腰椎间盘突出症康复治疗中腰部核心肌力训练的临床评估

为了系统评估腰椎间盘突出症患者康复治疗中腰部核心肌力训练治疗的临床疗效,本研究选取2012年1月至2014年1月研究者所在医院就诊的150例腰椎间盘突出症腰肌锻炼康复治疗患者,随机分成A、B两组。A组患者进行腰部核心肌力训练治疗,即核心肌力组;B组患者给予传统腰肌功能锻炼治疗,即传统腰肌锻炼组;康复治疗均在医生指导下进行,所有患者每天早晚各锻炼1次,每次持续15 min,共训练治疗12周。所有患者均定期随访,治疗后6周和12周分别通过VAS疼痛评分、JOA腰椎功能评分和ODI腰椎功能评分变化进行效果评价。治疗后6周,核心训练组VAS评分平均(5.0±1.5)分,JOA评分平均(21.4±2.6)分,ODI评分平均(29.5±8.0)分;但与传统腰肌训练组比较无明显差别(p>0.05);治疗后12周核心肌力锻炼组疼痛症状缓解明显,VAS平均(2.9±1.2)分;腰椎功能改善明显JOA评分平均(25.2±3.2)分,ODI评分平均(38.8±9.4)分;与传统腰肌训练组比较差异具有统计意义(p<0.05)。本研究说明腰肌核心肌力训练长期锻炼效果好于传统腰肌训练。     

Decompressive Laminectomy for Low Back and Sciatic Pain

A proportion of patients with lumbar disc syndromes have little in the way of disc protrusion, but have spinal canals, either congenitally narrow, or else narrowed by degenerative changes. These patients require myelography for their assessment and decompression by complete laminectomy for their treatment, as opposed to the more usual practice of discectomy via partial laminectomy and/or fusion. Five such cases with myelographic findings are presented.     

数值诊断的一种新方法──贝叶斯定理在数值诊断中的应用研究

根据贝叶斯定理,给出数值诊断的一种新方法——评分法．该方法简单易行,便于推广,且在治疗腰椎间盘突出症应用中收到满意效果．     

腰椎间盘突出症术后的中远期疗效分析

目的:回顾性分析腰椎间盘突出症患者术后的中远期疗效和预后情况并对手术疗法的效果作出评价。方法:以1995年12月到2014年12月期间在我院骨科接受治疗的腰椎间盘突出患者825例作为研究对象,对患者进行术后的跟踪回访,观察其术后的中远期疗效。结果:患者经术后随访效果均较佳,中期随访的患者优良率为94.2%,中长期随访的患者优良率为85.3%,超长期随访患者的优良率为80.0%;其中,中期效果最佳,与另外两组比较差异有统计学意义(P0.05)。患者的治疗后改善指数均在60%以上,患者恢复效果较佳。中期、长期及超长期随访的患者改善指数分别为87.3%、81.2%和72.8%。中期随访的患者疗效最好,效果最明显,与超长期比较差异有统计学意义(P0.05)。采用开窗髓核取出、全椎板切除减压及半椎板切除减压方法治疗,前两组的疗效比第三组预后好,优良率分别为94.1%、86.7%、85.5%,差异有统计学意义(P0.05)。结论:采用手术治疗腰椎间盘突出症的中远期疗效较佳,患者预后恢复理想,腰椎功能恢复优良,临床推广使用价值高。     

The occurrence of "mixed" nuclear bag intrafusal fibers in the cat muscle spindle

A total of 147 muscle spindles was studied histochemically in serial transverse sections of 42 cat tenuissimus muscle specimens. Nuclear bag1, nuclear bag2 and nuclear chain intrafusal muscle fibers were distinguished by the differential staining resulting from the reactions for myosin adenosine 5'-triphosphatase and nicotinamide adenine dinucleotide tetrazolium reductase. The majority of intrafusal fibers were of the same histochemical type at both fiber poles. However, seven muscle spindles contained one nuclear bag fiber each that presented as a bag1 in one pole and as a bag2 in the other pole. These "mixed" nuclear bag fibers were found in spindles that also contained at least one bag1 and one bag2 fiber of equivalent histochemical presentation in both fiber poles. The "mixed" bag fibers displayed differences of apparent fiber diameter and relative polar length between the two fiber poles. The motor innervation pattern, as revealed by staining for cholinesterase, was also dissimilar between the two poles of "mixed" bag fibers. The study indicates that the spindle equatorial region may in some instances serve as a boundary between two morphologically and histochemically different poles of the same intrafusal fiber.     

腰腹肌运动联合超声波对非特异性下腰痛的治疗效果及机制

为了解腰腹肌运动联合超声波治疗的效果,本研究对腰腹肌运动联合超声波治疗非特异性下腰痛进行了探讨。研究显示,治疗4周后,腰腹肌运动+超声波治疗组的疼痛评分(0.73)显著低于超声波治疗组(1.22)(p<0.05)。腰腹肌运动+超声波治疗组的立位体前屈活动幅度(2.35 cm)显著低于超声波治疗组(6.23 cm)(p<0.05)。腰腹肌运动+超声波治疗组的屈伸肌总功和屈伸肌峰值力矩比显著高于超声波治疗组(p<0.05)。腰腹肌运动+超声波治疗组的Oswestry功能障碍指数问卷表(ODI)评分显著低于超声波治疗组(p<0.05)。治疗4周后,腰腹肌运动+超声波治疗组的血清超氧化物歧化酶(SOD)和过氧化氢酶(CAT)水平显著高于超声波治疗组,而丙二醛(MDA)水平显著低于超声波治疗组(p<0.05)。为了进一步考察运动联合超声波疗法对下腰痛的治疗机制,本研究建立了完全弗氏佐剂诱导的腰椎间盘退变大鼠模型。采用阿利新蓝染色检测大鼠椎间盘纤维环区和髓核区蛋白多糖的水平,并采用免疫组化染色检测蛋白聚糖和Ⅱ型胶原的表达,发现运动联合超声波治疗可明显提高大鼠蛋白多糖、Ⅱ型胶原和蛋白聚糖水平。本研究表明,与超声波治疗相比,腰腹肌运动联合超声波治疗可更大程度地降低非特异性下腰痛患者的疼痛,提高肌肉功能和腰椎功能,增强血清抗氧化能力,并减少氧化应激损伤。此外,该联合疗法可明显提高腰椎间盘退变大鼠椎间盘中的蛋白多糖、Ⅱ型胶原和蛋白聚糖水平。     

Heart failure increases atrogin-1 and MuRF1 gene expression in skeletal muscle with fiber type-specific atrophy

Heart failure (HF) is characterized by a reduced tolerance to exercise due to early fatigue and dyspnea; this may be due in part to skeletal muscle myopathy with a shift from slow to fast fibers and loss of muscle mass. Muscle wasting does not occur similarly in all types of muscle fiber, thus we tested the hypothesis that HF induces skeletal muscle atrophy in a fiber type-specific manner altering the expression of atrogin-1 and MuRF1 in a fast muscle of rats with monocrotaline-induced heart failure. We studied extensor digitorum longus (EDL) muscle from both HF and control Wistar rats. Atrogin-1 and MuRF1 mRNA content were determined using Real-Time RT-qPCR while muscle fiber cross-sectional area (CSA) from sections stained histochemically for myofibrillar ATPase were used as an index of type-specific fiber atrophy. The measurement of gene expression by RT-qPCR revealed that EDL muscle mRNA expression of MuRF1 and atrogin-1 was significantly increased in the HF group. Muscle fiber type IIB CSA decreased in the HF group compared to the CT group; there was no significant difference in muscle fiber types I and IIA/D CSA between the HF and CT groups. In conclusion, we showed that HF induces fiber type IIB specific atrophy, up-regulating atrogin-1 and MuRF1 mRNA expression in EDL muscle of monocrotaline treated rats.     

腰椎间盘突出症260例临床分析

目的:总结腰椎间盘突出症的临床特点及诊治要点。方法:回顾性分析260例腰椎间盘突出症手术患者的临床资料。结果:直腿抬高与影像学检查结果符合率为100%,治疗优良率达88.08%,有效率100%。结论:腰、下肢和臀部疼痛、下肢麻木、体位改变、运动障碍、感觉障碍、肌萎缩都是腰椎间盘突出症的主要临床表现;直腿抬高试验高试验可作为早期诊断的重要参考指标,要要根据惠者体征、病程等具体情况选择适合的最佳治法。     

Compensatory adaptations of skeletal muscle fiber types to a long-term functional overload

We investigated selected histochemical and histometrical characteristics of the heterogeneous fiber types of rat skeletal muscle following long-term compensatory muscle growth. Sixty days following surgical removal of the synergistic gastrocnemius muscle, the compensated ipsilateral plantaris and soleus muscles and the corresponding control muscles from the contralateral leg were excised and stained histochemically for myofibrillar ATPase and DPNH-diaphorase activities. The number of fibers per cross-section was determined by a direct count from transverse sections taken from the midportion of the muscles. Fiber area was determined by direct planimetry. The plantaris and soleus muscles hypertrophied 103% and 45%, respectively, within 60 days. Compensatory hypertrophy of the plantaris muscle was accompanied by a significant but disproportionate increase in the cross-sectional areas of the three muscle fiber types. There was an approximate 4-fold increase in the number of slow-twitch-oxidative (SO) fibers observed per transverse section. The hypertrophied plantaris muscle exhibited a significantly greater number of fibers per cross-section (29%) than the respective control muscle. The compensated soleus muscle consisted of nearly 100% SO fibers compared to 83% for the control soleus muscle.     

A histochemical characterization of muscle fiber types in the avian M. stapedius

The muscle fiber types and sizes in the M. stapedius (middle ear muscle) of the domestic chicken, Gallus gallus were determined histochemically on the basis of their reactions to myofibrillar adenosine triphosphatase (mATPase), succinic dehydrogenase and NADH diaphorase. Only type II fibers were identified at pH 9.4 and 4.2. At pH 4.6 three levels of activity were seen: high, intermediate and low. With the staining techniques three subtypes of fibers for oxidative enzymes, Types II1 (highly glycolytic), II12 (intermediately glycolytic and lipolytic) and II123 (highly lipolytic) were identified. Fiber diameter was also measured for the different fiber types. The average fiber diameter was around 20 micron for each fiber type. Although similar in size, the fiber types were markedly different in their histochemical properties. These findings plus those of earlier physiological studies suggest that the M. stapedius of G. gallus is a fast twitch, muscle with fibers of similar diameter showing mainly fatigue resistance characteristics.     

经皮椎板间内镜与椎板小开窗术治疗腰椎间盘突出症临床疗效比较

目的：分析和比较椎板间内镜与椎板小开窗术治疗腰椎间盘突出症的临床疗效和安全性指标。方法：使用回顾性分析的方法 对2012-2014 年共计126 例在我科行椎板间内镜手术或椎板小开窗手术的腰椎间盘突出患者进行分析和比较。通过纳入和排除 标准的筛选,经皮椎板间内镜组纳入48例,椎板小开窗组纳入78 例。结合详实的术后随访,对两组患者在花费,住院时间等一般 性指标,疼痛指标,功能指标,并发症等数据进行分析和比较。结果：两组患者在术后均取得明显的治疗疗效,在疼痛、功能等指标 中都有明显的改善。但两组之间并无明显统计学差异(P>0.05)。而椎板间内镜组在住院时间,出血量,切口长度及并发症等方面明 显的优于小开窗组,具有统计学意义(P<0.05)。结论：经皮椎板间内镜手术作为一种脊柱微创手术,治疗效果确切,安全性好,能体 现微创的优势,可作为椎间孔镜技术在治疗椎间盘突出症的有益补充,在临床中进一步的开展和推广。     

Time-lapse analysis and mathematical characterization elucidate novel mechanisms underlying muscle morphogenesis

Skeletal muscle morphogenesis transforms short muscle precursor cells into long, multinucleate myotubes that anchor to tendons via the myotendinous junction (MTJ). In vertebrates, a great deal is known about muscle specification as well as how somitic cells, as a cohort, generate the early myotome. However, the cellular mechanisms that generate long muscle fibers from short cells and the molecular factors that limit elongation are unknown. We show that zebrafish fast muscle fiber morphogenesis consists of three discrete phases: short precursor cells, intercalation/elongation, and boundary capture/myotube formation. In the first phase, cells exhibit randomly directed protrusive activity. The second phase, intercalation/elongation, proceeds via a two-step process: protrusion extension and filling. This repetition of protrusion extension and filling continues until both the anterior and posterior ends of the muscle fiber reach the MTJ. Finally, both ends of the muscle fiber anchor to the MTJ (boundary capture) and undergo further morphogenetic changes as they adopt the stereotypical, cylindrical shape of myotubes. We find that the basement membrane protein laminin is required for efficient elongation, proper fiber orientation, and boundary capture. These early muscle defects in the absence of either lamininβ1 or lamininγ1 contrast with later dystrophic phenotypes in lamininα2 mutant embryos, indicating discrete roles for different laminin chains during early muscle development. Surprisingly, genetic mosaic analysis suggests that boundary capture is a cell-autonomous phenomenon. Taken together, our results define three phases of muscle fiber morphogenesis and show that the critical second phase of elongation proceeds by a repetitive process of protrusion extension and protrusion filling. Furthermore, we show that laminin is a novel and critical molecular cue mediating fiber orientation and limiting muscle cell length.     

腰椎间盘突出症260例临床分析

目的：总结腰椎间盘突出症的临床特点及诊治要点。方法：回顾性分析260例腰椎间盘突出症手术患者的临床资料。结果：直腿抬高与影像学检查结果符合率为100％,治疗优良率这88．08％,有效率100％。结论：腰、下肢和臀部疼痛、下肢麻木、体位改变、运动障碍、感觉障碍、肌萎缩都是腰椎间盘突出症的主要临床表现;直腿抬高试验高试验可作为早期诊断的重要参考指标,要要根据患者体征、病程等具体情况选择适合的最佳治法。     

The effect of age on the maximum moments of strength of the muscles of the lower extremities in patients with lumbar disc hernia

The maximum contractility of the muscles of the lower extremities was studied in patients with lumbar disc hernia in different age periods. Characteristics of the age-related changes in the muscle function of the patients were analyzed in comparison with the parameters of men with physiologically normal aging. It is shown that the maximum strength of muscles of the lower extremities (lower leg extensors and flexors and plantar flexors of the foot) in patients with lumbar disc hernia is 46–50% lower than in healthy subjects. This value is characterized by a negative correlation with age. The percentage of the age-specific decrease in the strength of three groups of muscles (lower leg extensors and flexors and plantar flexors of the foot) is 14% higher than in healthy men. The age-related decrease in the muscle strength of the lower extremities begins 30 years earlier.     

Changes in the metabolic profile of the equine gluteus medius as a function of sampling depth

1. Cross sections from the middle of the gluteus medius were removed from 10 adult horses and used to evaluate changes in histochemically determined muscle fiber type and biochemically determined metabolic enzyme activities as a function of sample depth. 2. Muscle fiber types determined using histochemical methods for myosin ATPase (pH 9.4) and succinic dehydrogenase (SDH) activity indicated percent fast-twitch glycolytic (FG) muscle fibers decreased and slow-twitch oxidative (SO) fibers increased as a function of increasing sampling depth. 3. Percent histochemically determined fast-twitch oxidative glycolytic (FOG) fibers decreased slightly only in the deepest region of the gluteus medius. 4. Citrate synthase (CS) enzymatic activity, used as a marker for mitochondrial oxidative potential, increased 2.5-fold in activity per g of muscle protein from 1 to 8 cm sampling depth. 5. 3-hydroxyacyl-CoA dehydrogenase (HAD) enzymatic activity, used as a marker for lipid oxidation potential, increased 3-fold in activity per g of muscle protein when the depth increased from 1 to 8 cm. 6. Phosphorylase (PS) enzymatic activity, used as a marker for potential glycogen utilization, decreased 50% in activity per g of muscle protein when going from 1 to 8 cm. 7. Lactate dehydrogenase (LDH) enzymatic activity, used as a marker for anaerobic glycolytic potential, decreased about 50% in activity as the sampling depth increased from 1 to 8 cm. 8. In summary, the superficial portion of the equine gluteus medius was found to be more glycolytic and less aerobic in its metabolic profile than deeper regions. The muscle became progressively more aerobic and less glycolytic with increasing sampling depth.     

Phenotype plasticity in postural muscles of the crayfish Orconectes limosus Raf.: correlation of myofibrillar ATPase-based fiber typing with electrophysiological fiber properties and the effect of chronic nerve stimulation

The characteristics of the medial and lateral superficial extensor muscles (sem and sel) in the crayfish Orconectes limosus abdomen and their developmental and activity-dependent plasticity were studied. It was shown that both muscles are innervated by at least five excitatory and one inhibitory motor neuron in a nonuniform pattern. The muscles are composed of at least three different mATPase histochemistry-based fiber types that are all different from a fourth type in the uniform deep extensor muscles. sem and sel are composed of different ratios of these fiber types but do not show a constant fiber type pattern between segments and even between hemisegments. The three histochemically defined superficial extensor-fiber types have characteristic electrophysiological properties. The fiber types were shown to develop successively during the first postembryonic stages of development without a change in the number of muscle fibers. Based on histochemical ATPase staining after 21 days of chronic stimulation by means of an implantable, double-hook electrode, we show preliminary evidence that the fiber composition in the sem can switch from the presumably fast fiber type III to an intermediate type II. Repeated axotomy up to 53 days had no effect on the fiber type composition of the muscles.     

Innervation and maturation of muscular tissue in testicular teratomas in strain 129/Sv-ter mice

In strain 129/Sv-ter mice, teratomas develop spontaneously during the 13th day of gestation. These testicular germ cell tumors exhibit characteristics of different germ layers closely resembling normal embryonic tissue. We investigated the interrelationship between nervous and muscular tissues (often found side by side) in teratomas of 4-week-old 129/Sv-ter mice. In well-differentiated mouse teratomas, histochemically and immunohistochemically distinct muscle fiber types could be distinguished, but not with all reactions. According to its aerobic oxidative capacity, teratoma muscle tissue was comparable with normal muscles. However, with respect to myosin-related properties, fiber type differentiation was incomplete. The muscle fibers - generally arranged in bundles - contained one centrally located endplate which was contacted mostly by a single nerve terminal. From this, proper endplate zones within the fiber bundles were formed. Occasionally "type grouping" was encountered, suggesting collateral axonal branching paralleled by synapse elimination. Together with the earlier in vivo observation of muscular contractions, we assume that teratoma muscle fibers are innervated by nerve cells (within the nervous tissue compartments) corresponding to spinal motoneurons. Thus, myogenesis, maturation and innervation of skeletal muscular tissue in mouse teratomas are largely comparable to normal development.     

Magnetic Resonance Imaging Interpretation in Patients with Sciatica Who Are Potential Candidates for Lumbar Disc Surgery

Background

Magnetic Resonance Imaging (MRI) is considered the mainstay imaging investigation in patients suspected of lumbar disc herniations. Both imaging and clinical findings determine the final decision of surgery. The objective of this study was to assess MRI observer variation in patients with sciatica who are potential candidates for lumbar disc surgery.

Methods

Patients for this study were potential candidates (n = 395) for lumbar disc surgery who underwent MRI to assess eligibility for a randomized trial. Two neuroradiologists and one neurosurgeon independently evaluated all MRIs. A four point scale was used for both probability of disc herniation and root compression, ranging from definitely present to definitely absent. Multiple characteristics of the degenerated disc herniation were scored. For inter-agreement analysis absolute agreements and kappa coefficients were used. Kappa coefficients were categorized as poor (<0.00), slight (0.00–0.20), fair (0.21–0.40), moderate (0.41–0.60), substantial (0.61–0.80) and excellent (0.81–1.00) agreement.

Results

Excellent agreement was found on the affected disc level (kappa range 0.81–0.86) and the nerve root that most likely caused the sciatic symptoms (kappa range 0.86–0.89). Interobserver agreement was moderate to substantial for the probability of disc herniation (kappa range 0.57–0.77) and the probability of nerve root compression (kappa range 0.42–0.69). Absolute pairwise agreement among the readers ranged from 90–94% regarding the question whether the probability of disc herniation on MRI was above or below 50%. Generally, moderate agreement was observed regarding the characteristics of the symptomatic disc level and of the herniated disc.

Conclusion

The observer variation of MRI interpretation in potential candidates for lumbar disc surgery is satisfactory regarding characteristics most important in decision for surgery. However, there is considerable variation between observers in specific characteristics of the symptomatic disc level and herniated disc.     

INDICATIONS FOR LUMBOSACRAL FUSION

In cases in which operation is indicated, the author advocates routine fusion of the lumbosacral joint in all cases of protrusion of the 5th lumbar disc, providing the spine above that level is considered essentially normal.He would do spinal fusion in all cases—provided operation were indicated—in which the primary complaint was that of low back pain and in which sciatic pain was absent or minimal. In such cases, the fusion area should extend as far as necessary to include the portion of the spine involved in pathologic change. Only in exceptional cases would spinal fusion be done in patients more than 50 years of age.With the exceptions noted, all patients requiring reoperation should have the benefits of lumbosacral fusion.     

经皮椎间孔镜与椎板开窗髓核摘除术治疗腰椎间盘突出症的临床疗效比较

目的:探讨和比较经皮椎间孔镜与椎板开窗髓核摘除术治疗腰椎间盘突出症的临床效果和安全性。方法:回顾性分析2011年-2014年我院收治的明确诊断为腰椎间盘突出症并行经皮椎间孔镜或椎板开窗髓核摘除术患者192例,其中118例给予经皮椎间孔镜治疗(PELD组),74例给予椎板开窗髓核摘除术(对照)。结合随访资料,评价并比较两组患者在术前后的VAS疼痛评分、Mac Nab疗效、Lehmann腰椎功能评分及住院时间、费用、手术出血量以及并发症的发生情况。结果:两组患者的术后疼痛评分、Lehmann腰椎功能评分、Mac Nab疗效、总费用、手术时间比较均无统计学差异(P0.05),但PELD组术中出血量、切口长度、并发症的发生率均较对照组降低或减小,差异有统计学意义(P0.05)。结论:经皮椎间孔镜技术作为一种新型微创脊柱外科技术,能够在保证良好疗效的前提下,明显减少出血及并发症,在临床工作中可以进一步的开展。