经皮椎体成形术中骨水泥剂量对骨质疏松椎体力学性能的影响

目的探讨经皮椎体成形术(PVP)中注入骨水泥的剂量与各节段骨质疏松椎体强度和刚度恢复之间的关系。方法 54个骨质疏松椎体(T8～L4)取自6具女性尸体,脊柱不同节段的椎体分别被随机分成三个组:2、4和6ml骨水泥组。所有椎体标本被制成压缩性骨折,测定原始强度和刚度;经单侧椎弓根分别注射骨水泥2、4或6ml后再次进行压缩实验,测定强化后椎体的强度和刚度。结果 2ml骨水泥能使胸椎椎体强度增加,而腰椎及胸腰段椎体需要4ml。而对于刚度,2ml骨水泥可使胸椎和胸腰段椎体刚度增加,4ml骨水泥才能使腰椎椎体刚度增加。结论 2ml骨水泥即可使胸椎及胸腰段椎体强度和刚度恢复或增加,而腰椎椎体则需要4ml骨水泥,不同节段的椎体骨水泥用量不同,这些数据可为临床PVP中注射骨水泥剂量提供参考。     

国产药械行经皮椎体成形术的实验研究

目的探讨国产药械行经皮椎体成形术(PVP)的可行性,为临床应用提供数据与指标.方法国产骨水泥(PMMA)按粉(g)/液(ml)比例2∶1、3∶2、1∶1配制分组;另外在PMMA中加入静脉用非离子型对比剂,以增加其在X线下的显影,按粉(g)/液(ml)/对比剂(ml)比例2∶1∶1、3∶2∶1、1∶1∶1配制分组;共6组,6份/组.分别测量各组的物料状态时期及产热温度.将各组PMMA制成直径1.0 cm,高3 cm的圆柱状,行X线摄片,测量其密度,并行抗压强度测试.对3具经甲醛溶液浸泡的正常成年男性尸体胸腰段躯干部分(T3～S1)模拟PVP操作,自T4至L4在透视监测下间隔椎体用国产穿刺针经椎弓根穿刺,每具尸体穿刺7个椎体,共穿刺21个椎体,并在透视监视下注射PMMA,记录各椎体的注射量.注射PMMA后,分别游离尸体椎体,将注射PMMA的椎体与邻近的下一个未注射PMMA的椎体作为一对,共21对标本;以同一尸体为单位,注射PMMA的椎体为实验组,未注射PMMA的椎体为对照组进行最大抗压强度测试.结果加入对比剂后不同比例组PMMA在固化期的产热均显著降低,3∶2∶1组的平均温度为67.4℃.经X线摄片的密度测量,加入对比剂的各组较未加入对比剂的各对应组不透X线特性显著增强(t值分别为20.00, 20.00, 22.86;P值均＜0.001),但加入对比剂的各组密度差异无显著性意义(t值分别为1.11, 1.18, 0.59;P值均 > 0.05).3∶2∶1比例组的浆糊期为(127±4.70) s,最大抗压强度(mPa)为47.23.尸体模拟PVP操作,均1次性穿刺成功,无椎弓根骨折,胸腰椎PMMA的平均注射量分别为5 ml与7.5 ml, 3个椎体出现PMMA外溢. 3组未注入PMMA椎体的最大抗压强度(mPa)分别为3.28,3.63,3.69;3组注入PMMA椎体的最大抗压强度(mPa)分别为4.52,4.73,4.81;注入PMMA椎体的最大抗压强度显著高于对照组(t值分别为3.17,3.55,3.99;P值均＜0.01).结论国产药械行椎体成形术是安全可行的,国产骨水泥(PMMA)3∶2∶1比例组的物料状态时期与最大抗压强度适宜于PVP.     

国产灌注剂行经皮椎体成形术的实验研究

目的　评估不同配比浓度国产灌注剂的材料性能 ,探讨国产灌注剂用于经皮椎体成形术的可行性。方法　将国产灌注剂按粉液比 (g/ml)为 2∶1、3∶2、4∶3,及粉剂中BaSO4 的百分比为 0、10 %、2 0 %、30 %,分成 12个组 ,每组 8个样本 ,测定其聚合时间、CT值、强度和刚度。对结果进行多因素方差分析。结果　随着粉液比例及粉剂中BaSO4 的百分比的改变 ,国产灌注剂的聚合时间、CT值、刚度和强度明显改变 ,差异有显著性 (P <0 .0 5 )。结论　通过改变国产灌注剂的配比浓度 ,可使其获得较满意的材料性能 ,其在椎体成形术中有良好的应用前景。     

椎体成形术的生物力学研究

胸腰段椎体复位后椎体内存在空隙以及骨折裂隙 ,这种骨折后椎体力学强度不够 ,远不能负重。如在胸腰段骨折行椎弓根内固定的同时 ,经伤椎椎体内填塞或灌注自固化磷酸钙骨水泥(ＣＰＣ) ,即可增强椎体的强度 ,从而大大提高内固定系统的稳定性 ,也有利于患者早期康复。笔者对其进行生物力学研究 ,为临床提供理论依据。一、材料与方法1.材料 :( 1)标本准备 :6具经体积分数 4%甲醛固定的老年尸体胸腰椎标本 ,男 4例 ,女 2例 ;平均年龄 6 4岁 ;平均身高 16 6 .5ｃｍ ;平均体重 6 4.5ｋｇ ;储存时间平均 5个月 ;均摄正侧位片 ,以排除先天性畸形、骨…     

人胸腰椎微骨折与疲劳的关系探讨

目的　探讨人胸腰椎微骨折与疲劳的关系。　方法　采用 7具成人T12 ～L4 胸腰椎标本 ,随机分为 5组 :Ⅰ ,对照组 (不施加任何载荷 ,标本数 =6 ) ;Ⅱ ,轴向压缩破坏组 (标本数 =6 ) ;Ⅲ～Ⅴ为疲劳载荷组 (每组标本数 =7)。力学测试前测试所有标本的骨密度。疲劳组的载荷频率为 2Hz,疲劳次数为 2 0 0 0 0次。Ⅲ～Ⅴ疲劳组的疲劳载荷分别为II组破坏载荷的 10 % ,2 0 %和30 %。力学测试后拍摄X线平片。用环钻在每个椎体上取 4个圆柱形骨标本。将骨标本在碱性复红中染色后制成骨切片 ,显微镜下计数 3个区域的微骨折 ,并应用体视学的方法计算其密度。结果　疲劳后标本的X线平片未见异常 ,且Ⅳ组 (2 5 .2 6 % )和Ⅴ组 (2 5 .42 % )的刚度增长率较Ⅲ组(9.15 % )显著增高 (P <0 .0 5 ) ,Ⅲ～Ⅴ组微骨折的密度增加依次为 0 .45 ,0 .6 4,0 .94# /mm2 ,各组间差异有显著性意义 (P <0 .0 5 )。　结论　在生理载荷下 ,腰椎椎体松质骨可产生X线不能发现的微骨折 ,且微骨折密度及刚度随疲劳载荷的增加而显著增加。     

骨质疏松性椎体骨折患者椎体成形术中骨水泥定向注射对骨水泥注射量及相关并发症的影响

目的 探讨骨水泥定向注射结合椎体成形术对骨质疏松性椎体骨折患者术中骨水泥注射量及相关并发症的影响。方法 回顾性分析2017年5月—2018年5月冀中能源峰峰集团有限公司总医院北院区骨科骨质疏松性椎体骨折患者100例临床资料,男性57例,女性43例;年龄55～78岁,平均64. 9岁。骨折节段:T107例,T1113例,T1242例,L125例,L213例。依照手术方式不同将行传统经典注射方式患者50例纳入传统组,行骨水泥定向注射患者50例纳入定向组。比较两组患者围术期指标、骨水泥注入量、骨水泥分布、术后功能恢复以及术后并发症发生情况。结果 定向组手术时间、下地活动时间、住院总时间短于传统组[(33. 1±4. 4) min vs.(32. 7±3. 7) min、(2. 9±0. 4) d vs.(2. 9±0. 8) d、(9. 8±2. 1) d vs.(9. 9±2. 2) d],术中出血量高于传统组[(34. 7±5. 9) m L vs.(33. 9±5. 4) m L(P 0. 05)],骨水泥注入量少于传统组[(4. 6±0. 8) m L vs.(5. 8±0. 9) m L(P 0. 05)];骨水泥分布优良率(82%)高于传统组(56%)(P 0. 05);两组术后1个月VAS评分、功能障碍指数(ODI)评分、Cobb角比较差异无统计学意义(P 0. 05);定向组术后并发症发生率(4%)低于传统组(20%)(P 0. 05)。结论 骨水泥定向注射结合椎体成形术可减少骨质疏松性椎体骨折患者骨水泥注射量,改善骨水泥分布情况,减少术后并发症的发生。     

国产骨水泥行经皮椎体成形术的初步临床应用

目的　探讨利用国产骨水泥行经皮椎体成形术 (PVP)的临床应用价值。方法　利用国产骨水泥对 3 1例患者的 3 6个病变椎体采用经单侧椎弓根穿刺法行PVP治疗。骨水泥的配比方案为粉液比 (g/ml) 3 2 ,粉剂中BaSO4的百分比含量为 2 0 %。记录患者术前、术后 2 4h ,术后 1周、术后 1月的疼痛视觉模拟划线法 (VAS) ,完成日常生活的能力 (ADL) ,活动能力 ,服用止痛药情况的得分 ;同时于注射骨水泥前、注射过程中、注射结束后 10min、注射结束后 3 0min记录患者的生命体征 (血压、心率及血氧饱和度 )变化情况。结果　患者于注射骨水泥过程中各时间点的生命体征变化无显著性差异 (P >0 .0 5 )。患者术前与术后各时间点的VAS、ADL、活动能力及服用止痛药的得分之间存在统计学差异 (P <0 .0 5 )。PVP术后无 1例椎体塌陷加重或发生新的骨折。除 8例发生无症状的骨水泥渗漏外 ,无 1例发生严重并发症。结论　利用国产骨水泥行PVP安全可行 ,患者术后止痛效果满意 ,疗效稳定。     

经皮椎体成形术的实验研究

目的：探讨经皮椎体成形术（percutaneous vertebroplasty,PVP)的几个关键技术和其作用机制。方法：将骨水泥（聚甲基丙烯酸甲酯，polymethylmethacrylate,PMMA)的粉、液比例分别按1：1、3：2、2：1共3种方式调配，每组10份，在体外测试其聚合过程。将4具正常成人尸体胸腰段，分成2组，1组取T12－14共10个椎体，在CT＋X线透视下行经皮椎体穿刺，注入骨水泥，另1组取T12－L4共10个椎体，作抗压强度测试的对照组。将注射组和对照组分别游离成各10个单个椎体，双盲法测量其纵向最大抗压强度。结果：3种比例骨沙的稀、稠阶段持续时间及聚合时温度的升高值具有显著性差异（P＜0．05）；合适的PMMA粉、液比例为3：2，均未发生椎弓根及椎体前缘骨皮质 损伤，平均每个注入骨水泥4．5ml，有4个椎体出现椎旁静脉渗漏，注入PMMA的椎体的最大抗压强度比对照组提高约38％（P＜0．05）。结论：掌握适宜的PMMA粉、液比例和注射时机是 PVP成功的关键因素；采用经椎弓根穿刺行PVP是可行的途径；椎体内注射PMMA可显著增强其抗压强度。     

椎体成形术的实验研究

目的　通过对骨质疏松的山羊椎体成形探讨椎体成形术的安全性和临床应用依据。材料与方法　将 5只复制成功的骨质疏松的山羊每只取 3个椎体 (L1～L5)共 15个椎体作为手术组 ,2个椎体 (L1～L5)共 10个椎体作对照组。手术解剖出椎弓根直视下椎体穿刺 ,注入聚甲基丙烯酸甲酯 (PMMA ,骨水泥 )。测量椎体中心、椎体前缘和椎体后缘的温度变化。CT检查椎体骨水泥充填情况。 3天后处死动物每只取 1个注射椎体共 5个椎体行病理检查。将另 10个注射椎体和 10个未手术对照组椎体游离成单个椎体 ,去掉椎间盘和椎体附件 ,双盲法测量其纵向最大负载、极限强度、弹性模量。结果　注射后椎体的最大负载、极限强度、弹性模量比对照组明显提高 (P <0 .0 5 )。注射骨水泥后椎体内中心温度为 5 1.12℃ ,椎体前缘 37.31℃ ,后缘 37.6 1℃。大体病理和显微病理显示骨水泥弥散在椎体内骨小梁间呈不均匀分布 ,同CT检查结果一致。结论　掌握适宜的粉液比例和注射时机是椎体成形术的关键因素 ,椎体内注入骨水泥可显著增强其纵向最大负载、极限强度、弹性模量     

Sky骨扩张器与球囊椎体后凸成形术的对比性实验研究

目的 从3个方面探讨Sky骨扩张器与球囊椎体后凸成形术(PKP)对椎体复位的作用进行比较研究:(1)椎体生物力学性质的改善情况;(2)椎体高度的恢复情况;(3)术中骨水泥向椎体外渗漏情况.方法 取20个胸腰段椎体(老年骨质疏松性椎体),经万能力学试验机轴向加载,制造椎体压缩骨折模型,随即行Sky骨扩张器与球囊PKP,测定椎体在骨折前、后及骨水泥注入后的高度并记录骨水泥注入前、后最大负荷,计算其刚度.结果 Sky骨扩张器组与球囊组均能增加椎体最大负荷(P＜0.01)和恢复刚度,Sky骨扩张器组与球囊组在骨折椎体的高度恢复方面的差异无显著性意义(P＞0.05).Sky骨扩张器组与球囊组骨水泥均分布比较均匀、集中.结论 Sky骨扩张器与球囊PKP生物力学测量结果和椎体高度恢复等实验结果无显著性统计学差异且骨水泥的渗漏率极低.Sky骨扩张器的操作相对简单,易于控制,且比球囊扩张系统更经济,Sky骨扩张器后凸成形术为椎体压缩骨折疾病的治疗提供了一种新的选择.     

Knee injury and Osteoarthritis Outcome Score (KOOS) - validation of a Swedish version

The Knee injury and Osteoarthritis Outcome Score (KOOS) is a self-administered instrument measuring outcome after knee injury at impairment, disability, and handicap level in five subscales. Reliability, validity, and responsiveness of a Swedish version was assessed in 142 patients who underwent arthroscopy because of injury to the menisci, anterior cruciate ligament, or cartilage of the knee. The clinimetric properties were found to be good and comparable to the American version of the KOOS. Comparison to the Short Form-36 and the Lysholm knee scoring scale revealed expected correlations and construct validity. Item by item, symptoms and functional limitations were compared between diagnostic groups. High responsiveness was found three months after arthroscopic partial meniscectomy for all subscales but Activities of Daily Living.     

Endovascular management of carotid-cavernous fistulas

Objective To investigate endovascular treatment of traumatic direct carotid-cavernous fistulas （CCF） and their complications such as pseudoaneurysms. Methods： Over a five-year period, 22 patients with traumatic direct CCFs were treated endovascularly in our institution. Thirteen patients were treated once with the result of CCF occluded, 8 twice and 1 three times. Treatment modalities included balloon occlusion of the CCF, sacrifice of the ipsilateral internal carotid artery with detachable balloon, coll embolization of the cavernous sinus and secondary pseudoaneurysms, and covered-stem management of the pseudoaneurysms. Results All the direct CCFs were successfully managed endovascularly. Four patients developed a pseudoaneurysm after the occlusion of the CCF with an incidence of pseudoaneurysm formation of 18.2% （4/22）. A total number of 8 patients experienced permanent occlusion of the ICA with a rate of ICA occlusion reaching 36.4% （8/22）. Followed up through telephone consultation from 6 months to 5 years, all did well with no recurrence of CCF symptoms and signs. Conclusion Traumatic direct CCFs can be successfully managed with endovascular means. The pseudoaneurysms secondary to the occlusion of the CCFs can be occluded with stent-assisted coiling and implantation of covered stents.     

The acutely limping child

Acute limping may be the result of multiple pathologies in children. The differential diagnosis varies based on the age of the child. Irrespective of age, the initial imaging work-up includes AP and frog leg radiographs of the pelvis and ultrasound; MRI may sometimes be helpful. In children less than 3 years, infections and trauma are most frequent. MRI is the imaging modality of choice when osteomyelitis is clinically suspected. Between the ages of 3 and 10 years, transient synovitis of the hip and Legg-Calvé-Perthes disease are main considerations but infection, inflammation and focal bony lesions are also considered. In children over 10 years, slipped capital femoral epiphysis also is considered.     

Do Balance Board Training Programs Reduce the Risk of Ankle Sprains in Athletes?

Introduction Ankle sprains are the most common musculo-skeletal injury that occurs in athletes,particularly in sports that require jumping and landing on one foot such as soccer,and basketball(1-4).These injuries often result in significant time loss from participation,long-term disability,and have a major impact on health care costs and resources(5-8).     

High Intensity Interval Training:New Insights

KEY POINTS ·High-intensity interval training(HIT)is characterized by repeated sessions of relatively brief，intermittent exercise.often performed with an“a11 out”effort or at an intensity close to that which elicits peak oxygen uptake(i.e.，≥90%of VO2 peak).     

Developmental validation of the PowerPlex(®) ESI 16 and PowerPlex(®) ESI 17 Systems: STR multiplexes for the new European standard

In response to the ENFSI and EDNAP groups’ call for new STR multiplexes for Europe, Promega^® developed a suite of four new DNA profiling kits. This paper describes the developmental validation study performed on the PowerPlex^® ESI 16 (European Standard Investigator 16) and the PowerPlex^® ESI 17 Systems. The PowerPlex^® ESI 16 System combines the 11 loci compatible with the UK National DNA Database^®, contained within the AmpFlSTR^® SGM Plus^® PCR Amplification Kit, with five additional loci: D2S441, D10S1248, D22S1045, D1S1656 and D12S391. The multiplex was designed to reduce the amplicon size of the loci found in the AmpFlSTR^® SGM Plus^® kit. This design facilitates increased robustness and amplification success for the loci used in the national DNA databases created in many countries, when analyzing degraded DNA samples. The PowerPlex^® ESI 17 System amplifies the same loci as the PowerPlex^® ESI 16 System, but with the addition of a primer pair for the SE33 locus. Tests were designed to address the developmental validation guidelines issued by the Scientific Working Group on DNA Analysis Methods (SWGDAM), and those of the DNA Advisory Board (DAB). Samples processed include DNA mixtures, PCR reactions spiked with inhibitors, a sensitivity series, and 306 United Kingdom donor samples to determine concordance with data generated with the AmpFlSTR^® SGM Plus^® kit. Allele frequencies from 242 white Caucasian samples collected in the United Kingdom are also presented. The PowerPlex^® ESI 16 and ESI 17 Systems are robust and sensitive tools, suitable for the analysis of forensic DNA samples. Full profiles were routinely observed with 62.5 pg of a fully heterozygous single source DNA template. This high level of sensitivity was found to impact on mixture analyses, where 54–86% of unique minor contributor alleles were routinely observed in a 1:19 mixture ratio. Improved sensitivity combined with the robustness afforded by smaller amplicons has substantially improved the quantity of data obtained from degraded samples, and the improved chemistry confers exceptional tolerance to high levels of laboratory prepared inhibitors.