背景:颈肌在维持椎体力学平衡以及颈椎病致病的每一阶段、每一环节都发挥着重要的作用,而且是临床多种颈部症状的主导病因,颈椎力学失平衡及颈椎间盘的退变可看作是以颈肌为主的软组织病变的结果.目的:观察颈前肌短缩痉挛所致颈椎动力失衡模型兔颈椎间盘终板软骨细胞的病理变化,以及异常应力下椎间盘各结构细胞的凋亡规律.方法:健康成年新西兰白兔28只,随机分成模型组(n=14)、假手术组(n=14).模型组于甲状软骨外下方约1 cm处将双侧胸锁乳突肌用医用硅胶硬管垫起致其短缩,建立颈椎动力失衡模型;假手术组仅暴露双侧胸锁乳突肌分离其中部后,直接逐层缝合.于造模后2个月同一时间取材.颈椎间盘及终板软骨组织切片苏木精-伊红染色,光镜下观察颈椎间盘终板软骨细胞的迁移变化情况,运用TUNEL法检测颈间盘终板软骨、纤维环中细胞的凋亡情况.实验方案经北京中医药大学第三附属医院动物实验伦理委员会批准.结果 与结论:①模型组颈椎间盘发生明显的病理学变化,而假手术组未见明显改变;模型组颈椎间盘终板关节软骨区与纤维环区界限明显,未发现明显细胞迁移现象,但椎间盘终板生长软骨区细胞已明显向关节软骨区迁移;模型组椎间盘关节软骨区、生长软骨区出现细胞过度凋亡,其凋亡指数显著高于假手术组(P<0.01),纤维环区细胞亦出现一定程度的凋亡,其凋亡指数较假手术组有明显增加(P<0.05);②结果表明,颈前肌短缩痉挛所致动力失衡(颈椎肌性痉挛所致的异常应力),短期内未发现终板软骨与纤维环之间的细胞迁移,但早期即可出现生长软骨层细胞明显向关节软骨层迁移,且椎间盘的终板软骨、纤维环区发生显著的细胞凋亡现象,可为研究椎间盘早期退变的病因机制提供实验证据.

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目的:探讨椎间孔镜配合经皮椎弓根螺钉系统治疗退行性腰椎滑脱症疗效.方法:收治退变性腰椎滑脱患者23例,均采用椎间孔镜配合经皮椎弓根螺钉系统治疗,观察治疗效果.结果:手术时间160～240 min,术中出血量100～250 mL,总住院时间7～10 d.23例切口甲级愈合;23例均获得随访,时间10～24个月.末次随访时患者腰痛VAS评分明显低于术前(P<0.05).末次随访时按Nakai标准评定疗效:优17例,良5例,可1例,优良率95.7％.结论:椎间孔镜配合经皮椎弓根螺钉系统治疗退行性腰椎滑脱症疗效显著.

目的:观察应用肌骨超声引导针刀治疗腰椎关节突关节源性腰痛的疗效,为本病的治疗提供一种新方法.方法:回顾2017年3月至2017年10月期间,北京中医药大学第三附属医院采用肌骨超声引导下针刀治疗腰椎关节突关节源性腰痛35例:其中男11例,女24例;年龄31～66岁,平均47.5岁;病史1 d～41个月.术后1周、2周及4周随访收集Oswestry功能障碍评分信息(ODI评分).术后10 min、1周及2周收集VAS评分信息.对患者治疗前后ODI评分、VAS评分进行分析比较,总结疗效.结果:1周后有5例病人ODI评分无好转,总有效率为85.7％.术后10 min VAS评分无改变7例,总有效率80％.均无并发症发生.术前后ODI评分、VAS评分分别行重复测量资料的单因素分析统计,差异有统计学意义(P＜0.05).结论:1)肌骨超声引导下针刀治疗定位准确,对腰椎关节突关节源性腰痛疗效显著;2)肌骨超声引导下针刀治疗操作安全,无并发症,可明显改善患者生活质量.

目的:观察“弯针穿刺”在高髂嵴L5S1椎间盘突出症射频消融髓核成形术中的应用疗效.方法:随机纳入本科2016年7月至2017年6月间确诊的L5S1椎间盘突出症96例,其中髂嵴高于L5上终板者为高髂嵴病例组31例,髂嵴低于L5上终板者为低髂嵴病例组65例,前者以“弯针穿刺”后,行经皮低温等离子射频消融髓核成形术,后者以常规直针穿刺后行相同术式.通过采用术前、术后疼痛视觉模拟评分(VAS)及腰椎功能MacNab评定标准,评估两组患者术后疗效.结果:高髂嵴病例采用弯针穿刺、低髂嵴病例采用常规直针穿刺,除1例高髂嵴病例外,均成功抵达消融靶点,两组VAS及Mac-Nab评分与术前比较差异有统计学意义(P＜0.05),疗效确切.二者组间比较,差异无统计学意义(P＞0.05),疗效相当.结论:应用“弯针穿刺”于高髂嵴L5S1间盘突出症的髓核消融术中,可切实克服常规直针难以达到靶点的技术困难,并达到与低髂嵴病例组常规穿刺手术相近的临床疗效,可操作性较强,值得应用推广.

Objective To evaluate the efficacy and safety of Wangbi preparation and anti-inflammatory drugs and non-steroidal anti-inflammatory drugs (NSAIDs) on the treatment of knee osteoarthritis (KOA).Methods Randomized controlled trials (RCT) literatures of KOA were collected by manual and online, and the electronic database including Chinese Journal Full-text Database (CNKI), China Science Periodical Database, Chinese Biomedical Literature Database, Full-text Database of Chinese Sci-tech Journals, PubMed, Embase.We included all published clinical research accord with the inclusive criteria, the bias risk and methodological quality evaluation were evaluated through Cochrane collaborative group methods, the relevant data were analyzed by heterogeneity test of Revman software implementation, Meta-analysis, drawing inversion funnel map and,etc.Results Four clinical research literatures were eligible for inclusion.All reports included the effectiveness and adverse response rates.Meta-analysis showed that, compared with NSAIDs, Wangbi preparation had better effective rate of KOA [OR=5.76, 95% CI (2.43, 13.65), Z=3.97, P<0.0001], with lower adverse reaction rate [OR=0.09, 95% CI (0.03, 0.25), P<0.000001], but there was no statistical difference on improving joint pain [MD=-0.13, 95% CI (-0.36, 0.11), P=0.29].The erythrocyte sedimentation rate (ESR) and C reactive protein (CRP) in Wangbi preparation group were lower than those in NSAIDs group.Conclusion This systematic review offers support that Wangbi preparation has effective treatment for KOA, with high security.However, given the low inclusion quality of research and the limitations of this study, the current evidence is difficult to draw a more reliable Conclusion.

OBJECTIVE:To observe the curative effect of musculoskeletal ultrasound-guided needle-knife on the degenerative meniscus disease, and to provide a new method in the treatment of degenerative meniscus disease.METHODS:Seventy-seven patients with degenerative meniscus disease treated in the Third Affiliated Hospital of Beijing University of Chinese Medicine from January 2015 to September 2015 were selected, including 30 males and 47 females, aged from 44 to 66 years old, with an average of 57.5 years old. VAS scores, Lysholm scores and distance of meniscal protrusion were analyzed and compared before treatment, 2 weeks and 1 month after treatment. The curative effect was summarized at last.RESULTS:The mean Lysholm scores were 51.63±15.26(before treatment), 77.13±11.82(2 weeks after treatment) and 87.56±8.65(1 month after treatment). The mean VAS scores were 7.080±1.574 (before treatment), 2.630±0.310(2 weeks after treatment) and 0.850±0.177(1 month after treatment). The mean of the distance of meniscal protrusion scores were 0.400±0.156 (before treatment), 0.298±0.140 (2 weeks after treatment) and 0.240±0.110 (1 month after treatment). VAS scores and Lysholm scores were improved significantly compared with preoperative results. The distance of meniscal protrusion showed an obvious improvement after treatment.CONCLUSIONS:The treatment of musculoskeletal ultrasound-guided needle-knife has advantages of high accuracy position and excellent effectiveness for degenerative meniscus disease. The treatment provides safety operation and significantly improves quality of life in patients without any complications.

目的:探讨中西医综合疗法对治疗颈性眩晕的作用机制及临床疗效观察.方法:将120例诊断为颈性眩晕的患者按随机数字表法分为对照组(针刀组、星状神经节阻滞术(SGB)及常规非手术治疗组)和治疗组:针刀+SGB组,每组各30例.观察治疗前后椎动脉、基底动脉的平均血流速度变化,采用颈性眩晕症状与功能评分法在治疗前后进行评分并进行疗效评定.结果:治疗组和对照组治疗后椎动脉、基底动脉的平均血流速度及颈性眩晕症状与功能评分均较治疗前明显提高.治疗组针刀+ SGB组较对照组3组之任一疗法改善均更明显.针刀+SGB组有效率为96.6％;对照组中针刀疗法有效率为86.6％,SGB疗法有效率为86.6％,常规非手术疗法有效率为76.7％,4组疗效比较差异均有统计学意义.结论:4组治疗颈性眩晕均有效果,而SGB+针刀采用中西医综合治疗方法效果更好,具有疗效叠加作用.

目的：探讨关节镜在膝关节滑膜皱襞综合征诊断及治疗中的价值。方法：对48例膝关节疼痛的患者进行关节镜检查，男15例，女33例。年龄47～75岁，中位数58．5岁。病程3个月至8年，中位数23．5个月。3例有膝关节扭伤史，38例合并膝骨关节炎。均有膝关节疼痛、髌内侧压痛，且Shelf征及MPP试验均为阳性；髌骨研磨试验阳性38例、McMurray试验阳性37例、浮髌试验阳性2例、关节弹响32例、关节交锁27例、打软腿26例、股四头肌萎缩19例。结果：48例患者均经关节镜检查确诊为膝关节滑膜皱襞综合征，均由髌内侧滑膜皱襞病变引起，术中彻底切除病变的滑膜皱襞。病变的滑膜皱襞形态按Sakakibara法分类，A型3例、B型7例、C型30例、D型8例。膝关节Lysholm评分由术前（51±17）分提高至术后（89±11）分。结论：关节镜检查可直观、准确地发现引发膝关节滑膜皱襞综合征的病变滑膜皱襞，并在术中彻底切除，迅速消除患者的临床症状和体征、恢复膝关节功能，应作为诊断和治疗该病的首选方法。

Objective:To discuss the characteristics of pathological grade of knee joint pigmented villonodular synovitis(PVNS) under arthroscopy.Methods:All the cases were collected who received arthroscopy from 2007 to 2012,among which 18 cases of PVNS confirmed by pathology were retrospectively analyzed.The 18 cases were examined by X-ray and MRI.Results:The imaging findings of knee joint X-ray and MRI,pathological findings after arthroscopy and the severity and the extent of PVNS of 18 cases were compared.The pathological findings of synovial cells were all PVNS.The limited and diffused fulvous synovial hyperplasia,congestion and hypertrophy,or soft tissue nodule and the synovial cluster conglomerate or villous prominent could be seen under arthroscopy.There was obvious effusion in articular but no invasion to other organizations within the joint.Four cases out of 15 with X-ray showed consistent findings with the above findings.For MRI,all 15 cases had consistent findings.Synovial hyperplasia and invaded intra-articular fat pad were seen in 5 cases,which were confirmed in no patients with X-ray and 5 with MRI.Synovial hyperplasia and invaded meniscus and cruciate ligaments were seen in 4 cases,which were confirmed in no patients with X-ray but 3 with MRI.Synovial hyperplasia and invaded cartilage and bones were seen in 2 cases,which were confirmed in no patient with X-ray but 2 with MRI.Conclusion:(1) MRI findings are more consistent with findings of arthroscopy than X-ray findings,so the MRI diagnostic specificity of PVNS is higher.(2) Knee joint PVNS can be classified into 3 grades with arthroscopy findings,thus different treatments can be selected according to the grades.(3) Arthroscopic surgery is the best treatment for PVNS at present.