预防性应用不同剂量甲基强的松龙对缺血再灌注损伤大鼠脊髓热休克蛋白27表达的不同影响

目的 研究预防性运用不同剂量甲基强的松龙(MP)对脊髓缺血再灌注损伤(SCII)后热休克蛋白27(Hsp27)表达的不同影响,探讨运用MP预防SCII的最佳剂量.方法 随机将100只大鼠平均分成A、 B、 C、 D、 E五组,采用夹闭腹主动脉后再灌注的方法建立大鼠SCII模型.A组不夹闭腹主动脉,余组用上述方法制SCII模型,C、D、E三组在术前30 min分别预防性应用10、20、30 mg/kg MP,B组给予同等剂量生理盐水,都通过尾静脉注射给药.3 h后取各组大白鼠脊髓标本,行HE染色观察,并用免疫组化的方法测量Hsp27的相对含量.结果 E组大鼠神经元的形态改善最明显.E组Hsp27的表达量最高,五组之间总体上差异有统计学意义(P<0.05).结论 预防性运用30 mg/kg MP可使对脊髓缺血再灌注损伤具有保护作用的Hsp27表达上调最明显,减少脊髓缺血再灌注损伤效果最好.     

甲泼尼龙预干预脊髓缺血再灌注损伤对Caspase-3表达的影响

目的 探讨甲泼尼龙(MP)预处理脊髓缺血再灌注损伤(SCII)对Caspase-3的影响.方法 取健康纯种成年雄性SD大鼠120只,随机分成3组:对照组(A组)只暴露腹主动脉,不做模型;SCII组(B组)夹闭腹主动脉30 min后松开,再灌注3 h建立SCII模型,然后处死大鼠,取腰段脊髓标本;MP组(C组)于建立SCII模型前30 min尾部静脉注射MP(30 mg/kg).通过HE染色观察损伤节段脊髓病理形态学变化,用免疫组织化学染色方法观察脊髓组织Casepase-3的表达.结果 A组神经元细胞轮廓清晰、极性存在、核圆、核仁清楚,尼氏体呈网状均匀排列于细胞核周围,胞浆均匀深染,组织结构完整清楚,无中性粒细胞浸润,无出血、水肿等异常现象;B组神经元细胞肿胀,数目减少,极性变钝,核仁轻度萎缩,尼氏体呈颗粒状、淡染,组织中有中性粒细胞浸润;C组部分神经元细胞轻度水肿,核仁尚清,组织中未见中性粒细胞浸润.B组脊髓组织内Caspase-3大量表达,与对照组比较差异有统计学意义(P<0.05);C组脊髓细胞内Caspase-3轻度增加,与B组比较差异有统计学意义(P<0.05).结论 MP预处理可降低大鼠SCII中Caspase-3的表达,预防性应用MP能减轻SCII,保护脊髓神经功能.

Abstract：

Objective To investigate the effect of methylprednisolone (MP) pretreatment of ischemia-reperfusion injury of spinal cord (SCII) on expression of caspase-3 in rats. Methods One hundred and twenty healthy, purebred, adult male SD rats were randomly divided into 3 equal groups (n = 40).Croup A was a normal one in which only the abdominal aorta was exposed without establishing an injury model. Croup B was an SCII model in which the abdominal aorta was first obstructed for 30 minutes and then relaxed and next reperfused. After reperfusion for 3 hours, the rats were killed to harvest samples of lumbar spinal cord. Group C was an MP pretreatment one in which tail intravenous injection of MP (30mg/kg) was conducted 30 minutes before establishment of an SCII model. Pathological changes of the injured spinal cord were observed by HE staining, and expressions of caspase-3 in the spinal cord tissue were observed by immunohistochemical staining. Results In group A, the outlines of neuronal cells were clear with polarity and a round nucleus. Ramified Nissl bodies were evenly arranged around the nucleus. Cytoplasm was stained uniformly dark. Organizational structure was integrated and clear without neutrophile granulocyte infiltration,hemorrhage or edema. In group B, neuronal cells were swelling and decreased in quantity, with blunt polarity and mild atrophy of nucleolus. Cranuloses of Nissl bodies were observed with pale staining. There was neutrophile granulocyte infiltration. In group C, mild edema was observed in part of neuronal cells, nucleoli were still clear and there was no neutrophile granulocyte infiltration. Caspase-3 was highly expressed in the spinal cord tissue in group B, with significant differences compared with group A ( P < 0. 05). Expression of caspase-3 in the spinal cord was slightly increased in group C, but the difference was significant compared with group B (P < 0. 05) . Conclusion Since MP pretreatment can reduce expression of caspase-3 in SCII rats, preventive use of MP may alleviate SCII and help protect neural function of the spinal cord.     

后路经椎弓根半椎体切除融合内固定治疗半椎体畸形

目的 评价后路经椎弓根半椎体切除、植骨内固定治疗半椎体畸形的疗效.方法 回顾性分析2007年6月至2009年6月共30例接受经椎弓根半椎体切除、植骨内固定治疗的先天性半椎体畸形病例,比较术前、术后脊柱全长正侧位片及脊柱侧凸Cobb角.结果 术前冠状面主弯Cobb角平均46.52°,术后Cobb角14.64°,侧凸平均矫正率68.51%,术前术后主弯Cobb角比较差异有统计学意义(P<0.05);无内固定断裂、出现神经症状病例.结论 后路经椎弓根半椎体切除、融合内固定治疗半椎体畸形可有效地矫正畸形.     

支具治疗指导表指导治疗青少年特发性脊柱侧凸的临床疗效

目的 建立支具治疗指导表并评价其是否能够正确而有效地指导青少年特发性脊柱侧凸(adolescent idiopathic scoliosis,AIS)患者的支具治疗.方法 2008年3月至2010年6月,采用改良Cheneau支具治疗68例顶椎(apex vertebrae,AV)均在T6以下的AIS患者.根据是否使用支具治疗指导表分组:干预组51例,男16例,女35例;年龄10.6～17.2岁,平均13.6岁;Cobb角20°～38°,平均29.5°;Risser征2～4级;椎体旋转度0～2.对照组17例,男6例,女11例;年龄10.8～16.8岁,平均13.2岁;Cobb角20°～37°,平均28.7°;Risser征2～4级;椎体旋转度0～2.对照组患者在初诊或复查时,被告知规范化的治疗方案;而干预组患者将获得支具治疗指导表2份,嘱其必须按照表格的要求治疗.分析治疗前、治疗后6、12、18个月的Cobb角,评价两组患者的支具治疗效果.结果 对照组中1例和干预组中2例女性患者失访,余65例随访时间为18～27个月.支具治疗指导表的α系数及内部相关系数值均＞0.60,内容效度良好,表格接受率为97.54%(199/204),合格率为100.00%(199/199).对照组Cobb角从28.71°降至25.76°,干预组从29.47°降至21.59°.在治疗18个月时,对照组有4例、干预组有34例患者的Cobb角减小值≥5°,两组Cobb角变化比较,差异有统计学意义.结论 支具治疗指导表具有良好的信度和效度,能够正确有效地指导AIS患者的支具治疗.

Abstract：

Objective To guide bracing treatment for adolescent idiopathic scoliosis (AIS). Methods A total of 68 AIS patients with apex vertebrae (AV) under T6 had received the improved Cheneau bracing treatment between March 2008 and June 2010. All patients were divided into two groups. There were 16males and 35 females, with a mean age of 13.6 years (range, 10.6-17.2) in the intervention group. The mean Cobb angle was 29.5° (range, 20°-38°); Risser sign was 2-4; Vertebralrotation degree was 0-2 in the group;while there were 6 males and 11 females, with a mean of 13.2 years (range, 10.8-16.8) in the control group.The mean Cobb angle was 28.7° (range, 20°-37°); Risser sign was 2-4; Vertebralrotation degree was 0-2 in the control group. All patients in control group were informed standardized bracing treatment method. But we gave patients in intervention group two copies of "The Form of Guiding Bracing Treatment" treatment of patients with AIS, and informed that they carried out the bracing treatment according requirement of the form.Cobb angle was measured before the treatment and at 6th, 12th, 18th month after treatment. Results Sixtyfive cases were followed up for 18-27 months. However, one female in control group and two females in intervention group were lost during follow-up. Coefficient and intraclass correlation coefficient of form were both over 0.60. The acceptance rate of the table was 97.54%(199/204), qualified rate was 100.00%( 199/199), and with good content validity. The mean Cobb angle decreased gradually from 28.71° to 25.76° in control group and from 29.47° to 21.59° in intervention group. Four cases in control group and 34 cases in intervention group had reduced more than 5° at 18 months after treatment. There was significant difference regarding Cobb angle between two group. Conclusion The form of guiding bracing treatment has good reliability and validity and can guide bracing treatment of AIS correctly and effectively.     

后路选择性椎弓根螺钉内固定矫正青少年特发性脊柱侧凸

目的探讨后路选择性节段椎弓根螺钉内固定治疗青少年特发性脊柱侧凸（AIS）的效果。方法47例AIS患者均行后路矫形,术前均行详细的临床和影像学检查评估,术后及随访时拍X线片,对侧凸Cobb角、顶椎旋转度、躯干偏移进行测量和分析。结果术后全部患者获11—48个月随访,平均16．6个月。手术前主侧凸Cobb角平均为53．4°±10．7°,术后平均为12．5°±5．3°,平均矫正率为68．0％,终末随访矫正丢失率平均2．1％。本组患者均无躯干失平衡及断钉、断棒。结论后路选择性节段椎弓根螺钉系统治疗青少年特发性脊柱侧凸可获得良好的临床效果。     

经皮椎体成形术治疗老年胸腰椎骨折对患者手术创伤程度及脊柱功能的影响

目的 探讨经皮椎体成形术(PVP)治疗老年胸腰椎骨折对患者手术创伤程度及脊柱功能的影响。方法 选择老年胸腰椎骨折患者113例,依据手术方法分为PVP组54例与开放组59例。PVP组采用PVP治疗,开放组采用切开复位内固定术治疗。记录两组出血量、住院时间和手术时间,术前和术后生物力学变化,术前、术后3 d和术后6个月视觉模拟评分(VAS)、椎体前缘高度和椎体后缘高度、后Cobb角和Oswestry功能障碍指数(ODI)变化。结果 PVP组出血量显著少于开放组,住院时间和手术时间显著短于开放组(P<0.05)。两组术后最大抗压强度和刚度较术前显著升高,而高度较术前显著降低(P<0.05);且PVP组术后最大抗压强度和刚度显著高于开放组,而高度显著低于开放组(P<0.05)。两组术后3 d和术后6个月VAS较术前显著降低(P<0.05);且PVP组显著低于开放组(P<0.05)。两组术后3 d椎体前缘高度较术前显著增加,而后凸Cobb角显著降低(P<0.05);但两组无统计学差异(P>0.05)。两组术后3 d和术后6个月ODI评分较术前显著降低(P...     

椎间孔镜靶向单通道治疗青年腰椎融合术后相邻节段退变

目的：比较椎间孔镜靶向单通道髓核摘除术（targeted one-channel percutaneous transforaminal endoscopic discectomy,TO-PTED）和腰椎间孔椎间融合术（transforaminal lumbar interbody fusion,TLIF）治疗青年腰椎融合术后相邻节段退变的临床疗效。方法：对2017年9月至2019年2月收治的64例青年腰椎融合术后相邻节段退变患者进行回顾性分析。其中30例采用TO-PTED治疗（TO-PTED组）,男19例,女11例;年龄23~34（31.20±1.67）岁;病程10~39（26.30±0.41）个月。34例采用TLIF治疗（TLIF组）,男21例,女13例;年龄22~34（32.10±1.74）岁;病程11~40（27.10±0.32）个月。比较两组患者的手术时间、术中出血量、住院时间、X线透视次数;术前、术后1个月、末次随访采用视觉模拟评分（visual analogue scale,VAS）和日本骨科协会（Japanese Orthopaedic Association,JOA）评分对临床疗效进行评估。结果：手术时间、术中出血量、住院时间、X线透视次数TO-PTED组分别为（76.30±5.08）min、（38.80±4.21）ml、（3.90±1.13）d、（8.80±2.53）次,TLIF组分别为（118.50±11.06）min、（162.71±19.31）ml、（7.30±1.42）d、（4.10±0.82）次,两组比较差异有统计学意义。所有患者获得随访,时间12~24（18.00±5.63）个月,在术后1个月及末次随访两组患者的VAS和JOA评分较术前均有明显改善,TO-PTED组优于TLIF组。结论：TO-PTED和TLIF治疗青年腰椎融合术后相邻节段退变均能获得良好的疗效,TO-PTED在减少手术时间、术中出血量和术后恢复时间方面更有优势,但手术期间会增加患者接受术中辐射的次数