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Objective To assess the clinical effect of Percutaneous transforaminal endoscopic spinal surgery for central lumbar spinal stenosis.Methods Total 92 patients (44 males and 48 females with average age of 68.6± 12.4 years) with central lumbar spinal stenosis were enrolled in our study during February 2012 and July 2016.All patients were treated with Percutaneous transforaminal endoscopic spinal surgery.Clinical and Radiographic evaluation were investigated on 1 week,3 months,6 months,12 months postoperatively and final follow-up.Visual analogue scale (VAS) for low back pain and leg pain,Oswestry disability index(ODI) for low back pain were used to evaluate the clinical efficacy of surgery.Pre and postoperative Dural sac cross sectional area(DSCA) was measured.And the correlation between changes of DSCA and clinical efficacy was analyzed.Results The operation time was 45-1 15 min.The mean operation time was 75±15 min.the mean blood loss was 15±5 ml (range 8-50 ml).All patients were followed for 12-46 months (24.5±5.3 months).VAS for low back pain,VAS for leg pain,and OD1 were significantly improved from 6.75± 1.28,7.79± 1.15 and 39.82％ ±5.06％ preoperatively to 2.21± 1.08,2.16± 1.14 and 9.82％ ±3.69％ at the latest follow-up.Dural sac cross sectional area significantly increased from 55.35±12.18 mm2 preoperatively to (102.36±15.38) mm2 at the latest follow-up.Correlation coefficient with DSCA change was-0.480 for ODI change,-0.612 for VAS(low back pain) change,-0.637 for VAS (leg pain)(P ＜ 0.05);obvious positive correlation existed between the change of DSCA and patient's clinical efficacy.It showed that the change of DSCA was positively correlated with the patient's clinical efficacy.The clinical results were excellent in 56 cases.good in 29,fair in 4,and poor in 3 based on the MacNab criteria.92.39％ demonstrated a good-to-excellent outcome.One case occurred cauterizing syndrome,3 cases of recurrence,and 2 cases of Dural tear.There was no severe vascular or nerve injury.Conclusion Percutaneous transforaminal endoscopic spinal surgery provides a new minimally invasive treatment for central lumbar spinal stenosis.It is safe and effective.It is found that the change of DSCA is positively correlated with the clinical efficacy of surgery.
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ABSTRACT:Objective To assess the effect of prolonged laparoscopic surgery on peritoneal mesothelial cells and fibrinolysis in humans.Methods We examined prospectively 1 6 consecutive patients who underwent laparoscopic surgery (LAP)and 2 1 patients who underwent conventional open surgery (OP)for high-medium rectal cancer with curative intent.During the procedure,biopsy of the parietal peritoneum was made before operation and at 45 min,90 min,and 120 min after operation.The tissue-type plasminogen activator (tPA)and plasminogen activator inhibitor-1 (PAI-1 )were determined by enzyme-linked immunosorbent assay in peritoneal tissues.The cellular injury was detected by LDH assay.The proliferation was quantified by MTT assay.Results PAI-1 activity in the peritoneal tissue was significantly lower in LAP group than in the OP group.tPA activity decreased after 45min of open surgery,but there was no significant change in the LAP group.With time extension,the LDH activity increased and the proliferation of the mesothelial cells decreased.Conclusion Preservation of a prolonged hypofibrinolytic state by inhibition of PAI-1 up-regulation during LAP may predispose patients to less postoperative peritoneal adhesion. The cellular injury becomes apparent and the proliferation is inhibited during prolonged laparoscopic surgery.
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Objective To prepare the composite of Polycaprolactone(PCL) and Bone powder(BP) for bone repairing,and evaluate the biocompatibility of the material.Methods The materials were prepared in college of chemical engineering and materials science,Shanghai Jiaotong University,and the animal tests were fulfilled in Animal Experimental Center of the Second Military Medical University of PLA from June 2010 to March 2011.The PCL and BP were blended together to get the copolymer by haake ( Rheocord 900 ) torque rheometer.Then the extracts of the material in DMEM for 24 hours were obtained.Firstly biological safety detection of the materials was performed:①cytotoxicity test:the extracts were mixed with DMEM to seed rabbit osteoblasts for 24 hours.The cell proliferation was detected by MTT method.The cell proliferation rate and toxicity grate were also calculated ( cytotoxicity of grade 0 or 1 was qualified).②hemolysis test:the extracts were mixed with fresh rabbit blood,hemolysis rate were calculated ( hemolysis mte less than 5％ was qualified).③pyrogenic test:the extracts were injected into the rabbit ear vein with the dose of 10 ml/kg.The anus temperature was measured per hour for three times.The elevator degree was calculated by subtracting the natural temperature from the highest one.Secondly,cellular adhesion test of the material composite was performed.The composite was casted on the cover glasses.The samples were put in 6-well tissue culture plates,totally 6 × 104 osteoblasts were seeded each well and cultured for 3 days.The cells were observed at 24 and 72 hours of culture,and photography was performed using inverted phase contrast microscope.④general toxioity test:the extracts were injected into mouse vein with the dose of 50 ml/kg.The toxic symptoms were observed within 72 hours.Results The novel copolymer of PCL/BP was prepared.①Biological safety:the cell viability of the composite was 87.8％ and cytotoxicity was grade 1.The hemolysis rate was 2.4％,less than 5％.The maximal variety of body temperature in rabbits were 0.4℃,which accorded with the national standard ( ＜0.6℃ ).The general toxicity test showed that there were no adverse effects in the animals,such as death,convulsion,paralysis,respiratory depression,diarrhea and decreasing weight.②Cell adhesion:adhesive cells manifold obviously and assembled 24 hours later,inosculated gradually 3 days later,and the cells were in good fettle.Conclusion The composite of PCL/BP accords with cytotoxicity demand of the biological materials,presenting no toxicity,pyrogenicity or hemolysis.It possesses good biocompatibility and cellular adhesion.
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Objective To investigate the effects of keratinocyte growth factor on peritoneal adhesion formation in rats. Methods Thirty Sprague-Dawley( SD) female rats were randomly assigned to 3 groups, KGF group( n = 10), positive control group (n = 10) , and negative control group (n = 10). Seven days after surgery, rats were killed and the adhesion degree was evaluated by Leach scale. Immunohistochemical technique was used to identify the expression of tPA and PAI-1. Stained with HE,the histomorphology changes of the adhesion tissue were observed by light microscope. Picrosirius-polarization method was used to observe the expression of type Ⅰ or Ⅲ collagens in two groups. Results In the KGF group,lower collagen fibers were noted and the gross adhesion scores was significantly lower than that in positive control group (4. 8 ± 1. 0 vs 7. 6 ± 1. 0; t = 5.422; P ＜ 0. 01). The expression level of type Ⅰ collagens was significantly lower in the KGF group than in positive control group (69 ±11 versus 55 ±9;t = 3. 214 ;P ＜0. 01) ,but there was no significant difference in the expression of type Ⅲ collagens among the two groups (48 ± 7 versus 50 ± 10; t = 0. 481; P ＞ 0. 05). The immunohistochemistry showed that the expression of tPA significantly increased in the KGF group than in positive control group and negative control group(88 ±4.0 versus 112 ±4.0, 101 ±2.0;F = 109. l,P＜0. 01) , However, no statistically significant difference for the expression of PAI-1 was noted among the three groups ( F = 1. 391, P ＞ 0. 05). Conclusions Keratinocyte growth factor promotes mesothelium repair, increases mesothelial fibrinolytic activity, inhibits the deposition of collagen and reduces the intensity of postoperative adhesions.
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Objective To study the corelation between the expression of COX-2 and postoperative adhesions and to determine the effect of COX-2 selective inhibitor,Celecoxib,on postoperative adhesion formation. Methods Fifty SD rats were randomly assigned to five groups each consisting of 10 rats,Study groups were as follows:(A)positive control group,(B)sodiumhyahronate group,(C)low dose Celecoxib group,(D)high dose Celecexib group,(E)negative control group,Five rats in each group were treated accordingly for consecutive 8 days and 15 days respectively and sacrificed,After treatment,intra-abdminal adhesions were scored using a standard method.The adhesions tissure and injured peritonaeum were subjected to Westem-blotting to detect the expression of COX-2. Results The level of postoperative adhesions and expression of COX-2 of sodiumhyahronate group、low dose Celecoxib group、high dose Celecoxib group were lower than that of positive control group(P<0.05),Sediumhyahronate treatment group was different formthe two Celecoxib treated groups(P<0.05).Conclusions Selective COX-2COX-2.mechanism,provides durable inhibition of intra-abdominal adhesions through an antiangiongenic COX-2 mechanism.