目的 探讨成人退行性脊柱侧凸(ADS)患者术后发生近端交界性脊柱后凸(PJK)的危险因素.方法 回顾性分析2013-01-2019-01 在郑州大学第一附属医院骨科行后路长节段椎体内固定融合术治疗的 98 例ADS患者的基线资料及影像资料.根据PJK定义,将其分为PJK组与非PJK组.采用t检验及χ2 检验比较2 组数据之间临床特征和影像学资料的差异,并进行单因素和多因素Logistic回归分析,探讨PJK发生的独立危险因素.结果 融合节段数、术前骶骨倾斜角、术前矢状面垂直轴、矢状面垂直轴减少值、术后近端交界角,为ADS患者术后PJK的独立危险因素(P＜0.05).结论 脊柱侧弯后路融合手术前,应仔细评估患者影像资料,在保证手术疗效与减少术后并发症之间达到相对平衡.

Objective This study aimed to investigate the relationship of the K-line with sagittal cervical curvature changes and surgical outcomes in patients with cervical ossification of the posterior longitudinal ligament (OPLL). Methods We retrospectively reviewed 84 patients with OPLL who underwent posterior cervical single-door laminoplasty. The patients were divided into a K-line-positive (+) group and a K-line-negative (−) group. Perioperative data, radiographic parameters, and clinical outcomes were compared between the two groups. Results Of 84 total patients, 50 patients were in the K (+) group and 29 patients were in the K (–) group. Neurological function improved in both groups after laminoplasty. The C2–7 Cobb angle, T1 slope, and C2–7 sagittal vertical axis were significantly changed in the K(−) group compared with those in the K (+) group before the operation and at the 3-month and final follow-ups. Conclusion Neurological function was recovered in both groups, and the clinical effect on the K (+) group was better than that on the K (−) group. The cervical curvature in patients with OPLL tends to be anteverted and kyphotic after laminoplasty and is an important factor in reducing the clinical effect.

BACKGROUND: Ankylosing spondylitis (AS) often re-sults in progressive spinal stiffness, making patients prone to spinal fractures. Cervical spine fractures in AS mostly occur in the lower segment and cause progressive neurological deficits. However, the optimal approach to treating this patient population is still controversial, and it is unclear what factors have an impact on prognosis. Thus, this study aimed to investigate the choice of surgical approach and prognostic factors in AS patients with cer-vical spine fractures.METHODS: A total of 22 AS patients with cervical fracture who were treated in our institution were reviewed from 2015 to 2020. We analyzed demographic data, peri-operative complications, postoperative results, and radio-graphic results. The Japanese Orthopaedic Association (JOA) score was used to assess preoperative and post-operative spinal cord function, and the improvement rate was calculated.RESULTS: Twenty-two patients were enrolled, including 6 patients in the anterior approach group, 11 in the poste-rior approach group, and 5 in the combined approach group. The operative time and intraoperative blood loss in the anterior approach group were significantly less than those in the posterior approach group and combined approach group (P = 0.00). Patients who underwent sur-gery within 48 hours of injury had a lower JOA score than patients who underwent surgery later (P = 0.01). Basic AS treatment before injury significantly improved JOA scores after surgery (P = 0.01).CONCLUSIONS: All approaches can provide good clin-ical results, and thus, the surgical approach should be individualized. It remains unclear whether the operation should be performed as soon as possible. Basic AS treat-ment is an independent factor that affects the prognosis of cervical spine fracture patients with AS.

Abstract Background: Schwann cells respond to nerve injury by transforming into a cell phenotype that promotes repair. These repair Schwann cells provide the essential signals and spatial cues to encourage axonal regeneration and induce target reinnervation. Endothelial cells (ECs), another crucial component of nerve tissue, contribute to the formation of regenerative microenvironment. Therefore, the way to control these peculiar cells, amplify their supportive functions and prevent their deterioration could be remarkable for the treatment of injured peripheral nerves. As the vital information mediators in the nervous system, exosomes have been proposed to take a significant role in regulating regeneration.Results: In the present study, we collected exosomes from media of ECs. We demonstrated that exosomes derived from ECs possessed the favorable neuronal affinity both in vitro and in vivo. Further research indicated that EC-exosomes could boost and maintain repair-related phenotypes of Schwann cells, thereby enhancing axonal regeneration, myelination of regenerated axons and neurologically functional recovery of the injured nerve. We found some highly enriched miRNAs in EC-exosomes, including let-7f-5p, miR199-5p and miR-3074-5p by the sequencing of miRNAs. In addition, miRNA sequencing in EXO-treated Schwann cells and control Schwann cells indicated that EC-exosomes significantly up-regulated the expression of miR199-5p. Furthermore, this study demonstrated that EC-exosomes drove the conversion of Schwann cell phenotypes in a PI3K/AKT/PTEN-dependent manner. Conclusion: In conclusion, our research indicates that the internalization of EC-exosomes in Schwann cells can promote nerve regeneration by boosting and maintaining the repair-related phenotypes of Schwann cells. And the mechanism may be relevant to the regulation of miRNAs and activation of PI3K/AKT/PTEN signaling pathway.

PURPOSE:Genetic diagnosis is a promising approach because several single-nucleotide polymorphisms (SNPs) associated with adolescent idiopathic scoliosis (AIS) progression have been reported. We review the predictive value of SNPs in curve progression of adolescent idiopathic scoliosis.METHODS:We reviewed DNA-based prognostic testing to predict curve progression. Then, the multiple polymorphisms in loci related to AIS progression were also reviewed, and we elucidated the predictive value of SNPs from four functional perspectives, including endocrine metabolism, neuromuscular system, cartilage and extracellular matrix, enzymes, and cytokines.RESULTS:The ScoliScores were less successful predictors than expected, and the weak power of predictive SNPs might account for its failure. Susceptibility loci in ESR1, ESR2, GPER, and IGF1, which related to endocrine metabolism, have been reported to predict AIS progression. Neuromuscular imbalance might be a potential mechanism of scoliosis, and SNPs in LBX1, NTF3, and SOCS3 have been reported to predict the curve progression of AIS. Susceptibility loci in SOX9, MATN1, AJAP1, MMP9, and TIMP2, which are related to cartilage and extracellular matrix, are also potentially related to AIS progression. Enzymes and cytokines play essential roles in regulating bone metabolism and embryonic development. SNPs in BNC2, SLC39A8, TGFB1, IL-6, IL-17RC, and CHD7 were suggested as predictive loci for AIS curve progression.CONCLUSIONS:Many promising SNPs have been identified to predict the curve progression of AIS. However, conflicting results from replication studies and different ethnic groups hamper their reliability. Convincing SNPs from multiethnic populations and functional verification are needed.

Abstract Background: Most prior studieshave used conventional statistical techniquessuch asthe nomogram to examine patient prognosis and survival based on the distinct subtypes and primary locations of chondrosarcoma. Nevertheless, few studies have examined overall survival in patients with non-metastatic chondrosarcomas. We aim to develop a machine learning algorithm to evaluate 5-year survival in this cohort and transform the most accurate prediction model into an online calculator for clinical use. Methods: Between 1975 and 2018, we gathered data on patients with non-metastatic chondrosarcoma from the Surveillance, Epidemiological, and End Result databases. From these data, nine features were used to develop four machine learning models, including the boosted decision tree, support vector machine, bayes point machine, and neural network models, which were then evaluated and compared based on discrimination, calibration, and overall performance. Results: Ultimately, 1202 patients met our inclusion criteria. With a c statistic of 0.88, a calibration slope of 0.997, a calibration intercept of -0.02, and a Brier score of 0.12, the Bayes point machine performed best overall, and it was integrated into a free, publicly available software interface that can be found at https://bayesglm.shinyapps.io/non-metastatic-chondrosarcoma/. Conclusion: Although this Bayes point machine-based prediction model has not been externally validated, the online calculator can be used as a reference tool for medical staff as well as patients on survival prediction. External validation of this prediction model should be the focus of future research to improve its credibility.

Abstract Background: Chondrosarcoma is a rare type of bone tumor which more commonly found in adults range from 40 to 60 years old. Few studies has described the characteristic and prognostic factors of patients older than 60 years. This study aimed to study this feature and identify the prognostic factors based on SEER database.Methods: Thus, we collected clinicopathological data of chondrosarcoma patients in the Surveillance, Epidemiology, and End Results registry database from 1975 to 2018, and then use the Kaplan-Meier to analyze the patients’ survival. We also utilize Cox proportional hazard model to explore the prognostic factors and relevant characteristic including patients’ baseline demographics (age, race, and gender), tumor characteristics (tumor extension, histologic subtype, therapy, primary site, stage and grade.Results: After the implementation of exclusion criteria, there were 610 patients with chondrosarcoma older than 60 years. Our data showed that the incidence of chondrosarcoma is slightly higher in men than in women (52.3% vs 47.7%). In general, 90.8% of tumor had metastasized to distant sites. Meanwhile, 41.8% of tumors occurred in axial location (pelvis, spine, and ribs), 50.8% of tumors occurred in extremity (long or short bones of the upper or lower extremity), and 7.4% in other location (mandible, skull, and other atypical locations). Dedifferentiated chondrosarcoma (hazard ratio [HR] =2.553; 95% confidence interval [CI]= 1.754-3.716), grade (g2:HR:=1.299; 95% CI:=0.888-1.900, g3:HR=1.839;95% CI= 1.174-2.881, g4:HR=3.284,95%CI=2.053-5.253), distant metastasis (HR=3.264; 95% CI= (2.288-4.058), non-surgery perform (HR = 2.854; 95% CI= 2.022-4.028) were independent risk factors for 5-year overall survival.Conclusion: In conclusion, higher grade, non-surgery perform, dedifferentiated chondrosarcoma and distant metastasis indicated worse prognosis survival. Surgery can significantly improve the survival time of patients.

OBJECTIVE:To compare the clinical and radiologic outcomes of patients with different 3-dimensional (3D) hemivertebra morphologies undergoing posterior-only hemivertebra resection and fusion. METHODS:The files of patients with congenital scoliosis (CS) due to single hemivertebra undergoing posterior-only hemivertebra resection and fusion from January 2010 to January 2018 were reviewed. After evaluating the 3D computed tomography images, CS patients were divided into a unison hemivertebra group and a discordant hemivertebra group. Clinical outcomes, radiologic outcomes, and incidence of complications were compared. RESULTS:A total of 42 consecutive patients with CS patients due to a single hemivertebra undergoing posterior-only hemivertebra resection and fusion were included in this study. The Cobb angle of the segmental curve was significantly improved postoperatively and at the last follow-up in both groups (all P < 0.05). At both postoperation and the last follow-up, no significant differences were found in the incidence of complications, Cobb angle of the segmental curve, correction rate of the segmental curve, or other radiologic outcomes between the unison hemivertebra group and discordant hemivertebra group (all P > 0.05). Compared with the unison hemivertebra group, increased operation time (P = 0.006) and intraoperative blood loss (P = 0.037) were found in the discordant hemivertebra group. CONCLUSIONS:For CS patients with unison hemivertebra or discordant hemivertebra, satisfactory radiologic results were obtained by posterior-only hemivertebra resection and fusion. In terms of surgery, the radiologic outcomes of discordant hemivertebra patients were similar to those of unison hemivertebra patients, but discordant hemivertebrae could easily result in longer operation time and more intraoperative blood loss.