Regulatory function and mechanism of autophagy on osteoclast / 中国骨伤

Osteoclast (OC) is multinucleated, bone-resorbing cells originated from monocyte/macrophage lineage of cells, excessive production and abnormal activation of which could lead to many bone metabolic diseases, such as osteoporosis, osteoarthritis, etc. Autophagy, as a highly conserved catabolic process in eukaryotic cells, which plays an important role in maintaining cell homeostasis, stress damage repair, proliferation and differentiation. Recent studies have found that autophagy was also involved in the regulation of osteoclast generation and bone resorption. On the one hand, autophagy could be induced and activated by various factors in osteocalsts, such as nutrient deficiency, hypoxia, receptor activator of nuclear factor(NF)-κB ligand(RANKL), inflammatory factors, wear particles, microgravity environment, etc, different inducible factors, such as RANKL, inflammatory factors, wear particles, could interact with each other and work together. On the other hand, activated autophagy is involved in regulating various stages of osteoclast differentiation and maturation, autophagy could promote proliferation of osteoclasts, inhibiting apoptosis, and promoting differentiation, migration and bone resorption of osteoclast. The classical autophagy signaling pathway mediated by mammalian target of rapamycin complex 1(mTORC1) is currently a focus of research, and it could be regulated by upstream signalings such as phosphatidylinositol 3 kinase(PI-3K)/protein kinase B (PKB), AMP-activated protein kinase(AMPK). However, the paper found that mTORC1-mediated autophagy may play a bidirectional role in regulating differentiation and function of osteoclasts, and its underlying mechanism needs to be further ciarified. Integrin αvβ3 and Rab protein families are important targets for autophagy to play a role in osteoclast migration and bone resorption, respectively. In view of important role of osteoclast in the occurrence of various bone diseases, it is of great significance to elucidate the role of autophagy on osteoclast and its mechanism for the treatment of various bone diseases. The autophagy pathway could be used as a new therapeutic target for the treatment of clinical bone diseases such as osteoporosis.

Minimum 2-Year Experience with Magnetically Controlled Growing Rods for the Treatment of Early-Onset Scoliosis: A Systematic Review

Magnetically controlled growing rods have been used to treat early-onset scoliosis for the last 9 years; however, few studies have been published, with only short-term follow-up. The aim of the present study is to systematically review the outcomes of magnetically controlled growing rods in the treatment of early-onset scoliosis with a minimum of 2-year follow-up. Studies were included if patients with early-onset scoliosis (scoliosis diagnosed before 10 years of age) underwent implantation of magnetically controlled growing rods with a minimum of 2-year follow-up. The literature review and data extraction followed the established preferred reporting items for systematic review and meta-analysis guidelines. Data of distraction frequency, number of distractions, distracted length, Cobb angle, kyphosis, T1–T12 length, and T1–S1 length preoperatively, postoperatively, and at final follow-up were collected. Data regarding complications and unplanned reoperations were also extracted. The mean values of these parameters were calculated, or pooled meta-analysis was performed if available. Ten articles were included in this systematic review, with a total of 116 patients and a follow-up period between 23 and 61 months. The mean preoperative Cobb angle and kyphosis angle were 60.1° and 38.0°, respectively, and improved to 35.4° and 26.1° postoperatively. At final follow-up, the Cobb and kyphosis angles were maintained at 36.9° and 36.0°, respectively. The average preoperative T1–T12 and T1–S1 lengths were 180.6 mm and 293.6 mm, respectively, and increased to 198.3 mm and 320.3 mm postoperatively. T1–T12 and T1–S1 lengths were 212.3 mm and 339.3 mm at final follow-up, respectively. The overall rate of patients with complications was 48% (95% confidence interval [CI], 0.38–0.58) and unplanned reoperation 44% (95% CI, 0.33–0.55) after sensitivity analysis. The current evidence from different countries with a minimum of a 2-year follow-up suggests that magnetically controlled growing rods are an effective technique to treat pediatric scoliosis and promote spine growth. However, nearly half of patients still developed complications or required unplanned reoperations.

Effects from sequential removal of posterior ligamentous complex on stability of injured thoracolumbar spine / 医用生物力学

Objective To investigate the effect from sequential removal of posterior ligamentous complex (PLC) on stability of injured thoracolumbar spine, and verify the role of supraspinous ligaments in maintaining stability of injured thoracolumbar spine complex. Methods Eight fresh human thoracolumbar specimens (T11-L3) were selected, and 1/3 of the L1 vertebral body was resected for "V" shape. The specimens were then mounted on the universal testing machine and subjected flexion and compression to make a fracture in L1. PLC in T12-L1 segment was then resected in a sequential manner from facet capsular ligament (FCL), interspinous ligament (ISL), supraspinous ligament (SSL) to ligamentum flavum (LF). The range of motion (ROM) and neutral zone (NZ) of the T12-L1 segment under flexion, extension, lateral bending and rotation movement were measured at each ligament removal step. Results Under flexion and extension, ROM and NZ presented a significant increase after fracture and removal of SSL. Under right lateral bending, ROM increased sharply after reduction of vertebrae and FCL, while the NZ showed a slight increase. Under left axial rotation, removal of vertebrae and FCL resulted in a significant increase in ROM, while the NZ showed no significant increase. Conclusions After removal of SSL, the stability of the T12-L1 segment decreases sharply, especially under flexion motion, and SSL is the pivotal ligament for PLC to maintain the stability of thoracolumbar spine.

The Surgical Management of Traumatic Lower Cervical Spondylolisthesis with Posterior Percutaneous Pedicle Screw Fixation

We reported a technical report of traumatic lower cervical spondylolisthesisca used by bilateral pedicle fracture, without neurological compression. The patient was treated with the minimally invasive technique of percutaneous pedicle screw fixation. Fracture healing and normal cervical motion were confirmed by plain films and physical examinations on the 18-monthpostoperatively. The technique of percutaneous pedicle screw fixation might be an alternative strategy for the treatment of traumatic lower cervical spondylolisthesis with pedicle fracture.

Development of shear force-induced intervertebral disc degeneration model / 医用生物力学

Objective To develop a shear force-induced intervertebral disc degeneration (IDD) in vivo animal model, and investigate the relationship between shear stress and IDD. Methods A total of 20 Japanese white rabbits were randomly divided into two groups. In loading group (n=10), shear force of 50 N was applied on the disc of L4/5 for 4 weeks by a custom-made external shear force loading device. In control group (n=10), the animals underwent a sham operation with the external loading device situated, but their discs remained unloaded. After 4 weeks, all the intervertebral discs of L4/5 were executed for the pathologic examination. Results The postoperative radiographic examination showed a perfect position of the loading device, and the operation process and implanted loading device had no effect on daily activities and diet of the experiment animals. The pathological examination showed an irregular arrangement of annulus fibrosus and a significant decrease of normal nucleus pulposus cells in loading group. Conclusions The new custom made device greatly reduced the wounds on animal vertebra and provided a reliable shear force. The development of in vivo animal model indicates that IDD can be induced by shear force, which is of significance to further study the relationship between loading and IDD.

Discectomy and discectomy plus Coflex fixation for lumbar disc herniation, a clinical comparison study / 中华外科杂志

<p><b>OBJECTIVE</b>To compare clinical efficacy between discectomy and discectomy plus Coflex fixation for lumbar disc herniation.</p><p><b>METHODS</b>From December 2007 to August 2008, 50 patients (31 males and 19 females) were treated by surgery of discectomy and discectomy plus Coflex fixation. The average age was 52.5 years (range, 30 - 72 years). There were 24 cases in the group of discectomy plus Coflex fixation and 26 cases in the group of discectomy. Preoperative and postoperative visual analogue scales (VAS), Japanese Orthopadic Association (JOA) and Oswestry disability index (ODI) were recorded, as well as radiological index. And use a paired t-test and one-way analysis of variance (one-way ANOVA) statistical method to evaluate the Coflex dynamic stabilization system in value in the treatment of lumbar disc herniation.</p><p><b>RESULTS</b>Both groups received significant improvement of JOA, ODI and VAS (t = -33.2 - 64.5, P < 0.01), but the group of discectomy was found with deterioration of ODI at last follow-up, 12 months after surgery 6.7 ± 1.5 to 10.2 ± 2.3 (t = -19.3, P < 0.05). The group of discectomy plus Coflex fixation was found with significant increase of height of dorsal intervertebral discs (HD), distance across the two adjacent spinous processes (DS), distance of intervertebral foramina (DIF) and spinal canal area(SA) (t = -34.4 - 4.5, P < 0.05). In contrast, the group of discectomy was found with significant decrease of HD, DS, DIF and SA (t = 3.4 - 52.8, P < 0.05). Coflex fixed group in HD, DIF, DS significant difference with simple discectomy group, with a statistically significant (F = 14.1 - 25.6, P < 0.05).</p><p><b>CONCLUSIONS</b>Both discectomy and discectomy plus Coflex fixation are apparently effective when treating lumbar disc herniation. Coflex can significantly increase the HD and DIF when used for lumbar disc herniation, and it has positive influence for keeping height of lumbar vertebral space and treating the nerve root symptom of lumbar disc herniation. Discectomy plus Coflex is better than pure discectomy in preventing lumbar degeneration.</p>

Advances on loading methods for spinal movement in vitro / 医用生物力学

Research on biomechanical testing of the spine in vitro is crucial to advance understanding about the function of spine, spine injury, spinal degeneration, and the influence of implants on spinal disorders. Spinal biomechanics is mainly composed of two parts: loading methods for the spine and measurement for the spinal movement. The loading method has gone through a process from gradual loading to continuous loading. In this paper, current literatures on spinal biomechanics were studied and up-to-date loading methods for the spinal movement in vitro were summarized to provide some references and help for the future research on loading methods of spinal movement.

Clinical evaluation of interspinous process device Coflex for degenerative disk diseases / 中华外科杂志

<p><b>OBJECTIVE</b>To study indications and complications of interspinous process device Coflex for degenerative disk diseases.</p><p><b>METHODS</b>One hundred and eight patients with degenerative lumbar disc diseases were underwent procedures of surgical decompression and additional fixation of Coflex between November 2007 and October 2010. Sixty-eight patients were male and the other fourty were female, and their average age was 53.5 years (range from 37 to 75 years). Fifty-nine patients were underwent surgery of excision of nucleus pulposus and Coflex fixation, 41 patients were underwent surgery of decompression by fenestration and Coflex fixation, 6 patients were underwent surgery of topping-off, and 2 patients were underwent surgery of Coflex fixation for two level. Preoperative and postoperative visual analogue scales (VAS) and Oswestry disability index (ODI) were recorded, as well as height of ventral intervertebral space (HV), height of dorsal intervertebral space (HD), height of intervertebral foramen (HIF) and segmental range of motion (ROM). One-way ANOVA was used for statistical analysis. Surgical complications were also recorded.</p><p><b>RESULTS</b>The average follow-up time was 28.8 months. All groups had apparent improvement of VAS and ODI, and maintained well to last follow-up (F = 6.16-25.92, P = 0.00). Statistical analysis showed that HD and HIF increased significantly in group with excision of nucleus pulposus and Coflex fixation and group with decompression by fenestration and Coflex fixation (F = 7.37 - 11.68, P < 0.05). Although both HD and HIF decreased one-year after surgery, they were still higher than those preoperatively (F = 6.31 and 7.05, P = 0.00). Preoperative segmental ROM was respectively 6.3° ± 1.8° and 6.2° ± 1.7° in group with excision of nucleus pulposus and Coflex fixation and group with decompression by fenestration and Coflex fixation, and 3.1° ± 0.6° and 3.0° ± 0.8° at last follow-up. Three cases were found with device-related complications and five with non-device-related complications, and all five cased were cured after appropriate treatment.</p><p><b>CONCLUSIONS</b>Surgical method assisted with Coflex has significant clinical efficacy for degenerative disc disease, it can maintain segmental stability, simultaneously, partly reserve movement. It's key to strictly master indications and precisely choose patients.</p>

Influence of intravertebral cleft for outcome of percutaneous kyphoplasty / 中华外科杂志

<p><b>OBJECTIVES</b>To study incidence and radiological features of intravertebral cleft (IVC) in patients with chronic pain due to osteoporotic vertebral compression fractures (OVCFs), and analyze influence of IVC for surgery of percutaneous kyphoplasty (PKP).</p><p><b>METHODS</b>Seventy-six patients with osteoporotic vertebral compression fractures and pain duration more than one month were underwent procedures of PKP between August 2005 and August 2010. The incidence and radiological features of IVC were analyzed. Sixty-one patients with single-level OVCFs were divided into two groups with and without IVC. Preoperative and postoperative kyphotic angle and relative anterior vertebral height were recorded, as well as visual analogue scales (VAS) and Oswestry disability index (ODI). Cement patterns of opacification and leakage were also recorded.</p><p><b>RESULTS</b>Thirty two patients with 39 vertebrates were found with IVC sign. The diagnostic sensitivity of X ray, CT and MRI for IVC was respectively 33.3%, 85.7% and 84.6%. Two groups with IVC and without IVC both had apparent correction of kyphotic angle and reduction of anterior height at 3 days after surgery and last follow-up (F = 21.82 - 72.18, P < 0.01). There was no statistical significance between two groups (P > 0.05). In addition, both groups had significant improvement as regard to VAS and ODI (F = 131.06 - 364.12, P < 0.01). Solid pattern accounted for 72.0% of all cemented vertebrates in the group with IVC and 19.4% in the group without IVC. Four cement leakage were found in the group with IVC and another four in the group without IVC.</p><p><b>CONCLUSIONS</b>There is a high incidence of IVC in patients with chronic pain due to osteoporotic vertebral compression fractures. CT and MRI are sensitive for detection of IVC. The procedure of PKP is effective for both groups with and without IVC. IVC produces an apparent influence on cement opacification and leakage location during the procedure of PKP.</p>

Development of an experimental device for measuring three-dimensional movement of the spine / 医用生物力学

Objective To develop a set of loading device that can simulate the spinal movement in vitro so as to carry out the biomechanical experiment on human spine. Methods Based on the principle of bearing, the rotary locking device was designed and fixed on the loading plate, which was rotated to the position for testing and then locked by the bolt before loading. And then, with the auto-loading power provided by the universal testing machine, the pure moment of flexion/extension, left/right bending and left/right axial rotation were applied on the spine specimen to simulate the spinal movement in vivo. Finally, the position of the spine specimen before/after loading was measured by the 3D scanner. With the loading device, the range of motion under these six loading conditions for six fresh (one-year age) porcine cervical spines (C2-C6) was tested, and precision of the loading device as well as error analysis were testified by experiments. Results A set of experimental device for the three-dimensional movement measuring for human spine was developed. Data of neutral zone and range of motion for the porcine cervical spine in six directions were acquired with the total measurement error being less than 3.5％. Conclusions The delicate design of this loading device could simulate the spinal motion in vitro and thus achieve the rapid loading of the human spine. This is an inexpensive, simple and practical device, which can significantly increase the test efficiency and has great application value in loading on the spine in vitro.

Advances in measuring methods for human spinal movement / 医用生物力学

Relative movement between the spine segments has close connection with spinal surgery. Understanding the spinal range of movement is crucial to advance our understanding about the biomechanical function of spine injury, spinal degeneration, and the development of new surgical treatments and implants for spinal disorders. The measurement of spinal movement has gone through the process from two dimensional plane to three dimensional measurement, from simple to complex, from rough estimation to precise calculation. This paper will describe the major achievements and deficiency of various methods of spinal movement measurement to provide reference and help for the research of spinal movement measurement.

Check ligament suspension for correction of congenital severe blepharoptosis / 中华整形外科杂志

<p><b>OBJECTIVE</b>To evaluate the clinical result of check ligament suspension for correction of congenital severe blepharoptosis.</p><p><b>METHODS</b>Since Jan. 2010 to Nov. 2010, 15 eyes in 15 cases with congenital severe blepharoptosis were treated with the check ligament suspension. Palpebral aponeurosis was exposure by opening fascia palpebral during blepharoplasty. Palpebral aponeurosis was cut off about 5 mm above the tarsus. The check ligament was seen in the intermuscular space between the segment of levator and the anterior one third of superior rectus attached to the conjunctival fornix. Congenital blepharoptosis could be corrected by suturing the check ligament and levator palpebrae superior to the upper margin of tarsal plate with 3-0 silk thread. Double eyelid plasty was carried out in the end.</p><p><b>RESULTS</b>The follow-up period was 3-11 months with good cosmetic result. All the cases could close their eyes in 15 to 30 days with no complication.</p><p><b>CONCLUSIONS</b>In conclusion, this technique is quite successful in raising the level of the upper eyelid in severe congenital blepharoptosis. The check ligament moves in a similar direction as the natural movement of levator muscle, so both the postoperative static and dynamic appearance of the upper lid is more natural.</p>

The application of minimally invasive surgery for different type of thoracolumbar fractures / 中华外科杂志

<p><b>OBJECTIVE</b>To study the therapeutic method and effect of minimally invasive surgery for the thoracolumbar fractures.</p><p><b>METHODS</b>A retrospective review of the minimally invasive surgically treatment thoracolumbar fractures from February 2005 to June 2010 was performed. There were 183 cases, 126 males and 57 females, aged 18 to 68 years, average 38.9 years. The involved levels of fractures were T(11) in 22, T(12) in 61, L(1) in 71, L(2) in 29. According to Gertzbein classification, 145 cases were type A fractures, 34 cases were type B fractures, 4 cases were type C fractures; According to Load-sharing score, 51 cases were 4 scores, 56 cases were 5 scores, 17 cases were 6 scores, 12 cases were 7 scores, 24 cases were 8 scores, 23 cases were 9 scores. Different surgical methods were selected according to the minimally invasive surgical strategy, 22 patients were treated with the minimally invasive percutaneous pedicle screws osteosynthesis (MIPPSO group), 102 patients were treated with the small-incision pedicle screws osteosynthesis (SISPSO group), 31 patients were treated with the small incision anterior thoracolumbar surgery (SIATS group) assisted by thoracoscope or headlight, and 28 patients were treated with the 270° decompression and reconstruction surgery (270° DRS group) via a posterior small incision. Preoperative and postoperative neurological status, the correction and loss of Cobb's angle, the decompression scope of spinal canal, the location and union of bone graft were followed up and reviewed.</p><p><b>RESULTS</b>All of 183 cases had successful surgery and were followed up. In the MIPPSO group, operative time was 52 - 100 min, blood loss was 35 - 55 ml. In the the SISPSO group, operative time was 48-68 min, the blood loss was 45 - 65 ml the correction of Cobb's angle in the two groups was 8° - 19°. In the SIATS group, operative time was 140 - 220 min, the blood loss was 160 - 1500 ml the correction of Cobb's angle was 15° - 25°, 1 case had pleural effusion, 1 had lateral femoral cutaneous nerve damage, the complications disappeared after treatment. In the 270° DRS group the operative time was 160-280 min, the blood loss was 700 - 4700 ml, the correction of Cobb's angle was 15° - 28°. The spinal canal mass was removed, the spinal canal was enlarged and completely decompressed. Neurological status improved in all of the preoperative incomplete paraplegia patients except 1 case whose neurological symptoms aggravated.</p><p><b>CONCLUSION</b>It is satisfactory that the minimally invasive surgical strategy was rational used in the treatment of thoracolumbar fractures.</p>

Therapeutic effects and complications of percutaneous pedicle screw fixation for thoracolumbar fractures / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the therapeutic effects and complications of percutaneous pedicle screw fixation for thoracolumbar fractures.</p><p><b>METHODS</b>From January 2002 to December 2008, 103 patients with thoracolumbar fractures were treated with percutaneous pedicle screw fixation, including 75 males and 28 females, the average age was 45.6 years (range, 18 - 72 years). All of them were of no neurological deficits. There were 65 cases of traffic injury, 23 cases of fall injury and 15 cases of smashed injury. According to the Denis classification, 64 patients were of compression fractures, and 39 patients of burst fractures. There were 5 cases had fractures in T(11), 30 in T(12), 42 in L(1), 15 in L(2), 4 in L(3), 3 in L(4), 2 in T(11-12), 1 in L(1-2), and 1 in L(2-3). Radiological examinations, including X-ray and CT examinations, and clinical examinations were carried out to evaluate the therapeutic effects.</p><p><b>RESULTS</b>Twenty one patients were lost to follow up, the remaining were followed up from 10 to 48 months with an average of 27.4 months. Before the operation, the vertebral height, the kyphosis angle and the occupation of spinal canal were (54.5 ± 8.7)%, 16.4° ± 2.9° and 1.2 ± 1.0, and were improved to (88.6 ± 6.4)%, 11.6° ± 2.7° and 0.5 ± 0.6 respectively after the operation. Preoperatively the visual analogue scale and the Oswestry disability index were 8.0 ± 1.2 and 41.2 ± 9.3, and were improved to 1.7 ± 1.8 and 6.7 ± 5.6 postoperatively, respectively. All of these values between pre- and post-operatively were significantly different (P < 0.01). Screw misplacement was found in 7 patients, superficial wound infection in 1, screw breakage in 3, screw dislodgment in 2, cement leakage in 5, transient neurological symptoms in 4, and 8 patients with low back pain remained, of which 2 patients required occasional oral analgesics. Bone fusion achieved in all cases.</p><p><b>CONCLUSIONS</b>The clinical efficacy of percutaneous pedicle screw fixation is similar with conventional open surgery. With the advantages of convenient procedure, less invasive, and rapid recovery, percutaneous pedicle screw fixation is an alternative method for thoracolumbar fractures without neurological deficits.</p>

Application of anterior percutaneous screw fixation in treatment of odontoid process fractures in aged people / 中国骨伤

<p><b>OBJECTIVE</b>To explore the efficacy of anterior percutaneous screw fixation in the treatment of odontoid process fractures in aged people.</p><p><b>METHODS</b>From February 2001 to April 2009, 15 elderly patients with odontoid fracture were treated with anterior percutaneous screw fixation,including 13 males and 2 females; the average age was 69.3 years (ranged, 60 to 86 years). According to Anderson classification, there were 10 patients with type II fractures (type II A in 7 cases, type II B in 3 cases, based on Eysel and Roosen classification), 4 patients with shallow type III fractures, 1 patient with deep type III fractures. Thirteen patients were fresh fractures, 2 patients were obsolete fractures. All patients had varying degrees of neck or shoulder pain, and limit activity of neck. There were 4 patients with neural symptoms including 2 grade D and 2 grade C according to Frankel classification. All the patients were followed up and were assessed by radiology. Clinical examination included neck activity, neurological function and the degree of neck pain. Radiology examinations including anteroposterior, lateral, open mouth position and flexion-extension radiographs of cervical vertebra were performed.</p><p><b>RESULTS</b>After surgery, all patients were followed up,and the duration ranged from 6 to 60 months (averaged 31.3 months). Two patients died of other diseases during the follow-up period (18 and 22 months after surgery respectively). All patients got satisfactory results, and all screws were in good position. As the screw was too long, esophagus was compressed by screw tail in one case. One case showed fibrous union, 12 cases had achieved solid bony union, 2 cases showed nonunion without clinical symptoms. The rotation of neck in 3 cases was mildly limited,the neck function of the remaining patients were normal. Four patients with symptoms nerve injuries improved after operation (Frankel E in 3 cases, Frankel D in 1 case). The symptom of neck pain had a significant improvement after surgery (P < 0.001). The VAS score decreased from preoperative (6.07 +/- 1.44) (4 to 8 scores),to postoperative (1.13 +/- 0.92) (0 to 3 scores). And there were no severe postoperative complications.</p><p><b>CONCLUSION</b>The anterior percutaneous screw fixation is less traumatic than conventional approaches for aged people in dealing with odontoid process fractures. Most patients will achieve satisfactory clinical results, as long as the general conditions of them are comprehensively assess. However, this procedure should not be used in patients with comminuted odontoid fractures or severe osteoporosis.</p>

Prediction of spinal cord decompression after cervical laminoplasty: the SC-line / 中华外科杂志

<p><b>OBJECTIVES</b>To report a new index (the SC-line) and a new classification for predicting of postoperative spinal cord decompression after cervical laminoplasty.</p><p><b>METHODS</b>From March 2008 to August 2009, MRI images of 25 patients treated with cervical laminoplasty were retrospectively studied. Using T2-weighted images of the cervical spine, point A was anterior point of the spinal cord at inferior endplate level of cranial compressed vertebra. Point B was anterior point of the spinal cord at superior endplate level of caudal compressed vertebra. The SC-line was defined as a line that connects A and B. Posterior surface of compressor at compression level did not exceed the line in Type I, connected the line in Type II, and exceeded it in Type III. Twenty-five patients who underwent cervical laminoplasty were classified into 3 groups according to the SC-line classification. The posterior shift of the spinal cord after the posterior decompression procedure was evaluated by using a modified gradation of degree of anterior spinal cord compression by MRI finding. The relationship between the degree of anterior spinal cord compression after surgery and the SC-line types were analyzed.</p><p><b>RESULTS</b>Preoperative cervical SC-line classification showed high correlations to the degree of spinal cord decompression. There were 3.82 ± 0.39 points in Type I before surgery, 3.90 ± 0.32 points in Type II, and 4.00 ± 0.00 points in Type III, respectively. After surgery, there were 1.15 ± 0.50 points in Type I, 2.70 ± 0.48 points in Type II, and 3.50 ± 0.55 points in Type III, respectively. Significant differences were found between each Type (F = 42.49, P < 0.01; Type I vs. Type II: P < 0.01; Type I vs. Type III: P < 0.01; Type II vs. Type III: P = 0.038).</p><p><b>CONCLUSION</b>SC-line can be used to predict the degree of postoperative spinal cord decompression following cervical laminoplasty.</p>

Biomechanical comparison with cervical spines of porcin, calf and human / 医用生物力学

Objective To identify whether the calf or porcine cervical spine is a suitable substitute specimen for vitro spine study by comparing the biomechanical characteristics of porcin, calf and human cervical segments. Method Twelve fresh (age: 1 year; average weight: 60-80 kg) porcine cervical spines (C0-T1) and twelve fresh (age: 1 week; average weight： 40-50 kg) calf cervical spines (C0 T1) were taken. The twelve specimens were divided into two groups. One group of six was divided into C2-C3, C4-C5, C6-C7; the other group was divided into C3-C4, C5-C6. The muscle and soft tissue of each functional segment (C2-C3, C3-C4, C4-C5, C5-C6, C6-C7) were removed, preserving the full ligament, and then each functional segment was tested respectively. The flexion/extension, axial left/right rotation, and right/left lateral bending were applied continuously on the range of motion(ROM) and neutral zone(NZ). The findings in the study were compared with the published data of human cervical spine. Results In rotating and extension/flexion of NZ, the calf and human cervical spines were relatively similar, but they were far greater than that of the porcine cervical spine. In the lateral bending, the NZ of porcine C2-C3 was 69.7% of human, the NZ of porcine C6-C7 was 60.4% of human, and other segments were far smaller than human; the calf cervical spines were different from human, except the C2-C3. In bending and extension flexion of ROM, the porcine and human cervical spines were very similar. But they were far less than the calf, approximately 50% of calf; in the rotation, C2-C3 of porcin was about 69% of human, and other segments were less than the human. The calf cervical spine was much larger than human, and the smallest gap was in C4-C5 of 3.5 °. Conclusions The C2-C3 and C6-C7 of porcin can replace the human cervical spine in nearly all biomechanical experiments on spines. The ROM of calf is bigger than human cervical, but the C2-C3 and C3-C4 of calf are similar to human in biomechanics.

Mid-term outcomes of minimally invasive transforaminal lumbar interbody fusion with unilateral pedicle screw fixation for lower lumbar degenerative diseases / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate the mid-term clinical outcomes of minimally invasive transforaminal lumbar interbody fusion (TLIF) with unilateral pedicle screw fixation for lower lumbar degenerative diseases.</p><p><b>METHODS</b>From April 2004 to December 2005, minimally invasive TLIF through paramedian approach with unilateral pedicle screw fixation was performed in a consecutive series of 43 patients, including 24 male and 19 female, aging from 38 to 71 years, with an average age of 49 years. The length of surgical incision was 3 cm. The operation level at L(3-4) were 3 cases, L(4-5) 27 cases, L(5)-S(1) 13 cases and no case was at multilevel. Clinical outcomes were assessed by ODI scores and JOA questionnaires before and after operation. Operation time, intraoperative blood loss, incision status and complications were recorded. Radiological examination was obtained for each patient to assess the height of intervertebral space, postoperative intervertebral fusion conditions and the degeneration of adjacent segments.</p><p><b>RESULTS</b>The mean operation time was 110 minutes, the mean blood loss was 150 ml and all the incisions were healed primarily. The follow-up time ranged from 36 to 58 months. The ODI scores decreased significantly from 60 ± 10 preoperatively to 12 ± 4 postoperatively (P < 0.01). The JOA scores were improved remarkably from 9.6 ± 2.2 preoperatively to 23.8 ± 2.0 postoperatively (P < 0.01) and the proportion with optimal effect was 86%. The ventral and dorsal heights of intervertebral disc were significantly higher than those before operation (P < 0.01). The fusion rate was 94%. The incidence of adjacent segment degeneration was 17%. There were no complications such as secondary scoliosis, screw loosening, internal fixation failure and cage slippage.</p><p><b>CONCLUSIONS</b>The minimally invasive TLIF through paramedian approach with unilateral pedicle screw fixation is an effective and convenient method with little surgical trauma. The mid-term follow up results showed favorable outcomes in patients receiving this surgery.</p>

Immune effects of three different programs for revaccination among adults of non- and hypo-responders to hepatitis B vaccine / 中华预防医学杂志

<p><b>OBJECTIVE</b>To investigate the immune effects of three different programs for revaccination among adults of non- and hypo-responders to recombinant Hepatitis B vaccine.</p><p><b>METHODS</b>Those who were once immunized with recombinant Hepatitis B vaccine more than one standard schedule (0, 1, and 6 months) in two years and negative for Hepatitis B markers were randomly given three-different projects for revaccination. 34 adults of A group were given GM-CSF 300 microg by subcutaneous injection for the first day, then 10 microg each time by intramuscular route for routine immune method. 33 adults of B group were given Hepatitis B vaccine 20 microg each time. 33 adults of C group were given Hepatitis B vaccine 10 microg each time. The blood samples were collected before the first injection and in 1, 2 and 8 months following the first injection to test Anti-HBs.</p><p><b>RESULTS</b>At T1, the anti-HBs positive conversion rate of group A, B and C was 26.47%, 48.48% and 18.18% respectively (chi-2 = 7.20, P = 0.027). At T8, the anti-HBs positive conversion rate of group A (64.71%) and group B (75.76%) were higher than group C (39.39%), and there was significant difference (chi-2 = 9.07, P = 0.011). At T1, the anti-HBs level of group B (417.00 +/- 69.36) was higher than that of group A (203.74 +/- 79.56). At T2, the anti-HBs level of group B (458.17 +/- 64.09) was higher than that of group C (257.86 +/- 76.60). At T8, the anti-HBs level of group A (501.48 +/- 70.00) and group B (532.73 +/- 68.82) were higher than those of group C (256.12 +/- 75.39) (t =4.27, P = 0.0173).</p><p><b>CONCLUSION</b>Schemes of augmentation doses of Hepatitis B vaccine and being combined with GM-CSF should be in effect for non- and hypo-responders to Hepatitis B vaccine.</p>

Study on rhGM-CSF as adjuvant in revaccination among adults of non-and hyporesponders to hepatitis B vaccine / 中华实验和临床病毒学杂志

<p><b>OBJECTIVE</b>To investigate the effect of recombinant human granulocyte macrophage colony stimulating factor (rhGM-CSF) as adjuvant on immune response in adults of non-and hyporesponders to hepatitis B vaccine.</p><p><b>METHODS</b>Those who were once immunized with recombined yeast gene hepatitis B vaccine more than one standard scheme in two years and negative for hepatitis B markers were randomly sorted as group A and group B. 33 adults of group A were given hepatitis B vaccine 10 microg each time. The immune procedure was 0, 1 and 6 month. 34 adults of group B were given rhGM-CSF 300 microg for the first day, then 10 microg each time for routine immune. The blood samples were collected before the first injection and in 1, 2 and 8 months (T1, T2, T8) following the first injection to test Anti-HBs.</p><p><b>RESULTS</b>Anti-HBs positive conversion rates of group A and B at T8 was 39.39% and 64.71% respectively (P = 0.038). Anti-HBs levels of group B at T1, T2, T8 were (113.85 +/- 198.56) mIU/ml, (312.40 +/- 349.44) mIU/ml, (427.74 +/- 411.58) mIU/ml (P = 0.001). There was significant difference between group A and B in T8 Anti-HBs levels (P = 0.010).</p><p><b>CONCLUSION</b>Better immune response was found in the group of rhGM-CSF with hepatitis B vaccine. So rhGM-CSF can induce the immune respond to hepatitis B vaccine.</p>