目的 探讨腰椎后路长节段固定选择性减压治疗老年退变性腰椎侧凸(DLS)并椎管狭窄的临床效果.方法 行选择性椎板减压长节段植骨融合内固定手术治疗的老年DLS合并腰椎管狭窄患者23例,术前、术后及随访时均采用疼痛视觉模拟评分(VAS)、Oswestry功能障碍指数(ODI)、日本骨科学会腰椎功能评分(JOA)评价患者症状;对腰椎Cobb角、腰椎前凸角进行统计分析.结果 术前、术后VAS、ODI及腰椎JOA有统计学差异(P<0.05);全部患者腰椎Cobb角、腰椎前凸角均有明显改善.结论 腰椎后路长节段固定选择性减压治疗老年DLS并椎管狭窄可达到较好中期疗效.

Currently, combining biodegradable polymeric scaffolds with living cells for bone repair has received significant attention. Ideal bone tissue engineering scaffolds should be biocompatible, biodegradable, and mechanically robust and have the ability to regulate cell function. The aim of this study was to fabricate graphene oxide-impregnated poly(lactic-co-glycolic acid)–gelatin (GO–PLGA–Gel) nanofibrous matrices that stimulate osteoblast proliferation and differentiation for bone regeneration. The GO– PLGA–Gel nanofibrous matrices were comprised of interconnected continuous fibres with threedimensional porous structure that were successfully fabricated via an electrospinning process. The morphology, surface properties, mechanical properties and chemical composition of nanofibrous matrices were characterized by SEM, ATR-FITR, XRD, a materials testing machine and water contact angle measurements. Subsequently, fluorescence staining and an MTT assay were utilized to observe the influence of the Gel and GO on the MC3T3-E1 cell proliferation and attachment in vitro. In addition, osteogenic differentiation was determined from the alkaline phosphatase activity (ALP), expression of osteogenic marker genes and alizarin red staining. The results demonstrated that the MC3T3-E1 cells attachment and proliferation on GO–PLGA–Gel nanofibrous matrices were much higher than on the pure PLGA nanofibrous matrices. More importantly, GO–PLGA–Gel nanofibrous matrices significantly increased the alkaline phosphatase activity (ALP), expression of osteogenesis-related genes and calcium deposition of MC3T3-E1 cells. Our data indicated that blending GO with Gel retained the osteogenesis nature of GO without negatively influencing the proliferation cell effect of the Gel. Therefore, it is concluded that the GO–PLGA–Gel nanofibrous matrices are versatile biocompatible scaffolds for bone tissue engineering.

Currently, combining biodegradable polymeric scaffolds with living cells for bone repair has received significant attention.

One of the goals of bone tissue engineering is to mimic native ECM in architecture and function, creating scaffolds with excellent biocompatibility, osteoinductive ability and mechanical properties. The aim of this study was to fabricate nanofibrous matrices by electrospinning a blend of poly (L-lactic-co-glycolic acid) (PLGA), hydroxyapatite (HA), and grapheme oxide (GO) as a favourable platform for bone tissue engineering. The morphology, biocompatibility, mechanical properties, and biological activity of all nanofibrous matrices were compared. The data indicate that the hydrophilicity and protein adsorption rate of the fabricated matrices were significantly increased by blending with a small amount of HA and GO. Furthermore, GO significantly boosted the tensile strength of the nanofibrous matrices, and the PLGA/GO/HA nanofibrous matrices can serve as mechanically stable scaffolds for cell growth. For further test in vitro, MC3T3-E1 cells were cultured on the PLGA/HA/GO nanofbrous matrices to observe various cellular activities and cell mineralization. The results indicated that the PLGA/GO/HA nanofibrous matrices significantly enhanced adhesion, and proliferation in MCET3-E1 cells and functionally promoted alkaline phosphatase (ALP) activity, the osteogenesis-related gene expression and mineral deposition. Therefore, the PLGA/HA/GO composite nanofibres are excellent and versatile scaffolds for applications in bone tissue regeneration.

利用微载体生物反应器获得足够数量的种子细胞一直是组织工程的研究热点。微载体技术较传统平面细胞培养方式具有许多优势，如在短期内能够提高细胞生长数量，简化了以往复杂繁琐的培养过程，大大节省了空间和人力，并且能为细胞生长提供一个更适宜的微环境。近年来，细胞微载体无论在材料种类、制备技术及生物医学应用等方面都获得了极大的进步。除了细胞扩增功能，生物降解微载体还可作为生物支架及药物载体应用于组织工程。将具有生物降解能力的微载体作为细胞和药物的运载工具将其输送至体内，为组织缺损提供了一种全新的治疗途径，因此被广泛应用于创伤修复治疗的研究中。本文就微载体材料、微载体的结构及改性、微载体技术在临床机体损伤修复中的应用等方面进行综述。

Objective To investigate the effect of polydopamine-modified poly (lactic-co-glycolic acid) (PLGA) and loaded with insulin-like growth factor 1 (IGF-1) on the material performance,and proliferation and differentiation of MC3T3-E1 cells.Methods The PLGA porous microcarriers were prepared by emulsion-solvent evaporation.The microcarriers were surface-modified with polydopamine and loaded with IGF-1.The surface morphology,surface groups and hydrophilicity of PLGA porous microcarriers were determined by scanning electron microscopy,Fourier transform infrared spectroscopy (FTIR) and contact angle tester before and after polydopamine modification.Lysozyme was used as the model protein,and BCA method was used to examine the protein adsorption of the material before and after the modification.PLGA microcarriers (PLGA group),polydopamine-modified PLGA microcarriers (PD-PLGA group) and IGF-l-loaded polydopamine-modified PLGA microcarriers (PD-PLGA/IGF-1 group) were co-cultured with MC3T3-E 1 cells,respectively.The effect of polydopamine-modified and IGF-l-loaded PLGA microcarriers on proliferation,adhesion and osteogenic differentiation of MC3T3-E1 cells were determined by MTT assay,DIPI staining and alkaline phosphatase (ALP) activity assay.Results Scanning electron microscopy showed that the surface of PLGA microcarriers was porous.Infrared spectroscopy analysis showed that polydopamine was successfully adhered to the surface of PLGA microcarriers.The hydrophilicity of PLGA microcarriers modified by polydopamine was greatly improved,and the adsorption capacity of surface protein was increased significantly (both P＜0.05).At 7 d after co-culture with MC3T3-E 1 cells,the cell proliferation and ALP activity in the PD-PLGA group and PD-PLGA/IGF-1 group were significantly higher than those in the PLGA group (all P＜0.05).At 3 d after co-culture with MC3T3-E1 cells,DIPI staining showed that the number of adherent ceils in the PD-PLGA group and PD-PLGA/IGF-1 group was higher than that in the PLGA group.Conclusion After the surface modification with polydopamine,the biological properties of PLGA porous microcarriers can be significantly improved;and loaded with IGF-1,it can significantly promote cell proliferation and osteogenic differentiation.

颈椎病的发病率逐年增高，保守治疗无效的患者多寻求手术治疗。颈椎前路手术因其直接接触椎间盘及后方骨赘对脊髓的压迫，常能达到彻底的减压效果，同时保证椎体良好的骨性融合，维持正常的椎间高度和生理曲度，已经成为治疗颈椎病的最常见手术方式。颈椎前路手术方式分为融合性手术与非融合性手术。融合性手术历来被认为是颈椎前路手术方式的金标准，目前常用类型分为：单纯植骨组，自体髂骨植骨内固定组，钛网钛板内固定组，椎间融合器（ Cage）和椎体间零切迹ZERO-P组。非融合性手术是上世纪末出现的一种新方法，目的是保留手术节段运动功能，对年轻患者适用。本文通过对各种颈前路手术技术的对比分析，阐明不同术式的优缺点。

腰腿痛在临床上十分常见，Golub等〔1，2〕提出韧带结构可能是椎间孔内的异常结构，并推断其在腰腿痛中的作用。随后人们逐渐意识到并肯定了椎间孔韧带在腰腿痛中的作用，但也有越来越多的学者认为椎间孔韧带结构是椎间孔内正常结构。为能更好理解椎间孔韧带在腰腿痛中的作用，本文将结合国内外研究资料，对腰椎间孔韧带相关知识作一综述。

The underlying molecular pathogenesis of osteosarcoma remains poorly understood. The transcription factor MEF2D promotes the survival of various types of cells and functions as an oncogene in liver cancer. However, its potential contribution to osteosarcoma has not been explored. In this study, we investigated MEF2D expression and function in osteosarcoma, finding that MEF2D elevation in osteosarcoma clinical specimens was associated with patients' poor prognosis. MEF2D suppression was shown to decrease the proliferation of osteosarcoma cells, while forced expression of MEF2D was able to promote the proliferation of normal bone fibroblast. Notably, MEF2D silencing abolished osteosarcoma tumorigenicity in an animal model. Mechanistic investigations revealed that MEF2D silencing triggered G2–M arrest in osteosarcoma cells by suppressing RPRM and CDKN1A. miR-144 was found to suppress the expression of MEF2D in osteosarcoma cells. Collectively, our results demonstrated that MEF2D is a candidate oncogene for osteosarcoma and a potential molecular target for cancer therapy.

目的：研究中国男性各年龄组的腰椎松质骨微结构、生物力学特征。方法取捐献的新鲜男性L3椎体32个，年龄20～59岁，分成四个年龄组，每组8个椎体。常规操作去除L3周围软组织及附属结构，只保留椎体部分。沿椎体正中矢状面将椎体切成左右两半。将每半制成规则试件，将试件平均分成两部分，行生物力学实验。对切下的试件周围松质骨喷金后，行扫描电镜观测，用 eflim 软件对骨小梁进行形态学分析、测量。结果20～29年龄组到30～39岁年龄组，横向、纵向骨小梁均明显减小（P＜0.01）。横向、纵向骨髓腔高均明显增大（P＜0.01）。40～49岁年龄组到50～59岁年龄组横向、纵向骨小梁均减小（ P＞0.05）。横向、纵向骨髓腔高均增大（ P＞0.05）。20～29年龄组到30～39岁年龄组，板状骨小梁厚明显减小（ P＜0.01），弹性模量和极限应力均减小（ P＜0.01）。40～49岁年龄组到50～60岁年龄组，板状骨小梁厚略减小（ P＞0.05）。极限应力显著减小（ P＜0.05），弹性模量减小（ P＞0.05）。结论中国男性20～59岁椎体横向、纵向骨小梁宽和板状骨小梁厚度均逐渐减小，横向和纵向骨髓腔的高逐渐增大，松质骨极限载荷和弹性模量随着年龄的增长均减小。随着年龄的变化，骨微结构、密度和生物力学的改变是引起骨质疏松和骨折危险性增加的根本原因。

Bone marrow mesenchymal stromal cells (BMSCs) are the common precursors for both osteoblasts and adipocytes. With aging, BMSC osteoblast differentiation decreases whereas BMSC differentiation into adipocytes increases, resulting in increased adipogenesis and bone loss. In the present study, we investigated the effect of asiatic acid (AA) on adipocytic differentiation of BMSCs. AA inhibited the adipogenic induction of lipid accumulation, activity of glycerol-3-phosphate dehydrogenase, and expression of marker genes in adipogenesis: peroxisome proliferation-activated receptor (PPAR)γ, adipocyte fatty acid-binding protein (ap) 2, and adipsin. Further, we found that AA did not alter clonal expansion rate and expression of C/EBPβ, upstream key regulator of PPARγ, and binding activity of C/EBPβ to PPARγ promoter was not affected by AA as well. These findings suggest that AA may modulate differentiation of BMSCs to cause a lineage shift away from the adipocytes, and inhibition of PPARγ by AA is through C/EBPβ-independent mechanisms. Thus, AA could be a potential candidate for a novel drug against osteoporosis.

布鲁氏菌性脊柱炎是一种严重的人畜共患传染病，是由布鲁氏杆菌感染间盘及椎体引起的化脓性炎症。以腰椎好发，其次为胸腰段，其病理改变以椎间盘炎症改变为主〔1〕。患者常因关节痛或持续剧烈腰背痛就诊于骨科。近几年在我国东北有逐渐上升的趋势。目前关于布鲁氏杆菌性脊柱炎的诊断和治疗的报道较少。笔者回顾近年文献，对布鲁氏菌脊柱炎的临床表现、影像学表现及治疗作一综述。

<正>脊柱滑脱的病例中,腰椎滑脱最为常见。成年人腰椎滑脱的发病率约为3%～4%,男女间的比例为2∶1,女性严重滑脱多见。6岁以下儿童很少发生此病,20岁左右的青年人易发生腰椎滑脱。腰椎滑脱的主要临床症状是腰背痛,退行性变时多伴有明显的腰痛或坐骨神经痛。1定义腰椎滑脱症是比利时医师Herbinlaux于1782年最先描述的L5椎体在骶骨上向前滑移的病例,1854年H.F.Kilian把两

Aim:To observe the density and biomechanics of vertebral cancellous bone of 20~60 year-old Chinese males.Methods:A total of 32 fresh L3 vertebral bodies were donated from Chinese men with age ranging from 20 to 60 years,and were divided into four groups(20~,30~,40~,50~60 years,8 in each group).The conventional lumbar separation was operated by removing soft tissue,subsidiary structure and leaving only the vertebral body.The vertebral body was cut into two halves along median sagittal plane to make specimens,retaining the upper and lower end plates.The specimens were divided into two equal parts.One part was randomly selected for the biomechanical experiments,and the other part was used for the density experiments.Results:With aging,collagen cross-linking capacity declined,the thicknesses of collagen fibrils were various,ranging almost the same,but loosing,sparse,disorder,and the finer collagen fibrils between the thick filaments were disorganized.Compared with those of 20~ years group,the apparent density and volume ratio of the other three groups decreased(F=8.280,10.600,P<0.001),but there were no significant differences among the three groups(P>0.05).Compared with those of 20~ years group,the elastic modulus and ultimate stress of 50~60 years group reduced(F=4.330,9.800,P<0.05).Conclusion:From 20 to 60 years old,the density,elastic modulus and ultimate stress of cancellous bone of Chinese males decreased with aging,which may lead to an increasing risk of osteoporosis and fracture.

颈椎间盘突出症主要是由于颈椎间盘髓核、纤维环、软骨板,尤其是髓核,发生不同程度的退行性病变后,在外界因素的作用下,导致椎间盘纤维环破裂,髓核组织从破裂之处突出或脱出椎管内,从而造成相邻的组织,如脊神经根和脊髓受压,引起头痛、眩晕、心悸、胸闷、颈部酸胀、活动受限、肩背部疼痛、上肢麻木胀痛、步态失稳、四肢无力等症状和体征,严重时发生高位截瘫危及生命.

目的比较老年多节段颈椎间盘突出症并发育性颈椎管狭窄两种后路手术的疗效。方法回顾性研究我院2005年6月至2010年6月采用颈椎后路(单或双开门)椎管扩大成形术治疗的老年性多节段颈椎间盘突出症并发育性颈椎管狭窄患者42例,pavlvo比值均<0.75。采用单开门椎管扩大成形术+侧块螺钉固定术20例,双开门椎管扩大成形术+人工梯形骨块固定22例。按JOA评分标准计算优良率,复查颈椎CT比较测量两组椎管矢状径情况并统计两组术后并发症情况。结果术后随访7~15个月,平均10个月,术前两组JOA评分及椎管矢状径(颈椎CT上测量)比较无统计学意义(P>0.05),术后椎管矢状径单开门组大于双开门组,差异有统计学意义(P<0.01)。并发症发病率单开门组高于双开门组(P<0.01)。术后神经功能恢复改善率,双开门组稍优于单开门组,两组差异有统计学意义(P<0.01)。结论老年多节段颈椎间盘突出症并发育性颈椎管狭窄后路手术中,单双开门手术均有效,但双开门手术组在改善率及术后并发症方面优于单开门手术组。

目的探讨一期后前路联合手术治疗合并脊髓型颈椎病的老年颈椎后纵韧带骨化症的临床疗效。方法选择2009年3月至2011年3月吉林大学第二医院骨科收治的合并脊髓型颈椎病的老年颈椎后纵韧带骨化症患者17例,一期采用后路双开门椎管扩大成形术和前路髓核摘除椎体次全切骨化物切除钛网植骨钛板内固定术,术后随访3～24个月,采用JOA评分,Nurick分级及X线检查评估疗效。结果所有患者均得到随访,平均随访时间14.5个月,术后JOA评分从术前的(7.5±1.3)分提高到(15.8±0.7)分(P<0.05);Nurick分级从术前的(3.2±1.4)级改善到术后的(0.6±1.1)级(P<0.05);X线检查表明所有病例在术后3个月植骨得到不同程度的融合。结论一期后前路联合手术是治疗合并脊髓型颈椎病的老年颈椎后纵韧带骨化症的有效方法。

目的构建表达Rho激酶(ROCK)-Ⅱ特异性siRNA的重组质粒。方法按照Elbashir等设计原则和siRNA表达载体的要求,利用Ambion公司在线siRNATatgetfinder软件,设计带有BamHI、BbsI酶切黏性末端、终止识别序列和LOOP环的shRNA,并将其克隆入载体pGPU6/GFP/Neo,构建成ROCK-Ⅱ特异siRNA重组质粒,然后进行酶切鉴定及基因测序。结果设计的shRNA成功克隆入载体pGPU6/GFP/Neo,构建成ROCK-Ⅱ特异siRNA重组质粒,酶切鉴定及基因测序表明设计序列完全相符,目的基因序列准确无误。结论重组质粒构建成功,为今后体外或体内研究ROCK基因在脊髓损伤后的功能修复提供了一种有效的方法。

大量临床研究已经证实,颈椎前路减压加植骨融合可较好的缓解近期和远期疼痛,从而替代保守治疗应用于治疗脊髓型颈椎病~([1]).