Complications from anterior decompression fusion for cervical ossification of the posterior longitudinal ligament (OPLL) are often related to the bone mineral density (BMD) of vertebral bodies and ossified masses. The aim of this study was to clarify whether dual-energy X-ray absorptiometry (DEXA) T-scores reliably predict BMD in these structures, and whether vertebral bone quality (VBQ) and Hounsfield units (HU) can be effectively used to screen for osteopenia and osteoporosis. A total of 122 patients with cervical OPLL and 105 non-OPLL patients were included. Vertebral BMD was assessed by VBQ and HU, and ossified mass BMD was assessed by ossified mass bone quality (OMBQ) and ossification mass HU (OMHU). Overall, VBQ scores and HU values demonstrated weaker correlations with T-scores in the OPLL group compared with the non-OPLL group. Receiver operating characteristic curve analyses showed that VBQ and HU effectively discriminated osteopenia/osteoporosis in the OPLL cohort, with area under the curve values ranging from 0.763 to 0.827, similar to the non-OPLL. No significant differences in BMD were observed between the OPLL and non-OPLL groups based on the common assessment of VBQ, HU and DEXA-derived BMD (p > 0.05). Both OMBQ and OMHU showed good reliability and were significantly correlated with T-scores (p < 0.05). In patients with cervical OPLL, VBQ and HU remain effective screening tools for osteopenia/osteoporosis, potentially guiding or obviating the need for further DEXA scans. Additionally, our findings suggest that patients with lower T-scores may exhibit reduced BMD in both vertebral bodies and ossified masses.

目的 探讨颈椎韧带骨化的分布特征、临床特征以及颈椎韧带骨化与颈椎活动度(ROM)的定量关系.方法 纳入2020年1月—2021年10月诊断为后纵韧带骨化(OPLL)的229例患者,其中单纯OPLL患者71例(OPLL组)、OPLL合并前纵韧带骨化(OALL)和/或项韧带骨化(ONL)患者158例(OPLL+组).同时纳入64例无韧带骨化的脊髓型颈椎病患者作为对照(CSM组).基于CT评估韧带骨化分布特征.收集各组患者的人口统计学数据、实验室检查结果和影像学资料并进行比较.采用Spearman相关分析检验各指标之间的相关性,采用多元线性回归方法分析影响ROM的因素.结果 OPLL最常发生的节段为C5,OALL最常发生于C5/C6水平,ONL最常发生于C4/C5水平.不同韧带骨化组在性别、年龄、体质量指数(BMI)、吸烟史、OPLL指数、最大椎管占位率、ROM和尿酸方面存在差异.OALL指数和OPLL指数均与ROM呈负相关(r=-0.308、-0.261,P<0.05).OALL指数是ROM降低的危险因素(偏回归系数为-2.47,95％置信区间为-3.52～-1.42,P<0.05).结论 OPLL、OALL和ONL主要发生在C5节段周围.OALL指数和OPLL指数与ROM呈负相关,OALL指数是ROM降低的危险因素.

The aim of this study was to explore the expression of nucleotide-binding oligomerization domain-like receptor protein 3 (NLRP3) inflammasome in children with febrile seizures (FS). Onset age at 1-3 years old, body temperature during attack >= 38.5(degrees)C, complex FS, family history of seizures, duration of attack >15 min, electroencephalographic abnormality, serum NLRP3 level >1.75 ng/L and interleukin-1 beta (IL-1 beta) level >48.01 pg/ mL were risk factors for recurrence after first attack (P<0.05). The area under the receiver operating characteristic curve, sensitivity and specificity of the prediction model in forest plot were 0.821 (95% confidence interval: 0.7710.878), 0.922 and 0.695, respectively, suggesting high accuracy. The standard curve fitted well with the prediction curve, indicating high concordance between predicted recurrence and actual condition. Serum NLRP3 level >1.75 ng/ L is a risk factor for recurrence after first attack in children, and NLRP3 level is accurate for predicting recurrence.

颈椎病是以颈椎椎间盘退变为主要病变基础,包括颈周围肌肉、关节继发性改变和相邻椎体退变增生直到压迫神经血管等,并诱发与之相关的临床症状和体征 [1].对于其治疗,临床上通常采取颈前路或颈后路等手术方式,其中颈前路椎间盘切除植骨融合术 ( anterior cervical discectomy and fusion,ACDF ) 是最常采用的手术方式,且通常可获得令人满意的手术疗效.但术后出现的各种并发症仍值得临床医师学习和警惕 [2],以提高对术后并发症的早期识别和处理,这对患者获得较好的预后至关重要.笔者通过回顾 ACDF 相关文献,整理评估了 ACDF 术后相关的并发症及其发生率,并归纳了相应预防和处理意见.

Acute spinal cord injury（ASCI），commonly seen in spinal surgery，is usually caused by mechanical injury to the spine. ASCI can lead to secondary lung injury and even acute respiratory distress syndrome（ARDS），seriously endangering the life safety of patients. Damage-associated molecular pattern（DAMP）is a sort of endogenous substances released after injury，including intracellular proteins，extracellular matrix，secretory factors and nucleic acid-related products. DAMP released after ASCI activates downstream signaling pathways and participates in lung injuries. DAMP-related studies have revealed molecular mechanism of lung injury after ASCI，and explored the possible therapeutic targets of lung injury. In this study，the authors review the mechanism of action of DAMP in lung injury after ASCI and the role of different kinds of DAMP in lung injury，so as to provide new ideas for clinical treatment of lung injury after ASCI.

TSCI have dyskinesia and sensory disturbance that can cause various life-threaten complications. The patients with traumatic spinal cord injury (TSCI), seriously affecting the quality of life of patients. Based on the epidemiology of TSCI and domestic and foreign literatures as well as expert investigations, this expert consensus reviews the definition, injury classification, rehabilitation assessment, rehabilitation strategies and rehabilitation measures of TSCI so as to provide early standardized rehabilitation treatment methods for TSCI.

目的 探索腰椎后滑脱节段分布及与腰骶部矢状位平衡参数的相关性,揭示腰椎后滑脱发生机制.方法 选取2016年9月—2019年6月海军军医大学附属长征医院收治的腰椎后滑脱患者47例,调查其腰椎后滑脱节段分布规律,并将其分为上腰椎后滑脱组(L1～3,34例)与下腰椎后滑脱组(L4～5,13例);选取同期入院的近似健康的患者29例作为对照组.比较3组患者腰椎前凸角(LL)、骶骨倾斜角(SS)、骨盆倾斜角(PT)、骨盆入射角(PI)的差异.结果 47例患者共56个节段后滑脱,其中L15例、L213例、L325例、L411例、L52例.与对照组相比,上腰椎后滑脱组LL、SS增大,PT减小,差异有统计学意义(P<0.05),PI差异无统计学意义(P>0.05);下腰椎后滑脱组LL、SS减小,PT增大,差异有统计学意义(P<0.05),PI差异无统计学意义(P>0.05).结论 腰椎后滑脱好发于L3,其次为L2、L4.腰椎后滑脱与腰骶部矢状位失衡密切相关.当上腰椎后滑脱时,LL、SS增大,而PT减小;当下腰椎后滑脱时,LL、SS减小,甚至变为后凸,而PT增大.

Circular RNAs (circRNAs), resulting from the non-canonical splicing of linear pre-mRNAs, have permanently altered our perspectives toward cancer recently, especially in carcinogenesis and cancer progression. However, the roles of circRNAs in esophageal squamous cell carcinoma (ESCC) remain largely unknown. In the current study, circRNAs expression profiles are screened in ESCC, using plasma samples from 10 ESCC patients, including different TNM stages and 5 normal controls. Characteristics of circRNAs including length, types, and the possibility of binding to proteins are analyzed. Candidate tumor-related circRNAs are then quantitated in ESCC tissues, plasmas and cell lines. ESCC tissues can secret circRNAs into plasma and patients with high plasma circ-SLC7A5 are associated with high TNM stage, tending to have shorter overall survival than those with high levels. In addition, the biological characteristics of circ-SLC7A5 including location, miRNAs binding, m6A modification were analyzed. Our study reveals a novel prognosis biomarker of circ-SLC7A5, providing a preliminary landscape of circRNA expression for detection of ESCC.

腰椎间盘突出症(LDH)是骨伤科的常见病、多发病,且发病日趋年轻化.这一疾病所产生的临床症状严重影响了患者的日常生活. LDH是由于椎间盘退变、纤维环破裂、髓核突出压迫神经根、脊髓、血管而引起一系列临床症状的综合征.椎间盘的突出可发生在单个节段也可多个节段同时发生,其中最常见的是L4/5、L5/S1.

Objective To explore the mid-term surgical outcomes and radiographic changes of C4/C5/C6/C73-level fusion with Zero-P spacer in the treatment of cervical degenerative disease through compared with traditional cage with titanium plate. Methods Totally 72 C4/C5/C6/C7 cervical fusion patients from July 2009 to May 2013 were included in this study,with 30 patients in group A using Zero-P for fusion,while 42 patients in group B using traditional cage and titanium plate. There was no significant difference in patient's preoperative parameters between 2 groups. The Japanese Orthopedic Association(JOA) score,neck disability index(NDI),cervical curvature,C4-7 Cobb's angle,incidence of dysphagia,fusion rate,adjacent segment degeneration rate were compared between 2 groups at 2 months,6 months,1 year,2 years after operation and the final follow-up. Results The JOA score,NDI,fusion rate and adjacent segment degeneration rate showed no statistically significant difference between 2 groups at all observation time points. The C4-7 Cobb's angle of group A showed slowly lost trend,and significantly lower than that of group B at postoperative 2 years and final follow-up(P < 0.05). The cervical curvature in group A also showed slowly lost trend,and significantly lower than that of group B only at final follow-up(P<0.05). The incidence of dysphagia in group A was significantly lower than that of group B(P<0.05) at postoperative 2 months,but had no significant difference at other follow-up time point. Conclusion Zero-P has a satisfactory mid-term outcomes with fewer complications when it is used in 3-level anterior cervical discectomy and fusion. It can effectively reduce the incidence of dysphagia at 2 months after operation,but it is poor in the maintenance of operated segment Cobb's angle and cervical curvature.

Objective To analyze the short-term clinical efficacy of long segment and short segment fixation for degenerative lumbar scoliosis(DLS) associated with spinal stenosis,and explore the surgical indications. Methods From January 2014 to July 2015,81 DLS patients with spinal stenosis treated in Changzheng Hospital were involved in this retrospective study. For long segment group(group A,33 cases),operated segments were T10 -S1 in 10 patients,T10 -L5 in 4,T11 -S1 in 12,T11 -L5 in 7;and short segment group(group A,348 cases),operated segments were L2-4 in 2 patients,L3,4 in 4,L3- 5 in 10,L4,5 in 12,L4 - S1 in 12,L5 - S1 in 8. Scoliosis Cobb's angle,rang of motion(ROM),low back pain visual analogue scale(VAS) score,leg pain VAS score,Oswestry disability index(ODI) and complications had been used for comparing the difference between the 2 groups. Results Scoliosis Cobb's angle and ROM in group A were significantly less than those in group B at the final follow-up(P<0.05). Low back pain VAS score and ODI in group A were significantly lower than those in group B at the final follow-up(P<0.05). Leg pain VAS score showed no statistical significance between the 2 groups(P>0.05). Cerebrospinal fluid leak and wound infection were occurred in 2 patients respectively,lung infection and nerve root injury in 1 respectively in group A,but there was only 1 case of cerebrospinal fluid leak case and nerve root injury respectively in group B. Conclusion Both long and short segment fixation can effectively improve the leg pain and intermittent claudication symptoms. Compared with short segment fixation,long segment fixation is better in relieving lumbar pain,but poorer in maintaining lumbar spine mobility and provides more complications.

Objective To investigate the clinical efficacy of Gallie technique on atlantoaxial sagittal instability,and determine its indication.Methods From February 2008 to June 2013,25 patients with atlantoaxial sagittal instability were treated by Gallie surgery. The visual analogue scale(VAS) score,neck disability index(NDI) and American Spinal Injury Association(ASIA) grading system were used to evaluate the clinical efficacy. Postoperative imaging data were used to evaluate the stability of atlantoaxial joint and bone fusion.Results All patients were followed-up for 24 -67 months,mean 29 months, and the occipitocervical pain has been relieved in all the patients at the final follow-up. The VAS score was 3.48±1.04 at pre-operation,and decreased to 0.52±0.60 at post-operation. NDI was 5.83±1.40 at pre-operation,and degraded to 5.83±1.40 at post-operation. According to ASIA grading system,15 patients were graded as grade E,9 as grade D,1 as grade C. The neurological function improved in all the patients. One grade C case recovered to grade D;in 9 grade D cases,8 recovered to grade E, and the remaining one unchanged. Twenty-one patients achieved good bone fusion within 3 months after the operation and 2 patients with delayed union;2 non-union patients underwent posterior pedicle screw fixation.Conclusion Gallie technique for treatment of atlantoaxial sagittal instability is safe and effective. After anterior relaxation for the treatment of irreducible atlantoaxial dislocation,it should be cautious to use Gallie technique as a posterior fixation and fusion methods.

[目的]总结伴颈性眩晕颈椎病患者手术疗效,探索该类患者手术治疗指征及手术要点.[方法]收集本院2010年1月～2014年12月伴颈性眩晕颈椎病患者127例,并根据性别、年龄、手术入路、手术节段、术前眩晕评分及术后颈椎前凸角进行分组,统计并比较各组患者改善率及改善度差异.[结果]女性、前路手术及术前评分超过3分患者改善率及改善度明显提高.长节段(＞2个)、术后颈椎前凸角超过10°患者改善率显著提高,但改善度差异无统计学意义.年龄超过60岁患者改善度显著低于年龄低于60岁患者.[结论]保守治疗无效、女性患者、年龄不超过60岁及眩晕评分超过3分可作为重要的手术指征.尽量选择前路手术,长节段固定不稳定的椎体,重建颈椎曲度有助于提高患者的改善率及改善程度.

Objective To investigate the pathogen distribution and risk factors of pulmonary infection after acute cervical spinal cord injury (ACSCI) in an attempt to offer reference for early antiinfection therapy.Methods The study comprised 223 cases who were admitted from October 2011 to October 2014.There were 149 males and 74 females,at (43.3 ± 13.5) years of age.Species of pathogens identified were gram-positive,gram-negative and mixed.Effects of age,gender,injury types and tracheotomy on pathogen distribution were analyzed.Results Gram-negative infection was found in 114 cases (51.1％),with tracheotomy accounting for 7.0％ of the cases and death accounting for 1.8％ of the cases,and the main causative pathogens were Klebsiella pneumonia,Escherichia coli,Pseudomonas aeruginosa and Acinetobacter baumannii.Gram-positive infection was found in 41 cases (18.4％),with tracheotomy accounting for 12.2％ of the cases and death accounting for 7.3％ of the cases,and the main causative pathogens were Staphylococcus aureus and Streptococcus pneumonia.Mixed infection was found in 68 cases (30.5％),with tracheotomy accounting for 22.1％ of the cases and death accounting for 13.2％ of the cases.Gender had no significant correlation with pathogen distribution.For the cases of complete spinal cord injury and tracheotomy,the ratio of mixed infection increased significantly (P ＜ 0.05).For the cases younger than 30 years,the pathogens were mainly gram-positive bacteria (P ＜ 0.05).Conclusions Main pathogens of pulmonary infection after ACSCI are gram-negative bacteria.The cases younger than 30 years are associated with higher risk of grampositive infection,while the cases with complete injury or tracheotomy are associated with higher risk of mixed infection.

目的：比较分析前路、后路及前后路联合病灶清除植骨融合内固定术治疗脊柱结核疗效。方法回顾性分析本院2007年10月至2011年10月间3种不同术式治疗69例胸腰椎结核患者。随访24月以上，观察其手术时间、出血量、住院时间、神经功能改善、红细胞沉降率、C反应蛋白变化、后凸畸形矫正度、植骨融合率及并发症发生率，进行统计学分析。结果3组间ASIA神经功能评分、红细胞沉降率及C反应蛋白改善情况无统计学差异（P>0.05），前后路联合组手术时间、出血量和住院时间均显著多于单纯前路组或单纯后路组（P<0.05）。单纯后路组和前后路联合组后凸畸形矫正度均显著优于单纯前路组（P<0.05），单纯后路组并发症发生率明显低于其他两组（P<0.05）3组患者植骨融合率无统计学差异（P>0.05）。各组患者术后影像学均提示无复发。结论3种不同手术入路均具有良好的疗效。掌握不同手术的适应征，明确患者的具体病情，选择合适的手术方式，对脊柱结核患者的临床治疗具有极为重要。

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.

OBJECTIVE:To investigate the clinical and imaging predictors of surgical outcomes in patients with ossification of the posterior longitudinal ligament (OPLL).MATERIALS AND METHODS:From May 2010 to April 2012, a total of 200 consecutive patients with cervical OPLL were recruited for this study. Of them, 184 patients (130 men and 54 women) who could be tracked for more than 24 months after surgery were finally included for analysis. Their demographic, clinical and radiological data were collected preoperatively. The recovery ratio in terms of JOA score was used to assess the outcome of the patients preoperatively and at 2 years postoperatively. A JOA recovery rate less than 50% was considered a poor outcome.RESULTS:Compared with good outcome group, an older mean age at operation, a longer mean duration of symptoms, a lower mean pre-operativer JOA score, and a higher proportion of diabetics were observed in poor outcome group. Patients in poor outcome group were more likely to present kyphotic cervical alignment, smaller mean transverse area of the spinal cord, and intramedullary signal abnormalities. The result of multivariate stepwise logistic regression showed that a longer duration of symptoms and the presence of T1 hypo-intensity intramedullary changes on MRI were significant risk factors of lower JOA recovery ratios.CONCLUSION:A longer duration of symptom, T1 hypointensity on MRI and a history of minor trauma were highly predictive of a poor outcome for patients undergoing surgical treatment of OPLL. Age at operation, the history of diabetes, the preoperative JOA score, the transverse area of the spinal cord and T2 hyper-intensity on MRI were also associated with the prognosis of OPLL.

High mobility group box protein- 1( HMGB- 1),a nuclear ubiquitous protein,is a DNA- binding protein with functions of stabilizing nucleolar structure and regulating gene expression. Under pathologic conditions,HMGB- 1 can be released into the extracellular milieu actively or passively. Extracellular HMGB- 1 is an important pro- inflammatory cytokines,which correlates with the pathogenesis of many diseases. Recently,the role of HMGB- 1 in trauma has attracted more and more attentions. And HMGB- 1 has been demonstrated to be an important mediator of the secondary injury after traumatic brain injury,acute spinal cord injury,burn,hemorrhagic shock,pulmonary contusion,and fracture by a series of basic and clinical studies.Therefore,it is expected that inhibition of HMGB- 1 release may be a novel therapeutic strategy for treating trauma.

目的 探讨一期联合手术治疗颈胸椎韧带串联骨化症的疗效.方法 回顾性分析本院2005年1月～2010年1月,一期联合手术治疗的颈胸椎韧带串联骨化症患者14例.术前及术后6个月、末次随访时行日本骨科学会(Japanese Orthopaedic Association,JOA)评分、Nurick分级法评价,分析比较术前、术后6个月及末次随访评分,并计算改善率.末次随访时行患者满意度评分.结果 所有患者均获得2～5年随访,出血量1 550.3±740.7 mL,手术时间278.5±54.6 min.1例患者出现血肿,2例患者术后出现C5神经根麻痹,1例患者术后神经功能加重.术后6个月JOA评分明显较术前提高(P＜0.01),与末次随访相比,差异无统计学意义(P＞0.05).Nurick分级法术前3.6±0.7,术后6个月时明显提高到2.6±1.0(P＜0.01),末次随访时为2.3±1.1 (P ＞0.05).满意度评分为1.8±1.1,Pearson相关分析显示患者满意度评分与JOA评分有明显的正相关性(r=0.649 3,P＜0.01),而与Nurick分级法呈负相关(r=-0.594 1,P＜0.05).结论 一期联合手术减压可达到良好的神经功能恢复效果.患者满意度与术后神经功能改善明显相关,围手术期的并发症及术后因串联骨化症进展而导致再手术会明显降低患者的满意度评分.

目的 观察绿色荧光蛋白转基因大鼠来源的骨髓间充质干细胞(bone mesenchymal stem cells,BMSCs)在急性脊髓损伤大鼠脊髓组织中的迁移和分化情况.方法 全骨髓贴壁培养法培养BMSCs,Allen法制作脊髓损伤大鼠模型,共30只大鼠.于造模1周后进行干预,随机选取造模成功的24只大鼠并随机分为脊髓损伤组、假移植组(生理盐水注射)和细胞移植组(BMSCs注射),每组8只.于移植前、移植后7d、14 d、21 d、28 d、35 d及42 d进行BBB(Basso,Beattie&Bresnahan locomotor rating scale)评分.HE染色、免疫荧光观察脊髓损伤的组织修复和BMSCs的迁移分化情况.结果 从第14天始,细胞移植组大鼠的BBB评分较脊髓损伤组和假移植组大鼠高,差异具有统计学意义(P＜0.05).HE染色显示细胞移植组大鼠的脊髓结构相对完整,液化和囊泡区缩小,炎性细胞减少.免疫荧光显示BMSCs聚集于脊髓损伤处,且能分化为神经元、神经胶质细胞和神经前体细胞.结论 BMSCs能向脊髓损伤部位迁移和聚集,并分化为相应的神经细胞促进脊髓功能恢复.