不同性别腰椎间盘突出症患者脊柱-骨盆矢状位参数差异研究

目的:探讨不同性别腰椎间盘突出症(Lumbar disc herniation,LDH)患者脊柱-骨盆矢状位参数差异特点。方法:回顾性分析2014年1月至2016年3月在第四军医大学西京医院脊柱外科因LDH住院手术治疗,且具有术前脊柱站立位全长X线片的患者共222例,其中男l25例,女97例,年龄20-80岁,平均年龄50.97岁;应用图形分析软件Surgimap进行参数测量,在站立位全长脊柱侧位x线片上测量参数包括:骨盆投射角(Pelvic incidence,PI)、骨盆倾斜角(Pelvic tilt,PT)和骶骨倾斜角(Sacral slope,SS),胸椎后凸角(Thoracic Kyphosis,TK)、腰椎前凸角(Lumbarlordosis,LL)、矢状面垂直轴(Sagittal vertical axis,SVA)。根据性别分组,比较不同性别之间各参数、发病累及节段、不同年龄段发病率之间的差异。应用SPSS 19.0对数据进行统计分析。结果:LDH患者男女性别之间比较发现,男性PI 43.82±8.66°,女性PI 47.75±8.50°,P=0.001(P0.05),具有统计学显著性差异,年龄、PT、SS、LL、TK、SVA无显著性差异;不同性别LDH患者所累及节段分别进行统计,P=0.480(P0.05),无统计学显著性差异;不同性别LDH患者不同年龄段的发病率进行统计,应用Pearson卡方检验进行统计分析,P=0.024(P0.05),具有统计学显著性差异。然后将各年龄段发病率通过u检验进行比较,20-40岁段P=0.023(P0.05),具有统计学显著性差异。结论:PI也可能与LDH的发病有关,男性患者PI小于女性患者,可能是在LDH发病中男性多于女性,且男性更早发病的一个重要原因。     

土耳其斯坦东毕吸虫的扫描电镜观察

血吸虫类中如血居科(sanguinicolidae)的Aporocotyle simplex Odhner,1900、裂体科(Schistosomatidae)的日本血吸虫(Schistosoma japonicum)曼氏血吸虫(S.mansoni)及埃及血吸虫(S.haematobium)等多种血吸虫均经扫描电镜观察(Johnson and Moriearts,1969;Silk et al., 1969;Robson and Erasmus, 1970; Miller et al., 1972; Kuntz et al.,1976、1977;Voge et al., 1978; Thulin, 1980;及何毅勋和马金鑫,1980等)。关于土耳其斯坦东毕吸虫[Orientobitharzia lurkestanica(skrjabin,1913)Dut et Srivastava,1955]的体表扫描电镜尚无报告,而只见有此虫种体壁及肠管的透射电镜观察的资料(Lavrov and Fedoseenke,1978)。本文部分作者最近在内蒙东部兴安岭以南部分地区进行牛羊土     

Rapid spinogenesis of pyramidal neurons induced by activation of glucocorticoid receptors in adult male rat hippocampus

Modulation of hippocampal synaptic plasticity by glucocorticoids has been attracting much attention, due to its importance in stress responses. Dendritic spines are essential for memory storage processes. Here, we investigated the effect of dexamethasone (DEX), a specific agonist of glucocorticoid receptor (GR), on density and morphology of dendritic spines in adult male rat hippocampus by imaging of Lucifer Yellow-injected spines in slices. The application of 100 nM DEX (stressful high concentration) induced rapid modulation of the density and morphology of dendritic spines in CA1 pyramidal neurons within 1h. The total spine density increased from 0.88 spines/microm (control) to 1.36 spines/microm (DEX-treated). DEX significantly increased the density of thin and mushroom type spines, however only a slight increase was observed for stubby and filopodium type spines. Because the presence of 10 microM cycloheximide, an inhibitor of protein synthesis, did not suppress the DEX effect, these responses are probably non-genomic. Western immunoblot analysis demonstrated the localization of classical type GR in Triton-insoluble synaptosomal fractions (enriched in postsynaptic membranes) from hippocampal slices, suggesting a possible action site of DEX at spines.     

Role of CT scan in theranostic and management of traumatic spinal cord injury

Traumatic spinal cord injury (TSCI) is a condition with suffering of neural structures from acute trauma with short-term or permanent sensory and motor problems. This study was conducted with the aim of determining the prevalence of TSCI in Tehran with emphasis on demographic characteristics of patients and to evaluate the effect of computed tomography (CT) in determining fracture type and severity grade of injury among TSCI patients. In a cross-sectional study, all TSCI and spinal fracture patients (N = 520) who referred to the main trauma center in Tehran, Iran, in 2013 and 2014 were selected. Radiography and CT scan were prepared and reported blindedly by two radiologists. Majority of the patients was 21–30 years male, married and their most common occupation was car driver. A significant difference was observed between gender and etiology (P = 0.001). The main etiology was traffic accident followed by falling from height. While the most common location of injury for males was thoracic vertebrae followed by lumbar vertebrae; for females it was lumbar followed by thoracic. Majority of patients had ASIA (American Spinal Injury Association) impairment scale of E (normal), followed by B (sensory incomplete). Most of the cases were hospitalized less than one week. Age of the patient and duration of hospitalization had a significant association (P = 0.015). The results showed that in traumatic spinal cord events, traffic accident and falling from height are the main etiologies; hence, authorities in Iranian health system could consider preventive policies to decline the load and TSCI effects in hospitals and population.     

Biomechanical consequences of running with deep core muscle weakness

The deep core muscles are often neglected or improperly trained in athletes. Improper function of this musculature may lead to abnormal spinal loading, muscle strain, or injury to spinal structures, all of which have been associated with increased low back pain (LBP) risk. The purpose of this study was to identify potential strategies used to compensate for weakness of the deep core musculature during running and to identify accompanying changes in compressive and shear spinal loads. Kinematically-driven simulations of overground running were created for eight healthy young adults in OpenSim at increasing levels of deep core muscle weakness. The deep core muscles (multifidus, quadratus lumborum, psoas, and deep fascicles of the erector spinae) were weakened individually and together. The superficial longissimus thoracis was a significant compensator for 4 out of 5 weakness conditions (p < 0.05). The deep erector spinae required the largest compensations when weakened individually (up to a 45 ± 10% increase in compensating muscle force production, p = 0.004), revealing it may contribute most to controlling running kinematics. With complete deep core muscle weakness, peak anterior shear loading increased on all lumbar vertebrae (up to 19%, p = 0.001). Additionally, compressive spinal loading increased on the upper lumbar vertebrae (up to 15%, p = 0.007) and decreased on the lower lumbar vertebrae (up to 8%, p = 0.008). Muscular compensations may increase risk of muscular fatigue or injury and increased spinal loading over numerous gait cycles may result in damage to spinal structures. Therefore, insufficient strength of the deep core musculature may increase a runner’s risk of developing LBP.     

Adaptive velocity-based six degree of freedom load control for real-time unconstrained biomechanical testing

Robotic biomechanics is a powerful tool for further developing our understanding of biological joints, tissues and their repair. Both velocity-based and hybrid force control methods have been applied to biomechanics but the complex and non-linear properties of joints have limited these to slow or stepwise loading, which may not capture the real-time behaviour of joints. This paper presents a novel force control scheme combining stiffness and velocity based methods aimed at achieving six degree of freedom unconstrained force control at physiological loading rates.     

Biomechanical allometry in hominoid thoracic vertebrae

Considerable differences in spinal morphology have been noted between humans and other hominoids. Although comparative analyses of the external morphology of vertebrae have been performed, much less is known regarding variations in internal morphology (density) and biomechanical performance among humans and closely related non-human primates. In the current study we utilize density calibrated computed tomography images of thoracic vertebral bodies from hominoids (n = 8-15 per species, human specimens 20-40 years of age) to obtain estimates of vertebral bone strength in axial compression and anteroposterior bending and to determine how estimates of strength scale with animal body mass. Our biomechanical analysis suggests that the strength of thoracic vertebral bodies is related to body mass (M) through power law relationships (y ∝ M^b) in which the exponent b is 0.89 (reduced major axis) for prediction of axial compressive strength and is equal to 1.89 (reduced major axis) for prediction of bending strength. No differences in the relationship between body mass and strength were observed among hominoids. However, thoracic vertebrae from humans were found to be disproportionately larger in terms of vertebral length (distance between cranial and caudal endplates) and overall vertebral body volume (p < 0.05). Additionally, vertebral bodies from humans were significantly less dense than in other hominoids (p < 0.05). We suggest that reduced density in human vertebral bodies is a result of a systemic increase in porosity of cancellous bone in humans, while increased vertebral body volume and length are a result of functional adaptation during growth resulting in a vertebral bone structure that is just as strong, relative to body mass, as in other hominoids.     

How do spinal segments move?

PurposeTo study and clarify the kinematics of spinal segments following cyclic torques causing axial rotation (T_z (t)), lateral-flexion (T_x (t)), flexion/extension (T_y (t)).MethodsA 6D--Measurement of location, alignment, and migration of the instantaneous helical axis (IHA) as a function of rotational angle in cervical, thoracic, and lumbar segments subjected to axially directed preloads.ResultsIHA retained an almost constant alignment, but migrated along distinct centrodes.Thoracic segmentsIHA was almost parallel to T_z (t), T_x (t), or T_y (t), stationary for T_x (t) or T_y (t), and migrating for T_z (t) along dorsally opened bows. IHA locations hardly depended on the position or size of axial preload.Lumbar segmentsIHA was also almost parallel to T_z (t), T_x (t), or T_y (t). In axial rotation IHA-migration along wide, ventrally or dorsally bent bows depending on segmental flexional/extensional status. Distances covered: 20–60 mm. In lateral-flexion: IHA-migration to the left/right joint and vice versa. In flexion/extension IHA-migration from the facets to the centre of the disc.Cervical segmentsIn flexion/flexion IHA was almost stationary for and parallel to T_y (t). In axial rotation or lateral-flexion IHA intersected T_z (t)/T_x (t) under approximately ?30°/+30°.ConclusionsGenerally joints alternate in guidance. Lumbar segments: in axial rotation and lateral-flexion parametrical control of IHA-position and IHA-migration by axial preload position. Cervical segments: kinematical coupling between axial rotation and lateral-flexion.The IHA-migration guided by the joints should be taken into account in the design of non-fusion implants. FE-calculations of spinal mechanics and kinematics should be based on detailed data of curvature morphology of the articulating surfaces of the joint facets.     

Appropriate endpoints for stereotactic body radiotherapy for bone metastasis: Classification into five treatment groups

Treatment of bone metastasis using stereotactic body radiotherapy (SBRT) is being widely used in clinical practice. The reported clinical advantages of SBRT include high pain and local control rates, high response rates against bone metastasis from radio-resistant tumors, and safe re-irradiations. Although most reports in the literature use local control as the primary treatment endpoint, this endpoint is not appropriate because local control does not relate directly to patient benefit. Herein, we proposed five pathophysiology-based patient groups, as well as appropriate endpoints for each group.     

The relation between the flexion relaxation phenomenon onset angle and lumbar spine muscle reflex onset time in response to 30 min of slumped sitting

Viscoelastic creep of spine tissue, induced by submaximal spine flexion in sitting, can delay the onset of the flexion-relaxation phenomenon (FRP) and low back reflexes (LBR). Theoretically, these two outcome measures should be correlated; however, no studies have investigated this. This study aims to determine whether 30 min of near-maximal spine flexion will affect the onset of FRP and LBR in the lumbar erector spinae (LS) and lumbar multifidus (LM), and to examine the relation between these parameters. 15 participants were recruited (9F, 6M). Spine angle (between L1 and S2) was monitored synchronously with bilateral muscle activity in the LS (L1) and the LM (L4). FRP onset and LBR were measured in a randomized order before and after 30 min of slouched sitting. No significant difference was found for any muscle LBR onset time between pre and post-sitting (p > 0.05). A significant increase in FRP onset was found in the RLM (p = 0.016) following sitting. No significant correlation was found between the FRP and the LBR for any muscle. These results suggest that the LBR onset might not be as sensitive as an outcome measure to investigate shorter exposures of sitting as FRP.