Objective To explore the changes of bone mineral density (BMD) and bone markers in senile osteoporosis patients treated with teriparatide,and evaluate the improvement on quality of life (QOL) as well as the clinical significance.Methods Forty-five senile osteoporosis inpatients were treated with 20 μg of teriparatide for one year.BMD and bone markers were detected before treatment and also in the third,sixth and twelfth month during treatment.The level of numerical rating scale (NRS) and QOL were assessed.Results The NRS before treatment was (4.96±2.25) , and those after treatment of 3, 6 and 12 months were(2.84±1.41), (1.56±1.16) and (1.36±1.00), respectively (P<0.01).The total scores of SF-36 significantly increased after treatment (P<0.01).After treatment of 3, 6 and 12 months, BMD of lumbar vertebra had increased 7.7%, 12.3% and 15.4%, respectively;that of femoral neck had increased 3.0%, 6.1% and 7.6%, respectively;and that of intertrochanteric bone had increased 5.7%, 8.6% and 10.0%, respectively.Meanwhile, the serum levels of osteocalcin, bone alkaline phosphatase and N terminal propeptide of type I procollagen were significantly higher than those before treatment (P<0.01), nevertheless beta collagen cross-linked C-terminal peptide (β-CTX) only significantly decreased at the 12th month after treatment (P<0.05).Conclusion Chronic teriparatide therapy could significantly relieve bone pain,improve the quality of life and increase lumbar vertebra BMD in senile osteoporosis.

Objective To investigate the feasibility of percutaneous transforaminal endoscopic spine system in thoracic discectomy for disc herniation. Methods One patient with thoracic disc herniation involved the level of vertebral segment in T11/12 was treated with percutaneous transforaminal endoscopic spine system and followed up for 1 month. The targeted puncture was performed under local anesthesia and fluoroscopic guidance with patient in prone position. The foramen of T 11/12 was enlarged gradually with four trephinations, and the working cannula was inserted transforaminal into the canal. Then the herniation was exposed and removed with full endoscopic technique, including the loosen nucleus pulposus. The dural sac was exposed and released adequately. Drainage was placed during operation. Results The procedure was successfully carried out and the dural sac was completely released. The drainage was removed in the second day of operation. The patient could walk in the third day after operation with obvious relief of back and leg pain. At the follow-up of one month postoperation, the visual analogue scale of leg pain decreased from 8 to 1, and the Oswestry disability index (ODI) decreased from 64 to 4. According to MacNab scale, excellent result was acquired. Conclusion There is the feasibility of the percutaneous transforaminal endoscopic spine system in thoracic discectomy for disc herniation. It is a good minimal invasive technique with good results and high technical requirements for surgeons.

AIM: To explore the effects of hydrogen sulfide (H_2S) on proliferation of vascular smooth muscle cells (VSMC) stimulated by endothelin (ET-1, 10 -7 mol/L ) and mitrogen-activated protein kinase (MAPK) activity in VSMCs. METHODS: Cultured VSMCs were divided into six groups: (1) control group, (2) serum group, (3) endothelin group, (4) NaHS groups, (5) serum+NaHS group, and (6) endothelin+NaHS group. VSMC proliferation was measured by [ 3H]-TdR incorporation and MAPK activity in VSMC was determined by radioactivity assay. RESULTS: ET-1 increased VSMC [ 3H]-TdR incorporation by 2.39 times ( P

AIM: The activity and expression of neutral endopeptidase (NEP) and the adrenomedullin (ADM) contents in various tissues were observed in septic shock and control rats to study the possible role of NEP in the change of ADM contents in tissues during septic shock. METHODS: The septic shock model of rats were established by cecal ligation and puncture (CLP). ADM contents, NEP activities, level of NEP mRNA and NEP protein were measured. RESULTS: (1) In early septic shock (ES), the ADM contents were generally higher in detected tissues, the NEP activity in left ventricle and small intestine were lower and was higher in blood than those in controls, and in lung, kidney and aorta were similar with the controls. NEP immunoreactive staining were less in lung, left ventricle, endothelium and media of aorta, but more in adventitia of aorta and kidney than those of the controls; (2) In late septic shock (LS), the ADM contents in small intestine was less but in plasma and other tissues were higher, and the NEP activity were less in plasma and other tissues than those in ES. The NEP immunoreactive staining were less in heart, endothelium and media of aorta, lung and kidney than those in ES, and was no significant change in adventitia of aorta compared with those of ES. RT-PCR found that NEP gene expression were significantly less in left ventricle, aortas, lung and small intestine than those in the controls. CONCLUSIONS: In septic shock rats, the NEP activity changes heterogeneously but the ADM contents elevate in most tissues. These results indicate that during the septic shock, the local concentrations and actions of ADM in various tissues may be regulated differently by the NEP. [

Objective:To evaluate the value and efficacy of self-anchored anterior lumbar discectomy and fusion (SA-ALDF) for L 5 isthmic spondylolisthesis. Methods:From June 2018 to December 2019, a total of 11 cases of L 5 isthmic spondylolisthesis were treated with SA-ALDF, including 4 men and 7 women, aged 43.2±12.6 (range 29-63) years. All patients had intractable low back pain aggravating during standing activities and alleviating during rest, without lower extremity radicular symptoms. Imaging examination showed bilateral isthmus cleft of L 5 with spondylolisthesis of 1 degree in 10 cases and 2 degree in 1 case according to Meyerding grading system. Under general anesthesia and supine French position, transverse 6 cm incision was made. Then, the L 5S 1 intervertebral disc was exposed via extraperitoneal approach between the bifurcation of abdominal aorta and vena cava. The intervertebral disc was sufficiently removed. The intervertebral space was released and distracted followed by canal ventral decompression and sequential mold testing. Suitable self-anchoring cage filled with auto iliac cancellous bone was implanted to restore intervertebral height and lordosis as well as reduction of spondylolisthesis. Under fluoroscopic guidance, the distal anchoring plate was knocked into the sacrum followed by direct reduction and proximal anchoring plate locking in the L 5 vertebral body. The patients were followed up for 12.1±4.7 (range 6-18) months. The visual analogue score (VAS) and Oswestry dysfunction index (ODI) were evaluated. The reduction and fusion were evaluated on the X-ray films. Furthermore, the rate of spondylolisthesis, the height and the lordosis of intervertebral space were measured. Results:The operation was performed successfully in all the patients with operation duration 90±18 (range 70-120) min, intraoperative blood loss 30±16 (range 10-60) ml. No severe complication such as nerve and blood vessel injury occurred. All patients experienced alleviation of symptom during follow-up. X-rays confirmed that the spondylolisthesis and alignment were recovered obviously without obvious cage displacement. However, the loss of reduction was 63.2% for the grade 2 spondylolisthesis. At the final follow-up, VAS decreased from 6.1±2.1 to 0.9±0.5, ODI decreased from 43.6%±14.2% to 6.0%±3.4%. The spondylolisthesis recovered from 17.7%±10.3% to 8.0%±7.2% with reduction rate of 54.8%±21.6%. The interverbral height recovered from 6.4±2.1 mm to 9.8±3.9 mm and intervertebral lordosis recovered from 4.8°±2.9° to 9.6°±4.7°.Conclusion:SA-ALDF can provide satisfactory outcomes for selected L 5 isthmic spondylolisthesis of degree 1 without neurological compromise. However, its mechanical stability may be insufficient for isthmic spondylolisthesis of degree 2.

Objective To estimate curative effect of reconstruction of rabbit knee joint cartilage defect with the homogeneitic tissue engineered cartilages.Methods The chondrocytes were isolated and collected from articular cartilages of eight New Zealand white rabbits.The tissue engineered cartilages after culturing chondrocytes and atelocollogen for two days.Cartilage defects were created in both keen joint of twenty-six rab- bits.Complexes of chodrocytes and atelocollagen was grafted into the defect of left knee joint at once as experi- mental group,and no implantation were served as control.General and histological examination were respec- tively performed in both group at four weeks and eight weeks after surgery.Results After implantation,the defects were filled with cartilaginous tissue in experiment group,while there were only tissue in control group. Histologically,defective areas were filled with chondrocytes in experiment group,but only fibroblast in control group.Conclusion The implantation of the tissue engineered cartilages contenting with chondrocytes and atelocollogen can effectively improve reconstruction of rabbit knee joint.

Objective To investigate the feasibility and effects of endoscopic surgical treatment of lumbar intervertebral disc herniation associated with veitebral osteochondrosis.Methods From June 2008 to December 2015,276 cases of lumbar intervertebral disc herniation associated with vertebral osteochondrosis were treated with endoscopic surgery,including 185 men and 91 women,with an average 39.2 years old (range,16-65 years old).The involved level included L2.3 in 2 cases,L3.4 in 9 cases,L4,5 in 126 cases and L5S1 in 139 cases.On preoperative axial CT,the diameter of ossification was more than half of the transverse or sagittal diameter of the spinal canal in 89 cases,and no more than half of the transverse and sagittal diameter of the spinal canal in 187 cases.All patients were operated on the side with serious symptom,181 cases were operated with mobile microendoscopic discectomy (MMED),and 95 cases were operated with percutaneous endoscopic surgery,including percutaneous transforaminal endoscopic discectomy (PTED) in 61 cases and the percutaneous interlaminar endoscopic discectomy (PIED) in 34 cases.The operation and complications were analyzed.Results The soft herniation,broken disc material and the periphery of compressing ossification were removed under the endoscope in all cases,until the nerve was well decompressed.However,the ossification was not complete resected.Dural sac tear occurred in 3 cases of MMED.In the early stage of PTED,2 cases converted to MMED because of intraoperative pain and difficulty,and one case had exiting nerve root injury.At the final follow-up of 12-60 months (average,20.6 months),visual analogue scale decreased from preoperative 8.5±1.2 to 1.0±0.9,Oswestry disability index decreased from preoperative 40.2±8.6 to 3.1±3.0.According to Macnab scale,the results were excellent in 89,good in 154 cases,moderate in 33 cases.Conclusion For most lumbar intervertebral disc herniation associated with vertebral osteochondrosis,good results can be achieve by removal of herniated and broken intervertebral disc and decompression of nerve with endoscope.Therefore,we speculate that the soft disc herniation and spinal stenosis are main pathogenic factors,and that the complete resection of ossification is not needed.

Objective To evaluate the clinical efficacy of treatment of severe thoracolumbar burst fractures by posterior short-segment instrumentation without spinal fusion and assess radiographic imaging and function recovery after surgery.Methods Thirty-eight patients with severe monosegmental thoracolumbar burst fractures treated between July 2011 and March 2013 were analyzed retrospectively.Operation procedures were posterior short-segment pedicle screw distraction reduction and fixation combined with screw insertion to the injured vertebrae and calcium sulphate augmentation.In addition,there was no need for posterolateral interbody fusion.X-ray and CT were performed before and after operation to evaluate local kyphotic angle,anterior fractured vertebral body height and canal encroachment.Visual analogue scale (VAS) and Oswestry disability index (ODI) were assessed before and after operation as well as in follow-up.Results All patients were followed up for average 14 months (range,3-20 months).Local kyphotic angle was (21.2 ±4.3)° before operation,(3.5 ± 1.8)°immediately after operation,and (4.8 ± 2.7) ° in final follow-up.Relative anterior vertebral height was (54.8 ± 14.6)％ before operation,(91.7 ± 8.0)％ after operation,and (87.2 ± 6.0)％ in final follow-up.Mean canal encroachment was (48.0 ± 4.5)％ preoperatively,(23.8 ± 7.8)％postoperatively,and (8.8 ± 4.6) ％ in final follow-up.In final follow-up,six patients with American Spinal Injury Association (ASIA) grade C on admission showed improvement to grade D (n =2) and grade E (n =4) ; 10 patients with ASIA grade E on admission showed improvement to grade E; 22 patients with grade E had no changes.ODI and VAS scored 15.5 ±8.8 and 2.3 ±0.8 in final follow-up with substantial improvement from those before operation (P ＜ 0.01).Complications from internal fixation were not found during follow-up.Conclusion Posterior short-segment fixation without fusion is one of the foremost effective methods for severe thoracolumbar burst fractures,for it can effectively restore the sagittal spinal alignment and the fractured vertebral body height.

Objective To evaluate the feasibility and clinical efficacy of microendoscopic discectomy-lumbar interbody fusion (MED-LIF) with mobile microendoscopic discectomy (MMED) technique. Methods The MMED includes outer working canal and inner operating canal, and large working canals (12 mm and 14 mm) are fabricated for this operation. The operation was designed as follow:an incision was made between pedicle projection sites and spinous process on the side with prominent symptom. Working canal was inserted along spinous process and a fenestration was performed. After discectomy and ipsilateral decompression, contralateral nerve was decompressed in case of contralateral stenosis. Then the intervertebral space was prepared and grafted. The inner operating canal was removed and the suitable cage was inserted, followed by percutaneous pedicles screws installation, reduction and fixation. A total of 102 patients with lumbar degenerative disc disease were treated by this technique. The index levels included L34 (n=11), L45 (n=64), L5S1 (n=21), L3-5 (n=3), and L4-S1(n=3). The operative data and follow-up results were recorded and evaluated. Results Surgery was successful in all patients, with no nerve injury or conversion to open surgery. The mean operative time was ( 120 ± 30) min (range, 90-200 min), with a mean blood loss of (120 ± 80) mL (range, 50-300 mL). The post-operative X-ray and CT scans showed improvement of spinal alignment with sufficient decompression. Patients were followed up for 6 to 36 months. The Oswestry disability index (ODI) score decreased from the pre-operative 44.2%±16.3%to the last follow-up 4.9%±4.7%. The visual analog pain score (VAS) of lumbar decreased from the pre-operative 5.3±4.1 to the last follow-up 2.1±1.7, and VAS of leg decreased from the pre-operative 6.7 ± 3.5 to 1.0 ± 0.8 at final follow-up. The clinical results were excellent in 46 cases, good in 50 cases and fair in 6 cases according to the Macnab standard. Conclusion MED-LIF can be easily performed with MMED technique, with sufficient decompression and reduction, providing satisfactory results with less invasive procedure.

Objective To evaluate the feasibility and clinical efficacy of microendoscopic discectomy-transforaminal lumbar interbody fusion (MED-TLIF) with mobile microendoscopic discectomy (MMED) technique. Methods The MMED includes outer working canal and inner operating canal. Large working canals and endoscopic chisel were fabricated for MMED-TLIF,which was designed as follow:the pedicles and index level were located with fluoroscopy, and a 2.5 cm incision was made between pedicle punctures sites on the symptomatic side. Working canal was inserted, and the facet was exposed,the inferior articular process and medial part of superior articular process were resected. The disc and cartilage endplates were curettage, and the intervertebral space was released and tested. The inner operating canal was removed and the interbody space was grafted and supported with suitable cage. Percutaneous pedicles screws were inserted and the residual displacement was evaluated under fluoroscopy, followed by the install of connecting rods for reduction and fixation. Fifty-six patients with lumbar stenosis including 32 cases of instability and spondylolisthesis (1 degree in 15 cases and 2 degree in 9 cases) were treated with this technique. The ODI index and VAS score were compared in patients before and after surgery. The efficacy was evaluated by Macnab standard. Results Surgery was successful in all patients, with no nerve injury or conversion to open surgery. The mean operative time was (120±30) min (range, 90–180 min),with a mean blood loss of (120±50) mL (range,50–200 mL). The post-operative X-ray and CT scans showed improvement of spinal alignment with mean reduction ratio of 72%. Patients were followed up for 6 to 36 months. The ODI score decreased from 50.1±11.2 to 5.8±5.6. The VAS score of lumbar decreased from 7.1±4.2 to 1.2±1.0 and VAS score of leg decreased from 4.1±2.5 to 1.1±0.9 at final follow-up. The clinical results were excellent in 36 cases,good in 20 according to the Macnab scale. Conclusion MED-TLIF can easily perform with MMED technique,with sufficient decompression and reduction, and providing satisfactory results with less invasive procedure.