腕管综合征神经卡压：内镜下腕管松解与有限小切口松解的效果及安全性评价

BACKGROUND:Existing evidence has shown endoscopic carpal tunnel release is superior to the open release in postoperative recovery time, grip and pinch strength, hospitalization time as well as incidence of postoperative scar tissues. OBJECTIVE: To systematically review the efficacy and safety of endoscopic release versus mini-open release for carpal tunnel syndrome. METHODS: A computer-based search of PubMed, the Cochrane Library, EMbase, Web of Science, CNKI, CqVip and Wanfang databases was performed. Randomized controlled trials comparing endoscopic release with mini-open release for patients with carpal tunnel syndrome were included, and the publishing time was up to November 1st, 2015. Two authors independently screened, extracted data and assessed the risk of bias of the included literatures. Then statistical analysis was conducted using RevMan 5.3 software. RESULTS AND CONCLUSION: A total of 11 randomized controlled trials involving 706 patients were included. The results of Meta-analysis demonstrated that: compared with mini-open release, endoscopic release could not only significanthy decrease the hospitalization time postoperative recovery time and complications (P < 0.05), but also achieve better symptom relief (P=0.16). However, there were no significant differences in grip and pinch strength between the two treatments. These results suggest that compared with the mini-open release, the endoscopic release contributes to shorter hospitalization time and postoperative recovery time, better symptom relief and lower risk of complications. But large-sample and high-quality randomized controlled trials are needed to provide more reliable evidence for these findings. 中国组织工程研究杂志出版内容重点：组织构建;骨细胞;软骨细胞;细胞培养;成纤维细胞;血管内皮细胞;骨质疏松;组织工程     

应用新型Peek Prevail椎间融合内固定系统治疗颈椎病的近期疗效观察

目的 :探讨颈椎前路椎间盘切除减压椎间融合内固定术中应用新型Peek Prevail椎间融合内固定系统治疗颈椎病的近期疗效。方法:2014年7月~2014年9月应用Peek Prevail椎间融合内固定系统行颈椎前路椎间盘切除减压椎间融合内固定术治疗颈椎病患者32例,均为单节段融合,其中脊髓型14例,神经根型11例,混合型7例;男18例,女14例;平均年龄55.3±3.4岁(34~64岁)。采用Bazaz吞咽困难评价标准、Park邻近节段骨化分级标准分别评估术后吞咽困难和邻近节段骨化发生情况;采用疼痛视觉模拟评分(VAS)、日本骨科学会评分(JOA)、颈椎残障指数评分(NDI)对患者术前术后脊髓神经功能、生活质量进行评估;术后定期行颈椎X线、CT、MRI检查观察颈椎曲度、内固定状态、植骨融合等情况。结果:全部患者获得随访,随访时间6~7个月,平均6.5±0.7个月。手术时间平均59.0±10.5min,术中出血量平均37.6±18.4ml。1例患者(3.1%)术后6h出现脊髓缺血再灌注损伤表现;3例患者(9.4%)术后36h逐渐出现不同程度吞咽困难,2例轻度,1例中度;均经对症处理后症状消失或明显改善。所有患者术后神经功能及临床症状均得到改善,VAS评分术前为7.5±1.7分,术后6个月时改善为2.5±1.2分(P0.05);NDI评分术前为43.3±3.6分,术后6个月时改善为10.7±2.9分(P0.05);JOA评分术前为9.43±2.55分,术后6个月时改善为16.07±1.02分(P0.05);颈椎曲度术前为-14.30°±1.9°,术后6个月时改善为17.12°±1.4°(P0.05)。随访期间未见植骨不融合、融合器下沉、邻近节段骨化及内固定松动等并发症。结论:颈前路椎间盘切除减压植骨融合内固定术中应用Peek Prevail椎间融合内固定系统治疗颈椎病具有操作简单、出血少、手术时间短、并发症少、吞咽困难发生率低的优点,近期临床疗效满意。     

西藏阿里地区97例膝骨关节炎患者发病形式及临床特点调查

目的调查西藏阿里地区高寒游牧民族膝骨关节炎患者的发病形式及临床特点。方法对西藏阿里地区膝骨关节炎患者进行现场调查,记录患者性别、年龄、身高、体质量及关节症状等资料,进行血沉、膝关节正侧位片检查。结果本组共纳入97例患者,男女比例为1∶1. 55,女性平均发病年龄为(46. 3±13. 4)岁,高峰在40～49岁,男性发病年龄为(51. 3±12. 8)岁,高峰在50～59岁;男、女患者中,体质量指数(BMI) 24～28 kg/m~2者占比分别为10. 5%、6. 8%;关节症状中,关节肿胀13例,关节压痛72例,关节活动受限61例;膝关节X线片以Ⅲ～Ⅳ级改变为主,占56. 7%;内侧胫股关节异常发生率为64. 9%,外侧胫股关节异常发生率为3. 1%,髌股关节异常发生率为4. 1%;因本病而停止家务劳动及放牧者占4. 1%,明显减轻工作量者占9. 3%,劳动量持续减少一半以上者占7. 2%。结论西藏阿里地区康乐小区的膝骨关节炎患者中,女性多于男性,且女性发病年龄显著早于男性,BMI对膝骨关节炎患病率无明显影响,膝关节X线片显示膝关节内侧胫股关节异常的发生率显著高于外侧胫股关节及髌股关节,疾病对部分患者的生活造成明显影响,降低了患者的生活质量。     

脊柱化脓性感染的诊断和治疗进展

<正>脊柱化脓性感染是指包括椎间盘炎、椎体骨髓炎、脊柱硬膜外脓肿等在内的一组疾病。如果处理不当常造成神经损伤、败血症等问题,严重时可危及生命。充分认知、尽早干预脊柱化脓性感染显得尤为重要。随着科学技术的发展,对脊柱感染的相关研究也逐渐增多,其中不乏一些新技术、新观念。笔者就脊柱化脓性感染的诊断与治疗进展简要阐述,以期能够为临床决策提供参考。     

新型复合壳聚糖季铵盐纳米粒子抗感染骨水泥的生物学特性

BACKGROUND: Postoperative infection in patients underlying total knee arthroplasty is a long-standing puzzle. Current bone cement with antibiotics cannot effectively treat kidney function deficiency and bacterial resistance. OBJECTIVE: To develop a novel kind of bone cement prepared by quaternary ammonium salt chitosan nanoparticles. METHODS: There were three groups including QCSNP-15, Palacos R and Palacos R+G groups. Morphology of the bone cement in each group was observed using scanning electron microscope, the setting time of bone cement was measured, and the in vitro compression strength, cytotoxicity and antibacterial activity tests were performed. RESULTS AND CONCLUSION: Scanning electron microscope observed that QCSNP-15 was made of quaternary ammonium salt chitosan nanoparticles and methyl methacrylate copolymer, and these nanoparticles distributed onto the material surface. The setting time of QCSNP-15 was longer than that of the Palacos R+G bone cement. The compressive strength of QCSNP-15 was significantly lower than that of the Palacos R bone cement (P < 0.05), but was larger than 70 MPa stipulated by ISO 5833. Osteoblasts MC3T3-E1adhered well on the QCSNP-15, and pseudopodia fully expanded. Similar findings were observed on the Palacos R+G bone cement. The attachment rate of osteoblasts of the QCSNP-15 at 3 hours was significantly lower than that of the Palacos R+G bone cement (P < 0.05). The antibacterial activity did not significantly differ between QCSNP-15 and Palacos R+G bone cements, even after 2-week immersion in the PBS. These findings suggest that QCSNP-15 exhibits appropriate setting time, good biomechanical property and antibacterial activity in vitro with no obvious cytotoxicity.     

中药导入牵引治疗颈椎病148例疗效观察

颈椎病是中老年的常见病、多发病。但最近几年来,门诊治疗的中青年患者有增加的倾向,这可能和目前人们生活节奏加快、伏案工作增加和长期处于某种工作姿势时间过长有密切关系。目前临床治疗中还没有特别满意的治疗方法。我科近几年来采用自制中药液,配合四头带牵引治疗颈椎病收到了满意效果,现就１４８例临床病人报告如下： １．临床资料 １４８例患者均经骨科及理疗科门诊检查、Ｘ线确诊。其中男８８例．女６０例;年龄＜４５岁３１例,为女性患者偏于中青年：≥４５岁－５０岁７２例,５０－６ｏ岁２８例．≥６０岁１７例;病程＜１年…     

一期前后路手术入路治疗斜坡齿状突型颅底陷入症

[目的]探讨一期前后路手术入路治疗斜坡齿状突型颅底陷入症的方法。[方法]对26例斜坡齿状突型颅底陷入症患者，进行了一期前后路手术，手术时间平均4．3h。出血量平均650ml。并随访6个月～5年。[结果]本组病例总有效率达90．6％，显效率为62．5％。术后无一例患者出现伤口感染及脑脊液漏，枕颈融合良好，无假关节形成。[结论]一期前后路手术入路治疗斜坡齿状突型颅底陷入症，可以在前路减压后即刻后路获得颅颈部的稳定性，避免延颈髓的继发性损伤，可明显缩短患者的住院时间，节省患者的费用。     

醒脑静注射液对急性脑梗死患者血清Copeptin、NT-proBNP水平及NIHSS评分的影响

目的：探讨醒脑静注射液对急性脑梗死患者神经功能的保护机制。方法选取112例急性脑梗死患者作为研究对象,患者随机分为观察组和对照组,每组56,对照组给予常规对症治疗,观察组则在常规对症治疗的基础上加用醒脑静注射液,观察比较2组患者治疗前、治疗后7、14 d的血清和肽素（ Copeptin ）、N端前脑钠肽（ NT-proB-NP）水平及美国国立卫生研究院卒中量表（ NIHSS）评分。结果治疗前,2组Copeptin、NT-proBNP水平及NIHSS评分比较,差异无统计学意义（ P ＞0剟．05）;治疗后7 d和14 d,观察组的Copeptin、NT-proBNP水平及NIHSS评分均明显低于对照组,差异有统计学意义（ P ＜0．05）。结论醒脑静注射液能够有效的降低急性脑梗死患者的血清Copeptin、NT-proBNP水平及NIHSS评分,保护患者的神经功能。     

拇指V°缺损再造的护理

总结了18例拇指V°缺损患者行游离足趾再造的术前及术后护理,包括:术前重视患者心理辅导,术后密切观察再造指血运,注意观察引起血管痉挛的因素并及时解决,预防发生血管危险,保证再造指的存活.同时,术后早期进行功能锻炼以促进再造指的功能锻炼功能恢复.认为经过护理后患者生活质量可显著提高,取得满意的效果.