OBJECTIVE:This study examines patients with metastatic spinal disease undergoing non-total en bloc spondylectomy, focusing on revision surgery reasons and its effectiveness in treating spinal instability, neurological issues, and pain. METHODS:This study conducted a retrospective case series in a single center and included 344 patients with metastatic spinal tumor who underwent non-total en bloc spondylectomy open surgery between 2013 and 2021 and were followed up for ＞2 years. RESULTS:Of 344 patients, 20 (7.1%) had revision surgery due to delayed infection (n = 1), fixation loosening (n = 2), and tumor recurrence (n = 17). The revision group had lower rates of radiotherapy (35%) and long-segment fixation (45%) than the unrevised group (60.2%, 74%; P < 0.001). Decompression surgery had the highest revision rate (15.8%), followed by vertebrectomy (8.9%), separation surgery (4.7%), and hybrid surgery (2.3%). Postoperative scores and survival rates were improved in the revision group (median survival 32 vs. 11 months; P < 0.05). CONCLUSIONS:Long-segment fixation with radiotherapy may reduce revision surgery need and extend the time between surgeries. Hybrid or separation surgeries lower the likelihood of revision. Revision surgery can relieve pain and improve neurological function. Patients in the revision group have longer survival times.

目的:探讨miR-29a对于膝关节骨性关节炎(KOA)大鼠滑膜损伤中的保护作用研究.方法:采用前交叉韧带横断法(ACLT)建立KOA大鼠模型.大鼠注射microRNA阴性对照和miR-29a.通过实时定量聚合酶链反应(RT-qPCR)检测KOA滑膜组织和滑膜细胞中miR-29a的表达.RT-qPCR和蛋白免疫印迹试验检测Toll样受体4/髓样分化蛋白88/核因子κB (TLR4/Myd88/NF-κB)信号通路相关蛋白的表达.检测KOA滑膜组织及滑膜细胞中炎症因子的表达水平.结果:KOA滑膜组织和滑膜细胞中miR-29a表达下调.上调miR-29a可抑制KOA大鼠滑膜细胞的炎症反应,促使KOA大鼠的TLR4/Myd88/NF-κB信号通路失活.结论:上调miR-29a可通过TLR4/Myd88/NF-κB信号通路失活化抑制KOA大鼠滑膜细胞炎症反应,从而保护滑膜损伤.

目的:探讨长链非编码RNA H19通过靶向microRNA(miR)-106a-5p对骨关节炎(OA)软骨基质降解和钙化的调控作用.方法:收集临床骨关节炎软骨组织和健康软骨组织,采用实时荧光定量PCR检测软骨组织中lncRNA-H19、miR-106a-5p mRNA表达水平;将人软骨细胞系(HC-A)分为H19干扰组(si-H19)、阴性转染组(si-Control)、miR-106a-5p mimic组(miR-106a-5p)、mimic阴性对照组(miR-106a-5p-NC)、miR-106a-5p抑制剂组(inhibitor)、阴性抑制剂对照组(inhibitor-NC)组、inhibitor+si-H19和inhibitor-NC+si-H19组,检测细胞中碱性磷酸酶(ALP)、骨钙素(OCN)和骨涎蛋白(BSP)mRNA表达水平;Western blot检测软骨细胞基质金属蛋白酶(MMP)-1、MMP-13和II型α1胶原纤维(COL2A1)的水平;CCK-8检测细胞增殖率;流式细胞术检测细胞凋亡率.结果:OA软骨组织中lncRNA-H19 mRNA表达上调(P<0.05),miR-106a-5p mRNA表达下调(P<0.05);沉默lncRNA-H19可明显抑制软骨细胞凋亡,促进软骨细胞增殖(P<0.05),并下调MMP-1和MMP-13的表达水平(P<0.05),上调COL2A1的表达(P<0.05).沉默lncRNA-H19可抑制软骨细胞ALP、OCN、BSP mRNA水平和ALP活性(P<0.05).沉默miR-106a-5p逆转了沉默lncRNA-H19对软骨细胞基质降解和钙化标志物的抑制作用(P<0.05).结论:lncRNA-H19可通过抑制miR-106a-5p表达,促进细胞外软骨基质的降解和钙化,从而参与OA的进展.

目的:探讨MⅡGX3硫酸钙骨水泥填充软骨下良性病变刮除后骨缺损的生物力学特点.方法:选择20例股骨近端骨软骨瘤患者,病变刮除后采用MⅡGX3硫酸钙骨水泥填充,X线定期对骨吸收和自体骨替代过程进行观察,于术后6和12个月,确保MⅡGX3硫酸钙骨水泥完全吸收并被自体骨替代,采用中心旋转测力机测定术后不同时期患侧下肢生物力学特性.结果:20例患者手术成功,切口一期愈合,MⅡGX3完全吸收并被自体骨替代,时间11～13周,平均(12.23±1.22)周;术后12个月巴氏评分高于术后6个月(P<0.05);术后12个月扭转1.5°时扭转刚度、扭转1.5°时扭矩、荷载800 N时压缩刚度均高于术后6个月,荷载800 N时压缩位移小于术后6个月,差异均具有统计学意义(P<0.05).结论:MⅡGX3硫酸钙骨水泥填充软骨下良性病变刮除后骨缺损生物力学表现较好,患者术后恢复情况及日常生活活动能力均较满意,适合推广.

Background. JMJD2B has been reported to be implicated in malignant tumors. This study is aimed at exploring the expression and prognostic significance of JMJD2B in osteosarcoma and its association with hypoxia-inducible factor 1 (HIF1).Methods. The histopathological and clinical characteristics were retrospectively reviewed from 53 osteosarcoma patients. JMJD2B and HIF1 were examined by immunohistochemical staining of paraffin-embedded osteosarcoma samples, and their association with clinical characteristics was examined by Spearman's test. Overall survival was examined by Kaplan-Meier analysis, and prognostic factors were identified by univariate and multivariate regression analyses.Results. JMJD2B and HIF1 expression levels were both significantly associated with Enneking stage, distant metastasis, and neoadjuvant chemotherapy, and the JMJD2B and HIF1 expressions were positively correlated (p<0.001,R=0.752). In addition, univariate analysis showed that the expression of both JMJD2B and HIF1 was significantly associated with overall survival, but multivariate analysis showed that only JMJD2B expression was significantly associated with overall survival in osteosarcoma patients.Conclusions. JMJD2B and HIF1 expression levels show significant correlation with osteosarcoma progression, and JMJD2B could predict poor prognosis of osteosarcoma patients.

Surgical treatment of benign subchondral lesions is the preferred treatment approach, but it leads to bone defects and requires filling treatment. MIIGX3 calcium sulfate bone cement is a new type of bone filling material. However, whether it affects bone defects after scraping benign lesions under the cartilage is unknown. SD rats were used to prepare the cartilage defect model on the femoral block and divided into control group, medical bone cement group and MIIGX3 calcium sulfate bone cement group followed by analysis of bone mineral density, ALP activity, type II collagen and BMP-2 level and TNF-alpha and IL-6 secretion by ELISA, COL2A1 and SOX9 expression by Real time PCR as well as glycosaminoglycan (GAG) content. The medical bone cement and MIIGX3 calcium sulfate bone cement can significantly increase ICRS score, bone density and ALP activity, elevate type II collagen and BMP-2 secretion and the expression of COL2A1 and SOX9 and GAG content compared to control (P < 0.05); MIIGX3 calcium sulfate bone cement can significantly improve these changes (P < 0.05). The TNF-alpha and IL-6 secretion of medical bone cement was increased but decreased in MIIGX3 group (P < 0.05). MIIGX3 calcium sulfate bone cement filled with benign lesions of subchondral bone after scraping can promote chondrocyte differentiation and expression, promote cartilage growth and reduce cartilage defects.

骨髓瘤骨病(myeloma bone disease,MBD)是多发性骨髓瘤(multiple myeloma,MM)常见的并发症.MBD的发病机制与破骨细胞活性增加和成骨细胞功能抑制有关,严重影响患者的生活质量.正常的骨重建由骨细胞、破骨细胞和成骨细胞通过平衡骨形成及骨吸收来维持,而且多种细胞因子可通过调节骨细胞、破骨细胞和成骨细胞的活性来影响骨形成及骨吸收.最近的文献报道,与破骨细胞活化和成骨细胞抑制有关的分子和途径有核因子-κB配体/骨保护素途径的受体激活剂、activin-A、Wnt信号抑制因子dickkopf-1 (DKK1)及硬化蛋白等,这些分子影响肿瘤生长,为开发治疗MBD的新药物和治疗MM提供了可能.本文就MBD的发病机制及治疗的最新进展做一综述.

目的:探讨后路显微镜辅助硬膜内病变切除联合脊柱内固定术治疗硬膜内转移癌的手术效果.方法:回顾性分析我院骨科2011年1月～2016年1月收治的随访资料完整的硬膜内转移癌患者10例.所有患者均采用后路显微镜辅助硬膜内病变切除联合脊柱内固定术.其中男性6例,女性4例,年龄44～63岁,中位年龄为55岁,原发肿瘤包括肺癌3例,乳腺癌3例,肾癌2例,舌癌和食管癌各1例,肿瘤位于颈椎管内1例,胸椎管内4例,胸腰段2例,腰椎管内3例.硬膜内髓外转移8例,硬膜内髓内转移2例.记录患者的手术时间、术中出血量、术后并发症发生率、生存时间.以视觉模拟评分(visual analogue scale,VAS)、椎管内肿瘤McCormick分级及功能状态(karnofsky performance score,KPS)评分分别对患者的术前、术后1个月的转移灶引起的疼痛、术后3个月神经及整体情况进行评估.结果:10例椎管内硬膜下转移癌患者的手术时间为130～260min(180.0±25.4min),术中出血量400～2100ml(1050.0±350.4)ml,术后的生存时间10～19个月(中位生存时间为11个月).所有患者术后疼痛均有明显的缓解,术后1个月VAS疼痛评分从术前的6.70±0.67分降至1.70±0.67分(P＜0.05).术后3个月KPS评分从术前的42.00±4.21分提升至术后的69.00±7.37分(P＜0.05).术后3个月Mc-Cormick分级9例较术前明显的提升,1例3级患者术后无明显改善,无术后神经症状恶化的病例.术后并发症2例(脑脊液漏1例,术后血肿1例),均为髓内转移患者,分别经保守及二次手术后好转.结论:后路显微镜辅助硬膜内病变切除联合脊柱内固定术治疗硬膜内转移癌,可以提高患者的生活质量,但对于脊髓内转移患者手术应谨慎施行.

Accumulation of single nucleotide polymorphisms (SNPs) in the displacement loop (D-loop) of mitochondrial DNA (mtDNA) may be associated with an increased cancer risk. We investigated the malignant melanoma (MM) risk profile of D-loop SNPs in a case-controlled study in Chinese Han population. A statistically significant increase in SNP frequency for the T16362C, A16399G and T195C alleles was observed in MM patients (p < 0.05) comparing the MM patients to controls, which indicted that the patients who carry these alleles were susceptible to MM. The study identified SNPs in the mitochondrial D-loop could increase MM risk in Chinese Han people. The analysis of genetic polymorphisms in the mitochondrial D-loop can help identify subgroups of patients who are at a higher risk of developing MM in Chinese Han population, thereby helping to make therapeutic decisions for these patients.

Objectives: To investigate the distributions of Id-1,vascular endothelial growth factor(VEGF) and microvessel density(MVD) in metastatic spinal tumor with different origins and their association with intraoperative blood loss.Methods: 32 metastases spinal specimens confirmed by pathological method in our hospital from 2005 to 2008 were collected.Based on the amount of blood loss,all cases were divided into low,medium and high blood loss subgroup,and all specimens were divided into epithelial group and mesenchymal derived group based on the origins of metastases.Immunohistochemical staining was used to detect Id-1,VEGF and CD34(microvascular markers) in all specimens.The above-mentioned index,tumor origin and blood loss were analyzed each other.Results: Id-1 associated significantly with tumor origin(P0.05),and showed positive relationship with intraoperative blood loss;Metastases from different origins had different expressions of VEGF(P0.05),which were positively correlated with the amount of blood loss;no significant difference was noted between MVD and metastases with different origins(P0.05).Spinal metastases with different origins showed statistical significance with blood loss(P0.05).Conclusions: Id-1 and VEGF expressions are different as for different metastasis origins,and are positively correlated with blood loss.Microvessel density is not significantly influenced by origin of spinal metastases.The epithelial origin metastases are associat ed with more blood loss.