增加前路cage融合对颈椎曲度、稳定性及轴性症状的影响

背景：对于严重的颈椎间盘突出、后纵韧带钙化、黄韧带增生,实施前后联合入路不仅可以达到彻底减压的目的,同时植入cage及前路钢板矫形固定可部分恢复椎体间隙及颈椎生理曲度。 目的：比较颈椎病颈后路单开门椎管扩大成形及增加前路cage融合内固定对治疗后患者颈椎曲度、稳定性及轴性症状发生的影响。 方法：回顾性分析颈椎病外科治疗50例患者的临床资料。其中行一期前后联合入路脊髓减压（前路 cage＋钢板融合固定）22例（前后路联合治疗组）;单纯行颈后路单开门椎管扩大成形（后路开窗铆钉固定）28例（单纯后路治疗组）。治疗后随访6-24个月,分别对两组治疗后神经功能恢复情况、轴性症状的发生率及颈椎曲度指数、病变节段椎间滑移度进行统计分析。 结果与结论：两组患者的神经功能恢复均获得较好的日本骨科学会（JOA）改善率,前后路联合治疗组患者轴性症状的发生率相对低,颈椎曲度指数较单纯后路治疗组患者有较为明显的改善,而单纯后路治疗组椎间滑移度相对较大。结果表明一期前后联合入路使用 cage、前路钢板、后路铆钉行脊髓减压可以有效维持颈椎的生理曲度从而维持矢状面的平衡,减少患者轴性症状的发生率,对维持治疗后颈椎长期的稳定性起到重要作用。     

Survivin、Ki-67核抗原在宫颈癌及宫颈上皮内瘤变中的表达意义

目的探讨生存素（Survivin）、Ki-67核抗原在宫颈癌和宫颈上皮内瘤变（CIN）中的表达及生物学意义。方法采用免疫组化S-P法,检测26例宫颈癌,78例宫颈上皮内瘤变（CINⅠ28例,CINⅡ23例,CINⅢ27例）及12例正常宫颈组织中Survivin、Ki-67的表达水平。结果 Survivin、Ki-67核抗原在正常宫颈组织、CIN及宫颈癌中的表达依次递增,Ki-67核抗原的表达随Survivin表达增加而上升,统计学上差异有显著意义（P〈0.05）。结论 Survivin、Ki-67核抗原在宫颈癌中的异常表达,可能与宫颈癌发生、发展过程中凋亡抑制和增殖能力增强有关。     

2006-2010年浙江省宁波市妇女宫颈癌发病特征分析

目的 了解宁波市妇女宫颈癌发病特征,为制定有效的干预策略提供依据。 方法 统计分析宁波市2006-2010年宫颈癌校正发病率及各年龄组和地区间宫颈癌发病率差异,用Joinpoint回归分析宫颈癌发病的时间趋势。 结果 40~59岁年龄组宫颈癌发病率最高,在20.96/10万~38.87/10万之间;奉化市宫颈癌标化发病率较其他2个监测区海曙区和余姚市高,为17.18/10万;未发现宫颈癌发病率有随时间变化的趋势。 结论 40~59岁年龄组妇女是宁波市宫颈癌高发人群,农村地区是宫颈癌高发地区。     

Cervical Spine Injuries in Children, Part I: Mechanism of Injury, Clinical Presentation, and Imaging

Background: Cervical spine injuries are difficult to diagnose in children. They tend to occur in different locations than in adults, and they are more difficult to identify based on history or physical examination. As a result, children are often subjected to radiographic examinations to rule out cervical spine injury. Objectives: This two-part series will review the classic cervical spine injuries encountered in children based on age and presentation. Part I will discuss the mechanisms of injury, clinical presentations, and the use of different imaging modalities, including X-ray studies and computed tomography (CT). Part II discusses management of these injuries and special considerations, including the role of magnetic resonance imaging, as well as injuries unique to children. Discussion: Although X-ray studies have relatively low risks associated with their use, they do not identify all injuries. In contrast, CT has higher sensitivity but has greater radiation, and its use is more appropriate in children over 8 years of age. Conclusion: With knowledge of cervical spine anatomy and the characteristic injuries seen at different stages of development, emergency physicians can make informed decisions about the appropriate modalities for diagnosis of pediatric cervical spine injuries.     

人乳头瘤病毒、人巨细胞病毒和单纯疱疹病毒感染与宫颈癌的关系

目的　本研究旨在探讨宫颈癌前病变和宫颈癌的发生发展与人乳头状瘤病毒及HSV、CMV的关系。方法　对81例不同宫颈病变组织进行HPV16 /18和HPV6 /11原位杂交,同时对98例不同宫颈病变组织用DNA扩增法检测HPV、HSV和CMV。结果　病毒DNA原位杂交信号的分布与HE染色中挖空细胞的分布一致。HPV16 /18与不同宫颈病变组织原位杂交阳性率平均为5 1 .1% ,HPV6 /11的则为6 4 .7%。HPV16 /18、HPV6 /11、HSV、CMV在不同宫颈病变组织中的阳性率分别为2 1%、4 %、2 3%、0 %。结论　HPV感染具有特定的组织学部位,HSV可协同HPV16 /18恶性转化宫颈上皮细胞。     

Cervical length, multifetal pregnancy reduction, and prediction of preterm birth

PURPOSE: To evaluate the application of transvaginal sonography assessment of cervical length before fetal reduction for predicting spontaneous preterm birth in triplet gestations reduced to twins. METHODS: This retrospective study was conducted at the ultrasound unit of a university-affiliated municipal hospital. The study cohort consisted of 25 women with triplet gestations following ovulation induction or assisted-reproduction techniques who underwent fetal reduction to twins. Cervical length was assessed via transvaginal sonography before fetal reduction, and data on pregnancy outcome were retrieved from maternal records and/or maternal interviews. RESULTS: Cervical length (mean +/- SD) at reduction was 4.0 +/- 0.85 (range: 1.2-5.5). Five women were excluded from statistical evaluation because pregnancy complications precluded spontaneous delivery. Two of 3 (67%) women with a cervical length of <3.5 cm delivered prior to 33 weeks' gestation compared with 1/17 (6%) women with a cervical length > or = 3.5 cm. This difference was statistically significant (P < 0.05). The sensitivity, specificity, positive predictive value, and negative predictive value of cervical lengths <3.5 cm to predict delivery prior to 33 gestational weeks was 67%, 94%, 67%, and 94%, respectively. CONCLUSIONS: Measurement of cervical length in triplet pregnancies before fetal reduction provides useful predictive information on the risk for preterm delivery.     

A Pap test screening clinic in a South Asian community of Vancouver, British Columbia: challenges to maintaining utilization

The purpose of this article is to describe experiences and challenges in establishing a South Asian Pap Test Clinic. The specialized Pap test clinic for immigrant South Asian women was a community-initiated response to high rates of cervical cancer within this population. Efforts were made to ensure that the clinic provided health services in a sensitive and culturally appropriate manner. Although women were generally positive about their experiences at the South Asian Pap Test Clinic and often encouraged other women to attend the clinic for Pap testing, attendance patterns have not been maintained. The three most significant challenges to the clinic's ongoing success were: (1) maintaining the continued involvement of stakeholders in developing long-term strategies to enhance community awareness about cervical cancer; (2) creating mechanisms to strengthen support from physicians in the community; and (3) meeting the needs of the underserved within a specialized health service for South Asian immigrant women. These challenges provide important lessons for others to increase the participation of immigrant women in screening practices. Nurses can play a key role in mobilizing and maintaining collaborations that are essential to the continuing success of community-based programs.     

P16、Ki-67蛋白表达及HPV检测在宫颈上皮内瘤变中的意义

目的探讨P16、Ki-67蛋白在宫颈上皮内瘤变(CIN)中的表达情况和意义及人乳头瘤病毒(HPV)感染与CIN的关系。方法选取2017年1月至2018年2月宿迁市钟吾医院160例行宫颈组织活检或宫颈LEEP术活检患者作为研究对象,其中40例正常宫颈黏膜上皮组织的患者作为对照组,120例出现CIN患者作为观察组,两组均检测P16、Ki-67蛋白的表达情况,同时检测HPV的感染情况。结果对照组P16、Ki-67的阳性率明显低于观察组,差异有统计学意义(P<0.05)。观察组在高度宫颈上皮内瘤变(CINⅡ和CINⅢ)患者中,P16和Ki-67的表达呈正相关(r=0.785,P<0.05),高度上皮内瘤变患者P16、Ki-67阳性率明显高于轻度宫颈上皮内瘤变(CINⅠ)患者。观察组HPV阳性率明显高于对照组,差异有统计学意义(P<0.05),HPV阳性率与P16的表达呈正相关(r=0.486,P<0.05),且HPV阳性率随CIN的发展而升高。结论联合检测P16和Ki-67可作为诊断CIN的有效指标,HPV的感染与CIN的发生有着密切联系,对临床上诊断CIN有着重要的意义。     

颈椎间盘并椎体后纵韧带部分切除治疗颈脊髓压迫症

目的探讨应用颈椎间盘、椎体及后纵韧带部分切除,植骨及带锁钢板内固定在治疗伴有后纵韧带压迫颈髓神经疾病中的应用. 方法单个椎间隙者13例手术采用前路间盘及相应部位后纵韧带部分切除,其余手术采用前路椎体大部分切除及相应部位后纵韧带部分切除,18例采用自体髂骨植骨融合,38例采用钛网笼内填充减压椎体之松质骨植骨,最后均予带锁钢板内固定. 结果术后复查MRI:见颈脊髓神经压迫去除满意.56例平均随访18个月,植骨全部于术后3～4个月骨性愈合.术后已恢复椎间隙高度没有发现再丢失现象,颈椎生理弧度恢复良好. 结论颈椎间盘及后纵韧带大部分切除术,颈椎及后纵韧带大部分切除术适用于部分伴有后纵韧带颈脊髓神经和神经根压迫症患者,有利于彻底解除神经压迫.     

Whiplash Associated Disorders: Pathomechanics, Diagnosis, and Management

Abstract:   Whiplash has been defined as an injury mechanism, an injury, a medico-legal or social dilemma, and a complex chronic pain syndrome. Whiplash associated disorders are frequent in the cervical spine, especially as a result of a motor vehicle accident. The mechanisms responsible for whiplash-related tissue trauma are complex and a clinician's understanding of these complexities lends to a more complete appreciation for the anatomical structures and pathological processes that are involved, as well as a comprehensive diagnosis and appropriate management. While several classification scales have been developed for whiplash associated disorders, a thorough and tissue-specific examination is merited. Management should be directed toward pain reduction and normalization of mechanics. While conservative measures can address many of clinical sequelae of whiplash, both invasive pain management procedures and surgical interventions may be paramount to a patient's complete recovery.     

McKenzie法治疗颈椎病的临床疗效

目的探讨McKenzie法在颈椎病患者中的应用效果.方法60例颈椎病患者均采用McKenzie法为主的治疗方法,神经根型辅以颈牵引,颈型辅以中频电疗法.治疗前后用目测类比法(VAS)评定疼痛程度,并进行McKenzie分型、颈运动功能缺失程度及临床疗效评定.结果60例患者平均治疗时间(6.4±2.6)d.VAS评分,与治疗前比较,神经根型和颈型均显著降低(P＜0.01),运动功能缺失程度改善;临床治愈率神经根型80.6%,颈型75.9%.结论McKenzie法对颈椎病有较好的疗效,且神经根型与颈型的治疗效果相近.     

颈椎曲度的X线测量在颈椎病康复评定中的应用价值

目的：探讨颈椎曲度的X线测量对颈椎病康复评定中的作用。方法：临床确诊的颈椎病患者82例,均应用综合物理疗法治疗。治疗前后颈椎X线侧位片采用Borden法测量颈椎曲度及颈椎活动度（ROM）。结果：82例患者治疗10-20次后,颈椎曲度与治疗前比较有明显改善,弓深平均增加（13.98±4.52）mm（P〈0.001）;颈ROM明显提高（P〈0.001）;疗效评定：显效34例,好转45例,无效3例,有效率为96.3%。结论：颈椎曲度的X线测量能够判断颈椎病的严重程度并在颈椎病的康复评定中具有明确的应用价值。     

一期后前路联合手术治疗多节段脊髓型颈椎病临床观察

目的；探讨一期后前路联合手术在治疗多节段脊髓型颈椎病中的价值。方法：11例脊髓型颈椎病患者均行前路椎间盘摘除或椎体切除减压、自体髂骨植骨融合、带锁钢板内固定，后路行单开门椎板成形术。结果：所有患者均获得随访，所有植骨均获得骨性愈合；疗效优8例，良2例，无效1例;并发症发生2例，其中1例C5神经根麻痹、1例手术后3个月出现相邻节段的后突、畸形。结论；一期后前路颈椎管减压、内固定、植骨融合术为多节段的脊髓型颈椎病手术治疗提供了一种比较安全、可靠的方法。     

浙江省台州农村地区妇女宫颈癌三阶梯横断面调查

目的 了解浙江省台州市农村地区妇女宫颈癌及癌前病变的发病现状,为该地区宫颈癌防治提供依据。 方法 于2012年6-12月对台州市海门、白云街道35~59岁妇女开展三阶梯宫颈癌筛查,即妇科、阴道分泌物、宫颈脱落细胞检查,脱落细胞检查结果可疑或异常者行阴道镜检查,阴道镜检查结果可疑或异常者再进一步宫颈多点活检后行组织病理学诊断。 结果 筛查6639人,筛查率65.58%,宫颈脱落细胞液基薄层细胞检测(TCT)阳性226例(3.40%)。147例(65.04%)TCT阳性妇女进行了宫颈组织细胞学检查,检出宫颈癌7例(4.76%),宫颈癌前病变56例(38.10%);宫颈癌前病变、宫颈癌在高度鳞状上皮内病变(HSIL)阳性妇女中检出率最高(63.33%,P0.01);宫颈癌前病变、宫颈癌分别在35~49岁、50~59岁TCT阳性妇女中检出率较高,但差异无统计学意义(P0.05)。 结论 台州市农村地区不同年龄阶段妇女宫颈癌及癌前病变患病率均较高,但筛查率低,尤其是低年龄组妇女(35~49岁),需进一步加强宫颈癌防治宣传教育,提高宫颈癌筛查率。     

Implantable direct current stimulation in para-axial cervical arthrodesis

This retrospective, case-controlled pilot study was designed to examine the efficacy and safety of an implantable direct current bone growth stimulator (IDCBGS) as an adjunct to cervical arthrodesis in patients at high risk for nonunion after undergoing cervical fusion in region from the occiput to C3. Twenty patients underwent para-axial cervical arthrodesis (involving posterior spine fusion and instrumentation using standard surgical techniques) for the correction of instability. All were at high risk for nonunion due to advanced age, rheumatoid arthritis, prior failed fusion attempts, infection, or immunosuppressive drug use. An IDCBGS was used to augment the surgical procedure. The mean follow-up period was 19 months, and 16 patients were available for follow-up. Radiographic evidence of fusion was demonstrated in 15 of 16 patients (94%). After surgery, all patients demonstrated clinical stabilization, a resolution of symptoms in combination with an improvement in neurologic status, or both. The mean elapsed time before fusion occurred was 4.6 months. No neurologic complications related to cathode or generator placement were observed. The use of the stimulator as an adjunct to instrument-or non-instrument-assisted surgical fusion of the para-axial region in these high-risk patients appeared both safe and efficacious. Further investigation is warranted to define the possible role and clinical utility of the IDCBGS in selected patients requiring cervical fusion, particularly those at high risk for nonunion.     

上海市徐汇区颈椎病患病情况调查分析

目的：研究和分析上海市徐家汇社区颈椎病的患病情况和致病因素,为颈椎病的防治提供依据。方法：采用自行设计问卷调查表对徐家汇社区常住居民1 326例进行颈椎病患病率问卷调查,内容包括性别、年龄、职业、临床症状、受凉、劳累、精神紧张、辅助检查等;对既往或疑有颈椎病的患者进行临床确诊和影像学检查;并对所得资料进行统计分析。结果：颈椎病患病率为19.1%,51～60岁年龄段的患病率为33.8%,明显高于其他年龄段（P〈0.05）;logistic回归分析显示年龄、职业、受凉、精神紧张等因素为颈椎病致病的危险因素;颈椎影像学检查示椎体增生及椎间隙变窄的发生率较高。结论：徐家汇社区颈椎病的患病率较高,急需通过健康宣教等方法进行社区干预。     

阴道镜活检联合宫颈锥切对宫颈癌的诊断价值

目的探讨阴道镜下病理活检联合宫颈锥切术用于诊断宫颈癌的价值。方法对753例宫颈上皮内瘤变(CIN)的患者行阴道镜活检和宫颈锥切术,术后标本送检,计算阴道镜活检诊断灵敏度、特异度、阳性预测值和阴性预测值。结果753例患者宫颈锥切术确诊CINⅠ级348例,CINⅡ级172例,CINⅢ级160例,浸润癌45例。阴道镜活检的诊断灵敏度94.24%(655/695),特异度为94.24%(34/58),阳性预测值为95.07%(655/689),阴性预测值为37.50%(24/64)。其中CINⅠ级、CINⅡ级、CINⅢ级与宫颈锥切术的符合率分别为95.98%、76.16%、63.13%。结论阴道镜下病理活检对CIN的诊断具有一定价值,但漏诊较多,联合宫颈锥切术可有效提高宫颈癌的早期诊断准确率,避免漏检。     

经腹腔镜宫颈环扎术与经阴道宫颈环扎术对宫颈机能不全病人预后的影响

目的:研究经腹腔镜宫颈环扎术与经阴道宫颈环扎术对宫颈机能不全病人预后的影响。方法:将本院收治的宫颈机能不全病人94例依据随机数字表法分为对照组和观察组各47例。对照组使用经阴道宫颈环扎术治疗,观察组使用经腹腔镜宫颈环扎术治疗。对比分析两组病人的围术期指标及妊娠结局。比较两组病人的分娩孕周及新生儿体重。结果:与对照组相比,观察组病人住院总时间、手术时间均较短,术中出血量较低,差异具有统计学意义(P<0.05)。与对照组相比,观察组术后流产发生率较低,足月分娩率及新生儿存活率较高,差异具有统计学意义(P<0.05)。观察组早产率略低于对照组,但差异无统计学意义(P>0.05)。与对照组相比,观察组分娩孕周较晚,新生儿体重较高,差异具有统计学意义(P<0.05)。术前两组生活质量相比,差异无统计学意义(P>0.05);术后6个月,两组精力、社会功能、生理功能、生理职能、情感职能、情感健康、躯体疼痛、总体健康评分均显著提升,且观察组评分更高,差异有统计学意义(P<0.05)。结论:相较于经阴道宫颈环扎术,腹腔镜宫颈环扎术更具损伤低、恢复快、宫颈机能改善效果好,保障更高的足月生产率及新生儿存活率,显著降低了流产发生率。