牵引对后凸畸形颈椎曲度的影响

目的：探讨颈椎牵引对颈椎后凸畸形的影响。方法：对颈曲反张患者５２例，用枕颌带坐位牵引，牵引角度１０～２０度，重量男女分别从６ｋｇ和４ｋｇ开始，牵引１０～２０次，牵引同时照射红外线，并对急慢性病历进行对比分析。结果：显效和有效各２３例，总有效率为８８％，急性组疗效及颈椎曲度的改善均明显优于慢性组（Ｐ＜０．０１）。结论：牵引可以纠正后凸畸形的颈椎曲度，有效地改善颈椎活动度。应用量化的弓深改变结合临床表现可以作为判定疗效的标准。     

新生儿心肺复苏时肾上腺素浓度和剂量的临床研究

目的　探讨新生儿心肺复苏（ＣＰＲ） 时肾上腺素的最佳用药浓度及剂量。方法　３８ 例新生儿ＣＰＲ病例,按静注肾上腺素的不同用药浓度和剂量归类为Ａ、Ｂ、Ｃ三组。Ａ 组用１ ：１ ０００ 肾上腺素０－０１ ～０－０３ ｍｇ／ｋｇ;Ｂ组,即大剂量组,用１：１ ０００ 浓度０－１～０－２ ｍｇ／ｋｇ;Ｃ组,即常规浓度剂量组,用１：１０ ０００ 浓度０－０１ ｍｇ／ｋｇ。对照分析三组肾上腺素首剂有效率、短期存活率和长期存活率的差异。结果　Ａ组和Ｂ组肾上腺素首剂有效率均明显高于Ｃ组（χ２１ ＝４－９９,χ２２ ＝６－１４,Ｐ＜ ０－０５） ,而在Ａ、Ｂ两组间无统计学差异（χ２ ＝０－２１,Ｐ＞０－０５）。短期存活率Ａ、Ｂ两组也明显高于Ｃ组（χ２１＝ ４－８９,χ２２ ＝５－２４ ,Ｐ＜０－０５） 。长期存活率则Ａ组显著高于Ｃ组（χ２＝ ５－２４,Ｐ＜ ０－０５）,Ｂ组和Ｃ组无统计学差异（χ２＝ １－５１,Ｐ＞０－０５）。结论　新生儿ＣＰＲ 时肾上腺素的最佳浓度和剂量是１：１０００ 浓度０－０１～０－０３ｍｇ／ｋｇ。     

深呼吸训练器在上腹部手术后的应用及观察

将７２ 例全胃切除及胃大部切除手术患者随机分为观察组（ ｎ ＝３７） 和对照组（ ｎ ＝３５）。对照组采用常规护理, 观察组于手术前后运用威鼎深呼吸训练器进行深呼吸训练。结果： 对照组术后发生肺部并发症的例数明显多于观察组（ Ｐ＜０－０５）; 观察组术后咳痰时间明显比对照组短（ Ｐ＜ ０－０１）。观察组术后训练器读数明显低于手术前（ Ｐ＜ ０－０１） , 随着术后日期的推移, 训练器读数逐渐增加, 术后７ｄ 已恢复至术前的７１％ 。     

颈前路椎间盘切除植骨融合术（ACDF）中后纵韧带生物力学作用的实验研究

目的 比较颈前路单双节段颈椎间盘切除减压植骨内固定术中后纵韧带切除前后颈椎的即刻稳定性变化,为临床手术中对后纵韧带的处理提供生物力学依据.方法 15具新鲜小牛颈椎标本（C3-T1）,1具用于预实验,将14具随机分为两组,每组7具标本,组1用于单间隙经前路颈椎间盘切除减压植骨内固定模型的检测,组2用于双间隙检测,按操作过程依次标记为：N正常标本组→A1、A2椎间盘切除＋植骨→B1、B2椎间盘切除＋植骨＋颈前路内固定→C1、C2椎间盘切除＋植骨＋后纵韧带切除→D1、D2椎间盘切除＋植骨＋后纵韧带切除＋颈前路内固定.用实验应力方法测试各组的生物力学特性.结果 颈椎椎体载荷-应变关系：A1、C1的应变比N在轴向压缩、前屈、后伸、侧屈状态均增加,均有显著性差异（P〈0.05）,B1组的应变比N均下降,均有显著性差异;B1组比A1组的应变平均下降26%,有显著性差异（P〈0.05）;D1组比B1组应变稍增加,其中在前屈状态增大最多（4%）,但无显著性差异（P〉0.05）;C1较A1组增大,前屈状态特别明显,有显著性差异（P〈0.05）,其余情况下相比无显著性差异（P〉0.05）.组2的检测结果经过统计分析发现其变化规律与组1相似.结论 在正常标本内颈椎后纵韧带的完整性在维持颈椎稳定性方面起重要作用,后纵韧带的切除导致脊柱标本在前屈状态下稳定性下降最明显.单节段和双节段颈前路椎间盘切除减压后的标本比正常标本的稳定性下降,此时后纵韧带的切除使得标本的稳定性下降更明显,并且单节段和双节段颈前路椎间盘切除减压后的标本通过植骨内固定有效地增强了术后标本的稳定性.     

胃癌病人血清TNF-α和IL-6的水平变化及临床意义探讨

探讨胃癌病人血清ＴＮＦ－α和ＩＬ－６水平的变化及其临床意义。方法：利用ＥＬＩＳＡ法测定３５例胃癌病人血清ＴＮＦ－α和ＩＬ－６水平,并与胃良性肿瘤组和正常对照组相比较。结果：胃癌病人血清ＴＮＦ－α和ＩＬ－６水平明显增高（Ｐ＜０．０１）,并与疾病分期有关（Ｐ＜０．０５）,病灶切除后血清ＴＮＦ－α和ＩＬ－６水平明显降低（Ｐ＜０．０５）。结论：胃癌病人具有细胞免疫功能紊乱,血清中ＴＮＦ－α和ＩＬ－６水平的增高可能和疾病的发生发展有关,测定血清ＴＮＦ－α和ＩＬ－６可作为胃癌病人病情判断和疗效观察的指标之一。     

氯喹对烟雾吸入伤大鼠肺细胞膜磷脂组分及膜流动性的影响

目的：观察氯喹对烟雾吸入伤大鼠肺细胞膜磷脂组分及膜流动性的影响。方法：８０只大鼠随机均分成正常对照组，烟雾吸入伤后１小时、３小时、６小时、１２小时和２４小时组，氯喹（１０ｍｇ／ｋｇ，伤后立即腹腔注射）治疗６小时和１２小时组。于各时间点取肺组织，分离细胞膜，用高效液相色谱仪分析细胞膜磷脂组分，用荧光偏振法测定细胞膜流动性。结果：烟雾吸入伤后３小时，细胞膜总磷脂已明显降低，到伤后２４小时仍明显低于正常对照组（Ｐ＜０．０１），其中磷脂酰胆碱（ＰＣ）、磷脂酰乙醇胺（ＰＥ）和磷脂酰肌醇（ＰＩ）降低尤为明显（Ｐ＜０．０５或Ｐ＜０．０１），同时伴有细胞膜荧光偏振度（Ｐ）、平均微粘度（η）和分子有序性（ｒ）增加及膜脂流动性（ＬＵＦ）降低（Ｐ＜０．０５或Ｐ＜０．０１）；腹腔注射氯喹能明显增加伤后细胞膜ＴＰ、ＰＣ和ＰＥ含量（Ｐ＜０．０５或Ｐ＜０．０１），并降低Ｐ、η和ｒ，增加ＬＵＦ。结论：烟雾吸入伤后立即注射氯喹可以防止肺细胞膜磷脂降解，并改善膜流动性     

血花生四烯酸释放及其对高血压病的调节作用

对６１例高血压病者血花生四烯酸含量变化及对ＴＸＢ２、６ｋｅｔｏＰＧＦ１α含量及Ｔ／６比值的调节进行研究．结果：（１）血压：治疗各组均较治疗前下降（Ⅰ组Ｐ＜０．０５，Ⅱ组、Ⅳ组Ｐ＜０．０１）；治疗后Ⅳ组较Ⅲ组血压下降显著（Ｐ＜０．０１）。（２）血花生四烯酸、ＴＸＢ２、６ｋｅｔｏＰＧＦ１α含量及Ｔ／６比值：①治疗前与对照组相比：花生四烯酸（Ｐ＜０．０５～Ｐ＜０．０１），ＴＸＢ２含量（Ｐ＜０．０５）及Ｔ／６比值（Ｐ＜０．０５～Ｐ＜０．０１）均显著升高；６ｋｅｔｏＰＧＦａ１α含量下降不显著。②治疗后花生四烯酸（Ⅰ组、Ⅱ组Ｐ＜０．０５，Ⅳ组Ｐ＜０．０１）、ＴＸＢ２（Ⅰ组Ｐ＜０．０５，Ⅱ组、Ⅳ组Ｐ＜０．０１）含量及Ｔ／６比值（Ⅱ组Ｐ＜０．０５，Ⅳ组Ｐ＜０．０１）均降低；６ｋｅｔｏＰＧＦ１α较前显著升高（Ｐ＜０．０５）。对照组治疗前后各项指标无显著改变。表明血花生四烯酸和ＴＸＡ２含量与血压变化趋势一致，提示其在高血压病的形成和发展中起重要作用     

牵引治疗颈椎间盘突出症疗效与体位变化分析

目的　探讨牵引体位对颈椎间盘突出症的疗效影响。方法回顾分析６年来颈椎间盘突出症６４例,Ａ组行仰卧位颈部牵引,Ｂ组行坐位颈部牵引治疗,对两组疗效进行统计学处理。结果牵引治疗总有效率Ａ组９６．５３％,Ｂ组９１．６７％,Ｐ＜０．０５。结论 牵引治疗颈椎间盘突出症疗效与卧位、坐位的体位变化无显著性差异（Ｐ＜０．０５）。     

牵引治疗颈椎间盘突出症疗效与体位变化分析

目的探讨牵引体位对颈椎间盘突出症的疗效影响。方法回顾分析６年来颈椎间盘突出症６４例,Ａ组行仰卧颈部牵引,Ｂ组行坐位颈部牵引治疗,对两组疗效进行统计学处理。结果牵引治疗总有效率Ａ组９６．５３％,Ｂ组９１．６７％,Ｐ＜０．０５。结论牵引治疗颈椎间盘突出症疗效与卧位、坐位的体位变化无显性差异（Ｐ＜０．０５）。     

足部按摩治疗颈椎病对人体自由基的影响

目的：比较足部反射区按摩和牵引并用离子导入疗法治疗颈椎病对人体自由基代谢的影响。方法：对足部反射区行按摩治疗５２例（Ａ组），每日１次，３０～４０分钟，共１２次，疗前用盐水浸足，疗后饮温开水；牵引并离子导入治疗３０例（Ｂ组），颈前屈２０～３０度坐位牵引，从６ｋｇ开始日增１ｋｇ至１２ｋｇ止，每次２０分钟，然后以３％碘化钾溶液于颈交感神经节反射区行直流电导入２０分钟。结果：治疗后两组患者血液超氧化物歧化酶、谷胱甘肽过氧化物酶的活性和总抗氧化活力均显著高于治疗前，而血液丙二醛含量低于治疗前（Ａ组Ｐ＜０．００１，Ｂ组Ｐ＜０．０５）。结论：两组治疗方法对人体自由基代谢均有影响，但Ａ组的影响明显大于Ｂ组。     

C4～C6颈椎有限元模型的建立和多点力学加载方法

背景:人体颈椎运动是多节段之间相互力学及位移关系的变化,建立多节段有限元模型及多点力学加载方法可以为颈椎生物力学研究提供高精度的模型和科学的计算分析方法。目的:建立人体C4~C6颈椎三维有限元模型,并在此基础上提出多点力学加载方法。方法:以正常人C4~C6颈椎CT图像作为数据源,利用Mimics10.0、Ansys11.0有限元分析软件建立三维有限元模型,对其进行多点力学加载测试,模拟生理状态时颈椎的轴向、屈曲、后伸、侧弯、扭转运动,分析各运动状态下C4~C6颈椎关节突和椎间盘的应力和位移改变。结果与结论:建立的C4~C6颈椎有限元模型几何形态逼真,重现了C4~C6颈椎节段解剖结构外形,整体显示直观,表面无过多简化,建成后的三维有限元模型与实体组织具有良好的几何相似性。应力Se、Sz在不同加载工况时,前屈/后伸>侧弯>轴向加载。轴向加载载荷明显小,导致应力位移水平低。提示应用正常人体原始资料构建的C4~C6颈椎有限元模型以及多点力学加载分析的方法科学有效,为颈椎的生物力学研究提供了高精度模型和科学的计算分析方法。     

人工颈椎间盘置换对下颈椎活动影响的三维有限元分析

建立人工椎间盘置入后下颈椎C_(3~7) 的三维模型,分析颈椎人工椎间盘置换后下颈椎运动情况.根据1例人工椎间盘置入患者术后6个月CT片,应用有限元方法建立其包含Bryan~(TM)人工颈椎间盘假体的下颈椎三维有限元模型,导入Ansys 9.0中,对椎体皮质骨、松质骨、椎间盘用三维十节点四面体结构实体单元进行网格划分后进行分析.对模型加载2 N·m的力矩,观察其在前屈/后伸、侧屈及旋转几种状态下的运动情况,了解其运动特性.通过与以往的研究结果比较,试验结果基本符合或趋势基本一致.结果提示,颈椎间盘置换后能基本保证下颈椎运动稳定性.     

Strain behavior of malaligned cervical spine implanted with metal-on-polyethylene,metal-on-metal,and elastomeric artificial disc prostheses – A finite element analysis

BackgroundPostoperative alterations in cervical spine curvature (i.e. loss of lordotic angle) are frequently observed following total disc replacement surgery. However, it remains unclear whether such changes in lordotic angle are due to preoperative spinal deformities and/or prostheses design limitations. The objective of the study is to investigate strain and segmental biomechanics of the malaligned cervical spine following total disc replacement.MethodsThree disc prostheses were chosen, namely a metal-on-polyethylene, a metal-on-metal, and an elastomeric prosthesis, which feature different geometrical and material design characteristics. All discs were modelled and implanted into multi-segmental cervical spine finite element model (C3-C7) with normal, straight and kyphotic alignments. Comparative analyses were performed by using a hybrid protocol.FindingsThe results indicated that as the spine loses lordotic alignment, the prosthesis with elastomeric core tends to produce significantly larger flexion range of motion (difference up to 6.1°) than metal-on-polyethylene and metal-on-metal prostheses. In contrast, when the treated spine had normal lordotic alignment, the range of motion behaviors of different prostheses are rather similar (difference within 1.9°). Large localized strains up to 84.8% were found with the elastomeric prosthesis, causing a collapsed anterior disc space under flexion loads.InterpretationChanges in cervical spinal alignments could significantly affect the surgical-level range of motion behaviors following disc arthroplasty; the in situ performance was largely dependent on the designs of the artificial disc devices in particular to the material properties.     

Dynamic response of the cervical spine to posteroanterior mobilisation

BACKGROUND: Posteroanterior mobilisation is a manual therapy technique that is commonly used in the examination and treatment of neck pain, but little is known about its biomechanical effect. The purpose of this study was to determine the intervertebral movements of the cervical spine produced by posteroanterior mobilisation. METHODS: The cervical spines of nineteen healthy subjects were scanned using an open interventional magnetic resonance imaging scanner. Posteroanterior mobilisation forces were applied to the fifth cervical vertebra whilst they were in the prone position. Sagittal images of the spine were obtained before and during mobilisation. FINDINGS: It was shown that posteroanterior mobilisation of the cervical spine generally produced extension of the upper motion segments and flexion of the lower segments. The middle segments were inconsistent in the direction of rotation. The cervical lordosis was found to increase with repeated PA loading cycles. INTERPRETATION: The magnitude of intervertebral movement produced by mobilisation is small. Forces applied at one spinous process produced not only movements at the target vertebra but also movements of the entire cervical spine resulting in an increase in lordosis. Mobilisation should be interpreted as three-point bending of the entire cervical spine, rather than simple gliding of one vertebra upon another.     

经皮髓核成形术治疗退变性颈椎间盘突出症

目的: 探讨经皮髓核成形术对不同退变程度颈椎间盘突出症的临床疗效及颈椎稳定性的影响。方法: 对我院2003 年12月～2006 年12 月因退变性颈椎间盘突出症住院行PCN治疗的88 例患者进行回顾性分析, 椎间盘退变程度根据MRI分为中度组(median Degeneration group, MDG)与重度组( severe degeneration group，SDG) , 对两组手术时间、临床效果及术后颈椎稳定性等方面进行比较。结果: 所有病例随访6～30 个月, 两组手术均成功。MDG手术时间为14．67±5.32min, SDG为13.93±3.96min, 两组间有显著性差异( P<0.01)；两组术后JOA评分均显著增高, 与术前比较有显著性差异( P<0.01) ；临床效果(Williams评价)MDG优于SDG, 有显著性差异( P<0.05)。两组手术后均无颈椎不稳病例发生,各手术间隙的椎体角度位移( angular displacement, AD) 及椎体水平位移( horizontal displacement, HD) 手术前后均无显著性差异( P>0.05) 。结论:经皮髓核成形术对颈椎稳定性影响小, 不会造成颈椎失稳的发生，适用于不同退变程度的颈椎间盘突出症。早期手术治疗可取得较好的临床疗效好     

C_4～C_6颈椎有限元模型的建立和多点力学加载方法

背景：人体颈椎运动是多节段之间相互力学及位移关系的变化,建立多节段有限元模型及多点力学加载方法可以为颈椎生物力学研究提供高精度的模型和科学的计算分析方法。目的：建立人体C4~C6颈椎三维有限元模型,并在此基础上提出多点力学加载方法。方法：以正常人C4~C6颈椎CT图像作为数据源,利用Mimics10.0、Ansys11.0有限元分析软件建立三维有限元模型,对其进行多点力学加载测试,模拟生理状态时颈椎的轴向、屈曲、后伸、侧弯、扭转运动,分析各运动状态下C4~C6颈椎关节突和椎间盘的应力和位移改变。结果与结论：建立的C4~C6颈椎有限元模型几何形态逼真,重现了C4~C6颈椎节段解剖结构外形,整体显示直观,表面无过多简化,建成后的三维有限元模型与实体组织具有良好的几何相似性。应力Se、Sz在不同加载工况时,前屈/后伸〉侧弯〉轴向加载。轴向加载载荷明显小,导致应力位移水平低。提示应用正常人体原始资料构建的C4~C6颈椎有限元模型以及多点力学加载分析的方法科学有效,为颈椎的生物力学研究提供了高精度模型和科学的计算分析方法。     

Comparison of cervical vertebral separation in the supine and seated positions using home traction units

This study was performed for the purpose of comparing the magnitude of cervical vertebral separation during cervical traction in supine and seated positions using home traction units. A repeated measures design with two within-subject factors (type of traction and time) was used. Seventeen asymptomatic volunteers received cervical traction in seated and supine position. Subjects received 5?minutes of static traction in sitting or supine using a force of 13.6?kg while in 15 degrees of neck flexion. A lateral radiograph of the cervical spine was taken before traction force was applied and after five minutes of static traction. Anterior and posterior distances between the inferior border of C2 and the superior border of C7 were measured by a radiologist. After supine traction there were significant increases (p=0.001) in posterior cervical vertebral separation compared to any changes after seated traction. There were no significant changes in anterior vertebral separation during either supine or seated traction positions (p=0.769). Supine cervical traction may be more effective for increasing posterior vertebral separation than seated cervical traction.     

Multiple muscle force simulation in axial rotation of the cervical spine

OBJECTIVE: To produce axial rotation of the cervical spine in vitro by coordinated application of eight simulated muscle forces. DESIGN: Biomechanical testing of the cervical spine by controlled pneumatics. BACKGROUND: Some muscle simulation experiments have been performed in vitro in the lumbar spine but data generally are lacking for this testing mode in the cervical spine. Thus, physiological biomechanical behavior in this region remains poorly understood. METHODS: Six human donor cervical spines were loaded by a set of computer-controlled pneumatic cylinders representing pairs of trapezius, splenius and sternocleiodmastoid muscles, plus longus and splenius colli left. Muscle functions were derived from a previously-developed mathematical optimization model. Muscle forces generally were achievable within 2 N of the intended values provided by the model. RESULTS: Rotation of the head followed fairly closely that predicted by the model. The resulting force components to produce 37 degrees were dominated by axial compression of about--100 N and the resulting moments were similar in all planes at about 2 Nm. Coupled motions were larger than primary motions in some intersegmental behavior. CONCLUSIONS: Slow, physiologic axial rotation of the head may be simulated by a complex and representative series of controlled pneumatics. Controlled rotation results in a relatively high compressive force and occurs through fairly balanced and small moments. RELEVANCE: Experimental approaches in biomechanics are generally limited to one or two simplified muscle forces whose representation of in vivo loading conditions can only be presumed. Improvements in the application of pneumatic technology are a promising approach to more thoroughly duplicating the physiological loading environment.     

Biomechanical comparison of the stable efficacy of two anterior plating systems

OBJECTIVE: To compare the immediate stable efficacy and load sharing effect of two types of anterior cervical screw-plating instrumentations: the Morscher Synthes titanium locking screw-plate system and the Caspar trapezoidal screw-plate system. DESIGN: Fresh porcine cervical spines with intact, two surgery unstable models, and then reconstructed with or without screw-plating instruments were compared in three physiological loading conditions. BACKGROUND: Two markedly instrumentation systems--Morscher Synthes titanium cervical locking screw-plate and Caspar trapezoidal screw-plate systems are commonly used in management of complex cervical spine disorders. Although the biomechanical study showed that the lower cost Caspar system performed superior in extension before and after plate fatigue, the clinic evaluations of two systems were contradictory. So (1) does the titanium cervical locking plate system pay for its higher cost? and (2) what is the load sharing character of strut graft in one level corpectomy?METHODS: Eight fresh ligamentous porcine cervical spines from C3 to C7 were undergone axial compression, rotation and sagittal flexion tests. The biomechanical experiment was sequentially repeated for the intact, C5-6 discectomy, C5 corpectomy, and then stabilized by either type of plate fixation devices with or without polymethylmethacrylate bone cement grafting. Strains measured by an extensometer across the operated motion segment were used as the index of stability. RESULTS: Analysis of the strain data showed both types of anterior fixation plate systems provided adequate-restored stability for the spinal column only aided with polymethylmethacrylate construction. Statistically, there was no significant difference in biomechanical evaluation for the stability effect between much cost Morscher Synthes plate and Caspar plate system (p<0.005). The spinal disc bore as much as 75% of axial loading. While the strut graft functioned as the disc substitute and spacer, it bore more than 90% of axial loading. In high degree of flexion, the transmitted compressive load was shifted anteriorly to the screw-plate. This might unload the polymethylmethacrylate graft and resulted in the strut graft in tensile fatigue failure. CONCLUSIONS: Statistically both systems showed similar stable efficacy, however, the Morscher Synthes cervical locking plate system might provide better stable effect in higher degrees of flexion motion. The strut graft played as the major load-bearing role in axial compression and sagittal flexion, while in axial rotation, the applied torque was mainly resisted by facet joint and screw-plate system complex. RELEVANCE: The minor discrepancy of two plating systems may be due to the nature of plate geometry and design but not the material properties. Combination of bone graft and either plating systems provides adequate fusion stability under physiological loadings. The high degree flexion may cause the posterior portion of polymethylmethacrylate graft in tensile fracture and then result in polymethylmethacrylate failure in clinic observation.