BackgroundCerebral palsy (CP) is a non-progressive brain injury primarily characterized by abnormal posture and movement disorders. Among them, spastic cerebral palsy (SCP) accounts for 70% of cases. Previous small sample hematological data analyses have revealed significant differences in inflammatory marker ratios between SCP patients and healthy controls. This study aims to expand the sample size and perform a multidimensional data analysis using routine hematological indicators to identify hematological features of spastic cerebral palsy, potentially providing new directions for the treatment of SCP.MethodsThis retrospective study included 305 children with spastic cerebral palsy and 149 healthy children, aged 3–12 years. Previous routine blood and biochemical test results were collected from the participants. Statistical analysis was performed on clinically common indicators and related composite indicators, and subgroup analyses were conducted based on age group (preschool vs. school-age).ResultsCompared to the healthy control group, SCP patients had significantly lower levels of NPAR, alkaline phosphatase (ALP), creatinine (Cr), SII, and MPV/PC (p < 0.05). AST/ALT, NLR, total protein, and SIRI levels were significantly higher in the SCP group (p < 0.05). Logistic regression analysis showed that ALP, Cr, SII, and MPV/PC were protective factors for SCP, while AST/ALT and NLR were risk factors for SCP. Combining these indicators for SCP diagnosis, the ROC curve analysis yielded an AUC of 0.781. Subgroup analysis showed that children aged 3–6 years with SCP had significantly lower Cr, AST/ALT, SII, MPV/PC, and NLR levels compared to children aged 7–12 years with SCP. Furthermore, creatinine, AST/ALT, SII, MPV/PC, and NLR levels were positively correlated with the age of SCP children.ConclusionThis study reveals a significant association between alkaline phosphatase, creatinine, AST/ALT, SII, MPV/PC, NLR in routine blood indicators and the risk of SCP, providing important reference for clinicians to monitor the health status of children with cerebral palsy, optimize treatment plans, and implement nutritional interventions.

Background Assessing various types of dysfunction in cerebral palsy is a key factor in the treatment and rehabilitation of patients. The objective of this study was to use meta-analysis and systematic review to identify the specific white matter lesions and DTI metrics strongly associated with various types of dysfunction in cerebral palsy. Methods We conducted a literature search of PubMed, Embase, Cochrane Library and Web of Science databases to identify trials published that had evaluated the correlation between DTI metrics in sensorimotor pathways and function scores in cerebral palsy. Correlation coefficient (r) values were extracted for each study, and the extent of r was quantitatively explored. The remaining part of the study was analyzed qualitatively. Results 46 studies involving 1458 children with cerebral palsy, were included. 19 articles for Meta-analysis and 27 articles were descriptively analyzed. DTI metrics such as FA、MD in both sensory and motor pathways significantly correlated with various function ratings. In overall motor dysfunction, compared with the CST and PTR, FA of the PLIC correlated more strongly with GMFCS, and showed no significant heterogeneity (r = -1.28, confidence interval [CI]-1.70 to -0.87,I2 = 38.2%,P = 0.233). In upper limb dysfunction, compared with the AHA and MA2, FA of the CST correlated more strongly with BBT, and showed no significant heterogeneity (r = -0.56, confidence interval [CI]-0.78 to -0.34,I2 = 0.0%,P = 0.511). Lower limb dysfunction and other dysfunctions we used qualitative analysis. The qualitative analysis offered a concise overview of each investigation. Conclusions This study basically identifies the specific white matter lesions corresponding to overall motor dysfunction, upper limb and lower limb motor deficits and other dysfunctions in patients with cerebral palsy, as well as the associated DTI metrics.

Vertebral compression fractures (VCF) is a common fragility fracture with high mortality worldwide. The management and prevention of VCF start with a proper nutrition. The Mediterranean diet (MD) is rich in balanced nutrients and has been shown to be beneficial for several chronic diseases. However, the association of adherence to Mediterranean diet (aMED) and prognosis of VCF patients remains unclear. To explore the association between aMED and all-cause and cardiovascular disease (CVD)-cause morality in VCF patients. In present study, patients aged ≥ 40 years old and with the VCF patients measurement were extracted from the National Health and Nutrition Examination Survey (NHANES) 2013–2014. The bone mineral density (BMD) dual-energy X-ray absorptiometry (DXA) was used to diagnose VCF. We used the weighted univariable Cox proportional hazards model to screen the covariates related to the prognosis of VCF patients. We utilized the weighted multivariable Cox proportional hazards models to explore the association between aMED and the risk of mortality in VCF patients, and were described as hazard ratios (HRs) and 95

Spinal cord injury (SCI) usually induces profound microvascular dysfunction. It disrupts the integrity of the blood-spinal cord barrier (BSCB), which could trigger a cascade of secondary pathological events that manifest as neuronal apoptosis and axonal demyelination. These events can further lead to irreversible neurological impairments. Thus, reducing the permeability of the BSCB and maintaining its substructural integrity are essential to promote neuronal survival following SCI. Tetramethylpyrazine (TMP) has emerged as a potential protective agent for treating the BSCB after SCI. However, its therapeutic potential is hindered by challenges in the administration route and suboptimal bioavailability, leading to attenuated clinical outcomes. To address this challenge, traditional Chinese medicine, TMP, was used in this study to construct a drug-loaded electroconductive hydrogel for synergistic treatment of SCI. A conductive hydrogel combined with TMP demonstrates good electrical and mechanical properties as well as superior biocompatibility. Furthermore, it also facilitates sustained local release of TMP at the implantation site. Furthermore, the TMP-loaded electroconductive hydrogel could suppress oxidative stress responses, thereby diminishing endothelial cell apoptosis and the breakdown of tight junction proteins. This concerted action repairs BSCB integrity. Concurrently, myelin-associated axons and neurons are protected against death, which meaningfully restore neurological functions post spinal cord injury. Hence, these findings indicate that combining the electroconductive hydrogel with TMP presents a promising avenue for potentiating drug efficacy and synergistic repair following SCI.

Abstract Background: Vertebral compression fractures (VCFs) is a common fragility fracture with high mortality worldwide. The management and prevention of VCFs start with a proper nutrition. The Mediterranean diet (MD) is rich in balanced nutrients and has been shown to be beneficial for several chronic diseases. However, the association of adherence to Mediterranean diet (aMED) and outcome of VCFs patients remains unclear. This study aims to explore the association between adherence to Mediterranean diet (aMED) and all-cause and Cardiovascular diseases-cause (CVD-cause) mortality in VCFs patients. Methods: In present study, patients aged ≥40 years old and with the VCFs measurement were extracted from the National Health and Nutrition Examination Survey (NHANES) 2013-2014. The bone mineral density (BMD) dual-energy X-ray absorptiometry (DXA) was used to diagnose VCFs. The weighted univariable and multivariable COX proportional hazards regression models were utilized to explore the moderating effect of aMED and the risk of mortality in VCFs patients, and were described as hazard ratios (HRs) and 95% confidence intervals (CIs). Subgroup analyses based on different complications were further assessed the association. Results: A total of 2,730 patients were included. Until 12 December 2019, 218 (7.99%) deaths were documented. VCFs was related to the high risk of all-cause mortality (HR= 1.75, 95%CI: 1.13-2.73) and CVD-cause mortality (HR=2.35, 95%CI: 1.12-4.91). Compared to the patients without VCFs and with aMED score ≥6, patients with VCFs and aMED score <6 has a higher risk of all-cause (HR=2.27, 95%CI: 1.25-4.13) and CVD-cause mortality (HR=4.25, 95%CI: 1.64-11.06). Our study also suggested that there was a moderating effect of aMED on the mortality of VCFs patients (all-cause mortality: HR: 1.36, 95%CI: 0.71-2.61; CVD-mortality: HR: 1.53, 95%CI: 0.46-5.12), especially in patients with dyslipidemia (HR: 2.49, 95%CI: 1.29-4.80), CVD (HR: 3.48, 95%CI: 1.56-7.74) and Chronic kidney disease(CKD) (HR: 3.64, 95%CI: 1.50-8.78). Conclusion: Greater adherence to the MD may have a moderating effect on the risk of all-cause and CVD-cause mortality in VCFs patients. Our research further supports the importance of the MD as a potentially healthy eating pattern.

As a specialty of traditional Chinese medicine, orthopedics and traumatology have formed some distinctive branches and schools due to the joint influence of historical periods and geographical factors.In December 2012,the State Administration of Traditional Chinese Medicine announced the first batch of 13 traditional Chinese medicine orthopedics inheritance studios.The inheritance content is distinctive, the development focuses on summarizing experience, and the research hotspots focus on the era.This is the status quo of the inheritance of orthopedics schools.In future development, we should sort out the profound heritage to achieve confidence development, sort out the experience to achieve inheritance development, highlight advantages to achieve standardized development, cross-integrate to achieve innovative development, adapt to the times to achieve transform development, and talent construction to achieve long-term development.Thereby maintaining the core competitiveness of the inheritance of orthopedics and traumatology schools, enhancing the comprehensive influence, and finally realizing the goal of modernization and internationalization of traditional Chinese medicine.

Background and objectives: Hip dislocation is a prevalent occurrence among children afflicted with spastic cerebral palsy. It has the potential to induce impairment of function, and a decline in the quality of life. Early prevention and management of hip dislocation remains an intricate problem. Our objective is to elucidate the risk factors influencing hip dislocation in children with spastic cerebral palsy. Methods: We included children with spastic cerebral palsy who were admitted to Dongzhimen Hospital, Beijing University of Chinese Medicine between January 2016 and January 2023. Participants' comprehensive clinical information, encompassing aspects such as gender, age, gestational age, birth weight, Gross Motor Function Classification System (GMFCS) level, and age of first standing, could be meticulously retrieved from medical records. All participants underwent pelvic X-ray examination. The severity of hip dislocation was assessed through the meticulous calculation of the Migration Percentage (MP) of the femoral head. Meanwhile, Acetabular Index (AI) and Neck-Shaft Angle (NSA) were obtained. Correlation analysis and multiple linear regression analysis were performed in the subsequent process. Results: A total of 291 patients (206 males and 85 females) fulfilled the inclusion criteria and were subsequently included in the analytical scope. The mean age was 8.3 years, ranging from 2 to 16 years. Correlation analysis showed that gender, age, gestational age, and birth weight were not related to MP ( p > 0.05). Multiple linear regression analysis revealed that GMFCS level ( p < 0.001), AI ( p < 0.001), NSA ( p < 0.001), and age of first standing ( p < 0.001) bore the stature of independent risk factors for MP. Conclusions: Our finding has revealed that GMFCS level, AI, NSA, and age of first standing are independent risk factors for the progression of MP in spastic cerebral palsy children. This study provided a new insight for the anticipation of hip dislocation.

Oxidative stress (OS) plays a pivotal role in the pathogenesis of spinal cord injury (SCI), yet its underlying mechanisms remain elusive. In this study, we explored the OS phenotype in a rat model of SCI. Subsequently, comprehensive bioinformatic analyses were conducted on microarray data pertaining to SCI (GSE45006). Notably, KEGG enrichment analysis revealed a pronounced enrichment of pivotal pathways, namely MAPK, FoxO, Apoptosis, NF-κB, TNF, HIF-1, and Chemokine across distinct phases of SCI. Furthermore, GO enrichment analysis highlighted the significance of biological processes including response to hypoxia, response to decrease oxygen levels, response to reactive oxygen species, cellular response to oxidative stress, reactive oxygen species metabolic process, and regulation of neuron death in the context of OS following SCI. Notably, our study underscores the prominence of nine genes, namely Itgb1, Itgam, Fn1, Icam1, Cd44, Cxcr4, Ptprc, Tlr4, and Tlr2 as OS key genes in SCI, consistently expressed in both the acute phase (1, 3, 7 days) and sub-acute phase (14 days). Subsequently, the relative mRNA expression of these key genes in different time points (1, 3, 7, 14 days) post-SCI. Finally, leveraging the DsigDB database, we predicted ten potential compounds potentially targeting OS and facilitating the repair of SCI, thus providing novel insights into the mechanisms underlying OS and identifying potential therapeutic targets for SCI.

目的 探讨数字骨科技术在中医骨伤科临床教学中的应用效果.方法 选取60 名规培轮转的临床医师,按随机数字表法分为实验组和对照组各 30 人.对照组予常规教学方式,实验组结合 3D打印模型及虚拟仿真技术辅助教学.采用满意度调查问卷及临床考核综合评估教学效果.结果 实验组在问卷调查和临床考核方面均优于对照组学生,差异具有统计学意义(P＜0.05).结论 骨伤教学新模式在传统教学基础上结合 3D打印及虚拟仿真技术,可增强实习医师对常见骨折畸形特点的理解及对中医骨伤手法整复技术的掌握,提升了学习的主动性和效率,进而有效提高临床实习质量.

目的:运用现代计算机技术分析外敷中药治疗闭合性骨折的组方用药特色及规律,为临床应用提供参考.方法:以中国知网(CNKI)为数据来源,以"外敷中药、骨折"为主题词检索,依据纳入标准进行筛选,全文阅读后提取中药处方信息,采用Excel软件建立方药数据库,进行频数、性味、归经统计,应用SPSS软件对高频药物进行系统聚类分析,利用SPSS Modeler软件进行关联规则分析.结果:纳入中药处方 137 首,涉及 184 味中药,挖掘出 12 组核心药物,形成 6 个聚类方.结论:外敷中药治疗骨折常以活血化瘀、清热凉血、燥湿利水为法,药性以温性为主,五味以苦为主,药物多归肝经.

背景:水凝胶作为生物支架已被广泛应用于脊髓损伤的基础研究,基于脊髓组织的电信号传导特性,导电水凝胶已有初步探索及应用,但疗效及机制尚不明确.目的:初步探索导电水凝胶促进脊髓损伤后轴突再生的潜在机制,评估导电水凝胶作为生物支架修复脊髓损伤的安全性与可行性.方法:在甲基丙烯酰化明胶水凝胶的基础上添加导电颗粒聚吡咯,制备导电水凝胶.将36只成年雌性SD大鼠随机分为假手术组、模型组和导电水凝胶组,每组12只.假手术组仅行椎板切除,模型组和导电水凝胶组建立T9脊髓完全横断模型,缺损间隙2 mm,导电水凝胶组造模后立即予以导电水凝胶填塞缺损间隙.术后1,3,7,14,28 d进行大鼠BBB评分;术后28 d,进行血清炎性指标、肝脾肾及脊髓组织形态、微血管再生及轴突再生检测.结果 与结论:①术后28 d,导电水凝胶组BBB评分优于模型组(P<0.05);②导电水凝胶组C-反应蛋白水平低于模型组(P<0.05),两组血沉比较差异无显著性意义(P>0.05);③苏木精-伊红染色显示,3组大鼠的肝、脾、肾等实质性器官无炎性细胞浸润;模型组断端处炎性细胞浸润明显,细胞排列紊乱,周围组织溶解;导电水凝胶组炎性细胞较少,细胞排列相对规整;Masson染色显示,模型组断端有大量胶原纤维长入,导电水凝胶组导电水凝胶周围仅被少量胶原纤维包裹;④免疫荧光染色显示,模型组脊髓缺损处血管内皮细胞较少,无成熟神经元细胞存在,导电水凝胶组血管内皮细胞明显多于模型组,有成形的血管轮廓,神经元数量较模型组多,但相较于假手术组细胞核固缩;⑤Western blot检测显示,导电水凝胶组血管内皮生长因子、神经丝蛋白200的蛋白表达量高于模型组(P<0.05);⑥导电水凝胶作为生物支架修复脊髓损伤安全有效,其促进轴突再生的机制可能与促微血管再生、改善微循环有关.

背景:近年来,可注射水凝胶在治疗严重脊髓损伤方面有很大的应用前景和独特的治疗可塑性.目的:综述可注射水凝胶材料在脊髓损伤中的研究进展.方法:检索PubMed、Web of Science、Embase、中国知网、万方、维普、中国生物医学文献数据库等数据库,中文检索词为"脊髓损伤、脊柱骨折、可注射水凝胶"等,英文检索词为"Spinal Cord Trauma、Myelopathy、Traumatic、Injuries、Spinal Cord、Spinal Cord Injury、Spinal Cord Transection、Spinal Cord Laceration、Post-Traumatic Myelopathy、Spinal Cord Contusion、injectable Hydrogel"等.筛选可注射水凝胶治疗脊髓损伤的相关研究.结果 与结论:在动物及细胞实验中,可注射水凝胶具有修复脊髓损伤的效果.可注射水凝胶具有创伤小、能够贴合不规则缺损的特性;具有导电性和温敏性能的可注射水凝胶,在理化特性方面对脊髓损伤具有较好的修复功能;搭载干细胞或神经营养因子的可注射水凝胶,有利于神经再生和脊髓损伤局部微环境的修复.可注射复合水凝胶材料具有临床应用前景.

背景:脑性瘫痪(简称脑瘫)是一种广泛的神经损伤性疾病,其病因在很大程度上仍不明确,用于该病分类或监测的分子指标也尚未见报道.目的:分离培养儿童脑瘫患者脑脊液来源的外泌体,使用无标记定量质谱蛋白质组学方法分析其外泌体的蛋白质组表达谱特征,为儿童脑瘫群体的分型、诊断和预后评估等提供分子生物学依据.方法:选择在北京中医药大学东直门医院进行选择性脊神经后根切断术的脑瘫患者,其中痉挛型脑瘫患者4例,混合型脑瘫患者3例,每位患者抽取3 mL脑脊液,通过超速离心法分离儿童脑瘫患者脑脊液中的外泌体,并使用纳米颗粒跟踪分析、透射电镜和蛋白质质谱分析对外泌体进行表征.结果 与结论:①透射电镜观察显示,儿童脑瘫患者脑脊液内存在外泌体形态的囊泡.Western blot检测到外泌体标志蛋白Syntenin-1和Flotillin-1的表达;②纳米颗粒跟踪分析显示囊泡的大小和浓度符合外泌体的异质性特征.对痉挛性脑瘫、混合性脑瘫的脑脊液外泌体进行蛋白质谱分析,共鉴定出551个蛋白;③生物信息学分析显示,鉴定出的脑脊液外泌体蛋白与负责外泌体功能和神经发育过程的分子信号机制相关,这些蛋白主要富集于额叶皮质、运动皮质等脑部区域,与脑瘫病理密切相关.研究结果提示儿童脑瘫患者脑脊液内存在外泌体,外泌体蛋白可能与脑瘫分子病理机制相关.

背景:脊髓损伤后炎性微环境的失衡会加剧脊髓继发性损伤,阻碍神经功能的修复,川芎嗪具有抑制炎症反应、保护神经细胞等作用,但其在脊髓损伤领域研究较少.目的:观察川芎嗪能否通过改善大鼠脊髓损伤后炎性反应促进神经功能恢复,并探索其潜在机制.方法:将36只SD大鼠随机分为假手术组、模型组、川芎嗪组,每组12只.假手术组行T10椎板切除术,后两组采用自制双刃显微剪行T10脊髓完全横断,川芎嗪组模型制备后给予盐酸川芎嗪注射液200 mg/(kg·d)腹腔注射,连续5 d.分别于术后1,3,7,14 d通过Basso-Beattie-Bresnahan(BBB)评分以及改良Rivlin斜板实验评估运动功能恢复情况;于术后14 d取材行苏木精-伊红染色、Nissl染色观察脊髓组织形态学改变;术后7,14 d,ELISA法检测C-反应蛋白表达变化,免疫组织化学染色法分析炎性因子(核因子κB、肿瘤坏死因子α、白细胞介素10)表达情况.结果 与结论:①脊髓损伤后各时间点,假手术组大鼠BBB评分、改良Rivlin斜板角度均高于其他两组,差异均有显著性意义(P<0.05);模型组与川芎嗪组大鼠BBB评分、改良Rivlin斜板角度相比差异均无显著性意义(P>0.05);②苏木精-伊红染色结果显示,川芎嗪组炎性细胞的数量较模型组显著减少;③Nissl染色结果表明,川芎嗪组断端两侧脊髓组织内神经元数量明显多于模型组;④模型组脊髓损伤后C-反应蛋白表达出现先升高再降低的趋势,川芎嗪能显著降低C-反应蛋白的表达量(P<0.05);⑤造模后7天,模型组核因子κB、肿瘤坏死因子α阳性表达均多于假手术组(P<0.05),白细胞介素10阳性表达较少;与模型组相比,川芎嗪组脊髓组织核因子κB表达量显著降低(P<0.05),白细胞介素10表达量显著升高(P<0.05);造模后14天,模型组核因子κB、肿瘤坏死因子α阳性表达均高于假手术组(P<0.05),白细胞介素10阳性表达低于假手术组(P<0.05);川芎嗪组的白细胞介素10表达量较模型组升高(P<0.05);⑥提示脊髓损伤后,促炎因子的表达量明显增加,炎性微环境失衡;川芎嗪能够调控脊髓损伤后免疫炎性反应,改善炎性微环境,促进脊髓损伤修复.

BackgroundSpinal cord injury (SCI) is a severe neurological injury for which no effective treatment exists. Granulocyte colony-stimulating factor (G-CSF) is used to treat autologous bone marrow transplantation, chemotherapy-induced granulocytopenia, Acquired Immune Deficiency Syndrome (AIDS), etc. Recent research has revealed the potential application of G-CSF on neuroprotective effectiveness. In central nervous system diseases, G-CSF can be used to alleviate neuronal injury.ObjectiveTo investigate the effects of G-CSF on Basso, Beattie, and Bresnahan (BBB) scale score, inclined plane test, electrophysiologic exam, quantitative analysis of TUNEL-positive cells, and quantitative analysis of glial fibrillary acidic protein (GFAP) immunostaining images in animal models of SCI.MethodsWe searched PubMed, Web of Science, and Embase databases for all articles on G-CSF intervention with animal models of SCI reported before November 2022. A total of 20 studies met the inclusion criteria.ResultsResults revealed that G-CSF intervention could improve the BBB scale score in both groups at 3, 7, 14, 28, and 35 days [at 35 days, weighted mean differences (WMD) = 2.4, 95% CI: 1.92–2.87, p < 0.00001, I2 = 69%]; inclined plane test score; electrophysiologic exam; quantitative analysis of TUNEL-positive cell numbers; quantitative analysis of GFAP immunostaining images in animal models of SCI. Subgroup analysis revealed that treatment with normal saline, phosphate-buffered saline, and no treatment resulted in significantly different neurological function effectiveness compared to the G-CSF therapy. SD rats and Wistar rats with SCI resulted in significant neurological function effectiveness. C57BL/6 mice showed no difference in the final effect. The T9–T10 or T10 segment injury model and the T8–T9 or T9 segment injury model resulted in significant neurological function effectiveness. The BBB score data showed no clear funnel plot asymmetry. We found no bias in the analysis result (Egger’s test, p = 0.42). In our network meta-analysis, the SUCRA ranking showed that 15 mg/kg-20 mg/kg was an optimal dose for long-term efficacy.ConclusionOur meta-analysis suggests that G-CSF therapy may enhance the recovery of motor activity and have a specific neuroprotective effect in SCI animal models.Systematic review registration: PROSPERO, identifier: CRD42023388315.

目的:脑性瘫痪因其高发病率及高致残率,严重影响儿童身心健康.佩戴踝足矫形器是该病一项重要治疗措施,但关于其改善脑性瘫痪儿童运动功能的效果方面还不十分确切.为此,文章系统评价了踝足矫形器改善脑瘫儿童运动功能的效果.方法:第一作者检索PubMed、EMbase、Web of Science、Cochrane Library、CBM、中国知网、万方和维普数据库,检索时限从建库至2020-09-09.根据制定的入组标准,纳入有关踝足矫形器治疗脑性瘫痪儿童的随机对照试验.至少2名评价员独立提取数据,使用Cochrane 5.1.0偏倚风险评估工具对纳入研究的质量进行评估,采用RevMan 5.3软件进行数据分析.结果:①纳入12项质量较高的随机对照试验,共480例脑性瘫痪儿童,其中踝足矫形器组239例为佩戴踝足矫形器,对照组241例不佩戴踝足矫形器,治疗疗程0-48周;②Meta分析结果显示,踝足矫形器组在GMFM-88-D/E区评分(MD=6.26,95％C/:3.54-8.98,P＜0.00001)、MAS评分(MD=-0.60,95％C/:-0.80至-0.40,P＜0.00001)、摆动位平均踝背屈角度(MD=14.96,95％CI:12.03-17.90,P＜0.00001)、运动功能改善有效率(MD=2.99,95％CI:1.19-7.50,P=0.02)和步幅(MD=0.06,95％C/:0.04-0.09,P＜0.00001)的改善方面均优于对照组.结论:现有的12项随机对照试验证据表明,脑性瘫痪患儿无论是佩戴踝足矫形器行走,亦或是佩戴一定时间后解除踝足矫形器行走,其短期内(治疗0-48周)运动功能恢复效果均显著,但长期运动功能的恢复情况还有待进一步研究.

混合型脑瘫以痉挛型合并不随意运动型多见,不随意运动型脑瘫是指因锥体外系受损导致随意运动障碍而不自主运动增加,常表现为扭转痉挛、肌张力障碍、手足徐动、姿势控制缺陷等[1],颈部肌张力障碍可加速颈椎退变,导致颈椎病的发生.脑瘫与脊髓型颈椎病神经系统损害症状表现的重叠常会延误和干扰诊治[2],由于脑瘫患者肢体功能残疾长期存在,微小的神经症状变化难以识别,当寻找其功能恶化的病因时,应考虑到继发脊髓型颈椎病的可能,早期手术修复损害的神经功能.2021年8月北京中医药大学东直门医院收治1例混合型脑瘫合并脊髓型颈椎病患者并行手术治疗,现报告如下.

[目的 ]探究腰骶段选择性脊神经后根切断术(selective posterior rhizotomy,SPR)对痉挛型脑瘫髋关节发育的影响.[方法]回顾性分析2017年2月—2020年2月本科行SPR的痉挛型脑瘫50例患儿(共100髋)的临床资料,根据年龄分为学龄前组与学龄组.比较两组临床与影像学结果.[结果]两组均顺利完成手术,无严重并发症.学龄前组手术时间与术中出血量均显著少于学龄组(P＜0.05).两组均获随访2～3年,平均(2.52±0.43)年,与术前相比,末次随访时两组粗大运动功能评定(Gross Motor Function Measure,GMFM)88项 E 区评分均显著提高(P＜0.05),髋屈-伸 ROM 和髋内收-外展 ROM,Ashworth 髋肌张力和MRC髋肌力评级均显著改善(P＜0.05);但相应时间点两组间上述临床指标差异均无统计学意义(P＞0.05).影像学方面,与术前相比,末次随访时两组髋臼指数(acetabular index,AI)和颈干角(neck shaft angle,NSA)均无显著变化(P＞0.05);学龄前组中心边缘角(center-edge angle,CE)显著增大(P＜0.05),而学龄组CE无变化(P＞0.05);两组股骨头偏移百分比(migration percentage,MP)均显著减小(P＜0.05).术前学龄前组AI、MP和NSA均显著大于学龄组(P＜0.05),CE显著小于学龄组(P＜0.05).末次随访时两组间比较,学龄前组AI和NSA仍显著大于学龄组(P＜0.05),但两组间MP差异已无统计学意义(P＞0.05),学龄前组CE仍显著小于学龄组(P＜0.05).[结论]腰骶段SPR术可以改善痉挛型脑瘫患儿髋关节发育.

背景:川芎嗪药理作用广泛,具备改善微循环、抗炎、抑制细胞凋亡等功能,在修复脊髓损伤方面具有显著疗效.目的:综述川芎嗪在脊髓损伤修复过程中的作用机制,以期为脊髓损伤的研究与治疗提供参考.方法:以"tetramethylpyrazine,spinal cord injury,ischemia-reperfusion injury"为英文关键词;以"川芎嗪,脊髓损伤,缺血再灌注损伤"为中文关键词,检索2003-2020年期间收录在PubMed、中国知网等数据库中的文献,纳入川芎嗪药理作用及其在脊髓损伤修复过程中机制相关的文献,排除重复与相关性弱的文献,对85篇文献进行总结分析.结果 与结论:目前的动物实验尚未完全阐明川芎嗪在脊髓损伤修复过程中的机制.川芎嗪在治疗脊髓损伤过程中的机制主要包括:抑制内皮素生成、抑制血管内皮细胞凋亡、拮抗钙离子内流、调节白细胞介素、抑制核因子кB信号通路、抑制中性粒细胞浸润以及抑制神经细胞凋亡等.临床使用川芎嗪单体注射液治疗脊髓损伤的报道较少,其临床疗效仍有待于进一步探究.