脊柱康复操在中轴型脊柱关节炎病人中的应用

目的:探究脊柱康复操应用于中轴型脊柱关节炎病人的效果及对脊柱活动度、功能状态的影响。方法:选取2021年2月—2022年8月科室收治的94例中轴型脊柱关节炎病人为研究对象,采用随机数字表法分为对照组、观察组,每组47例。对照组给予常规护理,观察组在常规护理的基础上增加脊柱康复操,比较干预前后两组病人疾病缓解程度[Bath强直性脊柱炎疾病活动性指数(BASDAI)、Bath强直性脊柱炎计量指数量表(BASMI)、Bath强直性脊柱炎功能性指数(BASFI)]、脊柱活动度(胸廓活动度、脊柱活动度、枕墙距)、心理情况[焦虑自评量表(SAS)、抑郁自评量表(SDS)]。结果:干预后观察组病人BASDAI、SAS、SDS、BASMI、BASFI评分,枕墙距小于对照组;胸廓活动度、脊柱活动度优于对照组,经比较差异有统计学意义(P<0.05)。结论:脊柱康复操用了中轴型脊柱关节炎病人可有效改善脊柱活动度和脊柱功能,缓解负性情绪。     

脊柱外科护理进展

脊柱外科护理进展７１００３２第四军医大学西京医院刘建华，邓小玲，李霞，巴红伟，于红近年来，脊柱外科在国内外发展很快，新手术方法，新手术器械不断涌现，脊柱外科的护理也迈上了新的台阶。应用Ｈａｒｒｉｎｇｔｏｎ、Ｌｕｑｕｅ，Ｇａｌｖｅｓｔｏｎ等手术方法治疗...     

脊柱关节病与未分化脊柱关节病

脊柱关节病是包括强直性脊柱炎 (ＡＳ)、银屑病关节炎、肠炎性关节病、瑞特综合征 ,以及未分化脊柱关节病等在内的一大组疾病。这类疾病具有一些共同的特点 :以ＨＬＡ Ｂ2 7为主要的遗传易感因子 ,以肌腱—骨附着点炎症为基本的病理改变 ;常常累及骶髂关节、脊柱和各大关节 ;类     

脊柱结核误诊为脊柱肿瘤30例临床分析

目的:探讨非典型脊柱结核误诊为脊柱肿瘤的原因及鉴别诊断要点.方法:回顾分析我院经手术后病理证实的30 例非典型脊柱结核的临床资料,重点分析影像学误诊原因.结果:相邻椎体骨质、椎间盘破坏,椎间隙狭窄或消失、椎旁脓肿形成是脊柱结核典型的影像特征.30例手术治疗后均痊愈,术后并发切口感染2例,窦道形成1例.结论:本病临床表现缺乏特异性,对其影像特点认识不足、未进行必要的鉴别诊断是造成误诊的主要原因.     

改良脊柱操在脊柱疾病患者中的干预效果分析

目的观察分析改良脊柱操对脊柱疾病患者的临床干预效果。方法将入选的150例颈腰椎病患者,采用随机数字表法分为观察组和对照组,每组75例。对照组给予手法、针灸、熏蒸、牵引;观察组在手法、针灸、熏蒸、牵引的基础上给予改良脊柱操的干预。两组患者均于治疗前和治疗后第1、2、4周采用日本骨科协会(JOA)颈椎病评分和下腰痛评分对入选患者进行疗效评定。结果两组患者治疗前和治疗后1周的运动功能、感觉功能、主观症状、临床体征、日常活动受限度、膀胱功能、JOA总分,组间差异均无统计学意义(P0.05);治疗后2、4周,观察组的运动功能、感觉功能、主观症状、临床体征、日常活动受限度、JOA总分与组内治疗前和对照组同时间点比较,差异均有统计学意义(P0.05)。结论改良脊柱操的干预可以增强肌力、调控肌群协调性、维持脊柱稳定性,提高治疗脊柱疾病的临床疗效。     

病灶清除、植骨融合术治疗脊柱结核25例分析

对我院1998—09～2004—05采用一期病灶清除植骨融合术治疗脊柱结核25例总结分析如下。1临床资料1．1一般资料本组男19例，女6例，除1例为9岁儿童外，其余年龄18～65（平均38）岁。本组均有不同程度颈、胸、腰、脊部疼痛和发热、消瘦等结核中毒症状，经X线片、CT、MRI检查诊断为脊柱结核。颈椎结核3例，胸椎结核5例，胸腰段结核11例，腰椎结核6例，有脊髓马尾神经损伤症状8例，按Franbel分级标准B级1例，C级5例，D级2例，E级17例。其中出现后凸畸形16例。     

Ⅰ期病灶清除、内固定治疗脊柱结核

目的 :观察前路Ⅰ期病灶清除、植骨、内固定治疗脊柱结核的疗效。方法 :回顾 1998年以来收治并行病灶清除Ⅰ期植骨融合内固定治疗并获随访的 3 0例脊柱结核病例 (术前后凸成角 10°～ 72° ,平均 3 1°) ,对其病例选择、手术时机、术后处理及术后康复情况进行回顾分析。结果 :平均随访 1 4年 ,优良率为 86 7% ,植骨融合率可达90 % ,后凸矫正角度 14° ,术后无一例复发。结论 :Ⅰ期病灶清除、植骨、内固定治疗脊柱结核病灶清除彻底 ,有利于重建脊柱稳定性 ,提高骨融合率 ,可纠正及预防脊柱后凸畸形 ,减少或避免结核复发     

脊柱康复操在中轴型脊柱关节炎患者康复中的应用

目的探讨脊柱康复操在中轴型脊柱关节炎(ax-SpA)患者康复中应用的效果。方法选取60例ax-SpA患者,随机分为对照组和研究组,每组30例。对照组给予常规治疗康复指导,发放疾病康复指导手册;研究组在对照组基础上开展脊柱康复操训练。对比2组患者康复护理前和康复护理6个月后晨僵时间、疼痛评分、指地距离、胸廓扩张度和枕墙距。结果康复护理6个月后,研究组的晨僵时间为(12.06±4.13)min、疼痛评分为(14.00±4.33)分,明显短于或低于对照组的(16.36±5.54)min、(19.23±8.09)分,差异有统计学意义(均P<0.05);研究组的指地距离为(11.47±3.45)cm、胸廓扩张度为(4.30±0.47)cm、枕墙距为(3.33±0.93)cm,改善情况明显优于对照组的(17.54±3.58)、(3.74±0.21)、(5.75±0.96)cm,差异有统计学意义(均P<0.001)。结论与健康教育行为相比,有计划的脊柱康复操训练对中轴型脊柱关节炎的病情改善效果更明显,可改善患者症状,提升脊柱及关节功能,促进患者康复。     

脊柱前路矫形术治疗特发性脊柱侧凸的护理

脊柱侧凸是脊柱在额状面出现偏离脊柱中轴线的凹凸弧度,特刎发性脊柱侧凸是脊柱侧凸中最常见的一种,约占脊柱侧凸的80%[1],病因不明,但主要是由于不对称的生长和不对称的肌肉作用所致.我院自1999年1月起应用脊柱前路矫形内固定植骨融合术,矫正特发性脊柱侧凸6例,经随访,术后效果良好,治愈率达100%.现将护理要点报告如下.     

脊柱内镜技术的历史、现状与发展

<正>近年来,经皮脊柱内镜下腰椎间盘摘除术(Percutaneous endoscopic lumbar discectomy,PELD)的临床应用已取得了丰硕的成果。随着脊柱内镜技术及相应技术的迅速发展,该技术也在传统开放手术领域中获得了成功的应用,脊柱内镜技术已逐步进入一个崭新的时代。在微创脊柱外科技术蓬勃发展的今天,正确认识脊柱内镜技术,掌握适应证和熟练的操作技巧是取得良好疗效的关键。如何正确地看待脊柱内镜技术是我们要冷静思考的问题,本文将就各种脊柱内镜技术在脊柱疾病治疗中应用的历史、     

Mapping of neuronal function in the healthy and injured human spinal cord with spinal fMRI

Functional magnetic resonance imaging of the human spinal cord is carried out with a graded thermal stimulus in order to establish the relationship between signal changes and neural activity. Studies of the lumbar spinal cord in 15 healthy subjects with 10 degrees C stimulation of the skin overlying the calf demonstrate a pattern of activity that matches the neuronal anatomy of the spinal cord. This pattern shows primarily dorsal horn activity, with expected components of motor reflex activity as well. Moreover, a later response shifting to noxious cold over time is also demonstrated with a shift to more dorsal horn activity. Signal intensity changes detected at different degrees of thermal stimulation have a biphasic nature, with much larger signal changes below 15 degrees C as the stimulus becomes noxious, and agree well with electrophysiological results reported in the literature. These findings demonstrate a strong correspondence between Spinal fMRI results and neural activity in the human spinal cord. Spinal fMRI is also applied to studies of the injured spinal cord, below the site of injury. Results consistently demonstrate activity in the spinal cord even when the subjects cannot feel the stimulus being applied. Signal intensity changes demonstrate the same stimulus-response pattern as that in noninjured subjects, but the areas of activity in the spinal gray matter are notably altered. In subjects with complete injuries, activity is absent ipsilateral to the thermal stimulation, but appears to be enhanced on the contralateral side. These findings demonstrate the reliability of Spinal fMRI and its clinical potential.     

脊髓损伤患者的性功能康复及治疗

脊髓损伤是一种常见疾病。据不完全统计 ,我国目前大约有 30万脊髓损伤患者 ,并且每年新增大约 2万例。脊髓损伤最常见的病因为车祸伤与跌伤 ,最常见的损伤部位是颈部和颈胸椎结合部。脊髓损伤后 ,患者不仅有肢体感觉、运动功能障碍 ,而且排尿、排便及性功能也产生障碍 ,对其回归社会 ,享受人生产生很大影响。脊髓损伤患者伤后对性、性的感觉、性的乐趣以及对性行为的态度并没有本质上的改变 ,这就要求我们医护工作者要详细了解脊髓损伤患者残有的性功能 ,对他们进行性康复教育 ,帮助他们解除烦恼 ,在生理、心理、精神方面能以较好的状态面…     

Arterial structure and function in physically active persons with spinal cord injury

OBJECTIVE: We tested the hypothesis that physically active people with spinal cord injury do not have increased subclinical atherosclerosis compared with an age-matched able-bodied group. METHODS: Subjects comprised 28 wheelchair athletes with spinal cord injury (mean age 22 (standard deviation (SD) 3) years) and 24 recreationally active aged-matched able-bodied control participants (mean age 23 (SD 3) years). Intima media thickness, arterial compliance and beta stiffness of the common carotid artery were measured using B-mode ultrasound. Aortic augmentation index was derived from applanation tonometry of the radial artery. RESULTS: Carotid mean intima media thickness in persons with spinal cord injury did not differ from that of controls (0.46, SD 0.07 vs 0.44, SD 0.06, p=0.94). Carotid artery beta stiffness in persons with spinal cord injury also did not differ from that of controls (4.92, SD 1.6 vs 5.70, SD 1.6, p=0.08). The augmentation index did not differ between groups (4.0% [-3.8-12.3] vs 4.5 %, [-8.0-12.0] of median and interquartile range, p=0.78). CONCLUSION: Participation in regular exercise may preserve arterial function in individuals with spinal cord injury when compared with aged-matched able-bodied participants.     

Sexual function and infertility following spinal cord injury

Changes in sexual function and fertility frequently occur following spinal cord injury (SCI). This article presents an overview of human sexual response and the changes that occur in that response following SCI. This article addresses the issues of childbearing for women with SCI, erectile function for men with SCI, and the issues of fertility and parenting for men and women with SCI.     

利伐沙班对脊柱创伤患者脊柱融合术后血液流变学、炎性因子及凝血功能的影响

目的  分析利伐沙班对脊柱创伤患者脊柱融合术后血液流变学、炎性因子及凝血功能的影响。 方法  选择2019年1月~ 2020年1月我院外科接受脊柱融合术治疗的脊柱创伤102例患者,按照随机数字表排布法分为观察组（n=51）和对照组（n=51）,对照组行术后常规处理,观察组在此基础上给予利伐沙班治疗,1次/d,1次1片,连续治疗14 d。比较两组患者术后1~14 d血液流变学（全血低切黏度、全血中切黏度、全血高切黏度、红细胞压积、血浆黏度及血小板黏附率）,炎性因子（白细胞介素8、白细胞介素10、肿瘤坏死因子-α及C反应蛋白）,凝血功能指标（凝血酶时间、凝血酶原时间、活化部分凝血酶时间、纤维蛋白原及D-二聚体）。 结果  经过治疗,两组患者全血低切黏度、全血中切黏度、全血高切黏度、红细胞压积、血浆黏度及血小板黏附率等血液流变学均有一定程度降低,且观察组与对照组差异有统计学意义（P < 0.05）;观察组炎症因子白细胞介素8、白细胞介素10、肿瘤坏死因子-α及C反应蛋白水平均显著低于对照组（P < 0.05）;观察组凝血酶时间、凝血酶原时间、活化部分凝血酶时间、纤维蛋白原及D-二聚体等凝血功能指标均低于对照组（P < 0.05）。 结论  利伐沙班可以有效改善脊柱融合术后脊柱创伤患者的血液流变学,降低相关炎性因子水平,且未明显改变相关凝血功能,具有一定的安全性和临床效果。     

Modulation of urinary bladder function with thyrotropin-releasing hormone in patients with spinal cord injuries during the spinal shock phase

Injury to the spinal cord is associated with large increases in plasma beta-endorphin immunoreactivity. To investigate the effect on vesical function of thyrotropin-releasing hormone (TRH), 13 patients with spinal injury were studied during the spinal shock phase. In seven of them (Group A), after basal cystometry together with anal sphincter electromyography (EMG), 1 mg of TRH was administered intravenously as a bolus dose, followed by 1 mg infused over 5 minutes. After the administration of the bolus dose of TRH, cystometry + EMG was repeated (Study I). These seven cases received TRH 1 mg intravenously 12 hourly for the next three days. On day 4, after basal cystometry + EMG, TRH was administered as above and the urodynamic study was repeated (Study II). Detrusor pressure (Pdct) with bladder filled to 800 ml (or upto tolerance) and bladder compliance were noted. Six cases underwent study I alone and received normal saline instead of TRH (Group B). After TRH in group A, the mean (+/- SE) Pdct increased by 10 +/- 3 cm H2O (p less than 0.05) in study I and by 10 +/- 3 cm H2O (p less than 0.05) in study II whereas the mean compliance decreased by 37 +/- 20 ml/cm H2O (NS) in study I and by 44 +/- 18 ml/cm H2O (p less than 0.05) in study II. In group B, the mean Pdct decreased by 1 +/- 2 cm H2O (NS) and the mean compliance increased by 1 +/- 2 ml/cm H2O (NS) in the post-normal saline study. These results show that TRH may improve bladder function in patients with injury-induced spinal shock by increasing detrusor pressure and by decreasing bladder compliance.     

Immune function in spinal cord-injured males

Infected and noninfected spinal cord-injured (SCI) patients, bilateral amputees (control for mobility), and a control group were compared for immune function. Immune measures involved acute phase reactants (erythrocyte sedimentation rate [ESR], c-reactive protein [CRP], and alpha-1 globulin [A1G], T cell measurements (absolute lymphocyte count [ALC]), and B cell function (gamma globulin [GG]). All subjects were at least three months postinjury, had no history of immune system disease, and were not taking potential immune system altering drugs. There was no T or B cell dysfunction, but acute phase reactants were elevated, even in patients without infection. Criteria for predicting infection included recent injury, few previous infections, and catheters. The best predictor of infection was CRP. Suggestions for further research include investigating nonhospitalized patients, searching for reasons for elevated acute phase reactants, and using the predicting formula on newly injured patients to see if it predicts infectious complications.     

康复治疗脊髓损伤功能恢复的疗效观察

目的研究康复治疗对脊髓损伤患者的运动功能,感觉平面恢复,排尿功能及ADL等的影响,为脊髓康复程序化治疗提供可靠的依据.方法脊髓损伤患者32例,损伤水平颈段11例,胸段9例,腰段12例.发病后距康复治疗时间为1～10个月,平均(4.8±3.6)个月,康复治疗持续时间为58～90d.采取运动功能训练,ADL训练,理疗,心理疏导等方法,进行运动平面总积分,感觉平面总积分,排尿功能分级,Barthel指数的评定.结果32例脊髓损伤患者治疗后运动平面总积分(55.88±16.48),感觉平面总积分(68.09±17.63),排尿功能分级(2.03±1.57)及Barthel指数(67.81±20.54),与康复治疗前比较差异均有非常显著性(P＜0.001);9例完全性脊髓损伤中,经康复治疗后,运动平面总积分,感觉平面总积分及Barthel指数均有明显提高(P＜0.05),而排尿功能分级改变不大(P＞0.05).结论脊髓损伤患者有一定恢复的潜力,不完全性脊髓损伤的恢复潜力较大.完全性脊髓损伤的排尿功能分级康复治疗前后变化不大,但运动功能、感觉功能及ADL均有明显改善.