三维牵引正脊疗法配合补阳还五汤治疗腰椎间盘突出症的临床疗效和安全性分析

目的观察计算机控制三维牵引联合补阳还五汤治疗腰椎间盘突出症的临床疗效和安全性。方法选择我院经常规骨科查体结合CT片、X线平片确诊的腰椎间盘突出症患者200例,采用多中心随机对照研究,随机分为治疗组100例（A组）,采用计算机控制三维牵引治疗,牵引距离50~70 mm,屈曲角度±（15°~25°）,旋转角度±（8°~25°）同时给予补阳还五汤;对照组100例（B组）,采用腰椎旋转复位法治疗。结果 A组中牵引1次93例,2次7例;B组中1次77例,2次23例。两组比较A组明显高于B组,差异有高度统计学意义（χ2=14.84,P〈0.01）。两组患者治疗后腰痛、下肢放射痛、下肢麻木、翻身困难、腰部压痛、直腿抬高及加强验试验等症状体征的积分比较,A组明显高于B组,且差异有统计学意义（P〈0.05）。A组疗程明显短于B组（P〈0.01）。结论这是一种计算机和中医正骨技术相结合的新型治疗方法,在规范化操作下,具有快速、安全、有效、实用、容易量化控制等特点。     

健康宣教对腰椎间盘突出症围手术期护理质量的影响

目的探讨健康宣教对椎间盘突出症围手术期护理质量的影响。方法选择腰椎间盘突出症行单节段髓核摘除手术的患者120例,随机分为观察组和对照组各60例,对照组实施骨科的常规护理。观察组在常规护理的基础上对患者进行健康宣教。结果观察组医患关系满意度明显高于对照组;观察组健康宣教知识知晓率明显高于对照组;观察组术后腰腿痛残留率明显低于对照组（P〈0.01）。结论健康宣教有助于提高医患关系满意度及健康宣教知晓率;降低患者术后腰腿痛残留率。     

舒适护理在腰椎间盘突出症患者术后的应用

目的探讨舒适护理在腰椎间盘突出症患者术后的应用。方法对38例腰椎间盘突出症术后患者实施心理、生理的舒适护理。结果38例患者在心理、生理上均获得满足和安全感,使治疗达到了最佳效果,减少了并发症,增强了自信心。结论对腰椎间盘突出症患者术后实施的舒适护理提高了患者的满意度和护理工作质量,取得良好的护理效果。     

不同手术方法治疗儿童先天性重度上睑下垂的临床观察

目的观察不同的手术方式矫治儿童重度先天性上睑下垂的治疗效果。方法 36例47眼,应用额肌筋膜瓣悬吊术组18例24眼,自体阔筋膜悬吊术组18例23眼,比较两组术后疗效。结果随访6个月,满意率比较两组无明显差异性(P>0.05)。结论两种方法各有优缺点,对治疗儿童重度上睑下垂均有效。     

经皮激光椎间盘减压术治疗颈椎间盘突出症合并早期脊髓损伤

目的探讨经皮激光椎间盘减压术对颈椎间盘突出症合并早期脊髓损伤的治疗作用。方法对56例颈椎间盘突出症合并早期脊髓损伤的患者,采取经皮激光椎间盘减压术进行治疗,根据Williams疗效评定标准进行疗效评定,采用JOA评分方法、40分计分法对患者术前、术后症状评分,并对术前、术后评分结果进行分析。结果根据Williams疗效评定标准,优30例(53.57%),良19例(33.93%),可7例(12.50%),手术后优良率为87.5%。JOA和40分计分法的改善率分别为74.30%和72.15%(P<0.05),无并发症发生。结论对于严格选择的颈椎间盘突出症合并早期脊髓损伤的患者,实行经皮激光椎间盘减压术,可获得较高的优良率和改善率。     

改良去骨瓣减压术与标准去骨瓣减压术治疗重度颅脑损伤的临床研究

目的对比改良去骨瓣减压术与标准去骨瓣减压术治疗重度颅脑损伤的临床疗效。方法随机将115例重度颅脑损伤患者分为标准去骨瓣减压术治疗组(标准组)和改良去骨瓣减压术治疗组(改良组),对比分析两组患者手术情况和临床疗效。结果组间手术时间和术中出血量、手术并发症、恢复良好率比较,差异均有统计学意义(P<0.05或P<0.01)。结论改良去骨瓣减压术治疗重度颅脑损伤疗效确切,具有手术时间短、术中出血量少、手术并发症低以及恢复良好率高等优势,值得继续研究与探讨。     

中医正骨手法治疗1100例腰椎间盘突出症临床研究

目的探讨中医正骨手法治疗腰椎间盘突出症的临床效果。方法对2005年1月～2011年12月笔者所在医院收治的1100例腰间盘突出症患者,实施中医正骨手法进行治疗,并观察治疗效果。结果本组患者治愈841例,显效148例,好转95例,无效16例,治愈率达76.45%,总有效率达89.91%。结论中医正骨手法可循序渐进的使粘连组织得到松懈,进一步兴奋神经,促进患处血液循环,使突出的椎间盘部分或全部得以还纳,疼痛迅速缓解,值得临床推广应用。     

Calcium pentosan polysulfate and sodium pentosan polysulfate may be used to treat intervertebral disc degeneration

Intervertebral disc degeneration (IDD) is a major health problem world-wide, and several spinal disorders are closely associated with it. Although people have invested a great deal of time and effort, how to prevent and reverse the IDD for the researchers is still a difficult and hot issue. Intervertebral disc belongs to cartilage tissue, and IDD also is the cartilage degeneration disease. A large quantity of studies have shown that Calcium pentosan polysulfate (CaPPS) and sodium pentosan polysulfate (NaPPS) possess chondroprotective activities and play an important role in maintaining cartilage integrity. We reasonably hypothesize that NaPPS and CaPPS may be used to treat IDD. The possible mechanism may include that: (1) the significant effects of NaPPS and CaPPS in improving capillary blood flow could maintain nutritional supply to intervertebral disc, and preserve intervertebral disc tissue against degeneration; (2) CaPPS and NaPPS preserve cartilage integrity, proteoglycan synthesis, and improve cartilage biomechanical properties; (3) as the multifaceted exosite inhibitors of proteinases NaPPS and CaPPS strongly impede the activity and production of proteinases; (4) promotion of the balance between proteinases and TIMPs also may be involved in treating IDD; (5) NaPPS and CaPPS exhibit potent anti-inflammatory effects, and then reduce inflammation-induced IDD. If the hypothesis were conformed, the symptoms caused by IDD and its related diseases would be a corresponding alleviation or even disappearance, which could greatly alleviate the suffering of patients from disc degeneration diseases. Certainly, many roles of CaPPS and NaPPS, such as effectiveness, safety and side effects, need to be tested, and further works such as animal model and clinical trial, need to be done to prove this hypothesis.     

Cefpodoxime 10 μg disc screening test for detection of Neisseria gonorrhoeae with mosaic PBP2 and decreased susceptibility to extended-spectrum cephalosporins for public health purposes

Antimicrobial resistance (AMR) in Neisseria gonorrhoeae remains a global public health problem. Susceptibility to first-line treatment extended-spectrum cephalosporins (ESCs) is decreasing worldwide resulting in therapeutic failures with oral ESCs. This study describes a cefpodoxime 10 μg disc test for screening for gonococci containing a penA mosaic allele encoding a mosaic penicillin-binding protein 2 (PBP2) and decreased ESC susceptibility. Selected clinical gonococcal isolates (n = 315), containing a high proportion of gonococci with decreased ESC susceptibility and high geographical, temporal and genetic diversity, were examined using agar dilution (n = 149; cefpodoxime and ceftriaxone) and Etest (n = 315; cefixime), and disc diffusion using a commercially available cefpodoxime 10 μg disc (n = 315). penA sequencing was performed on all isolates. The 2008 WHO gonococcal reference strains (n = 8) were included as quality controls. Using a ≤11 mm annular radius of growth inhibition as the breakpoint for the cefpodoxime 10 μg disc, all 78, with exception of one isolate (13 mm), mosaic PBP2-containing isolates, which also displayed decreased susceptibility to oral ESCs, were identified. In addition, 85 non-mosaic PBP2-containing isolates (44% of which contained a PBP2 A501 alteration) had annular radii ≤11 mm and raised minimal inhibitory concentrations to the ESCs. Screening for detection of mosaic PBP2-containing gonococci and decreased ESC susceptibility, most pronounced to oral ESCs, using a commercially available cefpodoxime 10 μg disc was rapid, inexpensive and sensitive. This test can be used in AMR surveillance programmes for public health purposes especially in less-resourced settings. Further studies to refine this disc testing-based approach are in progress.     

Assessment of glycosaminoglycan distribution in human lumbar intervertebral discs using chemical exchange saturation transfer at 3 T: feasibility and initial experience

Recent studies have proposed that glycosaminoglycan chemical exchange saturation transfer (gagCEST) is associated with a loss of glycosaminoglycans (GAGs), which may be an initiating factor in intervertebral disc (IVD) degeneration. Despite its promising potential, this application has not been reported in human in vivo IVD studies because of the challenges of B₀ magnetic field inhomogeneity in gagCEST. This study aimed to evaluate the feasibility of quantifying CEST values in IVDs of healthy volunteers using a clinical 3 T scanner. A single‐slice turbo spin echo sequence was used to quantify the CEST effect in various GAG phantoms and in IVDs of 12 volunteers. The phantom results indicated high correlation between gagCEST and GAG concentrations (R² = 0.95). With optimal B₀ inhomogeneity correction, in vivo CEST maps of IVDs showed robust contrast between the nucleus pulposus (NP) and the annulus fibrosus (AF) (p < 0.01), as well as higher signal in the central relative to the peripheral NP. In addition, a trend of decreasing CEST values from upper to lower disc levels was evident in NP. Our results demonstrate that in vivo gagCEST quantification in human lumbar IVDs is feasible at 3 T in combination with successful B₀ inhomogeneity correction, but without significant hardware modifications. Our initial findings suggest that it would be worthwhile to perform direct correlation studies between CEST and GAGs using cadaver samples, and to extend this novel technique to studies on patients with degenerative discs to better understand its distinct imaging features relative to conventional techniques. Copyright © 2011 John Wiley & Sons, Ltd.