Objective:To observe the efficacy and the complications of Apofix interlaminar clamp in the treatment of atlantoaxial instability and dislocation,and to study the causes of these complications and the preventive measures against them. Methods:17 patients with atlantoaxial instability or dislocation were treated with posterior atlantoaxial fusion and Apofix interlaminar clamp fixation.Results:One case of atlantoaxial dislocation was dead and another dislocation case was redislocated one week after the operation,while the others were followed up for 3 to 24 months and all recovered well.Conclusion:It is simple to apply Apofix interlaminar clamp.The clamp can provide reliable stability for the atlantoaxial segment,and is useful for the fusion of the bone implant.Correct indications are playing an important role in avoiding the complications.

Objective:To observe the result and to study the complications and prevention methods for the different anterior locking cervical plate systems.Methods:150 patients with the cervical fracture-dislocations,spondylotic myelopathy,tuberclusis and tumors of the cervical spine were treated using CSLP?ORION and CODMAN anterior locking cervical plate systems.Results:All the patients were followed up for 3-6 months. The symptom of nervous system recovered,and the bone grafting was fused completely.The complications related to the anterior cervical plate occurred including protrusion of the fixation screws into disc pace,defluxion of the plate,migration of the screws and plate.Most of the complications were caused by insufficient exposure and improperly technological performance.Conclusion:Anterior locking cervical plate systems can provide reliable stability for the fixation segments and it is useful for fusion of the grafting bone,it is important to be familiar with anatomical knowledge of the cervical vertebrae,sufficient exposure of the lesion,correct plate selection and proper technical principles of the different anterior locking cervical plate systems play an important role in avoiding the complications.

The transformaton of medical mode brings forward the new demand for orthopedics education.We should think highly of the cultivation of orthopedics post-graduates' professional ethics so as to promote their communication between medical staff and patients and give emotional concern to patients.Strengthening the cultivation of Orthopedics post-graduates' clinical skill,evidence-based medical thinking and scientific research competence is the key to cultivate the orthopedics talents with high quality and ability.

BACKGROUND:The main method to treat cervical spinal stenotic myelopathy caused by various factors is posterior lamninectomy, but the postoperative effect was not satisfactory.OBJECTIVE: To observe the postoperative functional reconstruction of the cervical vertebra of the patients with cervical spinal stenotic myelopathy through expansive open-door laminoplasty.DESIGN: An observational study by comparing the changes before and after the operation.SETTING: Department of Orthopaedics of the First Affiliated Hospital of Chongqing Medical University.PARTICIPANTS: Totally 32 patients (22 male and 10 female) with multi-segment cervical spinal stenotic myelopathy were treated at the Department of Orthopaedics of the First Affiliated Hospital of Chongqing Medical University from May 1995 to May 2004. Twelve cases suffered from degenerative spinal canal stenosis caused by spinal cord type of cervical spondylosis, 18 cases suffered from developmental spinal canal stenosis and 2from ossification of cervical posterior longitudinal ligament (OPLL).METHODS: Altogether 32 cases were treated through expansive opendoor laminoplasty to the cervical spine. These patients had been followed up for 6 months after the informed consent was obtained. The spinal function was evaluated according to Japanese Orthopaedic Association 17scores before operation, 2 weeks and 3 months after the operation respectively. The radian of the cervical vertebra, the stability of the spinal column and the complications were observed with X-ray.bility of the spinal column and the complications after the operation.RESULTS: According to intention-to-treat analysis, all the 32 patients entients before and after the operation: According to the evaluation standard stipulated by Japanese Orthopaedic Association (JOA), two weeks and three months after the operation, the scoring of the spinal function was significantly higher in 12 cases of cervical spondylosis myelopathy-induced degenerative stenosis, 18 cases of developmental spinal stenosis and 2 cases of ossification of cervical posterior longitudinal ligament (OPLL)( The score was 5.2, 5.7, 5.5 points respectively before the operation; 9.2, 9.7 , 9.4points respectively 2 weeks after the operation; and 11.3 , 11.8 , 11.6dian of the cervical vertebra, the stability of spinal column, and the complications after the operation: Radiographs indicated vanished cervical anteflexion curvature and straightened cervical vertebrae in three cases, but no re-closure or unstable spine happened.CONCLUSION: Expansive open-door laminoplasty for cervical spinal canal stenosis caused by various factors can still improve and increase the spinal functional evaluation scores shortly and 3 months after the operation, and it does not affect the stability of the cervical vertebrae.

[Objective]To investigate the in vitro antibacterial effect and biocompatibility of the bone filling materials of TiO_2-Ag-nHA/PA66.[Method]The inhibition ring test and plate-counting method were used to evaluate anti-bacterial performance against staphylococcus aureus ATCC25923 and escherichia coli ATCC25922.The effects of antiadhesion of staphylococcus aureus and escherichia coli were observed by scanning electron microscope(SEM).The cytotoxicity was detected via MTT and the biocompatibility of biofilm was evaluated by acute haemolysis test.[Result]The inhibition zone diameter of staphylococcus aureus and escherichia coli reaches the maximum at the first day[(23.6?1.14) mm and(18.8?0.84 mm)].The diameter of inhibition zone was lessening with the time going.It could effectively inhibite the survival and growth of staphylococcus aureus and escherichia coli within 33 and 24 days.The bacteria killing rate was 94.18% and 85.96%.Scanning electron microscope showed that the adhered bacteria in the experimental group were obviously fewer than in the control group.The MTT graded the cytotoxicity of the bone filling materials of TiO_2-Ag-nHA/PA66 as 1.The acute haemolysis assay showed that the hemolytic rate of bone filling materials of TiO_2-Ag-nHA/PA66 was 0.28%.[Conclusion]The bone filling materials of TiO_2-Ag-nHA/PA66 has good biocompatibility,significant antibacterial property against staphylococcus aureus and escherichia coli.No obvious cytotoxicity or erythrocyte destruction was found.

30mg partially purified pBMP was implanted into right quardriceps muscle in each rabbit. Whole blood was collected from ear veins before and after the operatin. Lymphocyte proliferation response to nonspecific mitogen PHA and to specific pBMP were measured by lymphocyte transformation test in vitro, using H—labelled thymidine incorporatcon method (~3H—TdR). The skin test and histological investigation of pBMP were also performed. It has been shown that no significant changes of cellular immunity in rabbit were observed after pBMP implantation; the immunogenicity of pBMP was weak. The likelihood of chinical use of pBMP is provided.

Objective To evaluate the clinical efficacy and surgical method in radical debridement and spinal fusion with internal fixation in surgical management of cervical vertebra tuberculosis.Methods Twenty-one patients of cervical vertebra tuberculosis were included,mean age of 31 years,including 2 cases at C_(1-2),3 at C_(2-3),9 at C_(4-5),3 at C_(5-6),3 at C_(6-7),1 at C_7T_1.After all patients underwent radical debridement of focuses,15 cases were grafted with iliac bone and 6 with titanium mesh,19 cases were fixed with plate,1 case with Apofix,1 case with Occipital-cervical fusion.The external fixation was needed for 3 months after surgery.Results The follow-up lasted for 21 months.One case grafted with titanium mesh failed,but other patients achieved satisfactory results of successful interbody fusion within 3 to 6 months.The kyphosis deformity was corrected to normal condition without associated complications.The neural symptoms were improved.All patients had no recurrence of tuberculosis.There were no plates and screws broken.Conclusion It is safe and effective to treat cervical vertebra tuberculosis by anterior radical debridement and primary autograft by internal fixation,with high correction rate of local kyphosis deformity,high fusion,and low complication rate.

Objective To evaluate the application and efficacy of direct anterior fixation of odontoid fractures with hollow screw.Methods From March 2001 to January 2006,13 patients with odontoid fractures were treated by direct anterior fixation with hollow screw.Results Of the 13 patients,except 2 patients with postoperative temporary dysphagia, 11 had excellent results.The follow-up was ranged from 9 to 18 months,with an average of 12.5 months.The odontoid fractures acquired fusion,and no unstability or pseudoarthritis was found. Conclusion The technique of direct anterior fixation with hollow screw is an efficacious means in the treatment of odontoid fractures.The meticulous surgical technique along with appropriate patients selection will be the key to successful surgery.

Objective To study the clinical effects of the artificial vertebral body of the biomimetic nano-hydroxyapatite/polyamide 66 (n-HA/PA66) composite for the structural reconstruction and the height restoring of the vertebral body in the thoracolumbar fractures by the anterior surgical procedures. Methods From December 2003 to January 2006, 42 patients with thoracolumbar fractures received the anterior surgical procedures to decompress and reconstruct the spinal vertebral structure with the artificial vertebral body of the n-HA/PA66 composite. Among the patients, there were 28 males and 14 females, aged 17-67 years, averaged 43.6 years. The thoracolumbar fractures developed at T12 in 5 patients, at L1 in 17, at L2 in 14, and at L3 in 6. The height of the anterior border of the vertebral body amounted to 29%-47% of the vertebral body height, averaged 40.6%. The Cobb angle on the sagittal plane was 21-38° averaged 27.6°. According to the Frankel grading scale, the injuries to the nerves were as the following: Grade A in 7 patients, Grade B in 19, Grade C in 8, Grade D in 6, and Grade E in 2. Results All the 42 patients were followed up for 6-25 months. Among the patients, 36 were reconstructed almost based on the normal anatomic structure, and 6 were well reconstructed. The mean height of the anterior border of the vertebral body was 40.6% of the vertebral body height before operation but 91.7% after operation. And the reconstructed height of the vertebra was maintained. The mean Cobb angle on the sagittal plane was 27.6°before operation but 13.4° after operation. All the patients had a recovery of the neurological function that had a 1-grade or 2-grade improvement except 7 patients who were still in Grade A and 2 patients who were in Grade D. The implant was fused 3-5 months after operation. No infection, nail break, bar/plate break or loosening of the internal fixation occurred. Conclusion The artificial vertebral body of the biomimetic n-HA/PA66composite can effectively restore the height and the structure of the vertebra, can be fused with the vertebral body to reconstruct the spinal structural stability effectively, and can be extensively used in the clinical practice.

Objective To investigate the curative effect of transpedicular screw fixation plus percutaneous vertebroplasty (PVP) for treatment of severe thoracolumbar osteoporotic vertebral compression fractures (OVCF).Methods Twenty-one patients with severe OVCF presenting to our hospital from July 2012 to May 2015 were analyzed retrospectively.There were nine male and twelve female patients,aged 50-78 years (mean,68.8 years).The level of injury was T1 1 in four patients,T12 in six,L1 in five,L2 in three,L3 in two and L4 in one.Time between injury and surgery was 2-16 d (mean,7.5 d).All patients underwent pedicle screw fixation at the injured level combined with PVP.Visual analogue scale (VAS) was used for evaluation of lower back pain after operation,Oswestry disability index(ODI) for lower back function,lateral thoracolumbar film for Cobb angle and anterior vertebral height compression ratio,and American Spinal Injury Association (ASIA) score for spinal cord nerve function.Postoperative complications were recorded.Results All patients were followed up for 12-21 months [(15.7 ± 2.9) months].Postoperative studies showed significant differences in VAS [(2.9 ± 1.1) scores],ODI [(30.8 ± 7.5) ％],Cobb angle [(21.5 ± 7.3) °] and anterior vertebral height compression ratio [(44.3 ± 13.9) ％] compared to the preoperative measures (P ＜ 0.05).Cobb angle and anterior vertebral height compression ratio at the final follow-up were (23.4 ± 7.7)° and (49.1 ± 13.7)％ respectively,and had no significant differences from the postoperative measures (P ＞ 0.05).According to the ASIA score,eight patients with neural function injury had one to two level recovery at the final follow-up.Asymptomatic cement leakage occurred in seven patients after operation.There was no internal fixation breakage at the final follow-up.Conclusions Transpedicular screw fixation plus PVP can not only restore the height and strength of the injured vertebrae and correct kyphotic deformity,but also relieve low back pain and improve function of the spine.Therefore,the technique is a safe,reliable and effective surgical treatment for severe thoracolumbar OVCF.