Tuberculosis of bone and joint most commonly occurs in spine, and the main treatment method is anterior debridement, bone grafting and internal fixation. Autologous bone is still considered the "gold standard" when the anterior reconstruction of spine after debridement is needed. Allogeneic bone, artificial bone and artificial intervertebral support bodies such as titanium mesh and some biological materials also have a broad clinical application, but still can not completely replace the autologous bone because of their defects. In the aspect of internal fixation, anterior fixation has become a conventional method for the patients who suffer from active spinal tuberculosis and need anterior debridement of the focus, because this method can provide good support. This review summarizes the present situation of choice for supporting and bone grafting material for anterior reconstruction after debridement of spinal tuberculosis.

Objective To modify the anterior fixation technique for thoracolumbar fractures so as to reduce blood loss and improve the success rate of the first vertebral screw implantation. Methods Only surface artery of the injured vertebrae was ligated and the discs adjacent to the burst vertebra excised. Then,the mass autograft ilium was harvested with most cartilage terminal lamina left. The bursted vertebra was resected so that the vertebral canal could be decompressed thoroughly. Structural ilium graft was performed,followed by Z-plate being placed and locked. Results The modified operative technique was used to treat 87 cases,of which 76 cases of fresh thoracolumbar fracture had hemorrhage capacity about 400-800 ml (average 560 ml) as well as operation time for 2.5-3 hours,and 11 cases with old fractures had hemorrhage capacity about 800-1 200 ml (average 1 080 ml) as well as operative time for 3.5-4 hours. Eighty-one cases with kyphosis deformity was completely corrected,four cases had kyphosis deformity of 5?-8? and two lordosis. A total of 39 cases with post-operative paralysis basically recovered,28 partially recovered,nine recovered fractionally and 11 was beyond recovery. No aggravation was found in post-operative nerve syndrome. Conclusions The modified anterior fixation technique is excellent in reducing blood loss,shortening the operation time and increasing the success rate of the primary vertebral screw implantation. [

[Objective]To evaluate the safety and efficacy of the surgery,which was done by a video-assisted thoracoscope to release the anteriorroute part of spine and done by posterior instrumented fusion with severe Adolescent Idiopathic Scoliosis(AIS).Clinic date:There were 10 cases of AIS(King Ⅱ 6,King Ⅲ 3,King Ⅳ 1),in which there were 6 males and 4 females.The average age was 17.2 years(range 14~21).The average preoperative primary curve in the coronal plane was 91.3?(ranged 67?~125?)and the average pliability of thoracic spine was 28.3%(ranged 19.3%~36.5%).[Method]With general anesthesia(onelung ventilation or two-lung ventilation),the disc complexes and part of the anterior longitudinal ligament of 5~6 disc near apex vertebra were excised under endoscopic visualization.In the same operation,the posterior instrumented fusion was done.[Result]The anterior releases under endoscopic visualization needed 120~150 min with average bleeding 157ml(ranged 100~200 ml).The thoracic draining was 100~150 ml After the posterior route surgery,the average coronal Cobbs angle was 47?(ranged 26?~75?)and the rate of rectification was 51.5%.The patients had good fusion and outlook without other complications.[Conclusion]This way,which is done by a videoassisted thoracoscope to release the anterior part of spine and done by posterior instrumented fusion has a good result about safety and efficacy.

BACKGROUND:Typical anterior cervical decompression and fusion method has many disadvantages.Cervical fusion cage has obtained satisfactory outcomes,but many problems should be solved.OBJECTIVE:To design a type of PDLLA Cage and to investigate the immediate stability of different fusion methods in a goat cervical spine model following C_(3-4) fusion.DESIGN,TIME AND SETTING:Randomized controlled study was performed at the Laboratory of Biomechanics,Sichuan University from June 2005 to January 2006.MATERIALS:C_(3-4) segment was obtained from a total of 15 adult female 2-year goat corpses.Additional C_(3-4) from 27 adult female 2-year goats was used in biomechanics test.Samples were supplied by the Animal Experimental Center,West China Clinical Medical College,Sichuan University to use in measurement of anatomy parameter and biomechanica test.METHODS:C_(3-4) segment obtained from goat corpse was subjected to X-ray test in an anterior lateral position.In accordance with C_(3-4) mean vertebral height,the angle of C_3 vertebral inferior border and anterior border,the anterior and posterior distance of C_3 vertebral inferior border,as well as the distance of anterior and posterior borders of the middle vertebral body,a type of PDLLA Cage was designed and made,and the biomechanical behavior analysis about the materials was performed.The 27 goat samples were not destroyed following biomechanics test (normal control group),and were assigned to 3 groups,PDLLA Cage group (n=9),titanium alloy Cage group (n=9) and autologous iliac bone group (n=9).Anterior longitudinal ligament was incised at FSU intervertebral space.Following excising the nucleus pulposus,adherent muscle was removed and the whole ligament was remained,as well as the bony terminal plate and cartilage subchondral bone were reserved.PDLLA Cage and titanium alloy Cage were respectively implanted in the cavity of the Cage main body in the PDLLA Cage group and titanium alloy Cage group.The Cage was fixed in the vertebral body using two fixing plates of anterior alar plate with 3.5-mm screw.Autologous cortical iliac bone from three surfaces was implanted in the autologous iliac bone group.MAIN OUTCOME MEASURES:Biomechanics was tested in flexion,extension,axial rotation,and lateral bending using 1,2,3,4 N·m moment of force method.The mean stiffness values and the range of motion were calculated in each group. RESULTS:In every loading mode,the displacement values were statistically significant difference between cage groups (PDLLA Cage group and titanium Cage group) compared with the normal control group (P<0.05);and the displacement of cage groups were lower than that of the autologous tricortical iliac crest bone graft group except for 4 N·m bending loading mode (P<0.05).Posterior extension was significant better in the PDLLA Cage group and titanium alloy Cage group compared with the autologous iliac bone group.Compared with the normal control group,the displacement of posterior extension and lateral bending was lower in the autologous iliac bone group (P<0.05).The stiffness of PDLLA Cage and the titanium Cage group in the flexion loading had no significant difference (P>0.05).In the others loading condition,the titanium Cage group was statistically greatest in all directions (P<0.05).The stiffness of PDLLA Cage was comparable with that of the titanium Cage and was statistically higher than that of the autologous tricortical iliac crest bone graft and intact (P<0.05).CONCLUSION:This type of PDLLA Cage can provide enough primary stability for cervical intervertebral fusion.

Objective To observe the effect of intravenous administration of bone marrow stromal cells (BMSCs) on the functional recovery after spinal cord injury in rats.Methods BMSCs harvested from 10 donor adult Sprague-Dawley rats were isolated,cultured,purified,amplified and labeled with bromodeoxyuridine (BrdU ).A total of 66 adult Sprague-Dawley rats were subjected to weight-drop impact causing complete paraplegia and randomly divided into three groups seven days after injury.Group A (22 rats) was treated with 2 × 106 BMSCs cultured in 1 ml phosphate-buffered saline by tail vein,Group B (22 rats) was treated with 1 ml Dulbecco' s modified Eagle medium and Group C (22 rats) was set as blank control group.The distribution and differentiation of donor cells in spinal cord were observed in recipient rats by using immunohistochemical staining and expressions of growth associated protein-43 ( GAP-43),neurofilament 200 (NF200) and nestin in the contused spinal cord measured at 2,3 and 6 weeks respectively after injection.The motor function of three groups was evaluated by the Basso-Beattie-Bresnahan ( BBB) scores at 1,2,3,4,5 and 6 weeks respectively after injection.Results BrdU-reactive cells were mainly distributed through the contused and near regions of spinal cord at 2,3 and 6 weeks after injection.The survived cells in contused spinal cord accounted for 4.9% ,4.4% and 2.6% of the total injection cells at 2,3 and 6 weeks respectively after injection.Two weeks after injection,BMSCs were mainly round or ellipse in shape,12.6% BrdU-reactive cells expressed glial fibrillary acidic protein (GFAP) and 5.4% expressed the neuronal nuclear antigen (NeuN).The expressions of GAP-43,NF200 and nestin were detected at 2,3 and 6 weeks after injection,with significant higher level in Group A than that in Groups B and C (P<0.05).BBB score in Group A was significantly higher than that in Groups B and C 3-6 weeks after transplantation (P<0.05).Conclusions With intravenous administration after spinal cord injury,BMSCs migrate and survive into contused spinal cord,exhibit site-dependent differentiation,up-regulate the expressions of GAP-43,NF200 and nestin,ameliorate nerve function and can be used for treatment of spinal cord injury.

Objective To design a type of poly (D, L) Lactide (PDLLA) cage, compare the characteristics of inter body fusion using PDLLA cage with those of titanium cage and autologous tricortical iliac crest graft in a goat cervical spine model in vi?vo. Methods Twenty?four goats underwent C3-4 discectomy and fusion were assigned to 3 groups, PDLLA cage group (n=8), titani?um alloy cage group (n=8) and autologous iliac bone group (n=8). Radiography was performed pre?and post?operatively and 1, 2, 4, 8, and 12 weeks after operation. At the same time points, disc space height (DSH), intervertebral angle (IVA), and lordosis angle (LA) were measured. After 12 weeks, the goats were killed and fusion sites were harvested. Biomechanical testing was performed in flexion, extension, axial rotation, and lateral bending to determine the stiffness and range of motion. All cervical fusion speci?mens underwent histomorphological observation. Results The IVA of PDLLA cage 4 weeks after operation and DSH 8 and 12 weeks after operation was statistically greater than that of autologous iliac bone graft (P<0.05). The LA values were shown no signif?icant difference among PDLLA cage, Titanium cage and autologous iliac bone graft groups. The stiffness of two types of cages in ax?ial rotation and lateral bending, the ROM in every movement was statistically greater than that of autologous iliac bone graft group (P<0.05). PDLLA cage and Titanium cage had no significant difference (P>0.05). Radiographic and histomorphological observa?tion showed better fusion results in cage groups than in autologous bone group. Conclusion This type of PDLLA cage has excel?lent biocompatibility and can provide an appropriate biological environment for bone ingrowth and osteogenesis at bone?implant in?terface. Furthermore, PDLLA cage can maintain DSH and increase the stability of fusion segments to create a good biomechanical environment for the last bone fusion.

[Objective]To explore the operative method through the trans-upper-sternal approach in the treatment of the cervicothoracic spinal lesions and evaluate its clinical effects.[Method]From August 1999 to February 2006,11 cervicothoracic patients,8 males and 3 females,age ranged from 17 to 77 years with a mean of 41.5 years underwent the trans-uppersternal approach surgical treatment.There were four traumatic lesions,six tumors and one tuberculosis.The lesions were located at T3,C7~T1 and T1、2 in 1 case respectively,C7 and C6~T1 in 2 cases respectively,T1 in 4 cases.The combined cervicothoracic incision and upper sternotomy were performed for the exposure of the vertebral bodies,then tumor or vertebral body was resected,the spinal cord was decompressed,the spinal column was reconstructed and fixed.Neurologic status was assessed using the Frankel classification.[Result]The duration of follow-up ranged from 10 to 56 months with an average of 31 months.One patient developed chyle leakage of 50 ml one day after surgery and the leakage stopped 2 days after continuous drainage.One patient had transient vocal cord paresis which recovered in 3 months.All patients had their neurological improvement at different level.Nonunion or instrument-related complications were not observed,and the vertebral column had good stability.[Conclusion]The trans-upper-sternal approach gives an excellent exposure of the cervicothoracic junction.It is a technically simple,safe and effective method for anterior decompression,maintenance of anatomic alignment,fusion with bone graft and internal fixation with less complications and trauma.Attention should be paid to avoid injury of the recurrent laryngeal nerve and the thoracic duct.

60?) in the Huaxi Hospital of Sichuan University. Three cases aged less than 15 years, but the patients or their relatives were informed of and consented the operation scheme. Without rectification, fusion segments were propped open about 5 mm via the upper and lower fixed vertebra, and anterior one was transplanted with fresh-frozen fibular allograft (offered by the donor corpse and excised extremities due to surgical trauma from the Department of Orthopaedics in Huaxi Hospital. The immunogenicity was greatly reduced by routine defat, acellular procedure, soaking sterilization and deep freezing), while rear one was transplanted with costal bone for supporting graft and filling the graft bone intervals with autogenous bone strips. Gypsum (brace) was used to assist external fixation for 8-10 month postoperation. The complications, graft incorporation, neurological function (Frankel grading scale A-E: complete paralysis-normal or no paralysis), back pain (0-3: none-severe), and mobility score (1-4: lying in bed-needing no assistance) before operation and at final follow-up of each patient were collected for analysis. RESULTS: All the patients were available for follow-ups and the mean period was 3.4 years (1.5-5 years).①Apparent fusion was observed in all cases with no graft fracture, only one patient reported mild graft shift and the kyphosis was unchanged.②There was no worsening of the neurological status in any patient. Frankel grades of 3 adult patients were unchanged after operation. All adolescent patients (n =3) had definite neurological improvement and could walk without assistance, while another was adult patient. Complete relief of back pain was observed in all patients. CONCLUSION: Fresh-frozen allograft fibular is a liable graft material for the treatment of severe kyphosis induced by inactive upper thoracic tuberculosis. Anterior decompression and fusion can promote the recovery of motive function and the alleviation of pain, especially is effective for neurological recovery of adolescent.

AIM:Neural stem cells can be induced to differentiate into various types of neural cells such as neurons and neuroglia cells,but the technique of depuration and cultivation does not consummate.This article determines the optimal culture technique of neural stem cells by different culture concentrations and passage methods. METHODS:Experiments were conducted from May to December 2006 at Laboratory of Transplantation Immunity of Sichuan University.①Clean pregnant female rats(embryonic age range from 12-16 days)and the disposition of animal met ethical standard.②The cerebral cortex of rat embryos were collected,and digested with trypsin and ethylenediamine tetraacetic acid mixture to obtain signal cell suspension.They were cultured in serum-free medium (DMEM/F12 medium containing B27,basic fibroblast growth factor and epidermal growth factor).The 3~(rd)passage cells were collected,and incubated at 1?10~7 L~(-1),1?10~8 L~(-1),1?10~9 L~(-1),1?10~(10)L~(-1),respectively.In addition,neural stem cells were collected 7-10 days after primary culture to harvest formative cell masses.Mechanical blow refers to soft blowing with haustorial tube from thick to thin after centrifugation,or sterile syringe with No.5 pinhead blowing cells when the blow was 5 times.Bubble production was avoided during the operation.Trypsin aspiration combined with mechanical blow refers to trypsin was added after centrifugation,at 37℃for 10 minutes,the neural stem cells were lightly blown with haustorial tube polished with flame or blown with sterile syringe with No.5 pinhead,and then fetal bovine serum was added to stop digestion.③The growth characteristic of the 3~(rd)passage cells at different culture concentration was observed and proliferation was measured at days 1,3,5 and 7 by MTT assay.The neural clone spheres of subcultured was counted to determine the optimal passage way.Immunofluorescence was carried out to detect nestin(special marker to neural stem cells),BrdU,neurone specific enolase,glial fibrillary acidic protein. RESULTS:①Growth characteristics and identification of rat embryonic neural stem cells in vitro:The dissociated neural stem cells from the cerebral cortex of rat embryos were continuously harvested and purified by suspension cultures to get the daughter cell clone.Nestin positive cells could be found in the neurospheres and after attachment they could differentiate into neurone specific enolase and glial fibrillary acidic protein positive cells,and immunofluorescence showed a great of BrdU-positive cells.②The effect of different incubated number of neural stem cells on proliferation:When the neural stem cells planted at the concentration of 1?10~9 L~(-1),the growth rate of the cells was the highest of all concentrations.The number of clone spheres exceeded others at concentration 1?10~7 L~(-1),1?10~8 L~(-1)and 1?10~10 L~(-1)(P

This study was aimed to compare the mechanical characteristics under different physiological load conditions with three-dimensional finite element model of rigid fixation and elastic fixation in the lumbar. We observed the stress distribution characteristics of a sample of healthy male volunteer modeling under vertical, flexion and extension torque situation. The outcomes showed that there existed 4-6 times pressure on the connecting rod of rigid fixation compared with the elastic fixations under different loads, and the stress peak and area of force on elastic fixation were much higher than that of the rigid fixations. The elastic fixation has more biomechanical advantages than rigid fixation in promoting interbody lumbar fusion after surgery.
Biomechanical Phenomena ; Finite Element Analysis ; Humans ; Lumbar Vertebrae ; surgery ; Male ; Models, Theoretical ; Pressure ; Range of Motion, Articular ; Spinal Fusion