经皮球囊扩张后凸成形术治疗严重骨质疏松性椎体压缩骨折

[目的]探讨经皮球囊扩张椎体后凸成形术(PKP)治疗骨质疏松性严重椎体压缩骨折的可行性及疗效.[方法]回顾性分析15例(共17椎体)严重压缩骨折患者经皮球囊扩张椎体成形术治疗效果.所有手术均在C型臂X线机引导下进行.术前及术后分别进行视觉模拟疼痛评分、活动能力评分、椎体高度测量及Cobb′s角测量.[结果]所有手术均顺利完成,无严重手术并发症.VAS评分由术前的7.9±1.3下降至术后的2.5±0.8(P<0.05),活动能力评分由术前的3.2±0.3改善到术后的1.3±0.2(P<0.05);椎体高度由术前的(0.9±0.1)cm,增加到术后的(2.5±0.2 )cm(P<0.05);Cobb′s角由术前的32°±7.1°, 矫正到术后的22°±5.3°(P<0.05).均较术前明显改善,疼痛缓解和功能改善显著.[结论]PKP是治疗骨质疏松性严重椎体压缩骨折的安全有效方法,值得推广应用.     

球囊扩张椎体后凸成形术治疗老年骨质疏松性椎体压缩骨折

目的 探讨椎体后凸成形术治疗老年骨质疏松性椎体压缩骨折的临床疗效.方法 采用经皮椎弓根穿刺球囊扩张椎体后凸成形术治疗老年椎体压缩骨折32例48椎,观察对比手术前后疼痛情况及活动能力,评估治疗效果.结果 术后患者疼痛明显减轻,活动能力改善.其中术后1 w患者疼痛VAS评分(2.2±0.6)较术前(7.6±0.7)明显下降,(P<0.01);活动能力评分(1.2±0.4)较术前(2.4±0.6)明显改善,(P<0.01).随访时间3～18个月,平均5.6个月.近期效果满意.结论 球囊扩张椎体后凸成形术治疗老年椎体压缩骨折可以有效缓解疼痛,改善活动能力,提高生活质量,疗效满意,值得推广.     

过伸复位结合椎体后凸成形术治疗后壁破裂的骨质疏松性椎体骨折

[目的]探讨过伸复位结合椎体后凸成形术治疗椎管后壁破裂的老年重度椎体压缩骨折的可行性和疗效.[方法]本组38例重度椎体压缩骨折患者均先过伸复位,再接受经皮球囊扩张后凸椎体成形术(PKP),术后对患者的疼痛及影像学结果进行分析.[结果]38例骨折椎体经皮穿刺均获成功,疼痛视觉评分(VAS)评分由术前平均(8.9±0.3)分到术后(2.0±0.4)分,有统计学意义(P＜0.05);体位复位球囊扩张前后椎体前、中、后缘高度差异有统计学意义(P＜0.05);Cobb角由术前的24.8°±3.7°矫正至术后的9.8°±2.9°,手术前后差异有统计学意义(P＜0.05).[结论]体位过伸闭合复位结合PKP是治疗后壁破裂的老年重度椎体压缩骨折的安全有效的治疗方法,能改善椎体高度,缓解疼痛.     

椎体后凸成形术治疗骨质疏松性椎体压缩骨折

目的探讨单球囊扩张椎体后凸成形术治疗老年骨质疏松性脊柱压缩骨折的临床疗效。方法采用单球囊双侧扩张椎体后凸成形术治疗老年骨质疏松性脊柱压缩骨折8例17椎,均为新鲜骨折,腰背部疼痛剧烈,无神经症状及体征。术前CT显示椎体后壁均完整。MRI显示骨折椎体在T1WI呈低信号,T2WI呈高信号。在X线C形臂透视下,采用经皮经椎弓根穿刺,在伤椎内先后植入同一枚球囊,扩张使椎体复位后,将含钡骨水泥注入椎体扩张所形成的空腔内。结果所有患者术后疼痛均明显缓解或消失。平均椎体前缘高度恢复50·2%±12·1%。平均灌注骨水泥5·8mL(4·5~7·6mL),1例椎体前缘发生骨水泥渗漏,未引起临床症状。所有患者均获得随访,随访时间6~48个月,平均14·5个月,未发现与手术有关的并发症出现。结论单球囊扩张椎体后凸成形术治疗老年骨质疏松性脊柱压缩骨折可以有效缓解疼痛,恢复椎体高度,疗效满意。     

椎体后凸成形术治疗高龄骨质疏松性椎体压缩骨折

目的探讨单一球囊扩张经皮椎体后凸成形术治疗80岁以上老年骨质疏松性椎体压缩骨折的疗效及安全性。方法回顾分析高龄（80岁及其以上）老年骨质疏松性椎体压缩骨折患者15例,男性3例,女性12例,平均年龄（82.2±1.9）岁。共45个椎体,均为骨质疏松性脊柱压缩骨折,压缩骨折椎体后壁均完整。全部在C型臂X线机引导下行单侧入路、单一球囊椎体后凸成形术。结果患者平均能在术后第2天下床行走,未发现严重手术并发症。椎体前缘、中部及后缘平均高度分别由术前的（2.17±0.82）cm、（1.75±0.66）cm、（2.95±0.43）cm增至术后的（2.40±0.73）cm、（2.11±0.51）cm、（3.00±0.45）cm,椎体前缘、中部高度差异有显著统计学意义（P〈0.01）;术后48 h患者胸腰背痛均有缓解,术前、术后48 hVAS评分比较差异有显著统计学意义（P〈0.01）。结论应用椎体后凸成形术治疗高龄骨质疏松性椎体压缩骨折,能够安全、有效地改善骨折椎体高度,明显缓解疼痛,早期下床活动。     

后凸成形术治疗骨质疏松性椎体压缩骨折

目的探讨经皮穿刺球囊扩张椎体后凸成形术选择性治疗骨质疏松性椎体压缩骨折的近期临床疗效。方法选取行球囊扩张椎体后凸椎体成形术的骨质疏松性椎体压缩性骨折老年患者共25例(65个椎体),其中男10例,女15例;年龄57~79岁,平均(62.3±5.5)岁。根据术前MRI检查明确疼痛性椎体及陈旧骨折椎体,行选择性球囊扩张后凸成形术的手术方法,对疼痛性椎体采用正常球囊扩张压力和足量骨水泥充填,对陈旧性骨折椎体采用较低球囊扩张压力和少量骨水泥充填,不追求恢复椎体高度。测定手术前后及随访期间椎体高度(前柱、中柱、后柱)、Cobb角、肺功能、疼痛视觉模拟评分(visual analogue scale,VAS)、活动功能。所得数据用SPSS 13.0统计软件包进行配对t检验。观察术后及随访期间症状改善、有无并发症等。结果 25例手术均顺利完成,术后24 h内疼痛均明显缓解。共1例1个椎体有骨水泥渗漏,无明显临床症状。患者手术前后椎体前柱、中柱平均高度差异及Cobb角改善均有统计学意义(P0.01),肺功能各项指标手术前后差异均有统计学意义(P0.01),疼痛及活动能力手术前后差异有统计学意义(P0.05)。结论经皮球囊扩张椎体后凸成形术能显著缓解疼痛、恢复椎体高度、改善后凸畸形和肺功能,患者活动能力提高,生活质量改善,取得满意的临床效果。     

球囊扩张与Sky扩张椎体后凸成形术的对比研究

[目的]探讨球囊扩张与Sky扩张后凸成形术对椎体压缩骨折复位作用的差异,并评价后凸成形术的临床疗效.[方法]自2005年10月～2007年10月,对19例骨质疏松性椎体压缩骨折患者分别施行球囊扩张和Sky扩张椎体后凸成形术,将其中19例压缩骨折患者随机分为两组(A组为球囊组9例,B组为Sky组10例,分别施行两种手术方式),分别测量手术前后椎体高度和Cobb's角,行VAS评分,观察术后并发症,比较术后两组疗效的差异.[结果]所有患者术后疼痛明显减轻或消失,两组椎体高度与术前相比均有显著恢复,P<0.001,有显著统计学意义.其中A组术后椎体前缘、中央高度恢复率分别为20.82%±12.43%、12.51%±10.53%,Cobb's角术后恢复9.64%±8.27%,VAS评分术后缓解6.28±1.2分;B组术后椎体前缘、中央高度恢复率分别为21.93%±13.39%、13.02%±11.68%,Cobb's角术后恢复10.33%±9.28%,VAS评分术后缓解6.46±1.1分,两组比较P>0.05,差别无统计意义.[结论]无论采用球囊扩张椎体后凸成形术,还是Sky扩张椎体后凸成形术,均可有效恢复压缩椎体的高度,纠正后凸畸形,迅速缓解疼痛,两者疗效无明显差异性.     

球囊单侧扩张椎体后凸成形术治疗老年骨质疏松性椎体压缩骨折

目的探讨球囊单侧扩张椎体后凸成形术治疗老年骨质疏松性椎体压缩骨折的疗效和安全性.方法2004年12月～2006年12月采用球囊单侧扩张椎体后凸成形术治疗30例骨质疏松性椎体压缩骨折患者,共44个伤椎,其中男13例19个伤椎,女17例25个伤椎;年龄66～83岁,平均72岁;骨折部位为T7～L5椎体,术前CT显示椎体后壁均完整.结果30例患者均手术顺利,3例3个椎体前缘有少许未引起临床症状的骨水泥渗漏,其余椎体X线片上均未见明显骨水泥渗漏.所有患者术后48h内疼痛明显减轻或消失并可下床活动,住院4～12 d.随访6～24个月,平均14个月,术前平均疼痛视觉模拟评分(VAS)为8.6±0.2分,术后为2.0±0.3分,末次随访时为2.1±0.2分,术后评分显著低于术前(P＜0.01);Oswestry功能评分由术前43.1±1.1分降低到术后20.3±1.2分和末次随访21.1±1.2分(P＜0.01);伤椎前、中柱的平均高度由术前15.1±1.8mm增加到术后24.3±2.1 mm和末次随访24.4±1.8 mm,手术前后差异有显著性(P＜0.05).脊柱后凸Cobb角由术前平均21.2°±4.3°减小到术后10.1°±3.2°和末次随访10.2°±3.3°(P＜0.05).结论球囊单侧扩张椎体后凸成形术可有效恢复骨质疏松性椎体压缩骨折椎体的高度,缓解疼痛,改善患者的脊柱功能及减少骨水泥渗漏,临床疗效满意.     

球囊扩张椎体后凸成形术治疗骨质疏松压缩骨折的初步结果

目的评价经皮球囊扩张椎体后凸成形术治疗疼痛性胸腰椎骨质疏松压缩骨折的效果和安全性。方法回顾性分析2002年5月～2005年4月应用球囊扩张椎体后凸成形术治疗38例患者62个骨质疏松压缩骨折的椎体(T4～L4),有症状的节段均行MRI检查证实。从发病至手术时间2d～1年。术后当天和随访1、3、6个月进行疼痛得分VAS测定和运动水平评价;手术前、后在侧位X线片测量骨折椎体前、中部的高度,评价手术效果。结果球囊扩张椎体后凸成形术可以快速止痛,明显增加脊柱负重能力,疼痛得分从8.2分降至2.4分,手术后62个骨折椎体前、中部的高度增加到了原椎体高度的(82.8±26.8)%和(88.8±21.8)%。椎体楔形变从15°降至8°,这种结果最长可以保持3年,本组患者无一例造成骨折后椎管狭窄加重,无严重并发症的发生。结论球囊扩张椎体后凸成形术可以快速改善运动功能和减轻疼痛,可安全增加椎体高度,迅速恢复老年患者活动水平,短期效果好,远期随访效果还有待最终评价。     

单球囊双侧扩张椎体后凸成形术的探讨

目的探讨单球囊双侧扩张椎体后凸成形术治疗老年骨质疏松性脊柱压缩骨折的临床疗效。方法2002年3月～2004年2月,采用单球囊双侧扩张椎体后凸成形术治疗老年骨质疏松性脊柱压缩骨折15例17椎,男6例6椎,女9例11椎;年龄62～83岁,平均70.5岁。T12 8椎,L1 7椎,T8 1椎,T11 1椎。术前CT显示椎体后壁均完整。MRI显示骨折椎体在T1WI呈低信号,T2WI呈高信号。经骨密度仪测定证实脊椎均存在不同程度的骨质疏松,平均骨密度为0.603g/cm2。结果所有患者术后疼痛均明显减轻,疼痛视觉模拟数字评分由术前平均8.3分降至术后平均2.1分。平均椎体前缘高度恢复54.2%±34.1%,中部恢复60.5%±35.4%,后缘恢复40.7%±32.3%。矢状面排列改善明显。手术前后侧位X线片示Cobb角平均改善9.5°(0°～28°)。平均灌注骨水泥5.9ml(3.5～7.8ml)。除1个椎体前缘有少许未引起临床症状的骨水泥渗漏外,其余椎体在X线片上均无明显骨水泥渗漏。所有患者均获得随访,随访时间2～48个月,平均10.5个月,未发现与手术有关的并发症出现。结论单球囊双侧扩张椎体后凸成形术治疗老年骨质疏松性脊柱压缩骨折可以有效缓解疼痛,恢复椎体高度,改善椎体矢状面排列,疗效满意。     

2015年乳腺癌辅助化疗进展

【摘要】〓乳腺癌是危害我国女性健康的头号杀手,尽管近年来辅助化疗的研究进展突飞猛进,但临床中仍有不少问题未能明确,如辅助化疗的合适人群、化疗的开始时间、蒽环及紫杉类的地位和用法、强化维持治疗的作用、疗效及预后的生物标志物等。本文结合乳腺癌辅助化疗在临床上的常见问题和2015年各大乳腺癌会议阐述乳腺癌辅助化疗的最新进展。     

Alterations in T-Cell Subset Frequency in Peripheral Blood in Obesity

Background: Obesity affects the regulation of immune and inflammatory responses. This study characterizes differences in peripheral blood lymphocyte phenotype in obese humans. Methods: Frequencies of lymphocyte subsets among peripheral blood mononuclear cells were compared between 10 obese (BMI ≥35) and 10 lean subjects, as determined by antibodies directed against cluster differentiation (CD) markers. Results: Obese patients demonstrated an increased frequency of CD3+CD4+ T-cells (mean difference 12%, P=0.004), a decreased frequency of CD3+CD8+ T-cells (mean difference 9.4%, P=0.016) and an increased frequency of CD3+CD8+CD95+ T-cells (mean difference 13.3%, P=0.032). No other differences among T-cell or monocyte subsets were noted. Conclusions: Obesity is associated with alterations in frequencies of peripheral CD4+ and CD8+ T-cells and aberrations in the expression of CD95 among CD8+ T-cells. These data suggest both CD4+ and CD8+ T-cell compartments, as well as the regulation of CD95 expression on CD8+ T-cells, as targets for further study into obesity's effects on the immune system.     

西宁地区烧伤病人动脉血气分析观察

对高海拔地区的27例烧伤病人动脉血气变化进行了分析和观察。结果证明:无论是存活病人还是死亡病人伤后均存在有低氧血症问题。并且在死亡病人和烧伤合并吸入性损伤病人其低氧血症的发生早于单纯烧伤病人。提示:吸入性损伤病人应立即行气管切开术以保障氧气供给,单纯烧伤病人可常规吸氧以维持正常血 PaO_2,ARDS 均发生在合并吸入性损伤的病人,高频喷射通气技术对纠正低氧血症有一定效果。     

Controversies in Fistula in Ano

Managing a complex fistula in ano can be a daunting task for most surgeons; largely due to the two major dreaded complications—recurrence & fecal incontinence. It is important to understand the anatomy of the anal sphincters & the aetiopathological process of the disease to provide better patient care. There are quite a few controversies associated with fistula in ano & its management, which compound the difficulty in treating fistula in ano. This article attempts to clear some of those major controversies.     

β-半乳糖苷酶在体内外成骨细胞中的表达

目的 研究β—半乳糖苷酶(β—gal)在成骨细胞中的表达状况，为阐明MorquioB综合征的发病机制提供依据。方法 裸鼠各器官和骨组织标本行X-gal染色检测。抽取羊和人骨髓行骨髓基质细胞(BMSCs)培养，分为4组：I：Adv-hBMP-2转染组；Ⅱ：Adv—β—gal转染组；Ⅲ：未转染组；Ⅳ：地塞米松诱导组。分别行X-gal染色和RT-PCR检测β—gal的表达。结果 裸鼠骺板两侧、骨膜内面及松质骨的成骨细胞和破骨细胞可见多量β—gal的表达。未转染BMSCs组有少量β—gal的表达，其他3组细胞的β—gal表达增高。结论成骨细胞和破骨细胞可表达多量β—gal，该两种细胞的β—gal缺乏可能是MorquioB综合征骨骼异常的直接原因。     

Smoking-Attributable mortality in Spain in 2016

IntroductionSmoking-attributable mortality (SAM) is a valuable indicator that can be used to characterize the course and health burden of the smoking epidemic. The aim of this paper was to estimate SAM in Spain in 2016 in the population aged 35 and over, using the best available evidence.MethodsA smoking prevalence-dependent analysis based on the estimation of population-attributable fractions was performed. Smoking prevalence (never, former, and current smokers) was calculated from a combination of the Spanish Health Survey (2016) and the European Health Survey (2014); the relative risk of death among current and former smokers was taken from the follow-up of various cohorts; and mortality rates were obtained from National Center for Statistics data. SAM estimates are presented globally, and by sex, age groups, and major disease categories: cancer, cardiometabolic diseases and respiratory diseases.ResultsIn 2016, 56,124 deaths were attributed to tobacco consumption, 84% in men (47,000), and 50% in the population aged over 74 (27,795). Overall, 50% of SAM was due to cancer (28,281), 65% of which was lung cancer. One in 4 attributable deaths (13,849) occurred before the age of 65.ConclusionsOne in 7 deaths in Spain in 2016 were attributable to smoking. This estimation of SAM clearly highlights the great impact of smoking on mortality in Spain, mainly due to lung cancer and chronic obstructive pulmonary disease.     

MicroRNAs in hepatic pathophysiology in diabetes

MicroRNAs(miRNAs or miRs) are small approximately 22 nucleotide RNA species that are believed to regulate diverse metabolic and physiological processes.In the recent past,several reports have surfaced that demonstrate the role of miRNAs in various biological processes and numerous disease states.For a disease as complex as diabetes,the emergence of miRNAs as key regulators leading to the disease phenotype has added a novel dimension to the area of diabetes research.On the other hand,the liver,a metabolic hub,contributes in a major way towards maintaining normal glucose levels in the body as it can both stimulate and inhibit hepatic glucose output.This equilibrium is frequently disturbed in diabetes and hence,the liver assumes special significance considering the correlation between altered hepatic physiology and diabetes.While the understanding of the mechanisms behind this altered hepatic behavior is not yet completely understood,recent reports on the status and role of miRNAs in the diabetic liver have further added to the complexities of the knowledge of hepatic pathophysiology in diabetes.Here,we bring together the various miRNAs that play a role in the altered hepatic behavior during diabetes.     

Fluid-phase transcytosis in the primate epididymis in vitro and in vivo

Ligated tubules from the corpus epididymidis of men and monkeys were incubated in medium containing horseradish peroxidase (HRP) as a marker for fluid-phase endocytosis. HRP was localized by light and electron microscopy after 0, 15, 30 and 60 min of incubation. Movement between the cells was prevented by tight junctions, but bypass of this barrier was apparently achieved by an intracellular vesicular mechanism leading to a time-dependent appearance of HRP in the lumen. Uptake of HRP into basal cells and capture by the lysosomal apparatus of principal cells were also observed. HRP-filled vesicles also appeared in the basal, mid and apical cytoplasm of epithelial cells in the caput 1 h after injection of the tracer into the epididymal circulation of the monkey, suggesting that this pathway also operates in vivo.