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BACKGROUND:Theoreticaly, lumbar semi-rigid fixation can slow down the degeneration of adjacent segments, but there is stil a lack of biomechanical support. OBJECTIVE:To explore the biomechanical effect of semi-rigid fixation system, taking Isobar TTL for instance, on adjacent segment disc by means of finite element analysis. METHODS: The finite element models of USS and Isobar TTL were constructed by putting respective parameters into a validated L2-S5 lumbar model. The angular displacement and von Mises stress of adjacent segments were recorded when the models were subjected to 400 N preload and 7.5 N?m moment of forces under different conditions: flexion, extension, lateral bending and axial rotation. RESULTS AND CONCLUSION:The angular displacement and inter-vertebral disc stress of adjacent segments in the USS and Isobar TTL models were higher than those of an intact state in every condition. But the values in Isobar TTL model were lower than the USS model in varying degrees. Compared with the USS model, the decrease rates of angular displacement in Isobar TTL model for flexion, extension, left bending, right bending, left axial rotation and right axial rotation were 19.2%, 15.1%, 11.1%, 12.2%, 18.4% and 22.1%, respectively. The decrease rates of von Mises stress were 33.0%, 20.2%, 23.9%, 18.6%, 28.8% and 28.0%, respectively. The results suggested that the Isobar TTL, when compared with the USS, partialy reduced the angular displacement and inter-vertebral disc stress of adjacent segments.
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BACKGROUND:For the treatment of distal tibial fractures, open reduction and plate fixation, minimal y invasive percutaneous plate fixation and intramedul ary nail fixation are effective, but each has advantages and disadvantages. OBJECTIVE:To compare the effects of intramedul ary nail combined with blocking screws versus minimal y invasive percutaneous plate fixation in treating distal tibial fractures. METHODS:Fifty-one cases of distal tibial fractures were divided into two groups. The blocking screw group (23 cases) was treated with closed reduction and internal fixation with interlocking nail combined with blocking screws. The plate fixation group (28 cases) was treated with minimal y invasive percutaneous plate fixation. Fracture healing time, recovery of tibial function and complication occurrence were observed during fol ow-up. RESULTS AND CONCLUSION:Al patients were fol owed up for 8 to 32 months. (1) Except one patient in the plate fixation group, the other patients had bony union. The healing time was (4.6±1.7) months in the blocking screw group and (6.9±2.3) months in the plate fixation group. Significant differences in healing time were detected between the two groups (P0.05). (4) Results suggested that interlocking intramedul ary nail combined with blocking screw fixation in the treatment of distal tibial fractures can promote fracture healing and joint function recovery.
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BACKGROUND:Creation of a precise finite element model is an important basis for the finite element mechanical analysis of the spine. The reports on the precise finite element model are less. OBJECTIVE:To create L 3-L 5 lumbar three-dimensional finite element model and validate this model with normal CT data. METHODS:A 39-year-old male healthy volunteer with the height of 175 cm and weighted 65 kg was selected, then the L 3-L 5 lumbar spines were scanned with 16 row spiral CT to obtain 101 CT images with the thickness of 1.25 mm. Solid geometric model was established with Geomagic9.0 software, then determined the unit type, divided the finite element mesh, and established the finite element model for loading and calculating. RESULTS AND CONCLUSION:A L 3-L 5 lumbar three-dimensional finite element model was established. It included 213 736 nodes and 799 779 elements. The ranges of motion of L 3-L 4 and L 4-L 5 segments of the model were consistent with cadaveric biomechanical testing results, verified the effectiveness of the model, so the model could be used for experimental research.
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Objective To explore surgical methods and their efficacy for post-traumatic Made-lung deformity complicated with dorsal or volar angulation in the adults. Methods Volar plate or exter-nal fixator, combined with the techniques osteotomy and bone grafting, were selected to treat adult pa-tients with post-traumatic Madelung deformity complicated with dorsal or volar angulation. The effects were preliminarily evaluated through comparing the volar tilting angle, ulnar inclination, radial shortening and the range of joint motion before and after the operation. Results All the patients were followed up for 6-27 months (mean 16 months). The volar tilting angle, radial inclination, radial shortening, range of joint motion of all patients were improved significantly (P<0.05). Conclusions For patients with Madelung deformity complicated with dorsal angulation, internal fixation of volar plate combined with volar osteotomy and bone grafting is recommended; while dynamic eternal fixator combined with combined with dorsal osteotomy and bone grafting is an ideal choice for patients with Madelung deformity complicated with volar angulation.
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Objective To explore the effect of anterior decompression plus posterior intradural release in treatment of old thoracolumbar fractures with paraparesis. Methods A total of 22 patients with old thoracolumbar fractures with paraparesis were admitted to our hospital since January 2004 to Jan-uary 2008. Before admission, all patients were treated with decompression and internal fixation with pos-terior pedicle system, with bony compression to the spinal cord found through CT scanning and intact spi-nal cord found by MRI but without obvious neurofunction recovery. Of all, 20 patients were kept with the original posterior fixation except for two patients that were fixed with Z-plate after removal of posterior hardware. Autologous bone grafts from iliac were utilized in all patients. Intradural release was done 3-6 months after anterior decompression. Results Of all, 19 patients were followed up for 17-49 months (average 28 months). Twenty patients obtained varied recovery of neurofunction after anterior decompres-sion, with ASIA motor scores increasing from average 59.4 points before decompression to 71.3 after de-compression. The followed-up patients won further recovery after secondary posterior intradural release, with ASIA motor scores further increasing to average 80.6 points. Conclusion For patients with old thoracolumbar fractures combined with paraparesis, the release of intradural sear and fibrocompression is also important besides anterior decompression.
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Objective To design a new method of posterior wall reconstruction for severely corn-minuted and obsolete fracture of the posterior wall of the aeetabulum. Methods (1) Biomechanical study (from two perspectives: the stability and the stress distribution on the femoral head and the acetabu-lure) : six fresh adult' s pelvis and femur specimens were collected and divided into experimental group ( consisted of the left sides) and control group ( consisted of the right sides). After the defects of the pos-terior wall were made, the defects were anatomically reconstructed with the harvested ilium by acetabular tridimentional memory fixation system (ATMFS) in the experimental group, whereas the acetabular frag-ments were repositioned to the defect sites and fixated by the plates and screws in the control group. Lon-gitudinal and latitudinal displacement, stability of the anatomically reconstructed posterior wall of the ace-tabulum, the fitness of femoral head to the acetabulum after anatomical reconstruction and mean and maxi-mum pressure of anterior wall, posterior and cupuh of the acetabuhm were analysed and compared. (2) Cinical study: The posterior wall defect on the harvested ilium piece was repaired with 3-directional loc-king of ATMFS in 10 male patients (at age of 16-50 years, mean 36.4 years) from January 2000 to June 2002. There were seven patients with flesh acetabular fractures and three with old acetabular fractures.The period from fracture to reconstruction for the patients with old fractures was 58-251 days ( 137.7 days an average). The patients were foUowed up for 5.8 years (average 5.2-7.1 years). Results (1) Biomechanical study showed no statistical difference upon stability and fitness of femoral head to acetabu-lum after reconstruction in experimental and control groups. (2) Clinical study: postoperative X-ray film showed no repeated displacement of the fracture and the patients began out-of-bed movement with weight bearing after 1.6 months (1.2-2.1 months). Heterotopic ossification was found in two patients, with no influence on the joint function. According to the elinieal ranking standard of Modified d' Aubigne and Postal, the excellence rate was 93%. Conclusions Anatomical reconstruction of posterior wall of the acetabulum by using serf ilium with ATMS has good stability and stress distribution of the femoral head and the reconstructed acetabulum in clinical application and offers a new method for treatment of severely comminuted and obsolete fracture of posterior wall of acetabulum.
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Objective To investigate the treatment effect of proximal femoral nail antirotation (PFNA) on unstable femoral intertrochanterie fractures in the elderly. Methods A retrospective stud- y was done on 65 patients with unstable femoral intertrochanteric fractures, who were treated with PFNA from December 2005 to October 2006 and followed up for at least half a year. There were 22 males and 43 females, at age range of 67-97 (mean 78.5 years). All the operations were carried out within a week af- ter fractures. The data of operation time, operative blood loss, complications, bone healing time and hip function scores were recorded for evaluating treatment outcomes. Results All the patients were fol- lowed up for 6-18 months (average 10.5 months). The operation lasted for (29.6±7.5) minutes, with mean blood loss of (150.5±40.2) ml and bone healing time of (9.1±2.2) weeks. All patients ob- tained satisfactory treatment results, except for 3 patients with proximal thigh pain, 2 with pulmonary in- fection occurred and 1 with thrombs of lower limb vein. Harris post trauma hip function score was (88.5 ± 6.3) points. Conclusion PFNA is an effective way for femoral unstable intertrochanteric fractures in the elderly, for it is characterized by short operation time, less blood loss and stable fixation.
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[Objective]To preliminarily explore the method and evaluate the effect of volar LCP fixation for dorsally displaced and unstable distal radial fractures.[Method]Thirty-five patients with the fractures were treated with volar LCP combined with the techniques of K-wires and bone grafting, whose effects were evaluated preliminarily through comparing and analyzing the volar tilt, radial inclination, radial shortening and wrist function.[Result]Followed up from 9 to 24 months (average 17months), 20 patients achieved excellent, 12 good and 2 fair with 1 poor, according to Sarmiento scale.[Conclusion]Volar LCP fixation is a safe and effective treatment for unstable and dorsally displaced distal radial fractures, which could prevent reduction lost, reduce need for bone grafting and avoid tendon irritation.
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[Objective]To compare the therapeutic effect on femoral intertrochanteric fractures with dynamic hip screw(DHS) and proximal femoral nail antirotation(PFNA).[Method]A retrospective study of 483 patients with femoral intertrochanteric fractures in Changhai Hospital from December 2001 to January 2008 were carried out.Totally 109 patients were treated with PFNA,while 374 patients were treated with DHS.The data of operative time,blood loss,walking time,union time and hip function scores were recorded.[Result]All the patients were followed up for 6~38 months(15.3 months in average).There were significant differences in operative time,blood loss and walking time between two groups.There were no significant difference in union time.There were no significant difference in the excellent rate between the two groups in stable femoral intertrochanteric fractures.The excellent rate of PFNA group was significantly higher than DHS group in unstable femoral intertrochanteric fractures.[Conclusion]Each of them have its own advantages and indications.Both are effective ways to treat stable femoral intertrochanteric fractures.PFNA has more advantages to treat unstable femoral intertrochanteric fractures.
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BACKGROUND: Independent urination and defection functions do not exist in patients with paraplegia above T12 because the injury disrupts the connection to the brain.OBJECTIVE: To reconstruct urination and defecation functions in patients with paraplegia with vascularized intercostal nerve transfer to sacral nerve roots with selected interfascicular anastomosis.DESIGN: Self-control observation.SETFING: Department of Orthopedics, Changhai Hospital of the Second Military Medical University of Chinese PLA.PARTICIPANTS: We recruited 30 patients with traumatic paraplegia at T9-L2 who received treatment in the Department of Orthopedics,Changhai Hospital of the Second Military Medical University of Chinese PLA, from January 1990 to December 2000. Paraplegia plane at T9-T11was found in 17 cases and paraplegia plane at T12-L2 in 13 cases. All the cases had undergone vertebral lamina decompression and internal fixation, 24 of whom had an additional operation to remove the internal fixation.METHODS: Two normal vascularized intercoastal nerves and artery and vein (intercostals nerves were generally at ribs 7 and 8 or 9 and10)above the spinal cord injury site were harvested by cutting in at their distal ends at the midclavicular line and separating the proximal ends from the levatores costarum. The nerves were then transferred to the vertebral canal through a submuscular tunnel. A sural nerve segment that had been harvested and sheared into two segments was sutured to the intercostal nerves by epiperineurial neurorrhaphy and then to the S2-4nerve roots by interfascicular neurorrhaphy. For patients with spinal injury plane below T11, intercostal nerve or subcostal nerve among the 10th and 11th ribs were harvested from the incision of abnormal wall. The nerves were transferred to the lumbar part through the channel of lateral abdominal wall. The transplanted sural nerve was conrected to S2-4 nerve root of partial nerve tract cut alternatively and exposed from S1,2 plane posterior. Defecation function of the patients was evaluated at postoperative 1, 3, 6, 12 and 24 months and follow-up; urodynamic examination was performed before and after operation.patients.RESULTS: A total of 30 patients were followed up for 5 years on average,tion and defecation functions of the patients: 26 (86.6%) had recovered defecation and urination sensation, 23 (76.7%)regained the micturition reflex and uriesthesis; 19 (63%) had recovered function of the detrusor The postoperative maximum urine flow ratio, surplus urine volume, and the maximum systolic pressure of detrusor muscle were obviously improved as compared with those before operation [(12.0±3.0) vs (2.0±0.3) mL/s,(80±12) vs (150±30) mL, (11.76±3.43) vs (5.88±1.47) kPa, P < 0.05]. Postoperative low compliance was found in 9 cases, and detrusor areflexia in 7cases. The number was both significantly decreased as compared with that of preoperative cases (26 and 27 respectively).CONCLUSION: Transfer of vascularized intercostal nerve to S2-4 nerve roots with selected interfascicular anastomosis can reconstruct partial urination and defecation functions, and sensation in buttock, perineal region and cunnus region in paraplegia.
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BACKGROUND: It is often found in the clinic that apart from oppression and instability, there is much difference in sensibility and motion function recovery in patients who have similar imageological changes. Studies show that adhesion in the dura mater of spinal cord, traction of fibrous strip,traumatic scar, malacosis and cyst are the main causes.OBJECTIVE: To investigate the clinical effects of spinal decompression and nerve tissue implantation for obsolete incomplete paralysis.DESIGN: Self-control observation.SETTING: Department of Orthopaedics, Changhai Hospital of Second Military Medical University of Chinese PLA.PARTICIPANTS: We selected 28 patients with traumatic obsolete incom plete paralysis from the Department of Orthopaedics, Changhai Hospital of Second Military Medical University of Chinese PLA, from June 1994 to August 2002. Injured vertebral segments were T7-T9 (5 cases), T10-T12 (12 cases), and L1-2(11 cases). Sixteen patients had undergone decompression, fusion and internal fixation. Thirteen cases of them had undergone posterior decompression and pedicle screw internal fixation. The internal fixation devices had been removed in 7 patients before this procedure. Six cases of traumatic obsolete incomplete paralysis had been treated by hyperbaric oxygen. According to the classification of Frankel, 16 cases were degree B and 12 cases were degree C.METHODS: The dura mater of spinal cord was opened, and the fibrous bands adhering to the spinal cord from arachnoid, pia mater spinalis, ligamenta denticulatum, initial part of nerve root were complete relieved. Then the spinal cord with scar fibers contracted was opened by 3-6 incisions,which were 0.1-0.2 mm deep and longer than the scar part. Cyst found in the spinal cord in 6 cases was opened and the liquid in it was sucked. After that, we denuded spineurium and perineurium of the autogenous sural nerve graft, making the texture and appearance of the nerve look like cauda equine. The nerve was lined in several strips and longitudinally implanted into the incised spinal cord and cyst, and then it was sutured with pia mater spinalis with 9-0 scatheless wire. Finally the endorachis was sutured or covered by sacrospinal muscle.RESULTS: Sixteen cases were followed up for an average of 2.5 years, and all the patients entered the result analysis. The sensibility and motion func tion increased above one grade. Eleven patients who had suffered gatism had obvious progress. The strength of main muscle was increased by 2 grades and reached grade 4 in 16 cases, and walking capability was recovered. In 10 cases it was increased by 1 grade Only sensation had progress in 2 cases.CONCLUSION: Relieving adhesion in the endorhachis, incising the cicatricial spinal cord and bridging the autogenous peripheral nerve have good therapeutic results for gatism and recovering the muscle power of the ex-tremities for the patients with traumatic obsolete incomplete paralysis.
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Objective To observe the effect of human serum containing Niaoduqing Capsule(NC)on proliferation and transdifferentiation of human renal tubular epithelial cells(HK-2).Methods The in-vitro cultured HK-2 were divided into 6 groups according to the culture media: normal control group,uremic serum groups(at the concentration of 5% and 10%), NC-containing serum groups(at the concentration of 5% and 10%),and Monopril group(at the concentration of 10-6mmol/L).Cell proliferation was measured by methylene blue assay.Cell life cycle and the percentage of cells with ?-smooth muscle actin(?-SMA)expression positive in every group were evaluated by flow cytometry.Results The optical absorption value in uremic serum groups was higher than that in the normal control group(P
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Objective To evaluate the effects of external fixators combined with vascularized bone graft in treatment of talar neck fractures. Methods We retrospectively reviewed the records of seven patients who were treated for fractures of talar neck from January 2004 to March 2005 in our department. Of them, six were type Ⅱ and one was type Ⅲ according to the Hawkin s classification. One case was managed with closed reduction and six with open reduction and internal fixation with percutaneous cannulated screws. In addition, all the patients were treated with transarticular external fixators combined with vascularized bone graft. Bone healing, osteonecrosis and hindfoot functional recovery were documented. Results All the patients were followed up for 13 to 24 months (average, 17 months). All of them achieved bony union. According to the Maryland hindfoot scoring system, five cases were excellent and two were good. No avascular necrosis was found. One patient complicated with talar body fracture developed posttraumatic arthritis that was later managed by tibiotalar fusion. Conclusions External fixators combined with vascularized bone graft can effectively prevent avascular necrosis of the talus, but the long-term effects of this method need further observation.
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Objective To explore the incidence of tibial plateau fracture with ligament injuries and the early diagnosis and management of the condition. Methods Fifty seven cases of tibial plateau fractures which had been treated operatively from Jan. 2001 to Jun.2003 and had satisfactory reduction of the articular surface were reviewed. The stability of their knee joints was analyzed. Results The follow up lasted 6 to 30 months with an average of 15 months. The incidence of knee unstability was low. The four potential reasons for the postoperative knee stability were found to be: 1) the low prevalence of ligament injury with displaced fractures of tibial plateau; 2) incomplete ligament disruption or mild ligament injury; 3) anatomic reduction and rigid internal fixation; 4) fine and detailed plan for immobilization and functional exercise. Conclusion The prevalence of complete ligament disruption is low, and nonoperative management can result in satisfactory outcomes for tibial plateau fracture with incomplete ligament injury.
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Objective To analyze the causes of postoperative step off of the tibial plateau fracture and to suggest strategies to cope with them. Methods 57 cases of tibial plateau fracture who had been treated operatively in our department from January 2001 to June 2003 with satisfactory reduction of the articular surface were reviewed. Their radiograms were analyzed. Results The follow ups lasted 6 to 30 months (average 15 months). Postoperative step off rate was 28.1%in all the cases according to radiological step off criteria. (A depression of the articular surface more than 3 millimeters or malalignment of the extremity more than 5 degrees is considered as step off.). Six causes of loss of reduction were: 1) more than sixty years of age, 2) severe osteoporosis, 3) preoperative displacement and fracture fragmentation, 4) poor anti shearing strength of screw and plate, 5) loose bonegraft, and 6) premature weight bearing. Conclusions The key points to enhance the outcome include precise judgment of the type of fracture, sufficient amount of bonegraft, rigid internal fixation after anatomic reduction and an appropriate plan for performing early, loadless, functional exercise. The traumatic osteoarthritis may be avoided or deferred if the above mentioned six causes can be taken into full consideration or preventive measures can be taken.
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Objective To discuss the clinical effects of external fixator combined with limited internal fixation in treatment of serious comminuted distal radius fractures. Methods 35 patients with serious comminuted distal radius fractures were treated by external fixator combined with limited internal fixation from January 2001 to May 2004. There were 16 males and 9 females with an average age of 47.3 years. According to AO/ASIF classification, 9 fractures were A3 type, 9 C2, and 17 C3. Reduction was achieved and maintained in 27 cases by longitudinal traction and external fixation, 5 by external fixator with percutaneous K-wire, and 3 by external fixatator combined with ulnar limited internal fixation. Results All the patients were followed up from 5 months to 30 months (12 months on average). According to the anatomical alignment, 9 were excellent, 24 good, and 2 fair. It was necessary to restore the anatomy of distal radius both on sagittal and coronal planes in order to obtain good functions. Preoperatively, the radial inclination angle was -15? to 15?(10.5? on average), and the palmar tilt angle was -30? to 0?(-10? on average). After operation, the two angels were reduced to 20? to 35?(25? on average), and 0? to 20?(11.5? on average)respectively. The joint function was assessed by Dienst criteria, the results suggested that 12 were graded as excellent, 21 good, and 2 fair. No severe complications were found. Conclusion The treatment of serious comminuted distal radius fractures using external fixator combined with limited internal fixation is of easy performance, reliable fixation, satisfactory effect, and lower complications. It offers a new method which can obviously improve the union of the fractures and decrease the infection rate postoperatively for the treatment of the fractures of distal radius.
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[Objective] To observe the therapeutic effect of Modified Jinsuo Gujin Pill (MJGP) on adriamycin-induced nephropathy in rats. [Methods] Twenty-four SD rats were randomized into normal control group, model group and MJGP group. Except the normal control group, rats in the other two groups were injected with one-dose adriamycin (6 mg/kg) into the caudal vein to induce nephrotic syndrome. Meanwhile, MJGP group was given MJGP decoction 96g/kg and the normal control group was given water of the same volume for 45 days. The effects of MJGP on the levels of 24-hour urine protein, serum total protein (TP), albumin (ALB), serum total cholesterol (TC), blood urea nitrogen (BUN) and serum creatinine (SCr), as well as on the renal histological features were observed. [Results] MJGP decreased the levels of 24-hour urine protein and serum TC, and increased serum TP and ALB levels, the difference being significant as compared with the model group (P
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ObjectiveTo observe the therapeutic effect of Niaoduqing Capsule(NC),which has the actions of lifting clear Qi and purging turbidity,for chronic renal failure(CRF) and to investigate its influence on kidney fibrosis parameters.【Methods】A prospective study was carried out in 78 CRF patients.The patients were equally randomized into two groups.Besides the basic treatment of feeding with small-dose high-quality protein,controlling blood pressure,maintaining water-electrolyte and acid-base balance,Group A received oxyamyli tectus aldehydum and group B received NC.Four weeks constituted one treatment course and the treatment lasted 2 courses.Before and after treatment,the scores of main symptoms and syndrome were counted,and laboratory parameters such as hematoglobin(Hb),red blood cells(RBC) count,serum creatinine(SCr),blood urea nitrogen(BUN),creatinine clearance(CCr),albumin(ALB),total cholesterol(TC),triglyceride(TG),low-density lipoprotein cholesterol(LDL-C),high-density lipoprotein cholesterol(HDL-C),serum laminin(LN),precollagen-Ⅲ(PC-Ⅲ) and hyaluronic acid(HA) were assayed.【Results】Total scores of main symptoms and scores of most single symptom were lower,and effect on the symptoms and total therapeutic effect were better in group B than those in group A(P0.05).【Conclusion】NC has an effect on relieving symptoms of CRF,and improving renal function and kidney fibrosis parameters,indicating that NC exerts a better counteraction on kidney fibrosis.
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Objective To investigate the stability of lumbar column after limited selective posterior rhizotomy(LSPR) and observe the healing of exscinded laminae and the deformation of lumbar column. Methods One hundred and twenty five children with spastic cerebral palsy were divided into six groups(A, B, C, D, E, F)according to the age(