一期后路病灶清除病椎置钉短节段内固定加椎间或关节突间植骨治疗单间隙腰椎布鲁杆菌病性脊柱炎

目的 评价一期后路病灶清除、病椎置钉短节段内固定加椎间或关节突间植骨治疗单间隙腰椎布鲁杆菌病性脊柱炎(BS)的可行性及疗效。方法 回顾性分析2015年1月—2016年1月河北北方学院附属第一医院收治的 27例BS患者的临床资料,其中男15例、女12例,年龄42～65岁。患者均为单间隙病变,累及两个椎体,其中L_1～2 1例,L_2～3 3例,L_3～4 8例,L_4～5 12 例,L₅～S₁ 3例;患者均合并不同程度神经功能损伤,术前至少经过一个疗程的规范药物治疗。均选用一期后路病灶清除、病椎置钉短节段内固定加椎间或关节突间植骨术治疗。对比手术前后Cobb角、VAS、美国脊髓损伤协会(ASIA )脊髓功能评定、红细胞沉降率(ESR)、C反应蛋白(CRP)、虎红平板凝集试验(RBPT)指标,以及X线片、CT、MRI影像学表现,结合临床预后进行临床疗效评价。结果 术后27例均获随访,随访时间12～25个月,平均18个月,无一例发生窦道形成及复发。侧凸Cobb角术前及术后3、6个月分别为14.89°±1.48°、4.00°±1.44°和4.01°±0.87°,VAS术前及术后3、6、12个月分别为(8.4±1.6)、(3.1±0.3)、(1.1±0.3)及(0.7±0.2)分,术后各时间点均较术前显著改善,差异均有统计学意义(P值均＜0.05);ASIA脊髓功能分级较术前明显好转,差异均有统计学意义(P值均＜0.01);随时间推移,术后ESR、CRP、Cobb角明显减小,术后各时间点与术前比较,差异均有统计学意义(P值均＜0.01)。RBPT术后转阴率(正常率)逐渐增高,术后3个月为48.14%,6个月为100%。临床疗效评价:术后3、6、12个月治愈率分别为59.25%(治愈16例、改善10例、无效1例)、81.48%(治愈22例、改善5例)、96.29%(治愈26例、改善1例),后一个时间点治愈率与前一个时间点比较,差异均有统计学意义(P值均＜0.05)。结论 在应用有效的药物控制前提下,一期后路病灶清除、病椎置钉短节段内固定加椎间或关节突间植骨治疗单间隙BS是可行的,其在解除疼痛、稳定脊柱及恢复神经功能等方面具有较好的临床疗效。     

Toll样受体4多态性与强直性脊柱炎易感性的荟萃分析

目的 用荟萃分析方法评价toll样受体(TLR)4基因多态性与强直性脊柱炎的关系. 方法 检索在2007年2月前在PubMed及中国期刊全文数据库发表的中英文献.用RevMan 4.2对纳入文献进行荟萃分析,评价合并效应量、功效、异质性及发表偏倚. 结果 共纳入4篇有关Asp299Gly多态位点和3篇Thr399Ile多态位点的病例对照研究.未发现异质性及发表偏倚,合并后功效在80%左右.Asp299Gly位点合并效应量OR=0.94(95%CI:0.66～1.35),Thr399Ile位点合并效应量OR=1.08(95%CI:0.70～1.65). 结论 TLR4基因不是强直性脊柱炎的主要易感基因.     

CT-guided fine-needle aspiration in vertebral osteomyelitis: true usefulness of a common practice

Computed tomography (CT)-guided biopsy of the spine is considered a safe, accurate, and relatively inexpensive examination technique. Our purpose was to determine the diagnostic accuracy of CT-guided biopsies exclusively for vertebral osteomyelitis. A retrospective study was performed from a consecutive series of 72 patients with confirmed vertebral osteomyelitis with 46 CT-guided biopsies performed in 40 patients. Biopsy specimens were sent for bacteriologic and cytologic analysis. An adequate specimen for microbiologic examination was not obtained in one case and not enough sample for additional pathologic examination in 17 cases. The mean age of patients was 58 years, with a range of 1–88 years, including 24 men and 16 women. The level of spinal biopsy was thoracic in 18 (40%) and lumbar in 28 (60%). The analysis revealed the infection agent in 20 cases (43% sensitivity). Diagnostic rates obtained in patients with previous antibiotic treatment were significantly lower (23% vs. 60%, p = 0.013). Computed tomography-guided fine-needle aspiration biopsy is an important tool in the diagnostic evaluation of vertebral osteomyelitis. However, this technique yields a lower diagnostic rate than previously reported biopsy of neoplastic vertebral lesions, especially if performed in patients with previous antibiotic treatment.     

A MISDIAGNOSED CASE OF SACROILIAC JOINT INJURY AND MALPOSITION

Sacroiliac joint malposition is one of the main causes evoking lumbocrural pain. Because its clinical symptoms are similar to those induced either by lumbar intervertebral disc protrusion or by ankylosing spondylitis (AS) at the early stage, and because X-ray results taken at its early stage were not evident for differentiating the diseases, misdiagnosis may occur in some doctors due to lack of experience. The authors treated several cases of pain in hip joint, which had been diagnosed as ankylosing spondylitis.     

自发性炎性疾病双转基因小鼠的研究

目的 通过建立强直性脊柱炎HLA－B2704和hβ2m双转基因动物模型,证实HLA－B2704和hβ2m基因在双转基因小鼠自发性炎性疾病发病过程中的作用,为研究B27相关性疾病的病因学、预防和治疗提供有力的工具。方法 将HLA－B2704和hβ2m转基因阳性小鼠交配后出生的子代,应用PCR、斑点杂交、Southern杂交、RT－PCR、流式细胞术和免疫组织化学等方法进行筛选鉴定和表达检测。同时隔日观察小鼠的发病情况,发病鼠行HE染色观察病理变化。结果 有8只高拷贝双转基因小鼠2周左右出现皮肤病变,关节炎和趾甲变化等自发性炎性疾病表现,正常小鼠、B27单转基因小鼠和HLA－B27／hβ2m双转基因小鼠流式细胞计的检测结果分别为0．63％、7．87％、35．87％,双转基因小鼠的细胞膜表面可见HLA－B2704高表达,而在B27单转基因小鼠表达不明显。结论 HLA－B2704重链可诱发转基因小鼠发生自发性炎性疾病,hβ2m可与B27形成稳定的复合体,从而稳定和增强HLA－B2704在细胞膜表面的表达。     

电针结合推拿治疗肥大性脊椎炎的临床观察

目的：观察电针结合推拿治疗肥大性脊椎炎的疗效。方法：将118例病人随机分为3组，分别是电针配合推拿组、电针组、推拿组，并进行比较。结果：电针结合推拿组和电针组、推拿组相比有显著性差异（P〈0．05）。结论：电针结合推拿治疗肥大性脊椎炎疗效显著。     

强直性脊柱炎湿热血瘀证辨证要素研究初探

目的：研究强直性脊柱炎湿热血瘀证的辨证要素，探讨证候的研究方法。方法：把中医辨证理论方法与流行病学调研方法、多元统计分析方法有机地结合，选取就诊的强直性脊柱炎患者进行调查研究并对资料进行统计学处理。结果：聚类分析发现，强直性脊柱炎的主要症状为：腰脊活动受限、晨僵、腰骶疼痛、脊背疼痛。Logistic分析得出湿热血瘀证候诊断的主要症状，对证候的归属进行判断，以预测概率0．5为判别分界点，总正确率为88．10．4。判别式分析得出对湿热血瘀证诊断有帮助的症状，并建立判断函数，符合率为89．2％，灵敏度为77．3％，特异度为92．7％，Kappa值为0．695。结论：应用临床流行病学的调查方法并结合统计学分析进行证候研究，包括中医辨病和辨证要素的研究是可行的。     

强直性脊柱炎非骨水泥型全髋关节置换术后中期随访

目的:观察强直性脊柱炎非骨水泥型全髋关节置换术后中期的随访结果。方法:对37例(52髋)强直性脊柱炎非骨水泥型全髋关节置换术后患者进行了24～172个月,平均69个月的随访。临床随访根据Harris的评分方法进行评分,X线随访根据Gruen等和DeLee and Charnley分区法分别进行股骨柄和臼杯X线分析,根据Brooker等0～4级分级法进行异位骨化分级。结果:患者髋关节屈伸、收展、内外旋总活动度由术前的平均27°提高到术后平均152°。术后无脱位、感染等并发症发生。Harris评分术前平均为32(8～64)分,术后平均为82(64～96)分,其中优38髋,良8髋,可6髋,优良率88.5％。X线片分析未见假体松动,11髋(21.2％)发生异位骨化。结论:人工全髋关节置换术治疗强直性脊柱炎髋关节病变,中期可取得满意的临床效果。     

Pain and fatigue in patients with rheumatic disorders

Summary The purpose of the study was to investigate whether fibromyalgia patients (n=50) differed from patients with rheumatoid arthritis (n=22) and ankylosing spondylitis (n=31) with respect to pain experience, pain coping and fatigue. A high general pain intensity level was recorded by the McGill Pain Questionnaire (p<0.01) and the visual analogue scale (p<0.01) in the fibromyalgia group compared to the other groups. The pain was of continuous duration in the fibromyalgia patients while the rheumatoid arthritis and ankylosing spondylitis patients experienced intermittent pain. A high correlation between sensory and affective pain rating indexes was determined in all patient groups (p<0.01). No statistically significant difference between the groups in pain coping was recorded. A high frequency of reported gastrointestinal problems (p<0.01) and high intensity of fatigue (p<0.01) were seen in the fibromyalgia group compared to the other groups. In the fibromyalgia group there was no correlation between the sleep problems and fatigue intensity. Thus, the fibromyalgia patients differed from the other groups in reporting frequently shoulder and upper arm pain, continuous pain, higher levels of fatigue and pain intensities as well as high frequency of gastrointestinal problems.     

Isolated thoracic spine lesion: is this the presentation of a SAPHO syndrome? A case report

A case of an isolated lesion of the thoracic spine attributed to SAPHO syndrome is presented. A 51-year-old man was referred for inflammatory pain in the thoracic spine. The general examination was normal (especially cutaneous and rheumatologic examinations). Laboratory analysis showed only a mild inflammatory reaction. Standard radiographs showed partial condensation of T8. Computed tomography showed osteolysis of the anterior corner of T8, and MRI revealed an abnormal signal of T8, with enlargement of the prevertebral soft tissue. Percutaneous and thoracoscopic biopsies showed a nonspecific inflammatory process, and cultures were sterile. Initially, several diagnoses were advanced: infectious spondylitis, malignant tumor, lymphomas, Paget disease, seronegative spondyloarthropathies and finally atypical SAPHO syndrome. Three months later, the patient experienced more pain. General examination was still normal. The radiological findings worsened, while the inflammatory blood tests were normal. A new thoracoscopic biopsy revealed a nonspecific inflammatory process. A diagnosis of SAPHO syndrome was made, despite the lack of typical lesions. Dramatically improving with anti-inflammatory therapy, the patients condition was favorable at 3-year follow-up. This atypical presentation of an isolated lesion in the spine makes the diagnosis of a SAPHO syndrome difficult but possible. Spine surgeons must be aware of this rare entity, to avoid misdiagnosis and unnecessary repeated surgical biopsies.