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Pedicle screw-rod system assisted with high speed drills for treatment of interlocking dislocation of cervical spine

Zhibin MENG ; Tao HUANG ; Guang FENG ; Jun LI ; Tingrui WANG ; Kaizhong ZHU

Chinese Journal of Trauma.2013;29(9):841-844. doi:10.3760/cma.j.issn.1001-8050.2013.09.011

Objective To evaluate the indications,techniques and effects of high speed drill assisted cervical pedicle screw-rod system in treatment of cervical interlocking dislocation.Methods A retrospective review was made on data of 13 cases of cervical interlocking dislocation undergone pedicle screw-rod fixation and reduction with assistance of high speed drills from December 2006 to July 2011.Dislocation localized in C3/4 (n =3),C4/5 (n =5),C5/6 (n =4) and C6/7 (n =1) respectively.Causes for injury contained cervical hyperextension due to traffic accidents (n =7) and a fall from the height (n =6).Two remained neurological intact,seven were combined with syndrome of central canal damage,and four had paraplegia.All the 13 cases received posterior pedicle screw fixation and reduction within 7 days after injury.Pedicle screws were implanted on adjacent segment of cervical spine with unlocking the interlocked small joints by a distraction device.Results All 13 cases obtained good reduction,including eight with complete anatomic reduction and five with 1-2 mm of vertebral slight slippage.Fifty-two screws were inserted and 49 pedicle screws were put in place except for the excursion in three pedicle screws on the postoperative radiographic and CT scans.There was no injury of spinal cord,nerve root or vertebral artery during operation.The patients showed significant improvement in sensory and motor function of the upper extremities in the follow-up of 12-36 months.One case had screw breakage at postoperative three months with no nerve symptoms.Conclusion High speed drill assisted pedicle screw-rod system is suitable for treatment of cervical interlocking dislocation,for its reduction process accords with the biomechanics and allows decompression therapy.

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Paraspinal approach versus conventional approach in pedicle screw fixation of thoracolumbar fractures

Zhongming REN ; Hongfei WU ; Yuan ZHANG ; Yuliang ZHANG ; Yinhua ZHANG

Chinese Journal of Trauma.2013;29(9):845-848. doi:10.3760/cma.j.issn.1001-8050.2013.09.012

Objective To estimate the effect of pedicle screw fixation of thoracolumbar fractures via paraspinal approach and compare it with the conventional posterior midline approach.Methods Forty-two cases of thoracolumbar monosegmental fractures subjected to single posterior pedicle screw fixation and reduction from December 2008 to May 2010 were included in the study.Among the patients,19 cases were operated through paraspinal muscular-sparing approach (paraspinal approach group) and 23 cases through posterior midline surgical approach (conventional approach group).Surgical incision length,operation time,intraoperative blood loss,postoperative drainage volume,postoperative hospital stay,pre-and post-operative VAS and other perioperative indices as well as fracture reduction outcome were compared between the two groups.Oswestry disability index (ODI) was assessed after operation.Results There were no statistical differences between the two groups in aspects of surgical incision length,operation time,postoperative hospital stay,height restoration of fractured vertebra (P ＞ 0.05),but intraoperative blood loss (148.5 ± 26.5) ml,postoperative draining loss (72.9 ± 17.3) ml,postoperative VAS (1.1 ± 0.3) points and ODI (13.4 ± 2.7) points in paraspinal approach group showed statistical differences from those in conventional approach group (P ＜ 0.05).Conclusion Paraspinal muscle-sparing approach is characterized by minor trauma,less bleeding,slight pain and quick recovery as compared with conventional posterior midline approach and hence may be the preferred choice for the treatment of thoracolumbar fracture without spinal canal decompression.

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Digital guide plates for correction of unilateral delayed orbitozygomatic complex fractures

Zhiyuan CHEN ; Hong KUANG ; Nan LIU ; Jingming LIU ; Tieli SONG ; Xuan WANG ; Xiaoxia WU

Chinese Journal of Trauma.2013;29(9):857-859. doi:10.3760/cma.j.issn.1001-8050.2013.09.015

Objective To investigate the clinical outcome of correction of unilateral delayed orbitozygomatic complex fractures with digital guide plates.Methods The study involved 14 cases of unilateral delayed orbitozygomatic complex fractures treated between September 2007 and March 2012.Craniofacial structures were measured by thin-section CT before operation,followed by data input to the image processing software.Before and after the processing of images,three dimensional skull models were produced using rapid prototyping technique and applied to have surgical simulation.Digital guild plates were produced for guiding the reduction of fractures and orbital walls were reconstructed as well.Results All cases were followed up for a period of 6-11 months,which showed basic restoration of facial structure and significant correction of diplopia and enophthalmos,with no infection or dislocation of implants buried in orbit floor.Mild ectropion of the lower eyelid occurred in one case and temporary decrease of frontal wrinkle in two cases,but all recovered in 3-6 months postoperatively.Conclusion Digital guide plate is easy in operation and reliable for treatment of unilateral delayed orbitozygomatic complex fractures.

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Survey and intervention on first aid skills for spinal cord injury in army members

Yuebin YUAN ; Jingsheng ZHAO ; Guodong LIU ; Yuchuan YAO ; Weiguo YI

Chinese Journal of Trauma.2013;29(9):871-874. doi:10.3760/cma.j.issn.1001-8050.2013.09.020

Objective To comprehensively understand the first aid skills for spinal cord injury of army members and improve their first aid skills through interventions.Methods A total of 2 200 troops members were selected within the army (Navy,Army and Air Forces).Intervention methods included questionnaire assessment,multimedia teaching and demonstration of first aid for spinal injuries.The total intervention time was 1 year,with once every four months.Results There distributed 2 200 copies of questionnaire before intervention and received 2 118 valid copies,with the total reclaim rate of 96.27％.A total of 2 118 copies of questionnaires were distributed after intervention and received 2 074 valid copies,with the total reclaim rate of 97.92％.Theoretical examination and skill test results of the army members were significantly improved after the intervention (all P ＜0.01).The general individual factors showed no effect on first aid of spinal cord injury before and after intervention.Before the intervention,the navy members had higher score than the land forces members and the air force members; however,no significant difference was found on the scores of different forces after the intervention.Conclusions The first aid skills for spinal cord injury of the army members has a big gap from the actual requirements.Improvement of first aid skills for spinal cord injury of the officers and soldiers can save the lives of themselves or comrades and hence is important in minimizing the combat attrition in future potential local high-tech wars.

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Effect of microglia/macrophage pre-activation on TLR2/NF-κb signaling pathway early after ischemic brain injury in rats

Yunfeng YANG ; Zhi CHEN ; Jianbo ZHANG ; Yuxing HUANG ; Qiang LI ; Hua FENG ; Gang ZHU

Chinese Journal of Trauma.2013;29(9):889-893. doi:10.3760/cma.j.issn.1001-8050.2013.09.024

Objective To investigate the effect and significance of microglia/macrophage activation prior to cerebral ischemic preconditioning (CIP) in regulating toll-like receptors 2 (TLR2)/nuclear factor-kappa B (NF-κB) inflammatory signaling pathway in early stage after ischemic brain injury in rats.Methods Thirty healthy male SD rats were selected and divided into normal control group,sham operation group,ischemia group,intervention group and treatment group according to random number table,with six rats per group.A rat model of focal permanent cerebral infarct was established by occlusion of middle cerebral artery (MCAO).CIP was performed by local ischemia-reperfusion.Minocycline was used to inhibit microglia/macrophage activation after CIP.Features of microglia/macrophage activation after CIP were detected by immunofluorescence; mRNA expressions of predominant factors (NF-κB inhibitor α,IκB-α;tumor necrosis factor α,TNF-α) of TLR2/NF-κB inflammatory signaling pathway in parietal cerebral cortex by in situ hybridization method; death rate by Kaplan-meier survival curves; neurological deficits by a 5-point neurological scale; brain infarct size by triphenyl tetrazolium chloride (TTC) staining.Results Microglia/macrophage started activation at one hour after cerebral ischemic injury in preconditioning group and presented a significant increase at 12 hours.Speed and range of activation were higher in preconditioning group than in ischemic group.IκB-α mRNA in preconditioning group started expression at one hour.TNF-α mRNA in preconditioning group remained a low expression in 12 hours and had a significantly lower peak value as compared with that in ischemic group (P ＜ 0.05).CIP increased rat survival rate significantly,improved nerve function and reduced infarction size when compared with the ischemia group (P ＜ 0.05).Minocycline inhibited nerve protection by CIP significantly (P ＜0.05).Conclusion CIP induces rapid activation of microglia/macrophage in early period of rat cerebral ischemic injury and provides brain protection probably via inhibition of TLR2/NF-κB activity and inflammatory overreaction to cerebral ischemia.

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Relationship of drug resistance in acinetobacter baumannii isolated from the burn patients with the expression alteration of efflux pump adeAB

Jun XIANG ; Yi DOU ; Cailian ZHU ; Jingning HUAN

Chinese Journal of Trauma.2013;29(10):915-918. doi:10.3760/cma.j.issn.1001-8050.2013.10.004

Objective To observe the expressions of efflux pump gene cluster adeAB in acinetobacter baumannii isolated from the burn patients and the expression changes of its upstream regulatory genes adeR and adeS and determine the influence of those genes on drug resistance of acinetobacter baumannii.Methods Nine drug-resistant strains and nine sensitive strains of acinetobacter baumannii isolated from the burn patients treated between June 2012 and March 2013 were used.After strain identification using 16SrDNA sequencing,acinetobacter baumannii standard strain ATCC19606 was employed as the control.mRNA expressions of efllux pump genes adeA and adeB and their upstream regulatory genes adeR and adeS were detected by real-time quantitative PCR.Results (1) adeA and adeB genes presented higher expressions in drug-resistant strains (3.71 ±0.95,76.16 ± 8.75) than in sensitive strains (0.92 ± 0.94,0.72 ± 0.78) (F =38.71,663.65 respectively,both P ＜ 0.05).(2) adeS and adeR genes showed higher expressions in drug resistant strains (18.02 ± 6.71,3.02 ± 2.69) than in sensitive strains (1.64±1.51,0.76±0.61) (F =51.04,5.57 respectively,bothP＜0.05).Conclusions The over-expression of efflux pump gene cluster adeAB induced by the expression alteration of its upstream regulatory genes adeR and adeS is closely associated with the drug resistance of acinetobacter baumannii in the burn patient.Besides,the regulatory genes may depend on adeS to sense the nosocomial environment condition,activate or inactivate adeR and hence regulate efflux pump expression.

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Antagonistic effect of astragaloside on immune response of regulatory T cells mediated by high mobility group box-1 protein in rats

Jinfeng LI ; Yongming YAO ; Lifeng HUANG ; Shuwen ZHANG ; Zhenyu ZHANG ; Zhiyong SHENG

Chinese Journal of Trauma.2013;29(10):919-923. doi:10.3760/cma.j.issn.1001-8050.2013.10.005

Objective To investigate the antagonistic effect of different doses of astragaloside Ⅳ (AST Ⅳ) on immune function of regulatory T (Treg) cells mediated by high mobility group box-1 protein (HMGB1) in rats and the mechanism by which AST Ⅳ exerts its influence.Methods CD4 + CD25 +Treg cells isolated from the spleens of clean-grade BALB/c mice were seeded on 72-well culture plate.Cells were divided into four groups (18 wells per group) according to the random number table,i.e.normal control group (cells were cultured merely),HMGB1 (1 μg/ml) group,HMGB1 (1 μg/ml) + AST Ⅳ (50 μg/ml) group,and HMGB1 (1 μg/ml)+AST Ⅳ (100 μg/ml) group.Each group consisted of three subgroups (6 wells per group),from which the Treg cells were collected at post-stimulation hours 24,48 and 72 respectively.Foxp3 intracellular protein and mRAN expressions were detected by flow cytometry and quantitative fluorescent PCR.Contents of IL-10 and TGF-β released into the supernatants were determined by ELISA method.Results As compared with the control group,Foxp3 intracellular protein and mRAN expressions in the Treg cells were decreased at 24 hours to 72 hours after HMGB1 stimulation (P ＜ 0.01),with particular reduction at 72 hours.Additionally,changes of IL-10 and TGF-βin the supernatants presented the same trends with Foxp3.Foxp3 protein and mRAN expressions in AST Ⅳ group were markedly higher than that in HMGB1 group at 24-72 hours (P ＜ 0.05) and the expressions in AST Ⅳ(100 μg/ml) group were much more significant than that in AST Ⅳ (50 μg/ml) group (P ＜ 0.05).While contents of IL-10 and TGF-β in supernatants revealed the same trend with Fox3 as well.Conclusions AST Ⅳ antagonizes the impact of HMGB1 on the activity of the Treg cells in a dose-dependent manner in vitro.It is suggested that AST Ⅳ has a strong inhibitory effect on HMGB1-mediated inflammatory response.

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Deviation factors of posterior atlantoaxial transarticular screw placement assisted by rapid prototyping drill templates

Yong HU ; Zhenshan YUAN ; Hui XIE ; Jianbing YUAN ; Weixin DONG ; Chengtao WANG

Chinese Journal of Trauma.2013;29(10):946-954. doi:10.3760/cma.j.issn.1001-8050.2013.10.014

Objective To validate the safety and accuracy of a rapid prototyping drill template (RPDT) for posterior atlantoaxial transarticular screw placement and analyze factors for screw deviation.Methods Twelve normal cadaveric cervical spines were examined using 64 slice CT with 1-mm thick scan and data in Dicom format were recorded.After data was processed using software Mimics 10.01 for three-dimensional (3-D) model reconstruction,computer-assisted design of optimum trajactory for atlantoaxial transarticular screw placement was worked out and made into a drill template,where the surface was created as the inverse of axial posterior surface.The drill template was materialized in a rapid prototyping machine and used to place the screws.After surgery,the position of posterior atlantoaxial transarticular screw was evaluated by X-ray and CT scan.Screw entry point,angle and orientation of the optimal and actual trajactory were determined after fitting the position of the pre-operative and post-operative specimen in computer software and the redefining the 3-D coordinate axis.Results Twenty-four screws were implanted with no cortex perforation.Depth of the optimum save screw trajectory for atlantoaxial transarticular fixation was (37.34 ± 2.31) mm on the left side and (37.11 ± 2.21) mm on the right side.Introversion angles of the optimum save screw trajectory was 0° in both sides,but the actual angle was (0.15 ±0.58)°on the left side and (0.11 ±0.46)°on the right side.Elevation angle of the optimum save screw trajectory was (49.35 ± 1.62) °on the left side and (48.83 ± 1.83) ° on the right side,but the actual angle was (49.29 ± 1.68) °and (49.10 ± 1.45) °respectively.Average displacement of screw entry point in the x,y and z axis was respective (0.21 ±0.65) mm,(0.69 ± 1.48) mm and (0.39 ±0.11) mm on the right side,while (0.19 ± 0.66) mm,(0.53 ± 1.45) mm and (0.38 ± 0.13) mm on the left side.There were no statistically significant differences in deviation levels of entry point and orientation between the optimum and actual screw trajectory (P ＞ 0.05).Conclusions Causes for deviation in RPDT-assisted placement of atlantoaxial transarticular screw are mainly intrinsic factors of the hardware and software and human factors in the operation.RPDT is easy in operation and has individualized design,which greatly improves the accuracy of screw placement and reduces screw deviation.RPDT can be widely used in clinical practice.

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Clinical comparative study of modified versus traditional posterior lumbar interbody fusion for lumbar spinal stenosis

Qing YE ; Deliang MA ; Wu HUANG ; Tiansen LIANG ; Shiwei LIANG

Chinese Journal of Trauma.2013;29(10):955-959. doi:10.3760/cma.j.issn.1001-8050.2013.10.015

Objective To compare the clinical outcomes of modified and traditional posterior lumbar interbody fusion (PLIF) in treatment of lumbar spinal stenosis.Methods A retrospective review was made on 47 patients who sustained monosegmental L4.5 stenosis due to lumbar degenerative revise and characterized by typical intermittent claudication and single or both limb numbness and pain.The patients were randomly allocated to Group A and Group B using the lottery method.Group A (n =24) consisted of 10 males and 14 females at mean age of 52 years (range,47-66 years) and the course of disease averaged 13 months (range,9-23 months).Group B (n =23) contained 8 males and 15 females at mean age of 53 years (range,49-67 years) and the course of disease averaged 11.5 months (range,6-22months).Modified PLIF including spinous process replantation combined with canal H-shaped bone grafting for posterior column reconstruction and interbody fusion was performed in Group A.Traditional PLIF,namely posterior spinal decompression and interbody fusion,was performed in Group B.Waist function rehabilitation after surgery of the patients in the two groups was assessed using the Oswestry disability index (ODI) and postoperative results were analyzed.Results There were no significant differences between Groups A and B regarding the operation time [(1 90 ± 15.66) min vs (170 ± 11.32) min] and intraoperative blood loss [(980 ± 35.58) ml vs (879 ± 21.25) ml] (P ＞ 0.05).Mean period of follow-up was 20 months (range,12-28 months).Postoperative results in Group A were graded as excellent in 19cases,good in three,fair in two and poor in zero,with excellence rate of 88％.While in Group B,the results were excellent in 13 cases,good in four,fair in four and poor in two,with excellence rate of 74％(P ＜ 0.05).ODI score and symptom improvement rate after operation were better in Group A than in Group B (P ＜ 0.05).Conclusion The modified PLIF including spinous process replantation combined with canal H-shaped bone grafting for posterior column reconstruction is relatively an ideal surgical technique for treatment of lumbar spinal stenosis and deserves wide promotion.

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Apixaban for prevention of venous thromboembolism after major orthopedic surgery: a Meta-analysis

Jianmin WANG ; Liying CAO ; Shengping YANG ; Mingjing JIANG ; Guan WANG

Chinese Journal of Trauma.2013;29(10):960-965. doi:10.3760/cma.j.issn.1001-8050.2013.10.016

Objective To systematically assess the clinical efficacy and safety of apixaban versus enoxaparin in the prevention of venous thromboembolism (VTE) after major orthopedic surgery.Methods Based on the principles and methods of Cochrane systematic review,the Cochrane Library,PubMed,EMBASE,Chinese Bio-medicine Database,China Journal Full-text Database,VIP Database were searched from their establishment to March 2012 in whatever languages.Related journals were handsearched as well.Randomized controlled trials (RCTs) of comparing apixaban and enoxaparin in the prevention of venous thromboembolism after major orthopedic operation were included.Cochrane Collaboration' s tool was used for assessing risk of bias in the included trials.Cochrane Collaboration' s software RevMan 5.1 was used for statistical analysis.Results Four RCTs totaling 12 897 patients were included.Apixaban treatment showed significant differences in aspects of total VTE and all-cause mortality [relative risk (RR) =0.63,95％ CI(0.41,0.96)],major VTE [RR =0.59,95％ CI(0.19,0.98)] and symptomatic deep vein thrombosis (DVT) [RR =0.50,95％ CI(0.26,0.97)] when compared with enoxaparin,but the difference in fatal pulmonary embolism was insignificant[RR =1.57,95％ CI(0.41,5.99)].For patients undergoing total knee arthroplasty,apixaban was associated with significantly fewer major bleeding events[RR =0.55,95％ CI(0.32,0.96)] and fewer total bleeding events[RR =0.79,95％ CI(0.66,0.95)] than enoxaparin.For patients undergoing total hip replacement,however,the two treatments revealed no statistically significant differences.With regard to the incidence of drug-related serious adverse events,the two treatments displayed no significant difference[RR =0.97,95％ CI(0.59,1.58)].Conclusion Apixaban is effective in the prevention of VTE after major orthopedic surgery and can significantly reduce the risk of postoperative VTE.

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