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Objective: To review the research progress in the treatment of high-grade spondylolisthesis (HS), in order to provide a reference for clinical treatment decision-making., Methods: The literature related to the treatment of HS at home and abroad in recent years was widely reviewed. The methods of conservative treatment, in situ fusion, and spondylolisthesis reduction were analyzed and summarized., Results: Surgical treatment is the main treatment of HS, but which method is the best is still controversial. The advantages, disadvantages, and applicability of various operations are also different, so individualized analysis is needed in clinic., Conclusion: The treatment plan of HS needs to be considered comprehensively according to the individual condition of the patient. It will be an important research direction to further compare the existing treatment methods and develop more safe and effective new technology.

Objective: To review and evaluate the technical advantages and disadvantages and research progress of percutaneous endoscopic lumbar interbody fusion., Methods: The domestic and foreign related research literature on percutaneous endoscopic lumbar interbody fusion was extensively consulted. The advantages, disadvantages, and effectiveness were summarized. And the development trend of this technology was prospected., Results: Compared with minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF), percutaneous endoscopic lumbar interbody fusion has less intraoperative and postoperative bleeding, better improvement of low back pain in the early stage after operation, and similar long-term effectiveness, fusion rate, and incidence of complication, but a longer learning curve. The operation time of biportal and large-channel uniportal endoscopic lumbar fusion is close to that of MIS-TLIF, but the operation time of small-channel uniportal endoscopic fusion is longer than that of MIS-TLIF., Conclusion: Percutaneous endoscopic lumbar interbody fusion has the advantages of less trauma and good effectiveness, but its learning curve is long, and indications should be strictly selected for this operation. In the future, with the continuous development and complementation of various endoscopic fusion technologies, this technology will gain better application prospects.

Objective: To compare the effectiveness of percutaneous coaxial large-channel endoscopic lumbar interbody fusion (PE-LIF) and minimal invasive transforaminal lumbar interbody fusion (MIS-TLIF) in the treatment of degenerative lumbar spinal stenosis., Methods: The clinical data of 134 patients with single-segment degenerative lumbar spinal stenosis who met the selection criteria between January 2019 and January 2021 were retrospectively analyzed, including 52 cases in PE-LIF group and 82 cases in MIS-TLIF group. There was no significant difference in general data such as gender, age, disease duration, surgical segment, and preoperative visual analogue scale (VAS) scores of low back pain and lower extremity pain, and Oswestry disability index (ODI) between the two groups ( P >0.05). The operation time, intraoperative blood loss, postoperative drainage, hospitalization stay, and complications were recorded and compared between the two groups. The level of serum creatine kinase (CK) was recorded at 1 day before operation and at 1 and 3 days after operation to evaluate intraoperative muscle damage. The Brantigan criteria was used to evaluate the interbody fusion in the two groups. The VAS scores of low back pain and lower extremity pain at 1 day before operation and at 3 days, 3 months, and 1 year after operation, and the ODI scores at 1 day before operation and at 3 months and 1 year after operation were recorded and compared between the two groups., Results: There was no significant difference in operation time and hospitalization stay between the two groups ( P >0.05). The intraoperative blood loss and postoperative drainage in the PE-LIF group were significantly lower than those in the MIS-TLIF group ( P <0.05). There was no significant difference in serum CK between the two groups before operation ( P >0.05), and the serum CK in the PE-LIF group at 1 and 3 days after operation were significantly lower than those in the MIS-TLIF group ( P <0.05). All patients were followed up regularly for 1 year. The postoperative VAS scores of low back pain and lower extremity pain and ODI score in both groups were significantly lower than those before operation ( P <0.05); there was no significant difference between the two groups ( P >0.05). At 1 year after operation, 48 patients in PE-LIF group had successful interbody fusion, and 77 patients in MIS-TLIF group had successful interbody fusion. There was no significant difference in the interbody fusion distribution between the two groups at 3 months and 1 year after operation ( P >0.05). There were 2 and 3 cases of lower limb numbness, 1 and 3 cases of neuroedema pain, 1 and 1 case of Cage displacement, 1 and 1 case of pedicle screw loosening in the PE-LIF group and MIS-TLIF group, respectively. No infection or dural sac tearing occurred in the two groups. There was no significant difference in the incidence of complications between the two groups (9.6% vs. 9.8%) ( χ 2 =0.001, P =0.979)., Conclusion: In the treatment of single-segment degenerative lumbar spinal stenosis, PE-LIF can achieve similar effectiveness as MIS-TLIF, and PE-LIF has less intraoperative blood loss and less muscle damage.

Objective: A prospective randomized controlled trial was conducted to study the effectiveness and safety of intravenous different doses tranexamic acid (TXA) in single-level unilateral minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF)., Methods: The patients treated with single-level unilateral MIS-TLIF between September 2019 and October 2020 were enrolled and randomly classified into low-dose TXA (LD) group ( n =39), high-dose TXA (HD) group ( n =39), and placebo-controlled (PC) group ( n =38). The LD, HD, and PC groups received intravenous TXA 20 mg/kg, TXA 50 mg/kg, the same volume of normal saline at 30 minute before skin incision after general anesthesia, respectively. There was no significant difference on baseline characteristics and preoperative laboratory results among 3 groups ( P >0.05), including age, gender, body mass index, surgical segments, hematocrit (HCT), hemoglobin (HGB), prothrombin time (PT), international normalized ratio (INR), D-dimer, fibrin degradation products (FDP), activated partial prothromboplastin time (APTT), alanine aminotransferase (ALT), aspartate aminotransferase (AST), creatinine (Cr), urea. The intraoperative blood loss (IBL), postoperative drainage volume, operation time, total blood loss (TBL), hidden blood loss (HBL), blood transfusion, hematological examination indexes on the first day after operation, and the incidence of complications within 1 month were compared among the 3 groups., Results: There were 3, 2, and 4 patients in the LD, HD, and PC groups who underwent autologous blood transfusion, respectively, and there was no allogeneic blood transfusion patients in the 3 groups. There was no significant difference in IBL, postoperative drainage volume, and operation time between groups ( P >0.05). The TBL, HBL, and the decreased value of HGB in LD and HD groups were significantly lower than those in PC group ( P <0.05), and TBL and HBL in HD group were significantly lower than those in LD group ( P <0.05); the decreased value of HGB between LD group and HD group showed no significant difference ( P >0.05). On the first day after operation, D-dimer in LD and HD groups were significantly lower than that in PC group ( P <0.05); there was no significant difference between LD and HD groups ( P >0.05). There was no significant difference in other hematological indexes between groups ( P >0.05). All patients were followed up 1 month, and there was no TXA-related complication such as deep venous thrombosis of lower extremity, pulmonary embolism, and epilepsy in the 3 groups., Conclusion: Intravenous administration of TXA in single-level unilateral MIS-TLIF is effective and safe in reducing postoperative TBL and HBL within 1 day in a dose-dependent manner. Also, TXA can reduce postoperative fibrinolysis markers and do not increase the risk of thrombotic events, including deep venous thrombosis and pulmonary embolism.

Objective: To review the definition and possible etiologies for C 5 palsy., Methods: The literature on C 5 palsy at home and abroad in recent years was extensively reviewed, and the possible etiologies were analyzed based on clinical practice experience., Results: There are two main theories (nerve root tether and spinal cord injury) accounting for the occurrence of C 5 palsy, but both have certain limitations. The former can not explain the occurrence of C 5 palsy after anterior cervical spine surgery, and the latter can not explain that the clinical symptoms of C 5 palsy is often the motor dysfunction of the upper limb muscles. Based on the previous reports, combining our clinical experience and research, we propose that the occurrence of C 5 palsy is mainly due to the instrumental injury of anterior horn of cervical spinal cord during anterior cervical decompression. In addition, the C 5 palsy following surgery via posterior approach may be related to the nerve root tether caused by the spinal cord drift after decompression., Conclusion: In view of the main cause of C 5 palsy after cervical decompression, it is recommended to reduce the compression of the spinal cord by surgical instruments to reduce the risk of this complication.

Objective: To assess the reliability, effectiveness, and the safety of full endoscopic transforaminal decompression (FETD) under local anesthesia guided by the classification of lateral region of the lumbar spinal canal (CLLSC) in treating lumbar spinal stenosis (LSS) in geriatric patients., Methods: The clinical data of 63 geriatric patients with LSS met the inclusion criteria underwent FETD surgery between June 2015 and July 2017 were retrospectively analyzed. There were 37 males and 26 females, with a median age of 76 years [interquartile range (IQR), 73-80 years], and a median symptomatic duration of 55 months (IQR, 16-120 months). There were 17 cases of grade B and 46 cases of grade C based on the Schizas morphological grading system. CLLSC was used for imaging evaluation for the stenotic condition, and intra-class correlation coefficients (ICC) were used to test intra-observer and inter-observer reliability of CLLSC. The stenotic condition of patients was re-evaluated by the surgeon after operation, and the results were compared with the findings of preoperative CLLSC. The visual analogue scale (VAS) score for low back pain and leg pain recorded before operation, and at 1 day, 3 months, and 6 months after operation, and last follow-up were used to assess the pain relieving; the functional improvement was evaluate by Oswestry disability index (ODI); the modified Macnab criteria were used to self-evaluate the surgical satisfaction., Results: The operation were successfully performed for all patients, with a median operation time of 75 minutes (IQR, 65-85 minutes), postoperative hospitalization stay of 48 hours (IQR, 48-72 hours), and the time to ambulation after operation of 24 hours (IQR, 24-24 hours). Sixty-three patients were followed-up and with a median follow-up time of 18 months (IQR, 13-20 months). Based on preoperative CLLSC classification, there were 72 stenotic zones, distributed 16 in zone 1, 6 in zone 2, 3 in zone 3, 2 in zone 4, 7 in zone 5, 34 in zones 1+2, 2 in zones 3+4, and 2 in zones 4+5. Perioperative complications occurred in 4 cases (6.3%), including 2 cases of intraoperative dural sac tear, 1 of preoperative numbness symptom aggravation, and 1 of postoperative urinary retention. VAS score of leg pain and ODI score at each time point after operation were significantly improved compared with those before operation ( P <0.05). VAS scores of low back pain showed no significant difference between pre- and post-operation ( P >0.05). At last follow-up, based on the modified Macnab criteria, 19 cases were excellent, 37 were good, 6 were fair, and 1 was poor, and the excellent and good rate was 88.9%. The reliability analysis showed that CLLSC had substantial intra-observer reliability in the geriatric population, with an average ICC of 0.78. There was also a substantial inter-observer reliability, with an average ICC of 0.73. While comparing the preoperative CLLSC results with the postoperative CLLSC results, 53 patients (73.6%) were in full agreement, 15 patients (20.8%) were in partial agreement, and 4 patients (5.6%) were not., Conclusion: CLLSC has high reliability in the diagnosis of LSS in the geriatric patients. Combined FETD with CLLSC, accurate diagnosis, and minimal invasion can be performed to achieve safe and effective result.

Objective: To observe the effectiveness and safety of percutaneous endoscopic transforaminal bilateral decompression for severe central lumbar spinal stenosis., Methods: A retrospective analysis of 44 patients with single-segment severe central lumbar spinal stenosis with bilateral lower extremity symptoms between October 2015 and December 2017 was performed. Among them, 36 cases underwent bilateral decompression through bilateral transforaminal approach, and 8 cases underwent bilateral decompression through unilateral transforaminal approach. There were 25 males and 19 females, the age ranged from 56 to 89 years with an average of 68.6 years. The disease duration was 5-39 months with an average of 14.5 months. Involved segments: L 3, 4 in 6 cases, L 4, 5 in 33 cases, and L 5 , S 1 in 5 cases. The dural sac cross-sectional area (DSCA) of the MRI was (66.36±8.48) mm 2 . Morphological grading (MG) classification: 29 cases of grade C, 15 cases of grade D. The visual analogue scale (VAS) score of preoperative low back pain was 2.3±1.0 and the VAS score of lower extremity pain was 7.8±1.2; the Oswestry disability index (ODI) was 77.8±7.3. Postoperative VAS scores, ODI scores, MG classification, and DSCA were recorded and compared with preoperative ones, and clinical outcomes were assessed by using the modified MacNab criteria., Results: All patients successfully underwent surgery and the wounds healed by first intention. All 44 patients were followed up 13-46 months with an average of 24.8 months. One patient developed postoperative lower extremity paralysis and 1 patient developed a dural tear. There was no infection, recurrence, or revision surgery during the follow-up. Postoperative imaging showed that the central spinal canal was enlarged and the area of the dural sac was significantly increased compared with preoperative one. The VAS score of low back pain was 2.4±0.6 and 2.5±0.8 at 1 month after operation and at last follow-up, showing no significant difference when compared with preoperative scores ( P >0.05). The VAS of lower limb pain was 2.1±0.6 and 2.0±1.1 at 1 month after operation and at last follow-up, which was significantly improved when compared with preoperative scores ( P <0.05); but no significant difference was found between at 1 month after operation and at last follow-up ( P >0.05). At last follow-up, the ODI score was 19.7±6.4, and the DSCA was (104.93±12.56) mm 2 , which was significantly improved when compared with preoperative values ( P <0.05). The MG classification was also significantly higher than preoperative one ( Z =-5.789, P =0.000). According to the modified MacNab criteria, the results were excellent in 32 cases, good in 9 cases, and fair in 3 cases, with an excellent and good rate of 93.2%., Conclusion: Percutaneous endoscopic transforaminal bilateral decompression for treating severe central lumbar spinal stenosis has the advantages of less trauma, adequate decompression, and rapid recovery. The short-term effectiveness is good.

People's understanding of lumbar spinal stenosis has become more and more comprehensive and reasonable, however, there are still many controversies about the concepts of "central lumbar canal" and "lateral lumbar spinal canal", and there is no unified standard at present. In this paper, we redefine and differentiate the two concepts. We believe that some kinds of central canal stenosis caused by bilateral recess stenosis can be completely solved by bilateral percutaneous endoscopic transforaminal discectomy. At the same time, the concept of "lumbar lateral recess" is ambiguous. We redefine it as "lateral lumbar spinal canal" and propose "West China Hospital classification" to guide surgical decision-making, which has been widely recognized and applied.

Objective: To manufacture fish swim bladder membrane material by crosslinking techniques, and to explore its physical and chemical properties and cytotoxicity., Methods: After decellularization, the swim bladders were randomly divided into two groups. The swim bladders were treated with 1-ethyl-3-(3-dimethylaminopropyl) carbodiimide (EDC)/N-hydroxysuccinimide (NHS) crosslinking method, surface hole making, and freeze-drying in crosslinking group, and only surface hole making and freeze-drying in non-crosslinking group. The physical and chemical properties of the materials were observed, including microstructure by scanning electron microscopy (SEM), mechanical properties (tensile strength and breaking elongation) by universal tensile machine, hydrophilicity by contact angle measuring instrument, porosity by ethanol infiltration method, degradation performance in vitro and thermal stability test, and the components of materials by infrared spectrum analysis. Mouse fibroblasts (L929) were cultured with the extracts of two groups of materials in order to determine the cytotoxicity of materials by using cell counting kit 8 (CCK-8) method., Results: The porous structure and rough surface of materials were observed by SEM. Compared with the non-crosslinking group, the tensile stress of the crosslinking group was higher, the breaking elongation was lower, and the porosity increased, showing significant differences ( P <0.05). There was no significant difference in contact angle between the two groups ( P >0.05). The degradation was faster within the first 7 days and then tended to be smooth in the two groups. But the degradation rates of crosslinking group were significantly lower than those of non-crosslinking group ( P <0.05). Differential scanning calorimeter showed that the denaturation temperature of the crosslinking group was (75.2±1.3)℃, which was significantly higher than that of the non-crosslinking group [(68.5±0.4)℃] ( t =4.586, P =0.002). Compared with the non-crosslinking group, the crosslinking group produced new C=O bond and N-H bond, and no other new groups were introduced into the cross-linking group. CCK-8 method showed that the absorbance values of the crosslinking group and the non-crosslinking group were not significant when compared with the positive control group ( P >0.05)., Conclusion: The fish swim bladder membrane obtained by crosslinking treatment with EDC/NHS method has good physical and chemical properties, no cytotoxicity, and is expected to be used as a dura mater repair material.

Objective: To evaluate the short-term effectiveness of percutaneous endoscopic lumbar discectomy (PELD) in treatment of buttock pain associated with lumbar disc herniation., Methods: Between June 2015 and May 2016, 36 patients with buttock pain associated with lumbar disc herniation were treated with PELD. Of 36 cases, 26 were male and 10 were female, aged from 18 to 76 years (mean, 35.6 years). The disease duration ranged from 3 months to 10 years (mean, 14 months). The location of the pain was buttock in 2 cases, buttock and thigh in 6 cases, buttock and the ipsilateral lower extremity in 28 cases. Thirty-four patients had single-level lumbar disc herniation, and the involved segments were L 4, 5 in 15 cases and L 5 , S 1 in 19 cases; 2 cases had lumbar disc herniation at both L 4, 5 and L 5 , S 1 . The preoperative visual analogue scale (VAS) score of buttock pain was 6.1±1.3. VAS score was used to evaluate the degree of buttock pain at 1 month, 3 months, 6 months, and last follow-up postoperatively. The clinical outcome was assessed by the modified MacNab criteria at last follow-up., Results: All patients were successfully operated and the operation time was 27-91 minutes (mean, 51 minutes). There was no nerve root injury, dural tear, hematoma formation, or other serious complications. The hospitalization time was 3-8 days (mean, 5.3 days). All incisions healed well and no infection occurred. Patients were followed up 12-24 months (median, 16 months). MRI examination results showed that the dural sac and nerve root compression were sufficiently relieved at 3 months after operation. Patients obtained pain relief after operation. The postoperative VAS scores of buttock pain at 1 month, 3 months, 6 months, and last follow-up were 1.1±0.6, 0.9±0.3, 1.0±0.3, and 0.9±0.4 respectively, showing significant differences when compared with preoperative VAS scores ( P <0.05); there was no significant difference in VAS score between the different time points after operation ( P >0.05). At last follow-up, according to the modifed MacNab criteria, the results were excellent in 27 cases, good in 9 cases, and fair in 2 cases, and the excellent and good rate was 94.4%., Conclusion: PELD can achieve satisfactory short-term results in the treatment of buttock pain associated with lumbar disc herniation and it is a safe and effective minimally invasive surgical technique.

Objective: To analyze the treatment of Gartland type Ⅱ and Ⅲ supracondylar fracture of the humerus in children., Methods: Between January 2015 and January 2017, 45 cases of Gartland type Ⅱ and Ⅲ supracondylar fracture of the humerus were treated. There were 28 boys and 17 girls with an age of 1-13 years (mean, 5.7 years). The causes of injury included sports injury in 43 cases and falling from height in 2 cases. Fractures were classified as type Ⅱ in 12 cases and type Ⅲ in 33 cases according to Gartland classification. The time from injury to operation was 2-12 hours (mean, 4.6 hours). All fractures were treated with closed reduction first, and 12 cases of Gartland type Ⅱ fracture were successful in closed reduction; 20 cases of Gartland type Ⅲ fracture were successful in closed reduction, 11 cases with reduction failure and 2 cases with radial nerve injury underwent assisted anterior transverse approach reduction. Then percutaneous crossed Kirschner wires fixation was performed., Results: The operation time was 16-52 minutes (mean, 32 minutes). The perspective frequency was 4-17 times (mean, 6.7 times). The hospitalization time was 3-7 days (mean, 4 days). All the 45 cases were followed up 8-20 months (mean, 12 months). The ulnar nerve paralysis occurred in 3 cases of Gartland type Ⅲ fracture that were treated with closed reduction, and recovered after 1-3 months. All fractures healed after operation, and the healing time was 2-3 months. No incision infection, Volkmann muscle contracture, and other complications occurred. The elbow joint function score at 6 months after operation showed that the results of closed reduction was excellent in 16 cases, good in 12 cases, and fair in 4 cases, with the excellent and good rate of 87.5%; in which Gartland type Ⅱ fracture was excellent in 9 cases and good in 3 cases, with an excellent and good rate of 100%, and Gartland Ⅲ was excellent in 7 cases, good in 9 cases, and fair in 4 cases with an excellent and good rate of 80%. The results of assisted anterior transverse approach reduction was excellent in 7 cases, good in 5 cases, and fair in 1 case, and the excellent and good rate was 92.3%., Conclusion: Gartland type Ⅱ and Ⅲ supracondylar fractures of the humerus can be treated with closed reduction or combined with the assisted anterior transverse approach reduction, then fixed by percutaneous crossed Kirschner wire, which is operational, smaller invasive, and less radiation exposure during operation, while postoperative function is good.

Objective: To investigate the feasibility, effectiveness, and security of percutaneous endoscopic spine surgery for treatment of lumbar spine disorders with intraspinal ossification., Methods: Between July 2008 and June 2016, 96 patients with lumbar spine disorders (lumbar disc herniation or lumbar spinal stenosis) with intraspinal ossification were treated with percutaneous endoscopic spine surgery. There were 59 males and 37 females, aged from 13 to 57 years (mean, 29.5 years). The disease duration was 3-51 months (mean, 18.2 months). Fifty-one cases had trauma history. Ninety-two cases were single segmental unilateral symptom, 4 cases were bilateral symptom. The ossification property was posterior ring apophysis separation in 89 cases, and ossification of the fibrous ring or posterior longitudinal ligament in 7 cases. There were 32 cases of lateral type, 13 cases of central type, and 51 cases of mixed type. The pressure factors, such as nucleus pulposus, hyperplasia of the yellow ligament, joint capsule, or articular osteophyma, were removed under the microscope. Local anesthesia or continuous epidural anesthesia was performed in the transforaminal approach with 50 cases, and continuous epidural anesthesia or general anesthesia was performed in the interlaminar approach with 46 cases. The visual analogue scale (VAS) score was used to evaluate the degree of leg pain preoperatively and at last follow-up. The effectiveness was evaluated at last follow-up according to the modified Macnab criteria., Results: All patients were successfully operated. Via transforaminal approach, the mean operation time was 53 minutes and the mean intraoperative fluoroscopy times was 8 times; and via interlaminar approach was 58 minutes and 3 times, respectively. The mean bed rest time after operation was 6.5 hours and the mean hospitalization time was 4.7 days. All patients were followed up 6-18 months (median, 11 months). Postoperative lumbar CT scan and three-dimensional reconstruction after 3 days of operation showed that ossification tissues of 26 cases were not resected, 12 cases were resected partly, and 49 cases were resected completely. Postoperative lumbar MRI after 3 months of operation showed that spinal cord and nerve root were not compressed. At last follow-up, VAS score of leg pain was 0.7±1.1, which was significantly lower than preoperative score (5.8±1.1) ( t =1.987, P =0.025). At last follow-up, according to modified Macnab criteria, the results were excellent in 87 cases, good in 5 cases, and fair in 4 cases, and the excellent and good rate was 95.8%., Conclusion: Percutaneous endoscopic spine surgery for treatment of lumbar spine disorders with intraspinal ossification is an effective, safe, and minimal invasive alternative, and the short-term effectiveness is reliable. Accounting for the treatment of intraspinal ossification, comprehensive analysis should be made by combining clinical symptoms, imaging characteristics, and risk assessment.

Objective: To discuss the effectiveness and the safety of accurate decompression via foraminoplasty in treating lumbar lateral recess stenosis patients who accompanied by disk-flavum ligamentum space and bony lateral recess stenosis, and to analysis the short-term effectiveness of the surgical procedures., Methods: Forty-five lumbar lateral recess stenosis patients accompanied by disk-flavum ligamentum space and bony lateral recess stenosis were treated by accurate decompression via foraminoplasty between January 2013 and January 2016. There were 29 males and 16 females with a median age of 58 years (range, 42-82 years). The disease duration was 3-96 months (mean, 24.4 months). The lesion segment included L 4, 5 in 36 cases and L 5 , S 1 in 9 cases. The visual analogue scale (VAS) score of low back pain and leg pain at preoperation and last follow-up were recorded, and the modified Macnab criteria was used to evaluate the effectiveness at last follow-up. Postoperative CT and MRI were reviewed to evaluate the stability and decompression of the lumbar spine., Results: All operations were successfully completed. All the 45 patients were followed up 3-18 months (median, 11 months). Dural tear occurred in 2 cases during operation, bone graft removed into the spinal canal in 1 case, postoperative low back pain occurred in 5 cases, and there was no nerve root injury, hematoma formation, or other complications. The leg pain VAS score at last follow-up (0.6±1.2) was significantly improved when compared with preoperative score (5.7±1.4) ( t =8.981, P =0.001); and the low back pain VAS scores showed no significant difference between preoperation and last follow-up (1.5±1.3 vs. 1.7±1.4; t =0.535, P =0.585). According to the modified Macnab criteria, the results were excellent in 20 cases, good in 22 cases, fair in 2 cases, and poor in 1 case at last follow-up, and the excellent and good rate was 93.3%., Conclusion: Accurate decompression via foraminoplasty is an effective, safe, and less invasive way for treating lumbar recess stenosis patients accompanied by disk-flavum ligamentum space and bony lateral recess stenosis.

Objective: To observe the character of spino-pelvic sagittal alignment in patients with high-grade L5 isthmic spondylolisthesis, and to analyze the sagittal alignment alteration after operation., Methods: Between January 2009 and June 2014, 25 patients with high-grade L5 isthmic spondylolisthesis underwent posterior surgery, and the clinical data were retrospectively analyzed as study group. There were 14 males and 11 females with a mean age of 42.5 years (range, 20-65 years). The mean disease duration was 6 months (range, 3-12 months). According to the Meyerding evaluating system, 15 cases were rated as degree III, and 10 cases as degree IV. Eighty healthy adult volunteers were recruited simultaneously as control group. The lumbar sacral angle (LSA), pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS), lumbar lordosis (LL), thoracic kyphosis (TK), and sagittal vertical axis (SVA) were measured on preoperative and last follow-up standing full length lateral X-ray films. And these parameters were compared between study group (preoperative parameters) and control group. Then the patients in study group were divided into 2 subgroups according to Hresko's method: the balanced pelvis subgroup (n = 14) and unbalanced pelvis subgroup (n = 11). The sagittal parameters were compared between 2 subgroups, and the alteration of sagittal parameters before surgery and at last follow-up was analyzed in each subgroup respectively., Results: All patients in study group were followed up 18 months on average (range, 6-48 months). After surgery, spondylolisthesis was reduced from degree III to degree 0 in 12 cases and to degree I in 3 cases, and from degree IV to degree 0 in 6 cases and to degree I in 4 cases. Bone fusion was obtained in all patients at last follow-up. The preoperative PI, SS, PT, and SVA of study group were significantly greater than those of control group (P < 0.05), while the TK was significantly smaller than that of control group (P < 0.05). In the balanced pelvis subgroup, LSA, LL, and SVA at last follow-up significantly decreased while TK significantly increased when compared with preoperative ones (P < 0.05). In the unbalanced pelvis subgroup, LSA, PT, and SVA at last follow-up significantly decreased while SS, LL, and TK significantly increased when compared with preoperative ones (P < 0.05). The preoperative LSA and PT in the unbalanced pelvis subgroup were significantly greater, while SS, LL, and TK were significantly smaller than those of balanced pelvis subgroup (P < 0.05); while at last follow-up, significant differentce was found only in LSA between 2 subgroups (P < 0.05)., Conclusion: The LSA should be paid more attention in surgery to assure recovery of the sagittal balance because patients with high-grade L5 isthmic spondylolisthesis have greater PI, abnormal lumbosacral kyphosis, and sagittal imbalance.

Objective: To investigate whether miR-93-5p suppresses osteogenic differentiation of mouse mesenchymal stem cells (C3H10T1/2) by targeting Smad5, a predicted target in silicon., Methods: Smad5 3'-UTR-luciferase vector (pmiR-RB-REPORT) was constructed and dual-luciferase reporter gene assay was employed to examine the effect of miR-93-5p on Smad5 3'-UTR-luciferase activity to identify whether Smad5 was the target gene of miR-93-5p. miR-93-5p mimics (group M), miR-93-5p inhibitor (group In), miR-93-5p mimics negative control (group MC), and miR-93-5p inhibitor negative control (group InC) were transfected into the C3H10T1/2 cells, respectively, and followed by induction of osteogenic differentiation. After 48 hours, the real-time fluorescent quantitative PCR (qRT-PCR) and Western blot assays were performed to detect the relative expressions of Smad5 mRNA and protein. At 14 days, to realize the regulation role of miR-93-5p in osteogenic differentiation, the extracellular calcium deposition during the osteogenesis of C3H10T1/2 cells was tested by Alizarin red staining., Results: Dual-luciferase reporter gene assay showed that miR-93-5p could combine with Smad5 mRNA 3'-UTR specificity, and inhibited its luciferase activity (P < 0.05). After 48 hours, no significant difference was shown in the relative expression of Smad5 mRNA between group M and group MC as well as between group In and group InC by qRT-PCR assay (P > 0.05); however, the results of Western blot assay showed that the relative expression of Smad5 protein was significantly decreased in group M and increased in group In when compared with groups MC and InC (P < 0.05). At 14 days after osteogenic induction, Alizarin red staining showed that the extracellular calcium deposition of group M was obviously less than that of group MC, and it was obviously more in group In than in group InC., Conclusion: Smad5 may be the target gene of miR-93-5p. And miR-93-5p can suppress osteogenic differentiation of C3H10T1/2 cells by directly targeting Smad5.

Objective: To evaluate the mid-term effectiveness of nano-hydroxyapatite/polyamide66 (n-HA/PA66) cage in the anterior spinal reconstruction., Methods: There were 177 patients who undergone the anterior decompression and fusion with n-HA/PA66 cage and internal fixation between January 2008 and January 2010 included in this study. There were 117 male and 60 female patients aged from 18 to 74 years. The diagnoses included cervical fracture in 47 patients, thoracic or lumbar fracture in 50 patients, cervical spondylopathy in 58 patients, spinal tuberculosis in 17 patients and spinal tumor in 5 patients. The X-ray and three-dimensional CT were followed up in all these patients to observe the spinal alignment, the rate of fusion and the rate of n-HA/PA66 cage subsidence and translocation. The neurological functions of patients with spinal fracture were evaluated by Frankel grading; the improvement of the clinical symptoms of the other patients were assessed by visual analogue scale (VAS) scores and Japan Orthopaedic Association (JOA) scores or SF-36 scores., Results: All the 177 patients had been followed-up for 36 to 70 months after surgery (average 51 months). Except the slight cage translocation been found in the only one patient with cervical fracture, no cage prolapsed or breakage was exist in our patients up to the last follow-up. In the patients with spinal fracture, the mean time for fusion was 4.5 months, the rate of fusion was 95.9% and the rate of cage subsidence was 5.2%; while in the patients with cervical spondylopathy, the mean time for fusion was 4.4 months, the fusion rate was 96.5% and the subsidence rate was 5.2%; while in patients with spinal tuberculosis, the mean fusion time was 5.5 months, the rate of fusion was 94.0%, the rate of subsidence was 5.9%; and in the patients with tumor, the mean time for fusion was 6.0 months, the fusion rate was 100%, and the cage subsidence was found in only one patient. The preoperative symptoms of each patient were improved to varying degrees after surgery. At the last follow-up, the Frankel grading of patients of spinal fracture with incomplete paralysis improved 0 to 2 classes; the VAS, JOA or SF-36 scores of the other patients were improved significantly than their respective scores before surgery (t = 2.982, 4.126 and 3.980, P < 0.05)., Conclusions: The n-HA/PA66 cage has much higher rate of osseous fusion and lower cage subsidence, it is an ideal cage which can provide effective restoring and maintaining for the spinal alignment and intervertebral height. Moreover, the mid-term clinical results of anterior reconstruction with this cage in the patients with spinal trauma, degeneration, tuberculosis or tumor are well content.

Objective: To determine the surgical indications for posterior expansive open-door laminoplasty (EOLP) extended to the C1 level., Methods: Seventeen patients undergoing C3-7 or C2-7 open-door laminoplasty were included as the case group between September 2005 and January 2010, whose spinal cord injury symptoms were not alleviated or aggravated again because of the cervical stenosis at C-4 level, and the causes of the surgery itself were eliminated, all of these patients underwent reoperation with decompress upward to C1 level. Fifteen patients with cervical stenosis who underwent C2-7 laminoplasty and C1 laminectomy were selected as the control group. There was no significant difference in gender, age, and disease duration between 2 groups (P > 0.05). The pre- and post-operative cervical curvature and spinal cord compression were evaluated according to the patients' imaging data; the pre- and post-operative neurological recovery situation was evaluated by Japanese Orthopaedic Association (JOA) 17 score and spinal cord function Frankel grade; the neurological recovery rate (according to Hirabayashi et al. method) was used to assess the postoperative neurological recovery situation., Results: In the case group, 8 patients underwent primary C37 laminoplasty. In 3 of these patients, there was a cervical stenosis at C1, 2 level, and discontinuous cerebrospinal fluid around the spinal cord was observed; 5 of them with a compression mass which diameter was exceed 7.0 mm in the C2-4 segments. The remaining 9 patients in the case group underwent primary C2-7 laminoplasty, and the diameter of the compression mass was exceed 7.0 mm in the C2-4 segments. In all 17 patients of the case group, reoperation was performed with the decompression range extended to the C1 level, and the follow-up time was 35-61 months with an average of 45.6 months. Cervical curvature: there were 11 cases of cervical lordosis, 4 cases of straight spine, and 2 cases of cervical kyphosis before operation; but after operation, 2 cases of cervical lordosis became straight spine and 1 straight case became kyphosis. The postoperative neurological improvement was excellent in 8 cases, good in 7, and fair in 2. In the control group, all the patients had a compression mass which anteroposterior diameter was exceed 7.0 mm in the C2-4 segments before operation. The follow-up time was 30-58 months with an average of 38.7 months. Cervical curvature: there were 13 cases of cervical lordosis and 2 cases of straight spine before operation; but after operation, 1 case of cervical lordosis became straight spine. The postoperative neurological improvement was excellent in 8 cases, good in 6, and fair in 1. No significant difference was found in the JOA score at pre- and post-operation between 2 groups (P > 0.05); however, there were significant differences (P < 0.05) in the JOA score between at last follow-up and at preoperation., Conclusion: The initially surgical indications which can be used as a reference for EOLP extended to C1 are as follows: (1) Upper cervical (C1, 2) spinal stenosis: C1 posterior arch above the lower edge part of cerebrospinal fluid around the spinal cord signal is not continuous, and the anteroposterior diameter of the spinal canal actual is less than 8.0 mm as judgment standard. (2) There is a huge compression at the lower edge of C2-4 vertebrae, and the most prominent part of the diameter is exceed 7.0 mm, which can not be removed through the anterior cervical surgery, or the operation is high-risk.

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 alpha1/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.

This paper is aimed to investigate the feasibility of applying the small intestine submucosa (SIS) as the scaffold in constructing tissue engineering cartilage in vitro. We obtained SIS from the small intestine of specific pathogen-free pigs. Then we isolated tunica submucosa layer from the mucosal, muscular, and serosal layers by gentle mechanic abrasion. The SIS was made acellular by combination of detergent and enzyme digestion. The chondrocytes were seeded onto the SIS and were cultured for 3 weeks. The cell growth, attachment and distribution were detected by histochemical stain, immunohistochemical stain and scan electron microscope. The chondrocytes could adhere and grow well on the matrix surface, and synthesize a large of the GAG and type U collagen. However, the chondrocytes grew only on the surface andsuperficial layer of the scaffold, they did not move into the inner part of the scaffold. It could be concluded that SIS has good cellular compatibility without cytotoxicity and provides temporary substrate to which these anchorage-dependent cells can adhere, and stimulate the chondrocytes anchored on the scaffold to proliferate and keep differentiated phenotype. Further study will be needed to promote the ability of chondrocyte chemotaxis in order to distribute the chondrocytes into the whole scaffold uniformly.

Objective: To summarize the basic research and the clinical application of biodegradable interbody fusion Cage., Methods: Recent literature concerning biodegradable interbody fusion Cage at home and abroad was extensively reviewed, and current developments of the basic research and the clinical application of biodegradable interbody fusion Cage were investigated., Results: Basic research shows that the stiffness of biodegradable interbody fusion Cage is lower than that of metallic Cage, so it can enhance interbody fusion. As interbody fusion proceeded, biodegradable interbody fusion Cage degrades constantly, but the speed of degradation can not keep in parallel with that of fusion. In addition, the tissue response to degradation products is controversy. Clinical application shows that the biodegradable interbody fusion Cage can enhance interbody fusion and maintain disc space height. The short-term results are good, however, the long-term results need further observation., Conclusion: Biodegradable interbody fusion Cage can effectively enhance interbody fusion.

Objective: To review present situation and progress in clinically treating floating shoulder injury., Methods: Recent literature concerned treatment of floating shoulder injury was reviewed and analyzed in terms of anatomy, pathogenesis, diagnosis, and treatment., Results: Conservative treatment and operative treatment can get good outcome. But the value of the results was limited, because different evaluation criteria were used in the literature., Conclusion: There is no uniform standards about the treatment of the floating shoulder injury. Both conservative treatment and operative treatment have advantages and disadvantages, which method will be used to treat the floating shoulder injury based on local damage and the patient's general condition.

Objective: To evaluate pulmonary function changes in patients with severe scoliosis undergoing anterior release, posterior segmental fixation and fusion, and convex thoracoplasty by resecting a short length of rib., Methods: From January 2006 to July 2007, 16 patients with severe scoliosis were treated with anterior release, posterior segmental fixation and fusion, and convex thoracoplasty by resecting a short length of rib. There were 6 males and 10 females with an average age of 16.9 years (range, 10-24 years). There were 1 case of Lenke 1 curve, 9 cases of Lenke 2 curve, and 6 cases of Lenke 4 curve. The preoperative Cobb angle was (104.8 +/- 10.9) degrees and the preoperative thoracic kyphotic angle was (30.0 +/- 4.2) degrees. The preoperative height of "razor back" deformity was (5.9 +/- 1.2) cm. Before operation, the actual value of forced vital capacity (FVC) was (2.04 +/- 0.63) L and that of forced expiratory volume in 1 second (FEV1.0) was (1.72 +/- 0.62) L. The percentage of actual values to expected ones in FVC was 70% +/- 16%, and that in FEV1.0 was 67% +/- 15%. All patients had pulmonary function tests before operation and 3, 6, 12, 24 months after operation., Results: All wounds healed by first intention. The Cobb angle at 24-month follow-up was (53.4 +/- 18.6) degrees and the correction rate was 49.0% +/- 15.3%. The thoracic kyphotic angle at 24-month follow-up was (34.0 +/- 2.4) degrees and the correction rate was 13.3% +/- 2.2%. The height of "razor back" deformity at 24-month follow-up was (2.2 +/- 0.8) cm. Compared with preoperative level, all these data showed significant differences (P < 0.05). At 3 and 6 months, the actual values of FVC and FEV1.0 declined, but no significant difference was found (P > 0.05). At 12 and 24 months, the actual values of FVC and FEV1.0 were close to the preoperative level (P > 0.05). The percentages of actual values to expected ones in FVC and FEV1.0 indicate continued improvement in pulmonary function from the postoperative 3 to 24 months follow-up. Compared with preoperative level, the percentages of actual values in FVC declined 19% 3 months postoperatively (P < 0.05) and 12% 6 months postoperatively (P < 0.05). The percentages of actual values to expected ones in FEV1.0 declined 16% 3 months postoperatively (P < 0.05), and 10% 6 months postoperatively (P < 0.05). The percentages of actual values to expected ones in FVC and FEV1.0 were close to the preoperative level 12 and 24 months after operation (P > 0.05)., Conclusion: In severe scoliosis patients who are treated with anterior release, posterior segmental fixation and fusion, and convex thoracoplasty by resecting a short length of rib, pulmonary function decreases obviously 3-6 months after operation. And it returns to the operative baseline 12-24 months after operation.

Objective: To evaluate the effect of minimally invasive dynamic hip screws (MIDHS) in treating aged intertrochanteric fractures., Methods: From April 2006 to March 2008, 49 aged patients with intertrochanteric fractures were treated with MIDHS. There were 22 males and 27 females, aged 65-78 years (average 70.2 years). Fracture was caused by traffic accident in 7 cases, by falling from height in 3 cases, and by injury from fall in 39 cases. The time from injury to operation was 2-12 days (average 5.5 days). According to Evans classification, there were 28 cases of types I, II (stable fracture) and 21 cases of types III, IV (unstable fracture). If the Singh index 3 was defined as osteoporosis, the osteoporotic rate was 71.4% (35/49). All patients were on a radiolucent fracture traction table and their fractures had satisfactory closed reduction. After the guide wire was inserted and reamed under fluoroscopy, the lag screw and side plate were introduced through the small incision. In all unstable fractures, an additional, antirotational and large cancellous bone screw was used cranial to the DHS., Results: The average operation time was 65.2 minutes. The average blood loss was 189.3 mL. All patients had satisfactory reduction and 79.6% (39/49) had adequate lag screw positions. The average postoperative hospitalization days was 5.8 days (3-12 days). All incision healed at stage I. There was no postoperative complications. Forty-nine patients were followed up 12 to 30 months (average 19.8 months). Fractures healed within 16 weeks in 47 patients and the average healing time was 13.1 weeks (12-16 weeks). The average Harris scoring was 90.8 (75-95). Implant failure and nonunion occurred in 2 cases, no serious complication occurred in other patients., Conclusion: The MIDHS is a simple, safe and effective method for treatment of aged intertrochanteric fractures.

Objective: To analyze the spinal injury in Wenchuan earthquake and to investigate its clinical features., Methods: Data of 146 patients in Wenchuan earthquake with spinal injuries (79 males, 67 females; aged 11-88 years old, average 51 years old) were collected and analyzed epidemiologically. Two patients under 16 years of age, 15 patients with the fractures of spinous process, transverse process or vertebra lamina, 1 patient with spinal fractures of type A2 according to AO classification but no corresponding type in Denis classification, and 9 patients with upper cervical injuries were excluded. The remaining 119 patients were divided into two groups according to their age: group A in which 78 patients were under 60 years of age, including 40 males and 38 females aged 18-58 years old (average 41 years old), and group B in which 41 patients were 60 years of age or above, including 24 males and 17 females aged 60-88 years old (average 71 years old). Analyses for the two groups were compared., Results: The leading causes of spinal injuries were fall from high places (27.40%) and crush by heavy objects (67.81%). According to Denis classification, the major types of spinal injuries were burst fracture (54.62%) and compression fracture (33.61%). Serious nerve injury, defined as grade A, B and C in ASIA neurological function assessment, occurred in 31.51% of patients. The most common injured site was in thoracic or lumbar vertebrae (78.77%), and 52.74% of patients had combined injuries, among which the fractures of limb (30.14%) and rib (19.86%) were the most common. Multi-level spinal fractures happened to 22.60% of patients. Comparative analysis revealed the rate of injury caused by fall from high places in group A (34.62%) was much higher than that in group B (12.20%). The commonest type of fracture in group A was burst fracture (58.97%), and it was compression fracture in group B (48.78%). The rate of serious nerve injury in group B (24.39%) was much lower than that in group A (44.87%). The rate of combined injury and multilevel vertebral body injury in group B was 70.73% and 39.02%, respectively, which was much higher than that in group A (combined injury 43.59%; multilevel vertebral body injury 21.79%). There were significant differences between two groups in all the indicators derived from clinical data (P < 0.05)., Conclusion: In Wenchuan earthquake, the leading causes of spinal injuries are fall from high places and crush by heavy objects, the major types of fracture are compression fracture and burst fracture, and the occurrence rates of spinal injury, combined injury and multilevel vertebral body injury are high.

Objective: To explore the relationship of the limited resource of the autologous bone marrow mesenchymal stem cells (MSCs) in articular cavity to the treatment results of full-thickness articular cartilage defect, and to investigate whether the extrogenous sodium hyaluronate (SH) promotes the migration of MSCs cultured in vitro to the articular defect in vivo., Methods: Sixty-six Japan rabbits were made the model of the full-thickness articular cartilage defect (5 mm width and 4 mm depth). The autologous MSCs were extracted from the rabbit femur, cultured in vitro, labeled by Brdu, and injected into the injured articular cavity with or without SH. The experiment was divided into 4 groups; group A (MSCs and SH, n=15); group B (MSCs, n=15); group C (SH, n=18); and group D (non-treatment, n=18). The morphologic observation was made by HE staining, Mallory staining and immunohistochemical staining after 5 weeks, 8 weeks and 12 weeks of operation., Results: There were significant differences in the thickness of repairing tissue between group A and group B (P<0.01); but there were no significant differences between group A and group C, and between group B and group D (P>0.05). The histological observation showed that the main repairing tissue was fibrocartilage in group A and fiber tissue in group B., Conclusion: MSCs cultured in vitro and injected into the articular cavity can not improve the treatment results of the articular cartilage defect. Extrogenous SH has effect on repairing cartilage defect. The extrogenous SH has no effect on the chemotaxis of the MSCs, and on the collection of MSCs into the joint defect.