Humans ; Minimally Invasive Surgical Procedures ; methods ; Tuberculosis, Spinal ; classification ; surgery

OBJECTIVETo evaluate perioperative occult blood loss following total knee arthroplasty (TKA).

METHODSA retrospective analysis of 40 patients undergoing TKA was conducted to calculate the mean blood loss and occult blood loss according to Gross formula.

RESULTSThe mean total blood loss was 1538 ml in these cases with occult blood loss of 791 ml. In patients with autologous blood transfusion, the mean total blood loss was 1650 ml with occult blood loss of 786 ml. In patients without autologous blood transfusion, the mean total blood loss was 1370 ml with occult loss of 798 ml.

CONCLUSIONTKA often results in large volume of occult blood loss in the perioperative period which can not be fully compensated by autologous blood transfusion, and additional blood supply is needed for maintenance of the circulating volume.

Aged ; Arthroplasty, Replacement, Knee ; adverse effects ; methods ; Blood Loss, Surgical ; statistics & numerical data ; Blood Transfusion, Autologous ; Female ; Hemoglobins ; analysis ; Humans ; Intraoperative Complications ; blood ; etiology ; Male ; Middle Aged ; Retrospective Studies

OBJECTIVETo investigate how to select an appropriate surgical approach in the management of fracture and dislocation of lower cervical spine combined spinal cord injury.

METHODSThe clinical data of 54 patients of lower cervical spine fracture and dislocation were retrospectively analyzed. There were 29 cases with vertebral body compressive fracture and dislocation, 7 cases with vertebral body bursting fracture and dislocation, 3 cases with unilateral facet dislocation, 15 cases with bilateral facet dislocation. All cases were associated with spinal cord injury. According to American Spinal Injury Association (ASIA) grades, 21 cases were in A grade, 5 cases in B grade, 22 cases in C grade and 6 cases in D grade. All patients had surgical reduction, decompression, stabilization and fusion, 43 cases in anterior approach and 11 cases in posterior approach.

RESULTSAll patients were followed up in 12 to 36 months, the mean follow-up time was 18 months. There were no great vessels, trachea, esophagus or spinal cord iatrogenic injury. There were no pull-out and breakage of screws or plates. Fusion was achieved in all patients at an average of 12 weeks postoperatively. There were no pseudarthrosis or bone nonunion. Of all the patients, 96.3% were acquired completely reduction and the normal intervertebral height and lordosis were maintained. Patients with complete spinal cord had no neurologic recovery, but they felt relief from upper limb pain or numb. Incomplete spinal cord lesions improved on average 1-2 Frankel grade after surgery.

CONCLUSIONSFor lower cervical spine fracture and dislocation, an ideal anatomy reduction can be obtained with either anterior or posterior approach surgery. It is important to select a suitable surgical approach according to different types of cervical fracture and dislocation.

Adolescent ; Adult ; Aged ; Cervical Vertebrae ; injuries ; surgery ; Diskectomy ; methods ; Female ; Humans ; Joint Dislocations ; complications ; surgery ; Laminectomy ; methods ; Male ; Middle Aged ; Retrospective Studies ; Spinal Cord Injuries ; complications ; Spinal Fractures ; complications ; surgery ; Spinal Fusion ; methods ; Treatment Outcome

OBJECTIVETo evaluate the anti degenerative effect of pectin/polyvinyl alcohol composite (CoPP) hydrogel as artificial nucleus material in an animal model.

METHODSThirty-six New Zealand white rabbits were used to build animal models, the L₄₋₅ intervertebral discs were pierced with a Gauge#16 needle and polyvinyl alcohol (PVA) or CoPP implants were inserted into the holes. For comparative purposes, L₃₋₄ discs underwent sham treatment or control treatment in which the disc was pierced but no implant was inserted. All the discs were divided into four groups as follows: sham disc group, pierced disc group, PVA disc group and CoPP disc group. The discs were analyzed radiologically and histologically for degenerative changes at 1, 3 or 6 months after surgery.

RESULTSNone of the animals died from operative complications, such as paraplegia or infection before being killed. Macroscopically, none of the implants showed any signs of displacement at the time of harvest. The radiological analysis revealed that significantly less disc height loss was found with the PVA and CoPP replacement treatment than with the pierced treatment (P < 0.05). Changes in disc height after the replacement treatment were not significantly different from that after the sham treatment (P > 0.05). Histological degeneration of the replaced discs was delayed in comparison with that of the pierced discs (P < 0.05), but progressed with time, and PVA replacement showed faster disc degeneration than CoPP replacement.

CONCLUSIONSDegeneration of the anulus fibrosus after the CoPP prosthetic nucleus replacement treatment is delayed by preserving disc height and occupying the space of the nucleus pulposus, and it has great potential clinical application value.

Animals ; Female ; Implants, Experimental ; Intervertebral Disc ; pathology ; surgery ; Lumbar Vertebrae ; surgery ; Male ; Models, Animal ; Pectins ; therapeutic use ; Polyvinyl Alcohol ; therapeutic use ; Rabbits

OBJECTIVETo study the risk factors of secondary kyphotic angle increment after bone cement vertebroplasty for osteoporotic vertebral compression fractures.

METHODSFrom October 2005 to May 2006, 32 (45 vertebrae) bone cement vertebroplasty procedures were performed. The operation time, injected cement volume, bone mineral density, visual analog scale (VAS) pain score, vertebral height, and kyphotic angle were recorded. The secondary increment of the kyphotic angle was calculated, and correlation analysis and linear regression analysis were performed.

RESULTSThe bone mineral density, the postoperative kyphotic angle and the vertebral midline height were significantly correlated to the secondary increment of the kyphotic angle.

CONCLUSIONLarge postoperative kyphotic angle, poor postoperative recovery of the vertebral midline height, and low bone mineral density are all risk factors of secondary increment of the kyphotic angle.

Aged ; Aged, 80 and over ; Female ; Fractures, Compression ; etiology ; surgery ; Humans ; Kyphosis ; etiology ; pathology ; Lumbar Vertebrae ; surgery ; Male ; Middle Aged ; Osteoporosis ; complications ; surgery ; Risk Factors ; Spinal Fractures ; etiology ; surgery ; Thoracic Vertebrae ; surgery ; Treatment Outcome ; Vertebroplasty ; adverse effects

OBJECTIVETo research the repair effect of transplantation of glial cell line-derived neurotrophic factor (GDNF) modified olfactory ensheathing cells (OECs) combination with injecting axonal growth inhibiting protein antibody (IN-1) in vivo.

METHODSTo construct lentivirus vector with GDNF gene and infect OECs in vitro, use the immunoblotting (Western Blot) to observe the expression of GDNF was detected through Western Blot. Fifty adult female SD rats which to establish thoracic spinal cord transection injury model were randomly divided into A (control group), B (IN-1 antibody group), C (OECs group), D (GDNF-OECs group), and E (GDNF-OECs+IN-1 group) 5 groups of each 10 rats. To observe regeneration of the impaired nerve axon by NF200 immunohistochemistry, Biotinylated dextran amine (BDA) anterograde tracing corticospinal tract. Basso, Beattie and Bresnahan (BBB) score was used to evaluating hindlimb motor function recovery.

RESULTSAdd up to 13 rats died post operation. OECs labeled by hoechst still survived and migrated in spinal cord 8 weeks post operation. Lots of confused and disorderly regenerated axons which crossing the injured region of spinal cord were displayed between spinal cord stumps in GDNF-OECs+IN-1 group and GDNF-OECs group; some of axons existed in OECs group, but there is no obviously continue nerve fibers crossing the injured region of spinal cord;in contrast to IN-1 and control groups, few of regenerated axons and atrophy of spinal cord stumps were observed. The results of BBB hindlimb motor rating scale were 7.70+/-0.24, 7.89+/-0.15, 10.50+/-0.25, 11.43+/-0.23 and 12.81+/-0.40 for the control group, IN-1 group, OECs group, GDNF-OECs group and the allied treatment group respectively.

CONCLUSIONSThe transplantation of GDNF-OECs combination with IN-1 antibody may benefit the survival and regeneration of the injured axons, and accelerate the repair of the injured spinal cord and functional recover of hindlimb locomotor in rats in a more efficient way than that with OECs or IN-1 alone.

Acute Disease ; Animals ; Antibodies, Monoclonal ; pharmacology ; Cell Transplantation ; Cells, Cultured ; Disease Models, Animal ; Female ; Genetic Vectors ; Glial Cell Line-Derived Neurotrophic Factor ; genetics ; pharmacology ; Olfactory Bulb ; cytology ; Rats ; Rats, Sprague-Dawley ; Spinal Cord Injuries ; therapy ; Transfection

OBJECTIVETo evaluate the biocompatibility of pectin/poly vinyl alcohol composite (CoPP) hydrogel for use as a prosthetic nucleus pulposus material.

METHODSThe in vitro cytotoxicity of CoPP hydrogel was tested in NCTC L929 cells, which were divided into normal control group, negative control group [treated with poly (vinyl alcohol) hydrogel, PVA], experimental group (treated with CoPP) and positive control group (0.64% phenol). The optical density of the cells on days 2, 4, and 7 of the corresponding treatments was determined and the relative growth rate calculated. For in vivo biocompatibility evaluation, dehydrated CoPP and PVA hydrogel were respectively implanted into the left and right gluteus of SD rats, and the wound healing and general status were observed. The muscular tissues containing the implants were taken 1, 4, and 12 weeks after the implantation for gross observation and microscopic observation of the inflammatory cell infiltration (ICI) and formation of the fibrous capsulation around the implants.

RESULTSThe L929 cells incubated with PVA and CoPP group both grew well, with relative growth rate over 80% and 75%, respectively. The cytotoxicity of PVA and CoPP was both lower than grade 1. In contrast, the relative growth rate in the positive control group was below 24%, with cytotoxicity over grade 4. In the SD rats, ICI of grade IV occurred in the muscular tissues around the PVA and CoPP implants at 1 week without formation of complete capsule, and at 4 weeks, ICI was lowered to grade 1 with grade 4 capsular reaction. Till week 12, the ICI and capsular reaction were both first grade.

CONCLUSIONCoPP hydrogel has in vitro grade 0 or 1 cytotoxicity and causes only mild inflammation after implantation in rats, suggesting good biocompatibility of the material.

Animals ; Biocompatible Materials ; Hydrogel, Polyethylene Glycol Dimethacrylate ; Implants, Experimental ; Intervertebral Disc ; surgery ; Materials Testing ; methods ; Pectins ; chemistry ; Polyvinyl Alcohol ; chemistry ; Rats

OBJECTIVETo analyze the intermediate-term results associated with the use of Zweymtiller hip system.

METHODSReview the 116 cases (142 hips) who were treated with total hip replacement from 1996 to 2002 by a single surgeon using cementless Zweymüller hip systems.

RESULTSSixty-one cases (77 hips) were followed up, 50 cases (64 hips) were evaluated both clinically and radiographically while 5 cases (6 hips) and 6 cases (7 hips) were only evaluated clinically and radiographically respectively. The average follow-up period was 7.3 years (range 5 to 11 years). The mean preoperative Harris Hip Score was 46 while the mean postoperative Harris Hip Score was 93. Distal cortical hypertrophy and medullary sclerosis were observed in 30 hips (42.3%) and 33 hips (46.5%) respectively. Heterotopic ossification arose in 45 hips (63.4%). Radiolucent lines occurred in 27 stems (38.0%) but in no cups. Radiolucent lines were mostly observed in Gruen zones 1. Osteolysis occurred in 7 cups (9.9%) and 18 stems (25.4%). Osteolysis was mostly observed in Delee Zone 3 and Gruen zone 7. In the distal Gruen zones 3, 4 and 5, no radiolucent line or osteolysis was observed. No hips had been revised, 3 cups needed revision surgery because of aseptic loosening.

CONCLUSIONThe 5-11 years follow-up results are satisfactory, but osteolysis is common.

Adolescent ; Adult ; Aged ; Arthroplasty, Replacement, Hip ; Female ; Follow-Up Studies ; Hip Prosthesis ; Humans ; Male ; Middle Aged ; Treatment Outcome ; Young Adult

OBJECTIVETo observe the clinical effect of a self-designed posterior STB thoracolumbar transpedicular screw-plate system in the treatment of spondylolysis and spondylolisthesis.

METHODSThis STB screw-plate system is developed with titanium alloy (TC4, Ti6Al4V). During December, 1999 and January, 2001, this system was applied in 51 cases, including lumbar spondylolysis and spondylolisthesis (36 cases), degenerative lumbar instability (15 cases). The patients were aged 22 - 78 years, mean age: 47.5 - years; among them there were 14 male cases, 37 female cases; There were 15 cases degenerative spondylolisthesis with grade I-II slip, 36 cases of spondylolysis and spondylolisthesis, including 34 cases with grade I-II slips and 2 cases with grade III slips; single level of 33 cases, two levels 3 cases. Decompression was performed for the 43 cases with interbody fusion using iliac crest or bilateral-lateral fusion using demineralized bone matrix and 8 cases were fixed with demineralized bone matrix fusion without decompression.

RESULTSAll the operations heeded about 60 - 120 minutes, and during the operations bleeding amounts were 200 - 500 ml. The cases completely recovered to work or normal action after 3 months of surgeries. 46 of all cases were achieved to satisfactorily reduction and clinical effect, 5 cases of grade II-III remained incomplete reduction (grade I slip).

CONCLUSIONThis STB system has advantages of biomechanical stability and reduction capability and its effect in clinical application is undoubtedly positive.

Adult ; Biomechanical Phenomena ; Bone Plates ; Bone Screws ; Humans ; Joint Dislocations ; surgery ; Lumbar Vertebrae ; Male ; Spinal Fusion ; instrumentation ; methods ; Spondylolisthesis ; physiopathology ; surgery ; Spondylolysis ; physiopathology ; surgery ; Treatment Outcome ; Young Adult

OBJECTIVETo test the efficacy of kyphoplasty using an enhanced balloon expander in restoring the height of vertebral compression fractures (OVCF).

METHODSFifteen lumbar vertebral bodies (L1-L5) were harvested from 3 young male fresh cadavers and separated into individual vertebral bodies with the bilateral pedicles of the vertebral arch removed. Before operation, plain X-ray films of all the vertebral bodies were obtained. All the vertebral bodies were compressed lengthwise to approximately 80% of their original heights using a universal material-testing machine to result in compression fractures. Post-compression vertebral bodies were then repaired using an enhanced balloon expander, and the delivery of the bone cement into the vertebral bodies was observed. The heights of the anterior and posterior borders of the vertebral bodied were measured before and after compression as well as after kyphoplasty.

RESULTSThe inflation of the balloon expander averaged 2.95-/+0.18 ml and the pressure was 122.67-/+27.89 psi (1 psi=6895 Pa). Kyphoplasty resulted in significant restoration of the vertebral body height lost due to the compression (P<0.01).

CONCLUSIONKyphoplasty using an enhanced balloon expander may restore vertebral body height damaged by compression and correct the kyphotic deformity. The balloon expander can be a effective and economic choice for kyphoplasty for its relatively low cost.

Adult ; Bone Cements ; Cadaver ; Catheterization ; Fractures, Compression ; etiology ; surgery ; Humans ; Lumbar Vertebrae ; injuries ; surgery ; Male ; Spinal Fractures ; complications ; surgery ; Tissue Expansion Devices ; Vertebroplasty ; instrumentation ; methods