激光定位G臂透视减少胸腰椎椎弓根置钉术中辐射暴露

分析激光定位G臂透视对减少胸腰椎椎弓根置钉术中辐射暴露的影响。研究纳入141例患者,C臂透视组70例置入432枚,激光定位G臂透视组71例置入397枚,结果显示激光定位G臂透视组辐射曝光总次数比C臂透视组低,辐射总曝光、透视操作及手术时间比C臂透视组短,激光定位G臂透视组透视总精准率比C臂透视组高（ P<0....     

单双侧穿刺PKP治疗骨质疏松性胸腰椎压缩骨折的比较研究

目的探讨单侧与双侧穿刺经皮椎体后凸成形术治疗老年骨质疏松性胸腰椎压缩性骨折在疗效和安全性上的差异。方法 40例患者随机分为单侧组和双侧组。单侧组24例,双侧组16例,记录VAS评分、椎体Cobb角、椎体前缘及中部高度变化、手术时间及X线暴露时间,比较组间差异。结果 40例患者均未发现神经损伤等并发症,患者术前术后VAS评分、椎体Cobb角、椎体前缘及中部高度恢复差异有统计学意义(<0.05),组间差异无统计学意义(>0.05);两组手术时间和透视次数比较,差异有统计学意义(<0.05)。结论单双侧穿刺经皮椎体椎体后凸成形术治疗老年骨质疏松性胸腰椎压缩性骨折手术效果无显著差异,单侧穿刺能明显减少手术和放射暴露的时间。     

经皮穿刺经椎弓根脊柱取活检方法的改进

目的探讨一种改进的脊柱取活检方法对椎体病变诊断的价值。方法改进脊柱取活检方法,用经皮椎体成形术部分手术器械联合小号刮匙及髓核钳,在C臂X光机透视引导下采用经皮穿刺经椎弓根取活检的方法,对23例疑难椎体病变行活检术,8例同时行椎体后凸成形术。结果 23例均成功穿刺取材,穿刺活检的阳性率为100%,全部病例取得较好质量病理切片,获得确诊,未发生穿刺并发症。结论 C臂X光机透视引导下使用椎体成形术手术器械联合小号刮匙及髓核钳,经皮穿刺经椎弓根穿刺活检是一种微创、可靠、安全的的活检方法,并可同时行PKP手术治疗。     

3D打印辅助经皮穿刺椎体成形术治疗重度骨质疏松性椎体压缩骨折的疗效

目的 探讨3D打印技术辅助经皮穿刺椎体成形术（PVP）治疗重度骨质疏松性椎体压缩骨折（OVCF）的疗效。方法 回顾性分析我院收治的82例重度OVCF患者的临床资料,根据手术方式不同将患者分为对照组（42例,采用常规PVP治疗）和观察组（40例,采用3D打印技术辅助PVP治疗）。比较2组手术和术后恢复相关指标、骨折椎体影像学指标、腰椎功能、疼痛程度、生活质量及并发症。结果 观察组穿刺定位时间、手术时间短于对照组（P<0.05）,透视次数少于对照组（P<0.05）,骨水泥渗漏发生率低于对照组（P<0.05）。2组术后腰椎功能、骨折椎体影像学指标、疼痛程度、生活质量均较术前改善（P<0.05）,但组间比较差异无统计学意义（P>0.05）。结论 3D打印技术辅助PVP治疗重度OVCF可缩短穿刺定位时间和手术时间,减少术中透视次数,降低骨水泥渗漏风险。     

基于增强现实技术的可视化实时引导系统在股骨头坏死髓芯减压术中定位的初步临床试验*

目的 探讨基于增强现实（AR）技术的可视化实时引导系统用于股骨头坏死微创介入手术定位的可行性、精准度和临床优势。方法 试验组纳入2021年1月至2021年3月于本院诊治的9例（10髋）股骨头缺血性坏死患者,在基于AR技术的可视化实时引导系统的辅助下行股骨头坏死髓芯减压术定位穿刺,记录术中定位时长、透视次数,术后利用影像学资料评价系统精度;按照配对原则选择2019年1月至2021年3月行传统股骨头坏死髓芯减压术的患者8例（10髋）作为对照组。对比两组定位时长、透视次数,评估该系统的有效性。结果 试验组和对照组的平均定位时长分别为（10.1±1.9）min和（19.1±2.5）min,两者比较差异有统计学意义（P<0.05）。试验组和对照组的平均透视次数分别为（5.5±1.3）次和（14.8±12.1）次,两者比较差异有统计学意义（P<0.05）。试验组平均距离定位误差（5.0±5.2）mm,平均角度定位误差（6.4±2.5）°。两组中均无不良事件发生。结论 基于AR技术的可视化实时引导系统相比于传统手术方式,在保证穿刺精度的同时极大程度地减少了定位时长和透视次数。     

C臂X光机下经椎弓根穿刺椎体活检术的临床应用

目的:探讨C臂X光机下经椎弓根脊柱椎体病变穿刺的取材成功率及安全性.方法:采用C形臂X光机透视引导下经椎弓根脊柱椎体病变穿刺术,对27例患者进行椎体活检,其中胸椎病变18例,腰椎病变9例.术中使用PKP穿刺通道系统,取病变部位组织进行病理组织学检查.结果:病灶取材率为100%.其中25例为阳性结果,2例为坏死组织无法诊断,椎体活检阳性率为92.6%.无严重并发症.结论:C臂X光机下经椎弓根穿刺椎体活检操作简单,定位准确,并发症少,阳性率高,是取得病理诊断较为可靠的手段.     

骨科机器人辅助经皮椎体后凸成形治疗多节段脊柱转移瘤

背景:经皮椎体后凸成形治疗多节段脊柱转移瘤存在手术时间长、透视剂量大、骨水泥易渗漏等相关问题。机器人辅助下经皮椎体后凸成形治疗可优化手术,减少并发症的发生。目的:评价机器人辅助下经皮椎体后凸成形治疗多节段脊柱转移瘤的安全性和优势所在。方法:回顾分析2018年1月至2019年4月收治的43例无神经损伤症状多节段脊柱转移瘤患者的临床资料,根据手术方法分为机器人辅助组(n=22)和传统透视组(n=21)。2组患者性别、年龄、病椎数量、原发肿瘤来源、术前目测类比评分等一般资料比较差异均无显著性意义(P>0.05),具有可比性。收集2组患者手术时间、透视次数、透视剂量、椎弓根突破率、穿刺内倾角及骨水泥渗漏情况;对比2组术前、术后2d及末次随访目测类比评分、椎体中线高度、Cobb角度。结果与结论:①机器人辅助组和传统透视组治疗的病椎数量分别为79个和70个;②机器人辅助组平均手术时间、透视次数明显少于传统透视组,透视剂量低于传统透视组,差异均有显著性意义(P<0.001);③机器人辅助组椎弓根突破率为6%,传统透视组为21%,差异有显著性意义(χ^2=6.040,P=0.014);④机器人辅助组穿刺内倾角大于传统透视组(P<0.001);⑤机器人辅助组骨水泥渗漏率显著低于传统透视组(8%,23%,χ^2=6.869,P=0.009);⑥术前、术后2d、末次随访2组间目测类比评分、椎体中线高度、Cobb角比较,差异均无显著性意义(P>0.05);⑦提示机器人辅助下经皮椎体后凸成形治疗多节段脊柱转移瘤可缩短手术时间,减少透视次数,降低透视剂量,穿刺准确率高,骨水泥渗漏风险低。     

经皮椎体成形术的实验研究及临床应用

目的 :完善经皮椎体成形术的方法并对其临床疗效进行评价。方法 :5具新鲜胸腰段脊柱 (T9～L5)标本随机选取 1 0个椎体节段行椎体成形术 ,观察PMMA在椎体内分布并进行椎体压缩试验。临床选择 4例骨质疏松腰椎压缩性骨折患者行经皮椎体成形术 ,观察其临床效果。结果 :1 0个椎体节段均穿刺顺利 ;PMMA骨水泥在椎体内沿骨小梁分布至整个椎体 ,有 1例出现椎体后静脉窦渗漏 ;椎体成形术后抗压强度由 (2 1 97± 355)N增加至 (4861 1 1 0 9)N ;临床治疗 4例患者疗效好 ,未出现椎体外漏导致的并发症。结论 :在C臂X线机透视引导下经皮椎体成形术安全、可靠 ;对骨质疏松椎体压缩性骨折具有良好疗效     

经皮椎体成形术治疗骨质疏松性胸腰椎压缩骨折

目的:观察经皮椎体成形术治疗骨质疏松性胸腰椎压缩骨折的临床疗效.方法:C臂X线透视监控下,以骨水泥为充填材料,经单侧或双侧椎弓根穿刺行经皮椎体成形术(PVP)10例12椎、经皮后凸成形术(PKP)5例8椎.结果:随访2～14个月,10例疼痛完全缓解,4例疼痛部分缓解,1例无效.有效率93.3%.术中穿刺针穿透椎体前壁1例,髓泥渗漏3例,均未产生严重后果.结论:PVP治疗骨质疏松性胸腰椎压缩骨折安全、有效,但要把握好确认"疼痛椎"、准确穿刺、注射骨水泥关键技术.     

光辅助X射线体表定位在骨科植入物内固定中的应用

背景：以往骨科内固定常使用C臂机进行体表定位,但固定中的反复透视会加大对人体的损伤及延长固定时间。 目的：探寻一种简便实用、更有利于骨科内固定的光辅助X射线体表定位技术。 方法：使用自制的简易装置将雷达状的红色激光投射在体表来辅助C臂机进行体表定位。使用SD大鼠和新西兰大白兔设计动物实验,模拟软组织内异物定位、骨折髓内钉远端锁钉置入、脊柱椎弓根螺钉进针点定位3种骨科内固定方法。分别使用传统C臂机和光辅助X射线体表定位技术各进行 30次定位。分析2种方法对操作的影响,并分析深度和活体因素对光辅助X射线体表定位技术的影响。 结果与结论：与传统C臂机定位相比,光辅助X射线体表定位技术在实验过程中能够更快的进行体表定位(P < 0.05),但定位的深度和活体因素会影响光辅助X射线体表定位技术的准确度(P < 0.05)。说明光辅助X射线体表定位技术具有简便、快速、动态化的优点,可方便骨科内固定的进行,但在固定过程中需考虑各种因素对定位准确性的影响,减小或消除这些影响因素将更好的发挥光辅助X射线体表定位技术的优势。     

Location, location, location: the BRMS1 protein and melanoma progression

There is a disproportionate burden of gout in African-Americans in the U.S. due to a higher disease prevalence and lower likelihood of receiving urate-lowering therapy (ULT), compared to Caucasians. There is an absence of strong data as to whether the response to ULT differs by race/ethnicity. BMC Musculoskeletal Disorders recently published a secondary analyses of the CONFIRMS trial, a large randomized controlled, double-blind trial of 2,269 gout patients. The authors reported that the likelihood of achieving the primary study efficacy end-point of achieving serum urate < 6 mg/dl was similar between African-Americans and Caucasians, for all three treatment arms (Febuxostat 40 mg and 80 mg and allopurinol 300/200 mg). More importantly, rates were similar in subgroups of patients with mild or moderate renal insufficiency. Adverse event rates were similar, as were the rates of gout flares. These findings constitute a convincing evidence to pursue aggressive ULT in gout patients, regardless of race/ethnicity. This approach will likely help to narrow the documented racial disparities in gout care. Please see related article: http://www.biomedcentral.com/1471-2474/13/15     

Location, location, location: The BRMS1 protein and melanoma progression

ABSTRACT: The metastasis suppressor, BRMS1, has been demonstrated to cause dramatic regression of metastatic lesions without blocking orthotopic tumor growth. The role of BRMS1 is well-documented for several non-melanoma malignancies such as breast cancer, ovarian cancer and non-small cell lung cancer. However, its role in melanoma is just beginning to be understood, with a recent article by Slipicevic et al. highlighting the levels of expression of BRMS1 in benign nevi, primary and metastatic melanoma samples. Their findings emphasize that the intracellular location of BRMS1 protein (cytoplasmic or nuclear), appears to have a significant impact upon the metastatic capacity of melanoma cells. Interestingly, this selective localization translates into a statistically significant decrease in the relapse-free period in melanoma patients, further associated with a thicker Breslow's depth of primary melanomas. However, and more importantly, this study begins to define a clearer role for BRMS1 in melanoma that is strictly dependent upon its cellular location, with nuclear expression associated with invasive and metastatic capacity and cytoplasmic expression resulting in repressive effects upon progression and metastasis. Please see related article: http://www.biomedcentral.com/1471-2407/12/73.     

Distribution of hand location in monkeys during spontaneous behavior

Recently it was shown that electrical stimulation of the precentral gyrus of monkeys can evoke complex, coordinated movements. In the forelimb representation, stimulation of each site caused the arm to move to a specific final posture, and thus the hand to move to a location in space. Among these stimulation-evoked hand locations, certain regions of the hands workspace were more represented than others. We hypothesized that a similar non-uniform distribution of hand location should be present during a monkeys spontaneous behavior. The present study examined the distribution of hand location of monkeys in their home cages. This distribution was similar to that found by stimulation of the precentral gyrus. That is, arm postures that were over-represented in spontaneous behavior were also over-represented in the movements evoked by cortical stimulation.     

The influence of post-nerve injury survival duration on receptive field size: location, location, location

In the present study, we examined the relationship between post-injury survival duration and receptive field size at multiple levels of the ascending somatosensory neuroaxis. In experimentally na?ve subjects, receptive fields on the glabrous hand are typically restricted to single digits. Yet, following targeted nerve section, receptive fields often span multiple digits. In these experiments, adult squirrel monkeys were subject to paired transections of the median and ulnar nerves and permitted to survive for varying periods (2-28 months) prior to terminal electrophysiological recording. The frequency of cutaneously activated multiple-digit receptive fields was evaluated in regions of brainstem, thalamus and cortex normally devoted to the (now) partially deafferented hand. We report that for area 3b of primary somatosensory cortex, receptive field size became smaller as a function of survival duration. In contrast, survival duration had no appreciable effect on the frequency of multiple-digit receptive fields in either the cuneate nucleus of the brainstem or the ventroposterior lateral nucleus of the thalamus. These observations suggest that the mechanisms responsible for the refinement of receptive fields are, primarily, resident to the cortex.     

跟骨骨刺定位与病因学特点的X射线片评价

文题释义：骨刺“垂直压缩”假说：骨刺突起是在病变局部受到持续的高强度的压力而引发的。具体是指由于受到持续压力,受压部位有发生应力性骨折的风险,出于机体自身的保护机制,此处的纤维软骨异常生长,最终形成骨刺。 骨刺“纵向牵拉”假说：肌腱或韧带附着与骨质上的反复牵拉引起骨刺。附着在骨质上的肌腱或韧带对骨质局部形成持续的牵引或摩擦,诱发局部无菌性炎症,最终肌腱或韧带发生反应性的骨化而形成骨刺。 背景：国内外大量研究已经证实跟骨骨刺的发生与足底筋膜炎和骨关节炎等疾病存在联系,对于跟骨骨刺的病因,目前已经提出“垂直压缩”和“纵向牵拉”两大假说,但都未得到证实。 目的：对跟骨骨刺的形态和位置进行统计,分析跟骨骨刺的病因。 方法：随机选取完整干燥跟骨标本831例和跟骨侧位X射线片222例(其中18-30岁33例,31-50岁97例,51-70例83例,71-90例9例),观察跟骨骨刺的形态和位置,游标卡尺直接测量标本中跟骨骨刺的长度和宽度,运用相关软件在跟骨侧位X射线片上测量骨刺长度。研究方案的实施符合南方医科大学的相关伦理要求,试验所用跟骨标本由南方医科大学解剖教研室提供,为供者自愿捐赠。 结果与结论：①跟骨标本有142例存在骨刺;跟骨侧位X射线片中有82例存在骨刺;跟腱骨刺最长处88.1%位于跟骨外侧缘,足底骨刺全部位于跟骨内侧结节;②X射线片无骨刺人群的平均年龄为(42.9±14.2)岁,有骨刺人群的平均年龄为(54.0±13.4)岁,单纯跟腱骨刺人群的平均年龄为(42.3±14.9)岁,有骨刺人群平均年龄显著大于无骨刺人群(P < 0.05);无骨刺人群与单纯跟腱骨刺人群的平均年龄差异无显著性意义(P > 0.05);③跟骨标本显示跟腱骨刺的形态为竖嵴状,足底骨刺为片状;④结果说明：跟骨侧位X射线片中跟骨骨刺发生率大于跟骨标本中跟骨骨刺发生率;跟腱骨刺多发生在跟腱附着处外侧,足底骨刺发生在跟骨内侧结节;不同年龄段人群中跟骨骨刺的发生率不同;提示跟腱骨刺可能由纵向牵拉引起,足底骨刺可能由垂直压缩引起。 ORCID: 0000-0003-0316-5954(武凯) 中国组织工程研究杂志出版内容重点：人工关节;骨植入物;脊柱;骨折;内固定;数字化骨科;组织工程     

Complement and human T cell metabolism: Location,location, location

The complement system represents one of the evolutionary oldest arms of our immune system and is commonly recognized as a liver-derived and serum-active system critical for providing protection against invading pathogens. Recent unexpected findings, however, have defined novel and rather “uncommon” locations and activities of complement. Specifically, the discovery of an intracellularly active complement system—the complosome—and its key role in the regulation of cell metabolic pathways that underly normal human T cell responses have taught us that there is still much to be discovered about this system. Here, we summarize the current knowledge about the emerging functions of the complosome in T cell metabolism. We further place complosome activities among the non-canonical roles of other intracellular innate danger sensing systems and argue that a “location-centric” view of complement evolution could logically justify its close connection with the regulation of basic cell physiology.     

An SV40 mutant oncoprotein has a nuclear location

T147 is an SV40 mutant that makes a normal small t antigen and a large T antigen that is only 147 amino acids long. We have introduced a second mutation into the genome of T147 which eliminates its ability to encode small t antigen. We show that this double mutant is able to transform C3H10T1/2 mouse cells in a focus assay and F111 rat cells in an agar suspension assay, demonstrating that the transforming domain of T antigen is located within its amino-terminal 147 amino acids. We also show that the T147 mutant T antigen, like wild-type T antigen, has a nuclear location. However, in contrast to wild-type T antigen, which is also found in the plasma membranes of wild-type transformed cells, we fail to detect any mutant T antigen associated with the plasma membranes of T147 transformants.