Lumbar disc herniation (LDH) is a prevalent degenerative spinal disorder causing chronic low back pain and sciatica through persistent neuroinflammation and central sensitization. Increasing evidence implicates the CXCL12/CXCR4 signaling axis in these processes, yet its modulation by acupuncture remains unclear. To explore this mechanism, a rat model of LDH was established by autologous nucleus pulposus implantation adjacent to the L5 dorsal root ganglion, and behavioral hypersensitivity was assessed using von Frey and plantar tests. LDH induced marked mechanical and thermal hyperalgesia accompanied by upregulation of CXCL12 and CXCR4 in the spinal dorsal horn. CXCL12 localized mainly to neurons and microglia, while CXCR4 was expressed in neurons, astrocytes, and microglia. Pharmacological blockade of CXCR4 with AMD3100 alleviated hypersensitivity and reduced neuronal and glial activation. Acupuncture similarly increased withdrawal thresholds, inhibited c-Fos, GFAP, and Iba-1 expression, and suppressed TNF-α, IL-1β, and IL-6 levels, whereas exogenous CXCL12 reversed these effects. Acupuncture also inhibited ERK1/2 and NF-κB phosphorylation, and selective inhibition of these pathways with PD98059 or PDTC reproduced its analgesic effects. These findings identify the CXCL12/CXCR4-ERK/NF-κB axis as a critical mediator of LDH-induced neuroinflammation and demonstrate that acupuncture mitigates neuropathic pain by suppressing this signaling pathway and glial activation.

ABSTRACTIn this study, we explored the impact of different biomechanical loadings on lumbar spine motion segments, particularly concerning intervertebral disc degeneration (IVDD). We aimed to uncover the cellular milieu and mechanisms driving ossification in the nucleus pulposus (NP) during IVDD, a process whose underlying mechanisms have remained elusive. The study involved the examination of fresh NP tissue from the L3‐S1 segment of five individuals, either with IVDD or healthy. The analysis consisted of histopathological evaluation and single‐cell RNA sequencing. To further validate the impact of biomechanical loading on IVDD, particularly on the CITED4 + METRN + NP chondrocytes and the bone‐fat balance mechanism, a retrospective analysis was conducted using paraffin‐embedded NP samples from patients. A distinct subset of CITED4 + METRN+ chondrocytes in the degenerated NP that were influenced by biomechanical loading was identified. These cells were evaluated for their potential as diagnostic biomarkers. Pseudotemporal analysis indicated that inflammation and repair processes were integral to NP ossification. Notably, the L4/5 and L5/S1 segments with severe IVDD showed pronounced ossification and heightened lipogenic metabolism. Cell communication analysis sheds light on the roles of bone‐fat balance proteins and various ossification genes. Additionally, immunohistochemistry and immunofluorescence confirmed that biomechanical loading intensified IVDD by fostering osteogenic differentiation, mediated by macrophage migration inhibitory factor (MIF)‐regulated bone‐fat balance. This research reveals the microenvironmental factors of IVDD NP ossification under biomechanical loading, highlighting the role of bone‐fat imbalance. These insights significantly enhance the understanding of IVDD pathogenesis and pave the way for innovative therapeutic approaches.

ObjectiveTo investigate the mechanism of action of “Biaoben acupoint” acupuncture in treating lumbar disc herniation (LDH) by identifying differentially expressed plasma proteins (DEPs) using timsTOF Pro-based 4D data-independent acquisition (DIA) proteomics and correlating them with clinical indicators.MethodsThis study enrolled 10 healthy individuals (H group) and 10 patients diagnosed with LDH. Plasma samples were collected from LDH patients both before treatment (LDH group) and after three weeks of “Biaoben acupoint” acupuncture treatment (Acu group). Clinical outcomes, including Visual Analogue Scale (VAS) for pain, Oswestry Disability Index (ODI) for lumbar function, and Japanese Orthopaedic Association (JOA) score for neurological status, were assessed before and after treatment. Plasma samples were collected for proteomic analysis and key core proteins were further validated by ELISA.ResultsAcupuncture treatment significantly improved VAS, ODI, and JOA scores in the Acu group compared to the LDH group (p < 0.001). Proteomic analysis quantified 3,685 proteins, identifying 376 DEPs across the healthy group and the experimental group (before and after treatment). Bioinformatics analysis revealed that these DEPs were primarily enriched in pathways related to cell structure and adhesion (e.g., cytoskeleton remodeling, focal adhesion), inflammation and immune signaling (e.g., chemokine and cytokine signaling), and cell signal transduction (e.g., calcium signaling, Rap1 pathway). Core DEPs included ACTB, CXCR4, ACTN1, CXCL12, SELP, and CCN2. Correlation analysis demonstrated that the expression levels of CXCL12, ACTN1, CXCR4, and CCN2 were significantly correlated with VAS, ODI, and JOA scores. To further validate these findings, ELISA was performed on plasma samples from all three groups. The results confirmed that CXCL12, CXCR4, and CCN2 levels were significantly elevated, while ACTN1 was decreased in the LDH group compared to healthy controls; these changes were reversed following acupuncture treatment, showing trends consistent with the proteomic data.Conclusion“Biaoben acupoint” acupuncture likely exerts its therapeutic effects by modulating multiple biological pathways related to inflammatory/immune responses, cytoskeleton organization, cell structure/adhesion, and tissue repair, thereby improving pain, lumbar function, and neurological deficits in LDH patients. Proteins such as CXCL12, ACTN1, CXCR4, and CCN2 are potential key mediators of these therapeutic effects.

>患者,男,89岁,因“腰背部疼痛伴活动受限15 d”于2023年1月30日入院。患者自诉15 d前因搬重物后出现腰部疼痛难忍,翻身及起床疼痛加重,腰椎活动受限,腰痛视觉模拟评分（visual analogue scale,VAS） [1] 8分,无下肢无力麻木,美国脊髓损伤协会（American Spinal Injury Associtation,ASIA）分级 [2] E级。既往高血压病病史10年,无肝病及血液系统疾病。专科查体:外观胸腰段后凸畸形,屈伸活动受限,胸腰段棘突及两侧压痛、叩击痛阳性,咳嗽,双侧下肢浅深感觉、肌张力正常,肌力V级,下肢腱反射正常,病理征阴性。

OBJECTIVE To investigate the clinical efficacy and safety of percutaneous foraminal endoscopy in the treatment of lumbar lateral recess stenosis in elderly. METHODS The clinical data of 31 elderly patients with lumbar lateral recess stenosis treated by percutaneous foraminal endoscopic decompression from March 2018 to August 2019 were retrospectively analyzed. Including 16 males and 15 females, aged from 65 to 81 years with an average of (71.13±5.20) years, the course of disease ranged from 3 months to 7 years with an average of (14.36±6.52) months. Visual analogue scale (VAS) and Oswestry disability index (ODI) were used to assess clinical symptom and functional status before operation and 1, 6, 12 months after operation. At the final follow-up, the modified Macnab standard was used to evaluate clinical efficacy. RESULTS All patients were completed the operation successfully. The operation time was from 75 to 120 min with an average of (97.84±11.22 ) min. All 31 patients were followed up from 12 to 28 months with an average of (17.29±5.56) months. Postoperative lumbago-leg pain VAS and ODI were significantly improved at 1, 6, and 12 months(P<0.01). At the final follow-up, according to the modified Macnab standard to evaluate the effect, 23 got excellent results, 5 good, 3 fair. One patient had severe adhesions between peripheral tissues and nerve root, and postoperative sensory abnormalities in the lower extremities were treated conservatively with traditional Chinese medicine and neurotrophic drugs, which recovered at 2 weeks after surgery. No complications such as nerve root injury and infection occurred. CONCLUSION The intervertebral foraminal endoscopy technique, which is performed under local anesthesia for a short period of operation, ensures adequate decompression while minimizing complications, and is a safe and effective surgical procedure for elderly patients with lumbar lateral recess stenosis.

临床上胫骨平台后外侧骨折常伴随胫骨平台其他部位的骨折,而其孤立发生的病例并不多见.由于解剖部位特殊,同时受腓骨头、外侧副韧带等毗邻结构遮挡,胫骨平台后外侧骨折的显露和固定均较为困难.为增加显露范围,便于骨折的复位和内固定,各种手术入路应运而生,其选择视骨折形态和选用的内植物类型而定.该文对胫骨平台后外侧骨折的手术入路及内固定技术的研究进展进行综述.

[目的]比较交叉与平行空心螺钉固定Garden Ⅰ和Ⅱ型股骨颈骨折的效果.[方法]回顾性分析2015年1月—2016年12月手术治疗的Garden Ⅰ和Ⅱ型股骨颈骨折26例患者的临床资料,其中12例采用交叉空心螺钉治疗(交叉组),14例采用平行空心螺钉治疗(平行组),比较两组临床与影像学资料.[结果]两组患者均顺利完成手术,无严重并发症.两组手术时间、术中透视次数差异均无统计学意义(P＞0.05).所有患者均获随访12个月以上.交叉组恢复完全负重时间和末次随访时Harris评分均显著优于平行组(P＜0.05).影像方面,术后12个月交叉组股骨高度丢失、股骨距丢失、股骨颈轴向长度短缩和螺钉退出程度均显著小于平行组P＜0.05).[结论]交叉空心螺钉固定Garden Ⅰ和Ⅱ型股骨颈骨折,可有效控制股骨颈骨折短缩及减少螺钉尾部退出,提高髋关节功能.

With accelerated aging process of the population, femoral intertrochanteric fractures have gradually become another major social health problem in China. Internal fixation is still the gold standard treatment for the fractures. Fracture reduction is the first step of the treatment and also the first element that affects the treatment efficacy. It is still controversial in clinical practice how to evaluate the quality of fracture reduction during internal fixation of the fractures. This article systematically expounds and analyzes the 7 systems of judging criteria for the reduction of intertrochanteric fractures from the aspects of fracture alignment, fracture apposition, difference in judgment criteria, and difference in imaging methods, in order to provide a reference for reaching consensus and improving curative effects.

穿支皮瓣是在传统轴型皮瓣基础上发展而来,以穿支血管供血,仅包括皮肤与浅筋膜组织的一种新型皮瓣,由于改变了深筋膜血管网是皮瓣赖以生存的传统观点,使皮瓣设计和形成更具灵活性和多样性 [ 1, 2, 3] 。2012年唐举玉 [ 4] 在国际上首次提出的特殊形式穿支皮瓣是应用传统穿支皮瓣的"微创与美学"理念、根据受区修复要求对皮瓣供区的一级源血管及其分支和相应供养的组织（皮肤、筋膜、肌肉、骨组织）进行优化设计、无创解剖、分割和重组,根据受区创面重建需要切取不同组织块（嵌合）或相同组织块（分叶）,然后再削薄、组装、拼接成与受区创面内容、形状及血液循环重建要求相匹配的新型皮瓣。特殊形式穿支皮瓣是传统穿支皮瓣的衍生和发展,是穿支皮瓣的更高形式,丰富了穿支皮瓣的内涵,扩大了穿支皮瓣的适应证 [ 5, 6, 7, 8, 9, 10, 11, 12, 13] 。

ObjectiveTo analyze the reasons and the influence of internal fixation about the guide pin eccentricity of helical blade during proximal femoral nail anti-rotation (PFNA) internal fixation for femoral intertrochanteric fractures.MethodsA retrospective analysis of the intraoperative imaging data of 175 patients with femoral intertrochanteric fractures, who underwent closed reduction and PFNA internal fixation between January 2018 and January 2020, was performed. There were 76 males and 99 females with an average age of 79.8 years (mean, 61-103 years). The internal between admission and operation was 12-141 hours (median, 32 hours). According to AO/Orthopaedic Trauma Association (AO/OTA) classification, the fractures were rated as type 31-A1 in 64 cases and type 31-A2 in 111 cases. In the intraoperative fluoroscopy image by C-arm X-ray machine, the caputcollum-diaphysis (CCD) was measured after closed reduction and internal fixation, respectively; the angles between the center line of the head nail hole and the axis of proximal nail and between the axis of guide pin and proximal nail were measured, and the difference between the two angles was evaluated; the quality of fracture reduction was evaluated according to the alignment of the medial cortex, anterior cortex of the head and neck bone block, and femoral shaft cortex; the position of the helical blade in the femoral head was evaluated according to the Cleveland method.ResultsThe CCDs of proximal femur were (134.6±6.8)° after closed reduction and (134.9±4.3)° after internal fixation. There was no significant difference between pre- and post-internal fixation ( t=0.432, P=0.766). The angles between the center line of the head nail hole and the axis of proximal nail and between the axis of guide pin and proximal nail were (125.4±2.44)° and (126.3±2.3)°, respectively, showing significant difference ( t=2.809, P=0.044). The difference between the two angles was (0.8±2.2)°. The guide pin eccentricity of helical blade occurred in 47 cases. After tapping the helical blade along the eccentric guide pin, 10 cases had fracture reduction loss, and 5 cases had a poor position of the helical blade in the femoral head.ConclusionDuring PFNA internal fixation, a variety of reasons can lead to the eccentric position of the guide pin of helical blade, including unstable fracture, soft tissue inserted, severe osteoporosis, mismatched tool, and fluoroscopic imaging factors. It is possible that the fracture end would be displaced again and the helical blade position may be poor when knocking into the helical blade along the eccentric guide pin. During operation, it should be judged whether the direction of the guide pin needs to be adjusted according to the eccentric angle.

OBJECTIVE To explore clinical effect of acupoint application of Chinese herbal medicine in preventing postoperative nausea and vomiting after orthopaedic surgery under general anesthesia. METHODS From January 2018 to December 2019, 168 patients who met inclusion criteria and were underwent selective spine surgery, were double-blind divided into two groups according to central random system, 84 patients in each group. In control group, there were 39 males and 45 females aged from 30 to 65 years old with an average of (53.83±9.17) years old, 37 patients were classified to typeⅠand 47 patients were typeⅡ according to American Society of Anesthesiologists (ASA) grading. In experiment group, there were 39 males and 45 females aged from 30 to 65 years old with an average of (54.08±9.00) years old; 32 patients were classified to typeⅠand 52 patients were typeⅡ according to ASA grading. Both of two groups were obtained acupoint application before anesthesia induction, and acupoint application were put on Zhongwan (CV 12) and bilateral Neiguan (PC 6) for 6 h, changed after 24 h, last for 2 d. The drug prescription of plasters in experimental group was consist of Rhizome Pinelliae Preparata, Ginger and Clove. The plasters in control group was consistent with drug plasters in experimental group in appearance and smell to the greatest extent. The ingredients were flour and excipients with 10% of experimental drug concentration. Incidence of nausea vomiting, visual analogue scale (VAS) of narusea degree at 24 h and 24 to 48 h after operation between two groups were compared, SF- 12 simple quality of life score before operation, 24 and 48 h after operation were also compared by using R3.6.1 Rstudio software by the third-party. RESULTS There were no statistical differences in incidence of nausea vomiting, VAS of narusea degree at 24 h after operation (P>0.05), while there were no differences in incidence of nausea vomiting, VAS of narusea degree at 24 to 48 h after operation (P>0.05) . There were no statistical differences in SF-12 before operation, 24 and 48 h after opertaion (P>0.05). CONCLUSION The curative effect of acupoint application of traditional Chinese medicine on the prevention and treatment of postoperative nausea and vomiting is not obvious.

[目的]介绍关节镜下边缘增强缝线桥全层修复肩袖分层撕裂的手术技术与初步临床疗效.[方法]2017年8月～2019年04月对21例肩袖分层撕裂患者进行镜下修复.镜下探明肩袖撕裂的部位,并进行清创,磨钻打磨肱骨大结节,直至磨平、松质骨渗血为止.复位分层肩袖,应用单排固定或内排打结固定加强缝合固定肩袖撕裂两端的止点,全层修复分层撕裂,于足印区缝线桥压紧固定整体肩袖.[结果]所有患者均顺利手术,无感染等并发症.随访时间至少12个月,UCLA评分由术前的(13.86±1.77)分提高到最终随访时的(32.62±1.53)分,Constant-Murley评分由术前(35.05±4.25)分提高到(92.67±3.86)分(P＜0.001).[结论]镜下边缘增强缝线桥全层修复能很好地恢复分层肩袖的整体性和完整性,防治肩袖进一步撕裂,增强肩袖整体的初始强度,改善患者关节功能.

[目的]探讨过伸型胫骨平台双髁骨折的临床特点及治疗策略.[方法]回顾性分析2015年1月～2018年6月采用膝关节后内侧联合前外侧入路切开复位内固定治疗的过伸型胫骨平台双髁骨折患者11例,男8例,女3例,平均年龄(58.24±6.18)岁.分析围手术期、随访与影像资料.[结果]所有患者均顺利完成手术.均无重要血管、神经损伤.随访12～27个月,平均(18.31±6.12)个月,随术后时间推移,VAS评分显著减少(P＜0.05),而HSS评分及ROM显著增加(P＜0.05).末次随访时,11例患者均未见膝内外翻畸形或膝关节僵硬,可完全下蹲,无跛行.影像方面,术后11例患者骨折均达到满意复位,关节面骨块无明显移位及塌陷,平整度良好,胫骨平台后倾角恢复至(8.63±1.15)°.所有患者均获得骨性愈合,平均愈合时间(137.42±18.74)d,至末次随访时,11例患者膝关节间隙均无明显狭窄,内固定物无松动. [结论]过伸型胫骨平台双髁骨折是一种以后倾角消失或变前倾的特殊类型骨折,治疗上最主要的是恢复平台后倾角、膝关节力线和关节面平整,术中注意评估膝关节稳定性.

Current classifications of tibial plateau fractures include three-pillar classification, four-quadrant classification, eight-segment classification, ten-segment classification, and four-column & nine-segment classification. This article reviews the various CT classifications of tibial plateau fractures, their advantages and disadvantages and surgical approaches as well. The essence of the CT classifications is to pay more attention to the coronary fracture line, especially the posterior coronal fracture fragments. A classification which combines the four-quadrant idea of the articular surface of the tibial plateau with the four-column idea of the peripheral cortex of the tibial plateau, and is supplemented by descriptions of non-articular surface structures (intercondylar spine, tibial tubercle and fibula head), may provide a more comprehensive understanding of a specific tibial plateau fracture, but may therefore be too complicated and difficult to use clinically due to too many combinations that need matching.

股骨近端外侧壁(lateral wall)的概念,由以色列骨科医生Gotfried[1]于2004年正式提出,是指向头颈骨块打入内植物的股骨近端外侧皮质.外侧壁对头颈骨块具有天然的支撑作用,同时,这一区域在内固定手术中,需要进行打入导针、皮质扩孔、安装头颈钉等操作,容易发生医源性损伤.而围术期发生外侧壁骨折,是导致手术失败或延误康复、功能效果不佳的最直接因素[2].因此,目前已将术前影像上的外侧壁完整性,作为骨折分型、手术方案选择、判断术后稳定性的一项重要参考指标[3].外侧壁、尖顶距及皮质支撑复位,被誉为近20年来股骨转子间骨折治疗的三大进展[4].完整地描述股骨近端外侧壁,包括许多参数,如:高度、宽度、厚度、面积、冠状面骨折线、生物力学强度、软组织外侧壁等[5-7].其中,基于X线平片测量的外侧壁厚度(femoral lateral wall thickness),是最简便快捷的评估指标.本文仅就外侧壁厚度的概念及其研究进展做一总结分析.

目的 探讨围手术期预防性应用渗透性泻剂及益生菌对老年髋部骨折患者围手术期便秘的预防效果.方法 选取上海市杨浦区中心医院2017年6月 ～2018年9月收治的老年髋部骨折患者133例,实验组84例,对照组49例.实验组与对照组均按照围手术期常规方式进行诊疗,同时,实验组围手术期预防性应用渗透性泻剂及益生菌,对照组不给予针对便秘任何形式的预防措施.观察两组围手术期便秘的发生情况.结果 实验组术后7 d与入院时在Wexner便秘量表评分、Bristol大便分类、排便周期方面比较差异均无统计学意义(P>0.05);对照组术后7 d与入院时在Wexner便秘量表评分、Bristol大便分类、排便周期方面比较,差异均有统计学意义(P<0.05);实验组口服渗透性泻剂及益生菌预防髋部骨折围手术期便秘总有效率显著高于对照组(P<0.05).结论 髋部骨折围手术期预防性应用渗透性泻剂及益生菌可改善肠功能,有效预防髋部骨折围手术期便秘症状的发生,应用价值较大.

目的 应用MRI研究创伤后骨筋膜室压力与骨骼肌纤维化修复以及远期患肢功能的关系.方法 选取36例具有完整骨筋膜室压力数据并行骨折切开复位内固定术的患者,在内固定物取出术后2个月进行MRI检查,评估骨骼肌纤维化修复的情况.末次随访时,分别采用DASH评价系统及IOWA评分系统评估患肢功能的恢复情况,并进行统计学分析.结果 患者均获得骨性愈合,并顺利完成内固定物取出术及MRI检查,经过软件测量及统计学分析,患侧/健侧肌肉体积比和患侧/健侧肌肉T2 WI信号比与骨筋膜室压力的最高值、ΔP(舒张压减去患肢的骨筋膜室压力)的最低值、骨筋膜室压力的累积值以及ΔP的累积值均相关,且与ΔP的累积值相关度最高.患肢功能评分为75～98分,与患侧/健侧肌肉体积比和T2 WI信号比的Pearson积距相关系数分别为0.735和-0.799.结论 骨骼肌的纤维化修复与骨筋膜室压力,尤其是ΔP的累积值密切相关.

目的 探讨转子间骨折中股骨干近侧断面环周皮质在CT三维影像上的形态学特征,为股骨转子间骨折的皮质支撑复位提供结构基础和解剖学依据.方法 收集80例AO/OTA分类31-A1、A2型股骨转子间骨折,通过CT扫描和三维重建,导入Mimics软件,进行骨折块分割与模拟复位后,沿与股骨干轴线呈130°角方向的斜断面,测量股骨干近侧断面残留的环周皮质长度及其前侧壁、外侧壁、后侧壁构成的宽度、以及前后壁皮质断面夹角.结果 A1型骨折21例,环周皮质长度平均为88.7 mm;前侧、外侧、后侧皮质宽度为36.9,36.9,27.3 mm;前后皮质断面夹角16.2°.A2型骨折59例,环周皮质长度平均为60.0 mm;前侧、外侧、后侧皮质宽度为32.3,27.4,9.2 mm;前后皮质断面夹角40.2°.A2型骨折残留环周皮质长度显著小于A1型骨折(P＜0.01).其中后侧皮质宽度变异度最大,前侧皮质宽度变异度较小,基本维持稳定(C.V分别为75.5％、20.0％).结论 转子间骨折中股骨近侧断面残留的环周皮质长度在A1与A2型间存在显著差异.后侧皮质宽度明显为小且变异度大,但前侧皮质宽度基本稳定,可作为骨折复位中获得皮质支撑砥住的主要结构.

Objective:To report the effect of a new method to reconstruct the sensory function of sural flap and to share the experience.Methods:From May, 2018 to November, 2019, 12 patients with hand and foot injuries were treated with sural flap. Blood vessel CDFI examination was performed on 24 shanks of 12 patients before operation. The perforator site was 6.8 -20.5 cm from the lateral malleolus apex, with an average of 12.5 cm. The inner diameter of the root was 1.0-1.8 mm, with an average of 1.35 mm. Before operation, the velocity of blood flow velocity at the vascular root was 28.7-51.6 m/s, with an average of 38.8 m/s. In order to reconstruct the sensation of flap, in the design of free sural skin flaps of 8 patients, the distal sural nerve or medial and lateral sural cutaneous nerve of the perforating branch was anastomosed with the cutaneous nerve of the recipient region. In 2 cases of propeller sural flap, the severed end of sural nerve on the small propeller side was directly anastomosed or bridged with the cutaneous nerve on at the proximal edge of the skin flap donor site. In 2 cases of distal fascial-pedicled sural flap, the lateral malleolus was cut in a distal longitudinal shape to separate the sural nerve and accompanying blood vessels. After distal cutting and rotation, the sural flap was anastomosed with the superficial peroneal nerve in the recipient site or the medial cutaneous nerve of the dorsum of the dorsal foot. This method of reconstructing sensory function by anastomosing the original distal cutaneous nerve of the flap was defined as retrograde neurorrhaphy.Results:All patients were followed-up for 6 months to 1.5 years. The mechanism recovery of the peripheral pathway was excluded in the sensory function examination of flap. According to the evaluation standard for sensory function established by the British Medical Research Council in 1954, sensory recovery was as follows: 1 case for S 4; 8 cases for S 3+; 2 cases for S 3; and 1 case for S 2. Conclusion:Retrograde neurorrhaphy has definite therapeutic effects in reconstructing the sensory function of sural skin flap, and can be able to significantly increase the chances of sensory function reconstructing reconstruction the sensory function of such kind of flaps.