颈椎前路手术中椎动脉定位的相关解剖研究

目的探讨颈椎前路手术中椎动脉的定位方法.方法对22具(44侧)经防腐固定的成人尸体标本,分别在C2～T1各椎间水平测量两侧颈长肌内缘间距及颈长肌内缘与椎动脉的内缘的水平距离,观察钩椎关节的增生特点及其前后部增生的差异和对椎动脉的影响.结果 C2～T1各椎间水平颈长肌间距为6.1～15.1 mm, 颈长肌与椎动脉内缘的水平距离为7.2～9.6 mm, 钩椎关节增生前部远重于后部,呈现以前部为主横向增生的特点,60岁以上标本中钩椎增生遮蔽椎动脉者13侧(81.5%),其中部分遮蔽8侧(61.5%),完全遮蔽5侧(38.5%).结论颈前路手术中对椎动脉的定位应联合应用钩椎关节和颈长肌等标志,尤其应重视钩椎关节增生造成的形态改变对定位的影响.     

桡神经深支的体表定位及其临床意义

目的:建立桡神经深支的体表定位方法。方法:取成人尸体标本48具(96侧上肢标本),显露桡神经深支,在前臂中立位,分别测量桡神经深支发出点与肱桡关节线的距离、桡神经深支穿出旋后肌的部位与肱桡关节线的距离及其与肱骨外上髁和Lister结节连线的水平距离、桡骨茎突与肱桡关节线的距离,并作统计学分析。结果:桡神经深支自桡神经主干发出的位置在肱桡关节上方平均为(15.4±2.5)mm。桡神经深支穿出旋后肌的部位均位于肱骨外上髁与桡骨Lister结节连线的尺侧,与连线的水平距离平均为(6.1±2.1)mm,与肱桡关节线的平均距离为(61.3±17.6)mm。结论:桡骨小头正前方或略偏外侧可作为桡神经深支近端的定位标志,肱桡关节线下方约6cm,肱骨外上髁与桡骨Lister结节连线尺侧约0.6cm可作为桡神经深支远端的定位标志。     

腰椎后路椎间融合（PLIF）术后深部感染手术治疗

目的 探讨腰椎后路椎间融合（PLIF）术后深部感染的诊断、治疗特点。方法通过对8例PLIF术后深部感染的检查及手术治疗，总结诊断PLIF术后深部感染的敏感指标、有效的治疗方法。结果血沉、CRP是诊断及监测PLIF术后深部感染的敏感化验指标；MRI对诊断急性感染有确诊意义，对诊断慢性感染早期意义不大；内固定牢固者可以保留内固定，不影响对感染的治疗；神经根刺激症状恢复不如腰痛症状恢复明显；所有病人经过规范治疗均在3个月内治愈。结论PLIF术后深部感染通过规范治疗，完全可以治愈，预后良好。     

颈筋膜中层的解剖特点及其在颈椎前路手术中的意义

目的了解颈筋膜中层的解剖特点及其与周围结构的关系,并对颈椎前路手术入路的方法提出一些改进。方法成人尸体标本22具,于颈中部纵形切开,显露颈动脉鞘和舌骨下肌群,观察颈筋膜中层的形态、质地及与颈动脉鞘的关系。向两侧分离脏器鞘和颈动脉鞘,观察二鞘之间连结组织的多少、质地,分析其可能对颈椎前路手术中钝性分离的影响,观察喉返神经、甲状腺下动脉与颈筋膜中层的解剖关系,观察喉返神经、甲状腺下动脉与颈动脉鞘的解剖关系。结果颈筋膜中层在颈总动脉的前外侧融入颈动脉鞘,层次、边界清楚。除颈筋膜中层外,脏器鞘和颈动脉鞘之间仅有少量疏松组织,容易分离。在颈右侧,喉返神经在约胸1椎体水平自颈动脉鞘内、后缘穿出椎前筋膜,始终不与颈筋膜中层接触。双侧甲状腺下动脉均在约颈6椎体水平自颈动脉鞘内、后缘穿出椎前筋膜,始终不与颈筋膜中层接触。结论颈筋膜中层的解剖特点及其与周围结构的关系应被充分理解与利用,使颈前手术入路更合理和安全。     

不同年龄段人骨髓间充质干细胞体外生长特点

目的 观察不同年龄段人骨髓间充质干细胞(human mesenchymal stem cells，hMSCs)体外生长、增殖的影响。方法 使用密度梯度离心法分离不同年龄人骨髓MSCs进行培养，保留贴壁细胞传代，观察细胞生长情况，检测其增殖活性、细胞周期。结果 低龄hMSCs较高龄hMSCs体外生长快、MTT活性高以及增殖期比例大。结论 hMSCs的增殖能力和活性随着年龄的增加而降低，建立其增殖参数可满足组织工程种子细胞在临床应用中不同患者的要求。     

肋骨移植治疗长骨纤维异样增殖症

纤维异样增殖症 ,可累及骨的全长或者多发 ,累及一侧肢体的股骨和胫骨 ,或肱骨和桡骨与尺骨 ,病变广泛给治疗带来一定困难 ,甚至有人将多骨多发骨的纤维异样增殖症列为手术治疗的禁忌证。其困难之一是于去除病变后进行植骨修复 ,而自体骨移植骨源困难。我们1995年以来采用肋骨移植治疗长段的或多发的病变 ,获得成功 ,报告于下。1.临床资料 :男 5例 ,女 3例 ;13、14岁儿童各 1例 ,2 1～ 33岁 6例。 8例纤维异样增殖症 ;其中累及 1侧股骨和胫骨全长者 3例 ,累及同 1股骨颈粗隆部和骨干全长者 3例 ,同侧肱骨干、尺桡骨全长 1例 ,肱骨干 1例。病…     

微载体技术体外扩增人骨髓间充质干细胞

目的 :建立一种快速、大量扩增人骨髓间充质干细胞 (hMSCs)的方法 ,以满足组织工程技术治疗大段骨缺损对细胞数量的需要。方法 :普通培养的第 3代人MSCs1× 10 7个及 0 5gCytodex3微载体 ,加入有 10 0ml培养基的搅拌生物反应器中培养 ,在前 6h ,每隔半小时以 40r/min的速度搅拌 2min ,以后连续搅拌。于培养的第 1、 3、 5、7、 9、 11d取样在相差显微镜下动态观察细胞生长情况 ,最后进行细胞表面生长因子的检测。结果 :接种 2 4h后 87%的MSCs细胞贴附于微载体并铺展 ,3d后生长加速 ,约 8～ 9d后细胞生长达最大值。最终细胞收获密度为接种时的约 15～ 2 0倍。流式细胞仪检测显示 ,所培养的MSCs均一的表达CD2 9和CD44 ,而CD3 4、CD45和HLA DR阴性。结论 :应用微载体技术可以大量、快速的培养扩增人骨髓间充质干细胞 ,细胞表面抗原特性不变 ,能够满足组织工程技术治疗大段骨缺损的需要     

髂后痛对椎间盘源性腰痛的临床诊断价值研究

腰痛是人类最常见的疾病之一,由于能够引起腰痛的解剖部位多且复杂,如何判断腰痛的来源,进行定性及定位诊断一直是临床实践中的难点.在众多的可能产生腰痛的病因中,近年来椎间盘源性腰痛受到更多的重视,并被认为是腰痛最常见的病因[1,2].     

Differentiation of adipose-derived stem cells towards nucleus pulposus-like cells induced by hypoxia and three-dimensional chitosan-alginate gel scaffold in vitro

Background Injectable three-dimensional (3D) scaffolds have the advantages of fluidity and moldability to fill irregular-shaped defects, simple incorporation of bioactive factors, and limited surgical invasiveness. Adipose-derived stem cells (ADSCs) are multipotent and can be differentiated towards nucleus pulposus (NP)-like cells. A hypoxic environment may be important for differentiation to NP-like cells because the intervertebral disc is an avascular tissue. Hence, we investigated the induction effects of hypoxia and an injectable 3D chitosan-alginate (C/A) gel scaffold on ADSCs. Methods The C/A gel scaffold consisted of medical-grade chitosan and alginate. Gel porosity was calculated by the liquid displacement method. The pore microstructure was analyzed by light and scanning electron microscopy. ADSCs were isolated and cultured by conventional methods. Passage 2 BrdU-labeled ADSCs were co-cultured with the C/A gel. ADSCs were divided into three groups (control, normoxia-induced, and hypoxia-induced groups). In the control group, cells were cultured in 10% FBS/DMEM. Hypoxia-induced and normoxia-induced groups were induced by adding TGF-β1, dexamethasone, vitamin C, sodium pyruvate, proline, bone morphogenetic protein-7, and 1% ITS-plus to the culture medium and maintained in 2% or 20% O2, respectively. Histological and morphological changes were observed by light and electron microscopy. ADSCs were characterized by flow cytometry. Cell viability was investigated by BrdU incorporation. Proteoglycan and type II collagen were measured by safranin O staining and the Sircol method, respectively. mRNA expression of hypoxia inducing factor-1α (HIF-1α), aggrecan, and type II collagen was determined by RT-PCR. Results C/A gels had porous exterior surfaces with 80.57% porosity and 50–200 μm pore sizes. Flow cytometric analysis of passage 2 rabbit ADSCs showed high CD90 expression, while CD45 expression was very low. The morphology of induced ADSCs resembled that of NP cells. BrdU immunofluorescence showed that most ADSCs survived and proliferated in the C/A gel scaffold. Scanning electron microscopy showed that ADSCs grew well in the C/A gel scaffold. ADSCs in the C/A gel scaffold were positive for safranin O staining. Hypoxia-induced and normoxia-induced groups produced more proteoglycan and type II collagen than that in the control group (P <0.05). Proteoglycan and type II collagen levels in the hypoxia-induced group were higher than those in the normoxia-induced group (P <0.05). Compared with the control group, higher mRNA expression of HIF-1α, aggrecan, and type II collagen was detected in hypoxia-induced and normoxia-induced groups (P <0.05). Expression of these genes in the hypoxia-induced group was significantly higher than that in the normoxia-induced group (P <0.05). Conclusions ADSCs grow well in C/A gel scaffolds and differentiate towards NP-like cells that produce the same extracellular matrix as that of NP cells under certain induction conditions, which is promoted in a hypoxic state.     

Dynesys动态内固定与融合术治疗L4/5单节段退变疾病的疗效对比

目的:评估Dynesys内固定或融合术治疗L4/5单节段腰椎退变疾病的临床疗效.方法:回顾分析2008年7月～2012年7月收治的L4/5单节段退变疾病患者76例,其中采用Dynesys动态固定35例(Dynesys组),融合术41例(融合组),随访时间均大于2年.评价指标采用Oswestry功能障碍指数(ODI),疼痛视觉模拟评分(VAS),手术节段及上端、下端邻近节段椎间高度及活动度(ROM),邻近节段椎间盘Pfirmman分级,并应用UCLA系统来评价邻近节段退变情况.结果:两组末次随访时的ODI及VAS评分均较术前明显改善(P＜0.05),两组间比较差异无统计学意义(P＞0.05).两组手术节段椎间高度术前无显著性差异,末次随访时Dynesys组较术前无明显变化,融合组明显增高(P＜0.05),两组间差异有统计学意义(P＜0.05).邻近节段椎间高度术前及末次随访时两组间比较差异均无显著性(P＞0.05).术前上端邻近节段ROM在Dynesys组为8.3°±2.1°,融合组为8.4°±1.5°,末次随访时Dynesys组为10.2°±2.2°,融合组为12.9°±2.1°,均较术前增加(P＜0.05),组间差异有统计学意义(P＜0.05).术前下端邻近节段ROM两组间差异无显著性,末次随访时融合组较术前明显增加(P＜0.05),但组间差异无显著性(P＞0.05).两组术前Pfirrmann分级无统计学差异,末次随访时Pfirrmann分级变化组内有统计学差异(P＜0.05),但组间仅上端邻近节段差异有统计学意义(P＜0.05).根据UCLA系统评分标准,Dynesys组8个节段出现影像学邻近节段退变,融合术组为22个节段,两组间差异有统计学意义(P＜0.05).仅融合术组有1例患者出现症状学邻近节段退变,行二次手术治疗.结论:Dynesys动态固定或融合术治疗单节段腰椎退变疾病均可取得满意临床疗效,前者在预防邻近节段退变方面更有优势.