This article introduces a new technology of prosthetic disc nucleus replacement to treat lumbar disc herniation. The preliminary clinic experience, short time following ups, indications, contraindications, size and method of the technique were discussed. It was noted that some patients had short but heavy lumbago after the operation but the pain was relieved after oral medication. It will be a trend in the future spine surgery to restore the functions of spine unit. The prosthetic disc nucleus is a good choice before a total disc prosthesis replacing or spine fusion.

BACKGROUND: Compared with artificial intervertebral disc replacement,prothetic nucleus replacement is easier to perform with fewer risks and requiting smaller incision.OBJECTIVE: To evaluate the effect of prosthetic disc nucleus replacement for treatment of lumbar disc herniation.DESIGN: A self-controlled trial.SETTING: Department of Orthopaedics, Zhujiang Hospital, Southern Medical University.PARTICIPANTS: Thirty-three patients including 21 male and 12 female patients with lumbar disc herniation received prosthetic disc nucleus replacement in Zhujiang Hospital of Southern Medical University from January 2002 to October 2003.METHODS: All the patients received prosthetic lumbar nucleus replacement and 3 weeks after the operation, X-ray examination was performed for observing the height and morphology of the intervertebral space. All the patients were followed up for 8 months and the therapeutic effects were assessed in a four-grade system(excellent, good, improved, poor). MAIN OUTCOME MEASURES: The change in the symptoms of low-back pain and the range of movement (ROM) of the lumbar spine.RESULTS: According to the intention-to-treat analysis, none of the 33 patients was lost to the analysis. During the follow-up, 29 patients had excellent, 3 good, and 1 poor outcome in terms of the symptoms of low-back pain and ROM of the lumbar spine, with a total rate of good outcome of 96. 97%(32/33) . X-ray examination in the 3rd month revealed normal size of the intervertebral space in 29 cases, and increased but still narrowed intervertebral space in 3 cases. No aggravation of retrograde changes was found in the adjacent segments.CONCLUSION: Prosthetic disc nucleus replacement can effectively relieve low-back pain in lumbar disc herniation, restore the spinal movement and decrease retrograde changes of adjacent intervertebral space and articular process.

To sieve a new type of polyether polyurethane as an injectable prosthetic nucleus pulpous through testing the cytotoxicity in vitro.Methods Five experimental groups were set as following:that samples 1,2,3 groups were polyether-polyurethane polymerized of different ratio of soft and hard segment with different catalysts; group 4 was polyether polyurethane polymerized slowly at 37 ℃ without catalyst; group 5was polyether polyurethane that toxic monomer responded completely.Additionally,a control group of culture medium was set without material extracts.Get 0.6 mg from each sample product and make into material extracts after disinfection,then dilution them by 50% and culture the mouse fibroblasts(cell L929)until 3 d,4d,5 d,by Adopting 3-(4,5-dimethyl-2-thiazolyl)-2,5-diphenyl tetrazolium bromide(MTT)colorimetric method to compare the 490 nm OD between the materials and control groups obtained by enzyme linked immune analysis,calculate the RGR of cells,and then evaluating the cytotoxicity of the materials.Results The RGR of L929 cell in group 4 and group 5 have no significant difference compared to the control group.Cytotoxic levels were 0 to 1; difference of the RGR of L929 cell between group 1-3 and control group were statistically significant.Cytotoxic levels were 1 to 2,but the cell morphology was normal.Conclusion The material polymerized without catalyst does not show cytotoxicity,and has great potential to be used as a substitute for nucleus pulposus.The cytotoxicity of the materials polymerized with catalyst needs to be tested more.

Objective To study the effect of osgentide (OST) on proliferation of mouse preosteoblast MC3T3-E1 under simulated microgravity ( SMG ) .Methods Under normal conditions , cell proliferation was evaluated by MTT assay to screen an OST compound of an effective concentration after MC 3T3-E1 cells were treated with series OSTs .Furthermore, cell proliferation and cell cycle distribution of MC 3T3-E1 cells were analyzed after treatment with 1 nmol/L OST5 by MTT assay and by flow cytometry ( FCM) scanning under SMG .Results Under normal conditions , 1 nmol/L OST5 was able to significantly promote the proliferation of MC3T3-E1 cells (P<0.01).Under SMG, proliferation of MC3T3-E1 cells was significantly inhibited and more cells entered G 1 than under normal conditions (CN).The proportion of S phase of MC3T3-E1 cells after treatment with 1 nmol/L OST5 ( OST-SMG) for 3 d was higher than that of untreated MC 3T3-E1 cells under SMG,suggesting that OST5 could promote DNA synthesis ( P<0.05 ) .Conclusion OST5 facilitates the proliferation of MC3T3-E1 cells under SMG, which provides a basis for the use of OST5 in the prevention and treatment of bone loss relat-ed to microgravity .

Objective To detect the genetic toxicity of a neotype in situ polymeric injectable artificial prosthetic nucleus pulposus.Methods The artificial prosthetic nucleus pulposus was soaked for preparing the leaching liquor which was used for tests of genetic toxicity.Salmonella typhimurium reverse mutation test(Ames Test),mammalian cell chromosome aberration(CA) test utilizing Chinese hamster ovary cells(CHO),and mouse micronucleus(MN) test were performed to detect the genetic toxicity of the extraction,including the effects on DNA,chromosome aberration and genetic mutation.Results The number of reverse mutation strains,from five strains of every dosage group,was all lower than half of quantum of control group,with or without the addition of S9,in the Ames Test,which assessed as negative.In CA test,no significant difference of chromosome aberration rate existed among the high,medium and low concentration group,while the CA rate of all the three groups was lower than that of the negative group(P0.05),but significantly lower than that of the positive control group(P

Objective To investigate the safety and efficacy of three column osteotomy (3-CO) procedures through previous spinal fusion site for the revision surgical treatment in severe spinal deformity patients.Methods From Oct.2010 to May 2014 in our hospital,a total of 12 severe spinal deformity patients underwent 3-CO for the revision surgical treatment.There were 7 males and 5 females with the average age of (21.8±3.8) years,ranging from 18 to 30 years.The mean time from the initial operation to the revision surgery was (10.2±4.8) years (ranging from 3 to 17 years).The reasons for revision were:curve progression in 7 patients,neurologic deficit in 2 cases,implant failure in 1 patient and pseudarthrosis in 2 patients.The coronal parameters including major Cobb angle and distance between C7 plumb line and center sacral vertical line (C7PL-CSVL),and the sagittal parameters including global kyphosis curve and sagittal vertical axis (SVA) were measured pre-operatively,post-operatively and at last followup,respectively.The operation time,intraoperative blood loss and complications were recorded.The paired t test was used to evaluate the difference among pre-revision,post-revision and last follow-up.Results The average operation time was (451.7±83.1) min (range,320-600 min) and the average blood loss was (4 016.7± 1 080.0) ml (range,2 700-6 000 ml).The average follow-up time after revision operation was (35.4±9.8) months (range,24-49 months).The coronal Cobb angles of pre-revision and post-revision were 83.8°±23.3°and 34.6°± 13.7°.The average correction rate was 60.1％ ±8.8％.At last follow-up,the average coronal Cobb angle was 34.9°±13.8°,there was no significant loss of correction.The pre-revision and post-revision values of global kyphosis were 99.1°±13.3°and 38.7°±7.8° with a mean correction rate of 60.8％ ±6.7％.At the last follow-up,the average global kyphosis was 39.3°±7.5°and no loss of correction was found.For the C7PL-CSVL and SVA,pre-revision (30.3± 17.1) mm and (40.1±31.1) mm were corrected to (14.3 ±7.6) mm and (19.1± 12.3) mm immediately after revision operation,respectively.At final follow-up,the average C7PL-CSVL and SVA were(14.1 ± 7.6) mm and (19.6± 12.1) mm,the correction was well maintained.Obviously,two patient's neurological status improved from Frankel C before revision surgery to Frankel E.Complications were encountered in five patients (41.7％),including SEP signal changed in 1 patient (8.3％),transient neurologic deficit after revision surgery in 1 patient (8.3％),cerebrospinal fluid leak in 1 patient (8.3％),and pleural effusion in 2 patients (16.7％).During the follow-up time,there was no patient experienced pseudarthrosis,implant failure,infection or significant loss of correction.Conclusion Based on results of this study,it was concluded that 3-CO procedures through previous spinal fusion sites could obtain satisfactory and safety results in severe spinal deformity revision surgery.However,it is a technique-demanding procedure with more blood loss,longer operative time and higher risk of perioperative complications.

Objective To discuss the experience of medical treatment and rescue of the ‘SHENZHOU' astronauts in the landing place in the past 10 years,and to establish more effective mobile ICU in medical helicopters to ensure ‘SHENJIU' astronauts safety.Methods The data collected from foreign nations and our country was reviewed.Formerly experience in first-aid and rescue astronauts of our team was summerized.The important reasons of accidental injuries of astronaut during aerospace flight were listed.More effective and reasonable prophylactic measurements and clinical treatments of the accidental injuries of astronauts were brought forward.Results we established three effective mobile ICU that could ensure the safety of the astronauts.The carriers of the ICU were helicopters,and damage control surgery can be performed there.Fine armature made us more effective.Conclusions Reasonable and effective prophylactic measurements and clinical treatments were the important aspect of the successful manned aerospace flight.The first-aid system in helicopters could realize the destination of swift response and first-aid.

Objective: To define radiographic features that response to serial casting and bracing for progressive early-onset scoliosis (EOS). Methods: A retrospective study of a total of 20 patients (10 females and 10 males) with complete radiographic data diagnosed as progressive early onset scoliosis treated with serial cast or brace for at least 12 months in the 306th Hospital of PLA from June 2011 to April 2018. Ages at initial diagnosis were all less than 5 years old. They were divided into two groups according to the main curve degree, those with cobbs angles more than 50 degree treated with serial cast, or else with brace. All the cases have radiographs of pretreatment, posttreatment, and last follow-up, and anteroposterior (lateral) film of the full length spine in standing position were taken to evaluate magnitudes and balance of coronal and sagittal malformations. We compared the general data of the two groups by independent sample t test and that of pretreatment, posttreatment and the last follow-up by paired-sample t test. Results: According to the effective standard of not less than 10 degrees improvement, 9 of them were effective, 4 cast and 5 brace, the effective rates were 44.44% and 45.45%, 3 cases from brace group progressed. The magnitudes of the main curve improved significantly after the first treatment of cast and brace (55.4±24.36 vs 42.35±23.62) degree (t=5.850, P=0.000), and at the last follow up, the curve decreased slightly compared of that before interventions (55.4±24.36 vs 51.8±26.33). The compensatory curves, segmental kyphosis, thoracic kyphosis, lumbar lordosis, balance of both coronal and sagittal also had no significant differences between the primal and the latest follow up. The widths 159.63±19.27 mm, 160.81±14.54 mm, 176.08±28.10 mm (t=3.942, P=0.001; t=-3.096, P=0.006) and heights 153.78±29.24 mm, 161.14±29.53 mm, 175.01±36.91 mm of the thoracic were significantly different between pre-posttreatment and the last follow up (t=-5.950, P=0.000; t=-3.997, P=0.001). Serial cast and brace application can preserve the growth of the thorax. Conclusion Serial cast and brace are viable growth friendly methods to deal with progressed EOS, Although a cure improvement cannot be always expected, they can stabilize relatively large curves in young children and may help delay eventual surgical intervention.

Objective: To investigate the causes of 30-day unplanned revision surgery following one-stage posterior vertebral column resection (PVCR) for severe spinal deformity and the methods of prevention and management. Methods: A total of 112 severe deformity patients underwent one-stage PVCR for surgical treatment in the 306^th Hospital of People′s Liberation Army from May 2010 to December 2015 were retrospectively reviewed. Six patients required reoperation within 30 days after PVCR, including 2 males and 4 females with average age of 21 years (ranging from 12 to 38 years). Four cases were congenital kyphoscoliosis, 1 was post-laminectomy kyphoscoliosis and 1 was post-tuberculous angular kyphosis. Three cases associated with preoperative neurologic deficit (Frankel C in 1 patient and D in 2 patients). The causes, management and outcomes of unplanned revision surgery within 30 days after PVCR were recorded. Results: The total incidence of unplanned revision surgery within 30 days following PVCR was 5.4% (6/112). There was 1 case due to cerebrospinal fluid leak, 5 cases with varying degrees of new neurologic deficits, the causes were as followed: dural buckling in 1 case, residual bone compression in 1 case, epidural hematoma compression in 2 cases, spinal subdural hematoma in 1 case. All the 6 cases underwent surgical exploration again, including further dural repair, decompression and hematoma clearance. After unplanned reoperation, 6 cases recovered completely. The average follow-up time after surgery was 30.8 months (ranging from 10 to 60 months). The major curve at coronal plane was improved from preoperative 87.7° to 34.2°, with a mean correction of 61.0% at final follow-up; the sagittal kyphosis curve was improved from preoperative 119.5° to 45.5°, with a mean correction of 61.9% at final follow-up. Two patients′ neurological status improved from Frankel D to Frankel E, one patient′s neurological status improved from Frankel C to Frankel E. Conclusions One-stage PVCR could be an effective method for treatment of severe spinal deformity. The causes of 30-day unplanned reoperation after PVCR are as followed: cerebrospinal fluid leak, dural buckling, residual bone compression and hematoma compression. Timely surgical exploration can gain good clinical outcomes.

Objectives:To analyze the characteristics of adjacent vertebral compression fracture(AVCF)after lumbar spinal fusion,and to investigate its treatment modality and clinical efficacy.Methods:353 patients treated with lumbar fixation and fusion for lumbar degenerative diseases at our center from January 2013 to January 2019 were retrospectively analyzed,and a total of 11 patients had AVCF after fusion,all were female,aged 70±7.2 years(61-83 years)old,including 1 case of T12 vertebral fracture,1 case of T12 combined with L1 vertebral fracture,4 cases of L1 vertebral fracture,2 cases of L2 vertebral fracture,1 case of L1 combined with L2 vertebral fracture,1 case of L3 vertebral fracture,and 1 case of L3 combined with T11 vertebral fracture.The fractures were treated accordingly based on the AVCF.characteristics,three cases underwent conservative treatments such as anti-osteoporosis due to healed fractures or other underlying diseases that were not suitable for surgery;Three cases of simple fractures without severe neurological damage symptoms were treated with percutaneous kyphoplasty(PKP)under local anesthesia;Five cases of fractures combined with lower limb nerve compression symptoms were treated with posterior revision surgery,spinal canal decompression,and upward extension and pedicle screws fixation.The mean follow-up time was 24.5±6.4 months(24-31 months).The visual analogue scale(VAS)score for low back pain and lower extremity pain and Japanese Orthopaedic Association(JOA)score for lumbar spine were performed preoperatively,1 week postoperatively,and at the final follow-up,and the occurrence of complications during the perioperative period and the follow-up were recorded.Results:The incidence of AVCF after lumbar fusion was 3.1％(11/353).The VAS score for low back pain was 5.2±2.3 preoperatively,3.5±1.8 at 1 week postoperatively(P＜0.05),and 3.9±2.0 at the final follow-up(P＜0.05);the VAS score for lower extremity pain was 7.1±2.2 preoperatively,3.0±1.6 at 1 week postoperatively(P＜0.05),and 3.7±1.9 at the final follow-up(P＜0.05);The JOA score of lumbar spine was 14.8±5.6 before operation,21.5±4.2 at one week after operation(P＜0.05)and 18.7±3.9 at the final follow-up(P＜0.05).According to the recovery rate(RR)of JOA at the final follow-up,5 cases were excellent,3 cases were good,2 cases were fair and 1 case was poor,and the satisfaction rate of clinical efficacy was 72％.A total of 4 patients(36％)had 5 complications.One patient developed a deep infection of staphylococcus aureus in the wound was treated with incision,debridement,irrigation,drainage,and sensitive antibiotics,and was cured afterward;One patient suffered from increased weakness of both lower extremities and urinary retention after surgery,and was treated with vertebral canal decompression and bone cement screw lengthening and fixation again,while after revision surgery,the patient suffered from temporary cardiac insufficiency,and recovered after treatment of salt and water restriction,cardiotonic diuresis,etc;One patient developed vertebral compression fracture after surgery and was treated with PKP bone cement reinforcement;One patient developed AVCF again and combined with intervertebral disc herniation and spinal stenosis after surgery,who underwent further revision and extended fixation.Conclusions:AVCF after lumbar fusion mostly occurs in the thoracolumbar segment and in elderly women,and simple AVCF without neurological symptoms can be treated with PKP,while AVCF with intervertebral disc herniation or spinal stenosis can be treated with lumbar revision and spinal decompression,and good clinical results can be achieved.