体质指数和腰臀比对中老年妇女腰椎前凸和骶骨倾斜度的影响

目的：探讨下腰痛患者体质指数（BMI）和腰臀比（wHR）对腰椎前凸和骶骨倾斜度的影响，讨论肥胖致下腰痛的机制。方法：对98例患有下腰痛的中老年妇女进行Roland功能障碍问卷（RDQ），测量身高、体重、腰围和臀围，并计算BMI和WHR。按BMI将病例分成正常组、超重组和肥胖组，按WHR将病例分成非向心性肥胖组和向心性肥胖组。立位摄腰椎X线侧位片，测量腰椎曲线指数（LCI）、腰椎前凸度（Cobb角）和骶骨倾斜角（SSA），对各组所测量的数据进行统计学分析。结果：超重组、肥胖组的LCI、Cobb角、SSA和RDQ明显高于正常组，向心性肥胖组的LCI、Cobb角、SSA和RDQ明显高于非向心性肥胖组。结论：体质指数超过24kg／m^2或腰臀比超过0．85时，均使腰椎前凸和骶骨倾斜度加大、RDQ评分增高。超重、肥胖，或向心性肥胖可致下腰痛。腰椎前凸和骶骨倾斜度增大，可能是肥胖致下腰痛的解剖基础之一。     

穿高跟鞋对中青年女性腰椎生理曲度的影响

目的探讨穿高跟鞋对中青年女性腰椎生理曲度的影响。方法对20例健康中青年女性志愿者在穿不同高度的高跟鞋后,摄立位腰椎X线侧位片,测量腰椎曲线指数（LCI）、腰椎前凸度（Cobb角）和骶骨倾斜角（SSA）,并对其进行2 km行走试验调查腰背不适情况。结果高鞋跟组的LCI、Cobb角、SSA明显高于低鞋跟组（P〈0.05）。2 km行走试验后腰背不适情况,60%发生在7 cm以上鞋跟组。结论穿高跟鞋可使腰椎生理曲度增大,易引发腰痛。     

体重、体质指数、腰围和腰臀比对正常成人骨密度的影响

目的探讨体重、体质指数(BMI)和腰围、腰臀比(WHR)对正常成人骨密度的影响。方法采用MarcomMx8000多层螺旋CT测定560例正常成人腰椎松质骨密度,将受试者按年龄不同分为青年组、中年组和老年组,然后在同年龄组根据BMI及腰围的不同将受试者分为肥胖组和正常体重组,分析骨密度与体重、BMI、腰围及WHR的关系。结果①以BMI分组,老年肥胖组BMD高于体重正常组(P<0.05);②以腰围分组,中年女性肥胖组BMD低于非肥胖组(P<0.05);③青年组和中年组BMD与腰围及WHR呈负相关,老年组BMD与体重和BMI呈正相关与腰围和WHR不相关。结论预防骨质疏松症在中青年应提倡运动锻炼,避免肥胖,在老年人不应该过分强调降低体重减少肥胖以避免骨量的丢失。     

内脂素、抵抗素与男性2型糖尿病患者骨密度及骨代谢关系的研究

目的 研究内脂素、抵抗素与男性2型糖尿病患者骨密度及骨代谢指标关系。 方法 收集我院就诊的男性2型糖尿病患者225例,根据体重指数分为肥胖组107例及非肥胖组118例,对照组为120例非糖尿病正常男性。体格检查计算腰臀比（WHR）及体重指数（BMI）,酶联免疫法( ELISA)测定血清内脂素、抵抗素水平,双能X线骨密度仪测定腰椎（L2-L4）及左股骨颈骨密度。 结果 肥胖糖尿病组BMI及WHR高于其他组（P<0.05）;肥胖及非肥胖糖尿病组的内脂素、抵抗素水平高于对照组（P<0.05）,且肥胖组高于非肥胖组（P<0.05）。肥胖及非肥胖糖尿病组的BGP、CTX-1水平低于对照组。非肥胖糖尿病组腰椎及股骨颈骨密度明显低于正常组与肥胖组（P<0.05）,且肥胖组的腰椎骨密度高于对照组,但股骨颈骨密度两组间无明显差异（P>0.05）。直线相关分析显示BMI、WHR、内脂素、抵抗素均与BGP、CTX-1负相关,BMI及WHR与腰椎及股骨颈骨密度正相关,内脂素、抵抗素与腰椎骨密度呈正相关（P<0.05）,但与股骨颈骨密度无明显相关（P>0.05）。 结论 血清内脂素、抵抗素水平与男性2型糖尿病患者骨代谢水平及腰椎骨密度相关。     

退变性腰椎侧凸与腰椎曲度和骶骨角关系及其临床意义

目的 评价退变性腰椎侧凸的角度与腰椎曲度和骶骨角相互之间的相关性,并在此基础上提出一种影像学上的分型方法.方法 对77例腰椎退变性侧凸进行X线标准正侧位检查,录入计算机进行侧凸Cobb角、曲度的切线角、骶骨角测量,利用相关性统计方法进行分析.结果 77例平均Cobb角为16.17°±8.88°;切线角为20.40°±9.34°;骶骨角为24.43°±7.53°,Cobb角与切线角、Cobb角与骶骨角均存在负相关关系,骶骨角与切线角存在正相关关系.将退变性腰椎侧凸按Cobb 角度大小分为4型,Ⅰ型:Cobb角≤10°;Ⅱ型:10°＜Cobb角≤15°;Ⅲ型:15°＜Cobb角≤20°;Ⅳ型:Cobb角＞20°.结论 腰椎退变性侧凸程度与腰椎曲度、骶骨角存在负相关关系,以Cobb角大小分型方法可以在影像学上反映侧凸畸形时腰椎曲度的改变.     

腰椎骶化者腰椎矢状曲度的测量及研究

目的测量腰椎骶化者及正常人的腰椎矢状曲度,探讨腰骶部移行椎更具临床意义的分型。方法根据Castellvi分型方法选出Ⅰ型37例(A组),Ⅱ、Ⅲ及Ⅳ型45例(B组),正常人50例(C组),在腰椎侧位片上测量腰椎前凸角(lumbar lordosis angle,LLA)、骶骨水平角(sacrum horizontal an-gle,SHA)、腰骶角(lumbosacral angle,LSA)和腰椎曲线指数(lumbar curvature index,LCI),并对三组间各参数进行统计学比较分析。结果 B组与A组LLA、SHA和LCI比较,差异有统计学意义(P<0.05);C组与B组LLA、SHA及LCI比较,差异亦有统计学差异(P<0.05);但A组与C组各参数值比较无统计学差异(P>0.05)。LSA在三组间相比较亦无统计学差异(P>0.05)。结论 Castellvi分型中Ⅰ型无具体临床意义,并提出新的分型供参考。     

腰椎间盘突出症与X线片测量指标的相关性研究

目的探讨单节段腰椎间盘突出症患者腰椎侧位X线片测量指标与腰椎间盘突出程度的相关性。方法回顾性分析自2016-01-2018-12诊治的60例单节段腰椎间盘突出症患者资料,通过腰椎矢状位MRI进行椎间盘退行性改变Pfirrmann分级,在腰椎侧位X线片上测量腰椎曲线指数、腰椎Cobb角、骶骨倾斜角、椎体后缘切线角及椎间隙高度,采用多元线性回归分析Pfirrmann分级与X线片测量指标之间的相关性。结果随着Pfirrmann分级增加,患者腰椎曲线指数、腰椎Cobb角、椎间隙高度逐渐减小,差异有统计学意义(P 0.05)。不同Pfirrmann分级患者的骶骨倾斜角、椎体后缘切线角比较差异无统计学意义(P0.05)。腰椎曲线指数、腰椎Cobb角、椎间隙高度与Pfirrmann分级呈负相关。多元线性回归分析结果显示,腰椎曲线指数(P=0.002)、腰椎Cobb角(P=0.001)、椎间隙高度(P=0.001)是椎间盘退行性改变Pfirrmann分级的独立影响因素。结论临床上测量单节段腰椎间盘突出症患者侧位X线片上腰椎曲线指数、腰椎Cobb角、椎间隙高度对于腰椎间盘突出症诊断具有重要意义。     

腰骶段SPR术对痉挛型脑瘫患儿腰椎稳定性影响的长期观察

[目的]观察腰骶段SPR术对痉挛型脑性瘫痪儿童腰椎稳定性中长期的影响。[方法]回顾分析2003年1月~2010年12月行腰骶段SPR治疗痉挛型脑性瘫痪的22例患儿,依据年龄分为学龄前组和学龄组。比较两组资料,包括影像测量冠状位Cobb角、侧位腰椎Cobb角、骶骨倾斜角、弓顶距、腰椎前凸指数、Posner指数和椎板缺损面积。[结果]两组患者术后随访7~13年,平均(9.91±2.35)年。学龄前组患儿术前有2例L5S1脊柱裂,10例轻度脊柱侧弯,至末次随访时Cobb角度数无显著增加。学龄组患儿术前有8例轻度脊柱侧弯,至末次随访10例轻度脊椎侧弯。末次随访时两组未见腰椎滑脱与腰椎峡部裂。术前与末次随访时比较,学龄前组除骶骨倾斜角有统计学意义(P0.05),其余各影像学指标均无显著变化(P0.05);学龄组除冠状位Cobb角、骶骨倾斜角有显著增加(P0.05),而其余指标无显著改善(P0.05)。至末次随访时两组Posner腰椎不稳评价指标无显著变化(P0.05)。两组患者均随术后时间的延长L4/5和L5S1椎板缺损率显著减少(P0.05)。术后半年学龄前组椎板缺损率显著大于学龄组(P0.05),而末次随访时学龄前组椎板缺损率显著小于学龄组(P0.05)。[结论]腰骶段SPR术对腰椎稳定性无明显影响。且行SPR手术的年龄越小,椎板再生更为显著。     

脐周八穴治疗单纯性肥胖症临床疗效观察

目的:观察脐周八穴针罐结合治疗单纯性肥胖症的临床疗效.方法:将95饲单纯性肥胖患者随机分为治疗组和对照组,治疗组(50例)采用脐周八穴为主穴,分别为滑内门、天枢、外陵、水分、阴交,采用针灸结合火罐的治疗方法;对照组(45饲)采用口服曲美,每天10mg,两组均治疗8用.分别对两组患者治疗前及治疗8周后体重、体质指数(BMI)、腰臀比(WHR)、体脂百分率(F%)进行洲定,观察其减肥的效果.结果:治疗组和对照组总有效率分别为98%及97.78%.与对照组比较,治疗组总有效率、体重、体质指数均无显著差异(P>0.05),但WHR、F%均低于对照组(P<0.05).结论:脐周八穴针罐疗法治疗单纯性肥胖与口服曲荚总有效率相当,而脐用八穴针罐疗法更能显著改善肥胖患者的WHR,F%,且安全、无不良反应.     

8周的基础军训对新疆边防部队新兵人体测量指数影响的分层研究

目的:探讨新兵入伍后8周的基础军事训练,对新兵的人体测量指数的影响。方法:随机抽取新疆边防部队2013年度入警的102名男性新兵,其中汉族67名,维吾尔族35名,分别在训练前后测定并记录身高、体重、腰围、臀围,体质指数和腰臀比。结果:经过8周的基础军事训练,对所有参加测试的新兵而言,体质指数变化不大,腰臀比则显著下降。分层研究表明,经过8周的基础军事训练,体重偏轻(体质指数18.5kg/m2)的新兵,体质指数显著增加,腰围变化不大,臀围显著增加,腰臀比不变;对于正常体重(18.5kg/m2≤BMI25 kg/m2)的新兵,体质指数变化不大,腰围显著降低,臀围显著增加,腰臀比显著降低;对于超重(25kg/m2≤BMI30kg/m2)的新兵,体质指数、腰围、臀围及腰臀比均显著降低。结论:新兵8周的基础军事训练,可以重塑体型,减少腹部脂肪的积聚,促进健康。     

Body composition assessment and methodology in nonathletic and athletic adolescent and adult males and females

The purpose of this review is to outline methodology for assessing body composition utilizing anthropometric and densitometric techniques. The objective of body composition assessment is to measure body fat and lean body mass. The quantity of these components varies due to growth, physical activity, dietary regimens, and aging. Anthropometric techniques incorporate selected skinfolds, circumferences, skeletal widths, or other variables to estimate body composition within k2.0-4.0%. These techniques are adequate for field testing of groups or individuals, but are population specific. Densitometry measures body volume irrespective of physique, sex, or age. This laboratory technique estimates body composition within 1.0-2.0%, is more difficult to administer, but is not population specific. Some limitation exists with any present technique due to biological variability and incomplete research of reference body composition in children, females, and the aged. J Orthop Sports Phys Ther 1984;5(6):336-347.     

Perioperative and long-term morbidity and mortality after above-knee and below-knee amputations in diabetics and nondiabetics

We performed a retrospective review of a vascular surgery quality assurance database to evaluate the perioperative and long-term morbidity and mortality of above-knee amputations (AKA, n = 234) and below-knee amputations (BKA, n = 720) and to examine the effect of diabetes mellitus (DM) (181 of AKA and 606 of BKA patients). All patients in the database who had AKA or BKA from 1990 to May 2001 were included in the study. Perioperative 30-day cardiac morbidity and mortality and 3-yr and 10-yr mortality after AKA or BKA were assessed. The effect of DM on 30-day cardiac outcome was assessed by multivariate logistic regression and the effect on long-term survival was assessed by Cox regression analysis. The perioperative cardiac event rate (cardiac death or nonfatal myocardial infarction) was at least 6.8% after AKA and at most 3.6% after BKA. Median survival was significantly less after AKA (20 mo) than BKA (52 mo) (P < 0.001). DM was not a significant predictor of perioperative 30-day mortality (odds ratio, 0.76 [0.39-1.49]; P = 0.43) or 3-yr survival (Hazard ratio, 1.03 [0.86-1.24]; P = 0.72) but predicted 10-yr mortality (Hazard ratio, 1.34 [1.04-1.73]; P = 0.026). Significant predictors of the 30-day perioperative mortality were the site of amputation (odds ratio, 4.35 [2.56-7.14]; P < 0.001) and history of renal insufficiency (odds ratio, 2.15 [1.13-4.08]; P = 0.019). AKA should be triaged as a high-risk surgery while BKA is an intermediate-risk surgery. Long-term survival after AKA or BKA is poor, regardless of the presence of DM.     

Postoperative nausea and vomiting and opioid-induced nausea and vomiting: guidelines for prevention and treatment

Postoperative nausea and vomiting (PONV) causes patient discomfort, lowers patient satisfaction, and increases care requirements. Opioid-induced nausea and vomiting (OINV) may also occur if opioids are used to treat postoperative pain. These guidelines aim to provide recommendations for the prevention and treatment of both problems. A working group was established in accordance with the charter of the Sociedad Espa?ola de Anestesiología y Reanimación. The group undertook the critical appraisal of articles relevant to the management of PONV and OINV in adults and children early and late in the perioperative period. Discussions led to recommendations, summarized as follows: 1) Risk for PONV should be assessed in all patients undergoing surgery; 2 easy-to-use scales are useful for risk assessment: the Apfel scale for adults and the Eberhart scale for children. 2) Measures to reduce baseline risk should be used for adults at moderate or high risk and all children. 3) Pharmacologic prophylaxis with 1 drug is useful for patients at low risk (Apfel or Eberhart 1) who are to receive general anesthesia; patients with higher levels of risk should receive prophylaxis with 2 or more drugs and baseline risk should be reduced (multimodal approach). 4) Dexamethasone, droperidol, and ondansetron (or other setrons) have similar levels of efficacy; drug choice should be made based on individual patient factors. 5) The drug prescribed for treating PONV should preferably be different from the one used for prophylaxis; ondansetron is the most effective drug for treating PONV. 6) Risk for PONV should be assessed before discharge after outpatient surgery or on the ward for hospitalized patients; there is no evidence that late preventive strategies are effective. 7) The drug of choice for preventing OINV is droperidol.