Bryan人工椎间盘置换术治疗颈椎病的研究进展

Bryan人工椎间盘置换术是治疗颈椎椎间盘退行性变的有效手段,与传统的颈前路植骨融合内固定术比较,颈椎人工椎间盘置换的最大优势在于在有效减压的同时重建节段的运动功能,使整个颈椎运动学特征最大程度地接近于置换前的生理状态,减少传统融合术后由于融合节段运动功能丧失所造成的相邻节段过度运动和应力集中,从而避免相邻节段退变的发生和发展.但没有统一的适应症标准、缺乏远期的临床观察、昂贵的费用等问题阻碍了其在临床上的广泛应用,该文着重进行颈椎人工椎间盘的生物力学特点、适应症与禁忌症、临床疗效以及并发症的文献综述.     

退行性腰椎滑脱临近节段椎间盘退变和关节突关节角度相关研究

目的:探讨退行性腰椎滑脱(DLS)临近节段椎间盘退变程度和关节突关节角度之间的关系。方法:选取我院2012年6月至2016年6月收治的120例DLS患者作为DLS组,另外选取来我院接受体检的健康者120例作为对照组,选择CT进行关节突关节角和腰椎滑脱度的测量,使用MRI的T2像对椎间盘进行Pfirrmann退变分级。结果:DLS组的各节段关节突关节角度均小于对照组(P0.05);DLS组不同滑脱程度的L2/3、L3/4、L5/S1节段关节突关节角度的比较,差异无统计学意义(P0.05);DLS组L2/3、L3/4、L5/S1节段不同椎间盘退变等级间的滑脱程度无显著性差异(P0.05)。L2/3和L3/4节段不同椎间盘退变程度间关节突关节角度差无显著性差异(P0.05),L5/S1节段不同椎间盘退变程度间关节突关节角度差有统计学差异(P0.05)。结论:退行性腰椎滑脱临近节段关节突关节角度明显小于正常人,且临近节段关节突关节的角度并未随着腰椎滑脱程度的加重而改变,退行性腰椎滑脱患者滑脱临近节段椎间盘退变与关节突关节的矢状化程度无关,但L5/S1关节突关节角度不对称性会影响到同节段椎间盘退变程度。     

关于椎间盘退变性疾病的手术治疗

椎间盘退变性疾病（degenemtivediscdisease,DDD）是脊柱外科最常见的疾病之一,数十年来,融合手术一直是治疗的金标准,但对其随访结果仍存在争论,一些前瞻性试验显示效果优于常规的保守治疗,而别一些则相反。由于存在对融合术的有效性和在邻近节段可能引起的退变的争议,多种非融合技术逐渐发展起来。本文的目的是对目前临床上针对椎间盘退变性疾病开展的手术治疗方案作一综述,为医师选择手术方案提供一定的依据。     

腰椎弹性固定进展研究

对于腰椎退变和不稳的治疗,传统方法是采用后路减压、椎弓根螺钉固定同时行植骨术(僵硬固定)。然而,僵硬固定存在加速周围椎体的退变等缺点。因而,人们逐步把目光投向腰椎弹性固定。最近几年,腰椎弹性固定因具有利于应力分散,防止周围节段退行性变,降低应力遮挡等优点,越来越多地被用于临床。大多数临床资料显示相较于传统坚强固定,弹性固定疗效相当,而固定节段骨萎缩、骨质疏松以及邻近节段退变的发生率显著降低,更利于脊柱生理特性。该文就腰椎弹性固定的发展过程、各种类型弹性固定的工作原理以及临床效果等作一综述。     

类风湿性关节炎患者腰椎手术的影响因素分析

关于类风湿性关节炎(RA)患者术后相邻节段病变(ASD)的研究相对较少,本研究的目的是揭示腰椎融合术和腰椎减压术对RA患者的ASD发病率和临床结局的影响。本研究共纳入了68例接受腰椎手术治疗的RA患者,36例行腰椎间盘减压融合术(融合组),32例行腰椎间盘减压术(非融合组),随访时间为3年。记录两组患者手术前后JOA评分和相邻节段病变情况,并在X线片上评估相邻椎间盘狭窄程度和椎体滑脱程度,评估ASD的危险因素。研究显示,患者平均年龄为(68.6±12.4)岁,男性17例,女性51例。研究结果表明:融合组和非融合组术后3年随访时的JOA评分均有显著改善(p0.05)。融合组患者的ASD发生率和翻修手术风险显著高于非融合组(p0.05)。手术后相邻节段病变在融合组中比在非融合组中更频繁和严重(p0.05)。基质金属蛋白酶3 (MMP-3)和C反应蛋白计算的28关节疾病活动指数(DAS28-CRP)与ASD的发病率显著相关(p0.05)。     

Bryan颈椎间盘假体置换术对脊髓型颈椎病患者疗效及颈椎生物力学的影响

目的:探讨Bryan颈椎间盘假体置换术对脊髓型颈椎病患者疗效及颈椎生物力学的影响。方法:选取2015年1月到2016年12月期间在我院接受治疗的脊髓型颈椎病患者48例,根据手术方式的不同将其分为植骨融合组(25例)和假体置换组(23例),其中植骨融合组采用颈椎前路减压植骨融合术进行治疗,假体置换组采用Bryan颈椎间盘假体置换术进行治疗。比较两组患者的日本骨科协会(JOA)颈椎评分、颈椎功能障碍指数(NDI)评分、视觉模拟疼痛量表(VAS)评分、颈椎生理曲度、颈椎活动度、手术节段活动度、上邻近节段活动度、下邻近节段活动度,并比较两组患者的并发症情况。结果:术后12个月假体置换组的NDI评分明显低于植骨融合组(P0.05);术后6个月、术后12个月植骨融合组的颈椎活动度低于假体置换组(P0.05);术后1个月、术后3个月、术后6个月、术后12个月假体置换组的手术节段活动度高于植骨融合组(P0.05);术后12个月植骨融合组的上邻近节段活动度、下邻近节段活动度高于假体置换组(P0.05);两组患者随访期间颈部轴性症状发生率比较差异有统计学意义(P0.05)。结论:与颈椎前路减压植骨融合术比较,Bryan颈椎间盘假体置换术对脊髓型颈椎病患者的远期疗效更佳,可更好的改善患者的颈椎生物力学,降低颈部轴性症状发生率,值得临床推广应用。     

腰椎管狭窄症脊椎融合术适应症研究进展

腰椎管狭窄症主要由腰椎关节强硬引起。腰椎狭窄症的临床表现分为两类:一类为局域性症状,如下腰痛,僵硬等,一类为神经根症状,如神经性跛行。适当保护性治疗可以改善这些症状,但是一些顽固病例仍需手术治疗。单纯腰椎管减压术适用于以神经根症状为初发表现并且脊椎生物力学稳定的患者。术前评估时如出现背部手术失败综合征,退行性不稳定,严重畸形,有症状的椎骨脱离,难治性退行性椎间盘疾病,以及邻近节段病的患者可行腰椎融合术。术中评估出现广泛椎体压缩合并椎间隙大或者骨储存量不足的患者可行腰椎融合术。     

退变性腰椎滑脱患者脊柱-骨盆矢状位参数及小关节的研究

目的:探讨退变性腰椎滑脱患者脊柱-骨盆矢状位参数和腰椎小关节的特点,分析退变性滑脱的发生发展机制。方法:从2014年1月份到2015年12月份,于我科收集L4-5节段退变性腰椎滑脱的患者,作为DS组,共46例患者。根据年龄和性别匹配原则,纳入46例L4-5节段椎管狭窄的患者,作为DSS组。通过影像学资料测量评估两组病例的如下参数:PI、PT、SS、LL、TK、SVA、小关节方向、小关节不对称性、小关节退变分级和滑脱程度。比较两组患者参数的差异。对退变性腰椎滑脱患者小关节方向与其他参数进行相关性分析,并根据小关节方向不同将滑脱患者,分为小关节矢状化程度重的A组和矢状化轻度相对较轻的B组。对比分析两组病例相关参数的差异。结果:DS组小关节退变分级高于DSS组(P=0.045)。DS组PI和PT大于DSS组(P0.001),小关节角度小于DSS组(P=0.004),两组小关节不对称程度没有统计学差异(P=0.483)。DS组小关节方向与PI、LL、PT、滑脱程度和小关节退变程度呈现显著负相关(P0.05)。A组小关节退变分级高于B组(P=0.037),PI、PT和滑脱程度均显著大于B组(P0.05)。结论:退变性腰椎滑脱患者小关节矢状化程度和退变较重,PI较大,大PI和小关节矢状化是退变性腰椎滑脱发生发展的重要因素。     

动态中和固定系统与后路锥间融合术治疗退变性椎管狭窄的近期疗效对比研究

目的:对比动态中和固定系统(Dynesys)与后路锥间融合术治疗退变性椎管狭窄的近期疗效。方法:70例椎管狭窄伴或不伴椎间盘突出患者,随机分为Dynesys组与后路锥间融合术组。前者行椎板减压并Dynesys内固定,后者行减压术并锥间融合术,术后随访24个月,对比两组术后功能恢复情况、椎间隙高度、活动度及邻近节段退变情况。结果:1两组患者术后随访结束时ODI指数、VAS评分均较手术前明显下降(P0.05),两组0DI指数与VAS评分无显著性差异(P0.05)。2术后两组固定节段间隙均较手术前明显增加(P0.05),Dynesys组L4-5节段、L5-S1节段活动度大为下降(P0.05),融合术组相应节段均融合良好,无活动度。3Dynesys组头侧相邻节段活动度与术前无明显变化,融合术组头侧相邻节段较术前活动度明显增加(t=2.286,P=0.026),两组术头侧相邻节段活动组差异有统计学意义(t=3.125,P=0.003)。4随访结束时Dynesys组有1例(2.6%)患者S1节段出现1根螺钉松动,邻近节段未见退变病例;融合组有4例(12.5%)邻近节段出现Ⅰ-Ⅱ度退变,两组邻近节段退变率差异有统计学意义(fisher p=0.039)。结论:Dynesys动态固定植入手术与传统后路椎间融合术治疗退行性椎管狭窄术后短期内效果相当,前者对邻近节段活动性的影响小于融合术。     

腰椎多节段退变性滑脱的手术治疗

目的:研讨腰椎多节段退变性滑脱手术减压和植骨融合方式与疗效的关系。方法:20例腰椎多节段退变性滑脱患者行后路椎弓根螺钉复位内固定后,采用椎管减压、神经根松解,行椎间植骨和后外侧植骨融合术,采用日本整形外科学会(JOA)下腰痛评分标准评价疗效。结果:获得连续随访者18例,随访时间9月～3年,平均24个月,优良率90%。结论:可靠的内固定、复位,神经根松解,椎间植骨融合治疗腰椎多节段退变性滑脱效果满意,充分的神经根松解是手术治疗的关键。     

六种藓类植物茎的比较解剖学研究

通过对6种藓类植物,即褶叶青藓(Brachythecium salebrosum(Web.et Mohr.)B.S.G.)、湿地匐灯藓(Plagiomnium acutum(Lindb.)Kop.)、侧枝匐灯藓(Plagiomnium maximoviczii(Lindb.)Kop.)、大凤尾藓(Fissidensnobilis Griff.)、大羽藓(Thuidium cymbifolium(Doz.et Molk.)B.S.G.)和大灰藓(Hypnum plumaeforme Wils.)嫩茎和老茎的石蜡切片和显微观察发现,同一藓类植株的嫩茎和老茎,茎结构稳定,不同种藓类植物茎横切面具有不同特征.植物体茎横切面形状、表层细胞的层数、细胞大小和细胞壁厚薄、皮层细胞大小和形状、中轴的有无以及比例等特征可以作为藓类植物的分科分类依据之一.     

Cause of Senescence of Nine Sorts of Flowers

The levels of endogenous phytohormones and respiratory rate in nine sorts of flowers such as Cymbidium faberi Rolfe, Nopalxochia ackermannii Kunth and others were investigated both at full bloom and senescence and meanwhile the effect of exogenous phytohormones on prolonging the blossoms and promoting ethylene production were tested. There is a high content of endogenous ethylene in all the long-lived flowere, about 3–16 folds higer than the short-lived ones. There is a high level of ABA at full blooming flowers of short-lived flowers, in which there is no or only some cytokinins in it, but the ratio of CTK (6BA+zeatin)/ABA is smaller(l.7). The endogenous ABA reached a much higher level at senescence in all nine sorts of flowers, so it is reasonable to consider that it is ABA which plays an important role of regulation in controlling flower's senescence. There is a much higher level of GA3 and zeatin in the long-lived flowers which is not demonstrated in the shortlived ones. The respiratory rate is one of the factors controtling the longevity of flowers, but it does not play a decided role. Application of 6BA and zeatin prolongs distinctly orchid’s longevity, however exogenous IAA through the promotive action on ethylene production, evidently extends the longevity of the flowers of the Nopalxochia ackermannii Kunth.     

龙胆科药用植物化学成分的研究现状

龙胆科植物在我国的分布范围很广,且多数为药用植物,其多数种属的药用植物,至今其化学成分尚未被系统研究。综述了目前龙胆科药用植物的化学成分的研究现状及一般提取方法,对近年来发现的环烯醚萜及裂环烯醚萜类化合物进行了总结,为本科药用植物的更深入研究提供了参考。     

The effects of glutamine of the maintenance of embryogenic cultures of Cryptomeria japonica

Summary Embryogenic tissues of sugi (Cryptomeria japonica) were induced on a modified Campbell and Durzan (CD) medium containing 1 μM 2,4-dichlorophenoxyacetic acid (2,4-D) and 600 mg l⁻¹ glutamine, and subcultured in the medium of the same composition for over 1 yr. This resulted in a mixed culture of embryogenic and non-embryogenic cells. When embryogenic cells were isolated and cultured independently, their capacity to form embryogenic aggregates was lost. Thus, the non-embryogenic cells present within a mixed culture system were essential to the formation of embryogenic aggregates. When embryogenic tissues were isolated and cultured independently on a high glutamine-containing (2400 mg l⁻¹) medium, dry weights and endogenous levels of glutamine increased, and the tissue could generate a large number of embryogenic aggregates. Amino acid analysis of embryogenic and non-embryogenic cells from the maintenance culture indicated a higher level of glutamine was present in the latter. The high endogenous level of glutamine in the non-embryogenic portion of mixed cell masses may be the supplier of glutamine for maintaining the embryogenic property of the tissues.     

Specificity of action of piperidylcholine derivatives as substrates of cholinesterases of various origin

The review deals with study of enzymologic properties of a novel highly specific acetylcholinesterase substrate, N-(β-acetoxyethyl) piperidinium iodomethylate (“piperidylcholine”), and its 30 derivatives that were tested as effectors of cholinesterases of mammals and various species of Pacific squids. It was proven for the first time that responsible for specificity of action was structure of cyclic ammonium grouping of the alcohol part of molecule of the ester substrate. Analysis of specificity is performed based on enzymatic hydrolysis parameters—activity of catalytic center of cholinesterases and bimolecular constant of the reaction rate that are determined at optimal and low substrate concentrations. Among the specially synthesized group of thioester compounds there is revealed one more highly specific acetylcholinesterase substrate—N-(β-acetoxyethyl) piperidinium.     

真菌类遗传学分析的知识结构教学

本文以认知结构理论为指导,讨论了真菌类遗传分析与高等动植物遗传分析的内在联系,认为利用这种内在联系进行教学可收到好的效果并说明了作者的具体教学过程。 Abstract:In the paper, the relationship between genetic analysis of Fungi and genetic analysis of high animal and plant was discussed.A good results were obtained when we adopted this method in the teaching.     

医疗机构合理用药评价模型的构建研究

目的 针对医疗机构的合理用药水平进行评价研究。方法 根据医疗机构合理用药的具体要求,构建医疗机构合理用药评价指标体系,采用基于模糊群决策的方法和多指标评价分析法构建医疗机构合理用药评价模型。结果 构建了基于模糊群决策的医疗机构合理用药评价模型,并通过实例分析证明了评价模型的可行性。结论 建立的基于模糊群决策的医疗机构合理用药评价模型能够对医疗机构的合理用药水平进行科学评价,为提高医疗机构合理用药水平奠定基础。     

The mechanism of hatching of eggs of Haemonchus contortus

Fluid collected from hatching eggs of Haemonchus contortus contained a lipase which hydrolysed 2-naphthyl laurate (about 0·7 μmol naphthol freed /h/10⁶ eggs). The fluid also hydrolysed l-leucinamide (about 2·3 μmol leucine freed/h/10⁶ eggs). The fluid when added to normal or heated eggs caused ‘hatching’. ‘Hatching’ also occurred in exsheathing fluid from infective juveniles and in a preparation of pancreatic lipase containing leucine aminopeptidase. A purified mammalian leucine aminopeptidase in combination with several different lipases did not attack egg shells.The ‘spontaneous’ hatching of eggs of H. contortus was strongly inhibited by 1,10-phenanthroline, 10^?3M, and this inhibition was reversed by Zn²⁺. However, the inhibition of ‘hatching’ of eggs in externally applied hatching fluid, or the hydrolysis of leucinamide in hatching fluid was generally less marked.