Clinical analysis of 73 cases of intraspinal nerve sheath tumor

Seventy-three patients with spinal nerve sheath tumor who were surgically treated in our hospital during the years 2004-2010 were retrospectively reviewed with respect to recovery of neurological function, recurrence of the tumor and occurrence of kyphotic deformities. Preoperative clinical manifestations, imaging data, surgical records and follow-up results were comprehensively analyzed. The follow-up duration was 12-60 months with an average of 32.0 months. Out of the 73 cases enrolled, 69 had gradual recovery of sensation, motor and sphincter functions 1 week to 3 months after operation. Forty-six cases had incomplete paralysis, whose American Spinal Injury Association (ASIA) grades, however, were gradually increased during the follow-up period, 4 cases had no significant improvement of the clinical symptoms and no change in ASIA grades during the follow-up period. Two cases had postoperative recurrence of the tumor. There were no deaths, no spinal instability, and no kyphotic malformations found in any cases. Our study indicated that complete removal of the tumor is important for good recovery, and an ideal surgical method may reduce the recurrence of the tumor or the occurrence of complications.     

关节镜下钮扣钢板固定四股半腱肌重建膝关节前交叉韧带

目的 探讨关节镜下钮扣钢板固定四股半腱肌重建膝关节前交叉韧带的治疗效果。方法 关节镜下四股半腱肌重建膝关节前交叉韧带20例。术前MRI证实膝关节前交叉韧带断裂,术中关节镜下均证实膝关节前交叉韧带断裂,四股半腱肌重建者用钮扣钢板固定。结果 平均随访7个月,无1例打软腿,假交锁症状消失,关节痛消失。X线见内固定物与术后一致,无移位。Lysholm膝关节功能评分：术前平均54.5,随访评分95.6。结论 关节镜下四股半腱肌重建膝关节前交叉韧带临床效果好,并发症少,手术时间短。     

联合应用粒细胞集落刺激因子和干细胞因子促进骨髓单个核细胞增殖和动员的实验研究

目的 探讨联合应用粒细胞集落刺激因子(G-CSF)和干细胞因子(SCF)对小鼠骨髓单个核细胞(BM-MNCs)增殖和动员的影响.方法 将昆明种小鼠随机分为4组(n=10):①G-CSF组,皮下注射重组鼠粒细胞集落刺激因子(rmG-CSF)100 μg/(kg·d),连续使用5 d;②SCF组,皮下注射重组鼠干细胞因子(rmSCF)25 μg/(kg·d),连续使用5d;③G-CSF/SCF组,皮下注射rmCrCSF 100μg/(kg·d)和rmSCF 25 μg/(kg·d),连续使用5 d;④空白对照组,皮下注射等剂量的生理盐水.于最后一次注射后6 h取小鼠骨髓,分离培养MNCs,在倒置相差显微镜下观察MNCs的生长情况,用苏木精-伊红常规染色和细胞荧光免疫化学法染色观察MNCs形态.计数成纤维样细胞集落形成单位(CFU-F)的个数;应用流式细胞仪检测MNCs细胞周期及表面抗原特征.结果 G-CSF/SCF组和G-CSF组,CFU-F形成能力显著增强(均P<0.05);并且G-CSF/SCF组的CFU-F计数大于G-CSF组(P<0.05).而SCF组CFU-F计数并没有显著地增加(P0.05).MNCs培养形成的CFU-F,其细胞表面抗原呈CD13+、CD29+、CD90+、CD105+,而不表达CD44.G-CSF/SCF组的MNCs,其G0/G1期细胞百分率较对照组低(P<0.05),而细胞增殖指数(PI)增高(P<0.05),SCF组对MNCs细胞周期的作用与对照组相比差异没有统计学意义(P0.05).结论 G-CSF/SCF可有效地诱导BM-MNCs增殖和动员,且其作用强于单独应用G-CSF.而单独应用小剂量SCF对促进BM-MNCs增殖和动员的作用不明显.     

Induction of chondrogenesis of adipose-derived stem cells by novel recombinant TGF-β3 fusion protein

A new type of TGF-β3 fusion protein with targeted therapy function was constructed,and its feasibility and target specificity of inducing chondrogenesis were investigated by transfecting LAP-MMP-mTGF-β3 gene into adipose-derived stem cells (ADSCs).The recombinant pIRESEGFP-MMP was constructed by inserting the sense and antisense DNA of encoding the amino acid of the synthetic MMP enzyme cutting site into the eukaryotic expression vector pIRES-EGFP.LAP and mTGF-β3 fragments were obtained by using RT-PCR and inserted into the upstream and downstream of MMP from pIRES-EGFP-MMP respectively,and the recombinant plasmid of pIRES-EGFPLAP-MMP-mTGF-β3 was constructed,which was transferred to ADSCs.The ADSCs were cultured and divided in three groups:experimental group (MMP group),negative control group (no MMP) and non-transfection group.The morphological changes were observed microscopically,and the expression of proteoglycan and type Ⅱ collagen (ColⅡ) was detected by using Alcian blue staining and immunohistochemistry staining at 7th,14th and 21st day after culture.The recombinant plasmid of pIRES-EGFP-LAP-MMP-mTGF-β3 was correctly constructed by methods of enzyme cutting and sequencing analysis.The mTGF-β3 fusion protein was successfully expressed after transfection,and in the presence of the MMP,active protein mTGF-β3 was generated,which significantly promoted differentiation of ADSCs into chondrocytes and the expression of cartilage matrix.The novel fusion protein LAP-MMP-mTGF-β3 can targetedly induce differentiation of ADSCs into chondrocytes,which would open up prospects for target therapy of cartilage damage repair in future.     

同种异体骨支撑架结合自体骨和DBM治疗股骨头坏死

目的探讨同种异体骨支撑架植入结合自体松质骨和脱钙骨基质（DBM）治疗成人股骨头坏死初步疗效。方法采用经大转子下通过股骨颈钻隧道至股骨头骨坏死区，将装有自体松质骨和DBM的同种异体骨支撑架经隧道置入骨坏死区直至软骨下骨约5mm处，隧道远端用自体髂骨填塞。结果经临床应用23例24个髋关节，随访12～27个月，并按成人股骨头缺血性坏死疗效百分评价法进行评价，优良率为95.8％。结论同种异体骨支撑架植入结合自体松质骨和DBM治疗成人股骨头坏死具有以下优点：①手术操作简单，不破坏患者股骨头本身的血液供应，创伤小，且不增加日后行人工关节置换的困难；②将具有骨诱导活性的DBM直接放入骨坏死区，成骨作用强；③增加股骨头负重区软骨下骨的机械支撑，降低局部应力，有利于股骨头坏死的修复及重建。     

同种异体骨支撑架结合自体骨和DBM治疗股骨头坏死的生物力学研究

[目的]研究同种异体骨支撑架结合自体骨和脱钙骨基质（decalcified bone matrix，DBM）植入治疗股骨头坏死生物力学变化。[方法]建立羊双侧股骨头坏死模型，4周后分为4组：单纯行髓芯减压组（A组）、髓芯减压后植入自体松质骨和OSTEOSET^2 DBM组（B组）、髓芯减压后植入同种异体骨支撑架／自体松质骨OSTEOSE^2 DBM组（C组）和正常对照组。术后分别于5、10、20周对股骨头行影像学、组织学观察和生物力学测定。[结果]影像学和组织学检查结果显示C组在髓芯减压区骨缺损修复及成骨方面较B组略高，B、C两组都较同时期的A组明显增强。生物力学测试结果表明，术后5、10、20周时C组力学强度较A、B两组明显增高．差异有统计学意义（P〈0．05），在10、20周时C组股骨头生物力学强度和正常股骨头己无明显差异。[结论]应用同种异体骨支撑架结合自体骨和脱钙骨基质治疗股骨头坏死，能有效加强股骨头的力学结构，促进坏死骨的修复，防止股骨头关节面的塌陷。     

两种强化股骨头力学结构治疗股骨头坏死临床疗效比较

[目的]比较同种异体骨支撑架/自体松质骨/脱钙骨基质（DBM）与钛合金支撑架/自体松质骨/脱钙骨基质（DBM）分别植入行髓芯减压后的股骨头,强化其力学结构,治疗股骨头坏死的疗效。[方法]2001年1月～2004年8月治疗成人股骨头坏死（FicatⅠ～Ⅲ期）63例（68髋）,在股骨头坏死行髓芯减压后分别植入同种异体骨支撑架/自体松质骨/DBM（A组）和钛合金支撑架/自体松质骨/DBM（B组）,A组32例（34髋）,B组31例（34髋）,分别观察2组病例的手术时间、术中出血量、Harris髋关节评分、X线影像学进展情况及并发症的发生率。[结果]两组所有患者均获得随访,平均随访47个月（24～67个月）,以最后1次随访资料作为最终评价依据。两组在手术时间、术中出血量、Harris评分变化、X线影像学进展情况及并发症的发生率方面均无显著性差异,但两组术后的Harris评分均较术前明显提高,差异有显著性。[结论]同种异体骨支撑架结合自体松质骨和DBM植入治疗成人股骨头坏死,和钛合金支撑架一样能增加股骨头负重区软骨下骨的机械支撑,有利于股骨头坏死的修复与重建。能用同种异体骨支撑架代替钛合金支撑架以加强股骨头软骨下骨的机械强度治疗股骨头坏死。     

缝隙连接阻断剂1-庚醇对小鼠骨髓基质干细胞体软骨分化的影响

[目的]研究缝隙连接阻断剂1-庚醇对小鼠骨髓基质干细胞体外软骨分化的影响。[方法]体外培养小鼠骨髓基质干细胞(MSCs),贴壁细胞传代,取第3代细胞,以生长分化因子-5(GDF-5)(100ng/ml)和1-庚醇(2.5μmol/L)干预培养后,MTT法测定1-庚醇对小鼠骨髓基质干细胞增殖的影响,RT-PCR和免疫细胞化学法检测Ⅱ型胶原的表达,Westernblotting检测Cx43蛋白的表达,阿尔辛蓝(Alcian)染色蛋白多糖。[结果]MTT结果显示2.5μmol/L浓度1-庚醇对小鼠MSCs的增殖不产生影响,对细胞没有毒性抑制作用;RT-PCR和免疫细胞化学显示1-庚醇能够抑制Ⅱ型胶原mRNA和蛋白的表达;Alcian染色结果显示1-庚醇抑制分化细胞分泌蛋白多糖基质;Western blotting结果表明1-庚醇对Cx43蛋白的表达没有作用。[结论]GDF-5能够定向诱导小鼠骨髓基质干细胞向软骨方向分化,Cx43蛋白介导的缝隙连接细胞间通讯在GDF-5诱导软骨分化中发挥着很重要的作用。     

Caspase-3在间质干细胞分化过程中的基因芯片分析及体外作用

目的 观察Caspase-3在小鼠胚胎肢芽间质干细胞分化过程中的作用,并将其运用于体外间质干细胞模型中进行验证.方法 用基因芯片技术检测Caspase-3在小鼠胚胎肢芽间质干细胞分化过程中的基因表达,分析其表达规律和可能作用;Yg用Caspase-3活性检测试剂盒,荧光比色法和Western blot法检测体外培养的骨髓间质干细胞诱导失巢凋亡中Caspme-3活性的改变;借助流式细胞仪分析骨髓间质干细胞凋亡的变化.结果 Caspase-3在小鼠胚胎肢芽间质干细胞向软骨分化的关键期(E12)出现显著的表达下调;Caspase-3的活性以及蛋白表达水平随诱导凋亡时间的延长而明显升高,且与细胞凋亡率相关.结论 Caspase-3蛋白在体内和体外诱导间质干细胞凋亡的过程中均发挥着重要作用;胚胎发育过程中,通过下调Caspase-3的表达以促进软骨形成,而抑制Caspase-3的活性可以有效降低细胞凋亡率.     

Clinical observation of particulate cancellous bone impaction grafting in combination with total hip arthroplasty for acetabular reconstruction

Objective： To investigate the effect of particulate cancellous bone impaction grafting in combination with total hip arthroplasty （THA） for acetabular reconstruction in patients with posttraumatic arthritis and bone loss after acetabular fractures.
Methods： Totally 15 consecutive cases with unilateral acetabular fracture were treated with bone impaction grafting in combination with THA in our department. There were 10 males and 5 females with mean age of 48.2 years （ranging from 36 to 73 years）. Eight cases had the fracture at left hips, 7 at right hips. The average age at injury was 28 years （ranging from 18 to 68 years）. The mean follow-up period was 4.3 years （ranging from 2 to 7 years）. Results： Compared with mean 42 points （ranging from 10 to 62） of the preoperative Harris score, the survival cases at the final follow-up had mean 84 points （ranging from 58 to 98）. One patient had mild pain in the hip. No revision of the acetabular or femoral component was undertaken during the follow-up. Normal rotational centre of most hips was recovered except 2 cases in which it was 0.8 mm higher than that in opposite side. All of them had a stable radiographic appearance. Progressive radiolucent lines were observed in Ⅰ,Ⅲ zones in 2 cases. One patient had a nonprogressive radiolucent line in zone Ⅲ. The cup prosthesis was obviously displaced （6 mm） in one patient, but had not been revised.
Conclusion： Particulate cancellous bone impaction grafting in combination with THA as a biological solution is an attractive procedure for acetabular reconstruction in patients with posttraumatic arthritis and bone loss after acetabular fracture, which can not only restore acetabular bone stock but also repair normal hip anatomy and its function.