黄芪桂枝五物汤联合针灸治疗血瘀型腰椎间盘突出症

目的:观察黄芪桂枝五物汤联合针灸治疗腰椎间盘突出症(血瘀型)的临床疗效。方法:将符合标准的100例患者随机分为2组(实验组和对照组),每组各50例,对照组予以中医针灸治疗,实验组在对照组的基础上加黄芪桂枝五物汤治疗,均治疗14天,通过观察2组的疗效评定标准及对比2组前后的中医证候来积分来判断其疗效、VAS评分来评定其疼痛缓解情况,ODI指数来评估对日常生活的影响情况。结果:实验组有效率86%,对照组有效率70%,2组有效率相比较,有统计学意义(P=0.016),且2组治疗后VAS、ODI及中医证候评分与治疗前相比,有统计学意义(P=0.00),治疗后2组相比较,亦有统计学意义(P=0.00),且实验组优于对照组。结论:黄芪桂枝五物汤联合针灸治疗腰椎间盘突出症(血瘀型)效果满意,能快速减轻患者症状以及恢复患者功能,比单独使用中医针灸效果更加显著。     

盆底肌锻炼联合生物反馈电刺激治疗对产后盆底功能的影响

目的 探讨盆底肌肉锻炼联合生物反馈电刺激治疗的方法 对产后盆底功能的影响.方法 选取2013年1月至2014年12月在安康市妇幼保健院就诊的310例产妇为研究对象,按治疗方法 不同,将其分为常规疗法组(对照组)、盆底肌肉锻炼组(A组)、生物反馈电刺激治疗(B组)和盆底肌肉锻炼联合生物反馈电刺激组(C组),观察治疗后产妇阴道肌电压、尿失禁发生率、盆底器官脱垂发生率的变化,并分析其对盆底功能的影响.结果 各组产妇治疗后阴道肌电压虽均较治疗前有显著升高(t=-28.193~-15.092,均P<0.05),而组间治疗后比较差异有统计学意义(F=5.921,P<0.05),C组产妇阴道肌电压明显高于其它组(t对-C=18.101,tA-C=15.052,tB-C=16.511,均P<0.05).与治疗前相比,治疗后B组、C组产妇尿失禁发生率均显著降低(χ2b=9.244、χ2c=18.679,均P<0.05),治疗后尿失禁发生率组间比较差异有统计学意义(χ2=15.575,P<0.05),C组治疗后尿失禁发生率为6.41%,明显低于其它各组(χ2对-C=12.221,χ2A-C=11.292,χ2B-C=11.152,均P<0.05).与对照组相比,治疗后A组、B组、C组产妇盆底器官脱垂发生率均显著降低(χ2a=8.486、χ2b=8.375、χ2c=29.538,均P<0.05),治疗后盆底器官脱垂发生率组间比较差异有统计学意义(χ2=15.976,P<0.05),C组治疗后盆底器官脱垂发生率为16.67%,明显低于其它各组(χ2对-C=15.110,χ2A-C=13.551,χ2B-C=12.985,均P<0.05).结论 盆底肌肉锻炼联合生物反馈电刺激治疗对产后盆底功能恢复具有显著疗效,且联合疗法的疗效要显著优于单独使用盆底肌肉锻炼和生物反馈电刺激治疗.     

Is there any relationship between proinflammatory mediator levels in disc material and myelopathy with cervical disc herniation and spondylosis? A non-randomized,prospective clinical study

The proinflammatory mediator (PIM) levels were assessed in surgically removed samples of herniated cervical intervertebral discs. The objective of this study was to investigate if there is a correlation between the levels of PIMs in disc material and myelopathy associated with cervical intervertebral disc herniation and spondylosis. The role of proinflammatory mediators in the degeneration of intervertebral disc and the inflammatory effects of disc herniations on radicular pain has been previously published. However, the possible relationship between PIMs and myelopathy related to cervical disc herniation and spondylosis has not been investigated before. Thirty-two patients undergoing surgery for cervical disc herniation and spondylosis were investigated. Surgically obtained disc materials, stored at 70 degrees C, were classified into two groups: cervical disc herniation alone or with myelopathy. Biochemical preparation and solid phase enzyme amplified sensitivity immunoassay (ELISIA) analysis of the samples were performed to assess the concentration of mediators in the samples. Very similar values of interleukin-6 were found in both groups whereas the concentrations of mediators were significantly higher in myelopathy group. This study has demonstrated that PIMs are involved in cervical intervertebral disc degeneration with higher concentrations in the samples associated with myelopathy.     

过度背伸腰椎手法治疗腰椎间盘突出症临床研究

依据手法治疗前后临床资料及X线影像学的变化 ,研究过度背伸手法临床疗效机理。对 35例腰椎间盘突出症患者采用过度背伸腰椎手法治疗前后的临床资料及CT片和腰椎动力位X线片进行研究 ,并与对照组 36例推拿治疗前后资料相对照。结果 ,合并腰椎小关节错位及腰椎失稳分别在腰椎间盘突出症中占 6 5 71%及48 5 7%。过度背伸手法治疗后腰椎小关节错位整复率 6 9 5 7% ,腰椎失稳整复率 5 8 82 % ;对照组整复率分别为33 33%、16 6 7%。腰椎小关节错位及腰椎失稳在腰椎间盘突出症的病理变化中起重要作用 ,过度背伸腰椎手法 ,通过整复腰椎小关节错位及治疗腰椎失稳 ,建立新的椎间平衡 ,减轻对神经根及硬膜囊的压迫     

兔颞下颌关节盘纤维软骨细胞分离培养的实验研究

【目的】探讨颞下颌关节盘纤维软骨细胞的分离及体外扩增的条件，观察关节盘纤维软骨细胞体外培养的生物学特性。【方法】在无菌条件下，切取2周龄新西兰白兔颞下颌关节盘，剪至1．0m^3的碎块，0．5g／mL胰酶消化30min、胶原酶消化4h，200目筛网过滤，获得关节盘纤维软骨细胞。在倒置显微镜下连续观察细胞的形态变化及贴壁率，甲苯胺蓝染色、、胶原免疫组化染色鉴定，测定其生长曲线。透射电镜观察细胞超微结构。【结果】原代培养的关节盘纤维软骨细胞12h可观察到贴壁细胞，48h贴壁细胞逐渐增多，大部分细胞为短梭形，小部分为多角形，第4天可见多个细胞克隆形成，第8天时细胞彼此相连，铺满平底，细胞以梭形为主，部分多角形。传代后12h贴壁率达90％，大部分为多角形，4～5d即可张满瓶底。甲苯胺蓝染色可见异染颗粒，胶原免疫组化染色胞浆内可见棕黄色颗粒。细胞内线粒体、内质网发达、高尔基体发达。【结论】体外分离培养的兔颞下颌关节盘纤维软骨细胞具有较强的增殖能力。     

半侧椎板截取回植在单侧腰椎间盘突出症治疗中的疗效评价

目的评价半侧椎板截取回植在治疗单侧腰椎间盘突出症中的临床疗效。方法对61例单侧腰椎间盘突出症的患者行半侧椎板截取髓核摘除再回植"工"型钛板固定术,统计术前、术后ODI、JOA、VAS评分、并发症发生率、影像学回植椎板愈合率及腰腿痛复发率。结果 60例获1年或以上随访,随访率98.36%,术中神经及硬膜囊损伤率(1.67%、3.28%);腰痛复发率5.00%,腿痛复发率1.67%。术后2周、3、6、12个月的ODI、JOA、VAS评分显著优于术前(P<0.05)。回植截骨部CT均显示骨性愈合,未见钛板螺钉的松动及断裂。结论采用半侧椎板截取回植固定术治疗单侧腰椎间盘突出症具有较低的术中神经硬膜囊损伤率及腰腿痛复发率、较高的椎板愈合率和较好的临床评分,是一种安全、有效的新方法。     

颈椎损伤伴颈椎间盘突出的疗效观察

目的 观察前路减压钢板内固定及solis颈椎cage融合治疗颈椎损伤伴颈椎间盘突出的疗效。方法 对25例颈椎损伤患者进行前路椎间盘摘除、脊髓减压、solis颈椎cage融合、前路钢板内固定治疗。有脱位者行牵引复位。结果 25例患者术后症状明显改善，未发生手术并发症．均获得骨性融合。术后影像学资料显示无植入物脱出或塌陷．无椎间高度明显丢失，无钢板螺钉断裂或脱落等。结论 前路钢板及solis颈椎cage融合有较高的强度和坚固能力，能提供较好的生物力学稳定作用，可以满足颈椎前路手术的需要。     

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     

腰椎间盘MRI或T2相变化与冯氏临床分型（四步腰型）关系的研究

目的探讨腰椎间盘突出症患者MRI T2相信号、性别、年龄、病程、临床分型之间的关系,验证冯氏临床分型与腰椎间盘MRI T2相信号变化的相关性。方法本研究收集102例腰椎间盘突出症患者的临床资料,根据腰椎间盘MRI T2相信号分3型,根据临床分型分为A、B两组,对患者性别、年龄、病程、腰型、腰椎间盘T2相信号变化,用医学统计软件spss13.0进行秩和检验和非参数相关性检验。结果1、MRI T2相信号与性别、年龄不相关;2、MRI T2相信号变化与临床分型密切相关,结论椎间盘T2相信号变化与临床分型有很强的相关性,但要结合临床综合判断,我们要重新认识椎间盘T2相信号变化的临床意义。     

Optimizing nonviral-mediated transfection of human intervertebral disc chondrocytes

BACKGROUND CONTEXT: The use of viral vectors for transfection of human disc chondrocytes has been well documented. However, because of immunological and cell toxicity concerns, nonviral reagents may provide gene delivery to intervertebral disc (IVD) chondrocytes without these associated obstacles. Several studies have been done using nonviral delivery systems with varying degrees of success. PURPOSE: The purpose of the study was to determine the efficiency, toxicity, and optimal conditions for gene delivery into human degenerative IVD cells via nonviral reagents in vitro. STUDY DESIGN/SETTING: In vitro viral and nonviral gene transfer. PATIENT SAMPLE: Human disc chondrocytes from 21 patients undergoing discectomy for trauma, disc herniation, and fusion for scoliosis or degenerative low back pain. OUTCOME MEASURES: Cell cytotoxicity and transfection efficiency as determined by microscopy, luciferase assay, and flow cytometry. METHODS: Seventeen lipid-based nonviral reagents coupled to DNA plasmids coding for luciferase were transfected into cultured chondrocytes. Cells were transfected with varying ratios of DNA plasmid to reagent, harvested at 48 hours and analyzed for transfection rates and cell viability. Transfections with adenoviral constructs were comparisons. The three most efficient reagents were then coupled to green fluorescent protein and the experiments repeated. The most efficient reagent after these experiments (LT1) was tested in standard chondrocyte-maintenance medium and a minimal medium mixture devoid of antibiotics, buffers, and amino acids. Finally, LT1 in minimal medium with various hyaluronidase treatments was tested. The most effective reagents and relative toxicity as measured by flow cytometry were analyzed using repeated measures analysis of variance. RESULTS: LT1 was most efficient and least toxic of nonviral reagents tested. LT1 had a mean percent survival of 78.1% versus 26.6% for TKO, 15.8% for T-Jurkat, and 70.8% in controls. Transfection was 1.5%. LT1 in minimal medium was significantly better than other reagents for both cell viability and transfection percentages. Minimal medium increased transfection with other reagents, yet cell viability with TKO and T-Jurkat was poor. Hyaluronidase had no effect on the viability of controls and decreased viability from 74.9% to an overall mean of 62.6% for all treatments. Transfection percentages increased from 1.8% without treatment to 15.2% with 40 units and 10.4% with four units of hyaluronidase given 24 hours before transfection and left in throughout the experiment. When treated at the time of transfection, efficiency was not significantly different to samples without hyaluronidase added. Additionally, hyaluronidase added 24 hours before transfection and washed out at the time of transfection significantly increased transfection percentages. CONCLUSIONS: LT1 was the most efficient reagent in terms of transfection ability and cell toxicity compared with other reagents. Treatments in minimal medium yielded significant increases in transfection and no significant difference in toxicity as compared with controls. Hyaluronidase treatments improve transfection significantly but also increase toxicity. These results suggest that the nonviral reagent LT1 can be used to transfect IVD chondrocytes in vitro and may help facilitate gene transfection of IVD chondrocytes in vivo.