Objective To explore the feasibilities, methods, outcomes and indications of atlas pedicle screw system fixation and fusion for the treatment of upper cervical diseases. Methods From October 2004 to January 2006, 17 patients with upper cervical diseases were treated with atlas pedicle screw system fixation and fusion. There were 13 males and 4 females, ageing 19 to 52 years. Of 17 cases, there were 14 cases of atlantoaxial dislocation(including 3 cases of congenital odontoid disconnection，4 cases of old odontoid fracture，2 cases of new odontoid fracture(typeⅡC), 3 cases of rupture of the transverse ligament, and 2 cases of atlas fracture； 2 cases of tumor of C2; 1case of giant neurilemoma of C2,3 with instability after the resection oftumors. JOA score before operation was 8.3±3.0. Results The mean operative time and bleeding amount were 2.7 hours (2.1-3.4 hours) and 490 ml (300-750 ml) respectively. No injuries to the vertebral artery and spinal cord were observed. The medial-superior cortex of lateral mass was penetrated by 1 C1 screw approximately 3 mmwithout affecting occipito-atlantal motions. All patients were followed up 3-18 months. The clinical symptoms were improved in some extents and the screws were verified to be in a proper position, no breakage or loosening of screw and rob occurred. All patients achieved a solid bone fusion after 3-6 months. JOA score 3 months after operation was14.6±2.2. JOA improvement rates were 73%-91%(mean 82%). Conclusion The atlas pedicle screw system fixation and fusion is feasible for the treatment of upper cervical diseases and has betteroutcomes, wider indications if conducted properly.
OBJECTIVE: To investigate a animal model of spinal cord injury in different degrees of impact. METHODS: A new weight-drop device was designed with the character of controlled degree of impact and time. After thirty-five rats underwent different degrees of impact, their motor function and pathological changes were observed. RESULTS: In control group, the rats could walk after reviving, and the micro-structure of spinal cord was normal. With 0.5 mm depth of impact, the rats also could walk, and the micro-structure of spinal cord did not change obviously. With 0.8 mm depth of impact, the rats could walk after several days of injury and only slight damage could be found in spinal cord. When the impact depth increased to 1.0 or 1.5 mm, the rats were paralyzed completely and could not walk after four weeks of injury. Severe injury was observed in spinal cord. CONCLUSION: This animal model of spinal cord injury is based on different degrees of impact. It has stable and repetitive characters for the research on spinal cord injury.
Objective To study the clinical results of focal debridement and primary internal fixation with CD rod in treatment of multisegmental spinaltuberculosis.Methods From July 1999 to November 2002, 16 patients with multisegmental spinal tuberculosis were given focal debridement and primary internal fixation with CD rod trans sick vertebra. There were 9 males and 7 females, aging from 21 to 59 years. The course of disease was 2 to 11 months. The locations of lesion were T 6T 11 in 11 patients and T 10 -L2 in 5 patients.The involved vertebral bodies were 3 segments in 13 patients, 4 or more than 4 segments in 3 patients. There were 5 cases of Pott’s paralysis (according to Frankel classification system: 3 cases of degree C, 2 cases of degree D) and 4 cases of kyphosis and 2 cases of collapse. Focal debridement and internal fixation was performed in 1 or 2 incisions according to concrete conditions. Results All patients were followed up 11 months (6 months-3years), spinal tuberculosis was completely cured and the grafted bones were fused in all 16 patients. All patients obtainedprimary healing of the incision. Postoperative complication met with cerebrospinal fluid leakage in 1 case. After 6 months, 5 cases of paraplegia recovered. The kyphosis was corrected partly. No loose and dislocation of the nails and rods was found. Conclusion Focal debridement and primary internal fixation with CD rod can stabilize involved spinal segments, prevent and correct local deformity,and improve its curative ratio and fused ratio of grafted bone.
Objective To elucidate the surgical indicationsand treatment outcome of total spondylectomy and reconstruction for thoracolumbar spinal tumors with neurological deficit. Methods From January 1999 to December 2005, 16 patients with thoracolumbar spinal tumors with neurological deficit were treated with total spondylectomy and reconstruction. There were 10 males and 6 females, with an average age of 31.5 years(16-62 years).There were 10 cases of primary tumors of spine (4 giant cell tumor of bone, 3 chondrosarcoma, 2 recurrent aneurysmal bone cyst, and 1 osteosarcoma), and 6 cases of solitary metastasis of thoracic or lumbar spine. Tomita’s surgical classification was as follows: 9 cases of type 4, 6 of type 5, and 1 of type 6. Frankel’s neurological classification was as follows: grade A in 1 case, B in 4, C in 7,and D in 4. All patients were treated with total spondylectomy and reconstruction through combined anterior and posterior approach. Results All patients were followed up from 10 to 63 months with an average of 27.5 months. Pain was relieved completely in all patients. The neurological function returned to grade D in 5 cases, to grade E in 11 cases. Among the 10 patients with primary spinal tumor, nine patients survived with tumor-free, and one with osteosarcoma died because of lung metastases 18 months after surgery. Among the 6 patients with spinal metastasis, three patients survived with tumorfree, and lung metastasis occurred in 1 case 10 months after surgery, two died because of multiple metastases of internal organs 10 months and 32 months after surgery. Conlusion Total spondylectomy and reconstruction is a safe and effective surgery for thoracolumbar spinal tumors with neurological deficit, with pain relief, neurological improvement and minimum tumor recurrence. It will be an optimal choice for patients with primary malignant, aggressive benign, or solitary metastatic bone tumors of the thoracolumbar spine with Tomita surgical classification type 3 to 5.
The capacity of embryonic spinal cord tissue in the repair of injured structure of spinal cord has been noted for years. In order to investigate the embryonic spinal cord graft in the repair of motor function of injured spinal cord, the embryonic spinal cord tissue was transplanted to the hemisection cavity in spinal cord in adult rat. One hundred adult Wistar Rats were used to simulate the hemisectional injury of spinal cord by drilling 2-3 mm cavity in lumbar enlargement. Sixty rats were treated with rat embryonic spinal cord tissue grafting while the other forty were chosen as control. The outcome was evaluated according the combined behavioural score (CBS) and motor evoked potential (MEP) in the 1, 2, 4 and 12 weeks. The grafting group was superior to the control as assessed by CBS (P lt; 0.05), especially within 4 weeks. (P lt; 0.01). The restoration of the latent peak of early wave(P1, N1) was better in the grafting group, too. This suggested that embryonic spinal cord graft could improve the recovery of motor function of injured spinal cord in adult rat. The effect of the embryonic spinal cord tissue graft might be concerned with its secretion of several kinds of neurotrophic factors, nerve growth factor, nerve transmitted factor, or adjustment of hormone.
ObjectiveTo investigate the expression changes of the receptor activator of nuclear factor-κB ligand (RANKL) in the peripheral blood of patients with aseptic loosening of the implant after total hip arthroplasty (THA) by comparing with that of patients with femoral neck fracture and to analyze the correlation between RANKL expression and aseptic loosening.
MethodsBetween January 2008 and January 2013,the peripheral blood were harvested from 58 patients with aseptic loosening of the implant after THA (trial group) and 63 patients with femoral neck fracture (control group).The 2 groups were well matched,with no significant differences in age and gender (P>0.05).The expressions of the RANKL mRNA and RANKL protein were evaluated by quantitative real-time PCR and Western blot respectively.At the same time,the concentration of RANKL was also measured by ELISA.
ResultsThe expression of the RANKL mRNA in the trial group was 18.30±1.09,which was significantly higher than that of control group (1.00±0.05)(t=125.390,P=0.000).The relative RANKL protein expression values in trial group and control group were 0.856±0.254 and 0.404±0.102 respectively,showing significant difference (t=13.032,P=0.000).The results of ELISA showed that the concentration of RANKL in trial group [(3.553 5±0.129 7) ng/mL] was significantly higher than that of control group [(1.912 3±0.126 2) ng/mL] (t=18.124,P=0.000).
ConclusionThe high RANKL expression in peripheral blood is probably correlated with aseptic loosening of the implant in patients undergoing THA,which possibly is the prognostic factor of aseptic loosening of the implant.
Objective To review the advances in repair of spinal cord injury by transplantation of marrow mesenchymal stem cells(MSCs). Methods The related articles in recent years were extensively reviewed,the biological characteristic of MSCs,the experimental and clinical studies on repair of spinal cord injury by transplantation of MSCs,the machanisms of immigration and therapy and the problems were discussed and analysed. Results The experimental and clinical studies demonstrated that the great advances was made in repair of spinal cord injury by transplantation of MSCs. After transplantation, MSCs could immigrate to the position of spinal cord injury, and differentiate into nervelike cells and secrete neurotrophic factors.So it could promote repair of injuryed spinal cord and recovery of neurologicalfunction. Conclusion Transplantation of MSCs was one of effective ways in repair of spinal cord injury, but many problems remain to be resolved.
OBJECTIVE: To investigate the protective effect of tumor necrosis factor-alpha(TNF-alpha) on spinal motor neurons after peripheral nerve injury. METHODS: Twenty Wistar rats were divided into two groups, the right sciatic nerves of 20 Wistar rats were transected, the proximal stumps were inserted into a single blind silicone tube. 16 microliters of normal saline(NS) and TNF-alpha(30 U/ml) were injected into the silicone tubes. After 2 weeks, the 4th, 5th lumbar spinal cord were taken for examination. Enzyme histochemical technique and image analysis were used to show acetylcholinesterase(AChE) and nitric oxide synthase(NOS) activity of spinal motor neurons. RESULTS: The number of AChE and NOS staining neurons were 8.65 +/- 1.98 and 5.92 +/- 1.36 in the experimental group and 6.37 +/- 1.42 and 8.67 +/- 1.45 in the control group respectively, there were significant difference between the two groups(P lt; 0.01). CONCLUSION: It suggests that TNF-alpha has protective effect on motor neurons after peripheral nerve injury.
ObjectiveTo review the research progress on etiology and pathogenesis of spina bifida. MethodsBy consulting relevant domestic and foreign research literature on spina bifida, the classification, epidemic trend, pathogenesis, etiology, prevention and treatment of it were analyzed and summarized. ResultsSpina bifida, a common phenotype of neural tube defects, is classified based on the degree and pattern of malformation associated with neuroectodermal involvement and is due to the disturbance of neural tube closure 28 days before embryonic development. The prevalence of spina bifida varies greatly among different ethnic groups and regions, and its etiology is complex. Currently, some spina bifida patients can be prevented by folic acid supplements, and with the improvement of treatment technology, the short-term and long-term survival rate of children with spina bifida has improved. ConclusionThe research on the pathogenesis of spina bifida will be based on the refined individual information on exposure, genetics, and complex phenotype, and will provide a theoretical basis for improving prevention and treatment strategies through multidisciplinary cooperation.
ObjectiveTo compare the anesthetic potency and influence on maternal hemodynamics among spinal anesthesia (SA), epidural anesthesia (EA) and combined spinal epidural anesthesia (CSEA) for women undergoing cesarean sections.
MethodsA total of 180 singleton term nulliparous pregnancies of American Sociaty of Anethesiologists physical status Ⅰor Ⅱ for cesarean sections in Guangyuan Central Hospital from January to December 2012 were allocated into three groups using the method of random number table. Patients in group SA received SA (n=60), group EA underwent EA (n=60) and patients in group CSEA accepted CSEA (n=60). Patients wderwent punere all placed in left lateral position. Group EA patients unctures at the L1-2 interspace and the volume of carbonated lidocaine used initially was 12-15 mL. Group SA and CSEA accepted the anesthesia at either L2-3 or L3-4 interspace. The volume for group SA was 0.75% bupivacaine 1.2 mL with 10% glucose solution 1 mL, and for group CSEA was 0.5% bupivacaine 1.4 mL with 10% glucose solution 0.8 mL. A catheter was inserted into the epidural space for 3-4 cm after spinal needle exit so as to add additional epidural medication according to the block level and the level of anesthesia subsidence. The values of the basis of blood pressure and heart rate, the lowest blood pressure and heart rate, umbilical venous blood gas, start effect and induction time of anesthesia and the highest block level of anesthesia were record.
ResultsThere were statistically significant differences in terms of start effect time of anesthesia among the three groups (F=24.642, P<0.001). The start effect time of anesthesia in group SA and CSEA was significantly shorter than that in group EA (t=8.076, 7.996; P<0.05). The induction time of anesthesia in group SA was significantly shorter than those in group EA and CSEA (P<0.05). The lowest blood pressure and heart rate in group SA and CSEA were significantly lower than the values of basis (P<0.05). The lowest blood pressure and heart rate in group SA was significantly lower than that in group EA (P<0.05). The incidence of hypotension and bradycardia in group SA and CSEA was significantly higher than that in group EA (P<0.05). The block level of anesthesia in the three groups were at thoracic 8.12±1.22, 8.36±1.88 and 8.52±1.92 respectively, and there was no significant difference among the three groups (F=0.081, P=0.923).
ConclusionEA and CSEA surpass SA in the choice of neuraxial anesthesia for cesarean sections, and 1.73% carbonated lidocaine for EA can improve anesthetic potency and better maintain relatively stable hemodynamic indexes.
