内镜技术治疗胸椎管狭窄症的研究进展

由于胸椎特殊的解剖特点,手术是治疗胸椎管狭窄症惟一有效的方式。传统开放手术创伤大,风险较高,但仍被认为是该疾病治疗的金标准。随着计算机和内窥镜技术的发展,近10年来,以椎间孔镜技术为代表的内镜技术在颈、腰椎疾病的治疗上应用广泛,取得了良好的疗效。在此基础上,国内外专家将内镜技术应用于治疗胸椎管狭窄症,也取得了良好的疗效。本文对内镜技术治疗胸椎管狭窄症的发展现状进行归纳和评述。

高载荷作用对大鼠椎间盘退行性变的影响

[目的]模拟战斗机飞行员超高加速度飞行和进行特殊战术动作时的高载荷环境,探索该环境对飞行员椎间盘退行性变的结构功能影响和潜在机制。[方法]利用动物离心机制备+6 Gz组、+10 Gz组高载荷下大鼠椎间盘退行性变模型各10只,通过对大鼠体重、L5/6椎间盘MRI成像和HE染色三种方法,对退行性变的发生情况进行检测。[结果]随着载荷的增强,大鼠椎间盘含水量减少,高度丢失,在HE染色中发现纤维环结构破坏。[结论]大鼠椎间盘退行性变与高载荷影响有关,且随着载荷的升高,椎间盘退行性变加重。

Meta-analysis comparing total hip arthroplasty with hemiarthroplasty in the treatment of displaced femoral neck fractures in patients over 70 years old

Objective： Total hip arthroplasty （THA） and hemiarthroplasty （HA） are effective methods currently used to treat femoral neck fracture in elderly patients, but the two options remain controversial in patients over 70 years old. The main purpose of our study was to determine whether THA or HA is a superior treatment of femoral fractures involving a displaced neck in patients who are over 70 years of age. Methods： A computer-based online search of Medline （1970-2011）, PubMed （1977-2011）, and the Cochrane Cen- tral Register of Controlled Trials （2002-201 l） was conducted. Six relevant randomized controlled trials with a total of 739 patients were included for the final analysis. The analysis was performed with software RevMan 5.0. Results： We found that compared with THA, HA needed shorter average time and lost less blood. While over the long-term follow-up, THA patients exhibited significantly less pain and better function and were less likely to require a revision hip surgery. Postoperative infection was equally common among HA and THA patients. Conclusions： The significant differences in outcomes suggest that THA is a valuable treatment option for active elderly hip fracture individuals. However, patients who are older, impaired or institutionalized benefit from HA.

棘间动态稳定系统Coflex的临床应用及研究进展

腰椎间盘突出症、腰椎管狭窄症等腰椎退行性疾病是引起急性腰腿痛的主要原因,对于保守治疗失败的患者,融合内固定术是治疗该类疾病的主要方式,被称为"金标准"。Coflex为棘突间U形固定装置,是棘突间动态稳定系统的一种。区别于椎弓根螺钉融合内固定术,该装置既保留了手术节段一部分的活动度,又实现了手术节段的相对稳定。因此,Coflex动态稳定既可以缓解患者的临床症状,又能在一定程度上避免如手术节段活动度消失以及邻近节段退变等融合相关并发症的发生。对于多节段的腰椎退变,Topping-off术式即下位节段腰椎融合手术联合上位节段腰椎Coflex动态稳定展现了独特的优势,其在融合椎与正常椎之间起缓冲作用,避免了应力集中,可降低邻近节段椎间盘退变发生的风险。在临床应用过程中,Coflex动态稳定系统在设计细节以及应用途径等方面得到不断改进与拓展,新型的棘突间动态稳定系统IntraSPINE也取得了一定的临床疗效。近年来,关于Coflex的研究不断加深,Coflex系统的安全性和有效性不断被认可,但仍缺乏高级别大样本多中心的临床研究作为支撑。因此,旨在为Coflex系统的临床应用提供参考依据,本文就Coflex系统的适应证与禁忌证、生物力学特点、临床疗效、术后并发症及新型动态稳定装置的进展等方面进行综述。