【Abstract】 Objective To review the progress in the research of complications after expansive laminoplasty such as axial symptom, kyphotic deformity, and segmental motor paralysis. Methods Recent articles about complications after expansive laminoplasty were reviewed, and comprehensive analysis was done. Results The pathogenesis of axial symptom, kyphotic deformity, and segmental motor paralysis has not yet fully been understood, but has brought new finding, such as the importance of the spinous process-ligament-muscle complex, C5 palsy theory, and the involvement of the spinal cord mechanism. Conclusion The pathogenesis of axial symptom, kyphotic deformity, and segmental motor paralysis should be further investigated to prevent and treat the complications.
Objective To review the research progress of heterotopic ossification (HO) pathogenesis.Methods Recent articles about HO including the risk factors and pathogenesis were reviewed and comprehensively analyzed. Results The pathogenesis of HO is not completely understood, but the extracellular factors, signaling pathways, and transcription factors in the pathogenesis of HO are understood deeply, such as bone morphogenic protein, Smad signaling, and core binding factor α1/runt-related transcription factor 2, which are probably involved in HO. Furthermore, some related microRNAs are also probably involved in HO. Conclusion The pathogenesis of HO should be further investigated so as to lay a foundation for preventing and treating HO.
Objective To discuss the surgical selection and effectiveness for patients with recurrent giant cell tumor of bone. Methods Between February 1988 and June 2007, 79 patients with recurrent giant cell tumor of bone were treated. There were 42 males and 37 females, with a mean age of 33.1 years (range, 15-72 years). In primary surgery, 76 patients underwent intralesional curettage, and the other 3 patients underwent resection; the recurrence time was 2-176 months after primary surgery. The locations of tumor were upper extremities in 14 cases and lower extremities in 65 cases. According to Companacci grade, 1 case was at grade I, 33 cases at grade II, and 45 cases at grade III before primary surgery. In secondary operation, 37 patients underwent intralesional curettage and bone grafting combined with adjuvant inactivated, and 42 patients underwent wide resection. Results Bone allograft immune rejection occurred in 2 cases, which led to poor healing; primary healing of incision was obtained in the other patients. The patients were followed up 68 months on average (range, 18-221 months). Recurrence occurred in 12 patients at 6-32 months after operation. The re-recurrence rate was 24.3% (9/37) in cases of intralesional curettage and bone grafting combined with adjuvant inactivated, and they were given the wide resection. The re-recurrence rate was 7.1% (3/42) in cases of wide resection and they were amputated. There was significant difference in the re-recurrence rate between the intralesional curettage and the wide resection (χ2=4.508, P=0.034). No recurrence was observed during 3-year follow-up among re-recurrence patients. Conclusion For benign recurrent giant cell tumor of bone, intralesional curettage and bone grafting combined with adjunctive therapy could get an acceptable effectiveness, however, it has higher local recurrence than wide resection. For large tumor and recurrent malignant giant cell tumor of bone, wide resection is recommended.
Objective To evaluate the early cl inical outcomes of subtotal corpectomy and intervertebral bonegrafting through posterior approach alone in the treatment of thoracolumbar burst fracture or thoracolumbar fracturedislocation.Methods Between January 2009 and December 2010, 20 patients with thoracolumbar burst fracture orthoracolumbar fracture dislocation were treated with subtotal corpectomy and intervertebral bone grafting through posteriorapproach alone. There were 14 males and 6 females, with an average age of 36.1 years (range, 19-47 years). Fractures were causedby falling from height in 12 cases, traffic accident in 6 cases, and crushing in 2 cases. According to AO classification, there were10 cases of A3 type, 8 cases of B2 type, and 2 cases of C2 type. Single segment was involved in 8 cases, double segments in 12cases. Twelve cases complicated by fracture dislocation and 6 cases by lateral displacement. All patients had bones occupancyin vertebral canal. The preoperative Cobb angle was (30.2 ± 3.9)°. According to Frankel classification for neurological function,there were 4 cases of grade B, 9 cases of grade C, and 7 cases of grade D at preoperation. The mean time between injury andoperation was 4.5 days (range, 1-12 days). Results All incisions healed by first intention, and no infection occurred.Twenty patients were followed up 8-16 months (mean, 12 months). The interbody fusion time was 6-9 months (mean, 7months). Neurological function recovered 1 to 3 grades: 1 case of grade C, 2 cases of grade D, 17 cases of grade E at last followup.The Cobb angle was (6.5 ± 4.2)° at last follow-up, showing significant difference when compared with preoperative value(t=2.39, P=0.00). No breaking or loosening of screw and implant sinkage occurred. Conclusion A combination of subtotalcorpectomy and intervertebral bone grafting through posterior approach alone has the advantages of complete decompression,restoration of spinal stabil ity, restoration of vertebral body height, high bone healing rate, and good recovery of neurologicalfunction. However, this surgical technique has a relatively large amount of blood loss and high requirements for surgeons.