BACKGROUND:Compared with rigid internal fixation, semi-restricted non-fusion system (Cosmic) can reduce the destruction of lumbar physiological structure during operation, partly retain the range of motion, maintain the stability of surgical segment, and help to prevent the adjacent segment degeneration.
OBJECTIVE:To observe the mid-term folow-up outcome of semi-restricted non-fusion system (Cosmic) in the treatment of lumbar degenerative disease.
METHODS:21 patients with lumbar degenerative disease, including 10 male patients and 11 female patients, at the age of 19-63 years old, received posterior decompression by fenestration, nucleotomy, and Cosmic system internal fixation. Visual analogue scale score and Oswestry disability index were used for clinical evaluation. Intervertebral height and range of motion of surgical segment and the proximal adjacent segment were colected before and after operation.
RESULTS AND CONCLUSION: Al the patients were folowed up for 15-48 months. No internal fixator loosening or rupture was found during the folow-up. The visual analogue scale score and Oswestry disability index at the last folow-up were lower than those before operation (P < 0.01). During the last folow-up, there were no significant differences in the intervertebral height of surgical segment and the proximal adjacent segment, and the range of motion of surgical segment was lower than that before operation (P < 0.01). No significant difference was found in range of motion of the proximal adjacent segment. These results suggest that semi-restricted dynamic non-fusion system (Cosmic) can reduce the destruction of lumbar physiological structure during operation, partly retain the range of motion, maintain the stability of surgical segment, and help to prevent the adjacent segment degeneration with wel mid-term folow-up outcomes.

ObjectiveTo study the influence of nitric oxide on the expression of CD44 of human osteosarcoma cell line (HOS).MethodsDifferent concentrations of sodium nitroprusside (SNP) were added into the culture solution of HOS in vitro. Through immunohistochemistry method (SP), the expression of CD44 were observed.ResultsThe expression of CD44 was depressed when the concentration of SNP was increased. ConclusionNitric oxide can depress the expression of CD44 of HOS and maybe change the invasive or metastatic abilities of HOS.

目的探讨应用非手术方法治疗老年患者腰椎管狭窄症的疗效。方法对74例老年(>60岁)腰椎管狭窄的患者采用手法矫正椎体的假性滑移、药物治疗、适当的腰背肌功能锻炼综合治疗。随访至少2年。采用自定标准评定疗效。结果优(无疼痛及间歇性跛行,无功能限制,不用止痛剂)34例,良(偶然疼痛及间歇性跛行,轻度功能受限,偶尔使用止痛剂)27例,一般(中度的疼痛及间歇性跛行,中度功能限制,无运动,经常使用止痛剂)11例,差(中度每天疼痛及间歇性跛行,或偶尔严重疼痛,每天日常生活活动受限,应用强止痛剂)2例。结论对老年腰椎管狭窄症采取综合的非手术方法能取得一定疗效。

Objective To evaluate the clinical efficiency of posterior unilateral open-door laminoplasty and leverage titanium plate internal fixation in the treatment of cervical spondylotic myelopathy ( CSM ) with multi-segmental spinal stenosis.Methods Between Mar 2011 and May 2015, 25 patients with multi-segmental CSM with multi-segmental spinal stenosis were treated by posterior unilateral open-door laminoplasty and leverage fixation .There were 16 males and 9 females, whose mean age was 60.6 ±9.9 years during the surgery.The change of clinical symptoms and signs was recorded during follow-up,and they all received X-ray and MRI.In all the patients, the preoperative and postoperative neurological function, the cervical curvature,cervical vertebra tube volume and axial symptoms were measured , recorded and analyzed. There was statistically significant difference (P<0.05) in the mean Japanese Orthopaedic Association (JOA) score, and Visual Analogue Scale ( VAS) .Results All the 25 patients were followed up for more than 6 months ( 6-24 months ) .No symptoms of C5 nerve root were found in our series .According to the JOA score and VSA score ,the neurological functions of each patient were significantly improved .The preoperative JOA score was 10.16 ±1.35 and the improvement rate 61.24%. There was statistically significant difference between the preoperative VSA score and the postoperative one (6.68 ±1.12 vs 2.32 ±0.84) ( P<0.05).The preoperative and postoperative meansurement of the spinal vertebrai canal diameter was (9.22 ±2.01) and (15.64 ±2.08) mm, respectively,so there was statistically significant difference (P <0.05), indicating that the cavical spinal canal was increased after operation .Conclusion Leverage titanium plate internal fixation can effectively help maintain the expanded vertebral canal after unilateral open -door laminoplasty ,reduce the incidence of postoperative axial symptoms , and maintain the cervical physical curvature .

ObjectiveTo explore the mechanism of extracorporeal shock wave (ESW) in treating osteogenic disorders and the ideal energy level. MethodsAfter success in marrow aspiration from patients' iliac crest, hMSCs were isolated by Percoll density gradient centrifugation and cultured in Dulbecco's modified Eagle's medium in a 5% CO2 and 37 ℃ incubator. Optimal ESW dose was determined by MTT of kinase-marked cytobiology. After hMSCs were exposed to ESW, their morphocytologic change, rate of adherence and doubling time were observed with IPCM. Enzyme cytochemistry reaction for the activity of alkaline phosphatase was also examined. ResultsESW of 5 kV and 100 times could increase cells' viability and proliferation (P<0.01), but higher than 7 kV would inhibit them. Rate of adherence of hMSCs in exposure group of passage 5 reached to 61.54%, which was significantly different from control group(P<0.05). Compared with control group, the MSCs' doubling time was short for 1.72 d (P<0.05). The curve of normal alkaline phosphatase activity of hMSCs was like type S, but ESW shortened its latent period, and promoted its peak time, which was significantly different from control group.ConclusionESW of 5 kV and 100 times can optimally promote the proliferation and activity of osteogen of hMSCs in vitro.

Objective To identify the role of paravertebral muscles in the pathogenesis of scoliosis.MethodsParavertebral muscles were gotten from the 37 patients(12 congenital scoliosis patients and 25 idiopathic scoliosis patients) during the operations.Cryostat sections were cut by 10 μm nd stained with H&E,m-GT,NADH-TR,ATPase.ResultsMyogenic changes,incuding muscle fibrosis,fiber necrosis,etc,were common in paravertebral muscles of scoliosis patients,however regenerating fibers were quite rare.Diffuse fibrosis and remarkablely disorganized fiber directions presented in most of congenital scoliosis patients,while focal fibrosis without necrosis in most of idiopathic scoliosis patients.Neurogenic changes were found in one congenital scoliosis patient and 4 idiopathic scoliosis patients,however four of the five patients had undergone orthopedics.Thickened capsule wall of muscle spindles and connective tissue infiltration in muscle spindles were found in both kinds of scoliosis.ConclusionThere are some differences on pathological changes of paravertebral muscles between congenital scoliosis and idiopathic scoliosis,which indicates that paravertebral muscles may play a special role in the pathogenesis of idiopathic scoliosis.

Objective:To evaluate the efficacy of unilateral biportal endoscopy (UBE) in the treatment of central lumbar spinal stenosis.Methods:The retrospective case-control study was conducted. 36 patients with central lumbar spinal stenosis were treated by unilateral dual channel spinal endoscopy who underwent Beijing Mentougou District Hospital from November 2019 to September 2021 were collected. There were 19 males and 17 females, including 11 cases of L 5-S 1, 19 cases of L 4-L 5 and 6 cases of L 3-L 4; The age was (70.0±3.9) years old, and ranged from 55 to 82 years old. The observation indicators: the changes of dural sac area in lumbar magnetic resonance cross-section before and after surgery, and the improvement of visual analogue of pain (VAS) score and Oswestry dysfunction index (ODI) before and after surgery in 1, 3, 6, and 12 months, as well as the occurrence of complications. Measurement data with normal distribution were represented as mean±standard deviation ( ± s), and comprison between groups was conducted using the t test; Comprison between groups of count data was conducted using the chi-square test or Fisher exact probability. Results:Postoperative MRI showed that the area of the transverse dural sac increased from (65.5±6.7) mm 2 before operation to (173.5±5.5) mm 2 after operation after the removal of the ligamentum flavum ( P<0.05). The follow-up of 36 patients for 12 months after operation showed that the VAS score decreased from (8.5±2.0) scores to (1.3±0.8) scores, and the ODI decreased from (59.3±12.3)% to (13.6±1.6)%( P<0.05). No complications such as nerve injury, cerebrospinal fluid leakage and infection related to operation occurred in 36 patients. Conclusions:Unilateral biportal endoscopy is one of the safe and effective treatment methods in the treatment of central lumbar spinal stenosis, with obvious improvement in symptoms, and the increase in the area of the spinal dural sac. It can obtain good early clinical effects.