椎间盘退变(intervertebral disc disease,IVDD)具有高发病率、高致残率等特点,在全球范围内流行,是当前严重危害人类生命健康的重大疾病之一.传统治疗包括卧床休息、物理治疗、抗炎止痛药物和手术,但都仅能起到缓解患者临床症状的作用,尚不能延缓或逆转IVDD的发展进程.富血小板血浆(platelet-rich plasma,PRP)是多种生长因子的天然载体,近年来的研究提示,它具有抑制炎症反应,抑制细胞凋亡、促进细胞增殖,增加细胞外基质等三方面的作用,可作为IVDD的有效治疗方法.该文主要阐述PRP作为一种再生疗法在IVDD中的治疗机制,并讨论其临床应用的研究进展.

椎间盘真空征由Magnusson[1]于1937年首次描述,是指随着椎间盘的退行性变,椎间盘脱水和裂隙扩大导致气体积聚.正常成年人群中1％～3％可通过影像学检查观察到椎间盘真空征[2],50岁以上腰腿痛患者检出率为20％[3].椎间盘真空征可改变椎间盘的应力负荷,导致轴向不稳,加速退行性变,引起椎间盘源性腰痛[4];部分合并有明显椎间盘突出的患者或气体积聚在硬膜外尤其是位于侧隐窝区、椎间孔区及椎间孔外口时,可压迫神经根,出现坐骨神经痛或严重的腰腿痛[5-6].

目的:探讨Pfirrmann分级与腰椎间盘突出症患者血清NF-κB蛋白水平及相关炎性因子含量的相关性.方法:根据Pfirrmann分级,选取腰椎间盘突出症患者60例(观察组)及健康自愿者15例(正常对照组).正常对照组为Ⅰ级组,观察组(Ⅱ～Ⅴ组)分为4组各15例.LISA法检测患者血清NF-κB蛋白及炎性因子IL-6、MMP-3含量.结果:Pfirrmann Ⅴ级组患者腰腿痛VAS评分及ODI指数明显高于Ⅱ～Ⅳ级组(P＜0.001);Pfirrmann Ⅰ级组患者血清NF-κB蛋白及炎性因子IL-6、MMP-3含量明显低于Pfirrmann Ⅱ～Ⅴ级组(P＜0.001);Pfirrmann Ⅴ级组患者血清NF-κ B蛋白及炎性因子IL-6、MMP-3含量明显高于Ⅱ～Ⅳ级组患者(P＜0.05).Pfirrmann分级与患者血清NF-κB蛋白及炎性因子IL-6、MMP-3含量呈显著正相关(P＜0.01).结论:NF-κB蛋白及炎性因子IL-6、MMP-3与椎间盘的退行性改变有关,其含量越高椎间盘退变越严重.

目的:评价口服独活寄生汤治疗经皮内窥镜下腰椎间盘切除术(percutaneous endoscopic lumbar discectomy,PELD)后残余症状的临床疗效.方法:应用计算机检索中国知网、维普网、万方数据库、中国生物医学文献服务系统、PubMed、Embase、Cochrane Library和Web of Science中关于口服独活寄生汤治疗PELD术后残余症状的随机对照试验文献,检索时限为建库至2021年7月1日.试验组采用口服独活寄生汤治疗,也可联合口服抗生素、口服甲钴胺或常规康复治疗;对照组采用口服抗生素、口服甲钴胺或常规康复治疗.由2名研究者独立检索、筛选文献,提取资料,并采用Cochrane偏倚风险评估工具对纳入文献的质量及偏倚风险进行评估.采用RevMan5.3软件进行Meta分析.结果:共检索出49篇相关文献,通过逐层筛选,最终纳入8篇文献,均为中文文献,共涉及700例患者,其中试验组351例、对照组349例.Meta分析结果显示,试验组患者腰腿部疼痛视觉模拟量表评分、腰椎Oswestry功能障碍指数评分均低于对照组[MD=-0.77,95％CI(-0.94,-0.59),P=0.000;MD=-7.98,95％CI(-9.10,-6.86),P=0.000],试验组患者日本骨科协会腰痛疾患疗效评分、尼龙绳试验评分均高于对照组[MD=3.51,95％CI(2.74,4.28),P=0.000;MD=1.96,95％CI(1.64,2.28),P=0.000].结论:现有的证据表明,口服独活寄生汤可以缓解PELD术后的腰腿部疼痛及下肢麻木、无力等症状,改善腰椎功能.

腰椎Modic改变是评估腰椎间盘退变程度的常用影像学指标,但其发生机制目前尚未完全清楚.腰椎间盘突出症是临床常见病、多发病,有关腰椎Modic改变对腰椎间盘突出症手术疗效影响的研究近年来逐渐增多.本文对腰椎Modic改变的分型及其分布特征进行了概述,并对腰椎Modic改变的发生机制、腰椎Modic改变与腰椎间盘突出症的关系、腰椎Modic改变对腰椎间盘突出症手术疗效的影响进行了总结.

目的:采用Meta分析方法评价身痛逐瘀汤治疗经皮内窥镜下腰椎间盘切除术(percutaneous endoscopic lumbar discectomy,PELD)后患者残余症状的有效性与安全性.方法:计算机检索2021年9月1日前发表在中国知网、万方数据知识服务平台、维普数据库、中国生物医学文献服务系统、PubMed、Embase、Cochrane Library、Web of Science数据库中所有关于身痛逐瘀汤治疗PELD术后患者残余症状的临床随机对照研究.Meta分析采用Review Manager 5.3软件,并依据Cochrane系统评价纳入文献的质量.结果:共纳入8篇文献,涉及588例患者,其中观察组(身痛逐瘀汤组)292例,对照组(常规药物组)296例.观察组患者视觉模拟疼痛评分(visual analogue scale,VAS)(MD=-0.65,95％CI[-0.77,-0.53],P<0.0000)、Oswestry功能障碍指数(oswestry disability index,ODI)(MD=-3.61,95％CI[-4.07,-3.16],P<0.00001)、日本骨科协会评估治疗分数(Japanese orthopaedic association,JOA)(MD=2.25,95％CI[1.28,3.22],P<0.00001)均优于对照组,差异有统计学意义(P<0.05).结论:身痛逐瘀汤在治疗PELD术后患者残余症状方面具有明显优势,可以缓解患者术后残余腰腿部疼痛、麻木及无力等症状,提高患者生活质量,且具有较高的安全性.但本研究结论仍需大样本、高质量文献验证其真实性与可靠性.

腰椎间盘突出症(lumbar disc herniation,LDH)是骨伤科的常见病、多发病,属中医学"腰痛""痹病""腰腿痛""经筋病"等范畴.历代医家对于该病的病因、病机多有论述.MRI在LDH的诊断方面具有较高的应用价值,基于MRI的Pfirrmann分级体系能直观、全面地反映腰椎间盘的退变程度.探讨LDH中医证候与Pfirrmann分级的关系,对于LDH的临床诊断和治疗都有积极作用.本文对LDH的中医证候和Pfirrmann分级进行了概述,并按照《中医病证诊断疗效标准》中LDH的辨证分型标准,分别探讨了LDH血瘀证、寒湿证、湿热证、肝肾亏虚证与Pfirrmann分级的关系,以期为LDH的诊断和治疗提供新的思路.

目的:探讨陇中损伤胶囊对老年性骨质疏松性椎体压缩骨折患者Wnt/β-catenin信号通路相关蛋白的调控及临床意义.方法:选取老年性骨质疏松性椎体压缩骨折患者60例,随机分为观察组和对照组,每组30例.对照组于行经皮椎体后凸成形术(percutaneous kyphoplasty,PKP)后以碳酸钙D3颗粒+阿法骨化醇口服治疗,观察组在对照组治疗的基础上加服损伤胶囊,两组共治疗12周.观察两组治疗前后疼痛视觉模拟评分(visual analogue score,VAS)、骨密度及血清β-链蛋白(β-catenin protein,β-catenin)及β-Ⅰ型胶原羧基端肽(β-carboxyterminal propeptide of type I procollagen,β-CTX)、总Ⅰ型胶原氨基端延长肽(total type 1 collagen n-terminal elongation peptide,T-PINP)水平变化情况.结果:两组治疗第3天及第12周时VAS评分较治疗前明显降低(P<0.05),治疗12周时观察组较对照组更低(P<0.05);治疗第12周时骨密度值两组较治疗前明显增加(P<0.05),且观察组增高程度大于对照组(P<0.05).治疗第12周时血清β-catenin水平两组均增高,但观察组增高更明显(P<0.05);治疗第12周时β-CTX表达量两组均降低(P<0.05),观察组降低程度大于对照组,但差异无统计学意义(P>0.05);治疗第12周时T-PINP表达量两组均下降,但治疗前后组内比较及治疗后组间比较,差异均无统计学意义(P>0.05).结论:损伤胶囊能够有效缓解患者腰背部疼痛症状,改善患者骨质疏松情况,可能与提高血清β-catenin的水平、降低血清β-CTX水平有关.

OBJECTIVE:To evaluate clinical effect of unilateral approach and bilateral decompression via large channel endoscopic system for the treatment of lumbar spinal stenosis. METHODS:The clinical data of 32 patients with lumbar spinal tenosis treated by unilateral approach and bilateral decompression via large channel endoscopy from February 2018 to February 2019 were retrospectively analyzed. There were 18 males and 14 females, aged 65 to 84 years old with an average of (70.6± 8.4) years. The course of disease was from 1 to 12 years. All 32 cases were accompanied by numbness or pain in the lower limbs, of which 28 cases were accompanied by intermittent claudication. Narrow segments were L3, 4 of 2 cases, L4, 5 of 19 cases, L5S1 of 13 cases, including double segments of 2 cases. Preoperative imaging showed 3 cases of central canal stenosis, 21 cases of bilateral lateral recess stenosis and 8 cases of mixed stenosis. Operation time and complications were recorded. X-ray, CT and MRI were analyzed at 3 days, 3 months and 1 year after operation. Visual analogue scale(VAS), Oswestry Disability Index (ODI), single continuous walking distance(SCWD) were observed before and after operation. Modified Macnab standard were used to evaluate the clinical effect at 1 year after operation. RESULTS:All the patients were followed up for 12-24 (17.68±2.43) months and all operations were successfully completed with the operation time of 70-160(85.64±11.94) min. Spinal dural tear occurred in 1 case during the operation, and sensory disturbance in the other side of lower limb in a short period of time occurred in 2 cases, all improved after corresponding treatment. Postoperative imaging showed that the spinal canal was significantly enlarged and the nerve root was fully released. Before operation and 3 days, 3 months, 1 year after operation, VAS scores of low back pain were 4.62 ±1.41, 2.73 ±1.35, 1.21 ±1.17, 1.11 ±0.34, respectively;VAS scores of leg pain were 6.83 ± 1.71, 3.10±1.50, 1.08±0.19, 0.89±0.24, respectively. VAS scores of low back pain and leg pain each time point after operation were obvious improved (P<0.05); there was significant difference between 3 months and 3 days after operation(P<0.05), and there was no significant difference between 3 months and 1 year after operation (P>0.05). Before operation and 3 days, 3 months, 1 year after operation, ODI scores were 38.40 ±6.48, 18.42 ±2.40, 5.48 ±0.77, 3.05 ±0.28, respectively; SCWD was (47.48±5.32) m, (52.89±11.23) m, (245.43±18.94) m, (468.97±55.87) m, respectively. The differences in ODI score and SCWD postoperative time points were statistically significant compared with those before operation (P<0.05). The difference between 3 months and 3 days after operation was statistically significant (P<0.05). The difference between 1 year and 3 months after operation was statistically significant (P<0.05). According to Macnab standard to evaluate clinical effect at 1 year after operation, 15 cases got excellent results, 14 good, 3 fair. CONCLUSION:It is a safe and effective way to treat lumbar spinal stenosis with unilateral approach and bilateral decompression via large channel endoscopic system. It has the advantages of sufficient decompression, less trauma, fast recovery, high safety and low incidence of postoperative complications. It can minimize the damage to the stable structure of the lumbar spine and is an ideal minimally invasive operation for the treatment of lumbar spinal stenosis.

目的 观察经皮脊柱内镜技术治疗腰椎椎体后缘骨骺离断症的临床疗效.方法 2014年8月至2017年8月,我科运用经皮脊柱内镜治疗并随访32例腰椎椎体后缘骨骺离断的患者,其中男15例,女17例;年龄17～44岁,平均30.5岁.病变节段L2～31例、L3～42例、L4～516例、L5～S113例.在经脊柱内镜治疗时L2～3、L3～4和L4～5节段采用经椎间孔入路,L5～S1节段运用经椎板间入路进行手术.术后采用疼痛视觉模拟评分(visual analogue scale,VAS)、Oswestry功能障碍指数(oswestry disability index,ODI)、改良MacNab对其进行临床疗效评价.结果 本组32例均获得随访,随访时间6～36个月,平均15.5个月,平均手术时间(74.6±7.4)min.术后所有患者腰部疼痛,腿部疼痛、麻木,下肢感觉异常、肌力减退较术前均有不同程度的缓解.术后所有患者未发现严重手术并发症.1例术后3个月出现责任间隙腰椎间盘突出,采用经皮脊柱内镜手术翻修.VAS评分术前(6.33±1.63)分,术后3个月(3.67±1.34)分,术后6个月(1.45±0.82)分,术后12个月(0.93±0.31)分;术后不同时间段与术前VAS评分比较,差异均有统计学意义(P<0.05).ODI评分术前(48.84±11.33)分,术后3个月(31.27±12.08)分,术后6个月(19.86±6.37)分,术后12个月(10.37±5.1)分.术后不同时间段与术前ODI评分比较,差异均有统计学意义(P<0.05).末次随访时运用MacNab评价临床疗效,优23例、良8例、可1例,优良率96.9％.结论 经皮脊柱内镜技术治疗腰椎椎体后缘骨骺离断症具有损伤小、出血少、安全性高、保留运动节段、术后并发症少、疗效确切等优点,其近期临床疗效满意.

目的:探讨中药洗剂对兔膝骨性关节炎(OA)模型组织形态学及关节液中基质金属蛋白酶-3(MMP-3)的影响.方法:将新西兰大白兔40只,雌雄不限,体质量(2.50±0.10) kg,随机分为4组:A组(正常对照组)、B组(模型对照组)、C组(中药洗剂组)、D组(扶他林软膏组),每组10只.适应性喂养7天后,B、C、D组兔膝关节腔内注入木瓜蛋白酶造成OA及滑膜炎病变模型.术中注意不刺激关节软骨及滑膜;A、B组造模成功后每天用热水袋热敷膝关节,早晚各1次,C组造模成功后用中药洗剂热敷膝关节,早晚各1次,D组造模成功后用扶他林软膏涂抹后每天用热水袋热敷膝关节,早晚各1次,以上各组均外敷右膝关节表面,每次均为40分钟,治疗8周后,测关节液中MMP-3的含量.结果:1)中药洗剂、扶他林软膏都能明显改善兔膝关节功能活动;2)模型对照组血清MMP-3含量高于正常对照组(P＜0.05),中药洗剂可降低关节液MMP-3水平;中药洗剂组、扶他林软膏组与模型对照组比较差异有统计学意义(P＜0.05),但中药洗剂组与扶他林软膏组比较差异无统计学意义(P＞0.05).结论:1)中药洗剂外敷与扶他林软膏外擦对兔膝骨性关节炎均有治疗作用;2)中药洗剂可降低关节滑液中MMP-3含量,对骨性关节炎具有治疗作用.

目的：探讨前后路联合手术固定治疗下颈椎骨折脱位的临床效果。方法：随机选取2013年6月～2014年12月我院收取的38例下颈椎骨折脱位患者作为研究对象，随机分为对照组19例，观察组19例，对照组采用前路减压及前路植骨内固定法进行治疗，观察组先接受后路手术复位再行前路减压和植骨内固定手术。观察两组的临床效果。结果：观察组的平均手术时间、术中出血量虽高于对照组，但平均固定节段数明显高于对照组且观察组治疗后的 JOA 评分颈椎骨折脱位改善率明显高于对照组，差异具有统计学意义（P ＜0．05）。结论：采用前后路联合手术固定治疗下颈椎骨折脱位能促进下颈椎骨折脱位复位，提高临床疗效，值得临床推广应用。

目的:观察中西医结合治疗骨质疏松性椎体压缩骨折的临床疗效.方法:选取93例骨质疏松性椎体压缩骨折患者作为研究对象,随机分为2组.对照组行经皮穿刺椎体成形术,观察组在对照组治疗基础上结合中医治疗.对比2组的临床疗效、术后不同时间点的疼痛程度.结果:观察组治疗总有效率为97.9％,高于对照组的84.8％,差异有统计学意义(P＜0.05).观察组术后1周内不同时间点疼痛视觉模拟评分法(VAS)评分均低于对照组,差异均有统计学意义(P＜0.05).结论:中西医结合治疗骨质疏松性椎体压缩骨折可活血通络、补肾壮骨,减轻疼痛症状.

目的:探讨当归注射液对椎板切除术后硬膜外粘连及瘢痕形成兔动物模型的预防作用和干预机制,为临床预防和治疗腰椎手术失败综合症(FBSS)提供理论依据.方法:选取成年健康新西兰大白兔45只分为3组,每组15只,分别为模型组(生理盐水组)、对照组(玻璃酸钠组)、实验组(当归注射液组).于术后2周、4周、6周分3批处死白兔,从组织学观察硬膜外粘连和测定瘢痕中血小板衍化因子(PDGF)含量.结果:第2周,3组比较,各组间比较差异无统计学意义(P＞0.05).第4周,模型组与对照组比较,P＜0.05,模型组与实验组比较,P＜0.05,差异均有统计学意义.而对照组与实验组比较差异无统计学意义(P＞0.05).第6周,模型组与对照组比较,P＜0.05,模型组与实验组比较,P＜0.05,差异均有统计学意义,而对照组与实验组比较差异无统计学意义(P＞0.05).说明当归注射液对预防硬膜外粘连有一定的效果,但与玻璃酸钠相比却无明显优势.结论:当归注射液可以减少FBSS兔局部成纤维细胞计数及PDGF含量的增加.

目的:探讨“蛋壳”技术应用于手术治疗脊柱结核的临床疗效.方法:对2008年1月~2011年12月间收治的36例运用“蛋壳”技术经后路病灶清除、植骨融合、钉棒系统内固定术[1]的脊柱结核病人回顾性分析.结果:36例脊柱结核患者,手术均顺利完成,钉棒系统位置及稳定性良好,术后0.5~3年随访,术后未出现脊髓神经症状加重.随访中术后1年植骨骨性融合率为70%,术后2年植骨融合率为99%,断钉及内固定失效发生率为0.其中仅1例出现切口延期愈合.结论“:蛋壳”技术应用于后路病灶清除、植骨融合、钉棒系统内固定术治疗脊柱结核中,病灶清除彻底,脊髓减压显著,能较好的纠正后凸畸形,结合钉棒系统,具有更好的稳定性.此术式有利于病灶的清除、愈合和植骨的融合,能更好的促进神经损伤的修复.联合抗结核药物治疗脊柱结核疗效显著,唯有彻底清除病灶加全程、足量抗结核治疗,才能有效减少结核致瘫的机率,提高患者的生活质量.

Lumbar spinal stenosis(lumbar spinal stenosis,LSS) refers to various causes of osteoporosis,or fibrous tissue hyperplasia,hypertrophy leading spinal canal or neural Canal of the sagittal diameter of short,irritation or compression of nerve root or cauda equina nerve caused by a series of clinical symptoms.The main clinical characteristics for low back pain,intermittent claudication symptoms and signs of light,to degenerative stenosis is the most common,is one of the common causes of low back pain in the elderly.More current treatment methods,surgical treatment,destruction of the traditional surgical treatment on spinal stability has become a reality,but with the increasing skills of modern medicine,minimally invasive spinal technology and the continuing development of the birth,surgical diseases of the spine,especially the surgical treatment of lumbar spinal canal stenosis,with a great deal of help.To this end,the spine is now we review progress of minimally invasive technique in treatment of LSS.

Objective:To observe the clinical efficacy of treatment on the vertebral artery type of cervical oblique wrench fixed by the seat.Methods:93 patients with vertebral artery type cervical spondylosis treatment with fixed-pointoblique wrench,before and after treatment,use transcranial doppler ultrasound(TCD) to check the right and left vertebralartery(VA),basilar artery(BA),peak systolic bloodflow velocity(Vpeak),end diastolic velocity(Vmin),pulsatility index(PI) and resistance index(RI),and compared.Results:VA,BA's vpeak,vmin value after treatment was significantly faster,closed to or returned to normal;PI,RI values decreased significantly compared with before treatment,there was statistically significant(P0.05).Conclusion:Cervical vertebral artery oblique wrench designated by the seat treatment significantly improved blood supply to the brain,and achieved therapeutic purposes.

Objective To investigate the protective effect of exogenous vascular endothelial growth factor(VEGF) on spinal cord tissue after spinal cord injury(SCI) in adult rats.Methods A contusion injury was produced to adult rats by using the modulated Allen's weight drop method. After SCI.seventy-two model rats were randomly divided into three groups,and the drugs were injected into subrachnoid space at the lesion site.In group A:saline 10μL,in group B:Matrigel 10μL,in group C:human recombinant VEGF_(165)+Matrigel 10μL.1,2,3,4 weeks after surgery, animals were killed to study spinal cord pathologic histology and the number of neurons.Results VEGF-treated animals had an increased amount of spared tissue in the lesion area.The number of neurons in VEGF-treated animals was much better than that in the control groups at all time points following SCI.Conclusion The exogenous vascular endothelial growth factor can protect spinal cord tissue from damage caused by spinal cord injury.

目的:探讨后路椎体间融合术治疗下腰椎疾患的疗效.方法:本组16例,男10例,女6例,年龄12～81岁,平均56.4岁;其中腰椎间盘突出症9例,腰椎滑脱4例,退变性脊柱侧弯3例.所有病例均行后路椎体间融合(PLIF)术.结果:本组病人均获得随访,随访1～18个月:应用日本骨科学会(JOA)评分系统,日本Nakano标准;本组优:11例,良:3例,可:2例,差:0,优良率87.5%;JOA评分系统评估,术前平均8.5分,术后平均18.5分.结论:后路椎体间融合治疗腰椎退变性失稳症效果优良,是标准的规范化手术.