PLIF与TLIF手术治疗老年单节段腰椎退变性疾病的临床疗效对比

目的:探讨改良后路腰椎体间融合术(PLIF)与改良经椎间孔入路腰椎体间融合术(TLIF)手术治疗老年单节段腰椎退变性疾病的临床疗效。方法:收集2009年1月-2015年1月期间我院收治的经确诊为老年单节段腰椎退变性疾病的80例患者,按照随机数字表法分为观察组和对照组,各40例;观察组患者采用TLIF手术,对照组患者采用PLIF手术;比较两组患者手术前后腰背部疼痛程度(VAS评分)与活动功能(ODI评分),临床指标及并发症发生率。结果:观察组患者手术时间、术中出血量及术后引流量均明显短于或少于对照组患者(P0.05);两组患者手术前腰背部VAS评分与ODI评分比较差异无统计学意义(P0.05),手术后6个月,两组患者腰背部VAS评分与ODI评分均明显低于手术前(P0.05),而组间比较差异无统计学差异(P0.05);观察组术后并发症总发生率为5.00%(2/40),显著低于对照组的22.50%(9/40),差异有统计学差异(P0.05)。结论:PLIF与TLIF手术治疗老年单节段腰椎退变性疾病患者在改善腰背部疼痛程度与腰椎活动功能中的疗效相当,但TLIF手术有助于显著缩短手术时间,降低术中出血量与术后引流量,降低术后并发症发生风险,值得临床推广应用。     

TLIF与PLIF对退行性腰椎滑脱合并腰椎管狭窄患者临床疗效及安全性比较

目的:比较经椎间孔椎体间融合术(transforaminal lumbar interbody fusion,TLIF)与经后路椎体间融合术(posterior lumbar interbody fusion,PLIF)对退行性腰椎滑脱合并腰椎管狭窄患者临床疗效及安全性。方法:选择2013年6月到2015年6月我院收治的90例退行性腰椎滑脱合并腰椎管狭窄患者,随机分为TLIF组和PLIF组,各45例。TLIF组患者给予TLIF治疗,PLIF组患者给予PLIF治疗。记录并比较两组患者手术时间、术中失血量、术后引流量及术后卧床时间。评价并比较两组患者治疗前后视觉疼痛评分(visual analogue scale,VAS)和Oswestry功能不良指数(oswestry disability index,ODI)。记录并比较两组患者治疗后神经根损伤、感染、硬膜囊破裂等并发症发生情况。结果:TLIF组患者的手术时间、术中失血量、术后引流量及术后卧床时间均明显小于PLIF组,均具有显著性差异(P0.05)。治疗前,两组患者VAS、ODI评分,相比均无显著性差异(P0.05);治疗后,两组患者VAS、ODI评分均明显小于治疗前,且TLIF组患者的VAS、ODI评分均明显小于PLIF组,均具有显著性差异(P0.05)。TLIF组患者的并发症发生率明显低于PLIF组,均具有显著性差异(X~2=3.873,P=0.049)。结论:相比于PLIF,TLIF治疗退行性腰椎滑脱合并腰椎管狭窄患者的临床疗效显著,有助于腰椎功能的恢复,并发症发生率较低,值得在临床上推广应用。     

经后路椎体间融合术与经椎间孔椎体间融合术治疗老年退行性 腰椎滑脱合并腰椎管狭窄的疗效

目的：研究经后路椎体间融合术（PLIF）与经椎间孔椎体间融合术（TLIF）治疗老年退行性腰椎滑脱合并腰椎管狭窄症的临 床疗效。方法：选取2011 年12 月到2014 年12 月我院收治的老年退行性腰椎滑脱合并腰椎管狭窄症患者40 例,根据手术方式 将患者分为PLIF组和TLIF组,比较两组手术时间、术中出血量、术后引流量、术后卧床时间、视觉疼痛评分（VAS）、Oswestry功能 不良指数（ODI）以及并发症的发生率。结果：TLIF组术中出血量、术后引流量及术后卧床时间均显著优于PLIT 组,差异具有统计 学意义（P＜ 0.05）;两组手术时间差异无统计学意义（P＞0.05）;两组术后半年VAS评分及ODI评分均显著优于手术前,差异具有 统计学意义（P＜0.05）;但两组之间比较,差异无统计学意义（P＞0.05）;TLIF 组并发症发生率显著低于PLIF 组,差异具有统计学 意义（P＜ 0.05）。结论：TLIF治疗老年退行性腰椎滑脱合并腰椎管狭窄症具有较好的临床疗效,且术后并发症较少。     

腰椎间融合器植入术治疗腰椎退行性疾病的临床疗效

目的:观察腰椎融合术结合腰椎间融合器植入对腰椎退行性疾病的治疗效果及对预后评估。方法:选择我院2013年1月至2014年1月收治的54例腰椎退行性疾病患者为研究对象,随机将其分为两组,对照组患者行单纯椎间植骨融合术,实验组患者给予腰椎融合术结合腰椎间融合器植入治疗,对两组患者的手术时间、手术失血量、住院天数、融合率及并发症情况进行观察,同时对术前、术后三个月均应用VAS评分、ODI评分评估患者恢复情况。结果:实验组融合率明显高于对照组,但实验组手术时间较对照组长,差异具有统计学意义(P0.05);两组术中出血量及住院天数无统计学意义(P0.05);与术前比较,两组患者VAS评分、ODI评分均明显降低,差异具有统计学意义(P0.05);与对照组比较,实验组术后VAS评分和ODI评分降低更明显,差异具有统计学意义(P0.05);疗效与并发症比较,实验组优于对照组(P0.05)。结论:腰椎融合术结合腰椎间融合器植入治疗腰椎退行性疾病临床疗效显著且安全性高,对患者预后较好。     

单、双枚椎间融合器在单节段腰椎后路融合术中的应用效果比较

目的:比较腰椎后路融合术(PLIF)单、双枚椎间融合器(Cage)的使用对远期疗效的影响。方法:回顾我院2004-2011年间164例因腰椎退变疾病行单节段PLIF患者的临床资料,按Cage数目将其分为单Cage组(114例)与双Cage组(50例)。获得其住院资料和术后2年以上临床与影像学随访资料并比较分析。结果:平均随访时间47.5个月。两组间的年龄、性别、术前JOA评分、术后随访时间的差别无显著性(P0.05),但单Cage组失血量更低(P0.05),但随访时相对椎间隙高度低于双Cage组(P0.05);而两组间JOA评分改善率、随访时JOA评分、优良率、手术耗时、住院天数、并发症发生率的差别无显著性(P0.05)。结论:PLIF中单、双Cage的使用均能获得满意的疗效与安全性,与双Cage相比,单Cage手术失血更少,但术后远期相对椎间隙高度更低,对于这类患者应加强随访并警惕断钉等并发症的发生。     

微创经椎间孔及后路腰椎椎间融合术对腰椎滑脱症患者术后隐性失血的 影响

目的:探究微创经椎间孔腰椎间融合术(MIS-TLIF)与后路腰椎椎间融合术(PLIF)对腰椎滑脱症患者术后隐性失血的影响。方法:选取2014年03月~2014年08月腰椎滑脱症患者共48例,其中行MIS-TLIF术治疗患者23例,行PLIF术治疗患者25例,记录两组手术相关指标,及手术前后红细胞平均压积(Hct),依据Gross循环血量线性方程计算患者失血总量及隐性失血量,比较两组患者术后并发症情况。结果:MIS-TLIF组手术时间长于PLIF组(P0.05),而住院时间明显少于PLIF组(P0.05);MIS-TLIF组患者隐性失血量低于PLIF组(P0.05);MIS-TLIF组术后并发症发生率低于PLIF组(P0.05)。结论:与传统PLIF术式相比,MIS-TLIF治疗腰椎滑脱症具有隐性失血少,术后并发症少,恢复快的优点,值得临床推广。     

微创腰椎后路减压融合术与传统全椎板切除术治疗老年腰椎管狭窄的疗效对比分析

目的:对老年腰椎管狭窄的两种治疗方式,微创腰椎后路减压融合术和传统全椎板切除术的治疗疗效进行比较,以及研究其临床应用价值。方法:选取2009年7月至2013年1月来我院治疗的76例老年腰椎管狭窄症患者,其中43例采用微创腰椎后路减压融合术(A组),33例患者接受全椎板切除手术(B组)。对所有患者进行术后随访6个月~2年,平均随访时间1年零7个月。比较分析两组的手术情况、术后不良反应发生率及JOA评分情况。结果:A组的患者手术切口小,术中出血量少及住院时间缩短,并且较B组差异有统计学意义(P0.05);两组患者发生不良反应的情况差异无统计学意义(P0.05);A组患者的JOA评分明显优于B组患者,说明A组疗效优于B组。结论:老年腰椎管狭窄患者采用微创腰椎后路减压融合手术方法创口小,术中出血量少,降低术后不良反应发生的风险,疗效明显,值得推广应用。     

改良后路腰椎体间融合术治疗腰椎管狭窄症的临床观察

目的:研究改良后路腰椎体间融合术(PLIF)治疗腰椎管狭窄症的临床疗效。方法:选取2010年7月到2014年7月我院收治的腰椎管狭窄症患者140例,按照随机数字表法将患者分为研究组和对照组,每组70例。研究组给予改良PLIF治疗,对照组给予传统PLIF治疗,比较两组手术时间、术中出血量、住院时间、术后下地时间,应用视觉模拟评分(VAS)评价术前、术后3个月、术后1年腰痛程度,应用Oswestry生活功能障碍指数(ODI)评分评价患者术前和术后1年的生活功能情况,并比较两组并发症的发生率。结果:两组手术时间、术中出血量比较无统计学意义(P0.05),研究组住院时间、术后下地时间显著短于对照组,差异具有统计学意义(P0.05);研究组术后3个月和术后1年VAS评分均显著低于对照组,差异具有统计学意义(P0.05);研究组术后1年ODI评分显著低于对照组,差异具有统计学意义(P0.05);研究组术后并发症发生率显著低于对照组,差异具有统计学意义(P0.05)。结论:改良PLIF治疗腰椎管狭窄症效果较PLIF好,能有效改善疼痛情况和日常生活,降低并发症的发生率。     

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)。     

MIS-TLIF结合钉棒系统治疗极外侧型腰椎间盘突出症的临床研究

目的:观察和比较使用通道下经椎间孔腰椎融合术(Minimally Invasive Transforaminal Lumbar Interbody Fusion;MIS-TLIF)与常规开放手术治疗极外侧型腰椎间盘突出症的临床疗效。方法:回顾性分析2012.01至2016.01经纳入及排除标准筛选后的共计61例腰椎间盘突出症患者。根据不同的手术方法,将上述患者分别纳入实验组(MIS-TLIF组)与对照组(常规开放手术组)。对患者手术前后的疼痛程度(VAS),功能障碍程度(JOA)及各围手术期指标(出血量,手术时间,透视次数,卧床时间,花费,并发症)进行统计学比较。结果:MIS-TLIF组与对照组患者在术前的VAS评分及JOA评分的比较中无显著性差异,经外科手术后,都有显著性改善(P0.05)且两组间无显著统计学差异(P0.05)。但MIS-TLIF组在出血量,卧床时间,并发症等指标中都显著优于对照组(P0.05)。结论:通道下经椎间孔腰椎融合术作为一种微创术式,能够显著改善极外侧型腰椎间盘突出症患者的临床症状,并具有其独有的优势和长处,在临床工作中可以进行进一步的使用和推广。     

Control of membrane fusion by phospholid head groups I. Phosphatidate/phosphatidylinositol specificity

We have studied the characteristics of fusion of large unilamellar vesicles composed of phosphatidate and phosphatidylinositol alone and in mixtures with other naturally occurring phospholipids. Fusion was induced by the addition of Ca²⁺ or Mg²⁺ and was monitored by detecting the mixing of aqueous vesicle contents. Release of vesicle contents was measured by dequenching of carboxyfluorescein fluorescence. Aggregation was monitored by 90° light scattering. The results indicated striking differences with respect to the fusion capacity of the different vesicles. Phosphatidate vesicles fuse in the presence of both Ca²⁺ and Mg²⁺ at threshold concentration ranges of 0.03–0.1 mM (Ca²⁺) and 0.07–0.15 mM (Mg²⁺) depending on the pH of the medium, 8.5-6.0, respectively. In contrast, phosphatidylinositol vesicles do not fuse with either Ca²⁺ or Mg²⁺ even at 50 mM concentrations, in spite of aggregation induced by both cations in the range of 5–10 mM. A large difference in terms of fusion capacity is retained even when these two phospholipids are mixed with phosphatidylserine, phosphatidylethanolamine and phosphatidylcholine in 2 : 2 : 4 : 2 molar ratios. The results are discussed in terms of the molecular mechanism of membrane fusion and the possible role of the metabolic interconversion of phosphatidylinositol to phosphatidate as an on-off control system for membrane fusion phenomena involved in secretion.     

Anti-human red cell monoclonal antibodies produced by macaque-mouse heterohybridomas: their reactivity with human and nonhuman primate erythrocytes.

Eighteen monoclonal antibodies (Mabs) against human red blood cells (RBCs) produced by macaque mouse heterobybridomas gave uniformly positive reactions with all human samples except for some with particular null phenotypes. Based on reactions with latter cells, the human antigenic targets of 11 antibodies could be identified: six were specific for glycophorin-related antigens (Wr(b), En(a), Ge4), and each of the live remaining antibodies showed one of the following specificities: CD55, CD44, CD59, Kell, and Rh proteins. Four Mabs recognized the Vc antigen of the chimpanzee V-A-B-D system. Six macaque Mabs detected polymorphisms in chimpanzee, gorilla, orangutan, and gibbon that did not correspond to any known blood group in these animals, while other Mabs gave monomorphic reactions with ape RBCs. The reagents produced by macaque hybridomas are useful tools not only for human blood grouping tests, but also for tracing the relationships among blood group antigens of man and anthropoid apes.     

Control of membrane fusion by phospholipid head groups II. The role of phosphatidylethanolamine in mixtures with phosphatidate and phosphatidylinositol

Membrane fusion induced by Ca²⁺ and Mg²⁺ in large unilamellar vesicles composed of mixtures of phosphatidylethanolamine with phosphatidate and phosphatidylinositol was studied by means of a fluorescence assay for the intermixing of internal aqueous contents of the vesicles. The threshold concentrations of Ca²⁺ or Mg²⁺ required for fusion increased only moderately when up to 80 mol% phosphatidylethanolamine was included with phosphatidate at pH 7.4, but no fusion could be detected in vesicles containing 70 mol% phosphatidylcholine even at high concentrations of Ca²⁺ or Mg²⁺. Phosphatidate-phosphatidylethanolamine (1 : 4) vesicles could be induced to fuse by 0.1 mM Ca²⁺ in the presence of a Mg²⁺ concentration which alone was insufficient for fusion. When equimolar amounts of phosphatidylethanolamine was included with phosphatidylinositol, the vesicles were susceptible to fusion by Ca²⁺, although pure phosphatidylinositol vesicles themselves merely aggregate and do not fuse (Sundler, R. and Papahadjopoulos, D. (1981) Biochim. Biophys. Acta 649, 743–750, accompanying paper). The role of phosphatidylethanolamine acyl chains, and hence the possible involvement of the bilayer-hexagonal (H_II) transition in membrane fusion, was examined by the temperature dependence of Ca²⁺-induced fusion in phosphatidylinositol-dimyristoylphosphatidylethanolamine (1 : 1) vesicles. Fusion was strictly dependent on the gel-liquid crystalline transition of the mixture and not on the phase behavior of the phosphatidylethanolamines. Comparable fusion rates were obtained for both egg yolk phosphatidylethanolamine and dimyristoylphosphatidylethanolamine at 50°C. As the dimyristoylphosphatidylethanolamine does not convert to a non-bilayer phase in this temperature range, we conclude that the bilayer-hexagonal transition is not necessary for membrane fusion. We propose that the dehydration characteristics of the phospholipids and their metal ion complexes are the critical factors determining fusion suceptibility of phospholipid membranes.     

Group fusion: the impact of winner, loser, and bystander effects on hierarchy formation in large groups

We present the results of a series of computer simulations thatexamined the impact of winner, loser, and bystander effectson hierarchy formation in fused groups. These effects and theirimplications for hierarchy structure and aggressive interactionswere first examined in small four-member groups. Subsequentto this, the two small groups were fused into a single largergroup. Further interactions took place in this fused group,generating a new hierarchy. Our models demonstrate clearly thatwinner, loser, and bystander effects strongly influence boththe structure and types of interactions that emerge from thefusion of smaller groups. Four conditions produced results inwhich the same general patterns were uncovered in pre- and postfusiongroups: (1) winner effects alone, (2) bystander loser effectsalone, (3) winner and bystander winner effects operating simultaneously,and (4) all four effects in play simultaneously. Outside thisparameter space, hierarchy structure and the nature of aggressiveinteractions differed in pre- and postfusion groups. When onlyloser effects were in play, one of the two clear alphas fromthe prefused groups dropped in rank in the eight-member fusedgroup. When bystander winner effects were in play, it was difficultto rank any of the eight individuals in the fused group, andplayers interacted almost exclusively with those that were notin their original four-member group. When loser and bystanderloser effects operated simultaneously, two top-ranking individualsemerged in the fused groups, but the relative rank of the otherplayers was difficult to assign.     

Group extinction and fusion in free-ranging vervet monkeys

Three cases of group fusion were observed among vervet monkeys in Amboseli National Park, Kenya, during the 1984 drought. In all cases, group fusion involved the migration of at least two females into a small neighboring group. Following migration, the females' natal groups ceased to exist. Although migrants initially assumed low ranks, none received high rates of aggression, and two rose in rank 6 months after their arrival. Migrant females appeared to employ a number of “strategies,” including grooming, allomothering, participation in intergroup encounters, and the formation of coalitions against males and each other to hasten integration. Results suggest that the causes of male and female migration differ fundamentally, and that group fusion occurs primarily in response to the inability of small groups of females to compete successfully with other groups for resources.     

Effects of fasting on collective movement and fission–fusion dynamics in both homogeneous and heterogeneous shoals of a group-living cyprinid fish species

The present study aimed to reveal the effect of fasting (21 days) on collective movement and interaction dynamics in both homogeneous (eight members fed a commercial diet or deprived of food) and heterogeneous (four fed + four starved members) shoals of juvenile qingbo (Spinibarbus sinensis). The authors of this study measured the shoaling behaviour in both a commonly used rectangular open arena with no spatial complexity and a radial arm maze. When measured in the open arena, the starved shoals had a faster swimming speed and acceleration rate and a longer interindividual distance than the fed shoals, possibly because of the elevated foraging motivation. Nonetheless, the values of the heterogeneous groups were similar to those of the fed groups. Furthermore, in contrast to the fish in homogeneous shoals, the starved fish in heterogeneous shoals showed a slower acceleration rate and speed than fed members in heterogeneous shoals. These results, combined with the relationships of variables at the among- and within-shoal levels, suggested that starved fish limited their motion in heterogeneous shoals to maintain group cohesion but that the fed fish contributed more to maintaining shoal structure, possibly because of the higher energy expenditure required for movement changes. When monitored in a radial arm maze, starved shoals showed more fission–fusion episodes without sacrificing group cohesion, as they adaptively adjusted the frequency and duration of each majority choice. The among-shoal variation revealed that the heterogeneous groups showed less variation in the open arena but more variation in the radius maze than did the homogeneous groups. This difference might arise because dominant members have opposite effects on shoal behaviour and consensus decisions. In conclusion, the present study showed opposite effects of feeding states on collective behaviour between homogeneous and heterogeneous shoals, possibly because of the complicated interactions among members with different energy storage levels and foraging motivations. Furthermore, the heterogeneous groups showed a difference between shoal behaviour in the open area and exploration in the radial arm maze. Future studies manipulating the personality composition of starved and fed members of heterogeneous groups might yield interesting results.     

Do sampling method and sample size affect basic measures of dolphin sociality?

Although the fission–fusion social patterns of bottlenose dolphins have been described, defining and measuring sociality is difficult. No study to date has investigated how much data are necessary to accurately depict social patterns in a fission–fusion species and whether this amount differs depending on the measure used. Using the long-term Shark Bay bottlenose dolphin study we examined four different measures of sociality for mothers and dependent calves ( n = 89). Our objectives were to determine (1) the amount of observation time necessary to accurately depict sociality using these measures, (2) correlations among these measures, and (3) if sampling method affects the validity of sociality measurements. A minimum of 10 h and 5 h of observations, respectively, were necessary to accurately capture calf associate numbers and percent time alone. A pairwise comparison of calf sociality measurements from focal and survey data found that calves spent from 0% to 70.2% of their time alone in focal data, but these same calves spent only 0%–7.7% alone in survey data. These findings indicate that (1) results differ depending on the type of sampling method and (2) the amount of observation time necessary to adequately capture individual variation differs depending on the measure of sociality.     

Troop Extinction and Female Fusion in Wild Japanese Macaques in Yakushima

We observed three cases of troop extinction and two cases of female fusion in the wild population of Japanese macaques on Yakushima Island, Japan. Troops P and T decreased in size relatively slowly over a few years until each troop consisted of only three monkeys. Several months later, the remaining adult female of P merged with the adjacent troop S, followed by the remaining female of T. S subsequently also decreased in size and disappeared about 2 years later. In the early stage of troop decline, the mortality rate of adult females was as low as in a growing troop, but the birthrate was quite low. In the late stage of troop decline, the mortality rate increased and the birthrate remained low. An important factor leading to troop extinction may be an increase in population density and the resulting increase in intergroup competition. During the period when P and T declined and ceased to exist, the range of the adopted troop shifted to cover their previous ranges. In the fused troop, there was no severe aggression directed towards the immigrant females or harassment from residents of the adopted troop and there was affiliative social interaction between the immigrant females and resident members. These results agree with previous reports on female fusion: it occurs when the shrinking group consists of one or no adult member, and the immigrant females are not at a severe disadvantage in their adoptive group. A possible benefit for immigrant females is to avoid disadvantage of one-adult group in conflict with conspecifics. A possible cost for immigrant females is transfer to the other troop or to unfamiliar area or both. The cost to transfer to another group may not be high because the members of the adoptive troop are relatively tolerant to immigrants. The cost to transfer to unfamiliar range may be minimized by immigration to the troop whose range shifted to the immigrants' former range.