Accordion technique used in treatment of hypertrophic nonunion / 中华创伤骨科杂志

Objective To evaluate the therapeutic effects of the accordion technique used in external fixation for long bone hypertrophic nonunion.Methods From August 2013 to December 2015,13 patients with hypertrophic nonunion were treated by the accordion technique (distraction,compression and re-distraction) used together with an Ilizarov ring external fixator or a monolateral external fixator.They were 10 males and 3 females with an average age of 44.6 years (from 18 to 63 years).The nonunion occurred in the middle femur in 5 patients,in the femoral supracondyle in one,in the tibial diaphysis in 4,and in the distal tibia in 3.The procedure was performed with a preassembled external fixator without open surgery or bone graft.The pathological sites were gradually distracted (0.25 mm/day) from the seventh day postoperatively.In case of deformity,correction was conducted to restore the alignment.At the same rate of distraction,compression was started after the equal length was achieved and next followed by distraction.The frequency of cycle depended upon the callus observed in the X-rays.Results The mean follow-up for the 13 patients was 19 months (from 10 to 38 months) after removal of the external fixator.All the cases of hypertrophic nonunion obtained bony union after a mean duration of 7.5 months (from 5 to 13 months).No nonunion or deformity recurred during the follow-up.The complications such as pin-site infection (in 4 cases) and mild Achilles's tendon contracture (in 2 cases) were prevented or treated by careful nursing and rehabilitation.Conclusion The accordion technique together with an external fixator is a reliable and effective treatment for hypertrophic nonunion.

Ultrasonic appearances and misdiagnosis analysis of intrascrotal adenomatoid tumors / 中国医学影像技术

Objective To investigate the sonographic features and to analyze misdiagnosis causes of intrascrotal adenomatoid tumors.Methods Preoperative sonographic data of 15 patients confirmed as intrascrotal adenomatoid tumor by surgery and pathology were retrospectively analyzed.Compared with pathological results,the sonographic features and the misdiagnosis causes were analyzed.Results Among 15 patients,the tumors located at the tail of epididymis in 8 patients,at the head of epididymis in 5 patients and within the testis in 2 patients.The lesions were misdiagnosed as inflammatory diseases in 3 patients,as cysts in 3 and as malignant tumors in 2 patients,while in the others were indeterminate.Solid tumors were detected with ultrasound in 12 patients,while cystica in 3 patients.Among 12 patients with solid tumors,lesions in 7 patients had clear boundary and regular shape,while the boundary in the rest 5 patients were less clear.The internal echo was homogeneous in 6 patients and inhomogeneous in the rest 6 patients with echoless and punctate hyperecho.Cystic mass was characterized by polycystic with isolation belt.Among 15 patients of intrascrotal adenomatoid tumor,detectable blood flow signals were found in 8 patients,while no obvious blood flow signals were found in the rest 7 patients.Conclusion Ultrasonic features of intrascrotal adenomatoid tumor were less characteristic.Combination of clinical information and other imaging findings might help to decrease misdiagnosis.

Clinical outcomes of posterior percutaneous endoscopic cervical discectomy for single level cervical spondylotic radiculopathy / 中华骨科杂志

Objective To investigate the clinical outcomes using posterior percutaneous endoscopic cervical discectomy (PECD) for single level cervical spondylotic radiculopathy (CSR).Methods From October 2015 to June 2016,33 patients (23 men,10 women,mean age 54.0 years,range from 30 to 85 years) who had single level CSR were treated by PECD,and the medical records were reviewed.All patients were followed up for an average of 13.5±4.6 months (range from 12 to 22 months).The operation related parameters (operation time,estimated blood loss,length of hospitalization,complications) and clinical parameters,including neck visual analog scale (Neck-VAS),ann visual analog scale (Arm-VAS),neck disability index (NDI) and the modified Macnab criteria were assessed at 3,6,and 12 months postoperatively and last follow-up.Disc height,shell angle,C2-C7 Cobb angle and range of motion were recorded preoperatively and at 3 months,6 months,12 months and last follow-up postoperatively.Results The mean operation time was 76.4±26.6 minutes (range from 40 to 120 minutes),the mean estimated blood loss was 30.2±15.6 ml (range from 20 to 80 ml),and the mean length of hospitalization was 3.5± 1.1 days (range from 2 to 8 days).There was significant decrease at different time points postoperatively in Neck-VAS,Arm-VAS,and NDI when compared with preoperatively (P＜ 0.05).According to the modified Macnab criteria,there was excellent concordance in 20 patients (60.6％),good in 7 patients (21.2％) and fair in 6 patients (18.2％) at the last follow-up.The disc height was significantly decreased at postoperative 3 months and 1 year compared with at preoperative (F=95.1,P＜0.01).The shell angle of index level (F=35.4.,P＜0.01),upper adjacent level (F=30.1,P＜0.01),lower adjacent level (F=1 1.7,P＜0.01) as well as spinal function units (F=22.2,P＜0.01) were increased significantly at postoperative compared with at preoperative.The range of motion of index level (F=8.1,P＜0.01) and upper adjacent level (F=64.0,P＜0.01) increased significantly at postoperative compared with at preoperative.The range of motion in lower adjacent level (F=1.5,P=0.23),spine functional unit of index level (F=2.9,P=0.06),as well as C2-C7 (F=0.6,P=0.56) had no significant difference between preoperative and postoperative 1 year (P＞0.05).One patient turned into traditional ACDF procedure because of hemorrhage limiting the vision during PECD operation.Upper extremity numbness and pain deteriorated in one case after a PECD procedure and was revised with ACDF at last.No other complications,like spinal cord injury,cervical root injury,cerebral spinal fluid leakage,infection as well as recurrence were found.Conclusion PECD,which can maintain normal cervical range of motion and intervertebral disc height,is a minimally invasive and essential procedure for CSR treatment with minor trauma,excellent outcome and quick recovery.Surgeon's experience,however,is needed in case of turning into open surgery for good outcome.

Effects of different growth factors on the antioxidant capacity of endplate chondrocytes / 中国组织工程研究

BACKGROUND:It is wel-known that vitamin E holds antioxidant capacity, but whether other growth factors have the same effect on endplate chondrocytes has not yet been reported. OBJECTIVE:To observe the effect of different growth factors on the antioxidant ability of endplate chondrocytes in the intervertebral disc. METHODS:Endplate chondrocytes were primary cultured, and then divided into four groups, including blank control, serum deprivation, hydrogen peroxide stimulation and hydrogen peroxide stimulation combined with different growth factors groups. The 4th group was subdivided into insulin-like growth factor-1, basic fibroblast growth factor, transforming growth factorβ, forskolin and vitamin E groups. The expression levels of caspase-3, matrix metal oproteinase 13 and 3, inhibitor of metal oproteinase 1 as wel as thrombin 4 and 5 were detected by real-time PCR. Cel apoptosis was analyzed through apoptosis kit and flow cytometry. Cel synthesis and secretion were detected by western blot assay. The total antioxidant capacity and the hydrogen peroxide content were determined by kit, and then statistical y analyzed. RESULTS AND CONCLUSION:Different growth factors had significant differences in the endplate chondrocyte apoptosis, secretion and antioxidant capacity. To conclude, transforming growth factorβand forskolin do further damage to the cel s stimulated by hydrogen peroxide, while insulin-like growth factor-1 and vitamin E expose protective effect on the injured cel s.

Ultrasonographic features and clinical pathological characteristics in yolk sac tumors of ovary / 中国医学影像技术

Objective To explore the ultrasonographic features of yolk sac tumors of ovary.Methods Totally 12 patients (13 lesions) of the yolk sac tumors of ovary confirmed by pathology were analyzed retrospectively.Two-dimensional ultra sonography,color Doppler and spectral Doppler features were observed and combined with clinical manifestations.Results Ultrasound showed 1 case with bilateral single lesion and 11 cases with unilateral single lesion,the median size of tumors was 11.82 cm × 11.19 cm.Thirteen lesions showed liquid-solid mixed echo,and the blood flows in solid region were ≥ grade Ⅱ according to Adlefs semi quantitative method,the resistance index of blood was 0.37 0.55;Six cases combined with abdominal cavity effusion.Pathology showed 2 cases combined with omentum or rectal pouch metastasis and 1 case was tubal,ovarian artery and vein invasion.Conclusion Ultrasound images in the yolk sac tumors of ovary have characteristics and diagnosis must closely combine with clinical manifestations,some cases still need to be confirmed by pathology and immunohistochemist r y.

Relationship between Macular Structure Changes and Prognosis of Visual Function in Patients with Macular Epiretinal Membrane before and after Operation / 现代生物医学进展

Objective:To investigate the changes of macular region structure before and after operation in patients with macular epiretinal membrane,and its relationship with the visual function of patients.Methods:The clinical data of 60 patients with macular epiretinal membrane (60 eyes) in our hospital from February 2014 to August 2016 were retrospectively analyzed.All patients were examined with optical coherence tomography (OCT) examination,and observed the changes ofmacula central fovea and retinal each azimuth thickness,and the best corrected visual acuity (BCVA) was recorded before and after operation,and the correlations of them were analysised.Results:The visual acuity was improved in 53 patients (53 eyes) after operation,accounting for 88.33％,and the visual acuity was unchanged in 7 patients (7 eyes),accounting for 11.67％.The preoperative BCVA of patients was (0.18± 0.07),and it was (0.38± 0.12) at 3 months after operation,which was significantly higher than before operation (P＜0.05).Postoperative macular central thickness,inner side of the inner ring thickness,nasal side of the inner ring thickness,above the inner ring thickness,below the inner ring thickness,outer ringtemporal side thickness,external ring nasal side thickness,above the outer ring thickness,below the outer ring thickness in patients compared with the preoperative were significantly lower,the difference was statistically significant (P＜0.05).The Pearson correlation analysis showed that preoperative macular central thickness,preoperative inner side of the inner ring thickness,preoperative outer ring temporal side thickness,the difference of macular fovea thickness before and after operation,the difference of the medial temporal before and after operationwas,the difference of outer ring temporal side before and after operation were negatively correlated with postoperative BCVA (P＜0.05).Conclusion:Vitrectomy can significantly reduce macular retinal thickness in patients with macular epiretinal membrane,and it can improve the visual function of patients,and the shape ofmacular region before operation had some influence on postoperative visual acuity.

Short-term clinical outcome and radiographic assessment of indirectly decompression of oblique lateral interbody fusion for degenerative lumbar spinal stenosis / 中华骨科杂志

Objective To investigate the short-term clinical outcome and radiographic assessment of Oblique Lateral Interbody Fusion to indirectly decompress for the degenerative lumbar spinal stenosis with or without lumbar spine instability.Methods All of 15 patients with diagnosis of degenerative lumbar spinal stenosis with or without lumbar spine instability (7 males and 8 females,age from 36y to 86,mean age 53.5± 15.2 y) were treated with OLIF surgery in our spine surgery center.The main symptoms included lumbar pain with unilateral or bilateral leg pain or intermittent claudication.The Visual analogue scale (VAS),Oswestry disability index (ODI),Japanese Orthopaedic Association (JOA) and SF-36 scores were used to assess the clinical effect pre and post-operatively while radiographic assessments were compared as well as comprehensive evaluation of the radiography,MRI,and CT images.Results All patients were followed up for an average of 12.5 (6-21) months.And all the patients enjoyed alleviation of symptoms although varying in extent.The radiographic results showed satisfactory indirect decompression of the neuro-elements,as well as reduction of the lumbar spine.The DH,VH and FH increased by 3.6mm,4.8mm and 5.7mm respectively.The foraminal area (FA) and canal area (CA) enlarged by 44.2mm2 and 24.8mm2.The canal diameters (CD) and disk-flavum ligamentum space (DLFS) increased by 2.5mm and 2mm respectively.The foraminal diameters (FD) increased by 0.3mm,but there was not significantly different.The segment angle and lumbar lordosis angle were partially restored after operation,and the angle increased by 14 ° and 13.6 °respectively.One of the patients had a transient paresthesia and mild weakness of muscle when hip flexor and recovered within 3 months.Another one case encountered serious back pain after a month and alleviated after reoperation with PPF.Conclusion OLIF can provide a satisfactory outcome for the patients with degenerative lumbar spinal stenosis through indirectly decompression,which can increase the disc height,foramen height,canal diameter and disk-flavum ligamentum space.

Ultrasonographic and pathological features of metaplastic carcinoma with squamous cell component of breast / 中国医学影像技术

Objective To observe the ultrasonographic and pathological features of metaplastic carcinoma with squamous cell component (MCSC) of the breast.Methods The ultrasonographic and pathological features of 7 patients with breast MCSC confirmed pathologically were retrospectively analyzed.Results Seven cases were single lesion and the maximal diameters of the lesions were 2.6-5.1 cm.On two-dimensional imaging,6 lesions with cystic and solid were complex echogenic,only 1 lesion was hypoechoic.All the lesions had irregular shape (lobulated)and indistinct margin.On CDFI imaging,most of lesions had rich blood flow signals with high resistance (resistance index 0.75-0.91),4 lesions were grade l,2 lesions were grade Ⅱ and 1 lesion was grade Ⅰ blood flow signals.On gross histopathological examination,6 masses had cystic cavity,only 1 mass was pure solid.On microscopic histopathological examination,5 masses were adenosqua mous carcinoma,only 2 masses were pure squamous cell carcinoma.Estrogen receptors,progesterone receptors and human epidermal growth factor receptor were negative in 4 masses (triple-negative breast cancer).Conclusion MCSC have some distinguished ultrasonic characteristics of larger volume,cystic-solid mixed echo,posterior echo enhancement,abundant vascularity with high resistance.

The preliminary exploration of lateral lumbar interbody fusion extended application in lumbar corpectomy and reconstruction surgery / 中华骨科杂志

Objective To investigate the clinical outcomes of lateral lumbar interbody fusion (LLIF) in lumbar corpectomy and reconstruction.Methods Overall,8 patients with lumbar burst fracture and dislocation and 1 patient with postoperative infection of lumbar fracture who were treated with LLIF from May 2014 to May 2016 in our hospital were retrospective analyzed.The included 9 patients,with 8 males and 1 female,had an average age of 5.5±6.7 years (28-59 years).Among them,4 cases were injured at L2 segment,4 cases at L3,and 1 case at L4.The main symptoms were back pain and dysfunction of perineum and lower extremity caused by nerve injury.Preoperative neurological functions were assessed according to the American Spinal Injury Association's modified Frankel classification,with 1 case at Grade A,2 Grade B,3 Grade C,1 Grade D,and 2 Grade E.The operation time,the amount of intraoperative bleeding,and the length of hospital stay were recorded.The clinical outcomes were evaluated by the ASIA grading,visual analog scale (VAS),and Oswestry disability index (ODI).The changes of body temperature,erythrocyte sedimentation rate (ESR),and C-reactive protein (CRP) before and after surgery were recorded for the patients with infection.The recovery of lumbar lordosis and the fusion of bone graft were evaluated by the radiographic examination of the lumbar spine and lumbar sagittal Cobb angle.Results The average operation time was 73± 12.7min,ranging from 50 to 90 min.The amount of intraoperative bleeding was 650±35.3 ml,with a range between 30 and 150 ml.All incisions were fully healed.The length of hospital stay was 5.0± 1.0 days,ranging from 4 to 7 days.All patients were followed up for 16.4±3.8 months (11-24 months).The VAS scores and ODI were improved significantly after surgery compared with pre-operation.For patients with infection,body temperature,ESR,and CRP went back to normal within 3,17,and 25 days after surgery,respectively.The ASIA improvement was observed in six patients,with one from grade A to C,one from grade B to D,one from grade B to E,one from grade C to D,one from grade C to E,and one from grad D to E.The lordosis of lumbar spine and surgical segments were restored significantly after surgery,with an increase by 19.9 and 5.1 degree,respectively.All the patients achieved bone fusion after operation.Hip weakness,thigh pain,numbness,retroperitoneal hematoma,and other complications were not observed in these patients.Conclusion The lateral lumbar interbody fusion is safe,reliable,and clinically satisfactory for the treatment of lumbar burst fractures,infections,or lumbar anterior and middle column pathology.This method provides new ideas for the treatment of lumbar anterior and middle column pathology.

Zinc-modified calcium silicate bioceramics coating and osteointegration / 中国组织工程研究

BACKGROUND:Zinc-modified calcium silicate (CaSiO3) bioceramics coating on the titanium surface prepared in preliminary experiments has good chemical stability and antibacterial property. OBJECTIVE:To observe the effects of zinc-modified CaSiO3 bioceramics coating on osteointegration. METHODS:MC3T3-E1 cels were respectively cultured on the titanium with zinc-modified CaSiO3 bioceramics coating (experiment group), titanium with CaSiO3 bioceramics coating (control group) and pure titanium (blank control group). Then, cel adhesion, proliferation, calcification rate and the expression of type I colagen and osteocalcin were detected. The implant materials mentioned above were respectively inserted into the femurs of New Zealand white rabbits, and after 1.5 months, the osteoproliferation and osteointegration between the implants and the host were tested. RESULTS AND CONCLUSION:In vitro experiment: The number of adhesive cels at 12 hours after co-culture was significantly increased in the experimental group compared with the control group and blank control group (P < 0.05). At 14 days after co-culture, cel proliferation ability and ability of calcium nodule formation in the experiment group were significantly better than those in the other groups (P < 0.05). At 21 days after co-culture, there was no significant difference in the expression of type I colagen, but the expression of osteocalcin in the experiment group was higher than that in the control group and blank control group (P < 0.05).In vivo experiment: In the experiment group, a large amount of bone substances were detected, the coating materials directly contacted with the bone interface, new bone tissues and little fibrous tissues were observed at the interface. In contrast, there was a small amount of bone hyperplasia in the control group and almost no bone hyperplase in the blank control group. Moreover, a small part of the implant directly contacted with the bone interface and the most part was separated from bone trabeculae by fibrous tissues. These findings indicate that zinc-modified CaSiO3 bioceramics coating can enhance the ability of osteointegration between titanium implants and the host.

Biological safety of silk fibroin/nano-hydroxyapatite composites / 中国组织工程研究

BACKGROUND:Silk fibroin has excel ent biocompatibility, biodegradability and unique mechanical properties. Its composite, silk fibroin/nano-hydroxyapatite, can simulate the composition and structure of nature bone tissue, contributing to remedying the insufficient mechanical properties of nano-hydroxyapatites. OBJECTIVE:To observe the biological safety of silk fibroin/nano-hydroxyapatite composites. METHODS:Silk fibroin/nano-hydroxyapetite composite biomaterial was synthesized by the coprecipitation method using silk fibroin, calcium chloride and diammonium phosphate as raw materials. According to the demands of International Standard Organization (ISO10993) and Technical Evaluation Standards of Biomedical Materials and Medical Instruments promulgated by Chinese Board of Health (GB/T 16886), experiments of cel toxicity in vitro, acute toxicity and hemolysis were investigated to evaluate the biocompatibility of silk fibroin/nano-hydroxyapetite composite. RESULTS AND CONCLUSION:L929 cel s co-cultured with silk fibroin/nano-hydroxyapatite composite leaching liquor had good cel morphology, metabolism and proliferation. The leaching extract of silk fibroin/nano-hydroxyapatite composite injected into mice intraperitoneal y had no significant adverse reactions. And silk fibroin/nano-hydroxyapatite composite extracts caused 2.39%blood hemolysis, less than the international standards 5%. These experimental results on cel toxicity test in vitro, acute toxicity and hemolysis met the demands of ISO10993 and GB/T, which show the biological safety of the silk fibroin/nano-hydroxyapatite composite for clinical application.

Application of evidence-based medicine concept in orthopedic clinical teaching for eight-year program medical students / 中华医学教育探索杂志

Objective To discuss the effect of applying evidence-based medicine (EBM) in orthopedic clinical teaching for eight-year program medical students in military medical university. Methods Totally 50 eight-year medical students in Shanghai Changzheng Hospital were equally divided into two groups:experimental group(EBM teaching group) and control group. The teacher of experimental group selected appropriate cases and set up the questions according to the difficulties encountered in clinical situation. Students retrieved the relevant medical literature and found out the most useful information for EBM system analysis. The results combined with the current cases were discussed. The teachers summarized clinical experiences and data according to the relevant depart-ment. Traditional direct infusion teaching mode was used in control group. Clinical work experiences were used to guide the students . After-department examination was conducted for both group after finishing the internship and questionnaire investigation was made among students in experiment group. Statistical analysis was carried out on the examination results with SPSS 17.0 software. Mea-surement data were expressed as x±s and comparison on mean differences between two groups was analyzed by t test. Results Average scores of subjective topic and military related topic in the theory exam were higher in experimental group than in traditional teaching group, with statistically significant differences(P<0.001). Excellent rate was 80%(20/25) in case discussion in experimental group and 60%(15/25) in control group. Experimental investigation questionnaire showed that: students got enhanced in learning initiative and broadened knowledge. 96%(24/25) students strengthened the learn-ing efficiency of military related chapters. 88%(22/25) students accepted this method and expected to continue. Conclusions Using the method of evidence-based medicine in eight-year program medical students in military medical university can cultivate the spirit of the stu-dents' self-study actively and rigorous earnest attitude. Students can grasp learning methods and sci-entific thinking. It also can strengthen students' awareness of military medicine and research.

Biphasic calcium phosphate nano-composite scaffolds reinforced with bioglass provide a synthetic alternative to autografts in a canine tibiofibula defect model / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Bone grafting is commonly used to repair bone defects. As the porosity of the graft scaffold increases, bone formation increases, but the strength decreases. Early attempts to engineer materials were not able to resolve this problem. In recent years, nanomaterials have demonstrated the unique ability to improve the material strength and toughness while stimulating new bone formation. In our previous studies, we synthesized a nano-scale material by reinforcing a porous β-tricalcium phosphate (β-TCP) ceramic scaffold with Na2O-MgO-P2O5-CaO bioglass (β-TCP/BG). However, the in vivo effects of the β-TCP/BG scaffold on bone repair remain unknown.</p><p><b>METHODS</b>We investigated the efficacy of β-TCP/BG scaffolds compared to autografts in a canine tibiofibula defect model. The tibiofibula defects were created in the right legs of 12 dogs, which were randomly assigned to either the scaffold group or the autograft group (six dogs per group). Radiographic evaluation was performed at 0, 4, 8, and 12 weeks post-surgery. The involved tibias were extracted at 12 weeks and were tested to failure via a three-point bending. After the biomechanical analysis, specimens were subsequently processed for scanning electron microscopy analysis and histological evaluations.</p><p><b>RESULTS</b>Radiographic evaluation at 12 weeks post-operation revealed many newly formed osseous calluses and bony unions in both groups. Both the maximum force and break force in the scaffold group (n = 6) were comparable to those in the autograft group (n = 6, P > 0.05), suggesting that the tissue-engineered bone repair achieved similar biomechanical properties to autograft bone repair. At 12 weeks post-operation, obvious new bone and blood vessel formations were observed in the artificial bone of the experimental group.</p><p><b>CONCLUSIONS</b>The results demonstrated that new bone formation and high bone strength were achieved in the β-TCP/BG scaffold group, and suggested that the β-TCP/BG scaffold could be used as a synthetic alternative to autografts for the repair of bone defects.</p>

Expression of fibroblast growth factor, transforming growth factor and connective tissue growth factor in lumbar ligamentum flavum hypertrophy / 中国组织工程研究

BACKGROUND:Ligamentum flavum hypertrophy is one of the most important factors of lumbar spinal stenosis, but the molecular mechanism is stil not very clear. OBJECTIVE:To explore the role of basic fibroblast growth factor, connective tissue growth factor and transforming growth factor β1 in hypertrophy of the lumbar ligamentum flavum. METHODS: The ligamentum flavum samples were divided into three groups according to different diseases: control group (acquired from the patients with lumbar spinal canal tumor,n=6), lumbar disc herniation (LDH) group (acquired from the patients with LDH,n=6) and lumbar spinal stenosis (LSS) group (acquired from the patients with LSS,n=6). Then the mRNA expressions of basic fibroblast growth factor, connective tissue growth factor, transforming growth factor β1 and colagen I, III, V of the ligamentum flavum were detected using real-time quantitative RT-PCR method. The roles of basic fibroblast growth factor, connective tissue growth factor and transforming growth factor β1 were explored. RESULTS AND CONCLUSION:The expression of basic fibroblast growth factor mRNA in the LSS group was significantly higher than that in the LDH and control groups (bothP 0.05); the expression of transforming growth factor β1 mRNA was significantly higher in the LSS group than in the LDH and control groups (bothP 0.05). This study indicate that both basic fibroblast growth factor and transforming growth factor β1 play important roles in the formation process of the lumbar ligamentum flavum hypertrophy, and the main type of the colagen in the hypertrophied ligamentum flavum is colagen I.

Research of bio-ceramic coatings on Ti-based implants in biomedical application / 国际生物医学工程杂志

Titanium alloy has been used widely in fields of hard tissue replacement and repair,despite its characteristics of bio-inert material.Bio-ceramic coating deposited on Ti-based implants surface using surface modification technique can improve the bioactivity and biocompatibility of Ti-alloy material.The hydroxyapatite coating has been applied in clinic treatment,but this type of coating is still plagued with low crystallinity and poor bonding strength.In order to obtain an implant with excellent integrated properties,some novel bio-ceramic coating materials have been prepared.These materials having excellent bioactivity and biocompatibility and can directly bond with the Ti-based implants and the bone tissue.This review will present research status of the application of bio-ceramic coating on titanium alloy surface in biomedical fields

Anterior decompression and autograft fusion under video-assisted thoraco-scopic to treat lower thoracic vertebrae bursting fracture complicated with intervertebral disc injury / 中华骨科杂志

ObjectiveTo study the effect of anterior decompression and autograft fusion under video-assisted thoracoscopic to treat lower thoracic vertebrae bursting fracture complicated with intervertebral disc injury.MethodsEleven patients who suffered from lower thoracic vertebrae bursting fracture complicated with intervertebral disc injury were treated with anterior decompression and autograft fusion under video-assisted thoracoscopic from December 2005 to May 2008.The involved vertebrae included T12 in 5cases,T11 in 4 cases,T10 in 1 case and Ts in 1 case.According to the AO classification,4 patients were A2.2and 7 were A3.According to the Frankel classification,5 patients were rated as grade A,2 as grade C,2 as grade D and 2 as grade E.ResultsEvery patient underwent successful operation.The operation time was 3.5-8 h(average,5.2±1.6).The blood loss was 600-3800 ml(average,1195±576).One patient got intercostal neuralgia after operation,which disappeared after treating with analgesic drugs for 7 days.All patients were followed up for 36-65 months (average,49.5±5.9).All patients got bony fusion according to the CT scans 24month after operation.There were no neurological function deterioration and other instrument complications happened.At the last follow-up,5 patients were rated as grade A,2 as grade D and 4 as grade E,according to the Frankel classification.ConclusionAnterior decompression and autograft fusion under video-assisted thoracoscopic is an effective method to treat lower thoracic vertebrae bursting fracture complicated with intervertebral disc injury.However,this method needs higher technology and has a long study-curve.

Posterior short-segment pedicle screw fixation at the injured level for thoracolumbar spine fractures / 中华创伤杂志

Objective To discuss indications,operation method and clinical outcome of posterior short-segment pedicle fixation at the injured level for treatment of thoracolumbar spine fractures.Methods A total of 38 patients with thoracolumbar spine fractures were equally randomized to Group A(treated with classic short-segment pedicle screw fixation)and Group B(treated with short-segment pedicle screw fixation at the injured level)based on fixation methods(19 patients per group).Preoperative and postoperative JOA score,segmental lordosis(Cobb' s angle),R value(anterior fractured vertebral body height/mean normal vertebral body height×100%),VSA score and internal fixation condition were assessed and compared clinically.Results All patients were followed up for 6-37 months(mean 20.5 months),which showed no statistical difference upon Frankel scores of two operation modes,while the segmental lordosis,VAS score and R value in Group B were than those in Group A.There occurred nuts loosening in one patient and screw bending in one in Group A.There was no implant breakage,loosening or emersion in Group B.Conclusion Posterior short-segmental fixation at the injured level is an adequate and effective procedure for compression fractures and mild to moderate burst fractures of the thoracolumbar spine.

Management of multiple segment lumbar pedicle and vertebral body fractures combined with spondylolisthesis / 中华创伤杂志

Objective To evaluate neurofunctional and radiographic results of transpedicular screw fixation reduction and anterior column fixation with use of screw-red system in treatment of multiple segment lumbar pedicle and vertebral body fractures combined with spondylolisthesis. Methods A consecutive series of 12 patients with unstable multiple segment lumbar pedicle fracture, vertebral body fracture, spondylolisthesis and neurologic deficit were managed with posterior transpedicular screw fixation including fractured pedicle and anterior screw-rod fixation instrumentation from January 2002 to December 2007. Results Patients were followed up for 24-30 months (mean 26 months). All the patients with incomplete neurologic deficits got improvement by at least one Frankel grade. Transpedicular screw brought satisfactory reduction. At the time of the latest follow-up, no screw breakage occurred. Con-clusions Excellent reduction of unstable multiple segment lumbar pedicle fractures combined with spon-dylolisthesis can attain better reduction and maintenance by means of selective pedicle screw fixation via fractured pedicle and anterior screw-rod instrument.

Expression changes of peripheral blood lymphocyte subsets following acute spinal cord injury in rats / 中华创伤杂志

Objective To observe the changes of the peripheral blood T lymphocyte subsets following acute spinal cord injury and investigate the possible mechanism of these changes. Methods The SCI models of rats were made by Allen's method. Forty SD rats were divided into four groups, ie,normal control group, sham operation group, 100 g·cm group and 200 g·cm group. The expressions of CD4 and CD8 subsets of the peripheral blood T lymphocyte of the injured rats were determined by immunofluorescence labelling and flow cytometry at different times after injury. Results It was found that the expression of CD4 was significantly reduced to (30.40±4.76)% in 100 g·cm group and to (26.54± 9.34) % in 200 g·cm group, which were significantly lower than that of normal control group ( P ＜0.01 ). At 36 hours after injury, the ratio of CD4/CD8 was significantly reduced to 1.81 ± 0.55 in 100 g·cm group and and 1.29 ± 0.50 in 200 g·cm group, with statistical difference (P ＜ 0.05).Conclusions The immunoreaction is significantly depressed at the early stage of acute spinal cord injury. The severer injury results in more significant decrease of CD4 and ratio of CD4/CD8. The changes of CD4 and CD4/CD8 ratio can be used to indicate the severity of spinal cord injury.

Application of spinal stability rebuilding in symptomatic lumbar instability / 中国组织工程研究

Approximately 20 percent patients with symptomatic lumbar spinal instability, most of which occurs due to symptomatic degenerative lumbar spinal instability, trauma, tumor, and isthmus cleft, have no well results after expectant treatments. So they eventually receive reconstruction treatment to achieve thorough decompression and rebuilding of lumbar spinal stability. There are various kinds of treatments, and each of them has specific features. Therefore, the internal fixation and fusion methods should be selected according to patient condition to improve fusion rate, shorten bed staying duration and reduce complications. This paper summarized indications and features of each kind of operation as well as techniques of the interbody fusion.