Objective To investigate the diagnosis and treatment of delayed infection after pedicle screw internal fixation via posterior approach. Methods The management of 17 cases of delayed infection after posterior pedicle screw internal fixation was retrospectively analyzed. Imaging examination was done before operation in all the patients. In petients whose operation was done within 9 months and non-fusion of bone graft was proved, debridement and suction-irrigation were given. For the patients in whom bone graft had fused, the implant was removed, followed by debridement, irrigation, and wound closure. Specimens were taken during operation for bacteriological study. Intravenous antibiotic was given after operation in all the patients. When 3 successive bacterial culture of wound drainage were proved to be negative and total drainage fluid was less than 50ml in 24h, drainage tube was removed. Results Wounds healed in all the patients. In 8 of 12 cases wound healed after debridement and irrigation-suction. In 9 patients fusion of the bone graft was confirmed, and internal fixators were removed, followed by debridement, irrigation-suction and primary closure of the incisions. In 4 cases infection recurred 3-18 months after first stage debridement and irrigation-suction, but X-ray confirmed that there was fusion of the bone graft. In 11 of 17 cases bacterial cultures were positive. Conclusions Delayed infection is a severe complication after internal fixation of the spine. Debridement and irrigation-suction are effective in controlling infection, and at the same time, it allows fusion of the bone graft. Removal of the internal fixators is not indispensable.

Objective To summarize clinical manifestations and diagnostic criteria of ischemic reperfusion (IR) injury to the spinal cord. Method The clinical manifestations and management of 15 cases of spinal cord IR injury after operation during 2000 to 2005 were retrospectively analyzed. Result All the patients with spinal cord IR injury presented progressive ascending motor and sensory functional impairment beginning from lower extremities 3h post operation, and they were all treated immediately with methylprednisolone and neurotrophy drugs to restore spinal cord function. However, mechanical compression with organic lesion should be ruled out to establish the diagnosis of spinal cord IR injury in the retrospective analysis. Different stages of spinal cord IR injury occurred in these 15 cases. Through symptomatic treatment, 8 patients recovered completely; the clinical symptoms were basically improved in 4 cases who could lead a normal life; in 3 patients clinical symptoms were improved but not satisfactory. Conclusion Though spinal cord IR injury seldom occurs in the clinic, its damage is disastrous. Proper management is critical to save patients from poor life quality.

Objective To investigate the effect of surgical decompression on lumbar spinal stenosis in senile people. Method 175 senile patients with lumbar spinal stenosis were admitted from Jan. 1997 to Dec. 2003. Among them, the data of effect of surgical decompression in 106 cases, including 49 males and 57 females, age ranged from 70 to 82 years, all of them having a disease history of 4-10 years, and followed-up for 2-6 years after the operation. Their data were analyzed retrospectively. All the patients had been treated conservatively. 42 patients were complicated by one internal disease, and 55 complicated by at least 2 internal diseases. In all the patients continuous movement could not last longer than 15 min before operation. Lamina decompression was done in 95 patients, and a combined operation of lamina decompression, pedicle fixation and post-lateral bone grafting in 11 patients. Result All the patients survived the operation. Complications occurred in 38 cases, and the patients recovered after effective treatment. During follow-up, lumber complaint was improved in 37 cases, numbness in both legs was improved in 63 cases, and no satisfactory improvement was seen in 6 cases. In 66 cases the Oswestry score was lower than 20%, and in 34 cases it was lower than 10%. The result of surgical decompression was satisfactory in 94% of cases, and the average continuous movement was prolonged to over 30 min after operation. Conclusion Based on the effective control of complicated disease, the operative treatment of lamina decompression with fusion or no fusion played an important role in the recovery of neurological function in senile patients with lumbar stenosis.

[Objective]To investigate surgical therapeutic methods of recurrent lumbar disc herniation(RLDH).[Method]From December 1996 to December 2003,a retrospective analysis on surgical treatment of 74 cases of RLDH was made and those cases acquired 1～5 years follow-up.There were 41 males,33 females aging from 21~53 years(mean,37.2 years),case history was 6~192 months from primary surgery to disc reprolapse(mean,37 months).Among primary surgery,9 cases were total laminectomy,23 cases were hemilaminectomy,31 cases were windowing,11 cases were microdiscectomy with diskoscope.Re-surgery:5 cases treated with lumbar disc excision,45 cases treated with posterior lumbar interbody fusion(PLIF)technich,23 cases treated with transforminal lumbar interbody fusion(TLIF)technich.[Result]No death case occurred during peri-operation.Various complications were found in 18 cases which recovered by symptomatic treatment.Cases with lumbar disc excision left bed in 3 weeks with the help of lumbar back brace and cases with fusion surgery left bed in 3～5 d after surgery.Oswestry score improved from(52.32?9.17)pre-operatively to(20.33?5.72)in average 18 months follow-up.Totally 73.5% cases had satisfactory surgical results.[Conclusion]Cases with RLDH can adopt propotional surgical methods,thoroughly decompression and gain satisfactory therapeutic effect on bases of imageology,clinical manifestation and surgery history.

Bi-polar,bi-pedicled separation delayed flaps were designed on the backs of New Zealand rabbits with the application of a medical silicon membrane as the separation material. Values of glucose and lactic acid, PtcO 2 were measured separately at proximal,middle and distal areas of the flaps after the distal pedice was cut at 0,1,4,7,14,21 days,respectively, after the formation of flaps. After flap delaying,PtcO 2 in separated flap was always lower than that of the mormal control,accompanied with glucose decrease and lactic acid increase, although there were significant differences in different areas of the flap. The survived area of the flap increased after 7 days. Furthermore,all the length of the flap survived after 21 days,although the level of glucose in the flap was still lower and lactic acid was still higher.The results suggested that by separation and delaying the flap may adapt gradually to hypoxia via lowered metabolism.For flap survival,the threshold value of glucose in flap is 0 01mmol/L , lactic acid is 0 47mmol/L,and PtcO 2 is 3mmHg .

Relation between change of capillary pressure, survival length in bi pedicled separation delay flap was observed. Bi polar, bi pedicled separation delay flaps were designed on the backs of New Zealand rabbits. Medical silicon membrane was used as separative material. Values of capillary pressure were measured at proximal, middle and distal points. Survival length increased with delayed time, capillary pressure at middle was lower in the bi pedicled separation delay flap. It is concluded that capillary pressure is increased greatly by separation delay, and there is a linear relation between capillary pressure and survival length of flaps.

0.05).The maximum relaxant forces of vitrification and fresh arteries groups were greater than the freezing group(P 0.05).The arteries of three groups began obvious relaxant responses when sodium nitroprusside was 10-7 mol/L, and nearly reached their maximal relaxant responses when sodium nitroprusside was 10-4 mol/L.CONCLUSION:The vitrification could preserve more active smooth muscle cells of arteries than the freezing method.The norepinephrine has better effect on contraction ability of artery, which preserved in the vitrification group than the freezing group;however, there is no difference in relaxation of sodium nitroferricyanide.

Fourty-three cases with spinal tumors treated with vertebral resection were reviewed regarding the preoperative treatment, the operations, and the results, in order to evaluate the value of resection of the vertebral body in prolonging the survival time and in improving the life quality of the patients. All the patients showed neurological recovery after surgical decompression. The average improvement was 2 grades by Frankel system. A second operation was necessary in 3 cases with recurrent lesions. Pulmonary and urinary complications were found in 3 cases. Absorption of bone grafts, collapse of vertebrae and loosening of implants were found in 2 cases. Resection of the involved tissue or segments and re-establishment of stability have become the most important treatment modality for patients with spinal tumors. With the help of adjuvant therapy, the survival time and the life quality of patients have been greatly improved.

Objective A retrospective study of the results of surgical or non-operative treatment in patients with herniation of lumbar disc 10 years or longer before,in order to evaluate the efficacy of different therapeatic strategies for lumbar disc herniation. Method Definite diagnosis of lumbar disc herniation was made in all cases before treatment,and the follow-up period was 10 to 38 years. The patients were divided into three groups according to different treatment methods: non-operative group,simple nucleus resection group,and nucleus resection combined with space fusion group. The long term therapeutic effects and image change of the three groups were observed. The difference of height of intervertebral space at the herniation site was measured before treatment and at the latest follow-up. Adjacent spaces were also observed. The data were analyzed statistically by t -test and ? 2 -test. Results Among 98 cases in non-operative group,85 cases enjoyed almost a normal life and work;vertebral canal decompression was performed for the rest 13 cases because of intermittent claudication. The protruded space was narrowed for 3.17?1.65mm in height in average after non-operative treatment,and there was degeneration of adjacent spaces in 13 cases. Among the 84 cases in simple nucleus resection group,relative good outcome was seen in 71 patients,and the remaining 13 cases had to receive a second operation because of symptom relapse. The protruded space was decreased 5.50?1.51mm in height in average as measured at the latest follow-up comparing with that of before operation. The degeneration of the adjacent space was observed in 15 cases. In 71 patients who received nucleus resection combined with space fusion experienced a good relief of symptoms. The space,where disc herniation had occurred,fused very well and no re-narrowing occurred. Degeneration of the adjacent space was observed in 39 cases,but the patients were symptomless. Conclusions The effect of either non-operative therapy or operation for patients with lumbar disc herniation was good after a long-term follow-up if the indication was chosen properly. We suggest that non-operative therapy should be the first choice for the lumbar disc herniation. The relatively normal nucleus should be preserved as much as possible when nucleus resection was performed. Intervertebral fusion was a relative better treatment comparing with the other two treatments.

OBJECTIVE:To evaluate the economic effects of different doses of methylprednisolone treatment regimes on traumatic reaction in patients with cervical spondylotic myelopathy after anterior decompressive operation.METHODS:56cervical spondylotic myelopathy cases who have been subjected to anterior decompressive operation were chosen to be the sub-jects.The56cases were divided into3groups and treated with different dosage of methylprednisolone,the initial dose for group A(18cases,low dose group)was80mg;the initial dose for group B(21cases,medium dose group)was600mg and that for group C(17cases,large dose group)was1000mg,the improvement of clinical symptom of each group was observed re-spectively and the cost-effectivenesses of the three groups were compared.RESULTS:The costs of the A,B,C groups were990.00,1339.10and1886.70yuan respectively;the effectiveness rates(E)of the A,B,C groups were5.56%,14.29%and35.29%respectively;The costs for each unit of obvious effectiveness(C/E)of the A,B,C groups were178.06,93.71and53.46yuan respectively;On the basis of group A,the needed costs of group B and C were39.99and30.16yuan respectively for each obvious effectiveness unit increase(?C/?E).CONCLUSION:Compared with group A and B,the effectiveness rates of group C had a bigger increase while the needed cost for each unit of obvious effectiveness was the lowest,therefore,the dose regimen of group C is more rational.