[Clinical application of a classification based on crucial curvature of coronal imbalance in degenerative lumbar scoliosis].

Objective: To present efficacy of clinical application of a classification based on crucial curvature of coronal imbalance in degenerative lumbar scoliosis (DLS). Methods: A case series study. Clinical data of 61 cases (8 males, 53 females) who underwent posterior correction surgery for DLS from January 2019 to January 2021 were retrospectively analyzed. The mean age was (71.7±6.2) years (ranged 60-82 years). According to the direction of C7 plumb line (C7PL) deviated from central sacral vertical line (CSVL) and orientation of L4 coronal tilt, the author determined which one was the crucial curve. If C7PL deviated from CSVL in the same direction as concave side of the thoracolumbar curve and L4 coronally tilts opposite direction of C7PL deviates from CSVL, then the crucial curve was thoracolumbar curve (type 1). On the contrary, if C7PL deviated from CSVL in the same direction as concave side of the lumbosacral curve and L4 coronally tilts consist with direction of C7PL deviates from CSVL, then the crucial curve was lumbosacral curve (type 2). According to absolute value of coronal balance distance (|CBD|), each type of patients was divided into two groups, respectively, namely coronal balance (CB) (|CBD|≤3 cm) and coronal imbalance (CIB) (|CBD|>3 cm). Changes of Cobb angles of thoracolumbar curve and lumbosacral curve and CBD were recorded and analyzed. Results: The rate of preoperative CIB was 55.7% (34/61) in all the patients. Of the patients, 23 cases were classified as type 1 and 38 cases as type 2. The rate of preoperative CIB was 34.8% (8/23) in type 1 patients and 68.4% (26/38) in type 2. The rate of postoperative CIB was 27.9% (17/61) in all the patients, with 13.0% (3/23) in type 1 and 36.8% (14/38) in type 2. The |CBD| of CB group in type 1 patients decreased from (2.6±1.4) cm before the operation to (1.5±1.0) cm after (P=0.015); and the correction rate of thoracolumbar curve (68.8%±18.4%) was significantly higher than that of lumbosacral curve (34.5%±23.9%) (P=0.005). The |CBD| of CB group in type 2 patients decreased from (2.6±3.0) cm before the operation to (1.6±1.2) cm after (P=0.027); the correction rate of lumbosacral curve (71.3%±18.6%) was higher than that of thoracolumbar curve (57.3%±21.1%), but the difference was not statistically significant (P=0.546). There was no significant difference in |CBD| of CIB group in type 2 patients before and after the operation (P=0.222); the correction rate of lumbosacral curve (38.3%±14.8%) was significantly lower than that of thoracolumbar curve (53.6%±16.0%) (P=0.001). There was a correlation between the change of CBD (3.8±1.5) cm and the difference in correction rate between thoracolumbar and lumbosacral curve (32.3%±19.6%) in CB group in type 1 patients after surgery (r=0.904, P<0.001). There was a correlation between the change of CBD (1.9±2.2) cm and the difference in correction rate between lumbosacral and thoracolumbar curve (14.0%±26.2%) in CB group in type 2 patients after surgery (r=0.960, P<0.001). Conclusion: Clinical application of a classification based on crucial curvature of coronal imbalance in DLS is satisfactory, and its combination with matching correction can effectively prevent the occurrence of coronal imbalance after spinal correction surgery.

Evaluation of the predictors of postoperative aggravation of shoulder imbalance in severe and rigid thoracic or thoracolumbar scoliosis.

OBJECTIVE: To study the predictors of postoperative aggravation of shoulder imbalance in severe and rigid thoracic or thoracolumbar scoliosis. METHODS: In this study, 49 patients with severe and rigid thoracic or thoracolumbar scoliosis were analyzed retrospectively. The patients underwent whole-spine anteroposterior and lateral radiography preoperatively and postoperatively. On the radiographs, we measured parameters, including T1 tilt, radiographic shoulder height (RSH), proximal curve, middle curve, distal curve, apical vertebral translation (AVT) of the middle curve, thoracic trunk shift (TTS), coronal balance, and sagittal balance. We regarded RSH and T1 tilt as postoperative shoulder balance parameters and divided the patients into improved and aggravated groups of shoulder imbalance. Univariate analysis, receiver operating characteristic (ROC) curve, and multivariate logistic regression analyses were used in the statistical analyses. RESULTS: The RSH was -17.01 ± 21.85 mm before surgery and 4.76 ± 18.11 mm at follow-up. The T1 tilt angle was -10.20° ± 19.53° before surgery and -2.72° ± 13.48° at follow-up. The results of the univariate analysis suggest that preoperative RSH and proximal to middle curve change ratio were significantly higher in the patients in the improved RSH group (p < 0.01). In addition, preoperative RSH, preoperative T1 tilt, and apical vertebral translation of the middle curve were significantly higher, and preoperative proximal curve, postoperative proximal curve, and preoperative distal curve were significantly lower in the patients with improved T1 tilt group (p < 0.01). In a binary logistic regression analysis, preoperative RSH [B = -0.120, odds ratio (OR) = 0.887, p = 0.006] was found to be an independent predictor of postoperative aggravation of RSH. Similarly, preoperative T1 tilt (B = -0.488, OR = 0.614, p = 0.001) was found to be an independent predictor of postoperative aggravation of T1 tilt. Moreover, the relationship between changes in RSH and T1 tilt was either concordant or discordant. CONCLUSION: Several radiographic parameters were found to affect postoperative aggravation of RSH and T1 tilt. In particular, preoperative RSH and T1 tilt were found to be independent predictive factors of postoperative aggravation of RSH and T1 tilt, respectively.

Using the modified Delphi method to establish a new Chinese clinical consensus of the treatments for cervical radiculopathy.

PURPOSE: Although cervical radiculopathy is very common, there is no standard treatment for this condition, with little high-level evidence available to guide the treatment choice. Thus, this study aimed to review the current data on the management of cervical radiculopathy; and, further, to establish a new Chinese clinical consensus of the treatments for cervical radiculopathy using the Delphi method. METHODS: First, a systematic review of the previously established treatment guidelines and of articles related to cervical radiculopathy was conducted to establish a protocol for the clinical consensus of the treatment for cervical radiculopathy. Second, from February 2012 to June 2014, we performed a modified Delphi survey in which the current professional opinions from 30 experienced experts, representing almost all of the Chinese provinces, were gathered. Three rounds were performed, and consensus was defined as ≥70% agreement. RESULTS: Consensus of the treatments for cervical radiculopathy was reached on seven aspects, including the proportion of patients requiring only non-surgical therapies; the effectiveness of neck immobilization, physiotherapy, pharmacologic treatment; surgical indications; contraindications; surgery. CONCLUSIONS: The modified Delphi study conducted herein reached a consensus concerning several treatment issues for cervical radiculopathy. In the absence of high-level evidence, at present, these expert opinion findings will help guide health care providers to define the appropriate treatment in their regions. Items with no consensus provide excellent areas for future research.

[Anterior lumbar interbody fusion of canine with allograft cortical ring plus autogenous cancellus].

OBJECTIVE: To prove the biological characteristics of spinal intervertebral fusion with allograft cortical ring plus autogenous cancellus from iliac bone (called as composite ring). METHODS: Eight hybrid dogs were adopted in the study. The composite ring and autogenous tri-cortical blocks were implanted into the intervertebral space of dogs respectively. The intervertebral discs were removed before implantation. The fusion segments were evaluated by x-ray, histological examinations at 1, 2, 4 and 6 months after operation to compare the healing status of two implants. RESULTS: The X-ray film and histological examination showed the lumbar interbody was fused after 4 months of operation in composite ring group, while the autogenous iliac bone blocks fused with peripheral bone tissue after 6 months of operation. Composite ring healed more quickly and completely, showed different osteogenesis behavior compared with that of massive allografts. CONCLUSION: Composite ring can promote the fusion of intervertebral body and can be used as a potential material for spinal surgery.

Relative bioavailability of salmon calcitonin given intramuscularly.

BACKGROUND: Salmon calcitonin, a polypeptide hormone, is used in the treatment of osteoporosis, hypercalcemia and Paget's disease. The purpose of this study was to evaluate the pharmacokinetics and relative bioavailability of two salmon calcitonin products, Miacalcic (Novartis Pharmaceuticals, Basle, Switzerland) and Calcinin (Purzer Pharmaceuticals, Taipei, Taiwan). METHODS: This was a randomized, single-dose, crossover study conducted under fasting conditions with a washout period of 1 week between doses. Ten healthy male subjects were enrolled in this study. Each subject received a 100 IU dose (20 micrograms; 50 IU/ampule x 2) of salmon calcitonin intramuscularly (i.m.) followed by collection of blood samples at specified time intervals. Serum salmon calcitonin concentrations were measured using a validated radioimmunoassay method with a detection limit of 15.0 pg/ml. Values for the area under the serum concentration from time zero to last time and infinity curve (AUC0-t and AUC0-infinity), peak concentration (Cmax), time to peak concentration, terminal first order rate constant, terminal half-life, mean residence time, total clearance divided by absolute bioavailability, onset time, maximal effect and duration were compared for each product. RESULTS: The 90% confidence intervals for AUC0-t, AUC0-infinity and Cmax after logarithmic transformation were 93.2% to 113.1%, 97.2% to 114.9% and 84.9% to 108.0%, respectively. CONCLUSIONS: Based on the two one-sided tests procedure, we conclude that Miacalcic and Calcinin are bioequivalent.

[Experimental study and clinical application on osteogenesis of percutaneous autogenous bone marrow grafting in bone defects].

OBJECTIVE: To observe the osteogenesis of percutaneous autogenous bone marrow grafting in cicatricial bone defect, to seek a good method for treating fracture nonunion. METHODS: Eighteen rabbits were adopted in this study. 1 cm bone defect model was made in each side of radius, 6 weeks later, 2 ml autogenous bone marrow was injected in the right radial bone defect as experimental group, 2 ml autogenous peripheral blood in the left side as control group. X-ray features, histologic changes, Ca and P content in the site of bone defect were studied in various times. Also 15 patients were treated clinically for the nonunion fracture, the average time from nonunion to bone marrow grafting was 13 months. RESULTS: In experimental group, the increasing new bone tissue were observed in X-ray and histologic examination. While in control group, no osteogenesis was observed. Ca and P content of experimental group was higher than that of control group. For the 15 patients, 13 cases healed in 5-9 months, 2 cases failed. CONCLUSION: Percutaneous autogenous bone marrow grafting is capable of osteogenesis in the cicatricial bone defects. It can be used in nonunion cases which are not fit for operation of bone grafting because of poor condition of the skin.

Selective reinnervation of regenerating mixed nerve fibres across a silicone tube gap. Further experimental evidence of neurotropism.

This study investigated specific regeneration of a mixed motor and sensory nerve by the method of spinal dorsal root ganglions resection. A 10 mm segment of tibial nerve was resected and the nerve ends inserted in a silicone tube. Fourteen weeks later, dorsal root ganglia from L6 to S1 were resected on the experiment side. Twenty weeks later, the regenerating motor nerve fibres of mixed nerves selectively grew into motor branches. The rate of misdirected growth in mixed nerves was less than 6%. These results suggest that regenerating motor and sensory axons of mixed nerves are able to select their distal target organs accurately. Better results may be obtained using the entubulation repair method.

[The study of repairing ability of freeze-dried bone allograft].

There were many methods to preserve allogeneic bone allograft, however, a lot of studies have shown that the freeze-dried bone allograft banking is the best one. But it is not clear what temperature to lyophilize the allograft is better. In this experiment, we used method, in which the temperature of lyophilization was raising naturally and regularly, to lyophilize the allograft. The repairing ability of the freeze-dried allograft was studied in rabbits and comparison was made with that of autograft and fresh allograft. The results indicated that the repairing ability of bone defects was not significantly different between autograft and freeze-dried allograft. There was no significant difference between autograft and fresh allograft 3 weeks after transplantation, but significant difference was noted 8 weeks after grafting. It is suggested that this might be associated with the latent period before immunological rejection and the method itself, in which the temperature of lyophilization raising naturally is beneficial.

Reconstruction of sheath with fascial graft in flexor tendon repair. An experimental study.

Using chicken's toes as an experimental model, we compared the healing process and function recovery of partially injured flexor tendons when the sheath was repaired with fascial graft, sheath patch or was left as a defect. Post-operatively, the toes were immobilised or mobilised immediately. Histological study and the measurement of tendon sliding revealed that the sheath reconstruction and mobilised groups were better than the sheath defect or immobilised groups. We also found the fascial graft was superior in the reconstruction of tendon sheath and may become synovial-like tissue under the sliding pressure of the tendon.

[Surgical treatment of intertrochanteric fracture].

75 cases of intertrochanteric fracture were treated operatively with different instrumentation according to the fracture patterns. Classification of these fractures in relation to choice of fixation device used were discussed. We are in favour of dividing these fractures into two types: stable, 31 fractures; 24 of them were fixed with compression screws, the rest 7 with compression sliding lag screw-plate; unstable, 44 fractures; they were fixed with compression sliding lag screw-plate except 6. Follow-up, average 1 year and 9 months, showed normal joint function in 64 cases (85%) and walking with crutches in 8 (10.8%).

[Experimental study of cementless fixation of pearl-surfaced hip arthroplasties].

Femoral head replacement with pearl-surfaced prosthesis was performed on one side of each of 33 mongrel dogs. 30 of the implants inserted were without cement fixation while the other 3 with for comparison. The specimens were taken out in times of 2 weeks, 1,2,4,6, and 8 months after implantation for radiologic, histologic and biomechanical studies. In 2 weeks' specimens, quite an amount of new bone tissues were found in the interspaces among the pearls on the surface of the prosthesis; by the end of the first month, the interspaces were full of new bone, commencing lamination and progressing to become denser and denser up to 2 months when it appeared as dense as that of cortex. Biochemically the combination strength in the cementless group as a rule, was stronger than that in the control group. Some specimens, the portion in which the prosthetic stem had been embedded, were equally divided into 3 segments, upper middle and lower, to measure the combination strength at different sites. The tested values showed that the strength ratio was 4:2:1 corresponding to the upper, middle and lower segment. It is convincible that the pearl-surfaced hip prosthesis provides reliable stability without cement and it could be safely applied in clinical use.