过伸复位结合经皮椎体后凸成形术治疗骨质疏松性椎体骨折

目的探讨过伸复位结合经皮椎体后凸成形术治疗骨质疏松性椎体压缩骨折的临床效果及注意事项。方法对25例骨质疏松性椎体骨折患者（共43个椎体）,在C型臂X线机透视下行过伸复位结合经皮经椎弓根球囊扩张注入骨水泥椎体后凸成形术。对术前、术后1d和术后6个月的椎体高度、Cobb′s角和疼痛评分等进行评估。结果术后23例胸背部疼痛消失,2例疼痛明显减轻,未出现神经系统损伤及肺栓塞等并发症。术后随访6～12个月,平均9.2个月,所有患者腰背痛症状均无复发,X线片示24例椎体高度未丢失,1例有邻近椎体再骨折发生。椎体高度、Cobb′s角较术前有显著改善。结论过伸复位结合经皮椎体后凸成形术具有微创、安全、临床疗效良好的优点,是治疗骨质疏松性椎体压缩骨折理想方法之一。临床应用时,应注意严格掌握适应证、适当扩张球囊、灌注骨水泥等技术要点,以避免严重并发症的发生。     

表皮生长因子对兔自体穿透性角膜移植伤口愈合的影响

目的：研究表皮生长因子（epidermal growth factor,EGF)对家兔自体穿透性角膜移植术后伤口愈合的影响。方法：12只家兔24只眼随机分为6组并制成自体穿透性角膜移植动物模型,采用测量伤口愈合强度,液闪计数测量伤口愈合时^3H-TdR的掺入率,AgNORs染色成纤维细胞计数,AgNORs染色、HE染色、VG染色和电镜等方法,观察表皮生长因子对家兔穿透性角膜移植术后伤口愈合的影响。结果：表皮生长因子点眼能增加家兔穿透性角膜移植术后8天、14天、21天伤口所能承受的极限压力,与对照组比较有非常显著的差异（P＜0．01）;能增加术后14天、21天伤口愈合时^3H-TdR的掺入率,与对照组比较差异非常显著（P＜0．01）;能增加术后8天伤口处成纤维细胞的数量,与对照组比较差异非常显著（P＜0．01）。结论：表皮生长因子点眼增强穿透性角膜移植术后伤口愈合的强度,增加伤口愈合时DNA的合成,在早期（术后8天）能明显增加伤口处成纤维细胞的数量。     

单侧椎弓根入路与双侧椎弓根入路PKP治疗Kummell's病的临床对比研究

[目的]对比研究单侧入路和双侧入路PKP治疗Kummell's病的临床疗效。[方法]回顾性分析本院2013年7月~2015年5月通过影像资料筛选出的63例行PKP手术治疗的Kummell's病患者。男24人,女39例,年龄55~88岁,平均68.5岁。腰背痛时间1个月~3年,平均3.5个月。38例行单侧椎弓根入路球囊椎体后凸成形术,其中2例失随访,最后,纳入单侧入路手术组的患者36例;25例行双侧椎弓根入路球囊椎体后凸成形术,其中3例失随访,最后纳入双侧入路手术组的有22例。分别测量术前、术后1 d及末次随访时侧位X线片受累节段的矢状面Cobb角度评估后凸角度的恢复程度,使用视觉模拟量表(visual analog scale,VAS)评分、Oswestry功能障碍指数(Oswestry disability index,ODI)和Roland-Morris功能障碍问卷表(roland-morris disability,RDQ)评估手术效果。[结果]随访12~36个月,平均15.8个月。单、双侧入路末次随访的VAS评分分别为(3.9±1.7)分和(3.7±0.7)分。单、双侧入路末次随访的ODI评分分别为(15.3±3.7)分和(13.8±2.7)分。单、双侧入路末次随访的RDQ评分分别为(10.2±1.7)分和(7.9±1.7)分。单侧入路组的手术时间为(47.6±7.8)分,双侧入路组的手术时间为(71.5±21.6)分。单侧骨水泥渗漏为2例,双侧骨水泥渗漏为7例。单侧入路手术组的手术时间明显较短,射线照射量、花费更少。围手术期的相关并发症组间比较差异无统计学意义。两组的年龄、性别、病程、随访持续时间差异均无统计学意义。[结论]单侧和双侧椎体成形术后临床表现和影像学表现在组内没有显著差异。双侧椎弓根入路的手术时间较长。骨水泥泄露的发生率组间比较差异无统计学意义(P>0.05)。单侧与双侧椎弓根入路球囊后凸成形术产生了相类似的临床表现和影像学结果,但单侧用时较少。因此,作者鼓励使用单侧椎弓根入路后凸椎体成形术治疗Kummell's病。     

单.双侧入路PKP治疗骨质疏松性椎体压缩性骨折的临床比较分析

目的探讨骨质疏松性椎体压缩性骨折患者应用双侧入路PKP治疗的实际效果。方法选取该院收治的骨质疏松性椎体压缩性骨折患者50例,按随机数字表法将其分成实验组25例,对照组25例,分别应用单侧、双侧入路PKP治疗,比较疗效。结果与对照组相比,实验组患者骨质疏松性椎体压缩性骨折的治疗效果更佳,实验组手术时间为（29.63±5.63）min、术后VAS评分为（26.3±1.32）分,术后并发症发生率为0%,以上数据与对照组比较,差异有统计学意义（P〈0.05）。结论为骨质疏松性椎体压缩性骨折患者应用双侧入路PKP治疗,效果显著,值得各级医院应用。     

经皮穿刺球囊扩张椎体后凸成形术治疗骨质疏松性胸腰椎骨折

[目的]探讨利用经皮穿刺球囊扩张椎体后凸成形术（percutaneous kyphoplasty,PKP）治疗骨质疏松性胸腰椎骨折的疗效.[方法]选取住院的骨质疏松性胸腰椎骨折病例96例,共111椎体,均采用PKP术治疗.比较患者治疗前、后疼痛视觉模拟评分（VAS评分）、伤椎椎体高度压缩率、椎体后凸畸形矫正度变化情况.[结果]96例患者111椎体均顺利完成手术,经单侧椎弓根穿刺行PKP术26例,经双侧椎弓根穿刺行PKP术70例.7例发生了骨水泥渗漏.所有病例均获6个月以上时间随访.患者腰背痛症状于术后即刻得到缓解,并能长时间维持;伤椎椎体高度和局部后凸畸形得到明显改善.[结论]PKP手术创伤小,能恢复椎体高度、纠正后凸畸形、迅速缓解疼痛和使脊柱达到稳定,减少患者卧床时间,降低各种卧床并发症的发生率,提高患者生活质量,是一种有效的治疗骨质疏松性胸腰椎骨折的微创手术疗法.     

Descemetocele

A corneal descemetocele, the anterior herniation of an intact Descemet membrane through an overlying stromal defect, is a rare, but serious outcome of progressive corneal ulceration and mandates urgent intervention owing to the imminent risk of perforation. Various ocular and systemic abnormalities that can lead to the formation of descemetocele include microbial keratitis, neurotrophic keratopathy, dry eye disorders, and corneal inflammation associated with immune-mediated disorders. The primary aim of management of a descemetocele remains prompt restoration of ocular integrity to prevent the rupture of the Descemet membrane and further complications. Medical therapy is instituted immediately while deciding on the most suitable operative modality for an individual case. Commonly available treatment options include therapeutic bandage contact lenses, tissue adhesives, amniotic membrane transplantation, corneal patch grafts, penetrating or lamellar keratoplasty, and conjunctival flaps. Infrequently, platelet-rich fibrin membrane grafting and umbilical cord patch transplantation have also been tried with success. The surgical strategy and the outcome are commonly determined by the size, location, and etiology of descemetoceles. Despite the availability of all these treatment options, ambiguity remains about management. We review the available literature on pathogenesis, causes, presentation, differential diagnoses, and management of this disorder and also discuss our experience.     

经皮椎体后凸成形术治疗骨质疏松性压缩骨折

目的探讨经皮椎体后凸成形术(PKP)治疗骨质疏松性压缩骨折(OVCFs)的效果,了解并发症的原因的影响因素,并行针对性预防。方法回顾性分析2008年8月至2012年12月期间收治的经PKP治疗OVCFs患者315例的临床病历资料,并对每个患者行术后随访1年。分别统计手术时间、术中透视时间、骨水泥注入量、骨水泥渗漏、住院天数及住院费用;记录术后椎体复位情况、术前术后疼痛程度(VAS评分)、ODI指数、病变椎体前缘、中部高度变化及后凸畸形Cobb角情况来评估PKP治疗的疗效,分析并发症发生的原因。结果经PKP治疗后315例患者中294例患者腰痛症状缓解,治疗有效率93.3%。术后1天VAS评分(2.0±0.8)分,VAS评分缓解率74.8%、Oswestry功能障碍指数(22.3±4.2)分、前缘高度比值(14.3±6.7)%、中部高度比值(12.8±5.6)%、Cobb角(11.6±4.8)°均比术前明显改善。PKP治疗骨折患者中,21例发生并发症,骨水泥渗漏13例,均无严重神经损伤症状,7例椎旁软组织渗漏,1例椎间孔外渗漏,3例椎间盘渗漏。结论 PKP治疗OVCFs缓解疼痛效果较好,术前、术中、术后采取相应的防范措施,以预防或减少并发症的发生。     

经皮球囊扩张椎体后凸成形术术后再发椎体骨折的危险因素和防治策略

目的探讨骨质疏松性椎体骨折PKP术后再发椎体骨折的危险因素,并提出对应的防治策略。方法对2007-01-2013-01本院行经皮球囊扩张椎体后凸成形术(percutaneous kyphoplasty,PKP)治疗的425例骨质疏松性椎体骨折患者进行回顾性分析。患者分为再发椎体骨折组和未再发椎体骨折的对照组。对两组患者基本情况、影像学资料、手术相关因素以及抗骨质疏松治疗进行分析。研究各因素与再发椎体骨折的关系。结果再发椎体骨折组(18例)比对照组(407例)骨密度低,平均骨折椎体数多,局部后凸角度大,椎体平均注入骨水泥量多,抗骨质疏松治疗依从性差,上述差异均有统计学意义。而两组在年龄、性别方面差异无统计学意义。结论骨密度低、多椎体骨折、术后病椎后凸角度大、椎体注入骨水泥量多、抗骨质疏松治疗依从性差,都是再发椎体骨折的危险因素。针对上述危险因素进行干预,可以降低再发椎体骨折的风险。     

银质针治疗对骨质疏松性胸腰椎压缩骨折经皮椎体后凸成形术术后并发症及生活质量的影响

目的:探讨银质针治疗对骨质疏松性胸腰椎压缩骨折经皮椎体后凸成形术(PKP)术后并发症及生活质量的影响。方法:将127例骨质疏松性胸腰椎压缩骨折行PKP手术的患者,按照随机数表法分为对照组(64例)和观察组(63例),对照组给予西医对症治疗并发症,观察组在对照组的基础上给予银质针针刺治疗,统计两组患者的胸闷,心慌,腹胀,尿潴留,便秘等术后并发症情况,于治疗前,治疗后,结束治疗后3、6个月评价两组患者的VAS评分、ADL评分、SF-36评分,观察治疗后患者的术后并发症发生率。结果:与本组治疗前比较,两组患者治疗后及结束治疗后3、6个月随访VAS疼痛评分均显著降低(P<0.05),ADL评分及SF-36评分均显著升高(P<0.05),且观察组各指标改善优于对照组(P<0.05);两组患者治疗4个疗程后PKP术后并发症胸闷、心慌、腹胀、尿潴留、便秘例数均较本组治疗前显著减少(P<0.05),且与同期对照组比较,观察组减少更明显(P<0.05)。结论:银质针配合西医药治疗骨质疏松性胸腰椎压缩骨折PKP术后并发症安全有效,能减轻患者疼痛、改善生活质量。     

Pathogenesis and treatments of TGFBI corneal dystrophies

Transforming growth factor beta-induced (TGFBI) corneal dystrophies are a group of inherited progressive corneal diseases. Accumulation of transforming growth factor beta-induced protein (TGFBIp) is involved in the pathogenesis of TGFBI corneal dystrophies; however, the exact molecular mechanisms are not fully elucidated. In this review article, we summarize the current knowledge of TGFBI corneal dystrophies including clinical manifestations, epidemiology, most common and recently reported associated mutations for each disease, and treatment modalities. We review our current understanding of the molecular mechanisms of granular corneal dystrophy type 2 (GCD2) and studies of other TGFBI corneal dystrophies. In GCD2 corneal fibroblasts, alterations of morphological characteristics of corneal fibroblasts, increased susceptibility to intracellular oxidative stress, dysfunctional and fragmented mitochondria, defective autophagy, and alterations of cell cycle were observed. Other studies of mutated TGFBIp show changes in conformational structure, stability and proteolytic properties in lattice and granular corneal dystrophies. Future research should be directed toward elucidation of the biochemical mechanism of deposit formation, the relationship between the mutated TGFBIp and the other materials in the extracellular matrix, and the development of gene therapy and pharmaceutical agents.