In this study, a composite hydrogel (QMPD hydrogel) composed of methacrylate anhydride (MA) grafted quaternary ammonium chitosan (QCS-MA), polyvinylpyrrolidone (PVP), and dopamine (DA) was designed for the sequential wound inflammation elimination, infection inhibition, and wound healing. The QMPD hydrogel formation was initiated by the ultraviolet light-triggered polymerization of QCS-MA. Furthermore, hydrogen bonds, electrostatic interactions, and "π-π" stacking between QCS-MA, PVP, and DA were involved in the hydrogel formation. In this hydrogel, the quaternary ammonium groups of quaternary ammonium chitosan and the photothermal conversion of polydopamine are capable of killing bacteria on wounds, which showed the bacteriostatic ratios of 85.6 % and 92.5 % toward Escherichia coli and Staphylococcus aureus, respectively. Moreover, the oxidation of DA sufficiently scavenged free radicals and introduced the QMPD hydrogel with good anti-oxidant and anti-inflammatory abilities. Together with the extracellular matrix-mimic tropical structure, the QMPD hydrogel significantly promoted the wound management of mice. Therefore, the QMPD hydrogel is expected to provide a new method for the design of wound healing dressings.

BACKGROUND AND OBJECTIVES:Posterior C1-C2 interlaminae compression fusion with iliac bone graft may lead to donor site complications and recurrent C1 posterior dislocation for posterior atlantoaxial dislocation (AAD) secondary to os odontoideum. C1-C2 intra-articular fusion often needs C2 nerve ganglion transection to facilitate exposing and manipulating the facet joint, leading to bleeding from the venous plexus and suboccipital numbness or pain. Therefore, this study was conducted to evaluate the outcomes of posterior C1-C2 intra-articular fusion with a C2 nerve root preservation technique in the treatment of posterior AAD secondary to os odontoideum.METHODS:Data of the 11 patients who underwent C1-C2 posterior intra-articular fusion because of posterior AAD secondary to os odontoideum were retrospectively reviewed. Posterior reduction was performed using C1 transarch lateral mass screws and C2 pedicle screws. Intra-articular fusion was performed using a polyetheretherketone cage filled with autologous bone from the caudal edge of the C1 posterior arch and cranial edge of the C2 laminar. Outcomes were evaluated by using the Japanese Orthopaedics Association score, Neck Disability Index, and visual analog scale for neck pain. Bone fusion was evaluated by using computed tomography and 3-dimensional reconstruction.RESULTS:The average follow-up duration was 43.9 ± 9.5 months. All patients achieved good reduction and bone fusion, without transection of the C2 nerve roots. The mean bone fusion time was 4.3 ± 1.1 months. There was no complication related to the surgical approach and instrumentation. Function of the spinal cord manifested by the Japanese Orthopaedics Association score significantly improved ( P < .05). The Neck Disability Index score and visual analog scale for neck pain markedly decreased (all P < .05).CONCLUSION:Posterior reduction and intra-articular cage fusion with a C2 nerve root preservation technique was a promising treatment of posterior AAD secondary to os odontoideum.

Osteoporotic vertebral compression fracture (OVCF) can lead to lower back pain and may be even accompanied by scoliosis, neurological dysfunction and other complications, which will affect the daily activities and life quality of patients. Vertebral augmentation is an effective treatment method for OVCF, but it cannot correct unbalance of bone metabolism or improve the osteoporotic status, causing complications like lower back pain, limited spinal activities and vertebral refracture. The post-operative systematic and standardized rehabilitation treatments can improve curative effect and therapeutic efficacy of anti-osteoporosis, reduce risk of vertebral refracture, increase patient compliance and improve quality of life. Since there still lack relevant clinical treatment guidelines for postoperative rehabilitation treatments following vertebral augmentation for OVCF, the current treatments are varied with uneven therapeutic effect. In order to standardize the postoperative rehabilitation treatment, the Spine Trauma Group of the Orthopedic Branch of Chinese Medical Doctor Association organized relevant experts to refer to relevant literature and develop the "Guideline for postoperative rehabilitation treatment following vertebral augmentation for osteoporotic vertebral compression fracture (2022 version)" based on the clinical guidelines published by the American Academy of Orthopedic Surgeons (AAOS) as well as on the principles of scientificity, practicality and advancement. The guideline provided evidence-based recommendations on 10 important issues related to postoperative rehabilitation treatments of OVCF.

目的 通过生物信息学策略探索强直性脊柱炎(AS)相关的差异基因,寻找疾病的新型诊断标志物.方法 通过美国国立生物技术信息中心的基因表达汇编(GEO)数据库下载AS相关的芯片数据,分析筛选出AS患者和健康人外周血之间的差异表达基因,利用注视、可视化和集成发现数据库(DAVID)对差异表达基因进行基因本体(GO)功能和京都基因与基因组百科全书(KEGG)信号通路分析,然后利用在线数据库String构建蛋白质-蛋白质相互作用(PPI)网络,利用Cytoscape 3.7.1软件筛选PPI网络中显著的蛋白质模块获取关键基因.计算ROC曲线的AUC值,评估关键基因对AS的诊断效能.结果 共筛选出187个差异表达基因,其中包含96个上调基因和91个下调基因.GO功能分析结果显示差异表达基因参与的生物学过程主要为核糖核苷一磷酸代谢过程、核苷一磷酸代谢过程和嘌呤核糖核苷一磷酸代谢过程等,KEGG信号通路分析结果显示差异表达基因参与的主要信号通路富集于非酒精性脂肪肝、亨廷顿病和氧化磷酸化等.基于PPI网络分析结果筛选出5个关键基因:ATP合成酶H+转运线粒体F0复合体亚基F6(ATP5J)、NADH:泛醌氧化还原酶亚基B3(NDUFB3)、泛醇-细胞色素c还原酶结合蛋白(UQCRB)、细胞色素c氧化酶亚基7A2(COX7A2)、泛醇-细胞色素c还原酶铰链蛋白(UQCRH).它们对AS的诊断效能显著,AUC值分别为0.859、0.852、0.840、0.820、0.805.结论 ATP5J、NDUFB3、UQCRB、COX7A2和UQCRH也许可作为外周血AS疾病相关的新型诊断标志物.

在中国步入中等老龄化社会以及新冠肺炎对认知障碍患者的感染性更强的背景下,针对认知障碍患者的康复训练,提出通过运动锻炼来干预认知训练的认知康复软件训练系统.该系统由Kinect数据采集模块和康复训练软件模块构成,结合数据库,实现运动锻炼干预认知训练.通过镜像的模型映射促进认知功能锻炼,通过循环多次检测保证姿势识别率,通过运动干预提高认知训练的康复效果.通过该系统可以将运动锻炼和认知训练相结合,虚拟训练可以提高患者的训练兴趣和注意力,为认知障碍的非药物治疗手段提供新的思路和方法.

为了克服常规踏板式步态训练器缺少移动性,无法配合患者的行动意愿.本研究研制了一种实现同步移动功能的踏板式康复训练助行器.采用SolidWorks2019对助行器进行三维建模,分别对支承减重车、踏板式步态康复训练器以及联动装置部分进行设计.联动装置与步态训练器的脚踏板和支承减重车的后车轮连接,通过脚踏板改变后轮的运动状态,后轮与脚踏板同步运动.使用Motion模块对助行器运动仿真,给脚踏板设定一个步态轨迹,求解了助行器脚踏板驱动小齿轮和后轮的角速度.结果表明,脚踏板驱动小齿轮和后轮角速度曲线有同步性,且光滑无尖点.训练器后轮角速度输出稳定,无较大震动及卡死情况,联动装置设计合理,实现了踏板式康复助行器的同步移动功能.

脊柱源性腹痛(APSO)是指因椎骨或脊髓神经病变引起的腹痛,约占急诊就诊病因的5.76％[1].主要表现为腹部压痛和神经系统功能异常,少数患者存在痛觉过敏的现象[2].早期观念认为引起APSO主要与腹部皮肤对痛觉过度敏感、腰椎解剖结构和生物力学特点改变等因素有关[3-5].近年研究显示,在损伤[6-7]、炎性反应[8-9]、肿瘤[10]和退行性变[11]等病理因素的作用下,椎骨或脊髓神经病变可引起腹痛.为阐明APSO病因、提高APSO诊治水平,本文通过查阅并分析国内外APSO相关研究文献,探讨APSO的病理机制、诊断和治疗,以期为临床提供参考.

表面肌电信号是一种重要的生理电信号.基于表面肌电信号建立人体康复动作识别系统操作方便,对身体无侵入性,对运动无干扰,有广阔的应用前景.肢体康复动作识别系统很大程度上依赖于信号特征提取和分类器的使用.文中对近几年基于人工神经网络建立的表面肌电信号分类器,包括LVQ分类器、ELM分类器、WNN分类器、ANFIS分类器、Alex Net分类器和GRNN分类器进行了回顾和探讨.通过对各种分类器的回顾比较,发现现有的不足之处并针对分类器的未来研究方向和发展趋势进行了分析和展望,为今后相关方面的研究提供一定的参考依据.

椎间盘退变(intervertebral disc degeneration,IVDD)是脊柱退行性疾病的重要病理基础之一.目前治疗椎间盘退变性疾病的方法主要集中于缓解症状,而非解决根本问题或恢复椎间盘本身的结构和功能[1].为了修复重建椎间盘组织,研究者研发了许多方法并取得了一定成果,例如干细胞治疗[2]和基因治疗[3]等.其中,干细胞生物治疗一直是再生医学领域的研究热点.

Study Design. Cross-sectional study. Objective. Alcohol abuse (AA) and alcohol withdrawal (AW), both belonging to alcohol use disorders, bring about vast health consequences, social issues, and financial burden in United States. This study aims to explore the relationship of AA and AW with perioperative outcomes following elective spine fusion surgery. Summary of Background Data. Large studies evaluating the outcomes of spine surgery in patients with AA or AW are lacking. Methods. We used the National Inpatient Sample (NIS) from 2006 to 2014 to extract records with a primary procedure of spinal fusion surgery. Multivariable regression analysis was used to assess the association of AA and AW with in-hospital mortality, perioperative complications, cost and length of stay (LOS). Results. Among 3,132,192 patients undergoing elective spinal fusion surgery, the prevalence of AA and AW was 1.14% (35,833) and 0.15% (4623), respectively. Among the AA admissions, 12.90% of patients developed AW. The incidence of overall complications was 6.14%, 10.15%, and 33.73% in patients without AA, with AA and with AW, respectively. After multivariable adjustment, AW was associated with elevated risk of overall complications (odds ratio [OR]: 4.51; 95% confidence interval [CI]: 3.86-5.27), neurologic (OR: 2.58; 95% CI: 1.62-4.12), respiratory (OR: 8.04; 95% CI: 6.62-9.77), cardiac (OR: 3.58; 95% CI: 2.60-4.93), gastrointestinal (OR: 2.31; 95%CI: 1.68-3.17), urinary and renal (OR: 2.68; 95% CI: 2.11-3.39), venous thromboembolism (OR: 3.06; 95% CI: 1.94-4.82), wound-related complications (OR: 3.84; 95% CI: 2.96-4.98) and in-hospital mortality (OR: 5.95; 95% CI: 3.25-10.90). AW was also linked to 40% higher cost and 85% longer LOS. Conclusion. Both AA and AW are associated with adverse outcomes in patients undergoing spinal fusion surgery with more pronounced risks for AW. Aggressive management in perioperative period is required to improve outcomes in these patients.

目的 探讨经皮椎体成形术(PVP)中注入不同剂量骨水泥治疗骨质疏松性椎体压缩性骨折(OVCF)的临床应用效果.方法 回顾性分析2017年7月—2018年7月在海军军医大学附属长征医院接受PVP治疗的122例老年胸腰椎单椎体OVCF患者临床资料.51例患者术中注入小剂量骨水泥(小剂量组,≥2.5 mL且<4.0 mL),71例患者术中注入大剂量骨水泥(大剂量组,≥4.0 mL且<6.0 mL).记录2组患者手术前后疼痛视觉模拟量表(VAS)评分、椎体前缘高度及术后骨水泥渗漏率.结果 2组患者术后1个月、1年的VAS评分均较术前明显改善,差异有统计学意义(P<0.05),术后各时间点组间比较差异无统计学意义(P>0.05).2组患者术后伤椎前缘高度均较术前显著改善,且大剂量组改善程度优于小剂量组,差异均有统计学意义(P<0.05).大剂量组骨水泥总渗漏率为14.08％(10/71),小剂量组骨水泥总渗漏率为5.88％(3/51),组间比较差异无统计学意义(P>0.05).结论 PVP术中注入不同剂量骨水泥治疗老年单椎体OVCF均可获得良好的临床效果,改善患者临床症状,恢复脊柱功能,且注入大剂量骨水泥可更有效地恢复椎体高度.

断肢再植术是指用手术方法将离断的肢体重新接回原位，恢复其生理机能的一种外科技术。陈中伟、钱允庆等在1963年成功实施了世界首例断肢再植手术，而所依据理论基础来自屠开元、赵定麟等在1962年发表的《离断肢体再植术的动物实验》一文，文章详细阐述了断肢再植术的相关技术、操作程序、手术要点及并发症处理。陈中伟、钱永庆正是按照文章中的操作要点才完成了世界首例人体断肢再植。断肢再植术是中国人的骄傲，激励着骨科一代又一代人不断勇于探索、敢于实践发展。

目的 评估低度腰椎滑脱患者矢状位失衡情况,并探讨维持低度腰椎滑脱矢状位平衡的主要代偿机制.方法 纳入2016年6月—2017年6月在上海市嘉定区中医医院确诊为单节段低度腰椎滑脱症的60例患者,其中30例为MeyerdingⅠ度滑脱(MeyerdingⅠ度组),30例为MeyerdingⅡ度滑脱(MeyerdingⅡ度组).纳入同期30名X线检查脊柱-骨盆无影像学异常的受试者作为对照组.收集患者性别、年龄、体质量指数(BMI)等一般资料,并利用术前站立位脊柱全长侧位X线片测量相关参数:最大胸椎后凸角(maxTK)、最大腰椎前凸角(maxLL)、骶骨倾斜角(SS)、骨盆倾斜角(PT)、骨盆入射角(PI)及矢状位偏移(SVA).采用秩相关分析探讨滑脱程度与脊柱-骨盆参数的相关性,采用单因素方差分析比较不同程度滑脱患者及对照组脊柱-骨盆参数的差异.结果 腰椎滑脱程度与maxTK呈负相关(rs=-0.512,P<0.05),与PI(rs=0.621,P<0.05)、SS(rs=0.385,P<0.05)和PT(rs=0.573,P<0.05)均呈正相关,而与年龄、BMI、SVA和maxLL之间无明显相关性.MeyerdingⅠ度和Ⅱ度滑脱组maxTK均小于对照组,差异有统计学意义(P<0.05),但Ⅰ度和Ⅱ度滑脱组之间差异无统计学意义(P>0.05);MeyerdingⅠ度和Ⅱ度滑脱组PI均大于对照组,且Ⅱ度滑脱组PI大于Ⅰ度滑脱组,差异均有统计学意义(P<0.05).结论 PI增大与腰椎滑脱的发生和进展密切相关,TK降低可能是维持低度腰椎滑脱患者矢状位平衡的主要代偿机制.

为提高基于表面肌电信号的人体腰背动作识别率,提出一种基于小波包能量与改进NARX神经网络的分类识别新方法.利用小波包变换对动作部位进行表面肌电信号特征提取,并采用改进NARX神经网络进行分类识别.选取8名实验者分别在扭腰、弯腰、侧弯腰3种动作下进行表面肌电信号数据采集,选择db4小波包函数对信号进行6层分解,得到第6层64个频带的小波包分解系数,代表各个动作信息的特征向量,作为改进NARX神经网络的输入进行分类识别.对照实验组中,改进NARX神经网络的识别率较高,总体识别率达到96.7％.实验结果表明,利用该识别方法对腰部动作进行分类识别,分类准确,且识别率更高.

脊髓损伤是导致瘫痪的主要原因之一,患者常伴有下肢运动功能障碍,给患者、家庭和社会带来沉重的负担.重建步行能力是帮助脊髓损伤患者重返社会的有效措施.我们总结了目前步态康复训练设备和辅助行走设备在帮助脊髓损伤患者重建步行能力中的应用情况,并对今后的发展作出展望与分析.

目的 系统评价保守与手术两种治疗方式对青少年腰椎间盘突出症的疗效.方法 按照Cochrane系统评价的方法,计算机检索1945年至今的Pubmed数据库、Embase数据库、Web of Science数据库、Cochrane图书馆及中国生物医学数据库,手工检索相关杂志,语种不限.搜集国内外关于青少年腰椎间盘突出症治疗的前瞻性对照试验(随机或非随机).制定入选和剔除标准,筛选出符合纳入标准的文献,评价纳入研究的方法学质量.提取相关数据利用RevMan 5.2进行Meta分析.结果 共有6篇研究符合纳入标准,共274例青少年腰椎间盘突出症患者,保守治疗156例,手术治疗118例.Meta分析结果显示:保守治疗总体优良率不及手术治疗[OR=0.47,95％CI(0.24,0.91)],随访1年及5年以上结果均显示手术治疗优良率优于保守治疗(P=0.003,P=0.04),而随访时间<1年的结果显示保守与手术优良率差异无统计学意义(P>0.05),手术治疗再手术率与保守治疗中转手术率差异无统计学意义(P>0.05).结论 青少年腰椎间盘突出症手术治疗的中长期疗效优于保守治疗,手术治疗再手术率与保守治疗中转手术率差异无统计学意义.对于有适应证的青少年患者,经适当保守治疗无效时可尽早行手术治疗以取得较好疗效.

Objective To measure the spinopelvic paratmeters in patients with degenerative lumbar scoliosis(DLS),and analyze their correlation and clinical significance. Methods From March 2006 to March 2014,30 patients with DLS(DLS group) and 30 subjects without DLS(Control group),with complete imaging data were selected in the study. The anteroposterior and lateral roentgenographs of the total spine standing were used to measure the spinopelvic parameters,including Cobb’s angle of scoliosis,pelvic incidence(PI),sacrum slope(SS),pelvic tilt(PT),lumbar lordosis(LL),thoracic kyphosis(TK) and sagittal vertical axis(SVA). All spinopelvic parameters between 2 groups were compared. Results Of the DLS group,LL was significantly lower than that of the Control group;the difference was statistically significant(P<0.05). The SVA and PT of the DLS group were significantly higher than those of the Control group;the differences were statistically significant(P<0.05). The differences were not statistically significant in SS,PI and TK between 2 groups(P>0.05). In both groups,there were significant correlations between SS and LL,PT and SVA. There was no correlation with all pelvic parameters(PI,PT and SS) in DLS group,while there was significant correlation with all pelvic parameters in Control group. In Control group,LL was significantly correlated with SVA,but LL was not correlated with SVA in DLS group. Conclusion The change of pelvic morphology is closely related to the sagittal sequence of the spine. Compared with Control group,DLS group has higher SVA and lower LL.

Objective To summarize the clinical effect of the atlas drawing back reduction pedicle screw-rod combined with axis pedicle screw internal fixation with its intraoperative reduction and fusion in treatment of unreducible atlantoaxial dislocation. Methods From January 2010 and December 2014,the clinical and radiographic records of 27 atlantoaxial dislocation patients were analyzed retrospectively. All patients had different degree of pain and activity limitation,and accompanied with neurological dysfunction. According to American Spinal Injury Association(ASIA) grading system,2 patients were graded as grade B,17 grade C,8 grade D. Japanese Orthopaedic Association(JOA) score before operation was 4 -14,mean 8.3. Preoperative MRI showed spinal cord compression in 20 patients,and T2WI high signal change was found in 8 patients. All the patients had undergone skull traction before operation,and 17 patients were partially reduced,10 not reduced at all. The preoperative atlantodental intervals(ADIs) were 4 -15 mm,mean 10.3 mm. The preoperative cervico-medullary angle(CMA) was 113.1° -135.7°,mean 120.9°. All patients were treated by the atlas drawing back reduction pedicle screw-rod combined with axis pedicle screw reduction fixation and bone grafting fusion. The postoperative clinical symptoms,improvement of the neurological function,the atlantoaxial reduction condition and bone fusion were observed.Results All the surgeries were performed successfully,and no intraoperative vertebral artery injury and spinal cord injury were noted. Postoperative-6-month CT and MRI showed that the cervical spine sagittal alignment was restored,and cerebral spinal fluid line was clear in the odontoid process area,and no spinal cord compression was found. All the patients were followed up for 6 -36 months,mean 20 months. Neurological function was significantly improved after 6-month follow-up,2 grade B cases recovered to grade C;in 17 grade C cases,2 recovered to grade E,and 15 recovered to grade D;8 grade D cases recovered to grade E. The postoperative JOA score was 10 -17,mean 14.6;the mean improvement rate was 78.4%. The postoperative ADI was reduced to 2 -4 mm,mean 2.6 mm. The postoperative CMA was 139.2° -152.4°,mean 144.6°. Solid bony fusion was achieved in all patients at postoperation 6 months,without loosening,displacement,or breakage of the screws and atlantoaxial instability or displacement.Conclusion Early surgical fusion is recommended for atlantoaxial dislocation causing instability and cord compression. Good clinical results can be achieved by atlas drawing back reduction pedicle screw-rod combined with axis pedicle screw reduction fixation and bone grafting fusion.

目的 回顾分析腰椎后路内固定融合术后深部感染的治疗,探讨其内固定移除的影响因素.方法 2008-01-2013-12病区共收治腰椎后路内固定融合术后术区深部感染35例,根据末次随访内固定是否移除分为内固定移除组(13例)和内固定保留组(22例),采用单因素及多因素Logistic回归分析内固定移除的影响因素.结果 金黄色葡萄球菌及耐甲氧西林金黄色葡萄球菌为腰椎后路内固定融合术后深部感染最常见病原菌,占40％.单因素分析发现迟发型感染、术中异体输血、清创次数≥3次与内固定移除有关(P＜0.05).多因素Logistic回归分析显示迟发型感染(OR=17.458,95％CI=1.639～185.919)、清创次数≥3次(OR=53.154,95％CI=2.591～ 1090.417)是腰椎后路内固定融合术后深部感染内固定移除最重要的影响因素.结论 腰椎后路内固定融合术后深部感染的治疗,对于迟发型感染及清创次数达到3次时应考虑移除内固定,以利于有效的控制感染.

目的 探讨体外培养颈椎后纵韧带骨化(ossification of posterior longitudinal ligament,OPLL)患者韧带细胞的方法并检测其成骨活性.方法 2013年1～12月颈椎外伤与后纵韧带骨化患者各15例行颈前路手术治疗.术中切取韧带标本,采用组织块培养法进行体外培养.取第3代细胞进行细胞鉴定,逆转录聚合酶链反应方法测量2组细胞骨钙素、碱性磷酸酶与Ⅰ型胶原mRNA表达差异.结果 组织块培养法培养7～14 d见细胞萌出,细胞呈梭形、纺锤形及多角的星形,细胞核大、卵圆形、细胞边界不清.免疫细胞化学及免疫荧光检测显示波形蛋白阳性表达,证实细胞培养成功.逆转录聚合酶链反应结果提示韧带骨化组细胞骨钙素、碱性磷酸酶与Ⅰ型胶原mRNA表达明显高于外伤组.结论 组织块培养法可成功培养颈椎后纵韧带组织细胞,形态学表现为成纤维细胞特点.体外培养的OPLL患者的韧带细胞具有明显的成骨活性.