腰椎间盘突出症患者术前焦虑及影响因素研究

目的　探讨腰椎间盘突出症患者术前焦虑的发生情况及相关因素。方法　应用状态—特质焦虑问卷 (STAI)、社会支持评定量表 (SSRS)、生活事件量表 (L ES)等对 80例腰椎间盘突出症患者进行测查。结果　腰椎间盘突出症患者术前状态焦虑问卷 (S- AI)分值明显高于正常人群 (49.5 5± 8.18Vs39.31± 8.6 6 )。逐步回归分析发现 ,影响患者术前焦虑的主要因素为性格内向、社会支持状况差、负性生活事件多、担心手术效果不好、担心手术医生责任心不强等。结论　腰椎间盘突出症患者术前有明显的焦虑情绪 ,其发生受多种因素的影响。     

牵引推拿复位术治疗中央型腰椎间盘突出症的临床研究

通过对 5 6例中央型腰椎间盘突出症 6 2个椎间盘治疗前后的大小、形态量化的分析 ,认为牵引推拿复位术的作用机制是通过椎间盘的还纳和椎间盘的变形 ,改变了神经根与突出物的位置关系 ,松解粘连 ,解除压迫。对回纳变形机制进行了分析 ,认为要使椎间盘回纳 ,突出的髓核必须具有一定流动性 ,再借助完整的纤维和后纵韧带的张力及手法的压力 ,共同协调作用 ,方能实现。     

自动经皮椎间盘切吸术治疗颈椎间盘突出症48例

目的　对自动经皮颈椎间盘切吸术治疗颈椎间突出症的适应证及疗效进行探讨。方法　在局麻下行颈前路经皮穿刺切吸术 ,4 8例以 4 0岁为限 ,小于 4 0岁为A组共 2 0例 ,大于 4 0岁为B组共 2 8例 ,术后随访 6～ 2 4个月。两组结果用 χ2 检验。结果　A组优良率为 95% ,B组优良率为 60 % ,其疗效比较有显著性差异 ,(P <0 .0 5)。结论　经皮颈椎间盘切吸术治疗颈椎病是一安全、有效的措施 ,严格掌握适应证是提高成功率的关键     

新型短节段内固定器治疗腰椎滑脱症的临床应用

目的：探讨新型短节段内固定器治疗腰椎滑脱症的临床应用价值。方法：对１８例腰椎滑脱的脊椎应用新型内固定器进行复位、固定,恢复脊椎的正常解剖结构,并自髂嵴后部取骨行横突间植骨融合。结果：术后随访１２￣２４个月,平均１８个月,滑脱复位率达９０％,４￣５月后达到骨性愈合,无螺钉松动,拨出,断裂及脊住骨滑脱现象。结论：新型短节段内固定器治疗腰椎滑脱症复位率高,固定螺钉松动,拨出,断裂及再滑脱等并发症少,疗效     

猴异体椎间盘移植--组织形态学研究

目的：探索治疗椎间盘病变的较好方法。方法选用恒河猴１２只进行腰椎间盘两两配对移植,观察术后不同时期间盘组织形态学变化。结果移植间盘高度术后１－５ｍｏ呈下降趋势,６－１２ｍｏ基本保持稳定,光镜下纤维环和软骨终板形态结构基本完好,有较度退变表现,未见炎症细胞浸润及骨坏死现象,透射电镜观察到移植组间盘髓核退变细胞较正常对照组增多,髓核基质中胶原原纤维数量较对照组增多,结论猴异体移植间盘在受体能够存活,移     

12例腰椎间盘突出合并腰骶神经背根节嵌压

目的：了解腰椎间盘同合并腰骶神经背根节（ＤＲＧ）嵌压的机制。方法：１２例腰椎间盘突出患者术中发现：髓核切除后神经根张力仍较大并固定,沿神经根探查发现腰骶神经ＤＲＧ充血并肿大,直径０．８－１．２ｃｍ,平均１．１ｃｍ。嵌压物为增生的上关节突和增生肥厚的关节囊韧带。１２例病人共探查１５个ＤＲＧ,其中位于椎间孔６例,椎管和椎间孔交界７例,椎间孔外２例同时合并腰神经在椎间孔外嵌压。     

人工心脏圆盘泵的流动特性研究

人工心脏（血泵）一直存在泵体对血细胞剪切力过大和流速过快容易引起溶血的问题。为了研究人体正常血压情况下,血泵内部剪切力和速度场的分布情况,选择圆盘泵叶轮代替传统离心泵叶轮,对两种模型进行数值计算,分析不同叶轮内部剪切力和速度场的分布规律。研究表明传统离心泵内部流速高,叶片表面剪切力大,对血细胞的伤害大。圆盘泵相比传统离心泵,剪切力更小,流场速度分布均匀,流速更小。和传统离心泵相比,不同转速下圆盘泵能降低溶血的发生率。圆盘泵叶片数为6片时,抗溶血性能更好。研究结果为血泵的优化提供理论依据。     

Signs of the principle body axes prior to primitive streak formation in the rabbit embryo

An early common element during anterior-posterior axis formation amongst amniotes is the primitive streak, running longitudinally in the two-layered embryonic disc. In mammals the primordium of this transient structure is the first definite morphological sign of the anterior-posterior axis, while in avian embryos the axis is visible and apparently defined earlier. Here we scrutinize suggestions that in mammals also there are earlier signs of axis formation by using correlative low and high-resolution light microscopy on tissues from rabbit embryos at 6.3 and 6.5 days post-conception, i.e. immediately before and after primitive streak formation. A series of semithin sections were cut from resin-embedded embryonic discs that had been photographed previously at low power. In embryos at 6.5-days post-conception the primitive streak is as long as up to half the diameter of the embryonic disc, extending anteriorly from a thickening, here called the posterior node, at the posterior margin, which contains the first mesoderm cells ingressing from the epiblast. On both sides of the primitive streak there is a triangular area that appears light in surface views of fixed embryos and correlates with stretches of low-columnar simple epithelium in an otherwise high-columnar pseudostratified epiblast. Within the anterior margin, which has a sharper contour than the rest of the circumference of the embryonic disc, there is a narrow, crescent-shaped dark zone caused by increased cellular height and number in both epiblast and hypoblast. These characteristics of the anterior margin are also found at 6.3 days post-conception, at which stage there is no sign of a primitive streak or a posterior node. The posterior margin, in contrast, is ill-defined in these earlier embryos, or there is a light crescent within the posterior margin, which has the same histological characteristics as the bilateral posterior triangular areas of primitive streak stages. Because the anterior differentiation occurs prior to primitive streak formation and is a sign of both the anterior-posterior and the transverse axes of the embryonic disc, and because some of its histological characteristics are found in primate and human embryos, we propose to name this structure the anterior marginal crescent and to add it to the list of transient structures that gradually establish the principal body axes in mammals. The anterior manifestation of body axes in mammals is thus essentially different from axis development in the avian embryo, where differentiation of these axes is first manifest at the posterior margin.Supported by the Deutsche Forschungsgemeinschaft (Vi 151/1-1); part of the results were presented at the First Joint Meeting of the Anatomical Society of Great Britain and Ireland and of the Anatomische Gesellschaft, Southampton, December 1994, and will be published in abstract form (J Anat, in press)     

Isovelocity investigation of the lengthening behaviour of the erector spinae muscles

The purpose of this study was to investigate the force-velocity (F/) relationship for the erector spinae muscles in submaximal activation movements, with particular attention to their response during lengthening movements and at lower shortening contraction velocities. Dynamic models that predict lower back muscle forces require reasonable representations of the modulating effect of instantaneous velocity. Ten males were observed performing trunk flexion and extension in the sagittal plane under constant load. Contraction velocities were measured as the first derivative from a devise sensitive to changes in spine curvature, and controlled by a visual feedback system while a constant load was applied through a chest harness. The erector spinae exhibited a yielding phenomenon which causes an abrupt drop in force during constant velocity stretching under constant, submaximal, stimulation. The findings were consistent with previous isovelocity muscle lengthening experiments. Yielding appeared dependent on the level of load/activation supporting the theory of a state-variableF/ relationship. The eccentric behaviour of the lower erectors (L3) seemed independent of velocity and length, while that of the upper erectors (T9) showed a dependence on length. At lower concentric velocities, concavity in torque-velocity curves was noted after a threshold velocity. The findings of this study strongly reinforce the notion that theF/ length relationship is not a continuous hyperbolic relationship during muscle shortening and that the commonly modelled force augmentation effect of lengthening is incorrect, at least for submaximal activation of the extensors of the lower back.     

192例腰椎间盘突出症患者的诊断及手术治疗分析

目的：总结分析１９２例腰椎间盘突出症及侧隐窝狭窄伴黄韧带肥厚患者的诊断和手术治疗。方法：经临床检查明确定位、定性诊断,影像学检查证实,采用小切口半椎板或全椎板切除减压、突出椎间盘髓核切除手术治疗。结果：手术证实腰椎间盘突出症１８９例,侧隐窝狭窄伴黄韧带肥厚３例,术后随访６月－５年,优良率７９％。结论：临床检查是腰椎间盘突出症诊断的基础,影像学检查对进一步明确定位诊断和鉴别诊断是必要的。手术指征的严格把握是手术成功的关键。