OBJECTIVETo investigate the outcome of radical debridement, reconstruction with bone autograft or allograft and plate internal fixation via the anterior approach for the treatment of cervicothoracic tuberculosis.

METHODSFrom Jun. 2000 to Dec. 2010, 20 patients with cervicothoracic tuberculosis were treated by debridement and bone grafting with internal fixation via the anterior approach. They included 17 males and 3 females who ranged in age from 25 to 46 years (mean 38 years). The course of disease ranged from 3 months to 2 years (mean 12 months). The onset of the disease was chronic in all patients, with main complaints of persistent pain, and cervical stiffness and deformity accompanied with low fever,night sweating and pathologic leanness. Preoperative X-ray, CT or MRI showed that the pathologic change occurred in C7-T1 segment in 10 cases, T1 segment in 6 cases, T1-T3 segment in 3 cases,and T2-T3 segment in 1 case. The Cobb angle ranged from 25 degrees to 60 degrees (mean 35 degrees) before surgery. The Frankel classification was as follows: 2 cases at grade A, 4 cases at grade B, 7 cases at grade C, 2 cases at grade D, and 5 cases at grade E. All the patients underwent a standard cervical approach by combined partial median steotomy and transverse steotomy through the synostosis between the manubrium and body of the sternum to expose the lesion adequately. Radical debridement was performed, and then a tricortical iliac crest bone autograft or allograft was placed and secured by internal fixation to reconstruct the spinal column. The change in Cobb angle and fusion of bone grafting were reexamined by X-ray regularly. The clinical symptoms and neurological function were evaluated according to NDI (neck disability index) score and Frankel classification.

RESULTSThere was no injury to blood vessels, spinal cord or recurrent nerve during surgery. All patients were followed-up from 16 to 39 (mean 25) months. The tuberculosis symptoms disappeared after surgery and there was no tuberculosis recurrence,incision infection, sinus formation and internal fixation failure in any of these patients. ESR re-examination recovered normally. Bony fusion was obtained in all patients and internal fixation position was normal at 3 to 6 month postoperatively. The Cobb angle ranged from 10 degrees to 16 degrees (mean 12 degrees) and NDI was reduced from (48.2 +/- 2.9) to (22.5 +/- 3.1) at the final followed-up. Except for 2 patients at grade A showing no recovery preoperatively, the Frankel classification of the other patients raised 1.5 grade on average at the final followed-up, and the nerve function of the spinal cord recovered at different degrees: 2 at grade A, 1 at grade B, 1 at grade C, 3 at grade D, and 13 at grade E.

CONCLUSIONThe anterior approach can provide direct and safe access to the lesion. The decompression effect of the vertebral canal is significant. The structural iliac crest autograft or allograft and anterior instrumentation could work effectively to stabilize the cervicothoracic junction.

Adult ; Bone Transplantation ; Cervical Vertebrae ; surgery ; Debridement ; methods ; Female ; Fracture Fixation, Internal ; methods ; Humans ; Male ; Middle Aged ; Thoracic Vertebrae ; surgery ; Tuberculosis, Spinal ; surgery

OBJECTIVETo investigate the outcome of the children with thoracic spine tuberculosis who underwent radical debridement, reconstruction with bone autograft or allograft and internal fixation via posterior approach.

METHODSFrom June 2005 to December 2010,9 children with thoracic spine tuberculosis underwent radical debridement, reconstruction with bone autograft or allograft and internal fixation via posterior approach including 7 males and 2 females with an average age of 7 years old ranging from 3 to 12 years. The course of the disease ranged from 3 months to 1 year (averaged 6 months). All the patients had continuous thoracic and back pain,intercostal nerve pain and kyphosis deformity, accompanied with low fever,night sweat and pathologic leanness. The predilection sites examined by X-ray, CT or MRI were in T4 to T9 segment. The kyphosis angle ranged from 35 degrees to 72 degrees (averaged 48.2 degrees) before surgery. The ASIA classification was as follows: 2 cases at grade B, 5 at grade C, 2 at grade D. All the patients underwent a standard one-stage operation via posterior approach. Radical debridement was performed, then iliac crest bone autograft or allograft was placed and transpedicular screw system internal fixation was done to reconstruct the spinal column. The change of kyphosis angle and fusion of bone grafting were reexamined by X-ray regularly. The neurological function were evaluated according to ASIA classification.

RESULTSThere was no injury of blood vessel or spinal cord during the surgery. Nine children were followed-up for 16 to 38 months (averaged 24 months). The tuberculosis symptoms disappeared after surgery and there was no tuberculosis recurrence,incision infection, sinus formation and internal fixation failure in any of these chiildren. ESR reexamination recovered normally. Bony fusion was obtained in all patients and internal fixation position was normal 4 to 8 month postoperatively. The kyphosis angle ranged from 12 degrees to 30 degrees (averaged 19.50) at final followed-up. The function of spinal cord improved postoperatively, the function of spinal cord recovered at different degrees: 2 cases at grade C, 2 at grade D, and 5 at grade E.

CONCLUSIONThe one-stage posterior approach can provide direct and safe access to the lesion. The effect of vertebral canal decompression and kyphosis deformity correction were significantly. The structural iliac crest autograft or allograft and posterior transpedicular screw system could work effectively to stabilize the thoracic junction.

Bone Transplantation ; Child ; Child, Preschool ; Debridement ; methods ; Female ; Fracture Fixation, Internal ; methods ; Humans ; Male ; Thoracic Vertebrae ; surgery ; Tuberculosis, Spinal ; surgery

OBJECTIVETo observe the curative effects and complications of Bryan cervical disc replacement for cervical disc herniation.

METHODSFrom Jannary 2005 to December 2008,39 patients with cervical disc herniation were treated with Bryan cervical disc replacement. There were 20 males and 19 females,with an average age of 47 years old (ranged, 35 to 59). Spinal compression symptom (20 cases) and nerve root symptom (19 cases) were main clinical symptoms. Single level disc was replaced in 35 cases and two-level replaced in 4 cases. Offset and activity of prosthesis,cervical physiological curvature, heterotopic ossification, prosthetic fusion were observed by dynamic X-ray. According to Odom's standard and JOA score,nerve function were evaluated; and depending on NDI standard,clinical symptom and daily function status were recorded.

RESULTSAll the patients were followed up from 16 to 36 months with an average of 24 months. Nerve function obviously improved and radiating pain of upper limb completely relieved. No patient with prosthetic anterior-posterior offset more than 2 mm was found. Prosthetic flexion and extention angle was (8.5+-1.8)degrees,left and right flexion range respectively were (3.5+/-1.2)degrees and (3.3+/-1.5)degrees. Cervical physiological curvature improved obviously or recovered normally. Three cases occurred in heterotopic ossification and 2 cases occurred in prosthetic fusion. According to Odom's standard,25 cases got an excellent results,9 good, 5 fair, the rate of excellent and good was 87.2%. JOA score increased from preoperative (8.26+/-1.32) to (15.71+/-1.89) at final follow-up and NDI decreased from preoperative (43.7+/-3.8) to (20.1+/-2.9) at final follow-up.

CONCLUSIONTreatment of cervical disc herniation with Bryan cervical disc replacement can get the good curative effects,which can obtain good nerve functional recovery,cervical stability and activity. Nevertheless,the operation has typical complication such as heterotopic ossification and prosthetic fusion. Thus,it is important in chosing indication and operative procedure.

Adult ; Cervical Vertebrae ; surgery ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Postoperative Complications ; etiology ; Total Disc Replacement ; adverse effects ; methods

OBJECTIVETo evaluate the therapeutic effect of embolization combined with endovascular stenting in the for treatment of intracranial pseudoaneurysms.

METHODSSeventeen patients with intracranial pseudoaneurysms received endovascular treatment with coil placement, NBCA glue embolization and endovascular stenting, and the therapeutic effect was evaluated according to the findings in immediate postoperative and follow-up angiography.

RESULTSFatal aneurysm rupture occurred in 1 case during embolization, and the surgical procedures were carried out smoothly in the remaining 16 cases. The aneurysm cavity dense coil packing ratio was 50% in coil embolization group and 42.9% in stent-assisted coil embolization group. In the follow-up for 3 months to 2 years, 2 patients in coil embolization group experienced pseudoaneurysm recurrence and were managed successfully with additional embolization with coils and stent. Aneurysms were not found postoperatively in stent-assisted coil embolization group.

CONCLUSIONEmbolization combined with endovascular stenting is a safe and effective treatment of intracranial pseudoaneurysms with minimized risk of recurrence.

Adolescent ; Adult ; Aneurysm, False ; therapy ; Embolization, Therapeutic ; Female ; Humans ; Intracranial Aneurysm ; therapy ; Male ; Middle Aged ; Stents ; Treatment Outcome ; Young Adult

Objective To explore the prevalence and analyze the related risk factors for post-stroke depression among middle-aged and elderly stroke patients of Mongolia and Han nationality in Inner Mongolia Autonomous Region.Methods A stratified multistage random cluster sampling method was used to investigate the prevalence of stroke in the population aged ≥45 years in different areas of Inner Mongolia Autonomous Region.A total of 11 088 people were investigated and 498 were stroke patients among them.A set of scale assessment and the general situation were used to investigate stroke patients and 443 patients completed the whole survey.Results The total prevalence of post-stroke depression (PSD) was 41.08％ in 443 stroke patients,among which the prevalence rate was 40.57％ for Mongolian population and 41.85％ for Han population,and no significant difference was found between Mongolian and Han nationality(x2=1.372,P=0.504).There were significant differences in the types of stroke between the Mongolian and Han nationality (x2 =7.347,P=0.025).The age (t=4.321,P=0.000),educational level (x2 =27.036,P=0.001) and economic burden (x2=27.877,P=0.000) were statistically significant between Mongolian and Han nationality.The differences of frequency of stroke (x2 =6.545,P=0.011),economic burden (x2 =16.148,P=0.001),cognitive dysfunction (x2 =9.065,P=0.003),daily living ability (x2 =34.466,P =0.000),alcohol consumption history(x2=4.516,P=0.034)were statistically significant.Logistic regression analysis showed that alcohol consumption history,economic burden,the frequency of stroke,and cognitive dysfunction were the influencing factors of PSD.Conclusion PSD is one of the important factors affecting the post-stroke psychological burden in Inner Mongolia Autonomous Region.There is no national difference in the prevalence of PSD among Mongolian and Han people,which provides a theoretical basis for the treatment and intervention of PSD.

OBJECTIVESTo discuss the possible cause of intracranial hemorrhage and treatment after carotid artery stenting (CAS) in patients with carotid artery stenosis.

METHODSFrom January 2003 to August 2009, 403 patients with carotid artery stenosis that were performed CAS, intracranial hemorrhage occurred in 5 cases after the procedure. We analyzed the feature of these cases and perioperative management retrospectively to summarize the possible cause of intracranial hemorrhage and preventive measure.

RESULTSCerebral hemorrhage were found 30 min after CAS in 2 cases, 5 days in 2 cases and 3 days in 1 case. One patient was treated conservatively whose hemorrhage was about 2 ml, one was performed draining of ventricle and the other three cases were all performed craniotomy to remove the hematoma and to depress. The position of hemorrhage were all in the side of carotid artery stenosis, and in 2 cases of them the hemorrhage were at the region of previous cerebral infarction. One patient was cured conservatively, the one who was performed draining of ventricle died. Among the other three cases performed craniotomy, one recovered with light neurological deficit and two died of multiple organ failure.

CONCLUSIONIntracranial hemorrhage is the most serious complication of CAS of carotid artery, and general measure should be taken to prevent it from occurring.

Aged ; Aged, 80 and over ; Carotid Stenosis ; surgery ; Female ; Humans ; Intracranial Hemorrhages ; etiology ; prevention & control ; Intraoperative Complications ; etiology ; prevention & control ; Male ; Middle Aged ; Retrospective Studies ; Stents

OBJECTIVETo study the effect of bio-derived bones, as substitutes of autogenous bone grafts and demineralized cadaver bones, on the attachment, spreading and proliferation of isolated osteoblasts.

METHODSOsteoblasts were isolated from the calvaria of a fetal rabbit through sequential collagenase digestion. In the attachment study, the osteoblasts labeled with 3H-leucine were incubated with the bio-derived bone materials in sterile microcentrifugable tubes for 15, 90 and 180 minutes, and 24 hours, respectively. The attached cells were collected and the radioactivity was measured with liquid scintillation spectrometry. In the proliferation study, the osteoblasts were cultured with the bio-derived bone materials for 24 hours and 3H-thymidine was added during the last 2 hours of the incubation. The attached cells were collected and the radioactivity was measured with liquid scintillation spectrometry. Osteoblasts were seeded on the bone graft materials for 60 or 120 minutes, 24 or 48 hours, and 3 or 7 days, then the co-culture was processed for scanning electron microscopy to observe the interaction of osteoblasts and the bio-derived bone materials.

RESULTSOsteoblasts attached to the bio-derived bone materials in a time-dependent manner. There were significantly (P<0.05) more attached cells after 180 minutes than after 15 and 90 minutes of incubations (P<0.05). Osteoblasts were proliferated in a large amount on the surface and in the materials. Osteoblasts seeded onto 100 mg bio-derived bones resulted in significantly (P<0.05) more measurable proliferation than those seeded onto 10 mg bones. Osteoblasts appeared round as they attached to the materials, then flattened and spread over with time passing.

CONCLUSIONSBio-derived bones can provide a good environment for the attachment and proliferation of osteoblasts.

Animals ; Bone Substitutes ; Cadaver ; Cell Culture Techniques ; methods ; Cell Proliferation ; Humans ; Osteoblasts ; cytology ; Osteogenesis ; Rabbits ; Skull ; cytology ; Tissue Engineering ; methods

OBJECTIVETo study the feasibility, security and validity of percutaneous angioplasty (PTA) or percutaneous angioplasty and stenting (PTAS) for symptomatic stenosis of middle cerebral artery.

METHODSThe results of treatment and follow-up of 39 cases with symptomatic stenosis of middle cerebral artery who had either recurrent transient ischemic attacks (TIAs) or resistant to medical therapy and were performed PTA or PTAS were studied retrospectively.

RESULTSAmong the 39 cases with stenosis of middle cerebral artery (23 in left, 13 in right, 3 in bilateral side and 5 cases combining with stenosis of carotid artery) PTA were successfully performed in 9 cases and PTAS in 30 (whose post-operative residual stenosis were less than 10%). After operation the patients were administrated with antiplatelet drugs. The clinic symptom and sign of ischemia were improved obviously after operation. During the procedure the contrast could be seen outside the vessel in 2 cases, the patients had no obvious symptom of hemorrhage and got well rapidly. But in another case her consciousness changed 1 h after PTAS and the limbs could not move in right side. Emergency CT scan showed cerebral hemorrhage in left basic node area. The patient suffered language barrier and incomplete hemiplegy in right side. No complication was occurred in the others. During 5 to 60 months follow-up, the symptom of weakness in right arm reoccurred but lighter than before in only one case. TCD rechecked in 26 cases and demonstrated the blood beam speed was faster than normal in two case. DSA rechecked in 14 cases showed restenosis in-stent in the 2 cases and they were treated by medicine.

CONCLUSIONSPTA and PTAS is a feasible, safe and effective therapeutic method for the patients with symptomatic stenosis of middle cerebral artery. Further study in large number of patients is needed for long-term outcome.

Adult ; Aged ; Angioplasty, Balloon ; Brain Ischemia ; surgery ; Feasibility Studies ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Middle Cerebral Artery ; surgery ; Retrospective Studies ; Stents ; Treatment Outcome

OBJECTIVETo study the feasibility, safety and validity of percutaneous angioplasty and stenting (PTAS) for symptomatic atherosclerotic stenosis of basilar artery.

METHODSThe results of treatment and follow-up of 40 cases with symptomatic atherosclerotic stenosis of basilar artery performed PTAS from August 2003 to December 2009 were studied retrospectively, who had either recurrent transient ischemic attacks (TIAs) or obvious ischemic symptoms and resistant to medical therapy.

RESULTSPTAS were successfully performed in all the 40 cases and the post-operative average residual stenosis descended to 14% ± 11% from pre-operative 82% ± 14%. After operation the patients were administrated with antiplatelet drugs. After procedure the clinic symptoms and signs of ischemia were improved obviously in 38 cases and deteriorated in 2 cases whose CT scanning showed that the range of infarction in brain stem enlarged. The symptoms improved after treatment but 2 patients had neurological deficit. No hemorrhagic complications occurred in the group. During the follow-up for 2 months to 7 years, transcranial doppler ultrasonography in 26 cases demonstrated the blood flow was faster than normal in 2 cases, and digital subtraction angiography (DSA) in 6 cases showed restenosis in-stent in 1 case. The second stent was implanted because of the symptomatic restenosis. In another case the follow-up DSA showed occlusion of basilar artery in-stent but there was no ischemia of post circulation because the generation of anastomoses.

CONCLUSIONSPTAS is a feasible, safe and effective therapeutic method for the patients with symptomatic atherosclerotic stenosis of basilar artery. Further study in large number of patients is needed for long-term outcome.

Adult ; Aged ; Angioplasty, Balloon ; methods ; Atherosclerosis ; complications ; Feasibility Studies ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Stents ; Treatment Outcome ; Vertebrobasilar Insufficiency ; etiology ; surgery

OBJECTIVETo discuss the efficiency and safety of carotid angioplasty stenting (CAS) in patients with contralateral carotid artery occlusion.

METHODSFrom January 2001 to January 2010, 56 carotid artery stenosis patients with contralateral carotid artery occlusion were performed CAS and the feature and results of these cases were analyzed retrospectively. All the cases were confirmed to be carotid artery stenosis with contralateral carotid artery occlusion by digital subtraction angiography (DSA). The diameter stenosis rate was 72% ± 15%. CAS were performed with distal protection device in 56 cases.

RESULTSThe technique success rate of CAS were 100% in all the 56 patients with contralateral carotid artery occlusion and post-procedure stenosis rate descended to 13% ± 8%, and the symptoms of cerebral ischemia were all improved. Only 1 case occurred remote hemorrhage in the position of previous cerebral infarction in the side of CAS after the procedure, and recovered with light neurological deficit after the craniotomy to remove the hematoma. No ischemic complications or death occurred. During the following up of 6 months to 3 years, no cerebral ischemic symptoms reoccurred. The rechecking results of color Doppler of 47 cases and DSA of 2 cases showed no restenosis in-stent.

CONCLUSIONSCAS is safe and effective for the patients with contralateral carotid artery occlusion. Critical election of the case, operation of skilled doctors and scrupulous post procedure general management can decrease the rate of complication.

Adult ; Aged ; Aged, 80 and over ; Angioplasty, Balloon ; methods ; Carotid Artery, Internal ; surgery ; Carotid Stenosis ; surgery ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Stents ; Treatment Outcome