微创椎间盘切除术治疗老年腰椎间盘突出症34例

目的探讨微创椎间盘切除术治疗老年腰椎间盘突出症的效果。方法选择2010年1月—2014年1月南充市中心医院收治的符合微创椎间盘切除术适应证的老年腰椎间盘突出症34例,行经Quadrant通道微创椎间盘切除术。记录手术时间、术中失血量、手术至开始行走时间、住院时间、住院费用;分别于术后第1、2、3、6个月随访1次,之后每半年随访1次。术前、术后2周及末次随访时行疼痛视觉模拟（VAS）评分评估腰腿痛的程度。末次随访时使用Macnab标准判定疗效。结果本组手术时间平均75 min,术中失血量平均150 ml,住院时间平均13 d,住院费用平均7430元,手术至开始行走时间平均11 d。随访时间5-53个月,平均18个月。术后2周及末次随访时VAS评分均低于术前（t=4.353、7.865,P〈0.05）,末次随访时VAS评分低于术后2周（t=6.597,P〈0.05）。末次随访时疗效：优20例,良8例,可5例,差1例,优良率82.35%。结论微创椎间盘切除术治疗老年腰椎间盘突出症有良好的效果。     

Sucker with a fat lip: The soft tissues underlying the viscoelastic grip of remora adhesion

Remoras are fishes that attach to a broad range of hosts using an adhesive disc on their head that is derived from dorsal fin elements. Research on the adhesive mechanism of remoras has focused primarily on the skeletal components of the disc and their contribution to generating suction and friction. However, the soft tissues of the disc, such as the soft lip surrounding the bony disc and the muscles that control the bony lamellae, have been largely ignored. To understand the sealing mechanism of the disc, it is imperative to understand the tissue morphology and material properties of the soft lip. Here, we show that the soft lip surrounding the remora disc is comprised of discrete multilayered collagen, fat, and elastic tissues which we hypothesize to have specific roles in the viscoelastic sealing mechanism of the remora disc. The central, heavily vascularized fat and collagen layer are infiltrated by strands of elastic tissue and surrounded by crossed-fiber collagen. A newly described jubilee muscle underneath the adhesive disc provides a mechanism for stopping venous return from the disc lip, thereby allowing it to become engorged and create a pressurized fit to the attachment substrate. Thus, the remora lip acts as a vascular hydrostat.     

The relationship between facet tropism and cervical disc herniation

Many studies have demonstrated the association between facet tropism and disc herniation in the lumbar spine. Some of them found that lumbar disc herniation was on the side of the more sagittal facet joint interface. However, little is understood about the association of facet tropism with disc herniation in the cervical spine. As the relationship between the facet orientation and the side of cervical disc herniation (CDH) is unclear, the purpose of this study is to investigate that relationship. Ninety-six patients with single-level CDH (C4-C5, C5-C6 or C6-C7) were included in the CDH group of this study. Another 50 age-matched and gender-matched healthy participants who accepted physical examinations were enrolled as the control group. The cervical facet angles of two sides were measured using axial computed tomography (CT). The intersection angle of the midsagittal line of the vertebra to the facet line represents the facet angle. Facet tropism was defined as the angular difference of 7º between the left and the right sides. Facet tropism angle was recorded as the absolute value of the difference of facet angles between two sides. There were 20 herniations at C4–C5 level, 50 herniations at C5–C6 level and 26 herniations at C6-C7 level. The present study showed that more cases in the CDH group had facet tropism than did those in the control group at C4-C5, C5-C6 and C6-C7 level (p = .021, p = .001, p = .015, respectively). The facet tropism angles in the CDH group were significantly bigger than those in the control group at C4-C5, C5-C6 and C6-C7 level (p = .001, p = .002, p = .028, respectively). In the CDH group, the facet angles on the herniated side were found to be significantly bigger than those on the healthy side at C4-C5, C5-C6 and C6-C7 level (p = .000, p = .000, p = .037, respectively). The findings of this present study suggest that facet tropism is associated with the disc herniation in the cervical spine. We also found that cervical disc herniates towards the side of the bigger facet angle with respect to the sagittal plane. There is a need for future studies to verify the biomechanical impact of facet tropism on CDH.     

腰椎后外侧融合术与360°融合术在严重腰椎管狭窄症治疗中的应用

目的比较腰椎后外侧融合术(PLF)与腰椎360°融合术(CF)在严重腰椎管狭窄症治疗中的临床疗效。方法回顾性分析2014年1月至2017年8月在我科住院治疗的161例不合并椎间盘突出或脱出的严重腰椎管狭窄症患者的临床资料,根据手术方式将患者分为腰椎后外侧融合组(PLF组,81例)和腰椎360°融合组(CF组,80例)。PLF组行腰椎后侧减压联合椎弓根螺钉固定及后外侧融合术;CF组行腰椎椎间盘切除联合后侧减压、椎弓根螺钉固定及360°融合术。比较2组患者术中出血量、手术时间、手术费用及术后并发症发生率;比较2组患者腰腿痛VAS、ODI、腰痛JOA评分评估临床症状;比较2组患者椎间隙高度、腰椎前凸角、融合率评估术后腰椎矢状位平衡及腰椎稳定性。结果术后2组患者的VAS、JOA、ODI较术前均明显改善,与术前比较差异有统计学意义(P<0.01),但2组间比较差异无统计学意义(P>0.05);2组患者术后均恢复了腰椎前凸角和椎间隙高度,且2组术后融合率比较差异无统计学意义(P>0.05);CF组的手术时间、术中出血量、手术费用比PLF组更多,2组比较差异有统计学意义(P<0.01);此外,2组共有8例发生术后并发症,其中PLF组1例(1.23%),CF组7例(8.75%),2组比较差异有统计学意义(P<0.05)。结论对于不合并椎间盘突出或脱出的严重腰椎管狭窄症,行腰椎后侧减压联合椎弓根螺钉固定及后外侧融合术后可以明显缓解临床症状,实现手术节段间骨性融合,达到与腰椎椎间盘切除联合后侧减压、椎弓根螺钉固定及360°融合术同样的手术效果,且手术时间、术中出血量、手术费用、并发症更少。     

颈后路全内镜下颈椎间盘切除术与颈前路颈椎间盘切除植骨融合术治疗颈椎间盘突出症的疗效对比

目的比较颈后路全内镜下椎间盘切除术(PPECD)与颈前路颈椎间盘切除植骨融合术(ACDF)治疗单节段旁中央型颈椎间盘突出症的疗效和对邻近节段退变的影响。方法回顾性分析2016年1月至2018年1月期间在本院行手术治疗的88例单节段旁中央型颈椎间盘突出症患者病例资料。按照所行的手术方式分为PPECD组(n=42)及ACDF组(n=46)。比较两组患者的基线情况,手术前、后颈及上肢视觉疼痛评分(VAS),颈椎功能障碍指数(NDI),手术邻近节段左、右侧屈曲及前屈后伸测定值和颈椎相邻节段退变情况。结果两组患者术后随访时间均为12个月。末次随访时,两组患者颈及上肢VAS和NDI评分与术前相比均有改善(0.05),而两组间比较差异无统计学意义(0.05); PPECD组邻近节段左、右侧屈曲及前屈后伸测定值术前比差异无统计学意义(0.05),ACDF组较术前增大(0.05),并且大于PPECD组(0.05); PECD组颈椎邻近节段退变情况优于ACDF组(0.05)。结论 PPECD和ACDF均能显著改善单节段旁中央型颈椎间盘突出症患者的临床症状,但PPECD对维持患者术后颈椎活动度、减少术后邻近椎体节段退变有一定优势。     

Infantile onset progressive cerebellar atrophy and anterior horn cell Degeneration-A novel phenotype associated with mutations in the PLA2G6 gene

Pontocerebellar hypoplasia (PCH) encompasses a group of neurodegenerative disorders. There are ten known subtypes with common characteristics of pontine and cerebellar hypoplasia or atrophy, neocortical atrophy, and microcephaly. PCH is associated with anterior horn cell degeneration in PCH1a and PCH1b due to mutations in the VRK1 and EXOSC3 genes. Late onset PCH1 has been described in single case reports. The molecular etiology remains mostly unknown. We describe two siblings from a consanguineous Moslem Arabic family with a unique combination of progressive cerebellar atrophy and a SMA-like anterior horn cell degeneration due to a homozygous mutation in the PLA2G6 gene (NM_003560.2). The PLA2G6 gene encodes phospholipase A2 beta, which is involved in the remodeling of membrane phospholipids, signal transduction and calcium signaling, cell proliferation and apoptosis. Mutations in PLA2G6 are known to cause Neurodegeneration with brain iron accumulation 2 (NBIA2): Our patients have some similarities with NBIA2; both are characterized by rapidly progressive psychomotor regression and cerebellar atrophy. However, NBIA2 is not known to exhibit anterior horn cell degeneration.Our patients' phenotype is more consistent with late onset PCH1; thus, indicating that the spectrum of clinical and radiological presentations of PLA2G6 mutations should be extended and that this gene should be included in the molecular evaluation of patients with late onset PCH1.     

腰椎间盘生物力学体内外研究的新进展

文题释义： 椎间盘：是一块位于两椎体之间的纤维软骨垫,由纤维环包绕髓核以及上下方的软骨终板构成,是最大的无血管器官,基本上通过脊椎神经支配。 生物力学：为将工程学尤其是机械力学原理运用于临床医学,对生物体力学问题进行定性定量分析的新型生物物理学分支。研究范围从组织器官到个体,通过对生物体力学特性的研究来指导临床实际操作。生物学和力学二者相辅相成,共同构成一门完整的学科。 背景：腰椎间盘退变造成的一系列临床症状已经是影响人类健康的常见疾病。过去研究中指出在腰椎间盘退变的发生发展中,腰椎间盘生物力学改变起到重要作用。 目的：简述腰椎间盘解剖学、组织学特性,总结近年来腰椎间盘生物力学的研究方法及进展。 方法：通过输入“生物力学,腰椎间盘,动物标本,人类尸体模型,有限元分析,影像学、磁共振成像,biomechanics,Intervertebral disc,lumbar spine,finite element analysis,imaging,MRI,DFIS,DSXS”等关键词,利用计算机检索CNKI、万方、维普、PubMed、Elsevier和Web of Science数据库,通过阅读标题及摘要进行初步筛选,排除与主题相关度低的文献,最终共纳入67篇文献进行结果分析。 结果与结论：①腰椎间盘的生物力学研究目前主要分为体外研究和体内研究;②体外研究包括动物标本实验、人类尸体标本实验、有限元分析,体外实验设计灵活,操作性强,但实验对象脱离人体生理环境,材料的力学特性存在差异,需要经过长期不断验证,筛选出在人体的适用性;③体内研究主要通过影像学手段,实时记录椎间盘在体运动受力形态变化,真实可靠,但受影像技术发展的限制,需要合理运用。最新出现的双平面荧光成像系统以及高速动态立体射线照相系统在这一领域具有独特优势,被越来越多的人所重视。 ORCID: 0000-0002-2070-2400(徐浩翔) 中国组织工程研究杂志出版内容重点：人工关节;骨植入物;脊柱;骨折;内固定;数字化骨科;组织工程     

青少年特发性脊柱侧凸腰主弯患者腰椎-骨盆的生物力学分析

文题释义： 青少年特发性脊柱侧凸：为脊柱三维平面上的畸形,会导致青少年脊柱结构发生明显的改变,结构的改变会导致椎骨及椎间盘应力发生相应的改变,且腰椎、骨盆在人体中的力学作用极为重要,青少年时期为人体脊柱生长发育的高峰期,脊柱结构及应力的改变在该时期的进展尤为明显。 背景：青少年特发性脊柱侧凸导致脊柱结构和应力发生改变,腰椎在脊柱中承受的载荷最大,骨盆也起着传导重力的作用,故青少年特发性脊柱侧凸腰主弯患者腰椎骨盆的生物力学分析尤为重要。 目的：建立青少年特发性脊柱侧凸腰主弯腰椎-骨盆三维数字化模型并进行有限元分析。 方法：根据1例13岁女性特发性脊柱侧凸腰主弯患者的腰椎-骨盆CT薄层数据,应用Mimics 15.0软件重建三维数字化模型,以Pro/E 5.0软件建立初步几何模型并导入Hypermesh 13.0进行网格划分,最终通过Abaqus 6.14软件对该模型进行有限元分析。分析有限元模型在6种载荷条件下的位移、应力变化及该模型各椎体及椎间盘的应力变化。患者家属对试验方案知情同意,且得到医院伦理委员会批准。 结果与结论：①建立了青少年特发性脊柱侧凸腰主弯患者的腰椎-骨盆的三维有限元模型;②模型在6种载荷条件下,L₁椎体上部在左、右侧屈时位移变化最大,骶骨下端在前屈时位移最大;③椎间盘右缘在右侧屈运动条件下所受应力最大;前屈位时,腰椎间盘所受应力为前缘最大,左缘所受应力最小;后伸位时后缘所受应力最大,而右缘所受应力最小;侧屈位及旋转位时,右缘所受应力最大,前缘所受应力最小;④L₅在6种运动中应力均最大,其中应力集中于上下关节突及椎弓根,尤其以右侧最为集中;⑤提示青少年特发性脊柱侧凸不同载荷会引起椎体或椎间盘不同位置受力及位移有相应变化,研究结果对脊柱侧凸的治疗和预防具有重要意义。 ORCID: 0000-0001-5810-6674(张聪) 中国组织工程研究杂志出版内容重点：组织构建;骨细胞;软骨细胞;细胞培养;成纤维细胞;血管内皮细胞;骨质疏松;组织工程     

1切2中垂直内移测量法在高位腰椎间盘突出症经皮椎间孔镜侧路手术治疗中的应用

目的 探讨1切2中垂直内移测量法在经皮椎间孔镜侧路手术治疗高位腰椎间盘突出症(L_1/2或L_2/3)的安全性及初步疗效分析。方法 纳入山西省人民医院骨科2017年6月—2018年8月单节段高位腰椎间盘突出症的患者20例进行回顾性分析,其中男13例、女7例,年龄55～84岁、平均65.14岁;病变节段位于L_1/2者8例,L_2/3者12例。术前均采用1切2中垂直内移测量法在MRI横断面测量后,确定穿刺旁开距离和穿刺点;手术均采用经皮椎间孔镜经椎间孔入路全内镜下逐步扩大椎间孔,直视下进行神经减压。分析手术时间,术前、术后3个月、6个月分别采用VAS、ODI对患者临床表现及功能情况进行评估,总体临床疗效的评价采用MacNab评估标准。结果 20例患者手术均顺利,无输尿管和肾脏损伤及其他并发症。手术时间(72.13±23.01)min;术后伤口均愈合良好,术后第2天均佩戴腰围下地活动、适当功能锻炼,术后第3天出院。术后均获得6个月以上的随访。根据MacNab评估标准,术后疗效优14例(70%)、良5例(25%)、可1例(5%),优良率为95%。术前、术后3个月、术后6个月,VAS分别为(65.15±7.16)分、(22.02±9.64)分和(10.13±9.61)分,ODI分别为45.17%±10.54%、16.51%±8.35%和11.65%±5.93%,术后3、6个月分别与术前比较,差异均有统计学意义(P值均＜0.01)。结论 在高位腰椎间盘突出症经皮椎间孔镜侧路手术治疗中,采用1切2中垂直內移测量法定位穿刺旁开距离和穿刺点安全可靠,可以达到较好的临床效果。     

12-15岁青少年腰椎椎弓根螺钉置入最佳选择的形态学分析

文题释义：椎弓根螺钉：椎弓根置钉是目前脊柱内固定的常用方法,椎弓根形态学参数决定置钉成功率,对于发育中的青少年脊柱疾患,椎弓根螺钉同样发挥重大作用。  三维重建测量：利用三维重建软件对人体组织结构进行3D重建,可清晰完整、更加直观地表现人体组织特点,得到的测量数据更准确,可以更好的服务于临床。 背景：关于成人胸腰段椎弓根形态的研究已经发表了大量文献,但对青少年椎弓根形态的了解较少,尤其是在亚洲人群中。青少年脊柱疾患日益增多且精确的形态学研究较少。 目的：研究内蒙古地区12-15岁青少年腰椎的解剖结构,为椎弓根螺钉置入提供详细资料,确定安全合适的螺钉大小,并为螺钉尺寸设计提供数据参考。 方法：收集内蒙古地区65例12-15岁青少年正常胸腰CT资料,根据年龄分2组,12-13岁31例,14-15岁34例。将连续扫描的胸腰椎断层影像原始数据以DICOM格式导入Mimics 21.0分析与测量,指标包括椎弓根宽、椎弓根高、椎管横径、椎管纵径、椎弓根长、椎弓根外偏角、椎弓根最大外偏角、椎弓根头倾角及椎弓根面积。 结果与结论：①2组L₁-L₄ 椎弓根宽小于椎弓根高,L₅椎弓根宽与椎弓根高相似,椎弓根宽决定螺钉直径,男性大于女性;②12-13岁,螺钉长L₁-L₅均为40-45 mm;14-15岁,螺钉长L₁-L₄为40-45 mm,L₅为45-50 mm;③2组规律相同,椎管横径均大于椎管纵径,椎管横径、椎管纵径之间差异有显著性意义(P < 0.05),男女之间差异无显著性意义;④椎弓根外偏角：12-13岁L₁-L₂变化不大,L₂-L₅逐渐增大;14-15岁L₁-L₅逐渐增大,2组均男性大于女性;⑤椎弓根最大外偏角：2组规律相同,L₁-L₅逐渐增大,随年龄增长而减小,左右侧与性别间差异均无显著性意义,不同年龄间差异有显著性意义(P < 0.05);⑥椎弓根头倾角： 12-13岁为3°-8°,14-15岁为0°-5°;随年龄增长而减小,L₃-L₄男女之间差异有显著性意义(P < 0.05);⑦椎弓根面积：2组规律相同,L₁-L₅逐渐增大,L₄-L₅有一个明显的变化趋势;⑧根据椎弓根参数分析可得出正常青少年腰椎各节段置入螺钉的适合尺寸,帮助临床医师掌握腰椎解剖结构,提高置钉准确性。 ORCID: 0000-0001-5877-8358(许阳阳) 中国组织工程研究杂志出版内容重点：人工关节;骨植入物;脊柱;骨折;内固定;数字化骨科;组织工程