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It remains controversial whether degenerative posterior longitudinal ligaments should be removed during anterior decompression procedures for cervical spondylotic myelopathy. Few data are available from studies that have compared removing and retaining the degenerative posterior longitudinal ligament. The goal of this retrospective study was to evaluate the benefit of degenerative posterior longitudinal ligament removal during such operations. Clinical data on 130 patients with confirmed degenerative posterior longitudinal ligament who underwent anterior cervical decompression surgery were retrospectively reviewed. All procedures were performed by the same senior orthopedic surgeon at the authors’ spinal surgery center. The degenerative posterior longitudinal ligament was removed in 62 patients (group A) and retained in 68 patients (group B). The 130 patients were followed for 36 months. The Japanese Orthopedic Association score improved from 9.0±2.7 to 14.7±1.5 in group A and from 9.4±2.6 to 14.1±1.7 in group B ( P =.028). The recovery rate for spinal cord neurologic function was 66.7% in group A and 61.3% in group B ( P =.031). Operating time was longer ( P =.002) and the sagittal median diameter of the vertebral canal was enhanced in group A ( P P =.044). No significant difference was found in the rates of common complications between groups. Removal of the degenerative posterior longitudinal ligament in anterior decompression procedures for cervical spondylotic myelopathy appeared to be beneficial and provided more complete decompression and better postoperative outcomes than surgery without removal of the ligament. Although this procedure was generally safe, it required longer operating times, was more technically challenging, and required more experienced surgeons than surgery without removal of the ligament. [ Orthopedics . 2015; 38(1):e54–e61.]

With the increasing advocacy for total disc replacement (TDR) as a potential alternative to fusion in the management of lumbar degenerative disc disease, intradiscal pressures (IDPs) and facet joint stresses at the adjacent levels of spine have generated considerable interest. The purpose of this study was to compare adjacent-level IDPs and facet joint stresses among TDR, discectomy, and fusion.Ten fresh human cadaveric lumbar specimens (L2-S1) were subjected to an unconstrained load in axial torsion, lateral bending, flexion, and extension by using multidirectional flexibility test. Four surgical treatment modes-control (disc intact), discectomy, TDR, and fusion-were tested in sequential order at L4-5. During testing, the IDPs and facet forces following each treatment were calculated at the adjacent vertebral levels (L3-4 and L5-S1).Intradiscal pressures and facet force pressures were similar between the intact condition and the TDR reconstruction at the L3-4 and L5-S1 levels under all loading conditions (p0.05). Compared with the intact and TDR groups, the discectomy and fusion groups had higher IDPs at the L3-4 and L5-S1 levels under all loading conditions (p0.05). No significant difference in the facet force pressure was noted among the intact, discectomy, and TDR groups at the L3-4 and L5-S1 levels under any loading conditions (p0.05). However, the facet force pressure produced for fusion was significantly higher than the mean values obtained for the intact, discectomy, and TDR groups at the L3-4 and L5-S1 levels under all loading conditions (p0.05).Lumbar TDR maintained adjacent-level IDPs and facet force pressures near the values for intact spines, whereas adjacent-level IDPs tended to increase after discectomy or fusion and facet forces tended to increase after fusion.

To evaluate the influence of perioperative nutritional support on nutritional status of patients with thoracolumbar spinal tuberculosis.Forty-eight patients with thoracolumbar spinal tuberculosis (male 25 and female 23, aged from 35 to 60 years, with an average of 48.25 years) were randomized into two groups. Twenty-four patients nutritional support were increased intravenously for 14 days (7 days before and after operation) in experimental group. Twenty-four patients in control group were supplied with routine diet. The body weight, plasma concentrations of albumin and ESR were detected on the 7th day before operation and on the 7th day after operation. The total wound drainage was recorded and compared.Body weight and plasma concentrations of albumin on the 7th day after operation and those on the 7th day before operation were not significantly different in experimental group (P0.05). In control group, body weight and plasma concentrations of albumin on the 7th day after operation was lower than those on the 7th day before operation (P0.05). The total wound drainage of experimental group was less than that of control group (P0.05). ESR on the 7th day after operation was lower than that on the 7th day before operation in two groups (P0.05); but the decrease of ESR in experimental group was more than that in control group (P0.05).Nutritional support is beneficial to alleviating innutrition caused by tubercle bacillus and operation. It can promote the effects of operation and anti-tuberculotic drugs.

To evaluate the operative method and the clinical efficacy of volar Barton's fracture treated by internal fixation with T type titanium plate.We performed the operation of the open reduction and internal fixation with T type titanium plate in 18 patients with volar Barton's fracture.The 18 patients were followed up after the operation at the average time of 13 months (6 to 31 months). X radiographs showed that all patients achieved solid bone union. Mehara's evaluation for volar Barton's fracture revealed excellent outcome in 12 patients, good in 5 patients, and fair in 1 patients. The excellent and good rate of clinical results was 94.4%. X-radiographs showed that the volar tilting angle was 8-18 (mean=11.0) degree, and the ulnar inclining angle was 16-26 (mean=22.4) degree. There was no shortening of the radius.The operative treatment with titanium T type plate fixation for volar Barton's fracture is in favor of fracture anatomic reduction, solid internal fixation, and catagmatic concrescence. It is beneficial for functional recovery of the wrist at the utmost. The outcome in the near future is satisfactory. It is an ideal method for volar Barton's fracture.

To analyze the relation between the clinical outcome and the integrity of the facets after a lumbar operation,and to provide a reference for choosing operative method and clinical prognosis.Forty-three patients with complete data underwent uni-segment discectomy were enrolled. There were 3 surgical interventions: open-window discectomy, full or semi-laminectomy. Groups were divided based on the integrity of the facets after the operation, and the clinical symptoms and signs were evaluated using the Japanese Orthopaedic Association Back (JOA) scores at 24-month follow-up.Preoperative JOA scores were not significantly different among the groups (P0.05). Compared with the facet intact group at 24-month follow-up,JOA scores were descended statistically in total uni-facetectomy group and total uni-facetectomy plus partial opposite facetectomy group (P0.01).Keeping facets integrated plays an important role in achieving good clinical results,and the damage of facet should be avoided in the lumbar operation.

To detect the mutations of EXT2 gene in hereditary multiple exostoses (HME) families and to investigate the sensitivity of denaturant gradient gel electrophoresis (DGGE) in screening the mutations in EXT2 gene.Five HME families and 3 sporadic patients were screened for the mutation detection in all exons of EXT2 gene covering the coding sequence and the flanking intronic sequence by DGGE, and DNA sequencing was performed for products with abnormal conformation.Among these HME patients, we found 2 disease-causing mutations: A313T (nonsense mutation) and 319 insGT (frameshift mutation).Two mutations of EXT2 gene are identified in the sample. DGGE can be an ideal choice for gene diagnoses of HME.

To explore the results of repairing widespread defects of traumatic soft tissue in heel by microvascular anastomotic anterolateral thigh flaps.Twenty-six consecutive free anterolateral thigh flaps in 26 patients were transplanted for repairing widespread defects of traumatic soft tissue in heel from October 1997 to March 2005, suturing the descending branch of the lateral circumflex femoral vascular and posterior tibial vascular to reconstruct the blood supply of transplanted flaps, repairing lateral femoral cutaneous nerve to recover their sensation, fixing tensor fasciae in the calcaneum to add their stabilization.All flaps survived completely,the wounds healed in the initial treatment, follow up 3 to 48 months, twenty-six cases achieved partial sensation, good contour and stabilization.The anterolateral thigh flap is an ideal flap for repairing widespread defects of traumatic soft tissue in heel, because it has such advantages as adequate blood supply, big dermatosis area and covert donor site, furthermore, nervi cutaneous femoris lateralis and tensor fasciae offer the good sensation and adequate stabilization.

To detect the changes of mitochondrion DNA (mtDNA) sequence in articular chondrocytes of cartilage affected by osteoarthritis and to clarified the pathogenetic mechanism of osteoarthritis.We analyzed the mtDNA 4,977 bp deletion mutations of articular chondrocytes in 10 patients with osteoarthritis and 3 normal cartilages using the gap-PCR amplification method. We designed a two round PCR detection method, in which total DNA was isolated from articular chondrocytes as the template of the first round PCR reaction and products from the first round were the template in the second round reaction.The results of the first rounds of PCR reaction showed the mtDNA 524 bp amplified products in the osteoarthritis group and in the corresponding peripheral blood samples were not detected, but the 533 bp products were detected. However,the results of the second round reaction revealed that the 524 bp zones were detected in 2 of the 10 osteoarthritis patients and the corresponding peripheral blood samples were not detected. The 533 bp products were detected in all specimens. The mtDNA 524 bp amplified products in all the normal articular chondrocytes and the corresponding peripheral white blood cells contrast were not detected in both rounds PCR.This was the first study to evaluate the mtDNA 4799 bp large fragment deletion mutational accumulation between nt8,470 - nt13,447 of articular chondrocytes in osteoarthritic cartilage. Osteoarthritis may be related to mtDNA mutation of articular chondrocytes.

To evaluate the curative effects of AO clavicular hook plate in the treatment of dislocation of acromioclavicular joint and fracture of distal clavicle.We retrospectively analyzed the clinical data of 39 patients with acromioclavicular joint dislocation or distal clavicle fractures treated with clavicular hook plate: 16 suffered from dislocation of acromioclaviculr joint, 18 suffered from far end collarbone fractures, and 5 patients had both symptoms.The 39 patients were followed up for 12 months averagely. All patients got good reduction and fixation. The acromioclavicular joint subluxation, breakage, and loosening of the clavicular hook plate were not observed. The acromioclavicular joint recovered quickly.AO clavicular hook plate is a good choice for acromioclavicular joint dislocation and distal clavicular fracture.

To explore the curative effect of surgical treatment for lumbar discogenic low back pain.Forty-two patients with lumbar discogenic low back pain were treated with disc excision and lumbar interbody fusion: 12 of them were treated with posterior lumbar interbody fusion (PLIF), 30 with afront lumbar interbody fusion (ALIF). The clinical results were evaluated by pre- and post-operative visual analogue scale (VAS), and the fusion rates of the lumbosacral spine were evaluated by X-ray.The average follow-up period was 18 months, ranging from 6 to 36 months. Low back pain basically disappeared in 11 patients treated with PLIF, with mild back pain in one patient; VAS after the operation decreased significantly in comparison with that preoperatively (P0.01). Low back pain basically disappeared in 28 patients treated with ALIF; VAS after the operation decreased significantly in comparison with that preoperatively (P0.01). The fusion rate was 90% in patients treated with PLIF, and 93% in patients with ALIF.Disc excision and interbody fusion is effective in the treatment of lumbar discogenic low back pain, but the operation indications should be paid attention to.

To retrospectively explore the diagnosis and treatment of postoperative lumbar intervertebral disc infection.Twelve patients who suffered from postoperative lumbar intervertebral disc infection between April 1995 and September 2004 were confirmed doubtlessly by the diagnosis. They were treated with early immobilization combined with early and sufficient antibiotics and adequate corticosteroid. Patients with severe symptoms were managed by percutaneous puncture and washing discectomy such as rising temperature and perivertebral muscle spasm besides nostalgia, and early debridement of all necrotic tissue was done.Six were healed by non-operation and operation in the other 6. All had gotten locomotion with corset after the operation for 6-8 weeks and were followed-up from 6 months to 3 years. They have achieved excellent outcomes.When a postoperative disc space infection occurs, early diagnosis and treatment should be undertaken to achieve excellent outcomes.

To evaluate the clinical outcome of ZEPHIR plate in treating cervical spondylotic myelopathy(CSM).We retrospectively analyzed 18 patients undergoing anterior decompression fusion and internal fixation with ZEPHIR plate. Follow-up period ranged from 3 to 12 months (an average of 9 months). The bone graft fusion rate, rehabilitation of neurological deficits, and the complications of the hardware were observed. We assessed the clinical effect with JOA score.Rehabilitation of neurological deficits were observed in 16 patients, The JOA score after the operation significantly increased than before the operation. The fusion rate was 100%, the intervertebral height were maintained, and no complications related to the plate were found.ZEPHIR plate in the treatment of cervical spondylotic myelopathy may increase the fusion rate of the bone graft significantly with low incidence of complication.

To discuss the clinical properties, operative results of thoracic spinal stenosis and factors correlating with prognosis.From September 1992 to January 2001, 16 patients who suffered from thoracic spinal stenosis caused by degeneration, ossified ligamentum flavum, diffuse idiopathic hyperostosis and trauma, were decompressed by operation. The operative method was selected according to the compressed position of spinal cord. All patients were followed up 6 months to 9 years. The pain severity, ambulatory status and paraplegia index were compared between before operation and after operation. The correlation between prognosis and ages, the length of stenosis and the duration of disease was studied.The results of Wilcoxon Signed Ranks Test show significant difference in pain severity, ambulatory status and paraplegia index between before operation and after operation (P0.01). The results of partial correlation analyzing show that only the duration of disease was correlated with paraplegia index (P0.05).Thoracic spinal stenosis frequently develops in the lower-thoracic segments in middle and old aged men. Decompression by operation early can achieve a good clinical result. Duration of disease affects the prognosis.

To observe the effect of nicotine on the secretion of TNF of human peripheral blood mononuclear cells (PBMC) in vitro, and explore the possible mechanism of the high level of TNF caused by smoking.Twenty-one non-smokers and 19 smokers were studied. The PBMCs isolated from each volunteer's blood sample were distributed to three groups, and cultured for 72 hours in supplemented RMPI 1640 alone or in supplemented RPMI 1640 containing 50 ng.ml-1 nicotine or 500 ng.ml-1 nicotine respectively. The level of TNF in supernate was quantified with the immuno-radioassay, and PBMC proliferation was observed.The level of TNF spontaneously secreted by PBMCs in smokers was significantly higher than that in non-smokers (P0.05). When the concentrations of nicotine were 50 ng.ml-1 and 500 ng.ml-1, the level of TNF increased significantly in non-smokers (P0.05, P0.01). In smokers, the level of TNF significantly increased when the concentration of nicotine was 50 ng.ml-1; however, the level of TNF significantly decreased (P0.05), and the proliferation of PBMCs was inhibited when the concentration of nicotine was 500 ng.ml-1 (P0.05, P0.05). The level of TNF was positively correlated to the multiple of PBMC proliferation (r = 0.93, P0.05). The linear regression equation was Y = 2.913X - 2.955.Nicotine can induce PBMCs to secrete more TNF, and the magnitude of the effect is strongly related to the dosage of nicotine, but a great dose of nicotine will inhibit the production of TNF.