Objective To investigate the surgical method and prel iminary cl inical result of managing the patient with lumbar burst fracture but not suitable for single-level fixation and fusion surgery with the reservation of the fractured vertebral body and the anterior decompression. Methods From September 2007 to December 2008, 11 patients with lumbar burst fracture underwent the removal of the posterior superior corner of the injured vertebral body, the removal of the inferior intervertebral disc adjacent to the injured vertebral body, bone graft fusion, and internal fixation. There were 8 males and3 females aged 21-48 years old (average 29.4 years old). All the fractures caused by fall ing from high places. Imaging exams confirmed all the fractures were Denis type B burst fracture. The fracture level was at the L1 in 4 cases, the L2 in 4 cases, the L3 in 2 cases, and the L4 in 1 case. Before operation, the nerve function was graded as grade B in 4 cases, grade C in 3 cases, and grade D in 4 cases according to Frankel scales; the visual analogue scale (VAS) was (7.30 ± 0.98) points; lateral X-ray films displayed the kyphosis Cobb angel was (24.94 ± 12.21)°; the adjacent superior and inferior intervertebral disc height was (12.78 ± 1.52) mm and (11.68 ± 1.04) mm, respectively; CT scan showed the vertebral canal sagittal diameter was (9.56 ± 2.27) mm; CT three-dimensional reconstruction revealed that the intact part of the injured vertebra was less than 50% vertebra body height and the fracture l ine crossed the pedicle. The time from injury to operation was 3-11 days (average 4.8 days). The neurological and radiological evaluations were carried out immediately and 3 months after operation, respectively, and compared with the condition before operation. Results All the patients successfully underwent the surgery. The wound all healed by first intention. All the patients were followed up for 6-18 months (average 14 months). All the patients had a certain degree of nerve function recovery. The Frankel scales in all the patients were increased by 1-2 grade immediately and 3 months after operation. The VAS score was (2.80 ± 1.49) points immediately after operation and (1.54 ± 0.48) points 3 months after operation, suggesting there were significant differences among three time points (P lt; 0.05). The vertebral canal sagittal diameter was significantly enlarged to (18.98 ± 4.82) mm immediately after operation and was (19.07 ± 4.37) mm 3 months after operation. The Cobb angle was (7.78 ± 4.52)° immediately after operation and (8.23 ± 3.57)° 3 months after operation. There were significant differences between before and after operation (P lt; 0.05). For the adjacent superior and inferior intervertebral disc height, there was no significant difference when the value immediately or 3 months after operation was compared with that of before operation (P gt; 0.05). X-ray films and CT scan 3 months after operation showed good internal fixation without theoccurrence of loosing and displacement. Conclusion For the treatment of lumbar burst fracture, the method of reserving the injured vertebral body and anterior decompression can decompress the vertebral canal and shorten the duration for bony fusion.
From January, 1983 through December, 1993, 20 different types of operations were carried out to treat a total of 54 cases from trauma or deformities around the occipitocervical region, in which 4 patients died. The causes of the deaths were analyzed, and the main factors responsible for the mortality were improper selection of the wires for internal fixation, inadequate decompression from operation, incorrect operative technique and errors in the selection of anesthesia.
Objective To construct a regulatable plasmid containing single chain fusion gene of murine interleukin-12 (mIL-12) which was regulated with mifepristone (RU486) and explore its expression in vitro. Methods The p40 and p35 subunit sequence of mIL-20 were respectively obtained from the plasmid GCp35Ep40PN by polymerase chain reaction (PCR) and they were cloned into pCA14 plasmid after introducing a linker by overlap PCR. The single chain mIL-12 gene was comfirmed by sequencing and subcloned into pRS-17 vector which contains RU486 regulator cassette. The positive clone named pRS-RUmIL-12 was identified by restriction endonuclease digestion and PCR. Lipofectamine 2000 was used to transfect the pRS-RUmIL-12 to HEK293 cells followed by manufacturer’s recommendations. The protein concentration of mIL-12 induced with RU486 in supernatant of the transfected HEK293 cells was measured by ELISA. Results The sequence of single chain mIL-12 what we obtained was the same as the expected result. The results of restriction endonuclease digestion and PCR showed that the RU486-inducible regulatory vector (pRS-RUmIL-12) was successfully constructed. No significant mIL-12 protein concentration in supernatant of HEK293 cells activation was measured without the inducer RU486, whereas higher concentration of the mIL-12 protein was observed in the presence of RU486. The relationship of concentration of the mIL-12 protein and RU486 was positive correlated under definite range. Conclusion A regulatable eukaryotic expression plasmid of mIL-12 single chain fusion gene was constructed, which could be used in the further research of gene regulation and gene therapy.
Objective To study the effects of pcDNA3/AFP/TK/Angio fusion gene targeting therapy for human primary liver cancer in nude mice implanted with SMMC-7721. Methods Human liver cancer cell line SMMC-7721 was implanted subcutaneously in nude mice to establish experiment model. Animals bearing liver cancer were randomly divided into five groups: control group， vector group， GCV (ganciclovir) group， pcDNA3/TK/Angio group; pcDNA3/AFP/TK/Angio group. Different plasmids were directly injected into tumors and GCV was intraperitoneally administrated simultaneously according to different groups. The growth of tumors was observed and the pathology was examined as well. Serum AFP level was measured by radioimmunology, the ultrastructural change of tumor cells was studied by using electron microscopy, the expressions of MVD and VEGF were respectively detected with immunohistochemistry and the cell apoptosis in situ was detected by TUNEL. Results The success rate to establish subcutaneous implanted liver cancer model in nude mice was 100%. The tumor volume, serum AFP level, VEGF and MVD expressions of pcDNA3/TK/Angio group and pcDNA3/AFP/TK/Angio group were lower than those in control group, vector group and GCV group (P＜0.05) and more apoptosis cells could be observed. While the tumor volume, serum AFP level, VEGF and MVD expressions of pcDNA3/AFP/TK/Angio group was lower than those in pcDNA3/TK/Angio group (P＜0.05); and apoptosis index was higher than that of the latter (P＜0.05).Conclusion pcDNA3/AFP/TK/Angio fusion gene inhibits the growth of tumor remarkably and becomes a promising new biological agent to treat human primary liver cancer.
Objective To evaluate differences of clinical effects between cervical total disc replacement (TDR) and anterior cervical discectomy and fusion (ACDF) for single symptomatic single-level cervical degenerative disc disease. Methods Randomized controlled trials (RCTs) from the Cochrane Library Central Register of Controlled Trials (Issue 1, 2009), MEDLINE (2000 to May 2009), EMbase (2000 to May 2009), Ovid (2000 to May 2009), CBM (2000 to May 2009) and CNKI (2000 to May 2009) were electronically searched. Additionally, six relevant journals were handsearched to identify RCTs about comparison of TDR and ACDF in the treatment of single-level cervical degenerative disc disease. All RCTs demonstrating these issues were included. RevMan 5.0 software was used for meta-analyses. Results Six RCTs involving 1 340 patients were included. The results of meta-analyses indicated that there were significant differences between the two groups in neurological success (RR=1.06, 95%CI 1.02 to 1.11, P=0.003), secondary surgical procedures (RR=0.30, 95%CI 0.17 to 0.53, Plt;0.0001) and overall success (RR=1.13, 95%CI 1.06 to 1.22, P=0.0006). However, there were no significant differences in Neck Disability Index (NDI) scores (WMD=1.53, 95%CI –0.55 to 3.61, P=0.15), neck pain scores (WMD= –2.87, 95%CI 7.75 to 1.81, P=0.23), arm pain scores (WMD= –0.7, 95%CI –0.86 to –0.54, P=0.48), radiography success (RR=0.96, 95%CI 0.92 to 1.01, P=0.11), and postoperative complications (RR=0.79, 95%CI 0.49 to 1.28, P=0.34) between the two groups. Conclusion The evidence indicates that compared with ACDF, TDR could improve neurological status, reduce secondary surgical procedures and promote overall success for single-level cervical degenerative disc disease, but there are no significant differences in postoperative NDI, neck and arm pain scores, radiography success, and complications.
Objective To evaluate the therapeutic effect ofthe two-level cervical artificial disc replacements combined with the nearby segments fused for the multi-level disc herniations and to investigate their interaction during the treatment. Methods The patient undergoing surgery was diagnosed as having intervertebral disc herniations in the C3-7 intervertebral discs. During the operation, the C4-6 discs were replaced with two Bryan artificial discs while the C3,4 and C6,7 discs were removed, followed by the bone grafting and the Zephir instrumentation. The range of motion (ROM) was assessed before and immediately after operation by the flexion-extension radiography. The patient’s functional exercise began as early as 2 days after operation and lasted for 3 weeks, followed by immobilization for 3 months. Results According to the follow-up for 1 year and 2 months, the patientcould move his neck in all directions without pain. The spinal and neural symptoms were significantly alleviated. ROM was close to the normal level postoperatively.Conclusion Artificial disc replacement combined with bone grafting and fusion is a new way to treat multilevel disc herniations surgically, with good clinical results. Early cervical functional exercise followed byrestriction is an effective way to deal with the contradiction of motion and immobilization.
To explore the treatment of multi-segmental lumbar disc herniation and spinal canal stenosis by laminectomy, removal of nucleus pulposus, fusion of intra-transverse process and general spine system(GSS) fixation. Methods From January 2004 to January 2006, 21 patients with multi-segmental lumbar disc herniation and spinal canal stenosis were treated by laminectomy, removal of nucleus pulposus and GSS pedicle screw spinal system. There were 14 males and 7 females with an average age of 53 years ranging from 46 to 61 years, and with an average disease course of 18 months ranging from 8 months to 15 years. All of the patients were examined by X-ray with AP position, lateral position and dynamic lateral position, CT and MRI, and all of them proved to be with multi-segmental lumbar disc herniation and different degrees of spinal canal stenosis. A total of 47 nucleuses were picked out, and 47 instable segments were filled in with granule selfbone. Results There were 21 patients who were followed up for 1 to 2 years with an average of 13 months. All patients achieved successful fusion and bony union postoperative from 8 to 12 months, and no artificial joint was formed. As to the cl inical results in 21 cases, according to the Macnab outcome criteria, 14 were excellent, 6 were good and 1 was poor, the excellent and good rate was 95.2%. Conclusion The methods of laminectomy, removal of nucleus pulposus, fusion of intra-transverse process and GSS system fixation are effective in treatment of multi-segmental lumbar disc herniation and spinal canal stenosis．
Objective To amplificate,clone and sequence the thymidine kinase (TK) gene of herpes simplex virusⅡ(HSVⅡ); to construct and appraise the fusion gene eukaryon expression vector, pcDNA3/HSVⅡ TK/angiostatin. MethodsThe Hep2 cells were infected by HSVⅡ Sav strain. HSVⅡ genomic DNA was purified from the Hep2 cells suspension and used as template to run PCR for TK gene amplification. The amplified products were cloned into PC DNA3 vector and sequenced. The vector pcDNA/HSVⅡ TK was cut by endonuclease. The gained TK gene was cloned into eukaryon expression vector. pcDNA3/angiostation, which had been constructed. ResultsCoding region of HSVⅡTK gene consisted of 1 128 bp except stop code, it encoded 376 amino acids.After cutting the new vector by endonuclease Hind Ⅲ and BamH Ⅰ,we gained the following gene fragment: 1000 bp (TK) and 700 bp (angiostation).Conclusion The fusion gene eukaryon expression vector， pcDNA3/HSVⅡ TK/angiostatin has been constructed.
Objective To evaluate the therapeutic effects of expandable pedicle screw (EPS) combined with interbody fusion cage on lumbar spondylolisthesis. Methods From June 2004 to March 2008, 23 patients with lumbar spondylolisthesiswere treated, including 9 males and 14 females aged 24-72 years old (average 48.7 years old). The course of the disease varied from 6 months to 6 years (average 30.4 months). There were 18 cases of degenerative spondylol isthesis and 5 of isthmic spondylolisthesis, including 1 case at L3,4 level, 14 at L4,5 level, and 8 at L5 and S1 levels. There were 17 cases of grade I, 4 of grade II, and 2 of grade III (including 1 case of recurrent L5 spondylolysis) according to Meyerding classification system. Posterior lumbar interbody fusion was performed using 48 PLIVIOS interbody fusion cages, and spondylolisthesis reduction and internal fixation were conducted using 84 pieces of EPS. The indications for use of EPS were initial operation with bone mass reduction or osteoporosis, reoperation of previous pedicle instrumentation, intraoperative screw relocation, sacral anchoring, and construct reinforcement. Cl inical outcomes, radiographic reduction of spondylol isthesis and bone fusion of lumbar interbody were evaluated based on JOA score, Boxall index, and Cook criteria. Results The incision healed by first intension in all cases except for one revision case that suffered from postoperative cerebrospinal fluid leakage and obtained delayed-healing without infection 23 days after operation using conservative treatment. No operative compl ications such as nerve and organ injuries were found.All cases were followed up for 12-39 months (average 17.8 months). X-ray exams of spine AP, lateral, fully extended position and fully flexed position view showed all 84 EPS were fully expanded within vertebral body. The improvement rate of JOA at the final follow-up visit was markedly effective in 14 cases, and effective in 5 cases, and noneffective in 4 cases, with a total effective rate of 82.61%. Anatomic reduction was achieved in 14 cases, improvement was obtained in 6 cases, no improvement was observed in 3 cases, and the reduction rate was 86.69%. Lumber interbody fusion was achieved in 20 cases, fixation was achieved in 2 cases, failure was observed in 1 cases, and the fusion rate was 86.69%. Conclusion EPS in complex with interbody fusion cage provides effective reduction, internal fixation and interbody fusion for the reconstruction of lumbar spondylolisthesis.
ObjectiveTo summarize the progress of the surgical selection of fusion levels for degenerative scoliosis. MethodsThe domestic and foreign related literature about degenerative scoliosis, including clinical features, classification, surgical treatment, and the fused segment, was summarized. ResultsDegenerative scoliosis is very complicated. Short segment fusion and long segment fusion are the main surgical types. The long segment fusion is better in terms of reconstructing the stability of spine; however, it has more related complications. The short segment fusion has been used widely in clinical, but it causes degenerative disease easily. W/AL value can be used to direct the selection of short or long segment fusion for degenerative scoliosis. ConclusionThe key to success surgery is choosing reasonable fused segment. Now there is no unified selection standard. With more knowledge about degenerative scoliosis, greater development can be expected in the future.