[Objective]To investigate the methods of surgical treatment of complicated lumbar spinal stenosis. [Methods]Totally 176 patients who were diagnosed as having complicated lumbar spinal stenosis,operated by back decompression,fused by bone graft and internal fixed by pedicle screws from January 1997 to January 2001 were retrospectively analyzed.Ninety-eight were males and 78 were females,with an average age of 58.5 years.Patient history was from 2 to 31 years.Thirty-five patients had a previous surgery on lumbar vertebrae,and 19 patients had two or more.Forty patients were complicated with one degree degenerated olisthe,42 were complicated with lumbar scoliosis and Cobb's angle more than 20?,21 had lumbar unsteadiness after surgery,19 patients had spinal stenosis in juncture after surgery.One ore two segments intervertebral discs were removed and vertebral plate were closed together,fused by bone graft and fused articular process.To the patients with more than two segments affection,processus articularis and processus transverses were fused to the patients need not remove intervertebral disk or remove less than half of processus articularis and interbody vertebral were fused to the patient need remove intervertebral disk.Patients with scoliolosis were decompressed and inserted pedicle screws.Revolve rod combined with compression and brace technique was used to correct scoliolosis,fuse the disk and articular process to the patient with severe intervertebral disk hernia and others were fused post-lateraly.[Results]Operation time was from 80 to 250 minutes.Blood loss was from 450ml to 1600ml and no patient died.The follow-up duration averaged 5.6 years.Fused disks had good to excellent rate of 87.4%,and multi-segments had good to excellent rate of 86.1%,and combined with scoliolosis good to excellent rate of 89.8%.The Cobb's angle was average 6.7? and correct rate was 73.8%.The fused rate of post-lateral was 92%(60/65),while the interbody vertebral fused rate was 97.9%(139/142).[Conclusion]The operation of complicated lumbar spinal stenosis is difficult to operate and has high risk.Back decompression,fused by bone graft and internal fixation by pedicle screws is a good method.

Objective:To discuss the clinical significance of overlapping infection of HGV in blood donorsand viral hepatitis. Methods :HGV-RNA was detected by reverse transcription-polymerase chain reaction.Results :The infectious rate of HGV in blood donors was 4% ,that in the patients with HBV and HCV was13. 9% and 15.8% respectively. Conclusion:Our results indicate that the HGV infection was widespread.Further study of immune response and status of viral replication in the liver tissue in overlapping infectionwith HBV and HCV,was needed.

Objective To carry out the quality control testing and evaluation for three digital mammography systems.Methods The performance of three digital mammography systems was assessed by applying methods recommended in the European guidelines for quality assurance in breast cancer screening and diagnosis and Chinese specification for testing of quality control in X-ray mammography.The performance of X-ray generator of three digital mammography systems were tested and evaluated.CDMAM 3.4 phantom with four different thickness(30,40,50,60 mm) were exposured in DR,PCM,and CR system,respectively.The average glandular dose (AGD) value was measured and image quality figure (IQF) analysis was performed in each thickness.Results The X-ray machine performance of DR and CR was in accordance with existing standard,however the standard was inappropriate to evaluate part of X-ray machine performance of PCM system.The AGDs for system DR were 1.20,1.42,1.75 and 2.20 mGy for 30,40,50 and 60 mm PMMA thickness,respectively.The respective AGDs for system PCM and CR were 0.82,1.19,1.33,1.70 mGy and 0.59,0.88,1.47,2.19 mGy.For the same phantom thickness sequence,the IQFs were 21.36,21.57,27.25 and 30.58 for system DR,28.02,29.10,35.90,and 41.24 for system PCM,whereas they were 39.78,39.30,43.85 and 48.08 for system CR.Conclusions The AGDs of all three systems were in accordance with the values recommended in European guideline.The AGD and IQF could provide an effective way for performance assessment and constancy checks for digital mammography systems.

Objective To discuss the selection of surgical treatment for lower cervical fractures and dislocations combined with locked-facet. Methods The clinical data of 68 patients with lower cervical spine fracture and dislocation combined with locked-facet were retrospectively analyzed. There were 33 patients with unilateral facet dislocation and 35 with bilateral facet dislocation. According to American Spinal Injury Association (ASIA) score, there were five patients at grade A, 11 at grade B, nine at grade C and 10 at grade D. All patients underwent skull traction. Anterior decompression and fixation were applied for reduction of the locked facet. Posterior unlocking reduction ,anterior decompression and plat fixation were applied for the patients with no reduction. Results There were no injuries on major blood vessels, trachea, esophagus, spinal cord. The follow-up lasted for average 41.5 months, which showed that the intervertebral height and lordosis were maintained normal. At six months postoperatively, bony fusion was achieved, with no plate and screw-related complications. The patients with neurological defect got improved at different degrees postoperatively. Conclusion For different lower cervical spine fractures and dislocations combined with locked-facet, selection of suitable surgical approach can attain satisfactory outcome.

Objective To compare the clinical outcomes of Bryan disc replacement with anterior cervical discectomy and fusion (ACDF) in patients with cervical spondylopathy. Methods Sixteen patients underwent Bryan cervical disc replacement (A group), and 35 patients underwent traditional ACDF (B group) were included in the study. Patients were followed up at regular intervals. The JOA score, SF-36, neck disability index (NDI) score and the dynamic flexion-extension radiographs were used to evaluated the oucomes.Results All the patients were followed up for more than 6 years (mean, 73.5 months). There were no severe adverse events in both groups. In A group, there were no differences between postoperative and preoperative mobility of surgical segments (P＞0.05). All patients obtained bone fusions 6 month after surgery in group B.In both groups, the clinical symptoms relieved obviously after surgery. The postoperative scores of the JOA,SF-36 and NDI significantly improved compared with those of preoperative ones (P＜0.05). In B group, range of motion (ROM) was significantly decreased postoperatively (P ＜0.01); in A group, there were no significant differences between postoperative and preoperative ROM (P＞0.05). The difference between two groups regarding ROM was noted (P＜0.05). Conclusion The mid-term outcomes of Bryan cervical arthroplasty are satisfied. And the cervical arthroplasty which can maintain the mobility of the segment, and decrease the incidence of the postoperative neck axial symptoms is a viable alternative to cervical spondylopathy.

Bone cement leakage is the most common complication in the treatment of thoracolumbar osteoporotic fractures by percutaneous vertebroplasty.The incidence rates of the literatures are different,with the range from 5％ to 80％.There are several different classifications of cement leakage;however there is no uniform classification standard.The classification criteria' s are based on anatomical location and leakage way.The independent risk factors of cement leakage are fracture semiquantitative severity grade and the viscosity of bone cement.The incidence rate of cement leakage increases with high fracture semiquantitative severity grade and low bone cement viscosity.For cortical leakage,the presence of cortical disruption and intravertebral cleft on MRI were identified as additional strong risk factors.The majority of bone cement leakage does not produce clinical symptoms.But some of the patients suffered from new adjacent osteoporotic vertebral compression fractures,neurologic deficits,pulmonary cement emboli,cardiac perforation,and even death.Therefore,we should strictly grasp the indications,select appropriate filling materials,and improve surgical techniques to avoid the occurrence of bone cement leakage.

Objective To investigate efficacy of KumaFix posterior spinal screw/rod system (KumaFix system) for thoracolumbar fractures.Methods Thirty patients with type A3 thoracolumbar fractures treated from June 2011 to June 2012 were divided into Group A and Group B according to odd and even number.Group A (n =15) underwent reduction and fixation with KumaFix system in combination with transpedicular bone grafting of fractured vertebrae.There were 7 males and 8 females at average age of (40.5 ±5.1) years (range,21-52 years).Group B (n =15) underwent posterior reduction and fixation with U-shaped screw/rod system in combination with transpedicular bone grafting of fractured vertebrae.There were 8 males and 7 females at average age of (41.3 ±4.8) years (range,22-51 years).Two groups were analyzed and compared in aspects of operation time,blood loss,visual analogue scale (VAS),anterior vertebral height ratio,kyphosis angle,spinal canal encroachment ratio,and Oswestry disability index (ODI).Results All patients were followed up for average 13.2 months.Operation time was shorter in Group A than in Group B (P ＜ 0.05),but there was no significant difference in blood loss between the two groups (P ＞ 0.05).Both groups achieved obvious improvement in aspects of VAS,anterior vertebral height ratio,kyphosis angle,spinal canal encroachment ratio after operation (P ＜ 0.05).ODI score was improved for the two groups after operation (P ＜ 0.05) and was better in Group A than in Group B at the last follow-up (P ＜ 0.05).Conclusions For treatment of type A3 thoracolumbar vertebral body fractures,the KumaFix system is able to achieve gradual,smooth and controllable distraction reduction that is conducive to the implement of transpedicular bone grafting of fractured vertebrae in comparison with the U-shaped screw/rod system.In the meantime,the KumaFix system avoids negative effect of internal fixation on adjacent articular process.

Objective To evaluate the reliability and reproducibility of the thoracolumbar osteoporotic vertebral compression fracture (OVCF) severity score system (TLOFS),so as to provide basis for clinical decision-making.Methods A total of 320 cases of thoracolumbar OVCF hospitalized between January 2014 and June 2015 were scored by TLOFS.There were 107 male and 213 female patients,aged 52-90 years (mean,63.78 years).All cases presented with a chief complaint of low back pain.Thirty-nine cases (TLOFS ≤3 in 21 cases,TLOFS =4 in 17 cases) were treated non-operatively,while 259 cases (TLOFS =4 in 23 cases,TLOFS ≥ 5 in 259 cases) were treated surgically.Pain was evaluated by the visual analogue scale (VAS).Reliability,reproducibility and content validity of the TLOFS were analyzed.Results Cronbach' sα coefficients of all TLOFS subgroups including evaluation of morphological changes,MRI,bone mineral density,clinical situation and therapy recommendation and total score evaluation were within the range of higher to high reliability (0.76-0.94).Kappa coefficients of all TLOFS subgroups were within the range of higher to high reproducibility (0.84-0.95).Mean content validity of all TLOFS subgroups was 0.916.VAS improved from preoperative(7.8 ± 2.1) to (1.3 ±0.7) at the final follow-up.Rates of correct diagnosis,sensitivity and specificity were 95.7％,87.6％ and 96.5％ respectively.Conclusion TLOFS exhibits good reliability and reproducibility,easy operation,and accurate and comprehensive evaluation,which is effective in guiding the clinical decision making in treatment of thoracolumbar OVCF.

Objective To explore the causes and clinical treatments of recurrent spinal tuberculosis complicated with sinus tract.Methods There were 21 patients suffered from recurrent spinal tuberculosis complicated with sinus tract in 87 patients with complicated spinal tuberculosis from January 1997 to January 2012.The dates of them were reviewed.There were 12males and 9 females with an average age of 38.8 years (range,22-58 years).There were 15 patients whose tuberculosis bacterial culture and drug sensitive experiments suggested drug resistance.All patients were excluded from mixed infection of sinus before the operation.According to the range of the tuberculous abscess,11 patients had undergone one stage sinus clearing and debridement,instrument removal,spinal fusion and internal fixation by anterior approach.The other 10 patients had undergone one stage anterior sinus clearing and debridement,instrument removal,bone graft and internal fixation by posterior approach.Results All patients were followed up for an average time of 29.7 months.16 patients were recovered.5 patients got recurrence with the rate of 23.8％(5/21).The recurrence rate of anterior internal fixation was 18.2％(2/11),and 30％ (3/10) for posterior internal fixation.3patients got recovered by conservative treatment and 2 patients by re-debridement.15 patients achieved bone fusion 6 months after the operation; 4 patients achieved bone fusion 9 months after the operation; 1 patient achieved bone fusion 12 months after the operation.The kyphosis Cobb' angle was corrected to 5.7°(ranged from 2° to 12°).Conclusion It is difficult for the treatment of recurrent complicated spinal tuberculosis combined with sinus tract.The causes of recurrence include drug-resistant strains of TB,uncompleted debridement,failure of spinal stability reconstruction,and combination with other organ tubeculosis.The key of successful surgical treatment includes effective chemotherapy,radical debridement and proper reconstruction of spinal stability.

Objective:To determine the contents of paraceltamol and caffeine in New compouad Folium Isatidis Tablets simultaneously by HPLC. Methods:The determination was carried out with C 18 chemical bonded silica gel as a solid phase, methanol-water (25∶75) as a mobile phase and UV deterction wavelength at 215 nm. Results: The average recovenies of the added sample were 99.6%( RSD=0.67, n=5) for paracetamol and 99.3%(RSD=0.58, n=5) for caffine, There was a good linear relationship between the concentration and absorption area value in the rang of 1.6?g～6.4?g for paractamol or 0.16?g～0.64?g for caffeine.Conclusions: The method is simple, quick and accurate.