Sacral morphometrics for sex estimation of dead cases in Central Thailand

Sex estimation by various forensic anthropology approaches is a crucial factor for identification of human skeletal remains. However, inexpensive, uncomplicated and reliable methods are still required, especially in a remote crime scene and a high crime incidence area. Here, we examined 13 sacral parameters from 78 independent skeletons derived from deceases found in Central Thailand (male, n = 46; female, n = 32) using simple standard anthropometric techniques for sex allocation. Discriminant analysis exhibited that anterior-posterior diameter of S₁ vertebra corpus (APS) is the most accurate sacral parameter for sex determination in our study with 82.1% of correct discrimination rate. The accuracy could be improved up to 97.4% when additional three sacral variables including the length of sacrum measured from the medial anterior-superior sacral promontory to the medial anterior-inferior S₅ vertebra (ASL), alar index (ALI), and the maximum anterior breadth of sacrum measured across sacral alar (ABS) were computed together with APS. These encourage the use of sacral morphometrics for sex assessment of human sacrum remains in Central Thailand. However, further investigation with broadening sacral morphometric data across the country might provide a promising sex determination equation from a sacral skeleton for Thai population.     

Percutaneous thermal ablation of sacral metastases: Assessment of pain relief and local tumor control

PurposeTo retrospectively report on safety, pain relief and local tumor control achieved with percutaneous ablation of sacral bone metastases.Materials and methodsFrom February 2009 to June 2020, 23 consecutive patients (12 women and 11 men; mean age, 60 ± 8 [SD] years; median, 60; range: 48-80 years) with 23 sacral metastases underwent radiofrequency (RFA) or cryo-ablation (CA), with palliative or curative intent at our institution. Patients’ demographics and data pertaining to treated metastases, procedure-related variables, safety, and clinical evolution following ablation were collected and analyzed. Pain was assessed with numerical pain rating scale (NPRS).ResultsSixteen (70%) patients were treated with palliative and 7 (30%) with curative intent. Mean tumor diameter was 38 ± 19 (SD) mm (median, 36; range: 11-76). External radiation therapy had been performed on five metastases (5/23; 22%) prior to ablation. RFA was used in 9 (39%) metastases and CA in the remaining 14 (61%). Thermo-protective measures and adjuvant bone consolidation were used whilst treating 20 (87%) and 8 (35%) metastases, respectively. Five (22%) minor complications were recorded. At mean 31 ± 21 (SD) (median, 32; range: 2-70) months follow-up mean NPRS was 2 ± 2 (SD) (median, 1; range: 0–6) vs. 5 ± 1 (median, 5; range: 4–8; P < 0.001) at the baseline. Three metastases out of 7 (43%) undergoing curative ablation showed local progression at mean 4 ± 4 (SD) (median, 2; range: 1-8) months follow-up.ConclusionPercutaneous ablation of sacral metastases is safe and results in significant long-lasting pain relief. Local tumor control seems sub-optimal; however, further investigations are needed to confirm these findings due to paucity of data.     

机器人辅助微创三角固定治疗单侧不稳定性骶骨骨折

目的比较机器人辅助微创入路与传统切开入路三角固定治疗单侧不稳定性骶骨骨折的临床疗效。方法回顾性分析2014年8月至2018年2月收治并获得完整随访的24例单侧不稳定性骶骨骨折患者资料。所有患者均合并骨盆前环损伤,均为AO C1.3型骨盆骨折,术前均接受神经核磁检查明确腰骶神经未被骨折断端或骨块卡压;骨盆损伤均一期采用前后联合固定,骶骨骨折采用三角固定。根据不同手术方法分为机器人辅助微创入路组[简称机器人组,12例,男10例,女2例;年龄(36.3±1.2)岁(范围,22~56岁);Dennis骶骨骨折分型,Ⅰ型4例,Ⅱ型8例;神经损伤2例,Gibbons分级Ⅱ级1例,Ⅲ级1例]和传统后正中切开入路组[简称切开组,12例,男11例,女1例;年龄(38.2±1.6)岁(范围,19~58岁);Dennis骶骨骨折分型,Ⅰ型3例,Ⅱ型9例;神经损伤3例,Gibbons分级Ⅱ级2例,Ⅲ级1例]。比较两组患者的手术时间、术中出血量、术中透视时间、骨折愈合时间及Majeed功能评分采用t检验,Mears和Velyvis评价、内固定置入准确度、骨折愈合率采用卡方检验,术后感染率采用Fisher精确检验,Gibbons分级变化采用秩和检验。结果所有患者均获得随访,随访时间(21.2±3.2)个月(范围,14~36个月)。手术时间,机器人组为(100.3±14.5)min,切开组为(202.0±18.5)min;术中出血量,机器人组为(180.0±17.4)ml,切开组为(850.0±15.2)ml;术中透视时间,机器人组为(23.3±4.5)s(包括切开前机器人扫描定位图像时间);切开组为(90.0±7.7)s。Mears和Velyvis评价,机器人组解剖复位7例,满意4例,不满意1例;切开组解剖复位7例,满意4例,不满意1例;两组复位满意率均为91.7%(11/12)。两组均置入36枚螺钉,其中机器人组螺钉置入准确率100%,切开组螺钉置入准确率为77.78%(28/36)。两组骶骨骨折均愈合,愈合率100%;愈合时间,机器人组(8.5±1.9)个月,切开组(12.8±2.4)个月。Majeed评分,机器人组(86.2±3.4)分,其中优7例,良4例,可1例;切开组(84.2±2.7)分,其中优6例,良4例,可2例。机器人组术后均未出现伤口感染,切开组术后出现1例伤口深部感染,2例表浅感染,感染率为25%。Gibbons分级,机器人组1例由术前Ⅱ级恢复至术后Ⅰ级,1例Ⅲ级恢复至术后Ⅱ级;切开组2例由术前Ⅱ级恢复至术后Ⅰ级,1例Ⅲ级恢复至术后Ⅱ级。机器人组与切开组患者Gibbons分级变化、Mears和Velyvis评价、骨折愈合率、Majeed评分及术后伤口感染率无统计学差异(均P>0.05);而在手术时间(t=14.99)、术中透视时间(t=32.13)、术中出血量(t=100.46)、内固定置入准确率(χ2=9.00)及骨折愈合时间(t=4.87)方面,机器人组均优于切开组,两组比较差异均有统计学意义(均P<0.05)。结论机器人辅助微创入路三角固定与传统切开固定相比,具有手术时间短、透视少、出血量小、内固定置入更为准确及骨折愈合时间短等优点,可作为治疗单侧不稳定性骶骨骨折的更优选择。     

肝细胞癌骶骨转移1例报告并文献复习

肝癌位居世界常见恶性肿瘤第6位,其死亡率居第3位,绝大多数为肝细胞癌(HCC)。近年来,肝癌诊断和治疗策略有所改善,患者生存时间得到延长,但5年生存率仍较低(16%),若发生肝外转移,生存率仅为4%[1-2]。有文献报道,HCC肝外转移发生率为15%~17%[3],除转移至肺、淋巴结、肾等,还可转移至皮下组织及骨骼肌肉系统[4]。在脊柱转移瘤中,骶骨转移瘤较胸椎(60%~80%)、腰椎(15%~30%)、颈椎(10%~15%)转移瘤发生率低[5-6]。肝癌骶骨转移发生率低,在局部呈多灶性、小片状、巨块状、虫蚀样改变,常累及骶孔,常见溶骨性破坏,破坏区无钙化,边缘不清晰。肿瘤若累及骶神经,可表现为运动感觉障碍及腱反射异常。本院2018年9月收治HCC骶骨转移患者1例,本研究组根据其临床表现,影像学、实验室及病理学检查并结合文献复习,探讨骶骨转移瘤的诊断,骶骨解剖结构、生物力学与手术治疗的关系及临床疗效评价,现报告如下。     

热湿敷配合腰骶部按摩诱导顺产后尿潴留产妇自行排尿的疗效观察

目的观察热湿敷配合骶2~骶4区间腰骶部按摩诱导顺产后尿潴留产妇自行排尿的疗效。方法将2017-01~2018-12的102例顺产后6 h无法自行排尿的产妇随机分成观察组和对照组各51例。对照组给予听流水声和开塞露塞肛门,观察组则行骶2~骶4区间腰骶部热毛巾湿敷并手法按摩,观察并记录两组产妇的临床疗效。结果观察组产后排尿成功率显著高于对照组,差异有统计学意义(P<0.01),排尿延迟率及需要插尿管率均显著低于对照组,差异有统计学意义(P<0.01)。结论热湿敷配合骶2~骶4区间腰骶部按摩能诱导顺产后尿潴留产妇自行排尿,方法简单易行,效果明显。     

机械力对骶韧带成纤维细胞细胞外基质mRNA表达的调节

目的观察机械力在盆底功能障碍性疾病中的作用,探讨机械力对子宫骶韧带成纤维细胞形态及细胞外基质mRNA表达的调节。方法选择本院因非POP行子宫切除手术患者的骶韧带,进行成纤维细胞的原代培养,并进行鉴定。选取13例3—4代的骶韧带成纤维细胞加载、加力,采用荧光实时定量PCR测量机械力对I、III型胶原、基质金属蛋白酶-1（matrixmetalloproteinase-1,MMP-1）、基质金属蛋白酶抑制剂（tissueinhibitorofmetalloproteinase-1,TIMP-1）mRNA表达量的调节。结果以静态不加力组（Oh）为对照组,应力刺激下,细胞的形态和伸展方向发生改变;加载力4、15hI型胶原mRNA表达量（0．7774-0．251,0．730±0．248）较0h（1．000±0．284）下降（q=4．5786,4．6458,P〈0．05）,24hmRNA表达量（1．102±0．308）回升,与0h差异无统计学意义（P〉0．05）。IⅡ型胶原mRNA4、15、24h表达量（4．771±0．879,6．146±1．109,5．022±0．907）较0h（1．001±0．284）升高（q=15．9481,21．7647,17．0099,P〈0．01）。MMP-1mRNA4h、15h、24h表达量（6．420±2．143,23．695±2．221,20．169±2．794）较0h（1．000±0．414）升高（q=9．3421,39．1178,33．0403,P〈0．01）。TIMP-14、15hmRNA表达量（0．455±0．370,0．481±0．386）较0h（1．000±0．425）下降（q=6．5265,6．3106,P〈0．05）,24hmRNA表达量（0．883±0．536）回升,与0h差异无统计学意义（P〉0．05）。结论子宫骶韧带成纤维细胞的形态、伸展方向及合成功能受机械力的调节,盆底基质重塑可能是对机械力的适应性改变。