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1.
Background Tumor necrosis factor a receptor 1 (TNFaR1) plays an important role in the signal pathway of apoptosis. The objective of this study was to investigate the effects of TNFaR1 knockout on the up-regulation of erythropoietin receptor (Epo-R) and the coordinated anti-apoptosis functions during myocardial ischemia-reperfusion injury in mice. Methods The ischemia-reperfusion injury model for cardiomyocytes was performed by ligating the left circumflex branch artery of TNFaR1 knockout (P55/) C17 B6 mice, as well as wild-type (P55^+/^+) C17 B6 mice. Triphenyltetrazolium chloride (TTC) staining was performed to observe the damaged area of the heart. TUNEL staining and DNA fragmentation were used to identify apoptosis. Mitochondrial Bcl-2 and Bax as well as expression of Epo-R and its downstream genes (Jak-2, stat-5, Akt, lkB-a, HIF-1a) were measured by Western blotting. The gene knockout mice were assigned into those undergoing the apoptosis surgical model group (KO group), and those subjected to sham operation (KOs group). Similarly, wild-type mice were either exposed to the surgical model (WT group) or subject to a sham operation (WTs group). Results The myocardial damage ratio of the wild-type group after the operation was significantly higher than that of the knockout group, (50.5±6.4)% vs (36.9±6.9)%, P 〈0.01. Similarly, TUNEL positive ratio of the wild-type group was significantly higher than that of the knockout group, (63.1±5.6)% vs (42.1±4.7)%, P〈0.01. The gray value ratios of Epo-R, Jak-2, stat-5, Akt, IkB-a, HIF-1 and mitochondrial Bcl-2 in the KO group were significantly higher than those of the WT group, P 〈0.05; however, mitochondrial Bax was significantly lower than that of the WT group significantly (P 〈0.05). Conclusions Using the ischemia-reperfusion injury model in mice, cardiomyocytes of TNFaR1 knockouts exhibited anti-apoptotic characteristics. This information could be used to coordinate the prevention of myocardial apoptosis by up-regulating and activating the Epo-R pathway.  相似文献   

2.
Objective: To observe the effect of Chinese medicine Shenshao Tablet (参芍片, SST) on the quality of life in coronary heart disease (CHD) patients with stable angina pectoris (SAP). Methods: Sixty-six patients with SAP confirmed by coronary angiography were enrolled and assigned to two groups by means of PROC PLAN using a SAS 6.12 software in a double-blinded, randomized, placebo-controlled design. Patients in the treated group were treated with SST, and the others in the control group were given placebo. The weekly angina frequency, quality of life scale [Seattle Angina Questionnaire (SAQ)] and incidence of important clinical events were observed to evaluate the intervention effect of SST on the quality of life for CHD patients with SAP. Results: During the study, one case dropped out in the treated group and two cases in the control group, respectively, and 63 cases including 32 cases in the treated group, and 31 cases in the control group completed the trial. After four weeks of treatment, the weekly angina frequency of the treated group (5.32± 2.46 times per week) was significantly less than that of the control group (7.32± 3.20 times per week, P 〈 0.05). The total score of the quality of life in the treated group (71.30± 5.44) was obviously higher than that in the control group (63.50± 4.60, P 〈 0.01), and the angina stability, angina frequency, and treatment satisfaction were significantly superior to those in the control group (P〈 0.01). The incidence of important clinical events of the treated group (3.1%) was lower than that of the control group (6.5%) during the six-month follow-up period, but the difference was insignificant (P 〉 0.05). Conclusion: SST could lower the angina frequency and greatly improve the quality of life in CHD patients with SAP.  相似文献   

3.
Background This retrospective study aimed to investigate the difference of the intra-dural reserving space for spinal cord in magnetic resonance imaging (MRI) between patients with and without developmental cervical stenosis and its clinical significance.Methods A total of 264 patients with cervical spondylotic myelopathy who had decompression surgeries were recruited.The average follow-up was 29 months.Based on their lateral radiographs,they were divided into stenosis group and non-stenosis group.On the magnetic resonance images,the ratio of the sagittal diameter of the dural sac to that of the vertebral body was measured and calculated as MRI Pavlov ratio at the mid-vertebral level on T2-weighted sagittal images from C3 to C7.The ratio of the transverse area of the spinal cord to that of the dural sac was measured and calculated as occupation ratio on T2-weighted axial images at the same levels.The MRI Pavlov ratio and occupation ratio were compared between the two groups.The stenosis group was further divided into space-reserving and non-space-reserving subgroups based on the occupation ratios; then clinical parameters were compared between the two subgroups to determine the clinical significance of the reserving space.Results The MRI Pavlov ratio of the stenosis group was significantly smaller than that of the non-stenosis group at C3-C7 (P <0.01),while the occupation ratio was significantly larger only at C7 (P <0.05).For the space-reserving subgroup,the postoperative recovery rate was lower (P <0.05).The postoperative recovery rate was (23±6)% in anterior approach,larger than (-23±15)% in posterior approach (P <0.05).Conclusions Developmental cervical stenosis is associated with a smaller sagittal diameter of the dural sac,but does not lead to a significant decrease in intra-dural space available for the cord.For patients with normal intra-dural space,the recovery after anterior decompression surgery was better than posterior approach.  相似文献   

4.
Objective: To explore the effect of Jisuikang (脊髓康, JSK) on kinetic dysfunction in patients after spinal injury. Methods: Eighty-four patients with spinal injury were assigned equally, according to a randomizing digital table to the treated group and the control group. Conventional treatment was given to both groups, and JSK was additionally given to the treated group. Changes of various kinetic function concerning parameters including kinetic score, grades of spinal injury, effectiveness of the treatment and available recovery rate in patients allocated in the treated group and the control group were observed and compared in the way issued by Association of Spinal Injury of America (ASIA). Results: Better effects were shown in the treated group than those in the control group in improving kinetic score (92.00 ± 9.95 scores vs 83.76 ± 24.12 scores), ASIA overall improvement rate (69.05% vs 45.24%) and grades of effectiveness (P〈0.05). However, the difference of available recovery rate between the two groups was insignificant (P〉0.05). Cenclusien: JSK could prevent secondary alteration of spinal injury, promote the recovery and regeneration of nerve tissues, but could not restore the function of a necrotic spine.  相似文献   

5.
Background The treatment strategies for multilevel thoracic ossification of the posterior longitudinal ligaments (T-OPLL) were rarely reported. The aim of this study was to investigate the clinical outcomes and complications of circumferential decompression for multilevel T-OPLL and compare two different methods in the management of the OPLL (resection or floating). Methods Data of sequentially treated patients who received surgical treatment for thoracic spinal stenosis caused by multilevel T-OPLL from January 2005 to February 2012 were retrospectively reviewed. Based on the surgical approaches applied, the patients were divided into two groups. Group A consisted the patients who received posterior decompression and group B consisted the patients who received circumferential decompression via the posterior approach. Group B was further divided into two subgroups: subgroup 1 (the resection group) where the OPLL was completely resected and subgroup 2 (the floating group) where the OPLL was floated. Results A total of 49 patients were included in the study. Fourteen patients with single posterior decompression were included in group A and 35 patients who received circumferential decompression were included in group B. In group B, 29 patients had complete resection of the ossified posterior longitudinal ligaments, while the other six underwent a flotation procedure. The follow-up data were available in 39 patients. Mean JOA scores improved from 5.4 ± 1.8 to 7.5 ± 2.8 in group A and from 3.7 ± 1.8 to 7.9 ± 2.4 in group B. The main complications included cerebrospinal fluid (CSF) leakage and postoperative neurelogic deterioration (ND). Twenty-three of the 25 cases with postoperative CSF leakage achieved a complete recovery at the last follow-up and 12 of the 15 cases with ND achieved some neurological improvement at the last follow-up. Conclusions Circumferential decompression via the posterior approach is an effective surgical method for thoracic spinal stenosis caused by multilevel OPLL  相似文献   

6.
Background Prospective mortality studies in the United States revealed that the mortality was elevated in diabetics compared to normal individuals following chronic spinal cord injury (SCI). Our study was conducted to investigate the levels of platelet-derived growth factor (PDGF) of astrocytes in SCI in streptozotocin (STZ)-induced diabetic rats. Methods Thirty male Sprague-Dawley (SD) rats were randomly divided into 3 groups: SCI group, diabetic SCI group, and sham operation control group. We employed STZ-induced diabetic SD rats and a weight-drop contusion SCI model. The rats were sacrificed on day 7 after the induction of SCI. Immunohistochemistry and Western blotting analysis were used to detect the PDGF expression level. Basso, Beattie and Bresnahan locomotor rating scale (BBB) was also used to evaluate the neurological recovery level of the rats. Results PDGF positive astrocyte numbers were significantly higher and PDGF staining was more intensive in astrocytes in the SCI group than in the diabetic SCI group (P〈0.05). The diabetic SCI group showed a slower recovery of motor function with a lower BBB score 7 days after acute spinal injury. Conclusions PDGF is an important factor for the recovery of neurological function after acute spinal injury and hyperglycemia in diabetic rats could depress the expression of PDGF in injured spinal cord. This may help to explain the slower recovery and higher mortality in diabetics after SCI.  相似文献   

7.
Background The mechanism of mucosal damage induced by ischemia-reperfusion (IR) after hemorrhagic shock is complex; mast cells (MC) degranulation is associated with the mucosal damage. Astragalus membranaceus can protect intestinal mucosa against intestinal oxidative damage after hemorrhagic shock, and some antioxidant agents could prevent MC against degranulation. This study aimed to observe the effects of astragalus membranaceus injection on the activity of intestinal mucosal mast cells (IMMC) after hemorrhage shock-reperfusion in rats Methods Thirty-two Wistar rats were randomly divided into the normal group, model group, low dosage group, (treated with Astragalus membranacaus injection, 10 g crude medication/kg) and high dosage group (treated with Astragalus membranacaus injection, 20 g crude medication/kg). The rat model of hemorrhagic shock-reperfusion was induced by hemorrhage for 60 minutes followed by 90 minutes of reperfusion. The animals were administrated with 3 ml of the test drug solution before reperfusion. At the end of study, intestinal pathology, ultrastructure of IMMC, and expression of tryptase were assayed. The levels of malondisldehyde (MDA), TNF-α, histamine, and superoxide dismutase (SOD) activity in intestine were detected, and the number of IMMC was counted. Results The Chiu's score of the rats in the model group was higher than in other groups (P〈0.01). The Chiu's score in the high dosage group was higher than that in the low dosage group (P〈0.05). Hemorrhage-reperfusion induced IMMC degranulation: Astragalus membranaceus injection attenuated this degranulation. Expression of tryptase and the number of IMMC in the model group increased compared with the other groups (P〈0.01) and was significantly reduced by the treatments of Astragalus membranaceus injection at both doses. There was no significant difference between the two treatment groups (P〉0.05). MDA content and concentration of TNF-α in the model group were higher than that in the other three groups (P〈0.05), and the concentration of TNF-α in the low dosage group was higher than that in the high dosage group (P〈0.05). SOD activity and the concentration of histamine in the model group were lower than the other three groups (P〈0.05). There was a negative correlation between the Chiu's score and the concentration of histamine and a positive correlation between the Chiu's score and the concentration of TNF-α and between the SOD activity and the concentration of histamine in the four groups (P〈0.05). Conclusion Astragalus membranaceus injection may reduce the damage to small intestine mucosa by inhibiting the activated IMMC after hemorrhagic shock.  相似文献   

8.
Background No-reflow phenomenon during percutaneous coronary intervention (PCI) for acute myocardial infarction (AMI) is a predictive factor of continuous myocardial ischemia, ventricular remodeling and cardiac dysfunction, which is closely associated with a worse prognosis. This study aimed to evaluate intracoronary nitroprusside in the prevention of the no-reflow phenomenon in AMI.
Methods Ninety-two consecutive patients with AMI, who underwent primary PCI within 12 hours of onset, were randomly assigned to 2 groups: intracoronary administration of nitroprusside (group A, n=46), intracoronary administration of nitroglycerin (group B, n=46). The angJographic results were observed. The real-time myocardial contrast echocardiography (RT-MCE), including contrast score index (CSI), wall motion score index (WMSI), transmural contrast defect length (CDL) and serious WM abnormal length (WML) were recorded at 24 hours and 1 week post-PCI. High sensitivity C-reactive protein (Hs-CRP) was examined by immune rate nephelometry. N-terminal prohormone brain natriuretic peptide (NT-proBNP) was tested with enzyme-linked immunosorbent assay. Patients were followed up for six months. Major adverse cardiac events (MACE) were recorded. Results The incidence of final TIMI-3 flow in group A was much higher than that in Group B (P 〈0.05), final corrected TIMI frame count (cTFC) in group A decreased significantly than that in group B (P 〈0.01). The CSI, CDL/LV length, WMSI and WL/LV length in group A were significantly lower than that in group B (P 〈0.01). Levels of Hs-CRP and NT-proBNP at 1 week post-PCI decreased significantly in group A than that in group B (P 〈0.01). Patients were followed up for 6 months and the incidence of MACE in group A was significantly lower than that in group B (P〈0.05).
Conclusion Intracoronary nitroprusside can improve myocardial microcirculation, leading to the decrease of the incidence of no-reflow phenomenon and better prognosis.  相似文献   

9.
Background Transcatheter Amplatzer occlusion of patent ductus artertiosus (PDA) has emerged as a minimally invasive alternative to surgical closure. The goal of this study was to compare long-term clinical outcomes between two procedures, especially on chronic residual shunt, late or very late procedure-related complications, and regression of pulmonary hypertension and left ventricular dilation.
Methods A total 255 patients having isolated PDA with a minimal diameter of ≥4 mm treated from January 2000 to July 2003 were included in this study and have been followed up until July 2008. The patients were assigned to either the device or surgical closure group according to the patients' and/or their parents' preference. Baseline physical exams, chest roentgenography, electrocardiography, and echocardiography were performed preprocedure and at each follow-up. Results Seventy-two patients accepted the transcatheter procedure (Group-TC) and 183 underwent surgical operation (Group-SO) for PDA closure, both groups were similar in their demographics and preoperative clinical characteristics. There were no cardiac deaths and late complications such as infectious endocarditis and Amplatzer duct occluder (ADO) dislodge in either group. More acute procedure-related complications were recorded in Group-SO (13.7%) compared with Group-TC (1.4%) (P=0.004). The recovery time was (8.7±2.3) days for the Group-SO and (1.3+0.5) days for the Group-TC (P〈0.001). The survival freedom from persistent residual shunt, defined as residual shunt that can not resolve automatically, was 91.3% for Group-SO and 98.6% for Group-TC (P=0.037 by Log-rank test). There was no significant difference in regression of pulmonary hypertension and left ventricular dilation; neither survival freedom from pulmonary hypertension nor abnormal left ventricular end-diastolic volume index were significantly different between the surgical group and the Amplatzer group.
Conclusions Our study confirmed the long-term safety and efficacy of transcatheter Amplatzer occlusion. In comparison to the time-proven surgical closure, transcatheter Amplatzer occlusion was less invasive and associated with fewer complications and residual shunt, and as effective in the regression of pulmonary hypertension and left ventricular dilation.  相似文献   

10.
Objective: To study the effect of the Chinese medicine Qiangxin Fumai Granule (强心复脉颗粒, QFG) on electrophysiological functions of the sinoatrial node during ischemia-reperfusion (IR) of the right coronary artery in rabbits. Methods: The right coronary artery IR model in rabbits was adopted. The modeled rabbits were randomly divided into 4 groups: the model group, the atropine group, the highdose QFG group, and the low-dose QFG group, with 8 animals in each group. In addition, twelve rabbits were selected for the sham-operative group. The drugs were administered once via duodenal perfusion after modeling had been stabilized for 10 min. The changes in AA interval, the sinoatrial conduction time (SACT), the sinus node recovery time (SNRT), the corrected sinus node recovery time (CSNRT) and the index of sinus node recovery time (ISNRT) at different time points during ischemia and reperfusion were measured. Results: The AA interval was prolonged for more than 40 ms in the model group during ischemia. Compared with the model group, the four electrophysiological parameters abovementioned in the high-dose QFG group and the low-dose QFG group were decreased to different extents at each time point (P〈0.01 or P〈0.05), and no statistically significant differences were found between the QFG groups and the atropine group (P〉0.05). Conclusion: QFG is beneficial for accelerating the recovery of sinus node autorhythmicity and conduction function, so as to protect electrophysiological functions of the sinoatrial node. Accelerating the recovery of autorhythmicity and conduction function in the sinus node is considered its electrophysiological mechanism in the treatment of sinoatrial node injury induced by ischemia.  相似文献   

11.
目的 研究脊髓型颈椎病(CSM)磁共振12加权高信号(ISI)部位与手术疗效的相关性,探讨12加权高信号的产生原因和临床意义.方法 回顾性分析72例在我院手术治疗并随访的颈椎病患者,比较高信号位于脊髓中央灰质区(A亚组)、灰质+白质区(B亚组)和高信号阴性组之间术前临床症状(JOA评分)和术后疗效(脊髓功能改善率)的差异.结果 高信号阴性组有40例患者,阳性组中A亚组有21例,B亚组有11例.组间比较:(1)阳性组(A+B)和阴性组术前JOA评分差异有统计学意义(P<0.05),但术后改善率无明显筹别[阳性组和阴性组术后1周、14周和52周改善率分别为:(20.8±14.5)%、(51.1±15.6)%、(60.1±14.2)%和(20.3±14.3)%、(54.4±22.3)%和(61.2±22.3)%,P>0.05].(2)阴性组和A亚组术后52周随访改善率均优于B亚组[阴性组、A亚组和B亚组术后52周改善率分别为(61.2±22.3)%、(64.3±13.3)%和(50.1±11.2)%,P<0.05].结论 高信号位于脊髓中央灰质患者术后疗效较高信号阴性患者无明显差异,高信号位于白质+灰质中提示预后较差.  相似文献   

12.
目的探讨脊髓型颈椎病患者核磁共振(magnetic resonance imaging,MRI)T2加权像高信号反映病情严重程度及外科预后的可能性。方法我院骨科2005年9月-2009年6月116例脊髓型颈椎病患者纳入此次研究,所有患者均进行颈椎后路减压手术。术前均进行MRI检查。依据MRI T2加权像出现的高信号强度分为3级。0级:未出现脊髓高信号;1级:轻度高信号(信号模糊);2级:高亮度信号(信号高亮)。采用日本矫形外科学会(Japanese Orthopaedic Association,JOA)制定的脊髓功能评分标准进行术前术后病情评分。结果 0级40例;1级47例;2级29例。病程:0级(11.2±25.6)月,2级(36±33.7)月。术前3等级JOA脊髓功能评分差异无统计学意义,但0级术后JOA评分最高为15.6±1.7,术后改善率最高为65.1±24.3;3级术后JOA评分最低为10.6±2.0,术后改善率最低为36.1±30.3。结论脊髓型颈椎病患者术前MRIT2加权像高信号与患者年龄、病程、术前JOA评分及术后JOA评分相关,MRI T2加权像信号强度最高的患者术后改善率最低,T2高信号的分级方法可作为评价脊髓型颈椎病预后的一个指标。  相似文献   

13.
陈德强  雪原 《中国现代医生》2011,49(34):54-56,161
目的 探讨颈椎后纵韧带骨化合并黄韧带骨化的手术治疗方法及其术后疗效的影响因素。方法 回顾性分析2007年5月~2011年3月在我院进行手术治疗的36例颈椎后纵韧带骨化合并黄韧带骨化患者,全部患者均采用全椎板切除减压,随访术后脊髓功能恢复情况,分析术前病程、术前JOA评分(日本矫形外科学会,17分)、硬化节段、脊髓信号改变与术后疗效的关系。结果 36例患者均获得随访,随访时间在10个月~4年,平均16个月。根据JOA评分标准进行术前和术后的疗效评价。术后JOA评分平均为14.36(11~17),较术前9.64(7~13)有显著改善(t=10.48,P〈0.01),术后疗效评价为优20例、良11例、可5例,优良率达86.1%。结论全椎板切除减压是治疗颈椎后纵韧带骨化合并黄韧带骨化的可靠、有效的手术方式。术前病程短、JOA评分高、单节段骨化及矢状位rI、2加权像髓内信号无改变的病例术后疗效好。  相似文献   

14.
目的 探讨胸椎黄韧带骨化症(ossification of ligamentum flavum,OLF)的临床特征,评估影响术后疗效的影响因素.方法 对本科2001年6月至2010年6月住院治疗并获得随访的28例胸椎黄韧带骨化症患者进行回顾性分析,运用术前、术后神经功能评价标准选用改良JOA评分(11分法),疗效评价...  相似文献   

15.
目的:回顾分析北京大学第三医院骨科颈椎后纵韧带骨化后路手术后,后纵韧带骨化进展导致颈脊髓病需再次手术的患者资料,通过总结颈椎后纵韧带骨化进展的再次手术治疗策略及其疗效,为颈椎后纵韧带骨化术后进展的再次外科治疗提供一定的临床参考。方法:在2006年5月至2012年7月住院的颈椎后纵韧带骨化患者中,选取既往因后纵韧带骨化行单开门椎管扩大成形术的17例患者作为研究对象。再次手术依据患者的临床表现结合影像学检查确定责任节段及手术入路,采用前方入路减压者12例,采用后方入路扩大减压者5例。采取日本骨科协会(Japanese Orthopedic Association, JOA)评分评价患者术前及术后的脊髓功能。将患者年龄,性别,术前症状持续时间,脊髓高信号,是否伴随高血压、糖尿病等临床因素与术前JOA评分及术后JOA改善率进行相关性分析;手术前、后的JOA评分比较采用重复测量ANOVA方差分析;手术前、后的JOA改善率比较采用配对t检验。结果:随访时间60~348个月,平均137.5个月。手术均顺利完成,首次手术和再次后路手术各发生C5神经根麻痹1例。再次手术时,前路手术有2例、后路有1例发生硬膜撕裂致脑脊液漏,无感染发生。不同临床因素与术前JOA评分及JOA改善率无显著相关性。首次椎管扩大椎板成形术后,患者的JOA评分从术前9.4±4.1升高到12.8±2.8,有显著改善(P<0.01),后纵韧带骨化进展导致颈脊髓病后又出现下降,再次手术后较术前神经功能显著改善(P<0.05)。再次手术的远期改善率较第一次术后的首次改善率和再次手术后6个月的改善率差异有统计学意义(P<0.01)。结论:根据后纵韧带骨化进展后的临床表现及影像学的改变制定的再次手术减压策略,能显著改善后纵韧带骨化进展导致的脊髓功能损害。  相似文献   

16.
目的 探讨MRI检查中过伸位与过屈位脊髓矢状径变化幅度与脊髓型颈椎病临床严重程度及预后之间的关系.方法 2006年2月至2008年11月,共53例颈椎病患者术前行高分辨率1.5 TMR中立位及过伸过屈位成像并量化脊髓T2信号强度值,所有患者随访时间11个月~3年,平均14.6个月.分别记录患者年龄、性别、病程、病变脊髓信号强度、颈椎活动度等不同指标.将患者按动态脊髓受压程度分为两组,分析两组间各观察指标的差异.并运用统计学相关性分析方法检验动态脊髓受压幅度与术前JOA评分及改善率的关系.结果 所有患者术前JOA评分为(9.2±2.5),末次随访为(13.8±2.8),末次随访改善率为(57.02±16.23)%.经两样本t检验,两组患者年龄、改善率差异无统计学意义;高动态受压变化组患者在颈椎活动度、脊髓T2信号强度方面高于低动态受压变化组,在术前JOA评分及病程方面小于低动态受压变化组.改善率、术前JOA评分与动态脊髓受压幅度的相关系数分别为0.07、P=0.643及-0.27、P=0.04.结论 在病程较短的前提下,脊髓神经动态受压变化的程度与脊髓型颈椎病的临床病情严重程度有一定相关关系,而与颈椎病预后的关系不密切.  相似文献   

17.
Wu DJ  Jiang ZS  Sun JM  Wang XW  Zhang C  Qiao Y  Wang DC  Ma SZ  Song Y  Gao CZ 《中华医学杂志》2011,91(26):1830-1833
目的 探讨腰背部轻微外伤对胸椎黄韧带骨化症(TOLF)患者手术效果的影响.方法 回顾性研究山东大学第二医院1997年6月至2009年8月和山东省立医院1996年5月至2009年8月连续收治的有完整随访资料TOLF患者94例.根据有无腰背部轻微外伤史分为轻微外伤组16例和无外伤组78例.比较两组在性别、年龄、病程长短、病变累及部位和节段数、MRI 上髓内异常信号(IMSC)出现率、术前及终末随访日本骨科协会(JOA)评分和恢复率等的差异,分析与终末随访JOA评分及恢复率相关的因素;并探讨手术时机对疗效的影响.结果 终末随访时轻微外伤组和无外伤组患者JOA评分分别为4.0±1.4和8.4±1.7,均高于术前的3.2±1.4和5.4±1.1(P=0.009和P=0.000).轻微外伤组的发病年龄(50 ±11岁)小于无外伤组(58 ±8岁)(P=0.046),IMSC出现率(75.0%)高于无外伤组(25.6%)(P=0.000),术前术后JOA评分均低于无外伤组(均P=0.000).多元线性回归分析示终末随访JOA评分与患者轻微外伤和IMSC呈负相关(r=-1.82和r=-1.87,均P=0.000),与术前JOA评分呈正相关(r=0.60,P=0.000),而术后恢复率与患者轻微外伤和IMSC呈负相关(r=-26.26和r=-33.70,均P=0.000).未发现手术时机对手术效果有明显影响(P=0.147).结论 有腰背部轻微外伤史的TOLF患者术后恢复差,外伤是其恢复不良的高危因素.
Abstract:
Objective To retrospectively explore the influences of minor back trauma on surgical outcomes in patients with thoracic ossification of ligamentum flavum (TOLF) and preliminarily detect its possible causes. Methods A total of 94 TOLF patients were divided into two groups according to the absence or presence of minor back trauma: MT (minor trauma, n = 16) and NT (no trauma, n = 78). They were compared in terms of gender, age, duration of symptoms, levels of involvement, numbers of involved segments, ratio of intramedullary signal changes (IMSC) , pre- & post-operative JOA (Japanese Orthopedic Association) score, recovery rate (RR) at the final follow-up. Multiple regression analysis was employed to elucidate the causes related with the surgical outcomes. The MT group was further divided into two subgroups according to the intervals between trauma and surgery to clarify the influences of surgical timing on the efficacies. Results The JOA scores were 4. 0 ± 1. 4 and 8.4 ± 1. 7 respectively in MT and NT groups at the final follow-up. The neurological status of patients improved in both groups (MT: P =0.009, NT: P =0. 000). The patients were younger in MT groups (50 ±11 years ) than those in NT groups (58 ± 8 years )(P = 0.046). The ratio of IMSC was higher in MT groups(75. 0% ) than that in NT groups(25. 6% ) (P =0. 000). The pre- & post-operative JOA scores were lower in MT groups than those in NT groups (both P =0. 000). Multiple regression analysis revealed that the postoperative JOA score at the final follow-up was positively related with the preoperative JOA score (r = 0. 60, P = 0. 000) and negatively with trauma and IMSC (r = - 1. 82 and r =- 1. 87, P = 0. 000) while the final postoperative RR were negatively related with trauma and IMSC (r = - 26. 26 and r = - 33. 70, P = 0. 000). The surgical timing after trauma did not influence the efficacies (P =0. 147). Conclusion The TOLF patients with minor back trauma have a worse post-operative recovery. A minor trauma might be a risk factor of adverse surgical outcomes.  相似文献   

18.
目的 探讨优化MED术治疗腰椎间盘突出症的疗效,分析其并发症、适应证及手术技巧.方法 分析行优化MED术78例腰椎间盘突出症患者的临床资料.对患者进行术前、术后1周、术后1个月、术后6个月及术后12个月JOA评分,VAS和ODI评分.结果 患者术前、术后1周、术后1个月、术后6个月及术后12个月JOA评分,手术后较手术前JOA评分有统计学差异(P<0.05),VAS手术后较手术前VAS差异有统计学意义(P<0.05),ODI评分手术后较手术前VAS差异有统计学意义(P<0.05);本组术后78例获随访3~35(11 ±3)个月,均无相应节段椎间盘髓核组织再次突出,未发生相关并发症.结论 优化MED手术治疗腰椎间盘突出症对保持脊柱稳定性有显著优势.  相似文献   

19.
目的 探讨磁共振(MR)弥散张量成像(DTI)的表观扩散系数(apparent diffusion coefficient,ADC)比值、各向异性分数(fractional anisotropy,FA)比值对脊髓型颈椎病(CSM)的临床症状及预后的评估价值.方法 对入选的50例CSM患者及36例正常对照人群进行MRI及DTI检查,选择脊髓白质前索、侧索、后索和中央灰质4个部位作为感兴趣区(ROI),CSM组测量和计算脊髓受压最重平面与C1/2平面的ADC比值和FA比值,正常对照人群测量和计算C3/4、C4/5、C5/6、C6/7平面与G1/2平面的ADC比值、FA比值.对比正常对照人群不同节段、不同年龄间DTI参数比值的差异;对比DTI参数(ADC、FA)和参数比值(ADC比值、FA比值)与CSM患者临床症状(JOA评分)及预后(JOA改善率)相关性的差异;CSM患者按术前JOA评分分为轻度损伤组、中度损伤组、重度损伤组,比较各组间DTI参数比值的差异;按术后JOA改善率分为优、中、差3组,比较各组间DTI参数比值的差异.结果 正常对照人群不同年龄组间4个部位ADC比值、FA比值间差异无统计意义;C3/4、C4/5 、C5/6 、C6/7各平面间脊髓白质前索、侧索、后索ADC比值、FA比值差异均有统计学意义(P<0.05).相关分析显示:脊髓前索、侧索、后索和中央灰质的ADC比值、FA比值与JOA评分、JOA改善率相关性优于ADC值、FA值(P<0.05或P<0.01),且FA比值优于ADC比值.与正常对照人群相比,轻度损伤组、中度损伤组、重度损伤组患者ADC比值逐渐升高,FA逐渐降低,差异有统计学意义(P<0.05);与正常对照人群相比,改善率为优、中、差3组CSM患者ADC比值逐渐升高,FA比值逐渐降低,差异有统计学意义(P<0.05).结论 DTI参数比值可消除年龄因素的影响,与CSM患者症状及预后有更优的相关性,可能具有较好的CSM临床症状及预后评估价值.  相似文献   

20.
目的:观察黄芪桂枝五物汤加减治疗神经根型颈椎病Key-Hole术后感觉异常的临床疗效。方法:选取我院脊柱微创骨科诊断为神经根型颈椎病患者52例,随机分为对照组和观察组,每组各26例。两组均在全麻下行内镜下颈椎后路KeyHole手术,对照组术后口服甲钴胺分散片治疗,观察组术后服用黄芪桂枝五物汤加减治疗。观察两组患者治疗1周、1月、3月后视觉模拟(VAS)评分、日本骨科协会(JOA)评分,并进行统计学分析。结果:随访3个月,总有效率对照组为82.6%,观察组为93.8%,差异有统计学意义(P<0.05)。VAS评分对照组由术前(6.52±0.61)分降至(2.13±0.58)分,观察组由(6.81±0.72)分降至(1.12±0.27)分,差异有统计学意义(P<0.05);JOA评分对照组由(8.76±0.63)增至(13.63±0.49)分,观察组由(7.14±0.51)增至(15.81±0.36)分,差异有统计学意义(P<0.05)。结论:黄芪桂枝五物汤加减治疗神经根型颈椎病Key-Hole术后感觉异常,近期疗效显著。  相似文献   

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