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 effect of nitric oxide synthase inhibitor, S-methyl thiocarbamate (SMT), on proteoglycan metabolism in repaired articular cartilage in rabbits.

METHODSTwenty-four male New Zealand white rabbits, aged 8 months and weighing 2.5 kg+/-0.2 kg, were used in this study. Cartilage defects in full thickness were created on the intercondylar articular surface of bilateral femurs of all the rabbits. Then the rabbits were randomly divided into 3 groups (n=8 in each group). The defects in one group were filled with fibrin glue impregnated with recombinant human bone morphogenetic protein-2 (rhBMP-2, BMP group), in one group with fibrin glue impregnated with rhBMP-2 and hypodermic injection with SMT (SMT group) and in the other group with nothing (control group). All the animals were killed at one year postoperatively. The tissue sections were stained with safranine O-fast green and analyzed by Quantiment 500 system to determine the content of glycosaminoglycan through measuring the percentage of safranine O-stained area, the thickness of cartilages and the mean gray scale (average stain intensity). Radiolabelled sodium sulphate (Na(2)(35)SO(4)) was used to assess the proteoglycan synthesis.

RESULTSAt one year postoperatively, the percentage of safranine O-stained area, the mean gray scale and the cartilage thickness of the repaired tissues in SMT group were significantly higher than those of BMP group (P<0.01) and the control group (P<0.05). Result of incorporation of Na(2)(35)SO(4) showed that the proteoglycan synthesis in SMT group was higher than those of BMP group and the control group (P<0.01).

CONCLUSIONSSMT, a nitric oxide synthase inhibitor, can significantly increase the content of glycosaminoglycan and proteoglycan synthesis, and computer-based image analysis is a reliable method for evaluating proteoglycan metabolism.

Analysis of Variance ; Animals ; Biopsy, Needle ; Cartilage Diseases ; drug therapy ; pathology ; Cartilage, Articular ; drug effects ; pathology ; Disease Models, Animal ; Immunohistochemistry ; Isothiuronium ; analogs & derivatives ; pharmacology ; Male ; Nitric Oxide Synthase ; antagonists & inhibitors ; pharmacology ; Probability ; Proteoglycans ; drug effects ; metabolism ; Rabbits ; Random Allocation ; Reference Values ; Sensitivity and Specificity

OBJECTIVETo explore the clinical outcome of unilateral pedicle screw fixation plus single cage interbody fusion through spatium intermuscular of multifidus by Quadrant system.

METHODSFrom April 2008 to April 2009, 47 patients underwent unilateral pedicle screw fixation plus single cage interbody fusion through spatium intermuscular of multifidus. There were 22 males and 25 females with the mean age of 58.2 years (range, 46-74 years). Among them 12 cases had far-lateral lumbar disc herniation, 7 cases had post-discectomy recurrence, and 28 cases had degenerative instability. Thirty-seven cases were treated with lumbar interbody fusion through transforaminal approach, 10 cases through posterior approach. After surgery, the radiography was carried out to demonstrate the fusion status, and the Nakai criterion was used for assessment.

RESULTSThe average skin incision length was 3.2 cm (range, 3.0 to 3.5 cm), the average operative time was 90 min (range, 70 to 160 min), and the average blood loss was 130 ml (range, 90 to 360 ml). All cases were followed up for 8 - 20 months (average 13.6 months). Postoperative radiography showed no evidence of instrument failure, and 43 cases got bone fusion, 4 cases got suspicious fusion. At final followed-up the average leg pain VAS decreased from 7.4 ± 1.1 preoperatively to 2.4 ± 1.3 postoperatively, the average low back pain VAS decreased from 6.7 ± 1.3 preoperatively to 1.8 ± 1.5 postoperatively. According to Nakai criterion, 31 cases were rated as excellent, 11 cases as good, and 5 cases as fair with the total excellent and good rate of 89.4%.

CONCLUSIONSUnilateral pedicle screw fixation plus single cage interbody fusion through spatium intermuscular of multifidus has some advantages of minimal invasiveness, less blood loss, less complications and reliable curative effect. It is a satisfactory lumbar fusion method under suitable indication.

Aged ; Bone Screws ; Female ; Follow-Up Studies ; Humans ; Lumbar Vertebrae ; surgery ; Male ; Middle Aged ; Minimally Invasive Surgical Procedures ; Muscle, Skeletal ; surgery ; Spinal Fusion ; methods ; Treatment Outcome

OBJECTIVETo analyze the factors affecting the occurrence of adjacent segment degeneration (ASD) after lumbar internal fixation.

METHODSThe clinical data of 147 surgical patients with lumbar disc herniation, lumbar spinal stenosis and lumbar spodylolisthesis undergoing surgeries between January 2002 and July 2007 in our hospital were reviewed. The correlations of gender, range of fixation, position of fixation, and characteristic of the adjacent disc to the occurrence of ASD were analyzed.

RESULTSThe patients were followed up for a mean of 30-/+10 months (18-84 months). The incidence of ASD was 13.6% in these patients, occurring all at the cephalad adjacent segment. The presence of preoperative degeneration of the adjacent disc gave rise to increased risk of ASD following the surgery (chi(2)=6.272, P=0.012), and multivariate analysis indicated that preoperative adjacent disc degeneration was a risk factor for postoperative ASD (P=0.046), but gender, range of fusion and site of fusion were not the risk factors.

CONCLUSIONPresence of adjacent segment degeneration before the operation is associated with a significantly increased risk of postoperative ASD.

Adolescent ; Adult ; Aged ; Female ; Humans ; Intervertebral Disc Degeneration ; etiology ; Lumbar Vertebrae ; surgery ; Male ; Middle Aged ; Multivariate Analysis ; Retrospective Studies ; Risk Factors ; Spinal Diseases ; etiology ; Spinal Fusion ; adverse effects ; Spinal Stenosis ; pathology ; surgery ; Spondylolisthesis ; pathology ; surgery ; 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

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 study the role of cAMP in repair of hemisection of spinal cord in rats models.

METHODSRats models of spinal cord hemisection were made and cAMP were injected once in the motor cortex or continuously input in the lesion area or in the subarachnoid cistern for 3 d. NFs, GFAP, CSTs and spinal axons in the lesion areas were observed by immunohistochemistry and hind limb movements were evaluated in BBB scales.

RESULTSMany regenerated axons were presented in the lesion areas in cAMP groups though no continuous long regenerated axons traversed the lesion area when cAMP was input in the motor cortex or in the local lesion area. In control group, no regenerated axon were presented in the lesion areas. When cAMP was input in the subarachnoid cistern, only few-labelled CST axon survived and presented in the lesion area comparing no labelled CST axon presented in the lesion area. More NFs and less GFAP were distributed and extended in the lesion area in the cAMP groups. All the rats restored to normally walk 4-5 weeks after operations and no significance existed between cAMP groups and control groups comparing the BBB scales of hind limb movements.

CONCLUSIONcAMP injected in the brain cortex or continuously input in the lesion area can induce the axonal regeneration.

Administration, Topical ; Animals ; Cyclic AMP ; administration & dosage ; physiology ; Hindlimb ; physiopathology ; Male ; Nerve Regeneration ; drug effects ; Rats ; Rats, Sprague-Dawley ; Spinal Cord Injuries ; drug therapy ; physiopathology

OBJECTIVETo gain stable genetic modification of neural stem cells (NSC) that constitutively secrete brain-derived neurotropic factor (BDNF) and to explore the biological role on the survival and neurite outgrowth of cultured dorsal root ganglion (DRG) neurons.

METHODSBDNF gene fragment from human brain cDNA libraries was obtained by using PCR. With molecular cloning technique, the recombinant stem cell viral vector with report gene was constructed, which is that MSCV-BDNF-IRES(2)-EGFP vector could encode Polycistronic mRNA. Viral particle was packaged by PT67 cell line and infected neural stem cells (mouse clone: C17.2). After selection with cloning cylinder, the expression of BDNF was assessed by immunohistochemistry enzyme linked immunosorbent assay (ELISA) and reverse transcriptase polymerase chain reaction (RT-PCR). The effects of stable gene-modified neural stem cells on embryonic mouse DRG neurons were evaluated in a dual-chambered cocultivation system at 3th, 10th day.

RESULTSRT-PCR analysis demonstrated expression of mRNA for human-BDNF. ELISA confirmed the presence of secreted BDNF 24 h after transfection and showed that the level of BDNF production by NSC-BDNF transfected C17.2 was at a rate of (14.6 +/- 0.8) ng x d(-1) x 10(-6) cells even after 3 months. With immunohistochemical analysis, compared with the control, the longer neurite outgrowth of cultured DRG cells and the more survival neurons were observed in NSC-BDNF transfected cells group.

CONCLUSIONSBDNF gene could be stably expressed in C17.2 cell line by MSCV, and the BDNF gene-modified NSC markedly enhances the survival and neurite outgrowth of cultured DRG neurons.

Animals ; Brain-Derived Neurotrophic Factor ; biosynthesis ; genetics ; Cell Culture Techniques ; Cell Survival ; Cells, Cultured ; Coculture Techniques ; Ganglia, Spinal ; cytology ; Humans ; Mice ; Neurons ; cytology ; metabolism ; Rats ; Rats, Sprague-Dawley ; Stem Cells ; cytology ; metabolism ; Transfection

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