Purpose: To investigate primary knee arthroplasty (PKA)-related POC incidence and identify its independent risk factors, focusing on perioperative medications, rehabilitation, and psychological status. Patients and methods: A retrospective cohort study was conducted on unilateral PKA patients at our Hospital (January 2022-June 2025). Patients were divided into the Constipation Group (within the first 7 days postoperatively, postoperative 1-week defecation <3 times/week + related symptoms) and the Non-Constipation Group. Clinical data were extracted; univariate and multivariate logistic regression screened risk factors, and ROC curves evaluated predictive value. Results: A total of 112 patients were included (Constipation Group: 44 cases, 39.29%; Non-Constipation Group: 68 cases, 60.71%). Multivariate regression identified two independent risk factors: postoperative combination opioid analgesia (OR = 10.74, 95%CI: 4.005-28.803, p < 0.001) and elevated Generalized Anxiety Disorder 7-Item Scale (GAD-7) score (OR = 1.125, 95%CI: 1.02-1.241, p = 0.019). Preoperative Shouhui Tongbian Capsule (SHTB) use and postoperative continuous passive motion (CPM) showed protective trends in univariate analysis (p < 0.05) but did not reach significance in multivariate models. ROC analysis confirmed acceptable predictive value for the two risk factors (AUC = 0.775 and 0.764). Conclusion: POC incidence after PKA is relatively high. Postoperative combination opioid analgesia and elevated GAD-7 score are independent risk factors; preoperative SHTB and postoperative CPM have potential protective effects. These findings support targeted POC prevention in PKA patients.

AIM:Deep vein thrombosis (DVT) is acknowledged as the primary complication associated with tibial plateau fractures (TPFs), necessitating the implementation of preventive measures such as physical exercise. While ankle pump exercise (APE) is an effective preventive measure, challenges such as insufficient monitoring and a shortage of nursing staff have been identified. Therefore, our study aimed to evaluate the efficacy of the self-developed telemonitored APE compared to conventional APE. METHODS:The study was conducted in a randomized parallel-group design (Consolidated Standards of Reporting Trials (CONSORT)-compliant). We randomized 60 participants with TPFs into two groups for traditional APE (Group A) and telemonitored APE (Group B) separately. The study population was recruited from Zhejiang Hospital between December 2022 and June 2024. Evaluate the efficacy by four indices: diameter and flow velocity of the femoral vein and popliteal vein in the lower extremity, the increased value of postoperative calf diameter, visual analogue scale (VAS), and D-dimer. RESULTS:Following both telemonitored and traditional APE, statistically significant differences (p < 0.05) were detected between the two groups in at least one assessment period. Group B showed significantly lower VAS than Group A on postoperative day 7 (p = 0.001) and day 14 (p < 0.001). Group B had a lower D-dimer level on postoperative day 7 (p = 0.004). Group B showed a smaller calf diameter increment on day 7, p = 0.001). Group B had a significantly higher popliteal vein flow velocity after APE (p < 0.001). CONCLUSIONS:The remote monitoring ankle pump system is more effective than traditional methods in reducing postoperative pain, improving venous hemodynamics, and reducing thrombotic risk indicators, demonstrating its significant clinical value in the prevention and rehabilitation of lower extremity deep vein thrombosis in patients with tibial plateau fractures. CLINICAL TRIAL REGISTRATION:Chinese Clinical Trial Registry (ChiCTR2200065384).

This work explored the relationship between nosocomial infection-related factors and inflammatory factors after total hip replacement (THA).

Background: Intervertebral disc degeneration (IVDD) is the main cause of low back pain (LBP), but the specific regulatory factors, pathways and specific molecular mechanisms remain unclear. Methods: We identified and quantitatively analyzed Pfirrmann Grade II (n=3) and Pfirrmann Grade IV (n=3) pulposus samples via MRI. The differential abundance of proteins in the samples was determined and quantitatively analyzed by relative and absolute quantitative analysis of the isotope marker levels combined with the liquid chromatography-tandem mass spectrometry (LC-MSMS/MS). Results: A total of 70 proteins (30 significantly increased proteins (> 1.2-fold change) and 40 significantly decreased proteins (< 0.8-fold change)) showed different levels among the groups. Kyoto Encyclopedia of Genes and Genomes and Gene Ontology (GO) enrichment analyses and Western blot analysis showed that CYCS, RAC1, and PSMD14 may play important roles in IVDD and that sclerosis (ALS) are the main pathways involved in IVDD. Conclusion: CYCS, RAC1 and PSMD14 may play important roles in IVDD, and Epstein-Barr virus infection, viral myocarditis, colorectal cancer, NAFLD and ALS may be the main pathways involved in IVDD.

This article has been withdrawn at the request of the author(s) and/or editor. The Publisher apologizes for any inconvenience this may cause.

Objective:To retrospectively explore the effect of a half-dose buprenorphine transdermal patch for analgesia after arthroscopic rotator cuff repair (ARCR). Methods:This analysis was performed with clinical data from patients who received unilateral ARCR in our hospital between October 2017 and December 2020. The patients were divided into three groups (30 cases each). In group A (control group), 100 mg flurbiprofen axetil (FA) was administered twice a day for 5 days after surgery. In group B (experimental group), 100 mg FA was administered twice a day for 5 days and half (2.5 mg) of a buprenorphine transdermal patch was applied after surgery; an additional half (2.5 mg) patch was applied 3 days later. In group C (condition control group), 100 mg FA was administered twice a day for 5 days and a 5-mg patch was applied directly after surgery. The visual analog scale (VAS) was administered repeatedly 1 day before surgery and 1, 2, 3, 5, and 14 days after surgery in each group. The simple shoulder test (SST) score, range of shoulder forward elevation (FE), and external rotation (ER) were recorded preoperatively and 12 weeks postoperatively. Results:VAS scores on postoperative days 3 and 5 were significantly lower in groups B and C than in group A (p < 0.05). The VAS score on postoperative day 14 was significantly lower in group C than in group A (p < 0.05). The difference in VAS score between groups B and C was not significant (p > 0.05). All patients had significantly improved VAS scores, SST scores, FE, and ER at 12 weeks postoperatively. Conclusion:The half-dose buprenorphine transdermal patch had a good analgesic effect with minimal side effects after ARCR and did not delay the recovery of shoulder joint function.

OBJECTIVE:To investigate the clinical efficacy of acrylic cement (PMMA) mixed with calcium sulfate combined with percutaneous kyphoplasty (PKP) in the treatment of osteoporotic fracture (OVCF). METHODS:The clinical data of 191 patients with OVCF treated with PKP from January 2020 to March 2021 were retrospectively analyzed. Among them, 82 patients with 94 vertebral bodies were treated with PMMA mixed with calcium sulfate as the observation group, and 109 patients with 125 vertebral bodies were treated with pure PMMA as the control group. Among the 82 patients in the observation group, there were 16 males and 66 females, with a mean age of (75.35±11.22) years old, including 36 thoracic vertebrae and 58 lumbar vertebrae. In the control group, there were 109 patients, 22 males and 87 females, with an average age of (74.51±9.21) years old, including 63 thoracic vertebrae and 62 lumbar vertebrae. The visual analog scale (VAS) before operation and 1 day, 3 months and 1 year after operation were calculated. The Oswestry disability index (ODI), Cobb's angle, vertebral body height and the probability of postoperative bone cement leakage were used to analyze the efficacy of the two groups. RESULTS:All the patients were followed up for more than one year. Compared with the control group, there was no significant difference in operation time, bleeding volume and bone cement injection volume between the two groups(P>0.05), while the leakage rate of bone cement was significantly lower in the observation group (P<0.05). In addition, there was no significant difference in VAS, ODI, Cobb angle, and vertebral body height between the two groups before operation, and 1 day, 3 months, and 1 year after operation (P>0.05), but each index was improved compared with that before operation (P<0.05). CONCLUSION:PMMA mixed with calcium sulfate has equivalent efficacy in treating OVCF than PMMA alone, but can effectively reduce the probability of cement leakage.

OBJECTIVE:To explore the clinical outcomes of anteromedial combined with lateral locking plate for complex proximal humeral fractures in the eldery. METHODS:From June 2018 to October 2020, 30 patients who underwent surgical treatment for Neer grade 3 to 4 proximal humeral fractures, including 8 males and 22 females, aged from 51 to 78 years old with an average of (61.5±7.5) years old. Of them, 15 patients had fractures fixed with anteromedial combined with lateral locking plate(ALLP group), whereas 15 received internal fixation with proximal humerus locking plate only(PHLP group). The clinical data, simple shoulder test (SST), humeral head height loss, varus angle and shoulder range of motion were compared between the two groups. RESULTS:All fractures were healed. The follow-up time ranged from 12 to 24 months, with an average of(14.3±2.9) months. The operation time of ALLP group was longer than that of PHLP group (P<0.05). There was no significant difference in intraoperative blood loss between the two groups (P>0.05). There was no significant difference in SST score between the two groups at 1, 3 and 12 months after operation (P>0.05). In terms of radiographic measurement, there was no significant difference in humeral head height loss and varus angle between the two groups at 1 and 3 months after operation (P>0.05). At 12 months after operation, the height loss and varus angle of humeral head in ALLP group were lower than those in PHLP group (P<0.05). In shoulder range of motion, the range of forward elevation in ALLP group was larger than that in PHLP group 1 year after operation(P<0.05). There was no significant difference in external rotation between the two groups. CONCLUSION:Anteromedial combined with lateral locking plate in the treatment of complex proximal humeral fractures in the elderly can increase the stability of the medial column and obtain a good fracture prognosis. But there are also disadvantages such as longer operation time, so it should be individualized according to the fracture type of the patient.

Objective: Chronic low back pain (CLBP) after percutaneous endoscopic transforaminal discectomy (PTED) surgery may be caused by preoperative lumbar microinstability (MI). However, there is a paucity of research on the relationship between lumbar microinst-ability and chronic low back pain. The purpose of this article is to assess the preoperative radiographic characteristics of patients and evaluate the effects of lumbar microinstability on patient-reported outcomes among single-level lumbar disc herniation (LDH) patients who underwent PTED.Methods: This study retrospectively reviewed the radiographic characteristics of a consecutive series of 127 patients with low back pain and leg pain caused by single-level LDH underwent PTED from August 2018 to March 2021. They were divided into three groups according to the radiographic parameters: the stable group (Group S), the dysfunctional group (Group D), and the microinst-ability group (Group M). The visual analogue scale (VAS) scores for leg and low back pain and Oswestry Disability Index (ODI) were evaluated preoperatively and postoperatively. Logistic regression analysis was used to identify independent risk factors for CLBP.Results: Compared with Group D and Group S, Group M had the highest ODI scores (P < 0.01) and VAS scores (low back pain) (P < 0.01) after 1 year, while there were no significant differences in the VAS scores for leg pain at different time points after surgery (P > 0.05). In addition, the logistic regression analysis results regarding CLBP revealed that muscle fatty degeneration on MRI (95% CI, 1.20-8.51, P = 0.02), and facet tropism (95% CI, 1.39 -11.37, P = 0.01) may be independent risk factors.Conclusion: Patients with lumbar microinstability may have CLBP after PTED, so patients with lumbar microinstability may need to take internal fixation surgery to solve their symptoms.

Postmenopausal Osteoporosis (PMOP) is the most prevalent primary osteoporosis, attributable to an imbalance in osteoblast and osteoclast activity. Modified You-Gui-Yin (MYGY), a traditional Chinese herbal formula, is able to effectively treat PMOP, while the critical components and pharmacological mechanisms of MYGY are still unclear. In this study, we aimed to investigate the therapeutic effects and underlying mechanisms of N-butanol extract of MYGY (MYGY-Nb) in ovariectomized (OVX)-induced osteoporosis mice. Histological staining and micro-computed tomography (μCT) analysis showed that MYGY-Nb was more effective in the suppression of OVX-induced bone loss than MYGY original formula. Subsequently, liquid chromatography and mass spectrometry analysis identified 16 critical compounds of MYGY-Nb and some of them are reported to affect osteoclast functions. Furthermore, in vivo and in vitro experiments demonstrated that MYGY-Nb significantly attenuated osteoclastogenesis by down-regulating RANKL-mediated NF-κB signaling. In conclusion, our study indicated that MYGY-Nb suppresses NF-κB signaling and osteoclast formation to mitigate bone loss in PMOP, implying that MYGY-Nb and its compounds are potential candidates for development of anti-PMOP drugs.

Objective: To investigate the clinical efficacy of long-segment pedicle screw reduction and internal fixation combined with kyphoplasty in the treatment of stage Ⅲ reducible Kummell disease. Methods: The clinical data of 32 patients with stage Ⅲ reducible Kummell disease treated at the Department of Orthopedics, Sir Run Run Shaw Hospital, Zhejiang University College of Medicine from January 2012 to March 2017 were analyzed retrospectively.There were 7 males and 25 females,aged (71.8±6.7)years(range:61 to 86 years).The injured segment was T10 in 1 patient,T11 in 8 patients,T12 in 13 patients,L1 in 7 patients,L2 in 2 patients and L3 in 1 patient.Preoperative American spinal injury association(ASIA) classification of patients all showed grade D.Bone mineral density (BMD),spinal X-ray,CT and MRI were examined before operation.All patients were treated with postural reduction, long-segment pedicle screw reduction and internal fixation combined with kyphoplasty.The operation time,intraoperative blood loss,length of stay and postoperative complications were recorded.The visual analogue scale (VAS) and Oswestry dysfunction index (ODI) as well as the BMD of hip were collected before and after operation.The Cobb angle of involved segment kyphosis and the height of anterior edge of diseased vertebrae were measured before operation,3 days and 12 months after operation.CT-related parameters were measured before and 3 days after operation,including sagittal anterior and posterior diameter of spinal canal,cross-sectional anterior and posterior diameter of spinal canal and cross-sectional spinal canal area.Paired sample t test and repeated measures were used to compare the data before and after operation. Results: All patients received the operation successfully.The operation time was (131.3±16.9) minutes (range:95 to 180 minutes),the blood loss was (82.5±27.1) ml (range:50 to 150 ml),and the length of stay was (8.3±2.4) days (range:5 to 14 days).All patients were followed up for more than 12 months.The VAS decreased gradually at 3 days,3 months,6 months and 12 months after operation,and the differences were statistically significant compared with the VAS before surgery (all P<0.01).ODI at 3,6 and 12 months after surgery was significantly improved compared with that before surgery(All P<0.01).The CT-related parameters at 3 days after operation were significantly higher than those before operation (All P<0.05).At 12 months after surgery,the Cobb angle decreased from (35.2±7.6) ° preoperatively to (4.3±1.7) ° (t=22.630,P<0.01),the height of anterior edge of diseased vertebrae increased from (4.3±1.0) mm preoperatively to (16.9±2.5) mm(t=-25.845,P<0.01),the bone mineral density of hip increased from -(2.2±0.6) preoperatively to -(2.8±0.6)(t=-0.040,P<0.01).Up to the last follow-up,2 patients had distal pedicle screw loosening, 1 patient had proximal junctional kyphosis,and there was no new vertebral fracture. Conclusions: Based on postural reduction,long-segment pedicle screw reduction and internal fixation combined with kyphoplasty is a safe and effective treatment method for stage Ⅲ reducible Kummell disease,which can reconstruct the stability of the diseased vertebrae.Postoperative standard anti-osteoporosis treatment is the basis to ensure the efficacy.

经皮椎间孔镜手术治疗腰椎间盘突出症可以经后外侧椎间孔入路,在镜下微创摘除突出的髓核,达到脊髓及神经根减压的目的[1].经皮椎间孔镜手术具有术野清晰、创伤小、术后恢复快等优点,但是复发率较高,文献报道腰椎间盘突出症患者手术后5年内复发率高达5％～15％,部分复发患者甚至出现了严重并发症[2-3i.笔者分别于2021-05、2021-06诊治2例经皮椎间孔镜术后短期复发巨大腰椎间盘突出,患者肌力下降明显,需进行翻修手术治疗,报道如下.

目的:对激素性股骨头坏死(SIONFH)患者外周血清中的基因芯片数据进行生物信息学分析,探究SIONFH发生的分子机制.方法:通过基因表达综合数据库(GEO)获取SIONFH患者与非SIONFH患者外周血清中的基因表达谱.通过R软件、Perl语言,借助5个疾病相关数据库、基因本体论、基因/蛋白质相互作用关系检索工具、Cytoscape分析软件及DAVID等数据库和分析工具,进行差异表达基因(DEGs)鉴定、功能注释和富集分析,并计算SIONFH患者外周血清中免疫细胞之间的关系.结果:从GEO数据库中下载基因表达序列GSE123568,包括30例SIONFH患者和10例非SIONFH患者.SIONFH组与非SIONFH组比较的外周血清的基因本体论(GO)富集分析中,上调的DEGs在生物学过程中主要富集在免疫反应、细胞防御反应、模式识别受体信号通路、神经炎症反应等方面;在细胞组分中主要富集在分泌颗粒膜、质膜外侧和内溶酶体等方面;在分子功能中主要富集在模式识别受体活性、趋化因子受体活性、免疫受体活性等方面.下调的DEGs在生物学过程中主要富集在组蛋白修饰、共价染色质修饰、肽基赖氨酸修饰和RNA剪接等方面;在细胞组分中主要富集在核斑点、中心粒和前核糖体等方面;在分子功能中主要富集在组蛋白结合、丝氨酸/苏氨酸激酶活性和转录共调节活性等方面.免疫细胞浸润结果显示,树突细胞(DC)和滤泡辅助性T细胞(Tfh)呈正相关性(r=0.670,P＜0.05),而CD8+T细胞和中性粒细胞呈负相关性(r=-0.500,P＜0.05);SIONFH组活化的DC(P=0.002)较非SIONFH组浸润程度显著降低,而SIONFH组的记忆B细胞较非SIONFH组浸润程度显著提高(P=0.014).结论:多个富集功能参与了 SIONFH发生的过程,精氨酸酶1(ARG1)、Toll样受体2(TLR2)和前列腺素内过氧化物合成酶2(PTGS2)被认为是SIONFH患者外周血清中的潜在生物标志物.SIONFH患者的外周血清免疫细胞具有一定的特异性.从生物信息学分析对SIONFH可能的发生机制进行探索,为未来的科学研究和临床治疗提供了思路和参考.

目的 探讨3种不同贴法的丁丙诺啡透皮贴剂用于全膝关节置换术(TKA)后镇痛效果.方法 选取2015年6月至2020年4月在浙江医院行单侧人工TKA并且术前1 d应用丁丙诺啡透皮贴剂进行超前镇痛的患者150例.根据丁丙诺啡透皮贴剂贴法不同,分为实验组、对照组和条件对照组3组,实验组术前1 d应用丁丙诺啡透皮贴剂半贴(2.5 mg),3 d后增加另半贴直至术后7d;对照组术前1d应用全贴(5mg)直至术后7d;条件对照组:术前1d直接应用半贴(2.5mg)直至术后7d.采用疼痛视觉模拟法评分(VAS)评定各组患者术前1 d及术后1、2、3、5、7 d的疼痛程度,统计术后不良反应发生情况.结果 术后1、2、3、5、7 d条件对照组患者VAS评分均高于对照组,术后2、3 d实验组患者VAS评分均高于对照组,术后3、7 d实验组患者VAS评分均低于条件对照组,差异均有统计学意义(均P<0.05).3组患者药物不良反应发生率均比较差异无统计学意义(P>0.05).结论 丁丙诺啡透皮贴剂前3d减半剂量的贴法具有可观的术后镇痛效果,同时减少了药物不良反应的发生.

Objective To investigate the prevalence of 11 thoracic vertebrae (TVs), four lumbar vertebrae (LVs) and six LVs among asymptomatic Chinese volunteers, and the influence of spine variations on the global spinal sagittal parameters. Methods A total of 389 asymptomatic Chinese volunteers were recruited. Each subject underwent a full‐spine X‐ray examination with measurement of global spinal sagittal parameters. The radiographs were examined by a spine surgeon and a radiologist to determine the variation in the number of vertebrae. These parameters were used to compare individuals with five LVs to those with 11 TVs, four LVs, and six LVs. Results The study population included 12 individuals (3.1%) with seven cervical vertebrae (C) + 11 thoracic vertebrae (T) + five lumbar vertebrae (L), 8 (2.1%) with 7C + 11T + 6L, 8 (2.1%) with 7C + 12T + 4L, and 15 (3.9%) with 7C + 12T + 6L. Compared to the 7C + 12T + 5L individuals, those with 7C + 11T + 5L had significantly lower C6–T5 Cobb values (P < 0.05); 7C + 12T + 4L individuals had significantly greater thoracic inlet angles (P < 0.05) and significantly lower pelvic tilt (P < 0.05); individuals with 7C + 12T + 6L had significantly greater sacral slope, pelvic tilt, pelvic incidence, and L1–5 Cobb values (all P < 0.05), but significantly lower thoracic inlet angle (P < 0.05). There were no significant differences in any of the parameters examined between the 7C + 11T + 6L group and the 7C + 12T + 5L group. Conclusions Asymptomatic adults with 7C + 12T + 6L, 7C + 12T + 4L, and 7C + 11T + 5L presented with different spinal sagittal alignment compared to those with 7C + 12T + 5L. Compared to variation in the number of LVs, the variation in the number of TVs had less effect on global spinal sagittal parameters. Spinal surgeons and researchers should be aware of the effects of variation in numbers of TVs and LVs on global spinal parameters and sagittal balance.

目的 探究丁丙诺啡透皮贴剂(TBP)抑制肩袖修补术后疼痛的效果及药物不良反应.方法 回顾分析2017年10月-2019年10月在浙江医院行单侧肩关节镜下肩袖修补术后未接受和接受TBP止痛治疗患者(各30例)的临床资料,分为A、B 2组.A组患者术后应用氟比洛芬酯100 mg每日2次镇痛至术后5 d;B组患者术前1d应用丁丙诺啡透皮贴剂至术后2周,术后应用氟比洛芬酯方法同A组.追踪2组患者术前1d及术后第1、2、3、5、14天疼痛视觉模拟评分(VAS),统计药物不良反应.术后12周进行VAS和肩关节简单功能评分(SST),测量前屈上举(FE)和体侧外旋(ER),与术前对比并组间比较.结果 B组术后第3、5、14天VAS评分明显低于A组,差异有统计学意义(均P＜0.05);术后12周随访时,A组和B组VAS、SST、FE、ER均较术前有明显改善(均P ＜0.05).组间比较显示B组FE较A组范围大,差异有统计学意义(P ＜0.05);2组VAS、SST、ER差异无统计学意义.B组的药物不良反应发生率(5/30,16.67％)较A组药物不良反应(2/30,6.67％)高,2组差异无统计学意义.结论 TBP应用于肩袖修补术后镇痛效果良好,且不影响肩关节功能恢复.

目的 探讨姜黄素对骨关节炎(OA)软骨细胞增殖及基质金属蛋白酶-13(MMP-13)、白细胞介素-6(IL-6)分泌的影响.方法 选取2018年1～6月在我院骨科接受关节置换的10例骨关节炎患者的关节软骨,设为炎症软骨细胞组(OA组),按是否加入姜黄素分为单纯培养基组(OAa组)与加入姜黄素组(OAb组);另选取因外伤致截肢的4例患者膝关节软骨为对照,设为正常软骨细胞组(N组),按是否加入姜黄素分为单纯培养基组(Na组)与加入姜黄素组(Nb组).进行软骨细胞培养,配制姜黄素溶液,加入姜黄素溶液(80μmol/L)刺激软骨细胞,采用MTT法检测软骨细胞增殖,测定上清液MMP-13、IL-6水平.结果 OAb组吸光度值明显低于OAa组(P<0.05),Nb组吸光度值较Na组下降,但差异无统计学意义(P>0.05).OAb组上清液MMP-13、IL-6水平均低于OAa组(P<0.05),OA组MMP-13、IL-6水平均高于N组(P<0.05).结论 姜黄素对OA软骨细胞增殖及释放MMP-13、IL-6均有明显抑制作用,可保护关节软骨细胞,减轻炎症反应.

Osteogenic differentiation of BMSCs is beneficial to the treatment of osteoarthritis. Progranulin (PGRN) is a chondrogenic factor. However, the role of progranulin in the differentiation of BMSCs under inflammation remains unclear. Rat BMSCs were isolated and divided into control group, inflammation group (treated with LPS), and PGRN group (5 and 10 /μM) followed by analysis of survival rate of BMSCs by MTT assay, Caspase 3 activity, ALP activity, expression of Runx2 and OP by real time PCR, level of MMP-3, TIMP-1, FAK and MAPK by Western blot and IL-6 and IL-10 secretion by ELISA. LPS treatment significantly inhibited BMSCs proliferation, increased Caspase 3 activity, decreased ALP activity, expression of Runx2 and OP, increased IL-6 secretion, decreased IL-10 secretion, increased MMP-3 expression, decreased expression of TIMP-1, FAK and p-P38 (P < 0.05). PGRN treatment on BMSCs under inflammation significantly promoted cell proliferation, decreased Caspase 3 activity, increased ALP activity, expression of Runx2 and OP, decreased IL-6 secretion, increased IL-10 secretion, decreased MMP-3 expression, and increased TIMP-1, FAK and p-P38 expression (P < 0.05) with more significant changes in the higher concentration. Under inflammation, BMSCs proliferation was inhibited, apoptosis was increased, and osteogenic differentiation was weakened. PGRN inhibits the proliferation of BMSCs and apoptosis, and promotes osteogenic differentiation by regulating FAK/MAPK pathway.

背景:老年退变性腰椎滑脱症是临床骨科常见疾病,开放融合手术对高龄、内科疾病多的患者来说手术时间长、创伤大,容易出现较多手术并发症.经皮经椎间孔内镜下腰椎间盘切除术(PTED)具有创伤轻微,出血少,术后疼痛轻、恢复快等优点.目的:探讨椎间孔镜下减压治疗老年Ⅰ度腰椎退行性滑脱症的短期临床疗效.方法:选择2015年3月至2017年2月间老年Ⅰ度腰椎退行性滑脱症患者18例.其中L4-5滑脱13例,L5-S1滑脱5例.记录并比较患者术前、术后3个月、术后6个月疼痛视觉模拟评分(VAS)、功能障碍指数(ODI)和日本骨科协会(JOA)评分.结果:所有患者均顺利完成手术.手术时间64～150 min,平均(88.0±12.5)min.所有患者均完成随访,随访时间6～12个月,平均随访(8.8±0.5)个月.患者术后3、6个月疼痛VAS评分、ODI均较术前降低[(3.2±0.3)、(3.0±0.2)分vs(7.1±0.5)分,(14.6±5.7)％、(15.1±5.1)％vs(41.6±8.7)％],JOA评分均较术前升高[(22.3±2.1)分、(23.2±1.9)分vs(12.6±1.7)分],且差异均有统计学意义(P均<0.01);而患者术后3个月与术后6个月疼痛VAS评分、ODI、JOA评分差异均无统计学意义.结论:椎间孔镜下减压治疗老年Ⅰ度腰椎退行性滑脱症,具有患者接受度高、短期临床疗效好、并发症少等优点,特别对老年合并内科疾患的患者是一种安全有效的治疗方式.