Percutaneous vertebroplasty (PVP) and percutaneous kyphoplasty (PKP) are safe and effective minimally invasive spinal techniques for the treatment of osteoporotic and pathological vertebral fractures, which are widely used in clinical practice. Cement leakage is the most common complication, which can lead to serious consequences such as adjacent vertebral refracture, pulmonary or cerebral embolism and paraplegia. Clinically, bone cement can penetrate into different sites along different paths, form different morphologies, and present different clinical symptoms. Therefore, an impeccable classification of bone cement leakage is beneficial to study its incidence, risk factors and prevention and treatment measures. So far, domestic and foreign scholars have proposed a variety of bone cement leakage classifications and elucidated its clinical significance despite certain limitations, but no uniform standard is established. Therefore, this review summarizes various classification and risk factors of cement leakage and evaluates their clinical implications, aiming at providing a reference for further clinical studies.

Objective To describe sagittal pelvic pattern,and to analyze sagittal spino-pelvic alignment in asymptomatic Chinese adults.Methods This was a prospective radiological analysis.Anteroposterior and lateral radiographs of the whole spine were taken in 139 Chinese volunteers,including 94 males and 45 females,aged from 21 to 28 years (average,23.5±1.5 years).By using picture archiving and communication systems,several pelvic and spinal parameters (pelvic incidence,pelvic tilt,sacral slope,lumbar lordosis,thoracic kyphosis,cervical lordosis,sagittal vertical axis,apex of total lumbar lordosis,total lumbar lordosis,upper arc of total lumbar lordosis,lower arc of total lumbar lordosis,junctional level,apex of total thoracic kyphosis,total thoracic kyphosis,total cervical lordosis,and lordosis tilt) were measured and the correlations of all parameters were analyzed.Results The mean value of pelvic incidence was 45.1°±9.6°,which was significantly less than those reported in western and Korean subjects.Total lumbar lordosis has a significant correlation with pelvic incidence,sacral slope,total thoracic kyphosis,cervical lordosis and sagittal vertical axis.The sagittal lumbar-pelvic alignment was classified into 4 types according to position of apex of total lumbar lordosis:type Ⅰ (11 cases),the apex was located in L5 or intervertebral space between L4 and L5; type Ⅱ (61 cases),the apex was located in bottom or middle of L4; type Ⅲ (33 cases),the apex was located in upper part of L4 or in intervertebral space between L3 and L4; type Ⅳ (34 cases),the apex was located at L3 level or more high level.Conclusions The sagittal pelvic pattern of Chinese adults is significantly different from those of western and Korean.Lumbar lordosis plays a critical role in regulating spinal sagittal balance.With upper shift of apex of total lumbar lordosis,the lower lumbar lordosis angle and sacral slope increase,but the lordosis tilt decreases.

Objective To study the characteristics of spinal fractures in ankylosing spondylitis(AS) in order to provide data in its diagnosis and treatment. Methods 19 cases of concomitant spinal fractures following AS, admitted in our hospital between January 1994 and October 2001, were studied retrospectively. Examination of AS, including A-P and lateral X-ray films of bilateral sacroiliac joint, HLA-B27, rheumatoid test and ESR were accomplished in all patients. MRI and CT scan were taken in 12 cases. 4 cases of thoracolumbar stress fracture treated surgically were conformed to pathological examination. 2 cases received preoperative puncture biopsy under CT guidance. In the group, there were 18 males and 1 female aging from 31 to 69 years with an average of 52.6 years. Results All of 19 cases were consistent with the diagnostic standards of AS. 17 of the patients prior to spinal fracture had a history of AS with duration of mean 20.6 years ranging from 8 to 37 years. All of 19 patients had round-backed deformity of different extent. Of 19 patients, 15 cases had a traumatic history. Falls while standing and walking were the cause of injury in 9 patients. The mechanism of injury appeared to be hyperextension in 7. 11 patients had the cervical fracture, and 8 had the thoracolumbar fracture. Of the patients with cervical fracture, 10 patients were due to shearing force, 9 of whom were located at C5-C7. In patients with thoracolumbar injury, stress fractures were seen in 7 patients, all of seven fractures occurred at T10-L2. Fracture through ankylosed disc was seen in 12 and vertebral body in 7. 16 of the 19 patients sustained fractures through three columns of the spine. 5 patients were associated with dislocation. 9 patients had spinal cord injury, 8 of whom were cervical fracture. The period from the injury to the diagnosis ranged from 10 hours to 7 months (mean 29.6 days). Conclusion Spinal fractures in AS can result from a mild trauma, and are associated with a high rate of neurological injury. Most frequent mechanism of the injury is hyperextension. Shearing fracture usually occurs at the lower cervical spine and stress fracture at thoracolumbar spine. Most of the fractures involve three columns of spine; and corresponding dislocation is common. The common fracture line is through the disc space. Delay in diagnosis is not rare.

Objective To explore the clinical features of thoracolumbar disc herniations and to improve the quality of the diagnostic procedure.Methods Clinical data of 65 patients with thoracolumbar disc herniations confirmed by X-ray examinations,CT,MRI,and operations from September 1995 to January 2004 were retrospectively reviewed.The 65 patients were divided into three groups: lower thoracic disc herniations(T_(10-11)~T_(12)L_1) in 43 patients,upper lumbar disc herniations(L_(1-2)~L_(2-3)) in 16 patients,and multiple levels of herniations in 6 patients.Results Paresthesia and lower extremity weakness were the most frequent symptoms,with their occurrence proportions being 89.2%(58/65) and 83.1%(54/65),respectively.Among the 65 patients,9.2%(6/65) showed the presentation of upper motoneuron involvement,47.7%(31/65) manifested symptoms of lower motoneuron impairment,and 43.1%(28/65) presented as mixed motoneuron disorders.Neurological deficits were usually extensive and the cauda equino syndrome was commonly seen,while isolated radicular impairment was noticed only in 3 patients.Back pain(44.6%,29/65) and lower extremity weakness(40.0%,26/65) were the most common initial complaints.Lower thoracic disc herniations were characterized by mixed motoneuron disorders at the occurrence proportion of 58.1%(25/43),with a tendency leading to ambulatory dysfunction,drop foot,increased lower extremity muscle tension,and positive pathologic reflexes.By contrast,most upper lumbar disc herniations were manifested as lower motoneuron disorders at the occurrence proportion of 93.8%(15/16),with back pain,lower extremity pain,and the cauda equino syndrome frequently encountered.Conclusions The clinical presentation of thoracolumbar disc herniations is complicated with the large-scale distribution and diversity of the symptoms and the complexity of clinical signs.We put forward four circumstances under which a high suspicion of thoracolumbar disc herniation was recommended: ①if there is a sensory disturbance at the anterior and lateral aspect of the thigh or at the groin area;②if there is a lower extremity weakness,especially in the quadriceps and the tibialis anterior muscle(drop foot);③if an extensive and irregular range of sensory and motion disturbances exists,with a lack of typical radicular distribution;or ④if there are mixed motoneuron disorders,or lower motoneuron disorders unexplained by lumbar disc herniations.

Objective:To examine the temperatment of children with vocal fold nodules.Method:To compare the temperatment dimension and temperatmental types of 42 children with vocal fold nodules with 46 vocally normal children, using Chinese children's Temperament Problem Screening system(CCTPSs).Result:The children with vocal fold nodules differed significantly from the comparasion group in their temperament dimension's adaptability,intensity of reaction, mood value, persistency and temperatmental types.Conclusion:There are more difficult and slow-to-warm-up children in patients with vocal fold nodules than vocally normal children.

In order to supply some reference about the construction of network course of physiology, we summed up the establishing experience from the course design, construction and application.

Objective To explore the relationship between thoracolumbar disc herniation (TLDH) and Scheuermann1's disease (SD),as well as the role of SD in the etiology of TLDH.Methods From June 2006 to June 2010,45 patients with TLDH (T10-11-L2-3) underwent surgery in our department.Forty-five patients with lower lumbar disc herniation (LDH,L3-4-L5S1) acted as controls.The incidence of SD and Scheuermann's signs of these patients were examined by reviewing CT,MRI and Ⅹ-ray films.The thoracolumbar kyphotic angles of the two groups were compared.Furthermore,in TLDH group,the incidence of disk herniation within segments with the Scheuermann's signs was compared to that within segments without Scheuermann's signs.Results All except one patient in TLDH group(97.8%) had been associated SD while the incidence of SD in LDH group was only 26.7%.The incidence of all Scheuennann's signs was higher in TLDH group than that in LDH group.The average thoracolumbar kyphotic angle of TLDH group was 15.8°±6.9° while that of LDH group was 4.8°±4.0°.In TLDH group,the incidence of disc herniation within segments with Scheuermann's signs was all higher than that within segments without Scheuermann's signs.Conclusion There is a close relationship between TLDH and SD,suggesting that TLDH is probably a manifestation of SD.Schmorl's node,irregular end plate,wedge-shaped vertebra and especially,posterior bony edge separation,are associated with disc herniation.

Objective:To explore the relationship between spino-pelvic sagittal and coronal parameters in Lenke 1 group of adolescent idiopathic scoliosis (AIS).Methods:The subjects were retrospectively col-lected from 2005 to 2013.On the posteroanterior and lateral radiographs, apical vertebra ( AV) , Cobb an-gle of main thoracic curve (MT), pelvic incidence (PI), C7 translation ratio (C7TR) and other sagittal parameters were measured and recorded.Comparison and correlation studies were conducted between these parameters using specific softwares.Results: In the study, 51 subjects, including 18 males and 33 fe-males, were recruited, aged (14.9 ±2.0) years averagely.The apical vertebra ranged from T7 to T11,with mean MT being 49.6闭±16.7闭, and mean PI 44.7°±6.7°.Significant correlation existed between PI and PT, SS, LL, as well as between LL and SS, TK ( P <0.05) .Significant differences were found in TK, LL and SS among the different LM groups, but no difference in the other sagittal parameters.AV had no significant correlation with any sagittal parameter.MT was significantly correlated with TK, LL and SS, but its correlation with PI was not significant.Conclusion:Most of sagittal parameters were significantly corre-lated in Lenke 1 adolescent idiopathic scoliosis, forming a regulation chain of spine-pelvic sagittal balance on the basis of PI.Significant correlation exists between some sagittal and coronal parameters.

Objective To investigate the effects of different magnitudes of mechanical stress on human interverte-bral disc degeneration. Methods The human intervertebral disc cells were subjected to different magnitudes of mechanical stress (0, 6%, 12%, or 18%elongation) for 24 h using a Flexercell Strain Unit. The mRNA expressions of anabolic genes (col-lagen-1A1, collagen-2A1, aggrecan and versican) and catabolic genes (MMP-3, MMP-13, ADAMTS-4 and ADAMTS-5) were examined by real-time PCR and Western blot methods. Results The expression levels of collagen-1A1 and collagen-2A1 were increased at 12%of mechanical stress, and collagen-2A1 was decreased at 18%of mechanical stress compared with those of control. The mRNA expressions of catabolic genes, MMP-13 and ADAMTS-5, were increased at 12%and 18%of mechanical stress than those of control. The mechanical stretch induced a magnitude-dependent increase in ADAMTS-4 synthesis, which was finely tuned by stretching-triggered activation of distinct mitogen-activated protein kinase cascades. Specifically, an ERK1/2 specific inhibitor, U0126, significantly inhibited the stretching-induced ADAMTS-4 expression, whereas the inhibitors of p38 and JNK, SP6000125 and SB203580, showed only slightly effect on the stretching-induced ADAMTS-4 expression. Conclusion The different magnitudes of mechanical stretch exhibited different effects on the bio-logical behavior of intervertebral disc cells, which profoundly affects the intervertebral disc degeneration.

Objective To investigate the clinical efficacy of acupuncture at affected-limb gallbladder meridian points and its effect on the recovery of lower limb function in treating hemiplegia patients with cerebral infarction. Methods Sixty hemiplegia patients with cerebral infarction were randomly allocated to treatment and control groups, 30 cases each. The treatment group received acupuncture at the gallbladder meridian points of the affected-side lower limb as main therapy and the control group, conventional acupuncture. After two courses of treatment, a pre-/post-treatment change in the Lower Extremity Fugl-Meyer Assessment score was observed in the two groups and post-treatment walking paces, pace lengths and incidences of strephenopodia were compared between the two groups.Results There was a statistically significant pre-/post-treatment difference in the Lower Extremity Fugl-Meyer Assessment score in the two groups (P<0.01). There was a statistically significant post-treatment difference in the Lower Extremity Fugl-Meyer Assessment score between the treatment and control groups (P<0.05). There were statistically significant post-treatment differences in walking pace, pace length and the incidence of strephenopodia between the treatment and control groups (P<0.05).Conclusion Acupuncture at affected-limb gallbladder meridian points can improve lower limb function and reduce the incidence of strephenopodia in hemiplegia patients with cerebral infarction.