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Preliminary results of the interspinous implants for treatment of lumbar degenerative diseases

Chinese Journal of Orthopaedics.2009;29(9):811-816. doi:10.3760/cma.j.issn.0253-2352.2009.09.003

Objective To describe our initial experience and evaluate the preliminary results as well as the possible complications of interspinous implant (device for intervertebral assisted motion, DIAMTM) in managing symptomatic lumbar degenerative disorders. Methods A group of 22 patients were analyzed ret-rospectively. Fourteen female and eight male patients were treated. Mean age was 38.5 (range, 24 -59) years. They had clinical evidence for lumbar facet joint pain and a facet joint injection therapy had good result. Pre-operatively MRI and CT scan was done to evaluate the lumbar spinous process, lumbar disc and facet joints. Fourteen patients were operated at single level, eight patients at double levels. Radiographic imaging, pain scores, and clinical assessments were obtained at 24th week, 66th week postoperatively. Results Pa-tients were evaluated clinically through the Odom's criteria: 31.8% (7 patients) excellent, 45.4% (10 patients) good, 4.5% (1 patient) fair and 18.1% (4 patients) poor results. A significant difference was observed in im-provement of visual analogue scale that decreased from preoperative mean 7.09±0.92 to postoperative mean 3.23±1.82. Statistically significant differences were noted in neural foraminal height and posterior disc height when comparing patients pre-and postoperatively. For the follow-up period, no migration and loosening of implant was found, and no revision surgery was needed in all cases. Conclusion In this preliminary result, it could be observed that the DIAMTM prosthesis can offer a pain relief in well selected patients suffering lum-bar facet joint pain. The indication should be very strict. The implant acts as: 1) A shock absorber, give dis-traction of the neuroforamina, realign facet interface; 2) Restore posterior column height and share in load transmission.

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Empirical study of autogenous dermal grafts in the prevention of epidoral fiSrosis and adhesions

Mushun HE ; Yuedong ZENG ; Zhiqiang QU

Chinese Journal of Orthopaedics.2009;29(8):765-770. doi:10.3760/cma.j.issn.0253-2352.2009.08.012

Objective To investigate the ability of auto-dermis grafts in the prevention of epidural fibrosis and adhesions, and provide reference for clinical application. Methods Five Tibet mini-pigs were used and laminectomy was performed in lumbar 2 and 4 segment. Dura was exposed and covered with auto-genous dermis grafts in lumbar 2 (the experimental group), without grafts in lumbar 4 (the autogeoous blank group). The specimens were observed grossly and histologically at 2, 4, 6, 8 and 10 weeks postoperatively. Epidural scar amount and adhere range was evaluated by modified Robertson scoring method and analyzed by SPSS 13.0. No sear and adhesion, 0 point; small amount scar and light-range adhesion, 1 point; medium sear and midrange adhesion, 2 pionts; bulk scar ang high-range adhesion, 3 pionts. Results All grafted dermis survived and thicken obviously than dermis in body surface (P< 0.05). Hair growth, sebaceous gland cyst and sweat cystogenesis were not observed. A larvaceous dissection abruption plane, little cicatricial tis-sue and adhesions rarefaction between dermis and dura were observed in the experimental group. Massive ei-catricial tissue from erector spinae filled in cavitas epiduralis was observed and dura was separated difficult-ly from cicatricial tissue in the autogeous blank group. Epidural scar amount and adhesion range in the ex-perimental group was significantly lower than the blank group (P< 0.05). Conclusion Dermis is a kind of favourable biomaterial with restraining cicatrisation and isolation barrier. Autogenous dermis grafts has the best effect on preventing peridural cicatrisation and adhesion after laminectomy.

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The clinical study of microwave heliotherapy on the malignant bone tmnors of scapula

Yongcheng HU ; Jingtao JI

Chinese Journal of Orthopaedics.2009;29(8):711-716. doi:10.376./cma.j.issn.0253-2352.2009.08.002

Objective To investigate the clinical Results of microwave heliotherapy on the malignant bone tumors of scapula. Methods Form June 1998 to February 2008, 17 patients with malignant bone tu-mors of scapula were treated with microwave heliotherapy. There were 12 males and 5 females, 48 years old on the average (ranging from 13 to 59 years). The tumors included: the primary malignant tumor of the scapula (12 cases), the metastases of the scapula (5 cases). Locations of tumors included: the SI region (14 shape or curved nick on the surface of scapula. The lesions were heated at 50 ℃ fur 20 min at 2450 MHz microwave, with surrounding soft tissue protected by copper mesh. The necrotic tumor tissues were excised after the treatment of microwave heliotherapy. Results The axillary nerve of the patient with the metastases of the scapula was cut off, and the broken ends were sewed up after the tumor was excised. The duration of surgery was from 60 minutes to 180 minutes (120 minutes on average). The blood loss was from 300 ml to 1000 ml (460 ml on average). All patients were followed up for 3 months to 10 years (4.2 years on average). Three cases with Ewing sarcoma died due to brain metastases, pulmonary metastases or all body metastases 8 to 24 months postoperatively. Three cases with malignant fibrous histiocytoma died due to pulmonary metastases or all body metastases 10 to 22 months postoperatively. Five cases with the metastases died due to metastases 6 to 14 months postoperatively. Three patient's superduet function of shoulder joint was re-stricted. Conclusion The clinical Results demonstrated that the advantages of microwave heliotherapy in-cluded quick increase of temperature, sensitive responses, easy control of temperature, and effective inacti-vation of tumor cells in the malignant bone tumors of scapula.

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Tibial tuberosity avulsion fracture in children

Guisen YAN ; Xieyuan JIANG ; Zhenghua ZHU

Chinese Journal of Orthopaedics.2009;29(7):658-661. doi:10.3760/cma.j.issn.0253-2352.2009.07.011

Objective To discuss the characteristics, treatment method and prognosis of tibial tuberosity avulsion fracture in children. Methods From January 1995 to December 2007, there were 25 cases (23 boys and 2 girls). The age at injury ranged from 12 to 16 years(average 13.5 years). All cases were unilateral involved (10 of left, 15 of right). All of the injuries resulted from participation in athletic activities, 10 in basketball, 7 while jumping, and 8 in football game. According to the classification of Ogden, there were 1 type 1A, 4 type 1B, 5 type 2A, 7 type 2B, 4 type 3A, and 4 type 3B fractures. One type 1A fracture was treated nonoperatively with east immobilization, and other 24 fractures with open reduction and internal fixation. Results All of 25 cases were followed from 14 months to 7 years (average 43 months). The range of motion of knee joint was 0°-140° 3 months after operation, and all of them recovered to pre-injury levels of activity by 6 months after operation. According to Mosier clinical assessment system, the final outcome was evaluated as excellent in all. Wound healed primary, no compartment syndrome was found. The time of bony union ranged from 2 to 5 months, with the mean time of 3 months. No complications of infection, ex-tremities deformity and inner fixation failure were found. Conclusion The tuberosity avulsion fracture in children is an uncommon and special type of epiphyseal injury. These fractures occur in the narrow range of 13 to 16 years of age. The majority of patients are males, and most of them are unilateral involved. This in-jury has an excellent outcome without deformity or functional loss, once adequate reduction and fixation of fracture fragments have been achieved.

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Cartilage tissue engineering by collagen-chitosan-chondroitin sulfate scaffold seeded with rat adipose tissue-derived stromal cells in vitro

Tao ZHANG ; Qin FU ; Zhiyong YU

Chinese Journal of Orthopaedics.2009;29(7):677-683. doi:10.3760/cma.j.issn.0253-2352.2009.07.015

Objective To evaluate the character of the collagen-chitosan-chondroitin sulfate scaffold seeded with rat adipose tissue-derived stromal cells. Methods A dipose tissue were harvested from 6 weeks old Wistar rats and the stromal cells were harvested by type Ⅰ collagenase and then cultured in vitro. Type Ⅰ collagen was fully mixed with chitosan, freeze-dried and cross-linked with chondroitin sulfate, then freeze-dried again and sterilized by ethylene oxide. The pore diameter, water content, porosity of the scaffold were tested. The adipose tissue-derived stromal cells were digested, seeded into the plates, scaffold, and cen-trifuged into pellet, and then induced into cartilage. MTT detection for cell proliferation was done. After 3 weeks, the cell morphology, and cell proliferation and adhesion were observed, and chondrngenic differenti-ation was also analyzed. Results The pore diameter, water content, porosity tested for the scaffold showed an appropriate form. Cell proliferation showed faster in the scaffold and pellet culture system after 5 day, there was still cell proliferation in the scaffold system after 14 days but no obvious changes in the pellet cul-ture system; ceils on the scaffold proliferated densely showed by histological staining, but there was a scaf-fold structure residues in the inner layer. The finding of type Ⅱ immunohistochemistry stain showed that cells express strong positive for type Ⅱ collagen in the scaffold and pellet culture system whereas it was weakly positive in the plate culture system; the specific mRNA for cartilage, type Ⅱ collagen, aggrecan and SOX-9 were expressed in all three systems showed by RT-PCR, but type X collagen was expressed continu-ously in the plate culture system and expressed after 21 days in the pellet culture system, whereas it was not detected in the collagen-chitosan-chondroitin sulfate scaffold system. Conclusion The parameters of the collagen-chitosan-chondroitin sulfate scaffold were suitable in our study. The results suggested that it can promote the adipose tissue-derived stromal cells proliferation and chondrogenic differentiation better than the plate and pellet culture systems and maintain the phenotype of chondrocytes well; it is the optimal choice for cartilage tissue engineering in the future.

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AO titanium elastic nail combined with autologous hone marrow injection for treatment of simple bone cysts of the long bones in children

Jianfeng FANG ; Xiaodong WANG

Chinese Journal of Orthopaedics.2009;29(7):653-657. doi:10.3760/cma.j.issn.0253-2352.2009.07.010

Objective To study the effects and advantages of the treatment for simple bone cysts of the long bones in children with AO titanium elastic nail and autologous bone marrow injection. Methods Eighteen patients with a simple bone cyst at humerus or femur were managed with AO titanium elastic in-tramedullary nail combined with autologous bone marrow injection. There were eleven boys and seven girls in total, with the mean age of 8.1 years, ranged from 6 to 12 years. Twelve cysts was located in the proximal end of humerus, five in the proximal end of femur and one in the middle part of the shaft of femur. Twelve cysts were active and six inactive according to Neer standard. Radiographic evaluation was performed three, six, twelve and eighteen months after operation during the 11 to 23 months follow-up by taking anteroposteri-or and lateral X-ray pictures. Then we measured residual radiolucent areas on X-ray pictures and did statistic research with group comparison. Results Six cysts (33.3%) healed completely, and twelve (66.7%) healed with residual radiolucent areas which were visible on X-ray pictures 3 to 6 months after operation. Residual radiolucent areas on X-ray pictures gradually reduced during the different phases and it has statistical signif-icance by group comparison. There was no recurrence or major complication except for one patient with mild irritation of skin caused by the end of the nail up to now. Conclusion The treatment for simple bone cysts of the long bones in children combined with AO titanium elastic nail and autologous bone marrow injection not only has satisfactory healing rate but also can provide early stability to the long bones, and accelerate the healing of cysts which allows early mobilization and thus obviates the long-term need for a plaster cast and decreases the prevalence of the most common complication: a pathological fracture.

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Long-term results of discectomy for lumbar intervertebral disc herniation

Bohua CHEN ; Fuling CHEN ; Yougu HU

Chinese Journal of Orthopaedics.2009;29(7):630-633. doi:10.3760/cma.j.issn.0253-2352.2009.07.005

Objective To investigate retrospectively the long-term results of discectomy for patients with lumbar intervertebral disc herniation. Methods From July 1988 to May 2003, 273 cases of 1040 patients with lumbar intervertebral disc herniation undergone surgical treatment in our hospital were followed up. All patients were divided three groups according the time of follow-up. The follow-up time was three years as middle follow-up group (Ⅰ), five years as longer follow-up group(Ⅱ) and ten years and more as sup-longer follow-up group (Ⅲ). Sixty-eight cases(24.91%) were in group Ⅰ, including 42 males and 26 females, with the average age of 43.7 years (14-63 years). The group Ⅱ included 141 cases (51.65%), 92 males and 49 females, with the average age of 46.1 years (18-76 years). As group ⅡⅢ, 64 cases (23.44%) were included 46 males and 18 females, with the average age of 43.5 years (20-63 years). The standards Scoring System of Chinese Spinal Association (CSA) and Japan Orthopaedic Association (JOA) were used for investigation. Results According to CSA system, the total good and excellent rate of surgical treatment for lumbar intervertebral disc herniation was 89.0%. The percentage of the satisfactory of the group Ⅰ, Ⅱ, Ⅲ were 92.6%, 91.5% and 79.7% respectively. There was significant difference between group Ⅰ and group Ⅱ, Ⅲ. The score of JOA were 24.75±5.08, 22.43±6.55, 21.64±7.18 postoperatively, with significant difference between group Ⅰ and group Ⅱ, Ⅲ. Conclusion The mid-term results of surgery for patients with lumbar iutervertebral disc herniation is good, and the good and excellent rate decreases gradually with the follow-up time. The results were similar to each other for evaluation between the standard of CSA and JOA.

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An electrophysiological study on brain functional reorganization of different operative modes of contralateral C7 transference treating total brachiai plexus avuision in young rats

Haifeng WEI ; Liang CHEN ; Yudong GU

Chinese Journal of Orthopaedics.2009;29(6):576-581. doi:10.3760/cma.j.issn.0253-2352.2009.06.014

Objective To detected the motor cortex reorganization and compared the influence on reorganization process as regard to different transfer modes of contralateral seventh cervical nerve root (C7)in young rats model of total brachial plexus root avulsion. Methods The young Sprague-Dawley rats model of total brachial plexus root avulsion was established. The left radix dorsalis and radix ventralis from the fifth cervical nerve root (C5) to the first thoracic nerve root (T1)were exposed and the roots from C5 to T1 were avulsed from the spinal cord. Then, the contralateral C7 transfer operation was performed. Three different operative modes were applied randomly which included contralateral C7 transference to anterior division of the upper trunk (group A, n=30), to both musculocutaneous and median nerves (group B, n=30), or to median nerve (group C, n=30). The movement evocation of motor cortex was measured by intracortical microstimula-tion in both hemispheres, and functional reorganization was assessed dynamically in 1.5, 3, 6, 9 and 12 months after operation. Results After contralateral C7 transference, the ipsilateral motor cortex initially acti- vated the injured limb at 1.5 month, and subsequently the motor cortex of both hemispheres activated the in-jured limb at the 3rd and 6th month. The injured limb was activated mainly by the contralateral motor cortex in group A at the 9th month. The contralateral motor cortex exclusively controlled the injured limb in all three groups at the 12th month after the operation. Meanwhile, the extent of functional reorganization was better in group B than that of group C. Conclusion After contralateral C7 transfer operation, motor cortex in charging injured limb developed a transhemispheric functional reorganization in young rats with total brachial plexus root avulsion. Different operative modes contributed to the functional reorganization of motor cortex. Transferring contralateral C7 to anterior division of the upper trunk or to both musculocutaneous and median nerves provided better functional reorganization than to median nerve.

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An anatomical and biomechanical study of the forearm interosseous membrane

Jun PAN ; Jia SU ; Xiaoshan GUO

Chinese Journal of Orthopaedics.2009;29(6):572-575. doi:10.3760/cma.j.issn.0253-2352.2009.06.013

Objective To observe the anatomical and biomechanieal properties of the forearm in terosseous membrane (IOM), providing the scientific theoretical basis for the diagnosis and treatment of the IOM injury. Methods Ten radius-IOM-ulna structures (left for 5 and right for 5) were harvested from 5 fresh-frozen adult cadavers to measure the length, width and thickness of the tendinous part. Then the tendi-nous part with its radial and ulnar insertions were isolated, embedding the proximal part of the radius and the distal part of the ttina in commercially available dental base acrylic resin powder. The embedded speci-mens were mounted on MTS 858 testing machine using a 10 000 N load cell for all tensile tests. The speci-mens were tested at a displacement rate of 50 mn/min until failure. The load-displacement curve was de-scribed by the computer while the maximum load and stiffness were recorded. Results The IOM consisted of three components: the tendinous part, the membranous part, and the dorsal oblique accessory cord. The IOM was fiat in the neutral position, while it flexed during the pronation and supination. Six specimens ob-tained the tear of tendinous portion at a maximum load of (1021.50±250.13) N. The stiffness was (138.24±24.29) N/mm with displacement to failure of (9.77±1.77) mm. Other 4 specimens failed by fracture through the ulnar fixed site before there was failure of the IOM at a maximum load of (744.40±109.85) N. The stiff-ness was (151.17±30.68) N/mm with displacement to failure of (6.51±0.51) ram. Conclusion The IOM has stiffness comparable to the ligament between the radius and the ulna and play an important role for the maintenance of longitudinal stability of the forearm. These results can provide objective criteria for the eval-uation of reconstructive methods.

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Efficacy of balloon Kyphoplasty for the treatment of multi-vertebral osteoporotic compression frac-ture

Liang CHEN ; Huilin YANG ; Tiansi TANG

Chinese Journal of Orthopaedics.2009;29(4):310-314. doi:10.3760/cma.j.issn.0253-2352.2009.04.005

Objective To evaluate the efficacy and safety of balloon kyphoplasty in the treatment of painful multi-vertebral osteoporotic compression fractures. Methods From October 2002 to April 2007, 42 patients (96 vertebrae) with painful multi-vertebral osteoporotic compression fractures underwent kyphoplasty. The group included 14 men and 28 women with an average age of 72.5 years (range 56-91 years). Each pro-cedure included insertion and insertion of balloon, fracture reduction and cement filling under "C"-arm monitoring. Preoperative and postoperative pain level, SF-36 score, vertebral height restoration, local kypho-sis correction and complications were recorded and analysed. Results All 42 patients tolerated the opera-tion well and were followed up for average 31.4 months (range 12-71 months). The mean VAS pain score decreased significantly from 7.1±2.4 preoperatively to 2.7±1.3 postoperatively, the mean height of anterior and medial vertebral body were (1.8±0.5) cm, (1.6±0.6) cm preoperatively and (2.3±0.6) cm, (2.2±0.7) cm postoperatively. No significant change of posterior vertebral height was recorded postoperatively.The mean correction of local kyphosis was 9.2°at each level. 6 of 8 subscahs measured by SF-36, including physical function, role function, bodily pain, vitality, role emotion, mental health, were significantly improved by the operation. Complications were found in 7 patients including 6 cases of cement leakage with no clinical symptoms (intradiscal cement leakage in two cases, paravertebral vessel leakage in two cases, paravertebral leakage in one case and cement leakage into canal in one case), and 1 case of pulmonary embelization with symptoms relieved after conservative treatment. Conclusion Kyphoplasty is effective and relatively safe for multi-vertebral osteoporotic compression fractures.

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