腰区脑脊液压预估颅内压的数学模拟

颅内压（Intracranial Pressure，ICP）的实时监测临床上有着十分重要的意义。临床测量颅内压的方法是通过穿刺小脑延髓池或侧脑室用压力管测量，然而此方法存在一定的风险。由于正常成人的颅腔和脊髓腔是一个连通的容器，因此腰区脑脊液压（1umbarcerebrospinal fluid pressure，LCP）和颅内压存在一定联系，检测腰区脑脊液压来预估颅内压成为临床的需要。本研究在动物（犬）实验结果的基础上，建立了反映颅内压变化的集中参数模型，模型中整合了腰区脑脊液压与颅内压和脑血流的相互作用，数值模拟了颅内压。结果显示，数值模拟得到的ICP曲线与动物实验检测的ICP曲线经秩和检验无显著性差异，模型参数的变化和动物实验状况的变化相吻合，可以为临床颅内压监测及诊疗提供一定的参考。     

电针加斜扳法治疗第三腰椎横突综合征的疗效观察

目的观察电针加斜扳法对第三腰椎横突综合征的疗效。方法将60例第三腰椎横突综合征患者随机分为电针加斜扳法治疗组30例和单纯电针组30例。治疗均以20d为限,1周后复查并进行疗效统计,通过比较两者的症状缓解情况和第三腰椎横突压痛点消失情况进行疗效评定。结果①第三腰椎横突压痛点消失情况,电针加斜扳法组为69．44％,电针组为40．00％。两者比较有显著差异（P〈0．05）。②临床症状缓解情况,电针加斜扳法组有效率为100．00％,电针组为93．33％,两组比较无显著差异性（P〉0．05）。结论电针加搬法比单纯电针治疗更有利于第三腰椎横突病灶的消除。     

手法配合痹祺胶囊治疗腰椎间盘突出症临床研究

为观察手法加痹祺胶囊治疗腰椎间盘突出症的临床疗效,对160例腰椎间盘突出症患者随机分为两组:治疗组病人80例,采用手法加痹祺胶囊治疗; 对照组病人80例, 只行痹祺胶囊治疗.经临床治疗显示: 治疗组总有效率为98.75%, 对照组为88.75%, 两组比较有显著性差异 (P＜0.05).临床治疗证明:手法配合痹祺胶囊治疗腰椎间盘突出症见效快,治愈率高.     

飞针加整脊治疗腰椎间盘突出症37例

对腰椎间盘突出症37例,采用飞针加整脊治疗,经2-6个疗程的治疗,总有效率达94.6%。治疗后脊柱活动恢复正常,腰腿痛症状消失,直腿抬高试验70°;个别患者腰腿痛症状减轻,腰部活动功能改善。由此证明,飞针加整脊是一种治疗腰椎间盘突出症的理想疗法。     

不同手术节段经皮椎间孔镜下腰椎间盘切除术的临床效果

目的 评价不同手术节段腰椎间盘突出症经皮椎间孔镜下腰椎间盘切除术(Percutaneous endoscopic lumbar discectomy, PELD)的临床效果。方法 回顾性分析2014年1月到2017年6月清华大学附属垂杨柳医院骨科收治行PELD的腰椎间盘突出症患者,根据不同手术节段,分为3组：A组为L2-3和L3-4,B组为L4-5,C组为L5-S1。所有患者行单节段PELD手术。术前、术后3天、3个月和6个月通过Oswestry腰椎功能障碍指数(Oswestry disability index, ODI)评分和改良MacNab标准评价临床效果。结果 A组患者的平均年龄、BMI最小,病程、住院时间和随访时间最短,Pfirrmann分级III级占68.8%,而C组IV级占48.0%,但是,三组患者没有显著统计学差异。A组均为椎间孔入路,B组绝大部分为椎间孔入路(90.3%),而C组以椎板间入路为主(68.0%)。与其他两组相比,C组手术时间长(F=4.014, P=0.028),出血量多(F=3.645, P=0.037)。A组没有发生手术相关并发症,也没有术后复发病例,而C组手术相关并发症发生率(12.0%)最高,复发概率(4.0%)也最高,B组居于两者之间(6.4%和3.2%),但是并没有统计学差异。尽管C组患者术后ODI评分得到很大改善,但是不如其他两组明显(F=43.483, P=0.043),尤其是术后3个月ODI评分高于其他两组(P值分别为0.039和0.028)。术后6个月C组ODI评分仍然高于其他两组,但是没有统计学差异(F=1.049, P=0.362)。术后6个月随访时,根据改良MacNab评价标准,总体优良率为95.9%,三组比较没有明显差异(χ_²=5.305,P=0.070)。结论 不同椎间隙水平的腰椎间盘突出症患者PELD术后临床效果不同,L5-S1手术时间相对长,出血量相对多,并发症发生率相对高,且术后ODI评分改善不如其他两组明显,需严格掌握适应症,周密术前计划。     

Postural Sway during Local Vibratory Stimulation for Proprioception in Elderly Individuals with Pre-Sarcopenia

Objective: Many studies have demonstrated that the loss of muscle mass (LMM) poses a risk of postural instability in the elderly; however, few studies have shown how LMM decreases proprioception. In this study, we investigated the changes in postural sway among older individuals with LMM induced by application of a local vibratory stimulus. Method: We enrolled 64 older adults (mean age). Postural sway was measured while applying vibration stimuli of 30, 60, and 240 Hz to both the gastrocnemius and lumbar multifidus muscles. We also measured the relative proprioceptive weighting ratio (RPW) of postural sway. The patients were divided into LMM and non-LMM (NLMM) groups. The study subjects were compared in terms of their age, height, weight, body mass index (BMI), lower leg skeletal muscle mass index (LSMI), L4/5 lumbar multifidus cross-sectional area ratio, and RPW at 30, 60, and 240 Hz. Results: Subjects in the LMM group showed a significantly lower RPW at 60 Hz, LSMI, and BMI than did those in the NLMM group. Conclusions: Decrease in RPW with 60-Hz stimulation concerning the lower leg proprioception is a risk factor for LMM-associated postural instability in the elderly. Consequently, with respect to the gastrocnemius muscles proprioception in LMM, it is necessary to perform assessments using muscle spindle stimuli.     

艺术体操运动员腰椎损伤的生物力学原理分析

从生物力学平衡的改变这一关键病因出发，分析了艺术体操运动员腰椎的生理特点，阐明了其生物力学平衡改变的基本过程，探讨了影响腰椎力学平衡结构的因素，提出了预防艺术体操运动员腰椎损伤的建议.     

Simultaneous solution of the Navier-Stokes and elastic membrane equations by a finite element method

Fluid flow through a significantly compressed elastic tube occurs in a variety of physiological situations. Laboratory experiments investigating such flows through finite lengths of tube mounted between rigid supports have demonstrated that the system is one of great dynamical complexity, displaying a rich variety of self-excited oscillations. The physical mechanisms responsible for the onset of such oscillations are not yet fully understood, but simplified models indicate that energy loss by flow separation, variation in longitudinal wall tension and propagation of fluid elastic pressure waves may all be important. Direct numerical solution of the highly non-linear equations governing even the most simplified two-dimensional models aimed at capturing these basic features requires that both the flow field and the domain shape be determined as part of the solution, since neither is known a priori. To accomplish this, previous algorithms have decoupled the solid and fluid mechanics, solving for each separately and converging iteratively on a solution which satisfies both. This paper describes a finite element technique which solves the incompressible Navier-Stokes equatikons simultaneously with the elastic membrane equations on the flexible boundary. The elastic boundary position is parametized in terms of distances along spines in a manner similar to that which has been used successfully in studies of viscous free surface flows, but here the membrane curvature equation rather than the kinematic boundary condition of vanishing normal velocity is used to determine these diatances and the membrane tension varies with the shear stresses exerted on it by the fluid motions. Bothy the grid and the spine positions adjust in response to membrane deformation, and the coupled fluid and elastic equations are solved by a Newton-Raphson scheme which displays quadratic convergence down to low membrane tensions and extreme states of collapse. Solutions to the steady problem are discussed, along with an indication of how the time-dependent problem might be approached.     

镁铝尖晶石的铝铬渣与用后镁碳砖低温合成

用铝铬渣和转炉用后镁碳砖细粉为主要原料,通过固相烧结反应合成MgAl2O4材料.用X射线衍射、扫描电镜及X'Pert plus软件对材料中主晶相进行表征.结果表明:当烧成温度为1 400℃,镁碳砖与铝铬渣摩尔比为5∶1时,生成的镁铝尖晶石晶粒发育完整清晰,排列致密,外貌呈典型的八面体形貌.镁铝尖晶石质量百分数达到92％.     

微血管形成在腰椎间盘退变过程中的表现特征及影响因素

目的观察微血管形成在腰椎间盘退变过程中的病理表现特征,并分析其相关影响因素.方法选取48例行单节段腰椎后路经椎间孔减压椎间植骨融合内固定术患者,术中切取患处组织,冷冻切片后HE染色,观察病理改变,Weidner微血管计数法统计微血管密度.根据是否有微血管分为有微血管组、无微血管组,比较微血管形成的可能影响因素,对差异具有统计学意义的因素进一步行Logistics回归分析.结果 25例患者椎间盘内存在明显微血管形成,组织切片中存在典型的条形管腔结构,血管内皮细胞核有明显蓝染,微血管形成率为52.08%,MVD值平均为11.9±2.5.有微血管组椎间盘钙化率明显高于无微血管组,差异具有显著统计学意义(P0.01);有微血管组JOA评分明显低于无微血管组,腰椎疼痛VAS评分明显高于无微血管组,差异具有统计学意义(P0.05);椎间盘退变程度、椎间盘疝出程度两组间比较差异无统计学意义(P0.05).多因素回归分析显示:椎间盘钙化、腰椎疼痛VAS评分与退变椎间盘内微血管形成有明显相关性(OR值分别8.992,7.359,P值均0.05).结论椎间盘退变伴随着微血管形成,椎间盘钙化、腰椎疼痛VAS评分与退变腰椎间盘微血管形成有关.