Management of patellar fracture with titanium cable cerclage.

Early rehabilitation after surgery for patellar fracture is challenging. The purpose of this study was to evaluate the surgical outcome of titanium cable cerclage for patellar fracture in early functional activity.We reviewed a series of 24 patients treated at our hospital with titanium cable. Functional exercises were started early. Patients were followed up for at least 12 months.Fifteen were males and 9 were females. Fracture occurred in the right knee in 13 patients and in the left knee in 11 patients. The most common mode of injury involves a tumble. None of the patients presented with any postoperative complications. The management resulted in satisfactory outcomes.Titanium cable cerclage offers a new strategy in treating patellar fracture.

A new model of tethered cord syndrome produced by slow traction.

The development of a suitable animal model is important for clarifying the pathogenesis of tethered cord syndrome (TCS). This study was undertaken to develop a new animal model for investigating the pathogenesis and therapeutic strategies for TCS. A traction device, a filum terminale tractor, was designed exclusively for this experiment. A TCS model was produced in cats using the tractor to fixate the filum terminale to the dorsal aspect of the second sacrum. The responses to tethering were evaluated by electron microscopy and electromyography for detection of somatosensory evoked potentials (SEPs) and motor evoked potentials (MEPs) at designated time points. Progressive swaying gait and lameness in clinical performance were observed with cord traction. Histopathological examination revealed an association between the increasing traction in the spinal cord and the increase in impaired nerve cells. No changes of SEPs and MEPs were detected in the untethered cats, while the latencies of SEPs and MEPs significantly increased in the tethered cats. The TCS model established in this study is simple and reproducible, in which varying degrees of tension could be applied to the neural elements.

Diastematomyelia: a 35-year experience.

STUDY DESIGN: Retrospective case series study. OBJECTIVE: This article describes our experience of the management of diastematomyelia. SUMMARY OF BACKGROUND DATA: Diastematomyelia is a rare entity, which presents distinct clinical characteristics and requires different managements compared with other more common occult spinal dysraphism. METHODS: A total of 156 patients with diastematomyelia were reviewed. All the patients underwent neurological and radiological examinations. Surgical excision of the lesion was performed for most patients and intradural exploration of the lumbar region was done to release tethering of conus in some patients. One patient died and autopsy was performed. Follow-up was carried out for all the patients, including surgical and nonsurgical approaches. RESULTS: There were 123 cases of type I diastematomyelia and 33 cases of type II diastematomyelia. The lumbar and thoracolumbar region was the most common site for diastematomyelia, and most spinal cords were split among 6 segments. The postoperative course was complicated by cerebrospinal fluid leakage in 2 patients, temporary neurological deterioration in 4 patients, and epidural hematoma in 1 patient. All cases did not have aggravation of symptoms during the follow-up of 2 to 20 years (mean of 4.5 yr). For the 123 patients with type I diastematomyelia, clinical symptoms were improved in 96 after surgical intervention and no worsening or occurrence of new clinical signs were observed during the follow-up. Those who did not receive surgery showed stabilization of neurological manifestation. Of the 33 type II cases, 9 surgical patients remained neurologically stable during the postoperative years without significant improvement in function, and 24 nonsurgical patients neither improved nor worsened in their neural deficit. CONCLUSION: Surgical treatment is the necessary management for type I diastematomyelia causing progressive neurological deterioration or with tethered filum, whereas conservative treatment is recommended to asymptomatic type I diastematomyelia and all type II diastematomyelia. LEVEL OF EVIDENCE: 5.

[Protective effect of puerarin on the secondary spinal cord injury in rats].

OBJECTIVE: To research the protective effect of puerarin on secondary spinal cord injury (SCI) in rats. METHODS: After the models of SCI were established by improved Allen's method on adult male SD rats, SOD, MDA, Bcl-2 and Bax gene protein expression between puerarin group and model group were compared after 1, 6, 12, 24 and 48 h. RESULTS: Puerarin could significantly enhance the activity of SOD and reduce the content of MDA, increase the expression of Bcl-2 gene protein products and decrease Bax gene protein product. CONCLUSIONS: Puerarin can increase the activity of SOD, reduce the content of MDA, promote the expession of Bcl-2 and restrain the expression of Bax in the early spinal cord injury. It has protective effect on the secondary spinal cord injury.

[Reactive astrocytes and nestin expression in adult rats following spinal cord compression injury].

OBJECTIVE: To observe the expressions of nestin and glial fibrillary acidic protein (GFAP) and their association with reactive astrocytes following spinal cord injury in adult rats. METHODS: Adult rats with compression injury of the spinal cord were divided into 7 groups (n=6) and examined at 1, 3, and 5 days and at 1, 2, 4 and 8 weeks after the injury. The recovery of the locomotor function after the injury was evaluated with Basso, Beattie and Bresnahan (BBB) scale, and the degree and scope of the spinal injury were assessed using toluidine blue staining. Immunohistochemistry, double immunofluorescent labeling and an image analysis system were employed to observe nestin and GFAP expression and cell proliferation in different regions of the spinal cord. RESULTS: The bilateral hind limb locomotor function of the rats declined severely 24 h after the spinal cord injury and underwent substantial recovery in 1 or 2 weeks after the injury, but followed by rather slow recovery afterwards. Toluidine blue staining of the spinal cord 24 h after the injury showed significant pathological changes in the neurons. The extension of the tissue injury increased with time till 1 week after the spinal cord injury. The site of injury and the adjacent tissues presented with markedly increased nestin and GFAP expressions 24 h after the injury, and nestin+/GFAP(-) cells dominated in the ependymal region around the central canal, whereas nestin+/GFAP+ dominated in the in other regions, showing significant difference from the control group. Nestin and GFAP expression reached the peak level 3 to 7 days after the injury and declined gradually till reaching nearly the control level at 2 weeks. CONCLUSION: Compression injury of the spinal cord induces up-regulated expressions of nestin and GFAP, and nestin expression is positively correlated to the reactive astrocytes, which, along with the neural stem cells, respond to spinal nerve injury and possibly play a role in repair of the central nervous system injury.