Objective To discuss the clinical efficacy and surgical indications of one?stage transforaminal debridement, interbody fusion combined with posterior instrumentation for thoracolumbar spinal tuberculosis. Methods All of 34 patients with thoracolumbar spinal tuberculosis were retrospectively analyzed,treated by one?stage transforaminal debridement, interbody fusion and posterior instrumentation from June 2010 to April 2013, including 21 males and 13 females, aged 21 to 64 years old, av?erage 38.2 years. All patients were treated by preoperative quadruple antituberculosis drugs therapy for 2-4 weeks, postoperative regular chemotherapy for 12-18 months. Preoperative and postoperative changes in clinical symptoms, nervous function, the situa?tion of the erythrocyte sedimentation rate (ESR) and C?reactive protein (CRP) with strict follow?up, as well as other related compli?cations were observed. The spinal fusion rate and fusion situation, changing of the physiological curvature, as well as loosening or breaking of the internal fixation device were detected through regular imaging examination. Results The surgery duration time was 60-150 min, average 110 min, and the blood loss was 80-550 ml, average 320 ml. Cerebrospinal fluid leakage occurred in one case. All of the operations were completed successfully without nerve or spinal cord injuries. Postoperative follow?up time was 1 to 4 years, average 2.5 years. Clinical symptoms improved significantly in three months after operation. The visual analogue scale (VAS) improvement rate was about 93%. All patients' ESR and CRP returned to normal levels at the last follow?up. The Kirkaldy?Willis function score showed that the total fine rate was 94%. 12 cases of patients had various degrees of neurological dysfunction before operation, which were back to normal at the final follow?up, except one case of ASIA class B turned to C. Inci?sion fistula formation happened in one case at the third months after surgery, and the wound was healed after debridement. All pa?tients got solid fusion between vertebral body, and there was no graft absorption or collapse, pseudarthrosis, tuberculosis recur?rence, and loosening or breaking of internal fixation devices. Cunclusion One?stage transforaminal debridement, interbody fu?sion and posterior instrumentation is a simple, effective and safety surgical approach, which has great application value for surgi?cal treatment of patients with thoracolumbar spinal tuberculosis.

Objective To evaluate the safety and effectiveness of one stage surgery of release and bone reduction by posterior approach to treat basilar invagination (BI) with irreducible atlantoaxial dislocation (IAAD),and to explore the indications and crucial techniques of posterior approach.Methods All of 17 Consecutive patients (8 males and 9 females) with BI and IAAD who underwent release and reduction by posterior approach from July 2000 to June 2015 were enrolled in the present study,the mean age was 35.2±13.8 years with a range of 12-56 years.The clinical symptoms and signs was recorded,and preoperative imaging examination,including anteroposterior,lateral,dynamic films,MRI and CT of cervical spine,were performed to identify the series.There were 14 cases with atlanto-occipital fusion,7 cases with C2,3 fusion,6 cases with Chiari malformation,6 cases with Syringomyelia,and 8 cases with myelomalacia.The clinic symptoms include occiput/neck pain in 15 cases,cervical movement limitation in 13 cases,short neck in 9 cases,torticollis in 12 cases,Paresthesia in 14 cases,weakness in 13 cases,tendon reflexes hyperfunction in 16 cases and ataxia in 13 cases.The postoperative X-rays,MRI or CT were used to observed the results of decompression,fixation and fusion.Neurological function was assessed by JOA scale and Ranawat's score before,after surgery and at final follow-up.Pre-and post-operative Chamberlain (CL),Wackenheim (WL),McGae (ML),atlantodental interval (ADI) and cervico-medullary angle (CMA) were analyzed by student t-test.Results The average operation time was 145 mins (90-210 mins) and blood loss was 175 ml (150-350 ml).The average follow-up was 44.47 months (9-94 months).JOA score was increased from 8.06 preoperatively to 15.20 postoperatively,the improvement rate was 77.2％.Preoperative Ranawat's score was Ⅱ in 1 case,Ⅲla in 12 cases,ⅢB in4 cases.Postoperative score was Ⅰ in 13 cases,Ⅱ in 4 cases.The preoperative CL,WL,ML,ADI and CMA were (12.52±5.17) mm,(6.59±3.04) mm,(6.96±4.32) mm,(9.88± 1.93) mm,115.35°± 12.40°,respectively.and the postoperative CL,WL,ML,ADI and CMA were (2.0±3.67) mm,(-3.06±1.85) mm,(-1.76±2.88) mm,(1.17± 1.18) mm,136.76°±11.44°,respectively.The perioperative complications were discovered in 2 cases,including 1 case of infection and1 case of cerebrospinal fluid(CSF) leakage.Conclusion Primary surgery of nerve release and bone reduction by posterior approach may be safe and efficient for the treatment of BI and IAAD.Preoperative evaluation,proper surgical indications and advanced surgical techniques are important for treatment results.

BACKGROUND:Spinal tuberculosis seldom involves cervical vertebra. The application of anti-tuberculosis drug has slight effects on patients combined with nerve dysfunction and severe vertebral destruction, which results in unstable cervical vertebra. OBJECTIVE: To evaluate biocompatibility of graft and host after one-stage anterior debridement graft fusion and internal fixation in the repair of adult cervical tuberculosis. METHODS: A total of 14 patients who suffered from cervical tuberculosis were admitted into Department of Spinal Surgery, First Affiliated Hospital, Xinjiang Medical University between May 2010 and June 2012. They underwent Zephir anterior cervical plate for one-stage anterior debridement graft fusion and internal fixation. RESULTS AND CONCLUSION:Compared with pre-fixation, erythrocyte sedimentation rate, C-reactive protein and visual analog scale score were lower in final folow-up (P < 0.05), and Japanese Orthopaedic Association score increased (P < 0.05). Except that Frankel grade recovered to grade D from grade C in one case, Frankel grade did not alter in the remaining patients. Compared with pre-fixation, Cobb angle was apparently shortened in seven patients with kyphosis. Folowing internal fixation, bone trabecula was visible between the vertebral body and graft region after fixation. No displacement, bone resorption, nonunion or pseudoarthrosis occurred. Neck pain and limited function relieved or disappeared to different degrees after fixation. These findings suggest this method can effectively treat cervical tuberculosis. Moreover, the biocompatibility of the plate and host is good.

Objective To observe endoplagmic reticulum stress in bone tissue of fluomsis rats and further explore the pathogenesis of skeletal fluorosis.Methods 48 Wistar rats were divided into 4 groups according to their body mass.The control and low.calcium group were fed with normal diet(0.79%calcium)and low-calcium diet(0.79%calcium)respectively,and both drank tap water(sodium fluoride concentrations＜1 mg/L).High fluoride and low.calcium plus high-fluoride groups were fed with normal diet(0.79%calcium)and low-calcium diet (0.79%calcium)respectively,and both drank tap water containing sodium fluoride(sodium fluoride concentrations 221 mg/L).During experimental period,rats were measured body mass once a week with a stand diet and water available ad libiturn.The experimental period was 3 months.The biochemical techniques were used to test the indicators of oxidative stress and ALP in seFum of fluorosis rats.The total RNA was extracted from the one side of the femur,and the transcription level of Bip,Xbp1,CHOP and PDI were investigated by reverse transcription polymerase chain reaction(RT-PCR).Results The level of MDA in serum of low-calcium plus high-fluoride group wag higher than that of the control[(14.74±3.11)μmol/L vs(10.15±1.96)μmol/L,P＜0.05];the activity of GPx was ma~edly higher in hish-fluoride group compared with the control[(3.87±0.41)×103 U/L vs(2.85± 0.55)×103 U/L,P＜0.05];the level of uric acid in sel'um was significantly lower both in high-fluoride group and low-calcium plus high-fluoride group compared with the respective control and the low-calcium group[(73.95± 9.52)μmol/L vs(110.43±25.48)μmol/L,(54.32±22.09)μmol/L vs(101.71±17.01)μmol/L,P＜0.05]. The activity of ALP wag obviously higher in low-calcium plus high-fluoride group compared with the control [(24.77±4.57)×103U/L vs (12.91±3.97)×103U/L,P＜0.01)].The mRNA expression of Bip/GAPDH in bone tissue was markedly higher in bone of high-fluoride group and low-calcium plus high-fluoride group compared with the control(1.38±0.24,1.35±0.12 vs 1.14±0.06,P ＜ 0.05). The expression of Xbp1/GAPDH in bone tissue significantly increased in low-calcium plus high-fluoride groups compared with the control and the low-calcium group (1.48±0.20 vs 1.02±0.25,1.07±0.25,P ＜ 0.05 or ＜ 0.01);and CHOP/GAPDH in bone tissue significantly increased in low-calcium plus high-fluoride groups compared with the control(0.84±0.18 vs 0.52±0.07,P ＜ 0.05 ). Conclusions Accelerated osteogenetic action is seen in fluorosis rats,accompanied by oxidative stress and bone endoplasmic reticulum stress,which is likely involved in the pathogenesis of skeletal fluorosis.

BACKGROUND:Telomerase reverse transcriptase plays an important role in telomerase activation, and lentiviral vectors carrying human telomerase reverse transcriptase that can inhibit astrocyte expression are rarely reported to have effects on spinal cord injury. OBJECTIVE:To transfect rat astrocytes with telomerase reverse transcriptase gene lentiviral vectors and to observe the effect of telomerase reverse transcriptase gene lentiviral vectors on apoptosis of astrocytes. METHODS: Astrocytes from rats were subject to primary culture and subculture, and then transfected with siRNA lentiviral vector carrying telomerase reverse transcriptase gene (siRNA transfection group), simple lentiviral vector (lentiviral vector group) and nothing (blank group), respectively. Then, the transfection efficiency and apoptosis in different time periods after transfection were determined. RESULTS AND CONCLUSION:The transfection efficiency was up to 85%-90% after siRNA lentiviral vector and simple lentiviral vector transfection. The apoptosis rate of astrocytes in the siRNA transfection group was 50%-60% at 24-48 hours after transfection, but there was no significant change in the other two groups. These findings suggest that siRNA lentiviral vectors carrying telomerase reverse transcriptase gene can accelerate astrocytes apoptosis.

28 days after injury (P < 0.05). In the fracture+spinal cord injury group, the level of serum transforming growth factor beta 1 had a rapid increase on the 7th day, and reached the peak on the 14th day, and then, this level had no significant decrease until the 28th day. In the simple fracture group, the level of serum transforming growth factor beta 1 began to increase on the 2nd day, reached the peak on the 7th day, and then decreased gradualy. Remarkable changes of serum transforming growth factor beta 1 levels in patients with bone fracture combined with spinal cord injury may be associated with fracture healing in different periods.

BACKGROUND:Telomerase reverse transcriptase (TERT) plays an important role in telomerase activation.
OBJECTIVE:To construct the targeting short hairpin RNA plasmid vector expressing TERT gene from astrocytes by using pLentilox3.7.U6.
METHODS:By using two sequences from TERT gene, we synthetized sense and antisense strand template sequences of RNA interference molecular in vitro, and then obtained the complementary strands through annealing procedure. We connected the strands with pLentilox3.7.U6 that was sequenced and transfected into the Escherichia coli. In the end, we tested its effect of reducing the TERT gene expressing by using cultured astrocytes from rat spinal cord in vitro through western blot and immunofluorescence technique.
RESULTS AND CONCLUSION:Western blot and immunofluorescence assay showed that, compared with the control group, the interference groups had a lower TERT expression in astrocytes. The targeting short hairpin RNA plasmid vector expressing TERT gene is useful to reduce the TERT gene expression. The targeting short hairpin RNA plasmid vector expressing TERT gene is valid for us to do the further test learning the mechanism of astrocytes in spinal cord injury.

BACKGROUND:In the animal model of spinal cord injury associated with fractures, the trauma is severe and postoperative survival rate is low. The improved Al en method and open femoral osteotomy method for making animal model has many advantages, such as simple operation, no need of special equipment, quick establishment, shortened operation time and reduced intraoperative bleeding, so they are suitable for preparing a femoral fracture model combined with spinal cord injury.
OBJECTIVE:To design an animal model of femoral fracture combined with spinal cord injury, which can maintain long time survival, meet clinical features, and is simple and easy.
METHODS:Forty-eight male Sprague-Dawley rats were randomly divided into simple femoral fracture group and femoral fracture merging spinal cord injury group. Femoral fracture model was caused by opening osteotomy to cause transverse fracture and implantation of internal fixator in femur. According to the improved Al en method, a self-made blow device was applied to cause acute T 10 segment contusion injury of spinal cord in rats. Thus the femoral fracture model merging spinal cord injury was successful y established. The rats in two groups were grossly observed at different time points after the modeling, and the fracture healing at 4 weeks was detected.
RESULTS AND CONCLUSION:Al the animal models of femoral fracture with spinal cord injury survived, which exhibited the loss of sensory and motor function of the lower limbs, but could slowly creep forward by the upper limbs. In the first 3 days, the rats had poor appetite and few activity, with tail suspension at night there were no ischemia and necrosis of the limb fracture. At 4 weeks, one rat in simple femoral fracture group died, while four rats in femoral fracture merging spinal cord injury group died, with the survival rate of 83.33%, intramedul ary fixation were not prolapsed. In the two groups, continuous bone cal us formation was found in the fracture, and the bone cal us volume in femoral fracture merging spinal cord injury group was significantly higher than those in simple femoral fracture group. The results demonstrated that combining the improved Al en method with smal lateral incision open femoral osteotomy is a simple and feasible method for the establishment of femoral fracture model merging spinal cord injury, and the models survive for 4 weeks.

BACKGROUND:As for patients with one-side backleg pain who were candidates for surgery treatment of lumbar intervertebral disc herniation, the common treatment includes lumbar vertebral plate opening and decompression, and laminectomy in combination with compression and bilateral pedicle screw fixation. However, these therapeutic approaches are not satisfactory. OBJECTIVE:To explore the feasibility and efficiency of single-side lumbar interbody fusion and unilateral pedicle screw fixation for treatment of lumbar intervertebral disc herniation patients with one-side backleg pain. METHODS:Forty patients with single-side lumbar disc herniation, suffering from unilateral backleg pain, were recruited from Shihezi People’s Hospital, China and were treated with single-side lumbar interbody fusion and unilateral pedicle screw internal fixation. The neurological function of patients was assayed using Japanese Orthopaedic Association score system before and after treatment, the improvement rate and excellent/good rate were calculated. Suk criterion was used to determine fusion status. RESULTS AND CONCLUSION:The mean fol ow-up period for 40 patients was ranging from 6 months to 60 months. Al incisions healed wel , with no infection. The Japanese Orthopaedic Association score after 6 months of treatment was significantly higher than that before treatment (P<0.05), with the excellent and good rate up to 88%. According to Suk criterion, 38 patients achieved bone graft fusion or possible fusion, with interbody fusion rate 95%, as revealed by radiographic and CT evidence. The remaining two patients were detected fusion at 9 months after treatment. Our findings indicate that, single-cage lumbar interbody fusion combined with single-side pedicle screw fixation is the feasible surgical technique and provides satisfactory effects in treating single-side lumbar disc herniation.

Humans ; Occupational Health ; Protective Devices ; utilization ; Welding