[Objective]To examine the safety and efficacy of closing-opening wedege osteotomy for angular kyphosis.Seven patients with angular kyphotic deformity of the thoracic or thoracolumbar spine were treated by closing-opening wedge osteotomy using a single posterior approach.[Method]Seven patients with angular kyphosis were treated.The apex level of kyphosiswas T5 in one patient,T11 in one,and T12 in five.There was old fracture in five patients,congenital deformity in one,and neurofibromatosis in one.The first 30?~35? of kyphosis were corrected using the closing wedge technique with the hinge of the anterior longitudinal ligament after veretebrectomy and circumspinal decompression of the spinal cord.Then the hinge was moved posteriorly to the spinal cord and the remainder of the requisit angle of osteotomy was corrected using the opening-wedge technique(closing-opening wedge osteotomy).Spinal curvature was stabilized using posterior instrumentation and graft.[Result]Localized kyphosis was reduced from and average of 67? to 18? at 2.2 to 7.5 years ' follow-up.Sagittal alignment from T1 to the sacrum became more physiologic than before.There were no neurologic complications.Bony fusion was achieved in all patients,and there was no correction loss.[Conclusion]Satisfactory correction is safely performed by closing-opening wedged osteotomy with a direct visuzlization of the circumferentiall decompressed spinal cord.Although the performance is technically laborious,it offers good correction without jeopardizing the integrity of the spinal cord.

[Objeetive] To investigate the effect of minimally invasive V-shaped osteotomy instead of traditional operative technique for correction of ankylosing kyphosis.[Method]The C-arm X-ray was used under the local anaesthesia to select the space of osteotomy,the length of incision were 6~8 cm and only exposed one interlaminal space,the width of laminar V-shaped osteotomy were 8~10 mm.The operating table was changed from reverse V to type after finished osteotomy,the space of osteotomy would be automatica ly closed and replaced,if the space could not be automaticly closed,careful manipulation would be applied to close it.The bone mass of osteotomy was used in posterior bone graft of lamina.Postoperation,stric and standardized regulation were performed to send the patient back to ward.The fractional manual correction and external fixation of hyperextended plaster vest were performed respectivly 2 weeks after operation.[Result]Fifty patients of this group acquired more satisfied results except 1 case appeared recurrent deformity due to early removing of the plaster vest.[Conclusion]Minimal damage,lower medical expenses(without internal fixation)and satisfied results demonstrated the minimally invasive V-shaped osteotomy is a very effective method.It has advantages of Mutual intercalated V-shaped osteotomy space and better stability after reduction,posterior bone graft of lamina and external fixation of hyperextended plaster vest,therefore,all patients can acquire the bone graft fusion afer 6 months.

[Objective]To introduce the operative method and clinical experience of 200 cases with halo pelvic distraction and elastic growing rods fixation for treatment of scoliosis during growing period and comparison with pedicle screw systems. [Method]According to the principle of Harrington hook-rod system,inferior extremity was one hook hanged on the total lamina of lumbar vertebrae and superior extremity were two hooks hanged on the inferior articular process of thoracic vertebrae,rod I and rod II were connected by joint,between the end of rod I and joint set the spring cover for automatic extension followed spine growth.For the longer growing period children,the small incision could be performed between the hook and rod for fractional distraction to help the spine longitudinal grown until skeletal development and maturation.[Result]The average rate of correction of 200 cases with Scoliosis were 70.32% after 2~15 years follow-up survey,the height of the patients were increased by 5~22 cm and the preserved range of spinal motion was better than pedicle screw systems in long term follow up.Incidence of hook displacement was 2% and rod breaking was 3%.Reasons of hook displacement and rod breaking was related to unfitting installation and methods of internal fixation,incidence of hook displacement and rod breaking were decreased significantly post reform.[Conclusion]Halo pelvic distraction and elastic growing rods fixation for treatment of scoliosis during growing period which is a kind of biological method,does not affect the longitudinal growth of spine and prevent the complication of crankshaft phenomenon caused by pedicle screw systems.

[Objective]To sum up the experience of wearing the halo pelvic and level traction costoplasty to treat 35 cases of severe scoliosis combined with collapsed chest. [Methods]When scoliosis of patients were corrected to a certain degree after three weeks of halo pelvic distraction, the most serious collapsed ribs of concave side of the curve underwent a transverse incision the cross ribs. A special rib bender was used to bend the exposed 3 to 6 ribs. The bent ribs were pulled up by double-stranded 10# thick silk which was extended out through the skin and fixed in the upright post of the instrument of Halo pelvic distraction with rubber membranes.[Results]Thirty-three in 35 patients underwent costoplasty. The collapsed chest was turned round, respiratory function improved significantly and cyanosis of lips and nail bed disappeared. These offered advantages for next scoliosis correction.Two patients failed to undergo costoplasty due toprimary pulmonary atelectasis and pulmonary deficiency.[Conclusion]The instrument of Halo pelvic distraction is a good and convenient fixed point. Bending and turning round ribs can provide a convenient condition for recovery of collapsed chest. Halo pelvic distraction can be used not only for scoliosis correction but also for costoplasty.

[Objective]To report a new surgical technique of total en bloc spondylectomy for complete resection of primary spinal malignancy and for oncologic curability.The conventional approach for primary spinal malignancy is via intralesional piecemeal resection,and very few reports have described en bloc extralesional resectioning with histopathologically wide or marginal surgical margins.[Method]Total en bloc spondylectomy,consisting of en bloc laminectomy and en bloc corpectomy followed by anterior instrumentation with spacer grafting and posterior spinal instrumentation,was performed in five patients with primary malignant tumors and two patients with giant cell tumors.Patients were observed for 2 years to 6.5 years,except for one patient who died 7 months after surgery because of mediastinal metastasis.[Result]All patients attained significant clinical improvement after surgery with no major complications except one.Histologically,the margins were wide or marginal except for the pedicles,and occasionally the spinal canal and the posterior,where they were accepted to be intralesional.One patient died of metastasis that was not directly related to surgery itself.There was no local recurrence.[Conclusion]The advantages of total en bloc spondylectomy include resection of the involved vertebra(e)in two major blocs,rather than in a piecemeal pattern,and completion of the procedure during one surgical session posteriorly.The"total en bloc spondylectomy"offers one of the most aggressive modes of therapy for primary spinal malignancy.

[Objective]To evaluate the value of distraction osteogenesis for treatment of deformity of spine during development.Distraction osteogenesis could be used for patients with campylorrhachia,dwarfism eccyliosis of spine or those combined with thoracocyllosis and obliquity pelvis.[Method]According to the principle of Halo-pelvic distraction apparatus which was divided into two parts of halo and pelvic,the halo was 4-nail fixation and the pelvic was 2-nail fixation.The halo and pelvic were connected by 4 standing pillar.Through the daily extending of 4 standing pillar the curved spine was extended and stretched gradually.As a result,action of 3D correction of deformity of spine was achieved.[Result]Ten patients of this group were treated by this methods.The action of 3D correction and automatic correction of deformity were showed in 70~120 days distraction that the wedge-shaped vertebra changed into squareness,curved spine was stretched and rotatory vertebra was reduced.[Conclusion]Distraction osteogenesis is a minimally invasive surgery instead of internal fixation of spine for the treatment of deformity of spine during development.

[Objective]To report the records of 185 patients in whom severe scoliosis had been treated with preoperative halo-pelvic distraction and following total spine osteotomy and internal fixation.[Method]Preoperative halo-pelvic distraction was applied to all patients to reduce the severity of curvatures and make the following treatment possible.Then total spine osteotomy and internal fixation were performed to rectify the remained deformity of the spine.Halo-pelvic distraction was maintained during the operation and postoperatively to limit the mobilization of the patients.At one day after the operation,the patients were able to get out of bed,stand up and move around,making nursing care more convenient.[Result]Between 1983 and 2003,a total of 185 cases of severe scoliosis were treated by this approach and an average correction rate of 70.32% was achieved.Complete bone fusions were achieved at the cut ends of thc bone.The average loss of correction rate was less than 5 degrees.In the late stage of postoperative duration,rod release occurred in four cases and was resolved by second surgical intervention,showing no adverse effect on the clinical outcome.At one year postoperative infective complication occurred in one case and the patient fully recovered after the removal of the inserted device.X-ray examination confirmed good healing of the hone grafts.Root pain occurred in one case and the patient gradually recovered without any medical intervention.None of the rest patients had evidence of spinal cord or nervous system complications.[Conclusion]Halo-pelvic distraction instrumenation,in combination with total spine osteotomy,is an effective treatment modality for severe spinal curvatures.Halo-pelvic distraction can facilitate the operative procedure for those cases that can not be cured by application of single instrumentation or have difficulty in the insertion of the internal fixation device.The combined total spine osteotomy can further correct the spinal curves,reduce the burden of the fixafion device and avoid the occurrence of release or break down of the rods,eventually cure the severe scoliosis effectively.

BACKGROUND:Kyphotic deformity in ankylosing spondylitis is the flexion deformity of spine sagittal plane in the late lesion. Spinal osteotomy is the only treatment method in patients with severe wheel-like kyphosis. For thoracic and thoracolumbar ankylosing spondylitis patients with lumbar severe wheel-like kyphosis, osteotomy at a single site cannot obtain safe and effective orthopedic effect. OBJECTIVE:To observe the orthopedic effect of total spine osteotomy combined with V-shaped osteotomy for correction of severe wheel-like kyphosis deformity due to ankylosing spondylitis, and to analyze stress distribution. METHODS:From May 2003 to October 2012, total spine osteotomy combined with V-shaped osteotomy and pedicle screw fixation were adopted for repair of concurrent thoracic, thoracolumbar and lumbar severe wheel-like kyphosis deformity due to ankylosing spondylitis in 36 male cases in the Sixth Affiliated Hospital of Xinjiang Medical University. Spinal convex angle, chin-brow vertical angle and C 7 plumb line were measured to evaluate orthopedic effect. RESULTS AND CONCLUSION:The whole spine convex Cobb angle was corrected from preoperatively (89.6±9.8)° to (32.2±6.7)° at 1 week after treatment, showing significant difference (P<0.05), with an average correction rate of 64%. The chin-brow vertical angle was 9.6° averagely after correction (P<0.05), with an average correction rate of 76%. The C 7 plumb line was 4.4 cm averagely after correction (P<0.05), with an average correction rate of 81%. After fol ow-up of 24-48 months, no significant difference in above indexes was detected during final fol ow-up and 1 week postoperatively (P>0.05). Radiographs demonstrated that fixation position was good in al patients. These results confirmed that in patient with severe wheel-like kyphosis deformity due to ankylosing spondylitis, the application of total spine osteotomy combined with V-shaped osteotomy is a safe and effective method, can better correct the spinal sagittal curvature and reduce the risk of sagittal angle, result in the stress distribution in many segments and the shortening of the spine and epidural buckling in relatively long segment, can avoid nerve damage induced by spinal cord shortening and epidural excessive buckling within short segment.

Objective To establish early diagnosis,treatment and prevention of tuberculosis infection following kidney transplantation.Methods Eighteen post-operative tuberculosis infections were identified among 1024 kidney transplantations performed in Beijing Chaoyang Hospital between January 2002 and December 2009.Triple immunosuppressive therapy strategy was used for these 18 patients.Of the 14 patients who received immune induction therapy,4 were treated with monoclonal antibody,and the other 10 were treated with anti-thymocyte globulin(ATG)or anti-lymphocyte globulin(ALG).Results The interval between renal transplantation and identification of tuberculosis infection ranged from 1 to 54 months.Posttransplant tuberculosis infection showed no typical clinical manifestations at early stage.Persistent or intermittent fever was the main symptom.High resolution CT and bronchoalveolar lavage fluid(BALF)test were useful tools for confirmed diagnosis.After routine anti-tuberculosis treatment,17 patients were cured and 1 patient died.Conclusions The early stage symptoms of post-transplant tuberculosis may be atypical,which could result in misdiagnosis.Pulmonary high-resolution CT examination and BALF test could provide strong evidence for tuberculosis infection.

BACKGROUND:In recent years, animal models of lumbar disc degeneration have been popularized to explore the effect of tissue engineering, cel engineering and genetic engineering technologies on intervertebral disc degeneration.
OBJECTIVE: To investigate the influence of biological patches on rabbit anulus fibrosus repair.
METHODS:L3-4, L4-5, L5-6 segments from rabbits were randomly divided into normal control group (the intervertebral disc was exposed correspondingly), control group (the annulus fibrosus was only cut with a surgical scalpel) and experimental group (the annulus fibrosus was cut and sutured with the surgical biomaterial). Six rabbits were selected randomly to take the lumbar X-ray and MRI preoperatively and 1, 2, 4, 8, 12 weeks postoperatively; one rabbit was chosen preoperatively and three rabbits selected respectively at 1, 2, 4, 8, 12 weeks postoperatively to execute hematoxylin-eosin and type II colagen immunohistochemistry.
RESULTS AND CONCLUSION:At postoperative 1, 2 and 4 weeks, the disc height index decreased significantly in the control and experimental groups. MRI and histopathological examination showed that the T2WI signal intensity and hematoxylin-eosin grading were both increased significantly in the control and experimental groups at 2 weeks after surgery (P < 0.05). With time, the number of nucleus pulposus cels gradualy reduced in the control and experimental groups. Annulus fibrosus defects were filed with granulation and fibrous tissues, and the biofilm was tightly fused with the annulus fibrosus. Findings from the type II colagen immunohistochemical staining showed that the histological staining of the nucleus pulposus was gradualy changed from positive to negative in the experimental and control groups. Therefore, cutting the annulus fibrosus can lead to severe disc degeneration at early period, and surgical biomaterials can be integrated with the annulus fibrosus wel to seal annulus fibrosus defects and further prevent nucleus pulposus protrusion. However, this approach cannot restrain the continuous process of disc degeneration.