Evidence-based guideline for clinical diagnosis and treatment of acute combination fractures of the atlas and axis in adults (version 2023) / 中华创伤杂志

The acute combination fractures of the atlas and axis in adults have a higher rate of neurological injury and early death compared with atlas or axial fractures alone. Currently, the diagnosis and treatment choices of acute combination fractures of the atlas and axis in adults are controversial because of the lack of standards for implementation. Non-operative treatments have a high incidence of bone nonunion and complications, while surgeries may easily lead to the injury of the vertebral artery, spinal cord and nerve root. At present, there are no evidence-based Chinese guidelines for the diagnosis and treatment of acute combination fractures of the atlas and axis in adults. To provide orthopedic surgeons with the most up-to-date and effective information in treating acute combination fractures of the atlas and axis in adults, the Spinal Trauma Group of Orthopedic Branch of Chinese Medical Doctor Association organized experts in the field of spinal trauma to develop the Evidence-based guideline for clinical diagnosis and treatment of acute combination fractures of the atlas and axis in adults ( version 2023) by referring to the "Management of acute combination fractures of the atlas and axis in adults" published by American Association of Neurological Surgeons (AANS)/Congress of Neurological Surgeons (CNS) in 2013 and the relevant Chinese and English literatures. Ten recommendations were made concerning the radiological diagnosis, stability judgment, treatment rules, treatment options and complications based on medical evidence, aiming to provide a reference for the diagnosis and treatment of acute combination fractures of the atlas and axis in adults.

Surgical treatment and perioperative multidisciplinary management of neuromuscular scoliosis in children / 中国小儿急救医学

Scoliosis is a common deformity in neuromuscular disease, which usually has the characteristics of early onset age, severe degree of deformity, and rapid progression.Neuromuscular scoliosis often leads to serious damages to the quality of life, and results in the loss of walking, standing and sitting, and cardiopulmonary insufficiency.Surgical treatment can improve the quality of life for children with neuromuscular scoliosis, but surgical treatment is still challenging due to the complex surgery and many complicated diseases.The complications are much higher than those of idiopathic scoliosis.A multidisciplinary team is necessary in the surgical treatment of neuromuscular scoliosis to promptly and effectively reduce the complications.

Comparison between Craniospinal Irradiation and Limited-Field Radiation in Patients with Non-metastatic Bifocal Germinoma / Journal of the Korean Cancer Association, 대한암학회지

Purpose@#Whether craniospinal irradiation (CSI) could be replaced by limited-field radiation in non-metastatic bifocal germinoma remains controversial. We addressed the issue based on the data from our series and the literature. @*Methods@#Data from 49 patients diagnosed with non-metastatic bifocal germinoma at our hospital during the last 10 years were collected. The Pediatric Quality of Life Inventory 4.0 was used to evaluate health-related quality of life (HRQOL). Additionally, 81 patients identified from the literature were also analyzed independently. @*Results@#In our cohort, 34 patients had tumors in the sellar/suprasellar (S/SS) plus pineal gland (PG) regions and 15 in the S/SS plus basal ganglia/thalamus (BG/T) regions. The median follow-up period was 52 months (range, 10 to 134 months). Our survival analysis showed that patients treated with CSI (n=12) or whole-brain radiotherapy (WBRT; n=34) had comparable disease-free survival (DFS; p=0.540), but better DFS than those treated with focal radiotherapy (FR; n=3, p=0.016). All 81 patients from the literature had tumors in the S/SS+PG regions. Relapses were documented in 4/45 patients treated with FR, 2/17 treated with whole-ventricle irradiation, 0/4 treated with WBRT, and 1/15 treated with CSI. Survival analysis did not reveal DFS differences between the types of radiation field (p=0.785). HRQOL analysis (n=44) in our cohort found that, compared with S/SS+PG germinoma, patients with BG/T involvement had significantly lower scores in social and school domains. However, HRQOL difference between patients treated with CSI and those not treated with CSI was not significant. @*Conclusion@#In patients with non-metastatic bifocal germinoma, it is rational that CSI could be replaced by limited-field radiation. HRQOL in patients with BG/T involvement was poorer.

Clinical guideline for surgical treatment of symptomatic chronic osteoporotic vertebral fractures / 中华创伤杂志

According to the pathological characteristics of symptomatic chronic thoracic and lumbar osteoporotic vertebral fracture (SCOVF), the different clinical treatment methods are selected, including vertebral augmentation, anterior-posterior fixation and fusion, posterior decompression fixation and fusion, and posterior correction osteotomy. However, there is still a lack of a unified understanding on how to choose appropriate treatment method for SCOVF. In order to reflect the new treatment concept and the evidence-based medicine progress of SCOVF in a timely manner and standardize its treatment, the clinical guideline for surgical treatment of SCOVF is formulated in compliance with the principle of scientificity, practicability and advancement and based on the level of evidence-based medicine.

Changes in blood coagulation in middle-aged and elderly patients with fresh vertebral compression fractures / 中华创伤骨科杂志

Objective@#To explore the short-term effects of fresh vertebral compression fracture on blood coagulation in middle-aged and elderly osteoporotic patients.@*Methods@#A retrospective analysis was conducted of the 140 middle-aged and elderly patients (70 ones with fresh vertebral compression fracture and 70 ones with degenerative spinal disease) who had been treated at Department of Orthopaedics, The First Affiliated Hospital to Peking University between January 2016 and December 2018. Collected were their baseline parameters including age, gender and American Society of Anesthesiologists (ASA) scores, preoperative blood parameters including coagulation indicators [D-Dimer, fibrinogen degradation product (FDP), prothrombin time (PT), activated partial thromboplastin time (APTT), fibrinogen (FIB), international normalized ratio (INR) and thrombin time (TT)] and platelets indicators, and fracture parameters including number of fractured vertebrae and duration of fracture. The 2 patients groups were divided into 5 age groups: 4 age groups for each 10 between 50 and 90 years and one age group for >90 years. The values of D-Dimer and FDP were compared between the 2 patient groups in each corresponding age group. The proportions of patients with D-Dimer negative and correlations between coagulation parameters and platelets before and after age adjustment were statistically analyzed.@*Results@#There were no statistically significant differences in the baseline parameters between the 2 patient groups(P>0.05). The mean onset time for the fracture group was 6.7 days. The values of D-Dimer, FDP, PT, INR, TT and FIB in the fracture group were significantly higher than those in the degenerative disease group(P<0.001). After the D-Dimer threshold adjusted by age, 75.71%(53/70) of the patients in the fracture group were negative while 98.57%(69/70) of those in the degenerative disease group were negative. Meanwhile, the values of D-Dimer and FDP showed a significant correlation (P<0.001) with a Pearson correlation coefficient of 0.932. Compared with the degenerative disease group, the values of D-Dimer and FDP in the fracture group increased significantly in the age groups from 61 to 90 years(P< 0.001).@*Conclusions@#Fresh vertebral compression fractures may have a significant effect on the blood coagulation in osteoporotic patients. It is therefore presumed that the middle-aged and elderly patients with fresh vertebral compression fracture may face a higher risk of deep vein thrombosis than those with degenerative spinal disease.

Effect of surgical factors on the augmentation of cement-injectable cannulated pedicle screw fixation by a novel calcium phosphate-based nanocomposite / 医学前沿

Bone cement-augmented pedicle screw system demonstrates great efficacy in spinal disease treatments. However, the intrinsic drawbacks associated with clinically used polymethylmethacrylate (PMMA) cement demands for new bone cement formulations. On the basis of our previous studies, a novel injectable and biodegradable calcium phosphate-based nanocomposite (CPN) for the augmentation of pedicle screw fixation was systematically evaluated for its surgical feasibility and biomechanical performance by simulated and animal osteoporotic bone models, and the results were compared with those of clinical PMMA cement. ASTM-standard solid foam and open-cell foam models and decalcified sheep vertebra models were employed to evaluate the augmentation effects of CPN on bone tissue and on the cement-injected cannulated pedicle screws (CICPs) placed in osteoporotic bone. Surgical factors in CICPs application, such as injection force, tapping technique, screw diameter, and pedicle screw loosening scenarios, were studied in comparison with those in PMMA. When directly injected to the solid foam model, CPN revealed an identical augmentation effect to that of PMMA, as shown by the similar compressive strengths (0.73 ± 0.04 MPa for CPN group vs. 0.79 ± 0.02 MPa for PMMA group). The average injection force of CPN at approximately 40-50 N was higher than that of PMMA at approximately 20 N. Although both values are acceptable to surgeons, CPN revealed a more consistent injection force pattern than did PMMA. The dispersing and anti-pullout ability of CPN were not affected by the surgical factors of tapping technique and screw diameter. The axial pullout strength of CPN evaluated by the decalcified sheep vertebra model revealed a similar augmentation level as that of PMMA (1351.6 ± 324.2 N for CPN vs. 1459.7 ± 304.4 N for PMMA). The promising results of CPN clearly suggest its potential for replacing PMMA in CICPs augmentation application and the benefits of further study and development for clinical uses.

Expression of heterogeneous nuclear ribonucleo-protein A2B1 in mouse cerebellar development and human medulloblastoma / 中华病理学杂志

Objective@#To investigate the expression and potential role of heterogeneous nuclear ribonucleo-protein A2B1 (HNRNPA2B1) in mouse cerebellar development and the significance of HNRNPA2B1 in human medulloblastoma.@*Methods@#The data of HNRNPA2B1 RNA expression in mouse and human cerebella were obtained from databases. Western blot and immunohistochemical staining were performed to detect the protein level of HNRNPA2B1 in mouse cerebella at different ages. The expression level of HNRNPA2B1 in control human cerebellum and medulloblastoma was detected by immunohistochemical staining. m6A-IP-qPCR method was applied to confirm whether HNRNPA2B1 RNA in Daoy cells was modified with m6A.Western blot was used to detect the effect of MG132 treatment on the HNRNPA2B1 protein level in Daoy cells.@*Results@#The level of HNRNPA2B1 protein in postnatal mouse cerebella was higher than that in adult mouse cerebella, with weak HNRNPA2B1 staining in external granular cells while strong staining in mature Purkinje cells and molecular layer. Compared with control normal human cerebella, the RNA expression level of HNRNPA2B1 increased in medulloblastoma, while immunohistochemical staining showed that the mean intensity of HNRNPA2B1 decreased in medulloblastoma. HNRNPA2B1 RNA in medulloblastoma and Daoy cells was modified by m6A. The HNRNPA2B1 protein level in Daoy cells increased upon MG132 treatment.@*Conclusions@#HNRNPA2B1 is dynamically expressed during mouse cerebellar development. Compared with normal human cerebella, HNRNPA2B1 is significantly up-regulated at transcriptional level but obviously down-regulated at translational level in medulloblastoma. These results indicate that HNRNPA2B1 may be involved in cerebellar development process and medulloblastoma tumorigenesis. The m6A methylation in HNRNPA2B1 transcript and protein ubiquitin-proteasome pathway may account for the down-regulation of HNRNPA2B1 at protein level.

Changes in blood coagulation in middle-aged and elderly patients with fresh vertebral compression fractures / 中华创伤骨科杂志

Objective To explore the short-term effects of fresh vertebral compression fracture on blood coagulation in middle-aged and elderly osteoporotic patients.Methods A retrospective analysis was conducted of the 140 middle-aged and elderly patients (70 ones with fresh vertebral compression fracture and 70 ones with degenerative spinal disease) who had been treated at Department of Orthopaedics,The First Affiliated Hospital to Peking University between January 2016 and December 2018.Collected were their baseline parameters including age,gender and American Society of Anesthesiologists (ASA) scores,preoperative blood parameters including coagulation indicators [D-Dimer,fibrinogen degradation product (FDP),prothrombin time (PT),activated partial thromboplastin time (APTT),fibrinogen (FIB),international normalized ratio (INR) and thrombin time (TT)] and platelets indicators,and fracture parameters including number of fractured vertebrae and duration of fracture.The 2 patients groups were divided into 5 age groups:4 age groups for each 10 between 50 and 90 years and one age group for ＞ 90 years.The values of D-Dimer and FDP were compared between the 2 patient groups in each corresponding age group.The proportions of patients with D-Dimer negative and correlations between coagulation parameters and platelets before and after age adjustment were statistically analyzed.Results There were no statistically significant differences in the baseline parameters between the 2 patient groups(P ＞ 0.05).The mean onset time for the fracture group was 6.7 days.The values of D-Dimer,FDP,PT,INR,TT and FIB in the fracture group were significantly higher than those in the degenerative disease group(P ＜0.001).After the D-Dimer threshold adjusted by age,75.71％ (53/70) of the patients in the fracture group were negative while 98.57％ (69/70) of those in the degenerative disease group were negative.Meanwhile,the values of D-Dimer and FDP showed a significant correlation (P ＜ 0.001) with a Pearson correlation coefficient of 0.932.Compared with the degenerative disease group,the values of D-Dimer and FIDP in the fracture group increased significantly in the age groups from 61 to 90 years(P ＜0.001).Conclusions Fresh vertebral compression fractures may have a significant effect on the blood coagulation in osteoporotic patients.It is therefore presumed that the middle-aged and elderly patients with fresh vertebral compression fracture may face a higher risk of deep vein thrombosis than those with degenerative spinal disease.

How to restore the proper lumbar lordosis in spine surgery / 中华外科杂志

Sagittal alignment of the spine significantly affects the physical function. In this article, we review the clinical application of several spinal-pelvic parameters, analyze the impact factors of sagittal alignment and provide calculating methods to value the correcting degrees. Spine surgeons should get a deep understanding of the spinal-pelvic parameters, differentiate the functional and structural imbalance. Every patient needs thorough preoperative evaluation to restore the proper alignment during surgery and avoid overcorrection.

The analysis of prognostic factors for postoperative patients with foot drop caused by lumbar degenerative disease / 中国脊柱脊髓杂志

Objectives:To analyze the clinical result and the prognostic factors for postoperative patients with foot drop caused by lumbar degenerative disease.Methods:2341 patients who suffered from lumbar degenerative disease and underwent lumbar surgery from January 2011 to January 2016 were reviewed,among which 125 cases suffered from foot drop and caused by lumbar spinal stenosis(LSS) or lumbar disc herniation (LDH).Among the 125 patients,108 cases were enrolled with complete follow-up.All patients underwent modified PLIF and nerve roots decompression.The mean follow-up period was 2.4±1.5 years(range,1.4-5.2 years).Patients whose tibialis anterior(TA) muscle strength recovered to grade 4 or grade 5,the ankle could move freely,with a relative normal gait,could be considered as recovery.The following indexes were included in the single factor analysis by Log-rank test:age,gender,type of lumbar degeneration,duration of palsy,preoperative tibialis anterior strength,physical sensation disorder of affected lower limbs,number of affected limbs,preoperative VAS score,cauda equine syndrome,affected levels and history of trauma.Cox regression analysis was used to analyze the prognostic factors of surgical treatment effect.Results:Among 108 cases of patients with foot drop,59 cases were cured,the recovery rate was about 54.6％.Among them,44 cases were LSS,and 15 cases were cured,the rate was 34.1％;64 cases were LDH,44 cases were cured,the rate was 68.7％.The single factor analysis showed that age,type of lumbar degeneration,duration of palsy,preoperative TA muscle strength and number of affected limbs had significant relation with prognosis (P＜0.05).The Cox regression analysis showed the following indexes were the prognostic factors of foot drop:age,type of lumbar degeneration,duration of palsy and preoperative TA muscle strength(P＜0.05).Conclusions:Age,type of degeneration,duration of palsy and preoperative TA muscle strength are significantly related to the prognosis of foot drop caused by lumbar degenerative disease.Patiets with younger age,shorter duration,stronger TA muscle strength recover better;compared with LSS,foot drop caused by LDH recover better.

Efficacy of transforaminal endoscopic nerve root decompression in the treatment of degenerative lumbar spinal stenosis / 北京大学学报(医学版)

Objective:To evaluate the feasibility of transforaminal endoscopic nerve root decompression for degenerative lumbar spinal stenosis (DLSS).Methods: From July 2011 to April 2016,96 cases of single segment DLSS were involved.All the patients had unilateral lower extremity neurological symptoms,signs,neurogenic intermittent claudication of less than 500 m.Imaging examinations (CT or MRI) or diagnostic nerve root block confirmed single segment degeneration.The mean age was (71.6±5.4) years,male: 55 cases,female: 41 cases.Their intraoperative blood loss,operation time,complications,ambulation time and discharge time were recorded.Leg pain VAS,ODI were used to evaluate the pain and lumbar function of the patients.The clinical efficacy was evaluated by Nakai evaluation.Results: All the patients were performed endoscopic decompression of the lateral recess and nerve root by removing the ventral part of the superior facet joint,the ligamentum flavum and the intervertebral disc.The decompression range was from the inferior edge of the upper pedicle to the superior edge of the lower pedicle.The nerve root was detected to have no compression and the pulse of nerve root returned to normal.The patient got ambulant on the operation day and discharged if he had no discomfort symptom.In the study,68 cases got follow up.The mean follow-up time was 12.1 months (6-63 months).The VAS at dif-ferent follow-up time points was improved relative to the baseline,and the difference was statistically significant (F=491.60,P<0.001).The ODI at different follow-up time points was improved relative to the baseline,and the difference was statistically significant (F=189.91,P<0.001).The excellent and good rates of Nakai evaluation were 79.4％ (excellent in 42 cases,good in 12 cases,fair in 10 cases and poor in 4 cases).The mean intraoperative blood loss was (49.29±11.86) mL.The mean operation time was (92.46±21.34) min.The mean ambulation time was 1.8 h.The mean discharge time was 2.3 days.Postoperative epidural hematoma was found in 1 case.Foot drop was found in 1 case.Second stage open surgery was performed in 6 cases.Conclusion: We can apply transforaminal endoscopic decompression for the patients of lumbar spinal stenosis who have unilateral nerve root irritation.Patients with transforaminal endoscopic decompression can get less surgical trauma,quick recovery and obtain good short-term outcome.

Polymethylmethacrylate augmentation of bone cement injectable cannulated pedicle screws was used to treat degenerative lumbar scoliosis with osteoporosis / 北京大学学报(医学版)

Objective:To describe the application of polymethylmethacrylate (PMMA) augmentation of cement-injectable cannulated pedicle screws for the treatment of degenerative lumbar scoliosis with osteoporosis.Methods: Retrospective cohort study was used to compare cement injectable cannulated pedicle screws (CICPs) group with PMMA augmentation and control group with traditional method in the correction surgery for Lenke-silva level Ⅲ and level Ⅳ degenerative scoliosis cases with osteoporosis.Both groups were followed up for 1 year.The clinical results were assessed by visual analog scale (VAS) of pain on lumbar and lower limbers,Oswestry disability index (ODI) score and EuroQol-5 dimensions (EQ-5D) score.The coronal major curve Cobb angel in coronal plane and thoracic kyphosis Cobb angle,lumbar lordosis Cobb angle and sagittal vertical axis (SVA) in sagittal plane were tested in whole long spine X ray.The fusion rates were evaluated by lumbar X ray and dynamic X ray.Results: In this study 34 cases were enrolled,15 cases in CICPs group and 19 cases in control group.The general characteristics including age,gender,weight,height,BMI and BMD were without statistical difference between the two groups.There were (5.7±2.2)PMMA augmentation screws in CICPs group.The operation time,blood loss and blood transfusion were higher in CICPs group than in control group,but without statistical difference.Lumbar VAS,lower limbers VAS,ODI score and EQ-5D were all better in 1 month post-operation,6 months postoperation and 1 year postoperation than in preoperation in both groups.lumbar VAS scores of CICPs group in 6 months postoperation(CICPs group 3.1±1.3 vs.control group 4.4±1.4,P<0.01) together with lumbar VAS scores (CICPs group 3.3±1.0 vs.control group 5.2±1.4,P<0.01),ODI scores (CICPs group 22.7±17.2 vs.control group 31.4±18.5,P<0.01) and EQ-5D in 1 year postoperation (CICPs group 2.9±2.0 vs.control group 3.5±2.5,P<0.01)were lower than those of control group.The coronal major curve Cobb angels were all lower in 1 month postoperation,6 months postoperation and 1 year postoperation than in preoperation in both groups;thoracic kyphosis Cobb angle and lumbar lordosis Cobb angle were all higher in 1 month postoperation,6 months postoperation and 1 year postoperation than in preoperation in both groups.The coronal major curve Cobb angel was lower in CICPs group than that in control group in 1 year postoperation (CICPs group 17.6°±6.9° vs.control group 21.2°±7.2°,P<0.01)and thoracic kyphosis Cobb angle was higher in CICPs group than that in control group in 6 months postoperation (CICPs group-33.5°±8.8 °vs.control group-28.9°±8.3°,P<0.01)and 1 year postoperation(CICPs group-33.0°±8.1° vs.control group-26.3°±7.4°,P<0.01) together with lumbar lordosis Cobb angle were higher in CICPs group than that in control group in 1 year postoperation(CICPs group 26.4°±8.1° vs.control group 22.1°±7.3°,P<0.01).Conclusion: Polymethylmethacrylate augmentation of bone cement-injectable cannulated pedicle screws for the treatment of degenerative lumbar scoliosis with osteoporosis was effective and safe,the short-term clinical result was good.

Clinical characteristics of children with medulloblastoma / 中华实用儿科临床杂志

Objective To investigate the clinical characteristics of children with medulloblastoma (MB). Methods The correlations amongst MB histopathological subtype,age at diagnosis,gender,primary tumor locations, relapsed tumor and relapsed tumor locations were analyzed retrospectively in 83 children who were diagnosed as MB by histopathology subtypes from February 2012 to April 2015 in Beijing Shijitan Hospital Affiliated to Capital Medical Uni-versity.The data was conducted by using SPSS 22.0 statistical software.Results Among the 83 cases (53 boys and 30 girls),there were 14 patients younger than 3 years old (9 boys and 5 girls)and 69 patients (44 boys and 25 girls)ol-der than 3 years old,including 28 relapsed (19 boys and 9 girls)and 55 non -relapsed cases (34 boys and 21 girls). The median age was 80.2 (13.1 -184.7)months at diagnosis.Of these 83 cases,48.2% (40 /83 cases)was classic medulloblastoma (CMB)(2 cases less than 3 years old),24.1 % (20 /83 cases)was desmoplastic /nodular medullo-blastoma (DMB)(6 cases less than 3 years old),12.1 % (10 /83 cases)was large cell/anaplastic medulloblastoma (LC /AMB)(1 case less than 3 years old),3.6% (3 /83 cases)was extensive nodular medulloblastoma (MBEN)(1 case less than 3 years old),and 12.1 % (10 /83 cases)(3 cases less than 3 years old)was mixed subtype.The rela-tionships between age at diagnosis and histopathological subtype,gender and primary tumor location were all statistically significant (χ2 =0.014,0.013,all P <0.05).Conclusions The incidence of boys with MB is higher than girls.CMB is the main histopathologic subtype in children over 3 years old.The primary tumor location involving the cerebellar vermis or cerebellar vermis and the fourth ventricle is higher in girls with MB.The primary tumor location involving the fourth ventricle,the fourth ventricle and other parts of the central nervous system,Cerebellar vermis and other parts of the central nervous system or other parts of the central nervous system is higher in boys with MB.

Construction of a polycaprolactone/bone extracellular matrix scaffold with three-dimensional printing technology and its osteoinductivity in vitro / 中国组织工程研究

BACKGROUND:Scholars are stil looking for ideal bone tissue-engineered scaffolds, and three-dimensional (3D) printing technology is a novel construction method. In the meanwhile, bone extracel ular matrix is becoming a hotspot in osteogenic induction. OBJECTIVE:To construct the polycaprolactone/bone extracel ular matrix scaffold using 3D printing technology and co-culture method, and to detect its osteogenic property. METHODS:216 3D-printed polycaprolactone scaffolds were divided into group A (96 pores, n=72) and group B(48 pores, n=144). Passage 5 bone marrow mesenchymal stem cel s from Sprague-Dawley rats were seeded onto the two kinds of polycaprolactone scaffolds, and the group A was used for alizarin red staining and Masson staining, while the group B for col agen and glycosaminoglycan detection at 1, 2 and 3 weeks of incubation. Afterwards, the scaffolds at 1, 2 and 3 weeks of culture were decel ularized and labeled as groups AE1, AE2, AE3, BE1, BE2 and BE3. Then passage 5 bone marrow mesenchymal stem cel s from Sprague-Dawley rats were seeded onto each scaffold again, and the former three groups underwent alizarin red staining, and the latter three were used for calcium, alkaline phosphatase activity and DNA quantitative analysis at 1, 2 and 3 weeks of culture. RESULTS AND CONCLUSION:Masson staining, glycosaminoglycan and hydroxyproline quantitative analysis showed that the extracel ular matrix on the composite scaffold increased with time. Alkaline phosphatase activity revealed that the composite scaffold had a significantly stronger osteogenic differentiation than the normal polycaprolactone scaffold (P<0.05). Alizarin red staining and calcium quantitative analysis showed that the mineralization of the composite scaffold was more obvious than that of the normal polycaprolactone scaffold (P<0.05), but the total DNA analysis did not differ significantly between scaffolds. These results suggest that the composite scaffold with extracel ular matrix is constructed successful y using the 3D technology and co-culture method and exhibits a better osteoinductivity.

Analysis of the clinical outcomes of the over 5-year follow-up study of degenerative lumbar scoliosis treated with posterior decompression and instrumented fusion / 北京大学学报(医学版)

Objective:To evaluate the over 5-year follow-up clinical outcomes of degenerative lumbar scoliosis treated with operation of decompression and fusion,and the effectiveness and risks factors about revision surgery cases.Methods:A total of 47 cases of diagnosis of degenerative lumbar scoliosis treated with posterior decompression and instrument fusion recorded from Jun.2003 to Jun.2008 were analyzed. Lumbar Japanese Orthopedic Association (JOA)score and visual analogue score (VAS)were applied to evaluate the improvement of the clinical effect after surgery treatment,and the clinical effect and reasons of revising operation were recorded and analyzed.Results:All the 47 patients had finished the over 5-year followed-up time with an average time of (8.2 ±3.6)years (range from 5.2 years to 12.5 years). The patient’s mean age was (67.0 ±9.6)years and the age of patient range from 56 years to 81 years. There were 10 patients who underwent revision surgery since primary operation,in whom 8 cases because of proximal failure of internal fixation and the other 2 cases because of distal failure of fusion segment. The average clinical improvement excellent rate was 83 .3% after 5 years since primary operation of 37 cases while the average fine rate of revision operation was 67 .6%.Conclusion:In the over 5-year follow-up,there was a better clinical outcome of degenerative lumbar scoliosis treated with posterior de-compression and instrumented fusion,which had a certain rate of revision operation and had a worse effect of clinical results compared with primary operation.The risks of revision surgery included the poor bone quality of patients,with fusion to L1 at proximal terminal and the fusion end to S1 at distal termi-nal.

Scoliosis fixation system implantation and the application of three-dimensional reconstruction technique / 中国组织工程研究

BACKGROUND: Scoliosis is a complex three-dimensional plane deformity, including lateral bending on the coronal plane, before physiological kyphosis reduction or increase in the sagittal plane, the rotational deformity of the spine in the axial plane. The method of ful decompression, maximum reconstruction of spinal balance in coronal and sagittal plane, long-segmental fixation and short-segmental fusion is the more ideal orthopedic method for degenerative scoliosis. OBJECTIVE: To analyze the characteristics of scoliosis fixation system. METHODS: The articles about scoliosis fixation system were retrieved from PubMed database, Chinese Journal Ful -text database from 1999 to 2015 by the first author using computer. “Scoliosis, Internal Fixation, Three-dimensional Correction” were taken as the search terms in English and Chinese. Total y 163 relevant articles were retrieved, and eventual y 34 articles met the inclusion criteria. RESULTS AND CONCLUSION: With the development of fixation materials, the spinal fixation system which was designed based on three-dimensional orthopedic concept of spine is a dynamical y developed system. The goal is to restore the balance of spine in three dimensions as comprehensive as possible. At present, the general spinal system within very broad application includes TSRH spinal fixation system, ISOLA spinal internal fixation system, Moss Miami spinal fixation system, CD Horizon spinal internal system and China Great Wal spinal fixation system. Spinal fixation system possesses three-dimensional orthopedic capability, and can correct the spinal deformity in coronal and sagittal plane, and biomechanics is reasonable, fixed and reliable. Bone grafting material is the key factor of preventing breakage of internal fixation, screw extraction and other complications. Compared with such bone grafting materials made of autologous bone, al ograft bone and xenograft bone, artificial bone can shorten the orthopedic time and reduce the risk of concurrent diseases because of bone grafting, which is the future trend of bone grafting material. Meanwhile, three-dimensional reconstruction has been used in clinical practice, and can develop programs for scoliosis orthopedic treatment, provide imaging reference to ensure the security of internal fixation and also has played a huge role in improving the comprehensive efficacy of spinal internal fixation system.

Establishment, application and progression of an animal model of cervical spondylosis / 中国组织工程研究

BACKGROUND:It is a very difficult task to transfer from the animal model of cervical spondylosis to clinical treatment. However, the pathology of cervical spondylosis is not very clear, and the main reason is the lack of an ideal animal model of the experiment. OBJECTIVE:To review the commonly used modeling methods and evaluate the advantages and disadvantages of different modeling methods through consulting literatures. METHODS:The key words were“cervical spondylosis, cervical spondylotic myelopathy, cervical spondylotic radiculopathy, vertebroarterial type of cervical spondylosis, animal model”. The first author retrieved Medline and CNKI for studies published from 1991 to 2015 concerning animal experiments or clinical studies on the construction of animal model of cervical spondylosis. Final y, 41 studies were included for reviewing. RESULTS AND CONCLUSION:There are many methods for the modeling of cervical spondylosis at the present stage, including implantation method, screw insertion method, bal oon compression method, mechanical compression, injection method, spinal suture method and mechanical imbalance method. Each has its advantages and disadvantages. In the study of cervical spondylosis, we should choose the appropriate animal model according to the research purpose. Further research and the establishment of a comprehensive animal model are stil the goal of efforts.

Excellence of differential velocity adherent procedure in primary culture of nucleus pulposus cells of intervertebral disc / 中国组织工程研究

BACKGROUND:As the main function cel of intervertebral disc, nucleus pulposus cel s are the focus of studying the degenerative mechanism;thereby, it is crucial to maintaining the physiological function of nucleus pulposus cel s in vitro and the stability of the cel phenotype. OBJECTIVE:To study the excel ence of differential velocity adherent procedure in primary culture of nucleus pulposus cel s of rat intervertebral disc through comparison. METHODS:Twenty male Wistar rats aged 4 weeks were enrol ed, and then nucleus pulposus cel s of intervertebral disc were isolated and cultured in vitro;cel passage culture was performed in different groups when the primary cel s were merged to 90%. Differential velocity adherent group cel s adhered for 30 minutes, and non-adherent cel s were aspirated and transferred to new culture dish after readjusting the concentration;the controls received no intervention. Passages 1 and 2 cel s in the differential velocity adherent group were isolated and purified by the same procedure. The morphology of three generations of cel s in the two groups was compared, the purity of the identification was detected by immunohistochemistry, the cel viability was detected by cel counting kit-8 and the cel growth curve was drawn. RESULTS AND CONCLUSION:Inverted phase contrast microscope and hematoxylin-eosin staining revealed that the cel homogeneity of the differential velocity adherent group was significantly higher than that of the control group, and there were more kinds of fibroblast-like cel s in nucleus pulposus cel s in the control group. Identification and purity analysis of col agen type II showed that the cytoplasm of two groups were both stained brown, indicating that they were the nucleus pulposus chrondrocytes. The positive rate of differential velocity adherent group was significantly higher than that of the control group (P<0.05). The cel growth curve of cel counting kit-8 showed cel s in the two groups al passed by the latency phase within 2 days, then to the logarithmic phase of 3 days, and entered the lag phase, while the growth rate of the control group was more rapid during the latency and the early logarithmic phases. These findings suggest that differential velocity adherence method is a practical and effective procedure for the isolation and purification of primary cultured rat nucleus pulposus cel s. Through the primary culture, twice differential velocity adherence procedure, the passage 3 rat nucleus pulposus cel s are metabolic exuberant, consistent with the phenotype, the cel purity is higher, and the logarithmic growth phase can be used as the optimal time for studying the mechanism of intervertebral disc cel s.

Research advances of three-dimension printing technology in vertebrae and intervertebral disc tissue engineering / 浙江大学学报·医学版

Three-dimensional (3D) printing technology is characterized by "inside-out" stack manufacturing. Compared with conventional technologies, 3D printing has the advantage of personalization and precision. Therefore, the shape and internal structure of the scaffolds made by 3D printing technology are highly biomimetic. Besides, 3D bioprinting can precisely deposit the biomaterials, seeding cells and cytokines at the same time, which is a breakthrough in printing technique and material science. With the development of 3D printing, it will make great contributions to the reconstruction of vertebrae and intervertebral disc in the future.

Clinical research of percutaneous vertebroplasty or percutaneous kyphoplasty for treating osteoporotic vertebral compression fractures induced by glucocorticosteroid / 北京大学学报(医学版)

Objective:To investigate the clinical characteristics of vertebral compression fracture ( VCF) in glucocorticosteroid-induced osteoporosis ( GIOP) and risk of vertebral refracture after percuta-neous vertebroplasty ( PVP) or percutaneous kyphoplasty ( PKP) .Methods:In the study, 570 cases who received PVP or PKP as treatments of VCF from January 2010 to December 2013 were retrospective re-viewed, of which 42 were GIOP and 21 were followed up as GIOP group, and the other 528 were primary osteoporosis and 391 were followed up, of which 84 were selected as Control group based on age and gen-der.The fracture location, ratio of single segment fracture and multiple segments fracture in the two groups were compared.In the final follow up, the reoperation rates for vertebral refractures by the Kap-lan-Meier method in the two groups were compared.Results:The follow up periods were (24.0 ±13.1) months in GIOP group and (25.8 ±14.4) months in control group(P>0.05).In GIOP group, there were 11 cases with one-segment fracture, 2 with two-segments fracture, 3 with three-segments fracture, 2 with four-segments fracture, 2 with five-segments fracture and 1 with eight-segments fracture.In Control group, there were 67 cases with one-segment fracture, 12 with two-segments fracture, 3 with three-seg-ment fracture, and 2 with four-segments fracture.The ratio of single segment fracture in GIOP group was significantly lower than that in Control group(52.4% vs.79.8%,P=0.01).There were 50 fracture segments in GIOP group and 109 fracture segments in Control group.The ratios of fracture segments loca-ted in thoracic segments(T1-T10), thoracolumbar segments(T11-L1)and lumbar segments(L2-L5) were 18%, 46%and 36% in GIOP group and 11.9%, 58.7% and 29.4% in Control group ( P >0.05).The refracture rate in GIOP group was higher than that in control group (23.8%vs.6.0%).The survival rate was lower in GIOP group than that in control group ( Pthoracic segments>lumbar segments).The risk of multiple segments VCF was higher in GIOP than in primary osteoporosis. The risk of vertebral refractures after PVP or PKP was higher in GIOP than in primary osteoporosis.