颈椎前路融合术后邻近节段退变的危险因素研究进展

颈椎前路椎间盘切除融合术（anterior cervical discectomy and fusion,ACDF）应用于临床近百年,取得了良好的临床疗效,被认为是治疗颈椎病的金标准。但融合术后邻近节段退变（adjacent segment degeneration,ASDeg）受到越来越多的关注,关于其发生机制的争论主要集中在融合术导致邻近节段生物应力的改变与年龄相关的自然退变。融合术后发生ASDeg将严重影响手术的中远期疗效,部分患者甚至需要二次手术治疗。为了降低甚至避免ASDeg的发生,临床上出现许多新的技术,诸如保留运动节段的人工椎间盘置换术,新兴的细胞移植技术等,但临床疗效仍需要大量的研究进行证实。因此,发现融合术后发生ASDeg的危险因素对于临床开展融合手术具有重要的意义。目前对于ASDeg危险因素的研究仍无统一认识,本文将从颈椎前路融合术后发生ASDeg的危险因素的研究进展及相应应对措施作一综述,以指导临床实践。     

颈椎前路Hybrid手术的短期临床疗效观察

目的：探讨颈椎前路Hybrid手术治疗双节段及3节段颈椎病短期临床疗效。方法 ：收集2018年1月至2019年1月行双节段或3节段Hybrid手术108例颈椎退行性疾病的住院患者,根据手术节段数目不同将患者分为双节段组52例和3节段组56例,其中双节段组男24例,女28例,年龄35～67(45.94±14.67)岁;3节段组男23例,女33例,年龄32～65(47.54±15.34)岁。比较两组的结局指标,其中临床指标采用颈椎功能障碍指数（neck disability index,NDI）评价患者日常活动能力,日本骨科协会（Japanese Orthopedic Association,JOA）评分评价神经功能改善情况,疼痛视觉模拟评分（visual analogue scale,VAS）评价疼痛强度,根据Odom’s评分对一般临床结果进行分级;并通过X线、CT及MRI测量颈椎活动度、融合情况及并发症等。结果：所有患者手术顺利完成,且获得12个月以上的随访。双节段组和3节段组手术时间分别为95～180 (152.30±44.74) min和110～210 (165.18±45.86)...     

子宫颈病变电环切(LEEP)术的护理

子宫颈癌是女性中最常见的恶性肿瘤之一,严重威胁着妇女的健康。其发生率仅次于乳腺癌,死亡率仅次于卵巢癌。医学科学的发展对其病因的研究已取得巨大的突破,证实高危型人乳头瘤病毒(hum an pap illom avirus,HPV)病毒感染是引起宫颈癌及其癌前病变的最主要的原因,几乎所有的宫     

桂枝加葛根汤联合项三针治疗神经根型颈椎病的疗效及安全性观察

目的:分析探讨桂枝加葛根汤联合项三针治疗神经根型颈椎病(Cervical Spondylotic Radiculopathy,CSR)的疗效及安全性.方法:选取2017年12月-2019年12月期间我院收治的90例CSR患者,采用随机数字表法分为观察组(45例)和对照组(45例).对照组给予口服甲钴胺片治疗,观察组在此...     

Cervical Alignment of Patients with Basilar Invagination: A Radiological Study

ObjectiveTo investigate the cervical alignment and the relative range of motion (ROM) in patients with basilar invagination (BI).MethodsA total of 40 BI cases (38.1 years old ± 17.9 years old, 19 male and 21 female) and 80 asymptomatic individuals (33.8 years old ± 10.8 years old, 40 male and 40 female) were included. The Skull‐C₂/Skull‐BV, Skull‐C₇, C₂‐C₇/BV‐C₇ wall angles, C₀‐C₂/C₀‐BV, C₀‐C₇, C₁‐C₇, and C₂‐C₇/BV‐C₇ angles were measured in dynamic X‐ray images (including neutral, extension, and flexion positions). Correlation between the upper and lower cervical curvatures were analyzed. The total, extension, and flexion ROMs of these angles were calculated, respectively.ResultsThe BI patients had a smaller C₀‐C₂/C₀‐BV angle (18.2° ± 16.4° vs 30.9° ± 9.3°), but larger C₂‐C₇/BV‐C₇ (32.2° ± 16.1° vs 19.4° ± 10.6°) and C₂‐C₇/BV‐C₇ wall angles (37.8° ± 17.2° vs 23.6° ± 10.2°) than the control group in neutral position. The upper and lower curvatures correlated negatively in neutral (r = −0.371), extension (r = −0.429), and flexion (r = −0.648) positions among BI patients, as well as in extension position (r = −0.317) among control group. The BI patients presented smaller total ROMs in Skull‐C₂/Skull‐BV (12.3° ± 16.6° vs 19.7° ± 10.9°), C₀‐C₂/C₀‐BV (8.1° ± 11.1° vs 17.6° ± 10.5°), and C₀‐C₇ angles (57.8° ± 14.2° vs 78.3° ± 17.9°), but a larger total ROM in C₂‐C₇/BV‐C₇ wall angle (52.8° ± 13.9° vs 27.0° ± 16.1°) than the control group. The BI patients also presented smaller extension ROMs in Skull‐C₂/Skull‐BV (6.9° ± 9.4° vs 12.5° ± 9.3°), Skull‐C₇ (24.5° ± 10.9° vs 30.7° ± 12.5°), and C₀‐C₂/C₀‐BV angles (4.4° ± 7.8° vs 9.9° ± 8.6°) than the control group. Moreover, the BI patients showed smaller absolute values of flexion ROMs in Skull‐C₂/Skull‐BV (−5.2° ± 9.4° vs −7.3° ± 8.0°), C₀‐C₂/C₀‐BV (−3.2° ± 8.8° vs −7.7° ± 8.7°), and C₀‐C₇ angles (−33.2° ± 13.0° vs −52.8° ± 19.2°), but a larger absolute value of flexion ROM in C₂‐C₇/BV‐C₇ wall angle (−33.9° ± 14.8° vs −8.2° ± 15.1°).ConclusionThe cervical spine was stiffer in BI patients than the asymptomatic individuals, especially in the upper cervical curvature. The negative correlation between upper and lower cervical curvatures was more obvious in BI patients.     

宫颈癌患者PICC导管多重耐药菌感染的危险因素及病原学特征

目的 探讨宫颈癌患者经外周静脉穿刺中心静脉置管(PICC)导管多重耐药菌感染的危险因素及病原学特征.方法 选取宫颈癌PICC导管患者589例,回顾性观察纳入者相关资料,对PICC导管多重感染者加强监测,着重分析、归纳感染危险因素;同时监测和记录感染者病原学特征.结果 宫颈癌PICC导管相关性感染94例、感染率15.96...     

中小学教师颈椎病患病情况及病因分析

目的了解中小学教师颈椎病患病情况及其病因。方法随机抽取某地区10所中学和8所小学的603例教师作为研究对象,调查教师的一般情况、职业史、生活习惯、颈椎病患病情况等。结果603例调查对象中,颈椎病患病率47.30%,教师每日伏案工作超过5h者颈椎病患病率高于伏案工作少于5h者(P<0.05),长期高枕者患病率高于无长期高枕者(P<0.05),合并咽喉炎者颈椎病患病率高于无咽喉炎者(P<0.05),女性患病率高于男性(P<0.05),有头颈部外伤者高于无头颈部外伤者(P<0.05)。结论中小学教师为颈椎病的高发人群,其中,女性教师多高于男性;教师伏案工作和教师咽喉疲劳等职业因素可能为中小校教师颈椎病高发的主要原因。     

阴道镜联合液基细胞学技术在宫颈病变诊断中的价值探讨

目的 探讨宫颈病变患者中阴道镜联合液基细胞学(TCT)检查的临床效果.方法 选取崇州市妇幼保健院2009年3月～2012年3月共1209例患者行TCT检查,其中284例TCT阳性患者并行阴道镜及TCT检查,细胞学诊断按TBS分类标准.分析阴道镜检查及TCT两种方法对比病理学诊断的差异性.结果 ①TCT检查敏感性为91.66％(176/192),TCT检查特异性为67.39％(62/92).阴道镜敏感性为94.95％(188/198),特异性为79.07％(68/86).阴道镜+TCT联合检测敏感性为98.53％(201/204),特异性为93.75％(75/80).②敏感性:阴道镜对比TCT:x2=0.90,P＞0.05;TCT对比联合:x2=5.00,P＜ 0.05;阴道镜对比联合:x2=1.94,P＞0.05.特异性:阴道镜对比TCT:x2=3.50,P＞0.05;TCT对比联合:x2=22.30,P＜ 0.05;阴道镜对比联合:x2=9.22,P＜0.05.结论 TCT、阴道镜联合检查可互补、相互完善,提高宫颈病变早期诊断、治疗的可能性,降低肿瘤在宫颈的发生率,效果显著.     

针刀触激星状神经节治疗颈源性眩晕的临床效果

目的研究针刀触激星状神经节治疗颈源性眩晕的疗效。方法将符合纳入标准的90例颈源性眩晕患者进行星状神经节针刀触激术治疗。每次治疗前后评估患者的病情,最后评估临床疗效。结果患者经针刀治疗后临床治愈65例,显效14例,好转9例,无效2例,治愈率为72.2%,总有效率达97.8%。结论针刀触激星状神经节治疗颈源性眩晕,具有易操作、创伤小、并发症少、安全、疗效显著、恢复快等优点。     

Polymorphism of CYP1A1 gene variants rs4646903 and rs1048943 relation to the incidence of cervical cancer in Chhattisgarh

Cytochrome P450 CYP1A1 is a phase 1 xenobiotic metabolizing enzyme involved in the metabolism of toxins, endogenous hormones and pharmaceutical drugs. It is therefore possible that polymorphism of CYP1A1 gene producing functional changes in the enzyme may be susceptible factors in cervical carcinogenesis. This study was aimed to look association of CYP1A1 m1 (T > C) and m2 (A > G) gene polymorphisms in Chhattisgarh population. In this case-control study, we analyzed leukocyte DNA from a total of 200 subjects form Chhattisgarh (100 cases and 100 controls). All subjects were genotyped for CYP1A1 m1 (T > C) and m2 (A > G) using PCR-RFLP with statistical analysis by using SPSS version 16.0 and VassarStats (online). Among the two gene variants rs4646903 (T > C) and rs1048943 (A > G), individuals with AG and GG genotypes of CYP1A1 m2 polymorphism have significantly higher and increased risk of cervical cancer (OR = 2.0, 95%CI = 1.04-3.84, p = 0.035; OR = 62.9, 95%CI = 3.72-1063.83, p = 0.004 respectively) and the association of CYP1A1 m1 polymorphism did not show any significant relationship with cervical cancer patients (p = 0.23). The ‘G’ allele showed strong association with the disease (p < 0.0001). Thus, CYP1A1 m2 polymorphism showed an increased risk in the population leading to cervical cancer. Our study suggested that the presence of ‘C’ allele of rs4646903 (T > C) showed no risk and ‘G’ allele of rs1048943 (A > G) might be a leading allele to cause increased cervical cancer susceptibility due to significant association of CYP1A1 m2 gene polymorphism.