恶性疟原虫多表位重组疫苗在大肠杆菌中的表达及纯化

目的 在体外表达和纯化目的的蛋白,为下一步抗攻击试验提供安全有效的产品。方法 将化学合成的恶生疟原虫保护性抗原复合基因（ＨＧＦＳＰ）与表达载体ｐＲＳＥＴ重组,在大肠杆菌ＧＩ２１进行表达;工程菌经超声破菌、离心、离子交换层析、疏水层析、分子支析等步骤纯化。结果 ＳＤＳ－ＰＡＧＥ显示表达产物以非融合、可溶性的形式表达,相对分子质量为２３ｋＤａ,占总菌体蛋白的２３．６５％,纯度可达９５％以上。Ｗｅｓｔｅ     

The impact of a corrective tether on a scoliosis porcine model: a detailed 3D analysis with a 20 weeks follow-up

Purpose

Non-fusion treatment for adolescent idiopathic scoliosis generates interest due to the potential for growth preservation and mobility. Using an established porcine scoliotic model, this study aims to evaluate the global alignment and the morphology of the spine with and without application of a non-fusion corrective tether.

Methods

At 12 weeks of age, 21 immature Yorkshire pigs had an induction of scoliosis. Once a 50° Cobb angle was obtained; animals were placed into one of the following groups: a scoliosis model group (SM, n = 11) where animals were euthanized, tether release group (TR, n = 5) where the inducing tether was removed, and an anterior correction group (AC, n = 5) where the inducing tether was removed and non-fusion corrective tether was applied. TR and AC were observed for a further 20 weeks and then euthanized. Post-mortem CT scans were used to create 3D spinal reconstructions to obtain global and morphologic parameters.

Results

Maximal Cobb angle of the scoliotic deformity was significantly lower for AC (27.9° ± 12.0°) than for the two other groups (TR 52.7° ± 10.0°, SM 48.3° ± 7.6°). AC experienced an increase in kyphosis (24.2° ± 15.9°) compared to TR (7.1° ± 6.4°). Correction in the axial plane was also observed in AC versus TR. Correction of vertebral wedging was found for AC compared to SM and TR in the three apical vertebrae.

Conclusions

3D realignment of scoliotic curves was observed with application of the corrective tether. The correction was the product of both mechanical action and growth modulation. These findings are encouraging for future development of a non-fusion device for the treatment of immature scoliotic curves.     

棘突间 CoflexTM 非融合固定的临床应用及疗效分析简

目的评价棘突间Coflex非融合固定治疗腰椎管狭窄症的临床效果及应用前景。方法对腰椎管狭窄症121例采用后路双侧椎板开窗减压,棘突间Coflex非融合固定手术。其中119例行单节段棘突间Coflex固定,2例行双节段棘突间Coflex固定。结果121例术后症状均得到明显改善,平均手术时间40．24min,平均失血量51．43ml;术前下腰椎JOA评分平均为13．62分,术后为25．06分;术前ODI评分平均为67．36％,术后为14．33％;术前腰痛VAS评分为7．89分,术后为2．01分：术前腿痛VAS疼痛评分平均为8．44分,术后为1．22分。结论应用双侧椎板开窗减压,棘突问Coflex非融合固定治疗腰椎管狭窄症具有良好的近期临床疗效。     

Flexible non-fusion scoliosis correction systems reduce intervertebral rotation less than rigid implants and allow growth of the spine: a finite element analysis of different features of orthobiom™

The orthobiom™ non-fusion scoliosis correction system consists of two longitudinal rods, polyaxial pedicle screws, mobile and fixed connectors and a cross-connector. The mobile connectors can move along and around the rod, thus allowing length adaptation during growth. The aim of this study was to determine the effects of different features of this novel implant on intervertebral rotations, to calculate the movement of the mobile connectors along the rods for different loading cases and to compare the results with those of a rigid implant construct. A finite element analysis was performed using six versions (M1–M6) of a three-dimensional, nonlinear model of a spine ranging from T3 to L2. The models were loaded with pure moments of 7.5 N m in the three main anatomical planes. First, the validated intact model (M1) was studied. Then, the orthobiom™ implant system was inserted, bridging the segments between T4 and L1 (M2). The effect of pedicle screws only in every second vertebrae was investigated (M3). For comparison, three connection variations of screws and rods were investigated: (1) an implant with rigid screws and mobile connectors (M4), (2) an implant with non-locking polyaxial screws and fixed connectors (M5) and (3) a completely rigid implant construct (M6). For flexion, extension and lateral bending, intervertebral rotation was reduced at all implant levels due to the implants. A rigid implant construct (M6) and an implant with non-locking polyaxial screws and fixed connectors (M5) led to the strongest reduction of intervertebral rotation. The orthobiom™ non-fusion implant system (M2, M3) allowed much more intervertebral rotation than a rigid implant (M6). Differences in intervertebral rotations were small when polyaxial screws were placed at every second level only (M3) instead of at every level (M2). For axial rotation, intervertebral rotation was strongly reduced by a rigid implant construct (M6) and by an implant with rigid screws and mobile connectors (M4). For rotation, an implant with non-locking polyaxial screws (M2, M3, M5) led to nearly the same intervertebral rotations as in an intact spine without an implant (M1). The predicted maximum translation of the mobile connectors along the rod was 4.2 mm for extension, 3.1 mm for lateral bending, 1.6 mm for flexion and 0.8 mm for axial rotation. The movement of the connectors was highest for those closest to the ends of the rods. With rigid screws, the maximum translation was significantly reduced. This study, conducted under a load-controlled loading protocol, showed that intervertebral rotation was reduced much less by the non-fusion orthobiom™ system than by a rigid implant. The mobile connectors moved considerably along the rod when the spine was bent. It can be expected that the connectors also move along the rod as the adolescent grows, possibly leaving the discs intact until the patient is fully grown.     

腰椎后路非融合技术生物力学研究进展

为避免融合术后相邻节段退变的问题,腰椎后路非融合技术相应出现并很快发展。但目前临床应用时间较短,相关基础研究尚不充分。本文总结了当前对腰椎后路非融合固定器械的生物力学评价,包括其对腰椎的活动度、椎间盘内压力、腰椎小关节的影响,以及相应的生物力学研究方法,通过这些研究,我们认为后路非融合技术可以用于治疗退变性腰椎疾患,有着很好的发展前景,同时也发现还有很多方面需要进一步深入研究。     

一种新型动力内固定系统联合经伤椎椎弓根椎体内植骨治疗单节段胸腰段爆裂骨折的生物力学研究

目的测试新型动力内固定系统联合经伤椎椎弓根椎体内植骨的稳定性效果。方法选取人新鲜尸体胸腰段标本制作L_2椎体爆裂骨折的模型,测试新型动力内固定系统联合经伤椎椎弓根椎体内植骨的稳定性效果。结果动力内固定联合经伤椎椎弓根椎体内植骨与骨折状态相比,屈伸及侧屈方向的ROM均显著减小;旋转方向的ROM虽也显著减小,但明显大于完整状态。结论新型动力内固定系统联合经伤椎椎弓根椎体内植骨能够维持胸腰段爆裂骨折在屈伸及侧屈方向的稳定性,但在旋转方向上不足以提供足够的稳定性。     

Isobar TTL系统治疗腰椎退行性疾病的疗效及术后融合率的探讨

目的：评价Isobar TTL动态内固定系统治疗腰椎退行性疾病的疗效并探讨术后融合率。方法：对2013年4月至2016年1月行Isobar TTL动态固定系统治疗的腰椎退行性疾病80例患者进行回顾性分析,其中男39例,女41例;年龄28～69岁,平均46.4岁;单节段42例,双节段38例。临床疗效采用疼痛视觉模拟评分（visual analogue scale,VAS）、Oswestry功能障碍指数（Oswestry Disability Index,ODI）评分、改良Macnab评价标准进行评估。通过影像学资料测量椎间活动度（rang of motion,ROM）,椎间隙高度比值（intervertebral space height ratio,ISR）,按照SUK等制定的标准评定动态固定节段的融合情况。结果：80例患者均获得临床随访,时间17～45个月,平均31.9个月,共有30例患者完成影像学复查。80例患者术前VAS、ODI评分分别为9.15±1.55,38.65±9.60,术后2周分别为0.55±1.18,1.06±2.17,末次随访分别为0.24±0.70,0.16±0.48,术后2周及末次随访VAS、ODI评分较术前均明显下降（P<0.05）;末次随访按照改良Macnab评价标准,优65例,良14例,可1例。完成影像学复查的30例患者动态固定节段ROM值术前（6.87±2.18）°,术后2周及末次随访降低至（3.52±2.80）°,（3.14±2.60）°（P<0.05）;邻近节段ROM值术前（4.36±1.28）°,术后2周及末次随访提高至（4.80±1.99）°,（6.54±4.83）°（P<0.05）。动态固定节段与邻近节段术前的ISR值分别为（36.73±6.36）%,（40.74±7.29）%,术后2周提高为（38.37±6.35）%,（41.59±7.77）%（P<0.05）,末次随访降低为（36.58±9.53）%,（38.25±8.08）%,较术前差异无统计学意义（P>0.05）。30例完成影像学复查的患者,可能融合20例,不融合10例。结论：Isobar TTL动态内固定系统治疗腰椎退行性疾病可以取得很好的临床疗效,虽然增加了邻近节段的活动度,但短期仍可有效防止邻近节段退变,动态固定节段有融合倾向。     

Wallis动态稳定系统治疗腰椎退行性疾病的研究进展

Wallis动态稳定系统作为腰椎非融合技术中的一种手术方式,是由棘间阻滞剂和涤纶人造韧带构成,在保持脊柱稳定的同时保留病变节段一定的活动度。近年来,研究发现Wallis动态稳定系统对腰椎退行性疾病治疗具有重要意义,既能改善临床症状,也能有效延缓邻近节段退变等并发症。本文通过综述Wallis动态稳定系统与腰椎退行性疾病相关的文献,阐述了Wallis动态稳定系统治疗腰椎退行性疾病的远期预后效果,为治疗腰椎退行性疾病的术式选择提供理论依据及参考。     

The surgical outcome of Lisfranc injuries accompanied by multiple metatarsal fractures: A multicenter retrospective study

Background

This study assessed the surgical outcomes of Lisfranc injuries accompanied by multiple metatarsal fractures. Metatarsal fractures here refers to metatarsal head, neck, and shaft (including shaft fractures accompanied by fractures of the base) fractures, as well as mixed (i.e., segmental fracture) fractures, as seen on imaging studies.

腰椎动态稳定系统Wallis治疗腰椎退行性疾病疗效分析

目的:探讨Wallis棘突间动态稳定系统治疗腰椎退行性疾病的初期效果。方法:选择我院自2009年1月至2010年3月收治的腰椎失稳症患者21例,失稳节段均行后路棘突间椎管减压、Wallis置入固定治疗,观察治疗前后疼痛视觉模拟法VAS评分、下腰痛JOA评分、Oswestry功能障碍指数变化;失稳节段和相邻节段的活动范围及L4/5节段椎间盘后高度的变化。结果:21例患者均获得随访,随访时间6~18个月,平均10.2个月。手术时间平均78 min(50~105 min),术中平均出血量250 mL(50~600 mL)。腰痛均消失,术后患者的症状和体征均有明显改善。治疗后VAS评分较术前显著降低(P<0.05),JOA评分较术前显著增加(P<0.05),ODI评分较术前显著降低(P<0.05)。术后L4/5节段的活动范围与术前相比明显减少(P<0.05),而术后相邻节段L3/4、L5/S1的活动范围与术前相比差异无统计学意义(P>0.05)。结论:Wallis动态稳定系统置入治疗腰椎失稳症能够取得比较满意的临床效果,可推广使用。