| Chapter 2 Neurophysiological monitoring during correction surgery of scoliosis in neurologically asymptomatic Chiari malformation-associated scoliosis: A comparison with idiopathic scoliosisObjectives.To analyze the somatosensory evoked potentials(SEPs)and motor evoked potentials(MEPs)in neurologically asymptomatic Chiari malformation-associated scoliosis(CMS)patients with and without syringomyelia as compared with those in idiopathic scoliosis(IS)ones,and to identify whether the deformities have impacts on the neurophysiological monitoring.Methods.This study included neurologically asymptomatic CMS patients undergoing posterior correction surgery between January 2010 and January 2016.IS patients were involved as control group and a subgroup of age-and height-matched IS patients were selected.The age,standing height and Cobb angles of main curve were measured.The SEPs latency and amplitude,MEPs amplitude,and the rate of abnormal SEPs pathologic change were compared between CMS and IS patients using independentsample t test and Chi-square test.Results.Sixty CMS patients and 210 IS patients were included.There was no difference between CMS patients and IS or matched IS patients in SEPs latency and amplitude,MEPs amplitude or rate of abnormal SEPs(p>0.05).Forty-eight CMS patients concurrent with syringomyelia were associated with higher Cobb angle of main curve and lower SEPs amplitude than those without syringomyelia(p<0.05).No significant difference was found between CMS patients with and without syringomyelia in age,height,SEPs latency,MEPs amplitude or rate of abnormal SEPs(p>0.05).Conclusions.Neurologically asymptomatic CMS patients showed similar absolute values of neurophysiological monitoring with IS patients.The syringomyelia in CMS indicated more severe curvature and lower SEPs amplitude even after posterior fossa decompression.Chapter 3(Section 1)SRS-Schwab Grade 4 osteotomy for congenital scoliosis: a comparison with radical hemi-vertebra resectionObjective.To compare the radiological and clinical outcomes between SRS-Schwab Grade 4 osteotomy and radical hemi-vertebra(HV)resection in congenital scoliosis(CS)patients with single non-incarcerated HV.Methods.CS patients with single HV undergoing SRS-Schwab Grade 4 osteotomy from February 2011 to May 2016 were retrospectively reviewed as S group.CS patients undergoing radical HV resection were selected as R group,who were age-,gender-,curve magnitude-and apex location-matched with those of S group.Comparisons were performed in terms of radiological results,clinical outcomes and complications at pre-,post-operation and last follow-up between S group and R group.Results.Both S group and R group included 25 CS patients and the mean age at surgery were 10.1±5.2 years.There was no significant difference in pre-operative radiologic parameters between two groups.Significantly improvements in Cobb angle and local kyphosis(LK)were observed post-operatively and at final follow-up in both R and S groups.Compared with the R group,the S group had a similar correction of Cobb angle at post-operation(38.6±6.7° vs 35.2±5.6°,p=0.057)and at last follow-up(38.4±7.0° vs 34.7±6.7°,p=0.062).The LK of S group averaged 39.8±8.9° before surgery,11.3±6.0° after surgery,and 11.5±6.3° at last follow-up while in R group averaged 42.2±9.2° before surgery,10.0±5.6° after surgery,and 10.1±6.0° at last follow-up.The estimated blood loss was 690.9±291.3ml in R group while 502.2±223.8ml in S group(p=0.023)and the operating time was 259.4±70.2min in R group while 206.9±61.2min in S group(p=0.007).During follow-up,no significant correction loss and major complication were observed in the S group,whereas 1 patient in the R group had rod breakage with pseudarthrosis at 24-month follow-up.Conclusions.SRS-Schwab Grade 4 osteotomy is a safe,effective,and less invasive procedure and achieved comparable correction with radical HV resection in the treatment of CS patients with single nonincarcerated HV.Chapter 3(Section 2)Efficacy of SRS-Schwab Grade 6 osteotomy for treatment of severe congenital angular kyphoscoliosisObjective.To evaluate the effectiveness and security of SRS-Schwab Grade 6 osteotomy in severe congenital angular kyphoscoliosis(SCAK)patients.Methods.Patients with SCAK undergoing SRS-Schwab Grade 6 osteotomy from 2005.1 to 2016.12 followed up at least 2 years were retrospectively reviewed.The potential indications of SRS-Schwab Grade 6 osteotomy were analyzed.The coronal Cobb angle(CCA),segmental kyphosis(SK),deformity angular ratio(DAR),C7 plumb line and center sacral vertical line,and sagittal vertical axis(SVA)were measured in the preoperative,postoperative,and final follow-up,respectively.The intraoperative and postoperative complications were recorded.Results.17 patients with SCAK(10M and 7F)were included and the mean follow-up was 30.8±16.4 months.Mean total DAR was 33.4±9.9 at preoperation.The SK was 102.9±23.8° at pre-operation,35.8±19.5° at post-operation and 43.5±19.2° at the last follow-up.Compared with preoperation,the CCA,SK and SVA at postoperation were significantly improved(p<0.05 for all).The mean operating time was 324.0 ± 108.6 min,and the estimated blood loss was 2540.4 ± 1463.1 ml.Three patients were found to have postoperative neurological deficit,and all these patients recovered after conservative treatment.Rod breakage occurred in 3 patients at 15-48 months’ followup,and revision surgeries were performed.At the last follow-up,firm bony fusion was observed in all patients.Conclusion.The technique-demanding SRS-Schwab Grade 6 osteotomy could provide satisfying correction of the SCAK deformity.Chapter 4 Application of a novel electroactive hydrogel in rats with peripheral nerve injuryObjective.To investigate the electrical conductivity and biocompatibility of the polyaniline/polyacrylamide conducting polymer hydrogel(PPH),and to observe the treatment outcomes of PPH on the peripheral nerve injure of the rats.Methods.PPH was prepared by copolymerization,and its swelling rate,electrical conductivity was characterized systematically.Neuro-2a(N2a)cells were co-cultured with PPH samples for 7 days to observe the cell compatibility.Sixteen Sprague-Dawley(SD)rats were modeled,enrolled into a left 10 mm sciatic nerve defect and randomized into PPH and injury roups.The PPH was implanted into the PPH group,and the nerve stumps were sutured to the adjacent muscle directly in the injury group.The sciatic functional index(SFI)and compound muscle action potential(CMAP)of the rats were detected every week after surgery.After 4 weeks,the HE staining,toluidine blue staining,and expression of the glial fibrillary acidic protein(GFAP)in peripheral nerve tissues were observed.Results.The swelling rate of PPH scaffold can reach more than 1800%,and its conductivity is 4.35 S/m.After co-cultured of N2 a cells and PPH for 7 days,the cells,onto the PPH,grew well and maintained normal morphology.Improvement of the SFI and CMAP amplitudes were better in the PPH group than in the injury group,postoperatively(p < 0.05).After 4 weeks,slight adhesions between PPH and surrounding tissues were observed in the PPH group;the adhesions were more severe in the injury group.Both staining of HE and toluidine blue indicated that the number of myelin sheaths in the PPH group was more than that in the injury group(p < 0.05).In addition,the expression of GFAP in the PPH group was significantly increased compared with the injury group(p < 0.05).Conclusion.The PPH holds an excellent electrical conductivity and biocompatibility,and is ideal for the treatment of peripheral nerve injury. |
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