RESUMO
BACKGROUND: Glucocorticoids (GCs) overuse is associated with decreased bone mass and osseous vasculature destruction, leading to severe osteoporosis. Platelet lysates (PL) as a pool of growth factors (GFs) were widely used in local bone repair by its potent pro-regeneration and pro-angiogenesis. However, it is still seldom applied for treating systemic osteopathia due to the lack of a suitable delivery strategy. The non-targeted distribution of GFs might cause tumorigenesis in other organs. RESULTS: In this study, PL-derived exosomes (PL-exo) were isolated to enrich the platelet-derived GFs, followed by conjugating with alendronate (ALN) grafted PEGylated phospholipid (DSPE-PEG-ALN) to establish a bone-targeting PL-exo (PL-exo-ALN). The in vitro hydroxyapatite binding affinity and in vivo bone targeting aggregation of PL-exo were significantly enhanced after ALN modification. Besides directly modulating the osteogenic and angiogenic differentiation of bone marrow mesenchymal stem cells (BMSCs) and endothelial progenitor cells (EPCs), respectively, PL-exo-ALN also facilitate their coupling under GCs' stimulation. Additionally, intravenous injection of PL-exo-ALN could successfully rescue GCs induced osteoporosis (GIOP) in vivo. CONCLUSIONS: PL-exo-ALN may be utilized as a novel nanoplatform for precise infusion of GFs to bone sites and exerts promising therapeutic potential for GIOP.
Assuntos
Exossomos , Células-Tronco Mesenquimais , Osteoporose , Humanos , Exossomos/metabolismo , Glucocorticoides/metabolismo , Células-Tronco Mesenquimais/metabolismo , Osteogênese , Osteoporose/induzido quimicamente , Osteoporose/tratamento farmacológico , Alendronato/farmacologiaRESUMO
This study sought to investigate and evaluate a modified axial translaminar screw fixation for treating odontoid fractures. We performed a retrospective study at Wenzhou Medical University Affiliated Second Hospital between March 2016 and June 2018. We retrospectively collected and analyzed the medical records of 23 cases with odontoid fractures. All patients were identified as type II odontoid fractures without neurological deficiency and serious diseases following the classification of Anderson. The average age, gender ratio, and body mass index (BMI) were 54.3 ± 11.1 years, 12 men to 11 women, and 22.6 ± 2.4 kg/m2 , respectively. Patients in this study accepted screw fixation using our modified axial translaminar screw fixation combined with atlas pedicle or lateral mass screw fixation. Within the technique, a small cortical "window" was dug in the middle of the axial contralateral lamina, such that the screws in the lamina were visualized to prevent incorrectly implanting the posterior spinal canal through the visualized "window." A total of 46 bone screws were accurately inserted into the axial lamina without using fluoroscopy. The length of all translaminar screws ranged between 26 and 30 mm, while the diameter was 3.5 mm. During the follow-up survey, the visual analog scale (VAS) and neck disability index (NDI) were measured. We provide a simple modification of Wright's elegant technique with the addition of "visualized windows" at the middle of the axial lamina. In all patients, screws were inserted accurately without bony breach and the screw angle was 56.1 ± 3.0°. Mean operative time was 102 ± 28 min with an average blood loss of 50 ± 25 mL. Postoperative hemoglobin and mean length of hospital stay were 12.0 ± 1.4 g/dL and 10.4 ± 3.4 days, respectively. The average follow-up time of all cases was 14.7 months and no internal fixation displacement, loosening, or breakage was found. All patients with odontoid fractures reported being satisfied with the treatment during the recheck period and good clinical outcomes were observed. At 1, 6, and 12 months, NDI and VAS showed that the symptoms of neck pain and limitations of functional disability improved significantly during follow-up. Our results suggest that the modified translaminar screw fixation technique can efficiently treat Anderson type II odontoid fracture, followed by the benefits of less soft tissue dissection, simple operation, no fluoroscopy, and accurate placement of screws.
Assuntos
Processo Odontoide , Fraturas da Coluna Vertebral , Fusão Vertebral , Adulto , Idoso , Parafusos Ósseos , Feminino , Fixação Interna de Fraturas/métodos , Humanos , Masculino , Pessoa de Meia-Idade , Processo Odontoide/diagnóstico por imagem , Processo Odontoide/lesões , Processo Odontoide/cirurgia , Estudos Retrospectivos , Fraturas da Coluna Vertebral/diagnóstico por imagem , Fraturas da Coluna Vertebral/cirurgia , Fusão Vertebral/métodos , Resultado do TratamentoRESUMO
BACKGROUND: The objective of this study was to perform a meta-analysis to investigate the specific relationship between the expression level of circulating adiponectin and osteoarthritis (OA). METHOD: Multiple databases were searched to estimate the high quality of studies relevant to adiponectin and OA. We extracted the data from the eligible studies and included them in the meta-analysis using a random effects model. Subgroup analysis and meta-regression were further performed to explore the potential sources of heterogeneity. RESULTS: Ten articles consisting of thirteen case-control studies that contained a combined total of 1255 subjects. Our results revealed that the OA patients displayed higher adiponectin levels than the healthy controls (SMD = 0.327, 95% CI: 0.11-0.55, P = 0.003). The ethnicity-stratified subgroup analysis indicated that the adiponectin was a sensitive biomarker in both Caucasians (P = 0.021) and Asians (P = 0.037). Moreover, the meta-regression analysis suggested that the sample size (P = 0.03) and nationality (p = 0.01) could account for a part of heterogeneity in our study. CONCLUSION: Taken together, the current study indicated that the adiponectin expression levels were higher in the OA patients than in the healthy controls and might be associated with OA prevalence.
Assuntos
Adiponectina/sangue , Osteoartrite/sangue , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Viés de PublicaçãoRESUMO
BACKGROUND: Anterior odontoid screw fixation (AOSF) has been suggested as the optimal treatment for type II and some shallow type III odontoid fractures. However, only the classical surgical trajectory is available; no newer entry points or trajectories have been reported. METHODS: We evaluated the anatomic feasibility of a new trajectory for AOSF using 3-dimensional (3D) screw insertion simulation software (Mimics). Computed tomography (CT) scans of patients (65 males and 59 females) with normal cervical structures were obtained consecutively, and the axes were reconstructed in 3 dimensions by Mimics software. Then simulated operations were performed using 2 new entry points below the superior articular process using bilateral screws of different diameters (group 1: 4 mm and 4 mm; group 2: 4 mm and 3.5 mm; group 3: 3.5 mm and 3.5 mm). The success rates and the required screw lengths were recorded and analyzed. RESULTS: The success rates were 79.03% for group 1, 95.16% for group 2, and 98.39% for group 3. The success rates for groups 2 and 3 did not differ significantly, and both were significantly better than the rate for group 1. The success rate was much higher in males than in females in group 1, but the success rate was similar in males and females in the other 2 groups. Screw lengths did not differ significantly among the 3 groups, but an effect of sex was apparent. CONCLUSIONS: Our modified trajectory is anatomically feasible for fixation of anterior odontoid fractures, but further anatomic experiments and clinical research are needed.
Assuntos
Parafusos Ósseos , Fixação Interna de Fraturas/instrumentação , Fixação Interna de Fraturas/métodos , Processo Odontoide/cirurgia , Software , Fraturas da Coluna Vertebral/cirurgia , Adulto , Idoso , Simulação por Computador , Feminino , Lateralidade Funcional , Humanos , Masculino , Pessoa de Meia-Idade , Adulto JovemRESUMO
Wound therapy remains a clinical challenge due to the complexity of healing pathology and high demand of achieving functional and aesthetically satisfactory scars. Newly formed blood vessels are essential for tissue repair since they can support cells at the wound site with nutrition and oxygen. In this study, we investigated the effects of Asperosaponin VI (ASA VI) isolated from a traditional Chinese medicine, the root of Dipsacus asper Wall, in promoting angiogenesis, as well as its function in wound therapeutics. Treatment of human umbilical vein endothelial cells (HUVECs) with ASA VI (20-80 µg/mL) dose-dependently promoted the proliferation, migration and enhanced their angiogenic ability in vitro, which were associated with the up-regulated HIF-1α/VEGF signaling. Full-thickness cutaneous wound model rats were injected with ASA VI (20 mg·kg-1·d-1, iv) for 21 d. Administration of ASA VI significantly promoted the cutaneous wound healing, and more blood vessels were observed in the regenerated tissue. Due to rapid vascularization, the cellular proliferation status, granulation tissue formation, collagen matrix deposition and remodeling processes were all accelerated, resulting in efficient wound healing. In summary, ASA VI promotes angiogenesis of HUVECs in vitro via up-regulating the HIF-1α/VEGF pathway, and efficiently enhances the vascularization in regenerated tissue and facilitates wound healing in vivo. The results reveal that ASA VI is a potential therapeutic for vessel injury-related wounds.
Assuntos
Subunidade alfa do Fator 1 Induzível por Hipóxia/fisiologia , Neovascularização Fisiológica/fisiologia , Saponinas/farmacologia , Fator A de Crescimento do Endotélio Vascular/fisiologia , Cicatrização/efeitos dos fármacos , Animais , Movimento Celular/fisiologia , Proliferação de Células/fisiologia , Células Cultivadas , Relação Dose-Resposta a Droga , Medicamentos de Ervas Chinesas/farmacologia , Humanos , Ratos , Transdução de Sinais/efeitos dos fármacos , Regulação para Cima/efeitos dos fármacosRESUMO
STUDY DESIGN: Retrospective cohort study. OBJECTIVE: To reveal the risk factors for dural tears in thoracic and lumbar (TL) burst fractures associated with vertical laminar fractures through multivariate analysis. SUMMARY OF BACKGROUND DATA: Dural tears associated with laminar fractures in patients with TL burst fractures represents a special group requires distinct treatment with different surgical prognosis. It is still very difficult to predict dural tears in patients with vertical laminar fractures. The risk factors for dural tears have seldom been evaluated. METHODS: Medical records of 113 patients of TL burst fractures with vertical laminar fractures were reviewed. The data were subdivided into two groups consisting of patients with and without dural tears. Demographic information, preoperative clinical, and radiological characteristics were compared between the groups. Multivariate logistic regression models were employed to determine the independent risk factors for dural tears. RESULTS: The incidence of dural tear was 27.4% in this retrospective cohort. When compared with the dural intact group, the dural tear group had significantly worse preoperative neurological status, wider interpedicular distance, greater separation of laminar fractures, and larger encroachment of retropulsed fragment in the bony spinal canal. Multivariate stepwise logistic regression analysis showed that the ratio of interpedicular distance greater than 125% (odds ratioâ=â9.5; Pâ<â0.001) and the ratio of encroachment of retropulsed fragment in the bony spinal canal of more than 50% (odds ratioâ=â61.2; Pâ<â0.001) were independent risk factors for dural tears. CONCLUSION: Patients with wider interpedicular distance and larger encroachment of retropulsed fragment in the bony spinal canal were more likely to have dural tears in TL burst fractures with vertical laminar fractures. LEVEL OF EVIDENCE: 3.
Assuntos
Dura-Máter/lesões , Vértebras Lombares/lesões , Traumatismos da Medula Espinal/etiologia , Fraturas da Coluna Vertebral/complicações , Vértebras Torácicas/lesões , Adulto , Dura-Máter/diagnóstico por imagem , Feminino , Humanos , Vértebras Lombares/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Fatores de Risco , Traumatismos da Medula Espinal/diagnóstico por imagem , Fraturas da Coluna Vertebral/diagnóstico por imagem , Vértebras Torácicas/diagnóstico por imagem , Tomografia Computadorizada por Raios XRESUMO
BACKGROUND: Some studies have reported that the conventional intersegmental pedicle screws (4-screw fixation [4S]) device for thoracolumbar fractures was associated with inadequate reduction of fractured vertebrae, insufficient correction of kyphosis, and implant failure. Recently, a series of biomechanical studies has confirmed that the addition of intermediate fixation screws (6-screw fixation [6S]) could provide stronger fixation and better reduction of fractured vertebrae. Nevertheless, the clinical and radiologic efficacy of the additional intermediate screws remains unclear. METHODS: A meta-analysis of randomized controlled trials was used to compare clinical and radiologic outcomes and complications of posterior pedicle screws combined with intermediate screws fixation versus conventional intersegmental pedicle screw fixation. We comprehensively searched MEDLINE, OVID, and Springer according to a search strategy, selecting articles based on inclusion criteria, and extracted data from these reports. Risk of bias in included studies was assessed. Pooled estimates and corresponding 95% confidence intervals were calculated. RESULTS: Six randomized controlled trials involving 310 patients were evaluated in this meta-analysis. Pooled estimates showed statistically similar baseline characteristics, hospital stays, postoperative visual analog scale scores, and infection rates between the 4S group and the 6S group. The 6S group had significantly less correction loss of segmental angle and of anterior vertebral height compression, and lower implant failure rate. The 6S group also showed a slightly longer operative time and more blood loss than did the 4S group. CONCLUSIONS: Based on our analysis, the combined intermediate screws fixation technique was associated with significantly improved radiologic outcomes but did not seem to compromise other perioperative outcomes.
Assuntos
Parafusos Ósseos , Fixação Interna de Fraturas , Vértebras Lombares/lesões , Fraturas da Coluna Vertebral/cirurgia , Vértebras Torácicas/lesões , Fixação Interna de Fraturas/instrumentação , Fixação Interna de Fraturas/métodos , Humanos , Vértebras Lombares/cirurgia , Ensaios Clínicos Controlados Aleatórios como Assunto , Vértebras Torácicas/cirurgiaRESUMO
BACKGROUND: Patients with laminar fractures have a higher chance of experiencing severe trauma and neurologic deficit. In previous studies, laminar fractures were divided into different types based on the axial plane of computed tomographic scans. No report described the morphology of vertical laminar fractures in the coronal plane. Furthermore, the correlation between a specific type of laminar fracture and the extent of severity of thoracolumbar (TL) burst fractures has rarely been mentioned. METHODS: A retrospective evaluation of 341 patients with TL burst fractures with or without laminar fractures were divided into 6 groups based on the morphology observed across reconstructed coronal and axial computed tomographic planes. The Thoracolumbar Injury Classification and Severity Score (TLICS), Load Sharing Classification (LSC), and American Spinal Injury Association (ASIA) impairment scale were evaluated for each patient. Intergroup comparisons were also performed for all metrics. RESULTS: The TLICS, LSC, and ASIA impairment scale were determined for each laminar fracture group. Statistical differences were found in most intergroup comparisons across all metrics. Significantly higher injury scores were observed in the groups with a more severe coronal and axial laminar fracture, and the injury severity in the coronal scan played a more decisive role. CONCLUSIONS: The morphology of vertical laminar fractures as observed across multiple image planes was more complex and accurate than an analysis based solely on the axial plane. Different morphologies indicated differences in the severity of associated TL burst fractures. The laminar fracture in the coronal plane was associated with the severity of spinal injury.
Assuntos
Vértebras Lombares/diagnóstico por imagem , Fraturas da Coluna Vertebral/diagnóstico por imagem , Vértebras Torácicas/diagnóstico por imagem , Acidentes por Quedas , Acidentes de Trânsito , Adulto , Feminino , Humanos , Escala de Gravidade do Ferimento , Vértebras Lombares/lesões , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Vértebras Torácicas/lesões , Tomografia Computadorizada por Raios XRESUMO
BACKGROUND: To obtain the correct coronal alignment and balancing in flexion and extension, we established a selective medial release technique and investigated the effectiveness and safety of the technique during primary total knee arthroplasty (TKA). METHODS: Four hundred sixty-six primary TKAs with varus deformity were prospectively evaluated between June 2013 and June 2015. A knee joint position similar to Patrick's sign was used to release the medial structure. The medial release technique consisted of release of the capsule and the deep medial collateral ligament (dMCL) (step1), selective release of superficial medial collateral ligament (sMCL) or posterior oblique ligament (POL) (step 2), and selective tibial reduction osteotomy (step 3). Improvement of medial joint gap at each step and other clinical outcomes were evaluated. RESULTS: Among the 466 knees, symmetrical gaps could be achieved by the limited release of the capsule and the dMCcL in 276 (59%) knees. One hundred fifty-two (33%) required additional sMCL release with 2-5 cm from the joint line distally or POL release. Thirty-eight (8%) necessitated an additional tibial reduction osteotomy. Anterior-medial release and 4-mm medial osteotomy contributed to more improvement of medial gap in flexion than in extension (each p < 0.01). Posteromedial release and posteromedial osteotomy contributed to more improvement in extension than in flexion (each p < 0.01). No specific complication related to our technique was identified. CONCLUSION: The technique of the tibial reduction osteotomy combined with medial soft structure release using Patrick's sign is effective, safe, and minimally invasive to obtain balanced mediolateral and extension-flexion gaps in primary TKA.
Assuntos
Artroplastia do Joelho/métodos , Osteotomia/métodos , Lesões dos Tecidos Moles/cirurgia , Tíbia/cirurgia , Idoso , Estudos de Coortes , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Lesões dos Tecidos Moles/diagnósticoRESUMO
The blood-spinal cord barrier (BSCB) plays significance roles in recovery following spinal cord injury (SCI), and diabetes mellitus (DM) impairs endothelial cell function and integrity of BSCS. Endoplasmic reticulum (ER) stress occurs in the early stages of SCI and affects prognosis and cell survival. However, the relationship between ER stress and the integrity of BSCB in diabetic rats after SCI remains unclear. Here we observed that diabetic rats showed increased extravasation of Evans Blue (EB) dye, and loss of endothelial cells and pericytes 1 day after SCI compared to non-diabetic rats. Diabetes was also shown to induce activation of ER stress. Similar effects were observed in human brain microvascular endothelial cells. 4-phenylbutyric acid (4-PBA), an ER stress inhibitor lowered the adverse effect of diabetes on SCI, reduced EB dye extravasation, and limited the loss of endothelial cells and pericytes. Moreover, 4-PBA treatment partially reversed the degradation of tight junction and adherens junction both in vivo and in vitro. In conclusion, diabetes exacerbates the disruption of BSCB after SCI via inducing ER stress, and inhibition of ER stress by 4-PBA may play a beneficial role on the integrity of BSCB in diabetic SCI rats, leading to improved prognosis.
Assuntos
Barreira Hematoencefálica/metabolismo , Estresse do Retículo Endoplasmático , Traumatismos da Medula Espinal/etiologia , Traumatismos da Medula Espinal/metabolismo , Junções Aderentes/metabolismo , Animais , Barreira Hematoencefálica/efeitos dos fármacos , Butilaminas/farmacologia , Diabetes Mellitus Experimental/complicações , Diabetes Mellitus Experimental/diagnóstico , Modelos Animais de Doenças , Progressão da Doença , Estresse do Retículo Endoplasmático/efeitos dos fármacos , Células Endoteliais/efeitos dos fármacos , Células Endoteliais/metabolismo , Feminino , Peróxido de Hidrogênio/metabolismo , Microvasos/efeitos dos fármacos , Microvasos/patologia , Pericitos/efeitos dos fármacos , Pericitos/metabolismo , Pericitos/patologia , Proteólise , Ratos , Traumatismos da Medula Espinal/tratamento farmacológico , Traumatismos da Medula Espinal/patologia , Junções Íntimas/metabolismoRESUMO
In this study, we examined the neuroprotective effects and anti-inflammatory properties of Dl-3-n-butylphthalide (NBP) in Sprague-Dawley (SD) rats following traumatic spinal cord injury (SCI) as well as microglia activation and inflammatory response both in vivo and in vitro. Our results showed that NBP improved the locomotor recovery of SD rats after SCI an significantly diminished the lesion cavity area of the spinal cord, apoptotic activity in neurons, and the number of TUNEL-positive cells at 7 days post-injury. NBP inhibited activation of microglia, diminished the release of inflammatory mediators, and reduced the upregulation of microglial TLR4/NF-κB expression at 1 day post-injury. In a co-culture system with BV-2 cells and PC12 cells, NBP significantly reduced the cytotoxicity of BV-2 cells following lipopolysaccharide (LPS) stimulation. In addition, NBP reduced the activation of BV-2 cells, diminished the release of inflammatory mediators, and inhibited microglial TLR4/NF-κB expression in BV-2 cells. Our findings demonstrate that NBP may have neuroprotective and anti-inflammatory properties in the treatment of SCI by inhibiting the activation of microglia via TLR4/NF-κB signalling.
Assuntos
Anti-Inflamatórios/farmacologia , Benzofuranos/farmacologia , Microglia/efeitos dos fármacos , Fármacos Neuroprotetores/farmacologia , Traumatismos da Medula Espinal/tratamento farmacológico , Animais , Linhagem Celular , Técnicas de Cocultura , Feminino , Regulação da Expressão Gênica , Lipopolissacarídeos/antagonistas & inibidores , Lipopolissacarídeos/farmacologia , Microglia/citologia , Microglia/metabolismo , NF-kappa B/antagonistas & inibidores , NF-kappa B/genética , NF-kappa B/imunologia , Células PC12 , Ratos , Ratos Sprague-Dawley , Transdução de Sinais , Medula Espinal/efeitos dos fármacos , Medula Espinal/imunologia , Medula Espinal/metabolismo , Medula Espinal/patologia , Traumatismos da Medula Espinal/genética , Traumatismos da Medula Espinal/imunologia , Traumatismos da Medula Espinal/patologia , Receptor 4 Toll-Like/antagonistas & inibidores , Receptor 4 Toll-Like/genética , Receptor 4 Toll-Like/imunologiaRESUMO
BACKGROUND: There is no consensus whether the use of the extramedullary femoral cutting guide takes advantage over the intramedullary one in total knee arthroplasty. The aim of this study was to compare the extramedullary femoral alignment guide system with the conventional intramedullary alignment guide system for lower limb alignment, blood loss, and operative time during total knee arthroplasty. METHODS: The Medline, Embase, Cochrane Library, China National Knowledge Infrastructure (CNKI), Wan Fang Chinese Periodical, Google, and reference lists of all the included studies were searched for randomized controlled trials. The following parameters were compared between the extramedullary technique and the intramedullary technique: (1) lower limb coronal alignment, (2) coronal alignment of femoral component, (3) sagittal alignment of femoral component, (4) blood loss, (5) and operation time. RESULTS: Four randomized controlled trials consisting of 358 knees were included in our study. There was no significant difference between the extramedullary and intramedullary groups for the lower limb coronal alignment (RR = 1.20, 95%CI 0.28~5.21, n.s.), coronal alignment of femoral component (RR = 0.65, 95%CI 0.19~2.22, n.s.), and sagittal alignment of femoral component (RR = 0.73, 95%CI 0.38~1.41, n.s.). A reduced blood loss was associated with the use of the extramedullary guide (MD = -120.34, 95%CI -210.08~-30.59, P = 0.009). No significant difference in operation time was noted between the two groups (MD = 1.41, 95%CI -1.82~4.64, n.s.). CONCLUSIONS: Neither extramedullary nor intramedullary femoral alignment is more accurate than the other in facilitating the femoral cut in total knee arthroplasty. Use of the extramedullary guide results in less blood loss and exhibits a similar operation time as compared with the intramedullary guide.
Assuntos
Artroplastia do Joelho/métodos , Fêmur/cirurgia , Artroplastia do Joelho/efeitos adversos , Artroplastia do Joelho/instrumentação , Perda Sanguínea Cirúrgica/prevenção & controle , Mau Alinhamento Ósseo/etiologia , Mau Alinhamento Ósseo/prevenção & controle , Humanos , Prótese do Joelho , Duração da Cirurgia , Ajuste de Prótese/métodos , Ensaios Clínicos Controlados Aleatórios como AssuntoRESUMO
OBJECTIVE: To report a new index, the spinal cord (SC) line, and a new classification to predict postoperative recovery effect in patients with multilevel cervical spondylotic myelopathy (CSM). METHODS: On T2-weighted magnetic resonance imaging (MRI) of the cervical spine, point A is the posteroinferior point of the spinal cord at C2, and point B is the posterosuperior point of the spinal cord at C7. The SC line is defined as a line connecting A and B. The posterior surface of the compressor at the compression level does not exceed the line in SC line type I, touches the line in type II, and exceeds the line in type III. Between January 2010 and January 2015, 121 patients with multilevel CSM who underwent surgery through an anterior approach (anterior cervical corpectomy with fusion or anterior cervical discectomy and fusion) or a posterior approach (laminoplasty or laminectomy) in our hospital were studied retrospectively. The patients were classified into 3 groups according to SC line type (I, II, or III). RESULTS: In the anterior surgical approach group, the Japanese Orthopaedic Association (JOA) recovery rate at the last follow-up was 84.88 ± 3.06% for SC line type I, 78.05 ± 2.89% for type II, and 68.69 ± 3.21% for type III. In the posterior surgical approach group, the JOA recovery rate at last follow-up was 69.35 ± 8.73% for type I, 58.05 ± 5.88% for type II, and 47.98 ± 4.31% for type III. The anterior surgery approach was associated with a higher postoperative recovery rate than the posterior surgery approach in type II and type III groups (type II anterior vs. type II posterior: 78.05 ± 2.89% vs. 58.05 ± 5.88%, P = 0.003; type III anterior vs. type III posterior: 68.69 ± 3.21% vs. 47.98 ± 4.31%, P = 0.001). In contrast, the anterior and posterior surgery were associated with similar postoperative recovery rates in the type I group (84.88 ± 3.06% vs. 69.35 ± 8.73%; P = 0.820). CONCLUSIONS: The SC line and its classifications can predict postoperative recovery in patients with multilevel CSM.
Assuntos
Imageamento por Ressonância Magnética , Complicações Pós-Operatórias/diagnóstico por imagem , Compressão da Medula Espinal/diagnóstico por imagem , Compressão da Medula Espinal/cirurgia , Espondilose/diagnóstico por imagem , Espondilose/cirurgia , Idoso , Vértebras Cervicais/diagnóstico por imagem , Vértebras Cervicais/cirurgia , Estudos de Coortes , Discotomia , Feminino , Humanos , Laminectomia , Laminoplastia , Masculino , Pessoa de Meia-Idade , Avaliação de Processos e Resultados em Cuidados de Saúde , Prognóstico , Estudos Retrospectivos , Medula Espinal/diagnóstico por imagem , Medula Espinal/cirurgia , Compressão da Medula Espinal/classificação , Fusão Vertebral , Espondilose/classificaçãoRESUMO
BACKGROUND: Anterior cervical diskectomy and fusion with plate-screw construct has been gradually applied for multilevel cervical spondylotic myelopathy in recent years. However, long cervical plate was associated with complications including breakage or loosening of plate and screws, trachea-esophageal injury, neurovascular injury, and postoperative dysphagia. To reduce these complications, the zero-profile spacer has been introduced. This meta-analysis was performed to compare the clinical and radiologic outcomes of zero-profile spacer versus cage-plate construct for the treatment of multilevel cervical spondylotic myelopathy. METHODS: We systematically searched MEDLINE, Springer, and Web of Science databases for relevant studies that compared the clinical and radiologic outcomes of zero-profile spacer versus cage and plate for multilevel cervical spondylotic myelopathy. Risk of bias in included studies was assessed. Pooled estimates and corresponding 95% confidence intervals were calculated. RESULTS: On the basis of predefined inclusion criteria, 7 studies with a total of 409 patients were included in this analysis. The pooled data revealed that zero-profile spacer was associated with a decreased dysphagia rate at 2, 3, and 6 months postoperatively when compared with the cage-plate group. Both techniques had similar perioperative outcomes, functional outcome, radiologic outcome, and dysphagia rate immediately and at >1-year after operation. CONCLUSIONS: On the basis of available evidence, zero-profile spacer was more effective in reducing postoperative dysphagia rate for multilevel cervical spondylotic myelopathy. Both devices were safe in anterior cervical surgeries, and they had similar efficacy in improving the functional and radiologic outcomes. More randomized controlled trials are needed to compare these 2 devices.
Assuntos
Discotomia/instrumentação , Desenho de Equipamento , Próteses e Implantes , Fusão Vertebral/instrumentação , Espondilose/cirurgia , Vértebras Cervicais/cirurgia , Falha de Equipamento , Seguimentos , Humanos , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/prevenção & controleRESUMO
Apoptosis has been regarded to mediate intervertebral disc degeneration (IDD); however, the basic question of how the apoptotic bodies are cleared in the avascular intervertebral disc without phagocytes, which are essential to apoptosis, remains to be elucidated. Our goals were to investigate the ultrastructure of nucleus pulposus (NP) cells undergoing chondroptosis, a variant of apoptotic cell death, in a rabbit annular needle-puncture model of IDD. Experimental IDD was induced by puncturing discs with a 16-G needle in New Zealand rabbits. At 4 and 12â weeks after puncture, progressive degeneration was demonstrated by X-ray, magnetic resonance imaging and histological staining. TUNEL staining suggested a significant increase in the apoptosis index in the degenerated NP. However, the percentage of apoptotic cells with the classic ultrastructure morphology was much less than that with chondroptotic ultrastructure morphology under transmission electron microscopy (TEM). The chondroptotic cells from the early to late stage were visualized under TEM. In addition, the percentage of chondroptotic cells was significantly enhanced in the degenerated NP. Furthermore, 'paralyzed' cells were found in the herniated tissue. Western blotting revealed an increase in caspase3 expression in the degenerated NP. The expression of the Golgi protein (58K) was increased by the fourth week after puncture but decreased later. These findings indicate that chondroptosis is a major type of programmed cell death in the degenerated rabbit NP that may be related to the progressive development of IDD.
Assuntos
Apoptose , Degeneração do Disco Intervertebral/patologia , Núcleo Pulposo/ultraestrutura , Animais , Caspase 3/metabolismo , Modelos Animais de Doenças , Degeneração do Disco Intervertebral/diagnóstico por imagem , Masculino , Núcleo Pulposo/enzimologia , CoelhosRESUMO
Spinal cord injury (SCI) is a severe neurological disease with few efficacious drugs. Autophagy is a cellular process to confront with stress after SCI and considered to be a therapeutic target of SCI. In this study, we investigated the therapeutic effect of metformin on functional recovery after SCI and its underlying mechanism of autophagy regulation. Using a rat model of traumatic SCI, we found improved function recovery which was paralleled by a reduction of apoptosis after metformin treatment. We further examined autophagy via detecting autophagosomes by transmission electron microscopy and immunofluorescence, as well as autophagy markers by western blot in each groups. The results showed that the number of autophagosomes and expression of autophagy markers such as LC3 and beclin1 were increased in SCI group, while autophagy substrate protein p62 as well as ubiquitinated proteins were found to accumulate in SCI group, indicating an impaired autophagy flux in SCI. But, metformin treatment attenuated the accumulation of p62 and ubiquitinated proteins, suggesting a stimulative effect of autophagy flux by metformin. Blockage of autophagy flux by chloroquine partially abolished the apoptosis inhibition and functional recovery effect of metformin on SCI, which suggested that the protective effect of metformin on SCI was through autophagy flux stimulation. Activation of AMPK as well as inhibition of its downstream mTOR signaling were detected under metformin treatment in vivo and in vitro; inhibition of AMPK signaling by compound C suppressed autophagy flux induced by metformin in vitro, indicating that AMPK signaling was involved in the effect of metformin on autophagy flux regulation. Together, these results illustrated that metformin improved functional recovery effect through autophagy flux stimulation and implied metformin to be a potential drug for SCI therapy.
Assuntos
Autofagia , Metformina/uso terapêutico , Recuperação de Função Fisiológica , Traumatismos da Medula Espinal/tratamento farmacológico , Traumatismos da Medula Espinal/fisiopatologia , Adenilato Quinase/metabolismo , Animais , Apoptose/efeitos dos fármacos , Autofagossomos/efeitos dos fármacos , Autofagossomos/metabolismo , Autofagossomos/ultraestrutura , Autofagia/efeitos dos fármacos , Ativação Enzimática/efeitos dos fármacos , Feminino , Lisossomos/efeitos dos fármacos , Lisossomos/metabolismo , Metformina/farmacologia , Modelos Biológicos , Neurônios/efeitos dos fármacos , Neurônios/patologia , Células PC12 , Ratos , Ratos Sprague-Dawley , Recuperação de Função Fisiológica/efeitos dos fármacos , Traumatismos da Medula Espinal/patologia , Serina-Treonina Quinases TOR/metabolismoRESUMO
OBJECTIVE: To investigate the surgical outcome of unilateral pedicle screw(UPS) after TLIF technique combined with contralateral percutaneous transfacet screw(PTS) fixation vs bilateral pedicle screws(BPS) fixation in treatment of degenerative lumbar disease. METHODS: From January 2009 to June 2012, 46 patients with degenerative lumbar diseases, including 30 males and 16 females with an average age of 51.5 years old, who were divided into two groups according to different fixation methods. Twenty-two cases underwent UPS after TLIF technique combined with contralateral PTS fixation (group A), while the others underwent BPS fixation(group B). The relative data were analyzed, such as blood loss volume, operative time, fusion rate, ODI score, JOA score and so on. RESULTS: All the patients were followed up for 1 to 3 years with an average of 22 months. Except one case of each group was uncertainty fusion, the rest have obtained bony fusion, and the fusion rates in group A and B were 95.5% and 95.8%, respectively. No displacement and breakage of screw were found during follow-up. Operative time and blood loss volume in group A were better than of group B(P<0.05). ODI and JOA scores had improved obviously than preoperation(P<0.05), but the differences had no statistical significance between two groups(P>0.05). CONCLUSIONS: Two approaches had similar clinical outcomes for degenerative lumbar disease with no severe instability. Compared with BPS fixation, the UPS after TLIF technique and contralateral PTS fixation has the advantages of less trauma, shorter operative time and less blood loss, and it is a safe and feasible surgical technique.