[Objective]To Probe the causes of significant operatiive complications of ossification of posterior longitudinal ligament as well as the treatment outcomes in order to reduce the surgical morbidities and to suggest preventive measures of complications.[Method]The surgical data of 85 cases with ossification of posterior longitudinal ligament were reviewed form March 2002 to May 2006.In continuous long segment OPLL which were treated by bilaminectomy with internal fixation system;short segment OPLL which were treated by corpectomy of anterior cervical approach with bone of autograft and anterior cervical spine locking plates.[Result]Totally 66 cases were followed-up from 3 to 25 months with an average of 13 months.Complication of posteior cervical approach:8 cases with the pain of neck-shoulder,which resulted from postoperative radiculopathy and nerve root irritation or injury.Most of 8 cases were recovered in 2 to 20 weeks by conservative treatment such as antalgica,dehydration and physiotherapy.Four cases with quadriparesis or symptom deteriorate,which resulted from reperfusion injury of spine cord.Two cases were recovered by hyperbaric oxygen and medication and 1 cases recovered not enough.Two cases with posterior cervical hemotoma were caused by bleeding of smaller blood vessels and obstruction of drainage.One case of CSF leakage were cured in 3 days with cervical spinal immobilization and moderate local compressiom.Two cases of local infection were cured during 20 days with antibiotics or combined with debridement and suturing.Complications of anterior cervical approach:a cases with quadriparesis or symptom deteriorate;1 case of CSF leakage.Complications related to instruments included 1 case of titanium net subsidence and 1 case of single lateral mass screw back-out.[Conclusion]Many kinds of operative complications could occur in either anterior or posterior approach of surgery of ossification of posterior longitudinal ligament.Preoperative good preparation,intraoperative carefull operation and postoperative strengthened management are the key points to decrease and prevent operative related complications.

[Objective]The purpose of this study was to determine the treatment odontoid fractures complicated by significant C2、3 displacement.[Method]Sixteen patients with odontoid fractures(12 type Ⅱ and 4 type Ⅲ,according to Anderson-D'Alonzo standard)were treated in this study.There were 11 male and 5 female with an average of 36 years(range 19-54 years).Group A included 9 cases of odontoid fracture with Hangman fracture and group B includcd 7 cases of odontoid fractures with C2、3 anterior fusion and 6 underwent dens screw with C2、3 posterior fusion.Postoperatively,neck collars were applied for 3 months.[Result]Successfully closed reduction of C1～2 was achieved in 16 patients.No complication occurred in the two groups.[Conclusion]Postoperatively there was no motion restriction in the neck or residual neck pain.Direct osteosynthesis of the fractured dens with screws is an effective procedure for unstable type Ⅱ fracture of the dens.Postoperative external immobilization with a neck collar seems to contribute much to the treatment.

Objective To study the expressions of C -met and COX -2 in thyroid papillary cancer ( TPC) and to analyze the relationship between their expressions and clinicopathological features .Methods S-P immunocytochemical technique was used to examine the expressions of C -met and COX-2 in 96 cases of TPC and 46 cases of benign tissues ,and their relationship with clinicopathological features were analyzed .Results The positive rates of C -met and COX -2 in 96 cases of TPC were 92.71% and 71.88%,showing obvious differences between TPC and benign tissues (P<0.001).In TPC there is a statistically significant difference of the expression of C-met in older than45 years and less than 45 years of age(P<0.05).Difference of COX-2 expression in TPC was statistically significant in patients with and without lymph node metastasis ( P<0.05 ) . The positive expression of COX -2 was closely related to the expression of C -met(r=0.451,P<0.05).Con-clusion The abnormal expressions of C -met and COX-2 could be important significance in the growth and in-vasion of TPC,and COX-2 might have some relationship with lymph node metastasis .

Objective To observe the clinical effect of percutaneous vertebroplasty f PVP)and percutaneous kyphoplasty(PKP)in the treatment of ostcoporotic vertebral compressive fracture. Methods Forty-two patients with osteoporotic vertebral compressive fractures were treated with PVP or PKP from August 2007 to July 2009.VAS and SF-36 scoring systems were employed to evaluate the Dain and quality of life.X-ray was used to evaluate the vertehral height restoration rate and the kyphosis correction rate.The bone cement leakage was determined based on the Chest X-ray. Results There was staitistical difference on PMMA leakage between PVP and PKP group.VAS and SF-36 scores at 2 wePks and 6months after operation were much better than those counted before operation in both PVP and PKP groups(P<0.05).The VAS and SF-36 scores at 6 months after operation showed no statistical difference in comparison with those before operation between PVP and PKP groups(P>0.05).At tWO weeks after operation,the height restoration rate of the fractured vertebral body(anterior and central column)in the PKP group waa better than that in the PVP group(P<0.05).The kyphotic correction rate in the PKP group was a little better than that in the PVP group(P>0.05).Conclusions In the treatment of osteoporotic vertebral compressive fracture,PVP and PKP have the similar effect on the pain relief,can refresh the height of the fractured vertebral body and correct the kyphotic angel of the fracture level to some extent.PVP has more PMMA leakage than PKP.

Objective To study the clinical and radiographic characteristics of complicated axis fractures combined with adjacent segment instability and explore reasonable surgical treatment strategy. Methods A retrospective study was performed on 21 patients with axis fractures treated from August 2003 to June 2009. There were 14 males and 7 females at mean age of 34 years. The treatment strategy was based on the fracture type and the stabilities of adjacent atlantoaxial joint and intervertebral C2/3.Treatment strategies included anterior C2/3 interbody discectomy and fusion, anterior cervical plate internal fixation, odontoid screw fixation, posterior C1-2 pedicle screw fixation, cervical lateral mass screw fixation or combined anteroposterior approach. Results All patients were immobilized in a hard collar for thee months and followed up for 6-36 months (average 12 months), which showed bony fusion and cervical stability, with no intraoperative surgery-related complications such as loosening, extrusion or breakage of fixation, vertebral artery injury, nerve damage, cerebrospinal fluid leakage or wound infection. Neurological recovery was observed in five patients. Conclusions For complicated atlas fractures, correct identification of fracture type and instability disturbance of adjacent atlantoaxial joint and C2/3 as well as active treatment can conduce to better effect.

Objective To observe the efficacy of extensive decompression through transforaminal lumbar interbody fusion (TLIF) pathway combined with pedicle screw fixation on treating degenerative lumbar stenosis in the dderly.Methods Seventy-five elderly patients (28 males and 47 females) with degenerative lumbar stenosis were treated with extensive decompression through transforaminal pathway at our hospital from Jan.2007 to Aug.2010.The operation is through the TLIF pathway to resect part of the articular facet,and expose unilaterally the intervertebral vertebral foramen.Decompression of the vertebral canal was conducted by removing the disc.In the end,we performed posterolateral fixation with pedicle screw and placement of bone graft in posterolateral part of the lumbar or did the interbody fusion.JOA scores were obtained before and 1 day after operation and in 3 month follow-up consultation.The intervertebral height and bone fusion were observed by X ray.Results The follow-up period of the 75 patients was 6-36 months with an average of 12 months.There was significant difference (t =20.79,P ＜ 0.05 ;t =25.89,P ＜ 20.05) in JOA score between 3 month follow-up (21.08 ± 3.60) and preoperation (10.91 ± 2.23),between 1 d follow-up (22.72 ± 3.26) and preoperation (10.91 ±2.23),respectively.The rate of improvement was (88.6 ± 10.8)％,with 98％ of excellent or good in 3-month follow-up.Lumbar plane films showed neither instability or internal fixation loosening,breakage or distortion in follow-up consultation.There were 2 cases in whom Cage dislocation occurred without any neurological symptoms.Conclusion Extensive decompression through TLIF pathway combined with pedicle screw fixation is an efficacious method of treating degenerative lumbar stenosis in elderly patients.This method can retain the structure of lumbar posterior complex,reduce the risk of low back pain.It is a safe choice for treatment of degenerative lumbar stenosis in the elderly.

Background: Enteritis is one of the most frequently reported symptoms in piglets infected with porcine circovirus type 2 (PCV2), but the immunopathogenesis has not been reported. Objectives: This study examined the effect of a PCV2 infection on the intestinal mucosal immune function through morphological observations and immune-related molecular detection. Methods: Morphological changes within the ileum of piglets during a PCV2 infection were observed. The expression of the related-molecules was analyzed using a gene chip. The immunocyte subsets were analyzed by flow cytometry. The secretory immunoglobulin A (SIgA) content was analyzed by enzyme-linked immunosorbent assay. Results: The PCV2 infection caused ileal villus damage, intestinal epithelial cells exfoliation, and an increase in lymphocytes in the lamina propria at 21 days post-infection.Differentially expressed genes occurred in the defense response, inflammatory response, and the complement and coagulation cascade reactions. Most of them were downregulated significantly at the induction site and upregulated at the effector site. The genes associated with SIgA production were downregulated significantly at the induction site. In contrast, the expression of the Toll-like receptor-related genes was upregulated significantly at the effector site. The frequencies of dendritic cells, B cells, and CD8 + T cells were upregulated at the 2 sites. The SIgA content decreased significantly in the ileal mucosa. Conclusions PCV2 infections can cause damage to the ileum that is associated with changes in immune-related gene expression, immune-related cell subsets, and SIgA production.These findings elucidated the molecular changes in the ileum after a PCV2 infection from the perspective of intestinal mucosal immunity, which provides insights into a further study for PCV2-induced enteritis.