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Ankylosing spondylitis (AS) combined with spinal fractures with thoracic and lumbar fracture as the most common type shows characteristics of unstable fracture, high incidence of nerve injury, high mortality and high disability rate. The diagnosis may be missed because it is mostly caused by low-energy injury, when spinal rigidity and osteoporosis have a great impact on the accuracy of imaging examination. At the same time, the treatment choices are controversial, with no relevant specifications. Non-operative treatments can easily lead to bone nonunion, pseudoarthrosis and delayed nerve injury, while surgeries may be failed due to internal fixation failure. At present, there are no evidence-based guidelines for the diagnosis and treatment of AS combined with thoracic and lumbar fracture. In this context, the Spinal Trauma Academic Group of Orthopedics Branch of Chinese Medical Doctor Association organized experts to formulate the Clinical guideline for the diagnosis and treatment of adult ankylosing spondylitis combined with thoracolumbar fracture ( version 2023) by following the principles of evidence-based medicine and systematically review related literatures. Ten recommendations on the diagnosis, imaging evaluation, classification and treatment of AS combined with thoracic and lumbar fracture were put forward, aiming to standardize the clinical diagnosis and treatment of such disorder.
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Oxidative stress, due to the disruption of the balance between reactive oxygen species (ROS) generation and the antioxidant defense system, plays an important role in the pathogenesis of rheumatoid arthritis (RA). Excessive ROS leads to the loss of biological molecules and cellular functions, release of many inflammatory mediators, stimulate the polarization of macrophages, and aggravate the inflammatory response, thus promoting osteoclasts and bone damage. Therefore, foreign antioxidants would effectively treat RA. Herein, ultrasmall iron-quercetin natural coordination nanoparticles (Fe-Qur NCNs) with excellent anti-inflammatory and antioxidant properties were constructed to effectively treat RA. Fe-Qur NCNs obtained by simple mixing retain the inherent ability to remove ROS of quercetin and have a better water-solubility and biocompatibility. In vitro experiments showed that Fe-Qur NCNs could effectively remove excess ROS, avoid cell apoptosis, and inhibit the polarization of inflammatory macrophages by reducing the activation of the nuclear factor-κ-gene binding (NF-κB) pathways. In vivo experiments showed that the swollen joints of mice with rheumatoid arthritis treated with Fe-Qur NCNs significantly improved, with Fe-Qur NCNs largely reducing inflammatory cell infiltration, increasing anti-inflammatory macrophage phenotypes, and thus inhibiting osteoclasts, which led to bone erosion. This study demonstrated that the new metal-natural coordination nanoparticles could be an effective therapeutic agent for the prevention of RA and other diseases associated with oxidative stress.
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Osteoporotic thoracolumbar fracture in the elderly will seriously reduce their quality of life and life expectancy. For osteoporotic thoracolumbar fracture in the elderly, spinal reconstruction is necessary, which should comprehensively consider factors such as the physical condition, fracture type, clinical characteristics and osteoporosis degree. While there lacks relevant clinical norms or guidelines on selection of spinal reconstruction strategies. In order to standardize the concept of spinal reconstruction for osteoporotic thoracolumbar fracture in the elderly, based on the principles of scientificity, practicality and progressiveness, the authors formulated the Clinical guideline for spinal reconstruction of osteoporotic thoracolumbar fracture in elderly patients ( version 2022), in which suggestions based on evidence of evidence-based medicine were put forward upon 10 important issues related to the fracture classification, non-operative treatment strategies and surgical treatment strategies in spinal reconstruction after osteoporosis thoracolumbar fracture in the elderly, hoping to provide a reference for clinical treatment.
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Objective:To compare the clinical efficacy of robot-assisted percutaneous screw implantation and free-hand open screw implantation by Wiltse approach in the treatment of thoracolumbar fracture.Methods:A retrospective cohort study was performed to analyze the clinical data of 71 patients with thoracolumbar fracture admitted to Second Affiliated Hospital of Soochow University from May 2018 to May 2020. There were 52 males and 19 females, with age range of 22-54 years［(41.0±7.8)years］. Of all, 33 patients were treated with robot-assisted percutaneous screw implantation (Group A) and 38 patients were treated with free-hand open screw implantation by Wiltse approach (Group B). Following parameters were measured, including frequency of radiation exposure, operation time, intraoperative blood loss, length of hospital stay, incidence of complications, rate of fracture healing at 3 months and 6 months postoperatively, visual analogue scale (VAS) and Oswestry dysfunction index (ODI) at 3 days, 3 months, 6 months postoperatively and at the last follow-up, anterior vertebral body height ratio and sagittal Cobb angle preoperatively, at 3 days postoperatively and at the last follow-up, and rate of screw implantation of grade A and B and rate of facet joint violation at 3 days postoperatively.Results:All patients were followed up for 10-24 months［(15.2±4.4)months］. Frequency of radiation exposure and operation time showed no statistical differences between the two groups (both P>0.05). Intraoperative blood loss was 100(100, 135)ml in Group A, less than 160(120, 200)ml in Group B ( P<0.01). Length of hospital stay was 8(7, 11) days in Group A, shorter than 12(10, 16)days in Group B ( P<0.01). There were no complications such as infection, spinal nerve injury or cerebrospinal fluid leakage in both group. There were no significant differences between the two groups in the rate of fracture healing at 3 and 6 months postoperatively (all P>0.05). VAS and ODI in Group A was 3(2, 4)points and 21(18, 23)points at 3 days postoperatively, lower than 4 (3, 5)points and 27(20, 32)points in Group B ( P<0.05 or 0.01), and the two groups showed no significant differences in VAS and ODI at other time points (all P>0.05). There were no significant difference in the anterior vertebral body height ratio or sagittal Cobb angle between the two groups at 3 days postoperatively and at the last follow-up (all P>0.05). Rate of screw implantation of grade A and B was 96.5% (191/198) in Group A, higher than 90.4% (206/228) in Group B ( P<0.05). Rate of facet joint violation was 4.0%(8/198) in Group A, lower than 11.8% (27/228) in Group B ( P<0.01). Conclusion:For thoracolumbar fracture, robot-assisted percutaneous screw implantation is superior to free-hand open screw implantation by Wiltse approach in terms of less bleeding, shorter hospitalization, earlier pain alleviation, higher accuracy of screw implantation and lower risk of facet joint violation.
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Objective:To investigate the related factors of vertebral body height reloss after pedicle screw fixation of thoracolumbar fracture and to determe the optimum prediction point.Methods:A retrospective case control study was made on 215 patients with thoracolumbar fracture admitted to Second Affiliated Hospital of Soochow University from January 2010 to December 2017. There were 155 males and 60 females，aged 21-80 years［（48.6±10.4）years］. According to Denis fracture classification，there were 73 patients with compression fractures（type A in 15 patients，type B in 51，type C in 7），135 burst fractures（type A in 28 patients，type B in 87，type C in 20）and flexion distraction fractures（type A in 4，type B in 2，type C in 1）. All patients were treated by pedicle screw fixation. Follow-up lasted for 12- 48 months［（23.8±8.2）months］. Vertebral body height loss occurred in 86 patients（loss group），but did not in 129 patients（non-loss group）. The two groups were compared concerning sex，age，osteoporosis self-assessment tool for Asians（OSTA），body mass index（BMI），fracture types，number of fractured vertebrae，preoperative sagittal Cobb angle，preoperative degree of vertebral compression，number of screws placed in injured vertebrae，extent of vertebral reset and other related factors. Univariate analysis was used to identify the correlation of those factors with vertebral body height reloss. Multivariate Logistic regression analysis was performed to identify the independent factors for the height reloss with the receiver operating characteristic curve（ROC）and area under the curve（AUC）calculated to evaluate the optimum point in prediction of vertebral height reloss.Results:The two groups showed no significant differences in sex，age，BMI，fracture types，number of injured vertebrae，preoperative sagittal Cobb angle and number of screws placed in injured vertebrae（ P>0.05），but the differences were statistically significant in OSTA，preoperative degree of vertebral compression and extent of vertebral reset（ P<0.05）. According to the univariate analysis，OSTA，preoperative degree of vertebral compression and extent of vertebral reset were significantly correlated with the occurrence of vertebral body height reloss（ P<0.05）. According to the multivariate Logistic regression，OSTA（ OR=1.109，95% CI 0.527-0.685， P<0.05）and preoperative degree of vertebral compression（ OR =0.038，95% CI 0.539-0.689， P<0.05）were significantly related to vertebral body height reloss. The AUC relating OSTA and preoperative degree of vertebral compression to vertebral body height reloss was 0.604 and 0.614，respectively. The optimum prediction point of OSTA and preoperative degree of vertebral compression for vertebral body height reloss was 1.9 and 31.3%，respectively. Conclusions:OSTA and the preoperative degree of vertebral compression are independent risk factors for vertebral body height reloss. OSTA≤1.9 or preoperative degree of vertebral compression ≥31.3% indicates a significantly higher risk of postoperative vertebral body height reloss.
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Objective:To evaluate the effect of zoledronic acid administration for osteoporotic vertebral compression fracture (OVCF) after treatment with percutaneous kyphoplasty (PKP).Methods:A retrospective case-control study was performed on 430 elderly patients with OVCF admitted to the Second Affiliated Hospital of Soochow University from January 2012 to December 2016. There were 31 males and 399 females, with age of 52-92 years[(72.8±8.3)years]. Fracture segments were at T 5-T 10 (82 vertebrae), T 11-L 2 (389 vertebrae) and L 3-L 5 (173 vertebrae). In zoledronic acid group ( n=178), patients were given zoledronic acid 3 days after PKP surgery. In basic treatment group ( n=252), patients were only given basic treatment after PKP surgery. Bone mineral density was measured before operation and one year after operation. Visual analogue scale (VAS) and Oswestry disability index (ODI) were assessed before operation, 3 days and one year after operation. Incidence rate of refracture, mortality and complication rate were recorded after operation. Results:All patients were followed up for 12-60 months (mean, 27 months). Before operation and at postoperative 1 year, the vertebral bone mineral density in zoledronic acid group was (-2.3±1.5)SD and (-1.2±2.3)SD ( P<0.05), and that in basic treatment group was (-2.2±1.2)SD and (-2.1±1.1)SD ( P>0.05). At postoperative 1 year, the bone mineral density in zoledronic acid group was significantly better than that in basic treatment group ( P<0.05). At preoperative 3 days, postoperative 3 days and postoperative 1 year, the VAS was (8.6±0.8)points, (2.8±0.8)points, (2.1±0.8)points in zoledronic acid group, and was (8.5±1.1)points, (2.9±0.9)points, (3.0±2.3)points in basal treatment group; ODI was 48.7±5.3, 24.0±2.9, 22.3±3.3 in zoledronic acid group, and was 48.3±6.1, 24.5±3.8, 27.6±4.0 respectively in basal treatment group. The VAS and ODI were significantly reduced in two groups at postoperative 3 days and 1 year compared to those before operation ( P<0.05). Moreover, the VAS and ODI in zoledronic acid group were significantly lower than those in basal treatment group at postoperative 1 year ( P<0.05). At postoperative 2 years, the incidence rate of refracture in zoledronic acid group was 10.1%(18/178), significantly lower than 16.7%(43/252) in basic treatment group ( P<0.05). Mortality rate in zoledronic acid group was 5.1%(9/178), and that in basic treatment group was 6.3%(16/252) ( P>0.05). No serious complications were observed in both groups such as nerve injury or pulmonary embolism. Conclusion:For OVCF patients, zoledronic acid given after PKP can improve the bone mineral density, reduce pain, fasten function recovery, and effectively decrease the refracture rate.
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Objective To investigate the clinical efficacy of treating injury to the upper cervical spine with posterior internal fixation without bone graft fusion.Methods Included in this retrospective study were 35 patients with upper cervical injury who had been treated at Department of Orthopedics,The Second Affiliated Hospital to Soochow University from June 2010 to August 2017.They were 21 males and 14 females with an average age of 44.1 years (from 26 to 56 years).They were all treated firstly by posterior occipitocervical internal fixation or internal fixation with atlantoaxial pedicle screws without bone graft fusion.The internal fixation was then removed after a solid bone union was confirmed by X-ray.The scores of Japanese Orthopedic Association (JOA),visual analogue scale (VAS),Neck disability index (NDI) and neck stiffness were used to evaluate the functional recovery of the upper cervical spine.We also observed the rotational range of the upper cervical spine using functional CT scan of C 1-C2.Results All the pedicle screws were successfully implanted after satisfactory intraoperative reduction,leading to no injury to the vertebral artery or spinal cord.All patients were followed up for an average of 18.1 months (from 7 to 28 months).At preoperation,post-implantation and final follow-up,the JOA scores were 6.5 ± 1.4,7.7 ± 1.5 and 16.1 ± 0.8 points,the VAS scores 6.1 ± 1.6,2.8 ± 0.8 and 1.1 ± 0.9 points,and the NDI scores 37.9 ± 2.6,20.3 ± 3.8 and 3.7 ± 1.7 points,showing significant improvements after internal fixation and after removal of internal fixation (P ＜ 0.05).Serious neck stiffness was observed in none of the 35 patients,mild neck stiffness in 12 patients and freedom from neck stiffness in 23 patients.The postoperative radiological analysis revealed fine fracture reduction and bony union in all.After 6 to 12 months the rotation of upper cervical spine was obviously improved and the left-to-right range of rotation of C 1-C2 was 35.4° ± 2.6° as revealed by functional CT scan.Conclusion For the middle aged and young patients with new injury to the upper cervical spine,the posterior occipitocervical internal fixation or internal fixation with atlantoaxial pedicle screws can be performed without bone graft fusion at the first stage and removal of internal fixation can be done at the second stage so that the atlantoaxial rotation can be preserved to ensure satisfactory clinical efficacy while bone union can be also ensured and pain reduced.
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Objective To investigate the correlation of DCEGMRI findings with pathologic tumor response to neoadjuvant chemotherapy for patients with tripleGnegative breast cancer (TNBC).Methods SixtyGnine patients with TNBC were enrolled,who underwent DCEG MRI before neoadj uvant chemotherapy,then completed neoadjuvant chemotherapy and surgery.Patterns of tumor volume reduction were divided into two types.Univariate and multivariate Logistic regression analyses were performed to detect the independent predictors of pathological tumor response.Results 30.4% (21/69)patients achieved a pathologic complete response.Multivariate Logistic regression analysis showed that homogenous enhancement on preGneoadj uvant chemotherapy MRI (OR＝1 0.87 ,9 5%CI＝2.94－48.3 1 ,P＜0.00 1 )and concentric shrinkage pattern on postGneoadj uvant chemotherapy (OR＝1 3.04,9 5%CI＝2.0 1－54.1 1 ,P＜0.00 1 )were the independent predictors of pathologic complete response.Conclusion Homogeneous enhancement on preGneoadj uvant chemotherapy MRI and the presence of concentric shrinkage pattern are correlated with pathologically complete response in patients with TNBC.
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Objective To investigate the effects of quercetin on glial scar formation and axonal regeneration after spinal cord injury (SCI) and its association with the p38 mitogen activated protein kinase (MAPK) signal pathway.Methods 128 female Sprague-Dawley (SD) rats were randomly divided into a control group (SCI + saline),an intervention group (SCI + quercetin + anisomycin),a treatment group (SCI + quercetin) and a sham-operation group (n =32).Basso Beattie Bresnahan (BBB) assessment and footprint analysis of the hind limb were performed on days 1,3,7,14,21 and 28 postoperation in each group.The expression levels of p38MAPK,phosphorylation p38MAPK,glial fibrillary acidic protein (GFAP) and neurofilament protein-200 (NF-200) were detected by Western blot.The numbers of GFAP and NF-200 positive staining cells in the injured spinal cord in each group were detected by immunohistochemistry.Results The BBB scores in the treatment group were significantly higher than in the intervention and control groups at each time point after SCI except on day 3 postoperation (P ＜ 0.05).The expression levels of phosphorylation p38MAPK protein in each SCI group were significantly higher than in the sham-operation group on days 3 and 7 postoperation (P ＜ 0.05).The expression levels of phosphorylation p38MAPK protein in the treatment group were significantly lower than in the control and intervention groups on days 3,7 and 14 postoperation (P ＜ 0.05),but there was no significant difference on day 28 postoperation among all the groups (P ＞ 0.05).The numbers of NF-200 and GFAP positive staining cells were significantly greater than in the sham-operation group at each time point postoperation (P ＜ 0.05);the NF-200 positive staining cells in the treatment group were significantly increased in comparison with the control and intervention groups (P ＜ 0.05);the GFAP positive staining cells in the treatment group were significandy fewer than in the control and intervention groups on days 7,14 and 28 postoperation (P ＜ 0.05).Conclusions Quercetin may have protective effects against acute SCI by decreasing glial scar formation,increasing axonal regeneration and promoting recovery of locomotor and nerve function in rats.The effects may be correlated with inhibition of the p38MAPK signal pathway.
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Objective To study the application effect of different internal fixation scheme in older children with proximal hu-merus fractures .Methods The clinical data of 102 cases of elder children with proximal humerus fracture from March 2009 to Feb-ruary 2014 in the hospital were retrospectively analyzed according to different internal fixation methods ,they were divided randomly into A ,B ,C group ,34 cases in group A ,using elastic intramedullary retrograde intramedullary internal operation ;32 cases in group B ,using open reduction and Kirschner wire internal fixation operation ;27 cases in group C ,using open reduction and plate internal fixation operation .Compared and study the operation treatment effect on children in three groups .Results The operation time ,hos-pitalization time ,fracture healing time ,the excellent and good rate of postoperative shoulder joint Neer score ,complication rate of patients among the three groups had no statistical significance (P > 0 .05) .Compared with group B and group C ,the amount of bleeding was significantly decreased and incision length was significantly shortened in group A(P< 0 .05) .Conclusion Elastic intr-amedullary retrograte internal fixation ,kirschner wire interal fixation ,open reduction internal fixation ,all can fix proximal humeral fractures in older children safely and effectively ,and the clinical effect of elastic intramedullary retrograte internal fixation is better than other two fixation .
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Objective To investigate the stability of lumbar single?level dynamicly fixed by socket track pedicle screws after decompression. Methods Socket track pedicle screws are made of titanium?alloy, swing like universal screw within the scope of 18° in the sagittal plane and 8° in the horizontal plane. Motion constraints were due to the hole which the screw goes through. Six pig spines (L1-5) were tested by applying a pure moment of 4.018 Nm in 3 directions of loading. The range of motion (ROM) of the following groups underwent different surgical procedures was measured:(1) intact;(2) dynamic fixation 1 (decompres?sion by total laminectomy and instrumentation with socket track pedicle screws); (3) dynamic fixation 2 (decompression by total laminectomy and bilateral facetectomy while instrumentation with socket track pedicle screws);( 4) instability resulted from decom?pression (decompression by total laminectomy plus bilateral facetectomy without any rod);(5) hybrid fixation (decompression by to?tal laminectomy and bilateral facetectomy while instrumentation with 2 socket track pedicle screws connected with 2 unilateral pedicle screws ). Results Compared with the intact specimens (in flexion, extension, lateral bending and rotation, corresponding angular displacements were 1.84°±0.75°, 1.55°±0.34°, 2.2°±1.07°, 2.06°±0.76° respectively), the ROM of segment L3, 4 of each group were significantly restricted except for axial rotation. In flexion, extension and lateral bending, the ROM was reduced to 0.71°±0.39°, 0.46°±0.18°, 0.85°±0.66° in dynamic fixation 1 group;0.79°±0.43°, 0.71°±0.20°, 1.17°±0.48° in dynamic fixation 2 group and 0.63°±0.50°, 0.37°±0.19°, 0.54°±0.60° in hybrid fixation group. The rotation ROM of dynamic fixation 1 group and hy?brid fixation group were decreased to 1.50°±0.64° and 1.22°±0.36°, whereas the ROM of dynamic fixation 2 had a non?significant reduction to 1.85°±0.67°. The extension and rotation ROM of dynamic fixation 2 increased significantly comparing to dynamic fixa?tion 1 group; the extension, lateral bending and axial rotation ROM of hybrid fixation group were reduced comparing to the state of dynamic fixation 2 group. Conclusion The dynamic instrumentation of single?level lumbar spine with socket track pedicle screws could offer stability in all directions. The flexion, extension, lateral bending and rotation ROM of spine with dynamic instru?mentation after total laminectomy and bilateral facetectomy could be reduced.
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Objective: To describe the applications and effects of electromagnetic navigation [EN] technology in distal locking for the treatment of long diaphyseal fracture [LDF] with interlocking intramedullary nailing [IIN]
Study Design: An interventional study
Place and Duration of Study: The Second Affiliated Hospital of Soochow University, China, from March 2013 to July 2014
Methodology: Patients who underwent IIN-LDF were selected. Twenty-four [50%] of whom were operated under EN guidance [group A] and the other 24 [50%] under conventional targeting guidance [group B]. The distal locking time and X-ray irradiation time of the two groups were compared
Results: Each group included 16 [33.3%] cases of femoral fracture and 8 [16.7%] cases of tibial fracture. The success rate of distal locking in group A was higher than that in group B [95.8% vs. 83.3%, p=0.045]. There were statistically significant differences in the distal locking time and X-ray irradiation time of femoral intramedullary nailing between the two groups [p=0.027 and p=0.001, respectively]. There were no statistically significant differences in the distal locking time and X-ray irradiation time of tibial intramedullary nailing between the two groups [p=0.347 and p=0.056, respectively]
Conclusion: EN-IN was advantageous as it enabled easy targeting, significantly reduced intraoperative fluoroscopy and operation time and small trauma and had other advantages when used for treating LDFs, especially femoral diaphyseal fractures
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Objective To study the clinical efficacy and safety of Bryan-Morrey approach combined with anatomic locking plate fixation for the treatment of type C fractures of distal humerus.Methods Performed a prospective study from from Mar.2011 to Aug.2014.Thirty-three cases of distal humerus fracture were included in our study,and the mean age was (37.3 ±4.1) years old.The fracture type of distal humerus was 13-C according to Mayo classification.All the fractures treated with a Bryan-Morrey approach and anatomic locking plates.In the follow-up,Mayo scores of elbow,measurement of range of motion,elbow flexion and extension muscle strength were recorded and analysed.Results In this study,there were no serious complications,such as nonunion,rupture of triceps tendon and the infection,except partial sensory function injury of ulnar nerve in 5 cases.At the last time of the follow-up,elbow flexion muscle strength and extension muscle strength did not significantly decreased significantly compared with strength of the normal side.The mean flexion of the injured side was (134.5 ± 10.1) degrees,and the mean extension was (-1 1.5 ± 8.1) degrees.According to Mayo elbow performance score,the average scores of elbow was (86.2 ± 7.8),84％ of the patients got excellent or very excellent function results.Conclusion The Bryan-Morrey approach combined with anatomic locking plate fixation is a good choice for the treatment of distal humerus fractures of AO C type.
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Objective To explore the clinical efficacy and application value of hemivertebra resection for treating congenital ky‐phoscoliosis .Methods 30 cases of congenital kyphoscoliosis and hemivertebral deformity in our hospital from January 2011 to Jan‐uary 2013 were selected as the research subjects .Among them ,12 cases of simple vertebral and non‐structural bending were per‐formed the posterior hemivertebral resection and short segment pedicle screw fixation ;3 cases of complicating lordosis and hemiver‐tebral protruding to the ventral side were performed the anterior hemivertebral resection and bone graft fusion fixation ;15 cases of complicating structural compensatory curve were performed the posterior transpedicle hemivertebral resection and compensatory bend long segment fixation and fusion .The clinical effects of surgical treatment for all patients were performed the comparative a‐nalysis .Results The mean postoperative kyphosis Cobb angle and the average final follow‐up Cobb angle were (8 .6 ± 3 .14) °and (11 .2 ± 7 .23) °respectively .The ultimate orthopedic rate of kyphosis was 58 .6% ;the average postoperative Cobb angle and and the average final follow‐up Cobb angle of scoliosis were (12 .8 ± 5 .47)°and (16 .2 ± 6 .24)°respectively ,the final orthopedic rate of scoliosis was 66 .5% .The mean Cobb angle of kyphosis and scoliosis after operation was significantly less than that before opera‐tion ,the difference was statistically significant(P< 0 .05) .Kyphosis and scoliosis were significantly improved .No significant post‐operative complications occurred .The effects were satisfied by the patients .Conclusion The hemivertebral resection has significant effect for treating congenital kyphoscoliosis with high kyphoscoliosis orthopedic rate and is worthy of further clinical study .
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Objective To investigate the effects of bone marrow stromal cell (BMSC) transplantation on axonal and glial scarring after spinal cord injury (SCI).Methods Thirty New Zealand white rabbits were randomly assigned to a sham operation group (group A),a saline treatment group (group B) or a BMSC treatment group (group C).Group A served as controls,in which the canal was opened without damage to the spinal cord.In groups C and B SCI models were established with aneurysm clips and the rabbits of groups C and B were then given injections of BMSCs and saline solution respectively via the intra-intercostal artery at 1 week post injury.At 1 day,1 week,2 weeks and 4 weeks post injury,Basso Beattie-Bresnahan (BBB) scores were assessed to evaluate the recovery of locomotor function in the hind limbs.Spinal cord samples were harvested for HE and Nissl staining,and immunohistochemistry and image analysis were used to detect any changes in neurofilament (NF200) and glial fibrillary acidic protein (GFAP) in the injured spinal cords.Results The average BBB scores of group A were significantly higher those that of groups B and C at each time point,and those of group C were significantly better than those of group B at the 2nd and 4th week post injury.At the 4th week post injury,HE staining showed there was no glial scarring or cavities in group A,but that there was glial cellular proliferation,glial scarring and cavity formation at the injury site in groups B and C.In group C all were obviously less than in group B.Nissl staining indicated there were more typical neurons in group A,while there were a larger number of ruptured neurons,more degradation,and irregular remaining neurons in groups B and C.These abnormalities were again significantly more prevalent in group C.Immunohistochemical examination showed significant increases in NF200 positive neurons and GFAP in groups B and C compared with group A.The number of NF200 positive neurons was significantly higher in group C than in group B,but the GFAP positive area was significantly smaller in group C than in group B.Conclusion BMSC transplantation via the intercostal arteries can effectively improve axonal regeneration,attenuate glial cellular proliferation and reduce glial scar formation,promoting functional recovery after SCI,at least in rabbits.
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Objective To discuss the value of the posterior long segments pedicle screws fixation in surgical treatment of thoracolumbar fracture-dislocation,and summarize the experience.Method s We reviewed the clinical information of 27 cases of thoracolumbar fracture-dislocation since July 2007 to March 2010; all the cases were treated with the posterior long segments pedicle screws fixation.In these cases,20were male,7 were female.And the age ranged from 18 to 58 years old (average age was 35 years).The posterior approach was used,and the pedicle screws were inserted into the 2 vertebrae above and below the fractured vertebrae.Posterior decompression and bone grafts for fusion were also accomplished during the operation.Results Follow-up ranged from 7 to 25 months,averaging 14 months.Completely restoration of the dislocation was got in 25 cases and the spine sequence resumed to nearly normal.One case with lateral dislocation failed to complete correction; another 1 case operated 20 days after surgery failed to complete correction of forward dislocation.At the last follow-up,the mean Cobb angle loss was 3 degrees,the height of the vertebral had obvious loss compared with that of post-operation.The loosen of screw nut was found during the follow-up,but no dislocation and secondary deformity were observed after fixation.There was no death,no infection.Conclusions The technique of posterior long segments pedicle screw fixation is of great value in the clinical applications,since it has the following advantages:the operation is simple,trauma is small,the fixation is firm,good restoration of fracture and dislocations can be easily got,and most importantly,it can effectively prevent long-term vertebral height loss and the backward protruding deformity.
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BACKGROUND:Insulin-like growth factor-1(IGF-1) is an important regulator in osteoblasts proliferation,differentiation and matrix synthesis,which participates in the process of fracture healing and repairing. OBJECTIVE:To investigate the potential bone regeneration effect of human bone marrow mesenchymal stem cells(MSCs) transfected into IGF-1 retroviruses vector on bone defects repairing. DESIGN,TIME AND SETTING:A controlled observation experiment was performed between March 2004 and May 2005 at the Laboratory Animal Center of Soochow University. MATERIALS:MSCs were transfected into IGF-1 retroviruses vector in vitro and combined with demineralized bone matrix(DBM) . METHODS:Fifteen BalB/C nude mice were prepared for 8 mm calvarial defects models and divided into 3 groups by number table method,with 5 animals in each group. DBM transfected with IGF-1 and DBM transfected with vector were implanted into the defect in MSCs cells transduced with IGF-1 and vector groups,respectively. There was no other intervention in the blank control group. The implants were harvested and evaluated by histological examination at 4 weeks after model preparation. MAIN OUTCOME MEASURES:①The mRNA expression of IGF-1 was analyzed by RT-PCR and Western Blot. ②The complexes of cells and DBM were analyzed by scanning electron microscope(SEM) at days 3 and 6 after co-culture. ③Gross observation of the calvarial defects models. ④Osteogenic activity of the implants was evaluated by hematoxylin-eosin staining at weeks 4 after model preparation. RESULTS:①There were mRNA and protein expression of IGF-1 in MSCs cells transduced with IGF-1 vector. ②SEM showed that there were plenty of cells adhered to surface of DBM,and grew into inner part at the 3 days after co-culture with IGF-1,which secreted much collagen fibers at days 6. The count of adherent cells and collagen fiber was smaller in the vector group at each time points. ③No obvious inflammatory reaction could be seen in each group at 4 weeks after model preparation. Compared with vector control,abundant new bone and blood vessel formation occurred in the calvarial defects treated with DBM/IGF-1,and no new bone formation in the blank control groups. ④Results of hematoxylin-eosin staining showed that grafts in the MSCs cells transduced with IGF-1 group was combined closely with calvarial defects,new bone and vessel could be found. There were few bone-like materials formation in vector group,and no defects in control group were repaired. CONCLUSION:The composites of IGF-1 transfected MSCs and DBM has good effect in repairing calvarial defects.
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BACKGROUND:There is no doubt that animal model of fracture is the basis of fracture healing research.The fracture animal mode is divided into open osteotomy model and closed fracture model.There is no research about the difference between two kinds of fracture rat models.OBJECTIVE:To compare the modeling process between open osteotomy model and closed fracture model in rats,and to compare fracture healing using radiograph.DESIGN,TIME AND SETTING:The randomized,controlled animal experiment was performed at the Laboratory of Department of Orthopaedics,Second Affiliated Hospital,Soochow University from January to May 2007.MATERIALS:A total of 40 SPF male Sprague Dawley rats,weighing(220?30) g,were randomly divided into an open osteotomy model group and a closed fracture model group,with 20 rats for each group.Electric swing saw was a kind of self-made percussion device for closed fracture models.METHODS:All rats in the open osteotomy model group received open osteotomy to create transverse fracture of the middle femur,and fixed using Kirschner wire.Rats in the closed fracture model group received retrograde Kirschner wire fixation,and midshaft femoral closed fracture induced by model establishment stent.MAIN OUTCOME MEASURES:Mean model establishment time;Successful rate of model establishment;Radiography of fracture healing at 2,3,4 and 8 weeks after surgery.RESULTS:Success rate of open osteotomy model establishment was 90%.Average modeling time was 17 minutes.Rate of malunion and nonunion was 40%.Successful rate of each closed fracture models was 85%,with average modeling time was 12 minutes.There was no malunion and nonunion.At 2,3 and 4 weeks after surgery,X-ray score was lower in the open osteotomy model group compared with the closed fracture model group(P 0.05).CONCLUSION:Model establishment of open osteotomy takes a longer time,with a high rate of malunion and nonunion.In near future or medium-term,fracture healing is significantly lagged.Thus,open osteotomy is not suitable for the study of early or medium-term fracture healing.
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Objective To observe whether the full-thickness defects of articular cartilage at the knee joint of rabbits could be repaired by implantation of polyglycolic-acid(PGA) composites adhered with bone marrow stromal cells (BMSCs). Methods Culture-expanded rabbits’BMSCs were seeded onto porous PGA scaffolds. After a 72-hour co-culturing, the cell-adhered PGA was implanted into the articular cartilage defect at the intercondylar fossa of the femur. The rabbits were sacrificed 12 weeks later after the operation and the specimens were examined histologically for morphologic features, and stained immunohistochemically for type Ⅱcollagen. Results The specimens harvested from BMSCs-PGA composite demonstrated a hyaline cartilage formation. No obvious progressive degeneration sign was found in the newly formed tissue. The control groups showed no hyaline-like cartilage formation. Conclusion PGA composites adhered with in vitro culture-expanded autologous BMSCs can facilitate formation of hyaline-like cartilage in rabbits.