BACKGROUND: Continuous passive motion assisted with diathermia will promote the restoration of joint movement of the extremities.OBJECTIVE: To improve joint movement with continuous motion assisted with diathermia after surgical treatment on simple fracture of upper or lower extremity.DESIGN: A randomized controlled trial.SETTING: Huaxi Hospital of Sichuan University.PARTICIPANTS: Eighty-four cases of simple extremity fracture treated in the Orthopedic Department of Huaxi Hospital of Sichuan University from October 2000 to July 2002 were included in this trial. Of them, 16 cases were elbow movement disorder and 68 were knee movement disorder. They were randomly assigned into two groups with 42 cases each.METHODS: The 42 cases in the treatment group were preheated before continuous passive motion while those in the control group just received continuous passive motion. The improvement of joint movement between thetwo groups were assessed and compared according to the joint movement scale.MAIN OUTCOME MEASURES: The joint movement before and after treatment and the indices of joint movement scale in the two groups.RESULTS: All of the eighty-four cases entered the analysis. The joint movement in the treatment group was better than that in the control group [ (101.40 ± 25.76)° vs (86.14 ± 27.66)°, t = 5.25, P ＜ 0.01 ]. The index of joint movement scale in the treatment group was also higher than that of the control group[ (84.32 ± 16.54) vs(64. 89 ± 13.76) ] ( t = 4.24, P ＜ 0.01 ) ].CONCLUSION: Continuous passive motion assisted with diathermia is better than simple continuous passive motion in improving the joint movement and function of elbow and knee.

ObjectiveTo evaluate the mid-term clinical effect of nano-hydroxyapatite and polyamide 66 (n-HA/PA66) intervertebral fusion cage in treatment of thoracolumbar burst fractures.Methods A total of 87 patients with thoracolumbar burst fractures were managed by thoracolumbar body resection combined with n-HA/PA66 intervertebral fusion cage from December 2007 to September 2008.The clinical effect, safety and radiographic outcomes were evaluated.Results No nerve damage was deteriorated in all the patients.The neural function was improved for 1-2 grade except for four patients at Frankel grade A.The patients were followed up for mean 21.3 months (17-24 months).The kyphosis was (14.4 ± 12.6)° preoperatively, (3.7 ± 8.7) ° immediately after surgery and (4.0 ± 8.3)° at final follow-up.The distance between the upper and lower vertebral bodies was (96.9 ± 17.2) mm preoperatively, (109.5 ± 17.1) mm immediately after surgery and (108.3 ± 16.4) mm at final follow-up.No cage replacement, internal fixation breakage or neurologic impairment were observed during follow-up period.There were 58 patients with grade E fusion, 22 with grade D fusion and 7 with grade C fusion.ConclusionsAnterior decompression combined with n-HA/PA66 intervertebral fusion cage is an effective method for treatment of thoracolumbar burst fracture.The kyphosis is rectified and the intervertebral distance is corrected, with a high rate of fusion.

Objective To analyze the relationship of the lateral angulation with the incision level after anterior approach operation for thoracolumbar fractures by evaluating the Cobb' s angle at different approach levels.Methods A retrospective study was done on 154 patients with thoracolumbar fractures treated consecutively with anterior operation from May 2004 to January 2008.The preoperative,postoperative and follow-up angle of coronal Cobb and the postoperative angle between screws and endplates on the anteroposterior radiograph were measured.According to the relationship between the injury vertebrae and the incision level,the patients were divided into two groups,ie,incision level ≥2 vertebrae group and incision level ≤ 1 vertebra group.Results All patients were followed up for 6-47 months(mean 37 months),which showed significant postoperative lateral angulation(P ＜ 0.01)especially at follow-up (P ＞ 0.05).The coronal Cobb' s angle showed insignificant difference before operation between two groups but it was increased after operation and during the follow-up(P ＜0.01).The screws A or B were more parallel to the endplate in two groups(P ＜ 0.01),while the parallel of the screws C or D to the endplate showed no statistical difference(P ＞ 0.05).Conclusions Compared with the operation with incision level ≥2 vertebrae,the operation with incision level ≤ 1 vertebra can more easily induce postoperative lateral angulation and exert a significant impact on implantation orientation of the vertebral screws A and B,which may indirectly lead to postoperative lateral angulation.

Objective To evaluate cause,treatment and prevention of esophageal fistula caused by anterior cervical spine surgery.Methods Between January 2004 and December 2011,2348 patients underwent anterior cervical spine surgery.Among them,5 patients suffered from esophageal fistula owing to operation,including 3 males and 2 females,with an average age of 34 years (range,14 to 48 years).The diagnosis of these patients included 3 cases of cervi(c)al injury,1 case of cervical spondylosis and 1 case of cervical tuberculosis.There was 1 patient whose esophageal injury was founded during the surgery,and that was directly repaired.For another 4 patients,esophageal fistulas were founded after operation; one case underwent debridement and orificium fistulae repair; one case only underwent debridement; one case underwent debridement and second-stage removal of hardware; and one case underwent debridement and second-stage removal of hardware and esophageal repair with sternocleidomastoid flap.Postoperative treatment included esophageal rest,enteral nutrition,wound drainage,and antibiotic administration.Methylene blue was used to evaluate status of orificium fistulae.Results All patients with esophageal fistula were cured 9 to 61 weeks after treatment,and oral intake was achieved.They were followed up for 6-48 months.There was no recurrence of esophageal fistula,cervical instability and infectious spondylitis in any ease.All patients were satisfied with swallowing function and outcome of cervical spine diseases.The Frankel grade was improved averagely one grade in patients with cervical injury,and the JOA score was improved from preoperative 9 points to postoperative 15 points in patients with cervical spondylosis.Conclusion Successful management of esophageal fistula caused by anterior cervical spinal surgery depends on primary closure of the perforation with or without muscle flaps,surgical drainage,esophageal rest and nutrition support,and removal of hardware if necessary.Prevention consists of the careful operation and gentle tissue handling.

Objective To investigate the clinical effect of vagus nerve preserving pericardial devascularization plus subtotal splenectomy in treating portal hypertension with a history of variceal bleeding.Methods The clinical data of 33 cases of portal hypertension with variceal hemorrhage treated with vagus nerve preserving selective pericardial devascularization plus subtotal splenectomy from April 2004 to December 2013 (study group) were compared with that of 34 cases treated with pericardial devascularization plus splenectomy (control group).Results There was no mortality in two groups.The postoperative gastric drainage during the first 72 h were(1 525 ±30) ml in the study group and (2 130 ±40) ml in control group(P ＜0.05).Portal vein thrombosis developed in one case in the study group and 15 cases in the control group(P ＜ 0.05).Postoperative 3-year recurrent gastroesophageal varices hemorrhage was 15％ in the study group and 25％ in the control group (P ＜ 0.05).Postoperative 5-year variceal hemorrhage recurrence rate were 28％ in the study group and 30％ in the control group (P ＞ 0.05).Conclusions Maitaining vagus nerve selective pericardial devascularization plus subtotal splenectomy is of less postoperative complication and lower portal vein thrombosis rate and better patients' survival compared with pericardial devascularizatim plus total splenectomy.

AIM: To investigate the use of therapy ultrasound to enhance nonviral gene delivery. METHODS: Endothelial cells (EC) and vascular smooth muscle cells (VSMC) were cultured in 6-well plates. Plasmid (pcDNA3.1/His/LacZ) with or without microbubbles at the different concentrations was transfected into the cells with the use of ultrasound for 1 min at 2 MHz, 1.8 mechanical index (MI). Additional controls included ultrasound alone, microbubble alone and microbubble plus plasmid. The rate of blue cells and the activities of ?-Gal were measured. In addition, cell viability was detected with different time from 1 to 30 min of ultrasound irradiation and the different concentrations of microbubbles. RESULTS: In the group of ultrasound with microbubble, the rate of blue cells and activity of ?-Gal markedly increased by 60% and 9-fold, respectively. Microbubbles at concentration of 10% led to the highest transfection effect. Ultrasoud exposure at 1 to 30 minute had no cell toxic effects, while microbubbles at the concentration of 50% had significant effect on cell survival. CONCLUSIONS: Albumin-coated microbubbles markedly enhance gene delivery by therapeutic ultrasound-mediated microbubble destruction, which can be used as a safe and practicality vectors in gene therapy.

ObjectiveTo explore the mechanism of estrogen inhibiting osteoblast apoptosis induced with serum hungry.MethodsOsteoblasts of the second or third generation from newly born SD rats calvaria were divided randomly into three groups: control group,serum hungry group,serum hungry with estrogen group.Cells of each group were incubated for 1,2,3,5,7 or 14 d,and then were stained immunohistochemically.The rates of positive cells of each group were analyzed.ResultsThere was a little positive expression of Bax,Bcl2 and Fas in control group.The expression of Bax and Fas were significantly increased(P<0.05)in serum hungry group,peak time was 14 d,but the expression of Bcl-2 were not affected.Compared with that of serum hungry group,the expression of Bax and Fas significantly decreased(P<0.05) in serum hungry and estrogen group,peak time was still 14 d,while that of Bcl-2 increased(P<0.05).ConclusionSerum hungry can increase the expression of Bax and Fas in osteoblast,that can be inhibited by estrogen.Estrogen can also increase the expression of Bcl-2 in osteoblast.All of these may play a role in inhibiting osteoblast apoptosis induced with serum hungry.

Objective To evaluate the clinical efficacy of anterior single segmental decompression and instrumentation through Endoring self-support retractor-assisted minimally invasive small incision approach in the treatment of Denis type B thoracolumbar burst fractures.Methods A retrospective case series study was made on 26 cases (14 males and 12 females,mean age of 48.5 years) of Denis type B thoracolumbar burst fractures treated by anterior single segmental decompression and instrumentation through Endoring self-support retractor-assisted minimally invasive small incision approach from January 2007 to June 2009.Age was 18-68 years (mean,48.5 years).The fractured vertebrae included T1 in three cases,L1 in 18 and L2 in five.The neurological status was Grade C in eight cases,Grade D in 12 cases and Grade E in six cases according to American Spinal Injury Association (ASIA) classification.The operation duration,blood loss and incision length were recorded.The neurological function,lower back pain were evaluated by visual analogue score (VAS),correction of kyphosis and restoration of the fractured vertebral body height followed and documented at 3,6 and 9 months and annually after surgery.The healing of the graft was assessed using Brantigan method based on 3-dimensional computed tomography at final follow-up.Results All patients were successfully managed with this approach.The operation duration was (214.6 ± 30.5)min,and the intraoperative blood loss was (389.7 ± 57.1) ml.The length of incision was (8.5 ± 1.3) cm.All patients were followed up for (6.3 ± 0.4) years.At final follow-up,the neurological functions of all patients with incomplete neurological deficit were improved for at least one grade.The VAS of lower back pain was improved from preoperative (7.8-± 1.6) points to (2.1 ± 0.8) points at final follow-up (P ＜ 0.05).The height of the intervertebral body was restored from preoperative (29.8 ± 5.3) mm to (35.2 ± 2.4) mm at final follow-up (P ＜ 0.05).The kyphosis was corrected from preoperative (20.4 ± 11.7) ° to (11.3 ± 5.5) ° at final follow-up (P ＜ 0.05).Bone fusion was achieved in all patients,with no looseness,breakage or displacement of internal fixation at follow-up.Conclusions Anterior single segmental decompression and instrumentation through Endoring self-support retractor-assisted minimally invasive small incision approach can reduce the surgical trauma,achieve complete spinal canal decompression,adjust kyphosis,fix segment,obtain high rate of bone graft fusion and hence is a safe and effective method with minimal invasion for Denis type B thoracolumbar burst fractures.

Objectives To assess the clinical outcomes,the technical characteristics of percutaneus endoscopic interlaminar decompression for lumbar lateral recess stenosis in elderly patients.Methods From May 2014 to June 2015,76 elderly patients with lumber lateral recess stenosis were accepted percutaneus endoscopic interlaminar decompression,including 48 males and 28 females aged from 60-91 years old (average,71.7:8.8 years).There were 40 patients with stenosis in L45,29 patients with stenosis in L5S1 and 7 patients with stenosis in L4.5 and L5S1.Back and leg pain were assessed by visual analogue scale (VAS).The influence of pain was evaluated by Oswestry disability index (ODI).The change of spinal canal was assessed by lateral recess angle.The MacNab criteria was evaluated at last follow-up.Results All of the 76 operations had been completed successfully with an average operation time of 64.3±23.9 min (range,56-98 min).An average follow-up time was 31.5 months (range,24-36months).There was no operative segment errors and nerve root tear during operation.Dural sac tear in 1 case,2 cases of nerve root injury and 1 case of postoperative kakesthesia,transient seizures after anesthesia occurred in 1 case and 1 case had postoperative delirium.There were significances in lumbocrural pain scores,leg pain scores and ODI scores between preoperation and postoperative 1,3,6,12 month and last follow-up (P＜0.05).In the MacNab last follow-up,the fineness rate was 92.1％,including 52 cases of excellence,18 cases of good,and 6 cases of fair.The latera recess angle between preoperation and postoperation was significantly different.During follow-up period,there were 3 cases developed into lumbar instability.No recurrence,discitis and leakage of cerebrospinal fluid were found,delayed incision healing was found in 1 case.Conclusions Percutaneus endoscopic interlaminar decompression for lumbar lateral recess stenosis in elderly patients is a safe,effective and minimally invasive method of operation with the characteristics of precise decompression of bone stenosis,sufficient resection of ligamentum flavum to decompress soft stenosis,small effect on spinal stability and low complications.

Objective:To summarize the existing problems and countermeasures of informed consent when children,one of the vulnerable groups in China,participate in clinical research,and further to provide reference for ethical review.Methods:We reviewed and comprehensively analyzed the domestic literatures that involved children and required informed consent.Results:Aiming at the unique physiological and psychological cognitive characteristics of children,this paper expounded the rationality of children's participation in clinical research and the timing of choice.It emphasized the existing problems in the process of informed consent such as inadequate informing,verbal acknowledgement,too long or too short time informed by the doctor-in-charge,as well as overspecialization of informed consent,inductive language,not describing potential risks and other incomplete information disclosure.According to these problems,the paper put forward some countermeasures.Conclusions:Informed consent of children's participation in clinical research should follow the general principles,consider children's characteristics,respect their willingness,and avoid unnecessary harm.