Volume 86  ·   Issue 25  ·  2006

The application of spinal internal fixation technique has been used for several decades. It is generally believed that the true internal fixation of spine began in the 1950s. Paul Harrington developed the first posterior internal fixation system, namely Harrington system (Harrington rod), for the correction of scoliosis and maintenance orthopedics, and the clinical application results were reported in 1962.

Spinal internal fixation can provide better correction and accurate spinal fusion in the sagittal and coronal planes. At present, the use of internal fixation equipment in spinal surgery is increasing day by day, especially in the process of treating spinal deformity and spinal instability. The incidence of deep infection at the surgical site of spinal internal fixation is relatively low, but the deep infection around endoimplants after spinal surgery will lead to prolonged hospital stay, increased treatment cost, and great physiological and psychological blow to patients and their families. The treatment of infection around endoimplants is very difficult, and early diagnosis and treatment of postoperative deep infection is of great significance to improve the infection control rate, shorten the rehabilitation process and reduce the treatment cost.

Lumbar degenerative disease is a clinical syndrome caused by lumbar degenerative changes causing disc dysfunction, lumbar ligament relaxation, articular process hyperplasia, and further leading to motor segment instability.

With the progress of science, new surgical techniques, internal fixation instruments and bone grafting materials have emerged one after another in the aspect of lumbar spine fixation and fusion. However, it is still controversial whether the treatment effect of lumbar spine diseases is really improved.

Objective to investigate the effects of chemotherapeutic drugs on the expression of X-chromosome linked apoptosis inhibitory protein (XIAP) and caspase-3 cleavage of bladder cancer cells. Methods Four bladder cancer cell lines, RT4, MGH-U1, EJ and T24, were cultured, and apoptosis was induced by low-dose doxorubicin and mitomycin. The killing effect of different concentrations of chemotherapeutic drugs on bladder cancer cells was determined by CCK-8 spectroscopy, and the chemotherapy-sensitive and drug-resistant cells were determined. The apoptosis induced by chemotherapeutic drugs was detected by flow cytometry; The effects of doxorubicin and mitomycin on XIAP protein level and caspase-3 cleavage in bladder cancer cells were detected by Western blot. Results There was no significant difference in the expression level of XIAP among the four bladder cancer cell lines. With the increase of doxorubicin and mitomycin concentrations, the inhibition rate of CCK-8 detected by chemotherapy drugs on bladder cancer cells increased correspondingly, and the apoptosis rate induced by chemotherapy drugs increased correspondingly by flow cytometry. In chemotherapy-sensitive RT4 cells, the cleavage of caspase-3 increased with the increase of chemotherapy drug concentration, but the protein level of XIAP decreased correspondingly, but this effect was not obvious in drug-resistant T24 cells. Conclusion Doxorubicin and mitomycin can kill bladder cancer cells in a dose-dependent manner, and this killing effect is achieved by inducing apoptosis of bladder cancer cells. XIAP and caspase-3 have some correlation with chemotherapy resistance of bladder cancer cells.

Objective to analyze the incidence of cardiovascular and cerebrovascular disease (CCVD) in patients with rheumatoid arthritis (RA); Methods the general condition, morbidity, laboratory examination, treatment plan and treatment response (European Anti-Rheumatic Alliance EULAR response standard), CCVD prevalence and traditional risk factors of 568 patients with RA were retrospectively analyzed. The risk factors of RA combined with CCVD were analyzed.Results (1) There were 92 cases (16.20%) of RA combined with CCVD, including 49 cases of coronary atherosclerotic heart disease (53.26%); Cerebrovascular diseases were 21 cases (22.83%); There were 12 cases of hypertensive heart disease complicated with coronary heart disease, accounting for 13.04%, of which 2 cases were complicated with heart failure; Color Doppler revealed the formation of atherosclerotic plaque in 6 cases, accounting for 6.52%; There were 4 cases of acral gangrene (4.34%). (2) Whether RA combined with CCVD was related to DAS28 disease activity score, platelet count, CRP level and the number of extraarticular organ involvement (P<0.001, OR =9.67; P<0.015, OR =6.91; P<0.003, OR =1.35; P<0.015, OR =2.14, respectively). (3) The occurrence of CCVD was related to treatment response, effective risk factor intervention, long-term use of Cox-2 selective non-steroidal antirheumatic drugs and high-dose glucocorticoid therapy (P =0.006, RR =2.31; P<0.001, RR =5.90; P<0.001, RR =2.63; P =0.013, RR =1.34, respectively). Conclusion The incidence of CCVD in RA patients was high, including RA disease activity, high inflammatory response state, involvement of extraarticular organ, poor treatment response, long-term use of high-dose glucocorticoid and selective cyclooxygenase-2 (Cox-2) inhibitor, and no effective traditional

Objective to investigate the prevalence of hyperuricemia in the population and analyze its related factors.Methods A cross-sectional survey was conducted in 1997 physical examination population.The demographic characteristics, diet and living habits and clinical indexes related to hyperuricemia were analyzed by Logistic multiple regression model.Results 163 cases of male hyperuricemia were found in this population, accounting for 13.8%; The Logistic multiple regression model showed that male, minority (Hui), severely impaired renal function, use of diuretics, overweight/obesity, hypertension and hypertriglyceridemia were associated with increased risk of hyperuricemia, while retirement was associated with decreased risk of hyperuricemia. Conclusion male, minority (Hui), severely impaired renal function, use of diuretics, overweight/obesity, hypertension and hypertriglyceridemia may be the risk factors of hyperuricemia. Retirement may be a protective factor.

Objective to evaluate the clinical value of intradermal test and serum specific IgE (sIgE) detection in the diagnosis of Artemisia pollen fever. Methods 1150 patients (5~75 years old) with allergic rhinitis and asthma in summer and autumn were tested for 20 inhaled allergens, including Artemisia pollen, and serum sIgE of Artemisia pollen. The concentration of Artemisia pollen and ragweed pollen infusion used in the intradermal test was 1:1000 (w/v), and the concentration of other allergens was 1:100 (w/v). All patients were tested for Artemisia pollen sIgE. According to the typical medical history, intradermal test and sIgE detection results, the clinical comprehensive diagnosis criteria were established and the clinical value of intradermal test and sIgE detection was evaluated by this criterion. Results When the clinical comprehensive diagnosis was used as the diagnostic criterion, the sensitivity (96.2%), specificity (74.2%), positive expectancy (93.5%), negative expectancy (85.7%) and diagnostic accuracy (91.6%) of intradermal test were higher than those of intradermal test when sIgE ≥0.35 kUa/L was used as the reference standard. The sensitivity (97.6%), specificity (94.9%), positive expectancy (98.7%), negative expectancy (91.1%) and diagnostic accuracy (97.0%) of sIgE detection were higher than those of in vitro test when intradermal test ≥5 mm was used as the reference standard. When intradermal test ≥10 mm or sIgE ≥0.70 kUa/L was used as the positive standard, the false positive rate of intradermal test and sIgE detection decreased from 35.0% and 22.7% to 25.6% and 5.1%, respectively. Conclusion There is a good correlation between intradermal test and sIgE detection, but both of them have the possibility of false positive in the diagnosis of Artemisia hay fever, and the false positive rate of intradermal test is higher than that of sIgE detection. When intradermal test or sIgE detection was used alone in the diagnosis of Artemisia hay fever, raising the positive diagnostic standard can reduce the false positive rate.

Objective to study the clinical and molecular biological characteristics of hereditary spinocerebellar ataxia type 7 (SCA7) in Chinese. Methods the number of CAG trinucleotide repeats in SCA7 gene was detected by polymerase chain reaction, polyacrylamide gel electrophoresis and capillary electrophoresis in 245 patients, 71 patients with sporadic SCA and 163 normal subjects from 184 families with clinical diagnosis of spinocerebellar ataxia (SCA). DNA sequencing of the abnormal allele fragments was performed, and linkage analysis was performed on one of the major families. Results the positive rate was 1.6% in 3 SCA7 families (15 patients). Sequencing confirmed that the number of CAG repeats of abnormal allele was 38~71, and the number of CAG repeats of SCA7 allele was 6~15 in other SCA patients and normal subjects. Especially in paternal inheritance. Linkage analysis of one of the families showed that the maximum LOD value of two points at microsatellite marker D3S1300 was 2.82 (θ =0.00). Conclusion SCA7 is a rare SCA subtype. Abnormal repeat mutation of SCA7 gene is the cause of pathogenesis of SCA7. 38 CAG repeats are the smallest pathological amplification of SCA7 reported in China.

Objective to investigate the treatment of cervical multi-segment fracture and dislocation by one-stage combined anterior and posterior approach internal fixation. Methods the medical records of 9 patients with cervical multi-segment fracture and dislocation accompanied by anterior and posterior column injury from 1997 to 2003 were retrospectively analyzed. Among them, 8 males and 1 female, aged 24-63 years, 7 cases of continuous injury were treated with anterior decompression, bone grafting, fusion plate internal fixation and posterior laminar decompression and lateral mass screw plate fixation. Two patients with type Ⅱ odontoid fracture combined with fracture and dislocation of lower cervical spine underwent anterior odontoid screw fixation plus posterior lateral mass screw fixation of lower cervical spine. All patients underwent cranial traction before operation, and the operation was performed under general anesthesia. The neurological function of the patients was evaluated by Frankel classification and ASIA motor index score. The average ASIA motor index score was 31.3 points. The average postoperative follow-up was 2 years and 7 months. Results The follow-up patients obtained satisfactory reduction, fixation and fusion, no surgical complications, no loosening or fracture of plate screws. The nerve injury of 3 patients recovered, including 2 nerve root function recovered, and 1 spinal cord function recovered to normal. The average ASIA motor index score was 63.8 points. Conclusion One-stage anterior and posterior combined internal fixation can decompress and stabilize the multi-segment cervical spine injury in a short time, create the conditions for the recovery of nerve function to the maximum extent and facilitate early functional exercise, which is a feasible choice for the treatment of multi-segment cervical spine injury.

Objective to explore the indications and technical essentials of the application of intervertebral fusion cage in posterior lumbar reoperation. Methods 17 cases of posterior lumbar reoperation were retrospectively analyzed. The operation sequence was lumbar spinal canal decompression, dura mater and nerve root adhesion release, intervertebral disc nucleus pulposus removal, posterior intervertebral fusion cage implantation, transpedicular internal fixation and lumbar intertransverse process bone grafting. According to the evaluation criteria of Macnab method, 88.2% of the patients had obvious relief of neurological symptoms of lower limbs and improved exercise ability before operation, and the surgical effect was satisfactory. X-ray films were reviewed regularly after operation and the surgical effect was evaluated, with an average follow-up of 18 months (12-43 months). Brantigan evaluation criteria showed no sign of failure of internal fixation, lumbar fusion was successful half a year after operation, and the surgical effect was always stable. Conclusion The use of intervertebral fusion cage in posterior lumbar reoperation not only solved the problem of nerve entrapment, eliminated the pain of intervertebral disc origin, restored the physiological curvature and alignment of lumbar vertebra, but also completed the internal fixation of lumbar vertebra and the fusion of anterior column, so good curative effect could be obtained.

Objective to clinically verify the feasibility, reliability and value of axial pedicle screw rod technique with axial lateral mass in the treatment of unstable atlas fractures. Methods A total of 17 cases of atlas fractures were treated, of which 14 cases of unstable atlas fractures were treated, and 11 cases were treated with limited internal fixation, 6 cases of 11 cases were combined with axial instability and transverse ligament rupture; One case was complicated with C2 lamina fracture; The remaining 4 cases were pure axial instability. After the insertion of axial lateral mass screw and C2 pedicle screw with the assistance of anatomical positioning and fluoroscopy, both sides were fixed by screw-rod connection; C1-C2 bone graft fusion was performed in patients with axial instability and transverse ligament injury. Results the average operation time was 124 min (90~176 min); The mean blood loss was 432ml (270~1200 ml); Mean fluoroscopy time 18 s; None of the 11 patients had nerve, vertebral artery and other surgical complications. All patients walked on the ground after fixation of cervical brace on 5 days after operation; The symptoms of spinal cord injury were not aggravated after operation.One case of vertebral artery rupture caused by electrosurgical burn of vertebral artery in C1-C2 segment, hemostatic gauze and bone cement were packed to stop the hemorrhage, and there were no symptoms of craniocerebral ischemia.After 3 months, the lateral cervical vertebra X-ray film showed bone healing without obvious signs of instability, and the fracture reduction was confirmed by postoperative CT. Conclusion In patients with unstable atlas fracture or atlantotransvertebral ligament injury, the atlas lateral mass and axial pedicle screw rod and transverse connection compression fixation can be performed with anatomical positioning and fluoroscopy assistance to achieve anatomical reduction and maintenance of occipital bone, atlas and axial vertebra. The successful application of this short-segment physiological repair technology in the treatment of severe atlas fracture may change the original treatment concept.

Objective to study the effect and advantages of transforaminal lumbar body fusion (TLIF) in the treatment of high lumbar disc herniation. Methods the operation, effect and complications of 18 cases of high lumbar disc herniation treated by TLIF were retrospectively analyzed. The pedicle internal fixation was performed during the operation, one or both upper and lower articular processes were removed, the intervertebral space was distracted by pedicle screw, the intervertebral disc was exposed and removed through the intervertebral foramen, and the intervertebral space was treated, and titanium mesh or intervertebral cage was inserted. Results 14 cases were unilateral transforaminal discectomy, and 4 cases were bilateral transforaminal discectomy. The average operation time was 82.3 min, the average intraoperative bleeding was 323 ml, and there was no spinal nerve injury. The follow-up was 12~54 months, with an average of 19.8 months. 11 cases were excellent, 4 cases were good, and 3 cases were acceptable, with an excellent and good rate of 83.3%. No symptom aggravation or recurrence was observed after operation. The height of intervertebral space and lumbar lordosis recovered well, and there were no complications such as failure of internal fixation. Conclusion TLIF can completely remove intervertebral disc, restore and maintain the normal physiological curvature of lumbar vertebra, and prevent postoperative lumbar instability. It is one of the effective surgical methods for the treatment of high lumbar disc herniation.

A 24-year-old female was admitted to the Department of General Internal Medicine of Peking Union Medical College Hospital on September 12, 2005 due to vomiting, diarrhea, low fever for more than 2 months, low back pain, frequent urination and urgency for 7 days. The patient had nausea, vomiting, low fever, accompanied by diarrhea and yellow watery stool after eating sashimi in Japan in June 2005, 3~4 times/d. 　　

Since 1966, when it was confirmed that lipid bilayers can permeate water molecules, passive diffusion has been considered as the only way for water to permeate biofilm structures [1].

Clinical data A 68-year-old female with a 6-year history of hypertension was admitted to the emergency department in December 2004 due to sudden headache and vomiting accompanied by left limb paralysis. She soon entered coma for 0.5 h. 　　

According to the data, the first surgery to correct scoliosis began in the middle and late 19th century. In 1839, French physician Jules Gue'rin attempted to treat scoliosis by cutting the paravertebral muscle and fixing it with braces. He reported that 50 patients were successfully cured by this method.

Charcot-Marie-Tooth disease (CMT) is the most common monogenic disease of peripheral nerves with high clinical and genetic heterogeneity in humans [1].

It is extremely rare for myasthenia gravis (MG) to first or mainly involve the laryngeal muscle directly related to vocalization. Among 1450 MG patients in our hospital in the past 15 years, we found a total of 7 cases with vocal cord paralysis as the first or prominent (including concomitant) manifestation (accounting for 4.8%o). The clinical characteristics of this type of MG have not been discussed in detail. The special analysis and report are as follows.

A 49-year-old male who appeared purple-red patches on his face and increased gradually for more than 6 months, came to the Sir Run Run Shaw Hospital affiliated to Zhejiang University School of Medicine in December 2004. In early June 2004, the patient had a purple-red patch on his forehead without obvious trigger, without obvious self-conscious symptoms, and was not treated. The rash gradually expanded and increased to his face. He went to a local hospital for treatment, but the diagnosis was unknown and he was given topical eloxone and antihistamines, but there was no obvious curative effect, and the rash continued to increase.