腰椎棘突间动态辅助运动系统治疗腰椎退变性疾病临床疗效研究

目的研究并分析腰椎棘突间动态辅助运动系统在应用于腰椎退变性疾病中的治疗疗效及其临床价值。方法选取该院自2008年9月—2011年6月所收治的腰椎退变性疾病患者共计26例为研究对象。以上患者自收治入院后采取腰椎棘突间动态辅助运动系统方式进行手术治疗。术后采取随访方式针对患者手术治疗情况进行检查分析。主要涉及到ODI（Oswestry功能障碍）以及VAS（视觉模拟）这两个方面的评价指标。结果首先,同接受腰椎棘突间动态辅助运动系统治疗手术前的ODI分值以及VAS分值相比,患者术后3～12个月的随访分值提升显著,两组数据对比差异有统计学意义（P〈0.05）,具有统计学意义;其次,同接受腰椎棘突间动态辅助运动系统治疗手术前的患者腰椎活动度相比,患者术后3～12个月的随访分值提升显著,两组数据对比差异显著（P〈0.05）,具有统计学意义。结论腰椎棘突间动态辅助运动系统作为腰椎退变性治疗领域的一种全新手术治疗方式,能够取得较为显著的临床疗效,且术中出血量小、手术持续时间短等优势显著,应予以临床推广。     

棘突椎板复合体截骨回植成形术在胸腰椎手术中的应用

目的 探讨棘突椎板复合体回植椎管成形术在胸腰椎后路手术中的应用价值.方法 通过对52例接受棘突椎板复合体回植椎管成形术患者的手术治疗资料的分析,验证棘突椎板复合体回植椎管成形术在胸腰椎后路手术治疗中的可行性及临床疗效.结果 52例接受棘突椎板复合体回植椎管成形术的患者,术后6个月再植椎板均愈合,没有发生骨质吸收、医源性椎管狭窄粘连、脊柱后突及不稳现象.结论 棘突椎板复合体回植椎管成形术于胸腰椎后路手术中的应用,有利于保持脊柱的稳定性和恢复椎管的完整性,避免医源性椎管狭窄、继发性椎体滑脱和腰椎不稳的发生,不失为一种较好的手术策略.     

棘突间移植物(Wallis)治疗腰椎关节突关节退变22例分析

目的:评价棘突间移植物-Wallis对腰椎关节突关节退变的治疗效果.方法:对接受Wallis移植的22例患者进行回顾性分析.结果:术后症状改善程度采用Odom评估法,优7例,良10例,可1例,差4例,优良率77.3%.随访期间未发生症状加重﹑移植物松脱及术后翻修.结论:应用棘突间移植物技术治疗腰椎关节突关节退变,保留了腰椎后柱结构稳定性,恢复了腰椎后柱高度.     

腰椎椎间融合术治疗脊柱不稳的临床观察

[目的]研究腰椎椎间融合术治疗脊柱不稳的重建方法和临床效果,为临床提供一种较为理想的椎间植骨选择.[方法]选择收治的腰椎段不稳患者78例,根据随机化原则分为对照组和实验组各39例,对照组行椎问自体髂骨块植骨,实验组行椎间自体棘突椎板连接处结构植骨.对两组患者术后融合率、融合所需时间以及疼痛改善和影像学诊断结果进行记录,应用统计学分析比较两组患者治疗的临床疗效.[结果]对照组和实验组在融合率、融合所需时间、疼痛缓解评分程度方面并无明显差异,但术后随访时(6个月,12个月),对照组患者的椎间隙高度明显低于实验组(P<0.05),而对照组患者椎体滑脱率明显高于实验组患者(P<0.05),在维持椎间隙高度及减少腰椎滑移危险方面差异有统计学意义.[结论]利用棘突根部与椎板连接处结构椎问植骨融合治疗脊柱不稳安全可行、疗效确切,临床应用前景广阔.     

答疑解惑

贵州读者陈戈问:腰椎棘突偏歪能否证明腰椎有病? 腰椎棘突由两侧椎板在中线处汇合向后,其末端膨大,下方如梨状。腰椎棘突具有杠杆作用,肌肉韧带附着其上可明显增加脊柱的坚固     

椎体间融合术治疗腰椎退变性疾病的术后护理

目的总结腰椎椎体间融合术治疗腰椎退变性疾病的术后护理。方法20例腰椎退变性疾病患者在接受腰椎体间融合术后实行相应护理。结果20例腰椎退变性疾病患者均顺利完成手术,手术疗效显著,在住院期间未发生护理并发症。结论腰椎椎体间融合术治疗腰椎退变性疾病是一种新的手术方式,全面、细致的护理是手术成功的重要保证。     

延边地区成人Tuffier’s线与腰椎水平的关系

目的探讨延边地区成人Tuffier’s线与腰椎水平的关系及性别、民族对它的影响。方法选择该地区成人264例,观测仰卧位腰椎平片上Tuffier’s线所经腰椎水平,并比较男性与女性、朝鲜族与汉族Tuffier’s线所经腰椎水平。结果该地区成人Tuffier’s线所经腰椎水平位于L3-4棘突间隙至L5-S1棘突间隙之间,约81%经L4棘突和L4-5棘突间隙。Tuffier’s线所经腰椎的平均水平女性较男性低,汉族较朝鲜族低,差异有统计学意义(P﹤0.01)。结论延边地区成人Tuffier’s线所经腰椎水平有性别、民族差异,临床确定腰椎水平应考虑其差异。     

腰椎后路动态固定系统非融合技术治疗腰椎退行性疾病

目的 探讨腰椎后路动态固定系统(Co flex)治疗腰椎退行性疾病的疗效.方法 对8例腰椎退行性疾病患者行手术减压,Co flex行动态非融合固定.结果 8例患者均随访,近期治疗效果满意.结论 腰椎后路Co flex可以有效维持椎间高度与活动度,预防和减少融合相邻节段的椎间盘退变,近期效果满意.     

椎弓根钉系统复位内固定椎体间植骨融合治疗腰椎滑脱症的研究

目的：探讨椎弓根钉系统复位内固定、椎体间植骨融合治疗腰椎滑脱症的疗效。方法：对28例腰椎滑脱患者行椎弓根螺钉系统复位内固定,利用减压时切下的棘突、椎板骨碎块,通过后路进行椎体间植骨融合。结果：随访12个月～30个月,平均20个月,28例患者的腰腿痛等临床症状缓解,26例患者完全复位,2例部分复位,术后4个月～6个月复查X线片,显示28例患者均获得椎体间骨性融合。结论：椎弓根螺钉系统复位内固定、椎体间植骨融合治疗腰椎滑脱症效果满意。     

DR在腰椎不稳诊断中的应用

目的:探讨数字化X线摄影(digital radiography,DR)在腰椎不稳诊断中的应用,为临床提供可靠诊断、治疗的依据.方法:对198例可疑腰椎不稳的腰腿痛患者进行常规DR腰椎正侧位片、过伸过屈位片检查,分析腰椎椎体向前、后移位,椎体成角和棘突分离或相互靠近情况.结果:根据国外White和Panjabi提出的方法,筛查出35例腰椎不稳患者.结论:与常规腰椎正侧位、斜位片相比,腰椎过伸过屈位片可发现腰椎失稳和功能改变,可对临床提供治疗依据及观察治疗前后疗效对比起到一定的指导作用.     

The human drama of genetics: 'hard' and 'soft' media representations of inherited breast cancer

This paper examines media coverage of 'breast cancer genetics', and explores its implications for public understanding. We present a content analysis of coverage in British newspapers and look at a variety of popular forms, including women's magazines, television soap opera and radio drama. Genetic/inherited risk receives a great deal of coverage across a wide range of media formats and outlets. Much of this attention has focused on individuals from 'high risk families' and dilemmas around prophylactic mastectomies. Through examining media coverage, combined with interviews with media personnel and their sources, we show why this story proved so attractive to the media and highlight the different production values which influence coverage. Finally, we introduce preliminary findings from focus group discussions to demonstrate how such 'human interest' framing has engaged audience attention and influenced public understandings. The paper concludes by highlighting the implications for analysing, predicting, and engaging with, media representations of science.     

Worker education in the primary prevention of occupational dermatoses

This paper reports the evaluation of a skin care education programmeconducted on a fine chemicals manufacturing site where over1,000 employees are located. Approximately 60% are involvedin chemical manufacture. Over a 12 month period production staffreceived training in prevention of occupational dermatoses linkedto a site-wide poster initiative. The incidence of new casesof occupational dermatoses fell from 0.055 (70 cases in 1,277employees) to 0.021 (27 cases in 1,277 employees) before andafter the intervention respectively (p<0.0001). After otherfactors such as chemicals handled, observer bias and changesin reporting related to socioeconomic climate were taken intoaccount it is concluded that this study demonstrates the importanceof worker education as a tool for primary prevention of disease.Training materials such as video and poster presentations maybe effectively used in the chemical manufacturing industry asan adjunct to prevention and control of exposure to substanceshazardous to the skin. Such methods may also be used in otherindustries where there are significant risks of dermatoses.     

Regional Variation in Travel-related Illness acquired in Africa,March 1997–May 2011

To understand geographic variation in travel-related illness acquired in distinct African regions, we used the GeoSentinel Surveillance Network database to analyze records for 16,893 ill travelers returning from Africa over a 14-year period. Travelers to northern Africa most commonly reported gastrointestinal illnesses and dog bites. Febrile illnesses were more common in travelers returning from sub-Saharan countries. Eleven travelers died, 9 of malaria; these deaths occurred mainly among male business travelers to sub-Saharan Africa. The profile of illness varied substantially by region: malaria predominated in travelers returning from Central and Western Africa; schistosomiasis, strongyloidiasis, and dengue from Eastern and Western Africa; and loaisis from Central Africa. There were few reports of vaccine-preventable infections, HIV infection, and tuberculosis. Geographic profiling of illness acquired during travel to Africa guides targeted pretravel advice, expedites diagnosis in ill returning travelers, and may influence destination choices in tourism.     

The design of hazard risk assessment matrices for ranking occupational health risks and their application in mining and minerals processing

Two hazard risk assessment matrices for the ranking of occupational health risks are described. The qualitative matrix uses qualitative measures of probability and consequence to determine risk assessment codes for hazard-disease combinations. A walk-through survey of an underground metalliferous mine and concentrator is used to demonstrate how the qualitative matrix can be applied to determine priorities for the control of occupational health hazards. The semi-quantitative matrix uses attributable risk as a quantitative measure of probability and uses qualitative measures of consequence. A practical application of this matrix is the determination of occupational health priorities using existing epidemiological studies. Calculated attributable risks from epidemiological studies of hazard-disease combinations in mining and minerals processing are used as examples. These historic response data do not reflect the risks associated with current exposures. A method using current exposure data, known exposure-response relationships and the semi-quantitative matrix is proposed for more accurate and current risk rankings.     

Psychopathological features of a patient population of targets of workplace bullying

BACKGROUND: A strong association between workplace bullying and subsequent anxiety and depression, indicated by empirical research, suggests that bullying is an aetiological factor for mental health problems. AIMS: To evaluate levels of stress and anxiety-depression disorder developed by targets of workplace bullying together with outcome at 12 months and to characterize this population in terms of psychopathology and sociodemographic features. METHODS: Forty-eight patients (36 women and 12 men) meeting Leymann Inventory of Psychological Terror criteria for bullying were included in a prospective study. Evaluations were performed at first consultation and at 12 months using a standard clinical interview, a visual analogue scale of stress, the Hospital Anxiety and Depression (HAD) scale, the Beech scale of stress in the workplace and a projective test (Picture-Frustration Study). RESULTS: At first consultation, 81% of patients showed high levels of perceived stress at work and 83 and 52% presented with anxiety or depression, respectively. At 12 months, only 19% of working patients expressed a feeling of stress at work. There was a significant change in symptoms of anxiety while there was no change in symptoms of depression. Stress at work and depression influenced significatively capacity to go back to work. At 12-month assessments, workers showed a significantly better score on the HAD scale than non-workers. Over half the targets presented a neuroticism-related predominant personality trait. CONCLUSION: Workplace bullying can have severe mental health repercussions, triggering serious and persistent underlying disorders.     

The rise and fall in incidence of malignant mesothelioma from a British Naval Dockyard, 1979-1999

BACKGROUND: The incidence of malignant mesothelioma in Britain is predicted to rise over the next 15-25 years because of past failure to protect the workforce against inhalation of asbestos. In British Naval dockyards, alternative insulation materials and respiratory protection were introduced from the mid-1960s. Aims This study was carried out to investigate the effects of these control measures on mesothelioma deaths in dockyard workers. METHODS: Cases of mesothelioma of the pleura and peritoneum between 1979 and 1999 in workers from the Devonport Naval Dockyard, south-west England, were sought from coroners' and medico-legal records. RESULTS: Three hundred and one cases were identified, 7% peritoneal. The peak incidence occurred in 1991 with 25 cases per annum (quadratic model fit R(2) = 74.2%, P < 0.001) and we predict that by 2003 the incidence will fall to fewer than five cases per annum. The mean time between first exposure and presentation was 48.5 years [95% confidence interval (CI) = 47.3-49.8], but this was significantly shorter in the more heavily exposed trades, when compared with the less heavily exposed (42 years, 95% CI = 39.0-45.0, versus 49.5 years, 95% CI = 48.2-50.9). Those with higher exposure were also at significantly greater risk of peritoneal disease (P < 0.023, Fisher's exact test). CONCLUSION: The reduction in incidence of mesothelioma is greater than can be accounted for by reduction in numbers of dockyard workers over the last 50 years. Changes in insulation materials and improved industrial hygiene measures introduced into the Devonport Dockyard from the mid-1960s have resulted in an earlier decline in the incidence of malignant mesothelioma than that predicted for the British workforce as a whole.     

Organophosphate toxicity and occupational exposure

The ubiquitous organophosphates present a continuing health hazard in agriculture, public health eradication programmes and as chemical warfare agents. Despite significant progress in understanding the potential mechanisms of toxicity far beyond the commonly accepted mechanism of cholinesterase inhibition in intentional exposures, the precise health effects following occupational exposures are yet to be completely defined. A much greater understanding exists of the clinical features of organophosphate poisoning. These are characterized by a triphasic response involving an initial acute cholinergic phase, an intermediate syndrome (both associated with high mortality) and a disabling but non-lethal delayed polyneuropathy. The delayed polyneuropathy may occur in the absence of the cholinergic or intermediate phases. However, progress is still required in order to improve the quantification and assessment of occupational exposures and the implementation of appropriate preventive measures. Finally, evidence-based guidelines for appropriate or optimal therapeutic interventions following poisoning are required urgently and collaborative work with colleagues in developing countries, where the occurrence of organophosphate exposures is more frequent, may provide the answers.     

Miliaria rubra of the lower limbs in underground miners

This report documents a case series of miliaria rubra of the lower limbs in miners at a deep underground metalliferous mine in tropical arid Australia. During the summer months of February and March 1999, all cases of miliaria rubra of the lower limbs in underground miners seen at the mine's medical centre were clinically examined and administered a questionnaire. Twenty-five patients were seen, an incidence of 56.4 cases per million man-hours. Miliaria rubra was most often located between the ankle and knee (88% of cases). Twenty-four percent had concurrent folliculitis and 20% had concurrent tinea. Thirty-two percent had a personal history of asthma. Walking through ground-water and splashing of the legs was common. Three to 4 weeks of sedentary duties in air conditioning was generally required to achieve resolution of miliaria rubra. The incidence of miliaria rubra of the lower limbs is 38% of the incidence of heat exhaustion at the same mine. The length of disablement is greater, however. Atopics may be at increased risk of miliaria rubra. Control measures are discussed.     

Planning research

The starting point for any research project should be a question.Once this has been defined and the relevant scientific literaturereviewed, a protocol should be drawn up. This will be used notonly as a guide to the conduct of the study and in the preparationof the final report, but also in seeking any financial supportand approvals that are required for the investigation. A protocolis normally arranged in sections covering the background tothe study, the question(s) that it will address, the methodsthat will be used for the collection and analysis of data, thestatistical power of the investigation (where relevant), anyethical considerations, and the financial input that will beneeded. A pilot study is often helpful where aspects of thestudy method are untried or of uncertainvalidity.     

Stress in the Norwegian police service

BACKGROUND: High levels of stress have been attributed to the conditions of police work, but there is little empirical evidence for this. AIMS: To develop a new instrument to measure job stress in the police; to assess the most severe and frequent police stressors; to compare levels of stress according to the demographic and organizational factors; and to study stress in relation to personality traits, work locus of control and coping strategies. METHODS: A comprehensive nationwide questionnaire survey of 3272 Norwegian police at all hierarchical levels, including the Norwegian Police Stress Survey (NPSS), the Job Stress Survey, the Basic Character Inventory, the Work Locus of Control Scale, and the Coping Strategies Scale. RESULTS: Work injuries were appraised as the most stressful but least frequent stressor and job pressure was reported the least severe but most frequent stressor. Females experienced job stressors less frequently, but appraised them as more severe than men did. Older police officers reported more job pressure severity and fewer work injuries. The police in districts where peer support was planned but not implemented, and who worked in districts with more than 50,000 inhabitants, perceived the lack of support more severely than others. The correlations between stress and personality traits, work locus of control, and coping were moderate. CONCLUSIONS: The NPSS captures police-specific stressors that are not adequately measured by global stress instruments. The study of stress in police work should preferably involve a nationwide use of police-specific stress instruments.