成人腰椎峡部裂型滑脱症的微创治疗

Objective To investigate the clinical experiences and technical skills of adult isthmic spondylolisthesis. Methods Twenty-one patients with adult isthmic spondylolisthesis underwent minimally invasive surgery. There were 12 men and 9 women, with the mean age of 51.7 years. Isthmic spondylolisthe-sis occurred at the L4.5 in 7 patients, and at the L5S1 in 14 patients. According to Meyerding classification, 13 cases were of Grade Ⅰ, 7 of Grade Ⅱ, 1 of Grade Ⅲ. Under general anesthesia, guiding by fluoroscopy, the surgeries performed minimally invasive microendoscopic(METRx) techniques for posterior decompression, interbody cage fusion and novel Sextant-R percutaneous pedicle screw techniques for deformity reduction and fixation. Results Seventeen cases were followed up 1 year postoperatively. The average low back pain VAS reduced from preoperative 6.0±2.6 to postoperative 2.9±2.5. The average leg pain VAS decreased from preoperative 6.7±3.3 to postoperative 2.8±1.6. The average ODI decreased from preoperative 44.3% to post-operative 27.1%. The Nakai good and excellent rate was 90%. The mean operative time 170 min, blood loss 160 ml, and postoperative stay in bed 7.5 d. The sagittal spondylolisthesis rate significantly decreased from preoperative 35.5%±2.5% to postoperative 8.3%±7.5%. The lordotic angle from preoperative 11.5°±1.7° in-creased to postoperative 16.8°±9.5°; the intervertebral disc height from preoperative (5.4±2.5) mm increased to postoperative (9.1±3.0) mm. According to Lenke judgement for fusion, complete fusion rate was 76%, in-complete fusion rate was 12%, nonfusion rate was 12%. Conclusion The minimally invasive microendo-scopic (METRx) assisted with a novel Sextant-R percutaneous pedicle screw systems for deformity reduction and fixation to treat adult isthmic spondylolisthesis, is not only a minimally invasive and safe surgical tech-nique, also an effective treatment for deformity reduction and fixation.     

5例胸腰段脊柱前路手术并发症分析

目的：分析胸腰段脊柱前路手术入路并发症，以提高胸腰段脊柱前路手术的水平，方法：对近4年来我科53例胸腰段脊柱前路手术出现的5例并发症进行回顾性分析，探讨并发症发生的原因。结果；本组病例1例发生腹膜后乳糜液漏，1例切口疝，1例气胸，2例深静脉血栓栓塞，经过积极治疗，全部治愈。结论：胸腰段脊柱前路手术并发症的发生大多数和术者对该段解剖知识，手术操作，认识程度和经验有关，可以避免或及早发现。     

局限性骨脓肿23例报告

目的：回顾性地总结局限性骨脓肿的临床和X线特点，为今后诊治提供参考。方法：将既往2个医院诊治的该病资料完整的23例进行临床分析，找出其一定的规律性。结果：该病好发于股骨中下段和胫骨上下端，其中发生在于骺端占17例。发病年龄9-46岁，其中半数为13岁以下儿童。发生于干骺端松质骨内14例，皮质骨内9例。结论：有局限性炎性症状。X线片显示为一饲皮质骨增生者，应考虑本病，行CT扫描确诊。手术治疗可取得良好效果。     

心肌营养素1/破伤风毒素重链C端片段融合蛋白的构建及其靶向大鼠嗜铬细胞瘤细胞的研究

目的：探讨心肌营养素1（cardiotrophin 1，CT1）/破伤风毒素重链C端片段（tentanus toxin C fragment,TTC）（CT1/TTC）融合蛋白的构建及其对大鼠嗜铬细胞瘤（pheochromocytoma,PC12）细胞的靶向性。方法：采用聚合酶链式反应（PCR）、T-A克隆等分子生物学方法构建CT1/TTC融合蛋白。体外培养PC12细胞,并将CT1/TTC融合蛋白与PC12细胞共培养,红色荧光免疫组化染色后在激光共聚焦显微镜下观察融合蛋白能否在TTC的靶向作用下进入PC12细胞。结果：成功构建了CT1/TTC融合蛋白,测序显示融合基因序列正确,免疫组化染色结果显示融合蛋白能够进入PC12细胞，并发出红色荧光。结论：采用PCR和T-A克隆等分子生物学方法能成功构建CT1/TTC融合蛋白．并且TTC能够将CT1靶向进入PC12细胞。     

成人腰椎峡部裂型滑脱症的微创治疗

Objective To investigate the clinical experiences and technical skills of adult isthmic spondylolisthesis. Methods Twenty-one patients with adult isthmic spondylolisthesis underwent minimally invasive surgery. There were 12 men and 9 women, with the mean age of 51.7 years. Isthmic spondylolisthe-sis occurred at the L4.5 in 7 patients, and at the L5S1 in 14 patients. According to Meyerding classification, 13 cases were of Grade Ⅰ, 7 of Grade Ⅱ, 1 of Grade Ⅲ. Under general anesthesia, guiding by fluoroscopy, the surgeries performed minimally invasive microendoscopic(METRx) techniques for posterior decompression, interbody cage fusion and novel Sextant-R percutaneous pedicle screw techniques for deformity reduction and fixation. Results Seventeen cases were followed up 1 year postoperatively. The average low back pain VAS reduced from preoperative 6.0±2.6 to postoperative 2.9±2.5. The average leg pain VAS decreased from preoperative 6.7±3.3 to postoperative 2.8±1.6. The average ODI decreased from preoperative 44.3% to post-operative 27.1%. The Nakai good and excellent rate was 90%. The mean operative time 170 min, blood loss 160 ml, and postoperative stay in bed 7.5 d. The sagittal spondylolisthesis rate significantly decreased from preoperative 35.5%±2.5% to postoperative 8.3%±7.5%. The lordotic angle from preoperative 11.5°±1.7° in-creased to postoperative 16.8°±9.5°; the intervertebral disc height from preoperative (5.4±2.5) mm increased to postoperative (9.1±3.0) mm. According to Lenke judgement for fusion, complete fusion rate was 76%, in-complete fusion rate was 12%, nonfusion rate was 12%. Conclusion The minimally invasive microendo-scopic (METRx) assisted with a novel Sextant-R percutaneous pedicle screw systems for deformity reduction and fixation to treat adult isthmic spondylolisthesis, is not only a minimally invasive and safe surgical tech-nique, also an effective treatment for deformity reduction and fixation.     

心肌营养素—1的研究进展

心肌营养素 1(CT 1)是一种新近发现的细胞因子 ,属于IL 6家族。人CT 1mRNA编码 2 0 3个氨基酸 ,以gp130和LIFR为受体。CT 1通过JAK /STAT3信号转导途径诱导心肌肥大 ,p2 4/p44MAPK途径保护心肌。CT 1也能维持神经元存活 ,并有IL 6样生物学功能。     

心肌营养素-1基因转染对大鼠脑损伤的保护作用

目的 在体观察腺病毒介导的心肌营养素-1基因(Adv-CT1)脑内转染对创伤大脑组织细胞的生物效应,探讨CT-1对创伤性脑损伤(TBI)治疗的作用和机制.方法 以Allen方法建立大鼠TBI模型,利用Adv-CT1脑内转染技术,以Nissl染色、原位细胞凋亡检测、流式细胞凋亡检测等技术,观察CT-1基因治疗TBI后创伤大脑细胞凋亡及存活的变化及规律.结果 TBI后12 h～7 d创伤对照组大脑皮层和海马等损伤脑区细胞凋亡明显增加,存活细胞减少;利用Adv-CT1脑内转染治疗TBI,伤后12 h～14 d损伤脑区凋亡细胞较创伤对照组减少,存活细胞增加.结论 CT-1可减少TBI后脑细胞凋亡发生,增加脑细胞的存活数量,对损伤脑区细胞的生存有保护作用.     

Minimally invasive strategies and options for far-lateral lumbar disc herniation

Objective： To investigate the surgical procedures, options and surgical indications for far-lateral lumbar disc herniation between three different minimally invasive procedures.
Methods： From January 2000 to October 2006, 52 patients with far-lateral lumbar disc herniation （29 males and 23 females, with the average age of 41.5 years） were treated with minimally invasive procedures. All the patients were assessed by X-ray and CT. Some were given additional myeography, discography, Computerized tomography myelography （CTM） and MRI examination. Yeung Endoscopy Spine System （YESS）, METRx and X-tube procedures were performed in 25, 13 and 14 cases, respectively. All patients were followed up for a mean period of 13.5 months. Clinical outcomes were assessed by visual analog score （VAS） and Nakai criteria.
Results： The results indicated that the three procedures could significantly improve the radiating leg symptoms （P〈0.05）. The postoperative overall excellent and goodrates of YESS, METRx and X-tube procedures were 84.0%, 84.6% and 92.8% respectively, with no statistical difference among three groups （P〉0.05）. The YESS procedure had several advantages including shortest operation time, simplest anesthesia and least trauma as compared with the other two procedures, especially for simple type I far-lateral lum- bar disc herniation. METRx procedure was specially suitable for simple type II. And the procedure of posterior endoscopic facetectomy, posterior lumbar interbody fusion and unilateral pedicle screw instrumentation with X-tube was designed for far-lateral disc herniation combined with degenerative lumbar instability.
Conclusion： Minimally invasive strategies and options should be determined by different types of far-lateral lumbar disc herniation.     

腺病毒介导的心肌营养素1基因修饰大鼠神经干细胞

目的:以心肌营养素1基因修饰大鼠神经干细胞,为心肌营养素1基因修饰的神经干细胞移植治疗中枢神经系统损伤提供物质基础。方法:实验于2002-06/2003-06在第三军医大学野战外科研究所全军重点开放实验室进行。从W istar大鼠胚胎海马和室管膜区组织分离、培养大鼠胚胎神经干细胞,以构建纯化好的重组腺病毒-心肌营养素1和重组腺病毒-增强绿色荧光蛋白载体转染神经干细胞。相差显微镜下直接观察细胞生长存活情况,应用免疫细胞化学和免疫荧光技术检测神经干细胞及其诱导后分化细胞的特异性蛋白巢蛋白、神经微丝蛋白、胶质纤维酸性蛋白,外源性Brdu和增强绿色荧光蛋白的掺入情况,并观察心肌营养素1基因在神经干细胞中的表达。结果:①从胚胎大鼠分离的神经干细胞可在体外多次传代,经细胞增殖标记物Brdu掺入实验证明神经干细胞具有分裂增殖能力。②检测神经干细胞标志物巢蛋白、神经元标志物神经微丝蛋白和胶质细胞标志物胶质纤维酸性蛋白,证实神经干细胞具有多向分化潜能。③重组腺病毒-心肌营养素1及重组腺病毒-增强绿色荧光蛋白转染神经干细胞后应用免疫组化和荧光示踪技术,检测到神经干细胞中心肌营养素1和报告基因增强绿色荧光蛋白表达明显持续增加。结论:①实验成功地分离和培养出大鼠神经干细胞,并在体外可多次传代增殖并可诱导分化为神经元和胶质细胞。②重组腺病毒-心肌营养素1和重组腺病毒-增强绿色荧光蛋白转染神经干细胞后,外源性心肌营养素1基因和增强绿色荧光蛋白在细胞中可持续稳定表达。     

核心结合因子α1基因转染NIH3T3成纤维细胞成骨表型转化

目的：观察细胞因子诱导成骨的共同信号分产核心结合因子α1基因转染NIH3T3成纤维细胞，其成骨表型转变的可能性。方法：实验于2003-10／2004-10在解放军第三军医大学新桥医院骨科中心实验室完成。采用脂质体转染技术行核心结合因子α1基因转染NIH3T3成纤维细胞，成骨标志基因Ⅰ型胶原、骨钙素、骨唾液蛋白、碱性磷酸酶、核心结合因子α1 mRNA的表达采用反转录．聚合酶链反应检测，骨钙素的表达采用免疫细胞化学染色检测，Cbfa蛋白的表达采用Western blot检测。结果：①NIH3T3成纤维细胞经核心结合因子α1基因转染后出现骨钙素、骨唾液蛋白、碱性磷酸酶的表达，Ⅰ型胶原表达增强，说明在转录水平有成骨标志基因的表达。②免疫细胞化学染色检测到了骨钙素的表达，显示NIH3T3细胞已发展为成骨细胞。③Western blot检测到了核心结合因子α1蛋白的表达，证实了成纤维细胞发生了表型的改变。结论：核心结合因子α1基因转移NIH3T3成纤维细胞改变了成纤维细胞向成骨表型转化，增加了成骨细胞数量，使成骨能力增强成为可能。