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 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 measure the vertebral rotational centers in sagittal and transverse plane. These data may be quite valuable for the design of artificial disc. Methods Ten healthy volunteers of 40-60 years old were recruited under IRB approval and informed consent. Three-dimension lumbar spine models of L_2, L_3 and L_4 were reconstructed from MR scans. Spine motions were then reproduced using combined dual fluoroscopic imaging system (DFIS) and MR scan technique during flexion-extension and left-right twisting of the body. Based on the geometrical features of the vertebrae, ranges of motion (ROM) of 3 representative lo-cations were measured from anterior to posterior, the vertebral body center, the spinal cord canal center and the spinous process tip. Rotational centers of the vertebral segments were then located by calculating the point of zero ROM. Results Motion patterns: The ROMs of L_2 with respect to L_3 (L_(2,3)) and L_(3,4) increased pro-portionally from anterior to posterior locations. During flexion-extension motion, the vertebral body center moved within a range of 0.6 mm, while the spinous process tip moved within 7.5 mm in the sagittal plane. During left-right twisting, the vertebral body center moved within 1.0 mm, while the tip moved within 1.6 mm in the transverse plane. No statistical differences were found in the ROMs between L_(2,3) and L_(3,4). Rotational centers: the rotational centers of flexion-extension in sagittal plane for both L_(2,3) and L_(3,4) segments were located at posterior one-third of the vertebral body. The rotational centers of both L_(2,3) and L_(3,4) segments were located approximately 30 mm anterior to the front edge of the vertebral body. Conclusion The anterior portion of the vertebrae was found to have smaller ROM than the posterior portion. The vertebra rotates with the center of rotation located at approximately the posterior one-third of the vertebral body in sagittal plane. However, the vertebra rotates in transverse plane with respect to a point about 30 mm in front of the vertebra. The data indicated that the different portions of the vertebra have distinct motion characters during different motions.

AIM: Anterior cervical discectomy and Cage bone graft fusion followed by steel plate internal fixation can decompress the vertebral canal and then spinal cord in patients with multilevel cervical spondylotic myelopathy. Complete decompression is very important for such patients. This study is to investigate the effect of this technique on reconstruction of spinal function.METHODS:①Thirty-eight inpatients with multilevel cervical spondylotic myelopathy admitted to Department of Spine Surgery, Tianjin Hospital between April 2003 and February 2006 were involved in this study. The involved patients, 35 male and 3 female, were aged 43-72 years, with disease course of 0.5 to 5 years. Informed consents of therapeutic regimen were obtained from all the patients.②All the patients underwent anterior cervical discectomy and cage placement operation. The patients with destabilized combination underwent titanium-plate fixation, and those with stabilized combination underwent cage implantation alone. The cage used in the experiment was made of tetragonal polyether ether ketone (Intromed Company), and titatium-plate was Zephir plate (sofarmor Danek Company). The elastic modulus of tetragonal polyether ether ketone Cage was similar to bone tissue and could allow X-ray pass through, which was easy for postoperative fusion of implanted bone. The outer design of Cage bone graft with certain angle could allow cervical physiological antecurvature well recover; Surface radian was the same as end plate, and good fitness contributed to the good fusion rate of bone graft; The sawtooth antiskid design on the surface provided good stability immediately after implantation; Elastic modulus was between os integumentale and cancellous bone that made stress-shielding and subsidence of fusion cage reduced, and had good anticausticity and biocompatibility. ③ The clinical results were evaluated with Japanese Orthopaedic. Association (JOA) scoring system before, 2,8 and 24 weeks after operation: upper limb motor function (4 points), lower limb motor function (4 points), sensation (6 points) and bladder function (3 points). Higher scores indicated better function. Postoperatively, body examination and X-ray and MRI scanning of anteroposterior cervical vertebra were performed.RESULTS: Thirty-eight patients with multilevel cervical spondylotic myelopathy participated in the final analysis. Within postoperative several days, nervous symptoms improved obviously, muscle strength of lower limb was increased, limbs were more flexible after operation than before operation, and paresthesia of two upper limbs recovered in 38 patients. JOA was a score of (9.25±1.85) before operation, and it was (12.4±2.08) at postoperative 2 weeks, (13.2±2.07) at postoperative 8 weeks and (13.8±1.67) at postoperative 24 weeks.CONCLUSION: Multilevel discectomy and Cage implantation obviously improve sensorimotor function and lessen symptoms of patients with multilevel cervical spondylotic myelopathy.

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 influence of stereoscopic vision on the development of posterior capsule opacification (PCO) after intraocular lens implantation. The efficacy of Nd: YAG laser was studied. Design Case-controlled study. Participants 57 consecutive patients with POC(59 eyes with phacoemulsification and IOL implantation). Methods A prospective observational study was conducted comprising 57 patients (59 eyes) who had postoperative PCO. Neodymium: YAG (Nd: YAG) laser posterior capsulatomy was performed on all patients following a standardizes procedure. Preoperative and postoperative evaluation included LogMAR visual acuity, best-corrected visual acuity (BCVA), contrast sensitivity and stereoscopic vision. Main Outcome Measures LogMAR visual acuity, BCVA, contrast sensitivity and stereoscopic vision. Results The average LogMAR eyesight median of sick eye before laser treatment was (0.22?0.31) and the contrast sensitive degree of each frequency area was relatively lower than the opposite eye; After the treatment, there was evident improvement of the sick eye, and the LogMAR eyesight median of that was 0.00; The ratio of reaching the central spatial eyesight and the average sharpness degree both improve much than ahead of treatment. Those whose spatial eyesight sharpness don't get normal after the low best remedy eyesight. Irregular dipodic and previous eye disease. Conclusions LogMAR visual acuity, BCVA, contrast sensitivity and stereoscopic vision were damaged markedly with PCO. Our results indicate that Nd: YAG capsulotomy may affect the reconstruction of stereoscopic vision. Nd:YAG laser posterior capsulotomy is a valuable and clinically relevant method for clinical treatment of PCO.

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.