退变性腰椎不稳症手术治疗的疗效分析

目的:探讨退变性腰椎不稳症手术治疗的疗效。方法:随访我院60例腰椎不稳症患者运用椎板扩大开窗或全椎板切除减压,摘除髓核,椎体间植骨,后路钉棒系统加压内固定及腰椎间融合术。结果:术后随访半年到3.5年,平均12个月,复查X线示骨性融合,2例出现断钉及松动现象,患者症状完全消失48例,基本消失7例,无明显缓解5例(可3例,差2例)。根据日本骨科学会(JOA)评分法,优良率91.3%。结论:椎弓根螺钉内固定加椎管减压,椎体间植骨融合可使不稳节段即刻稳定,骨性融合率高,是治疗腰椎不稳症的较好方法。     

复发性腰椎间盘突出症的研究进展

腰椎间盘突出症是骨科常见病,手术是治疗该病的有效方式,但是仍有5．0％～20．0％的患者发生腰椎手术失败综合征,其中以复发性腰椎间盘突出症为主。该文综述了复发性腰椎间盘突出症的定义、病因、诊断、治疗和预防等方面的研究进展。     

The Relation Between Sox9, TGF-��1, and Proteoglycan in Human Intervertebral Disc Cells

Objective

The aim of this study is to elucidate the effects of transforming growth factor-β (TGF-β)1 and L-ascorbic acid on proteoglycan synthesis, and the relationship between Sox9, proteoglycan, and TGF-β1 in intervertebral disc cells.

Methods

Human intervertebral disc tissue was sequentially digested to 0.2% pronase and 0.025% collagenase in DMEM/F-12 media and extracted cells were cultured in 37℃, 5% CO₂ incubator. When intervertebral disc cells were cultured with TGF-β1 or L-ascorbic acid, the production level of sulfated glycosaminoglycan (sGAG) was estimated by dimethyl methyleneblue (DMMB) assay. The changes of Sox9 mRNA and protein levels via TGF-β1 were detected by RT-PCR and Western blot analysis in each.

Results

The amount of sGAG was increased with the lapse of time during incubation, and sGAG content of pellet cultured cells was much larger than monolayer culture. When primary cultured intervertebral disc cells in monolayer and pellet cultures were treated by TGF-β1 20 ng, sGAG content of experimental group was increased significantly compared to control group in both cultures. L-Ascorbic acid of serial concentrations (50-300 ug/ml) increased sGAG content of mono layer cultured intervertebral disc cells significantly in statistics. The co-treatment of TGF-β1 and L-ascorbic acid increased more sGAG production than respective treatment. After treating with TGF-β1, Sox9 mRNA and protein expression rates were significantly increased in disc cells compared with the control group.

Conclusion

This study suggests that TGF-β1 would increase sulfated glycosaminoglycan (sGAG) and other proteoglycans such as versican by elevating Sox9 mRNA and protein expressions in order.     

中药熏蒸加牵引配合独活寄生汤治疗腰椎间盘突出症疗效观察

目的:观察中药熏蒸加牵引配合独活寄生汤治疗腰椎间盘突出症的临床疗效。方法:将70例患者随机分为两组,中药熏蒸加牵引配合独活寄生汤治疗组40例,采用吉林省亮达医疗器械有限公司生产的DXZ-1型电脑中药熏蒸多功能治疗机进行熏蒸,熏蒸治疗30min,熏蒸后即行腰椎牵引,持续牵引30min,1次/d,10次为1个疗程,同时配合口服独活寄生汤,1剂/d,10d为1个疗程。单纯中药熏蒸加牵引30例,治疗方法和疗程与治疗组相同。结果:两个疗程后进行比较,治疗组治愈率70%,总有效率100%;对照组治愈率53.3%,总有效率83.3%。治疗组治愈率和有效率明显高于对照组(P<0.05)。结论:中药熏蒸加牵引配合独活寄生汤治疗腰椎间盘突出症与单纯中药熏蒸加牵引相比疗效更好。     

腰椎间盘突出症突出物自然吸收与腰椎曲度的相关性研究

目的研究腰椎间盘突出症组织不同程度自然吸收与腰椎曲度的相关性。方法回顾分析上海市宝山区仁和医院2015年1月至2019年6月CT检查确诊腰椎间盘突出症病人61例,均为保守治疗,并具有6~24个月随访复查资料。根据突出物自然吸收程度分为明显重吸收组(10例),部分重吸收组(8例),基本不变组(30例),增大组(13例)四组,配对比较每组腰椎曲线指数、腰椎前凸角变化,并进行相关分析。结果腰椎间盘突出症明显重吸收组、部分重吸收组、基本不变组、增大组的首次CT检查腰椎曲线指数、腰椎前凸角比较,差异无统计学意义(P>0.05);经治疗后随访CT腰椎曲线指数［10.65(9.23,13.31)mm 比11.69(8.31,15.25)mm 比8.63(6.75,11.00)mm 比8.06(5.00,10.05)mm］、腰椎前凸角［46.30(43.96,48.18)°比45.36(44.15,47.67)°比39.37(32.27,45.74)°比35.39(29.60,43.16)°］比较,差异有统计学意义(P<0.05)。明显吸收组、部分重吸收组随访腰椎曲线指数、腰椎前凸角较首次CT检查增大(P<0.05);增大组随访腰椎曲线指数、腰椎前凸角较首次CT检查减小(P<0.05);基本不变组腰椎曲线指数、腰椎前凸角前后配对比较差异无统计学意义(P>0.05)。腰椎间盘突出症自然吸收程度与腰椎曲线指数、腰椎前凸角变化均呈正相关(rs=0.50、0.47,P<0.05)。结论腰椎曲线指数及腰椎前凸角随着腰椎突出椎间盘自然吸收而增大,当腰椎突出椎间盘增大时腰椎曲线指数及腰椎前凸角也相应减小。腰椎间盘突出症组织自然吸收程度与腰椎曲度变化呈正相关。     

Clinical and radiographic features of spinal osteoarthritis predict long-term persistence and severity of back pain in older adults

BackgroundPatients with back pain can show one or more features of spinal osteoarthritis (OA), such as morning stiffness, limited or painful range of motion (ROM), and lumbar disc degeneration (LDD). However, it has not been investigated whether these features are prognostic of long-term back pain.ObjectivesThis study assessed whether spinal morning stiffness, ROM and LDD are prognostic factors for back pain after 1 year in older adults with back pain.MethodsThis prospective observational study (BACE cohort) included patients aged > 55 years visiting a general practitioner for a back-pain episode. Baseline patient-reported morning stiffness, physical examined ROM and radiographic LDD features (i.e., multilevel osteophytes and disc space narrowing) were analysed as potential prognostic factors in unadjusted and adjusted regression models with the outcomes of persistent back pain (yes/no) and back pain severity after 1-year follow-up.ResultsThis study included 543 patients with mean (SD) age 67 (8) years, 59% female, and 62% reporting back pain at 1-year follow-up. When studied in separate adjusted models, persistent back pain was associated with morning stiffness > 30 min (OR 3.0, 95%CI 1.3; 5.5), restricted lateroflexion (OR 1.8, 95%CI 1.0; 3.2), pain during rotation (OR = 1.7, 95%CI 1.0; 2.9), multilevel osteophytes (OR 2.4, 95%CI 1.4; 4.1), and multilevel disc space narrowing (OR 1.5, 95%CI 0.9; 2.4). When investigated in the same adjusted model, persistent back pain remained associated with only morning stiffness > 30 min (OR 2.4, 95%CI 1.0; 3.9), pain during rotation (OR 1.6, 95%CI 0.9; 2.8), and multilevel osteophytes (OR 2.1, 95%CI 1.2; 3.7). The same spinal OA-related features were associated with back pain severity.ConclusionsSpinal morning stiffness, painful rotation, and multilevel osteophytes are prognostic factors for persistent back pain and back pain severity after 1 year. Evaluating these clinical and radiographic features of spinal OA could help clinicians identify older patients who will experience long-term back pain.     

Influencia de la longitud axial ocular en el grosor de la capa de fibras nerviosas peripapilar medido con tomografía de coherencia óptica

BackgroundOptical coherence tomography (OCT) allows the measurement of the peripapillary optic nerve fiber layer (RNFL) thickness. The effect of ocular axial length (AL) on RNFL thickness measurement may be relevant in the interpretation of OCT results in diagnosing optic nerve diseases.PurposesTo assess the influence of ocular AL on RNFL thickness and on optic disc topographic parameters (optic disc area, rim area and cup volume) measured by OCT, in healthy individuals.MethodA sample of 109 healthy eyes classified into three groups according to AL (A: AL <22 mm; B: AL 22–24.5 mm; C: AL >24.5 mm) was studied. RNFL thickness and optic disc topographic parameters were measured using Swept-Source OCT Triton (Topcon Corporation, Tokyo, Japan) and were compared between groups using a variance analysis. Correlation between the AL and the study variables was performed using a Pearson's correlation coefficient test.ResultsThe RNFL thickness was lower in eyes with higher AL in the superior (r = −0.41; p < 0.001), inferior (r = 0.58; p < 0.001) and nasal (r = −0.43; p < 0.001) quadrants, in the mean value of the RNFL (r = −0.49; p < 0.001), optic disc area (r = −0.40; p < 0.001) and rim area (r = −0.25; p = 0.01).ConclusionAL is negatively correlated with RNFL thickness and optic disc topographic parameters measured by Swept-Source OCT Triton (Topcon).     

视盘倾斜在高度近视中的研究进展

随着近视在亚洲地区的流行,高度近视的患病率也在逐步上升,高度近视无疑已经成为亚洲地区甚至全球范围内的公共卫生问题。视盘倾斜作为一种相对常见的病理改变多出现于高度近视的患者眼中,并且还有可能成为青光眼和黄斑病变等疾病的危险因素,从而增加对视力损害的风险。然而目前对于高度近视中出现视盘倾斜的机制以及视盘倾斜在高度近视并发症加重过程中所发挥的作用还需深入探究。因此,该文章收集整理视盘倾斜的相关文献,从高度近视导致视盘形态改变的机制以及对于各种并发症的影响做出综合性论述,以便为临床针对高度近视及其并发症的诊治提供一定依据。     

Über den Hautcyclus einer neuen Spontanmutante (Nackig) mit mangelhafter Haarkeratinisierung bei der Maus

Summary The collagen type composition of normal and pathologic scars was examined in comparison with normal skin from the same individual. Particular care was taken to separate scar tissue from adjacent normal dermis. After urea extraction, the tissue specimens were cleaved with cyanogen bromide. The presence of the dermal collagen types I and III was deduced from the electrophoretic distribution patterns of the CNBr peptides in 12% SDS-polyacrylamide gels. The intensity of the type III specific peptide bands correlates with the type III content of the samples. Using this method, the presence of both type I and type III collagen can be proved in normal as well as pathologic scars. The type III content in older normal scars is slightly increased, whereas the type III content of pathologic scars is significantly increased in comparison with the type III content of normal skin. The electrophoretic CNBr peptide distribution pattern of pathologic scar tissue is almost the same as that of fetal skin. Both are clearly different from the peptide pattern of normal adult skin.