Objective To explore clinical outcomes of using improved 2D computer-assisted fluoroscopic navigation of inu'tation 3D vertebra image to guide the pedicle screws in lumbar disease. Methods The anterio posterior, lateral and oblique radiographic materials were got in 43 lumbar disease patients performed neck of vertebra internal fixation, and used the method of improved computer-assisted fluoroscopic navigation to imitate anterio posterior, lateral spinal and axial pedicle virtual image to guide the pedicle screws implantation. Results One hundred and eighty-eight lumbar pedicle screws were implanted, deviation mean position 1.5 mm and mean angle deviation 0.8° in match navigation virtual path with real pedicle screws image. Postoperative CT showed all pedicle screws contained within the pedich, without invasion to lateral and inner bone cortical of the pediele. Deviation mean 1.0° by measured pedicle screws with longitudinal axis vertebra compared with preoperational predict implant screws sagttial angle. Conclusions Improved 2D computer-assisted fluoroscopic navigation is simple and convenient, use anterio posterior,lateral and oblique radiographic materials to imitate anterio posterior,lateral spinal and axial pediele virtual image can precisely guide the pedicle screws implantation.

Objective To discuss the technology of modest isolating and enriching the intestinal epithelial stem cells. Methods Mouse intestinal epithelial cells were stained by Rhodamine 123 (Rho), sorting the Rhodamine 123 low staining cell population ( Rholow ) and Rhodamine 123 strong straining cell population ( Rhobri ) by fluorescence activated cell sorting(FACS) in flow cytometer; Detecting the musaashi-1 and p-glycoprotein 1 (p-g-p1) mRNA expression of two groups by RT-PCR; Analyzing the cell cycle and the percentage of the musashi-1 positive cells by flow cytometry. Results The intestinal epithelial cells were divided into three groups, Rhodamine 123 low staining cells( 12. 34% of total cells), Rhodamine 123 middle staining cells (45.26% of total cells) and Rhodamine 123 strong staining cells ( 41. 40% of total cells). The Rholow cell fraction and Rhobri cell fraction were isolated successfully. Both of musashi-1 and p-g-p1 mRNA were strongly expressed in Rho1ow cell fraction, and Rhobri cell fraction little expressed p-g-p1 mRNA. Most of Rho1ow cells were in G0/G1 phase, and the musashi-1 positive cells were about 10.37% of total cells in this fraction. Conclusion The intestinal epithelial stem cells can be modestly isolated and enriched by Rhodamine 123 staining.

Objective To explore clinlical outcomes of using improved computer-assisted fluoroscopic navi-gation to guide the percutaneous vertebroplasty to treat multiple osteoporotic spinal compression fractures. Methods Twenty-eight multiple osteoporotic spinal compression fractures patients with 73 painful vertebral body were got an-terio posterior,lateral and oblique radiographic imaging by using computer-assisted fluoroscopic navigation to imitate anterior- posterior. Lateral spinal and axial pedicle virtual image was obtained to guide the percutaneous kyphoplas-ty. Results All painful vertebral body were one-sided punctured,all percutaneous kyphoplasties were succeed by guiding with computer-assisted fluoroscopic navigation. Navigation virtual puncture needle image basically matched with reality view. PMMA dosage was 2.5 ～ 4 ml. Postioporational CT showed that the PMMA filled spinal focus very well. 11 cases completely relieved and 17 cases partially relieved. Conclusion Using improved computer-assisted fluoroscopic navigation to guide the PKP to treatment multiple osteoporotic spinal compression fractures decreases op-erative time and radiation injury. It is a safe,precise,minimally invasive method.

Objective To compare the surgical outcomes between microsurgery lumbar discectomy and microendoscopic discectomy for lumbar disc herniation. Methods A prospective study was conducted on the surgical procedures for lumbar disc herniation.The target of our study was a group of 33 patients who underwent surgery by microsurgery lumbar discectomy(MSLD group)and 36 patients who underwent surgery by microendoscopic discectomy(MED group).The items investigated were the operation time,amount of bleeding,duration of hospitalization,pre-and postoperative scores based on judgment criteria for treatment of lumbar spine disorders established by the Japanese Orthopaedic Association score,visual analog scales (VAS,0 to 10) for lumbago and sciatica before surgery and at discharge,perioperative complications.Results The mean duration of follow-up was 2 years and 2 months (11 months to 4 years).There were no significant differences between the 2 surgical procedures in the frequency of the pre-and postoperative Japanese Orthopaedic Association scores or postoperative VAS for lumbar pain and sciatica,operation time and duration of hospitalization. Statistically significant differences were observed in amount of bleeding and operation time,but the differences were not large, and may not have been clinically significant.Conclusion Both microsurgery lumbar discectomy and microendoscopic discectomy are appropriate for lumbar disc herniation.

Objective To find an ideal operative method of i nteral fixation for supracondylar a nd in-tercondylar femur comminuted fractures.Methods 30cases with supracondylar and inte rcondylar femur frac-tures were treated percutaneously with retrograde femoral intramedullary nail(GSH)in condition of close reduction technique with assistance of endosc ope and fluroscope.Results The mean 115ml blood loss was seen in 30cases without grafting intraoperatively.Thigh edema recovery and over90?knee flexion motion were seen one week after the operation.All fractu res were united in 6months.Postoperative following-up for 18months revealed the mean 125?knee motion,normal gait in all cases,no varus or valgus defo rmities and no osteoarthotitis.Conclusion The percutaneous tech.of retrograd e nailing with assistance of endosco pe and fluroscope is an ideal surgery method to treat supracondylar and intercondylar femur factures.

Objective To explore the clinical application of computer-assisted three-dimensional navigation system for thoracic pedicle screw placement. Methods From May 2003 to May 2004, the computer-assisted three-dimensional navigation system was used for thoracic pedicle screw placement in 80 screws of 15 cases, including 30 in the upper thoracic spine and 50 in the middle or lower thoracic spine. These fifteen patients included ten male and five female with a mean age of 47 years (range 13-76 years). In this series of 15 patients, thoracic spinal surgery was performed for tumor resection and reconstruction in 5, burst fracture in 4, ossification of thoracic ligamentum flavum in 2 and thoracic scoliosis in 4. The pedicle screw position was assessed with "C"-arm fluoroscopy during operation and with CT post-operation. The cost of time for pedicle screw installation and amount of bleeding were recorded. Results The cost of time averaged 15 minutes (range 10-20 min) for each pedicle screw placement. The amount of bleeding varied, it averaged 1200 ml in thoracic tumor resection and reconstruction, 800 ml in posterior fixation for burst fracture, 300 ml in resection of ossified ligamentum flavum, and 500 ml in surgery for scoliosis. The pedicle screw position was graded post-operatively with CT scanning into three groups: gradeⅠ, perfectly placed, grade Ⅱ, cortical perforation less or equal to 2 mm, and grade Ⅲ, perforation more than 2 mm. Of these 80 screws, 76 screws (96%) were found in gradeⅠ, 2 in gradeⅡ, and 2 in grade Ⅲ. All of the 4 screws in gradeⅡor Ⅲ were placed deviating to the lateral portion of pedicles, and no neurological deficit was resulted. Conclusion The computer-assisted three-dimensional navigation system is a valuable tool both for improving the accuracy of thoracic pedicle screw installation, and increasing the overall safety of the procedure during thoracic spine surgery.

Objective To explore the efficacy of computer-assisted fluoroscopic navigation to guide the treatment of thoracolumbar burst fractures. Methods 18 patients with thoracolumbar unstable fractures were treated with short-segment vertebral pedicle screw fixation guided by computer-assisted fluoroscopic navigation, and fractures were reinforced with CPC cement vertebroplasty. Postimplantatively, the implants' images-error between virtual image of fluoroscopy and X-ray image was measured. Results The implant's location was excellent. All patients were allowed sitting-up or bearing body weight one week after operation. The vertebral height restored 40% postoperatively. 12 months after operation the vertebral height only changed 0.15%. Dynamic X-ray films showed no abnormal segment instability and no instrument breaking. Conclusion Using computer-assisted fluoroscopic navigation to guide the treatment of thoracolumbar burst fractures with CPC vertebroplasty and short-segment pedicle srew fixation could determine the internal fixation approach and let implants to the precise position by one time of X-ray image. It increases the security of pedicle screw fixation and vertebroplasty.