Anterior Column Reconstruction Using Titanium Ring Cages in Severe Vertebral Osteomyelitis

Abstract Background and Purpose: The use of instrumentation in spinal infections is still a controversial issue. The aim of the present study was to evaluate the efficiency of titanium cages in the surgical treatment of severe vertebral osteomyelitis (synonym spondylodiscitis) concerning eradication of the infection as well as biomechanical aspects. Materials and Methods: The peri- and postoperative data of 43 consecutive patients with vertebral osteomyelitis who underwent single-stage posterior stabilization, anterior debridement including decompression, and anterior column reconstruction using modular titanium ring cages filled with autologous bone were analyzed retrospectively. In 29 cases, a clinical and radiological follow-up of on average 2.5 years (median 2.2 years) was available. To assess the course of spinal alignment, a detailed radiometric analysis was performed. Results: The time of symptoms prior to surgery averaged 4.6 months. Preoperatively, 37% of the patients showed neurologic compromise with partial or complete recovery in 88% after surgery. In 25 patients (58%), a germ was isolated with Staphylococcus aureus being the most frequent pathogen (44%). Except for one patient with anterior revision and exchange of the cage for persistent infection, primary eradication of the infection was accomplished in all patients. At follow-up, all infections were eradicated, and all cages appeared radiographically fused. The present loss of correction in the sagittal plane amounted 1.5° at the affected segment(s) reconstructed by cage interposition and 4.4° at posterior fusion levels. Conclusion: Single-stage posterior instrumentation and fusion combined with anterior debridement and anterior column reconstruction using modular titanium ring cages represent a safe and efficient strategy in cases of severe vertebral osteomyelitis necessitating surgery. The use of titanium cages guarantees long-term maintenance of correction without increased risk of persistent or recurrent infection.     

内固定在退变性腰椎疾病中的应用研究

目的探讨内固定在退变性腰椎疾病的应用研究。方法采用椎弓根内固定系统结合融合治疗退变性腰椎疾病89例，其中后外侧融合63例，后外侧结合Telamon融合器3例，结合Pyramesh融合器23例。结果89例术后随访4～21月，平均12．5月，术后有1例出现假关节内固定松动断裂，8例影像学表现有假关节形成。骨融合率为91．01％。疗效评定按日本骨科学会(JOA)下腰痛评分15分法评定，术前平均3．6分，术后平均13．8分，随访结果采用改善率表示，结果术后平均改善率89．47％。优级改善率75％～100％共55例(80．01％)，良级改善率50％～74％共11例，可级改善率25％～49％2例。全组优良率92．13％。结论在退变性腰椎疾病的治疗中使用内同定，可提高融合率，早期康复。     

核素骨断层扫描对颈椎融合器内植骨成活的评价

目的:探索评价颈椎螺纹融合器内植骨成活情况的无创性方法。方法:选择因颈椎病行颈前路减压钛合金螺纹融合器植骨融合 钢板内固定术的41例患者作为观察组,术后随访3～15个月,以99锝标记的亚甲基二膦酸盐(99mTc-MDP)为显像剂行颈椎核素骨断层扫描,根据计算机“感兴趣区”技术,定量计算出植骨部位与自体胸骨上窝水平胸椎的放射性计数比;另选颈椎病术前患者20例作为对照组,行核素骨断层扫描,计算病变间隙相邻椎体与自体胸骨上窝水平胸椎的放射性计数比作为对照。所有观察组患者同期行颈椎CT重建,分别在矢、冠、轴位观察融合器内植骨融合情况,然后将核素扫描与CT结果对比分析。结果:观察组放射性计数比为1.880±0.293,对照组为1.084±0.016,两组间差异有显著性(P<0.05),观察组植骨成活率为100%。CT重建显示观察组中3例骨性融合较差,骨性融合率为92.7%。结论:应用核素骨断层扫描法可对颈椎融合器内移植骨成活情况做出分析,且骨融合一定说明骨成活,植骨成活却不一定完全骨性融合。     

Microstructural Variation of Clay during Land Subsidence and the Correlation between Macroscopic and Microscopic Parameters

The nonlinear deformation, visco-elasto-plasticity and other macroscopic properties of soil are the concentrated manifestations of its microstructural state. In order to study the microstructural characteristics and variations of the clay under the action of additional stress caused by groundwater exploitation, borehole sampling was carried out on the clay layers at different depths in a typical land subsidence area. Consolidation tests, freeze-drying, ion sputtering, and scanning electron microscope (SEM) were conducted in order to scan and analyze the microstructure of the test samples at different scales. The Particles and Cracks Analysis System (PCAS) was used to quantify the microscopic parameters, the variations of the microstructural parameters with consolidation loads at different sizes were revealed, and the correlation between the macroscopic and microscopic parameters were discussed. The results show that: (1) the microstructural characteristics of soils with different buried depths have directivity, to a certain extent; (2) as the consolidation load increases, the average unit area and average form factor of the soil microstructure generally decrease, the structural arrangement of the unit gradually tends to be orderly, and the average pore area, apparent void ratio and the number of pores generally show a decreasing trend; (3) under the action of a consolidation load, when the microstructure at a relatively large scale is basically stable, the microstructure at a smaller scale will continue to adjust; (4) the apparent void ratio has a good linear regression relationship with the conventional void ratio, and the apparent void ratio has a good exponential growth relationship with the compressibility.     

羟基磷灰石和多聚左旋乳酸制可吸收性椎体间固定融合cage的力学特性

[目的]评价羟基磷灰石和多聚左旋乳酸(hydroxyapatite/poly-L-lacticacid:HA/PLLA)制可吸收性椎体间固定融合cage的力学特性.[方法]形状设计相同的HA/PLLAcage(n=16)和Brantigan碳纤维cage(n=16)用于实验.用材料实验机MTS分别将两种cage行压缩破坏和压缩疲劳试验.记录cage压缩破坏时的压力,弹性系数及10万次疲劳试验后cage的高度变形率,并加以比较.[结果]HA/PLLAcage和碳纤维cage压缩破坏所需平均压力分别为12000N和10900N,两者间无显著差异.平均弹性系数分别为2.8GPa和2.2GPa,无显著差异;但是,10万次疲劳试验后,HA/PLLAcage和碳纤维cage的平均压缩率分别为8.4%和13.3%,两者间的差异具有显著性.[结论]与碳纤维cage相比,HA/PLLAcage不仅具有同等的瞬间抗破坏强度,而且具有较高的长期抗压缩能力.     

升陷汤联合西药治疗气虚血瘀型胸痹（心绞痛）随机平行对照研究

[目的]观察升陷汤联合西药治疗气虚血瘀型胸痹（心绞痛）疗效。[方法]使用随机平行对照方法,将60例住院患者按随机数字方法分两组,心绞痛发作时舌下含服硝酸甘油,次数不限;降压、调节血糖、降血脂等常规对症治疗。对照组30例硝酸异山梨醇酯10mg,3次／d;肠溶阿司匹林100mg,1次／d。治疗组30例升陷汤（生黄茂30g,知母10g,桔梗、柴胡、升麻各6g,当归身15g;气虚极加人参12g或桑寄生12g;心阳虚加桂枝9g,干姜12g;气分郁结胸胁痛加乳香、没药各10g;血瘀重加丹参20g,红花10g。）1剂／d,水煎300mL,早晚服。西药治疗同对照组。连续治疗15d为1疗程。观测临床症状（胸痛、胸闷、气短、乏力、脉沉细）、伴随症状（心悸、头晕、耳鸣、健忘、纳差）、心电图指标、硝酸甘油用量、不良反应。治疗1疗程,判定疗效。[结果]总有效率治疗组主证93．33％、伴证86．67％,对照组主证73．33％,伴证66．67％,症状疗效治疗组优于对照组（P〈0．05）;硝酸甘油用量两组均有改善（P〈0．05,P〈0．01）,治疗组改善优于对照组（P〈0．05）;心电图疗效治疗组优于对照组（P〈0．05）。[结论]升陷汤联合西药治疗气虚血瘀型胸痹,疗效满意,无副作用,值得推广。     

帽式颈椎椎间融合器的生物力学性能研究

目的：测试自行研制的帽式颈椎椎间融合器(HCIFC)的生物力学性能，探讨其用于颈椎椎间融合的可行性。方法：48个羊颈椎标本随机分为6组，A组，完整颈椎节段；B组，自体三面皮质髂骨；C组，Harms cage；D组，Syncage C；E组，Carhon cage；F组，HCIFC。除A组外均完全切除C3／4椎间盘后置入以上颈椎内置物，进行生物力学测定．计算出各组平均刚度及体积相关刚度，并行统计学比较。结果：置入HCIFC后颈椎屈曲刚度显著增大，而伸展、侧屈和轴向旋转刚度无变化；Syncage C在各方向上的刚度均最大，HCIFC与Carboncage相似；HCIFC在屈曲、伸展和侧屈刚度上小于Harms cage，而轴向旋转刚度显著大于Harms cage。与移植的三面皮质髂骨相比，所有cage在体积相关刚度上均有显著增加。Harms cage在各个方向上的体积相关刚度显著大于其它cage，其次为Syncage C、HCIFC及Carbon cage。结论：HCIFC可为颈椎椎间融合提供足够的初始生物力学稳定性．     

Anterior cement augmentation of adjacent levels after vertebral body replacement leads to superior stability of the corpectomy cage under cyclic loading—a biomechanical investigation

Background

In the operative treatment of osteoporotic vertebral body fractures, a dorsal stabilization in combination with a corpectomy of the fractured vertebral body might be necessary with respect to the fracture morphology, whereby the osteoporotic bone quality may possibly increase the risk of implant failure. To achieve better stability, it is recommended to use cement-augmented screws for dorsal instrumentation. Besides careful end plate preparation, cement augmentation of the adjacent end plates has also been reported to lead to less reduction loss.

可吸收腰椎间融合器降解过程的动物实验研究

目的研究可吸收腰椎间融合器在体内的降解过程。方法将可吸收腰椎间融合器通过前路手术植入山羊的腰椎间隙,通过大体标本、扫描电镜观察其组织学改变。结果PDLLA在椎间植骨融合中的降解过程是不等速的降解,在植骨融合早期,PDLLA降解主要集中在材料表面,其基本形状保持完好。随内部自催化作用逐渐明显,材料内部降解速度逐渐加快,而其表面降解明显;24周时材料仍可维持其基本结构,对保证植骨融合的力学要求具有重要意义;在36周时,材料的表面和内部降解主要表现为材料崩解为泥砂样颗粒,已经逐渐失去其外型,被周围组织包裹。结论可吸收腰椎间融合器是现有腰椎间融合器的一种较为理想的替代产品。     

后路腰椎椎体间融合术后cage移位的危险因素分析及处理策略

目的:探讨开放后路腰椎椎体间融合术后cage移位的发生率、相关危险因素及其处理对策.方法:回顾性分析2016年1月～2017年12月在我院骨科腰椎专业组行开放后路腰椎椎体间融合手术的970例患者,男423例,女547例;年龄14～87岁(56.8±12.5岁).随访时腰椎侧位X线片上cage后缘标记线位置较术后首次测量...