OBJECTIVE: To investigate the short-term effectiveness of uni-portal non-coaxial spinal endoscopic surgery (UNSES) via crossing midline approach (CMA) in the treatment of free lumbar disc herniation (FLDH). METHODS: Between March 2024 and June 2024, 16 patients with FLDH were admitted and treated with UNSES via CMA. There were 9 males and 7 females with an average age of 55.1 years (range, 47-62 years). The disease duration was 8-30 months (mean, 15.6 months). The pathological segments was L _{3, 4} in 4 cases, L _{4, 5} in 5 cases, and L ₅, S ₁ in 7 cases. The preoperative pain visual analogue scale (VAS) score was 6.9±0.9 and the Oswestry disability index (ODI) was 57.22%±4.16%. The operation time, intraoperative bleeding volume, postoperative hospital stay, and incidence of complications were recorded. The spinal pain and functional status were evaluated by VAS score and ODI, and effectiveness was evaluated according to the modified MacNab criteria. CT and MRI were used to evaluate the effect of nerve decompression. RESULTS: All 16 patients underwent operation successfully without any complications. The operation time was 63-81 minutes (mean, 71.0 minutes). The intraoperative bleeding volume was 47.3-59.0 mL (mean, 55.0 mL). The length of hospital stay after operation was 3-4 days (mean, 3.5 days). All patients were followed up 1-3 months, with 15 cases followed up for 2 months and 14 cases for 3 months. The VAS score and ODI gradually decreased over time after operation, and there were significant differences between different time points ( P<0.05). At 3 months after operation, the effectiveness was rated as excellent in 12 cases and good in 2 cases according to the modified MacNab criteria, with an excellent and good rate of 100%. CT and MRI during follow-up showed a significant increase in the diameter and cross-sectional area of the spinal canal, indicating effective decompression of the canal. CONCLUSION When using UNSES to treat FLDH, choosing CMA for nerve decompression has the advantages of wide decompression range, large operating space, and freedom of operation. It can maximize the preservation of the articular process, avoid fracture and breakage of the isthmus, clearly display the exiting and traversing nerve root, and achieve good short-term effectiveness.
Humans ; Male ; Intervertebral Disc Displacement/diagnostic imaging* ; Middle Aged ; Female ; Lumbar Vertebrae/surgery* ; Endoscopy/methods* ; Treatment Outcome ; Operative Time ; Pain Measurement ; Length of Stay

Osteoporosis is a systemic metabolic bone disease characterized by decreased bone mass, damage to bone tissue microstructure, increased bone fragility, and susceptibility to fractures, while sarcopenia is a syndrome characterized by progressive reduction in overall muscle mass and functional decline. Based on the common pathophysiological mechanism and close correlation between the two, the concept of "osteosarcopenia" has gradually emerged to describe the simultaneous attenuation of muscles and bones. Signaling pathways serve as important signal transmission channels between muscles and bones, and if abnormal, they can lead to osteosarcopenia. The aim of this article, therefore, is to review the signaling pathways related to osteogenesis and myogenesis, such as Hedgehog, Hippo, mTOR, MAPK, in order to provide new ideas for targeted treatment of osteosarcopenia.

Objective To assess the perioperative hidden blood loss in aged patients with femoral intertrochanteric fracture.Methods Clinical data of 243 patients (111 males and 132 females) with intertrochanteric fracture admitted from 2009 September to 2015 September were retrospectively reviewed.Two hundred and seventeen patients aged 60-98 years received surgical treatment and 26 patients aged 62-91 years received conservative treatment (non-surgical group).In surgical group,17 cases were operated within 1 d after fracture,71 within 3 d,73 within 7 d,31 within 14 d,and 25 cases were operated after 14 d.Hidden blood loss was evaluated and blood routine was tested.Results The hidden blood loss was (340 ± 216) ml in non-surgical patients,(602 ± 216) ml in patients operated after 14 d,(671 ± 327) ml in patients operated 8-14,(596 ± 362) ml in patients operated 4-7 d,and (505 ± 119) ml in patients operated 2-3 d,(498 ± 244) ml in patients operated within 1 d;there was significant difference among groups (F =14.758,P =0.001).The hemoglobin level in non-surgical group was (121.8 ± 17.6) g/Lwithin 1 d after fracture,(101.1 ±23.3) g/L on 1-3 d,(91.5 ±31.9) g/L on4-7 d,(92.2 ±31.6) g/L on 8-14 d,and (108.3 ± 22.4) g/L after 14 d;there was statistically significant among groups (F =12.457,P =0.001).Conclusions Hemoglobin level in elderly patients with femoral intertrochanteric fracture is dynamically changed,and reaches the lowest point within 1-2 weeks after injury;and operation is an important factor of hidden blood loss in femoral intertrochanteric fracture patients.

One hundred and fifty femoral head necrosis patients with intramedullary decompression received autologous stem cell transplantation. The blood was taken from unilateral or bilateral iliac, in each group the volumes of blood taken were 200, 300 or 400 ml respectively. The number of mononuclear cells was counted before and after centrifugation. The mononuclear cell count in subgroup of 200 ml,300 ml and 400 ml taken from unilateral iliac after centrifugation was (3. 11 ±1. 42) × 1010/L, (2. 62 ±1. 31 ) × 1010/L and(2. 13 ±. 91) × 1010/L. The concentration was significantly lower in subgroup of 400 ml than that of 200 ml (t=5. 118, P<0. 01). The mononuclear cells count in subgroup of 200 ml,300 ml and 400 ml taken from bilateral iliac was(4. 51 ±. 21) × 1010/L, (3. 89 ±. 06) × 1010/L and (2. 98 ±1. 39) × 1010/L, the concentration was significantly lower in subgroup of 400 ml than that of subgroup of 200 ml (t = 6. 446, P < 0. 01). Whether 200 ml or 300 ml or 400 ml blood were taken, the mononuclear cell count in blood taken from bilateral iliac after centrifugation was significantly higher than that from unilateral iliac(t = 3. 119,P < 0. 01; t = 5. 544, P < 0. 01 ;t = 2. 207 ,P < 0. 05). The results indicate that the concentration of isolated bone marrow mononuclear cells is higher from bilateral iliac than unilateral iliac. The concentration of isolated monocytes is reduced gradually with the increased blood volume.

BACKGROUND: Glucocorticoid-induced osteoporosis has relationship with the down-regulation of osteoprotegedn expression. Osteoprotegerin could inhibit bone resorption in the animal experiment and clinical application for treating oestrogenic hormone deficiency osteoporosis. OBJECTIVE: To investigate the effects of exogenous recombinant osteoprotegerin fusion protein on glucocorticoid-induced osteoporosis in rats. DESIGN, TIME AND SETTING: Randomized grouping, controlled animal expenment was performed in the Institute of Orthopedics, Chinese PLA General Hospital between January 2006 and June 2008. MATERIALS: Sixty healthy male Wistar rats of clean grade; Dexamethasone was produced by Tianjin Jinyao Amino Acid Co., Ltd (Licenca No. H12020515). METHODS: Sixty rats were divided into 3 groups randomly with 20 rats in each. Control group: the rats were administrated with 0.9％ sodium chloride. Dexamethasone group: the rats were administrated with dexamethasone intramuscularly. Osteoprotegedn group: the rats were administrated with dexamethasone and recombinant osteoprotegerin intramuscularly. MAIN OUTCOME MEASURES: All rats were sacrificed at 12 weeks after administration. The urine calcium, phosphor, creatinine, bone mineral density, biomechanics tests of femur and vertebral body, were measured. Immunohistochemistry staining were performed to observe osteoprotegerin expression.RESULTS: Sixty rats were all involved in the final analysis. ①Compared with control group, udne calcium increased in the Dexamethasone group (P < 0.05); the bone mineral density of lumbar vertebra and femur decreased significantly (P < 0.05), especially lumbar vertebra (P < 0.01); biomechanics tests of femur and vertebral body (maximum load, maximum stress, elasticity load, elasticity stress, elastic modulus) decreased significantly (P < 0.05); immunohistochemistry staining showed that endogenous osteoprotegerin expressions were reduced significantly in bone marrow of Dexamethasone group (P < 0.01). ②Compared with Dexamethasone group, urine calcium decreased in the osteoprotegerin group (P < 0.01 ); the bone mineral density of lumbar vertebra and femur increased (P < 0.05); the parameters of biomechanics testa of femur and vertebral body increased (P < 0.05); the osteoprotegerin expression was not changed between Dexamethasone group and osteoprotegerin group.CONCLUSION: Glucocorticoid could inhibit osteoprotegerin expression in the bone followed by progressive bone loss and induce osteoporosis. Recombinant osteoprotegerin works effectively in inhibiting bone resorption after administrated with glucocorticoid, reduce bone resorption index, increase bone mineral index and bone strength, thus improving the osteoporosis which is induced by glucocorticoid.

[Objective]To examine the relationship of thoracic kyphosis with gender,age,shape of thoracic vertebral bodies and intervertebral discs.[Method]The gender,age data and MR films of Thoracic spines of 61 cases were collected in a retrospective study.The MR films were scanned into computer.Vertebral and disc morphology,as represented by antero-posterior height ratios,were quantified in computer.Kyphosis was indicated by the Cobb angle.Pearsons correlation analysis and stepwise regression were applied to examine relationship between them.[Result]Vertebral morphology was highly related with thoracic curvature,while a poorer association was noted to disc morphology.The combined infuence of both morphology of vertebral body and intervertebral disc accounted for the variability in kyphosis in 81% female,and 72% in male.[Conclusion]The normal kyphosis of the thoracic spine is determined by the morphological state of both the vertebral bodies and intervertebral discs,especially in female.