目的 回顾性分析后外侧入路内镜下腰椎融合术(posterolateral endoscopic lumbar interbody fusion,PELIF)治疗腰椎滑脱症的疗效和手术安全性.方法 回顾性分析本科自2019 年 1 月～2020 年 3 月开展PELIF手术治疗的 31 例腰椎滑脱症患者,滑脱节段:L3-43 例,L4-521 例,L5-S17 例;滑脱程度:Ⅰ度25 例,Ⅱ度6 例.统计患者围术期指标,以及手术疗效和影像学指标的改善情况.结果 31 例术后获访15～27 个月,平均(21.3±4.2)个月.手术时间137～210 min,平均(169.5±19.4)min;术后住院时间3～7d,平均(3.9±1.2)d.术后有2 例发生神经根刺激症状,对症处理6d后好转.与术前相比,所有患者术后2周、6 个月和末次随访时的腰痛VAS评分、下肢痛VAS评分以及ODI指数均显著降低(P<0.05).与术前相比,所有患者术后2周、末次随访时的椎间隙高度和局部前凸角均显著增加(P<0.05),而腰椎滑脱率则显著降低(P<0.05),腰椎前凸角的变化并不显著(P>0.05).截止末次随访时,椎间植骨融合率100%;随访观察期间,未见钉棒断裂、螺钉松动、脱出等并发症.结论 PELIF手术治疗腰椎滑脱症的总体疗效满意,手术创伤小,安全有效,可显著减轻腰痛和下肢根性痛,改善功能障碍情况,术后融合率高.

Objective To investigate the effect of high tibia osteotomy（HTO） on knee osteoarthritis and medial knee function. Methods A total of 126 patients with osteoarthritis of the medial compartment of knee joint who were surgically treated in Zhengzhou University Hospital were selected as the research subjects. Among them, 61 patients were treated with HTO technology（HTO group） and 65 patients were treated with unicompartmental knee arthroplasty（control group）. The surgical trauma and postoperative rehabilitation indicators, knee function, knee imaging features, and surgical complications in the two groups were statistically analyzed. Results The operation time, intraoperative blood loss, and incision length of the HTO group were lower than those of the control group, and the difference was statistically significant（P＜0.05）. Compared with that before operation in this group, there were significantly higher（P＜0.05）. Six months after operation, the posterior inclination angle of tibial plateau and lateral patellar angle in HTO group and control group were significantly higher than those before operation（P＜0.05）. The femoral-tibial angle, patellar fit angle and patellar inclination angle of the patients in the group were significantly lower than those before operation（P＜0.05）. Conclusion The effect of HTO in the treatment of osteoarthritis of the medial compartment of knee joint is not much different from that of single knee replacement surgery. On the basis of ensuring the surgical effect, it has the advantages of short operation time, less bleeding and less trauma.

目的 观察强直性脊柱炎(AS)伴胸腰段骨折患者应用后路长节段经皮置钉内固定术治疗的临床效果观察.方法 回顾性分析2017年6月至2018年12月于郑州大学医院接受后路长节段常规切开内固定治疗(对照组,n=65例)及接受后路长节段经皮置钉内固定术治疗(研究组,n=54例)的AS伴胸腰段骨折患者的临床资料.比较两组患者术中及术后相关指标,术前、术后1周、术后6个月疼痛程度(VAS评分),术前、术6个月、术后12个月椎体前缘高度、伤椎Cobb角,术前、术后12个月腰背功能恢复情况(ODI指数),并记录术后6个月内并发症出现情况.结果 术后6个月,两组优良率分别为92.59％、90.77％,差异无统计学意义(P＞0.05).研究组患者术中出血量,手术及住院时间均低于对照组(P＜0.05).术前、术后1周、术后6个月,两组组内VAS评分比较,差异有统计学意义(P＜0.05),且研究组术后各时间点VAS评分低于对照组(P＜0.05).术前、术后6个月、术后12个月,两组组内各时间点椎体前缘高度、后凸Cobb角比较,差异有统计学意义(P＜0.05);但两组组间术后各时间点上述指标比较,差异无统计学意义(P＞0.05).术前、术后6个月、术后12个月,两组组内各时间点ODI指数比较,差异有统计学意义(P＜0.05),且研究组术后各时间点ODI指数低于对照组(P＜0.05).术后6个月内,研究组并发症发生率低于对照组(P＜0.05).结论 对于强直性脊柱炎伴胸腰段骨折患者,应用后路长节段经皮置钉内固定术治疗效果显著,不仅可缩短手术及住院时间,降低术中出血量,也能有效地降低术后疼痛,促进腰背功能恢复,降低术后并发症,具有较好的应用价值.

Objective:To investigate the ligament regeneration in the knee cavity and the osteointegration at the tendon-bone interface after anterior cruciate ligament (ACL) reconstruction using silk-collagen scaffold in a rabbit model.Methods:The silk-collagen scaffold was fabricated using degummed knitted silk scaffold and collagen Ⅰ matrix. The silk-collagen scaffold was rolled up to make a graft for replacing native ACL in the rabbit model. All specimens were harvested at 4 and 16 weeks postoperatively to evaluated ligament regeneration by hematoxylin and eosin (HE) and immunohistochemistry staining, and tendon-bone healing by HE and Russell-Movat staining. Micro-CT, biomechanical tests were also used to assess the tendon-bone healing process.Results:At 16 weeks postoperatively, HE and immunohistochemistry staining revealed that more aligned cell arrangement and more extracellular matrix (ECM) deposition in the silk-collagen scaffold in the knee cavity than those of 4 weeks postoperatively. At week 16, more bone formation which grew into the silk-collagen scaffold was observed, while new trabecular bone could be observed at 4 weeks after surgery. BV/TV=(39.25±1.51)%, bone mineral density (BMD)=(400.88±58.32) mg/cm 3, at 16 weeks postoperatively were significantly higher than those at 4 weeks [BV/TV=(19.36±2.29)% ( t=16.010, P<0.05), BMD=(245.04±17.68) mg/cm 3, t=5.718, P<0.05] after surgery. Higher signals indicating more bone mineral formation were detected in the specimens of 16 weeks than those of 4 weeks postoperatively, which were consistent with the results of biomechanical test [failure load, (25.87±4.57) N vs. (43.67±6.52) N, t=4.994, P<0.05; stiffness, (4.85±0.84) N/mm vs. (9.18±0.76) N/mm, t=8.556, P<0.05]. Conclusion:Silk-collagen scaffold induced ligament regeneration in the knee cavity and osteointegration at the tendon-bone interface after ACL reconstruction.