Local application of basic fibroblast growth factor increases the risk of local infection after trauma: An in-vitro and in-vivo study in rats

Introduction?Local application of growth factors to stimulate wound and fracture healing is attracting increasing interest. We studied the effect of local application of a potent angiogenic growth factor, basic fibroblast growth factor (bFGF), on resistance to local infection after soft tissue trauma.

Methods?For in-vitro and in-vivo experiments, we used recombinant human bFGF. The in-vitro investigations were performed by isolation of human leukocyte fractions, cytokine analysis, phagocytosis assay, flow cytometry, and LDH assay. For the in-vivo investigation, a paired comparison of infection rates was carried out on Sprague-Dawley rats after standardized, closed soft tissue trauma and local, percutaneous bacterial inoculation of different concentrations of Staphylococcus aureus (2 × 10⁴ to 2 × 10⁷ colony-forming units (cfu)). The lower leg was treated with 1, 10 or 100 ng bFGF (16 animals for each concentration) and without bFGF (16 animals).

Results?Cytotoxic reactions due to the concentrations of bFGF used could be excluded in the in-vitro tests since incubations of isolated peripheral blood mononuclear cells (PBMCs) with increasing concentrations of bFGF for 24 h did not lead to an increase in the release of lactate dehydrogenase in the culture supernatants compared to corresponding control incubations without any bFGF added. A significant increase in cytokine release was observed after the co-incubation of PBMCs with 100 or 200 ng of the same bFGF that was used for the animal experiments. Furthermore, the capacity of phagocytes in whole blood to phagocytose bacteria was suppressed in the presence of 100 ng exogenously added bFGF. We found continuously reduced granulocytic phagocytosis in FGF-supplemented blood compared to non-supplemented blood.

In the in-vivo investigation, the infection rate for the group without bFGF was 0.25. In the groups with 1, 10 and 100 ng bFGF, the infection rates were 0.5, 0.7 and 0.8, respectively. A dose-dependent increase in infection rate was observed after local application of bFGF, compared to the untreated control group. The difference in infection rates for the groups in which 10 and 100 ng bFGF was used, relative to the group without bFGF, was statistically significant.

Interpretation?If these initial results are confirmed for other potent angiogenic growth factors, then the local use of growth factors for stimulation of wound and bone healing—a main focus of current research in traumatology—will have to be reconsidered and preceded with a strict evaluation of the risks and benefits.     

合并骶骨裂的腰椎椎弓峡部裂的手术治疗策略

[目的]探讨合并骶骨裂的腰椎椎弓峡部裂手术治疗原则。[方法]回顾性研究一组合并骶骨裂的腰椎椎弓峡部裂病人共26例，男性19例，女性7例；平均年龄23．2岁。所有病人均经过X线、CT、MRI检查，并在此基础上将椎间盘退变分为5级，椎体滑移4度分级，并且提出骶骨裂新的分型方法：A型骶骨椎板单侧发育不良，但与棘突仍有相连，仅仅为椎板之间有裂隙；B型骶骨双侧板均发育不良，棘突呈游离状态；C型骶骨椎板完全缺如，棘突缺如；D型骶骨裂合并其他畸形，如骶骨终板钩状、L5横突畸形、腰椎裂。[结果]本组手术方式包括单椎节固定9例，单节段固定13例，2节段固定4例。随访26例，随访时间6～37个月，平均11．2个月，随访疗效结果：优8例，良13例，可5例，差0例。[结论]对于腰椎峡部裂合并骶骨裂病人手术选择的问题，建议应注意骶骨裂的分型、腰椎峡部裂的滑移程度及椎间盘退变情况。     

腰椎退变性滑脱症(附24例手术报告)

1981～1989年我科对24例有马尾神经症状的腰椎退变性滑脱症进行手术治疗。腰椎退变性滑脱症老年人发病率高,其病理是继发性椎管,侧隐窝狭窄,小关节增生,黄韧带肥厚,椎间盘退变突出等改变,造成对神经根或马尾神经的压迫,临床表现似腰椎间盘突出症。作者根据病因不同采用三种术式。细致操作,充分减压,解除压迫因素是手术和疗效的关键。     

Uroneurological assessment of spina bifida cystica and occulta

AIMS: Spina bifida is a rare but well-documented congenital spinal anomaly comprising a cystic form, which appears in infancy, and an occult form, which appears in late childhood and in adulthood. Herein, we report the results of uroneurological assessment in patients with spina bifida cystica and occulta, with respect to diagnosis and management of the disorders. METHODS: We performed a neurological examination, urinary questionnaire, and urodynamic studies in 28 consecutive patients with urinary symptoms, including 16 with the cystic form (nine male and seven female patients, ages 2 to 25 years), all of whom underwent neonatal surgical management, and 12 with occult form (six men and six women, ages 7 to 32 years) diagnosed by myelography and spinal magnetic resonance imaging who did not undergo surgery. RESULTS: Neurological examination revealed a combination of flaccid and spastic paresis, with dominant lower motoneuron signs in the cystic form, whereas there were dominant upper motoneuron signs in the occult form. Four patients with occult spina bifida presented with urinary symptoms as the sole initial complaint. There was no correlation between neurological findings and urodynamic abnormalities. Urinary incontinence and enuresis were common at all ages, and large post-micturition residuals and vesicoureteral reflux were not uncommon, particularly in the cystic form. Bladder abnormalities in the cystic and occult forms included detrusor hyperreflexia during filling in 38% and 42%, low compliance detrusor in 81% and 67%, supersensitivity to bethanechol in two (100%) patients with the cystic form and in three of four (75%) with the occult form, and impaired bladder sensation in 25% and 8% in each form, respectively. Urethral abnormalities in cystic and occult forms included detrusor/sphincter dyssynergia in 50% and 27%, low Pure max in 56% and 17%, silent sphincter electromyographic activity in 25% and 0%, absent bulbocavernosus reflex in 87% and 56%, absent anal reflex in 100% and 57%, neurogenic motor unit potentials in one patient with cystic form studied and in two of three patients with occult form, respectively. CONCLUSIONS: Spina bifida cystica and occulta present with a wide spectrum of urodynamic abnormalities including upper and lower motoneuron types of bladder and urethral dysfunction. Careful uroneurological assessment and spinal magnetic resonance imaging are important for diagnosing young adult patients with spina bifida occulta because they may present with urinary symptoms as the sole initial complaint and have no other obvious neurological abnormalities.     

退变性腰椎滑脱的治疗策略

目的回顾分析非手术治疗(Ⅰ组)、椎板切除减压结合融合(Ⅱ组),以及减压结合植骨融合并椎弓根内固定术式(Ⅲ组)3种治疗方法的临床疗效,探讨退变性腰椎滑脱的治疗策略。方法采用视觉模拟评分法评定疼痛程度,Stauffer-Coven-try法对两手术组进行术后疗效评定。统计分析手术时间、出血量、神经损伤发生率、再次手术率及植骨融合率。结果Ⅰ组可有效地缓解疼痛,疗效满意。Ⅱ组手术前后评分差异显著(P<0.01),各时间点评分无统计学差异(P>0.05),Ⅲ组亦发生类似改变。手术前后Ⅱ组和Ⅲ组疼痛评分无统计学差异(P>0.05)。Stauffer-Coventry结果示,Ⅱ组优良率为89.7%,Ⅲ组优良率为89.9%,组间无显著性差异。结论根据病理特点治疗退变性脊柱滑脱,内固定仅提高植骨融合率,对手术疗效无显著提高。     

改良经后路椎体间融合术治疗腰椎滑脱症

目的探讨单枚Cage加自体骨块椎间融合的改良经后路椎体间融合(PLIF)治疗腰椎滑脱症的疗效。方法自2000年12月～2006年6月,笔者在椎弓根螺钉系统复位固定的基础上用1枚Cage加1块自体骨椎间融合的手术方法治疗腰椎滑脱症46例,崩裂性滑脱24例,退变性滑脱22例。其中男25例,女21例;年龄29～67岁。部位:L3、42例,L4、523例,L5S121例。根据Meyerding滑移分度法:Ⅰ度22例,Ⅱ度19例,Ⅲ度5例。结果随访8～72个月,平均25个月。根据Nakai疗效评定标准:优23例,良22例,可1例。术后滑脱复位44例,Ⅲ度恢复到Ⅰ度2例。结论Cage加自体骨块融合的改良PLIF手术治疗腰椎滑脱症,具有固定坚强、较好维持椎间高度、良好的椎间骨融合、疗效确实等优点。     

腰椎滑脱手术治疗的并发症分析

目的探讨手术治疗腰椎滑脱的并发症及其预防措施。方法通过对我院从1998年9月1日至2003年9月1日的5a时间内收治的行手术治疗的198例腰椎滑脱的患者进行了回顾性分析,198例患者中男74例,女124例,其中Ⅰ°滑脱97例,Ⅱ°滑脱86例,Ⅲ°滑脱12例,Ⅳ°滑脱3例。结果术后3个月获得随访174例,术后6个月获得随访136例,术后1a或者更长时间获得随访52例,平均随访1.9a(3个月~4年)。围手术期并发症:神经损伤3例,硬膜撕裂3例,取骨处疼痛3例。远期并发症:术后残留神经症状3例,复位丢失10例,内固定失败9例,假关节形成8例;邻近节段退变加速4例。结论术后复位丢失,假关节形成和邻近节段退变的加速是腰椎滑脱手术治疗的多发并发症,应该引起足够的重视。     

Moss Miami内固定系统治疗退变性腰椎滑脱症

目的探讨应用Moss Miami内固定系统手术治疗退变性腰椎滑脱症的疗效。方法应用Moss Miami系统手术治疗退变性腰椎滑脱32例，其中Ⅰ度滑脱12例，Ⅱ度13例，Ⅲ度7例；最短随访时间为1a。结果术后及随访时的X线显示平均复位率在82．5％，无明显复位丢失。临床疗效综合评价优良率达90％以上。结论在手术中进行阶段性彻底减压的条件下，应用Moss Miami内固定系统结合椎间支撑融合很好地恢复了腰椎正常的解剖关系，可以获得滑脱腰椎的基本复位，具有良好的临床效果。该系统是治疗退变性腰椎滑脱的最理想的内固定之一。     

腰椎退变性滑脱的病理变化及诊断与治疗

目的：探讨因退行性病变因素，造成相邻椎节相互位移并导致该节段椎管变形和狭窄，引起马尾神经或神经根压迫症。方法：报告９２例腰椎退变性滑脱伴有神经根压迫，均经手术治疗。根据临床表现及影像学特征分别采用了３种手术方法，其中４５例实施病变节段椎板部分切除减压及植骨融合术；单纯神经根减压２１例；前路植骨融合术２６例。结果：８４例获随访平均５年６个月，根据Ｍａｃｎａｂ评定法，优良者７３例（８６９％）。研究认为，退变性腰椎滑脱在病理和临床上与因峡部因素的滑脱有明显差别，因此，治疗方法的选择也不同     

Urological follow-up of adult spina bifida patients

AIMS: The vast majority of the current urological literature understandably has concentrated on the management of children with spina bifida, because in the past the majority did not survive into adulthood. With improvements in the understanding and multidisciplinary care of spina bifida patients it has become a disease of adults. Our aim was to evaluate the current literature to attempt to formulate evidence based guidelines for the management of this difficult group of patients. METHODS: We reviewed the literature on adult urological management of spina bifida, all relevant articles which concentrated on adults and long-term management were studied in full. RESULTS: Renal function may begin/continue to deteriorate into adulthood, becoming the leading cause of adult death. This is thought to occur because of changes in the adult bladder, with increases in storage pressure. Medical and surgical management should aim to preserve renal function as well as the maintenance of continence in the face of the growing and changing urinary tract. Follow-up should be regular and in the context of a specialist multidisciplinary clinic. Despite being unvalidated in the follow-up of adult spina bifida patient's annual serum creatinine, ultrasound and urodynamics are currently the best tools available. CONCLUSIONS: There is no reason why the majority of spina bifida sufferers cannot use their own kidneys for the rest of their lives. This however relies on urological treatment being instigated soon after birth and continuing into adulthood.     

Spina bifida occulta in isthmic spondylolisthesis: a surgical trap

An 11-year-old girl presented with symptomatic grade IIB isthmic type spondylolisthesis, with an elongated pars, confirmed on magnetic resonance imaging (MRI). Posterolateral in situ fusion of L5/S1 was performed. At surgery, a significant bony defect in the posterior aspect of S1 was noted. Awareness of this possible co-existence is paramount if iatrogenic damage to neural elements is to be avoided during surgery.     

Sexuality and seeking medical help for erectile dysfunction in young adults with spina bifida

OBJECTIVES: The objectives of this study were to evaluate the correlation between the sexual function of spina bifida (SB) patients and Sharrard classification, touch sensation on the penis, to examine if SB patients who are sexually active have erectile dysfunction (ED) on the International Index of Erectile Function-5 (IIEF5), and to clarify if they seek medical treatment for ED. METHODS: Thirty-six male SB patients aged over 18 years were enrolled. A questionnaire was sent to all patients that included the following items: touch sensation on the penis, psychogenic erection, rigidity at erection, ejaculation, orgasm and experience in sexual intercourse. In addition, patients who had experience in sexual intercourse were asked about ED through the use of the IIEF5 and whether or not they sought medical help for their ED. RESULTS: Twenty-six patients responded. The positive rates of psychogenic erection, rigidity at erection, ejaculation and orgasm were 85%, 54%, 88% and 65% respectively. Psychogenic erection and ejaculation correlated with Sharrard classification. Rigidity at erection and orgasm correlated with touch sensation on the penis. Eleven patients had experience in sexual intercourse and six of them were diagnosed as having ED on the IIEF5. There were no factors correlating with ED. None of the patients sought medical advice and none was treated for ED. CONCLUSIONS: Sexual function of SB patients could be predicted by Sharrard classification and touch sensation on the penis to some degree. However, ED did not correlate with sexual function. Therefore, we should not evaluate the neurological loss but instead provide adequate information.     

椎体融合器内固定治疗腰椎滑脱症

目的　报告椎体融合器 (TFC)治疗腰椎滑脱症的疗效。方法　应用椎体融合器治疗腰椎滑脱症 12例。前路手术 10例 ,其中TFC横卧位 8例 ,前后卧位 2例 ;后路手术 2例。结果　术后随访 3～ 35个月 ,所有融合器均未见移位松动等并发症。术后症状消失 10例 ,明显减轻 2例。结论　本手术具有损伤小 ,术后有即刻固定作用 ,且卧床时间短 ,融合率高等优点。