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Objective: To discuss the operation treatment for the severe and rigid idiopathic scoliosis., Methods: The clinical data of 24 patients with severe and rigid idiopathic scoliosis, 15 females and 9 males, with an average age of 17 (12 approximately 20) who had undergone operations from June 1999 to June 2003 were analyzed retrospectively. The patients were classified according to PUMC operative classification systerm, including 16 cases of type Ia, 2 cases of type Ib, 3 cases of type IIb2, and 1 case of types IIb1, IIc2, and IIc3 each. The average standing coronal Cobb angle was 98 degrees (80 degrees to 117 degrees ) and the average flexibility rate of the major curves was 20.8% (5% to 29.5%) before operation. Fifteen cases had sagittal deformities. Bone fusion was performed on all the cases according to the PUMC classification principles. 17 cases received anterior spinal release with posterior correction by two stages, and 2 cases by one stage. 5 cases received one-stage posterior correction. All the patients were followed up for 12 approximately 30 months (18 months on average)., Results: The mean standing coronal Cobb angle of the major curves was reduced to 58 degrees (32 degrees to 100 degrees ) after operation with a correction rate of 41.0% (10.9% to 61.0%). The results of sagittal plane correction were satisfying. The mean Cobb angle of the major curves at the final follow up was 63 degrees (31 degrees to 104 degrees ), and the mean lost was 5 degrees (0 degrees to 10 degrees ). One case had to undergo revision surgery because of hook displacement. One case had steel wire broken but without neurological symptoms and only needed observation. No pseudoarthrosis and decompensation occurred., Conclusion: Compared with vertebral osteotomy for the correction of scoliosis, the anterior spinal release combined with posterior correction and simple posterior correction have the advantages of low risk, less blood loss, and low infection rate. They can be used effectively and safely for the correction of idiopathic severe and rigid idiopathic scoliosis. The key points for the surgical procedures are appropriate correction and recovery of the balances of the coronal and sagittal planes.

Objective: To observe early clinical efficacy of general spine system (GSS) in spondylolisthesis combined with lumbar canal stenosis, lumbar decompression, reduction and bone graft., Methods: Sixteen patients with degenerative lumbar spondylolisthesis combined with lumbar canal stenosis, 10 male, 6 female, average age 58.5 years (range 42 - 72 years) underwent lumbar decompression, bone graft and internal fixation using GSS. Preoperatively 10 patients had degree I spondylolisthesis and 6 patients had degree II spondylolisthesis. Clinical efficacy, reduction effectiveness and complications were recorded., Results: The 16 patients in this group were followed up postoperatively for an average of 21.2 months (18 - 24 months). At latest follow-up after surgery, preoperative clinical symptoms had disappeared completely in 15 of 16 patients, and low back pain relief was seen in 15 patients. Average duration of surgery was 170 min (120 - 270 min), and average blood loss was 375 ml (100 - 800 ml). X-ray results showed complete reduction for all spondylolisthesis patients, and results remained good in follow-up. Dura mater tearing, pedical fracture, nerve injury and other surgical complication did not occur. Screw breakage, screw loosening and instrument loosening at the screw-rod juncture were not observed after surgery or in follow-up., Conclusion: GSS provides good reduction for spondylolisthesis, and shows good early clinical efficacy.

Objective: To observe the characteristics of gene expression of type X collagen in the cartilage of end-plate and the fibrous annulus in the intervertebral disc of idiopathic scoliosis (IS) patients., Method: Investigating the expression of type X collagen in the peak disc and the lower end disc of 21 IS patients, the peak disc of 16 congenital scoliosis (CS) and the lumbar disc of 3 normal people (according with the principle of medical ethnics) by reverse transcript polymerase chain reaction., Results: The expression of type X collagen in the concave side of IS peak disc was higher than the convex side (P < 0.05). There was no significant difference of gene expression of type X collagen between the convex side and the concave side of the lower end disc (P > 0.05). The gene expression of type X collagen in the IS peak disc was higher than those of lower end disc (P < 0.05). For the CS peak discs, the expression of type X collagen of the concave side was higher than the convex side (P < 0.05)., Conclusion: The expression of type X collagen of the IS peak disc increases, and the expression of type X collagen of the concave side is higher than the convex side. These changes may be secondary.

Objectives: To evaluate the incidence of immediate postoperative pulmonary complications and their correlation to preoperative pulmonary function tests (PFTs), preoperative pulmonary symptoms and surgical approaches., Methods: The case records of 298 patients, who underwent anterior or posterior fusion, were reviewed. Preoperative PFTs were recorded and abnormal PFTs were defined as forced vital capacity (FVC) is less than 80% of FVC predicted. Preoperative pulmonary symptoms (breathless on exertion) were noted, and postoperative pulmonary complications were defined when the presence of atelectasis, infiltrates, pneumothorax, hemothorax, pneumonia or requirement of postoperative ventilatory support was noted., Results: The mean age of this group was 16.4 years (range from 6-62 years). The average coronal Cobb angle was 73.26 degrees (range from 45 degrees-141 degrees ). Of all the patients, 115 patients had normal preoperative PFTs, the other 183 cases had abnormal PFTs. Nineteen cases of all the patients were found with postoperative pulmonary complications including postoperative ventilatory support in 6 cases, atelectasis in 4 cases, infiltration in 2 cases, pneumothorax in 3 cases, pneumonia in 3 cases and hypoxemia in 1 case. The incidence of postoperative pulmonary complication was 6.4% in all the patients, while 18.99% in the 79 patients with thoracotomy and 1.85% in the 216 patients without. The correlation between postoperative pulmonary complications and the surgical approach was statistically significant (P=0.0000). When the patients were classified into 3 groups: 60%< FVCR <80%, 40%< FVCR <60%, FVCR <40%, the incidence of postoperative pulmonary complications were 2.72% (3/110), 7.40% (4/54) and 31.6% (6/19) respectively, which showed an increasing complication incidence. In the 115 patients with normal PFTs, 3 patients had preoperative pulmonary symptoms (2.68%), while 14 of the 183 patients with abnormal PFTs had preoperative pulmonary symptoms (7.65%). The correlation between presence of preoperative respiratory symptoms and abnormal results on PFTs was statistically significant (P=0.01). No significant correlation was found between preoperative respiratory symptoms and postoperative pulmonary complications (P=0.52)., Conclusions: The incidence of postoperative pulmonary complications increases with the deterioration of PFTs. The posterior procedure has a very low incidence of postoperative pulmonary possibility of complications, but a transthoracic procedure increases the complications significantly. Preoperative respiratory symptoms usually predict abnormal results of PFTs but have no correlation with postoperative pulmonary complication.

Objective: To study the distribution of collagen X in the intervertebral disc and determine its role in the pathogeny of idiopathic scoliosis (IS)., Methods: The data included apical disc and intermediate disc from 14 cases of AIS, 26 discs from 13 cases of scoliosis of confirmed pathogeny which included 10 cases of congenital scoliosis and neurofibromatosis scoliosis (CS group). Six discs were obtained from 3 cases of sudden death of normal young man served as controls. The distribution of collagen X in the apical disc of IS was examined by immunohistochemistry and in situ hybridization (ISH) with RNA probe. The figure of collagen X hybridization in the endplate cartilage was input to the figure analysis system. The mRNA content of collagen X was compared between every 2 groups by SPSS software., Results: Collagen X was mainly distributed around the hypertrophic chondrocyte in the endplate cartilage. Its mRNA was expressed in the hypertrophic chondrocyte. Positive signal was found in the nuclei of several scoliosis patients, which was not related to the pathogeny. The collagen X mRNA contents of the apical disc and intermediated disc of the IS group and of the CS group were significantly higher than those of the normal group (P < 0.05). There was no difference between the IS and CS groups., Conclusions: Collagen X is mainly distributed around the hypertrophic chondrocyte in the endplate cartilage. Its can also be secreted by the chondrocyte-like cells in the nucleus under special condition. Higher expression of collagn X gene in scoliosis patients may be the effects of long term abnormal stress which causes calcification of endplate cartilage. Collagen X expressed in the nucleus may be the result of secretion of chondrocyte-like cells in the disc under abnormal mechanical condition.

Objective: To define the criteria of posterior selective thoracic fusion in patients with adolescent idiopathic scoliosis., Methods: By reviewing the medical records and roentgenograms of 17 patients with adolescent idiopathic scoliosis who underwent posterior selective thoracic fusion, the curve type, Cobb angle, apical vertebral rotation and translation, trunk shift, and thoracolumbar kyphosis were measured and analyzed., Results: There were 17 King type II patients (PUMC type: IIb, 13, IIc3 4). The coronal Cobb angle of thoracic curve before and after operation were 56.9 degrees and 21.6 degrees respectively, the mean correction rate was 60.1%. The coronal Cobb angle of lumbar curve before and after operation were 34.8 degrees and 12.1 degrees respectively, and the mean spontaneous correction rate was 64.8%. At final follow-up, the coronal Cobb angle of thoracic and lumbar curve were 23.5 degrees and 15.2 degrees respectively, there were no significant changes in the coronal Cobb angle, apical vertebral translation and rotation compared with that after operation. One patient had 12 degrees of thoracolumbar kyphosis after operation, no progression was noted at final follow-up. There was no trunk decompensation or deterioration of the lumbar curve. In this group, 3.9 levels were saved compared with fusing both the thoracic and lumbar curves., Conclusion: Posterior selective thoracic fusion can be safely and effectively performed in King type II patients with a moderate and flexible lumbar curve, which can save more mobile segments and at the same time can maintain a good coronal and sagittal balance.

Aim: To explore the effect of beta-amyloid (A beta) on metabolism of cytoskeletal protein neurofilament, and search for effective cure to the lesion., Methods: Wild type murine neuroblastoma N2a (N2awt) and N2a stably transfected with wild type amyloid precursor protein (N2aAPP) were cultured. Sandwich ELISA, immunocytochemistry, and Western blot were used respectively to measure the level of A beta, the expression and phosphorylation of neurofilament proteins., Results: The immunoreactivity of neurofilament protein was almost abolished in N2aAPP, which beard a significantly higher level of A beta. Melatonin effectively decreased the level of A beta, and restored partially the level of phosphorylated and non-phosphorylated neurofilament in N2aAPP., Conclusion: Overproduction of A beta inhibits neurofilament expression, and melatonin attenuates the A beta-induced lesion in cytoskeletal protein.

Objective: To assess efficacy and safety of alendronate sodium treatment in osteoporosis patients with hip fracture., Methods: One year randomized, double-blind clinical trial was carried out in 77 osteoporosis patients with hip fracture. The bone mineral density (BMD) in lumbar spine (L(2 - 4)), femoral neck (Neck), Wards triangle (Wards) and great trochanter (Troch) was measured by dual energy x-ray absorptiometer (DEXA)., Results: In our study, alendronate sodium induced marked increases in BMD of the L(2 - 4) (7.0% +/- 13.0%), Neck (7.3% +/- 11.1%), Wards (4.6% +/- 5.9%), Troch (4.5% +/- 3.2%) (mean +/- s) versus decreases of 2.0% +/- 4.5%, -0.9% +/- 6.9%, 3.6% +/- 4.9% and 1.14% +/- 6.0% with placebo (P < 0.05). Blood Ca, P, ALP, BGP and Urine Pyd/C were no significant difference between before and after therapy. There were usually mild and transient side-effect, such as gastrointestinal symptoms., Conclusion: Alendronate is an efficacy and safety drug in treatment of osteoporosis.

Aim: To explore the protective effects of melatonin (Mel) on the abnormal phosphorylation of neuronal cytoskeletal proteins., Methods: We generated a neuroblastoma (SH-SY5Y) cell system in which cytoskeletal proteins are abnormally phosphorylated resulting in microtubule disruption due to the marked inhibition of protein phosphatase activities by okadaic acid (OA)., Results: OA-induced declines in cell viability and mitochondrial metabolic activity were remarkably prevented by Mel. In addition, the hyperphosphorylation/accumulation of neurofilament-(NF-) H/M subunits and the disruption of microtubules, induced by OA, were significantly inhibited by Mel., Conclusion: Our results suggest multiple protective functions of Mel against a series of pathological lesions known to culminate in AD, including abnormal phosphorylation of cytoskeletal proteins, microtubule disassembly and mitochondrion-initiated cell toxicity.

Objective: To define the criteria of selective thoracic fusion in adolescent idiopathic scoliosis patients., Methods: By reviewing the roentgenograms of adolescent idiopathic scoliosis patients undergoing selective thoracic fusion, the curve type, Cobb angle, apical rotation and translation, trunk shift, and thoracolumbar kyphosis were measured and analyzed., Results: There were 12 King type II patients (PUMC type: IIb1 9, IIc3 3). The coronal Cobb angle of thoracic curve before and after surgery were 54.0 degrees and 19.0 degrees respectively, and the average correction rate was 62.7%. The coronal Cobb angle of lumbar curve before and after surgery were 34.6 degrees and 12.5 degrees respectively, and the average spontaneous correction rate was 64.7%. At the final follow-up, the coronal Cobb angle of thoracic and lumbar curve was 18.8 degrees and 15.9 degrees respectively. There was no significant change in the coronal Cobb angle, apical vertebral translation and rotation compared with that after surgery. 1 patient had 12 degrees of thoracolumbar kyphosis after surgery, no progression was noted at the final follow-up. There was no trunk decompensation or deterioration of the lumbar curve. In this group, 3.5 levels were saved compared with fusing both the thoracic and lumbar curves., Conclusion: Selective thoracic fusion can be safely and effectively performed in patients with a moderate and flexible lumbar curves, which can save more mobile segments to maintain a good coronal and sagittal balance.

Objective: To explore the effect of anterior spinal release on severe scoliosis., Methods: Twenty-six cases of severe scoliosis were retrospectively reviewed from January 1998 to December 2001. There were 7 males and 19 females with an average age of 15 years (ranging from 10 to 21 years). Twenty-four cases were classified according to King classification for adolescent idiopathic scoliosis, including King type I 4 cases, type II 9 cases, type III 5 cases, King IV 4 cases, King V 2 cases; another two cases were thoracolumbar curve. The major curves were averaged respectively 89.8 degrees, 66.5 degrees, 67.7 degrees, 61.2 degrees on standing, traction, bending and fulcrum film before operation. The distance of apex vertebrae deviated from sacral midline was 39.7 mm before operation., Results: Six cases received anterior spinal release with posterior correction by one stage, 20 cases by two stages. The cases with two stage operation increased the spinal flexibility about 17.8 degrees after anterior release. The major curve was 52.6 degrees on average, and the distance of apex vertebrae deviated from sacral midline was 9.9 mm after operation. The major curve was 54.9 degrees on average, loss the correction 6.4% during follow-up. There was no complication related to the operation in this group., Conclusions: The anterior spinal release alone has little effect on severe scoliosis with flexibility less than 20% preoperation. The curve can be corrected to a great degree by anterior osteotomy for spine.

Objective: To evaluate the efficacy of self-designed General Spine System (GSS) through the measurement of the biomechanical characteristics and the outcomes of preliminary clinical application., Methods: The General Spine System implants were made of titanium alloy (TC4, Ti6Al4V) and the instruments were made of stainless steel after design. Pull-out strength of GSS screw, CCD, SOCON, TSRH and Diapason screw were tested in fresh normal cadaveric spine specimens respecting and the biomechanical stability analyses of GSS and SOCON were also tested. GSS was applied clinically in 16 patients with degenerative lumbar spondylolisthesis combined with lumbar canal stenosis. Clinical efficacy, reduction effectiveness, and complications were recorded., Results: The pull-out strength of GSS screw was more than other control screws. Biomechanical stability of GSS was similar to SOCON system. Average postoperative follow-up for all patients was 12.6 months (11.5-14.5 months). All patients got satisfied clinical results at the latest follow-up. X-ray results showed complete reduction for all spondylolisthesis patients, and results remained good in follow-up. Complications related to implants or operation were not observed after surgery or in follow-up., Conclusion: GSS pedicle screws have strong anchoring ability and good stabilization for spondylolisthesis. This system can provide good reduction for spondylolisthesis. Its clinical efficacy is confirmed.

The use of anterior surgical techniques for the treatment of adolescent idiopathic scoliosis (AIS) has increased recently and anterior discectomy, anterior release and fusion, instrumentation of the thoracic scoliosis can be performed through a thoracoscopic approach. The thoracoscopic approach has several advantages: small surgical trauma, early return to work, reduced postoperative pain and improved postoperative respiratory functions. Although the thoracoscopic approach still has some shortcomings currently, it will be widely accepted with further development of this technique and instrumentations in the future.

Objective: To evaluate the biomechanical stability of Shen's instrumentation in the management of thoracolumbar fractures., Methods: The ranges of movement (ROM) in three dimensions of twelve T(12) - S(3) specimen of fresh adult cadavers were measured sequentially in the states of normal, injured, GSS and SOCON fixation, fatigued GSS and SOCON fixation. Data were then compared., Results: For the L(2 - 3) segment, the average normal ROM in flexion was 8.3 degrees. In the established spondylolisthesis models, the ROM was 14.7 degrees. After fixation with SOCON, the ROM was decreased to 3.0 degrees, indicating that SOCON fixation can produce good stability. The ROM after fatigue test was 3.6 degrees, significantly lower than that of the normal state, indicating that SOCON still produces good stability after fatigue. For the L(4 - 5) segment, the average normal ROM in flexion was 8.6 degrees. In the established spondylolisthesis models, the ROM was 13.7 degrees. After GSS fixation, the ROM was decreased to 3.2 degrees, significantly lower than that in the normal state, indicating that GSS fixation can produce good stability. ROM after fatigue test was 3.7 degrees, significantly lower than that of the normal state, indicating that GSS can produce good stability after fatigue. The ROM measurements in the other five directions were similar to those for flexion described above., Conclusion: GSS produces good stability for spondylolisthesis, good fatigue resistance, and can be used in pedicle screw revision surgery. There were no significant differences between GSS and SOCON.

Objective: To examine endogenous heme oxygenase (HO) expression on the surface of placental trophoblasts of pregnant women who had a fetus with intrauterine growth retardation (IUGR), so as to explore the pathogenesis of IUGR., Methods: Immunohistochemical method were used to detect the expression of HO-1 in idiopathic IUGR patients (IUGR group), patients with pregnancy induced hypertension (PIH) complicated by IUGR (PIH+IUGR group) and normal pregnant women (control group) with specific HO antibody. Quantitative analysis was conducted to determine the quantity of HO., Result: The staining areas of HO-1 in IUGR group (64.27+/-10.59 micrometer(2)) and PIH+IUGR group (61.54+/-10.59 micrometer(2)) were significantly lower than that of control group (96.56+/-15.23 micrometer(2), P<0.01), but there was no significant differences between the former 2 groups., Conclusion: Abnormal reduction in endogenous HO on the surface of placental trophoblasts may be one of the important mechanisms for the onset of IUGR.

Objective: To analyze the causes of the complications associated with the pedicle screw fixation during and after operation, as well as the methods for prevention and treatment., Methods: From January 1988 to December 1999, 475 patients who underwent pedicle screw fixation for various spinal disorders were reviewed retrospectively with statistical analysis., Results: Four hundred and twenty-eight patients (90.1% of all) were followed up for (6.0 +/- 3.7) years. Complications of CD, DRFS, Dick, RF and steffee among 72 cases (80% of all) occurred during the operation of pedical screw fixation in 26 cases with the incidence of 5.5% and after the operation in 64 cases with the incidence of 15%. The incidence of operative/postoperative complications were 0-12.9% in CD, 6.8%-11.9% in DRFS, 7.3%-12.7% in Dick, 2.4%-19.5% in RF, and 10.1%-21.5% in Steffee respectively. The main complications included pseudoarthrosis, pedicle screw broken, pedicle screw malposition and so on. The complications were mainly due to unskilled technique of pedicle screw fixation, implant defect in design and so on., Conclusions: The complications associated with the technique of pedicle screw fixation must not be neglected. The main causes are laid on unskilled technique of pedicle screw fixation and implant defect in design.

Objective: To evaluate the therapeutic effects of patellofemoral replacement for severe patellofemoral osteoarthritis., Methods: Patellofemoral replacement was performed in 30 patients (36 knee joints) with severe patellofemoral osteoarthritis, among whom were 5 males and 25 females. The patients ranged in age from 36 to 74 years old (mean +/- s, 55.8 +/- 8.5) and were followed up for 2-10 years., Results: Significant improvement was made in both the knee score and functional score after the patellofemoral replacement. The effective rate was 88.9% and 91.7% evaluated with knee score and functional score respectively., Conclusion: Patellofemoral replacement is effective in treating severe patellofemoral osteoarthritis in appropriate cases.

Objective: To explore the value of surgical treatment on spine metastatic tumor., Methods: 31 cases of spine metastatic tumor with severe pain or/and neurological deficit were selected and treated with various operative methods., Results: Except for 4 cases, all the patients survived from 3 months to 7 years (average 17.6 months). The patients had no complication during treatment. The symptoms and neurological functions recovered with various extent after operation., Conclusions: Surgical treatment should cautiously be adopted. When the spine metastatic tumor with severe pain and neurological deficit has no response to the conservative methods, the surgical treatment with decompression and internal fixation should be performed to improve the life quality for the patients.