Wnt signaling pathway has a critical role in differentiation, proliferation, supersession and metabolism of osteocyte. Although the principal components are relatively simple, however, the numerous components consisted of Wnt signaling participate in the reaction, including several LRPs ( low density lipoprotein receptor-related protein,LRP) , 19 different Wnt proteins and 19 different FZDs( frizzled receptor, FZD) , and non-canonical Wnt signaling and multiple inhibitors of Wnt signaling.The Wnts linked to mem-brane coreceptor and activated downstream of canonical Wnt signaling or non-canonical Wnt signaling, In addition, different Wnts had different roles in differentiation, bone formation and bone absorption of osteocyte.This review aims to understand the relationship be-tween Wnt signaling and osteocyte metabolism and bone diseases, by analyzing a variety of factors and the process of Wnt protein and Wnt signaling pathway in activity of osteocyte.

Objective With the development of minimally invasion and the popularization of arthroscopy the technology of ar-throscopy has been widely applied for the treatment of acute and the safety of this has been validated.To analyze the clinical effect of ar-throscopically assisted double Endobutton plate reconstruction of coracoclavicular ligament in the treatment of acute acromioclavicular joint dislocation. Methods From November 2013 to December 2014, a total of 23 patients with Rockwood type III,Ⅳ,Ⅴshoulder joint dis-location were included, all cases was treated by arthroscopic double Endobutton fixaton technique.Patients were followed up for 6 to 18 months.The changes of shoulder joint forward elevation and external rotation, Japanese Orthopaedic Association score(JOA), and Visual Analogue score( VAS) of acromioclavicular joint in both perioperative and postoperative were recorded. Results The mean follow-up time was (9.3 ±2.4) months ( range from 6 to 18 months),and mean time from injury to surgery was(10.1 ±3.2)days.The therapeutic effects were achieved in all patients after the arthroscopically assisted double Endobutton plate reconstruction.All the measurements, in-cluding the mean forward elevation JOA scores before and after fixation (71.0 ±5.4 vs 93.5 ±3.6), and mean VAS scores (4.6 ±1.0 vs 1.9 ±0.9), mean forward elevation [(102.5 ±8.6) degrees vs (144.3 ±6.3) degrees], and mean external rotation[(107.1 ±6.2) de-grees vs (149.6 ±7.5) degrees] improved significantly (P<0.05) after the treatment. Conclusion Arthroscopic double Endobutton fixaton technique could provide an effective immobilization of shoulder and acromioclavicular joint, thus improving the function of the joint and achieving an excellent effect in the treatment of acute acromiocla-vicular joint dislocation.

ObjectiveTo investigate the clinical efficacy of the 3-in-1 technique of Disc-FX system,namely:discectomy,radiofrequency ablation and annuloplasty for discogenic low back pain in the early stage.MethodsFrom February 2010 to February 2011,40 patients with the discogenic low back pain underwent discectomy,radiofrequency ablation and annuloplasty using Disc-FX system were retrospectively analyzed,including 22 males and 18 females with an average age of 38.7 years(range,32-58 years).The visual analogue scale (VAS) scoring was applied to evaluate the back and low limb pain at preoperative,postoperative 1week,3 months,6 months,and last follow-up.The Macnab score was also evaluated at last follow-up.Results All the patients were followed up for average 13.8 months (range,6-18 months).The operative time averaged 26 min(range,20-40 min).No surgical complication was found during the follow-up.The VAS of preoperative low back pain was 6.60±1.47,VAS score of low back pain at postoperative 1 week,3 months,6 months,and final follow-up were 1.05±0.68,1.15±0.70,1.00±0.62,0.95±0.63,respectively.The postoperative VAS of low back pain decreased significantly compared with that preoperative.The VAS of preoperative limb pain was 3.05±1.23,VAS score of limb pain at postoperative 1 week,3 months,6 months,and final follow-up after operation were 1.10±0.74,1.15±0.70,1.10±0.72,0.95±0.54,respectively.The postoperative VAS of limb pain decreased significantly compared with that preoperative.The evaluation of Macnab score were excellent in 20 patients,good in 17,fair in 2,and poor in 1,suggesting an effective rate of 92.5％ (37/40).Conclusion Disc-FX system,which combined three surgical technique in one procedure,provides a new choice for orthopedics to treat discogenic low back pain.It can give satisfactory clinical outcomes during a short-term followup,but the long term clinical outcomes remains unknown.

Objective To evaluate the clinical outcomes of modified eggshell technique through posterior approach for the treatment of hard thoracic disc herniation. Methods From January 2006 to June 2009, 22 patients admitted for hard thoracic disc herniation were reviewed, including 13 males and 9 females, with an average age of 49.5 years (range, 33-69). The courses of disease were 11 months on the average (range, 3-18 ). The lesions located in T8-9 for 4 cases, T9-10 for 9, T10-11 for 7, T11-12 for 2. Each of the patients underwent X-ray, CT scanning and MRI examination before surgery. There were 16 cases of central type, and 6 cases of paracentral type. All patients were treated surgically by modified eggshell technique via posterior approach. Results The mean operative time was 210 min (range, 180-300 min), with a mean blood loss of 860 ml (range, 600-1200 ml). All surgeries were performed successfully without neurological symptoms aggravation. Surgical complications included dural laceration in 2 cases, both dural lacerations were repaired intraoperatively, epidural hematoma in 1 case with lower extremity neurological symptoms, full neurologic recovery was observed after surgical removal of the hematoma. All patients were followed up for average 27.5 months (range, 12-54). The mean JOA score increased from 3.36±1.79 before operation to 7.45±2.99 after the operation at 12 months follow up, and the mean improvement rate of neurological status was 58.3%±30.7%. There was significant difference in JOA score before and after surgery(t=10. 12,P＜0.01 ).The results of 14 cases were ranked as good, 6 as fair, 2 as unchanged, and none as worsened. All cases obtained bony fusion without instrument failure. Conclusion Modified eggshell technique enable ventral and dorsal spinal decompression from the posterior approach in cases of hard thoracic disc herniation, with reduction of the rate of postoperative paralysis.

BACKGROUND:O-arm navigation integrates CT image quality and the flexible mobility of the C-arm. Surgery for severe spinal deformity is very difficult, with high incidence of nerve injury, so it is a chalenging surgery for spinal surgery. The role of O-arm in the correction of spinal deformity is particularly important. OBJECTIVE:To explore the effect and safety of pedicle screw placement in severe spinal deformity under the guidance of O-arm navigation system. METHODS:Clinical data of 25 patients with severe spinal deformity with the aid of O-arm navigation were retrospectively analyzed. We observed pedicle screw insertion, operation time, intraoperative blood loss, correction of scoliosis and correction of kyphosis, and assessed the safety of screw insertion. RESULTS AND CONCLUSION:(1) Totaly 326 pedicle screws were implanted in 25 patients. According to NEO classification, 280 pedicle screws (92%) belonged to grade 0 (no perforation of pedicle cortex). Grade 1: perforation of pedicle cortex, < 2 mm, including 44 screws (8%); grade 2: perforation of pedicle cortex, > 2 mm, < 4 mm, including 0 screw (0%); grade 3: perforation of pedicle cortex, > 4 mm, including 0 screw (0%). (2) Operation time was (272.3±17.3) minutes. Intraoperative blood loss was (1 710.0±229.1) mL. (3) Cobb angle of scoliosis was changed from (70.5±6.0)° preoperatively to (22.8±4.8)° postoperatively. Cobb angle of kyphosis was changed from (72.0±5.2)° preoperatively to (28.1±5.7)° postoperatively. Significant differences were detected (P< 0.05). (4) These findings verify that with the guide of the O-arm navigation system, the accuracy of screw insertion is high. The risk of intraoperative nerve injury was reduced. The scoliosis and kyphosis deformity were improved effectively.

This study was aimed to optimize the extraction process of double-marker components for Arctium lappa L. The central composite design and response surface methodology was used. According to 3 main factors, the extraction rates of arctiin and arctigenin was used as evaluation indexes. Multiple linear regression and two-order polynomial equation were used. The binomial fitting model was performed in the optimization of arctiin and arctigenin extraction technology. The results showed that the indentified optimized extraction technology of arctiin and arctigenin was 70% ethanol, 24-fold, ultrasonic solvent extraction for 15 minutes. It was concluded that this technology was able to extract large amount of arctiin and arctigenin, which provided experiment evidences for arctiin and arctigenin preparation. It also provided references for the development and utilization of arctiin and arctigenin.

Objective To investigate the efficacy and safety of the resection of cervical posterior longitudinal ligament (PLL) in Bryan cervical disc arthroplasty. Methods Thirty-one patients underwent Bryan cervical disc implantation only in one level from August 2006 to January 2009 were investigated in this study. Cervical PLL was preserved in 14 patients, but not in other 17 patients. The clinical (JOA score,VAS score for neck and arm pain) and radiographic parameters (the FSU angle, ROM and diameter of the spinal cord) were compared between the two groups. Results No differences were found in terms of age, affected segment, gender, follow-up period, operation time and blood loss between the two groups. Patients underwent removal of cervical PLL were significantly superior to those underwent reservation of cervical PLL in term of clinical outcomes. There were no differences between the two groups with regard to the increase of FSU angle and ROM. However, the diameter of the spinal cord had a significant increase in patients underwent removal of cervical PLL. No severe complication was found in the two groups. Conclusion Removal of the cervical PLL is beneficial for the clinical outcomes and does not have an impact on the angle and ROM of the affected segment. The procedure is safe and feasible.

Objective To explore value of trephine in pedicle subtraction osteotomy (PSO) for old thoracolumbar compression fracture with kyphotic deformity.Methods Thirty seven patients who underwent surgical treatment for old thoracolumbar kyphotic deformity in our hospital from February 2005 to February 2010 were retrospectively reviewed.Among them,21 patients underwent conventional PSO and 16 patients underwent PSO with trephine.In conventional PSO group,there were 14 males and 7 females,the average age was 55.6±3.7 years and the mean Cobb angle was 45.3°±4.6°.In PSO with trephine group,there were 11 males and 5 females,the average age was 53.3±4.2 years and the mean Cobb angle was 47.6°±5.9°.Results All patients were successfully followed up.The duration of follow-up ranged from 12 to 22 months in conventional PSO group,while 13 to 20 months in PSO with trephine group.The operation time,blood loss,amount of blood transfusion were 224±45 min,1043±234 ml,876±300 ml respectively in conventional PSO group,while 180±31 min,785±163 ml,500±230 ml in PSO with trephine group.Immediately after operation,correction rate of Cobb angle was 91.4％ in conventional PSO group and 90.9％ in PSO with trephine group.At final follow-up,the correction of Cobb angle lost 5.8％ in conventional PSO group and 6.2％ in PSO with trephine group.The improvement rate of JOA score was 81.1％ in conventional PSO group and 83.7％ in PSO with trephine group.The VAS score decreased 7.7±1.1 in conventional PSO group and 7.8±0.8 in PSO with trephine group.One patient in conventional PSO group experienced saddle numbness immediately after operation,which alleviated at final follow up.All patients achieved bony fusion at final follow up.No infection,screw loosening or breakage occurred in both groups.Conclusion The use of trephine in PSO for old thoracolumbar compression fracture with kyphotic deformity can reduce operation time,blood loss and improve efficiency of osteotomy.

Objective To investigate the appropriate surgical approach in the management of cervical cord injury following ossification of the posterior longitudinal ligament. Methods The clinical data of 25 patients with cervical cord injury following ossification of the posterior longitudinal ligament who received surgical treatment were retrospectively analyzed. According to Frankel grades, two patients were at grade A, three at grade B, 14 at grade C and six at grade D. The surgical procedures consisted of anterior decompression (12 patients), posterior decompression (8 patients) and combined posteroanterior decompression (5 patients). Results No iatrogenic injury of great vessels, trachea, esophagus or spinal cord occurred. All the patients were followed up for 15-86 months (mean 38.3 months). All segments with anterior fixation attained solid fusion, without implants loosening or breakage. No reelosed open-door was found in patients who received posterior laminoplasty. The spinal function got improved in 21 patients, and a relief of pain or numb of the upper limb was attained in four patients whose spinal cord injury was not cured. Conclusions The surgical outcome of cervical cord injury following ossification of the posterior longitudinal ligament is satisfactory. It is important to select a suitable surgical approach according to the imaging manifestations associated with the general conditions of the patients.

Objective To evaluate the effectiveness of rehabilitative treatment for severe cervical spondylotic myeiopathy after combined posterior-anterior surgery. Methods Fifty-four patients (mean age, 59.5) who had undergone combined posterlor-anterior surgery of the cervical spine due to severe cervical spondylotic myelopathy were studied with an average follow-up of 38.7 months. All the patients were allocated into either a rehabilitation treatment group (28 patients) or a control group (26 patients). Neurological function in the two groups was assessed using the Japanese Orthopedic Association (JOA) grading system. In addition, the status of axial symptoms, wound healing and post-operative complications were also evaluated. Results The bone grafts completely fused in both groups. All of the wounds in the rehabilitation treatment group healed without any infection. Three wounds were infected in the control group, but were cured by prompt treatment. Two patients in the rehabilitation group and 9 in the control group suffered laryngeal edema. There was no significant difference between the two groups before the operation with regard to their JOA scores, which significantly increased postoperation in both groups. In the rehabilitation treatment group, the postoperation JOA scores were significantly higher than in the control group. At the same time, there were significantly fewer patients with neck axial symptoms in the rehabilitation treatment group than that in the control group (25.0% versus 69.2% , P < 0.01 ). Conclusions Systematic rehabilitation treatment pro-and post-operation of patients with severe cervical spondylotie myelopathy can accelerate neurological recovery and help prevent postoperative complications and neck axial symptoms.