病灶清除联合脊柱固定手术治疗脊柱结核

①目的探讨病灶清除联合脊柱内固定手术治疗脊柱结核的可能性。②方法采用病灶清除联合脊柱内固定手术治疗胸椎、腰椎、胸腰段结核33例、，对其临床疗效进行回顾分析、③结果33例中术前有截瘫症状13例，Frankel分级：B级2例，C级8例。D级3例；后凸畸形采用cobbs法测量，并以胸段，胸腰段和腰段分别评价，术后校正率平均85％。本组患中有巨大脓肿，术前排脓5例。术后随诊1．5年以上，截瘫均恢复至E级。术后6～10个月病灶椎问骨融合25例，1．5年以上病灶区稳定椎间骨融合不完善5例。3例结核复发、复发率9％。④结论一期痛灶清除联合脊柱内固定手术治疗脊柱结核，具有病灶清除彻底，后凸畸形矫正满意、缩短病程，稳定脊柱和增加融合率等优点。     

抗旋髓内钉与动力髋部螺纹钉治疗股骨粗隆间骨折疗效比较

目的比较股骨近端抗旋髓内钉(PFNA)和动力髋部螺纹钉(DHS)治疗老年骨质疏松性股骨粗隆间骨折的疗效。方法选择老年骨质疏松性股骨粗隆间骨折患者80例,随机分为PFNA组40例和DHS组40例。比较两种方法的治疗效果和术后并发症发生情况。结果对于稳定型骨折,两组疗效比较差异无统计学意义(P>0.05);对于不稳定型骨折,PF-NA组的优良率显著高于DHS组(χ2=3.9720,P<0.05);PFNA组患者切口长度、手术时间、术中出血量、负重时间、骨折愈合时间均优于DHS组(P<0.05或P<0.01);术后12个月内PFNA组并发症发生率显著低于DHS组(χ2=4.0205,P<0.05),差异有统计学意义。结论 PFNA比DHS操作简单,手术时间短,创伤少,内固定可靠,恢复快,并发症少,适应证广,尤其是治疗股骨粗隆间不稳定型骨折的理想方法。     

根痛平颗粒联合腺苷钴胺治疗神经根型颈椎病的临床研究

目的采用网络药理学和分子对接技术探讨祛肺毒一号方治疗新型冠状病毒肺炎（COVID-19）的物质基础和潜在作用机制。方法检索祛肺毒一号方中各药味的归经,并构建药味-归经网络;在中药系统药理学分析平台（TCMSP）数据库检索并筛选祛肺毒一号方中各药味潜在活性成分,通过文献检索补充不满足上述条件但具有药理活性的成分;采用TCMSP和Swiss Target prediction数据库获取成分相关靶标,采用Genecards数据库获取COVID-19疾病靶标;运用DAVID数据库对成分和疾病共有靶标进行KEGG通路注释和GO功能富集分析;通过STRING数据库和Cytoscape3.5.1软件构建靶标蛋白互作PPI网络和成分-靶标-通路网络;采用SYBYL-X.v1.3进行分子对接验证。结果祛肺毒一号方中药味主要归经是肺经和胃经。预测和筛选得到260个成分和85个靶标,核心化合物有槲皮素、β-谷甾醇、咖啡酸、人参皂苷Rh₄、甘草查尔酮A等18个,靶标主要涉及PTGS2、NOS2、MAPK14、PPARG、PTGS1等55个,PPI核心网络涉及GAPDH、TP53、MAPK3、EGFR、TNF、IL6等11个靶标。通过GO富集获得BP、MF和CC条目分别352、71和41条,获得121条（P<0.05） KEGG信号通路,核心通路有33条,主要涉及乙型肝炎、甲型流感、PI3K-Akt信号通路、丙型肝炎、HIF-1信号通路、TNF信号通路、MAPK信号通路、T细胞受体信号通路、VEGF信号通路等。驴食草酚和3''-甲氧基光甘草定与ACE2有较好的结合活性,刺果甘草查尔酮、驴食草酚和咖啡酸与3CLpro具有较好的结合活性。结论阐释了祛肺毒一号方治疗COVID-19的多靶标、多通路协同作用,为中医药治疗COVID-19提供一定的科学依据与参考。     

Coflex棘突间动力内固定装置植入治疗老年退行性腰椎管狭窄症临床观察

目的 探讨Coflex棘突间动力内固定装置植入治疗腰椎管狭窄的疗效和安全性.方法 83例腰椎管狭窄患者随机分为2组,获得随访80例.Coflex组(38例)应用Coflex植入治疗,PLIF组(42例)应用后路腰椎椎体间融合术(PLIF)治疗.比较2组手术创伤程度指标(手术时间、术中出血量、48 h内伤口引流量、术后3 d切口疼痛程度VAS评分、术后下地活动时间)及临床疗效指标(腰部及下肢疼痛VAS评分、采用13本矫形外科协会JOA评分、Oswestry功能障碍指数ODI评分),椎间隙高度及椎管矢状径(MSD).结果 手术时间[(104.3±9.5)、(174.6±24.2)min]、术中出血量[(230.7±29.6)、(536.8±163.3)ml]、48 h内伤口引流量[(110.6±34.5)、(319.2±142.8)ml]、术后3 d切口疼痛程度(VAS)评分[(3.2±1.3)、(4.8±2.7)分]、术后下地活动时间[(13.6±2.0)、(15.7±2.6)d],Coffex组显著少于PLIF组(t值分别为16.720、11.380、8.771、3.320、4.018,P均<0.01);腰腿痛VAS评分、JOA评分、ODI评分、椎间高度及MSD,2组患者术后均较术前有显著改善(P均<0.01).随访12个月2组均未出现内固定松动脱出及棘突骨折等严重并发症.结论 两种术式均可有效增加椎间孔面积并维持椎间隙的高度,保留了腰椎后柱结构的稳定性,但Coflex棘突间动力内固定装置植入术更具有手术时间短、出血少、创伤小、可早期进行功能锻炼等优点.

Abstract：

Objective To explore the efficacy and safety of coflex interspinous dynamic fixation device implantation in the lumbar spinal stenosis. Methods Eighty-three patients with lumbar spinal stenosis were randomly divided into two groups, and 80 cases were followed up. Coflex group (38 patients) received coflex implantation,posterior lumbar interbody fusion (PLIF) group(42 patients) received PLIF treatment. Indicators of surgical trauma degree (operation time, blood loss volume, wound drainage volume within 48 hours, incision pain (VAS) score after surgery 3 days,postoperative ambulation time),indicators of clinical effect (waist and leg pain VAS scores,Japan Orthopaedic Association JOA score,Oswestry functional disability index ODI score),intervertebral space height and median sagittal diameter (MSO) were measured and compared between the two groups. Results In the Coflex group, the operation time, blood loss volume, wound drainage volume within 48 hours, incision pain (VAS) score after surgery 3 days,postoperative ambulation time were (104.3 ±9.5) min,(230. 7 ±29.6) ml,(110. 6 ±34. 5)ml,3. 2 ±1.3, (13. 6 ±2.0) d,which were significantly lower than those of (174. 6 ±24. 2) min,(536. 8 ±163.3) ml, (319. 2 ± 142. 8) ml,4. 8 ±2. 7, (15. 7 ±2. 6) d in the PLIF group(t= 16. 720,11. 380,8. 771,3. 320,4.018,Ps <0. 01). In the back and leg pain VAS score,JOA score,ODI score,intervertebral height and MSD,indicators after surgery were significantly improved than before surgery in both groups(Ps <0. 01). There were no significant difference before and after treatment 12 months in both groups (Ps >0. 05) on severe complications such as internal fixation loosening and spinous process fractures.Conclusion The two surgical methods both can effectively increase the foraminal area and intervertebral height to maintain the stability of the spinal posterior colum. However, Coflex interspinous dynamic fixation device implantation had more advantages,such as shorter operation time,less bleeding,less trauma,and early functional exercises.