Objective:To investigate the influences and mechanism of berberine on wound healing of full-thickness skin defects in diabetic mice.Methods:The experimental research method was adopted. Mouse dermal fibroblasts (MDF) conventional-glucose complete medium (hereinafter referred to as conventional medium) were prepared with final mass concentrations of berberine of 0 (no berberine), 1.25, 2.50, 5.00, 10.00, 20.00, 40.00, 80.00, and 160.00 μg/mL, respectively. Primary MDF were cultured using conventional medium and MDF high-glucose (30 mmol/L glucose) complete medium (hereinafter referred to as high-glucose medium), and the 3 rd to 6 th passage cells were collected for the following experiments. Cells cultured in conventional medium were taken and subjected to starvation treatment for 12 hours, and then cultured in conventional media containing different concentrations of berberine for 48 hours to screen out the optimal working concentration of berberine using the cell counting kit 8 (CCK-8), the sample number was 6, and the selected optimal berberine concentration was used for subsequent cell culture experiments. Cells cultured in 2 media were taken, of which the cells cultured in conventional medium were included to the normal control group; cells cultured in high-glucose medium were divided into high-glucose alone group and high-glucose+berberine group according to the random number table (the same grouping method below). After 48 h of cultivation, cell viability was detected by CCK-8, cell migration capacity was evaluated by scratch test and Transwell assays, and mRNA and protein expression levels of platelet-derived growth factor (PDGF), vascular endothelial growth factor (VEGF), transforming growth factor-β 1 (TGF-β 1), matrix metalloproteinase 9 (MMP-9), and cysteine aspartic acid specific protease (caspase-3) in the cells were detected by real-time fluorescence quantitative reverse transcription polymerase chain reaction and Western blotting, respectively, and the sample numbers of the aforementioned experiments were 6, 3, 9, 3, and 6, respectively. Fifteen 8-week-old male BALB/c mice were used to establish diabetic mouse model, then full-thickness skin defect wounds on their backs were made and divided into diabetes alone group, diabetes+low-concentration berberine group (25 μg/mL), and diabetes+high-concentration berberine group (75 μg/mL) for corresponding treatments, with 5 mice in each group. The wound areas were measured using ImageJ software on post injury day (PID) 0 (immediately), 3, 7, 14, and 21. On PID 21, histological changes and collagen formation in the wound tissue were detected by hematoxylin-eosin and Masson staining, respectively, protein expression and mRNA levels of MMP-9, PDGF, TGF-β 1, VEGF, CD31, and caspase-3 in the wound tissue were detected by immunohistochemistry and real-time fluorescence quantitative reverse transcription polymerase chain reaction, respectively, the sample number of animal experiments was all 5. Data were statistically analyzed with one-way analysis of variance, independent sample t-test, Tukey's test, and factorial design analysis of variance. Results:After 48 hours of cultivation, the cell viability was the highest when the mass concentration of berberine was 20.00 μg/mL. After 48 h of cultivation, compared with that in normal control group, cell viability in both high-glucose alone group and high-glucose+berberine group reduced significantly ( P<0.05); compared with that in high-glucose alone group, the cell viability in high-glucose+berberine group was significantly enhanced ( P<0.05). After 48 h of cultivation, scratch test results showed that, the cell migration rates in 24 h in both high-glucose alone group and high-glucose+berberine group were significantly decreased than that in normal control group ( P<0.05); compared with that in high-glucose alone group, the cell migration rate in 24 h in high-glucose+berberine group was significantly enhanced ( P<0.05). After 48 h of cultivation, the results of Transwell experiments showed that, compared with (141±7) of cells migrating in 24 h in normal control group, the number of cells migrating in 24 h in high-glucose alone group and high-glucose+berberine group were 28±3 and 86±6, respectively, which were significantly decreased ( P<0.05); compared with that in high-glucose alone group, the number of cells migration in 24 h in high-glucose+berberine group was significantly increased ( P<0.05). After 48 h of cultivation, compared with those in normal control group, the mRNA levels of PDGF, VEGF, TGF-β 1, and MMP-9 of cells in high-glucose alone group and high-glucose+berberine group were significantly decreased ( P<0.05), the mRNA levels of caspase-3 were significantly increased ( P<0.05); compared with those in high-glucose alone group, the mRNA levels of PDGF, VEGF, TGF-β 1, and MMP-9 of cells in high-glucose+berberine group were significantly increased ( P<0.05), the mRNA expression level of caspase-3 was significantly decreased ( P<0.05). After 48 h of cultivation, compared with those in normal control group, the protein expression levels of PDGF, VEGF, TGF-β 1, and MMP-9 of cells in high-glucose group and high-glucose+berberine group were significantly decreased ( P<0.05), the protein expression levels of caspase-3 were significantly increased ( P<0.05); compared with those in high-glucose alone group, the protein expression levels of PDGF, VEGF, TGF-β 1, and MMP-9 of cells in high-glucose+berberine group were significantly increased ( P<0.05), and the protein expression level of caspase-3 was significantly decreased ( P<0.05). Compared with those in diabetes alone group, the wound areas of mice in diabetes+low-concentration berberine group on PID 14 and 21 and in diabetes+high-concentration berberine group on PID 3, 7, 14, and 21 were significantly decreased ( P<0.05); compared with that in diabetes+low-concentration berberine group, the wound area in diabetes+high-concentration berberine group was significantly decreased on PID 3, 7, 14, and 21 ( P<0.05). On PID 21, the wound of mice in diabetes alone group was not epithelialized with a large number of inflammatory cells and granulation tissue in the dermis; most of the wound tissue of mice in diabetes+low-concentration berberine group was already epithelialized, although there was a large number of inflammatory cells in the dermis; and most of the wound tissue of mice in diabetes+high-concentration berberine group had completed epithelialization with a small number of hair follicles and inflammatory cells in the dermis. On PID 21, compared with that in diabetes alone group, the collagen area of wound of mice in diabetes+low-concentration berberine group and diabetes+high-concentration berberine group was significantly increased ( P<0.05); compared with that in diabetes+low-concentration berberine group, the collagen area of wound of mice in diabetes+high-concentration berberine group was significantly increased ( P<0.05). On PID 21, compared with those in diabetes alone group, the protein expression levels of MMP-9, PDGF, TGF-β 1, VEGF, and CD31 in wound tissue of mice in diabetes+low-concentration berberine group and diabetes+high-concentration berberine group were significantly increased ( P<0.05), the protein expression levels of caspase-3 were significantly decreased ( P<0.05); compared with those in diabetes+low-concentration berberine group, the protein expression levels of MMP-9, PDGF, TGF-β 1, VEGF, and CD31 in wound tissue of mice in diabetes+high-concentration berberine group were significantly increased ( P<0.05), the protein expression level of caspase-3 was significantly decreased ( P<0.05). On PID 21, compared with those in diabetes alone group, the mRNA levels of MMP-9, PDGF, TGF-β 1, VEGF, and CD31 in wound tissue of mice in diabetes+low-concentration berberine group and diabetes+high-concentration berberine group were significantly increased ( P<0.05), the mRNA levels of caspase-3 were significantly decreased ( P<0.05); compared with those in diabetes+low-concentration berberine group, the mRNA levels of MMP-9, PDGF, TGF-β 1, VEGF, and CD31 in wound tissue of mice in diabetes+high-concentration berberine group were significantly increased ( P<0.05), the mRNA level of caspase-3 was significantly decreased ( P<0.05). Conclusions:Berberine can promote the proliferation and migration of MDF and the healing of full-thickness skin defect wounds of mice in diabetic mice by up-regulating the expression of biofactors including MMP-9, PDGF, TGF-β 1, and VEGF, and down-regulating the expression of caspase-3, a pro-apoptotic factor in wound tissue of mice.

目的 探讨桂枝加葛根汤联合运用子午流注低频治疗仪治疗颈型颈椎病的临床疗效.方法 将2020年9月—2021年9月湖北省中医院收治的90例颈型颈椎病患者随机分为对照组和治疗组,每组45例,对照组给予口服洛索洛芬钠片治疗,治疗组行桂枝加葛根汤联合子午流注低频治疗仪治疗,观察两组患者治疗前后VAS评分及JOA评分,评价临床疗效及短期复发率情况.结果 治疗组的治疗总有效率88.89%明显高于对照组71.11%,差异有统计学意义(χ2=4.444,P<0.05);与治疗前比较,两组治疗后VAS评分降低,JOA评分升高,且治疗组各项指标评分均优于对照组,差异有统计学意义(P<0.05);治疗组短期复发率明显低于对照组,差异有统计学意义(P<0.05).结论 桂枝加葛根汤联合运用子午流注低频治疗仪治疗颈型颈椎病疗效明确,可以有效缓解颈项部疼痛、僵硬,改善颈椎功能活动.

背景:急性脊髓损伤具有较高的致残率和致死率,在急性期进行积极有效的治疗对预防继发性损害具有重要意义.目的:观察通腑逐瘀法指导下抵当汤加减治疗大鼠急性脊髓损伤后水肿和肢体功能恢复的疗效,探讨通腑逐瘀法治疗急性脊髓损伤的作用机制.方法:将60只SD大鼠随机分为假手术组、模型组、抵当汤组、TGN-020组以及抵当汤+TGN-020组,每组12只.假手术组行椎板切除术,不予脊髓打击,其余各组均采用纽约大学打击器制造急性脊髓损伤模型.造模成功后,假手术组和模型组不采取任何治疗措施,抵当汤组术后给予5.04 g/kg抵当汤灌胃;TGN-020组术后给予5 mg/kg TGN-020(水通道蛋白4特异性抑制剂)腹腔注射;抵当汤联合TGN-020组术后采用5 mg/kg TGN-020腹腔注射联合5.04 g/kg抵当汤灌胃处理,1次/d,持续7 d.分别于术后1,3,5,7天评估BBB评分和Reuter评分,术后第7天取材进行脊髓组织大体观察和含水率检测,苏木精-伊红染色观察组织受损程度,免疫荧光检测各组脊髓组织中水通道蛋白4和胶质原纤维酸性蛋白共表达细胞个数,Western Blot法检测各组脊髓组织中水通道蛋白4、胶质原纤维酸性蛋白、硫酸软骨素蛋白聚糖、增殖细胞核抗原蛋白的表达量.结果 与结论:①行为学评分结果显示,与模型组相比,各用药组BBB评分均显著升高(P<0.05),Reuter评分均显著降低(P<0.05),且各用药组之间无显著差异(P>0.05);②脊髓组织含水率结果显示,与模型组相比,各用药组脊髓组织含水率均显著降低(P<0.05),且各用药组之间无显著差异(P>0.05);③苏木精-伊红染色结果显示,模型组脊髓组织结构离乱,大量瘢痕组织和脊髓空洞形成;与模型组相比,各用药组可见组织结构较完整,可见少量瘢痕组织增生和脊髓空洞,组织形态得到有效改善;④免疫荧光结果显示,与模型组相比,各用药组水通道蛋白4和胶质原纤维酸性蛋白共表达细胞数量较少,亮度较低,细胞肿胀程度减轻(P<0.05),且各用药组之间无显著差异(P>0.05);⑤Western Blot结果显示,与模型组相比,各用药组脊髓组织中水通道蛋白4、胶质原纤维酸性蛋白、硫酸软骨素蛋白聚糖、增殖细胞核抗原蛋白的表达均显著降低(P<0.05),且各用药组之间无显著差异(P>0.05);⑥提示通腑逐瘀法指导下抵当汤加减可促进急性脊髓损伤大鼠肢体功能恢复,其作用机制可能通过抑制水通道蛋白4表达减轻急性脊髓损伤大鼠损伤处水肿,从而有效抑制反应性星形胶质细胞的活化和增生,减少胶质瘢痕的形成.

距骨骨样骨瘤是临床上罕见的良性骨样骨瘤,约占所有骨样骨瘤的2％～10％[1-2].97％的距骨骨样骨瘤发生于距骨颈,而发生于距骨负重面的病例较少[3-4].鉴于距骨骨样骨瘤病例比较罕见,影像学表现不典型,漏诊率较高,本文报道1例关节镜下治疗距骨骨样骨瘤病例,以期为临床诊治距骨骨样骨瘤提供参考,提高临床医师对距骨骨样骨瘤的认识,现报告如下.

Objective:To investigate the effect of percutaneous kyphoplasty on the vertebral height and Cobb angle in elderly patients with osteoporotic thoracolumbar compression fractures.Methods:Seventy elderly patients with osteoporotic thoracolumbar compression fractures who were admitted to the Affiliated Hospital of Hubei University of Traditional Chinese Medicine from March 2019 to March 2020 were selected as the study objects. They were grouped according to the random number table method, with 35 patients in each group. The patients in the observation group were treated with multi-point balloon expansion percutaneous kyphoplasty, and the patients in the control group were treated with single balloon expansion percutaneous kyphoplasty. The Visual Analogue Scale (VAS) and Oswestry Dysfunction Index (ODI) score were compared between the two groups before and after treatment. The relative height of injured vertebrae, Cobb angle, bone cement diffusion volume ratio, operation time, radiation exposure time and bone cement injection volume were recorded.Results:There was no significant difference in VAS and ODI score between the two groups before operation (all P>0.05). At 12 months after operation, the VAS and ODI score of the two groups were lower than those before operation (all P<0.05), and the ODI score of the observation group was significantly lower than that of the control group ( P<0.05). At 12 months after operation, the relative height of injured vertebrae in the observation group was higher than that in the control group, and the local Cobb angle was significantly lower than that in the control group (all P<0.05). The total effective rate of the observation group was significantly higher than that of the control group (94.28% vs 82.86%, P<0.05). Compared with the control group, the observation group had higher proportion of grade Ⅱ in the diffusion volume ratio of bone cement and more bone cement injection, and longer operation time (all P<0.05), while there was no significant difference in the radiation exposure time between the two groups ( P>0.05). Conclusions:The treatment of percutaneous kyphoplasty with multi-point expansion of balloon under overextended posture can more effectively improve the relative height of injured vertebrae and improve local Cobb angle of elderly patients with osteoporotic thoracolumbar compression fractures, and does not increase the risk of bone cement leakage. It is worthy of clinical application and promotion.

骨关节炎(Osteoarthritis,OA)是最常见的退行性关节疾病,其特征是关节软骨的进行性退化和软骨下骨的重塑以及骨赘的形成,临床上引起关节疼痛、功能障碍,甚至残疾.关节软骨细胞外基质(Extracellular Matrix,ECM)分解代谢的增加是OA发生发展的关键因素.ECM的主要成分是蛋白聚糖、Ⅱ型胶原和非胶原蛋白,其在合成或降解过程中一些特定的碎片得以释放到体循环中.随着分子生物学的发展,这些释放出来的可溶性物质作为生物标志物,正在被探索作为早期骨关节炎诊断、监测疾病进展、评估疗效和判断预后的非放射学选择,并越来越受到重视.OA病理进展第一阶段的特征是软骨基质的蛋白分解,因此,为了识别早期骨关节炎患者以及了解软骨退变程度,揭示OA病情,近些年的研究聚焦于蛋白聚糖、Ⅱ型胶原及非胶原蛋白的可溶性代谢产物.本文对近年来研究中反映关节软骨早期退变的生物学标志物进行系统综述.

目的:观察骨质疏松性椎体压缩骨折(osteoporotic vertebral compression fracture,OVCF)经皮椎体成形术(percutaneous ver-tebroplasty,PVP)中骨水泥椎间盘渗漏对手术疗效的影响.方法:回顾性分析2016年1月至2019年1月采用PVP治疗的162例OVCF患者的病例资料,其中30例出现骨水泥椎间盘渗漏(渗漏组)、132例未出现骨水泥渗漏(无渗漏组).比较2组患者的伤椎疼痛视觉模拟量表(visual analogue scale,VAS)评分、Oswestry功能障碍指数(Oswestry disability index,ODI)、Cobb角、椎间盘高度及邻近椎体骨折发生率.结果:渗漏组随访时间19～32个月,中位数26个月.无渗漏组随访时间17～33个月,中位数25个月.①伤椎疼痛VAS评分.时间因素与分组因素存在交互效应(F=3.571,P=0.039).2组患者伤椎疼痛VAS评分总体比较,组间差异无统计学意义,即不存在分组效应(F=2.875,P=0.092).手术前后不同时间点伤椎疼痛VAS评分的差异有统计学意义,即存在时间效应(F=792.352,P=0.000).2组患者的伤椎疼痛VAS评分随时间变化均呈下降趋势,但2组的下降趋势不完全一致.术前、术后1 d,2组患者伤椎疼痛VAS评分的组间差异均无统计学意义[(7.21±1.32)分,(7.15±1.41)分,t=-0.227,P=0.821;(2.81±0.59)分,(2.89±0.83)分,t=0.508,P=0.612];末次随访时,渗漏组伤椎疼痛VAS评分低于无渗漏组[(1.58±0.64)分,(2.23±0.84)分,t=4.734,P=0.000].②ODI.时间因素与分组因素不存在交互效应(F=1.283,P=0.279).2组患者ODI总体比较,组间差异无统计学意义,即不存在分组效应(F=0.007,P=0.935).手术前后不同时间点ODI的差异有统计学意义,即存在时间效应(F=662.717,P=0.000).2组患者的ODI随时间变化均呈下降趋势,且2组的下降趋势完全一致[渗漏组:(41.29±5.74)％,(22.75±5.97)％,(11.46±5.24)％,F=192.697,P=0.000;无渗漏组:(42.51±5.19)％,(21.27±6.37)％,(11.56±5.71)％,F=941.928,P=0.000].③伤椎Cobb角.时间因素与分组因素不存在交互效应(F=0.157,P=0.773).2组患者伤椎Cobb角总体比较,组间差异无统计学意义,即不存在分组效应(F=0.890,P=0.347).手术前后不同时间点伤椎Cobb角的差异有统计学意义,即存在时间效应(F=633.877,P=0.000).2组患者的伤椎Cobb角随时间变化均呈减小趋势,且2组的减小趋势完全一致(24.07° ±4.15°,13.64° ±1.48°,13.54° ±1.49°,F=184.863,P=0.000;24.70° ±4.36°,13.91° ±1.94°,13.86° ±1.86°,F=886.434,P=0.000).④伤椎椎间盘高度.时间因素与分组因素存在交互效应(F=94.251,P=0.000).2组患者伤椎椎间盘高度总体比较,组间差异无统计学意义,即不存在分组效应(F=1.189,P=0.277).手术前后不同时间点伤椎椎间盘高度的差异有统计学意义,即存在时间效应(F=786.319,P=0.000).2组患者的伤椎椎间盘高度随时间变化均呈下降趋势,但2组的下降趋势不完全一致.术前、术后1 d,2组患者伤椎椎间盘高度的组间差异均无统计学意义[(7.01±1.49)mm,(6.92±1.30)mm,t=-0.320,P=0.750;(6.91±1.44)mm,(6.96±1.29)mm,t=0.172,P=0.864];末次随访时,渗漏组伤椎椎间盘高度低于无渗漏组[(5.17±1.46)mm,(6.06±1.25)mm,t=3.450,P=0.001].⑤邻近椎体骨折发生率.末次随访时,渗漏组8例出现邻近椎体骨折,其中胸段2例、胸腰段4例、腰段2例;无渗漏组25例出现邻近椎体骨折,其中胸段6例、胸腰段14例、腰段5例.2组患者邻近椎体骨折发生率比较,差异无统计学意义(χ2=0.900,P=0.343).结论:OVCF患者PVP治疗后出现骨水泥椎间盘渗漏,不影响伤椎的Cobb角及活动功能恢复、不会增加邻近椎体骨折的风险,反而可以在短期内缓解疼痛症状,但远期可能加速椎间盘退变.

目的 观察桂枝加葛根汤对颈椎病模型兔不同节段颈椎纤维环细胞凋亡的影响.方法 将24只6月龄新西兰兔随机分为空白组、模型组和桂枝加葛根汤组,每组8只.模型组和桂枝加葛根汤组新西兰兔使用颈椎固定装置制备颈椎病模型,造模2个月后,桂枝加葛根汤组予以桂枝加葛根汤浓缩液灌胃,空白组和模型组予以等体积生理盐水灌胃,干预2周后处死取材.采用苏木精-伊红(HE)染色观察纤维环组织形态学改变,实时荧光定量聚合酶链式反应(Real-time PCR)检测纤维环组织凋亡相关因子mRNA表达水平.结果 与空白组相比,模型组的纤维环细胞数量变少、界限不清,而桂枝加葛根汤组的纤维环细胞数量较模型组多,界限清楚.在相同的组别中,C5-6节段的纤维环细胞数量最少,组织形态不规整,其次是C6-7,最后是C4-5.在C5.6和C6-7两个节段颈椎中,与空白组相比,模型组纤维环细胞BaxmRNA、Caspase-3mRNA表达上升,而Bcl-2mRNA表达下降(P＜0.05);与模型组相比,桂枝加葛根汤组纤维环细胞BaxmRNA、Caspa-se-3mRNA表达下降,而Bcl-2mRNA表达上升(P＜0.05);而在C4-5节段颈椎中,BaxmRNA、Caspase-3 mRNA、Bcl-2mRNA的表达差异无显著差异(P＞0.05).结论 桂枝加葛根汤可以维持纤维环的正常形态,抑制纤维环细胞的凋亡,对C5-6节段的影响较显著,其次是C6-7,而对C4-5节段的影响不太明显.

目的:探讨微创经椎间孔腰椎椎间融合术(MIS-TLIF)治疗腰椎间盘突出症的临床疗效.方法:回顾性分析2017年1月至2019年6月采用MIS-TLIF治疗的32例腰椎间盘突出症患者,收集患者手术时间、术中出血量、术后引流量、椎间融合率及术后相关并发症,记录手术前后的椎间隙高度(DH)、腰椎前凸角(LL)、融合节段角(FSA)、疼痛视觉模拟量表评分(VAS)及Oswestry功能障碍指数(ODI).结果:32例患者随访12～15个月,平均12.9个月.手术时间为(191.34±42.34)min(123～269 min),术中出血量为(154.38±42.14)mL(97～262 mL),术后引流量为(61.03±19.21)mL(32～94 mL).术后切口浅表感染1例,经保守治疗痊愈;置钉位置不佳1例,末次随访时未出现不适.术后不同时点的VAS评分、ODI均较术前显著改善,差异均有统计学意义(P＜0.05);随术后时间推移,VAS评分及ODI持续下降,差异有统计学意义(P＜0.05).影像学方面,术后1周及术后12个月的DH、LL、FSA均较术前显著改善,差异有统计学意义(P＜0.05);术后1周上述指标和术后12个月比较,差异均无统计学意义(P＞0.05).随访期间椎间融合率为90.62％,未发现融合器移位、下沉及内固定装置松动断裂等情况.结论:MIS-T LIF治疗腰椎间盘突出症能解除神经压迫,恢复椎间隙高度和脊柱稳定性,改善患者生活质量,具有创伤小、出血少、术后恢复快等优势,疗效确切.

目的 探讨桂枝加葛根汤对颈椎病模型兔纤维环细胞凋亡和炎性因子的影响.方法 6月龄新西兰兔随机分为空白组、模型组、桂枝加葛根汤组.除空白组外,其余2组采用颈椎固定装置制备颈椎病模型,造模过程持续2个月.造模成功后,桂枝加葛根汤组予以桂枝加葛根汤灌胃,空白组和模型组用等体积生理盐水灌胃.治疗结束后,采用苏木精-伊红(HE)染色和实时荧光定量PCR技术分别观察各组颈椎间盘纤维环组织形态和纤维环细胞凋亡相关因子、炎性因子表达水平.结果 空白组纤维环细胞排列整齐,界限清楚,形态基本正常;模型组纤维环细胞数量变少,界限不清;桂枝加葛根汤组纤维环细胞数量较模型组多,界限清楚.与空白组比较,模型组纤维环细胞Bax mRNA、Caspase-3 mRNA、TNF-α mRNA和IL-1βmRNA表达升高(P＜0.05),Bcl-2 mRNA表达下降(P＜0.05);与模型组比较,桂枝加葛根汤组纤维环细胞Bax mRNA、Caspase-3 mRNA、TNF-α mRNA和IL-1β mRNA表达下降(P＜0.05),Bcl-2 mRNA表达有所升高(P＞0.05).结论 桂枝加葛根汤可以减少颈椎病模型兔纤维环细胞凋亡和炎症反应,从而起到保护椎间盘的作用.

目的 观察盘龙七片联合四维牵引治疗腰椎间盘突出症椎间孔镜术后神经根刺激症状的临床疗效.方法 将70例行椎间孔镜术的腰椎间盘突出症患者采用随机数字表法分为治疗组和对照组,各35例.2组均行椎间孔镜术摘除髓核,术后治疗组采用盘龙七片联合四维牵引治疗,对照组采用甘露醇注射液静脉滴注及甲钴胺片口服治疗.2组均治疗4周,比较2组治疗前后日本骨科协会评估治疗(JOA)评分、Oswestry功能障碍指数(ODI)评分.结果 治疗后2组JOA评分均明显升高,ODI评分均明显降低,与同组治疗前比较差异有统计学意义(P＜0.05),且治疗组对JOA、ODI评分的改善作用明显优于对照组(P＜0.05).结论 盘龙七片联合四维牵引可明显改善腰椎间盘突出症椎间孔镜术后神经根刺激症状,有利于神经功能的恢复,值得临床推广应用.

当今社会人口的高度老龄化表明骨质疏松症(OP)正成为一个日益严峻的问题,骨质疏松性椎体压缩性骨折作为骨质疏松症的主要并发症,其发病率和死亡率逐年上升.进一步提高治疗水平和患者的远期生活质量是目前临床骨质疏松性椎体压缩性骨折(OVCF)治疗的焦点,针对这样的现状,本研究从OVCF的中西医治疗进展方面进行综述.

目的 评价后路减压钛笼植骨联合长节段内固定治疗Kümmell病伴后凸畸形的临床效果.方法 回顾性分析湖北省中医院骨科2016年3月至2018年6月采用后路减压联合钛笼植骨长节段内固定手术治疗的12例胸腰椎Kümmell病伴后凸畸形病人的临床资料,收集病人手术时间、术中失血量、输血量、术后相关并发症以及手术前后的后凸Cobb角、疼痛视觉模拟量表(VAS)评分、Oswestry功能障碍指数(ODI).结果 12例病人随访12～14个月,平均12.8个月.手术时间为(240±22)min,术中失血量为(831±121)ml,输血量为(717±80)ml.术后伤口感染1例,钛笼下沉1例,下肢深静脉血栓形成1例,均经保守治疗痊愈.术后2周及末次随访时的Cobb角、VAS评分、ODI均较术前明显改善,差异均有统计学意义(P均<0.05);但术后2周和末次随访时Cobb角、VAS评分、ODI比较,差异均无统计学意义(P均>0.05).未发现内固定松动断裂等并发症.结论 后路减压钛笼植骨联合长节段内固定能有效纠正和恢复Kümmell病伴后凸畸形病人的脊柱平衡和稳定性,明显提高病人生活质量,效果确切.

目的 探讨淫羊藿苷对类风湿关节炎小鼠的干预作用及NL-RP3炎性小体信号通路的影响.方法 将50只雄性DBA/1小鼠随机分为对照组、模型组、淫羊藿苷10 mg/kg组、淫羊藿苷20 mg/kg组、淫羊藿苷40 mg/kg组,每组10只.模型组和淫羊藿苷各组尾巴根部皮下注射含Ⅱ型胶原的完全弗氏佐剂诱导类风湿关节炎模型,在第21天二次免疫造模后,淫羊藿苷各组开始给予相应剂量淫羊藿苷灌胃,对照组和模型组灌胃等体积的生理盐水,均每天1次,连续3周.观察各组小鼠关节炎评分和关节肿胀度;眼球取血,采用ELISA法检测各组小鼠血清白细胞介素-1β(IL-1β)和白细胞介素-18(IL-18)水平;分离关节滑膜组织,采用HE和番红O染色观察各组小鼠关节滑膜的病理变化;采用RT-PCR检测各组小鼠滑膜组织中IL-1β和IL-18 mRNA表达水平;采用Western blot法检测各组小鼠滑膜组织中NLRP3炎性小体信号通路分子(IL-1β、Caspase-1及NLRP3)表达水平.结果 首次免疫21 d后,模型组及淫羊藿苷各组小鼠的关节炎评分开始增加,模型组小鼠的关节炎评分持续增加至实验结束;从第27天开始,淫羊藿苷各组小鼠的关节炎评分与模型组比较呈剂量依赖性降低(P均<0.05).淫羊藿苷各组关节肿胀度均明显低于模型组(P均<0.05),且呈剂量依赖性降低.模型组小鼠血清中IL-1β、IL-18水平和滑膜组织中IL-1βmRNA、IL-18 mRNA、IL-1β、Caspase-1、NLRP3表达水平均显著高于对照组(P均<0.05);淫羊藿苷各组小鼠血清中IL-1β、IL-18水平和滑膜组织中IL-1βmRNA、IL-18 mRNA、IL-1β、Caspase-1、NLRP3表达水平均显著低于模型组(P均<0.05),且呈剂量依赖性降低.病理结果显示模型组小鼠滑膜组织中出现严重的炎性细胞浸润、基质破坏及钙含量显著减少,淫羊藿苷各组炎性症状及基质破坏减轻,钙含量显著增加.结论 淫羊藿苷可通过抑制NLRP3炎性小体介导的炎症反应来缓解类风湿关节炎,对类风湿关节炎的治疗具有潜在价值.

目的探讨跗骨窦切口联合外固定架固定治疗SandersⅡ、Ⅲ型跟骨骨折的临床疗效。方法回顾性分析2016年1月至2018年1月湖北省中医院骨伤科收治的50例跟骨骨折病人的临床资料。将采用跗骨窦切口联合外固定架治疗的27例纳入观察组,其中男15例,女12例,年龄为（32.6±6.7）岁;SandersⅡ型13例,SandersⅢ型14例。将采用"L"形切口锁定钢板内固定治疗的23例纳入对照组,其中男12例,女11例,年龄为（32.2±7.2）岁;SandersⅡ型13例,SandersⅢ型10例。比较两组病人的手术时间、切口长度和伤口并发症等情况,术前、末次随访的跟骨B?hler角和Gissane角,以及末次随访时患足美国足踝外科医师协会（American Orthopedic Foot and Ankle Society, AOFAS）踝-后足评分。结果 50例病人获得8～20个月的随访,平均随访12.4个月。观察组的手术时间和切口长度分别为（66.7±6.5）min和（5.1±0.3）cm,优于对照组的（90.0±4.0）min和（12.5±0.3）cm,差异均有统计学意义（P均＜0.05）。观察组末次随访B?hler角明显优于对照组,差异有统计学意义（t=4.008,P＜0.001）;两组末次随访Gissane角差异无统计学意义（P＞0.05）。观察组末次随访的AOFAS踝-后足评分为（85.5±1.8）分,优于对照组的（82.8±1.8）分,差异有统计学意义（t=5.333,P＜0.001）。对照组发生伤口并发症4例,观察组未发生伤口并发症。结论跗骨窦切口联合外固定架治疗跟骨骨折创伤较小、手术时间较短、伤口感染并发症少,在术后功能恢复方面有一定的优势,并且避免了取出存留的钢板对病人的二次创伤。

Objective To observe the clinical effect of Xuelian injection combined with arthroscopic surgery in treatment of knee osteoarthritis (KOA) in the elderly.Methods 108 cases of elderly patients with KOA received Xuelian injection or sodium hyaluronate injection combined with arthroscopic treatment were retrospectively analyzed.According to the different injections,the patients were divided into treatment group and control group.Treatment group received intraoperative injection of Xuelian injection 2mL,control group received intraperitoneal injection of sodium hyaluronate injection 2mL at the 1st,2nd,3rd,4th,5th weeks after arthroscopy.Both groups received orthopaedic outpatient care at the 5th weeks,the 3rd,6th 12th months after discharge,and followed up and scored according to Lysholm knee score system.Results 108 patients were followed up for 12 to 24 months,an average of 18.2 months,no surgical incision infection cases.According to the Lysholm score,the score was (89.8±6.9) at the 6th month and (88.3±7.6) at the 12th month in treatment group.Control group had a score of (84.6±4.7) at the 6th month and (83.2±4.8) at the 12th month;the excellent and good rate of treatment group was 75.5％ at the 6th month and 71.7％ at the 12th month after operation;the excellent rate of control group was 67.3％ at the 6th month and 61.8％ at the 12th month after operation,the differences were significant (P＜0.05).Conclusion Xuelian injection combined with arthroscopic can achieve good clinical efficacy in elderly patients with KOA,it is a reliable treatment option.

髌骨骨软骨骨折是髌骨骨折的一种特殊类型,指髌骨关节面骨软骨剥脱性骨折,临床少见.由于骨折块不带或仅带少量骨质,X光片有时难以显示,极易漏诊而延误治疗,导致预后不佳.2005年2月～2007年12月,我院采用关节镜检及镜下手术或切开复位内固定手术治疗髌骨骨软骨骨折28例,取得了良好疗效,现报道如下.

深静脉血栓(deep venous thrombosis,DVT)是骨科手术十分常见的并发症,尤其多见于下肢手术或创伤.本文选取下肢骨科术后出现深静脉栓塞的中老年患者,分别使用中医辨证论治配合西医的溶栓治疗和单纯的溶栓治疗,旨在讨论中西医结合治疗下肢骨科手术后深静脉血栓的疗效及运用前景.