Histone lactylation is a novel epigenetic regulator that is reported to participate in gene expression. Ferroptosis is an oxidative form of cell death and chondrocyte ferroptosis crucially impacts the development of osteoarthritis (OA). The study aimed at investigating the effect of lactate dehydrogenase B (LDHB) and its mediated histone lactylation on chondrocyte ferroptosis during OA. Our study focused on the establishment of in vivo mouse model and in vitro interleukin-1β (IL-1β)-induced chondrocytes model and administrated LDHB knockdown (siLDHB). Histopathological assessment of cartilage was conducted via HE staining, while serum levels of cartilage oligomeric matrix protein (COMP) and crosslinked C-telopeptides of type II collagen (CTX-II) were quantified using ELISA to evaluate OA severity. The matrix degradation was further examined by expression of Collagen II and Aggrecan. Levels of total iron, ferrous iron (Fe2+), and lipid reactive oxygen species (ROS) were considered measurements of ferroptosis. Assessment of cell viability and proliferation relied on cell counting kit 8 (CCK-8) together with colony formation assay. Western blotting assay served for detecting the relative expression of proteins and protein lactylation. The epigenetic regulation of ACSL4 by LDHB was determined by chromatin immunoprecipitation (ChIP) and luciferase reporter gene assay. OA mice presented remarkably elevated protein level of LDHB and H3K18 lactylation in the cartilage versus the sham group. Knockdown of LDHB downregulated the levels of COMP and CTX-II, as well as alleviated chondrocyte ferroptosis in vitro and in vivo. Results from ChIP and luciferase reporter gene assay demonstrated direct histone lactylation of ACSL promoter, and knockdown of LDHB and treatment with LDH inhibitor reduced histone lactylation and expression of ACSL4. ACSL4 overexpression could reverse the impact of LDHB depletion on chondrocyte proliferation and ferroptosis. LDHB promotes ACSL4 by histone lactylation to induce chondrocyte ferroptosis, which further contributes to OA development. The findings in the study assist in understanding the modulating mechanism of LDHB-mediated lactylation against chondrocyte ferroptosis in OA progression.

Objective. Spinal cord injury (SCI) is one of the most devastating central injuries, resulting in serious locomotor deficits. Triad1 is known to play an important role in SCI, but its effects on the inflammatory response and physiological behavior have not been thoroughly studied. This study is aimed at examining the effects of Triad1 on the inflammatory response and neuronal injury in acute SCI in rats. Methods. Twenty-four male Sprague–Dawley (SD) rats were randomly divided into a control group, SCI group, sh-NC group, and Triad1 knockout group (sh-Triad1). The Basso Beattie Bresnahan locomotor rating scale was utilized for the assessment of the motor ability of rats. Hematoxylin and eosin (H&E), Luxol fast blue (LFB), and TUNEL staining were used to assess the pathological injury, demyelination, and neuronal apoptosis, respectively. ELISA was used to detect the levels of IL-1β, IL-10, and TNF-α, and qRT-PCR was used to examine the expression level of Triad1. Furthermore, the protein levels of Triad1, Bax, Bcl-2, and cleaved caspase-3 were determined using western blotting. Results. The Triad1 expression level was upregulated in damaged spinal cord tissue. Knockdown of Triad1 improved motor function and reduced SCI as well as apoptosis of spinal cord neurons. In addition, the knockdown of Triad1 inhibited the inflammatory response caused by SCI. Conclusion. Knockdown of Triad1 can reduce SCI in rats with acute SCI by inhibiting the inflammatory response and apoptosis.

目的 探讨经后路颈椎全内镜下椎间盘切除术(posterior percutaneous endoscopic cervical discectomy,PPECD)治疗单节段不完全性无骨折脱位型颈脊髓损伤(spinal cord injury without radiographic abnormality,SCIWORA)的临床疗效及术后并发症.方法 选取2017年1月—2019年12月就诊的51例SCIWORA患者进行前瞻性研究,按随机数字表法分为对照组与观察组,观察组21例,对照组30例.对照组接受前路减压椎间植骨融合内固定术(anterior cervical discectomy fusion,ACDF),观察组接受PPECD.记录手术时间、术中出血量、术中透视次数.术后随访3个月,通过对比术前、术后3 d、术后3个月颈部、上肢VAS评分、颈部JOA评分、颈椎Cobb角、颈椎活动度(range of motion,ROM),评价临床疗效;记录对比术后并发症发生率.结果 观察组术中出血量及术后透视时间较对照组对比具有统计学差异(P<0.05);术后3 d、术后3个月VAS评分和JOA评分均较术前好转(P<0.05),两组间无统计学差异(P>0.05);术后3个月颈椎Cobb角及颈椎ROM较术前均好转(P<0.05),且观察组对比对照组具有统计学差异(P<0.05).观察组较对照组改变更佳;两组均未发生硬膜外血肿及神经硬膜损伤并发症发生;对照组中术后3个月内见1例切口感染(3.33％),3例切口水肿并发症发生(10.00％).结论 PPECD与ACDF治疗SCIWORA患者术后短期疗效相当,PPECD术中出血量更少,但术中透视次数较多;术后均可改善颈椎Cobb角和活动度,但PEECD较ACDF改善更佳,且术后并发症更少.

In the past 10 years, the technology of percutaneous spine endoscopy has been continuously developed. The indications have expanded from simple lumbar disc herniation to various degenerative diseases of the cervical, thoracic, and lumbar spine. Traditional surgery for the treatment of cervical radiculopathy includes anterior cervical decompression surgery, anterior cervical decompression plus fusion surgery, and posterior limited fenestration surgery. This article mainly studies the treatment of cervical spondylosis caused by radiculopathy caused by the nucleus resection of the posterior cervical spine percutaneous spinal endoscopy based on deep learning. In the PPECD group, the height of the intervertebral cavity was measured before the operation and during the final follow-up, and the height change of the intervertebral cavity was evaluated. The relative angle and relative displacement of the sagittal plane of the operation segment in the PPECD group were measured, and the stability was evaluated. Using the cervical spine X-ray Kelvin degeneration evaluation criteria, before and during the final follow-up operation, the degeneration of the adjacent segments of the two groups was evaluated. A retrospective analysis of 26 cases of cervical radiculopathy that met the criteria for diagnosis, inclusion, and exclusion was reviewed. Among them, 11 cases were treated with PPECD surgery; 15 cases were treated with ACDF surgery. According to the evaluation method of Odom, the excellent rate and the good rate of the two groups were compared. According to the location of the lesion, the nerve detection or dull tip device is exposed under the armpit or shoulder of the nerve root, and the protruding nucleus pulposus tissue is explored and removed, and annulus fibrosus is performed as needed. After hemostasis was detected, the surgical instruments were removed and the surgical incision was completely sutured. Before the operation and 3 months after the operation, the final follow-up made no significant difference in the overall average height of the intervertebral cavity (F = 2.586, P>0.05). The results show that posterior foramen expansion is an effective surgical method for the treatment of cervical spondylotic radiculopathy, but surgical adaptation requires strict management. In order to achieve satisfactory results, appropriate cases must be selected.

BACKGROUND This study aimed to investigate the therapeutic and prognostic effects of percutaneous transforaminal endoscopic decompression (PTED) for degenerative lumbar spinal stenosis (DLSS). MATERIAL AND METHODS One hundred eighty-eight patients with DLSS were randomly divided into the fenestration and the PTED group for decompression treatment. Operative time, incision length, amount of blood loss, length of hospitalization, and rates of complications in the 2 groups were compared. All patients underwent computed tomography (CT) scanning and magnetic resonance imaging (MRI) on the first postoperative day. All patients were assessed preoperatively and the treatment effects at 3, 6, and 12 months postoperatively were evaluated using visual analog scale (VAS), Japanese Orthopedic Association Score (JOA) and Oswestry Disability Index (ODI). The modified MacNab criteria were used to assess patient satisfaction 1 year after surgery at the last follow-up. RESULTS Patients who underwent PTED had shorter incisions, less blood loss, and shorter hospital stays than those in the fenestration group, but operative times and complication rates were similar in the 2 groups. Moreover, CT scanning and MRI revealed similar treatment effects in the 2 groups. Compared with preoperative status, improvements in VAS, ODI, and JOA scores occurred at different times after surgery in the 2 groups. In particular, all 3 scores in the PTED group were higher than those in the fenestration group at 3 and 6 months postoperatively. There were no significant differences in MacNab scores between the 2 groups. CONCLUSIONS PTED is safer and more effective than traditional fenestration for management of DLSS.

目的 探讨Waveflex动态固定系统治疗腰椎间盘突出症(LDH)的临床效果.方法 LDH患者70例分为两组,分别采用Waveflex动态固定系统治疗(A组,35例)和腰椎后路融合内固定治疗(B组,35例).比较两组手术时间、术中出血量以及腰椎整体活动度.结果 A组手术时间和术中出血量较B组减少[(104.03±10.49)min vs.(116.31±12.10)min和(133.96±29.70)ml vs.(222.05±40.20)ml](P<0.05).A组末次随访时腰椎整体活动度高于B组[(7.16±0.34)度vs.(5.68±0.55)度](P<0.05).结论 与腰椎后路融合内固定术比较,Waveflex动态固定系统治疗LD H具有手术时间短、术中出血量少和术后恢复好等优势.

目的 分析AO分型43-A型胫骨骨折应用经皮微创接骨板内固定技术(MIPPO)、专家级髓内钉(ETN)以及外固定支架固定方法治疗的临床效果.方法 回顾性分析2010年1月至2016年12月苏北人民医院收治的106例AO分型43-A型胫骨骨折患者的临床资料.根据治疗方法的不同将其分为A、B、C 3组,A组35例患者给予MIPPO治疗,B组35例患者给予ETN治疗,C组36例患者给予外固定支架固定治疗.观察比较3组患者的手术时间、术中出血量、骨折愈合时间等指标,出院后1、3、6个月分别复查X线了解骨折愈合的情况,采用美国足踝外科协会(AOFAS)对患者治疗后中前足情况进行评分.结果 A、B组患者的手术时间、术中出血量、骨折愈合时间以及AOFAS中前足评分比较差异无统计学意义(P>0.05).C组患者的手术时间较A、B组更短,差异有统计学意义(P<0.05);但A、B组患者的术中出血量明显多于C组,且骨折时间明显较短,差异均有统计学有意义(P均<0.05).C组患者的AOFAS中前足评分明显低于A、B组,差异有统计学有意义(P<0.05).结论 MIPPO、ETN、外固定支架固定方法对于AO分型43-A型胫骨骨折患者均有一定的治疗效果,临床上一般首选内固定术式,对于不适合进行内固定治疗的患者,应当给予远端交叉置钉不跨踝关节的外固定治疗.

Objective To research the clinical effect of more than three segments of pedicle screw internal fixation treating spinal injury. Methods Random selection from June 2014 to Tune 2016, 80 patients with more than three segments of spinal injury, and were divided into two groups randomly, the experiment group and the control group, each group for 40 cases. The experiment group was treated with more than three segments of pedicle screw internal fixation, and the control group was treated with two segments of pedicle screw internal fixation. The clinical treatment effect of two groups was com-pared and analyzed. Results The length of stay and incidence rate of complications after operation in the experiment group was evidently lower than that in the control group. The effective rate of the experiment group was 95%, and that of the con-trol group was 75%. The difference had statistical significance(P<0.05﹚. Conclusion Applying more than three segments of pedicle screw internal fixation to treat the patients with spinal injury in the experiment group not only can improve the clini-cal treatment effect and avoid fracture and loose of pedicle screw, but also can reduce the infection of postoperative compli-cations, which has great application value in clinical practice.

腰胸段是脊柱的转换点,也是最容易受伤和发病的部位,一般情况下,间接暴力、直接暴力、肌肉收缩等等都有可能造成胸腰椎骨折,临床表现为剧烈疼痛、腰背部活动受限、肌肉痉挛、腹痛,另外还常合并神经功能损伤、脏器损伤等其他并发症,给治疗带来较大难度.临床发现,胸腰椎骨折后期易发生椎体塌陷、高度丢失,远期断钉、断杆、螺钉松动、Cobb角增加等不良反应,严重影响患者的健康,并且在很大程度上阻碍了预后的康复[1,21.对此,本院采用经伤椎置钉并植人人工骨复合物治疗胸腰椎骨折患者,取得了显著的临床效果.现报道如下.

目的：分析影响腰椎间盘突出症患者术后疗效的因素，总结部分临床效果不佳的原因，为提高腰椎间盘突出症术后疗效提供参考。方法通过对2006年~2013年我院经手术治疗的腰椎盘突出症患者的病历进行分析统计，判定其术后疗效，分析其影响因素。结论患者自身的因素、疾病的严重程度、影像学检查因素、手术因素、术后并发症因素都有可能影响术后疗效，严格选择手术时机，严格把握手术适应证，做好术前准备；术中操作要谨慎、有序，认真探查，小心剥离，彻底减压；术后要精心护理，加强功能锻炼。这样才能让腰椎间盘突出症手术患者达到满意的疗效。

目的:探讨髋臼前壁骨折的诊断和治疗方法。方法:自2008年5月-2011年6月共收治髋臼前壁骨折6例,其中1例采用非手术治疗,5例采用手术治疗,手术入路均采用Smith-Petersen入路。结果:随访1～3年,平均2年。结果手术治疗组关节功能表现优良者4例,可1例,优良率为80%。非手术治疗的1例关节功能表现优良。结论:骨折块较大、移位比较严重且伴有髋关节前脱位、关节内有游离骨块的髋臼前壁骨折需要手术治疗,手术入路以Smith-Petersen入路最佳。

目的:探讨老年性胫腓骨远段骨折的手术方式并分析其临床疗效.方法:自2001年6月～2008年6月共手术治疗老年性胫腓骨远段骨折156例164肢,其中闭合性骨折97例,开放性骨折59例(Gustilo分类:Ⅰ型34例、Ⅱ型12例、Ⅲ型13例),波及胫骨踝关节面19例.使用交锁髓内钉治疗38例41肢(A组)、使用钢板内固定治疗63例67肢(B组)、使用胫骨外固定架治疗55例56肢(C组).结果:平均随访21个月后分析各组临床疗效,按照Johner-Wruhs的评价标准,A组:优27例、良7例、可2例、差2例,B组:优37例、良12例、可11例、差3例,C组:优35例、良13例、可6例、差1例.结论:根据胫腓骨骨折的部位、分型选用合适的手术方式是治疗成功的关键,外固定架加有限内固定及腓骨钢板是治疗老年性胫腓骨远段开放性粉碎性骨折的首选治疗措施.

Objective:To detect the expressions of CD 44V6 and β-catenin in osteosarcoma and to analyze the association of their expressions with migration and invasion of osteosarcoma cells. Methods:Expressions of CD 44V6 and β-catenin were examined by immunohistochemical SP method in 35 specimens of human osteosarcoma tissues, 15 specimens with osteochondroma, and 15 cases of normal bone tissues. Results:The positive expressions of CD 44V6 and β-catenin were significantly higher in osteosarcoma than osteochondroma and normal control tissues (P0.01). Their expressions significantly correlated with clinical staging, tumor metastasis, and 2-year death (P0.05); but had no correlation with the age and gender of patients, tumor size, histological classification, and with or without preoperative chemotherapy (P0.05). In osteosarcoma, expression of CD 44V6 was positively associated with the expression of β-catenin (P0.01). Conclusion:The positive expressions of CD 44V6 and β-catenin closely correlate with the occurrence, development, and metastasis of osteosarcoma. They may play synergistic role in the invasion and metastasis of osteosarcoma. Combined detection of CD 44V6 and β-catenin may be used as an indicater for diagnosis and prognosis of metastasis of osteosarcoma.

Objective To detect the expression level of β-catenin in osteosarcoma cells, and toinvestigate the correlation between the invasion of osteosarcoma cells and the expression of β-catenin.Methods The expression of β-catenin was assayed by immuno -histochemistry SP method in 35 specimensof common human osteosarcoma tissue, 15 specimens of osteochondroma and 15 specimens of normal bonetissue. Results The positive expression rate of β-catenin in osteosarcoma was 57.12%(20/35) and significantly higher than that in osteochondroma and normal bone tissue(P<0.01). It was correlated to clinicalstaging, metastasis and the two-year death rate (P < 0.05); while it had no correlation with the patient's age,gender, histologicl types and preoperative chemotherapy (P > 0.05). Conclusion The expression of β-catenin closely correlates with the pathogenesis, growth and metastasis of osteosarcoma. It may play animportant role in the invasion and metastasis of osteosarcoma. It might be used as an prospective indicator forthe prognosis and metastasis.

<正>Pilon骨折是指胫骨远端1/3波及胫距关节面的骨折,常合并有腓骨下段骨折和严重的软组织挫伤,且其并发症发生率较高,临床治疗非常棘手。我院自2001年1月至2004年10月对48例Pilon骨折患者行手术治疗,获得了良好的疗效,现报道如下。

目的比较胫骨平台骨折的治疗方法,选择最佳治疗方案.方法将胫骨平台骨折39例,按AO分型和塌陷程度分为B、C二型;B1、B2型主要采用手法整复牵引或石膏外固定;B3、C1型主要采用撬拨复位,植骨后采用松质骨螺钉或骨栓固定;C2、C3型主要采用T型或L型髁钢板坚强固定.结果37例术后获随访,按Merchnt评分标准,优良率达86.48%.结论重建和维持关节面的吻合关系和对线,加之早期膝关节功能练习能够获得满意的治疗效果.

目的:探讨带隐神经营养血管吻合支岛状筋膜皮瓣的手术方法和临床应用.方法:从1998年6月起应用带隐神经营养血管吻合支的岛状筋膜皮瓣修复踝、足部软组织缺损24例;切取皮瓣范围5em×6em～11cm×12em,均带有吻合支且逆行移位.结果:术后24例均成活,其中4例远端出现2em～4em水疱,换药后愈合,随访6～36个月,外观功能良好,6个月后感觉大部分恢复.结论:逆行切取带隐神经营养血管吻合支的岛状筋膜皮瓣,安全可靠,灵活性大,比较适用于修复踝足部软组织缺损.

我院自1997-06～2001-10采用单锥体复位固定系统治疗腰椎峡部裂及滑脱13例,均获得满意效果,报告如下. 1 对象和方法 1.1 对象本组男9例,女4例,年龄18～49岁,平均31.4岁;病程最长12 a,最短7个月,平均34个月;L4/52例,L5/S1 11例,Oswestry 功能障碍指数[1]65%～89%,平均76.6%,根据Meyerding分类方法[2]术前Ⅰ°滑脱5例,Ⅱ°滑脱8例.

近年来,四肢骨关节损伤较为多见,尤其近关节内骨折,若处理不当,易出现感染、肌萎缩、关节僵硬、创伤性关节炎、骨不连等并发症而影响肢体功能.自 1990年7月至2001年7月,笔者应用AO张力带内固定治疗四肢近关节内骨折419例,疗效满意.现报告如下.

半月板结构与功能的特点使其成为膝关节内最易损伤的组织之一,但是半月板损伤急性期诊断十分困难,绝大部分得不到确诊.我院自1996-05～2002-03共收治半月板损伤96例,其中78例为早期误诊,占60.9%,观察资料完整的69例分析如下.