单纯后路手术治疗胸腰椎结核的临床应用

对收治我科的16例胸腰椎结核患者行一期后路病灶清除、植骨融合内固定手术,术后评价结核控制及植骨愈合程度等,并用ASIA分级及评分对神经功能情况进行统计学分析。术后资料示植骨融合、畸形矫正满意,无结核复发。患者感觉和运动功能ASIA评分改善具有统计学意义(P0.05)。因而合理应用本法治疗胸腰椎结核可作为临床骨科医师优先考虑的手术方式。     

西方脊柱手法医学的进展与镜鉴

脊柱手法在东西方治疗脊柱退变性疾病都有数千年的历史。近半个世纪以来,西方国家的脊柱手法治疗的发展已经形成了现代科学研究的框架和体系。许多基础研究和手法机制的研究已经得到现代医学科学的认可。以经验医学为主导的脊柱手法治疗能够在一个以现代实验医学占主导的欧美国家生存和发展实属不易。本文就此进行了综述和剖析。分析了当代脊柱手...     

A comparison of cortico-cortical communication during air-pistol shooting in elite disabled and non-disabled shooters

This study examined the difference in electroencephalographic (EEG) coherence, an index of cortico-cortical communication, during air pistol shooting between disabled and non-disabled elite shooters. Participants included 22 non-disabled and 12 disabled members of the Korean national air-pistol shooting team at the world class level. Electrocortical activation was recorded during 20 self-paced 10-meter air pistol shots. Higher cortico-cortical communication between brain regions was observed in disabled shooters. The higher functional communication appears to be a strategy to compensate for the attenuated function of the brain resulting from spinal cord injury. This compensatory mechanism could explain why there is no significant difference in shooting performance between elite disabled and non-disabled shooters.     

Recovery of Locomotion in Monkeys with Spinal Cord Lesions

This study reanalyzes kinematically (via film) the pre- and postoperative locomotor behavior of 4 of the 10 monkeys with partial spinal cord lesions (T8) briefly described by Eidelberg, Walden, and Nguyen (1981). The behavior of the remaining 6 monkeys is qualitatively described. The analysis reveals that 5 of the animals initially exhibited unilateral hind limb stepping. Hind and forelimb cycle durations often differed postoperatively; the hind limbs commonly showed increased values, whereas fore-limb cycle durations were reduced. Ipsilateral interlimb phase values were usually inconsistent.

A review of prior studies of primate spinal cord lesions indicates that sparing of the ventrolateral quadrant may not be essential for locomotor recovery (cf. Eidelberg, Walden, and Nguyen, 1981). Furthermore, this review as well as the kinematic analysis indicates that primates with very significant spinal lesions can still exhibit locomotor movements. Thus, although the primate's spinal cord seems less able than other mammals' to readily organize locomotor movements (Eidelberg, Walden, & Nguyen, 1981), the total absence of stepping in primates with completely transected cords is unexpected and warrants further research.     

Imagination after neurological losses of movement and sensation: The experience of spinal cord injury

To what extent is imagination dependent on embodied experience? In attempting to answer such questions I consider the experiences of those who have to come to terms with altered neurological function, namely those with spinal cord injury at the neck. These people have each lost all sensation and movement below the neck. How might these new ways of living affect their imagination?     

Motor imagery in spinal cord injured people is modulated by somatotopic coding,perspective taking,and post‐lesional chronic pain

Motor imagery (MI) allows one to mentally represent an action without necessarily performing it. Importantly, however, MI is profoundly influenced by the ability to actually execute actions, as demonstrated by the impairment of this ability as a consequence of lesions in motor cortices, limb amputations, movement limiting chronic pain, and spinal cord injury. Understanding MI and its deficits in patients with motor limitations is fundamentally important as development of some brain–computer interfaces and daily life strategies for coping with motor disorders are based on this ability. We explored MI in a large sample of patients with spinal cord injury (SCI) using a comprehensive battery of questionnaires to assess the ability to imagine actions from a first‐person or a third‐person perspective and also imagine the proprioceptive components of actions. Moreover, we correlated MI skills with personality measures and clinical variables such as the level and completeness of the lesion and the presence of chronic pain. We found that the MI deficits (1) concerned the body parts affected by deafferentation and deefferentation, (2) were present in first‐ but not in third‐person perspectives, and (3) were more altered in the presence of chronic pain. MI is thus closely related to bodily perceptions and representations. Every attempt to devise tools and trainings aimed at improving autonomy needs to consider the cognitive changes due to the body–brain disconnection.     

Do Older Adults and Those Recovered from Low Back Injury Share Common Muscle Activation Adaptations?

Theoretical models suggest trunk muscle activation compensates for spinal systems impairments. The purpose of this study was to determine if two populations (older adults and those recovered from a lower back injury (rLBI)) with spinal system impairments have similar muscle activation patterns to each other, but differ from controls. Trunk electromyograms collected from 12 older adults, 16 rLBI, and 19 controls during two dynamic tasks showed that older adults and rLBI had higher activation amplitudes, sustained temporal and more synergistic activation relative to controls. However, differences found between older adults and rLBI suggest that spinal system impairments differed between groups or that recent pain (rLBI) uniquely influenced muscle activation. This sheds light on our understanding of the relationship between spinal system impairments and muscle activation.     

Problem-solving training via videoconferencing for family caregivers of persons with spinal cord injuries: a randomized controlled trial

Objective

To examine the effectiveness of an individualized problem-solving intervention delivered in videoconferencing sessions with family caregivers of persons living with a spinal cord injury (SCI) and possible contagion effects on care recipients.

Design

Family caregivers were randomly assigned to an education-only control group or an intervention group in which participants received problem-solving training (PST) in monthly videoconference session for a year.

Participants

Sixty-one caregivers (54 women, 7 men) and their care recipients (40 men, 21 women) consented to participate.

Main outcome measures

The Social Problem-Solving Inventory-Revised was administered to caregivers. Caregivers and care recipients completed the Inventory to Diagnose Depression, the SF-36 and the Satisfaction with Life scale at pre-treatment, 6 months and 12 months.

Results

Twenty-eight caregivers discontinued the study and their follow-up data were unavailable at the final assessment. Older caregivers were more likely than younger caregivers to remain in the study. Intent-to-treat analyses projected a significant decrease in depression among caregivers receiving PST; efficacy analyses indicated this effect was pronounced at the 6th month assessment. ITT analyses and efficacy analyses revealed that care recipients of caregivers receiving PST reported gains in social functioning over time.

Conclusions

Community-based, telehealth interventions may benefit family caregivers and their care recipients, but the mechanisms of these effects are unclear. Attrition and sample issues should be considered in future studies with these populations.     

Assessment of Biopsychosocial Risk Factors for Medical Treatment: A Collaborative Approach

There is a growing body of evidence that psychosocial variables have a significant ability to predict the outcome of medical treatment procedures, especially when the procedure is performed to reduce pain. The study described in this paper serves as an illustration of the valuable role psychologists can play in dealing with the challenges of biopsychosocial assessment of patients who are candidates for medical treatments, especially elective, invasive procedures. Based on a convergent model of risk factors that can potentially influence outcomes from spinal surgery and spinal cord stimulation, exclusionary and cautionary risk factors were identified, and the BHI 2 and BBHI 2 tests were used to assess them. An estimate of the prevalence of these risk factors was calculated using data obtained from 1,254 patient and community subjects gathered from 106 sites in 36 US states. Standardized Cautionary Risk and Exclusionary Risk scores demonstrated a test-retest reliability of .85 to .91. Evidence of validity of these scores was also provided based on subjective and objective criteria, using multiple groups of patients and community subjects. Recommendations are made regarding how biopsychosocial assessments could be used in collaborative settings for presurgical candidates to identify risks that could compromise a patient’s ability to benefit from other medical treatments as well. Once identified, appropriate interventions could ameliorate these risks, or lead to the consideration of other treatments that are more likely to be effective. Methods of refining this approach for specific clinical applications are also discussed.     

脊柱疾患临床诊断的辩证思维

脊柱外科是骨科学的一个亚专科,也是外科学领域中发展最为迅速的一个分支学科。脊柱外科疾患的正确诊断有赖于诊断过程中的正确辩证思维。在临床诊断思维中,从疾病学角度和症状学角度,需要正确处理几个辨证关系,同时要避免临床思维常见误区,才能提高诊断正确性。