后路减压内固定融合矫形治疗退变性腰椎侧凸伴椎管狭窄的临床研究

目的:探讨后路减压内固定融合矫形治疗退变性腰椎侧凸伴椎管狭窄的临床疗效。方法:将我院2009年1月~2015年1月收治的退变性腰椎侧凸伴椎管狭窄患者按照手术方法分为两组,实验组进行后路减压内固定融合矫形术治疗,对照组进行单纯后路减压固定矫形术治疗,对比两组患者术前、术后6个月和18个月的Cobb角、腰椎前凸角、日本骨科学会(JOA)评分、疼痛视觉模拟量表(VAS)情况,SRS-22国际标准量表评分情况以及出血量情况。结果:实验组术后18个月的Cobb角、腰椎前凸角分别为(16.8±5.16)°和(36.8±5.82)°,均分别低于对照组的(20.2±6.61)°和(41.2±5.67)°,且均低于术前(P0.05),而术前及术后6个月时两组比较无差异(P0.05);两组患者术后6个月和18个月的JOA评分、VAS评分比较均较术前明显改善(P0.05),且组间比较显示,术后18月两组比较均存在显著差异(P0.05);SRS-22国际标准评估量表显示,术后18个月两组患者的自理能力、自我评价、精神状态方面无显著差异(P0.05),而疼痛情况存在显著差异(P0.05)。两组术中出血量比较无统计学差异(P0.05)。结论:后路减压内固定融合矫形术治疗退变性腰椎侧凸伴椎管狭窄疗效显著,且后路减压内固定融合矫形术在改善患者的腰椎侧凸程度、功能障碍及疼痛程度方面优于单纯后路减压矫形内固定术,值得临床推广。     

根据退行性脊柱侧凸患者症状选择不同手术方案的临床研究

目的:探究根据退行性脊柱侧凸患者症状选择不同手术方案的治疗效果。方法:随机选取我院2007年9月到2015年10月收治的退行性脊柱侧凸患者124例,根据症状不同分A组和B组。A组62例患者腰背痛,接受长节段矫形内固定术;B组62例患者下肢症状明显,接受责任节段减压内固术。治疗期间记录两组手术时间、术中出血量、固定节段数及腰前凸角度,于治疗前、治疗后1个月以及末次随访时腰椎侧凸处的Cobb角,并采用视觉模拟评分法(VAS)和Oswestry功能障碍指数(ODI)评价患者疗效。结果:A组手术时间、出血量、固定节段数及腰前凸角度显著高于B组(P0.05);治疗后和末次随访两组患者VAS评分、ODI指数及Cobb角均有明显好转(P0.05),两组治疗后和末次随访之间的差异无统计学意义(P0.05)。结论:退行性脊柱侧凸在治疗时需根据患者具体症状选择不同的手术方案,长节段矫形内固定术耗时长、术中出血量多,在治疗时应谨慎,预防相关并发症的发生。     

Short-Term Effect of Unilateral Pedicle Screw Fixed Intervertebral Fusion in Treatment of Degenerative Disc Disease Via MAST QUADRANT Minimally Invasive System

To assess the short-term outcome of unilateral pedicle screw fixed intervertebral fusion surgery for degenerative disc disease via MAST QUADRANT minimally invasive system. Thirty patients with degenerative lumbar disease from September 2009 to September 2011 were enrolled and divided into two groups: (1) unilateral pedicle screw fixed intervertebral fusion via MAST QUADRANT system; and (2) conventional bilateral pedicle fixed intervertebral fusion via open surgery. The perioperative parameters (operation time, intraoperative blood loss, and length of stay) and the follow-up clinical curative effect parameters (VAS and ODI) were compared between two groups. All patients successfully completed surgery and were followed up for more than 1 year. The perioperative parameters of MAST QUADRANT system group were significantly better than the control group (P < 0.05). And the clinical curative effects were similar to conventional surgery (P > 0.05). Unilateral pedicle screw fixed intervertebral fusion via MAST QUADRANT system is a less invasive and safer surgical techniques. It offers a quick recovery and effective surgical option in the treatment of lumbar degenerative diseases.     

椎体加椎间植骨融合术在腰椎爆裂性骨折患者中的应用效果与安全性探究

目的:探讨椎体加椎间植骨融合术在治疗腰椎爆裂性骨折患者中的临床效果及安全性。方法:选取2016年12月～2017年10月我院骨科收治的腰椎爆裂性骨折患者90例,按照手术方式将患者分成研究组和对照组,每组45例。研究组给予后路内固定术联合椎体加椎间植骨术治疗,对照组给予后路内固定术联合后外侧植骨术治疗。比较两组患者的手术时间、手术出血量以及术后3个月和12个月的椎体Cobb角、患者术后骨折愈合情况、内固定有效情况。结果:研究组手术时间、术中出血量、术后3个月和12个月椎体Cobb角明显短于或低于对照组,但骨折愈合率、内固定有效率显著高于对照组,组间差异均有统计学意义(P0.05)。结论:椎体加椎间植骨融合术治疗腰椎爆裂性骨折的临床综合效果显著优于后路内固定术联合后外侧植骨术治疗,且安全性较好。     

椎弓根内固定联合椎体间植骨融合术治疗退行性腰椎滑脱症的临床探讨

目的:探讨椎弓根内固定联合椎体间植骨融合术治疗退行性腰椎滑脱症的临床效果。方法:回顾性分析我院2012年3月至2014年3月收治的30例采用椎弓根内固定联合椎体间植骨融合术治疗的退行性腰椎滑脱症患者临床资料,观察患者对手术效果的满意度,并对症状进行JOA评分。比较患者术前术后的腰椎X线的影像学变化,观察术后临近节段的退变发生率与影像的融合率。结果:术后随访1-3年发现患者JOA评分的平均改善率为(73.81±16.12)%,术后滑脱率与椎间高度均有明显改善,与术前比较差异具有统计学意义(P0.05)。术后影像学显示植骨融合A级15例,B级12例,C级3例,融合优良率为90%。结论:椎弓根内固定联合椎体间植骨融合术对退行性腰椎滑脱症具有显著的临床效果,不仅可以缓解疼痛,改善功能评分,而且使患者影像学变化恢复正常生理形态,是理想的手术方法之一。     

Expression of matrix metalloproteinase-1 (MMP-1) in Wistar rat's intervertebral disc after experimentally induced scoliotic deformity

Minimally invasive spine surgery is becoming more common in the treatment of adult lumbar degenerative disorders. Minimally invasive techniques have been utilized for multilevel pathology, including adult lumbar degenerative scoliosis. The next logical step is to apply minimally invasive surgical techniques to the treatment of adolescent idiopathic scoliosis (AIS). However, there are significant technical challenges of performing minimally invasive surgery on this patient population. For more than two years, we have been utilizing minimally invasive spine surgery techniques in patients with adolescent idiopathic scoliosis. We have developed the present technique to allow for utilization of all standard reduction maneuvers through three small midline skin incisions. Our technique allows easy passage of contoured rods, placement of pedicle screws without image guidance, and allows adequate facet osteotomy to enable fusion. There are multiple potential advantages of this technique, including: less blood loss, shorter hospital stay, earlier mobilization, and relatively less pain and need for pain medication. The operative time needed to complete this surgery is longer. We feel that a minimally invasive approach, although technically challenging, is a feasible option in patients with adolescent idiopathic scoliosis. Although there are multiple perceived benefits, long term data is needed before it can be recommended for routine use.     

椎旁肌退变与短节段腰椎融合内固定术后螺钉松动的相关性分析

摘要 目的：分析椎旁肌退变与短节段腰椎融合内固定术后螺钉松动的相关性。方法：回顾性分析2018年6月至2020年6月广州市番禺区中医院行短节段腰椎融合内固定术治疗的251例腰椎退行性疾病患者的临床资料，根据术后螺钉松动情况分为松动组（n=47）和对照组（n=204）。收集患者的临床资料，对比两组椎间植骨融合情况、螺钉直径、螺钉长度、螺钉椎内长度、椎旁肌的肌肉相对总横截面积（rtCSA）和脂肪浸润程度（FI）。应用多因素logistic回归分析短节段腰椎融合内固定术后螺钉松动发生的危险因素，并描绘受试者工作特征（ROC）曲线检验危险因素预测短节段腰椎融合内固定术后螺钉松动的效能。结果：251例患者平均随访时间（24.16±7.28）个月，其中47例患者在最终随访时发生螺钉松动，总体松动率18.73%。两组性别、骨密度比较差异有统计学意义（P＜0.05）。与对照组相比，松动组的多裂肌FI增高（P＜0.05）。与对照组相比，松动组的竖脊肌rtCSA减少，竖脊肌FI增高（P＜0.05）。多因素logistic回归分析显示竖脊肌FI较高是短节段腰椎融合内固定术后螺钉松动发生的独立危险因素，而竖脊肌rtCSA较高、骨密度较高则是保护因素（P＜0.05）。ROC曲线分析显示：骨密度、竖脊肌rtCSA、竖脊肌FI等3指标单独及联合应用时：ROC-AUC（0.95CI）分别为0.708（0.446～0.971）、0.736（0.495～0.951）、0.648（0.335～0.965）、0.842（0.719～0.957）。联合应用预测效能较高。结论：竖脊肌的退变是短节段腰椎融合内固定术后螺钉松动的危险因素。当骨密度＜-3.00 g/cm²、竖脊肌rtCSA＜1.45%及FI＞35.00%时，提示术后发生螺钉松动的可能性大，可作为短节段腰椎融合内固定术后评价螺钉松动风险的参考指标。     

A retrospective analysis of health-related quality of life in adolescent idiopathic scoliosis children treated by anterior instrumentation and fusion

Background

Idiopathic scoliosis is the most common type of spinal deformity. Scoliosis is defined as a lateral curvature of the spine greater than 10° accompanied by rotation of the vertebrae. The treatment available for adolescent idiopathic scoliosis is observation, orthosis, and surgery. The surgical options include open anterior release and instrumentation, posterior instrumentation, and thoracoscopic approaches. The Scoliosis Research Society Questionnaire (SRS-30) is a specific instrument to measure health-related quality of life in patients with scoliosis, who had or had not undergone surgery. The purpose was to assess the post-operative functional outcome using SRS-30 in children who underwent anterior release, instrumentation, and fusion using autogenous rib graft for adolescent idiopathic scoliosis (AIS).

Methods

In a retrospective cohort study, 25 patients between the ages of 11 and 17 years, who underwent anterior release, instrumentation, and fusion using autogenous rib graft for adolescent idiopathic scoliosis (AIS) between 2008 and 2014, were included in the study.

Results

The total average score was 4.26 with a SD of 0.014 and had maximum average score 4.5 (for pain) and minimum average score 3.8 (for self-image).

Conclusion

Anterior release, instrumentation, and fusion using autogenous rib graft is having good functional outcome in all domains.

     

自体髂骨移植用于后路椎弓根钉棒系统矫形内固定术治疗脊柱侧凸的临床效果及对预后的影响

目的:探讨自体髂骨移植用于后路椎弓根钉棒系统矫形内固定术治疗脊柱侧凸的临床效果及对患者预后的影响。方法:选取2014年4月至2017年4月90例在我院及山西医科大学进行手术治疗的退行性脊柱侧凸患者作为研究对象,按照随机法将患者分为两组,各组45例患者。对照组采用后路椎弓根钉棒系统矫形内固定术,观察组采用后路椎弓根钉棒系统矫形内固定结合自体髂骨移植术。比较两组患者围手术期情况,术前、术后7天及术后12个月腰椎后凸角度、Cobb角、JOA评分、ODI评分的变化及术后并发症发生情况。结果:两组患者手术时间、术中出血量、体温恢复时间、WBC恢复正常时间、引流管置管时间比较差异无统计学意义(P0.05)。两组患者术后腰椎前凸角度、Cobb角较手术前明显改善(P0.05);术后12个月,观察组患者腰椎前凸角度高于对照组,Cobb角显著低于对照组(P0.05)。两组患者术后JOA评分高于手术前,ODI评分低于手术前(P0.05);观察组患者术后12个月JOA评分高于对照组,ODI评分低于对照组(P0.05)。观察组患者并发症发生率显著低于对照组(P0.05)。结论:自体髂骨移植应用于后路椎弓根钉棒系统矫形内固定术治疗退行性脊柱侧弯效果较好,不仅可纠正脊柱侧弯,同时可减轻患者疼痛感及不适感,安全性较高。     

Real time noninvasive assessment of external trunk geometry during surgical correction of adolescent idiopathic scoliosis

Study design

Retrospective study.

Objective

To evaluate the radiological results of fusion with segmental pedicle screw fixation in juvenile idiopathic scoliosis with a minimum 5-year follow-up.

Summary of background data

Progression of spinal deformity after posterior instrumentation and fusion in immature patients has been reported by several authors. Segmental pedicle screw fixation has been shown to be effective in controlling both coronal and sagittal plane deformities. However, there is no long term study of fusion with segmental pedicle screw fixation in these group of patients.

Methods

Seven patients with juvenile idiopathic scoliosis treated by segmental pedicle screw fixation and fusion were analyzed. The average age of the patients was 7.4 years (range 5–9 years) at the time of the operation. All the patients were followed up 5 years or more (range 5–8 years) and were all Risser V at the most recent follow up. Three dimensional reconstruction of the radiographs was obtained and 3DStudio Max software was used for combining, evaluating and modifying the technical data derived from both 2d and 3d scan data.

Results

The preoperative thoracic curve of 56 ± 15° was corrected to 24 ± 17° (57% correction) at the latest follow-up. The lumbar curve of 43 ± 14° was corrected to 23 ± 6° (46% correction) at the latest follow-up. The preoperative thoracic kyphosis of 37 ± 13° and the lumbar lordosis of 33 ± 13° were changed to 27 ± 13° and 42 ± 21°, respectively at the latest follow-up. None of the patients showed coronal decompensation at the latest follow-up. Four patients had no evidence of crankshaft phenomenon. In two patients slight increase in Cobb angle at the instrumented segments with a significant increase in AVR suggesting crankshaft phenomenon was seen. One patient had a curve increase in both instrumented and non instrumented segments due to incorrect strategy.

Conclusion

In juvenile idiopathic curves of Risser 0 patients with open triradiate cartilages, routine combined anterior fusion to prevent crankshaft may not be warranted by posterior segmental pedicle screw instrumentation.     

脊髓型颈椎病手术治疗新进展

颈椎病是指因颈椎间盘退行性变及其继发改变所导致的脊髓、神经、血管等结构受压而表现出的一系列临床症状和体征,根据发病机制可分为神经根型、脊髓型、椎动脉型、交感型、混合型,以及近年来受到重视的脊髓前动脉受压症等,脊髓型颈椎病是其中一种严重类型,保守治疗效果不佳,目前临床上常用的治疗方法为手术治疗。根据患者病情手术的入路可分为前路和后路,本文分别从手术的前后入路出发,对近年来脊髓型颈椎病手术治疗方式的进展作一综述。     

Bryan颈椎间盘假体置换术对脊髓型颈椎病患者疗效及颈椎生物力学的影响

目的:探讨Bryan颈椎间盘假体置换术对脊髓型颈椎病患者疗效及颈椎生物力学的影响。方法:选取2015年1月到2016年12月期间在我院接受治疗的脊髓型颈椎病患者48例,根据手术方式的不同将其分为植骨融合组(25例)和假体置换组(23例),其中植骨融合组采用颈椎前路减压植骨融合术进行治疗,假体置换组采用Bryan颈椎间盘假体置换术进行治疗。比较两组患者的日本骨科协会(JOA)颈椎评分、颈椎功能障碍指数(NDI)评分、视觉模拟疼痛量表(VAS)评分、颈椎生理曲度、颈椎活动度、手术节段活动度、上邻近节段活动度、下邻近节段活动度,并比较两组患者的并发症情况。结果:术后12个月假体置换组的NDI评分明显低于植骨融合组(P0.05);术后6个月、术后12个月植骨融合组的颈椎活动度低于假体置换组(P0.05);术后1个月、术后3个月、术后6个月、术后12个月假体置换组的手术节段活动度高于植骨融合组(P0.05);术后12个月植骨融合组的上邻近节段活动度、下邻近节段活动度高于假体置换组(P0.05);两组患者随访期间颈部轴性症状发生率比较差异有统计学意义(P0.05)。结论:与颈椎前路减压植骨融合术比较,Bryan颈椎间盘假体置换术对脊髓型颈椎病患者的远期疗效更佳,可更好的改善患者的颈椎生物力学,降低颈部轴性症状发生率,值得临床推广应用。     

Treatment of thoraco-lumbar curves in adolescent females affected by idiopathic scoliosis with a progressive action short brace (PASB): assessment of results according to the SRS committee on bracing and nonoperative management standardization criteria

 

In children with Prader Willi syndrome (PWS), besides growth hormone (GH) therapy, control of the food environment and regular exercise, surgical treatment of scoliosis deformities seems the treatment of choice, even though the risks of spinal surgery in this specific population is very high. Therefore the question arises as to whether the risks of spinal surgery outweigh the benefits in a condition, which bears significant risks per se. The purpose of this systematic review of the Pub Med literature was to find mid or long-term results of spinal fusion surgery in patients with PWS, and to present the conservative treatment in a case study of nine patients with this condition.

Methods

Types of studies included; all kinds of studies; retrospective and prospective ones, which reported upon the outcome of scoliosis surgery in patients with PWS. Types of participants included: patients with scoliosis and PWS. Type of intervention: surgery. Search strategy for identification of the studies; Pub Med; limited to English language and bibliographies of all reviewed articles. Nine patients with PWS from our data-base treated conservatively have been found, being 19 years or over at the time this study has been performed. The results of conservative management are described and related to the natural history and treatment results found in the Pub Med review.

Results

From 2210 titles displayed in the Pub Med database with the key word being "Prader Willi syndrome", 5 different papers were displayed at the date of the search containing some information on the outcome of surgery and none appeared to contain a mid or long-term follow-up. The PWS patients treated conservatively from our series all stayed below 70° and some of which improved.

Discussion

If the curve of scoliosis patients with PWS can be kept within certain limits (usually below 70 degrees) conservatively, this treatment seems to have fewer complications than surgical treatments. The results of our retrospective study of nine patients demonstrate that scoliosis in this entity plays only a minor role and surgery is unnecessary when high quality conservative management exists.

Conclusion

There is lack of the long follow-up studies in post-surgical cases in patients with PWS and scoliosis. The rate of complications of spinal fusion in patients with PWS and scoliosis is very high and the death rates have been found to be higher than in patients with Adolescent Idiopathic Scoliosis (AIS). The long-term side-effects of the intervention are detrimental, so that the risk-benefit ratio favours the conservative approaches over spinal fusion surgery.     

Treatment of massive thoracolumbar wounds and vertebral osteomyelitis following scoliosis surgery

Closure of thoracolumbar wounds and vertebral osteomyelitis after scoliosis surgery often proves difficult due to tautness and lack of usable tissue, and the resulting dead space containing metallic fixation devices is predisposed to infections and complications. The authors present their experience with 33 patients in whom massive thoracolumbar wounds and vertebral osteomyelitis developed following scoliosis surgery. Postoperative infection, due to the lack of vascularized tissue and presence of metallic hardware near the wound, is common and extremely counterproductive; within these cavernous wounds lie infected vertebrae, metallic hardware, and bone graft. The use of a modified and extended latissimus dorsi myocutaneous flap to close and supply blood to wounds in the lower thoracic and thoracolumbar areas is described. This surgical approach, predicated on effective débridement along with reconstruction by transposition of vascularized tissue, allows the wound to close and drastically decreases the risk of postoperative infection. Furthermore, for wounds already infected, the procedure allows for closure and increased blood supply to the area, thus giving the wound a much greater ability to heal. For wounds involving the lumbosacral area, the authors combine this with a transposed gluteus maximus muscle flap to obtain coverage over the caudal extent of the wound. In this study, all flaps accomplished their intended purpose: to secure the healing of once-infected wounds and to allow preservation of orthopedic instrumentation and bone graft. Follow-up revealed no flap losses, pseudarthroses, or loss of orthopedic instrumentation in the study group.     

Sagittal spinopelvic malalignment in degenerative scoliosis patients: isolated correction of symptomatic levels and clinical decision-making

Background

This study aims to determine if (1) loss of lumbar lordosis (LL), often associated with degenerative scoliosis (DS), is structural or rather largely due to positional factors secondary to spinal stenosis; (2) only addressing the symptomatic levels with a decompression and posterolateral fusion in carefully selected patients will result in improvement of sagittal malalignment; and (3) degree of sagittal plane correction achieved with such a local fusion could be predicted by routine pre-operative imaging.

Methods

A retrospective study design with prospectively collected imaging data of a consecutive series of surgically treated DS patients who underwent decompression and instrumented fusion at only symptomatic levels was performed. Pre- and post-operative plain radiographs and pre-operative magnetic resonance imaging (MRIs) of the spinopelvic region were analyzed. LL, pelvic incidence (PI), pelvic tilt (PT), and sacral slope (SS) were assessed in all patients. As a requirement for the surgical strategy, all patients presented with a pre-operative PI-LL mismatch greater than 10^°. Post-operative complications were assessed.

Results

Pre-operative MRIs and lumbar extension radiographs revealed a mean LL of 42^° (range 10–66^°) and 48^° (range 20–74^°), respectively, in 68 patients (mean follow-up 29?months). LL post-operatively was corrected to a mean PI-LL of 10^°. Of patients who achieved PI-LL mismatch within 10^o on their pre-operative extension lateral lumbar radiographs, 62.5% were able to maintain a PI-LL mismatch within 10^° on their initial post-operative films. Only 37.5% were not able to achieve that mismatch on extension radiographs (p?=?0.001, OR?=?9.58). Similarly, 54.2% were able to achieve a PI-LL?<?10^° on initial post-operative radiographs, when pre-operative MRI revealed a PI-LL mismatch within 10^°. In contrast, only 20.5% achieved that goal post-operatively if their mismatch was greater than 10^o on their MRI (p?=?0.003, OR?=?4.25).

Conclusion

With a decompression and instrumented fusion of only the symptomatic levels in symptomatic DS patients, we were able to achieve a PI-LL mismatch to within 10^°. The loss of LL observed pre-operatively may be largely positional rather than structural. The amount of LL correction observed immediately after surgery can be predicted from pre-operative lumbar extension radiographs and supine sagittal MRI.

     

The effect of limited interlaminar decompression versus complete laminectomy on intrathecal volume in degenerative lumbar spinal stenosis.

INTRODUCTION: There is a controversial discussion about the adequate surgical procedure for degenerative lumbar spinal stenosis. Due to the observation that the degenerative lumbar spinal stenosis takes place predominantly at the interlaminar region on the level of the disc involving facets and bulging of the ligamentum flavum, resection of the whole lamina might not be necessary. A biomechanical study was designed to assess the effect of different decompression techniques using cadaver lumbar spine models. METHODS: Twelve cadaver spines with CT verified degenerative lumbar spinal stenosis were dissected in order to measure the volume of the dural sac at different flexion and extension angles. Each segment (L3/4, L4/5) was decompressed first by limited interlaminar decompression and second by complete laminectomy. Intrathecal volume measurements were taken initially, after limited interlaminar decompression and after complete laminectomy. RESULTS: Before surgical procedure, the cadaver spines showed an increase of the intrathecal volume in flexion and decrease in extension. After limited interlaminar decompression, there was a significant reduction of volume loss in extension. There was no significant additional reduction of volume loss in extension after complete laminectomy in comparison to limited interlaminar decompression. CONCLUSION: The results allow to conclude that limited interlaminar decompression is efficient for decompression in degenerative lumbar spinal stenosis.     

半椎板切除全椎管减压治疗退行性腰椎管狭窄症的效果观察

目的：探讨半椎板切除全椎管减压治疗退行性腰椎管狭窄症的手术效果。方法：2005年7月．2009年6月手术治疗退行性腰椎管狭窄症的患者162例,均行半椎板切除全椎管减压结合椎弓根内固定及后外侧植骨融合术。结果：随访6～24个月,平均10．5个月,术后JOA评分由术前的（15．26±5．26）分提高到术后的（21．38±5．16）分（配对t检验P〈0．05）。结论：行半椎板切除全椎管减压结合椎弓根内固定及后外侧植骨融合手术治疗腰椎管狭窄症既可以起到椎管彻底减压的目的,又可以尽可能保留脊柱后柱结构的稳定性及完整性。     

Suppression of mTOR signaling pathway promotes bone marrow mesenchymal stem cells differentiation into osteoblast in degenerative scoliosis: in vivo and in vitro

To investigate the role of mTOR signaling pathway in bone marrow mesenchymal stem cells (BMSCs) differentiation into osteoblast in degenerative scoliosis (DS). The rat model of DS was established. Thirty-two Sprague–Dawley (SD) rats were selected and divided into the normal control group, the positive control group (normal rats injected with rapamycin), the negative control group (DS rats injected with PBS) and the experiment group (DS rats injected with rapamycin). H&E staining was performed to observe the osteogenesis of scoliosis. The BMSCs were obtained and assigned into seven groups: the normal control group, the positive control group, the negative control group and 1.0/10.0/100.0/1000.0 nmol/L experiment groups. Flow cytometry was conducted to testify cell cycle. The mRNA and protein expressions of mTOR and osteoblastic differentiation markers were measured by qRT-PCR and western blotting. In vivo, compared with the negative control group, bone trabecular area and the number of differentiated bone cells were significantly increased in the experiment groups. In vitro, at 24 and 48 h after rapamycin treatment, compared with the negative control group, BMSCs at G0/G1 stage increased, but BMSCs at S stage decreased in the 1.0/10.0/100.0/1000.0 nmol/L experiment groups; the expressions of mTOR and p70-S6K1 proteins were reduced in the 1.0/10.0/100.0/1000.0 nmol/L experiment groups, while ALP activity, OC levels, calcium deposition, Co1-I protein expression and the mRNA expressions of OC and Co1-I were significantly increased. Suppression of mTOR signaling pathway by rapamycin could promote BMSCs differentiation into osteoblast in DS.     

Fifteen to twenty-five year functional outcomes of twenty-two patients treated with posterior Cotrel-Dubousset type instrumentation: a limited but detailed review of outcomes

Background

Long-term outcomes of patients undergoing extensive fusions for adolescent idiopathic scoliosis (AIS) have conflicting results. Moskowitz found uninstrumented scoliosis fusion patients had similar back pain as a normal age matched population. Recently, long-term outcomes of patients with Harrington rod instrumentation were reviewed and found similar functional outcome scores to non-scoliosis patients, with trending toward worse outcomes when fusions extended to L4. Our study examined long-term functional outcomes of patients treated with Cotrel-Dubousset (CD) instrumentation and determined whether distal level of instrumented fusion (L4 and L5) correlate with increased back pain or lower functional level.

Methods

Retrospective review of AIS surgeries from 1986 to 1996 was undertaken. Patient demographics and surgical data were collected via case-note audit. Patients were contacted and asked to complete a series of functional outcome questionnaires including visual analog scales (VAS) for pain, Short-Form 36 (SF-36), Scoliosis Research Society 22 (SRS-22) and Oswestry Disability Index (ODI) for function. ANOVA technique categorically compared outcome scores to most distal levels of fusion. Linear regression compared patient reported outcomes to time elapsed since surgery. Statistical significance was p?<?0.05.

Results

One hundred twelve patients were identified, 50 patients were contacted, and 22 agreed to participation and completed a full assessment. Follow-up time since surgery ranged from 15 to 26 years and age ranged from 30 to 43 years. Six patients reported daily VAS back pain of ≥5; with a mean of 2.5. Back pain was not associated with level of distal fusion (p?=?0.92). ODI was 15.36, with six patients' ODI >20. No relationship was shown between ODI and distal level of fusion (p?=?0.72). SF-36 and SRS 22 values were also not related to distal level of instrumentation. Patient reported VAS back pain scores (r²?=?0.18, p?=?0.05), ODI (r²?=?0.09, p?=?0.17), and SF-36 and SRS-22 were not worse in patients with longer follow-up over time. Back pain and certain functional score subcategories of the SF-36 and SRS-22 trended toward improved results over time.

Conclusions

Most patients who underwent multi-segment spinal fixation appeared to do well long-term, with minimal back pain. Lowest instrumented segment did not appear to be associated with increased back pain after 15 to 25 years follow-up.

     

Spectral CT Imaging in Patients with Budd-Chiari Syndrome: Investigation of Image Quality

To assess the image quality of monochromatic imaging from spectral CT in patients with Budd-Chiari syndrome (BCS), fifty patients with BCS underwent spectral CT to generate conventional 140 kVp polychromatic images (group A) and monochromatic images, with energy levels from 40 to 80, 40 + 70, and 50 + 70 keV fusion images (group B) during the portal venous phase (PVP) and the hepatic venous phase (HVP). Two-sample t tests compared vessel-to-liver contrast-to-noise ratio (CNR) and signal-to-noise ratio (SNR) for the portal vein (PV), hepatic vein (HV), inferior vena cava. Readers’ subjective evaluations of the image quality were recorded. The highest SNR values in group B were distributed at 50 keV; the highest CNR values in group B were distributed at 40 keV. The higher CNR values and SNR values were obtained though PVP of PV (SNR 18.39 ± 6.13 vs. 10.56 ± 3.31, CNR 7.81 ± 3.40 vs. 3.58 ± 1.31) and HVP of HV (3.89 ± 2.08 vs. 1.27 ± 1.55) in the group B; the lower image noise for group B was at 70 keV and 50 + 70 keV (15.54 ± 8.39 vs. 18.40 ± 4.97, P = 0.0004 and 18.97 ± 7.61 vs. 18.40 ± 4.97, P = 0.0691); the results show that the 50 + 70 keV fusion image quality was better than that in group A. Monochromatic energy levels of 40–70, 40 + 70, and 50 + 70 keV fusion image can increase vascular contrast and that will be helpful for the diagnosis of BCS, we select the 50 + 70 keV fusion image to acquire the best BCS images.