Treatment options and prognosis for repeatedly recurrent giant cell tumor of the spine

Background

Giant cell tumor of the spine has high rate of postoperative recurrence. There are not much published studies on repeatedly recurrent GCTS (RRGCTS). Also, there are controversies as to the prognostic factors and treatment options for RRGCTS.

Methods and materials

A retrospective survival analysis between 2000 and September 2014 was performed on the 74 times of in-hospital treatment of the 21 patients. Recurrence-free survival was defined as the time between the date of surgery and the date of recurrence. Factors with P values <0.05 in univariate analysis were subjected to multivariate analysis by means of proportional hazard analysis.

Result

A total of 21 patients comprising ten males and 11 females with a mean age of 29.7 years (range 15–49) were included, with a total of 74 times of surgery performed. Eighteen patients had no evidence of disease. Univariate and multivariate analysis suggested that total spondylectomy and bisphosphonate therapy were independent prognostic factors for better RFS in RRGCTS patients.

Conclusion

Patients of RRGCTS are suitable for further surgical treatment with relatively good healing process and restoration of nervous function. Early diagnosis of recurrence may be associated with better prognosis. Total spondylectomy in combination with bisphosphonate therapy could reduce postoperative recurrence rate.

     

钛缆经喙突-锁骨固定技术治疗肩锁关节损伤

[目的]探讨Tossy分类Ⅲ型的肩锁关节损伤手术治疗新方法.[方法]通过回顾性研究,对比两种方法治疗TossyⅢ型肩锁关节脱位患者共48例的疗效.病例按手术方法不同分两组:钛缆经喙突、锁骨固定组(25例),及钩钢板治疗组即对照组(23例);术中对所有病例均不过多的暴露和修复损伤的喙锁韧带.所有病例12～19个月后取出内植物,对所有患者的临床症状、体征和影像学表现进行随访,对结果进行统计学分析.[结果]平均随访时间为3.5年,钛缆经喙突、锁骨固定组:Constant-Murley评分平均(93.4±8.3)分,Karlsson评分优良率96%,并发症发生率4%;钩钢板固定组:Conslant-Mudey评分平均(88.1±9.5)分,Karlsson评分优良率87%,并发症发生率13%.经方差齐性检验和独立样本t检验,两组Constant-Murley评分有明显统计学差异,P＜0.05.[结论]钛缆经喙突-锁骨固定技术是治疗肩锁关节脱位的一种符合生理学原理、简便和效果良好的方法.不过多的暴露和修复喙锁韧带对新鲜损伤病例愈合无明显影响却能减少损伤.     

Reconstructed bladder innervation above the level of spinal cord injury to produce urination by abdomen-to-bladder reflex contractions

Neurogenic bladder dysfunction following spinal cord injury is a major medical and social problem for which there is no ideal treatment strategy. This paper describes the authors' attempts to establish bladder reinnervation, by establishing an abdomen-to-bladder reflex pathway, in a patient with an injury to the conus medullaris.     

温敏性壳聚糖止血膜的止血作用及体内降解吸收

背景：尽管温敏性壳聚糖是壳聚糖的一种,但其止血效果、组织相容性及体内代谢吸收情况还需要验证。目的：探讨温敏性壳聚糖止血膜的止血作用、体内降解和组织相容性。方法：取SD大鼠48只,随机均分为4组,同时进行两种实验：①制作肝脏创面出血模型,其中3组分别采用温敏性壳聚糖止血膜、纤维素止血棉和明胶海绵止血材料贴敷大鼠肝创面止血,以不做任何处理的为空白对照。记录出血时间及出血量。②在上述3组大鼠的股四头肌内分别再植入对应的止血材料,空白对照组不植入任何材料。术后1,2,3,4,6周取两处创面行大体观察,术后4周行苏木精-伊红染色和电镜观察。结果与结论：温敏性壳聚糖组、纤维素组止血时间和出血量少于空白对照组、明胶海绵组(P < 0.05)。温敏性壳聚糖止血膜于术后6周完全降解,纤维素止血棉于术后3周完全降解,明胶海绵于术后2周完全降解。温敏性壳聚糖组肝小叶结构完整,肝细胞结构基本正常,肿胀轻,炎症细胞浸润程度轻,电镜显示整个肝细胞外形结构清楚,细胞核无破损,细胞器良好;肌肉纤维结构完整,炎症细胞浸润程度轻,电镜显示肌纤维走向整齐,肌细胞核形态正常,细胞器良好。可见温敏性壳聚糖止血膜具有较好的止血作用和组织相容性。中国组织工程研究杂志出版内容重点：生物材料;骨生物材料; 口腔生物材料; 纳米材料; 缓释材料; 材料相容性;组织工程全文链接：     

Zero-P椎间融合器颈椎前路置入内固定治疗颈椎病的优势

背景：颈前路椎间盘切除减压植骨融合使用颈前路钢板可能引起治疗后吞咽困难等并发症。 目的：观察采用颈椎前路一体化Zero-p椎间融合器置入治疗颈椎病的临床疗效以及减少治疗后并发症的优势。 方法：采用颈椎前路一体化Zero-p椎间融合器行颈前路椎间盘切除减压植骨融合治疗颈椎病患者51例。在治疗前、治疗后第3天,治疗后3,6个月,治疗后1年及2年等时间节点采用颈部及上肢疼痛目测类比评分、颈椎功能障碍指数、日本矫形外科学会评分法对患者的神经功能情况进行评估;采用吞咽困难评分法对患者术后吞咽困难相关并发症的发生情况进行评估;拍摄颈椎正侧位及动力位X射线片评价术后植骨融合程度及内固定相关并发症情况。 结果与结论：患者随访时间为6-30个月,平均15.4个月。治疗后切口均Ⅰ期愈合,所有患者治疗后获得疼痛缓解,肌力恢复;目测类比评分及颈椎功能障碍指数评分均较术前有显著改善;脊髓型颈椎病患者日本矫形外科学会评分平均改善率为85.7%。治疗后第2天有7例患者出现轻、中度的吞咽困难。随访期间未发现内置物沉降,也未发生螺钉松动、断裂或内固定器移位等并发症。表明颈前路椎间盘切除减压植骨融合式中采用颈椎前路一体化Zero-p椎间融合器置入治疗颈椎病的近期临床效果良好,其设计同时具备了颈椎间融合器以及颈椎前路固定钢板的优点,内固定相关并发症少。中国组织工程研究杂志出版内容重点：人工关节;骨植入物;脊柱;骨折;内固定;数字化骨科;组织工程全文链接：     

Modelling of the passive mobility in human tarsal gears implications from the literature

The biomechanics of the human tarsus have been extensively modelled using different types of links within the tarsal bones. Since movement coupling ratios between the calcaneus and tibia have been reported to change continuously, many recent studies accept neither a single rigid hinge joint nor a universal joint representing movement coupling between the rearfoot and lower leg. Traditionally, bony structures and ligaments limiting the range of motion are considered in kinematic chains. However, recent studies suggest distinguishing between limiting (strained) and guiding (isometric) ligaments. The consideration of guiding ligaments in models of tarsal gears has already been shown to improve the simulation of tarsal movements in the sagittal plane. To improve the knowledge on movement coupling, e.g. three-dimensional, additional tarsal gears need to be established. The large discrepancies of the reported movement coupling ratios indicate that there is presently no validation available which allows to characterisation of human tarsal function to an acceptable degree.     

MicroRNA-10a, -210, and -563 as circulating biomarkers for ossification of the posterior longitudinal ligament

BACKGROUND CONTEXTThe presence of ossification of posterior longitudinal ligament (OPLL) can lead to symptomatic spinal cord compression and myelopathy. The surgical approach in patients with myelopathy is influenced by the presence of OPLL. Diagnose of OPLL currently requires computed tomography which incurs a large dose of radiation. Circulating disease-specific microRNAs (miRNAs) may serve as promising diagnostic markers with no radiation and easy accessibility for OPLL patients.PURPOSEThe purpose of this study is to evaluate the accuracy and significance of OPLL-specific microRNAs in discriminating OPLL from normal and intervertebral disc degenerated (IDD) patients by detecting the microRNAs’ plasma level.STUDY DESIGN/PATIENT SAMPLESThe level of microRNAs in OPLL patients’ plasma or serum were detected and compared to that of normal and IDD patients to evaluate the accuracy and significance of diagnosing OPLL.METHODSTaking advantage of the high through-put microRNA sequencing data, we selectively tested the ten most differentially regulated microRNAs in patients with: (1) radiologically diagnosed OPLL (n = 68), (2) radiologically diagnosed disc herniated patients with no evidence of OPLL (n = 45), (3) non-OPLL and nonmyelopathy patients (n = 53).The feasibility of the biomarkers in identifying OPLL was assessed through analysis of sensitivity, specificity, accuracy, negative predictive value, positive predictive value, and area under the curve (AUC) values.RESULTSOf the ten miRNAs validated, miR-10a-3p, miR-10a-5p, miR-563, miR-210-3p, and miR-218-3p showed significance between OPLL and non-OPLL blood samples. While miR-10a-5p, miR-563, and miR-210-3p showed high accuracy and significance in identifying OPLL from other groups individually, and an index that combines these miRNAs achieved the highest accuracy and AUC among these individual miRNAs.CONCLUSIONSAnalysis of miR-10a-5p, miR-563, and miR-210-3p may be of important value in diagnosing OPLL. These markers maybe useful in a clinical setting in the early detection of OPLL patients by blood testing.