目的:比较伊班膦酸与唑来膦酸抑制脊柱转移瘤的临床疗效.方法:采用回顾性分析方法,68例脊柱转移瘤患者在多靶点经皮椎体成形术后分别采用伊班膦酸(36例)或唑来膦酸(32例)治疗1年,同时继续原化疗方案治疗.比较两组患者治疗前后VAS评分和JOA评分的变化,以及神经症状、病理性骨折发生率和药品不良反应发生情况.结果:两组患者治疗6个月后,VAS评分和JOA评分均较治疗前和治疗3个月时明显改善,治疗12个月时上述评分进一步改善(P＜0.05);且唑来膦酸组两项评分均优于同期伊班膦酸组(P＜0.05).两组神经症状发生率差异无统计学意义(P＞0.05).伊班膦酸组病理性骨折发生率高于唑来膦酸组(P＜0.05);但药品不良反应总发生率低于唑来膦酸组(P＜0.05).结论:脊柱转移瘤应用唑来膦酸缓解转移癌疼痛以及治疗椎体病理性骨折严重塌陷效果优于伊班膦酸,但药品不良反应总发生率较伊班膦酸高.

背景:缺氧诱导因子是骨缺氧微环境中关键的基因表达调节因子,了解缺氧诱导因子在骨形成、骨重塑中的作用机制及其对骨稳态失衡类疾病的影响,对探索骨稳态失衡类疾病的防治新途径具有重要意义.目的:查阅国内外相关医学文献,对缺氧诱导因子在骨形成、骨重塑过程中的作用机制,以及对缺氧诱导因子与骨稳态失衡类疾病相关性的研究进展进行综述分析.方法:在2021年4月检索中国知网、万方、维普、NCBI和PubMed数据库2000-2021年所发表的文献,中文关键词:"缺氧诱导因子、骨形成、骨重塑、骨稳态失衡类疾病、调控机制";英文关键词:"Hypoxia inducible factor,bone formation,bone remodeling,bone homeostasis disorders,regulatory mechanism";通过对相关资料的整理与分析,综述缺氧诱导因子对骨形成、骨重塑的作用机制,并分析缺氧诱导因子在骨稳态失衡类疾病中的作用.结果 与结论:①缺氧应激条件下成骨细胞过度表达的缺氧诱导因子1α能够促进骨形成,增加长骨体积,而破骨细胞中缺氧诱导因子2α表达的显著上调能促进破骨细胞的成熟与分化,引起进行性骨丢失.②抑制破骨细胞中缺氧诱导因子1α表达可削弱破骨细胞活性,降低骨吸收,提高骨重塑,缺氧诱导因子2α则通过介导成骨细胞与破骨细胞间的调节来实现骨重塑.③关于缺氧诱导因子3在骨形成、骨重塑中的作用机制目前尚未有研究涉及.④在骨质疏松症中,成骨细胞数量、成骨功能及血管形成能力下降,抑制部分缺氧诱导因子α表达,引起骨量减少、骨密度下降,增加了骨折发生风险.⑤在骨关节炎中,缺氧诱导因子2α呈明显高表达,其通过调控炎性因子、基质分解酶类等分解代谢基因的表达,刺激所介导的软骨细胞凋亡,并加速软骨成分破坏.⑥在软骨肉瘤中,新血管的生成与缺氧诱导因子1α过表达相关,缺氧诱导因子1α可作为软骨肉瘤中与肿瘤新血管生成相关的恶性标志物,缺氧诱导因子1抑制治疗可干预软骨肉瘤中的血管生成.⑦缺氧诱导因子对骨稳态失衡类疾病的血管生成过程及成骨细胞、破骨细胞、软骨细胞组织的增殖与活性具有重要调控作用,因此研发缺氧诱导因子相关激活类或抑制类药物,对修复骨缺损、加快骨折愈合、改善骨关节炎症等骨稳态失衡类病变有十分积极的意义.

Objective:To investigate the effects of S secreted frizzled-related protein-2 (SFRP2) gene DNA methylation on transcription and protein expression in postmenopausal osteoporosis (OP) , as well as the molecular mechanism of Mir-152-3p regulating SFRP2 gene methylation.Methods:The postmenopausal OP patients who visited the Department of Orthopedics of Hengshui People’s Hospital from Sep.2017 to Sep.2020 were selected as the research subjects, and 200 healthy menopausal women who underwent physical examination in our hospital during the same period were included as the healthy control group. The methylation level of SFRP2 gene was quantitatively detected in OP patients and healthy controls. Quantitative real-time polymerase chain reaction (qRT-PCR) was used to detect the relative mRNA and mirNA-148a expressions of SFRP2 gene. Enzyme linked immunosorbent assay (ELISA) was used to assay the protein expression levels of SFRP2 and DNA methyltransferase (DNMT1) . Osteoblasts of SD rats were treated with miR-152-3P mimic, inhibitor and NC mimic and inhibitor and the expression levels of DNMT1 and SFRP2 methylation was detectd.Results:The methylation level of SFRP2 gene in OP group was 3.87%±0.76%, significantly lower than that in the control group (6.36%±1.44%, t=4.632, P<0.001) . The mRNA expression level of SFRP2 gene in OP group was 3.35±0.79, significantly higher than that in control group (2.28±0.52, t=4.858, P<0.001) . The expression level of SFRP2 gene protein in OP group was (4.15±0.62) pg/ml, significantly higher than that in control group[ (2.83±0.51) pg/ml, t=4.858, P<0.001]. The relative expression level of mirNA-152-3P in OP group was 3.14±0.76, significantly higher than that in control group[ (1.63±0.51) , t=5.318, P<0.001]. After transfection of miR-152-3p into SD rat osteoblasts, the expression levels of DNMT1 and SFRP2 methylation in mimic group were significantly decreased, while those of inhibitor group were significantly increased ( P<0.001) . Conclusion:miR-152-3p can regulate the methylation level of SFRP2 gene by acting on the downstream target protein DNMT1and participating in the occurrence of OP.

目的 探讨苦碟子注射液联合低分子肝素预防全膝关节置换术(TKA)后下肢深静脉血栓(DVT)形成的疗效.方法 选取本院2017年1月至2019年1月TKA患者共180例,随机分为对照组(n=90)和观察组(n=90).在常规治疗基础上,对照组手术后12h给予低分子肝素4 100 AXaIU · d-1,ih;观察组在对照组的基础上加用苦碟子注射液40 mL,ivgtt,qd,2组均用药14 d.比较2组患侧肿胀程度、疼痛程度、血液流变学指标和炎性因子、D-二聚体、血浆凝血功能水平及不良反应发生情况.进行术后30 d随访,统计DVT发生率.结果 术后7d开始,与对照组相比,观察组患者的全血高切黏度、全血低切黏度、血浆黏度、红细胞聚集指数和血细胞比容下降(P＜ 0.05),肿瘤坏死因子α、白细胞介素(IL)-6、IL-8和D-二聚体水平降低(P＜0.05),凝血酶原时间、活化部分凝血活酶时间无显著变化(P＞0.05),疼痛程度及患肢肿胀程度明显减轻(P＜0.05).观察组与对照组不良反应发生率无显著差异(6％vs.4％,P＞ 0.05).术后30 d,观察组DVT发生率显著低于对照组(4％ vs.13％,P＜0.05).结论 苦碟子注射液联合低分子肝素能够有效预防TKA术后下肢DVT的发生,显著改善患者血液流变学指标,减轻机体炎症反应,减轻患者疼痛程度及患肢肿胀程度,且不良反应轻微.

Objective: The study aims to investigate the effect of PTED on serum inflammatory factors and pain in patients with lumbar disc herniation. Methods: 94 patients with lumbar disc herniation treated in our hospital were enrolled in this study. Patients were randomly divided into group A (n=47) and group B (n=47). Group A were treated with fenestration discectomy, and Group B were treated with PTED discectomy. The general clinical data, the duration of surgery, bleeding amount, the length of hospital stay, and the complications of patients were compared between two groups. The serum level of TNF-a and IL-6 was detected by enzyme-linked immunosorbent assay (ELISA), and the visual an-alogue score (VAS) between group A and group B was compared by Japanese Orthopaedic Association Scores (JOA). Results: The total duration of surgery, total bleeding amount, and length of hospital stay in group B were less or shorter than those in group A (P<0.001). The TNF-alpha level, IL-6 level and VAS score after treatment in group B were lower than those in group A (P<0.001). While the JOA score in group B was higher than that in group A (P<0.001); the incidence of adverse complications such as lumbar deformation, aggravate pain and postoperative distasia in group B was lower than that in group A (P>0.05). The quality of life scores in group B were higher than those in group A (P<0.001). Conclusion: In summary, PTED has a better effect on the disease control and pain relief in patients with lumbar disc herniation; it has played a greater role in improving patients' quality of life, which is worthy of clinical promotion.

OBJECTIVE:To investigate the difference between four transforaminal endoscopic approaches in the treatment of serious lumbar disc herniation. METHODS:Between October 2010 and February 2015, a total of 122 patients with serious lumbar disc herniation were enrolled and treated with discectomy under transforaminal endoscope. The patients were divided into 4 groups according to the different approaches. The transforaminal endoscopic spine system (TESSYS) technology was used in group A (31 cases), Yeung endoscopic spine system (YESS) technology was used in group B (30 cases), improved transforaminal endoscopic access (ITEA) technology was used in group C (31 cases), and interlaminar dorsal access (IDA) technology was used in group D (30 cases). There was no significant difference in gender, age, disease duration, lesion segment, and preoperative visual analogue scale (VAS) score of low back pain, VAS score of bilateral lower extremities pain, Oswestry disability index (ODI), intervertebral height, lumbar curvature index (LCI), and disc degeneration grading between groups ( P>0.05). The removal volume of nucleus pulposus was compared; after operation, VAS score, ODI score, LCI, intervertebral height, and disc degeneration grading were used to evaluate the effectiveness. RESULTS:The removal volumes of nucleus pulposus in groups A, B, C, and D were (3.6±0.9), (3.5±0.7), (4.6±1.0), (3.1±1.1) cm 3, respectively. There were significant differences between groups ( P<0.05). All incisions healed by first intention, and no early postoperative complications was found. All cases were followed up 12-35 months, with an average of 24 months. During follow-up, there was no recurrence of nucleus pulposus herniation, infection of intervertebral space, cerebrospinal fluid leakage, epidural hematoma, or other complications. At last follow-up, the VAS scores of low back pain and bilateral lower extremities pain, and ODI scores in each group significantly improved when compared with those before operation ( P<0.05); there was no significant difference in the scores and improvements between groups after operation ( P>0.05). At last follow-up, the disc degeneration grading in group B significantly improved when compared with that before operation ( P<0.05); there was no significant difference between groups ( P>0.05). At last follow-up, there was no significant difference in LCI of each group when compared with that before operation ( P>0.05); and there was no significant difference in LCI and loss value between groups ( P>0.05). There was no significant difference in the intervertebral height of the 4 groups at immediate after operation and last follow-up when compared with preoperative value ( P>0.05), and there was no significant difference between groups at immediate after operation and last follow-up ( P>0.05). CONCLUSION:Application of transforaminal endoscope in the treatment of serious lumbar disc herniation has great clinical outcomes. The ITEA technology can obtain a wider field of view and be more convenient to find and remove the degenerative nucleus pulposus. However, the appropriate approach should be selected according to the symptoms and characteristics of lumbar disc herniation.

目的:探讨苦碟子注射液联合低分子肝素预防髋关节置换术后下肢深静脉血栓(deep venous thrombosis,DVT)形成的临床疗效.方法:选取哈励逊国际和平医院于2017年1月至2019年1月收治的拟行髋关节置换术的患者120例,以随机数字表法分为对照组(n=60)和观察组(n=60).对照组患者术后给予低分子肝素治疗,观察组患者术后给予低分子肝素联合苦碟子注射液治疗.比较两组患者下肢DVT发生率、患肢肿胀程度及疼痛程度,血液流变学指标、D-二聚体、炎症因子和凝血功能指标水平及不良反应发生情况.结果:术后30 d内,观察组患者DVT发生率为5.00％(3/60),明显低于对照组的16.67％(10/60),差异有统计学意义(χ2=4.23,P<0.05).术后7 d,观察组患者患肢肿胀程度及疼痛程度较对照组明显减轻;观察组患者血液流变学指标、炎症因子及D-二聚体水平较对照组明显降低,差异均有统计学意义(P<0.05).观察组、对照组患者的不良反应发生率分别为8.33％(5/60)、6.67％(4/60),差异无统计学意义(P>0.05).术前及术后7 d,两组患者凝血功能指标水平比较,差异均无统计学意义(P>0.05).结论:苦碟子注射液联合低分子肝素能够降低髋关节置换术后患者的血液流变学指标及炎症因子水平,减轻患者疼痛及患肢肿胀,减少DVT发生.

目的 探讨苦碟子注射液联合低分子肝素预防老年下肢骨折术后下肢深静脉血栓(DVT)形成的疗效.方法 选取老年(≥60岁)下肢骨折患者120例,按随机数字表法分为对照组(n=58)和试验组(n=62).对照组术后12 h给予低分子肝素,试验组术后12 h给予苦碟子注射液联合低分子肝素.比较2组术前、术后7 d的血液流变学指标(全血高切黏度、全血低切黏度、血浆黏度)、D-二聚体、凝血功能(凝血酶原时间、活化部分凝血活酶时间)及炎性因子(肿瘤坏死因子-α、白细胞介素-6、白细胞介素-8)变化情况.采用数字疼痛量表法记录术后1、3、5、7d疼痛评分.测量术前、术后3 d、7 d患肢与健肢大腿及小腿周径差.随访30 d内DVT发生率及不良反应发生率.结果 2组术前各指标比较差异均无统计学意义(P>0.05).术后7 d,试验组较对照组血液流变学、D-二聚体、炎性因子均降低(P<0.05),2组凝血功能差异无统计学意义(P>0.05).术后3、5、7 d,试验组较对照组疼痛评分均降低(P<0.01).术后7 d,试验组较对照组患肢与健肢大腿及小腿周径差均减小(P<0.01).试验组DVT发生率低于对照组(3.23％vs.13.79％,P<0.05),不良反应发生率差异无统计学意义(4.84％vs.3.45％,P>0.05).结论 苦碟子注射液联合低分子肝素能够降低老年下肢骨折患者术后血液流变学及炎性因子水平,减轻患者疼痛及患肢肿胀,减少DVT发生.

背景:有研究证实,采用高黏度骨水泥进行椎体成形治疗,可明显降低骨水泥渗漏风险.目的:分析高黏度骨水泥椎体成形治疗对骨质疏松性椎体压缩骨折的临床疗效.方法:纳入2014年10月至2017年2月衡水市人民医院骨病科收治的骨质疏松性椎体压缩骨折患者200例,其中男82例,女118例,年龄60-82岁,随机分2组:试验组(n=100)采用高黏度骨水泥行椎体成形治疗,对照组(n=100)采用低黏度骨水泥行椎体成形治疗,记录术中骨水泥渗漏情况.治疗前及治疗后3个月、1年,利用目测类比评分、下腰痛功能障碍指数评分、健康调查简表SF-36评分评估临床症状改善情况,利用影像学检查评估伤椎椎体高度恢复与Cobb角矫正情况.试验已获得哈励逊国际和平医院伦理委员会批准,批准号:2015-2-003(卫).结果与结论:①试验组骨水泥渗漏率明显低于对照组(10％,27％,P=0);②治疗后3个月、1年,两组的目测类比评分、下腰痛功能障碍指数评分明显低于治疗前(P<0.05),SF-36评分明显高于治疗前(P<0.05),两组间目测类比评分、下腰痛功能障碍指数评分及SF-36评分比较差异均无显著性意义(P>0.05);③治疗后3个月、1年,两组的伤椎椎体高度与Cobb角均较治疗前明显改善(P<0.05),两组间伤椎椎体高度与Cobb角比较差异无显著性意义(P>0.05);④结果表明,高黏度骨水泥与低黏度骨水泥椎体成形治疗骨质疏松性椎体压缩骨折均具有较好的临床疗效,但使用高黏度骨水泥的骨水泥渗漏风险较低.

目的 观察并分析高粘度骨水泥结合膨胀式椎体成形器械和经皮椎体后凸成形术(percutaneous kyphoplasty,PKP)治疗骨质疏松性椎体压缩骨折(osteoporotic vertebral compression fracture,OVCF)的临床效果.方法 选取2014年10月至2017年2月期间在我院住院的OVCF患者共224例为研究对象.采用随机双盲法分为两组,观察组112例采用高粘度骨水泥结合膨胀式椎体成形器械进行椎体成形术治疗,对照组112例采用高粘度骨水泥PKP治疗.比较两组手术时间、术中出血量、骨水泥注射量、骨水泥渗漏发生率和骨水泥弥散系数,术前、术后1d及术后1年两组Cobb角、椎体高度及视觉模拟评分法(visual analogue scale,VAS)评分变化,术后满意度.结果 观察组手术时间、术中出血量及骨水泥注射量均显著少于对照组(P＜0.05),观察组骨水泥渗漏发生率显著低于对照组(P＜0.05),两组骨水泥弥散系数比较差异无统计学意义(P＞0.05);术后1d及术后1年,两组Cobb角和伤椎前缘高度比较差异无统计学意义(P＞0.05);术后1d及术后1年,两组VAS评分比较差异无统计学意义(P＞0.05);两组术后满意度比较差异无统计学意义(P＞0.05).结论 高粘度骨水泥结合膨胀式椎体成形器械治疗OVCF患者与高粘度骨水泥PKP治疗效果相似,但可有效缩短手术时间,减少出血量,降低骨水泥渗漏率,纠正后凸畸形,恢复椎体高度,减轻疼痛,提高术后满意度.

目的 探讨软组织平衡术联合第一跖骨双截骨治疗中重度青少年(母)外翻的疗效.方法 纳入2012年1月至2016年12月在哈励逊国际和平医院采用软组织平衡术联合第一跖骨双截骨治疗并获随访的中重度青少年(母)外翻患者25例(30足),其中男3例(4足),女22例(26足),年龄14～30岁,平均(19.7±3.4)岁.比较术前、术后末次随访时的(母)外翻角(hallux valgus angle,HVA),第一、二跖骨间角(inter metatarsal angle,IMA),跖骨远端关节面角(distal metatarsal articular angle,DMAA),并采用美国足踝矫形协会(American Orthopaedic Foot and Ankle Society,AOFAS)趾-跖趾-趾间关节功能评分进行前足功能评价.结果 25例患者随访时间2～4年,平均2.3年.所有患者截骨处愈合良好,无(母)内翻发生,无转移性跖痛症.与术前比较,术后末次随访时HVA、IMA、DMAA及AOFAS评分均明显改善,差异有显著性(P<0.05).3足术后出现(母)趾内侧麻木,考虑最内侧皮神经损伤,给予神经营养药物治疗后半年内均恢复.结论 软组织平衡术联合第一跖骨双截骨手术方式简单,矫正畸形能力强,患者可以早期下地活动,并发症较少,是治疗中重度青少年(母)外翻的理想方法.

Study Design: Clinical and radiographic results of a randomized, controlled, double-blind clinical trial Objective: To investigate the clinical applicability of a ball-point slide-type interbody distractor in posterior reduction and internal fixation for mid- to high-grade isthmic spondylolisthesis. Summary of Background Data: Posterior reduction and internal fixation is the effective treatment for spondylolisthesis. However, for the mid and high-grade isthmic spondylolisthesis patients with the conditions of vertebral osteoporosis and extremely narrow intervertebral space, the reduction is difficult; post-surgery intervertebral space height lost becomes serious; the fracture and loosening rate of fixation system is higher. No study regarding the prevention of these adverse outcomes in this technique is reported. Methods: A total of 59 patients of mid and high-grade isthmic spondylolisthesis were randomly divided into random groups (investigational group and control group) applying simple randomized method in this study. In addition, 30 patients received posterior reduction and internal fixation as control. Twenty-nine patients received posterior reduction and internal fixation by ball-point slide-type interbody distractor were assigned to the investigational group. X-ray examination was performed before and after operation. The degree of reduction, height of intervertebral space were compared. The preoperative and postoperative Visual Analog Scale (VAS) and Oswestry Disability Index (ODI) were evaluated. Additionally, rate of the fixation system fracture was also assessed. Results: Before treatment, there were no significant differences in ISH (P = .72), DR (P = .85), VAS of back pain (P = .55), VAS of leg pain (P = .83) and ODI (P = .68) were found between 2 groups. After 12-month treatment, there were no significant differences in ISH (P = .26), VAS of back pain (P = .09) and VAS of leg pain (P = .96) between two groups. Significant differences of DR (P = .02), ODI (P = .03) and adverse events (P = .00) were found between 2 groups. Conclusions: The results of this prospectively study showed that the ball-point slide-type interbody distractor in the posterior reduction and internal fixation produced good outcomes after 12-month treatment. More high quality randomized controlled trials and cases should still be needed to warrant the results of this study.

Objective To analyze the correlation between the lumbar disc and lumbar facet joint degenera-tion sequence with the age.Methods Six hundreds patients with lumbocrural pain and intact imaging data in this hospital from January 2014 to June 2016 were selected.The intervertebral disc degeneration was judged by using the Pfirrmann method and the Weishaupt classification criterion was used to judge the degeneration of lumbar facet joint.The intervertebral discs and facet joints at L3 -4,L4 -5and L5-S1were performed the graded evaluation.The incidence and age group distribution of each degenerative grade were recorded.The correlation between the degeneration of intervertebral disc and facet joint with the age and the degeneration sequence were analyzed.Results The lumbar disc degeneration and lumbar facet joint degeneration were positively correlated with the age increase(r=0.56,0.62,P<0.05).The lumbar facet joint degeneration rate in the patients aged less than 45 years old was greater than the lumbar disc degeneration rate,however the lumbar disc degenera-tion rate in the patients aged ≥45 years old was greater than lumbar facet joint degeneration rate.Conclusion Lumbar intervertebral disc and facet joint degeneration closely correlated with the age.The lumbar facet joint degeneration is predominant in the early stage and the lumbar intervertebral disc degeneration is predom-inant in the later stage.

目的 探究他莫西芬对骨肉瘤细胞增殖、凋亡、侵袭的影响及临床意义.方法 不同浓度他莫西芬干预骨肉瘤MG-63细胞(1、2、4、8、16μmol/L),MTT法检测细胞的增殖情况;流式细胞术和Transwell法检测他莫西芬(16μmol/L)处理的骨肉瘤MG-63细胞的凋亡率和侵袭能力;采用无血清培养基稀释MG-63细胞注射入SPF大鼠胫骨近端骨髓腔中,构建骨肉瘤大鼠模型,并予他莫西芬,观察肿瘤的体积;蛋白质印迹法(Western印迹)检测细胞中基质金属蛋白酶-9(MMP)-9、MMP-2蛋白的水平.结果 与对照组相比,他莫西芬可显著抑制细胞的增殖(P<0.05),且具有一定的浓度依赖性.他莫西芬处理的细胞凋亡率显著增加(P<0.05),侵袭能力显著下降(P<0.05).骨肉瘤大鼠模型经他莫西芬干预后,肿瘤体积显著低于模型组(P<0.05).他莫西芬可显著降低骨肉瘤细胞中MMP-9、MMP-2蛋白的水平(P<0.05).结论 他莫西芬可抑制骨肉瘤细胞的增殖,促进其凋亡,可能通过下调MMP-9、MMP-2蛋白的表达抑制细胞的侵袭能力.

背景:以往研究表明,17β-雌二醇、淫羊藿苷均能够促进大鼠骨髓间充质干细胞成骨分化,二者联合应用的报道较少。目的:观察17β-雌二醇联合淫羊藿苷对骨髓间充质干细胞向骨细胞分化的影响。方法:运用全骨髓贴壁分离法分离培养SD大鼠骨髓间充质干细胞,流式细胞仪进行骨髓间充质干细胞表面标志物（CD29,CD45,CD90）的鉴定。将培养细胞分为对照组、17β-雌二醇组、淫羊藿苷组、联合诱导组,进行相应成骨诱导。各组细胞经成骨诱导7,14,21 d后分别进行碱性磷酸酶活性、Ⅰ型胶原、骨钙素浓度检测及茜素红染色观察钙结节形成量。结果与结论:（1）17β-雌二醇联合淫羊藿苷作用下细胞成骨能力均增强;（2）成骨诱导7 d后,各组碱性磷酸酶活性均表达,联合诱导组＞17β-雌二醇组＞淫羊藿苷组＞对照组;（3）成骨诱导14 d后,各组Ⅰ型胶原活性均表达,联合诱导组＞17β-雌二醇组=淫羊藿苷组＞对照组;（4）诱导21 d后,各组骨钙素均表达,联合诱导组＞17β-雌二醇组＞淫羊藿苷组＞对照组;（5）茜素红染色镜下钙结节数量:联合诱导组＞17β-雌二醇组=淫羊藿苷组＞对照组;（6）结果表明,17β-雌二醇联合淫羊藿苷能够诱导大鼠骨髓间充质干细胞向骨细胞方向分化,且具有协同作用。

Zoledronic acid is regarded as the most potent bisphosphonate and is widely used in patients with osteoporosis; however, its side effects, including acute-phase reactions, gastrointestinal complaints, renal dysfunction and bisphosphonate-associated osteonecrosis impair the safety and quality of life of patients. The present study was designed to determine the minimal effective concentration of zoledronic acid through testing the dose-dependent effects of zoledronic acid on osteoclast suppression. A primary culture of bone marrow mononuclear cells obtained from C57 mice (age, 6 weeks) was established and induced to form osteoclasts. The number of multinuclear cells was determined by tartrate-resistant acid phosphatase staining and compared among cultured marrow cells treated with different concentrations of zoledronic acid. Furthermore, the cellular properties, including adhesion, migration and bone resorption, were compared at the minimal effective concentration. At a concentration of 1×10-6 mol/l, zoledronic acid significantly inhibited the formation of osteoclasts. This inhibitory effect was further enhanced at the concentration of 1×10-5 mol/l. However, the inhibitory effect of zoledronic acid tapered at the concentration of 1×10-4 mol/l and there was no further dose-dependent increase. In addition, the concentration of 1×10-6 mol/l was sufficient to alter cellular functions, including cell adhesion, migration and bone resorption. In conclusion, zoledronic acid was effective in reducing osteoclast formation and suppressing cellular functions. The minimal effective concentration of zoledronic acid in vitro was 1 µmol/l. Based on these results, a comparable dosage should be explored in clinical applications.

Objective:To investigate the effect and effectiveness analysis of different approaches of transforaminal endoscope on extirpation amount of nuclues pulposus. Methods:Between August 2011 and December 2014, a total of 165 patients with lumbar disc herniation were retrospectively enrolled and were treated with nucleus pulposus discectomy through transforaminal endoscope. The patients were randomly divided into 4 groups according to different approach of transforaminal endoscope. The posterolateral approach (Yeung's technology) was used in group A (42 cases), transforaminal endoscopic spine system (TESSYS) technology was used in group B (40 cases), improved transforaminal endoscopic access (ITEA) technology was used in group C (43 cases), and interlaminar approach (40 cases) was used in group D (40 cases). There was no significant difference in gender, age, disease duration, symptomatic side, and segments among 4 groups ( P>0.05). The extirpation amount of nuclues pulposus was calculated and compared among 4 groups; the effectiveness was evaluated by pre- and post-operative visual analogue scale (VAS) score, Oswestry disability index (ODI), lumbar curvature index (LCI), and intervertebral height. Results:The discectomy amount of nucleus pulposus was (3.7±0.8), (3.6±0.7), (4.5±1.1), and (3.0±0.8) cm 3 in groups A, B, C, and D, respectively. The amount of group C was significantly larger than that of the other 3 groups ( P<0.05), and the amount of group D was significantly smaller than that of the other 3 groups ( P<0.05); no significant difference was found between groups A and B ( P>0.05). Cerebrospinal fluid leakage was found in 1 case; no other postoperative complications including intervertebral space infection and epidural hematoma was found. All the incisions healed by first intension. All the patients were followed up 12-24 months (mean, 18 months), and no typical symptoms of recurrence was found during the follow-up period. There was no significant difference in preoperative lower back pain VAS score, lower extremities VAS score, and ODI scores among 4 groups ( P>0.05). The above scores at last follow-up were significantly improved when compared with preoperative ones in each group ( P<0.05), but no significant difference of above scores and recovery values was found among 4 groups ( P>0.05). The difference in LCI and intervertebral height at preoperation and at last follow-up were not significant between 4 groups ( P>0.05). The difference in LCI and intervertebral height of each group between at preoperation and last follow-up were not significant ( P>0.05). And the recovery value of LCI and the lost of height at last follow-up also showed no significant differences between 4 groups ( P>0.05). Conclusion:The ITEA technology can give a wider field of view than other technologies. It is more convenient to find and remove the nucleus pulposus. However, the appropriate operative approaches should be chosen according to the symptoms and characteristics of lumbar disc herniation.

The standard treatment for osteoporosis was controversial. Denosumab and bisphosphonates were two most common drugs. The purpose of this study was to compare the efficacy and safety of denosumab with bisphosphonates to treat osteoporosis.

Objective Applicate annulus fibrosus suture to investigate its effect on the biomechanical strength of intervertebral disc.Methods A total of 36 sheep were underwent retroperitoneal 3 levels exposure of the lumbar spine (L2/3,L3/4,L4/5).Three ways were used in these discs:(1) Did not penetrate into the annulus fibrosus in Group A.(2) Penetrate into the annulus fibrosus in Group B,and didn' t perform annulus fibrosus suture.(3) Penetrate into the annulus fibrosus and perform annulus fibrosus suture in Group C.At 48 weeks after surgery,MRI images were taken and these segments were underwent biomechanical testing to assess the strength of the disc and anulus.Histology was also conducted on these specimens.Results Compared with control group,the lost of intervertebral space height on annulus suture group was (0.90 ± 0.25) mm,and non suture group was (2.41 ± 0.85) mm,the difference was statistically significant (P =0.015).The strength of intervertebral disc on control group was (3.91 ± 0.78) mPa,non suture group was (1.99 ±0.58) mPa,suture group was (3.07 ±0.67) mPa;the difference was statistically significant (P =0.004).The nucleus pulposus volume on control group was (0.83 ± 0.60) cm3,suture group was (0.82 ± 0.48) cm3,and non suture group was (0.85 ± 0.42) cm3,thedifference was not statistically significant (P =0.058).Conclusion Application of annulus fibrosus suture after resection of nucleus pulposus can effectively maintenance of biomechanical strength,it play a positive role in the repair of annulus fibrosus.

Objective To investigate the effects of ibandronate on intervertebral fusion the lumbar spondylolisthesis patients underwent lumbar posterior decompression and interbody fusion and internal fixation.Methods Sixty-three cases of lumbar spondylolisthesis patients were underwent lumbar posterior interbody fusion and internal fixation.The patients were divided into experimental group and control group according to different postoperative drug use.The experimental group of 33 patients used 3mg ibandronate for 120 minutes by slow intravenous a week after surgery,every 3 months for 24 months.The control group of 30 patients did not use the application of ibandronate drugs.The two groups were evaluated on the low back pain Oswestry Dability Index(ODI) score,lumbago leg pain symptoms Visual Analogue Scale(VAS)score,bone density,X-ray and CT examinations before and at the last follow-up and the clinical symptom score,intervertebral height,fusion rate and bone mineral density were compared between the two groups.Results At the end of the follow-up,pain ODI score and VAS score of two groups were significantly lower than those before operation,the experimental group was lower than the control group according to the ODI score and VAS score of the lumbago(P ＜0.05).The height of the intervertebral space of the 2 groups was smaller than that of the postoperative,the height of the intervertebral space of the experimental group was higher than that of the control group,loss of intervertebral height was less in experimental group,and the interbody fusion the rate of experimental group was higher than the control group(P ＜0.05).The bone mineral density of the lumbar spine and the bone mineral density of the left femur were higher in the experimental group than in the control group,the bone mineral density of the lumbar spine and the bone mineral density of the left femur were higher in the experimental group than those in the control group(P＜0.05).Conclusion Application of ibandronate can promote interbody fusion,improve the symptoms of low back pain after the posterior lumbar decompression and reduction and interbody fusion.