Objective To investigate the effects of surgical management for upper thoracic tuberculosis with neurological deficits using primary bone grafting and internal fixation through right anterior intrapleural approach. Methods In this study, 6 cases of upper thoracic tuberculosis were admitted to our hospital from January 1999 to June 2002, of which 3 cases were male and 3 female. The age ranged from 26 to 48 years, and the period from the onset of the symptom to hospitalization was 12 months to 24 months. Clinical features included thoracic and back pain, kyphosis and neurological deficits. The kyphosis angle ranged from 15 to 30 degrees. One case involved T3 to T5, 4 cases involved T4,5, and 1 case involved T3 to T6. Neurological deficits were evaluated by ASIA score system. The results showed that there were 5 cases in C grade, and 1 case in D grade. MRI showed compression of dura in all cases, and abscess inside the vertebral canal in 2 cases and outer abscess in 4 cases. All were treated with primary debridement, decompression, interbody autografting and internal fixation of "K" shape plate or Ventrofix by right anterior intrapleural approach. The antituberculous treatment and nutritional supplement were also performed routinely during the perioperative period. Results During the follow-up period of an average 21 months, all cases healed without any recurrence and complications such as infection, respiratory failure and so on. The thoracic and back pain disappeared and erythrocyte sedimentation rate (ESR) decreased to a normal level. All neurological deficits recovered within 3 months, 4 cases of which recovered at 4 weeks after operation. Spinal fusion occurred after 3 to 8 months after operation, and sixteen degrees of kyphosis correction was achieved. Conclusion It is a safe and effective method to use right anterior intropleural approach, primary autografting and internal fixation in the management of upper thoracic tuberculosis associated with neurological deficits.

[Objective]To investigate the clinical curative effect and superiority of subtotal corpectomy through the pedicle,titanium rete support and pedicle screws system fixation in the treatment of burst fracture of thoracic vertebrae with paralysis.[Method]Twenty-three patients who suffered from the burst fracture of thoracic vertebrae with paralysis were treated with subtotal corpectomy through pedicle,titanium rete supporting bone autograft and pedicle screws system fixation.[Result]The patients were followed up for 8 months to 2 years.All had their bone grafts fused,and no incision infection,pneumothorax,hemothorax,pulmonary infection,internal fixation loosening or breakage occurred.The mean loss of Cobb's angle was 3.5?.According to Frankel grading,6 of grade A had no obvious recovery.In 5 of grade B,3 improved to C,1 to D,and the last one to E.In 7 of grade C,3 improved to D,4 to E.Five cases of grade D improved to E.[Conclusion]There had relatively less operation wound and good clinical curative effect with subtotal corpectomy through pedicle,titanium rete supporting bone autograft and pedicle screws system fixation.

[Objective]To evaluate curative effect of armor plate and xenogenic bony plate in congenital pseudarthrosis of the tibia.[Method]Five cases of congenital pseudarthrosis of the tibia were reviewed from 1998 to 2004,there were 2 men and 3 women,average age was 5.8(ranged,3~10)years.All the patients were treated by armor plate and xenogenic bony plate.[Result]All of the patients were followed up for more than 3 years(from 3 years to 7 years),four cases achieved bony union.Average time of bony union was 5 months.The lower limbs resumed walking ability and bear a heavy burden.[Conclusion]Outcome of 4 patients demonstrates that treatment of congenital pseudarthrosis of the tibia with armor plate and xenogenic bony plate is a reliable treatment.

Objective To evaluate the safety and efficacy of the newly combined anterior platerod system in treatment of acute thoracolumbar burst fracture combined with neurologic deficit.Methods A retrospective study was carried out on 84 consecutive patients with acute thoracolumbar burst fracture combined with neurologic deficits treated by anterior surgery,bone fusion,and internal fixation with the new plate-rod system.There were 61 males and 23 females with a mean age of 31.4 years (range,19-53 years).Primary pathogenesis was high falls in 67 patients,traffic accidents in 13 patients and others in 4 patients.Fractured segments included T11 in 19 patients,T12 in 22,L1 in 25,and L2 in 18.Visual analogue scale (VAS),spinal canal encroachment,and loss of kyphosis correction were measured for all patients to evaluate radiologic and neurological outcomes.Results Bony union occurred in all patients at the 3-5 months of follow-up.There was no pseudarthrosis or vascular complications related to the fixation device.Percentage of canal encroachment decreased from preoperative 70％ to postoperative 2％.Mean segmental kyphotic angle measured 27.9 ° before operation and 7.4 ° after operation,with a mean correction of 20.5°.All patients demonstrated at least one grade of neurological improvement at final follow-up.Mean VAS was improved significantly from preoperative 7.3 points to postoperative 2.9 points.Conclusion The new anterior plate-rod system is safe and effective in treatment of acute thoracolumbar burst fracture combined with neurologic deficit.

Objectives To observe the anesthetic effects of an improved anesthetic method on goat by comparing with the original method, and to provide theoretical and practical reference for anesthesia during the establishment of goat models.Methods A total of 72 goats were selected to make tibial fracture models, 36 were enrolled as group A and others as group B.The group A was injected with Sumianxin and diazepam.The group B was injected with Sumianxin, diazepam and pumped propofol by intravenous pump.The times of animal struggle, total dose of additional Sumianxin, death rate, and recovery time were evaluated.Results The death rate of group A was 16.67% and there was no death in the group B.The times of struggle, the total dose of additional Sumianxin and the recovery time of the group A were higher than group B, showing a significant difference (P<0.05).Conclusions The improved anesthetic method can decrease the times of goat struggle times, reduce the dose of anaesthetics, and lower the death rate.

Objective To evaluate our noval rod-screw construct in anterior single-segmental decompression and fixation for the treatment of Denis type B burst fractures.Methods From February 2007 through May 2010,we treated 28 patients with Denis type B burst fracture.They were aged from 18 to 52 years (average,37.4 years).The fractures were located at T1 1 in 3 cases,at T12 in 10,L1 in 12,and L2 in 3.Of them,7 were complicated with unilateral pedicle fracture and 3 with bilateral pedicle fractures.According to the American Spinal Injury Association (ASIA) scale,the neurological deficits were rated as grade B in 11 cases,as grade C in 9,and grade B in 8.All the patients received anterior single-segmental decompression,titanium mesh and autogenous bone graft,and fixation with our noval rod-screw construct.The therapeutic efficacy was evaluated in terms of visual analogue scale (VAS),cobb angle,and spinal canal encroachment.Results The mean follow-up time was 26 months (range,from 17 to 33 months).The average length of surgery was 144 minutes(range,from 90 to 176 min);the mean blood loss was 580 mL (range,from 300 to 1 100 mL).The mean VAS score,cobb angle and spinal canal encroachment were improved from 8.2 ± 1.5,17.4° ± 4.3° and 53％ ± 16％ preoperatively to 2.7 ± 2.4,9.4° ± 5.8° and 4％ ±2％ at the final follow-up,respectively(P ＜ 0.05).None of the patients exhibited neurological deterioration.Conclusion Our noval rod-screw construct is a safe and effective device that can be used in the anterior single-segmental decompression and fixation for the treatment of Denis type B burst fractures.

Objective To develop and apply portable bracket of lower limb in operation of tibia interlocking intramedullary nail. Methods Portable bracket of lower limb is composed of two fir panels and support structure. The level of support and the knee flexion is controlled with it. It is used in preoperative high-pressure disinfection, and then trouble limb is placed on the bracket to complete operation of tibia interlocking intramedullary nail. Results The applications save labor, reduce iatrogenic injury, make for union of fracture and avoid radiation damage of staff. No one is used to lift up leg in operation procedure and X-ray examination. Conclusion Potable bracket of lower limb has advantages in simple production, low cost, labor-saving, minimally invasive surgery wound and so on.

BACKGROUND: Autologous bone graft was always applied to repair bony cavity defect produced by benign bone tumor.OBJECTIVE: Taking autogenous bone graft for repairing bony cavity defect caused by bone tumor or tumor-like pathological change as control standard, to observe transplantation of deproteined bovine cancellous bone combined with autogenous red marrow in occluding the residual cavity and the density of newly formed bone.DESIGN: A randomized grouping design, controlled observation SETTING: Department of Orthopaedics, the 175 Hospital of Chinese PLA PARTICIPANTS:We recruited 175 cases of bony cavity defect who received treatment in the Department of Orthopaedics, the 175 Hospital of Chinese PLA from July 1993 to July 1998. They were randomly assigned into two groups: experimental group and control group. There were 63 cases treated in the experimental group. The average disease-suffering time was (6.2±2.1) months and bone defect was (136±30) mm3. There were 62 cases treated in the control group. The average disease-suffering time was (6.1±2.3)months, and bone defect was (133±37) mm3.METHODS: Deproteined bovine cancellous bone combined with autogenous red marrow was transplanted in the experimental group and autologous bone graft was applied in the control group. We curetted tumor completely, cauterized the wound with alcohol of 0.95 volume fraction, then curetted the area of cauterization to make it bled. Bone graft was applied.The quantity of implanted bone should be abundant, and disposed compactly. The X-ray films of the first week after operation were used as a standard for density of new bone growth. X-ray films were taken at the 3rd,6th and 8th months postoperatively, and the X-ray films of the eighth months after operation were used as a standard.MAIN OUTCOME MEASURES: To compare the bone union in two groups with a standard of residual cavity occluding and density of bone growth.RESULTS: All patients were followed up for an average of 20 months.One case was lost six months after operation. And two cases were lost eighteen months after operation respectively in the experimental group and control group. After 8 months of operation, residual cavities of bone defect of 44 cases in experimental group and 46 cases in control group were disappeared. Palingenetic bone fused with left bone organization. Its density was the same as or higher than normal bone organization. Residual cavities of 12 cases in experimental group and 10 cases in control group were disappeared basically. The density of palingenetic bone was approximate to normal bone organization. To compare with autologous bone graft, deproteined bovine cancellous bone and an autogenous red marrow had an identical effect for repairing bony cavity defect.CONCLUSION: Bony cavity defect produced by benign bone tumor is often repaired by bone transplantation. To explore the substitutable grafting materials of autogenous bone in this study, a composite material composed of deproteined bovine cancellous bone and an autogenous red marrow (DBCAM) is applied to repair the bony cavity defect.

Objective To evaluate the possibility and curative effect of total en bloc spondylectomy (TES) for the treatment of primary tumors of the lumbar spine. MethodsBetween June 2005 and July 2009,nine cases of primary tumor of the lumbar spine were treated with total en bloc spondylectomy through a single posterior approach performed in seven cases(L1 giant cell tumor, L1 osteosarcoma, L2 giant cell tumor,L2 solitary plasmacytoma, L2 chondrosarcoma, L2 chordoma, and L3 histiocytic sarcoma), and two cases through a single stage anterior and posterior combined approach (L4 giant cell tumor with paraspinal mass and L4 fibrosarcoma). They were performed a single stage reconstruction after removing tumors of vertebra. Neurofunction was evaluated perioperatively and recurrence of tumor was tracked for all cases.ResultsThe follow up was obtained for 3-49 months (averaging 19 months). All patients attained significant clinical improvement after surgery without any severe complications. There was no local recurrence and distal metastasis in shortterm follow-up. ConclusionThe treatment by TES to remove tumors and reconstruction of spine are reliable for primary tumors of the lumbar spine. The curative effect of short-term follow-up is satisfactory. However, the long-term curative effect remain to be further follow-up.

Objective To explore the clinical outcome of atlantoaxial pedicle screw instrument in treatment of extension-type odontoid fracture combined with aflantoaxial subluxation. Methods From December 2002 to December 2006, seven patients with extension-type odontoid fracture combined with at-lantoaxial subluxation were reduced and fixed with atlantoaxial pedicle screw instrument of Vertex system under general anesthesia. There were five males and two females, at mean age of 39.2 years (range 21-59 years). All odontoid fractures were fresh type Aderson Ⅱ. JOA scores of spinal core function was 8.6-14.9 (average 10.7) preoperatively. The X-ray examination, CT scanning and skull traction were performed in all patients preoperatively. Results There found no severe complications such as injuries of vertebral artery, nerve root and spinal cord postoperatively. All patients obtained complete reduction and healing of the fracture and dislocation. The mean off-bed time was four days (3-6 days) after opera-tion. A follow-up for 12-36 months (average 22 months) in all patients showed that the clinical symptom was improved significantly six months postoperatively and that all screws were in proper position verified by X-ray and CT scanning. All patients obtained solid bony union on radiographs, with no loosing or breakage of instrument. The postoperative JOA scores was 13.5-16.9 (average 15.8). Conclusions Allantoaxial pedicle screw fixation has advantages of intraoperative reduction, reliable fixation and high fusion rate and can be used as an effective method for extension-type odontoid fracture combined with at-lantoaxial subluxation.