Objective To retrospectively analyze whether the kyphosis exists after removal of the internal fixators for thoracolumabar vertebrae fractures. Methods A total of 18 patients (35-68 years old) with thoracolumabar vertebrae fractures (T11-L2 ) were fixed with short segment pedical screw. The fixators were removed one year postoperatively to observe the changes of the Cobb' s angle and trauma vertebra'height. Results All the patients were followed up for 6-24 months ( average 18.7 months),which showed no intraoperative or postoperative complication, breakage or loosening of the screws. Compared to the Cobb angle and the vertebra height before removal of the internal fixators, the average loss of the Cobb angle was 0.7° and that of the vertebra height was 0.8 mm six months after removal of the fixators, 1.9° and 1.1 mm respectively one year after removal of the fixators, and 2.4° and 1.3 mm respectively two years after removal of the fixators in 16 patients without osteoporosis (P ＞0. 05). Among two patients with osteoporosis, the average loss of the Cobb angle and the vertebra height was 6° and 8°respectively and 3 mm and 5 mm respectively six months after removal of the fixators; 13° and 17° respectively and 5 mm and 7 mm respectively one year after removal of the fixators; 15° and 19° respectively and 6 mm and 7.5 mm two years after removal of the fixators. Conclusions After the internal fixation for thoracolumbar vertebrae burst fractures, kyphosis develops mildly, with insignificant change of the vertebral height. While the kyphosis becomes worse after removal of the fixators for thoracolumbar vertebrae burst fractures in patients with osteoporosis.

Objective:To evaluate the over 5-year follow-up clinical outcomes of degenerative lumbar scoliosis treated with operation of decompression and fusion,and the effectiveness and risks factors about revision surgery cases.Methods:A total of 47 cases of diagnosis of degenerative lumbar scoliosis treated with posterior decompression and instrument fusion recorded from Jun.2003 to Jun.2008 were analyzed. Lumbar Japanese Orthopedic Association (JOA)score and visual analogue score (VAS)were applied to evaluate the improvement of the clinical effect after surgery treatment,and the clinical effect and reasons of revising operation were recorded and analyzed.Results:All the 47 patients had finished the over 5-year followed-up time with an average time of (8.2 ±3.6)years (range from 5.2 years to 12.5 years). The patient’s mean age was (67.0 ±9.6)years and the age of patient range from 56 years to 81 years. There were 10 patients who underwent revision surgery since primary operation,in whom 8 cases because of proximal failure of internal fixation and the other 2 cases because of distal failure of fusion segment. The average clinical improvement excellent rate was 83 .3% after 5 years since primary operation of 37 cases while the average fine rate of revision operation was 67 .6%.Conclusion:In the over 5-year follow-up,there was a better clinical outcome of degenerative lumbar scoliosis treated with posterior de-compression and instrumented fusion,which had a certain rate of revision operation and had a worse effect of clinical results compared with primary operation.The risks of revision surgery included the poor bone quality of patients,with fusion to L1 at proximal terminal and the fusion end to S1 at distal termi-nal.

Objective To evaluate the biomechanical effects of using a new injectable calcium phosphate cement to consolidate the fixation of osteoporotic intertrochanteric fracture.Method Five matchod pairs of human cadaver femora were used to produce the model of intertrochanteric fracture.All fractures were fixed with dynamic hip screws(DHS),and divided into two groups.In the CPC consolidation group of each pair,CPC was used to grout the hip screw and to fill the posteromedial defect.All femora were subjected to biomechanical test.Results Under the loading of 500 N,in the CPC consolidation group,the mean axial stiffness is(691.93±18.90)N/mm and the horizontal shear stiffness is(5553.84±27.47)N/mm.The mean lateral and medial strength is(5.15±0.35)MPa and(4.13±0.24)MPa.The torsion stiffness was 0.41 and the ultimate loading is(3580±286)N.In the control group,the mean axiak stiffness is(453.45±19.75)N/mm,the horizontal shear stiffness is(3848.87±22.63)N/mm,the mean lateral and medial strength is(3.12±0.37)MPa and(1.80±0.21)MPa,and,the torsion stiffness is 0.35 and the ultimate loading is(2512±189)N.Consolidation fixation with CPC increased each of the biomechanical efficiency(P＜0.05).Conclusions CPC consolidation of osteoprotic femoral head and the medial defect of intertrochanteric fracture can significantly improve the overall stability and decrease the rate of postoperative complication.

BACKGROUND:Percutaneous injection of bone cement into the vertebral body can enhance the vertebral strength and vertebral stability, and obtain pain relief. But the bone cement may leakage into the paravertebral vessels during injection, and may back to the right ventricle and flow into the pulmonary artery through vena cave and thus causing pulmonary embolism.
OBJECTIVE:To evaluate the relationship between cement paravertebral vascular leakage and pulmonary cement embolism during percutaneous vertebroplasty.
METHODS:Total y 134 cases of osteoporotic compression fractures treated with vertebroplasty were retrospectively analyzed. Among them, 23 cases of cement paravertebral vascular leakage were considered as the experimental group, and the 43 cases without cement paravertebral vascular leakage and had the complete imaging data were considered as the control group. The spine and chest X-ray films were taken before and after vertebroplasty to detect whether there were cement paravertebral vascular leakage and pulmonary cement embolism in the patients of two groups.
RESULTS AND CONCLUSION:Among the 134 patients, 23 patients had cement paravertebral vascular leakage, and accounted for 17.2%. Among the 23 patients with cement paravertebral vascular leakage, three cases had pulmonary cement embolism without chest symptoms, and accounted for 13%. No pulmonary cement embolism occurred in the 43 patients without paravertebral vascular leakage of the control group, and there was no significant difference between two groups (P=0.039). Although the patients with cement pulmonary embolism remained asymptomatic, pulmonary cement embolism remained possible if cement paravertebral vascular leakage was detected during vertebroplasty.

ObjectiveTo analyze the influencing factors and clinical results of radial shortening after operation of intra-articular fractures. MethodsA total of 54 patients with intra-articular fractures of the distal radius treated surgically from January 2003 to January 2008 were followed up and divided into radial shortening group ( ＞ 4 mm) and control group ( ＜ 4 mm) by whether radial shortening was more than 4 mm. Fracture types, comminution and defection degree, age, surgical approach and internal fixation method, whether bone implant in operation, post-operative volar tilting angle and ulnar inclination angle, and wrist function score were investigated and compared between the two groups. ResultsThe incidence of radial shortening in post-operation of intra-articular fractures of the distal radius was 30％.Age and whether bone implant in operation were significantly different between the two groups. Type C fractures were more liable to radial shortening than type B fractures. Operation approach and internal fixation method have no significant influence on the radial shortening. Volar tilting angle and ulnar inclination angle were not significantly different between the two groups and the excellent and good rate of function score was lower in the radial shortening group. ConclusionThere is a high incidence of radial shortening after operation for the intra-articular fractures of the distal radius, which affects the clinical results of operation. Therefore, we should pay more attention to the influencing factors and take corresponding precaution methods during operation.

Objective To explore the pathogenic genes relevant to Behcet's disease (BD) by building the differentail gene expression profiles of peripheral blood leukocytes in BD. Methods Oligonucleotide gene array from Affymetrix Company was applied to study the differed expression levels of whole genome between three age and sex matched BD patients and normal controls. Four genes, BCL6, LRAP, ICOSLG and MME, were selected to be tested for gene expression levels by real-time PCR in the groups of BD, normol controls (NC), Lupus and rheumatoid arthritis (RA) peticnts. Results ① Differential gene expression profile of BD compared to that of normal controls was built up. It contained 89 up-regulated and 57 down-regulated genes. ② Four genes mentioned above had significantly higher expression levels in active BD patients than those in NC but had lower exoression levels in stable BD patients. The expression levels of BCL6 and MME were also proved to be increased significantly in BD than in RA and SLE patients. Conclusion ① Our work shed some light on further research of the etiopathogenesis of BD. ② The expression levels of the four genes are proved to be relevant to BD the first time by us. Further analysis showes that TNF-α and IFN-γ can up-regulate the expression levels of BCL6, LRAP and ICOSLG which may be novel to BD. The MME gene is expressed on the surface of cells, which is convenient for test and may potentially be a marker for the diagnosis of BD.

Objective:To investigate the clinical characteristics of vertebral compression fracture ( VCF) in glucocorticosteroid-induced osteoporosis ( GIOP) and risk of vertebral refracture after percuta-neous vertebroplasty ( PVP) or percutaneous kyphoplasty ( PKP) .Methods:In the study, 570 cases who received PVP or PKP as treatments of VCF from January 2010 to December 2013 were retrospective re-viewed, of which 42 were GIOP and 21 were followed up as GIOP group, and the other 528 were primary osteoporosis and 391 were followed up, of which 84 were selected as Control group based on age and gen-der.The fracture location, ratio of single segment fracture and multiple segments fracture in the two groups were compared.In the final follow up, the reoperation rates for vertebral refractures by the Kap-lan-Meier method in the two groups were compared.Results:The follow up periods were (24.0 ±13.1) months in GIOP group and (25.8 ±14.4) months in control group(P>0.05).In GIOP group, there were 11 cases with one-segment fracture, 2 with two-segments fracture, 3 with three-segments fracture, 2 with four-segments fracture, 2 with five-segments fracture and 1 with eight-segments fracture.In Control group, there were 67 cases with one-segment fracture, 12 with two-segments fracture, 3 with three-seg-ment fracture, and 2 with four-segments fracture.The ratio of single segment fracture in GIOP group was significantly lower than that in Control group(52.4% vs.79.8%,P=0.01).There were 50 fracture segments in GIOP group and 109 fracture segments in Control group.The ratios of fracture segments loca-ted in thoracic segments(T1-T10), thoracolumbar segments(T11-L1)and lumbar segments(L2-L5) were 18%, 46%and 36% in GIOP group and 11.9%, 58.7% and 29.4% in Control group ( P >0.05).The refracture rate in GIOP group was higher than that in control group (23.8%vs.6.0%).The survival rate was lower in GIOP group than that in control group ( P<0.01) .Conclusion:The predilection site of VCF was similar in GIOP and primary osteoporosis ( thoracolumbar segments>thoracic segments>lumbar segments).The risk of multiple segments VCF was higher in GIOP than in primary osteoporosis. The risk of vertebral refractures after PVP or PKP was higher in GIOP than in primary osteoporosis.

Objective:To describe the application of polymethylmethacrylate (PMMA) augmentation of cement-injectable cannulated pedicle screws for the treatment of degenerative lumbar scoliosis with osteoporosis.Methods: Retrospective cohort study was used to compare cement injectable cannulated pedicle screws (CICPs) group with PMMA augmentation and control group with traditional method in the correction surgery for Lenke-silva level Ⅲ and level Ⅳ degenerative scoliosis cases with osteoporosis.Both groups were followed up for 1 year.The clinical results were assessed by visual analog scale (VAS) of pain on lumbar and lower limbers,Oswestry disability index (ODI) score and EuroQol-5 dimensions (EQ-5D) score.The coronal major curve Cobb angel in coronal plane and thoracic kyphosis Cobb angle,lumbar lordosis Cobb angle and sagittal vertical axis (SVA) in sagittal plane were tested in whole long spine X ray.The fusion rates were evaluated by lumbar X ray and dynamic X ray.Results: In this study 34 cases were enrolled,15 cases in CICPs group and 19 cases in control group.The general characteristics including age,gender,weight,height,BMI and BMD were without statistical difference between the two groups.There were (5.7±2.2)PMMA augmentation screws in CICPs group.The operation time,blood loss and blood transfusion were higher in CICPs group than in control group,but without statistical difference.Lumbar VAS,lower limbers VAS,ODI score and EQ-5D were all better in 1 month post-operation,6 months postoperation and 1 year postoperation than in preoperation in both groups.lumbar VAS scores of CICPs group in 6 months postoperation(CICPs group 3.1±1.3 vs.control group 4.4±1.4,P<0.01) together with lumbar VAS scores (CICPs group 3.3±1.0 vs.control group 5.2±1.4,P<0.01),ODI scores (CICPs group 22.7±17.2 vs.control group 31.4±18.5,P<0.01) and EQ-5D in 1 year postoperation (CICPs group 2.9±2.0 vs.control group 3.5±2.5,P<0.01)were lower than those of control group.The coronal major curve Cobb angels were all lower in 1 month postoperation,6 months postoperation and 1 year postoperation than in preoperation in both groups;thoracic kyphosis Cobb angle and lumbar lordosis Cobb angle were all higher in 1 month postoperation,6 months postoperation and 1 year postoperation than in preoperation in both groups.The coronal major curve Cobb angel was lower in CICPs group than that in control group in 1 year postoperation (CICPs group 17.6°±6.9° vs.control group 21.2°±7.2°,P<0.01)and thoracic kyphosis Cobb angle was higher in CICPs group than that in control group in 6 months postoperation (CICPs group-33.5°±8.8 °vs.control group-28.9°±8.3°,P<0.01)and 1 year postoperation(CICPs group-33.0°±8.1° vs.control group-26.3°±7.4°,P<0.01) together with lumbar lordosis Cobb angle were higher in CICPs group than that in control group in 1 year postoperation(CICPs group 26.4°±8.1° vs.control group 22.1°±7.3°,P<0.01).Conclusion: Polymethylmethacrylate augmentation of bone cement-injectable cannulated pedicle screws for the treatment of degenerative lumbar scoliosis with osteoporosis was effective and safe,the short-term clinical result was good.

OBJECTIVETo develop an improved substrate for indirect immunofluorescence test (IIF) for detecting anti-Ro60/Sjogren's syndrome A (Ro/SSA) autoantibodies.

METHODS60-kDa Ro/SSA autoantigens (Ro60) cDNAs were obtained from human placental cDNA library using polymerase chain reaction (PCR) and were cloned into the mammalian expression vector-pEGFP-C1. Then, the recombinant plasmids were transfected into HEp-2 cells. We confirmed the overexpression, localization and antigenicity of fusion proteins in transfected cells by means of immunoblotting, confocal fluorescence microscopy and IIF. HEp-2 and HEp-Ro60 were analyzed by IIF using a panel of 10 precipitin-positive anti-Ro human sera simultaneously.

RESULTSStable expression of Ro60-green fluorescent protein (Ro60-GFP) fusion proteins were maintained ten more generations. Ro60-GFP kept the antigenicity of Ro while demonstrating its own characteristic immunofluorescent pattern in HEp-Ro60 cells. The transfectants dramatically increased the sensitivity of IIF testing (a mean increase of 6.7-fold in endpoint titer). Eight over ten (8/10) positive anti-Ro sera showed characteristic immunofluorescent patterns for HEp-Ro60, including two sera that were anti-nuclear antibodies (ANA) negative for untransfected HEp-2. IIF-ANA in all healthy sera was negative for HEp-Ro60.

CONCLUSIONSAs a new substrate for IIF, the Ro60 transfectants can be used to detect anti-Ro antibodies. In addition, transfected HEp-2 cells keep the immunofluorescent properties of HEp-2 cells in IIF-ANA tests and can be employed as a substrate for routine IIF-ANA detection.

Antibodies, Antinuclear ; blood ; Autoantigens ; Cell Line ; Fluorescent Antibody Technique, Indirect ; Humans ; Molecular Weight ; RNA, Small Cytoplasmic ; Recombinant Fusion Proteins ; immunology ; Ribonucleoproteins ; immunology ; Transfection

According to the pathological characteristics of symptomatic chronic thoracic and lumbar osteoporotic vertebral fracture (SCOVF), the different clinical treatment methods are selected, including vertebral augmentation, anterior-posterior fixation and fusion, posterior decompression fixation and fusion, and posterior correction osteotomy. However, there is still a lack of a unified understanding on how to choose appropriate treatment method for SCOVF. In order to reflect the new treatment concept and the evidence-based medicine progress of SCOVF in a timely manner and standardize its treatment, the clinical guideline for surgical treatment of SCOVF is formulated in compliance with the principle of scientificity, practicability and advancement and based on the level of evidence-based medicine.