一期后路经椎弓根截骨术治疗胸腰椎后凸畸形疗效观察

目的观察后路经椎弓根截骨术治疗胸腰椎后凸畸形的效果。方法采用经椎弓根截骨术治疗胸腰椎后凸畸形16例,观察患者后凸矫正、临床症状和神经功能恢复情况。结果平均随访15个月,全部患者腰痛症状缓解,后凸明显改善,Cobb角平均矫正38°,4例神经功能障碍者得到了良好恢复,无术中及术后严重并发症。结论一期经椎弓根截骨结合植骨内固定术治疗胸腰椎后凸畸形安全有效。     

两种椎板截骨方法治疗脊柱后凸畸形效果比较(附117例报告)

将 117例脊柱后凸畸形患者按不同的手术方法分为两组 ,即单平面椎板截骨组 (A组 ,68例 )和多平面椎板截骨组 (B组 ,49例 ) ,对两组治疗效果进行比较。结果 :按 Cobb方法测量后凸角 ,术前 A组 5 6°～ 115°,平均 75 .8°;B组 5 3°～ 10 7°,平均 73 .6°,两组比较无显著差别 (P>0 .0 5 )。手术矫正角度 :A组 3 4°～ 78°,平均 40 .5°,平均矫正率 43 .6% ;B组 3 6°～ 90°,平均 46.9°,平均矫正率 5 2 .5 % ,两组比较差别显著 (P<0 .0 1)。 95例获随访 :A组 5 2例随访 6～ 111个月 ,平均 41个月 ,矫正角丧失 8°～ 3 6°,平均 17.2°;B组 43例随访 6～ 92个月 ,平均 3 8个月 ,矫正角丧失 3°～ 13°,平均 5 .3°。随访时间 A、B两组无显著差别 (P<0 .0 5 ) ,矫正角丧失 :A组大于 B组 (P<0 .0 1)。可见多平面椎板截骨治疗脊柱后凸畸形较单平面椎板截骨手术创伤大 ,但操作安全 ,矫形效果优于单平面椎板截骨     

胫骨高位截骨Giebel系统固定治疗老年人膝内翻畸形

目的探讨应用胫骨高位截骨术及Giebel系统内固定治疗老年患者膝内翻畸形的有效性和优势。方法对老年膝内翻患者16例26膝采用上述方法手术。患者术前内翻畸形平均12．5°,膝关节活动度大于90°,不伴有其他关节间室病变,膝关节稳定性无明显异常,膝关节症状以内侧间室疼痛为主。对患膝进行精确的胫骨高位截骨术并应用Giebel系统内固定截骨端。手术前后测量患者关节活动度的大小,进行Lysholm评分。术后对患者进行主观满意度调查。结果术后未出现钢板螺钉断裂及神经血管损伤;1例切口脂肪液化延迟愈合。截骨处至术后12～16周均骨性愈合。测量矫正角度平均12．4°。对16例随访平均21个月,随访期间X线检查,下肢力线维持在术后水平,内外侧关节间隙无明显退变加重。至随访终末时,手术效果优良率为87．5％,81．3％患者对手术效果表示满意。手术前后膝关节活动度无明显变化;Lysholm评分由术前的49．1分增至79．4分,内外关节间隙差由术前的4．7 mm减至0．6 mm,内翻角度由术前的12．5°减至0．2°,手术前后差异均有统计学意义(P<0．01)。结论胫骨高位截骨术Giebel系统固定可有效地治疗老年患者轻中度膝关节内翻畸形,其创伤较小,固定强度大,骨愈合率高。     

后路手术治疗陈旧性胸腰段骨折继发严重后凸畸形

目的观察后路手术治疗陈旧性胸腰段骨折继发后凸畸形的效果。方法24例陈旧性胸腰椎段骨折继发严重后凸畸形患者,经后路行楔形截骨矫形椎管减压、椎体旁植骨＋椎弓根螺钉系统内固定脊柱短缩术。结果本组术前Frankel分级A级2例,术后B、C级各1例;术前B级7例,术后为B级3例,C、D级各2例;术前C级10例,术后为C级2例,D级6例,E级2例;At前D级4例,术后为D、E级各2例;术前E级1例,术后仍为E级。结论后路手术治疗陈旧性胸腰段骨折继发后凸畸形安全有效。     

前路减压固定治疗腰胸椎爆裂型骨折21例

胸腰椎爆裂骨折主要为前、中柱的力学结构破坏 ,脊髓受压大多来自椎管前方。 1994～ 2 0 0 0年 ,我们采用前方椎管减压及固定治疗胸腰段爆裂型骨折 2 1例 ,取得满意疗效。现报告如下。一般资料 :本组 2 1例胸椎爆裂型骨折患者中 ,男 13例 ,女 8例 ;年龄 2 0～ 49岁 ,平均 36岁。损伤部位 :T81例 ,T1 0 2例 ,T1 1 5例 ,T1 2 9例 ,L1 4例。后凸畸形 (Cobb角 ) 17.6°～ 45°,平均 30 .5°。2 1均行 CT或 MRI检查 ,显示为爆裂型不稳定骨折。其中前、中柱损伤 15例 ,三柱均有损伤 6例 ;均有后移骨块占据椎管造成脊椎损伤。神经功能按 Frank…     

强直性脊柱炎胸腰椎后凸畸形与髋关节病变的相关性分析

目的 探讨强直性脊柱炎(AS)胸腰椎后凸畸形患者髋关节病变的危险因素.方法 本组66例AS患者,男性57例,女性9例,年龄17～53岁,平均(33±10)岁,其中50例为AS伴胸腰椎后凸畸形患者(A组),16例为无胸腰椎后凸畸形AS患者(B组).收集患者的临床资料、实验室检查、影像学资料及生活质量评估量表.临床资料包括年龄和病程;实验室检查包括:红细胞沉降率(ESR)、C反应蛋白(CRP)和人类白细胞抗原(HLA)-B27;影像学资料包括:胸腰椎后凸Cobb角(GK)、髋关节病变评分(BASRI-hip);生活质量评估量表包括:AS疾病活动性量表(BASDAI)、AS功能量表(BASFI)和Oswestry功能障碍量表(ODI).运用BASRI-hip对髋关节病变进行评分,并定义评分大于2分为有髋关节病变,定义有髋关节病变组为C组,无髋关节病变组为D组.统计学处理采用独立样本t检验和Spearman相关性分析以及多元回归分析.结果 A组50例胸腰椎后凸畸形AS患者中,27例(54％)发生髋关节影像学病变,B组16例无胸腰椎后凸畸形AS患者,3例(19％)发生髋关节影像学病变(OR=5.08).多元回归分析显示GK和病程是AS胸腰椎后凸畸形患者的髋关节病变的高危因素.相关性分析显示BASFI评分与AS患者的髋关节病变显著相关(r=0.345,P=0.014).结论 较大GK和较长病程是AS胸腰椎后凸畸形患者髓关节病变的高危因素,AS患者的髋关节病变显著降低其生活质量.     

病灶清除植骨内固定治疗胸腰椎结核的近期疗效分析

目的 临床研究同期病灶清除植骨融合内固定术治疗胸腰椎结核的近期疗效.方法 将一期病灶清除植骨融合内固定术治疗并随访到的46例,平均随访2.5年,植骨融合按Moon观察标准为主,神经功能恢复情况按Frankel分级进行评价.结果 胸腰椎后凸畸形全部矫正（P＜0.01）.平均12 d下床活动.术后3个月骨性融合率60%;6个月骨性融合率90%.31例并截瘫者神经功能平均恢复3级（Frankel分级）;结核治愈率98%.结论 一期病灶清除植骨融合内固定术可有效地治疗胸腰椎结核并可早期活动.     

强直性脊柱炎胸腰段后凸畸形外科治疗的研究进展

强直性脊柱炎(AS)是一种主要累及中轴骨骼的慢性炎症性风湿性疾病,可引起脊柱韧带进行性成骨性改变,最终导致僵硬后凸,常导致胸腰段、颈胸段后凸畸形,以胸腰段后凸畸形多见.对于AS导致的脊柱胸腰段后凸畸形以手术截骨矫形为主要治疗手段.该文就胸腰段后凸畸形外科治疗的研究进展作一综述.     

外展截骨治疗肘内翻畸形27例

1990～ 1998年 ,我们采用肱骨外展截骨术治疗肘内翻畸形患儿 2 7例 ,取得良好效果 ,现总结如下。临床资料 :本组男 2 1例、女 6例 ,年龄 5～ 17岁 ;均为陈旧性骨折畸形愈合 ;病程为 2个月至 3年 ,平均 1.5年。病变为右侧 18例 ,左侧 9例 ;均有不同程度的前臂内收畸形 ,正常提携角消失 ,肘内翻 15～ 30°;肘关节主动屈曲 12 0～ 145°。治疗方法 :臂丛麻醉下 ,患者取仰卧位。截骨部位 :于肱骨外髁向上作纵行 5 cm切口 ,于肱桡肌与肱三头肌间隙进入 ,楔形截骨的下位水平线位于尺骨鹰嘴上缘上方 1.5 cm处 ,该线与肱骨下端关节面平行。骨膜下显…     

病灶清除植骨内固定治疗胸腰椎结核的近期疗效分析

目的　临床研究同期病灶清除植骨融合内固定术治疗胸腰椎结核的近期疗效。方法 将一期病灶清除植骨融合内固定术治疗并随访到的46例,平均随访2.5年,植骨融合按Moon观察标准为主,神经功能恢复情况按Frankel分级进行评价。结果 胸腰椎后凸畸形全部矫正(P<0.01)。平均12d下床活动。术后3个月骨性融合率60%;6个月骨性融合率90%。31例并截瘫者神经功能平均恢复3级(Frankel分级);结核治愈率98%。结论 一期病灶清除植骨融合内固定术可有效地治疗胸腰椎结核并可早期活动。     

Three layer functional model and energy exchange concept of aging process

Relying on a certain degree of abstraction, we can propose that no particular distinction exists between animate or living matter and inanimate matter. While focusing attention on some specifics, the dividing line between the two can be drawn. The most apparent distinction is in the level of structural and functional organization with the dissimilar streams of ‘energy flow’ between the observed entity and the surrounding environment. In essence, living matter is created from inanimate matter which is organized to contain internal intense energy processes and maintain lower intensity energy exchange processes with the environment. Taking internal and external energy processes into account, we contend in this paper that living matter can be referred to as matter of dissipative structure, with this structure assumed to be a common quality of all living creatures and living matter in general. Interruption of internal energy conversion processes and terminating the controlled energy exchange with the environment leads to degeneration of dissipative structure and reduction of the same to inanimate matter, (gas, liquid and/or solid inanimate substances), and ultimately what can be called ‘death.’ This concept of what we call dissipative nature can be extended from living organisms to social groups of animals, to mankind. An analogy based on the organization of matter provides a basis for a functional model of living entities. The models relies on the parallels among the three central structures of any cell (nucleus, cytoplasm and outer membrane) and the human body (central organs, body fluids along with the connective tissues, and external skin integument). This three-part structural organization may be observed almost universally in nature. It can be observed from the atomic structure to the planetary and intergalactic organizations. This similarity is corroborated by the membrane theory applied to living organisms. According to the energy nature of living matter and the proposed functional model, the decreased integrity of a human body's external envelope membrane is a first cause of the structural degradation and aging of the entire organism. The aging process than progresses externally to internally, as in single cell organisms, suggesting that much of the efforts towards the restoration and maintenance of the mechanisms responsible for structural development should be focused accordingly, on the membrane, i.e., the skin. Numerous reports indicate that all parts of the human body, like: bones, blood with blood vessels, muscles, skin, and so on, have some ability for restoration. Therefore, actual revival of not only aging tissue of the human body's membrane, but the entire human body enclosed within, with all internal organs, might be expected. We assess several aging theories within the context of our model and provide suggestions on how to activate the body's own anti-aging mechanisms and increase longevity. This paper presents some analogies and some distinctions that exist between the living dissipative structure matter and inanimate matter, discusses the aging process and proposes certain aging reversal solutions.     

Unusual responses of nocturnal pineal melatonin synthesis and secretion to swimming: Attempts to define mechanisms

Abstract: The effect of swimming at night on rat pineal melatonin synthesis was compared with that of light exposure at night. Rats were forced to swim at 0030 hr (lights out at 2000 hr) and sacrificed by decapitation 15 and 30 min later, immediately after swimming. Other groups of animals were exposed to white light (650μW/cm²) for 15 and 30 min at same time. Swimming caused a rapid and highly significant drop in the melatonin content in the pineal gland; however, the activity of N-acetyltransferase (NAT), the supposed rate limiting enzyme in the melatonin production, was not changed. Despite the drop in pineal melatonin levels, serum concentrations of the indole remained elevated in the rats that swam. In contrast, melatonin levels in the pineal and serum of light exposed rats fell precipitously, accompanied by a significant suppression of NAT activity. Since we anticipated that the strenuous exercise associated with swimming may induce release of artrial natriuretic peptide (ANP) from the heart, which in turn could cause the release of pineal melatonin, in a second study we injected physiological saline intravenously to stretch the cardiac muscle and release ANP. Three milliliters of normal saline was injected during the day into the jugular vein of anesthetized rats that were pretreated with isoproterenol to stimulate pineal melatonin production. Animals were killed 15 min after the saline injection, and pineal NAT activity and pineal melatonin levels were measured. The saline injections caused no alteration in the elevated levels of either NAT or melatonin. These data suggest that the disparity in pineal NAT activity (which was high) and pineal melatonin (which was low), in animals swum at night, may not be caused by ANP which is released during strenuous exercise such as swimming.     

Melatonin and photoperiodic time measurement: Seasonal breeding in the sheep

Abstract: Well-established circadian physiology supports the view that photoperiodic time measurement utilizes the coincidence between the presence of light and a photosensitive phase of a 'biological clock' to alter reproductive status—the so-called external coincidence model of seasonal breeding. In this review, we examine the mechanism whereby photoperiod interacts with presumed suprachiasmatic nuclei activity to allow endogenous melatonin to normally synchronize reproductive activity to the optimal time of year. The Romney Marsh sheep is particularly explored as an experimental model. It is suggested that the on/off activity of seasonal reproduction may be a robust mechanism able to be predictably manipulated by the judicious use of the light/dark cycle and exogenous melatonin, but firmly based on circadian principles.     

The immunoneuroendocrine role of melatonin

Abstract: A tight, physiological link between the pineal gland and the immune system is emerging from a series of experimental studies. This link might reflect the evolutionary connection between self-recognition and reproduction. Pinealectomy or other experimental methods which inhibit melatonin synthesis and secretion induce a state of immunodepression which is counteracted by melatonin. In general, melatonin seems to have an immunoenhancing effect that is particularly apparent in immunodepressive states. The negative effect of acute stress or immunosuppressive pharmacological treatments on various immune parameters are counteracted by melatonin. It seems important to note that one of the main targets of melatonin is the thymus, i.e., the central organ of the immune system. The clinical use of melatonin as an immunotherapeutic agent seems promising in primary and secondary immunodeficiencies as well as in cancer immunotherapy. The immunoenhancing action of melatonin seems to be mediated by T-helper cell-derived opioid peptides as well as by lymphokines and, perhaps, by pituitary hormones. Melatonin-induced-immuno-opioids (MHO) and lymphokines imply the presence of specific binding sites or melatonin receptors on cells of the immune system. On the other hand, lymphokines such as -γ-interferon and interleukin-2 as well as thymic hormones can modulate the synthesis of melatonin in the pineal gland. The pineal gland might thus be viewed as the crux of a sophisticated immunoneuroendocrine network which functions as an unconscious, diffuse sensory organ.     

Serological survey of HIV and syphilis in pregnant women in Madagascar

Objectives Peripartal transmission of human immunodeficiency virus (HIV) and Treponema pallidum, the causative agent of syphilis, leads to severe consequences for newborns. Preventive measures require awareness of the maternal infection. Although HIV and syphilis testing in Madagascar could be theoretically carried out within the framework of the national pregnancy follow‐up scheme, the required test kits are rarely available at peripheral health centres. In this study, we screened blood samples of pregnant Madagascan women for HIV and syphilis seroprevalence to estimate the demand for systemic screening in pregnancy. Methods Retrospective anonymous serological analysis for HIV and syphilis was performed in plasma samples from 1232 pregnant women that were taken between May and July 2010 in Ambositra, Ifanadiana, Manakara, Mananjary, Moramanga and Tsiroanomandidy (Madagascar) during pregnancy follow‐up. Screening was based on Treponema pallidum haemagglutination tests for syphilis and rapid tests for HIV, with confirmation of positive screening results on line assays. Results Out of 1232 pregnant women, none were seropositive for HIV and 37 (3%) were seropositive for Treponema pallidum. Conclusions Our findings are in line with previous studies that describe considerable syphilis prevalence in the rural Madagascan population. The results suggest a need for screening to prevent peripartal Treponema pallidum transmission, while HIV is still rare. If they are known, Treponema pallidum infections can be easily, safely and inexpensively treated even in pregnancy to reduce the risk of transmission.     

Response of rat pineal melatonin to calcium, magnesium, and lithium is circadian stage dependent

Abstract: Herein we documented the response of pineal melatonin production to electrolytes known to be effective on pineal function in view of a possible circadian stage dependence. We studied the release of melatonin by perifused rat pineal glands at 2 different circadian stages corresponding to the middle of the light and dark periods, i.e., respectively, 7 and 19 HALO (Hours After Light Onset, L:D = 12:12). The initial efflux rates were, as expected, much higher in the perifusates of glands removed from rats sacrificed during the dark phase than of those removed during the light phase. After 3 hr of perifusion, melatonin release reached similar levels which were found constant up to the 8th hr of perifusion, whatever the circadian stage. Perifusion of the glands with physiological concentrations for the rat of calcium (5.2 mmol/1) and magnesium (1.34 mmol/1) resulted in a stimulatory effect on the pineal glands removed from rats sacrificed in the middle of the dark period (19 HALO), whereas no effects were observed on the pineal glands removed from rats sacrificed during the light (7 HALO). Lithium (0.28 and 0.55 mmol/1) was ineffective on melatonin release in pineal glands removed 7 and 19 HALO. Our results show differences in the initial efflux rates of melatonin and in the response of perifused pineal glands to calcium and magnesium according to the circadian stage.