自拟益气通闭汤治疗尿潴留验案

尿潴留证见尿液滞留于膀胱,病人有强烈尿意,膀胱胀痛,但不能自行排尿,属于中医＂癃闭＂的范畴,常见于外科手术、产后及某些内科疾病伴随并发症。     

发育性寰椎管狭窄症的手术治疗

目的 :探讨发育性寰椎管狭窄症的手术方法及疗效。方法 :2014年1月～2018年5月我院共收治发育性寰椎管狭窄症患者15例,根据寰枢椎CT薄层扫描图像特征,将发育性寰椎管狭窄症分为4种类型,即Ⅰ型(小寰椎型)、Ⅱ型(寰椎后弓肥厚型)、Ⅲ型(寰椎后弓内陷型)和Ⅳ型(枢椎齿状突肥大型)。针对不同类型采用相应手术方法:①对不合并寰枢椎脱位或失稳的Ⅰ、Ⅲ、Ⅳ型患者实施单纯寰椎后弓切除术;②对Ⅱ型患者采用后弓磨薄回植术;③对合并有寰枢椎脱位或失稳的Ⅰ、Ⅱ、Ⅲ型患者,附加后路枕颈固定融合术;④对合并寰枢椎脱位的Ⅳ型患者采用经口咽前路枢椎齿状突打磨削薄+寰枢椎脱位内固定术的方法。术后复查颈椎MRI和CT,观察高位颈脊髓压迫改善情况;采用JOA评分评价手术前后脊髓功能的改善情况。结果:15例患者中,Ⅰ型7例,Ⅱ型2例,Ⅲ型2例,Ⅳ型4例。共实施寰椎后弓切除并后路枕颈固定融合术6例,单纯寰椎后弓切除术5例,寰枢椎后弓削薄回植术2例(其中1例因合并寰枢椎脱位同时实施枕颈固定融合手术),齿状突削薄寰枢椎前路复位内固定术2例。手术顺利,未发生术中神经脊髓损伤、椎动脉损伤等严重并发症。术后复查MRI和CT显示寰椎平面的脊髓压迫解除。随访时间12～34个月(14±3个月),患者术后肢体麻木、无力、走路不稳等症状均有不同程度的改善,术前JOA评分10.60±0.96分,术后3个月恢复到14.10±0.37分,末次随访时为14.70±0.63分,改善率为64%。结论:发育性寰椎管狭窄症可分为4种类型,根据不同类型采用针对性的手术治疗可以获得满意的临床效果。     

退变性脊柱侧凸患者的步态特征及其与脊柱X线片上影像学参数的相关性分析

目的：分析退变性脊柱侧凸（degenerative scoliosis,DS）患者的步态特征，探讨其与脊柱X线片影像学参数的相关性。方法：纳入9例DS患者，年龄63～73(67.7±3.1)岁。使用红外运动捕捉系统（SMART-D 400）对患者进行三维步态运动分析，主要包括时空参数（跨步时长、支撑时长、摆动时长、支撑周期、摆动周期、单足支撑周期、双足支撑周期、绝对速度、相对速度、步频、步长、步宽）、步态偏差指数（gait deviation index,GDI）和脊柱平衡参数[步态分析过程中第一个5m和最后一个5m的冠状面的偏斜角（thoracic-whole spine coronal angle,TS-CA）、矢状面偏斜角（thoracic-whole spine sagittal angle,TS-SA）、运动周期骨盆倾斜角（pelvic tilt in motion cycle,PTM）]。在脊柱全长X线片上测量患者胸椎后凸角（T5/T12 Cobb）、腰椎前凸角（L1/L5 Cobb）、骶骨倾斜角（sacral slope,SS）、骨盆入射角（pelvic incidenc...     

不同体位腹膜后大血管及腰大肌的MRI影像解剖学差异

目的 比较仰卧位、俯卧位及侧卧位时，腹主动脉和下腔静脉在腰椎各椎间隙水平的位移变化和腰大肌厚度及位移变化，确定经侧路进行腰椎融合术的安全工作区。方法 15名志愿者在3种体位接受腰椎磁共振检查，记录L_1/2～L_4/5椎间隙水平腹主动脉和下腔静脉的位置、腰大肌的厚度及位移情况并进行比较。结果 相同节段不同体位下腔静脉分布相似。而在L_1/2～L_3/4水平，相较于仰卧位，腹主动脉在侧卧位和俯卧位部分向前方移动至椎体前缘。相同节段不同体位腰大肌厚度存在差异(L_2/3A区，L_3/4A区、Ⅳ区和P区，L_4/5Ⅱ区和Ⅳ区)(P<0.05)。不同节段腰大肌前移距离存在差异，在L_1/2水平，俯卧位(-7.53±3.30)mm及侧卧位(-7.25±3.96)mm的前移距离大于仰卧位(-10.90±3.31)mm,P=0.012；在L_2/3水平，侧卧位的前移距离(-0.12±5.59)mm明显大于仰卧位(-5...     

颈椎前路多节段融合术后邻椎病的再手术策略

目的 探讨颈椎前路多节段融合术后邻椎病的手术治疗策略。方法 对2015年至2020年我院收治的13例颈椎前路多节段融合术后邻椎病再手术治疗的患者进行回顾分析，采取颈椎前路Zero-P钢板固定术治疗8例单节段邻椎病，后路颈椎单开门椎管扩大成形术治疗5例2个节段邻椎病，采用JOA评分、VAS评分及NDI指数进行疗效评价，分析X线、CT或MRI影像学表现。结果 本组所有病例得到随访，平均随访11.6个月（6～24个月）。两种术式术后患者JOA评分、VAS评分、NDI指数均得到显著改善。颈椎前路Zero-P钢板术后内固定物位置良好，随访未见钢板螺钉松动，骨融合平均时间为7.6个月。颈椎后路单开门椎管扩大成形术治疗患者均未出现C5神经根麻痹、椎板再关门等并发症。结论颈椎前路多节段融合术后邻椎病再手术方式的选择应遵循个体化原则，单节段邻椎病且不伴严重后纵韧带骨化，可选择前路减压融合Zero-P固定术；邻椎病变节段≥2处，可选择后路单开门椎管扩大成形术。     

Comparison of Jefferson-fracture reduction plate and micro titanium plate in the transoral single-segment fixation of unstable atlas fractures北大核心CSCD

Objective To compare Jefferson-fracture reduction plate (JeRP) and micro titanium plate in the transoral single-segment fixation of unstable atlas fractures. Methods From January 2008 to December 2020, 45 patients with unstable atlas fracture were treated by single-segment fixation through an oral approach with a JeRP or a micro titanium plate at Department of Orthopedic Surgery, General Hospital of Southern Theatre Command. They were 24 males and 21 females, aged from 15 to 67 years. By the Gehweiler classification, 11 atlas fractures were type Ⅰ and 34 type Ⅲ; by the American Spinal Injury Association (ASIA) classification, the spinal cord injury was grade D in 7 cases and grade E in 38 cases; by the Dickman classification, the atlas transverse ligament injury was type Ⅰ in 4 cases and type Ⅱ in 11 cases. Of the patients, 26 were treated by transoral single-segment fixation with a JeRP and 19 by transoral single-segment fixation with a micro titanium plate. The 2 groups were compared in terms of baseline data, operation time, blood loss, hospital stay, visual analog scale (VAS) for neck pain and atlas lateral mass displacement (LMD) before operation and at the last follow-up, and intraoperative and postoperative complications. Results The 2 groups were comparable because there was no significant difference between them in the preoperative general data (P>0.05). All patients were followed up for 12 to 55 months (mean, 21.8 months). Wound dehiscence or infection was observed in none of the patients after operation. About 12 months after operation, all fractures achieved bony union, neck pain basically disappeared, and neck movement had no obvious limitation. The hospital stay was (13.9±2.2) d for the JeRP group and (14.2±2.9) d for the micro titanium plate group, showing no significant difference between the 2 groups (P>0.05). The operation time was (203.5±173.4) min and the blood loss (167.3±138.6) mL in the JeRP group, significantly more than those in the micro titanium plate group [(121.5±50.5) min and (98.4±57.2) mL] (P<0.05). In the JeRP group, the preoperative LMD was (6.7±1.7) mm and the preoperative VAS score (6.8±1.0) points, significantly higher than the last follow-up values [(0.7±0.6) mm and (0.7±0.6) points] (P<0.05). In the micro titanium plate group, the preoperative LMD was (6.6±1.5) mm and the preoperative VAS score (6.7±0.9) points, significantly higher than the last follow-up values [(0.9±0.6) mm and (0.8±0.7) points] (P<0.05). However, there was no significant difference in the preoperative or the last follow-up comparison between the 2 groups (P>0.05). Implant loosening was observed in one patient in the JeRP group while foreign body sensation in the throat was reported in one patient after operation in the micro titanium plate group. Conclusions Both JeRP and micro titanium plate in the transoral single-segment fixation can lead to effective treatment of unstable atlas fractures. Compared with JeRP, the micro titanium plate can effectively shorten operation time and reduce blood loss due to its smaller size and lower incision. © 2022 Chinese Journal of Orthopaedic Trauma. All rights reserved.