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Lumbar degenerative disease is one of the most common diseases in orthopaedic clinics, and the chronic low back pain caused by it seriously affects patients' living quality. Currently, intervertebral fusion and rigid fixation are the main surgical methods for lumbar degenerative disease. Although the intervertebral fusion and rigid fixation can achieve a higher fusion rate, due to the stress concentration of adjacent segments, the adjacent segment degeneration may occur and make the patient's satisfaction rate much lower than the imaging fusion rate. Dynamic fixation is a new fixing concept, which can control the abnormal motion of the spine segment while retaining part of the movement of the fixed segment. Moreover, dynamic fixation is also beneficial to reduce the degeneration of adjacent segments and the incidence of breakage of internal fixation. Nowadays, various lumbar transpedicular dynamic fixation systems have appeared on the market. Most of these transpedicular dynamic fixation systems are derived from the design of pedicle screws and rods used in spinal fusion surgery in the 1980 s and 1990 s. The original intention of their design is to stabilize the abnormal segments and reduce the pressure on degenerated intervertebral discs and facet joints, while maintaining the normal movement of relevant segments. By reviewing the biomechanical research, clinical efficacy, existing problems and advantages and disadvantages of common backward lumbar transpedicular dynamic fixation systems, this article intends to provide new ideas for the improvement of the backward lumbar transpedicular dynamic fixation system design, as well as offering surgical treatment strategies for clinicians.
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Objective To discuss the application of mobile C-arm CT scan in the operations for thoracolumbar burst fractures of type A3.Methods From January 2012 to December 2014,21 patients with single-segment thoracolumbar burst fracture (AO type A3) were treated.They were 15 males and 6 females,aged from 17 to 68 years (average,43.6 years).By the American Spinal Injury Association (ASIA) grading,one was grade A,2 were grade B,12 grade C,4 grade D and 2 grade E.Preoperative CT examination was conducted.Mobile C-arm CT scan was performed to evaluate reduction of the fragments after the fracture was reset by posterior pedicle screwing.Laminotomy for canal decompression or reduction of the fragments would be performed if it was indicated by the results of mobile C-arm CT scan.CT examination was conducted postoperatively to assess the fracture reduction and recovery of the canal calibre.Results All the patients were followed up for an average of 15.5 months (from 10 to 18 months).Their cobb angle,vertebral anterior margin compression rate,spinal occupancy rate,vertebral translocation rate and visual analogue score at postoperation and final follow-up were significantly improved compared with their preoperative values (P ＜ 0.05),but there were no significant differences between postoperation and final follow-up in all the above indexes (P ＞ 0.05).Postoperative ASIA grading showed that the spinal function was improved from grade B to grade C in one,from grade C to grade D in 4 cases,from grade C to grade E in 5 cases,and from grade D to grade E in 3 cases.Conclusion Since intraoperative C-arm CT scan can help decide whether laminectomy for canal decompression is conducted or not in the surgery of thoracolumbar burst fractures,it enhances the surgical safety and reliability.
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Objective To discuss the application of mobile C-arm CT scan in the operations for thoracolumbar burst fractures of type A3.Methods From January 2012 to December 2014,21 patients with single-segment thoracolumbar burst fracture (AO type A3) were treated.They were 15 males and 6 females,aged from 17 to 68 years (average,43.6 years).By the American Spinal Injury Association (ASIA) grading,one was grade A,2 were grade B,12 grade C,4 grade D and 2 grade E.Preoperative CT examination was conducted.Mobile C-arm CT scan was performed to evaluate reduction of the fragments after the fracture was reset by posterior pedicle screwing.Laminotomy for canal decompression or reduction of the fragments would be performed if it was indicated by the results of mobile C-arm CT scan.CT examination was conducted postoperatively to assess the fracture reduction and recovery of the canal calibre.Results All the patients were followed up for an average of 15.5 months (from 10 to 18 months).Their cobb angle,vertebral anterior margin compression rate,spinal occupancy rate,vertebral translocation rate and visual analogue score at postoperation and final follow-up were significantly improved compared with their preoperative values (P ＜ 0.05),but there were no significant differences between postoperation and final follow-up in all the above indexes (P ＞ 0.05).Postoperative ASIA grading showed that the spinal function was improved from grade B to grade C in one,from grade C to grade D in 4 cases,from grade C to grade E in 5 cases,and from grade D to grade E in 3 cases.Conclusion Since intraoperative C-arm CT scan can help decide whether laminectomy for canal decompression is conducted or not in the surgery of thoracolumbar burst fractures,it enhances the surgical safety and reliability.
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Objective Degenerative lumbar scoliosis is frequent clinic spine malformation ,and it is complicated by lumbar inter-vertebral disc ,joint of lumbar vertebra cataplasia and lumbar spinal stenosis .The aim of this paper is to study surgical therapeutic regimen for analyzing clinic feature of degenerative lumbar scoliosis .Methods We comprehended symptom and analyzed imageology feature for lumbar spinal stenosis through reviewing 48 cases of operation from August 2003 to August 2010 ,and then approached its therapeutic principle and regimen .Results There were good therapeutic effect on the basis of comprehending degenerative lum-bar scoliosis and designing different treatment plan by different case feature .Conclusion Ii is need to know degenerative lumbar scoliosis again ,in order to work out individual therapeutic regimen based on clinic feather ,process segment ,state of spinal stenosis , angle of lumbar scoliosis ,degree of vertebra rotation and lumbar destabilizing .
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BACKGROUND:Studies have demonstrated that tetrandrine has protection on acute spinal cord injury,but the specific mechanism remains poorly understood.OBJECTIVE:To study the protection of tetrandrine on rat acute spinal cord injury and to study its mechanism from apoptosis pathway.METHODS:A total of 100 rats were randomly divided into 4 groups.All rats were prepared for spinal cord injury models using modified Allen method except that in the sham-surgery group.Methylprednisolone and tetrandrine was injected into rats in the methylprednisolone and tetrandrine groups by tail intravenous injection prior to and at 24,48 hours after model preparation.The same volume of physiological saline was injected in the sham-surgery and model groups.Basso-BeatUe-Bresnahan(BBB score)was recorded at 8 hours,1,3,7 and 14 days after model preparation.The morphological changes of spinal cord injury sites were observed by hematoxylin-eosin staining and the expressions of bcl-2 and bax were determined by immunohistochemistry.RESULTS AND CONCLUSION:The BBB score of methylpradnisolone and tetrandrine groups were significantly higher than that model group at 7 and 14 days(P<0.05),but there were no significant difference between the methylprednisolone group and tetrandrine group(P>0.05).Hematoxylin-eosin staining showed that the spinal cord injured severely at 3-7 days,the injury degree in the methylpradnisolone group and tetrandrine group was slighter than that of the model group,with smaller bax expression and greater bcl-2 expression(P<0.01).The findings demonstrated that,tetrandrine is able to protect neurons from apoptosis and promote the nerve function recovery by inhibiting the expression of Bax and promoting the expression of Bcl-2.Its effect is not inferior to methylprednisolone.
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BACKGROUND: There are few reports about vascularization in the repairing of bone defect by heterogeneous deproteinized bone.OBJECTIVE: To verify the vascularization characteristics of heterogeneous deproteinized bone, tissue engineering scaffold material, in the repairing of large segmental bone defect.DESIGN, TIME AND SETTING: The randomized controlled animal experiment was performed between March 2005 and February 2007 at the Third Military Medical University, Chongqing, China.MATERIALS: Twenty-four 10 to 12 months old goats, weighing (22.5±2.5)kg, were obtained from the Animal Center of the Third Military Medical University, Chongqing, China. Segmental bone defects of 20 percent right tibia middle and inferior diaphysis of the 24 goats were made.METHODS: The 24 goats were divided into test group (n=16) and control group (n=8) randomly. Goats in test group were implanted with deproteinized bone+autologous MSCs+recombinant human bone morphogenetic protein-2 (rhBMP-2), goats in control group were implanted with autograft bone, and all fixed with half-ring sulcated external fixator. Every 4 weeks, 3 goats were killed after ink perfusing through femoral artery. A thick slice of new bone tissue was made to observe the vascularization.MAIN OUTCOME MEASURES: Vascularization of new bone observed through gross anatomy and imaging; vascular network of new bone observed through thick section, blood vessel amount and area measured by Image-proplus really image analysis software.RESULTS: No goat was infected or dead. Animal soft tissue was dyed black, blood vessels'size, ditribution and network structure were observed in subcutaneous tissue, fascia and periosteum. At 4 weeks postoperation implant margin became crude in the defect area; at 8 weeks postoperation transparent bone absorbing area of different size and irregular shape appeared; after 12 weeks postoperation high-dense calcification shadow appeared at the ends of defect bone and new bone connected with the ends completely. On 4 to 24 weeks postoperation, the blood vessel amount became large, alignment became regular, and their size and distribution became uniform. It showed no significant difference in blood vessel amount and area between 2 groups (P>0.05).CONCLUSION: Composite of heterogeneous deproteinized bone+autologous MSCs+rhBMP-2 has the same vascularization degree. of autogeneous bone graft in repairing of large segmental tibia defect.
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[Objective]To evaluate therapeutics for lumbar tuberculosis. [Method]Data from 65 patients treated with five different therapeutics were retrospectively reviewed.Group A(n=14) was treated with focal debridement.Group B(n=15) with focal debridement and bone grafting fusion.Group C(n=9) with posterior focal debridement plus bone grafting fusion and internal fixation.Group D(n=12) with posterior fixation and anterior focal debridement plus,bone grafting fhsion.Group E(n=15) with anterior focal debridement plus bone grafting fusion and anterior internal fixation.Patients all received routine support and anti-tuberculosis therapy before and after operation.Follow-up, erythrocyte sedimentation rate was studied,and bone fusion and kyphosis correction with X-ray plain film and 3D-CT reconstruction were evaluated.[Result]There were not damages occurring in the great vessels,nerves or ureters.No recurrence was found during the follow-up of 12~16 months(average 13 months).Grafting bone were all fused after 4~6 months with an average time of 3.8 months.There was no missing of angel of kyphosis correction,complications of looseness or break of internal fixation.[Conclusion]Efficient anti-tuberculosis therapy and the debridement is the key for treatment of tuberculosis.The selection of fusion or internal fixation is depended on the severity of tuberculosis.Reasonable selection may improve the therapeutic effect of lumbar tuberculosis.