[Treatment of thoracolumbar deformity with transpedicular eggshell technique].

OBJECTIVE: To evaluate the clinical effects of transpedicular eggshell technique in treating thoracolumbar deformity. METHODS: From December 2008 to December 2011,36 patients with thoracolumbar deformity were treated with transpedicular eggshell technique. There were 20 males and 16 females with an average age of 45 years old (ranged from 20 to 58). Among them, 5 cases were congenital hemivertebrae deformity, 12 cases were secondary to tuberculotic deformity, 14 cases were post-traumatic deformity with pain, 5 cases were ankylosing spondylitis. Low back pain, living ability, scoliotic Cobb angle were analyzed according to VAS scoring, Oswestry Disability Index (ODI), radiological examination. RESULTS: Average operative time was 245 min and average bleeding was 1 900 ml in 36 patients. All patients were followed up more than 1 year and obtained bone fusion at 1 year after operation. Preoperative,postoperative at 1 week and 1 year, VAS scoring was 7.2 +/- 1.4, 2.5 +/- 1.0, 1.8 +/- 0.5, respectively; ODI was (72.50 +/- 10.80)%, (42.50 +/- 11.10)%, (22.50 +/- 7.90)%, respectively; kyphosis Cobb angle was (76.31 +/- 2.52) degrees, (23.66 +/- 1.16) degrees, (23.67 +/- 1.16) degrees, respectively; lumbar scoliosis Cobb angle was (71.86 +/- 4.02) degrees, (30.81 +/- 2.33) degrees, (30.82 +/- 2.32) degrees, respectively. Postoperative at 1 week and 1 year,above data had obviously improved than that of preoperative (P < 0.05); and there was no significant difference in Cobb angle between postoperative at 1 week and postoperative at 1 year (P > 0.05). CONCLUSION: Treatment of thoracolumbar deformity with transpedicular eggshell technique could obtain effective correcting and clinical results.

[Clinical characteristics and treatment for patients with low back and leg pain caused by lumbar annular tears].

OBJECTIVE: To investigate whether annular tears is a cause of low back and radiating leg pain and explore the clinical characteristics and treatment for patients with this condition. METHODS: A total of 34 patients with low back and radiating leg pain, but without lumbar disc herniation on CT (computed tomography) or MRI (magnetic resonance imaging), were examined by electrophysiological studies and discography to identify whether there were or not annular tears and nerve root injury and decipher the relations between them. The series included 15 males and 19 females with an average age of 45.6 years old and the average duration of symptoms was 25.8 months. All patients with annular tears and positive pain provocation test were treated by local windowing decompression and debridement of nucleus pulposus after failed conservative treatment. The pre- and post-operative functions and pain were evaluated by JOA (Japanese Orthopedic Association) and VAS (visual analog scale) scores respectively. The average follow-up was 17.4 months. RESULTS: The clinical manifestations included low back and radiating leg pain, intermittent claudication and nerve root injury. No significant abnormalities were discovered on X-ray and CT scan. T2W images of magnetic resonance demonstrated a low intensity or black disc in all patients and high-intensity zone (HIZ) (n = 21). Electromyography showed nerve root injury (n = 27). Abnormality of conduction velocities of common peroneal nerve (n = 7) and tibial nerve (n = 3) were found. Thirty-four patients with 38 discs displayed pain reproduction on contrast injection during discography and the sites of annular tears were confirmed on CT scan after discography. Pre- and post-operative average JOA scale score was 8.7 points and 13.5 points, the recovery ratio 76.2% and the excellent and good outcomes 88.2%. Pre- and post-operative average VAS score was 8.6 points and 2.8 points. And the recovery rate was 80.5%. CONCLUSION: The annular tears result in low back and radiating leg pain. And the typical characteristics are low back and radiating leg pain, intermittent claudication and nerve root injury. MRI and electrophysiological studies play an important role in diagnosing this condition. Lumbar discography is the decisive method and prerequisite of selecting surgery. Local windowing decompression and debridement of nucleus pulposus is a simple and effective method.

[Intraobserver and interobserver reliability of the King, Lenke, and PUMC classification systems for idiopathic scoliosis].

OBJECTIVE: To evaluate the intraobserver and interobserver reliability and main influencing factors of the King, Lenke, and PUMC classification systems for idiopathic scoliosis (IS) using radiographs that had not been premeasured. METHODS: Fifty-six patients with IS, 9 male and 47 female, aged 15.4 (11 - 18), underwent preoperative X-ray photography of spine standing full-length posteroanterior and lateral films and left and right supine side-bending radiographs. The films were read by four orthopedic surgeons independently to do measurement and typing according to the King, Lenke, and PUMC classification systems respectively. Two weeks later, the sequence of the X-ray films was re-ordered and the 4 surgeons read them and did measurement and typing once more. The average percentage of intraobserver and interobserver agreement was calculated. Kappa coefficients were used to determine the intraobserver and interobserver reliability. RESULTS: King classification demonstrated fair interobserver reliability and excellent intraobserver reliability. The mean interobserver reliability was 65.8% (Kappa coefficient = 0.542), while the intraobserver reliability was 82.6% (Kappa coefficient = 0.767). The main reason of disagreement was distinguishment of the King type II and type III. Another reason was assessment of King type V. The complete Lenke classification demonstrated poor reliability. The mean interobserver reliability was 50.0% (Kappa coefficient = 0.438), and the intraobserver reliability was 47.0% (Kappa coefficient = 0.402). The 3 components of Lenke classification had fair interobserver and intraobserver reliability when they were examined separately. The main reasons for disagreement arose from judging whether there was a structural upper thoracic curve and assigning sagittal thoracic modifier. The PUMC type demonstrated excellent intraobserver and interobserver reliability with a mean interobserver reliability of 87.8% (Kappa coefficient = 0.757), and a mean intraobserver reliability of 92.9% (Kappa coefficient = 0.958). Its subtypes demonstrated fair agreement with the mean interobserver reliability of 70.2% (Kappa coefficient = 0.629), and a mean intraobserver reliability of 74.1% (Kappa coefficient = 0.674). The main reasons for disagreement were definition of a curvature and Cobb angle measurement. CONCLUSION: King and PUMC classification systems have higher interobserver and intraobserver reliability than Lenke classification. The reliability levels of the 3 classification systems are all influenced by many factors. Judgment of an upper thoracic curve, variable of Cobb angle measurement, and relationship of the central vertical sagittal line to apex of curve are the common reasons for disagreement in these 3 classifications.

[Continuous in situ monitoring of the dissolution rate of solid pharmaceutical preparations using a multiple channel fiber-optic chemical sensor].

AIM: To study the dissolution rate of solid pharmaceutical preparation on-line, a multiple channel fiber-optic chemical sensor based on fluorescence multiple quenching (FOCSMQ) without filtering and sampling was made. METHODS: Using the multiple channel FOCSMQ linked with computer, the dissolution rates of ofloxacin tablets, metronidazole tablets and nitrofurantoin tablets were monitored continuously on-line. The instrument can give the sample data, display the real time curve and calculate the T1/2 and td automatically. A computer was used to select the best function from five common fitting models to fit the dissolution curve. RESULTS: The average recoveries of the FOCSMQ method were 97.4%-104.4%, 97.4%-103.8% and 96.6%-102.1%. The RSDs (n = 6) of within-day and between-day were less than 5%. The parameters of the dissolution and all results of measurement using the instrument have no significant difference compared with the Chinese Pharmacopoeia (ChP) (2000) method and the United States Pharmacopoeia (USP) (23) method (P > 0.05). It does not need sampling and dilution, and never contaminate sample. It can shorten time of the experiment. CONCLUSION: The method is simple, rapid and reliable.