spine雜志01上半期摘要翻譯課件

indexBasicScienceEffectofPolyetherEtherKetoneonTherapeuticRadiationtotheSpine:APilotStudy聚醚醚酮樹(shù)脂PEEK對(duì)脊柱放射治療的影響：初步研究DeletionofOpgLeadstoIncreasedNeovascularizationandExpressionofInflammatoryCytokinesintheLumbarIntervertebralDiscofMice敲除小鼠Opg基因?qū)е卵甸g盤(pán)中炎癥細(xì)胞因子的表達(dá)和新生血管形成的增加indexCervicalSpineComplicationandReoperationRatesFollowingSurgicalManagementofCervicalSpondyloticMyelopathyinMedicareBeneficiaries醫(yī)療保險(xiǎn)受益人髓性頸椎病手術(shù)治療后的并發(fā)癥和再手術(shù)率EfficacyofDiffusionTensorImagingIndicesinAssessingPostoperativeNeuralRecoveryinCervicalSpondyloticMyelopathy擴(kuò)散張量成像指數(shù)在評(píng)估頸椎脊髓病性脊髓病術(shù)后神經(jīng)恢復(fù)的成效RoutineUseofIntraoperativeNeuromonitoringDuringACDFsfortheTreatmentofSpondyloticMyelopathyandRadiculopathyIsQuestionable:AReviewof15,395Cases在ACDF治療髓性或根性頸椎病術(shù)中常規(guī)使用神經(jīng)監(jiān)護(hù)是可疑的：回憶15,395例indexClinicalCaseSeriesRoutineUseofIntraoperativeNeuromonitoringDuringACDFsfortheTreatmentofSpondyloticMyelopathyandRadiculopathyIsQuestionable:AReviewof15,395Cases在ACDF治療髓性或根性頸椎病術(shù)中常規(guī)使用神經(jīng)監(jiān)護(hù)是可疑的：回憶15,395例DermalDiscolorationsandBurnsatNeuromonitoringElectrodesinPediatricSpineSurgery兒科脊柱手術(shù)使用神經(jīng)電極導(dǎo)致皮膚色素沉著和燒傷PreventiveEffectofDynamicStabilizationAgainstAdjacentSegmentDegenerationAfterPosteriorLumbarInterbodyFusion動(dòng)態(tài)穩(wěn)定對(duì)后路腰椎間融合后相鄰節(jié)段退變的預(yù)防效果LumbarDegenerativeSpondylolisthesis:ChangesinSurgicalIndicationsandComparisonofInstrumentedFusionWithTwoSurgicalDecompressionProcedures腰椎退行性脊椎滑脫：手術(shù)適應(yīng)癥的變化和兩種減壓手術(shù)的比較INDEXDeformityDiscrepancyBetweenStandingPostureandSagittalBalanceDuringWalkinginAdultSpinalDeformityPatients成年脊柱畸形患者行走和站立姿勢(shì)矢狀平衡之間的差異FunctionandClinicalSymptomsaretheMainFactorsthatMotivateThoracolumbarAdultScoliosisPatientstoPursueSurgery功能和臨床病癥是促使成人胸腰椎脊柱側(cè)凸患者進(jìn)行手術(shù)的主要因素INDEX

EpidemiologyFrequencyandRiskFactorsforAdditionalLesionsintheAxialSpineinSubjectsWithChordoma:IndicationsforScreening脊柱脊索瘤患者脊柱軸向其他病變的頻率和危險(xiǎn)因素HealthServicesResearchTheInfluenceofRaceonShort-termOutcomesAfterLaminectomyand/orFusionSpineSurgery種族對(duì)椎板切除和/或融合脊柱手術(shù)后短期結(jié)果的影響INDEXLiteratureReviewASystematicReviewoftheSoft-TissueConnectionsBetweenNeckMusclesandDuraMater:TheMyoduralBridge連接頸部肌肉和硬腦膜之間的軟組織的系統(tǒng)評(píng)價(jià)：肌肉橋OutcomesComparisonofOutcomesofSingle-LevelAnteriorCervicalDiscectomyWithFusionandSingle-LevelArtificialCervicalDiscReplacementforSingle-LevelCervicalDegenerativeDiscDisease單節(jié)段前路頸椎椎間盤(pán)切除融合術(shù)和單節(jié)段頸椎椎間盤(pán)置換術(shù)對(duì)單節(jié)段頸椎退行性椎間盤(pán)疾病的預(yù)后比較INDEXPerioperativeComplicationsin155PatientsWhoUnderwentObliqueLateralInterbodyFusionSurgery:PerspectivesandIndicationsFromaRetrospective,MulticenterSurvey155例OLIF患者的圍手術(shù)期并發(fā)癥SurgicalSiteInfectionsinPosteriorLumbarSurgery:AControlled-CohortStudyofEpiduralSteroidPaste后路腰椎手術(shù)切口感染：控制性隊(duì)列研究硬膜外類(lèi)固醇使用CanadianConsensusforthePreventionofBloodLossinSpineSurgery加拿大對(duì)預(yù)防脊柱手術(shù)出血的共識(shí)MetallosisPresentingasaProgressiveNeurologicDeficitFourYearsAfteraPosteriorSpinalFusionforAdolescentIdiopathicScoliosis:ACaseReport金屬沉著導(dǎo)致青少年特發(fā)性脊柱側(cè)凸后路脊柱融合術(shù)四年后漸進(jìn)性的神經(jīng)功能障礙：病例報(bào)告TITLEEffectofPolyetherEtherKetoneonTherapeuticRadiationtotheSpine:APilotStudy聚醚醚酮樹(shù)脂PEEK對(duì)脊柱放射治療的影響：初步研究StudyDesign.Cadavericmodel.研究設(shè)計(jì)：尸體模型。ABSTRACTObjectives.TocomparetheeffectofPEEK

versus

conventionalimplantsonscatterradiationtoasimulatedtumorbedinthespine目的：比較PEEK與傳統(tǒng)植入物對(duì)脊柱模擬放射治療的影響ABSTRACTSummaryofBackgroundData.Giventhehighlyvasculaturenatureofthespine,itisthemostcommonplaceforbonymetastases.Aftersurgicaltreatmentofaspinalmetastasis,adjuvantradiationtherapyistypicallyadministered.Radiationdosingisprimarilylimitedbytoxicitytothespinalcord.Thescattereffectcausedbymetallicimplantsdecreasestheaccuracyofdosingandcanunintentionallyincreasetheeffectivedoseseenbythespinalcord.Thisrepresentsadose-limitingfactorfortherapeuticradiationpostoperatively.背景資料概述：由于椎體的血運(yùn)豐富，所以是骨轉(zhuǎn)移最常發(fā)生的部位。脊柱轉(zhuǎn)移癌的外科治療后，通常需要輔助放射治療。輻射劑量主要受脊髓毒性的限制。金屬植入物引起的散射效應(yīng)降低劑量的準(zhǔn)確性，并可以無(wú)意中增加脊髓的有效劑量。這代表術(shù)后放射治療的劑量限制因素。ABSTRACTMethods.Acadavericthoraxspecimenwasutilizedasametastatictumormodelwithtwoseparatethree-levelspineconstructs(oneupperthoracicandonelowerthoracic).Eachconstructwasexaminedindependently.Allfourgroupscomparedincludedidenticalposteriorinstrumentation.Theanteriorconstructsconsistedofeither:ananteriorpolyetheretherketone(PEEK)cage,ananteriortitaniumcage,ananteriorbonecementcage(polymethylmethacrylate),oracontrolgroupwithposteriorinstrumentationalone.Eachconstructhadsixthermoluminescentdetectorstomeasuretheradiationdose.方法：使用尸體胸部標(biāo)本作為具有兩個(gè)完整脊柱三柱構(gòu)造〔一個(gè)上胸椎和一個(gè)下胸椎〕的轉(zhuǎn)移性腫瘤模型。獨(dú)立地檢測(cè)每個(gè)構(gòu)建體。所有四組比較包括相同的后路內(nèi)固定物。前柱固定使用：前聚醚醚酮〔PEEK〕，鈦籠，骨水泥籠〔聚甲基丙烯酸甲酯〕或僅有后路內(nèi)固定的對(duì)照組。每個(gè)構(gòu)建體用六個(gè)熱釋光檢測(cè)器以測(cè)量輻射劑量。ABSTRACTResults.Themeandosewassimilaracrossallconstructsandlocations.Therewasmorevariabilityintheupperthoracicspineirrespectiveoftheconstructtype.ThePEEKconstructhadamoreuniformdosedistributionwithastandarddeviationof9.76.Thestandarddeviationoftheothersconstructswas14.26forthecontrolgroup,19.31forthetitaniumcage,and21.57forthecement(polymethylmethacrylate)construct.結(jié)果：所有構(gòu)建體和位置的平均劑量相似。無(wú)論內(nèi)固定類(lèi)型如何，上胸椎存在更多的變異性。PEEK構(gòu)建體具有更均勻的劑量分布，標(biāo)準(zhǔn)偏差為9.76。其他構(gòu)建體的標(biāo)準(zhǔn)偏差：對(duì)照組為14.26，鈦籠為19.31，骨水泥〔聚甲基丙烯酸甲酯〕構(gòu)建體為21.57。ABSTRACTConclusion.ThePEEKinter-bodycageresultedinasignificantlymoreuniformdistributionoftherapeuticradiationinthespinewhencomparedwiththeotherconstructs.Thismayallowfortheapplicationofhighereffectivedosingtothetumorbedforspinalmetastaseswithoutincreasingspinalcordtoxicitywitheitherfractionatedorhypofractionatedradiotherapy.結(jié)論：與其他構(gòu)建體相比，PEEK籠手術(shù)后放射治療的輻射在脊柱中有更顯著均勻的分布。這可以允許對(duì)脊柱轉(zhuǎn)移腫瘤施加更高的有效劑量，而不增加放療的脊髓毒性。SampleradiationplanningmodelcreatedfromaplanningCTscanforoneofourcadavericspecimens.Theseparateiso-denselinescanbeseenwiththepercentageofthetotaldoseadministered.Theyellowareaisthespinalcordthathasbeenselectedduringtheradiationplanningasanareatoprotect.Notetherediso-denseline's,representing100%dose,lackofuniformdistributioninthePMMAconstructanditsoverlapwiththespinalcord.Aclinicalphotographofarepresentativeconstructwiththeposteriorspinalrods(bluearrow),thecircumferentiallydecompressedspinalcord(whitearrow),andthePMMAanteriorconstruct(yellowarrow).

B,Aclinicalphotographafterthesensorswereplacedintheirrespectivetrocarandthenplacedintheback.Thetrocarswereplacedthroughtheskintoallowformoresecurepositioning.Eachtrocarwaslabeledforaccuraterecoveryofthesensorfromitscorrespondinglocation..AcartonrepresentationoftheTLDsensorplacementlocation.EachTLDsensorplacementwasconfirmedvisuallybeforeclosingtheincisionandfillingitwiththephantommaterial.RepresentativeimagesfromacompleteplanningCTscanwithbeamanglesandiso-denselinesillustrated.Coronal,sagittal,axial,and3Dimagesareincluded.Thephantomcanbeseeingfillingthelungs.Thelowerconstructdosingwasplannedseparately.ArepresentativeT2sagittalMRIofapatientafterposteriorinstrumentationandanteriorreconstructionwithaPEEKcage.Notethescatterwiththepediclesscrews(redarrows).ThePEEKcagehasminimalscatteraffectingtheimagingsequence(yellowarrow).

RepresentativeaxialCTscanimagesdemonstratingthedifferenceinscattereffectfromametalanteriorconstruct(A)

versus

aPEEKanteriorconstruct(B).*Despiteadvances,metastaticdiseasecontinuestoaffectthespineanditcancausesymptomsfrompainandweaknesstocompleteparalysisleadingtosignificantmorbidityanddisability*盡管取得進(jìn)展，但轉(zhuǎn)移性疾病任然影響脊柱，并且可引起疼痛和無(wú)力，甚至完全癱瘓*ThePEEKinterbodycageresultedinasignificantlymoreuniformdistributionoftherapeuticradiationinthespinewhencomparedwiththeotherconstructsinacadavericspinemodel.*與尸體脊柱模型中的其他內(nèi)固定構(gòu)造相比，PEEK椎間融合器的治療輻射在脊柱中有更加顯著均勻的分布。*Thisknowledgemayallowfortheapplicationofhighereffectivedosingtothetumorbedforspinalmetastaseswithoutincreasingspinalcordtoxicitywitheitherfractionatedorhypofractionatedradiotherapy.*這種知識(shí)可以對(duì)脊柱轉(zhuǎn)移的腫瘤應(yīng)用更高的有效劑量，而不增加放療的脊髓毒性。

TITLEDeletionofOpgLeadstoIncreasedNeovascularizationandExpressionofInflammatoryCytokinesintheLumbarIntervertebralDiscofMice敲除小鼠Opg基因?qū)е卵甸g盤(pán)中炎癥細(xì)胞因子的表達(dá)和新生血管形成的增加StudyDesign.NeovascularizationandexpressionofinflammatorycytokineswereexaminedinOsteoprotegerin(Opg)knockout(KO)micethatshowintervertebraldisc(IVD)degeneration.研究設(shè)計(jì)：研究骨保護(hù)素〔Opg〕敲除〔KO〕小鼠的椎間盤(pán)〔IVD〕變性模型中炎癥細(xì)胞因子的表達(dá)和新血管的形成。ABSTRACTObjective.TheaimofthisstudywastoclarifythepathologicalchangesinlumbarIVDdegenerationinOpgKOmice.目的：本研究的目的是說(shuō)明OpgKO小鼠腰椎IVD變性的病理變化。ABSTRACTSummaryofBackgroundData.OsteoporosisisacontroversialriskfactorforIVDdegeneration.DeletionofOpgresultedinIVDdegenerationinmice.NeovascularizationandinflammatorycytokinesarekeyfactorsinIVDdegeneration.背景數(shù)據(jù)概述：骨質(zhì)疏松是IVD變性的有爭(zhēng)議的風(fēng)險(xiǎn)因素。敲除Opg導(dǎo)致小鼠中的IVD變性。新血管形成和炎癥細(xì)胞因子是IVD變性的關(guān)鍵因素。ABSTRACTMethods.OpgKOmiceandtheirwild-type(WT)littermateswereeuthanized.LumbarIVDswereharvested.SafraninO/FastGreenstainingwasperformedtoexaminethepathologicalchanges.Microcomputedtomographic(micro-CT)analysiswasperformedtodeterminethestructuralchangesatthejunctionoflumbarIVDcartilageandvertebrae.Tartrate-resistantacidphosphatase(TRAP)stainingwasperformedtoevaluateosteoclastformation.ProteinexpressionofvascularendothelialgrowthfactorA(VEGF-A),CD31,VE-cadherin,CD34,interleukin-1β(IL-1β),andtumornecrosisfactorsα(TNF-α)wereanalyzedbyimmunohistochemistry(IHC)assays.GeneexpressionsofIL-1β,IL-6,andTNF-αwereanalyzedbyreal-timepolymerasechainreaction(RT-PCR).方法：將OpgKO小鼠及其野生型〔WT〕同窩小鼠安樂(lè)死。獲取腰部IVD。進(jìn)行SafraninO/FastGreen染色以檢查病理變化。進(jìn)行微計(jì)算機(jī)斷層掃描〔micro-CT〕分析以確定腰椎IVD軟骨和椎骨的連接處的結(jié)構(gòu)變化。進(jìn)行酒石酸鹽抗性酸性磷酸酶〔TRAP〕染色以評(píng)價(jià)破骨細(xì)胞形成。通過(guò)免疫組織化學(xué)〔IHC〕測(cè)定分析血管內(nèi)皮生長(zhǎng)因子A〔VEGF-A〕，CD31，VE-鈣粘蛋白，CD34，白細(xì)胞介素-1β〔IL-1β〕和腫瘤壞死因子α。通過(guò)實(shí)時(shí)聚合酶鏈反響〔RT-PCR〕分析IL-1β，IL-6和TNF-α的基因表達(dá)。ABSTRACTResults.In12-week-oldOpgKOmice,newbonewasformedintheendplatecartilageoflumbarIVDsandthisbecamemoreobviousin24-week-oldOpgKOmice.Three-dimensional(3D)μCTreconstructionanalysesshowedthattheedgesoftheL4andL5vertebraewereruggedwithbonemarrowcavitiesinit.ProteinexpressionofVEGF-A,CD31,VE-cadherin,andCD34wasincreasedintheendplateandgrowthplateoflumbarIVDsofOpgKOmice.GeneexpressionofIL-1β,IL-6,andTNF-αaswellasproteinexpressionofIL-1βandTNF-αwerehighlyexpressedinthelumbarIVDsofOpgKOmice.結(jié)果：在12周齡的OpgKO小鼠中，腰椎IVD的終板軟骨中形成新骨，這在24周齡的OpgKO小鼠中變得更明顯。三維〔3D〕μCT重建分析顯示，L4和L5椎骨的邊緣與骨髓腔骨質(zhì)增生。在OpgKO小鼠的腰椎IVD的終板和生長(zhǎng)板中VEGF-A，CD31，VE-鈣粘著蛋白和CD34的蛋白表達(dá)增加。IL-1β，IL-6和TNF-α的基因表達(dá)以及IL-1β和TNF-α的蛋白表達(dá)在OpgKO小鼠的腰部IVD中高度表達(dá)。ABSTRACTConclusion.DeletionofOpgleadstoincreasedneovascularizationandexpressionofinflammatorycytokinesinthelumbardiscinOpgKOmice,whichmayplayimportantrolesinIVDdegeneration.結(jié)論：Opg的缺失導(dǎo)致OpgKO小鼠腰椎間盤(pán)的新血管形成和炎癥細(xì)胞因子的表達(dá)增加，這可能在IVD變性中起重要作用。Newbonewasformedintheendplatecartilageofthelumbar4/5IVDsin

Opg

KOmice.

(A)

SafraninOandFastGreenstainingshowedthatthenewbonewasfoundattheedgeoftheendplatecartilagein12-week-old

Opg

KOIVDs(arrow,middlepanel),andwasdevelopedthroughouttheendplatecartilagein24-week-old

Opg

KOIVDs(arrowheads,rightpanel).Thegrowthplatebecamethinner(arrow,rightpanel).

(B)

Newboneformationwasquantifiedbytheratioofnewboneareaandendplatecartilageareainlumbar4/5IVDs.Inboth12-week-oldand24-week-oldmice,newboneformationinendplatecartilageof

Opg

KOIVDswassignificantlyincreasedthanthatofWTIVDs(P

<0.01).n=3.

(C)

3Dreconstructionanalysisfromthetransversepositionshowedthatin12-week-old

Opg

KOmice,newcavitiesappearedontheedgesoftheL4andL5vertebrae.In24-week-old

Opg

KOmice,thevertebraebecameevenruggedwithalotofcavitiesinit(pixelsize:906x906).*DeletionofOpgleadstoincreasedneovascularizationinlumbarintervertebraldiscofmice.*DeletionofOpgleadstoincreasedexpressionofinflammatorycytokinesinlumbarintervertebraldiscofmice.*LumbarIVDdegenerationinOpgKOmicecouldbeacceleratedbytheinteractionsamongosteoclastformation,inflammatorycytokines,andneovascularization.*敲除Opg導(dǎo)致小鼠腰椎間盤(pán)增加新血管形成。*敲除Opg導(dǎo)致小鼠腰椎間盤(pán)中炎癥細(xì)胞因子的表達(dá)增加。*OpgKO小鼠的腰椎IVD變性可以通過(guò)破骨細(xì)胞形成，炎癥細(xì)胞因子和新血管形成之間的相互作用而加速。TitleComplicationandReoperationRatesFollowingSurgicalManagementofCervicalSpondyloticMyelopathyinMedicareBeneficiariesDepartmentofOrthopaedicSurgery,JohnsHopkinsHospital,Baltimore,MD醫(yī)療保險(xiǎn)受益人髓性頸椎病手術(shù)治療后的并發(fā)癥和再手術(shù)率StudyDesign.Retrospectivedatabasereview.研究設(shè)計(jì)：回憶性數(shù)據(jù)庫(kù)審查。ABSTRACTObjective.Tocomparecomplicationandreoperationratesafteranteriorcervicaldiscectomyandfusion(ACDF),posteriorcervicalfusion(PCFs),andanteriorcervicalcorpectomyandfusion(ACCF)forcervicalspondyloticmyelopathy(CSM)usingalargenationaldatabaseofMedicarebeneficiaries.目的：使用國(guó)家醫(yī)療保險(xiǎn)受益人的大型國(guó)家數(shù)據(jù)庫(kù)，比較頸椎前路椎間盤(pán)切除融合術(shù)和頸椎后路融合術(shù)〔PCF〕，頸椎前路椎體融合術(shù)〔ACCF〕治療頸椎髓性頸椎病〔CSF〕的并發(fā)癥和再手術(shù)率。ABSTRACTSummaryofBackgroundData.CSMisthemostcommoncauseofmyelopathyinpatientsover55yearsandisconsideredthemostcommoncauseofspinalcorddysfunctionintheworld.SurgicaltreatmentincludesACDF,PCF,orACCFprocedures.背景資料概述：CSM是55歲以上患者中脊髓壓迫最常見(jiàn)的原因，并且被認(rèn)為是世界上導(dǎo)致脊髓功能障礙的最常見(jiàn)原因。手術(shù)治療包括ACDF，PCF或ACCF。ABSTRACTMethods.ThePearlDiverdatabase(2005–2021)wasutilizedtodeterminerevisionratesaftersurgicaltreatmentofCSMbyoneoftheaforementionedsurgicaltreatments.Specifically,1to2levelACDF,ACCF,andPCFand3+levelPCFcohortswereincluded.Eachcohortwasstratifiedbytheageof65years.Survivorshipcurvesweregraphedandcompared.方法：使用PearlDiver數(shù)據(jù)庫(kù)〔2005-2021〕確定上述手術(shù)治療的CSM患者的返修率。具體來(lái)說(shuō)，包括1至2階段ACDF，ACCF和PCF和3+PCF隊(duì)列。每個(gè)隊(duì)列按65歲分層。繪制并比較存活曲線。ABSTRACTResults.Ofthepatientsyoungerthan65yearsofage,therewere10,557patientstreatedwith1to2levelACDFprocedures,1319patientswith1to2levelPCFprocedures,1203patientswith1to2levelACCFprocedures,and2312patientstreatedwith3+levelPCFprocedures.Oftheelderlypatients,24,310patientsweretreatedwith1to2levelACDFs,4776with1to2levelPCFprocedures,3109with1to2levelACCFs,and7760with3+levelPCFs.Patientsyoungerthan65yearsofageweresignificantlymorelikelytohaveareoperationprocedure,thanthose65yearsorolderwhenanalyzingACCF,ACDF,and3+levelPCFprocedures.ACCFsweresignificantlymorelikelythanACDFstorequirereoperation.PatientstreatedwithPCFwereconsistentlymorelikelytohavenondysphagia-relatedcomplicationsthanthosetreatedwithACDF.Ratesoftransfusion,dysphagia,andhematoma/seromaformationweresignificantlyincreasedwithACCFcomparedwithACDFwithintheelderlypopulation.結(jié)果：在65歲以下的患者中，有10,557例患者接受1?2階段的ACDF手術(shù)，1319例患者接受1?2階段的PCF手術(shù)，1203例患者接受1?2階段的ACCF手術(shù)，2312例患者接受3+級(jí)PCF程序。在老年患者中，24,310例患者接受1?2階段的ACDF治療，4776例接受1?2階段的PCF手術(shù)，3109例接受1?2階段的ACCF，7760例接受3?4階段的PCF。65歲以下的患者ACCF，ACDF和3+級(jí)PCF比65歲或更大的患者明顯更有可能進(jìn)行再次手術(shù)。ACCF明顯比ACDF更可能需要再次手術(shù)。PCF治療的患者比用ACDF治療的患者更可能患有非吞咽困難相關(guān)的并發(fā)癥。輸血，吞咽困難和血腫形成率在老年人口中的ACDF組顯著增加。ABSTRACTConclusion.TheelderlyaresignificantlylesslikelytohavearevisionsurgeryaftersurgicaltreatmentforCSM.PatientstreatedwithACCFaremorelikelytoneedarevisionthanthosetreatedwithACDF.結(jié)論：老年人在CSM手術(shù)治療后進(jìn)行返修手術(shù)的可能性顯著降低。用ACCF治療的患者比用ACDF治療的患者更可能需要翻修。*PatientstreatedwithACCFaremorelikelytoneedrevisionsurgerythanthosetreatedwithACDForPCF.*ThereisnosignificantdifferenceinrevisionratewhencomparingACDFandPCFprocedures.*Theelderlyweresignificantlylesslikelythanyoungerpatientstohavearevisionsurgerywhenconsideringallsurgeries.*PCFisassociatedwithgreatercomplicationrates,thoughlowerdysphagiarates.*ACCF治療的患者比ACDF或PCF治療的患者更可能需要翻修手術(shù)。*當(dāng)比較ACDF和PCF程序時(shí)，翻修率沒(méi)有顯著差異。*在考慮所有手術(shù)時(shí)，老年人比年輕患者進(jìn)行翻修手術(shù)的可能性顯著降低。*PCF與較高的并發(fā)癥發(fā)生率相關(guān)，但吞咽困難率較低。

TITLEEfficacyofDiffusionTensorImagingIndicesinAssessingPostoperativeNeuralRecoveryinCervicalSpondyloticMyelopathyDepartmentofspinesurgery,GangaHospital,Coimbatore,India.擴(kuò)散張量成像指數(shù)在評(píng)估頸椎脊髓病性脊髓病術(shù)后神經(jīng)恢復(fù)的成效StudyDesign.Prospectiveobservationalcohortstudy.研究設(shè)計(jì)：前瞻性觀察性隊(duì)列研究。ABSTRACTObjective.Theaimofthisstudywastoanalyzetheefficacyofdiffusiontensorimaging(DTI)anisotropyindicesinpredictingthepostoperativerecoveryincervicalspondyloticmyelopathy(CSM)patientsandtodescribepostoperativechangesintheDTIindicesbasedonneurologicalrecoveryaftersurgery.目的：本研究的目的是分析擴(kuò)散張量成像〔DTI〕各向異性指數(shù)在預(yù)測(cè)頸髓性脊髓病〔CSM〕患者的術(shù)后恢復(fù)的效果，并描述手術(shù)后神經(jīng)恢復(fù)的DTI指數(shù)的術(shù)后變化。

ABSTRACTSummaryofBackgroundData.SurgicalresultsofCSMareunpredictableandcannotbeestimatedbasedonpreoperativeMRI.DTIindiceswerefoundtohavegoodsensitivitytodetectchangesinCSM,buttheirefficacyinpredictingpostoperativerecoveryandpostoperativechangesinDTIindiceshasnotbeenstudiedbefore.背景資料總結(jié)：CSM的手術(shù)結(jié)果是不可預(yù)測(cè)的，不能基于術(shù)前MRI進(jìn)行估計(jì)。DTI指數(shù)具有良好的敏感性以檢測(cè)CSM的變化，但DTI指數(shù)術(shù)后變化在預(yù)測(cè)術(shù)后恢復(fù)的成效尚未進(jìn)行過(guò)研究。ABSTRACTMethods.Thirty-fivepatientswhounderwentsurgicaldecompressionforcervicalspondyloticmyelopathyunderwentDTIevaluationpreoperativelyandpostoperativelyat12months.DTIindices—fractionalanisotropy,apparentdiffusioncoefficient(ADC),relativeanisotropy,volumeratio,andeigenvectors(E1,E2,andE3)—wereobtainedandclinicalevaluationsweremadepreoperativelyand12monthspostoperatively.方法：35例頸椎病接受手術(shù)減壓的患者術(shù)前和術(shù)后12個(gè)月進(jìn)行DTI評(píng)估。獲得DTI指數(shù)-分?jǐn)?shù)各向異性，表觀擴(kuò)散系數(shù)〔ADC〕，相對(duì)各向異性，體積比和特征向量〔E1，E2和E3〕，并在術(shù)前和術(shù)后12個(gè)月進(jìn)行臨床評(píng)價(jià)。ABSTRACTResults.Twenty-sixpatientswereavailableforfinalfollow-upat12months.Twentypatientsshowedimprovementbyatleast1Nurickgrade,fivemaintainedthepreoperativeNurickgradestatusandonepatientwasnotedtohavedeteriorationby1grade.ThepreoperativeDTIvaluescouldnotpredictneurologicalrecoverypatternspostoperatively.AlthoughconventionalMRIshowedadequatedecompressioninallpatientsirrespectiveoftheclinicaloutcome,DTIindicesshowedvariableresults.ThereweresignificantimprovementsinpostoperativeDTIindicesforADC(P

=0.002),E1(P

<0.001),andE2(P

=0.012)valuesinpatientswhoshowedneurologicalrecoveryat12months.PostoperativeDTIindicesforcoefficientsADC,E1,andE2inneurologicallystatic/worsenedindividualsremainedunchangedorinsignificant(P

=0.05)結(jié)果：在12個(gè)月時(shí)有26名患者獲得了最終隨訪。20例患者表現(xiàn)出至少1級(jí)的Nurick改善，5例維持術(shù)前Nurick分級(jí)狀態(tài)，1例患者1級(jí)惡化。術(shù)前DTI值無(wú)法預(yù)測(cè)術(shù)后神經(jīng)恢復(fù)。盡管常規(guī)MRI在所有患者中顯示充分的減壓，而不管臨床結(jié)果如何，但DTI指數(shù)顯示可變的結(jié)果。在12個(gè)月時(shí)顯示神經(jīng)恢復(fù)的患者中，ADC〔P=0.002〕，E1〔P<0.001〕和E2〔P=0.012〕值的術(shù)后DTI指數(shù)有顯著改善。在神經(jīng)靜態(tài)/惡化個(gè)體中，ADC系數(shù)，E1和E2的術(shù)后DTI指數(shù)保持不變或不顯著〔P=0.05〕ABSTRACTConclusion.TheDTIindicesweresensitiveenoughtoindicatepostoperativeneurologicalrecoveryobservedfollowingsurgery.PreoperativeDTIevaluationcouldnotpredictpostoperativerecoveryforpatientswithcervicalspondyloticmyelopathy.結(jié)論：DTI指數(shù)足夠敏感預(yù)測(cè)手術(shù)后觀察到神經(jīng)恢復(fù)。術(shù)前DTI評(píng)估無(wú)法預(yù)測(cè)髓性頸椎病患者的術(shù)后恢復(fù)。

*PostoperativeDTIindicesweresensitivetodifferentiatepostoperativeclinicaloutcomefollowingsurgery,showingcomparablechangewithrecoveryandnosignificantchangewasseeninpatientswhoshowednorecoveryorworsenedaftersurgery.*StatisticallysignificantimprovementwasnotedinDTIindicesvaluesforADC,EigenvectorsE1andE2at12monthsfollowingsurgeryinthepatientsshowingneurologicalrecovery.*ThoughpostoperativeMRIshowedsatisfactorydecompressioninallsurgicallytreatedpatientspostoperativeDTIindicesshowedvariableresults.*PreoperativeDTIcouldnotpredictwhichpatientwouldshowclinicalrecoveryfollowingsurgicaldecompression.*術(shù)后DTI指數(shù)對(duì)手術(shù)后的臨床結(jié)果敏感，顯示與恢復(fù)相當(dāng)?shù)淖兓?，在手術(shù)后未恢復(fù)或惡化的患者中未見(jiàn)顯著變化。*在顯示神經(jīng)恢復(fù)的患者中，在手術(shù)后12個(gè)月的ADC，特征向量E1和E2的DTI指數(shù)值中觀察到統(tǒng)計(jì)學(xué)顯著的改善。*雖然術(shù)后MRI顯示所有手術(shù)治療患者的減壓良好，術(shù)后DTI指數(shù)顯示可變的結(jié)果。*術(shù)前DTI無(wú)法預(yù)測(cè)患者在手術(shù)減壓后的臨床恢復(fù)

磁共振彌散張量成像

〔diffusiontensorimaging,DTI〕實(shí)現(xiàn)活體觀察組織結(jié)構(gòu)的完整性和連通性，利于對(duì)各種疾病的引起的白質(zhì)纖維束的損害程度及范圍的判斷?？捎糜陲@示腦白質(zhì)內(nèi)神經(jīng)傳導(dǎo)束的走行方向，實(shí)現(xiàn)對(duì)人的中樞神經(jīng)纖維精細(xì)成像。MR圖像的信號(hào)：組織T1、T2馳豫時(shí)間、H1的密度、分子彌散運(yùn)動(dòng)DTI的根本原理：利用擴(kuò)散敏感梯度脈沖將水分子彌散效應(yīng)擴(kuò)大，來(lái)研究不同組織中水分子擴(kuò)散運(yùn)動(dòng)的差異〔擴(kuò)散加權(quán)相DWI〕。DTI可利用擴(kuò)散敏感梯度從多個(gè)方向?qū)λ肿拥臄U(kuò)散各向異性進(jìn)行量化，因此有可能反映組織內(nèi)的細(xì)微結(jié)構(gòu)及病理生理改變。擴(kuò)散張量成像(difusiontensorimaging，DTI)可以觀察脊髓病變及再生修復(fù)的動(dòng)態(tài)過(guò)程，進(jìn)行組織微觀結(jié)構(gòu)改變的定量分析，纖維束示蹤成像技術(shù)可以立體展現(xiàn)白質(zhì)纖維束的形態(tài)表觀擴(kuò)散系數(shù)(apparentdifusioncoefficient，DCADC值越大，說(shuō)明水分子的彌散能力越強(qiáng)；三個(gè)互相垂直方向的ADC值的平均數(shù)是平均擴(kuò)散率(meandisivity，MD)，它不受方向影響；各向異性包括局部各向異性(fractionanisotropy，F(xiàn)A)和相對(duì)各向異性(relativeanisotropy，RA)FA、RA都是非矢量值(數(shù)值，無(wú)方向性)，取值范圍為是0～1既組織結(jié)構(gòu)排列越規(guī)律緊密，組織的各向異性越強(qiáng)，各向異性系數(shù)越大張量方向由于彌散張量具有方向性，可以從彌散張量所含信息中顯示出纖維方向的圖，利用纖維束示蹤成像技術(shù)，立體展現(xiàn)白質(zhì)纖維束的形態(tài)TheAssessmentofNeuronalStatusinNormalandCervicalSpondyloticMyelopathyUsingDiffusionTensorImaging彌散張量成像在正常和脊髓型頸椎病對(duì)神經(jīng)元的狀態(tài)的評(píng)價(jià)STUDYDESIGN:Aprospectiveobservationalanalysisofdiffusiontensorimaging(DTI)datametricscollectedfromcontrolandpatientswithcervicalspondyloticmyelopathy(CSM).研究設(shè)計(jì)：收集脊髓型頸椎病〔CSM〕的彌散張量成像〔DTI〕數(shù)據(jù)前瞻性觀察分析。AbstractOBJECTIVE:TheaimsweretostudytheuseofDTIinCSMandtoprobewhetherDTIdatametricsandtractographywillcorrelatewithmagneticresonanceimagingandclinicalfindings.目的：目的是研究在CSM患者中使用DTI和探討DTI跟蹤技術(shù)磁共振成像和臨床表現(xiàn)相關(guān)。AbstractSUMMARYOFBACKGROUNDDATA:Magneticresonanceimagingisthecurrent"goldstandard"intheassessmentofcordstatusinCSM;however,variousparameterssuchasextentofcompressionandpresenceofsignalintensitychangesdonotcorrelatewellwithclinicalstatus.DTIisanovelinvestigationtoolwithprovenapplicationsinbrainpathologiesbutisnotroutinelyusedinspinalcordevaluation.背景資料概述：磁共振成像是在目前CSM狀況評(píng)估的“金標(biāo)準(zhǔn)〞;然而，各種參數(shù)與臨床情況相關(guān)性不是很好。DTI是一種新型的檢測(cè)方式，常用在顱腦的診斷中，但在脊柱脊髓的診斷中不常使用。AbstractMETHODS:PatientswithCSM(n=35)whorequiredsurgicaldecompression(meanage=48yr)and40normalindividuals(meanage=38yr)wereincluded.DiffusionTensorImagingofthecervicalspinewasobtainedusinga1.5Tmagneticresonanceimage.Apparentdiffusioncoefficient,fractionalanisotropy,andeigenvalues(E1,E2,andE3)wereobtainedateachcervicallevel.TheDTIdatametricsofCSMpatientswerecomparedwithnormalvolunteersandcorrelatedwithindividualandgroupedNurickgrades,whichindicatetheneurologicalstatusofpatients.方法：35名需要手術(shù)減壓的CSM患者〔平均年齡=48歲〕和40名正常人〔平均年齡=38歲〕納入研究。頸椎的彌散張量成像是使用1.5T磁共振圖像獲得。獲取每個(gè)節(jié)段的表觀擴(kuò)散系數(shù)，分?jǐn)?shù)各向異性，和特征值〔E1，E2和E3〕的數(shù)據(jù)。CSM患者的DTIdatametrics與正常人進(jìn)行了比較，并和Nurick等級(jí)關(guān)聯(lián)起來(lái)。AbstractRESULTS:TherewassignificantdifferenceinDTIdatametricsbetweenpatientswithmyelopathyandcontrol(P<0.05),withdecreaseinfractionalanisotropy(0.49±0.081vs.0.53±0.07)andincreaseinapparentdiffusioncoefficient(1.8±0.315vs.1.44±0.145)andeigenvalues(E1:2.82±0.395vs.2.37±0.221,E2:1.64±0.39vs.1.18±0.198,E3:0.956±0.277vs.0.76±0.142).Therewasalsoasignificantdifferencebetweenincreasinggradesofmyelopathywhenindividualsweregroupedas-control,self-ambulant(Nurickgrades1and2),anddependent(Nurickgrades3,4,and5).結(jié)果：在CMS和對(duì)照組中DTIdatametrics存在顯著差異〔P<0.05〕，各向異性分?jǐn)?shù)降低〔0.49±0.081與0.53±0.07〕，表觀擴(kuò)散系數(shù)〔1.8±0.315與1.44±0.145〕和特征值增加〔E1：2.82±0.395與2.37±0.221，E2：與0.198±，E3：0.956±0.277與0.76±0.142〕。根據(jù)Nurick等級(jí)得分的不同，脊髓的MRIDTI也不同。1.Tractographypatterns:(A)normal,(B)waisting,(C)partiallyinterrupted,and(D)completelyinterrupted.Arrowsshowcompressedregions.AbstractCONCLUSION:ThestudyshowsthatDTIisapromisingandusefulinvestigationaltoolinevaluationofCSM.TherewasasignificantdifferenceinallDTIvaluesbetweencontrolandpatientswithCSM,andtherewasasignificanttrendofchangeinvaluesbetweencontrol,self-ambulant,anddependentpatients.Ourresultsencouragefurtherinvestigationofthisimportantmodality.結(jié)論：該研究說(shuō)明，DTI是評(píng)價(jià)CSM的一個(gè)有前途的和有用的研究性的工具。對(duì)照組和CMS組的DTI數(shù)值是顯著不同的，并且與Nurick等級(jí)得分有關(guān)系。我們的研究結(jié)果指導(dǎo)下一步的繼續(xù)研究。TITLERoutineUseofIntraoperativeNeuromonitoringDuringACDFsfortheTreatmentofSpondyloticMyelopathyandRadiculopathyIsQuestionable:AReviewof15,395CasesUCLAMedicalCenter,DepartmentofOrthopaedicSurgery,LosAngeles,CA在ACDF治療髓性或根性頸椎病術(shù)中常規(guī)使用神經(jīng)監(jiān)護(hù)是可疑的：回憶15,395例StudyDesign.Aretrospectivedatabasestudy.研究設(shè)計(jì)：回憶性數(shù)據(jù)庫(kù)研究。ABSTRACTObjective.Thegoalofthisstudywasto(1)evaluatethetrendsintheuseofintraoperativeneuromonitoring(ION)foranteriorcervicaldiscectomyandfusion(ACDF)surgeryintheUnitedStatesand(2)assesstheincidenceofneurologicalinjuriesafterACDFswithandwithoutION.目的：本研究的目的是〔1〕評(píng)估在美國(guó)使用術(shù)中神經(jīng)監(jiān)護(hù)〔ION〕用于前頸椎間盤(pán)切除術(shù)和融合〔ACDF〕手術(shù)的趨勢(shì)，以及〔2〕評(píng)估ACDF后神經(jīng)損傷的發(fā)生率有和沒(méi)有ION。

ABSTRACTSummaryofBackgroundData.Somatosensory-evokedpotentials(SSEPs)andmotor-evokedpotentials(MEPs)arethecommonlyusedIONmodalitiesforACDFs.ControversyexistsontheroutineuseofIONforACDFsandthereislimitedliteratureonnationalpracticepatternsofitsuse.背景數(shù)據(jù)的概述：體感誘發(fā)電位〔SSEP〕和運(yùn)動(dòng)誘發(fā)電位〔MEP〕是ACDF常用的ION方式。關(guān)于ION用于ACDF的常規(guī)使用存在爭(zhēng)議，并且關(guān)于其使用的國(guó)家實(shí)踐模式的文獻(xiàn)有限。

ABSTRACTMethods：AretrospectivereviewwasperformedusingthePearlDiverPatientRecordDatabasetoidentifycasesofspondyloticmyelopathyandradiculopathythatunderwentACDFfrom2007to2021.ThetypeofIONmodalityusedandtheratesofneurologicalinjuryaftersurgerywereassessed.方法：使用PearlDiver患者記錄數(shù)據(jù)庫(kù)進(jìn)行回憶性評(píng)估，以確定2007年至2021年期間接受ACDF的髓性頸椎病和根性頸椎病的病例。評(píng)估使用ION方式類(lèi)型和手術(shù)后神經(jīng)損傷的發(fā)生率。pearldiver已經(jīng)建立了一個(gè)世界上最大的醫(yī)療保健數(shù)據(jù)庫(kù)超過(guò)40億符合HIPAA病人記錄。在這個(gè)根底上，pearldiver能夠提供醫(yī)院、醫(yī)務(wù)人員、醫(yī)療設(shè)備公司高管、分析師和監(jiān)管機(jī)構(gòu)的關(guān)鍵見(jiàn)解和可操作的信息。PearlDiverhaspartneredwithComprehensiveHealthInsightstointegrateHumana’s〔醫(yī)療保險(xiǎn)巨頭〕fullclaimsdatabaseintothePearlDiverresearchprogram.AsofJuly,2021Humanarepresents20.9millionpatientsthroughoutthedurationofthesetincludingclaimsfrom2007throughQ32021.Nosamplingisperformedonthisdata.ResearchisconductedoverthefullsetincludingcommercialandMedicareadvantagepopulations.Whilede-identifiedandHIPAAcompliant,thisresearchsetisfullycapableoflongitudinalresearchbaseduponuniquepatientidentifiercodes.ResearchcanbeperformedutilizinganyoneorcombinationofidentifiablefieldsontheclaimrecordprocessedbyHumana.Fieldsincludebutarenotlimitedto;ICD-9&ICD-10diagnosiscoding,DRGproceduralcoding,ICD-9&ICD-10proceduralcoding,CPTproceduralcoding,prescriptionNDCcoding,labrecordLOINCcoding,dischargestatus