Rationale:Tuberculous aortic pseudoaneurysm associated with vertebral tuberculosis is a rare disease but with very high mortality. We review the literature and find 19 reports with 22 patients. Here we report three cases with vertebral tuberculosis, who also have tuberculous pseudoaneurysm of the aorta. These patients were treated by different methods. We try to analyze the epidemiology, pathogenesis, presentation, and management of this disease to find the best treatment.Patient concerns:The patients presented with different symptoms such as pain (chest, abdominal or back), fever, blood volume reduction or hemorrhagic shock symptoms. Large mass also could be observed by imaging. In addition to clinical manifestations, enhanced computed tomography or magnetic resonance imaging could also help the diagnosis of this disease.Diagnoses:Tuberculous aortic pseudoaneurysm associated with vertebral tuberculosis.Interventions:Three patients were treated with anti-tuberculosis(TB) drugs or combined with different sequences surgical treatment: Case 1 refused to receive pseudoaneurysm surgery and only had anti-TB drug treatment; Case 2 received thoracic spinal surgery first; Case 3 received endovascular stent grafting.Outcomes:Two patients (case 1 and case 2) who refused to undergo aneurysm surgery died. The last patient (case 3) underwent endovascular repair and antibiotic therapy for tuberculosis, and the postoperative course was uneventful; the patient recovered and survived.Lessons:Once the diagnosis of tuberculous pseudoaneurysm is confirmed, surgical treatment should be provided immediately combined with anti-tuberculosis drugs. The aim of the treatment is to save lives, prevent relapse, and facilitate the return to normal life, regardless of the size of the pseudoaneurysm. The pseudoaneurysm should be treated first to prevent aneurysm rupture before the vertebral tuberculosis surgery.

Porous hydroxyapatite (HA) ceramic cylinder tubes coated with polylactic acid on the exposed surfaces were implanted in four nonskeletal sites (omentum, peritoneum, vastus lateralis, and side of femur). Six months postoperatively, proper amount of Chinese ink was injected to dye the implanting areas. Decalcified and nondecalcified sections were observed under inverted microscope. The results showed that the soft tissues around the HA cylinder tubes in peritoneum, vastus lateralis, and side of femur groups appeared visible black. Some small blacked vascular architectures were also discernible. However in omentum group, only small number of blacked vessels existed. Histological observations indicated that vascularization and ossification occurred in peritoneum, vastus lateralis, and side of femur groups. In omentum group, there was no any sign of vascularization and ossification. A conclusion could be made in this study that excepting bones and muscles, parietal peritoneum could serve as a potential spot for culturing histoengineering hydroxyapatite (HA)-polylactic acid (PLA) ceramic bone substitutes.

We created 66 male and 74 female virtual three-dimensional models of the pelvis based on computed tomography data from 140 patients. Virtual cylindrical bolts (VCBs) were placed in the anterior column (AC), which was then resliced serially along the bolt's long axis. AC screw tunnel mainly comprises two long, narrow triangular prisms [zone III (acetabular fossa) and zone V (obturator foramen)]--forming the III/V angle--linked by a larger, shorter cylinder [zone IV (acetabular notch)]. VCBs' mean length and maximum diameter were 111.13 ± 7.33 and 7.37 ± 1.90 mm, respectively. The models' anatomical zone lengths were similar between the sexes. Zone V's narrowest diameters and the III/V angles were significantly different. VCBs >6.5 mm were accommodated in 65 of 66 male models and 31 of 74 female models. VCBs >5.0 and <6.5 mm were accommodated in one male and 30 female models. Eleven female models accommodated only VCBs >3.5 and <5.0 mm. However, to 13 female pelvic models with maximum VCB accommodation of <5 mm for the anterior column, the maximum diameter of the VCBs was 8.23 ± 1.22 mm in medial passage and 10.3 ± 1.91 mm in lateral passage, respectively. Percutaneous fixation of the AC with screws is a safe technique, even though in Chinese female patients. The narrowest diameters in zone V and the III/V angles are the key factors for application of AC screws. Female patients with a smaller interosseous space at zone V and a large III/V angle can accommodate segmental passage screws.