 95.2%, 85.7%, 58.2%, 37.6% respectively.</p><p><b>CONCLUSION</b>According to Tomita system, the different surgical treatments can be selected for patients with spinal metastatic tumors, which can relieve pain, improve the neurological status and spine stabilization, maintain local control, improve quality of life.</p>

Preliminary application of intraoperative CT in treatment of severe scoliosis with posterior total pedicle screws / 中国骨伤

<p><b>OBJECTIVE</b>To study the clinical effects and application value of intraoperative CT in treatment of severe scoliosis with posterior total pedicle screws.</p><p><b>METHODS</b>Thirty-two cases of severe scoliosis were retrospectively analysed in our hospital from June 2009 to June 2011,which were treated by posterior total pedicle screws with intraoperative CT including 12 males and 20 females with an average age of 16.8 years ranging from 10 to 38 years. There were 19 cases combined with thoracic kyphosis among 32 cases. Multiple planar reconstruction technology of intraoperative CT was applied to assess screw position. The numbers (rates) of pedicle screws were calculated and evaluated as different grades in upper thoracic vertebra (T1-T4) ,middle thoracic vertebra (T5-T8), lower thoracic vertebra (T9-T12) and lumbar vertebra. The pedicle screws of 2 grade and 3 grade were defined as malpositioned screws. Times of applicating intraoperative CT were calculated. Cobb angle of all cases and kyphosis angle of the cases combined with thoracic kyphosis were measured before and after surgery. Scoliosis correction rates and kyphosis correction rates were calculated.</p><p><b>RESULTS</b>There were 686 pedicle screws placed in thoracolumbar of 32 patients (including 544 thoracic pedicle screws,142 lumbar pedicle screws) and 14 patients underwent osteotomy. The rate of malpositioned screws in thoracolumbar was 7.3% by evaluating with intraoperative CT,and it respectively was 5.6%,11.1%, 6.7% and 4.3% in upper thoracic vertebra, middle thoracic vertebra,lower thoracic vertebra and lumbar vertebra. The malpositioned screws were amended in surgery. The mean times of intraoperative CT was 2.6 times (ranged from 2 times to 4 times). The mean preoperative Cobb angle was 95 degrees (ranged from 78 degrees to 123 degrees) and the mean postoperative Cobb angle was 340 (ranged from 19 degrees to 53 degrees). The mean correction rate of Cobb angle was 64%. The mean preoperative kyphosis angle of the patients combined with thoracic kyphosis was 69 degrees (ranged from 46 degrees to 82 degrees) and the mean postoperative kyphosis angle was 32 degrees (ranged from 22 degrees to 45 degrees). The mean correction rate of kyphosis angle was 54%. Four patients suffered cerebrospinal fluid leak after surgery. No infection, vascular lesion and nervous lesion were found. All patients had an average 18-month follow-up (ranged from 12 to 26 months). No broken nails, broken rods and pseudarthrosis were founded.</p><p><b>CONCLUSION</b>Application of in traoperative CT in severe scoliosis with posterior total pedicle screws can detect and amend malpositioned screws timely in surgery, to avoid secondary surgery for malpositioned screws and protect the safety of surgery. The effects of surgery is satisfactory.</p>

A feasibility research of minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) using hybrid internal fixation for recurrent lumbar disc herniation / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the feasibility of minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) using hybrid internal fixation of pedicle screws and a translaminar facet screw for recurrent lumbar disc herniation.</p><p><b>METHODS</b>From January 2010 to December 2011, 16 recurrent lumbar disc herniation patients, 10 male and 6 female patients with an average age of 45 years (35-68 years) were treated with unilateral incision MIS-TLIF through working channel. After decompression, interbody fusion and fixation using unilateral pedicle screws, a translaminar facet screw was inserted from the same incision through spinous process and laminar to the other side facet joint. The results of perioperative parameters, radiographic images and clinical outcomes were assessed. The repeated measure analysis of variance was applied in the scores of visual analogue scale (VAS) and Oswestry disablity index (ODI).</p><p><b>RESULTS</b>All patients MIS-TLIF were accomplished under working channel including decompression, interbody fusion and hybrid fixation without any neural complication. The average operative time was (148 ± 75) minutes, the average operative blood loss was (186 ± 226) ml, the average postoperative ambulation time was (32 ± 15) hours, and the average hospitalization time was (6 ± 4) days. The average length of incision was (29 ± 4) mm, and the average length of translaminar facets screw was (52 ± 6) mm. The mean follow-up was 16.5 months with a range of 12-24 months. The postoperative X-ray and CT images showed good position of the hybrid internal fixation, and all facets screws penetrate through facets joint. The significant improvement could be found in back pain VAS, leg pain VAS and ODI scores between preoperative 1 day and postoperative follow-up at all time-points (back pain VAS:F = 52.845, P = 0.000;leg pain VAS:F = 113.480, P = 0.000;ODI:F = 36.665, P = 0.000).</p><p><b>CONCLUSION</b>Recurrent lumbar disc herniation could be treated with MIS-TLIF using hybrid fixation through unilateral incision, and the advantage including less invasion and quickly recovery.</p>

Early posterior spinal canal decompression and circumferential reconstruction of rotationally unstable thoracolumbar burst fractures with neurological deficit / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Among the various treatments of neurologically involved unstable thoracolumbar burst fractures, the combination of anterior and posterior instrumentation provides the most stable reconstruction. However, the use of both approaches on a trauma patient may increase the morbidity. This study is a retrospective matched cohort study to evaluate the advantages of a single stage posterior approach for spinal canal decompression in combination with circumferential reconstruction by comparing the clinical and radiographic results.</p><p><b>METHODS</b>From March 2005 to September 2009, patients with matched type spinal fracture, ages at surgery, and involved levels in our institute underwent either a single stage posterior approach (group one, n = 12) or traditional combined approach (group two, n = 14) for spinal canal decompression and circumferential reconstruction were reviewed. Pre- and post-operative X-ray flms were reviewed and changes in Cobb angle of thoracolumbar spine were documented. Intra-operative, post-operative, and general complications were registered.</p><p><b>RESULTS</b>The mean follow-up was (27.7 ± 9.6) months (range, 14 to 56 months) in group one and (29.2 ± 7.4) months (range, 20 to 60 months) in group two (P > 0.05). The mean operation time was 214 minutes (range, 186 ± 327 minutes) in group one and 284 minutes (range, 219 ± 423 minutes) in group two (P < 0.05). The average volume of intraoperative blood loss was 1856 ml (range, 1250 ± 3480 ml) in group one and 2453 ml (range, 1600 ± 3680 ml) in group two (P < 0.05). There was no statistical difference between the groups one and two in average vertebral body height loss at the injured level and the average Cobb angle in sagittal plane before and immediately after surgery. Postoperatively, there was an epidural hematoma in one patient in group one and two patients in group two. Bony union after stabilization was obtained in all patients, without loosening or breakage of screws. Loss of correction (5°) was seen in 1 patient in group one at the 6th month owing to the subsidence of the Titanium mesh cages into the vertebra. In group two, totally four patients suffered respiratory-related complication, including pneumonia in two, severe atelectasis in one and pleural effusions in one. Importantly, there were no intraoperative or postoperative deaths in any group. All patients with incomplete neurologic deficits improved at least 1 Frankel grade.</p><p><b>CONCLUSION</b>Single-stage posterior vertebra resection in combination with circumferential reconstruction is a new option to manage severe thoracolumbar burst fractures.</p>

Effect of continuous cropping and soil treatment on rhizosphere fungal community of Panax quinquefolium / 中国中药杂志

<p><b>OBJECTIVE</b>To analyze the effects of continuous cropping and soil treatment on rhizosphere fungal community of Panax quinquefolium, and the correlation between rhizosphere fungal community and growth of P. quinquefolium.</p><p><b>METHOD</b>Field plot trail of continuous cultivated P. quinquefolium was conducted, meanwhile continuous cropping soil was treated by organic carbon fertilizer plus methylene dithiocyanate and Kingbo respectively. The rate of seedling survival, root disease index and root weight were investigated. Dilution plating was used to analyze the rhizosphere fungal community, multiple comparisons including H, M(a) and J were performed between rhizosphere fungal community and growth of P. quinquefolium.</p><p><b>RESULT</b>As to P. quinquefolium planted in continuous soil, the rate of seedling survival, root weight decreased, root disease index increased remarkably (P<0.05). Meanwhile the fungal counts decreased 50% -63% , the diversity index (H') decreased 39%-43%, while the ratio of Penicillium and Aspergillus increased. There was a significant negative correlation between rhizosphere fungal diversity and P. quinquefolium root disease index (r = -0.970, P=0.006). Organic carbon fertilizer plus methylene dithiocyanate treatment could improve the rate of seedling survival and root weight, and could partly increase the rhizosphere fungal diversity.</p><p><b>CONCLUSION</b>In continuous cropping soil of P. quinquefolium, the rhizosphere fungal counts and diversity index decreased, meanwhile the fungal community composition changed. Organic carbon fertilizer plus methylene dithiocyanate treatment could improve the growth of continuous cultivated P. quinquefolium.</p>

One-stage total en bloc spondylectomy and reconstruction via a single posterior approach for thoracic vertebral symptomatic hemangioma associated with spinal cord dysfunction / 中华外科杂志

<p><b>OBJECTIVES</b>To investigate the surgical results of one-stage total en bloc spondylectomy (TES) and reconstruction via a single posterior approach for thoracic symptomatic vertebral hemangioma associated with spinal cord dysfunction and evaluate its curative effect.</p><p><b>METHODS</b>A total of 9 patients treated with one-stage TES (7 cases) and total vertebrectomy (2 cases) by posterior approach from March 2006 to January 2010 were retrospectively reviewed. The cases included 2 males and 7 females with a median age of 33.6 years (range 14 to 77 years), and with 1 case of Grade A, 3 cases of Grade B, 3 cases of Grade C, 2 cases of Grade D according to Frankel grade system. All patients suffered from moderate to severe pain and neurological deficit with an average symptom duration of 14.4 months (range 3 - 24 months) MRI revealed severe spinal cord compression. The spinal reconstruction was obtained by titanium mesh filled with autograft and posterior internal fixation with rod-screw system.</p><p><b>RESULTS</b>The operation time was 210 minutes on average (180 - 270 minutes) and the average blood loss was 1800 ml (1000 - 5000 ml). The follow-up period lasted from 18 months to 5 years. All cases with preoperative pain relieved after operation. The visual analogue scale pain scores decreased to 1.1 from 8.3 at 3 months after surgery. No disruption of dural mater, cerebrospinal fluid leakage, iatrogenic spinal cord injury and major vessel damage occurred. Up to now, there was no local recurrence in all cases. Significant neurological function improvement was achieved in all patients with one to three grades in Frankel grade system. Fusion of the autograft was well achieved and no internal fixation failure in all patients.</p><p><b>CONCLUSIONS</b>One-stage TES and spine reconstruction by a single posterior approach is feasible, safe and effective to this disease. It is favourable in decreasing the hemangioma recurrence and improvement of the neurological function.</p>

A feasibility research of unilateral incision minimally invasive transforaminal lumbar interbody fusion using pedicle screws and a translaminar screw hybrid fixation / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the feasibility and safety of unilateral incision hybrid fixation using pedicle screws and a translaminar screw in minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF).</p><p><b>METHODS</b>From January to June 2010, 18 patients with single-level lumbar disc disease were treated with MIS-TLIF under METRx(TM) X-tube. After decompression and fixation using unilateral pedicle screws, a translaminar screw was inserted from the same incision to the other side. The results of perioperative parameters, radiographic images and clinical outcomes were assessed.</p><p><b>RESULTS</b>All patients underwent MIS-TLIF were accomplished unilateral hybrid fixation without any neural complication. The average operative time was (107 ± 19) min, the average operative blood loss was (62 ± 21) ml, and the average postoperative ambulation time was (21 ± 5) h. The average length of translaminar facets screw was (52 ± 2) mm, and the postoperative images showed all screws penetrate through facets joint. During the follow-up the visual analogue scale and Oswestry disability index scores were significant improved compared with preoperative (F = 42.221 - 259.833, P < 0.01).</p><p><b>CONCLUSIONS</b>Bilateral hybrid fixation could be completed through unilateral incision by pedicle screws and a translaminar screw in MIS-TLIF, and the advantage including less invasion, quickly recovery, short operative time, and saving fixation cost.</p>

Correction of severe post-traumatic kyphosis by posterior vertebra column resection / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Post-traumatic kyphosis is a common potential complication of spinal trauma and correct management of this problem is becoming ever more important. Although posterior vertebra column resection has been increasingly adopted to correct severe spinal deformity, no series of reports were found on severe post-traumatic kyphosis in the thoracolumbar region. Therefore, the present cohort retrospective study is presented to evaluate the clinical and radiographic results of posterior vertebra column resection with instrument fusion performed in patients with severe post-traumatic kyphosis.</p><p><b>METHODS</b>From May 2004 to May 2006, 53 patients (38 male, 15 female) at an average age of 37.6 years (range, 24 to 66 years), were surgically treated for symptomatic post-traumatic thoracolumbar kyphosis with a posterior wedge closing osteotomy at our hospital. Among them, 5 consecutive adult patients with severe post-traumatic kyphosis were included in this study. Operation time, blood loss and complications were noted in each case. Radiographic documentation was made on the basis of standing anterior-posterior (AP) and lateral views and three dimensional reconstruction images of computed tomography (CT) scans were used to further identify the apex region of a sharp angular deformity. Sagittal correction was assessed in terms of effective regional deformity (ERD) for the injury level. Assessment of radiological fusion at follow-up was based on the presence of trabecular bone bridging at the osteotomy site according to Brantigan. Preoperative and postoperative clinical assessments were performed by using Oswestry disability index (ODI), back pain was rated in all patients by the visual analog scale (VAS) preoperatively, postoperatively and at the latest follow-up.</p><p><b>RESULTS</b>The mean operating time was 265 minutes (220 - 408 minutes), with an average blood loss of 1362 ml (870 - 2570 ml). Each patient finished at least two years of follow-up. The average ERD significantly decreased from 69 degrees (58 degrees - 86 degrees ), preoperatively to 4 degrees (1 degrees - 8 degrees ) after surgery (P = 0.017); with a mean correction of 65 degrees . ERD averaged 10.4 degrees (7 degrees - 17 degrees ) at the latest follow-up with a mean loss of 6.4 degrees . VAS and ODI scores improved from preoperative 7.4 (6.0 - 9.0) and 55.2 (48.0 - 60.0) to 2.3 (1.0 - 4.0) and 12.2 (7.0 - 18.0) at the latest follow-up. Full bone fusion was achieved in all patients. Complications occurred in two patients: one had a transient weakness of the left side lower extremity and the symptom improved spontaneously without further treatment within one month; the other patient suffered a deep wound infection three weeks after the operation, and recovered well by additional debridement, continuous perfusion and drainage.</p><p><b>CONCLUSIONS</b>Posterior vertebra column resection can satisfactorily correct severe post-traumatic kyphosis in thoracolumbar region. Nevertheless, this challenging procedure should be performed by experienced spinal surgeon to minimize complications.</p>

Vertebral column decancellation for the management of rigid scoliosis: the effectiveness and safety analysis / 中华外科杂志

<p><b>OBJECTIVE</b>to explore the effectiveness and safety of vertebral column decancellation (VCD) for the management of rigid scoliosis.</p><p><b>METHODS</b>from May 2004 to February 2008, 32 patients with rigid scoliosis underwent VCD were reviewed. There were 12 males and 20 females with an average age of 18 years (range, 10 - 56 years). The operation techniques included multilevel vertebral body decancellation and residual intervertebral disc resection, followed by realignment and posterior correction with pedicle screws. The effectiveness was evaluated by preoperative and postoperative radiography and three-dimensional CT scan reconstruction at final follow-up. The intraoperative and postoperative complications of all patients were recorded.</p><p><b>RESULTS</b>a mean of 2.1 vertebrae were performed with VCD and a mean of 10.6 vertebral levels were instrumented and fused (range, 8 - 13 vertebrae). The mean duration of surgery was 270 minutes (range, 215 - 380 minutes). The average intraoperative blood loss was 1560 ml (range, 900 - 4800 ml). Complications were encountered in 4 patients. There were 2 cases with transient neurological deficits, 1 case with CSF leak, 1 case with epidural hematoma. The average time of follow-up was 31 months (range, 24 - 48 months). The correction rate was 61% on the coronal plane (from 108° to 42°), and the correction rate was 65% on the sagittal plane (from 82.0° to 28.7°). All patients had solid fusion at osteotomy site, and no instrumentational failure and loosening were found over the follow up.</p><p><b>CONCLUSION</b>single stage posterior VCD is an effective option to manage rigid scoliosis.</p>

The clinical outcomes of surgical treatment for adult idiopathic scoliosis using pedicle subtraction osteotomy / 中华外科杂志

<p><b>OBJECTIVE</b>to evaluate the clinical outcomes of transpedicular lumbar wedge resection osteotomy in treating adult idiopathic scoliosis.</p><p><b>METHODS</b>twenty-five adult idiopathic scoliosis patients treated with transpedicular lumbar wedge resection osteotomy from July 2001 to November 2007 were included, among whom 18 were female and 7 were male. Nine of 25 were with double major curve in thoracic and thoracolumbar/lumbar spine, and 16 were with single curve in thoracolumbar/lumbar spine. The average age was 35 years (29 - 48 years) at operation. Osteotomy were performed at T(11), T(12), L(1) or L(2). The motion evoked potential monitoring system and awaking test were used during surgery. The preoperative, postoperative immediately and latest standing posteroanterior and lateral radiographs were reviewed.</p><p><b>RESULTS</b>all patients were operated successfully. The average operation time was 274 min (range, 220 - 380 min) and the average blood loss were 2328 ml (range, 1500 - 5000 ml). The average coronal Cobb angle of all patients in thoracolumbar/lumbar curves was 88° (range, 70° - 121°) before operation, which was corrected to 43° (range, 35° - 70°). The coronal correction rate was 44%. The average kyphosis angle of all in thoracolumbar/lumbar curves was 63° (range, 50° - 90°) before operation, which was corrected to 10° (range, -40° - 21°). The sagittal correction rate was 86%. Nerve root injury occurred in 3 of all patients who complained about postoperative radicular pain. No spine cord injury, delayed paralysis, infection and instrumentation failure were found. With a follow-up of 2 - 4 years, no correction loss or decompensation happened. The back pain existing before operation was relieved in large measure. The cosmetic appearance were all promoted significantly.</p><p><b>CONCLUSIONS</b>the transpedicular thoracolumbar/lumbar wedge osteotomy is efficient and safe in the correction of adult idiopathic scoliosis. The correction is much better on the sagittal plane than that on the coronal plane.</p>

Treatment of shearing-type and comminuted talar body fractures / 中国骨伤

<p><b>OBJECTIVE</b>To study the treatment and therapeutic effects in the shearing-type and comminuted talar body fractures.</p><p><b>METHODS</b>From October 1988 to September 2005,34 patients with shearing-type or comminuted talar body fractures were followed up. There were 19 males and 15 females ranged from 13 to 55 years (averaged 28.8 years). The disease course ranged from 3 to 14 days (averaged 6.0 days). Ten patients with a displacement of no more than 3 mm were treated with plastic cast. Eighteen patients were treated with open reduction and internal fixation, 6 patients were treated with joint fusion. The assessment of clinical efforts depend on patients' ache, active range of the joint and limp.</p><p><b>RESULTS</b>The mean follow up was 5.04 years (ranged from 3 to 19 years). All the patients were healed. The clinical outcomes were evaluated according to Hawkins evaluation score in which ache, active range of the joint and limp was respectively acssessed. There were 6 patients reached an excellent result, 9 good, 11 fair and 8 poor. Fifteen patients had osteonecrosis, 18 patients had traumatic arthritis of ankle joint, and 14 patients had traumatic arthritis of subtalar joint.</p><p><b>CONCLUSION</b>Patients whose displacement of fracture is not more than 3 mm should be treated with plastic cast. Operation and internal fixation should be performed in patients whose displacement of fracture is more than 3 mm after close reduction. Joint fusion should be performed in patients whose talar body fracture is comminuted severely and the surface of joint can not be repaired. The patients of talar body scissored fracture or comminuted fracture has bad prognosis.</p>

An experimental study of correction of idiopathic-type scoliosis by staple / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate the feasibility of the correction idiopathic-type scoliosis by implanting the staple in growing animal models.</p><p><b>METHODS</b>Fourteen female goats were performed unilateral pedicle screws asymmetric tethering in left side in combination with right rib resection (age: 5 to 8 weeks, weight: 6 to 8 kg). The observing time was about 8 weeks. Goats that had been created scoliosis model successfully were classified in 2 groups randomly.</p><p><b>CONTROL GROUP</b>just removing the posterior tether, no treatment was offered. Correct group: the removing of posterior tether and the stapling of anterior spinal epiphysis were performed simultaneously. Dorsoventral and lateral plain radiographs were taken preoperatively and postoperatively. Serial X-ray postoperatively were performed every 4 weeks to measure the Cobb angle of the spine and to observe the condition of the insert. The observing time is about 8 weeks.</p><p><b>RESULTS</b>Radiography showed that 12 goats had created scoliosis model successfully. CONTROL GROUP (n = 6): Series X-ray show that the change of the Cobb angle was not obviously. The initial curves after the procedures measured an average of 40.8 degrees (28 degrees-56 degrees), the average Cobb angle was 42.5 degrees (30 degrees-58 degrees) after 8 weeks, no statistics difference are found (P > 0.05). Treatment group (n = 6): no complication such as pedicel screw break, instrument loosen, dislocation, injury of blood vessel, nerve injury and organ injury of thoracic cavity etc, were found during the observing period. The initial curves after the procedures measured an average of 44.5 degrees (36 degrees-57 degrees), to some degree, the Cobb angle decreased and the average was 42.5 degrees (30 degrees-58 degrees) after 8 weeks. There are statistics difference between the initial and final curves (P < 0.05).</p><p><b>CONCLUSION</b>As a means of mechanical modulation, stapling can be manipulate conveniently and safely, and can modulate the spinal growth of the animal model successfully, predicted that it may be a new selection for idiopathic-type scoliosis in growing children.</p>

Modified posterior closing wedge osteotomy in patients of posttraumatic thoracic lumbar kyphosis / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate the outcome of posterior trans-pedicle + disc osteotomy in patients with post-traumatic thoracolumbar kyphosis.</p><p><b>METHODS</b>Between June 2000 and June 2003, 26 adult patients, 16 male and 10 female, average 30.6 years old (21 - 42 y), of post-traumatic thoracolumbar kyphosis were corrected by means of single posterior trans-pedicle + disc osteotomy technique. Operation time, blood loss, and surgical complication were counted. Back pain Visual Analog Scale (VAS) Oswestry score and Frankel neurological grade were used to for clinical evaluation. All the radiographic and clinical data were requested at 3 time points (before operation, directly postoperatively, and at final follow-up).</p><p><b>RESULTS</b>No severe complications were found in this group. Local kyphosis (T(10)-L(2) Cobb angle) was corrected from average 22.3 degrees +/- 3.5 degrees to 2.2 degrees +/- 2.1 degrees (corrective rate 90.1%). Intraoperative average blood loss was (680.0 +/- 31.5) ml and average operational time was (186.0 +/- 22.8) min. All the patients finished at least 3 - 5 years follow-up, Neural improvement achieved in this group (before operation Frankel D 12 cases, Frankel C 6 cases and Frankel B2 cases; 3 years postoperation Frankel E 14 cases, Frankel D 2 cases Frankel C1 case and Frankel B 1 case), postoperative back pain was reduced from preoperative 8.6 +/- 1.3 to 2.2 +/- 0.5 in VAS and Oswestry score improved from (62.5 +/- 8.6)% to (16.2 +/- 4.3)% at last follow up.</p><p><b>CONCLUSION</b>Single posterior trans-pedicle + disc osteotomy technique is suitable to thoracolumbar post-traumatic kyphosis.</p>

Clinical outcomes of single level Bryan cervical disc arthroplasty: a prospective controlled study / 中华外科杂志

<p><b>OBJECTIVE</b>To compare the clinical outcomes of single level Bryan cervical disc replacement with traditional anterior cervical discectomy and fusion (ACDF).</p><p><b>METHODS</b>From Dec 2003 to May 2005, 59 patients with primary, single-level cervical radiculopathy and/or myelopathy were prospectively randomized into 2 groups: Bryan group with artificial disc replacement and ACDF group with traditional anterior cervical discectomy and fusion. Operation time, blood loss and hospitalization duration were compared between the 2 groups. Follow-up was taken at six weeks, 3, 6, 12 and 24 months after operation, and each case in both groups was evaluated with serial radiographic studies, neck disability indices (NDI), visual analog scale scores (VAS) for arm and neck pain.</p><p><b>RESULTS</b>No difference was found in the operation time, intraoperative blood loss and hospital stay between the 2 groups. But at the follow-up of 6 weeks and 3 months after operation, significant difference in NDI and VAS of neck pain existed. All replaced segments remained normal range of motion in sagittal rotation, while no motion occurred in any of the fusion segments. In ACDF group movement of the whole cervical spine decreased but gradually recovered to preoperative level in 6 months after operation. In Bryan group, pre- and postoperative motion of the whole cervical spine remained unchanged at any of the follow-up time.</p><p><b>CONCLUSIONS</b>Bryan disc replacement can achieve similar clinical improvement compared with traditional ACDF. Arthroplasty has the advantages of motion maintenance for the cervical spine and short recovery time after operation.</p>

Design and animal study of a posterior instrumentation system with sliding ring pedicle screws without arthrodesis in the immature spine / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate a sliding ring pedicle screw system without arthrodesis for the treatment of scoliosis in the immature spine.</p><p><b>METHODS</b>Twelve goats of 3 months old were randomized into three groups: limited anchoring group, multi anchoring group, and blank contrast group. Growth of the spine and sliding of the instruments were assessed through conventional radiography and three dimensional CT reconstruction scan. Vertebral columns were resected 3 months after operation and pathological sections were observed.</p><p><b>RESULTS</b>Three-dimensional CT scan and pathological analysis indicated no difference in structural development of the instrumented segments of the spine in the two operated groups as compared with the same segments of the spine in the control group. According to gross anatomic evaluation and radiographic measurement, the increase in height from L5 to T10 averaged 43.0 mm in limited anchoring group, 43.5 mm in multi anchoring group and 40.9 mm in blank contrast group. Total sliding in the instrumentation system was 41.2 mm in limited anchoring group and 39.4 mm in multi anchoring group, respectively. There were no statistically significant difference in the longitudinal growth of the spine among the three groups.</p><p><b>CONCLUSIONS</b>The sliding ring pedicle screw system can glide smoothly to accommodate the growth of the immature spine in an in vivo animal model.</p>

Clinical study on transpedicular spinal osteotomy and vertebrectomy in 125 cases of severe rigid spinal deformity / 中华外科杂志

<p><b>OBJECTIVE</b>A retrospective clinical study of 125 patients with severe rigid spinal deformity who underwent transpedicular spinal osteotomy or vertebrectomy by posterior approach only and correction by posterior segmental instrumentation to analyze the risks of posterior alone osteotomy or vertebrectomy including surgical manipulation, operative time, blood lose, complications, so that to evaluate the safety of this procedure.</p><p><b>METHODS</b>All patients suffered from severe rigid spinal deformity. In all of these patients, 27 patients were with severe rigid idiopathic scoliosis, 67 with congenital scoliosis, 7 with old spinal fracture, 17 with spinal tuberculosis, 6 with ankylosing spondylosis and 6 with other disorders. Among them, 88 were male and 37 were female with a average age of 21 years. These deformities were corrected by transpedicle spinal osteotomy or vertebrectomy through only posterior approach. Surgical technique was summarized.</p><p><b>RESULTS</b>A mean surgical time was 210 minutes and blood loss during the procedure was an average of 1400 ml. Intercostal nerve injury occurred in 13 patients with automatic relieve. Dura tearing happened in 6 patients without any neurological problems and healed after removing drainage. Haemothorax and pneumothorax were found in 6 cases during procedure which were healed after 1 week for thoracic drainage. Abdominal skin strain and blister occurred in one patient with ankylosing spondylosis and healed after two weeks. Acute deep wound infection occurred in one case and healed after the treatment of debridement and irrigation. Paraplegia occurred in one patient after surgery and full recovery was noticed after 4 months. The complications occurred principally in earlier stage for this technique.</p><p><b>CONCLUSIONS</b>In correction of severe rigid spinal deformity, transpedicle spinal osteotomy or vertebrectomy by posterior approach only is safe and the procedure is simple. Complications could be avoided by careful operation.</p>