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Objective To compare the incidence of adjacent segment degeneration (ASDeg) and clinical outcomes of minimally invasive versus traditional transforaminal lumbar interbody fusion (TLIF) in the treatment of L 4,5 single?segment lumbar spinal stenosis (LSS) and explore the risk factors of ASDeg. Methods All of 115 patients with LSS who were treated by the same group of doctors from 2009 to 2013, with a minimum follow?up of 5 years. Thirty?eight patients underwent minimally invasive trans?foraminal lumbar interbody fusion (MIS?TLIF) and 77 patients underwent traditional TLIF. Standing radiographs at the preopera?tive period and the final follow?up were assessed. Radiological parameters included lumbar lordosis (LL), fused segment angle (FSA), disc height (DH) and range of motion (ROM). Babu classification was used to identify facet joint violation (FJV) in patients at 5?year follow?up. Clinical outcomes were assessed according to visual analog scale (VAS) score, Japanese Orthopaedic Associa?tion (JOA) score and Oswestry Disability Index (ODI). Student's t?test, Chi?square test, and non?parametric test were used as the main statistical methods. Results The mean age of MIS?TLIF group was 58.2±8.8 years, and that of TLIF group was 54.7±11.2 years, and there was no significant difference between the two groups. The mean follow?up time was 64.5±3.8 months in the MIS?TLIF group and 63.9±3.3 months in the TLIF group, and there was no significant difference between the two groups. There were 17 cases of degenerative spondylolisthesis in MIS?TLIF group (44.7%) and 35 cases of degenerative spondylolisthesis in TLIF group (45.5%), and there was no significant difference between the two groups. There was no significant difference in DH and ROM of L 3,4, L 4,5, L5S1 between the two groups before operation. There was no significant difference in VAS, JOA and ODI scores between the two groups before operation. The VAS, JOA and ODI scores were significantly improved at the last follow?up compared with those before operation. After 5?year follow?up, 56 cases (48.7%) had ASDeg. The incidence of ASDeg was 31.6% in MIS?TLIF group and 57.1% in TLIF group, and there was statistical differences between the two groups (χ2=6.656,P<0.01). Among them, 32 cases only had upper segment ASDeg (6 cases in MIS?TLIF group, 26 cases in TLIF group), 19 cases only had lower segment ASDeg (6 cases in MIS?TLIF group, 13 cases in TLIF group), and 5 cases had both upper and lower ASDeg (5 cases in the TLIF group). The DH of adjacent segments decreased after operation, but the loss of DH in MIS?TLIF group was smaller than that in TLIF group, including L 3,4 segments (-4.9%±6.4% vs-8.7%±7.2%, t=-2.761, P<0.01), L5S1 segment (-4.7%±9.8% vs-10.5%± 11.7%, t=-2.623, P<0.01). The ROM of adjacent segments increased in both groups, but the increase of ROM in MIS?TLIF group was smaller than that in TLIF group, including L 3,4 segments (1.1°± 1.8°vs 2.3°± 2.5°, t=-3.122, P<0.01), L5S1 segment (0.9°± 1.9°vs 1.8°±1.9°, t=-2.353, P<0.01). The incidence of FJV was 54.2% in patients with ASDeg in MIS?TLIF group and 47.7% in patients with ASDeg in TLIF group. Chi?square analysis showed that FJV was related to ASDeg in both groups (χ2=3.869,P <0.05). Conclusion Both of the two surgical methods have good clinical effects on L 4,5 single?segment LSS. The incidence of AS?Deg after MIS?TLIF is lower than that of TLIF. FJV is a risk factor for ASDeg.
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Objective@#To compare the incidence of adjacent segment degeneration (ASDeg) and clinical outcomes of minimally invasive versus traditional transforaminal lumbar interbody fusion (TLIF) in the treatment of L 4,5 single-segment lumbar spinal stenosis (LSS) and explore the risk factors of ASDeg.@*Methods@#All of 115 patients with LSS who were treated by the same group of doctors from 2009 to 2013, with a minimum follow-up of 5 years. Thirty-eight patients underwent minimally invasive trans-foraminal lumbar interbody fusion (MIS-TLIF) and 77 patients underwent traditional TLIF. Standing radiographs at the preopera-tive period and the final follow-up were assessed. Radiological parameters included lumbar lordosis (LL), fused segment angle (FSA), disc height (DH) and range of motion (ROM). Babu classification was used to identify facet joint violation (FJV) in patients at 5-year follow-up. Clinical outcomes were assessed according to visual analog scale (VAS) score, Japanese Orthopaedic Associa-tion (JOA) score and Oswestry Disability Index (ODI). Student's t-test, Chi-square test, and non-parametric test were used as the main statistical methods.@*Results@#The mean age of MIS-TLIF group was 58.2±8.8 years, and that of TLIF group was 54.7±11.2 years, and there was no significant difference between the two groups. The mean follow-up time was 64.5±3.8 months in the MIS-TLIF group and 63.9±3.3 months in the TLIF group, and there was no significant difference between the two groups. There were 17 cases of degenerative spondylolisthesis in MIS-TLIF group (44.7%) and 35 cases of degenerative spondylolisthesis in TLIF group (45.5%), and there was no significant difference between the two groups. There was no significant difference in DH and ROM of L3,4, L4,5, L5S1 between the two groups before operation. There was no significant difference in VAS, JOA and ODI scores between the two groups before operation. The VAS, JOA and ODI scores were significantly improved at the last follow-up compared with those before operation. After 5-year follow-up, 56 cases (48.7%) had ASDeg. The incidence of ASDeg was 31.6% in MIS-TLIF group and 57.1% in TLIF group, and there was statistical differences between the two groups (χ2=6.656, P <0.01). Among them, 32 cases only had upper segment ASDeg (6 cases in MIS-TLIF group, 26 cases in TLIF group), 19 cases only had lower segment ASDeg (6 cases in MIS-TLIF group, 13 cases in TLIF group), and 5 cases had both upper and lower ASDeg (5 cases in the TLIF group). The DH of adjacent segments decreased after operation, but the loss of DH in MIS-TLIF group was smaller than that in TLIF group, including L3,4 segments (-4.9%±6.4% vs-8.7%±7.2%, t=-2.761, P <0.01), L5S1 segment (-4.7%±9.8% vs-10.5%±11.7%, t=-2.623, P <0.01). The ROM of adjacent segments increased in both groups, but the increase of ROM in MIS-TLIF group was smaller than that in TLIF group, including L 3,4 segments (1.1°±1.8° vs 2.3°±2.5°, t=-3.122, P <0.01), L5S1 segment (0.9°± 1.9 ° vs 1.8°±1.9 °, t=-2.353, P <0.01). The incidence of FJV was 54.2% in patients with ASDeg in MIS-TLIF group and 47.7% in patients with ASDeg in TLIF group. Chi-square analysis showed that FJV was related to ASDeg in both groups (χ2=3.869, P < 0.05).@*Conclusion@#Both of the two surgical methods have good clinical effects on L 4,5 single-segment LSS. The incidence of AS-Deg after MIS-TLIF is lower than that of TLIF. FJV is a risk factor for ASDeg.
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Objective@#To analyze the necessity of routinely performing foraminoplasty during percutaneous transforaminal endoscopic discectomy (PETD).@*Methods@#A total of 412 patients including 231 males and 181 females with an average age of 39.1±13 (20-80) years were enrolled in the present study. All patients were preoperatively diagnosed with single-segment lumbar disc herniation and underwent PETD by the same surgical group. The affected segments were at L3-4 in 32 cases, L4-5 in 289 cases, and L5S1 in 91 cases. Among them, 306 cases had no prolapse, 89 had mild up/down prolapse, and 17 had severe prolapse. MRI sagittal imaging was used to measure the height and width of the intervertebral foramen of L3, 4, L4, 5 and L5S1 segments, the distance between the lower edge of vertebral pedicle and the upper edge of the lower vertebral pedicle and the distance between the point 3 mm to the ventral side of the intervertebral space to the superior articular process. The necessity of performing foraminoplasty was evaluated by measuring the change of intervertebral foramen width using dynamic X-ray and verified during operation.@*Results@#The height of the intervertebral foramen of L3,4, L4,5 and L5S1 segments were 1.99±0.25, 1.89±0.15 and 1.52±0.26 cm, respectively. The width of the intervertebral foramen was 0.78±0.14, 0.75±0.13 and 0.64±0.13 cm, respectively. The distance between the lower edge of vertebral pedicle and the upper edge of the lower vertebral pedicle were 1.14±0.17, 1.05±0.16, and 0.98±0.19 cm, respectively. The distance between the point 3 mm to the ventral side of the intervertebral space to the superior articular process were 1.11±0.31, 1.17±0.20, and 0.95±0.14 cm, respectively. The width of the intervertebral foramen of the L3, 4 and L4,5 segments was significantly greater at the over-flexion position than at the over-extension position (P<0.05). Intraoperative verification showed that 347 cases (group A) did not need foraminoplasty. However, the other 65 patients (group B) needed foraminoplasty, including 31 at L4, 5 segment and 34 at L5S1 segment. One patient in group A and one in group B underwent revision operation due to residual intervertebral disc. At 2 years of follow-up, recurrence occurred in 4 patients in group A and 2 patients in group B. The ODI score and JOA score in group A and B were 18%±9%, 24.2±1.3 and 16%±7%, 23.9±1.3, respectively. There were not significantly different between patients in group A and B (t=1.70, P=0.090; t=1.71, P=0.088). The VAS score of lumbar pain of patients in group A was better than that of patients in group B (P<0.05).@*Conclusion@#Most of PETD of L3-S1 segments can reach the therapeutic target without performing foraminoplasty with half-half technique combined with far lateral access technique. Due to the special anatomical position of L5-S1 segment, the probability of performing foraminoplasty during operation is much higher. Performing foraminoplasty or not depends on the preoperative measurement of foramina and verification during the operation.
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Objective To observe the effects of bisphosphonate on the inhibit proliferation and the apoptosis effect in osteo‐sarcoma MG‐63 cells in vitro ,explore the phosphonic acid salt of bone sarcoma cells ,induce apoptosis and its possible mechanism . Methods Sixty three osteosarcoma MG‐63 cells were cultured in vitro .After treated with bisphosphonate 400 μg/mL ,without bi‐sphosphonate but normal saline ,they were incubated 72 h after the application of the two group cell immunofluorescence test ;then observe the expression of apoptosis factors Caspase 3 and Fas ;Flow cytometry detection line was used to detect the osteosarcoma cell line MG‐63 cells apoptosis rate of each group .Results 72 h after treatment with bisphosphonate ,the expression of apoptosis factor of Caspase‐3 and Fas in osteosarcoma MG‐63 cells were strongly expressed ,and it was observed by immunofluorescent assay , while in blank control group ,we could barely see the expression of apoptosis factors Caspase‐3 and Fas ;Flow cytometry test results showed that two phosphonic acid salt 400 μg/mL intervention group cell apoptosis rate was 54 .00% ,far more than normal saline blank control group ,of which the apoptosis rate was 3 .10% ,the difference was statistically significant (P<0 .05) ,there is an obvi‐ous phenomenon of induced apoptosis .Conclusion Bisphosphonate has a strong apoptotic effects of bisphosphonate in osteosarcoma MG‐63 cells in vitro .Bisphosphonate can inhibit osteolysis of osteosarcoma MG‐63 cells via regulating the expression of Caspase‐3 , Fas in osteosarcoma MG‐63 cells .Bisphosphonate may serve as a potential therapeutic agent for treatment of osteosarcoma .
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BACKGROUND:The number of elderly patients with hip fracture is huge, and this population mainly combines with a variety of internal diseases. The general condition was bad. Compared to total hip arthroplasty, bipolar hemiarthroplasty can shorten operation time, reduce the time of anesthesia and improve surgical safety, but the operation using which fixation mode is always controversial. OBJECTIVE:To compare the safety and curative effects of bipolar hemiarthroplasty with cementless or cement femoral stem prosthesis in elderly patients with osteoporotic complex hip fracture. METHODS:From June 2007 to June 2010, 198 elderly patients with osteoporotic hip fracture aged more than 75 years old, who were treated with bipolar hemiarthroplasty in the People’s Hospital of Xinjiang Uygur Autonomous Region, China, were enroled in this study. Al patients were divided into cementless group (n=69) and cement group (n=129) according to the type of prognosis. Osteoporosis was treated conventionaly in both groups after replacement. Operation time, intraoperative blood loss, incidence of postoperative hip pain, out of bed activity time post surgery, Harris scores of last folow-up and loosening rate of the prognosis were compared between the two groups. RESULTS AND CONCLUSION:176 of above 198 cases were folowed up for 48 to 84 months, including 122 in the cement group and 54 in the cementless group. Operation time was longer in the cement group than in the cementless group, but out of bed time was earlier in the cement group than in the cementless group post surgery, and there were significant differences (P 0.05). The incidences of loosening rate were 5% and 4% in the cement and cementless groups, respectively, which showed significant differences (P< 0.05). These results indicate that bipolar hemiarthroplasty with or without cement for osteoporotic hip fracture in the elderly can obtain good middle- and long-term effects. Bipolar hemiarthroplasty with cement can reduce the out of bed time, but operation time was longer, and incidences of hip pain and loosening were higher in cement prosthesis than in cementless prosthesis.
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Objective To explore a safe dose range of spinal IMRT by comparing the cell damage in Beagles at different dose levels.Methods Thirty Beagles were randomly divided into 5 groups.The Beagle clinical model of tumor was established in the ninth and tenth thoracic spine.The Beagles were subjected to IMRT with the total doses of 0,40,50,60,70 Gy,respectively.The samples of spine were taken out from the same locum of the ninth and tenth thoracic spine at 3 month after radiation.All the samples were observed by the hematoxylin-eosin staining,and the VEGF expression in spine was evaluated by immunohistochemistry.Terminal deoxynucleatidyl transferase mediated dUTP nick and labeling (TUNEL) technique was used to examine the apoptotic cells in the spine.Results The osteocytes in the spine showed reversible injury in 40 Gy group,and cell apoptosis in 50,60,70 Gy groups.Compared with 40 Gy group,the rates of lacuna were increased in 50,60,70 Gy groups(F =2.57,P ＜0.05),as well as the cell apoptotic rates(F =3.52,P ＜ 0.05) and the expression of VEGF (F =3.64,P ＜ 0.05),but there were no significant differences among 50,60,70 Gy groups (P ＞ 0.05).Conclusions The late radiotherapy response of the spine was obviously observed at 3 month after radiation,especially at 50 Gy.