Objective To evaluate the effect of percutaneous pedicle screw fixation（PPSF） using three different treatments on thoracolumbar fractures. Methods A total of 63 patients with single-segment thoracolumbar fractures treated with PPSF,without neurological symptoms, and with a Load sharing classification（LSC） score ＜7 were selected. The patients were divided into Group A（transvertebral fixation）, Group B（unilateral pedicle screw fixation）, and Group C（bilateral pedicle screw fixation）.The clinic data of operative time, bleeding, Visual analog score（VAS）, and Oswestry disability index（ODI） were assessed in the three groups. The changes of the Anterior height ratio of injured vertebral（AHRIV） and the Cobb angle of injured vertebral（CAIV）in the sagittal plane were also assessed using imaging techniques. Results There was no statistically significant difference between the three groups in terms of VAS scores at each postoperative follow-up and ODI scores at the last follow-up. In terms of operative time, the differences between the three groups were statistically significant when compared with each other. In terms of bleeding volume, the differences were statistically significant in group C compared with groups A and B, respectively. In terms of AHRIV, there was a statistically significant difference between group A and group C at the last postoperative follow-up, and there was a statistically significant difference between group A compared with its own first postoperative follow-up. In terms of postoperative CAIV loss, there was a statistically significant difference between the two follow-ups in group A, and the difference was statistically significant in group A compared with group B and with group C. Conclusion The use of PPSF for singlesegment thoracolumbar fracture with TLSC ＜7 has achieved good results by performing Unilateral pedicle screw fixation, and can effectively reduce loss of AHRIV and CAIV in the middle and distant stages of repositioning, which can achieve more satisfactory clinical results.

This study assesses the effect of bone marrow derived mesenchymal stem cells (BMSC) on chemotherapy resistance of osteosarcoma. 60 SPF mice were randomly separated into control group and model group. Serum alkaline phosphatase (ALP), Calcium (Ca), Phosphorus (P) and tumor formation rate were observed. The osteosarcoma tissues were taken to construct drug-resistant osteosarcoma cell lines. Control group, 5-fluorouracil (5-Fu) group, BMSC group, 5-Fu+BMSC group, and then set 5-Fu+BMSC+agonist group, 5-Fu+BMSC+inhibitor group, respectively. Osteosarcoma cell sensitivity to 5-Fu (IC50) and β -catenin/p- β -catenin expression were examined. Compared with control group, the ALP level and tumor formation rate in model group were higher and P level was remarkably lower. Ca level showed no difference between two groups ( P >0.05). The 5-Fu+BMSC group and 5-Fu group had the highest IC50 levels and the control group and BMSC group had the lowest IC50 levels. The β -catenin/p- β -catenin expressions were the highest in 5-Fu+BMSC group and 5-Fu group, and their expressions in control group and BMSC group were the lowest. 5-Fu+BMSC+agonist group showed higher β -catenin, p- β -catenin and IC50 levels, which are lower in 5-Fu+BMSC+inhibitor group. Endogenous BMSC can promote the chemotherapy resistance of osteosarcoma. They can promote β -catenin and β -catenin phosphorylation level, down-regulate osteosarcoma cell sensitivity to 5-Fu, and then promote drug resistance. Therefore, β -catenin signaling can be used as a target to reverse the resistance of osteosarcoma cells to 5-Fu.

Chordoma is a rare malignant bone tumor originating from the remnants of the notochord. Here, the role of long noncoding LOC554202 in chordoma progression and its associated mechanism were explored. Cell proliferation was analyzed by 3-(4, 5-dimethylthiazol-2-yl)-2, 5 diphenyltetrazolium bromide and colony formation assays. Flow cytometry was conducted to analyze cell apoptosis rate. The migration and invasion of chordoma cells were analyzed by transwell migration and invasion assays and wound healing assays. A xenograft tumor model was established in nude mice to explore the role of LOC554202 in regulating tumor growth in vivo . The interaction between microRNA-377-3p (miR-377-3p) and LOC554202 or sekelsky mothers against d PP (SMAD) family member 3 (SMAD3) was verified by dual-luciferase reporter and RNA immunoprecipitation assays. The glycolytic rate of chordoma cells was analyzed using glucose assay kit, lactic acid kit and ApoSENSOR ADP/ATP ratio assay kit. LOC554202 expression was upregulated in chordoma tissues and cell lines. LOC554202 silencing suppressed the proliferation, migration and invasion and induced the apoptosis of chordoma cells. LOC554202 knockdown restrained xenograft tumor growth in vivo . miR-377-3p was confirmed as a target of LOC554202, and miR-377-3p silencing largely overturned LOC554202 knockdown-mediated anti-tumor effects in chordoma cells. miR-377-3p interacted with the 3′ untranslated region (3′UTR) of SMAD3 and miR-377-3p overexpression-mediated antitumor effects in chordoma cells were largely attenuated by SMAD3 overexpression. LOC554202 could positively regulate SMAD3 expression by sponging miR-377-3p in chordoma cells. LOC554202 contributed to the glycolysis of chordoma cells by targeting binding to miR-377-3p/SMAD3 axis. LOC554202 facilitated the proliferation, migration, invasion and glycolysis and inhibited the apoptosis of chordoma cells by mediating miR-377-3p/SMAD3 axis.

Objective:The study aimed to investigate the effect of anterior cervical surgery in the treatment of spinal cord injury without radiographic abnormalities (SCIWORAs) and analyze the related factors affecting the prognosis of patients.Methods:A total of 86 patients with SCIWORA who were admitted to our hospital from June 2018 to March 2021 were selected as the research subjects. According to the different treatment methods selected by the patients, they were divided into the control group (n = 38) and the observation group (n = 48). The control group was treated with conservative therapy, and the observation group was treated with anterior cervical total laminectomy decompression, internal fixation, and bone graft fusion. The efficacy of the treatment was assessed preoperatively and 6 months after surgery using the Japanese Orthopedics Association (JOA) functional evaluation criteria for cervical spinal cord injury. The improvement rate of the JOA score at the last follow-up visit was calculated according to the Hirabayashi formula to evaluate the prognosis of patients.Results:The JOA score of the observation group six months after surgery was (14.98 ± 2.75) that was higher than that of the control group (12.16 ± 2.54) (P < 0.05). After surgery, the improvement rate of the JOA score in the observation group was higher than that in the control group (P < 0.05). After surgery, the scores of health condition, physiological function, and role physical in the observation group were (23.18 ± 1.09), (22.75 ± 1.54), and (22.64 ± 1.46), which were higher than those in the control groups (20.94 ± 1.65), (20.26 ± 1.78), and (19.56 ± 1.82) (P < 0.05). The results of univariate analysis showed that the ASIA classification of cervical spinal cord injury, the type of MRI cervical spinal cord injury, the scope of cervical spinal cord injury, lumbar disc herniation, and the time from injury to treatment were all related to the prognosis of the patients (P < 0.05). Multivariate analysis showed that the ASIA classification of cervical spinal cord injury, the type of MRI cervical spinal cord injury, the scope of cervical spinal cord injury, and the time from injury to treatment were the independent factors affecting the prognosis of patients (P < 0.05).Conclusion:For patients with SCIWORA, anterior total lamina decompression and internal fixation with bone grafting and fusion can effectively promote the recovery of cervical spinal cord function and improve the prognosis and quality of life of patients. The ASIA classification of cervical spinal cord injury, the type of MRI cervical spinal cord injury, the scope of cervical spinal cord injury, and the time from injury to treatment were the independent prognostic factors for patients.

Thoracolumbar fracture is familiar spinal injuries in the highenergy violence and traffic accidents, accounting for more than 50 percent of the total number of spinal fractures. Despite some thoracolumbar fractures patients who do not have neurologic dysfunction respond well to conservative treatment, short-segment pedicle screw fixation has been proven to be a more effective approach to resort vertebral height, correct kyphosis and stabilize fractures. In the past few years, minimally invasive percutaneous pedicle screw fixation (MIPPSF) as the alternative approach to treat the thoracolumbar fractures, aims to decrease the injury of soft tissue and perioperative complications. Originally used to treat degenerative spine diseases, the MIPPSF system have been demonstrated to be effective in decreasing blood loss and complications, avoiding muscle and tissue injury, and shortening the hospital stays and recovery times. Although there are similar advantages in treating the thoracolumbar fractures, the evidence is mostly limited to low-energy and low-level observational studies. In addition, the lack of long-term efficacy of the MIPPSF in treating the thoracolumbar fractures further limits the available evidence for this technique. Therefore, the purpose of our study is to compare the radiological and clinical results of thoracolumbar spine injury stabilized by standard open pedicle screw fixation (OPSF) and the MIPPSF system.We hypothesize thatMIPPSF technique will lead

Osteoarthritis (OA) is a widespread degenerative joint disease that affects more than 350 million people worldwide. Although YAP1 has been proved to play a key role in OA, the biological function and mechanism of YAP1 in OA still need further investigation. In the present study, we demonstrated that YAP1 was highly expressed in OA rat chondrocytes. Recently, growing microRNAs (miRNAs) have been reported to play important roles in OA development. Among them, miR-582-3p is one of the few significantly downregulated miRNAs and attracted our attention. Functional investigations indicated that miR-582-3p inhibited chondrocyte apoptosis, reduced the proinflammatory cytokine production and suppressed extracellular matrix (ECM) degradation. Subsequently, molecular mechanism exploration implied that YAP1 is a downstream target of miR-582-3p. Furthermore, rescue assays revealed that YAP1 amplification can reverse miR-582-3p mimic-mediated effects on chondrocyte apoptosis, inflammatory response, and ECM degradation. Moreover, the OA rat model was established to explore the function of miR-582-3p/YAP1 axis in vivo. The results showed that YAP1 overexpression can recover the effects induced by injection of AAV-miR-582-3p mimic on OA progression. To sum up, these findings implied a crucial role of miR-582-3p/YAP1 axis in OA, which may provide a promising therapeutic strategy for OA.

Sulfiredoxin-1 (SRX1) is a conserved endogenous antioxidative protein, which is involved in the response to cellular damage caused by oxidative stress. Oxidative stress and inflammation are the primary pathological changes in spinal cord injuries (SCI). The aim of present study was to explore the roles of SRX1 in SCI. Using reverse transcription-quantitative PCR and western blotting, the present study discovered that the expression levels of SRX1 were downregulated in the spinal cord tissues of SCI model rats. Massive irregular cavities and decreased Nissl bodies were observed in the model group compared with the sham group. Thus, to determine the underlying mechanisms, neuron-like PC12 cells were cultured in vitro. Western blotting analysis indicated that SRX1 expression levels were downregulated following the exposure of cells to lipopolysaccharide (LPS). Following the transfection with the SRX1 overexpression plasmid and stimulation with LPS, the results of the Cell Counting Kit-8 assay indicated that the cell viability was increased compared with LPS stimulation alone. Furthermore, the expression levels of proinflammatory cytokines secreted by LPS-treated PC12 cells were downregulated following SRX1 overexpression. Increased malondialdehyde content, decreased superoxide dismutase activity and reactive oxygen species production were also identified in PC12 cells treated with LPS using commercial detection kits, whereas the overexpression of SRX1 partially reversed the effects caused by LPS stimulation. The aforementioned results were further verified by determining the expression levels of antioxidative proteins using western blotting analysis. In addition, nuclear factor erythroid-2-related factor 2 (NRF2), a transcription factor known to regulate SRX1, was indicated to participate in the protective effect of SRX1 against oxidative stress. Inhibition of NRF2 further downregulated the expression levels of SRX1, NAD(P)H dehydrogenase quinone 1 and heme oxygenase-1 in the presence of LPS, while activation of NRF2 reversed the effects of LPS on the expression levels of these proteins. In conclusion, the results of the present study indicated that the anti-inflammatory and antioxidative effects of SRX1 may depend on NRF2, providing evidence that SRX1 may serve as a novel molecular target to exert a neuroprotective effect in SCI.

STUDY DESIGN:In vitro studies of the role of 17β-estradiol (E2) and its possible targets in intervertebral disc degeneration (IDD).OBJECTIVE:To define the regulatory role of E2 in IDD and the potential mechanisms.SUMMARY OF BACKGROUND DATA:IDD has intricate etiology that is influenced by multiple risk factors. However, the underlying molecular mechanisms of occurrence and progression of IDD are not well elucidated. The degradation of extracellular matrix (ECM) has been extensively observed in IDD. E2 was found to inhibit ECM degradation in human nuleus pulposus cells (HNPCs), but the molecular mechanism remained to be determined.METHODS:Western blot and qPCR was performed to quantify the expression of target proteins in HNPCs. Luciferase reporter gene assay was applied to detect the effects of E2 and forkhead box O-3 (FOXO3) on matrix metalloproteinases (MMP)-3 promoter activity. Chromatin immunoprecipitation assay analyzed the binding of FOXO3 to MMP-3 and the effect of E2 on this process.RESULTS:We identified the upregulation of collagen II and aggrecan by E2 independent of time and concentration. And E2 downregulated MMP-3 expression in human nucleus pulposus cells. The phosphorylation of FOXO3 led to the reduction of MMP-3 promoter activity. Furthermore, 17β-estradiol-induced the activation of PI3K/Akt pathway is required for FOXO3 phosphorylated.CONCLUSION:E2 prevents the degradation of ECM by upregulating collagen II and aggrecan expression via reducing MMP-3 expression in HNPCs, and PI3K/Akt/FOXO3 pathway is dispensable for MMP-3 downregulated. Therefore, E2 protects against IDD by preventing ECM degradation.LEVEL OF EVIDENCE:3.

Objective: Cervical spondylotic myelopathy (CSM) is the most common cause of spinal cord dysfunction. Our study aims to explore the correlation of osteoprotegerin (OPG) gene polymorphisms and the risk factors and severity of CSM. Patients and methods: The peripheral blood samples from 494 CSM patients and 515 healthy individuals were collected for detecting the 950T/C, 1181G/C and 163A/G genotypes and genetic equilibrium of OPG in the CSM and control groups and analyzing the genotype distribution and allele frequency. The severity of CSM and the impaired segments were evaluated by the Japanese Orthopedic Association (JOA) scoring combined with cervical magnetic resonance imaging (MRI), in order to investigate the relations between the three genotypes of OPG promoter gene loci (950T/C, 163A/G and 1181G/C) and occurrence as well as severity of CSM. Results: The risk rate of TC genotype carrier suffered from CSM was 0.46, of TT genotype carrier was 0.27. The risk rate of T allele carrier suffered from CSM was 0.37. In 950T/C single nucleotide polymorphism (SNP), patients with TC, TT and T genotypes had lower risk to suffer from CSM. Conclusion: Taken together, OPG 950T/C SNP protects against CSM, and it is correlated with the severity of CSM, providing a new idea for the prevention and treatment of CSM.

Objective:To observe the clinical effects of targeted percutanous ozone ablation on lumbar disc herniation (LDH) patients with high intensity zone (HIZ) in lumbar disc annulus fibrosus on MRI T2 weighted imaging.Methods:136 LDH patients with HIZ in lumbar disc annulus fibrosus on MRI T2 were divided into two groups according to therapy methods.In group A,75 patients were injected with 2 ～5 mL of 40 μg/mL mixture of O3 and O2 after targeted percutanous puncturing under the guidance of X-Ray machine with C-type arm.In group B,61 patients were treated with conservative treatment.MacNab score criterion and Oswestry disability index (ODI) were used in assessment of the efficacy.Results:Except 24 patients,all the other cases were followed up for 18 ～ 44 months.At the postoperative 1st,2nd,3rd,6th,9th,12th and 18th month,according to MacNab score criterion,the effective rates were respectively 88.00 ％,90.67 ％,93.33 ％,89.39 ％,84.85 ％,78.13 ％ and 73.44 ％ in group A and respectively 68.85 ％,62.30 ％ 55.74 ％,61.82 ％,58.12 ％,54.17 ％ and 47.92 ％ in group B.There were significant differences between two groups at the same time point (P＜0.05).At the postoperative 12th and 18th month,ODI was lower in group A,and there was no significant difference between two time points (P＞0.05).But it was significant different with that preoperatively and in group B at the same time point (P＜0.05).Conclusion:Targeted percutanous ozone ablation is an effective method with stable clinical efficacy in treating LDH with HIZ in lumbar disc annulus fibrosus on MRI T2 weighted imaging.

Objective To investigate the effect of combining metformin and suberoylanilide hydroxamic acid (SAHA) on the proliferation and apoptosis of human osteosarcoma MG-63 cells. Methods MG-63 cells were treated with metformin and SAHA for 72 h. The proliferation of MG-63 was tested by MTS assay. The capability of colony formation of MG-63 was as-sessed by clonogenicity assay. The cell apoptosis was detected by flow cytometry. The cell cycle and apoptosis associated pro-teins were assessed by Western Blot. Results Metformin or SAHA could inhibit the proliferation of MG-63 cells,respec-tively,and the cell proliferation was inhibited more obviously after combination of theses two drugs. Moreover,combination of two drugs could inhibit colony formation and promote cell apoptosis more significantly. P27,P21,Cyclin D1,Mcl-1,XIAP, Bim,Cytochrome C were significantly changed after the combination therapy. Conclusion Combination of metformin and SAHA could inhibit proliferation and colony formation and promote apoptosis more effectively in MG-63 cells.

目的 观察二甲双胍对骨肉瘤MG63细胞的迁移侵袭能力的影响.方法 以骨肉瘤MG63细胞株为研究对象,二甲双胍处理后分别采用transwell小室法检测细胞迁移和侵袭能力的变化,采用明胶酶谱实验检测基质金属蛋白酶2(MMP-2)和MMP-9的活性,采用real-time PCR法检测细胞中埃兹蛋白(Ezrin) mRNA的表达,采用Western blot检测Ezrin蛋白的表达;Li-pofectamine 2000转染Ezrin质粒到细胞中观察其对二甲双胍诱导的细胞迁移侵袭抑制及对下游信号通路的影响.结果 二甲双胍可显著抑制MG63细胞的迁移和侵袭,并降低MMP-2和MMP-9的酶活性.用药48 h后,MG63细胞内Ezrin的mRNA和蛋白水平均明显下降,且上调Ezrin可减弱二甲双胍诱导的骨肉瘤细胞迁移和侵袭抑制及二甲双胍诱导的MAPK/Erk信号通路抑制.结论 二甲双胍可抑制MG63细胞的迁移和侵袭能力,可能是通过下调Ezrin和MAPK/Erk信号通路而实现.

Objective To investigate the clinical effects of minimal-invasive percutaneous pedicle screw fixation ( MIPPSF) in management of thoracolumbar fractures. Methods Eighty-nine patients with single-segment thoraco-lumbar fractures were divided into two groups according to the operative methods:MIPPSF group(Group A,n=36) and open pedicle screw fixation(OPSF) group(Group B,n=53). The incision length,operative time,blood loss,VAS on the 3rd day postoperatively,the fractured vertebral height ratio and Cobb′s angle in 1 year postoperatively were compared between two groups. The internal fixation failure rate and Oswestry disability index( ODI) in 1 year postop-eratively were evaluated. Results All the cases had been followed up for 12~18 months. Group A had shorter inci-sion length and operative time,lower blood loss and VAS on the 3rd day postoperatively and there were significant difference compared with group B(P<0. 05). The fractured vertebral height ratio,Cobb′s angle,internal fixation fail-ure rate and ODI in 1 year postoperatively had no significant difference between the two groups(P>0. 05). Conclu-sions In management of thoracolumbar fractures,MIPPSF can be minimal injury,meanwhile it can achieve the simi-lar clinical effects with OPSF.

目的 探讨七氟醚预处理对大鼠脊髓缺血再灌注损伤时5脂氧合酶(5-LOX)表达的影响.方法 雄性成年SD大鼠45只,体重250～300g,采用随机数字表法,将大鼠随机分为3组(n=15):假手术组(S组)、脊髓缺血再灌注组(I/R组)和七氟醚预处理组(I组).采用胸主动脉球囊阻断+体循环低血压法制备大鼠脊髓缺血再灌注模型.I组吸入3.4％七氟醚2h,24 h后制备模型.于再灌注24 h时采用神经功能缺陷评分(NDS)法评价大鼠神经功能,随后处死取脊髓,分别采用Western blot法和RT-PCR法测定5-LOX、p-ERK1/2和t-ERK1/2蛋白及其mRNA的表达水平.应用ELISA检测血清中肿瘤坏死因子-α(TNF-α)的含量.结果 与S组比较,I/R组和I组神经功能缺陷评分升高,I/R组5-LOX和p-ERK1/2蛋白及其mRNA表达上调,TNF-α含量升高,I组5-LOX mRNA和p-ERK1/2蛋白及其mRNA表达上调(P＜0.05);与I/R组比05).结论 七氟醚预处理可能通过下调5-LOX表达,抑制ERK1/2信号通路,从而减轻大鼠脊髓缺血再灌注损伤.

目的 探讨椎间孔镜技术治疗极外侧型腰椎间盘突出症的近期疗效.方法 回顾性分析该院2011年7月-2013年3月23例极外侧型腰椎间盘突出症患者,均采用椎间孔镜技术治疗;年龄34 ～ 54岁,平均42.1岁;采用腰腿痛视觉模拟评分(VAS)测评入院时和椎间孔镜术后(术后即刻、术后1周、1个月、3个月及末次随访),末次随访采用改良MacNab标准评定临床疗效.结果 23例患者手术后随访9～18个月,平均12.6个月.所有患者腰痛、腿痛的VAS评分由术前的(6.87±1.38)和(8.58±1.42)分下降到术后末次随访时的(2.45±0.52)和(1.55±0.45)分,术后随访与术前比较差异均有显著性(P＜0.01).末次随访采用改良Macnab疗效评定标准评估,术后优良率均为91.3％,1例患者于术后出现腰背部疼痛,于卧床休息服用非甾体消炎药3d后症状消失.结论 椎间孔镜技术治疗极外侧型腰椎间盘突出症近期疗效明显.

目的 探讨行单侧椎弓根螺钉固定联合椎间融合术治疗腰椎间盘突出症的临床疗效.方法 回顾性分析本院2011年1月至2012年12月96例腰椎间盘突出症患者,均行单侧椎弓根螺钉固定联合椎间融合术;年龄42 ～ 68岁,平均52.3岁;采用腰腿痛视觉模拟评分测评入院时和单侧椎弓根螺钉固定联合椎间融合术后(术后1周、1个月、3个月及末次随访腰腿疼痛程度),末次随访采用改良MacNab标准评定临床疗效,并行CT检查了解椎间融合情况.结果 96例患者手术后随访12 ～ 30个月,平均18.6个月.所有患者均无神经损伤和脑脊液漏并发症发生.患者术后不同时期的VAS评分与术前比较差异均有统计学意义(P＜0.01).采用改良MacNab标准评价临床结果,优良率为94.79％.末次随访时行CT检查,均无内固定失效和椎间不融合发生,6例发生椎间融合器塌陷入终板,但无不适,考虑与骨质疏松或过早负重活动有关.结论 单侧椎弓根螺钉固定联合椎间融合治疗腰椎间盘突出症疗效满意,具有创伤小、并发症少、费用低的优点.

目的 探讨应用峡部植骨融合联合节段内钉-钩系统内固定术治疗青年腰椎峡部裂的临床疗效.方法 回顾性分析该院2010年7月～2013年3月15例青年腰椎峡部裂患者,均采用峡部植骨融合联合节段内钉-钩系统内固定术治疗;年龄16～32岁,平均23.3岁;采用腰痛视觉模拟评分测评入院时和峡部植骨融合联合节段内钉-钩系统内固定术后(术后3个月、6个月、1年及末次随访),末次随访采用改良MacNab标准评定临床疗效,并了解椎弓峡部融合情况.结果 15例患者手术后随访12～42个月,平均20.3个月.所有患者均无神经损伤并发症发生.患者术后不同时期的VAS评分与术前比较差异均有显著性(P＜0.01).采用改良MacNab标准评价临床结果,优良率为93.33％.末次随访时行CT检查,均无内固定失败和椎弓峡部不融合发生.1例患者术后出现髂骨取骨区疼痛,予以对症治疗后症状缓解.结论 峡部植骨融合联合节段内钉-钩系统内固定术治疗青年腰椎峡部裂疗效满意,具有融合率高,并发症少,不影响腰椎活动度的优点.

目的 探讨颈前路分段减压植骨融合术治疗多节段脊髓型颈椎病的疗效.方法 该科采用前路分段减压植骨融合术治疗并获得随访的35例多节段脊髓型颈椎病患者.病情较轻者行椎间盘切除减压和自体髂骨植骨术,在病变严重的部位行椎体次全切除+钛网或髂骨块植骨术.记录手术时间、出血量.根据JOA评估系统评估其疗效,记录患者术前、术后3及12个月时的JOA分值并计算改善率;采用X线正侧位、动力位和CT-3D重建方法来进行评估融合程度.结果 35例患者经10 ～ 52个月,平均25.6个月随访,所有患者在术后1个月内均感到神经症状有明显好转,下肢肌力增加,肢体活动度较术前明显改善,且双上肢感觉异常基本消失.JOA评分由术前的平均(8.35±2.34)分上升到术后(13.2±2.54)分,差异有显著性(P＜0.05).术后改善率为56.1％,术后疗效按JOA标准评定[1]:优12例,良17例,可6例.术后12个月植骨融合率为100％,1例术后出现邻近节段退变现象,余无明显异常.结论 前路分段减压植骨融合术可达到充分的减压,即刻重建颈椎的稳定性,植骨融合率高,是治疗多节段脊髓型颈椎病的有效方法之一.

Objective To study the clinical curative effect of TLIF surgery by the way of multifidus muscle interval and by traditional postmiddle approach treating lumbar degenerative disease.Methods 149 cases on the basis of the dif-ferent way of TLIF surgery were divided into two groups.Observation group:75 cases of patients , by the way of multifi-dus muscle interval;Control group:74 cases of patients , by traditional postmiddle approach.Various perioperative indi-cations and postoperative VAS , JOA scores of the two groups were compared.Results Operation time, intraoperative blood loss , incision size and flow in observation group were less than the control group ( all P<0.05 );Preoperative VAS score and JOA score in two groups were of no significant difference ( P>0.05 );There was significantdifference between postoperative score of the two groups ( P<0.05 ).Conclusions Damage on multifidus muscle and nerve function of TLIF surgery by the way of multifidus muscle interval treating lumbar degenerative disease was significantly smaller than traditional postmiddle approach , and it is minimally invasive , safe and worthy of clinical promotion.

Objective:To investigate the clinical effect of cervical posterior unilateral expansive open -door laminoplasty with mini tita-nium plate fixation in the treatment of multilevel cervical spondylotic myelopathy .Methods:A retrospective analysis of our hospital from July 2009 to December 2012 21 cases of multilevel cervical spondylotic myelopathy patients , underwent cervical posterior unilateral expan-sive open-door laminoplasty with mini titanium plate fixation;age 47 to 68 years old, average 55.3 years old;preoperative and postoper-ative at last follow-up for patients with spinal cord function of Japanese Orthopaedic Association ( JOA) score, improvement rate of JOA score evaluation of postoperative neurological function improvement;VAS score of postoperative axial pain;at the last follow-up X-ray and MRI examination evaluation internal fixation position and spinal cord compression to improve the situation .Results:21 patients were followed up for 12~24 months after surgery , average 15.8 months.Nerve function were improved after surgery , JOA score from preopera-tive 8.3 ±2.2 to the last follow-up of 14.3 ±1.7 (P<0.01), the average improvement rate was 69%;2 cases of neck axis pain , the incidence rate was 9.52%, the average VAS score was 2.13 ±0.33 at last follow-up;at the last follow-up X-ray and MRI examina-tion showed mini titanium plate in good position , no loosening and fracture , had no door closed phenomenon .Conclusion:Cervical posteri-or unilateral expansive open -door laminoplasty with mini titanium plate fixation in the treatment of multilevel cervical spondylotic myelop -athy with satisfied effect , has the advantages of simple operation , reliable fixation , less complication .