半侧椎板截取回植在单侧腰椎间盘突出症治疗中的疗效评价

目的评价半侧椎板截取回植在治疗单侧腰椎间盘突出症中的临床疗效。方法对61例单侧腰椎间盘突出症的患者行半侧椎板截取髓核摘除再回植"工"型钛板固定术,统计术前、术后ODI、JOA、VAS评分、并发症发生率、影像学回植椎板愈合率及腰腿痛复发率。结果 60例获1年或以上随访,随访率98.36%,术中神经及硬膜囊损伤率(1.67%、3.28%);腰痛复发率5.00%,腿痛复发率1.67%。术后2周、3、6、12个月的ODI、JOA、VAS评分显著优于术前(P<0.05)。回植截骨部CT均显示骨性愈合,未见钛板螺钉的松动及断裂。结论采用半侧椎板截取回植固定术治疗单侧腰椎间盘突出症具有较低的术中神经硬膜囊损伤率及腰腿痛复发率、较高的椎板愈合率和较好的临床评分,是一种安全、有效的新方法。     

大鼠丘脑中央下核GABA纤维终末与腹外侧眶皮质投射神经元的突触联系

目的:观察大鼠丘脑中央下核(Sm)GABA纤维终末与腹外侧眶皮质(VLO)投射神经元的突触联系。方法:18只大鼠麻醉后固定于脑立体定位仪上,于VLO微量注射辣根过氧化物酶(HRP),48h后,应用包埋前HRP组化和GABA免疫组化双重标记电镜技术观察大鼠SmGABA纤维终末与VLO投射神经元的突触联系。结果:光镜下Sm内有大量GABA纤维终末及少数阳性神经元,电镜下可见GABA纤维终末与HRP标记的阳性神经元胞体及树突间构建了对称性和(或)非对称性突触。结论:形态学上证实了Sm内GABA纤维终末与VLO投射神经元胞体及树突发生突触联系。     

人工全髋关节置换术在强直性脊柱炎中的应用

目的探讨强直性脊柱炎全髋置换术的手术特点,评价其术后疗效。方法 14例强直性脊柱炎患者行人工全髋置换术,其中全髋单髋置换4例,全髋双髋置换10例。结果随访时间2～10年,平均5.25年。Harris评分由术前的平均26.33分（12～46分）提高到随访时的平均82.96分（74～96分）,髋关节术前总活动度由术前的100.04°（0°～172°）改善为术后的185.38°（186°～247°）。14例术后均可生活自理。结论全髋置换术治疗强直性脊柱炎可获得满意疗效,选择合理的手术策略及合适的假体对手术效果尤为关键。     

颈椎终板软骨细胞凋亡的检测及相关意义

目的检测颈椎终板软骨细胞的细胞凋亡指数,探讨其在椎间盘退变中可能的作用机制。方法颈椎间盘终板及髓核取自我院行颈椎前路手术的35例颈椎椎间盘退变患者（退变组）和19例颈椎外伤患者（外伤组）。光镜观察退变组和外伤组终板和髓核的细胞密度,TUNEL法检测两组终板软骨细胞和髓核细胞的细胞凋亡指数,咔唑分光光度法比较两组髓核蛋白多糖含量。结果退变组终板细胞密度较外伤组减少（P〈0.05）,TUNEL染色显示退变组终板细胞凋亡指数为（34.6±16.1）%,外伤组为（20.1±9.3）%,两组间比较差异有统计学意义（P〈0.05）。Pearson相关分析显示,颈椎终板TUNEL染色阳性细胞率与终板细胞密度、髓核蛋白多糖含量之间呈负相关（r=—0.805,P=0.001;r=—0.677,P=0.023）,与髓核TUNEL阳性细胞率之间呈正相关（r=0.758,P=0.003）。结论颈椎退变终板软骨细胞凋亡率较高,推测在椎间盘退变过程中可能发挥重要作用;软骨细胞凋亡可能与髓核细胞凋亡增加、终板细胞密度与髓核蛋白多糖含量降低密切相关。     

Type II collagen fragment HELIX-II is a marker for early cartilage lesions but does not predict the progression of cartilage destruction in human knee joint synovial fluid

To determine whether there is a direct correlation between the concentration of type II collagen fragment HELIX-II in synovial fluid and the severity of cartilage damage at the knee joint, 83 patients who had undergone knee arthroscopy or total knee replacement were enrolled in this study (49% women, mean ± SD age 49.5 ± 19). The content of HELIX-II in the synovial fluid samples was measured by enzyme-linked immunosorbent assay (ELISA). Cartilage damage at the knee joint was classified during arthroscopy or direct surgical observation, using the Outerbridge cartilage damage scoring system. The maximum damage score was defined as the highest score among the six areas of the knee joint, and the cumulative score was defined as the sum of the scores of the six areas of the knee joint. The intra-assay and inter-assay variations of the HELIX-II ELISA were lower than 13 and 15%, respectively. The level of HELIX-II in the severely damaged cartilage groups (cumulative scores = 11–24 or maximum score = 2–4) was much higher than in the slightly damaged cartilage groups (cumulative scores = 0–10 or maximum score = 0–1). The level of HELIX-II in cartilage from severely damaged cartilage groups was significantly higher than in the slightly damaged groups, but no significant difference was detected in the level of HELIX-II among the severely damaged cartilage sub-groups. There was a significant correlation between the HELIX-II concentration in the synovial fluid and the cumulative (r = 0.807) and maximum scores (r = 0.794). Thus, elevated HELIX-II level is correlated with early cartilage lesions, but does not have the sensitivity to predict the progression of severity of cartilage damage in the knee joint.     

应力性骨折武警新兵患者血清CGRP及SP水平变化及其临床意义

[目的]探讨应力性骨折(stress fracture,SF)新兵患者血清中降钙素基因相关肽(calcitonin gene-re-lated peptide,CGRP)及P物质(substance P,SP)水平及其临床意义。[方法]采用1:1配比的病例对照研究,选取武警新兵应力性骨折病例及正常对照各40例,采用ELISA法检测血清中CGRP及SP水平。[结果]应力性骨折新兵患者在入院时、入院后24h及72h血清中CGRP及SP水平明显升高,与正常对照组相比有统计学差异(P<0.01)。[结论]应力性骨折患者体内CGRP及SP水平升高,CGRP与SP可能参与了应力性骨折的发病过程。     

Clinical assessment of a CMC/PEO gel to inhibit postoperative epidural adhesion formation after lumbar discectomy: a randomized, control study

Purpose

To evaluate effectiveness of carboxymethylcellulose/polyethylene oxide (CMC/PEO) gel in improving clinical outcomes after the first-time lumbar discectomy.

Method

Ninety-three patients with herniated lumbar disc at L4–L5 or L5–S1 were enrolled and randomized into two groups: CMC/PEO gel treatment group and control group. All the patients underwent laminotomy and discectomy by posterior approach. The preoperative and postoperative Oswestry Disability Index (ODI) and Visual Analogue Scale (VAS) scores for lower-back pain and leg pain were analyzed and compared between two groups at 30- and 60-day time points.

Results

No patient presented with any clinically measurable adverse event during surgery. There were no significant differences between the treated group and the control group on the preoperative ODI and VAS scores. In general, the ODI and VAS scores decreased in both groups at all the time points. At the 30-day time point, the VAS scores for back pain and leg pain and the ODI scores in treatment group were lower by 9.9 % (P = 0.0302), 27.0 % (P = 0.0002) and 16.3 % (P = 0.0007) than those in control group. And at the 60-day time point, the ODI and VAS scores further decreased in both groups. The VAS scores for leg pain in treatment group were lower by 4.5 % than that in the control group (P = 0.0149). However, no significant difference was detected between two groups on the ODI and VAS scores for back pain.

Conclusions

The results demonstrated that CMC/PEO gel is effective in reducing posterior dural adhesions in the spine with no apparent safety issues. It can improve patients’ postoperative clinical outcome.     

Nutrition and degeneration of articular cartilage

Purpose

To determine the importance of synovial fluid (SF) or subchondral bone marrow (BM) as nutrition sources in cartilage degeneration.

Methods

Ninety-five-month-old male rabbits were randomly divided into 5 groups according to sources of nutrition: SFBM-both; BM-only; SF-only; None-SFBM; and Free plug (unrestricted). Nutrition to 4-mm-diameter cylindrical osteochondral plugs created on the trochlea of the distal femurs was obstructed by Polyvinyl Chloride (PVC) cap. Cartilage changes were assessed after 4, 8, and 12 weeks by histology, immunohistochemistry, and real-time PCR.

Results

Cartilage in the BM-only group suffered the greatest damage, followed by the None-SFBM and SF-only groups. Apoptosis was increased in the BM-only and None-SFBM groups compared with others. Cartilage was significantly thinner at all time points in the BM-only and None-SFBM groups when compared with SFBM-both and Free plug, whereas in the SF-only group, this difference occurred after 8 weeks. Compared with SFBM-both and Free plug, expression of collagen II and aggrecan mRNAs in all groups was decreased but MMP-3 increased, respectively.

Conclusion

Our data indicate that SF-derived nutrition is the dominant source of sustenance for adult cartilage structure and function. Cartilage damage is observed when the only nutrition source is the BM.     

关节镜下盂肱关节前方松解对原发性冻结肩的早期疗效

目的观察应用关节镜进行关节囊前方松解术对原发性冻结肩的治疗效果。 方法2015年3月至2017年3月陕西省人民医院收治的60例原发性冻结肩患者,所有患者经术前MRI检查或术中探查确诊,排除由其余肩部疾病(骨折、肩峰撞击、肩袖损伤、钙化性肌腱炎)引起的继发性冻结肩,所有患者应用关节镜行盂肱关节前方松解术。采集术前及术后的疼痛视觉评分(VAS)、Constant评分、复旦大学肩关节功能评分系统(FUSS),应用单因素重复测量方差分析对结果进行统计学分析评估,对肩关节各方向的被动活动度应用配对t检验方法进行统计学分析。 结果所有患者术后均未出现腋神经损伤或肩关节不稳等并发症。与术前相比,术后12周时患者的VAS评分[(0.7±0.6)vs (8.1±0.7),F ＝38.01]、Constant评分[(93.9±3.0)vs (34.2±3.4),F ＝121.42]及FUSS评分[(93.8±1.3)vs (40.1±2.2),F ＝220.09]差异有统计学意义(均为P <0.01);同时,与术前相比,患肩被动外展[(152±13)° vs (74±9)°,t ＝37.678]、前屈[(156±12)° vs (60±10)°,t ＝46.469]、体侧外旋[(66±11)° vs (8±3)°,t ＝37.762]及内旋在术后12周时明显改善(均为P <0.01)。 结论应用关节镜对盂肱关节囊前方结构进行彻底松解,可有效改善原发性冻结肩患者肩关节功能。     

骨水泥封堵股骨髓腔对全膝关节置换术围手术期失血量的影响

目的探讨骨水泥封堵股骨髓腔对全膝关节置换术(TKA)围手术期失血量的影响。 方法回顾性分析陕西省人民医院2014年1月至2016年12月因骨关节炎行单侧初次TKA的患者173例,具有完整的影像学资料、血液学检验报告且伴发疾病不影响凝血或血流动力学的患者共116例,其中男53例,女63例,年龄平均(64±5)岁。65例患者使用自体截骨块制成的塞子填塞股骨髓腔口(A组),51例患者在使用自体骨塞的基础上采用面团期骨水泥封堵残存的股骨髓腔裂隙(B组)。采用卡方检验比较两组患者的性别、麻醉方式、异体输血率及深静脉血栓(DVT)发生率,采用独立样本t检验比较两组患者的年龄、身体质量指数(BMI)、手术时间、术中出血量、截骨厚度、术后引流量及围手术期显性出血量及隐性出血量。 结果所有患者均顺利完成手术,两组患者在性别(χ²＝0.161,P >0.05)、年龄(t＝－8.38,P >0.05)、BMI(t＝1.837, P >0.05)、麻醉方式(χ²＝0.91,P >0.05)、手术时间(t＝1.714,P >0.05)及截骨厚度(t＝0.448,P >0.05)方面差异无统计学意义。A组的显性出血量为(237.7±58.7)ml,B组的显性出血量为(225.5±68.1)ml,2组之间差异无统计学意义(P >0.05);A组的隐性出血量为(624.6±77.1)ml,B组的隐性出血量为(543.1±63.3 )ml, A组的隐性出血量明显高于B组(t ＝6.104,P <0.05)。A组的异体输血率为35%,B组的异体输血率为21%,经比较二者之间差异有统计学意义(χ²＝4.861,P <0.05)。A组和B组下肢DVT的发生率分别为6.1%与3.9%,差异无统计学意义(P >0.05)。 结论使用骨水泥封堵股骨髓腔可有效减少TKA围手术期隐性失血量。