椎弓根系统治疗胸腰椎骨折的临床探讨

目的:探讨对椎弓根系统治疗胸腰椎骨折的临床疗效。方法:本组98例均采用后路减压、植骨及椎弓根系统内固定。结果:术中C臂及术后x摄片见植入椎弓根螺钉平行于椎体上下终板95例,3例有4°-6°的成角。伤前后突畸形平均25°,术后矫正至平均4°。术前伤椎压缩50%-75%,术后恢复至89%-95%。获随访1-3年,内固定松动2例,拔钉3例,断钉2例,椎体高度及Cobb角丢失5°-9°有6例。慢性腰痛12例。神经功能除A级有7例未恢复外,其余病例均有1-3级的恢复。结论:后路手术较完善,适应范围广,创伤小,对屈曲压缩型、骨折脱位型的整复及下腰椎的固定优于前路手术。特别强调准确的椎弓根植入技术及有效的植骨融合是保证后路手术脊柱稳定和防止远期并发症的主要手段。     

脊髓IL-6在脊神经结扎模型所引起的热痛敏中的作用

目的：研究脊髓中IL-6在大鼠脊神经结扎（spinal nerve ligation,SNL）所引起的神经病理性痛中的作用。方法：建立大鼠SNL模型,以ELISA法检测脊髓IL-6含量。鞘内分别给予外源性IL-6,以及IL-6的中和抗体以拮抗内源性的IL-6,观察大鼠对热刺激的缩足反应潜伏期（paw withdrawal latencies,PWL）。结果：①SNL手术后3天和7天,脊髓IL-6水平明显上调（P〈0.05）。②手术7天后给予外源性IL-6不能明显引起假手术组的PWL变化,但是与给予生理盐水的假手术组和SNL组相比,给予IL-6的SNL组PWL明显下降（P〈0.05）。③手术7天后给予IL-6的中和抗体不能引起假手术组的PWL改变,但是与给予生理盐水的SNL组相比,给予中和抗体的SNL组PWL明显上升（P〈0.05）。结论：IL-6在脊神经结扎模型所引起的神经病理性痛中发挥促伤害性作用     

经皮穿刺椎弓根螺钉内固定治疗胸腰段脊柱骨折的疗效及对患者氧化应激与术后疼痛的影响

摘要 目的：探讨经皮穿刺椎弓根螺钉内固定治疗胸腰段脊柱骨折的疗效及对患者氧化应激及术后疼痛的影响。方法：选取本院2017年4月到2021年4月在本院诊治的胸腰段脊柱骨折患者126例作为研究对象,依据手术方式的不同将其分为微创组与开放组各63例。微创组给予经皮穿刺椎弓根螺钉内固定治疗,开放组给予开放式椎弓根内固定术治疗。结果：微创组的切口长度等围手术指标均少于开放组（P<0.05）;微创组术后1 d、3 d、5 d与7 d的疼痛视觉模拟评分（VAS）低于开放组（P<0.05）;微创组术后7 d的的感染、切口愈合不良、内固定移位、神经根脊髓压迫等并发症发生率为3.2 %,低于开放组的22.2 %（P<0.05）;两组术后7 d的血清P物质（SP）,和β-内啡肽（β-EP）含量高于术前1 d,微创组高于对照组（P<0.05）;两组术后7 d的血清谷胱甘肽过氧化物酶（GSH-Px）与晚期氧化蛋白产物（AOPP）含量高于术前1 d,微创组高于开放组（P<0.05）。结论：经皮穿刺椎弓根螺钉内固定治疗胸腰段脊柱骨折可有效控制氧化应激指标、疼痛介质水平,减少创伤,减轻术后疼痛,降低并发症,有利于患者康复。     

罗哌卡因抑制脊髓胶质细胞的激活而减轻CCI大鼠的神经病理性疼痛

目的:通过硬膜外注射局麻药罗哌卡因,评价其对神经病理性疼痛模型大鼠的作用及其机制.方法:在坐骨神经损伤神经病理性疼痛大鼠模型(CCI)术后7d,进行硬膜外置管手术,在术后8d和11d由硬膜外导管注入罗哌卡因,观测CCI大鼠机械痛阈(PWT)和脊髓后角纤维酸性蛋白(GFAP)的变化.结果:硬膜外注射罗哌卡因能够升高CCI大鼠患肢的机械痛阈,降低脊髓后角GFAP的表达.结论:在CCI大鼠模型硬膜外注射罗哌卡因可以较长时间抑制脊髓胶质细胞的激活,从而减轻神经病理性疼痛.     

PER3 VNTR circadian gene is associated with arterial stiffness variable in healthy subjects

It is established that arterial stiffness is one of the risk factors for cardiovascular morbidity and mortality. We tested the hypothesis that alterations in genetic structure of circadian gene PER3 could affect hemodynamic parameters. Previously, we showed that CLOCK gene variants had a pronounced effect on arterial vasculature. Augmentation index (AIx) was significantly higher in the PER3^5/5 group than in the PER3^4/4 and PER3^4/5 groups, whereas other hemodynamic parameters, such as RWTT, PWV, and ASI, were not significantly different.     

氟氏佐剂诱导大鼠慢性前列腺炎疼痛模型中L5-S2脊髓中枢小胶质细胞的活化

目的:观察大鼠慢性前列腺炎疼痛模型中L5-S2脊段背角小胶质细胞活化的变化.方法:通过前列腺完全弗氏佐剂注射制作大鼠慢性前列腺炎疼痛模型,对照组注射生理盐水,观察时间为0、4、12、24d,用热辐射痛阈测定法和前列腺病理进行疼痛模型鉴定,采用实时荧光定量RT-PCR检测L5-S2脊段后角中小胶质细胞标志物IBA-1的表达.结果:成功建立慢性前列腺炎疼痛大鼠模型,并观察到L5-S2脊髓背角中存在小胶质细胞的活化.结论:慢性前列腺炎疼痛可以引起L5-S2脊髓中枢小胶质细胞活化,小胶质细胞异常活化可引起神经炎性疼痛,有可能与慢性前列腺炎疼痛的持续和泛化有密切关系.     

脊髓细胞外调节激酶1/2在大鼠后足切割痛中的表达和作用

目的：探讨大鼠后足切割后脊髓ERK的表达情况。方法：以大鼠右后足切割作为急性疼痛模型;用免疫组织化学法测试脊髓磷酸化ERK（pERK）表达情况。ERK抑制剂U0126（1μg）在切割前20min或切割后20min鞘内注射。用von Frey纤维测试大鼠机械性痛敏。结果：大鼠后足切割后1min,在切割侧L4-L5脊髓浅层背侧角（板层Ⅰ和板层Ⅱ）ERK被迅速地激活,并在5min达到峰值,随后恢复到基础值。切割前鞘内给予U0126能显著减轻机械性痛敏,然而,切割后鞘内给予U0126对机械性痛敏的作用并不明显。结论：脊髓ERK在大鼠后足切割痛中产生机械性痛敏发挥了重要的作用。     

减压AF系统内固定治疗胸腰椎爆裂性骨折伴脊髓损伤的疗效

目的:探讨减压AF系统内固定治疗胸腰椎爆裂性骨折伴脊髓损伤的疗效。方法:本研究选取了82例胸腰椎爆裂性骨折伴脊髓损伤的患者,年龄20-67岁,采用减压AF系统内固定方式治疗,对患者术前及术后6个月,12个月的伤椎椎体高度比,Cobb's角,Frankel标准分级,VAS评分,Oswestry功能障碍指数等指标进行检测,以评价减压AF系统内固定的疗效。结果:与术前相比,患者术后6个月,12个月的伤椎体高度比值明显升高,Cobb角值明显下降(P0.05)。术后6个月与12个月伤椎椎体高度比值和Cobb角值改善情况相比,差异没有统计学意义(P0.05)。神经功能恢复方面,16例恢复到了E级,术后A级有4例未恢复,Frankel分级为A的患者术后有效恢复率为90.2%;B级有2例未恢复,B级术后有效恢复率89.5%。C级和D级术后有效恢复率均为100%。患者术后6个月,12个月的VAS和ODI值均低于术前分值(P0.05),且术后12个月ODI值与术后6个月的相比,有显著性差异(P0.05)。结论:减压AF系统内固定法对胸腰椎爆裂性骨折及脊髓神经损伤情况具较好的治疗效果,患者术后痛觉感受明显降低,下腰功能恢复良好,治疗效果满意。     

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。     

Body movements during the off-ice execution of back spins in figure skating

Using an optoelectronic motion capture system, we quantitatively assessed the arrangement of body segments and the displacement of the horizontal projection of the center of mass (CM) in seven skaters performing off-ice back spins on a rotating device (spinner). The position of the CM at the beginning of the spins was not a determining factor, but its rapid stabilization towards the center of the spinner, together with the achievement of a stable arrangement of trunk and limbs, was crucial to get the dynamic equilibrium, necessary for a lasting performance. At full spinning, however, there was an indicative variety of individual body postures. A final deceleration, associable with the loss of body equilibrium, was detected in the last spin of most of skaters.In conclusion, the current investigation demonstrated that the off-ice execution of back spin, a critical movement of ice skating, can be measured in laboratory, thus providing quantitative information to both the skaters and the coaches. The analysis is not invasive, and it may be proposed also for longitudinal evaluations of skating and postural training.     

Accuracy and reproducibility of bending stiffness measurements by mechanical response tissue analysis in artificial human ulnas

Osteoporosis is characterized by reduced bone strength, but no FDA-approved medical device measures bone strength. Bone strength is strongly associated with bone stiffness, but no FDA-approved medical device measures bone stiffness either. Mechanical Response Tissue Analysis (MRTA) is a non-significant risk, non-invasive, radiation-free, vibration analysis technique for making immediate, direct functional measurements of the bending stiffness of long bones in humans in vivo. MRTA has been used for research purposes for more than 20 years, but little has been published about its accuracy. To begin to investigate its accuracy, we compared MRTA measurements of bending stiffness in 39 artificial human ulna bones to measurements made by Quasistatic Mechanical Testing (QMT). In the process, we also quantified the reproducibility (i.e., precision and repeatability) of both methods. MRTA precision (1.0±1.0%) and repeatability (3.1±3.1%) were not as high as those of QMT (0.2±0.2% and 1.3+1.7%, respectively; both p<10⁻⁴). The relationship between MRTA and QMT measurements of ulna bending stiffness was indistinguishable from the identity line (p=0.44) and paired measurements by the two methods agreed within a 95% confidence interval of ±5%. If such accuracy can be achieved on real human ulnas in situ, and if the ulna is representative of the appendicular skeleton, MRTA may prove clinically useful.     

阿米替林对脊髓电刺激治疗幻肢痛疗效的影响

目的：本研究旨在探讨阿米替林干预对脊髓电刺激（SCS）治疗幻肢痛疗效的影响。方法：研究对象为2007年1月至2009年6月在我科行SCS置入术且符合入组标准并自愿参加研究的幻肢痛患者,共获7例。术后SCS均开启,阿米替林治疗在术后1个月时开始。疼痛、情绪、生活质量评估采用视觉模拟评分法（visual analogue scales,VAS法）,现时疼痛强度评分法（presentpain intensity。PPI）,综合性医院焦虑抑郁量表（The Hospital Anxiety and Depression Scale,HAD）,疼痛失能指数（Pain disability index,PDI）。结果：（1）开启SCS后患者的疼痛、抑郁焦虑情绪及生活质量均得到显著改善。（2）所有患者在使用阿米替林治疗以后疼痛、情绪及生活质量也显著改善。结论：阿米替林能显著提高SCS对幻肢痛的疗效。     

Methods for assessment of trunk stabilization,a systematic review

Trunk stabilization is achieved differently in patients with low back pain compared to healthy controls. Many methods exist to assess trunk stabilization but not all measure the contributions of intrinsic stiffness and reflexes simultaneously. This may pose a threat to the quality/validity of the study and might lead to misinterpretation of the results. The aim of this study was to provide a critical review of previously published methods for studying trunk stabilization in relation to low back pain (LBP). We primarily aimed to assess their construct validity to which end we defined a theoretical framework operationalized in a set of methodological criteria which would allow to identify the contributions of intrinsic stiffness and reflexes simultaneously. In addition, the clinimetric properties of the methods were evaluated. A total of 133 articles were included from which four main categories of methods were defined; upper limb (un)loading, moving platform, unloading and loading. Fifty of the 133 selected articles complied with all the criteria of the theoretical framework, but only four articles provided information about reliability and/or measurement error of methods to assess trunk stabilization with test–retest reliability ranging from poor (ICC 0) to moderate (ICC 0.72). When aiming to assess trunk stabilization with system identification, we propose a perturbation method where the trunk is studied in isolation, the perturbation is unpredictable, force controlled, directly applied to the upper body, completely known and results in small fluctuations around the working point.     

下颈椎骨折脱位合并急性脊髓损伤的手术方式选择及疗效对比

目的:分析不同手术方式处理下颈椎骨折脱位合并急性脊髓损伤疗效。方法:选取2012年10月-2015年10月本院收治的110例下颈椎骨折脱位合并急性脊髓损伤患者作为研究对象。A组36例实施前路手术,B组44例实施后路手术,C组30例实施前后路联合手术。比较三种手术方式的治疗效果。结果:术后12个月,三组患者Cobb角、椎体水平位移距离均较术前显著改善(P0.05),C组患者改善程度显著高于A、B组(P0.05);C组患者JOA评分优良率显著高于A、B组(P0.05);在术后随访过程中,三组患者并发症总发生情况无统计学差异(P0.05)。结论:前后路联合手术治疗可更好地恢复颈椎解剖结构,促进脊髓神经功能恢复,值得在临床工作中进行推广。     

阿米替林对脊髓电刺激治疗幻肢痛疗效的影响

目的:本研究旨在探讨阿米替林干预对脊髓电刺激(SCS)治疗幻肢痛疗效的影响。方法:研究对象为2007年1月至2009年6月在我科行SCS置入术且符合入组标准并自愿参加研究的幻肢痛患者,共获7例。术后SCS均开启,阿米替林治疗在术后1个月时开始。疼痛、情绪、生活质量评估采用视觉模拟评分法(visualanaloguescales,VAS法),现时疼痛强度评分法(presentpainin-tensity,PPI),综合性医院焦虑抑郁量表(The Hospital Anxiety and Depression Scale,HAD),疼痛失能指数(Pain disability index,PDI)。结果:(1)开启SCS后患者的疼痛、抑郁焦虑情绪及生活质量均得到显著改善。(2)所有患者在使用阿米替林治疗以后疼痛、情绪及生活质量也显著改善。结论:阿米替林能显著提高SCS对幻肢痛的疗效。     

Alterations in trunk bending stiffness following changes in stability and equilibrium demands of a load holding task

The contribution of the trunk neuromuscular system (TNS) to spine stability has been shown in earlier studies by characterizing changes in antagonistic activity of trunk muscles following alterations in stability demands of a task. Whether and/or how much such changes in the response of TNS to alteration in stability demand of the task alter spinal stiffness remains unclear. To address this research gap, a repeated measure study was conducted on twenty gender-balanced asymptomatic individuals to evaluate changes in trunk bending stiffness throughout the lumbar spine’s range of flexion following alterations in both stability and equilibrium demands of a load holding task. Trunk bending stiffness was determined using trunk stiffness tests in upright posture on a rigid metal frame under different equilibrium and stability demands on the lower back. Increasing the stability demand by increasing the height of lifted load ∼30 cm only increased trunk bending stiffness (∼39%) over the lower range of lumbar flexion and under the low equilibrium demand condition. Similarly, increasing the equilibrium demand of the task by increasing the weight of lifted load by 3.5 kg only increased trunk bending stiffness (55%) over the low range of lumbar flexion and under the low stability demand condition. Our results suggest a non-linear relationship between changes in stability and equilibrium demands of a task and the contribution of TNS to trunk bending stiffness. Specifically, alterations in TNS response to changes in stability and equilibrium demand of a given task will increase stiffness of the trunk only if the background stiffness is low.     

Cocontraction measured with short-range stiffness was higher in obstetric brachial plexus lesions patients compared to healthy subjects

We suggest short range stiffness (SRS) at the elbow joint as an alternative diagnostic for EMG to assess cocontraction.Elbow SRS is compared between obstetric brachial plexus lesion (OBPL) patients and healthy subjects (cross-sectional study design). Seven controls (median 28 years) and five patients (median 31 years) isometrically flexed and extended the elbow at rest and three additional torques [2.1, 4.3, 6.4 N m] while a fast stretch stimulus was applied. SRS was estimated in silico using a neuromechanical elbow model simulating the torque response from the imposed elbow angle.SRS was higher in patients (250 ± 36 N m/rad) than in controls (150 ± 21 N m/rad, p = 0.014), except for the rest condition. Higher elbow SRS suggested greater cocontraction in patients compared to controls. SRS is a promising mechanical alternative to assess cocontraction, which is a frequently encountered clinical problem in OBPL due to axonal misrouting.