球囊扩张椎体成形术治疗老年胸腰椎多发性压缩骨折

目的探讨一次多椎体球囊扩张椎体成形术治疗老年胸腰椎多发性压缩骨折的临床疗效。方法应用一次多椎体球囊扩张椎体成形术,先扩张症状最严重椎体,再同时用球囊扩张其余椎体,恢复椎体部分或全部高度,每个椎体注入骨水泥3～8ml,术后行X线检查以评价椎体高度恢复、骨水泥填充情况及有无渗漏。疗效判断采用测类比评分法(VAS)计算患者的疼痛缓解率。结果 48例均经3～24个月的随访(平均13个月),疼痛缓解率平均为86.2%。术后X线片显示骨水泥在椎管内充填满意,椎体高度平均恢复达到60%～80%,前屈后伸未见椎体前缘高度改变。结论一次多椎体球囊扩张椎体成形术微创、止痛效果好,疗效明显,是治疗老年胸腰椎多发性压缩骨折的有效方法。     

椎体内裂隙样变对椎体成形术治疗椎体压缩骨折疗效的影响

目的 研究经皮椎体成形术(PVP)治疗并存椎体内裂隙样变骨质疏松性椎体压缩骨折的疗效,并与单纯性(不合并椎体内裂隙样变)骨质疏松性椎体压缩骨折的疗效进行对比,以分析椎体内裂隙样变对疗效的影响.方法 回顾性分析PVP治疗95例患者、176节椎体骨质疏松性压缩骨折的临床及影像学资料.本组研究中除外多节段骨折、合并肿瘤病史、影像资料不全和术后随访不配合患者.入选43例分A、B两组,18例骨质疏松性椎体压缩骨折合并裂隙样变患者为A组,25例无椎体内裂隙样变患者为B组.比较两组间术前疼痛和功能障碍情况,分析两组术后1周局部疼痛缓解和功能改善情况;观察两组并发症情况.结果 A组与B组术后1周疼痛缓解及日常活动功能改善明显(P＜0.05);两组间术后1周疼痛缓解的程度和日常活动功能改善的程度差异无统计学意义(P＞0.05);两组间骨水泥外漏发生率相似(P＞0.05),但两组间骨水泥外漏类型分布有差异(P＜0.05).结论 PVP是治疗骨质疏松性椎体压缩骨折的有效方法;椎体内裂隙样变对PVP的止痛疗效、功能改善与骨水泥外漏发生率无明显影响,但对骨水泥的外漏类型有一定影响.     

ADC值与外伤性椎体压缩骨折时间的相关性研究

目的 通过椎体压缩骨折外伤时间与MRI表现的相关性研究,探讨MRI表观扩散系数(ADC)值在推断外伤性椎体压缩骨折时间中的应用价值.方法 选取外伤性胸、腰椎压缩骨折患者40例及志愿者10名.根据外伤时间分为7个时段,分别进行磁共振跟踪扫描.脊柱线圈TSE序列,常规行矢状位T2 WI、T1WI、T2 WI-Fs扫描,轴位T2 WI、DWI扫描,观察各时段信号强度,测量ADC值.结果 随着骨折愈合时间的延长,ADC值逐渐下降,骨折≥60天的患者其ADC值与对照组比较无显著差异(P＞0.05).结论 运用磁共振成像量化指标表观扩散系数(ADC)值可以推测外伤性胸、腰椎压缩骨折损伤时间.     

经皮椎体成形术治疗椎体压缩骨折15例

经皮椎体成形术（PVP）是治疗脊椎病变的一项新技术,具有增加椎体强度、防止骨折移位和止痛效果确切等优点。2001年10月～2004年6月,我们采用PVP治疗椎体压缩骨折15例（23个椎体）,疗效满意。     

经皮椎体成形术治疗胸腰椎骨质疏松性压缩骨折疗效及相关因素分析

目的探讨经皮椎体成形术(PVP)在治疗胸腰椎骨质疏松性压缩骨折的疗效。方法选择我院收治的骨质疏松性胸腰椎压缩骨折患者共176例,患者根据治疗方式不同分为PVP组及经皮椎体后凸成形术(PKP)组,PVP组102例,PKP组74例。比较两组患者手术时间、住院时间、骨水泥注射量、Cobb角及治疗有效率,VAS评分评估两组手术前后疼痛情况。结果 PVP组手术时间、住院时间均显著低于PKP组(P<0.05)。PVP组及PKP组术后24 h及术后1个月的VAS评分均显著低于术前(P<0.05)。PVP及PKP组术后Cobb角均较术前显著降低(P<0.05)。治疗有效率比较,PVP及PKP组差异无统计学意义(P>0.05)。PVP组病程<6个月的患者治疗有效率(98.4%)显著高于病程≥6个月的患者(73.6%)(P<0.05)。结论经皮椎体成形术是治疗胸腰椎骨质疏松性压缩骨折的有效、可行的方法,病程长短会影响椎体成形术的治疗有效率。     

老年性低钙性骨质疏松引起的椎体楔形变

报告我科二年来150例资料完整的60岁以上男性、50岁以上女性的胸腰椎正侧位拍片，其中16例无外伤史椎体压缩骨折，男性4例，占男性62例的6．4％；女性12例，占女性88例的13．6％。     

经皮椎体成形术治疗骨质疏松性椎体压缩骨折

目的 探讨经皮椎体成形术(PVP)治疗骨质疏松性椎体压缩骨折的适应证、椎体造影表现、关键技术、近期疗效及并发症的预防。资料与方法 43例骨质疏松症并55节椎体压缩骨折。患者在透视监视下经椎弓根行椎体穿刺，所有椎体均用非离子型对比剂行椎体造影，注入粉／液／对比剂比例为3：2：1的聚甲基丙烯酸甲脂(poly—methylmethaerylate，PMMA)，术后CT观察PMMA分布状况和有无渗漏，并进行临床疗效评价和观察有无并发症发生。结果 PVP技术成功率100％。椎体造影主要有4种表现，其中独特的征象是对比剂注入压缩骨折椎体内后呈囊状分布并滞留。PMMA平均注入量胸椎3．3ml，腰椎4．5ml。随访1-18个月，完全缓解(CR)、部分缓解(PR)和无效(NR)分别为74．4％、20．9％和4．7％，总有效率95．3％。CT证实椎体周围PMMA渗漏5例，但无l例出现临床症状。结论 PVP治疗骨质疏松性椎体压缩骨折安全可行；椎体造影有助于预测注射PMMA在椎体内的分布状况和发生渗漏的可能性；主要并发症为PMMA渗漏，防止渗漏的关键是必须在PMMA黏稠阶段及透视监视注射。     

撬拨复位联合椎体内植骨治疗胸腰椎压缩骨折的疗效

 目的 探讨经伤椎椎弓根撬拨复位联合椎体内植骨治疗胸腰椎压缩骨折的疗效。方法 回顾性分析2010-10至2012-08共49例单节段DenisA型胸腰椎压缩骨折患者在我院手术治疗的病历资料。根据手术方式将其分为A组:23例,采用椎弓根钉棒撑开复位联合撬拨复位椎体内植骨术治疗;B组:26例,采用短节段椎弓根钉撑开固定术治疗。手术前后测量X线片,观察椎体相对高度及后凸角(Cobb角)改善情况,记录手术时间和出血量等数据并进行统计分析。结果 所有手术均顺利完成,切口均一期愈合。B组在手术时间及术中出血量上(130.8±27.7) ml明显低于A组(250.6±51.6) ml,差异有统计学意义(P<0.05);术后1周及末次随访时,两组患者伤椎平均高度和局部Cobb角较术前均有显著恢复(P<0.05);在伤椎平均高度恢复上,A组患者在不同时间点均优于B组(P<0.05);在Cobb角维持上,术后1周时两组比较差异无统计学意义(P>0.05),但末次随访时A组较B组更有优势 (P<0.05);术后两组患者VAS评分均有显著降低(P<0.05),但至末次随访时A组下降程度更大 (P<0.05)。结论 经伤椎椎弓根撬拨复位联合椎体内植骨是治疗胸腰椎压缩骨折的有效方法,可减少椎体矫形高度丢失及空壳样椎体发生。     

在X线、CT导引下经皮椎弓根穿刺胸腰椎椎体活检术的价值

目的 探讨在X线、CT导引下经皮椎弓根穿刺胸腰椎椎体活检术在胸腰椎椎体疾病中的应用价值.资料与方法 选择2003年9月至2007年10月间在X线、CT导引下经皮椎弓根穿刺胸腰椎椎体活检术患者26例,其中在X线导引下穿刺腰椎6例,在CT导引下穿刺腰椎16例、胸椎4例.结果 26例全部穿刺成功,穿刺成功率100%,无严重并发症发生.结论 胸椎采用CT导引,腰椎采用X线或CT导引,行椎体经椎弓根穿刺活检术是一种简便、微创、有效的检查方法,可提高对椎体病变的确诊率,为椎体病变的进一步治疗提供有效的帮助,临床价值极大.     

椎体强化在骨质疏松性椎体压缩骨折中的应用

目的分别以聚甲基丙烯酸甲酯骨水泥（PMMA）和碳酸化羟基磷灰石水泥（CHC）作为椎体强化充填材料,采用椎体成形术和后凸成形术治疗骨质疏松性椎体压缩骨折,观察其临床疗效。方法58例骨质疏松性椎体压缩骨折采用以下4种方法治疗：椎体成形术＋PMMA（11例13个椎体）,椎体成形术＋CHC（23例26个椎体）,后凸成形术＋PMMA（8例8个椎体）,后凸成形术＋CHC（16例19个椎体）。根据术前和术后侧位X线片计算椎体高度压缩率和恢复率、后凸角度和恢复率,并采用VAS（visual analog scale）进行术前和术后疼痛评分。结果所有患者均未出现并发症。后凸成形术椎体高度恢复率和后凸角度恢复率优于椎体成形术。椎体增强材料充填剂量各组间无显著性差异。椎体成形术手术时间明显短于后凸成形术。VAS评分术前各组无显著性差异,术后充填PMMA者优于充填CHC者,术后4周二者间无显著性差异。结论椎体强化是一种微创、安全、有效治疗骨质疏松性椎体压缩骨折的方法,应根据患者的具体情况选择治疗方法和椎体充填材料。     

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.     

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).     

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.     

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.     

Bronchial stump fistula :treatment with covered retrievable hinged metallic stents-preliminary clinical experience

Objective To evaluate the preliminaily clinical efficacy and retrievability of a retrievable hinged covered metallic stent in the treatment of the bronchial stump fistula （BSF）. Methods Between April 2003 and March 2005, 8 patients with bronchial stump fistula after pneumonectomy or lobectomy were treated with two types （A and B） of retrievable hinged covered metallic stents. Type A stent was placed in 6 patients and type B in 2 under fluoroscopic guidance. The stent was removed with a retrieval set when BSF was healed or complications occurred. Results Stent placement in the bronchial tree was technically successful in all patients, without procedure-related complications. Immediate closure of the BSF was achieved in all patients after the procedure. Stents were removed from all patients but one. Removal of the stents was difficult in two patients due to tissue hyperplasia. Patients were followed up for 6 - 21 months. Placement of the stents remained stable in all patients except one due to severe cough. Permanent closure of BSF was achieved in 7 （87.5%） of 8 patients. Conclusion Use of a retrievable hinged covered expandable metallic stent is a simple, safe, and effective procedure for closure of the BSF. Retrieval of the stent seems to be feasible. （J Intervent Radiol, 2007, 16： 253-257）     

Prevalence and severity of hip and groin pain in sub‐elite male football: a cross‐sectional cohort study of 695 players

The purpose of this study was twofold: (a) to investigate the prevalence of hip and groin pain in sub‐elite male adult football in Denmark and (b) to explore the association between prevalence and duration of hip and groin pain in the previous season with the Copenhagen Hip and Groin Outcome Score (HAGOS) in the beginning of the new season. In total 695 respondents from 40 teams (Division 1–4) were included. Players completed in the beginning of the new season (July–Sept 2011) a self‐reported paper questionnaire on hip and/or groin pain during the previous season and HAGOS. In total 49% (95% CI: 45–52%) reported hip and/or groin pain during the previous season. Of these, 31% (95% CI: 26–36%) reported pain for >6 weeks. Players with the longest duration of pain during the previous season had the lowest HAGOS scores, when assessed at the beginning of the new season, P < 0.001. This study documents that half of sub‐elite male adult football players report pain in the hip and/or groin during a football season. The football players with the longest duration of pain in previous season displayed the lowest HAGOS scores in the beginning of the new season.