先天性脊柱侧凸合并高肩胛征的影像学特征

目的:探讨先天性脊柱侧凸(congenital scoliosis,CS)合并高肩胛征患者的影像学特征,并分析高肩胛征与双肩平衡的相关性。方法:回顾性分析2000年1月～2015年10月在我科以脊柱畸形首诊且影像学资料完整的24例CS合并高肩胛征患者,其中男11例,女13例,平均年龄11.8±6.0岁(2～31岁)。通过站立位全脊柱正侧位X线,测量并记录患者侧凸类型、Cobb角、顶椎位置、上下端椎位置、双肩高度差、高肩胛的位置及半椎体位置等。并对双肩高度差和弯型参数进行Spearman相关性分析。结果:24例患者均表现为颈胸椎或胸椎侧凸畸形,平均侧凸Cobb角49.5°±23.3°。侧凸顶椎位于T1～T11,其中16例患者表现为单节段或多节段半椎体畸形,半椎体发生于T4及以上节段10例;合并肋骨畸形15例,其中9例发生于脊柱侧凸的凹侧,3例发生于侧凸凸侧,3例发生于侧凸两侧。高肩胛发生于脊柱侧凸凸侧15例(62.5%)、凹侧7例(29.2%)、双侧2例(8.3%)。高肩胛位于侧凸凸侧的15例患者均为凸侧肩高于凹侧;高肩胛位于侧凸凹侧的7例患者中,5例凹侧肩高于凸侧,2例凸侧肩高于凹侧。双肩高度差平均为15.7±21.0mm。Spearman相关性分析显示,双肩高度差与Cobb角、顶椎位置、上下端椎位置等无明显相关性(P0.05)。结论 :CS合并高肩胛征患者多表现为颈胸段和胸段侧凸畸形,以T4以上节段半椎体多见,高肩胛征及合并的肋骨畸形均多见于脊柱侧凸的凸侧,而双肩高度差与弯型特征无明显相关性。     

先天性脊柱侧凸患者中的脊髓畸形和脊椎畸形

目的:探讨先天性脊柱侧凸患者的各类脊髓畸形与脊椎畸形之间的关系。方法:对我院2003年～2005年收治的211例已确诊的先天性脊柱侧凸患者的临床资料进行回顾性分析,统计先天性脊柱侧凸患者脊髓畸形、脊椎畸形的发生率及其好发部位,观察两者间的关系。结果:211例先天性脊柱侧凸患者中脊髓畸形44例(20.85%),其中脊髓空洞症25例次(11.85%),脊髓纵裂30例次(14.22%),马尾终丝栓系28例次(13.27%),低位圆锥12例次(5.69%),其他类型少见,多种畸形常并发存在;脊髓畸形好发于脊柱胸段、胸腰段、腰段、腰骶段。44例伴有脊髓畸形的先天性脊柱侧凸病例中不良分节34例(77.27%),孤立性半椎体1例(2.27%),非孤立性半椎体21例(47.73%),脊柱裂30例(68.18%),混合型41例(93.18%);脊椎畸形好发于脊柱胸段、腰段、腰骶段。结论:先天性脊椎畸形常合并脊髓畸形,总体上脊髓畸形与脊椎畸形的好发部位相似,但各种脊髓畸形、脊椎畸形间缺少显著的、特定的对应关系。     

一期后路半椎体切除治疗半椎体所致先天性脊柱畸形

目的探讨一期后路半椎体切除内固定治疗半椎体所致先天性脊柱畸形的可行性及疗效。方法自1998年10月～2003年6月,对11例半椎体所致的先天性脊柱畸形采用一期后路半椎体切除内固定矫形。男5例,女6例,年龄2.5～23岁,平均15.4岁。单个半椎体7例,多个半椎体2例,半椎体合并对侧骨桥或肋骨融合2例;病变位于胸段(T3、T4、T6、T9)4例、胸腰段(T11 1例、T12 1例、L1 2例)4例、腰段(L3 1例、L4 2例)3例。术前侧凸Cobb 角为44°～82°,平均60.5°;伴后凸畸形3例,Cobb角分别为13°(L4)、27°(L3)和48°(L1)。躯干偏移4~36.7mm,平均21.2mm。内固定使用CD2例,中华长城2例,SYNERGY1例,TSRH6例。结果手术时间平均为185min;术中出血平均850ml。长节段固定9例;短节段单侧固定1例,短节段双侧固定1例。术后平均随访1年10个月。固定融合节段为2~11个椎体,平均8.4个。侧凸Cobb角为0°～24°,平均18.7°,平均矫正率为69.1%;3例伴后凸畸形患者,后凸Cobb角分别为-11°、-8°和0°。术后躯干偏移0~16.3mm,平均为6.2mm,侧、后凸和躯干偏移无明显矫正丢失。术中并发症包括椎弓根或椎板骨折2例;1例术后出现切口渗液及脊柱轻度不稳定。结论应用一期后路半椎体切除、内固定治疗半椎体所致的先天性脊柱畸形效果满意,近期疗效可靠。     

前路一期病灶清除植骨内固定治疗胸椎及胸腰段脊柱结核并不全瘫

目的 探讨前路一期病灶清除联合植骨融合内固定治疗胸椎及胸腰段脊柱结核合并不全瘫痪的治疗效果.方法 对16例胸椎及胸腰段脊柱结核并脊髓损伤致不完全瘫痪的患者经胸或胸腹前路行一期病灶清除、椎间肋骨(钛网)植骨、椎体行内固定术.术后正规四联化疗方案治疗.结果 患者切口均一期愈合.16例均获随访,时间12 ～60个月.植骨部分融合时间为3～8个月,到末次随访时植骨全部融合.后凸畸形明显改善.无钛网移位及内固定松动发生.结论 经胸及胸腹前路一期病灶清除联合肋骨(钛网)植骨及内固定治疗胸椎及胸腰段脊柱结核合并不全瘫痪疗效满意.     

肋骨畸形对中度先天性脊柱侧凸患者肺功能的影响

目的:探讨不同程度肋骨畸形对中度先天性脊柱侧凸(CS)患者肺功能的影响。方法:回顾性分析我院2008年1月～2016年12月收治的108例中度CS(胸弯Cobb角40°～70°)患者的临床资料,其中男性49例,女性59例,年龄10～18岁,平均13.5±2.1岁。根据患者肋骨畸形的形态特征及范围将患者分为三组。无畸形组,无肋骨畸形;简单畸形组,有1～2根肋骨数目改变或2～3根肋骨局部融合或分叉;复杂畸形组,3根以上肋骨融合或分叉,或出现胸壁缺损。测量三组患者的影像学及肺功能参数。影像学参数包括:侧凸Cobb角、胸椎后凸角、胸弯累及椎体数、胸廓高度、胸廓横径;肺功能参数包括:肺活量(VC)、用力肺活量(FVC)、第1秒用力呼气容积(FEV1)、最大通气量(MVV)实测值以及实测值占预计值的百分比(实/预)和FEV1/FVC值。对各组影像学参数和肺功能参数的差异进行分析。同时采用卡方检验对各组患者肺功能损害程度和损害模式分布进行分析。结果:三组患者影像学参数(胸弯Cobb角、胸弯后凸角、胸弯累及椎体节段数、胸廓高度、胸廓横径等)均无统计学差异(P0.05)。三组患者中简单畸形组和无畸形组相比,肺功能无显著差异[VC:(81.88±11.11)%vs(78.22±8.49)%; FVC:(81.66±9.72)%vs (78.35±6.74)%; FEV1:(79.50±10.18)%vs (75.73±8.44)%; MVV:(79.10±12.48)%vs (75.04±7.21)%,P0.05]。而复杂畸形组患者肺功能明显比无畸形组较差[VC:(64.68±10.00)%vs (78.22±8.49)%,P=0.012; FVC:(64.61±10.57)%vs (78.35±6.74)%,P0.001; FEV1:(59.57±10.16)%vs (75.73±8.44)%,P0.001; MVV:(62.82±12.02)%vs (75.04±7.21)%,P=0.014]。无畸形组和简单畸形组患者肺功能损害程度无统计学差异,均以轻度及中度肺功能障碍患者为主(χ~2=1.314,P=0.532);而在复杂畸形组中,则以中度及重度肺功能障碍患者居多(χ~2=40.1,P0.001)。三组CS患者肺功能损害类型均以混合性通气功能障碍为主(χ~2=6.4,P=0.202)。结论:对于中度CS患者,简单肋骨畸形对肺功能的影响与无畸形组相比无显著差异,而复杂肋骨畸形与其他两组相比对于肺功能的影响较大,其肺功能损害程度以中重度肺功能障碍为主,肺功能损害类型方以混合性通气功能障碍为主。     

后路松解楔形截骨矫治先天性胸腰段半椎体并重度僵硬性脊柱侧后凸畸形

目的:评价经后路松解楔形截骨矫治先天性胸腰段半椎体并重度僵硬性脊柱侧后凸畸形的安全性和临床初步效果,并探讨其融合固定节段的选择。方法:2007年4月～2010年3月收治先天性胸腰段半椎体并重度僵硬性脊柱侧后凸畸形患者11例,男4例,女7例,年龄14～22岁,平均17.1岁;半椎体均为单个完全分节型,T11 3例,T12 4例,L1 1例,L2 3例;术前侧凸Cobb角82°～125°,平均94.4°,侧凸柔韧性为17.4%～28.9%,平均24.8%;后凸Cobb角72°～145°,平均101.1°;C7铅垂线与骶正中线距离1.5～5.5cm,平均2.9cm。均行经后路松解楔形截骨矫形手术,以触及椎(touched vertebrae,TV)(指站立前后位像上被骶正中线触及的最近端椎体)作为融合固定下端椎;1例合并脊髓拴系和脊髓纵裂者,术中一期行骨嵴切除,解除拴系。结果:均顺利完成手术。平均松解3.0个椎间隙。手术时间5.5～10.0h,平均7.7h;术中出血量1000～7000ml,平均3500ml。无脊髓神经损伤。1例术中切除肋骨小头时引起左侧胸膜撕裂,发生血气胸,行胸腔闭式引流,2周后痊愈;1例术后出现螺钉穿破背部皮肤,1枚螺钉钉尾外露,术后3个月取出该枚螺钉。术后侧凸Cobb角7°～54°,平均28.0°,平均矫正率为70.9%;后凸Cobb角20°～36°,平均27.8°,平均矫正率为71.7%;C7铅垂线与骶正中线距离0.1～2.3cm,平均0.6cm,冠状位平衡平均矫正率为78.1%。随访14～35个月,平均23.4个月,末次随访侧凸Cobb角8°～57°,平均29.7°,丢失率为7.3%;后凸Cobb角22°～38°,平均29.9°,丢失率为7.7%;C7铅垂线与骶正中线距离0.2～2.5cm,平均0.7cm;随访X线片证实植骨均融合,内固定物无松动、断裂。选择TV作为远端融合椎(lowest instrumented vertebrae,LIV)比选择稳定椎(stable vertebrae,SV)平均节省了1.09个椎体,未发现失代偿现象。结论:经后路松解楔形截骨矫治先天性胸腰段半椎体并重度僵硬性脊柱侧后凸畸形安全有效,选择TV作为LIV可以减少融合节段。     

关注胸腰脊柱脊髓损伤的临床研究

<正>胸腰椎损伤约占全部脊柱损伤的一半或以上,其中T1～T10约占20%～30%,胸腰段(T11～L2)约占60%～70%,下腰椎约占10%。根据骨折类型的不同,胸腰椎损伤中约有14%～55%的患者合并不同程度的脊髓、圆锥或马尾神经损伤,导致部分患者终生残疾。因此,正确及时的诊断和治疗十分重要。然而,国内     

胸腰段椎间盘突出症的诊断与治疗

目的探讨胸腰段椎间盘突出症的临床诊断和治疗方法。方法4例病人分别为T11-12、T12-L1、L1-2、L2-3椎间盘突出症,均行手术治疗,下胸段2例采用半椎板和部分肋骨头及椎弓根切除,行椎管减压及胸椎问盘切除,极高位腰椎间盘突出症患者采用椎板大部分切除,椎管减压髓核切除术。结果4例瘫痪症状明显好转,随访6月～9年,2例下胸段手术患者,恢复正常工作,但踝震挛仍轻度存在,上腰段2例患者,1例全部恢复,1例瘫痪症状在恢复中。结论瘫痪为胸腰段椎间盘突出症的首发临床症状,而腰痛及自下而上的进行性双下肢无力是其突出物渐进性压迫脊髓的表现,胸腰段MRI检查可以确诊,有症状者早期手术,可免于瘫痪。     

按压法治疗胸腰段压缩性骨折的临床研究

目的:寻求治疗胸腰段骨折简单有效的方法。方法:胸腰椎骨折患者57例,男29例,女28例;年龄15～81岁,平均48.3岁。T113例,T1214例,L124例,L216例。用按压法手法复位,对比治疗前后受伤椎体高度和Cobb角的变化。结果:57例患者1年后随访,按胸腰椎压缩性骨折疗效标准:优16例,良30例,可10例,差1例,优良率达80.7%。患者治疗前前柱前缘平均高度(19.67±2.46)mm,治疗后(24.78±2.23)mm(P<0.01);治疗前中柱前缘平均高度为(24.01±2.32)mm,治疗后为(26.10±1.76)mm(P<0.01);Cobb角治疗前后分别为(14.95°±1.69°)和(7.89°±2.50°)(P<0.01)。患者脊柱畸形及疼痛等症状明显好转。结论:按压法手法复位治疗胸腰段单纯性骨折,简单易行,疗效确切。     

不同部位骨质疏松性椎体压缩骨折行PKP手术后脊柱-骨盆矢状位参数的改善情况分析

目的 探讨不同部位骨质疏松性椎体压缩骨折(osteoporotic vertebral compression fracture,OVCF)行PKP术后的脊柱-骨盆矢状位参数改善情况.方法 纳入2018年3月～2020年5月于本科收治的OVCF患者137例,其中T1～T9段13例(胸段组),T10～L2段105例(胸腰...     

2015年乳腺癌辅助化疗进展

【摘要】〓乳腺癌是危害我国女性健康的头号杀手,尽管近年来辅助化疗的研究进展突飞猛进,但临床中仍有不少问题未能明确,如辅助化疗的合适人群、化疗的开始时间、蒽环及紫杉类的地位和用法、强化维持治疗的作用、疗效及预后的生物标志物等。本文结合乳腺癌辅助化疗在临床上的常见问题和2015年各大乳腺癌会议阐述乳腺癌辅助化疗的最新进展。     

Alterations in T-Cell Subset Frequency in Peripheral Blood in Obesity

Background: Obesity affects the regulation of immune and inflammatory responses. This study characterizes differences in peripheral blood lymphocyte phenotype in obese humans. Methods: Frequencies of lymphocyte subsets among peripheral blood mononuclear cells were compared between 10 obese (BMI ≥35) and 10 lean subjects, as determined by antibodies directed against cluster differentiation (CD) markers. Results: Obese patients demonstrated an increased frequency of CD3+CD4+ T-cells (mean difference 12%, P=0.004), a decreased frequency of CD3+CD8+ T-cells (mean difference 9.4%, P=0.016) and an increased frequency of CD3+CD8+CD95+ T-cells (mean difference 13.3%, P=0.032). No other differences among T-cell or monocyte subsets were noted. Conclusions: Obesity is associated with alterations in frequencies of peripheral CD4+ and CD8+ T-cells and aberrations in the expression of CD95 among CD8+ T-cells. These data suggest both CD4+ and CD8+ T-cell compartments, as well as the regulation of CD95 expression on CD8+ T-cells, as targets for further study into obesity's effects on the immune system.     

西宁地区烧伤病人动脉血气分析观察

对高海拔地区的27例烧伤病人动脉血气变化进行了分析和观察。结果证明:无论是存活病人还是死亡病人伤后均存在有低氧血症问题。并且在死亡病人和烧伤合并吸入性损伤病人其低氧血症的发生早于单纯烧伤病人。提示:吸入性损伤病人应立即行气管切开术以保障氧气供给,单纯烧伤病人可常规吸氧以维持正常血 PaO_2,ARDS 均发生在合并吸入性损伤的病人,高频喷射通气技术对纠正低氧血症有一定效果。     

Controversies in Fistula in Ano

Managing a complex fistula in ano can be a daunting task for most surgeons; largely due to the two major dreaded complications—recurrence & fecal incontinence. It is important to understand the anatomy of the anal sphincters & the aetiopathological process of the disease to provide better patient care. There are quite a few controversies associated with fistula in ano & its management, which compound the difficulty in treating fistula in ano. This article attempts to clear some of those major controversies.     

β-半乳糖苷酶在体内外成骨细胞中的表达

目的 研究β—半乳糖苷酶(β—gal)在成骨细胞中的表达状况，为阐明MorquioB综合征的发病机制提供依据。方法 裸鼠各器官和骨组织标本行X-gal染色检测。抽取羊和人骨髓行骨髓基质细胞(BMSCs)培养，分为4组：I：Adv-hBMP-2转染组；Ⅱ：Adv—β—gal转染组；Ⅲ：未转染组；Ⅳ：地塞米松诱导组。分别行X-gal染色和RT-PCR检测β—gal的表达。结果 裸鼠骺板两侧、骨膜内面及松质骨的成骨细胞和破骨细胞可见多量β—gal的表达。未转染BMSCs组有少量β—gal的表达，其他3组细胞的β—gal表达增高。结论成骨细胞和破骨细胞可表达多量β—gal，该两种细胞的β—gal缺乏可能是MorquioB综合征骨骼异常的直接原因。     

Fluid-phase transcytosis in the primate epididymis in vitro and in vivo

Ligated tubules from the corpus epididymidis of men and monkeys were incubated in medium containing horseradish peroxidase (HRP) as a marker for fluid-phase endocytosis. HRP was localized by light and electron microscopy after 0, 15, 30 and 60 min of incubation. Movement between the cells was prevented by tight junctions, but bypass of this barrier was apparently achieved by an intracellular vesicular mechanism leading to a time-dependent appearance of HRP in the lumen. Uptake of HRP into basal cells and capture by the lysosomal apparatus of principal cells were also observed. HRP-filled vesicles also appeared in the basal, mid and apical cytoplasm of epithelial cells in the caput 1 h after injection of the tracer into the epididymal circulation of the monkey, suggesting that this pathway also operates in vivo.     

Surgical management of ductal carcinoma in situ in Australia in 1995

Background: In the present paper we describe the presentation and management of ductal carcinoma in situ (DCIS) of the breast in women in Australia in 1995. This representative, national data set provides a historical comparator for studies examining DCIS management that follow. Methods: Surgeons identified by population‐based cancer registries as having treated a new diagnosis of DCIS between 1 April and 30 September 1995 completed a questionnaire on the presentation and management of each case. Results: Two hundred and five surgeons supplied treatment details on 418 DCIS tumours in 415 women . Half of all tumours were detected at BreastScreen clinics and a further 25% were detected at other mammography centres. Twenty‐six percent of tumours were palpable at presentation, 33% were multifocal and 55% were high grade (including comedocarcinoma). Breast conserving therapy (BCT) rather than mastectomy was utilized in 260 (62%) of cases. Tumours that were of low grade, small in size and not multifocal were more likely to be treated by BCT. Surgeons seeing six or more DCIS cases in the 6‐month period were more likely to utilize BCT. Of the conservatively treated cases, 22% were referred for a radiation oncology consultation. The most common reasons for treating DCIS with mastectomy were that the tumour was too extensive or multifocal (63%), it extended to margins of the specimen (42%), or patient concerns about recurrence (34%). Conclusions: In 1995 the majority of DCIS was treated with breast conserving surgery alone. Surgeons treating more DCIS cases were more likely to perform conservative surgery than surgeons treating only one DCIS case in the study period.     

Smoking-Attributable mortality in Spain in 2016

IntroductionSmoking-attributable mortality (SAM) is a valuable indicator that can be used to characterize the course and health burden of the smoking epidemic. The aim of this paper was to estimate SAM in Spain in 2016 in the population aged 35 and over, using the best available evidence.MethodsA smoking prevalence-dependent analysis based on the estimation of population-attributable fractions was performed. Smoking prevalence (never, former, and current smokers) was calculated from a combination of the Spanish Health Survey (2016) and the European Health Survey (2014); the relative risk of death among current and former smokers was taken from the follow-up of various cohorts; and mortality rates were obtained from National Center for Statistics data. SAM estimates are presented globally, and by sex, age groups, and major disease categories: cancer, cardiometabolic diseases and respiratory diseases.ResultsIn 2016, 56,124 deaths were attributed to tobacco consumption, 84% in men (47,000), and 50% in the population aged over 74 (27,795). Overall, 50% of SAM was due to cancer (28,281), 65% of which was lung cancer. One in 4 attributable deaths (13,849) occurred before the age of 65.ConclusionsOne in 7 deaths in Spain in 2016 were attributable to smoking. This estimation of SAM clearly highlights the great impact of smoking on mortality in Spain, mainly due to lung cancer and chronic obstructive pulmonary disease.