经皮激光气化减压术治疗腰椎间盘突出症不同输出功率疗效的比较

目的探讨不同激光输出功率对经皮激光椎间盘汽化减压术(percutancous laser disc decompression,PLDD)治疗腰椎间盘突出症的作用。方法回顾性分析2015年2月至2016年6月,单节段腰椎间盘突出症患者63例,根据不同的功率10 W(A组)、15 W(B组)、20 W(C组)随机分为三组,每组21例患者,进行PLDD治疗,激光总能量3 500 J。记录术中激光手术的时间、术中出现不适症状次数,比较分析三组患者术前、术后1周、术后3个月时ODI功能障碍评价(Oswestry disability index,ODI)。结果 A、B和C组患者PLDD手术时间分别(8.90±1.3)min、(6.48±0.9)min和(5.76±0.9)min,A组与B、C组比较,差异具有统计学意义(P0.05)。A、B和C组患者术中出现不适症状次数分别为(0.71±0.6)次、(1.24±0.7)次和(2.62±1.0)次,A、B两组比较,差异无统计学意义(P0.05),A、B两组与C组比较,差异具有统计学意义(P0.05)。三组术前、术后3个月ODI评分进行组间比较,差异无统计学意义(P0.05);术后1周A、B组与C组比较,差异均具有统计学意义(P0.05);不同时间点A、B和C组ODI评分进行组内比较,均具有统计学意义(P0.05)。结论采用激光输出功率15 W时,进行PLDD治疗腰椎间盘突出症具有缩短治疗时间、减少治疗过程中出现的不适症状、术后短期内患者症状较快缓解等优势。     

新型C形椎管内骨折块复位器治疗胸腰椎骨折的临床研究

目的:评估自制C型椎管内骨折块复位器在胸腰椎骨折后路手术中的疗效及应用价值。方法:36例病人手术前CT及MRI提示胸腰椎骨折并伴有椎体后缘骨折块突入椎管压迫脊髓,行后路切开复位椎弓根钉棒系统内固定+全椎板减压,用自制C型椎管内骨折块复位器在后侧方推挤使椎体后缘骨折块复位,达到恢复椎管容积的目的,并自体骨横突间植骨,术后随访以评价脊柱矫形、椎管占位、复位及神经功能恢复情况(Frankel分级法)。结果:术后X光平片、CT检查36例椎管容积均恢复至正常80%以上,。术后随访6~72月(平均24月),未发生椎体后突畸形,Frankel分级平均进步1~2级。结论:自制C形椎管内骨折块复位器扩大了胸腰椎骨折后路手术治疗适应证范围,复位效果确切,操作简便安全,值得推广。     

中药熥敷保健颈托的研制及临床应用

目的:研制一种治疗颈椎病的中药熥敷保健颈托,并观察其临床疗效.方法:中药熥敷保健颈托由普通颈托与中药熥敷合剂药袋组成,药袋粘贴入特制的颈托凹陷内.选择160例颈椎病患者随机分为观察组和对照组,观察组采用佩戴中药熥敷保健颈托治疗,对照组采用奇正炎痛贴治疗,2个疗程后观察疗效.结果:观察组治愈率和有效率分别为72.5%和9...     

后方入路经椎旁病灶清除椎弓根钉内固定治疗胸腰椎结核42例

目的：探讨后方入路经椎旁病灶清除、植骨、椎弓根钉内固定技术治疗胸、腰椎结核的疗效。方法：对42例胸腰椎结核患者采用后方入路经椎旁病灶清除、植骨、椎弓根钉内固定术,术后定期随访,观察近、远期疗效。结果：所有切口一期愈合,全部病例植骨骨性融合,神经损害有1～2级的改善,脊柱后凸畸形有不同程度纠正,结核无局部复发。结论：后方入路经椎旁病灶清除、植骨、椎弓根钉内固定术是治疗胸腰椎结核简便、有效、安全的方法。     

旋转手法治疗腰椎间盘突出症研究进展

腰椎间盘突出症是临床常见病症。旋转手法是腰椎间盘突出症非手术治疗的常用手法之一,近年来得到广泛的运用和深入的研究。本文就近年来该手法在腰椎间盘突出症中的运用与研究进展做一总结,以便更好的指导临床应用,提高该法治疗腰突症的安全性和有效性。     

周期性牵张椎间盘纤维环细胞肌动蛋白骨架的重排

BACKGROUND: When the intervertebral disc is under stress, the hydraulic pressure generated inside the nucleus pulposus makes the annulus fibrosus extend outward and expand, and the annulus collagen fibers are stretched so that the extracellular matrix of annulus fibrosus cells is also under the pressure. In the intervertebral disc, aggrecan is the main component of proteoglycans, matrix metalloproteinase-2 is a major enzyme for extracellular matrix degradation, and tissue inhibitor of metalloproteinase is a multifunctional specific inhibition factor for matrix metalloproteinase activity. There is a mutual regulation between the latter two to keep the homeostasis between them. OBJECTIVE: To investigate the mechanism of cyclic tensile strain in the metabolism of intervertebral disc annulus matrix. METHODS: Rat anulus fibrosus cells were subjected to 2% or 10% cyclic tensile strain at 1.0 Hz for 2 and 12 hours using Flexcell4000 tension system. Then cells were collected and cultured in conditioned medium for gene and protein detection. Real-time quantitative PCR was used to detect mRNA expression of aggrecan, matrix metalloproteinases-2 and tissue inhibitor of metalloproteinase-2. Gelatin zymography was used to detect matrix metalloproteinases-2 activity. RESULTS AND CONCLUSION: The use of 2% cyclic tensile strain had no obvious effect on the stress fiber of actin cytoskeleton, whereas actin cytoskeleton was depolymerized in response to 10% cyclic tensile strain. The 2% cyclic tensile strain raised the expression of Aggrecan at 12 hours; whereas raised the matrix metalloproteinases-2 and tissue inhibitor of metalloproteinase-2 at 2 hours, both of which were in homeostasis; matrix metalloproteinases-2 activity had no significant changes. 10% cyclic tensile strain had no effect on the mRNA expression of Aggrecan. No matter stretching 2 or 12 hours, the matrix metalloproteinases-2 was up-regulated, and the tissue inhibitor of metalloproteinase-2 was down-regulated, both of which were not in balance. Moreover, the matrix metalloproteinases-2 activity was not significantly changed. These findings indicate that the mRNA expressions of Aggrecan, matrix metalloproteinases-2 and tissue inhibitor of metalloproteinase-2 alter in response to cyclic tensile strain in rat anulus fibrosus cells, and the tensile strain induces different mechano-responses in the actin cytoskeleton.      

经皮激光汽化减压术治疗腰椎间盘突出症的临床应用进展

微创介入手术做为治疗腰椎间盘突出症(lumbar disc herniation,LDH)的有效方式在临床治疗中已得到肯定,其中经皮激光汽化减压术(percutaneous laser disc decompression,PLDD)是微创介入手术中较为理想的一种治疗方式。自1987年首次在临床应用并取得较好的疗效以来,PLDD治疗LDH已有20多年历史,本文就PLDD的研究背景及治疗原理、适应证及禁忌证、PLDD手术的应用现况、最新进展、存在的问题及展望等进行简要综述。     

经后路伤椎置钉结合功能锻炼治疗胸腰椎骨折临床观察

目的:探讨经伤椎椎弓根钉内固定结合术后功能锻炼治疗胸腰椎骨折的方法及效果。方法 :短节段经伤椎治疗胸腰椎骨折患者78例,72例获得随访,术后对伤椎前缘高度、伤椎Cobb角、椎管容积、腰背痛及神经功能恢复等方面进行评价。结果:获得随访的患者术后伤椎前缘高度恢复至(95.2±3.5)%,脊柱Cobb角恢复至术后的(4.5±3.2)°,伤椎平均正中矢状径恢复至术后的(96.5±2.3)%,手术前后有显著性差异(P0.05)。患者腰背痛症状明显缓解,VAS评分由术前的(9.4±0.6)分降到术后的(2.4±2.7)分。神经功能除术前4例A级的患者下肢感觉、运动无改善,剩下患者神经功能均有1~3级的恢复;术后随访出现1例患者椎弓根螺钉断裂现象。结论:经伤椎椎弓根钉内固定术对骨折复位满意,重建脊柱的稳定性,术后功能锻炼对腰背痛及术后神经功能恢复起到促进作用,减少术后并发症。     

PLDD联合针灸及杜仲腰痛丸治疗腰椎间盘突出症临床观察

目的:观察分析经皮激光汽化减压术(Percutaneous laser discdecompression,PLDD)联合针灸及杜仲腰痛丸治疗腰椎间盘突出症(Lumbar dise herniation,LDH)的临床疗效。方法:回顾性分析2013年5月—2016年6月在甘肃省中医院脊柱骨科采用PLDD联合针灸及杜仲腰痛丸治疗的117例LDH患者的临床资料,按不同疗法分为3组:A组(PLDD+针灸组)患者37例;B组(PLDD+中药组)患者41例;C组(PLDD+针灸+中药组)患者39例。记录各组不同时间点VAS疼痛评分,评价术后随访2个月的临床疗效,分析各治疗手段的有效性,总结治疗经验。结果:治疗后1周、2周、1个月、6周和2个月,C组VAS评分明显低于A、B组,且C组疼痛评分的减轻程度显著高于A、B组,差异具有统计学意义(P0.05);术后随访2个月,A、B、C 3组有效率无明显统计学意义(P0.05),优良率分别为67.6%、65.9%、76.9%,C组明显高于A、B两组,差异具有统计学意义(P0.05)。结论:运用PLDD联合针灸及杜仲腰痛丸治疗LDH疗效显著,值得临床推广运用。     

探讨绝经后骨质疏松症“从肝论治”思想的相关机理

绝经后骨质疏松症(postmenopausal osteoporosis,PMOP)在骨质疏松症(osteoporosis,OP)中占有比例最大,严重影响中老年女性的健康及生活质量。中医药治疗PMOP有独特的优势,但PMOP的中医诊疗指导思想多以藏象"肾-骨"为主要理论依据,往往忽略了"肝"的重要作用。女子以肝为先天,对于中老年女性来说,"从肝论治"尤为重要。笔者基于对肝主疏泄-畅情志、肝藏血、肝-筋等肝生理功能与PMOP的发病相关机理作一探讨,以期对PMOP的防治诊疗提供新思路。