Impact of anterior cervical fusion surgeries on adjacent segments: a finite element analysis / 南方医科大学学报

<p><b>OBJECTIVE</b>To investigate the changes in the range of motion (ROM) and stress of the intervertebral disc and facet joint of the adjacent segments following anterior cervical corpectomy and fusion (ACCF) and anterior cervical discectomy and fusion (ACDF) using finite element analysis.</p><p><b>METHODS</b>A three-dimensional finite element model of the lower cervical vertebrae was constructed and validated by comparing the ROM of the finite element model against the published data. After the validation of successful modeling, finite element models of ACDF and ACCF were constructed. The ROM and the stress of the intervertebral disc and facet joint of the adjacent segments were compared between the intact lower cervical vertebrae and the cervical vertebrae after ACDF and ACCF.</p><p><b>RESULTS</b>The ROM of the finite element model was consistent with the published data. The total ROM and the ROM of the fusion segments with ACDF and ACCF were significantly decreased compared with the intact cervical vertebrae. In the adjacent segments following ACDF and ACCF, the ROM the adjacent segments and the stress peak of the intervertebral disc and facet joint all increased obviously compared with those of intact cervical vertebrae.</p><p><b>CONCLUSION</b>After fusion surgeries, the total ROM of the cervical vertebrae decreases and the ROM of the adjacent segment increases. The stress peak of the intervertebral disc and facet joint of the adjacent segments also increases to significantly alter the physiological characteristics of the intact cervical vertebrae.</p>

Clinical observation on the treatment of atlantoaxial dislocation based on the classification / 中国骨伤

<p><b>OBJECTIVE</b>To retrospectively analyze the surgical methods and its clinical effects and explore a clinical classification and treatment strategy for atlantoaxial dislocation(AAD).</p><p><b>METHODS</b>The clinical data of 89 patients with atlantoaxial dislocation were analyzed from September 2005 to September 2013. There were 49 males and 40 females, aged from 13 to 67 years with an average of 48.1 years. According to the reductive effects with preoperative cervical dynamic radiograph and high weight skeletal traction under general anesthesia, the dislocations were classified into three types:easy reduction type, hard reduction type and irreducible type. The patients with easy reduction type were treated with posterior screw rod internal fixation after manual reduction, while the patients with hard reduction type were treated with posterior screw rod fixation after high weight skeletal traction reduction under general anesthesia. The patients with irreducible type were treated with transoral atlantoaxial joint release or depression and posterior internal fixation and fusion. According to JOA scores to evaluate the neurological status and treatment outcome.</p><p><b>RESULTS</b>Thirty patients were classified as easy reduction type, 55 patients as hard reduction type, and 4 patients as irreducible type. The preoperative JOA score was 8.2±3.1 on average, while the postoperative score was 14.2±2.4. The improvement rate was 40.1% to 82.5% with an average of 62.5%. Eighty nine patients were followed up from 6 to 37 months with a mean of 17.3 months. Eighty two cases obtained anatomical reduction and 85 cases obtained bony fusion. One case complicated with hyponatremia after operation and 1 case combined with Guillain-Barre syndrome, 4 cases complicated with delayed union wounds, 1 case died of for respiratory failure 2 years after operation. No wound infections were found in the patients approach for transoral operation.</p><p><b>CONCLUSIONS</b>According to the cervical dynamic radiograph and high weight skeletal traction under general anesthesia to classify for atlantoaxial dislocation, and adopting well strategies to treat the patients, can achieve satisfactory effects.</p>

Clinical application of continuous douche and vacuum sealing drainage in refractory tissue, bone and joint infections after debridement / 中国骨伤

<p><b>OBJECTIVE</b>To explore effect and the application value of continuous douche and vacuum sealing drainage (VSD) in refractory tissue, and joint infections after complete debridement.</p><p><b>METHODS</b>As retrospective analysis of treatment time and restoration or recurrence, from Jan. 2006 to Dec. 2007, 61 cases of refractory tissue, bone and joint infections underwent continuous douche and VSD combined with the treatment of anti-inflammatory and rehabilitation training after debridement in our hospital. The 61 patients included 39 males and 22 females with age ranging from 10 to 58 years with an average of (35 +/- 12) years, among whom 61 identified to have ankle ulcers combined with infections,open fracture combined with infections, sacrococcygeal pressure ulcers combined with infections, infections after hip replacement, infections after open fracture, and infections after skin avulsion postoperation were 11, 15, 9, 3, 5 and 18 cases respectively. The course was from 2 weeks to 11 months with an average of 4 months.</p><p><b>RESULTS</b>In all 61 patients,the mean healing time was 17, 36, 42, 24, 32, 29 and 28 days in ankle ulcers and infections, tibia and fibula open fracture and infections, femoral shaft fracture and infections, sacrococcygeal pressure ulcers and infections, infections after hip replacement, infections after open fracture, and infections after skin avulsion postoperation respectively. The replacement of VSD was 1, 2-4, 3-5, 1-3, 2-4, 2-3 and 1-3 times in each group respectively. There was no wound recurrence except for 2 cases with recurrent in 61 cases with external fixation nail hole semi-pathological fracture in 1 case of femoral shaft fracture and infection and 1 case of tibia and fibula fracture and infection after follow-up at least one year.</p><p><b>CONCLUSION</b>Application of continuous douche and VSD can effectively decrease incidence of complications and promote the refractory tissue, bone and joint infections wound growth, healing and considerably shorten the healing time.</p>

Isolation, culture and purification of olfactory ensheathing cells from human fetal olfactory mucosa / 南方医科大学学报

<p><b>OBJECTIVE</b>To explore the method for obtaining olfactory ensheathing cells from human fetal olfactory mucosa by cell culture for selective adhesion in the presence of neurotrophin-3 (NT3) and low-concentration serum.</p><p><b>METHODS</b>The olfactory ensheathing cells were cultured alternatively in DMEM/F12 culture medium containing 10% fetal bovine serum (FBS) and the medium containing NT3 and 2.5% FBS every 72 h. The cells were observed for morphological changes and identified using immunocytochemistry with P75NTR and GFAP, and the cell purity was estimated.</p><p><b>RESULTS</b>The olfactory ensheathing cells from human fetal olfactory mucosa were positive for P75(NTR) and GFAP, and in in vitro culture, the cells exhibited dipolar or tripolar appearance with long thin neurites. On the 9th day of cell culture, the purity of the olfactory ensheathing cells reached about 83%.</p><p><b>CONCLUSION</b>The olfactory ensheathing cells can be obtained by in vitro culture for selective adhesion in the presence of NT3 and low-concentration serum.</p>