Comparison between discectomy combined with transpedicular dynamic stabilization and transforaminal lumbar interbody fusion in the treatment of single-level lumbar disc herniation / 中华骨科杂志

Objective:To compare the clinical effects of discectomy combined with transpedicular dynamic stabilization and transforaminal lumbar interbody fusion (TLIF) in treating single-level lumbar disc herniation.Methods:From November 2012 to November 2015, a total of 96 patients with single-level lumbar disc herniation (disc height decreased more than 1/3, the width of the basilar part of the herniated disc >6 mm, massive disc herniation or Modic type I endplate changes) treated by discectomy combined with Dynesys dynamic stabilization (Dynesys group, n=48) or TLIF (fusion group, n=48) were enrolled. Clinical assessments included operation duration, intraoperative blood loss, MacNab score, visual analogue scale (VAS), Oswestry disability index (ODI) and rate of complications. Radiographs were evaluated for lumbar mobility, intervertebral height, etc. Results:A total of 86 patients were included in the final analysis (44 in Dynesys group and 42 in fusion group) and were evaluated after 5 years follow-up. The operation duration of Dynesys group (159.61±37.29 min) was less than that of the fusion group (177.42±39.90 min) significantly ( t=2.140, P=0.035). Intraoperative blood loss in Dynesys group (151.78±50.88 ml) was less than that in fusion group (197.74±76.55 ml) with significant difference ( t=3.293, P=0.001). At 5 years follow-up, there were 2 cases with screw loosening and 5 cases with adjacent segmental degeneration in Dynesys group without symptom. In fusion group, there were 12 cases with adjacent segmental degeneration and two of them with symptom. There were significant differences in the incidence of adjacent segment degeneration between the two groups ( χ2=4.012, P=0.045). According to the MacNab criteria, excellent or good cases accounted for 95% in Dynesys group and 93% in fusion group without significant differences ( Z=0.425, P=0.671). VAS back, VAS leg and ODI scores were improved significantly in both groups after 2 years and 5 years ( P<0.05). However, there were no significant differences between the two groups ( P<0.05). The activity of the surgical segment was 4.59°±0.48° in Dynesys group and 1.00°±0.42° in fusion group at 5 years after surgery. The height of intervertebral space in Dynesys group decreased from 11.19±2.07 mm before surgery to 9.98±2.02 mm at 2 years after surgery and to 9.86±1.64 mm at 5 years after surgery ( F=6.462, P=0.002). However, there was no statistically significant difference between the 2 and 5 years follow-up ( q=0.415, P>0.05). At 5 years after surgery, the activity of the first proximal segment in the two groups was 9.74°±3.29° and 11.69°±3.89°, respectively ( t=2.514, P=0.014). Conclusion:Both discectomy combined with dynamic stabilization and TLIF can achieve satisfied clinical effects in treating single-level lumbar disc herniation. Dynamic stabilization preserves the intervertebral activity of surgical segments and results in a lower incidence of adjacent segment degeneration compared with that in fusion surgery. Furthermore, discectomy combined with dynamic stabilization is a less invasive intervention with shorter operation duration and less blood loss compared with TLIF.

Effects of internal limiting membrane peeling during macular hole surgery on retinal anatomical and functional outcomes / 中华实验眼科杂志

Idiopathic macular hole (IMH) refers to full thickness defects of retinal neuroepithelial layer in macular area without clear reasons,and the combination of pars plana vitrectomy (PPV) with internal limiting membrane peeling (ILMP) is a standard procedure for macular hole.This technique can improve anatomical success and reduce the tangential forces,and thus accelerating the macular hole closure.With increasing use of ILMP and vital dye,the controversial issue of the intentional ILMP has arisen.First,the earliest change in the macula after ILMP is postoperative swelling of the arcuate retinal nerve fiber layer and dissociated optic nerve fiber layer occurs later in the postoperative period;second,retinal thickness modification,such as the thinning of retinal nerve fiber layer (RNFL),ganglial cell layer (GCL) and inner plexiform layer (IPL);third,displacement of foveal area toward optic disc and decrease of the foveal avascular zone area decrease retinal sensitivity and changes of the focal macular electroretinogram.This article reviewed the effects of ILMP during macular hole surgery on retinal anatomical and functional outcomes.

Drug-resistant spectrums and retrospective study of individualize surgery and chemotherapy for patients with drug-re-sistant tuberculosis / 中华骨科杂志

Objective To analyse the phenotypes of the drug?resistant tuberculosis, and investigate the outcomes of the individualize surgery and chemotherapy for these patients. Methods From January 2009 to June 2012, we retrospectively ana?lyzed 49 patients with drug?resistant tuberculosis spondylitis admitted in Southwest Hospital. 33 were initial cases and 16 were re?curring cases. All the 49 patients received individualized open operation or CT?guided percutaneous drainage and local chemother?apy depending on the characteristics of the focus. Individualized chemotherapy regimens were tailored for all patients according to the drug?resistant spectrum and all patients were followed up successfully at least 24 months. All the clinical data were collected and analyzed by statistical methods. Results Among the 49 patients, 14 were monoresistance tuberculosis, 11 were polyresis?tance tuberculosis, and 24 cases were multi?drug resistant tuberculosis. Frequence of the drug?restistance from high to low was Iso?niazid, Rifampicin, Streptomycin, Levofloxacin, Dipasic/Rifapentine, Ethambutol, Protionamide, Capreomycin, Paza?aminosalicy?late, and Amikacin. 43 patients received open operation and 6 patients received CT?guided percutaneous drainage and local che?motherapy. Time of the percutaneous drainage was (48±11) days (39-60 days), and all patients received Individualized chemother?apy with an average of (29.5±2.5) months (24-36 months) postoperatively. At the last follow?up, all patients had remarkable pain remission, 44 patients with paraplegia got slight or remarkable recovery and 17 patients with kyphosis got significant correction. Conclusion The main drug?resistant spectrums are Isoniazid、Rifampicin、Streptomycin、Levofloxacin. The individualized sur?gery combined with individualized chemotherapy made according to the drug?resistance is a feasible treatment for the drug?resis?tant tuberculosis especially the multi?drug resistant tuberculosis.

Surgical strategies based on four clinical classifications of lumbosacral junction tuberculosis / 中华骨科杂志

Objective To study the efficacy and safety of four surgical techniques of tuberculosis of lumbosacral junction retrospectively. Methods Between Jul 2001 and Jan 2013, 79 patients with lumbosacral spinal tuberculosis underwent surgery. Antituberculous chemotherapy and nutrition support prior to surgery were used for at least two weeks. 45 patients underwent single stage radical debridement, fusion and anterior instrumentation (A group). 18 patients underwent combined anterior and posterior spinal surgery (AP group), 10 patients underwent transpedicular drainage, posterior instrumentation, and fusion (P group), and 6 patients underwent anterior radical debridement (D group). All the patients were treated by antituberculous chemotherapy for 18 months and followed regularly. The operation duration, blood loss, clinical status, ESR, VAS, ODI, roentgenogram and 3D?CT were concerned to estimate the progress of tuberculosis. Radiographs were analyzed before surgery, immediately after surgery, and at the final follow?up examination to assess the result of anterior fusion and maintenance of correction. Results There was no inju?ry of blood vessel, ureter or cauda equina during surgery. The mean follow?up period was 23 months (range 18-42 months). No obvious loss of deformity correction was observed. There was no recurrence, no tuberculous peritonitis, and no incidence of im?potence or retrograde ejaculation in any of these patients. The average operating duration(min) were 144.31 ± 23.18, 444.72 ± 141.63, 351.50 ± 85.25, 90.00 ± 29.66, respectively; The average blood loss(ml)were 266.67 ± 104.45, 988.99 ± 488.26, 890.00 ± 306.23, 200.00±104.88, respectively; The average Pre?op VAS were 4.71±1.79, 5.22±1.48, 3.30±1.64, 2.50±1.52, respectively;The average last follow?up VAS were 0.89±0.68, 0.90±0.74, 1.00±0.63, respectively; The average Pre?op ODI(%)were 29.64± 7.85, 32.17±7.59, 28.20±4.26, 20.67±4.63, respectively; The average last follow?up ODI(%)were 5.09±3.59, 4.78±3.78, 4.80± 3.39, 4.00 ± 1.18, respectively; The average Pre?op lumbosacral angle(°)were 20.61 ± 4.92, 23.78 ± 5.84, 25.10 ± 4.28, 21.67 ± 4.27, respectively; The average Post?op lumbosacral angle were 27.17±3.66, 30.56±5.31, 32.10±4.01, 24.83±2.32, respectively;The average last follow?up lumbosacral angle were 23.89 ± 3.12, 27.00 ± 5.46, 29.00 ± 4.85, 23.33 ± 2.50, respectively. Conclu?sion Single stage anterior interbody fusion with anterior instrumentation worked effectively to stabilize lumbosacral junction (less invasive, short surgical duration, no injury of posterior column). Anterior interbody fusion combined with posterior instrumentation was recommended for patients with extensive bone defect and low iliocava junction.

The early diagnosis of mild spinal tuberculosis and outcomes of nonoperative treatment / 中华骨科杂志

Objective To set the criteria of mild spinal tuberculosis and investigate the ettect of standard chemotherapy regimen for further establishing the clinical classification of spinal tuberculosis and standardizing management.Methods According to the criterion,a total of 89 patients with mild spinal tuberculosis were enrolled for outpatient conservative management and follow-up.Ambulant treatments were carried out in all patients,including nutrition support and standard chemotherapy regimen.The regimen was consisting of four first-line antituberculosis drugs (rifampicin,isoniazid,ethambutol and pyrazinamide).All patients were followed up one month later,then every 3 months for the following 12 months,and subsequently at intervals of half a year.The clinical manifestations,kyphosis progression,neurological status,erythrocyte sedimentation rate and liver function were analyzed.Results A mean of 30.62± 13.20 (range,18-46) months' follow-up was achieved in 85 patients,whose tuberculosis lesions were cured completely.Another 4 patients,who were diagnosed with drug-resistant tuberculosis later,had underwent surgery for progressive bone destruction and no response to chemotherapy.The mean visual analogue scale score and Cobb's angle was 5.6± 1.6 and 6.25°±3.11° before chemotherapy,and 2.1 ± 1.1 and 12.36° ±6.31 °at the last follow-up time,respectively.Signals of vertebral body and intervertebral disc returned to normal in 6 patients,while solid bony fusion of adjacent segment was achieved in 79 patients.Asymptomatic mild kyphosis was observed in 69 patients.2 patients with sinus before treatment all healed.No neurological deficit was found.Conculusion For patients early diagnosed with mild spinal tuberuclosis,standard chemotherapy regimen could work safely and effectively for healing the tuberculous lesion,avoiding surgery as well as preventing kyphosis,vertebral instability and neurological deficit.Mild spinal tuberculosis that was early diagnosed could be considered as a subtype of spinal tuberculosis.

Evaluation of repair of large segmental defects with vascularized tissue-engineered bone induced by endothelial progenitor cells in rabbits / 中华创伤杂志

Objective To evaluate the bone healing effect of vascularized tissue-engineered bone induced by endothelial progenitor cells(EPCs)in repair of large segmental radius defects in rabbits.Methods A total of 68 healthy New Zealand white rabbits were enrolled in the study and randomized into three groups,ie,experimental group(EPCs group):EPCs plus bone marrow mesenchymal stem cells (BMSCs)plus decalcified bone matrix(DBM);control group:BMSCs plus DBM;sham control group:pure DBM.Materials mentioned above were implanted into middle radius defects for 15 mm.At 12 and 16 weeks post-operatively,X-ray test,bone mineral density test,histological light microscopic test,osteocalcin immunohistochemical staining test and biomechanical test were carried out.Results Growth and plasticity of callus,speed of medullary cavity recanalization,bone healing speed and biomechanical intensity in the experimental group were all significantly better than those of control group.Conclusions Vascularized tissue-engineered bone induced by EPCs has strong osteegenic ability,can accelerate bone healing and hence is an effective method for repair of large segmental bone defects.

Modified microendoscopy discectomy and conventional microendoscopy discectomy for treatment of lumbar disc herniation: a comparative study / 中华创伤杂志

Objective To explore the outcome, recurrence rate and postoperative MRI of the modified microendoscopy discectomy (MED) and the conventional MED. Method A total of 107 patients with disc herniation treated from January 2005 to December 2009 were randomly divided into Group A (54 patients) and Group B (53 patients). The patients in Group A were treated with the modified MED that removed the prominent nucleus pulposus but did not access into the annulus. The patients in Group B were treated with traditional MED that removed the prominent nucleus pulposus and cut annulus fibrosus and removed the nucleus pulposus within the annulus fibrosus. The operation outcome, recurrence rate and lumbar spine MRI were compared for observing the morphological changes of intervertebral disc and its surrounding structures. Results All patients were followed up for 1-4 years ( average 2 years),which showed no recurrence in Group A but four patients with recurrence Group B. According to Japanese orthopedic association (JOA) scoring of low back pain, the efficacy was excellent in 51 patients (94%)and good in three (6%), with excellence rate of 100% in Group A; while the efficacy was excellent in 42 patients (79%), good in seven (13%) and poor in four (8%), with excellence rate of 92% in Group B. Videman semi-quantitative assessment of disc signal showed no significant difference of MRI in aspects of signal intensity, thickness, diameter of the spinal canal in Group A before and after operation but highlighted significant differences in protruding degree,spinal canal diameter and lateral recess diameter. Substantial differences of MRI in aspects of signal intensity, thickness, protruding degree, spinal canal diameter and width were observed before and after operation in Group B. There was no significant difference in spinal canal diameter. Conclusions Both methods have sound clinical efficacy. However, the modified MED procedures take advantages of minimizing the damage of disc structure, maintaining the relative stability of the spine and delaying the disc degeneration, which contributes to lower recurrence rate.

Principle of multi-echelon medical care for the injured in Chinese Wenchuan earthquake / 中华创伤杂志

Objective To discuss the application value and improvement of principle of multi-echelon medical care in emergent rescue of the injured in Chinese Wenchuau earthquake. Methods The author analyzed and evaluated the medical rescue that was done at disaster site, in the front line hospital and higher level hospitals during earthquake. Results A total of 4 689 patients were treated at disaster site, including 413 patients with severe injury, of whom 3 died. Different kinds of operations including debridement were performed at disaster site, with infection incidence of open wound was nearly 80%. In the front hne hospital, 1 400 patients were treated, with 200 operations done. Of all, 110 patients with severe trauma were treated emergenfly, with an amputation rate of 3.0% and postoperative infection incidence of 66.8%. In the station hospitals, 125 patients received definite surgeries, with 1-5 surgeries per injury site. There was no postoperative cross infection, amputation or death. Conclusions The multi-echelon medical care is the basic mode for medical rescue of large number of patients in natural disaster rescue. First aid at disaster site should be performed as early as possible. Transportation is crucial for successful rescue and an improved patient grading system can help increase the efficiency of rescue. The front line hospitals should mainly provide life support, debridement and fixation of simple fracture, while the specific treatment and definite surgery should be carried out in the station hospitals.

Fabrication of alginate microsphere for controlled release and investigation of its release characteristics in vitro / 生物医学工程学杂志

This study sought to producte alginate sodium microsphere for controlled release bovine serum albumin(BSA) and to investigate the protein release profile of the BSA-alginate sodium microsphere in vitro, which threw some light on the angiogenesis of tissue engineering bone with vascular endothelial growth factor (VEGF) controlled release under stress. The BSA-alginate sodium microsphere was fabricated with W/O emulsification and ion cross-linking method using alginate sodium. The appearance, microsphere diameter and envelopment rate were detected, and the release characteristics of the BSA-alginate sodium microsphere in vitro was investigated. The alginate microsphere was found to be spherical in shape and evenly distributed. Its mean grain diameter was determined to be 230 +/- 60 microm, carrying capacity 80.3 microg/mg and envelopment rate 61%. Smooth controlled release in BSA-alginate sodium microsphere was shown to last more than 2 weeks. Alginate sodium proved an excellent biodegradable material for protein or polypeptide controlled release. The emulsification and ion cross-linking method was noted to be simple; it was propitious to the structural and functional stablility of protein or polypeptide, thus leading to the prolonged efficacious time of the microsphere.

Clinical study on transplantation of iliac allograft with plate in the cervical single level anterior operation / 中国矫形外科杂志

[Objective]To investigate the application value of the iliac allograft combined with anterior plate in the cervical anterior operation.[Method]Sixty-eight cases of anterior cervical decompression and fusion were performed with the iliac allograft combined with anterior plate.The data such as operative time,blood loss during operation and continue X-ray on their cervical spine were recorded,and were compared with the correspondent data of the control group which were transplanted of the iliac autograft combined with anterior plate.[Result]Compared with that of the control group(iliac autograft combined with anterior plate),the operative time and blood loss during operation in the group of iliac allograff combined with anterior plate was less(P

Immortalization of human articular chondrocytes and induction of their phenotype / 中华医学杂志(英文版)

<p><b>OBJECTIVE</b>To immortalize human articular chondrocytes (HACs) using gene transfection and to maintain stable phenotype of transformed HACs after induction.</p><p><b>METHODS</b>HACs were transfected with the retroviral vector pLXSN encoding human papillomavirus 16E7 (HPV16E7), and the transformed clones were sorted and proliferated. Karyotype analysis, clone forming tests and nude mice tumor forming tests were applied to check the characteristics of the transformation. Type II collagen of transformed chondrocytes was inducted with free serum medium (FSM) supplemented with nutridoma-sp and ascorbate.</p><p><b>RESULTS</b>Immortalized HACs were isolated with fifty passages achieved. The HPV16E7 transformed cells were confirmed to be benign. Induction of FSM with nutridoma-sp and ascorbate promoted type II collagen of transformed chondrocytes to the high levels of normal chondrocytes.</p><p><b>CONCLUSION</b>HACs transformed with HPV16E7 survive for long periods in vitro, and type II collagen can maintain stability after induction.</p>

Repair of flexor tendon defects of rabbit with tissue engineering method / 中华创伤杂志(英文版)

<p><b>OBJECTIVE</b>To repair rabbit tendon defects with tissue engineering method.</p><p><b>METHODS</b>The third passage of fetal skin fibroblast cells was labeled with 5-bromo-2' deoxyuridine (Brdu) and then seeded on human amnion extracellular matrix (HA-ECM). Using 1 cm-long-Achilles tendon defects as repairing models in the experimental group, tendon defects were core bridged with polydioxanone (PDS) and then capsulated with the complex of fibroblasts-HA-ECM. In the control group I, defective tendons were sutured with PDS following the former procedure and capsulated with HA-ECM (without fibroblasts). In the control group II, only PDS was applied to connect the defective tendons. Gross examination, light microscopy, scanning electronmicroscopy and biomechanical measurement of the repaired tendons were respectively performed at postoperative 1, 2, 3 month as well as immunohistochemical examination.</p><p><b>RESULTS</b>The optimal cell concentration for seeding fibroblasts was 3.5 x 10(6) cells/ml. Cells grew well and radiated or paralleled on HA-ECM. Immunohistochemistry showed that the labeled seed fibroblasts played an important role in tendonization. The results of light microscopy, electron microscopy, and biomechanical assessment suggested that the rate and quality of tendonization in the experimental group was superior to those of the control group I and II. The tensile strength in the experimental group was the greatest, the next was in the control group I, and the worst in the control group II (P<0.05).</p><p><b>CONCLUSIONS</b>HA-ECM is the excellent carrier for fibroblasts. Fibroblasts-HA-ECM complex has the capability to repair tendon defect and to tendonize with rapid rate and good performance three months after operation. Its tensile strength is 81.8% of that of normal tendon.</p>

The experimental study of culture in vitro of fibroblasts seeded onto human amnion extracellular matrix (HA-ECM) / 中华整形外科杂志

<p><b>OBJECTIVE</b>The aim of this experiment is to find proper cell carrier for skin tissue engineering.</p><p><b>METHODS</b>Various concentration of fibroblasts were seeded onto HA-ECM and cultured in vitro. The performance of cells' growth, array, adhesion and collagen secretion on HA-ECM was observed with light microscope and transmission electron microscope.</p><p><b>RESULTS</b>The fusiform fibroblasts oriented radiantly or longitudinally and closely packed onto the HA-ECM, they attached firmly and proliferated to confluence on the stromal surface of HA-ECM.</p><p><b>CONCLUSION</b>The optimal cell concentration is 3.5 x 10(6)/ml, HA-ECM is ideal carrier for fibroblasts because of its excellent scaffold and diffusion characteristics. Futhermore, it has the bioactive molecules such as fibronectin and laminin which play an important role in fibroblasts attachment and proliferation on HA-ECM.</p>