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BACKGROUND:The treatment of lower cervical spine fracture and dislocation is aimed to improve neurological functions of patients, the selection of surgical approach is conductive to the reduction and spinal decompression, also maintain strong fixation and bone graft fusion. OBJECTIVE:To explore the restoration approach of lower cervical spine fracture and dislocation, and investigate the effect on bone graft fusion and cervical stability. METHODS: A total of 126 patients with lower cervical spine fracture and dislocation were treated surgicaly from January 2009 to September 2013 in the First Affiliated Hospital of Xinjiang Medical University. Based on Frankel system, 7 cases were grade A, 48 were grade B, 54 were grade C, and 17 were grade D before surgery. Based on SLIC system, 15 cases were 4 points, 23 were 5 points, 25 were 6 points, 22 were 7 points, 18 were 8 points, 16 were 9 points, and 6 were 10 points. Surgical approaches were determined based on the SLIC system, with a combination of sub-axial injury classification system, the type of fracture, spinal cord compression, and cervical spine injury degree. Anterior surgery (single gap or cervical corpectomy and fusion, bone graft internal fixation) was performed on 91 cases; Posterior treatment (posterior decompression, reduction and internal fixation) was performed on 6 cases; Combined posterior and anterior approach was performed in 29 cases. The neurological function improvement was evaluated at folow-ups; fracture healing, bone graft fusion and cervical stability were determined with imaging findings. RESULTS AND CONCLUSION:Al the 126 patients underwent surgery safely without severe complications such as tracheal or esophageal injury. Four patients appeared spinal cord injury and cerebrospinal fluid leakage, which were healed after corresponsive intervention. Al patients were immobilized in a hard colar for 3 months postoperatively and were folowed up for 6-18 moths. At postoperative 6 months, 5 cases of grade A were not recovered, one case of grade B was not recovered, 1-2 degree of neurological function recovery was achieved in the remaining cases by Frankel system. X-ray finding showed the good recovery of cervical vertebrae sequence after operation. Fusion was achieved in al cases within 12 months (mean 8.5 months) except non-fusion in one case and delayed fusion in two cases. There was no pseudarthrosis or nonunion occurred. The interbody height, physiological curvature and cervical stability maintained wel. The SLIC system, with a combination of sub-axial injury classification system, the type of fracture, spinal cord compression, and cervical spine injury degree should be considered before surgery. Reasonable selection of surgical approach can reconstruct spinal stability and achieve anatomical reduction and complete decompression, which is conducive to the recovery of neurological function.
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ObjectiveTo explore the effect of celecoxib on the tendon adhesion and healing after anastomosis.Methods54 New Zealand white rabbits were randomly assigned to one of 3 ( celecoxib,ibuprofen,and saline) groups.The deep flexor tendon was transected,followed by a primary repair.The care was begun the day after surgery and was continually provided for 14 days.Celecoxib was given[20 mg/( kg · d) ],ibuprofen was given [75 mg/( kg · d) ],or the same volume of saline solution was given respectively.At the 4th and 8th week the animals were killed and assessed by general observation,histologically observation,and biomechanical testing.ResultsGeneral observation,celecoxib group and ibuprofen group showed good shape of tendons,smooth surface,and covered with a film - like tissue,and it was easy to be separated.Saline group showed that tendon and surrounding tissue medium had dense adhesions,and it was difficult to be separated.Histologically observation showed between tendon and paratenon had clear gap in celecoxib and ibuprofen group.The mature fiber cells gradually arranged rules and in the same direction.Saline between the tendon and paratenon gradually emerged a gap,but more fibroblasts and arranged in irregular.Biomechanical testing showed that tendon sliding resistance appeared in celecoxib and ibuprofen group.Compared with saline group,the differences were statistically significant (0.354 ± 0.078/0.382 ±0.121 vs 0.521 ±0.126,P ＜0.05;0.075 ±0.035/0.097 ±0.043 vs 0.414 ±0.110,P ＜0.01).UTS (ultimate tensile strength had statistical significance among celecoxib,saline groups and ibuprofen group.(36.812 ±6.388 vs 24.899 ±4.667,P ＜0.05;34.297 ±8.132 vs 24.899 ±4.667,P ＜0.01 ;54.515 ±4.688/59.037 ± 6.606 vs 42.418 ± 5.594,P ＜ 0.01 ).ConclusionsCelecoxib can effectively prevent tendon adhesion,and does not affect the tendon healing.