1.Timing Principles for Spinal Cord Injury (review)
Chinese Journal of Rehabilitation Theory and Practice 2014;(8):738-741
The early treatment principles of spinal cord injury (SCI) included early drug using, early surgery and early rehabilitation.The literatures on how to use drug early and how to control the time for SCI before surgery were reviewed.
2.Anti-chronic stress effect of bone marrow mesenchymal stem cell transplantation in rats with spinal cord injury
Jiajia SUN ; Jun ZHOU ; Huilin YANG
Chinese Journal of Trauma 2016;32(4):337-343
Objective To investigate the anti-chronic stress effect of bone marrow mesenchymal stem cell (BMSCs) transplantation in rats with spinal cord injury.Methods Forty-eight adult SD rats were divided into control group,model group and treatment group according to the random number table,with 16 rats each.In model and treatment groups,lower thoracic (T10) spinal cord injury were constructed using the modified Allen's method.In control group,only laminectomy was performed.After 7 days,100 μl Hank's buffer suspension containing 1.0 × 106 BMSCs was injected into the subarachnoid space of L4-5 intervertebral space of rats in control group and treatment group.While in model group,only the equal volume of Hank's buffer was used.Basso-Beattie-Bresnahan (BBB) scale was performed to evaluate hindlimb motor function in rats.At postoperative 14 and 28 days,blood samples were collected to measure adrenocorticotropic hormone (ACTH),norepinephrine (NE),epinephrine (E) and corticosterone (CORT) using the ELISA method;brains were harvested for the α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid (AMPA) receptor proteins GluR1 and GluR2 immunohistochemical staining.Results After injury,BBB scores in model and treatment groups were similar,but both were lower than that in control group (P < 0.05).After BMSCs transplantation,BBB score in treatment group [21 d:(9.85 ± 0.82)points and 28 d:(11.23 ±0.68)points] improved continuously compared to model group [21 d:(8.42 ± 0.39) points and 28 d:(8.84 ± 0.25) points],but all were lower than that in control group [(21.00 ±0.00)points,P <0.05].ACTH contents in model and treatment groups at 14d [(104.80±6.16) and (98.50 ± 4.07) pg/ml] and 28 d [(101.40±2.33) and (96.50± 2.28) pg/ml] were higher than those in control group [(90.40 ± 1 1.36) and (83.20 ± 5.22) pg/ml] (P < 0.05).CORT contents in model and treatment groups [(44.40 ± 1.44) and (43.30 ± 1.17) ng/ml] was lower than that in control group [(48.20 ± 2.27) ng/ml] at 14 d,but were found to be elevated [(70.40 ± 1.90) and (61.40 ± 1.83) ng/ml] compared to control group [(46.40 ± 1.49) ng/ml] at 28 d (P < 0.05).Meanwhile,the CORT content in treatment group was lower than that in model group (P < 0.05).Changes in NE and E contents among the groups were similar with ACTH.Immunohistochemical staining suggested the amounts of GluR1 and GluR2 positive cells in treatment group lowered compared to control group (P < 0.05),but increased in model group compared to control group (P < 0.05).Conclusion BMSCs transplantation can improve the hindlimb motor function,contribute to reducing the secretion of stress-related hormones ACTH,CORT,NE and E,and down-regulate the expression of AMPA receptor proteins GluR1 and GluR2 in rats with spinal cord injury,suggesting a potential role in antichronic stress.
3.The basic research and long term follow up study of lumbar spondylolysis and isthmic spondylolisthesis treated with direct repair and fixation with single vertebra reduction and fixation system
Zhonglai QIAN ; Tiansi TANG ; Huilin YANG
Chinese Journal of Orthopaedics 2000;0(11):-
Objective To conduct biomechanical study and three dimensional finite element analysis on lumbar spondylolysis and spondylolisthesis treated with single vertebra reduction and fixation system(LSRF), and to evaluate the long term outcome of isthmic spondylolisthesis treated with direct repair and fixation with LSRF. Methods Biomechanical characteristics of LSRF was tested, and three dimensional finite element model of lumbar spondylolysis and isthmic spondylolisthesis was established, the stress of lumbar in spondylolisthesis was observed after fixation and reduction. Thirty two patients with spondylolysis and isthmic spondylolisthesis were treated with direct repair and fixation with LSRF designed by the authors from 1992 to 1995. Eighteen cases had spondylolysis, and the others accompanied with spondylolisthesis. The patients age was 28-46 years, with an average of 36.4 years. Results The biomechanical study and three dimensional finite element analysis showed that LSRF has good ability in reduction and rigid fixation. All patients were followed up for an average of 5.6 years. The latest radiographs showed that bony union occurred in 29 cases. There was no breakage and pullout of screws except dislocation of hook in 2 patients. By Henderson standard, the result was excellent in 22, good in 6, fair in 2, poor in 2. Conclusion LSRF has stronger fixation strength and higher fusion rate. Direct repair and fixation with LSRF is a good procedure for younger and middle aged patients with spondylolysis and isthmic spondylolisthesis.
4.Complications associated with the b agby and kuslich method of lumbar int erbody fusion in the treat-ment of spondylolisthesis
Liang CHEN ; Tiansi TANG ; Huilin YANG
Chinese Journal of Orthopaedics 2001;0(06):-
Objective To review and analyze the complications of spondylolisthesis treated wi th BAK interbody fusion cages.Methods One hundred and eighteen patients wi th spondylolisthesis were treated with BAK interbody fusion ca ges,the intraoperative and postoperative complications were reviewed,which include dural tear,nerve root injury,unsatisfactory cage position,cage retropulsion,cage subsidence and postlaminectomy adhesive arachnoiditis.Results The intraoperative complication ra te was 11%and the most commonly seen were dural tear 4c ases(3.4%),nerve root damage 3cases(2.5%)and unsatisfactory cage position 9cases(7.6%),2cases had both dural tear and unsatisfactory cage position,1patient had both nerve root injury and unsatisfactory cage position.The postoperative c omplication rate was 7.6%,which chiefly consisted of cage retropuls ion 3cases(2.5%),cage subsidence 4cases(3.4%),and postlaminec-tomy adhesive arachnoiditis 2cases(1.7%),2cases of cage retropulsion and 2ca ses of cage subsidence show partial nonunion,2cases of cage subsidence had arachnoiditis.Conclusion As a new technique,lumbar interbody fusion with BAK cages are r apidly gaining popularity,however,the complications described here suggest the importance of selection s of surgical indications and proper manipulations.[
5.Biomechanical study of lumbar spondylolysis and spondylolisthesis single vertebrae reduction fixation system
Zhonglai QIAN ; Tiansi TANG ; Huilin YANG
Chinese Journal of Orthopaedics 2001;0(08):-
Objective To evaluate biomeehanic characteristics of lumbar spondylolysis and spondylolisthesis single vertebrae reduction fixation system (LSRF), and discuss its mechanism of reduction. Method Twenty-four adult isthmus lumbar vertebrae specimen were disconnected and fixed with LSRF, Hefti, Salib's method respectively, and the biomechanic characteristics of the fixation devices were tested. Isthmus of L5 in 4 adult spine specimen was destroyed under loading to produce the spondylolisthesis model, and reduction by LSRF. Result The LSRF has a good ability for reduction and its strength for reduction is 1.6, 2.7 times as high compared with the Hefti, Salib's methods respectively. The mechanism of reduction is that the LSRF used contacted point of lamina by lamina hook as the fulcrum, through the pedicle screw to pull the spondylolisthetic vertebrae, and reduce the anterior displacement of vertebrae. Conclusion LSRF gives rigid fixation and good reduction, and provides a new and effective method for lumbar spondylolysis and isthmic spondylolisthesis.
6.The long term results of thoracolumbar burst fractures treated with short segment pedicle instrumentation
Baoshan XU ; Tiansi TANG ; Huilin YANG
Chinese Journal of Orthopaedics 2000;0(11):-
Objective To analyze the long term results of thoracolumbar burst fractures treated with short segment pedicle instrumentation. Methods Sixty eight cases of thoracolumbar burst fractures fixed with short segment pedicle instrumentation were followed up for at least 5 years (5-13 years, average 8 years). All of them were checked with radiography pre and post operation and before implant removal. At final follow up assessment, all were examined with radiography, 18 cases were checked with CT scan as well. Results 1) Neurological status improved at least 1 Frankel grade in 90.3% of the patients who had preoperative incomplete paraplegia, while no improvement was obtained in those who had preoperative complete paraplegia. Low back pain was evaluated according to Denis Pain Scale, the results showed P1 41 cases (60.3%), P2 24 cases (35.3%), P3 3 cases (4.4%). 2) The shortest distances between the upper and lower pedicle screws tips shortened for 0-6.5 mm (average 2.5 mm) before removal in contrast to that at post operative immediately. Of the 68 cases, nuts loosened in 1 case, pedicle screws loosened in 1 case, bent in 2 cases and broken in 5 cases. Of the 8 cases whose implants were not removed timely, screw broke in 2 cases, and seepage occurred through incision in 2 cases. 3) At final follow up, the correction of anterior vertebral body height averaged 30.5%, and Cobb angle 5.8?, despite a mean correction loss of Cobb angle 12.1?. Correction loss was most evident at the above disc spaces, then the below disc spaces. Correction loss of vertebral body height averaged 1.9% in the anterior, and 6.0% in the middle part. 4) The collapse of vertebral body was most serious in the middle part. The deformity of "codfish vertebrae" occurred in the superior part of vertebrae body in 21 cases, among them the upper adjacent vertebral body sank into the injured body in 5 cases, 3 of whom engendered kyphoses greater than 25?. Evident intra corporeal gaps were found in 16 of 18 patients who were checked with CT, and the gaps communicated with the above disc space. The fractured body could have a deformity of the "cup" after reduction. 5) Degeneration and narrowing of the disc spaces next to fractured vertebrae were very common, and the above space disappeared in 27 cases, while the lower space disappeared in 14 cases. The upper disc space adjacent to fixation levels degenerated in 1 of 8 cases whose implants were not removed timely. Five patients had Cobb angle greater than 20?, three of them had low back pain, and one had mild symptom of nerve compromise. Low back pain was not correlated with degeneration of discs. Conclusion Short segment pedicle instrumentation provides satisfying stability for thoracolumbar burst fractures. It helps physiologic postural contour restoration and facilitates neural recovery, but is associated with relatively high rates of implant failure and correction loss which is most evident at adjacent discs spaces. Deficiency of bone grafting and delayed implant removal are the most probable causes for correction loss.
7.Balloon kyphoplasty with calcium phosphate cement augmentation in treatment of osteoporotic vertebral compressive fractures
Huilin YANG ; Ha YUAN ; Liang CHEN
Chinese Journal of Orthopaedics 2001;0(05):-
Objective To evaluate the efficacy and safety of balloon kyphoplasty in the treatment of painful osteoporotic vertebral compressive fractures. Methods From May 2000 to June 2002, 56 consecutive procedures were performed in 30 patients of painful osteoporotic vertebral compressive fractures with intact posterior vertebral body wall. Each procedure includes bilateral insertion of inflatable balloon, fracture reduction and fulfilled with bone cement. Preoperative and postoperative symptom levels, complications and radiographic findings were recorded and analyzed. Results All 30 patients tolerated the procedure well with immediate relief of their back pain in 48 hours. The mean loss of the anterior and mid vertebral body heights were (13.6?2.3) mm, (9.2?1.4) mm preoperatively and (4.7?1.5) mm, (3.4?1.1) mm postoperatively. The mean kyphosis was improved from 23.4??5.2? to 9.2??4.7?. Cement leakage and cerebrospinal fluid leakage occurred at one level respectively and resulted in no clinical symptoms, no other complication was found. Conclusion As a promising minimally invasive surgery, balloon kyphoplasty can provide early improvement of pain and function as well as spinal alignment in treatment of painful osteoporotic compressive fractures.
8.Bilateral transpedicular kyphoplasty in the treatment of osteoporotic vertebral compression fractures with single balloon
Huilin YANG ; Liujun ZHAO ; Jian LU
Chinese Journal of Orthopaedics 2000;0(11):-
Objective To investigate the clinical results of bilateral transpedicular kyphoplasty for the osteoporotic vertebral compression fractures with single balloon. Methods From March 2002 to February 2004, percutaneous bilateral transpedicular kyphoplasty with single balloon was performed in 15 patients, who presented with painful vertebral compression fractures. In the group, there were 6 vertebrae of 6 males and 11 vertebrae of 9 females, and the average age of the patients was 70.5 years with a range of 62 to 82 years. 17 osteoporotic vertebral compression fractures, which involved 8 T12, 7 L1, 1 T8 and 1 T11, were treated. Osteoporosis was identified in all cases by the measurement of lumbar bone mineral density (BMD) and the evaluation of radiographs. The average BMD was 0.603 g/cm2. CT scan showed the posterior vertebral wall intact in all patients, and MRI displayed low signal on T1WI and high signal on T2WI of the vertebral fractures. Results All patients experienced dramatic pain relief after the procedures. The mean pain score (VAS) decreased significantly from 8.3 preoperatively to 2.1 after operation. The mean vertebral body height restoration was 54.2%?34.1% on the anterior border, 60.5%?35.4% in the middle portion, and 40.7%?32.3% on the posterior border respectively. And the sagittal alignment was improved significantly, as the average correction of the Cobb's angle reached 9.5?. No cement leakage was found on X-ray, except one with less cement at the anterior vertebral edge, but no clinical symptom occurred. All the patients were available at the final follow-up, the mean period was 10.5 months (range, 2-48 months). Conclusion Bilateral transpedicular kyphoplasty with single balloon not only can provide effective pain relief and vertebral height restoration, but also can improve the sagittal alignment significantly. Its clinical outcome was satisfactory.
9.The clinical significance of locating percutaneous puncturing sites and track according to the spinous process
Xiaoyong LIU ; Huilin YANG ; Tiansi TANG
Chinese Journal of Orthopaedics 2001;0(08):-
0.05). Conclusion The study of the characteristic of track of percutaneous transpedicular puncture is good for the safe procdure under image guidance. The standard track is safe for transpedicular or parapedicular puncture. The percutaneous transpedicular puncturing sites can be located according to the spinous process.
10.Clinical study of the treatment to lumbar disc herniation with posterior edge separation of the vertebral body
Hangping YU ; Shunwu FAN ; Huilin YANG
Chinese Journal of Orthopaedics 2001;0(03):-
Objective To investigate therapeutical methods on lumbar disc herniation with posterior edge separation of the vertebral body. Methods Different methods were applied to 31 patients, including 24 males and 7 females whose ages ranged from 18 to 61 years. Except that 2 patients with mild lumbar pain were treated with conservative therapy, the other 29 patients were treated with operation. The operations were made according to the relationship between compressive hernia and vertebral canal. For instance, for cases that the herniated mixtures were lateral, decompression with fenestration or amplified fenestration was applied to the trouble side; for cases that mixtures were central or paracentral, the same treatment was applied to both sides; and posterior lumbar interbody fusion(PLIF) or transforaminal lumbar interbody fusion (TLIF) was applied to those that the mixtures occupied most part of the front canal. Results The follow-up studies were made for all the patients for 1 to 4 years with an average period of 2.6 years. For the two patients treated with conservative therapy, one was fully recovered and the other, who took no effect from former therapy, was finally recruited after decompression with fenestration on the trouble side. Among the patients who were treated with operation, those with lateral herniated mixtures received significant effect, while only 60% of those with central or paracentral mixtures recovered (the unrecovered or even worsened patients after operation finally recruited by PLIF), and for those with mixtures occupying most part of the front canal, satisfactory effect were achieved. Conclusion Operation treatment should be applied to patients as early as possible when conservative therapy has no obvious effect. Different operation methods should be taken according to the relationship between compressive hernia and vertebral canal: 1) Decompression with fenestration or amplified fenestration on the trouble side be applied to those with lateral herniated mixtures; 2) Decompression with fenestration on both sides be applied to those with paracentral mixtures but no lateral crypt narrowness, and PLIF or TLIF to those with central mixtures or lateral crypt narrowness; 3) PLIF or TLIF be applied to those with mixtures occupying most part of the front canal.