Objective:To evaluate the effectiveness and procedure of C-arm fluoroscopy-guide percutaneous vertebroplasty(PVP) for the treatment of multiple level vertebral body compression fractures.Methods:Seven cases(5women and 2 men) suffering from multiple level vertebral body compression fractures( range 3-9 levels), underwent 3 to 6 levels' PVP guided by a single plane C-arm fluoroscopy in prone position or lateral recumbent position.The age of cases was from 60 to 79.Visual analgesic scale(VAS), analgesic use and mobility were measured in each patient at pre-PVP, 2 days post-PVP and 4 months post-PVP.Results:PVP procedures were successful in prone position of 2 cases and in lateral recumbent position of 5 cases.The time consumed by PVP in each patient was from 2.0 to 4.5 hours. Unipedicular approach was used in 16 fractured vertebrae and bipedicular approach in 9 fractured ones.The volume of polymethylmethacrylate(PMMA) injected into each vertebral body was from 0.5 ml to 4.0 ml.In all 7 cases, the procedure increased mobility and decreased analgesic use ( T=0,P

Objective To compare the feasibility and efficacy of PPSF with OPSF for thoracolumbar fractures.Methods We searched the PUBMED,OVID and Cochrane CENTRAL databases through Jan 2014.All of the clinical trials included were extrac-ted and evaluated by two reviewers independently.Data were analyzed using RevMan 5.2.6 software by the Cochrane Collabora-tion.Results Seven studies including 353 patients met the inclusion criteria.The Meta analysis found there were significant differ-ences between the two procedures in intraoperation blood loss (RR = 1.89,95%CI :1.55 - 2.29,P < 0.05)and operation time (RR=1.21,95%CI :1.12-1.30,P <0.05).For the correction of sagittal Cobb′s angle and the anterior vertebral body height,a-nalysis did not find any significant difference between the PPSF and OPSF(P >0.05).Conclusion Both PPSF and OPSF are safe and efficacious internal fixation methods for treating thoracolumbar fractures,while,PPSF may cause less blood loss and cost less time.

Objective To evaluate the curative effect and problems of X-ray fluoroscopy guided percutaneous vertebroplasty (PVP) in treating osteoporotic spinal compression fractures. Methods Twenty-four patients (15 females and 8 males) with 44 vertebral compression fractures underwent PVP. They were average 69 years of age (48-83 years). The fracture segment was within T 5-L 3 (20 thoracical vertebrae, 24 lumbar vertebrae). Under the guidance of C-arm fluoroscopy, bone marrow biopsy needle was inserted percutaneously via transpedicular way into the fractured vertebrae. Polymethylmethacrylate (PMMA) was then injected into the fractured vertebrae. Vasual analogue scale (VAS), mobility and analgesic usage were evaluated 2 days before and after PVP and in the follow-up period. Results PVP was successful in 21 cases (40 vertebrae ), but failed in 2 cases (4 vertebrae) due to weak position endurance. The volume of PMMA injected was 1.0-8.0 ml per vertebrae. The average follow-up period was 3.1 months (1-7 months). VAS was sharply decreased from pre-PVP 7.5?1.2 to 2.8?1.0 at day 2 after PVP (P

BACKGROUND: Generally, repairing the injuries of sketetal muxcle is to suture the epimysial and exterior muscular nerve. OBJECTIVE: To determine the intramuscular nerve effects on the recovery of lacerated musculus rectus femoris. DESIGN, TIME AND SETTING: The randomized control animal experiment was performed at the Animal Experimental Center, Chongqing Medical University from September 2006 to August 2007. MATERIALS: Twenty New Zealand rabbits weighing 2.0-2.5 kg were used to establish models of right skeletal muscle injury; left side was used as controls. METHODS: Twenty rabbits were randomly divided into two groups. Rabbits in the intact intramuscular nerve group underwent complete muscle laceration with intramuscular nerve intact. Musculus rectus femoris was traversed at 4.0-5.0 mm from nerve entry point. Rabbits in the intramuscular neurotmesis group underwent complete muscle laceration, but intramuscular nerve was cut concomitantly at the same place as above. MAIN OUTCOME MEASURES: 28 weeks after surgery, wet weight and isometric contraction of musculus rectus femoris were detected. Morphological change of musculus rectus femoris was observed by Hematoxylin & Eosin Staining. Fibrous degree was measured by Masson trichrism staining. Myofibrillar type was examined by myosin ATPase staining and tetrazolium staining method of reduced coenzyme Ⅰ to calculate cross-sectional area of muscle fiber. RESULTS: Compared with the controls, wet weight and isometric contraction of musculus rectus femoris reduced in the intramuscular neurotmesis group (P

BACKGROUND: LIM Mineralization protein 1 (LMP-1), an intracellular non-secretory protein, plays roles in bone calcification. Presently, it is found that LMP-1 can promote an increase in bone morphogenetic protein 2 and transforming growth factor ? 1. This indicates that LMP-1 may recruit a mass of ossified factors to participate in the differentiation of osteoblasts. OBJECTIVE: To construct human LMP-1 gene adenovirus recombinant with AdEasy adenovirus vector system, and to detect LMP-1 expression in infected rabbit bone marrow mesenchymal stem cells (BMSCs). DESIGN, TIME AND SETTING: An opening experiment was performed at the Central Laboratory of South West Hospital, Third Military Medical University of Chinese PLA from March 2006 to February 2007. MATERIALS: Three New Zealand rabbits were used to isolate bone marrow mesenchymal stem cells. Plasmid pIRES2-EGFP-LMP-1 carrying human LMP-1 gene was kept in Department of Orthopedics, Second Hospital Affiliated to Chongqing Medical University. AdEasy was presented by Dr. Tong-Chuan He from USA. Human embryo kidney 293 cells were gifted by Wang from Department of Clinical Laboratory of Chongqing Medical University. METHODS: LMP-1 gene with a sequence encoding His-tag was amplified by using pIRES2-EGFP-LMP-1 plasmid as a template for polymerase chain reaction (PCR) with a specially designed downstream primer. The target gene was cloned to the pMD18-T vector for sequencing. Once verified, the gene was cut out by double endonucleases, connected to the shuttle vector pAdTrack-CMV. The newly constructed vector was linearized by PmeⅠ following efficient homologous recombination with the backbone vector pAdEasy-1 in BJ5183. The correct recombinant pAd-LMP-1 was linearized with Pac I and transfected to HEK293 cell by means of mediated Lipofectamine. The titer of virus was measured after amplification and purification. The mRNA and protein expression of LMP-1 was detected in BMSCs, which were infected with Ad-LMP-1 at the most appropriate MOI, were detected by reverse transcription (RT)-PCR and Western blot, respectively. MAIN OUTCOME MEASURES: Plasmid pAd-LMP-1 identification, its titre and efficiency of infection. mRNA and protein expression of LMP-1 were detected by RT-PCR and Western blot, respectively. RESULTS: The recombinant plasmid pMD18-T-LMP-1 carrying LMP-1 gene with His-tag was successfully constructed. After packaging and amplification of the recombinant adenovirus, the 3.5?109 efu/ml titer of Ad-LMP-1 was obtained by CsCl gradient purification. The optimal efficiency infection was 50%-70%, which was get after Ad-LMP-1 infected BMSCs for 3 days at the most appropriate MOI 150. The mRNA and protein expression of LMP-1 in infected BMSCs had been proved. CONCLUSION: The recombinant adenovirus containing human LMP-1 gene with His-tag is successfully constructed. The BMSCs infected with recombinant adenovirus Ad-LMP-1 can effectively express LMP-1.

BACKGROUND: Nerve growth factor (NGF) and myelin-associated glycoprotein (MAG) can promote the repair of peripheral nerve. However, increasing the expression of NGF and MAG in the injured peripheral nerve by transgene technology has not been reported.OBJECTIVE: To investigate the expression of NGF and MAG after adenovirus (Ad) mediated transfection in the injured sciatic nerve in rats.METHODS: Forty Sprague-Dawley rats were randomly divided into normal, model, Ad, NGF and NGF-MAG groups. Sciatic nerve injury models were established in the latter four groups by cutting and suturing the right sciatic nerve. Afterwards, the rats in each group were subject to the intramuscular injection of normal saline, normal saline, Ad (1×108 PFU), Ad-NGF (1×108 PFU), and Ad-NGF-MAG (1×108 PFU), respectively, once every 2 days, for consecutive three times.RESULTS AND CONCLUSION: The expression level of NGF in the rat sciatic nerve in the Ad and normal groups was significantly higher than that in the NGF and NGF-MAG groups (P < 0.05). Compared with the Ad, NGF and normal groups, the expression level of MAG in the NGF-MAG group was significantly increased (P < 0.05). To conclude, the Ad-mediated NGF and MAG after double gene transfection were expressed effectively in the injured sciatic nerve in rats.

Objective To investigate the efficacy of the clinical pathway in geriatric orthope-dics clinical teaching. Methods From March 2010 to December 2011, 80 clinical undergraduates, who practiced in the Department of Orthopedics in the Second Affiliated Hospital of Chongqing Medi-cal University, were equally randomized divided into two groups. One group was taught by the con-ventional methods and the other group was taught by the clinical pathway teaching. After the teaching, the theoretical exam and operational skill test were performed among students in both groups. SPSS 17.0 software was employed and the scores before and after the teaching and scores between two groups was analyzed by paired t-test(inspection level α=0.05). Results There was no significant difference in average scores between two groups before teaching(theoretical exam: P=0.81, operating skill test:P=0.65) while significant increases were observed in scores of theoretical exam and operational skill test after teaching (theoretical exam and operating skill test: P<0.05) and clinical pathway teaching group had higher scores than conventional teaching group (theoretical exam and operating skill test:P=0.02 and P=0.01). Conclusions Better effects can be achieved by clinical pathway approach re-garding geriatric orthopedics teaching.

Objective To evaluate the feasibility, safety, and clinical outcome in patients with cervical spondylotic radiculopathy underwent cervical nerve root decompression using the anterior percutaneous endoscopic surgery.Methods Eleven subjects consisting of 6 men and 5 women treated from July 2012 to December 2013 were enrolled in the study.Mean age was 42.1 years (range, 27 to 63 years).All were diagnosed to be unilateral single-segment injury involving C3/4 in 1 case, C4/5 in 2 cases, C5/6 in 6 cases and C6/7 in 2 cases.Because of unsatisfactory results 6 week following the non-operative treatment, the patients were operated on using the anterior percutaneous endoscopic osteophyte removal and nerve root decompression.Operation time, postoperative complications, visual analogue scale (VAS) and modified Macnab scale were recorded.Results Operation time was (102.5 ± 21.3) min (range, 80-140 min).Nine patients were followed up for 12 months and no complications were noted.VAS improved significantly at postoperative 3 days and 1, 3, 6, as well as 12 months compared to the preoperative value (P ＜ 0.01).Modified Macnab scale presented great improvement at postoperative 3 and 12 months compared to the preoperative value (P ＜ 0.01).Conclusion The technique is reliable and effective in treatment of cervical spondylotic radiculopathy.

Objective To evaluate the feasibility, safety and efficacy of percutaneous vertebroplasty (PVP) for osteoporotic compression fracture of the upper thoracic spine.Methods The study enrolled 20 patients with osteoporotic compression fracture in 25 upper thoracic segments.The subjects (5 males and 15 females) aged at (71.0 ± 10.8) years (range, 57-89 years).Fracture occurred in 2 T1, 3 T2,5 T3 and 15 T4 segments.The subjects were submitted to puncture process via unilateral extrapedicular approach.Operation time, volume of infused bone cement, X-ray images and CT scan were recorded after operation.Visual analogue score (VAS), mobility score and Oswestry disability index (ODI) were assessed after operation.Results The procedure was successfully accomplished in all patients.Mean operation time was (39.7 ± 10.6)min.Infusion volume of bone cement was 2.0-6.0 ml [(3.3 ± 1.5)ml].Eighteen patients were available to the follow-up of 5.5-18 months [(7.6 ± 2.7) months].Three patients (15％) were associated with cement leakage into the epidural (n =1), paravertebral soft tissues (n =1) and disc (n =1) but remained asymptomatic.One patient (5％) had new fracture at the non-adjacent and non-operative segments within 15 days, and had no recurrence after PVP.No other serious complications such as rib fracture, pneumothorax, pulmonary embolism, vascular injury, spinal injury and infection were found.VAS, mobility score and ODI improved at 3 d, 1 month, 3 months and final follow-up compared to those at 1 d pre-operation (P ＜0.O1).Conclusions PVP is a safe and effective treatment for upper thoracic osteoporotic compression fracture, which is associated with few complications,reduced pain and improved mobility as well as quality of life.Rational surgical position and puncture approach are beneficial to a successful surgery.

Objective To evaluate the safety,feasibility,and clinical outcome of anterior percutaneous endoscopic cervical discectomy (PECD).Methods The study involved 28 patients undergone PECD.Visual analogue scale (VAS) and MacNab scale were recorded before operation and at 3 days,1,3,6,12 and 18 months after operation.In addition,MRI examination was conducted at postoperative l month,3 months and 12 months.After data collection,single-factor T test with SAS software was performed.Results Follow-up (range,18-24 months,mean 19 months) was achieved in 25 patients.When compared to the preoperative score,VAS and MacNab scale presented improvement at postoperative 3 days (P ＞ 0.05) and great improvement at postoperative 1,3,6,12,18 and 24 months (P ＜ 0.01).VAS and MacNab scale at postoperative 3 days presented statistical differences as compared to those at postoperative 3,6,12 and 18 months (P ＜0.05),but the differences were not statistically insignificant at postoperative 3,6,12,and 18 months (P ＞ 0.05).Moreover,VAS and MacNab scale showed significant improvement at postoperative 24 months as compared to those before operation (P ＜0.01) and those at postoperative day 3 (P ＜ 0.01).Conclusion Anterior PECD is effective in treatment of cervical soft or partial hard disc herniation.