腰椎滑脱(lumbar spondylolisthesis)与脊柱-骨盆矢状面参数关系的研究近年来受到极大的关注,腰椎滑脱主要以峡部裂性和退变性两种类型较为常见,半数腰椎滑脱的病理学基础为峡部裂,是引起腰痛常见的原因之一.峡部裂性腰椎滑脱的原因被认为是多因素的,在腰椎和骶椎的连接处,椎间隙的角度变大,从而承受更大的斜向剪切力,这是因为来自腰椎的力在该水平处最大,在下腰椎,部分的横截面解剖相对较薄,再加上集中在腰部的力量增加,最终造成关节间部的应力骨折.

Kümmell病的定义是创伤后迟发性椎体塌陷,其主要特征为轻微外伤后出现腰背部疼痛,且经过长短不一的无症状期后脊柱同一部位会再次出现疼痛,并伴有脊柱后凸畸形进行性加重,甚至出现神经症状.目前该病的发病机制尚不明确,诊断依据主要包括病史、影像学和病理学检查结果,而典型表现是影像学检查结果显示椎体内真空裂隙征.对于尚无神经症状的早期Kümmell病患者,微创治疗便可获得满意效果;对于晚期患者,只能行开放手术,以恢复脊柱稳定性,并矫正后凸畸形.随着全球人口老龄化进程的加快,Kümmell病的发病率逐年上升,已成为社会重大公共卫生问题.该文对Kümmell病的治疗进展进行综述,旨在引起公众对该病的重视,并为临床诊疗工作提供参考.

背景:成人特发性脊柱侧凸是临床上常见的导致成人脊柱畸形的疾患,手术矫形为治疗该疾病的有效手段,但手术时机以及手术矫形策略的选择却对临床医生提出了挑战.目的:分别于5年前、后对同一位Lenke3型成人特发性脊柱侧凸志愿者进行脊柱有限元建模并模拟矫形手术,以了解该类型成人脊柱侧凸的疾病进展、脊柱和内植物的生物力学变化特点以及不同矫形术式矫形效果的变化,为该类型疾病的治疗提供数据参考.方法:选择典型的Lenke3型成人特发性脊柱侧凸志愿者1例为研究对象,男性,28岁,对该志愿者的脊柱进行连续CT扫描,将得到的原始图像导入至有限元软件中进行建模,对该模型进行进一步清理、优化后建立完整的包括胸廓结构在内的Lenke3型成人特发性脊柱侧凸有限元模型,并在此模型上分别进行有限元手术模拟,Case1:后路上端椎至下端椎双侧置钉、去除相应节段后路关节囊以达到关节松解的目的;Case2:后路关键椎置钉、去除相应节段后路关节囊进行关节松解;Case3:后路关键椎置钉、去除相应节段后路关节囊、松解前路侧凸处的胸椎;Case4:后路关键椎置钉、去除相应节段后路关节囊、松解前路侧凸处的腰椎;Case5:后路关键椎置钉、去除相应节段后路关节囊、松解前路侧凸处的胸、腰椎.5年后再次对该志愿者的脊柱侧凸进行有限元建模、模拟手术,以了解5年后该志愿者的疾病进展、脊柱和内植物的生物力学变化特点以及不同矫形术式矫形效果的变化.结果 与结论:①在5年后建立的脊柱侧凸模型上,顺利完成了Case1-Case5手术矫形方案.各手术方案对胸椎侧凸的矫形率为56.8％,48.9％,49.8％,55.9％,57.0％,腰椎侧凸的矫形率为33.0％,36.9％,29.4％,30.0％,34.3％.Case3、5模拟手术矫形效果均较5年前下降明显,同时最大螺钉应力区域与最小螺钉应力区域均不同.②该Lenke3型成人特发性脊柱侧凸志愿者随着年龄的增长腰椎侧凸畸形发生增加,胸椎侧凸则无明显进展;5年后各手术方案对该志愿者胸、腰椎侧凸的矫形率以及矫形效果均下降明显,同时各术式下的螺钉应力最大区域也发生了变化.

Objective:To explore the clinical efficacy of posterior short-segment internal fixation for the treatment of brucella spondylitis (BS).Methods:The medical records of 34 patients with BS admitted from January 2014 to June 2019 were retrospectively analyzed. There were 22 males and 12 females; the age was 52.3±10.6 years (range 35-72 years). On the basis of standardized use of antibacterial drugs, the lumbar spine posterior short-segment internal fixation was used. Twenty-nine cases underwent simple internal fixation, and posterolateral bone graft fusion, while 5 cases underwent primary debridement, autologous bone grafting and interbody fusion. Monitor erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and test tube agglutination test (SAT) were used to assess inflammation control. Imaging examinations of patients before operation, 1 month after operation, 3 months after operation, 6 months after operation, 1 year after operation to the last follow-up were analyzed to evaluate the condition of intervertebral fusion. The clinical efficacy evaluation was based on the pain visual analog scale (VAS), Japanese Orthopaedic Association (JOA) score, modified MacNab grading, and American Spinal Injury Association (ASIA) grading, as well as surgery-related complications.Results:The operation time of 34 patients was 104.64±16.72 min (range 65-145 min), the average hospital stay was 16.49±7.41 days (range 7-38 d), and the average postoperative follow-up time was 20.2 months (range 12-34 months). At the last follow-up, the ESR and CRP fell to the normal range, and the SAT was negative. At 3 months postoperatively, 11 cases (32.35%) reached Bridwell fusion criteria of grade II, 23 cases (67.65%) of grade III; 3 cases (8.82%) of grade I fusion at 6 months after surgery, 31 cases reached grade II fusion (91.18%); all reached grade I fusion at the last follow-up. After the operation, the symptoms of the waist or lower extremities were significantly relieved. The VAS score was 6.3±1.4 before the operation, 4.1±1.2 at 1 month after the operation, 2.7±1.4 at 3 months after the operation, 1.6±1.0 at 6 months after the operation, and 1.2±0.8 at the last follow-up. The JOA score before surgery was 13.8±2.4, 1 month after surgery 17.6±2.6, 3 months after surgery 21.7±3.1, 6 months after operation 4.9±2.7, and at the last follow-up 25.7±1.8. Compared with the preoperative time nodes of the above indicators, the differences were statistically significant. At the last follow-up, of the 12 patients (2 cases of grade C, 10 cases of grade D) with preoperative neurological dysfunction, 2 cases recovered from grade C to grade D, and 10 cases recovered from grade D to E; the excellent and good rate of modified MacNab grading reached 97.06% (33/34). No extradural hematoma, nerve damage, cerebrospinal fluid leakage and other surgical complications occurred. Only 1 case had wound infection complication, and the prognosis was good after active treatment. There were no recurrences during the follow-up period.Conclusion:On the basis of standardized antimicrobial treatment, posterior lumbar short-segment internal fixation is a safe and effective method for the treatment of BS, and good clinical effects can be obtained.

背景:由于成人特发性脊柱侧凸的多样性及僵硬性,个别患者甚至需进行截骨术和个性化的手术设计才能使手术顺利完成,这些均影响患者的手术安全和预后.设计手术方案时要考虑到各个因素对胸腰侧凸畸形矫形的影响.目的:在修正好的Lenke3型成人特发性脊柱侧凸模型上分别模拟不同的手术方式,了解不同手术方式椎弓根螺钉的应力大小及其矫形效果.方法:在优化后的Lenke3型成人特发性脊柱侧凸有限元模型上,分别进行5种有限元手术模拟.Case1:上下端椎双侧置钉结合后路关节突关节松解;Case2:模拟后路关键椎置钉结合后路关节囊松解;Case3后路关键椎置钉结合后路关节囊松解及前路侧凸处胸椎松解;Case4:关键椎置钉结合后路关节囊松解结合前路腰椎侧凸处松解;Case5:关键椎置钉结合后路关节囊松解结合前路胸腰椎侧凸处松解.分析Lenke3型成人特发性脊柱侧凸不同手术方案的三维矫形效果及生物力学特征.结果 与结论:①在优化后的模型上,顺利完成了设计的Case1-5共5种手术方案;②各种手术矫形后各椎弓根螺钉应力最大值均低于螺钉本身的折弯临界值.各组置钉的螺钉应力集中在L4下端椎位置,并且应力主要集中在钉尾与钉身交界处以及钉尾与矫形棒联接处的2个部位;③Case1-5手术方案脊柱胸椎侧凸的矫形率分别为63.9％,59.9％,67.6％,61.5％,66.4％;腰椎侧凸的矫形率分别为39.1％,32.2％,36.8％,42.9％,49.3％;④Case3,5两种胸椎松解术实验在胸椎矫形过程中其矫正效果未明显提高,但其相应结构的椎弓根螺钉应力却明显减低,Case5结果显示腰椎去旋转及降低胸腰椎螺钉的应力上明显优于其他组;⑤实验结果为成人特发性脊柱侧凸的有限元生物力学实验提供了量化指标,为Lenke3型成人特发性脊柱侧凸矫形手术效果的预测以及结合临床进行手术方案的制定提供了一定的理论基础.

目的 该文主要就骨科教学过程中LBL-PBL-LBL的应用效果进行了探究.方法 就该院2016年在骨科学习的临床护理专业学生120名作为研究对象,对所有患者进行随机分组,其中观察组与对照组各60名,就两组学生的考试成绩跟教学反馈评分情况进行对比分析.结果 该次研究中.两组学生的考试成绩对比差异无统计学意义(P>0.05),但是观察组学生的教学反馈评分要显著高于对照组(P<0.05).结论 在骨科教学过程中通过LBL-PBL-LBL教学模式的应用,其能够在保障学生们学习成绩的基础上,还能够进一步提升学生的学习积极性,因此值得临床应用跟推广.

LBP(下腰痛)是一种以影响成人为主的常见病症,是重要的福利和经济问题.LBP具有复杂的临床症状与发病机制.LBP的临床评价、治疗依赖于发病机制的推测.本文主要通过对LBP基础与临床研究进行综述,旨在提高专科医生的LBP临床决策水平.

Objective To observe the expression of vascular endothelial growth factor receptor-1 (VEGFR-1) and VEGFR-2 in hypoxic chorioretinal endothelial cells of monkeys (RF/6A),and to evaluate the effect of minocycline.Methods RF/6A was cultured and divided into four groups:control group,hypoxia group,hypoxia and low dose of minocycline group (0.5 μmol/L),hypoxia and medium dose of minocycline group (5 μmol/L),and hypoxia and high dose of minocycline group (50 μmol/L).Real-time reverse transcription-polymerase chain reaction (RT-PCR) and immunohistopathological staining were used to measure the mRNA and protein expression of VEGFR-1 and VEGFR-2,respectively.Results RT-PCR showed that the expression of VEGFR-1 mRNA did not vary significantly between groups (F24 h =0.17,F48 h =1.53,F72 h =2.04; P＞0.05).Compared with hypoxia group,the expression of VEGFR-2 mRNA in all minocycline treated groups were significantly down-regulated (low minocycline,medium minocycline,high minocycline:t=4.69,20.16,17.12; P＜0.001).The immunohistopathological study showed the cells with positive staining of VEGFR-1 can be observed in all groups,and the staining was relatively weak and mainly located in cell membrane and cytoplasm.The optical density value analysis showed that the protein expression of VEGFR-1 did not vary significantly between groups at all time points(F24 h =0.251,F48 h=0.340,F72 h =0.589; P＞0.05).The VEGFR-2 positive staining cells were also observed in all groups,and the staining was relatively high.Brown staining particles of VEGFR-2 were observed in the cell membrane with minor staining particles in cytoplasm.The staining density of VEGFR-2 was significantly higher in hypoxia group than control group.Compared with the hypoxia group,the protein expression of VEGFR 2 in minocycline treated groups was significantly lower (F24 h =19.147,F48 h =14.893,F72 h =11.984; P＜0.05).Conclusion The expression of VEGFR-2 is up-regulated in RF/6A,and minocycline somewhat shows an inhibition effect.

目的:探讨封闭负压引流技术(Vacuum Sealing Drainage,VSD)治疗四肢感染性皮肤缺损的效果及护理要点.方法:对40例四肢皮肤缺损、感染、长期不愈合的创面进行清创及VSD治疗,术后加强对封闭负压引流装置的管理,观察患者预后.结果:32例患者经过VSD治疗后,缺损创面肉芽组织生长良好;7例患者经过二次VSD治疗后,缺损创面肉芽组织生长新鲜,创面逐步完全闭合;1例未成功.结论:对于四肢皮肤缺损、感染、长期不愈合的创面使用VSD治疗,可促进创面愈合,能缩短病程,减轻患者痛苦,术后加强对封闭负压引流装置的管理,是创面早期愈合的关键.

Currently, retinopathy of prematurity (ROP) has become a worldwide important cause of blindness in children, accounting for 6% to 18% of causes of blindness in children. It has become a global concern to improve the quality of life in preterm infants by controlling ROP. Therefore, the establishment of an appropriate animal model of retinal neovascularization has become an important means of discussing the pathogenesis of retinal neovascularization and assessing the effect of drug treatment. In this paper, a variety of models to simulate the process of ROP were reviewed.