后正中入路Dynesys置入对腰椎全椎板减压术后生理性稳定性的作用

目的：探讨经后正中入路切除腰椎椎管内神经鞘瘤同时行腰椎动态稳定重建系统（ Dynesys ）置入对重建脊柱生理性稳定的作用。方法对采用后正中入路全椎板切除上腰椎椎管内神经鞘瘤的6例患者,术后应用腰椎Dynesys进行脊柱稳定性重建。结果神经鞘瘤均完整切除。术后1周、3个月、6个月时X线片复查示腰椎过伸、过屈位各椎体活动度良好,椎间隙等宽;内置物位置良好,无临近节段退变、脊柱失稳、椎体滑脱现象。结论对腰椎椎管内神经鞘瘤采用全椎板切除后置入Dynesys能够充分暴露肿瘤所在区域的视野,完整切除神经鞘瘤,有效避免损伤脊髓神经。 Dynesys既能达到传统强直融合的脊柱稳定性,还能够有效重建生理性稳定,防止临近节段脊椎发生退变。     

比较不同方式置入椎弓根钉内固定修复胸腰椎爆裂骨折的生物相容性

BACKGROUND: During the repair of thoracolumbar fracture, pedicle screw fixation is a commonly used treatment method. In the process of fixation, the different approaches can be used.  OBJECTIVE: To compare effect and biocompatibility of pedicle screw by percutaneous approach, posterior median approach, and intervertebral space approach for thoracolumbar fracture.  METHODS: 118 cases of thoracolumbar fracture were included after pedicle screw fixation. All patients were divided into three groups according to the approach: posterior median approach group (38 cases), intervertebral space approach group (40 cases) and percutaneous approach group (40 cases). After 12 months of follow-up, perioperative conditions, pain score, vertebral height of anterior border, kyphosis correction effect, adverse events and biological compatibility were compared among three groups. RESULTS AND CONCLUSION: (1) Operation time, intraoperative bleeding and time in bed after surgery were shorter or less in the percutaneous approach and intervertebral space approach groups than in the posterior median approach group. Postoperative drainage was better in percutaneous approach and intervertebral space approach groups than in the posterior median approach group (all P < 0.05). Except drainage in the percutaneous approach and intervertebral space approach groups, no significant difference in other indicators was found. (2) Patients received imaging examination at different time points. The percentage of anterior vertebral height and kyphosis were significantly improved immediately after treatment and in final follow-up (all P < 0.05). No significant difference was detected before treatment, immediately after treatment and in final follow-up. (3) Visual Analogue score was identical before treatment. Visual analogue score was lower in the percutaneous approach and intervertebral space approach groups than in the posterior median approach group at 24 hours and 3 days after treatment and in final follow-up (all P < 0.05). No significant difference was detectable at 24 hours and 3 days after treatment and in final follow-up between the percutaneous approach and intervertebral space approach groups. (4) No rejection or wound non-healing was seen at 12 months after treatment. Some patients suffered from mild low back pain, which was improved by active symptomatic treatment. (5) These findings suggest that intervertebral space approach percutaneous approach obtained satisfactory outcomes compared with posterior median approach for treatment of thoracolumbar spine fractures, and good biocompatibility was found.        

桃红四物汤对老年骨质疏松性股骨粗隆间骨折患者PFNA术后血清RANKL、骨保护素水平及转化生长因子-β1表达水平的影响

目的探讨桃红四物汤对老年骨质疏松性股骨粗隆间骨折患者应用股骨近端防旋髓内钉(PFNA)术后临床疗效及血清核因子(NF)-κB受体活化因子配体(RANKL)、骨保护素(OPG)、转化生长因子(TGF)-β1表达水平的影响。方法采取前瞻性研究法,将238例老年骨质疏松性股骨粗隆间骨折患者,按照随机数字表法分为对照组(常规治疗)或观察组(桃红四物汤+常规治疗),每组119例。比较两组术后Harris评分、骨折愈合时间及手术前后血清骨钙素(OC)、血清骨型碱性磷酸酶(BLAP)、全甲状腺旁腺素(i PTH)、Ⅰ型胶原羧基端肽β特殊序列(β-CTX)、总Ⅰ型胶原氨基酸延长肽(t PⅠNP)、骨形态发生蛋白(BMP)-2、血管内皮生长因子(VEGF)、胰岛素样生长因子(IGF)-1、白细胞介素(IL)-1、IL-6、IL-10、IL-18、肿瘤坏死因子(TNF)-α、RANKL、OPG、TGF-β1水平差异。结果观察组Harris评分优良率[86.6%(103/119)]明显高于对照组[76.5%(91/119),χ~2=2.117,P=0.034]。观察组骨折愈合时间(13.2±1.3)w明显少于对照组[(14.5±1.5)w,t=7.144,P=0.000]。术后3个月,观察组OC、BLAP、t PⅠNP、VEGF、IGF-1、TGF-β1水平明显高于对照组,而i PTH、β-CTX、BMP-2、IL-1、IL-6、IL-10、IL-18、TNF-α、RANKL、OPG水平明显低于对照组(均P<0.05)。结论桃红四物汤可改善老年骨质疏松性股骨粗隆间骨折患者骨代谢水平及骨折愈合微环境,减少炎症因子释放,加速骨折愈合。