Objective To evaluate the bony variations in lumbar vertebral body among the patients with lnmbar disc herniation and determine its significance to microendoscopic discectomy(MED). Methods The CT images of 160 patients who underwent MED for lumbar disc herniation were reviewed. Measurements of vertebral bony dimensions related to surgical procedure were recorded, which included the angle of spinal process and lamina, spinal process direction, length, thickness and angle of the laminar, facet depth, spinal process width, and the distance between facets and lamina. The relationship between the bony variations and clinical outcome was analyzed. Results The majority of anatomic parameters are greater in male patients and in L5S1 segment than those in female and in L 4-5 (P

Objective: To discuss the effect of volatile organic compounds to the potential of embryonic development. From the angle of the laminar flow process, we found ways to control VOCs to ensure that the potential of embryonic development. Methods:To collect the air from the outdoor, laboratory hundred and thousand grade level central corridor three VOCs for testing;we used raw, medium effect filter to replace the original filter and got different results. Results:The indoor VOCs were higher than outdoor;Changes in concentrations of VOCs can affect embryonic development potential. The effect of replaced filter is bigger. After a period of time in a laminar flow system, it gradually getting better and finally change more than before. Conclusion:The embryo laboratory has volatile organic compounds VOCs. VOCs have larger influence on embryonic development potential and can be effectively controlled.

Objective To study the safety and efficacy of transpedicular osteotomy en bloc lamina resection to treat thoracic spinal stenosis.Methods A retrospective study of 23 consecutive patients underwent transpedicular osteotomy en bloc lamina resection from June 2004 to December 2008,including 12 males and 11 females,with a mean age of 46 years(range,38-62 years)was conducted.The courses of diseases were 1.5 to 20 months with an average of 6.5 months.There were 18 cases caused by thoracic ossification of ligamentum flavum(OLF),4 cases caused by ossification of posterior longitudinal ligament(OPLL)and 1 case caused chondroma.Preoperative CT and MRI examinations showed that all patients got spinal cord compression.Preoperative ASIA Grade was A for 1 case,B for 3 cases,C for 7 cases and D for 13 cases.Postoperative neurological status was evaluated by ASIA grade system.Results The postoperative follow-up duration ranged from 16 to 58 months(mean 30 months).The operation time varied from 90 to 210 min,with the average of 163 min.Blood loss varied from 600 to 3200 ml,with the average of 2150 ml.Pedicle screws were used in 10 cases with T9-T12 stenosis,and dura excisions were repaired by lumbodorsal fascia in 5 cases.Cerebrospinal fluid leakage occurred in 2 cases.Postoperative ASIA grade showed that there was A for 1 case,B for 2 cases,C for 2 cases,D for 5 cases and E for 13 cases.Conclusion Transpedicular osteotomy is a good approach,which avoid sclerotic cortex and ossified ligamentum flavum,to resect en bloc lamina with with shorter operative time and less blood loss.

Objective To observe the in vivo degradation of poly-DL-lactic acid ureteral stent in canine and the pathological change in canine ureter.Methods Poly-DL-lactic acid ureteral stent was inserted into 19 canine ureters,respectively.The stents were taken out every two weeks with their degradation observed with electronic microscopy and their molecular weight change detected by gel permeation chromatography.Pathological change in ureteral tissue specimens stained with hematoxylin and eosin was observed by light microscopy.Results The molecular weight of poly-DL-lactic acid ureteral stent was decreased to 8 033 seven weeks after degradation from 68 900 before degradation,with a degradation rate of 88.3%.Electronic microscopy showed that the number of pores in stent was gradually increased and their diameter became larger.The stent was degraded.The main pathological change observed in canine ureter tissue was non-specific inflammation.Conclusion Poly-DL-lactic acid ureteral stent is good in degradation property and tissue compatibility in vivo.

ObjectiveTo observe the effect of early-stage intervention with acupuncture on gastrointestinal dysfunction in critically ill patients.MethodTotally 112 critically ill patients were randomized into two groups. Based on the treatment for primary disease, the conventional group additionally received Lived Combined B. Subtilis and E. Faecium Enteric-coated Capsules, plus Alanyl Glutamine injection when parenteral alimentation was required; in addition to the treatments given to the conventional group, the acupuncture group received electroacupuncture, once a day. Before treatment, and on treatment day 7 and day14, the gastrointestinal function and nutritional state (hemoglobin, albumin), nutrition type, APACHEⅡscore, incidence rate of gastrointestinal function failure, and mortality rate were evaluated and compared.ResultAfter 7-day treatment, the gastrointestinal function scores were significantly improved in both groups (P<0.05), and there was a significant difference between the acupuncture group and conventional group (P<0.05); after 14-day treatment, the gastrointestinal function scores were significantly improved in both groups compared to that before treatment (P<0.01), and there was a significant difference between the acupuncture group and conventional group (P<0.05). Respectively after 7-day and 14-day treatment, the APACHEⅡscores were significantly improved in both groups (P<0.01), and there was a significant difference between the acupuncture group and conventional group (P<0.05); after 14-day treatment, there was a significant difference between the two groups (P<0.05). After 7-day treatment, the hemoglobin levels were insignificantly changed in the two groups (P>0.05), and the difference was insignificant between the two groups (P>0.05); after 14-day treatment, the hemoglobin levels were significantly changed in both groups compared to that before treatment (P<0.05), and there was a significant difference between the two groups (P<0.05). After 7-day treatment, the albumin levels were insignificantly changed in the two groups (P>0.05), and the between-group difference was statistically insignificant (P>0.05); after 14-day treatment, the albumin levels were significantly changed in both groups compared to that before treatment (P<0.05), and there was a significant difference between the two groups (P<0.05). In the acupuncture group, 10 patients were dead, and there were 13 dead in the conventional group, and the between-group difference in death rate was statistically insignificant (P>0.05), though the death rate was comparatively lower in the acupuncture group; in the acupuncture group, 3 patients turned from complete parenteral nutrition to mixed nutrition, while 4 patients turned to mixednutrition because of intolerance to enteral nutrition and 2 cases turned to complete parenteral nutrition in the conventional group.Conclusion The two groups of treatments both can effectively improve the gastrointestinal function, decrease the incidence rate of gastrointestinal function failure, and the efficacy in the acupuncture group was more significant than that in the conventional group;the two groups of treatments both can sustain the gastrointestinal function and nutrition supply, and improve the nutrition state of the patients, and the acupuncture group was superior to the conventional group; the two methods both can effectively reduce APACHEⅡ score and improve the prognosis, while the acupuncture group was superior to the conventional group. Regardingthe death rate and enteral nutrition, the acupuncture group produced a higher comprehensive efficacy than the conventional group.

Objective To investigate the methods, feasibility, outcome and indications of atlantoaxial pedicle screw system in the treatment of upper cervical injury. Methods Thirteen patients with upper cervical injury were treated by atlantoaxial pedicle screw system. There were four patients with old odontoid fractures, two with new odontoid fractures (Aderson ⅡC), three with rapture of the transverse ligament of C1 and four with C1 fracture. Results A total of 26 pedicle screws and 26 pedicle screws were implanted. The mean operation time and perioperative blood loss were 2.6 hours and 470 ml, respectively. No injury to the vertebral artery and spinal cord was observed. All patients were followed up for 4-25 months (mean 13 months). The clinical symptoms were improved to some extent according to Japanese Orthopedic Association scoring system, with improvement rate of 72%-91% (mean 81%). The screws were verified to be fixed in a proper position, and no hardware broken or loosening was observed except for one C1 screw penetrating the medial superior cortex of lateral mass for 3 mm without affecting occipito-aflantal motions. All patients had a solid bony fusion 3-6 months later. Conclusion The atlantoaxial pedicle screw system is feasible in the treatment of upper cervical injury with the advantages of better outcomes and wider indications.

Objective To evaluate narrow band imaging (NBI) assisted argon plasma coagulation (APC) in treatment of Barrett's esophagus (BE). Methods Suspected BE lesion was observed under white light, NBI and magnification, biopsies were taken at the site with characteristic pit pattern and capillary architecture of BE. A total of 86 patients with pathologically confirmed BE were randomly divided into NBI group (n= 42) to receive APC under NBI, or control group (n= 44) to receive APC under whit light. For APC procedure, the probe was inserted through biopsy channel to reach 1 cm beyond the endoscope tip, and was located 1-2 cm from the lesion to assure safe use. All patients were followed up with endoscopy and biopsy at 3 and 6 months after APC, respectively. Results There was no significant difference between 2 groups in effective rate of BE mucosal eradication at 3 and 6 months after APC procedure (P > 0.05). Conclusion NBI assisted APC is safe and effective in eradication of BE epithelium, in reducing procedure time and in relieving of functional gastrointestinal symptoms related with BE.

Objective To discuss the complication risk factors for early death after cervical injuries and explore the indication for treatment. Methods A retrospective study was carried out on early death and complications in 419 patients with cervical injuries admitted into our hospital. We observed the relationship of all kinds of complications with cervical cord injury severity and the incidence rate of complications in all patients. Results The respiratory complication was the main cause of early death, accounting for 79.11%. There found complications including hypoalbuminemia ( 85.29% ), hypotension(50%) and hyponatremia ( 35.29% ) in the death patients. Conclusions The existence of complications, especially hypoalbuminemia, can aggravate the original dysfunction and is the risk factor for early death. The early treatment of the dangerous complications could prevent multiple organ failure and early death and provide sound condition for functional recovery.

ObjectiveTo identify the anatomical feasibility of cross screw fixation in the atlas via posterior arch,provide a reference for clinical applications.MethodsA total of 10 dry atlas specimens were used to measure anatomic data and three dimension(3D) CT data.The data included height of the posterior tubercle,width of the posterior arch,distance from the ideal point to the interior of the vertebral artery sulcus,from nail point to central line,and the ideal direction of the screws.Statistical analysis was done to compare the two methods.Then 100 3D CT data were measured.The parameters included height of the posterior tubercle (mid-sagittal plane),width of the posterior arch (the inner side where arch transformed to the vertebral artery sulcus),distance from the ideal point to the interior of the vertebral artery sulcus (where screws completely located in the medullary cavity),distance between the nail point to central line,and angle of the ideal screws (between screws and horizontal line).The anatomy of the atlas was analyzed for whether height of the posterior tubercle is more than 7 mm,width of the posterior arch is more than 3.5 mm,and whether or not cross screws can be planted.ResultsThere was no statistical difference between anatomic and 3D-CT measures.Thickness of the C1 laminar was (4.7±0.9) mm in the left side,(4.6±0.8) mm in the right side,and 93.5％ of specimens were thicker than 3.5 mm.Distance of the ideal screw was(15.9±3.0) mm in the left side,(15.9±3.0) mm in the right side.Height of the C1 posterior tuber was (7.8±1.2) mm,with 91％ of the data higher than 7.0 mm.Angle between the axial of C1 laminar and frontal plane was 26.8°±6.8° (8°-44°) in the left side,26.8°±6.3°(13°-44°) in the right side,and about 11％ of them can not cross plant.ConclusionIt is feasible and safe to place cross screws in the posterior arch of the C1 in anatomy.

Objective To study the effect of different rod curvature on the postoperative stability and stress of thoracolumbar junction fracture using the finite element simulation.Methods (1) Thoracolumbar finite element model of T11 to L1 from three-dimensional CT data of a 30-year-old healthy male volunteer was established,including the assignment of cortical bone,cancellous bone,disc,ligaments and facet joints.On this basis,the T12fracture model was also established.T11 to L1 bilateral pedicle screw fixation was loaded,and the rod connection was divided into straight rod group and pre-bended rod group (lordotic 15°-25°) according to angle of the rod.A 400 N stress was loaded on the top of the upper endplate of T11 to simulate the upper part body gravity,while applying a 10 N · m torque to generate flexion and extension,lateral flexion and rotation.Stress distribution of different methods of pre-bending for thoracolumbar fractures after reduction was compared.(2) A retrospective cohort analysis was made on 56 cases of thoracolumbar fractures surgically treated from July 2012 to July 2016,including 31 cases in straight rod group and 25 cases in pre-bended rod group.Two groups were compared in angle between adjacent level before operation,after operation and at final follow-up.Results (1) In flexion,extension,lateral bending and rotation,both rod bending methods effectively controlled the thoracolumbar junction displacement.The peak stress of connecting rod (151,315,369,377 MPa respectively) in pre-bended rod group was lower than that in straight rod group (110,239,281,189 MPa respectively) (P ＜ 0.05),and straight rod group appeared relatively obvious stress concentration.(2) Mean follow-up time was 21.4 months (range,4-33 months).Preoperative kyphosis angle was (21.7 ± 7.4)°in straight rod group and (20.3 ± 6.8)° in pre-bended rod group (P ＞ 0.05).Postoperative lordosis angle in straight rod group was (3.3 ± 1.2) °versus (8.3 ± 2.8) ° in pre-bended rod group (P ＜ 0.05).At the final follow-up,the lordosis angle in straight rod group was reduced by (8.7 ± 2.3) ° versus (3.9 ± 1.7)°in pre-bended rod group (P ＜0.05).Implant failure was seen in 3 cases in straight rod group,but there was no implant failure in pre-bended rod group.Conclusion Pre-bended (lordotic 15°-25°) and pre-loaded rods used in internal fixation of thoracolumbar fractures may reduce the stress of rods,decrease the incidence of implant failure and facilitate the recovery of spine stability.