椎体成形术后再骨折相关因素分析

目的:分析经皮穿刺椎体成形术(percutaneous vertebroplasty,PVP)治疗骨质疏松性椎体压缩骨折(osteoporosis vertebral compression fracture,OVCF)后再发骨折的相关因素,探讨引起再骨折的主要因素.方法:回顾性分析行PVP治疗的264例(394个椎体)OVCF患者,分为A组(再发骨折组)34例,B组(未再发骨折组)230例.随访时间6～35个月,平均20.5±8.8个月,记录患者的年龄,性别,术后再发骨折的时间、部位、发生率,空腔样椎体数目,终末随访定量CT(QCT)值,骨水泥渗漏的部位及渗漏率,手术前后VAS评分等因素并对以上因素进行两组间对比分析.结果:PVP后首次再发邻近椎体骨折与跨跃式椎体骨折的总发生率为13％(共34例),时间为11.7±9.2个月,有21例患者第2、3次再发骨折发生在3个月内.年龄、性别、空腔样椎体数目等因素在A组和B组间差异无显著性(P＞0.05);QCT值在A组和B组间差异有显著性(P＜0.05);术前、术后第3天VAS评分在A组、B组各组内比较有显著意义(P＜0.05),末次随访时VAS评分两组问比较差异有显著性(P＜0.05).骨水泥渗漏共34例36个椎体,骨水泥渗漏率为9％,渗漏后均无临床相关症状;骨水泥渗漏在A组和B组间差异无显著性(P＞0.05),A组和B组两组间不同部位骨水泥渗漏情况比较,不管是椎间隙渗漏还是其他部位渗漏,均提示差异无显著性(P＞0.05);不同部位骨水泥渗漏的患者间在VAS评分(术前、术后、末次随访)对比,均提示差异无显著性(P＞0.05).结论:OVCF患者行PVP治疗,能够取得满意效果,年龄、性别、空腔样椎体数目、骨水泥渗漏与PVP后再发骨折无明显相关性,骨质疏松可能是引发椎体成形术后再骨折的一个主要因素.     

双膦酸盐对骨质疏松症患者腰椎融合影响的系统评价和Meta分析

目的通过Meta分析系统评价双膦酸盐对骨质疏松症患者腰椎融合的影响。方法系统检索Pub Med、Science Direct、Google Scholar、CNKI、VIP和Wan Fang Data自建库以来到2017年1月的文献,运用Stata11.0定量分析纳入的文献。结果最终有9篇研究符合纳入标准,Meta分析结果显示:双膦酸盐组与对照组的对比中,植骨融合情况[RR=1.138,95%CI(1.064,1.217)]、终末随访骨密度T值[MD=0.038,95%CI(0.025,0.052)]、ODI指数[MD=-4.36,95%CI(-6.372,-2.348)]、骨吸收生化标志物CTX值[MD=-0.401,95%CI(-0.511,-0.291)]、VAS评分[MD=0.940,95%CI(0.548,1.332)]之间差异均有统计学意义(P0.01);终末随访术后骨形成生化标志物PINP值[MD=-4.328,95%CI(-8.954,0.298)]、不良反应情况[RR=0.725,95%CI(0.420,1.251)]之间差异无统计学意义(P=0.067和P=0.248)。结论腰椎术后应用双膦酸盐并不影响骨质疏松症患者的骨融合结果,而且通过治疗能有效抑制骨吸收代谢,改善其骨量和术后功能恢复程度,且与对照组安全性相近。     

单双侧椎弓根螺钉内固定并后路腰椎体间融合修复腰椎退行性疾病的系统评价

BACKGROUND: At present, the internal fixation and fusion surgical treatment of lumbar degenerative disease tends to diversify, but posterior lumbar interbody fusion within a single bilateral pedicle screw fixation is still common in clinical practice; the two ways after treatment can achieve satisfactory clinical efficacy, but which way has advantages is still controversial. OBJECTIVE: To evaluate the efficacy and safety of unilateral and bilateral pedicle screw fixation and single segment lumbar interbody fusion in the repair of lumbar degenerative disease by a meta-analysis system. METHODS: According to the Cochrane Collaboration search strategy, we searched MEDLINE, PubMed, EMBASE, CBMdisc, CNKI, VIP and WanFang Data. Randomized controlled trials concerned unilateral and bilateral pedicle screw fixation and single segment lumbar interbody fusion in the treatment of lumbar degenerative diseases. By two reviewers, in strict accordance with inclusion and exclusion criteria, literatures were screened, data were extracted, and the methodology quality of included trials was critically assessed. RevMan5.1 software was used for meta-analysis. RESULTS AND CONCLUSION: Six randomized controlled trials involving 507 patients were included. The results of meta-analysis showed that fixed unilateral and bilateral pedicle screw between single lumbar fusion and surgery in the treatment of lumbar degenerative diseases, significant differences were detected in surgical time [WMD=-40.29, 95% CI (-43.79, -36.79)], intraoperative blood loss [WMD= -74.13, 95% CI (-86.13, -62.13)], length of hospital stay [WMD=-1.04, 95% CI (-1.30, -0.79)], final follow-up Visual Analogue Scale score [WMD=0.33, 95% CI (0.24, 0.42)], final follow-up Oswestry dysfunction index [WMD=-1.07, 95% CI (-1.57, -0.56)]; unilateral side was better than bilateral side (P < 0.000 1). There was no significant difference in complication rate [RR=0.54, 95% CI (0.25, 1.17)] and fusion rate [RR=0.53, 95% CI (0.22, 1.28)] (P=0.12 and P=0.16). These results suggested that unilateral and bilateral pedicle screw fixation and single lumbar fusion in the treatment of lumbar degenerative disease has achieved satisfactory results. Unilateral pedicle screw fixation can reduce operation time, intraoperative blood loss and length of stay. Visual Analogue Scale score and Oswestry dysfunction index improved significantly in a short period after treatment.         

选择性神经根造影加封闭术对退行性腰椎管狭窄症患者的诊断意义和临床价值

目的探讨选择性神经根造影加封闭术对退变性腰椎管狭窄症患者的诊断意义及临床价值。方法对30例体征不明显的退行性腰椎管狭窄症患者进行选择性神经根造影及封闭术以确定"责任节段",在此基础上对确定的"责任节段"进行相应的选择性椎管减压手术;同时通过手术前后JOA评分比较及术后1年手术改善率来评价手术整体效果。结果 30例患者术后腰痛JOA评分较术前明显改善(P<0.01),术后12个月改善率优28例(93.3%),良1例(3.3%),好转1例(3.3%);总有效率100.0%。结论选择性神经根造影加封闭术对于部分定位体征不十分明显的退变性腰椎管狭窄症及影像学(MRI)显示为多节段的椎管狭窄患者,可以明确"责任节段",从而使手术的创伤及对患者腰椎稳定性的影响降到最低。本方法创伤小,简单易行、安全,且具有敏感性高、特异性强的特点,易为患者接受,可作为退变性腰椎管狭窄症临床辅助诊断的主要内容加以运用。     

超前镇痛及规律性按时给药对腰椎间盘突出症术后疼痛及功能影响的临床研究

[目的]研究塞来昔布超前镇痛及规律性按时给药对腰椎间盘突出症手术患者术后疼痛评分、援助镇痛药物的使用及不良反应、术后功能改善的影响。[方法]将60例行单节段后路椎板间开窗髓核摘除术的腰椎间盘突出症患者随机分为A组(观察组)和B组(对照组),每组30例,通过不同的镇痛方法进行镇痛治疗后比较两组术后疼痛的VAS评分、援助镇痛药物的使用及不良反应,并通过术前1 d及术后第3、14 d JOA评分来比较两种不同的镇痛方法对术后功能改善影响的情况。[结果]A组在术后各时点的VAS评分均低于B组,差异有显著性(P<0.05)。在术后3 d内,A组使用曲马多、哌替啶的次数少于B组(P<0.05),两组之间不良反应事件发生率均无显著性差异(P>0.05),每组患者术后第3 d的JOA评分较术前1 d有明显的改善(P<0.05),A组术后第3 d功能改善率>75%,较B组有显著性差异(P<0.05),两组术后第14 d JOA评分无显著性差异(P>0.05)。[结论]塞来昔布超前镇痛及规律性按时给药用于腰椎间盘突出症手术患者,能有效缓解术后疼痛,并能减少术后阿片类药物的使用,改善术后功能。     

急性期神经根型颈椎病患者的血清差异蛋白组学分析

背景：正常健康人向急性期神经根型颈椎病转化的具体分子机制尚未完全明确，需进一步深入研究。目的：探讨正常健康人群与急性期神经根型颈椎病患者的血清蛋白组学差异表达，并寻找及鉴定两者之间的潜在特异性血清标志物。方法：收集急性期神经根型颈椎病患者、正常健康人群血清各8例，应用绝对定量技术联合液相色谱-串联质谱技术进行蛋白组学筛选与分析，以期探寻与鉴定急性期神经根型颈椎病患者差异表达的血清蛋白质。结果与结论：(1)绝对定量技术筛查出有意义差异蛋白183种，鉴定出11种显著性差异蛋白质(P <0.05)，其中与正常健康人组相比，急性期神经根型颈椎病组中人类白细胞抗原A、分泌珠蛋白家族1a成员1、蛋白4-羟基苯丙酮酸双加氧酶等3种差异蛋白显著上调，免疫球蛋白IgG3恒定区、皮肤因子、肌球蛋白轻链3等7种差异蛋白显著下调；(2)基因本体富集分析结果表明，这些差异蛋白参与了抗原结合、免疫球蛋白受体结合等分子功能；(3)蛋白相互作用网络分析表明，正常健康人群与急性期神经根型颈椎病之间的共同差异蛋白中HLA-A、HPD、PSMA3、DMKN、SCGB1A1、MYL3等6种位于功能网络节点，且与机体免疫...