经伤椎置椎弓根钉内固定治疗胸腰椎椎体骨折脱位36例临床观察

目的探讨经伤椎置椎弓根钉内固定治疗胸腰椎椎体骨折脱位36例临床疗效。方法选取2009年1月～2010年12月本院收治的36例胸腰椎椎体骨折脱位患者,经过经伤椎置椎弓根钉内固定手术治疗,并对其进行回顾性分析。结果经研究发现患者术后Cobb角、伤椎椎体前缘高度恢复良好,术后12个月与术后1个月相比无明显差异。结论经伤椎置椎弓根钉内固定治疗胸腰椎椎体骨折脱位,可使伤椎椎体高度得以恢复,尤其是伤椎椎体前缘高度的比值得到改善,Cobbs角改善明显,术后并发症也明显减少,效果满意。     

AF钉治疗胸腰椎骨折脱位疗效分析

目的分析AF钉复位固定治疗胸腰椎骨折脱位的方法和疗效。方法应用AF钉复位固定治疗胸腰椎骨折脱位33例,33例均行横突间或椎板间植骨融合,7例同时经伤椎椎弓根行椎体内植骨术,平均随防17个月。结果AF钉复位固定治疗胸椎骨折脱位,伤椎术后椎体高度均得到完全或基本完全恢复,33例无断钉、钉松动或矫正度丢失现象。结论AF钉复位固定,结合后路植骨融合或椎体内植骨术是治疗胸腰椎骨折脱位的良好方法。     

伤椎置钉治疗胸腰椎单节段骨折

目的探讨胸腰椎单节段骨折伤椎置钉固定治疗的疗效分析。方法 2008年2月至2010年1月住院患者中选用合适的惠者,使用后路脊柱椎弓根固定系统(RSSⅡ)对伤椎置钉治疗65例,在手术中使用后路椎弓根螺钉同时固定伤椎及临近椎体、C臂X光机透视下观察骨折复位、椎弓根置钉及固定情况,根据视觉疼痛评分(VAS)、Cobb氏角、椎体前后缘高度比进行评价。结果术后随访14²0个月,平均(16.9±4.2)月,术后1、3、6个月,治疗组病例在视觉疼痛评分(VAS)、Cobb氏角、椎体前后缘高度比评分中,较对比组中更好的评分。结论胸腰椎单节段骨折伤椎置钉固定治疗是一种有效治疗方法,有效恢复胸腰椎序列的稳定、降低了患者胸腰椎骨折术后疼痛的发生率,让患者更快恢复。     

钉棒系统治疗胸腰椎骨折35例疗效分析

目的探讨后路椎弓根钉棒系统治疗胸腰椎爆裂性骨折疗效。方法应用椎弓根钉棒系统经伤椎复位固定和经伤椎椎弓根颗粒植骨和有选择半椎板减压治疗胸腰椎爆裂性骨折。结果 35例均获得随访,随访时间6~24个月,所有患者椎体高度恢复良好,骨折全部愈合,无钉棒断裂发生。结论应用钉棒系统经伤椎置钉固定和经伤椎植骨椎体复位满意、骨折愈合良好,取得良好治疗效果。     

经伤椎椎弓根椎体内植骨置钉内固定治疗下腰椎爆裂性骨折

目的探讨经伤椎椎弓根椎体内植骨置钉内固定治疗下腰椎爆裂性骨折的临床疗效。方法采用后路椎弓根螺钉系统复位加椎管间接减压并经伤椎椎弓根植骨置钉植骨内固定治疗下腰椎爆裂性骨折13例。结果经7～55个月随访,平均33个月。术后伤椎椎体高度恢复90%以上,椎管狭窄症状明显改善。复查X线片未见复位的椎体高度丢失。复位后的椎体高度无丢失,无明显后凸畸形,Frankel分级获得1～3级以上改善。结论下腰椎爆裂性骨折严重影响脊柱的稳定性,需积极手术治疗,经伤椎椎弓根椎体内植骨置钉内固定治疗下腰椎爆裂性骨折,可有效重建脊柱的稳定性,改善神经功能。     

电钻引导徒手椎弓根置钉全椎弓根钉内固定治疗胸腰椎爆裂骨折

目的探讨电钻引导徒手椎弓根置钉技术在胸腰椎爆裂骨折临床应用。方法选择65例新鲜胸腰椎爆裂骨折病例,经后路切开,应用电钻引导徒手置钉技术,固定节段内,全椎弓根钉固定。伤椎置钉对伤椎推挤,达到脊柱冠状位及矢状位序列复位目的,同时恢复伤椎椎体高度。结果 65例共置钉407枚,置钉节段T10-L5,非伤椎置钉274枚,伤椎置钉133枚,无神经、血管、硬脊膜损伤,内脏损伤。结论电钻引导徒手椎弓根置钉技术是一种有效椎弓根置钉技术,全椎弓根置钉固定分散应力,增加固定稳定性,有利于固定节段融合。     

伤椎置钉与跨节段椎弓根螺钉内固定术治疗胸腰椎骨折的比较研究

目的分析研究后路经伤椎置钉与跨节段椎弓根螺钉固定治疗胸腰椎骨折的临床疗效。方法回顾性分析2010年1月至2011年1月56例(观察组)伤椎置钉内固定治疗胸腰椎单一椎体骨折患者的临床资料,随机选择同期跨节段椎弓根螺钉内固定50例作为对照组,术后随访6～24个月。结果所有患者平均随访时间18.5个月。观察组在术后矫正率、术后椎管面积改善值、远期丢失率、内固定失效率方面明显优于对照组,两组比较差异有统计学意义(P<0.05)。结论伤椎置钉内固定治疗胸腰椎单一椎体骨折可以增强内固定系统的牢固性,降低术后矫正角度的丢失及内固定的失败率,是治疗胸腰椎骨折的有效方法。     

经伤椎置钉三椎体固定治疗胸腰椎爆裂骨折

目的:探讨经伤椎置椎弓根钉固定治疗胸腰椎爆裂骨折的可行性.方法:我院收治符合经伤椎置钉治疗的胸腰椎爆裂骨折患者24例,8例用5钉三椎体固定,16例用6钉三椎体固定.结果:伤椎置钉均顺利完成,螺钉位置及椎体复位均可,脊髓神经无损伤加重,全部病例均无切口感染.所有患者获得6～12个月的随访,平均10.8个月,末次随访未出现内固定的松动断裂,除2例A级无变化外,其他患者较术前都有1～2级的恢复.末次随访中,Cobb角由术前10～45度,矫正至-1～20度;椎体前缘的高度由术前丢失9%～48%恢复至正常高度的82%～100%.结论:经伤椎置椎弓根钉三椎体固定法较传统方法有椎体复位容易,前中柱重建稳定,后柱固定牢固,矫正丢失小,疗效满意,是治疗胸腰椎爆裂骨折的有效方法.     

经伤椎椎弓根置钉治疗胸腰椎骨折的临床分析

目的了解胸腰椎骨折使用经伤椎椎弓根置钉治疗的方法 ,探讨经伤椎椎弓根置钉对胸腰椎骨折的临床疗效。方法选择本院2010年6月～2013年4月20例胸腰椎骨折患者作为观察对象,使用经伤椎椎弓根置螺钉系统进行固定治疗,然后使用X线和计算机体层摄影对伤椎前缘高度、Cobbs角、伤椎失状面指数（SI）和伤椎前缘高度压缩进行测定,评定临床疗效。结果手术治疗1周、3个月、6个月、12个月后的伤椎前缘高度、Cobbs角、伤椎失状面指数（SI）和伤椎前缘高度压缩与治疗前相比存在显著统计差异（P〈0.05）,但治疗后的1周、3个月、6个月、12个月后的伤椎前缘高度、Cobbs角、伤椎失状面指数（SI）、伤椎前缘高度压缩相比差异无统计学意义（P〉0.05）。结论使用经伤椎椎弓根置钉对胸腰椎骨折进行治疗,伤椎前缘高度恢复良好,固定疗效固定,对减少伤椎高度丢失和促进伤椎神经功能康复有积极作用。     

经伤椎椎弓根置钉四钉短节段固定法在无神经损伤胸腰椎骨折治疗中的临床效果研究

目的 探讨在无神经损伤胸腰椎骨折治疗中采取经伤椎椎弓根置钉四钉短节段固定法的安全性和稳定性.方法 选择我院2010年3月到2013年3月收治的50例无神经损伤胸腰椎骨折患者,根据手术方法的不同随机将患者分为研究组和对照组各25例,研究组采取经伤椎椎弓根置钉四钉短节段固定法治疗,对照组采取跨伤椎四钉固定法进行治疗.对比观察两组患者胸腰椎的恢复情况.结果 两组患者术后椎体前缘高度及椎间角较术前明显增加,研究组患者较对照组效果改善更明显,其差异具有统计学意义（P＜0.05）.术前,研究组与对照组椎管侵占率分别为（31.7±3.6）、（33.1±5.4）％;术后,分别为（23.9±4.9）％、（26.5±3.5）％.椎管侵占率较术前明显降低,研究组患者优于对照组患者,两组间差异具有明显的统计学意义（P＜0.05）.结论 无神经损伤胸腰椎骨折采取经伤椎椎弓根置钉四钉短节段固定法治疗,可恢复患者骨折处的椎体高度,椎管容积,纠正成角畸形,对继发性神经操作及脊柱的重建具有积极的意义,同时能够提高轴向运动方向的灵活性,固定效果更好,稳定性更强.     

Nail discoloration due to tinzaparin sodium

Tinzaparin sodium is a low molecular weight heparin formed by the enzymatic degradation of porcine unfractionated heparin, and is effective in the prevention and treatment of thromboembolic disease. We report a 31-year-old female patient with a history of recurrent pregnancy loss due to thrombophilia, who developed nail discoloration after 8 weeks of tinzaparin sodium therapy. No other pigmentation was found elsewhere on the skin, mucous membranes, teeth, or sclerae. To our knowledge, nail pigmentation following tinzaparin sodium therapy is an unknown side effect and has not been reported previously in the English literature.     

In-vitro Permeability of the Human Nail and of a Keratin Membrane from Bovine Hooves: Penetration of Chloramphenicol from Lipophilic Vehicles and a Nail Lacquer

Lipophilic vehicles and especially nail lacquers are more appropriate for topical application on the nail than aqueous systems because of their better adhesion. This work has, therefore, studied the penetration through the human nail plate of the model compound chloramphenicol from the lipophilic vehicles medium chain triglycerides and n-octanol and from a lacquer based on quaternary poly(methyl methacrylates) (Eudragit RL). The results were compared with data obtained with a keratin membrane from bovine hooves. If the swelling of the nail plate or the hoof membrane is not altered by use of lipophilic vehicles, the maximum flux of the drug is independent of its solubility in the vehicle and is the same as that from a saturated aqueous solution. These vehicles are not able to enter the hydrophilic keratin membrane because of their non-polar character and so cannot change the solubility of the penetrating substance in the barrier. If the concentration of the drug in the nail lacquer is sufficiently high, the maximum flux through both barriers equals that from aqueous vehicles or even exceeds it because of the formation of a supersaturated system. Penetration through the nail plate follows first order kinetics after a lag-time of 400 h. The course of penetration through the hoof membrane is initially membrane-controlled and later becomes a matrix-controlled process because of the membrane's greater permeability. Chloramphenicol is dissolved in the lacquer up to a concentration of 31%. The relative release rates from these solution matrices are independent of the drug concentration but they decrease on changing to a suspension matrix. These results show that drug flux is independent of the character of the vehicle and that penetration of the drug is initially membrane-controlled and changes to being matrix-controlled as the drug content of the lacquer decreases.     

闭合复位交锁髓内钉内、锁定加压钢板内固定治疗胫骨干骨折的临床疗效对比

目的:分析比较闭合复位交锁髓内钉内、锁定加压钢板内固定治疗胫骨干骨折的临床疗效。方法:将某院门诊和住院胫骨干骨折患者60例随机分为两组,研究组患者行复位交锁髓内钉术,对照组患者行锁定加压钢板内固定术,比较两组的手术指标及临床疗效。结果:两组患者手术时间、术中出血量、骨折愈合时间比较差异均无统计学意义(P0.05),研究组住院时间显著低于对照组,差异具有统计学意义(P0.05);两组治疗总有效率比较差异无统计学意义(P0.05)。结论:交锁髓内钉与锁定加压钢板内固定均是治疗胫骨干骨折的有效方法。     

Iontophoretically Enhanced Ciclopirox Delivery into and Across Human Nail Plate

Transungual delivery of antifungal drugs is hindered by the low permeability of human nail plates, and as such, repeated dosing over a long period of time is necessary for effective treatment. The objectives of this study were to explore the possibilities of (a) enhancing the delivery of ciclopirox (CIC) across human nail plates and (b) sustaining CIC delivery from the larger resultant drug depot in the nail plates with constant voltage iontophoresis. In vitro passive and 9 V cathodal iontophoretic transport experiments of CIC across human nails were performed. Transungual CIC delivery with Penlac® was the control. The amounts of CIC released from and deposited in the nails were determined in drug release and extraction experiments, respectively. Iontophoresis increased the flux of CIC permeated across the nail approximately 10 times compared to passive delivery from the same formulation or from Penlac®. A significant amount of CIC was loaded into and released from the nails; the CIC concentrations were estimated to be above the minimum inhibitory concentrations of CIC for dermatophytic molds. The apparent transport lag time decreased in iontophoretic transport. The results demonstrate that iontophoresis was able to deliver an effective amount of CIC into and across the nails, and this suggests the feasibility of a constant voltage battery-powered transungual iontophoretic device. © 2008 Wiley-Liss, Inc. and the American Pharmacists Association J Pharm Sci 98:3608–3616, 2009     

DHS与Gamma钉治疗股骨粗隆间骨折的疗效比较

目的比较动力髋螺钉(DHS)与Gamma钉治疗股骨粗隆间骨折的疗效。方法入选的80例股骨粗隆间骨折患者根据手术方法的不同随机分为DHS组及Gamma钉组各40例,探讨两组的手术疗效。结果 80例患者无1例死亡,DHS组、Gamma钉组的总有效率比较,差异无显著性,但Gamma钉组的手术时间及出血量均短于或少于DHS组,而骨痂出现时间、骨折愈合时间、住院时间却长于DHS组。随访7个月～2年后,DHS组并发症发生率明显高于对照组,差异有显著性(P<0.05)。结论两种手术方法均是治疗股骨粗隆间骨折的有效手术方法,但各有优缺点,临床医师应选择好适应证。