骨保护蛋白和骨保护蛋白配体在脊柱结核病灶骨中的表达

背景：脊柱结核病灶骨组织硬化的病理过程较为复杂,其发生机制尚不明确。 目的：探讨脊柱结核病灶骨不同部位的骨保护蛋白和骨保护蛋白配体的表达。 方法：取脊柱结核患者脊柱结核术中切除的骨质,按照部位分成硬化骨组,亚正常骨组和正常骨组。应用PV-6000二步法免疫组化检测技术测定各组标本中骨保护蛋白和骨保护蛋白配体的平均吸光度及阳性面积比,并进行统计学分析。 结果与结论：脊柱结核硬化骨组骨保护蛋白平均吸光度,阳性面积比以及骨保护蛋白和骨保护蛋白配体表达的比值均显著高于亚正常骨组和正常骨组(P < 0.01或P < 0.05)。结果表明骨保护蛋白和骨保护蛋白配体的表达变化与脊柱结核病灶周围硬化骨的产生有关。     

脊柱结核外科治疗骨缺损的修复

背景：脊柱结核外科干预治疗中如何有效修复破坏之椎体,是脊柱结核治疗中的重点和难点。 目的：探讨国内目前脊柱结核病灶清除后骨缺损修复方法、骨缺损修复的有效方法及新进展。 方法：CNKI数据库检索2006/2010-01-01五年间相关脊柱结核外科治疗文献,先检索关键词“脊柱结核”,再分别以：“内固定”,“植骨”,“人工骨(材料)”,“钛网”, “骨水泥”,“人工椎体”,为关键词在以上数据中检索,根据入选条件,选择相关文献,对其文献报道病例、手术方法(包括骨修复方法)、疗效(包括治愈率、复发率、Cobb角纠正)进行统计分析。 结果与结论：自体骨(髂骨、肋骨)是脊柱结核目前骨缺损的主要修复来源,其次是钛网植骨,人工骨及人工椎体少量用于临床治疗。提示,自体骨仍是脊柱结核骨缺损修复的主要来源,是钛网植骨次之,人工骨及人工椎体有广阔的发展空间,成为将来植骨理想替代品。     

经髂骨上缘入路病灶清除植骨内固定治疗腰骶椎结核

腰骶椎结核发病率较低,约占脊柱结核的2%～3%,但腰骶椎局部解剖较为复杂,生物力学性质特殊,广泛显露较为困难,外科治疗棘手[1-2]。手术治疗的目的是彻底清除病灶、解除神经压迫、重建脊柱稳定、尽早恢复脊柱功能[3-6]。2008年5月至2011年2月,我们采用髂骨上经腹膜外入路行结核病灶清除、取自体髂骨植骨、前路椎体钉棒内固定治疗腰骶椎结核5     

一期前后联合入路治疗胸腰段脊柱结核

目的探讨前路一期结核病灶清除植骨融合联合后路钉棒系统内固定治疗胸腰段椎体结核的疗效。方法 2007年2月～2009年10月手术治疗胸腰段椎体结核13例,均采用前路一期结核病灶清除取自体髂骨植骨融合联合后路钉棒系统内固定治疗胸腰段椎体结核,根据术前、术后X线平片分析植骨融合及术后畸形矫正效果。结果经6～18个月随访,脊髓神经功能得到不同程度的恢复,植骨融合满意,无内固定失败和脊柱结核病灶复发。结论前路一期结核病灶清除植骨融合联合后路钉棒系统内固定治疗胸腰段椎体结核具有椎管减压彻底,脊柱后凸侧弯畸形易于矫正,内固定远离病灶处等特点,是治疗胸腰段椎体结核的一种有效手术治疗方法。其缺点是手术创伤相对较大[1],术中操作相对繁琐。     

经椎弓根入路不同植骨材料内固定治疗胸椎结核

背景：对于脊柱结核病灶清除后的骨质缺损,可以选择自体髂骨、自体肋骨、钛网加同种异体骨等多种植骨材料。 目的：对比椎弓根入路不同植骨材料内固定治疗胸椎结核的效果。 方法：纳入40例胸椎结核患者,其中18例伴有截瘫,15例存在后凸畸形,经正规抗结核治疗2-4周行后路椎弓根系统内固定,一期经椎弓根入路病灶清除植骨融合内固定,根据植骨材料的不同分为自体髂骨组、自体肋骨组、钛网加同种异体骨组。治疗后随访24个月,观察病灶愈合、植骨融合、截瘫恢复、后凸畸形矫正及不良反应发生率。 结果与结论：自体髂骨组植骨融合时间短于自体肋骨组、钛网加同种异体骨组(P < 0.05),后两组间植骨融合时间比较差异无显著性意义。3组均未发生植骨块及钛网脱落、断裂与移位,无骨不连及假关节等现象,无结核病灶复发。截瘫与脊柱后凸畸形患者经3-6个月的对症治疗,肌力基本恢复,脊柱后凸畸形基本矫正。表明自体髂骨治疗效果最好,自体肋骨、钛网加同种异体骨治疗效果相当。 中国组织工程研究杂志出版内容重点：生物材料;骨生物材料; 口腔生物材料; 纳米材料; 缓释材料; 材料相容性;组织工程     

后路椎弓根系统内固定并髂骨植骨修复多节段腰骶椎结核:重建稳定的腰骶段

背景:多节椎体破坏的腰骶椎结核在治疗上比较复杂,除了考虑病灶清除,解除脊髓压迫外,恢复脊柱椎体的高度及脊柱的稳定性也是必要的。目的:探讨后路椎弓根系统内固定前路一期病灶清除自体髂骨植骨修复多节段腰骶部结核的效果。方法:选择2005年3月至2012年12月收治的多节段腰骶椎脊柱结核患者25例,病变节段位于L2-S2,经正规抗结核治疗2-4周后,行一期后路椎弓根系统内固定、前路病灶清除自体髂骨植骨治疗。修复后定期复查X射线片与CT扫描,评估骨块融合和畸形矫正情况,并记录不良事件及材料宿主反应。结果与结论:修复后进行了平均16个月的随访,23例切口全部愈合,2例切口二期愈合,无窦道形成,术后所有患者腰腿痛均消失;随访期间植骨块无滑脱移位,无断钉断棒,6个月内均出现骨性融合,术后1年结核病灶无复发,血沉正常,X射线片显示病变椎体已骨性愈合。术后腰骶角为16°-36°,平均26°;末次随访时为15°-30°,平均20°。提示:一期病灶清除多节段腰骶骨结核,并同期行后路椎弓根系统内固定完成后凸畸形矫正,可重建稳定的腰骶段,恢复躯体矢面平衡,取自体髂骨植骨能提高融合率,效果满意。     

硫酸钙人工骨/骨髓间充质干细胞构建组织工程化骨诱导脊柱融合

背景：硫酸钙具有良好的组织相容性和可降解性,是一种安全有效的骨移植替代物。 目的：观察医用硫酸钙人工骨与兔骨髓间充质干细胞复合的成骨作用。 方法：取36只新西兰大白兔,行腰椎后路L4/5椎间盘摘除后,随机均分为3组,自体骨组在椎间隙植入自体髂骨,异种骨组在椎间隙植入异体脱钙小牛骨,组织工程骨组椎间隙植入医用硫酸钙人工骨与同种异体骨髓间充质干细胞复合物。植入后4,8,16周摄腰椎正侧位X射线片,观察椎体间植骨愈合及塑形情况;留取骨痂标本行组织学观察椎间植骨愈合程度;于16周对脊柱融合部位进行生物力学分析。 结果与结论：植入16周时,自体骨组椎间骨小梁连续,椎间融合基本完成,大量编织骨相互融合成片;异种骨组椎间隙形成不完全骨性融合,软骨组织大部分分化为骨组织,但中间仍为纤维组织;组织工程骨组椎间骨小梁连续,椎间融合基本完成,大量编织骨相互融合成片,人工骨基本吸收、骨化,仅有少部分残留;自体骨组、组织工程骨组失效强度和刚度均优于异种骨组(P < 0.05)。提示医用硫酸钙人工骨/骨髓间充质干细胞构建的组织工程骨具有具有良好的成骨和骨诱导作用,可以较好地促进脊柱椎体间融合。中国组织工程研究杂志出版内容重点：生物材料;骨生物材料; 口腔生物材料; 纳米材料; 缓释材料; 材料相容性;组织工程全文链接：     

带血管蒂肋骨或髂骨椎间植骨治疗胸腰椎结核

目的：探讨胸腰椎结核病灶清除术后带血管蒂的肋骨或髂骨椎间植骨的疗效。方法：手术治疗胸腰椎结核22例，首先清除病灶，其后T5～T11结核10例及T12～L1结核4例采用带肋间血管蒂的肋骨椎间植骨，L2～L5结核8例采用带旋髂深血管蒂髂骨椎间植骨。结果：本组22例术后均在2．5～3个月内愈合。随访7个月～17a，平均32．4个月，无复发。合并不全瘫的3例胸椎结核，半年后均已恢复。结论：带血管蒂肋骨或髂骨椎间植骨为活骨移植，其血运丰富，愈合快，是治疗胸腰椎结核的有效方法。     

脊柱结核外科内固定治疗的进展

近年来,由于人口的增长和耐药结核病尤其是耐多药结核病的出现与扩散[1],结核患者逐年增多.全世界有结核病患者2000万,每年新增800~1000万,每年因结核病死亡人数约300万[2].我国结核病例数居世界第二位.脊柱结核是常见的肺外结核病之一,在全部结核中占3%,在骨与关节结核中占50%~60%[3].为此已有众多学者通过大量的临床实践对脊柱结核的治疗不断改进和完善,并提出许多新的治疗方法.     

钛网植骨结合椎弓根钉棒内固定修复胸椎结核:重建脊柱生理曲度及稳定性

背景:胸椎结核经前入路或前后联合入路病灶清除、植骨、内固定是常用的修复方案,已沿用数十年,但存在创伤大、切除肋骨、减压不彻底、胸腹腔干扰大、术后疼痛、气胸、胸腔及肺部感染等不足。目的:观察钛网自体骨植骨融合与椎弓根钉棒系统内固定修复胸椎结核,重建脊柱生理曲度及稳定性的随访结果。方法:对32例胸椎结核患者采用后路椎体切除病灶清除,充分解除脊髓压迫,植入钛网自体骨,椎弓根钉棒系统内固定治疗。取后正中切口,应至少包括病变部位头、尾侧各2节脊椎,暴露双侧椎板至小关节外侧及肋骨近端1.0-2.0 cm,并与病椎头、尾侧脊椎双侧分别置入椎弓根螺钉,头、尾侧各2对,一侧固定。在另一侧病椎及下一椎切除一侧椎板、关节突、肋骨头,肋骨切除约1 cm,游离神经根,椎管减压,注意保护脊髓及神经根,吸出椎旁脓肿中脓液。切除椎弓根,受累椎间盘,椎体病灶,直至椎体病灶边缘组织外观正常,无死骨,无结核物质及肉芽组织,椎体破坏严重,两侧椎旁脓肿流注节段较多,经一侧病灶不能清除干净的部分患者,减压侧连接钉棒,以保持病变椎体切除时椎体的暂时稳定。同法从另一侧彻底清除同侧病灶,完全游离硬脊膜,反复冲洗。观察患者的植骨融合时间、骨折愈合、神经功能恢复情况及相关并发症。结果与结论:随访12-38个月,全部患者于治疗后11-19个月(平均16.3个月)植骨融合,脊柱后凸畸形获得70%-100%(平均86%)矫正,脊髓神经功能恢复正常,未出现复发及内固定失效病例。提示Ⅰ期经后路病灶清除、钛网植骨、椎弓根钉棒系统内固定修复胸椎结核,具有病灶清除彻底,创伤小,畸形矫正,植骨融合满意等优点,是修复胸椎脊柱结核的有效方案。     

Validation of pncA gene sequencing in combination with the mycobacterial growth indicator tube method to test susceptibility of Mycobacterium tuberculosis to pyrazinamide

Pyrazinamide is important in the treatment of tuberculosis. Unfortunately, the diagnosis of pyrazinamide resistance is hampered by technical difficulties. We hypothesized that mutation analysis combined with the mycobacterial growth indicator tube (MGIT) phenotypic method would be a good predictor of pyrazinamide resistance. We prospectively analyzed 1,650 M. tuberculosis isolates referred to our tuberculosis reference laboratory in 2008 and 2009. In our laboratory, the MGIT 960 system was used for pyrazinamide resistance screening. If a pyrazinamide-resistant strain was detected, we performed a pncA gene mutation analysis. A second MGIT 960 susceptibility assay was performed afterwards to evaluate the accuracy of the pncA mutation analysis to detect true- or false-positive MGIT results. We observed pyrazinamide resistance in 69 samples using the first MGIT 960 analysis. In a second MGIT 960 analysis, 47 of the 69 samples proved susceptible (68% false positivity). Sensitivity of nonsynonymous pncA mutations for detecting resistant isolates was 73% (95% confidence interval [CI], 61% to 73%), and specificity was 100% (95% CI, 95% to 100%). A diagnostic algorithm incorporating phenotypic and molecular methods would have a 100% positive predictive value for detecting pyrazinamide-resistant isolates, indicating that such an algorithm, based on both methods, is a good predictor for pyrazinamide resistance in routine diagnostics.     

Pyrazinamide resistance among South African multidrug-resistant Mycobacterium tuberculosis isolates

Pyrazinamide is important in tuberculosis treatment, as it is bactericidal to semidormant mycobacteria not killed by other antituberculosis drugs. Pyrazinamide is also one of the cornerstone drugs retained in the treatment of multidrug-resistant tuberculosis (MDR-TB). However, due to technical difficulties, routine drug susceptibility testing of Mycobacterium tuberculosis for pyrazinamide is, in many laboratories, not performed. The objective of our study was to generate information on pyrazinamide susceptibility among South African MDR and susceptible M. tuberculosis isolates from pulmonary tuberculosis patients. Seventy-one MDR and 59 fully susceptible M. tuberculosis isolates collected during the national surveillance study (2001 to 2002, by the Medical Research Council, South Africa) were examined for pyrazinamide susceptibility by the radiometric Bactec 460 TB system, pyrazinamidase activity (by Wayne's assay), and sequencing of the pncA gene. The frequency of pyrazinamide resistance (by the Bactec system) among the MDR M. tuberculosis isolates was 37 of 71 (52.1%) and 6 of 59 (10.2%) among fully sensitive isolates. A total of 25 unique mutations in the pncA gene were detected. The majority of these were point mutations that resulted in amino acid substitutions. Twenty-eight isolates had identical mutations in the pncA gene, but could be differentiated from each other by a combination of the spoligotype patterns and 12 mycobacterial interspersed repetitive-unit loci. A high proportion of South African MDR M. tuberculosis isolates were resistant to pyrazinamide, suggesting an evaluation of its role in patients treated previously for tuberculosis as well as its role in the treatment of MDR-TB.     

Drug susceptibility testing of Mycobacterium tuberculosis complex by use of a high-throughput, reproducible, absolute concentration method

Accurate drug susceptibility testing (DST) for Mycobacterium tuberculosis is highly important for both therapy guidance and surveillance of drug resistance. Although liquid medium DST methods are used increasingly and seem most efficient and fast, the high costs hamper widespread implementation. In addition, an inability to check the colony morphology of the growing bacteria is a disadvantage of these methods. Moreover, these methods discriminate only between susceptibility and resistance and do not determine the MIC. In this paper, we describe a low-cost, reproducible, high-throughput, proportional absolute concentration DST method. The method uses a concentration series of antituberculosis drugs, including pyrazinamide in 7H10 medium, distributed semiautomatically in 25-well plates. The performance of this 25-well DST method was evaluated by the World Health Organization and the International Union against Tuberculosis and Lung Disease in 10 rounds of proficiency testing regarding sensitivity, specificity, efficiency, reproducibility, and predictive value for resistance and susceptibility. The performance of the method for these characteristics was 100% for isoniazid and from 96 to 100% for rifampin, 91 to 100% for streptomycin, and 85 to 100% for ethambutol. The method was 100% reproducible for all four drugs. The levels of drug resistance and the MIC distributions for the first-line antituberculosis drugs were determined for all 7,956 M. tuberculosis strains isolated in The Netherlands from 1998 to 2005 and amounted to 7.5% for isoniazid, 1.4% for rifampin, 8.5% for streptomycin, and 1.0% for ethambutol. Pyrazinamide testing was successful for 7,026 (88.3%) of the isolates and showed a resistance level of 0.8%.     

载三联抗痨药硫酸钙/聚氨基酸人工骨植入脊柱结核病灶内：植骨界面的组织学改变

BACKGROUND: Most researchers have devoted to study the control-release system in spinal tuberculosis focus and implant material for bone defects, but the effective combination to obtain a novel implant material and its treatment outcomes are rarely reported. OBJECTIVE: To observe the histological change of the implant-bone interface after implantation of the calcium sulfate/polyaminoacid artificial bone carrying triple-anti-tuberculosis drugs including isoniazid, rifampicin and pyrazinamide in a rabbit model of spinal tuberculosis, and to assess the fusion ability of the material. METHODS: Thirty-six New Zealand rabbits were randomly divided into experiment, control and blank control groups (n=12 per group). Models of spinal tuberculosis were established in the rabbits and randomly assigned into either experiment or control groups, followed by implantation with the calcium sulfate/polyaminoacid artificial bone carrying triple-anti-tuberculosis drugs including isoniazid, rifampicin and pyrazinamide, or the calcium sulfate/polyaminoacid artificial bone, respectively. Healthy controls received the implantation with calcium sulfate/polyaminoacid artificial bone only. RESULTS AND CONCLUSION: Hematoxylin-eosin staining showed that the artificial bone was covered by fibers and tightly adhered to the wound in each group at 2 weeks after implantation, the graft started to degrade obviously at the 4th week, degraded mostly at the 8th week, and disappeared completely at the 16th week. There was obvious callus formation at 4 weeks after implantation in the experiment group, but the bone healing was later than that of the blank control group. The bone healing ended in the control group. In the blank control group, callus formation and early osteogenesis appeared at the 4th week, and healed completely at the 16th week. Transmission electron microscope and scanning electron microscope revealed that osteoblasts could crawl through the gap of materials to form new bone. These results suggest that the calcium sulfate/polyaminoacid artificial bone carrying triple-anti-tuberculosis drugs can be used as a scaffold, and osteocytes in the bone defect area can crawl through the gap of materials, thereby promoting bone osseointegration at the bone-implant interface.     

胸骨柄松质骨结合钛网支撑满足颈椎前路修复植骨需求的可行性

背景：现今临床上常用的自体植骨材料多为髂骨、胫骨、腓骨等部位的松质骨块或骨碎块。采用胸骨柄松质骨作为植骨材料融合稳定颈椎未见报道。 目的：测量国人胸骨柄标本及无明显退变的颈椎X射线侧位片,探讨胸骨柄内松质骨结合钛网植骨在颈椎前路手术中应用的可行性,为自体骨移植开发一个新的植骨材料来源。 方法：测量40具胸骨柄标本的胸骨柄长、胸骨柄最大宽、胸骨柄最小宽、胸骨柄厚、胸骨柄前皮质厚及胸骨柄后皮质厚,计算胸骨柄体积。将胸骨柄长、胸骨柄最大宽、最小宽每边减去4 mm,胸骨柄前、后皮质骨减去1 mm作为胸骨柄内松质骨取骨区(以下简称供区)边界,计算胸骨柄内供区的体积。选择106例无明显退变的中立位颈椎侧位X射线片,测量C_2~3至C₇~T₁椎间隙和C3~C7椎体高度。计算常规颈椎前路术中单间隙、双间隙、三间隙椎间盘切除,1个椎体+2个椎间盘及2个椎体+3个椎间盘切除所需钛网长度和钛网内所需植骨体积。验证供区内松质骨是否满足临床需要。 结果与结论：胸骨柄体积为(17 735.51±    5 231.93) mm³;供区松质骨体积为(8 982.83± 2 437.56) mm³。颈前路术中使用钛网最短和所需植骨量最小为单间隙植骨,所需钛网最长和所需植骨量最大为2个椎体+3个椎间隙切除。颈椎前路常用的任意一种术式中,钛网内所需盛骨体积均明显小于供区体积。提示胸骨柄内松质骨结合钛网支撑可满足大多数颈椎前路融合过程中的植骨需求。与自体髂骨植骨相比,操作更简单方便,不影响患者早期功能锻炼和负重行走。     

前方双钛网支撑植骨联合后方椎弓根内固定重建腰椎结核患者的脊柱稳定性

文题释义： 腰椎结核：常引起脓肿形成、脊髓功能障碍、脊柱失稳以及后凸畸形等并发症。临床上往往通过前路病灶清除并植骨融合内固定治疗等手术方法进行治疗,以清除病灶,解除脊髓、神经压迫,矫正后凸畸形和重建脊柱稳定性。 钛网：是由钛制成的网状结构,具有良好的支撑功能及界面稳定性,在结核导致的骨缺损部位置入后,可帮助患者恢复正常椎间隙及生理曲度。钛网中包裹的颗粒骨可通过网孔与置入部位的骨组织进行骨性融合,有助于组织的修复。 背景：常规前路病灶清除并植骨融合内固定治疗腰椎结核对患者的创伤大,且造成的并发症较多,而双钛网支撑植骨联合后方椎弓根内固定重建手术治疗可明显改善患者预后,但目前尚无临床研究对比这两种方法治疗效果的差异。 目的：对比腰椎结核经前方双钛网支撑植骨联合后方椎弓根内固定和常规前路病灶清除并植骨融合内固定治疗效果的差异。 方法：回顾性收集2015年5月至2018年3月西南医科大学绵阳市中心医院脊柱外科收治的腰椎结核患者40例的病历资料,按照治疗方案分为2组,每组20例,试验组以前方双钛网支撑植骨联合后方椎弓根内固定治疗,对照组以前路病灶清除并植骨融合内固定治疗。所有患者对治疗方案均知情同意,且得到医院伦理委员会批准。 结果与结论：①两种方法均可以有效治疗腰椎结核;②与对照组相比,试验组手术时间较短,术中出血量较少,且植骨融合较快;③随术后时间的延长,2组患者的红细胞沉降率以及病变节段的矢状面Cobb角逐渐降低,且试验组红细胞沉降率和病变节段的矢状面Cobb角略低于对照组;④经治疗后部分患者的美国脊髓损伤协会分级有所改善;⑤试验组不良反应发生率低于对照组;⑥提示双钛网支撑植骨联合后方椎弓根内固定重建可有效改善病椎的稳定性,且对于腰椎结核的治疗效果优于常规前路病灶清除并植骨融合内固定。 ORCID: 0000-0002-1584-1334(尹振宇) 中国组织工程研究杂志出版内容重点：人工关节;骨植入物;脊柱;骨折;内固定;数字化骨科;组织工程     

骨组织块法和酶消化法联合培养人成骨细胞

背景：成骨细胞培养难度大,不同培养方法得到的成骨细胞数量、纯度、增殖及分化活性各有区别。 目的：探讨理想的人成骨细胞体外培养的方法。 方法：取人髂骨松质骨,同时结合骨组织块法和酶消化法分离培养人成骨细胞。 结果与结论：分离培养的人成骨细胞生长状态良好,纯度较高。细胞贴壁生长,形态多样化,多呈多边形、纺锤型、梭形、三角形,胞浆丰富向外伸展出生长突,具有典型的成骨细胞形态特征;细胞增殖良好,碱性磷酸酶染色及矿化结节茜素红染色阳性。说明联合骨组织块法和酶消化法可成功分离培养人成骨细胞,是进行人成骨细胞体外培养较为理想的方法。 关键词：成骨细胞;原代培养;碱性磷酸酶;组织块法;酶消化法 doi:10.3969/j.issn.1673-8225.2012.07.002     

Intraosseous hibernoma: a potential mimic of metastatic carcinoma

Intraosseous hibernoma is a rare benign bone tumor, with only 3 cases reported in English literature. In this report, we describe a 50-year-old woman with a history of stage IIB breast cancer and posterolateral right hip pain. Imaging studies showed a sclerotic lesion in the right ilium, which was biopsied and showed mildly thickened bone trabeculae and multivacuolated brown fat cells replacing the normal white fat and hematopoietic elements, diagnostic of intraosseous hibernoma.     

经胸前路一期病灶清除椎间钛网植骨内固定治疗胸椎结核15例

目的探讨经胸前路一期病灶清除椎间钛网植骨内固定治疗胸椎结核的手术方法和临床效果。方法选取2006年~2012年我院收治的15例胸椎结核患者,术前行正规抗结核化疗2~3周,一期行经胸前路结核病灶清除,切除病变椎体,减压椎管,钛网椎体间植骨,并在椎体侧方采用钉棒内固定系统重建脊柱稳定性。病人术后卧床2~8周,并继续正规化疗12~18个月。观察术后腰背部疼痛缓解程度、脊髓神经功能恢复、植骨融合愈合率及结核有无复发。结果随访时间为24~36个月,平均29个月,无病例失访。14例患者手术切口一期愈合,1例术后伤口感染,经换药后完全愈合;腰背痛均得到有效缓解;术前伴有脊髓功能障碍的7例患者术后神经功能均基本恢复;所有患者植骨均融合,未见内固定失效,脊柱后凸畸形获得明显矫正且矫形得到了保持,无一例病例复发。结论经胸前路一期病灶清除椎间钛网植骨内固定治疗胸椎结核能彻底清除病灶,解除病灶对脊髓压迫,重建脊柱稳定性,取得较满意的临床疗效,是安全、确切、有效的胸椎结核手术方法。     

骨髓间充质干细胞移植治疗脊髓损伤的途径及联合方式

背景：不同途径移植骨髓间充质干细胞后脊髓损伤的功能恢复程度存在较大差异,并且单纯的骨髓间充质干细胞移植对脊髓损伤的修复作用并不理想。 目的：综述骨髓间充质干细胞修复实验性脊髓损伤的移植途径及联合治疗方式。 方法：由第一作者检索1995年1月至2011年12月 CNKI数据库和Pubmed数据库相关文献。中文检索词为“骨髓间充质干细胞,细胞移植,脊髓损伤,移植途径,联合方式”;英文检索词为“Bone marrow mesenchymal stem cells,cellular transplant,spinal cord injury,explantation channel,modality alliance”。最终选择47篇文献进行综述。 结果与结论：细胞移植治疗脊髓损伤的途径方法很多,如：损伤局部移植、经脑脊液移植、静脉移植、腹腔移植及组织工程支架移植等。组织工程支架移植效果最佳,其次是损伤原位移植、经脑脊液移植,经静脉和腹腔移植效果较差。骨髓间充质干细胞联合生物工程材料、药物、物理等手段移植治疗脊髓损伤已经得到广泛学者的认可,但对于不同损伤时间、损伤方式和损伤程度移植治疗方案需要进一步规范和评估。