Objective:To observe the effect of wrist and ankle acupuncture combined with celecoxib on the clinical efficacy and pain mediators after lumbar spine surgery. Methods : Sixty patients with postoperative pain in lumbar spine were divided into the control group and the observation group by using random number table method,with 30 cases in each group. The control group was treated with celecoxib,and the observation group was treated with wrist and ankle acupuncture on the basis of the treatment of the control group. Visual analogue scale（VAS） scores,pain mediators [serum prostaglandin E2（PGE2）,substance P（SP）,β-endorphin（β-EP） ],Japanese Orthopaedic Association（JOA）scores,complications,and patient satisfaction before and after treatment were compared between the two groups. Results:The VAS score of the two groups decreased with the passage of time,and the VAS score of the observation group was lower than that of the control group on day 1,2,3and 7 after surgery（P＜0.05）. The level of PGE2 、SP in the two groups was firstly increased and then decreased with the passage of time（P＜0.05）,but the serum level of PGE2、SP in the observation group was lower than that in the control group on day 1,2,3 and 7 after surgery（P＜0.05）. The β-EP level of two groups firstly decreased and then increased as time went by（P＜0.05）,and the β-EP level of the observation group was higher than that of the control group on day 1,2,3 and 7 after surgery（P＜0.05）. JOA scores were improved in both groups,but the JOA score of the observation group was significantly higher than that of the control group on day 7 after surgery（P＜0.05）. There was no significant difference in the incidence of complications between the observation group and the control group（P＞0.05）. The satisfaction with postoperative pain management plan of the observation group was higher than that of the control group（P＜0.05）.Conclusion:Wrist and ankle acupuncture combined with celecoxib can significantly reduce postoperative pain,reduce the expression of related pain mediators,and improve spinal function.

Objective To explore efficacy of minimally invasive transforaminal lumbar interbody fusion with Wiltse approach（MIS-TLIF） in the treatment of lumbar spondylolisthesis（LS）. Methods 98 patients with LS in our hospital were selected and randomly divided into the observation group and the control group, 49 cases in each group. The control group received posterior median approach interbody fusion（TLIF） treatment, and the observation group received Wiltse approach MIS-TLIF treatment. The surgical effect, perioperative indicators, Oswestry Disability Index（ODI） score before and after surgery, improvement of lumbar function, visual analogue scale（VAS） score, serum adrenocorticotropic hormone（ACTH）and cortisol（Cor） levels before and after surgery were compared between the two groups. Results There was no significant difference in the surgical effect between the two groups（P＞ 0.05）. The intraoperative blood loss in the observation group was less than that in the control group, the hospitalization time was shorter than that in the control group, and the operation time was longer than that in the control group（P ＜0.05）. 3 monthes after surgery, the ODI score, intervertebral disc height,spondylolisthesis degree, and spondylolisthesis angle of the two groups were improved compared with those before surgery（P ＜0.05）, but there was no significant difference between the two groups. The VAS scores of the two groups were lower than those before surgery, and those in the observation group were lower than those in the control group（P＜0.05）. The serum ACTH and Cor levels of the two groups were higher than those before surgery, but those in the observation group were lower than those in the control group（P ＜0.05）. Conclusion TLIF and Wiltse approach MIS-TLIF have similar effect in the treatment of LS, which can effectively improve lumbar spine function, but the latter has more advantages in optimizing perioperative indicators and pain degree, and causes less trauma.

目的 探究磁共振成像(MRI)骶髂关节评分评估五藤治尪汤结合西药治疗强直性脊柱炎的效果.方法 将56例强直性脊柱炎患者随机分为对照组及研究组各28例,对照组以西药治疗,研究组以五藤治尪汤结合西药治疗,患者治疗前后均进行MRI检查,观察患者治疗前后临床疗效与加拿大脊柱关节炎研究协会MRI骶髂关节评分系统评价结果 ,分析MRI骶髂关节评分评估疗效的价值.结果 两组患者临床评价[BASDAI、Bath AS功能指数(BASFI)、BASFI评分、C反应蛋白(CRP)、血沉(ESR)]指标水平及MRI SPARCC评分较治疗前均显著降低(P<0.05),且研究组低于对照组(P<0.05);治疗后,研究组患者临床治疗总有效率显著高于对照组(P<0.05);ROC曲线分析显示,MRI SPARCC评分评价五藤治尪汤结合西药治疗强直性脊柱炎ASAS 40标准疗效达标的曲线下面积为0.782(CI95％=0.591～0.976,P<0.05),评估敏感度84.61％,特异性75.00％.结论 五藤治尪汤结合西药治疗强直性脊柱炎疗效显著,以MIR骶髂关节评分评估该方案疗效具有较高评估效能.

目的:探讨颈椎后路单开门微型钢板内固定术治疗颈椎管狭窄症的临床疗效和安全性.方法:2017年3月至2019年3月收治25例颈椎管狭窄症患者.男15例,女10例.年龄33～68岁,中位数45岁.C3～C5狭窄16例,C3～C6狭窄9例.发育型狭窄18例,退行性狭窄7例.病程1～7年,中位数4年.均采用颈椎后路单开门微型钢板内固定术治疗.测定患者的颈椎曲度和活动度,采用视觉模拟量表(visual analogue scale,VAS)和Oswestry功能障碍指数(Oswestry disability index,ODI)量表评价颈肩部疼痛情况,采用日本骨科学会(Japanese Orthopedic Association,JOA)脊髓型颈椎病评分量表(17分法)评价颈髓功能,采用Odom评级标准评价整体疗效,记录并发症发生情况.结果:所有患者均随访至术后12个月.与术前相比,术后3个月时患者的颈椎曲度和活动度均增大(5.25° ±3.05°,8.02° ±3.13°,t=3.169,P=0.003;38.48° ±13.60°,56.12° ±12.90°,t=4.705,P=0.000),颈肩部疼痛VAS评分和ODI均减小[(7.69±0.53)分,(3.14±0.21)分,t=39.906,P=0.000;(21.75±5.48)分,(10.13±2.12)分,t=9.888,P=0.000].患者术前及术后3个月、6个月、12个月的JOA评分比较,总体差异有统计学意义[(8.22±1.51)分,(14.75±3.32)分,(16.53±3.52)分,(16.78±3.66)分,F=41.001,P=0.000];术后3个月、6个月、12个月的JOA评分均高于术前(P=0.000;P=0.000;P=0.000).术后12个月时,按照Odom评级标准评定,优12例、良10例、一般2例、差1例;疗效评定为差的1例患者,经非手术治疗后病情控制.1例患者术后出现背部疼痛,服用非甾体抗炎止痛药后疼痛缓解;均未出现吞咽困难、脊髓损伤、内固定松动等并发症.结论:采用颈椎后路单开门微型钢板内固定术治疗颈椎管狭窄症,能有效改善患者的颈椎曲度和活动度、减轻颈肩部疼痛症状、改善颈髓功能,总体疗效较好,而且具有较高的安全性.

目的?观察后路经单侧椎弓根入路病灶清除植骨内固定术治疗胸腰椎结核的近远期疗效.方法?选取2016年1月—2018年1月在河南省洛阳正骨医院就诊的胸腰椎结核患者50例,采用随机数字表法分为对照组、观察组,各25例.对照组给予常规病灶清除术治疗,观察组给予经单侧椎弓根入路病灶清除术治疗.比较两组手术总有效率及红细胞沉降率;比较两组术前及术后1周、1个月的视觉模拟评分法(VAS)评分;比较两组术前及术后1周、1个月的腰椎Oswetry功能障碍指数(ODI)评分;比较两组术后脊髓损伤神经功能分级(ASIA).结果?观察组总有效率显著高于对照组,术后1周及1个月VAS评分、ODI评分均显著低于对照组(均P<0.05);观察组ASIA分级显著优于对照组,红细胞沉降率显著低于对照组(P<0.05).结论?采用后路经单侧椎弓根入路病灶清除术治疗胸腰椎结核有效率高,能缓解临床症状,改善神经功能损伤及腰椎功能障碍,降低红细胞沉降率,提高远期疗效.

目的 探讨微创椎弓根螺钉固定联合椎管穹隆状减压治疗双节段脊柱骨折合并脊髓损伤的临床疗效.方法 纳入2015年6月～2017年6月于本院采用微创椎弓根螺钉固定联合椎管穹隆状减压治疗的42例双节段脊柱骨折患者,术后随访24个月以上,记录围术期指标及随访期并发症发生情况和手术疗效.结果 42例患者手术平均用时(145. 41±24. 65) min,切口总长度(9. 31±1. 45)cm,出血量(466. 23±54. 65)mL,住院时间(10. 14±1. 98)d;术后发生2例一过性腰腿痛,1例切口延迟愈合,1例谵妄,无硬膜囊破裂、继发神经损伤、内固定失效等并发症.术后1个月、末次随访时,矢状面Cobb角、疼痛VAS评分均显著低于术前,伤椎前缘高度比显著高于术前,差异有统计学意义(P<0. 05);末次随访ASIA分级较术前显著改善,差异有统计学意义(P<0. 05).结论 微创椎弓根螺钉固定联合椎管穹隆状减压治疗双节段脊柱骨折,能够有效改善后凸畸形,提升椎体高度,在保证良好椎管减压的同时降低了手术创伤.

目的 探讨电磁导航辅助经椎间孔脊柱内窥镜系统(TESSYS)靶向定位穿刺治疗腰椎椎间盘突出症(LDH)的临床价值.方法 回顾性分析2018年4月—2019年4月在洛阳正骨医院接受TESSYS治疗的72例LDH患者临床资料,其中36例术中采用电磁导航靶向定位穿刺(导航组),另36例采用常规定位穿刺(常规组).记录手术时间、透视次数、透视时间、穿刺时间、减压时间及相关并发症发生情况.采用疼痛视觉模拟量表(VAS)评分、日本骨科学会(JOA)评分、Oswestry功能障碍指数(ODI)及改良MacNab标准评价临床疗效.结果 所有手术顺利完成,患者随访7～18个月,平均12.1个月;导航组导航建立时间为(11.97±2.14)min.导航组手术时间、透视次数、透视时间、穿刺时间均少于常规组,差异有统计学意义(P<0.05);2组减压时间差异无统计学意义(P>0.05).2组末次随访腿痛VAS评分、JOA评分、ODI较术前明显改善,差异均有统计学意义(P<0.05);组间比较差异无统计学意义(P>0.05).改良MacNab标准评价疗效:导航组优21例,良12例,可3例,优良率为91.7％(33/36);常规组优18例,良13例,可5例,优良率为86.1％(31/36);组间差异无统计学意义(P>0.05).所有患者均未发生严重神经根损伤、血管损伤和感染等并发症,常规组4例患者在穿刺过程中出现一过性神经根疼痛,调整穿刺方向后疼痛消失.结论 电磁导航辅助TESSYS靶向定位穿刺治疗LDH能减少手术时间、术中透视次数、穿刺时间,与常规穿刺方法疗效及安全性相当,可降低TESSYS学习曲线,提高青年医师一次性穿刺成功率.

目的 观察电磁导航辅助下脊柱内镜系统经椎间孔入路穿刺及椎间孔成形的临床应用价值.方法 本研究为前瞻性队列研究.选取河南洛阳正骨医院脊柱外科2018年4月至2019年4月诊断为腰椎间盘突出症伴侧隐窝狭窄的患者60例,采用随机数字表法分为两组.观察组30例接受电磁导航辅助下经椎间孔入路内窥镜脊柱系统(transforaminal endoscopic spine system,TESSYS)行椎间孔成形,其中男18例,女12例;年龄(40.73±5.90)岁.对照组30例采用标准TESSYS技术行椎间孔成形,其中男19例,女11例;年龄(42.67±6.40)岁.两组患者性别、年龄、身体质量指数(body mass index,BMI)、术前视觉模拟评分(visual analogue scale,VAS)及病变节段差异无统计学意义(P>0.05).记录两组术中定位穿刺时间、关节突成形时间、手术时间、透视次数、与穿刺和椎间孔成形相关的并发症、改良MacNab评分并进行比较.结果 观察组透视次数、定位穿刺时间、关节突成形时间及手术时间低于对照组,差异有统计学意义(P<0.05).改良MacNab评分两组比较差异无统计学意义(P>0.05).术中并发症发生率观察组为6.7％(2/30),对照组为16.7％(5/30),两组比较差异无统计学意义(P>0.05).结论 电磁导航辅助下进行腰椎内镜TESSYS技术操作,有利于精准穿刺定位和椎间孔成形,能够有效减少术中透视次数,降低医患辐射暴露剂量,缩短手术时间,降低青年医师的学习曲线.

目的 探讨MRI联合CT扫描图像融合技术(SPECT/CT)在脊柱病变鉴别诊断中的价值.方法 回顾性分析2017年1月-2019年1月我院收治的102例脊柱病变患者的临床及诊治资料,均行MRI、SPECT/CT扫描检查,以术后病理结果为金标准,评估MRI、SPECT/CT以及MRI联合SPECT/CT在脊柱病变鉴别诊断中的价值.结果 脊柱结核,常规MRI表现:病变椎体失去正常形态,骨质破坏较为明显,椎间隙明显变窄或者消失,病变椎体信号不均匀,MRI增强扫描:多呈环形强化,有广泛且明显椎旁脓肿;脊柱转移瘤,MRI表现:发病部位无规律且呈多发表现;脊柱结核,SPECT/CT表现:骨质破坏伴周围软组织肿胀,存在异常放射性浓聚;脊柱恶性肿瘤,SPECT/CT表现:单发或多发性斑点状、低密度,边缘不规则、边界清晰、无硬化,伴压缩性骨折或软组织肿块等;MRI联合SPECT/CT诊断脊柱病变的灵敏度、特异度、准确度分别为94.33％、87.76％、91.18％,较两者单一诊断高,其中MRI诊断灵敏度、特异度、准确度各为71.70％、79.59％、75.49％,SPECT/CT诊断的81.13％、81.63％、81.37％,且MRI联合SPECT/CT鉴别诊断脊柱肿瘤良恶性的灵敏度、特异度、准确度各为92.86％、80.95％、87.76％.结论 MRI联合SPECT/CT在脊柱病变鉴别诊断中有较高的应用价值,有临床推广应用优势.

目的 研究单纯后路手术方式用于治疗胸腰椎结核的临床效果,并观察术后并发症发生情况.方法 将本院2015年12月-2019年4月收治的72例胸腰椎结核患者使用随机数字表法分为观察组和对照组,各36例.观察组使用单纯后路手术方式进行治疗,对照组使用单纯前路手术方式进行治疗,记录两组手术情况(术中出血量和手术耗时);在出院时统计两组的平均住院时间和住院费用,并评价两组的治疗效果和并发症发生率.结果 (1)在治疗效果方面,观察组为94.44％,高于对照组的86.11％,两组比较差异无统计学意义(P>0.05);(2)观察组的术中出血量、手术耗时、住院时间和住院费用均低于对照组,两组比较差异无统计学意义(P<0.05);(3)两组术后并发症比较:观察组为11.11％,低于对照组的19.44％,两组比较差异无统计学意义(P>0.05).结论 单纯后路方式能有效降低胸腰椎结核患者手术耗时和术中出血量,并能降低住院费用,缩短住院时间,具有较好的治疗效果.

目的:观察经椎间孔腰椎椎体间融合术、经皮椎间孔镜下椎间盘切除术治疗极外侧型腰椎间盘突出症的近远期疗效.方法:选取2016年3月～2017年3月治疗的极外侧型腰椎间盘突出症患者94例,按照治疗方案不同分为TLIF组和PTED组,各47例.TLIF组给予经椎间孔腰椎椎体间融合术治疗,PTED组给予经皮椎间孔镜下椎间盘切除术治疗.比较两组术中出血量、手术时间及卧床时间、远期疗效总优良率;比较两组术前、术后1个月、术后1年腰椎功能障碍程度评分.结果:PTED组术中出血量、卧床时间均少于TLIF组,差异有统计学意义(P＜0.05);两组手术时间对比,差异无统计学意义(P＞0.05).术前两组腰椎功能障碍程度评分比较无显著差异(P＞0.05);术后1个月、术后1年PTED组,腰椎功能障碍程度评分均低于TLIF组,差异有统计学意义(P＜0.05);PTED组远期疗效总优良率高于TLIF组(P＜0.05).结论:相比于经椎间孔腰椎椎体间融合术,对极外侧型腰椎间盘突出症患者给予经皮椎间孔镜下椎间盘切除术治疗能够减少术中出血量,缩短卧床时间,改善腰椎功能,提高远期疗效.

目的:探讨磁共振脊髓水成像(magnetic resonance myelography,MRM)技术在腰椎椎管狭窄症(lumbar spinal stenosis,LSS)诊断中的应用价值.方法:以拟行手术探查的60例疑似LSS患者为研究对象.术前均应用MRM技术进行检查,采用Nitz评估标准评价MRM成像质量,以手术探查结果为金标准,计算MRM诊断LSS的敏感度、特异度和准确度.结果:60例疑似LSS患者MRM硬脊膜成像质量评分平均2.78分、神经根袖成像质量评分平均2.82分.MRM检查结果显示,L3～4中央椎管狭窄42例,敏感度97.62％、特异度66.67％、准确度95.56％;L4～5中央椎管狭窄56例,敏感度98.18％、特异度60.00％、准确度95.00％;L5 S1中央椎管狭窄52例,敏感度92.00％、特异度33.33％、准确度83.05％.L3～4侧方椎管狭窄35例,敏感度97.14％、特异度75.00％、准确度94.87％;L4～5侧方椎管狭窄56例,敏感度98.18％、特异度50.00％、准确度94.92％;L5S1侧方椎管狭窄55例,敏感度96.43％、特异度75.00％、准确度95.00％;S1～2侧方椎管狭窄15例,敏感度93.75％、特异度100.00％、准确度94.12％.结论:MRM能清晰显示硬脊膜囊和神经根袖等结构,诊断LSS的准确度高,是针对该病的一种较为可靠的影像筛查方式.

[目的]探讨椎间孔镜靶向单通道下髓核摘除术(TO-PETD)治疗青年重度脱出移位型腰椎间盘突出症(HMLDH)的安全性和有效性.[方法]2014年3月～2017年12月入住本院且手术治疗的重度脱出移位型青年腰椎间盘突出症患者51例,椎板开窗单纯髓核摘除术(FD) 18例.比较两组VAS腿痛和腰痛评分、ODI评分和改良MacNab评分、手术节段椎间隙高度变化.[结果]TO-PETD组在术中出血量、术后止痛药应用比例及住院时间方面小于FD组,差异有统计学意义(P＜0.05),TO-PETD组手术时间长于FD组,差异有统计学意义(P＜0.01).两组早期并发症发生率差异无统计学意义(P＞0.05).随访12～36个月,平均(21.68±7.52)个月.两组手术前后VAS-下肢痛评分差异无统计学意义(P＞0.05).术后1d、术后1个月VAS-腰痛评分及术后1个月ODI评分,TO-PETD组小于FD组,差异有统计学意义(P＜0.05).两组末次随访VAS、ODI评分差异无统计学意义.两组改良MacNab评定临床优良率和椎间隙高度丢失度的差异无统计学意义(P＞0.05).[结论]椎间孔镜靶向单通道下髓核摘除术治疗重度脱出移位型青年腰椎间盘突出症不但可达到与椎板开窗单纯髓核摘除术同样的安全性和有效性,且创伤更小、恢复更快.

[目的]探讨靶向穿刺经皮椎间孔镜下腰椎间盘切除术治疗腰椎间盘突出症的安全性和有效性.[方法]2014年4月～2016年12月,采用靶向穿刺椎间孔镜治疗单节段青年腰椎间盘突出症患者131例,其中男90例,女41例,年龄18～44岁,平均(33.50±7.55)岁.采用VAS评分、ODI评分、JOA评分和改良MacNab标准评估手术疗效,MRI测量椎间隙高度变化.[结果]本组131例患者,均顺利完成手术,未发生血管、内脏损伤等并发症,虽发生4例硬膜损伤,但无不良后果.手术时间平均(112.84±26.26) min,术中出血量平均(31.87±26.33) ml.随访12～28个月,平均(17.41±6.20)个月.腿痛VAS评分由术前(5.89±1.06)减少至术后12个月(1.02±0.75)分;腰痛VAS评分由术前(3.17±1.51)减少至术后12个月(0.99±0.90)分;ODI评分由术前(55.15±10.86)减少至术后12个月(10.76±6.78)分,而JOA评分由术前(8.91±4.10)分增加至术后12个月(26.29±2.29)分,上述指标变化差异均有统计学意义(P＜0.05).按照MacNab评价标准,术后1个月优良率98.47％,术后6个月优良率94.66％,术后12个月优良率91.60％.本组131例中,原间隙复发5例,复发率为3.82％.[结论]经皮椎间孔镜靶向技术治疗腰椎间盘突出症创伤小、并发症少、术后恢复快、近期疗效可靠,靶向穿刺是手术成功的首要前提和重要步骤.

Objective:To explore the effects of Pingle bone-setting manipulation in the reduction of subaxial cervical fracture-dislocation.Methods:The data of 35 patients treated with Pingle bone-setting manipulation between January 2014 and March 2016 were included.Results:The patients successfully completed the operation and the incision healed well.A total of 35 patients with intraoperative fluoroscopy showed a successful reduction.Patients were followed for 6 months to 36 months,the average was 15 months.All patients were rated for neurological functionin the last follow-up visit,there were 6 cases in level A,7 in level B,6 in level C,10 in level D,6 in level E according to ASIA scale.One patient was with severe pain in the postoperative neck,but without serious complications such as spinal cord injury or severe spinal cord injury.Conclusion:The use of Pingle bone-setting manipulation is conducive in the reduction of subaxial cervical fracture-dislocation.

Objective to investigate the clinical efficacy of decompression and pedicle screw fixation through posterior approach for complete thoracic spine fracture dislocation.Methods The clinical data of six patients with complete thoracic spine fracture and dislocation treated from September 2002 to June 2016 were analyzed retrospectively by case series study.There were five males and one female,aged 21-67 years old (mean,47.2 years).The injury segments were T3～4 dislocation in one case,T5～6 dislocation in two cases,T6 ～7 dislocation in two cases and T8 ～9 dislocation in one case.There was one case of ASIA grade E and five cases of Grade A,and all of six cases were associated with multiple rib fractures and hemopneumothorax.The companied status was one case of sternal fracture,one case of atlantoaxial complex fractures and three cases of pulmonary contusion.The posterior median incision decompression and pedicle screw system fixation were performed,and the intervertebral bone grafting was conducted after restoration.The surgery time,bleeding volume during surgery,fracture restoration,bone grafting fusion,failure of internal fixation and other complications were recorded.The Visual Analogue Scale (VAS) and American Spinal Injury Association (ASIA) classification were used to assess the pain and neurological function improvement between the preoperative visit and final follow-up visit.Results The surgery time was 150-240 minutes (mean,205 minutes).The bleeding volume during the surgery was 700-2 100 ml (mean,1167 ml).One case was died of pulmonary infection at one week after surgery,the others were followed up for 3-14 months (mean,7.4 months).After operation,five patients were satisfied with the reduction,and the lateral displacement was partially restored in one cases.Five cases of intervertebral bone grafting all had bone fusion.There was no fixation failure.The VAS was (7.4 ± 0.6) points before surgery,(4.5 ± 1.6) points at one week after surgery and (1.8 ± 0.3) points at final visit of follow-up,which had significant difference from the preoperative status (P ＜ 0.05).One case of ASIA grade E had no postoperative aggravation and four cases of grade A had no improvement.Conclusion Posterior decompression and pedicle screw fixation system is optimal choice of treatment for complete thoracic fractures and dislocations for it can attain reduction of fracture and dislocation as well as bone fusion,provide stability for spine and relieve pain.

The aims of the present study were to examine the expression of transforming growth factor (TGF)-β1 and microRNA (miR)-185 in the bone tissue, blood and cerebrospinal fluid of patients with spinal cord injuries and to evaluate the regulation of spinal cord injuries by miR-185. A total of 44 patients with spinal cord injuries induced by thoracolumbar spine compression fractures, who were hospitalized at Luoyang Orthopedic-Traumatological Hospital between June 2012 and February 2015 were enrolled in the present study. Among the patients enrolled, 18 underwent surgery between 1 and 7 days following fracture, and 26 patients underwent surgery between 8 and 14 days following fracture. Bone tissue, peripheral blood and cerebrospinal fluid were subsequently harvested from patients for analysis. Reverse transcription-quantitative polymerase chain reaction was performed to determine the expression of miR-185 and TGF-β1 mRNA. Western blotting was performed to evaluate TGF-β1 protein expression in bone tissue and ELISA was employed to quantify TGF-β1 protein expression in the blood and cerebrospinal fluid. TGF-β1 mRNA and protein levels in bone tissue, blood and cerebrospinal fluid from patients who underwent surgery 8-14 days post-fracture were significantly higher than those who underwent surgery 1-7 days post-fracture (P<0.05). By contrast, miR-185 levels were significantly lower in bone tissue, blood and cerebrospinal fluid from patients who underwent surgery 8-14 days post-fracture compared with those who underwent surgery 1-7 days post-fracture (P<0.05). The results of the present study desmonstrate that the upregulation of TGF-β1 in the bone tissue, blood and cerebrospinal fluid of patients with spinal cord injuries induced by thoracolumbar spine compression fractures is correlated with the downregulation of miR-185. Furthermore, miR-185 may target TGF-β1, affecting its transcription and translation, indicating that it serves an important role in spinal cord injuries induced by thoracolumbar spine compression fractures.

目的：探讨应用纳米羟基磷灰石/聚酰胺66人工骨块行颈椎后路双开门椎管扩大成形术的临床疗效和安全性。方法：2011年1月至2013年12月收治颈部疾病患者32例。男23例，女9例；年龄32~78岁，中位数56岁；脊髓型颈椎病11例，发育性颈椎管狭窄症7例，颈椎后纵韧带钙化症14例；病程5~15个月，中位数10个月。均采用颈椎后路双开门椎管扩大成形术治疗，以纳米羟基磷灰石/聚酰胺66人工骨块作为间隔物。采用日本骨科学会（Japanese orthopaedic association，JOA）制定的脊髓型颈椎病评分标准（17分法）评定脊髓功能；进行颈椎 X 线、CT、MRI 检查，观察颈椎曲度和活动度、植骨块位置和愈合情况，测定椎管矢状径；观察记录治疗及随访期间的并发症发生情况。结果：所有患者均行 C3~ C6后路双开门椎管扩大成形术，手术时间（1.6±0.3）h，术中出血量（188±50）mL。所有患者均获12个月以上随访，切口均甲级愈合，未出现过敏或毒性反应，均未出现脊髓损伤加重表现。术后所有患者的症状均明显缓解，3例患者出现单侧或双上肢烧灼样疼痛，治疗1~3个月后消失；术前、术后1周、术后3个月、术后12个月的 JOA 评分分别为（6.56±2.52）分、（10.82±1.47）分、（11.94±1.63）分、（12.35±1.96）分。影像学检查显示术后颈椎椎管容积明显增加、颈脊髓漂移满意、脊髓压迹消失；术前最狭窄部椎管矢状径（8.86±3.69）mm，出院时增加至（14.27±2.54）mm；植骨块位置维持良好，所有植骨块均与棘突融合；未发生再关门、颈椎后凸畸形及颈椎节段性不稳等并发症。结论：应用纳米羟基磷灰石/聚酰胺66人工骨块行颈椎后路双开门椎管扩大成形术，可有效扩大并维持颈椎管容积，促进脊髓功能恢复，且植骨愈合良好，并发症少，值得临床推广应用。

Objective To evaluate the efficacy and safety of anterior distraction and leverage reduction for lower cervical spine fracture and dislocation combined with locked facet.Methods Sixtyone patients with lower cervical spine fracture and dislocation combined with locked facet presenting to hospital between January 2009 and July 2014 were analyzed retrospectively.There were 48 males and 13 females,aged 18-81 years (mean,48.6 years).Responsible injured segments were C3/4 in eight patients,C4/5 in 15,C5/6 in 23,C6/7 in 11 and C7/T1 in four.A total of 18 patients had unilateral locking of facets and 43 patients bilateral locking of facets.American Spinal Injury Association (ASIA) impairment score was grade A in nine patients,grade B in 13,grade C in 17,grade D in 16 and grade E in six.Under general anesthesia,the patients were performed decompression,reduction and fixation through cervical anterior approach.Postoperative intervertebral height,vertebral horizontal displacement and cervical kyphosis angle and reduction condition were evaluated.Interbody fusion was evaluated using the Bridwell criterion,neurological function using the ASIA score,and spinal cord function using the Japanese Orthopedic Association (JOA) score.Results Complete reduction was achieved in all patients.Fifty-six patients received 3-36 month follow-up (mean,18 months).A second surgery was required for the postoperative recurrent dislocation in one patient and postoperative delayed union was seen in two patients.No patients had perioperative complications such as incision infection,nerve damage and esophageal injury.All incisions were stage I/first category healed.Cervical physiological curvature and intervertebral height were well maintained.Intervertebral height improved from preoperative 39％-86％ [(67.6 ± 14.1)％] to postoperative 89％-109％ [(101.2 ± 15.1)％],horizontal displacement of vertebrae improved from preoperative 5.36-11.74 mm [(8.12 ± 1.89) mm] to postoperative 0-2.56 mm [(1.29 ± 0.29) mm],and Cobb angle improved from preoperative-3°-26° [(14.3 ±6.2)°] to postoperative-13°-7°[(-3.6 ± 0.7) °] (all P ＜ 0.05).Nerve function was improved with no aggravation after operation.JOA score was 0 to 17 points [(13.9 ± 0.7) points] at follow-up versus 0-17 points [(7.3 ± 0.9) points] before operation (P ＜ 0.01),and the improvement of spinal cord function was 68％ after operation.Conclusion Anterior distraction and leverage reduction effectively improves spinal function,indicating an effective and save method in the treatment of cervical spine fracture dislocation combined with locked facet.

郭维淮教授从事中医骨伤科临床、教学、科研工作60余年，有深厚的理论造诣和丰富的临床经验，在学术界享有很高的知名度。他基于对腰椎间盘突出症病因病机的深刻认识，在祖传验方的基础上不断地提炼完善，创制了活血益气通经汤。本文从注重内因为本、外因为标，重视气血辨证和强调从痰而治3个方面对郭维淮教授采用活血益气通经汤治疗腰椎间盘突出症的经验作了简单总结分析。