微创和传统开放后路腰椎椎间融合术治疗腰椎退行性疾病的远期预后

目的探讨微创后路腰椎椎间融合术(MIS-PLIF)和传统开放PLIF对腰椎退行性疾病(LDD)远期疗效及安全性的影响。方法 2011年1月-2014年12月收治LDD患者182例,其中96例采用传统开放PLIF治疗(PLIF组),86例采用MIS-PLIF治疗(MIS-PLIF组)。比较2组腰椎矢状位参数、多裂肌横截面积及萎缩率、融合率、疼痛视觉模拟量表(VAS)评分、日本骨科学会(JOA)评分、Oswestry功能障碍指数(ODI)及术后并发症发生情况,分析多裂肌萎缩率与顽固性腰背痛的相关性。结果 2组术后各随访时间点椎间隙高度恢复值和节段性前凸角恢复值差异均无统计学意义(P > 0.05)。2组术后1年腰椎前凸角恢复值差异无统计学意义(P > 0.05);但术后5年和末次随访时,MIS-PLIF组腰椎前凸角恢复值显著高于PLIF组,差异均有统计学意义(P < 0.05)。MIS-PLIF组术后各随访时间点多裂肌横截面积大于PLIF组,多裂肌萎缩率低于PLIF组,差异均有统计学意义(P < 0.05)。2组术后随访6个月融合率差异无统计学意义(P > 0.05)。2组术后各随访时间点下肢痛VAS评分差异无统计学意义(P > 0.05);MIS-PLIF组术后各随访时间点腰痛VAS评分、JOA评分及ODI均优于PLIF组,差异有统计学意义(P < 0.05)。MIS-PLIF组顽固性腰背痛发生率显著低于PLIF组,差异有统计学意义(P < 0.05)。合并顽固性腰背痛患者多裂肌萎缩率高于未合并顽固性腰背痛的患者,差异有统计学意义(P < 0.05)。结论术后多裂肌萎缩可能是导致顽固性腰背痛的重要原因,相较于传统开放PLIF,MIS-PLIF治疗LDD能够更有效地保持腰椎生理曲度,改善肢体活动功能,降低多裂肌萎缩程度,有助于避免顽固性腰背痛的发生。     

Hip Displacement in Cerebral Palsy: The Role of Surveillance

IntroductionHip displacement is common in cerebral palsy (CP) and is related to the severity of neurological and functional impairment. It is a silent, but progressive disease, and can result in significant morbidity and decreased quality of life, if left untreated. The pathophysiology of hip displacement in CP is a combination of hip flexor-adductor muscle spasticity, abductor muscle weakness, and delayed weight-bearing, resulting in proximal femoral deformities and progressive acetabular dysplasia. Due to a lack of symptoms in the early stages of hip displacement, the diagnosis is easily missed. Awareness of this condition and regular surveillance by clinical examination and serial radiographs of the hips are the key to early diagnosis and treatment.Hip surveillance programmesSeveral population-based studies from around the world have demonstrated that universal hip surveillance in children with CP allows early detection of hip displacement and appropriate early intervention, with a resultant decrease in painful dislocations. Global hip surveillance models are based upon the patients’ age, functional level determined by the Gross Motor Function Classification system (GMFCS), gait classification, standardized clinical exam, and radiographic indices such as the migration percentage (MP), as critical indicators of progressive hip displacement.ConclusionDespite 25 years of evidence showing the efficacy of established hip surveillance programmes, there is poor awareness among healthcare professionals in India about the importance of regular hip surveillance in children with CP. There is a need for professional organizations to develop evidence-based guidelines for hip surveillance which are relevant to the Indian context.     

Prevalence of degenerative disease in temporomandibular disorder patients with disc displacement: A systematic review and meta-analysis

To assess the available literature on the prevalence of degenerative joint disease (DJD) in patients with anterior disc displacement (ADD) of the temporomandibular joint (TMJ), using a systematic review with meta-analysis.Search strategies were performed in the following databases: PubMed/MEDLINE, EMBASE, LILACS, Web of Science, Scopus, and LIVIVO. A search was also carried out in the gray literature. Two independent reviewers selected the included articles using a two-phase process based on the eligibility criteria. Three reviewers independently collected the required information from the included articles. The methodological quality of the selected studies was assessed individually.In accordance with the inclusion and exclusion criteria, 1349 studies were found and 18 articles were included. The total sample size was 3158 TMJs. The sex distribution was predominant for females (1161 females and 345 males). The average age was 46 (range 10–82) years. Among the 1762 TMJs quantitatively assessed, the prevalence of DJD involving disc displacement with reduction (DDWR) was 35%, while for disc displacement without reduction (DDWoR) the prevalence was 66%. The prevalences of different features of DJD were as follows: sclerosis 24.3%, erosion 23.5%, osteophyte 17.9%, and subcortical cyst 7.6%.The prevalence of DJD in temporomandibular disorder patients with disc displacement is around 50% and is higher in DDWoR (66%) than in DDWR (35%). Sclerosis and erosion would be the most expected radiological signs in a developing DJD. Clinicians should adequately address the frequent DJD features associated with disc displacement in terms of diagnostics and therapeutic management.     

颈椎终板弧形高度与椎间隙后缘骨赘的相关性研究

目的：通过对颈椎病患者上下终板弧形高度、椎间隙高度与椎间隙后骨赘的影像学测量，研究其相关性及其临床应用价值。方法：收集2017年9月至2018年9月颈椎病手术108例患者的临床资料，男48例，年龄30~72岁，平均52岁，女60例，年龄37~79岁，平均54岁。其中C_2，3 6例，C_3，4 15例，C_4，5 32例，C_5，6 42例，C_6，7 13例。术前及术后摄颈椎X线片，利用PACS（Picture Archiving and Communication Systems）调阅影像，测量椎间隙的下上终板弧形高度（L₁，L₂），椎间隙高度（L₃）及后方骨赘的宽度（L₄）。利用Spearman分析它们之间的相关性。结果：L₁与L₄对比（r=-0.34，P<0.05），L₃与L₄对比（r=-0.36，P<0.05），存在负相关。L₁与L₃对比（r=0.38，P<0.05），L₂与L₃对比（r=0.48，P<0.05），存在正相关。L₁与L₂对比（P>0.05），L₂与L₄对比（P>0.05），差异无统计学意义。结论：下终板弧形高度与椎间隙后缘骨赘宽度呈负相关，通过其测量可明确颈椎退变程度，对颈椎病的早期防治有指导意义。     

髋关节置换术治疗老年患者的严重粉碎移位的股骨粗隆间骨折的临床研究

目的：观察使用髋关节置换术治疗严重粉碎移位的股骨粗隆间骨折老年患者的临床疗效。方法：选取严重粉碎移位股骨粗隆间骨折老年患者103例,他们均是2018年4月-2020年4月期间被我院收治入院实施手术治疗。将患者分成两组施行手术,其中研究组53例,该组患者接受髋关节置换术治疗,对照组50例,该组患者接受内固定术治疗。患者治疗后进行3个月的随访,观察患者的治疗效果以及症状的改善程度、症状体征恢复情况,包括骨折愈合时间、手术后关节可活动时间,记录好患者治疗后出现的不良反应类型。结果：研究组骨折愈合时间(31.8±8.59)天、术后可活动时间(6.9±2.69)天,均显著少于对照组,而Harris评分(92.7±1.88)分明显高于对照组,差异具统计学意义(P<0.05)。研究组治疗后总有效率(96.2%)明显高于对照组(76.0%),差异具统计学意义(P<0.05)。研究组不良反应发生率(9.43%)明显低于对照组(20%),差异具统计学意义(P<0.05)。结论：运用髋关节置换术治疗老年患者严重粉碎移位的股骨粗隆间骨折,可达到创口小、疼痛低的效果,症状得到更好的改善,骨折愈合时间更短、不良反应少,安全性和预后良好。     

大鼠尾椎间盘退变造模器械的研发与应用

目的:研制一种简便、微创、针刺深度可控的大鼠椎间盘退变模型的造模器械。方法 :自行设计一种新型针刺大鼠尾椎间盘退变的造模器械,由C型套环和针筒两部分构成。取3月龄雄性SD大鼠20只,分为针刺组(10只)和对照组(10只),将造模器械的C型套环套在鼠尾上,用21G针对针刺组的大鼠尾椎Co6/7、Co8/9椎间盘分别行横贯(10mm)和半横贯穿刺(5mm);对照组大鼠尾椎无任何处理。造模前和造模后4周时对两组大鼠的尾部行X线片和MRI检查,在X线片上测量椎间盘高度,计算目标椎间盘高度指数(DHI)比;在MRI T2像上采用Pfirrmann评分评价目标椎间盘退变情况。再处死大鼠取目标椎间盘固定切片后行番红O染色,观察椎间盘退变情况;对非针刺节段尾椎间盘内注射造影剂(碘海醇)后,X线下显影并用针抽吸髓核组织。结果:造模过程中大鼠无死亡,术后无感染等并发症。向大鼠椎间盘注射碘海醇后造影显影良好,可以抽取一定量的髓核组织。造模后4周,针刺组Co6/7和Co8/9的DHI比分别为0.65±0.07和0.73±0.09、Pfirrmann退变评分分别为4.3±0.82和3.5±0.71分,对照组分别为0.98±0.02和0.97±0.02、1.1±0.32分和1.1±0.32分,两组同节段比较均有显著性差异(P0.05),针刺组两个节段间比较有显著性差异(P0.05),对照组两个节段间比较无显著性差异(P0.05)。番红O染色针刺组Co6/7髓核消失,与纤维环界限不清,终板骨化;针刺组Co8/9穿刺侧髓核和纤维结构紊乱,另一侧髓核与纤维环较完整;对照组Co6/7和Co8/9髓核、纤维环和终板形状完整,结构清晰。结论:造模器械穿刺可以成功建立大鼠尾椎间盘退变模型,且横贯穿刺较半横贯穿刺椎间盘退变重;利用该造模器械可以向椎间盘内注射造影剂或药物,抽取髓核。     

脊柱-骨盆矢状面参数与腰椎椎间盘突出症相关性研究进展

腰椎椎间盘突出症(LDH)是指腰椎椎间盘发生退行性病理改变,纤维环破裂,髓核组织从破裂处突出/脱出,刺激或压迫神经引起的以腰腿痛为主要症状的病变,给患者的工作生活带来一定影响。近年有研究发现,脊柱-骨盆矢状面参数与LDH密切相关,正常脊柱-骨盆形态可使身体处于最佳平衡状态,若发生改变则平衡状态被破坏,导致脊柱矢状面生物力学发生改变,从而加速脊柱退行性变[1-3]。本文查阅分析脊柱-骨盆矢状面参数与LDH的相关性研究,发现脊柱-骨盆矢状面失衡不仅与LDH的发生机制相关,且与其临床症状和预后也有关联,现综述如下。