Objective To study the clinical outcome of short segment percutaneous pedicle screw(PPS) combined with unilateral percutaneous vertebroplasty(PVP) for Kümmell disease stage Ⅲ without neurological symptoms. Methods Retrospective analysis of 11 patients with Kümmell disease stage Ⅲ hospitalized in the department of spine surgery of Luoyang Orthopedic-Traumatological Hospital of Henan Province from May 2018 to August 2019(5 males and 6 females),who were received posterior short-segment percutaneous pedicle screw fixation combined with unilateral percutaneous vertebroplasty. The mean age was 72.2 years old, with an average disease course of 5.5 months. All the patients had osteoporosis. The lesion segments included T11, T12 and L1. According to the follow up results,including the operation time,blood loss,the volume of injected bone cement,kyphosis Cobb angle,Oswesay disability index(ODI),height restoration of the vertebral, the incidence of adjacent vertebral fracture and stability of implant were assessed. Results The operations were successfully performed on the 11 patients, and all the patients were followed up for 12 to 15 months, average (14.27±1.01) months. Compared with preoperation, the observational targets (ODI, VAS score, Cobb angle and the height of anterior edge of injured vertebra) in last follow-up and a week after surgery were improved significantly(P＜0.05). Two cases had slight displacement of internal fixation during the follow-up, and 1 case had cement leakage without symptom to the disc during operation. Conclusions Short segment percutaneous pedicle screw fixation combined with unilateral percutaneous vertebroplasty is safe and effective for treatment of Kümmell disease stage Ⅲ without neurological symptoms, alleviate clinical symptoms and reduce the complication of long-term bed rest.

目的 研究经腰椎横突行极外侧单侧穿刺入路,治疗老年骨质疏松性腰椎压缩骨折的临床效果.方法 选取2017年4月至2019年3月河南省洛阳正骨医院老年性骨质疏松腰椎椎体压缩性骨折患者48例,采用经腰椎横突极外侧单侧穿刺入路,利用骨水泥椎体内沿骨皮质内壁"返涌"弥散,完成经皮穿刺椎体成形术,分别记录T1(术前1 d)、T2(术后3 d)、T3(术后1个月)和T4(术后3个月)的视觉模拟评分(VAS)及Oswestry功能障碍指数(ODI)以评估治疗效果.结果 所有患者均顺利完成手术操作,骨水泥灌注满意,均可顺利越过椎体中线抵达对侧,无血管、神经损伤等严重并发症发生,术后患者疼痛症状均有明显减轻.术后各时间点的VAS评分、ODI均低于术前(P＜0.05).结论 经腰椎横突极外侧单侧穿刺入路治疗老年骨质疏松性腰椎骨折安全、经济、有效.

目的 对比无骨折脱位型颈髓损伤手术与保守治疗对脊髓功能恢复程度的影响差异.方法 选择2012年8月至2015年8月河南省洛阳正骨医院收治无骨折脱位型颈髓损伤患者36例,按治疗方法分为手术治疗组21例,保守治疗组15例.按照日本骨科学会(JOA)评分分别于治疗前及治疗后3、6、12个月进行评价.结果 手术治疗组与保守治疗组在治疗前相比,差异无显著性(P>0.05).手术治疗组与保守治疗组JOA评分在治疗3、6、12个月后相比,差异有显著性(P<0.05),手术组治疗后3、6、12个月JOA评分增加幅度与保守组比较,差异有显著性(P<0.05).结论 无骨折脱位型颈髓损伤手术治疗效果明显优于保守治疗,对无骨折脱位型颈髓损伤患者,只要全身条件允许,应尽早手术治疗.

目的:探讨解毒饮对术后全身炎症反应的疗效.方法:2017年8-12月收治80例骨科手术患者.按随机数字表法分为试验组和对照组,每组40例.试验组服用解毒饮,对照组服用5％淡红糖水,连续7d,观察手术后1d(T1)、4d(T4)、7d(T7),外周血WBC、血清TNF-a、IL-6、SIRS发病率和评分变化.结果:试验组和对照组,T1时WBC计数、血清TNF-a、IL-6,差异均无统计学意义(P1均>0.05);T4、T7时,差异均有统计学意义(P4、7均<0.05).T1时,SIRS发生率试验组(58％)和对照组(53％),差异无统计学意义(P1>0.05);T4、7时,SIRS发生率试验组(28％,8％)和对照组(45％,25％),差异有统计学意义(P4、7均<0.05).T1时,SIRS评分试验组(5.6±1.20)分和对照组(5.3±1.15)分,差异无统计学意义(P1>0.05);T4、7时,SIRS评分试验组(3.2±0.60,1.3±0.30)分和对照组(4.9±1.03,2.8±0.61)分,差异有统计学意义(P4、7均<0.05).结论:解毒饮具有良好清热解毒、活血化瘀作用,能快速有效清除炎性介质,预防SIRS发生.

目的:探讨经肋横突关节椎体成形术治疗胸椎骨质疏松性压缩骨折的临床疗效和安全性.方法:2012年10月至2017年10月,采用经肋横突关节椎体成形术治疗胸椎骨质疏松性压缩骨折患者60例.男28例,女32例;年龄50～85岁,中位数70岁.损伤节段位于T52例、T62例、T74例、T812例、T910例、T106例、T1111例、T1213例.合并高血压20例、糖尿病12例、冠状动脉粥样硬化性心脏病10例.椎体骨密度T值-6.9～-2.8,中位数-3.2.受伤至手术时间1～9 d,中位数6 d.记录手术时间和骨水泥注入量,随访观察胸椎后凸畸形矫正、伤椎高度丢失、患者背部疼痛和胸椎功能改善及并发症发生情况.结果:60例患者均顺利完成手术,手术时间21～45 min,中位数28.6 min;骨水泥注入量1.6～4.8 mL,中位数3.8 mL.60例患者均获随访,随访时间3～12个月,中位数7个月.胸椎后凸Cobb角,术前63.47° ±12.08°、术后第2天41.89° ±9.75°、术后3个月42.89° ±9.75°、术后6个月44.13° ±9.52°;伤椎前缘高度丢失比,术前(72.71±14.94)％、术后第2天(44.45±12.28)％、术后3个月(45.58±12.23)％、术后6个月(47.04±12.03)％;背部疼痛视觉模拟量表评分,术前(7.80±1.71)分、术后第2天(2.96±1.90)分、术后3个月(1.13±1.14)分、术后6个月(0.85±0.85)分;Oswestry功能障碍指数,术前(42.24±5.24)％、术后第2天(27.69±5.59)％、术后3个月(21.18±4.75)％、术后6个月(19.95±4.42)％.并发骨水泥渗漏4例,渗入静脉1例、渗入终板2例、渗入椎体前方1例;并发伤椎上位椎体骨折2例、伤椎下位椎体骨折1例;均无神经损伤发生.结论:经肋横突关节穿刺椎体成形术治疗胸椎骨质疏松性压缩骨折,可矫正胸椎后凸畸形、维持椎体高度、缓解背部疼痛、改善胸椎功能,且安全性高.

Objective To analyze the risk factors of reoperation after percutaneous vertebroplasty (PVP) and kyphoplasty (PKP), and to propose surgical tips during reoperation as well as preventive measures.Methods From June 2012 to December 2017, 465 patients underwent PVP and PKP in our hospital.Among them, 41 cases underwent reoperation.There were 8 males and 33 females, aged from56 to89 years (average, 75 years).There were 37 cases of osteoporotic fracture, 2 cases of vertebral metastases, and2 cases of plasma cell myelom.The lesion segments were as follows:T9 in 2 cases, T10 in 3 cases, T11 in 6 cases, T12 in 6 cases, L1 in 11 cases, L2 in 5 cases, L3 in 3 cases, L4 in 3 cases, and L5 in 2 cases.According to the American Spinal Injury Association (ASIA) classification, 5 patients with spinal cord injury were rated as follows:grade A in 1 cases, grade B in 1 cases, grade C in 2 cases, grade D in 1 cases.Two patients with nerve root injury had skin hypesthesia, and their muscle strength was gradeⅡ-Ⅲ.Thirty-four patients without spinal cord or nerve root injury had an average visual analogue scores (VAS) of 7.8 and underwent vertebral strengthening, including PKP in 14 patients and PVP in 20 patients, while the rest 7 with spinal cord and nerve root injury underwent open surgery.The patients received reoperation at 2 hours to 1 year following the first surgery.Results All 41 patients were followed up for 6 to 29 months (average, 18 months).The reasons for reoperation were as follow:pseudoarthrosis in 3 cases (3/41, 7.32％), bone cement leakage in the spinal canal in 7 cases (7/41, 17.07％), and fracture in non-surgical vertebral segments in31 cases (31/41, 75.61％).At the final follow-up, 2 patients with nerve root injury only had residual numbness;among the 5 patients with spinal cord injury, 1 case improved to grade C, 1 case to grade D, 2 cases to grade E, and1 case remained grade A according to the ASIA scales;the mean VAS score was 2.3 points in 3 patients who had pseudoarthrosis, while 31 patients with vertebral fractures of non-surgical segments had an average VAS score of 1.8.Conclusion The reasons for reoperation after PVP and PKP include intraspinal leakage of cement, pseudoarthrosis in vertebral body, and vertebral fractures of non-surgical segments.Sequential bone cement injection, critical selection of PVP and PKP cases, routine pathological examination, prevention of falls and rehabilitation exercises can reduce the risk of reoperation.

目的 探讨开窗髓核摘除联合椎间支点植骨术治疗腰椎间盘突出症的临床疗效.方法 选取2010年1月—2012年12月河南洛阳正骨医院脊柱外科收治的42例腰椎间盘突出症患者采用开窗髓核摘除联合椎间支点植骨术治疗.疗效评定依据疼痛视觉模拟评分(VAS)和Oswestry功能障碍指数(ODI).患者术前及术后随访时二维CT片对椎间隙高度、椎间植骨块长度和直径比较,评价手术疗效.用Bridwell方法评价腰椎融合情况.结果 42例患者均获得随访,随访时间12～48个月.术后48个月下肢疼痛VAS及ODI较术前减低,差异有统计学意义(P<0.05).术后不同时间点椎间隙高度、植骨柱长度和直径较术前比较无差异(P>0.05).末次随访,根据Bridwell腰椎间融合评价标准,Ⅱ和Ⅲ级37例(88％).所有患者无永久性神经根损伤、无大血管损伤和硬膜囊撕裂等并发症.结论 开窗单纯髓核摘除联合椎间支点植骨术治疗腰椎间盘突出症手术简单、费用低、临床疗效好、而且可保留椎间盘突出节段活动度.

目的:探讨高速磨钻在颈椎前路减压椎间融合术治疗椎体后缘骨赘型脊髓型颈椎病中的应用价值.方法:2015年1月至2017年12月,采用颈椎前路减压椎间融合术治疗椎体后缘骨赘型脊髓型颈椎病患者62例.男36例,女26例;年龄51～81岁,中位数63岁.病变节段为C2～C33例、C3～C49例、C4～C513例、C5～C616例、C6～C78例、C2～C41例、C3～C53例、C4～C65例、C5～C72例、C3～C62例.病程6个月至12年,中位数10个月.术中应用高速磨钻在减压节段上位椎体后下缘和下位椎体后上缘的左右侧各打磨出1个骨槽,打磨掉部分椎体后缘皮质骨和骨赘.记录手术时间和术中出血量,随访观察颈椎功能恢复及并发症发生情况.结果:本组62例患者,单节段减压49例、双节段减压13例.手术时间50～125 min,中位数75 min;术中出血量80～500 mL,中位数210 mL.患者均获随访,随访时间3个月.日本骨科学会脊髓型颈椎病评分,术前(12.3±1.6)分,术后1周(15.3±0.6)分,术后3个月(16.3±0.5)分.均无感染、脑脊液漏及神经根、脊髓损伤等并发症发生.结论:采用颈椎前路减压椎间融合术治疗椎体后缘骨赘型脊髓型颈椎病,术中应用高速磨钻,手术时间短、出血少,有利于颈椎功能恢复,安全性高.

Manual inspection (i.e., visual inspection and/or with professional equipment) is the most predominant approach for identifying and assessing superficial damage of masonry historic structures at present. However, this method is costly and at times difficult to apply to remote structures or components. Existing convolutional neural network (CNN)‐based damage detection methods have not been specifically designed for the multiple damage identification of masonry historic structures. To overcome these limits, a deep architecture of CNN damage classification techniques for masonry historic structures is proposed in this article using a sliding window‐based CNN method to identify and locate four categories of damage (intact, crack, efflorescence, and spall) with an accuracy of 94.3%. This is the first attempt to identify the multidamage of historic masonry structures based on CNN techniques and achieve excellent classification results. The data are only trained and tested from images of the Forbidden City Wall in China, and the pixel resolutions of stretcher brick images and header brick images are 480 × 105 and 210 × 105, respectively. Two CNNs (AlexNet and GoogLeNet) are both trained on a small dataset (2,000 images for training, 400 images for validation and testing) and a large dataset (20,000 images for training, 4,000 images for validation and testing). The performance of the trained model (94.3% accuracy) is examined on five new images with 1,860 × 1,260 pixel resolutions.

Objective To evaluate the effect of surgical treatment for spondylolisthesis of the third and fourth degree.Methods From Oct 2009 to May 2013 totally 40 cases of spondylolisthesis were treated with vertebral pedicle fixation,posterior decompression and interbody fusion.Patients were followed up for 24 ～ 33 months,average 27 months.Measured the slip rate of before and after the operation,pelvic incidence,intervertebral height and sacral inclination angle index,combined with disposable walking distance and VSA score to evaluate the clinical curative effect.Results The preoperative spondylolisthesis rate was (65.5 ± 2.3) ％,the immediate postoperative time was (10.5 ± 2.5) ％,and the final follow-up was (12.0 ± 2.3) ％.The rate of spondylolisthesis at the last follow-up was statistically significant (P ＜0.01),and there was no significant difference (P ＞ 0.05).Lumbosacral-pelvic parameters (PI,PT,LL,SS)were improved,the average preoperative disposable walking distance was (300 ± 15) meters,after 1 years of disposable walking distance was (1500±50) meters,the difference was statistically significant before and after operation (P ＜0.01).The mean preoperative VSA score was (8.6 ±0.2),an average of 6 months after surgery (1.2 ± 0.3),after one year the average (1.0 ± 0.2),at the end of the follow-up (one year) the average score (1.0 ± 0.2),statistically significant differences were found between before and after operation (P ＜ 0.01).The effect of clinical treatment was satisfactory.Conclusion Vertebral pedicle fixation,posterior decompression and interbody fusion were effective methods for the treatment of spondylolisthesis.

The vertical displacement of a cross section of a bridge has a close correlation with the carrying capacity and the ability to resist dynamic loads. Therefore it has been one of the most important parameters for structural health monitoring and safety assessment. Moreover, when a natural disaster such as a hurricane or an earthquake occurs, a large number of bridges will be affected. To evaluate safety performance and investigate failures preliminarily, rapid inspections of displacement are essential for bridges. This paper presents a bridge distributed displacement investigation technique using smartphones. This smartphone-based technique is a beneficial complement to conventional structural health monitoring techniques for its cost efficiency and operability. Based on photogrammetry technology, an algorithm is used to develop an app called D-Viewer. Multipoint dynamic displacement monitoring is implemented synchronously using smartphones. Experiments conducted in the laboratory with reduced-scale models show that this technique is able to monitor the distributed displacement response with reasonable precision. Through data processing, performance of bridges will be evaluated. Low cost and convenience of this technique make it possible for anyone to monitor or inspect the displacement of every short and medium span bridge preliminarily.

21世纪以来,在大数据和GPU加速训练的支持下,以深度学习为核心的人工智能技术迅速发展,并在多领域得到了广泛应用.与此同时,随着国民经济实力和文化素质的不断提升,国家对于古建筑的保护也愈发重视.然而在长期自然及人为因素的共同作用下,古建筑难免会受到不同程度的损伤,这些损伤在很大程度上表现在结构的表层,如裂缝、酥碱、剥落、倾斜、空鼓等.因此,对这些表层损伤实施快速和高效的识别和定位,为后续的诊断和修复工作提供指导具有重大意义.目前国内对于古建筑表层损伤的检测主要为人工方法,即通过目测和借助专业的设备完成工作.然而人工方法效率不高,且需要较强的专业性和经验因素.为解决该问题,文中提出了一种基于人工智能方法的古建筑表层损伤检测技术,通过获取大量具有多类损伤古建筑的表层图像样本并进行人工分类,使用卷积神经网络对样本进行训练,得到一个用于识别损伤的分类器并验证其准确性.分类器成功建立后,使用滑动窗口算法对结构表层图像进行测试,从而完成损伤的定位工作.最后提出了众包式检测的思想,通过调动公众来收集训练样本,达到提高效率,节约成本的目的.

文中提出了一种基于智能手机的结构新型位移监测技术，此项技术具备经济、高效、便捷等优点，是对传统结构健康监测技术的一个有益补充。依据摄影测量技术原理，设计出一套位移求解算法，基于此算法，分别在iOS平台和Android平台开发出位移监测应用软件“D-Viewer”，并进行静态和动态验证实验，实验结果显示，此项技术具有较好的精确性和显著的实用性。

Devastating earthquake can often cause the disaster area communication interrupt, traffic paralysis, etc. It is difficult for the emergency rescue force to get the disaster area in time. Therefore, active local participation in the quake-hit areas to aid each other appeals extremely important. The paper is based on a self-developed smartphone software called “E-Explorer”, study its significance and its working methods to help the public participate in the earthquake rescue actively when external network are cut off. “E-Explorer” can help deliver important information for personal survival, let rescue workers locate the positions of survivors trapped, creating an efficient self-help and mutual rescue platform for the earthquake-stricken people.

目的总结前路减压植骨内固定治疗在胸腰椎爆裂性骨折伴脊髓损伤中的应用,并探讨其临床疗效。方法对2010年6月6日至2012年7月4日我院收治的40例胸腰椎爆裂性骨折伴脊髓损伤患者的临床资料及治疗方法进行回顾性分析。结果 40例胸腰椎爆裂性骨折伴脊髓损伤患者皆成功进行手术,所有患者均给予6个月~3年的随访,CT检查显示,内固定未出现松动或者断裂症状,生理弯曲状况出现明显的改善,植骨得到有效的融合,位置趋于正常,未产生假关节现象。治愈24例,有效13例,无效3例,总有效率为92.50%;Frankel分级神经功能均有所恢复,其中15例达到E级。结论对于胸腰椎爆裂性骨折伴脊髓损伤患者,给予前路减压植骨内固定治疗,安全性及可靠性较高,神经功能可恢复正常状态,其疗效较为理想,值得在医疗实践中推广使用。

目的分析脐带间充质干细胞移植治疗脊髓损伤的临床效果,更好地提高我国临床治疗的水平。方法将2009年5月至2012年7月在我院接受脐带间充质干细胞移植的50例脊髓损伤病患作为研究对象,分析病患治疗前后感觉及运动、生活自理的能力。结果患者治疗后和治疗前相比,脊髓损伤病患的生活自理能力、感觉以及运动评分等方面均有显著改善,患者的各项身体生化指标无异常,未见明显的不良反应与严重并发症现象,治疗前后病患的评分具有差异性,即P>0.05。结论采用脐带间充质干细胞移植方法对治疗脊髓损伤具有重要的意义,而且疗效明显,可提高病患的生活质量与我国的临床治疗水平。

OBJECTIVES:To investigate the safety and therapeutic efficacy of autologous olfactory ensheathing cell (OEC) transplantation in cervical spinal cord injury (SCI).METHODS:Patients with cervical SCI of >6 months' duration were treated with autologous OECs, injected into the area surrounding the SCI under magnetic resonance imaging guidance, twice a week for 4 weeks. Patients were evaluated before treatment and at 3, 6, 12 and 24 months post-treatment, using the American Spinal Injury Association (ASIA) Impairment Scale, the ASIA sensory and motor score and the Functional Independence Measure (FIM) score.RESULTS:Eight patients were recruited to the study. Three months after treatment, ASIA and FIM scores had improved significantly compared with pretreatment, though by 1 year no further significant improvements in the ASIA score were seen. The return of substantial sensation and motor activity in various muscles below the injury level was observed in three patients during follow-up. In addition, bladder function was restored in two patients. There were no serious complications postoperatively or during the follow-up period.CONCLUSIONS:This study provides preliminary evidence of the safety and possible efficacy of autologous OEC transplantation.

Objective To investigate the artificial cervical disc replacement for the treatment of cervical spondylotic myelopathy.Methods In 2010 June to 2012 September,10 cases of invalid conservative treatment of patients with 11 segments for the artificial cervical disc replacement,6 cases were male,4 female;age 41-61 years,mean 48±0.8 years old.9 cases of single segment,1 cases of double segments,followed up for 3 months to 12 months.Results All patients were healed wound phase I clinical,intraoperative and postoperative no nerve and blood vessel injury,combined examination of cervical range check,neurological symptoms,Odom rating,JOA score and imaging before and after surgery,patients with nervous system symptoms were satisfactory improvement,JOA score was significantly higher than that before operation.Cervical curvature,replacement of segmental function activity,replacement segment inferior vertebral height is maintained.Prosthesis no sinking or offset,no heterotopic ossification.Conclusion Cervical artificial disc replacement in the maintenance of segmental motion function at the same time,can obtain good effect of nerve decompression,the short term curative effect of artificial disc replacement is satisfactory.

目的探讨"工"字形减压植骨内固定术在颈椎前路手术中的应用效果。方法对多椎间隙狭窄、后缘增生明显等经椎间隙前路减压困难者15例颈椎疾患采用"工"字形减压植骨内固定术。结果术后随访6～15个月,植骨完全愈合,内固定无松动、断裂,神经症状恢复满意。结论 "工"字形减压植骨内固定术优于保留椎体后壁的椎体次全切除减压植骨内固定术,是基层医院应大力推广的良好术式。

目的 探讨内固定椎板间植骨融合术治疗椎体终板骨软骨炎所致胸腰背部疼痛的手术方法及疗效.方法 2007年1月至2010年5月,采用椎弓根螺钉固定,双侧椎板间植骨融合术治疗椎体终板骨软骨炎所致胸腰背部痛患者18例.结果 18例均获得随访,时间6 ～24个月,平均14个月.根据Denis 疼痛分级,手术后胸腰背部疼痛16例消失,2例明显缓解.椎板间植骨融合标准参照FDA推荐的Simmons法,手术后3个月融合良好.结论 内固定椎板间植骨融合术治疗椎体终板骨软骨炎所致胸腰背部疼痛,操作简单、临床疗效满意.