纳米羟基磷灰石/聚酰胺66融合器在颈椎前路椎间融合术中应用的中期效果

目的 :探讨纳米羟基磷灰石/聚酰胺66椎间融合器(n-HA/PA66 cage)重建颈椎前中柱稳定性的中期效果。方法:回顾性分析2010年1月~2012年1月在我院行颈前路减压椎间盘切除植骨融合内固定术(anterior cervical discectomy and fusion,ACDF)的患者。根据术中所用的植骨材料不同将患者分为两组:A组采用nHA/PA66 cage植骨融合,124例;B组采用PEEK cage植骨融合,50例。比较两组的性别、年龄、术中出血量、手术时间、并发症发生率、术后影像学和临床疗效。影像学评价包括颈椎曲度、融合节段曲度、融合节段高度,采用Brantigan评分判断植骨融合和cage下沉、移位等情况。临床疗效采用视觉模拟量表(visual analog scale,VAS)评分、日本骨科学会(Japanese Orthopaedic Association,JOA)评分和颈椎功能障碍指数(neck disability index,NDI)评价。结果 :两组患者性别比、年龄、术前VAS评分、JOA评分、NDI,术前颈椎曲度、融合节段高度、融合节段曲度、手术时间、术中出血量等均无统计学差异(P0.05)。术后B组2例患者出现短暂的咽喉部不适,术后72h消失,无吞咽困难发生。所有患者均未出现脑脊液漏、血肿、切口感染等并发症。所有患者术后均获得随访,A组随访52.10±24.30个月,B组随访49.50±26.50个月,两组随访时间无统计学差异(P0.05)。末次随访时两组患者VAS评分、NDI及JOA评分较术前均有显著性改善(P0.05);术后和末次随访时融合节段高度、融合节段曲度、颈椎曲度与术前比较均有显著性差异(P0.05),两组同时间点比较均无显著性差异(P0.05)。A组2例患者cage出现下沉,B组3例患者cage出现下沉,两组下沉率比较有统计学差异(P0.05)。其他患者未发现cage移位、破裂以及其他内固定并发症。两组患者末次随访时均获得满意融合(Brantigan评分均≥3分),融合时间分别为4.2±1.8个月及4.1±2.0个月(P0.05)。结论:应用n-HA/PA66 cage行颈前路椎间植骨融合的骨融合率与PEEK cage相似,可维持融合节段高度及曲度,是一种较理想的颈椎前中柱重建材料。     

前路颈椎单椎体次全切除术中采用髂骨块植骨/Cage填充自体碎骨植骨治疗脊髓型颈椎病

目的　比较前路颈椎单椎体次全切除术中采用髂骨块植骨/Cage填充自体碎骨植骨治疗脊髓型颈椎病(CSM)的中期临床疗效。方法 2000年3月—2004年12月采用单椎体次全切除术并自体髂骨块植骨治疗CSM患者21例(A组),2013年1月—2015年12月采用颈椎前路单椎体次全切除术并Cage填充自体碎骨植骨治疗CSM患者32例(B组),对2组患者临床资料进行回顾性分析,对比颈椎整体曲度、融合节段角度、融合节段椎体间高度、融合率、沉降率及颈椎日本骨科学会(JOA)评分等指标。结果术后3 d及末次随访时2组颈椎整体曲度、融合节段角度及融合节段椎体间高度与术前相比均显著改善,差异有统计学意义(P 0.05),组间比较差异无统计学意义(P 0.05)。A组1例发生植骨未融合,B组无植骨未融合发生。术后3个月及末次随访时2组JOA评分与术前相比均显著改善,差异有统计学意义(P 0.05),组间比较差异无统计学意义(P 0.05)。末次随访时B组沉降率(34.3%)高于A组(23.8%),差异有统计学意义(P 0.05)。2组末次随访时发生沉降者JOA评分与未发生沉降者相比,差异无统计学意义(P 0.05),并未影响远期临床疗效。结论前路颈椎单椎体次全切除术治疗CSM,与采用传统髂骨块植骨融合相比,术中采用Cage填充自体碎骨植骨可获得相近的影像学及临床疗效,Cage沉降并未显著影响远期疗效。     

颈前路减压cage融合术与自体髂骨块植骨钛板内固定术治疗脊髓型颈椎病的中期疗效

目的:观察颈椎前路减压cage植骨融合术与颈椎前路减压自体髂骨块植骨融合钛板内固定术治疗脊髓型颈椎病的中期临床疗效。方法:2001年1月～2006年4月128例脊髓型颈椎病患者按照手术方式分为A、B两组,A组61例患者采用前路减压单纯PEEK cage植骨融合术治疗,其中病变节段与手术节段均为单节段22例,双节段39例;B组67例采用颈椎前路减压自体髂骨块植骨融合钛板内固定术,其中单节段27例,双节段40例。观察手术前后JOA评分、椎间高度和颈椎曲度情况。结果:A组手术时间为58.1±1.4min,术中出血量为42.4±2.0ml,B组分别为72.0±5.3min、82.7±3.9ml,两组比较差异有统计学意义(P<0.05)。A组23例(39.3%)出现一过性咽部不适,1例硬脊膜破裂,2例cage塌陷、移位;B组49例(73.1%)出现一过性咽部不适,1例硬脊膜破裂,5例髂骨供区痛,2例钉板松动。每组患者术后JOA评分、椎间高度和颈椎曲度均较术前明显改善(P<0.05),A、B组术后JOA评分改善率分别为(82.30±6.61)%和(83.80±4.42)%,组间比较差异无统计学意义(P>0.05)。随访24～60个月,平均36个月,末次随访时A、B组椎间融合率分别为95.2%和96.3%,两组比较差异无统计学意义(P>0.05);末次随访时每组JOA评分、椎间高度和颈椎曲度与术后比较差异无统计学意义(P>0.05)。术前、术后和末次随访时JOA评分、椎间高度和颈椎曲度两组比较差异无统计学意义(P>0.05)。结论:颈椎前路减压cage植骨融合术与颈椎前路减压自体髂骨块植骨融合钛板内固定术治疗脊髓型颈椎病的中期疗效均较好,但前者手术方法简单、近期并发症少。     

颈前路椎间盘切除椎间植骨融合内固定术治疗脊髓型颈椎病疗效分析

目的分析颈前路椎间盘切除椎间植骨融合内固定术治疗脊髓型颈椎病(CSM)的临床疗效。方法回顾性收集76例CSM患者的临床资料,根据前路减压术式不同分为A组和B组各38例,A组行颈椎前路椎间盘摘除融合术,B组行颈前路椎间盘切除椎间植骨融合内固定术。记录两组手术基本情况及颈肩部疼痛、脊髓功能改善效果,根据X线片测量相关影像学指标。结果两组手术时间、颈托保护时间、住院时间比较无统计学意义(P0.05),但B组术中失血量明显少(P0.05),两组均未见严重并发症。两组术前颈肩部视觉模拟疼痛(VAS)评分、日本矫形外科学会(JOA)评分比较无统计学意义(P0.05),术后1、2、6个月两组VAS评分、JOA评分依次显著改善(P0.05),且与A组比较,B组术后1、2个月VAS评分显著较低,术后1、2、6个月JOA评分升高幅度明显较大(P0.05)。两组术前椎间高度、融合节段Cobb角及颈椎曲度比较无统计学意义(P0.05),术后1个月椎间高度、融合节段Cobb角及颈椎曲度均显著增高(P0.05),但A组、B组术后6个月上述影像学指标维持效果比较有统计学意义(P0.05)。结论颈椎前路椎间盘摘除融合术、颈前路椎间盘切除椎间植骨融合内固定术治疗CSM均可取得较好的临床疗效,但后者术后见效更快,更有利于椎间高度、融合节段Cobb角及颈椎曲度的维持。     

前路两种不同术式治疗脊髓型颈椎病的疗效分析

目的探讨前路两种不同的减压植骨融合术治疗脊髓型颈椎病的疗效。方法回顾性分析2004年9月-2009年6月治疗的65例脊髓型颈椎病患者。37例采用颈椎前路减压+自体髂骨植骨+锁定钢板内固定术(A组),28例采用颈椎前路减压+钛网融合器+锁定钢板内固定术(B组),术后根据JOA评分及X线表现比较2种方法的疗效。结果 2组患者术后3个月、末次随访时JOA评分与术前比较,差异有显著性(P0.05)。平均椎间高度末次随访时,A组和B组比较差异无显著性(P0.05)。术后6个月植骨全部融合。结论脊髓型颈椎病治疗的关键在于充分减压及有效植骨融合,自体植骨或钛网融合器+锁定钢板固定牢固是治疗脊髓型颈椎病的较好方法 。     

BMP-2混合自体髂骨植骨在寰枢椎脱位后路复位固定融合术中的应用

目的评价BMP-2混合自体髂骨植骨在可复性寰枢椎脱位后路复位固定植骨融合术中的融合效果的。方法回顾性分析自2004-01—2012-01采用BMP-2与自体髂骨混合植骨进行寰枢椎后路复位固定融合术治疗的41例可复性寰枢椎脱位(BMP-2组),并与同期仅采用自体髂骨植骨治疗的65例(自体髂骨组)进行比较。比较2组手术时间、术中出血量、术后引流量、自体髂骨取骨量、并发症发生率,以及术后12个月时VAS评分、JOA评分、颈椎曲度、颈椎活动度。结果 106例获得平均(25.8±1.6)个月随访,术后12个月影像学检查显示均获得满意复位及骨性融合,融合率达100%。2组手术时间、术中出血量、术后引流量,以及术后12个月的VAS评分、JOA评分、颈椎曲度、颈椎活动度比较差异无统计学意义(P0.05);但BMP-2组自体髂骨取骨量明显少于自体髂骨组,差异有统计学意义(P0.05)。2组并发症发生率差异无统计学意义(χ~2=1.459,P=0.083)。结论采用BMP-2混合自体髂骨进行可复性寰枢椎脱位后路钉棒内固定植骨融合术可以减少自体髂骨的切取量,缩短术后疼痛缓解时间,而且并未增加术后并发症的发生率。     

椎间融合器与自体髂骨在颈椎前路椎间植骨融合术中的疗效比较

目的评价颈椎前路减压融合术中椎间融合器(cage)与自体骨植骨融合治疗颈椎病的疗效。方法回顾性分析自2010-04—2014-09行颈椎前路减压融合钢板内固定术的87例单间隙颈椎病,采用cage融合52例(cage组),采用自体髂骨融合35例(自体髂骨组)。结果 87例术后均随访12~14个月,平均12.6个月。均无术后感染、脑脊液漏发生。cage组术后12个月JOA评分较术前明显改善,差异有统计学意义(t=3.246,P0.001);自体髂骨组术后12个月JOA评分较术前明显改善,差异有统计学意义(t=3.389,P0.001)。与自体髂骨组相比,cage组手术时间、住院时间更短,并发症发生率更低,术后3、6个月融合率更低,差异有统计学意义(P0.05)。2组术中出血量、术后12个月的JOA评分和融合率差异无统计学意义(P0.05)。结论与颈椎前路术中自体髂骨植骨相比,cage植骨也具有良好的融合效果,可取得满意临床疗效,能缩短手术时间、减少手术并发症,但需要更长的融合时间。     

颈前路椎管减压植骨融合内固定术中应用钛笼与n-HA/PA66人工椎体的疗效比较

目的比较颈椎病颈前路椎管减压植骨融合内固定术中置入钛笼与置入纳米羟基磷灰石/聚酰胺66(nanohydroxyapatite/polyamide66,n-HA/PA66)人工椎体的疗效。方法回顾性分析自2012-01—2017-02采用颈前路椎管减压植骨融合内固定术治疗的97例颈椎病,50例在术中置入钛笼(钛笼组),47例在术中置入n-HA/PA66人工椎体(人工椎体组),比较2组术后即刻、术后3个月、术后6个月颈椎前凸角度与JOA评分,比较2组术后椎体下沉情况以及末次随访时神经功能改善等级。结果97例均顺利完成手术并获得完整随访,随访时间平均10.4(6~18)个月。末次随访时97例均获得骨性融合。2组术后即刻、术后3个月、术后6个月颈椎前凸角度、JOA评分比较差异无统计学意义(P>0.05)。术后6个月钛笼组6例出现钛笼下沉现象,人工椎体组未出现人工椎体下沉现象。人工椎体组椎体下沉情况较钛笼组优,差异有统计学意义(P<0.05)。2组末次随访时神经功能改善等级比较差异无统计学意义(P>0.05)。结论钛笼与n-HA/PA66人工椎体均能有效重建颈椎的稳定性、改善脊髓功能并获得良好的植骨融合率,n-HA/PA66人工椎体置入后可以获得较低的椎体下沉率。     

纳米羟基磷灰石/聚酰胺66椎体支撑体在颈椎前路手术重建中的应用

[目的]探讨纳米羟基磷灰石/聚酰胺66(n-HA/PA66)椎体支撑体在颈椎前路手术结构重建中的应用及临床效果。[方法]采用n-HA/PA66椎体支撑体行颈椎前路结构重建138例,其中颈椎病81例,后纵韧带骨化症9例,颈椎椎体肿瘤16例,颈椎骨折伴脊髓损伤32例。采用JOA评分改善率和Frankel分级评价患者神经功能恢复情况,根据术后X线片及三维CT判定颈椎序列恢复情况,评估支撑体融合以及下沉移位情况。[结果]138例获得随访,随访时间3~36个月,平均(12.81±1.73)个月。末次随访时,颈椎病、后纵韧带骨化症及颈椎椎体肿瘤患者JOA改善率分别为81.33%、75.92%及69.28%。32例颈椎骨折患者中,27例Frankel分级改善1~3级。所有患者术后3~6个月时支撑体全部融合,平均融合时间(4.54±0.98)个月。影像学检查显示术后颈椎高度、曲度基本恢复正常;最后随访共有5例出现支撑体轻度下沉,下沉率为3.59%;末次随访支撑体融合界面形态良好、无骨吸收。[结论]n-HA/PA66椎体支撑体在颈椎前路手术后中长期能有效维持颈椎高度和正常序列,是颈椎前柱手术重建的理想支撑材料。     

颈椎前路减压cage与zero-p椎间植骨融合内固定治疗单节段脊髓型颈椎病的疗效比较

目的比较颈椎前路减压cage椎间植骨融合钛板内固定与zero-p椎间植骨融合内固定治疗单节段脊髓型颈椎病的临床疗效及并发症情况。方法纳入自2013-06—2015-06诊治的110例单节段脊髓型颈椎病,采用颈椎前路减压cage椎间植骨融合钛板内固定治疗55例(cage组),采用颈椎前路减压zero-p椎间植骨融合内固定治疗55例(zero-p组)。比较2组手术时间、术中出血量、住院时间,术后12个月JOA评分、NDI指数、颈椎曲度、颈椎节段高度及植骨融合率,术后1周、3个月吞咽困难发生例数。结果所有患者均获得(22.78±3.10)个月随访。2组手术时间、术中出血量、住院时间比较差异无统计学意义(P0.05)。2组术后12个月JOA评分、NDI指数、颈椎曲度、颈椎节段高度、植骨融合率差异无统计学意义(P0.05)。zero-p组术后1周、3个月吞咽困难发生例数少于cage组,差异有统计学意义(P0.05)。结论颈椎前路减压cage椎间植骨融合钛板内固定与zero-p椎间植骨融合内固定治疗单节段脊髓型颈椎病均可取得满意的临床疗效,但zero-p椎间植骨融合内固定术后吞咽困难发生的风险明显较低,其安全性更符合临床需要。     

Presenteeism and Absenteeism Before and After Total Hip and Knee Arthroplasty

BackgroundAbsenteeism is costly, yet evidence suggests that presenteeism—illness-related reduced productivity at work—is costlier. We quantified employed patients’ presenteeism and absenteeism before and after total joint arthroplasty (TJA).MethodsWe measured presenteeism (0-100 scale, 100 full performance) and absenteeism using the World Health Organization’s Health and Work Performance Questionnaire before and after TJA among a convenience sample of employed patients. We captured detailed information about employment and job characteristics and evaluated how and among whom presenteeism and absenteeism improved.ResultsIn total, 636 primary, unilateral TJA patients responded to an enrollment email, confirmed employment, and completed a preoperative survey (mean age: 62.1 years, 55.3% women). Full at-work performance was reported by 19.7%. Among 520 (81.8%) who responded to a 1-year follow-up, 473 (91.0%) were still employed, and 461 (88.7%) had resumed working. Among patients reporting at baseline and 1 year, average at-work performance improved from 80.7 to 89.4. A Wilcoxon signed-rank test indicated that postoperative performance was significantly higher than preoperative performance (P < .0001). The percentage of patients who reported full at-work performance increased from 20.9% to 36.8% (delta = 15.9%, 95% confidence interval = [10.0%, 21.9%], P < .0001). Presenteeism gains were concentrated among patients who reported declining work performance leading up to surgery. Average changes in absences were relatively small. Combined, the average monthly value lost by employers to presenteeism declined from 15.3% to 8.3% and to absenteeism from 16.9% to 15.5% (ie, mitigated loss of 8.4% of monthly value).ConclusionAmong employed patients before TJA, presenteeism and absenteeism were similarly costly. After, employed patients reported increased performance, concentrated among those with declining performance leading up to surgery.     

The German emergency and disaster medicine and management systemdhistory and present

As well for optimized emergency management in individual cases as for optimized mass medicine in disaster management, the principle of the medical doctors approaching the patient directly and timely, even close to the site of the incident, is a long-standing marker for quality of care and patient survival in Germany. Professional rescue and emergency forces, including medical services, are the “Golden Standard” of emergency management systems. Regulative laws, proper organization of resources, equipment, training and adequate delivery of medical measures are key factors in systematic approaches to manage emergencies and disasters alike and thus save lives. During disasters command, communication, coordination and cooperation are essential to cope with extreme situations, even more so in a globalized world. In this article, we describe the major historical milestones, the current state of the German system in emergency and disaster management and its integration into the broader European approach.     

Differences in Osteocyte Density and Bone Histomorphometry Between Men and Women and Between Healthy and Osteoporotic Subjects

Bone defects related to osteoporosis develop with increasing age and differ between males and females. It is currently thought that the bone remodeling process is supervised by osteocytes in a strain-dependent manner. We have shown an altered response of osteocytes from osteoporotic patients to mechanical loading, and osteocyte density is reduced in osteoporotic patients, which might relate to imperfect bone remodeling, leading to lack of bone mass and strength. Hence, information on osteocyte density will contribute to a better understanding of bone biology in males and females and to the assessment of osteoporosis. Osteocyte density as well as conventional histomorphometric parameters of trabecular bone were determined in cancellous iliac crest bone of healthy postmenopausal women and men and of osteoporotic women and men. Osteocyte density was higher in healthy females than in healthy males and lower in osteoporotic females than in healthy females. Bone mass was reduced in osteoporotic patients, both male and female. In females, trabecular number was reduced, whereas in males, trabecular thickness was reduced and eroded surface was increased. There were no correlations between the parameter groups bone architecture, bone formation, bone resorption, and osteocyte density. These results are consistent with impaired osteoblast function in osteoporotic patients and with a different mechanism of bone loss between men and women, in which osteocyte density might play a role. The reduced osteocyte numbers in female osteoporotic patients might relate to imperfect bone remodeling leading to lack of bone mass and strength. M. G. Mullender and S. D. Tan contributed equally to this work.     

Tendon and Ligament Healing and Current Approaches to Tendon and Ligament Regeneration

Ligament and tendon injuries are common problems in orthopedics. There is a need for treatments that can expedite nonoperative healing or improve the efficacy of surgical repair or reconstruction of ligaments and tendons. Successful biologically-based attempts at repair and reconstruction would require a thorough understanding of normal tendon and ligament healing. The inflammatory, proliferative, and remodeling phases, and the cells involved in tendon and ligament healing will be reviewed. Then, current research efforts focusing on biologically-based treatments of ligament and tendon injuries will be summarized, with a focus on stem cells endogenous to tendons and ligaments. Statement of clinical significance: This paper details mechanisms of ligament and tendon healing, as well as attempts to apply stem cells to ligament and tendon healing. Understanding of these topics could lead to more efficacious therapies to treat ligament and tendon injuries. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 38:7–12, 2020