How to enhance the ability of mesenchymal stem cells to alleviate intervertebral disc degeneration

Intervertebral disc(ID)degeneration(IDD)is one of the main causes of chronic low back pain,and degenerative lesions are usually caused by an imbalance between catabolic and anabolic processes in the ID.The environment in which the ID is located is harsh,with almost no vascular distribution within the disc,and the nutrient supply relies mainly on the diffusion of oxygen and nutrients from the blood vessels located under the endplate.The stability of its internal environment also plays an important role in preventing IDD.The main feature of disc degeneration is a decrease in the number of cells.Mesenchymal stem cells have been used in the treatment of disc lesions due to their ability to differentiate into nucleus pulposus cells in a nonspecific anti-inflammatory manner.The main purpose is to promote their regeneration.The current aim of stem cell therapy is to replace the aged and metamorphosed cells in the ID and to increase the content of the extracellular matrix.The treatment of disc degeneration with stem cells has achieved good efficacy,and the current challenge is how to improve this efficacy.Here,we reviewed current treatments for disc degeneration and summarize studies on stem cell vesicles,enhancement of therapeutic effects when stem cells are mixed with related substances,and improvements in the efficacy of stem cell therapy by adjuvants under adverse conditions.We reviewed the new approaches and ideas for stem cell treatment of disc degeneration in order to contribute to the development of new therapeutic approaches to meet current challenges.

Early efficacy of endoscopic translaminar and intervertebral foraminal approaches in the treatment of lumbar disc herniation

Objective:To investigate the early efficacy of two approaches for lumbar disc herniation under spinal endoscopy.Methods:45 cases of lumbar disc herniation were divided into interlaminar approach(27 cases)and intervertebral foramen approach(18 cases)according to different surgical approaches.Postoperative pain visual analogue scale(VAS)was used.Japanese Orthopaedic Association(JOA)lumbar spine score(JOA)and modified Macnab criteria were used to evaluate the postoperative outcome.Results:(1)VAS score.There is no interaction effect between the access mode and the time factor(F=0.620,P=0.603).There were statistically significant differences in pain VAS scores between preoperative and postoperative time points,that is,there was a time effect(F=2157.488,P=0.000).The overall VAS scores of the two groups were compared,and the difference was not statistically significant,that is,there was no grouping effect(F=2.610,P=0.114).The VAS score of pain in both groups decreased with time,and the differences between the two groups were not statistically significant before surgery,at discharge,1 month after surgery and 3 months after surgery(t=0.067,P=0.947;t=1.415,P=0.164;t=0.564,P=0.575;t=0.442,P=0.660);JOA score.There is no interaction effect between the access mode and the time factor(F=1.296,P=0.280).The difference of JOA score between preoperative and postoperative time points was statistically significant,that is,there was a time effect(F=1464.830,P=0.000).JOA scores of the two groups showed an increasing trend with time,and the differences between the two groups were not statistically significant before surgery,at discharge,1 month after surgery and 3 months after surgery(t=0.067,P=0.947;t=1.415,P=0.164;t=0.564,P=0.575;t=0.442,P=0.660);(2)The improved Macnab standard was used to evaluate the excellent and good rate at 3 months after surgery.In the interlaminar group,12 cases were excellent,13 cases were good and 2 cases were fair.The excellent and good rate was 92.6%.In the intervertebral foramen group,7 cases were excellent,10 cases were good and 1 case was fair.The excellent and good rate was 94.4%.The overall excellent and good rate of the two groups was 93.3%.Conclusion:Both approaches can achieve satisfactory efficacy in the treatment of lumbar intervertebral disc herniation,which is worthy of clinical application.However,for beginners,l5-s1 lumbar disc herniation is more suitable for intervertebral disc approach,so as to achieve satisfactory efficacy.

An esterase-responsive ibuprofen nano-micelle pre-modified embryo derived nucleus pulposus progenitor cells promote the regeneration of intervertebral disc degeneration

Stem cell-based transplantation is a promising therapeutic approach for intervertebral disc degeneration(IDD).Current limitations of stem cells include with their insufficient cell source,poor proliferation capacity,low nucleus pulposus(NP)-specific differentiation potential,and inability to avoid pyroptosis caused by the acidic IDD microenvironment after transplantation.To address these challenges,embryo-derived long-term expandable nucleus pulposus progenitor cells(NPPCs)and esterase-responsive ibuprofen nano-micelles(PEG-PIB)were prepared for synergistic transplantation.In this study,we propose a biomaterial pre-modification cell strategy;the PEG-PIB were endocytosed to pre-modify the NPPCs with adaptability in harsh IDD microenvironment through inhibiting pyroptosis.The results indicated that the PEG-PIB pre-modified NPPCs exhibited inhibition of pyroptosis in vitro;their further synergistic transplantation yielded effective functional recovery,histological regeneration,and inhibition of pyroptosis during IDD regeneration.Herein,we offer a novel biomaterial pre-modification cell strategy for synergistic transplantation with promising therapeutic effects in IDD regeneration.

Comparison of microendoscopic discectomy and open discectomy for single-segment lumbar disc herniation

BACKGROUND Lumbar disc herniation is a common disease.Endoscopic treatment may have more advantages than traditional surgery.AIM To compare the clinical efficacy and safety of microendoscopic discectomy(MED)and open discectomy with lamina nucleus enucleation in the treatment of singlesegment lumbar intervertebral disc herniation.METHODS Ninety-six patients who were operated at our hospital were selected for this study.Patients with single-segment lumbar disc herniation were admitted to the hospital from March 2018 to March 2019 and were randomly divided into the observation group and the control group with 48 cases in each group.The former group underwent lumbar discectomy and the latter underwent laparotomy and nucleus pulpectomy.Surgical effects were compared between the two groups.RESULTS In terms of surgical indicators,the observation group had a longer operation time,shorter postoperative bedtime and hospital stay,less intraoperative blood loss,and smaller incision length than the control group(P<0.05).The excellent recovery rate did not differ significantly between the observation group(93.75%)and the control group(91.67%).Visual analogue scale pain scores were significantly lower in the observation group than in the control group at 1 d,3 d,1 mo,and 6 mo after surgery(P<0.05).The incidence of complications was significantly lower in the observation group than in the control group(6.25%vs 22.92%,P<0.05).CONCLUSION Both MED and open discectomy can effectively improve single-segment lumbar disc herniation,but MED is associated with less trauma,less bleeding,and a lower incidence of complications.

Transplantation of gene-modified nucleus pulposus cells reverses rabbit intervertebral disc degeneration

Background Intervertebral disc degeneration is the main cause of low back pain. The purpose of this study was to explore potential methods for reversing the degeneration of lumbar intervertebral discs by transplantation of gene-modified nucleus pulposus cells into rabbit degenerative lumbar intervertebral discs after transfecting rabbit nucleus pulposus cells with adeno-associated virus 2 （AAV2）-mediated connective tissue growth factor （CTGF） and tissue inhibitor of metalloproteinases 1 （TIMP1） genes in vitro. Methods Computer tomography （CT）-guided percutaneous annulus fibrosus injury was performed to build degenerative lumbar intervertebral disc models in 60 New Zealand white rabbits, rAAV2-CTGF-IRES-TIMPI-transfected rabbit nucleus pulposus cells were transplanted into degenerative lumbar intervertebral discs （transplantation group）, phosphate-buffered saline （PBS） was injected into degenerative lumbar intervertebral discs （degeneration control group） and normal lumbar intervertebral discs served as a blank control group. After 6, 10 and 14 weeks, the disc height index （DHI） and signal intensity in intervertebral discs were observed by X-ray and magnetic resonance imaging （MRI） analysis The expression of CTGF and TIMP1 in nucleus pulposus tissue was determined by Western blotting analysis, the synthesis efficiency of proteoglycan was determined by a 35S-sulfate incorporation assay, and the mRNA expression of type II collagen and proteoglycan was detected by RT-PCR. Results MRI confirmed that degenerative intervertebral discs appeared two weeks after percutaneous puncture. Transgenic nucleus pulposus cell transplantation could retard the rapid deterioration of the DHI. MRI indicated that degenerative intervertebral discs were relieved in the transplantation group compared with the degeneration control group. The expression of collagen II mRNA and proteoglycan mRNA was significantly higher in the transplantation group and the blank control group compared with the degeneration control group （P 〈0.05）. Conclusions CT-guided percutaneous puncture can successfully build rabbit degenerative intervertebral disc models. Both CTGF and TIMPl-transfected cell transplantation helps to maintain disc height, and promotes the biosynthesis of tvDe II collaQen and proteoalvcan in intervertebral discs, reversinq the de（：ieneration of intervertebral discs.

Autologous nucleus pulposus transplantation to lumbar 5 dorsal root ganglion after epineurium discission in rats： a modified model of non-compressive lumbar herniated intervertebral disc

Background Nucleus pulposus of intervertebral discs has proinflammatory characteristics that play a key role in neuropathic pain in lumbar herniated intervertebral disc. One of the most commonly used animal models （the traditional model） of non-compressive lumbar herniated intervertebral disc is created by L4-L5 hemilaminectomy and the application of autologous nucleus pulposus to cover the left L4 and L5 nerve roots in rats. However, such procedures have the disadvantages of excessive trauma and low success rate. We proposed a modified model of non-compressive lumbar herniated intervertebral disc in which only the left L5 dorsal root ganglion is exposed and transplanted with autologous nucleus pulposus following incision of epineurium. We aimed to compare the modified model with the traditional one with regard to trauma and success rate. Methods Thirty Sprague-Dawley male rats were randomized into three groups： sham operation group （n=6）, traditional group （n=12）, and modified group （n=12）. The amount of blood loss and operative time for each group were analyzed. The paw withdrawal threshold of the left hind limb to mechanical stimuli and paw withdrawal latency to heat stimuli were examined from the day before surgery to day 35 after surgery. Results Compared with the traditional group, the modified group had shorter operative time, smaller amount of blood loss, and higher success rate （91.7% versus 58.3%, P 〈0.05）. There was no decrease in paw withdrawal latency in any group. The sham operation group had no decrease in postoperative paw withdrawal threshold, whereas the modified and traditional groups had significant reduction in paw withdrawal threshold after surgery （mechanical hyperalgesia）. Conclusions Transplantation of nucleus pulposus onto the L5 dorsal root ganglion following incision of epineurium in rats established an improved animal model of non-compressive lumbar herniated intervertebral disc with less trauma and more stable pain ethology.

侧后路经皮椎间孔镜髓核摘除术治疗腰椎间盘突出症的效果

目的探讨侧后路经皮椎间孔镜髓核摘除术在腰椎间盘突出症治疗中的应用效果。方法选取2017年1月—2019年12月福建医科大学附属闽东医院91例腰椎间盘突出症患者为对照组,采取后路椎板间开窗髓核摘除术治疗;并选取2020年1月—2022年12月福建医科大学附属闽东医院91例腰椎间盘突出症患者为观察组,采取侧后路经皮椎间孔镜髓核摘除术治疗。对比治疗效果,包括术中出血量、手术时间、住院时间、颈脊髓功能评分法(Japanese Orthopaedic Association scores,JOA)、视觉模拟评分法(visual analogue scale,VAS)评分和并发症发生情况。结果观察组术中出血量少于对照组,手术时间长于对照组,但术后住院时间短于对照组,差异有统计学意义(P<0.05);术后,观察组JOA评分高于对照组,差异有统计学意义(P<0.05)。观察组术后1、3 d VAS评分低于对照组(P<0.05)。观察组并发症总发生率为5.49%,低于对照组的15.39%(P<0.05)。结论侧后路经皮椎间孔镜髓核摘除术在腰椎间盘突出症治疗中应用价值较高,不仅可以减少整体治疗时间及术中出血量,且能够提高腰椎功能,减轻疼痛。此外,该方法有助于降低术后并发症发生率。

经皮椎间孔镜髓核摘除术与经椎间孔入路椎管减压椎间植骨融合内固定术治疗腰椎间盘突出症的疗效比较

目的:对比经皮椎间孔镜髓核摘除术(PELD)与经椎间孔入路椎管减压椎间植骨融合内固定术(TLIF)治疗腰椎间盘突出症(LDH)的疗效。方法:回顾性分析222例LDH患者的临床资料,根据手术方法的不同分为TLIF组(n=144)和PELD组(n=78)。两组均随访至术后6个月,比较两组围术期相关指标、治疗前后腰腿疼痛情况[视觉模拟评分法(VAS)]、腰椎功能[Oswesry功能障碍指数问卷表(ODI)]及随访期间并发症情况。结果:PELD组手术时间、首次下床活动时间、住院时间短于TLIF组,术中出血量少于TLIF组(P<0.05),切口长度短于TLIF组(P<0.05)。术后,两组下腰痛和腿痛VAS评分均随着时间推移而减轻,且各时间点PELD组下腰痛VAS评分均低于TLIF组(P<0.05);出院时,PELD组腿痛VAS评分低于TLIF组(P<0.05)。相较于TLIF组,PELD组术后6个月ODI及Cobb角更低(P<0.05),腰椎前屈及腰椎后伸更高(P<0.05)。PELD组总并发症发生率低于TLIF组(P<0.05)。结论:相比TLIF,PELD治疗LDH具有创伤小、恢复快的优势,有利于腰腿疼痛缓解和腰椎功能恢复,且并发症发生率更低。

Nimbolide targeting SIRT1 mitigates intervertebral disc degeneration by reprogramming cholesterol metabolism and inhibiting inflammatory signaling

Inflammation,abnormal cholesterol metabolism,and macrophage infiltration are involved in the destruction of the extracellular matrix of the nucleus pulposus(NP),culminating in intervertebral disc degeneration(IDD).Whether nimbolide(Nim),a natural extract,can alleviate IDD is unclear.In this study,we demonstrated that Nim promotes cholesterol efflux and inhibits the activation of the nuclear factor kappa B(NF-κB)and mitogen-activated protein kinase(MAPK)signaling pathways by activating sirtuin 1(SIRT1)in nucleus pulposus cells(NPCs)during inflammation.Thus,Nim balanced matrix anabolism and catabolism of NPCs.However,the inhibition of SIRT1 significantly attenuated the effects of Nim.We also found that Nim promoted the expression of SIRT1 in RAW 264.7,which enhanced the proportion of M2 macrophages by facilitating cholesterol homeostasis reprogramming and impeded M1-like macrophages polarization by blocking the activation of inflammatory signaling.Based on these results,Nim can improve the microenvironment and facilitate matrix metabolism equilibrium in NPCs.Furthermore,in vivo treatment with Nim delayed IDD progression by boosting SIRT1 expression,modulating macrophage polarization and preserving the extracellular matrix.In conclusion,Nim may represent a novel therapeutic strategy for treating IDD.

经后路椎间盘摘除植骨融合内固定术与开窗减压髓核摘除术治疗腰椎间盘突出症对远期疗效的影响

目的 探讨经后路椎间盘摘除植骨融合内固定术与开窗减压髓核摘除术治疗腰椎间盘突出症对患者远期疗效的影响。方法 方便选取2020年1月-2022年12月江苏省南通市中山骨科医院收治的122例腰椎间盘突出症患者为研究对象,按照治疗方法分为两组,施以开窗减压髓核摘除术进行治疗的61例为对照组,施以经后路椎间盘摘除植骨融合内固定术进行治疗的61例为观察组,在接受治疗1年后随访分析两组患者的治疗效果。结果 观察组临床疗效为93.44%高于对照组的77.05%,差异有统计学意义(χ^(2)=6.517,P<0.05),对照组的复发率高于观察组,差异有统计学意义(P<0.05);治疗后,观察组承受疼痛程度评分低于对照组,差异有统计学意义(P<0.05);观察组患者手术时间、术中出血量、下床时间均优于对照组,差异有统计学意义(P<0.05)。结论 腰椎间盘突出症患者通过经后路椎间盘摘除植骨融合内固定术治疗相较于开窗减压髓核摘除术,能够最大程度地缓解患者的疼痛感,让患者拥有更为理想的治疗成效,且其复发率低,值得临床推广。

椎间盘镜和小切口开窗髓核摘除手术疗效比较

目的比较椎间盘镜(MED)与小切口开窗髓核摘除术治疗腰椎间盘突出症的临床疗效,探讨各自的手术适应证。方法200例腰椎间盘突出症患者分为两组,行MED和小切口开窗髓核摘除术各100例。结果按Naka i疗效评价标准,MED组优72例,良21例,可5例,差2例;小切口开窗手术组优70例,良20例,可6例,差4例。两组并发症主要为术后复发MED组2例,小切口开窗组3例;椎间盘炎各1例。无神经根及脊髓损伤。结论两种手术方式疗效均较为肯定,术后疗效大体一致,MED术中出血少,平均住院时间短,但对于多节段椎间盘突出、巨大型、游离型、中央型以及合并椎间盘钙化的手术,小切口开窗疗效较为显著。

鼠神经生长因子对腰椎间盘突出患者术后神经恢复的作用

目的观察鼠神经生长因子对腰椎间盘突出术后患者的临床疗效。方法 60例腰椎间盘突出患者,分为治疗组30例和对照组30例。两组均采用后路椎板切除减压髓核摘除椎弓根螺钉内固定术常规治疗。治疗组加用鼠神经生长因子注射液。两组疗程均为30 d。两组均在治疗前后分别记录症状及体征,采用疼痛视觉模拟评分法(VAS)进行评定,检测治疗前后胫后神经及腓总神经传导速度及主要肌群肌电图。结果治疗组VAS评分优于对照组(P<0.05),治疗组痊愈+显效率76.7%,高于对照组的50.0%(P<0.05);治疗组各神经传导速度及主要肌群动作电位恢复情况均优于对照组(P<0.05)。结论鼠神经生长因子可改善腰椎间盘突出术后患者的疼痛及神经功能。

经后路摘除后外侧型颈椎间盘突出的疗效与安全性评价

目的探讨后外侧型颈椎间盘突出采取后路手术切除髓核、并行颈椎侧块螺钉固定术的指征、疗效与安全性。方法自2006年10月至2012年12月我们收治了35例颈椎间盘外侧型突出、经颈后路手术切除椎间盘并行颈椎侧块螺钉内固定术进行回顾性研究。术后全组病例平均随访期为12个月,评价两项指标包括神经功能障碍和疼痛的改善状况。结果本组病例均采用日本骨科协会治疗评价分数(Japanese Orthopaedic Association Scores,JOAS),并比较手术前、后神经功能的变化情况。JOAS在术后为(14.35±1.65)分,与术前(6.82±2.36)分比较,经统计学分析有显著相差性(P<0.001)。术后神经功能平均改善率为87%,28例疼痛完全消失,7例明显好转。肌力及腱反射29例显著改善,6例有改善,无1例发生并发症。结论后外侧颈椎间盘突出行后入路髓核摘除术,是一种安全、有效的技术方法,对病损节段颈椎行侧块螺钉固定术,具有保护脊柱功能、重建其稳定性并防止术后椎间盘突出复发的良好作用。

腰椎间盘突出症术后复发再次椎板间开窗手术治疗体会

目的探讨复发性腰椎间盘突出症行椎板间再次开窗手术治疗的临床疗效。方法对23例复发性腰椎间盘突出症再次行椎板间开窗或扩大开窗椎间盘髓核摘除术,进行回顾性研究。结果 23例患者术后腰腿疼痛均明显缓解,参见Epstein法对患者主观感觉评价,术后2月优良率91.3%,末次随访仍达82.6%,术后腰腿疼痛JOA功能评分、VAS评分均较术前有显著性差异,P<0..05,术后2月与末次随访疼痛评分无明显差异P>0.05。结论采用椎板间再次开窗或扩大开窗治疗腰椎稳定的复发性腰椎间盘突出症疗效满意。

单侧双通道内镜微创髓核摘除手术治疗腰椎间盘突出的效果及其对JOA评分影响

目的探究并分析单侧双通道内镜技术(UBE)在腰椎间盘突出(LDH)患者的治疗效果及其对日本骨科学会(JOA)评分的影响。方法选取2020年10月~2021年12月收治的69例LDH患者,按照随机数字表法将其分为观察组(n=34)和对照组(n=35)。对照组采用后路切开髓核摘除椎弓根内固定椎间融合治疗治疗,观察组采用UBE进行治疗。观察两组患者一般资料(年龄、性别、病变区域、手术的时间、病程、出血量等)、手术前后评分即视觉模拟评分(VAS)、JOA评分、腰痛Oswestry功能障碍指数(ODI)评分。结果两组患者术前VAS评分差异无统计学意义(P>0.05),术后VAS评分均较术前下降(P<0.05),观察组患者术后1、24、72 h的VAS评分较对照组下降(P<0.05);两组患者术前JOA评分差异无统计学意义(9.34±0.33 vs 9.23±0.43,P>0.05),术后JOA评分均较术前升高(P<0.05),术后6月观察组患者的JOA评分高于对照组(15.54±0.52 vs 14.23±0.43,P<0.05);两组患者术前ODI评分差异无统计学意义(15.43±3.54 vs 15.74±3.34,P>0.05),术后1月、6月两组ODI评分较术前升高(P<0.05),术后6月观察组患者ODI评分高于对照组(51.43±3.73 vs 48.75±3.64,P<0.05)。两组患者术前血清HMGB1、IL-6水平差异无统计学意义(4.43±0.54 vs 4.41±0.65、44.74±4.25 vs 45.54±4.54,P>0.05),术后1月、6月两组患者较术前均有升高(P<0.05),且观察组患者术后6月均较对照组降低(5.4±0.54 vs 6.54±0.32、46.85±4.45 vs 52.63±4.41,P<0.05)。结论UBE手术较后路切开髓核摘除椎弓根内固定椎间融合术更能有效降低LDH患者的疼痛程度,改善患者腰椎稳定性,值得临床推广。

椎间孔镜系统治疗神经根型颈椎病近中期临床效果

目的探讨椎间孔镜系统治疗神经根型颈椎病近中期临床效果。方法按照手术方案不同将2016年7月~2017年7月我院接诊的78例神经根型颈椎病患者均分为观察组和对照组各39例,观察组患者接受后路椎间孔镜下椎间盘髓核摘除术治疗,对照组患者接受颈椎前路椎间盘切除内固定术治疗,比较两组患者手术情况、住院情况以及治疗前后颈椎曲度、病变颈椎椎间高度、疼痛程度、神经功能、生活质量变化情况。结果观察组患者手术时间、术中出血量及术后住院时间均显著低于对照组,差异有统计学意义(P<0.05);观察组患者末次随访时颈椎曲度显著高于对照组,差异有统计学意义(P<0.05);观察组患者末次随访时JOA评分、SF-36评分显著高于对照组,VAS评分显著低于对照组,差异有统计学意义(P<0.05)。结论和后路椎间孔镜下椎间盘髓核摘除术治疗对比,椎间孔镜系统治疗神经根型颈椎病微创效果明显,患者手术时间、术中出血量及术后住院时间较低,治疗安全性相对较高,患者颈椎曲度、JOA评分、SF-36评分、VAS评分改善较好,治疗效果好,生活质量改善明显,而且患者疼痛较轻,值得临床推荐。

腰椎间盘脱出髓核游离的MRI表现

目的:探讨MRI对腰椎间盘脱出髓核游离的诊断价值。方法:回顾性分析本院2014年7月-2015年10月经手术证实的20例腰椎间盘脱出髓核游离患者的临床及影像学资料。结果:20例患者中,髓核向上移位10例,向下移位6例,居中4例,均为单发病灶,其形态呈圆形、卵圆形、扁平及带状不规则形。游离髓核与同节段供体椎间盘髓核在各序列均类似。MRI诊断与手术病理结果符合率高于CT,比较差异有统计学意义(P<0.05)。结论:MRI诊断腰椎间盘脱出及髓核游离准确率高,值得临床应用。

经皮椎间孔镜与椎板开窗髓核摘除术治疗中年腰椎间盘突出症对比疗效分析

目的对比分析经皮椎间孔镜与椎板开窗髓核摘除术治疗中年腰椎间盘突出症患者的疗效。方法回顾性分析2015年1月—2017年12月住院的腰椎间盘突出症患者80例。按照手术方式分为常规开放性手术组(42例)和孔镜组(38例)。观察两组病员术前术后VAS、ODI、术中切口长度,手术时间,术中出血量,术后卧床,术后住院时间,住院费用及术后优良率等指标。结果两组病员术中切口长度,手术时间,术中出血量,术后卧床,术后住院时间,住院费用组间比较差异有统计学意义(P<0.05),除手术时间孔镜组长于常规组之外,其余孔镜组均低于常规组。VAS评分及ODI评分,术后组间比较差异有统计学意义(P<0.05),术前术后组内比较差异有统计学意义(P<0.05),两组病员术后VAS均明显低于术前,术后平均值孔镜组均低于常规组。两组患者均具有良好的优良率,组间比较差异无统计学意义(P>0.05)。结论在治疗中年腰椎间盘突出症的病员时,在熟练地掌握了孔镜技巧后经椎间孔镜髓核摘除术(PTED)是较好的选择。PTED近期疗效优于椎板开窗髓核摘除术(FD)组,并且住院费用花费更少,值得临床推广。

小切口开窗髓核摘除术治疗腰椎间盘突出症效果的临床研究

目的:探讨小切口开窗髓核摘除术治疗腰椎间盘突出症的效果。方法:回顾性分析本院2015年6月-2017年6月手术治疗的64例腰椎间盘突出症患者临床资料,按随机数字表法分为对照组与研究组,每组32例。对照组采用传统手术,研究组采用小切口开窗髓核摘除术手术。比较两组切口长度、手术时间、术中出血量、治疗效果、日本骨科学会评分(JOA)及视觉模拟评分法(VAS)评分。结果:研究组切口长度、手术时间及术中出血量均低于对照组(P<0.05);研究组治疗效果优良率高于对照组(P<0.05);研究组术后JOA评分高于对照组、而VAS评分低于对照组(P<0.05)。结论:小切口开窗髓核摘除术创伤小,既能解决椎间盘突出问题,又能减少对脊椎后方组织的破坏,维持脊柱的动力性稳定,是治疗腰椎间盘突出症极其可行的微创手术方法。

Adenovirus-mediated GDF-5 promotes the extracellular matrix expression in degenerative nucleus pulposus cells

Objective： To construct a recombinant adenovirus vector-carrying human growth and differentiation factor-5 （GDF-5） gene, investigate the biological effects of adenovirus-mediated GDF-5 （Ad-GDF-5） on extracellular matrix （ECM） expression in human degenerative disc nucleus pulposus （NP） cells, and explore a candidate gene therapy method for intervertebral disc degeneration （IDD）. Methods： Human NP cells of a degenerative disc were isolated, cultured, and infected with Ad-GDF-5 using the AdEasy-1 adenovirus vector system. On Days 3, 7, 14, and 21, the contents of the sulfated glycosaminoglycan （sGAG）, deoxyribonucleic acid （DNA） and hydroxyproline （Hyp）, synthesis of proteoglycan and collagen II, gene expression of collagen II and aggrecan, and NP cell proliferation were assessed. Results： The adenovirus was an effective vehicle for gene delivery with prolonged expression of GDF-5. Biochemical analysis revealed increased sGAG and Hyp contents in human NP cells infected by Ad-GDF-5 whereas there was no conspicuous change in basal medium （BM） or Ad-green fluorescent protein （GFP） groups. Only cells in the Ad-GDF-5 group promoted the production of ECM, as demonstrated by the secretion of proteoglycan and up-regulation of collagen II and aggrecan at both protein and mRNA levels. The NP cell proliferation was significantly promoted. Conclusions： The data suggest that Ad-GDF-5 gene therapy is a potential treatment for IDD, which restores the functions of degenerative intervertebral disc through enhancing the ECM production of human NP ceils.