BACKGROUND:Most patients with lumbar disc herniation can be relieved or cured by surgical or non-surgical treatment; however, postoperative persistent radiculopathy is common. This study demonstrates the regulation of autophagy by the FOXG1/SATB2 axis in lumbar disc herniation (LDH). METHODS:Rat dorsal root neurons were induced with TNF-α in vitro. Sprague Dawley (SD) rats were used to construct the LDH rat model, which was treated with L. paracasei S16 or oe-FOXG1. Paw withdrawal threshold or latency assay (PWT/L) was performed. Peripheral blood samples were collected and analysed using ELISA and miRNAseq. RT-qPCR was used to analyse the expression of FOXG1, LC3B, Beclin1, p62, and SATB2. TUNEL staining and flow cytometry were used to analyse apoptosis. The expression of Cyclin D1, PCNA, Ki67, FOXG1, SATB2, and autophagy proteins was measured using western blotting. RESULTS:TNF-α induced low expression of FOXG1 and SATB2 in dorsal root ganglion (DRG) neurons of rats. TNF-α induced an increase in p62 protein and a decrease in LC3II/I and Beclin-1 proteins in neurons, which were blocked by oe-FOXG1. oe-FOXG1 suppressed inflammation and apoptosis in TNF-α-induced DRG neurons and LDH rats and promoted the expression of Cyclin D1, PCNA, and Ki67. Many miRNAs were increased in the peripheral blood of LDH rats, but decreased after L. paracasei S16 intervention. L. paracasei S16 affects miR-31a-5p and SATB2 expression. Dual luciferase reporter gene assay confirmed that miR-31a-5p bound to SATB2. Co-IP analysis confirmed the interaction between FOXG1 and SATB2. Silencing of SATB2 inhibited the beneficial effects of oe-FOXG1 in TNF-α-induced dorsal root ganglion neurons. Animal experiments further demonstrated that oe-FOXG1 improved LDH disease characteristics by downregulating PWT, PWL, inflammation, and apoptosis levels and upregulating SATB2-autophagy levels. CONCLUSIONS:MiR-31a-5p/SATB2 is involved in the treatment of L. paracasei S16 in LDH rats. Overexpression of FOXG1 promotes autophagy through SATB2 to improve LDH levels This provides a new approach for the treatment of LDH.

Lumbar spinal stenosis (LSS), which can lead to irreversible neurologic damage and functional disability, is characterized by hypertrophy and fibrosis in the ligamentum flavum (LF). However, the underlying mechanism is still unclear. In the current study, the effect of Smurf1, a kind of E3 ubiquitin ligase, in promoting the fibrosis and oxidative stress of LF was investigated, and its underlying mechanism was explored. The expression of oxidative stress and fibrosis-related markers was assessed in the tissue of lumbar spinal stenosis (LSS) and lumbar disc herniation (LDH). Next, the expression of the top 10 E3 ubiquitin ligases, obtained from Gene Expression Omnibus (GEO) dataset GSE113212, was assessed in LDH and LSS, and confirmed that Smurf1 expression was markedly upregulated in the LSS group. Furthermore, Smurf1 overexpression promotes the fibrosis and oxidative stress of LF cells. Subsequently, NRF2, an important transcription factor for oxidative stress and fibrosis, was predicted to be a target of Smurf1. Mechanistically, Smurf1 directly interacts with Nrf2 and accelerates Nrf2 ubiquitination and degradation. In conclusion, the current study suggests that Smurf1 facilitated the fibrosis and oxidative stress of LF and induced the development of LSS by promoting Nrf2 ubiquitination and degradation.

Background Osteoarthritis (OA) is one of the most prevalent musculoskeletal diseases and is the leading cause of pain and disability in the aged population. However, the underlying biological mechanism has not been fully understood. This study aims to reveal the causal effect of circulation metabolites on OA susceptibility. Methods A two-sample Mendelian Randomization (MR) analysis was performed to estimate the causality of GDMs on OA. A genome-wide association study (GWAS) of 486 metabolites was used as the exposure, whereas 8 different OA phenotypes, including any-site OA (All OA), knee and/or hip OA (knee/hip OA), knee OA, hip OA, spine OA, finger and/or thumb OA (hand OA), finger OA, thumb OA, were set the outcomes. Inverse-variance weighted (IVW) was used for calculating causal estimates. Methods including weight mode, weight median, MR-egger, and MR-PRESSO were used for the sensitive analysis. Furthermore, metabolic pathway analysis was performed via the web-based Metaconflict 4.0. All statistical analyses were performed in R software. Results In this MR analysis, a total of 235 causative associations between metabolites and different OA phenotypes were observed. After false discovery rate (FDR) correction and sensitive analysis, 9 robust causative associations between 7 metabolites (e.g., arginine, kynurenine, and isovalerylcarnitine) and 5 OA phenotypes were finally identified. Additionally, eleven significant metabolic pathways in 4 OA phenotypes were identified by metabolic pathway analysis. Conclusion The finding of our study suggested that identified metabolites and metabolic pathways can be considered useful circulating metabolic biomarkers for OA screening and prevention in clinical practice, and can also serve as candidate molecules for future mechanism exploration and drug target selection.

OBJECTIVE:To obtain the quantitative measurements of the muscle morphology of cervical extensors in patients with multilevel cervical spondylotic myelopathy, and determine whether the morphological parameter of each muscle correlates with the patients' demographic features, symptoms, and cervical sagittal balance. METHODS:We retrospectively evaluated 100 hospitalized patients scheduled to undergo surgery for multilevel cervical spondylotic myelopathy. Demographic data, including age, sex, and body mass index, were recorded, and symptoms were evaluated using the visual analog scale (VAS), neck disability index (NDI), and modified Japanese Orthopedic Association scale scores. The cross-sectional area (CSA) of the multifidus, semispinalis capitis, semispinalis cervicis, splenius capitis and splenius cervicis were measured on magnetic resonance imaging. The CSA of the total extensor muscles, deep extensor muscles (DEM, consisting of multifidus and semispinalis capitis), and superficial extensor muscles (consisting of semispinalis cervicis, splenius capitis and splenius cervicis) were calculated. The adjusted CSA (aCSA) was calculated as the CSA of the muscle/CSA of the corresponding vertebral body. The fat infiltration ratio (FIR) of the posterior extensor muscles was assessed using a pseudocoloring technique. Sagittal parameters, including cervical lordosis (CL), C2-7 cervical sagittal vertical axis (SVA), T1-slope, mismatch between T1-slope and CL (T1S-CL), and range of motion, were measured. The measured parameters were compared between the males and the females, between the patients with higher muscle aCSA and the patients with lower muscle aCSA, and between the patients with and without sagittal balance. A Pearson correlation analysis was conducted to determine the correlations between the paraspinal muscle measurements, and the clinical and radiographic parameters. RESULTS:There were 67 males and 33 females in this study, and the mean age was 59.22 ± 9.54 years. Compared with females, male patients showed higher CSA and aCSA of extensor muscles. Patients with lower muscle aCSA were significantly older and had worse NDI scores, with significantly greater C2-7 SVA and T1S-CL. Patients with sagittal imbalance showed significantly lower aCSA of total extensor muscles and DEM, as well as a significantly higher FIR. Age was significantly correlated with the aCSA of each measured muscle and the FIR. The aCSA of the DEM was correlated with the NDI score, the visual analog scale score, the SVA, the T1-slope, and the T1S-CL. CONCLUSIONS:In patients with multilevel CSM, age and sex were demographic factors that were highly correlated with muscle morphology changes. Extensor muscles, especially DEM, play important roles in maintaining cervical sagittal balance and are associated with the severity of neck symptoms.

目的 :探讨颈椎后纵韧带骨化（ossification of posterior longitudinal ligament,OPLL）或颈椎间盘突出合并无骨折脱位颈脊髓损伤患者手术治疗的效果及其差异性。方法:回顾性分析2017年1月～2019年12月我科收治的无骨折脱位颈脊髓损伤并经手术治疗患者,选取其中35例3个节段及以上OPLL或者颈椎间盘突出患者纳入本研究。其中男性19例,女性16例。根据术前MRI及CT影像学特点将患者分为OPLL组（A组18例）与颈椎间盘突出组（B组17例）,两组间年龄及性别无统计学差异（P＞0.05）。手术方式均为颈椎后路椎管扩大成形术。记录两组患者术前及术后1周、3个月、6个月的mJOA评分及ASIA分级,计算并比较mJOA评分改善率和ASIA分级改善值。结果:A组手术时间为95±12min,B组为95±15min （P＞0.05）;A组术中出血量为450±55ml,B组为440±60ml（P＞0.05）;A组住院时间为10.5±1.3d,B组为10.2±1.4d（P＞0.05）。随访期间两组患者均未出现严重并发症。A组术前、术后1周、术后3个月、术后6个月mJOA评分分别为5.2±5.6分、7.1±4.3分、8.6±3.7分、12.9±3.8分,B组分别为4.8±3.8分、6.7±4.1分、7.0±3.8分、9.3±3.6分,两组间差异无统计学意义（P＞0.05）。术后1周两组mJOA评分改善率分别为16.2%和14.1%,ASIA分级改善值分别为1.2分和1.0分,两组间无统计学差异（P＞0.05）;术后3个月mJOA评分改善率分别为26.5%和16.5%,ASIA分级改善值分别为2.3分和1.5分,两组间有统计学差异（P＜0.05）;术后6个月mJOA评分改善率分别为62.3%和33.6%,ASIA分级改善值分别为2.6分、1.8分,两组间有统计学差异（P＜0.05）。结论:后路椎管扩大成形术治疗无骨折脱位颈脊髓损伤能够获得满意疗效,其中合并OPLL患者神经功能恢复改善程度在术后3个月及术后6个月时优于合并颈椎间盘突出患者,该差异可能与脊髓致压物的性质有一定关系。

Lumbar disc herniation (LDH) is a common cause for low back pain. In this study, we aimed to explore the effects of a specific Lactobacillus paracasei ( L. paracasei ), L. paracasei S16 , on the symptoms of LDH using a mouse model of LDH. The results showed that L. paracasei S16 treatment improved the behavior, increased the cell proliferation, and decreased the apoptosis in LDH mice. Moreover, L. paracasei S16 treatment alleviated the aberrant inflammation response in the LDH mice, which is characterized by the decreased anti-inflammatory cytokines, increased pro-inflammatory cytokines, and decreased percentage of Th1 and Th2 cells and Th17/Treg ratio. 16S rRNA sequencing results showed that the LDH mice treated with L. paracasei S16 have higher relative abundance of Lachnospiraceae and Ruminococcaceae and lower abundance of Lactobacillaceae than mice in the LDH group. Additionally, the serum metabolites involved in the linoleic acid metabolism, alanine. aspartate, and glutamate, glycerophospholipid, and TCA cycle were significantly decreased and the metabolite involved in purine metabolism was significantly increased after the L. paracasei S16 treatment in the LDH mice. These results showed that administration of L. paracasei S16 can improve inflammation response, alter gut microbiota, and modulate serum metabolomics in a mouse model of LDH.

Gliomas are primary malignant brain tumors. Monocytes have been proved to actively participate in tumor growth. Weighted gene co-expression network analysis was used to identify meaningful monocyte-related genes for clustering. Neural network and SVM were applied for validating clustering results. Somatic mutation and copy number variation were used for defining the features of identified clusters. Differentially expressed genes (DEGs) between the stratified groups after performing elastic regression and principal component analyses were used for the construction of risk scores. Monocytes were associated with glioma patients’ survival and exhibited high predictive value. The prognostic value of risk score in glioma was validated by the abundant expression of immune checkpoint and metabolic profile. Additionally, high risk score was positively associated with the expression of immunogenic and antigen presenting factors, which indicated high immune infiltration. A prognostic model based on risk score demonstrated high accuracy rate of receiver operating characteristic curves. Compared with previous studies, our research dissected functional roles of monocytes from large-scale analysis. Findings of our analyses strongly support an immune modulatory and prognostic role of monocytes in glioma progression. Notably, monocyte could be an effective predictor for therapy responses of glioma patients.

Background. Metastatic osteosarcoma is a common and fatal bone tumor. Several studies have found that tumor-infiltrating immune cells play pivotal roles in the progression of metastatic osteosarcoma. However, the heterogeneity of infiltrating immune cells across metastatic and primary osteosarcoma remains unclear. Methods. Immune infiltration analysis was carried out via the “ESTIMATE” and “xCell” algorithms in primary and metastatic osteosarcoma. Then, we evaluated the prognostic value of infiltrating immune cells in 85 osteosarcomas through the Kaplan–Meier (K-M) and receiver operating characteristic (ROC) curve. Infiltrations of macrophage M1 and M2 were evaluated in metastatic osteosarcoma, as well as their correlation with immune checkpoints. Macrophage-related prognostic genes were identified through Weighted Gene Coexpression Network Analysis (WGCNA), Lasso analysis, and Random Forest algorithm. Finally, a macrophage-related risk model had been constructed and validated. Results. Macrophages, especially the macrophage M1, sparingly infiltrated in metastatic compared with the primary osteosarcoma and predicted the worse overall survival (OS) and disease-free survival (DFS). Macrophage M1 was positively correlated with immune checkpoints PDCD1, CD274 (PD-L1), PDCD1LG2, CTLA4, and TIGIT. In addition, four macrophage-related prognostic genes (IL10, VAV1, CD14, and CCL2) had been identified, and the macrophage-related risk model had been validated to be reliable for evaluating prognosis in osteosarcoma. Simultaneously, the risk score showed a strong correlation with several immune checkpoints. Conclusion. Macrophages potentially contribute to the regulation of osteosarcoma metastasis. It can be used as a candidate marker for metastatic osteosarcoma’ prognosis and immune checkpoints blockades (ICBs) therapy. We constructed a macrophage-related risk model through machine-learning, which might help us evaluate patients’ prognosis and response to ICBs therapy.

Objective To compare the clinical effects of spatium intermusculare approach and conventional posterior approach single open-door laminoplasty in treatment of multi-segmental cervical degenerative disease. Methods From March 2016 to August 2016,40 patients with multi-segmental cervical degenerative disease,including multi-segmental cervical spondylotic myelopathy(MCSM) with cervical stenosis in 18,cervical ossification of the posterior longitudinal ligament(OPLL) in 22,were treated with posterior single open-door laminoplasty. Patients were randomly divided into 2 groups according to the chronological order:traditional lamina and muscle dissection approach(group A) in door-shaft side and modified intermusculare space of multifidus muscles approach(group B) in door-shaft side. The length of stay,operation time,intraoperative blood loss,drainage,pre- and post-operative Japanese Orthopaedic Association(JOA) score,visual analogue scale(VAS) score, neck disability index(NDI),sagittal diameter of the spinal canal and postoperative door-shaft side tissue fluid leakage area were recorded and compared between the 2 groups. Results All patients were operated successfully without incision infection, cerebrospinal fluid leakage,and the incisions healed primarily. There was no significant difference in length of stay,postoperative JOA score,postoperative sagittal diameter of the spinal canal between the 2 groups(P > 0.05). The operation time,intraoperative blood loss,drainage,postoperative VAS score,postoperative NDI and postoperative door-shaft side tissue fluid leakage area of group B were all superior to those of group A,and there were statistically significant differences between the 2 groups(P < 0.05).Conclusion Cervical posterior single open-door laminoplasty for the treatment of multi-segmental MCSM with spinal stenosis and multi-segmental cervical OPLL has a good rapeutic effect. Compared with conventional posterior approach,intermusculare space approach does not increase the incidence of surgical complications,and has certain advantages in terms of operation time, intraoperative blood loss,VAS score and NDI improvement,thus being worthy of wider clinical application.

Objective To investigate the postoperative clinical results of calcified intervertebral disc herniation treated by percutaneous endoscopic transforaminal discectomy(PETD). Methods From September 2013 to September 2014, the clinical data of 20 patients(L5/S14 and L4/L516) with calcified lumbar intervertebral disc herniation underwent PETD and calcified tissue removal were retrospectively analyzed. Lumbar CT and MRI were performed before and after the surgery. The surgical approach was determined based on the different shape,position of the herniation and the relationship between herniation and traversing nerve root. Preoperative and postoperative clinical status were analyzed by visual analogue scale(VAS) score and MacNab criteria. Results All the operations were performed successfully. The patients were followed up for more than 3 months. The postoperative lumbar CT showed calcification at the paracentral position and nerve root was fully resected on the symptomatic side. The calcification at the center or the asymptomatic position remained partially. The spinal nerve root canal was decompressed. The postoperative VAS score for leg and back pain was 0-1,and the evaluation was excellent based on MacNab criteria. Conclusion PETD avoids excessive traction of nerve roots,reduces the probability of intraoperative nerve injury,and can remove the calcification at the nerve root canal. It can also effectively relieve the symptoms of patients,and is safe and effective for the treatment of calcified lumbar disc herniation.

STUDY DESIGN:Prospective study.OBJECTIVE:The purpose of this study is to elucidate mid-term outcomes of anterior cervical fusion for cervical spondylosis with sympathetic symptoms (CSSS).SUMMARY OF BACKGROUND DATE:The terminology, pathogenesis, diagnosis, and treatment of CSSS remain controversial. Surgical treatment of CSSS has been rarely reported. This is the first prospective study to evaluate the mid-term outcome of surgical treatment of CSSS.METHODS:Thirty-one patients who were diagnosed with CSSS in 2006 were evaluated prospectively. All patients were assigned to undergo anterior cervical fusion with posterior longitudinal ligament (PLL) resection and followed up for ≥5 years. Sympathetic symptoms such as vertigo, headache, and tinnitus, etc. were evaluated using the sympathetic symptom 20-point score. Neurological status was assessed using the Japanese Orthopedic Association (JOA) score. Clinical and radiologic data were prospectively collected before surgery, and at 1 week, 2 months, 6 months, 2 years, and 5 years after surgery. Surgical complications and morbidities of other diseases during the follow-up were also recorded.RESULTS:The mean 20-point score decreased significantly from 7.3±3.5 before surgery to 2.2±2.7 at the final follow-up (P<0.001), giving a mean recovery rate of 66.1%±50.3%. Good to excellent results were attained in 80.6% of these patients. The sympathetic symptoms were relieved in 23 of the 31 patients in the early postoperative period, and 5 patients in 2 months. No relief of sympathetic symptoms was found in 3 patients. The mean JOA score improved significantly from 12.0±1.9 before surgery to 14.8±1.5 by the end of the follow-up (P<0.001). No late neurological deterioration was found in this group.CONCLUSIONS:The mid-term outcomes of anterior cervical fusion with PLL resection for CSSS have been satisfactory. Differential diagnosis before surgery is of great importance. PLL may play a role in presenting sympathetic symptoms.

Objective To analyzed the digestive system management clinical application in pa-tients with cervical spine injury with paraplegia in perioperative period,retrospectively. Methods Analysis of Shanghai changzheng hospital spinal surgery in 2011-2013,84 patients with digestive system management mode of treatment of cervical vertebra trauma patients with paraplegia with clini-cal data,including age, gender,injury factors,cervical vertebra injured segments,operation situation, abdominal management methods and prognosis,statistical via abdomen symptom relief after processing. Digestive management of patients with paraplegia with cervical vertebra trauma,our methods are the nutrition support, fluid management,physical stimuli,effective purge and so on. Results Through perioperative effective digestive system managemen,67 patients’s abdominal symptoms eased in the varying degree,no one had colostomy. That method proved to improve the quality of life. Conclusion Reasonable and timely digestive system management can effectively reduce the cervical vertebra trauma patients with paraplegia with abdominal symptoms, improving quality of life of postoperative patients.

骨科亚学科的分化导致专业型增强。调查发现，脊柱外科研究生对脊柱激素损伤的基本概念、救治流程、预后判断和并发症防治掌握不足。教学组将损伤控制理念引入研究生的脊柱脊髓外伤教学中，帮助其把握该理念在临床应用中的适应证、熟知实际操作流程，对完成研究生期间的临床实践有明显的促进作用。

分析了骨科术后随访的重要性,采用摸底调查发现骨科研究生在术后随访中存在的不能持之以恒、形式单调、效率低下等问题,以案例教学、设计随访表、灵活使用随访方式、有效利用资料等方法进行针对性的教学,在教学中注意过程督导、医患沟通能力培养、医德教育等方面,取得了良好效果.

Objective To compare the incidence of secondary surgical procedures after cervical disc arthroplasty vs anterior cervical discectomy with fusion in patients treated for symptomatic single level cervical spondylosis.Methods An online search of Pubmed, Medline, Ovid, Embase, Cochrane Library, CBM database, Wanfang data and VIP database were searched for prospective randomized controlled trial of cervical disc arthroplasty versus anterior cervical discectomy with fusion in incidence of secondary surgical procedures.Data were collected and extracted by two reviewers independently.Risk of bias was assessed using the criteria of Cochrane Reviews Handbook 5.1.0.Review Manager 5.2 software system was used to evaluate the data for Meta analysis.Results A total of 12 trials were included.Six of them were short-term follow up (two years).The 6 other trials were mid-and long-term follow up (mean 5.8 years).There are 4 trials with low risk of bias, 7 trials with moderate risk of bias, and 1 trial with high risk of bias.The results of meta-analysis showed there was no statistical difference in reoperation rate of adjacent level between the two groups at two years follow-up;however, the reoperation rate of non-fusion group was significantly lower in the non-fusion group compared with fusion group at mid-and long-term follow-up.The incidence of secondary surgical procedures at index level was higher in fusion group than in non-fusion group.No statistical difference was found between the two groups in using ‘ removal’ for secondary surgical procedure at two years follow-up;however, the rate of non-fusion group was significantly lower than fusion group at mid-and long-term follow-up.Conclusion Cervical disc arthroplasty was partly superior to anterior cervical discectomy with fusion in avoiding secondary surgical procedures of adjacent levels.However, non-fusion surgery doesn't have any advantages in short time (two years) follow up.Reducing the incidence of pseudarthrosis was an effective way to decrease the incidence of secondary surgery procedures in index level.

将目前流行的各类教学模式应用于脊柱外科研究生教学的情况进行了对比，评价其优缺点，得出多种教学模式灵活应用、重视论文的读写、结合医疗改革安排教学内容等综合优化，有利于培养脊柱外科研究生的主动学习能力、训练临床思维、提高临床技能，帮助其在硕士研究生在读期间，完成从初级住院医师到高级住院医师的转变。

Objective To explore the effect of orthopedic sub-discipline rotation mode in the postgraduate orthopaedic education. Meth-ods Randomly selected orthopaedic postgraduate students from grade 2011 and grade 2012 (30 students each grade). Students from grade 2011 went through the traditional teaching mode,and students from grade 2012 adopted 2 months of rotation in each sub-discipline. The clini-cal examination results and teaching satisfaction of the two groups were analyzed. Results The clinical examination results and teaching sat-isfaction of students from the two grades showed statistically differences (P<0. 05). Conclusion Orthopaedic sub-discipline rotation teach-ing mode improved the postgraduates in different ways such as orthopaedic theoretical knowledge, clinical skills, case analysis and so on. Meanwhile,the new teaching mode can get students more satisfied.

目的:测试后路板-棒内固定系统治疗不稳定寰椎骨折的稳定性,为临床使用提供理论基础.方法:采集新鲜成年人尸体颈椎骨(C0～C3)标本6具,用聚甲基丙烯酸甲酯(PMMA)上下包埋,在生物力学实验机上,以150N为最大生理载荷,最大力矩为1.50N·m,依次测量完整模型组(A组)、骨折模型组(B组,包括寰椎后弓两处骨折与典型Jefferson骨折,分别作为B1组和B2组,骨折模型制作时保持横韧带完整)、内固定模型组(C组,包括B1组+内固定系统、B2组+内固定系统,分别作为C1组、C2组)C0-C1、C1-C2节段前屈/后伸、左/右侧屈和左/右旋转等6个方向的三维运动范围(ROM),通过比较,评价后路板-棒内固定系统治疗寰椎骨折的生物力学稳定性.根据测量所得ROM值,设A组各方向三维运动稳定性指数(Sf)为100％,计算B组、C组模型各运动方向Sf,进一步直观比较各模型的稳定性变化.结果:C0-C1节段,A组前屈/后伸、左右侧屈、左右轴向旋转方向的ROM分别为11.06°±1.00°,7.08°±0.62°,13.24°±1.24°;B1、B2组前屈/后伸、左右侧屈、左右轴向旋转方向ROM均较A组明显增大(P＜0.05);C1组前屈/后伸、左右侧屈、左右旋转方向的ROM均较B1组明显减小(P＜0.05);C2组各方向ROM均较B2组明显减小(P＜0.05);C1、C2组前屈/后伸、左右侧屈、左右轴向旋转方向ROM与A组比较均无统计学差异(P＞0.05).C1-C2节段,A组前屈/后伸、左右侧屈、左右轴向旋转方向的ROM分别为10.07°±1.12°,5.56°±0.54°,20.83°±2.12°;B1、B2组各方向ROM均较A组明显增大(P＜0.05);C1组各方向的ROM较B1组明显减小(P＜0.05);C2组各方向ROM较B2组明显减小(P＜0.05);C1、C2组各方向ROM与A组比较均无统计学差异(P＞0.05).C0-C1节段,B1组前屈/后伸、左/右侧屈、左/右轴向旋转方向Sf分别为71％、70％、64％,B2组各方向Sf分别为61％、55％、58％,C1组各方向Sf分别为102％、108％、108％,C2组各方向Sf分别为91％、91％、92％.C1-C2节段,B1组前屈/后伸、左/右侧屈、左/右轴向旋转方向Sf分别为70％、61％、35％,B2组各方向Sf分别为59％、54％、37％,C1组各方向Sf分别为105％、111％、106％,C2组各方向Sf分别为91％、90％、92％.结论:寰椎后路板-棒内固定系统既能恢复上颈椎稳定性,又可保留其生理运动功能.使用该系统治疗寰椎后弓两处骨折,在稳定性方面效果稍优于典型Jefferson骨折.

Sympathetic symptoms associated with cervical disorders, such as vertigo, headache, dizziness, etc., are common clinical disorders bewildering both clinicians and patients. In our clinical practice we observed that sympathetic symptoms associated with cervical disorders were apparently relieved in some patients after undergoing routine anterior cervical decompression and fusion plus posterior longitudinal ligament (PLL) resection. This study was designed to investigate the sympathetic nerve innervations in the cervical PLL and its potential correlation with cervical sympathetic symptoms such as vertigo.Method: In animal research, cervical PLLs of 9 adult rabbits were harvested and stained with sucrose-phosphate-glyoxylic acid (SPG), which is a specific fluorescence staining method for sympathetic postganglionic fibers. In human research, cervical PLL of 8 patients of cervical spondylosis with sympathetic symptoms were harvested during surgery and stained with SPG. All sections were observed under fluorescence microscope. Sympathetic symptoms were evaluated using the sympathetic symptom 20-point score preoperatively and at 1 week, 2-month, and 6-month postoperatively.Results: In rabbit specimens, a large number of sympathetic postganglionic fibers were distributed in the cervical PLL of every segment. The density of sympathetic fibers distributed in the intervertebral portion of PLL was more than that in the vertebral portion. Compared with deep layer section, the nerve fibers in the superficial PLL layer section were thicker and more densely populated. Existence of sympathetic postganglionic fibers was also confirmed in human specimens. Those nerve fibers were mostly short and isolated in areatus form, with non-interwoven branches. The mean sympathetic symptoms score decreased significantly from 6.6 +/- 2.6 before surgery to 2.0 +/- 1.9 at 6 months postoperatively after anterior cervical decompression and fusion with PLL removed.Conclusion: According to the experimental result and clinical practice, we hypothesized that sympathetic nerve fibers distributed in PLL may represent a pathologic basis of stimulation induced by cervical vertebral degenerative changes and thus are susceptible to being a potential causative factor in cervical spondylosis with sympathetic symptoms. (C) 2014 Published by Elsevier Ltd.

BACKGROUND: Pathophysiological mechanisms after spinal cord injury are very complex, so there is no compressive and in-depth understanding on it. OBJECTIVE: To study the effect of dura mater spinalis integrity on cytokine levels in the cerebrospinal fluid of animal models of spinal cord injury. METHODS: The white rabbit models of spinal cord injury were established using clamp compression method, and then the models were randomly divided into four groups: no dura mater spinalis defect group, dura mater spinalis defect group, dura mater spinalis defect composite with membrane repairing group and dura mater spinalis defect composite with autologous fascia repair group. Enzyme-linked immunosorbent assay was performed to detect the changes of levels of cytokines (interleukin-6, interleukin-10 and tumor necrosis factor α) in the cerebrospinal fluid at 30 minutes, 1, 3, 6, 12 and 36 hours after surgery. RESULTS AND CONCLUSION: The levels of interleukin-6, interleukin-10 and tumor necrosis factor α in the cerebrospinal fluid of the dura mater spinalis defect group, dura mater spinalis defect composite with membrane repairing group and dura mater spinalis defect composite with autologous fascia repair group were significantly lower than those of the no dura mater spinalis defect group at 6 hours after surgery (P < 0.05). There were no significant differences in the levels of interleukin-6, interleukin-10 and tumor necrosis factor α at other time points between groups (P > 0.05). The results indicate that maintaining the integrity of dura mater spinalis of the spinal cord injury model can affect the levels of interleukin-6, interleukin-10 and tumor necrosis factor α in the cerebrospinal fluid, thus inhibiting the inflammatory response.