Objective To observe the effect of methylprednisolone on the expression levels of aquaporin-4 (AQP-4) and S100 protein in brain tissue of hypertensive intracerebral hemorrhage in rats and to investigate the treatment timing and the possible neuroprotective mechanism of methylprednisolone for hypertensive intracerebral hemorrhage. Methods Sixty-four rats were randomly divided into 3 groups:a sham operation group ( n= 8 ), a control group ( n= 8 ), and a methylprednisolone group ( n= 48 ). The methylprednisolone group was redivided into 2, 4, 8, 12, 24, and 48 hsubgroups (n=8 in each subgroup) according to the modeling to the time intervals of methylprednisolone treatment. Methylprednisolone was administered intraperitoneal y (30 mg/kg fol owed by 15 mg/kg every 6 hours for 3 d) at the corresponding time points in the methylprednisolone group, and the equal volume normal saline was administered intraperitoneal y in the control group. Neurological behavior score was conducted at 24 and 72 h after methylprednisolone treatment. The dry-wet weight method was used to measure hemispheric water content. In situ hybridization and immunohistochemical staining were used to detect the expression changes of AQP-4 mRNA and AQP-4 protein respectively. Double staining immunohistochemistry was used to detect AQP-4 and S100 protein. Results Compared with the sham operation group, the expression level of AQP-4 and brain water content in the control group were significantly increased (al P<0. 05). Compared with the control group, the neurological scores, expression levels of AQP-4 mRNA and protein, as wel as the brain water content in early methylprednisolone subgroups (2 h, 4 h and 8 hsubgroups) were significantly decreased (al P<0. 05). Double staining immunohistochemistry showed that expression levels of AQP-4 and S100 protein in early methylprednisolone subgroups (2 h, 4 h and 8 hsubgroups) were significantly decreased than those in the control group (al P<0. 05). Conclusions Early methylprednisolone may downregulate the expression levels of AQP-4 and S100 protein in the brain tissue after hypertensive intracerebral hemorrhage in rats, and thus attenuate brain edema after intracerebral hemorrhage.

Objective To investigate whether the polylactic acid(PLA)membrane can reduce the scar size and or improve the clinical outcome of the patients after lumbar disc herniation surgery,and the association between peridural scarring and recurrent pain after lumbar disc herniation surgery.Methods Seventy-two patients treated with lumbar disc herniation surgery were collected and randomly divided into two groups, including 38 cases were treated with PLA membrane,and 34 cases as the control group.All patients underwent MRI at 12 months after surgery for grading the size,location and development of the scar.NRS was used to assess the severity of lower limb pain before and 12 months after surgery.The modified Macnab scale was used to assess the clinical outcomes of the patients.Results For 9 cases(23.7%)in the PLA membrane group,the scar tissue had an effect on the nerve root,while 16 cases(47.1%)in the control group experienced the same,the difference was statistically sigificant(χ2=4.326,P=0.038).There was significant difference in scar score between the two groups(Z=2.340,P=0.019),but there was no significant difference in leg pain degree between the two groups(t=0.687,1.014,0.426,0.000,P=0.532,0.324,0.675,1.000).There was no significant difference between the two groups in modified Macnab classification grading(χ2=1.202,P=0.273).Conclusion PLA membranes used in lumbar disc herniation surgery could reduce peridural scar formation,but it does not significantly improve the clinical results.

Objective To evaluate the reliability of the TLICS and AO-TLICS scoring system for the thoracolumbar fracture and the effectiveness of the final treatment scheme.Methods The clinical data of 56 adult patients with acute traumatic thoracolumbar fracture diagnosed in Department of Orthopedics,Chui Yang Liu Hospital Affiliated to Tsinghua University from June 2015 to June 2017 were analyzed retrospectively.There were 35 males and 21 females,aged (32.3 ± 9.8) years,with an age range of 21-53 years.Two senior deputy chief orthopaedic physicians retrospective analyzed DR plain films,CT,MRI images and clinical records of thoracolumbar spine by independent blind method.According to TLICS and AO-TLICS scoring system (include injury morphology,neurologic status,posterior ligament complex (PLC) damage or M1 modifier,the severity scores of thoracolumbar fracture were classified and calculated.The score was divided into TLICS score group and AO-TLICS score group,each group of scores was the above 56 patients.Three months later,the two physicians repeated the above analysis process and compared the consistency of the scores between the observer and the observer's own control.The consistency of the two groups was compared,and the accuracy,sensitivity and specificity of the final treatment were compared.Cohen kappa test was used for consistency comparison according to the score and the mean value was taken.Measurement data were expressed as mean ± standard deviation (Mean ± SD),and t test was used for inter-group comparison.Results In the TLICS score group,the Cohen kappa coefficients of the observer's own control in fracture type,neurological status assessment,and PLC injury were 0.810,0.966,and 0.698,respectively,and the total scores were consistent (k=0.727).Cohen kappa coefficients between the observers in fracture morphology,neurological status assessment,and PLC injury were 0.725,0.931,and 0.594,respectively,and the total scores were consistent (k =0.615).In the AO-TLICS score group,the Cohen kappa coefficients of the observer's own control in terms of fracture type,neurological status assessment,and M1 correction factor were 0.760,0.892,and 0.711,respectively,and the total scores were consistent (k =0.666).Cohen kappa coefficients of the observers in terms of fracture type,neurological status assessment and M1 correction factor were 0.707,0.836 and 0.604,respectively,and the total score was consistent (k =0.592).According to the TLICS score,the correct rate of treatment was (84.2 ± 2.8) ％,the sensitivity was (84.1 ±2.1)％,and the specificity was (85.9 ± 6.5)％.According to the AO-TLICS score,the correct rate of treatment was (89.0 ± 2.6) ％,the sensitivity was (88.3 ± 3.5) ％,and the specificity was (89.6 ± 2.4) ％.There was a statistically significant difference in the rate of correct rate (t =2.485,P =0.047).Conclusion The advantage of TLICS score is better consistency in interobservers or intraobservers,but the AO-TLICS score system is more comprehensive,and the choice of treatment plan is more instructive.

Objective To evaluate the effect of diabetes on the effect of percutaneous transforaminal discectomy (TPED) for patients with lumbar disc herniation (LDH).Methods Retrospective analysis 69 LDH patients treated with TPED from January 2014 to June 2017 in Department of Orthopedics,Chui Yang Liu Hospital Affiliated to Tsinghua University.There were 32 males and 37 females with an age of (58.2±14.8) years and body mass mdex (BMI) (22.4 t 4.0) kg/m2.According to whether they had diabetes or not,they were divided into control group (53 cases) and diabetes mellitus (DM) group (16 cases).Agex,BMI,course of disease,operative segment,MRI grade of Pfirrmann lumbar disc herniation,operative time,blood loss,hospitalization time and perioperative complications were compared between the two groups.Outpatient follow-up was conducted for 6 months.The follow-up included Oswestry dysfunction index (ODI) and modified MacNab criteria.ODI score,modified MacNab criteria and postoperative complications were compared between the two groups.Independent sample t test was used to compare the measurement data between groups,and repeated measurement data analysis of variance was used to compare ODI scores.x2 test or Fisher exact test were used to compare the counting data between groups;Kruskal-Wallis rank sum test was used to compare the graded grouped data between groups.Results The average age,the BMI,the course of the disease,the time of follow-up,the distribution of the lumbar disc herniation and the severity of the lumbar disc were not significantly different between the two groups.The time of hospitalization in DM group was significantly longer than that in the control group (t =2.095,P =0.045).The operation time of DM group was slightly longer (t =1.369,P =0.182),and the amount of bleeding was slightly more (t=1.833,P =0.077).In DM group,the incidence of operative complications (18.8％) and the recurrence rate (6.3％) was higher,while the incidence of operative related complications (3.8％) and the recurrence probability (1.9％) was lower in the control group,but there was no statistical difference (P =0.233 and 0.393).In DM group,the improvement of ODI score after operation was not as good as that in the control group (F =10.475,P =0.003),especially in 3 months and 6 months after operation,the ODI score was higher than that in the control group (P =0.043 and 0.048).After 6 months of follow-up,the overall good rate was 92.8％ according to the modified MacNab criteria,and there were significant differences between the two groups (U =311.00,P =0.033).Conclusions TPED is a safe and effective treatment for LDH,which can significantly improve the quality of life after LDH,but has a limited effect on the postoperative effect.In the actual clinical work,in order to obtain better effect of TPED operation,we should pay attention to the control of

Objective To evaluate the efficacy and satefy of percutaneous kyphoplasty for treating Kummel disease with severe osteoporosis.Methods The clinical data of 23 Kummell's patients with severe osteoporosis attending orthopedics in ChuiYang Liu Hospital Affiliated to Tsinghua University from March 2013 to July 2016 were retrospectively analyzed.The patients underwent percutaneous kyphoplasty,the first day after surgery was evaluated during the hospitalization period,outpatient review for 3 months and 1 year.All measurement data were expressed as ((x) ± s),repeated measures analysis of variance was used for statistical analysis of preoperative and postoperative pain visual analogue scale,Oswesay dysfunction index,mean vertebral anterior,central and posterior height,kyphotic angle and operative complications.Results Outpatients were followed up for 12 to 24 months,with an average follow-up of (18.1 ± 5.6) months.The mean preoperative visual analogue scale of the patients with percutaneous kyphoplasty was (8.4 ± 1.5) scores after operation,(2.2 ± 1.1) and (3.1 ± 1.7) scores at 1st day after operation,3 months and (4.6 ± 2.0) scores at 1 year after operation respectively,all P ＜0.001.The preoperative average Oswesay disability index score was (70.1 ± 10.5) scores,(27.4 ± 7.9) and (36.6 ± 8.1) scores at 1st day after operation,3 months,and (46.5 ± 9.3) scores at one year after operation,all P ＜0.001.Postoperative one year pain visual analogue scale and Oswesay dysfunction index score compared with 1 st day and 3 months after operation,the difference was statistically significant (P ＜ 0.05).The mean preoperative vertebral body height percentage was (44.4 ± 6.9)％,(50.1 ± 6.3)％ and (88.2 ± 4.1)％,respectively,(65.5 ± 5.0)％,(66.2 ± 5.7)％ and (89.3 ± 3.7)％ respectively at 1st day after operation,(63.8 ± 7.4)％,(64.6 ± 5.0)％ and (88.1 ± 3.9)％ respectively at 3 months after operation,(57.8 ± 6.3)％,(63.0 ± 6.7)％ and (87.1 ± 4.2)％ respectively at 1 year after operation.Postoperative vertebral anterior and central height percentage compared with the preoperative significantly improved (P ＜ 0.05).There was no significant difference in the height of vertebral trailing edge.The height of vertebral body at 1 year after operation was significantly different from that at one day and three months after operation (P ＜ 0.05).The kyphotic angle improved significantly from 25.0° ± 7.5° to 16.5° ±4.1° at 1st day after surgery (P =0.001),18.2° ±5.8° at 3 months after surgery (P =0.032),but the kyphotic angle increased to 21.3° ± 8.1° at 1 year after the procedure (P =0.051).However,asymptomatie peripheral bone cement leakage occurred in 2 patients and 5 patients sustained adjacent fractures after percutaneous kyphoplasty,the rest of the patients did not have surgical complications and adjacent vertebral fractures.Conclusion Percutaneous kyphoplasty is a safe and effective method for the treatment of Kummell's disease,though it has long-term deterioration of adjacent vertebral fractures and kyphosis,but it can provide spinal stability and relieve pain in the short term,which is conducive to the recovery of patients.

Objective To evaluate the clinical efficacy of hybrid surgery,which combines fusion with cervical disc replacement (CDR),compared to anterior cervical discectomy and fusion (ACDF) in patients with multi-level cervical spondylosis.Methods From January 2015 to March 2017,the clinical data of 53 patients with multi-level cervical spondylosis admitted to Department of Orthopedics,Chui Yang Liu Hospital Affiliated to Tsinghua University,were retrospectively analyzed.They were divided into anterior cervical discectomy and fusion group (ACDF) (n =29) and hybrid surgery group (n =24) according to different operative methods.The operation time and intraoperative bleeding were analysised.Visual analogue scale (VAS) score,neck disability index (NDI),Japanese orthopaedic association (JOA) scores,Odom criteria and surgical complications were evaluated when outpatient reviewed for 1,3 and 6 months postoperative.The cervical range of motion (ROM),and adjacent segments degeneration (ASD) were assessed with radiographs.The measurement data of normal distribution were expressed as ((x) ± s),the comparison between groups was conducted by independent sample t test,and the repeated measurement data were analyzed by variance analysis.Counting data were expressed as percentage (％) and intergroup comparisons were performed by x2 test or Fisher exact test,and inter-group comparisons of classified data were performed by Kruskal-Wallis H (K) rank test.Results The operation time [(81.0 ± 15.4) min] and the amount of bleeding [(69.0 ± 38.4) ml] in the hybrid surgery group were less,but there was no statistical difference (t =1.487,1.065,P =0.154,0.301).Compared with postoperative complications,dysphagia occurred in 19 patients (65.5％) in group ACDF,which was significantly higher than 5 in group hybrid surgery (20.8％),but there was no significant difference in overall complications (x2 =9.759,P =0.082).Significant improvements in VAS score,NDI score and JOA score were observed postoperation in ACDF and hybrid surgery group,but there was no significant difference between the two groups (Fintra-group =31.225,70.358,32.412,P =0.000,0.000,0.000;Finter-group =1.258,2.451,0.914,P =0.277,0.135,0.352).There was no significant difference in Odom criteria between the two groups (x2 =260.500,P =0.077).The ROM of C3-C7 in group ACDF decreased significantly,while that in group hybrid surgery was not significantly decreased (t =2.514,1.776,P =0.022,0.093).The ROM of C3-C7 was significantly different at 6 months postoperation (t =2.353,P =0.030).Although no ASD changes were found in the hybrid surgery group during the follow-up period,there was no significant statistical significance in the two groups (x2 =2.632,P =0.105).Conclusion Compared with the previous ACDF operation,there is no significant difference in the clinical results of hybrid surgery operation for multilevel cervical spondylosis,but it can effectively preserve cervical ROM,reduce adjacent segment degeneration and postoperative dysphagia.