Objective To summarize the progress of percutaneous endoscopic lumbar interbody fusion in the treatment of lumbar degenerative diseases. Methods The relevant literature about percutaneous endoscopic lumbar interbody fusion at home and abroad in recent years was reviewed, the approaches, technical characteristics, short- and long-term effectiveness, and complications of different surgical procedures were summarized. Results Percutaneous endoscopic lumbar interbody fusion is a safe and reliable treatment. At present, the main surgical methods in clinical application can be roughly summarized as percutaneous endoscopic posterior transforaminal lumbar interbody fusion (Endo-PTLIF), percutaneous endoscopic transforaminal lumbar interbody fusion (Endo-TLIF), percutaneous endoscopic oblique lumbar interbody fusion (Endo-OLIF), percutaneous endoscopic lumbar interbody fusion/Z’s percutaneous endoscopic lumbar interbody fusion (Endo-LIF/ZELIF), and unilateral biportal endoscopic transforaminal lumbar interbody fusion (UBE-TLIF). Each surgical method has its own technical characteristics and development. Conclusion Percutaneous endoscopic lumbar interbody fusion is a kind of combined technology based on the individualization of the patient’s anatomical structure and the technical differentiation of the surgeon. Surgical experience, choosing adaptive indication and operative way reasonably are the key for the success.
Objective To introduce the research advances of scaffold materials of intervertebral disc tissue engineering. Methods The recent original articlesabout the scaffolds in intervertebral disc tissue engineering were extensively reviewed. Results At present, agarose, alginate gel, collagentype Ⅰ, PLA, PGAare still major scaffold materials for intervertebral disc tissue engineering because of their good biocompatibility. Conclusion It is one of the popular studies on current intervertebral disc tissue engineering to explore the ideal scaffold materials.
【摘要】 目的 探討急性腦梗死對心臟自主神經活性的影響。 方法 Wistar大鼠32只隨機分為正常組、假手術組和腦梗死組，腦梗死組用線栓法行右側大腦中動脈阻塞。腦梗死組和假手術組于術前及術后24 h作心率變異性（HRV）檢測，同時檢測正常組HRV，將3組的HRV指標進行比較。實驗終點取各組心肌組織檢測兒茶酚胺和神經肽Y（NPY），進行組間比較。 結果 術后24 h腦梗死組和正常組、假手術組相比，竇性心搏間期標準差、均方根，總功率譜、高頻功率譜（HF）、低頻功率譜（LF）降低，差異有統計學意義。3組比較LF/HF和分數維無明顯差異。腦梗死組心肌組織去甲腎上腺素（NA）和NPY高于正常組和假手術組。 結論 腦梗死引起心臟自主神經總活性降低、自主神經功能受損，自主神經末梢去甲腎上腺素和NPY的異常分泌可能是重要的原因。【Abstract】 Objective To investigate the effect of acute cerebral infarction on cardiac autonomic nervous activity. Methods A total of 32 Wistar rats were divided into normal group, sham operation group and infarction group by random. Experimental cerebral infarction in Wistar rats was induced by intraluminal occlusion of middle cerebral artery. About 24 hours after the occlusion or 24 hours after sham operation, the heart rate variability (HRV) sequences were measured, and the HRV values in the three groups were compared. The levels of catecholamine and neuropeptide (NPY) in myocardium were measured. Results At the 24th hour after the occlusion, the standard deviation and root mean square standard deviation of R-R interval, the total power, high frequency (HF) and low frequency (LF) in infarction group were lower than those in normal and sham operation group. LF/HF and fractal dimension did not differ much among the three groups. The levels of noradrenaline and NPY in myocardium in infarction group were higher than those in the other groups. Conclusion It is suggested that acute cerebral infarction may cause the decrease of autonomic nervous activity and damage of the autonomic nervous function; the abnormal secretion of noradrenalin in autonomic nerve ending and NPY may be the important reasons.
Objective To retrospectively analyze the effectiveness of percutaneous anterior odontoid and transarticular screw fixation for type II odontoid fracture treated in the elderly patients. Methods Between October 2009 and March 2012, 5 patients with odontoid fracture were treated with anterior triple screws fixation. There were 4 males and 1 female with an average age of 69.4 years (range, 65-74 years). Fracture was caused by falling injury from height in all cases. The average time between injury and operation was 6.8 days (range, 3-12 days). According to Anderson-D’Alonzo classification system, all 5 cases were classified as type II odontoid fractures; 1 case accompanied by anterior arch fracture. Four cases were rated as grade E and 1 case as grade D on the basis of Frankel classification system on nerve function evaluation. Percutaneous anterior odontoid and transarticular screw fixation were used in all cases. The operation time, intra-operative blood loss, X-ray exposure time, and complications were recorded. The X-ray films were taken to observe atlantoaxial stability and implant conditions. Results All patients were successfully complete the surgery, and no open operation was needed. The average operation time was 103.6 minutes (range, 93-114 minutes). The average intra-operative blood loss was 5.6 mL (range, 3-10 mL). The average X-ray exposure time was 24.2 seconds (range, 17-32 seconds). Good reduction of atlantoaxial joint and primary healing of incision were obtained in 5 patients. The average follow-up duration was 21.4 months (range, 12-35 months). Transient dysphagia occurred in 3 cases, and was cured after 5 days of expectant treatment. No major complications of carotid artery laceration, spinal cord injury, esophageal perforation, airway obstruction, and implant failure occurred. The X-ray films showed odontoid bony union, atlantoaxial stability and good position of screws. The average time of odontoid fracture union was 7 months (range, 5-10 months). Five patients had normal neurological function (Frankel grade E) at last follow-up. Three patients complained of neck discomfort and movement limitation and had normal daily activities without special therapy; the other 2 patients had no clinical symptom of discomfort. Conclusion Percutaneous anterior odontoid and transarticular screw fixation is a safe and effective procedure for treatment of type II odontoid fractures in the elderly patients with minimally invasive surgical advantages.
Objective To evaluate the prel iminary cl inical outcomes of percutaneous endoscopic lumbar discectomy (PELD) for patient with discogenic chronic low back pain (CLBP) and fail ing to respond to conservative treatment. Methods From June 2007 to May 2008, 52 patients with CLBP and fail ing to respond to conservative treatment were treated, including 15 males and 37 females aged 29-46 years old (average 38.2 years old). Those patients were diagnosed ith discogenic pain by low pressure discography. Duration of CLBP was 6-110 months with an average of 32.1 months. MRI exam revealed 108 “black intervertebral discs” low in signal on T2 image, including 3 discs of L2,3, 17 of L3,4, 48 of L4,5 and 40 of L5-S1. Pressure-controlled discography showed positive response, fluoroscopy or intraoperative CT confirmed annulus fibrosus tears of posterior intervertebral disc in 79 discs. PELD was performed. Visual analogue scale (VAS) was evaluated before operation, 1 month after operation and at the final follow-up. The cl inical outcome was determined by modified Macnab criteria at the final follow-up. Results The average operation time of each disc was 30.7 minutes (range 21-36 minutes), and the mean length of postoperative hospital stay was 3.7 days (range 2-5 days). No compl ications such as infection and the injury of blood vessels and nerves occurred. Transient paralysis of nerve occurred in 5 cases on operation day, and those symptoms were disappeared at the final follow-up visit without special treatment. Fifty-two cases were followed up for 3-15 months (average 7.3 months). VAS score before operation, 1 month after operation and at the final follow-up was (7.34 ± 1.52), (3.62 ± 0.92) and (1.57 ± 0.48) points, respectively, indicating there were significant differences compared with preoperative score (P lt; 0.01). According to the modified Macnab criteria, 11 cases were graded as excellent, 23 as good, 13 as fair, 5 as bad, and the excellent and good rate was 65.38%. Conclusion Prel iminary study suggests that PELD is safe and effective in treating patient with discogenic CLBP and fail ing to respond to conservative treatment.
Objective To compare the growth and extracellular matrix biosynthesis of nucleus pulposus cells (NPCs)and bone marrow mesenchymal stem cells (BMSCs) in thermo-sensitive chitosan hydrogel and to choose seed cells for injectable tissue engineered nucleus pulposus. Methods NPCs were isolated and cultured from 3-week-old New Zealand rabbits (male or female, weighing 150-200 g). BMSCs were isolated and cultured from bone marrow of 1-month-old New Zealand rabbits (male or female, weighing 1.0-1.5 kg). The thermo-sensitive chitosan hydrogel scaffold was made of chitosan, disodium β glycerophosphate, and hydroxyethyl cellulose. Then, NPCs at the 2nd passage or BMSCs at the 3rd passage were mixed with chitosan hydrogel to prepare NPCs or BMSCs-chitosan hydrogel complex as injectable tissue engineered nucleus pulposus. The viabil ities of NPCs and BMSCs in the chitosan hydrogel were observed 2 days after compound culture. The shapes and distributions of NPCs and BMSCs on the scaffold were observed by scanning electron microscope (SEM) 1 week after compound culture. The histology and immunohistochemistry examination were performed. The expressions of aggrecan and collagen type II mRNA were analyzed by RT-PCR 3 weeks after compound culture. Results The thermo-sensitive chitosan hydrogel was l iquid at room temperature and sol idified into gel at37 (after 15 minutes) due to crossl inking reaction. Acridine orange/propidium iodide staining showed that the viabil ity rates of NPCs and BMSCs in chitosan hydrogel were above 90%. The SEM observation demonstrated that the NPCs and BMSCs distributed in the reticulate scaffold, with extracellular matrix on their surfaces. The results of HE, safranin O histology and immunohistochemistry staining confirmed that the NPCs and BMSCs in chitosan hydrogel were capable of producing extracellular matrix. RT-PCR results showed that the expressions of collagen type II and aggrecan mRNA were 0.564 ± 0.071 and 0.725 ± 0.046 in NPCs culture with chitosan hydrogel, and 0.713 ± 0.058 and 0.852 ± 0.076 in BMSCs culture with chitosan hydrogel; showing significant difference (P lt; 0.05). Conclusion The thermo-sensitive chitosan hydrogel has good cellular compatibil ity. BMSCs culture with chitosan hydrogel maintains better cell shape, prol iferation, and extracellular matrix biosynthesis than NPCs.
ObjectiveTo investigate the clinical results and complication prevention of minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) in the treatment of single-segment severe lumbar spinal stenosis (LSS).MethodsThe clinical data of 112 patients with severe LSS treated with MIS-TLIF between January 2010 and January 2017 were retrospectively analyzed. There were 43 males and 69 females, aged 52-81 years, with an average age of 65.3 years. The disease duration ranged from 4 to 126 months, with an average of 10.5 months. Clinical manifestations: 104 cases of low back pain, 91 cases of nervous intermittent claudication of both lower limbs, 21 cases of unilateral nerve root pain and/or numbness, and 5 cases of cauda equina nerve injury. The 112 cases were all severe central spinal stenosis, including 32 cases with lateral recess stenosis, 20 cases with foramen stenosis, 9 cases with ossification of ligamentum flavum, 38 cases with disc herniation; 14 cases with two complications and 5 cases with three. Stenosis segment: L3, 4 in 6 cases, L4, 5 in 89 cases, and L5, S1 in 17 cases. Surgical methods included bilateral decompression through bilateral approach (60 cases), bilateral decompression through unilateral approach (15 cases), and unilateral decompression (37 cases). The operation time, intraoperative blood loss, visual analogue scale (VAS) score of low back pain and leg pain, Oswestry disability index (ODI) score, fusion rate, and surgical complications were recorded. At last follow-up, the lumbar fusion was evaluated by Bridwell method, grades Ⅰ and Ⅱ were expressed as fusion.ResultsThe operation time was 83-186 minutes (mean, 126.8 minutes), and the intraoperative blood loss was 65-630 mL (mean, 163.1 mL). All the 112 patients were followed up 25-49 months, with an average of 35.1 months. The VAS score of low back pain and leg pain and ODI score at each time point after operation were significantly improved when compared with preoperative scores (P<0.05). There was no significant difference between the VAS score of low back pain and leg pain and ODI score at the other time points except 1 month after operation (P<0.05). At last follow-up, 2 cases of cauda equina nerve injury recovered and 3 cases partially recovered. According to Bridwell classification criteria, 58 cases were grade Ⅰ, 47 cases were grade Ⅱ, and 7 cases were grade Ⅲ. The fusion rate was 93.8%. Perioperative complications included 5 cases of incision complications (superficial infection in 3 cases, hematoma formation in 2 cases), 19 cases of internal fixator complications (intraoperative end plate fracture in 8 cases, fusion cage sinking in 11 cases at last follow-up), and 15 cases of neurological complications (dural sac tear in 10 cases, transient neurological symptoms of lower extremities aggravated in 5 cases). Conclusion MIS-TLIF treatment of single-level severe LSS can achieve good clinical results, while there is a risk of serious complications. Full understanding of the clinical and imaging features of the disease and reasonable and careful operation are helpful to control the occurrence of cauda equina nerve damage.