腰椎间孔镜不良事件原因分析

目的分析腰椎间孔镜技术不良事件的原因。方法回顾性分析2015年3月~2018年3月椎间孔镜179例资料,16例共发生不良事件19例次(10.6%),其中Ⅱ级事件1例(神经根损伤),Ⅲ~Ⅳ级事件18例(硬膜囊撕裂3例,类脊髓高压综合征3例,椎间盘突出复发4例,术中减压不充分2例,导丝断裂1例,术后形成椎间盘囊肿1例,中转开放手术4例)。结果随访12~30个月,(15.2±1.2)月,除1例神经根损伤无恢复外,余均恢复。结论椎间孔镜治疗腰椎疾患初期有一定的不良事件发生率,良好清晰的镜下解剖结构、开放手术的经验、规范的培训以及术中及时的备选方案是防止不良事件发生、发挥椎间孔镜优势的关键。     

小切口肌间隙入路Dynesys动态内固定在治疗腰椎间盘突出症中的应用

目的:分析后正中小切口经双侧肌间隙入路Dynesys置入、开窗髓核摘除术治疗腰椎间盘突出症的可行性和临床疗效。方法:回顾性分析2014年4月~2016年4月间,我院采用后正中小切口经双侧肌间隙入路Dynesys置入、开窗髓核摘除治疗腰椎间盘突出症25例患者的临床及影像学资料,并选取相同时间段内行常规显露Dynesys置入、开窗髓核摘除术治疗的腰椎间盘突出症患者25例做对比。记录切口长度、手术时间、术中出血量、并发症;评估术前、术后3d、术后3个月及末次随访时腰痛及下肢放射痛VAS评分、ODI评分;测量围手术期血清C反应蛋白(CRP)结果;测量手术节段椎间隙高度、活动度、邻近节段活动度;测量术后1年时多裂肌残存率。结果:两组患者均获得完整随访,术后随访时间30~54个月。小切口组平均随访时间35.5±7.3个月,常规显露组平均随访时间34.8±5.1个月。两组患者术前VAS评分和ODI评分组间差异无统计学意义,末次随访时均较术前明显改善(P<0.05),两组间差异无统计学意义(P<0.05)。小切口组在手术时间、术中出血量、切口长度、术后引流量优于常规显露组(P<0.05)。两组患者术后腰痛VAS、腿痛VAS、ODI均较术前明显缓解(P<0.05),小切口组术后3d腰痛VAS评分优于常规显露组(P<0.05)。小切口组患者术后3d和5d的CRP水平低于常规显露组(P<0.05)。手术节段在末次随访时仍存在4.1°±1.5°的活动度,所有患者末次随访时均未发现断钉及螺钉松动病例,小切口组减压侧多裂肌残留率高于常规显露组(P<0.05)。手术椎间隙高度在术后3个月时有所增高,但在末次随访是恢复到术前水平(P<0.05)。小切口组2例切口延迟愈合,常规显露组1例切口延迟愈合。结论:后正中小切口经双侧肌间隙入路Dynesys置入、开窗髓核摘除术治疗腰椎间盘突出症,较常规显露方法手术时间短,出血量、引流量、切口长度较常规显露小,对肌肉组织损伤小,是手术治疗腰椎间盘突出症的选择之一。     

Reliability of gadolinium-enhanced magnetic resonance imaging findings and their correlation with clinical outcome in patients with sciatica

Background contextGadolinium-enhanced magnetic resonance imaging (Gd-MRI) is often performed in the evaluation of patients with persistent sciatica after lumbar disc surgery. However, correlation between enhancement and clinical findings is debated, and limited data are available regarding the reliability of enhancement findings.PurposeTo evaluate the reliability of Gd-MRI findings and their correlation with clinical findings in patients with sciatica.Study designProspective observational evaluation of patients who were enrolled in a randomized trial with 1-year follow-up.Patients samplePatients with 6- to 12-week sciatica, who participated in a multicentre randomized clinical trial comparing an early surgery strategy with prolonged conservative care with surgery if needed. In total 204 patients underwent Gd-MRI at baseline and after 1 year.Outcome measuresPatients were assessed by means of the Roland Disability Questionnaire (RDQ) for sciatica, visual analog scale (VAS) for leg pain, and patient-reported perceived recovery at 1 year. Kappa coefficients were used to assess interobserver reliability.MethodsIn total, 204 patients underwent Gd-MRI at baseline and after 1 year. Magnetic resonance imaging findings were correlated to the outcome measures using the Mann-Whitney U test for continuous data and Fisher exact tests for categorical data.ResultsPoor-to-moderate agreement was observed regarding Gd enhancement of the herniated disc and compressed nerve root (kappa<0.41), which was in contrast with excellent interobserver agreement of the disc level of the herniated disc and compressed nerve root (kappa>0.95). Of the 59 patients with an enhancing herniated disc at 1 year, 86% reported recovery compared with 100% of the 12 patients with nonenhancing herniated discs (p=.34). Of the 12 patients with enhancement of the most affected nerve root at 1 year, 83% reported recovery compared with 85% of the 192 patients with no enhancement (p=.69). Patients with and without enhancing herniated discs or nerve roots at 1 year reported comparable outcomes on RDQ and VAS-leg pain.ConclusionsReliability of Gd-MRI findings was poor-to-moderate and no correlation was observed between enhancement and clinical findings at 1-year follow-up.     

Dietary nickel chloride induces oxidative stress,apoptosis and alters Bax/Bcl-2 and caspase-3 mRNA expression in the cecal tonsil of broilers

The purpose of this study was to investigate the effects of dietary NiCl₂ on antioxidant function, apoptosis, and the protein expression, mRNA expression and contents of the bcl-2, bax and caspase-3 in the cecal tonsil of broilers. 280 one-day-old avian broilers were divided into four groups and fed on a corn–soybean basal diet as control diet or the same basal diet supplemented with 300, 600 and 900 mg/kg of NiCl₂ for 42 days. The activities of SOD, CAT and GSH-Px, and the ability to inhibit hydroxy radical, and GSH content were significantly decreased in all experimental groups. MDA content was significantly increased. The protein expression, mRNA expression and contents of bcl-2 were decreased, and bax and caspase-3 were increased in all experimental groups. The percentages of apoptotic lymphocytes were significantly increased. In conclusion, dietary NiCl₂ in excess of 300 mg/kg caused oxidative stress, and then induced decreased the protein expression, mRNA expression and the contents of bcl-2, and increased protein expression, mRNA expression and the contents of bax and caspase-3 proteins in the cecal tonsil. The local intestinal mucosal immunity could finally be impaired due to the oxidative stress and apoptosis in the cecal tonsil caused by NiCl₂.     

中医特色疗法联合护理配合治疗腰椎间盘突出症的疗效观察

目的：观察中医特色疗法联合护理配合治疗腰椎间盘突出症的疗效。方法将500例腰椎间盘突出患者随机分为观察组280例和对照组220例。对照组给予常规治疗护理措施,对照组使用中医特色疗法及护理措施进行治疗。观察2组患者治疗效果。结果观察组总有效率为98.93%高于对照组的82.73%,差异有统计学意义（P ﹤0.05）。结论中医特色疗法及护理配合治疗腰椎间盘突出症具有显著的效果,值得临床推广应用。     

中医护理在腰椎间盘突出症患者中的应用

目的 观察中医护理在腰椎间盘突出症患者中的应用效果.方法 将102例腰椎间盘突出症患者随机分为观察组和对照组,各51例.观察组采用中医特色的辨证施护,针对不同疾病证型,实施情志护理、饮食调护、生活起居护理并应用针灸、中药熏蒸等中医特色技术.对照组采用常规的护理,如卧床休息、心理安慰、功能锻炼指导等.评价两组的治疗效果.结果 观察组和对照组的治愈率为35.29％和11.76％,好转率为50.98％和33.33％,两组比较差异有统计学意义（P＜0.01）.结论 中医辨证施护可提高腰椎间盘突出症患者的疗效,值得临床推广应用.     

早期中药湿热敷治疗腰椎间盘突出症术后残余痛的效果分析

目的观察早期中药湿热敷对腰椎间盘突出症术后残余痛的临床疗效。方法选取2010年2月～2013年2月在本院行腰椎间盘突出症后路开窗髓核摘除的患者106例,将其随机分为治疗组和对照组各53例,对照组患者进行常规药物治疗和康复锻炼,治疗组在常规治疗的基础上行中药湿热敷进行早期干预,于1、6个月比较两组的临床疗效。结果两组患者均按时随访,术后1个月治疗组优良率为92．45％,对照组为73．58％,术后6个月治疗组优良率为92．45％,对照组为71．70％,治疗组术后1、6个月的优良率均高于对照组,差异有统计学意义（P〈0．01）。结论早期对腰椎间盘突出症经后路髓核摘除的患者进行中药湿热敷,可明显减少术后残余痛的发生,且操作简单,安全经济,无副作用,值得临床推广。     

单侧和双侧内固定联合髓核摘除椎间融合术治疗腰椎间盘突出症的效果比较

目的：比较单侧和双侧内固定联合髓核摘除椎间融合术治疗腰椎间盘突出症的效果。方法回顾性分析本院2010年1月~2012年12月行髓核摘除椎间融合固定术治疗的49例单间隙腰椎间盘突出症患者。依据固定方式将患者分为单侧内固定组和双侧内固定组。比较两组的手术用时、术中出血量、住院时间、住院费用、疼痛VAS评分、Oswestry功能障碍指数（ODI）评分、融合率和并发症发生率等。结果两组术前的VAS、ODI评分比较差异无统计学意义（P>0.05）,末次随访时,两组的VAS、ODI评分均显著降低（P<0.05）,但两组比较差异无统计学意义（P>0.05）。单侧组的手术用时明显短于双侧内固定组,术中出血量明显少于双侧内固定组,住院费用明显低于双侧内固定组（P<0.05）。两组的融合率和并发症率发生率比较差异无统计学意义（P>0.05）。结论单侧与双侧内固定椎间融合对单间隙腰椎间盘突出症的治疗效果相当,但手术用时较短、术中出血量较少、住院费用较低。     

Lactobacillus rhamnosus GG in adenoid tissue: Double-blind,placebo-controlled,randomized clinical trial

Conclusion: Lactobacillus rhamnosus GG (L.GG) was present in all adenoids of children receiving the L. GG product. However, since L.GG was also found from the placebo group, one cannot confirm its effect on the occurrence of rhinovirus (RV) or enterovirus (EV). Objectives: The present study was conducted to determine whether a 3-week oral consumption of L.GG would lead to presence of the probiotic in adenoid tissue. Furthermore, nasopharyngeal RV and EV findings and symptom data were investigated. Method: The tissue samples were collected from 40 children aged 1–5 years about to undergo adenotomy due to recurrent acute/secretory otitis media, chronic rhinitis, or recurrent sinusitis after a 3-week daily consumption of L.GG (n = 20) or placebo (n = 20). Strain-specific real-time PCR was used to detect RV, EV, and L.GG in adenoid tissue. Results: L.GG was recovered in the adenoid sample in 100% of children in the L.GG group and in 76% in the placebo group (p = 0.07). Both RV and EV were found in 31% of children in the L.GG group and in 18% of children in the placebo group (p = 0.67). The majority of the positive samples were positive for both RV and EV. Study diaries showed no differences in symptoms between the groups.     

后路脊柱全内镜结合类固醇激素鞘内注射手术治疗腰椎间盘突出症

目的探讨腰椎间盘内镜技术(microendoscopic disectomy,MED)结合类固醇激素神经根鞘内注射治疗腰椎间盘突出症的效果。方法 2010-02—2012-12收治的60例腰椎椎间盘突出患者随机分为MED组30例,行MED手术,MED神经根鞘内注射组治疗30例,行MED手术并在神经根鞘杰注入5 mg地塞米松。记录两组手术前后疼痛视觉模拟量表(visualanalogue scale,VAS)评分、直腿抬高角度及术后恢复正常工作的时间,术中、术后并发症发生情况。结果与治疗前比较,两组患者治疗后VAS评分明显减低,直腿抬高角度明显升高,差异有统计学意义(P0.05);与MED组比较,MED神经根鞘内注射组患者治疗后VAS评分及直腿抬高角度的改变更明显,差异有统计学意义(P0.05);MED神经根鞘内注射组患者治疗后恢复正常工作时间明显短于MED组患者(P0.05);MED神经根鞘内注射组患者出现2例并发症,发生率6.7%,术中硬脊膜撕裂并出现脑脊液漏1例,术后因侧隐窝减压不充分和瘢痕粘连再手术1例;MED组患者出现切口感染1例,发生率为3.3%(P0.05)。结论后路脊柱显微内镜结合鞘内注射类固醇激素治疗腰椎椎间盘突出,能显著改善术后疼痛、恢复肢体活动范围及更早的恢复日常生活。