Objective To investigate the effectiveness in the treatment of single segment thoracic vertebra tuberculosis by limited decompression combined with epidural absorbable haemostat covering and vertebral plate reconstruction based on one-stage posterior approach, debridement, bone fusion, and internal fixation. Methods Between September 2005 and March 2010, 90 cases of single segment thoracic vertebra tuberculosis were treated by using limited decompression combined with epidural absorbable haemostat covering and vertebral plate reconstruction based on one-stage posterior approach, debridement, bone fusion, and internal fixation in 44 patients (treatment group) and by one-stage posterior approach, bone fusion, and internal fixation in 46 patients (control group). There was no significant difference in gender, age, disease duration, affected segment, Cobb angle, Frankle grade, erythrocyte sedimentation rate (ESR), and Oswestry disability index (ODI) between 2 groups (P gt; 0.05). Results All incisions healed by first intension. All 90 cases were followed up 24-44 months (mean, 38 months). There was no significant difference in ESR between 2 groups at 1 week and 3 months after operation (P gt; 0.05). Postoperative iconography indicated that the bone fusion rate of the treatment group was 100% and no epidural cicatricial tissue or failure of internal fixation was observed, showing significant difference when compared with control group (3 cases having failure of internal fixation) (P=0.032). The Cobb angles were significantly corrected after operation when compared with preoperative angles in 2 groups (P lt; 0.05). At 2 years after operation and at last follow-up, the Cobb angle and correction loss in treatment group were significantly better than those in control group (P lt; 0.05). The ODI and Frankel grade were significantly improved at last follow-up when compared with preoperative ones in 2 groups (P lt; 0.05); the treatment group was significantly better than the control group in the ODI, improvement rate of ODI (P lt; 0.05), and in Frankel grade (Uc=4.368, P=0.000). Conclusion Compared with conventional operation method, it is an ideal operation method to use limited decompression combined with epidural absorbable haemostat covering and vertebral plate reconstruction based on one-stage posterior approach, debridement, bone fusion, and internal fixation for treatment of single segment thoracic vertebra tuberculosis, with minimal wound, less complications, and good function recovery.
Objective To assess the effectivness of different bone graft fusion ways in the treatment of thoracolumbar burst fractures. Methods Between June 2000 and June 2009, 126 cases of thoracolumbar burst fractures were treated by onestageposterior short segment internal fixation combined with bone graft fusion. All patients had acute spine and spinal injuryat the levels of T11-L2, who were with different degrees of neural function injury (below Frankel grade D). The patients were randomly divided into 3 groups and were treated respectively by centrum combined with interbody bone graft fusion (group A), posterolateral bone graft fusion (group B), and ring bone graft fusion (group C) combined with posterior short segment pedicle instrumentation. The changes of the Cobb angle, correction loss of Cobb angle, bone fusion rate, internal fixation failure rate, Oswestry Disabil ity Index (ODI), and Frankel grade of the fracture vertebral were observed after operation to evaluate the effectiveness of different bone graft fusion ways. Results All 126 cases were followed up 24-32 months (mean, 28 months). The operation time and bleeding volume in group C were significantly larger than those in groups A and B (P lt; 0.05), but no significant difference was found between groups A and B (P gt; 0.05). At 2 years after operation and last follow-up, the Cobb angle and correction loss in group B were significantly larger than those in groups A and C (P lt; 0.05), but there was no significant difference between groups A and C (P gt; 0.05). At last follow-up, the bone fusion rate and internal fixation failure rate were 100% and 0 in group A, 78.6% and 21.4% in group B, and 97.5% and 0 in group C; there were significant differences between group B and groups A, C (P lt; 0.05), but no significant difference was found between groups A and C (P gt; 0.05). ODI and Frankel grade were obviously improved after operation, showing significant differences between preoperation and last follow-up (P lt; 0.05) in 3 groups, between group B and groups A, C (P lt; 0.05), but no significant difference was found between groups A and C (P gt; 0.05). Conclusion The centrum combined with interbody bone graft fusion is best in 3 bone graft fusion ways because of its optimum bone fusion and according with human body biomechanics mechanism. Back outboard bone graft fusion may not a appropriate bone fusion way because of its high internal fixation failure rate and not according with human body biomechanics mechanism. The ring bone graft fusion may not be an indispensable bone fusion way because of its common bone fusion ratio and lower cost-performance ratio.
Objective To study operative methods of treating upper cervical spine instability without injury. Methods Twentythree cases were treated by internal fixation with autologous bone grafts. Atlantoaxial arthrodesis were performed in 10 cases with Apofix interlaminar clamp(5 cases), Atlas cable system(3 cases) and Brookes(2 cases). Occipitocervical fusion were performed in the other 13 cases by using of CD-cervical(3 cases), Cervifix(8 cases) and Ustick fixation(2cases). Results All the 23 cases were followed up for 2.5 years in average (ranged from 6 months to 5 years). Solid arthrodesis was obtained in all 23 cases . Six months after operation, of the 20 cases with preoperation nervous lesion, improvement was achieved in 16 cases. According to JOA standard and Hirabashiformula,the rate of improvement was 27.1%.Conclusion Posterior fusion is recommended for upper cervical unstability.
Compare the effect of different chemical methods for preparation of acellular nerve scaffold and to provide an effective nerve scaffold for tissue engineering. Methods Fifteen male SD rats of 2 months old, weighing 200-250 g were selected; the bilateral sciatic nerves were harvested and divided into 3 groups according to preparation methods: group A (normal nerve), group B (Sondell method) and group C (optimal method by Triton X-200, SB-10 and SB-16). The morphology was compared by HE, immunohistochemistry and SEM after dispose; the degrees of decellularization, degrees of demyel ination and integrity of the nerve fiber tube were assessed by scoring system. Results HE staining: In group A, thecross section of nerve was roundness, the cell nuclei was dark blue and the myel in sheath was reticular structure. In group B, the axon and cell nuclei disappeared and the structure of endoneurium was destroyed. In group C, the axon and cell nuclei disappeared and the endoneurium become anomal istic round cavum. The immunohistochemistry staining of Laminin: In group A, the myel in sheath was surrounded by basement membrane with dark blue SC nuclei inside. In group B, the myel in sheath and SC nuclei disappeared and the structure of basement membrane destroyed. In group C, the myel in sheath and SC nuclei disappeared and basement membrane become anomal istic round cavum. The immunohistochemistry staining of S-100: In group A, the myel in sheath and SC were brown. In groups B and C, there were no apparent stained myel in sheath. SEM: In group A, the myel in sheath and axon were clear. In group B, the axon and myel in sheath disappeared and basement membrane became anomal istic. In group C, the basement membrane was more regular than that of group B. The degrees of acellularization and demyel ination of groups B and C were superior to that of group A (P lt; 0.05), and the degrees of demyel ination of group C were superior to that of group B (P lt; 0.05). The integrity of nerve fiber tube of group C was superior to that of group B (P lt; 0.05) and similar to that of group A (P gt; 0.05). The total score was the lowest in group C but the qual ity was the best. Conclusion The effect of decellularization of optimal method was similar to that of traditional Sondell method, but the effect of demyel ination and integrity of nerve fiber tube were better than that of traditional Sondell method. And this acellular nerve can be used as a new kind of nerve scaffold material.