目的:探讨零切迹颈椎前路椎间融合术(Anterior Cervical Discectomy and Fusion,ACDF)治疗双节段颈椎病术后矢状位参数的变化.方法:回顾性分析2017年5月至2021年5月行双节段椎间融合且使用ROI-C融合器的患者,建立Excel数据库,观察胸1倾斜角(T1S)、C2～7 Cobb角、C2～7矢状面轴向距离(C2～7 SVA)及手术节段角(SA)术前及末次随访时的变化.采用t 检验或非参数检验分析术前及末次随访时各数据是否存在差异;Pearson相关或秩相关(Spearman法)分析各数值之间的相关性.结果:共纳入35例患者,男12例,女23例;年龄为46～69岁,平均为(57.94±6.05)岁;随访时间为6～38个月,平均为(9.23±7.97)个月.手术节段C3～4、C4～5 1例,C4～5、C5～6 20例,C5～6、C6～7 14例.末次随访时T1S、C2～7 Cobb角及手术节段角较术前增加,差异有统计学意义(P＜0.05).相关性:T1S与C2～7 Cobb角、T1S与C2～7矢状面轴向距离、T1S与手术节段角及C2～7 Cobb角与手术节段角之间存在正相关性(P＜0.05).结论:对于双节段颈椎病患者,使用ROI-C融合器行颈椎前路椎间融合术能够改善颈椎矢状位参数,恢复颈椎矢状位平衡,对于颈椎病的治疗有积极作用.

目的:探讨皮质骨轨迹(CBT)椎弓根螺钉治疗腰椎后路融合术后邻椎病(ASD)的疗效和优势.方法:回顾性分析2017年9月至2021年7月应用皮质骨轨迹椎弓根螺钉治疗邻椎病23例患者临床资料.其中男7例,女16例;年龄为58～81岁;与初次手术间隔时间为1.7～10.0年.统计患者体重指数(BMI)、手术节段、手术时间、术中出血量、手术并发症等.通过影像学检查判断是否发生内固定松动、假关节形成和再次邻近节段退变.比较术前及末次随访时腰痛和腿痛视觉模拟量表(VAS)评分和Oswestry功能障碍指数(ODI)评分,评估患者手术前后疼痛缓解和功能改善情况.结果:所有患者均顺利完成手术,手术时间为(210±38)min;术中出血量平均为309 mL(300～400 mL).2例术后并发急性膀胱炎,给予抗感染后治愈.未出现螺钉松动及假关节形成等内固定相关并发症,未再次出现症状性邻近节段退变.术前患者腰痛VAS评分为(4.8±1.1)分,腿痛评分为(6.1±1.6)分,ODI评分为50.6％±8.3％.末次随访患者腰痛VAS评分为(1.7±0.5)分,腿痛评分为(1.3±0.4)分,ODI评分为13.5％±5.1％.所有患者随访时间平均为37个月(17～52个月),末次随访患者各指标评分均较术前明显改善,差异有统计学意义(P＜0.01),总体临床效果满意.结论:皮质骨轨迹椎弓根螺钉应用于腰椎术后邻椎病,有损伤小、抗拔出力强的优势,可作为腰椎邻椎病手术方案.

腰椎退行性疾病多见于中老年人,临床常表现为腰痛及下肢放射痛等,与肝肾亏虚、风寒湿邪侵袭等有关,常采用补益肝肾等方法治疗,但效果欠佳.脾虚贯穿腰椎退行性疾病的始终,是该病的关键病机.本文从理论基础和临床应用2个方面,对基于"脾为后天之本"理论从脾论治腰椎退行性疾病进行了理论探讨.

NOD-like receptor protein 1 (NLRP1) inflammasome plays an important role in the innate immune response of human body. It can promote the activation of cysteinyl aspartate specific proteinases(Caspases), further activate interleukin-18 and interleukin-1 β, and mediate pyroptosis. NlRP1 inflammasome plays a role in traumatic central nervous system injury. In this study, the structure of NLRP1 inflammasome, the activation of NLRP1 inflammasome in traumatic central nervous system injury and the treatment with NLRP1 inflammasome as a target are reviewed.

目的:探究补阳还五汤对急性脊髓损伤(SCI)大鼠NOD样受体蛋白1(NLRP1)/半胱氨酸蛋白水解酶-1(Caspase-1)细胞焦亡通路的影响.方法:将32只SPF级大鼠随机分成假手术组、甲强龙组、补阳还五汤(BYHWT)组和模型组,造模成功后补阳还五汤组每天给予补阳还五汤灌胃1次,连续14 d,甲强龙组给予甲强龙冲击治疗;假手术组及模型组注射等补阳还五汤剂量的生理盐水;干预后的第1,3,7及14天以BBB评分评价大鼠神经功能恢复情况,Western Blot法检测损伤脊髓中组织NL-RP1,Caspase-1及IL-18蛋白的表达.结果:BBB评分:假手术组大鼠评分无变化,BYHWT组及甲强龙组治疗后3d,7d及14d评分大于模型组,差异有统计学意义(P＜0.05),治疗后7d及14 d,各组大鼠评分变化不明显.干预后第14天大鼠损伤脊髓组织中NLRP1,Caspase-1及IL-18蛋白的表达结果:BYHWT组和甲强龙组蛋白表达均低于假手术组,高于模型组,差异有统计学意义(P＜0.05).结论:补阳还五汤联合脊髓减压治疗急性SCI效果明显,作用机制可能是通过抑制NLRP1/Caspase-1通路以减少细胞焦亡.

BACKGROUND: Although C1-C2 pedicle screw techniques have been extensively reported in pediatric series, reports on their use have examined only small series with short follow-up periods. The aim of this study was to report pediatric patients with atlantoaxial rotatory dislocation treated with these techniques with a minimum 5-year follow-up. METHODS: Retrospective review was performed of 27 pediatric patients with atlantoaxial rotatory dislocation who underwent C1-C2 pedicle screw fixation between 2004 and 2012. Clinical and radiographic outcomes were collected and compared with a control group. RESULTS: Follow-up period was 60-142 months (mean 84 months). Torticollis was completely corrected postoperatively in all but 1 patient. All patients experienced significant pain relief and improvement in range of motion, and 6 patients with neurologic deficits experienced significant improvement postoperatively. Both atlantodental interval and space available for the cord were significantly improved compared with preoperative values. At final follow-up, curvature was lordotic in 20 cases and straight in 7 cases. Compared with the control group, range of motion of the patient group was not significantly different in any direction except in flexion and rotation. Mean anteroposterior diameters of the spinal canal at C1 and C2 levels were not significantly different from the control group. CONCLUSIONS: C1-C2 pedicle screw techniques are safe and effective for treatment of atlantoaxial rotatory dislocation and result in no obvious limitation on growth in older children.