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Secondary injury and the glial scar after spinal cord injury can adversely affect nerve regeneration in the microenvironment, leading to treatment difficulties. Mesenchymal stem cells (MSCs) have multi-differentiation, self-renewal ability, participation in immune regulation and other functions and can be used to treat spinal cord injury, but they are not easy to pass the blood spine barrier and have high tumorigenicity and other disadvantages. MSCs-derived exosomes are nanometer exosomes secreted by MSCs, which contain many active substances. These exosomes have a strong neurorepair effect in spinal cord injury research, and have advantages of easy penetration, stability and low tumorigenicity, etc. These exosomes make up for the disadvantages of MSCs treatment, and are expected to replace MSCs in treatment of spinal cord injury. The authors review the biological characteristics of MSCs-derived exosomes and its mechanism in the treatment of spinal cord injury, so as to provide references for the treatment of spinal cord injury.
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BACKGROUND: Tuberculosis clearance, bone graft, internal fixation with or without plate for patients with spinal tuberculosis always lead to C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) changes, which are associated with bone graft union time to certain degree.OBJECTIVE: To analyze the correlation between CRP, ESR and bone graft union time in patients with spinal tuberculosis.METHODS: A total of 60 patients with spinal tuberculosis underwent tuberculose focus clearance, autologous iliac bone grafting, and internal fixation without or with plate, including 38 undergoing fixation and 22 not undergoing fixation. They were divided into mild elevation, moderate elevation, high elevation, and extremely high elevation groups according to CRP and ESR. Correlation between CRP, ESR and bone graft union time was analyzed.RESULTS AND CONCLUSION: (1) CRP: there were 18 cases of mild elevation, 21 of moderate elevation, 13 of high elevation and 8 of extremely high elevation. There were significant differences in bone union time among groups (P=0.003). Spearman correlation analysis showed a correlation coefficient r=0.420, P=0.001, indicating positive correlation between CPR and bone union time. (2) ESR: there were 16 cases of mild elevation, 20 of moderate elevation, 13 of high elevation and 11 of extremely high elevation. There were significant differences in bone union time among groups (P=0.003). Spearman correlation analysis showed a correlation coefficient r=0.414, P=0.001, indicating positive correlation between ESR and bone union time. (3) Bone union was rapider in fixation group compared with non-fixation group, indicating that immediate, strong fixation can benefit bone union.
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BACKGROUND: Clinical practice showed that there are certain correlations between postoperative C-reactive protein levels and bone graft fusion time following focal debridement,autologous iliac bone graft,with or without plate internal fixation,for the treatment of spinal tuberculosis.OBJECTIVE: To analyze the correlation between postoperative C-reactive protein levels and bone graft fusion time of spinal tuberculosis patients.METHODS: A total of 60 cases with spinal tuberculosis were selected from January 2007 to December 2009.All patients were underwent focal debridement,autologous iliac bone graft,with or without plate internal fixation,and confirmed by pathology.The C-reactive protein levels were determined at 1,7 and 14 days after operation,and then,according to average changes of C-reactive protein levels,the cases were assigned into 4 groups: 10-25 mg/L served as the mildly increase group,26-50 mg/L as the moderately increase group,51-100 mg/L as the highly increase group,and greater than 101 mg/L as the extremely increase group.Postoperative C-reactive protein levels were examined at 12,16,and 24 weeks after operation,the bone graft fusion was observed by X-ray or CT examination,in addition,bone block fusion time was recorded.All groups of patients with spinal tuberculosis postoperative C-reactive protein diversity and bone graft fusion time were analyzed by variability and correlation analysis.RESULTS AND CONCLUSION: There were 18 cases in the mildly increase group,21 cases in the moderately increase group,13 cases in the highly increase group,and 8 cases in the extremely increase group.The bone fusion time showed that: there were8 cases equal to or less than 12 weeks,34 cases equal to or less than 16 weeks,and 18 cases equal to or less than 24 weeks.There were significant differences among 4 groups in bone graft fusion times(X2=13.990,P=0.003).Spearman correlation analysis showed that,there was a positive correlation between postoperative C-reactive protein levels and bone fusion time(r=0.420,P=0.001).
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Objective To study the theraputic effect of rebuilt posterior ligamentous complex in the treatment of thoracolumbar fracture.Method From 2003 to 2007,60 patients who had simple thoracolumbar fractures were treated with rebuild of posterior ligamentous complex(group A).At the same time,50 patients with the same condition were treated with ablation of posterior ligamentous complex(group B).Modify Japanese orthopedic association low back pain score(M-JOA)score and Functional Rating scales for Low Back Pain(FRS)score for lumbar function were compared between two groups perioperatively.Results Preoperative M-JOA score for lumbar function of group A was from 19 to 30 score,on average of23.83.M-JOA score of group B was from 17 to 30 score on average of 21.68.There was no significant different between group A and group B(P＞0.05).Postoperative M-JOA score for lumbar function of group A was from 8 to 12 score,on average of 9.05.M-JOA score of group B was from 9 to 14 score.on average of 11.95.There was significant difference between group A and group B(P＜0.01).Preoperative FRS score was 28.85 in group A and 26.56 in group B averagely(P＞0.05)while postoperative FRS score was 68.22(46-84)in group A and 46.87(39-65)in group B(P＜0.05).Conclusion Management with rebuild of posterior ligamentous complex for thoracolumbar fractures contributes to the improvement of the postoperative lumbar function and clinical symptoms.
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Objective To study the method and therapeutic efficacy of the combined iliac screw with pedicle screw system internal fixation and one-stage anterior interbody autograft with iliac crest bone after focal cleaning in lumbosacral tuberculosis. Methods We summarized our 12 cases with lumbosacral tuberculosis treated using iliac screw combined with pedicle screw system internal fixation and one-stage anterior focus elimination plus iliac crest bone grafting during 3 years. Results All the incisions were healed by first intention. All patients can off-bed activity wearing lower back protector two weeks after operation and above eight months after operation,the follow up X-ray film showed all bone-grafts obtained solid fusion. Conclusion It was a safe and reliable method to treat lumbosacral tu-berculosis by using ilisc screw combined with pedicle screw system internal fixation and one-stage anterior focus elimi-nation plus iliac crest bone grafting.