目的 探討重組人p53腺病毒(recombinant human p53 adenovirus, rAd-p53)在脊柱轉移瘤的治療中的近期療效。 方法 2006年6月-2009年8月，以經皮注射rAd-p53聯合放療及單獨放療方法治療肺鱗狀細胞癌來源脊柱轉移瘤患者各18例，通過比較兩組治療前后的腫瘤體積變化評價療效，觀察兩組治療后腫瘤細胞壞死率情況，檢測P53蛋白在癌組織中的表達以及血清中抗特異p53基因腺病毒抗體水平。 結果 聯合治療組療效評定有效率為66.7%，高于單獨放療組的27.8%，差異有統計學意義(Plt;0.05)。聯合治療組可見明顯腫瘤細胞壞死、P53蛋白表達陽性及血清中抗特異p53基因腺病毒抗體水平強陽性。 結論 rAd-p53基因治療能抑制腫瘤生長，聯合放療可彌補單一放療的不足，提高放療的敏感性，有效治療脊柱轉移瘤。
Objective To investigate the osteoblasts effect, compl ications and influencing factors in the appl ication of small freeze-drying allogeneic bone plots mixed autologous bone fragments in spinal surgery, and to compare with autogenous bone graft. Methods From January 2003 to January 2007, 515 cases of spinal injuries were treated. A total of 324 cases weretreated with small freeze-drying allogeneic bone plots mixed with autologous bone grafts (group A), including 211 males and 113 females with an average age of 36 years (18-83 years). There were 182 cases of thoracolumbar vertebra fracture, 68 cases of lumbar spondylol isthesis, 47 cases of lumbar vertebral canal stenosis, 17 cases of cervical disc herniation, 5 cases of cervical spine fracture-dislocation and 5 cases of thoracolumbar vertebra tumor. The weight of bone graft was 10-60 g (mean 30 g). A total of 191 cases were treated with autogenous bone grafting (group B), including 135 males and 56 females with an average age of 32 years (23-78 years). There were 109 cases of thoracolumbar vertebra fracture, 23 cases of lumbar spondylol isthesis, 17 cases of lumbar vertebral canal stenosis, 19 cases of cervical disc herniation, and 23 cases of cervical spine fracture-dislocation. The weight of bone graft was 10-50 g (mean 25 g). Results In group A, effusion of wound increased in 4 cases and the result of bacterial culture was negative; effusion was absorbed after 2 weeks of local irrigation, drainege and cortin management. In group B, no obvious effusion was observed. The follow-up time was 10-36 months (mean 17.4 months) in group A and 8-36 months (mean 16.8 months) in group B. The bone heal ing was achieved in 308 cases within 4-10 months (mean 8.1 months) and in 184 cases within 4-10 months (mean 5.8 months), and the bone fusion rates were 95.06% and 96.34% in groups Aand B, respectively. There was no significant difference in bone fusion rate between groups (P gt; 0.05). According to Mankin and Komender evaluation standard, the response rates were 95.06% and 96.34% in groups A and B, respectively, showing no significant difference (P gt; 0.05). Conclusion Mix-bone grafting has the same effective to autologous bone grafting in bone fusion rate. It could be used as the supplement of the autologous bone inadequacy.