目的 探讨3D打印及计算机辅助导航技术在脊柱外科规培生教学中的应用及效果.方法 将2020年7月至2022年7月在我院脊柱外科接受规范化培训的52名学员,随机分为试验组和对照组,每组26人.对照组采用传统的多媒体授课、模型展示及操作演示;试验组采用多媒体授课、3D打印模型进行教学演示、计算机辅助导航技术进行操作培训.学习结束后以调查问卷的形式评估学生对教学方法及教学内容的满意度,并对学生进行理论知识和临床技能考核.结果 试验组与对照组学生的理论知识成绩分别为(89.37±5.31)分和(84.42±4.26)分,差异具有统计学意义(t=3.708,P=0.001).在临床技能考核中,试验组学生病例分析、影像学阅片及椎弓根螺钉置钉操作成绩均明显高于对照组[(24.72±3.25)分vs.(22.26±2.14)分、(26.45±2.71)分vs.(24.67±2.38)分、(35.43±3.47)分vs.(32.52±2.65)分,t=3.224,P= 0.002;t=2.516,P=0.015;t=3.398,P=0.001].同时,试验组学生对授课教师的教学方法和教学内容评价[(95.46±4.83)分、(92.37±4.15)分]高于对照组[(87.75±5.31)分、(88.53±5.42)分],差异具有统计学意义(t=5.477,P＜0.001;t=2.868,P=0.006).结论 3D打印及计算机辅助导航技术应用于临床教学,可有效解决脊柱外科在理论授课及临床实践中所面临的难题,从而显著提高脊柱外科的临床教学质量.

A prospective source of stem cells for bone tissue engineering is adipose-derived stem cells (ADSCs), and BMP-2 has been proven to be highly effective in promoting the osteogenic differentiation of stem cells. Rarely has research been conducted on the impact of lactoferrin (LF) on ADSCs’ osteogenic differentiation. As such, in this study, we examined the effects of LF and BMP-2 to assess the ability of LF to stimulate ADSCs’ osteogenic differentiation. The osteogenic medium was supplemented with the LF at the following concentrations to culture ADSCs: 0, 10, 20, 50, 100, and 500 μg/mL. The Cell Counting Kit-8 (CCK-8) assay was used to measure the proliferation of ADSCs. Calcium deposition, alkaline phosphatase (ALP) staining, real-time polymerase chain reaction (RT-PCR), and an ALP activity assay were used to establish osteogenic differentiation. RNA sequencing analysis was carried out to investigate the mechanism of LF boosting the osteogenic development of ADSCs. In the concentration range of 0–100 μg/mL, LF concentration-dependently increased the proliferative vitality and osteogenic differentiation of ADSCs. At a dose of 500 μg/mL, LF sped up and enhanced differentiation, but inhibited ADSCs from proliferating. LF (100 and 500 μg/mL) produced more substantial osteoinductive effects than BMP-2. The PI3 kinase/AKT (PI3K/AKT) and IGF-R1 signaling pathways were significantly activated in LF-treated ADSCs. The in vitro study results showed that LF could effectively promote osteogenic differentiation of ADSCs by activating the PI3K/AKT and IGF-R1 pathways. In our in vitro investigation, an LF concentration of 100 μg/mL was optimal for osteoinduction and proliferation. Our study suggests that LF is an attractive alternative to BMP-2 in bone tissue engineering. As a bioactive molecule capable of inducing adipose stem cells to form osteoblasts, LF is expected to be clinically used in combination with biomaterials as an innovative molecular and cellular therapy to promote bone repair.

OBJECTIVE:To explore the clinical characteristics and surgical treatment strategies of delayed spinal cord injury (SCI) caused by atypical compression of old thoracolumbar fracture. METHODS:Between January 2011 and June 2018, 32 patients with delayed SCI caused by atypical compression of old thoracolumbar fracture who met the inclusion criteria were admitted and divided into group A (20 cases, underwent anterior subtotal vertebral body resection+titanium mesh reconstruction+screw rod internal fixation) and group B (12 cases, underwent posterior 270° ring decompression of vertebral canal+titanium mesh reconstruction+screw rod internal fixation) according to the different operation approaches. There was no significant difference between the two groups in age, gender, cause of injury, fracture segment, disease duration, preoperative American Spinal Injury Association (ASIA) classification, and preoperative back pain visual analogue scale (VAS) score, lumbar Japanese Orthopaedic Association (JOA) score, kyphosis angle, and vertebral canal occupational ratio ( P>0.05). The incision length, operation time, intraoperative blood loss, complications, and bone fusion time of reconstructed vertebrae were recorded and compared between the two groups; the kyphosis angle, back pain VAS score, and lumbar JOA score were used to evaluate the effectiveness. RESULTS:Except that the incision length in group A was significantly shorter than that in group B ( t=-4.865, P=0.000), there was no significant difference in intraoperative blood loss and operation time between the two groups ( P>0.05). There was no deaths or postoperative paraplegia cases in the two groups, and no deep infection or skin infection occurred. There was 1 case of cerebrospinal fluid leakage, 1 case of inferior vena cava injury, and 1 case of chyle leakage in group A. No serious complications occurred in group B. There was no significant difference in the incidence of complications between the two groups ( P=0.274). All 32 patients were followed up 12-61 months, with an average of 20.8 months. The follow-up time for groups A and B were (19.35±5.30) months and (23.25±12.20) months respectively, and the difference was not significant ( t=-1.255, P=0.219). The reconstructed vertebrae in all cases obtained bony fusion postoperatively. The fusion time of groups A and B were (8.85±2.27) months and (8.50±2.50) months respectively, and the difference was not significant ( t=0.406, P=0.688). The kyphosis angle, back pain VAS score, and lumbar JOA score of the two groups at each time point after operation and last follow-up were significantly improved when compared with preoperatively ( P<0.05); the lumbar JOA score was further improved with time postoperatively ( P<0.05), while the kyphosis angle and the VAS score of back pain remained similarly ( P>0.05). Comparison of kyphosis angle, back pain VAS score, and lumbar JOA score between the two groups at various time points postoperatively showed no significant difference ( P>0.05). At last follow-up, the JOA score improvement rate in groups A and B were 83.87%±0.20% and 84.50%±0.14%, respectively, and the difference was not significant ( t=-0.109, P=0.914); the surgical treatment effects of the two groups were judged to be significant. CONCLUSION:In the later stage of treatment of old thoracolumbar fractures, even mild kyphosis and spinal canal occupying may induce delayed SCI. Surgical correction and decompression can significantly promote the recovery of damaged spinal cord function. Compared with anterior approach surgery, posterior approach surgery has the advantages of less trauma, convenient operation, and fewer complications, so it can be preferred.

Objective:To study the mechanism of skeletal muscle injury in patients infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2, also known as coronavirus disease-19, COVID-19).Methods:We reported relevant clinical and laboratory features and histopathological findings in skeletal muscle of two COVID-19 patients: one from a gastrocnemius puncture specimen from a patient who died of multiorgan failure and the other from a left lower extremity amputation due to thrombosis.Results:The patients presented with the symptom of muscle ache and laboratory examination showed abnormal biochemical parameters related to skeletal muscle injury such as increased creatine kinase-MB and lactate dehydrogenase. The pathological findings were mild, and no significant acute histological changes or inflammation were identified in the two muscle cases examined. The pathological findings in patient 1 were mainly scattered atrophic muscles, while fiber necrosis and minor inflammation were identified in patient 2. The mild infiltration was confirmed by CD68 and leukocyte common antigen (LCA) staining to be predominantly macrophages and lymphocytes. The differential diagnosis included chronic neuromuscular disease in patient 1 and the possibility of fascial compartment syndrome due to thrombosis in patient 2.Conclusion:From the clinical evidence and pathological changes related to skeletal muscle injury found in the two patients with COVID-19, we speculated that there may be some potential sites of action between SARS-CoV-2 and muscle tissue.

Background To the best of our knowledge, muscle soreness is a common manifestation for the coronavirus disease-19 (COVID-19) patients, but the mechanism of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) injury to skeletal muscle remains unclear, there has been no publication focused on muscle involvement in COVID-19 patients. Case presentation We present the case of two Chinese men with COVID-19, whose common symptoms were fatigue and muscle soreness. They went through different treatments, patient 1, 81-year-old, eventually died of multi-organ failure, and patient 2, 53-year-old, underwent amputation of the mid-lower section of left thigh. Laboratory tests in both patients showed abnormal biochemical parameters associated with skeletal muscle injury. We obtained skeletal muscle samples from these two patients, one from postmortem biopsy of gastrocnemius muscle and the other from a resected left lower limb due to thrombosis. The pathological findings in patient 1 were mainly scattered atrophic muscles, while fiber necrosis and minor inflammation were identified in patient 2, and the mild infiltrations were confirmed by CD68 and LCA staining to be predominantly macrophages and lymphocytes. Conclusions We report the clinical and laboratory features together with histopathological findings in skeletal muscle tissues from two COVID-19 cases and speculate that the SARS-CoV-2 may cause skeletal muscle injury. Due to the particularity of individual differences in case reports, the background of chronic neuromuscular disease in patient 1 and a minimal compartment syndrome caused by thrombosis in patient 2 need to be excluded prior to the conclusion that the skeletal muscles have been involved in COVID-19.

Objective:To investigate the clinical effect of lateral rectus abdominis approach combined with presacral decompression for surgical treatment of old Denis type II sacral fractures complicated with upper sacral plexus injury.Methods:A retrospective case series study was performed on the clinical data of 9 patients with old Denis type II sacral fractures complicated with upper sacral plexus injury (L 4-S 1) admitted to Zhongnan Hospital of Wuhan University from June 2010 to December 2016. There were 6 males and 3 females, aged (33.1±7.5)years (range, 15-58 years). Embolization of internal iliac artery and preimplantation of abdominal aortic balloon were performed 2 hours before operation under the guidance of digital subtraction angiography (DSA). Surgery was performed using a single lateral rectus abdominis approach combined with presacral decompression. The operation time, intraoperative blood loss and full weight-bearing time were recorded. The visual analogue scale (VAS) and European QOL Five Dimensional health scale (EQ-5D) were compared before and after operation. The Gibbons' impairment scale was used to assess neurological function. X-ray and CT scan were used to observe internal fixation and fracture healing. The complications during and after operation were recorded. Results:The patients were followed up for 24-52 months [(35.2±5.2)months]. The operation time was (2.9±0.6)hours. The intraoperative bleeding was (573±138)ml, and the full weight-bearing time was (11.6±1.2)weeks. X-ray and CT scan showed bone healing in all patients at the latest follow-up. The VAS and EQ-5D scale improved from preoperative (7.8±0.6)points and (0.34±0.07)points to the final follow-up of (0.8±0.3)points and (0.81±0.05)points ( P<0.05). According to Gibbons classification, 8 patients were grade I and 1 patient was grade II one year after operation ( P<0.01). Namely, the radiation pain of lower extremities was significantly improved in all patients, among which 8 patients showed pain disappeared and completely returned to normal and 1 patient showed residual numbness and hypoesthesia of the affected limbs. No major complications (eg, iatrogenic lumbosacral plexus injury, vital blood vessels or pelvic organs injury) occurred during the operation. During the follow-up period, only one patient developed traumatic hip arthritis and underwent total hip arthroplasty 6 months after operation. Fractures of the remaining patients were healed well without complications like infection, pressure ulcer or implant failure. Conclusions:For old Denis type II sacral fractures complicated with upper sacral plexus injury, lateral rectus abdominis approach combined with presacral decompression can fully decompress the upper sacral plexus nerve, relieve pain, and promote functional rehabilitation, with low incidence of complications. It is an alternative surgical method for the treatment of old Denis type II sacral fractures complicated with upper sacral plexus injury.

The present study aimed to evaluate the clinical efficacy of Andersson lesion (AL) treatments and prognostic factors using medium‐ to long‐term follow‐up data and discuss the clinical characteristics and treatment of AL. Forty‐eight consecutive AL cases at our center from June 2011 to March 2018 were retrospectively analyzed, including 13 cases treated conservatively and 35 treated surgically. Epidemiological characteristics, treatment modalities, clinical features and outcomes, and prognostic factors of the Japanese Orthopaedic Association (JOA) recovery rate were reviewed. Neurological functional recovery was evaluated by American Spinal Injury Association (ASIA) classification. Clinical efficacy was evaluated by JOA score, visual analog scale (VAS) score, and Cobb's angle. The mean overall follow‐up duration was 44.5±18.5 months (range, 27–85 months). There were 36 male and 12 female patients, with a mean age of 49.4±13.1 years (range, 26–72 years). The most common lesion location was the thoracolumbar region, i.e., T10‐L2 (n=33; 68.8%), followed by the thoracic (n=10) and lumbar (n=5) regions. Patients treated surgically showed significantly better JOA scores, VAS scores and Cobb's angles at the final follow‐up than did patients treated conservatively ( P <.05). Univariate and binary logistic regression analyses identified two prognostic factors of the JOA score recovery rate: treatment modality (OR=0.157; 95%CI, 0.028–0.89; P =.036) and bone fusion (OR=9.965; 95%CI, 2.052–48.387; P =.004). Conservative treatment and bone nonunion predict worse JOA score recovery. Surgery remains the optimal treatment for AL in ankylosing spondylitis patients, with better clinical efficacy demonstrated by medium‐ to long‐term follow‐up data.

目的 探讨磁共振成像(MRI)在布氏杆菌性脊柱炎(BS)与脊柱结核(TS)鉴别诊断中的应用价值.方法 回顾性分析2016年1月～2018年12月在我院明确诊断的35例BS患者及33例TS患者的MRI影像资料,对二者的MRI影像特征进行统计分析.结果 受累椎体异常信号上,TS组以弥散型信号为主,占比85.87％;BS组局灶型、扇形信号比例分别为27.71％、21.69％,明显高于TS组的14.13％、0.00％(P<0.05).TS组椎体塌陷及脊柱后凸畸形发生率分别为42.39％、21.74％,均明显高于BS组的0％、3.61％(P<0.05).两组硬膜外脓肿、硬膜外脓肿伴神经症状、前纵韧带下脓肿发生率比较均无统计学差异(P>0.05),TS组韧带下脓肿扩散≥3个椎体水平发生率明显高于BS组(P<0.05).结论 BS、TS在骨质破坏程度、脓肿扩散程度、椎体信号形态上有明显差异,这有助于二者在MRI影像上的鉴别诊断.

目的 探究多层螺旋CT(MSCT)后处理技术在脊柱侧弯诊断中的价值.方法 选择2016年2月至2019年3月我院收治的71例脊柱侧弯患者作为研究对象,所有患者均行脊柱正、侧位X线片、MSCT及其后处理技术检查.分析MSCT后处理技术对椎体的显示情况,比较MSCT及X线片对脊柱异常的检出率.结果 71例患者X线共检出脊柱畸形88处,MSCT检出畸形178处,X线及MSCT对脊柱畸形的检出率比较差异具统计学意义(P<0.05);多平面重建(MPR)/曲面重建(CRP)可允许各个角度观察畸形椎体冠状面、矢状面影像,可较好的显示椎管及脊髓情况;表面遮盖显示(SSD)重建对脊柱侧弯椎体形态显示良好,重建后通过图像旋转可观察脊柱矢状位曲度的改变,但对于椎管结构及软组织显示欠佳;容积显示技术(VRT)可通过调节不同密度阈值观察骨质及椎管形态,对脊柱形态、附件、椎管、脊髓等均可较好显示.结论 MSCT及其图像后处理技术可提供脊柱侧弯畸形立体结构及空间位置信息,对于脊柱异常的检出率优于X线片,可为临床诊断提供可靠的影像资料.

目的 探讨腹直肌旁入路在盆腔腹膜外软组织肿瘤手术中应用的效果.方法 2012年1月～2017年1月间收治的应用腹直肌旁入路治疗的盆腔腹膜外软组织肿瘤病人19例.单一腹直肌旁入路5例,腹直肌旁入路+延长入路8例,腹直肌旁入路联合后方K-L入路6例.结果 19例盆腔腹膜外软组织肿瘤均完整切除,切口长度9～23 cm,手术时间90～210分钟,出血量420～1240 ml,无神经、盆腔脏器损伤及下肢深静脉血栓等并发症.2例术中出现股静脉损伤且术中及时修补,术后1周和术前VAS评分分别为3.4±0.8和7.3±1.6.19例均得到随访,随访时间8～58个月,平均(26.0±5.8)个月,无复发14例,局部肿瘤复发并再次行手术切除2例,恶性肿瘤因远处转移死亡3例.结论 腹直肌旁入路可快速进入盆腔腹膜后位置,相比于骨盆其他手术入路,可触及解剖结构更为广泛,适用于盆腔腹膜后软组织肿瘤切除手术.

跳跃性脊柱结核也被称为非相邻多椎体脊柱结核（noncontiguous multi-tiered spinal tuberculosis）,其特点是存在至少两处脊柱椎节病灶,其间为正常的椎体所隔开。有部分跳跃性脊柱结核无全身结核中毒症状典型的临床表现,称其为跳跃性非典型脊柱结核。早期由于影像学技术的缺乏,此类非典型脊柱结核的诊断较为困难,国内外多以个案的形式报道,其发生率约占所有脊柱结核的

U-shaped sacral fractures are rare and often difficult to diagnose primarily due to the difficulty in obtaining adequate imaging and the severe associated injuries. These fractures are highly unstable and frequently cause neurological deficits. The majority of surgeons have limited experience in management of U-shaped sacral fractures. No standard treatment protocol for U-shaped sacral fractures has been available till now. This study aimed to examine the management of U-shaped sacral fractures and the early outcomes. Clinical data of 15 consecutive patients with U-shaped sacral fracture who were admitted to our trauma center between 2009 and 2014 were retrospectively analyzed. Demographics, fracture classification, mechanism of injury and operative treatment and deformity angle were assessed. All the patients were treated with lumbopelvic fixation or (and) sacral decompression. EQ-5d score was applied to evaluate the patients’ quality of life. Of the 15 consecutive patients with U-shaped sacral fracture, the mean age was 28.8 years (range: 15–55 years) at the time of injury. There were 6 females and 9 males. The mean followup time was 22.7 months (range: 9 47 months) and mean full weight-bearing time was 9.9 weeks (range: 8–14 weeks). Ten patients received lumbopelvic fixation and sacral decompression, one lombosacral fixation, and 4 merely sacral decompression due to delayed diagnosis or surgery. The post-operation deformity angle (mean 27.87°, and range: 8°–90°) of the sacrum was smaller than that pre-operation (mean 35.67; range: 15–90) with no significance difference noted. At the latest follow-up, all patients obtained neurological recovery with different extents. Visual analogue score (VAS) was reduced from preoperative 7.07 (range: 5–9) to postoperetive 1.93 (range: 1–3). All patients could walk without any aid after treatment. Eight patients were able to care for themselves and undertook some daily activities. Five patients had returned to work foil time. In conclusion, lumbopelvic fixation is an effective method for stabilization of U-shaped sacral fractures with fewer complications developed. Effective reduction and firm fixation are the prerequisite of early mobilization and neurological recovery. Sacral decompression effectively promotes neurological recovery even in patients with old U-shaped sacral fractures.

Objective The purpose of this article is to examine the expression and significance of integrinαvβ3 and αvβ5 in osteosarcoma patient with lung metastasis.Methods 25 osteosarcoma samples were collected from our hospital and divided into experimental 16 osteosarcoma patients with lung metastasis) and control group (9 osteosarcoma patients without lung metastasis.The expression of integrin αvβ3 and αvβ5 were measured by immunohistochemistry,real-time fluorescent quantitative polymerase chain reaction (FQ-PCR) and Western blotting staining.Results Both integrin αvβ3 and αvβ5 were expressed in 25 osteosarcoma specimens,but the expression amount and a positive amount in the experimental group with lung metastasis is much higher (68.8％ and 81.3％) than that in the control group (22.2％ and 34.0％).The results showed that the expression of integrin ovβ3 and αvβ5 correlated with tumor size.The larger the tumor size,the higher the expression of integrin αvβ3 and αvβ5.Conclusion High expression and positive rate of osteosarcoma patients with lung metastasis indicated that integrin αvβ3 and αvβ5 have great value in diagnosis and prognosis.

Osteoarthritis (OA) is a highly prevalent chronic and degenerative joint disease characterized by the continuous destruction of the articular cartilage. MicroRNAs (miRNAs) have been reported to be strongly involved in the pathogenesis of OA. The aim of this study was to explore whether miR-449a regulates the expression of growth differentiation factor5 (GDF5), which promotes chondrocyte extracellular matrix (ECM) degradation. We found that miR-449a expression was upregulated in OA cartilage compared to that in normal cartilage. Overexpression of miR-449a increased the expression of chondrocyte ECM catabolic factors, such as matrix metalloproteinases and a disintegrin and metalloproteinase with thrombospondin motif, while inhibiting that of anabolic genes, such as type II collagen and aggrecan. In contrast, suppression of miR-449a exerted the opposite effects. Moreover, GDF5 was identified as a direct target of miR-449a, and its expression was significantly suppressed by miR-449a overexpression. In addition, the suppression of chondrocyte ECM degradation induced by miR-449a inhibitor was attenuated by small interfering RNA-mediated knockdown of GDF5. Overall, these results suggest that miR-449a contributes to chondrocyte ECM degradation in OA via directly targeting GDF5, thereby providing insights to a promising therapeutic target for the treatment of human OA.

Objective To investigate the surgical treatment of complex Denis zone Ⅲ sacral fractures.Methods A retrospective study was conducted on the 15 complex Denis zone Ⅲ sacral fractures which had been treated from June 2011 to September 2015 in our hospital.They involved 9 men and 6 women,with an average age of 28.8 years (from 15 to 55 years).There were 8 U-shaped,6 H-shaped and 3 lambda fractures.By the Gibbons grading for the sacral nerve injury,3 cases were rated preoperatively as grade Ⅱ,5 cases as grade Ⅲ and 7 as grade Ⅳ.Of them,10 received π-shaped lumbopelvic fixation and sacral decompression 2 weeks after injury,one had lumbosacral fixation and sacral decompression 6 days after injury,and 4 underwent only sacral decompression 3 months after injury when they presented with symptoms of neural injury after fracture malunion.Their sacral malformation angle,visual analogue scale and EQ-5d scale were compared between preoperation and postoperation.Results The 15 cases were followed up for 9 to 47 months (average,24.9 months).Their full-weight-bearing time ranged from 8 to 14 weeks (average,9.9 months).All the incisions healed well without any infection,pressure sore,implant loosening or breakage.There was no significant difference between the preoperative angle of malformation (35.7° ± 5.0°,from 15° to 90°) and the postoperative value (27.9°±6.0°,from 8° to 90°) (t =1.003,P=0.324).Their VAS pain score decreased significantly from preoperative 7.0 ±0.3 to postoperative 1.9 ±0.2,and their EQ-5D score increased significantly from preoperative 0.20 ± 0.03 to postoperative 0.79 ± 0.04 (P ＜ 0.05).The final follow-ups revealed more or less recovery of neural function in all the patients.Conclusions π-shaped lumbopelivic fixation is an effective treatment for complex Denis zone Ⅲ sacral fractures.Effective decompression and stable fixation are prerequisites for early neurological and functional recovery.Simple sacral decompression can effectively promote nerve recovery in patients with old complex Denis zone Ⅲ sacral fractures.

OBJECTIVES:Interleukin 23 (IL-23) pathway and IL-1 cluster genes play prominent role in the etiopathology of ankylosing spondylitis (AS). The aim of this study was to investigate the diagnostic and prognostic role of 5 single-nucleotide polymorphisms related to IL-23 pathway and IL-1 cluster genes in AS patients.METHODS:Four hundred thirty-one patients with AS and 206 age- and sex-matched healthy controls were recruited in this prospective cohort study. Five potential single-nucleotide polymorphisms (IL-23R [rs11209026], IL-12B [rs6871626], TYK2 [rs6511701], IL-6R [rs4129267], and IL-1R2 [rs2192752]) related to IL-23 pathway and IL-1 cluster genes by analyzing previous studies were genotyped. Among 431 total AS patients, 198 active cases were treated and followed up for 24 weeks.RESULTS:Frequencies of IL-12B AA (rs6871626) and IL-6R TT (rs4129267) genotypes were increased in AS patients compared with healthy controls (both P < 0.001), and IL-12B A (rs6871626) as well as IL-6R T (rs4129267) allele increased the risk of AS independently (both P < 0.001). The Bath Ankylosing Spondylitis Disease Activity Index score was found to be elevated in AS patients with IL-12B AA (rs6871626) compared with patients with the CA and CC genotypes (P = 0.002 and P < 0.001, respectively), and the Bath Ankylosing Spondylitis Functional Index score was also increased in AS patents with IL-12B AA (rs6871626) than in those with the CA and CC genotypes (P = 0.001 and P < 0.001). In addition, IL-6R T (rs4129267) allele could predict a worse ASAS-20 (Assessment of SpondyloArthritis international Society) response at week 24 as an independent factor by multivariate logistic regression analysis with additive model (P = 0.011).CONCLUSIONS:Interleukin 12B (rs6871626) and IL-6R (rs4129267) gene polymorphisms could serve as promising biomarkers for diagnosis and prognosis in AS patients.

PURPOSE:The purpose of the study is to perform a systematic review and meta-analysis to evaluate the clinical results of percutaneous endoscopic lumbar discectomy (PELD) and open lumbar microdiscectomy (OLM) for the treatment of lumbar disc herniation (LDH). METHODS:Randomized controlled trials or non-randomized controlled trials published from the time when databases were built to March 2016 that compared the clinical effectiveness of PELD and OLM surgical approaches for the treatment of LDH were acquired by a comprehensive search in four electronic databases (PubMed, EMBASE, Web of Science and Cochrane library). A total of 7 studies (1389 patients) were included in this systematic review and meta-analysis. Pooled mean differences (MD) and odds ratios (OR) and with 95% CIs were calculated for the outcomes. RESULT:The results showed that there were no statistically between the PELD group and OLM group in terms of preoperative VAS-BP score (WMD = 0.03; 95% CI: -0.99 to 1.05; P = 0.95), postoperative VAS-BP score (WMD = -0.56; 95% CI: -1.43 to 0.31; P = 0.21), postoperative ODI (WMD = -0.98; 95% CI: -4.96 to 3.00; P = 0.63), complication rate (OR = 1.79; 95% CI: 0.95 to 3.37; P = 0.07) or reoperation rate (OR = 1.44; 95% CI: 0.94 to 2.20; P = 0.09). PELD group was associated with shorter operation time (WMD = -12.83; 95% CI: -24.79 to -0.87; P = 0.04) and hospital stay (WMD = -5.49; 95% CI: -8.63 to -2.35; P = 0.0006). CONCLUSION:The existing evidence indicate that no superiority exists between the two surgical approaches for the treatment of LDH in terms of functional outcome, complication rate and reoperation rate, in spite of that PELD surgical group can achieve shorter operation time and hospital stay than OLM surgical group.

目的:探讨ToyamaⅢ型颈椎管哑铃型肿瘤的手术方式及疗效.方法:回顾性分析我院2012年7月-2015年7月收治的21例ToyamaⅢ型颈椎管哑铃型肿瘤手术患者的临床资料,所有患者均由影像学资料明确诊断,病理结果确诊.采用JOA评分对患者术前、末次随访的神经功能的改善进行评价,计算改善率,并作统计学分析.结果:21例患者获得3-18个月的随访,平均6、7个月.末次随访时脊髓神经功能较术前有不同程度的改善(P＜0.05),无远期并发症.结论:颈椎管哑铃型肿瘤的患者应根据其Toyama分型选择手术方式,尽可能完全切除肿瘤,可以获得满意的疗效.

1940年,Jaffe[1]首次报道了骨巨细胞瘤（giant cell tumor,GCT）。GCT是一种常见于长骨干骺端的低度恶性肿瘤,多发生于20~40岁的女性患者[2]。脊柱GCT相对少见,约占脊柱原发肿瘤的1.4%~9.4%[3],好发于胸腰椎和骶尾骨[4],而颈椎GCT则更为罕见。近期我院收治1例颈椎GCT复发的患者,报告如下。临床资料患者,女,34岁,2014年5月因"颈肩部疼痛1年余,加重伴左手麻木7天"入院。查体:颈椎压痛（约C3~5棘突）。左颈肩及左上肢感觉略有减退,左臂偶有隐痛,左手拇指及食指麻木。病理征未引出。外院CT、MRI示C5椎体病理性骨折（图1a d ）。由于脊髓受压症状明

目的 探讨无骨折脱位型颈脊髓损伤的治疗策略及疗效.方法 回顾性分析我院2013年1月～2015年1月收治的42例无骨折脱位型颈脊髓损伤患者的临床资料,所有患者均由影像学资料明确诊断.采用Frankel分级和JOA评分对患者术前、末次随访的脊髓神经功能进行评价,并计算改善率和优良率.研究不同治疗方式的疗效和手术时机选择对疗效的影响,并作统计学分析.结果 42例患者获得1 ～18个月的随访,平均9.5个月.末次随访时脊髓神经功能较术前有不同程度的改善(P＜0.05),伤后早期(＜3天)行手术治疗的患者与其他患者相较,改善率和优良率具有明显差异(P＜0.05).结论 无骨折脱位型颈脊髓损伤的患者应根据其病情及特点尽早进行手术治疗,可以获得较好的疗效.