Objective To investigate the effectiveness of radical debridement, reconstruction with bone allograft, and pedicle screw-rod internal fixation via combined anterior and posterior approach in the treatment of lumbosacral tuberculosis. Methods Between January 2005 and May 2010, 16 patients with lumbosacral tuberculosis were treated. Radical debridement wasperformed via extraperitoneal approach, then tricortical il iac bone allograft was placed and pedicle screw-rod internal fixation was used to reconstruct the spinal column. There were 12 males and 4 females aged 38-65 years (mean, 48 years). The disease duration ranged from 6 to 24 months (mean, 10 months). The main cl inical symptom was persistent pain in lumbosacral area. The involved segments included L4, 5 (3 cases), L5, S1 (8 cases), and L4-S1 (5 cases). The lumbosacral angle was 18-32° (mean, 22°). The erythrocyte sedimentation rate (ESR) was 15-55 mm/1 hour (mean, 25 mm/1 hour). All the patients were given antituberculosis chemotherapy for 12 months after operation. Results The operation time was 120-240 minutes (mean, 180 minutes). The amount of bleeding was 300-600 mL (mean, 420 mL). All wounds healed by first intention, and no relative compl ication occurred. All 16 cases were followed up 12-24 months (mean, 16 months). No recurrence occurred and ESR recovered to normal. Persistent pain in lumbosacral area and radicular pain in lower extremities disappeared. The X-ray films demonstrated that bony fusion was obtained in all patients at 8-12 months postoperatively. The lumbosacral angle was 16-31° (mean, 21°) at last follow-up. Conclusion The extraperitoneal approach can provide direct and safe access to the lesion. The structural il iac bone allograft and posterior instrumentation could reconstruct effectively the stabil ity of the lumbosacral junction.
【Abstract】 Objective To investigate the effect of salidroside on rat bone marrow mesenchymal stem cells (BMSCs)differentiation into the chol inergic nerve cells, so as to provide the theory basis of the combination of salidroside and stem cellsfor cl inical therapy of nervous system diseases. Methods BMSCs were isolated from 2 Wistar rats (aged 4-6 weeks, weighing 120 g), which were identified by CD34, CD45, CD90, and CD106 with flow cytometry. According to inducing method, BMSCs at passage 2 were divided into 3 groups: In groups A and B, BMSCs were induced by salidroside (20 μg/mL) and retinoic acid (5 μmol/mL) respectively for 1, 3, 6, and 9 days, in group C, BMSCs were cultured with serum-free DMEM/F12 medium as control. MTT assay was used to detect the cellular prol iferation activity. The immunofluorescence chemical technology was used to detect the expressions of nerver growth factor (NGF) and relevant marker molecule of nerve cells, including neuron-specific enolase (NSE), microtubule-associated protein 2 (MAP2), β-Tubulin III, gl ial fibrillary acidic protein (GFAP), and the marker of cholinergic neuron, such as Acetylcholine (Ach) and NGF. RT-PCR was used to detect mRNA expressions of NSE, β-Tubulin III, GFAP, brain derived neurotrophic factor (BDNF), and γ-aminobutyric acid (GABA). ELISA was used to detect the levels of BDNF and NGF, and the expression level of NGF protein was analyzed by Western blot. Results The results of the flow cytometry showed that the cultured cells were CD90 and CD106 positive, and CD34 and CD45 negative, which indicated that the cells were BMSCs. The cellular proliferation activity in groups A and B were significantly higher than that in group C at 6 days and 9 days (P lt; 0.05). RT-PCR results showed that the expression level of NSE, BDNF, β-Tubulin III, GFAP mRNA were increased in groupA at 6 days; In group B, that expression level of NSE mRNA was up-regulated at 6 days, that expression level of BDNF mRNA increased at 1 days and reached the peak at 6 days, and that expression level of β-Tubulin III mRNA was up-regulated at 3 days, which was significantly higher than that at the other time points, and than that in group C (P lt; 0.01). But no GABA mRNA expression was detected in each group. Immunofluorescence chemical technology staining showed that the positive rates of NSE, MAP2, β-Tubulin III, and GFAP were significantly higher in group A than those in group C at 3 days; the positive rates of Ach were significantly higher at 3, 6, and 9 days than those at 1 day in groups A and B, and in groups A and B than in group C (P lt; 0.01); the positive rates of NGF in groups A and B were significantly higher than those in group C (P lt; 0.01). The levels of BDNF and NGF in groups A and B were significantly higher than those in group C at 1, 3, 6, and 9 days (P lt; 0.01), but no significant difference of BDNF was found between groups A and B (P gt; 0.05). The expression level of NGF protein in groups A and B were significantly higher than that in group C (P lt; 0.01). The NGF expression reached the peak at 6 days in group A and at 3 days in group B. Conclusion Sal idroside could induce rat BMSCs differentiate into chol inergic nerve cells in vitro.
Objective Gunshot wound spreads to the surrounding tissues and organs, it is difficult to debride and easy to infect. The conventional treatment is thorough, extensive debridement, fully open drainage, which often causes normal tissue damage and compl ications. To evaluate the effectiveness of vacuum seal ing drainage (VSD) treating thepenetrating wound in porcine extremity by MRI and pathological methods so as to provide theoretical basis for future cl inical use. Methods Eight healthy adult pigs, weighing (45 ± 5) kg, were selected. Eight pairs of hind l imb penetrating wounds (16 wounds) were made by using Chinese-made 95-type rifle at 25 meters distance, which were randomly divided into experimental group (left side, n=8) and the control group (right side, n=8). After debriding and disinfecting the penetrating wounds at 6 hours after injury, wounds were treated with VSD in experimental group. The ball istics exports of the wounds were covered with single-layer gauze and imports were directly sutured and covered with sterile gauze in control group. The trajectory and the general condition of the adjacent skin were observed. MRI and histological observation were taken at 5, 24, 48, and 72 hours after injury, bacterial counting analysis was done at 0, 12, 24, 48, and 72 hours after injury. Results The aperture of the trajectory exit and entry were (5.00 ± 2.50) cm and (0.30 ± 0.15) cm immediately after injury. The wound surface was clean, rosy without leakage and swell ing after 72 hours in experimental group; wound and adjacent tissue were swell ing obviously, pus, muscle necrosis and exfol iative tissue was observed, and deep defect cavity at the trajectory exit could be seen in control group. MRI showed that pairs of l inear low signal in T1WI and T2WI was seen in trajector of experimental group at 5 hours after injury, and signal in T1WI gradually increased at disrupted area and tissue deformation area at 24, 48, and 72 hours; in control group, low signal in T1WI was observed at 5 hours after injury, and signal in T2WI gradually increased and a clear boundari between edema and surrounding tissue, and the increase of signal in T1WI was not obvious at 24, 48, and 72 hours. The histological observation showed that wound was dominated by effusion at 5 hours after injury, granulation tissue gradually increased, muscle tissue dissolved and inflammatory cell infiltration was not obvious at 24, 48, and 72 hours in experimental group; in control group, the gradual dissolution of muscle fibers and inflammatory cell infiltration were observed at 5, 24, and 48 hours, muscle tissue became swell ing, dissolving and degeneration and a large number of inflammatory cell infiltration gathered into the bacteria group at 72 hours. There was no significant difference in the number of bacteria per gram of tissue (P gt; 0.05) between experimental group and control group at 0 hour after injury; the numbers of bacteria in control group were significantly higher than those in experimental group at 12, 24, 48, and 72 hours (P lt; 0.05). Conclusion MRI combined with pathology show diagnostic meaning in treatment of gunshot wound with VSD. MRI can accurately reflect the scope of l imb gunshot wound 72 hours after injury. VSD may be an approach to delay infective time, shorten wound heal ing time, and promote the growth of healthy granulation tissue.
Studying effects of 50 Hz sinusoidal electromagnetic fields (SEMFs) with different intensities on peak bone mass (PBM) of rats may provide a theoretical basis for application of electromagnetic clinical field. 30 female SD rats, 6 weeks of age, were randomly divided into three groups: the control group, 0.1 mT electromagnetic field group (EMFs) and 0.6 mT EMFs. The EMFs groups were treated for 3 h/day. After 8 weeks, we examined their bone mineral densities (BMD), measured their bone biomechanical properties, and made serum levels of osteocalcin (OC), tartrate-resistant acid phosphatase 5b (TRACP 5b), and histomorphometry. It was found that the BMD (P < 0.01), maximum mechanical load (P < 0.01) in the 0.1 mT group were significantly higher than those in the control group, and Yield strength (P < 0.05), the analyses of serum bone turnover markers and histomorphometric parameters were better than those in the control group (P < 0.05). However, the 0.6 mT group did not have significantly difference comparing with that in the control group. This study proved that 50 Hz 0.1 mT SEMFs can increased BMD, bone strength, and bone tissue microstructure. Therefore, 50 Hz 0.1 mT SEMFs can improve peak bone mass of rats.