椎弓根螺钉内固定并椎间Cage植骨治疗腰椎滑脱症

目的 观察后路椎弓根螺钉内固定联合椎间Cage植骨融合治疗腰椎滑脱症的手术疗效,并与椎间单纯颗粒植骨融合术进行对比分析.方法 2006年8月至2009年1月对46例腰椎滑脱症患者采用椎弓根钉棒系统复位内固定治疗,其中椎间Cage植骨组(A组)24例,椎间单纯自体骨粒打压植骨组(B组)22例.术前、术后随访期间拍摄X线片测量腰椎滑脱复位率、相对椎间隙高度以及腰骶角的变化,观察融合节段的融合率,并且按照日本矫形外科学会(JOA)的下腰痛评分标准进行临床疗效评价.结果 通过手术复位所有患者的腰腿疼痛症状得到缓解,且在随访18个月时显示A组滑脱复位率为94.7%、相对椎间隙高度为(74.93±7.85)%、腰骶角为36.6°±3.6°,B组分别为89.9%、(68.72±12.40)%、39.3°±5.6°,两组比较差异有统计学意义(P<0.05).A组植骨融合率为95.83%(23/24),B组植骨融合率为90.91%(20/22),两组比较差异有统计学意义(P<0.05).结论 采用椎弓根螺钉内固定联合椎间Cage植骨融合治疗腰椎滑脱症可有效防止腰椎滑脱复位丢失,中远期疗效明显,是治疗腰椎滑脱症较理想的方法.

Abstract：

Objective To observe the therapeutical effect by using pedicle screw and interbody fusion cage,and compare with posterior interbody simple autogenous bone graft. Methods From August 2006 to January 2009,46 cases of lumbar spondylolisthesis patients were treated by using pedical screw internal fixation system, including 24 cases of cage-graft (group A), 22 cases of interbody simple autogenous bone graft (group B), efficacy evaluation using JOA evaluation standard, and measured lumbar olisthe reset rate, relative intervertebral space height and lumbosacral angle of recovery and observed fusion rate through the preoperative and postoperative follow-up X-ray films. Results All the patients' waist pain symptoms relieved after operative reduction. At 18 months of follow-up , group A of lumbar olisthe reset rate was 94.7%, relative intervertebral space height was (74.93 ± 7.85)% ,lumhosacral angle was 36.6° ± 3.6° ,meanwhile group B was 89.9%, (68.72 ± 12.40)%,39.3°± 5.6°. There were significant differences between two groups (P<0.05). Bone graft fusion rate in group A was 95.83% (23/24), in group B was 90.91%(20/22), there was significant difference between two groups (P < 0.05). Conclusion Pedicle screw system and interbody cage-graft in treatnent of lumber spondylolisthesis can effectively prevent the loss of reduction,mid and long-term effects are satisfactory,it is a stable and reliable method.     

髋臼骨折的手术治疗

目的 探讨髋臼骨折的手术方法和疗效.方法 2001年3月至2006年3月共手术治疗髋臼骨折患者41例.按照Letournel-Judet分型,简单型22例,复杂型19例,采用K-L入路31例(其中14例附加大转子截骨)、髂腹股沟入路8例,前后联合入路2例.重建钢板和螺钉固定.结果 随访16～36(24.31±5.31)个月,根据Matta影像学评分标准,解剖复位27例,良好复位8例,差3例,关节轮廓复位3例.根据Merle D'Aubigne临床评定标准:优14例,良18例,一般5例,差4例,优良率78%(32/41).股骨头坏死3例,异位骨化4例,创伤性关节炎3例,坐骨神经损伤4例,股神经损伤1例,神经损伤均在6个月内恢复.下肢深静脉栓塞3例,溶栓后恢复.无死亡病例,无感染、骨折不愈合等并发症.结论 大多数髋臼骨折的手术可以通过单一的K-L入路或髂腹股沟入路完成显露.双钢板或单钢板+拉力螺钉固定牢靠,可以满足髋关节早期功能锻炼的需要.

Abstract：

Objective To investigate the method and curative effect for the operative treatment of acetabular fractures.Methods Forty-one patients with acetabular fractures were treated operatively from March 2001 to March 2006.All fractures were classified according to the Letournel-Judet classification,22cases were simple fractures and 19 cases were complicated fractures.Kocher-Langenbeck (K-L) approach were adopted in 31 cases (14 cases through osteotomy of greater trochanter additionally),ilioinguinal approach were adopted in 8 cases and anterior combined posterior approach were adopted in 2 cases.Different fractures were fixed by reconstructive plates and screws.Results All the patients were followed up for 16-36 (24.31 ± 5.31 ) months.According to the reduction criteria of Matta radiography,there were 27 cases with anatomic reduction,8 cases with satisfactory reduction,3 cases with poor reduction and 3 cases with joint contour reduction.According to the Merle D' Aubigne clinical criteria for joint functions,14 cases showed excellent results,18 cases were good,5 cases were fair and 4 cases were poor,and the excellent-good rate was 78%( 32/41 ).Necrosis of the femoral head was found in 3 cases,heterotopic ossification in 4 cases,traumatic arthritis in 3 cases,sciatic nerve injury in 4 cases,femoral nerve injury in 1 case,all the nerve injury recovered in 6 months.Lower extremity deep venous thrombosis in 3 cases,all of them were recovered by given anticoagulation.No death,infection or nonunion were found.Conclusions K-L approach or ilioinguinal approach are adopted in the most of the operative treatment of acetabular fractures.Dual reconstructive plates or single.reconstructive plate combine lag screws can fix solid.It can make hip to do early exercise.     

磁共振成像在急性脊柱脊髓创伤中的诊断价值

Objective To study the diagnostic value of MRI in acute 70 patients suffered from acute trauma of the spine and spinal cord, and compared the manifestations in different imaging techniques. Results MRI is superior to CT and plain film in detecting acute spinal cord injury, slight vertebral body fracture, intraspinal and soft tissue injuries adjacent to vertebral body. Conclusion MRI is indispensable in the diaghosis of acute trauma of the spine and spinal cord.     

选择性椎管减压加长节段内固定术治疗退行性脊柱侧凸

目的 观察选择性椎管减压、椎间植骨融合加侧凸长节段椎弓根螺钉内固定术治疗超过3个节段的退行性脊柱侧凸的疗效.方法 2003年1月至2009年7月,对52例超过3个节段的退行性脊柱侧凸患者采用后路选择性椎管减压、椎间植骨融合加侧凸长节段椎弓根螺钉内固定术治疗,对其临床效果进行追踪随访.结果 所有患者均获得随访,随访时间12～60个月.腰腿痛缓解情况按Oswestry评分进行评估,术后1周、3个月、12个月Oswestry评分分别为(25.91±9.05)、(26.75±8.37)、(26.90±8.45)分,与术前的(46.35±8.12)分比较差异均有统计学意义(P＜0.05);冠状位Cobb角由术前的15.23°±3.35°矫正到术后1周的10.02°±3.26°,差异有统计学意义(P＜0.05).所有患者术后3、6、12个月X线复查均未出现内植物松动、断裂等情况,术后18～24个月椎间及椎板植骨均达到骨性融合.结论 选择性椎管减压、椎间植骨融合加侧凸长节段椎弓根螺钉内固定术治疗退行性脊柱侧凸可取得良好的手术效果.

Abstract：

Objective To observe the operative effect of selective decompressive laminectomy and long segment pedical screw internal fixation for degenerative scohosis beyond 3 segments. Methods During January 2003 to July 2009, 52 cases with degenerative scoliosis beyond 3 segments were treated by posterior selective decompressive laminectomy, intervertebral implanted bone fusion and long segment pedical screw internal fixation, vetebral plate fusion seperately, and all the cases were followed up. Results All the patients were followed up for 12-60 months after operation. The status of back leg pain relief were evaluated through Oswestry score system. The Oswestry score of 1 week,3 months and 12 months after operation were (25.91 ± 9.05), (26.75 ± 8.37), (26.90 ± 8.45) scores respectively and there was statistical significance compared to the preoperative [(46.35± 8.12) scorns] (P ＜0.05). The average coronal Cobb angle was corrected from 15.23°± 3.35° to 10.02°± 3.26° 1 week after operation (P ＜ 0.05). All the internal implant didn't appear loosing or fracture confirmed by X-ray at 3,6,12 months after operation. The intervertebral implanted bone fusion and vetebral plate fusion all got well in 18-24 months after operation. Conclusion Selective decompressive laminectomy and long segment pedical screw internal fixation for the degenerative scoliosis can get better operative effect.     

普胸术后大量渗血的多因素分析

Objective To explore multi-causes and therapy of massive hemothorax after thoracic operation.Methods Sixty-six patients suffered from massive hemothorax after thoracic operation.All of them were executed conservative treatments for postoperative hemothorax.The noneffeetive cases were executed re-exploration.The relationship of area of residual cavity,fluctuation of intrapleural pressure and volume of hemothorax were analyzed between lobectomy in 30 eases and wedge,segmental or no excision of lung in 24 cases in 24 h postoperation.Results Thirty-two of 66 cases being executed conservative treatments were suteessful,2 cases were dead,while 32 cases were executed re-exploration,and 29 of them were cured.but 1 case of them dead,and 2 cases suffered from bronchial fistula,who were cured by thoracoplasty.The operations of wedge,segmental or no excision of lung in 24 cases were compared with lobectomy in 30 cases.It Was proved that the former had the smaller area of residual cavity,the lower intrapleural pressure.and the less volume of hemothorax(P＜0.05).Conclusions The multiplicity analysis of massive hemothorax after thoracic operation are flucmafion of intrapleural pressure after operation,intracavitary suction with negative pressure,rise of pressure in microcirculation at wound,abnormality of blood coagulation function and so on.It can reduce complications that proper therapy is timely performed,and even avoid of re-exploration.     

坐位蛛网膜下隙与硬膜外隙联合麻醉在择期剖宫产术中的效果观察

目的 观察坐位蛛网膜下隙与硬膜外隙联合麻醉(腰硬联合麻醉)在择期剖宫产术中的效果.方法 将100例择期行剖宫产术的产妇按随机数字表法分为对照组和观察组,每组50例,对照组采用左侧卧位腰硬联合麻醉,观察组采用坐位腰硬联合麻醉,比较分析两组的麻醉起效时间、手术时间、麻黄碱用量、新生儿Apgar评分、不良反应.结果 对照组3例无随访记录,观察组1例行紧急剖宫产术.观察组麻醉起效时间、麻黄碱用量均小于对照组(P<0.05).观察组不良反应发生率[14.3%(7/49)]明显低于对照组[31.9%(15/47)](P<0.05).结论 坐位腰硬联合麻醉应用于择期剖官产术,麻醉起效时间短,麻黄碱用量少,不良反应发生率低,降低了产妇及新生儿的麻醉危险.

Abstract：

Objective To investigate the effect of combined spinal epidural anesthesia with sitting position in parturient woman undergoing elective cesarean section. Methods One hundred parturient women undergoing elective cesarean section were divided into two groups by random digits table, 50 cases of control group adopted combined spinal epidural anesthesia with left lateral position, 50 cases of observation group adopted combined spinal epidural anesthesia with sitting position, the onset time of anesthesia, operation time, dose of ephedrine, neonatal Apgar scores and side effects of two groups were compared and analyzed. Results Three cases of control group failed to be followed up,1 case of observation group performed urgent cesarean section.The onset time of anesthesia and dose of ephedrine of observation group was significantly shorter than that of control group, there was significant difference between two groups (P < 0.05 ); the operation time and neonatal Apgar scores of two groups were compared, there were no significant differences (P > 0.05); the incidence of side effect of observation group was significantly lower than that of controlgroup [ 14.3%(7/49) vs. 31.9%( 15/47)], there was significant difference (P< 0.05). Conclusion Combined spinal epidural anesthesia with sitting position in parturient women undergoing elective cesarean section has satisfactory results, shorter onset time of anesthesia, less dose of ephedrine, lower incidence of side effect, reducing the risk of maternal and neonatal anesthesia.     

不同下斜肌前转位术式治疗分离性垂直偏斜的疗效评价

Objective To assess the clinical effect of anterior transposition of the inferior oblique muscle (ATTO) with and without resection in the treatment of dissociated vertical deviation (DVD). Methods Thirty-six patients ( 59 eyes ) with DVD were divided into the standard group ( 30 eyes) and the resection group (29 eyes) by random digits table undertaking ATIO with and without a 7-mm resection. The vertical deviation degree in primary position and the eyeball motility were recorded and evaluated. Results The vertical deviation degree in primary position were 0△-10△ (3.5 △± 2.7△) after 3 months operation in the standard group,while 0△-12△ (3.3△±3.6△) in the resection group. There were no significant differences between two groups (P＞ 0.05). In the standard group, 2 cases revealed +2 inferior oblique muscle overaction (IOOA), 7 cases revealed +1 and 21 cases revealed 0 after 3 months operation. In the resection group, 1 case revealed +2 IOOA, 4 cases revealed +1 and 24 cases revealed 0 after 3 months operation. There were no significant differences between two groups(P＞ 0.05 ). The presence or absence of IOOA did not influence the result of ATIO for either group. Conclusions ATIO is an effective treatment for DVD and can be used to treat DVD in patients without IOOA. A 7-mm resection with the standard ATIO has no advantage to improve the surgery outcome.     

多层螺旋CT灌注成像技术在肝硬化中的应用价值

Objective To research the value of hepatic perfusion with multi - slice spiral CT in the diagnosis of liver cirrho-sis. Methods Using Philips Brilliance 6 spiral CT and post - processing software to study 25 cases normal person CT perfusion ima-ging data and 32 cases patients with cirrhosis. Results Compared with the control group,TTP of hepatic artery has no difference, in portal vein,liver tissue and spleen tissue were delayed, and the peak of TIP were reduced in Liver and spleen. BF were reduced, BV were reduction, MTT were significantly slowed down. Conclusion Multi - slice spiral CT perfusion imaging technology not only pro- vides the morphology of cirrhosis information, but also provide hepatic hemedynamic changes. CT perfusion technology can be used as a routine examination in patients with liver cirrhosis.     

11例甲型H1N1流感孕产妇的临床分析

Objective To study the clinical characteristics and therapeutic effect of pregnant women infected with severe influenza A(H1N1), to survey the disease effects for the newborns. Methods The clinical data of 11 pregnant women infected with influenza A(H1N1 ) in our hospital from November to December 2009 were analyzed retrospectively. Results All the cases were in serious conditions, and 3 cases were in critical. All the patients were with symptoms of fever and cough, the temperature were in 38.7-39.6 ℃, and duration were 3-14 days. There were 9 cases with low lymphocytes, and 9 cases with high WBC. CRP were elevated in all the cases ( 12-129 mg/L), 9 cases were with hypochromia (22.4-30.2 mg/L). X ray showed increases of pulmonary hilar density for all the cases. By comprehensive treatment, 10 patients were cured and one showed marked progress. 9 cases continued pregnacy. One infant with septicemia was cured, other newborns and fetus were in good condition. Conclusions Pregnant women infected with influenza A (H1N1) are likely to develop severe condition. It is important to use antiviral treatment promptly,supplementary comprehensive treatment. Continuing pregnancy is safe, but the outcome to newborn needs further study.     

漂浮电极导管法临时心脏起搏器的围手术期应用

Objective To discuss the application of implantation temporary cardiac pacing by balloon-tipped floating catheter for peroperative period patients. Method Thirty-three patients with severe bradyarrhythmia were received the balloon-tipped floating catheter to RV by Seldinger puncture technique.Meantime, the pacing signals of ECG were observed. The threshold and QRS waves to ensure the electrode position were determined. Result All of 33 cases were successfully punctured and 32 cases get paced, except 1 case had the electro - mechanical dissociation (EMD). Pacing threshold was less than 0. 9V, and mean remaining time was 12.47 ～ 161 (67. 05 ±34. 48) hours. Apical pacing was operated in 23 patients,and right ventricular outflow tract pacing in 10 patients. No severe complications were occurred. Conclusion The implantation method of temporary cardiac pacing by balloon-tipped floating catheter was convenient and safe. It could help the patients get safety in anesthesia and peroperative period.     

后路经椎管内椎体植骨结合椎弓根螺钉系统固定治疗严重腰椎爆裂性骨折的临床研究

目的探讨后路经椎管内椎体植骨结合椎弓根螺钉系统固定治疗腰椎爆裂性骨折的临床疗效。方法回顾性分析泰安市中心医院骨科2006年12月-2012年12月共68例腰椎爆裂性骨折患者,31例为后路椎管减压经椎管内椎体植骨结合椎弓根螺钉系统固定,37例为单纯椎管减压椎弓根螺钉系统固定,随诊6⁴8个月,评价两组术前、术后及随诊时伤椎高度比值、脊柱后凸成角矫正、腰背疼痛并发症、内固定失效情况。结果经椎管内椎体植骨结合椎弓根螺钉系统固定术后椎体前缘高度及术后后凸成角丢失少,内固定失效率低,与单纯内固定无植骨组比较具有统计学差异(P<0.05)。结论经椎管内椎体植骨结合椎弓根螺钉系统固定能有效防止复位固定后的矫正丢失和内固定失效,对治疗严重腰椎爆裂性骨折有良好的临床疗效。     

经肌间隙入路、自制器械经椎弓根椎体内植骨、伤椎置钉微创治疗胸腰段椎体骨折

目的：探讨经肌间隙微创入路、自制器械经椎弓根伤椎植骨、伤椎置钉手术在治疗胸腰椎骨折中的有效性和安全性。方法：2008年7月-2010年12月期间笔者所在科收治胸腰段椎体骨折患者共60例,采用肌间隙微创入路、自制器械经椎弓根伤椎植骨、伤椎置钉手术治疗。结果：患者伤椎植骨及伤椎置钉术中均顺利完成,手术时间75～105min,平均93min;术中出血量100～180ml,平均110ml,切口愈合良好,无切口感染。术后随访12～20个月,平均18个月,未出现手术后长时间背痛,仅4例患者轻度酸痛,药物治疗即可缓解,对工作生活无明显影响,未出现明显＂蛋壳＂样骨缺损,未出现钉棒松动或断裂现象。椎体前缘高度由术前平均55.3%恢复至90.1%,后凸角由术前平均23.5°矫正至6.1°,椎管占位率由术前平均32.4%恢复至5.4%;神经功能恢复除2例D级无变化外,其余均恢复至E级。结论：采用肌间隙微创入路、自制器械经椎弓根伤椎植骨、伤椎置钉手术治疗胸腰段椎体骨折具有组织损伤轻,出血少,可有效地防止内固定失败、脊柱骨折复位丢失、后凸畸形,降低手术创伤导致的椎旁肌退变及术后腰背痛的发生率。     

寰枢椎椎弓根钉内固定重建上颈椎不稳

目的 探讨寰枢椎椎弓根钉内固定融合重建上颈椎不稳的临床疗效.方法 采用寰枢椎椎弓根钉内固定自体髂骨植骨治疗上颈椎不稳患者21例,其中Ⅱ型齿状突骨折13例,齿状突不连5例,横韧带损伤3例.在寰枢椎后弓间植骨融合,使寰枢椎复合体得到稳定.结果 共置入84枚螺钉,术中2枚螺钉穿破寰椎左侧椎弓根外侧壁,未发生脊髓、椎动脉损伤.所有患者X线片示寰椎完全复位,枢椎齿状突骨折处复位良好.CT片示螺钉与椎动脉及脊髓位置关系良好.按JOA评分标准,优15例,良3例,可2例,差1例,优良率85.71%(18/21).17例患者获得随访,随访时间12～26(12.83±4.23)个月,均获得骨性融合,未发现钉板断裂.结论 寰枢椎椎弓根螺钉结合钉板系统固定重建上颈椎不稳能显著增强寰枢椎间生物力学稳定性,植骨融合率高,该术式在寰枢椎融合术中具有较高的推广应用价值.     

后路复位椎弓根螺钉固定治疗严重胸椎骨折脱位的临床疗效

目的:探讨后路复位椎弓根螺钉治疗严重胸腰椎骨折脱位的临床疗效。方法:应用钉棒系统椎弓根螺钉复位内固定治疗严重胸腰椎骨折脱位18例,全部采用后入路手术,术中视情况决定椎管减压、椎间融合或后外侧融合。结果:全部病例经过6个月～4年随访,椎体前缘高度由术前平均34%恢复至术后90%,后缘平均高度由术前的54%恢复到术后的96%。cobb角由术前平均29°恢复至术后7°,合并脊髓损伤ASIA分级神经功能评分均升高一级,椎间植骨或外侧植骨均融合,无断钉、断棒、螺钉松动及感染发生。结论:后路复位椎弓根螺钉治疗严重胸腰椎骨折脱位具有骨折复位满意、固定牢靠,操作简单等优点,是治疗严重胸腰椎骨折脱位的一种可靠方法。     

中上胸椎骨折脱位合并脊髓不完全性损伤的手术治疗

目的探讨中上胸椎骨折脱位合并脊髓不完全性损伤的手术治疗方法及疗效。方法 2006年4月至2010年3月,采用后路减压植骨融合长节段椎弓根钉内固定治疗中上胸椎骨折脱位合并脊髓不完全性损伤患者15例,观察术前、术后随访的X线及CT片,比较伤椎的Cobb角、椎体高度和神经损伤的变化情况。结果 15例患者均获12～48个月(平均26.5个月)随访,切口均一期愈合,骨折愈合时间:6～14个月(平均9.5个月)。术后并发症:肺部感染1例,深静脉血栓l例,均经处理后痊愈,无内固定失效发生。术前和术后在伤椎的Cobb角、椎体高度丢失方面进行比较,差异有统计学意义(P<0.05)。术后神经损伤按照ASIA分级:B级2例改善为C级,1例改善为D级;C级5例改善为D级,2例改善为E级;D级3例均改善为E级,无加重患者。结论中上胸椎骨折脱位合并脊髓不完全性损伤采用后路减压植骨融合长节段椎弓根钉内固定治疗可获得满意疗效,把握手术时机以及术中仔细操作是成功的关键。     

中上胸椎骨折脱位合并脊髓不完全性损伤的手术治疗

目的探讨中上胸椎骨折脱位合并脊髓不完全性损伤的手术治疗方法及疗效。方法 2006年4月至2010年3月,采用后路减压植骨融合长节段椎弓根钉内固定治疗中上胸椎骨折脱位合并脊髓不完全性损伤患者15例,观察术前、术后随访的X线及CT片,比较伤椎的Cobb角、椎体高度和神经损伤的变化情况。结果 15例患者均获12～48个月（平均26.5个月）随访,切口均一期愈合,骨折愈合时间：6～14个月（平均9.5个月）。术后并发症：肺部感染1例,深静脉血栓l例,均经处理后痊愈,无内固定失效发生。术前和术后在伤椎的Cobb角、椎体高度丢失方面进行比较,差异有统计学意义（P〈0.05）。术后神经损伤按照ASIA分级：B级2例改善为C级,1例改善为D级;C级5例改善为D级,2例改善为E级;D级3例均改善为E级,无加重患者。结论中上胸椎骨折脱位合并脊髓不完全性损伤采用后路减压植骨融合长节段椎弓根钉内固定治疗可获得满意疗效,把握手术时机以及术中仔细操作是成功的关键。     

急性脊柱创伤的临床诊断及切开减压椎弓根内固定治疗效果探讨

目的研究急性脊柱创伤诊断及急性脊柱创伤手术治疗效果。方法回顾45例脊柱创伤的患者的临床及影像学资料,均采用短节段椎弓根钉固定治疗。术后随访1年,观察骨折的恢复情况,脊髓功能恢复情况。脊髓功能按Frankel评分。结果患者术后椎体高度、生理弧度恢复满意,Frankel评分有显著改善。术后随访一年,压缩椎体高度比手术前有明显恢复,畸形角基本矫正,脊髓功能恢复到D与E级的为36例,C级的为6例,B级的为2例,A级的为1例。结论急性脊柱损伤并截瘫早期采用切开减压椎弓根钉内固定手术治疗是可以取得很好疗效的。     

不同融合术式联合椎弓根复位内固定系统治疗峡部裂性腰椎滑脱症247例临床观察

目的研究不同融合术式(PLIF/PLF)联合椎弓根复位内固定系统治疗峡部裂性腰椎滑脱症的疗效及优缺点。方法回顾性分析PLIF和PLF术式联合椎弓根内固定系统治疗峡部裂性腰椎滑脱症247例,分别记录手术经过、效果和并发症。139例获得随访,其中PLIF术式72例,PLF术式67例,随访24～35个月,平均27.5个月,采用Otani标准评价随诊结果。结果平均手术时间,平均出血量,术前和术后椎间高度比较用两样本均数的T检验,使用SPSS 13.0医学软件包进行统计分析。平均手术时间,平均出血量有统计学差异(p<0.05)。行PLIF融合手术的平均手术时间和平均出血量大于PLF。两种融合术手术后的优良率采用χ2检验,结果无统计学差异(p>0.05)。结论PLIF及PLF术式联合椎弓根钉复位内固定均可达到椎管彻底减压,恢复腰椎生理曲度及椎间隙高度,防止术后腰椎失稳,是腰椎滑脱症治疗的有效术式。但PLIF术式能更好地恢复椎间隙高度,能有效地防止复位的丢失,而且其植骨融合速度快。     

胸腰椎椎弓根螺钉位置不良临床病例初次探讨

目的：探讨胸腰椎椎弓根螺钉内固定置钉位置失误的原因、危害及预防措施。方法：回顾性分析200例患者行胸腰椎椎弓根螺钉内固定,共置入螺钉1150枚,观察患者术后的症状体征、正侧位 X 线、薄层 CT 平扫结果,观察螺钉在椎弓根内的位置、角度和穿破椎弓根骨皮质的情况。结果：36枚螺钉穿出了椎弓根皮质,失误率3.130％。术后出现神经根损伤表现5例,占总螺钉的0.43％,占位置不良螺钉的13.89%。结论：经椎弓根固定较易出现螺钉位置不良,可能导致神经根损伤,置钉需要个体化,术前要仔细研究患者影像资料,术中 C 臂透视确认,发现螺钉位置不良及时调整,可以有效减少胸腰椎椎弓根螺钉的置钉不良发生率。     

胸腰段骨折伴脊髓损伤的手术治疗分析

目的探讨胸腰段骨折伴脊髓损伤的治疗。方法胸腰段骨折伴脊髓损伤患者39例,全部均采用前路、后路及前后联合手术入路的方法行手术治疗。其中单节段受累35例,T11 5例、T1215例、L115例。双节断受累4例,T11和T123例、T12和L11例。Frankel分级：A级5例、B级14例、C级13例、D级7例。结果所有的脊髓均获得了充分的有效的减压,脊柱得到了良好的内固定,平均随访24个月,植骨处融合良好,有1例出现了脊柱后凸畸形,有2例出现椎弓根螺钉松动,伤椎由术前的（1．6±0．3）cm恢复到术后的（3．0±0．3）cm,Cobb角由术前的（27±2）。恢复到（40±3）°。Frankel分级A级4例、B级6例、c级19例、D级8例、E级2例。结论胸腰段骨折伴脊髓损伤的手术治疗中,前后路均为有效的方法,且各有优缺点。但前路手术可直接脊髓减压、复位内固定植骨融合,且融合率高,在脊柱的畸形矫正以及脊柱的稳定性重建方面为一种更为确切而且有效的方法。