单开门颈椎管扩大成形Centerpiece钛板内固定术治疗脊髓型颈椎病的中期临床疗效

目的:探讨单开门颈椎管扩大成形Centerpiece钛板内固定术治疗脊髓型颈椎病的中期临床疗效。方法:选择2009年1月~2011年6月在我院行后路椎管扩大成形Centerpiece钛板内固定术治疗的脊髓型颈椎病患者59例,其中男性42例,女性17例,年龄21~68岁,平均56.2±9.8岁。MRI显示3个节段狭窄12例,4个节段狭窄29例,5个节段狭窄18例。以日本骨科协会(JOA)评分(17分法)及其改善率评价术后神经功能改善情况;视觉模拟评分(visual analogue scale/score,VAS)及颈部功能障碍指数(neck dysfunction index,NDI)评价患者的疼痛及功能变化情况;术后复查颈椎X线、CT及MRI,在术前及末次随访时的颈椎X线片上测量C2~C7夹角、颈椎活动度(ROM),在颈椎三维CT上测量椎管矢状径及椎管横截面积,计算椎管扩大率[(术后椎管矢状径-术前椎管矢状径)/(术前椎管矢状径)×100%],评价椎管扩大和维持情况及门轴侧骨融合情况。结果:手术时间为142.2±18.1min,术中出血量为264.5±50.5ml,术后引流量为252.3±28.6ml,住院日为7.2±0.7d。在术后随访过程中,15例出现了颈后部轴性疼痛症状,按照VAS评分,13例为轻度疼痛,2例为中度疼痛,所有患者颈部轴性疼痛症状均于术后1年内消失。1例术后第3天出现C5神经根麻痹症状,经2周保守治疗症状明显缓解,于术后12周时症状完全消失。随访48~72个月,平均60.5±2.7个月,术前JOA评分为8.5±0.5分,末次随访为15.4±1.3分,改善率为(77.1±5.2)%。术前平均VAS评分为3.9±0.4分,末次随访时为1.3±0.6分。术前平均NDI为20.3±5.4,末次随访时为6.5±1.8。影像学复查示术后随访期间颈椎管扩大满意,脊髓受压完全解除,椎管矢状径平均值术前为9.7±0.9mm,末次随访时为16.8±1.2mm,椎管扩大率为(67.6±13.9)%,椎管矢状面积术前为128.1±13.5mm~2,末次随访时为318.3±34.3mm2。末次随访时颈椎ROM值较术前减少9.6°±2.4°,手术前与术后随访期间C2~C7夹角未见明显差异(P0.05)。术后6个月门轴侧均达骨性愈合,随访期间均未出现关门及神经损害症状加重的情况。结论:单开门颈椎管扩大成形Centerpiece钛板内固定术是治疗脊髓型颈椎病的一种简便、安全的方法,中期临床疗效较满意。     

颈椎间盘置换术与颈前路椎间融合术治疗双节段颈椎间盘退变性疾病疗效的Meta分析

目的 :系统评价颈椎间盘置换术(TDR)与颈前路椎间盘切除椎间植骨融合术(ACDF)治疗相邻两个节段颈椎间盘退变性疾病的疗效。方法:检索Pubmed、Medline、Embase等数据库,筛选应用两种手术方式治疗相邻两个节段颈椎间盘退变性疾病的前瞻性临床对照研究;各研究中观察组术式为TDR(TDR组),对照组术式为ACDF(ACDF组);两组病例数均不少于10例;随访时间均不少于2年;术后疗效评价指标至少包括以下指标中的一项:颈痛及上肢痛VAS评分(VAS),颈部功能障碍指数(NDI),健康调查简表SF-36评分(SF-36),术后不良事件(AE)等指标。采用Doowns-Black评分及NOS评分评价纳入研究的质量。结果:共纳入5篇英文文献,2篇为随机对照研究(RCT),3篇为前瞻性队列研究,研究质量Doowns-Black评分均在18分及以上,NOS评价前瞻性队列研究质量均为6星。共纳入593例患者,其中TDR组314例,ACDF组279例。经Meta分析合并效应指标,末次随访时颈痛VAS评分标准化均数差(SMD)及不良事件发生相对危险度(RR)两组比较无显著性差异(P0.05);TDR组上肢痛VAS评分、NDI评分、邻近上节段和下节段屈伸ROM、邻近节段退变低于ACDF组(P0.05),SF36-PCS躯体健康评分及手术节段屈伸ROM SMD高于ACDF组(P0.05)。结论 :相邻两个节段颈椎间盘退变性疾病行TDR的疗效较ACDF具有优势,安全性较高,但需要更多大样本随机对照研究以及更长时间的随访结果来验证。     

经肋间隙探查定位于内乳区的前哨淋巴结对乳腺癌淋巴分期的影响

目的 探讨乳腺癌前哨淋巴结在内乳区时对其探查与否对淋巴结分期的影响。方法 2006-01—2016-01间,对501例c T1-4N0-1M0期乳腺癌患者进行前哨淋巴结探查术,发现有蓝染淋巴管通向内乳区的患者,经肋间隙入路行内乳区前哨淋巴结活检术(IM-SLNB)+腋窝前哨淋巴结探查+改良根治术100例为A组;行腋窝前哨淋巴结探查+改良根治术401例为B组。观察A组经肋间隙入路IM-SLNB的病理结果与假设该组病例不探查相对比,了解探查对其淋巴分期的影响。观察经肋间隙入路的IMSLNB对手术时间、出血、并发症及恢复等的影响。结果 A组探查发现内乳区淋巴结癌转移19例相对于假设不探查为0例,其淋巴结分期修正率19.0%,(P0.05)有统计学意义;经肋间隙入路IM-SLNB阶段所用时间(23.93±5.89)min;仅1例术中胸廓内动脉出血,切断肋软骨显露血管后结扎止血,出血量约10~20 m L,其余99例均5 m L;胸膜破损0例、气胸0例;术后并发症和愈合时间与B组无统计学差异(P0.05)。结论 选择乳腺癌前哨淋巴结在内乳区时对其进行探查其阳性率高,有助于淋巴结准确分期;经肋间隙入路的内乳区淋巴结探查,创伤小、风险小、不增加并发症。     

间断式Arch钢板固定在单开门颈椎管成形术中的应用

正2010年2月~2012年8月,我科对21例脊髓型颈椎病患者进行颈后路单开门时,采用Arch钢板行颈椎管成形术,间断式固定C_(3,5,7)或C_(3,6),疗效满意,报道如下。1材料与方法1.1病例资料本组21例,男17例,女4例,年龄44~81岁。临床症状主要表现为上下肢双侧或单侧无力、麻木,出现痉挛步态、踩棉花感以及胸部束带感,有8例患者出现括约肌功能障碍、尿潴     

青少年颈椎生理曲度异常的影像学表现和临床症状研究

目的 探讨青少年颈椎生理曲度异常的影像学特征和主要临床症状.方法 选择2014年1月至2015年12月秦皇岛经济技术开发区医院神经内科门诊就治的有神经系统临床症状并伴有X线异常的青少年患者116例,根据X线平片颈椎生理曲度异常程度,将入组患者的颈椎生理曲度异常分为轻度组(38例)、中度组(34例)、重度组(44例),分别比较三组患者临床症状和神经系统体征.结果 颈椎生理曲度减小和变直分别占颈椎生理曲度异常分型的29.31%和37.93%;轻、中、重三组患者中头痛积分随颈椎生理曲度异常程度增加而逐渐加重,且血压呈上升趋势,两两比较组间差异有统计学意义(P<0.05);轻、中、重三组阳性Hoffmann征积分分别为6.0、18.0、26.0,差异有统计学意义(P<0.05);Romberg征阳性积分分别为18.0、35.5、29.5,差异有统计学意义(P<0.05).结论 颈椎曲度异常是颈椎病较早出现的X线征象,对青少年早期颈椎影像学资料进行分析研究可及时明确疾病的发生发展.     

445例体表淋巴结针吸细胞学误诊分析

目的：分析体表淋巴结针吸细胞学镜下特点及误诊原因。方法经术后组织病理学证实,回顾性总结德阳市人民医院及旌阳区中医院2010年1月至2015年5月445例体表淋巴结针吸细胞学诊断准确率及误诊原因。结果445例针吸细胞学诊断正确率为95.51%(425/445),误诊率为4.49%(20/445),误诊的主要原因有坏死严重未见有效成分、过诊断、漏穿、肿瘤细胞少未见典型病变及肿瘤细胞异型性小。结论体表淋巴结针吸细胞学诊断准确率较高,不断总结误诊原因可以提高体表淋巴结针吸细胞学诊断准确率。     

Transient receptor potential vanilloid 1 expression and function in splenic dendritic cells: a potential role in immune homeostasis

Neuro‐immune interactions, particularly those driven by neuropeptides, are increasingly implicated in immune responses. For instance, triggering calcium‐channel transient receptor potential vanilloid 1 (TRPV1) on sensory nerves induces the release of calcitonin‐gene‐related peptide (CGRP), a neuropeptide known to moderate dendritic cell activation and T helper cell type 1 polarization. Despite observations that CGRP is not confined to the nervous system, few studies have addressed the possibility that immune cells can respond to well‐documented ‘neural’ ligands independently of peripheral nerves. Here we have identified functionally relevant TRPV1 on primary antigen‐presenting cells of the spleen and have demonstrated both calcium influx and CGRP release in three separate strains of mice using natural agonists. Furthermore, we have shown down‐regulation of activation markers CD80/86 on dendritic cells, and up‐regulation of interleukin‐6 and interleukin‐10 in response to CGRP treatment. We suggest that dendritic cell responses to neural ligands can amplify neuropeptide release, but more importantly that variability in CGRP release across individuals may have important implications for immune cell homeostasis.     

Long-term recovery of normal sexual function in testicular cancer survivors

Testicular cancer (TC) is the most common solid cancer in men between the third and fourth decade of life. Due to successful treatment approaches, TC survivors (TCSs) have long life expectancy, but with numerous potential long-term sequelae, including sexual dysfunction. We investigated predictors of long-term normal sexual function (SF) recovery in TCSs. Sociodemographic, medical, and psychometric data were analyzed in 143 Caucasian-European TCSs, who underwent orchiectomy at a single institution. Health-significant comorbidities were scored with the Charlson Comorbidity Index (CCI). Patients completed the International Index of Erectile Function (IIEF). Statistical models tested the association between predictors (including age at surgery, body mass index, CCI, and adjuvant therapy: radiotherapy [RT], chemotherapy [CT], CT followed by retroperitoneal lymph node dissection [RPLND] and RPLND alone) and the long-term recovery of normal SF (defined as IIEF-erectile function [EF] ≥26, and sexual desire [SD], intercourse satisfaction [IS] orgasmic function [OF], and overall satisfaction [OS] domain scores in the upper tertiles). At a mean follow-up of 86 months, 35 (25.5%) TCSs had erectile dysfunction (ED), with 16 (11.2%) experiencing severe ED. Median time of EF recovery was 60, 60, and 70 months after CT, RT, and RPLND, respectively. Only adjuvant RT emerged as an independent predictor of nonrecovery of normal EF (HR: 0.55, P= 0.01). Neither adjuvant CT nor CT plus RPLND or RPLND alone significantly impaired the recovery of normal erections. Adjuvant therapy was not associated with impaired recovery of normal sexuality as a whole, considering the IIEF-SD, -OF, -IS, and OS domains.