OBJECTIVETo explore the effects of removing dampness and promoting diuresis method on autoimmune and immuno-inflammatory response caused by nucleus pulposus of rats, in order to provide the basis for the treatment of lumbar disc herniation with Chinese medical immunotherapy.

METHODSForty male Wistar rats were divided into 4 groups randomly according to body weight layer:sham operation group (group A), model contrast group (group B), colchicine tablets group (group C), modified Qingyao decoction group (group D). There were 10 rats in each group. Nucleus pulposus of coccygeal vertebra was transplanted to the gluteal muscle by operation in groups B, C, D, which can lead to autoimmune and immuno-inflammatory response of rats; the rats of group A were only treated with sham operation. At the 3rd day after operation, the rats were fed through intragastric administration, the group A and B with distilled water (10 ml/kg), the group C and D respectively with suspension of colchicine tablets (10 ml/kg, 0.01 mg/ml) and water-decocted liquid of modified Qingyao decoction (10 ml/kg,1.035 g/ml), once a day and continuous medication for 18 days. All rats were killed at the 21th day after operation. The immunoglobulin G (IgG), immunoglobulin M (IgM) and interleukin-1beta (IL-1beta), interleukin-8 (IL-8) level in serum of different groups were detected by ELISA method. At the same time, surrounding tissues of the transplanted nucleus pulposus were observed by pathological section.

RESULTSThe level of IgG, IgM, IL-1beta, IL-8 in serum of group B was significantly higher than that of group A (P < 0.01), while the level of IgG, IgM, IL-1beta, IL-8 in serum of group C, D was significantly lower than that of group B (P < 0.05 or P < 0.01). Moreover, pathological section indicated that immuno-inflammatory response was hardly found in surgical site of group A, while local immuno-inflammatory response of surrounding tissues of the transplanted nucleus pulposus of group C and D was much lighter than that of group B.

CONCLUSIONRemoving dampness and promoting diuresis method could inhibit autoimmune and immuno-inflammatory response caused by nucleus pulposus of rats.

Animals ; Autoimmunity ; Disease Models, Animal ; Immunoglobulin G ; blood ; Immunoglobulin M ; blood ; Interleukin-1beta ; blood ; Interleukin-8 ; blood ; Intervertebral Disc Displacement ; immunology ; pathology ; therapy ; Lumbar Vertebrae ; Male ; Medicine, Chinese Traditional ; Rats ; Rats, Wistar

OBJECTIVESTo explore the long-term effects,operating opportunity,indication of anterior debridement and decompression and bone graft in treating thoracolumbar tuberculosis with paraplegia.

METHODSFrom March 2006 to September 2008, the data of 56 patients with spinal tuberculosis were retrospectively analyzed. They were 36 cases male and 20 cases female, the age in ranging from 19 to 78 years with the mean of 42.5 years; course of disease in ranging from 3 months to 4 years. The lesion level was in T11-L2, including one stage in 6 cases, two stages in 42 cases, three stages in 7 cases, four stages in 1 case. According to the Frankel grade, grade A in 5 cases, B in 25, C in 21, D in 5. Preoperative Cobb angle had 30 cases under 30 degrees, 24 cases in 30 degrees-60 degrees, 2 cases more than 60 degrees [averaged in (35.0 +/- 3.3) degrees]. The mean VAS was 7.3 +/- 2.1 preoperatively. All patients had chemotherapy for 2-3 weeks. The clinical effects were evaluated by Cobb angle, VAS, condition of Frankel grade and fusion segments.

RESULTSAll patients were followed up from 12 to 38 months with an average of 24 months. All wound obtained primary healing. The Cobb angle was(19.0 +/- 5.5) degrees immediately after operation, and lost (1.8 +/- 0.7) degrees at the follow up. The mean VAS was 1.4 +/- 0.3 postoperatively and 1.3 +/- 0.4 at final follow up. The Cobb angle and VAS significant improved in postoperatively (P < 0.05), and there was no statically difference between after operation and last follow up(P > 0.05). At 1 year after operation, all patients obstained successful bony fusion. Among 51 cases incomplete paraplegia recovered partially or completely (over Frankel D) through chemotherapy and rehabilitation training for 1-1.5 years; 5 cases of complete paraplegia had partially recovered, 3 cases from Frankel A to C, 2 cases from Frankel A to B.

CONCLUSIONBase on the chemotherapeutic effect, paraplegia reason and location, total body condition to select different operative opportunity can effectively relieve spinal compression, stabilize spinal column, correct kyphosis and promote recovery of paraplegia.

Adult ; Aged ; Female ; Humans ; Lumbar Vertebrae ; surgery ; Male ; Middle Aged ; Pain Measurement ; Paraplegia ; surgery ; Retrospective Studies ; Thoracic Vertebrae ; surgery ; Tuberculosis, Spinal ; surgery

Adult ; Ankle Injuries ; therapy ; Humans ; Joint Dislocations ; therapy ; Male ; Manipulation, Orthopedic ; methods

OBJECTIVETo compare clinical effects of different fixations in order to provide the best therapeutic choice for comminuted patellar fractures.

METHODSFrom February 2003 to June 2009, 56 patients with comminuted patellar fractures were treated with three methods of fixation. Of them, 18 patients (group A) were treated with Kirschner-wire with steel wire fixation, there were 9 males and 9 females, ranging in age from 32 to 52 years with an average of (47.62 +/- 4.82) years; 13 patients (group B) with circular silk thread fixation and plaster immobilization, there were 3 males and 10 females,ranging in age from 38 to 65 years with an average of (48.58 +/- 8.28) years; 25 patients (group C) with memory alloy patella holder fixation, there were 9 males and 16 females, ranging in age from 32 to 68 years with an average of (48.36 +/- 9.59) years. According to criteria of Böstman, eight indexes were compared, including the range of motion of the knee, pain, walking and so on.

RESULTSAll patients were followed up from 8 to 26 months with an average of 15.6 months. All the fractures healed. The Böstman scoring of group A, B, C were respectively 26.00 +/- 4.6, 22.08 +/- 5.31, 26.44 +/- 3.77. The clinical effects of group A and C were better than that of group B (P < 0.05).

CONCLUSIONThe method of Kirschner-wire with steel wire fixation or memory alloy patella holder fixation can obtain satisfactory effects in treating comminuted patellar fractures because of steady fixation and early function recovery.

Adult ; Aged ; Bone Wires ; Female ; Fracture Fixation, Internal ; methods ; Fractures, Comminuted ; surgery ; Humans ; Male ; Middle Aged ; Patella ; injuries

OBJECTIVETo evaluate the therapeutic effects of cannulated compression screws for the treatment of femoral neck fractures, and to investigate the related factors influencing the avascular necrosis of femoral head after surgery.

METHODSA retrospective review was done for 96 patients with femoral neck fractures treated with cannulated compression screws from January 2003 to June 2009. Among them, there were 44 males and 52 females with 21 to 88 years old (averaged 56.3 years old). According to Garden classification, 4 patients were type I, 34 patients were type II, 37 patients were type III and 21 patients were type IV. Factors such as patients' age, gender, fracture type, duration from injury to surgery and fracture reduction quality were statistically analysed to find correlations with nonunion and avascular necrosis of femoral head.

RESULTSEighty-four patients were followed up ranging from 9 to 60 months and the mean time was 25.4 months. Postoperative complications included deep venous thrombosis of lower extremity in 2 cases, bone nonunion in 8 cases and avascular necrosis of femoral head in 11 cases. According to Harris criterion, the total postoperative Harris score was 86.20 +/- 11.00, and 40 patients got an excellent result, 32 good, 7 fair and 5 poor. The incidence of avascular necrosis of femoral head in nondisplaced fracture group and displaced fractures group were 3.22% and 18.87% respectively;and there were significant difference between the two groups (P = 0.037). The incidence of avascular necrosis of femoral head in anatomical reduction group and non-anatomical reduction group were 5.00% and 20.45% respectively; also,significant difference was existed between the two groups (P = 0.036). However, there was no statistically significant difference of the incidence of avascular necrosis of femoral head according to different age, sex, operative time.

CONCLUSIONThe therapeutic effect of cannulated compression screws for non-displaced femoral neck fractures is good. The fracture type and reduction quality are found to be main factors correlated with avascular necrosis of femoral head statistically. For young patients with a displaced femoral neck fracture,in order to avoid incidence of avascular necrosis of femoral head, anatomical reduction should be ensured. For elder patients with a severe displaced femoral neck fracture, the total hip replacement should be recommended.

Adult ; Aged ; Aged, 80 and over ; Bone Screws ; Female ; Femoral Neck Fractures ; surgery ; Fracture Fixation, Internal ; methods ; Humans ; Male ; Middle Aged ; Osteonecrosis ; etiology ; Postoperative Complications ; etiology ; Retrospective Studies

OBJECTIVETo study therapeutic effects of self-designed canal decompressor in the posterior surgical treatment of thoracolumbar burst fractures, and provide evidence for widespread application.

METHODSFrom January 2008 to December 2008, the self-designed canal decompressor was used in 43 patients (30 males and 13 females, ranging in age from 22 to 49 years) with thoracolumbar burst fractures. According to Denis classification, there were 12 cases of type A, 24 cases of type B, 6 cases of type D and 1 case of type E. Affected segment: 16 patients in T12,19 patients in L1 and 8 patients in L2. The index of intra-operative blood loss, postoperative 24 h wound drainage volume, and operative time were compared with those of 16 patients who undergone traditional operation. The preoperative and postoperative vertebral canal volume, Cobb angles, residual vertebral body height, neurological outcome, and back pain were evaluated and compared.

RESULTSAll the patients healed without wound infection, neurological symptoms and other complications. Forty-three patients were followed up ranging from 12 to 24 months, with a mean of (16.5 +/- 2.5) months. Compared with traditional posterior operation, the blood loss and operative time in modified posterior approach group had statistically significant difference, but the postoperative 24 h wound drainage had no significant difference between the two groups. CT scan indicated that applying the canal decompressor allowed efficient restore of canal volume from preoperative (49.4 +/- 16.7)% to postoperative (12.8 +/- 4.2)%. The X-ray showed Cobb angles reduced from preoperative (30.1 +/- 2.4)degrees to postoperative (5.1 +/- 0.6) degrees. Mean vertebral height was restored to (81.5 +/- 5.5)% after operation. Follow-up evaluation indicated that neurological recovery presented in 33 patients,with an average improvement of 0.87 Frankel grades. Neurological deterioration was not observed.

CONCLUSIONApplying the canal decompressor enables efficient and safe spinal decompression, restore the height of the injured vertebrae, reconstruction of the anterior-middle column stability,and prevention of postoperative vertebral height and Cobb angle lost.

Adult ; Case-Control Studies ; Decompression, Surgical ; methods ; Female ; Humans ; Lumbar Vertebrae ; injuries ; surgery ; Male ; Middle Aged ; Spinal Fractures ; surgery ; Thoracic Vertebrae ; injuries ; surgery

OBJECTIVETo evaluate the efficacy and the feasibility of bending rod reduction in situ technique in treating low lumbar burst fracture.

METHODSFrom March 2007 to June 2009, 21 patients with low lumbar burst fracture were retrospectively analyzed, 11 cases were in L3,6 in L4 and 4 in L5. There were 16 males and 5 females, ranging in age from 25 to 59 year with an average of 37.9 years. According to ASIA classification, nerve function was level A in 2 cases, level B in 2, level C in 10, level D in 4 and level E in 3. Pedicle screws were implanted and bending rod reduction in situ technique was applied through posterior approach. Radiographic and neurological scores were compared before and after operation.

RESULTSAll patients were followed up from 12 to 39 months with an average of 16.5 months. Radiographic examinations demonstrated that anterior height of fractured vertebral body was from 57.9% preoperatively to 94.1% postoperatively (P < 0.01 ); sagittal index was from 29.1 preoperatively to 0.240 postoperatively (P < 0.01). Spinal canal occupation ratio was from 49.6% preoperatively to 13.4% postoperatively (P < 0.01). Nerve function was level A in 2 cases,level B in 0, level C in 0, level D in 4 and level E in 15.

CONCLUSIONBending rod in situ technique could achieve 3-column reduction in 3-dimentionally at the same time, and reconstruct the stability of low lumbar.

Adult ; Bone Screws ; Female ; Fracture Fixation, Internal ; methods ; Humans ; Lumbar Vertebrae ; injuries ; surgery ; Male ; Middle Aged ; Retrospective Studies ; Spinal Fractures ; surgery

OBJECTIVETo analyze locking plates with bone graft fusion in treating displaced intraarticular calcaneal fractures and determine whether it is beneficial in maintaining restoration of calcaneal height and anatomic reduction of the articular surface.

METHODSFrom January 2007 to January 2008, 22 patients with displaced intraarticular calcaneal fractures were treated with locking plates with and without bone graft (divided into the bone graft group and non-bone graft group). There were 17 males and 5 females, ranging in age from 18 to 59 years with the mean of 35 years. Sanders III was in 14 cases and Sanders IV in 8 cases. Autologous iliac bone filled defects with locking plates fixation for the bone graft group; just locking plates fixation were performed for non-bone graft group. The Böhler angle and Gissane angle were measured before and after operation. The foot function of two groups were compared according to Maryland standard at the 6th month, 1, 2 years after operation.

RESULTSAll patients were followed up with an average of 25 months. There was no significant difference in the recovery of Böhler angle and Gissane angle between two groups (P > 0.05). After the 6 months,1, 2 years, there was no significant difference in the foot function between two groups (P > 0.05), in bone graft group, excellent result was in 6, 7 ,7 cases respectively; and in non-bone graft group, excellent results in 5, 6, 7 cases respectively.

CONCLUSIONBone graft in the surgical treatment of calcaneal fractures is not an advantage.

Adolescent ; Adult ; Bone Plates ; Bone Transplantation ; Calcaneus ; injuries ; surgery ; Female ; Humans ; Intra-Articular Fractures ; surgery ; Male ; Middle Aged ; Young Adult

Adult ; Clavicle ; injuries ; surgery ; Fractures, Bone ; diagnostic imaging ; surgery ; Humans ; Male ; Radiography

OBJECTIVETo evaluate the value of pedicle parameter obtained by the reformation images on multi-slice spiral CT (MSCT) in the surgical treatment of lumbar spondylolisthesis.

METHODSFrom January 2009 to March 2010, 60 patients with lumbar spondylolisthesis failing in conservative treatment were enrolled into the study and divided into experimental and control group randomly (each group with 30 patients). There were 26 males and 34 females ranging in age from 18 to 59 years with an average of (42.60 +/- 9.36) years. The experimental group was examined with volumetric scanning on MSCT before operation. Reformation such as multiplanar reconstruction (MPR) and volume rendering (VR) were carried out at the work station. Transverse section angle (TSA), sagittal section angle (SSA), pedicle length (PL), pedicle width (PW) and pedicle height (PH) were measured on different images and pedicle screws were implanted according pedicle parameter. In control group, the pedicle screws were implanted according to conventional anatomic landmark. Preparative time of screw canal and accuracy of screw were compared between two groups.

RESULTSA hundred fifty-six screws were inserted in experiment group,143 screws were excellent, 11 good, and 2 poor. A hundred fifty screws were inserted in control group, 101 screws were excellent, 26 good, and 23 poor. There was significant difference in accuracy of screw between two groups (P < 0.001). The preparative time of screw canal in experiment group was (66.20 +/- 7.31) s, and was shorter than that of control group [(104.11 +/- 9.51) s, P < 0.001)].

CONCLUSIONAbundant information and parameter could be obtained with the MSCT reconstruction images. The images and parameters could make a perfect operative strategy before operation, adjust the direction of pedicle screws during operation, avoid and decrease operative complications effectively.

Adolescent ; Adult ; Bone Screws ; Female ; Humans ; Lumbar Vertebrae ; diagnostic imaging ; surgery ; Male ; Middle Aged ; Spondylolisthesis ; diagnostic imaging ; surgery ; Tomography, Spiral Computed ; methods