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.

Objective:To evaluate the feasibility and clinical efficacy of the treatment of lumbar spine steno-sis by modified unilateral approach for bilateral decompression under microendoscope.Method:217 cases with degenerative lumbar spine stenosis from September 2003 to December 2008 were treated by modified unilater-al approach for bilateral decompression of central spinal canal and nerve root canal under microendoscope.A-mong them laminectomy of one segment was done in 163 cases,two segments were done in 54 cases.After surgery,the routine radiograph were carried out and the Nakai criterion was used for assessment.Result:The mean operative time was 48±13min (range,25 to 95min),the average blood loss was 37±9ml (range,25 to 180ml),the average skin incision length was 2.2±0.2cm(1.8 to 2.4cm).2 cases had dural matter tearing,which healed after filling with gelatin foam and 2 weeks bed rest,after that no cerebrospinal fluid leakage was noted after surgery.Mislocation was noted in 1 case.No nerve inury and postoperative infection oceurred.Postoperative CT scan demonstrated complete decompression of the central spinal canal and nerve root canal.All patients were followed-up for an average of 14 months (range,3 months to 24 months).The Nakai criterion at final follow-up showed clinical excellent in 134 cases,good in 63 cases,fair in 16 cases and worse in 4 cases, with the excellent and good rate of 90.8%.No lumbar spine instability was noted.Conclusion:Treatment of de-generative lumbar spine stenosis by modified unilateral approach for bilateral decompression under mieroendo-scope has the merit of minimal invasive,less complications and reliable therapeutical effect.

Objective To evaluate the efficacy and safety of balloon kyphoplasty in the treatment of painful multi-vertebral osteoporotic compression fractures. Methods From October 2002 to April 2007, 42 patients (96 vertebrae) with painful multi-vertebral osteoporotic compression fractures underwent kyphoplasty. The group included 14 men and 28 women with an average age of 72.5 years (range 56-91 years). Each pro-cedure included insertion and insertion of balloon, fracture reduction and cement filling under "C"-arm monitoring. Preoperative and postoperative pain level, SF-36 score, vertebral height restoration, local kypho-sis correction and complications were recorded and analysed. Results All 42 patients tolerated the opera-tion well and were followed up for average 31.4 months (range 12-71 months). The mean VAS pain score decreased significantly from 7.1±2.4 preoperatively to 2.7±1.3 postoperatively, the mean height of anterior and medial vertebral body were (1.8±0.5) cm, (1.6±0.6) cm preoperatively and (2.3±0.6) cm, (2.2±0.7) cm postoperatively. No significant change of posterior vertebral height was recorded postoperatively.The mean correction of local kyphosis was 9.2°at each level. 6 of 8 subscahs measured by SF-36, including physical function, role function, bodily pain, vitality, role emotion, mental health, were significantly improved by the operation. Complications were found in 7 patients including 6 cases of cement leakage with no clinical symptoms (intradiscal cement leakage in two cases, paravertebral vessel leakage in two cases, paravertebral leakage in one case and cement leakage into canal in one case), and 1 case of pulmonary embelization with symptoms relieved after conservative treatment. Conclusion Kyphoplasty is effective and relatively safe for multi-vertebral osteoporotic compression fractures.

Objective To investigate the causes and clinical significance of cement leakage into disc space during kyphoplasty. Methods Since 2002, 178 patients with osteoporotic vertebral compression fractures underwent kypboplasty and 15 of them were detected intradiscal cement leakage and followed up more than 2 years (mean 2 years and 8 months). The mean injection of cement in these patients was 4.2ml.The series comprised 10 females and 5 males, with an average of 71.2 years old ( range, 54～84 years old).Visual analog scale was used to score back pain pre- and postoperatively. The height and MRI index of the involved disc were recorded and compared. Results The discs involved were as following: T10-11 for 4 cases,T11-12 for 1, T12L1for 4, L1-2 for 2, L2-3 for 3, L3-4 for 1. Cement leakage was detected in the disc above the fractured vertebrae in 10 cases, and in the disc below the fractured vertebrae in 5 patients. The back pain significantly alleviated and the average visual analog scale (VAS) score was decreased from 8.5±2.1 preoper-atively to 3.3±1.4 postoperatively (P< 0.05). The anterior disc height was (5.1±2.1)mm preoperatively and (4.8±1.9) mm at the final follow-up, the middle disc height was (7.4±3.2) mm preoperatively and (7.3±2.9) mm at the final follow-up, the posterior disc height was (4.9±2.5) mm preoperatively and (5.0±1.8) mm at fi-nal follow-up, the heights of intervertebral space were well maintained. The signal intensity decreased and became inconsistent in some discs, and the preoperative MRI index significantly decreased from 25482.4± 3467.5 to 18927.6±2519.4 at the final follow-up (t=1.967,P< 0.05). Conclusion Pain relief is impressive in patients with intradiseal cement leakage during kyphoplasty. However, cement leakage into disc space may accellerate the process of disc degeneration.

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.

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.

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.

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.

Objective To discuss the individual method and its feasibility and security of balloon kyphoplasty for the treatment of osteoporotic vertebral fractures with vertebral body wall incompetence. Methods Thirty-nine vertebral bodies were performed for kyphoplasty in 35 osteoporotic patients with vertebral compression fractures with incompetence of vertebral body wall. During operation, the cement was injected twice to avoid anterior leaking in the patients with anterior wall incompetence, while in the patients with posterior or lateral wall incompetence, the cement was injected with continuously X-ray monitoring by C-arm to prevent lateral or posterior leaking. The symptoms improvement, vertebral height restoration and complications were observed. Results All patients tolerated the procedure well with immediate relief of back pain after kyphoplasty. No symptomatic complications were found in all patients. The vertebral height had a recovery rate of 68.46%, and the mean Cobb angle was improved 8.6?. There was significant difference in Cobb angles between preoperation and postoperation (P

[Objective]To explore the complications of tibial fracture treated with interlocking intramedullary nail.[Method]The full data of 785 cases of tibial fiacture treated with interlocking intramedullary nail were studied retrospectively.[Result]Mean follow-up period was 27 months (8~40months).There were some complications as follows: infection rate was 2.7% (21 cases),fracture nonunion 1.5% (12 cases),fracture delayed union 6.8% (53 cases),fracture malunion 0.9% (7 cases),knee pain 6.8% (53 cases),nail broken 1.4% (ll cases),locking screw broken or drop out 2.2% (17 cases).[Conclusion]Proper manipulations,strict indications,and postoperative treatment are vital to prevent the complications.