Objective To observe the influence of the bone cement injection volume on the efficacy of percutaneous vertebroplasty（PVP） in elderly patients with osteoporotic vertebral compression fracture（OVCF）,and to provide reference for clinicians to choose the volume of bone cement injection.Methods A total of 90 elderly patients with OVCF admitted to Luoyang Orthopedic-Traumatological Hospital of Henan Province from January 2019 to January 2021 were selected as the study subjects.All patients were treated with PVP.According to the ratio of volume of bone cement to the volume of vertebral body（Vbc/Vvb）,the patients were divided into low-dose group（0.1＜Vbc/Vvb≤0.2）,medium-dose group（0.2＜Vbc/Vvb≤0.3） and high-dose group（Vbc/Vvb＞0.3）,with 30 patients in each group.At the time points of before operation, the first day after operation, 3 and 12 months after operation, the patients′ back pain was assessed by visual analogue scale（VAS）,and their functional recovery was assessed by Oswestry dysfunction index（ODI）.All patients were reexamined with CT on the first to second day after operation to observe the leakage of bone cement.All patients were followed up for 12 months to observe the refracture of the injured vertebral body and adjacent vertebral body.Results There was no significant difference in the VAS score and ODI score among the three groups at the time points of before operation, the first day after operation, 3 and 12 months after operation（P＞0.05）.The VAS score and ODI score of the patients in the three groups on the first day, 3 and 12 months after the operation were significantly lower than those before operation（P＜0.05）.The leakage rate of bone cement in the low-dose group, middle-dose group and high-dose group was 13.33%（4/30）,16.67%（5/30） and 40.00%（12/30）,respectively.The leakage rate of bone cement in the low-dose group and medium-dose group was significantly lower than that in the high-dose group（χ~2=4.022,0.020;P＜0.05）.There was no statistically significant difference in the leakage rate of bone cement between the low-dose group and medium-dose group（χ~2=1.131,P＞0.05）.Within 3 months after operation, the refracture rate of patients in the low-dose group, medium-dose group and high-dose group was 3.33%（1/30）,0.00%（0/30） and 6.67%（2/30）,respectively.There was no statistically significant difference in the refracture rate among the three groups（χ~2=2.069,P＞0.05）.Within 6 months after operation, the refracture rate of patients in the low-dose group, medium-dose group and high-dose group was 6.67%（2/30）,0.00%（0/30） and 6.67%（2/30）,respectively.There was no statistically significant difference in the refracture rate among the three groups（χ~2=2.093,P＞0.05）.Conclusion The PVP with medium-dose bone cement injection（0.2＜Vbc/Vvb≤0.3） can effectively relieve the low back pain, promote the functional recovery of OVCF patients, and reduce the incidence of bone cement leakage.

背景:以髌股关节软骨损伤为主要特征的疾病临床发病率高,但目前的研究对其病因认识不足.过度活动是临床广泛认可的病理机制之一,对认识髌股关节损伤的发生与发展有重要的意义.目的:观察顺轴疲劳运动对髌股关节软骨的影响,探究疲劳运动对兔髌股关节软骨造成的损害,为了解过度活动对髌股关节软骨病变的影响提供实验依据.方法:将8只新西兰大耳白兔适应性饲养1周后,选取右后膝为实验侧,将右后膝固定于造模机上进行顺轴疲劳运动,活动角度设置为0°-95°,活动频率为60次/min,每天活动90 min,持续2周;左后膝不做处理.造模结束后采集动物膝关节MRI图像,之后麻醉处死动物并取材,对髌股关节进行软骨组织切片观察以及软骨Mankin评分.结果 与结论:①实验侧髌骨软骨出现明显的损害;②顺轴疲劳运动2周后,实验侧髌骨软骨颜色晦暗、可见裂隙存在,髌骨软骨面粗糙,髌骨-股骨接触面边缘增生;对照侧没有发现明显的软骨退变;③膝关节MRI结果显示,实验侧髌骨软骨信号不均匀;④苏木精-伊红染色后,光镜下观察实验侧软骨表面不光滑,可见软骨细胞增殖,排列紊乱,多条潮线;实验侧Mankin评分明显高于对照侧,差异有显著性意义(P＜0.05);⑤提示持续2周的顺轴疲劳运动可以造成兔髌股关节软骨轻度病损,出现软骨肿胀、裂隙等病理改变.

Objective To analyze the risk factors of reoperation after percutaneous vertebroplasty (PVP) and kyphoplasty (PKP), and to propose surgical tips during reoperation as well as preventive measures.Methods From June 2012 to December 2017, 465 patients underwent PVP and PKP in our hospital.Among them, 41 cases underwent reoperation.There were 8 males and 33 females, aged from56 to89 years (average, 75 years).There were 37 cases of osteoporotic fracture, 2 cases of vertebral metastases, and2 cases of plasma cell myelom.The lesion segments were as follows:T9 in 2 cases, T10 in 3 cases, T11 in 6 cases, T12 in 6 cases, L1 in 11 cases, L2 in 5 cases, L3 in 3 cases, L4 in 3 cases, and L5 in 2 cases.According to the American Spinal Injury Association (ASIA) classification, 5 patients with spinal cord injury were rated as follows:grade A in 1 cases, grade B in 1 cases, grade C in 2 cases, grade D in 1 cases.Two patients with nerve root injury had skin hypesthesia, and their muscle strength was gradeⅡ-Ⅲ.Thirty-four patients without spinal cord or nerve root injury had an average visual analogue scores (VAS) of 7.8 and underwent vertebral strengthening, including PKP in 14 patients and PVP in 20 patients, while the rest 7 with spinal cord and nerve root injury underwent open surgery.The patients received reoperation at 2 hours to 1 year following the first surgery.Results All 41 patients were followed up for 6 to 29 months (average, 18 months).The reasons for reoperation were as follow:pseudoarthrosis in 3 cases (3/41, 7.32％), bone cement leakage in the spinal canal in 7 cases (7/41, 17.07％), and fracture in non-surgical vertebral segments in31 cases (31/41, 75.61％).At the final follow-up, 2 patients with nerve root injury only had residual numbness;among the 5 patients with spinal cord injury, 1 case improved to grade C, 1 case to grade D, 2 cases to grade E, and1 case remained grade A according to the ASIA scales;the mean VAS score was 2.3 points in 3 patients who had pseudoarthrosis, while 31 patients with vertebral fractures of non-surgical segments had an average VAS score of 1.8.Conclusion The reasons for reoperation after PVP and PKP include intraspinal leakage of cement, pseudoarthrosis in vertebral body, and vertebral fractures of non-surgical segments.Sequential bone cement injection, critical selection of PVP and PKP cases, routine pathological examination, prevention of falls and rehabilitation exercises can reduce the risk of reoperation.

目的:研究且分析合并软骨黏液样纤维瘤样形态特征骨肉瘤的临床病理特征.方法:回顾性研究并分析本院从2016年5月至2018年3月期间收入的6例伴有软骨黏液样纤维瘤样形态特征骨肉瘤患者的临床、影像及病理资料,分析涉及样本的临床病理特征,判断鉴别诊断结果.结果:经对合并软骨黏液样纤维瘤样形态特征的骨肉瘤患者分析显示,影像学表现未肿瘤呈现膨胀性溶骨性破坏现象,瘤组织内可见到成骨现象,合并皮质破坏表现,均出现软组织肿块的临床表现.病理表现为低倍镜下显示肿瘤呈现出分叶结构,间质存在丰富的黏液,高倍镜下显示大部分区域存在稀疏的细胞,黏液样基质中散在分布一些星形细胞、短梭形细胞,细胞异型不明显,即为软骨黏液样纤维瘤样,部分区域细胞丰富,细胞显示为卵圆形、短梭形,少量嗜酸性胞质,细胞核核仁不明显,核分裂象较少见,存在不规则且成片的骨样组织,显示为菌丝状、花边样,合并灶片状钙化现象.肿瘤中存在片状坏死表现.结论:合并软骨黏液样纤维瘤样形态特征的骨肉瘤属于普通型骨肉瘤的一种亚型,临床相对罕见,临床表现、影像学检查与病理学检查相结合,有利于诊断该疾病.

目的:探讨总结原发性骨淋巴瘤的影像学表现及病理特征,以提高其诊断准确性.方法:回顾性分析2012年1月至2017年12月经病理证实的21例原发性骨淋巴瘤患者的X线片,CT,MRI及SPECT的影像学资料,仔细复习其影像学征象并与病理特征作参照.结果:21例患者,单发18例,多发3例.单发18例中,椎骨6例,股骨4例,肱骨及髂骨各2例,肋骨、腓骨、尺骨、肩胛骨各1例.多发3例中,多节段椎骨1例,累及椎骨、髂骨1例,累及下颌骨、股骨、胫骨、左腕骨及双足跗骨1例.X线和CT显示溶骨型19例,混合型2例,病理骨折1 1例,有明显的软组织肿块11例.MRI检查9例,信号均匀7例,信号不均匀2例;病灶T1WI呈等信号或稍低信号,T2WI呈稍高信号2例、高信号7例.MRI增强扫描7例,肿瘤不均匀强化3例,均匀强化4例.SPECT显像8例,病灶均表现为核素异常浓聚.病理类型均为弥漫性非霍奇金淋巴瘤,其中B细胞19例,T细胞2例.结论:原发性骨淋巴瘤可发生于全身骨骼各个部位,有一定影像学特征,综合应用多种影像学检查可增加病变显示的信息量,但最终确诊仍需要病理学检查.

目的 评价脊柱后凸成形术联合康复训练在骨质疏松椎体压缩型骨折中的治疗效果、安全性.方法 选入该院2015年12月—2016年12月时间段收治的骨质疏松性椎体压缩型骨折患者90例,采用抽签法的分组形式将其平均划分成为两个组别,即实验组与对照组,每组45例.实验组行康复训练法,对照组在此基础上联合采用脊柱后凸成形术治疗方式,对比两组治疗效果与安全性.结果 经过调查对照组治疗效果为77.8％,实验组为95.6％,对照组低于实验组,两组数据比较差异有统计学意义(P<0.05).对照组再次骨折与用药失误安全事故发生次数较多,实验组安全性高于对照组,两组数据比较差异有统计学意义(P<0.05).结论 在骨质疏松性椎体压缩型骨折实际治疗的过程中,采用脊柱后凸成形术联合康复训练治疗方式,能够帮助患者全面提升治疗效果,保证患者的安全性,具有较高的广泛推广优势.

目的:探讨后路切开复位减压内固定结合椎体成形术治疗合并神经损伤的老年胸腰椎骨折的临床疗效.方法:回顾性分析采用切开复位减压内固定结合椎体成形术治疗合并神经损伤的老年胸腰椎压缩骨折14例患者的临床资料,观察患者手术前后伤椎椎体前缘、中间的压缩率变化情况,VAS评分改善,后凸Cobb's角改善情况.结果:椎体前缘压缩率术前为62.79％±11.97％,术后1周降为37.00％±19.41％,术后1年为37.79％±20.32％,椎体中间压缩率术前为55.74％±12.99％,术后1周降为37.00％±19.41％,术后1年为37.79％±20.32％.VAS评分术前(7.71±0.91)分同术后1周(2.71±0.73)分及术后1年(1.43±0.51)分,差异有统计学意义(P＜0.05).Cobb角术前为24.29°±2.30°,术后1周为11.21°±2.75°,术后1年为10.71°±2.73°;术后检查发现椎间隙骨水泥渗漏4例,均无明显临床症状,没有其它相关并发症发生.结论:应用后路切开复位减压内固定结合椎体成形术治疗合并神经损伤的老年胸腰椎压缩骨折,既能改善病人疼痛情况,解除神经压迫,又能维持脊柱稳定性,安全性好,疗效满意.

目的 研究经皮椎旁间隙入路微创手术与传统手术对脊柱胸腰椎骨折患者中的生活质量及康复效果.方法 选取该院2015年9月—2016年9月期间就诊的80例脊柱胸腰椎骨折患者,采用随机数字表法的形式将80例患者平均分为实验组与对照组,每组40例.其中,对照组采用传统手术治疗方法,实验组采用椎旁间隙入路微创手术治疗方法,对比两组患者生活质量评分与康复效果.结果 经两组患者临床治疗效果比较分析发现,实验组生活质量评分高于对照组,且康复效果优于对照组,组间对比差异有统计学意义(P<0.05).结论 在临床治疗脊柱胸腰椎骨折的过程中,采用经皮椎旁间隙入路微创手术治疗方法,使手术创伤减小,且患者术后痛苦感得以缓解,一定程度上优化了患者的术后生活质量,改善了患者的康复效果,临床推广应用价值明显.

To report the surgical technique and clinical outcomes for the treatment of AAD with atlas assimilation by single stage posterior reduction and fixation applying intraoperative distraction between occipital and C2 screws. From April 2008 to January 2014, 25 patients underwent single-stage posterior reduction and fixation applying occipital plate, C2 screws and rigid cantilever beam system through intraoperative distraction between occipital and C2 screws. The pre- and postoperative radiologic parameters and JOA score were examined. Follow-up ranged from 6 to 17months in 25 patients. Clinical symptoms improved in 24 patients (96%) and were stable in 1 patient (4%). Radiologic assessment illustrated that complete reduction was achieved in 24 patients and partial reduction (>60%) in 1 patient. Overall, satisfactory decompression and reduction were showed on postoperative MRI and 3D-CT scans of all 25 patients. The single-stage posterior reduction and fixation applying occipital plate, C2 screws and rigid cantilever beam system through intraoperative distraction between occipital and C2 screws for AAD with atlas assimilation is simple, fast, safe and effective. Cl screws insertion for the treatment of AAD with atlas assimilation should be considered.

目的 观察骨碎补总黄酮对大鼠诱导膜中血管内皮生长因子(VEGF)、骨形态发生蛋白-2(BMP-2)表达的影响.方法 60只3月龄SD大鼠,随机分为3组:模型组、填充组和填充+TFDR组,每组20只,建立大鼠长段骨缺损模型,模型组骨缺损处仅克氏针固定,填充组及填充+TFDR组骨缺损处用抗生素骨水泥填充,并用克氏针固定;填充+TFDR组ig给予TFDR(67.5 mg/kg),模型组及填充组ig等量生理盐水,每天给药1次,连续6周.给药结束后,处死大鼠,切取骨水泥周围包绕的白色膜状物,模型组切取对应阶段的瘢痕组织,Elisa定量及免疫组化法观察诱导膜中BMP-2、VEGF表达变化.结果 填充组BMP-2、VEGF表达水平显著高于模型组,填充+TFDR组BMP-2、VEGF表达水平均显著高于填充组和模型组,各组间差异均有统计学意义(P＜0.05);免疫组化检测结果显示相同趋势.结论 TFDR促进Masquelet技术诱导膜中BMP-2和VEGF表达.

目的 探讨牛膝多糖对半月板组织损伤及病理性过度肥大的影响.方法 选取成熟兔的16个半月板组织并进行修饰,共提取240个标本,运用随机数字表法将其分为3组,对其中一组进行压力刺激,另一组进行药物刺激,最后一组作为对照组,运用细胞活性检测方式对各组半月板细胞的成活率进行检测;并运用二甲基亚甲基蓝检测各组半月板中蛋白多糖的含量;运用RT-qPCR与Western blot方式检测MMP13、IL-1等相关因子表达量.结果 药物组的细胞死亡量高于对照组,但低于压力组;压力组的蛋白多糖的含量明显高于对照组与药物组;药物组的MMP13、IL-1等相关因子表达量明显低于力学压力组,差异有统计学意义(P＜0.05).结论 牛膝多糖糖能够有效地对半月板组织损伤进行治疗,并且能够抑制其病理性过度肥大.

目的 探讨CD117在骨肉瘤组织中的表达及其临床意义.方法 选取2009年1月至2016年12月洛阳正骨医院保存的骨肉瘤组织标本及肿瘤周围正常骨组织标本各45例,采用免疫组织化学法检测骨肉瘤组织及正常骨组织中CD117的表达,分析骨肉瘤组织中CD117的表达与患者临床病理特征的关系.结果 骨肉瘤组织和正常骨组织中CD117阳性表达率分别为53.3％ (24/45)、0.0％ (0/45),骨肉瘤组织中CD117阳性表达率显著高于正常骨组织(r=32.727,P＜0.05).骨肉瘤组织中CD117表达与患者的年龄、性别及肿瘤直径无相关性(P＞0.05),而与肿瘤组织学类型、肿瘤转移及TNM分期有相关性(P＜0.05).结论 骨肉瘤组织中CD117表达上调,且与肿瘤组织分化程度、肿瘤转移及TNM分期有相关性,CD117可以作为骨肉瘤恶性程度的判断指标.

磷酸盐尿性间叶组织肿瘤(phosphaturic mesenchymal tumor,PMT)是一种罕见的肿瘤,与肿瘤性骨软化症密切相关.组织学表现复杂多样且缺乏明确的特征性,常在临床或病理诊断中被误诊,我们收集7例PMT病例,并结合文献探讨其临床特点、影像学表现、病理特征及鉴别诊断.

This study examined the ability of lipopolysaccharide (LPS) to affect glioma and glioma stem-like cells (GSCs) in vitro and to induce antitumor immunity in vivo and the role of TLR4 in these processes.

Cells respond to their surroundings through an interactive adhesion process that has direct effects on cell proliferation and migration. This research was designed to investigate the effects of TiO2 nanotubes with different topographies and structures on the biological behavior of cultured cells. The results demonstrated that the nanotube diameter, rather than the crystalline structure of the coatings, was a major factor for the biological behavior of the cultured cells. The optimal diameter of the nanotubes was 20 nm for cell adhesion, migration, and proliferation in both glioma and osteosarcoma cells. The expression levels of vitronectin and phosphor-focal adhesion kinase were affected by the nanotube diameter; therefore, it is proposed that the responses of vitronectin and phosphor-focal adhesion kinase to the nanotube could modulate cell fate. In addition, the geometry and size of the nanotube coating could regulate the degree of expression of acetylated α-tubulin, thus indirectly modulating cell migration behavior. Moreover, the expression levels of apoptosis-associated proteins were influenced by the topography. In conclusion, a nanotube diameter of 20 nm was the critical threshold that upregulated the expression level of Bcl-2 and obviously decreased the expression levels of Bax and caspase-3. This information will be useful for future biomedical and clinical applications.

目的:研究姬松茸多糖对小鼠骨髓来源树突状细胞抗肿瘤功能的影响,为临床应用提供理论依据.方法:体外培养小鼠骨髓来源DC,加入ABP溶液,流式细胞仪检测DC表面CD86和CD11a的表达,混合淋巴细胞反应检测ABP对DC抗原提呈能力的影响,MTT法检测ABP对细胞毒性T淋巴细胞(CTL)对H22肝癌细胞杀伤功能的影响.结果:中剂量ABP组(100 μg/mL)DC表面CD86、CD11a表达上调;CTL对肿瘤细胞的杀伤率升高,差异有统计学意义(P＜0.05).结论:适当浓度的ABP能促进DC分化成熟,增强DC的抗肿瘤作用.

目的 探讨不同级别胶质瘤中P53蛋白与O6-甲基鸟嘌呤-DNA甲基转移酶(MGMT)表达的关系.方法 2013年1月至2013年12月在我院进行神经外科手术切除的98例脑胶质瘤组织作为研究对象,采用免疫组织化学的方法分析不同级别胶质瘤组织中P53蛋白与MGMT表达的关系.结果 在不同级别胶质瘤组织间,MGMT阳性表达无统计学差异(P=0.462),但表达强度差异明显(P=0.019).MGMT表达强度与肿瘤分级呈负相关(r=-0.629,P＜0.05).MGMT与P53在阳性表达强度上呈负相关(r=-0.750,P＜0.05).结论 P53蛋白与MGMT在不同级别的胶质瘤中的表达有一定的关系,而且P53表达增强和MGMT表达减弱均会对胶质瘤的发生及其恶性程度产生影响.

OBJECT:Allergy and immunoglobulin E levels are inversely associated with glioma risk. Previous studies have focused on respiratory and food allergies, and little information is available regarding drug allergies. This study evaluated the rate of positive penicillin skin tests (PenSTs) and blood eosinophil counts in a large population of patients with glioma compared with nontumor controls to provide evidence for the relationship between drug allergies and glioma risk. METHODS:A retrospective case-control study was conducted in patients diagnosed with glioma (n = 913) between January 2004 and June 2013. The study patients were matched with nontumor controls (n = 1091) for age, sex, and date of admission to the hospital. Preoperative results of the PenST and eosinophil counts were obtained, and odds ratios (ORs) with 95% confidence intervals (CIs) were calculated using conditional logistic regression models, while a Kaplan-Meier analysis was used to assess overall survival. RESULTS:The percentage of positive PenSTs was higher among patients with glioma than in control subjects. The age-, sex-, and admission date-adjusted OR for positive versus negative PenSTs was 2.392 (95% CI 1.891-3.026). Eosinophil counts were also higher in glioma cases than in controls: the OR for eosinophil > 0.06 × 10(9)/L versus ≤ 0.06 × 10(9)/L was 1.923 (95% CI 1.608-2.301). There was no association between positive PenST/eosinophil counts and glioma grade or patient survival (n = 105). CONCLUSIONS:In contrast to previously reported relationships between allergy and glioma, in the present study a significantly higher rate of positive PenSTs and higher eosinophil counts were found in patients with glioma than in nontumor controls. These results suggest a complex relationship between allergies and glioma development.

In order to investigate the interplay between the cells and TiO2 nanotube array, and to explore the ability of cells to sense the size change in nano-environment, we reported on the behavior of glioma C6 cells on nanotube array coatings in terms of proliferation and apoptosis. The behavior of glioma C6 cells was obviously size-dependent on the coatings; the caliber with 15 nm diameter provided effective spacing to improve the cells proliferation and enhanced the cellular activities. C6 cells' biological behaviors showed many similar tendencies to many phorocytes; the matching degree of geometry between nanotube and integrin defined that a spacing of 15 nm was optimal for inducing signals to nucleus, which results in achieving maximum activity of glioma cells. In addition, the immune behavior of cells was studied, a variety of inflammatory mediator's gene expression levels were controlled by the nanoscale dimension, the expressions of IL-6 and IL-10 were higher on 30 nm than on 15 nm nanotube.

长骨造釉细胞瘤是一种罕见的低度恶性的骨原发肿瘤,在骨肿瘤中占0.4％,且80％～90％好发于胫骨[1].由于症状不典型,影像表现可呈良性肿瘤特征,术前穿刺活检率低,造成术前误诊的几率相对较高.组织学形态多样,与上皮细胞转移灶、滑膜肉瘤等鉴别困难.我们收集8例长骨造釉细胞瘤病例,并结合文献对其临床特点、组织学形态、免疫表型进行观察分析,以提高对本病的认识,避免误诊.