-
[show abstract]
[hide abstract]
ABSTRACT: To investigate the outcome of radical debridement, reconstruction with bone autograft or allograft and plate internal fixation via the anterior approach for the treatment of cervicothoracic tuberculosis.
From Jun. 2000 to Dec. 2010, 20 patients with cervicothoracic tuberculosis were treated by debridement and bone grafting with internal fixation via the anterior approach. They included 17 males and 3 females who ranged in age from 25 to 46 years (mean 38 years). The course of disease ranged from 3 months to 2 years (mean 12 months). The onset of the disease was chronic in all patients, with main complaints of persistent pain, and cervical stiffness and deformity accompanied with low fever,night sweating and pathologic leanness. Preoperative X-ray, CT or MRI showed that the pathologic change occurred in C7-T1 segment in 10 cases, T1 segment in 6 cases, T1-T3 segment in 3 cases,and T2-T3 segment in 1 case. The Cobb angle ranged from 25 degrees to 60 degrees (mean 35 degrees) before surgery. The Frankel classification was as follows: 2 cases at grade A, 4 cases at grade B, 7 cases at grade C, 2 cases at grade D, and 5 cases at grade E. All the patients underwent a standard cervical approach by combined partial median steotomy and transverse steotomy through the synostosis between the manubrium and body of the sternum to expose the lesion adequately. Radical debridement was performed, and then a tricortical iliac crest bone autograft or allograft was placed and secured by internal fixation to reconstruct the spinal column. The change in Cobb angle and fusion of bone grafting were reexamined by X-ray regularly. The clinical symptoms and neurological function were evaluated according to NDI (neck disability index) score and Frankel classification.
There was no injury to blood vessels, spinal cord or recurrent nerve during surgery. All patients were followed-up from 16 to 39 (mean 25) months. The tuberculosis symptoms disappeared after surgery and there was no tuberculosis recurrence,incision infection, sinus formation and internal fixation failure in any of these patients. ESR re-examination recovered normally. Bony fusion was obtained in all patients and internal fixation position was normal at 3 to 6 month postoperatively. The Cobb angle ranged from 10 degrees to 16 degrees (mean 12 degrees) and NDI was reduced from (48.2 +/- 2.9) to (22.5 +/- 3.1) at the final followed-up. Except for 2 patients at grade A showing no recovery preoperatively, the Frankel classification of the other patients raised 1.5 grade on average at the final followed-up, and the nerve function of the spinal cord recovered at different degrees: 2 at grade A, 1 at grade B, 1 at grade C, 3 at grade D, and 13 at grade E.
The anterior approach can provide direct and safe access to the lesion. The decompression effect of the vertebral canal is significant. The structural iliac crest autograft or allograft and anterior instrumentation could work effectively to stabilize the cervicothoracic junction.
Zhongguo gu shang = China journal of orthopaedics and traumatology 04/2012; 25(4):291-4.
-
[show abstract]
[hide abstract]
ABSTRACT: To investigate the effectiveness of radical debridement, reconstruction with bone allograft, and pedicle screw-rod internal fixation via combined anterior and posterior approach in the treatment of lumbosacral tuberculosis.
Between January 2005 and May 2010, 16 patients with lumbosacral tuberculosis were treated. Radical debridement was performed via extraperitoneal approach, then tricortical iliac bone allograft was placed and pedicle screw-rod internal fixation was used to reconstruct the spinal column. There were 12 males and 4 females aged 38-65 years (mean, 48 years). The disease duration ranged from 6 to 24 months (mean, 10 months). The main clinical symptom was persistent pain in lumbosacral area. The involved segments included L4,5 (3 cases), L5, S1 (8 cases), and l-S1 (5 cases). The lumbosacral angle was 18-32 degrees (mean, 22 degrees). The erythrocyte sedimentation rate (ESR) was 15-55 mm/1 hour (mean, 25 mm/1 hour). All the patients were given antituberculosis chemotherapy for 12 months after operation.
The operation time was 120-240 minutes (mean, 180 minutes). The amount of bleeding was 300-600 mL (mean, 420 mL). All wounds healed by first intention, and no relative complication occurred. All 16 cases were followed up 12-24 months (mean, 16 months). No recurrence occurred and ESR recovered to normal. Persistent pain in lumbosacral area and radicular pain in lower extremities disappeared. The X-ray films demonstrated that bony fusion was obtained in all patients at 8-12 months postoperatively. The lumbosacral angle was 16-31 degrees (mean, 21 degrees) at last follow-up.
The extraperitoneal approach can provide direct and safe access to the lesion. The structural iliac bone allograft and posterior instrumentation could reconstruct effectively the stability of the lumbosacral junction.
Zhongguo xiu fu chong jian wai ke za zhi = Zhongguo xiufu chongjian waike zazhi = Chinese journal of reparative and reconstructive surgery 10/2011; 25(10):1176-9.
-
[show abstract]
[hide abstract]
ABSTRACT: Traumatic posterior atlantoaxial dislocation without related fractures of the odontoid process and anterior arch of the atlas is exceedingly rare, with only ten published cases reported so far in English literature. We report on a 44-year-old man with post-traumatic posterior displacement of the atlas with respect to the axis without any associated fractures and neurological deficit caused by a crush injury in earthquake. Radiographs, computed tomography and magnetic resonance imaging revealed posterior displacement of the atlas with the odontoid peg lying anterior and to the right of the anterior arch of the atlas. Partial odontoidectomy and posterior fixation with bone graft were performed in one-stage procedure after several unsuccessful attempts of closed reduction. The patient did not have neurological deterioration after operation.
Archives of Orthopaedic and Trauma Surgery 01/2011; 131(5):681-5. · 1.37 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: To investigate the influence of different transplantation times on the survival and immigration of the bone marrow mesenchymal stem cells (BMSCs) in injured spinal cord by subarachnoid administration, and to evaluate the most optimal subarachnoid administration times for BMSCs.
Eight adult male rats (weighing 120 g) were used to isolate BMSCs that were cultured, purified and labeled with Hoechst 33342 in vitro. Another 75 adult Wistar rats (weighing 220 g) were made the spinal cord injury (SCI) models at T9,10 level according to the improved Allen's method and were randomly divided into 5 groups (groups A, B, C, D, and E, n=15). The labeled BMSCs at 1 x 10(7)/mL 0.1 mL were injected into subarachnoid space of the rats via a catheters under the subarachnoid space in groups A (one time at 1 week), B ( two times at 1 and 3 weeks), C (3 times at 1, 3, and 5 weeks) and D (5 times at 1, 3, 5, 7, and 9 weeks) and 0.2 mL phosphate-buffered saline (PBS) was injected in group E (5 times at 1, 3, 5, 7, and 9 weeks) as blank control. The neurological functions were evaluated using the Basso-Beattie-Bresnahan (BBB) scale 1, 3, 5, 7, 9, and 12 weeks after transplantation. The migration, survival, differentiation, and histomorphological changes of BMSCs were observed by HE, immunohistochemistry, and fluorescence microscopy.
At 3 weeks after injury, there were significant differences in the BBB scores between group E and groups A, B, C, D (P < 0.01), and between groups A, B and groups C, D (P < 0.01). At 7, 9, and 12 weeks, the BBB scores were significantly higher in groups C and D than in groups A and B (P < 0.01), and in group B than in group A (P < 0.01). There were no significant differences in the BBB scores between groups C and D (P > 0.05). The fluorescence microscopy showed that the transplanted BMSCs survived and grew in the injured region at 3 weeks after injury and as time went on, the transplanted cells gradually decreased in group A; in groups B, C, and D, BMSCs count reached the peak values at 5 and 7 weeks and then gradually decreased. At 12 weeks, the survival BMSCs were significantly more in groups C and D than in groups A and B (P < 0.01). HE staining showed that the formation of cavity was observed in each group at 3 weeks after injury and the area of cavity gradually decreased in groups A, B, C, and D. At 12 weeks, the area of cavity was the maximal in groups C and D, moderate in groups A and B, and the maximal in group E. The immunohistochemistry staining indicated that the expression of NF-200 was more intense in groups C and D than in groups A and B. The expression of NF-200-positive fibers was more intense in group C.
Multiple administration of BMSCs promotes the restoration of injured spinal cord and improves neurological functions, and three times for BMSCs transplantation is best.
Zhongguo xiu fu chong jian wai ke za zhi = Zhongguo xiufu chongjian waike zazhi = Chinese journal of reparative and reconstructive surgery 02/2010; 24(2):180-4.
-
[show abstract]
[hide abstract]
ABSTRACT: To investigate tissue engineered spinal cord which was constructed of bone marrow mesenchymal stem cells (BMSCs) seeded on the chitosan-alginate scaffolds bridging the both stumps of hemi-transection spinal cord injury (SCI) in rats to repair the acute SCI.
BMSCs were separated and cultured from adult male SD rat. Chitosan-alginate scaffold was produced via freeze drying, of which the structure was observed by scanning electron microscope (SEM) and the toxicity was determined through leaching liquor test. Tissue engineered spinal cord was constructed by seeding second passage BMSCs on the chitosan-alginate scaffolds (1 x 10(6)/mL) in vitro and its biocompatibility was observed under SEM at 1, 3, and 5 days. Moreover, 40 adult female SD rats were made SCI models by hemi-transecting at T9 level, and were randomly divided into 4 groups (each group, n=10). Tissue engineered spinal cord or chitosan-alginate scaffolds or BMSCs were implanted in groups A, B, and C, respectively. Group D was blank control whose spinal dura mater was sutured directly. After 1, 2, 4, and 6 weeks of surgery, the functional recovery of the hindlimbs was evaluated by the Basso-Beattie-Bresnahan (BBB) locomotor rating score. Other indexes were tested by wheat germ agglutinin-horseradish peroxidase (WGA-HRP) retrograde tracing, HE staining and immunofluorescence staining after 6 weeks of surgery.
Chitosan-alginate scaffold showed three-dimensional porous sponge structure under SEM. The cells adhered to and grew on the surface of scaffold, arranging in a directional manner after 3 days of co-culture. The cytotoxicity of chitosan-alginate scaffold was in grade 0-1. At 2, 4, and 6 weeks after operation, the BBB score was higher in group A than in other groups and was lower in group D than in other groups; showing significant differences (P < 0.05). At 4 and 6 weeks, the BBB score was higher in group B than in group C (P < 0.05). After 6 weeks of operation, WGA-HRP retrograde tracing indicated that there was no regenerated nerve fiber through the both stumps of SCI in each group. HE and immunofluorescence staining revealed that host spinal cord and tissue engineering spinal cord linked much compactly, no scar tissue grew, and a large number of neurofilament 200 (NF-200) positive fibers and neuron specific enolase (NSE) positive cells were detected in the lesioned area in group A. In group B, a small quantity of scar tissue intruded into non-degradative chitosan-alginate scaffold at the lesion area edge, and a few of NSE fluorescence or NF-200 fluorescence was observed at the junctional zone. The both stumps of SCI in group C or group D were filled with a large number of scar tissue, and NSE positive cells or NF-200 positive cells were not detected. Otherwise, there were obviously porosis at the SCI of group D.
The tissue engineered spinal cord constructed by multi-channel chitosan-alginate bioscaffolds and BMSCs would repair the acute SCI of rat. It would be widely applied as the matrix material in the future.
Zhongguo xiu fu chong jian wai ke za zhi = Zhongguo xiufu chongjian waike zazhi = Chinese journal of reparative and reconstructive surgery 02/2010; 24(2):190-6.
-
[show abstract]
[hide abstract]
ABSTRACT: To study the effects of various methods of cryopreservation on the bioactivity of tissue engineered bone.
MSCs were cocultured with partialy deproteinised bone to produce tissue engineered bone. The experiment was divided into A, B, C and D group. Group A: Tissue engineered bone was stored in preservation solution with cryopreservation medium. Group B: Tissue engineered bone was stored in preservation solution without cryopreservation medium. Group C: Tissue engineered bone was stored without cryopreservation. Group D: MSCs were cultured without cryopreservation. The tissue engineered bone of group A and B had been cryopreserved at -80 degrees C for three months and thawed three months later. The electronic scanning microscope was used to evaluate the adhesion and distribution of MSCs, cell viability was measured by MTT, ALP activity was detected by p-nitrophosphate, cell cycle was analysed by flow cytometry.
MSCs could adhere to the surface of the material and distribute in the hole of material. The cell viability of MSCs adhered to the material was C > A > B group (P < 0.01, P < 0.05). The ALP activity of MSCs adhered to material was C > A > B group (P < 0.01). The cell cycles of different groups did not change significantly; the abnormal cells were not observed.
The choice of proper cryopreservative solution could optimize the bioactivity of tissue engineered bone.
Zhongguo gu shang = China journal of orthopaedics and traumatology 01/2008; 21(1):49-51.
-
[show abstract]
[hide abstract]
ABSTRACT: To study the effect of bio-derived bones, as substitutes of autogenous bone grafts and demineralized cadaver bones, on the attachment, spreading and proliferation of isolated osteoblasts.
Osteoblasts were isolated from the calvaria of a fetal rabbit through sequential collagenase digestion. In the attachment study, the osteoblasts labeled with 3H-leucine were incubated with the bio-derived bone materials in sterile microcentrifugable tubes for 15, 90 and 180 minutes, and 24 hours, respectively. The attached cells were collected and the radioactivity was measured with liquid scintillation spectrometry. In the proliferation study, the osteoblasts were cultured with the bio-derived bone materials for 24 hours and 3H-thymidine was added during the last 2 hours of the incubation. The attached cells were collected and the radioactivity was measured with liquid scintillation spectrometry. Osteoblasts were seeded on the bone graft materials for 60 or 120 minutes, 24 or 48 hours, and 3 or 7 days, then the co-culture was processed for scanning electron microscopy to observe the interaction of osteoblasts and the bio-derived bone materials.
Osteoblasts attached to the bio-derived bone materials in a time-dependent manner. There were significantly (P<0.05) more attached cells after 180 minutes than after 15 and 90 minutes of incubations (P<0.05). Osteoblasts were proliferated in a large amount on the surface and in the materials. Osteoblasts seeded onto 100 mg bio-derived bones resulted in significantly (P<0.05) more measurable proliferation than those seeded onto 10 mg bones. Osteoblasts appeared round as they attached to the materials, then flattened and spread over with time passing.
Bio-derived bones can provide a good environment for the attachment and proliferation of osteoblasts.
Chinese Journal of Traumatology (English Edition) 05/2005; 8(2):86-90.
-
[show abstract]
[hide abstract]
ABSTRACT: To review researches on bone defect repaired by different kinds of bio-derived bone.
The recent relevant literatures were extensively investigated. Preparation of bio-derived bone and effect of bone defect repair were reviewed.
The allogeneic and xenogeneic bone treated by different physicochemical method were not only the substitution for bone but also the scaffold material co-cultured with seed cells to reconstruct tissue engineered bone.
The tissue engineered bio-derived bone is a breakthrough for treatment of bone defect.
Zhongguo xiu fu chong jian wai ke za zhi = Zhongguo xiufu chongjian waike zazhi = Chinese journal of reparative and reconstructive surgery 04/2005; 19(3):241-4.
-
[show abstract]
[hide abstract]
ABSTRACT: To study the difference of repairing segmental bone defect with bio-derived bone preserved by various methods.
Freeze-dried biomaterials had been stored in two different preservation solutions for three months, while the biomaterials stored for same period were observed as control group. The experimental model of 15 mm radial segmental defect was made in 60 New Zealand white rabbits, which were divided into groups A, B and C according to transplant materials preserved by various methods. Groups A and B were deeply divided into A1 and A2 subgroups, B1 and B2 subgroups according to whether materials were cocultured with osteoblasts. Tissue engineered bone was used to repair bone defects of left limbs in A1 and B1 subgroups, while simple material to repair defects of right limbs in A2 and B2 subgroups. Group C was divided into C1 and C2 subgroups. Freeze-dried material was used to repair bone defects of the left limbs, while defects of the right limbs as blank control group. The samples were harvested and observed by the roentgenographical, histomorphological, biomechanical and computerized graphical analysis at 4, 8 and 16 weeks.
All of the defects treated with implants exhibited new bone formation 4, 8 and 16 weeks postoperatively, increasing with time. The radiological, histomorphological and biomechanical evaluation showed that the ability of new bone formation was arranged in 6 subgroups as follows: A1>A2>C1>B1>B2>C2, the difference was significant between them (P<0.001, P<0.05). The ability of new bone formation was strongest and at 16 weeks the defect was bridged with the appearance of marrow cavities in A1 subgroup, the biomechanical properties in implants approached to those of normal bone.
The choice of proper preservation solution can improve the ability of repairing bone defect.
Zhongguo xiu fu chong jian wai ke za zhi = Zhongguo xiufu chongjian waike zazhi = Chinese journal of reparative and reconstructive surgery 02/2005; 19(2):95-9.
-
[show abstract]
[hide abstract]
ABSTRACT: To study the effect of various storage methods on cellular compatibility of bio-derived bone.
Freeze-dried biomaterials had been stored in two different preservation solutions for three months, while the biomaterials stored for the same time were observed as control group. The experiment was divided into groups A, B, C and D according to different storage methods (group A: with materials stored in preservation solution 1; group B: with materials stored in preservation solution 2; group C: with freeze-dried materials; and group D: simple osteoblasts). Osteoblasts at 2 x 10(6)/ml had been cocultured with materials for 1, 3, 5, and 7 days. The cell-material complex was observed under phase microscope and electronic scanning microscope to evaluate the adhesion and growth of osteoblasts; the cell viability and alkaline phosphatase(ALP) activity were measured, and the cell cycle was analysed by flow cytometer.
Osteoblasts adhered to materials preserved by different methods, differentiated and proliferated in the hole of materials. The difference of cell viability was not significant between three groups on day 1 and day 3. The cell viability of osteoblasts adhered to three materials was A > C > B group on day 5 and day 7 (P < 0.01, P < 0.05). The ALP activity of osteoblasts adhered to three materials was A > C > B group on day 7 (P < 0.01). The cell cycle of different groups did not change significantly, the abnormal cells were not seen.
The choice of proper preservation solution can optimize the cellular compatibility of bio-derived bone.
Zhongguo xiu fu chong jian wai ke za zhi = Zhongguo xiufu chongjian waike zazhi = Chinese journal of reparative and reconstructive surgery 05/2004; 18(3):209-13.
-
[show abstract]
[hide abstract]
ABSTRACT: The objective of this study was to investigate the outcome of the patients with cervicothoracic tuberculosis who underwent radical debridement, reconstruction with bone autograft or allograft, and plate internal fixation via anterior approach. From June 2000 to December 2010, 20 patients with tuberculosis in cervicothoracic junction underwent a standard cervical approach, which was combined with a partial median osteotomy and transverse osteotomy through the synostosis between the manubrium and body of the sternum to expose the lesion adequately. Radical debridement was performed, then tricortical iliac crest bone autograft or allograft was placed and internal fixation was done to reconstruct the spinal column. The pathologic change regions were as follows: 10 in the C7-T1 segment, 6 in the T1 segment, 3 in the T1-T3 segment, and 1 in the T2-T3 segment. The classifications of Frankel were as follows: 2 at grade A, 4 at grade B, 7 at grade C, 2 at grade D, and 5 at grade E. There was no injury of blood vessel, spinal cord, or recurrent nerve during the surgery. The follow-up period ranged approximately 16 to 39 months. Bony fusion was obtained in all patients, and there was no internal fixation failure and tuberculosis recurrence in any of these patients. The nerve function of the spinal cord recovered at different degrees: 2 at grade A, 1 at grade B, 1 at grade C, 3 at grade D, and 13 at grade E. The anterior approach can provide direct and safe access to the lesion. The structural iliac crest autograft or allograft and anterior instrumentation could work effectively to stabilize the cervicothoracic junction.
International surgery 96(4):358-62. · 0.36 Impact Factor
