Objective: To evaluate the safety and efficacy of percutaneous transforaminal endoscopic decompression (PTED) under local anesthesia in frail elderly patients (≥ 75 years) with severe lumbar spinal stenosis (LSS).Methods: Forty-one patients (mean age: 82.4 ± 4.2 years) with severe central LSS (MRI grade ≥ 3), lateral recess stenosis (grade II in 38 cases), advanced disc degeneration (Pfirrmann IV–V), and frailty (score ≥ 3) underwent unilateral PTED. Outcomes included operative time, hospitalization duration, clinical metrics (VAS, ODI, Barthel Index), radiological improvements (dural sac cross-sectional area [DSCA], stenosis grading), and complications.Results: Mean operative time was 100.6 ± 19.2 minutes, with a postoperative hospital stay of 3.85 ± 1.21 days. At final follow-up (20.1 ± 4.2 months), significant improvements were observed: VAS back pain decreased from 3.65 ± 0.48 to 2.43 ± 0.50 (p < 0.01), VAS leg pain from 6.51 ± 0.50 to 2.07 ± 0.41 (p < 0.001), ODI from 67.2 ± 8.1 to 26.7 ± 6.9 (p < 0.001), and Barthel Index from 54.2 ± 8.2 (moderate disability) to 77.8 ± 6.12 (near independence) (p < 0.001). Radiologically, the dural sac cross-sectional area (DSCA) increased from 53.5 ± 21.2 mm² preoperatively to 70.8 ± 25.1 mm² postoperatively (p < 0.001). Lateral recess stenosis resolved in 90.2% of cases (IQR: 0 [0–1]), and foraminal stenosis improved in 68.3% (IQR: 1 [1–1]). Complications included residual leg pain (9.8%), deep vein thrombosis (4.9%), and no reoperations.Conclusions: PTED under local anesthesia is a safe and effective minimally invasive strategy for frail elderly patients with severe LSS, providing durable symptom relief and functional restoration. Lateral recess decompression is critical for optimal outcomes. Larger prospective studies are warranted to validate these findings.

Objective Our study aimed to develop a day anterior cervical discectomy and fusion (ACDF) procedure to treat degenerative cervical spondylosis (DCS). The goal was to analyze its clinical implications, safety, and early effects to provide a better surgical option for eligible DCS patients. Methods A retrospective analysis was performed to identify DCS patients who underwent day ACDF from September 2022 to August 2023. The operative time, intraoperative blood loss, postoperative drainage, preoperative and postoperative visual analog scale (VAS) scores, neck disability index (NDI) scores, Japanese Orthopedic Association (JOA) scores, JOA recovery rate (RR), incidence of dysphagia-related symptoms, 30-day hospital readmission rate, and incidence of other complications were recorded to evaluate early clinical outcomes. Radiography was performed to assess the location of the implants, neurological decompression, and cervical physiological curvature. Results All 33 patients (23 women and 10 men) underwent successful surgery and experienced significant symptomatic and neurological improvements. Among them, 26 patients underwent one-segment ACDF, 5 underwent two-segment ACDF, and 2 underwent three-segment ACDF. The average operative time was 71.1 ± 20.2 min, intraoperative blood loss was 19.1 ± 6.2 mL, and postoperative drainage was 9.6 ± 5.8 mL. The preoperative VAS and NDI scores improved postoperatively (7.1 ± 1.2 vs. 3.1 ± 1.3 and 66.7% ± 4.8% vs. 24.1% ± 2.5%, respectively), with a significant difference ( P < 0.01). Moreover, the preoperative JOA scores improved significantly postoperatively (7.7 ± 1.3 vs. 14.2 ± 1.4; P < 0.01) with an RR of 93.9% in good or excellent. Postoperative dysphagia-related symptoms occurred in one patient (3.0%). During the follow-up period, no patient was readmitted within 30 days after discharge; however, an incisional hematoma was reported in one patient on the 6th day after discharge, which was cured by pressure dressing. The postoperative radiographs revealed perfect implant positions and sufficient nerve decompression in all patients. Furthermore, the preoperative cervical physiological curvature improved significantly after the operation (14.5° ± 4.0° vs. 26.3° ± 5.4°; P < 0.01). Conclusions Day ACDF has good safety and early clinical efficacy, and it could be an appropriate choice for eligible DCS patients.

This was a single-centre retrospective study. Minimally invasive techniques for transforaminal lumbar interbody fusion (MIS-TLIF), oblique lumbar interbody fusion (OLIF), and percutaneous endoscopic transforaminal lumbar interbody fusion (Endo-TLIF) have been extensively used for lumbar degenerative diseases. The present study analyses the short-term and mid-term clinical effects of the above three minimally invasive techniques on L4/L5 degenerative spondylolisthesis. In this retrospective study, 98 patients with L4/L5 degenerative spondylolisthesis received MIS-TLIF, 107 received OLIF, and 114 received Endo-TLIF. All patients were followed up for at least one year. We compared patient data, including age, sex, body mass index (BMI), Oswestry disability index (ODI), visual analogue scale of low back pain (VAS-B), visual analogue scale of leg pain (VAS-L), surgical time, blood loss, drainage volume, hospital stay, complications, and neurological status. Moreover, we performed imaging evaluations, including lumbar lordosis angle (LLA), disc height (DH) and intervertebral fusion status. No significant differences were noted in age, sex, BMI, preoperative ODI, preoperative VAS-B, preoperative VAS-L, preoperative LLA, or preoperative DH. Patients who underwent OLIF had significantly decreased blood loss, a lower drainage volume, and a shorter hospital stay than those who underwent MIS-TLIF or Endo-TLIF (P < 0.05). The VAS-B in the OLIF group significantly decreased compared with in the MIS-TLIF and Endo-TLIF groups at 6 and 12 months postoperatively (P < 0.05). The VAS-L in the Endo-TLIF group significantly decreased compared with that in the MIS-TLIF and OLIF groups at 6 months postoperatively (P < 0.05). The ODI in the OLIF group was significantly better than that in the MIS-TLIF and Endo-TLIF groups at 6 months postoperatively (P < 0.05). No statistically significant differences in the incidence of complications and healthcare cost were found among the three groups. Follow-up LLA and DH changes were significantly lower in the OLIF group than in the other groups (P < 0.05). The intervertebral fusion rate was significantly higher in the OLIF group than in the other groups at 6 and 12 months postoperatively (P < 0.05). In conclusion, while MIS-TLIF, OLIF, and Endo-TLIF techniques can effectively treat patients with L4/5 degenerative spondylolisthesis, OLIF has more benefits, including less operative blood loss, a shorter hospital stay, a smaller drainage volume, efficacy for back pain, effective maintenance of lumbar lordosis angle and disc height, and a higher fusion rate. OLIF should be the preferred surgical treatment for patients with L4/5 degenerative spondylolisthesis.

Background The clinical applications of endoscope-assisted transoral release for irreducible atlantoaxial dislocations are limited. This study aimed to investigate the clinical effect and prognostic factors of traditional and endoscope-assisted transoral release, as well as posterior reduction and fixation, in treating irreducible atlantoaxial dislocations. Materials and Methods We conducted a retrospective study on 59 patients with irreducible atlantoaxial dislocation who underwent either traditional or endoscope-assisted transoral release, posterior fixation, and fusion between January 2018 and January 2023. Various data, including surgical time, blood loss, drainage volume, oral intake, hospital stay, complications, and neurological status (assessed by the Japanese Orthopedic Association [JOA] score and Oswestry Disability Index [ODI]), were recorded. Imaging parameters such as the atlantodontoid interval (ADI), space available for the cord (SAC), and cervicomedullary angle (CMA) were analyzed and compared. In addition, the correlation between ODI, JOA and patient age, course of disease, preoperative ADI, SAC and CMA were analyzed. Results No significant differences were observed in age, sex, BMI, preoperative ADI, preoperative SAC, or preoperative CMA. All patients achieved excellent reduction with no significant differences between the two groups. Patients in the endoscopic group experienced significantly reduced blood loss, earlier oral intake, and shorter hospital stays compared to those in the open group (P < 0.05). The ODI and JOA scores improved significantly in both groups at 1, 6, 12, 18, and 24 months postoperatively (P < 0.05). Postoperative ADI, SAC, and CMA values in both groups were significantly better than preoperative values (P < 0.001). The patient age, course of disease and the preoperative ADI were negatively correlated with the postoperative ODI and the JOA improvement ratio (P<0.01), and the preoperative SAC and preoperative CMA had positive correlations with the postoperative ODI and the JOA improvement ratio (P < 0.01) at 6, 12 and 24 months postoperatively. Conclusion Patient age, course of disease, preoperative ADI, SAC and CMA are correlated with the operative prognosis of irreducible atlantoaxial dislocation. The endoscope-assisted transoral approach, compared to the traditional transoral approach, is minimally invasive, resulting in less operative blood loss, earlier oral intake and a shorter length of hospital stay, which could be offered as an alternative for irreducible atlantoaxial dislocation.

目的 比较颈椎零切迹椎间融合器与传统颈前路减压植骨融合内固定(ACDF)手术治疗颈椎病的疗效.方法 选取 2017 年 5 月至 2021 年 4 月在遂宁市中心医院脊柱外科接受手术治疗的 116 例单节段脊髓型颈椎病患者作为研究对象,采用随机数字表法将患者分为研究组和对照组各 58 例,研究组患者采用颈前路颈椎零切迹椎间融合器实施手术治疗,对照组患者采用传统ACDF手术实施治疗.比较两组患者的手术时间、出血量、住院时间;比较两组患者手术前后的影像学参数(椎间隙高度、Cobb角、颈椎曲度指数)、视觉模拟疼痛评分(VAS)、日本骨科协会(JOA)评分及手术并发症发生率.结果 研究组手术时间少于对照组(P＜0.05),两组患者出血量、住院时间无明显差异(P＞0.05).两组患者术前、术后 3个月、术后 6个月的椎间隙高度、Cobb角、颈椎曲度指数均无明显差异(P＞0.05);术后 3 个月、6 个月,两组患者的椎间隙高度、Cobb角、颈椎曲度指数均较术前显著升高(P＜0.05).两组患者术前VAS评分、JOA评分无显著差异(P＞0.05);术后 3 个月、术后 6 个月研究组患者JOA评分均高于对照组(P＜0.05),VAS评分两组间无差异(P＞0.05);术后 3 个月和 6 个月,两组患者的VAS评分均较术前降低(P＜0.05),JOA评分均较术前升高(P＜0.05);研究组患者术后发生并发症 3 例(5.17%),对照组患者术后发生并发症 6 例(10.34%),两组间无统计学差异(P＞0.05).结论 颈椎零切迹椎间融合器与传统ACDF手术治疗单节段脊髓型颈椎病均能取得较好的临床效果,颈椎零切迹椎间融合器治疗方式能取得更好的恢复效果.

目的:探究将颈前路椎间盘切除融合术(anterior cervical discectomy and fusion,ACDF)治疗颈椎退变性疾病(cervical degenerative diseases,CDD)纳入日间管理模式的安全性及早期疗效.方法:回顾性分析2022年9月～2023年3月接受日间ACDF手术治疗的12例CDD患者.其中,女性10例,男性2例,年龄53.7±8.6岁(36～67岁),单节段手术8例,双节段手术4例.记录手术时间、术中出血量、术后引流量、出院后30d再入院率及并发症、患者就医满意度等,评价手术安全性及早期临床结果.术前和出院当日采用视觉模拟评分量表(visual analogue scale,VAS)、颈椎功能障碍指数(neck disability index,NDI)、日本骨科协会(Japanese Orthopedic Association,JOA)评分及JOA评分改善率(recovery rate,RR)评估患者疼痛改善情况及神经功能.术后2d,拍摄颈椎X线片、CT及MRI以评估置入物的位置、神经减压情况和颈椎生理曲度.结果:12例患者均手术成功,随访时间2.5±0.8个月(1～6个月),患者疼痛症状及神经功能均有明显改善.手术时间为71.3± 20.5min,术中出血量为 14.6±8.4mL,术后引流量为 8.8±7.3mL.出院当日 VAS(2.1±0.9 分)、NDI[(22.4±3.5)％]、JOA 评分(14.3±1.1 分)较术前 VAS(6.6±1.7 分)、NDI[(66.3±4.7)％]、JOA 评分(8.3±1.3 分)分别明显改善(P＜0.05),JOA评分RR为100％.术后1例患者出现轻度吞咽困难(8.3％),未经特殊处理,症状自行消失.随访期间,无出院后30d内再入院病例,1例患者出院后6d出现切口血肿,患者无呼吸及吞咽困难,经专科检查评估后行加压包扎,4d后自愈.所有患者术后影像学检查显示置人物位置理想,神经减压充分,术后颈椎生理曲度(28.7°±2.0°)较术前(15.7°±4.6°)明显改善(P＜0.05).结论:日间ACDF的安全性及早期疗效较为满意,可为合适的CDD患者提供一种新的手术模式选择.

目的 比较改良Wiltse入路椎弓根螺钉内固定术与经皮椎弓根螺钉内固定术对AO分型B型胸腰椎骨折患者应激反应、腰背功能恢复等的影响效果.方法 采用随机数表法将103例AO分型B型胸腰椎骨折患者分为经皮组(采用经皮椎弓根螺钉内固定术)51例与改良组(采用改良Wiltse入路椎弓根螺钉内固定术)52例,比较2组手术情况、腰背功能恢复情况[术前、术后1个月、术后3个月评估Oswestry功能障碍指数(ODI)评分]、应激反应[术前、术后3 d检测血清皮质醇(Cor)、肾上腺素(E)与肌酸激酶(CK)水平]、影像学检查相关指标[术前、术后1年检测椎后凸Cobb角、伤椎椎体前缘高度比(AVHR)]和疼痛程度[术前、术后1周、术后1个月评估视觉模拟评分法(VAS)评分].结果 改良组手术时间、术中透视时间均短于经皮组,术中出血量少于经皮组,差异有统计学意义(P＜0.05);术后1、3个月时,2组ODI评分均低于术前,且改良组低于经皮组,差异有统计学意义(P＜0.05);术后3 d时,2组血清Cor、E、CK水平均高于术前,但改良组血清Cor、E、CK水平均低于经皮组,差异有统计学意义(P＜0.05);术后1年时,2组Cobb角小于术前,AVHR大于术前,且改良组AVHR大于经皮组,差异有统计学意义(P＜0.05);术后1周、1个月时,2组VAS评分均低于术前,且改良组低于经皮组,差异有统计学意义(P＜0.05).结论 相较于经皮椎弓根螺钉内固定术,改良Wiltse入路椎弓根螺钉内固定术治疗AO分型B型胸腰椎骨折有利于缩短手术时间、术中透视时间,减轻机体应激反应,对促进患者术后腰背功能与生理解剖结构恢复和减轻疼痛程度具有重要意义.

目的 探讨椎间孔镜经横突间入路治疗L5-S1椎间孔外型腰椎间盘突出症的可行性及临床疗效.方法 本组共12例患者,其中男7例,女5例,年龄56～72岁,平均58.5岁,均行椎间孔镜经横突间入路髓核摘除,采用腰腿痛VAS评分评价手术疗效,末次随访时采用改良MacNab标准评价手术优良率.结果 12例患者手术均顺利完成,术后随访9～18个月,平均12.5个月.所有患者腰痛、腿痛VAS评分均较术前明显降低,术后随访与术前比较差异均有显著性(P<0.01).末次随访时采用改良MacNab评定标准评估疗效,术后优良率为91.67％.结论 椎间孔镜经横突间入路治疗L5-S1椎间孔外型腰椎间盘突出症,操作性好、手术创伤小,临床疗效确切.

目的 探讨SRS-Schwab Ⅳ级截骨术治疗胸腰段创伤性后凸畸形(post-traumatic thoracolumbar kyphosis,PTK)患者的疗效.方法 回顾性分析2014年1月～2019年1月本院采用SRS-Schwab Ⅳ级截骨术治疗的90例PTK患者临床资料,记录手术时间、术中出血量、随访情况、并发症发生情况、生活质量,以及术前、术后2周和术后24个月时的影像学参数和临床指标.结果 手术时间140～235 min,平均(208.40±53.17)min,术中出血量为400～1200mL,平均(621.54±80.26)mL;术后切口均愈合良好.随访12～24个月,平均(12.53±2.16)个月,患者均获得良好的骨性融合.术后2周和术后24个月时胸椎后凸角(thoracic kyphotic,TK)、腰椎前凸角(lumbar lordosis,LL)、骶骨倾斜角(sacral slope,SS)显著高于术前,胸腰段Coob角、矢状面平衡距离(sagittal vertical axis,SVA)、骨盆倾斜角(pelvic tilt,PT)显著低于术前(P<0.05);且末次随访时胸腰段Coob角、TK、PT、SVA显著高于术后2周,SS、LL显著低于术后2周(P<0.05).术后2周和术后24个月时VAS评分、ODI指数显著低于术前,且术后24个月时VAS评分、ODI指数显著低于术后2周(P<0.05).术后24个月时,患者SRS-22评分中的疼痛、心理状况、自我形象、功能状况及对治疗的满意度评分显著高于术前(P<0.05).3例患者出现并发症,2例麻痹性肠梗阻,1例双下肢短暂麻木,均给予对症支持治疗后恢复;所有患者随访期间未出现内固定松动、断裂等情况.结论 SRS-Schwab Ⅳ级截骨术治疗PTK患者疗效显著,可缓解疼痛程度,改善功能障碍,恢复矢状面平衡,提高生活质量,且安全性较高.

AbstractObjectiveTo investigate the protective effect and mechanism of shikonin on human intervertebral disk degeneration.MethodsHuman primary nucleus pulposus (NP) cells cultured in vitro were used for the experiments. The effects of different concentrations of shikonin (1, 2, 4, 8, and 16 µM) on the activity of lipopolysaccharide (LPS)‐induced NP cells were determined using the CCK‐8 assay, and the appropriate drug concentration was determined. The experiment was divided into the control, LPS, and LPS + shikonin groups. ELISA and Western blot were used to detect the expression of the inflammatory factors tumor necrosis factor (TNF)‐α and interleukin (IL)‐1β. NP cell apoptosis was measured using Western blot and caspase 3 activity. Western blot and immunofluorescence assays were used to detect the protein expression of p‐P65 and P65 and the nuclear translocation of P65.ResultsThe CCK‐8 assay showed that shikonin had no cytotoxic effect on NP cells and increased the activity of LPS‐induced NP cells, especially at a concentration of 4 μM. Shikonin reversed the expression of the inflammatory cytokines TNF‐α and IL‐1β and apoptosis‐related molecules Bax, Bcl‐2, and cleaved caspase 3 in LPS‐induced NP cells. In addition, shikonin significantly decreased apoptosis and caspase‐3 activity in LPS‐induced NP cells. Furthermore, shikonin treatment significantly inhibited the expression of p‐P65 and nuclear translocation of P65, and nuclear factor‐kappa B (NF‐κB) pathway inhibitor Pyrrolidinedithiocarbamate ammonium (PDTC) significantly enhanced the anti‐inflammatory and antiapoptotic effects of shikonin in LPS‐induced NP cells.ConclusionShikonin significantly inhibited the inflammatory response and apoptosis of human primary NP cells, possibly through the NF‐κB pathway.

Background Percutaneous endoscopic lumbar discectomy (PELD) is satisfactory for hospitalized patients with lumbar disc herniation (LDH). Currently, only a few studies have reported about the day surgery patients undergoing PELD. Methods A total of 267 patients with LDH underwent PELD during day surgery and were followed up for at least 3 years. Clinical outcomes were assessed using the visual analog scale (VAS) for leg and lower back pain (VAS-B and VAS-L, respectively) and the Oswestry disability index (ODI). The radiological outcomes, such as lumbar lordosis (LL), sacral slope (SS), the disc-height ratio, and disc instability, were recorded and compared. The clinical effects between patients treated by PELD during day surgery and microendoscopic discectomy (MED) for contemporaneous hospitalized 116 patients with LDH were compared. Results Patients treated by PELD had lower blood loss and shorter hospital stay ( P < 0.001) compared to those treated by MED. VAS-L, VAS-B, and ODI decreased significantly after PELD than before the operation and 3 years postoperatively. The postoperative VAS-B in the PELD group was significantly decreased than in the MED group ( P = 0.001). The complications rate was 9.4% in the PELD group and 12.1% in the MED group ( P = 0.471). The 1-year postoperative recurrence rate in the PELD group was much higher than that in MED group ( P = 0.042). The postoperative LL and SS in the PELD group improved significantly compared to the values in the MED group ( P < 0.001). According to the disc-height ratio at 3-year follow-up, a significant height loss was observed in the MED group than in the PELD group ( P = 0.014). Conclusions Although the 1-year postoperative recurrence rate was relatively high, the day surgery for LDH undergoing PELD had advantages in terms of less blood loss intraoperatively, short hospital stay, efficacy for back pain, and efficiency to maintain lumbar physiological curvature.

目的:探讨改良椎管扩大成形术和后路椎弓根螺钉固定术对脊柱椎管肿瘤病人围手术期指标、术后神经功能改善和脊柱稳定性的影响.方法:选取128例脊柱椎管肿瘤病人的临床资料行回顾性分析,其中行改良椎管扩大成形术75例(A组),行后路椎弓根螺钉固定术53例(B组).比较2组病人手术时间、术中出血量、术后脑脊液漏发生率等围手术期指标、术后3、6、12个月JOA评分、JOA评分改善率及脊柱不稳发生率.结果:A组病人的手术时间、术中出血量、术后脑脊液漏发生率显著低于B组(P<0.05～P<0.01).2组病人术后JOA评分显著增高(P<0.01);A组病人术后3、6、12个月JOA评分和JOA评分改善率显著低于B组(P<0.01).2组病人术后3、6、12个月腰椎不稳发生率差异无统计学意义(P>0.05).结论:相对后路椎弓根螺钉固定术,改良椎管扩大成形术可缩短脊柱椎管肿瘤病人的手术时间,减少术中出血量及术后脑脊液漏发生率.上述两种术式均具有较好的术后脊柱稳定效果,但后路椎弓根螺钉固定术创伤大、出血多,影响脊柱固定节段的活动度,临床上应根据病人具体情况选择最佳方案.

目的:探讨超声微泡联合骨髓间充质干细胞(BMSCs)移植对脊髓损伤大鼠的神经保护作用.方法:采用Allen's打击法构建SD大鼠脊髓损伤模型并分组进行对应处理,术后进行BBB评分,HE染色和尼氏染色检测脊髓组织与尼氏小体形态变化,ELISA检测炎症因子水平,免疫荧光染色和qRT-PCR检测神经相关因子与凋亡相关因子表达.结果:与模型组比较,超声微泡组、BMSCs组和超声微泡+BMSCs纽术后第7天和第21天BBB评分增加,脊髓组织病理损伤减轻,尼氏小体形态得到改善,炎症反应减轻,Nestin,GFAP表达及BDNF,NT3,Bcl-2 mRNA表达升高,Bax,Caspase-3 mRNA表达下降,差异有统计学意义(P＜0.05),且超声微泡和BMSCs联用效果更佳.结论:超声微泡联合BMSCs移植能够对脊髓损伤大鼠发挥神经保护的作用.

目的 探讨紫草素对IL-1β人椎间盘髓核细胞凋亡的影响及机制.方法 体外培养人椎间盘髓核细胞,采用CCK-8检测紫草素对髓核细胞毒性及IL-1β诱导的髓核细胞活性的影响.实验分为对照组、IL-1β处理组和IL-1β+紫草素处理组,hochest 33258染色和流式细胞术Annexin V/PI双染法检测髓核细胞的凋亡水平,Western blot实验检测各组髓核细胞凋亡蛋白cleaved caspase 3和Bax、抗凋亡蛋白Bcl-2的表达水平,及各组髓核细胞PI3K和AKT蛋白的表达水平.结果 紫草素浓度在5、10、15 μM时对髓核细胞活性没有毒性,且10 μM时对IL-1β诱导的髓核细胞活性增加最明显,因此,选择浓度为10 μM的紫草素进行后续实验.紫草素可明显降低IL-1β诱导的髓核细胞凋亡水平;降低IL-1β诱导的髓核细胞的凋亡蛋白cleaved caspase 3和Bax,增加抗凋亡蛋白Bcl-2的表达;亦能明显增加IL-1β诱导的髓核细胞内p-PI3K和p-AKT蛋白表达.结论 紫草素能抑制IL-1β诱导的人髓核细胞凋亡水平,其机制可能是通过PI3K/AKT通路发挥作用.

目的 研究小切口开放经椎间孔腰椎椎体间融合术(MA-OTIF)与微创经椎间孔入路腰椎椎体间融合术(MIS-TLIF)治疗对老年性腰椎退行性病变疗效和脊柱形态的影响.方法 选取2016年3月至2018年1月本院收治的老年性腰椎退行性病变患者90例为研究对象,根据治疗方法的不同分为MA-OTIF组和MIS-TLIF组,每组45例.比较两组患者的手术时间,术中出血量,术后引流量,住院时间,术后卧床时间,术前和术后7d、1个月、12个月的视觉模拟评分(VAS),Oswestry功能障碍评分(ODI),并发症发生率,随访12个月,观察两组患者椎间植骨融合率、脊柱侧弯情况.结果 与MIS-TLIF组比较,MA-OTIF组手术时间更短,X线曝光次数更少(P均＜0.05),而术中出血量、术后引流量、住院时间、术后卧床时间、并发症发生率差异无统计学意义(P均＞0.05);两组术后7d、1个月、12个月的VAS评分和ODI评分均较术前降低(P＜0.05),但两组间比较差异无统计学意义(P＞0.05);随访12个月,两组患者椎间植骨融合率、脊柱侧弯发生率差异均无统计学意义(P均＞0.05).结论 MA-OTIF与MIS-TLIF治疗老年性腰椎退行性病变疗效相当,但MA-OTIF手术时间更短,X线曝光次数更少.

目的:探讨三维重建用于侧方入路椎间孔镜治疗腰4/5椎间盘突出症精准定位的应用价值.方法:选取2015年7月至2017年10月遂宁市中心医院收治的58例L4/5 LDH患者,均行侧方入路椎间孔镜下髓核摘除术.采用随机分组方法,分为实验组(29例)与对照组(29例).实验组采用三维重建技术辅助穿刺,对照组参照既往经验穿刺.分析两组手术时间、穿刺次数、术中透视次数及术后并发症.采用疼痛视觉模拟评分(VAS)评估两组患者疼痛缓解情况;采用Oswestry功能障碍指数(ODI)评定腰椎功能改善情况.结果:所有患者均成功完成手术.症状较术前改善.实验组在手术时间、穿刺次数及透视次数与对照组比较有统计学意义(P<0.05),两组患者在VAS评分及Oswestry功能障碍指数差异比较无统计学意义(P>0.05).结论:三维重建技术可辅助用于侧路经皮椎间孔镜腰4/5髓核摘除术中精准穿刺定位,缩短穿刺操作时间,减少放射性损伤,提高手术安全性.

Abstract Background: Although numerous studies have shown good clinical results of percutaneous endoscopic lumbar discectomy (PELD) for hospitalized patients with lumbar disc herniation (LDH), there are few articles that report on the day surgery patients undergoing PELD.Methods: Atotal of 267 patients with LDH received PELD during day surgery were followed up for at least 3 years. Relevant data and clinical outcomeswere recorded and assessed. Meanwhile, we compared the clinical effects between patients treated by PELD during day surgery and microendoscopic discectomy (MED) for contemporaneous hospitalized patients with LDH (116 patients).Results: Patients treated by PELD had lower blood loss (10.8 ± 4.1 mL, 71.3 ± 23.3 mL,respectively; P < 0.001) and shorter hospital stay ( 22.7 ± 4.2 hours, 48.1 ± 22.6 hours, respectively; P < 0.001 ) compared with patients treated by MED. The visual analogue scale (VAS) for leg and back pain (VAS-L and VAS-B, respectively) and Oswestry disability index (ODI) decreased significantly after PELD than those before the operation at 3 years postoperative, and the postoperative VAS-B in PELD group was significantly decreased from the MED group ( P = 0.001). The complications rate was 9.4% (25/267) in the PELD group and 12.1% (14/116) in the MED group, without significant difference ( P = 0.471). The 1-year postoperative recurrence rate in PELD group ( 5.2%, 14/267) was much higher than that in MED group ( 0.9%, 1/116) ( P = 0.042). The postoperative lumbar lordosis（LL）(34.0 ±10.3 ), and sacral slope（SS) (27.5 ± 5.6) in PELD group improved significantly compared with the values in MED group (26.9 ± 9.8, 23.6 ± 6.8, respectively; all P < 0.001). The disc-height ratio at 3-year follow-up was ( 85.7 ± 6.4) % of the preoperative disc height in PELD group while ( 81.9 ± 7.0) % in MED group，with significant height loss in MED group ( P = 0.014).Conclusions: Day surgery for LDH undergoing PELD has favorable long-term outcomes.

目的 总结一期前后路联合手术治疗下颈椎骨折脱位的临床疗效.方法 2008年1月—2018年1月遂宁市中心医院采用前后路联合手术治疗成人颈椎骨折脱位127例,对随访2年以上的35例行疗效分析.其中男性24例,女性11例;年龄19～68岁,平均35.5岁;单侧小关节绞锁13例,双侧小关节绞锁18例,椎弓根骨折4例;单纯脱位26例,骨折脱位9例.术前神经功能美国脊髓损伤协会(ASIA)分级:A级4例,B级7例,C级18例,D级4例,E级2例.后路采用小关节撬拨解锁复位27例,后路关节突切除解锁复位4例,后路经内固定压棒复位4例,患者均行经侧块螺钉固定;前路采用椎间盘切除减压植骨内固定26例,前路采用椎体次全切除减压植骨内固定9例.采用影像学对颈椎序列、椎体高度、椎间隙高度和颈椎曲度进行评价,采用ASIA神经功能分级对神经功能进行评价.结果 围手术期安全,未发生手术相关、卧床相关并发症.术后影像学检查显示颈椎序列、椎体高度、椎间隙高度和颈椎曲度恢复好.35例获得随访27～96个月,平均41.5个月,末次随访时颈椎序列、椎体高度、椎间隙高度和颈椎曲度维持好;ASIA分级:A级4例,B级0例,C级3例,D级4例,E级24例.结论 一期前后路联合手术治疗下颈椎骨折脱位可恢复和维持颈椎序列、椎体高度、椎间隙高度和颈椎曲度,神经功能改善良好,临床效果满意.

Abstract Background Surgery remains the main curative option for the treatment of intraspinal tumour. The purpose of the present study was to analyze the clinical outcomes of laminoplasty with process-lamina complex replantation compared with laminectomy with pedicle screw fixation for intraspinal tumours. Methods In our retrospective analysis, 27 patients received tumour resection surgery by laminoplasty with reconstruction plate fixation and 32 patients received laminectomy with pedicle screw fixation. All patients were followed up for at least 1 year. Data, including surgical time, blood loss, volume of drainage, drainage time, hospital stay, complications, and neurological status were compared. In addition, imaging evaluation was also included. Results Patients in the laminoplasty group had lower blood loss (laminoplasty group: 281.5 ± 130.2 mL; laminectomy group: 450.0 ± 224.3 mL; p = 0.001), shorter surgical time (laminoplasty group: 141.7 ± 26.2 min, laminectomy group: 175.3 ± 50.4 min; p = 0.003), lower volume of drainage (laminoplasty group: 1578.9 ± 821.7 mL, laminectomy group: 2621.2 ± 1351.0 mL; p = 0.001), shorter drainage time (laminoplasty group: 6.6 ± 2.5 days, laminectomy group: 9.7 ± 1.8 days; p = 0.000), and a shorter hospital stay (laminoplasty group: 16.9 ± 4.9 days, laminectomy group: 21.0 ± 4.4 days; p = 0.002) compared with patients in the laminectomy group. There were significant differences of oswestry dysfunction index (ODI) between the two groups at 12 months postoperatively (p = 0.034). The incidence of secondary spinal stenosis in the laminoplasty group was significantly reduced (p = 0.029). Conclusions Laminoplasty in intraspinal tumour resection has a lower blood loss and volume of drainage, shorter surgical time and hospital stay as advantages over the standard laminectomy technique. Moreover, laminoplasty can effectively avoid iatrogenic spinal canal stenosis and thus enhancing functional recovery of spinal cord.

目的 探讨姜黄素对人椎间盘髓核细胞自噬和退变的影响.方法 人椎间盘髓核组织来源于2018年3～11月四川省遂宁市中心医院骨科收治的7例椎间盘突出患者,并进行体外髓核细胞原代培养,将其分为三组:对照组、白细胞介素-1β(IL-1β)组和白细胞介素-1β+姜黄素组.四甲基偶氮唑盐比色法(MTT)检测姜黄素对人髓核细胞毒性情况,RT-PCR和Western blot分别检测各组细胞内基质金属蛋白酶-3(MMP-3)、MMP-13、聚集蛋白聚糖(aggrecan)和胶原蛋白(Collagen)Ⅱ的表达水平,同时检测各组细胞内自噬蛋白微管相关蛋白3(LC3)和Beclin 1的蛋白表达情况;采用GFP-LC3腺病毒转染观察各组细胞内自噬水平.结果 MTT结果显示,当姜黄素浓度<80μmol/L时对髓核细胞是没有细胞毒性的,考虑到对髓核细胞无毒性,同时对髓核细胞能发挥最大的药物作用,选择姜黄素浓度为80μmol/L进行后续的实验.姜黄素能显著增加髓核细胞内的自噬颗粒数,促进细胞自噬蛋白LC3的水平升高和P62蛋白水平下降(P<0.05);同时,姜黄素显著提高髓核细胞aggrecan和CollagenⅡ的水平,降低MMP-3和MMP-13的表达水平(P<0.05).结论 姜黄素能减缓椎间盘的退变,其机制可能是通过促进细胞的自噬水平.