【Abstract】 Objective To summarize the current development of the correction of severe and rigid scol iosis. Methods Recent l iterature concerning the correction of severe and rigid scol iosis at home and abroad was extensively reviewed, and current developments of the correction of severe and rigid scol iosis were summarized. Results The correction of severe and rigid scol iosis shows developments as follows: the application of Halo-gravity traction increase and Halo-femoral traction is applied in posterior correction surgery. Fixation and correction technique with all pedicle screws was gradually popularized. The applications of posterior vertebral column resection, one-stage anterior and posterior surgery, and posterior-only correction surgery increase. Conclusion The developments of all kinds of correction techniques improve the correction effects of severe and rigid scol iosis. Now there is no standardized treatment protocol for severe and rigid scol iosis. Greater development can be expected in the future.
ObjectiveTo review the research progress of pathogenesis mechanism of spinal deformity in neurofibromatosis type 1 (NF1). MethodsRecent literature concerning the pathogenesis mechanism of spinal deformity in NF1 was extensively reviewed, and current developments of the correction of spinal deformity and NF1 and the pathogenesis mechanism were summarized. ResultsThe pathogenesis mechanism of spinal deformity in NF1 is not yet clearly known. Current theories include erosion and stress of neurofibromas, melatonin-related decreased contractility of paraspinal muscles, osteopenia and osteoporosis, sexual precocity and mesoderm dysplasia. ConclusionThe clinical manifestations of NF1 may cause the spinal deformities in patients with NF1. The research of pathogenesis mechanism of spinal deformity in NF1 will be conducive to further understanding, diagnosis and treatment of NF1-related spinal deformity.
【Abstract】 Objective To study the short-term effects of thoracoscopic anterior spine release combined with posterior correction on the pulmonary function in patients with idiopathic scoliosis (IS). Methods Between April 2004 and June 2008, 21 cases of IS underwent thoracoscopic anterior spine release combined with posterior correction. There were 9 males and 12 females with a mean age of 15.6 years (range, 12 to 24 years). Of 11 patients, 2 had left protrusion deformity and 19 had right protrusion deformity, including 12 cases of Lenke type I and 9 cases of Lenke type II, with an average coronal Cobb’s angle of 79.6° (range, 65-125°). The disease duration ranged from 1 year and 6 months to 9 years (mean, 2.5 years). The results of pulmonary function tests (PFTs) were compared between pre-operation and postoperative 6th month, including lung capacity, ventilation function, and thoracic compliance. Results The opening time of the chest was 90 to 150 minutes (mean, 127 minutes) at the thoracoscopic anterior spine release and all incisions healed by first intention with no chest cavity infection. All the patients were followed up from 6 to 36 months (mean, 13.5 months). The average coronal Cobb’s angle was 43.7° (range, 36-75°) at 1 week after posterior correction. At 6 months after operation, the vital capacity and total capacity were significantly increased (P lt; 0.05), but no significant change was observed in the percentage of actual value and expected one when compared with pre-operation (P gt; 0.05). The functional residual capacity and the percentage of actual value and expected one of residual volume was significantly decreased when compared with those at pre-operation (P lt; 0.05). The forced expiratory volume in one second (FEV1) and FEV1/FEV were not significantly improved (P gt; 0.05) , but the maximum ventilatory volume was significantly increased when compared with the preoperative value (P lt; 0.05). In addition, the Raw Total, Raw Insp, and Raw Exp decreased significantly after operation (P lt; 0.05). Conclusion Although the thoracoscopic anterior spine release combined with posterior correction might disturb the function of the thoracic cavity, the PFTs of the patients could be improved at different aspects because of the shape changes of the thoracic cavity, and the pulmonary function still needed further observation.
ObjectiveTo assess the feasibility and clinical value of lumbar elastic fixation through the clinical research of elastic fixation for lumbar intervertebral fusion. MethodsAccording to the criteria, we selected 12 patients with lumbar degenerative disease diagnosed between September 2011 and March 2013 as our study subjects. Among them, 8 were females, and 4 were males, aged between 40 and 62 years old, averaging 52.9 years. Elastic fixation was adopted in the lumbar fusion. Evaluation indicators included visual analogue scale (VAS) scores, Oswestry disability index (ODI) score and its rate of improvement, intervertebral height changes, the rate of intervertebral fusion, intervertebral bone callus formation, patient satisfaction and clinical success rate. ResultsAll patients were followed up. During various postoperative follow-up points, VAS score and ODI score improved significantly (P<0.05). A large amount of callus formation was shown in lumbar CT. No fracture, loosened or shifted internal fixation occurred. ConclusionElastic fixation for lumbar intervertebral fusion provides another choice for the treatment of lumbar degenerative disease.
This study was aimed to compare the mechanical characteristics under different physiological load conditions with three-dimensional finite element model of rigid fixation and elastic fixation in the lumbar. We observed the stress distribution characteristics of a sample of healthy male volunteer modeling under vertical, flexion and extension torque situation. The outcomes showed that there existed 4-6 times pressure on the connecting rod of rigid fixation compared with the elastic fixations under different loads, and the stress peak and area of force on elastic fixation were much higher than that of the rigid fixations. The elastic fixation has more biomechanical advantages than rigid fixation in promoting interbody lumbar fusion after surgery.
ObjectiveTo explore the effectiveness and safety of treatment of thoracic tuberculosis with thoracoscope supported by digital technology. MethodsBetween June 2010 and February 2012, 11 patients with thoracic tuberculosis were treated and the clinical data were retrospectively analyzed. There were 7 males and 4 females with an average age of 23.6 years (range, 16-47 years) and an average disease duration of 16 months (range, 6-18 months). Two vertebral bodies and one intervertebral space were involved at T6-11. At preoperation, the neurologic function degree was classified as Frankel grade E. Three dimensional reconstruction of thorax and spine and surgical procedure design (including focal clearance, bone grafting, and screw fixation) were done at SUPERIMAGE workstation. Surgery procedures were conducted following the preoperative designs. ResultsThe operative procedures were consistent with preoperative designs. All of these operations were successfully performed. The mean time of operation was 146 minutes (range, 120-180 minutes); the mean blood loss was 120 mL (range, 100-150 mL); the mean indwelling time of closed thoracic drainage was 38 hours (range, 24-48 hours); and the mean hospitalization time was 4.6 days (range, 3-5 days). Eleven patients were followed up 12-25 months (mean, 16 months). No complication of nerve damage, incision pain and infection, or pulmonary infection was observed. Rigid fixation and born fusion were obtained at last follow-up; no obvious change of thoracic vertebral alignment was detected and no internal fixation failure occurred. ConclusionIt is a minimally invasive, effective, and safe method to treat thoracic tuberculosis with thoracoscope supported by digital technology.
Objective To discuss the effectiveness of atlantoaxial joint release through anterior retrophayngeal approach and staged posterior reduction fixation and fusion for irreducible atlantoaxial dislocation (IAAD). Methods Fifteen patients with IAAD (9 males, 6 females), aged 14-53 years (mean, 31.4 years) were included in the study. The disease duration was 3 months to 17 years (mean, 5.7 years). IAAD was attributed to trauma in 13 cases, and 2 cases were caused by congenital odontoid disconnection. Preoperative imaging examination showed atlantoaxial dislocation and could not be reset automatically in functional position. The preoperative visual analogue scale (VAS) score was 3-7 (mean, 4.1), and the preoperative Japanese Orthopaedic Association (JOA) score was 10-17 (mean, 13.8). All patients received atlantoaxial joint release through anterior retrophayngeal approach and staged posterior fixation and fusion. Results Anatomical reduction was achieved in all 15 patients, and the alignment of atlantoaxial joints was restored. After operation, the neck pain and neurological symptom were partially or fully improved in all patients, without deterioration of neurological function. One patient developed pharyngeal discomfort and cough after one-stage operation, 4 patients developed pharyngeal discomfort and foreign body sensation after operation, and 2 patients developed pin-path lipstick swelling during skull traction. All patients were cured by symptomatic treatment. No pulmonary infection, pressure ulcers, venous thrombosis, and incision infection was found during the treatment. All 15 patients were followed up 24-36 months, with an average of 28.6 months. Bony fusion was achieved in all patients, and the fusion time was 3-5 months, with an average of 3.6 months. At last follow-up, the VAS score was 0-2 (mean, 0.5) and the JOA score was 13-17 (mean, 15.9). There was no dislocation, recurrence, or other abnormal sign in the cervical X-ray films and three-dimensional CT. Conclusion Anatomical reduction can be achieved by atlantoaxial joint release through anterior retrophayngeal approach and staged posterior fixation and fusion for treating IAAD. It is an optional procedure for IAAD.
Objective To investigate short-term effectiveness of spinal navigation with the intra-operative three-dimensional (3D)-imaging modality in pedicle screw fixation for congenital scoliosis (CS). Methods Between July 2010 and December 2011, 26 patients with CS were treated. Of 26 patients, 13 patients underwent pedicle screw fixation using the spinal navigation with the intra-operative 3D-imaging modality (navigation group), while 13 patients underwent the conventional technique with C-arm X-ray machine (control group). There was no significant difference in gender, age, hemivertebra number and location, major curve Cobb angle, and Risser grade between 2 groups (P gt; 0.05). Operation time, operative blood loss, frequency of the screw re-insertion, and postoperative complication were observed. The pedicle screw position was assessed by CT postoperatively with the Richter’s standard and the correction of Cobb angle was assessed by X-ray films. Results All patients underwent the surgery successfully without major neurovascular complication. There was no significant difference in operation time, operative blood loss, and pedicle screw location between 2 groups (P gt; 0.05). A total of 58 screws were inserted in navigation group, and 3 screws (5.2%) were re-inserted. A total of 60 screws were inserted in control group, and 10 screws (16.7%) were re-inserted. There was significant difference in the rate of pedicle screw re-insertion between 2 groups (χ2=3.975, P=0.046). Patients of navigation group were followed up 6-24 months, and 6-23 months in control group. According to Richter’s standard, the results were excellent in 52 screws and good in 6 screws in navigation group; the results were excellent in 51 screws, good in 5 screws, and poor in 4 screws in control group. Significant difference was found in the pedicle screw position between 2 groups (Z= — 1.992, P=0.046). The major curve Cobb angle of 2 groups at 1 week and last follow-up were significantly improved when compared with preoperative value (P lt; 0.05), but there was no significant difference between 1 week and last follow-up (P gt; 0.05). No significant difference in correction rate of the major curve Cobb angle was found between 2 groups at last follow-up (t=0.055, P=0.957). Conclusion Spinal navigation with the intra-operative 3D-imaging modality can improve the accuracy of pedicle screw implantation in patients with CS, and effectually reduce the rate of screw re-insertion, and the short-term effectiveness is satisfactory.
【 Abstract】 Objective To construct a lentiviral expression vector carrying Nogo extra cellular peptide residues 1-40(NEP1-40) and to obtain NEP1-40 efficient and stable expression in mammalian cells. Methods The DNA fragment ofNEP1-40 coding sequence was ampl ified by PCR with designed primer from the cDNA l ibrary including NEP1-40 gene, and then subcloned into pGC-FU vector with in-fusion technique to generate the lentiviral expression vector, pGC-FU-NEP1-40. The positive clones were screened by PCR and the correct NEP1-40 was confirmed by sequencing. Recombinant lentiviruses were produced in 293T cells after the cotransfection of pGC-FU-NEP1-40， and packaging plasmids of pHelper 1.0 and pHelper 2.0. Green fluorescent protein (GFP) expression of infected 293T cells was observed to evaluate gene del ivery efficiency. NEP1-40 protein expression in 293T cells was detected by Western blot. Results The lentiviral expression vector carrying NEP1-40 was successfully constructed by GFP observation， and NEP1-40 protein expression was detected in 293T cells by Western blot. Conclusion The recombinant lentivirus pGC-FU-NEP1-40 is successfully constructed and it lays a foundation for further molecular function study of NEP1-40.