目的 总结脊柱痛风的诊断及治疗特点.方法 对1例腰椎关节突痛风石老年女性患者的临床资料进行回顾性分析.结果 患者症状表现为腰痛伴右下肢疼痛,查体腰椎主被动活动受限,活动时疼痛,双下肢肌力3级,右下肢直腿抬高试验阳性,加强试验阳性,双足第一跖趾关节可见痛风石结节.腰椎MRI检查提示L4/5、L5/S1间隙水平椎管狭窄,L5/S1右侧关节突附近可见些许点状高信号,尿酸678μmol/L.保守对症治疗症状无改善后行手术治疗,术中发现右侧L5下关节突及S1上关节突及椎板处广泛灰白色组织浸润,确诊脊柱痛风.充分清除病灶,松解神经,术后患者腰痛及右下肢放射痛明显缓解.结论 脊柱痛风诊断需结合病史、症状、体征、血尿酸及CT、MRI、双能CT等检查.治疗方面,对于非紧急病例应首选保守治疗,对于神经系统症状明显、进展快或继发性脊柱不稳的患者可采取手术治疗,术后保守治疗.

The purpose of this study was to evaluate the application of multimodal intraoperative monitoring (MIOM) system in patients with congenital scoliosis (CS) and adolescent idiopathic scoliosis (AIS). Twelve patients who underwent posterior surgical correction of scoliosis for CS and AIS from June 2014 to July 2018 were enrolled in this study. During the operation, we monitored the functional status of the spinal cord by MIOM. An abnormal somatosensory evoked potential was defined as a prolonged latency of more than 10% or a peak-to-peak amplitude decline of more than 50% when compared to baseline. An abnormal transcranial motor evoked potential (TcMEP) was defined as a TcMEP amplitude decrease of more than 50%. A normal triggered electromyography response, which presented with the absence of an electrical response on stimulation at 8.2mA, indicated that the pedicle screw was not in contact with the spinal cord or nerve root. A total of 12 patients underwent MIOM surgery, of which 9 patients with negative MIOM had no significant deterioration of neurological function postoperatively, and exhibited satisfactory surgical correction of scoliosis during follow-ups. However, the remaining 3 patients suffered from MIOM events, 2 patients had normal neurological function, and 1 patient had deteriorated neurological function postoperatively. Using MIOM in CS and AIS surgery could promptly detect iatrogenic neurological injury at the early stage. Therefore, rapid response by appropriate intraoperative interventions can be taken to minimize the injury. Besides, stable MIOM recordings encourage surgeons to correct scoliosis even when the Cobb angle of scoliosis was extremely large.

目的:分析实施健康教育对颈椎病患者生活质量的影响.方法:将来我院接受治疗的80例颈椎病患者平均分为对照组和观察组.对观察组患者实施健康教育,而对照组患者则不进行干预,3个月后,对比分析两组患者的疾病复发率,并自制生活质量评分量表对两组患者的生活质量进行调查.结果:观察组患者的疾病复发率为15.0％,明显低于对照组患者的35.0％,组间比较差异显著(P<0.05),观察组患者的生活质量评分为(13.2±1.1)分,明显高于对照组患者的(7.9±0.8)分,组间比较差异显著(P<0.05).结论:对颈椎病患者实施健康教育,可有效改善患者的临床症状,降低疾病的复发率,提高患者的生活质量.

RATIONALE:The purpose of this study was to estimate the efficacy and safety of percutaneous periacetabular screw (PPS) insertion assisted by screw view model of navigation (SVMN) to treat fracture of acetabulum.PATIENT CONCERNS:A 61-year-old male patient was injured in a motorcycle accident, which caused pain, swelling, deformity and limited mobility on his right hip.DIAGNOSES:He was diagnosed with fracture of acetabulum.INTERVENTIONS:We used PPS insertion assisted by SVMN to treat fracture of acetabulum in this patient.OUTCOMES:The follow up lasted 24 months. Totally 2 screws were inserted into anterior and posterior column of acetabulum respectively and both of them displayed grade 0. Compared with the preoperative gap and step of fracture displacement, the postoperative ones were significantly reduced. It took 11.7 minutes for designing the screws, 6.7 minutes for implanting the guide wire, and 45.5 minutes for placing the screws. Intraoperative blood loss was 29 mL and total fluoroscopic time was 4.1 minutes. No clinical complications such as nerve vascular injury, infection and screw loosening were found after the operation.LESSONS:The study indicated that SVMN is favorable to the PPS insertion for acetabular fracture. Our lesson is that the relative position between the acetabular and the patient tracker must be static to ensure the accuracy of the entire system throughout the operation.

Rationale: The purpose of this study was to evaluate the accuracy of a retrograde transpubic screw fixation assisted by a screw-view model of navigation in treating a pelvic fracture. Patient concerns: A 30-year-old female patient injured in a motor vehicle accident, displayed symptoms characterized by swelling and pain of the pudendum. Diagnoses: The patient was diagnosed with a fracture of the pubic ramus. Interventions: We used a screw-view model of navigation to assist our retrograde transpubic screw fixation in this patient. Outcomes: In total, 2 screws were inserted into the bilateral pubic ramus and both were excellently positioned. It took 7.4 minutes to design the screws, 8.1 minutes to implant the guidewire, and 39.3 minutes to place the screws. Intraoperative blood loss amounted to 21 mL and the total fluoroscopic time was 3.8 minutes. No clinical complications, such as neurologic, vascular, or urologic injury, infection, screw loosening, or loss of reduction, were found after the operation. Follow-up lasted 28 months. Lessons: The outcome of our study suggests that the screw-view model of navigation maximizes the retrograde transpubic screw insertion accuracy in the treatment of a pubic ramus fracture, which is made efficient by pain relief and early out-of-bed mobilization. Our suggestion is, therefore. that the relative position between the pubic ramus and the patient tracker must be static to ensure the accuracy of the entire system throughout the operation.

目的:探讨对骨巨细胞瘤患者行人工肩关节伴肩胛骨置换术的围术期护理方法.方法:对患者术前加强心理护理;术后做好体位护理、疼痛处理、肿胀处理、负压引流护理,积极预防感染,预防关节脱位和假体松动,并进行康复训练及出院指导.结果:手术取得成功,患者出院后,定期电话随访效果良好,未出现假体松动、移位,感染等并发症,患者取得良好的功能恢复.结论:有针对性的围手术期护理和早期有效的康复训练指导可使患者肩关节得到良好的恢复,提高其生活质量.

This study aims to evaluate the application of multimodal intraoperative monitoring (MIOM) in surgical treatment for spine burst fracture and dislocation (SBFD) patients.Eleven patients who underwent posterior reduction and instrumentation (PRI) for SBFD from June 2014 to July 2016 were included into the study. The function of the spinal cord was monitored by MIOM. The muscle strength of the lower extremities and American Spinal Injury Association (ASIA) scores were, respectively, evaluated (before surgery, and at 1, 3, 6, and 12 months after surgery). Furthermore, the extent of reduction was also assessed.Muscle strength recovery, ASIA score changes, and the extent of reduction were correlated with MIOM results. Among the 11 patients who received surgery under MIOM, 8 patients with negative MIOM results during the operation did not demonstrate neurological deterioration postoperatively and exhibited improvements in ASIA scores during follow-ups. However, among the 3 patients who encountered MIOM events (case 4, 7, and 8), 2 patients avoided nerve lesion and 1 patient suffered from neurologic deterioration postoperatively.The application of MIOM technology during PRI surgery may detect spinal cord impairment at the early stage, and operative schemes can be modified before permanent nerve compromise is triggered by surgical manipulation.

目的 研究分析品管圈在髋关节骨折患者术后康复护理中的应用效果.方法 选取2016年5月至2017年5月间我院收治的髋关节骨折手术治疗患者共60例,将其随机分为试验组30例、对照组30例,对照组患者采取常规护理措施,试验组患者在此基础上加以品管圈管理,对比分析两组患者的Harris髋关节评分与并发症发生率.结果 试验组患者出院时的Harris髋关节评分明显高于对照组,而在治疗过程中的并发症发生率则显著低于对照组,组间数据对比差异均符合统计学意义(P<0.05).结论 在髋关节骨折患者术后康复护理中应用品管圈管理,可有效改善患者的髋关节功能,同时降低并发症发生率,具有较高的临床应用价值.

目的:探讨分析行为转变理论护理干预对下肢骨折老年患者下肢静脉血栓和便秘的影响.方法:选取我院2016年1月～2017年1月收治的50例下肢骨折老年患者为研究对象,随机分为对照组与观察组,对照组接受常规护理方式,观察组接受行为转变理论护理,对比两组患者临床护理效果.结果:观察组并发症发作率显著低于对照组,血液流变情况优于对照组,P<0.05,有统计学意义.结论:行为转变理论护理干预在下肢骨折老年患者的护理过程中能够有效降低下肢静脉血栓和便秘的发病率,提升治疗效果,改善血液流变,值得推广.

Uric acid is the end product of purine metabolism.It is also an important endogenous antioxidant in the body and plays an important role in oxidative stress,which is an independent risk factor for osteoporosis.Therefore,there may be some correlations between serum uric acid and bone loss.In recent years,there are many researches on the correlations between serum uric acid and bone mineral density in both China and overseas,but the exact relationship is still controversial.This paper mainly elaborates the relationship between serum uric acid and bone mineral density in different populations,the possible mechanisms.,and the controversy on their correlation,etc.,in order to deepen the understanding of the two and to provide new ideas for research on clinical management.

We aimed to identify key genes associated with rheumatoid arthritis ( RA).The microarray datasets of GSE1919, GSE12021, and GSE21959 (35 RA samples and 32 normal controls) were downloaded from the Gene Expression Omnibus database. Differentially expressed genes (DEGs) in RA samples were identified using the t test in limma package. Functional enrichment analysis was performed using clusterProfiler package. A protein-protein interaction (PPI) network of selected DEGs was constructed based on the Human Protein Reference Database. Active modules were explored using the jActiveModules plug-in in the Cytoscape Network Modeling package.In total, 537 DEGs in RA samples were identified, including 241 upregulated and 296 downregulated genes. A total of 24,451 PPI pairs were collected, and 5 active modules were screened. Furthermore, 19 submodules were acquired from the 5 active modules. Discs large homolog 1 (DLG1) and related DEGs such as guanylate cyclase 1, soluble, alpha 2 (GUCY1A2), N-methyl d-aspartate receptor 2A subunit (GRIN2A), and potassium voltage-gated channel member 1 (KCNA1) were identified in 8 submodules. Plasminogen (PLG) and related DEGs such as chemokine (C-X-C motif) ligand 2 (CXCL2), laminin, alpha 3 (LAMA3), complement component 7 (C7), and coagulation factor X (F10) were identified in 4 submodules.Our results indicate that DLG1, GUCY1A2, GRIN2A, KCNA1, PLG, CXCL2, LAMA3, C7, and F10 may play key roles in the progression of RA and may serve as putative therapeutic targets for treating RA.

目的:评价多模式术中神经监测系统(MIOM)在脊柱骨折脱位手术中应用的实用性.方法:选取2014至2016年于吉大二院行后路骨折复位内固定术的11例脊柱骨折脱位患者(胸椎8例,腰椎3例),手术均在脊髓监测下完成.分别于术前、术后1、3、6、12月行双下肢肌力评估、脊髓损伤评分测定;也对术后骨折复位程度进行了评估.结果:肌力恢复情况、脊髓损伤评分的变化、骨折复位的程度均与术中监测警报提示直接相关,其中8例患者术中神经监测无异常,术后无神经损伤症状出现且脊髓损伤评分在随访过程中逐渐改善,3例患者出现术中监测异常,这3例病人术中及时采取相应措施,2人术后神经功能完整,1人出现神经损伤症状.结论:MIOM可以监测术中医源性神经损伤,提示医生术中及时采取措施从而避免手术操作造成的永久性神经损伤.