应用实时定量PCR技术检测慢性粒细胞白血病患者bcr/ablP190融合基因转录本

目的研究bcr/ablP190融合基因转录本在慢性粒细胞白血病(CML)中表达水平及其临床相关性.方法应用实时定量聚合酶链反应(RQ-PCR)检测74例CML患者骨髓单个核细胞中的bcr/ablP190转录本.结果 bcr/ablP190转录本阳性54例(77.1%),中位含量2.60(1.08～8.58)×10-3,与性别、年龄、白细胞总数、血红蛋白含量、血小板计数、bcr/ablP210转录本类型和表达水平均不相关,但bcr/ablP190阳性患者的白细胞总数和血小板计数较阴性者明显降低.bcr/ablP190转录本水平在急变期与慢性期患者以及不同类型急变患者中都无差异,而细胞遗传学完全缓解患者的bcr/ablP190水平较慢性期患者、干扰素无效患者和急变期患者则明显下降.结论不同阶段CML患者体内大都存在着不同的bcr/abl剪切型转录本,不同剪切型的存在具有一定的血液学相关性.     

应用单侧椎间孔入路腰椎体间融合术治疗腰椎滑脱症早期疗效观察

目的 探讨腰椎滑脱症的适宜手术入路及方式。方法 应用单侧椎间孔入路腰椎体间融合术治疗腰椎滑脱症21例。通过观察及分析术中出血量、手术时间、早期疗效及手术前后X线片资料。结果 21例病例早期临床优良率100％．术后随访6个月,植骨融合率100％。结论 经单侧椎间孔入路腰椎体间融合术是一种安全可行,疗效满意的治疗腰椎滑脱症的手术方法。     

C形根管的形态与识别

根管治疗中根管的机械化学预备是感染控制的关键步骤,但C形根管的形态给根管的清理、成形带来巨大的挑战.在治疗前正确识别、评估根管形态变得尤为重要.随着检查方法的进步及设备、耗材的更新,C形根管的诊断率及治疗成功率均得到了显著提高.因此,了解C形根管的形态及临床意义,掌握C形根管的临床检查和识别方法,对于提高根管治疗成功率...     

针刀结合牵引治疗腰椎间盘突出症的体会

目的探讨针刀结合牵引治疗腰椎间盘突出症的疗效。方法选择2011年3月至2013年3月在江西省婺源县人民医院行针刀松解术后进行牵引治疗的腰椎间盘突出症患者80例,观察患者治疗前后功能障碍指数评分、视觉模拟评分(VAS)、直腿抬高试验的变化,并对临床治疗效果给予评价。结果治疗后,患者功能障碍指数评分、VAS评分、直腿抬高试验均较治疗前显著改善,差异有统计学意义(P<0.05),且总有效率为92.5%。结论针刀结合牵引治疗腰椎间盘突出是以保护和恢复椎间盘为立足点,是治疗腰椎间盘突出一种有效手段。     

腰椎间盘突出症的椎间孔镜治疗

开放手术治疗腰椎间盘突出症虽然疗效确切,但对腰部软组织及脊柱附属结构破坏较大,脊柱正常载荷传导及运动功能的紊乱,加速邻近节段退变,从而影响手术的远期疗效。随着外科技术及器械的发展,微创治疗成为治疗腰椎间盘突出症的重要组成部分,其具有创伤小,恢复快,并发症少等优点。该文将目前主流微创技术的临床应用现状进行归纳总结。     

Bone marrow blood supply in gadolinium-enhanced magnetic resonance imaging

A retrospective study was performed to determine whether bone blood supply can be assessed on gadolinium-enhanced magnetic resonance imaging. Lumbar spine magnetic resonance imaging (MRI) examinations of 49 patients attending for post-laminectomy examination were reviewed (30 male, 19 female, mean age 46.4 years, age range 23–84 years). Each study included sagittal T1-weighted spin echo sequences before and after gadolinium administration. Regions of interest were drawn within the L3 vertebral body from a parasagittal slice from each sequence. Signal intensity (SI) values were ascertained and the percentage increase in SI was calculated. For each patient, changes in receiver gain for pre and post-gadolinium images were corrected by an image scaling factor. In all cases, a measurable increase in SI was found (mean 15.3%, range 4.4–55.7) due to bone vascularity. The results give no indication of the quantity or timing of blood supply but provide a basis for further work.     

螺旋CT数据简易化处理在PLD术中L5～S1椎间盘穿刺入路选择的应用价值

目的 探索螺旋CT数据简易化处理在经皮腰椎间盘切吸术(PLD)中L5～S1椎间盘穿刺入路选择的价值.方法 搜集2007年6月至2010年6月于新乡医学院第一及第二附属医院行PLD的L5～S1椎间盘突出症患者196例.按不同L5～S1椎间盘穿刺路径选择将其分为A、B两组,A组为2009年6月以前根据既往常规穿刺点范围、穿刺参数,经皮椎间盘穿刺施术的病例,共115例;B组:为2009年6月以后经螺旋CT数据处理、选择的穿刺路径施术的病例,共81例.测量与穿刺路径相关的解剖结构数据,经相关统计学分析,探索其内在规律.分析A、B两组在穿刺点定位用时、穿刺到位用时、穿刺次数、术中X线用时之间的差异性.结果 穿刺深度、重组矢状面各层椎间隙宽度平均值、L5～S1椎间盘中心厚度、L5椎体中心厚度、L5两侧关节突最大距离、L5两侧横突最大宽度及最大距离、L5两侧横突最大距离、髂骨最高点与L5椎体终板上缘中心点高度差的标准差和变异系数偏大.定位用时分别为A组(1.09±0.22) min,B组(1.04±0.40) min(P ＞0.05);穿刺到位用时A组(3.29±1.53) min,B组(2.79±1.07)min(P ＜0.05);穿刺平均次数A组4.41±1.91,B组2.23±1.09(P ＜0.05);术中X线用时A组(11.9±5.2) min,B组(6.7 ±3.6)min (P ＜0.05).结论 穿刺前对与穿刺路径相关的解剖结构进行螺旋CT数据简易化处理不增加体表穿刺点定位用时,明显缩短经皮穿刺到位用时、穿刺次数及术中X线用时,并能最大程度减少并发症,值得临床推广.     

PET／MR与PET／CT的对比研究

目的通过与PET／CT在病灶检测及定量分析方面的比较,论证PET／MR一体机应用于临床的可行性。方法2012年5月至2013年2月共300例患者同天间隔15—35min行PET／CT和PET／MR检查,其中临床及影像学资料完整的277例[男165例,女112例,平均年龄（52．9±12．6）岁]纳入该研究。扫描范围由下颌至大腿根部。PET／CT采集为2或3min／床位,PET／MR采集为5min／床位,MRI图像包括T1、T2及弥散加权成像,图像重建采用Vender软件及MRI散射校正Mu图。PET、CT、MRI中只要有1项为阳性,即认为PET／CT及PET／MR的结果为阳性。勾画ROI并计算SUVmax。不同显像技术间探测效率的比较采用配对X2检验,并对PET／CT与PET／MR的SUVmax进行相关分析。结果277例患者随访证实阳性220例,病灶353个。与PET／CT比,PET／MR少发现了6个病灶,但多发现了30个病灶。两者的探测效率差异有统计学意义（P〈0．05）。以病灶和患者计,两者的一致性分别为89.8％（317／353）和85．9％（189／220）。相同部位病灶PET／CT和PET／MR的SUVmax的相关性良好（rs=0．91,P〈0．01）,多数正常组织（除肺和主气管）的SUVmax也具有良好的相关性（rs=0．62-0．76,均P〈0．01）。结论PET／MR一体机在半定量分析方面与PET／CT有良好的相关性,在躯干部尤其是腹、盆腔病变及软组织病变检测方面优于PET／CT,可以为临床提供可靠的影像学诊断。     

Lumbosacral epidural lipomatosis: MRI grading

Lumbosacral epidural lipomatosis (LEL) is characterized by excessive deposition of epidural fat (EF). The purpose of our retrospective study was to quantify normal and pathologic amounts of EF in order to develop a reproducible MRI grading of LEL. In this study of 2528 patients (1095 men and 1433 women; age range 18–84 years, mean age 47.3 years) we performed a retrospective analysis of MRI exams. We obtained four linear measurements at the axial plane parallel and tangent to the superior end plate of S1 vertebral body: antero-posterior diameter of dural sac (A-Pd DuS), A-Pd of EF, located ventrally and dorsally to the DuS, and A-Pd of the spinal canal (Spi C). We calculated (a) DuS/EF index and (b) EF/Spi C index. We developed the following MRI grading of LEL: normal, grade 0: DuS/EF index ≥1.5, EF/Spi C index ≤40%; LEL grade I: DuS/EF index 1.49–1, EF/Spi C index 41–50% (mild EF overgrowth); LEL grade II: DuS/EF index 0.99–0.34, EF/Spi C index 51–74% (moderate EF overgrowth); LEL grade III: DuS/EF index ≤0.33, EF/Spi C index ≥75% (severe EF overgrowth). The MRI exams were evaluated independently by three readers. Intra- and interobserver reliabilities were obtained by calculating Kappa statistics. The MRI grading showed the following distribution: grade 0, 2003 patients (79.2%); LEL grade I, 308 patients (12.2%); LEL grade II, 165 patients (6.5%); and LEL grade III, 52 patients (2.1%). The kappa coefficients for intra- and interobserver agreement in a four-grade classification system were substantial to excellent: intraobserver, kappa range 0.79 [95% confidence interval (CI), 0.65–0.93] to 0.82 (95% CI, 0.70–0.95); interobserver, kappa range 0.76 (95% CI, 0.62–0.91) to 0.85 (95% CI, 0.73–0.97). In LEL grade I, there were no symptomatic cases due to fat hypertrophy. LEL grade II was symptomatic in only 24 cases (14.5%). In LEL grade III, all cases were symptomatic. A subgroup of 22 patients (42.3%) showed other substantial spinal pathologies (e.g., disk herniation). By means of simple reproducible measurements and indexes MRI grading enables a distinction between mild, moderate, and severe EF hypertrophy. Kappa statistics indicate that LEL can be reliably classified into a four-grade system by experienced observers.     

Wiltse手术入路和后正中入路经椎间孔腰椎椎体间融合术治疗退变性腰椎滑脱症

目的 比较后正中入路、Wiltse手术入路经椎间孔腰椎椎体间融合术(transforaminal lumbar interbody fusion,TLIF)治疗退变性腰椎滑脱的临床疗效.方法 2008年3月-2010年3月收治37例退变性腰椎滑脱患者,其中23例行后正中入路TLIF手术(后正中入路组),14例行Wiltse入路TLIF手术(Wiltse入路组),观察两组患者手术前后日本骨科学会(JOA)评分、疼痛视觉模拟评分(visual analogue scale,VAS)及融合情况,比较两组疗效.结果 术后随访6～26个月,平均15.7个月,两组患者腰腿痛等临床症状明显缓解,X线片显示滑脱复位无丢失、植骨融合良好、内固定器械无松动或断裂.术后末次随访时Wiltse入路组融合率为86％,后正中入路组融合率为87％.Wiltse入路组和后正中入路组手术时间分别为(117.8±25.6)min、(128.5±38.7)min(P＞0.05);术中出血量分别为(203.5±16.4)ml、(284.4±27.6)ml(P＜0.05).Wiltse入路组和后正中入路组治疗后JOA评分与治疗前比较均有明显降低(P＜0.05).术后1周腰痛VAS评分两组间比较差异有统计学意义(P＜0.05),腿痛VAS评分两组间比较差异无统计学意义(P＞0.05);末次随访腰痛及腿痛VAS评分两组间比较差异无统计学意义(P＞0.05).结论 后正中入路、Wiltse入路TLIF手术治疗退变性腰椎滑脱均可达到满意的椎间融合率和临床效果,Wiltse入路术中出血量相对较少,术后恢复相对较快.