BackgroundThe Triglyceride-glucose (TyG) index is a marker of insulin resistance, but its role in sarcopenia is controversial. The purpose of this study was to investigate the association of the TyG index with sarcopenia.Methods4030 participants aged 20 years and above were selected from National Health and Nutrition Examination Survey for cross sectional study. Weighted logistic regression model was used to estimate the association between TyG index and sarcopenia. Threshold effect analysis and restricted cubic spline were employed to describe nonlinear link, with interaction tests and subgroup analyses performed.ResultsIt was found in the fully adjusted model that the TyG index was positively associated with sarcopenia (per 1-unit increase in the TyG index: OR = 1.31, 95%CI: 1.07, 1.60). This association was further highlighted in groups characterized by the absence of MetS or diabetes, as well as the absence of vigorous or moderate work activity. Furthermore, analysis of the curve fitting and threshold effects indicated a nonlinear relationship, which exhibited a turning point at 9.14.ConclusionThe study results indicated that the TyG index was positively associated with sarcopenia. Enhancing the management of insulin resistance could help reduce the risk of developing sarcopenia.

At present, the education sector has launched a wide range of online teaching and on this basis,the online teaching mode based on online resources and platform for orthopedics and traumatology department of traditional Chinese medicine was explored. In order to explore the online teaching mode, residents in the orthopedics department of Beijing Traditional Chinese Medicine Hospital Affiliated to Capital Medical University were selected for standardized training. After the application of diversified online teaching methods, the advantages of online teaching have been brought into play and some results have been achieved, but there are still a lot of problems to be solved.

目的 观察铍针联合CT引导下脊神经后支脉冲射频消融治疗腰椎骨关节病的临床效果.方法 选取2017年5月至2020年5月在首都医科大学附属北京中医医院骨伤科运用铍针联合CT引导下脊神经后支脉冲射频消融治疗腰椎骨关节病的50例患者.所有患者术后随访1年,记录治疗前后视觉模拟量表(VAS)评分,采用改良MacNab标准评价患者治疗后3个月、1年的临床疗效.结果 患者治疗后24 h、1周、1个月、3个月、1年VAS评分均低于术前[(2.24±0.94)、(2.00±0.86)、(1.80±0.40)、(1.34±1.30)、(2.14±1.95)分比(6.16±0.77)分],差异均有统计学意义(均P<0.05).治疗后3个月时患者优良率为84.0％(42/50),1年时患者优良率为72.0％(36/50).患者术后穿刺部位均未见出血、感染、神经损伤等并发症发生.结论 铍针联合CT引导下脊神经后支脉冲射频消融治疗腰椎骨关节病安全有效.

目的:探讨低温等离子髓核消融术(Percutaneous Cervical Disc Nucleoplasty,PCDN)治疗颈椎间盘突出症(Cervical Disc Herniation,CDH)的中期疗效及其影响因素.方法:回顾性分析2019年1月至2020年1月行低温等离子髓核消融术治疗的80例颈椎间盘突出症患者资料,所有患者术后均获随访2年,根据颈椎功能障碍指数(NDI)评分、视觉模拟量表(VAS)评分、日本骨科协会(JOA)评分和改良MacNab标准评价低温等离子髓核消融术治疗颈椎间盘突出症的临床疗效.对患者的性别、体重指数(BMI)、手术节段、主要症状、年龄及病程进行单因素分析和多因素逻辑回归分析,探讨低温等离子髓核消融术的影响因素.结果:与术前相比,所有患者术后2年的NDI评分、VAS评分、JOA评分显著降低,差异有统计学意义(P＜0.05).末次随访时,优22例,良32例,中7例,差19例,总优良率为67.5％.单因素分析显示,年龄、病程、是否以头晕为主要症状均是临床疗效的影响因素;多因素回归分析显示,年龄在20～30岁(OR=0.107)、病程＜6个月(OR=0.506)以及以头晕为主要症状(OR=0.176)的患者,临床效果及预后相对较好.结论:低温等离子髓核消融术治疗颈椎间盘突出症具有良好的中期疗效,年龄小、病程短、以头晕为主的颈椎间盘突出症患者临床疗效相对较好.

目的:观察颈椎后路单开门椎管扩大成形术后患者颈椎矢状面平衡的变化,为患者术后康复训练提供影像学依据.方法:选择接受颈椎后路单开门椎管扩大成形术患者32例,根据术前矢状位轴向距离(SVA)值的中位数(15.75 mm)将患者分为低SVA组和高SVA组,每组16例.对2组患者术前及末次随访的影像学及临床资料进行回顾性分析,检测术前及术后末次随访时患者颈椎X线侧位片SVA值、颈椎前凸角(Cobb角)和T1 倾斜角(T1s),分析 2 组患者术后日本骨科协会(JOA)评分、颈椎残障功能指数(NDI)评分和满意度评分.结果:与术前比较,术后高SVA组患者NDI评分降低(P<0.01),JOA评分升高(P<0.01).与术前比较,术后低SVA组患者NDI评分降低(P<0.01),JOA评分升高(P<0.01),SVA值升高(P<0.01),Cobb角和T1s差异无统计学意义(P>0.05).低SVA组和高SVA组患者轴性症状发生率比较差异无统计学意义(P>0.05).结论:在术后至少2年的随访中,颈椎后路单开门椎管扩大椎板成形术对患者颈椎矢状面平衡有一定影响,主要表现为颈椎有前倾趋势和重心前移,但整体稳定性尚可,术前高SVA患者术后轴性症状发生率更高.

OBJECTIVE:To investigate the short-term clinical effect of the cervical anterior Hybrid surgery in the treatment of two-segment and three-segment cervical spondylosis. METHODS:From January 2018 to January 2019, 108 patients who were performed anterior Hybrid surgery with cervical degenerative diseases were collected. The patients were divided into a two-segment group with 52 patients and a three-segment group with 56 patients according to surgical segments. In two-segment group, there were 24 males and 28 females, aged from 35 to 67 years old with an average of(45.94±14.67) years old. In three-segment group, there were 23 males and 33 females, aged from 32 to 65 years old with an average of (47.54±15.34) years old. The outcome indicators of the two groups were compared. Clinical indicators:neck disability index(NDI) was used to evaluate daily life ability, Japanese Orthopedic Association(JOA) score was used to evaluate neurological function improvement, visual analogue scale(VAS) was used to evaluate pain intensity, and general clinical results were graded according to Odom's score. Cervical range of motion (ROM), fusion and complications were measured by X-ray, CT and MRI. RESULTS:All operations were successfully completed and all patients were followed up for more than 12 months. The operation time of two-segment group and three-segment group were 95 to 180 min with an average of(152.30±44.74) min and 110 to 210 min with an average of (165.18±45.86) mins, the blood loss were 20 to 100 ml with an average of (32.88±8.75) ml and 20 to 150 ml with an average of(34.64±10.63) ml respectively which has no statistical differences between the two groups (P>0.05). Compared with those before surgery, NDI, JOA, VAS and Odom's scores between two groups were significantly improved at 12 months after operation(P<0.05). However, there was no significant difference in the NDI, JOA and Odom's scores between two groups (P>0.05), and VAS in three-segment group was higher than that in two-segment group. There was no significant difference in C3-C7 cervical mobility between two groups. Surgical incisions healed smoothly in all patients without complication such as spinal cord injury and cerebrospinal fluid leakage. The bone fusion of the two groups were 43 cases (82.69%) and 45 cases(80.35%) respectively. In two-segment group, there were 2 cases of adjacent segmental hyperosteogeny, and there were 3 cases of adjacent segmental hyperosteogeny and 1 case of adjacent posterior longitudinal ligament ossification in the three-segment group. In addition, in three-segment group, there was 1 case of looseness of implants with no obvious clinical symptoms. CONCLUSION:The anterior Hybrid surgery in treating multi-level cervical spondylosis could not only improve clinical symptoms of patients but also preserve mobility. Meanwhile, the efficacy and safety of Hybrid surgery in different multi-level cervical disc diseases are confirmed, proving its value in clinical practice.

目的 探讨冰痛消喷剂治疗急性软组织损伤的疗效及安全性.方法 将60例急性软组织损伤患者随机分为2组,观察组采用冰痛消喷剂治疗,对照组采用利多卡因氯己定气雾剂治疗.59例完成治疗,其中观察组33例,对照组26例.对2组治疗前后疼痛VAS评分、肿胀面积及功能障碍进行评价并做统计学分析.结果 观察组治疗后总有效率优于对照组,但差异无统计学意义(P>0.05);VAS评分,观察组较对照组有明显改善;肿胀减轻及功能改善,2组在治疗第3天差异无统计学意义,观察组治疗第7天优于对照组,差异具有统计学意义(P<0.05).此次临床观察期间,2组均无任何不良反应.结论 冰痛消喷剂有明确的镇痛效果,能够改善急性软组织损伤引起的肿胀及功能障碍,疗效满意且安全性好.

慢性肌肉骨骼疼痛[1(Chronic Musculoskeletal Pain,CMP)是指发生在肌肉、骨骼、关节、肌腱或软组织等部位超过3个月的疼痛.铍针[2]为《灵枢·九针十二原》中"九针"的一种,现代将其应用到各种慢性肌肉骨骼疼痛中,治疗效果满意且取得了大量的研究成果.笔者通过分析总结铍针疗法的相关文献,认为铍针的作用机理可以概括为减压减张、松解粘连两个方面,在慢性肌肉骨骼疼痛中,铍针对皮神经卡压综合征、颈椎病、肩周炎、膝骨关节炎、颈、腰椎术后等疾病疗效尤为显著.

[目的]探讨颈椎前路椎间盘切除融合术(anterior cervical discectomy and fusion,ACDF)治疗伴随眩晕症状颈椎病患者的临床疗效与颈椎影像学参数变化的相关性.[方法]回顾性分析2017年7月—2019年7月本院行ACDF治疗的颈椎病伴随眩晕症状32例患者的临床资料.分析患者手术前后眩晕症状与影像学相关参数的相关性.[结果]所有患者均顺利完成手术,术中无神经、血管损伤等严重并发症.平均随访时间(28.45±2.87)个月,术后随时间推移,患者DHI、NDI评分均显著降低(P＜0.05),而JOA评分显著增加(P＜0.05).影像学方面:椎间隙撑开高度平均为基准高度的119.3％.术后患者椎间隙高度、椎管面积、C2～7前凸角均显著改善(P＜0.05).手术前后责任节段平均椎管面积变化量与DHI评分变化值呈显著正相关(P＜0.05).[结论]ACDF手术可有效治疗颈椎病及其伴随的眩晕症状,适度撑开椎间隙高度,并增加颈椎曲度;眩晕症状改善与椎管面积的增加呈正相关.

目的:观察颈椎下终板形态对人工颈椎间盘置换术(Artificial Cervical Disc Replacement,ACDR)的影响.方法:回顾性分析2018年1月至2020年9月收治的行单节段ACDR的颈椎病患者44例.根据术前颈椎下终板穹隆顶点位置将患者分为3组:A组(Ⅰ型),穹隆顶点位置靠前;B组(Ⅱ型),穹隆顶点位置居中;C组(Ⅲ型),穹隆顶点位置靠后.比较患者的临床评分和影像学参数,并按Odom's标准评定治疗效果.结果:椎体下终板矢状径平均为(17.13±2.62)mm,下终板穹隆高度平均为(2.18±0.75)mm.终板形态分布:Ⅰ型8例(18％),Ⅱ型13例(30％),Ⅲ型23例(52％).术后平均随访(21.73±8.62)个月,VAS、NDI评分较术前下降,差异有统计学意义(P＜0.05);JOA评分较术前升高,改善率为73.13％,差异有统计学意义(P＜0.05).与术前相比,FSU、SVA、手术节段活动度及整体活动度,差异有统计学意义(P＜0.05);C2～C7 Cobb角、Ti倾斜角差异无统计学意义(P＞0.05).3组终板形态之间,C2～C7 Cobb角在末次随访时差异有统计学意义(P＜0.05).邻近节段退变(ASD)2例(4.55％).Odom's标准评定结果:优25例,良13例,可4例,差2例,优良率为86.36％.结论:ACDR术后短期随访临床疗效满意,颈椎下终板形态对术后颈椎整体曲度恢复产生一定影响.

[目的 ]比较聚醚醚酮(polyetheretherketone,PEEK)棒与钛棒椎弓根螺钉内固定系统治疗腰椎退行性疾病的临床疗效.[方法]2019年8月—2020年11月对60例腰椎退行性疾病患者行减压椎弓根固定术.根据医患沟通结果,30例采用PEEK棒,30例采用钛棒.比较两组围手术期、随访及影像结果.[结果]两组均顺利完成手术,无严重并发症.两组手术时间、切口长度、术中失血量、透视次数、切口愈合等级、住院时间、下地行走时间的差异均无统计学意义(P＞0.05).两组恢复完全负重活动时间的差异无统计学意义(P＞0.05).随访12个月以上,随时间推移,两组患者术后腰部疼痛VAS和ODI评分均显著减少(P＜0.05),术后2周PEEK组的VAS评分显著优于钛棒组(P＜0.05),但术后12个月时两组间差异无统计学意义(P＞0.05).术后各时间点两组ODI指数差异均无统计学意义(P＞0.05).影像方面,术后12个月PEEK组固定节段ROM显著大于钛棒组(P＜0.05),相应时间点,两组间固定节段、上邻节段和下邻节段的Pfirrmann分级的差异均无统计学意义(P＞0.05).[结论]两种材质的内固定系统均能明显改善腰椎退行性疾病的临床症状,PEEK组患者术后早期腰痛程度更轻,并保持更好的腰部活动度.

目的 探讨中医微调手法推拿对腰椎间盘突出症(lumbar disc herniation,LDH)患者腰部核心稳定肌群功能的影响.方法 选取2018年2月至2020年9月本院骨科门诊收治的120例LDH患者,按随机数字表法分为对照组和观察组,各60例.对照组行常规康复训练联合腰椎间歇牵引,观察组在对照组的基础上加用中医微调手法推拿.比较两组临床疗效、复发率、功能障碍、疼痛程度、肌肉厚度以及腰背伸肌群力学性能.结果 观察组治疗总有效率明显高于对照组(P<0.05),复发率明显低于对照组(P<0.05);治疗后,两组患者日本骨科协会评分和腰背伸肌的峰力矩、平均功率明显高于治疗前(P<0.05),且观察组明显高于对照组(P<0.05);治疗后,两组患者视觉模拟评分、腰背屈/腰背伸比值明显低于治疗前(P<0.05),且观察组明显低于对照组(P<0.05);治疗后,两组患者腹横肌、多裂肌厚度明显优于治疗前(P<0.05),且观察组明显优于对照组(P<0.05).结论 中医微调手法推拿应用于LDH可有效改善患者腰背伸肌生物力学性能,增加腹横肌、多裂肌厚度,同时能够减轻腰部疼痛,降低复发率.

目的:基于网络药理学预测金匮肾气丸治疗骨质疏松症的作用机制.方法:通过中药系统药理学数据库与分析平台(TCMSP)、中药分子机制综合数据库(TCMID)、中药分子机制生物信息学分析工具(BATMAN-TCM)等数据库检索金匮肾气丸药物成分及成分相关靶点;以"Osteoporosis"为关键词在人类基因数据库(GeneCards)、在线人类孟德尔遗传数据库(OMIM)、DrugBank等数据库检索骨质疏松症疾病相关靶点;制作韦恩图,获取药物-疾病交集靶点;利用String数据库、Cytoscape 3.6.1软件构建药物-疾病交集靶点蛋白互作网络及药物-成分-疾病-靶点网络;通过DAVID数据库对药物-疾病交集靶点进行基因本体(GO)、京都基因和基因组百科全书(KEGG)富集分析,并将富集结果可视化.结果:共获得金匮肾气丸药物成分118个,包括槲皮素、山柰酚、大黄素等;有效成分相关靶点202个,疾病相关靶点1856个,药物-疾病交集靶点87个,包括前列腺素内过氧化物合酶2(PTGS2)、转录因子(JUN)、胞间黏附分子1(ICAM1)等;GO富集分析功能条目376条,其中生物过程(BP)290条,细胞组分(CC)28条,分子功能(MF)58条,包括RNA聚合酶Ⅱ启动子的转录正调控、类固醇激素受体活性等;KEGG信号通路共90条,包括类风湿性关节炎信号通路、破骨细胞分化信号通路、催乳激素信号通路等.结论:金匮肾气丸通过槲皮素、山柰酚、大黄素、薯蓣皂苷元、β-谷甾醇等有效成分作用于PTGS2、JUN、ICAM1、白细胞介素-1β(IL-1β)、基质金属蛋白酶9(MMP9)等关键靶点通过抗氧化、抑制炎症反应、促进成骨细胞增殖分化、抑制破骨细胞骨吸收等作用机制达到治疗OP的作用.

目的 基于网络药理学预测独活寄生汤治疗强直性脊柱炎的作用机制.方法 通过中药系统药理学数据库与分析平台(TCMSP)、中药分子机制综合数据库(TCMID)、中药分子机制生物信息学分析工具(BATMAN-TCM)等数据库搜索独活寄生汤中各药物成分及其相关靶点,以Ankylosing spondylitis为关键词在DrugBank、GeneCards、OMIM、TTD等数据库搜索强直性脊柱炎的疾病相关靶点,通过制作韦恩图,获取药物-疾病交集靶点,利用String数据库、Cytoscape 3.6.1软件构建药物-疾病交集靶点蛋白互作网络、药物-成分-疾病-靶点网络,最后通过DAVID数据库对药物-疾病交集靶点进行基因本体(GO)功能富集分析、京都基因与基因组百科全书(KEGG)通路富集分析,并将富集结果可视化.结果 通过TCMSP、TCMID、BATMAN-TCM三个数据库共获得独活寄生汤药物化学成分264个,包括槲皮素、山柰酚、柚皮素、汉黄芩素、黄芩素等;有效成分与强直性脊柱炎共同作用靶点129个,包括肿瘤坏死因子(TNF)、白细胞介素6(IL6)、脂多糖受体(CD14)、前列腺素内过氧化物合酶1(PTGS1)等;GO富集分析功能条目547条,其中生物过程(BP)435条,细胞组分(CC)40条,分子功能(MF)72条,包括细胞对脂多糖的反应、类固醇激素受体活性等;KEGG信号通路共101条,主要包括核因子κB(NF-kB)信号通路、核苷酸结合寡聚域(NOD)样受体信号通路、低氧诱导因子-1(HIF-1)信号通路、催乳素信号通路等.结论 独活寄生汤治疗强直性脊柱炎主要是通过槲皮素、山柰酚、柚皮素、汉黄芩素、黄芩素等活性成分作用于信号转导和转录激活因子3(STAT3)、白细胞介素1β (IL1B)、血管内皮生长因子(VEGFA)、白细胞介素10 (IL10)等关键靶点基因从而调节多条生物学功能与信号通路,最终达到治疗强直性脊柱炎作用.

目的 系统评价脉冲射频术(pulsed radio frequency,PRF)治疗腰骶神经根性疼痛(lumbosacral radicular pain,LRP)的有效性及安全性.方法 计算机检索中国知网、万方、维普、中国生物医学文献数据库、Medline、Embase、Cochrane Library、Cochrane对照试验注册库以及(WHO ICTRP)和Clinical Trial两个临床试验注册库中有关PRF治疗LRP的随机对照试验(randomized controlled trials,RTC),时限为建库至2020年10月.采用Cochrane偏倚风险评估工具行方法学质量评价,采用RevMan 5.3软件行Meta分析.结果 共纳入8项PRF治疗LRP的RTC,涉及334例受试者.PRF组与对照组对比:①有效性:疼痛视觉模拟(VAS)评分降低,差异具有统计学意义(P<0.05);Oswestry功能障碍指数(ODI)评分降低,差异无统计学意义(P>0.05).②安全性:不良事件发生率差异无统计学意义(P>0.05);8项研究均报告未发生严重不良事件.结论 与常规治疗相比,PRF在缓解LRP方面可能具有良好的疗效.但受纳入样本量和方法学质量的限制,上述结论仍有待更多高质量的研究予以验证.

目的:基于网络药理学探讨补阳还五汤治疗强直性脊柱炎的作用机制.方法:通过中药系统药理学数据库与分析平台(traditional chinese medicine systems pharmacology database and analysis platform,TCMSP)、中药分子机制综合数据库(traditional Chinese medicine integrated database,TCMID)、中药分子机制生物信息学分析工具(bioinformatics analysis tool for molecular mechanism of traditional Chinese medicine,BATMAN-TCM)等数据库搜索补阳还五汤药物成分及其相关靶点;以"Ankylosing spondylitis"为关键词在DrugBank、人类基因数据库(GeneCards)、在线人类孟德尔遗传数据库(online mendelian inheritance in man,OMIM)、治疗靶标数据库(therapeutic target database,TTD)等数据库搜索强直性脊柱炎的相关靶点;通过制作韦恩图,获取补阳还五汤与强直性脊柱炎的交集靶点,利用String数据库、Cytoscape 3.6.1软件构建药物疾病共同靶点蛋白互作网络、药物-成分-疾病-靶点网络;最后通过DAVID数据库(The database for annotation,visu-alization and integrated discovery)对共同靶点进行基因本体(gene ontology,GO)、京都基因和基因组百科全书(kyoto ency-clopedia of genes and genomes,KEGG)富集分析,并将富集结果可视化.结果:通过TCMSP、TCMID、BATMAN-TCM 3个数据库共获得补阳还五汤药物化学成分106个,包括槲皮素、山柰酚、木樨草素、黄芩素、芒柄花黄素等;有效成分与强直性脊柱炎共同作用靶点82个,包括白细胞介素-6(interleukin-6,IL-6)、肿瘤坏死因子(tumor necrosis factor,TNF)、血管内皮生长因子(vascular endothelial growth factor A,VEGFA)等;GO富集分析功能条目366条,其中生物过程(biological process,BP)284条,细胞组分(cellular component,CC)31条,分子功能(molecular function,MF)51条,包括细胞对脂多糖的反应、类固醇激素受体活性等;KEGG信号通路共87条,主要核因子kB(nuclear factor-k-gene binding,NF-κB)信号通路、核苷酸寡聚化结构域(nucleotide oligomerzation domain,NOD)样受体信号通路、缺氧诱导因子1(hypoxia inducible factor-1,HIF-1)信号通路等.结论:补阳还五汤治疗强直性脊柱炎主要是通过槲皮素、山柰酚、木樨草素、黄芩素、芒柄花黄素等活性成分作用于VEGFA、IL-10、基质金属蛋白酶9(matrix metallopeptidase 9,MMP9)、前列腺素内过氧化物合酶2(prostaglandin-endoperoxide synthase 2,PTGS2)等靶点基因,从而调节多条生物学功能与信号通路,最终达到治疗作用.

Objective:To compare the effect and clinical significance of unilateral and bilateral percutaneous kyphoplasty (PKP) combined with hyperextension reduction in the treatment of fresh osteoporotic vertebral compression fracture (OVCF).Methods:The clinical data of OVCF patients treated in Beijing Traditional Chinese Medicine Hospital Affiliated to Capital Medical University from January to December 2018 were retrospectively analyzed.A total of 62 patients were included.According to the surgical approach, 62 patients were divided into unilateral puncture approach group and bilateral puncture approach group, with 31 cases in each group.The patients in the unilateral puncture group were treated with limb hyperextension reduction combined with unilateral PKP.In the bilateral puncture approach group, limb hyperextension reduction combined with bilateral PKP was used.The changes of visual analogue pain scale (VAS), Oswestry disability index (ODI), vertebral anterior height, vertebral midline height and Cobb angle were observed and compared before operation, 1 day and 2 weeks after operation.At the same time, the operation time, intraoperative fluoroscopy times, intraoperative bone cement injection and adverse reactions were compared between the two groups.Results:The VAS scores of patients in the unilateral puncture approach group before operation, 1 day and 2 weeks after operation were (8.10±0.17), (2.20±0.26) and (1.90±0.39), respectively.The scores of bilateral puncture approach group were (8.10±0.13), (2.30±0.26) and (2.00±0.30), respectively.The results of repeated measurement ANOVA showed that F intra-group=13 790.444, P<0.001, F inter-group=1.951, P=0.168, F interaction=0.735, P=0.481.There were significant differences in VAS scores between the two groups 1 day and 2 weeks after operation (all P<0.05). There was significant difference in VAS score between the two groups 1 day after operation and 2 weeks after operation (all P<0.05). The ODI scores of patients in the unilateral puncture group before operation, 1 day and 2 weeks after operation were (40.30±5.30), (23.20±3.40), (22.30±4.49) points respectively, and those in the bilateral puncture group were (41.00±4.49), (21.90±2.48), (20.70±5.70) points, respectively.The results of repeated measurement ANOVA showed that F intra-group=339.046, P<0.001, F inter-group=1.385, P=0.244, F interaction=1.083, P=0.342.There were significant differences in ODI scores between the two groups 1 day and 2 weeks after operation (all P<0.05). There was significant difference in ODI score between the two groups 1 day after operation and 2 weeks after operation (all P<0.05). The anterior height of vertebral body in unilateral puncture group was (18.26±2.40), (21.97±1.17), (22.03±1.35) mm before operation, 1 day and 2 weeks after operation, and that in bilateral puncture group was (18.94±1.80), (22.06±2.79), (20.29±1.19) mm.The results of repeated measurement ANOVA showed that F intra-group=51.228, P<0.001, F inter-group=1.594, P=0.212, F interaction=6.452, P=0.002.There were significant differences in the anterior vertebral height between the two groups 1 day and 2 weeks after operation (all P<0.05). The height of vertebral midline in the unilateral puncture group was (17.97±2.14), (26.13±1.43), (26.00±1.79) mm before operation, 1 day and 2 weeks after operation, and in the bilateral puncture group was (18.84±1.77), (24.74±1.77), (24.68±2.06) mm.The results of repeated measurement ANOVA showed that F intra-group=358.837, P<0.001, F inter-group=3.850, P=0.054, F interaction=9.117, P<0.001.There were significant differences in the height of vertebral midline between the two groups 1 day and 2 weeks after operation (all P<0.05). The Cobb angles in the unilateral puncture group were (21.74±2.11)°, (11.77±1.91)° and (10.94±1.12)° before operation, 1 day and 2 weeks after operation, respectively, and in the bilateral puncture group were (22.13±2.50)° and (12.0±2.38)° and (11.71±1.37°, respectively.The results of repeated measurement ANOVA showed that F intra-group=674.732, P<0.001, F inter-group=1.975, P=0.165, F interaction=0.376, P=0.688.There were significant differences in Cobb angle between the two groups 1 day and 2 weeks after operation (all P<0.05). There were significant differences in operation time ((52.0±3.8) min and (67.0±6.7) min), intraoperative fluoroscopy times ((15.0±5.8) times and (32.0±6.1) times), and bone cement injection volume ((4.6±0.3) mL and (5.0±0.1) mL) between unilateral puncture approach group and bilateral puncture approach group (all P<0.001). Conclusion:Unilateral and bilateral PKP combined with hyperextension reduction can alleviate the pain of OVCF, restore the lost vertebral height and correct kyphosis.The unilateral puncture approach PKP combined with hyperextension reduction has the advantages of shorter operation time, concise operation process, fewer times of intraoperative fluoroscopy and less use of bone cement.

膝骨关节炎(knee osteoarthritis,KOA)是多种因素引起的关节软骨纤维化、皲裂、溃疡、脱失而导致的关节疾病[1].随着人口老龄化的加剧,KOA的发病率逐年升高.最新流行病学调查结果表明,195个国家约30 310.68亿人患有髋、膝关节骨关节炎,美国每年KOA患者的医疗消耗约为8 000万美元[2].

OBJECTIVE:To investigate the clinical effect of anterior cervical Hybrid surgery in the treatment of cervical degenerative diseases (CDD) and observe the incidence of heterotopic ossification of disc replacement segment at 1 year after surgery. METHODS:From January 2015 to April 2018, 35 patients who received anterior cervical hybrid surgery met the inclusion and exclusion criteria and the complete clinical follow up data were analyzed retrospectively. Complete imaging follow-up data were obtained from 24 patients. There were 15 males and 20 females, aged from 39 to 70(55.57±7.73) years old. The amount of bleeding was for 20 to 100 (40.29±18.39) ml, and the hospitalstay was for 4 to 28(11.03±4.63) days, and the follow-up time was(12.97±1.36) months. Clinical outcomes were assessed by the Tanaka Yasushi cervical spondylitis symptom scale 20 score (YT20), and Japanese Orthopaedic Association (JOA) score. The occurrence of heterotopic ossification after Hybrid surgery was evaluated by X-ray according to McAfee standard one year after operation. Patients with or without heterotopic ossificationwere divided into two groups and their clinical effects were compared. RESULTS:At the final follow up, the mean YT20 score and JOA score were significantly higher than those before operation (P <0.05), and the average improvement rate of JOA was (70.66 ±0.44)%. One year after operation, the heterotopic ossification occurred in 10 of 24 segments, with incidence of 41.70%(10/24), including 29.20% in gradeⅠand 12.50% in gradeⅡ. The results of clinical efficacy comparison between patients with and without heterotopic ossification were as follows:there was no significant difference in JOA score before and after operation (P>0.05);there was no significant difference in YT20 score before operation (P>0.05), and YT20 score in patients with heterotopic ossification was significantly lower than that in patients without heterotopic ossification(P<0.05). CONCLUSION:The short-term clinical effect of Hybrid surgery is satisfactory for cervical degenerative diseases, and the cause of heterotopic ossification still needs tobe further explored.

目的:观察颈椎前路Hybrid手术(颈椎前路减压椎间融合术+颈椎全椎间盘置换术)治疗颈椎病的临床疗效.方法:收集2017年7月～2019年12月接受颈椎前路Hybrid手术的颈椎病患者的临床资料,符合纳入和排除标准并获得临床随访资料者共56例,其中获得完整影像学随访资料者40例.56例患者中神经根型颈椎病36例,混合型颈椎病12例,脊髓型颈椎病7例,交感型颈椎病1例;双节段病变39例,三节段病变17例;男25例,女31例;年龄34～72(54.23±8.72)岁.分别在术前、末次随访时记录患者田中靖久颈椎病症状量表评分(Tanaka Yasushi cervical spondylitis symptom scale 20 score,YT20评分)及颈椎JOA评分;在X线片上测量患者C2-7 Cobb角、手术节段脊柱功能单位Cobb角、C2-7矢状面轴向距离和T1倾斜角;依据Goffin标准对Hybrid手术后邻近节段退变(adjacent segment degeneration,ASD)进行分级.结果:56例患者的手术时间为88～360min (175.25±55.97min),术中出血量10～20ml(14.91±4.21ml),引流量5～80ml(17.92±17.13ml),住院时间4～29d(11.20±5.70d),随访时间6～29个月(11.59±6.11个月).1例患者术后2d于切口附近出现血肿.末次随访时YT20评分和JOA评分均较术前显著好转(9.02±3.50 vs 17.18±3.24,P＜0.05;14.38±1.93 vs 16.40±1.12,P＜0.05),JOA评分改善率平均为81.12％(0％～100％);C2-7 Cobb角(1.59°±6.76°vs 5.60°±8.32°,P＜0.05)、手术节段Cobb角(8.64°±10.68°vs 11.91°±10.94°,P＜0.05)均较术前明显改善.末次随访时C2-7矢状面轴向距离(17.63±8.54mm vs 17.79±10.67mm,P＞0.05)、T1倾斜角(23.32°±7.25°vs 24.42°±7.10°,P＞0.05)较术前无统计学差异.末次随访时,40个上邻近节段中ASD发生率为20.00％,其中退变分级较术前增加1级的为12.50％,较术前增加2级的为7.50％;37个下邻近节段中ASD发生率为16.22％,其中退变分级较术前增加1级的为8.11％,较术前增加2级的为8.11％,均无较术前增加3级者.上邻近节段发生退变与未发生退变患者比较,术前和末次随访时JOA评分、YT20评分均无统计学差异(P＞0.05);下邻近节段发生退变与未发生退变患者比较,术前及末次随访时JOA评分、YT20评分均无统计学差异(P＞0.05).手术节段上节段置换35例、融合5例,下节段置换3例、融合37例;手术节段上节段融合的ASD发生率(40.00％)与置换的ASD发生率(17.14％)比较无统计学差异(P＞0.05),下节段融合的ASD发生率(20.00％)与置换的ASD发生率(0.00％)比较无统计学差异(P＞0.05).结论:颈椎前路Hybrid手术后近期临床症状明显改善,颈椎C2-7和手术节段曲度明显增加;但ASD发生率相对较高,手术节段置换或融合对ASD的影响不大,仍需进一步观察ASD的影响因素.