Clinical Features, Diagnosis and Management of Fibrodysplasia Ossificans Progressiva / 罕见病研究

Fibrodysplasia ossificans progressiva(FOP) is a rare congenital disease characterized by progressive heterotopic ossification, causing severe immobility with multi-system involvement. The relatively low incidence rate and incomplete knowledge among clinicians of the disease often result in misuse of invasive procedures or surgical treatment, leading to the progression of heterotopic ossification. To promote the knowledge of FOP, this article presents a comprehensive review involving epidemiology, pathological mechanisms, clinical features, diagnosis, and management of the FOP.

Meta analysis of operative versus non-operative treatment for thoracolumbar burst fracture without neurological deficit / 中华创伤杂志

Objective To compare the outcomes of operative with non-operative treatment for thoracolumbar burst fracture without neurological deficit using Meta-analysis.Methods Electronic database were searched from inception to February 2014 by two independent reviewers,including Pubmed Medline,Excerpta Medica Database (Embase),Cochrane Central Register of Controlled Trials,Chinese Biology Medicine (CBM),Chinese Wanfang Database,and China National Knowledge Infrastructure (CNKI).Inclusion and exclusion criteria were applied to select the studies.Quality appraisal and data extraction were based on Cochrane Collaboration guidelines.Results Two randomized controlled trials (RCTs),which reported outcomes for 79 patients (41 with operative treatment and 38 with nonoperative treatment) at a follow-up of two years or more were included.Between-study heterogeneity was found to be significant,for one reported better results in surgery group concerning pain relief,function recovery and returning to work.However,opposite results were found in another trial.Meta-analysis showed surgery led to higher complication rates (RR =2.85,95％ CI 0.83-9.75),including subsequent surgery (RR =8.39,95％ CI 1.12-62.87).Conclusion Operative and nonoperative managements produce similar results with respect to pain relief,function regain,and returning to work when performed for thoracolumbar burst fractures without neurologic deficit,but operation is often associated with more complications.

Association of coronal balance reconstruction of unfused segments after posterior selective fusion for thoracolumbar and lumbar idiopathic scoliosis / 中华骨科杂志

Objective To assess the relationship between reconstruction of coronal trunk shift and changes of unfused segments after selective posterior thoracolumbar/lumbar curves fusion for idiopathic scoliosis.Methods Radiographic data of patients with thoracolumbar/lumbar idiopathic scoliosis who underwent selective posterior correction at our hospital from October 2005 to October 2011 with a minimum of 2 year follow-up period was retrospectively analyzed.Posteroanterior and lateral radiographs of the whole spine before surgery,after surgery and at the last follow-up were performed.Changes of coronal trunk shift during follow-up period were observed and multiple linear regression analysis was performed to determine its relationship with changes of upper thoracic curve,main thoracic curve,lumbar curve,distal unfused segments and coronal sacral inclination.Results Thirty-seven patients with 4 males and 33 females were included in this study.The average age was 14.6±2.0 years (range,12-20 years).The mean follow-up period was 3.6 years (range,2-8.9 years).The mean preoperative Cobb angles of lumbar and thoracic curve were 44.2° and 25.2°,respectively.At the last follow-up,they were corrected to 10.3° and 13.6°,indicating 75.7％ and 44.9％ correction rate,respectively.The pre-and post-operative mean trunk shifts were 2.2 cm and 2.0 cm with no significant differences.At the last follow-up,it compensated to 0.9 cm,which showed significant differences compared with that of postoperation.Linear regression analysis suggested that trunk shift changes during follow-up period were only correlated with changes of distal unfused segments.The regression equation could be described as Changes of trunk shift (cm) =1.248 7+0.137 8×Changes of distal unfused segments (°).Conclusion The reconstruction of coronal trunk balance is mainly compensated by distal unfused segments after selective posterior correction for thoracolumbar/lumbar idiopathic scoliosis.Although preserved most of its levels,unfused thoracic segments do not play an important role in the reconstruction of trunk shift.

Efficacy and safety of thromboprophylaxis with low molecular weight heparin after lumbar decompressive surgery / 中华骨科杂志

Objective To evaluate the efficacy and safety of thromboprophylaxis with low molecular weight heparin after lumbar decompressive surgery.Methods Between January 2004 and April 2011,patients who had undergone lumbar decompressive surgery and had high or very high risk of venous thrombosis were selected.All patients received subcutaneous injection of low molecular weight heparin (Fraxiparine),starting at 6 hours after surgery with a half dose and subsequently once every 24 hours with full dose until discharge.When 24-hour drainage volume was less than 50 ml,the drainage tube was removed 2 hours prior to low molecular weight heparin administration.The occurrences of deep venous thrombosis (DVT),pulmonary embolism (PE),bleeding complications and side effects were recorded.Results Seventy eight patients were enrolled in the study.The average time of drug use was 8.5 days.No symptomatic DVT,PE and major bleeding events occurred.Drainage tube was placed in all patients except 3 patients with lumbar disc herniation.The mean total drainage volume was (319.5±218.5) ml,and the average time from operation to removal of drainage tube was (43.2±14.4) hours.Incision site ecchymosis occurred in 1 patient,incision bleeding in 1 patient,mild elevation in hepatic aminotransferase levels in 4 patients,and mild anaphylaxis in 1 patient.Conclusion It is effective and safe to prevent VTE with low molecular weight heparin for patients with high or very high risk of venous thrombosis after lumbar decompressive surgery.

Prognosis of new occurred proximal thoracic curve after posterior correction in adolescent idiopathic scoliosis / 中华骨科杂志

ObjectiveTo analyze the prognosis of the new occurred proximal thoracic(PT) curve after posterior correction surgery in adolescent idiopathic scoliosis (AIS) patients.MethodsThe radiographs of 21 AIS patients,who had a primary main thoracic (MT) curve and suffered from a new PT curve after posterior correction surgery,were retrospectively reviewed.All patients were followed up for an average of 19.8 months.Imaging parameters including coronal Cobb angle,T1 tilt and radiographic shoulder height,were measured and analyzed.ResultsThe average coronal Cobb angle of the MT curve was 54.3° preoperatively,14.1° at the final follow-up,with an average correction rate of 74.6％.Before operation,5 patients had negative T1 tilt and 16 without T1 tilt.After operation,all the 21 patients had positive T1 tilt and new PT curves;the average T1 tilt was 6.0° and the average coronal Cobb angle of the PT curve was 16.0°.At the final follow-up,the average T1 tilt and coronal Cobb angle of the PT curve were 4.0° and 13.2°,respectively; eighteen patients still had positive T1 tilt and 17 patients still had PT curves larger than 10°.As for the radiographic shoulder height,5 patients had equal shoulders and 16 patients had right shoulder elevation before operation; after operation,19 patients had left shoulder elevation and 6 patients had unbalanced shoulders; at the final follow-up,14 patients still had left shoulder elevation and 5 patients had unbalanced shoulders.At the final follow-up,T1 tilt and coronal Cobb angle of the PT curve were better than those postoperatively immediately,while the incidences of the new PT curve,left shoulder elevation,unbalanced shoulders were all not significantly different from those postoperatively immediately.ConclusionThe new occurred PT curves after posterior correction surgery in AIS patients are difficult to be compensated and could cause shoulder imbalance,thus great attention should be paid to prevent the occurrence of the PT curve.

Gender differences of Scoliosis Research Society-22 scores in adolescent idiopathic scoliosis / 中华骨科杂志

Objective To compare differences of SRS-22 scores between male and female AIS patients.Methods From October 2007 to April 2009,298 AIS patients from 7 spine centers completed simplified Chinese edition of SRS-22 questionnaire,including 62 males and 236 females with an average age of 15.7 years old,and the average Cobb angle was 52.8°.Of 62 male patients,34 were from urban areas and 28 rural areas.Among 236 female patients,132 were from urban areas and 104 rural areas.A comparison was conducted in terms of age,Cobb angle,the ratio of urban population to rural population,and the scores of all domains and the subtotal scores of SRS-22 questionnaire between male and female patients.Results There was no difference of age,Cobb angle and the ratio of urban population to rural population between male and female patients(P＞0.05).The scores of four domains and subtotal scores of SRS-22 questionnaire were significantly higher in male patients when compared with female patients(P＜0.05).Conclusion Gender difference should be taken into the consideration when estimating the quality of life in AIS patients by SRS-22 questionnaire.The quality of life in male patients with AIS was better than that of female patients.

Single or dual growing rod in treatment of early onset scoliosis:which is better? / 中华骨科杂志

Objective To retrospectively analyze the application of single and dual growing rod techniques in treatment of early onset scoliosis,and compare the early results of two techniques.Methods Retrospective study was done on 18 cases of early onset scoliosis treated with growing rod technique from November 2002 to March 2009.Single growing rod group included 5 cases and dual growing rod group included 13 cases.We compared the operation time,intra-operative bleeding,correction rate,changes in distance between C7-S1 and incidence of complications of the first operation between two techniques.Results The average post-operative follow-up duration was 39.9 months (14-89).There was no difference in operation time,intra-operative bleeding and incidence of complications between two techniques.There was no difference in preoperative coronal Cobb angle and preoperative sagittal Cobb angle between single growing rod group and dual growing rod group.Correction rate of dual growing rod group was significantly superior to single growing rod group in coronal plane (P＜0.01),but not in sagittal plane.Increase of the distance between C7-S1 dual growing rod group was significantly larger than the single growing rod group (P＜0.05).Conclusion Growing rod technique is an effective option for early onset scoliosis.Dual growing rod technique is relatively superior to single growing rod technique in correction outcomes.

Improving effect of general spine system on the low back pain and intermittent claudication of patients with lumbar degenerative spondylolisthesis / 中国组织工程研究

BACKGROUND: Low back pain and low limb disability are classical symptoms of patients with degenerative lumbar spondylolisthesis who are often treated with operative internal fixation.OBJECTIVE: To observe the improvement of low-back pain and low-limbs disability of patients with degenerative lumbar spondylolisthesis following the treatment with general spine system(GSS).DESIGN: Self control clinical study with patients as subjects.SETTING: Department of Orthopaedics, Peking Union Medical College Hospital.PARTICIPANTS: Sixteen patients with degenerative lumbar spondylolisthesis combined with lumbar stenosis, including 10 males and 6 females with the average age of 58.5 years(ranged from 42 to 72 years) received treatment in our hospital between September 2001 and December 2001. Patients with low back pain were found in 16 cases and low-limb claudication in 15cases; preoperative spondylolisthesis of grade I was observed in 10 cases and grade Ⅱ in 6 cases.METHODS: After receiving lumbar canal decompression by spinal process and GSS for restoring spondylolisthetic vertebra, as well as internalfixation and lumbar fusion operation, patients were followed up at postoperative week 2 and month 1,3,6,12,18,24 for assessing the low-back pain and low-limb disability and meanwhile preoperative spondylolisthesis and postoperative restroration were also assessed with X-ray.RESULTS: Totally 16 patients were followed up for an average of21.2appeared in 15 out of 16 patients, and intermittent claudication resumed to time of follow-up revealed that all spondylolisthetic vertebra were restored with restoring rate of 100% (16/16).CONCLUSION: GSS was proved of satisfactory therapeutic effect in patients with spondylolisthesis by obviously improving their low-back pain and intermittent claudication.

Anterior spinal fusion with TSRH instrumentation for scoliosis / 中国医学科学杂志(英文版)

<p><b>OBJECTIVE</b>To introduce a new spinal internal fixation system, Texas Scottish Rite Hospital (TSRH), and to investigate its early clinical outcomes.</p><p><b>METHODS</b>The preliminary clinical outcomes of 15 patients with thoracolumbar or lumbar scoliosis treated by anterior spinal fusion with TSRH instrumentation were studied retrospectively. Fourteen patients were diagnosed as idiopathic scoliosis and 1 as neuromuscular scoliosis.</p><p><b>RESULTS</b>Preoperatively, the Cobb's angle on the coronal plane was 55.8 degrees (range 35 degrees to approximately 78 degrees), and 14 degrees postoperatively, with an average correction of 74.8%. The average unfused thoracical curve was 35.9 degrees preoperatively (range 26 degrees to approximately 51 degrees) and 21.8 degrees (10 degrees to approximately 42 degrees) postoperatively, with 40% correction. The sagittal curve of lumbar was kept physiologically, preoperative 27.9 degrees and postoperative 25.7 degrees respectively. The trunk shift was 13.4 mm (5 to approximately 28 mm) preoperatively and 3.5 mm (0 to approximately 7 mm) postoperatively. The averaged apic vertebra derivation was 47.8 mm (21 to approximately 69 mm) before operation and 10.8 mm (3 to approximately 20 mm) after operation. The distance of C7 to center sacrum vertical line (CSVL) was 19.5 mm (16 to approximately 42) preoperatively and 11.3 mm (0 to approximately 32 mm) postoperatively. The apical vertebra rotation was 3 degree in 15 patients preoperatively, and were improved to normal in 10 patients, 1 degree in 4 patients, and 2 degree in 1 patients postoperatively. None had neurological injury and infection. Only 1 patient complained a cool feeling in the low extremity of concave side, and the symptom vanished at 3-month followed up.</p><p><b>CONCLUSION</b>If used appropriately, TSRH anterior spinal system is a good teatment for low thoracic or thoracic lumbar scoliosis.</p>

Study of the mechanism of preventing proteinuria by Yishen Gujing Decoction (YSGJD) in early diabetic nephropathy / 中西医结合学报

To study the mechanism of preventing proteinuria by traditional Chinese medicine YSGJD in early diabetic nephropathy (DN) in rats.

Evaluation of radiographic methods for predicting scoliosis correction / 中华骨科杂志

Objective To evaluate the standing bending, traction and fulcrum bending radiographies in the prediction of scoliosis correction. Methods 27 patients with thoracic scoliosis with an average of 16.4 years old were selected for the evaluation. All the patients were treated with the posterior correction and bone grafting fusion, and fixed with the third generation system of the segmental vertebral fixation, such as TSRH, CD, or CD+Horizon. Measurement of the Cobbs angle was carried out in the preoperative posterior anterior radiographies with the natural position, standing bending, traction and fulcrum bending and in the postoperative posterior anterior radiographies. Results Mean of Cobbs angle at the thoracic curve after operation was 31 degrees, which decreased significantly in comparison with the preoperative data. Average correction rate was 51.6%. The postoperative Cobbs angle at the thoracic curve was positively correlated with the preoperative Cobbs angle in the standing bending, traction and fulcrum bending radiographies. It was significantly different from the preoperative Cobbs angle in the standing bending and traction radiographies, while no difference was seen with the fulcrum bending radiography. Conclusion The fulcrum radiography can be used to evaluate the flexibility of the thoracic scoliosis, and is better than the standing bending and traction radiographies. The three methods should be used together for the analysis of the scoliosis to predict the result of the scoliosis correction.