28 days after injury (P < 0.05). In the fracture+spinal cord injury group, the level of serum transforming growth factor beta 1 had a rapid increase on the 7th day, and reached the peak on the 14th day, and then, this level had no significant decrease until the 28th day. In the simple fracture group, the level of serum transforming growth factor beta 1 began to increase on the 2nd day, reached the peak on the 7th day, and then decreased gradualy. Remarkable changes of serum transforming growth factor beta 1 levels in patients with bone fracture combined with spinal cord injury may be associated with fracture healing in different periods.

BACKGROUND:In the animal model of spinal cord injury associated with fractures, the trauma is severe and postoperative survival rate is low. The improved Al en method and open femoral osteotomy method for making animal model has many advantages, such as simple operation, no need of special equipment, quick establishment, shortened operation time and reduced intraoperative bleeding, so they are suitable for preparing a femoral fracture model combined with spinal cord injury.
OBJECTIVE:To design an animal model of femoral fracture combined with spinal cord injury, which can maintain long time survival, meet clinical features, and is simple and easy.
METHODS:Forty-eight male Sprague-Dawley rats were randomly divided into simple femoral fracture group and femoral fracture merging spinal cord injury group. Femoral fracture model was caused by opening osteotomy to cause transverse fracture and implantation of internal fixator in femur. According to the improved Al en method, a self-made blow device was applied to cause acute T 10 segment contusion injury of spinal cord in rats. Thus the femoral fracture model merging spinal cord injury was successful y established. The rats in two groups were grossly observed at different time points after the modeling, and the fracture healing at 4 weeks was detected.
RESULTS AND CONCLUSION:Al the animal models of femoral fracture with spinal cord injury survived, which exhibited the loss of sensory and motor function of the lower limbs, but could slowly creep forward by the upper limbs. In the first 3 days, the rats had poor appetite and few activity, with tail suspension at night there were no ischemia and necrosis of the limb fracture. At 4 weeks, one rat in simple femoral fracture group died, while four rats in femoral fracture merging spinal cord injury group died, with the survival rate of 83.33%, intramedul ary fixation were not prolapsed. In the two groups, continuous bone cal us formation was found in the fracture, and the bone cal us volume in femoral fracture merging spinal cord injury group was significantly higher than those in simple femoral fracture group. The results demonstrated that combining the improved Al en method with smal lateral incision open femoral osteotomy is a simple and feasible method for the establishment of femoral fracture model merging spinal cord injury, and the models survive for 4 weeks.

Objective To evaluate the operative technique and the short-term clinical results of ce-mentless total hip arthroplasty (THA) for developmental dysplasia of the hip (DDH) in adults with high level dislocation. Methods Nine patients (11 hips) with DDH of Hartofilakidis type Ⅲ, who underwent cement-less THA between 1997 and 2002, were analyzed. Of 9 patients, 8 were females, and 1 male with an average age of 29.4 years (range, 17 to 56 years). There were unilateral DDH in 7, and bilateral in 2. The patients had no previous surgery. The preoperative average length difference between the two legs was 4.1 cm (range, 0 to 7 cm). The femoral head was dislocated upward from the normal position by 4.8 cm on average (range, 3.2 to 7.0 cm). The Zweym?ller cup was placed on the original acetabulum in all patients with more than 80% bony coverage on the cup, and no bone graft needed. In 4 hips with more than 5 cm of displacement, the reduction of prosthesis was achieved by shortening osteotomy below lesser trochanter. The preoperative average Harris score was 40.2. Results All of 9 patients were obtained follow-up of X-ray films and clinical evaluation. The follow-up ranged from 6 to 32 months with a mean of 18.2 months, the osteotomy of 4 hips were bony healed at 3 months postoperatively showed by X-ray films. The postoperative average difference of the two leg length reduced to an average 1.1 cm (range, 0 to 3 cm), and the postoperative average Harris score increased to 90. Femoral nerve impairment occurred in 1 case, and recovered 4 months later. There were no loosening, dislocation and infection at follow-up. Conclusion Based on the short-term results of the cementless total hip arthroplasty for the developmental dislocation of the hip in adults with high level dislocation, it is proven to be a good technique, and the satisfied clinical results would be obtained.

[Objective]To introduce the safety of the spinal wedge osteotomy by a single posterior approach and to discuss the selection of fusion and fixation. [Method]Sixteen patients with severe post-adolescent congenital spinal deformities were treated by spinal wedge osteotomy by a single posterior approach from February 2000 and July 2006.There were 10 males and 6 females with an average age of 21.4 years(range 16 to 29 years).There were 11 patients with hemivertebre and 5 with fused ribs or bone bridge.Two patients had previous surgery history.The average Cobb's angles of scoliosis and kyphosis before operation were 84.7 ?and 52.6?.The average trunk shift was 15.4 mm.Bony septum in the canal was found in 2 patients on the preoperative CT or MRI.[Result]The follow-up ranged from 2 to 4 years with an average of 2 years and six months.The average fused vertebrae were 10.6 segments(range 8 to 14 segments).The postoperative average Cobb's angles of scoliosis and kyphosis were 38.5 and 27.7.The average correction rates of scoliosis and kyphosis were 54.5% and 47.4%.The average trunk shift was improved to 4.6 mm.There was no significant correction loss of the scoliosis,kyphosis and trunk shift at final follow-up evaluation.No patient developed severe complications except that two had pedicle fracture,one had L1 nerve root injury,one had superior mesenteric artery syndrome and one had exudates of incision.[Conclusion]Spinal wedge osteotomy by the single posterior approach is a reliable and safe surgical technique for correcting severe post-adolescent congenital spinal deformities.

Objective To investigate the effects of exercise on learning and memory after cerebral ischemia. Methods Ninety Sprague-Dawley rats were randomly divided into a sham-operated group, a model group and a treadmill training group ( n=30 for each) , which were further subdivided into groups to receive 7 days, 14 days or 28 days of training with 10 rats in each. The training was treadmill running at 10 m/min for 30 min a day. Cerebral ische-mia was induced in the model and training groups using permanent, bilateral common carotid artery occlusion. The training began three days after the operation. Morris water maze tests were used to measure the rats′ learning and memory ability, and Nissl staining was employed to detect the survival rates of pyramidal neurons in the CA1 area of the hippocampus. Results The average escape latency in the treadmill trained group had shortened significantly by day 7, then further by days 14 and 28. It was significantly shorter than the model group′s average at each time point. The average platform crossing time increased significantly compared with the model group′s average. Few dead neu-rons were observed in the sham-operated group. On days 14 and 28 the average survival rate of pyramidal neurons in the model group was significantly lower than in the treadmill training group or the sham-operated group, though there was no significant difference on day 7. Conclusion Treadmill training can improve learning and memory after cere-bral ischemia, at least in rats. Better effects can be observed after longer training.

Objective To evaluate the safety and effectiveness of one stage surgery of release and bone reduction by posterior approach to treat basilar invagination (BI) with irreducible atlantoaxial dislocation (IAAD),and to explore the indications and crucial techniques of posterior approach.Methods All of 17 Consecutive patients (8 males and 9 females) with BI and IAAD who underwent release and reduction by posterior approach from July 2000 to June 2015 were enrolled in the present study,the mean age was 35.2±13.8 years with a range of 12-56 years.The clinical symptoms and signs was recorded,and preoperative imaging examination,including anteroposterior,lateral,dynamic films,MRI and CT of cervical spine,were performed to identify the series.There were 14 cases with atlanto-occipital fusion,7 cases with C2,3 fusion,6 cases with Chiari malformation,6 cases with Syringomyelia,and 8 cases with myelomalacia.The clinic symptoms include occiput/neck pain in 15 cases,cervical movement limitation in 13 cases,short neck in 9 cases,torticollis in 12 cases,Paresthesia in 14 cases,weakness in 13 cases,tendon reflexes hyperfunction in 16 cases and ataxia in 13 cases.The postoperative X-rays,MRI or CT were used to observed the results of decompression,fixation and fusion.Neurological function was assessed by JOA scale and Ranawat's score before,after surgery and at final follow-up.Pre-and post-operative Chamberlain (CL),Wackenheim (WL),McGae (ML),atlantodental interval (ADI) and cervico-medullary angle (CMA) were analyzed by student t-test.Results The average operation time was 145 mins (90-210 mins) and blood loss was 175 ml (150-350 ml).The average follow-up was 44.47 months (9-94 months).JOA score was increased from 8.06 preoperatively to 15.20 postoperatively,the improvement rate was 77.2％.Preoperative Ranawat's score was Ⅱ in 1 case,Ⅲla in 12 cases,ⅢB in4 cases.Postoperative score was Ⅰ in 13 cases,Ⅱ in 4 cases.The preoperative CL,WL,ML,ADI and CMA were (12.52±5.17) mm,(6.59±3.04) mm,(6.96±4.32) mm,(9.88± 1.93) mm,115.35°± 12.40°,respectively.and the postoperative CL,WL,ML,ADI and CMA were (2.0±3.67) mm,(-3.06±1.85) mm,(-1.76±2.88) mm,(1.17± 1.18) mm,136.76°±11.44°,respectively.The perioperative complications were discovered in 2 cases,including 1 case of infection and1 case of cerebrospinal fluid(CSF) leakage.Conclusion Primary surgery of nerve release and bone reduction by posterior approach may be safe and efficient for the treatment of BI and IAAD.Preoperative evaluation,proper surgical indications and advanced surgical techniques are important for treatment results.

BACKGROUND:The method in repair of primary lumbar intervertebral infection is different in different positions, mainly containing anterior, posterior and anteroposterior pathways. In posterior pathway, muscle gap approach is recognized by many fel ows. This program has its special advantage compared with conventional posteromedial approach. OBJECTIVE:To evaluate the clinical effects of debridement, bone graft and internal fixation of pedicle screw placement in repair of primary lumbar intervertebral infection through posterior paraspinal muscle approach. METHODS:Clinical data of 13 patients with primary lumbar intervertebral infection were analyzed retrospectively. There were one case of L 2-L 3 , two cases of L 3-L 4 , four cases of L 4-L 5 and six cases of L 5-S 1 . Lumbar pain was obvious in al patients. Nine cases suffered from radioactive lower limb pain. Al patients received debridement, bone graft and internal fixation of pedicle screw placement through paraspinal muscle approach via posteromedial incision. After treatment, clinical effects were evaluated using Visual Analog Scale and lumbar Japanese Orthopaedic Association scores. RESULTS AND CONCLUSION:Al patients were fol owed up for 12-18 months, no recurrence. X-ray review demonstrated bony fusion, so loosening and breakage were not found in al patients. Visual Analog Scale scores revealed that Visual Analog Scale score was 8.15 preoperatively, 2.15 at 1 week postoperatively, 1 at final fol ow-up, showing significant difference (P<0.05). There was significant difference in pain between pre-treatment and post-treatment, and pain apparently relieved after treatment. Lumbar Japanese Orthopaedic Association score showed that effective outcomes were found in al patients after treatment, including nine cases of excel ent effects, three cases of good effects, one case of average effects, with the excel ent and good rate of 92%. Above findings confirmed that one-stage debridement, bone graft and internal fixation of pedicle screw placement through posterior muscle gap approach provides a good repair method for patients with primary lumbar intervertebral infection. It can achieve intervertebral space directly through intervertebral foramen, retain the central spinous process and lamina, reduce the injury to paraspinal muscle, and keep spinal ligament complex. However, strong spine fixation contributes to bone fusion, and keeps the stability of the spine after repair.

BACKGROUND: Studies showed that both anterior cervical disc replacement and anterior cervical decompression and fusion can achieve good clinical result in cervical spondylosis. However, it is not conclusive about which kind of surgical method has an advantage in avoiding the adjacent segment degeneration. OBJECTIVE: To compare the effect on adjacent segment degeneration of single segment cervical disc herniation treated with anterior cervical decompression and fusion and anterior cervical disc replacement. METHODS: We col ected clinical data of 178 patients with cervical disc herniation and receiving anterior cervical disc replacement or anterior cervical decompression and fusion from January 2009 to December 2012. A retrospective analysis was performed. There were 116 cases in the anterior cervical decompression and fusion group and 62 cases in the anterior cervical disc replacement group. RESULTS AND CONCLUSION: (1) Evaluation: visual analogue scale score, Japanese Orthopaedic Association Scores and neck disability index were improved significantly in both groups during final fol ow-up compared with that pre-treatment (P < 0.05). (2) No significant difference in range of motion of operation segment, adjacent upper segment and adjacent lower segment was detected between final fol ow-up and pre-operation in the anterior cervical disc replacement group (P > 0.05). At 3 months after surgery, in the anterior cervical decompression and fusion group, surgical segment was confluent, and range of motion lost. During final fol ow-up, range of motion of adjacent upper segment and adjacent lower segment was significantly increased, and the increased range of motion in the upper segment was bigger than that of the lower segment (P < 0.05). (3) During final fol ow-up, X-ray films and MRI images revealed the number of degenerated adjacent segment was more in the anterior cervical decompression and fusion group than in the anterior cervical disc replacement group (P <0.05). The number of degenerated middle and upper segments was more than that of the lower segment in both groups (P < 0.05). (4) The findings confirmed that anterior cervical disc replacement or anterior cervical decompression and fusion for treating cervical disc herniation could effectively relieve nerve symptoms of patients. However, compared with the anterior cervical disc replacement, adjacent segment degeneration occurs more commonly after anterior cervical decompression and fusion.

Background and Purpose:In recent years,along with marked rise in the incidence of lung cancer,the incidence of brain metastasis from lung cancer has increased year by year.The main treatment strategy of lung cancer with brain metastasis is irradiation,while so far there are only few researches concerning chemotherapy combined with radiotherapy for these patients.The aim of this study is to evaluate the therapeutic effect,survival rate and toxicity of chemotherapy with VM_(26)+DDP regimen given concurrently with whole-brain radiotherapy in lung cancer with brain metastasis.Methods:From Sep.2000 to Oct.2001,forty-one patients with lung cancer with brain metastasis were divided randomly into two groups: 20 patients(14 male,6 female) received concurrent chemoradiotherapy(chemoradiotherapy group),the other 21 patients(14 male,7 female) received only radiotherapy(radiotherapy group).In the chemoradiotherapy group,the average age was 50 years with range 40 to 70 years,16 patients were non-small-cell lung cancer,4 patients were small-cell lung cancer.In the radiotherapy group,the average age was 52 years with range 40 to 73 years and 19 patients were non-small-cell lung cancer,2 patients were small-cell lung cancer.For both groups,the same radiation technique was given with conventional fraction.Radiotherapy was delivered by 6MV.Fractionations of 3Gy/fraction/day was delivered 10Gy/5 factions/week.The total dose was 30Gy/10Fr/2W.For chemoradiotherapy group,the patients were also given concurrent chemotherapy(VM_(26) 60mg/m~(2)/ day iv on days 1-3,cisplatin 60 mg/m~(2) iv on the 1~(st)day).Results:The response rate and complete response in the chemoradiotherapy group was significantly higher than that in the radiotherapy group(75% ?? 38.10%,P

Objective To evaluate the effect of treatment of the intervertebral infection via single?stage posterior midline incision and bilateral muscle gap approach. Methods A retrospective of 39 cases (male 25 cases, female 14 cases) of lumbar in?tervertebral infected patients from October 2012 to December 2014 who were treated by posterior debridement, interbody fusion using allograft and posterior instrumentation through paraspinal muscle gap approach were analyzed, whose mean age was 48 years (range 11-70 years). According to the confirming diagnosis, patients underwent postoperatively anti?inflammatory or chemotherapy treatment. The disease controlling statues were evaluated based on laboratory results of ESR, CRP;Imaging examinations were tak?en to evaluate the fusion of vertebral body;Clinical effects were evaluated using the Visual Analog Scale (VAS) and the JOA score of lumbar function. Results In these 39 cases of intervertebral infection patients, 8 cases ware diagnosed as pyogenic infec?tious, 25 cases were diagnosed as tuberculosis infections, 2 cases were diagnosed as unknown infections, and brucellosis infec?tious was found in 4 cases. All patients' symptoms were significantly improved. The lower back VAS score: average 8.22±0.93 points before operation, average 2.21 ± 0.88 points one week after operation, and an average score of 0.80 ± 0.58 points by the last follow?up time. The lower extremity VAS score: average 2.32 ± 1.82 points before operation, average 1.89 ± 0.62 points one week after operation, and an average score of 0.61±0.47 points by the last follow?up time. All patients were followed up for 12-18 months (average 13 months), One patient with pyogenic infectious occurred wound infection 1 week postoperatively, and healed after a repeatedly surgery. No internal fixation loosening, fracture, or segmental collapse was observed ,and good fusion was present in all patients after 12 months. JOA lumbar function score: all patients were effective after operation, the improve?ment rate was excellent in 76.9%, good in 17.9%, and passable in 5.2%. Comparing with preoperation, the excellent and good rate was 94.8%. Conclusion The treatment of lumbar intervertebral infection via single?stage posterior midline incision and bi?lateral muscle gap approach was clinically effective, which can completely remove the lesion, and achieve rigid internal fixation.