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Objective To investigate the clinical efficacy of posterior anti‐rotation plate plus cancellous screws for treating unicondylar Hoffa fracture and to systematically analyze its injury mechanism ,clinical diagnosis ,treatment method and clinical fol‐low up results .Methods The imageological and clinical data in 9 cases of unicondylar Hoffa fractures treated by anti‐rotation plate plus cancellous screws from March 2009 to April 2014 were retrospectively analyzed .Results All fractures were healed within 4 months .The average follow up time of the patients was 34 months(24~50 months) .Seven cases obtained the anatomic reduction and 2 cases got the satisfactory reduction .The reduction loss and fixation failure were not found in all the cases .One cases of wound infection occurred early after operation and healed within 1 week after anti-infection .One case of knee joint ankylosis complicating pain occurred during the follow up period .According to the KSSs scoring standard ,the knee joint prognosis function scores were ex‐cellent in 4 cases ,good in 4 cases and poor in 1 case .Conclusion Using anti‐rotation plate combined with cancellous screws for con‐ducting the Hoffa fracture fixation can confront the strong shear force beard by femoral condyle with the advantages of rigid fixa‐tion ,reliability fixation and early weight bearing functional exercise .
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BACKGROUND:A large number of biomechanical studies and clinical application research showed that unilateral pedicle screw fixation with a single cage can not only make the spine to obtain immediate stability, and also reduces the fixed segment stiffness. However, there is not related research on the change of adjacent segment disc nucleus pulposus volume with unilateral pedicle screw. OBJECTIVE:To evaluate the effects of unilateral pedicle screw fixation with a single cage on adjacent segment degeneration for treating lumbar degenerative disease with MRI measurement of lumbar nucleus pulposus volume. METHODS:A total of 34 patients with lumbar disc herniation were treated by posterior lumbar interbody fusion with unilateral pedicle screw fixation with a single cage insertion. There were L4-5 segment in 16 patients (9 males and 7 females) and L5-S1segment in 18 patients (10 males and 8 females). The fixator was taken out at 18 months after surgery. They were folowed up for 24 to 36 months. With MRI, the transverse diameter and sagittal diameter of the nucleus pulposus were measured by using T2-weighted images at 6, 12, 18, 30 months after treatment, while the nucleus pulposus height was measured by middle sagittal position. Cephalic intervertebral height was measured with angular bisector method on X-ray films. Effects of unilateral pedicle screw fixation on cephalic intervertebral disc degeneration were evaluated according to nucleus pulposus volume and the intervertebral space height. RESULTS AND CONCLUSION:(1) Nucleus pulposus volume at cephalic L3-4 on the fixed L4-5segment was reduced in male patients after 30 months of treatment compared with pre-treatment (P=0.139), but increased in female patients (P=0.143). (2) Nucleus pulposus volume at L4-5 near to fixed L5-S1 segment was slightly reduced in male patients after 30 months of treatment (P=0.096); nucleus pulposus volume was slightly increased in female patients after 6, 12, 18 and 30 months of treatment (P > 0.05). (3) Disc space height at cephalic L3-4 near to L4-5 segment was diminished in male and female patients at 30 months of treatment (P > 0.05). (4) Disc space height at cephalic L4-5 near to L5-S1 segment was slightly reduced in male and female patients compared with pre-treatment (P > 0.05). (5) Unilateral pedicle screw with a single cage could effectively prevent adjacent segment degeneration in treatment of partial lumbar intervertebral degenerative disease.
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Objective To evaluate the early clinical outcome of one‐stage posterior approach operation for rigid scoliosis caused by lumbosacral hemivertebra in adolescencts .Methods Eighteen adolescencts with rigid scoliosis caused by lumbosacral hemivertebra were surgically treated by the posterior hemivertebral resection and long segment fixation .Hemivertebrae were sited in L5 (14 cases) ,S1 (4 cases) .There were 12 cases of full‐segmented hemivertebrae and 5 cases of semi‐segmented hemivertebrae and 1 case of wedge vertebral body ,10 patients had coronal trunk imbalance .Results The patients were successfully completed sur‐gery .The operation time was 4 .5-8 .5 h ,averaged 6 .3 h ;and the perioperative bleeding was 600-2 800 mL ,averaged 1 180 mL . 2 patient suffered from nerve root injury who received neuro nutrition drugs and Prednisolone after operation and recovered com ‐pletely after one weeks .All cases were follow ed up for 12-38 months ,averaged 21 .6 months .The coronal Cobb angles of lumbo‐sacral curve and proximal lumbar after one week of operations and at the time of the last follow‐up were much better than those be‐fore the operations ,the differences were statistically significant (P<0 .05) .Postoperative radiography demonstrated that no implant failure was observed .Coronal trunk shift was improved in 17 patients after surgery ,1 patient had coronal trunk decompensation . Conclusion The posterior surgery with hemivertebrae resection and long segment fixation is an effective procedure in the treatment of rigid scoliosis caused by lumbosacral hemivertebra in adolescencts .The reconstruction of the coronal plane is the key to the oper‐ation .
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BACKGROUND:After spinal cord injury, endogenous neural stem cel s are activated to proliferate and migrate to repair damaged tissue. As a clinical medicine, methylprednisolone shows a lot of functions, but its effects on endogenous neural stem cel s are stil unknown. OBJECTIVE:To explore the effects of methylprednisolone on the proliferation and migration of endogenous neural stem cel s after spinal cord injury. METHODS:Seventy-five Sprague-Dawley rats were used to make animal models of T10 complete paraplegia using Al en’s method, and randomized into methylprednisolone, normal saline and model groups. Rats in these three groups were given intraperitoneal injection of 1 g/L methylprednisolone solution at a dose of 30 mg/kg for 10 minutes and at a dose of 5.4 mg/kg/h for 23 hours, given intraperitoneal injection of normal saline at the same dose and given no treatment, respectively. Neurological and motor functions were assessed by somatosensory evoked potential and Basso Beattie Bresnahan scores at 7, 14, 21, 28 days after spinal cord injury. BrdU and Nestin staining of the injured spinal cord segment was conducted. RESULTS AND CONCLUSION:A large amount of BrdU-and Nestin-positive cel s were visible in al the groups, and the number of these cel s reached the peach at 14 days after spinal cord injury. Methylprednisolone was found to inhibit BrdU-, Nestin-or double-positive cel s, indicating methylprednisolone can inhibit the proliferation and migration of endogenous neural stem cel s. The results of Basso Beattie Bresnahan scores showed no notable improvement in the motor function of the limbs. Methylprednisolone also showed no significant effects on the motor evoked potential latency, but promoted nerve conduction recovery. Al these findings indicate that methylprednisolone has some hindering effects on spinal cord repair by inhibiting the proliferation and migration of endogenous neural stem cel s after spinal cord injury.
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Objective To investigate the in vitro cytocompatibility of three-dimensional porous scaffolds of poly-D,L-lactic acid (PDLLA) and discuss the feasibility of PDLLA as a scaffold for bone tissue engineering.Methods BMSCs of the third passage were seeded on osteogenetic differentiation medium or culture medium containing 20％ volume fraction degraded liquid (PDLLA degradation liquid of 0,3,6,9,and 12 weeks) according to the random number table.Osteogenetic differentiation medium or culture medium without PDLLA was used as controls.Cell viability,cytotoxicity,and osteogenic differentiation were detected for study on cytocompatibility of PDLLA.Scanning electron microscopy was used to observe the growth of BMSCs on the surface of PDLLA scaffolds.Results PDLLA scaffolds presented no significant cytotoxic on the growth of BMSCs.PDLLA scaffolds had no negative effect on cell viability compared with the controls (t3 =-0.441,P =0.671; t6 =1.596,P =0.154; t9 =-0.492,P =0.636; t12 =-1.135,P=0.283).ALP staining and calcium nodule staining were positive and there were no significant differences in ALP and collagen Ⅰ protein quantitative detection compared with the controls.BMSCs grew well on the inner surface of the PDLLA three-dimensional porous scaffolds.Conclusion Three-dimensional porous scaffolds of PDLLA present good cytocompatibility in vitro and can be used as bone tissue engineering scaffolds for subsequent in vivo research.
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Objective To investigate the therapeutic effects of nano-hydroxyapatite/polyamide 66/platelet-rich plasma com-pound(n-HA/PA66/PRP)on the recovery of rabbit femur bone defect.Methods 40 New Zealand rabbits were artificially made to be bone defect by resecting the 1 cm substantia ossea with periosteum of femur,and were divided into two groups averagely depen-ding on implanted materials:experimental group(n-HA/PA66/PRP),control group (n-HA/PA66).Every five rabbits were sacri-ficed on week 2,4,8,12,and the femur healing status was observed by X ray,histology,and immunohistochemistry.Results No rabbit was infected or died,no implantation objects dropped.Gross observation,X-ray result and histology results demonstrated that the experimental group began to have a new bone tissue at 2 weeks after the operation,with the extension of time,the experimental group new bone growth speed and the quantity was better than the control group.The Lane-Sandhu method X-ray score showed that the experimental group (6.80±2.05)points and the control group(4.20±1.30)points at 12 weeks after the operation,and there were significant differences between two groups(P 0.05).Conclusion PRP combined with n-HA/PA66 artificial bone could accel-erate the healing of bone defect,and the effect of repair of bone defect is better than that of n-HA/PA66 artificial bone in the early.
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Objective To compare the clinical outcomes of transforaminal lumbar interbody fusion (TLIF) through Wiltse approach and posterior midline approach in the treatment of degenerative lumbar spondylolisthesis.Methods A total of 37 patients with degenerative lumbar spondylolisthesis were treated between March 2008 and March 2010,including 23 patients managed by TLIF via posterior midline approach ( posterior midline approach group) and 14 by TLIF via Wiltse approach ( Wiltse approach group).The Japanese Orthopaedic Association (JOA) score and visual ltanalogue scale (VAS) before and after operation,and the interbody fusion condition in both the Wiltse approach group and posterior midline approach group were reviewed and the clinical outcomes of both groups were compared.Results The follow-up lasted for 6-26 months ( mean,15.7 months),during which both groups had obvious relief in clinical symptoms like pain of waist and legs.X-ray photographs showed good spondylolisthesis reduction and interbody fusion,with no loosening or breakage of the internal fixators.The fusion rate of Wiltse approach group and posterior midline approach group at the last follow-up were 86％ and 87％,respectively.The operation time of Wiltse approach group and posterior midline approach group was ( 117.8 +25.6) minutes and ( 128.5 ± 38.7 ) minutes respectively ( P ＞ 0.05 ).The intra-operative blood loss of Wiltse approach group and posterior midline approach group was (203.5 ± 16.4) ml and (284.4 ±27.6) ml respectively (P ＜0.05).Both groups presented significant decrease of JOA score post-opera-tively (P ＜ 0.05).Also,the two groups sbowed significant difference concerning the VAS score in low back pain one week post-operatively (P ＜ 0.05),but no significant difference in terms of VAS score in leg pain at one week after operation (P＜0.05) and VAS score in pain of low back and legs at the final follow-up ( P ＞0.05).Conclusions In the management of lumbar spondylolisthesis,TLIF via Wiltse approach and via posterior midline approach can both achieve satisfactory interbody fusion rate and clinical outcomes,but the Wiltse approach results in relatively less intra-operative blood loss and faster postoperative recovery.
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Objective To compare the effect of anterior and superior reconstruction plate internal fixation in treatment of middle clavicular fractures in the old patients.Methods Thirty-nine old patients with middle clavicular fractures received anterior and superior reconstruction plate internal fixation treatment,respectively.There were 19 males and 20 females at average age of 66.7 years.The operation time,intraoperative blood loss and healing time were observed and compared in two groups.According to the Constant scoring system,shoulder functional evaluation was made at half a year after operation and the latest follow-up.Results All the patients were followed up for 10-32 months (average 18.7 months).Of the two groups,there was no statistical significance in aspects of healing time and Constant score at half a year after operation and the latest follow-up ( P ＞0.05 ).The complication of superior reconstruction plate internal fixation group was significant higher than that of anterior reconstruction plate internal fixation group,while the anterior reconstruction plate internal fixation group had shorter operation time and less intraoperative blood loss in comparison with the superior reconstruction plate internal fixation group ( P ＜ 0.05).Conclusion As for the middle clavicular fractures in the old patients,both anterior and superior reconstruction plate internal fixation can obtain satisfactory curative effect.With shorter operation time,less intraoperative bleeding and less complications,anterior reconstruction plate internal fixation is a much reliable treatment for middle clavicle fractures in the old patients and deserves wider application.
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Objective To study the effect of atlantoaxial pedicle and lateral mass screw in treat-ment of atlantoaxial instability. Methods A retrospective analysis was done on 11 eases of aflantoaxi-al instability treated with atlantoaxial pedicle and lateralmass screw from June 2006 to December 2007. Results The postoperative radiographs verified good position of all screws, with satisfactory atlantoaxial reduction. Follow-up for 3-21 months (average 12 months) showed no spinal cord and vertebral artery in-jury or interfixation failure. Conclusion Atlantoaxial pediele and lateral mass screw technique is a convenient method with solid fixation for treatment of atlantoaxial instability.
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Objective To discuss the application of nano-hydroapatic crystals and polyamide composite(n-HA/PA66) for artificial vertebrae in treating thoracic or lumbar vertebrae tumor.Methods A total of 14 cases suffering from thoracic or lumbar vertebrae tumor underwent deuto-total vertebrae resection via anterior approach,then canalis vertebralis was deboosted,artificial vertebrae was implanted and fixed with screw-stick system.Fourteen patients,9 male and 5 female were admitted by our hospital from Dec 2003 to Sep 2005,aged 32 to 68 years old(average 50).The tumor located at T_(11) in 2 cases,T_(12) in 2,L_1 in 5,L_2 in 5.Pathological diagnosis showed 3 cases were of aneurysmal bone cyst,5 of hemangioma,2 of giant cell tumor,3 of metastatic thoracic lumbar vertebra tumor. Results The follow-up lasted 3-18 months,mean 10 months.The rate of bone graft fusion reached 85.7%,with no loosened internal fixation or breakage of screw or stick.No screw breakage or spinal instability occurred during the follow-up.All cases were alive till follow-up finished.Conclusion If the thoracic vertebral tumor compresses spinal cord seriously,the patients should be recommended for surgical treatment.Total vertebrectomy followed by reconstruction could relieve the compression caused by tumor and restore the stabilization of spine effectively.Artificial vertebrae is the ideal substitute material for bone transplantation,for it has good biocompatibility,high security,high rate of bone graft fusion and firm fixation.