【Abstract】 Objective To evaluate the biocompatibil ity of the sheep BMSCs cultured on the surface of photografting modified copolymers of 3-hydroxybutyrate and 3-hydroxyvalerate(PHBV). Methods BMSCs were isolated from bone marrow of the posterior il iac crest of a 6-month old sheep by whole marrow adherent culture method. The 3rd passage BMSCs were seeded onto modified PHBV and conventional PHBV films, or three-dimension scaffolds. Cell-adhesion rates were calculated by hemocytometer at 1, 2 and 6 hours after seeded. Cell morphology was examined by scanning electron microscope when the BMSCs were cultured for 3 days, 1 week and 3 weeks. Cell cycle was analyzed by flow cytometry at 5 days after seeded. The content of protein in BMSCs was determined by BCA assay and the content of DNA was quantified by Hoechst 33258 assay at 4, 8 and 12 days after seeded. Results At 1 hour after seeded, cell-adhesion rate on modified PHBV films (52.7% ± 6.0%) was significantlyhigher than that of conventional PHBV films (37.5% ± 5.3%) (P lt; 0.05); At 2 and 6 hours after seeded, cell-adhesion rate of modified PHBV films was similar to that of PHBV films (P gt; 0.05). The surface of modified PHBV film was rougher. In the early culture stage, more cells adhered to modified PHBV and the cells displayed much greater spreading morphology. Furthermore, ECM on modified PHBV were richer. There were no significant differences between the trial team and the control on the cell cycle and the content of DNA and protein of BMSCs (P gt; 0.05). Conclusion Photografting modification on PHBV can promote BMSCs’ adhesion and enhance their biocompatibil ity.
Objective To analyze the medium and long-term effectiveness of microendoscope-assisted minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) for lumbar degenerative diseases in comparison with conventional tubular retractor-assisted MIS-TLIF. Methods Between November 2008 and March 2013, 53 patients with single segment lumbar degenerative diseases were enrolled. According to the different working channel performed, 28 patients were treated by microendoscope-assisted MIS-TLIF (observation group), while the remaining cases received conventional tubular retractor-assisted MIS-TLIF via Wiltse approach (control group). Preoperative baseline data, including age, gender, body mass index, disease etiology, operated level, the ration for requiring bilateral canal decompression, and preoperative visual analogue scale (VAS) socre of low back pain and leg pain, Japanese Orthopedic Association (JOA) score, Oswestry disability index (ODI) score, showed no significant difference between the two groups (P>0.05). The operation time, intraoperative blood loss, intraoperative fluoroscopy time, postoperative analgesic drug dose, postoperation in-bed time, and perioperative complication incidence were recorded respectively and compared between the two groups. Radiographic evaluation of interbody fusion was performed based on Bridwell grading system at 2 years after operation. VAS scores of low back pain and leg pain, JOA score, and ODI score were assessed before operation, at 2 years after operation, and at last follow-up respectively. Surgical outcome satisfaction was assessed by modified MacNab criteria at last follow-up. Results When compared with those in control group, both intraoperative blood loss and postoperative analgesic drug dose were significantly decreased in observation group (P<0.05); similarly, the operation time and intraoperative fluoroscopy time were also significantly increased in observation group (P<0.05). There was no significant difference of postoperative in-bed time between the two groups (t=–0.812, P=0.420). Both groups were followed up 6-10.3 years, with an average of 7.9 years. Regarding perioperative complication, its incidence was 14.3% and 20.0% in observation group and control group, respectively, showing no significant difference between both groups (χ2=0.306, P=0.580). Specifically, there were intraspinal hematoma formation in 1 case, incision infection in 1 case, urinary infection in 1 case, transient delirium in 1 case in observation group. By contrast, there were dural tear and cerebrospinal fluid leakage in 1 case, urinary infection in 1 case, pneumonia in 1 case, transient delirium in 2 cases in control group. Bridwell criterion was used to judge the intervertebral fusion at 2 years after operation, the fusion rates of observation group and control group were 92.9% and 92.0%, respectively, showing no significant difference (χ2=0.162, P=0.687). At both 2-year postoperatively and last follow-up, the VAS scores of low back pain and leg pain, JOA score, and ODI score were significantly improved when compared with those before operation (P<0.01), whereas no significant difference between the two groups at either time point was found (P>0.05). At last follow-up, the results of patients’ satisfaction with surgery evaluated by modified MacNab criteria, and the excellent and good rates of the observation group and the control group were 96.4% and 92.0%, respectively, showing no significant difference (χ2=0.485, P=0.486). Conclusion The medium and long-term effectiveness of microendoscope-assisted MIS-TLIF are similar to those of conventional tubular retractor-assisted MIS-TLIF for lumbar degenerative diseases. The former operation has the additional advantages in terms of more clear surgical site visually, less intraoperative blood loss, and reduced postoperative analgesic dose, all of which seem more feasible to clinical teaching.