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 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 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 evaluate the available surgical treatment modalities so as to explore the optimal strategy of managing early breast cancer.

METHODSThe clinical data of 2173 consecutive early-stage breast cancer patients treated by surgery treatments were retrospectively reviewed in order to clarify the indications and contraindications of different modalities. Therapeutic outcome of different surgical treatment modes were compared in terms of recurrence-free survival ( RFS) , disease-free survival ( DFS) , overall survival (OS). The cosmetic results of breast conservation and reconstruction were also evaluated .

RESULTSThe median age of these patients was 51 years ranging from 18 to 91. Of 2173 patients, 547 had stage 0- I lesions and 1626 stage II , and 1155 (53. 2% ) premenopausal. The proportion of patients who received radical surgery, breast conservation and reconstruction after mastectomy was 83. 6% (1817/2173), 10. 5% (229/2173) and 2. 5% (55/2173) , respectively. Younger and premenopausal patients prefer conservative and reconstructive surgeries, which are reasonable for stage 0-I and non-invasive breast cancer patients. Conservative surgery was not suitable for Paget's disease of breast (P = 0. 004) , mastectomy followed by reconstruction in this type of cancer was up to 38. 5%. The recurrence and metastasis rate of conservation or mastectomy were similar with a comparable 3-year RFS of 97. 4% and 95. 4% , respectively; there were also no significant differences in RFS(P =0. 2435) , DFS( P =0. 1395) and OS(P =0. 9406) after having been followed for 3 to 64 months. Similarly, immediate reconstruction did not show any negative effects with only 1 recurrence and 1 metastasis. Aesthetic outcomes were assessed as excellent or good in 90. 0% of breast conservation surgery, and the acceptability of reconstruction was 94. 5%.

CONCLUSIONBreast conserving surgery not only has comparable survival as mastectomy, but also has better cosmetic outcomes. Immediate breast reconstruction can be a suitable option without compromising survival. It is very important in the management for early breast cancer by selecting the most suitable surgery mode for every individual patient not only to cure her disease but also to satisfy the patient psychologically. Conservation should be preferred prior to reconstruction whenever possible.

Adolescent ; Adult ; Aged ; Aged, 80 and over ; Breast Neoplasms ; pathology ; surgery ; Carcinoma, Ductal, Breast ; pathology ; surgery ; Carcinoma, Intraductal, Noninfiltrating ; pathology ; surgery ; Disease-Free Survival ; Female ; Follow-Up Studies ; Humans ; Lymphatic Metastasis ; Mastectomy ; methods ; Middle Aged ; Neoplasm Recurrence, Local ; Neoplasm Staging ; Paget's Disease, Mammary ; pathology ; surgery ; Reconstructive Surgical Procedures ; Retrospective Studies

OBJECTIVETo investigate the use of anterior cervical discectomy and fusion with self-locking cages to treat multi-segmental cervical myelopathy.

METHODSFrom April 2008 to March 2010, anterior cervical discectomy and fusion with self-locking cages were performed on 45 patients who suffered from multi-segmental cervical myelopathy, among of them there were 23 male and 22 female, aged from 32 to 67 years (average 53 years). Recording the Japanese Orthopedic Association (JOA) scores and SF-36 scores in the protocol time point, in order to investigate the clinical outcome, meanwhile, accumulating the pre-operation and postoperation X-ray films of cervical spine for measuring the height of intervertebral space, whole curvature of cervical spine and the rate of fusion by repeated measures analysis of variance.

RESULTSThe mean follow-up time was 28.4 months (24 - 35 months). JOA scores ascended from preoperative 6.5 ± 3.1 to postoperative 13.4 ± 1.7 (F = 17.84, P = 0.001), the 7 scores of SF-36 improved significantly after operation (t = 1.151 - 12.207, P < 0.05), but mental health not. The fineness rate was 91.1%. Height of disc space ascended from preoperative (5.5 ± 1.8) mm to postoperative (8.3 ± 0.8) mm (F = 11.71, P = 0.043), globle curvature of cervical spine ascended from preoperative 5° ± 7° to postoperative 10° ± 14° (F = 234.53, P = 0.000), the change of the two index was significantly, respectively. Fat necrosis in one case and hematoma in another case at the bone donor-site were found, both of the two cases were cured by physiotherapy. All of the 45 cases (111 segments) achieved bone fusion.

CONCLUSIONThe use of anterior cervical discectomy and fusion with self-locking cages to treat multi-segmental cervical myelopathy possess many advantages as follows: satisfactory clinical outcome, minimally invasive, higher fusion rate, higher orthopaedic ability.

Adult ; Aged ; Cervical Vertebrae ; surgery ; Decompression, Surgical ; methods ; Diskectomy ; methods ; Female ; Follow-Up Studies ; Humans ; Internal Fixators ; Male ; Middle Aged ; Spinal Cord Diseases ; surgery ; Spinal Fusion ; instrumentation ; methods ; Treatment Outcome

OBJECTIVETo observe the effects of lithium chloride combined with human umbilical cord blood mesenchymal stem cell (hUCB-SCs) transplantation in the treatment of spinal cord injury in rats.

METHODSEighty female SD rats with complete T9 spinal cord transaction were randomized into 4 groups (n=20), namely the control group (group A), lithium chloride group (group B), hUCB-SCs group (group C) and hUCB-SCs(+) lithium chloride group (group D). On days 1 and 3 and the last days of the following weeks postoperatively, the motor function of the hindlimb of the rats were evaluated according to the BBB scores. At 8 weeks, all the rats were sacrificed and the spinal cords were taken for morphological observation. The spinal cord tissues at the injury site were observed with Brdu nuclear labeling to identify the survival and migration of the transplanted SCs. The regeneration and distribution of the spinal nerve fibers were observed with fluorescent-gold (FG) spinal cord retrograde tracing.

RESULTSBrdu labeling showed that the transplanted hUCB-SCs survived and migrated in the spinal cord 8 weeks postoperatively in groups C and D. FG retrograde tracing identified a small amount of pyramidal cells that migrated across the injury site in groups C and D. The BBB scores of the hindlimb motor function 8 weeks postoperatively were 4.11∓0.14, 4.50∓0.15, 8.31∓0.11 and 11.15∓0.18 in groups A, B, C and D, respectively.

CONCLUSIONLithium chloride can promote the survival and differentiation of hUCB-SCs into neural cells at the injury site. Lithium chloride combined with hUCB-SCs transplantation may accelerate functional recovery of the hindlimbs in rats with complete transection of the spinal cord.

Animals ; Cord Blood Stem Cell Transplantation ; Female ; Humans ; Lithium Chloride ; therapeutic use ; Rats ; Spinal Cord Injuries ; therapy

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 determine the stress distribution on endplate after lumbar prosthetic disc nucleus (PDN) replacement.

METHODSSix fresh lumbar vertebrae with normal Modic classification were harvested. The specimens were used to establish L4-5 intact, nucleotomy, prosthetic nucleus pulposus replacement models. Vertical compression tests were performed with MTS machine at the rate 50 N per second to maximum load of 1300 N. The stress under the endplate were measured directly with accurate pressure sensors.

RESULTSFor intact specimens, the stress on the endplate maintained higher in the central zone of the endplate, and decreased gradually to the periphery, and was well-distributed. After nucleotomy, the stress on the central zone of endplate was significantly decreased, and increased stress occurred in the periphery of endplate. After PDN replacement, the stress on the central zone of endplate was found more 15.1% higher than that in intact disc (P < 0.05), and the neighboring zone also showed higher stress measurements.

CONCLUSIONSAfter lumbar prosthetic disc nucleus replacement, the stress concentration on endplate may occur in the central zone of prosthetic disc nucleus insertion. Therefore, the prosthetic nucleus pulposus with suitable shape, proper biomechanical functions and updated materials need further study.

Adult ; Arthroplasty, Replacement ; Cartilage, Articular ; physiology ; Humans ; Intervertebral Disc ; surgery ; Joint Prosthesis ; Lumbar Vertebrae ; surgery ; Middle Aged ; Stress, Mechanical

OBJECTIVETo compare the clinical effects of dynamic fixation and rigid fixation in the management of degenerative lumbar spondylosis.

METHODSThe hospitalized patients with degenerative lumbar spondylosis, including degenerative lumbar instability, lumbar spondylolisthesis and lumbar stenosis from January 2002 to December 2006 formed the subjects of our study. According to the inclusion criteria, 100 patients (male 58, female 42) were selected. The cases were divided into rigid fixation group (A) and dynamic fixation group (B), with 50 cases in each. The average age was (56 +/- 6) years old of group A, and (57 +/- 9) years old of group B. Standing plain radiography, computerized tomography (CT) or magnetic resonance imaging (MRI) were taken in all the cases. The observation index included incidence of adjacent segment degeneration (ASD), breakage of implant, fusion rate, lumbo-pelvic parameters and visual analogue scales (VAS) scores.

RESULTSSix cases developed ASD in group A (12.0%), and 1 case in group B (2%). Implant breakage happened in 2 cases in group A (4.0%), while none in group B. There was 1 case of pseudo-articular formation in group A (2.0%), but none in group B. Lumbar lordosis (LL) was corrected with (14.2 +/- 2.2) degrees in group A, and (20.2 +/- 3.7) degrees in group B (P = 0.031). Sacral slope (SS) was corrected with (12.6 +/- 4.3) degrees in group A and (15.8 +/- 6. 5) degrees in group B (P = 0.052). Pelvic tilt (PT) was corrected with (8.3 +/- 2.7) degrees in group A and (4.5 +/- 2.2) degrees in group B (P = 0.014). Pelvic incidence was corrected with (2.0 +/- 0.1) degrees in group A and (0.9 +/- 0.1) degrees in group B (P = 0.008). The VAS score decreased significantly in both groups within the first 2 years after operation. But as time going, the patients with rigid fixation felt pain gradually, and the pain was more severe than in patients with dynamic fixation.

CONCLUSIONDynamic fixation could prevent ASD and implant failure effectively.

Female ; Follow-Up Studies ; Fracture Fixation, Internal ; methods ; Humans ; Lumbar Vertebrae ; Male ; Middle Aged ; Prospective Studies ; Spinal Diseases ; surgery ; Treatment Outcome