Objective To study the occurrence and influencing factors of cognitive dysfunction in patients with spinal cord injury.Methods The clinical data of 140 spinal cord injury patients in our hospital from August 2019 to May 2022 were retrospectively analyzed.The Montreal cognitive assessment scale(MoCA)＞26 points were set as the cognitive normal group,and the MoCA≤26 points were set as the cognitive impairment group.The general data,ASIA classification of spinal cord injury,Hamilton anxiety scale(HAMA),Hamilton depression scale(HAMD),and inflammation levels were compared between the two groups.Results Of the 140 patients,57 cases had MoCA more than 26 points,accounting for 40.71%,while 83 had MoCA less than or equal to 26 points,accounting for 59.29%.There was no significant difference in gender,age,time of spinal cord injury,nature of spinal cord injury and educational level between the two groups(P＞0.05).The ASIA grade of spinal cord injury in the cognitively normal group was significantly higher than that in the cognitively impaired group,and the proportion of cervical spinal cord injury and brain injury was significantly lower than that in the cognitively impaired group,with statistically significant differences(P＜0.05).The HAMA and HAMD scores of the cognitively normal group were significantly lower than those of the cognitively impaired group,and the differences were statistically significant(P＜0.05).There was no significant difference in IL-1β,IL-6,CRP and TNF-α between the two groups(P＞0.05).After multivariate logistic regression analysis,cervical spinal cord injury,brain injury,spinal cord injury ASIA grade A,spinal cord injury ASIA grade B,HAMA,and HAMD were all risk factors for cognitive impairment in patients with spinal cord injury(P＜0.05).Conclusion The incidence of cognitive dysfunction in patients with spinal cord injury is generally high,which is closely related to cervical spinal cord injury,brain injury,etc.,and clinical intervention should be active to improve cognitive dysfunction and curative effect.
Objective To investigate the related factors of bone healing failure after conservative treatment of acute unilateral lumbar spondylolysis(LS).Methods The data of 96 patients with unilateral acute LS who received conservative treatment in our hospital from January 2018 to June 2021 were analyzed retrospectively.The patients'data were reviewed,and the bone healing,gender,age,course of disease,pathological stage,contralateral condition,pathological segment,occult spina bifida,VAS,ODI before treatment and other data were recorded.The difference in clinical data between bone healing and non bone healing patients was observed,and the risk factors affecting osteosynthesis were observed.Results After conservative treatment,bone healing failed in 37 patients,and the incidence of non bone healing was 38.54%.The age and course of LS unhealed patients were significantly higher and longer than those in bone healing group(P＜0.05).The incidence of nonunion was significantly higher in men,pathological stage,progressive stage,contralateral bone defect and diseased segment L5(P＜0.05).Multivariate logistic analysis showed that L5 segment,contralateral bone defect and advanced LS were the risk factors of bone nonunion in LS conservative treatment(P＜0.05).Conclusion Advanced stage,L5 segment lesion and contralateral bone defect are the risk factors of bone nonunion in patients with acute unilateral ls.Direct surgical treatment should be considered in order to achieve bone healing as soon as possible.
目的 探讨基于脊髓损伤压力性损伤风险评估量表(spinal cord injury pressure ulcer scale,SCIPUS)评分的分级护理联合骑跨体位干预预防脊髓损伤(spinal cord injury,SCI)患者压力性损伤(pressure injury,PI)的作用.方法 使用随机数表法将2021 年6 月～2022 年2 月在本院就诊的74 例SCI患者分为对照组(n=37)和观察组(n=37).给予对照组常规护理;在此基础上,给予观察组基于SCIPUS评分的分级护理联合骑跨体位干预.比较两组患者PI发生率和干预前后的心理状态、心理弹性.结果 观察组PI发生率10.81%,低于对照组的32.43%(P＜0.05);干预后,两组抑郁-焦虑-压力量表精简版(depression anxiety and stress scale,DASS-21)评分均降低,而心理弹性量表(connor-davidson resilience scale,CD-RISC)评分均升高,且观察组DASS-21 评分低于对照组、CD-RISC评分高于对照组,差异均有统计学意义(P＜0.05).结论 基于SCIPUS评分的分级护理联合骑跨体位干预,可有效降低SCI患者PI发生风险,且能缓解患者不良情绪,提高其心理弹性水平.
腰椎不稳的融合手术多种多样,但根据所使用的器械不同而有所不同.每种技术均有其优点和缺点[1]. OLIF是逐渐被脊柱外科医生使用的新兴腰椎融合手术[2] ,可通过腹膜后间隙直接进入椎间隙,从而避免对椎旁肌、腰肌和腰丛的损伤[3]. 2018 年10 月～2020年10 月,三峡大学附属仁和医院骨科采用微创可扩张通道辅助下OLIF入路(图1a)对单节段腰椎不稳进行治疗,同时在同一体位行后路单侧经皮椎弓根钉固定,现将该术式的效果及术后并发症报道如下.
Objective To investigate the effect of modified posterior cervical laminoplasty in the treatment of multilevel cervical spondylotic myelopathy(CSM).Methods A total of 84 patients with multi segmental CSM in our hospital from January 1,2014 to June 1,2019 were selected and divided into two groups according to the random number table method,with 42 cases in each group.The control group were treated with traditional posterior cervical laminoplasty,and the observation group with modified posterior cervical laminoplasty.The open angle of vertebral lamina and the backward drift distance of spinal cord were compared between the two groups.The range of motion of cervical spine(ROM),cervical curvature,Japanese Orthopaedic Society(JOA)score and neck dysfunction index(NDI)score were compared before and 12 months after operation,and the incidence of axial symptoms was compared between the two groups.Results ROM and cervical curvature of the observation group were higher than those of the control group 12 months after operation(P＜0.05),JOA score was higher than that of the control group(P＜0.05),and NDI score was lower than that of the control group(P＜0.05);the incidence of axial symptoms of the observation group was lower than that of the control group(P＜0.05).The difference was statistically significant.Conclusion The modified posterior cervical laminoplasty is superior to the traditional operation in spinal cord decompression,with less influence on ROM and cervical curvature and low incidence of axial symptoms.
Objective To compare the clinical efficacy of the two anterior cervical surgery methods and the effect on the sagittal balance of cervical spine.Methods A retrospective analysis was performed on the clinical data of 53 cases of cervical spondylosis patients admitted to the Department of Spine Surgery in our hospital from January,2018 to January,2020.There were 25 cases in Group A,who had an operation on single segment ACCFand 28 cases in Group B,who had an operation on two adjacent segments ACDF.The relevant parameters on lateral radiographs of cervical spine were measured before surgery and at the last follow-up after surgery,and the above data were statistically analyzed.Results There were statistically significant differences in C2-7 Cobb angle,SCobb,C2-7 SVA,T1S and NT between the two groups before and after surgery(P＜0.05).There was statistically significant difference in C2-7 SVA between the two groups at the last follow-up(P＜0.05),and there was statistically significant difference in T1s between the two groups before surgery and at the last follow-up(P＜0.05).There were statistically significant differences in VAS score and NDI index between the two groups in preoperative and final postoperative follow-up(P＜0.05).C2-7 Cobb angle was positively correlated with SCobb angle(r=0.644,P＜0.05)and T1S(r=0.417,P＜0.05),and negatively correlated with C2-7 SVA(r=-0.493,P＜0.05).Conclusion Both ACCF and ACDF anterior surgery methods can achieve good clinical efficacy in patients with cervical spondylosis by changing sagittal balance.The alteration effect of both methods on cervical sagittal balance is similar,and C2-7 Cobb angle is correlated with other cervical sagittal parameters.
目的 探讨自体脂肪间充质干细胞(adipose tissue mesenchymal stem cells,AT-MSC)联合透明质酸治疗盘源性腰痛的效果.方法 选择2018 年1 月～2019 年6 月在本院就诊的104 例CDLBP患者作为研究对象,采用随机数字表法将患者分为对照组和观察组各52 例.对照组给予射频热凝术治疗,观察组给予AT-MSC联合透明质酸(hyaluronic acid,HA)椎间盘内注射治疗.观察两组患者术后并发症发生率和有效率,观察两组患者术前、术后1～12 个月时的VAS评分、Oswestry功能障碍指数(Oswestry disability index,ODI).结果 术后1～12 个月时,两组患者VAS和ODI均较术前显著降低(P＜0.05);术后1 个月时,观察组VAS和ODI显著高于对照组(P＜0.05);术后3 个月、6 个月时,两组VAS和ODI差异无统计学意义(P＞0.05);术后9 个月、12 个月时,观察组VAS和ODI显著低于对照组(P＜0.05).观察组 12 个月时,VAS降低≥50%、ODI改善≥50%所占比例和有效率均显著高于对照组(P＜0.05).两组患者术后并发症发生率差异无统计学意义(P＞0.05).结论 AT-MSC治疗CDLBP具有良好的中远期效果,值得进一步研究探讨.
经椎间孔入路腰椎椎体间融合术(transforaminal lumbar interbody fusion, TLIF)术后邻近节段退变(adjacent seg-ment degeneration,ASD)发生率为 25％～40％ [1-2]. ASD 再手术治疗有一定难度,手术风险较高[3-4] . 本研究探讨经皮椎间孔内镜下椎间盘切除术(per-cutaneous transforaminal endoscopic dis-cectomy,PTED)治疗 TLIF 术后相邻节段腰椎间盘突出症(lumbar disc hernia-tion,LDH)的临床疗效.
Objective To investigate the effect of lumbar facet joint angle on foraminoplasty and postoperative efficacy in percutaneous endoscopic lumbar discectomy(PELD).Methods To investigate the effect of lumbar facet joint angle on foraminoplasty and postoperative efficacy in percutaneous endoscopic lumbar discectomy(PELD).Methods Sixty patients with L4-5 lumbar disc herniation(LDH)who underwent PELD surgery in our department from January 2017 to December 2020 were recruited in the study.The joint angle of the facet joint before surgery on CT films was measured and divided into three groups on average according to the degree.The number of cases requiring intervertebral foramina formation and the efficacy of the three groups were compared.Results The angle of facet joint in group A was 36-44.1(40.0±6.9)°,and the foraminoplasty was performed in 3 cases(20%of the group);the angle of facet joint in group B was44.2-52.3(47.2±5.6)°,with 13 cases of foraminoplasty(44.8%);the facet joint angle of group C was52.4-60.5(55.6±6.7)°,with11 cases of foraminoplasty(68.8%).Compared with before operation,the VAS score and ODI index of the three groups of patients were significantly improved at each time point after operation,and the difference was statistically significant(P＜0.05).There was no statistically significant difference between the groups(P＞0.05)The patients were divided into two groups according to whether the foraminoplasty was performed or not.The average operation time of the 27 cases in the foraminoplasty group was(52.32±12.05)min and the average intraoperative blood loss was(27.27±5.32)mL,and there was one case of postoperative complication.The average operation time of the 33 cases in the unformed intervertebral foramen group was(50.90±10.16)min,and the average intraoperative blood loss was(28.03±7.37)mL,and there was one case of postoperative complication.The difference was not statistically significant(P＞0.05).Conclusion In PELD surgery,the greater the lumbar facet joint angle,the higher the probability of foraminoplasty.Whether foraminoplasty is performed during the operation has no effect on the postoperative curative effect.
Objective To investigate the relationship between postoperative depression and anxiety symptoms and functional recovery of patients with degenerative lumbar spinal stenosis(DLSS).Methods Altogether 113 patients with DLSS who underwent surgery in our hospital from July 2019 to June 2021 were selected as the research objects.Anxiety(HADS-A)and depression(HADS-D)subscales of hospital anxiety and depression scale(HADS)were used to evaluate the anxiety and depression status of patients before and one month after operation.Lumbar spinal stenosis scale(SSS)was used to evaluate the symptoms and function of patients at baseline,6 months and 12 months after operation,and the relationship between HADS-A and HADS-D before and one month after operation and SSS symptoms and SSS function 12 months after operation was observed.Results The positive rate of preoperative anxiety was 47.79%,and the positive rate of depression was36.28%.The positive rate of anxiety one month after operation was30.09%,and the positive rate of depression was23.01%.The positive rates of anxiety and depression one month after operation were lower than those before operation,and the difference was statistically significant(P=0.006,0.029).Six and twelve months after operation,the SSS symptom score and SSS function score were significantly lower than those at baseline(P＜0.05).The SSS symptoms and SSS function of patients with preoperative depression,preoperative anxiety,postoperative depression and postoperative anxiety were higher than those of negative patients at baseline,6 months and 12 months after operation(P＜0.05).After balancing confounding factors,postoperative anxiety and depression were positively correlated with SSS symptoms and SSS function scores 12 months after operation(P＜0.05).Preoperative anxiety and depression were not significantly correlated with SSS symptoms and SSS function 12 months after operation(P＞0.05).Conclusion There is a correlation between postoperative depression and anxiety in patients with DLSS and their symptoms and functional status 12 months after operation.Early intervention should be considered for patients with persistent depression and anxiety after operation.
目的 探讨艾司氯胺酮在胸腰椎骨折手术后自控镇痛中的运用效果.方法 纳入2020 年12 月～2022 年12 月本院88 例胸腰椎骨折患者,均采用后路椎弓根螺钉内固定治疗,术后给予自控静脉镇痛(patient-controlled intravenous analgesia,PCIA).采用随机数字表法均分为两组,对照组PCIA药物为芬太尼,观察组在对照组基础上加用艾司氯胺酮.比较术后 3h、6 h、12 h、1 d、2 d时的NRS评分以及Ramsay镇静评分(Ramsay sedation score,RS),记录PCIA按压次数、首次下床时间等围术期指标以及不良反应发生情况.结果 两组术后6 h、12 h、1 d、2 d较术后3h的NRS评分、RS评分均逐渐降低,且观察组术后3 h、6 h、12 h、1 d的NRS评分、RS评分显著低于对照组(P＜0.05),术后 2d两组NRS评分、RS评分差异无统计学意义(P＞0.05);观察组PCIA按压次数、首次下床时间显著低于对照组(P＜0.05),术中出血量、手术时间、住院时间差异无统计学意义(P＞0.05);观察组恶心呕吐、呼吸抑制发生率显著低于对照组(P＜0.05),两组谵妄、皮肤瘙痒发生率差异无统计学意义(P＞0.05).结论 艾司氯胺酮用于胸腰椎骨折手术后PCIA,能够减轻疼痛症状、缩短下床时间,降低不良反应发生率.
Objective To study the prevalence and predictive factors of asymptomatic cervical spinal stenosis(ASCSS)in patients with symptomatic lumbar spinal stenosis(LSS).Methods A total of 233 patients with LSS diagnosed by MRI in our hospital from January 2018 to March 2022 were selected as the research objects.All patients underwent T2 weighted MRI of lumbar spine and cervical spine to evaluate the patients'redundant nerve roots(RNR),dural sac cross-sectional area(DCSA),facet joint angle(FJA),lumbar lordosis angle(LLA),pelvic angle of incidence(PI),torg-pavlov ratio(TPR)and lumbosacral transitional vertebra(LSTV).The prevalence and influencing factors of ASCSS were observed,and the correlation between cervical spinal stenosis index(CSI)and lumbar spinal canal stenosis index(LSI)was observed.Results Altogether 93 of 233 patients with LSS were diagnosed as ASCSS,accounting for 39.91%.There was no significant difference in age,sex,body mass index,Charlson comorbidity index(CCI),LSS segment,FJA and LSTV between ASCSS and non ASCSS patients(P＞0.05).The symptom time,RNR,DCSA,LLA and PI of the two groups were significantly higher than those of non ASCSS patients(P＜0.05).The C3-C6 segment TPR of ASCSS patients was lower than that of non ASCSS patients(P＜0.05),and there was no significant difference in C7 segment TPR between the two groups(P＞0.05).The sagittal diameter measured at C3 to C7 segments in ASCSS patients was lower than that in non ASCSS patients,and there was no statistically significant difference in sagittal diameter measured at C7 segment between the two groups of patients(P＞0.05)Multivariate logistic analysis showed that LLA≥37° and DCSA＜83.4mm2 were the risk factors for ASCSS(P＜0.05).Spearman correlation showed that there was a significant positive correlation between CSI and LSI(r= 0.530,P＜0.001).Conclusion LSS patients with increased LLA and decreased DCSA should undergo cervical MRI examination to rule out the presence of cervical lesions.
目的 分析Wiltse入路结合后正中入路行减压植骨内固定术对腰椎间盘突出症患者疗效及安全性的影响.方法 采取前瞻性对照研究,选择2017 年2 月～2019 年2 月于本院行减压植骨内固定术的 136 例腰椎间盘突出症患者作为研究对象,采用随机数字表法分为对照组和观察组各 68 例;对照组采用后正中入路,观察组采用Wiltse入路结合后正中入路进行手术.随访12 个月,记录围手术期各项信息、以血清肌酸激酶(creatine kinase,CK)、谷草转氨酶(aspartate aminotransferase,AST)作为观察指标,在不同时间点进行VAS评分和Oswestry功能障碍指数(Oswestry disability index,ODI)评价,比较两组术前及术后12 个月多裂肌MRI评分,计算多裂肌面积萎缩率.结果 观察组术后引流量和住院时间均明显少于对照组(P＜0.05);所有患者均获得随访,观察组术后1d的血清CK水平明显低于对照组(P＜0.05);观察组术后5d的VAS评分、ODI指数均明显低于对照组,术后12 个月多裂肌MRI评分及多裂肌面积萎缩率均明显低于对照组(P＜0.05).结论 Wiltse入路结合后正中入路行减压植骨内固定术治疗腰椎间盘突出症,在解除患者临床症状和保护椎旁肌方面具有优势,进而促进术后恢复,值得应用.
目的 探讨脊柱定点旋转复位手法联合中医药枕治疗颈型颈椎病的临床疗效.方法 使用随机数表法将2021 年12月～2022 年12 月在郑州中医骨伤病医院就诊的140 例颈型颈椎病患者分为对照组(n=70)和观察组(n=70).两组均接受常规治疗,对照组在此基础上接受脊柱定点旋转复位手法治疗,观察组在对照组基础上接受中医药枕治疗.比较两组治疗前后颈椎曲度、疼痛程度、颈椎功能及血流动力学指标水平.结果 治疗2 周、4 周后,两组Borden值均高于治疗前(P＜0.05),而VAS评分和颈椎功能障碍指数(neck disability index,NDI)均低于治疗前(P＜0.05),且观察组治疗2 周、4 周后的Borden值高于对照组(P＜0.05),而VAS评分和NDI评分低于对照组(P＜0.05);治疗 4 周后,两组基底动脉(basilar artery,BA)、左侧椎动脉(left vertebral artery,LVA)、右侧椎动脉(right vertebral artery,RVA)的平均血流速度(mean blood flow velocity,Vm)水平均高于治疗前(P＜0.05),且观察组治疗4 周后BA、LVA、RVA的Vm水平高于对照组(P＜0.05).结论 脊柱定点旋转复位手法联合中医药枕治疗可有效改善颈型颈椎病患者的血流动力学和颈椎曲度,对于缓解患者疼痛、提高患者颈椎功能有积极作用.
目的 探讨腰椎间盘突出症患者接受经皮经椎间孔镜椎间盘切除术(percutaneous transluminal endoscopic discectomy,PTED)手术前后的弥散张量成像(diffusion tensor imaging,DTI)评估结果,以及DTI结果与临床症状之间的关系.方法 共有51 例PTED手术患者接受研究,所有患者均于术前和术后3 个月进行MRI检查,观察患者常规MRI和DTI参数,通过DTI计算L4 至S1 神经有症状侧和无症状侧的分数各向异性(fractional Anisotropy,FA)、表观扩散系数(apparent diffusion coefficient,ADC),根据FA相关的纤维束成像,确定症状侧神经是否存在异常;采用逐步多元线性回归分析验证JOA评分与FA、ADC的相关性.结果 术后患者椎间孔中部矢状径、椎管横截面积和椎间孔面积均显著高于术前(P＜0.05).无症状侧术前、术后的FA和ADC值差异均无统计学意义(P＞0.05);症状侧术后近端、中间、远端FA值显著升高(P＜0.05);手术前后症状侧ADC值差异无统计学意义(P＞0.05).术前症状侧近端、中间和远端FA值低于无症状侧(P＜0.05),近端、远端ADC值高于无症状侧(P＜0.05).术前弥散张量纤维束成像(diffusion tensor fiber tractography,DTT)显示症状侧纤维束明显异常,术后DTT显示纤维束异常明显好转(P＜0.05).多元线性回归分析显示,JOA评分与术前症状侧近端和远端FA值存在相关性(P＜0.05),与中间FA值不存在相关性(P＞0.05);JOA评分与所有亚区ADC值均无相关性.结论 PTED术后受压神经根的FA值升高,且受压神经的FA值与临床症状密切相关,关节下区FA值可反映相应受压神经的显微结构变化.
Objective To investigate the effects of different fusion cages on the imaging and tissue trauma of lumbar spinal stenosis.Methods The clinical data of 76 patients with lumbar spinal stenosis admitted to the Affiliated Hospital of Chengde Medical College from January 2017 to December 2019 were collected and analyzed retrospectively.According to the types of interbody fusion cage,they were divided into titanium alloy group(n=38)and polyether ether ketone(PEEK)group(n=38).The titanium alloy and PEEK were printed by 3D printing technology respectively.The clinical efficacy,operation time,intraoperative blood loss,first ambulation time,complications and bone graft fusion rate of the two groups were counted,and the quantitative indexes of lumbar function,pain degree and trauma before and after operation were compared.Results(1)12 months after operation,the excellent and good rate of titanium alloy group was 89.74%,which had no significant difference compared with 87.18%in PEEK group(P＞0.05).(2)There was no significant difference in operation time,intraoperative blood loss and first ambulation time between the two groups(P＞0.05).(3)The JOA and VAS scores of the two groups were significantly improved 3 and 6 months after operation(P＜0.05),and there was no significant difference between the two groups 3 and 6 months after operation(P＞0.05).(4)24 hours after operation,the levels of serum CRP and CK in the two groups were higher than those before operation(P＜0.05).(5)There was no significant difference in the subsidence rate of the cage between the titanium alloy group and the PEEK group(P＞0.05).(6)There was no significant difference in the bone graft fusion rate between the titanium alloy group and the PEEK group 6 and 12 months after operation(P＞0.05).Conclusion Compared with PEEK fusion cage,3D printed titanium alloy fusion cage can reduce the sink rate of fusion cage in lumbar spinal stenosis and improve the interbody fusion rate in the same period,but there is no significant difference between them.
Objective To investigate the risk factors of cervical sagittal imbalance after posterior cervical decompression(PCDS).Methods The data of 251 patients with CSM and OPLL in three unit of grade two or above in our city were analyzed retrospectively.The patients'age,gender,height,body mass,body mass index(BMI),smoking history,drinking history,operation method,number of decompressed vertebral bodies,cervical instability,C2～C7 decompression,estimated blood loss,operation time,length of hospital stay,modified Japanese Orthopaedic Association(mJOA)score,standing position X-ray parameters and incidence of cervical sagittal imbalance were collected.Standing position X-ray film parameters included T1 slope(T1S),cervical lordosis(CL),TS-CL,C2-7 SVA,McGregor slant(MCGS),etc.Patients were divided into preoperative non cervical sagittal imbalance(NCSI)group,preoperative cervical sagittal imbalance(CSI)group,postoperative cervical sagittal imbalance(PCSI)and non postoperative cervical sagittal imbalance(NPCSI)group according to the presence or absence of cervical sagittal imbalance.The risk factors affecting PCSI were observed.Results There were significant differences in smoking and cervical instability between CSI and NCSI groups(P＜0.05).The levels of T1S,TS-CL,C2-7 SVA and MCGS in CSI group were higher than those in NCSI group(P＜0.05),and the level of CL was lower than that in NCSI group(P＜0.05).The levels of T1S and mJOA in CSI group increased one year after operation(P＜0.05),and the level of CL decreased(P＜0.05).In NCSI group,CL decreased one year after operation(P＜0.05),and the levels of TS-CL,C2-7 SVA and mJOA increased(P＜0.05).One year after operation,T1S,TS-CL and C2-7 SVA in CSI group were higher than those in NCSI group(P＜0.05),and the level of CL was lower than that in NCSI group(P＜0.05).There were significant differences in the number of decompressed lamina,C2 decompression,C5 nerve root paralysis and hospital stay between PCSI and NPCSI groups(P＜0.05).One year after operation,CL in patients with PCSI was significantly lower than that before operation,and TS-CL,C2-7 SVA and mJOA were significantly higher than those before operation(P＜0.05).One year after operation,T1S and Cl in patients with NPCSI were significantly lower than those before operation(P＜0.05),and C2-7 SVA and mJOA were significantly higher than those before operation(P＜0.05).One year after operation,TS-CL and C2-7 SVA in patients with PCSI were higher than those in patients with NPCSI,and MCGS was lower than that in patients with NPCSI(P＜0.05).Multivariate logistic analysis showed that C2 or C7 decompression and C2-7 SVA≥30 mm were the significant influencing factors of PCSI(P＜0.05).Conclusion C2 or C7 decompression and C2-7 SVA≥30 mm are the significant influencing factors of PCSI.Clinicians should reasonably arrange the operation mode according to the situation of patients.
目的 探讨腰椎后路手术后引流量的影响因素.方法 本研究对象为2019 年1 月～2019 年12 月本院 145 例腰椎后路手术患者,分析不同性别、年龄、手术节段数患者引流量的差异,并经多元逐步线性回归分析得出腰椎后路手术后引流量的影响因素.结果 145 例患者术后平均引流量为(351.60±37.90)mL.是否合并糖尿病、使用氨甲环酸、自体血回输,不同疾病种类、多裂肌浸润程度和手术节段数患者的术后引流量差异显著(P＜0.05),不同性别、是否合并高血压术后引流量差异不显著(P＞0.05);年龄、手术时间、引流时间、术中出血量与术后引流量呈正相关关系(P＜0.05).多裂肌脂肪浸润＞50%、手术节段数≥3 个、使用氨甲环酸、自体血回输、术中出血量、特发性腰椎侧凸,均是腰椎后路手术后引流量的影响因素(P＜0.05).结论 腰椎后路手术后引流量较多,应根据多裂肌浸润、手术节段数等影响因素采取针对性措施以降低引流量,以促进早期康复.
Objective To construct the iRGD modified nanoparticles(NPs)loaded with Juglone(Jug)and paclitaxel(PTX)and evaluate their inhibitory effect on human osteosarcoma cell line Saos-2.Methods iRGD-PLGA-(Jug,PTX)NPs were prepared by emulsification method,and their material properties,drug loading capacity,and in vitro release results were evaluated.The uptake of iRGD-PLGA-(Jug,PTX)-NPs in vitro was observed using a fluorescence microscope,then the inhibitory effects of each group on the proliferation of Saos-2 cells were compared using MTT method.Results ①Under the conditions of Jug:PTX=0.1 mg:0.1 mg,iRGD-PLGA=1 mg,iRGD-PLGA-(Jug,PTX)-NPs were successfully prepared.②Under transmission electron microscopy,the size of the nanoparticles was uniform,with a particle size of 233.3 nm.The drug loading rate of Jug was8.68%,the encapsulation rate was 31.87%,the drug loading rate of PTX was 8.98%,and the encapsulation rate was 30.18%.③In vitro drug release experiment displayed that nanoparticles exhibited slow release characteristics.After 96 hours,the cumulative release of Jug was 72.108±1.243%,and the PTX was(69.980±3.626)%.④Cell uptake experiments showed that iRGD modified nanoparticles entered cells more frequently than unmodified particles.⑤The MTT results showed that both Jug and PTX inhibited the proliferation of Saos-2 cells in a dose-dependent manner.After 24 hours of drug treatment,the inhibition rate of the naked drug group was significantly higher than that of the other groups,while after 48 hours,the inhibition rate of iRGD-PLGA-(Jug,PTX)-NPs was higher than that of the naked drug group.Conclusion iRGD-PLGA-(Jug,PTX)NPs have good stability,and the loaded drug bears slow release characteristics,and the iRGD modification has significant inhibitory effect on human osteosarcoma cell line Saos-2.
Objective To establish a finite element(FE)model of L1-S1 segment to analyze the effect of facetoplasty on lumbar biomechanics during transforaminal endoscopic surgery.Methods CT data of the lumbar spine were obtained from a volunteer without lumbar history.A FE model of the normal L1-S1 segment was created and the validity was verified.L4-5 disc herniation model(M1),5 mm facetoplasty model(M2)and 7.5 mm facetoplasty model(M3)were established.The degree of L4 vertebral displacement,pressure changes in the L3-4,L4-5,and L5-S1 intervertebral discs,and stress changes in the L4-5 facet joints of the three groups of models were analyzed under six conditions.Results The finite element model developed in this study was effective.The M2 and M3 models of the left synchondral joint of L4-5 showed a decrease in stress compared to the M1 model in forward flexion;the M2 and M3 models displayed a greater stress than the M1 model in left lateral flexion;the M2 and M3 models of the right synchondral joint of L4-5 showed an increase in their stress compared to the M1 model in forward flexion;the M3 model presented a higher stress than the M2 model,and the M2 model showed a higher stress than the M1 model in left rotation;in posterior extension,the M3 model of the disc of L4-5demonstrated a greater stress than the M2 model;in right rotation,the M3 model of that disc showed a greater stress than the M2 model and the M2 model of that disc displayed a greater stress than the M1 model.The L4-5 intervertebral disc stress was greater in the M3 model than in the M1 and M2 models in the posterior extension condition;in the right rotation condition,the disc stress was greater in the M3 model than in the M2 model,and in the M2 model than in the M1 model.Conclusion In this study,the 7.5 mm facet arthroplasty is found to increase the stress of facet joints and segmental intervertebral discs in left flexion or left rotation,which may lead to disc degeneration at the operated level but does not cause degeneration at the adjacent level.
