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Abstarct:Objective To evaluate mid-term efficacy and complications of Prestige LP cervical disc arthroplasty ( CDA) for treatment of single-level cervical spondylotic myelopathy .Methods Retrospectively analyzed the clinical data of 29 patients who underwent Prestige LP cervical disc arthroplasty from June 2009 to December 2013 and were followed up for 2 to 6 years.Among them, there were 19 males and 10 females, and the average age was (45.4 ±7.6)years old (ranged from 28 to 58 years old).Cardinal symptom of spinal compression occured in 20 cases of them,and nerve root compression occured in the other 9 cases.Clinical symptoms and functional outcomes were evaluated with Japanese Orthopaedic Association(JOA) scores,neck and arm visual analog scale(VAS) scores,and Neck Disability Index(NDI).Oerpation segmental range of motion(ROM) were evaluated with follow-up dynamic X-ray.Displacement,subsidence of the prosthesis,heterotopic ossifi-cation(HO) and other complications were also investigated .Results The 29 patients were followed up for 24 to 66 months,(35.5 ±10.4) months averagely .At the final follow-up,the JOA score,NDI,Neck-VAS and Arm-VAS were (15.62 ±1.12) points,(14.65 ±5.68)%,(1.93 ± 1.10) points,and (0.76 ±0.99) points respectively,which were significant improved compared with (12.03 ±2.23) points,(42.52 ± 16.31)%,(5.00 ±2.22) points,and (4.59 ±3.18) points preoperatively,and the differences were of statistical significance (P<0.05). The opreation segmental ROM was (7.37 ±3.11)°,which was better remained compared with (8.50 ±3.35)°before operation.After the surgery,there were 1 case of forward displacement ,3 cases of backward displacement ,1 case of subsidence of the prosthesis ,3 cases of adja-cent segment degenerations ,and 14 cases of heterotopic ossification .Conclusion The mid-term efficacy and safety of Prestige LP cervical disc arthroplasty is fine .But there is a high incidence of the prosthesis-related complications which may counteract the function of protecting the adjacent segment .Therefore,the indication,operation skills and perioperative period management of cervical disc arthroplasty are impor -tant aspects to avoid the adverse effect .
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Objective To compare the effect of radionuclide bone imaging and MRI in locating responsible vertebrae after osteoporotic vertebral compressive fractures (OVCF).Methods A retrospective analysis was made on 25 patients with OVCF treated by percutaneous kyphoplasty (PKP)from May 2015 to December 2015.There were 4 males and 21 females,at age range of 63-87 years [(73.3 ±6.16)years].The fractured vertebrae included 2 T4,3 T5,2 T6,2 T7,5 T8,3 T9,3 T10,7 T11,9 T12,11 L1,10 L2,2 L3,5 L4 and 1 L5.Cervical imaging examinations (X-ray,bone mineral density,MRI,radionuclide bone imaging) were performed on admission.Oswestry disability index (ODI) and visual analogue scale (VAS) were estimated before operation and 1 d after operation.Results of MRI and radionuclide bone imaging were compared.Results A total of 64 vertebrae were included in our study.Thirty-six vertebrae were recognized as fresh OVCFs by MRI,and 40 by radionuclide bone imaging.Kappa-test indicated the results of the examination methods were statistically significant (P ＜0.05).Specificity (96.6％) and accuracy (98.4％) of MRI were higher than radionuclide bone imaging bone scan (82.8％,92.2％).Conclusions Radionuclide bone imaging has a high consistency with MRI in locating responsible vertebrae after OVCF,but MRI is associated with higher specificity and accuracy.In exceptional cases,radionuclide bone imaging can partly replace MRI as a way to locate OVCF.
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Objective To investigate the curative effect of transpedicular screw fixation plus percutaneous vertebroplasty (PVP) for treatment of severe thoracolumbar osteoporotic vertebral compression fractures (OVCF).Methods Twenty-one patients with severe OVCF presenting to our hospital from July 2012 to May 2015 were analyzed retrospectively.There were nine male and twelve female patients,aged 50-78 years (mean,68.8 years).The level of injury was T1 1 in four patients,T12 in six,L1 in five,L2 in three,L3 in two and L4 in one.Time between injury and surgery was 2-16 d (mean,7.5 d).All patients underwent pedicle screw fixation at the injured level combined with PVP.Visual analogue scale (VAS) was used for evaluation of lower back pain after operation,Oswestry disability index(ODI) for lower back function,lateral thoracolumbar film for Cobb angle and anterior vertebral height compression ratio,and American Spinal Injury Association (ASIA) score for spinal cord nerve function.Postoperative complications were recorded.Results All patients were followed up for 12-21 months [(15.7 ± 2.9) months].Postoperative studies showed significant differences in VAS [(2.9 ± 1.1) scores],ODI [(30.8 ± 7.5) ％],Cobb angle [(21.5 ± 7.3) °] and anterior vertebral height compression ratio [(44.3 ± 13.9) ％] compared to the preoperative measures (P ＜ 0.05).Cobb angle and anterior vertebral height compression ratio at the final follow-up were (23.4 ± 7.7)° and (49.1 ± 13.7)％ respectively,and had no significant differences from the postoperative measures (P ＞ 0.05).According to the ASIA score,eight patients with neural function injury had one to two level recovery at the final follow-up.Asymptomatic cement leakage occurred in seven patients after operation.There was no internal fixation breakage at the final follow-up.Conclusions Transpedicular screw fixation plus PVP can not only restore the height and strength of the injured vertebrae and correct kyphotic deformity,but also relieve low back pain and improve function of the spine.Therefore,the technique is a safe,reliable and effective surgical treatment for severe thoracolumbar OVCF.
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OBJECTIVE@#To investigate the standard value of foot tapping test (FTT) in healthy population and FTT for lower extremity motor function in patients with cervical compressive myelopathy.@*METHODS@#Totally 124 patients [68 males, (58.49±14.60) years old; 56 females, (57.55±18.27) years old] diagnosed of cervical myelopathy and 160 healthy volunteers [80 males, (45.43±17.98) years old; 80 females, (45.2±17.47) years old] participated in our study. The patients who underwent surgery were evaluated both before and 1 year after the surgery. We performed FTT and Grip and Release Test and evaluated with the modified Japanese Orthopaedic Association (JOA) score for cervical myelopathy.@*RESULTS@#The value of FTT was (22.23±2.53) in myelopathic patients, significantly lower than (33.23 ±3.17) in the healthy group (decreasing with age) (P<0.05). The value of FTT was positively correlated with the lower extremity motor function of modified JOA score and the value of Grip and Release Test. In the patients who underwent surgery, the value of FTT was (22.23±2.53) preoperatively and was improved to (28.48±1.99) at one year postoperatively (P<0.05).@*CONCLUSION@#The FTT score has been improved by surgery. The FTT is an easy and useful quantitative assessment for lower extremity motor function in patients with cervical myelopathy, especially those who cannot walk.
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Adult , Aged , Female , Humans , Male , Middle Aged , Cervical Vertebrae , Foot , Lower Extremity , Movement , Orthopedics , Methods , Postoperative Period , Spinal Cord Compression , Diagnosis , Treatment OutcomeABSTRACT
Objective To evaluate the outcome of reoperation(after I stage anterior/posterior operation)for thoracolumbar fractures combined with kyphosis and spinal cord injury. Methods A retrospective study was done on the medical records of 12 patients who underwent two-stage decompression with kyphosis and neurologic deficit due to single-stage approach(anterior or posterior) operation of thoracolumbar fractures combined with spinal cord injury between January 2005 and April 2009.There were 9 males and 3 females,at mean age of 34.6 years(range,19-57 years).According to the Denis classification,there were five patients with burst fractures,five with compression fractures and two with fracture dislocation.All the patients had couns medullaris injury.Of all the patients,five underwent one stage anterior approach surgery and the others underwent posterior approach operation.All the patients had vailous degrees of neurological symptoms.The patients treated with one stage anterior surgery were treated with two stage posterior surgery and the patients treated with one stage posterior surgery were treated with the two stage anterior operation.The mean interval from one stage operation to two stage decompression was 13.4 months(range,12-18 months).The radiologic,neurologic and functional outcomes were assessed through observation of the Cobb angle,Frankel spinal cord injury grading and Japanese Orthopaedic Association Scores(JOA). Results AIl the patients were followed up for mean 25 months (12-48months),which showed primary healing of the incisions in all the patients.The average anterior and posterior heisht of the vertebrae wers corrected from preoperative 42.6%and 70.5%to postoperative 92.5%and 95.7%and to 87.3%and 92.2%at the final follow-up respectively.Neurologic status was improved at least one Frankel grade in the patients who had preoperative incomplete paraplegia.The Cobb angle was corrected from preoperative 36.3°to postoperative 5.8°and to 5.9°at the final follow-up(P<0.05).No patient had any notable loss of correction between discharge and final follow-up.According to JOA coring,the results were excellent in nine patients,good in two and fair in one,with excellence rate of 92%. Conclusions Two stage decompression for epiconus and cauda equina syndrome resulted from one stage approach(anterior or posterior)operation of thoracolumbar fractures combined with spinal cord injury call attain satisfactory correction of the kyphosis and nerve decompression as well as various degrees of nerve function recovery.
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Objective To develop and validate a novel method of atlantoaxial pedicle screw placement by using three-dimensional reconstruction software Mimics and rapid prototyping. Methods Three-dimensional reconstruction of 20 CT scanned cadaver atlantoaxial specimens was performed by using Mimics and the parameters of the pedicles were measured. Then, physical model of the pedicles was manufactured by using rapid prototyping and the parameters of the cadaver pedicles were measured. The parameters of the atlantoaxial pedicle were directly measured. All the data were analyzed statistically to verify the accuracy of the reconstructed images and physical models. The optimal pedicle channel was found to design individual fixation parameters, based on which fixation of cadaver specimens was performed under direct guidance of physical model. The accuracy of fixation was assessed by CT scanning. Results There was no statistical difference in parameters of the reconstructed images, the physical model and the specimens, which could reflect accurate atlantoaxial anatomy. Postoperative CT scanning showed that the pedicle screws were inserted successfully in 16 sides of four specimens, except for one screw wearing medial bone cortex of the atlas artery. Conclusions Three-dimensional reconstruction of the atlantoaxial specimens by using Mimics and physical models made by rapid prototyping technology facilitate atlantoaxial pedicle screw placement and can enhance the accuracy of screw fixation.
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This study was aimed to evaluate the preliminary efficacy and the safety of the fusion cage made of biomimetic nano-hydroxyapatite and polyamide 66 (n-HA/PA66) composites for the structural reconstruction and the restoration of height of vertebral body in the case of cervical spondylosis by anterior surgical procedures. 52 patients with cervical spondylosis, received the therapy by discectomy with or without vertebrae resection and decompression, and the fusion cage of n-HA/PA66 vertebra implant with bone chip, and titanium plate system was fixed. All cases were followed up for 6 to 25 months. All the patients' preoperative symptoms subsided without any serious complication, and no patient complained of lasting soreness. No effusion or flare was found, and no recurrence happened in the follow-up. The preoperative JOA score was 10.4, and post-operative JOA score 15.7. The X-ray films of all cases demonstrated successful fusion with good curvature and height, and there was no sinking or collapse. The stability was satisfactory; the reconstructive height of vertebra was maintained. No complications such as infection and screw broken came into being. The fusion cage of the biomimetic n-HA/PA66 composites can effectively restore the height and structure of vertebra. It may have the potential for use as a satisfactory prosthestic vertebral body replacement.
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Adult , Aged , Female , Humans , Male , Middle Aged , Young Adult , Biocompatible Materials , Therapeutic Uses , Biomimetics , Cervical Vertebrae , Pathology , General Surgery , Hydroxyapatites , Nanoparticles , Nylons , Orthopedic Fixation Devices , Spinal Fusion , Methods , Spondylosis , General SurgeryABSTRACT
Objective To characterize the viability and transgene expression of articular chon-drocytes cultured in 3-Dimensional scaffolds provided by four types of carriers.Methods Articular chondrocytes from rabbit knees were cultured and infected with adenovirus that could express green fluo-rescence protein (AdGFP) and GL3 luciferase (AdGL3-Luc).The viability and gene expression were determined with fluorescence microscopy and luciferase assays in four types of scaffolds;type I collagen sponge, fibrin glue, hyaluronan and open-cell polylactic acid (OPLA).Cartilage matrix production was assessed by Alcian blue staining.Results Articular chondrocytes of rabbits were effectively infected by AdGFP and exhibited sustained GFP expression.All the tested scaffolds supported the survival and gene expression of the infected chondrocytes.However, the highest transgene expression was observed in the OPLA carrier (P<0.01).Alcian blue-positive matrix materials were readily detected in OPLA cultures four weeks later.Conclusion OPLA supports the highest transgene expression and is the most conduc-tive scaffold for matrix production, suggesting that OPLA may be a suitable scaffold for cell-based gene therapy of articular cartilage repair.
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Objective To analyze the clinical features of patients with open injuries combined with infections in Chinese Wenchuan earthquake and summarize the therapeutic experience. Methods An analysis was done on 54 patients with open injuries combined with infection transferred to our depart-ment from May 13, 2008 to June 10, 2008. Thorough debridement was performed based on general sup-porting management and anti-bacterial thempies done on the basis of results of bacteria culture and sus-ceptibility test. In the meantime, other managements including high-pressure oxygen therapy and external fixation were done for open fractures. Results Infection could be found in all open injuries, primarily combined infections with G+ coccus and G- bacillus or anaerobic. Moreover, most of the patients were infected by anaerobia. Of all, 1 patient with amputation received multiple debridement and repair because of severe infection of the amputation site and no death occurred. All patients recovered uneventfully, with sound wound healing, except for 2 patients. External fixation was stable and in good position. Conclu-sions The repeated and thorough debridement and the timely closure of wounds on the basis of energeti-cally anti-infection measures are key to diminishing the mortality rate and mutilation rate. Appropriate ad-junctive therapy can dramatically improve the curative effect.
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Objective To study the clinical effects of the artificial vertebral body of the biomimetic nano-hydroxyapatite/polyamide 66 (n-HA/PA66) composite for the structural reconstruction and the height restoring of the vertebral body in the thoracolumbar fractures by the anterior surgical procedures. Methods From December 2003 to January 2006, 42 patients with thoracolumbar fractures received the anterior surgical procedures to decompress and reconstruct the spinal vertebral structure with the artificial vertebral body of the n-HA/PA66 composite. Among the patients, there were 28 males and 14 females, aged 17-67 years, averaged 43.6 years. The thoracolumbar fractures developed at T12 in 5 patients, at L1 in 17, at L2 in 14, and at L3 in 6. The height of the anterior border of the vertebral body amounted to 29%-47% of the vertebral body height, averaged 40.6%. The Cobb angle on the sagittal plane was 21-38° averaged 27.6°. According to the Frankel grading scale, the injuries to the nerves were as the following: Grade A in 7 patients, Grade B in 19, Grade C in 8, Grade D in 6, and Grade E in 2. Results All the 42 patients were followed up for 6-25 months. Among the patients, 36 were reconstructed almost based on the normal anatomic structure, and 6 were well reconstructed. The mean height of the anterior border of the vertebral body was 40.6% of the vertebral body height before operation but 91.7% after operation. And the reconstructed height of the vertebra was maintained. The mean Cobb angle on the sagittal plane was 27.6°before operation but 13.4° after operation. All the patients had a recovery of the neurological function that had a 1-grade or 2-grade improvement except 7 patients who were still in Grade A and 2 patients who were in Grade D. The implant was fused 3-5 months after operation. No infection, nail break, bar/plate break or loosening of the internal fixation occurred. Conclusion The artificial vertebral body of the biomimetic n-HA/PA66composite can effectively restore the height and the structure of the vertebra, can be fused with the vertebral body to reconstruct the spinal structural stability effectively, and can be extensively used in the clinical practice.
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[Objective]To investigate the in vitro antibacterial effect and biocompatibility of the bone filling materials of TiO_2-Ag-nHA/PA66.[Method]The inhibition ring test and plate-counting method were used to evaluate anti-bacterial performance against staphylococcus aureus ATCC25923 and escherichia coli ATCC25922.The effects of antiadhesion of staphylococcus aureus and escherichia coli were observed by scanning electron microscope(SEM).The cytotoxicity was detected via MTT and the biocompatibility of biofilm was evaluated by acute haemolysis test.[Result]The inhibition zone diameter of staphylococcus aureus and escherichia coli reaches the maximum at the first day[(23.6?1.14) mm and(18.8?0.84 mm)].The diameter of inhibition zone was lessening with the time going.It could effectively inhibite the survival and growth of staphylococcus aureus and escherichia coli within 33 and 24 days.The bacteria killing rate was 94.18% and 85.96%.Scanning electron microscope showed that the adhered bacteria in the experimental group were obviously fewer than in the control group.The MTT graded the cytotoxicity of the bone filling materials of TiO_2-Ag-nHA/PA66 as 1.The acute haemolysis assay showed that the hemolytic rate of bone filling materials of TiO_2-Ag-nHA/PA66 was 0.28%.[Conclusion]The bone filling materials of TiO_2-Ag-nHA/PA66 has good biocompatibility,significant antibacterial property against staphylococcus aureus and escherichia coli.No obvious cytotoxicity or erythrocyte destruction was found.
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BACKGROUND:The main method to treat cervical spinal stenotic myelopathy caused by various factors is posterior lamninectomy, but the postoperative effect was not satisfactory.OBJECTIVE: To observe the postoperative functional reconstruction of the cervical vertebra of the patients with cervical spinal stenotic myelopathy through expansive open-door laminoplasty.DESIGN: An observational study by comparing the changes before and after the operation.SETTING: Department of Orthopaedics of the First Affiliated Hospital of Chongqing Medical University.PARTICIPANTS: Totally 32 patients (22 male and 10 female) with multi-segment cervical spinal stenotic myelopathy were treated at the Department of Orthopaedics of the First Affiliated Hospital of Chongqing Medical University from May 1995 to May 2004. Twelve cases suffered from degenerative spinal canal stenosis caused by spinal cord type of cervical spondylosis, 18 cases suffered from developmental spinal canal stenosis and 2from ossification of cervical posterior longitudinal ligament (OPLL).METHODS: Altogether 32 cases were treated through expansive opendoor laminoplasty to the cervical spine. These patients had been followed up for 6 months after the informed consent was obtained. The spinal function was evaluated according to Japanese Orthopaedic Association 17scores before operation, 2 weeks and 3 months after the operation respectively. The radian of the cervical vertebra, the stability of the spinal column and the complications were observed with X-ray.bility of the spinal column and the complications after the operation.RESULTS: According to intention-to-treat analysis, all the 32 patients entients before and after the operation: According to the evaluation standard stipulated by Japanese Orthopaedic Association (JOA), two weeks and three months after the operation, the scoring of the spinal function was significantly higher in 12 cases of cervical spondylosis myelopathy-induced degenerative stenosis, 18 cases of developmental spinal stenosis and 2 cases of ossification of cervical posterior longitudinal ligament (OPLL)( The score was 5.2, 5.7, 5.5 points respectively before the operation; 9.2, 9.7 , 9.4points respectively 2 weeks after the operation; and 11.3 , 11.8 , 11.6dian of the cervical vertebra, the stability of spinal column, and the complications after the operation: Radiographs indicated vanished cervical anteflexion curvature and straightened cervical vertebrae in three cases, but no re-closure or unstable spine happened.CONCLUSION: Expansive open-door laminoplasty for cervical spinal canal stenosis caused by various factors can still improve and increase the spinal functional evaluation scores shortly and 3 months after the operation, and it does not affect the stability of the cervical vertebrae.
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Objective To evaluate the application and efficacy of direct anterior fixation of odontoid fractures with hollow screw.Methods From March 2001 to January 2006,13 patients with odontoid fractures were treated by direct anterior fixation with hollow screw.Results Of the 13 patients,except 2 patients with postoperative temporary dysphagia, 11 had excellent results.The follow-up was ranged from 9 to 18 months,with an average of 12.5 months.The odontoid fractures acquired fusion,and no unstability or pseudoarthritis was found. Conclusion The technique of direct anterior fixation with hollow screw is an efficacious means in the treatment of odontoid fractures.The meticulous surgical technique along with appropriate patients selection will be the key to successful surgery.
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Objective To evaluate the clinical efficacy and surgical method in radical debridement and spinal fusion with internal fixation in surgical management of cervical vertebra tuberculosis.Methods Twenty-one patients of cervical vertebra tuberculosis were included,mean age of 31 years,including 2 cases at C_(1-2),3 at C_(2-3),9 at C_(4-5),3 at C_(5-6),3 at C_(6-7),1 at C_7T_1.After all patients underwent radical debridement of focuses,15 cases were grafted with iliac bone and 6 with titanium mesh,19 cases were fixed with plate,1 case with Apofix,1 case with Occipital-cervical fusion.The external fixation was needed for 3 months after surgery.Results The follow-up lasted for 21 months.One case grafted with titanium mesh failed,but other patients achieved satisfactory results of successful interbody fusion within 3 to 6 months.The kyphosis deformity was corrected to normal condition without associated complications.The neural symptoms were improved.All patients had no recurrence of tuberculosis.There were no plates and screws broken.Conclusion It is safe and effective to treat cervical vertebra tuberculosis by anterior radical debridement and primary autograft by internal fixation,with high correction rate of local kyphosis deformity,high fusion,and low complication rate.
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The transformaton of medical mode brings forward the new demand for orthopedics education.We should think highly of the cultivation of orthopedics post-graduates' professional ethics so as to promote their communication between medical staff and patients and give emotional concern to patients.Strengthening the cultivation of Orthopedics post-graduates' clinical skill,evidence-based medical thinking and scientific research competence is the key to cultivate the orthopedics talents with high quality and ability.
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30mg partially purified pBMP was implanted into right quardriceps muscle in each rabbit. Whole blood was collected from ear veins before and after the operatin. Lymphocyte proliferation response to nonspecific mitogen PHA and to specific pBMP were measured by lymphocyte transformation test in vitro, using H—labelled thymidine incorporatcon method (~3H—TdR). The skin test and histological investigation of pBMP were also performed. It has been shown that no significant changes of cellular immunity in rabbit were observed after pBMP implantation; the immunogenicity of pBMP was weak. The likelihood of chinical use of pBMP is provided.
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Objective:To observe the result and to study the complications and prevention methods for the different anterior locking cervical plate systems.Methods:150 patients with the cervical fracture-dislocations,spondylotic myelopathy,tuberclusis and tumors of the cervical spine were treated using CSLP?ORION and CODMAN anterior locking cervical plate systems.Results:All the patients were followed up for 3-6 months. The symptom of nervous system recovered,and the bone grafting was fused completely.The complications related to the anterior cervical plate occurred including protrusion of the fixation screws into disc pace,defluxion of the plate,migration of the screws and plate.Most of the complications were caused by insufficient exposure and improperly technological performance.Conclusion:Anterior locking cervical plate systems can provide reliable stability for the fixation segments and it is useful for fusion of the grafting bone,it is important to be familiar with anatomical knowledge of the cervical vertebrae,sufficient exposure of the lesion,correct plate selection and proper technical principles of the different anterior locking cervical plate systems play an important role in avoiding the complications.
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Objective:To observe the efficacy and the complications of Apofix interlaminar clamp in the treatment of atlantoaxial instability and dislocation,and to study the causes of these complications and the preventive measures against them. Methods:17 patients with atlantoaxial instability or dislocation were treated with posterior atlantoaxial fusion and Apofix interlaminar clamp fixation.Results:One case of atlantoaxial dislocation was dead and another dislocation case was redislocated one week after the operation,while the others were followed up for 3 to 24 months and all recovered well.Conclusion:It is simple to apply Apofix interlaminar clamp.The clamp can provide reliable stability for the atlantoaxial segment,and is useful for the fusion of the bone implant.Correct indications are playing an important role in avoiding the complications.