椎管成形辅助不同内固定术治疗颈椎后纵韧带骨化症的术后轴性痛对比分析

目的 探讨术前颈椎不稳和术中不同内固定对多节段颈椎后纵韧带骨化症(OPLL)患者行颈椎管后路单开门扩大成形减压术后并发轴性痛(PAP)特征和门轴侧骨槽融合率影响。方法 回顾性分析2010年1月—2014年4月武警部队后勤学院附属医院和天津医院脊柱外科106例OPLL患者的临床资料。其中男82例,女24例;年龄51～68岁,平均58.7岁;均行颈椎管后路单开门扩大成形减压术。按照患者术前合并颈椎不稳与否,分为颈椎不稳组(36例)和颈椎稳定组(70例);再按照辅助内固定装置类型,将颈椎不稳组36例分为连续节段Centerpiece微型钛板固定组(14例)和椎弓根钉棒固定组(22例),颈椎稳定组70例分为椎弓根钉棒固定组(17例)和微型钛板固定(53例)。所有患者术后均随访3年以上,比较两组患者PAP发生率,以及组内实施不同内固定术式的两亚组间术后3个月门轴侧骨槽融合率、PAP发生率、首发时间、严重程度和持续时间。结果 术后颈椎不稳组PAP发生率高于颈椎稳定组,两组分别为27.78%(10/36)和11.43%(8/70),差异有统计学意义(χ²=4.516, P<0.05)。颈椎稳定组患者,椎弓根钉棒固定术后3个月门轴侧骨槽融合率高于Centerpiece微型钛板,差异有统计学意义(t=2.995, P<0.05);椎弓根置钉术后PAP持续时间短于Centerpiece微型钛板固定,差异有统计学意义(t=11.450, P<0.05);两亚组PAP发生率、首发时间和严重程度间比较,差异均无统计学意义(P值均>0.05)。术前颈椎不稳组患者,椎弓根固定组术后PAP发生率低于微型钛板固定组,差异有统计学意义(χ²=9.841, P<0.05);两亚组PAP首发时间、严重程度、持续时间和术后3个月门轴侧骨槽融合率间比较,差异均无统计学意义(P值均>0.05)。结论 术前颈椎不稳患者更易继发PAP,其辅助椎弓根较微型钛板固定者可在一定程度减少PAP发生率。术前颈椎稳定患者行颈椎管后路单开门扩大成形减压术治疗时,联合应用椎弓根钉棒较Centrepiece微型钛板固定,更有利于提高早期门轴侧骨槽融合率和缩短PAP持续时间。     

Merocel高膨胀海绵止血材料在鼻出血的应用

目的 　进一步探讨更好的鼻腔出血填塞物。方法 　比较传统的凡士林纱条与 Merocel高膨胀海绵作为鼻腔充血填塞物的临床效果。 结果 　比较两组病人填塞后 48h出血量 ,两者之间无统计学差异 ( P>0 .0 0 5 )。填塞时及取出时疼痛的程度、应用 Merocel高膨胀止血材料填塞及填塞期间的主要症状都较凡士林纱条组的病人轻。 结论 　应用 Merocel高膨胀止血海绵是理想的鼻出血鼻腔填塞物。     

Study on Crack Development and Micro-Pore Mechanism of Expansive Soil Improved by Coal Gangue under Drying–Wetting Cycles

Expansive soil is prone to cracks under a drying–wetting cycle environment, which brings many disasters to road engineering. The main purpose of this study is use coal gangue powder to improve expansive soil, in order to reduce its cracks and further explore its micro-pore mechanism. The drying–wetting cycles test is carried out on the soil sample, and the crack parameters of the soil sample are obtained by Matlab and Image J software. The roughness and micro-pore characteristics of the soil samples are revealed by means of the Laser confocal 3D microscope and Mercury intrusion meter. The results show that coal gangue powder reduces the crack area ratio of expansive soil by 48.9%, and the crack initiation time is delayed by at least 60 min. Coal gangue powder can increase the internal roughness of expansive soil. The greater the roughness of the soil, the less cracks in the soil. After six drying–wetting cycles, the porosity and average pore diameter of the improved and expanded soil are reduced by 37% and 30%, respectively, as compared to the plain expansive soil. By analyzing the cumulative pore volume and cumulative pore density parameters of soil samples, it is found that the macro-cracks are caused by the continuous connection and fusion of micro-voids in soil. Coal gangue powder can significantly reduce the proportion of micro-voids, cumulative pore volume, and cumulative pore density in expansive soil, so as to reduce the macro-cracks.     

锚定法与微型钛板固定法颈后路单开门椎管扩大成形术后老年患者轴性症状对比研究

目的观察评价老年患者颈后路单开门椎管扩大成形术中应用锚定法与微型钛板对术后轴性症状的影响。方法选择2010-02-2014-08在本科行颈后路单开门椎管扩大成形术患者83例,其中应用锚定法固定43例,应用微型钛板固定40例。锚定法组43例,其中男31例,女12例,年龄46~72岁,平均68.6岁,JOA评分为5~12分,平均(8.34±1.25)分;微型钛板组40例,其中男33例,女7例,年龄47~71岁,平均64.1岁,JOA评分为6~13分,平均(8.89±1.98)分。结果两组患者手术过程顺利,术后切口均一期愈合,术后2个月和术后1年轴性症状发生率比较,锚定法组高于微型钛板组,差异有统计学意义(P0.05)。结论对老年患者应用微型钛板完成颈后路单开门椎管扩大成形术,可获得早期稳定,便于功能锻炼,减少颈椎轴性症状的发生,具有一定优势。     

两种后路内固定结合单开门手术治疗多节段脊髓型颈椎病的近期疗效比较

目的比较后路颈椎板成形术钉棒固定与微型钛板固定治疗多节段脊髓型颈椎病的近期疗效。方法将47例多节段脊髓型颈椎病患者随机分为两组:23例行后路颈椎板成形微型钛板固定术(微型钛板组),24例行后路颈椎板成形钉棒固定术(钉棒组)。比较两组手术时间、术中出血量、JOA评分、VAS评分、术后椎管矢状径、颈椎曲度、术后活动度影响及手术并发症等,评价两种手术方式的临床疗效。结果患者均获得随访,微型钛板组为(23.8±8.1)个月,钉棒组为(23.6±8.0)个月。两组手术时间、术中出血量、手术并发症比较差异无统计学意义(P0.05)。JOA评分:两组手术后均较术前显著升高(P0.05),两组间比较差异无统计学意义(P0.05)。颈痛VAS评分:术前钉棒组显著高于微型钛板组(P0.05),术后两组评分均较术前显著降低(P0.05),两组间比较差异无统计学意义(P0.05)。颈椎矢状径:两组术后3 d和未次随访时均较术前明显改善(P0.05),两组间比较差异无统计学意义(P0.05)。术后3 d和末次随访时微型钛板组颈椎曲度改善明显优于钉棒组(P0.05)。末次随访时两组活动度均较术前减少(P0.05),钉棒组减少的度数明显大于微型钛板组(P0.05)。结论后路颈椎板成形术钉棒固定与微型钛板固定治疗多节段脊髓颈椎病神经功能改善相似,微型钛板对颈椎的活动度影响较少。     

颈椎“双开门”椎管扩大成形同种异体骨植骨治疗脊髓型颈椎病的疗效分析

目的 总结分析颈椎后路双开门椎管扩大成形同种异体骨植骨治疗脊髓型颈椎病的临床效果.方法 对61例行颈椎后路“双开门”椎管扩大成形同种异体骨植骨治疗的脊髓型颈椎病患者进行回顾性分析,采用JOA评分法、颈椎管平均矢状径评价临床疗效,X线、CT判定植骨融合状况.结果 术后所有患者症状体征得到改善,JOA评分由术前平均10.6...     

Pseudotumoral presentation of multiple sclerosis

INTRODUCTION: Multiple sclerosis is one of the most common diseases of the central nervous system with a variety of clinical and radiological presentations. Several cases have been reported of demyelinating processes mimicking a tumour of the central nervous system. OBSERVATION: A 45-year-old man was admitted with acute right hemiparesis associated with intracranial hypertension syndrome. Initial CT scan and magnetic resonance imaging of the brain revealed a mass lesion in the left hemisphere. Combined, careful history taking, assessment of the clinical course and magnetic resonance imaging findings led to the final diagnosis of multiple sclerosis. COMMENTARY AND CONCLUSION: This case report illustrates the wide variety of multiple sclerosis presentation. Recognition of the demyelinating tumor like lesions is essential; the diagnosis of multiple sclerosis should be considered in young adults with similar presentations.     

Effect of Confining Conditions on the Hydraulic Conductivity Behavior of Fiber-Reinforced Lime Blended Semiarid Soil

The hydraulic properties of expansive soils are affected due to the formation of visible cracks in the dry state. Chemical stabilization coupled with fiber reinforcement is often considered an effective strategy to improve the geotechnical performance of such soils. In this study, hydraulic conductivity tests have been conducted on expansive clay using two different types of fibers (fiber cast (FC) and fiber mesh (FM)) exhibiting different surface morphological properties. The fiber parameters include their dosage (added at 0.2% to 0.6% by dry weight of soil) and length (6 and 12 mm). Commercially available lime is added to ensure proper bonding between clay particles and fiber materials, and its dosage was fixed at 6% (by dry weight of the soil). Saturated hydraulic conductivity tests were conducted relying on a flexible wall permeameter on lime-treated fiber-blended soil specimens cured for 7 and 28 days. The confining pressures were varied from 50 to 400 kPa, and the saturated hydraulic conductivity values (k_sat) were determined. For FC fibers, an increase in fiber dosage caused k_sat values to increase by 9.5% and 94.3% for the 6 and 12 mm lengths, respectively, at all confining pressures and curing periods. For FM fibers, k_sat values for samples mixed with 6 mm fiber increased by 12 and 99.2% for 6 and 12 mm lengths, respectively for all confining pressures at the end of the 28-day curing period. The results obtained from a flexible wall permeameter (FWP) were compared with those of a rigid wall permeameter (RWP) available in the literature, and the fundamental mechanism responsible for such variations is explained.     

混料设计优化康复新胃漂浮片处方

目的:优选康复新胃漂浮片的处方,为康复新的开发利用提供参考。方法:采用全粉末直接压片法制备康复新胃漂浮片,以体外漂浮性能与释药性能为综合评价指标,在单因素试验基础上,采用混料设计考察羟丙甲基纤维素(HPMC)、交联聚维酮(PVPP)及NaHCO3对康复新胃漂浮片处方的影响。利用HPLC测定氨基酸含量,流动相[0.1mol·L-1乙酸钠缓冲溶液(pH6.5)-乙腈(93∶7)]-[乙腈-水(80∶20)]梯度洗脱,检测波长254nm,柱温40℃。结果:最佳处方为25%康复新冻干粉,28.38%HPMCK4M,13.38% NaHCO3,18.24% PVPP,14%微晶纤维素,1%硬脂酸镁。康复新胃漂浮片的起漂时间(2±0.2)min,持漂时间>12h,体外释放符合零级动力学模型。结论:制备的康复新胃漂浮片具有良好的体外漂浮性能和释药性能,可增加康复新在胃部的滞留时间,对治疗消化性溃疡具有重要意义。     

带线锚钉在颈椎单开门手术治疗脊髓型颈椎病中的应用探讨

目的研究带线锚钉在颈椎单开门手术治疗脊髓型颈椎病中的应用及效果。方法将86名脊髓型颈椎病患者随机分成锚钉组和对照组,每组43人,锚钉组行颈椎单开门颈椎管扩大成型手术,使用带线锚钉进行门轴侧固定;对照组行单纯后路单开门手术。根据术后JOA评分,手术对生产生活质量的影响和影像学指标进行临床疗效评价比较。结果锚钉组患者在术中应用自制颈椎侧块锚钉固定时均未出现神经、血管损伤等并发症,术后随访平均JOA评分15.2,与术前及对照组比较改善效果明显,术后6个月仅3例仍有颈部轻度压痛,活动受限。影像学评估显示内固定牢靠,未见螺钉松动和再关门现象。结论在颈椎单开门手术治疗脊髓型颈椎病中应用带线锚钉固定操作简单易行,临床效果非常良好,同时有效降低了术后轴性症状的发生。