ABSTRACT
Objective:To investigate the effects of posterior internal fixation combined with transpedicular bone grafting in elderly patients with osteoporotic thoracolumbar fractures.Methods:Clinical data of 92 elderly patients with osteoporotic thoracolumbar fractures were retrospectively analyzed.According to the operation method, patients were divided into the control group(n=38)and the observation group(n=54). The control group received the conventional posterior approach and short-segment transpedicular fixation, and the observation group underwent transpedicular fusion in addition to the treatment the control group received.Surgery quality metrics, clinical effects and postoperative recovery were compared between the two groups.Results:The operation time and bleeding volume were higher in the observation group than in the control group( P<0.05). The bone fusion rate was higher and the failure rate of internal fixation was lower in the observation group than in the control group(96.3% vs.78.9%, 3.7% vs.15.8%, χ2=6.929 and 4.103, all P<0.05). The Japanese Orthopaedic Association score(JOA score)increased in both groups after operation( Ftime=47.628, P<0.05). The increase of the JOA score( Finteraction=4.477, P<0.05)and the overall JOA score( Fgroup=5.638, P<0.05)were greater in the observation group than in the control group.The Oswestry Disability Index(ODI)index in both groups decreased with time( Ftime=72.581, P<0.05). The decrease of the ODI index( Finteraction=7.421, P<0.05)and the overall ODI( Fgroup=9.276, P<0.05)were higher in the observation group than in the control group.The visual analogue scale(VAS)score in both groups decreased with time( Ftime=93.157, P<0.05). The decreases of the VAS score( Finteraction=9.473, P<0.05)and the overall VAS( Fgroup=13.272, P<0.05)score were greater in the observation group than in the control group.The Frankel nerve function grade was better in the observation group than in the control group 12 months after operation( z=2.123, P<0.05). Conclusions:Posterior internal fixation combined with transpedicular bone grafting can help improve nerve function, reduce postoperative pain, and has a high bone fusion rate and a low failure rate of internal fixation.
ABSTRACT
Objective To investigate the molecular mechanism of the glucocorticoid?induced osteoblasts apoptosis,and to develop the effective intervention measures. Methods The MC3T3?E1 cells were treated with different concentrations of dexamethasone for 24 hours,then the apoptosis rate was detected with TUNEL analysis,the intracellular expression of Bim and Bax were determined by Westen blot. In addition,MC3T3?E1 cells were randomly divided into Bim?siRNA group,negative control siRNA group and control group. Twenty?four hours after transfection,10-4mmol/L dexamethasone was added to each group of cells for another 24 hours administration. The apoptosis rate was analyzed using the TUNEL,the mito?chondrial transmembrane electric potential was detected by flow cytometry after JC?1 staining,the expression of Bax,Bcl?2 in mitochondrial and Cyt?C,AIF in cytosolic were determined by Western blot. Results The rate of osteoblast apoptosis and Bim expression in cells were both significantly in?creased with the dosage of dexamethasone,there was no significant difference between the groups in the expression of Bax;the rate of osteoblast apop?tosis after the expression of silence Bim was significantly lower than the negative control siRNA group and control group,the expression of Bax and Cyt?C,AIF in cytosolic were significantly reduced,and the mitochondrial transmembrane electric potential was increased. Conclusion Bim is the key molecules in hormone?induced apoptosis of osteoblasts ,the expression of silence Bim can inhibit dexamethasone induced osteoblasts apoptosis through the mitochondrial pathway.