Objective:To evaluate the clinical efficacy of posterior transpedicular screw system internal fixation and anterior radical focus debridement with interbody autografting in the treatment of low lumbar and sacrum spinal tuberculosis with kyphosis deformity.Methods:There were 17 cases of low lumbar and sacrum spinal tuberculosis with kyphosis deformity in this series,including 1 case of L3,4 cases of L4,3 cases of L5,3 cases of L3~4,4 cases of L4~5 and 2 cases of L5S1.The mean age was 37 years.All cases received posterior transpedicular screw system internal fixation,anterior radical focus debridement and autografting with iliac bone.Bed rest was for 8 weeks after surgery and no brace was needed.Anti-tuberculosis treatment lasted 12~18 months.Results:The mean period follow-up was 23 months.All patients achieved satisfactory results,and showed successful interboby fusion within 3~6 months.The kyphosis deformity was corrected and the normal low lumbar and sacrum lordosis were maintained without associated complication.All patients had no focus recurrence of tuberculosis.There were no internal implant complications.Conclusion:It is a safe and effective method to treat low lumbar and sacrum spinal tuberculosis with kyphosis deformity by posterior transpedicular screw system internal fixation and anterior radical focus debridement with iliac bone grafting.

Objective:To evaluate the clinical efficacy of radical debridement and spinal fusion with internal fixation and to discuss the safety of anterior instrumentation in surgical management in thoracolumbar spinal tuberculosis.Methods:There were 16 cases in this series.The mean age was 45 years.16 cases of thoracolumbar spinal tuberculosis were radical focus debrided and grafted with iliac bone.8 cases were fixed with TSRH,3 cases with Ventrofix and 5 cases with Z-plate.No brace was needed after surgery.Results:The period of follow-up lasted 19 months.All patients had good results.The incision of all cases were cured for the first term.No case had sinus.13 degree of the kyphosis deformity was improved without associated complication.All patients had no recurrence of tuberculosis.Conclusion:The results show that the radical focal debridement and anterior bone transplantation with internal fixation can reconstruct the spinal stability and it is safe to implant anterior instrumentation in tuberculosis foci.

Objective:To discuss the surgical management of spondylodiscitis after the lumbar discectomy.Methods:7 cases of spondylodiscitis after the lumbar discectomy were analysed retrospectively.All patients were treated with surgical management of posterior approach combined with antibiotics.Results:In 7 patients,4 were males and 3 females.The mean age was 45 years old.The spinal segment involved included L 4/5 in three and L 5S 1 in four cases.The history, clinical courses,ESR and MRI are very useful in the diagnosis of postoperative spondylodiscitis.3 cases presented positive in the bacterial culture and 4 cases negative.After the surgery of the posterior focal debridement and bone plantation with internal fixation, the symptoms were relieved in a short period of time.The roentgenographic followe-up showed the spinal fusion 2.5～3.5 months after surgery.Conclusion:The surgical management of the posterior approach has more advantages over the anterior approach.It is one of the most effective methods for treatment of the spondylodiscitis after lumbar discectomy.

Objective:To evaluate the clinical efficacy of radical debridement and spinal fusion with internal fixation in surgical management of cervical spinal tuberculosis with kyphosis deformity.Methods:There were 14 cases in this series.The mean age was 32 years.14 cases of cervical spinal tuberculosis were radical focus debrided and grafted with iliac bone.5 cases were fixed with Orion,4 cases with Zephir,4 cases with Codman and 1 case with Apofix.The brace was needed for 3 months after surgery.Results:The period of follow-up lasted 21 months.All patients achieved satisfactory results,and showed successful interboby fusion within 3～6 months.The kyphosis deformity were corrected and the normal cervical lordoisis were maintained without associated complication.The neural symptoms were improved.All patients had no recurrence of tuberculosis.There were no plates and screws complications.Conclusion:It is safe and effective to treat cervical spinal tuberculosis by anterior radical debridement with primary autograft and internal fixation,and it is a good treatment option with high correction rate in local kyphosis deformity,high fusion,and low complication rate.

BACKGROUND:The main method to treat cervical spinal stenotic myelopathy caused by various factors is posterior lamninectomy, but the postoperative effect was not satisfactory.OBJECTIVE: To observe the postoperative functional reconstruction of the cervical vertebra of the patients with cervical spinal stenotic myelopathy through expansive open-door laminoplasty.DESIGN: An observational study by comparing the changes before and after the operation.SETTING: Department of Orthopaedics of the First Affiliated Hospital of Chongqing Medical University.PARTICIPANTS: Totally 32 patients (22 male and 10 female) with multi-segment cervical spinal stenotic myelopathy were treated at the Department of Orthopaedics of the First Affiliated Hospital of Chongqing Medical University from May 1995 to May 2004. Twelve cases suffered from degenerative spinal canal stenosis caused by spinal cord type of cervical spondylosis, 18 cases suffered from developmental spinal canal stenosis and 2from ossification of cervical posterior longitudinal ligament (OPLL).METHODS: Altogether 32 cases were treated through expansive opendoor laminoplasty to the cervical spine. These patients had been followed up for 6 months after the informed consent was obtained. The spinal function was evaluated according to Japanese Orthopaedic Association 17scores before operation, 2 weeks and 3 months after the operation respectively. The radian of the cervical vertebra, the stability of the spinal column and the complications were observed with X-ray.bility of the spinal column and the complications after the operation.RESULTS: According to intention-to-treat analysis, all the 32 patients entients before and after the operation: According to the evaluation standard stipulated by Japanese Orthopaedic Association (JOA), two weeks and three months after the operation, the scoring of the spinal function was significantly higher in 12 cases of cervical spondylosis myelopathy-induced degenerative stenosis, 18 cases of developmental spinal stenosis and 2 cases of ossification of cervical posterior longitudinal ligament (OPLL)( The score was 5.2, 5.7, 5.5 points respectively before the operation; 9.2, 9.7 , 9.4points respectively 2 weeks after the operation; and 11.3 , 11.8 , 11.6dian of the cervical vertebra, the stability of spinal column, and the complications after the operation: Radiographs indicated vanished cervical anteflexion curvature and straightened cervical vertebrae in three cases, but no re-closure or unstable spine happened.CONCLUSION: Expansive open-door laminoplasty for cervical spinal canal stenosis caused by various factors can still improve and increase the spinal functional evaluation scores shortly and 3 months after the operation, and it does not affect the stability of the cervical vertebrae.

Objective To evaluate the clinical efficacy and surgical method in radical debridement and spinal fusion with internal fixation in surgical management of cervical vertebra tuberculosis.Methods Twenty-one patients of cervical vertebra tuberculosis were included,mean age of 31 years,including 2 cases at C_(1-2),3 at C_(2-3),9 at C_(4-5),3 at C_(5-6),3 at C_(6-7),1 at C_7T_1.After all patients underwent radical debridement of focuses,15 cases were grafted with iliac bone and 6 with titanium mesh,19 cases were fixed with plate,1 case with Apofix,1 case with Occipital-cervical fusion.The external fixation was needed for 3 months after surgery.Results The follow-up lasted for 21 months.One case grafted with titanium mesh failed,but other patients achieved satisfactory results of successful interbody fusion within 3 to 6 months.The kyphosis deformity was corrected to normal condition without associated complications.The neural symptoms were improved.All patients had no recurrence of tuberculosis.There were no plates and screws broken.Conclusion It is safe and effective to treat cervical vertebra tuberculosis by anterior radical debridement and primary autograft by internal fixation,with high correction rate of local kyphosis deformity,high fusion,and low complication rate.

Objective To develop and validate a novel method of atlantoaxial pedicle screw placement by using three-dimensional reconstruction software Mimics and rapid prototyping. Methods Three-dimensional reconstruction of 20 CT scanned cadaver atlantoaxial specimens was performed by using Mimics and the parameters of the pedicles were measured. Then, physical model of the pedicles was manufactured by using rapid prototyping and the parameters of the cadaver pedicles were measured. The parameters of the atlantoaxial pedicle were directly measured. All the data were analyzed statistically to verify the accuracy of the reconstructed images and physical models. The optimal pedicle channel was found to design individual fixation parameters, based on which fixation of cadaver specimens was performed under direct guidance of physical model. The accuracy of fixation was assessed by CT scanning. Results There was no statistical difference in parameters of the reconstructed images, the physical model and the specimens, which could reflect accurate atlantoaxial anatomy. Postoperative CT scanning showed that the pedicle screws were inserted successfully in 16 sides of four specimens, except for one screw wearing medial bone cortex of the atlas artery. Conclusions Three-dimensional reconstruction of the atlantoaxial specimens by using Mimics and physical models made by rapid prototyping technology facilitate atlantoaxial pedicle screw placement and can enhance the accuracy of screw fixation.

Objective To study the clinical effects of the artificial vertebral body of the biomimetic nano-hydroxyapatite/polyamide 66 (n-HA/PA66) composite for the structural reconstruction and the height restoring of the vertebral body in the thoracolumbar fractures by the anterior surgical procedures. Methods From December 2003 to January 2006, 42 patients with thoracolumbar fractures received the anterior surgical procedures to decompress and reconstruct the spinal vertebral structure with the artificial vertebral body of the n-HA/PA66 composite. Among the patients, there were 28 males and 14 females, aged 17-67 years, averaged 43.6 years. The thoracolumbar fractures developed at T12 in 5 patients, at L1 in 17, at L2 in 14, and at L3 in 6. The height of the anterior border of the vertebral body amounted to 29%-47% of the vertebral body height, averaged 40.6%. The Cobb angle on the sagittal plane was 21-38° averaged 27.6°. According to the Frankel grading scale, the injuries to the nerves were as the following: Grade A in 7 patients, Grade B in 19, Grade C in 8, Grade D in 6, and Grade E in 2. Results All the 42 patients were followed up for 6-25 months. Among the patients, 36 were reconstructed almost based on the normal anatomic structure, and 6 were well reconstructed. The mean height of the anterior border of the vertebral body was 40.6% of the vertebral body height before operation but 91.7% after operation. And the reconstructed height of the vertebra was maintained. The mean Cobb angle on the sagittal plane was 27.6°before operation but 13.4° after operation. All the patients had a recovery of the neurological function that had a 1-grade or 2-grade improvement except 7 patients who were still in Grade A and 2 patients who were in Grade D. The implant was fused 3-5 months after operation. No infection, nail break, bar/plate break or loosening of the internal fixation occurred. Conclusion The artificial vertebral body of the biomimetic n-HA/PA66composite can effectively restore the height and the structure of the vertebra, can be fused with the vertebral body to reconstruct the spinal structural stability effectively, and can be extensively used in the clinical practice.

For better adaptation to clinical work and scientific research as well as self-development,medical postgraduates are required to improve their reading ability to harvest information from medical English articles.Constructing formal schema based on linguistic schema and enriching content schema can significantly enhance medical English reading ability,according to schema theory and education practice.Therefore,the learning mode was explored based on schema theory and this theory was applied in practice to elevate reading ability by means of reading report.

Objective To evaluate the application and efficacy of direct anterior fixation of odontoid fractures with hollow screw.Methods From March 2001 to January 2006,13 patients with odontoid fractures were treated by direct anterior fixation with hollow screw.Results Of the 13 patients,except 2 patients with postoperative temporary dysphagia, 11 had excellent results.The follow-up was ranged from 9 to 18 months,with an average of 12.5 months.The odontoid fractures acquired fusion,and no unstability or pseudoarthritis was found. Conclusion The technique of direct anterior fixation with hollow screw is an efficacious means in the treatment of odontoid fractures.The meticulous surgical technique along with appropriate patients selection will be the key to successful surgery.