Individualized treatment selection and effect evaluation for intraspinal cement leakage after percutaneous vertebroplasty / 中华创伤杂志

Objective:To explore different surgical treatment options and effect for intraspinal cement leakage after percutaneous vertebroplasty (PVP).Methods:A retrospective case series study was carried out to analyze the clinical data of 5 patients with intraspinal cement leakage after PVP for osteoporotic vertebral compression fracture (OVCF) admitted to People's Hospital of Shanxi between May 2016 and January 2020, including 1 male and 4 females, with the age of 65-82 years [(75.4±7.5)years]. Injured segments were located at T 12-L 1 in 1 patient, L 1 in 1, L 2-4 in 1, L 3 in 1 and L 4-5 in 1. The American Spinal Injury Association (ASIA) classification was grade C in 2 patients and grade D in 3. Muscle strength was grade II in 2 patients and grade III in 3. The leakage of bone cement in the spinal canal was strip or columnar in 3 patients, leaning to one side of the spinal canal and adjacent to the nerve root, and the bone cement was removed by transforaminal endoscope for decompression. The leakage of bone cement in the dura mater and spinal canal was found in 2 patients. The intradural bone cement leakage was removed by durotomy, and the bone cement in the spinal canal was removed by transpedicular osteotomy, bone graft fusion and internal fixation. The visual analogue scale (VAS), Oswestry dysfunction index (ODI), ASIA grade and muscle strength were observed before operation, at 3 days, 3 months after operation and at the last follow-up. Results:All patients were followed up for 12-16 months [(13.6±1.8)months]. The VAS was significantly decreased at postoperative 3 days, 3 months and at the last follow-up [(2.6±0.6)points, (2.1±0.3)points, (1.9±0.5)points] when compared to (7.1±1.5)points before operation ( P<0.01). However, the VAS had no statistical difference at different time points after operation ( P>0.05). The ODI was 42.4±10.2, 25.6±6.0 and 21.4±3.6 at postoperative 3 days, 3 months and at the last follow-up, significantly different from that before operation (74.2±7.3) ( P<0.05 or 0.01). However, the ODI had no statistical difference at postoperative 3 months and at the last follow-up ( P>0.05). Two patients with preoperative ASIA grade C recovered to grade D and 3 patients with preoperative grade D recovered to grade E at the last follow-up ( P<0.05). Two patients could walk without crutches with muscle strength improved from grade II preoperatively to grade IV at the last follow-up ( P<0.01). Three patients had completed recovery of neurological function with muscle strength improved from grade III preoperatively to grade V at the last follow-up ( P<0.01). Conclusions:For OVCF patients with intraspinal canal cement leakage and neurological symptoms after PVP, if the bone cement is located on one side of the spinal canal and adjacent to the nerve root, the bone cement should be removed by foraminal endoscope for decompression; if the cement leakage occurs in the dura mater, the dura mater should be cut to remove the bone cement for decompression, which can effectively relieve pain and promote functional recovery.

Research progress of genetic susceptibility genes associated with intervertebral disc degeneration / 中华骨科杂志

The process of intervertebral disc degeneration,which could result in intervertebral disc structural and functional change,is a chronic one with multiple factors.The pathophysiologic process is still not completely find out.More and more research reports manifest that certain gene polymorphism also lead to increased risk of intervertebral disc degeneration except environmental factors.Discussions about related genetic factors and their pathophysiological role in the process of degeneration could have a further understanding to disease development.Elucidating genetic components which are associated with degeneration could not only provide insights into the mechanism of the process,but also have clinical significance for early diagnosis and prevention.In order to have a thorough understanding of functional role played by different genes,this paper summarize polymorphism and disease correlation by selecting 15 genes after reviewed the related literature published in recent years.Genetic polymorphisms in 15 genes have been analyzed in association with intervertebral disc degeneration,including aggrecan,collagen Types Ⅰ,Ⅸ and Ⅺ,fibronectin,HAPLN 1,CILP,MMP-1,2 and 3,PARK2,IL-1,6 and VDR.Each genetic polymorphism codes for a protein which has a functional role in the pathogenesis of disease.Among the 15 genes analyzed,polymorphisms in aggrecan,Type Ⅸ collagen,MMP3,IL1,IL6 and VDR show the most promise as functional variants.Genetic studies are necessary for understanding the mechanism of the degeneration.Relevant genetic information could be used as a predictive model for determining individuals' risk for intervertebral disc degeneration eventually.

The curative effect of medical clue jointed muscle flap for the treatment of spinal dural injury with cerebro-spinal fluid leakage during the spinal operation process / 中国基层医药

Objective To report a method of handling dural injury with cerebrospinal fluid leakage during the spinal operation process and analyze its effect,to comparatively analyze with the existing methods and to find a better way processing this problem.Methods A total of 36 patients with dural injury and cerebrospinal fluid leakage during the spinal operation process were collected.Among these clinical cases,there were 15 males,21 females,age ranged from 26 to 78 years old,average 58 years old.During the spinal operation process,the injured dura was sutured or repaired.After that,the dural wound was glued with a piece of muscle or fascia by a kind of medical glue named KangPaiTe.After the operation,broad -spectrum antibiotics and timely fresh dressing changing for the wound were applied.The nature and volume of the drainage fluid was documented and analyzed.When the volume of the drainage fluid was below 50mL per day,the drainage tube was pulled away,and the incision of the drainage tube was sutured again.Results The cerebrospinal fluid leakage lasted from 0 day to 4 days,average 1.5 days;the drainage tube was placed from 1 day to 5 days,average 2 days;no wound infection and other complications occurred among all the clini-cal cases included in this study.Conclusion After the injured dura was sutured or repaired,gluing the dural wound with a slice of muscle or fascia by a kind of medical glue named Kangpaite is a better method of handling dural injury with cerebrospinal fluid leakage.

Correction of the complex rigid talipes equinovarus deformities with the Ilizarov technique / 中华骨科杂志

Objective To evaluate the clinical results of the Ilizarov technique for the treatment of the complex rigid talipes equinovarus deformities.Methods From July 2005 to July 2011,28 patients (41 feet) with rigid talipes equinovarus deformities which had been corrected with the Ilizarov technique were retrospectively analyzed,including 18 males (26 feet) and 10 females (15 feet) with an average age of 15.3 years.According to the classification system proposed by Diméglio,31 feet were categorized as grade Ⅲ,and 10 as grade Ⅳ.We performed corrections with a soft tissue release in 23 feet,and with a limited osteotomy in 18,and then a Ilizarov external fixator was applied.Anteroposterior and lateral X-rays were taken to compare the pre and postoperative data in terms of the angle of plantarflexion and dorsiflexion,the range of motion of the ankle joint,radiological measurements of the talocalcaneal angle.Results All the 28 patients achieved an outpatient follow-up,with an average of 25 months.All patients achieved a plantigrade foot with an almost normal appearance as the fixator was removed after applied for an average of 5.1 months (range,2-14).At the preoperative and final follow-up respectively,the angle of dorsiflexion of the foot was -45.0°±12.0° and 9.5°±5.5°,the angle of plantarflexion was 67.0°±14.0° and 45.5°±7.8°,talocalcaneal angle was 6.5°±4.5° and 22.5°±5.5° in anteroposterior radiograph and 5.5°±11.0° and 40.6°±8.5° in lateral radiograph.Spastic ischemia occurred in one foot and relieved by a slower distraction rate.Wire-hole infections occurred in 5 feet and treated by dressing changs,wire tract altering and antibiotic therapy,finally the infections were controlled.Deformity relapsed in one foot three months after the device was removed,then corrected with an additional fixator application and has not recurred till the final follow-up.Toe contracture and residual deformity occurred in 5 feet and 3 feet,respectively.Conclusion The Ilizarov technique is an effective method for correction of complex rigid talipes equinovarus deformities,with which the appearance and function of the foot could be kept as much as possible,and without impact on food development.

Surgical treatment for the intraspinal extramedullary neoplasms in the cervical vertebrae (a report of 26 cases) / 中华骨科杂志

Objective To investigate the different operative style for the intraspinal extramedullary neoplasms in the cervical vertebrae as well as evaluate the clinical effect of titanium net for spinal canal reconstruction and bone autograft after laminectomy. Methods Since March 2002 to September 2008, 26patents (14 men, 12 women) with the intraspinal extramedullary neoplasm in the cervical vertebrae. The average age was 38 years (range, 6-76 yr). According to Frankel classification, there were 26 cases for grade B before operation, 8 cases for grade C, 11 for grade D, and 4 for grade E. All patients underwent hemilaminectomy (as group HL) or total laminectomy combined with spinal canal reconstruction with titanium net (as group TL). Recovery of nerve function and bone fusion were recorded. Preoperative and postoperative cervical curvature index and ranges of neck motion were recorded and compared. Results Among the 3cases with incomplete paraplegia, neurological status ameliorated from Frankel grade B to C; 8 cases of Frankel grade C recovered to grade D; 11 cases of Frankel grade D improved to grade E in 10 cases and 1to grade D. Bone fusion was formed on the titanium net and spinal stability was well after operation. Loss of cervical curvature indices was 2.2±2.3 in group HL and 4.3±2.5 in group of TL, and the difference was of statistically significant (t=2.05,P＜0.05). At the same time, loss of ranges of neck motion was 1.3°±1.2°ingroup of HL and 9.2°±4.1°in group TL, significant difference was also seen (t=1.71 ,P＜ 0.05). Conclusion Hemi-laminectomy approach to intradural lesions lends itself well to eccentric tumors with smaller size. For the cases of total laminectomy, it is necessary and reliable to reconstitute integrity of spinal canal with titanium net and bone autograft.

Venous drainage in the lesser saphenous sural neurovenofasciocutaneous distally based flap:an experimental study in rabbit model / 中华创伤杂志

Objective To investigate the venous drainage of lesser saphenous aural neurov enofasciocutaneous distally based flap through fluorescence tracing technique and discuss the pattern of venous drainage.Methods Venous blood for 0.1 ml was collected from every rabbit ear vein of 20 rabbits respectively for separation of the erythrocytes and labeling with FITC.The lesser saphenous sural neurovenofasciocutaneous distally based flaps were successfully established in hind limbs of 20 rabbits that were then allocated into four groups according to different inspection time points at 30 minutes ( Croup A) ,24 hours (Group B) ,72 hours (Group C) and 7 days (Group D) after operation.The labeled erythrocytes (5 μl) were injected into the flaps via lesser saphenous vein (in Groups A and B)or hypoderma (in Groups C and D).Then,the flaps were removed five seconds (in Groups A and B) or 10 seconds (in Groups C and D) after injection,immediately frozen and sectioned (5-7 μm in thickness) for microscopic analysis of fluorescent distribution in the pedicle.Results FITC-labeled red blood cells showed steady green fluorescence under inversion fluorescence microscope.Fluorescence was mainly distributed in the wall of lesser saphenous vein and peripheral vessels,as well as inner and outer membrane of perforator artery.There was only faint fluorescence around sural nerve in Groups B,C and D.HE staining showed that the lumina of lesser saphenous vein in Groups C and D were fully filled with thrombosis.Conclusions Vein of the lesser saphenous sural neurovenofasciocutaneous distally based flaps is refluxed mainly through wall of lesser saphenous vein and peripheral vessels as well as through inner and outer membrane of perforator artery in the pedicle.Thrombosis occurs in the lumina of lesser saphenous but there is no venous blood reflux through the valve of lesser saphenous vein.

Experimental Study on Stability of Pelvic Ring Reconstruction Using Fibular Autograft for Periacetabular Tumor Type Ⅱ Resection / 中国康复理论与实践

@#Objective To evaluate the stability of the pelvic ring reconstruction using fibular autograft for periacetabular tumor type Ⅱ resection. Methods 6 adult cadaveric specimens were tested. The periacetabular tumor resection models were established according to Ennecking's type Ⅱ resection. The resected pelvic rings were reconstructed with double-fibular graft fixed by four internal fixation techniques including plates, pedicle-rods (PR), lateral-rods (LR) or sacral-iliac rods (SIR). Axial loading from the proximal L3 vertebral body was applied by MTS load cell in the gradient of 0～500 N in the double feet standing state. Images in front view were obtained using CCD camera. Based on Image J software, displacement of the first sacral vertebrae （S1） of the reconstructed pelvis and intact pelvis were calculated using digital maker tracing method with center-of-mass algorithm. Results The rotational movements and vertical displacement of S1 around the normal side femoral head of the reconstructed pelvis in coronary plane were found in simulated bilateral leg standing position. The average vertical load-displacement and load-angular rotation curve of S1 in coronary plane were approximately linear behavior under the vertical load 500 N. The average vertical displacement and angle of S1 in coronary plane had not overacted. The stability of axial direction and rotation had not changed significantly when reconstructed by LR or Plates compared with the intact pelvis, but the SIR did. Conclusion Plates and LR fixation were more stabile for periacetabular tumor type Ⅱ resection.