Objective To study the clinical features,surgical treatments and the prognosis of the103patients with the metastatic tu mors in the spine.Methods From Jan.1996to Dec.2001,103cases were treated by operation in our department,there were62males and41females,aging from33to79years old(average,59years).The lesions were located at cervical spines in34cases,thoracic spines in39,lumbar spines in25and sacrum in5.The patients underwent anterior,posterior,combined or staged antero-posterior operations based on the location of lesions in the spine.Most of the patients were adopted vertebral recon-struction and internal fixation depending on the conditions.Preoperative clinical evaluation included of gen-eral condi tions,X-ray films,CT scan,MRI and ECT in order to decide the endurance of the patient to the sur gi cal treatment.The operation was only considered when the patient could have the ex pected survival time more than6months.Operative indications,surgical methods and prognosis were analyzed and summa -rized.Re sults The postopera tive follow-up ranged from6months to5years.No death related to the op-eration.Eighty-five of 103cases had partial or even complete relief of local pain and radiculopathy,54cases were im proved in neu rological status caused by spinal cord compression.The postoperative survival rates at6months,one year,two years,three years and four years intervals were97.1%,90.3%,44.7%,29.1%and8.7%respectively,9patients survived more than4years.Conclusion Local pain was the predomi nant symptom in metastatic tu mor of spine,and some of them suffered from spinal cord and nerve compromise.The surgical treatments for the spinal metastatic diseases were indicated depending spinal instability,progressive neurological deteriora tion,in tractable pain,or the need for histological diagnosis.The most im por tant factor being consid-ered was the patient's condition when operative treatment was decided.The anterior,posterior,combined or staged antero-poste rior operations were influenced by location of lesions in the spine,en durance of the patient,life ex pectan cy and so on.Surgical interven tion could stabilize and reconstruct the spine,relieve pain,maintain or improve the neurological status of the patients,thus improve the life qualities in limited life expectancy pa-tients.[

Objective To investigate the results of surgical treatment of atlantoaxial instability through posterior approach. Methods Seventy eight patients with atlantoaxial instability were used for this collective review, the patients included 38 with unstable odontoid fractures,15 with os odontoideum,8 with a disrupted transverse ligament, 6 with C1,2 tumor,6 with congenital occipitocervical abnormalities,5 with old Jefferson fractures. There were 57 males and 21 females. The mean age of the patients was 42 years(range, 3-78 years). All patients were treated by operation. Thirty seven patients were operated upon by atlantoaxial arthrodesis using wire fixation with autologous bone grafts. Nine were treated by C1,2 posterior wiring fixation and atlantoaxial facet screw fixation. Nine were operated on by atlantoaxial arthrodesis using Apofix interlaminar clamping with autologous bone grafts. Occipitocervical fusion was performed in 32 patients, arthrodesis simple with autologous bone grafts and external fixation was done in 11 patients. CD-Cervical fixation was used in 11 patients. Cervifix fixation was used in 10 patients. Results The patients were followed up for an average of 38.4 months(range, 6-216 months). Solid arthrodesis was obtained in 75 patients and non union in 3 cases. All the non union cases occurred after occipitocervical fusion. Conclusion Posterior fusion is recommended for atlantoaxial instability due to traumatic fracture or ligament disruption, tumor, inflammatory, skeletal dysplasias, congenital abnormalities. It is emphasized that adequately controlling atlantoaxial motion, meticulously preparing the fusion bed are the important measures for successful operation.

Objective To investigate the clinical characteristics, surgical staging of primary tumors of cervical spine, the effects of different surgical approach and operative method. Methods The location, characteristics,surgical staging, clinical manifestation of tumors, different operative approach and opertative methods were described respectively. Surgical staging of the tumors in 45 cases was divided into four stages: 10 cases in stageⅠ,11 cases in stage Ⅱ, 9 cases in stage Ⅲ, 15 cases in stage Ⅳ. Eleven cases were treated with intracapsule excision, 18 cases by marginal excision, 15 cases by wide excision. Results The following up period lasted from 6 months to 10 years(average 3 years). One case with upper cervical spine tumor died from quadriplegia, respiratory and circulatory failure 10 days after operation. The short term results after operation were satisfactory in 44 cases. The local pain and neurological symptoms were improved or resolved. Megrim in 2 cases disappeared;1 cases with malignant nerve sheath tumors and 1 cases with chondrosarcoma died from metastasis, and systemic failure in 13 months, 24 months. Tumors focus recurred one year after the surgery in 1 case with osteoblastomas, 1 case with chondrosarcoma and 1 case with giant cell tumor. Conclusion The surgical approach and operative methods must be selected according to the location, surgical staging, characters of tumors; operative methods and postoperative comprehensive therapy play important roles on prognosis of the tumor cases.

Objective To retrospectively study the character, surgical interventions of chordomas in the cervical spine. Methods All the clinical data of 8 cases of chordoma arising in the cervical spine which under went surgical treatment in our department from 1989 to 2006 were retrospectively reviewed, which including 5 males and 3 females. The patients ranged from 34 to 72 years at diagnosis, with an average age of 53.8 years. Surgical interventions were defined according to WBB criteria. 3 patients underwent subtotal centrum or total centrum resection, 2 patients underwent sagital resection and 2 patients received subtotal or total spondylectomy. Extracapsular excision was performed in a intradural invasion case. Autogenic iliac blocks were used as bone graft in 5 cases and titanium mesh with bone cement filling-in for anterior pedestal in 2 cases for reconstructing the stability of spine. Radiation therapy was given as an adjuvant treatment after surgery. Results Symptom of nerve root irritation disappeared or relieved prominently and the patients suffering spinal cord compression symptom got well recovery with at least 1 or 2 levels after operation. The typical “Physaliphorous cell” could be found in the oncologic examination in all those cases. Follow-up average 43.5 months, ranged from 3 to 120 months. All the internal fixation got well fusion and the rate of fusion for the bone graft was 100%. There were 4 cases in which the postoperative local recurrence of the tumor can be seen, with one patient dead of complications of high paralysis, but no local recurrence was observed in the cases which received total spondylectomy. No evidence of distant metastasis was observed in 7 cases for our series except the special intradural case which had the operation history for “sacral chordoma” before. So we consider it as a intradural metastasis case of the primary sacral chordoma. Conclusion Chordomas are rarely seen in the cervical spine and the typical clinical manifestation is rare in pristine cases. So we should think highly of the CT and MR examination for diagnosis. Total spondylectomy with postoperative radiation therapy could lower the rate of local recurrence.

Objective To investigate the clinical characteristic, surgical stage, operative approach, resection and stability reconstruction of dumbbell intra-extradural tumor of cervical spine. Methods From January 1999 to December 2005, 37 consecutive cases with cervical dumbbell intra-extradural tumor were retrospectively studied. 18 males and 19 females ranged from 18 to 80 years old were involved in this study, including 25 schwannomas, 3 neurofibromas, 5 multi-neurofibromas and 4 malignant schwannomas. According to tumor location and involved range, all tumors were divided into five stages: 8 cases in Ⅰ stage, 9 cases in Ⅱstage, 13 cases in Ⅲ stage, 5 cases in Ⅳ stage and 2 cases in Ⅴ stage. Resection and reconstruction were performed at 20 patients through posterior-lateral approach, 17 patients through anterior-lateral combined with posterior-lateral approach. Lateral mass screw internal fixation system were used in 26 cases, while anterior combined posterior fixation were performed in 5 cases and none fixation in 6 cases. Results The follow-up period was from 3 months to 7 years. 1 case developed a transient weakening of upper limb, 1 case developed anesthesia in posterior neck, and 1 case developed Horner's sign. Vertebral artery ligation was performed in 1 case because of vertebral artery injury. 2 cases with malignant schwannoma occurred local recurrence in 1-2 years postoperation and received second operation. The recent effects after operation were satisfactory in majority cases,with complete recovery of spinal cord function in 19 cases. 2 cases without fixation appeared recuration deformity in cervical spine in 1-2 years postoperation. Conclusion The surgical approach and operative methods must be selected according to the location, surgical staging, characters of tumors. Stability reconstruction plays important roles in maintaining stability of cervical spine. More care should be taken in procedure for protecting vertebral artery, cervical nerve and spinal cord.

Objective To study the effect of Schwann cell enclosed by antibody of neural cell adhesion molecule L1 on injured spinal cord. Methods Over 98% of the purity of Schwann cells obtained from bilateral sciatic nerves of 2 days newborn SD rats, the concentration of Schwann cells was about 2.5?104 /?l. The Schwann cells were enclosed by the antibody of neural cell adhesion molecule L1 using co-culture. The adult SD rats (weight 200-250 g) were used to establish the model of spinal cord injury by hemi-transection at the left side of T10 level. The animals were divided into three groups; the SC group was transplanted with 20 ?l suspension Schwann cells; the anti-L1 group with 20 ?l Schwann cells enclosed by antibody of neural cell adhesion molecule L1; and the control group was injected solely with normal saline to the injured cord. Eight weeks later regenerated neural axons were investigated through horseradish peroxiase HRP retrograde trace immunohistochemistry of neurofilament and Western blot. Results Few regenerated neural axons appeared in the control group; some of regenerated neural axons could be observed in anti-L1 group; plentiful and bulky regenerated neural axons were found in SC group. The group with antibody had significant less HRP positive neurons and neural axons than the group without antibody. Western blot showed that the quantity of neurofilament in the anti-L1 group was only two thirds of the SC group. Conclusion Schwann cell-derived neural cell adhesion molecule L1 is able to enhance the neural axon regeneration of injured spinal cord.

Objective To study the clinical features, treatment strategy and prognosis of children and adolescent with spinal bone tumors. Methods Forty-three patients were retrospectively investigated from January 1987 to June 2002, thirty-one of which were male, and the others were female. The age of patients ranged from 3 to 16 years with an average of 11.8 years. The pathological examination suggested that tumor-like conditions were 11 cases (25.6%), benign tumors 13 cases (30.2%), and malignant tumors 19 cases (44.2%). The cervical vertebrae tumors were 15 cases, thoracic vertebrae 16 cases, lumbar vertebrae 6 cases, and sacral vertebrae 6 cases. Treatment included: 1 case of malignant lymphoma was only subjected to chemotherapy; and the others were undertaken tumor resection and bone grafting to fusion with or without internal fixation. All patients of malignant tumors were performed adjuvant radiotherapy or chemotherapy after operation. Results The follow-up period was from 1 to 10 years with an average of 4.3 years. All patients of benign tumors obtained satisfied outcomes with local symptom and neural deficits improved, and no tumor recurrence happened. 6 cases (2 cases of primitive neural ectodermal tumor, 1 case of Ewing's sarcoma, 1 case of neuroblastoma, 1 case of plasma cell sarcoma and 1 case of chondrosarcoma) of malignant patients were died from metastasis and systemic failure, and the ratio was 14% and 31.6% of total and malignant tumor respectively. One case of bone giant cell tumor and 1 case of Schwannoma got recurrence at 2.5 years and 10 months after operation respectively. Conclusion For patients of children and adolescent with spinal bone tumors, the prognosis of the benign is better if tumors were removed radically. However, the patients with malignant tumors had worse prognosis with higher recurrent or death rate, and its prognosis is closely correlated to tumor's characters, operation strategy, and extending postoperative therapy.

AIM: To investigate the effect of indomethacin on prevention of heterotopic ossification (HO) after operative treatment of total hip replacement. METHODS: Forty patients taking indomethacin after total hip replacement were enrolled at First Hospital Affiliated to Zhengzhou University from February 2003 to February 2005 as medication group. Forty patients received the same operation were enrolled from February 1996 to February 1999 as control group. The patients in the medication group were taken indomethacin from the first day after operation, 50 mg/times, twice a day, for 3 weeks. The patients were successfully followed up immediately before the end of the operation, at weeks 3, 12, months 3, 6 and 12 after operation. Follow-up included X-ray at normal position of double hips, oblique position of obturator foramen and oblique position of iliac bone to assess the incidence of HO. Hip joint function was assessed according to modified d'Aubigne and Postel standards. RESULTS: Follow-up was performed in 40 patients of the medication group. The follow-ups averaged 21.2 months (ranged from 6 to 37 months). HO occurred in six cases. According to Brooker evaluation of HO, four cases were rated as degree Ⅰ, two as degree Ⅱ, and none as degree Ⅲ or Ⅳ. The incidence of HO was 15%. In the control group, totally 40 patients were followed up, averagely 27.1 months ranged from 5-60 months. The incidence of HO was 40% (16/40). Five patients developed severe HO. Significant differences were found in the incidence of HO and severe HO of the two groups (P

Objective:To investigate the influence of different depression degree status on the clinic symptoms and survival status in the patients with metastasis tumor in spine (MTS). Methods: By using Zung's self rating depression scale (SDS), we studied 125 patients with MTS between 1999 and 2001. Results: It was found that 44% patients with MTS were affected by depression. The survival period in the negative depression group(NDP) was longer than that in the moderate and the severe groups after a mean of 21 months follow up( P

Objective:To study the influence of anti-tumor drug incorporation on the physicochemical properties of calcium phosphate cement(CPC).Methods: Methotrexate(MTX),epirubicin(EPI),hydroxy camptothecin(OH-CPT),and arsenic trioxide(As_2O_3) were incorporated,each in a proportion of 2%,5%,and 8%,into the powder-phase CPC.Untreated CPC was taken as control.The setting time,compression strength,and the microstructure of the resultant products were evaluated and tested.Results: Compared with control group,the setting time was significantly prolonged when 2% EPI was incorporated into CPC(P