髓核对背根节神经元GDNF表达影响及其与痛觉过敏的关系

目的:探讨腰神经根周围髓核组织移植对背根节胶质细胞源性神经营养因子(glialcellline-derivedneurotrophicfactor,GDNF)表达的影响及其与痛觉过敏之间的关系。方法:从鼠尾椎间盘取髓核组织移植到腰神经根周围,采用神经行为学观察痛觉过敏的出现规律,免疫荧光染色的方法计数背根节内GDNF免疫反应阳性神经元百分比,分析其与痛觉过敏之间的关系。结果:在髓核组织刺激下,背根节内GDNF免疫反应阳性细胞明显增多(P<0.01),这种变化与痛觉过敏有显著的正相关性(P<0.05)。结论:内源性GDNF很可能参与了痛觉过敏的调控。     

三种材料修补颅骨缺损的疗效分析

颅骨缺损是颅脑外伤手术后常见的后遗症,一般3个月后可行颅骨修补.颅骨修补材料种类繁多,但目前临床使用的材料主要有3种:自体颅骨、金属材料(如钛板、钛网)和非金属材料(硅橡胶涤纶网、羟基磷灰石、珊瑚等).本院1995年1月至2005年4月,采用自体颅骨骨瓣、硅橡胶涤纶网、钛金属网3种材料修补颅骨缺损患者共205例,报告如下.     

互联网上脊髓损伤研究的信息资源

当今社会,脊髓损伤(spinalcordinjury,SCI)呈现出高发生率(美国3.0~3.5万/10万)、高致残率(全瘫占67%)、高耗费(5~7万美元圆/患者/年,美国)、低死亡率(<5%)、青壮年患者居多(60%30岁前受伤,70%患者小于40岁)的特点。因此,有关SCI的临床治疗、康复、基础研究和相关的神经科学研究一直是临床和基础医学研究的热点,研究论文发表的数量和质量均较高。SCI研究的信息在互联网(Internet)上十分丰富,利用互联网既可以在最短的时间得到最新的有关SCI信息资料,也可以查询新近的SCI文献。1搜索引擎Google(www.google.com):目前最优秀的支持多语…     

低温下乙醇保存自体颅骨治疗颅骨缺损的临床应用

颅脑损伤及脑肿瘤术后由于颅内压高行去骨瓣减压 ,常造成颅骨缺损。特殊结构因失去了正常颅骨的屏障作用较易受损 ,且颅骨缺损能引起多种症状并影响外观 ,常需行颅骨成形术。目前临床应用的材料有多种 ,但均存在不足。自 1998年以来 ,我院采用低温下乙醇保存自体颅骨治疗颅骨缺损 ,效果良好。现报告如下。临床资料　 (1)本组男 5 5例 ,女 12例 ;年龄 8～ 62岁 ,平均 3 8.2岁。其中额颞部颅骨缺损 3 8例 ,其他部位颅骨缺损 2 9例。病变包括急性硬膜下血肿 3 8例 ,脑内血肿 2 7例 ,脑膜瘤 2例。缺损范围 :(8～ 10 )ｃｍ× (12～ 15 )ｃｍ。颅…     

Options for preventing postlaminectomy adhesion：a comparative study in rabbit model

OBJECTIVE: To compare the various methods for prevention of peridural adhesion. METHODS: Laminectomy was performed in lumbar 1, 3 and 5 segments in 30 adult rabbits that were divided into 5 groups. A 10 mmx5 mm dura was exposed, and then covered with autogenou purifieds pearl fat (APPF) mixed with basic fibroblast growth factor (bFGF) in Group A, with APPF treated with insulin in Group B, with APPF in Group C, with 2% sodium hyaluronate (SHA) in Group D, and uncovered in Group E. The slide sections for histological study were observed at 2, 4, 6, 8 and 12 weeks postoperatively. The specimens were observed with a computed imaging analysis system at 4 and 8 weeks postoperatively. RESULTS: Severe peridural adhesions were formed in Groups B, C, D and E after laminectomy. But no adhesion was formed in the Group A at all time points. bFGF could stimulate pearl fat revascularization, increase the number of newly formed vessels and contribute to the survival of pearl fat. However, insulin had no certain effect in preventing degradation and deterioration of pearl fat. SHA had some effect in prevention of peridural adhesions only in the early stage, which was weakened with the lapse of time. CONCLUSIONS: APPF implantation mixed with bFGF provides a potential new approach to improving fat survival and preventing peridural adhesion postlaminectomy.     

成人腰椎峡部裂型滑脱症的微创治疗

Objective To investigate the clinical experiences and technical skills of adult isthmic spondylolisthesis. Methods Twenty-one patients with adult isthmic spondylolisthesis underwent minimally invasive surgery. There were 12 men and 9 women, with the mean age of 51.7 years. Isthmic spondylolisthe-sis occurred at the L4.5 in 7 patients, and at the L5S1 in 14 patients. According to Meyerding classification, 13 cases were of Grade Ⅰ, 7 of Grade Ⅱ, 1 of Grade Ⅲ. Under general anesthesia, guiding by fluoroscopy, the surgeries performed minimally invasive microendoscopic(METRx) techniques for posterior decompression, interbody cage fusion and novel Sextant-R percutaneous pedicle screw techniques for deformity reduction and fixation. Results Seventeen cases were followed up 1 year postoperatively. The average low back pain VAS reduced from preoperative 6.0±2.6 to postoperative 2.9±2.5. The average leg pain VAS decreased from preoperative 6.7±3.3 to postoperative 2.8±1.6. The average ODI decreased from preoperative 44.3% to post-operative 27.1%. The Nakai good and excellent rate was 90%. The mean operative time 170 min, blood loss 160 ml, and postoperative stay in bed 7.5 d. The sagittal spondylolisthesis rate significantly decreased from preoperative 35.5%±2.5% to postoperative 8.3%±7.5%. The lordotic angle from preoperative 11.5°±1.7° in-creased to postoperative 16.8°±9.5°; the intervertebral disc height from preoperative (5.4±2.5) mm increased to postoperative (9.1±3.0) mm. According to Lenke judgement for fusion, complete fusion rate was 76%, in-complete fusion rate was 12%, nonfusion rate was 12%. Conclusion The minimally invasive microendo-scopic (METRx) assisted with a novel Sextant-R percutaneous pedicle screw systems for deformity reduction and fixation to treat adult isthmic spondylolisthesis, is not only a minimally invasive and safe surgical tech-nique, also an effective treatment for deformity reduction and fixation.     

甲状腺激素人工神经桥接大鼠坐骨神经缺损的组织学观察

目的对甲状腺激素人工神经外消旋聚乳酸-三碘甲状腺素原氨酸[Poly(dextrogyr-levogyr)lactideacide-triiodothyronine,PDLLA-T3]桥接大鼠坐骨神经缺损的效果进行组织学评价。方法将90只SD大鼠左侧坐骨神经切断造成1cm缺损,随机分为3组,每组30只。A组:自体神经移植组;B组:PDLLA-T3组;C组:不含甲状腺激素人工神经外消旋聚乳酸(PDLLA)组;桥接坐骨神经缺损。D组:正常对照组(大鼠右侧正常坐骨神经)。于术后2周,1、2个月收集标本,行透射电镜、HE染色、Bielschowsky神经纤维银染及S-100免疫组织化学染色,观察再生神经的数量和质量,经图像处理后进行统计分析。结果术后2周:组织学观察显示B、C组材料尚未完全降解,透射电镜下神经的髓鞘厚度较薄,约0.5μm,A、B、C组间差异无统计学意义(P>0.05);1个月:组织学观察见A组再生神经纤维等组织通过远端吻合口,其间有新生的血管,B、C组材料未完全降解,S-100免疫组织化学及Bielschowsky神经纤维银染显示B组PDLLA-T3成功桥接神经缺损,缺损段有再生神经通过,再生神经髓鞘厚度1.81±0.19μm,优于A、C组,但差异无统计学意义(P>0.05);2个月:B、C组材料完全降解,B组S-100免疫组织化学染色示神经纤维数110.00±8.75,Bielschowsky神经纤维银染显示再生有髓神经纤维数77.00±6.33,两者均优于C组(P<0.05),且与A、D组比较差异有统计学意义(P<0.05);髓鞘厚度为2.15±0.27μm,优于C组(P<0.05),但小于A、D组(P<0.05)。结论PDL-LA-T3桥接大鼠坐骨神经缺损,再生神经纤维数量和质量较好,是一种有前途的组织工程人工神经。     

MED Ⅱ行腰椎间盘突出症微创手术的示教效果研究

腰椎间盘突出症是脊柱外科常见病和多发病,应用后路显微内窥镜系统(MEDⅡ)下行腰椎间盘突出症的微创手术逐渐成熟。该手术已成为我科近年来进修医生学习的主要内容之一。2001年2月至2005年5月,针对进修医生的学习要求,我们采用PBL模式(Problem based learning,基于问题的学习)结合电视监控系统行MEDⅡ下腰椎间盘突出症微创手术的示教取得了良好的教学效果。现报告如下。1材料与方法1.1示教病例选择根据进修生的教学计划,首选典型病例,以后增加复杂病例的示教,共示教236例,其中腰4、5椎间盘突出症143例,腰5骶1椎间盘突出症93例。1.2进修…     

脊神经节损伤与脊髓背角C-fos原癌基因表达

目的探讨脊神经节(DRG)不同损伤方式后,不同损伤时间的脊髓背角C-fos原癌基因蛋白表达情况,并探讨该蛋白表达程度与神经行为异常改变之间的关系。方法健康家兔42只随机分为手术对照组、机械性压迫组、炎性损伤组和正常对照组,制备相应的脊神经节损伤模型。术后检测动物神经行为改变,并对中枢神经伤害性刺激反应物C-fos原癌基因蛋白进行免疫组化检测分析。结果DRG损伤后1周,伤侧脊髓背角C-fos癌基因蛋白的阳性细胞数分别为手术对照组(47±17)、机械性压迫组(58±22)、炎性损伤组(55±20),均较正常对照组(28±18)显著增强(P<0.05);术后2,4,8周3个实验组结果也比对照组显著增强(P<0.05)。结论DRG损伤所导致动物脊髓背角伤害感受性神经元的过度兴奋,可能介导了神经细胞的兴奋性毒性损伤和伤肢的痛觉过敏。     

保留终板的脊柱前路椎体间植骨融合

目的　研究椎体终板在脊柱前路椎体间植骨融合手术中的作用。　方法　将 2 1只家犬按 4 ,8,1 2周 3个时相点随机分成 3组 ,每组 7只。采用自身对照 ,在每只犬的 2个腰椎间隙制成保留终板 (实验组 )和不保留终板 (对照组 )的前路椎体间植骨融合术模型 ,应用组织学、生物力学的方法对两组的植骨愈合情况进行比较 ,并用免疫组化方法标记植骨界面的新生血管情况 ,同时比较两组标本的抗压性能。　结果　 (1 )术后 4周时实验组的植骨愈合情况差于对照组 ,8周时趋于相等 ,1 2周时无差别。 (2 )术后 4周时实验组新生血管数量少于对照组 ,8周时差别减小 ,1 2周时两组基本相等。 (3)引起实验组植骨间隙 1mm位移时的抗压强度大于对照组 (P <0 .0 5)。　结论　保留终板的脊柱前路椎体间植骨融合术有较好的生物力学性能 ,且终板的保留不会对植骨愈合的整体进程有明显影响 ,因而是一种较好的手术方式。