不同下颌前伸力对髁突Runx2和X型胶原表达的影响

目的:探讨不同作用方式的下颌前伸力对髁突软骨内成骨的影响.方法:将28只5周龄雄性wistar大鼠随机分配到周期性、静止性、功能性下颌前伸组及阴性对照组(n=7).各组按照设定的相关参数接受下颌前伸力刺激.实验结束时取标本,免疫组织化学染色,对Runx2、X型胶原的表达进行半定量分析.结果:Runx2和X型胶原表达动态组最高(与对照组比P＜0.01),静态组和功能组较低(与对照组比P＜0.01).静态组X型胶原表达高于功能组(P＜0.01),Runx2表达静态组与功能组差异无显著性(P＞0.05).结论:不同作用方式及作用时间的下颌前伸力差异性调节髁突软骨细胞Runx2及X型胶原的表达水平.     

Prevention and Treatment Of Heterotopic Ossification After Spinal Cord Injury

Abstract

Background/Objectives: Heterotopic ossification (HO) is a frequent, irreversible complication afterspinal cord injury (SCI). The objective of this article is to explain the etiology of HO; present new advances in prevention, diagnosis, and management of this complication; and provide a suggested algorithm for clinical management.

Etiology: Although still hypothetical, trauma and overexpression of bone morphogenic protein(s) in traumatized soft tissue appear to play important roles as initiating factors of HO.

Prevention: Preventive use of nonsteroidal antiinflammatory agents (NSAIDs) reduces the incidence of HO by a magnitude of 2 to 3.

Management: Early determination of serum creatine phosphokinase may have a diagnostic value in predicting the onset and severity of HO, and an NSAID may be added to etidronate therapy in the initial inflammatory phase of HO formation until C-reactive protein Ieveis return to normal range. Surgery is indicated in a subset of patients, and a regimenthat includes radiation therapy may prevent postoperative recurrence.

Conclusion: Significant progress has been made in the early prevention and management of HO. Further studies are needed to elucidate the etiology.     

Use of Imatinib in the Prevention of Heterotopic Ossification

Background

Heterotopic ossification (HO) is a common complication following orthopedic and trauma surgery, which may have substantial negative effects on the postoperative outcome. Angiogenesis appears to play a critical role in heterotopic ossification. One of the involved signaling molecules is platelet-derived growth factor (PDGF) which may be inhibited by imatinib.

Questions/Purposes

Our goal was to prevent HO by pharmacologically interfering with the molecular signaling pathways involved in the developmental process. We hypothesized that by administering a proven inhibitor of PDGF expression, heterotopic bone formation may be prevented.

Methods

The effect of imatinib on HO formation was studied in a murine model which reliably produces islets of HO within the soft tissue following Achilles tenotomy. The control group underwent Achilles tenotomy only. The imatinib group received imatinib mesylate. After trial completion, the limbs were harvested and scanned by micro-CT. Heterotopic bone volume was then identified and quantified.

Results

The mean volume of heterotopic bone formed in the control group was 0.976mm³ compared to 0.221 mm³ in the imatinib group. The volume of HO in the treatment group was reduced by 85% compared to the control group.

Conclusions

The administration of imatinib was associated with a significantly reduced volume of HO. This may be due to the inhibitory effect of imatinib on the PDGF signaling pathway during development of HO.

Clinical Relevance

The successful reduction of HO formation following imatinib administration has led to further insight concerning the pathogenesis of HO which in the future may lead to new clinical approaches towards the prevention of HO.

Electronic supplementary material

The online version of this article (doi:10.1007/s11420-013-9335-y) contains supplementary material, which is available to authorized users.     

胸椎黄韧带骨化症的手术疗效及影响因素分析

目的探讨胸椎黄韧带骨化症的手术疗效及相关影响因素。方法以手术治疗的96例胸椎黄韧带骨化症患者为研究对象,记录治疗前(T0)、术后6个月(T1)、术后12个月(T2)、术后24个月(T3)的下腰痛评分及改善率。根据疗效评估结果将受试者分成优、良组(A组)和可、差组(B组),比较两组年龄、性别、体质指数、病程、术前JOA评分、影像学分型、手术节段、椎管面积残余率、合并其他脊柱病变症状、术前MRI T2相脊髓内高信号情况等的差异。对单因素分析后有统计学意义的指标行非条件Logistic回归分析。结果 1 96例经24个月随访,疗效评估结果显示:74例为A组,优44例(45.8%)、良30例(31.3%);22例为B组,可17例(17.7%)、差5例(5.2%)。所有受试者T3时JOA评分较T0时显著提高(P0.05)。2两组患者的性别、体质指数、影像学分型、合并其他脊柱病变症状及术前MRI T2相脊髓内高信号情况等资料比较差异均无统计学意义(P0.05)。A组年龄60岁者52例(70.3%),病程24个月者53例(71.6%),中上胸节段者50例(67.6%),椎管面积残余率≥50%者48(64.9%),术前JOA评分为(7.0±1.5)分,各项依次高于B组的9例(40.9%)、8例(36.4%)、9例(40.9%)、8例(36.4%)、(5.1±1.0)分,差异均有统计学意义(P0.05)。3年龄≥60岁、病程≥24个月、手术节段累及胸腰段、椎管面积残余率50%及术前JOA评分6分均为影响胸椎黄韧带骨化症患者手术效果的独立危险因素(P0.05)。结论年龄、病程、手术节段、椎管面积残余率、术前JOA评分均为影响胸椎黄韧带骨化症患者手术治疗效果的重要因素,需引起临床重视。     

胚胎移植术后17例宫内外同时妊娠分析及文献复习

目的探讨胚胎移植术后宫内外同时妊娠的发生率、影响因素、诊断和治疗,以加强临床医生对宫内外复合妊娠的认识。方法回顾性分析我中心2011年1月1日至2014年12月31日胚胎移植术后发生宫内外同时妊娠的17例病例的临床资料。结果我中心2011年1月至2014年12月31日试管婴儿助孕中宫内外同时妊娠发生率为0.26%(17/6 623),全部17例宫内外同时妊娠均由阴道超声确诊。其中腹腔镜手术切除妊娠侧输卵管14例,腹腔镜下妊娠侧宫角楔形切除1例,经阴道穿刺减胎手术1例,宫内胎儿均存活;保守治疗1例,宫内胚胎停育。结论经阴道超声早期诊断、动态监测是提高宫内外同时妊娠诊断率的可行方法,腹腔镜手术是治疗宫内外同时妊娠的有效方法。     

颈椎带锁钢板内固定术对颈椎退变性疾病神经功能改善的分析

Thetreatmentswithcervicallockingplateforcervicalfractureanddislocationhavegainsatisfactoryeffects，buttherearesomedisputesonusingofplateduringthetreatmentwithanteriordecom－pressionandbonegraftforcervicaldegenerationdiseasebetween１or２interspaces．FromJune２０００toFebruary２００１，wehaveap－pliedanteriordecompression，bonegraftandinternalfixationwithcervicallockingplatetotreat２３patientswithcervicaldegenerationdisease，andtheeffectsaresatisfactory．１Subjectandmethod１．１SubjectAcohortof…