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.

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 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: 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.

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 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 investigate the risk factors and treatment strategy in treating adjacent segment diseases (ASD) after anterior cervical decompression and fusion.Methods Fourteen patients with ASD after anterior cervical decompression and fusion from December 2005 to August 2012 were analyzed.The overall curvature of the cervical spine,local curvature of surgical segments,and the distances between the plate and the upper and lower intervertebral space were measured and analyzed.10 males and 4 females,age at initial surgery was 36 to 68 years old,the mean was 52.0±11.0 years old.The secondary surgery was taken,according to the number of involved segments and other factors.Anterior decompression and fusion and internal fixation was taken to patients who segment number ≤2 without severe ossification of posterior longitudinal ligament or ossification of the ligamentum flava; posterior decompression and laminoplasty was conducted in patients whose segment number ≥3,but not accompanied with significant kyphosis,instability and serious ossification of the ligamentum flava; and posterior laminectomy and fusion was performed in patients with significant kyphosis,instability and not suitable for anterior decompression due to technical reasons,as well as patients with serious ossification of the ligamentum flava.Results The average time of occurrence of ASD after the initial surgery was 9.3±4.4 years,and the average age of reoperation was 61.3±12.4 years old.The overall curvature of the cervical spine,surgical segment local curvature after the initial surgical procedure were 12.4°± 10.8 o,1.5o±6.8o,respectively; and the distances between the plate and the upper and lower interyertebral space were:0.9± 1.8 mm,3.8±3.2 mm.The secondary surgeries were taken as follows:9 cases anterior decompression and fusion and internal fixation,3 cases posterior decompression and laminoplasty,and 2 cases posterior laminectomy and fusion.All 14 patients were followed up 30.4± 17.8 months,and the average improvement rate of Japanese Orthopaedic Association scores at the last follow up was 73.9％±9.7％.Conclusion The smaller distance between the plate and neighboring intervertebral space,and poorer local curvature of surgical segments might be the risk factors for ASD after anterior cervicad decompression and fusion.The appropriate secondary surgery was taken after comprehensive analysis of the number of adjacent segments,compression factors,cervical curvature and other factors.

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.

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 investigate the clinical effect of different surgical approaches on multi-level cervical spondylosis in elderly patients.Methods A total of 53 aged patients with multi-level cervical spondylosis (≥70 years old) who received operation in our department during May 2007 to May 2014 were retrospectively studied, and divided into anterior cervical surgical group (n=22) and posterior cervical group (n=31), according to the surgical approach.The operation duration, intraoperative blood loss, hospitalization time, postoperative complications, Japanese orthopedics association (JOA) scores, Neck disability index (NDI), postoperative subjective improvement of clinical symptoms and spinal fusion of the two groups were evaluated and compared respectively.Results The mean operative time was longer in the anterior surgical group than in the posterior surgical group [(2.7±0.5)h vs.(1.9±0.3) h, P＜0.05].The average blood loss of the anterior surgical group was less than that of posterior surgical group [(90.0±50.4) ml vs.(160.7±40.5)ml, P＜0.05].The hospitalization time of the anterior surgical group was less than that of posterior surgical group [(10.3±2.5) d vs.(15.7±3.6) d, P＜0.05].Postoperative JOA score of anterior surgical group was higher than that of posterior surgical group 6 months after surgery [(14.7 ±0.8)vs.(13.8±1.2), P＜0.05], while there was no significant difference in JOA score between the two groups up to the last follow-up [(14.8±1.2) vs.(14.7±1.8), P＞0.05].NDI score was lower in anterior surgical group than in posterior surgical group 3, 6, 12 months after operation and at the last follow-up.Among the 41 patients, radiographic outcomes showed that there were 16 cases of anterior surgical group with no bony fusion at the follow-up 3 months after operation, and all the 16 patients achieved bony fusion at the follow-up 1 year after operation, and there were 4 cases with titanium mesh subsidence (＜ 3 mm).Conclusions Both anterior cervical decompression and fusion and posterior cervical single open-door laminoplasty have good efficacy in the treatment of multilevel cervical spondylosis in elderly patients, which have advantages on the limb functional recovery time and cervical function assessment.When anterior cervical surgical contraindications were excluded, the anterior cervical decompression and fusion may be a good choice for the treatment of multilevel cervical spondylosis in aged patients.