单侧椎弓根螺钉对侧关节突螺钉固定黄韧带保留治疗腰椎退变性疾病的临床疗效

目的：观察单侧椎弓根螺钉对侧关节突螺钉固定黄韧带保留治疗腰椎退变性疾病的临床疗效。方法对45例退变性腰椎间盘突出、椎管狭窄、下腰椎失稳患者采用单侧椎弓根螺钉对侧关节突螺钉固定黄韧带保留手术治疗,采用日本骨科协会（ Japanese Orthopedic Association,JOA）评分对手术疗效进行评估。通过影像学评价椎板关节突螺钉位置,并观察术后和末次随访时内固定位置、融合情况以及病变节段椎间隙高度情况。结果本组患者术后症状明显缓解,JOA评分较术前有显著改善,影像评价椎板关节突螺钉位置良好,未发现内固定松动和断裂,椎间融合率100%。结论单侧椎弓根螺钉对侧关节突螺钉固定黄韧带保留治疗腰椎退变性疾病手术创伤小,术后融合率高,有效预防了手术后神经粘连,疗效肯定。     

脊髓型颈椎病肌电图检测结果与临床术后评估的相关性分析

目的探讨脊髓型颈椎病（CSM）患者肌电图检测结果与其手术疗效间的相关性。 方法选择根据临床表现及影像学检查确诊的CSM患者,给予常规肌电图检查,排除合并腕管综合征、肘管综合征等周围神经病变的患者,共入选81例。均行颈前路减压植骨融合内固定术,术后进行随访。按照肌电图检查结果进行分类,并根据手术前、后日本骨科协会（JOA）颈椎病评定标准评分计算其临床改善率,相关数据进行统计处理,分析肌电图检测结果与临床改善率的相关性。 结果根据肌电图检查结果分为I型27例、II型19例、III型16例、IV型19例,术后疗效优34例、良23例、可16例、差8例,对肌电图类型与术后疗效的关系行秩和检验,结果显示：Hc=13.67,P<0.05,表明根据肌电图分型的CSM患者术后疗效比较,差异具有统计学意义。 结论CSM患者的肌电图检测类型与其临床改善率间存在显著相关性,因此肌电图检测有助于更准确地预测手术效果。     

肌电图联合MRI判断脊髓型颈椎病预后的相关性分析

[目的]探讨肌电图联合MRI检测在评估脊髓型颈椎病患者手术疗效中的应用价值。[方法]选择经临床表现及影像学检查确诊为脊髓型颈椎病的患者,给予常规肌电图检查,选取其中肌电图检查排除合并腕管综合征、肘管综合征等周围神经病变的患者共89例,根据病情采用前路、后路或后前路联合手术,术后进行随访。按照肌电图检查结果与MRI T2WI是否存在高信号进行分类,即Ⅰ型:EMG/MRI为-/-,Ⅱ型:EMG/MRI为-/+,Ⅲ:EMG/MRI型为+/-,Ⅳ型:EMG/MRI为+/+。根据手术前后JOA分值计算临床改善率,进而将相关数据进行统计处理,分析彼此间的相关性。[结果]肌电图表现为I型36例、Ⅱ型17例、Ⅲ型10例、Ⅳ型26例,术后疗效优42例、良20例、可18例、差9例,各种类型与术后疗效的关系行秩和检验,结果显示:Hc=30.72,P0.05,表明不同类型间术后疗效差异具有统计学意义。[结论]肌电图联合MRI检测类型与临床改善率间存在显著相关性,从而有助于更准确地预测手术效果。     

关节突螺钉固定在腰椎前路椎间融合手术中的应用研究

目的探讨分析关节突螺钉固定在腰椎前路椎间融合手术中的应用。方法选择16具尸体标本实施在腰椎前路椎间融合手术,按手术差异区分组别,探究组(n=8)及对比组(n=8),探究组在腰椎前路椎间融合手术基础上加以关节突螺钉固定,对比组实施单纯腰椎前路椎间融合手术。对两组尸体标本术后手术节段刚度情况及椎体活动度情况予以比较。结果经组间比较显示探究组术后手术节段刚度明显优于对比组(P0.05);探究组椎体活动度亦明显优于对比组(P0.05)。结论在腰椎前路椎间融合手术中运用关节突螺钉固定可提升术后机体稳定性,故可作为腰椎疾病首选手术方式。     

内皮祖细胞移植联合早期运动改善脊髓损伤区血管再生及后肢功能

BACKGROUND: Endothelial progenitor cells are widely used in the treatment of various vascular diseases, and early exercise training contributes to restore motor function after spinal cord injury. However, the therapeutic effects of endothelial progenitor cell transplantation or early exercise training alone are unfavorable. OBJECTIVE: To observe the influence of transplantation of endothelial progenitor cells combined with early exercise training on blood vessel regeneration and hind limb function in rats after spinal cord injury. METHODS: Eighty adult Sprague-Dawley rats were enrolled to establish spinal cord injury models using the modified Allen’s method, and then randomly divided into four groups. Rats were respectively given culture medium via the tail vein, injection of endothelial progenitor cells (3×106) via the tail vein, roller and treadmill trainings for 2 weeks, or injection of endothelial progenitor cells via the tail vein followed by 2 weeks of roller and treadmill trainings in the model, cell transplantation, exercise and combined groups. RESULTS AND CONCLUSION: At 2 weeks after transplantation, the hindlimb motor function of rats in the combined group was better than that in the cell transplantation group and exercise group, and moreover, the percentage of CM-Dil positive cells, the number of horseradish peroxidase-positive nerve fibers, capillary density and expression of vascular endothelial growth factor and brain-derived neurotrophic factor were also significantly higher in the combined group than the cell transplantation group and exercise group. These findings indicate that early exercise training has a neuroprotective role in spinal cord injury; endothelial progenitor cell transplantation combined with early exercise training can promote regeneration of synapses and blood vessels and improve hindlimb motor function of rats, probably by increasing expression levels of vascular endothelial growth factor and brain-derived neurotrophic factor.       

颈前路减压融合内固定治疗双节段脊髓型颈椎病术后轴性症状分析

目的:分析颈前路椎体次全切除融合内固定与颈前路双节段椎间盘摘除融合内固定治疗双节段脊髓型颈椎病术后轴性症状(AS)的发生情况。方法:2004年3月～2007年5月113例双节段脊髓型颈椎病患者分别行颈前路椎体次全切除融合内固定(A组,61例)和颈前路双节段椎间盘摘除融合内固定(B组,52例)。观察两组患者术前和末次随访时的JOA评分、融合节段高度和矢状面Cobb角,计算每组的神经功能改善率,统计每组术后颈部AS的发生率。结果:随访24～48个月,平均32.2个月。末次随访时A、B组神经功能改善率分别为(70.1±12.2)%、(63.5±4.7)%,无统计学差异(P0.05);融合节段高度变化值分别为-0.04±0.02cm、0.05±0.02cm,有统计学差异(P0.05);融合节段后凸率分别为34.4%、13.5%,有统计学差异(P0.05);颈部AS发生率分别为45.9%(28/61)、26.9%(14/52),有统计学差异(P0.05)。末次随访时融合节段高度降低者颈部AS发生率较高度增大者高(P0.05),A组中融合节段高度降低者的比例数明显大于B组(P0.05)。末次随访时,A组中融合节段明显后凸者的颈部AS发生率明显高于无后凸或轻度后凸者(P0.05),A组中融合节段明显后凸者的比例数明显大于B组(P0.05)。结论:颈前路减压融合内固定术后融合节段高度降低和明显后凸的患者AS发生率较高。与颈前路椎体次全切除融合内固定术相比,颈前路双节段椎间盘摘除融合内固定术治疗颈椎病在取得良好临床疗效的同时减少了术后颈部AS的发生。     

早期运动训练联合神经干细胞移植对脊髓损伤模型大鼠后肢运动功能的影响

BACKGROUND: Studies have shown that neural stem cell transplantation combined with exercise training can promote the recovery of hindlimb motor function from spinal cord injury in rats, but its mechanism of action has not been fully elucidated. OBJECTIVE: To investigate the effects of early exercise training combined with neural stem cell transplantation on the recovery of hindlimb motor function in rats with spinal cord injury. METHODS: Sixty Sprague-Dawley rats with spinal cord injury were randomly divided into three groups: control group (n=20, given conventional treatment after injury), cell transplantation group (n=20, given neural stem cell transplantation after injury), experimental group, (n=20, given neural stem cell transplantation combined with early exercise training after injury). Recovery of the hindlimb motor function was assessed by Basso, Beattie and Bresnahan scale and inclined plane test before and at 1, 7, 14, 21 days after injury. Western blot assay was used to detect caspase-3 and myeloperoxidase expression. Hematoxylin-eosin staining was done at 21 days after injury to observe the structure changes of the injured spinal cord. RESULTS AND CONCLUSION: (1) Scores of Basso, Beattie and Bresnahan scale and inclined plane test were significantly better in the experimental group than the cell transplantation group followed by the control group (P < 0.05). (2) In the control group, the expression of caspase-3 and myeloperoxidase was significantly increased at 14 days after injury. In the cell transplantation, the expression of caspase-3 and myeloperoxidase was significantly higher than the experimental group (P < 0.05). (3) Pathological inflammation was reduced most in the experimental group followed by the cell transplantation group. In the experimental group, the structure of injured spinal cord was improved and became relatively clear and intact. These findings indicate that neural stem cell transplantation combined with early exercise training can effectively promote the recovery of hindlimb motor function from spinal cord injury in rats, by reducing the expression of caspase-3 and myeloperoxidase and alleviating secondary lesion of the spinal cord.