经皮椎体成形术治疗胸腰椎压缩骨折350例临床研究

目的探讨经皮椎体成形术治疗胸腰椎压缩骨折的疗效、术中策略及并发症的预防。方法回顾性研究2004年6月—2010年6月采用经皮椎体成形术治疗胸腰椎压缩骨折350例,术后并发骨水泥渗漏2例术中骨水泥渗漏到椎管内,压迫脊髓神经产生腰背痛及下肢放射性疼痛,于术后12 d及23 d行椎管探查渗漏骨水泥清除术。结果随访12～22个月。VAS评分从术前(9.2±0.6)分到术后(2.3±1.5)分和最终随访(2.6±1.2)分(P<0.05)。Oswestry功能评分由术前(64±8.1)分到术后(25±4.4)分和最终随访(27±3.7)分(P<0.05)。结论椎体成形术(PVP)是微创治疗椎体骨质疏松压缩骨折的有效方法。通过充分的术前准备及术中策略可有效减少并发症的发生。     

经皮椎体成形术的临床应用

目的　探讨经皮椎体成形术 (PVP)治疗椎体病变引起的压缩骨折的技术操作和临床效果。资料与方法　对 30例共 4 6个椎体行PVP ,其中骨质疏松 2 0例 ,血管瘤 1例 ,多发性骨髓瘤 1例 ,转移瘤 8例。年龄 31～ 98岁 ,平均 5 8岁。穿刺方法为患者俯卧 ,影像增强器向矢状面足侧成角 10°～ 15° ,椎体上下缘没有双边影 ,使欲穿刺侧的椎弓根投影在椎体的中外 1/ 3处 ,将穿刺针、X线管、椎弓根成一直线进针 ,穿刺成功后将聚甲基丙烯酸甲酯 (PM MA ,骨水泥 )按粉液比 3∶2 (g/ml)混合成糊状 ,在透视下用 1ml注射器均匀缓慢注入病变椎体。如骨水泥弥散不良再行对侧穿刺。术后当天、7天、1个月、3个月CT检查注射椎体 ,随访病情变化。结果　所有病例均成功施行了PVP ,单侧穿刺 32个椎体 (胸椎 8个 ,腰椎 2 4个 ) ,双侧穿刺 14个椎体 (胸椎 8个 ,腰椎 6个 )。单侧穿刺胸椎骨水泥平均用量 2 .5ml,腰椎 3.7ml;双侧穿刺胸椎骨水泥平均用量 3.2ml,腰椎 4 .7ml。治疗效果同骨水泥的注射量无关 ,同单双侧穿刺无关。 2 1例良性病例疼痛完全缓解 (CR) 14例 ,部分缓解 (PR) 7例 ;9例恶性病例中PR 7例 ,2例无效(NR) ;随访 6个月良性病例止痛效果良好 ,恶性病例 3个月后止痛效果下降。CT、X线随访骨水泥术后形态无变化 ,未见椎体     

经皮椎体成形术治疗骨质疏松性椎体骨折疗效观察

目的探讨经皮椎体成形术治疗骨质疏松性椎体压缩性骨折的临床疗效及应用价值。方法36例骨质疏松性压缩性骨折患者45个椎体，在C型臂X线透视下，取俯卧位，经皮穿刺，在病椎注入聚甲基丙烯酸甲酯。术前及术后3d进行疼痛视觉类比评分（VAS评分），并进行统计学分析。结果治疗后36例患者疼痛较治疗前有明显好转，VAS评分差异有统计学意义（P〈0．001）；活动能力也有不同程度改善；部分椎体的前缘和椎体中部高度有一定恢复。结论经皮椎体成形术治疗骨质疏松性椎体压缩骨折止痛效果明显，能很快改善患者的活动能力，早期下床活动。该手术属微创手术，在骨科临床有一定的应用前景。     

应用椎体成形术治疗老年骨质疏松性椎体压缩骨折疗效观察

目的:观察老年骨质疏松性椎体压缩性骨折应用椎体成形术治疗疗效。方法对20例22个椎体经皮穿刺椎体成形术治疗的老年骨质疏松性压缩骨折患者,术前均行胸腰椎正侧位X线片及T1W1,T2W1及STIR像MRI检查,结合患者的疼痛及叩痛部位来确定病椎。其中单侧注射10例,双侧注射12例,骨水泥注射量3~6 ml。临床疗效采用VAS评分和Roland-Morris功能评分进行评价。结果VAS评分由术前9.07到术后2.46和最终随访时2.15(P<0.001)。RolandMorris评分由术前21.25到术后6.70和最终随访时5.55(P<0.01),所有患者腰背疼痛均基本缓解,其中18例疼痛完全消失,2例基本缓解。2例出现不同程度骨水泥渗漏,但渗漏至椎间隙及椎体前缘约2mm,无神经压迫症状。术后患者均于术后3h至术后第2d下地行走,翻身及行动时疼痛缓解最为明显。结论应用椎体成形术是老年性骨质疏松性压缩骨折的很好的治疗方法,但需严格掌握适应症,术中掌握骨水泥搅拌时间及注入时机。     

单侧经皮后凸成形术治疗老年骨质疏松性椎体压缩骨折治疗体会

目的分析单侧经皮椎体后凸成形术(PKP)治疗老年骨质疏松性椎体压缩骨折(OVCF)的临床疗效。方法 2015年1月—2017年12月西南医科大学附属中医医院采用PKP治疗老年OVCF患者共113例,其中男性41例,女性72例;年龄70～97岁,平均75. 1岁。患者均行单侧穿刺。通过X线比较术前、术后椎体前缘、中部高度以及后凸Cobb角了解评估手术情况;通过术前、术后3d及末次随访的VAS、Oswe-stry功能障碍指数(ODI)评分系统评估临床疗效。通过术后及随访X线片、CT了解是否存在骨水泥渗漏及邻近节段再次骨折。结果患者获得随访6～24个月,平均12. 6个月。术后3d及末次随访时VAS、ODI评分、椎体前缘和中部高度以及后凸Cobb角与术前比较差异均有统计学意义(P <0. 05)。术后骨水泥渗漏4. 42%(5/113),邻近椎体再骨折发生率为2. 65%(3/113)。患者术前VAS、ODI评分、椎体前缘和中部高度以及后凸Cobb角分别为:(8. 95±0. 82)分、(85. 18±2. 99)分、(14. 33±1. 36) mm、(17. 26±1. 42) mm、(30. 55±4. 57)°,术后3d及末次随访VAS评分分别为:(3. 92±0. 79)分、(2. 11±0. 82)分,ODI评分分别为:(35. 32±5. 43)分、(32. 19±5. 33)分,椎体前缘分别为:(22. 19±1. 77) mm、(21. 15±1. 57) mm,椎体中部高度分别为:(23. 05±1. 28) mm、(22. 25±1. 18) mm,Cobb角分别为:(14. 69±3. 83)°、(15. 27±4. 36)°,术后3d及末次随访与术前相比各项指标差异均有统计学意义(P <0. 05),术后3d与末次随访的各项指标对比差异均无统计学意义(P> 0. 05)。结论单侧PKP手术治疗老年骨质疏松性椎体压缩骨折能够快速恢复椎体高度,缓解背部疼痛,改善后凸畸形,减少患者卧床时间,进而进行正常日常生活。     

经皮椎体后凸成形术治疗骨质疏松性椎体压缩性骨折

目的探讨经皮球囊扩张椎体后凸成形术(PKP)治疗骨质疏松性椎体压缩骨折的疗效。方法45例(共99个椎体)骨质疏松性椎体压缩骨折患者行PKP治疗。所有手术均在C形臂X线机引导下进行。术前、术后及最终随访时分别进行视觉模拟疼痛评分、活动能力评分、使用止痛药物评分及Cobb角测量。结果所有手术均顺利完成,无严重手术并发症。视觉模拟评分(VAS)由术前的(7.8±1.1)分下降至术后的(2.3±0.8)分,最终随访时为(2.5±0.6)分。活动能力评分由术前的(3.3±0.5)分改善到术后的(1.2±0.3)分,最终随访时为(1.3±0.4)分。使用止痛药物评分由术前的(1.6±0.5)分下降至术后的(0.3±0.1)分,最终随访时为(0.4±0.2)分。Cobb角由术前的(30±5.3)°,矫正到术后的(21±3.6)°,最终随访时为(23±3.8)°。术后与术前、最终随访时与术前差别有显著性意义(P0.05);术后与最终随访时差别无显著性意义(P0.05)。结论经皮球囊扩张椎体后凸成形术是治疗骨质疏松性椎体压缩骨折的有效方法,创伤小,安全性好,能有效缓解疼痛,矫正后凸畸形。     

用国产器械行椎体后凸成形术治疗老年骨质疏松脊柱压缩骨折的价值

目的探讨用国产器械行椎体后凸成形术治疗骨质疏松性脊柱压缩骨折的疗效和安全性。方法 16例疼痛性老年骨质疏松脊柱压缩骨折患者,累及椎体19个。在 X 线监测下,经双侧椎弓根穿刺受累椎体,置人可扩张球囊,推注对比剂扩张球囊,使塌陷椎体复位,并在椎体内形成空腔,应用骨水泥在牙膏期时向空腔内填充。术后观察疼痛缓解状况与骨折复位情况。结果 16例患者手术顺利,术后48 h 内疼痛均完全缓解,无临床并发症。术前受累椎体前缘和中部高度分别压缩(14.8±4.1)mm 和(10.4±4.4)mm,术后分别压缩(10.7±3.5)mm 和(5.4±2.7)mm,差异有统计学意义(t 值分别为3.96、5.37,P 值均<0.01)。后凸畸形由术前平均(22.4±5.8)°,矫正至术后(12.1±5.3)°,手术前后差异有统计学意义(t=5.93,P<0.01)。术后 CT 检查发现1例患者在椎体前侧缘有少量骨水泥外溢。结论用国产器械行椎体后凸成形术治疗老年骨质疏松脊柱压缩性骨折,安全有效。     

经皮椎体成形术或椎体后凸成形术治疗多节段老年骨质疏松性脊柱骨折

目的 探讨经皮椎体成形术、椎体后凸成形术治疗多节段老年骨质疏松性脊柱压缩骨折的疗效.方法 根据影像学特点,对13例老年骨质疏松性多节段脊柱压缩骨折选择性进行单侧经皮椎体成形术或球囊扩张椎体后凸成形术.年龄54～83岁;其中2个椎体压缩8例,3个椎体压缩4例,4个椎体压缩1例.结果 13例在术后腰背部疼痛基本消失,24小时后均离床活动,患者的视觉模拟评分(VAS)由术前(8.3±1.5)分降至术后(2.5±1.2)分,手术前后差异有统计学意义(P<0.01),椎体高度恢复明显,Cobb角平均矫正10.17°.术后随访6～12个月,腰背痛无复发.结论 对多节段老年骨质疏松性脊柱骨折的患者,根据影像学特点选择经皮椎体成形术、球囊扩张椎体后凸成形术治疗能取得满意的疗效.     

骨填充网袋辅助经皮椎体成形术治疗伴椎体后壁破损的脊柱转移瘤

目的 探讨经皮椎体成形术(PVP)在骨填充网袋辅助下治疗因转移瘤致椎体后壁破损性骨折的疗效及安全性.方法 31例患者因脊柱转移瘤致椎体后壁破坏而接受骨填充网袋辅助PVP治疗,共43节病变椎体.所有患者原发肿瘤均诊断明确.PVP术前1d,术后1d、3d、1个月、3个月和末次随访采用视觉模拟评分(VAS)评估疼痛程度,Oswestry功能障碍指数(ODI)评估患者运动功能状态.术后记录骨水泥渗漏情况.结果 43节椎体PVP手术成功率100％.术前VAS评分8.2±0.4,术后1d降至2.5±0.7;术前VAS评分均明显高于术后1d、3d、1个月、3个月和末次随访,差异有统计学意义(P均＜0.05).术后ODI均较前明显降低(P均＜0.05),患者运动功能状态得到改善.术后影像学(DSA、CT)证实无严重骨水泥渗漏事件发生.结论 PVP在骨填充网袋辅助下治疗因转移瘤致椎体后壁破损性骨折是安全可靠的,并能获得良好的止痛效果及改善患者运动功能状态.     

经皮椎体后凸成形术治疗老年骨质疏松性胸腰椎压缩骨折临床效果观察

目的观察经皮椎体后凸成形术治疗老年骨质疏松性胸腰椎压缩骨折的临床效果。方法选取苏州平江医院自2014年1月至2018年1月收治的74例老年骨质疏松性胸腰椎压缩骨折患者为观察对象,根据术式不同,将患者分入A组(n=30,接受经皮椎体成形术治疗)与B组(n=44,接受经皮椎体后凸成形术治疗)。比较两组患者手术时间、术中失血量、骨水泥注入量、疼痛评分、功能障碍指数评分、椎体高度、Cobb角,以及不良反应发生情况。结果两组患者手术时间及术中失血量比较,差异均无统计学意义(P> 0. 05)。两组术后3 d疼痛评分比较,差异无统计学意义(P> 0. 05);但两组术后3 d疼痛评分均低于本组术前(P <0. 05)。两组术后3 d功能障碍指数评分比较,差异无统计学意义(P> 0. 05);但两组术后3 d功能障碍指数评分均低于术前(P <0. 05)。两组术后3 d椎体前缘高度均高于本组术前(P <0. 05),且B组术后3 d椎体前缘高度明显高于A组(P <0. 05)。两组术后3 d椎体后缘高度均高于本组术前(P <0. 05),且B组术后3 d椎体后缘高度明显高于A组(P <0. 05)。两组术后3 d的Cobb角均低于本组术前(P <0. 05),且B组术后3 d的Cobb角明显低于A组(P <0. 05)。两组术后均未出现脊髓损伤、感染等并发症。结论经皮椎体后凸成形术治疗老年骨质疏松性胸腰椎压缩骨折的临床效果显著,有助于恢复椎体高度,改善Cobb角,且安全性较高。     

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.