OBJECTIVETo comparatively study the efficacy and safety of unilateral and bilateral balloon kyphoplasty in the treatment of painful multi-vertebral osteoporotic compression fractures.

METHODSFrom May 2002 to June 2007, 41 consecutive patients with painful multi-vertebral osteoporotic compression fractures underwent unilateral or bilateral kyphoplasty. The unilateral group included 3 male and 14 female with an average age of 70.4 (range 52 to 91 years old). The bilateral group included 4 men and 20 women with an average age of 72.4 (range 61 to 87 years old). Each procedure included insertion of inflatable balloon, fracture reduction and cement filling under "C"-arm monitoring. Preoperative and postoperative pain level, SF-36 score, radiographs and complications were recorded and analyzed.

RESULTSAll 41 patients tolerated the operation well. The mean operation time were (86 +/- 32) min and (120 +/- 26) min for unilateral and bilateral groups respectively; the mean volume of cement injected into one level were (3.9 +/- 1.6) ml and (5.4 +/- 2.1) ml for unilateral and bilateral groups respectively. The mean follow-up were (32.5 +/- 17.2) months and (30.7 +/- 14.3) months for unilateral and bilateral groups respectively. The mean VAS pain score of unilateral group decreased significantly from 7.4 +/- 2.1 preoperatively to 2.7 +/- 1.9 postoperatively (t = 2.50, P < 0.05) and 3.1 +/- 2.2 at final follow-up, the mean VAS pain score of bilateral group decreased significantly from 7.9 +/- 2.1 preoperatively to 2.3 +/- 2.5 postoperatively (t = 2.41, P < 0.05) and 2.7 +/- 2.2 at final follow-up, no significant difference was found between two groups. Significant increase of the mean height of anterior and medial vertebral body were recorded after the operation and maintained at final follow-up. The mean correction of local kyphosis was 7.2 degrees +/- 4.9 degrees for unilateral group and 7.3 degrees +/- 5.9 degrees for bilateral group, no significant difference was found between two groups. Postoperatively, 6 of 8 subscales measured by SF-36 were significantly improved for both groups. Complications were found in 7 patients including 6 cases of cement leakage and 1 case of pulmonary embolization.

CONCLUSIONAs a minimally invasive procedure, unilateral or bilateral kyphoplasty is effective and relatively safe for multi-vertebral osteoporotic compression fracture.

Aged ; Aged, 80 and over ; Female ; Follow-Up Studies ; Fractures, Compression ; etiology ; surgery ; Humans ; Male ; Middle Aged ; Osteoporosis ; complications ; Spinal Fractures ; etiology ; surgery ; Treatment Outcome ; Vertebroplasty ; methods

Objective To discuss the histology change,apoptosis state and Bcl-2,Bax expression after the bone cement leakage into the intervertebral disc in vertebroplasty.Methods Eight majority canis familiaris were studied.Three lumbar intervertebral discs(L2 to L5)in each dog were randomly classified into three groups(control group,PMMA group,and CPC group),the canine discs were stabbed by 18-gauge needle,and 0.1 ml cement was injected into them.Control discs were only stabbed and injected with nothing.Histology of all discs was studied 24 weeks after the operation.Terminal-deoxynucleotidyl transferase mediated nick end labeling(TUNEL)and immunohistochemisty were used to detect apoptosis and Bcl-2,Bax expression in the discs.The data were statistically analyzed by SPSS 12.0.Results Intervertebral disc degeneration was not found in control groups.In bone cement groups,however,ruptured or serpentine patterned fibers,decreased cellularity of the nucleus pulposus and condensed matrix of the nucleus pulposus were found in histologic results.The Bax protein decreased in the order of control group, CPC group,and PMMA group.However,the Bcl-2 protein increased in the order of control group,CPC group,and PMMA group.The histology grade was significantly different among the three groups under ANOVA analysis(P

Objective To study the clinical outcomes of titanium-coated interbody fusion system in treating lumbar isthmic spondylolisthesis.Methods A retrospective study was made in 22 cases with lumbar isthmic spondylolisthesis including 15 with degree I spondylolisthesis and seven with degree II spondylolisthesis treated by posterior lumbar interbody fusion using titanium-coated fusion cages from June 2002 to December 2003 in our hospital.There were six males and 16 females,with age range of 41-68 years(mean 52.5 years).In all cases,double cages were implanted with additional posterolateral bone graft,supplemented with pedicle screw systems.The average preoperative and postoperative disc space height,foraminal height,segmental and lumbar lordosis,spondylolisthesis and domain of sagittal rotation on flexion-extension radiographs were measured and fusion state observed.The Oswestry disability index (ODI)was used to evaluate the clinical outcome.Results The fusion rate was 95.4%.There was significant recovery of disc space height,foraminal height and domain of sagittal rotation.ODI decreased significantly.Conclusion The anatomic titanium-coated fusion system is effective and safe in treatment of lumbar isthmic spondylolisthesis because it has advantages in restoring sagittal alignment and keeping bony endplate intact.

Objective To explore the feasibility of artificial silastic framework(SF)in repair of large area of tracheal wall defects.Methods Twenty healthy adult dogs with tracheal defects for 2.5 cm?6.0 cm-3.0 cm?6.0cm were randomly and equally divided into experimental group(repaired with SF combined with sternohyoid fasciae)and control group(repaired with T-silastie tubule combined with sternohyoid fascial flap).After the operation,the animals were sacrificed at the 4th,8th,16th,24th, and 48th weeks respectively for harvesting the tracheae that were used for tracbeoscopically observing in- flammatory reaction of the repaired defect area and light microscopically observing epithelium healing on the repaired defect area.Results In the experiment group,the repaired trachea was smooth,without proliferation of granulation;and at the 8th week,the repaired defect area was covered with epithelial cells,with good functional recovery of respiration,phonation and deglutition.In the control group,there was obvious proliferation of granulation on the tracheal surface near anterior and posterior ends of T-silas tic tubule.The animals were under asphyxia to die with extraction of T-silastic tubule.Conclusions SF has excellent tracheal skeletal function.In the meantime,SF combined with sternohyoid fasciae is a simple but effective method for repair of large area of tracheal wall defects.

Objective:To study the modulatory effect of hydrogen sulfide (H2S) on oxidative stress in the development of pulmonary hypertension induced by hypoxia. Methods:Twenty male Wistar rats were randomly divided into control group (n=6), hypoxic group (n=6) and hypoxia+NaHS group (n=8). Hypoxic challenge was performed everyday for 21 days. NaHS solution was injected intra-peritoneally everyday before hypoxic challenge for rats in the hypoxia+NaHS group. After 21 days of hypoxia, the mean pulmonary artery pressure(mPAP) was measured by cardiac catheterization. The weight ratio of right ventricle to left ventricle+septum [RV/(LV+SP) ] was also measured. The lung homogenates were assayed for total antioxidant capacity(T-AOC), superoxide dismutase (SOD), oxidized glutathione (GSSG), reduced glutathione (GSH), malondiadehyde(MDA) and hydroxy radical(?OH), and the SOD mRNA levels were assayed by real time polymerse chain reaction. Results: After three weeks of hypoxic disposure, hypoxic hypertension and vascular remodeling developed. Compared with the control group, the mPAP[(23.7?2.2) mm Hg vs. (16.3?3.7) mm Hg,P

Since the late 20th century owing to the improvement of spinal surgery techniques, the diagnosis and treatment of thoracolumbar fracture have been perfected more and more. Although the advent of modern spinal surgery in China was late, we have gained some advanced achievements owing to various international communications benefited from the open policy. Therefore, it is essential to evaluate the current status and perspective of diagnosis and treatment of thoracolumbar fracture. There are several issues we would like to discuss here.
China ; Female ; Follow-Up Studies ; Fracture Fixation ; standards ; trends ; Fracture Healing ; physiology ; Humans ; Injury Severity Score ; Lumbar Vertebrae ; injuries ; Male ; Quality of Health Care ; Spinal Cord Injuries ; prevention & control ; Spinal Fractures ; diagnosis ; surgery ; Thoracic Vertebrae ; injuries

BACKGROUND:Oversize stress of a dental implant and its surrounding tissue is the main factor to affect the
long-term use of dental implants. So, the reasonable and precise design of implant shape is one of the important methods of prolonging the life span of dental implants.
OBJECTIVE:To make the optimal analysis and design of the diameters of connector screw and central screw of the adjustable-angle dental implant invented in the earlier stage.
METHODS: The finite element analysis model of the edentulous mandible with adjustable-angle dental implant was established by software Pro/E 5.0, Mimics 10.0 and ANSYS Workbench 14.5. The maximum equivalent
stress of dental implant-edentulous mandibular model was analyzed.
RESULTS AND CONCLUSION:The maximum equivalent stress of dental implant-edentulous mandibular model

OBJECTIVETo provide appropriate guidelines for treatment of tandem ossification of the posterior longitudinal ligament (OPLL) and flaval ligament (OFL). Data sources Published articles about OPLL and OFL were selected using Medline and Embase electronic databases. Study selection An English literature search from January 1980 to December 2006 was conducted. Because many reported cases were incorporated in OFL studies, the key words for search were OFL or OFL and OPLL. The first step revealed 93 studies of which 13 reports of tandem OPLL and OFL (tandem ossification) were selected.

RESULTSAll studies were case series or case report and advocated that the primary therapy for tandem ossification should be operative. The clinical outcomes of surgery were evaluated in most reports, predominantly using the JOA scores. Gender is the only factor which has prognostic value. A higher proportion of women was found in the failure group. A two-stage classification of tandem ossification was developed to relate diagnosis to outcome.

CONCLUSIONSAll patients with suspected ossification of the spinal ligaments should undergo routine MRI screening of the whole spine. The correlation of the classification with surgical treatments needs further studies to validate its usefulness.

Female ; Humans ; Ligamentum Flavum ; pathology ; Male ; Ossification of Posterior Longitudinal Ligament ; classification ; pathology ; Ossification, Heterotopic ; classification ; pathology

OBJECTIVETo evaluate the outcome of open-door laminoplasty for the treatment of failed anterior cervical spine surgery.

METHODSFrom February 2003 to June 2009, 15 patients underwent open-door laminoplasty for the failed anterior cervical spine surgery. The causes of revision and the progression of disease were analyzed. Japanese Orthopedic Association (JOA) scores and Nurick grade were adopted to record the improvement of neurological status and walking ability.

RESULTSTwo patients were excluded for analysis because of lost follow-up and follow-up less than 12 months. The mean follow-up period after revision surgery for the other 13 patients was 26 months (ranged 13-52 months). The mean interval between the initial and revision surgery was 24 months (ranged 5 months to 6 years). The causes of revision were as following: degeneration of the adjacent segment in 2 cases, inadequate decompression in 5 cases, mis-diagnosis of ossification of posterior longitudinal ligament (OPLL) as myelopathy in 4 cases, and progression of OPLL in 2 cases. Posterior laminoplasty was recommended for each patient. After the operation, 13 patients improved neurologically with respect to JOA score, 12 patients improved their walking ability while 1 remained unchanged. The mean modified JOA scores improved from 10.5 to 13.8 (P<0.05), the average recovery rate was 53.0% after the revision operation. The mean overall Nurick grade was 3.1 preoperatively and 1.9 at the final follow-up (P<0.05), the mean improvement of the Nurick grade was 1.2. Complications included cerebrospinal fluid leakage in 1 case, new axial neck pain in 1 case, and transient C5 nerve root palsy in 1 case.

CONCLUSIONSOpen-door laminoplasty is a straightforward and effective treatment for failed anterior cervical spine surgery due to inadequate decompression, progressive OPLL or degeneration of the adjacent segment. The merit of the open-door laminoplasty for failed anterior spine fusion is able to avoid high risk from initial anterior cervical spine surgery.

Aged ; Cervical Vertebrae ; surgery ; Decompression, Surgical ; Female ; Follow-Up Studies ; Humans ; Laminectomy ; methods ; Male ; Middle Aged ; Reoperation ; Spinal Fusion ; Spondylosis ; surgery ; Treatment Outcome

BACKGROUNDThe iron catalyzed lipid peroxidation plays an important role in the autodestruction of the injured spinal cord. This study was to detect the antioxidation of melatonin against spinal cord injury (SCI) in rats.

METHODSSity Sprague-Dawley rats were randomly divided into four groups: group A (n = 15) for laminectomyanly, group B (n = 15) for laminectomy with SCI, group C (n = 15) for SCI and intraperitoneal injection of a bolus of 100 mg/kg melatonin, and group D (n = 15) for SCI and intraperitoneal injection of saline containing 5% ethanol. The SCI of animal model was made using modified Allen's method on T12. Six rats of each group were sacrificed 4 hours after injury, and the levels of free iron and malondialdehyde (MDA) of the involved spinal cord segments were measured by the bleomycin assay and thiobarbituric acid (TBA) separately. Functional recovery of the spinal cord was assessed by Modified Tarlov's scale and the inclined plane method at 1, 3, 7, 14, 21 days after SCI. The histologic changes of the damaged spinal cord were also examined at 7 days after SCI.

RESULTSAfter SCI, the levels of free iron and MDA were increased significantly and the modified Tarlov's score and inclined plane angle decreased significantly in groups B and D. In group C, the Tarlov's score and inclined plane angle were increased significantly at 7, 14 and 21 days, with histological improvement.

CONCLUSIONMelatonin can reduce the level of lipid peroxidation and prevent damage to the spinal cord of rat.

Animals ; Antioxidants ; therapeutic use ; Iron ; analysis ; Lipid Peroxidation ; drug effects ; Male ; Malondialdehyde ; analysis ; Melatonin ; therapeutic use ; Rats ; Rats, Sprague-Dawley ; Spinal Cord Injuries ; drug therapy ; metabolism ; pathology