三维矫形系统后路手术治疗脊柱侧凸47例

目的:探讨三维矫形系统矫正脊柱侧凸的疗效。方法:应用三维矫形系统治疗脊柱侧凸47例,其中特发性侧凸35例,先天性侧凸12例,术前冠状面畸形(cobb法)为35～80°,旋转畸形(Nash-moe法)为Ⅰ～Ⅲ度。结果:所有病例随访1～10年,平均4.6年,冠状面畸形为18～45°,平均21.1°,平均矫正率为63.4%,旋转畸形平均矫形Ⅰ度。所有病例术中、术后均无脊髓神经损伤。结论:三维矫形系统后路手术治疗脊柱侧凸具有安全、有效、良好的矫形疗效。     

应用中华长城内固定系统治疗青少年特发性脊柱侧凸12例

应用中华长城内因达到系统治疗青少年特发性脊柱侧凸12例,结果12例患者均获随访,剃刀背畸形明显改善,冠状面畸形cobbs角最小矫正率84%,最大98%,平均矫正率91.2%;矢状面畸形平均矫正率60.2%,旋转畸形平均矫正Ⅰ￣Ⅱ度,无1例出现神经并发症,所有患者至今无矫正度丢失。提示中华长城内固定系统针对脊柱侧凸的三维畸形从三维空间进行矫正虽然费时,却安全可靠。     

后路截骨减压治疗软骨发育不全所致脊柱畸形

目的 探讨软骨发育不全所致脊柱畸形的手术治疗方法.方法 软骨发育不全所致脊柱畸形6例,男3例,女3例;年龄12～36岁,平均年龄18.5岁.均表现为胸腰段后凸畸形伴腰椎管狭窄,其中,4例患者合并神经系统症状.均行后路截骨矫形、椎管减压术.所有病例术前、术后和随访时拍摄站立位全脊柱X线,测量矢状面局部后凸Cobb角;通过复习病例,记录围手术期并发症;通过JOA评分评价术前术后神经系统症状的改善情况.结果 全部病例随访5～24个月,平均10.2个月.手术时间160～460 min,平均320 min.术中出血量400～3000 ml,平均1300 ml.固定融合节段5～10节,平均8节.矢状面局部后凸Cobb角由术前平均53.3°矫正至13.3°,矫正率75.0%;4例合并神经系统损伤的患者术前JOA平均4.5分,随访时平均8.5分.结论 对于软骨发育不全所致胸腰段脊柱后凸和腰椎管狭窄,后路截骨矫形、椎管减压术可取得良好的治疗效果.     

后路脊柱截骨矫形治疗重度僵硬后凸型脊柱侧凸

目的:评价应用后路脊柱截骨矫形治疗重度僵硬后凸型脊柱侧凸的效果 .方法:回顾性分析北京大学第一医院骨科自2005年3月至2006年9月应用后路脊柱截骨矫形治疗重度脊柱僵硬后凸型侧凸11例(平均年龄11.2岁),其中神经纤维瘤病3例,先天性脊柱侧弯5例,脊髓灰质炎1例,特发性脊柱侧凸2例.11例患者的Bending像脊柱活动度均小于25%.平均随访时间1.3年(0.5～2年).结果:术中1节段后柱楔形截骨3例,2节段后柱楔形截骨2例,3节段后柱楔形截骨2例,经椎弓根截骨2例,椎体切除+后柱切除2例.术前后凸畸形平均108°(87°～135°),侧凸畸形平均97°(65°～135°),术后后凸畸形平均矫正至49°(改善率55%),侧凸平均矫正至37°(改善率66%).术后身高平均增加4.7 cm.11例矫形手术无神经系统并发症发生. 结论:应用后路脊柱截骨矫形治疗重度僵硬后凸型脊柱侧凸是一种较为有效的手术方法.     

后路顶点经椎弓根截骨术治疗重度僵硬性脊柱侧后凸畸形

目的 评价后路顶点经椎弓根截骨术治疗重度僵硬性脊柱侧后凸畸形的安全性和早期临床治疗效果.方法 回顾性分析12例行后路顶点经椎弓根截骨术治疗重度僵硬性脊柱侧后凸畸形患者的术前、术后及随访时的X光像,对侧凸Cobb角、后凸Cobb角、躯干平衡等进行测量和分析.复习手术记录和病历,记录围手术期并发症.结果 本组患者12例,男4例,女8例,平均年龄20.1(9～57)岁,其中成人脊柱侧凸2例,先天性脊柱侧后凸畸形10例.平均随访9.2个月.融合固定节段平均12个节段.手术时间平均5.0 h,术中出血量平均1517 ml,回输自体血平均780 ml,异体输血平均1109 ml.手术前后主弯冠状面Cobb角分别为100.9°和48.8°,平均矫正率51.8%(P=0.000).节段性后凸Cobb角分别为81.7°和42.2°,平均矫正率为49.8%(P=0.000).随访时主弯冠状面Cobb角及节段性后凸Cobb角分别为50.7°和46.0°,矫形无明显丢失(P=0.763,P=0.698).手术前、后及随访时冠状面躯干平衡分别为16.3、14.7和12.0mm,随访时仅1例发生冠状面躯干失平衡(22 mm).2例患者出现一过性的下肢单侧肢体麻木、无力,获完全恢复.所有患者均无脊髓损伤.结论 后路顶点经椎弓根截骨术是矫正重度僵硬性脊柱侧后凸畸形的安全方法 ,早期结果 令人满意.     

前路病灶清除植骨Ⅰ期前路内固定治疗脊柱结核

目的 评估不同节段脊柱结核前路内固定的疗效和安全性.方法 46例患者平均年龄45.58岁,测量术前、术后及最终的后凸畸形的角度及病椎的融合率.在有神经系统症状的患者中,随访其神经功能恢复情况.所有患者最少随访2年,平均随访39个月.结果 前路内固定能有效地纠正后凸畸形,平均矫正角度(18.58°±4.37°),有利于脊柱融合,平均丢失角度(1.72°±1.56°).有神经症状的44例患者中27例(61.3%)全部恢复,17例(38.7%)部分恢复.所有病例没有假关节形成,无内固定失败.所有患者都临床愈合,无未愈及复发病例.结论 前路病灶清除植骨内固定由于手术方法相对简单,融合节段短,能够为脊柱融合提供可靠的稳定性,融合率高,是一种治疗脊柱结核的安全有效方法.     

一期后路半椎体切除椎弓根钉短节段内固定矫治先天性脊柱侧后凸

目的:评价一期后路半椎体切除椎弓根钉短节段内固定矫治先天性脊柱侧后凸畸形的手术风险与临床效果.方法:先天性半椎体脊柱侧后凸畸形患者17例,平均年龄10.3岁,畸形主弯位于胸腰段(T10～L2)者11例,腰段(L3～L5)者3例,胸段(T1～T9)者3例.17例行一期后路半椎体切除椎弓根钉系统内固定术,比较末次随访和术前脊柱侧弯、后凸Cobb角及矢状面、冠状面平衡矫正情况.结果:所有患者顺利完成手术,手术固定4～7椎节,平均4.6椎节.随访平均18.9个月(12～24个月),脊柱侧弯矫正率平均(68.7±6.78)％,后凸矫正率平均(66.7±4.05)％.所有患者均获骨性愈合,未发生内固定失败及脊髓神经根受损,躯干失代偿均得到矫正.结论:一期后路半椎体切除椎弓根钉短节段固定术安全、有效,脊柱三维矫形稳定,最大程度保留了脊柱功能,具有融合率高、并发症少的优点.     

三维矫正治疗脊柱侧弯畸形三例报告

目的:探讨后路三维矫正治疗脊柱侧弯畸形的临床效果。方法:2001年12月~2004年12月应用中华长城椎弓根三维矫形系统治疗特发性脊柱侧凸2例,TSRH系统后路三维矫形系统治疗,先天性脊柱侧弯1例。本组共3例,均为女性。最小14岁,最大19岁,平均16岁。术前侧凸cobb角40~100°,平均70°。结果:全部病例均安全完成矫形手术,侧凸矫正率45%~98%,平均85%,术中、术后无脊髓损伤及其它并发症发生。结论:三维矫正治疗脊柱畸形,可获得冠状面与矢状面两畸形和轴向旋转畸形理想矫正,同时提供了一个较坚强内固定,植骨愈合率高,术后早期配合带支具下地活动。     

万向椎弓根螺钉在脊柱畸形后路矫正中的应用

目的 分析和总结万向椎弓根螺钉在脊柱畸形后路矫正中的矫正方法及矫正效果.方法 应用万向椎弓根螺钉治疗各种脊柱畸形17例,术前使用多种方法减轻脊柱畸形程度,术中强调使用原位转钉等方法矫正脊柱三维畸形.测量术前及术后脊柱主要结构性侧凸平均Cobb角;测量术前及术后脊柱矢状面胸段、胸腰段和腰段的角度,判断脊柱矢状面是否正常化;采用椎弓根标记法测量术前及术后顶椎椎体旋转程度(除外3例顶椎全切病例).记录有无内固定并发症.结果 术前脊柱主要结构性侧凸平均Cobb角63.18°,术后平均25.35°,秩和T=153.00,P＜0.005,差异有显著性.矢状面异常的15例病例术后复片显示矢状面正常化.顶椎椎体旋转(除外3例顶椎全切病例),术前Ⅰ度3例,术后均为0度,余病例均有不同程度的旋转畸形残留.所有病例无重要血管、神经损伤,无内置物松动、滑脱或断裂.结论 万向椎弓根螺钉可以简化脊柱畸形的操作,增加安全性,同时可以取得良好的矫正效果.     

后路半椎体切除治疗先天性脊柱侧凸

目的探讨后路半椎体切除、器械矫正内固定治疗先天性脊柱侧凸的临床效果。方法采用一期后路半椎体切除、器械矫正内固定治疗先天性脊柱侧凸畸形15例。术中咬除半椎体的后部附属结构,沿椎弓根外侧壁剥离至椎体前缘,切除半椎体、上下椎间盘及邻近椎体的软骨面,通过内固定器械凸侧加压闭合畸形椎切除后所致的间隙,矫正脊柱畸形。术后定期门诊复诊,观察脊柱融合、畸形矫正率和内固定稳定情况。结果本组15例均获得随访,随访时间12~36个月,平均24个月。术前侧凸Cobb角35°~78°,平均57°,术后Cobb角15°~36°,平均25°,矫正率54%;术前后凸Cobb角22°~65°,平均45°,术后后凸Cobb角8°~36°,平均18°,矫正率60%。术后未发现脊髓、神经损伤,无内固定松动,无切口感染。结论后路半椎体切除、器械矫正内固定治疗先天性脊柱侧凸是一种安全、有效的矫正方法。     

脊柱骨软骨瘤

目的 :提高对脊柱骨软骨瘤诊断和治疗水平。　方法 :将 1994年 1月至 2 0 0 1年 12月我科收治的 6例脊柱骨软骨瘤患者的临床资料进行分析。　结果 :6例患者入院后均行手术治疗 ,2例术前诊断骨软骨瘤 ,术后经病理证实 ,另 4例术后病理明确诊断 ,术前诊断率为 33.3%。　结论 :认识本病的临床特点 ,行CT和MRI检查可早期确诊。一旦确诊 ,应尽早行手术治疗。     

颈前路带锁钢板在颈椎创伤中的应用

目的：研究颈前路开槽式减压，自体髂骨移植及前路带钢锁钢板固定治疗颈椎创伤的临床疗效。方法：对３０例颈椎骨折脱位的病例采用经颈前路开槽式减压，自体髂骨移植及ＡＯ颈前路带锁钢板固定，并于术后行Ｘ线片检查，２９例获得随访。结果：植骨均３个月内完全融合，无钢板螺钉松动，滑脱等并发症。结论：颈椎创伤经减压及植骨后若辅以钢板内固定将使融合节段更加稳定，更有助于植骨节段的融合，ＡＯ颈前路带锁钢板具备高度的内的稳     

Lumbus dosal spine

<正>209195 Biomechanical analysis of a novel perfusional pedicle screw augmentation with bone cement in osteoporotic vertebra/Yang Huilin(Dept Orthopaed First Affil Hosp Soochow Univ Suzhou 215006)…∥Chin J Orthop.-2009,29(3).-241~247Objective To clarify the biomechanical stability of novel perfusional pedicle screw(NPPS) in spinal vertebrae with osteoporosis.Methods Forty-two vertebrae(T11 to L5) obtained from 6 formalin preserved cadavers (5 males and 1 females; mean age,73 years) were used.The mean bone mineral density was (0.696±0.14)g/cm2.The NPPS was inserted into one pedicle of each vertebra,then early-doughtime cement 2 ml was perfused with the bone cement pusher and perfusion tube under X-ray into the vertebra body through the hollow part of NPPS,and the control screw,an improved CD2 screw,was inserted into the contralateral pedicle.Three vertebrae were chosen to observe the distribution of cement,and the other 39 vertebrae were randomly divided into three groups to make the pull-out test,rotation-out torque test,and cyclic bending resistance test respectively.Ten novel perfusional pedicle screws and ten control screws were respectively examined by three-point bend test.Results Cement perfused around the side holes of the distal screw in all vertebral body and no cement leakage occured.The mean maximum force at pull-out was (760±178) N for the NPPS and (355±87)N for the control screw.The mean maximum rotating-out torque was (1.34±0.377)N·m for the NPPS and (0.488±0.205) N·m for the control screw.In cyclic bending resistance test,the NPPS was found to with stand a greater number of cycles or greater loading before loosening.About 30.8%(4/13) of the NPPS became loosing (displacement>2.000 mm),the mean load of the loosening screws was (150±46)N and the mean displacement of the non-loosening screws was (0.661±0.289) mm.All of the control screws were loosening among 50-200 N before 800 cycles.Conclusion The manipulation of NPPS is simple with the application of cement pusher and pe     

Lumbus dorsal spine

Sagittal spine alignment reconstruction in highgrade lumber spondylolisthesis;Clinical signs and symptoms relate to IgM and IgG in herniated lumbar intervertebral disc;The diagnosic and therapeutic value of stress slippage rate on lumbar isthmic spondylolisthesis;Analysis of the parameters about selective anteriot fusion of thoracolumber;Comparative percutaneous with open pedicle screw fixation in the treatment of thoracolumbar burst fractures without neurological deficit     

Lumbus dorsal spine

Meta-analysis of fusion with and without instrumentation in the treatment of chronic low back pain,A prospective study of video-assisted minimal access total lumbar disc replacement： analysis of spinal sagittal balance,Comparative study of posterolateral fusion versus transpedicular grafting for surgically treated burst fractures of thoracolumbar spine,Treatment of unstable thoracolumbar burst fractures： a comparson between anterior approach and posterior approach     

Lumbus dorsal spine

<正>209352 Local X-irradiation promotes regeneration of spinal cord central nervous system in a rat model/Shen Yixin(沈忆新,Dept Orthop,2nd Affil Hosp Suzhou Univ,Suzhou 215004)…∥Chin J Surg.-2009,47(12).-934～936Objective To evaluate the effect of local X-irradiation on spinal cord injury by using physiology,kinology,electrophysiology and histology method.Methods 46 female Spargen-Dawley rats were subjectied to spinal cord injury by weight dropping on T11-12.All animals were divided ito 3 groups randomly.One of the animal groups was irradiated with 10 Gy at the lesion site;another was irradiated with 20 Gy,the other without irradiation is regarded as sham-group.The animals were euthanized at different time points at 4 and 12 weeks after irradiation.Spinal cord callus was assessed by using physiology,kinology,and electrophysiology and histology method.Results In all the groups,the NF at 14 weeks were found higher than that of 6 weeks.Both 10 Gy irradiated and 20 Gy irradiated groups were higher than those of group at each time point (P<0.05).The MBP decreased at 14 weeks in irrdiated groups(P<0.05),but increases at 14 weeks in sham-group(P<0.05),the MBP of irradiated groups was lower than that of sham group at 14 weeks (P<0.05).The GFAP and Nogo-A at 14 weeks were higher than that at 6 weeks in all the groups (P<0.05),and there was no statistical significance with physiology,kinology,electrophysiology test in all groups.Conclusion A self-repair mechanism exists after SCI,which will last at least 14 weeks.Local irradiation promotes the regeneration of spinal cord system after injury to some extent.11 refs,2 tabs.     

Lumbus dorsal spine

<正>210127 Posterior short-segment pedicle screw fixation at the injured level for thoracolumbar spine fractures/Zhu Yunrong(朱云荣,Dept Orthop,Changzheng Hosp,2nd Mil Med Univ,Shanghai 200003)…Chin J Trauma.-2010,26(3).-221～224 Objective To discuss indications,operation method and clinical outcome of posterior short-segment pedicle fixation at the injured level for treatment of thoracolumbar spine fractures.Methods A total of 38 patients     

Lumbus dorsal spine

<正>209510 Meta-analysis of lumbar posterolateral fusion versus circumferential fusion in the treatment of the lumbar disease/Cui Cui(崔璀,Dept Orthop,1st Affil Hosp China Med Univ,Shenyang 110001)…∥Chin JSurg. -2009,47(18). -1374 ～1378