目的:分析颈椎前路椎间盘切除融合(anterior cervical discectomy and fusion,ACDF)术后发生C5神经根麻痹的相关危险因素,为预测术后C5神经根麻痹发生风险提供参考依据.方法:回顾性收集2020年8月~2021年8月因颈椎病于我院接受ACDF术治疗...目的:分析颈椎前路椎间盘切除融合(anterior cervical discectomy and fusion,ACDF)术后发生C5神经根麻痹的相关危险因素,为预测术后C5神经根麻痹发生风险提供参考依据.方法:回顾性收集2020年8月~2021年8月因颈椎病于我院接受ACDF术治疗的99例患者的临床资料并进行病例对照研究.根据患者术后是否出现C5神经根麻痹,将患者分为C5神经根麻痹组(C5 palsy组)、无C5神经根麻痹组(无C5 palsy组).采集两组患者基本资料,包括性别、年龄、体质指数(body mass index,BMI)、高血压病史、糖尿病病史;临床指标,包括日本骨科学会(Japanese Orthopaedic Association,JOA)评分、疼痛视觉模拟(visual analogue scale,VAS)评分及颈椎功能障碍指数(neck disability index,NDI);颈椎X线、CT和MRI等影像学参数,包括术前及术后1d两组患者的颈椎生理曲度、C4/5椎间隙高度、术前C4/5椎间孔横径和手术节段数,以及患者术前颈椎MRI T2像C4/5节段高信号情况.采用卡方检验、Logistic回归分析,探究术后C5神经根麻痹发生的危险因素.结果:99例患者中9例在术后7d内出现C5神经根麻痹症状.两组患者间术前C4/5椎间孔横径(2.70±0.88mm vs 3.93±1.06mm,P=0.001)、C4/5椎间隙高度变化(术后高度-术前高度)(3.02±2.03mm vs 1.33±1.45mm,P=0.002)存在差异,其他指标间无显著性差异(P>0.05).多因素Logistic回归分析显示,术后C4/5椎间隙高度[OR=1.698(1.041~2.769),P=0.034]、术前C4/5椎间孔横径[OR=0.207(0.064~0.672),P=0.009]是C5神经根麻痹发生的危险因素.结论:对于行ACDF术的患者术前C4/5椎间孔横径较小、术后C4/5椎间隙高度增加的患者术后发生C5神经根麻痹的可能性较高.术中避免过度撑开C4/5椎间隙并选择大小合适的融合器,保证术后合理C4/5椎间隙且C4/5椎间孔适度减压,以降低术后C5神经根麻痹发生率.展开更多
Estrogen affects the generation and transmission of neuropathic pain,but the specific regulatory mechanism is still unclear.Activation of the N-methyl-D-aspartate acid receptor 1（NMDAR1） plays an important role in t...Estrogen affects the generation and transmission of neuropathic pain,but the specific regulatory mechanism is still unclear.Activation of the N-methyl-D-aspartate acid receptor 1（NMDAR1） plays an important role in the production and maintenance of hyperalgesia and allodynia.The present study was conducted to determine whether a relationship exists between estrogen and NMDAR1 in peripheral nerve pain.A chronic sciatic nerve constriction injury model of chronic neuropathic pain was established in rats.These rats were then subcutaneously injected with 17β-estradiol,the NMDAR1 antagonist D（-）-2-amino-5-phosphonopentanoic acid（AP-5）,or both once daily for 15 days.Compared with injured drug na？ve rats,rats with chronic sciatic nerve injury that were administered estradiol showed a lower paw withdrawal mechanical threshold and a shorter paw withdrawal thermal latency,indicating increased sensitivity to mechanical and thermal pain.Estrogen administration was also associated with increased expression of NMDAR1 immunoreactivity（as assessed by immunohistochemistry） and protein（as determined by western blot assay） in spinal dorsal root ganglia.This 17β-estradiol-induced increase in NMDAR1 expression was blocked by co-administration with AP-5,whereas AP-5 alone did not affect NMDAR1 expression.These results suggest that 17β-estradiol administration significantly reduced mechanical and thermal pain thresholds in rats with chronic constriction of the sciatic nerve,and that the mechanism for this increased sensitivity may be related to the upregulation of NMDAR1 expression in dorsal root ganglia.展开更多
文摘目的:分析颈椎前路椎间盘切除融合(anterior cervical discectomy and fusion,ACDF)术后发生C5神经根麻痹的相关危险因素,为预测术后C5神经根麻痹发生风险提供参考依据.方法:回顾性收集2020年8月~2021年8月因颈椎病于我院接受ACDF术治疗的99例患者的临床资料并进行病例对照研究.根据患者术后是否出现C5神经根麻痹,将患者分为C5神经根麻痹组(C5 palsy组)、无C5神经根麻痹组(无C5 palsy组).采集两组患者基本资料,包括性别、年龄、体质指数(body mass index,BMI)、高血压病史、糖尿病病史;临床指标,包括日本骨科学会(Japanese Orthopaedic Association,JOA)评分、疼痛视觉模拟(visual analogue scale,VAS)评分及颈椎功能障碍指数(neck disability index,NDI);颈椎X线、CT和MRI等影像学参数,包括术前及术后1d两组患者的颈椎生理曲度、C4/5椎间隙高度、术前C4/5椎间孔横径和手术节段数,以及患者术前颈椎MRI T2像C4/5节段高信号情况.采用卡方检验、Logistic回归分析,探究术后C5神经根麻痹发生的危险因素.结果:99例患者中9例在术后7d内出现C5神经根麻痹症状.两组患者间术前C4/5椎间孔横径(2.70±0.88mm vs 3.93±1.06mm,P=0.001)、C4/5椎间隙高度变化(术后高度-术前高度)(3.02±2.03mm vs 1.33±1.45mm,P=0.002)存在差异,其他指标间无显著性差异(P>0.05).多因素Logistic回归分析显示,术后C4/5椎间隙高度[OR=1.698(1.041~2.769),P=0.034]、术前C4/5椎间孔横径[OR=0.207(0.064~0.672),P=0.009]是C5神经根麻痹发生的危险因素.结论:对于行ACDF术的患者术前C4/5椎间孔横径较小、术后C4/5椎间隙高度增加的患者术后发生C5神经根麻痹的可能性较高.术中避免过度撑开C4/5椎间隙并选择大小合适的融合器,保证术后合理C4/5椎间隙且C4/5椎间孔适度减压,以降低术后C5神经根麻痹发生率.
基金supported by the Youth Shihezi University Applied Basic Research Project of China,No.2015ZRKYQ-LH19
文摘Estrogen affects the generation and transmission of neuropathic pain,but the specific regulatory mechanism is still unclear.Activation of the N-methyl-D-aspartate acid receptor 1（NMDAR1） plays an important role in the production and maintenance of hyperalgesia and allodynia.The present study was conducted to determine whether a relationship exists between estrogen and NMDAR1 in peripheral nerve pain.A chronic sciatic nerve constriction injury model of chronic neuropathic pain was established in rats.These rats were then subcutaneously injected with 17β-estradiol,the NMDAR1 antagonist D（-）-2-amino-5-phosphonopentanoic acid（AP-5）,or both once daily for 15 days.Compared with injured drug na？ve rats,rats with chronic sciatic nerve injury that were administered estradiol showed a lower paw withdrawal mechanical threshold and a shorter paw withdrawal thermal latency,indicating increased sensitivity to mechanical and thermal pain.Estrogen administration was also associated with increased expression of NMDAR1 immunoreactivity（as assessed by immunohistochemistry） and protein（as determined by western blot assay） in spinal dorsal root ganglia.This 17β-estradiol-induced increase in NMDAR1 expression was blocked by co-administration with AP-5,whereas AP-5 alone did not affect NMDAR1 expression.These results suggest that 17β-estradiol administration significantly reduced mechanical and thermal pain thresholds in rats with chronic constriction of the sciatic nerve,and that the mechanism for this increased sensitivity may be related to the upregulation of NMDAR1 expression in dorsal root ganglia.
