弥漫性特发性骨质增生症合并脊柱骨折的临床特点

<正>弥漫性特发性骨质增生症(diffuse idiopathic skeletal hyperostosis,DISH)是一种以软组织钙化、骨化为特征的系统性疾病,最常累及脊柱,并引起脊柱强直。因此,DISH患者很容易并发脊柱骨折,而且与一般脊柱骨折相比,DISH合并脊柱骨折又有其特殊的临床特点及治疗原则~([1、2])。我们对近年收治的12例DISH合并脊柱骨折的患者进行了回顾性分析,报告如下。     

弥漫性特发性骨肥厚症并不完全性脊髓损伤1例报告

弥漫性特发性骨肥厚症（DISH）是一种以脊柱前外侧韧带钙化或骨化为特征的骨骼疾病,可累及全脊柱乃至全身骨骼,有研究^［1］显示,其好发于中老年人群,男性较女性更为多见。DISH合并颈椎后纵韧带骨化症（OPLL）临床并不少见,但外伤后出现脊髓损伤症状的报道不多,现将本院收治的1例DISH并不完全性脊髓损伤患者的治疗情况报告如下。     

弥漫性特发性骨肥厚症合并胸腰椎骨折的治疗进展

弥漫性特发性骨肥厚症(DISH)是强直性脊柱疾病的一种, 好发于中老年人, 临床主要表现为韧带及肌腱附着点的骨化和钙化, 是一种主要累及脊柱但不伴有严重椎间盘退变或骶髂关节及椎间小关节强直的骨病。DISH合并胸腰椎骨折具有很高的延迟诊断率和神经恶化率, 所以应及时诊断和治疗。但对于此种骨折的治疗方法和术后的疗效各个资料结论不一, 目前仍存在争议。笔者查阅相关文献, 就DISH合并胸腰椎骨折的治疗方法作一综述, 以为此种骨折的临床治疗提供借鉴。     

弥漫性特发性骨肥厚症继发吞咽困难1例

正弥漫性特发性骨肥厚症(diffuse idiopathic skeletal hyperostosis,DISH)多发于老年男性~([1]),国外文献报道发病率为2.9%~28%~([1~3])。累及颈椎的DISH的病理特点为颈椎相关韧带钙化、骨质增生~([4]),严重者可出现脊柱强直、骨折、声音嘶哑、呼吸或吞咽困难等。该疾病国内报道不多,笔者手术治愈因弥漫性特发性骨肥厚症累及颈椎所致严重吞咽困难1例,取得较满意的临床疗效,报道如下。     

弥漫性特发性骨质增生症（DISH）

弥漫性特发性骨质增生症（diffuse idiopathic skeletal hyperostosis,DISH）,60余年前由Forestier和Rotes—Querol首次详细报告,又称Forestier病[1]。DISH在临床上并不少见,好发于中老年人,以软组织（主要为韧带、肌腱附着点）部位的钙化和骨化为特征,最常累及脊柱。病因不明,     

弥漫性特发性骨肥厚症研究进展

弥漫性特发性骨肥厚症(DISH)是一种以韧带和肌腱附着点的骨化、钙化为特征的全身性疾病,多见于老年男性。Forestier等^[1]于1950年首次描述了该病,并将其描述为"老年强直性脊椎骨肥大",亦称为Forestier病。20世纪70年代,Resnick等^[2]归纳总结了Forestier病的影像学和病理学特点,正式将其命名为DISH。DISH常累及椎旁韧带,多见于胸椎,其次是颈椎和腰椎^[3]。周围关节(如肩、肘、腕、骨盆、髋、膝和脚踝)也可发生软组织增厚和钙化^[4]。DISH缺乏特征性的临床症状,多局限于影像学表现,其诊断容易被忽略。本文通过查阅DISH相关文献,从流行病学、发生机制、临床表现、影像学表现、诊断和治疗等方面展开分析,以期为DISH的临床诊治提供参考,综述如下。     

颈椎弥漫性特发性骨肥厚症1例

弥漫性特发性骨肥厚症(diffuse idiopathic skeletal hyperostosis,DISH)是一种以脊柱前外侧韧带钙化为特征、可累及全身的骨骼疾病,最早在1950年由Forestier和Rotes-Querol描述.多发生于中老年人群,男性多见,我国尚无相关流行病学研究,国外研究资料提示在年龄超过50岁的人群中,男性发病率为25％,女性为15％[1].颈椎DISH最常见于C4～C6[2],高位颈椎DISH较少见,我们遇到1例,报道如下.     

脊柱韧带骨化相关的易感基因研究进展

弥散性特发骨肥大症（diffuse idiopathic skeletal hyperostosis，DISH），也称Forestier病，是一种常见的老年型疾病，表现为脊柱前纵韧带骨化和各种脊柱外韧带骨化。DISH病与后纵韧带骨化（ossification of posterior longitudinal ligamentum，OPLL）和黄韧带骨化（ossification of the ligamentum flavum，OLF）的病理病变过程均为软骨内骨化；它们均是临床常见的多因素迟发疾病，起病隐匿，男性多见，男女比率为3—1：1。[第一段]     

机械应力因素在脊柱韧带骨化发生机制中的作用研究进展

正脊柱韧带骨化是一种以脊柱正常韧带发生异位骨化为特点的慢性、退行性疾病。主要包括后纵韧带骨化(OPLL)、黄韧带骨化(OLF)及弥漫性特发性骨肥大症(DISH)~([1])。后纵韧带和黄韧带解剖位置特殊,直接参与椎管结构的组成,因此,OPLL和OLF的发生常常导致脊髓和神经根受压,引起严     

伴与不伴弥漫性特发性骨质增生症的腰椎管狭窄症患者脊柱骨盆参数的比较

目的 :探讨弥漫性特发性骨质增生症(diffuse idiopathic skeletal hyperostosis,DISH)对腰椎管狭窄症(lumbar spinal stenosis,LSS)患者脊柱骨盆矢状面参数的影响。方法 :回顾性分析2014年1月~2017年6月于南京鼓楼医院行腰椎后路全椎板切除减压椎间融合手术的伴DISH的LSS患者40例,其中男23例,女17例,年龄51~75岁(65.1±7.3岁)。同时选取年龄及性别匹配且接受相同术式的不伴DISH的LSS患者40例作为对照组,其中男23例,女17例,年龄51~75岁(64.7±7.1岁)。两组患者性别、年龄、责任节段分布均无统计学差异(P0.05)。分别测量两组患者术前胸椎后凸角(thoracic kyphosis,TK)、腰椎前凸角(lumbar lordosis,LL)、矢状面平衡(sagittal vertical axis,SVA)、骨盆入射角(pelvic incidence,PI)、骨盆倾斜角(pelvic tilt,PT)、骶骨倾斜角(sacral slope,SS)、腰骶角(lumbar-sacral angle,LSA)、腰5入射角(L5 incidence,L5I)等脊柱骨盆参数,并用术前VAS评分和ODI评分评估入选对象的生活质量。采用独立样本t检验比较两组患者脊柱骨盆参数的差异及生活质量的差异。结果:伴DISH的LSS患者的术前SVA显著低于不伴DISH的LSS患者(20.0±38.7mm vs.40.0±46.3mm,P=0.039),而TK(27.2°±10.7°vs 25.5°±16.0°)、LL(48.1°±13.7°vs 47.1°±13.5°)、PI(51.4°±14.1°vs 52.5°±13.9°)、PT(18.0°±8.0°vs 19.0°±7.6°)、SS(33.6°±9.5°vs 34.4°±7.8°)、LSA(17.0°±12.0°vs 18.4°±6.7°)及L5I(22.4°±9.8°vs 24.7°±11.9°)两组均无统计学差异(P0.05)。伴DISH患者术前腰痛和下肢痛VAS评分及ODI评分(分别为5.6±1.0,6.5±1.3,36.9±4.9)均高于不伴DISH组患者(分别为5.4±1.2,6.2±1.7,36.8±5.0),但差异均无统计学意义(P0.05)。结论:与不伴DISH的LSS患者相比,伴DISH的LSS患者SVA显著降低,TK、LL、PI、PT、SS、LSA及L5I等其他脊柱骨盆矢状面参数无显著差异。     

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.     

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.