Objective To investigate the clinical efficacy of microfocusing high-energy shockwave in the treatment of osteoporotic fracture . Methods Sixty patients with osteoporotic vertebral bone fractures from Jan . 2013 to Jan.2014 in our hospital were divided into the control group and the observation group according to the treatment method.Patients in the control group were treated with conservative treatment ,and the observation group was treated with microfocusing high-energy shockwave .The postoperative pain VAS scores ,vertebral height restora-tion rate,Oswestry Disability Index,Cobb angle,proximal femur BMD and adverse reactions between two groups were compared.Results The VAS score after treatment in the observation group (3.2 ±1.0) was significantly lower than that of the control group [(6.3 ±0.9),P<0.05)].The fractures of vertebral height restoration rate ,Oswestry Disability Index and Cobb angle after treatment in the observation group [ ( 23.9 ±12.1 )%, ( 25.3 ±9.4 ) °and&nbsp;(14.2 ±4.1)°] were better than those in the control group [(34.8 ±13.4)%,(56.8 ±11.2) °and (19.3 ± 3.6)°,P<0.05].The BMD of proximal femur after treatment in the observation group [(0.611 ±0.112 g/cm2)] was significantly higher than that in the control group [(0.534 ±0.107) g/cm2,P<0.05].There was no serious adverse reaction in either groups . Conclusion Microfocusing high-energy shockwaves can significantly reduce pain,improve clinical parameters ,increase bone density and prevent bone loss ,meanwhile,it can improve the quality of life of the patients with osteoporotic fractures .It is worthy for clinical application .

Objective To explore the effectiveness of different operative approaches on thoracolumbar multiple level spinal fracture (MSF). Methods Data of 48 patients with thoracolumbar MSF in our hospital from Nov.2009 to Nov.2015 was retrospectively analysed.Twenty-eight cases recievced the posterior operative approach surgery and another 20 cases received anterior approach sugery.There was no significant difference between two groups in age,gender,complicated injury and the type of fracture.Indexes including the perioperative results,bone reduction,spinal nerve function and pain score were compared. Results The cases were followed up for 18 months on average.There were significant differences in bone reduction[(33.14±4.73) in posterior approach and (30.74±3.83) in anterior approach] and Cobb angle [(5.31±2.51) in posterior approach and (5.48±2.41) in anterior approach] when compared with before operation,but had no remarkable difference between two groups.There was no significant difference between two groups in spinal nerve function except for the motional function,with (67.31±2.51) in posterior approach and (78.48±2.41) in anterior approach.The anterior approach was worse than posterior in surgery time and perioperative bleeding but better in pain score. Conclusion Both operative approches are effective interventions for thoracolumbar MSF.There is no significant difference in bone reduction and spinal nerve function.But the anterior approach could do better in motional funtion.We beilive anterior appoarch is suitable in MSF with heavy nerve injury.

目的 探讨腰椎术后反应性疼痛与引流液中炎症因子的相关性.方法 2012年3月-7月,40例单节段腰椎椎间盘突出患者在本院行单节段腰椎后路椎板减压、椎间盘切除、椎间植骨融合内固定术.其中出现术后非切口部位的腰臀部或下肢疼痛13例.于术后1～3d连续记录出现非切口部位疼痛的视觉模拟量表(VAS)评分.术后1～3d连续留取伤口引流液,检测伤口局部炎症因子白介素-1β(IL-1β)、白介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)水平及外周血炎症因子水平;术后1～3d连续检测红细胞沉降率(ESR)、C反应蛋白(CLP).通过统计学分析,探讨炎症因子与疼痛程度、ESR及CRP的相关性.结果 引流液IL-1β,IL-6,TNF-α水平与术后疼痛VAS评分呈正相关,而与血液中炎症因子水平无相关性,与ESR,CRP无相关性.结论 腰椎术后反应性疼痛与术后引流液中IL-1β,IL-6,TNF-α水平显著相关,提示疼痛与术后炎症因子的局部增加有密切的关系.

BACKGROUND: Platelet-rich plasma gel serves as a three-dimensional scaffold in which stem cel s can exhibit a three-dimensional growth. Meanwhile, platelet-rich plasma gel can release large amounts of growth factors to promote the proliferation and differentiation of adipose-derived mesenchymal stem cel s. OBJECTIVE: To explore the repair effect of injection of autologous platelet rich plasma-adipose derived mesenchymal stem cel s complex on rabbit intervertebral disc degeneration. METHODS: Rabbit arterial blood was extracted to prepare autologous platelet-rich plasma using secondary centrifugal method, and adipose-derived mesenchymal stem cel s were isolated from the fat tissue of rabbit scapular area. Then, adipose-derived mesenchymal stem cel s-platelet-rich plasma gel complex was prepared. New Zealand white rabbits were randomized into control group, model group, platelet-rich plasma gel group and complex group (adipose-derived mesenchymal stem cel s-platelet-rich plasma gel complex). Intervertebral disc degeneration model was made in the latter three groups using puncture method. At 2 weeks after modeling, corresponding materials were injected into the disc in the four groups, respectively. RESULTS AND CONCLUSION: After intervertebral disc degeneration in rabbits, the intervertebral gap was significantly reduced, the nucleus pulposus signal was obviously decreased, nucleus pulposus matrix appeared to have a high density and to be deeply stained. The symptoms above mentioned were improved significantly after intervention with the platelet-rich plasma gel or the complex of adipose-derived mesenchymal stem cel s-platelet-rich plasma gel, while the latter was better in curative effects. Injection of platelet-rich plasma gel and adipose-derived mesenchymal stem cel s-platelet-rich plasma gel complex can reduce the influence of disc degeneration, and the effect of adipose-derived mesenchymal stem cel s-platelet-rich plasma gel complex is more outstanding.

Objective:To compare proximal femoral nail antirotation-Ⅱ(PFNA-Ⅱ)with InterTan proximal femoral intramedullary nail(PFIN)in the clinical curative effects and safety for the treatment of intertrochanteric fractures in old patients.Methods:The medical records of 68 old patients who underwent surgery for intertrochanteric fractures were analyzed retrospectively.Forty-four patients(PFNA-Ⅱgroup)underwent PFNA-Ⅱfixation,while the others(InterTan group)underwent InterTan PFIN fixation.The 2 groups were compared with each other in such parameters as operative time,blood loss,differences of hemoglobin(HGB)between pre-operation and post-operation,hospital stay,Harris scores at last follow-up and incidence rate of complications.Results:The operative time and blood loss of PFNA-Ⅱgroup were all lower than those of InterTan group respectively[(70.81±11.34)min vs(82.92±16.74)min,t=-3.160,P=0.003;(135.81±49.05)mL vs(180.80±92.91)mL,t=-2.246,P=0.032];while there were no statistical differences in HGB differences between pre-operation and post-operation and hospital stay between PFNA-Ⅱgroup and InterTan group respectively[(20.68±8.49)g·L-1 vs(24.46±11.12)g·L-1,t=-1.542,P=0.128;(11.29±3.33)d vs(11.33±2.77)d,t=-0.047,P=0.962].The patients in the 2 groups were all followed up for 9 to 23 months with a median of 18.5 months.There was no statistical difference in Harris scores between PFNA-Ⅱgroup and InterTan group at the last follow-up[(83.20±5.03)vs(85.44±11.14),t=-0.459,P=0.658].At last follow-up,5 patients in PFNA-Ⅱ group and 2 patients in InterTan group felt occasional affected limbs vague pain,which didn′t influence their daily activities.The pulmonary infection were found in 5 patients in PFNA-Ⅱgroup and 3 patients in InterTan group.No complications including bedsore,venous thromboembolism and failed internal fixation were found in the 2 groups.There was no statistical difference in complication rate between the 2 groups(χ2=0.000,P=1.000).Conclusion:Both PFNA-Ⅱfixation and InterTan PFIN fixation are safe and effective treatment for intertrochanteric fractures in old patients,while the former is relatively easy to operate.

BACKGROUND: Research has shown that artificial dura applied for prevention and reduction of lumbar postoperative scarring has achieved good results, but whether it can reduce the releasing of inflammatory cytokines after lumbar surgery is not clear at present.OBJECTIVE: To explore the effects of artificial dura on concentration of inflammation factors in blood and drainage fluid after lumbar surgery.METHODS: A total of 40 patients with prolapse of lumbar intervertebral disc and lumbar spinal stenosis in the Institute of Orthopedics and Traumatology, General Hospital of Beijing Military Area Command of Chinese PLA between March and July 2012, who underwent posterior lumbar decompression, intervertebral disk removal and intervertebral fusion internal fixation, were selected. They were randomly assigned to two groups. Patients using the artificial dura were considered as the experimental group, while the others were considered as the control group. In addition, an additional 10 healthy volunteers were tested as the blank control group. The concentrations of interleukin-1β, interleukin-6 and tumor necrosis factor-α in the blood samples were determined before surgery, at 2 and 3 days following surgery in the three groups. Enzyme-linked immunosorbent assay was used to measure mass concentrations of interleukin-1β, interleukin-6 and tumor necrosis factor-α in drainage fluid at 1, 2 and 3 days after surgery in the experimental and control groups.RESULTS AND CONCLUSION: (1) Drainage fluid: the concentration of interleukin-1β, interleukin-6 and tumor necrosis factor-α at different time points in experimental group was significantly lower than that in the control group (P < 0.05), and there were no fever, allergies or foreign body rejection in the experimental group. Patients in experimental group had a less oozing compared with the control group (P < 0.05). (2) Blood: the concentrations of interleukin-1β and tumor necrosis factor-α were significantly lower in the experimental group than those in the control group at 3 days (P < 0.05). The concentrations of interleukin-1β, interleukin-6 and tumor necrosis factor-α in the experimental and control groups were significantly higher than those in the blank control group at various time points (P < 0.05). These results suggested that artificial dura can reduce the concentrations of interleukin-1β, interleukin-6 and tumor necrosis factor-α after lumbar surgery in fluid drainage, and slightly decrease the concentrations of inflammatory factors in peripheral blood.