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ABSTRACT: STUDY DESIGN:: Retrospectively study. OBJECTIVES:: To analyze the influence of preoperative brace treatment on the pulmonary function tests (PFTs) in female adolescent idiopathic scoliosis (AIS). SUMMARY OF BACKGROUND:: Brace is a selection of conservative treatment for some AIS patients. Some authors reported that wearing brace could impair the PFTs, while there is no report that analyze the related factors. METHODS:: Preoperative PFTs were evaluated in 270 female patients with AIS. The patients were classified into two groups: group A-with preoperative brace treatment, 70 cases; group B-without preoperative brace treatment, 200 cases. Compare the differences of the PFTs between the 2 groups. RESULTS:: The predicted values of forced vital capacity (FVC) and forced expiratory volume in one second(FEV1) in group A and B were 3.26L and 3.20L, 2.78L and 2.73L, respectively(both P>0.05). The actual values of FVC and FEV1 in group A and B were 2.61L and 2.72L, 2.37L and 2.48L, respectively(both P>0.05). The percentage of actual value and predicted value of FVC(FVC%) and FEV1(FEV1%) in group A and B were 80.6% and 85.2%, 85.7% and 91.1%, respectively, and group A had significant lower values than those of group B(both P<0.05). This difference was significant in patients with a primary thoracic curve (166 cases) (P<0.05), while not in patients with a primary thoracolumbar/lumbar curve(104 cases) (P>0.05). In group A, there were significant correlations between the sagittal Cobb angle of the thoracic curve and the actual values of FVC and FEV1, and FVC% and FEV1%(both P<0.05). CONCLUSIONS:: Preoperative brace treatment can reduce the FVC% and FEV1% in thoracic AIS. The sagittal Cobb angle of the thoracic curve may be the influential factors.
Journal of spinal disorders & techniques 02/2013; · 1.21 Impact Factor
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ABSTRACT: An analysis of computed tomography (CT) images of patients with adolescent thoracic idiopathic scoliosis for posterior pedicle screw placement.
To evaluate the relative position of the aorta to the spine by the axial CT scans in patients with right thoracic idiopathic scoliosis, and to discuss the safe trajectory and screw length for posterior pedicle screw placement.
Posterior pedicle screw instrumentation and fusion are widely used in the correction of scoliosis. Pedicle screw placement in the thoracic spine implies risk of injuring the aorta. Literatures on the relative position of the aorta to the spine are mostly focused on the anterior surgery. However, few are reported about the posterior surgery.
A total of 47 patients with adolescent right thoracic idiopathic scoliosis who underwent CT scan of total spine before surgery were included in this study. Transverse plane including bilateral pedicles, lamina, and transverse process was selected for measurement from T4 to T12. We defined a new coordinate system, and 5 parameters were measured in each vertebral body from T4 to T12 of the patients. The point where the left pedicle axial line and the base of the left transverse process intersected was defined as the origin of the coordinate system. A line connecting bilateral intersection was defined as x-axis. y-axis perpendicular to the x-axis is drawn ventrally from the origin. The left pedicle-aorta angle (α), the left aorta angle (β), the left pedicle-aorta distance (PAD), the aorta-x-axis distance (AXD), and the vertebral rotation angle (γ) were measured.
The values of angles α and β had a tendency of first increasing and then decreasing, and increasing again from T4 to T12. The lowest value of angle α occurred at T10 (7.45±6.10 degrees), followed by T4 (8.89±6.49 degrees), T11 (9.13±7.59 degrees), and T9 (9.74±6.11 degrees). PAD and AXD values had a tendency of decreasing first and then increasing from T4 to T12. The lowest values of PAD and AXD occurred at T6; 25.94±5.33 and 23.64±6.53 mm, respectively. From the cephalad to the caudal spine, angle γ increased first and then decreased. The highest value occurred at T7 (2.32±6.83 degrees), which rotated to the right side. The second largest value occurred at T8 (2.23±7.76 degrees). Statistical analysis indicated that the apical vertebral translation and vertebral rotation angle were significantly positively correlated to angles α and β (P<0.05).
The highest risk of injuring the aorta when placing pedicle screw during posterior scoliosis surgery was at T10, followed by T4, T11, and T9 in right thoracic idiopathic scoliosis. Taking a spine CT scan and evaluating the relative position of the aorta to the thoracic spine before surgery are significant in precise and safe pedicle screw placement.
Journal of spinal disorders & techniques 02/2012; 25(4):E103-7. · 1.21 Impact Factor
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ABSTRACT: BMI-1 is a member of the polycomb group of genes (PcGs), and it has been implicated in the development and progression of several malignancies, but its role in osteosarcoma remains to be elucidated.
In the present study, we found that BMI-1 was overexpressed in different types of osteosarcomas. Downregulation of BMI-1 by lentivirus mediated RNA interference (RNAi) significantly impaired cell viability and colony formation in vitro and tumorigenesis in vivo of osteosarcoma cells. BMI-1 knockdown sensitized cells to cisplatin-induced apoptosis through inhibition of PI3K/AKT pathway. Moreover, BMI-1-depletion-induced phenotype could be rescued by forced expression of BMI-1 wobble mutant which is resistant to inhibition by the small interfering RNA (siRNA).
These findings suggest a crucial role for BMI-1 in osteosarcoma pathogenesis.
PLoS ONE 01/2011; 6(2):e14648. · 4.09 Impact Factor
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Guixing Qiu,
Yong Qiu,
Zezhang Zhu,
Zhen Liu,
Yuemin Song,
Yong Hai,
Zhuojing Luo,
Zude Liu,
Hongqi Zhang,
Guohua Lv, Yipeng Wang,
Jianguo Zhang,
Jianxiong Shen,
Xu Sun
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ABSTRACT: A multicenter cross-cultural study to re-evaluate the reliability and validity of the simplified Chinese version of Scoliosis Research Society-22 (SRS-22) Patient Questionnaire.
To assess the concurrent validity and reliability of this instrument in mainland China.
The SRS-22 Questionnaire was developed to assess the health-related quality of life for patients with scoliosis in the United States. More recently, the reliability and validity analyses of traditional and simplified Chinese versions of this questionnaire were performed, respectively. However, with respect to the diversity of population and large proportion of rural patients in China, a multicenter study might be necessary to re-evaluate its adaptation.
The original English version of the SRS-22 Questionnaire was translated into simplified Chinese. Considering the different health care systems in mainland China, the question 15 was modified; the respondent might be the parent if the patient was younger than 18 years. This multicenter study was performed by 13 scoliosis surgeons involving seven spine centers. The SRS-22 Questionnaire and a previously validated 36-Item Short-Form Health Survey Questionnaire were given to 391 patients with idiopathic scoliosis or congenital scoliosis without neurologic deficits. Of those, 136 patients were randomly selected for a second identical SRS-22 Questionnaire filled 1 week later and mailed back with a stamped return envelope.
A total of 333 patients fully completed both SRS-22 and 36-Item Short-Form Health Survey Questionnaires. Good consistency was observed for all the five domains of the SRS-22. Poorer internal consistency was found in questions 15 and 18. If question 15 was excluded, the α coefficient would increase to 0.68. The pain domain of SRS-22 had a high ceiling effect being 67.5%. The test-retest reproducibility was observed "good" in the pain domain and "excellent" for the remaining domains of SRS-22 Questionnaire. Good (10 domains) and moderate (23 domains) correlations were demonstrated while seven domains had poor correlation.
The simplified Chinese version of the SRS-22 Questionnaire was re-evaluated by a multicenter study to respect the diversity of population and cultural differences in mainland China, which showed good internal consistency and satisfactory test-retest reproducibility. It might be useful for clinical evaluation of Chinese adolescents and young adults with scoliosis treated with bracing or surgery, although it also encountered previously reported difficulties with some of the items related to different cultures and health care systems.
Spine 01/2011; 36(8):E545-50. · 2.08 Impact Factor
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ABSTRACT: Retrospective clinical study.
To evaluate the predictive factors of postoperative pulmonary complications in unselected scoliotic patients with moderate or severe pulmonary dysfunction.
Many scoliotic patients with moderate or severe pulmonary dysfunction develop postoperative pulmonary complications during hospitalization. However, little is reported about the postoperative pulmonary complication events in this population at the first visit to the hospital.
A total of 88 scoliotic patients with moderate or severe pulmonary dysfunction were identified. The demographic distribution, medical history, and clinical data were collected to investigate the predictive factors of immediate postoperative pulmonary complications by logistic regression.
A total of 16 (18.2%) patients were documented with postoperative pulmonary complications including increased requirement of postoperative ventilatory support (6.3%), atelectasis (31.3%), pneumothorax (6.3%), pneumonia (12.5%), and hypoxemia (43.8%). There were no statistical differences in age, sex, body mass index, abnormal echocardiogram, and prior symptoms between the 2 groups (P>0.05). Of the patients with postoperative pulmonary complications, a slightly higher proportion of patients underwent anterior approach, 2 (12.5%) versus 2 (2.8%) (P=0.091). The Cobb angle before surgery was 102.1+/-25.5 degree with postoperative pulmonary complications versus 87.7+/-23.8 degree without postoperative pulmonary complications (P=0.034). Forced vital capacity was 47.0+/-10.5% versus 52.4+/-9.0% (P=0.037). Number of levels fused was 13.7+/-2.3 versus 13.1+/-2.2 (P=0.319). Operation time was 376.8+/-125.6 minutes versus 350.4+/-97.8 minutes (P=0.357). Anesthesia time was 415.3+/-126.8 minutes versus 388.0+/-97.5 minutes (P=0.341). Estimated blood loss was 1050.0+/-769.4 mL versus 777.8+/-460.9 mL (P=0.065), respectively. Logistic regression analysis showed that thoracoplasty correlated with postoperative pulmonary complications (odds ratio 3.81, 95% confidence interval 1.11-13.16).
Thoracoplasty is the only independent predictor of postoperative pulmonary complications. However, the abnormal echocardiogram, prior symptoms, forced vital capacity, and other clinical characteristics play a less relevant role in the prediction of postoperative pulmonary complications.
Journal of spinal disorders & techniques 08/2010; 23(6):388-92. · 1.21 Impact Factor
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ABSTRACT: A case-control association study was conducted to investigate the genetic etiology for congenital scoliosis (CS) in a Chinese Han population.
To identify whether TBX6 polymorphisms are associated with susceptibility to CS in a Chinese Han population.
CS is a 3-dimensional deformity of the spine, resulting from defection of normal vertebral development. Although there are many types of defects observed in CS, all result from abnormal formation and segmentation of the vertebral precursors, called somites. Developmental studies in animal models have identified many genes regulating somite formation and segmentation. T-box factor, TBX6, is a prerequisite for somite segmentation in vertebrates. In mouse TBX6 knockouts, the phenotypes are similar with that of some human birth defects, such as CS, raises the possibility that TBX6 gene may be a potential susceptibility gene for CS, so we investigated the relations between TBX6 polymorphisms and CS.
Two known single-nucleotide polymorphisms (SNPs) of TBX6 gene were genotyped among 254 Chinese Han subjects (127 CS patients and 127 controls with matched sex and age) by GenomeLab SNPstream genotyping system. The 2 markers (the only tagging SNP and a functional SNP) with minor allele frequency above 5% were analyzed by the allelic and genotypic association analysis, the genotype-phenotype (CS patients were divided into type I 31 cases [failure of formation], type II 46 cases [a failure of segmentation], and type III 50 cases [mixed defects]) association analysis, and the haplotype analysis.
The single SNP analysis showed allele frequency of rs2289292 (exon 8, the only tagging SNP) and rs3809624 (5' untranslated region) demonstrated significant difference between CS cases and controls (P = 0.017 and P = 0.033). No SNP was found to be correlated with clinical phenotype. Moreover, the 2 makers (rs2289292 and rs3809624) in TBX6 gene were found to be in strong linkage disequilibrium (D' = 1.0; gamma = 0.984; 95% confidence interval, 0.96-1.0; LOD = 57.48) in the controls. Both global haplotype analysis and individual haplotype analysis showed that the haplotype of SNP1/SNP2 showed significant association with the disease (P = 0.017), G-A haplotype was more frequently observed in controls than in cases (odds ratio, 0.71; 95% confidence interval, 0.51-0.99).
This is the first report on SNPs of TBX6 gene in CS that suggests genetic variants of TBX6 gene is associated with CS and may play an important role in mediating susceptibility to developing CS in the Chinese Han population.
Spine 03/2010; 35(9):983-8. · 2.08 Impact Factor
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ABSTRACT: The etiology of adolescent idiopathic scoliosis is undetermined despite years of research. A number of hypotheses have been postulated to explain its development, including growth abnormalities. The irregular expression of growth hormone and insulin-like growth factor-1 (IGF-1) may disturb hormone metabolism, result in a gross asymmetry, and promote the progress of adolescent idiopathic scoliosis. Initial association studies in complex diseases have demonstrated the power of candidate gene association. Prior to our study, 1 study in this field had a negative result. A replicable study is vital for reliability. To determine the relationship of growth hormone receptor and IGF-1 genes with adolescent idiopathic scoliosis, a population-based association study was performed. Single nucleotide polymorphisms with potential function were selected from candidate genes and a distribution analysis was performed. A conclusion was made confirming the insufficiency of an association between adolescent idiopathic scoliosis and the single-nucleotide polymorphism of the growth hormone receptor and IGF-1 genes in Han Chinese.
Orthopedics 07/2009; 32(6):411. · 2.66 Impact Factor
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Guixing Qiu,
Qiyi Li, Yipeng Wang,
Bin Yu,
Jun Qian,
Keyi Yu,
Chia I Lee,
Jianguo Zhang,
Jianxiong Shen,
Yu Zhao,
Xisheng Weng,
Ting Wang,
Darwesh M K Aladin,
Weijia William Lu
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ABSTRACT: Comparison of 2 radiographic scoliosis classification systems by multiple surgeons.
Compare the reliability of Peking Union Medical College (PUMC) and Lenke scoliosis classification systems and analyze their differences.
The PUMC classification is a newly reported system based on radiographic measurements with recent popularity, while the Lenke classification is widely accepted worldwide in surgical design. Both these classification systems have their own individual characteristics, hence it is necessary to compare their reliability.
Five scoliosis surgeons independently evaluated and classified presurgical radiographs of 62 adolescent idiopathic scoliosis patients based on the PUMC and Lenke classification systems on 2 separate occasions. Radiographs were cleaned before each evaluation. Inter- and intraobserver reliabilities were quantified using Kappa statistics. Data were compared using chi2 analysis.
The PUMC classification's inter- and intraobserver percentage of agreement averaged to 91.0% (Kappa coefficient 0.896) and 90.2% (Kappa coefficient 0.892), respectively. While those of the Lenke curve type classification were 86.5% (Kappa coefficient 0.808) and 87.4% (Kappa coefficient 0.826). The PUMC classification from 10 individual measurements had 17 cases (27.4%) of disagreements, while in the Lenke curve type classification, 24 cases (38.7%) had disagreements. PUMC classification normally has discrepancies between type IIb, IIc, and IId, while Lenke classification has discrepancies in curve types 1 and 2. Out of 17 inconsistent PUMC curve type cases, 7 did not affect surgical fusion levels, while in the Lenke's only 2 out of 24 cases with discrepancies did not affect fusion range selection, with an obvious statistical difference.
The reliability of both PUMC classification and Lenke curve type classification were categorized as good-to-excellent. PUMC classification is relatively simple, with less confusion among inter- and intraobservers, with corresponding surgical fusion guidance and planning. The mismatch of curve classification had less influence on PUMC's fusion range selection than Lenke's.
Spine 11/2008; 33(22):E836-42. · 2.08 Impact Factor
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ABSTRACT: A genetic association study of tryptophan hydroxylase 1 gene (TPH1) and arylalkylamine N-acetyltransferase gene(AANAT) with adolescent idiopathic scoliosis (AIS) in Han Chinese.
To access whether TPH1 and AANAT polymorphisms are associated with the predisposition, gender, and/or severity of AIS.
Studies have shown that AIS is a multifactorial inheritance disease, but the etiology is still unknown. In addition, several lines of evidence show that melatonin deficiency is closely associated with AIS, although there are still doubts and debates. Some polymorphisms in TPH1 and AANAT, the genes of 2 critical enzymes involved in melatonin biosynthesis, may contribute to variability of melatonin production in pineal glands.
We genotyped 16 reported single nuclear polymorphisms (SNPs) present in TPH1 and AANAT in 103 AIS patients and 108 controls with matched sex and age. The data of 6 SNPs with minor allele frequence (MAF) above 5% were analyzed by the allelic and genotypic association analysis, the genotype-phenotype (gender and Cobb angle) association analysis, and the haplotype analysis.
The single SNP analysis showed that rs10488682, located in the promoter region of TPH1, was related with the occurrence of AIS (P < 0.05). No SNP was found to be correlated with gender or Cobb angle. Two makers (rs8176799 and rs2108977) in TPH1 were found to be in strong LD [ D' = 1.0 (95% CI, 0.9-1.0), gamma = 0.501, LOD = 18.93] in the controls. Both global haplotype analysis and individual haplotype analysis showed that there was no haplotype significantly associated with AIS in this LD block.
TPH1 polymorphisms were associated with AIS but not with gender and Cobb angle in AIS patients. AANAT polymorphisms were not associated with AIS. These results suggested that TPH1 was an AIS predisposition gene, and there was a close relationship between the dyssynthesis of melatonin and AIS.
Spine 10/2008; 33(20):2199-203. · 2.08 Impact Factor
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ABSTRACT: A prospective study.
Comparison study of radiologic and clinical outcomes, efficiency, and cost between anterior spinal fusion (ASF) and posterior spine fusion (PSF) in surgical treatment of moderate lumbar/thoracolumbar adolescent idiopathic scoliosis (AIS).
ASF and PSF indicated for lumbar and thoracolumbar adolescent idiopathic scoliosis surgical treatment have respective advantages and disadvantages. However, up until today, a related prospective AIS comparative study has rarely been reported.
Thirty-two cases in this prospective study with patients enrolled in either method A or B alternately in a sequence were divided into 2 groups. Group A underwent ASF with single solid rod and single screw constructs, and group B underwent PSF with segmental total pedicle screw system. Inclusion criteria were: (1) AIS diagnosis; (2) diagnosis classification as Lenke5CN type; (3) Cobb angles 35 degrees-60 degrees on anteroposterior view radiographs. Exclusion criteria were: (1) a history of spinal surgery; (2) age younger than 10 years; (3) Risser sign 0 degree; (4) lumbar/thoracolumbar kyphosis. All patients were observed with 2-year minimum follow-up (24-46 months). Clinical and radiologic outcomes of both groups A and B were analyzed.
Statistical t test or Mann-Whitney U test demonstrated no significant difference in preoperative age (P = 0.380), Risser sign (P = 0.733), magnitude (P = 0.936), flexibility (P = 0.815), apical vertebra rotation (AVR, P = 0.756), and apical vertebra translation (AVT, P = 0.355) of the lumbar/thoracolumbar curves, trunk shift (TS, P = 0.448), sagittal kyphosis from T5-T12 (P = 0.792) and sagittal lordosis from L1-L5 (P = 0.299). Average coronal correction of thoracolumbar/lumbar curves was 83% after surgery and 77% at follow-up in group A and 87% after surgery and 82% at follow-up in group B (P = 0.236 and P = 0.138). No significant differences were observed regarding correction of sagittal alignment, TS, AVT, AVR and hospitalization days on last follow-up between both groups (P > 0.05). No pseudarthrosis, reoperation, neurologic complications, infection, and no other problems were observed. Excellent clinical fusion results were present in all patients on their last follow-up. However, significant differences were evident in group A in regards to reduced operative time (P = 0.046), reduced estimated blood loss (P = 0.003), decreased blood transfusion (P = 0.006), reduced implants cost and hospitalization expenses (P = 0.000). Additionally, group A had shorter fusion levels than group B (p50 = 4 vs. p50 = 5, P = 0.003).
ASF versus PSF comparison in treating moderate lumbar/thoracolumbar AIS did not show significant differences in regards to safety or efficacy but demonstrated shorter fusion levels, reduced surgical trauma and costs in ASF.
Spine 10/2008; 33(20):2166-72. · 2.08 Impact Factor
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ABSTRACT: In idiopathic scoliosis patients, after anterior spinal fusion and instrumentation, the discs (interspace angle) between the lowest instrumented vertebra (LIV) and the next caudal vertebra became more wedged. We reviewed these patients and analyzed the changes of the angle.
By reviewing the medical records and roentgenograms of adolescent idiopathic scoliosis patients underwent anterior spinal fusion and instrumentation, Cobb angle of the curve, correction rate, coronal balance, LIV rotation, interspace angle were measured and analyzed.
There were total 30 patients included. The mean coronal Cobb angle of the main curve (thoracolumbar/lumbar curve) before and after surgery were 48.9 degrees and 11.7 degrees , respectively, with an average correction rate of 76.1%. The average rotation of LIV before surgery was 2.1 degree, and was improved to 1.2 degree after surgery. The interspace angle before surgery, on convex side-bending films, after surgery, at final follow up were 3.2 degrees , -2.3 degrees , 1.8 degrees and 4.9 degrees , respectively. The difference between the interspace angle after surgery and that preoperatively was not significant (P = 0.261), while the interspace angle at final follow-up became larger than that after surgery, and the difference was significant(P = 0.012). The interspace angle after surgery was correlated with that on convex side-bending films (r = 0.418, P = 0.022), and the interspace angle at final follow-up was correlated with that after surgery (r = 0.625, P = 0.000). There was significant correlation between the loss of the interspace angle and the loss of coronal Cobb angle of the main curve during follow-up(r = 0.483, P = 0.007).
The interspace angle could be improved after anterior correction and instrumentation surgery, but it became larger during follow-up. The loss of the interspace angle was correlated with the loss of coronal Cobb angle of the main curve during follow-up.
Journal of Orthopaedic Surgery and Research 02/2007; 2:17.
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ABSTRACT: A randomized prospective study.
To compare safety, efficacy, and cost between 1-stage and 2-stage anterior and posterior spinal fusion in treating rigid thoracic adolescent idiopathic scoliosis (AIS).
Retrospective study issued different outcomes comparing 1-stage with 2-stage surgical procedures in treating neuromuscular and congenital scoliosis. A randomized prospective study in AIS has rarely been reported. METHODS.: Twenty-four patients were randomly divided into 2 groups. Group A underwent a 2-stage procedure, group B a 1-stage procedure. Inclusion criteria were: (1) AIS; (2) rigid single thoracic curve, > or =90 degrees on anteroposterior and > or =60 degrees on side bending view; and (3) pulmonary function tests, vital capacity > or =500 mL or FEV1 > or =50%. Exclusion criteria were: (1) curves either <90 degrees on anteroposterior or <60 degrees on bending view; and (2) pulmonary function tests, both vital capacity <500 mL and FEV1 <50%. The mean follow up was 3.3 years (range 2-5.1). Clinical outcomes between the 2 groups were analyzed.
A statistical t test demonstrated no significant difference in age (P = 0.299), curves on anteroposterior (P = 0.908), on bending (P = 0.905), after surgery (P = 0.699), and at last follow-up (P = 0.946). No significant difference in blood loss (P = 0.089), transfusion (P = 0.334), operation time (P = 0.172), fusion segments anterior (P = 0.161), posterior (P = 0.546), wound drainage (P = 0.557), thoraco drainage (P = 0.948), and loss of correction at follow-up (P = 0.596). However, significant differences were found in length of stay (P < 0.001), patient cost of hospitalization (P < 0.001) between 2 groups, and curve correction (P < 0.001) in each group. Perioperative complications included 1 patient each with pneumonia, pneumothorax (group A), and ileus (group B). Screw nut loosing was found in 1 patient in group B, but no curve deteriorated. No neurologic deficit occurred in either group.
A comparison of 1-stage versus 2-stage fusion in treating rigid thoracic curves in AIS did not show significant differences in safety or efficacy but did demonstrate significant difference in length of stay and patient cost.
Spine 11/2006; 31(22):2525-8. · 2.08 Impact Factor
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ABSTRACT: To compare the expression of cytokines and core protein of proteoglycan in the scoliotic concave and convex cartilaginous endplate using immunohistochemical staining.
To define the possible role of transforming growth factor beta 1 (TGFbeta1), basic fibroblast growth factor (bFGF), and core protein of proteoglycan in the development of adolescent idiopathic scoliosis.
Changes in the endplate composition have been implicated as possible etiologic factors in the pathogenesis of adolescent idiopathic scoliosis. Cytokines have exclusive effects on cartilage. Thus comparing the expression of the cytokines and matrix on the convex and concave sides of scoliotic endplate tissues may help to understand the role of endplate tissues in the induction and/or progression of idiopathic scoliosis.
The convex and concave half of cartilage endplate was collected at the apex and end vertebrae from 12 patients. The expression of TGFbeta1, bFGF, and core protein on both sides was examined with the immunohistochemistry method, and results were analyzed with the image analysis system.
TGFbeta1, bFGF, and core protein of proteoglycan were all expressed in the cytoplasm of chondrocytes in the cartilaginous endplate. The area density and quantity density of TGFbeta1 and bFGF on the concave side are expressed in an even significantly higher level than that on the convex side (P > or = 0.05). The expression of the core protein of proteoglycan on the convex side is higher than that on the concave side, the difference is not significant (P > 0.05).
There was a significantly higher expression of TGFbeta1 and bFGF, although a lower expression of the core protein on the concave side, which suggests a possible etiological factor or a secondary change in the development of adolescent idiopathic scoliosis.
Spine 10/2005; 30(17):1973-8. · 2.08 Impact Factor
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Guixing Qiu,
Jianguo Zhang, Yipeng Wang,
Hongguang Xu,
Jia Zhang,
Xisheng Weng,
Jin Lin,
Yu Zhao,
Jianxiong Shen,
Xinyu Yang,
Keith D K Luk,
Duosai Lu,
William W Lu
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ABSTRACT: A retrospective radiographic study on the type of surgically treated idiopathic scoliosis, with a prospective study on the reliability of the type-related fusion guide.
To identify and classify surgically treated idiopathic scoliosis, and define its related fusion levels by a new classification system.
Some classification methods for idiopathic scoliosis have been suggested. However, poor intraobserver reproducibility and interobserver reliability were experienced in these studies, and were not appropriate for guiding surgical planning.
A total of 427 surgically treated idiopathic scoliosis cases were reviewed. Preoperative and postoperative standing anteroposterior, lateral, and preoperative supine side-bending radiograph were analyzed using the Scoliosis Research Society definition of scoliosis and curve apex. The resulting classification was tested for intraobserver reliability and interobserver reliability, and by 6 surgeons. Apical frequencies were determined for each type, and prospective surgical testing of the new type and its related fusion guide was performed.
Three major types and 13 subtypes were identified, of which the Peking Union Medical College type I accounted for 56.62%, type II 42.16%, and type III 1.22%. The interobserver reliability testing was 85% (kappa coefficient 0.832), while intraobserver reproducibility was 91% (kappa coefficient 0.898). Each type had its corresponding fusion levels. A prospective study of 152 cases was performed according to the classification. All of these cases were followed over 18 months, and no postoperative decompensation was noted.
The Peking Union Medical College classification of idiopathic scoliosis is one system to combine each type with its corresponding fusion level, and it had much higher interobserver reliability and intraobserver reproducibility than the King system. Further prospectivestudies would help to clarify and expand this system.
Spine 07/2005; 30(12):1419-26. · 2.08 Impact Factor
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ABSTRACT: To introduce a new spinal internal fixation system, Texas Scottish Rite Hospital (TSRH), and to investigate its early clinical outcomes.
The preliminary clinical outcomes of 15 patients with thoracolumbar or lumbar scoliosis treated by anterior spinal fusion with TSRH instrumentation were studied retrospectively. Fourteen patients were diagnosed as idiopathic scoliosis and 1 as neuromuscular scoliosis.
Preoperatively, the Cobb's angle on the coronal plane was 55.8 degrees (range 35 degrees to approximately 78 degrees), and 14 degrees postoperatively, with an average correction of 74.8%. The average unfused thoracical curve was 35.9 degrees preoperatively (range 26 degrees to approximately 51 degrees) and 21.8 degrees (10 degrees to approximately 42 degrees) postoperatively, with 40% correction. The sagittal curve of lumbar was kept physiologically, preoperative 27.9 degrees and postoperative 25.7 degrees respectively. The trunk shift was 13.4 mm (5 to approximately 28 mm) preoperatively and 3.5 mm (0 to approximately 7 mm) postoperatively. The averaged apic vertebra derivation was 47.8 mm (21 to approximately 69 mm) before operation and 10.8 mm (3 to approximately 20 mm) after operation. The distance of C7 to center sacrum vertical line (CSVL) was 19.5 mm (16 to approximately 42) preoperatively and 11.3 mm (0 to approximately 32 mm) postoperatively. The apical vertebra rotation was 3 degree in 15 patients preoperatively, and were improved to normal in 10 patients, 1 degree in 4 patients, and 2 degree in 1 patients postoperatively. None had neurological injury and infection. Only 1 patient complained a cool feeling in the low extremity of concave side, and the symptom vanished at 3-month followed up.
If used appropriately, TSRH anterior spinal system is a good teatment for low thoracic or thoracic lumbar scoliosis.
Chinese Medical Sciences Journal 04/2003; 18(1):41-5.
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ABSTRACT: To assess surgical treatment of lumbar spinal stenosis associated with unstable degenerative spondylolisthesis.
In 86 patients with lumbar spinal stenosis associated with unstable degenerative spondylolisthesis. (30 men and 56 women, aged from 30 to 77 years), 63 patients complained of lower back pain with both lower extremity pain, 10 patients pain in one leg, and 13 patients only lower back pain. Seventy-two of these patients complained of intermittent claudication, with a walking distance ranging from 10 to 1 000 m. Thirty-two patients had some changes in sensation, motion and reflexes of the foot. According to White' critera, all patients showed dynamic instability of the lesion. Meyerding criteria showed degree 1 in 79 patients, and degree 2 in 7. CT scan was made in 56 patients, MRI in 24 and MRM in 6 before operation. Myelography was performed in 61 patients, and CTM in 6. Stenosis and spondylolisthesis located between L(4) and L(5) in 49 patients, between L(3) and L(4) in 6, between L(5) and S(1) in 25, between L(3) and L(4) and between L(4) and L(5) in 2, and from L(3) to S(1) in 4. The patients with pathological spondylolisthesis were excluded. Lateral recess stenosis of one leg was observed in 10 patients, lateral recess of both legs in 22, and central canal stenosis in 54, of whom 12 patients were associated with protrusion of the lumbar disc. Decompression and autograft with iliac bone and various internal fixation were performed in all patients.
The patients were followed up from 8 months to 13 years, longer than 1 year (average 5.6 years) in 81 patients. According to Amundsen et al, excellent results were obtained in 78 patients, good in 5, and fair in 3. Spondylolisthesis was completely reduced in 70 patients of degree 1 (89.9%), and in 6 patients of degree 2 (85.7%). No patient showed slippage aggravated. 74 patients gained bone graft fusion within 3 months and 10 patients within 6 months. Two patients showed pseudoarthrosis during the follow-up. Complications included internal fixation breakage in 1 patient, and delayed infection in 1.
Complete decompression and bone graft fusion are the key to treatment. Decompression and internal fixation improve the symptoms of patients with lumbar spinal stenosis associated with spondylolisthesis. Transpedicle instrumentation can reduce spondylolisthesis and maintain the physical curve of the lumbar.
Zhonghua wai ke za zhi [Chinese journal of surgery] 11/2002; 40(10):723-6.
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ABSTRACT: To evaluate the effect of surgical treatment on metastatic spinal tumor.
The results of surgical intervention for metastatic spinal tumor of 31 consecutive patients since October 1985 were reviewed.
The average survival time was 17.6 months (range from 3 months to 9 years), and 4 patients are still alive with an average survival time of 24.6 months (range, 14 to approximately 84 months). No postoperative complication was noted. The preoperative symptoms were partially relieved and neurological functions were improved after surgery.
Surgical treatment for metastatic spinal tumor could improve the life quality, but should be adopted cautiously. The surgical procedures such as decompression and internal fixation should be involved only when neurological deficits occurred. The surgery with postoperative complementary therapy may not only improve the life quality, but also extend the patients' life span.
Chinese Medical Sciences Journal 10/2002; 17(3):183-8.
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ABSTRACT: To investigate the treatment of infected total knee arthroplasty (TKA).
Between 1983 and 2000, 6 patients with infection after TKAs were treated, including 2 men and 4 women, aged on average 63 years (44 - 75 years). Initial knee arthroplasty was performed for osteoarthritis in 4 patients and for rheumatoid arthritis in 2 knees. The timing of diagnosis of infection after knee arthroplasty averaged 50 months (range, 1 month-11 years). Simple debridement and antibiotic treatment were prescribed for 3 patients, debridement and one-stage reimplantation for 1, debridement and two-stage reimplantation for 1, and athrodesis for 1.
Of the 3 patients with simple debridement, one was cured, one failed but underwent athrodesis later, and one lost to follow up. Two patients with reimplantation were cured and had good function recovery. All of the 6 patients were followed up on average for 4 years. No infection recurred except one who lost to follow-up.
Management of infection after total knee arthroplasty includes antibiotic suppression and debridement with prosthesis retention, insertion of another prosthesis as a one-stage or two-stage exchange technique, knee arthrodesis and amputation. These treatments have specific indications. To treat infection after total knee arthroplasty, suitable method should be taken according to patient's condition. Arthrodesis is the best salvage operation, though it may handicap patients' daily life. Reimplantation of another prosthesis could maintain a functional joint.
Zhonghua wai ke za zhi [Chinese journal of surgery] 10/2002; 40(9):669-72.
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ABSTRACT: To discuss the indications for surgical procedures of spinal myeloma.
A retrospective analysis was made of the data of operation results of Nineteen patients with spinal myeloma, 13 males and 6 females, with the mean age of 45.1 (range 31 approximately 52). Pain was present in all patients. Nine patients had neurological deficit. According to Frankel classification 5 cases were Frankel B, 3 cases were Frenkel C, and 1 case was Frenkel D. Fourteen cases were diagnosed before operation, and 5 cases were diagnosed by pathology after operation. Surgical procedures performed included anterior approach in 11 cases, posterior approach in 7 cases and combined approach in 1 case.
Decrease of pain was observed in all cases after surgery. Neurological improvement was observed in 8 out of the 9 cases. Complication (alteration of intestinal flora) occurred in one case. Follow-up lasted more than 1 year except in one case with a follow-up of only 6 months. Four cases were lost of follow-up. One case was still alive during the follow-up 8 years after operation. Other cases survived for 26.5 months on average (range 16 approximately 48 months).
Surgery can ensure neurological improvement and spinal stability for patients with spinal myeloma, but should be associated with adjunctive medical treatment.
Zhonghua yi xue za zhi 09/2002; 82(16):1118-20.
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ABSTRACT: To evaluate the results of the TRAFIX instrumentation in correcting scoliosis.
Since October 1997, 47 patients with scoliosis received spinal fixation with the TRAFIX instrumentation at the Peking Union Medical College Hospital. The average age was 14. 3 years (range 10 to 38 years). There were 27 idiopathic cases, 16 congenital cases, 2 cases with Marfan syndrome and 2 with neurofibromatosis. Twelve of the 47 patients underwent anterior release, while 4 patients received the revision approach. The average follow-up time was 26 months (13 -38 months).
The measurements of primary coronal deformity before and after surgery were 74 degrees (50 degrees approximately 115 degrees) and 38.7 degrees (11 approximately 95 degrees), respectively. The average curve correction was 54%. The average number of fused segments was 12.5 (7 approximately 17) vertebrae. The distance between the center of apex and the C7 plumb line was 56.8 mm before surgery (25 approximately 107 mm) and 31 mm after surgery (10 approximately 87 mm).
The TRAFIX instrumentation provides three-dimensional correction with refinement, convenience and reliable fixation.
Chinese Medical Sciences Journal 04/2002; 17(1):52-6.
