主动脉牵拉后的顺应性和强直性脊柱炎脊柱后凸矫正的 …

目的：探讨强直性脊柱炎（ＡＳ）脊柱后凸矫正术的适应症与主动脉钙化的关系。方法：（１）６例新鲜尸体主动脉按１０％、１５％、２０％、２５％、３０％和３５％牵拉后的力学变化，用压力换能器在生理二道记录仪上记下压力值，作组织切片、光镜观察；（２）３０例高血压主动脉钙化硬化病人在核磁共振下动脉由弯腰变伸直进行弯腰试验；（３）４１例ＡＳ合并主动脉钙化患者，脊柱后矫正前后行Ｘ线观察主动脉与椎体相对位移情况。结论     

手术矫正脊柱后凸畸形的生物力学分析

目的探讨脊柱截骨矫正后凸畸形的生物力学特点。方法12具新鲜猪胸腰椎段脊柱标本,随机分成截骨组和对照组,每组6具,截骨组标本截骨两处并行椎弓根钉固定,在生理负荷下进行前屈、后伸、左右侧屈和顺逆时针轴向旋转6种运动范围的测试,记录载荷值大小,并行统计学分析。结果生理负荷下截骨组屈伸、侧屈和轴向旋转运动稳定性与对照组无差异性。结论脊柱截骨后采用椎弓根钉固定后的稳定性能够达到对照组水平。     

脊柱后凸畸形矫正的受力分析及应用

利用力学原理在脊柱后凸畸形顶点附近进行后方楔形截骨,能有效恢复脊柱生理曲线,减轻其负荷;根据椎体解剖生理特点,选择椎体内截骨、使截骨面最大吻合,压强最小,愈合快,手术操作简单安全;由椎弓根高度与椎弓根中点至椎体前1/3处长度之比,设计保留三柱,杆极受力承受度最大的单处截骨角度;依患者后凸圆(cobb's 法),计算应截骨面的个数,设计了一次性多平面椎弓椎体楔形截骨术式。矫正脊柱后凸畸形200例,平均矫正57.2°(30°～100°),平均矫正率达77.2%。效果显著,并发症少,是目前治疗脊柱后凸较理想的方法。     

强直性脊柱炎胸腰椎后凸畸形患者全脊柱最大后凸角与骨密度的相关性分析

目的 探讨强直性脊柱炎（AS）胸腰椎后凸畸形患者全脊柱最大后凸角（GK）与骨密度的相关性。方法 横断面研究。纳入2011年4月—2018年11月南京大学医学院附属鼓楼医院脊柱外科AS胸腰椎后凸畸形患者90例,其中男84例、女6例,年龄20~66（37.0±10.6）岁,病程1~38（10.3±8.0）年。测量患者术前GK及L_1~4椎体和股骨颈骨密度T值及Z值,采用Pearson相关分析对GK与L_1~4椎体和股骨颈骨密度T值、Z值的相关性进行分析。结果 患者GK与股骨颈T值、Z值均呈负相关性（r=-0.259、-0.242,P=0.014、0.021）,与L_1~4椎体T值、Z值均无相关性（P值均>0.05）。结论 AS胸腰椎后凸畸形患者的GK与股骨颈骨密度相关。     

前路后凸顶椎前移法矫正少儿脊柱结核严重后凸畸形的初步结果

目的报道一种新的经前路矫正少儿脊柱结核所致严重后凸畸形的手术方法。方法运用前路后凸顶椎前移的方法治疗少儿脊柱结核伴后凸畸形5例,对比术前、术后影像学检查,了解矫形效果。结果 5名患儿随访6~24个月,平均14.2个月;术前脊髓神经症状在术后一段时间均完全消失,无医源性脊髓神经并发症发生。后凸角度﹙Cobb角﹚由术前32~55°平均42.2°,改善为术后5~26°平均12.8°;内固定物无松动、断裂,植骨融合。初期治疗效果较满意。结论前路后凸顶椎前移法是矫正少儿脊柱结核所致非僵硬严重后凸畸形可选择的一种有效方法。     

脊柱术后近端交界性后凸畸形的研究进展

目的 总结脊柱术后近端交界性后凸(PJK)的最新研究进展。方法 以proximal junctional kyphosis、incidence、spine和近端交界性后凸、发病率、脊柱为关键词,分别在PubMed、万方数据库查阅2000年1月—2015年5月有关PJK畸形的文献,分别对PJK的生物力学影响因素、影像学参数、诊断角度、分型、临床因素等方面的最新研究进展进行归纳和总结。结果 脊柱手术中近端横连的使用可降低PJK的发生。手术时年龄＞55岁、腰椎前凸角>30°、术前胸椎侧弯角>30°、术前胸椎后凸角＞30°、术前术后腰椎前凸角改变＞30°、T_5~12胸椎后凸角＞40°、前后路联合和后路手术可能是PJK发生的独立危险因素。PJK诊断的角度问题及PJK翻修的手术指症尚无统一意见。结论PJK的发生是多因素共同作用的结果,与脊柱的生物力学、影像学参数、临床因素具有一定的相关性。PJK的危险因素目前尚无统一定论,还需进一步深入研究。     

不同截骨节段重建ⅢA型强直性脊柱后凸矢状面平衡的生物力学分析

背景:强直性脊柱后凸畸形的矫形技术已较为成熟,术者也可根据患者的弯曲类型、弯曲度数等选择不同的截骨术式,但由于缺少被广泛认可的分型系统,导致强直性脊柱后凸畸形的描述和手术策略制定都较为混乱。目的:应用计算机辅助软件建立强直性脊柱炎后凸截骨三维有限元模型,分析其生物力学特性。方法:获取1例301分型ⅢA型强直性脊柱后凸畸形患者的影像资料,建立强直性脊柱后凸畸形三维有限元模型,测量T12、L1、L2和L34个不同节段截骨角度,模拟去松质骨截骨术,对截骨矫形后的模型进行钉棒系统固定,分析其生物力学特性。结果与结论:①截骨节段越靠近尾端螺钉应力越大,螺钉应力分布大小的顺序为L3>L2>L1>T12,不同截骨节段的螺钉应力分布特点相同,都集中在截骨节段的相邻上/下2个节段的螺钉上,明显大于其他节段的螺钉应力;②钛棒的应力大小顺序为L2>L3>L1>T12;③截骨节段越靠近头端截骨接触面应力越大,截骨接触面应力大小顺序为T12>L1>L2>L3;④结果表明对于ⅢA型强直性脊柱后凸畸形,选择L2截骨节段可获得较佳的矫形程度、降低内固定应力分布集中导致的并发症发生。     

青少年脊柱后凸畸形后路截骨矫形术后发生近端交界性后凸的临床研究

目的：探讨脊柱后凸畸形截骨矫形术后近端交界性后凸（ PJK）的发生率、相关危险因素及其预防方法。方法选取2005年1月-2009年1月西安市红会医院收治的87例脊柱胸腰段后凸畸形患者,年龄11~20岁,平均14.8岁,均行后路截骨矫形术,观察其近端交界区后凸角度的变化情况。分别在术前、术后3月和末次随访时,记录患者影像学参数。结果所有患者均获得随访,随访时间5~9年,平均6.4年。87例中,24例（27.6%）术后发生PJK（PJK组）,且在随访过程中,有加重的趋势,其中3例局部疼痛明显,1例再次手术;余63例归入非PJK组。末次随访时,PJK组近端交界区后凸角度为17.5°±2.6°,非PJK组为7.1°±2.6°,两组比较差异有统计学意义（P〈0.05）。两组患者年龄、近端融合范围、近端交界区后凸角度、术后全脊柱矢状位平衡以及术前术后矢状面平衡距离纠正程度比较,差异均有统计学意义（P值均〈0.05）。结论脊柱后凸畸形后路截骨矫形术后PJK发生率为27.6%,其相关的危险因素包括年龄、近端融合范围、近端交界区后凸角度、术后全脊柱矢状位平衡以及术前术后矢状面平衡距离纠正程度。     

强直性脊柱炎胸腰椎后凸畸形患者睡眠质量的影响因素分析

目的通过对强直性脊柱炎（AS）胸腰椎后凸畸形患者睡眠质量的评估,探讨其睡眠障碍的影响因素。方法收集32例AS患者年龄、发病年龄、病程和胸腰椎后凸病史等临床资料,血细胞沉降率（ESR）、C反应蛋白（CRP）等实验室检查结果,以及站立位全脊柱正侧位片上测量胸腰椎后凸Cobb角。采用匹兹堡睡眠质量指数（PSQI）量表评估患者睡眠质量,汉密尔顿焦虑量表（HAMA）评估患者焦虑程度,同时采用Bath AS疾病活动指数（BASDAI）量表、Bath AS功能指数（BASFI）量表、Oswestry功能障碍指数（ODI）评估患者生活质量。采用Spearman相关分析AS胸腰椎后凸畸形患者睡眠质量的影响因素。结果32例患者PSQI评分为（6．8±4．2）分,HAMA评分为（9．7±8．0）分,BASDAI评分为（3．5±1．6）分,BASFI评分为（3．1±2．0）分,ODI评分为33．0±16．8,后凸畸形Cobb角59．5°±22．1°,ESR（25．4±15．5）mm／h,CRP（22．7±21．7）mg／L。Spearman相关分析显示,PSQI总分与患者年龄、病程长短、ODI、BASFI及HAMA评分呈正相关（P值均〈0．05）,与发病年龄、后凸病史长短、ESR、CRP、BASDAI及胸腰椎后凸Cobb角无明显相关性（P值均〉0．05）。结论AS胸腰椎后凸畸形患者睡眠质量显著下降,与患者年龄、病程长短、疼痛、功能受损程度以及焦虑情绪等相关,主要影响因素为疼痛和焦虑情绪;而与ESR、CRP及胸腰椎后凸Cobb角无相关性,其不是影响患者睡眠质量的关键因素。     

强直性脊柱炎后凸畸形矫形修复中截骨方法的进展☆

背景：强直性脊柱炎后凸畸形是病变后期出现的脊柱矢状面上的屈曲畸形,脊柱截骨矫形是唯一的治疗方法。 目的：综述国内外关于强直性脊柱炎后凸畸形的截骨矫形方法及其应用现状。 方法：计算机检索中国生物医学文献数据库、中文科技期刊全文数据库、中文学术期刊全文数据库及PubMed、EMbase数据库2000-01/2011-12期间的相关文章,检索词为“强直性脊柱炎,脊柱后凸,截骨;ankylosing spondylitis;kyphosis;osteotomy”。此外还查阅相关文献中引用的原始文献数篇。纳入强直性脊柱炎后凸畸形的截骨方法、适应证和效果的论著类文章。 结果与结论：按照截骨矫形后的三柱变化,临床常用的截骨方法主要有：开张型、闭合型和闭合-开张型截骨。目前强直性脊柱炎后凸畸形的截骨矫形术式主要有:后路多节段经椎间关节V形截骨、经椎弓根椎体截骨、脊椎切除以及脊柱去松质骨截骨。前二者是目前临床上治疗强直性脊柱炎后凸畸形应用最多的两种标准化矫形技术,而后二者则主要应用于后凸顶点较局限或顶椎区楔形变的重度角状后凸畸形。且不同截骨方法各有其相应技术要点、适应证及并发症,选择恰当的截骨方法有助于后凸畸形的有效矫正。      

单节段经椎弓根椎体截骨术治疗强直性脊柱炎

目的总结单节段经椎弓根椎体截骨术治疗强直性脊柱后凸畸形的临床疗效。方法 2005~2010采取单节段经椎弓根椎体截骨术治疗20例强直性脊柱炎后凸畸形患者。术前、术后均行胸腰椎X线检查,评定胸腰段Cobb角矫正情况、植骨愈合情况、临床疗效、内固定位置及手术并发症。结果无术中死亡及术后感染,术中2例患者硬膜破裂,术后1例患者麻痹性肠梗阻,2例出现短暂不全瘫。随访15~60个月,后凸畸形均获明显矫正,胸腰段Cobb角平均矫正35.6°,矫正前后有显著性差异﹙<0.05﹚。末次随访无内固定断裂、脱出,均达骨性融合。结论单节段经椎弓根椎体截骨术治疗强直性脊柱脊柱后凸畸形,矫形效果及临床疗效满意。     

下端融合椎的选择对强直性脊柱炎胸腰椎后凸畸形椎弓根截骨矫形术后骨盆投射角的影响

目的:探讨经椎弓根椎体截骨矫形术（PSO）中选择不同的下端融合椎（LIV）对强直性脊柱炎（AS）胸腰椎后凸畸形患者术后骨盆投射角（PI）的影响。方法:回顾性队列研究。纳入2006年3月—2014年9月南京大学医学院附属鼓楼医院94例AS胸腰椎后凸畸形患者的临床资料,其中男83例、女11例,年龄19～59（34.7±8....     

钴合金椎弓根螺钉植入修复脊柱结核重度后凸畸形：自身对照临床试验方案

BACKGROUND: There is evidence that internal fixation through an anterior or posterior approach for treatment of severe kyphotic deformity in spinal tuberculosis exhibits good curative effects. However, few prospective, long-term follow-up case control studies are reported.     

Genetics and genomics of ankylosing spondylitis

Summary: Ankylosing spondylitis (AS) is a common, highly heritable arthropathy, the pathogenesis of which is poorly understood. The mechanism by which the main gene for the disease, HLA-B27, leads to AS is unknown. Genetic and genomic studies have demonstrated involvement of the interleukin-23 (IL-23) signaling pathway in AS, a finding which has stimulated much new research into the disease and has led to therapeutic trials. Several other genes and genetic regions, including further major histocompatibility complex (MHC) and non-MHC loci, have been shown to be involved in the disease, but it is not clear yet how they actually induce the condition. These findings have shown that there is a strong genetic overlap between AS and Crohn’s disease in particular, although there are also major differences in the genes involved in the two conditions, presumably explaining their different presentations. Genomic and proteomic studies are in an early phase but have potential both as diagnostic/prognostic tools and as a further hypothesis-free tool to investigate AS pathogenesis. Given the slow progress in studying the mechanism of association of HLA-B27 with AS, these may prove to be more fruitful approaches to investigating the pathogenesis of the disease.     

单核细胞CD36表达与强直性脊柱炎

背景：强直性脊柱炎是一种涉及到慢性全身炎症的自身免疫性疾病,肿瘤坏死因子和白细胞介素6在强直性脊柱炎患者中升高,而肿瘤坏死因子和白细胞介素6等炎症因子可以抑制CD36在单核细胞的表达。 目的：分析单核细胞CD36的表达与强直性脊柱炎的关系。 方法：纳入84例初诊为强直性脊柱炎的患者和111例健康对照人群,应用流式细胞学技术检测强直性脊柱炎患者和健康人群单核细胞CD36的表达情况,同时,检测两组的生物化学、免疫学、血液常规以及相关炎症因子等指标。 结果与结论：两组受试者基本资料比较结果显示,强直性脊柱炎患者单核细胞CD36荧光强度低于健康对照人群(P < 0.01)。单核细胞CD36荧光强度水平与C-反应蛋白、血沉、白细胞介素6以及肿瘤坏死因子负相关。另外,单核细胞CD36荧光强度水平与BASDAI评分呈负相关。Logistic回归分析结果显示,血沉、肿瘤坏死因子、白细胞介素6以及单核细胞CD36荧光强度与强直性脊柱炎相关,为强直性脊柱炎患者的危险因素(P < 0.05)。结果提示,强直性脊柱炎释放的炎症因子可以下调单核细胞CD36的表达,单核细胞CD36低表达与在强直性脊柱炎存在联系。在临床上,检测单核细胞CD36的表达可能可以作为判断强直性脊柱炎患者机体炎症反应程度和疾病活动性有效的指标。 中国组织工程研究杂志出版内容重点：组织构建;骨细胞;软骨细胞;细胞培养;成纤维细胞;血管内皮细胞;骨质疏松;组织工程     

Gelsolin and Progression of Aortic Arch Calcification in Chronic Hemodialysis Patients

Background:Vascular calcification (VC) is a key process associated with cardiovascular mortality in dialysis patients. Gelsolin is an actin-binding protein that can modulate inflammation, correlated inversely with hemodialysis (HD) mortality and involved in bone calcification homeostasis. In this report, we aim to characterize progression in aortic arch calcification (AAC) and investigate its association with gelsolin.Methods: 184 HD patients were enrolled and their annual posterior-anterior chest X-ray films (CXR) in 2009 and 2013 were examined. The severity of AAC was classified as grade 0 to 3. Blood levels of gelsolin were measured by ELISA kits. Biographic and biochemical data at baseline were analyzed with status of AAC at baseline and changes after 4 years.Results: At baseline, 60% of the patients had detectable AAC on CXR. After 4 years, 77% had AAC. Patients with grade 1 and 2 AAC had increased risk of progression (Odds ratio [OR] 2~3, P=0.001) compared to those with grade 0 at baseline. Compared to those with no AAC, patients with AAC progression had older age, lower gelsolin, higher waist circumference and prevalence of vascular disease. Regression analysis confirmed baseline gelsolin (odds ratio 0.845, 95% confidence interval [0.734-0.974]) and waist circumference as the independent factors associated with AAC progression. Gelsolin is positively correlated with serum albumin and negatively with tumor necrosis factor-alpha.Conclusion: Our study demonstrated that HD patients with grades 1 or 2 baseline AAC are at increased risk of further progression compared to those with grade 0. We also found lower blood levels of gelsolin associated with progressive AAC. Further investigation into the mechanistic roles of gelsolin in vascular calcification may provide new understanding of this key process.     

Stretch activation and myogenic oscillation of isolated contractile structures of heart muscle

Summary Glycerinated or freeze-dryed fibre bundles of heart muscles (papillary and trabecular muscles of rabbit or guinea pig) show in ATP-salt solution with about 10^–6M Ca²⁺ an active, delayed tension increment after quick or sinusoidal stretching. The active tension increase is completely different from the passive tension increment caused by stretching of the elastic structures of the muscle; this well known length dependence of tension is also in phase with the length changes (or the tension-phase preceeds the length-phase in visco-elastic bodies). On the other hand, the active tension increase is delayed with respect to the length change; this can be observed very well after rectangular changes in length. The delayed activation of the contractile bonds at stretch and the delayed deactivation at shortening induce the muscle-during sinusoidal length changes in a characteristic frequency range-to produce power output. The frequency range corresponds to the heart beat frequency of the living muscle. Temperature rise and inorganic phosphate accelerate, Mg-ions and ADP retard the contraction speed. Ca-ions influence only the amount of the isometric tension, but not the contractile velocity.Supported by the Deutsche Forschungsgemeinschaft (Grant RU 154/3).