OBJECTIVE:To observe clinical efficacy and safety of Xianlinggubao combined with alendronate sodium in the treatment of osteoporosis. METHODS:112 patients with osteoporosis were randomly divided into treatment group and control group with 56 cases in each group. Both group were given routine treatment as calcium carbonate,vitamin D and life style. Control group were given alendronate sodium 10 mg orally,qd;treatment group was additionally given Xianlinggubao capsule 1.5 g,bid, on the basis of control group. Both groups received 12 weeks of treatment. The levels of S-Ca,S-P,24 h urinary calcium(U-Ca), alkaline phosphatase(ALP),osteocalcin,IL-6,bone mineral density(BMD)of L2-4 lumbar spine and femoral neck were observed in 2 groups before and after treatment. Clinical efficacy and toxic reaction were compared. RESULTS:There was no statistical sig-nificance in the levels of S-P and S-Ca between 2 groups after treatment(P>0.05);the level of ALP、osteocalcin、BMD increased in treatment group after treatment,the level of U-Ca and IL-6 decreased compared to before treatment,and the treatment group was better than the control group,with statistical significance(P<0.05). Total effective rate of treatment group(92.86%)was sig-nificantly higher than that of control group (73.21%),with statistical significance (P<0.05). No obvious toxic side effects was found in 2 groups. CONCLUSIONS:Xianlinggubao combined with alendronate sodium shows significant therapeutic efficacy for patients with osteoporosis with good safety.

BACKGROUND: Hydrogen sulfide signaling has been proved to promote distraction osteogenesis; however,the underlying mechanism remains unclear.OBJECTIVE: To evaluate the relationship between hydrogen sulfide and hypoxia-inducible factor-1α (HIF-1α)during the osteogenesis of rat bone marrow mesenchymal cells under tensile stress.METHODS: 2000 μ strain was loaded on the in vitro cultured rat bone marrow mesenchymal cells by a four-point bending apparatus, and hydrogen sulfide donor or HIF-1α inhibitor was adopted in the tensile unit. Subsequently, the levels of osteogenic markers were detected.RESULTS AND CONCLUSION: Exogenous hydrogen sulfide signaling could promote the osteogenesis of rat bone marrow mesenchymal cells under tensile stress. However, this promotion was obviously eliminated when the endogenous HIF-1α expression was inhibited.These results show that hydrogen sulfide signaling system promotes the osteogenesis of rat bone marrow mesenchymal cells under tensile stress probably through HIF-1α.

Objective To summarize the clinical features and diagnostic flow of cervical spondylosis with proximal upper extremity amyotrophy;and further analyze the clinical effect of cervical anterior decompression and fusion on cervical spondylosis with proximal upper extremity amyotrophy.Methods Twenty-two cases of cervical spondylosis with proximal upper extremity amyotrophy were analyzed retrospectively from June 2006 to December 2013.Seventeen males and 5 females with an average age of (55.73 ± 8.64) years (38 to 68 years) were included.The mean preoperative course of disease was (19.2 ± 21.86) months (1-72 months).Clinical symptoms,imaging findings and electrophysiological findings were analyzed.The muscular strength recovery of atrophic muscles was evaluated by Manual Muscle Testing (MMT).The clinical improvement rate was evaluated by the Japanese Orthopedic Association (JOA) score,and the clinical satisfaction was assessed at followed up.Results The muscles involved in patients of cervical spondylosis with proximal upper extremity amyotrophy are mainly the deltoid muscle,biceps and scapula levator muscle.Most cases of imaging findings showed multi-segmental degeneration,of which C4,5,C5,6 segments were most common.Neuroelectrophysiological examination showed that affected muscles experienced obvious denervation and decreased action potential.The average follow-up time was (44.14 ± 20.51) months (14 to 102 months).At the last follow-up,the JOA score (16.29 ±0.59) in 17 cases was higher than preoperative (15.12 ± 0.93),the difference was statistically significant (F=51.814,P=0.000),and the average improvement rate was 73.3％.MMT assessment showed that 19 patients (86.4％) in this group had muscle strength recovery for more than 1 grade at the last follow-up.The average clinical satisfaction was 83.7％.Conclusion The clinical diagnosis of cervical spondylosis with proximal upper extremity amyotrophy requires a combination of clinical symptoms,imaging findings and neurophysiological examination results for comprehensive judgment.Anterior cervical decompression and fusion in the treatment of cervical spondylosis with proximal upper extremity amyotrophy patients can achieve good clinical results.

Objective To analyse the results of Zephir semiconstrained or Window dynamic cervical plates with autogenous cortical bone graft in treating the cervical spondylotic myelophathy(CSM). Methods A retrospective review was performed with 43 patients who underwent anterior cervical discectomy, autogenous cortical bone graft with endplate retaining, fixation with Zephir or Window cervical plates. Follow-up period ranged from 0.5 to 4.0 years (in average of 22 months). The clinical effect, the fusion rate, the intervertebral height and the degeneration of adjacent levels were observed. Results The JOA score after operation was significant higher than that before operation (P

BACKGROUND:Long course of treatment and complications limit the extensive application of distraction osteogenesis, which cannot meet the clinical requirements. OBJECTIVE:To investigate the effect of general administration of eucommia alcohol extract on new bone regeneration based on the rabbit model of mandibular distraction osteogenesis. METHODS:Twenty-four New Zealand white rabbits were randomly divided into experimental group and control group. Unilateral mandibular distraction osteogenesis model was established by 1 mm/12 h distraction protocol. During the distraction period, the rabbits in the experimental group were intragastricaly administered with eucommia alcohol extract and the control animals received the same amount of physiological saline, respectively. Six weeks later, the animals were sacrificed for osteogenic testing. RESULTS AND CONCLUSION: New bone formation was observed in the distracted gap in both groups. However, the amount, mineralization and biomechanical strength of new regenerated bone in the experimental group were obviously greater than those in the control group by histological observation, dual energy X-ray absorptiometry, micro-CT and biomechanical test. General administration of eucommia alcohol extract can markedly promote distraction osteogensis in rabbit mandibular osteodistraction.

Objective To evaluate the impact of hydrogen sulfide signal system during the process of rat bone marrow-derived mesenchymal cells osteogenesis under tensile stress. Methods After the H2S signal system of cell rooms regulated by tool drugs (Group A with propargylglycine;Goup B with PBS;Group C with GYY3147), 4 000 μ strain tensile stress were applied on rat BMMCs by four-point bending apparatus for 60 minutes. Four hours later, the H2S signal system and cystathionine-γ-lyase were detected. Meanwhile, the change of the alkaline phosphate, osteocalcin, procollagen typeⅠN-terminal propeptide, and runt-related transcription factor 2 mRNA level were also examined to evaluate the osteogenic ability. Results With the increase of H2S expression, the osteogenic capacity gradually increased, while the osteogenic capacity was compromised after the endogenous cystathionine-γ-lyase was inhibited. Conclusion The H2S signal system plays an important role during BMMCs osteogensis under tensile stress. The up-regulation expression of H2S may promote osteogenesis during distraction osteogenesis.

Objective To assess the risk of sympathetic nerve injury in oblique lumbar interbody fusion (OLIF) in different lumbar spine segments based on anatomical study.Methods Twenty-four healthy adult volunteers (12 male and female) were selected and routine lumbar spine scanning was performed with MAG MAGOMOM Verio 3.0 T.The anatomical structures of left lumbar sympathetic trunk,abdominal aorta and left psoas muscle were identified on T2 images of L2,3,L3,4,L4,5 intervertebral space.And the anatomical parameters of the OLIF operation approach and the anatomical parameters of the left sympathetic trunk and adjacent structures were measured.The t-test was used to compare the parameters between the different sexes.The comparison of the data between the different segments was performed by the least significant difference (LSD) single factor analysis of variance.Results From the L2,3 to L4,5 segments,the anatomical parameters of the OLIF operation approach and the anatomical parameters of the left sympathetic trunk and the adjacent structures showed regular changes.The distances between the anterior margin of the left psoas muscle and the abdominal aorta from L2,3 to L4,5 were 13.65±4.10 mm to 9.42 ± 4.00 mm in adult healthy male individuals,and 13.89±3.18 mm to 8.38 ± 3.33 mm in female individuals,showing a significant downward trend.The distances between the left sympathetic trunk and the abdominal aorta from L2,3 to L4,5 were 10.76±3.89 mm to 6.68±3.39 mm in adult healthy male individuals,and 11.52±3.02 mm to 6.12±2.95 mm in female individuals,also showing a significant downward trend.There were significant differences in the operation area of OLIF surgery between different segments.The operation area of OLIF surgery was relatively large in L 2,3 segment,and the risk of sympathetic nerve injury was relatively small.The left lumbar sympathetic trunk in the L3,4 intervertebral space was walking front and inside,and there was a greater risk of injury in the OLIF surgery.Conclusion The left lumbar sympathetic trunk located in or close to OLIF surgery operation field in L2-L5 segments.There was a certain risk of sympathetic nerve injury in OLIF surgery,and the risk of sympathetic nerve injury was different in L2,3,L3,4,L4,5 segments.

Objective To determine anatomic parameters related to the surgery of lumbar cortical bone trajectory of normal adults and the feasibility of screw application in cortical bone and its specification and dimension.Methods Lumbar 3D image data of 80 adults between 18 and 40 years old (40 for each gender) were randomly selected as subjects of our research.With the help of the imaging software for 3D interactive viewing,the ideal starting point was supposed to be the junction of the center of the superior articular process and 1 mm below the inferior border of the transverse process.The diameter,length,lateral angle to the vertebral horizontal plane,cephalad angle to the vertebral sagittal plane of the trajectory and the horizontal distance from the insertion point to the lateral edge of the vertebral plate were measured.Differences of anatomic parameters for each gender,side and segment were analyzed.Results Differences of anatomic parameters on both sides of each segment had no statistical significance.At the ideal trajectory,the mean screw length was 37.56±2.41 mm at L1,38.72±2.36 mm at L2,39.51 ±2.51 mm at L3,39.78± 2.87 mm at L4 and 38.83±2.74 mm at L5.The mean screw diameters from L1 to L5 were 6.04±1.23 mm,6.17±1.24 mm,7.15±1.22 mm,8.02± 1.41 mm and 8.68± 1.42 mm respectively.However,differences of ideal entry angle of L1 to L5 had no statistical significance.The mean lateral angle from L1 to L5 were 8.46°±2.11°,9.37°±2.84°,9.62°±2.16°,9.53°± 1.98°,9.04°± 1.97°,while the mean cephalad angle to the vertebral sagittal plane from L1 to L5 were 26.49°±4.97°,25.94°±4.56°,26.42°±4.42°,26.29°±3.48°,26.89°±3.69°.The mean distance from the insertion point to the lateral edge of the vertebral plate gradually increased from L1 to L5,which were 1.19±0.75 mm,1.54±1.08 mm,2.01±1.45 mm,3.49±1.52 mm,4.47±1.32 mm respectively.The screw diameters of each segment for men were greater than those for women.Conclusion The common length of screw for lumbar cortical bone trajectory of normal adults might be from 35 mm to 40 mm.The safe upper limits of the screw diameter were 5.5 mm at L1,5.5-6.0 mm at L2,6.5-7.0 mm at L3,7.5 mm at L4 and 8 mm at L5.The average lateral angle of all 5 lumbar segments was 9.20°± 2.11° and the average cephalad angle was about 26.41°±4.22°.

Objective To investigate the relationship between the relevant platelet parameters and the thromboelastographic in-dexes with the the occurrence and development of diabetic vascular complications so as to early find the high-risk group of vascular complications or early patients .Methods According to the WHO diagnostic criteria for diabetes ,268 patients with diabetes and 80 retired people with the physical examination (normal control group) were selected as the research subjects .268 cases were divided into the group A(HbA1c <6 .2% without vascular complications) the group B(HbA1c >6 .5% without vascular complications) and the group C(HbA1c >8 .0% with vascular complications ) .The Siemens ADVIA2120 fully automatic blood analyzer was adopt-ed to detect the platelet parameters of mean platelet volume (MPV) ,platelet distribution width(PDW) ,large-platelet(L-PLT) , MPM and mean platelet concentration(MPC);The TEG@ 5000 coagulation analyzer was adopted to perform the thromboelastogra-phy for detecting the values of R ,K ,Angle A and MA .All obtained data were statistically analyzed .Results L-PLT in the group B and the platelet parameters in the group C had statistical differences compared with the normal control group (P<0 .05) .The val-ues of R ,K ,Angle A in the group B and the values of R ,K ,Angle A and Ma in the group C had statistical differences compared with the normal control group (P<0 .05) .Conclusion Relevant platelet parameters and the thrombelastogram detection have the important significance to help to the clinical diagnosis of diabetic angiopathy ,guide the treatment and the condition monitoring ;the thrombelastogram is more sensitive than the detection of the relevant platelet parameters in early finding the patients with diabetic angiopathy .

Objective To investigate causes and treatment strategy of cage retropulsion after lumbar interbody fusion.Methods Data of 11 patients with cage retropulsion after lumbar interbody fusion from December 2005 to October 2011 in our hospital were retrospectively analyzed.There were 7 males and 4 females.Their age ranged from 36 to 78 years (average,52.3 years) at the time of the primary operation.Six cases occurred cage retropulsion 0.5 to 3 months after the primary operation,while 5 cases occurred cage retropulsion 14 to 36 months after the primary operation.The causes of cage retropulsion were analyzed.Moreover,corresponding managements were performed and results were recorded.Results The early cage retropulsion was associated with mismanagement of intervertebral space,too much residual of nucleus pulposus,insufficient erasion of cartilage end plate,too small size of cage,malposition of cage,insufficient fixation and so on.The late cage retropulsion was associated with improper choice of surgical strategies,multi-level fusion,preoperative unsteady of vertebrae,advanced age,osteoporosis,diabetes and so on.Three patients underwent conservative treatment and 8 patients underwent revision surgery.All 11 patients were followed up for 6 to 72 months (average,34 months).There was no re-migration of cage,fusion failure,pedicle screw loosening and other complications during the follow-up period.Conclusion The causes of cage retropulsion after lumbar interbody fusion were complex and diverse,and the time of cage retropusion had some clinical value for the cause analysis.It was more advisable to make an individualized treatment program based on the causes of cage retropulsion,clinical manifestations and imaging results.