Objective To eveluate the result of the use of prosthetic disc nucleus (PDN) for treatment of degenerative disc diseases in the lumbar spine. Methods Twenty-two patients with degenerative disc diseases were treated with PDN replacement after the removal of the degenerated intervertebral disc. Results The patients were followed-up for an average 12 months (4-18 months). Both lumbago and leg pain disappeared in all the 22 patients who resumed their work and normal life one month after the operation. PDN translocation was found in 2 out of 10 patients in the early period, but no PDN translocation was found in the remaining 12 patients in the later period. Conclusion PDN could restore disc height and flexibility after nucleotomy. Artificial nucleus replacement was a good option for the treatment of degenerative lumbar disc disease.

Objective To study the relevant position of atlas pedicle to axis lateral mass, set up a technique of C1 pedicle screw placement with the lateral mass of axis as an anatomic landmark, and evaluate the reliability of the present screw placement technique by clinical practice. Methods 50 paired atlas and axis specimens were used to measure the distance from the sagittal midline to the medial border, the midpoint (the middle point of the mediolateral border) and the lateral border of C1 pedicle and C2 lateral mass. Furthermore, the distance between the medial border of C1 pedicle and that of C2 lateral mass, the distance between the midpoint of C1 pedicle and that of C2 lateral mass and the distance between the lateral border of C1 pedicle and that of C2 lateral were calculated respectively. The technique of C1 pedicle screw fixation was established. Using the present landmark technique, C1 pedicle screws were placed in 6 patients of atlantoaxial instability, including 5 males and 1 female averaged 41 years old, with os odontoideum in 1, odontoid hypoplasia in 3, and old odontoid fractures in 2. Results The medial border, the midpoint and lateral border of C1 pedicle was averaged (1.37?0.51) mm, (1.60?0.61) mm and (2.15?0.60) mm medial to C2 lateral mass, respectively. The entry point of C1 pedicle screw in present technique was defined as the method of making a vertical line through the midpoint of C2 lateral mass, and the entry point was 3 mm under the cross point of the superior rim of C1 posterior arch with the vertical line. 12 C1 pedicle screws were placed exactly in all 6 patients, and no neural or vascular injury was observed. The postoperative radiographs and CT scans verified all of C1 screws with a good position. Conclusion There is a steady anatomic relation between C1 pedicle and C2 lateral mass, the C2 lateral mass could be as a convenient anatomic landmark to determine the location of C1 pedicle and the position of C1 pedicle screw entry point.

Objective To observe the difference of efficacy of three different treatment of internal fixation of intervetebral crasis on cervical spondylosis (spinal cord) .Methods From January 2009 to January 2013 ,There are 167 cases of patients admitted to hospital from cervical spondylosis (spinal cord ) ,randomly selected different fusion fixation methods are divided into three groups :in the first group ,there were 55 patients treated with autologous iliac bone graft fusion plate fixation ;in the second group , there were 60 patients treated with zero profile material PEEK interbody fusion with autologous bone graft ;in the third group ,the 52 patients were treated with the PEEK material MC + self‐locking cervical interbody fusion with autologous bone graft .Observa‐tion and comparison indicators include :spinal cord function JOA scores before and after surgery ,surgical segment intervertebral height and cervical curvature condition .Results Follow‐up lasted from 13 to 50 months ,the average length was 26 months .The difference in operation time ,blood loss during surgery analysis ,wherein the first group and the second or third group of three groups was statistically significant (P<0 .05) ,the difference between the second group and the third group was not statistically significant (P>0 .05) .In the first group ,there were 17 patients had transient throat discomfort and symptom disappeared 48 hours later ;dysphagia relieved or disappeared in one week ;there were two cases of screws and titanium loosen one week after operation , and were treated with immediate revision surgery .In the second ,third group ,there were 19 cases and 13 cases showed temporary throat discomfort disappeared within 48 hours after surgery respectively ,there was no dysphagia .No patient experienced cerebrospi‐nal fluid leakage ,hematoma and wound infection .The postoperative JOA scores spinal cord function (17 points France) ,surgical segmental cervical intervertebral height and curvature of three groups improved significantly compared with preoperative evaluation index ,and there was no significant difference among three groups (P>0 .05) .In the last follow‐up ,the interbody fusion rates of the first ,second and third groups were 67 .1% ,66 .3% and 65 .9% ,the difference between groups was not statistically significant (P>0 .05) .Conclusion Anterior decompression and interbody fusion locking device applications showed good performance in maintai‐ning the intervertebral height segment surgery ,rehabilitation cervical curvature ,and promote bone fusion with autogenous titanium plate fixation comparison .Patients can get a good surgery ,and the former has a simpler surgical fixation method ,shorter time ,less bleeding and less complications .

Objective To introduce extreme lateral interbody fusion (XLIF) as a new minimally inva-sire spinal surgery with established correction and fusion methods to assess its clinic use for degenerative scoliosis. It is emphasized the value and highlight of this technique in spinal surgery. Methods Surgical treatment of 8 patients with degenerative scoliosis were performed with XLIF between March 2006 and April 2008. In this group of patients, 5 cases provided an anterior cage in every disc space, and another 3 supplemented with vertebrae screw fixation. Blood loss was 50 ml every procedure. To observe the low back pain, corrective rate, achieving a balanced and complications. Results The low back pain have been relieved in all patienta after operations, the disc height can be restored, allowing more room at the foraminal level for nerve roots, and lumber lordosis can be maintained. Corrective rate was 64%, there wasn't neurologic and vascular injury, 2 case had correction loss a little postoperation 6-30 month. Conclusion The potential benefits of XLIF include safe, effective, less approach-related blood loss, improved cosmetic result with smaller incisions, and reduced hospital stay for degenerative scoliosis.

BACKGROUND:C2 transpedicle screw fixation for Hangman fractures has been paid more attention due to reliability and no loss of physiological function.However,there are lacks of biomechanical evidences for indication treatment because the fixation is single segmental.OBJECTIVE:To investigate the biomechanical stability of C2 transpedicle screw fixation for Hangman fractures.DESIGN,TIME and SEITING:This was a contrast study which was performed at the General Key Laboratory of Biomechanics,First Military Medical University of Chinese PLA from May to August 2004.MATERIALS:AO-universal titanium alloy transpedicle screw of 18 25 mm in length and 3.5 mm in diameter was adopted in this study.Six fresh C1-C4 cervical vetebrae samples were ordiually made into type Ⅰ,ⅡA,and Ⅱ Hangman fracture models.METHODS:After transpedicle screw fixation.Hangman fracture models were measured by non-destroyed style with spinal anterior flexion/posterior extension,left/right lateral curvature,and left/right axial direction.Loading/unlonding circulation was performed three times during each testing.Kinematics indicators were measured on the 3rd circulation.MAIN OUTCOME MEASURES:Spinal motor images at zero load and maximal load were obtained with laser photoscanning(0.1% in precision),and the corresponding systematic software was adopted to calculate 3D range of movement.RESULTS:The relative stability of type Ⅰ Hangman fracture models after C2 transpedicle screw fixation was 100.62%(inflexion),96.91%(posterior extension),99.19%(lateral curvature),and 97.12%(rotation)as compared to control group (P＞0.05).The relative stability of type Ⅱ Hangman fracture models after C2 transpedicle screw fixation was 47.84%(inflexion),21.29%(posterior extension),65.98%(lateral curvature),and 41.69%(rotation)as compared to control group (P＜0.05).CONCLUSION:Biochemical evaluation suggests that type Ⅰ and Ⅱ A Hangman fractures do fit for C2 transpedicle screw fixation,and the fixation may generate well physiological fixation or stability.However,stability of type Ⅱ Hangman fracture is poor,so it is not suitably adopted single transpedicle screw fixation.

BACKGROUND: Decompression-internal fixation is needed in the treatment of atlantoaxial dislocation accompanying with spinal compression caused by cranium-neck junction area malformation and other diseases.Different internal fixation methods are chosen according to different conditions, including anterior atlantoaxial internal fixation, posterior atlantoaxial internal fixation or occipitocervical internal fixation. Transoralpharyngeal atlantoaxial plate internal fixation is a method for atlantoaxial anterior fixation. It is developed recently and used for difficult and complicated atlantoaxial dislocation induced by congenital disease, trauma or rheumatoid arthritis.OBJECTIVE: To probe into the clinical application of transoralpharyngeal atlantoaxial reduction plate system in the atlantoaxial dislocation caused by obsolete odontoid fracture.DESIGN: Single Sample observation SETTING: Department of Orthopaedics, Guangzhou General Hospital of Guangzhou Military Medical University of Chinese PLA PARTICIPANTS: Twelve patients with atlantoaxial dislocation caused by obsolete odontoid fracture were selected in the Department of Orthopaedics, General Hospital of Guangzhou Military Medical University of Chinese PLA from January 2003 to October 2005. Among them, 7 were male and 5 were female, they were aged 47 years on average ranging from 36 to 59 years. The mean injured time was 19 months ranging from 4.5 to 36 months; 6 patients were graded as C degree, 3 as D degree and 3 as E degree in Frank gradation.METHODS: Twelve obsolete odontoid fracture caused by atlantoaxial dislocation underwent transoralpharyngeal anterior decompression. Transoralpharyngeal atlantoaxial reduction plate system was used in reduction and fixation. Autogeneic ilium was implanted into bilateral articulatio atlantoepistrophica.MAIN OUTCOME MEASURES: ① Frank gradation of patients at the 4th week after operation. ② whether the internal fixation is loose or not after operationRESULTS: ①Frank gradation at the 4th week after operation: Among the 6 patients who were primarily graded as C degree, 4 patients improved to be E degree and 2 patients D degree; Three patients who were primarily graded as D degree all improved to be E degree; Patients who were primarily graded as E degree did not changed. ② Except for one patient who suffered dislocation again for loosening of screw caused by tumble, the other patients had firm fixation, ideal fusion and satisfying spinal decompression.CONCLUSION: Transoralpharyngeal atlantoaxial reduction plate system finishes atlantoaxial reduction and fixation once. It avoids conducting posterior fusion fixation operation after anterior decompression. It also avoids fetal injury for spinal cord caused by extreme atlantoaxial unsteadiness in the process of movement and turning over.

Objective: To observe the effect of acupuncture at points selected from different regions on the positive expression of interstitial cells of Cajal (ICC) and the stem cell factor (SCF) in gastric antrum tissues in diabetic gastroparesis (DGP) rats, and to explore the influence of region-based point selection on the acupoint combination efficacy. Methods: Sixty Sprague-Dawley (SD) rats were randomly divided into a normal group (group A), a model group (group B), a group of Zusanli (ST 36) plus Zhongwan (CV 12) (group C), a group of Zusanli (ST 36) plus Neiguan (PC 6) (group D), and a group of Zusanli (ST 36) plus non-meridian non-acupoint points (group E), based on the random number table (n=12). DGP rat model was established by single intraperitoneal injection of 2% streptozotocin and common diet. After successful modeling, the rats were treated once a day for 4 weeks. Positive ICC and SCF expressions were measured by immunohistochemistry. Results: Compared with group A, the gastrointestinal propulsion rate of group B showed a statistically significant decrease (P<0.05). Compared with group B, the gastrointestinal propulsion rate and the expression of ICC in the gastric antrum were significantly higher in group C, group D and group E, and the between-group differences were statistically significant (P<0.05); the expression of C-kit protein in group C was statistically significantly higher than that in group D and group E (P<0.05). The expression of SCF protein was significantly increased in group C than in group B, and the difference was statistically significant (P<0.05). Conclusion: Acupuncture can improve the symptoms of delayed gastric emptying in DGP model rats, and regulate the expression of ICC and SCF in gastric antrum tissues. The effect of Zusanli (ST 36) plus Zhongwan (CV 12) in the gastric region is superior to that of the Zusanli (ST 36) plus distal Neiguan (PC 6) or non-meridian non-acupoint point, indicating that region-based point selection is the key factor affecting the effect of acupoint combination.

Objective To evaluate the biomechanical characteristics and the clinical advantage of transoral atlantoaxial reduction plate(TARP)Ⅲ.Methods Design of TARP-Ⅲ was based on TARP-Ⅱ.The screw hole in the axis was moved 1-2 mm upwards and inwards in a plate which turned a vertebral screw into a pedicle screw or an articular process screw.A polyaxial self-lock ring and polyaxial guiding drill were added to the crew hole of the plate.Finally,the withdrawal resist ence force of the three axis screws was tested and TARP-Ⅲ was used in 44 patients with complicated irreducible atlantoaxial dislocation.The axis was fixed with the pedicle screw or the articular process screw.Results The maximum withdrawal resist ence force of the anterior pedicle screw,the articular process screw and the vertebral screw in the axis was(593.1 ± 97.8)N,(469.9 ± 73.3)N and(395.2 ± 75.1)N respectively,with statistical difference between groups among three fixation methods(P ＜ 0.05).All 44 patients were followed up for 5-38 months(average 18 months),which showed complete anatomic reduction in 36 patients and appropriate anatomic reduction in eight,with basic correction of the angles between the brain stem and the spinal cord and sufficient decompression of the spinal cord.The decompression rate of the cervical spinal cord was average 88.2% according to the Yin evaluating method of cervical cord decompression.The improvement rate of spinal cord function was average 76.6% according to Japanese Orthopaedic Association(JOA)score.Conclusion With the design of polyaxial self-lock mechanism,TARP-Ⅲ with the pedicle screw or the articular process screw surpasses TARP-Ⅱ with vertebral screw in aspect of biomechanics.

OBJECTIVETo conduct a clinical trial of ketogenic diet (KD) in patients with acute spinal cord injury (SCI) and evaluate its safety and feasibility by measuring blood ketone bodies and blood glucose levels.

METHODTen patients with acute SCI were recruited in the trial during the period from May, 2012 to October, 2013. The patients received a standard KD after fasting for 48 h. The levels of blood ketone, blood glucose and uric ketone were tested daily, and routine blood examination, electrolytes, liver and kidney function, body mass index (BMI), sensory and motor function, and adverse reactions were monitored weekly to assess the safety and feasibility of KD.

RESULTSKD treatment lasted for a mean of 12.9 days (4 to 29 days) in these patients. In all the patients, blood ketone level increased during the fasting and maintained a level above 2.0 mmol/L after taking KD, while the uric ketone level ranged from +++ to ++++. The blood glucose level was in the normal range during KD. Except for blood chloride level and BMI, routine blood test results, electrolytes, liver and kidney function showed no significant changes after KD. No significant changes were observed in the sensation of light touch and pinprick. The average motor ASIA score increased from 33.3 to 35.1 after KD. Gastrointestinal dysfunction (diarrhea, nausea, poor appetite, gastric pain, and abdominal distension) was recorded in 5 patients, hypoglycemia occurred in one patient early after KD, and one patient experienced urticaria during KD. All the adverse reactions were relieved after symptomatic treatments.

CONCLUSIONThis preliminary clinical trial demonstrated that KD could increase ketone bodies level and maintain a normal blood glucose level, suggesting its safety and feasibility in patients with acute SCI.

Adolescent ; Adult ; Aged ; Diet, Ketogenic ; adverse effects ; methods ; Feasibility Studies ; Female ; Humans ; Male ; Middle Aged ; Spinal Cord Injuries ; diet therapy ; Treatment Outcome ; Young Adult

Objective To investigate the clinical effect of posterior screw-rod fixation fusion for the treatment of atlantoaxial dislocation due to rheumatoid arthritis.Methods From January 2011 to December 2015,15 patients with atlantoaxial dislocation due to rheumatoid arthritis were treated,including 6 males and 9 females,aged 35 to 75 years (mean 55 years).All cases were evaluated about the difficulty of relocation by extension-flexion X-ray and treated with posterior screw-rod reduction,fixation and autogenous bone grafting under general anesthesia.Atlantodental interval (ADI) was measured and collected before and after surgery.Visual Analogue Scale/Score (VAS),American Spinal Cord Injury Association (ASIA) and Japanese Orthopaedic Association (JOA) scores were comprehensively used to evaluate the clinical effect.1 week,3,6,12 months postoperatively and the annual review of the X-ray and CT were checked,in order to evaluate the reduction,internal fixation and bone graft fusion.Results All patients were reducible dislocation and successfully performed the posterior screw-rod fixation fusion surgery.The patients were followed up for 3 to 24 months (average,15 months).Atlantoaxial solid bony fusion was obtained from 3 to 6 months.ADI reduced from preoperative 6.3±1.7 mm to postoperative 2.2±0.8 mm,VAS score reduced from preoperative 5.4±2.7 to postoperative 1.7±1.0,ASIA motor score improved from preoperative 82.3±15.6 to 95.3±4.5 at 6 months after the surgery,JOA score increased from preoperative 13.8±2.9 to 15.5±1.4 at 6 months after the surgery,and the statistical significance was revealed between preoperation and postoperation.Nine cases were in D grade of ASIA,3 cases improved from D to E grade after surgery,2 cases reached E grade in the other 6 cases after 6 months,2 cases recovered to E grade after 12 months and other 2 cases in D grade got uniformity after surgery.Well internal fixation and no redislocation were found on X-ray and CT during follow-up period.Conclusion Atlantoaxial dislocation because of rheumatoid arthritis was numerously reducible genre.Posterior screw-rod fixation and autogenous bone grafting can gain satisfying clinical efficacy.