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1.
Infect Genet Evol ; 82: 104292, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32240798

RESUMO

OBJECTIVE: To investigate the relationship between melanocortin-3 receptor (MC3R) gene polymorphism and tuberculosis (TB) susceptibility in Han population in southern China. METHODS: A total of 341 patients with TB (173 with pulmonary TB and 168 with multifocal TB) and 359 healthy controls were enrolled. Genotyping was performed by PCR and DNA sequencing, and detection of protein was performed by western blot. RESULTS: The distributions of genotype and allele frequencies of rs6127698 differed significantly between the pulmonary and multifocal TB groups, and between the multifocal TB and control groups. The GG genotype was significantly more common among multifocal TB patients than among pulmonary TB patients (P = .009) and those in the control group (P = .001) under the recessive model. GG+GT genotype was more common in multifocal TB than in pulmonary TB (P < .01) and control group (P < .01) under the dominant model. G allele was more common in multifocal TB than in pulmonary TB (P < .0167) and control group (P < .0167). Patients with multifocal TB had an increased expression of MC3R protein than healthy controls (P < .05). CONCLUSIONS: In the southern Chinese Han population, the MC3R rs6127698 polymorphism, which accompanying an increased expression of MC3R protein,was associated with susceptibility to multifocal TB. Presence of the G allele increased the risk of developing multifocal TB.

2.
World Neurosurg ; 127: e407-e415, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30910755

RESUMO

OBJECTIVE: We aimed to compare the clinical efficacy of titanium mesh cage with that of allogeneic bone graft to reconstruct the anterior column through posterior approach for the surgical management of patients with thoracolumbar spinal tuberculosis with kyphosis. METHODS: From January 2011 to March 2013, 57 patients with single-segment or two-segments thoracolumbar spinal tuberculosis with kyphosis were treated by debridement, interbody graft, posterior instrumentation, and fusion via a posterior-only procedure. Twenty-four patients in group A were treated with allogeneic bone graft to reconstruct the anterior column, whereas 33 patients in group B were treated with titanium mesh cage. The clinical efficacy was evaluated by visual analog scale (VAS), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), neurologic function recovery, kyphotic Cobb angle, and postoperative complications. RESULTS: The mean follow-up was 72.4 months. Neurologic function was significantly improved after surgery in all cases. There were significant differences of VAS, ESR, and CRP between preoperation and postoperation at the final follow-up, with no significant difference between the two groups. The kyphotic Cobb correction was significantly improved when compared with those in preoperation, but there was no significant difference between the two groups. One patient in group A with two segments involved experienced graft fracture. He had anterior bone graft with titanium mesh cage. CONCLUSIONS: Minimum 5-year follow-up outcomes showed that one-stage posterior focus debridement, interbody graft using titanium mesh cages, posterior instrumentation, and fusion is an effective treatment for patients with thoracolumbar spinal tuberculosis accompanied by kyphosis. It may obtain better clinical efficacy than allogeneic bone graft for treating two-segments thoracolumbar spinal tuberculosis.


Assuntos
Transplante Ósseo , Fixadores Internos , Cifose/cirurgia , Telas Cirúrgicas , Tuberculose da Coluna Vertebral/cirurgia , Adulto , Idoso , Transplante Ósseo/métodos , Feminino , Seguimentos , Humanos , Fixadores Internos/efeitos adversos , Cifose/complicações , Vértebras Lombares/cirurgia , Masculino , Pessoa de Meia-Idade , Fusão Vertebral/métodos , Vértebras Torácicas/cirurgia , Titânio , Transplante Homólogo , Resultado do Tratamento , Tuberculose da Coluna Vertebral/complicações
3.
Infect Genet Evol ; 57: 138-144, 2018 01.
Artigo em Inglês | MEDLINE | ID: mdl-29158203

RESUMO

Spinal tuberculosis (TB) accounts for 1%-5% of all TB infections. Host genetic variation influences susceptibility to Mycobacterium tuberculosis (MTB). P2X7 receptor (P2X7R) expressed on cells has been identified as a regulatory molecule in cell death/apoptosis, killing of intercellular pathogens, and bone turnover. This study investigated the P2X7 gene polymorphisms and protein levels in spinal TB. P2X7 gene -762C>T and 489C>T polymorphisms were genotyped. The expression of P2X7R in bone or intervertebral disc (ID) tissues was analyzed by Western blot assay. The -762C>T and 489C>T polymorphisms were associated with susceptibility to spinal TB. Having the -762CC genotype and -762C allele increased the risk of developing spinal TB (CC vs. TT: P=0.031, OR [95%CI]=1.865 [1.053-3.304]; C vs. T: P=0.028, OR [95%CI]=1.355 [1.034-1.775]). The presence of the 489T allele was associated with an increased risk of developing spinal TB (TT vs. CC: P=0.004, OR [95%CI]=2.248 [1.283-3.939]; CT vs. CC: P=0.044, OR [95%CI]=1.755 [1.011-3.047]; T vs. C: P=0.004, OR [95%CI]=1.482 [1.134-1.936]; TT+CT vs. CC: P=0.010, OR [95%CI]=1.967 [1.171-3.304]; TT vs. CT+CC: P=0.037, OR [95%CI]=1.489 [1.023-2.167]). The expression of P2X7R in TB-induced bone lesions increased significantly among spinal TB patients (t=0.011). Carrying the P2X7 -762CC genotype and 489T allele is associated with an increased risk of developing spinal TB in a Southern Chinese Han population.


Assuntos
Grupo com Ancestrais do Continente Asiático , Predisposição Genética para Doença , Polimorfismo de Nucleotídeo Único , Receptores Purinérgicos P2X7/genética , Receptores Purinérgicos P2X7/metabolismo , Tuberculose da Coluna Vertebral/genética , Alelos , Estudos de Casos e Controles , China , Feminino , Estudos de Associação Genética , Genótipo , Haplótipos , Humanos , Desequilíbrio de Ligação , Masculino , Fenótipo , Tuberculose da Coluna Vertebral/patologia
4.
Injury ; 48(2): 378-383, 2017 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-28063678

RESUMO

PURPOSE: To analyse the efficacy and feasibility of surgical management for elderly patients with multilevel non-contiguous spinal tuberculosis(MNSTB)by using one-stage posterior focus debridement, interbody graft using titanium mesh cages, posterior instrumentation and fusion. METHODS: From September 2009 to October 2013, 15 elderly patients with MNSTB were treated with one-stage posterior focus debridement, interbody graft using titanium mesh cages, posterior instrumentation and fusion. There were 10 males and 5 females with a mean age of 63.2 years (range: 60-68 years) at the time of surgery. The mean follow-up time was 40 months(range 26-68 months). Patients were evaluated before and after surgery in terms of erythrocyte sedimentation rate(ESR), neurological status, pain and kyphotic angle. RESULTS: The spinal tuberculosis was completely cured, and the grafted bones were fused in all 15 patients. There were no recurrent tuberculous infections. The ESR reached a normal level within 3 months in all patients. The ASIA neurological classification improved in all cases, and pain relief was reported by all patients. The average preoperative kyphosis was 20.1° (range 8-38°) and decreased to 7.6° (range 1-18°) postoperatively. There was no significant loss of the correction at the latest follow-up. CONCLUSIONS: Our results showed that one-stage posterior focus debridement, interbody graft using titanium mesh cages, posterior instrumentation and fusion was an effective treatment for elderly patients with MNSTB. It is characterized by minimum surgical trauma, good neurological recovery, and good correction of kyphosis.


Assuntos
Desbridamento/métodos , Cifose/cirurgia , Fusão Vertebral/métodos , Telas Cirúrgicas , Tuberculose da Coluna Vertebral/complicações , Idoso , China/epidemiologia , Desbridamento/instrumentação , Descompressão Cirúrgica , Estudos de Viabilidade , Feminino , Seguimentos , Humanos , Fixadores Internos , Cifose/diagnóstico por imagem , Cifose/epidemiologia , Cifose/prevenção & controle , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fusão Vertebral/instrumentação , Titânio , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Tuberculose da Coluna Vertebral/diagnóstico por imagem , Tuberculose da Coluna Vertebral/epidemiologia , Tuberculose da Coluna Vertebral/patologia
5.
Zhongguo Gu Shang ; 30(5): 406-410, 2017 May 25.
Artigo em Chinês | MEDLINE | ID: mdl-29417770

RESUMO

OBJECTIVE: To investigate the clinical effects, indications and key techniques of debridement, internal fixation, and reconstruction with titanium mesh in lumbar tuberculosis via a posterior-only approach in adults. METHODS: The clinical data of 26 patients with monosegment lumbar tuberculosis treated with surgery from March 2012 to March 2014 was retrospectively analyzed. Among them, 15 cases were male and 11 cases were female, and patients' age ranged from 21 to 68 years old (average, 44.7 years old). All patients suffered from back pain and/or pain with radiation to the legs. The clinical efficacy was evaluated based on the complications, erythrocyte sedimentation rate (ESR), imaging examination, and back and leg pain score of visual analogue scale (VAS). RESULTS: All operations were successful in 26 patients with an average operation time of (2.4±0.8) h (range from 2 to 4 h), with an average blood loss of (320±86) ml(range from 200 to 700 ml) .VAS was decreased from (5.7±1.4) points preoperatively to (1.6±0.5) points 2 weeks postoperatively (P<0.01); and ESR was decreased from (42.8±10.4)mm/h preoperatively to (12.1±5.6)mm/h 3 months after surgery (P<0.01). All the patients were followed up for 24 to 48 months with an average of(28.3±5.8) months. One patients suffered from the recurrence of TB and sinus tract formation at 2 months after surgery, and was cured by stronger anti-tuberculosis drugs, local debridement with drainage, and sinus tract healed at 3 months after operation. All intervertebral bone graft obtained fusion within 1 year after operation and no local recurrence of TB was found at final follow-up. CONCLUSIONS: Debridement, internal fixation, and reconstruction with titanium mesh via a posterior-only approach is a effective and safe method for the treatment of monosegment lumbar tuberculosis, especially for the patients with secondary spinal stenosis.


Assuntos
Desbridamento , Vértebras Lombares/cirurgia , Fusão Vertebral/métodos , Titânio , Tuberculose da Coluna Vertebral/cirurgia , Adulto , Idoso , Feminino , Humanos , Região Lombossacral , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento , Adulto Jovem
6.
Dis Markers ; 2017: 4590235, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-29430075

RESUMO

Objective: To investigate the association of single-nucleotide polymorphisms (SNPs) in SP110 gene and TNF-α gene among pulmonary TB (PTB) and spinal TB (STB) patients. Methods: In a total of 190 PTB patients, 183 STB patients were enrolled as the case group and 362 healthy individuals at the same geographical region as the control group. The SP110 SNPs (rs722555 and rs1135791) and the promoter -308G>A (rs1800629) and -238G>A (rs361525) polymorphisms in TNF-α were genotyped. Results. TNF-α -238G>A polymorphism was involved in susceptibility to STB, but not to PTB. The TNF-α -238 A allele was a protective factor against STB (A versus G: OR [95% CI] = 0.331 [0.113-0.972], P = 0.044). Furthermore, the presence of the -238 A allele was considered a trend to decrease the risk of STB (AG versus GG: P = 0.062, OR [95% CI] = 0.352 [0.118-1.053]; AA + AG versus GG: P = 0.050, OR [95CI%] = 0.335 [0.113-0.999]). However, SP110 SNPs (rs722555 and rs1135791) and TNF-α -308G>A (rs1800629) showed no association with PTB and STB in all genetic models. Conclusion: The TNF-α -238 A allele appeared a protective effect against STB, whereas the SP110 SNPs (rs722555 and rs1135791) and TNF-α -308G>A (rs1800629) showed no association with susceptibility to PTB and STB patients in southern China.


Assuntos
Antígenos de Histocompatibilidade Menor/genética , Proteínas Nucleares/genética , Polimorfismo de Nucleotídeo Único , Tuberculose Pulmonar/genética , Tuberculose da Coluna Vertebral/genética , Fator de Necrose Tumoral alfa/genética , Adulto , China , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Regiões Promotoras Genéticas
7.
Arch Med Res ; 47(4): 255-61, 2016 05.
Artigo em Inglês | MEDLINE | ID: mdl-27664484

RESUMO

Estrogen receptor plays critical roles in osteogenesis but the underlying mechanism remains unclear. In order to determine the effect of ERα and ERß on several critical factors in regulating osteogenesis in human osteoblasts. Cell based assy, RT-PCR and immunoblot analyses were used in the research. Both RT-PCR and immunoblot showed that gene expression of OPG, MBP2, TGF-ß, RUNX2, IGF-1 was significantly reduced while expression of RANKL was drastically increased after shRNA-based depletion of ERα in MG-63 osteoblasts. Surprisingly, 17ß-estradiol (E2) treatment led to remarkably reduced RANKL compared with that in E2 untreated cells. In contrast, ERß plays an opposite role in regulating gene expression of OPG, MBP2, TGF-ß, RUNX2, IGF-1 and RANKL. However, double depletion of ERα and ERß could not rescue the gene expression of these factors in vitro. Our results provide a novel mechanism of estrogen receptor in controlling osteogenesis in human cells as well as a potential clinic therapeutic target in human osteoporosis.


Assuntos
Estradiol/farmacologia , Receptor alfa de Estrogênio/metabolismo , Receptor beta de Estrogênio/metabolismo , Osteoblastos/efeitos dos fármacos , Proteína Morfogenética Óssea 2/metabolismo , Linhagem Celular , Subunidade alfa 1 de Fator de Ligação ao Core/metabolismo , Receptor alfa de Estrogênio/genética , Receptor beta de Estrogênio/genética , Técnicas de Silenciamento de Genes , Humanos , Fator de Crescimento Insulin-Like I/metabolismo , Osteoblastos/fisiologia , Osteogênese/efeitos dos fármacos , Osteoprotegerina/metabolismo , Ligante RANK/metabolismo , Fator de Crescimento Transformador beta/metabolismo
8.
Mol Med Rep ; 14(4): 3662-8, 2016 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-27600753

RESUMO

Liraglutide, a synthetic analogue of glucagon-like peptide­1, is utilized in the treatment of type 2 diabetes and obesity. Liraglutide has been previously demonstrated to prevent osteoblastic differentiation of human vascular smooth muscle cells, resulting in the slowing of arterial calcification, however, its effect on bone formation remains unclear. The present study investigated the effect of liraglutide on osteoblastic differentiation using Alizarin Red S staining, and examined the molecular mechanisms underlying the regulatory effect by western blot analysis. The present study demonstrated that protein expression levels of phosphorylated adenosine monophosphate­activated protein kinase (p­AMPK) were downregulated in MC3T3­E1 cells during osteoblastic differentiation in commercial osteogenic differentiation medium, whereas protein expression levels of transforming growth factor­ß (TGF­ß) and phosphorylated mammalian target of rapamycin (p­mTOR) increased. Liraglutide was subsequently demonstrated to dose­dependently attenuate the osteoblastic differentiation of MC3T3­E1 cells, to upregulate p­AMPK, and downregulate p­mTOR and TGF­ß protein expression levels. Treatment with an AMPK­specific inhibitor, Compound C, eradicated the effect of liraglutide on osteoblastic differentiation, and p­mTOR and TGF­ß downregulation. An mTOR activator, MHY1485, also abolished the inhibitory effect of liraglutide on osteoblastic differentiation, and resulted in p­mTOR and TGF­ß downregulation, but did not attenuate the liraglutide­induced increase in p­AMPK protein expression levels. The results of the present study demonstrate that liraglutide attenuates osteoblastic differentiation of MC3T3­E1 cells via modulation of AMPK/mTOR signaling. The present study revealed a novel function of liraglutide, which contributes to the understanding of its pharmacological and physiological effects in clinical settings.


Assuntos
Proteínas Quinases Ativadas por AMP/metabolismo , Diferenciação Celular/efeitos dos fármacos , Hipoglicemiantes/farmacologia , Liraglutida/farmacologia , Osteoblastos/efeitos dos fármacos , Transdução de Sinais/efeitos dos fármacos , Serina-Treonina Quinases TOR/metabolismo , Animais , Linhagem Celular , Camundongos , Osteoblastos/citologia , Osteoblastos/metabolismo , Osteogênese/efeitos dos fármacos
9.
Childs Nerv Syst ; 32(8): 1495-502, 2016 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-27392447

RESUMO

PURPOSE: The purpose of this study was to determine the efficacy and feasibility of surgical management of children with thoracolumbar spine tuberculosis with kyphosis by using one-stage posterior focus debridement, interbody grafts, and posterior instrumentation and fusion. METHODS: From October 2010 to September 2013, 21 children with thoracolumbar spinal tuberculosis accompanied by kyphosis were treated with one-stage posterior decompression, interbody grafts, and posterior instrumentation and fusion. There were 13 males and 8 females, aged from 7 to 13 years old (average age 9.9 years). The mean follow-up was 34 months (range26-48 months). Patients were evaluated before and after surgery in terms of ESR, neurologic status, pain, and kyphotic angle. RESULTS: Spinal tuberculosis was completely cured, and the grafted bones were fused in all 21 patients. There was no recurrent tuberculous infection. ESR got normal within 3 months in all patients. The ASIA neurologic classification improved in all cases. Pain relief was obtained in all patients. The average preoperative kyphosis was 29.7° (range 12-42°) and decreased to 5.5° (range 2-10°), postoperatively. There was no significant loss of the correction at the latest follow-up. CONCLUSIONS: Our results show that one-stage posterior decompression, interbody grafts, and posterior instrumentation and fusion were an effective treatment for children with thoracolumbar spinal tuberculosis. It is characterized as minimum surgical trauma, good neurologic recovery, good correction of kyphosis, and prevention of progressive kyphosis.


Assuntos
Desbridamento/métodos , Descompressão Cirúrgica/métodos , Cifose/etiologia , Cifose/cirurgia , Fusão Vertebral/métodos , Tuberculose da Coluna Vertebral/complicações , Adolescente , Sedimentação Sanguínea , Criança , Feminino , Humanos , Estudos Longitudinais , Imagem por Ressonância Magnética , Masculino , Doenças do Sistema Nervoso/etiologia , Dor/etiologia , Estudos Retrospectivos , Resultado do Tratamento
10.
Int Orthop ; 40(6): 1117-24, 2016 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-26983410

RESUMO

PURPOSE: Aged patients represent a high risk group for acquiring spinal tuberculosis, and it still remains a leading cause of kyphosis and paraplegia in developing nations. Aged patients often combined with cardiovascular and respiratory disease and single lung ventilation via anterior approach surgery could result in more post-operative complications. We aimed to analyze the efficacy and feasibility of surgical management of aged patients with lumbo-sacral spine tuberculosis using one-stage posterior focus debridement, interbody graft using titanium mesh cages, posterior instrumentation, and fusion. METHODS: From March 2009 and July 2012, 17 aged patients with lumbo-sacral spinal tuberculosis were treated with one-stage posterior focus debridement, interbody graft using titanium mesh cages, posterior instrumentation, and fusion. There were eight male and nine female with a mean age of 63.3 years (range: 60-71 years). The mean follow-up was 46.5 months (range 38-70 months). Patients were evaluated before and after surgery in terms of ESR, neurological status, visual analog scale (VAS), and lumbosacral angle. RESULTS: Spinal tuberculosis was completely cured and the grafted bones were fused in all 17 patients. There were no recurrent tuberculous infections. ESR became normal within three months in all patients. The ASIA neurological classification and VAS scores improved in all cases. The average preoperative lumbosacral angle was 20.6° (range 18.1°-22.5°) and became 29.4° (range 27.1°-32.5°) at final follow-up. CONCLUSIONS: Our results showed that one-stage posterior focus debridement, interbody graft using titanium mesh cages, posterior instrumentation, and fusion was an effective treatment for aged patients with lumbo-sacral spinal tuberculosis. It is characterized with minimum surgical trauma, good pain relief, good neurological recovery, and good reconstruction of the spinal stability.


Assuntos
Desbridamento/métodos , Região Lombossacral/cirurgia , Fusão Vertebral/métodos , Titânio/uso terapêutico , Tuberculose da Coluna Vertebral/cirurgia , Idoso , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Próteses e Implantes , Resultado do Tratamento
11.
Orthop Surg ; 8(1): 89-93, 2016 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-27028387

RESUMO

Surgical treatment for spinal tuberculosis includes focal tuberculosis debridement, segmental stability reconstruction, neural decompression and kyphotic deformity correction. For the lesions mainly involved anterior and middle column of the spine, anterior operation of debridement and fusion with internal fixation has been becoming the most frequently used surgical technique for the spinal tuberculosis. However, high risk of structural damage might relate with anterior surgery, such as damage in lungs, heart, kidney, ureter and bowel, and the deformity correction is also limited. Due to the organs are in the front of spine, there are less complications in posterior approach. Spinal pedicle screw passes through the spinal three-column structure, which provides more powerful orthopedic forces compared with the vertebral body screw, and the kyphotic deformity correction effect is better in posterior approach. In this paper, we report a 68-year-old male patient with thoracic tuberculosis who underwent surgical treatment by debridement, interbody fusion and internal fixation via posterior approach only. The patient was placed in prone position under general anesthesia. Posterior midline incision was performed, and the posterior spinal construction was exposed. Then place pedicle screw, and fix one side rod temporarily. Make the side of more bone destruction and larger abscess as lesion debridement side. Resect the unilateral facet joint, and retain contralateral structure integrity. Protect the spinal cord, nerve root. Clear sequestrum, necrotic tissue, abscess of paravertebral and intervertebral space. Specially designed titanium mesh cages or bone blocks were implanted into interbody. Fix both side rods and compress both sides to make the mesh cages and bone blocks tight. Reconstruct posterior column structure with allogeneic bone and autologous bone. Using this technique, the procedures of debridement, spinal cord decompression, deformity correction, bone grafting, and internal fixation can be completed with only one incision and surgical position, and the deformity correction efficiency is higher than anterior surgery.


Assuntos
Desbridamento , Fusão Vertebral/métodos , Vértebras Torácicas/cirurgia , Tuberculose da Coluna Vertebral/cirurgia , Idoso , Terapia Combinada , Humanos , Masculino , Parafusos Pediculares , Fusão Vertebral/instrumentação
12.
Eur Spine J ; 23(1): 234-41, 2014 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-23771578

RESUMO

STUDY DESIGN: A retrospective clinical study. OBJECTIVE: To evaluate the outcomes of two-level (T12 and L3) pedicle subtraction osteotomy (PSO) for severe thoracolumbar kyphosis in ankylosing spondylitis (AS), and to discuss the surgical strategies of this surgery. BACKGROUND: Cases were limited on the results of two-level PSO for correction of severe kyphosis caused by AS, nor on surgical strategies of this type of surgery. METHODS: From March 2006 to December 2010, nine consecutive AS patients with severe kyphotic deformity, underwent T12 and L3 PSOs. Chin-brow vertical angle (CBVA) and radiographic assessments which contain thoracic kyphosis (TK), lumbar lordosis (LL), global kyphosis (GK), and sagittal vertical axis were carefully recorded pre and postoperatively to evaluate the sagittal balance. Intra and postoperative complications were also registered. All patients were asked to fill out Oswestry Disability Index before surgery and at the last follow-up visit. RESULTS: All nine patients (8M/1F), averaged 41.4 years old (range 35-51 years), were received two-level (T12 and L3) PSO, and were followed up after surgery for a mean of 39.9 months (range 24-68 months). Good cosmetic results were achieved in all patients. Mean correction at two-level PSO was 67.9 ± 5.5°. All CBVA, TK, LL, and GK were changed significantly after surgery (P < 0.05), the mean amount of correction of which were 59.5 ± 13.8, 34.7 ± 3.8, 33.2 ± 2.4, and 54.0 ± 14.8 degrees, respectively, and with a small loss of correction at the last follow-up visit. Sagittal imbalance was significantly improved from 27.3 ± 4.4 to 3.4 ± 0.7 cm postoperatively. Neither mortalities nor any major neurological complications were found. The mean ODI score was significantly improved from 53.4 ± 15.5 before surgery to 8.2 ± 4.7 at the last visit. CONCLUSION: The outcomes of follow-up showed that two-level (T12 and L3) PSO can effectively and safely correct severe thoracolumbar kyphosis in AS.


Assuntos
Cifose/etiologia , Cifose/cirurgia , Osteotomia/métodos , Espondilite Anquilosante/complicações , Vértebras Torácicas/cirurgia , Adulto , Feminino , Humanos , Cifose/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Parafusos Pediculares , Complicações Pós-Operatórias/diagnóstico , Radiografia , Estudos Retrospectivos , Espondilite Anquilosante/diagnóstico por imagem , Resultado do Tratamento
13.
Arch Orthop Trauma Surg ; 133(9): 1211-8, 2013 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-23812354

RESUMO

PURPOSE: We present a retrospective study of 15 cases with severe posttuberculous kyphosis of thoracolumbar region that underwent posterior vertebral column resection. METHODS: From 2004 to 2009, 15 consecutive patients with posttubercular kyphotic deformity underwent posterior vertebral resection osteotomy. Six subjects were females and nine were males with an average age of 35.8 years (range 20-60 years) at the time of surgery. None of the patients had neurological deficits. The mean preoperative visual analogue scale was 8.7 (range 3-9), and the average preoperative Oswestry Disability Index was 46.5 (range 40-56). RESULTS: The average duration of postoperative follow-up was 36.1 ± 10.7 months (range 24-62 months). The number of vertebra resected was 1.3 (range 1-2) on average. There were ten patients with one-level osteotomy and five patients with two-level osteotomy. The average operation time was 446.0 ± 92.5 min (range 300-640 min) with an average blood loss of 1,653.3 ± 777.9 ml (range 800-3000 ml). The focal kyphosis before surgery averaged 92.3 ± 8.9° (range 74-105°), and the kyphotic angle decreased to 34.5 ± 8.7° on average after the surgical correction. The average kyphotic angle at the last follow-up was 36.9 ± 8.5°, loss of correction was 2.4 ± 1.4° on average. All patients postoperatively received bony fusion within 6-9 months. CONCLUSIONS: Our results showed that although posterior vertebral resection is a highly technical procedure, it can be used safely and effectively in the management of severe posttuberculous kyphosis. It is imperative that operations be performed by an experienced surgical team to prevent operation-related complications.


Assuntos
Cifose/etiologia , Cifose/cirurgia , Vértebras Lombares/cirurgia , Osteotomia , Vértebras Torácicas/cirurgia , Tuberculose da Coluna Vertebral/complicações , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Osteotomia/métodos , Estudos Retrospectivos , Índice de Gravidade de Doença , Adulto Jovem
14.
Arch Orthop Trauma Surg ; 133(3): 333-41, 2013 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-23242452

RESUMO

PURPOSE: The purpose of this study is to compare the clinical outcomes of surgical management by one-stage posterior debridement, transforaminal lumbar interbody fusion (TLIF) and instrumentation and combined posterior and anterior approaches for lumbar spinal tuberculosis, and determine the clinical effectiveness of the posterior only surgical treatment for lumbar spinal TB at the same time. METHODS: Thirty-seven patients who suffered lumbar tuberculosis were treated by two different surgical procedures in our center from May 2004 to June 2012. All the cases were divided into two groups: 19 cases in Group A underwent one-stage posterior debridement, TLIF and instrumentation, and 18 cases in Group B underwent posterior instrumentation, anterior debridement and bone graft in a single-stage procedure. The operation time, blood loss, lumbar kyphotic angle, recovery of neurological function and fusion time were, respectively, compared between Group A and Group B. RESULTS: The average follow-up period for Group A was 46.6 ± 16.7 months, and for Group B, 47.5 ± 15.0 months. It was obvious that the average operative duration and blood loss of Group A was less than those of Group B. Lumbar tuberculosis was completely cured and the grafted bones were fused in 10 months in all patients. There was no persistence or recurrence of infection and no differences in the radiological results in both groups. The kyphosis was significantly corrected after surgical management. The average pretreatment ESR was 60.7 ± 22.5 mm/h, which became normal (9.0 ± 2.8 mm/h) within 3 months in all patients. CONCLUSIONS: Surgical management by one-stage posterior debridement, TLIF and instrumentation for lumbar tuberculosis is feasible and effective. This approach obtained better clinical outcomes than combined posterior and anterior surgeries.


Assuntos
Vértebras Lombares/cirurgia , Fusão Vertebral/instrumentação , Tuberculose da Coluna Vertebral/cirurgia , Adolescente , Adulto , Criança , Desbridamento , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Adulto Jovem
15.
Chin Med J (Engl) ; 125(7): 1297-302, 2012 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-22613605

RESUMO

BACKGROUND: Many investigators advocate anterior release combined with halo-femoral traction and posterior fusion when treating stiff thoracic curves in patient with adolescent idiopathic scoliosis (AIS). But the anterior operations often induce severe complications. Some surgeons choose posterior-only surgery with halo-femoral traction, posterior wide release and correction. But to the best of our knowledge, there are only rare prospective studies on these posterior-only surgeries for AIS patients who have a rigid curve more than 80° and flexibility less than 35%. METHODS: Sixty-four AIS patients were recruited from September 2006 to June 2009. All patients had rigid curves and underwent spinal correction. They were randomly divided into group A (combined anteroposterior surgery) and group B (posterior-only surgery). Images and scoliosis research society-22 questionnaire (SRS-22) scores were performed pre- and post-operation and during follow-up visits. The operation time, blood loss, hospital days, and hospital charges were compared between the two groups. RESULTS: These patients were followed for an average of 37.5 months (range, 24 - 65 months). No serious complications were observed. There were no significant differences between the two groups in gender, age, preoperative radiographic data, or preoperative SRS-22 score. The average operation time, blood loss, hospital days and hospital charges in group B were less than those in group A. The SRS-22 score in group B was better than in group A at post-operation and at final follow-up. CONCLUSIONS: In AIS with a rigid curve more than 80° and flexibility less than 35%, strong halo-femoral traction with wide posterior spinal release and three dimensional spinal correction can provide better SRS-22 scores, comparable curve correction, shorter operation time, less blood loss, shorter hospital stays and lower charges when compared to combined anterior and posterior surgery.


Assuntos
Escoliose/diagnóstico por imagem , Adolescente , Criança , Feminino , Humanos , Masculino , Estudos Prospectivos , Radiografia , Escoliose/cirurgia
16.
Arch Orthop Trauma Surg ; 132(9): 1273-9, 2012 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-22622797

RESUMO

PURPOSE: Various surgical methods have been described for the management of lumbar tuberculous spondylitis in the literature. However, there were few reports on the two-stage surgical treatment of lumbar tuberculosis in children of elementary school age. We present a retrospective clinical study of 14 patients with lumbar and lumbosacral tuberculous spondylitis treated by two-stage surgery (first stage: posterior instrumentation; second stage: anterior debridement and allografting). The purpose is to determine the clinical efficacy of such surgical treatment for lumbar tuberculosis in children. METHOD: Our series was comprised 9 males and 5 females with an average age of 7.5 years treated with the above-mentioned surgical procedure. All patients had lumbar and lumbosacral involvement with one patient having spondylitis at L2-3, three at L3-4, seven at L4-5, and three at L5-S1. All patients had single motion segment involvement. The Frankel scoring system was used to assess the neurological deficits. Frankel's grade B in two patients, grade C in four and grade D in eight. The following data were followed-up for an average period of 50.1 months (42-64 months) in these patients: healing of disease, deformity correction and its maintenance, neurologic function, and spinal bony fusion. RESULTS: The average preoperative local deformity angle was -13.8°, correcting to 3.4° postoperatively and 1.5° at the final follow-up. With the exception of one patient who received a D at the final follow-up, all cases obtained complete neurological recovery. No breakage and looseness of internal fixation was found. Bony fusion was achieved in all cases within 6 months postoperatively. There was no recurrent tuberculous infection. CONCLUSION: Two-stage (posterior and anterior) surgery is a safe and effective procedure for the patient of elementary school age suffering from lumbar and lumbosacral tuberculous spondylitis, especially for the patients in poor general condition. The procedure has the advantage of minor surgical invasion, effective kyphosis correction and less complications.


Assuntos
Vértebras Lombares , Sacro , Tuberculose da Coluna Vertebral/cirurgia , Transplante Ósseo , Criança , Pré-Escolar , Desbridamento , Seguimentos , Humanos , Masculino , Estudos Retrospectivos , Fusão Vertebral/instrumentação , Transplante Homólogo
17.
Childs Nerv Syst ; 27(5): 735-42, 2011 May.
Artigo em Inglês | MEDLINE | ID: mdl-21057955

RESUMO

PURPOSE: To determine the efficacy and feasibility of surgical management of cervicothoracic tuberculosis accompanied by kyphosis in children by using one-stage posterior focus debridement, bone graft fusion, and instrumentation at a single institution. METHODS: Ten consecutive cases with cervicothoracic tuberculosis with kyphosis were treated with one-stage posterior focus debridement, bone graft fusion, and instrumentation. The mean follow-up was 36 months (range 26-47 months). The kyphotic angle ranged from 35° to 62° before operation, 50.5° in average. The American Spinal Injury Association score system was used to evaluate the neurological deficits. RESULTS: Spinal tuberculosis was completely cured in all ten patients. There was no recurrent tuberculous infection. The postoperative kyphotic angle was 10° to 22°, 17.5° in average, and there was no significant loss of the correction at the latest follow-up. Solid fusion was achieved in all cases. Neurological condition in all patients was improved after surgery. CONCLUSIONS: One-stage posterior debridement, bone grafting, and instrumentation can be an effective treatment method of cervicothoracic spinal tuberculosis with kyphosis in children.


Assuntos
Desbridamento/métodos , Cifose/cirurgia , Fusão Vertebral/métodos , Tuberculose da Coluna Vertebral/cirurgia , Parafusos Ósseos , Transplante Ósseo/instrumentação , Transplante Ósseo/métodos , Criança , Pré-Escolar , Desbridamento/instrumentação , Feminino , Humanos , Cifose/etiologia , Masculino , Fusão Vertebral/instrumentação , Resultado do Tratamento , Tuberculose da Coluna Vertebral/complicações
18.
Int Orthop ; 35(7): 1037-42, 2011 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-20703456

RESUMO

The aim of this study was to investigate the feasibility and clinical efficacy of treatment of adolescent idiopathic scoliosis of >100° via posterior-only surgery with strong halo-femoral traction and posterior wide release. From December 2003 to August 2006, 121 patients with adolescent idiopathic scoliosis were treated in our hospital; among them, 29 patients with curves over 100° were included in this study. From December 2003 to June 2005, group A included the first 12 patients who underwent combined anterior release followed by two-week halo-femoral traction and then posterior instrumentation. From July 2005 to August 2006, 17 patients in group B underwent posterior surgery alone with strong halo-femoral traction and posterior wide release. All of the patients were followed-up for a minimum of 31 months (mean, 36 months; range, 31-41 months). There were no severe complications. All of the patients achieved bony fusion without instrumentation breakage or pseudarthrosis. There were no statistically significant differences between the two groups in gender, age, type of adolescent idiopathic scoliosis, preoperative coronal major curve values, major curve flexibility, or final follow-up major curve correction rate. The average operative time, blood loss and hospital stay in group B were less than those in group A. In adolescent idiopathic scoliosis with Cobb >100°, posterior-only surgery with strong halo-femoral traction and posterior wide release can provide comparable curve correction with shorter operative time, less blood loss and shorter hospital stay when compared to combined anteroposterior surgery.


Assuntos
Fêmur/cirurgia , Cifose/cirurgia , Escoliose/cirurgia , Fusão Vertebral/instrumentação , Tração/instrumentação , Adolescente , Perda Sanguínea Cirúrgica , Transplante Ósseo , Fixadores Externos , Feminino , Humanos , Cifose/diagnóstico por imagem , Cifose/fisiopatologia , Tempo de Internação , Masculino , Radiografia , Escoliose/diagnóstico por imagem , Escoliose/fisiopatologia , Tração/métodos , Adulto Jovem
19.
Arch Orthop Trauma Surg ; 131(4): 475-80, 2011 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-20632021

RESUMO

STUDY DESIGN: Retrospective case series. OBJECTIVE: To study the correction and fusion strategies for adult thoracolumbar or lumbar scoliosis with Chiari malformation and syringomyelia by using posterior pedicle screw instrumentation (PPSI). Surgical intervention for Chiari malformation and syringomyelia before surgical correction of scoliosis has been reported; however, there are no clinical trials for the PPSI-based correction and fusion procedures used in these patients. METHODS: From 2002 to 2009, 13 adult patients (mean age, 34.9 years) suffering from thoracolumbar or lumbar scoliosis with Chiari malformation and syringomyelia underwent correction and fusion by using PPSI. Preoperative, postoperative, and final follow-up coronary Cobb angle, correction rate, pelvic obliquity (PO), apical vertebral rotation (AVR), apical vertebral translation (AVT), trunk shift (TS), sagittal thoracic kyphosis angle, and lumbar lordosis angle were analyzed on radiographs. RESULTS: The preoperative and postoperative mean coronary Cobb angle was from 46.8° to 9.2°, correction rate was 80.7%, PO from 9.9° to 3.2°, AVR from 1.9° to 0.3°, AVT from 3.6 to 0.8 cm, TS from 16.8 to 1.6 cm, sagittal thoracic kyphosis angle from 18.2° to 23.5°, and lumbar lordosis angle was from 37.4° to 41.8°. The mean follow-up period was 35.2 months (range, 24-50 months). There were no obvious pseudoarticulations or loss of correction and trunk equilibrium at the final follow-up; no aggravation of the original neural symptoms or new irreversible neural injury was observed. CONCLUSIONS: In patients with mild or moderate adult thoracolumbar or lumbar scoliosis with Chiari malformation and syringomyelia, the correction and fusion by using PPSI can yield a satisfactory clinical effect.


Assuntos
Malformação de Arnold-Chiari/complicações , Escoliose/complicações , Escoliose/cirurgia , Fusão Vertebral/métodos , Siringomielia/complicações , Adulto , Potenciais Somatossensoriais Evocados , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Adulto Jovem
20.
Orthopedics ; 33(11): 808, 2010 Nov 02.
Artigo em Inglês | MEDLINE | ID: mdl-21053886

RESUMO

The goal of this study was to determine the efficacy and feasibility of surgical management of advanced thoracolumbar spine tuberculosis with kyphosis in children in poor general condition with 1-stage posterior decompression, interbody grafts, and posterior instrumentation and fusion. Between 2006 and 2008, 7 children with advanced thoracolumbar spinal tuberculosis accompanied by kyphosis and in poor general condition were treated with 1-stage posterior decompression, interbody grafts, and posterior instrumentation and fusion followed by chemotherapy. Mean follow-up was 34 months (range, 27-42 months). Patients were evaluated pre- and postoperatively for erythrocyte sedimentation rate (ESR), neurological status, pain, spinal canal compromise, and kyphotic angle. Spinal tuberculosis was completely cured and the grafted bones fused in all 7 patients. There was no recurrence of the disease in any patient at final follow-up. In all patients, ESR was normal within 3 months, Frankel neurological classification improved, and pain relief was obtained. Average canal compromise was 52.57% (range, 35%-75%) preoperatively and 9.86% (range, 0%-19%) postoperatively. Average preoperative kyphosis was 37.9°, which decreased to 5.4° postoperatively. There was no significant loss of correction at last follow-up. Our results show that 1-stage posterior decompression, interbody grafts, and posterior instrumentation and fusion followed by chemotherapy is an alternative treatment for children with advanced thoracolumbar spinal tuberculosis and in poor general condition.


Assuntos
Cifose/cirurgia , Vértebras Lombares/cirurgia , Fusão Vertebral/métodos , Vértebras Torácicas/cirurgia , Tuberculose Osteoarticular/terapia , Antituberculosos/uso terapêutico , Transplante Ósseo , Criança , Terapia Combinada , Descompressão Cirúrgica/métodos , Feminino , Humanos , Cifose/microbiologia , Cifose/patologia , Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/microbiologia , Imagem por Ressonância Magnética , Masculino , Osseointegração , Radiografia , Estudos Retrospectivos , Fusão Vertebral/instrumentação , Vértebras Torácicas/diagnóstico por imagem , Vértebras Torácicas/microbiologia , Resultado do Tratamento , Tuberculose Osteoarticular/complicações , Tuberculose Osteoarticular/patologia
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