Objective Obtaining sufficient decompression and solid fusion and avoiding approach‐related injuries simultaneously are still challenging for the treatment of hard disc herniation in thoracolumbar junction. A combined full‐endoscopic decompression and interbody fusion via a transforaminal approach was used to achieve this goal. The purpose of this study was to introduce the technical notes and clinical outcomes of this novel technique. Methods Twenty segments of hard disc herniations in the thoracolumbar junction of 14 patients treated with full‐endoscopic interbody fusion via the transforaminal approach between January 2018 and September 2021 were analyzed. The patients were an average age of 43.3 years. Full‐endoscopic interbody fusion and discectomy via the transforaminal approach were performed under local anesthesia, followed by percutaneous pedicle screw system fixation under general anesthesia. Imaging, including magnetic resonance imaging (MRI), computed tomography (CT), and X‐ray, was carried out. MRI was performed on the second day and 3 months postoperatively. CT was performed on the second day, 6 months, and 1 year (as needed) postoperatively. Back and radicular pain, neurological function, and thoracic spine function were scored using a visual analog scale, the Nurick scale, and modified Japanese Orthopaedic Association (mJOA) scale, and the Oswestry disability index at 1 week, 3 months, 6 months, and 1 year postoperatively. Results All the operations were successfully completed, and no intraoperative conversion of the surgical methods occurred. Postoperative thoracolumbar junction MRI and CT examinations of all the patients revealed a sufficiently decompressed spinal cord or cauda equina, without any residual compression. At the 1‐year follow‐up, all the surgical segments were fused. Back and radicular pain was relieved in all the patients, and neurological function was restored. The average recovery rate of the mJOA was 72.5%, including seven excellent, five good, and two fair cases. Although dural tears occurred in two cases during the operation, no cerebrospinal fluid leakage or pseudomeningocele occurred during follow‐up. No other surgical complications were noted. Conclusions A combined full‐endoscopic decompression and interbody fusion via a transforaminal approach can achieve complete spinal canal decompression and solid interbody fusion with fewer approach‐related injuries. It is a safe and effective minimally invasive spine surgery for treating hard disc herniation in the thoracolumbar junction.
中枢神经系统表面铁沉积症（superficial siderosis of the central nervous system,SSCNS）是一种因含铁血黄素沉积于软脑膜下、脑组织、脑神经和脊髓表面所导致的罕见神经系统变性综合征，1908年由Hamill首次报道 [1] 。其特征性临床表现为：感音神经性耳聋、小脑共济失调、锥体束征阳性。特征性的影像学表现为T2WI MRI上显示脑、脊髓表面线样低信号影 [2、3] 。病理结果可见脑干、小脑及脊髓表现含铁血黄素、铁及铁蛋白沉积。其病因尚未明确，
Objectives:To observe the osteogenic properties and sustained release of 3D printed nano-hydroxyapatite(nHA)artificial bone loaded with a novel triple anti-tuberculosis drug combination(PaMZ)of Pretomanid(Pa),Moxifloxacin(M),Pyrazinamide(Z)and bone morphogenetic protein 2(BMP-2)in vivo.Methods:40 New Zealand rabbits were divided into four groups randomly and constructed spinal bone defect models.Group A(experimental group)implanted with 3D-printed PaMZ/BMP-2-loaded nHA artificial bone;group B(negative control group)implanted with blank nHA artificial bone;group C(positive control group)implanted with autologous iliac bone;group D(blank group)without bone grafting.The general conditions were observed,body temperature,weight,and liver and kidney function were monitored.The bone defect restoration was observed by spiral CT 3D reconstruction at the 4th,8th and 12th week postoperatively and was evaluated with CT-Hedberg scale;the gross observation of tissues and histopathological observation of the implants-bone defect interface were carried out at the 8th and 12th week postoperatively.100 SD rats were divided into two groups randomly,experimental group implanted with 3D-printed PaMZ/BMP-2-loaded nHA artificial bone,control group implanted with blank nHA artificial bone.The drug concentrations in the plasma and muscle tissue around the material at different time points was tested with high performance liquid chromatography.Results:All animal models were successfully constructed without incision infection or death.The body temperature,weight and liver and kidney function indexes of the experimental groups in the rabbit models were normal,with no statistical differences from those of the control groups(P＞0.05).The CT-Hedberg score showed that there was no statistical difference between group A and group C at the 4th,8th and 12th week(P＞0.05),however,there was statistical difference between all the other groups at different time points(P＜0.05).The observation of the gross specimens at the 12th week after surgery showed that the artificial bone in group A was completely encapsulated or replaced by new bone,but there was still some artificial bone exposed in group B.Quantitative analysis of the total trabecular area at the implant-bone defect interface showed no statistical difference between groups A and C at the 8th and 12th week postoperatively(P＞0.05),and a statistical difference between the remaining groups(P＜0.05).No drug components were detected in the SD rat model control group,the three drugs Pa,M,Z in experimental group can be sustained-released in local tissues for at least 84d.The blood drug concentration was not detected at the initial time point after local implantation of the drug-loaded artificial bone,and the subsequent measured results were much lower than the local tissue drug concentration,and the two had a positive correlation.Conclusions:The 3D printed PaMZ/BMP-2-loaded nHA artificial bone has good osteogenic properties in vivo,the effect of restoring spinal bone defects is comparable to that of autologous iliac bone,which is better than that of HA artificial bone scaffold alone.Its sustained release behavior in vivo is satisfactory,and the blood drug concentration is much lower than the local tissue drug concentration.
Objectives:To explore the early clinical efficacies of unilateral decompression and bilateral decompression by one-hole split endoscope(OSE)technique for moderate-severe lumbar spinal stenosis(LSS)with unilateral symptoms amongst middle aged and elderly people.Methods:A retrospective analysis was performed on the patients with moderate-severe LSS who underwent unilateral decompression and bilateral decompression using OSE technique between January 2021 and December 2021.According to the inclusion and exclusion criteria,a total of 120 patients were enrolled in this study,with 60 patients in the unilateral decompression group(group A)and 60 patients in the bilateral decompression group(group B).The length of hospitalization,operative time,incision length and intraoperative blood loss were counted and compared between group A and group B.Moreover,range of motion(ROM)and sagittal translation(ST)on lumbar dynamic X-ray,facet preservation rate on the approach side,and cross-sectional area of the canal(CAC)of the surgical segment before and after operation were recorded and compared.The visual analogue scale(VAS)of back and leg pain was used before surgery,and at 7 days,3 months and 18 months after surgery,the Oswestry disability index(ODI)was used to evaluate the functional improvement,and the clinical efficacy was evaluated by modified Macnab criteria at the last follow-up.All the clinical scores of both groups were analyzed and compared between before and after surgery.Results:All the patients underwent surgical inter-vention successfully.There was no statistical significance in the length of hospitalization between groups A and B(P＞0.05),but group B was longer in operative time,bigger in incision,and more in blood loss than group A,with statistical significance(P＜0.05).The VAS for back and leg pain and the ODI after operation in both groups were all significantly lower than those before surgery,respectively(P＜0.05),and the values at each postoperative time point within group were significantly different when compared pairwise(P＜0.05);There was no significant difference between the two groups before surgery(P＞0.05),but group B had more significant improvement than group A at 7 days,3 months and 18 months after surgery(P＜0.05).There was no statistical significance in ST and ROM of surgical segment before and after surgery between the two groups(P＞0.05).The postoperative facet preservation rate was higher in group B than in group A(P＜0.05).There was no sig-nificant difference in the CAC of the surgery segment before operation between the two groups(P＞0.05),how-ever,the CAC of the surgical segment in group B was larger than that in group A(P＜0.05).The rate of im-provement in CAC was higher in group B than in group A(P＜0.05).The CAC of the surgical segment postop-eratively in both groups were significantly larger than before surgery,with statistical significance(P＜0.05).Ex-cellent-good rate at 18 months after surgery was 86.7％in group A and 91.7％in group B.There was no significant difference in the number of excellent and good cases between the two groups at 18 months after operation(P＞0.05).One patient in group A had numbness and discomfort in the lower limb on the healthy side after surgery,and one case with mild dural tear in group B.Conclusions:Both unilateral decompression and bilateral decompression under OSE are safe and effective in the treatment of moderate and severe central canal and bilateral lateral recess stenosis with unilateral symptoms in the middle-aged and elderly people,with definite early clinical efficacy.Bilateral decompression is more complete and better in clinical efficacy than unilateral decompression,but further follow-up is required in the long term.
Objectives:To systematically evaluate the risk factors for dysphagia after anterior cervical spine surgery(ACSS),identify the independent risk factors,and to provide a guidance for the prevention and treatment of perioperative complications.Methods:A total of 8 databases including Wanfang,CBM,CNKI,VIP,PubMed,Embase,Cochrane Library,and Web of Science were searched for case-control and cohort studies about the risk factors of dysphagia after ACSS from the establishment of each database to July 15,2023.Newcastle-Ottawa scale(NOS)was adopted to evaluate the qualities of the included literaure.Related data such as the first author,publication year,research type,sample size,assessment method,evaluation time,and risk factors were extracted and Stata 12 software was used to do the meta-analysis.Results:29 articles were included,consisting of 4 cohort studies and 25 case control studies.All of the articles were of high quality.The total sample size of patients with dysphagia after ACSS was 89571 and the number of patients in the control group was 3092967.Age(OR=1.093,95％CI:1.067-1.120),female(OR=2.419,95％CI:1.654-3.539),diabetes mellitus(OR=2.733,95％CI:2.240-3.333),disease duration(OR=4.259,95％CI:2.458-7.381),levels of surgery(OR=1.791,95％CI:1.718-1.868),operative level(OR=2.332,95％CI:1.812-3.003),operative time(OR=1.434,95％CI:1.110-1.852),plate(OR=2.188,95％CI:1.413-3.175)and revision surgery(OR=2.687,95％CI:2.316-3.119)were related to dysphagia after ACSS,while smoking(OR=1.323,95％CI:0.852-2.056),hypertension(OR=1.006,95％CI:0.591-1.713),body mass index(BMI)(OR=1.037,95％CI:0.929-1.159),cervical disc arthroplasty(OR=0.577,95％CI:0.085-3.943)and difference between postoperative and preoperative C2-7 angles(dC2-7)＞5°(OR=1.716,95％CI:0.925-3.183)were not.Conclusions:Patients who are female,old aged,with long preoperative disease duration and diabetes mellitus,undergoing double or multi-level surgery,upper cervical spine surgery,and revision surgery,prolonged operation time,and use of plate,are prone to have dysphagia after ACSS.
Objectives:To investigate the clinical efficacy and safety of posterior reduction and fixations in patients with thoracolumbar burst fractures with Load-sharing classification(LSC)score of 7 and 8 points.Methods:The data of 36 patients with LSC score of 7 and 8 who underwent posterior reduction and internal fixation between October 2009 and December 2014 were retrospectively analyzed.There were 21 males and 15 females,with an average age of 42.67±14.67 years(range 21 to 67 years).The fractured vertebrae were T12-Ll.LSC score was graded according to the imaging data including X-ray radiographs,CT and MRI.The index vertebral Cobb angle and anterior vertebral height were collected at preoperative,postoperative 1 week and final follow-up,respectively.Visual analogue scale(VAS)was used to evaluate residual back pain at final follow-up.The complications were recorded for safety evaluation.Results:All the patients were followed up for 49.83±18.20 months on average(23-86 months),of which 19 cases had internal fixations removed,and the follow-up period for patients after internal fixation removal was 28.00±20.12 months on average(3-69 months).Fracture healing was achieved in all the patients without significant residual pain,or broken screw or rod,or significant kyphosis,or pedicle screw cutting vertebral body or loosening of the internal fixation.For imaging evaluation,the postoperative sagittal Cobb angle was significantly improved to 6.67°±5.06° from the preoperative 15.87°±8.35°,and the postoperative height of anterior margin of the fractured vertebral body recovered to 2.88±0.32cm from 1.81±0.49cm before operation,all with statistically significant differences(P＜0.05).The vertebral body height at the final follow-up was 2.81±0.41cm,and there was no statistically significant difference between postoperative and the final follow-up vertebral body heights(P＞0.05).At the final follow-up,the neurological functions of all the patients recovered compared with the conditions at the time of injury,with no loss of intervertebral space height.The anterior edge height of the vertebral body recovered to(94.92±18.41)％,the middle edge height recovered to(81.16±11.82)％,and the posterior edge height recovered to(97.48±7.63)％,all with significant differences compared to those before surgery(P＜0.05).Conclusions:The posterior reduction and internal fixation for patients with thoracolumbar burst fracture with LSC scores of 7 and 8 can achieve good preservation of vertebral stability at later stage,high safety,and satisfactory clinical efficacy and imaging results.
Objectives:To establish a model of Mycobacterium tuberculosis infection of osteoclasts(OC)and explore the mechanism of Mycobacterium tuberculosis infection on OC.Methods:Peripheral blood mononuclear cells(peripheral blood mononuclear cells,PBMCs)were isolated from healthy volunteers.Receptor activator of nuclear factor-KB ligand(RANKL)and macrophage-colony stimulating factor(M-CSF)were used to make PBMCS into OC,and tartrate resistant acid phosphatase(TRAP)staining was performed on the cells.The constructed kanamycin resistant H37Rv pMV261-GFP green fluorescent strain was resuscitated and cultured with 10％oleic albumin dextrose catalase(OADC),7H9 and kanamycin containing Mycobacterium tuberculosis special liquid medium in an incubator at 37℃ until the optical density(OD)value was about 0.5 at 600nm.The OC cells cultured alone were set as the blank control group.And OC cells were also infected with Mycobacterium tuberculosis at different multiplicity of infection(MOI)for 24h,and MTT colorimetric method was used to detect cell survival rate.The MOI with the highest cell survival rate was selected as experimental MOI,and OC cells infected with H37Rv at experimental MOI were set as the experimental group.Fluorescence microscopy and Mycobacterium tuberculosis acid-fast staining were used to observe the transfection of Mycobacterium tuberculosis at the experimental MOI.Quantitative real-time PCR(qRT-PCR)was used to detect the expressions of non-receptor tyrosine kinase C-src,cathepsin K(CK),carbonic anhydrase 2(CA2),Integrin-β3 and matrix metalloproteinase-9(MMP-9).Immunohistochemistry was used to detect the expressions of P-src,CK,CA2,Integrin-β3 and MMP-9 on the cell surface.Western blot(WB)was used to detect the protein expression levels of P-src,CK,CA2,Integrin-β3,and MMP-9.Results:TRAP staining showed that more than 90％of the cells were OC after 15d of culture,which could be used for experiments.The results of MTT colorimetric assay showed that the cell survival rate was the highest when the MOI was 20:1(P＜0.05).This transfection multiplicity can be used as the concentration of experimental group.Fluorescence microscopy showed that when the transfection multiplicity ratio was 20:1,the green fluorescent Mycobacterium tuberculosis entered the OC and was successfully transfected into the OC.The results of acid-fast staining after infection of OC with Mycobacterium tuberculosis showed that when the MOI was 20:1,the acid-fast Mycobacterium tuberculosis stained red entered OC and was also successfully transfected into OC.The results of qRT-PCR,cell immunohistochemistry,and WB showed that the expressions of MMP-9,CK,C-src,CA2,and Integrin-β3 in the experimental group were higher than those in the blank control group(P＜0.05).Conclusions:Mycobacterium tuberculosis can transfect OC;Compared with the blank control group,the levels of five bone destruction factors in the experimental group transfected with OC by Mycobacterium tuberculosis were increased,suggesting that bone destruction of spinal tuberculosis may be related to this,which may provide a new exploration direction for the diagnosis and treatment of bone tuberculosis diseases.
慢性腰痛(low back pain,LBP)与椎间盘退变(inter-vertebral disc degeneration,IDD)密切相关,约 40％的 LBP由IDD引起[1].IDD的过程主要是髓核细胞活性和数目的减少及细胞外基质(extracellular matrix,ECM)分解,伴各种炎症因子的表达,最终导致椎间盘水分的丢失及高度的降低[2].IDD也会造成纤维环的破裂或椎间隙变窄,在腰椎IDD的基础上形成的腰椎间盘突出、腰椎管狭窄和腰椎滑脱等,引起LBP[3].目前LBP的传统治疗包括保守治疗和手术治疗,保守治疗仅能部分缓解临床症状,而手术会导致腰椎活动度的下降和相邻节段椎间盘退变加速等.有研究显示,对于IDD引起的慢性LBP,手术后症状改善情况并不优于保守治疗,均难以控制或逆转IDD的病理过程[4、5].干细胞通过内源性修复的机制,可逆转IDD的病理过程[6].
人工智能(artifical intelligence,AI)是近年来发展迅速的一种多学科交叉的尖端技术,可以通过算法对海量数据的学习实现类似AI解决问题的能力[1].近年来,AI技术的积累和储备已经完成,AI赋能传统产业已进入大规模应用的快速发展时期.在医疗领域,AI与医疗的深度融合也正不断推进,在医学影像识别、疾病诊断、手术规划和预后等方面取得了大量重要成果.
Objectives:To explore the operative strategies of revision surgery after atlanto-axial dislocation(AAD)surgery.Methods:12 patients undergone AAD revision surgery in our hospital between January 2016 and August 2019 were analyzed in this retrospective study,including 3 males and 9 females,aged 7-62 years[45.5(34.25,52.50)years].The interval of initial operation and revision operation was 3-360 months[30(5,93)months].Internal fixation and bone graft were removed before revision surgery.The patients were assessed to receive anterior release according to the conditions of 1/6 body weight dose skull traction.According to preoperative imaging and intraoperative exploration,larger diameter and longer screws,new screw track,and extended fixed segments were performed optionally to increase the overall internal fixation strength,and the lateral atlantoaxial joint release and grafting were performed to increase bone graft fusion.The follow-up peri-od ranged 12-50 months[24.0(17.25,34.00)months].The atlanto-dental interval(ADI),clivus-axial angle(CAA),cervico-medullary angle(CMA)and Japanese Orthopaedic Association(JOA)score were assessed at 3 days after surgery and final follow-up,the CT examination was performed at 3 days,3 months,6 months,12months and final follow-up after surgery to evaluate the bone graft fusion.Results:There were 8 patients receiving inter-nal fixation and bone graft removing before revision surgery.Among the patients,4 received anterior releasing combined with posterior reduction and internal fixation and fusion,the other 8 patients underwent posterior reduction and internal fixation and fusion.Of all the patients,occipital screw revision was performed in 4 with new screw track;C1 screw revision was performed in 4,of which 2 patients were fixed with larger di-ameter and longer screws,and 2 patients were fixed with new screw track;C2 screw revision was performed in 8,of which 5 patients were fixed with larger diameter and longer screws,and 3 patients were fixed with new screw track;extended fixed segments were preformed in 3 patients;the lateral atlantoaxial bone grafting was performed in all 12 patients.Anatomical reduction was obtained in all the patients.The postoperative 3d and final follow-up ADI were significantly reduced compared with pre-operative ADI,and the CCA and CMA were significantly increased than those at pre-operation(P＜0.05).The JOA at 3 days after surgery and final follow-up were significantly improved than that at pre-operation.Bony fusion was achieved in all the patients,with a bone fusion rate of 100％,and the bone fusion time ranged 3-7 months[3.5(3.0,6.0)months].Con-clusions:Anterior release is suitable for the patients with un-reduced atlantoaxial dislocation after removal of primary internal fixation under heavy traction.During posterior revision surgery,occipital screws need to change trajectory to maintain firm internal fixation,and larger diameter and longer screw is suitable for C1,and C2 screws,while extended fixed segments are suitable for patients whose C1 or C2 screws cannot be in-serted.The lateral atlantoaxial joint bone grafting is suitable for all AAD revision.
随着人口老龄化的加剧,越来越多与年龄相关的疾病得到临床医生的重视.退变性脊柱侧凸(degenerative scoliosis,DS)的发病率随年龄增长而上升,已逐渐成为全球性的公共卫生问题,主要表现为脊柱冠状位及矢状位失衡,极大地影响患者的生存质量[1、2].脊柱是一个多组织的结构复合体,其稳定性主要依靠骨性结构、椎旁肌肉及相关韧带结构来维持,其中椎旁肌肉的作用至关重要[3.已有研究表明,椎旁肌肉退变与DS的发生和发展具有相关性,但具体作用机制尚不明确.笔者通过回顾相关文献,对椎旁肌退变及其与DS关系的研究现状进行综述,并对疾病的诊断治疗提出展望,以期提高DS患者的诊疗水平,改善老年人的远期生活质量.
Objectives:To analyze the clinical efficacy of Cheneau brace in adolescent idiopathic scoliosis(AIS)patients and to discuss the changes of curve type during the treatment.Methods:75 patients with AIS treated with Cheneau brace from October 2016 to November 2021 were included.There were 69 females and 6 males,averaged 11.9±1.0 years old when starting to wear the brace,with a mean initial main curve Cobb angle of 29.8°±8.5° and an initial Risser's sign ≤2.Clinical and imaging data were collected,including age,gender,menarche age,time of daily wear,and full-length radiographs of the spine before initial treatment and at the final follow-up.All the patients were followed up for 1 year after finishing brace treatment.The curve types of the patients were counted using the main curve type and the modified Lenke classification system(mLenke),and changes in curve types and the efficacy of bracing in patients with different curve types were analyzed.Results:After 25.7±10.8 months of brace treatment,the patients averaged 14.2±1.2 years old when finishing brace treatment,and the mean main Cobb angle was 27.6°±12.0°.Among the patients,scoliosis was controlled in 63 while progressed in 12,and 23 patients were treated surgically.The rates of success of brace and control of curve were higher in patients with main lumbar curve than those in patients with main thoracic curve(P=0.043,P=0.003).There was a difference in the rate of brace success and control of curve in patients with each mLenke classification(P＜0.001,P=0.005).The highest rates of brace success and control of curve were found in patients of mLenke type Ⅴ,while mLenke type Ⅳ patients had the lowest success rate of brace treatment success and mLenke type Ⅱ patients had the lowest rate of control of curve.Before and after brace treatment,there was a difference in the proportion of patients with each main curve type(P=0.019),and the proportion of patients with each mLenke classification had no statistical difference(P=0.071).There were differences in the rate of change of curve type in each main curve type and each mLenke classification both(P＜0.001,P=0.020).No significant differences were seen in the rates of success of brace treatment and control of curve between patients with and without change in curve type under the two curve type classifications.Conclusions:The efficacy of Cheneau brace varies among AIS patients with different curve types.Patients with a main thoracic curve tend to have a poor response to bracing compared with patients of main lumbar curve;During the treatment with Cheneau brace,the patient's curve types may change,and the overall trend of curve type change is upward shifting of the main curve.The rate and outcome of curve type changes vary among patients with different curve types,and curve type changes may also occur in curve controlled or corrected patients.
Objectives:To evaluate the values of sagittal CT image histogram features in the differential diagnosis of brucella spondylitis(BS)and pyogenic spondylitis(PS).Methods:The data of 40 BS patients[25 males,15 females;age:51.6±13.0 years old;body mass index(BMI):23(20,28)kg/m2,the BS group]and 33 PS patients[13 males,20 females;age:50.8±16.7 years old;BMI:23(20,26)kg/m2,the PS group]who underwent CT examination of the spine in our hospital and were confirmed through pathology and/or etiology were collected.The region of interest(ROI)was delineated on each level of the sagittal CT images of the two groups of patients by using the 3D Slicer platform and grayscale global histogram analysis was performed.The clinical data were compared using chi square test,independent sample t-test,and Mann Whitney U test between the two groups of patients;Univariate analysis,correlation analysis,and multivariate analysis were used in sequence to identify the histogram features with significant differences between the two groups(including 10％percentile,1％percentile,25％percentile,5％percentile,median,minimum,skewness,and variance);Logistic regression and the screened features were combined for modeling,and receiver operating characteristic(ROC)curves were drawn and areas under the curve(AUC)were calculated to compare the discriminative ability of each histogram feature.Results:There was no statistically significant difference in age,gender,and BMI between the two groups of patients(P＞0.05).Among the histogram parameters,10％percentile value,1％percentile value,25％percentile value,5％percentile value,median,minimum value,skewness,and variance were statistically different between the two groups(P＜0.05).The 10％percentile value displayed the best diagnostic performance,with an AUC value of 0.824 and a specificity of 0.893.The combined model had an AUC value of 0.860 and a specificity of 0.946.Conclusions:Based on 10％percentile value of CT grayscale histogram and joint model,PS and BS can be distinguished effectively,providing a basis for accurately distinguishing the two diseases in clinical practice.
目的:分析2013年～2018年我国多中心创伤性颈脊髓损伤(traumatic cervical spinal cord injury,TC-SCI)患者人口学与临床特征的现状和趋势、治疗现状、住院期间费用现状.方法:收集我国13家医院[西安市红会医院、上海市东方医院、天津医科大学总医院、苏州大学附属第一医院、深圳市第二人民医院、上海市第一人民医院、秀山县人民医院、西安交通大学第一附属医院、西安一四一医院(现西安交通大学第一附属医院东院区)、成都大学附属医院、金湖县人民医院、首都医科大学宣武医院、井陉县医院]中TCSCI住院患者的病历资料,包括:性别、年龄、职业、致伤原因、损伤节段、损伤程度、美国脊髓损伤协会残障(ASIA impairment scale,AIS)分级、治疗方式选择、减压手术时间窗、类固醇皮质激素药物[甲泼尼龙琥珀酸钠(methylprednisolone sodi-um succinate,MPSS)/甲基强地松龙(methylprednisolone,MP)]的使用时间窗.收集患者在住院期间医疗费用和住院时长.统计分析以上数据资料的现状,计算年度变化百分比(annual percentage change,APC)来分析患者人口学和临床特征在6年间的变化趋势;分析患者治疗方式和医疗支出的现状.结果:共纳入2102例TCSCI患者,2013～2018年TCSCI数量呈逐年增加趋势(APC=16.9％,95％CI:10.2～24.1,P＜0.01),患者的平均年龄(APC=1.7％,95％CI:1.0～2.4,P＜0.01)和老年患者所占比例(APC=12.5％,95％CI:6.0～19.3,P＜0.01)呈上升趋势.男性占79.9％,最常见的职业是农民(32.8％);常见的致伤原因前三位为:摔倒(36.7％)、交通事故(30.0％)、高坠(18.4％).最常见的损伤节段为C4水平(26.8％),其次是多节段损伤(24.4％)和C5水平(18.9％),有超过半数的患者为不完全性四肢瘫痪(67.8％)和AIS D级(51.9％),截瘫(包括完全性和不完全性)所占比例呈下降趋势.66.0％的患者接受了减压手术治疗,但其中只有2.0％的患者是在伤后24h内进行的手术.有18.2％的患者接受了大剂量MPSS/MP治疗,其中有34.2％的患者在伤后8h内使用;伤后24h以后仍使用大剂量MPSS/MP的有173例,占使用大剂量MPSS/MP患者的45.2％.急性和亚急性期住院总费用平均为6.93万元,日均费用平均为0.42万元.男性患者住院期间总医疗费用和日均医疗费用的均值高于女性.在不同的损伤程度分组中,完全性四肢瘫痪患者住院期间医疗费用最高;在不同AIS分组中,AIS A级的患者住院期间医疗费用最高.结论:TCSCI患者的数量、平均年龄、老年患者占比均在逐年上升,在TCSCI患者的实际临床治疗中,减压手术时间窗、类固醇皮质激素的用法用量等与指南建议并不完全一致.
2022年,颈椎外科领域做出了大量新颖独到、精准创新的研究.传统热点问题得到充分阐述论证,提出了更具指导意义的精准诊疗建议,人工智能、可穿戴设备等高新技术的蓬勃发展也为颈椎外科注入新的活力,相关研究如火如荼.我们通过PubMed检索了 2022年脊柱外科领域三大期刊(Spine Journal、Spine、European Spine)和其他专业领域顶级期刊(如Lancet、European Radiology等),以及通过中国知网检索了《中国脊柱脊髓杂志》等中文核心期刊发表的颈椎外科相关的文献,通过人工阅读筛选出颈椎退变性疾病临床相关研究并进行总结,主要目的是了解颈椎退变的最新临床研究进展,为该领域的工作者提供研究思路以及新的研究方法.
目的:探究缺氧诱导因子1α(HIF-1α)调控wnt/β-catenin信号通路对常氧培养下大鼠髓核细胞衰老的影响及作用机制.方法:取5只4周龄雌性SD大鼠,提取鼠尾髓核原代细胞进行研究.(1)将髓核细胞分为5组:转染对照组[用磷酸盐缓冲盐水(PBS)处理髓核细胞]、空载腺病毒组(用空载腺病毒处理髓核细胞)、过表达HIF-1α组(用载过表达HIF-1α质粒的腺病毒处理髓核细胞)、空载siRNA组(用空载siRNA处理髓核细胞)、敲减HIF-1 α组(用siRNA敲减HIF-1α处理髓核细胞),在常氧下培养48h后,免疫蛋白印迹(western blot,WB)检测HIF-1α和衰老相关基因p53、p21、p16,β-gal染色检测细胞衰老,评估常氧条件下HIF-1α对于髓核细胞衰老的影响.(2)取髓核细胞,分为空载腺病毒组、过表达HIF-1α组、空载siRNA组、敲减HIF-1α组,处理方式同前,在常氧下培养48h后,WB检测HIF-1α、GSK-3β和β-catenin通路的表达.取髓核细胞,分为对照组(用PBS处理髓核细胞)、过表达HIF-1α组(用载过表达HIF-1α质粒的腺病毒处理髓核细胞)、XAV-939组(用XAV-939处理髓核细胞)、XAV-939+过表达HIF-1α组(用XAV-939+载过表达HIF-1α质粒的腺病毒处理髓核细胞),WB检测HIF-1α、p53、p21、p16和wnt/β-catenin的表达,β-gal染色检测细胞衰老,以检测HIF-1α与wnt/β-catenin信号通路的关系以及对髓核细胞衰老的影响.结果:(1)腺病毒转染HIF-1α后,与转染对照组和空载腺病毒组相比,过表达HIF-1α组HIF-1α表达增加(P＜0.05).小干扰RNA转染HIF-1α后,与转染对照组和空载siRNA组相比敲减HIF-1α组HIF-1α表达降低(P＜0.05).WB结果显示,与空载腺病毒组相比过表达HIF-1α组HIF-1α表达增加(P＜0.05),而p53、p21和p16表达降低(P＜0.05),与空载siRNA组相比敲减HIF-1α组HIF-1α表达降低(P＜0.05),而p53和p16表达增加(P＜0.05).β-gal染色显示,在常氧条件下培养48h,与空载腺病毒组相比,过表达HIF-1α组衰老细胞降低(P＜0.05),与空载siRNA组相比,敲减HIF-1α组衰老细胞数量则增加(P＜0.001).(2)与空载腺病毒组相比,过表达HIF-1α组β-catenin表达升高(P＜0.01),同时GSK-3β表达降低(P＜0.05).与空载siRNA组相比敲减HIF-1α组β-catenin表达降低(P＜0.0001),同时 GSK-3β 表达升高(P＜0.05).与对照组相比,XAV-939 组 β-catenin 表达降低(P＜0.001),p53、p21和p16的表达升高,XAV-939+过表达HIF-1α组β-catenin表达降低(P＜0.05),p21表达升高(P＜0.05).与过表达HIF-1α组相比XAV-939+过表达HIF-1α组衰老细胞数增加(P＜0.001),与对照组相比过表达HIF-1α组的细胞核内β-catenin表达更多,而XAV-939组和XAV-939+过表达HIF-1α组则相对较少(P＜0.05).结论:HIF-1α通过激活wnt/β-catenin信号通路抑制常氧条件培养下大鼠髓核细胞的衰老.
先天性畸形、肿瘤、感染、创伤及退行性病变等常导致上颈椎失稳而需要内固定手术治疗,不同的发病机制及损伤部位选择的内固定方式也不同,目前固定方式主要有齿状突螺钉内固定、寰枢椎经关节螺钉内固定、枕寰枢螺钉内固定、寰枢椎螺钉-棒内固定、枢椎椎弓根螺钉内固定等.但一些经典的手术方式常需要较大的切口来暴露术区,对软组织的创伤大,术中出血较多,围手术期疼痛较明显.
高毒力肺炎克雷伯菌(hypervirulent Klebsiella pneumoniae,HvKP)是肺炎克雷伯菌(Klebsiella pneumoni-ae,KP)的新型高毒力变种,其显著特征是高黏液表型[1].与经典肺炎克雷伯菌(classic Klebsiella pneumoniae,cKP)相比,HvKP毒力更强,多在健康人群中引起社区获得性感染,且发展迅速,常引起全身多灶感染[2).硬脊膜外脓肿(spinal epidural abscess,SEA)是椎管内硬脊膜外脂肪组织和静脉丛的化脓性感染,临床误诊率及致残率均较高3].
目的:评价矢状位年龄校正评分(sagittal age-adjusted score,SAAS)和以国人年龄匹配脊柱为基线修正的SAAS评分(M-SAAS)预测国人成人脊柱畸形(adult spinal deformity,ASD)术后发生近端交界性后凸/失败(proximal junctional kyphosis/failure,PJK/PJF)的能力.方法:收集来自我院影像学系统66例年龄匹配脊柱-骨盆序列的受试者资料,其中男性28例,女性38例,年龄54.7±6.2岁,测量骨盆入射角(pelvic incidence,PI)、腰椎前凸角(lumbar lordosis,LL)、骨盆倾斜角(pelvic tilt,PT)以及 T1 骨盆角(Tl-pelvic-angle,TPA)并统计分析年龄与PI-LL、PT以及TPA的线性回归方程,将公式记为M-SAAS.回顾性分析68例于2017～2021年在我院行脊柱矫形术的ASD患者病历资料,其中男性10例,女性58例,年龄64.0±8.1岁,术后PJK/PJF发生12例.测量PI、LL、PT以及TPA,计算SAAS评分并观察PJK/PJF发生率与评分的匹配程度.将68例ASD患者术后影像学参数代入M-SAAS,计算M-SAAS评分并观察PJK/PJF发生率与评分的匹配程度.结果:SAAS评分为1.9±2.6分(-4～6分),术后即刻评估为"矫正不足""匹配"及"过度矫正"的患者分别为5例(7.4％)、25例(36.7％)和 38 例(55.9％),PJK/PJF 发生率分别为 40.0％(2/5)、20.0％(5/25)和 13.2％(5/38),匹配组 PJK/PJF 发生率与另两组差异无统计学意义.依据正常脊柱-骨盆序列得M-SAAS线性回归方程为:理想Pl-LL=0.47x(年龄-55)+0.3、理想PT=0.44×(年龄-55)+14和理想TPA=0.37x(年龄-55)+9.ASD患者最终M-SAAS分数为0.2±2.8分(-5～5分),术后即刻被评估为"矫正不足""匹配"及"过度矫正"的患者分别为17例(25.0％)、31例(45.6％)和 20 例(29.4％),术后 PJK/PJF 发生率分别为 11.8％(2/17)、6.5％(2/31)和 40.0％(8/20),"过度矫正"组PJK/PJF发生率高,与"匹配"组差异有统计学意义(P=0.008).结论:SAAS不适用于对国人ASD患者术后发生PJK/PJF的预测评价,根据国人中老年年龄匹配脊柱-骨盆序列参数关系修正的M-SAAS可预测ASD患者术后发生PJK/PJF的概率.
