骨水泥强化椎弓根螺钉联合椎间融合复位治疗老年重度腰椎滑脱的临床研究

摘要 目的：观察椎间融合复位联合骨水泥强化椎弓根螺钉治疗老年重度腰椎滑脱的临床效果。方法：回顾性分析我院于2016年3月~2019年3月期间收治的老年重度腰椎滑脱患者92例,根据治疗方案的不同可将患者分为A组（n=44）和B组（n=48）,A组给予椎弓根螺钉联合椎间融合复位治疗,B组给予骨水泥强化椎弓根螺钉联合椎间融合复位治疗,对比两组视觉疼痛模拟评分（VAS）、Oswestry功能障碍指数（ODI）及日本骨科协会（JOA）腰腿痛评分、临床指标、滑脱距离、滑脱率、椎间隙高度、椎间融合率、椎间孔高度、并发症及螺钉松动情况。结果：术后12个月,两组VAS、ODI、JOA评分均下降,且B组低于A组（P<0.05）。两组术中出血量对比组间无统计学差异（P>0.05）,B组手术时间长于A组,住院时间短于A组,椎间融合率高于A组（P<0.05）。术后12个月,两组滑脱距离、滑脱率均下降,且B组小于A组（P<0.05）。术后12个月,两组椎间隙高度、椎间孔高度均升高,且B组高于A组（P<0.05）。两组并发症发生率组间对比无差异（P>0.05）。结论：老年重度腰椎滑脱患者椎间融合复位联合骨水泥强化椎弓根螺钉治疗,虽一定程度上延长了手术时间,但可促进临床症状,改善椎间高度及腰椎滑脱程度,缩短住院时间,且不增加并发症发生率。     

椎弓根钉棒系统加植骨融合治疗胸腰椎爆裂性骨折并脊髓损伤的 临床研究

目的:探讨椎弓根钉棒系统加植骨融合治疗胸腰椎爆裂性骨折并脊髓损伤的疗效。方法:回顾性分析2010年3月至2014年12月,采用椎弓根钉棒系统加植骨融合治疗93例胸腰椎爆裂性骨折并脊髓损伤患者的资料,男56例,女37例。致伤原因:交通事故伤27例,高处坠落伤47例,重物压伤19例。骨折节段:L1骨折22例,L2骨折16例,L3骨折6例,T11骨折15例,T12骨折34例。结果:本研究共93例患者,所有患者经过一般12个月的随访,其中平均随访13.8月(10-16月)。与术前相比,患者术后6个月伤椎前缘高度比值明显增加,Cobb角值和椎管占位率明显降低(t=6.167,7.241,7.143,P0.05)。术后12个月伤椎前缘高度比值明显增加,Cobb角值和椎管占位率明显降低(t=9.345,11.541,11.263,P0.05)。且患者术后12个月与术后6个月在伤椎前缘高度比值、Cobb角、椎管占位率上比较,差异具有统计学意义(t=9.632,8.154,7.415,P0.05),根据Frankel神经分级,术后大部分患者神经功能有所恢复。其中,Frankel分级为A的患者有35例恢复,术后有效恢复率为87.5%;B级患者有25例恢复,术后有效恢复率89.3%。C级和D级患者术后有效恢复率均为100%,B,C,D级患者与A级患者有效恢复率相比,差异没有统计学意义(x~2=0.051,2.196,1.253,P0.05),随访12个月期间,2例患者术后5个月出现内固定物松动,1例术后12个月发生螺钉断裂,其余患者无伤口感染、肺部感染、深静脉血栓等并发症发生。结论:椎弓根钉棒系统加植骨融合能有效治疗胸腰椎爆裂性骨折并脊髓神经损伤,术后患者神经功能恢复较好,并发症较少,值得临床推广使用。     

椎弓根螺钉置入内固定法治疗胸腰段骨折脱位的效果分析

目的:研究应用椎弓根螺钉置入内固定系统治疗胸腰段骨折脱位患者的临床效果。方法:回顾分析我院52例胸腰段骨折脱位患者临床资料,应用椎弓根螺钉置入内固定系统治疗,对比实施内固定前后及随访1年后脊柱损伤、骨折复位的恢复情况,Cobb角、前缘高度百分比、后缘高度百分比、矢状位指数、楔变指数、VAS评分。结果:各时期A级比例,无统计学意义(P0.05)。B-E级中,治疗后、随访1年与治疗前相较,差异具有显著性(P0.05),随访1年与治疗后相较,无统计学意义(P0.05)。后缘高度在治疗前后、随访1年中对比,无统计学意义(P0.05)。前缘高度、Cobb角在治疗后、随访1年中与治疗前相较,差异具有显著性(P0.05),前缘高度、Cobb角在治疗后、随访1年中对比,无统计学意义(P0.05)。治疗后、随访1年矢状位指数、楔变指数、VAS评分与治疗前相较,呈显著差异(P0.01),但随访1年与治疗后相较,无统计学意义(P0.05)。结论:胸腰段骨折脱位患者应用椎弓根螺钉置入内固定系统治疗效果显著,应予推广。     

椎弓根螺钉用于植骨融合术治疗胸腰椎结核的临床研究

目的:探讨椎弓根内固定联合植骨融合术治疗胸腰椎结核的临床效果。方法:回顾性分析2013年5月至2014年5月在我院接受治疗的50例胸腰椎结核患者的临床资料,结合影像资料评价患者手术前后的红细胞沉降率、后凸畸形矫正情况、Frankel分级及术后并发症的发生情况等。结果:所有患者术后病理均证实为脊柱结核,术中27例植入大块自体髂骨,23例植入自体肋骨捆绑植骨。24例采用椎体侧前方钉棒内固定,26例采用后路椎弓根螺钉系统内固定。术中未出现脊髓、神经、血管损伤及血气胸等并发症。患者术后红细胞沉降率获得改善,差异具有统计学意义(P0.05)。术后Cobb角明显获得矫正,差异具有统计学意义(P0.05)。患者术后脊柱损伤程度明显改善,差异具有统计学意义(P0.05)。结论:椎弓根内固定联合椎体间植骨融合术治疗胸腰椎结核具有良好的临床效果,不仅可以改善红细胞沉降率,而且可以矫正患者脊柱后凸畸形,值得临床推广应用。     

Identification of key tissue type for antler regeneration through pedicle periosteum deletion

Epimorphic regeneration is the “holy grail” of regenerative medicine. Research aimed at investigating the various models of epimorphic regeneration is essential if a fundamental understanding of the factors underpinning this process are to be established. Deer antlers are the only mammalian appendages that are subject to an annual cycle of epimorphic regeneration. In our previous studies, we have reported that histogenesis of antler regeneration relies on cells resident within the pedicle periosteum (PP). The present study elaborates this finding by means of functional studies involving the deletion of PP. Four yearling and four 2-year-old stags were selected for total PP deletion or partial PP deletion experiments. Of the animals in the total PP deletion group, one showed no signs of antler regeneration throughout the antler growth season. Two showed substantial and one showed marginal delays in antler regeneration (at 34, 20 and 7 days, respectively) compared with the corresponding sham-operated sides. Histological investigation revealed that the delayed antlers were derived from regenerated PP. Unexpectedly, the regenerative capacity of the antler from the total periosteum-deleted pedicles depended on antler length at surgery. Of the four deer that had partial PP deletion, two regenerated antlers exclusively from the left-over PP on the pedicle shafts in the absence of participation from the pedicle bone proper. The combined results from the PP deletion experiments convincingly demonstrate that the cells of the PP are responsible for antler regeneration. The authors thank the New Zealand Foundation of Research, Science and Technology and Deer Industry New Zealand for funding their research.     

Growth of the first antler in Iberian red deer (<Emphasis Type="Italic">Cervus elaphus hispanicus</Emphasis>)

In this study, we describe the process of pedicle and first antler growth in Iberian red deer (Cervus elaphus hispanicus) and document relationships among body development, maternal milk supply and composition, and maternal weight on the length of first antlers. Antler length of 53 males of Iberian red deer was measured every 2 weeks from birth to 20 months of age. Deer weight, age, and the date of occurrence of the major events during the antler growth cycle were also recorded. The first evidence of pedicle development occurred when the animals were 38.0 ± 0.6 weeks old and weighed 60.7 ± 0.9 kg. Antler cleaning took place at a mean age of 63.8 ± 0.7 weeks and a mean weight of 91.5 ± 1.8 kg. The antler growth period lasted 16.7 ± 0.4 weeks, and the cleaning period lasted 5.1 ± 0.4 weeks. First antler growth followed a sigmoid curve, reaching a final length of 38.3 ± 1.0 cm. Antler length was positively correlated with body weight during the antler growth cycle. Additionally, the final length of the first antler was related to total milk yield, date of antler growth initiation, body weight at 6 months of age, and the antler growth time interval.     

Role of adipose-derived stromal cells in pedicle skin flap survival in experimental animal models

The use of skin flaps in reconstructive surgery is the first-line surgical treatment for the reconstruction of skin defects and is essentially considered the starting point of plastic surgery. Despite their excellent usability, their application includes general surgical risks or possible complications, the primary and most common is necrosis of the flap. To improve flap survival, researchers have used different methods, including the use of adiposederived stem cells, with significant positive results. In our research we will report the use of adipose-derived stem cells in pedicle skin flap survival based on current literature on various experimental models in animals.     

Deer antler – A novel model for studying organ regeneration in mammals

Deer antler is the only mammalian organ that can fully grow back once lost from its pedicle – the base from which it grows. Therefore, antlers probably offer the most pertinent model for studying organ regeneration in mammals. This paper reviews our current understanding of the mechanisms underlying regeneration of antlers, and provides insights into the possible use for human regenerative medicine. Based on the definition, antler renewal belongs to a special type of regeneration termed epimorphic. However, histological examination failed to detect dedifferentiation of any cell type on the pedicle stump and the formation of a blastema, which are hallmark features of classic epimorphic regeneration. Instead, antler regeneration is achieved through the recruitment, proliferation and differentiation of the single cell type in the pedicle periosteum (PP). The PP cells are the direct derivatives of cells resident in the antlerogenic periosteum (AP), a tissue that exists in prepubertal deer calves and can induce ectopic antler formation when transplanted elsewhere on the deer body. Both the AP and PP cells express key embryonic stem cell markers and can be induced to differentiate into multiple cell lineages in vitro and, therefore, they are termed antler stem cells, and antler regeneration is a stem cell-based epimorphic regeneration. Comparisons between the healing process on the stumps from an amputated mouse limb and early regeneration of antlers suggest that the stump of a mouse limb cannot regenerate because of the limited potential of periosteal cells in long bones to proliferate. If we can impart a greater potential of these periosteal cells to proliferate, we might at least be able to partially regenerate limbs lost from humans. Taken together, a greater understanding of the mechanisms that regulate the regeneration of antlers may provide a valuable insight to aid the field of regenerative medicine.This article is part of a Directed Issue entitled: Regenerative Medicine: the challenge of translation.     

生物活性玻璃提高骨质疏松绵羊椎弓根螺钉稳定性的体内实验研究

目的:研究生物活性玻璃(Bioactive Glass,BG)在骨质疏松绵羊体内强化椎弓根螺钉固定的力学效果,并观察钉道界面及材料吸收等情况。方法:4只成年雌性小尾寒羊,采用去势联合激素注射方法建立骨质疏松绵羊模型。选择绵羊L2至L5双侧椎弓根,随机化选取一侧直接拧入椎弓根螺钉(空白组),对侧采用BG强化钉道后拧入椎弓根螺钉(实验组)。术后3月随机选取6个椎体(12枚椎弓根螺钉),对螺钉骨质界面行显微CT分析和组织学观察。对剩余10个椎体(20枚椎弓根螺钉)行轴向拔出实验,分析螺钉固定强度。结果:术前绵羊腰椎BMD为0.818±0.0310 g/cm2,建模完成后为1.000±0.0316 g/cm2,BMD平均值下降22.38%,差异有统计学意义(P<0.05)。实验组螺钉骨质界面的Tb.Th、Tb.N组较对照组分别增加143.60%和33.56%,差异有统计学意义(P<0.05)。实验组钉道周围材料绝大部分已经降解吸收,大量新生骨组织紧密包裹螺钉;对照组钉道周围骨量较少,钉骨结合不紧密,实验组螺钉骨质界面结合优于对照组。实验组的最大轴向拔出力为1083.04±86.37N,空白组为871.76±79.03N,前者较后者提高25.26%,差异有统计学意义(P<0.05)。结论:生物活性玻璃能显著改善骨质疏松情况下螺钉骨质界面的骨微观结构,进而提高椎弓根螺钉的把持力。     

经皮RTS钉固定与常规椎弓根固定在胸腰段压缩骨折中的疗效比较

目的:分析和比较使用经皮RTS钉固定与常规椎弓根固定在胸腰段骨折中的临床疗效和安全性。方法:对2017年6月至2018年6月在我院住院,经诊断为胸腰段骨折,且经纳入及排除标准筛选后的共计74例患者进行回顾性分析。根据不同的手术方式和选择,将纳入的患者分为经皮RTS钉固定组(观察组;40例)和常规椎弓根螺钉固定组(对照组;34例)。在术后的3天,1月及1年比较两组患者的疼痛评分及功能评分;并通过其影像学指标(伤椎高度恢复,cobb角恢复等)比较两组的影像学疗效;比较两组患者的手术时间,出血量,切口长度等手术指标;比较两组患者的并发症等情况。结果:在术后3天时,观察组患者的VAS评分显著优于对照组(P0.05),而在术后1月及1年时,两组患者未见显著差异(P0.05)。两组患者的Cobb角及前缘高度百分比较术前均有显著改善(P0.05),且两组间均有显著差异(P0.05)。两组患者在手术时间,切口长度,透视次数,出血量,出院时间等均有显著差异(P0.05)。两组患者在并发症的比较中并无统计学差异(P0.05)。结论:与常规的开放椎弓根螺钉固定相比,对于胸腰椎压缩骨折,RTS螺钉能够有效的恢复影像学指标,特别是在前缘高度及Cobb角恢复,并且能够有效地减少创伤及出血,加快功能恢复,在临床中可以进一步推广。