Objective To perform digital 3D measurement of anatomic parameters associated with vertebral units fixed by ribs and pedicle fixation of T4-T10,providing evidence for clinical application.Methods Spiral CT scan of T4-T10 vertebrae was conducted in 15 normal adults without spinal disorder.The data were imported into computer to establish units and disc models of thoracic and rib vertebrae T4-T10 using Mimics 16.0 software and Ansys 11.0 finite element software.The following data were measured in the vertebral pedicle-rib unit fixation group (group A) by software:transverse diameter of vertebral pedicle-rib unit,length of the outside pedicle screw,inclination angle of pedicle screw,and maximum and minimum inclination angles of pedicle screw;the following data were also measured in the pedicle fixation group (group B) by software:pedicle transverse diameter,length of pedicle screw,inclination angle of pedicle screw,and maximum and minimum inclination angles of pedicle screw.The corresponding parameters were compared between groups A and B.Results In both groups,the transverse diameters and screw lengths gradually increased with the increase in the vertebral sequence while the inclination angle of pedicle screw,and maximum and minimum inclination angles of pedicle screw decreased with the increase in the vertebral sequence.All the parameters in groups A were significantly larger than the corresponding ones in group B (P ＜ 0.05).Conclusions Of the spinal segment of T4-T10,the rib vertebral unit fixation can provide greater safe screw angles and screw diameters for clinical surgery.This is of vital significance for reducing the surgical complexity and improving screw prehension.

BACKGROUND:Thoracic lumbar segment is prone to spinal tuberculosis, caseous necrosis tissue, dead bone compression of spinal cord and nerve root may cause neurological symptoms, and the majority of them is accompanied with mild and moderate spinal kyphosis deformity. Surgical treatment of spinal tuberculosis has been frequently reported in recent years, the commonly used treatment includes lesion clearance, bone graft fusion and internal fixation. OBJECTIVE:To investigate the principle of choosing different internal fixation treatment for thoracolumbar spinal tuberculosis. METHODS:42 patients with thoracolumbar spinal tuberculosis were involved in this study from January 2001 to December 2011. Al patients suffered from waist and back pains, with the disease course range of 1 month to 7 years. Four cases showed neurological deficit before surgery. According to the Frankel classification, 1 case was graded as Frankel C and 3 cases as Frankel D. The preoperative average Cobb angle of kyphosis was 27° (range 12°-45°). The internal fixation approaches were chosen according to the tuberculose focus and vertebral fracture extent. Thoraco-abdominal approach for thoracolumbar spine via diaphragm with the removal of 11 rib and(or) 12 rib was performed for al patients. Among these protocols, 25 cases underwent anterior focal debridement and bone grafting. 17 cases had anterior focal debridement and posterior pedicle screw internal fixation (one-stage surgery in 7 cases and second-stage surgery in 10 cases). Al patients received anti-tuberculosis chemotherapy before and after operation. 36 cases used rib and 6 cases used iliac bone as bone graft. Al patients were fol owed up from 17 months to 9 years. The correction of spinal deformity, spinal stability and spinal functional recovery were observed. RESULTS AND CONCLUSION:30 patients were fol owed up after operations and the back pains disappeared. X-ray examination showed that, al patients were fixed wel without no loosening and rupture, and achieved bony fusion (the mean time were 5.4 months). No tuberculosis recurred. Four cases complicated with spinal cord injury were E grade according to the Frankel classification. The Cobb angle was 0-26° (mean 14°) at 12 months after operation. On the premise of standard anti-tuberculosis chemotherapy, various internal fixation methods can be determined according to general conditions of patients and tuberculose focus site.

BACKGROUND:Studies have shown that posterior orthopedic internal fixation and anterior orthopedic internal fixation al can get good clinical outcomes for treatment of adult idiopathic scoliosis, however, it has not been reported on what kind of methods could achieve a better clinical outcome for treatment of Lenke3 type adult idiopathic scoliosis, have less risk of pedicle screws breakage and more reliable long-term efficacy. OBJECTIVE:To establish the Lenke 3 type adult idiopathic scoliosis finite element model and thoracic screw guide target 3D model using finite element analysis software, so as to provide scientific basis for biomechanical analysis and scientific pedicle screw implantation. METHODS:The CT scan image from T 1 to sacrum of one 28 years old volunteer with Lenke 3 type adult idiopathic scoliosis was imported into Mimics 16.0 software by Dicom form. Integral idiopathic scoliosis three dimensional model was established by geometry clear technology. Nail guide target of thoracic vertebra was established on vertebral model by design module in Mimics 16.0 software. The point cloud form of three dimensional model was imported into Geomagic Studio 11.0 software. Series of image processing of model were conducted. At last, three dimensional model was imported into ANSYS 14.0 finite element analysis software in order to build finite element model with biological properties. RESULTS AND CONCLUSION:Complete Lenke 3 type adult idiopathic scoliosis three dimensional finite element model was established successful y. It concluded 440 975 tetrahedron units and 580 bar units, total y 441 555 units and 1 077 318 nodes. Total y 12 nail guide target models of thoracic vertebra were established, including 4 682 tetrahedron units and 7 390 nodes. Lenke 3 type adult idiopathic scoliosis three dimensional finite element model and nail guide target of thoracic vertebral model with a realistic appearance were established successful y in this experiment. These results confirm that Lenke 3 type adult idiopathic scoliosis three dimensional finite element model provides scientific basis for further biomechanical experiments. Meanwhile, the construction of nail guide target model of thoracic vertebra provide a new scientific method for thoracic pedicle screw placement.

BACKGROUND:At present,there is lack of relevant biomechanical model for the T6-T7-T8 rib-vertebral fix unit.In addition,there is no support of parameters of basic studies on reasons and reasonable explanation of screw breakage,poor quality of bone fusion and adjacent segment degeneration.OBJECTIVE:To develop a three-dimensional finite element model of bone graft with vertebral tuberculosis debridement and posterior rib-vertebral unit fixed system through tuberculosis of thoracic spine (T6-8),and to analyze the stress so as to improve it.METHODS:Spiral CT data of one male patient (172 cm,71 kg,39-year-old) with T7 vertebral tuberculosis were imported into computer to develop a three-dimensional finite element model of bone graft with vertebral debridement and posterior vertebral unit fixed system through tuberculosis of T6-8 by Mimics 13.0 and Ansys 11.0 finite element software.500 N pressure and 10 N?m torque were loaded to the vertebral body by 3 kinds of physiological loads which simulated flexion,extension and lateral bending.The stress distribution of fixation devices under different loads was compared.RESULTS AND CONCLUSION: At the positions of anteflexion and extension,the stress mainly concentrated to screw tail,and the stress of upper screw was greater than the middle and lower screws.For connecting rods,the stress of the middle was always less than the lower middle and the middle stress was zero.At lateral bending position,the stresses of upper and middle screw tail were quite,and the unilateral stress of connecting rod was also equivalent.For three different dynamics at the same point,the stress of middle connecting rod increased in the lateral bending motion,and the stress of lower screw tail was equivalent.These data suggested that it is prone to fatigue fracture at upper screw tail by bone graft with vertebral tuberculosis debridement and posterior rib-vertebral unit fixed system through tuberculosis of thoracic spine (T6-8) at the three positions of anteflexion,extension and lateral bending.The lower connecting rod at the positions of anteflexion and extension and the middle connecting rod at the position of lateral bending easily cause fatigue fracture.

BACKGROUND:In recent years, neural stem cels are considered to be ideal for the treatment of spinal cord injury, but the proportion of its natural differentiation into neurons in the host body is relatively low, which severely restricts the therapeutic effect on spinal cord injury. OBJECTIVE:To investigate the effect of erythropoietin on the differentiation of neural stem cels in vitro. METHODS:Under sterile condition, neural stem cels from the hippocampus of neonatal Wistar rats were isolated, cultured and identified by immunofluorescencein vitro. The third generation of neural stem cels were randomly divided into 0.5, 5, 50 U/mL erythropoietin groups and control group (with no erythropoietin). RESULTS AND CONCLUSION:Compared with the control group, the differentiation rate of neural stem cels was significantly improved in the 0.5, 5, 50 U/mL erythropoietin groups (P< 0.05); moreover, the differentiation rate of neural stem cels in the 5, 50 U/mL erythropoietin groups was higher than that in the 0.5 U/mL erythropoietin group (P < 0.05). In addition, there was no significant difference between the 5, 50 U/mL erythropoietin groups (P > 0.05). These findings indicate that erythropoietin can effectively induce the differentiation of neural stem cels into neurons in vitro, and moreover, it can significantly improve the differentiation rate of neural stem cels into neurons.

Objective To study the clinical characteristic of non puerperal mastitis and estimate the effect of anti-mycobacterial agents for non puerperal mastitis .Methods 22 cases of periductal mastitis and gran-ulomatous mastitis receiving anti-mycobacteria drugs therapy from Mar .2012 to Mar.2014 were retrospectively analyzed.Results All patients were female.The mean age was 30 years(ranging from 24 to 46 years).The main clinical manifestation of the 22 patients were 18 patients(81.8%)with mass, 20 patients(90.9%)with abscess, 15 patients(68.2%)with fistula and 9 patients(40.9%)with all of the above 3 symptoms.6 patients had incision and drainage of abscess and 2 patients had tumor resection before anti-mycobacterial therapy .All of the 8 patients had postoperative recurrence .All patients underwent anti-mycobacterial therapy with 3 to 16 months.11 cases (50.0%)patients were cured without recurrence until now .7 cases(31.8%) patients were improved markedly and they still received drug treatment .2 cases(9.0%)patients with tumor size reduced to 2 cm were ready to sur-gical resection.2 cases(9.0%)were lost to follow-up.Conclusion Patients with refractory non puerperal masti-tis can be treated with anti-mycobacterial agents with relatively long treatment time and can also avoid mastecto-my.

BACKGROUND:Scoliosis is a complex spinal pathology characterized as a three-dimensional spine deformity combined with vertebral rotation. The finite element analysis can replace traditional biomechanical experiment for repeated experimental analysis and for processing digital simulation. It has been widely used in the study of scoliotic biomechanics.
OBJECTIVE:To emphasize the application of finite element analysis on the brace and surgical treatment of scoliosis.
METHODS:An online search of PubMed and Wanfang database was performed by using key words of“scoliosis, finite element”in Chinese for articles published between January 1986 and May 2013. A total of 38 papers related to finite element of scoliotic treatment, published in authorized journal and considered to be a representative, were selected.
RESULTS AND CONCLUSION: How to design an individualized brace in accordance with biomechanical characteristics of scoliosis is the hot topic. By using multi-imaging technology, the rib, chest bone and pelvis are introduced into the finite element models, in a broader attempt to analyze the optimal three-dimensional orthopedic force pattern for scoliosis. The results of relative research showed that, the ideal loading pattern is given at the protruding area of scoliosis. Finite element analysis can predict and evaluate the orthopedic procedure and effect of patients, thus assisting the design of reasonable orthopedic treatment scheme. Through finite element analysis, we can simulate and analyze the stress distribution of internal fixator in spine, which contributes to prevent the complications.

BACKGROUND:The conditions of teenager and adult skeletons have great differences. Thus, it is dangerous to place screw on teenagers using the methods for adults.
OBJECTIVE:To observe the anatomical features of teenagers’ upper-middle thoracic vertebra images, and to provide experimental basis for pedicle nailing and pedicle-rib head unit nailing in teenagers’ upper-middle thoracic vertebrae.
METHODS:We chose 30 teenagers (13 to 18 years old) without spine lesions, and then they were scanned (0.625-1.25 mm) from T 1 to T 12 segments using CT. The original data were loaded into a three dimensional software in DICOM format for measuring related indicators. At last, we analyzed the data according to different segments.
RESULTS AND CONCLUSION:The trend between the width of pedicle and pedicle-head unit was similar, showing a“V”shape. The minimum of width was located in the T 4 , and there were significant differences between the corresponding vertebral bodies (P<0.05). The trend between pedicle nail road length and pedicle-rib head unit nail road length was similar, and the trend between them was gradual y increasing. The minimum of length was located in T 1 , and the maximum of length was located at T 10 , and there were significant differences between the corresponding vertebral bodies (P<0.05). The trend between the pedicle transverse angle and pedicle rib-head unit transverse angle was similar. The trend from T1 to T10 was on a decline, and there were significant differences in corresponding vertebrae (P<0.05). The trend of curves between pedicle sagittal angle and pedicle rib-head unit sagittal angle was similar, showing a wavy shape, and there were significant differences in corresponding vertebrae (P<0.05). These results confirmed that the same segmental pedicle rib-head unit can provide a safer nailing place than the pedicle relatively.

BACKGROUND:Establishment of high-quality finite element model is an important basis of biomechanical analysis. The reports on three-dimensional finite element model of complete adolescent idiopathic scoliosis are less. OBJECTIVE:To set up three-dimensional finite element model of PUMCIId1 adolescent idiopathic scoliosis for building ideal digitization platform for further biomechanical study. METHODS:A 14-year-old female patient with PUMCIId1 adolescent idiopathic scoliosis was included as volunteer for the current study. CT images obtained from CT transverse scanning from T 1 to sacrococcyx were imported into Mimics 16.0 software to form qualified three-dimensional geometric model, including thoracic cage, which was further delivered to Geomagic Studio 11.0 software to build three-dimensional finite element model by a series of modules and optimization of cleaning. The geometric model was imported to ANSYS 14.0 software to build complete three-dimensional finite element adolescent idiopathic scoliosis model by adding ligaments, setting unit type, and defining material properties. RESULTS AND CONCLUSION:A complete three-dimensional finite element model of PUMCIId1 adolescent idiopathic scoliosis was built successful y, consisting of 522 887 tetrahedron elements and 730 rod elements, a total of 523 617 units and 159 008 nodes. Three-dimensional finite element model of PUMCIId1 adolescent idiopathic scoliosis was lifelike, and can be used as the reliable digital model for further biomechanical analysis.

BACKGROUND:The structure surrounding upper thoracic spine is complicated. Transverse diameter of pedicle was relatively smal . There were important organs in front of the vertebral body. Screws deviated from axis or screws were too long. The safety and effectiveness of screw implantation were not implemented. It is necessary to understand the key structure of surroundings. OBJECTIVE:To analyze the relationship of anatomic position between the axis of screw of pedicle of upper thoracic spine and key adjacent structure of the vertebral body. METHODS:A total of 30 healthy adult volunteers received T 1-T 4 pedicle axis paral el to CT scans. The positions of esophagus, trachea position, aortic arch, carotid and vertebral arteries were observed when the pedicle screw was implanted along the pedicle axis. The shortest distance on both sides of a vertebral pedicle axis from these structures was measured. Paired t-test was utilized for analysis. RESULTS AND CONCLUSION:240 measurement parameters were analyzed. The distance from the left pedicle axis on T 1-3 to esophagus was smal , and the left pedicle on T 2 was minimal. The distance from the right pedicle axis on T 2-4 to trachea was smal . The distance from right pedicle axis on T 3 , T 4 to right main bronchus was smal . Carotid and vertebral artery did not show the risk of injury. 62%of the patients were in the aortic arch on T 4 plane, and no risk of damage was found. These results indicated that the left pedicle screws were easy to damage the esophagus, and the right pedicle screw was easy to damage trachea. Carotid artery, vertebral artery and aortic arch were not easy to be damaged. The anatomic position of easily damaged structure could be identified by careful analysis of CT data before screw implantation in the pedicle of upper thoracic spine.