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ObjectiveTo explore the clinical diagnosis and treatment of rare primary lumbar intervertebral space infection with Klebsiella pneumoniae and Enterobacter cloacae， and provide clinical experience for the diagnosis and treatment of this rare spinal infection. MethodsAn elderly male patient with low back pain and numbness in the left lower extremity for more than 7 months， which aggravated for more than 1 week， was diagnosed with lumbar disc herniation after laboratory and imaging examinations. After admission， the symptoms became acutely aggravated， and re-examination of lumbar enhanced MRI showed local enhancement at the posterior edge of the L3/4 intervertebral space. The VAS score was 9 points， and the lumbar JOA score was 6 points. A posterior lumbar interbody fusion of L3-L5 was performed， and L3/4 intervertebral disc specimens were collected during the operation for bacterial culture. ResultsBacterial culture results showed Klebsiella pneumoniae and Enterobacter cloacae infection. The patient was treated with sensitive antibiotics for 6 weeks after the operation， and the patient was cured during the follow-up of half a year after the operation. ConclusionFor middle-aged and elderly patients with clinical manifestations of acute severe low back pain or lower extremity pain， the possibility of spinal infection should be considered when routine laboratory and imaging examinations suggest lumbar degenerative diseases.
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[Abstract] Objective To provide an optimized animal model for basic research by comparing the establishment of proprioceptive hypoesthesia model of anterior cruciate ligament (ACL) by open surgery and minimally invasive surgery. Methods Totally 30 normal cynomolgus monkeys were randomly divided into five groups: minimally invasive surgery group: unilateral ACL injury under arthroscope, n = 6; open surgery group: unilateral ACL injury through direct incision of knee joint, n = 6; minimally invasive sham operation group: unilateral ACL without injury through arthroscopic cleaning only, n = 6; open surgery group: unilateral ACL exploration without injury through direct incision of knee joint, n = 6; positive normal group: no surgical intervention, n = 6. Four weeks later, the neurophysiological examination [somatosensory evoked potentials (SEPs) and motor nerve conduction velocity (MCV)] was carried out. The macaque was killed and its unilateral ACL was stained with gold chloride. The number and variation of ACL proprioceptors were observed and recorded. Results In the aspect of neuroelectrophysiology, except the normal group, the latency of SEPs and MCV were prolonged, and the amplitude decreased. In terms of proprioceptors, the total number of minimally invasive surgery group: 578. 00± 12. 68, amplitude: 36. 33 ± 3. 72; total number of open surgery group: 367. 67 ± 9. 33, amplitude: 77. 00 ± 5. 55; total number of open sham operation group: 969. 00±18. 26, amplitude: 0±0; total number of normal group: 970. 46±16. 34, amplitude: 0± 0, the total number of proprioceptors decreased and the number of variation increased in all four groups except the normal group. At the same time, in the comparison of the two aspects, there were significant differences between the open operation group and the minimally invasive operation group, the open operation group and the open sham operation group, and the minimally invasive operation group and the minimally invasive sham operation group (P0. 05). Conclusion Both the open operation group and the minimally invasive operation group can build ACL proprioceptive hypoesthesia model, but the minimally invasive operation has less damage to the tissues around ACL, more scientific and single model, and less experimental error, which is of great significance in the basic research of ACL injury.
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Objective To research the clinical significance of the tibiofibular syndesmosis based on the anatomical characteristics of the tibiofibular syndesmosis. Methods A total of 51 tibiofibular syndesmosis collected from Southwest Medical University were measured based on the anatomical characteristics of the lower tibia and fibula of anticorrosive specimens. Results The geometrical data of the anterior tibiofibular ligament, posterior tibiofibular ligament and transverse tibiofibular ligament were measured respectively, and mean ± standard deviation was described. Include: the length, width, thickness of the anterior tibiofibular ligament (8. 53±0. 69, 19. 06±1. 34, 15. 99±1. 44) mm, the length, width, thickness of the posterior tibiofibular ligament (9. 34±0. 63, 16. 92±1. 76, 14. 36±0. 89) mm, the length, width, thickness of the transverse tibiofibular ligament (18. 42±2. 48, 21. 93±2. 59, 4. 56±0. 17) mm. The angel between the anterior tibiofibular ligament and the coronal surface and the angle of the horizontal plane were (20. 49±4. 86, 42. 20± 3. 42)°. The angel between the posterior tibiofibular ligament and the coronal surface and the angle of the horizontal plane were (13. 2±2. 06, 40. 92±3. 13) °. The angel between the transverse tibiofibular ligament and the coronal surface and the angle of the horizontal plane were (13. 45±1. 57, 32. 73±3. 70)°. According to the data analysis, the anterior, posterior and transverse tibiofibular ligaments have statistical difference between men and women, but there is no statistical difference between left and right feet. Conclusion The tibiofibular syndesmosis is of great significance to the stability of the ankle joint and the anatomical structure has important guiding significance for clinical treatment.