Clinical Medicine ; Delphi Technique ; Humans

Objective To describe sagittal pelvic pattern,and to analyze sagittal spino-pelvic alignment in asymptomatic Chinese adults.Methods This was a prospective radiological analysis.Anteroposterior and lateral radiographs of the whole spine were taken in 139 Chinese volunteers,including 94 males and 45 females,aged from 21 to 28 years (average,23.5±1.5 years).By using picture archiving and communication systems,several pelvic and spinal parameters (pelvic incidence,pelvic tilt,sacral slope,lumbar lordosis,thoracic kyphosis,cervical lordosis,sagittal vertical axis,apex of total lumbar lordosis,total lumbar lordosis,upper arc of total lumbar lordosis,lower arc of total lumbar lordosis,junctional level,apex of total thoracic kyphosis,total thoracic kyphosis,total cervical lordosis,and lordosis tilt) were measured and the correlations of all parameters were analyzed.Results The mean value of pelvic incidence was 45.1°±9.6°,which was significantly less than those reported in western and Korean subjects.Total lumbar lordosis has a significant correlation with pelvic incidence,sacral slope,total thoracic kyphosis,cervical lordosis and sagittal vertical axis.The sagittal lumbar-pelvic alignment was classified into 4 types according to position of apex of total lumbar lordosis:type Ⅰ (11 cases),the apex was located in L5 or intervertebral space between L4 and L5; type Ⅱ (61 cases),the apex was located in bottom or middle of L4; type Ⅲ (33 cases),the apex was located in upper part of L4 or in intervertebral space between L3 and L4; type Ⅳ (34 cases),the apex was located at L3 level or more high level.Conclusions The sagittal pelvic pattern of Chinese adults is significantly different from those of western and Korean.Lumbar lordosis plays a critical role in regulating spinal sagittal balance.With upper shift of apex of total lumbar lordosis,the lower lumbar lordosis angle and sacral slope increase,but the lordosis tilt decreases.

Objective To investigate the effects of different magnitudes of mechanical stress on human interverte-bral disc degeneration. Methods The human intervertebral disc cells were subjected to different magnitudes of mechanical stress (0, 6%, 12%, or 18%elongation) for 24 h using a Flexercell Strain Unit. The mRNA expressions of anabolic genes (col-lagen-1A1, collagen-2A1, aggrecan and versican) and catabolic genes (MMP-3, MMP-13, ADAMTS-4 and ADAMTS-5) were examined by real-time PCR and Western blot methods. Results The expression levels of collagen-1A1 and collagen-2A1 were increased at 12%of mechanical stress, and collagen-2A1 was decreased at 18%of mechanical stress compared with those of control. The mRNA expressions of catabolic genes, MMP-13 and ADAMTS-5, were increased at 12%and 18%of mechanical stress than those of control. The mechanical stretch induced a magnitude-dependent increase in ADAMTS-4 synthesis, which was finely tuned by stretching-triggered activation of distinct mitogen-activated protein kinase cascades. Specifically, an ERK1/2 specific inhibitor, U0126, significantly inhibited the stretching-induced ADAMTS-4 expression, whereas the inhibitors of p38 and JNK, SP6000125 and SB203580, showed only slightly effect on the stretching-induced ADAMTS-4 expression. Conclusion The different magnitudes of mechanical stretch exhibited different effects on the bio-logical behavior of intervertebral disc cells, which profoundly affects the intervertebral disc degeneration.

OBJECTIVE:To observe the effect of Sanhuang decoction combined with compound amino acid liposome healing membrane on treatment stage Ⅲ pressure ulcer. METHODS:According to the random number table,ninety cases of stage Ⅲ pres-sure ulcer were divided into control group A,control group B,and experimental group with 30 cases in each group. On the basis of the basic processing for each group,control group A was treated by dressing change with Sanhuang decoction only,control group B by dressing change with compound amino acid liposome healing membrane only,and experimental group by dressing change with Sanhuang decoction combined with compound amino acid liposome healing membrane. The results of treatment were observed and the curative effects were compared among 3 groups after 21 days or pressure ulcer healing. Three groups were com-pared with chi-square test and each two groups were compared with chi-square segmentation method. RESULTS:There was no dif-ference on total curative effect in control group A(62.1%)and control group B(66.7%)(P>0.05),however,there was statistical significance on total curative effect in experimental group(93.3%)and control group A(P<0.05),also in experimental group and control group B(P<0.05). CONCLUSIONS:The effect of Sanhuang decoction combined with compound amino acid liposome healing membrane on treatment of stage Ⅲ pressure ulcer is better than the effect of dressing change with Sanhuang decoction only or compound amino acid liposome healing membrane only,and the healing time of wound is shortened. This research is deserved further study.

Objective To evaluate the effects ofbeta-endorphin (β-EP) and substance P (SP)with sedative and analgesic drugs on mechanical ventilated patients. Methods Twenty-eight mechanical ventilated patients were randomly divided into two groups: midazolam group (M group, 14 cases) and midazolam combined with fentanyl group (M + F group, 14 cases). Eight healthy persons were as control group (C group). The sedative target was VAS≤3 scores and Ramsay 2-4 scores. The levels of serum β -EP and SP were tested before sedation and 12, 24 h after sedation in mechanical ventilated patients and at 8 Am in C group. The sedation levels were evaluated and the hemodynamie and respiratory parameters were recorded before sedation and 1, 12, 24 h after sedation in mechanical ventilated patients. The oxygenation index was measured before sedation and 1,12, 24 h after sedation. Results The levels of serum β -EP and SP in M and M+F group were significantly higher than those in C group(P< 0.05). After sedation, the level of SP in M+F group [(101.42 ± 12.46) ng/L]was significantly lower than that in M group [(132.72 ± 23.82) ng/L] (P < 0.05). Compared with before sedation, there were significant differences in heart rate, VAS and Ramsay scores between M group and M+F group (P< 0.05). Compared with M group, pressure airway and respiratory rate at 12, 24 h and total after sedation were lower in M+F group (P <0.05). The amount of serum SP in mechanical ventilated patients. Fentanyl improves the ventilator synehron and reduces the dose of midazolam.

Objective To evaluate the feasibility,safety and efficacy of surgical treatment of the thoracic and thoracolumbar disc herniations through the posterior far lateral approach,Methods From April 2005 to June 2010,24 consecutive patients with thoracic or thoracolumbar disc herniations were treated surgically,using the posterior far lateral approach.There were 15 males and 9 females with the mean age of 53.6 years old(range,25-69 years).The levels of herniated discs were located in T4-s,T5-6,T6-7 for 1 case,in T9-10 for 1 case,in T10-11 for 2 cases,in T10-11,T11-12,T12L1 for 1 case,in T11-12 for 3 eases,in T11-12,T12L1 for 3 cases,in T12L1 for 4 cases,in T12L1,L1-2 for 3 cases,and in L1-2 for 6 eases.There were one level disc herniation in 16 cases,two levels disc herniation in 6 cases and three levels disc herniation in 2 cases.16 out of 24 cases had "bony protrusions",including bony separation of the endplate,bony spur,disc calcification or OPLL.The average preoperative Cobb angle of localized kyphosis was 10.5°.According to the Frankel grading system,5 cases were classified as C,16 as D,and 3 as E,preoperatively.Results Average operation time was 3.5 h(2.0-4.5 h),and mean blood loss was 800 ml(300-4000 ml).Postoperative localized kyphosis was an average of 4.6°,with average correction rate of 56.2%.24 cases were followed up for 1 to 62 months,with an average of 18 months.According to Japanese Orthopaedic Association(JOA)criteria system,there were 12 cases(50.0%)with excellent outcome,9 cases(37.5%)with good outcome,and 3 cases(12.5%)with fair outcome.The postoperative Frankel grading were C for 1 case,D for 2 cases,and E for 21 cases.There were no complications intraoperatively and postoperatively.The symptoms were improved in all patients.Conclusion By using "safe triangular zone" and dekyphosis stabilization,the posterior far lateral approach was a relatively safe,reliable,effective and better view surgical procedure for the treatment of the thoracic and thoracolumbar disc herniations.

Objective To investigate the safety and efficiency of thoracic laminectomy with dekyphosis for thoracic myelopathy due to multi-segmental ossification of the posterior ligaments.Methods The clinical data of five cases of thoracic myelopathy due to multi-segmental ossification of longitudinal ligaments who were surgically treated in our hospital between August 2012 and March 2013 were retrospectively analyzed,among which two were male and the other three were female,with an average age of 52 (range,45-56) years old.The pre-operative duration ranged from 2 months to 6 years.All five cases were suffering from progressive bilateral partial paraplegia with an average preoperative JOA score 3.8 (range,3-6),an average segment-number of ossification of the posterior ligaments 7.6 (range,5-10),and also an average segment-number of 5.0 (range,2-10) ossification of the ligamentum flavum.All the five cases showed different kyphosis at the stenotic area of thoracic spine,with an average kyphotic angle (Cobb) of 35.8° (range,22°-56°).Their pre-operative Japanese Orthopaedic Association score (JOA) was 3.8 averagely (range,3-6).Clinical features,operation time,blood loss,perioperative complications and postoperative outcome were recorded.Results The segment number of laminectomy of these five cases was 8.2 averagely.The segment number of dekyphosis was 2 for 2 cases and 1 for the other 3 cases,with a average dekyphotic degree of 7.8° (range,2°-15°).The average operation time was 6.3 hours (range,5.5-7.0 hours) and the average blood loss was 3900 ml.The perioperative complications included cerebrospinal fluid leakage in 4 cases who were treated conservatively,and epidural hematoma in 1 case who underwent reoperation for removing the hematoma.All cases were followed up for 21 to 27 months,and their average final JOA score was 10,with an average recovery rate of 85.6％,and a rate of excellent or good was 100％ by the modified Epstein standard.Conclusion The result of thoracic laminectomy combined with dekyphosis for thoracic myelopathy due to multi-segmental ossification of longitudinal ligaments is quite satisfying,however this procedure is demanding with a long operation time,a huge blood loss and a high complication rate.

BACKGROUND: Forest frog is a rare medicinal animal in China, but the skin of forest frog is waste after Oviductus Ranae production. The forest frog skin is rich of collagen, and is large in quantity without pollution and disease risk. So the forest frog skin has potential to be developed into collagen sponge; however, there is no research on collagen sponge preparation as yet.OBJECTIVE: To optimize the preparation of collagen sponge from forest frog skin, and to investigate the physical properties and in vitro cell compatibility.METHODS: Chitosan and glutaraldehyde were used to modify collagen sponge from forest frog skin. Chitosan/collagen (w/w) (1:1, 1:2, 1:4) and glutaraldehyde concentration (1%, 1.5% and 2%) were selected as the experimental factors.The significant water absorbency, mechanical properties and thermal denaturation temperature were chosen as the indexes. Using the orthogonal experimental design, we optimized collagen sponge preparation process. We also investigated the in vitro cell compatibility and surface morphology of the collagen sponge. The nine kinds of collagen sponges from forest frog skins were co-cultured with human foreskin fibroblasts to detect cell proliferation.RESULTS AND CONCLUSION: When the chitosan/collagen was 1:1 and the glutaraldehyde concentration was 1%, we could get the collagen sponge with ideal water absorbency (water absorption capacity=5.22), mechanical properties (elongation at break=10.96%) and thermal denaturation temperature (81.24 ℃). The aperture of the forest frog skin collagen sponge was 200-400 μm, and the pores were consistent in the size and arranged regularly. Except the chitosan/collagen of 1:4 and the glutaraldehyde concentration of 1% or 5%, all kinds of forest frog skin collagen sponges could promote the viability of human foreskin fibroblasts and exerted benefits to cell viability and growth. To conclude,the forest frog skin collagen sponge has good biocompatibility and apparent morphology, in aggreement with the requirements of biological materials.

OBJECTIVETo provide reference for correct clinical treatment by summarizing the characteristics and surgical experience in spinal deformity of the upper thoracic (T(1)-T(4)) short angular kyphosis.

METHODSMedical history was taken in 15 cases are reviewed. The results of X-ray and MRI examinations were analyzed. The kyphotic angles were measured using the Cobb technique. All cases underwent the anterior spinal cord decompression, by posterolateral approach in 4 cases and posterior in 11 cases.

RESULTSKyphosis was congenital in 7 cases and due to tuberculosis approach in 8 was. The average age at deformity was first noted was 3.6 years in 7 congenital cases and 9.0 years in 8 tuberculosis cases. All cases had neurologic deficits. The mean kyphosis was 86.5 degrees (range, 45 - 100 degrees). The delay between first observation of the deformity and subsequent neurologic loss was 16.5 years and 18.1 years respectively. The operation failed in 1 case. 13 cases were followed up, with an average 42 months. Seven cases showed improvement, 2 no change and 4 deterioration in neurologic deficit.

CONCLUSIONSIn cases of or tuberculosis kyphosis, the usual time for kyphosis to occur is during the preadolescent growth spurt. Neurologic deficits may occur without treatment and will be always progressive. The result of operation is not satisfactory. Early diagnosis and adequate management of kyphosis will prevent progression and thus any possible spinal cord compression. Early fusion is usually necessary to control the kyphosis.

Adolescent ; Adult ; Aged ; Child ; Female ; Follow-Up Studies ; Humans ; Kyphosis ; diagnosis ; surgery ; Male ; Middle Aged ; Thoracic Vertebrae

Objective: To evaluate the efficacy and safety of Smith-Petersen osteotomy (SPO) assisted by releasing disk space from posterior approach for thoracolumbar kyphosis. Methods: A review was conducted on 8 patients (3 males and 5 females) with thoracolumbar kyphosis were treated with SPO assisted by releasing disk space from posterior approach at Department of Orthopaedics, Peking University Third Hospital from June 2016 to September 2017. The age was 56.5 years (range:18-71 years). There were 3 cases of Scheuermanns kyphosis, 2 cases of degenerative kyphosis, 1 case of proximal junctional kyphosis (PJK) after lumbar surgery, and 2 cases of kyphosis after thoracolumbar laminectomy. The paired t test was used for statistical analysis in thoracolumbar kyphosis angle, osteotomy segment kyphosis angle, sagittal vertical value (SVA), visual analogue score (VAS), Oswestry dysfunction index (ODI) before and after surgery. Statistical difference was confirmed with P<0.05. Results: Osteotomy level included 2 cases in T_11-12, 3 cases in T₁₂-L₁, 3 cases in L_1-2. The average operation time was 339 min (range: 247-416 min), bleeding volume was 1 275 ml (range: 500-2 500 ml). The mean follow-up time was 16.5 months (range: 12-24 months). The average thoracolumbar kyphosis angle was 59.9° (range: 40°-73°) pre-operation, 9.5°(range:-5.1°-20°) post-operation and 13.5°(range:-1.3°-28°) at the latest follow-up. It made an average correction with 46.4°and corrective rate with 78.0%. The osteotomy segment kyphosis angle was 37.9° (range: 26°-46°) pre-operation, -1.3° (range:-11°-13°) post-operation making an 39.2° open-up angle, and 2.0° (range:-13.5°-13°) at the latest follow-up. Lumbar lordosis was 47.5° (range: 2°-76°) pre-operation, 41.2°(range:15°-62°) post-operation and 36.9°(range:15°-58°) at the latest follow-up. SVA was 54 mm(range:-34 mm-149 mm) pre-operation and 39 mm(range:-3 mm-119 mm) at the latest follow-up. VAS score of low back pain was 6.3(range:0-9) pre-operation and 3.0(range:0-6) at the latest follow-up. ODI score was 21.9(range: 0-42) pre-operation and 11.0(range: 0-26) at latest follow-up. Comparing to pre-operation value, there were statistical difference in the thoracolumbar kyphosis angle(t= 8.547, P=0.000), osteotomy segment kyphosis angle(t=9.739, P=0.000), VAS(t=3.077, P=0.018), ODI(t=5.800, P=0.001) at the latest follow-up. There was no neuropathic complication in all patients. Cerebrospinal fluid leakage occurred in 2 cases with spinal surgery history, and recovered after symptomatic treatment. Conclusions SPO assisted by releasing disk space from posterior approach could safely achieve effective correction of rigid thoracolumbar kyphosis deformity within 40°.