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Objective To discuss and observe the clinical effect of intervertebral pedicle internal fixation and debride?ment combined with bone graft through posterior approach/trans-intervertebral space approach on the treatment of uni/multi-segmental lumbosacral vertebral tuberculosis (TB). Methods A cohort of 37 patients, with single or multiple segmental ver?tebral destruction due to TB, were treated by trans-intervertebral debridement, posterior pedicle screw system internal fixa?tion and intervertebral bone graft. All patients underwent X-ray,CT and MRI examination to observe the combination treat?ment effect. Results Most patients (n=34) enjoyed primary healing, in which include only 4 cases that presented symptom of nerve root stretch injury during operation but all recovered after 3 months. Other 3 patients underwent secondary healing due to sinus but two were rectifying with anti-TB therapy and wound dressing. The other 1 case suffered from sinus tract was healed through second debridement and rectifying therapy. X-ray, CT and MR at 6 months after operation indicated that all patients present great graft osseous fusion, good recovering of height of vertebral body without kyphosis deformity nor internal fixation loosening nor screw breakage. Conclusion Intervertebral pedicle internal fixation and debridement combined with bone graft through posterior approach/trans-intervertebral space approach is with minimum invasion but good graft fusion ef?fects, harder fixation and satisfactory clinical effects in the treatment of uni/multi-segmental lumbosacral vertebral tuberculosis.
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BACKGROUND:Lots of bone graft materials such as autologous iliac bone, autologous rib, titanium mesh plus alograft are available in the treatment of bone defects after spinal tuberculosis debridement. OBJECTIVE: To compare the fixation effect of different kinds of bone graft materialsvia pedicle approach fixation for treatment of thoracic spinal tuberculosis. METHODS: Totaly 40 patients with thoracic spinal tuberculosis were enroled, including 18 patients accompanied with paraplegia and 15 patients accompanied with kyphosis deformity. Both of them were subjected to by standard anti-tuberculosis treatment for 2-4 weeks and consequent posterior pedicle screw fixation combined with debridement/bone grafting fusion. They were grouped by the variables of bone graft materials: autologous iliac bone, autologous rib, titanium mesh plus alograft groups. Al patients were folowed up for 24 months. The lesion healing, bone graft fusion, rehabilitation of paraplegia, correction of kyphosis and incidence of adverse reaction were observed. RESULTS AND CONCLUSION: The time of bone graft fusion in the autologous iliac bone group was shorter than that in the autologous rib and titanium mesh plus alograft groups (P < 0.05), and there was no significant difference between autologous rib and titanium mesh plus alograft groups. No adverse phenomenons such as grafts and titanium mesh faling off, fracture and displacement, nonunion and pseudarthrosis, tuberculosis recurrence were found in these three groups. After the symptomatic therapy for 3-6 months, the muscle strength of patients with paraplegia and spinal kyphosis deformity basically recovered, spinal kyphosis deformity was basically corrected. These results demonstrate that the treatment effect of autologous iliac bone is the best; however, the treatment effect of autologous rib is as good as the titanium mesh plus allograft.
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10.3969/j.issn.2095-4344.2013.26.003
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BACKGROUND:Majority of patients appeared different degrees of hip joint bursitis and gradual y developed into femoral head necrosis in the early rehabilitation process of severe acute respiratory syndrome. OBJECTIVE:To analyze various causes of the severe acute respiratory syndrome sequela, and to review the treatment method of femoral head necrosis. METHODS:The PubMed database, China Journal Ful-text database (CNKI), VIP database and Wanfang database were retrieved by the first author with computer for the related articles from January 1997 to August 2012. The key words of“infectious atypical pneumonia, sequela, femoral head necrosis, bone ischemia, etiology, infectious atypical pneumonia virus, conservative treatment, operation treatment, total hip replacement”in English and Chinese were put in the title and abstract to search articles. A total of 872 articles were screened out after primary retrieval, and eventual y 56 articles were included for review. RESULTS AND CONCLUSION:Severe acute respiratory syndrome sequela, femoral head necrosis, was related with the dose and duration of hormone, patient’s sensitivity to hormone, using method, the secretion of leptin and bone calcitonin, and also infectious atypical pneumonia virus. The femoral head necrosis caused by the above factors can be treated with conservative treatment to slow down the process of femoral head necrosis and delay prosthesis replacement. Eventual y, most of the patients wil receive surgical method. For the treatment of advanced severe acute respiratory syndrome sequelae femoral head necrosis, prosthesis replacement can get the best effect.
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BACKGROUND: Tendon transplantation is limited by deficiency of donor tendon or immunological rejection. With the development of cell culture and transplantation techniques and biomaterial science, tissue-engineered tendon, a novel ideal tendon substitute, can be used to repair tendon defect. OBJECTIVE: To summarize the research course and novel advances of tissue-engineered tendon. RETRIEVAL STRATEGY: A computer-based online search of PubMed database was undertaken to identify related English articles published between January 1994 and December 2007 with keywords "tissue engineering, artificial biocompatible tendon". In addition, we searched Wanfang database for related Chinese articles dated from January 1994 to December 2007 with the same keywords in Chinese. Eighty articles were collected from the above-mentioned databases, including 55 Chinese and 25 English. Only ①original articles with reliable argument, ②articles with clear viewpoints, and ③articles strongly correlated with the objective of the article were selected. Eight articles with unrelated content and 40 repetitive studies were excluded. LITERATURE EVALUATION: Thirty-two articles accorded with the inclusive criteria were included, including 10 animal experiments and in vivo, ex vivo and cytology experiments, 12 review articles, comments and lectures, and 10 clinical studies. DATA SYNTHESIS: Tendon injury not treated promptly may result in limb disturbance. Tissue-engineered tendons can repair the appearance and rebuilt the function of injured tendon, and serve as permanent substitutes. Currently, although tissue engineering is developing rapidly, there are still many problems in clinical application. Firstly, seed cells cannot only be harvested from autologous tenocytes. Secondly, how to improve materials to become ideal three-dimensional scaffold material for constructing organ, and how to simulate body environment to construct tendon tissue in vitro are still uncertain. CONCLUSION: Using bioreactor to simulate body environment to construct tissue-engineered tendon is future research focus.