Objective To investigate outcomes of different surgical approaches for treating cases of fracture and dislocation of the lower cervical spine.Methods The study involved 26 cases of fracture and dislocation of the lower cervical spine treated surgically from December 2002 to January 2012,including 19 males and 7 females with age ranging from 27 to 62 years (average 39 years).According to the AO classification,there were 12 cases of type B3.1,three of type B3.2,two of type C2.1,three of type C3.1,and six of type C3.2.Preoperative spinal cord function graded by Frankel criteria was six cases of grade A,five of grade B,seven of grade C,six of grade D,and two of grade E.Conventional skull traction was done for all patients before operation.Vertebral cannal decompression and interbody fusion through anterior,posterior or anterior-posterior approaches were determined according to type of fracture dislocation and severity of spinal cord injury.Radiography was performed regularly after operation to review the correction of dislocation,restoration of vertebral height,and interbody fusion.Spinal cord function was also evaluated postoperatively.Results No large blood vessel injury or aggravation of spinal cord injury occurred intraoperatively.There were no complications of incision infection,leakage of cerebrospinal fluid,herniation of bone graft or implant breakage postoperatively.All cases obtained successful correction of fracture and dislocation of the lower cervical spine as well as the recovery of cervical sequence,physiological curvature,and vertebral height in the 12 to 24 months of follow-up (average 16 months).Bony fusion was obtained for all cases at postoperative 3-6 months (average 3.5 months).Spinal function evaluated by Frankel criteria at the latest follow-up showed was grade A in six cases,grade B in three,grade C in five,grade D in five and grade E in seven,with different degree of improvement for all cases.Conclusions Operative approaches should be selected according to the specific status of fracture and dislocation of the lower cervical spine.Anterior approach can be performed for vertebral or intervertebral disc injury straightly and the procedure handles cervical instability immediately.Posterior surgical approach can be used to settle dislocation and interlocking of the articular process directly,but the intervertebral disc injury should be ruled out simultaneously in order to avoid further injury of spinal cord during the reduction process.Combined anterior and posterior surgical approach can be applied to treat fracture and dislocation of lower cervical spine and intervertebral disc injury concurrently but has high risk and large operation wound.

Objective To evaluate the long-term clinical efficacy of iliac bone block allograft in anterior reconstruction of thoracolumbar fractures.Methods A follow-up study was carried out on 93 patients with thoracolumbar fractures treated by anterior decompression and interbody fusion with iliac bone block allograft from February 2004 to March 2007.The radiographic and clinical outcomes were retrospectively assessed.Results Sixty-six patients were followed up for 60-97 months (mean,78 months).The effective interbody fusion rate was 100％,with the fusion time of 6-12 months (mean,10 months).The Cobb' s angle corrected from pre-operative (21.6 ± 8.3)° to post-operative (5.8 ±5.2)°,but when the infusion became effective,the angle showed average loss of 2.4°.All the 66 patients were associated with various degrees of neurological deficiency,but the patients with incomplete nerve dysfunction obtained different degree of recovery.Conclusions Iliac bone block allograft is effective in reconstruction of spinal anterior-middle column stability with the aid of internal fixation instruments.Thereby,it may be a potential alternative to autograft in the treatment of thoracolumbar fractures and can attain early and late stage persistent spinal stability.

Aim To evaluate the clinical value of two cervical spinallocking plates, Orion and Zephir, and a new anterior cervical instrumentalsystem combining an intradiscal cage with an integrated plate(PCB) afteranterior cervical decompression surgery. Methods 47 patients were followedup for 7 - 26 months with an average of 15 months after surgery. Of them, 30were treated with Orion, 1 1 with Zephir and another 6 with PCB. Results 26cases with preoperative intervertebral space constriction and 18 cases withchanges of cervical physiological protrusion all achieved satisfying effect ofrebuilding intervertebral space height after operation. The cases with obviousintervertebral space height loss were not seen after follow up. The physio-logical curvature corrected by operation was well kept. Neurological functionwas improved in 43 cases on different extent after operation. The other 4cases with no obvious recovery of neurological function were all that withcomplete paraplegia after trauma. Conclusion PCB is suitable for treatmentof the acute cervical protrusion or the cervical spondylotic myelopathy at onelevel. Zephir and Orion are suitable to all kinds of cervical vertebra lesions atmore than one level and complex lesion at one level, which helps the re-covery of cervical physiological curvature and height of disc space.

BACKGROUND:Systemic lupus erythematosus is a kind of heterogeneous disease, and the difference of clinical features may also be the risk factors of osteonecrosis besides of treatment with glucocorticoids according to the literature. However, it remains controversial on the risk factors of osteonecrosis in systemic lupus erythematosus patients.
OBJECTIVE:To systematical y review the major risk factors of osteonecrosis in the Chinese patients with systemic lupus erythematosus.
METHODS:The CNKI database, CBMdisc database and Wanfang database were retrieved for the published case-control study literatures on the risk factors of osteonecrosis in the Chinese patients with systemic lupus erythematosus. The literatures met the inclusion and exclusion criteria were included, and a Meta-analysis was conducted by RevMan 5.0 and Stata software. Then, the pooled odd ratio and 95%confidence interval of each risk factor were calculated.
RESULTS AND CONCLUSION:Ten case-control study literatures were included involving 332 cases in the case group and 986 cases in the control group. The pooled odd ratio and 95%confidence interval of each risk factor of osteonecrosis in the Chinese patients with systemic lupus erythematosus were as fol ows:Raynaud’s
phenomenon 3.28(1.69-6.38), dental ulcer 2.95(2.13-4.09), renal involvement 1.21(0.83-1.74), vasculitis 5.64(2.84-11.21), hyperlipidemia 5.11(3.10-8.42), anti-phospholipid antibody 2.32(1.49-3.61) and joints involvement
2.02(1.33-3.07). It has been clear that the glucocorticoids is an independent risk factor of osteonecrosis in the patients with systemic lupus erythematosus. However, it is not the one and only risk factor. The fol owing risk factors of
vasculitis, hyperlipidemia, Raynaud’s phenomenon, dental ulcer, positive anti-phospholipid antibody and joints involvement are the risk factors of osteonecrosis in the patients with systemic lupus erythematosus.

Objective To observe the damage to Langerhans cells induced by UVB irradiation,and to evaluate photoprotective effect of these cells from UVB irradiation by epigallocatechin-3-gallate (EGCG).Methods Biopsy specimens were obtained from normal adult foreskin,and epidermal cells were isolated.Density gradient centrifugation and magnetic cell sorting were used simultaneously to purify Langerhans cells from the cell suspension.These cells were then divided into three groups,control (no ir- radiation or EGCG treatment),UVB (irradiation) and EGCG (irradiation+ECCG treatment) groups. The cells in the UVB and EGCG group were irradiated by UVB (30 mJ/cm~2).After the irradiation,the U- VB group was incubated with RPMI-1640 containing 10% bovine serum for 4 hours,while the EGCG group with the same medium containing 200?g/mL of EGCG for 4 hours.Another four hours after the treatment, the cells were collected for the detection of apoptosis rate by propidium iodide staining and flow cytometry. Results Exposure to UVB (30 mJ/cm~2) significantly increased the apoptotic rate of Langerhans cells.The apoptotic rate in EGCG group was significantly lower than that in the UVB group,but was higher than that in the control group.Conclusion Rate of apoptosis of Langerhans cells could be increased by UVB irradia- tion,while EGCG could prevent the increase of apoptosis.

Objective To construct the tissue-engineered bone with the allogenic demineralized bone matrix (DBM) as the scaffold material and the in vitro cultured human mesenchymal stem cells (hMSCs) and to evaluate the geosteogenesis efficacy and safety by implantation of tissue-engineered bone in nude mice subcutaneously. Methods After cultured and amplified, hMSCs were combined with DBM at the density of 1.857?10 6/ml to construct the tissue-engineered bone. The hMSCs and DBM combination was cultured in vitro for 3, 5, 7 d and tested for biocompatibility under scanning electron microscope and each sample was implanted into 36 nude mice subcutaneously, DBM as the control. The culture suspension of the hMSCs and DBM combination was injected into another 4 nude mice to observe the oncogenesis. Specimens were harvested after 4, 8, 12 weeks for histological observation. Results At day 3 of culture, hMSCs and DBM combined well and at day 5, the cell matrix was productive and full of the scaffold. The osteocytes were found inside in the scaffold in the experimental groups, while no osteocytes in the control groups. Conclusion The DBM has good biocompatibility, providing good three-dimension space for hMSCs. It is safe and successful to construct the tissue-engineered bone by the method we introduced.

Objective To explore preliminary clinical results of a new anatomical shape allogeneic bone posterior lumbar fusion cage. Methods Follow-up patients used the allogeneic bone posterior lumbar fusion cage and use imaging methods and clinical score (VAS, ODI) to evaluate the patients′ clinical efficacy. Results 14 patients were followed up for 6 months or more , with an average follow-up time of 9.7 months , mean preoperative VAS 6.8 ± 1.1, ODI 32.7 ± 4.5. The mean preoperative disc height was (9.7 ± 2.0) mm and the average intervertebral height of 3 days post operation was (13.2 ± 1.7) mm. All patients got bony fusion in 6 months post operation, pain and function scores improved significantly compared with the pre-operation: VAS 2.4 ± 0.8 (P =0.000), ODI 9.8 ± 2.5 (P = 0.000), the average intervertebral height was (13.1 ± 1.7) mm (P = 0.000). The average was VAS 2.1 ± 0.1 (P = 0.000), average ODI was 8.9 ± 0.9 (P = 0.000) at last follow up. Average of intervertebral height was (13.0 ± 1.8) mm, no significant difference compared to three days after surgery (P=0.831). No serious complications and deep surgical site infection was observed. All implants were found no fragmentation, shift, cutting boards, and obviously sinking. Conclusion The anatomical shape allogeneic bone posterior lumbar fusion device is suitable for posterior lumbar interbody fusion , advantages of high fusion rate , satisfactory clinical results in the initial clinical trials , but its long-term efficacy requires further observation.

Objective To set the criteria of mild spinal tuberculosis and investigate the ettect of standard chemotherapy regimen for further establishing the clinical classification of spinal tuberculosis and standardizing management.Methods According to the criterion,a total of 89 patients with mild spinal tuberculosis were enrolled for outpatient conservative management and follow-up.Ambulant treatments were carried out in all patients,including nutrition support and standard chemotherapy regimen.The regimen was consisting of four first-line antituberculosis drugs (rifampicin,isoniazid,ethambutol and pyrazinamide).All patients were followed up one month later,then every 3 months for the following 12 months,and subsequently at intervals of half a year.The clinical manifestations,kyphosis progression,neurological status,erythrocyte sedimentation rate and liver function were analyzed.Results A mean of 30.62± 13.20 (range,18-46) months' follow-up was achieved in 85 patients,whose tuberculosis lesions were cured completely.Another 4 patients,who were diagnosed with drug-resistant tuberculosis later,had underwent surgery for progressive bone destruction and no response to chemotherapy.The mean visual analogue scale score and Cobb's angle was 5.6± 1.6 and 6.25°±3.11° before chemotherapy,and 2.1 ± 1.1 and 12.36° ±6.31 °at the last follow-up time,respectively.Signals of vertebral body and intervertebral disc returned to normal in 6 patients,while solid bony fusion of adjacent segment was achieved in 79 patients.Asymptomatic mild kyphosis was observed in 69 patients.2 patients with sinus before treatment all healed.No neurological deficit was found.Conculusion For patients early diagnosed with mild spinal tuberuclosis,standard chemotherapy regimen could work safely and effectively for healing the tuberculous lesion,avoiding surgery as well as preventing kyphosis,vertebral instability and neurological deficit.Mild spinal tuberculosis that was early diagnosed could be considered as a subtype of spinal tuberculosis.

ObjectiveTo investigate the design and mechanical properties of bone cement injectable canulated pedicle screw (CICPS) so as to provide a safe and effective internal fixation for osteoporotic spinal disorder.Methods ( 1 ) Bone cement injection test was performed in vitro,and within osteoporotic cancellous bone models and osteoporotic vertebrae respectively.The distribution of bone cement and screw-bone interface were observed by X-ray films and CT.(2) Ten CICPSs already injected with bone cement and ten conventional pedicle screws were respectively examined by shear strength test.(3) CICPS in the cancellous bone models was augmented with 2-3 ml of bone cement.Then,the maximum axial pull-out strength of the CICPS was measured and were compared with that of conventional screws.ResultsBone cement overflowed from each side hole of the CICPS and distributed only around the front of screws in an even and extensive way.Also,no bone cement leakage was founded.The mean shear load of CICPS and conventional screws was ( 10 600.8 ± 360.1 ) N and ( 15 458.1 ± 31 1.4) N respectively ( P ＜0.05 ).The mean maximum axial force at pull-out was ( 209.3 ± 13.3 ) N for the CICPS and ( 27.0 ± 5.0) N for the conventional screws ( P ＜ 0.05 ).Conclusions By dispersing bone cement uniformly,CICPS reduces the risk of cement leakage and significantly improves the pullout strength of screws in osteoporotic vertebrae.CICPS with good efficacy and safety provides theoretic basis for its clinical application.

Humans ; Leiomyoma ; pathology ; Microtomy ; methods ; Microwaves ; Paraffin Embedding ; methods ; Specimen Handling ; methods ; Thyroid Neoplasms ; pathology