Objective To investigate the expressions and role of bone morphogenetic protein(BMP) 2,basic fibroblast growth factor(bFGF),Core-binding factor al(Cbfa1)in the process of pathological bone formation in ankylosing spondylitis.Methods The expressions of BMP-2,bFGF and Cbfa1 in the synovial tissues of AS patients'sacroiliac ioint were detected using in situ hybridization.They were compared with those of patients with hip replacement and the gray scale of cells was analyzed with image analysis.Results The positive expressions of BMP-2,bFGF and Cbfal in the synovial tissues of patients'sacroiliac joint with AS were stronger than those of the control group(P＜0.01).Conclusion BMP-2,bFGF and Cbfal are important factors in the process of pathological bone formation in patients with AS.They areclosely correlated with the process of bone formation in patients'sacroiliac ioint with AS.Reduction of the expressions of BMP-2,bFGF and Cbfa1 with AS can block the process of pathological bone formation.

In order to explore the effect of anti vegf on fracture healing process,rabbits with left radius fracture were used as an animal model and divided randomly into control and experiment groups.VEGF polyclonal antibody was given to the animals of the experiment group films were thken at the fracture sites after 1,3,5 and 8 weeks of the fracture.the results showed that the cellular necrosis increased in the experiment group shortly after the fracture.Although there was fibroblast proliferation at 72 hours after the fracture,continuous focal necrosis was seen from 1 to 5 weeks in the fracture sites,and the vascularization reduced obviously 3 weeks after the injury.The organelle degeneration was observed in the fibroblasts and osteoblasts under microscope.The fracture sites were filled with fibrous tissue at the 8 th week and nonunion was ween in the fracture sites on X ray films.These results suggest that the lack of VEGF in the fracture sites might be one of the important reasons of fracture healing.

Objective To observe the role of vascular endothelium growth factor (VEGF) in promoting vascular reconstruction and bone repair in the necrotic region of femoral head in rabbits. Methods The femoral head necrosis model was made by liquid nitrogen frozen. The necrotic femoral head was transfected by adenovirus human VEGF121 (Ad-hVEGF121) to observe the bone formation in subchondral necrotic region by means of histological method, measure BMD value by SPA-2 analyser and measure bone trabecular morphology by image analysis. Results Revascularization level, bone formation rate, bone quality and quantity and mineralization level in subchondral necrotic region of gene transfection group were significantly higher than the control groups that had more subchondral bone resorption compared with gene transfection group. Conclusions VEGF may have effect in promoting bone formation and revascularization in subchondral necrotic region of femoral head, indirectly protecting the necrotic bone trabecula from being absorbed and avoiding descending of subchondral mechanics function.

[Objective]To complete comparison between anterior cervical surgery by microendoscopic and open operation,explore feasibility and efficacy of anterior cervical decompression,interbody fusion and fixation by microendoscopic surgery,and give preliminary clinical evaluation of mieroendoscopic surgery.[Method]In a retrospective study,46 patients underwent one level cervical surgery by anterior approach.23 patients(23~64 years,41.5 years in average)were treated with microendoscopic surgery as microendoscopic group.Under general anesthesia,a transverse incision(1.6 cm)was made at right side of neck.A tubular retractor was then inserted and fixed,and a specially designed endoscope was placed inside the tubular retractor.Discectomy and interbody fusion with insertion of Cage or/and plate fixation was performed by endoscope.At fracture and dislocation patient group,titanium Cage was used in 1 case,CBK in 1 case,plate in 5 cases.At cervical disc herniation patient group,titanium Cage was used in 2 cases,CBK in 12 cases,plate in 2 cases.During the same period,23 patients(25~68 years,46.5 years in average)were treated with open surgery as open group.A transverse incision(4～5 cm)was made by right route approach.Discectomy and interbody fusion with Cage or/and plate fixation was performed by general procedure.[Result]At microendoscopic group,23 cases were followed up from 10 to 22 months(16.5 months in average),and mean operative time were 95 minutes,mean blood loss 90 ml.For fracture and dislocation patients,by Frankels classification,2 cases with complete tetraplegia showed no improvement,2 cases with incomplete tetraplegia improved from grade C to grade D postoperatively,1 case upgraded from C to E.For cervical spondylotic myelopathy patients with disc herniation,according to Odoms scoring system,10 cases had excellent outcome,5 good,1 fair.At open group,23 cases were followed up from 8~21 months(15.2 months as average),and mean operative time was 95 minutes,mean blood loss 90 ml.By Frankels classification,2 cases with complete tetraplegia had no improvement,3 cases with incomplete tetraplegia improved from C to D,1 case from D to E.According to Odoms scoring system,8 patients suffering from cervical spondylotic myelopathy with disc herniation had excellent result,6 good,2 fair.[Conclusion]Compared with open surgery,microendoscopic surgery with endoscopic instrument and technique can be used for one level discectomy,interbody fusion and internal fixation,and offer a similar short-term good clinical outcome with minimal incision,less traumatic reaction and postoperative discomfort.

Objective To study the effect of application of vascular endoth el ial growth factor (VEGF) and anti-VEGF on the expression of fracture healing rel ated factors and observe the pathological changes at fractured site. Methods Fra cture models were established in 105 rabbits. All rabbits were randomly assigned into controlled group, VEGF treated group and anti-VEGF treated group. The fact ors related to fracture healing were detected, and pathological changes were obs erved at 8, 24, 72 h and 1, 3, 5, 8 weeks after fracture. Results After the appl ication of VGEF, BMP was expressed earlier and the express period was prolonged . On the contrary, anti-VEGF completely inhibited the expression of BMP in the f ractured ends. The fractured sites were filled with fibrous callus, cartilage ca llus and bony callus at the 3rd week and they were converted into woven bone at the 5th week. The fracture reached to normal healing at the 8th week in the VEGF treated group. Cellular necrosis increased in the earlier period in the VEGF po lyclonal antibody treated group, continuous focal necrosis was seen in the fract ured sites between 1st week to 5th week, vascularization reduced obviously at th e 3rd week. Conclusion Fracture healing is the result of mutual modulation and c oordination among many factors. VEGF may be an important factor which plays impo rtant role in the course of fracture healing.

[Objective]To explore the feasibility and efficiency of treatment of lumbar degenerative disease with unilateral decompression,interbody fusion and percutaneous pedicle screw fixation under endoscopic system.[Method]From June 2004 to March 2007,20 patients underwent minimally invasive transforaminal lumbar interbody fusion(TLIF) or posterior lumbar interbody interbody fusion(PLIF),which consisted of 11 male and 9 female patients.The mean age was 46.2 years(range,31～70),and the preoperative diagnosis consisted of postoperative recurrent lumbar disc herniation(n =8),far lateral lumbar disc herniation(n =4),spinal stenosis(n = 3),lumbar instability(n = 3),and discogenic lumbar pain(n =2).One-level decompression and intebody fusion with unilateral pedicle screw fixation under endoscopic system was performed in all of cases(12 at L4、5,and 8 at L5S1).A paramedian,muscle-sparing approach was performed through a tubular retractor docked unilaterally on the facet joint.A total facetectomy was then conducted,exposing and removing the disc(TLIF),or microendoscopic discectomy(MED) was performed(PLIF).The intervertebral space preparation were completed through the X-tube or METRx system.Interbody fusion was achieved with autograft bone and interbody cages.Unilateral pedicle screw-rod placement was accomplished.[Result]There was no conversions to open surgery.Operative time averaged 115 minutes(range,100～165 min).Blood loss averaged 130 ml(range,50～180 ml).Mean length of postoperative hospital stay was 11 days(range,7～15 days).All patients presenting with preoperative low back pain and /or lower extremity radicular pain(n= 20) had resolution of symptoms postoperatively.Complications included two cases of new radiculopathy postoperatively(one from graft dislodgement,the other from hematoma formation).Twenty patients were followed up 10～39 months(average 21.6 months).The preoperative,1 month postoperative and last follow-up Oswestry Disability Index(ODI scores were 42.05+8.36,21.33?6.37 and 12.31?3.75 separately(P

[Objective]To evaluate the early-middle stage clinical results of cervical disc hemiation treatment with the Bryan cervical disc prosthesis.[Method]There were 51 patients with cervical disc herniation.There were 16 female and 35 male patients aged between 31 and 57(mean age 43).The herniated disc was located at C3、4 in 8 cases,C4、5 in 4 cases,C5、6 in 31 cases,C6、7 in 2 cases,C4～6 in 2 cases,C3～6 in 2 cases.and C5～7in 2 case.There were 16 patients with myelopathy and 31 with radiculopathy.A total of 57 sets of Bryan cervical disc prosthesis were implanted,with single level disc replaced in 45 cases and bi-level in 6 cases.The Bryan cervical disc prosthesis contained a proprietary,low-fiction,wear-resistant,unique polyurethane nucleus.The nucleus was located in shaped titanium plates(shells) that include convex porous ingrowth surfaces,to allow bony fixation to the adjacent vertebral endplates.The level of stableness and mobility at the implanting location were observed on dynamic radiograph postoperatively.[Result]The average follow-up was 1 year to 4 and half year.There was no prosthesis displacement and loosening in all cases.One patient had a definite spontaneous fusion of treated segment after 4 years of follow-up.Two patient had grade Ⅱ heterotopic ossification(HO).The range of motion(ROM) at implant level was 9.3 degrees on the flexion-extension radiographs.Significant improvement in neurological symptoms were observed in all cases,and radicular pain for patients suffering from raduculopathy was relieved completely.The average improvement was 8.5 points based on CSM criteria.Effective rate was 100%.[Conclusion]Artificial cervical discs prosthesis provides a new effective treatment for cervical disc herniation.Definite stabilization and satisfactory mobility were achieved after the implantation of cervical disc prosthesis.

Objective To summarize the perioperative complications of microendoscopic discectomy(MED)for lumbar disc herniation,and to discuss the therapeutic strategies for these complications.Methods From October 1999 to Decmeber 2006,1852 patients with lumbar disc herniation were treated by MED in our hospital,140 of them developed perioperative complications.The clinical data of these patients were analyzed.Results Hemorrhage from the vertebral venous plexus was found in 48 cases,among which,MED was completed after controlling the bleeding under an endoscope in 42 cases,open discectomy was carried out in the other 6.In 47 cases,the herniated disc was incorrectly localized,and the MED was completed after correcting the location and direction of the endoscope.Twenty-one cases developed rupture of the dura mater during the MED,2 of them were converted to open surgery.Thirteen patients had leakage of the nucleus pulpous,and received a second-stage MED to remove the spinal nucleus.Six patients developed nerve injury and recovered completely one month later.Intraspinal infection was found in 5 patients after the MED;one of them was cured by conservative therapy,and the other 4 recovered after receiving the evacuation of the intraspinal lesions.Conclusion Complications of MED for lumbar disc herniation can be prevented or reduced effectively by proper therapeutic strategies.

Objective To explore the feasibility of the treatment of special types of lumbar disc herniation using microendoscopic discectomy system(MED-Ⅱ) Methods Posterior interlaminal approach microendoscopic discectomy using the MED-Ⅱ was employed in 53 cases of bi-interspace lumbar disc herniation,75 cases of central type lumbar disc herniation,and 9 cases of extraforaminal lumbar disc herniation.Results All the operations were successfully completed with an operation time of(60~110 min) (mean,70 min) and an intraoperative blood loss of 50~130 ml(mean,70 ml).The length of hospital stay was 5~19 days(mean,13 days).The stitches were taken out at 12 days after operation and the sutured wound healed by first intention in all the cases.Follow-up for 3~8 months(mean,5 months) showed no complications.According to the Nakai classification,there were 40 cases of excellent results,11 cases of good results,and 2 cases of fair in the 53 cases of bi-interspace lumbar disc herniation.Of the 75 cases of central lumbar disc herniation,53,17,and 4 cases were endowed excellent,good,and fair results,respectively,and 1 case got a poor result.Of the 9 cases of extraforaminal lumbar disc herniation,the numbers were 6,2,and 1,respectively.(Conclusions) Use of the MED-Ⅱ for the treatment of special types of lumbar intervertebral disc herniation is effective.

Objective To study the surgical techniques,indications and clinical effects of microendoscopic lumbar discectomy with the preservation of the ligamentum flavum.Methods A total of 65 patients with lumbar disc herniation were enclosed in the study.All the patients suffered from low back pain and radicular syndrome.The diagnosis was confirmed with CT scanning and/or MRI examination.The Microscope Endoscopic Tubular Retractor System(METRx) was used to access the interlaminar space.The superior,inferior and lateral edges of the ligamentum flavum were released using a micro-scalpel.The nerve root was retracted medially with a nerve root retractor to expose the herniated lumbar disc for performing the discectomy.The dissociative ligament was restored anatomically after disc removal and the decompression of the nerve root.Results The operation was completed smoothly in all the 65 patients without conversions to open surgery.The operation time was 136?21 min(range,110~170 min).The wound healed by first intention in all the patients.No nerve root injuries,intervertebral infection,or cerebrospinal fluid leakage were observed.A follow-up was carried out for 6~24 months(mean,14.5 months).According to the Nakai classification,excellent results were achieved in 42 patients,good in 18 patients,fair in 3,and poor in 2,the rate of excellent or good outcomes being 92.3%(60/65).Conclusions Microendoscopic lumbar discectomy with the preservation of the ligamentum flavum using the METRx is feasible.The preserved ligamentum flavum,as a good natural barrier,is helpful to prevent epidural fibrosis.