为开阔临床医师视野，提供理论水平和借鉴临床经验，今后将陆续推出在读战友和临床感兴趣的战友利用业余时间创作的spine等杂志的中英文对照稿供大家参阅鉴赏。感谢无私奉献的战友！战友的成长离不开您辛勤的汗水向无私奉献的战友致敬！！期待更多的战友参与活动一、规则：1、 愿意参与翻译工作的战友，请以回帖形式申请具体翻译的部分 ，为避免重复翻译，以每个主题加予序号（1、2、3....）为单位的形式认领 a、（每位战友每月限领1－2个专题，以减轻工作量，也给其他战友积极参与的机会）b、重复翻译者（未跟贴认领，导致其他战友重复翻译）未跟贴者无积分奖励。c、已经认领的显示为 红色尚未认领的显示为 黑色认领翻译文献请到这里：>3、翻译小组成员：感兴趣言而有信者即可参与4、日常事物处理：shamo5、daihatsu、心愿、小骨头注：各组员如有特殊情况无法及时完成工作，请提前pm版主，以便作出相应安排。三、积分奖励机制：（试行）1、摘要一篇，奖励1分；全文一篇奖励3分2、校验工作，摘要每1贴次1分，全文每1贴次3分。C1 Anatomy and Dimensions Relative to Lateral Mass Screw PlacementC1的解剖及尺寸与侧块螺钉置钉的关系[Anatomy]AbstractStudy Design. An anatomic surface osteometric analysis of cadaveric cervical spines.研究设计：对颈椎的尸体标本进行解剖学上骨表面的测量分析Objective. To assess the feasibility of placing a 3.5-mm cortical screw in the lateral mass of C1 in a large number of specimens for the purpose of gaining internal fixation for various conditions.目的：为了能在各种情况下进行内固定，通过一组大样本的颈椎标本，评估在C1侧块中植入1枚3.5mm皮质骨螺钉的可行性。 Summary of Background Data. Previous studies have addressed surface dimensions of the atlas vertebra and computerized tomography-measured dimensions of the lateral masses of the atlas. These studies used a limited number of specimens with potentially homogeneous origins.背景资料概述：以往的研究已经报道了寰椎的表面尺寸和寰椎侧块CT测量的尺寸，而这些研究用到的样本数量较少，且还可能存在同源性。Methods. A total of 120 atlas (C1) vertebrae for a total of 240 lateral masses were examined and external measurements obtained to assess the feasibility of placing a 3.5-mm cortical screw in the lateral mass.方法：对总共120例寰椎（C1）椎骨240个侧块进行检测，获得其外部尺寸，评估在侧块中置入一3.5mm皮质骨螺钉的可行性。Results. The minimum lateral mass dimensions found from 240 C1 lateral masses were 13.15 mm anterior-posterior, 4.22 mm medial-lateral, and 4.73 mm cephalocaudal. The height of the posterior arch at the groove for the vertebral artery (pedicle analog) was less than 4 mm in 46 of 240 (19.2%) arches.结果：从240例C1侧块中发现最小的侧块的尺寸：前后距为13.15mm，内外侧距为4.22，头尾侧距为4.73mm。240例中的46例（19.2%），在椎动脉沟处（类似于椎弓根）后弓的高度不到4mm。Conclusions. It is feasible to safely and reproducibly place a 3.5-mm cortical screw in the lateral mass of C1 when the appropriate starting point and trajectory of the screw are chosen.结论：如果选择合适的进钉点和方向，在C1侧块中安全地、可重复地置入一枚3.5mm皮质骨螺钉是可行的。Key words: atlas anatomy; cervical fixation; atlantoaxial fixation; atlanto-occipital fixation; cervical pedicle screws; cervical posterior fixation关键词：寰椎解剖；颈椎固定；寰枢椎固定；寰枕固定；颈椎弓根螺钉；颈椎后路固定 The Reliability of the Clinical Tests and Questions Recommended in International Guidelines for Low Back Pain[Health Services Research]国际性指南推荐的有关下腰痛临床试验和问卷调查的可信度AbstractStudy Design. An intertester reliability study of the questions and tests recommended in guidelines for the management of low back pain (LBP).研究设计：对一些指南所推荐的治疗下腰痛(LBP)的临床试验和问卷调查，研究检测者之间的可信度。Objective. This study undertook a reliability study to evaluate the reliability of the items of the LBP clinical examination with a large sample of LBP patients.目的：该研究进行了一项可信度调查，通过一个大样本的LBP患者，评价LBP临床检查项目的可信度。Summary of Background Data. A crucial part of the diagnostic triage process, recommended by many national and international guidelines for the management of LBP, is the clinical examination. The questions and tests used in this process have never been rigorously evaluated for their intertester reliability in first contact clinicians who are not medically trained.背景资料概述：临床检查是诊断分类过程中关键性的一部分，这对于治疗LBP，是被很多国家性的和国际性的指南所推荐的。而这一过程中用到的调查问卷和临床试验，还从来没有将首次接触的没有丰富临床训练的医师作为其检测者，严格的对这些检测者之间的可信度进行评估。Methods. Patients, referred to physiotherapy departments across the United Kingdom with LBP (n = 301) were recruited in a sample of convenience. The 50 questions and physical tests were administered by a physiotherapist and then repeated by another physiotherapist within the same day. Data were analyzed using kappa and weighted kappa correlation coefficients ([kappa]). Confidence intervals (95% CIs) were calculated.方法：来自英国范围内理疗科患LBP的病例（n=301）被很便利地纳入这一样本中。50个问题和查体试验先由1位理疗师进行一遍，然后再由另一位理疗师在同一天内重复。数据均用kappa和加权kappa相关系数([kappa])进行分析，并计算可信区间(95% CIs)。Results. Eighty-six percent (n = 43) of the questions and test demonstrated [kappa] of 0.41 (fair agreement) or above. Five questions and 2 physical tests (prone knee bend and myotomal assessment) demonstrated agreement of only slight levels. CIs were generally narrow and the uncertainty regarding the kappa coefficients demonstrated correspondingly low.结果：86%（n=43）的问题和试验显示[kappa] 为 0.41（良好的一致性）或更高。有5个问题和2项查体试验（向膝屈和肌节评定）显示其仅有很低的一致性。CIs普遍较窄，kappa系数显示相关的不可靠性相对较低。Conclusions. This study has rigorously evaluated the intertester reliability of the clinical examination process of the diagnostic triage. These clinicians generally demonstrated fair agreement when testing features of the “nerve root,” “yellow” and “red flag” presentations recommended in international guidelines for the management of LBP and nonspecific LBP. However, reliance on single tests with only fair levels of agreement may be unwise. Further work is required to investigate the validity of the tests.结论：这一研究严格地评价了诊断分类过程中临床检查检测者之间的可信度。对于LBP和非特异性LBP的处理中，国际性指南推荐的检测其表现出来的“神经根”、“黄色”“红色标志”的特征，这些临床医师普遍地显示出较高的一致性。然而，依赖于单个试验具有较高的一致性可能不太明智。下一步要做的是调查这些试验的有效性。Key words: low back pain; diagnosis; reliability; guidelines关键词：下腰痛；诊断；可信度；指南Torsion-Induced Pressure Distribution Changes in Human Intervertebral Discs: An In Vitro Study. 扭（转）力引起的人体椎间盘压力分布的改变：一项体外研究Biomechanics 生物力学Abstract: 摘要Study Design. Biomechanical testing of human cadaveric lumbar specimens was performed to evaluate the effects of torsional torque on intradiscal pressure and disc height. 试验设计：生物力学测试人尸体腰椎样本评估扭(力)矩对椎间盘内压力和椎间盘高度的影响Objective. Evaluate the effects of small torsion torques on intradiscal pressure and disc height in human lumbar specimens. 目的：评估很小的扭(力)矩对椎间盘内压力和椎间盘高度的影响Summary of Background Data. Nuclear depressurization in addition to an instantaneous disc height increase were found in previous porcine research when small (<2[degrees]) axial vertebral rotations were applied. If applicable to human spines, this phenomenon may support spinal manipulation for the relief of low back pain.研究背景资料摘要：以前在猪身上的试验研究发现当椎体在轴向发生很小（<2度）的扭转时髓核内压降低并且椎间盘高度有瞬间的升高。如果这个现象再人类脊柱也会发生，就可能支持脊柱推拿术可以缓解下腰痛这一说法。Methods. Six human lumbar cadaveric functional spine units (FSU) were loaded in the neutral position with 600 N axial compression. Intranuclear pressure measurements were then obtained at 0, 0.5, 1.0, and 2.0 Nm of torsion. Posterior elements were removed and measurements were repeated for the disc body unit (DBU). 方法：给六个人尸体腰椎脊柱功能单位先在中立位施加600牛的轴向压力，再分别施加0, 0.5, 1.0, 和2.0牛的扭（转）力然后分别测量髓核内压力。椎体后柱结构切除后给盘体单位重复以上操作测量髓核内压力。Results. There was no statistically significant difference in nuclear pressure or intervertebral disc height with different torsion torques among or between the FSUs and DBUs. However, a disc height increase ranging from 0.13 mm to 0.16 mm occurred with the insertion of a 1.85-mm diameter pressure probe cannula. 结果：在施加不同的扭（转）力后，各个腰椎脊柱功能单位和盘体单位本身或两者之间在髓核压力或椎间盘厚度方面的差异无统计学意义。然而，当插入直径为1.85-mm的压迫探条插管时椎间盘的高度升高了0.13 mm 到 0.16 mm不等。Conclusions. Small torsion torques showed no significant difference in intradiscal pressures or disc heights. This is an unlikely mechanism for the perceived benefits of spinal manipulation.结论：很小的扭（转）力使椎间盘内压力或椎间盘厚度改变的差异没有意义。脊柱推术有利于下腰痛缓解的理论是不成立的。Effect of Immunomodulation With Human Interferon-[beta] on Early Functional Recovery From Experimental Spinal Cord Injury. 实验性脊索损伤早期功能恢复中人β干扰素的免疫调节作用Basic Science 基础科学Abstract:摘要： Study Design. Electron and light microscopic changes, neutrophil infiltration, and lipid peroxidation in the spinal cord and early neurologic examination were studied in rats.研究设计： 我们研究了大鼠脊索的电子和光学显微镜下改变、嗜中性粒细胞浸润和脂过氧化作用情况，同时还研究了其早期的神经系统检查情况。Objective. To examine the effects of immunomodulator treatment with recombinant human interferon-[beta] after spinal cord contusion injury. 目标：测定脊挫伤后的重组人β干扰素免疫调节的效用。Summary of Backgroud Data. Immunomodulator treatment with interferon-[beta] has been the subject of extensive studies, but mainly in relation to multiple sclerosis. Recently, it was reported that interferon-[beta] possessed significant neuroprotection after experimental transient ischemic stroke. However, to our knowledge, there have been no previous reports about the neuroprotective effect of interferon-[beta] after spinal cord injury. 背景概述：β干扰素免疫调节处理一直是普查的项目之一，但它主要用在多发性硬化上。最近，曾有报导说在实验性短暂性缺血性中风病例中，β干扰素表现出了显著的神经保护效应。但是，在我们的所知领域中，之前还没有关于β干扰素在脊索损伤方面起神经保护效应的报导。Methods. Rats were randomly allocated into 5 groups. Group 1 was control and after clinical examination, normal spinal cord samples were obtained. Group 2 was introduced 50 g/cm contusion injury. Group 3 was vehicle, immediately after trauma 1 mL of physiologic saline was injected. Group 4 was given 30 mg/kg methylprednisolone sodium succinate intraperitoneally immediately after trauma. Group 5 was given 1 x 107 IU interferon-[beta] immediately and 0.5 x 107 IU interferon-[beta] 4 hours after trauma. Animals were examined by inclined plane and Basso-Beattie-Bresnahan scale 24 hours after trauma. Spinal cord samples obtained following clinical evaluations. Neutrophil infiltration was evaluated by myeloperoxidase activity and lipid peroxidation was estimated by thiobarbituric acid test. Electron and light microscopic results were also performed to determine the effects of interferon-[beta] on tissue structure. 方法：大鼠被随机分配到5个组中。第一组为对照组，在临床检查后，我们从这一组取到了正常的脊索样本。第二组给予了50 g/cm的挫伤。第三组是病媒动物，在创伤后立即被给予了1ml的生理盐水。第四组在创伤后在腹膜内注射了30 mg/kg甲基泼尼龙琥珀酸钠。而第五组则在创伤后立即给予了1 x 107 IU的β干扰素，并且在4小时后再次给予了0.5 x 107 IU的β干扰素。在创伤后24小时，所有的动物都进行了斜面和Basso-Beattie-Bresnahan评分。在临床评估后，我们取出了脊索样本。我们用髓过氧化物酶活性测定了嗜中性粒细胞浸润情况，用丙二酰硫脲试验测定了脂过氧化作用情况。同时，我们还进行了电子光学显微镜检查，来确定β干扰素对组织结构的影响。Results. Interferon-[beta] treatment improved neurologic outcome, which was supported by decreased myeloperoxidase activity and lipid peroxidation. Electron and light microscopic results also showed preservation of tissue structure in the treatment group. 结果：β干扰素处理改善了神经方面的结果，这在髓过氧化物酶活性和脂过氧化方面上都得到了支持。电子光学显微镜结果也显示了在处理组的组织保护作用。Conclusions. Immunomodulator treatment with interferon-[beta] possesses obvious neuroprotection after acute contusion injury to the rat spinal cord. 结论：在大鼠脊索急性挫伤模型中，β干扰素的免疫调节处理表现出了明显的神经保护作用。 Age-Related Changes in Expression of Tissue Inhibitor of Metalloproteinases-3 Associated With Transition From the Notochordal Nucleus Pulposus to the Fibrocartilaginous Nucleus Pulposus in Rabbit Intervertebral Disc. 兔子椎间盘脊索髓核向纤维软骨髓核转变过程中的金属蛋白酶3组织抑制因子表达的年龄相关改变Basic Science 基础科学Abstract: 摘要：Study Design. Experimental study on age-related changes in expression of tissue inhibitor of metalloproteinases-3 (TIMP-3) associated with transition from notochordal nucleus pulposus (NP) to fibrocartilaginous NP in rabbit intervertebral disc (IVD). 研究设计：兔子椎间盘(IVD)脊索髓核(NP)向纤维软骨NP转变过程中金属蛋白酶3(TIMP-3)组织抑制因子年龄相关改变的实验性研究。Objectives. To identify roles of notochordal NP in extracellular matrix (ECM) metabolism of IVD. 目标：研究IVD代谢过程中细胞外基质(ECM)的脊索NP所扮演的角色。Summary of Background Data. One of most interesting properties of TIMP-3 is to inhibit aggrecanases in addition to matrix metalloproteinases. Balance of aggrecanase/TIMP-3 is critical to maintain homeostasis of ECM metabolism. 背景概述：除了抑制基质金属蛋白酶外,TIMP-3的最有趣的特性就是抑制aggrecanases。在ECM代谢的内稳态维持中，homeostasis与TIMP－3的平衡非常重要。Methods. Four-week-old and 160-week-old male Japanese white rabbits were used. Age-related changes in IVDs were evaluated histologically using previously established grading system. Immunohistochemistry of TIMP-3 and semiquantitative reverse transcriptase-polymerase reaction (RT-PCR) of TIMP-3, a disintegrin and metalloproteinases with thrombospondin motifs (ADAMTS) 4, 5, and transforming growth factor-[beta]1 (TGF-[beta]1), were conducted. 方法：我们使用了4周大和160周大的日本白兔。在先前建立的分级系统的基础上，我们在组织学水平评估了IVDs的年龄相关改变。具体地讲，我们测定了TIMP－3的免疫组化、RT-PCR、糖蛋白G基序的解聚素和金属蛋白酶(ADAMTS)以及转化生长因子(TGF-[beta]1)。Results. Semiquantitative assessment of histologic changes indicated that 4-week-old rabbit was equivalent to fetus to 2-year-old human and 160-week-old rabbit was equivalent to 11- to 30-year-old human, particularly 11- to 16-year-old, which corresponds to transition period from notochordal to fibrocartilaginous NP. Immunohistochemistry revealed that TIMP-3 was positive in 4-week-old rabbit only. Semiquantitative RT-PCR revealed that levels of expressions of TGF-[beta]1 and TIMP-3 mRNAs in 4-week-old were significantly higher than those in 160-week-old rabbits. There was no significant difference in expression of ADAMTS4 mRNA. ADAMTS5 mRNA was not detected or extremely low in both groups. Expression of TIMP-3 mRNA in NP was upregulated by TGF-[beta]1 but was not affected by IL-1[beta]. On the contrary, expression of ADAMTS4 mRNA was not upregulated by TGF-[beta]1 but was upregulated by IL-1[beta]. 结果：组织学改变上的半定量测定显示，4个月的兔子相当于2岁的孩子，160个月大的兔子相当于11到30岁大的成人，尤其相当于11到16个月大，相对地，这段时间正好是脊索向纤维软骨NP转换的时期。免疫组化显示，TIMP－3仅仅在4个月大的兔子中表现为阳性。RT-PCR的半定量测定显示，4个月大的兔子的TGF-[beta]1 和 TIMP-3 mRNAs表达水平明显比160个月大的兔子要高。在ADAMTS4 mRNA表达上，两组兔子并没有统计学上的差异。而两组中ADAMTS5 mRNA的表达基本上没有被检测到或者非常低。TGF-[beta]1使得TIMP－3的表达上提了，但是IL-1[beta]对其就没有作用。相对地，ADAMTS4 mRNA表达就不受TGF-[beta]1的影响，但是却被IL-1[beta]上调了。 Conclusions. Levels of expression of TIMP-3 in notochordal NP were significantly lower in 160-week-old rabbits than those in 4-week-old rabbits. Decrease in expression of TIMP-3, possibly mediated in part by TGF-[beta]1, may cause imbalance of ADAMTS4/TIMP-3 ratio at transition period from notochordal to fibrocartilaginous NP. 结论：160个月大的兔子中的脊索NP TIMP－3的表达水平要明显低于4个月大的兔子。可能受TGF-[beta]1调节的TIMP-3表达水平的降低，可能会导致在脊索NP向纤维软骨NP转换过程中的ADAMTS4/TIMP-3比例的失衡。Halo Pin Insertion-Associated Brain Abscess: Case Report and Review of Literature. Case Reports Halo针道相关性脑脓肿 :病例报告和文献回顾Spine. 32:E271-E274, April 15, 2007.Saeed, Musab U. MD; Dacuycuy, Mary Abigail C. MD; Kennedy, Donald J. MD Abstract: Study Design. A case report of a patient with a halo pin-associated brain abscess and a review of literature. 研究设计：报告一例Halo针道相关性脑脓肿并且作一文献回顾。Objectives. To report a rare complication of halo pin insertion-associated brain abscess, and to discuss the diagnostic and treatment approach to its management. 目的：报告一例罕见的halo针道相关性脑脓肿，讨论它的诊断和治疗方法。Summary of Background Data. Halo orthosis is a commonly used, well-tolerated spinal stabilizing device. However, on rare occasions, it can penetrate the inner table of the cranium, resulting in abscess formation that needs to be investigated urgently and treated promptly. 背景介绍：halo架固定是一个常用的并且很好耐受的脊柱稳定设置。然而，在罕见情况下，它能穿透颅骨的内板，引起脓肿形成，这需要紧急检查和适宜的治疗。Methods. A 23-year-old male sustained a C2 vertebral fracture from a motor vehicular accident and was placed in halo traction. Two and a half months later, he noted loosening of the right occipital halo pin, which was tightened in the clinic. Fourteen days after pin tightening, he developed right-sided headaches, and it was decided to remove the halo traction. After the halo removal, the patient noted purulent discharge from the right occipital pin site, worsening headache, and associated nausea and vomiting. Magnetic resonance imaging of the brain demonstrated a right parietal lobe abscess and a sinus tract extending through the overlying calvarium. The patient underwent an evacuation of the abscess, and the culture was positive for methicillin-resistant Staphylococcus aureus. The patient was treated with intravenous vancomycin for 6 weeks. 方法：一个23岁的男性病人，摩托车事故导致C2椎体骨折被采用了halo牵引。2个半月后，他注意到右侧枕骨处halo针松动，这被在诊所拧紧。拧紧4天后，他发展到右侧头疼，然后被去掉了halo架。halo架去掉后，病人注意到右侧枕骨halo针道处流脓，头疼恶化，伴随恶心和呕吐。颅部MRI证实右侧顶骨耳垂部存在脓肿和穿过覆盖该处颅盖骨的窦道。病人被行脓肿清除术，耐甲氧西林金黄色葡萄球菌培养阳性。病人治疗为静脉输注万古霉素6周。Result. The patient reported mediated improvement after surgery and on a follow-up visit was doing well without any neurologic sequelae. 结果：病人叙述术后症状改善，经随访疗效很好并且没有神经后遗症。Conclusion. Halo pin-associated brain abscess is a rare but extremely important complication requiring prompt diagnosis and immediate intervention. Halo pin loosening with signs of local infection, fever, headaches, or seizures needs to be investigated urgently with neuroimaging. We conclude that with early diagnosis and appropriate treatment, serious morbidity and mortality can be avoided. 结论：halo针道相关性脑脓肿是一个罕见但是极重要的并发症，需要迅速诊断和立即手术。Halo针松动伴有局部感染，发烧，头疼，突然发作等征象时需要紧急神经影像检查。我们的结论是：早期诊断和治疗，严重的病态和致死率是可以避免的。先翻译完了一篇（不好意思，还没经过版主批准就翻译了）Magnetic Resonance Imaging and Magnetic Resonance Myelography in the Presurgical Diagnosis of Lumbar Foraminal Stenosis. 磁共振成像和磁共振脊髓造影在腰椎孔狭窄术前诊断中的应用Diagnostics 诊断学Spine. 32:896-903, April 15, 2007.Aota, Yoichi MD *; Niwa, Tetsu MD +; Yoshikawa, Kohki MD [S]; Fujiwara, Atsushi MD ++; Asada, Toshio RT [//]; Saito, Tomoyuki MD * Abstract: Study Design. Retrospective case series with a control group. 研究设计。病例组和对照组的回顾性分析[/color][color=black]Objective. To measure the diagnostic performance of magnetic resonance imaging (MRI) and MR myelography (MRM) for symptomatic foraminal stenosis in patients who need surgery. [color=blue]目标：测定须行手术治疗的症状性椎孔狭窄病人的磁共振成像（MRI）和磁共振脊髓造影（MRM）表现。[/color]Summary of Background Data. MR images are extensively used in the evaluation of foraminal stenosis and are often used to evaluate nerves exiting from the foramen. There has been no published report of the diagnostic performance of these imaging methods (MRI and MRM). 背景摘要：磁共振成像（MRI）广泛用于椎孔狭窄的评估，也常用于评估从椎孔发出的神经。至今还没有这些成像方法（MRI和MRM）的诊断学表现发表。Methods. Diagnostic performances were studied in 90 patients in whom the site of the stenosis was confirmed by means of selective decompression surgeries. The disease prevalence among patients was 26% (23 of 90 patients). The disease prevalence among foramens was 3% (25 of 936 foramens). The prevalence of abnormal findings in 27 asymptomatic volunteers was also studied. Two blinded observers interpreted foraminal narrowing on combinations of sagittal and axial MR images, abnormalities of the course of the nerve root in the foramen, and spinal nerve swelling on MRM. 方法：研究了90例病人的诊断学表现，他们的狭窄位置通过选择性减压手术证实。这些病人中椎孔狭窄的患病率为26%（23/90例）。所有椎孔中的椎孔狭窄的患病率为3%（25/936个椎孔）。同时还研究了27例无症状志愿者的异常发现的患病率。2个双盲观察者结合矢状位和轴状位磁共振成像解释了椎孔狭窄，MRM上表现为椎孔内神经根路线的异常和脊神经膨胀。Results. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of MRI for the diagnosis of symptomatic foraminal stenosis were 96%, 67%, 4%, and 100%, respectively. The corresponding values for abnormal nerve root course on MRM were 96%, 83%, 7%, and 100%, respectively, and for spinal nerve swelling on MRM were 60%, 99%, 35%, and 99%, respectively. 结果：MRI用于诊断症状性椎孔狭窄的敏感性、特异性、阳性预测价值（PPV）和阴性预测价值（NPV）分别为96%，67%，4%和100%。MRM上神经根路线异常的相应值分别为96%，83%，7%和100%，MRM上脊神经膨胀的相应值分别为60%，99%，35%和99%。Conclusions. Compared with conventional MRI, MRM affords more specific information for the presurgical diagnosis of symptomatic foraminal stenosis. 结论：同传统MRI相比，MRM在症状性椎孔狭窄的术前诊断方面能够提供更多的专业信息。(C) 2007 Lippincott Williams & Wilkins, Inc.再把认领的第二篇也翻译了Adolescent Idiopathic Scoliosis in Twins: A Population-Based Survey. 发生于双胞胎的青少年特发性脊柱侧突：人群调查[/color]Health Services Research [color=blue]健康服务研究Spine. 32:927-930, April 15, 2007.Andersen, Mikkel O. MD *; Thomsen, Karsten MD, DMSci *; Kyvik, Kirsten O. MD, PhD + Abstract: Study Design. A questionnaire-based identification of adolescent idiopathic scoliosis (AIS) patients in a twin cohort. 研究设计：双胞胎人群中青少年特发性脊柱侧突的问卷调查鉴定Objective. The purpose of this study was to establish a scoliosis twin cohort to provide data on the heritability of AIS. 目标：本研究的目的是创建脊柱侧突的双胞胎群体来提供青少年特发性脊柱侧突（AIS）的遗传度的数据。Summary of Background Data. The etiology of AIS is still unclear, and the true mode of inheritance has yet to be established. Concordance rates in monozygotic twins have been reported to be between 0.73 and 0.92, and in dizygotic twins between 0.36 and 0.63. Studies on concordance in twin pairs provide a basis for analyzing the influence of genetic versus environmental factors. 背景摘要：AIS的病因学至今还不清楚，它的真正遗传方式也还没有确立。报道的单卵双生性双胞胎的同病率在0.73到0.92之间，双卵双生性双胞胎为0.36到0.63之间。关于双胞胎同病率的研究可以为分析遗传VS环境因素的影响提供根据。Methods. All 46,418 twins registered in the Danish Twin Registry born from 1931 to 1982 were sent a questionnaire, which included questions about scoliosis. A total of 34,944 (75.3%) representing 23,204 pairs returned the questionnaire. 方法：向丹麦注册的生于1931到1982年之间的所有46，418对双胞胎发送调查表，包括了有关脊柱侧突的问题。共有34，944人（75.3%）返还了调查表，他们代表了23，204对双胞胎。Results. A subgroup of 220 subjects considered to have AIS was identified, thus giving a prevalence of 1.05%. The concordant twin pairs were all monozygotic. Pairwise, the concordance rate was 0.13 for monozygotic and zero for dizygotic twin pairs; proband-wise concordance was 0.25 for monozygotic and zero for dizygotic pairs. The concordance of monozygotic and dizygotic pairs was significantly different (P < 0.05). 结果：共鉴定出有220例受试者患有AIS，由此得到的患病率为1.05%。所有单卵双生双胞胎都是单合子的。单卵双生性双胞胎的同病率为0.13，异卵双生性双胞胎为0；单卵双生性双胞胎的先证者发病一致率为0.25，异卵双生性双胞胎为0。单卵双生性双胞胎和异卵双生性双胞胎的同病率明显不同（p<0.05）Conclusion. We have found evidence for a genetic etiology in AIS, but the risk of developing scoliosis in 1 twin whose other twin has scoliosis is smaller than believed up until now. 结论：我们发现了AIS的遗传病因学证据，但是双胞胎中1人患有脊柱侧突，另外1人也患脊柱侧突的风险要比直到现在所认为的小。(C) 2007 Lippincott Williams & Wilkins, Inc.一种计算机辅助的特发性脊柱侧弯支架的设计和调整方法的预评价研究设计：前瞻性随机临床研究目的：在一组青少年特发性脊柱侧弯受试者中，评价一种三维视觉软件辐助设计和校正的支架应用后获得的脊柱矫正结果，并将之与应用传统方法获得的矫正结果进行比较。摘要和背景数据：在青少年特发性脊柱侧弯中应用的波士顿矫形支具的修整线、衬垫的放置和起伏区域的最优设计目前是通过临床检查和冠状Ｘ线拍照来完成的，但是三维的校正尚无人涉猎。方法：48个需要安放波士顿矫形支具的青少年特发性脊柱侧弯受试者前瞻性进入本次研究。24个病人（试验组），利用计算机辐助方法和表面局部解剖学进行支架的设计和调整以及躯干的三维重建。余下的受试者（对照组）支架的设计和调整是通过传统的方法完成的。脊柱支架置入立即的校正结果在初次探视时进行了比较。结果：在年龄、性别、弯曲类型和冠状面和矢状面的平均畸型水平等方面都具有可比性。支架置入前胸廓畸型的科布角为35°，试验组腰弯为32°而对照组为35°。两组的胸部畸形和腰部畸型的冠状位弯曲和最大畸型位弯曲都有得到了统计学和临床意义上的明显改善，但试验组的改善更加明显。试验组的支架置入后胸曲的改善为12°＋－7°，对照组为7°＋－5°。试验组支架置入后腰区的改善为10°＋－5°，对照组为6°＋－5°。最大畸型部位的改善结果也是相似的。另外，仅试验组腰区最大畸型平面的方向得到了37°到23°的明显改变，表明本组的三维校正得到了实现。结论：利用可以获得脊柱曲线和躯干外型三维图像的计算机辅助软件，我们可以改善ＡＩＳ支架的设计和调整，从而使侧弯曲线得到三维的改善。关键词：青少年特发性脊柱侧凸　支架　设计　矫形器　计算机辅助Preliminary Evaluation of a Computer-Assisted Tool for theDesign and Adjustment of Braces in Idiopathic ScoliosisStudy Design. Prospective and randomized clinicalstudy.Objectives. To evaluate the correction of the spine　obtained using a 3-dimensional visualization software　tool developed to assist the design and adjustment of　braces compared with the correction obtained with the　conventional method in a cohort of subjects with adolescentidiopathic scoliosis (AIS).Summary of Background Data. The optimal design and adjustment of trim lines, pad placement, and areas ofrelief for the Boston brace system in AIS are currently done using clinical examination and coronal radiographs. Correction of spinal curves in the coronal plane has been achieved with this technique, but 3-dimensional correctionhas yet to be demonstrated.Methods. Forty-eight consecutive subjects with AIS requiring treatment with a Boston brace were prospectivelyentered in the study. For 24 patients (test group), brace design and adjustment was obtained using the computer-assisted tool combining surface topography, surface pressure measurement, and 3-dimensional reconstructions of the trunk, while design and adjustment for the remaining subjects (control group) was done in theconventional manner. Immediate in-brace correction of the spine at the initial visit was compared in both groups.Results. Both groups were comparable in terms of age, sex, curve type, and average deformity in both thecoronal and sagittal planes. The average prebrace thoracic deformity was 35° of Cobb angle, while the averagelumbar curve was 32° in the test group and 35° in controls. A statistically and clinically significant improvementin correction of coronal curves and of curves in the plane of maximal deformity was found for both thoracic andlumbar curves in both groups, but the improvement was significantly greater in the test group. The average inbracecorrection in the test group was 12° _ 7° compared with 7° _ 5° in the control group for thoracic curves, whilethe average in-brace correction in the test group was 10° _ 5° compared with 6° _ 5° in the control group forlumbar curves. Similar average corrections were detected in the plane of maximal deformity. In addition, a significantimprovement in the orientation of the plane of maximum deformity from 37° to 23° for lumbar curves was noted only in the test group, indicating that true 3-dimensional correction by the brace was obtained in this group.Conclusion. It is possible to improve the design and adjustment of braces in AIS and to achieve 3-dimensionalcorrection of scoliotic curves with the use of a computerassisted tool allowing 3-dimensional visualization of the spinal curves and the external shape of the trunk.Key words: adolescent idiopathic scoliosis, brace, design, orthosis, computer assistance.腰部背根神经节神经元在器官培养系统中的轴突生长潜能研究设计：研究腰部背根神经节神经元在器官培养系统中的轴突生长潜能目的：检测神经元损伤和肿瘤坏死因子对两种类型的伤害感受背根神经元轴突生长潜能的影响。这两种神经元分别为：神经生长因子敏感和胶质细胞源神经营养性细胞因子敏感神经元。背景数据摘要：神经内向生长进入椎间盘通常被认为是椎间盘源性疼痛的原因。几乎所有这些支配椎间盘的神经元都是神经营养因子敏感的。但ＮＧＦ敏感神经元的轴突生长潜能上未被阐明。方法：成年Ｓ-Ｄ大鼠被用来进行免疫组化（7只）和细胞活力研究（6只）。双侧Ｌ３-Ｌ５背根神经节（取用过程中无任何损伤），在分别包含0，0.01，0.1和1ng/mlTNF的无血清培养基中培养或不培养48小时（每组ｎ＝5）。然后利用激活转录因子3（神经元损伤标记）对这些背根神经元进行免疫染色，或同时利用生长相关蛋白43（轴突生长标记）和异凝集素Ｂ4（ＧＤＮＦ敏感神经元标记物）进行双染色。利用乳酸脱氢酶测定和ＭＴＳ测定进行细胞活性检测（每组ｎ＝6）。结果：培养的损伤神经元（ＡＴＦ3阳性）的免疫反应证据可以经常观察到，但非培养神经元则从来没观察到过。任何情况的ＴＮＦ存在的情况下，ＮＧＦ敏感的神经元的轴突生长潜能明显高于ＧＤＮＦ敏感神经元。超过95％的培养神经元具有活力。结论：结果表明培养的背根神经元显示出与损伤神经元相似的病理变化。在病理情况下，在ＴＮＦ存在的情况下，ＮＧＦ敏感神经元，包括支配椎间盘的神经元，比ＧＤＮＦ敏感神经元具有更大的伸展其轴突的功能。关键词：器官培养　　背根神经节　　激活转录因子3　生长相关蛋白43 肿瘤坏死因子ａ椎间盘性痛　轴突生长　Axonal Growth Potential of Lumbar Dorsal RootGanglion Neurons in an Organ Culture SystemStudy Design. The axonal growth potential of dorsal　root ganglion (DRG) neurons in an organ culture system　was investigated.Objective. To examine the effects of neuronal injury　and tumor necrosis factor-_ (TNF-_) on the axonal growth　potential of 2 types of nociceptive DRG neurons: nerve　growth factor (NGF)-sensitive and glial cell line-derived　neurotrophic factor (GDNF)-sensitive neurons.Summary of Background Data. Nerve ingrowth into　the disc is recognized to be one of the causes of discogenic　pain. Almost all of these disc-innervating neuronsare NGF-sensitive. The axonal growth potential of NGFsensitive　neurons has not been investigated.Methods. Adult Sprague-Dawley rats were used for　immunohistochemistry (n _ 7) and cell viability studies　(n _ 6). Bilateral L3–L5 DRGs, which were successfully　removed without damage, were noncultured or cultured　in serum-free medium containing TNF-_ at 0, 0.01, 0.1,　and 1 ng/mL for 48 hours (n _ 5, each treatment). The　DRGs were then immunostained for activating transcription　factor 3 (ATF3, a marker for injured neurons) or double-stained for growth-associated protein 43 (GAP-43, a　marker for axonal growth) with calcitonin gene-related　peptide (CGRP, a marker for NGF-sensitive neurons) or　isolectin B4 (IB4, a marker for GDNF-sensitive neurons).Cell viability was assessed by a lactate dehydrogenase(LDH) assay and an MTS assay (n _ 6, each treatment).Results. Immunoreactive evidence of injured neurons　(ATF3 positive) was frequently observed in cultured　DRGs, but never in noncultured DRGs. The percentage ofneurons exhibiting axonal growth potential (GAP-43 immunoreactive)　was significantly higher for NGF-sensitive　neurons than for GDNF-sensitive neurons at any concentrationof TNF-_. More than 95% of the cultured neurons were viable.Conclusions. The results suggest that the cultured　DRG neurons exhibit pathologic changes similar to those found in injured neurons. NGF-sensitive neurons, whichinclude disc-innervating neurons, may have a greater potential to extend their axons in response to neuronal injury under pathologic conditions in the presence of TNF-_than GDNF-sensitive neurons.Key words: organ culture, dorsal root ganglion, activating transcription factor 3, growth-associated protein 43, nerve growth factor, tumor necrosis factor-_, discogenicpain, axonal growth.12. Diagnostics 911-917 Intraoperative Monitoring of Motor-Evoked Potentials in Children Undergoing Spinal Surgery 儿童脊柱手术中监测运动诱发电位Abstract: 摘要Study Design. Clinical case series. 研究设计：临床病例研究Objective. To study the combined use of modifications of stimulation methods and adjustments of anesthetic regimens on the reliability of motor-evoked potential (MEP) monitoring in a large group of children undergoing spinal surgery. 目标：研究刺激方法的修正和麻醉策略的调节联合应用在儿童脊柱手术中监测运动诱发电位的可靠性。Summary of Background Data. Monitoring of MEPs is advocated during spinal surgery, but systematic data from children are sparse. 背景：脊柱手术中运动诱发电位监测已被提倡，但关于儿童的系统性数据却较少Methods. A total of 134 consecutive procedures in 108 children <18 years of age were analyzed. MEPs were elicited by transcranial electrical stimulation (TES) and supplemented by temporal and spatial facilitation. The standard anesthesia regimen consisted of propofol, nitrous oxide, and remifentanil. Propofol was replaced with ketamine if no reliable MEPs could be recorded. In children <6 years of age, a ketamine-based anesthesia was used. 方法：连续分析了108名小于18岁儿童的134例手术。运动诱发电位由经颅电刺激（TES）引出并辅以时间及空间易化。标准的麻醉策略包括异丙酚、一氧化二氮及雷米芬太尼。若记录不到可靠的运动诱发电位则将异丙酚换为氯胺酮。在小于6岁的儿童中使用基于氯胺酮的麻醉。Results. With temporal facilitation alone, reliable MEPs were obtained in 78% (105 of 134) of the procedures and, if combined with spatial facilitation, in 96% (129 of 134) of the procedures. Reliable MEPs were documented in 98% (111 of 113) of children >6 years and in 86% (18 of 21) in children <6 years of age. 结果：仅用时间易化，可获得78%（105/134）的可靠运动诱发电位，若联合空间易化则可达到98%（129/134）。可靠的运动诱发电位在大于6岁的儿童中可获得98%（111/113），小于6岁的儿童中可获得86%。Conclusions. Combining spatial facilitation with a TES protocol improved monitoring of corticospinal motor pathways during spinal surgery in children. A ketamine-based anesthetic technique was preferred in children <6 years of age.结论：经颅电刺激联合空间易化可改进儿童脊柱手术中对皮质脊髓运动通路的监测。小于6岁的儿童首选基于氯胺酮的麻醉策略。19. Case Reports E267-E270 Upper-Airway Obstruction After Short Posterior Occipitocervical Fusion in a Flexed Position 屈曲位短节段后路枕颈融合术后上气道梗阻Abstract: 摘要Study Design. Case report. 研究设计：病例报告Objective. To stress the importance of the fusion angle of the occipitocervical spine based on an unusual case of upper-airway obstruction after a posterior fusion from the occipital bone to the second cervical vertebra (O-C2) in a flexed position. 目标：通过一例少见的后路枕骨与颈2在屈曲位融合术后出现上气道梗阻的病例强调枕颈脊柱融合角度的重要性。Summary of Background Data. It is well known that cervical malalignment after occipito-cervicothoracic fusion may cause dysphagia or, rarely, dyspnea. However, to the best of our knowledge, there have been no previous English reports of prolonged upper-airway obstruction after an O-C2 fusion. 背景：众所周知枕颈胸融合术后颈部顺列差可能导致吞咽困难或罕见的呼吸困难。然而，据我们所知，目前尚没有关于枕-颈2融合术后出现持久的上气道梗阻的英文报告。Methods. We present the case of a 77-year-old woman with rheumatoid arthritis, who developed an upper-airway obstruction immediately after an O-C2 fusion. She was reintubated immediately and extubated the next day. She again suffocated suddenly 3 days after surgery, and a tracheotomy was performed. Suspecting that the main cause of the airway obstruction was not only pharyngeal edema, but also the fixture of the upper cervical angle in a flexed position, we changed the angle to the neutral position 14 days after surgery. 方法：我们报告了一例77岁类风湿性关节炎女性，行枕-颈2融合术后立即出现上气道梗阻。立即重新插管并在第二天拔管。术后第3天再次突发窒息，行气管切开。怀疑气道梗阻的主要原因不仅是咽部水肿，而且与上颈部固定于屈曲位的角度有关。术后第14天笔者将屈曲角恢复为中立位。Results. After revision surgery, the upper-airway obstruction disappeared. 结果：翻修术后上气道梗阻消失。Conclusion. An adequate fixation angle is necessary to avoid airway obstruction after an occipitocervical fusion, even for short upper cervical fusions, especially in patients with rheumatoid arthritis.结论：枕颈融合术需要一个合适的固定角度防止出现术后气道梗阻，甚至包括短节段上颈椎融合，尤其在有类风湿性关节炎的患者。