[The clinical significance of osteotomy angle prediction for sagittal alignment reconstruction].

As an effective way to reconstruct the spinal alignment, osteotomy has been widely used to reconstruct the sagittal alignment of spine and achieved significant results.In order to avoid the secondary sagittal disequilibrium caused by the inaccurate osteotomy angle, it is very important to make an appropriate operation plan before the operation and evaluate the osteotomy angle accurately.At present, scholars have proposed different targets for sagittal reconstruction of the spine with different patients and diseases.They also proposed various prediction methods of osteotomy angle according to different reconstruction standards and principles, as well as the selection of osteotomy sites and methods.In this paper, the preoperative evaluation of the osteotomy angle was reviewed in terms of the target of sagittal reconstruction, the prediction of osteotomy angle and the selection of osteotomy method and osteotomy site.

Downregulation of miR-21 promotes tibial fracture healing in rabbits through activating ERK pathway.

OBJECTIVE: The aim of this study was to investigate the effect of micro ribonucleic acid (miR)-21 on tibial fracture healing in rabbits by regulating the extracellular signal-regulated kinase (ERK) signaling pathway, and to explore its possible underlying mechanism. MATERIALS AND METHODS: A total of 15 healthy male rabbits were randomly divided into three groups, including: model group A (fracture group, n=5), model group B (fracture treatment group, n=5), and model group C (miR-21 siRNA + treatment group, n=5). Fracture healing was observed by imaging. The content of the serum collagen I and collagen II in rabbits was detected via enzyme-linked immunosorbent assay (ELISA). The morphology of bone tissues was observed via staining. Moreover, the expressions of ERK, transforming growth factor-ß1 (TGF-ß1), and Smad in osteoblasts of tibia were observed via Western blotting and Reverse Transcription-Polymerase Chain Reaction (RT-PCR), respectively. RESULTS: There was bony callus formation in group B and C when compared with group A. Compared with group B, bony callus formation was significantly accelerated in group C, while healing cycle was shortened. Hematoxylin-eosin (HE) staining and Masson staining indicated that compared with group A, group C had more fibrous calluses, new capillaries, and fibroblasts in tissues. Meanwhile, group C exerted better maturity of collagen tissues and higher osteoid content at 20 d after modeling. Compared with group C, there were more osteoid tissues with poor maturity in group B. Meanwhile, intramembranous bone formation was deformed, and collagen content was remarkably lower in group B. The content of serum collagen I and collagen II remarkably increased in group B compared with group A (p<0.05). However, it was significantly upregulated in group C compared with group B, showing statistically significant differences (p<0.05). According to the results of Western blotting, the protein expressions of TGF-ß1, Smad, and ERK in osteoblasts were significantly upregulated in group B when compared with those in group A (p<0.05). However, they increased remarkably in group C when compared with group B (p<0.05). Besides, RT-PCR results revealed that the messenger RNA (mRNA) expressions of TGF-ß1, Smad, and ERK in osteoblasts were significantly higher in group B than those in group A (p<0.05). However, they were markedly raised in group C in comparison with group B (p<0.05). CONCLUSIONS: Down-regulation of miR-21 promotes tibial fracture healing in rabbits by activating the ERK signaling pathway.

[Surgical treatment of intractable odontoid fracture with atlantoaxial dislocation in children with spinal cord injury].

Objective: To discuss the surgical treatment and its effectiveness of odontoid fracture complicated with atlantoaxial dislocation in children with spinal cord injury. Methods: From January 2010 to December 2014, 10 cases of children under 14 years old, with intractable odontoid fracture with atlantoaxial dislocation were enrolled. The mean duration between injury and admission was 8.5 d (range 1-30 d). The surgery was performed using posterior reduction and internal fixation or anterior release combined with posterior fixation. The medical date including preoperative and postoperative neurological function, degree of reduction and fusion. Results: All cases were followed-up for 12-48 months. The last follow-up X ray and CT examinations showed good reduction and fusion. No fixation failure was observed among all the patients. According to the Frankel, the preoperative neurological function was C in 2 cases, D in 4 cases, and E in 4 cases. At the last follow-up, out of 2 cases with Frankel C improved to D, and the other 8 cases were back to normal. Conclusions: Diagnosis of odontoid fracture complicated with atlantoaxial dislocation is usually delayed in children. One-stage posterior reduction and internal fixation or anterior release combined with posterior fixation is an effective and safe surgical procedure for such cases.

[Diagnostic significance of serum free DNA human telomerase reverse transcriptase quantitative determination on spinal cord injury].

Objective: To investigate the relationship between the content of human telomerase reverse transcriptase (hTERT) and its clinical features in serum free DNA in patients with different degree of spinal cord injury. Methods: From December 2013 to December 2016, inpatients of the Central Hospital of Bazhong, Sichuan Province were enrolledand divided into the experimental group, the disease control group and the negative control group. For the experimental group: 46 patients with spinal cord injury were graded according to the criteria of the American Association of Spinal Cord Injury (ASIA), including 12 cases of grade A, 10 cases of grade B, 10 cases of grade C, 7 cases of grade D and 7 cases of grade E; for the disease control group: 15 patients with spinal fractures (without spinal cord injury) at the same period were included; and for the negative control group: 20 healthy adult volunteers aged 18-50 years were selected.Real-time fluorescence quantitative PCR and immunoblotting were performed to detect the content of hTERT in serum free DNA both in patients and healthy controls and to compare the difference between them. The results of the somatosensory evoked potential (SEP) of all patients were compared and analyzed.The receiver operating characteristic (ROC) curve was used to analyze the diagnostic value of hTERT content in serum free DNA in patients with spinal cord injury. Results: Comparison of serum free DNA hTERT content: in the experimental group, the serum free DNA hTERT content of grade A, B, C, D, E was (99.63±8.23), (76.24±4.37), (46.07±5.43), (16.30±0.95) and (15.74±1.12)µg/L, respectively.While it was (15.01±1.39)µg/L in the disease control group and (14.54±1.03)µg/L in the negative control group. The total difference was statistically significant between patients of each group and the control group (F=857.917, P<0.001). Comparison of the protein content of TERT: in the experimental group, the protein content of TERT of grade A, B, C, D, E was 0.736±0.214, 0.641±0.172, 0.606±0.184, 0.411±0.132 and 0.307±0.152, respectively.The protein content of TERT in the disease control group and the negative control group was about 0.312±0.098 and 0.322±0.177, the difference between patients of each group and the control group was statistically significant (F=62.461, P<0.001). Detection results of surface evoked potential (SEP) showed that in the experimental group, level A patients all had conduction block.Two cases of level B patients had conduction block and 8 cases had delayed conduction.Among level C patients, 1 case had conduction block, 9 cases had delayed conduction.Among level D patients and patients from the control group and the negative control group, SEP detection all had no conduction block. Conclusion: The detection of the hTERT content in serum free DNA in patients with spinal cord injury has a certain guiding significance for the diagnosis of spinal cord injury and the degree of injury.

[Efficacy and safety of vertebrae pedicle subtraction osteotomy by posterior trans apical for correction of severe and rigid idiopathic scoIiosis].

Objective: To evaluate the efficacy and safety of pedicle subtraction osteotomy for correction of severe rigid idiopathic scoliosis. Methods: From January 2003 to December 2014, eighteen patients with severe rigid idiopathic scoliosis were treated by posterior wedge osteotomy in department of spinal surgery, the First Affiliated Hospital of Xinjiang Medical University. There were 5 males and 13 females, and the average age at was (16.9±9.1)years, and the average follow-up was 47.6 months. The coronal and sagittal Cobb's angles, sagittal trunk shifts, apical vertebral translation, height change and fusion segments were measured on standing AP and lateral radiographs before, after surgery and the final follow-up. Results: The Cobb's angle in the coronal plane was corrected from (94.3±13.3)°to (31.6±14.8)°, representing 64.8% correction rate. The Cobb's angle in the sagittal plane was corrected from (62.5±17.8)°to (27.1±11.7)°, representing 82.6% correction rate. Coronal trunk shift was obviously improved from -29.8 mm to -3.5 mm. the average fusion segments was 13.7±1.8 ranging from 11 to 17 segments. Perioperative complications consisted of pleura injury in 4 cases, cerebrospinal fluid leakage in 2 cases transient neurological damage in 2 cases and delayed infection in 1 case. Conclusion: Pedicle Subtraction Osteotomy correction by the single posterior approach is a reliable and safe surgical technique for correction of severe rigid idiopathic scoliosis.

[Diagnosis and treatment of Tuberculous primary psoas abscess].

Objective: To retrospective analysis the clinical characteristics of diagnosis and treatment the disease of tuberculous psoas abscess (TPA). Method: The medical records of 13 consecutive patients presenting to our hospital with TPA were reviewed from November 2002 to December 2015.Demographic data, presenting features, predisposing factors and the investigations performed were recorded and the outcomes were analysed. Results: The thirteen patients were included, 11 cases all had lower backache, 6 cases had Lower abdomen or groin area pain, 2 cases had fever, eleven cases were treated with Open drainage, one with Ultrasound guided drainage, and the last case used antibiotics alone, median hospital stay of 35 days, follow-up showed no recurrence or death in patients. Conclusion: The incidence of TPA is probably underreported.The vague presentation leads to delays in diagnosis and increases morbidity and a high index of suspicion is the key to early diagnosis.Open drainage has Lower recurrence and death rates, and used widely, is the most reliable method for the treatment of primary tuberculous psoas abscess.