Many reasons cause low back pain, such as muscles and ligaments injury, vertebral joints retrogression, spinal canal stenosis, lumbar disc herniation, lumbar spondylolisthesis, spondyloarthritis, infection, tumor and metabolic bone disease. It is in recent years that discogenic low back pain be recognised, especially after the MRI widely applied in clinics. This article makes a summary on discogenic low back pain of recent years from etiology, pathogenesis, diagnosis and therapy.

There is a lot of drug to cure the osteoporosis.The drug effect feature is different,and clinicle choice and application is complicated,too.This paper will review the advancement of drugs and their mechanism for treating osteoporosis,including calcium and vitamin-D,estrogen,selective estrogen receptor modulators,caicitonin,bisphosphonates,parathormone and fluoride etc.

Extremely severe pancytopenia induced by low dosage of azathioprine in systemic lupus erythematosus patients is rare. A 40-year-old Chinese female was diagnosed with systemic lupus erythematosus. She suffered worse erythema, oral ulceration, raised erythrocyte sedimentation rate and high anti-dsDNA in August 2013. Then she was initiated on oral azathioprine 50mg/d and extremely severe pancytopenia was seen in September 2013. She was recovered by a series of treatments. Regular monitoring of blood counts is highly recommended to reduce the possible serious myelosuppression induced by azathioprine.

Objective To evaluate the visual function before and after photodynamic therapy(PDT) in patients with subfoveal choroidal neovascularization (CNV) caused by age-related macular degeneration (AMD). Methods Twenty-five consecutive patients (34 eyes) treated with PDT (verteporfin) for subfoveal CNV in age-related macular degeneration diagnosed by fluorescein angiography (FFA), indocyanine green angiography (ICGA) and optical coherence tomography (OCT). Visual function including best corrected visual acuity, contrast sensitivity frequency, binocular function, confusion, stereo-vision, color vision, metamorphopsis and central scotoma were examed before photodynamic therapy and 1 week, 1 month, 3 month after photodynamic therapy. The follow-up time varied from 3 months to 2 years (mean 7.6 months). Results The changes of visual function at the 3rd month after photodynamic therapy revealed improving in 13 eyes (38.24%), without any change in 17 eyes (50.00%), and decreasing in 6 eyes (17.65%). Visual acuity with logMRA improved after photodynamic therapy, but without statistic difference. All spatial contrast sensitivity improved. Contrast sensitivity for spatial frequencies 5 cycles per degree (cpd) was better after photodynamic therapy with significant difference (P=0.045).Binocular function, fusion function, stereo function and color vision were slightly improved without statistic difference. Conclusion Damage of visual function in macular degeneration is many-sided. The treatment of PDT for exudative AMD can improve part visual function.

BACKGROUND:For the elderly osteoporotic thoracolumbar burst fractures without nerve root symptoms,it is difficult to choose between traditional surgical and conservative treatment,because they have their advantages and disadvantages.How to select their advantages and to discard their disadvantages? Concept of minimal invasion builds a new platform and provides a new way of thinking and therapeutic tool.OBJECTIVE:To design and develop a new thoracolumbar distraction reduction devicein vitro in the repair of elderly osteoporotic burst fractures.METHODS:We designed and developed a new type of thoracic and lumbar spinein vitrodistraction reduction device,including bracket,guide pin and two holow screws.Its characteristic is that it also contained distractor,pressurizer and wrench.In accordance with the theory of muscles as important as bones and actual anatomical condition,bone fragment in the spine canal was restored using percutaneous ligament reconstructive technique.RESULTS AND CONCLUSION:This thoracic and lumbar spinein vitro distraction reduction device combined with ligament reconstructive technique can be used in elderly osteoporotic burst fractures and elderly osteoporotic compression fractures.It is percutaneous minimaly invasive operation,can restore the height of anterior and central cylinders and correct Cobb's angle through multi angle distraction.Simultaneously,percutaneousvertebroplasty can be utilized.Bone cement was infused in the injured vertebra.According to patients' economic situation,percutaneous baloon kyphoplasty can be employed.These can provide an inexpensive,less-pain,less-invasive way to repair.

2% hydroxypropyl methyl cellulose (HPMC, medical grade, Taian Ruitai Cellulose Co., Ltd.) was added into calcium phosphate cement (Orthopedics Institute of General Hospital of Chinese PLA) and the mixture was put into distilled water to observe whether the surface was corrupt. Some calcium phosphate cement was immersed in water at different time and the residual cement was weighed 24 hours later. The results showed that there was no surface corruption in calcium phosphate cement with 2% HPMC after shake; the residual weight measured 24 hours later showed that 2% HPMC could shorten calcium phosphate cement cohesion time from 4 minutes to 1 minutes. The experiment indicates that 2% HPMC can significantly increase the waterproof performance of calcium phosphate cement, increase the work time and is adaptable in clinical application.

Objective To explore the management alternatives to tr aumatic periprosthetic femoral fractures after hip replacement. Metho ds A retrospective analysis was done on five cases of traumatic perip rosthetic femoral fractures posterior to hip replacement admitted in from June 1 998 to June 2003. There were two males and three females, with age range of 52- 71 years (average 59 years). One case suffered from traffic accident and the oth er four from slipping. Three cases had received hip replacement for femoral head aseptic necrosis, the other two for femoral neck non-union. Total hip replacem ent was carried out in four cases (five hips) and femoral head replacement in on e. These traumatic periprosthetic fractures occurred from one month to 17 years after hip replacement. According to classification to periprosthetic fracture of Vancouver (1995), there were 3 cases of type B and 2 type C. Two cases (one cas e of type B and one type C) were treated with traction and conservative treatmen ts, two (type B) with long shaft prosthesis revision combined with shape memory saw tooth embracing fixator or wires and one (type C) with anatomical plate inte rnal fixation. Results All 5 cases were followed up for f rom two months to five years and attained fracture union with no complications s uch as infection, nonunion or fixation breakage. Conclusions Traumatic periprosthetic femoral fractures after hip replacement are hard to deal with. The management alternatives differ according to fracture site, prost hesis loosening, bone quality and general status of patients. Classification cri teria and corresponding managements of periprosthetic fractures of Vancouver are proved to be suitable guidelines.

Objective To analyze the results and indications of anterior, posterior or combined surgery for thoracolumbar burst fractures. Methods A retrospective review of surgically managed thoracolumbar burst fractures from 1998 to 2003 was performed. There were 76 males and 13 females, and the age of the patients were from 17 to 51 years with an average of 36.8 years. The fractures were located at T11 in 10, T12 in 21, L1 in 29, L2 in 18 and L3 in 11. According to Magerl classification, type A fractures were 68, and type C were 21. Of the 89 patients, 41 received posterior surgeries, 40 anterior surgeries, and 8 combined anterior and posterior surgeries. Operative notes, preoperative and postoperative neurological status, radiographs, CT scans, and follow-up records were reviewed. Results All of the 89 cases had successful surgery. Seventy-eight patients were followed-up for 6 to 48 months (average 12 months). Neurological status improved at least 1 ASIA grade in all of the 65 patients who had preoperative incomplete paraplegia. In the posterior surgeries, pedicle screws broken in 2 cases, deep infection in 1 case which was cured after debridement. The correction of anterior vertebral body height and Cobb's angle averaged 9.4 mm and 14.8? postoperatively, and the correction loss averaged 0.5 mm and 7.5? respectively at 6 months after surgery. And the correction loss was most evident at the above disc spaces, then the below disc spaces. In the anterior surgeries, leakage of cerebrospinal fluid in 2 cases which cured with dressing change, the other cured after debridement, implant removal and posterior fixation. The spinal canal was enlarged, and the spine recovered normal curvature. No evident correction loss, pseudoarthrosis or implant failure was noted at follow-up. Conclusion The choice of anterior, posterior or combined surgery for thoracolumbar burst fractures depends on neurological status and column stability. The vertebral compression, canal encroachment, posterior column stability and concomitant displacement should be considered in the choice of appreciate surgical approach.

Objective To analyze the reasons and mechanisms of stereoscopic function abnormality in elder patients after the cataract extraction with intraocular lens implantation. Methods 150 cases with artificial lens implantation were randomly selected.Routine eye examinations were carried out and the associated refractive error and presbyopia were corrected.Bilateral simultaneous visual perception and fusion function were examined.The stereoscopic function was tested using "the stereoscopic function examination diagram"created by Yan Shao-ming.Ninety-seven patients who were found to have unrecover-ed or abnormal stereoscopic function were enrolled for analysis. Results In these 97 cases,53(54.6%)were found to have preexisting eye disorders that could affect visual acuity and binocular single vision before the operation.Macular problem was the most prevalent problem in this group.Twenty-seven(27.8%)patients had complicated with corneal astigmatism,after cataract,paralysing strabismus and diplopia as well as macular edema after the operation.In addition,the contralateral unoperated cataract in 17(17.5%)patients and post-operative anisometropia in 9(9.3%)patients were also the causes of stereoscopic function abnormality.There was no reason could be identified in 8 cases. Conclusions The pre-existing eye disorders before lenses implantation,complications of the operation,contralateral unoperated cataract and anisometropia are all the major factors that affect visual acuity recovery and bilateral stereoscopic function rehabilitation.

Objective To analyze the results of one-stage combined anteroposterior surgery in lateral position for serious thoracolumbar fracture dislocation. Methods A retrospective review was performed for surgically treated thoracolumbar fractures from October 1998 to September 2005. Of all the 192 patients, the 34 serious cases were treated with one-stage combined anteroposterior surgery. There were 25 males and 9 females, 34.2 years old on the average (ranging from 18 to 56 years). Segments involved: T11 in 2 cases, T12 in 5 cases, L1 in 11 cases, L2 in 8 cases, L3 in 5 cases, L4 in 2 cases and L4,5 in 1 case. According to the Classification of Magerl, there were 12 cases of type A3, 2 cases of B1, 2 cases of B2, 12 cases of C1, 4 cases of C2 and 2 cases of C3. During the operation the patients were in lateral position. Laminectomy and pedical screw insertion were performed posteriorly first; anterior corpectomy, reduction and strut graft were accomplished through an additional anterior approach. The final fixation was finished by clapping the strut graft with pedical screw system. Operative notes, preoperative and postoperative neurological status, ASIA scales, radiographs, CT scans, and follow-up records were reviewed. Results All these surgeries were performed successfully without any neurological deterioration. 32 of 34 patients were followed-up for 6 to 60 months (13 months on average). Neurological status improved at least 1 ASIA grade in 24 patients with preoperative incomplete paraplegia. 6 patients complained intercostals nerve injury symptom which alleviated with conservative treatment. During follow-up, lumbar physical lordosis was reconstructed and no evident correction loss, pseudoarthrosis or implant failure was noted. Conclusion One-stage combined anteroposterior surgery can be accomplished in a lateral position. It was proved to be an effective treatment for serious thoracolumbar fracture dislocation.