2.Evaluation of perioperative blood loss following total knee arthroplasty.
Ji-wei LUO ; Da-di JIN ; Mei-xian HUANG ; Hua LIAO ; Da-chuan XU
Journal of Southern Medical University 2006;26(11):1606-1608
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
3.Unilateral pedicle screw fixation plus interbody fusion by Quadrant system through spatium intermuscular of multifidus.
Qing-chu LI ; Hui-lin HU ; Hui-bo YAN ; Da-di JIN
Chinese Journal of Surgery 2010;48(17):1317-1320
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
4.Effects of mechanical vibration on the morphology of the acellular scaffold for the spinal cord.
Wen-hua YIN ; Da-di JIN ; Xu-yong DENG ; Kai-wu LU
Journal of Southern Medical University 2008;28(10):1748-1751
OBJECTIVETo investigate the effects of mechanical vibration on the morphology of the acellular scaffold for the spinal cord and establish a procedure to construct an acellular rat spinal cord allograft retaining intact matrix fibers for repairing spinal cord injuries.
METHODSFifteen segments of rat spinal cord were divided randomly into 3 groups and subjected to mechanical vibration at the frequency 80 r/min (group A, n=5), 120 r/min (group B, n=5), and 160 r/min (group C, n=5) respectively. The spinal cord was treated with Triton X-100 and sodium deoxycholate at room temperature and washed with distilled water. The specimens were observed microscopically with HE staining, and the ultrastructure was observed using scanning electron microscope.
RESULTSIn group A, the spinal cord specimens contained numerous cells and neural sheaths. Vibration at 120 and 160 r/min (in groups B and C) resulted in depletion of all the cells, axons and neural sheaths from the spinal cord after treatment with Triton X-100 and sodium deoxycholate. The acellular spinal cord consisted of a meshwork of the matrix fibers in longitudinal arrangement. In group C, however, obvious disruption of both the spinal dura mater and the matrix fiber occurred in the acellular spinal cord.
CONCLUSIONAll the cells, axons and neural sheaths in the spinal cord can be removed by chemical extraction with Triton X-100 and sodium deoxycholate. Mechanical vibration at suitable frequency may cell preserve the 3-dimensional structure of the matrix fibers. The acellular spinal cord scaffold may serve as an ideal material for constructing tissue-engineered spinal cord.
Animals ; Cell Separation ; methods ; Female ; Male ; Rats ; Rats, Sprague-Dawley ; Spinal Cord ; anatomy & histology ; cytology ; Spinal Cord Injuries ; therapy ; Tissue Engineering ; methods ; Vibration
5.Lithium chloride combined with human umbilical cord blood mesenchymal stem cell transplantation for treatment of spinal cord injury in rats.
Xu-yong DENG ; Rong-ping ZHOU ; Kai-wu LU ; Da-di JIN
Journal of Southern Medical University 2010;30(11):2436-2439
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
6.Factors affecting adjacent segment degeneration after rigid lumbar internal fixation.
Ze-zheng LIU ; Zhong-min ZHANG ; Da-di JIN
Journal of Southern Medical University 2010;30(5):1134-1137
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
7.The repair of acute spinal cord injury in rats by olfactory ensheathing cells graft modified by glia cell line-derived neurotrophic factor gene in combination with the injection of monoclonal antibody IN-1.
Hui-bo YAN ; Zhong-min ZHANG ; Da-di JIN ; Xiao-jia WANG ; Kai-wu LU
Chinese Journal of Surgery 2009;47(23):1817-1820
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
8.Evaluation of the biocompatibility of pectin/poly vinyl alcohol composite hydrogel as a prosthetic nucleus pulposus material.
Cao HUANG ; Da-di JIN ; Zhong-min ZHANG ; Dong-bin QU
Journal of Southern Medical University 2008;28(3):453-456
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
9.Kyphoplasty using an enhanced balloon expander: an experimental study.
Deng-jun ZHANG ; Jian-ting CHEN ; Da-di JIN
Journal of Southern Medical University 2006;26(5):705-710
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
10.Risk factors of secondary kyphotic angle increment after veterbroplasty for osteoporotic vertebral body compression fractures.
Jian-ting CHEN ; Ying XIAO ; Da-di JIN ; Kai-wu LU ; Jian-jun WANG
Journal of Southern Medical University 2008;28(8):1428-1430
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