BackgroundTetramethylpyrazine (TMP) is a natural alkaloid compound with antioxidant and neuroprotective effects. We hypothesized that TMP could exert neuroprotective effects by inhibiting ferroptosis through modulating iron metabolism, but its mechanism is unclear. Through in vivo and in vitro experiments, we have explored how TMP can regulate neurons’ iron metabolism through the NRF2/ARE pathway to Inhibit ferroptosis.MethodsIn the in vivo experiment, the effects of TMP on nerve function and secondary spinal cord injury were observed through behavioral tests and morphology staining. Transmission electron microscopy, molecular biology tests and immunofluorescence staining were used to investigate the role of TMP in the regulation of iron metabolism and ferroptosis through the Nrf2/ARE pathway. Using in vitro experiments to investigate the mechanism of TMP in inhibiting ferroptosis through the Nrf2/ARE pathway.ResultsFirstly, through in vivo experiments, we found that TMP improves motor function of rats with spinal cord injury, reduces spinal cord tissue damage and nerve cell death caused by secondary injury. Moreover, neuronal death and the formation of spinal cord cavities are inhibited by TMP. By regulating lipid peroxidation, TMP can inhibit mitochondrial damage and reduce ROS accumulation. Our study also demonstrated that TMP regulates iron metabolism through the NRF2/ARE pathway to inhibit ferroptosis and repair spinal cord injury. To further explore the regulatory mechanisms of TMP we down-regulating Nrf2 expression in subsequent in vitro experiments. We find that a key ferroptosis pathway, lipid peroxidation, can be regulated by TMP. Additionally, TMP inhibits iron overload-mediated ferroptosis by increasing Nrf2 transcriptional activity.ConclusionA regulatory effect of TMP on the NRF2/ARE pathway was found in both in vitro and in vivo experiments. It promotes the transcription and translation of iron metabolizing and antioxidant molecules. Our study explored the inhibitory effect of TMP on ferroptosis from the iron metabolism pathway and provided new ideas for the treatment of SCI.

OBJECTIVE:To investigate the effect of Polyetheretherketone (PEEK) rod semi-rigid pedicle screw fixation system in lumbar spine non-fusion surgery. METHODS:A total of 74 patients with tow-level lumbar degenerative diseases who underwent surgery from March 2017 to December 2019 were divided into PEEK rod group and titanium rod group. In the PEEK rod group, there were 34 patients, including 13 males and 21 females, aged from 51 to 79 years old with an average of (62.4±6.8) years old;There were 1 patient of L1-L3 segments, 7 patients of L2-L4 segments, 20 patients of L3-L5 segments and 6 patients of L4-S1 segments. In the titanium rod group, there were 40 patients, including 17 males and 23 females, aged from 52 to 81 years old with an average of (65.2±7.3) years old;There were 3 patient of L1-L3 segments, 11 patients of L2-L4 segments, 19 patients of L3-L5 segments and 7 patients of L4-S1 segments. The general conditions of operation, such as operation time, intraoperative blood loss, postoperative drainage was recorded. The visual analogue scale (VAS) for low back pain and Oswestry disability index (ODI) were compared in preoperatively and postoperatively(3 months, 12 months and last follow-up) between two groups. The change of range of motion (ROM) was observed by flexion and extension x-ray of lumbar. RESULTS:All patients successfully completed the operation. The follow-up time ranged from 22 to 34 months with an average of(26.8±5.6) months. The operative time (142.2±44.7) min and intraoperative blood loss(166.5±67.4)ml in PEEK group were lower than those in titanium group [(160.7±57.3) min、(212.8±85.4) ml](P<0.05). There was no significant differences in postoperative drainage between the two groups (P>0.05). At the final follow-up visit, in PEEK group and titanium group VAS of low back pain[(0.8±0.4) points vs (1.0±0.5) points], VAS for leg pain [ (0.7±0.4) points vs (0.8±0.5) points] and ODI [(9.8±1.6)% vs (12.1±1.5)%] were compared with preoperative [ (5.8±1.1) points vs (6.0±1.1)points], [ (7.2±1.7) points vs (7.0±1.6) points], [(68.5±8.9)% vs(66.3±8.2)%] were significantly different(P<0.05). There was no significant difference in VAS scores between the two groups at each postoperative time point (P>0.05). At 3 months after surgery, there was no difference in ODI between the two groups (P>0.05). There were significant differences in ODI between PEEK group and titanium rod group at 12 months [(15.5±2.1)% vs (18.4±2.4)%] and at the last follow-up [(9.8±1.6)% vs (12.1±1.5)%] (P<0.05). The total range of motion (ROM) of lumbar decreased in both groups after surgery. At 12 months after surgery and the last follow-up, the PEEK group compared with the titanium rod group, the total range of motion of lumbar was statistically significant (P<0.05). The range of motion (ROM) of the fixed segments decreased in both groups after surgery. The ROM of the fixed segments in PEEK group decreased from (9.5±4.6)° to (4.1±1.9)° at the last follow-up (P<0.05), which in the titanium rod group was decreased from (9.8±4.3)°to (0.9±0.5)° at the last follow-up (P<0.05). The range of motion (ROM) of upper adjacent segment increased in both groups, there was statistical significance in the ROM of upper adjacent segment between the two groups at 12 months after surgery and the last follow-up, (P<0.05). There was no screw loosening and broken rods in both groups during the follow-up period. CONCLUSION:The PEEK rod semi-rigid pedicle screw internal fixation system used in lumbar non-fusion surgery can retain part of the mobility of the fixed segment, showing comparable short-term clinical efficacy to titanium rod fusion. PEEK rod semi-rigid pedicle screw internal fixation system is a feasible choice for the treatment of lumbar spine degenerative diseases, and its long-term efficacy needs further follow-up observation.

[目的]测量新型国产人工颈椎间盘假体在山羊颈椎的活动度.[方法]12只山羊随机分为3组,每组4只,包括羟基磷灰石(hydroxyapatite,HA)涂层的间盘假体组,非HA涂层的间盘假体组和假手术组.HA组和非HA组动物摘除C3/4间盘并置入相应国产人工颈椎间盘假体,假手术组仅行手术显露,未处理椎间盘.动态测量颈椎整体活动度及置换节段活动度(range of motion,ROM).[结果]术后动物实验中所有山羊均成活,无切口感染及瘫痪.随时间推移HA组和假手术组的C2～C5 ROM和C3/4 ROM均无显著变化(P＞0.05),而非HA组的C2～C5 ROM和C3/4ROM显著减少.术前及术后即刻三组间C2～C5ROM和C3/4 ROM的差异均无统计学意义(P＞0.05),但术后1和3个月时,HA组和假手术组的C2-C5 ROM和C3/4 ROM均显著大于非HA组(P＜0.05),而HA组与假手术组的C2-C5 ROM和C3/4ROM差异无统计学意义(P＞0.05).[结论]HA涂层的新型国产人工颈椎间盘置换术后较好的保持了山羊颈椎的活动度.

To examine the short-term efficacy and imaging results of using the Mobi-C in cervical hybrid surgery on 2-level cervical spondylolisthesis. To observe post-operative changes in the flexion–extension centre of rotation (FE-COR) and anterior bone loss (ABL) of the anterior cervical disc replacement (ACDR) segment. Forty-two patients (20 males and 22 females, aged 42‒67 years) who underwent cervical hybrid surgery were retrospectively analysed. Their ACDR segment used Mobi-C, and the fusion segment used ROI-C, with a follow-up of 25‒42 months (31.1 ± 4.8 months). The modified Japanese Orthopaedic Association (mJOA) score, Neck Disability Index (NDI), and visual analogue scale (VAS) were used to assess clinical outcomes. Pre-operative, 6-month post-operative, and final follow-up radiographs were collected to compare total cervical spine curvature (C2–C7), curvature of the operated segments, range of motion (ROM) in the total cervical spine, operated segmental ROM, ACDR segmental ROM, and operated adjacent segmental ROM. The height of the superior articular process (HSAP), the orientation of zygapophyseal joint spaces (OZJS), and the length of the superior articular surface (LSAS) were measured. The FE-COR of the ACDR segment was measured using the mid-plumb line method. The translation distance of the Mobi-C was measured. The degree of disc degeneration in the adjacent segment, bony fusion of the ACDF segment, and ABL of the upper and lower vertebra of the ACDR segment were observed. In our group, all patients have shown improvements in their postoperative mJOA, NDI, and VAS scores. Overall cervical ROM and surgical segmental ROM decreased (P < 0.05). However, there was no significant decrease in ACDR segmental ROM and upper or lower adjacent segmental ROM compared with pre-operatively (P > 0.05). For FE-COR-X, only the last follow-up compared with pre-surgery showed statistical significance (46.74 ± 7.71

目的 探讨经皮电刺激疗法联合手术治疗促进长管骨骨折愈合的临床效果.方法 选取2021年2-12月北京中医药大学东直门医院收治的60例长管骨骨折的患者作为研究对象,采用随机数字表法分为对照组与电刺激组,各30例.比较术后第4～6周两组患者Lane-Sandhu X线评分、视觉模拟评分法(visual analogue scale,VAS)疼痛评分、肿胀程度与并发症发生情况.结果 电刺激组治疗后Lane-Sandhu X线评分高于对照组,差异有显著性(P＜0.01).在术后第7天、第14天时,电刺激组VAS评分均低于对照组,差异有显著性(P＜0.01).随着时间推移,两组肿胀指数均呈现递减趋势,肿胀程度均减轻,在术后第1天、第4天、第7天、第14天时,电刺激组肿胀指数低于对照组,差异有显著性(P＜0.01).两组术后均未发生愈合不良、切口感染、骨不连等并发症.结论 电刺激疗法可显著促进长管骨骨折患者的愈合进程,缓解患者疼痛程度,改善患肢的肿胀程度.

Background This study is the first to summarize the evidence on how the use of anti-inflammatory drugs during acute pain has an impact on the development of chronic pain. Methods Randomized controlled trials retrieved from nine databases included anti-inflammatory drugs (NSAIDs or steroids) versus non-anti-inflammatory drugs in patients with acute pain and reported the incidence of chronic pain. No specified date, age, sex, or language restrictions. Subgroup analyses were performed according to pain classification, follow-up time, and medication. The GRADE method was used to evaluate quality of evidence. Results A total of 29 trials (5220 patients) were included. Steroids or NSAIDs did not reduce the incidence of chronic nociceptive pain. Steroid use in acute phase significantly reduced the incidence of chronic neuropathic pain. In subgroup analysis, benefits were observed for methylprednisolone and dexamethasone, with some adverse effects. Steroids or NSAIDs were statistically significant in reducing pain intensity over 1 year, but the effect size was too small, and whether the long-term effect is clinically relevant needs to be further studied. Conclusion Quality of the evidence was low to moderate. No drug can be recommended to prevent chronic nociceptive pain. Injections of steroids (methylprednisolone or dexamethasone) during the acute phase reduce the incidence of chronic neuropathic pain, but most included studies also used local anesthetics. The results are indirect and need to be interpreted with caution. The pooled data effect sizes for pain intensity were small, so the clinical relevance was unclear. Study registration PROSPERO (CRD42022367030).

目的 比较新型国产人工颈椎间盘置换与颈椎前路减压植骨融合内固定术对山羊施术节段邻近颈椎间盘退变的影响.方法 12只实验山羊随机分为3组,每组4只:间盘组(CDR组)行C3/4间盘摘除、新型国产人工颈椎间盘植入术;融合组(ACDF组)行C3/4间盘摘除、植骨融合内固定术;对照组不进行手术.分别于术后1、3个月行颈椎正侧位X线检查,根据改良Kellgren评分法及椎间盘相对高度测量(RDH)法进行评价.结果 动物实验中所有山羊均成活,无切口感染及肢体瘫痪.间盘组与对照组在术后1个月与3个月Kellgren评分比较,差异无统计学意义(P＞0.05);术后1个月与术后3个月融合组Kellgren评分高于间盘组,且差异有统计学意义(P＜0.05).三组术前的RDH比较差异无统计学意义,术后1个月及3个月融合组的RDH均低于间盘组、对照组,且与两组比较差异均有统计学意义(P＜0.05),间盘组与对照组术后RDH比较差异无统计学意义(P＞0.05).结论 新型国产人工颈椎间盘置换可以有效防止山羊颈椎手术邻近节段的退变.

弥漫性特发性骨肥厚症(DISH)是一种以脊柱前外侧韧带钙化或骨化为特征的骨骼疾病,可累及全脊柱乃至全身骨骼,有研究[1]显示,其好发于中老年人群,男性较女性更为多见.DISH合并颈椎后纵韧带骨化症(OPLL)临床并不少见,但外伤后出现脊髓损伤症状的报道不多,现将本院收治的1例DISH并不完全性脊髓损伤患者的治疗情况报告如下.

OBJECTIVE:To explore the etiology of wound infections in patients with open tibia and fibula fractures and the treatment effects.METHODS:In this retrospective study, a total of 76 patients with open tibia and fibula fractures were included in this research. These patients were divided into the control group (n=38) and the observation group (n=38) according to the treatment methods for wound infection. The distribution and drug resistance of pathogenic bacteria in wound infections were analyzed. Clinical effects, time for body temperature returning to normal, time for disappearance of exudates, time for clearance of pathogenic bacteria, recovery effects and patients' satisfaction rate were also compared between two groups.RESULTS:A total of 152 strains of pathogenic bacteria were separated. The main pathogenic bacterium was Acinetobacter baumannii, accounting for 30.92% (47/152). Pathogenic bacteria were demonstrated to be highly sensitive to vancomycin and imipenem. The proportion of wound healing by first intention and the Johner-Wruhs scores in observation group were significantly higher than those in control group, while recurrent infection rate, the time to restore normal body temperature, the time for exudates to disappear, the time to remove pathogenic bacteria, hospital stays and VAS scores in observation group were obviously shorter or lower than those in control group (all P<0.05). Moreover, the satisfaction rate of patients in the observation group was significantly higher than that in the control group (P<0.05).CONCLUSION:Understanding pathogenic characteristics and drug resistance of wound infection in patients with open tibia and fibula fractures is helpful to subsequent treatment. Comprehensive control measures should be taken to decrease incidence of wound infection.

目的:观察武当医学电导入疗法对健康或无严重疾病的成年人基本生理指标的影响,并检测电流、电压数值,评价武当医学电导入疗法的安全性.方法:纳入健康或无严重疾病的成年人100名,记录受试者接受武当医学电导入疗法前后的心率、脉搏、血压、血氧饱和度、呼吸频率,并检测试验过程中的电流、电压.结果:40名男性受试者试验前后心率、脉搏、舒张压、血氧饱和度的变化无统计学意义,收缩压和呼吸频率显著降低(P＜0.01),但仍处于正常生理范围.60名女性受试者试验前后心率、呼吸频率的变化无统计学意义,脉搏、收缩压、舒张压、血氧饱和度显著降低(P＜0.05,P＜0.01),但仍处于正常生理范围.试验期间流经受试者身体的平均电流强度为(3.79±0.41)mA,平均电压为(23.78±2.16)V.所有受试者均未出现不良反应.结论:武当医学电导入疗法对健康或无严重疾病成年人的基本生理指标无不良影响,且流经受试者身体的电流、电压符合当前电疗设备的行业标准.

Bone marrow-derived mesenchymal stem cells (BM-MSCs) are well-established as vital regulators of fracture healing, whereas angiogenesis is one of the critical processes during the course of bone healing. Accordingly, the current study sought to determine the functions of microRNA (miR)-29b-3p from BM-MSCs-derived extracellular vesicles (EVs) on the angiogenesis of fracture healing via the PTEN/PI3K/AKT axis. Firstly, BM-MSCs-EVs were extracted and identified. The lentiviral protocol was adopted to construct miR-29b-3pKD-BMSCs or miR-negative control-BMSCs, which were then co-cultured with human umbilical vein endothelial cells (HUVECs) in vitro to determine the roles of EVs-encapsulated miR-29b-3p on the proliferation, migration, and angiogenesis of HUVECs in vitro with the help of a CCK-8 assay, scratch test, and tube formation assay. Subsequent database prediction, luciferase activity assay, RT-qPCR, and Western blot assay findings identified the downstream target gene of miR-29b-3p, PTEN, and a signaling pathway, PI3K/AKT. Furthermore, the application of si-PTEN attenuated the effects induced by miR-29b-3pKD-EVs. Finally, a mouse model of femoral fracture was established with a locally instilled injection of equal volumes of BM-MSCs-EVs and miR-29b-3pKD-BM-MSCs-EVs. Notably, the mice treated with BMSC-EVs presented with enhanced neovascularization at the fracture site, in addition to increased bone volume (BV), BV/tissue volume, and mean bone mineral density; whereas miR-29b-3pKD-BMSCs-EVs-treated mice exhibited decreased vessel density with poor fracture healing capacity. Collectively, our findings elicited that BM-MSCs-EVs carrying miR-29b-3p were endocytosed by HUVECs, which consequently suppressed the PTEN expression and activated the PI3K/AKT pathway, thereby promoting HUVEC proliferation, migration, and angiogenesis, and ultimately facilitating fracture healing.

目的 观察老年骨质疏松性椎体压缩性骨折患者局麻经皮椎体后凸成形术(PKP)前联合肌注咪达唑仑和盐酸哌替啶的围术期镇痛镇静效果.方法 86例单节段骨质疏松性椎体压缩骨折患者随机分为观察组(44例)和对照组(42例),两组均行PKP,观察组术前10 min肌肉注射咪达唑仑注射液1 mg、盐酸哌替啶注射液50 mg作预镇静镇痛,对照组不作处理.比较两组围术期不同时点NRS评分、心率、血压及手术时间、透视次数、穿刺透视次数和手术满意率、不良反应.结果 与对照组比较,观察组T2、T3时点NRS评分低(P均<0.05);与同组T0时点比较,两组T5 NRS评分时点NRS评分低(P均<0.05).与对照组比较,观察组T2、T3、T4时点HR和MAP低(P均<0.05).与对照组比较,观察组手术时间短,透视次数、穿刺透视次数少(P均<0.05).观察组及对照组手术满意率分别为90.90％、85.71％,不良反应发生率分别为27.27％、26.19％,两组比较,P均>0.05.结论 PKP术前使用咪达唑仑和盐酸哌替啶能有效缓解老年骨质疏松性椎体压缩性骨折患者术中疼痛,缩短手术时间,减少透视次数,安全性高.

背景:腰椎融合术后邻椎病的治疗是脊柱外科的研究热点,传统延长融合节段的手术有可能加速邻椎病的再次出现.以椎弓根螺钉为基础的非融合技术在治疗腰椎退行性疾病和预防邻近节段退变中表现出良好的中短期疗效,但采用非融合技术治疗腰椎融合术后邻椎病的临床疗效亟待研究.目的:评估Isobar EVO非融合动态固定治疗腰椎融合术后邻椎病的效果.方法:选择2013年7月至2017年12月于东直门医院因保守治疗无效后再次手术的邻椎病患者,纳入了其中15例接受Isobar EVO原位非融合动态稳定治疗的患者,并回顾了病历、手术报告和X射线成像研究.比较手术前后的临床结果(包括腰痛和下肢痛目测类比评分、腰椎功能障碍指数、SF-36量表生理健康评分)和影像学测量指标(包括手术节段及上位邻近节段活动度、手术节段前凸角和腰椎前凸角、手术节段及上位邻近节段平均间隙高度指数).结果 与结论:15例患者完成了至少3年的随访.①临床结果:末次随访时各项评分较术前有显著改善(P<0.05),但随访各时段之间比较无显著差异(P>0.05).②影像学测量指标:末次随访时,手术节段活动度较术前明显减少[(3.16±0.45)°vs.(6.32±1.81)°,P<0.05],上位邻近节段活动度较术前明显增加[(5.51±1.22)°vs.(4.87±1.47)°,P<0.05],腰椎前凸角较术前明显增加[(30.95±8.96)°vs.(27.12±9.67)°,P<0.05],手术节段前凸角较术前明显增加[(11.32±4.86)°vs.(10.14±6.44)°,P<0.05],手术节段平均间隙高度指数较术前明显增大(33.23±3.83 vs.32.79±4.06,P<0.05),但上位邻近节段平均间隙高度指数较术前差异无统计学意义(P>0.05);以上指标在术后随访各时段之间相比差异均无统计学意义(P>0.05).所有病例在随访周期内未见内置物松动,未再次发生邻椎病.③结论:Isobar EVO非融合动态固定是治疗邻椎病的有效方式,临床效果明显.术后3年以上随访结果显示该术式可在一定程度上预防再手术后邻椎病的发生,长期效果有待于进一步随访的结果和更高级别循证医学证据的支持.

目的:探讨骨伤1号方联合塞来昔布治疗寒湿痹阻证膝骨关节炎(KOA)的疗效及对血清细胞因子的影响.方法:将72例患者按随机数字表法分为对照组和观察组,各36例.两组患者均给予口服塞来昔布胶囊基础治疗,0.2 g/次,1次/d.观察组在西医治疗基础上,中药骨伤1号方免煎颗粒熏洗治疗,每次1袋,1次/日,每周熏洗5次,两组患者均治疗4周.观察两组患者用药前后视觉模拟疼痛评分(VAS),美国膝关节协会评分(KSS),血清白细胞介素-1β(IL-1β),肿瘤坏死因子-α(TNF-α),转化生长因子-β1(TGF-β1)水平变化情况并评估临床疗效.结果:与本组治疗前比较,治疗后两组患者VAS评分明显降低(P＜0.01),KSS评分明显增高(P＜0.01),且观察组临床效果改善更佳.与本组治疗前比较,治疗后两组患者血清中IL-1β,TNF-α水平明显下降(P＜0.01),且治疗后观察组低于对照组(P＜0.05);两组患者TGF-β1水平较本组治疗前显著升高(P＜0.01).结论:骨伤1号方联合塞来昔布治疗寒湿痹阻证KOA,可有效缓解KOA患者的临床症状,改善关节功能,提高生活质量,同时能降低血清炎性因子IL-1β,TNF-α水平,并增加TGF-β1水平.

目的:观察骨伤1号外洗方联合塞来昔布对膝骨关节炎(KOA)血清中白细胞介素-1β(IL-1β)、肿瘤坏死因子-α(TNF-α)及转化生长因子-β1(TGF-β1)的影响,探讨骨伤1号外洗方治疗KOA可能的作用机制.方法:纳入KOA患者60例,按照随机数字表法,随机分为观察组(骨伤1号外洗方联合塞来昔布口服)和对照组(塞来昔布口服)各30例.治疗4周后,观察两组患者用药前后视觉模拟疼痛评分(VAS)和膝关节功能评分(KSS)的改变,同时抽取治疗前后血清,采用酶联免疫吸附(ELISA)法检测IL-1β、TNF-α及TGF-β1含量并进行本组治疗前后和两组间比较.结果:治疗后两组中医症状积分和VAS评分均显著降低(P＜0.01),KSS评分显著升高(P＜0.01),且观察组低于对照组(P＜0.05,P＜0.01);治疗后两组血清中IL-1β、TNF-α含量显著降低(P＜0.01),TGF-β1含量显著升高(P＜0.01),观察组血清IL-1 β、TNF-α含量显著低于对照组(P＜0.05),TGF-β1含量显著高于对照组(P＜0.01).结论:骨伤1号外洗方联合塞来昔布能够有效改善KOA患者临床症状,疗效优于单用塞来昔布,其作用机制可能与骨伤1号外洗方抑制炎症因子IL-1β、TNF-α,增加TGF-β 1表达有关.

目的 探讨颈椎前路减压、自稳性椎间融合器植骨融合术治疗近侧型肌萎缩型颈椎病的临床疗效.方法 回顾性分析2014年1月至2018年1月我科采用颈椎前路减压自稳性椎间融合器植骨融合术治疗的近侧型肌萎缩型颈椎病12例,男8例,女4例;年龄36～65岁,平均(45.2±7.6)岁;术前肌萎缩症状持续时间为6～36个月,平均(16.6±5.4)个月.术前肌电图评估神经损害情况,通过影像学观察神经受侵犯节段情况、神经减压及内固定情况,采用徒手肌力测试方法评估患者术前及术后肌力,根据肌力改善程度分成优、良、中、差4个等级,优和良评估为疗效满意.结果 肌电图报告所有病例均显示受累上肢肌肉的神经源性损害,且均未显示舌肌纤颤电位及胸锁乳突肌神经源性损害;12例均获随访,随访时间为12～60个月,平均(35.5±8.8)个月.9例患者肌力较术前改善,其中优4例,良5例,肌力无明显改善3例,无术后肌力较术前下降情况,疗效满意率为75％.结论 肌萎缩型颈椎病临床少见,且易与脊髓侧索硬化等运动神经元疾病相混淆,肌电图和MRI检查有助于鉴别诊断,采取颈椎前路减压自稳性融合器植骨融合术治疗近侧型肌萎缩型颈椎病有比较满意的效果.

目的 了解中医骨伤科学全面网络教学的实施效果,探索今后继续开展网络教学的可行性.方法 2020春季学期,北京中医药大学第一临床医学院中医骨伤教研室完成了2个班的线上授课,之后教研室组织进行了调查研究,分析总结中医骨伤科学网络教学实施情况,通过问卷调查分析总结关于中医骨伤学网络教学效果,分析教学设计实施环节存在问题及解决方法,包括教学筹备、教学环节设置、教学平台搭建、教学实施和反馈等方面,总结本次网络教学的实效.结果 课程结束之际,发放调查问卷,共18个问题,回收有效问卷86份.学生对本次中医骨伤科学网络教学的实际体验总体良好率达到93.02％;从教学效果来看,有89.66％的学生认为本次网络教学基本完成了教学目标;52.87％的学生表示今后可以接受网络教学和课堂教学的混合方式,20.69％的学生认为仍然只接受线下课堂教学.结论 随着科技进步,教学软硬件条件具备,中医骨伤科学网络课堂教学切实可行,能够实现既定教学目标.

Although the Mobi-C artificial disc and the ROI-C cervical cage have been widely used in the treatment of cervical degenerative disc diseases (CDDD), few reports addressed the features of combined application of both devices. This study is aimed at comparing the clinical and radiological outcomes of treating contiguous two-level CDDD using Mobi-C and ROI-C combined in a hybrid surgery (HS) with anterior cervical discectomy and fusion (ACDF) using ROI-C. We reviewed ninety-one patients who underwent HS (n = 48) or ACDF (n = 43) surgery for symptomatic contiguous two-level CDDD. >2 years’ clinical and radiological outcomes were reviewed and evaluated retrospectively. At the last follow-up, significant improvement in the mean VAS, JOA, and NDI scores was found both in the HS and ACDF groups (p < 0.05), while the differences between groups were not significant (p > 0.05). The global range of motion (ROM) in the HS group was significantly larger than that in the ACDF group (p < 0.05). The local lordosis improved significantly after surgery in all patients (p < 0.05). Bone resorption and heterotopic ossification (HO) were found after surgery. The result showed that, for the selected patients, HS may provide an alternative approach for the treatment of contiguous two-level CDDD. HS also offers the benefit of both greater global ROM and greater ROM at the Mobi-C index level. Some degree of bone resorption may be an integral component in the early stage of bony fusion in the cage index level. Further studies and long-term follow-up are still needed.

股骨头坏死作为骨科难治性疾病,对早期股骨头坏死患者可以采取非手术治疗.非手术治疗包括降脂药、抗凝剂、血管扩张剂、双膦酸盐、中医药等药物治疗以及物理治疗.药物治疗主要针对股骨头坏死的病因,可减轻疼痛,改善功能,延缓病程.体外震波和高压氧能改善微循环,促进血管修复,从而改善软骨下骨重建和预防股骨头塌陷.非手术治疗主要用于股骨头坏死的早期,对于其临床疗效,有待进一步研究.