Risedronate inhibits rat bone marrow adipogenesis and reduces RANKL expression in adipocytes / 南方医科大学学报

OBJECTIVE@#To investigate the effects of risedronate on bone marrow adipogenesis and the expression of the receptor activator of nuclear factor κB ligand (RANKL) in adipocytes in the bone marrow micro-environment.@*METHODS@#Primary cultured rat mesenchymal stem cells (BMSCs) with or without adipogenic induction for 14 days were treated with 1, 5, 10, and 25 μmol/L risedronate. The droplets of the differentiated adipocytes were analyzed, and Western blotting was performed to detect the expression level of RANKL. Female SD rats (24-week-old) were randomly divided into sham-operated group and ovariectomy (OVX) group, and 12 weeks after the operation, the OVX rats were further divided into control group and risedronate group (2.4 μg/kg, injected subcutaneously for 3 times a week). Eight weeks later, the bone mineral density (BMD) of the rats and bone marrow histopathology of the femurs was examined to evaluate the effect of risedronate on the fat fraction in the bone marrow.@*RESULTS@#Risdronate significantly inhibited adipogenic differentiation of rat BMSCs and suppressed RANKL expression in the adipocytes derived from the BMSCs in a concentration-dependent manner. In OVX rats, risdronate treatment significantly increased the BMD and decreased the fat content in the bone marrow.@*CONCLUSIONS@#Risdronate can effectively inhibit the adipogenic differentiation of rat BMSCs, decrease fat content in the bone marrow, and suppress the generation and function of osteoclasts by down-regulating the expression of RANKL, which can be an important mechanism underlying the therapeutic effect of risedronate against osteoporosis.

A new technique of angulated innominate osteotomy for treating developmental dysplasia of the hip / 中华骨科杂志

Objective@#To introduce a new technique of angulated innominate osteotomy modified from Salter innominate osteotomy and to compare its early clinical effects with the traditional Salter technique.@*Methods@#Data of 45 cases treated with innominate osteotomy from January 2015 to December 2016 were retrospectively analyzed. There were 14 cases (1 male and 13 females; average age 34.21 months, range from 20 to 43 months) treated by traditional Salter innominate osteotomy (the traditional group) and 31 cases (5 males and 26 females; average age 25.42 months, range from 17-42 months) treated by angulated innominate osteotomy (the modified group). The acetabular index was evaluated radiographically for assessing surgical effects. The operation time and total blood loss during the operation were also collected. McKay method was used for clinical evaluation at the last follow-up. The images of the follow-ups, including the latest one, were used to confirm the exist of complications of avascular necrosis of femoral epiphysis, re-dislocation or subluxation of the hip.@*Results@#The mean follow-up time of traditional group was 23.64 months (range, 8-50 months) and modified group's was 18.94 months (range, 8-35 months). The mean time consumption of modified group (262.42±67.56 min) was significantly lower than traditional group's (306.43±48.37 min) (t=2.482, P=0.018) and the mean total amount of blood loss in the modified group was 81.28±29.00 ml, significantly lower than that of the traditional group's of 117.85±45.55 ml (t=2.762, P=0.013). All the involved hips in the two groups achieved varying degrees of deformities correction after surgery. In the traditional group, the mean correction angle was 13.19°±2.89°, compared to 15.46°±4.29° of the modified group's, and there was statistical differences (t=-2.078, P=0.045). As for McKay results, the excellent combined with good rates in the traditional group and the modified group were 86% and 90%, respectively. The occurrence rate of avascular necrosis of modified group was about 25.81% while traditional group's was 50%. Two patients had subluxation signs in the traditional group.@*Conclusion@#In this research, the angulated innominate osteotomy had good early outcomes with less blood loss and lower incidence of complications than the traditional one.

A new technique of angulated innominate osteotomy for treating developmental dysplasia of the hip / 中华骨科杂志

Objective To introduce a new technique of angulated innominate osteotomy modified from Salter innominate osteotomy and to compare its early clinical effects with the traditional Salter technique. Methods Data of 45 cases treated with innominate osteotomy from January 2015 to December 2016 were retrospectively analyzed. There were 14 cases ( 1 male and 13 fe?males; average age 34.21 months, range from 20 to 43 months) treated by traditional Salter innominate osteotomy (the traditional group) and 31 cases (5 males and 26 females; average age 25.42 months, range from 17-42 months) treated by angulated innomi?nate osteotomy (the modified group). The acetabular index was evaluated radiographically for assessing surgical effects. The opera?tion time and total blood loss during the operation were also collected. McKay method was used for clinical evaluation at the last follow?up. The images of the follow?ups, including the latest one, were used to confirm the exist of complications of avascular necro?sis of femoral epiphysis, re?dislocation or subluxation of the hip. Results The mean follow?up time of traditional group was 23.64 months (range, 8-50 months) and modified group's was 18.94 months (range, 8-35 months). The mean time consumption of modi?fied group (262.42±67.56 min) was significantly lower than traditional group's (306.43±48.37 min) (t=2.482, P=0.018) and the mean total amount of blood loss in the modified group was 81.28±29.00 ml, significantly lower than that of the traditional group's of 117.85±45.55 ml (t=2.762, P=0.013). All the involved hips in the two groups achieved varying degrees of deformities correction after surgery. In the traditional group, the mean correction angle was 13.19°±2.89°, compared to 15.46°±4.29° of the modified group's, and there was statistical differences (t=-2.078, P=0.045). As for McKay results, the excellent combined with good rates in the traditional group and the modified group were 86% and 90%, respectively. The occurrence rate of avascular necrosis of modi?fied group was about 25.81% while traditional group's was 50%. Two patients had subluxation signs in the traditional group. Con?clusion In this research, the angulated innominate osteotomy had good early outcomes with less blood loss and lower incidence of complications than the traditional one.

Segmental decompression with fixation and fusion for treatment of lumbar canal stenosis with degenerative scoliosis / 中华骨科杂志

Objective To investigate the clinical results of selective decompression and short-segment fusion with fixation for symptomatic degenerative lumbar stenosis combined with lumbar scoliosis.Methods All of 30 patients from Jul.2008 to Oct.2013 were recruited for this retrospective study.There were 11 males and 19 females,whose mean age was 60.3±12.7 years.The preoperative X-ray of the total spine showed the mean Cobb's angle was 24.3°±8.8°.And the mean lumbar lordosis angle was 30.5°±15.5°.Pain and function were assessed by Visual Analogue Scale (VAS) and Oswestry dsability index (ODI).The responsible segments were determined from physical examination and radiological findings.Selective decompression and short-segment fixation and fusion were performed.The radiographic parameters,ODI,VAS of pre-operation and post-operation were recorded and compared.Results All the patients were followed up for 21-73 months with mean 46.0±10.9 months.The complication incidence was 33.3％.The ODI and VAS assessment was significantly improved during the follow-up,as well as the sagittal and coronal radiographic parameters (LL,SS,PT,SVA,Cobb's angle,C7PL-CSVL).The improvement of VAS and ODI of lumbar spine was significant correlated with sagittal parameters (LL,PT),whilst not correlated with coronal parameters.Conclusion The surgical strategy of selective decompression and short-segment fusion with fixation is effective for the patients with symptomatic degenerative lumbar stenosis combined with lumbar scoliosis.

Application of internal iliac artery embolization and presetting abdominal aorta balloon for complicated pelvic frac-tures / 中华骨科杂志

Objective To evaluate the clinical outcome of bleeding control by preoperative embolization of internal iliac artery with DSA and intra?operative presetting abdominal aorta balloon, combine with the operation techniques of exposure, reduc?tion and internal fixation of pelvic fracture through lateral?rectus approach. Methods From March 2012 to May 2015, 7 patients with type C3 pelvic fractures admitted to our department from March 2012 to May 2015, treated with preoperative embolization of internal iliac artery under digital subtraction angiography 2 h before surgery and presetting abdominal aorta balloon were retrospec?tively reviewed. There were 3 males and 4 females, with an average age of 34 years (range, 16 to 61 years). According to AO classi?fication, all 7 cases belonged to type C3 (3.2:5 cases;C3.3:2 cases), including 5 cases with limb fracture, 2 cases with craniocere?bral trauma, 4 cases with pulmonary contusion, 2 cases with injury of abdominsal organs. Time from injury to operation was 19 days on average (10 to 33 days). Patients received damage control surgery treatment including bleeding control and temporary ex?ternal fixation, and ipsilateral tractions with heavy weight, intensive care and corrections of general situation before operation. The fracture model was manufactured by 3D printing and fracture reduction was simulated on computer preoperatively. Embolization of internal iliac artery was performed in the side of severe displaced sacroiliac joint with DSA 2 hours preoperatively. Reduction was performed to stabilize anterior-posterior pelvic ring and acetabular fractures via the intraoperative lateral?rectus approach. And 2 cases were performed by temporary balloon occlusion of abdominal aorta (≤60 min) for bleeding control in reduction of in the side of sacroiliac joint fractures. Results All the 7 cases had undergone the operations successfully, and the operating time was from 135-320 min with blood loss from 440-3 350 ml. According to Matta radiological evaluation postoperatively, reduction of pelvic fracture was rated as anatomic in 5 cases, satisfactory in 2, without complications. All 7 cases were complicated with lumbosacral plexus injury or lumbosacral trunk injury at different degrees (M0 2 cases, M1 2 cases, M2 2 cases, M3 1 case). According to the BMRC scoring system, 5 cases had well recovered and the other 2 cases had no improvement after three months (M4 2 cases, M5 3 cases). Conclusion Surgical management of pelvic fracture through preoperative internal iliac artery embolization and intra?oper?ative occlusion of abdominal aorta could effective control bleeding and achieve favorable conditions for reduction. Lateral?rectus approach can provide adequate exposure of the anterior and posterior ring, and this approach could also provide excellent visual control of reduction and fixation.

Application of three-dimensional printing personalized acetabular wing-plate in treatment of complex acetabular fractures via lateral-rectus approach / 中华外科杂志

Objective@#To investigate reduction and fixation of complex acetabular fractures using three-dimensional (3D) printing technique and personalized acetabular wing-plate via lateral-rectus approach.@*Methods@#From March to July 2016, 8 patients with complex acetabular fractures were surgically managed through 3D printing personalized acetabular wing-plate via lateral-rectus approach at Department of Orthopedics, the Third Affiliated Hospital of Southern Medical University. There were 4 male patients and 4 female patients, with an average age of 57 years (ranging from 31 to 76 years). According to Letournel-Judet classification, there were 2 anterior+ posterior hemitransverse fractures and 6 both-column fractures, without posterior wall fracture or contralateral pelvic fracture. The CT data files of acetabular fracture were imported into the computer and 3D printing technique was used to print the fractures models after reduction by digital orthopedic technique. The acetabular wing-plate was designed and printed with titanium. All fractures were treated via the lateral-rectus approach in a horizontal position after general anesthesia. The anterior column and the quadrilateral surface fractures were fixed by 3D printing personalized acetabular wing-plate, and the posterior column fractures were reduction and fixed by antegrade lag screws under direct vision.@*Results@#All the 8 cases underwent the operation successfully. Postoperative X-ray and CT examination showed excellent or good reduction of anterior and posterior column, without any operation complications. Only 1 case with 75 years old was found screw loosening in the pubic bone with osteoporosis after 1 month′s follow-up, who didn′t accept any treatment because the patient didn′t feel discomfort. According to the Matta radiological evaluation, the reduction of the acetabular fracture was rated as excellent in 3 cases, good in 4 cases and fair in 1 case. All patients were followed up for 3 to 6 months and all patients had achieved bone union. According to the modified Merle D′Aubigné and Postel scoring system, 5 cases were excellent, 2 cases were good, 1 case was fair.@*Conclusions@#Surgical management of complex acetabular fracture via lateral-rectus approach combine with 3D printing personalized acetabular wing-plate can effectively improve reduction quality and fixation effect. It will be truly accurate, personalized and minimally invasive.

Minimal invasive surgery of pelvic fractures sustained in earthquake through an incision near the rectus abdominis muscle / 南方医科大学学报

<p><b>OBJECTIVE</b>To assess the effects of minimal invasive surgery through an incision near the rectus abdominis muscle for treatment of pelvic fractures sustained in earthquake.</p><p><b>METHODS</b>Nine patients with pelvic fractures during Ludian earthquake (August 3, 2014) were treated with minimal invasive surgery through an incision near the rectus abdominis muscle followed by anterior ring fixation and reconstruction plate or posterior ring fixation with percutaneous sacroiliac lag screws. The operative time, incision length, blood loss volume, and pre- and postoperative pain levels were recorded. The surgical complications such as lateral femoral cutaneous nerve injury and hip adduction incapability were observed.</p><p><b>RESULTS</b>The minimal invasive surgery achieved satisfactory clinical effects and allowed convenient operation with better surgical exposure, shorter operative time, less blood loss and pain. The patients showed excellent fracture reduction and stable internal fixation without lateral femoral cutaneous nerve injury or hip adduction incapability.</p><p><b>CONCLUSIONS</b>The minimal invasive surgery through an incision near the rectus abdominis muscle is suitable for treatment of pelvic fractures with anteriorly interior fixation, especially in rescuing victims in the event of an earthquake where blood supply can be very limited.</p>

Closed reduction and percutaneous pinning in treatment of "irreducible" supracondylar humerus fractures in children / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate the clinical effects of closed reduction and percutaneous pinning in treatment of "irreducible" supracondylar humeral fractures in children.</p><p><b>METHODS</b>Seventy-six consecutive children of Gartland III supracondylar humeral fractures treated in the Department of Pediatric Orthopedics of the Third Affiliated Hospital of Southern Medical University from July 2011 to July 2013 were analyzed retrospectively, of which 69 were extension type fractures and 7 were flexion type. There were 52 male and 24 female patients with an average age of 6.5 years (range 1.6 to 13 years). The average time from injury to operation was 6.8 hours (range 4 to 48 hours). The mechanism of injury included 15 cases of high falling, and 61 cases of falling to the ground while walking or running. All cases were treated via closed reduction and percutaneous pinning. The radiographs were assessed every follow-up, including the healing and function of the elbow.</p><p><b>RESULTS</b>No major complications such as osteofascial compartment syndrome or neurovascular injuries occurred in these patients. Two cases with neurological injuries before the surgery were recovered fully after the surgery. According to Flynn criteria at follow-up evolution, 71 cases were excellent, and 5 were good.</p><p><b>CONCLUSIONS</b>For the treatment of Gartland type III supracondylar humerus fractures in children, including "irreducible" supracondylar fractures of the humerus, closed reduction and percutaneous pinning is a safe and minimally invasive procedure, by which good fractures reductions and postoperative functions of the elbow can be achieved.</p>

Causes and prevention of postoperative spinal cord injury after anterior approach surgery for cervical spondylotic myelopathy / 中华创伤杂志

Objective To investigate the causes and prevention strategies of postoperative spinal cord injury after anterior approach surgery for cervical spondylotic myelopathy. Methods The clinical data of 749 patients with cervical spondylotic myelopathy treated with anterior approach surgery from 2001 to 2009 were retrospectively studied.There were five patients with spinal cord dysfunction instantly or early after operation,including three males and two females at average age of 52 years (range,48-62 years).Two patients were combined with ossification of the posterior longitudinal ligament.The Japanese Orthopaedic Association (JOA) score was average 12.4(9-16)preoperatively.The surgeries included anterior cervical diskectomy(or corpectomy)and interbody fusion(iliac bone graft or cage or titanium mesh)and locking plates fixation.The blood loss was 50-200 ml.The symptoms included instant spinal cord injury in two patients,loss of the motor and feeling of both legs at 6 h after surgery in one,paralysis of one side limbs at 24 h after surgery in one and numbness of limbs at 5 days after surgery in one.Four patients were treated by large dose of methylprednisolone.Five patients underwent anterior exploration surgery,of which one patient received posterior cervical one-door expansive laminoplasty. Results The patients were followed up for average 16 months(12-24 months).The JOA score of four patients was recovered at three months and WaS better than preoperation after surgery.The function of spinal cord of one patient showed no improvement at one year after surgery.The causes for spinal cord injury included inappropriate surgical manipulation in decompression and haemostasis in two patients,insufficient decompression in one,epidural hematoma in one and absorbable hemostatic gauze in one. Conclusions The major causes of postoperative spinal cord injury in anterior approach surgery for cervical spondylofic myelopathy are the delayed postoperative injury.The spinal cord can recover to normal and has satisfactory prognosis if discovered promptly.We must avoid the spinal cord injury by surgical Manipulation that may result in permanent neurological deficits.

Effects of metformin on osteoclasts differentiation in vitro / 中华骨科杂志

Objective To investigate the effects of mefformin on the differentiation of osteoclastas well as relative mechanism.Methods Raw264.7 cells from the murine macrophage cell line was used.Receptor activator of NF-κB ligand (RANKL) was used to stimulate osteoclast differentiation from Raw264.7 cells.Osteoclast differentiation was assessed by tartrate-resistant acid phosphatase (TRAP) and actin fluorescence staining and counting the TRAP-positive cells after exposure to different concentrations of mefformin (0 μmol/L,400 μmol/L,800 μmol/L and 1000 μmol/L) or rapamicin (100 nmol/L) in the presence of 50 ng/ml RANKL for 5 days.Bone-resorbing activity was evaluated by BD BioCoatTM OsteologicTM Bone Cell Culture System.The expression of osteoclast-specific genes like TRAP,capthesin K,calcitonin receptor (CTR) and matrix metalloproteinase (MMP-9) was evaluated by RT-PCR.The expression of tumor necrosis factor-α(TNF-ct) S6K1Thr389,S6 Ser235/236,4E-BP1Thr37/46 and c-Fos protein was evaluated by ELISA kit and Western blot analysis,respectively.Results Mefformin dose-dependently inhibited RANKL-stimulated osteoclasts differentiation in Raw264.7 cell culture,as manifested by decrease of TRAP-positive multinucleated cells and pit erosion area,down-regulation of TRAP,cathepsin K,CTR and MMP-9 mRNA and reduction of TNF-α and c-Fos protein expression.Further study revealed that RANKL activated mTOR complex 1(mTORC1) signaling,while mefformin impaired RANKL-stimulated mTORC1 signaling.Rapamycin,an mTORCl-specific inhibitor and immunosuppressive macrolides could also prevent RANKL-induced osteoclast differentiation and bone resorption in vitro.Conclusion Mefformin inhibits osteoclastogenesis in vitro,which may due to reduction of TNF-α and c-Fos protein expression,and mTORC1 signaling is involved in this process.

A new classification of spinal tuberculosis:based on MRI findings (Southern Medical University classification) / 中华骨科杂志

Objective To outline the classification of spinal tuberculosis based on MRI findings (Southern Medical University classification,SMU classification) and explore its use in the diagnosis,surgical protocols.Methods The MRI data from 230 cases with spinal tuberculosis were analyzed retrospectively.Our classification system was based on clinical and radiological criteria (abscess formation,disc degeneration,vertebral collapse,kyphosis,sagittal index,instability and neurological problems).The surgical strategies were made according with this classification.Results Two hundred and thirty cases with spinal tuberculosis were classified into the 5 types.There were signal change type (type Ⅰ) in 28 cases,abscess formation type (type Ⅱ) in 39,vertebral collapse type (type Ⅲ) in 78,canal compression type (type Ⅳ) in 46 and kyphosis type (type Ⅴ) in 39 respectively.In type I lesion,25 patients had been followed up.Twenty patients were treated medically.Recurrence of tuberculosis was found in 2 cases.Surgical meticulous debridements were done in 5 cases without recurrence.In type Ⅱa lesion,6 patients were treated medically.The other 6 patients underwent surgical meticulous debridement with recurrence occurred in one patient.There was no difference between medical and surgical treatment regarding outcomes in patients with type Ⅰ and Ⅱa lesion.In type Ⅱb-Ⅴ,surgical treatments were carried out according to the pathological changes.There was no difference between medical and surgical treatment regarding outcomes in the patients with type Ⅱb-Ⅴ.Conclusion The SMU classification helps in differentiating the various manifestations of spinal tuberculosis and appears to correlate with the surgical treatment of spinal tuberculosis.We believe that this new classification system can be used as a practical guide in the treatment of spinal tuberculosis.

The experimental study on differentiation of human umbilical cord blood mesenchymal stem cells into neural cells induced by lithium chloride / 中华显微外科杂志

Objective To study the possibility of inducing human umbilical cord blood mesenchymal stem cells(MSCs) to differentiate into neuron-like cells by lithium chloride(LiCl) in vitro.Methods Human umbilical cord blood was collected from mature neonates.All samples were obtained sterilely with 20 U/ml heparin.The cord mononuclear cells were isolated with lymphocyte separation medium(density 1.077 g/ml), then purified by wall sticking screening and expanded with slight sugar DIEM containing 15% FBS.The third passage of the expanded MSCs were pre-inducted with DIEM containing 15% FBS and 20 ng/ml bFGF for 24 hours, then induced with DIEM without serum but 3 mol/L LiCl for 6 days in group A.The MSCs were induced with DIEM containing 3 mol/L Licl for 7 days in group B.The MSCs were normally cultured with DIEM containing 15% FBS in group C.The morphological changes of the cells were observed under phase contrast microscope.The neuron specific markers containing neuron specific enolase(NSE), microtubule associated protein2(MAP2) and glial fibrillary acid protein(GFAP) were evaluated by indirect immunocyto-chemistry staining.Results After inducted for 3 days, morphological changes were observed obviously in group A and B.6 days later, the differentiated cells showed typical neuronal morphology.The expression of NSE and MAP2 were positive for the majority cells in group A and B, and that of group A[(73.6 ± 7.8)%, 75.5 ± 8.5)% respectively]were obviously higher than group B[(31.0 ± 4.3)%,(33.5 ± 5.0)% respectively], few expressed GFAP in both groups.Conclusion The combination of LiCl and growth factor may induce the human umbilical cord blood MSCs into neuron-like cells in vitro.

Effects of nitric-oxide synthase inhibitor on matrix metalloproteinase's expression in osteoarthritls cartilage by Luminex analysis / 中华风湿病学杂志

Objective To investigate the effects of nitric-oxide synthase inhibitor on matrix metalloproteinases (MMPs) expression in osteoarthritis (OA) cartilage by Luminex analysis,and to explore the mechanism of nitric-oxide synthase inhibitor on modification of the metabolism of OA cartilage.Methods Fifteen specimens of articular cartilage taken from the patients with OA were cultured and divided in two groups.The control group was those with no intervention.L-NIL group was co-cultured with NOS inhibitor L-NIL.After 72 h cultivation,the release of NO and the activity of NOS on OA cartilage were measured by Griess reaction and spectrophotometric methods.MMPs (MMP-1,MMP-2,MMP-3,MMP-9,MMP-13) expression was measured by Luminex analysis.Comparisons between groups were performed with paired sampies t test.Results After cultured for 72 h,spectrophotometric analysis showed high concentration of NO release[(216±47) μmol/L ] and high level of active NOS [(5.7±1.3)U/ml]in supernatants of the control,1 mmol/L concentration L-NIL could evidently reduce NO release [(55±20)μmol/L,P<0.01] and NOS activity [(1.7±0.7)U/ml,P<0.01 ].Luminex analysis demonstrated high MMP-1,MMP-2,MMP-3,MMP-9,MMP-13 expression in cartilages of the control group [respectively for (10.8±5.4)ng/ml,(9.2±3.3) ng/ml,[11.6±4.2 )ng/ml,(1.27±1.07)ng/ml,(3.6±1.3)ng/ml] and 1 mmol/L concentration L-NIL could evidently inhibit MMP-1,MMP-2,MMP-3,MMP-9,MMP-13 expression [respectively for (3.6±1.8)ng/ml,(2.3±1.2)ng/ml,(3.6±1.4)ng/ml,(0.65±0.21)ng/ml,(1.8+0.5)ng/ml,P<0.05 ].Conclusion Luminex analvsis has shown that NOS inhibitor can reduce NO release and NOS activity and modify metabolism of articular cartilage by inhibiting the over-expression of MMPs.

Calcium sulphate/bone matrix gelatin composite biomaterial for repair of bone defects / 中国组织工程研究

BACKGROUND: Calcium sulfate (CS) is a good bone conduction material due to its good biocompatibility and degradability. However, simple CS lacks of osteoinductive capability, so it can not satisfy clinical requirements.OBJECTIVE: To verify the potential ofCS/bone matrix gelatin (BMG) composite biomaterial in the repair of segmental bone defects.DESIGN, TIME AND SETTING: An in vivo multi-dimensional observation was performed in the Laboratory Animal Center, Nanfang Hospital, Southern Medical University between December 2004 and April 2006.MATERIALS: Twenty-one healthy adult New Zealand rabbits, weighing 2.5-3.5 kg, were included. The segmental ulnar defects of 15 mm were created bilaterally. CS and BMG were self-prepared.METHODS: CS and BMG were composited at 2:1 and then implanted into 15-mm rabbit ulnar bone defect. The present study consisted of 3 groups: CS/BMG group, defects were filled with CS/BMG; CS group, defects were filled with CS; and blank control group, untreated control defects.MAIN OUTCOME MEASURES: At weeks 4, 8, and 12 post-surgery, repair of bone defect was observed by gross observation, radiographic, histomorphological and tetracycline tracing analysis.RESULTS: Surgical incisions all primarily healed. No inflammatory or foreign reaction was found around all the defects. Both CS/BMG and CS were almost completely absorbed at week 8 post-surgery. In the CS/BMG group, newly formed bone was found throughout the defects after 4 weeks; all defects were repaired with a well-organized trabecular pattern and a thit neocortex after 12 weeks. In the CS group, mass of new bone tissue formed at the periphery of the defect at week 4 post-surgery, but the development of new bone in the center of defect was latter compared with the CS/BMG group: at 12 weeks, all defects were bridged by newly formed bone tissue with little adjacent medullary bone. In the blank control group, slight new bone was found at the periphery of the defect region, and the defects were filled with fibrous tissue.CONCLUSION: CS/BMG composite is totally bioresorbable and biocompatible. The composite can repair bone defects effectively as a bone graft substitute.

Functional evaluation of human umbilical cord blood mesenchymal stem cell transplantation for spinal cord injury in rats / 中国组织工程研究

BACKGROUND: Basso, beattie and bresnahan (BBB) score and tilt table test are associated with the height of spinal cord injury degree in study of spinal cord models. OBJECTIVE: To establish modified complete spinal cord transected rat models, and to observe effects of BBB score and tilt table test on function following human umbilical cord blood mesenchymal stem cell transplantation. DESIGN, TIME AND SETTING: The observation control experiments were performed at the Key Laboratory of Tissue Construction and Detection of Guangdong Province from April 2007 to July 2008. MATERIALS: Cord blood was collected from healthy puerperants after full-term delivery. Fifty SPF healthy adult female Sprague Dawley rats were randomly divided into group A (sham operation) (n=10), group B (spinal cord transection and phosphate buffered saline, PBS injection) (n=20), group C (spinal cord transection and hMSCs transplantation) (n=20). METHODS: Human umbilical cord blood stem cells were harvested and cultured in vitro. After incising rat dural sac, arachnoid membrane, spinal cord, bilateral wall and ventral dura mater of spinal cord were completely incised in the dural mate of spinal cord to establish complete spinal cord transected rat models. Vertebral plates were only opened in the group A. Rats in the group C were injected with human umbilical cord blood mesenchymal stem cells (6?109 -7?109L-1) at two broken ends of fractured spinal cord. Phosphate buffer saline was injected into rats in the group B. MAIN OUTCOME MEASURES: At 12 weeks after surgery, a behavioral testing was performed every 2 weeks upon each hindlimb for all animals by using the BBB scoring system and tilt table test. RESULTS: No significant difference in hindlimb motor function was detected in the group A. From the second weeks after surgery, motor function of hindlimbs was gradually recovered in the groups B and C. BBB scoring system and tilt table test showed a consistent increasing tendency in a positive correlation. From the fourth week after surgery, significant difference in tilt table test was detected between rats with BBB score

Micromanipulation used in surgical procedure of transected spinal cord treated with umbilical cord blood stem cells grafts in rats / 中国矫形外科杂志

[Objective]To establish effective and reliable complete spinal cord transection models in rats,and to investigate the effects of micromanipulation used in surgical procedure of transected spinal cord treated with human umbilical cord blood stem cells(UCBSCs) grafts in rats.[Method]Human UCBSCs were obtained from umbilical cord blood of term deliveries.Sixty Sprague-Dawley(SD) female rats were divided randomly into group A(control group),group B(spinal cord transection and PBS injection),group C(spinal cord transection and UCBSCs transplantation) and group D(spinal cord transection and UCBSCs transplantation by using micromanipulation).All groups were operated,and 1 ?l UCBSCs(6?109/L ~7?109/L) were injected into the both ends of the completely transected spinal cord at the groups C and D by two different surgical procedures respectively.From 1 week to 8 week post-operation,a behavioral testing was performed weekly upon each hindlimb for all animals according to the BBB scoring system.At the 8th week,all animals were sacrificed and the spinal cords were taken out for morphological observation.[Result]No changes were observed at group A pre-and post-operation.After 2 weeks post-operation,the hindlimb motor function of groups C and D began to recover.After 3 weeks post-operation,the group D showed more improvement than group C,and the difference between groups D and C were significant in the BBB scores(P

Lumbar spinal pedicle subtraction osteotomy on single segment for correction of kyphosis in ankylosing spondylitis / 中国矫形外科杂志

[Objective] To assess the outcomes of lumbar spinal pedicle subtraction osteotomy on single segment for correction of kyphosis in ankylosing spindylitis.[Methods]15 patients were treated with L2 or L3 pedicle subtraction osteotomy and internal fixation by pedicle screw system.All the patients underwent X-ray examinations in standing position before and after the operations.The angles in different part of the sagittal planes were measured and the preoperative and postoperative differences were compared.[Results]All the operations were well complete.The mean time of operations was 3h and the mean bleeding was 840 ml.The lumbar lordosis angle increase from(14.5?15.5)?to(48.4?11.9)?,the total spinal kyphosis angle and the thoracolumbar kyphosis angle improve from(36.1?14.7)?and(30.7?9.3)?to(0.2?14.2)?and(23.7?12.3)? respectively,the sacral slope increase from(12.0?12.7)?to(28.9?8.8)?,whereas thoracic kyphosis angle remained relative stable.[Conclusion]Lumbar spinal pedicle subtraction osteotomy on single segment is a satisfactory and reliable technique for correction of kyphosis in ankylosing spindylitis and the average correction of lumbar lordosis was 33.9?.

Experimental study on treatment of bone defects with calcium sulfate containing bone matrix gelation / 中国矫形外科杂志

[Objective] To investigate the osteogenetic effect of calcium sulfate(CS)combined with bone matrix gelatin(CS)as bone substitute material in a rabbit ulnar defect model.[Method]Twenty one adult New Zealand White rabbits were used.The segmental ulnar defects of 15 mm were created b/laterally and were divided into tbree groups:Group 1,defects were filled with CS/BMG;Group 2,defects were filled with CS;Group 3,untreated control defects.The samples were harvested at 4,8,12 weeks and were examined by radiographic,histomorphological and tetracycline tracing analysis.[Result]No inflammatory or foreign body reaction was observed around all the defects.Both CS/BMG and CS were almost completely resorbed 8 weeks postoperation.At the group 1,nem bone was found throngbout the defects after 4 weeks.All defects were repaired with a well-organized traheeular pattern and a thin neocortex after 12 weeks.At the group 2,mass of new bone tissue formed at the periphery of the defect 4 weeks postoperatlon,but the development of new bone at the central of the defect was latter than that at the group 1.At 12 weeks,all defects were bridged by new bone tissue with little adjacent medullary bone.At the group 3,slight new bone was observed at the periphery of the defect region,and the defects were filled with fibrous tissue.[Conclusion]Calcium sulfate containing bone matrix gelatin is totally bioresorbable and biocompatible.The compound material can enhance the repair bone defects effectively as a bone graft substitute.

Role and change of IL-1?,IL-6 and TNF-? during rabbit lumbar cartilage endplate degeneration / 中国矫形外科杂志

[Objective]To study the role of nitric oxide on the degeneration of the cartilage endplate(CEP).[Method]Twenty-four New Zealand rabbits were divided into experiment and control groups.In the experiment group,the model of lumbar CEP degeneration was established by resection of all lumbar supraspinous and interspinous ligaments,excision of parts of zygapophysial joints and detachment of the posterior paravertebral muscles from lumbar vertebraes.Mechanical instability of the lumbar spine could induced the process of CEP degeneration.The X-ray examination of lumbar spine was examined by at 12,24 and 36 weeks with or without operation,respectively.Changes of the ultrastructure of CEP were also observed by scanning electron microscope(SEM) during this process,and the content of IL-1?,IL-6,TNF-? in the CEP were also detected during the periods.[Result]X-ray graph showed that the CEP calcified gradually with time increasing,and those of the experiment groups calcified more obviously than those of the control groups.The SEM showed that collagen fibers became thin,irregular and fissured and the content of proteoglycan decreased severely with the elapse of time.The changes in experiment groups were more obvious than those in control groups.The content of IL-1?,IL-6,TNF-? had a significant difference between the experiment groups and the control groups(P0.05).[Conclusion]It implies that inflammatary cytokin may play an important role in the development and progression of the degeneration of cartilage endplate.

Experimental study on biocompatibility of nacre / 中国矫形外科杂志

[Objective]To study the biocompatibility of nacre on cultured human osteoblasts in vitro.[Method]The iliac bone of human were added with collagenase-trypsin,a lot of osteoblasts were released out.Then the osteoblasts were purified and cultured.Subsequently,the 3rd generation cultured human osteoblasts were inoculated with the extract of three materials:nacre,hydroxyapatite,and rubber.The appearance of osteoblast was observed under the phase contrast microscope.Microstructure of the osteoblast was observed under transmission electron microscope.Additionally,to determine whether these three materials affect cell proliferation,the numbers of BrdU-labeled cells were examined at three groups.MTT assay was tested to observe the viability of human osteoblasts.[Result]Under the phase contrast microscope,the appearance of the osteoblasts in two groups were spindle or triangle like,and black nodes were seen in confluent cell layer 19 days after cultured.The observation of electron microscopy showed that the nucleus of the osteoblasts in two groups were big and round,and there were a large number of mitochondrion and rough endoplasmic reticulum in two groups.Stereological analyses of the numbers of BrdU-labeled cells revealed that females produced more cells than males in the dentate gyrus but not in the subventricular zone.[Conclusion]The nacre have no harmful effect to character of biology of human osteoblasts in vitro.