术中头部体位对强直性脊柱炎胸腰椎后凸畸形患者后路截骨矫形时唤醒试验的影响

【摘要】 目的：探讨术中头部体位对强直性脊柱炎（ankylosing spondylitis,AS）胸腰椎后凸畸形患者经椎弓根椎体截骨（pedicle subtraction osteotomy,PSO）时唤醒时间及苏醒质量的影响。方法：选取2005年5月~2012年11月在我院行PSO的35例AS胸腰椎后凸畸形患者,分为头部抬高体位组（抬高组）和头部未抬高体位组（未抬高组）。两组患者麻醉方式、麻醉诱导用药和维持用药均相同,同时用脑电双频指数（bispectral index,BIS）监测麻醉深度使其保持一致,比较抬高组和未抬高组患者PSO术中唤醒时间及苏醒质量（采用Imani等分级标准分级）。结果：所有患者术中唤醒试验均成功。抬高组患者的术中唤醒时间为24.9±5.13min,未抬高组为39.8±9.41min,两组差异有显著性（P<0.05）。唤醒试验中,抬高组1例、未抬高组5例患者突然睁眼,并伴有四肢不自主活动,苏醒质量为2级,其余29例患者苏醒质量均为1级。抬高组患者术后颜面部及球结膜水肿的外观表现均较未抬高组轻。结论：AS胸腰椎后凸畸形患者PSO术中头部抬高体位可以缩短术中唤醒时间、提高患者的苏醒质量。     

Fractures of the Cervical Spine in Patients with Ankylosing Spondylitis

Fractures of the cervical spine in six patients suffering from ankylosing spondylitis are presented. Three patients had a hyperextension type of injury. These fractures were extremely unstable and combined with spinal cord damage. in the other cases the fracture was caused by a flexion mechanism. These fractures were stable and there was no damage to the spinal cord. Treatment modified according to the demands of the fractures is outlined.     

The effect of flurbiprofen and tiaprofenic acid on serum cytokine levels of patients with osteoarthrosis

39 patients with active knee osteoarthrosis, chosen according to ACR criteria, were assigned to receive flurbiprofen (n 12, 2 &#50 100 mg), tiaprofenic acid (n 14, 2 &#50 300 mg) and placebo (n 13) in a 3-week, placebo-controlled study. All patients completed the study, and both medications were found to be effective: improvement occurred in the clinical signs. These drugs reduced the TNF- &#102 levels. Flurbiprofen especially affected the IL-6 levels. Our findings indicate that NSAIDs may be effective in the etiopathogenesis of osteoarthrosis.     

丹鹿通督片联合柳氮磺吡啶治疗强直性脊柱炎的临床研究

目的探讨丹鹿通督片联合柳氮磺吡啶治疗强直性脊柱炎的临床疗效。方法选取2015年7月—2016年9在河南省直第三人民医院接受治疗的强直性脊柱炎患者90例,随机分为对照组(45例)和治疗组(45例)。对照组患者口服柳氮磺吡啶肠溶片,第1周2片/次,第2周3片/次,第3周及以后4片/次,均为2次/d。治疗组在对照组的基础上口服丹鹿通督片,4片/次,3次/d。两组患者均连续治疗2个月。评价两组患者临床疗效,同时比较两组患者治疗前后BASDAI、BASFI和临床症状评分以及血清C反应蛋白(CRP)、白介素-1β(IL-1β)、IL-4、IL-10和IL-17等血清学指标变化。结果治疗后,对照组和治疗组总有效率分别为77.78%、95.56%,两组总有效率比较差异有统计学意义(P0.05)。治疗后,两组BASDAI、BASFI评分均明显下降(P0.05);且治疗组这些指标降低水平优于对照组(P0.05)。治疗后,两组下腰背疼痛、外周关节疼痛、外周关节肿胀等症状评分均显著降低(P0.05);且治疗组上述临床症状评分降低更显著(P0.05)。治疗后,两组CRP、IL-1β、IL-17均显著降低,而IL-4、IL-10均显著升高,同组治疗前后比较差异有统计学意义(P0.05);且治疗组上述血清学指标改善程度优于对照组,两组比较差异具有统计学意义(P0.05)。结论丹鹿通督片联合柳氮磺吡啶治疗强直性脊柱炎的临床效果显著,有利于临床症状的改善及降低机体炎症反应,具有一定的临床推广应用价值。     

强直性脊柱炎患者Th17/Treg相关细胞因子及 miR-155与脊柱活动度的关系

探讨强直性脊柱炎患者辅助性T细胞17（Th17）/调节性T细胞（Treg）相关细胞因子、微小核糖核酸-155（miR-155）与脊柱活动度的关系。方法 回顾性分析2018年1月～2021年3月 我院收治的强直性脊柱炎患者116例为观察组,根据强直性脊柱炎疾病活动指数（BASDAI）分为活动期（BASDAI≥4,n=52）、稳定期（BASDAI＜4,n=64）;另选取同期于我院进行健康体检的健康志愿者97例为对照组。对比各组Th17/Treg相关细胞因子、miR-155表达水平;对比活动期和稳定期的脊柱活动度Bath AS测量指数（BASMI）,分析强直性脊柱炎患者Th17/Treg相关细胞因子、miR-155与脊柱活动度的相关性。结果 观察组IL-17、IL-23、miR-155表达水平明显高于对照组（P＜0.05）。活动期IL-17、IL-23、miR-155表达水平明显高于稳定期（P＜0.05）。活动期强直性脊柱炎患者BASMI评分明显高于稳定期（P＜0.05）。经 Pearson相关系数分析显示,强直性脊柱炎患者IL-17、IL-23、miR-155表达水平与BASMI评分呈正相关,IL-10、TGF-β表达水平与BASMI评分呈负相关（P＜0.05）。结论 强直性脊柱炎患者高表达miR-155、Th17相关细胞因子、低表达Treg相关细胞因子,Th17/Treg呈失衡状态,且Th17/Treg相关细胞因子、miR-155与强直性脊柱炎患者脊柱活动度具有一定的相关性,可作为临床评估病情的辅助检查。     

针灸治疗强直性脊柱炎

强直性脊柱炎(ankylosing spondylitis,AS)是一种全身性的炎症疾病,目前医学界尚未完全了解其病因及病理。患者通常产生全身性的关节发炎,由骶髂关节上行至腰椎、胸椎、颈椎等中轴关节;下行至髋、膝、踝关节等,并常波及到眼、耳、肺、心脏、前列腺等。早期极易误诊为坐骨神经痛     

加味安肾汤治疗早中期强直性脊柱炎肾虚督寒证的疗效及对患者血清炎性因子、免疫功能、骨代谢指标的影响

目的 观察加味安肾汤治疗早中期强直性脊柱炎肾虚督寒证的临床疗效及对患者血清炎性因子、免疫功能、骨代谢指标的影响。方法 120例患者随机分为对照组和观察组,各60例。在甲氨蝶呤治疗基础上,对照组口服补肾舒脊颗粒,观察组口服加味安肾汤,疗程均为8周。观察治疗前后两组临床症状 ［综合指数积分（BAS-G）,巴氏强直性脊柱炎活动指数（BASDAI）,加拿大脊柱骨关节研究协会制定的影像学指数（SPARCC）,中医证状积分］,血清炎性因子［肿瘤坏死因子-α（TNF-α）,巨噬细胞移动抑制因子（MIF）,白细胞介素-23（IL-23）］,免疫功能［免疫球蛋白A（IgA）,免疫球蛋白G（IgG）,免疫球蛋白M（IgM）］,骨代谢指标［骨钙素（BGP）,骨形态发生蛋白-2（BMP-2）,骨特异性碱性磷酸酶（BALP）］水平变化情况。观察两组临床疗效、不良反应及随访12个月复发率。结果 研究期间对照组脱落4例,观察组脱落2例。观察组总有效率96.55%（56/58）,明显高于对照组的80.36%（45/56）（χ²=4.827,P<0.05）;观察组随访12个月复发率5.17%（3/58）,明显低于对照组的19.64%（11/56）（χ²=5.187,P<0.05）。与对照组治疗后比较,观察组BAS-G,BASDAI,SPARCC,中医证状积分,TNF-α,MIF,IL-23水平明显降低（P<0.05）,BGP,BMP-2,BALP,IgA,IgG,IgM水平明显升高（P<0.05）。观察组在研究期间不良反应发生率12.07%（7/58）,明显低于对照组的32.14%（18/56）（χ²=4.826,P<0.05）。结论 加味安肾汤可明显改善早中期强直性脊柱炎肾虚督寒证患者的临床症状、血清炎性因子、免疫功能、骨代谢指标,不良反应发生率低。     

TNF-α-850位点基因多态性与强直性脊柱炎易感性的Meta分析

目的 综合分析肿瘤坏死因子（TNF）-α-850位点基因多态性与强直性脊柱炎（AS）易感性的关系.方法 通过中国生物医学文献数据库（CBM）、中国期刊全文数据库（CNKI）、Cochrane Library数据库、PubMed、Ovid等数据库检索国内外已发表或未发表TNF-α-850位点基因多态性与AS相关的病例-对照研究,采用Meta分析对各研究数据进行统计学处理.结果 本研究共纳入4篇文献,包括205例病例和536例对照,Meta分析结果显示携有TT基因型[OR =3.90,95％ CI（2.18,6.97）,P＜0.00001]或T等位基因[OR =4.74,95％ CI（2.38,9.41）,P＜0.00001]的人群AS发病风险增高.结论 TNF-α-850位点基因多态性与AS易感性相关,携有TT基因型或T等位基因的人群是AS的高危人群.受纳入文献数量所限制,其结果尚需更多大样本的研究进一步证实.     

Two-level pedicle subtraction osteotomy for severe thoracolumbar kyphotic deformity in ankylosing spondylitis

Study design

A retrospective clinical study.

Objective

To evaluate the outcomes of two-level (T12 and L3) pedicle subtraction osteotomy (PSO) for severe thoracolumbar kyphosis in ankylosing spondylitis (AS), and to discuss the surgical strategies of this surgery.

Background

Cases were limited on the results of two-level PSO for correction of severe kyphosis caused by AS, nor on surgical strategies of this type of surgery.

Methods

From March 2006 to December 2010, nine consecutive AS patients with severe kyphotic deformity, underwent T12 and L3 PSOs. Chin-brow vertical angle (CBVA) and radiographic assessments which contain thoracic kyphosis (TK), lumbar lordosis (LL), global kyphosis (GK), and sagittal vertical axis were carefully recorded pre and postoperatively to evaluate the sagittal balance. Intra and postoperative complications were also registered. All patients were asked to fill out Oswestry Disability Index before surgery and at the last follow-up visit.

Results

All nine patients (8M/1F), averaged 41.4 years old (range 35–51 years), were received two-level (T12 and L3) PSO, and were followed up after surgery for a mean of 39.9 months (range 24–68 months). Good cosmetic results were achieved in all patients. Mean correction at two-level PSO was 67.9 ± 5.5°. All CBVA, TK, LL, and GK were changed significantly after surgery (P < 0.05), the mean amount of correction of which were 59.5 ± 13.8, 34.7 ± 3.8, 33.2 ± 2.4, and 54.0 ± 14.8 degrees, respectively, and with a small loss of correction at the last follow-up visit. Sagittal imbalance was significantly improved from 27.3 ± 4.4 to 3.4 ± 0.7 cm postoperatively. Neither mortalities nor any major neurological complications were found. The mean ODI score was significantly improved from 53.4 ± 15.5 before surgery to 8.2 ± 4.7 at the last visit.

Conclusion

The outcomes of follow-up showed that two-level (T12 and L3) PSO can effectively and safely correct severe thoracolumbar kyphosis in AS.