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 evaluate the efficacy of posterior approach discectomy with and without fusion in the treatment of lumbar disc herniation. Methods We searched MEDLINE (1950 to June 2007), OVID (1950 to April 2007), PUBMED, the China Biological Medicine Database (1978 to June 2007) and Wanfang Database (1981 to February 2007). We also handsearched several relevant journals for randomized controlled trials (RCTs) and quasi-randomized controlled trials (quasi-RCTs) comparing posterior approach discectomy with and without fusion in the treatment of lumbar disc herniation. The quality of the included trials was assessed. The Cochrane Collaboration’s RevMan 4.2.8 software was used for statistical analysis. Results Nine eligible trials involving 1911 patients were included. The meta-analyses found no statistically significant differences between the two operative procedures in the incidence of postoperative leg pain [RR 0.94, 95%CI (0.69, 1.28)], the proportion of patients requiring re-operation [RR 0.77, 95% CI (0.57, 1.04)], the incidence of post-operative lumbar canal stenosis [RR 1.23, 95%CI (0.26, 5.86)], and the relapse rate at other intervertebral spaces [RR 1.05, 95%CI (0.49, 2.26)] (Pgt;0.05).There is statistically significant differences between the two group in the incidence of peri-operative complications [RR 1.46, 95%CI (1.06, 2.00)]. Discectomy plus fusion was superior to discectomy alone in incidence of postoperative back pain [RR 0.70, 95%CI (0.53, 0.94)], relapse rate at either intervertebral space [RR 0.30, 95%CI (0.18, 0.48)] and at the same intervertebral space [RR 0.12, 95%CI (0.04, 0.37)]. Conclusions Since all the included studies were controlled trials with a great potential for biases, high-quality, large-scale randomized controlled trials are required.
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.
Objective To evaluate the effectiveness of Poster Fusion Cage combined with xenogeneic bone graft augmentation for bone defect management in distal radius fractures. MethodsA retrospective analysis was conducted on 20 patients with bone defects complicating distal radius fractures who met the selection criteria and were treated between June 2022 and June 2024. The cohort comprised 2 males and 18 females, aged 54-87 years (mean, 63.3 years). Etiologies included falls in 17 cases, traffic accidents in 2 cases, and crush injury in 1 case. According to AO classification, there were 5 cases of type A, 8 cases of type B, and 7 cases of type C. The interval from injury to operation ranged from 2 to 10 days (mean, 5.8 days). All patients underwent volar plate fixation augmented with Poster Fusion Cage and demineralized xenogeneic bone matrix grafting. The operation time, intraoperative blood loss, fracture healing time, and postoperative complications were recorded. Radiographic parameters, including radial height, volar tilt, and ulnar deviation, were measured on standardized X-ray films obtained immediately postoperatively and at last follow-up, and whether secondary reduction loss occurred was judged. At last follow-up, wrist range of motion (extension, flexion, radial deviation, ulnar deviation, pronation, and supination) and grip strength (expressed as a percentage of the contralateral side) were measured. Wrist function was assessed using the Disabilities of the Arm, Shoulder, and Hand (DASH) score and Patient-Rated Wrist Evaluation (PRWE) score. Results The operation time was 70-200 minutes (mean, 116.4 minutes), and the intraoperative blood loss was 10-80 mL (mean, 36.5 mL). All surgical incisions healed by first intention, with no neurovascular complications documented. All patients were followed up 9-12 months (mean, 11.6 months). All fractures healed normally, with a healing time of 8-14 weeks (mean, 9.95 weeks). No significant difference was observed in radial height, volar tilt, or ulnar deviation between immediate postoperatively and last follow-up (P>0.05). All fractures achieved satisfactory reduction, with no secondary loss of reduction or implant failure occurring during follow-up. At last follow-up, the range of motion of the affected wrist joint was 60°-65° (mean, 62.5°) in extension, 67°-75° (mean, 71.1°) in flexion, 18°-23° (mean, 20.4°) in radial deviation, 28°-33° (mean, 30.1°) in ulnar deviation, 69°-80° (mean, 74.7°) in pronation, and 69°-82° (mean, 75.6°) in supination. Grip strength recovered to 75%-85% (mean, 80%) of the contralateral side. Functional scores showed a DASH score of 5-15 (mean, 9.4) and PRWE score of 8.0-12.5 (mean, 10.2). ConclusionThe combination of Poster Fusion Cage and xenogeneic bone graft augmentation provides a safe and effective treatment for bone defects in distal radius fractures.
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.
ObjectiveTo explore the surgical indications,decompression and fusion method,and fusion level selection of degenerative lumbar scoliosis (DLS) and multi-segment lumbar spinal stenosis. MethodsBetween April 2000 and November 2011,46 cases of DLS and multi-segment lumbar spinal stenosis were treated with multi-level decompression by fenestration and crept enlargement plus internal fixation by interbody and posterior-lateral bone graft fusion (5 segments or above).Of 46 cases,25 were male and 21 were female,with a mean age of 70.2 years (range,65-81 years) and with a mean disease duration of 6.4 years (range,4 years and 6 months to 13 years).X-ray films showed that the lumbar Cobb angle was (26.7±10.0)°,and the lumbar lordotic angle was (20.3±8.8)°.The lumbar CT and MRI images showed three-segment stenosis in 24 cases,four-segment stenosis in 17 cases,and five-segment stenosis in 5 cases.A total of 165 stenosed segments included 12 L1,2,34 L2,3,43 L3,4,45 L4,5,and 31 L5 and S1.Visual analogue scale (VAS) score,Oswestry disability index (ODI),and Japanese Orthopedic Association (JOA) score (29 points) were employed to evaluate effectiveness. ResultsThirteen patients had leakage of cerebrospinal fluid during operation,and no infection was found after corresponding treatment; pulmonary infection and urinary system infection occurred in 4 and 2 patients respectively,who relieved after received antibiotic therapy; 8 patients with poor wound healing received dressing change,adequate drainage,debridement and suture.No death,paralysis,central nervous system infection,or other complication was observed in these patients.Forty-six cases were followed up 12-72 months (mean,36.2 months).Lumbago and backache and intermittent claudication of lower extremity were obviously improved.During follow-up,no screw incising,loosening and broken screws,or pseudarthrosis was noted under X-ray film and CT scanning.At last follow-up,the lumbar Cobb angle was reduced to (9.8±3.6)°,while the lumbar lordotic angle was increased to (34.1±9.4)°,which were significantly improved when compared with preoperative ones (t=16.935,P=0.000;t=15.233,P=0.000).At last follow-up,VAS,ODI,and JOA scores were 3.2±1.2,35.5%±14.0%,and 26.6±5.7 respectively,showing significant differences when compared with preoperative scores (8.0±2.2,60.8%±13.3%,and 12.9±3.4) (t=19.857,P=0.000;t=16.642,P=0.000;t=15.922,P=0.000). ConclusionMulti-segment decompression by fenestration and crept enlargement plus internal fixation by interbody and posterior-lateral bone graft fusion is helpful to relieve nerve compression symptoms,rebuild spinal balance,and improve the life quality of the patients.It is a very effective way to treat DLS and multi-segment lumbar spinal stenosis.
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.
Dementia is a neurodegenerative disease closely related to brain network dysfunction. In this study, we assessed the interdependence between brain regions in patients with early-stage dementia based on phase-lock values, and constructed a functional brain network, selecting network feature parameters for metrics based on complex network analysis methods. At the same time, the entropy information characterizing the EEG signals in time domain, frequency domain and time-frequency domain, as well as the nonlinear dynamics features such as Hjorth and Hurst indexes were extracted, respectively. Based on the statistical analysis, the feature parameters with significant differences between different conditions were screened to construct feature vectors, and finally multiple machine learning algorithms were used to realize the recognition of early categories of dementia patients. The results showed that the fusion of multiple features performed well in the categorization of Alzheimer’s disease, frontotemporal lobe dementia and healthy controls, especially in the identification of Alzheimer’s disease and healthy controls, the accuracy of β-band reached 98%, which showed its effectiveness. This study provides new ideas for the early diagnosis of dementia and computer-assisted diagnostic methods.
Objective To discuss the selection of anterior or posterior or a combination of anterior and posterior surgical treatment of lower cervical dislocation. Methods A retrospectively study was performed on 28 patients with lower cervical dislocation who received operative treatment between January 2005 and October 2008. There were 19 males and 9 femaleswith an average age of 38 years (range, 19-57 years), including 21 cases of fresh dislocation and 7 cases of old dislocation. The time from injury to hospitalization was 3 hours to 58 days. According to Allen classification, all cases had flexion injury, including 19 cases of degree I dislocation, 2 cases of degree II, 5 cases of degree III, and 2 cases of degree IV. At admission according to Frankel classification, 7 cases were rated as grade A, 4 as grade B, 9 as grade C, 3 as grade D, and 5 as grade E. All patients received open reduction, internal fixation, and il iac bone graft spinal fusion. Of them, combined anterior and posterior approach operation were given in 4 cases, single anterior operation in 22 cases, and single posterior operation in 2 cases. Results All operations were completed successfully and the spinal cord injury did not deteriorate after operation. Esophageal fistula occurred in 1 case receiving anterior approach operation and was cured after 1 month. Infection of wound occurred in 1 case and was cured after dressing change. The other incisions healed by first intention. One case (Frankel grade A) died of pulmonary infection 6 weeks after operation. Twenty-seven patients were followed up 21-38 months. Two cases suffered from shoulder pain 12 months after operation. X-ray films showed complete reduction, normal height of vertebral space and normal sequence of cervical spine after operation. All cases obtained bone fusion after 3.5-6.0 months of operation (4.2 months on average). Frankel grades were improved in different degrees after operation. Conclusion The operation plan of lower cervical dislocation should be determined by the neurologic status of the patient, and the classification of the injury as a unilateral or bilateral dislocation. Anterior cervical discectomy, fusion, and fixation were available in the lower cervical dislocation.
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.