AIM: To investigate the risk indicators, pattern of clinical presentation and treatment strategy of superior mesenteric artery syndrome (SMAS) after scoliosis surgery.METHODS: From July 1997 to October 2003, 640 patie...AIM: To investigate the risk indicators, pattern of clinical presentation and treatment strategy of superior mesenteric artery syndrome (SMAS) after scoliosis surgery.METHODS: From July 1997 to October 2003, 640 patients with adolescent scoliosis who had undergone surgical treatment were evaluated prospectively, and among them seven patients suffered from SMAS after operation. Each patient was assigned a percentile for weight and a percentile for height. Values of the 5th、 10th、 25th、 50th、 75th、 and 95thpercentiles were selected to divide the observations. The sagittal Cobb angle was used to quantify thoracic or thoracolumbar kyphosis. All the seven patients presented with nausea and intermittent vomiting about 5 d after operation.An upper gastrointestinal barium contrast study showed a straight-line cutoff at the third portion of the duodenum representing extrinsic compression by the superior mesenteric artery (SMA).RESULTS: The value of height in the seven patients with SMAS was above the mean of sex- and age-matchednormal population, and the height percentile ranged from 5% to 50%. On the contrary, the value of weight was below the mean of normal population with the weight percentile ranging from 5% to 25%. Among the seven patients, four had a thoracic hyperkyphosis ranging from 55° to 88°(average 72°), two had a thoracolumbar kyphosis of 25° and 32° respectively. The seven patients were treated with fasting, antiemetic medication, and intravenous fluids infusion. Reduction or suspense of traction was adopted in three patients with SMAS during halo-femoral traction after anterior release of scoliosis. All the patients recovered completely with no sequelae. No one required operative intervention with a laparotomy.CONCLUSION: Height percentile＜50% , weight percentile ＜25%, sagittal kyphosis, heavy and quick halo-femoral traction after spinal anterior release are the potential risk indicators for SMAS in patients undergoing correction surgery for adolescent scoliosis.展开更多
Objective： To determine whether an adenoviral construct containing bone morphogenetic protein-4 （BMP4） gene can be used for lumbar spinal fusion. Methods： Twelve New Zealand white rabbits were randomly divided int...Objective： To determine whether an adenoviral construct containing bone morphogenetic protein-4 （BMP4） gene can be used for lumbar spinal fusion. Methods： Twelve New Zealand white rabbits were randomly divided into two groups, 8 in the experimental group and 4 in the control group. Recombinant, replication-defective type 5 adenovirus with the cytomegalovirus （CMV） promoter and BMP-4 gene （Ad- BMP4） was used. Another adenovirus constructed with the CMV promoter and β-galactosidase gene （Ad-β-gul） was used as control. Using collagen sponge as a carrier, Ad-BMP-4 （2.9 × 10^8 pfu/ml ） was directly implanted on the surface of L5-L6 lamina in the experimental group, while Ad-β-gal was implanted simultaneously in the control group. X-ray was obtained at 3, 6, and 12 weeks postoperatively to observe new bone formation. When newbone formation was identified, CT scans and three- dimensional reconstruction were obtained. After that, the animals were killed and underwent histological inspection. Results： In 12 weeks after operation, new bone formation and fusion were observed on CT scans in the experimental group, without the evidence of ectopic calcification in the canal. Negative results were found in the control group. Histological analysis demonstrated endochondral bone formation at the operative site and fusion at early stage was testified. Conclusions： In vivo gene therapy using Ad-BMP-4 for lumbar posterolateral spinal fusion is practicable and effective.展开更多
文摘AIM: To investigate the risk indicators, pattern of clinical presentation and treatment strategy of superior mesenteric artery syndrome (SMAS) after scoliosis surgery.METHODS: From July 1997 to October 2003, 640 patients with adolescent scoliosis who had undergone surgical treatment were evaluated prospectively, and among them seven patients suffered from SMAS after operation. Each patient was assigned a percentile for weight and a percentile for height. Values of the 5th、 10th、 25th、 50th、 75th、 and 95thpercentiles were selected to divide the observations. The sagittal Cobb angle was used to quantify thoracic or thoracolumbar kyphosis. All the seven patients presented with nausea and intermittent vomiting about 5 d after operation.An upper gastrointestinal barium contrast study showed a straight-line cutoff at the third portion of the duodenum representing extrinsic compression by the superior mesenteric artery (SMA).RESULTS: The value of height in the seven patients with SMAS was above the mean of sex- and age-matchednormal population, and the height percentile ranged from 5% to 50%. On the contrary, the value of weight was below the mean of normal population with the weight percentile ranging from 5% to 25%. Among the seven patients, four had a thoracic hyperkyphosis ranging from 55° to 88°(average 72°), two had a thoracolumbar kyphosis of 25° and 32° respectively. The seven patients were treated with fasting, antiemetic medication, and intravenous fluids infusion. Reduction or suspense of traction was adopted in three patients with SMAS during halo-femoral traction after anterior release of scoliosis. All the patients recovered completely with no sequelae. No one required operative intervention with a laparotomy.CONCLUSION: Height percentile＜50% , weight percentile ＜25%, sagittal kyphosis, heavy and quick halo-femoral traction after spinal anterior release are the potential risk indicators for SMAS in patients undergoing correction surgery for adolescent scoliosis.
基金This project was supported by the National Natural Science Foundation of China （No. 30300099 ） and the Key Item of Health Bureau of Jiangsu Province （ No. H200111 ）
文摘Objective： To determine whether an adenoviral construct containing bone morphogenetic protein-4 （BMP4） gene can be used for lumbar spinal fusion. Methods： Twelve New Zealand white rabbits were randomly divided into two groups, 8 in the experimental group and 4 in the control group. Recombinant, replication-defective type 5 adenovirus with the cytomegalovirus （CMV） promoter and BMP-4 gene （Ad- BMP4） was used. Another adenovirus constructed with the CMV promoter and β-galactosidase gene （Ad-β-gul） was used as control. Using collagen sponge as a carrier, Ad-BMP-4 （2.9 × 10^8 pfu/ml ） was directly implanted on the surface of L5-L6 lamina in the experimental group, while Ad-β-gal was implanted simultaneously in the control group. X-ray was obtained at 3, 6, and 12 weeks postoperatively to observe new bone formation. When newbone formation was identified, CT scans and three- dimensional reconstruction were obtained. After that, the animals were killed and underwent histological inspection. Results： In 12 weeks after operation, new bone formation and fusion were observed on CT scans in the experimental group, without the evidence of ectopic calcification in the canal. Negative results were found in the control group. Histological analysis demonstrated endochondral bone formation at the operative site and fusion at early stage was testified. Conclusions： In vivo gene therapy using Ad-BMP-4 for lumbar posterolateral spinal fusion is practicable and effective.
