颈椎椎体次全切除钛网钉板系统的临床应用

目的探讨颈椎前路椎体次全切除钛网钉板植骨融合的临床效果。方法自2001年3月～2003年3月间应用颈前路椎体次全切除钛网植骨融合及钉板固定治疗颈椎管狭窄性疾病22例，其中4例患者行2椎体次全切除3节椎间隙减压手术。术后观察减压、固定、融合及神经功能恢复情况，并行X线摄片或CT扫描检查。结果患者获6～12个月随访，神经功能得到不同程度改善，无加重情况。椎间隙高度无丢失、无成角，均获得骨性融合。术后3d在颈围领固定下下床活动，4周后可恢复较轻工作。结论此术式可避免传统手术方法的缺点，即不取自体髂骨，融合率高，稳定性好，并减压彻底，疗效好，是一种值得推广的新技术。     

计算机体层成像多平面重建在评价椎间融合中的作用

目的 探讨计算机体层成像多平面重建(CTMPR)在评价椎间融合中的作用,寻找定量评价椎间融合的新方法.方法 13例行腰椎间融合的患者术后1周、3个月、6个月行CTMPR,行椎间融合器(Cage)内植骨CT值定量测量.结果 术后1周Cage内植骨CT值为(619.52±26.97)Hu,术后3个月为(628.69±42.60)Hu,术后6个月为(657.77±37.43)Hu.术后1周与术后3个月相比无显著性差异,与术后6个月相比有显著性差异.结论 CT值的测量在椎间融合的判断中具有高准确性.     

A comparative study of the anatomical,radiological and therapeutic features of the lumbar facet joints

Summary An anatomical study of the lumbar apophyseal joints was carried out to facilitate recognition of facet joint lesions, which we now examine routinely by percutaneous arthrography. Special attention was given to the configuration of the different compartments of the joint space and to its relationships with the contents of the intervertebral foramen. The abnormalities seen on lumbar facet joint arthrography are very varied; two major groups should be stressed: synovial fringe hypertrophy and pseudodiverticular synovial ectasia. The percutaneous approach to lumbar facet joint arthrography allows it to be used a therapeutic measure, with injection of anti-inflammatory drugs into the joint space, the beneficial effects of which were confirmed in our series. The precision, efficiency and cost-effectiveness of this outpatient technique justify and should encourage its more widespread application in the diagnosis and treatment of low back pain.     

The evolution of a neo-XY1Y2 sex chromosome system by autosome–sex chromosome fusion in Dundocoris nodulicarinus Jacobs (Heteroptera: Aradidae: Carventinae)

Sibling subspecies of Dundocoris nodulicarinus, inhabiting different isolated indigenous evergreen forests in South Africa, have chromosome numbers of 2n(male) = 14XY, 9XY1Y2 and 7XY1Y2. The ancestral chromosome number of Dundocoris is probably 2n(male) = 28XY and several chromosome fusions were involved in the karyotype evolution of these taxa. The XY1Y2 sex chromosome system of the 9XY1Y2 D. nodulicarinus novenus originated by the fusion of a large autosome with the X-chromosome, forming a neo-X with the homologue of the fused autosome forming the neo-Y (=Y1) and the original Y-chromosome, the Y2. While the original X- and Y-chromosomes are heterochromatic and heteropycnotic during prophase I, the autosomal part of the neo-X and the neo-Y stay euchromatic and behave like a normal autosomal pair, forming synapsis and chiasmata. The XY1Y2 sex chromosome system of the 7XY1Y2 D. nodulicarinus septeni probably originated from the 9XY1Y2 karyotype when the homologous chromosomes of a small autosomal pair fused with the original X- and Y-chromosomes, respectively. In both the subspecies with the neo-XY1Y2 systems, the original sex chromosomes still undergo chromatid segregation at anaphase I (= post-reductional). The evolution and behaviour of the karyotypes and sex chromosome systems during the course of meiosis in the subspecies of D. nodulicarinus are described, discussed and illustrated.     

具有靶向免疫抑制作用新型重组融合蛋白B7-2-PE40KDEL真核表达载体的构建及其生物效应

目的:构建B7-2-PE40KDEL的真核表达载体,探讨通过体内表达重组融合蛋白,特异性杀伤高表达CD28 T细胞,阻断B7∶CD28/CTLA4共刺激信号途径诱导免疫耐受的可能性.方法:以原核表达载体pRSETA-B7-2-PE40KDEL质粒为模板,采用PCR及酶切连接的方法构建真核表达载体pcDNA3.1/Zeo( )-B7-2-PE40KDEL.利用RT-PCR、Western 印迹及ELISA法从mRNA、蛋白质水平检测了B7-2-PE40KDEL在RPE-CHO真核细胞中的表达情况.采用MTT法对其特异性杀伤高表达CD28 T细胞的生物活性进行测定.结果:成功构建了pcDNA3.1/Zeo( )-B7-2-PE40KDEL真核表达载体,转染入RPE-CHO细胞后可转录翻译为重组融合毒素蛋白,相对分子质量约为71×103,平均106个转染细胞24 h表达0.23 μg/L.活性测定显示真核载体所表达的B7-2-PE40KDEL可特异性地抑制高表达CD28的人T淋巴细胞系,而对CD28阴性的人白血病细胞系的抑制率较低.结论:真核载体表达的B7-2-PE40KDEL具有良好的靶向性免疫抑制活性,为进一步开展其体内特异性防治移植排斥反应及自身免疫性疾病奠定了基础.     

经皮穿刺腰椎间盘切吸术治疗腰椎间盘突出症的远期疗效

目的 观察X线电视引导下经皮穿刺腰椎间盘切吸术治疗腰椎间盘突出症的远期疗效。方法 32例经CT扫描证实的腰椎间盘突出症患者，其中，膨出型29例，游离型2例，以及突出型1例，均经X线电视引导下经皮穿刺腰椎间盘切吸术治疗，术后均经随访0.5～11.0a。结果 术后1周～3个月，32例中的24例临床症状与体征得到有效控制或明显减轻，随访5～11a观察表明，症状完全消失和明显减轻者分别见于23例和6例，总有效率90.6%，预后极好和较好者均见于膨出型腰椎间盘突出症患者。结论 游离型和突出型腰椎间盘突出症的疗效均不理想，因此，术前认真选择适应证是获得理想疗效的关键性因素。     

The role of JOA score as an indication for surgical or conservative treatment of symptomatic degenerative lumbar spinal stenosis

Abstract The aim of this study was to evaluate the short- to medium-term results (up to 2 years) of conservative and surgical treatments of patients with symptomatic lumbar stenosis. To our knowledge, no previous study has provided strict indications for conservative or surgical treatment. We retrospectively studied 184 patients, who were divided into 3 groups according to JOA (Japanese Orthopaedic Association) score. A cutoff JOA score was arbitrarily fixed at 7. Patients with a score ≤7 (n=12; group A) underwent surgery, while patients with a score >7 (n=172) were conservatively treated. Group A included patients surgically treated within two months from diagnosis. Group B consisted of 144 patients who received conservative treatment, while group C (28 patients) represented patients who underwent surgery after a period of failed conservative treatment. The outcomes of surgical and conservative treatments were evaluated after 12 and 24 months, and were rated as satisfactory, not totally satisfactory, not satisfactory or totally unsatisfactory. Conservative treatment consisted of physical, orthotic and drug therapy, whereas surgical treatment included spinal decompression and instrumentation (if indicated), either rigidly or dynamically performed. Surgery was indicated in 22% of all patients and we obtained excellent results in 85% of them. Operative treatment provides excellent results for patients with severe clinical presentation (JOA score ≤7), while individuals with mild to moderate spinal stenosis (JOA score >7) should receive conservative treatment.     

后凸成形术结合体位复位治疗创伤性胸腰椎椎体骨折的临床观察

目的：观察在体位复位辅助下后凸成形术治疗创伤性胸腰椎椎体骨折的临床疗效。方法：37例新鲜单节段胸腰椎椎体骨折患者,男28例,女9例;年龄24～79岁,平均48岁。通过体位复位及Sky扩张器撑开复位后,经双侧椎弓根穿刺充填自固化磷酸钙人工骨（CPC）。根据Denis胸腰椎骨折的分型：压缩性骨折,B型27例,C型3例,D型5例;爆裂性骨折2例,均为B型。利用体位复位,经皮穿刺,Sky椎体成形器扩张椎体,注入可降解的自固化磷酸钙人工骨。根据术前和术后侧位X线片测量椎体高度、后凸畸形角度,并计算椎体高度丢失率和后凸畸形矫正率,记录分析视觉模拟评分（VAS）及伤椎形态变化。结果：术后随访9～24个月,平均13个月。术后伤椎处疼痛均显著缓解,VAS评分改变从术前平均（7.6±2.5）分降至术后平均（1.8±1.5）分,椎体前壁高度和中间高度明显恢复,后凸畸形得到矫正。随访期间疗效满意,伤椎高度无明显丢失。结论：在严格掌握适应证、选择合适病例的前提下,采用体位复位辅助下经皮椎体后凸成形术治疗创伤性胸腰椎椎体骨折,能迅速缓解疼痛,有效恢复椎体高度和矫正后凸畸形。