早期手术治疗胸腰椎爆裂性骨折的临床研究

目的：探讨早期手术对胸腰椎爆裂性骨折的治疗价值,以选择最佳手术时机。方法：回顾性分析我院2006年4月～2008年4月手术治疗的新鲜胸腰椎爆裂性骨折68例,按伤后接受手术时间（72 h以内及72 h以后）将患者分为A、B两个治疗组,进行术前及术后影像学观察指标与神经损伤恢复程度比较。通过影像学检查观察伤椎高度恢复、Cobb角及椎管占位情况,脊髓损伤的神经功能按ASIA2000标准进行分级及评分。结果：68例随访12～24个月,平均15个月。术后68例患者的伤椎高度、Cobb角及椎管占位均获得明显改善;组间比较,A组患者的改善情况较B组明显,差异有统计学意义（P＜0.05）。神经损伤恢复结果提示,A、B两组术后均有不同程度的恢复,A组患者的恢复程度较B组明显,差异有统计学意义（P＜0.05）。结论：手术治疗胸腰椎爆裂性骨折疗效显著,伤后手术时间越早,术后脊髓神经功能恢复越好;在全身情况允许时,对脊髓损伤患者尽可能在早期行内固定减压手术,以最大程度地恢复脊髓神经功能。     

下腰椎骨折并发马尾综合征的手术疗效分析

目的:马尾综合征(CES)包括下腰痛、坐骨神经痛、下肢运动感觉功能障碍、会阴区麻木,以及膀胱直肠功能障碍或丧失,CES的一些认识已经明确,但是临床上采取什么样的治疗最恰当存在争议,有关腰椎间盘突出引起的CES,已经积累了大量的病例资料。但是有关下腰椎骨折引起的马尾综合征临床少有报道。方法:从1998年到2006年,收集17例L2—5腰椎骨折并发马尾综合征的病人,其中车祸伤11例,高处坠落伤6例,脊髓圆锥损伤导致的CES的病例除外,记录所有病例的体征、受伤机制、影像资料、受伤时间、手术方法、神经损伤和恢复情况。结果:所有病例随访至少12个月。所有的病人在出现CES48小时之内进行手术减压治疗,其中14个病人恢复效果满意,另外3个病人虽然在伤后24小时内进行了手术治疗,但是效果不好。双下肢无力在4个月内恢复,膀胱和直肠功能在3个月恢复。总的来看,病人恢复效果的好坏与手术时间的早晚无关。结论根据临床研究,下腰椎骨折引起的CES恢复效果与受伤时马尾损伤的程度密切相关,虽然对于手术的时机存在争议,但是本研究建议在出现CES48小时内施行手术治疗。     

可调式中空人工椎体治疗脊柱严重粉碎性骨折(附9例报告)

目的　探讨可调式人工椎体治疗椎体严重粉碎性骨折的临床效果。方法　 1997年 3月～ 2 0 0 1年 12月间 ,用可调式中空钛合金人工椎体 (AHT -AVB)治疗脊柱严重粉碎性骨折患者 9例 ,T12 椎体粉碎性骨折伴截瘫 2例 ,L1椎体粉碎性骨折伴截瘫 2例 ,T12 椎体陈旧性压缩骨折伴马尾综合征 2例 ,颈椎骨折伴脱位 3例。植骨来源为自体骨 /自体骨 +Osteoset人工骨。观察患者手术时间、输血量、手术前后椎节高度、椎节间夹角以及人工椎体稳定性及融合情况等。结果　本组病例全部获得随访 ,随访时间 8～ 30个月 ,平均 18个月。术后椎节高度基本恢复正常。术后 3个月Osteoset人工骨大部份已吸收 ,椎间隙可见骨融合征象 ,术后 12个月时大多数已形成骨性融合。人工椎体无脱落或移位。神经功能改善 8例 ,无变化 1例 ,无明显并发症出现 ;结论　对严重粉碎的椎体骨折 ,无法行自体骨重建者 ,人工椎体不失为一种选择 ,但应严格掌握适应证     

Ethanol-induced malfunction of neutrophils respiratory burst on patients suffering from alcohol dependence

Background: Polymorphonuclear, neutrophil granulocytes (PMN) play a major role in the control of infections, and people who abuse alcohol are susceptible to infections. Resistance against infections ensues intracellularly following initial phagocytosis of microorganisms with the oxygen‐dependent respiratory burst, the key enzyme of which is the respiratory burst oxidase, whereby oxygen radicals are produced for microbial destruction. To date there is insufficient information available in connection with the process of impaired defence against infection in patients suffering from alcohol dependence. Therefore, our investigation was carried out to determine the influence of alcohol exposition on the formation of oxygen radicals and the respiratory burst. Methods: 4.5 ml of whole blood was taken from 10 healthy adults and 10 patients suffering from alcohol dependence. An additional 3.5 ml of whole blood was taken from the alcoholic patients for determination of the blood alcohol concentration. The respiratory burst of PMN was tested using the Four‐Colour‐Continuous Flow Cytometer. Each experimental procedure consisted of 4 test samples [negative controls, Escherichia coli, FMLP‐supplement (N‐formyl‐l‐methionyl‐l‐leucyl‐l‐phenylalanin), PMA‐supplement (phorbol‐12‐myristate‐13‐acetate)]. Differing concentrations of ethanol were also introduced to each of the tests performed (0.20 to 4.00 g/l). Results: Ethanol revealed a marked decrease of burst activity in those patients suffering from alcoholism with increased alcohol concentration. A dependence between the burst activity and the ethanol concentration was seen to be statistically significant. This effect was only evident after stimulation with E. coli and FMLP in those patients with alcohol dependence. Conclusion: The results presented in this study show an impairment in the function of PMN in those patients addicted to alcohol due to the decrease in burst activity. In view of the results of the different stimuli, the second‐messenger effects were not evident. A clarification of this phenomenon could well be assumed as an allosteric receptor effect on the burst oxidase, namely, a direct effect on the phagocytosis interaction between circulating granulocytes and causative organisms.     

椎弓根螺钉短节段固定联合椎体成形术治疗单节段胸腰段骨质疏松性椎体爆裂骨折

【摘要】 目的：探讨椎弓根螺钉短节段固定联合椎体成形术治疗单节段胸腰段骨质疏松性椎体爆裂骨折的临床疗效。方法：回顾性分析我院2008年1月～2012年3月收治的86例单节段胸腰段爆裂椎体骨折患者的临床资料,对其中32例合并骨质疏松症的患者进行随访分析。男14例,女18例;年龄56～78岁,平均64.5岁;跌倒伤14例,车祸伤9例,高处坠落伤5例,重物砸伤4例;骨折节段：T11 3例;T12 10例;L1 15例;L2 4例。手术时均在骨折上下椎置入椎弓根螺钉,安装连接棒,通过体位结合撑开实现骨折椎体复位,然后在伤椎注入骨水泥。应用VAS及SF-36量表评估患者疼痛及生活质量改变情况,通过X线片测量计算伤椎椎体前缘高度恢复、受伤节段后凸矫正及丢失情况,随访观察治疗效果。结果：所有患者均顺利完成手术,术中无明显并发症。随访12～36个月,平均16.5个月。术后VAS评分（2.43±1.81分）及末次随访时VAS评分（2.17±1.81分）与术前（7.67±2.25分）比较差异有统计学意义（P<0.05）;末次随访SF-36评分（123.5±22.3分）与术前（95.7±17.5分）比较差异有统计学意义（P<0.05）。术前Cobb角为22.3°±3.6°,术后Cobb角矫正至5.2°±1.2°,末次随访时为6.0°±2.3°,丢失0.8°±1.5°;术前椎体高度（56.4±5.8）%,术后椎体高度恢复至（95.3±2.9）%,末次随访时为（91.4±3.7）%,丢失（4.0±2.5）%。3例出现椎旁静脉骨水泥栓塞,无明显症状,无内固定断裂。结论：后路短节段椎弓根螺钉固定联合椎体成形术能够有效恢复并维持伤椎高度,减少后凸畸形矫正丢失及内固定失败的发生,具有良好的疗效。     

Anterior decompression with single segmental spinal interbody fusion for Denis type B thoracolumbar burst fracture: a midterm follow-up study

Purpose

Our goal was to observe the midterm results of a case series of Denis type B thoracolumbar burst fracture treated with anterior decompression with single segmental spinal Interbody fusion.

Methods

Twenty patients with Denis type B thoracolumbar burst fractures underwent anterior decompression with single segmental spinal Interbody fusion. They underwent clinical and radiologic follow-up for at least three years after the surgery.

Results

The mean follow-up period lasted 57 months. To the last follow-up, there were no cases of internal fixation loosening, failure and other complications. Titanium mesh or interbody bone grafts were in good position. Spinal kyphosis was not observed. Interbody fusion was achieved for all cases. The average fusion time was 4.5 months. Based on visual analogue scale (VAS) pain scores, percentage of vertebral body height loss and Cobb angle, the difference was statistically significant between the preoperative period and postoperative one year or final follow-up (P < 0.05). Results at postoperative one year and final follow-up were better than the preoperative period. However, the difference was not significant between postoperative one year and final follow-up (P > 0.05).

Conclusions

Good midterm results on clinical and radiologic evaluation of anterior decompression with single segmental spinal Interbody fusion for suitable patients with Denis type B thoracolumbar burst fracture can be achieved. The incident rate of relative complications is low.     

Daily electromyography in females with Parkinson's disease: A potential indicator of frailty

Females with Parkinson's disease (PD) are at increased risk for frailty, yet are often excluded from frailty studies. Daily electromyography (EMG) recordings of muscle activity can dissociate stages of frailty and indicate functional decline in non-neurological conditions. The purpose of this investigation was to determine whether muscle activity can be used to identify frailty phenotypes in females with PD. EMG during a typical 6.5-h day was examined in biceps brachii, triceps brachii, vastus lateralis and biceps femoris on less-affected PD side. Muscle activity was quantified through burst (>2% maximum exertion, >0.1 s) and gap characteristics (<1% maximum exertion, >0.1 s). Differences across frailty phenotype (nonfrail, prefrail, frail) and muscle (biceps brachii, BB; triceps brachii, TB; vastus lateralis, VL; biceps femoris, BF) were evaluated with a 2-way repeated measure ANOVA for each burst/gap characteristic. Thirteen right-handed females (mean = 67 ± 8 years) were classified as nonfrail (n = 4), prefrail (n = 6), and frail (n = 3) according to the Cardiovascular Health Study frailty index (CHSfi). Frail females had 73% decreased gaps and 48% increased burst duration compared with nonfrail. Decreased gaps may be interpreted as reduced muscle recovery time, which may result in earlier onset fatigue and eventually culminating in frailty. Longer burst durations suggest more muscle activity is required to initiate movement leading to slower movement time in frail females with PD. This is the first study to use EMG to dissociate frailty phenotypes in females with PD during routine daily activities and provides insight into how PD-associated motor declines contributes to frailty and functional decline.     

Estimating the correlation between bursty spike trains and local field potentials

To further understand rhythmic neuronal synchronization, an increasingly useful method is to determine the relationship between the spiking activity of individual neurons and the local field potentials (LFPs) of neural ensembles. Spike field coherence (SFC) is a widely used method for measuring the synchronization between spike trains and LFPs. However, due to the strong dependency of SFC on the burst index, it is not suitable for analyzing the relationship between bursty spike trains and LFPs, particularly in high frequency bands. To address this issue, we developed a method called weighted spike field correlation (WSFC), which uses the first spike in each burst multiple times to estimate the relationship. In the calculation, the number of times that the first spike is used is equal to the spike count per burst. The performance of this method was demonstrated using simulated bursty spike trains and LFPs, which comprised sinusoids with different frequencies, amplitudes, and phases. This method was also used to estimate the correlation between pyramidal cells in the hippocampus and gamma oscillations in rats performing behaviors. Analyses using simulated and real data demonstrated that the WSFC method is a promising measure for estimating the correlation between bursty spike trains and high frequency LFPs.     

Partial Pedicle Subtraction Osteotomy for Patients with Thoracolumbar Fractures : Comparative Study between Burst Fracture and Posttraumatic Kyphosis

ObjectiveTo evaluate the surgical outcomes of partial pedicle subtraction osteotomy (PPSO) in patients with thoracolumbar fractures and compare the outcomes of PPSO for burst fractures with those for posttraumatic kyphosis (PTK). MethodsFrom June 2013 to May 2019, 20 consecutive adult patients underwent PPSO for thoracolumbar fractures at the levels of T10 to L2. Of these patients, 10 underwent surgery for acute fractures (burst fractures), and 10 for sequelae of thoracolumbar fractures (PTK). Outcomes of PPSO were evaluated and compared between the groups. ResultsTwenty patients (each 10 patients of burst fractures and PTK) with a mean age of 64.7±11.1 years were included. The mean follow-up period was 21.8±11.0 months. The mean correction of the thoracolumbar angle was -34.9°±18.1° (from 37.8°±20.5°preoperatively to 2.8°±15.2° postoperatively). The mean angular correction at the PPSO site was -38.4°±13.6° (from 35.5°±13.6° preoperatively to -2.9°±14.1° postoperatively). The mean preoperative sagittal vertical axis was 93.5±6.7 cm, which was improved to 37.6±35.0 cm postoperatively. The mean preoperative kyphotic angle at the PPSO site was significant greater in patients with PTK (44.8°±7.2°) than in patients with burst fractures (26.2°±12.2°, p=0.00). However, the mean postoperative PPSO angle did not differ between the two groups (-5.9°±15.7° in patients with burst fractures and 0.2°±12.4° in those with PTK, p=0.28). The mean angular correction at the PPSO site was significantly greater in patients with PTK (-44.6°±10.7°) than in those with burst fractures (-32.1°±13.7°, p=0.04). The mean operation time was 188.1±37.6 minutes, and the mean amount of surgical bleeding was 1030.0±533.2 mL. There were seven cases of perioperative complications occurred in five patients (25%), including one case (5%) of neurological deficit. The operation time, surgical bleeding, and complication rates did not differ between groups. ConclusionIn cases of burst fracture, PPSO provided enough spinal cord decompression without corpectomy and produced sagittal correction superior to that achieved with corpectomy. In case of PTK, PPSO achieved satisfactory curve correction comparable to that achieved with conventional PSO, with less surgical time, less blood loss, and lower complication rates. PPSO could be a viable surgical option for both burst fractures and PTK.     

Spontaneous burst fracture of the thoracolumbar spine in osteoporosis associated with neurological impairment: A report of seven cases and review of the literature

Summary This is a report of seven patients suffering from osteoporosis, who sustained unstable burst fractures in the thoracolumbar spine associated with neurological impairment, without trauma. The manner of presentation, the neurological involvement, the radiological findings, as well as the surgical treatment with respect to functional and neurological recovery are discussed.