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。     

开塞露改良注入加按摩器综合治疗产后尿潴留临床研究

目的 探讨开塞露改良注入加按摩器综合治疗产后尿潴留的临床疗效.方法 将患者随机分为两组各75例,观察组采用开塞露40ml导尿管插入直肠7～9cm注入,加按摩器穴位按摩与心理疗法综合治疗;对照组采用传统方法诱导排尿.结果 观察组疗效显著优于对照组(P<0.01).结论 开塞露改良注入法加按摩器穴位按摩综合治疗产后尿潴留效果更佳.     

冷冻异体骨加TGF-β1和bFGF复合移植修复骨缺损的研究

目的　观察重组TGF - β1和bFGF在经冷冻处理的同种异体骨移植修复骨缺损过程中促进骨愈合的作用。 方法　以家兔作为实验动物 ,修复桡骨 1.2cm缺损。冷冻处理后的异体骨加纤维蛋白载体携带bFGF和TGF - β1移植作为实验组 (A组 ) ,自体桡骨移植 (B组 )和单纯异体骨移植 (C组 )作为对照组。术后不同时间拍摄X线片 ,同位素骨扫描计数分析和HE染色组织切片观察和扫描电镜观察。结果　X线检查自体移植较异体移植提前愈合 ,同位素扫描计数分析 2周后A和B组明显优于C组 ,并有显著差异 (P <0 .0 1)。组织学观察异体移植骨切片可见明显的髓腔内诱导成骨相。结论　TGF - β1和bFGF能明显促进异体移植修复骨缺损中的骨愈合过程     

脊髓电刺激的机制探讨和临床应用

脊髓电刺激已经应用了约 30年 ,但只是到最近 5年来才被广泛的接受和得到医学界的承认 ,既往该项操作都是由神经外科医生进行的 ,现在麻醉医生、骨科医生、理疗医生都进行了这项操作。治疗疼痛是脊髓电刺激最为广泛的应用 ,较为成熟的技术已经使操作者们能成功的治疗各种疼痛综合征。例如广泛反射性交感性营养失调 ,手术失败综合征等。其他的应用也正在得到发展 ,结合此项技术刺激脊髓、神经根和周围神经来治疗心绞痛、尿失禁、枕神经痛等都得到很好的效果。计算机交互程序的广泛应用使单独刺激和多频及多电极排列刺激也成为现实 ,这都增加…     

腰椎管内骨软骨瘤二例报告

骨软骨瘤好发于长骨的干骺端,中轴骨的骨软骨瘤很少见,国内外文献均为个案报道,至今共报道数百例,而椎管内骨软骨瘤相对好发于颈胸椎,腰椎少见[1-4]。椎管内骨软骨瘤通常为孤立性生长,发病隐匿,多数生长于小关节突内侧并向椎管内生长而逐渐压迫马尾和神经根,引起神经压迫时表现出临床症状。或同时伴发椎间盘突出、椎管狭窄而出现相应的临床症状。椎管内骨软骨瘤具备特征性的影像学表现。以手术切除为主,脊柱稳定性的重建与否取决于手术范围及方式的选择,现报告我科收治的两例腰椎管内骨软骨瘤病例。     

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.     

脑血管意外患者的观察与护理

脑血管意外是神经内科的常见病和多发病，多见于老年人，死亡率较高，多留下终身残疾，是危害人身健康严重疾病之一。该病分为出血性和缺血性两大类，前者包括脑出血、蛛网膜下腔出血；后者为脑血栓形成，脑栓塞及短暂性脑缺血发作（TIA）。随着人们生活水平提高，营养过剩人数日见增多，劳动强度减轻，受社会老龄化等因素的影响，脑血管意外的发病率日趋提高。[第一段]