目的 分析腰椎内固定融合术后翻修的原因并探讨再次手术治疗方案的选择.方法 回顾性分析从2011年7月—2019年3月治疗的腰椎固定融合术后失败病人38例,对每一例病情进行详细分析,总结术后翻修的原因,并针对原因选择合理的翻修方法 .通过观察翻修术前术后VAS评分、Oswestry功能障碍指数(Oswestry disability index ODI)及MacNab标准评价翻修术后疗效.结果 术后随访12～48个月,平均36.8个月,翻修术后VAS评分明显改善(P<0.001)、ODI评分由翻修手术前的(88.30±12.53)％减少到末次随访(10.10±8.57)％(P<0.001),末次随访MacNab评分,优28例,良7例,可2例,差1例.结论 腰椎内固定融合术后翻修的原因比较多,具体分析翻修的原因,选择合理的翻修方案,仍可以得到满意的治疗效果.因此术前应掌握脊柱内固定融合手术指证和应用原理,规范手术操作,减少翻修率.

目的 探讨miR-422a调控骨肉瘤细胞自噬及凋亡的作用和机制及其与靶基因ATG12的关系.方法 采用瞬时转染miR-422a模拟物和抑制物分别上调或下调骨肉瘤细胞的miR-422a表达水平,采用MTT法检测各时间点骨肉瘤细胞的增殖能力,瞬时转染miR-422a后采用流式细胞术检测骨肉瘤细胞凋亡情况,采用实时荧光定量聚合酶链式反应(RT-qPCR)检测转染miR-422a对靶基因mRNA的影响.结果 RT-qPCR结果 显示,miR-422a在肿瘤组织及细胞中均高表达,ATG12在肿瘤组织及细胞中均低表达.MTT法结果 显示,miR-422a-mimic组吸光度值明显升高,miR-422a-inhibitor组吸光度值明显降低(P<0.05).流式细胞术检测结果 显示,miR-422a-inhibitor组细胞凋亡率高于空白组与NC组(P<0.0001).Western blot检测结果 显示,miR-422a-mimic组细胞中ATG12、LC3-Ⅱ和LC3-Ⅰ蛋白量明显低于空白组与NC组(P<0.05);miR-422a-inhibitor组细胞中ATG12、LC3-Ⅱ蛋白量明显高于空白组与NC组,LC3-Ⅰ蛋白量明显低于空白组与NC组(P<0.05);miR-422a-inhibitor组细胞中LC3-Ⅱ/Ⅰ明显高于空白组与NC组(P<0.05).结论 miR-422a/ATG12信号轴可能调控骨肉瘤细胞的自噬及凋亡.

目的 探讨异硫氰酸苯乙酯(PEITC)联合阿霉素(ADM)诱导骨肉瘤细胞凋亡的作用.方法 选用U2-OS细胞株,根据处理方法的不同将其分为PEITC组、ADM组、PEITC+ADM组和空白对照组.采用MTT法检测不同处理组药物对U2-OS细胞增殖能力的影响.采用TUNEL法测定不同处理组U2-OS细胞的凋亡情况.采用Western blot法检测不同处理组U2-OS细胞Caspase-3、Fas、FasL蛋白的表达情况.结果 PEITC和ADM浓度对U2-OS细胞的半抑制浓度(IC50)分别为4.37μM/ml和6.61μg/ml.与单独使用PEITC或ADM处理相比,联合使用两种药物对U2-OS细胞的增殖抑制率更高(P<0.05).低剂量的PEITC联合ADM产生协同效应,而高剂量的两种药物联合产生相加效应.与单药物处理相比,PEITC联合ADM能够显著提高U2-OS细胞凋亡率(P<0.05),增加Caspase-3蛋白的活性及表达(P<0.05).结论 PEITC增强了ADM诱导骨肉瘤细胞凋亡的作用,可能与Caspase-3蛋白活性升高和表达量上调有关,这为PEITC联合ADM的临床应用提供了参考依据.

目的 探讨分析对寰枢椎脱位使用寰枢椎椎弓根钉的治疗效果及不良反应.方法 选择2010年1月～2019年12月本院收集到配合本研究的寰枢椎脱位患者112例,按照随机数字表法分为2组,对照组患者56例给予常规内固定治疗,研究组患者56例给予寰枢椎椎弓根钉治疗.分析两组患者的治疗效果,并评价不良反应.结果 研究组患者治疗效果比对照组优,差异对比显著,差异有统计学意义(P<0.05);不良反应发生率比对照组低,差异对比具有统计学意义(P<0.05).结论 对寰枢椎脱位患者使用寰枢椎椎弓根钉,治疗效果显著,且不良反应低,安全可靠,具有临床应用的意义.

目的 分析多节段颈椎病患者行颈椎前路椎间盘切除融合术(ACDF)前后生活质量变化及健康改善的影响因素.方法 选择2010-02～2017-02该院收治的143例行ACDF治疗的多节段颈椎病患者,采用SF-36量表对其手术前后的生活质量进行评价.分析患者术后健康改善的影响因素.结果 多节段颈椎病患者ACDF前生活质量普遍受限,ACDF可显著改善患者的生活质量.JOA评分<9分(OR=2.357)、教育程度为初中及以下(OR=1.645)、病程>6年(OR=3.122)、年龄>60岁(OR=5.049)及工作不稳定(OR=2.616)均为影响多节段颈椎病患者ACDF后健康改善的危险因素.结论 ACDF可显著改善多节段颈椎病患者的生活质量,可对具有影响术后改善相关危险因素的患者给予更多的护理措施,以有效改善其术后生活质量.

目的 探讨本体感觉神经肌肉促进技术(PNF)结合中医综合疗法对脊髓损伤患者的临床疗效.方法 选择2012-10～ 2015-03该院收治的脊髓损伤并不全瘫患者141例,随机分为A组(n=42,PNF结合中医综合康复治疗)、B组(n =43,单纯PNF康复治疗)和C组(n=43,单纯中医综合康复治疗).比较三组康复治疗前后感觉评分、运动评分和Barthel指数评分.结果 在康复治疗前三组运动评分、感觉评分和Barthel指数评分比较差异无统计学意义(P＞0.05).康复治疗后,三组各项评分均较治疗前提高,差异有统计学意义(P＜0.05).在康复治疗结束时、康复治疗后第3个月、康复治疗后第6个月,A组的三项指标评分均高于B组与C组,差异有统计学意义(P＜0.05);但B组各项指标评分与C组比较差异无统计学意义(P＞0.05).结论 采用PNF结合中医综合康复治疗脊髓损伤并不全瘫患者较单独应用PNF和中医综合康复治疗所取得的疗效更好,值得临床上推广应用.

[Objective] To explore the risk factors of early deep vein thrombosis in the lower extremity after spinal fusion surgery.[Method] A total of 216 patients who underwent spinal fusion surgery in the People's Hospital of Guangxi Zhuang Autonomous Region from July 2015 to January 2017 were enrolled into this study.According to results of ultrasonography on both lower extremities after surgery,the patients were divided into two groups,the DVT group and the non DVT group.Age,gender,BMI,diabetes,hypertension,blood clotting function,D-dimer,fusion segments,operating time,blood transfusion,anticoagulants,postoperative bed time were recorded.Chi-square test and multivariate logistic regression were used to explore the risk factors of DVT.[Result] Of the 216 patients,including 87 males and 129 females,33 patients (15.3％) developed DVT after surgery with 3 symptomatic patients (1.4％) and 30 asymptomatic patients were classified as the DVT group,whereas the remaining 183 patients without DVT were fallen into non DVT group.Chi-square test showed there were significant differences between the two groups in age,BMI,operation time,blood transfusion and postoperative bed time.In addition,multivariate logistic regression revealed age ≥60,BMI≥24 kg/m2,blood transfusion and postoperative bed time≥5 days were risk factors associated with occurrence of DVT after spinal fusion surgery.[Conclusion] The patients with age ≥60,BMI≥24 kg/m2,blood transfusion and postoperative bed time ≥5 days are more likely to have early deep vein thrombosis of lower extremity after spinal fusion surgery.

BACKGROUND:The safety and effectiveness of combined intravenous and topical administration of tranexamic acid (TXA) on the reduction of blood loss in patients undergoing posterior lumbar fusion are not yet clear. The study aimed to investigate the safety and effectiveness of the combined intravenous and topical administration of TXA on the reduction of blood loss in patients undergoing posterior lumbar fusion.METHOD:One hundred and eighteen patients who underwent double-segment posterior lumbar decompression and fusion from February 2014 to May 2016 in our hospital were retrospectively reviewed. Patients were divided into two groups, the experimental group and the control group. Preoperative demographics, operative parameters, and adverse effect were recorded and compared.RESULTS:Intraoperative blood loss, postoperative 24-hour drainage volume, and blood transfusion ratio and volume were significantly lower in the experimental group than in the control group (P < .01); on postoperative 24 hours and 48 hours, hemoglobin and hematocrit levels were significantly higher in the experimental group than in the control group (P < .01). Prothrombin time and fibrinogen content were not significantly different between the 2 groups. The postoperative length of hospital stay was shorter in the experimental group than in the control group (P < .01). No postoperative thrombotic events were reported in either group.CONCLUSIONS:Combined intravenous and topical administration of TXA seems to be effective and safe in reducing allogenic blood transfusion and blood loss in double-segment posterior lumbar decompression and fusion surgery.

[目的]探讨强直性脊柱炎(AS)早发髋关节强直的相关因素,为选择恰当的治疗方案提供依据.[方法]搜集AS患者1000例,记录患者的一般情况,AS早发髋关节强直阳性家族史,临床表现,实验室检查数据,放射学检查结果.采用Logistic回归的方法筛选出AS早发髋关节强直的相关因素,建立Logistic回归模型,显示其相关的危险性.[结果]在AS患者中共有早发髋关节强直182例,占全部病例的18.20％,占髋关节疼痛者的55.49％.单因素分析结果显示,HLA-B27、血沉、病程、起病时骶髂关节炎、持续肌腱端炎、髋关节疼痛、阳性家族史与早发髋关节强直具有相关性.多因素分析显示与早发髋关节强直相关的临床因素包括,HLA-B27、阳性家族史、持续肌腱端炎、髋关节疼痛.[结论] AS早发髋关节强直的相关危险因素有:HLA-B27阳性、持续肌腱端炎、髋关节疼痛、家族史有早发髋关节强直.当出现以上危险因素,应早期积极进行针对性干预治疗,减轻或延缓髋关节强直的进展,避免髋关节残疾的发生.

OBJECTIVE: Tranexamic acid (TXA) significantly reduces the visible and hidden blood loss associated with joint replacement. At present, many studies have examined the safety and effectiveness of the intravenous or topical administration of TXA after posterior lumbar surgery. However, randomized and controlled trials examining the presence of differences in the effect of TXA on the visible and hidden blood loss between these 2 modes of administration are lacking. The current study investigated the effects of intravenous and topical administrations of TXA on the visible and hidden blood loss of patients undergoing posterior lumbar interbody fusion (PLIF). METHODS: In a single-center, placebo-controlled, randomized design, a total of 150 patients with lumbar degenerative disease who underwent PLIF between September 2015 and August 2017 volunteered for this study. Of these patients, 126 fulfilled the inclusion criteria and were randomly assigned to 1 of 3 groups: the intravenous administration group (n = 45, group A), the topical administration group (n = 39, group B), or the placebo group (n = 42, group C). SPSS, version 17.0, was used to analyze the patient data, their blood biochemical indices, blood loss, and the number of blood transfusions across the 3 groups during the perioperative period. RESULTS: The postoperative drainage volume, number of blood transfusions, length of hospital stay, and extubation time significantly differed between group C and both groups A and B (P < 0.05); however, no significant differences were noted between groups A and B (P > 0.05). Intraoperative blood loss and visible or hidden blood loss as well as the levels of postoperative hemoglobin and hematocrit significantly differed among the 3 groups (P < 0.01). The results of the visual analogue scale, prothrombin time, and fibrinogen content did not significantly differ among the 3 groups (P > 0.05). CONCLUSIONS: For patients undergoing double-segment PLIF, both administrations of TXA can reduce blood loss, extubation time, and the length of hospital stay. Moreover, intravenous administration can reduce both visible and hidden blood loss more efficiently.

Objectives:To investigate and analyze the risk factors of early lower extremity deep vein thrombosis after posterior lumbar interbody fusion.Methods:A total of 165 patients undergoing spinal fusion surgery in the Guangxi Zhuang Autonomous Region People's Hospital from July 2015 to May 2017 were collected.Type-B ultrasonic was perforemed on lower extremities before and after surgery.According to the results of ultrasonography after surgery,these cases were divided into two groups,DVT group and non DVT group.Age,gender,BMI,diabetes,hypertension,blood clotting function,D-dimer,fusion segments,operation time,blood transfusion,anticoagulants,postoperative bed time were recorded.Chi square test was used to analyze the risk factors of early deep vein thrombosis after posterior lumbar interbody fusion,and multivariate logistic regression analysis was applied to explore the main risk factors of DVT.Results:The incidence of DVT after posterior lumbar interbody fusion was 14.5％(24 of 165 cases).Single-factor analysis showed that there were significant differences between the two groups in age,body mass index(BMI),operation time,blood transfusion and postoperative bed time.Multivariate logistic regression analysis showed age≥60 (OR=6.444,95％ CI=2.116-19.628),BMI≥24kg/m2(OR=4.463,95％ CI=1.603-12.426),blood transfusion(OR=3.484,95％CI=1.110-10.932),postoperative bed time≥5 days(OR=3.155,95％ CI=1.027-9.695) were risk factors associated with occurrence of DVT after posterior lumbar interbody fusion.Conclusions:Aged≥60,BMI≥24kg/m2,blood transfusion and postoperative bed time ≥5 days are more likely to have early lower extremity deep vein thrombosis after posterior lumbar interbody fusion.

目的 比较观察后路颈椎管扩大成形钛板固定术与传统单开门椎管扩大成形术治疗发育性颈椎管狭窄症的临床疗效.方法 回顾分析49例发育性颈椎管狭窄症患者的临床资料,随机分为两组,其中观察组25例采用钛板固定,对照组24例采用丝线悬挂,对比分析两组患者手术情况,术后症状改善情况JOA评分,末次随访术后椎板开门角度,脊髓后移距离,术后测量颈椎曲度的改变,轴性症状发生率,以及观察手术时间、术中出血量对比情况.结果 经术后6个月～3年的随访,观察组术后6个月JOA评分改善率为(62.5±16.0)％,对照组为(59.2±9.8)％,两组比较差异无统计学意义(P＞0.05).观察组椎板开门角度为(43.6±3.5)°,对照组为(40.5±4.1)°,两组比较差异有统计学意义(P＜0.05).观察组末次随访时脊髓平均后移距离(2.97±1.8)mm,对照组为(2.96±1.7)mm,两组比较差异无统计学意义(P＞0.05).观察组术后6个月颈椎曲度为(18.6±4.8)°,与术前(18.3±4.8)°比较差异无统计学意义(P＞0.05);对照组术后6个月颈椎曲度为(17.0±5.6)°,与术前(19.9±6.2)°比较差异无统计学意义(P＞0.05);观察组术后6个月轴性症状发生率为12.0％,明显低于对照组的41.7％,两组比较差异有统计学意义(P＜0.05).两组患者无一例出现C5神经根麻痹.结论 后路颈椎管扩大成形钛板固定术与传统单开门椎管扩大成形术皆为治疗发育性颈椎管狭窄症的有效术式,但后路颈椎管扩大成形钛板固定术更能降低术后再关门及术后轴性症状的发生率,是治疗发育性颈椎管狭窄症的一种有效治疗术式.

目的 观察神经肌肉本体感觉促进(proprioceptive neuromuscular facilitation,PNF)技术联合高压氧治疗脊髓损伤合并不完全性截瘫的临床疗效.方法 选取脊髓损伤合并不完全性截瘫患者48例,均行脊髓减压、脊柱内固定手术治疗,均于手术后1～2周开始进行康复治疗.随机分为A组和B组,每组24例.A组采用PNF技术联合高压氧治疗;B组采用常规运动康复训练治疗及针灸治疗,两组均康复治疗6个月.根据中国脊髓损伤协会评分标准对康复治疗前后的感觉及运动进行评分,根据改良巴氏指数(modified Barthel index,MBI)评定表对日常生活活动能力进行评定.结果 两组患者康复治疗后感觉、运动评分及MBI较治疗前显著提高(P＜0.05).A组康复治疗后感觉、运动评分及MBI增加幅度明显大于B组(P＜0.05).结论 PNF技术联合高压氧治疗脊髓损伤合并不完全性截瘫有助于患者脊髓功能恢复,可显著改善患者的运动能力及生活自理能力.

[目的]比较前外侧小切口(OCM)入路与前外侧入路人工全髋关节置换治疗成人髋臼发育不良的近中期临床疗效.[方法]回顾分析2001年6月～2011年6月在广西壮族自治区人民医院骨科进行单侧全髋关节置换的61例成人髋臼发育不良伴骨性关节炎患者的临床资料.手术采用OCM和前外侧两种入路.对两组术口长度、术中出血量、手术时间、术后引流量、手术前后血红蛋白值、术后起床时间、术后住院时间、以及术前、术后、术后12个月及末次随访髋关节Harris评分及术后X线片影像进行评估比较.[结果]术后伤口均一期愈合,随访4～14年,平均(5.8±2.5)年.两组术中出血量、手术时间、术后引流量、手术前后血红蛋白值差异均无统计学意义(P＞0.05);两组术口长度、术后起床时间、术后住院时间差异有统计学意义,OCM入路明显优于前外侧入路(P＜0.05);两组术前、术后3、12个月及末次随访髋关髋关节功能Harris评分比较差异无统计学意义(P＞0.05).[结论]两种入路人工全髋关节置换治疗成人髋臼发育不良中期疗效相当;OCM入路创伤小、患者术后恢复更快.

目的:探讨颈椎融合术后邻近节段退变(adjacent segment degeneration,ASD)的相关影响因素.方法:收集2009年1月31日～2011年1月31日在我科行颈椎前路减压植骨融合钢板内固定术治疗的患者,按照纳入和排除标准,共有235例患者纳入本研究,其中男126例,女109例,手术时年龄33 ～70岁,随访时间5～7年.在术前、术后1周以及末次随访时均行颈椎标准正侧位X线片及MRI检查,记录患者的年龄、性别、随访时间、融合节段数等,通过X线片测量并计算术前颈椎管率、手术前后颈椎弧弦距、钢板边缘至手术节段椎体边缘的距离(plate to disc distance,PDD)等影像学指标.根据X线片上Kellgren退变分级法和MRI上Miyazaki椎间盘退变分级法,将患者分为无ASD组和影像学ASD组.采用t检验及x2检验比较两组间各指标的差异,用Logistic回归分析ASD的相关影响因素.结果:末次随访时共有107例患者(45.53％)出现影像学ASD.影像学ASD组患者手术时年龄为39～70岁(53.47±6.33岁),术后弧弦距为0～10.30mm(5.58±2.34mm),上、下PPD均＜5mm 50例,上或下PPD＜5mm 43例,上、下PPD均≥5mm 14例;无ASD组患者年龄为33～61岁(47.56±5.39岁),术后弧弦距0.10～11.21 mm (7.63±2.85mm),上、下PPD均＜5mm 39例,上或下PPD＜5mm 62例,上、下均≥5mm 27例,两组患者手术时年龄、术后弧弦距、PDD差异均有统计学意义(P＜0.05);两组性别比、融合节段数、术前弧弦距、术前与术后弧弦距的差值以及术前颈椎管率均无统计学差异(P＞0.05).Logistic同归分析结果显示手术时年龄、PDD、术后弧弦距与ASD发生率均有显著相关性(P＜0.05).结论:手术时年龄、术后颈椎弧弦距、PDD与颈椎融合术后影像学ASD显著性相关,手术时年龄越大、术后颈椎生理前凸恢复不佳以及PDD＜5mm更容易发生ASD.

Objective To compare the effects of Quadrant minimally invasive channel versus traditional open surgery for treatment of simple thoracolumbar fractures .Methods Fifty-seven patients who suffered from simple thoracolumbar fractures were enrolled in the study . Twenty-seven cases in the minimally invasive group were treated with transpedicular internal fixation with screw -rod using Quadrant minimally invasive system.Thirty cases in the open surgery group were treated with traditional open transpedicular internal fixation with screw -rod.The operation duration,intraoperative blood loss,visual analogue scale (VSA) scores and Cobb angle before and after operation were compared between two groups.Results The minimally invasive group had longer operation duration ,less intraoperative blood loss ,shorter incision length and hospital stay,and lower postoperative VAS score compared with open surgery group (all P<0.05).There were no significant differences in the Cobb angles of different postoperative stages between two groups (P>0.05).Conclusion Transpedicular internal fixation with screw-rod using Quadrant minimally invasive system has the advantages of smaller incision ,shorter hospital stay ,less postoperaive pains and better discovery .

目的:观察PNF技术结合针灸推拿康复治疗胸腰椎骨折并不全瘫患者的临床效果.方法:选取脊髓损伤合并不全截瘫患者60例.随机分为治疗组(30例)和对照组(30例),治疗组采用P N F技术结合针灸推拿治疗,对照组采用针灸推拿治疗,6个疗程后进行疗效比较.患者均做脊髓减压,脊柱内固定手术治疗,手术后2周内开始进行康复治疗.在康复治疗前、后用ASIA评分标准进行感觉及运动评分,改良巴氏指数评定表(MBI)评定日常生活活动能力.结果:两组患者康复治疗后感觉、运动评分及MBI指数较治疗前提高显著(P<0.05).治疗组康复治疗后感觉、运动评分及MBI指数增加幅度明显大于对照组 (P<0.05).结论:PNF技术结合针灸推拿对胸腰椎骨折并不全瘫进行康复治疗有助于患者脊髓功能恢复,可显著改善患者的运动能力及生活自理能力.该治疗方法,具有疗效高、见效快的特点,值得临床推广运用.

[目的]应用桡神经浅支端侧移位修复猕猴尺神经高位损伤(肘关节以上),观察手内在肌组织学及吻合口神经病理学变化.[方法]选用成年的雄性猕猴9只,以上肢为研究单位,将9只猕猴双侧上肢随机分为3组,每组6侧上肢.实验组:于猕猴上臂上段切断尺神经,再重新吻合.于远端切断桡神经浅支,移位于腕部与尺神经作外膜开窗端侧吻合.对照组(1):于猕猴上臂上段切除尺神经2.5 cm,两侧断端分别折叠后结扎.腕部处理同实验组.对照组(2):上臂尺神经处理与实验组相同.腕部不作处理.观察术后猴尺神经所支配的手内在肌萎缩程度.取术后1、4、8、12个月猕猴尺神经支配的手内在肌端侧吻合口、端侧吻合口以远的神经干及小鱼际肌组织,做成切片,光镜下观察其显微结构变化.[结果]术后12个月观察到实验组猕猴手内在肌自主活动恢复,实验组术侧手内在肌肌肉萎缩不明显,对照组(1)手内在肌肌肉萎缩,程度较对照组(2)轻,对照组(2)手内在肌肌肉萎缩明显.组织学观察结果显示术后实验组神经纤维数量和密度随时间延长渐增,对照组(1)术后神经纤维数量和密度达到一定数值后无明显变化,但未见肌肉出现变性坏死.对照组(2)神经纤维数量明显减少,肌纤维数量明显减少,最终大部分肌纤维萎缩并玻璃样变、间质出血、肉芽组织形成.[结论]桡神经浅支端侧移位修复猕猴尺神经高位损伤能有效防止猕猴手内在肌萎缩、变性、纤维化,为尺神经高位损伤修复后的再生、长入创造了良好条件.