胶质细胞源性神经营养因子缓释微球及NogoA,ChABC缓释微球联合应用损伤脊髓再生的形态学变化

背景:促进轴突再生的原则是改善抑制再生的环境和提高轴突生长能力,措施主要有轴突生长抑制因子阻滞剂和神经营养因子应用。用可降解微球加载药物是一种在局部提供持续药物释放的方法。目的:探讨胶质细胞源性神经营养因子、NogoA、ChABC缓释微球联合应用促进大鼠损伤脊髓再生病理形态学修复的作用。方法:建立SD大鼠T10脊髓完全横断伤模型,分别在损伤局部给予生理盐水、胶质细胞源性神经营养因子、胶质细胞源性神经营养因子缓释微球、NogoA缓释微球、ChABC缓释微球及3种微球联合治疗,并设立未造模的正常组及假手术组。损伤后10周,每组行四甲基若丹明葡聚糖胺顺行示踪,及神经丝蛋白200、生长相关蛋白43、胶质细胞源性神经营养因子免疫组化检查,并采用免疫组化图像分析系统进行定量分析。结果与结论:胶质细胞源性神经营养因子、NogoA、ChABC缓释微球联合能提高脊髓损伤局部神经丝蛋白200、生长相关蛋白43、胶质纤维酸性蛋白的表达水平,显示局部脊髓再生修复加强,其效果优于单用胶质细胞源性神经营养因子缓释微球。提示,胶质细胞源性神经营养因子缓释微球及NogoA,ChABC缓释微球联合促大鼠损伤脊髓再生修复其效果优于单用胶质细胞源性神经营养因子缓释微球。     

Coflex棘突间动力重建系统治疗腰椎退变性疾病18例

背景:近年来脊柱非融合技术一直是脊柱外科研究与争论的热点。Coflex棘突间动力重建系统作为腰椎后路非融合器材,国外虽已应用较长时间,但国内尚处于试用阶段。目的:探讨Coflex棘突间动力重建系统治疗腰椎退变性疾病的适应证,并对其早期临床疗效进行评价。方法:2008-10/2010-06使用Coflex棘突间动力重建系统治疗腰椎退变性疾病31例,对其中随访超过1年的18例患者临床资料进行分析总结。治疗方式均为后路髓核摘除,椎管减压、Coflex棘突间动力重建系统置入;1例患者术中置入2枚Coflex。治疗前及各次随访时均对患者进行日本骨科学会下腰痛功能量表、中文版Oswestry功能障碍指数量表及目测类比评分法评估,并测量治疗前后、各次随访时腰椎前屈后伸位置入节段及其上下节段活动范围、Colfex上下极板夹角及置入节段椎间隙高度。结果与结论:患者均获随访,随访时间12～20个月。末次随访时患者日本骨科学会下腰痛功能量表评分、中文版Oswestry功能障碍指数量表评分及目测类比评分均获显著改善;治疗前后置入节段椎间高度及其上下节段椎间活动度差异均无显著性意义(P>0.05),末次随访时Coflex上下极板夹角在过伸位较中立位显著增大(P<0.05)。提示Coflex棘突间动力重建系统对腰椎间盘突出症、椎管狭窄及腰椎不稳等腰椎退变性疾病安全有效,在腰椎后伸时能够有效分担载荷,同时对腰椎生理活动影响较小,有利于维护腰椎功能,早期临床疗效肯定。     

微创克氏针置入并外固定架修复桡骨远端不稳定骨骺骨折

背景:单纯使用克氏针或外固定架治疗桡骨远端骨骺骨折的临床实践中,仍存在桡骨短缩、骨折移位等固定后并发症,尤其在不稳定骨骺骨折情况下.克氏针主要治疗桡骨远端骨折,对其骨骺骨折使用相对较少.目的:观察外固定支架结合经皮克氏针复位固定微创治疗桡骨远端不稳定性骨骺骨折的临床效果.方法:对90例桡骨远端骨骺骨折患儿行固定治疗,在不切开情况下微创闭合复位骨折骨骺,随机分成2组,对照组采用单纯跨腕关节外固定支架固定方案;观察组采用跨腕关节外固定支架结合经皮克氏针闭合帮助复位固定骨骺骨折方案.固定后行腕关节功能锻炼,分别于固定后9周及24个月随访观察.对比两组患者固定后中远期的临床疗效、腕关节功能恢复及X射线检查情况.结果与结论:固定后24个月随访按Cooney标准评定腕关节功能,对照组优良率77%,X射线评定优良率63%;观察组腕关节功能优良率93%,X射线评定优良率为90%,两组差异具有显著性意义(P < 0.01).两组骨骺骨折患者均获临床骨愈合,腕关节均功能恢复.提示外固定支架结合克氏针闭合复位微创治疗桡骨远端不稳定骨骺骨折,可应用克氏针辅助复位掌倾角及尺偏角,治疗简单,固定可靠,腕关节功能恢复良好,骨骺畸形愈合并发症少,固定后基本生活学习功能恢复正常,疗效稳定满意,其临床疗效明显优于单纯跨外固定支架固定.     

汶川大地震骨折伤员日常生活活动能力受限的临床研究

目的：研究四川汶川大地震骨折伤员的日常生活活动（ADL）能力受限的特点,为地震骨折伤员的康复治疗提供依据。方法：对因2008年5月12日四川汶川地震后1月仍在华西医院骨科病房诊治的36例骨折伤员,进行生活状况问卷,记录其早期并发症,根据Barthel指数评定不同性别和不同部位骨折伤员各项ADL能力,统计伤员各项ADI。等级构成比,比较不同性别和不同部位骨折伤员总ADL评分。结果：本次地震骨折伤员以下肢骨折多见,其次是躯干骨折（主要是脊柱骨折）,上肢骨折相对少见;且ADL下降明显,尤其是躯干骨折和下肢骨折伤员;而早期并发症以伤口感染为主。结论：地震骨折伤员ADL明显下降,加强ADL能力训练尤其重要,临床康复措施主要集中于下肢和脊柱骨折的康复;早期并发症的防治主要是预防伤口感染。     

Is the EQ-5D-5L a responsive test to evaluate results in elective foot and ankle surgery?

PurposeTo analyze the responsiveness and the minimally clinical important change (MCIC) of the EuroQol (EQ) 5D-5 L score in patients that had undergone foot/ankle surgery.MethodsPatients that underwent elective foot/ankle surgery from January 2019 to December 2020 were included. They were assessed with the EQ-5D-5L, visual analogue pain scale and Manchester Oxford Foot Questionnaire (MOXFQ) preoperatively and 1 year postoperatively. The pre-post differences of all variables, Effect Size (ES) and MCIC were analyzed.Results167 patients. All variables showed a significant pre-post improvement. The ES for EQ-index and EQ-VAS were 0.61 and 0.33 respectively. MCIC for EQ-index was 0.17 and EQ-VAS was 8.54. MOXFQ index ES was 1.46 and the MCIC was 23.8. VAS decreased from 59.4 to 26.62.ConclusionThe EQ-5D-5L is a sensitive test to detect changes after elective foot and ankle surgery with good responsiveness relative to the ES values in the EQ-index.Level of evidenceII     

Hemiepiphysiodesis for juvenile hallux valgus deformity: A systematic review

BackgroundAmong the numerous surgical interventions for correcting hallux valgus deformity in skeletally immature patients, hemiepiphysiodesis is a simple technique with a low complication rate yet its effectiveness remains unclear. This systematic review evaluates hemiepiphysiodesis of the first metatarsal for treating juvenile hallux valgus (JHV) deformities with respect to radiological outcomes, postoperative clinical outcomes, and postoperative complications.MethodsEMBASE, MEDLINE, PubMed, Cochrane Central Register of Controlled Trials (CENTRAL), and Cumulative Index to Nursing and Allied Health Literature (CINAHL) database were searched from inception to September 15th, 2022, for studies investigating hemiepephysiodesis for JHV and its effect on clinical and radiological outcomes. The search, data extraction and methodologic assessment were performed in duplicate for all included studies.ResultsSix studies out of 488 with a total of 147 feet in 85 patients were included in the final qualitative synthesis. The American Orthopaedic Foot & Ankle Society hallux metatarsophalangeal interphalangeal scale (AOFAS Hallux MTP-IP scale) was used in two studies. The mean pooled preoperative score was 62.2 ± 8.9 and improved to 88.6 ± 4.8 postoperatively in 33 patients. All six studies reported significant improvement in the hallux valgus angle (HVA) from mean preoperative angle of 29.2° ± 3.7–23.8° ± 4.5° postoperatively, while the intermetatarsal angle (IMA) preoperative and postoperative means corrected from 13.9° ± 1.1–11.4° ± 1.2°, respectively. Out of 147 feet, 21 (14.2%) had reported complications including recurrence and need for revision surgery.ConclusionThis systematic review confirms that hemiepiphysiodesis of the first metatarsal in patients with JHV has improved clinical and radiological outcomes.Level of evidenceLevel IV, Systematic review     

COVID-19疫情下普通患者脊柱外科手术的围手术期管理专家共识

新型冠状病毒(SARS-CoV-2)感染引起的2019冠状病毒病(COVID-19)目前呈世界大流行趋势,中国的疫情已经得到控制,现阶段的主要任务是防止外源性输入病例及无症状感染者导致的二次爆发[1-2].