ABSTRACT
Objective:To investigate the clinical value of short segment fusion and long segment fusion combined with posterior pedicle screw system internal fixation in the treatment of degenerative scoliosis.Methods:74 patients with degenerative scoliosis who were treated in the Affiliated Hospital of Southwest Medical University from January 2014 to February 2018 were enrolled in the study. The patients were divided into group A and group B with a random number table of 37 cases each. Group A was treated with short segment fusion and posterior pedicle screw system internal fixation, while group B was with long segment fusion and posterior pedicle screw system internal fixation. The Cobb angle of scoliosis, the balance of coronal and sagittal plane of spine were observed before operation, 1 week after operation, 3 months after operation and 6 months after operation, and the incidence of early and long-term complications were counted.Results:The Cobb angle of scoliosis in group B was lower than that of group A at 1 week, 3 months and 6 months after operation ( P<0.05). There was no significant difference in the balance of coronal plane and sagittal plane between the two groups at 1 week and 3 months after operation ( P>0.05). There was significant difference in the balance of coronal plane and sagittal plane between the two groups at 6 months after operation ( P<0.05). There was no significant difference in the incidence of early postoperative complications between the two groups ( P>0.05). Conclusions:Long segment fusion and posterior pedicle screw system internal fixation can improve the Cobb angle and reduce the incidence of postoperative scoliosis, but it is easy to appear the imbalance of coronal and sagittal planes, which can be selected according to the actual situation.
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Objective:To investigate the role of Akt signaling pathway in the regulation of breast cancer bone metastasis induced pain behavior in rat.Methods:Model rats were randomly divided into three groups:Model group,Model+GSK690693 group and Model+ Saline group.On PID 13,14 and 21,Model+GSK690693 group rats were intrathecally injected with GSK690693,a specific inhibitor of Akt.Model+Saline group were injected with saline instead.The pain related behaviors were respectively recorded on PID 0,7,14 and 21.The expression ofp-Akt in DRG used for western bloting were examed on PID 21.Results:After the injection of Akt specific inhibitor GSK690693 by intrathecal,In the Model+GSK690693 group,the threshold value of mechanical contraction reflex was increased,the spontaneous pain behavior and the expression of p-Akt in DRG decreased.On PID 14 d and 21 d,the pain behavior of rats in Model+GSK690693 group was significantly different from that of Model+Saline group and Model group (P＜0.01);On PID 21 d,There was significant statistical significance (P＜0.01) on the expression of p-Akt and Model in the ipsilateral Model+GSK690693 of DRG group,which was statistically significant (P＜0.05) compared with the Model+Saline group.Conclusion:Intrathecal injection of Akt specific inhibitor GSK690693 inhibits rat pain related behaviors induced by bone metastasis in rat breast cancer.
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Objective To investigate the characteristics and treatment effects in patients with spinal fractures associated with dural tears.Methods A retrospective analysis was made on 185 patients with spinal fractures presenting to hospital from February 2013 to February 2015.There were 103 males and 82 females,aged 17-73 years (mean,58 years).Causes of injury were high falls in 72 patients,traffic collisions in 58,hitting by heavy objects in 41,ground-level falls in 12,and collision events in two.Cervical spine fractures were seen in 65 patients,thoracic vertebra fractures in 51,and lumbosacral vertebral fractures 69.Neurologic deficit was assessed using the American Spinal Injury Association (ASIA) score,including grade A in 24 patients,grade B in 22,grade C in 26,grade D in 37 and grade E in 76.Eighty patients were managed by simply anterior surgery,97 by posterior surgery,and eight by anterior-posterior surgery.Twenty-one patients were found with dural tears (group A) and 164 patients without dural tears (group B).Incidence of dural tears in cervical,thoracic and lumbosacral vertebral fractures were recorded and compared.Preoperative neurologic deficit,laminar fracture and spinal canal encroachment rate were compared between groups.Neurological function and complications associated with dural repair were detected.Results In group A,ten patients were rated ASIA grade A,five grade B,three grade C,one grade D and two grade E.In group B,14 patients were rated ASIA grade A,17 grade B,23 grade C,36 grade D and 74 grade E.Group A accounted for 11％ (7/65) of cervical,10％ (5/51) of thoracic,and 13％ (9/69) of lumbosacral spine fractures (P ＞ 0.05).Nineteen patients (91％) in group A were complicated with neurological deficit,compared to ninety patients (54.9％) in group B (P ＜ 0.01).Eighteen patients (86％) in group A had laminar fractures,compared to fifteen patients (9.1％) in group B (P ＜ 0.01).In group A,rate of spinal canal encroachment was (62.3 ± 12.1)％ and 17 patients (81％) showed spinal canal encroachment of greater than 50％.While in group B,rate of spinal canal encroachment was (36.2 ± 15.6)％ and 25 patients (15.2％) showed spinal canal encroachment of greater than 50％ (P ＜ 0.01).For dural tears in group A,11 patients were treated by direct suturing,four by thoracolumbar fascia repair,three by artificial dural coverage and three by fibrin glue sealing.In group A,19 patients were followed up and one of them presented persistent cerebral spinal fluid leak that necessitated an irrigation and debridement to cure.ASIA score was improved from grade A to B in two patients,grade B to C in one,grade C to D in one and grade D to E in one at the final follow-up.Conclusions Majority patients with spinal fractures associated with dural tears exist severe neurologic deficit,spinal canal encroachment and laminar fractures.Incidence of dural tear in cervical,thoracic and lumbosacral vertebral fractures is similar.Incidence of complications related to dural tear repair is low,but the neurological function recovery is poor after operation.