Can whole spine magnetic resonance imaging predict radiographic progression and inflammatory activity in axial spondyloarthritis?

ObjectiveTo investigate whether initial whole spine magnetic resonance imaging (MRI) predicts radiographic progression and inflammatory activity in patients with axial spondyloarthritis (axSpA).MethodsA retrospective analysis of spine MRI and X-rays from 70 axSpA patients was conducted. The number of affected discovertebral units was determined according to the definition of pathologic lesions on spine MRI set down by the ASAS/OMERACT group. Radiographic progression was defined as an increase in the modified Stoke Ankylosing Spondylitis Spinal Score (mSASSS) of ≥ 2 compared with baseline. The association of spine MRI with radiographic progression, cumulative C-reactive protein (CRP), and cumulative erythrocyte sedimentation rate (ESR) was investigated.ResultsThe axSpA-relevant lesions on spine MRI at baseline were independent predictors of radiographic progression. Arthritis of the costovertebral and costotransverse joints on MRI showed the highest odds ratio at 3 years (OR [95% CI]: 2.54 [1.29–5.02]). Receiver operating characteristic curve analysis revealed that the area under the curve (AUC) for radiographic progression at 2 years was 0.89 [95% CI: 0.81–0.96] for structural lesions and 0.83 [95% CI: 0.72–0.94] for inflammatory lesions. Notably, subgroup analysis of 26 patients with mSASSS = 0 showed that fatty metaplasia on MRI were highly predictive of radiographic progression at 3 years (AUC [95% CI]: 0.87 [0.61–1.00]). Moreover, 3-year cumulative ESR and CRP values increased in proportion to the extent of inflammatory lesions on initial MRI.ConclusionInitial MRI assessment of the whole spine may predict radiographic progression and subsequent systemic inflammatory burden in axSpA patients, particularly those without axSpA-relevant abnormalities on spine X-rays.     

基于基因表达汇编数据库的外周血中脊柱椎间盘退行性变诊断标志物的生物信息学分析

目的 通过生物信息学分析椎间盘退行性变（IDD）相关的差异表达基因（DEG）,寻找疾病的新型诊断标志物。方法 通过基因表达汇编（GEO）数据库GSE124272、GSE150408数据集下载IDD相关的外周血样本芯片数据,筛选出IDD组和正常组之间的DEG。使用DAVID在线数据库对DEG进行基因本体（GO）功能富集和京都基因与基因组百科全书（KEGG）信号通路富集,然后利用STRING在线数据库和Cytoscape软件构建蛋白质-蛋白质相互作用（PPI）网络并获取关键基因,并利用GSE23130数据集中的纤维环样本芯片数据进行验证。利用GSE124272、GSE150408数据集中的数据,采用受试者工作特征（ROC）曲线评估外周血中关键基因的诊断效能。结果 联合分析后筛选出597个DEG,包含363个上调基因和234个下调基因。GO功能富集分析发现DEG主要参与细胞黏附、细胞凋亡、趋化作用和细胞迁移等功能,KEGG分析发现DEG主要参与细胞外基质受体相互作用和癌症中的信号通路。PPI网络分析筛选出17个关键基因,经验证获得RBMX、EEF1A1、SSR1和POLR2C这4个基因,ROC曲线分析显示这4个基因对IDD诊断效能显著,曲线下面积分别为0.763、0.741、0.710、0.702。结论 RBMX、EEF1A1、SSR1和POLR2C或可成为IDD的新型诊断标志物,为该病进一步的功能研究提供理论依据。     

开放微波消融联合椎体成形和钉棒系统内固定治疗胸腰椎转移瘤

目的:探讨开放微波消融联合椎体成形、钉棒系统内固定在胸腰椎转移性肿瘤治疗中的初步临床效果。方法:对2014年1月至2016年1月收治的12例胸腰椎转移癌行开放微波消融联合椎体成形、钉棒系统内固定治疗的患者进行回顾性分析,其中男6例,女6例;年龄30～75岁,平均55.6岁。转移癌类型:肺转移癌5例,乳腺转移癌2例,甲状腺转移癌2例,肾转移癌2例,肝转移癌1例。转移部位:胸椎转移癌7例,腰椎转移癌5例。Tomita预后评分主要集中在3～6分。脊髓神经功能按ASIA分级:C级3例,D级1例,E级8例。术前的VAS评分为8.3±0.4,术后1、3、6个月以及末次随访时采用视觉模拟评分(visual analogue scale,VAS)评价临床效果。结果:12例患者手术出血量500～2 050 ml,平均850 ml。手术时间3.5～5.5 h,平均4.5 h。术中无神经损伤病例。术后发生脑脊液漏3例,经保守治疗后自愈。切口浅表感染2例,经换药后愈合。肺部感染1例。无深部感染、下肢血栓等并发症。术后12例患者均获得随访,时间9～40个月,平均28.6个月。临床症状均有明显改善,下肢运动功能不同程度的恢复,ASIA分级2例C级恢复至D级,1例C级恢复不明显,1例D级恢复至E级。1例患者术后10个月死于原发性肝癌。随访期间1例患者局部肿瘤复发。术后第1、3、6个月以及末次随访时VAS评分分别为2.7±0.6、2.5±0.4、2.6±0.5、2.5±0.5,与术前比较明显改善(P0.05)。结论:开放微波消融联合椎体成形、钉棒系统内固定治疗胸腰椎转移瘤效果肯定,术中出血量较少、手术时间较短、术后疼痛缓解明显、肿瘤复发率低。     

A mobile hemangioblastoma of the cauda equina: Case report and review of the literature

Context: Cases of migratory spinal tumors have been reported since 1963. Most involve spinal schwannomas, which are benign tumors of the lining of nerve cells. We report a rare case of a mobile spinal hemangioblastoma, which is a type of benign vascular tumor.

Findings: A 50-year-old man visited the hospital for painful swelling in his lower back. An MRI scan indicated that a lesion was at the L5 vertebral level. Two weeks later, however, an enhanced MRI showed that the lesion had migrated to the L4 vertebral level. During surgery, the location of the lesion remained consistent with the enhanced MRI reviewed. The histopathological diagnosis was hemangioblastoma.

Conclusion: This is the first known report of a mobile spinal hemangioblastoma. Mobile spinal hemangioblastoma requires careful preoperative and intraoperative evaluation of its real-time location to avoid performing surgery at the wrong vertebral level.     

分离手术治疗老年脊柱骨转移瘤的临床研究

目的总结分离手术治疗老年脊柱骨转移瘤的临床特征。 方法回顾性分析解放军第九六〇医院2014年1月至2018年12月间所有接受分离手术的老年脊柱骨转移瘤患者的临床资料,按性别、年龄、肿瘤类型、累及部位、脊柱稳定性评分（SINS）、硬膜外脊髓压迫分级（ESCC分级）、神经功能评价（Frankel分级）、肿瘤处理方式、内固定方式、手术时间、出血量、术前合并内科疾病、围手术期并发症分别进行统计,分析其临床特征。 结果33例老年脊柱骨转移瘤患者纳入本研究,其中男14例（42.4%）,女19例（57.6%）,男女比例为0.74∶1。发病年龄为60～75岁,平均年龄65.2岁,Frankel神经功能分级包括：A级2例,B级1例,C级2例,D级19例,E级9例。SINS平均得分为11.6分,最低分8分,最高分16分。ESCC分级,1b2例,1c2例,2级13例,3级16例。术前合并内科疾病患者17例,无内科疾病患者16例,7例患者在椎体肿瘤刮除后行直视下骨水泥填塞,另外26例患者均单纯行肿瘤刮除。所有患者均行椎弓根螺钉固定,平均使用螺钉数为7.2（4～9）个。中位出血量600（150～2500）ml。中位手术时间168（94～277）min。3例患者出现了围手术期并发症。29例（87.9%）患者获得术后症状改善。 结论存在硬膜外压迫的老年脊柱骨转移瘤患者,在做好围手术期准备后,采用分离手术能够在控制创伤的同时获得良好的症状改善。     

侧卧交叉按压微调法治疗颈性眩晕的临床研究

目的:对侧卧交叉按压微调法与传统推拿方法治疗椎动脉型颈椎病(Cervical Spandylosis of Vertebral Arterytype,CSA)的临床疗效进行观察、比较及评价。方法:选取156名CSA患者,并将其随机分为传统推拿组和按压微调组。将2组治疗前后的临床疗效分别使用通用的临床评定方法和改良《颈性眩晕症状与功能评估量表》法进行评估比较、分析。结果:传统推拿组及按压微调组总有效率(包括痊愈、显效、有效)分别为83.12%和93.67%,痊愈率分别为:15.58%和30.38%,2组总有效率及痊愈率差异均有统计学意义(P<0.05);量表评估方法显示:2组治疗方法均可显著改善CSA患者眩晕、颈肩痛、头痛、日常生活及工作、心理及社会适应等症状(P<0.01),而按压微调组较传统推拿组对于改善眩晕、日常生活及工作、心理及社会适应等症状更为显著(P<0.01,P<0.05),对于颈肩痛及头痛症状改善无显著作用(P>0.05)。结论:传统推拿方法及侧卧交叉按压微调法对于改善CSA的各种症状均有显著疗效,且侧卧交叉按压微调法疗效尤为显著。     

Quantification of lumbar stability by using 2 different abdominal activation strategies

OBJECTIVE: To determine whether the abdominal hollowing technique is more effective for lumbar spine stabilization than a full abdominal muscle cocontraction. DESIGN: Within-subject, repeated-measures analysis of variance was used to examine the effect of combining each of 4 loading conditions with either the hollow or brace condition on the dependent variables of stability and compression. A simulation was also conducted to assess the outcome of a person activating just the transversus abdominis during the hollow. SETTING: Laboratory. PARTICIPANTS: Eight healthy men (age range, 20-33y). INTERVENTIONS: Electromyography and spine kinematics were recorded during an abdominal brace and a hollow while supporting either a bilateral or asymmetric weight in the hands. MAIN OUTCOME MEASURES: Spine stability index and lumbar compression were calculated. RESULTS: In the simulation "ideal case," the brace technique improved stability by 32%, with a 15% increase in lumbar compression. The transversus abdominis contributed .14% of stability to the brace pattern with a less than 0.1% decrease in compression. CONCLUSIONS: Whatever the benefit underlying low-load transversus abdominis activation training, it is unlikely to be mechanical. There seems to be no mechanical rationale for using an abdominal hollow, or the transversus abdominis, to enhance stability. Bracing creates patterns that better enhance stability.     

椎管内髓外硬膜下毛细血管瘤临床及MRI特征

目的 探讨椎管内髓外硬膜下毛细血管瘤的临床及MRI特征。方法 回顾性分析5例经手术病理确诊的椎管内髓外硬膜下毛细血管瘤的临床资料及MRI表现。结果 临床表现:胸背痛伴双下肢麻木、无力4例,颈部疼痛伴双上肢疼痛1例。MRI示肿块均为单发,均位于椎管内硬脊膜下脊髓背侧,胸段4例,颈段1例;T1WI呈等(4例)或低信号(1例),T2WI呈高信号,增强后多均匀强化(4例);病灶周围可见含铁血黄素沉积(1例)、脊膜尾征(1例)及肿块头侧可见引流血管(1例)。结论 椎管内髓外硬膜下毛细血管瘤好发于中年人,位于脊髓背侧。MRI特征表现为肿块周围引流血管、含铁血黄素沉积、脊膜尾征、显著均匀强化。     

成人腰椎滑脱症手术治疗进展

腰椎滑脱症是临床上的常见病和多发病,主要症状为下腰部疼痛,可有间歇性跛行及神经根性痛等下肢神经症状,越来越多的患者正饱受其困扰。随着医学技术的不断发展,本病的手术治疗也在不断发展和完善,但其临床表现复杂,目前对其治疗方式的选择尚未达成统一的认识,其手术治疗方式的选择仍在争论和探索。本文对近年手术治疗腰椎滑脱症的相关文献资料进行回顾与总结。     

VSD闭式冲洗引流技术在治疗脊柱后路内固定术后感染中的应用

目的：评价VSD闭式冲洗引流技术应用于脊柱后路内固定术后感染的治疗效果。方法回顾性分析南昌大学第二附属医院2010年1月至2014年6月脊柱后路内固定手术后发生感染的15例患者的治疗过程,全部病例均早期进行清创,术中安装VSD装置进行闭式冲洗引流,根据细菌培养结果给予敏感抗生素,7d后拆除VSD装置,根据伤口情况及引流液细菌培养情况,决定是否直接闭合伤口或更换VSD继续冲洗引流,直至伤口可以闭合为止。结果15例患者冲洗7-21d （平均13.5d）后二期关闭伤口,全部获得愈合,C反应蛋白、血沉降至正常水平,随访5-48个月,无感染复发病例。结论 VSD闭式冲洗引流技术是治疗脊柱后路内固定术后感染的有效治疗方式。