Generation and characterization of highly purified canine Schwann cells from spinal nerve dorsal roots as potential new candidates for transplantation strategies

Schwann cells are promising candidates for transplantation strategies in the central nervous system by promoting axonal regeneration. The dog represents a translational model for human spinal cord injury (SCI) for studies with new repair strategies after intervertebral disk herniation (IVDH). To overcome the necessity for an additional surgical procedure, for the first time a protocol for the isolation and purification of canine Schwann cells from spinal nerve biopsies during standard hemilaminectomy in IVDH‐affected paraplegic dogs for potential transplantation has been developed. Purity was assessed by flow cytometry. The results were compared with biopsies from dogs without SCI. Within 26 ± 4 days, 90.2 ± 8.8% p75 neurotrophin receptor (p75^NTR)‐positive cells were achieved in IVDH dogs. The total cell count in acute/subacute and chronic IVDH (acute/subacute: 6.82 ± 6.36 × 10⁶; chronic: 2.29 ± 2.00 × 10⁶) differed significantly (p = 0.0120) at the potential time point of transplantation. No differences in culture period and purity were detected between dogs with and without IVDH. Despite the small sample size and the altered environment, the isolation of Schwann cells was successful. Negative influences on isolation and purification due to potential pathological changes at the biopsy site of IVDH‐diseased dogs were ruled out by comparison of Schwann cell pellets from diseased and control dogs. Finally, the functionality of Schwann cells from dogs with IVDH was outlined in co‐culture experiments with canine dorsal root ganglion neurons. In conclusion, nerve root biopsies provide a sufficient number of highly purified and functional Schwann cells within a useful time period for novel therapeutic strategies in dogs with SCI.     

腰椎间盘突出症患者术后康复锻炼自我效能及其影响因素的调查

目的 描述腰椎间盘突出症患者术后康复锻炼自我效能水平,分析患者术后康复锻炼自我效能的影响因素。方法 采用方便抽样法选取2016年1月至6月在上海市第六人民医院骨科脊柱外科病区实施腰椎后路减压融合内固定术的患者120例为研究对象。采用自行设计患者一般资料量表、一般自我效能感量表和腰椎JOA评分表分别于患者术前和术后6个月对患者进行调查。结果 数据的单因素分析可以看出,自我效能感与职业,家庭成员之间关系,医疗费用来源,年龄,体重指数以及腰椎JOA术后评分,改善指数和改善率是相关的。数据的多元线性回归分析显示：职业,年龄,体重指数和改善指数是自我效能感的影响因素。结论 护理人员对职业为农民或家务的患者、年龄较大的患者、体重指数较高的患者给予更多的康复指导和鼓励,以提高患者的康复锻炼自我效能水平和增强康复效果。     

针灸治疗腰椎间盘突出症临床研究概况

腰椎间盘突出症的发病机制为在肾气亏虚的基础上受到外力损害,或风寒湿等外邪侵袭,经络受到闭阻,气血在瘀血阻滞的作用下运行不畅,筋骨得不到有效的濡养,疼痛在不同的情况下产生,造成脊柱内外阴阳失衡,最终导致腰椎间盘突出症的发生.辨证多与脾肾精血亏虚、督脉失养有关.疼痛部位多位于督脉及膀胱经循行部位,针灸取穴多取此两经的穴位及夹脊分布的夹脊穴,此外兼取脾经、肾经、任脉等补元固本之穴或治疗腰痛的特定穴等,使经络气血得以宣通则其痛自止.     

消退素D2对椎间盘突出所致根性神经痛的作用

目的 观察消退素D2（RvD2）对非压迫性腰椎间盘突出症所致根性神经痛模型大鼠的影响。 方法 选取雄性Sprague-Dawley(SD)大鼠36只,按随机数字表法分为假手术组,模型组和RvD2组,每组大鼠12只。模型组和RvD2组均采用自体髓核组织填充法制作非压迫性腰椎间盘突出症模型,假手术组仅暴露相应手术部位,不作其它处理。造模成功后连续3d对假手术组和模型组均鞘内给予磷酸盐缓冲液（PBS）10μl,RvD2组则鞘内给予RvD2溶液10ng/10μl。于造模前1d和造模成功后连续7d观察3组大鼠术侧的50%缩足阈值（PWT）,并于造模成功后第7天获取大鼠术侧L4至L6节段脊髓背角,采用蛋白质印迹法测定磷酸化的蛋白激酶B(p-AKT),蛋白激酶B(t-AKT),磷酸化的糖原合成激酶3β(p-GSK-3β)和糖原合成激酶3β(GSK-3β)的蛋白表达量,并用酶联免疫吸附试验测定肿瘤坏死因子α（TNF-α）、白介素-6（IL-6）、转化生长因子-β1（TGF-β1）和白介素-10（IL-10）的蛋白表达含量。 结果 造模成功后第1～7天,模型组和RvD2组大鼠50%PWT与假手术组同时间点比较,差异均有统计学意义（P<0.05）;造模成功后第3～7天,RvD2组的50%PWT分别为（6.31±2.11）g、（7.37±1.58）g、（7.96±1.73）g、（8.46±1.55）g、(8.55±1.44)g,与模型组同时间点比较,差异均有统计学意义（P<0.05）。造模成功后第7天,模型组和RvD2组的p-AKT和p-GSK-3β蛋白阳性表达水平与假手术组比较,差异有统计学意义（P<0.05）;且RvD2组的p-AKT和p-GSK-3β蛋白阳性表达水平与模型组比较,差异亦有统计学意义(P<0.05)。造模成功后第7天,模型组和RvD2组大鼠脊髓背角促炎细胞因子TNF-α和IL-6以及抗炎因子TGF-β1和IL-10的蛋白表达水平与假手术组比较,差异均有统计学意义（P<0.05）; 且RvD2组促炎细胞因子TNF-α和IL-6以及抗炎因子TGF-β1和IL-10的蛋白表达水平与模型组比较,差异均有统计学意义（P<0.05）。 结论 RvD2可减轻非压迫性椎间盘突出大鼠的根性神经痛,其机制可能与抑制GSK-3β活性,下调促炎因子以及上调抗炎因子的蛋白表达水平相关。     

单节段颈椎间盘突出症前路减压术后上肢近端麻痹的研究

 目的 探讨单节段颈椎间盘突出症(cervical disc herniation ,CDH)行前路减压术后继发上肢近端麻痹(proximal upper limb palsy ,PULP)的发作特征及危险因素。方法 回顾性分析颈椎管前路减压分别联合融合或非融合固定术,治疗235例单节段CDH患者资料,术后随访时间均在12个月以上。术前PULP组和非PULP组一般资料比较,差异均无统计学意义。按照术前临床表现,分为以脊髓型和神经根型损害两组。减压节段包括C_3/4、C_4/5、C_5/6和C_6/7椎间隙。分别比较不同手术节段或术前定位体征亚组间术后PULP发生率。以C₅椎体为界,比较其上(下)椎间水平减压术后总体PULP发生率。结果 术后26例PULP患者均接受非手术治疗,末次随访均获得基本缓解。除C_4/5椎间隙和C₅髓节外,其余节段减压术后亦可继发PULP。C₅椎体上(下)各两个椎间减压术后PULP发生率和中下水平4个颈椎间隙减压术后PULP发生率比较,差异均无统计学意义。术前脊髓型表现者,术后PULP发生率高于神经根型表现者,差异有统计学意义。结论 术前为上运动神经元通路损害为主要表现者,CDH前路减压术后更易继发PULP。PULP发作应与固有束神经元体系的早期、可逆和暂时损害密切相关。     

Inflamación en la hernia del disco intervertebral

Up until fairly recently, it was thought that sciatic pain in the lumbar herniated disc was caused by compression on the nerve root. However, the lumbar herniated disc shows mixed pictures which are difficult to explain by simple mechanical compromise. In recent years various immunology, immunohistochemistry and molecular biology studies have shown that the herniated tissue is not an inert material, but rather it Is biologically very active with the capability of expressing a series of inflammatory mediators: cytokines such as interleukin-1, interleukin-6, interleuquin-8 and tumor necrosis factor being the ones which stand out. The inflammation is not only induced by the chemical irritation of the bioactive substances released by the nucleus pulposus but also by an autoimmune response against itself. Thus, in addition to the mechanical factor, the biomechanical mediation plays an important role in the pathophysiology of sciatic pain and of radiculopathy. Through a review of a wide range of literature, we researched the cellular molecular mediators involved in this inflammatory process around the lumbar herniated disc and its involvement in sciatic pain.     

下腰椎板间隙的影像解剖学测量及其临床意义

目的　应用影像解剖学测量腰椎板间隙参数,探讨其临床意义。 方法　观察145例腰椎间盘突出症患者的腰椎正位片,比较患侧（症状组）与健侧（对照组）椎板间隙形态,根据不同性别分别测量L4/5以及L5/S1节段双侧椎板间隙的高度、宽度和面积;通过腰椎三维CT测量腰椎板间隙的有效直径并进行统计分析。 结果　在腰椎正位片上健侧L4/5、L5/S1的椎板间隙多呈椭圆形,而患侧的椎板间隙以三角形和扁圆形多见;患侧腰椎板间隙狭窄发生率为68.1%,L4/5节段发生率为65.1%,L5/S1节段71.0%;高度改变的同时伴随宽度的改变;腰椎三维CT测量结果表明,76.5%的患者患侧椎板间隙有效直径小于工作通道直径,其中72.3%位于L4/5节段,80.6%位于L5/S1节段;男性椎板间隙的高度、宽度、面积以及有效直径其均值大于女性,差异具有统计学意义（P<0.05）;总体上,L5/S1节段椎板间隙的高度、宽度、面积以及有效直径的均值大于L4/5节段。 结论　腰椎间盘突出症与椎板间隙的改变存在密切联系,掌握腰椎板间隙的高度、宽度、面积以及有效直径,可指导微创手术方式的选择及术中操作。     

腰椎间盘突出症的CT与MRI诊断分析

目的:对腰椎间盘突出症的患者进行CT与MRI检查诊断,并对其诊断效果进行分析。方法:将滨州医学院附属医院疼痛科2019年6月—2020年6月接治的60例腰椎间盘突出症患者作为观察对象,均对其使用CT与MRI检查诊断。结果:对60例患者均进行CT与MRI检查诊断,CT组与MRI组诊断的阴性率分别为15(例)25.00%、5(例)8.33%,阳性率分别为45(例)75.00%、55(例)91.66%,误诊率分别为13(例)21.66%、1(例)1.66%,漏诊率分别为11(例)18.33%、2(例)3.33%。两组之间差异有统计学意义(P<0.05)。结论:对腰椎间盘突出症患者进行检查诊断时采用MRI检查方式,效果显著、诊断符合率更高,值得推荐使用。     

经皮椎间孔镜髓核摘除术治疗脱出型腰椎间盘突出症的效果

目的观察经皮椎间孔镜髓核摘除术(PTED)治疗66例脱出型腰椎间盘突出症(LDH)的效果,并探讨预后影响因素。方法回顾性分析66例采用PTED治疗脱出型LDH患者的临床资料,所有患者均行腰椎动力位片和核磁共振检查。记录术前及术后视觉模拟评分法(VAS)评分,卡氏功能状态评分标准(KPS)评分及日本矫形外科学会(JOA)腰痛评分,术后随访期间记录症状缓解、复发及并发症发生情况。结果术后,患者VAS评分低于术前,KPS及JOA评分高于术前,差异均有统计学意义(P<0.05)。术后并发症的发生与椎间盘突出程度相关(P<0.05);复发型LDH患者术后更易复发(P<0.05)。结论PTED手术时间短,术中出血量及术后并发症较少,是治疗脱出型LDH的安全、有效方法。重度LDH患者应更加注意预防术后并发症的发生,复发型LDH患者在选择PTED治疗时应注意把握适应证。