胸椎黄韧带骨化症(thoracic ossification of the ligamentum flavum,TOLF)是脊柱韧带异位骨化性疾病之一,可导致胸椎椎管狭窄、脊髓受压,可严重影响及危害患者运动神经功能,是胸脊髓病最常见的发病原因[1]。该病起病隐匿,多数患者在外...胸椎黄韧带骨化症(thoracic ossification of the ligamentum flavum,TOLF)是脊柱韧带异位骨化性疾病之一,可导致胸椎椎管狭窄、脊髓受压,可严重影响及危害患者运动神经功能,是胸脊髓病最常见的发病原因[1]。该病起病隐匿,多数患者在外伤诱因作用下或慢性神经损伤症状急剧加重才就诊,病情往往较重,常合并其他脊柱疾病,临床表现复杂多变,容易漏诊及误诊,手术风险及难度较大,若处理不当可能造成瘫痪。展开更多
The Hanjiang Formation of Langhian age （middle Miocene） in the Pearl River Mouth Basin （PRMB）, South China Sea consists of deltaic siliciclastic and neritic shelf carbonate rhythmic alternations, which form one of...The Hanjiang Formation of Langhian age （middle Miocene） in the Pearl River Mouth Basin （PRMB）, South China Sea consists of deltaic siliciclastic and neritic shelf carbonate rhythmic alternations, which form one of the potential reservoirs of the basin. To improve stratigraphic resolutions for hydrocarbon prospecting and exploration in the basin, the present study undertakes spectral analysis of high-resolution natural gamma-ray （NGR） well-logging record to determine the dominant frequency components and test whether Milankovitch orbital signals are recorded in rhythmic successions. Analytical results indicate the orbital cycles of precession （~19 ka and ~23 ka）, obliquity （-41 ka）, and eccentricity （~100 ka and --405 ka）, which provide the strong evidence for astronomically driven climate changes in the rhythmic alternation successions. Within biochronological constraint, a high-resolution astronomical timescale was constructed through the astronomical tuning of the NGR record to recent astronomically calculated variation of Earth＇s orbit. The astronomically tuned timescale can be applied to calculate astronomical ages for the geological events and bioevents recognized throughout the period. The first downhole occurrences of foraminifers Globorotalia peripheroronda and Globigerinoides sicanus are dated at 14.546 Ma and 14.919 Ma, respectively, which are slightly different from earlier estimates in the South China Sea. When compared with the global sea-level change chart, the astronomical estimate for the sequences recognized based on microfossil distributions have the same end time but the different initiation time. This is probably due to the local or regional tectonic activities superimposed on eustatic rise which postponed the effect of global sea-level rising. Astronomical timescale also resolves the depositional evolution history for the Langhian Stage （middle Miocene） with a variation that strongly resembles that of Earth＇s orbital eccentricity predicted from 13.65 Ma to 15.97 Ma. We infer that the main factor controlling the variability of the sedimentation rate in the Hanjiang Formation is related to the ^-405-ka-period eccentricity.展开更多
IGCP 630,with its full title of"Permian-Triassic(P-Tr)climatic and environmental extremes and biotic response",is an International Geoscience Program project sponsored by the United Nation Educational,Scient...IGCP 630,with its full title of"Permian-Triassic(P-Tr)climatic and environmental extremes and biotic response",is an International Geoscience Program project sponsored by the United Nation Educational,Scientific&Cultural Organization(UNESCO)and International Union of Geological Sciences(IUGS).This project was approved in 2014 and ended in 2018,and has applied for one-year extension in 2019.IGCP 630 consists of 150 geoscientists across multidisciplinary geosciences from 27 countries around the world.展开更多
目的探讨后路一期胸椎管后壁切除、局限性后纵韧带骨化块切除联合去后凸治疗胸椎多节段后纵韧带骨化症(ossification of the posterior longitudinal ligament,OPLL)的安全性与有效性。方法自2012年08月至2016年08月共采用此技术治疗胸...目的探讨后路一期胸椎管后壁切除、局限性后纵韧带骨化块切除联合去后凸治疗胸椎多节段后纵韧带骨化症(ossification of the posterior longitudinal ligament,OPLL)的安全性与有效性。方法自2012年08月至2016年08月共采用此技术治疗胸椎多节段OPLL患者31例,其中获得2年以上随访的29例患者纳入研究。男9例,女20例;年龄32-65岁,平均(48.5±7.1)岁。后纵韧带骨化节段数量为3-11节段,平均(6.5±2.2)节段;切除椎板节段数量为4-13节段,平均(7.9±2.5)节段。其中26例合并胸椎黄韧带骨化症。采用"揭盖法"将OPLL对应节段椎管后壁切除,在靠近后凸顶点及对脊髓压迫最重部位的OPLL骨化块进行限局性切除;然后经椎间隙楔形截骨减轻后凸畸形程度。术后随访主要观察指标为脊髓功能改善情况及影像学参数测量,统计学分析采用配对设计t检验。结果27例患者采用单节段局限性切除,2例采用双节段局限性切除。手术时间131-423 min,平均(245.2±75.1)min;术中出血量300-6 000 ml,平均(1 307.9±1 457.7)ml。术后随访时间25-69个月,平均(40.2±14.9)个月。术前胸椎管狭窄节段范围内后凸Cobb角平均28.7°±9.6°,术后即刻平均17.3°±8.6°,与术前比较差异有统计学意义,后凸角度平均减少11.4°±3.5°;末次随访时平均22.3°±10.3°,与术后即刻比较差异有统计学意义,平均减少7.4°±3.1°。切除后纵韧带骨化块长度平均(11.3±3.9)mm,后纵韧带骨化块切除部位的相邻椎体后缘短缩长度平均(5.0±3.0)mm(0.4-13. 8 mm)。术前平均日本骨科协会(Japanese Orthopaedic Association Scores,JOA)评分(11分法)为(4.3±2.2)分(1-9分),末次随访时为(9.3±2.3)分(3-11分),与术前比较差异有统计学意义。症状缓解率中位数为85.7% (-100%-100%),优良率为89.7%。术后6例患者术后出现一过性神经症状加重,最终均恢复至优于术前;1例患者发生持续性截瘫;19例发生脑脊液漏,均经保守治疗后痊愈。结论对于胸椎多节段后纵韧带骨化患者,一期后路胸椎椎管后壁切除、局限性后纵韧带骨化块切除联合去后凸手术可获得明显的脊髓功能改善,且术后并发截瘫的风险低,是一种安全、有效的手术方式。展开更多
目的探讨腰椎拟融合节段的相邻节段术前存在的椎管狭窄因素对术后早期临床疗效的影响。方法采用前瞻性对比研究,将2015年7月-2017年12月收治的符合选择标准的183例L4~S1腰椎管狭窄症患者,根据术前椎间盘退变情况及椎管狭窄情况判断的相...目的探讨腰椎拟融合节段的相邻节段术前存在的椎管狭窄因素对术后早期临床疗效的影响。方法采用前瞻性对比研究,将2015年7月-2017年12月收治的符合选择标准的183例L4~S1腰椎管狭窄症患者,根据术前椎间盘退变情况及椎管狭窄情况判断的相邻节段退变(adjacent segment degeneration,ASD)状态不同分成两组,A组98例(术前相邻节段无退变),B组85例(术前相邻节段已退变)。两组患者性别、美国麻醉医师协会(ASA)分级、体质量指数(body mass index,BMI)、合并滑脱状态及术前腰、腿痛疼痛视觉模拟评分(VAS)、日本骨科协会(JOA)评分、Oswestry功能障碍指数(ODI)等一般资料比较差异无统计学意义(P>0.05);A组患者年龄显著小于B组(t=-3.560,P=0.000)。记录并比较两组患者手术时间、术中出血量、住院时间、围术期并发症;末次随访时采用腰、腿痛VAS评分、JOA评分、ODI评分评价疗效。比较两组间末次随访时ASD发生情况,采用logistic回归分析影响患者术后出现ASD的独立危险因素。结果两组患者手术时间、术中出血量及住院时间比较差异均无统计学意义(P>0.05)。A、B组围术期并发症发生率分别为13.3%和20.0%,比较差异无统计学意义(χ^2=1.506,P=0.220)。两组患者均获随访,A、B组随访时间分别为(24.9±8.8)个月和(24.8±7.8)个月,差异无统计学意义(t=0.050,P=0.960)。至末次随访时,两组患者均未出现相邻节段病变。两组患者末次随访时椎间盘Pfirrmann分级与术前比较差异均无统计学意义(P>0.05);术前及末次随访时两组间Pfirrmann分级差异均有统计学意义(P<0.001)。至末次随访时A、B组分别有21例(21.4%)和53例(62.4%)出现ASD,比较差异有统计学意义(χ^2=31.652,P=0.000);术后相邻节段椎管狭窄程度加重是术后发生ASD的主要原因。两组患者末次随访时各临床评分均较术前显著改善(P<0.05),末次随访时A组JOA评分显著高于B组(P<0.05)。B组患者中术后出现ASD患者末次随访时的腰痛VAS评分、ODI评分显著高于非ASD患者(P<0.05)。logistic回归分析显示,术前相邻节段存在退变因素与BMI是影响患者术后出现ASD的独立危险因素(P<0.05)。结论术前相邻节段存在退变因素,会显著影响患者术后早期临床疗效及增加术后出现ASD的风险,相邻节段椎管狭窄程度加重是术后早期ASD主要的病理类型。应根据术前相邻节段椎管的整体退变情况评估术前相邻节段的退变状态。展开更多
文摘胸椎黄韧带骨化症(thoracic ossification of the ligamentum flavum,TOLF)是脊柱韧带异位骨化性疾病之一,可导致胸椎椎管狭窄、脊髓受压,可严重影响及危害患者运动神经功能,是胸脊髓病最常见的发病原因[1]。该病起病隐匿,多数患者在外伤诱因作用下或慢性神经损伤症状急剧加重才就诊,病情往往较重,常合并其他脊柱疾病,临床表现复杂多变,容易漏诊及误诊,手术风险及难度较大,若处理不当可能造成瘫痪。
基金supported by Australian Research Council discovery grant(DP0770938 to ZQC)National Science and Technology Major Project (2011ZX05001-001-006)
文摘The Hanjiang Formation of Langhian age （middle Miocene） in the Pearl River Mouth Basin （PRMB）, South China Sea consists of deltaic siliciclastic and neritic shelf carbonate rhythmic alternations, which form one of the potential reservoirs of the basin. To improve stratigraphic resolutions for hydrocarbon prospecting and exploration in the basin, the present study undertakes spectral analysis of high-resolution natural gamma-ray （NGR） well-logging record to determine the dominant frequency components and test whether Milankovitch orbital signals are recorded in rhythmic successions. Analytical results indicate the orbital cycles of precession （~19 ka and ~23 ka）, obliquity （-41 ka）, and eccentricity （~100 ka and --405 ka）, which provide the strong evidence for astronomically driven climate changes in the rhythmic alternation successions. Within biochronological constraint, a high-resolution astronomical timescale was constructed through the astronomical tuning of the NGR record to recent astronomically calculated variation of Earth＇s orbit. The astronomically tuned timescale can be applied to calculate astronomical ages for the geological events and bioevents recognized throughout the period. The first downhole occurrences of foraminifers Globorotalia peripheroronda and Globigerinoides sicanus are dated at 14.546 Ma and 14.919 Ma, respectively, which are slightly different from earlier estimates in the South China Sea. When compared with the global sea-level change chart, the astronomical estimate for the sequences recognized based on microfossil distributions have the same end time but the different initiation time. This is probably due to the local or regional tectonic activities superimposed on eustatic rise which postponed the effect of global sea-level rising. Astronomical timescale also resolves the depositional evolution history for the Langhian Stage （middle Miocene） with a variation that strongly resembles that of Earth＇s orbital eccentricity predicted from 13.65 Ma to 15.97 Ma. We infer that the main factor controlling the variability of the sedimentation rate in the Hanjiang Formation is related to the ^-405-ka-period eccentricity.
文摘IGCP 630,with its full title of"Permian-Triassic(P-Tr)climatic and environmental extremes and biotic response",is an International Geoscience Program project sponsored by the United Nation Educational,Scientific&Cultural Organization(UNESCO)and International Union of Geological Sciences(IUGS).This project was approved in 2014 and ended in 2018,and has applied for one-year extension in 2019.IGCP 630 consists of 150 geoscientists across multidisciplinary geosciences from 27 countries around the world.
文摘目的探讨腰椎拟融合节段的相邻节段术前存在的椎管狭窄因素对术后早期临床疗效的影响。方法采用前瞻性对比研究,将2015年7月-2017年12月收治的符合选择标准的183例L4~S1腰椎管狭窄症患者,根据术前椎间盘退变情况及椎管狭窄情况判断的相邻节段退变(adjacent segment degeneration,ASD)状态不同分成两组,A组98例(术前相邻节段无退变),B组85例(术前相邻节段已退变)。两组患者性别、美国麻醉医师协会(ASA)分级、体质量指数(body mass index,BMI)、合并滑脱状态及术前腰、腿痛疼痛视觉模拟评分(VAS)、日本骨科协会(JOA)评分、Oswestry功能障碍指数(ODI)等一般资料比较差异无统计学意义(P>0.05);A组患者年龄显著小于B组(t=-3.560,P=0.000)。记录并比较两组患者手术时间、术中出血量、住院时间、围术期并发症;末次随访时采用腰、腿痛VAS评分、JOA评分、ODI评分评价疗效。比较两组间末次随访时ASD发生情况,采用logistic回归分析影响患者术后出现ASD的独立危险因素。结果两组患者手术时间、术中出血量及住院时间比较差异均无统计学意义(P>0.05)。A、B组围术期并发症发生率分别为13.3%和20.0%,比较差异无统计学意义(χ^2=1.506,P=0.220)。两组患者均获随访,A、B组随访时间分别为(24.9±8.8)个月和(24.8±7.8)个月,差异无统计学意义(t=0.050,P=0.960)。至末次随访时,两组患者均未出现相邻节段病变。两组患者末次随访时椎间盘Pfirrmann分级与术前比较差异均无统计学意义(P>0.05);术前及末次随访时两组间Pfirrmann分级差异均有统计学意义(P<0.001)。至末次随访时A、B组分别有21例(21.4%)和53例(62.4%)出现ASD,比较差异有统计学意义(χ^2=31.652,P=0.000);术后相邻节段椎管狭窄程度加重是术后发生ASD的主要原因。两组患者末次随访时各临床评分均较术前显著改善(P<0.05),末次随访时A组JOA评分显著高于B组(P<0.05)。B组患者中术后出现ASD患者末次随访时的腰痛VAS评分、ODI评分显著高于非ASD患者(P<0.05)。logistic回归分析显示,术前相邻节段存在退变因素与BMI是影响患者术后出现ASD的独立危险因素(P<0.05)。结论术前相邻节段存在退变因素,会显著影响患者术后早期临床疗效及增加术后出现ASD的风险,相邻节段椎管狭窄程度加重是术后早期ASD主要的病理类型。应根据术前相邻节段椎管的整体退变情况评估术前相邻节段的退变状态。
