Introduction Intervertebral disc (IVD) degeneration (IDD) is one of the most widespread musculoskeletal diseases worldwide and remains an intractable clinical challenge. Currently, regenerative strategies based on biomaterials and biological factors to facilitate IVD repair have been widely explored. However, the harsh microenvironment, such as increased ROS and acidity, of the degenerative region impedes the efficiency of IVD repair. Here, an intelligent biodegradable nanoplatform using hollow manganese dioxide (H-MnO 2 ) was developed to modulate the degenerative microenvironment and release transforming growth factor beta-3 (TGF-β3), which may achieve good long-term therapeutic effects on needle puncture-induced IDD. Methods Surface morphology and elemental analysis of the MnO 2 nanoparticles (NPs) were performed by transmission electron microscopy and an energy-dispersive X-ray spectroscopy detector system, respectively. The biological effects of MnO 2 loaded with TGF-β3 (TGF-β3/MnO 2 ) on nucleus pulposus cells (NPCs) were assessed via cytoskeleton staining, EdU staining, qPCR and immunofluorescence. The efficacy of TGF-β3/MnO 2 on needle puncture-induced IDD was further examined using MRI and histopathological and immunohistochemical staining. Results The MnO 2 NPs had a spherical morphology and hollow structure that dissociated in the setting of a low pH and H 2 O 2 to release loaded TGF-β3 molecules. In the oxidative stress environment, TGF-β3/MnO 2 was superior to TGF-β3 and MnO 2 NPs in the suppression of H 2 O 2 -induced matrix degradation, ROS, and apoptosis in NPCs. When injected into the IVDs of a rat IDD model, TGF-β3/MnO 2 was able to prevent the degeneration and promote self-regeneration. Conclusion Use of an MnO 2 nanoplatform for biological factors release to regulate the IDD microenvironment and promote endogenous repair may be an effective approach for treating IDD.
Clinical value of expansive pedicle screw in lumbar short-segment fixation and fusion for patients with osteoporosis was investigated. A total of 80 patients with lumbar compression fracture but without obvious nerve compression were selected and divided into the observation group (n=40) and the control group (n=40) using a random number table. The observation group used the expansive pedicle screw, and the control group received conventional pedicle screw fixation and bone graft fusion. In the observation group, the operation and hospitalization time after operation were shorter and the intraoperative bleeding amount was less than that in control group (p<0.05). At 1 week, 1, 3 and 6 months after operation, the observation group had better straight leg raising test (SLRT) scores, higher lower limb sensory scores but lower visual analogue scale (VAS) scores than control group (p<0.05). Besides, the proportions of postoperative infection, dural mater tear, nerve root injury and spinal cord injury during operation in the observation group were lower than those in the control group (p<0.05), and the bone graft fusion rates at 3 and 6 months after operation were obviously superior to those in control group (p<0.05). Moreover, after operation, the spinal stenosis rate in the observation group was lower than that in control group (p<0.05), the vertebral height ratio was larger than that in control group (p<0.05), and the Cobb's angle was smaller than that in the control group (p<0.05). In addition, there was a negative correlation between bone mineral density (BMD) and hospitalization time after operation in the observation group (p<0.05). In conclusion, the internal fixation with expansive pedicle screw for osteoporosis patients with lumbar compression fracture is characterized by short operation time, less intraoperative bleeding, few complications, quick recovery of postoperative neurological function and satisfactory surgical effect. However, reasonable intervention in osteoporosis is also necessary.
A 27-year-old man presented with intermittent right knee pain for 1 year with no previous trauma. Physical examination revealed only tenderness over the patella. Typical fluid–fluid levels were visible on magnetic resonance imaging (MRI), which highly suggested aneurysmal bone cyst (ABC) of the patella. After removal of a large window of thin cortical bone, curettage and bone grafting followed by cerclage wiring was performed. Histology confirmed the initial diagnosis of primary ABC of the patella. At the final follow-up visit at 71 months after surgery, the patient had normal joint activity with no pain or evidence of recurrence. Previous publications indicated patellectomy in the initial series, but curettage and bone grafting have more recently provided excellent results and good graft incorporation in most cases, even for aggressive lesions. In our patient, thorough curettage and bone grafting through a wide cortical window followed by cerclage wiring fixation and figure-eight sutures was a successful treatment option for primary ABC of the patella without articular disruption.
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