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Polyetheretherketone (PEEK) as a new type of thermoplastic engineering plastic, has good biological activity, elastic modulus close to human cortical bone and radiation permeability, and has been widely used in medical field. This study aims to explore the safety and clinical efficacy of using 3D printing personalized PEEK materials to repaire scapular bone defects after bone tumor resection. A total of 6 patients who underwent the implantation of 3D printed PEEK scapular prosthesis from January 2020 to December 2021 in Yunnan Cancer Hospital were retrospectively analyzed. There were 3 males and 3 females, with age ranged from 14 to 52 years. There were 1 case of synovial sarcoma, 1 of Ewing's sarcoma, and 4 of chondrosarcoma. PEEK prosthesis was designed and fabricated based on CT data before surgery. Tumor resection and prosthesis replacement were performed under the premise of ensuring safe surgical boundaries, including 2 cases of total scapular prosthesis replacement and 4 cases of partial scapular prosthesis replacement. The operation time was 90-170 min, and the intraoperative blood loss was 100-400 ml. All 6 patients received satisfactory follow-up, with a tumor progression free survival time of 16-28 months. No tumor recurrence or metastasis was observed, and all patients survived tumor free. At last follow-up, the Constant-Murley shoulder joint score was a minimum of 62 points and a maximum of 68 points. The Japanese Orthopaedic Association's shoulder joint score was 63 points minimum and 78 points maximum. Computer-aided design 3D printing PEEK material prosthesis has certain advantages in the treatment of scapular tumor limb salvage. It has light weight, well adapted, relatively simple installation, good histocompatibility, and can obtain a better appearance and function of the shoulder joint after operation. It can become one of the options for limb salvage treatment of scapular tumor.
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To observe the efficacy and safety of apatinib in the treatment of advanced bone and soft tissue sarcoma, and to analyze the possible related factors affecting the progression-free survival (PFS) of patients. Methods: Twenty-one patients with ad-vanced bone and soft tissue sarcoma admitted to the Department of Orthopaedics, Yunnan Cancer Hospital from June 2017 to Sep-tember 2018, were treated with apatinib tablets. The main efficacy index was progression free survival (PFS), and the secondary effica-cy index was overall survival (OS). Clinical efficacy was evaluated according to response evaluation criteria in solid tumors (RECIST) 1.1, and overall response rate (ORR), disease control rate (DCR), and safety were olserved according to the National Cancer Institute (NCI) 4.0 standard. Results: All of the 21 patients were followed up. At the last follow-up time point, March 31st, 2019, there were no CR, 2 patients (9.5%) with PR, 7 patients with SD (33.3%), and 12 patients with PD (57.1%). The ORR was 9.5%, the DCR was 42.8%, the medi-an PFS was 8 months, and the median OS was 14 months. The patient's gender, age, ECOG score, tissue source, surgery, or chemother-apy had no statistically significant effect on PFS (P>0.05). Only the history of radiotherapy before taking apatinib was a factor for pa-tients with PFS. The effect was statistically significant (P<0.05), and patients with a history of radiotherapy had a lower PFS than pa-tients without a history of radiotherapy. The adverse reactions of gradeⅢand above had hand-foot syndrome (14.3%), pneumotho-rax (14.3%) and anemia (4.8%). Conclusions: Apatinib has a certain effect for advanced bone and soft tissue sarcoma. The adverse re-actions are generally predictable, controllable and reversible. Apatinib can be a choice for patients with advanced bone and soft tissue sarcoma with good treatment adherence and no other treatment options.
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Objective To explore the clinical efficacy of percutaneous kyphoplasty(PKP)via unilateral transverse process-pedicle approachunder lateral positionfor osteoporotic vertebral compression fracture(OVCF). Methods From January 2014 to January 2016,36 patients were divided into group A(n=17)receiving PKP un-der lateral position,and group B(n=19)receiving PKP under prone position.The surgical duration,blood loss, volume of cement injection,and rate of cement leakage were compared. Modified Kolcaba questionnaire was used for assessing the degree of comfortunder different position. The kyphotic angle,VAS score and anterior vertebral height compression ratio in pre-and post-operation were applied for assessment of surgical outcomes. Results All the patients received the procedures successfully under local anaesthesia with no serious complications including spinal cord injury. The surgical duration was(73.5 ± 23.4)min in group A and(44.7 ± 15.4)min in group B.The blood loss was(29.1 ± 16.9)mL and(15.7 ± 7.1)mL;and the comfort questionnaire score was(64.3 ± 17.9)and (43.7 ± 17.1),respectively.There were significant statistical differences between the two groups(P<0.05). There were no differences in cement injection,cement leakage,kyphotic angle,VAS score and anterior vertebral height compression ratio(P > 0.05). Conclusions PKP via unilateral transverse process-pedicle approach under lateral position is a safe and effective way for OVCF.But the surgical durationis longer in lateral position than in prone posi-tion due to the more difficult technique.PKP under lateral position may be an alternative approach for PKP.
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Objective To explore the clinical application of one-stage surgery combined posterior inter-fix-ation and anterior debridement for thoracolumbar tuberculosis in children. Methods The clinical data of thoraco-lumbar tuberculosis in children treated by combined surgery of posterior and anterior approach from January 2006 to December 2014 was reviewed retrospectively. The enrolled patients were divided into group A(25 patients under-went one-stage surgery)and group B(16 patients underwent two-stage surgery). Operation time,blood loss and complications were compared. The clinical effectiveness was evaluated by using visual analogue scale(VAS), kyphotic angle,neurological function(ASIA)and bone fusion. Results All operations completed successfully. There was statistically significance between two groups regarding to operation time [(202 ± 50)min vs. (254 ± 46)min]and blood loss[(332 ± 162)mL vs.(432 ± 106)mL]. The follow-up of 12 ~ 60 months indicated that bone grafts were fused without instrumentation failure. For patients with spinal cord injury ,there was 1 or 2 grades improvement by ASIA grading. VAS and the kyphotic angle were improved after operation ,but there was no statisti-cally significance between two groups regarding to the efficiency. Conclusions One-stage surgery combined pos-terior and anterior approach is a safe and effective method for thoracolumbar tuberculosis in children for immediate stability of spine,less blood loss and shorter operation time.
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Objective To explore the clinical application of one-stage surgery combined posterior inter-fix-ation and anterior debridement for thoracolumbar tuberculosis in children. Methods The clinical data of thoraco-lumbar tuberculosis in children treated by combined surgery of posterior and anterior approach from January 2006 to December 2014 was reviewed retrospectively. The enrolled patients were divided into group A(25 patients under-went one-stage surgery)and group B(16 patients underwent two-stage surgery). Operation time,blood loss and complications were compared. The clinical effectiveness was evaluated by using visual analogue scale(VAS), kyphotic angle,neurological function(ASIA)and bone fusion. Results All operations completed successfully. There was statistically significance between two groups regarding to operation time [(202 ± 50)min vs. (254 ± 46)min]and blood loss[(332 ± 162)mL vs.(432 ± 106)mL]. The follow-up of 12 ~ 60 months indicated that bone grafts were fused without instrumentation failure. For patients with spinal cord injury ,there was 1 or 2 grades improvement by ASIA grading. VAS and the kyphotic angle were improved after operation ,but there was no statisti-cally significance between two groups regarding to the efficiency. Conclusions One-stage surgery combined pos-terior and anterior approach is a safe and effective method for thoracolumbar tuberculosis in children for immediate stability of spine,less blood loss and shorter operation time.
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Objective To investigate the characteristics and treatment effects in patients with spinal fractures associated with dural tears.Methods A retrospective analysis was made on 185 patients with spinal fractures presenting to hospital from February 2013 to February 2015.There were 103 males and 82 females,aged 17-73 years (mean,58 years).Causes of injury were high falls in 72 patients,traffic collisions in 58,hitting by heavy objects in 41,ground-level falls in 12,and collision events in two.Cervical spine fractures were seen in 65 patients,thoracic vertebra fractures in 51,and lumbosacral vertebral fractures 69.Neurologic deficit was assessed using the American Spinal Injury Association (ASIA) score,including grade A in 24 patients,grade B in 22,grade C in 26,grade D in 37 and grade E in 76.Eighty patients were managed by simply anterior surgery,97 by posterior surgery,and eight by anterior-posterior surgery.Twenty-one patients were found with dural tears (group A) and 164 patients without dural tears (group B).Incidence of dural tears in cervical,thoracic and lumbosacral vertebral fractures were recorded and compared.Preoperative neurologic deficit,laminar fracture and spinal canal encroachment rate were compared between groups.Neurological function and complications associated with dural repair were detected.Results In group A,ten patients were rated ASIA grade A,five grade B,three grade C,one grade D and two grade E.In group B,14 patients were rated ASIA grade A,17 grade B,23 grade C,36 grade D and 74 grade E.Group A accounted for 11％ (7/65) of cervical,10％ (5/51) of thoracic,and 13％ (9/69) of lumbosacral spine fractures (P ＞ 0.05).Nineteen patients (91％) in group A were complicated with neurological deficit,compared to ninety patients (54.9％) in group B (P ＜ 0.01).Eighteen patients (86％) in group A had laminar fractures,compared to fifteen patients (9.1％) in group B (P ＜ 0.01).In group A,rate of spinal canal encroachment was (62.3 ± 12.1)％ and 17 patients (81％) showed spinal canal encroachment of greater than 50％.While in group B,rate of spinal canal encroachment was (36.2 ± 15.6)％ and 25 patients (15.2％) showed spinal canal encroachment of greater than 50％ (P ＜ 0.01).For dural tears in group A,11 patients were treated by direct suturing,four by thoracolumbar fascia repair,three by artificial dural coverage and three by fibrin glue sealing.In group A,19 patients were followed up and one of them presented persistent cerebral spinal fluid leak that necessitated an irrigation and debridement to cure.ASIA score was improved from grade A to B in two patients,grade B to C in one,grade C to D in one and grade D to E in one at the final follow-up.Conclusions Majority patients with spinal fractures associated with dural tears exist severe neurologic deficit,spinal canal encroachment and laminar fractures.Incidence of dural tear in cervical,thoracic and lumbosacral vertebral fractures is similar.Incidence of complications related to dural tear repair is low,but the neurological function recovery is poor after operation.
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BACKGROUND:Adipose-derived stem cel s have a wide variety of sources and strong proliferation ability, which are easy to access and simple to culture. Therefore, adipose-derived stem cel s that are secondary to bone marrow mesenchymal stem cel s are expected to become the most promising seed cel s for bone tissue engineering. OBJECTIVE:To explore the feasibility of rabbit adipose-derived stem cel s with demineralized bone matrix to repair ulna defects. METHODS:Ulna defect model was made in rabbits. Demineralized bone matrix was implanted into the right defect region as control group. After osteogenic induction, rabbit adipose-derived stem cel s/demineralized bone matrix composite was implanted into the left defect region as experimental group. At 12 weeks after implantation, defect tissues were taken for CT scanning and histological detection. RESULTS AND CONCLUSION:CT results showed that there was unclear boundary between the broken ends of fractured bone and the composite material in the experimental group, and paral el cal uses out of the broken end could be seen. In the control group, the broken end was clearly seen and no cal us occurred continuously. Fibers were connected at the defect site, and no new bone occurred. Histological findings showed that typical regenerated bone tissues were seen in the experimental group with osteocytes, bone lacunae and bone trabeculae;there were more osteocytes and bone lacunae, but bone trabecula was only seen in a part of bone defects;a few of col agens interlarded the regenerated bone tissues. In the control group, the residual of demineralized bone matrix was seen as wel as some col agenous fibers, and periosteal bone formed a little, but no large amount of regenerated osteoid tissues were found. These findings indicate that under osteogenic induction, rabbit adipose-derived stem cel s combined with demineralized bone matrix are feasible to repair ulna defects.
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Objective To summarize the efficacy of cervical pedicle screw fixation in the treatment of cervical spinal cord injury without fracture and dislocation.Methods From September 2007 to March 2010,21 patients with cervical spinal cord injury without fracture and dislocation combined with developmental cervical stenosis were managed by pedicle screw fixation in unstable segments,and then single open-door laminoplasty in stenosis segments.The clinical outcomes were reviewed and summarized.Results All the patients received follow-up of 1-3 years.Two patients had superficial wound infection,which was cured by dressing change.One presented intra-incisional hematoma one week post-operatively and was cured by hemostasis and drainage.One had door-reclosing without symptom aggravation.There was neither perforation of pedicle screws nor breakage,loosening or displacement of internal fixation.The curvature of cervical lordosis at follow-up had significant rectification in comparison with that at preoperation,but showed unobvious change as compared with that immediately after operation.According to the modified Japanese Orthopedic Association (JOA) score,the neurological score improved from preoperative 4-15 points to 9-17 points at the final follow-up,which revealed more than 80％ of recovery in 13 patients,50％ -80％ of recovery in six and 5％ -50％ of recovery in two,with the average recovery rate of 75％.Conclusion For unstable segments in patients with cervical spinal cord injury without fracture and dislocation combined with developmental spinal stenosis,posterior pedicle screw fixation can avoid the risk of further spinal cord injury in single open-door laminoplasty and restore the physiological curvature of cervical vertebrae,which provides solid foundation for backward drift of spinal cord and creates favorable condition for recovery of spinal cord function.
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Objective To explore the effect on effect of combined use of Y27632 (ROCK II inhibitor)and TDZD-8(GSK-3β inhibitor)on axonal regeneration of dorsal root ganglion (DRG) neurons in neogenetic rats. Methods All the thoracolumbar DRGs of two neogenetic Sprague-Dawley (SD)rats(<5 days)were harvested under the stereopsis raicrostat,and then the DRG neurons were cultured,purified and indentified.Fifteen adult female SD rats were randomly divided into three groups,ie,complete paraplegia group(5 rats),sham operation control group(5 rats)and normal group(5 rats)respectively.The T8-10 spinal cord extracts (SCEs) were harvested in the complete paraplegia group,sham operation control group and normal group respectively at day 7 after spinal cord injury.The experiment was divided into group A(DRG neurons + PBS),group B(DRG neurons + complete paralysis SCE),group C(DRG neurons + complete paralysis SCE + different concentration Y27632),group D(DRG neurons + complete paralysis SCE + different concentration TDZD-8)and group E(DRG neurons + complete paralysis SCE + proper concentration Y27632 and TDZD-8).The average axonal length and expression intensity of Tubulin βⅢ at distal end of neuronal axons were observed after two days of co-culture respectively in intro. Results (1)The average axonal length and expression intensity of Tubulin βⅢ at axon shaft and growth cone in the group B were significantly shorter and weaker than that in the group A,with statistical difference.(2)In the group C,the average axonal length and expression intensity of Tubulln βⅢ at axon shaft and growth cone in 5-10 μmol/L Y27632 treatment groups were more than that in the group B but lower than that in the group A.The average axonal length and expression intensity of Tubuhn βⅢ at axon shaft and growth cone in 20-50 μmol/L Y27632 treatment group were longer and stronger than that in the group A and the group B,especially the group B.Among different concentration Y27632 treatment groups,there was a longest average axonal length and strongest expression intensity of Tubulin βⅢ in 30 μmol/L treatment group.(3) In the group D,there was a longer average axonal length in 0.5-3 μmol/L TDZD-8 treatment group than that in the group A and the group B,with the longeat average axonal length in l μmool/L TDZD-8 treatment group.In 5-25 μmol/L TDZD-8 treatment groups,the average axonal length showed no difference compared with the group B but wns shorter than that in the group A.In all different concentration TDZD-8 treatment groups,the expression intensity of Tubulin βⅢ at axon shaft and growth cone was significantly stronger than that in the groups A and B.(4) In the group E,although the average axonal length was increased in the group E,there was no statisilcal difference compared with the group A,30 μmol/L Y27632 treatment group and l μmol/L TDZD-8treatment group.There was a significantly longer average axonal length in the group E than it in the group B and the expression intensity of Tubulin βⅢ at axon shaft and growth cone was stronger in the group E compared to the group A,30 μmol/L Y27632 treatment group and l μmol/L TDZD-8 treatment group.Conclusion The complete paralysis SCEs obviously inhibits DRG axonal growth,induces axonal retraction and growth cone collapse.High concentration of Y27632 can more obviously promote the axon growth compared with the low concentration,while the low concentration of TDZD-8 can obviously promote the axon growth.Combined use of appropriate concentration of TDZD-8 and Y27632 can promote the axon growth and induce the axons branching,as facilitates the formation of the axon circuit.
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Objective To study the clinical feature, diagnossis and therapy of open spinal cord injury. Methods A retrospective study was performed in 15 patients with open spinal cord injury including 14 males and one female, at age range of 15-46 years (mean 23 years). There were two patients with open cervical spinal cord injury, 11 with open thoracic spinal cord injury and two with open lumbar spinal cord injury. Injury causes included sharp knife injury in 12 patients, firearm injury in two and stick stabbing in one. According to ASIA scale, there was one patient at Grade A, two at Grade B, seven at Grade C, four at Grade D and one at Grade E preoperatively. Foreign bodies were found in the wound in four patients. There were three patients combined with spinous process fracture, eight with vertebral plate fracture and five with vertebral body fractures. All 15 patients were treated by emergency management including vertical canal exploration, hematoma debridement or foreign body removal. Results Postoperative complications included cerebrospinal fluid leakage in two patients and wound infection ( without spinal cord infection) in one. There were different degrees of neural functional recovery in five patients. The post-operation ASIA scale: one patient at Grade A, three at Grade C, 10 at Grade D and one at Grade E,with no patient at Grade B. Conclusions For open spinal cord injury, emergency operation is necessary under adequate preoperative preparation. Preoperative identification of foreign bodies, exploration and decompression are beneficial to spinal cord function recovery and reduction of the incidence rate of postoperative complications like infection or hemorrhage.
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This paper is aimed to explore the correlation of clinical outcomes with material science features of implant in the treatment of atlantoaxial instability by the Vertex technique.A total of 26 cases with atlantoaxial instability and dislocation were enrolled from the Affiliated Hospital of Luzhou Medical College between January 2004 and January 2006.They all underwent the internal fixation via posterior cervical pathway and atlantoaxial fusion in Vertex system that was produced by American Sofamor Danek Company.The intraoperative complications and postoperative neurological recovery of each case were documented.Dynamic radiograph and digital tomography were used to evaluate the extent of the atlantoaxial vertebrae stability.①The result of X-ray showed that bony fusion was successful in 22 patients during 3-month follow-ups,3 patients during 6-month follow-ups,and 1 case after implantation following bony resorption.②There was no deterioration of spinal cord injury and the JOA scores of neurofunction increased from 3-17 points(mean 6.8 points) to 5-17 points(mean 14.8 points) ,with the rate of improvement as 83%.③All 26 patients were normal in the movements of expansion and flexion,but the rotation was partly limited.There were 18 cases rotate in 120?,6 cases in 100? and 1 case in 60?.Vertex system is effective in dealing with internal fixation via posterior cervical pathway.Due to the connection with stick by multiaxial screw,Vertex system presents superiority in clinic,such as secure fixation,random length and convenient connection.Vertex system internal fixation is effective in dealing with atlantoaxial instability and dislocation.
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[Objective]To evaluate the value of ECT in diagnosing and treatment the spinal tuberculosis.[Method]ECT by injecting 99Tcm-MDP to human body was used to know the developing of focus in spinal tuberculosis and whether other bone and joints tuberculosis were complicating simultaneously.[Result]The developing of 175 patients were positive,including multi-vertebral bodies tuberculosis 146 cases,which were composed of 2 vertebral bodies 78 case,3 vertebral bodies 26 cases,4 vertebral bodies and more 42 cases.Complicating tuberculosis of bones and joints 22 cases,articulatio sacroiliaca 29 cases.[Conclusion]ECT plays an important role in diaognosing the spinal tuberculosis and the tuberculose focus of body can be found and has the guidance for doctors to formulate the therapeutic regimem of spinal tuberculosis.
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[Objective]To discuss the causes and preventive measures of early complications after using Vertes technique in treating dens axis fracture with atlantoaxial dislocation.[Method]Eighteen cases performed Vertex technique were included in this study.The early complications(postoperative or at surgery) included vertebral artery injury(2 cases),logagnosia(1 case),anopsia(1 case),hematorrhea(1 case) and wrong instrumentation(1 case).The causes of these complications and how to prevent were analyzed.[Result]All these complications were treated in time,and no sequela was found.[Conclusion]The early complications of Vertex technique in treating dens axis fracture with atlantoaxial joint dislocation can be prevented.The timely treatment must be performed when it occurs,and the effect would be satisfactory.