正骨手法治疗单纯收缩期高血压伴颈椎病的病例对照研究

目的:探索正骨手法治疗单纯性收缩期高血压伴随颈椎病的疗效及安全性。方法:自2012年1 月至2015 年1 月,收治单纯收缩期高血压伴颈椎病患者320 例,分为治疗组和对照组。治疗组160例,男84例,女76例,平均年龄(39.82±10.33)岁,平均血压(149.61±10.75)/(81.01±8.25) mmHg,NPQ评分24.61±8.14;对照组160例,男90例,女70例,平均年龄(41.37±9.42)岁,平均血压(151.48±11.32)/(79.65±9.32) mmHg,NPQ评分25.78±9.53.治疗组予颈椎屈顶旋锁定正骨手法治疗,每2日1次,连续20 d;对照组予坐位颈椎旋转复位法治疗,每2日1次,连续20 d.于治疗前后测量血压及填写NPQ量表以评估疗效。结果:治疗前及1个疗程结束后收缩压,治疗组分别为(149.61±10.75) mmHg和(129.67±12.26) mmHg,对照组分别为(151.48±11.32) mmHg和(132.02±11.73) mmHg,两组治疗后收缩压均较治疗前下降,治疗后治疗组收缩压改善优于对照组。治疗前后舒张压,治疗组分别为(81.01±8.25) mmHg和(78.15±10.34) mmHg,对照组分别为(79.65±9.32) mmHg和(76.89±9.79) mmHg,两组舒张压变化差异无统计学意义。治疗前后NPQ 评分,治疗组分别为24.61±8.14和12.46±7.94,对照组分别为25.78±9.53和14.17±8.86,两组治疗后评分均优于治疗前,治疗后两组评分差异无统计学意义。总体疗效比较,治疗组优于对照组。结论:单纯收缩期高血压伴颈椎病患者早期行正骨手法治疗效果显着,颈椎屈顶旋锁定正骨手法效果较传统坐位颈椎旋转复位法疗效更佳,更为安全。     

Compression screw fixation without bone grafting for scaphoid fibrous nonunion

Purpose

Bone graft is often recommended as an adjuvant for treatment of scaphoid nonunions. However, recent literature has suggested that fibrous nonunion may be suited to treatment with rigid fixation without bone grafting. This work reported on outcomes of compression screw fixation for established scaphoid fibrous nonunions without bone graft.

Methods

Fourteen patients underwent surgical compression screw fixation without bone grafting of scaphoid fibrous nonunion between January 1, 2000, and December 31, 2012, with minimum follow-up until the time of clinical and radiographic healing. Fibrous nonunion of the scaphoid was defined as a scaphoid fracture with all of the following features: (1) persistent tenderness, (2) incomplete trabecular bridging on three X-ray views, (3) injury that had occurred at a minimum of 6 months prior to surgery, and (4) identification of fibrous union at the time of surgery. Outcomes were assessed with range of motion assessment, Disability of the Arm, Shoulder and Hand (DASH) scores, and plain radiographs.

Results

Twelve of the 14 patients healed successfully, while two patients required secondary vascularized bone grafting. Both unhealed patients sustained proximal pole fractures and had a duration of ≥1 year from injury to surgery. Average time to healing was 4.4 ± 2.0 months. Average flexion was 73 ± 22° and average extension was 66 ± 22° postoperatively. Average grip strength was 90 ± 25 lbs on the operative side. Mean postoperative pain score was 1.4 (range, 0 to 7). Mean postoperative DASH score was 10.2 (range, 0 to 52). Increasing age and an interval from injury to surgery of >1 year correlated with worse DASH and pain scores.

Conclusions

Patients with fibrous scaphoid nonunion demonstrated good results with rigid fixation without bone grafting. Increasing age and >1-year interval between injury and surgery resulted in lower self-assessed outcomes.

Level of Evidence

Therapeutic Level IV, retrospective case series     

单双侧椎体后凸成形术治疗骨质疏松性胸腰椎压缩骨折的疗效分析

目的 对比单双侧椎体后凸成形术(PKP)治疗骨质疏松性单一胸腰椎压缩骨折的临床疗效.方法 回顾性分析自2010-06-2013-04北京积水潭医院脊柱科诊治的PKP患者451例,分为单侧和双侧入路组.评价指标:手术时间、透视次数、骨水泥量、VAS评分、椎体高度、Cobb角及骨水泥渗漏.结果 所有患者均顺利完成手术.平均手术时间、骨水泥填充量、平均手术时间、骨水泥注射量、X线曝光时间2组比较,差异有统计学意义(P＜0.05).2组术后VAS评分、平均椎体高度、Cobb角较术前显著改善,差异有统计学意义(P＜0.05).2组骨水泥渗漏率相似,差异无统计学意义(P＞0.05).结论 单侧入路行PKP治疗骨质疏松性单椎体骨折比双侧入路具有手术时间更短、X线放射次数更少等优点,能取得经双侧入路穿刺相似的治疗效果.     

P物质、降钙素基因相关肽、白介素6与椎体骨折并发远隔部位疼痛的相关性研究

目的探讨胸腰段椎体压缩骨折出现远隔部位疼痛的病因。方法选取Denis分类屈曲型骨折的手术病例62例,腰痛伴远隔部位疼痛11例为实验组,腰痛不伴远隔部位疼痛51例为对照组。术中取多裂肌标本,制作冰冻切片,P物质(SP)、降钙素基因相关肽(CGRP)、白介素6(IL-6)抗体免疫组化染色;计算椎体前缘高度和后缘高度的比值来衡量伤椎的压缩程度;手术前及手术后2周分别行VAS、JOA、ODI评分。结果实验组:术前椎体压缩程度(68.73±11.91)%、VAS(8.09±1.51)分、ODI(40.45±3.48)%、JOA(14.00±3.80)分,术后椎体压缩程度(84.00±6.08)%、VAS(5.00±1.34)分、ODI(21.73±3.80)%、JOA(15.36±3.56)分;对照组:术前椎体压缩程度(75.27±14.14)%、VAS(7.65±1.43)分、ODI(39.24±4.64)%、JOA(11.90±3.59)分,术后椎体压缩程度(83.75±8.89)%、VAS(2.76±1.18)分、ODI(15.82±3.65)%、JOA(20.84±3.71)分。实验组与对照组术前椎体压缩程度比较,差异无统计学意义(P0.05),术后椎体压缩程度比较,差异无统计学意义(P0.05)。实验组与对照组术前VAS、ODI、JOA评分差异无统计学意义(P0.05),术后VAS、ODI、JOA评分对照组优于实验组(P0.05)。免疫组化:实验组11例标本SP、CGRP、IL-6染色结果均为阳性。对照组51例标本SP、CGRP、IL-6染色结果阴性。结论屈曲暴力造成脊柱后方组织损伤,SP、CGRP、IL-6介导的炎症反应刺激脊神经后支,是产生远隔部位疼痛的重要原因。     

胫骨远端前内侧入路双锁定加压钢板内固定治疗复杂Ｐｉｌｏｎ骨折

目的：探讨复杂Pilon骨折应用胫骨远端前内侧入路双锁定加压钢板内固定治疗效果。方法对2009年5月至2013年4月50例胫骨远端前内侧入路双锁定加压钢板内固定治疗的复杂Pilon骨折患者临床资料进行回顾性分析。结果50例患者手术时间为（55.3±7.7）min;术中出血量为（20.1±2.2）mL;术后随访时间为（16.3±2.3）个月;骨折愈合时间为（15.2±1.3）周。踝关节功能优良率94.0％。结论复杂Pilon骨折患者应用胫骨远端前内侧入路双锁定加压钢板内固定治疗效果显著,不良反应少。     

Efficacy of stabilisation splint therapy combined with non‐splint multimodal therapy for treating RDC/TMD axis I patients: a randomised controlled trial

Stabilisation splint therapy has long been thought to be effective for the management of temporomandibular disorders (TMD). However, the superiority of stabilisation splint therapy compared to other TMD treatments remains controversial. The aim of this study was to determine the efficacy of stabilisation splint therapy combined with non‐splint multimodal therapy for TMD. A total of 181 TMD participants were randomly allocated to a non‐splint multimodal therapy (NS) group (n = 85) or a non‐splint multimodal therapy plus stabilisation splint (NS+S) group (n = 96). Non‐splint multimodal therapy included self‐exercise of the jaw, cognitive–behavioural therapy, self‐management education and additional jaw manipulation. Three outcome measurements were used to assess treatment efficacy: mouth‐opening limitation, oro‐facial pain and temporomandibular joint sounds. A two‐factor repeated‐measures analysis of variance (anova ) was used to evaluate the efficacy of the two treatment modalities (NS vs. NS+S), and Scheffe's multiple comparison test was used to compare the treatment periods. Subgroup analyses were performed to disclose the splint effects for each TMD diagnostic group. All three parameters significantly decreased over time in both groups. However, there were no significant differences between the two treatment groups in the total comparison or subgroup analyses; an exception was the group with degenerative joint disease. No significant difference between the NS and NS+S treatment approaches was revealed in this study. Therefore, we conclude that the additional effects of stabilisation splint are not supported for patients with TMD during the application of multimodal therapy.     

寰枢整复手法治疗气滞血瘀型椎动脉型颈椎病的临床观察

Objective: To investigate the clinical effect of spinal manipulation therapy for the treatment of cervical spondy-losis of vertebral artery type (CSA) combine with atlanto-axial joint instability. Methods: A deep analysis of previous randomized controlled trial was performed on 51 CSA combine with atlanto-axial joint instability patients from January 2016 to September 2019. The treatment group (n=27) accepted spinal manipulation therapy, while the control group (n=24) was treated with electro-acupuncture therapy. The effectiveness and changes of hemodynamic indexes of vertebra-basilar arterial system in the two groups before and after treatment were observed and compared. Results: The improvement of all the hemodynamic indexes in the treatment group was more significant than that in the control group (P<0.05). After treatment,the clinical effective rate was 96.30% in the treatment group and 87.50% in the control group,the difference being significant (P<0.05). Conclusion: Spinal manipulation therapy can improve the symptoms of CSA combine with atlanto-axial joint instability effectively. However, the assessment of the patient before treatment is necessary.