Objective To investigate the diagnosis,treatment and prevention strategies of pharyngostoma and esophagostoma caused by anterior cervical spine surgery.Methods A retrospective analysis were performed in 17 cases of anterior cervical operation complicated with pharyngeal and esophageal fistula from 1999 March to 2010 June,including 11 male cases and 6 female cases,aged from 7 to 67 years with the mean age of 44.23 years.16 cases (94％) got inflammation of anterior cervical surgery incision and throat pain.2 cases (11％) accompanied by high fever,whose body temperature was as high as 39.2° and incision particles or liquid flew after eating.17 cases underwent upper gastrointestinal radiography,and regular oral methylene blue.Barium overflew from fistula in 2 cases (11％) after upper gastrointestinal tract barium meal angiography,while methylene blue overflew from incision in 7 cases (41％) after oral methylene blue.Through X-ray examination,gas fistula before vertebral was visible in 14 cases (82％).A diagnosis can be made by outflow through fistula after barium esophagography or oral administration of methylene blue.For unknown but highly suspected pharyngeal and esophageal injury,operation can be confirmed if no improvement of symptoms was found after fasting,nasogastric or parenteral nutrition,and ant-infection treatment for 1 week.Results All of 17 patients underwent surgical treatment.During operation,fistula dot or small irregular shape can be seen in 8 cases;long stripe in 3 cases;boundary not clear or irregular in 2 cases;adhesion around the fistula of anterior cervical fascia,similar to tear in 1 case;two fistula in 1 case;fistula located in pharynx posterior wall or esophageal which was not clear or fistula of unknown reason in 2 cases (fascia might be not at the same side of incision or fascia was small and already closed).Pharynx posterior wall and esophageal fistula was found in 3 cases during surgical exploration,which was immediate sutured and placed with drainage tube.After 7 to 14 days,if flow was less than 30 ml,and no bacterial growth was found in 3 consecutive drainage fluids,we pull out the tube.Patients who underwent nasal feeding for 2 to 3 weeks,and then took liquid diets complained nothing,and cured after 1 month.12 cases underwent debridement,stitching fistula,irrigation and drainage tube placement instantly.The wash pipe was removed after 12 to 21 days and 3 consecutive drainage fluids showed no bacterial growth.Then 2 to 3 days later the drainage pipe was pull out.Two to three months later these patients healed.2 cases firstly underwent debridement and suture or part suture,and then the incision was opened and filled with nitrofurazonium gauze tamponade.Gradually pull out the filling gauze and change the dressing of wound.If the residual cavity was large or the drainage was pus,flush the wound with physiological saline once a day,then three times a week,and finally once a week.These patients healed after 6 to 12 months.Pharyngostoma or esophagostoma of all patients was found timely,and active surgical treatment was performed,so no obvious complications was found postoperatively.All 17 patients recovered and resumed diet after 1 to 12 months postoperatively.Conclusion Pharyngeal and esophageal fistula is a rare but severe complication after anterior cervical surgery,which seriously affect the effect of operation and even lead to death.Early diagnosis and active intervention can obtain satisfactory curative effect.

Spinal cord injury has been considered the disease seriously suffering people.Their oligodendrocyte cells cannot form the channel guide to axons' migrating and secrete inhibitors,as well as astrocytes format glial scar in the injured district after rapidly reactive proliferation and inhibit axon growth.Thus,the treatment of spinal cord injury is still a thorny issue in medical field at present.Olfactory ensheathing cells have a good specific process axis linking of axon regeneration and accurately target.The effects of low power laser irradiation on the nervous system and olfactory ensheathing cells not only included its reservations and even promotion of the activity of damaged neurons,decrease in scar formation,prevention of the degeneration of neurons,but also increase in olfactory ensheathing cell activity by intervening some factors.Olfactory ensheathing cell transplantation and low power laser irradiation play an important role in the repair of spinal cord injury.

BACKGROUND:Due to the emergence of drug-resistant tuberculosis and mismanagement in tuberculosis patients,the incidence of delayed healing or recurrent after spinal tuberculosis surgery is gradualy increasing,especialy in strongly predisposal children.Therefore,exploring the risk factors of delayed healing orpost-operative recurrence in pediatric patients after spinal tuberculosis surgery,wil have significance in the prevention and treatment of tuberculosis.OBJECTIVE:To analyze the risk factors of delayed healing or post-operative recurrence in pediatric spinal tuberculosis,and evaluate the efficacy of individualized re-operation.METHODS:From June 1998 to June 2013,clinical data of 145 pediatric patients with spinal tuberculosis were reviewed retrospectively,and some cases of delayed healing or post-operative recurrence in spinal tuberculosis were compared with other without delayed healing or post-operative recurrence.The patient's age,gender,nutritional condition,lesion debridement,history of chemotherapy and internal fixation,complicated spinal lesion,scope of lesions,preoperative erythrocyte sedimentation rate ＞60 mm/h,and postoperative complications were analyzed by Logistic regression analysis.The risk factors of delayed healing or post-operative recurrence were analyzed.After re-operation,erythrocyte sedimentation rate,C-reactive protein and imaging studies were detected.RESULTS AND CONCLUSION:After surgery,29 cases appeared delayed healing or post-operative recurrence and 12 of them received re-operation.The incidence of delayed healing or post-operative recurrence in pediatric spinal tuberculosis was 20％and the re-operation rate was 8.3％.Logistic regression analysis showed that,nutritional condition,history of chemotherapy,lesion debridement,and scope of lesions were significantly correlated with delayed healing or post-operative recurrence (P＜0.05).While patient's age,gender,history of internal fixation,complicated spinal lesion,preoperative erythrocyte sedimentation rate ＞60 mm/h,and postoperative complications had no correlation with the delayed healing or post-operative recurrence (P ＞0.05).Individualized re-operation can achieve good outcomes.Experimental findings indicate that,the risk factors of delayed healing or post-operative recurrence in pediatric spinal tuberculosis are very complex,enhancing the nutrition,complete debridement of lesions,and receiving chemotherapy can effectively decrease the incidence.According to the initial surgery and patient's conditions,individualized re-operation is the key to the success.

Objective To discuss the clinical efficacy and surgical indications of one?stage transforaminal debridement, interbody fusion combined with posterior instrumentation for thoracolumbar spinal tuberculosis. Methods All of 34 patients with thoracolumbar spinal tuberculosis were retrospectively analyzed,treated by one?stage transforaminal debridement, interbody fusion and posterior instrumentation from June 2010 to April 2013, including 21 males and 13 females, aged 21 to 64 years old, av?erage 38.2 years. All patients were treated by preoperative quadruple antituberculosis drugs therapy for 2-4 weeks, postoperative regular chemotherapy for 12-18 months. Preoperative and postoperative changes in clinical symptoms, nervous function, the situa?tion of the erythrocyte sedimentation rate (ESR) and C?reactive protein (CRP) with strict follow?up, as well as other related compli?cations were observed. The spinal fusion rate and fusion situation, changing of the physiological curvature, as well as loosening or breaking of the internal fixation device were detected through regular imaging examination. Results The surgery duration time was 60-150 min, average 110 min, and the blood loss was 80-550 ml, average 320 ml. Cerebrospinal fluid leakage occurred in one case. All of the operations were completed successfully without nerve or spinal cord injuries. Postoperative follow?up time was 1 to 4 years, average 2.5 years. Clinical symptoms improved significantly in three months after operation. The visual analogue scale (VAS) improvement rate was about 93%. All patients' ESR and CRP returned to normal levels at the last follow?up. The Kirkaldy?Willis function score showed that the total fine rate was 94%. 12 cases of patients had various degrees of neurological dysfunction before operation, which were back to normal at the final follow?up, except one case of ASIA class B turned to C. Inci?sion fistula formation happened in one case at the third months after surgery, and the wound was healed after debridement. All pa?tients got solid fusion between vertebral body, and there was no graft absorption or collapse, pseudarthrosis, tuberculosis recur?rence, and loosening or breaking of internal fixation devices. Cunclusion One?stage transforaminal debridement, interbody fu?sion and posterior instrumentation is a simple, effective and safety surgical approach, which has great application value for surgi?cal treatment of patients with thoracolumbar spinal tuberculosis.

BACKGROUND:There are no systematic and coherent studies on the mitochondrial apoptotic pathway of fluoride-induced osteoblast apoptosis, and the specific pathways to induce apoptosis in osteoblasts by fluorine are stil unclear. OBJECTIVE:To explore the possible pathways of apoptosis in osteoblasts induced by fluoride and its molecular characteristics. METHODS:A fluorosis model of human osteosarcoma cel line Saos-2 was establishedin vitro. After in vitro culture, the cels were treated with sodium fluoride at different concentrations (0, 5, 10, 20, 40, 80 mg/L). Flow cytometry was used to inspect the mitochondrial membrane potential at 24 hours after intervention; 84 apoptosis-related genes were detected by PCR Array; parts of the differentialy expressed genes were verified by western blot method. RESULTS AND CONCLUSION: When the concentrations of sodium fluoride were 20, 40 and 80 mg/L, the mitochondrial membrane potentials in osteoblasts were 27.0%, 28.8%, 38.6%, respectively (alP < 0.05). PCR array found 13 genes upregulated and 15 genes down-regulated. Immunoblotting results showed Bim, Caspase 9, Caspase 14, BCL2, BAX expressions enhanced with increasing doses of sodium fluoride; Caspase 3 expression was decreased at the concentration of 5 mg/L, but increased gradualy at over 10 mg/L. Caspase 7 expression had no significant difference. The expression of Caspase 10 decreased with the increasing doses of sodium fluoride. These findings indicate that fluoride may induce apoptosis in osteoblasts through the mitochondrial pathway (including the endoplasmic reticulum stress pathway) and death receptor pathway.

Objective To study the clinical characteristics of spinal hydatid disease and help to diagnozy and treat the disease. Methods 14 cases with spinal hydatid disease, admitted in our hospital between July 1994 and October 2003, were studied retrospectively. Besides routine examinations, plain X-ray films were performed in all 14 cases, CT in 8 cases and MRI in 13 cases, respectively. 8 cases sufferred serodiagnostic tests for human hydatidosis. All cases underwent operation and the histopathological examination. There were 5 males and 9 females with an average age of 25.8 years(range, 5-53 years) in this series. All 14 cases had the living history in endemic area and the average duration of symptom was 26.7 months(range, 4-120 months). The lesions most frequently involved the thoracic segments, accounting for 35.8%, and then 21.4% in the lumbar, and 28.6% in the lumbosacral segments, cervical segments were the least commonly involved. According to Dew'classification, spinal hydatid cysts located primarily at intradural extramedullary area in 1 case, extradural intraspinal in 2 cases, vertebral in 7 cases, paravertebral in 1 case and combination of various extradural tissues involved in other 3 cases. Results The clinical manifestations were localized back pain or radiating pain, mass and gradually progressive neurological dysfunction. Eight of 14 cases displayed abnormality in X-ray films which showed local, well-defined and irregular erosions with or without surrounding sclerosis or calcifications. CT scans presented multiloculated low density lesions. The MRI characteristics of the lesions were multiloculated cysts, signal intensities of the cyst content were similar to that of CSF. On T1W images the cyst wall appeared iso- or slightly more hypo-intense than the cyst content, T2W images demonstrated a low intensity rim and the hyper-intense cyst content resembling a bunch of grapes. Seven of 8 cases performed the 3-tests serodiagnosis were positive, and 3 cases with positive 3-tests serodiagnosis accepted 8-tests were positive. All the specimens were shown to be Echinococcus Granulosus. Conclusion MRI was the most sensitive diagnostic method and the best method to determinate the site and extent of the cystic lesions. CT and serological examination are useful for diagnosis. The key of avoiding misdiagnosis is to enhance understanding of the disease.

Objective To study the diagnosis of thoracic myelopathy caused by ossification of ligamenta flava(OLF) and the influence of the improved surgical procedure on clinic effect. Methods From October 1994 to December 1999, 14 patients with thoracic myelopathy secondary to OLF were diagnosed and treated by improved procedure. The chief clinic manifestation of the disease were insidious and progressive onset of numbness, sensory loss of lower extremities or trunk, motor weakness, gait disturbance and imbalance, hyperreflexia and sphincter dysfunction. 41 levels of OLF were found by means of plain radiography,MRI associated with CT or CTM and were resected.There were 4 levels at T 8-9, 10 levels at T 9-10, 11 levels at T 10-11 and 5 levels at T 11-12. OLF were removed by means of improved posterior “floating”procedure that open “window”at cranial and caudal end and cut“bridge”at left and right side of ossified mass. The latest results were assessed according to JOA scale score system and recovery ratio. the preoperative average JOA scale score was 4.1 point (range 1 to 8 points). Results 14 patients were followed up from 6 to57 months with an average of 23 months. The postoperative average JOA scale score was 9.4 point (range 5 to 11), the recovery ratio was 76.8% and the excellent and good results was 85.6%. The average amount of blood loss was 370 ml and the average operative time was 175 minutes. Conclusion Clinic history and neurological examination associated with MRI and CT or CTM was the important means of the diagnosis of OLF, improved surgical technique was more effective and reliable.オ

[Objective]To introduce the safety of the spinal wedge osteotomy by a single posterior approach and to discuss the selection of fusion and fixation. [Method]Sixteen patients with severe post-adolescent congenital spinal deformities were treated by spinal wedge osteotomy by a single posterior approach from February 2000 and July 2006.There were 10 males and 6 females with an average age of 21.4 years(range 16 to 29 years).There were 11 patients with hemivertebre and 5 with fused ribs or bone bridge.Two patients had previous surgery history.The average Cobb's angles of scoliosis and kyphosis before operation were 84.7 ?and 52.6?.The average trunk shift was 15.4 mm.Bony septum in the canal was found in 2 patients on the preoperative CT or MRI.[Result]The follow-up ranged from 2 to 4 years with an average of 2 years and six months.The average fused vertebrae were 10.6 segments(range 8 to 14 segments).The postoperative average Cobb's angles of scoliosis and kyphosis were 38.5 and 27.7.The average correction rates of scoliosis and kyphosis were 54.5% and 47.4%.The average trunk shift was improved to 4.6 mm.There was no significant correction loss of the scoliosis,kyphosis and trunk shift at final follow-up evaluation.No patient developed severe complications except that two had pedicle fracture,one had L1 nerve root injury,one had superior mesenteric artery syndrome and one had exudates of incision.[Conclusion]Spinal wedge osteotomy by the single posterior approach is a reliable and safe surgical technique for correcting severe post-adolescent congenital spinal deformities.

BACKGROUND:Numerous studies have demonstrated various therapeutic methods for cerebrospinal fluid leakage after spinal column surgery, including intraoperative and postoperative measures. Few studies addressed the therapeutic methods of cerebrospinal fluid leakage after cervical vertebra surgery using lumbar subarachnoid catheter drainage.
OBJECTIVE:To evaluate the therapeutic efficacy of sustainable drainage and lumbar subarachnoid catheter drainage for cervical postoperative cerebrospinal fluid leakage.
METHODS:923 patients underwent cervical spine surgery in the Department of Spinal Surgery, the First Affiliated Hospital of Xinjiang Medical University, China from June 2009 to October 2012. There were 24 cases of postoperative cerebrospinal fluid leakage with an incidence of cerebrospinal fluid leakage of 2.6%(24/923). The dural laceration that could not be repaired or be found induced cerebrospinal fluid leakage. Of them, 12 cases received lumbar subarachnoid catheter drainage (catheter group), and 12 cases received sustainable drainage (drainage group).
RESULTS AND CONCLUSION:Compared with the drainage group, the duration of cerebrospinal fluid leakage was significantly shorter in the catheter group (P<0.05). In the catheter group, one case affected cerebrospinal fluid infection. In the drainage group, two cases experienced cerebrospinal fluid cyst and one case suffered from cerebrospinal fluid infection. They were cured by symptomatic treatment. A total of 24 cases were fol owed up for 9-12 months. None of them affected cerebrospinal fluid leakage, cerebrospinal fluid infection or cerebrospinal fluid cyst. Results demonstrated that lumbar subarachnoid catheter drainage in the treatment of cervical postoperative cerebrospinal fluid leakage has a good effect.

BACKGROUND:Open reduction is general y not advocated for the treatment of children clavicle fracture, because the thick and tough periosteum remains intact and attached by the ligament attachment. In clinic, twin-ring external fixation and simple suspension are commonly used, but there is no reliable basis on which method can get better effect.
OBJECTIVE:To compare the stability of twin-ring external fixation and simple suspension for the treatment of children clavicle fracture.
METHODS:The patients with children clavicle fracture and treated by twin-ring external fixation and simple suspension were selected from June 2008 to December 2012, including 17 patients treated with simple suspension and 22 patients treated with twin-ring external fixation. The X-ray film examination was performed regularly to observe the fracture healing and shoulder function.
RESULTS AND CONCLUSION:The 17 patients treated with simple suspension had good healing;three cases had gap between fracture ends at 1 week after treatment, and re-suspension to increase the height and final y two fracture ends contacted in one case;for the other two cases, there was stil gap between fracture ends, and changed for twin-ring external fixation, the fracture ends contacted. Al the 22 patients in the twin-ring external fixation group obtained healing;five cases had performance of upper extremity neurovascular compression on the fracture side after fixation;after releasing, three cases had recovery, and two cases were treated with simple suspension, the fracture ends began to contact;six cases had armpit redness;four cases had early sleep difficulties;two cases had gap between fracture ends at 1 week after treatment, and after re-adjust, the fracture ends contacted in two cases. The results showed both two methods could not cause appearance deformity, and both could get healing. The simple suspension fixation is easy to operate with reliable effect, and it is comfortable which make it easy to accept by the children, it has the advantages of early for functional exercise, less tissue damage, does not affect the blood supply;the twin-ring external fixation is easy to compress the axil ary arteries and nerves on both sides, thus resulting in upper extremity swel ing, numbness and skin redness, and it can cause discomfort night sleeping and poor comfort which is not easy for children to accept. But, no matter what method we take, the review after 1 week, as wel as the line between proximal and distal part and the contact between fracture ends is stil important.