后路内固定治疗胸腰椎爆裂型骨折的比较

目的：比较几种后路内固定治疗胸腰椎爆裂型骨折的效果。方法：121例胸腰椎爆裂型骨折伴脊髓损伤的患才,随机分组,分别应用Harrington、Dick、RF、DRFS治疗胸腰椎爆裂型骨折,观察神经恢复及骨折复位内固定情况。结果：经平均4年8个月的随访,Harrington、Dick、RF、DRFS治疗胸腰椎爆裂型骨折均有明显的复位固定作用,RF和DRFS在矫正后突畸形、恢复病椎高度上较Dick、Harrington更好,神经功能恢复上无明显差异。结论：RF和DRFS复位固定效果上优于Dick、Harrington,在临床应用上应根据病人的具体情况而定。     

Tenor脊柱内固定系统治疗胸腰椎骨折脱位

目的：评价Tenor脊柱内固定系统治疗胸腰椎骨折脱位的效果。方法：对12例胸腰椎骨折脱位患者应用Tenor脊柱内固定系统进行复内固定手术。结果：12例患者术中均获得良好复位，平均随访19．4个月（6－25个月），骨折全部愈合，瘫痪得到不同程度恢复，疗效满意。结论：Tenor脊柱内固定系统操作简便，复位理想，固定牢靠，是手术治疗胸腰椎骨折脱位有效的内固定方法。     

Uss内固定系统治疗胸腰椎骨折脱位

[目的]探讨Uss脊柱内固定系统治疗胸腰椎骨折脱位的应用技术。[方法]对28例胸腰椎骨折脱位患者应用Uss脊柱内固定系统进行复位内固定手术。[结果]28例患者术中均获得良好复位，平均随访15．6个月，骨折全部愈合，神经功能评价按Frankeal分级得到不同程度恢复，疗效满意。[结论]Uss脊柱内固定系统操作简便、复位理想、固定牢靠，是治疗胸腰椎骨折脱位有效的内固定方法：     

经椎弓根钉内固定治疗胸腰椎骨折脱位

目的 评价经椎弓根钉内固定治疗胸腰椎骨折脱位的临床应用价值.方法 对58例胸腰椎骨折脱位患者行经椎弓根钉内固定治疗,分析患者手术前后的临床表现,X线和CT扫描测量结果.结果 经椎弓根钉内固定治疗胸腰椎骨折脱位后复位满意,内固定牢固,不全瘫患者神经功能均有不同程度的恢复.结论 经椎弓根钉内固定治疗胸腰椎骨折脱位,复位固定满意,有利于脊髓功能的恢复.     

AF系统内固定治疗胸腰椎骨折脱位

胸腰椎骨折脱位在临床上并不少见,常合并有脊髓神经损伤,给患者生理和心理带来较大的创伤。AF系统内固定治疗胸腰椎骨折脱位简单易行、复位满意、固定牢靠,已成为治疗胸腰椎骨折脱位的主要方法。作者从2001年开始应用AF系统内固定治疗胸腰椎骨折脱位98例,经随访疗效满意。现总结分析如下。     

胸腰椎骨折使用三种内固定治疗结果比较

治疗胸腰椎骨折脱位的内固定方法较多 ,由于其结构、作用机理及效果不同 ,各家评述不一。我院于 1989年 11月以来应用Dick钉及Harrington棒、AF系统内固定治疗胸腰椎骨折脱位 92例 ,取得一定效果 ,现将这三种内固定器治疗结果作一个介绍和比较。1　临床资料1.1　一般资料　本组 92例病人 ,男 6 8例 ,女 2 4例 ,年龄 17～ 6 8岁 ,平均 34 .2岁。致伤原因 :高处坠落伤 47例 ,直接压砸伤 2 3例 ,交通事故伤 2 2例。骨折类型 :骨折脱位型 38例 ,爆裂型 2 7例 ,屈曲压缩型 2 7例。骨折部位 :T7,8　 1例 ,T11　 6例 ,T11,12 8例 ,T12 2 3例 ,L…     

复位内固定治疗胸腰椎骨折脱位

复位内固定治疗胸腰椎骨折脱位肥城矿务局第二医院骨科（２７１６１３）郭延章，杨德勇，李光宪，郭伟胸腰椎骨折椎体脱位合并截瘫是煤矿医院常见的一种损伤。复位减压及内固定是目前治疗脊柱骨折脱位合并脊髓损伤的主要方法，其内固定器械较多，更新换代较快，自１９９１...     

Steffee钢板内固定治疗胸腰椎骨折脱位及腰椎滑脱

目的探讨治疗胸腰椎骨折脱位及腰椎滑脱的最佳方法。方法 应用 Ｓｔｅｆｆｅｅ椎弓 螺钉钢板内固定系统治疗胸腰椎骨折脱位及腰椎滑脱３２例。手术行相应椎板切除减压，探查，采用在纵向对抗牵引脊柱的基础上垂直提拉椎弓根螺钉，拉顶复位相结合的方法复位。结果 平均随访２６个月，复位满意，固定牢固，植骨均融合，平均脱位改善程度７４％。     

GSS-Ⅰ用于胸腰椎骨折脱位的疗效评价

目的介绍应用GSS-Ⅰ(GeneralSpineSystem通用脊柱内固定系统)治疗胸腰椎骨折脱位的新方法。方法依照GSS-Ⅰ钛合金特性及三维内固定效果治疗胸腰椎骨折脱位,至2003年4月用该系统治疗34例。结果采用GSS-Ⅰ系统,患者神经功能恢复较术前有明显好转。术中操作方便,复位满意,固定可靠,生物相容性及抗腐蚀性好。结论GSS-Ⅰ三维内固定系统的应用为胸腰椎骨折脱位治疗提供了一个新的有效的方法。     

椎间盘损伤对胸腰椎椎体骨折脱位手术疗效的影响

目的：分析、探讨椎间盘损伤对胸腰椎椎体骨折脱位手术疗效的影响。方法：收集我院1998年1月～2010年1月门诊及住院胸腰椎椎体骨折脱位伴随间盘损伤患者资料,分析、讨论胸腰椎椎体骨折脱位合并严重椎间盘损伤患者手术前后影像学资料及手术疗效。结果：16例胸腰椎椎体骨折脱位合并椎间盘损伤患者中椎体复位不良者10例,椎间隙成角畸形4例,脱位椎体复位欠满意4例,椎间隙过撑2例,内固定断裂10例。内固定取出后椎间隙高度降低8例,再脱位6例,后凸成角畸形4例。结论：胸腰椎椎骨折脱位、特别是严重胸腰椎椎体骨折脱位患者,术前需要进行完善的术前检查,包括X线、CT和MRI检查,明确是否存在椎间盘的损伤,并根据椎间盘损伤程度选择合适的手术方案,以确保手术疗效。     

How to deal with abdominoplasty in an abdomen with a sear

Abdominoplasty is a common procedure in plastic surgery. Reviewing 150 patients who underwent abdominoplasty, it has been observed that 72% of the patients already had an abdominal scar. How to deal with abdominoplasty in an abdomen with a previous scar is discussed in this article.     

Salvage of foot with extensive giant cell tumour with transfer of vascularised fibular bone graft

Though giant cell tumor is not uncommon in young adults, simultaneous involvement of multiple mid-foot bones is very uncommon and very difficult to treat. For reconstruction of large segmental bony defects following tumour excision, free vascularized bone graft is an excellent surgical option. We report a case with extensive involvement of all the tarsal bones and metatarsal bases in a young adult. After excision his foot was reconstructed with vascularised bone flap. We were able to save his foot after a wide local excision and reconstruction with free fibula graft. Graft united early and showed excellent remodelling because of good vascularity. We feel that this method deserves consideration as a last attempt to salvage functional foot in disease like this.     

Clinical experience with duodenum-preserving total resection of the head of the pancreas with pancreaticocholedochoduodenostomy

The results of duodenum-preserving total resection of the head of the pancreas (DpTRHP) in 20 patients were compared with the results of pylorus-preserving pancreatico-duodenostomy (PpPD), a procedure in conventional use for the treatment of benign diseases, in 19 patients. The mean operative time for DpTRHP was 4.5±0.9 h, this being not significantly different from that for PpPD, whereas the mean intraoperative blood loss with DpTRHP (825±508ml) was significantly less than that with PpPD (1382±798 ml) (P<0.05). The morbidity and mortality rates of patients treated with DpTRHP were 25% and 0%, respectively, and there were no significant differences between the two surgical treatment groups for these values. The outcome of treatment with DpTRHP was excellent, as was that of PpPD, in terms of the frequency of early gastric stasis, the duration of hospital stay, the patient's capacity for taking food, gaining weight, and working, and the performance status 6 months postoperatively. Thus, DpTRHP, which entails the least extent of resection of the head of the pancreas compared to other currently employed procedures and enables the operator to accomplish reconstruction of the pancreatic and biliary systems without resecting or interrupting the continuity of the digestive tract, was not attended by any serious complications, while, digestive tract function was well preserved, and satisfactory results were produced.     

Living with a heart transplant: long-term adjustment

The number of heart transplants performed worldwide has increased greatly in the past 10 years, and survival rates will continue to improve with the introduction of new immunosuppressive therapies. With this improved lifespan outlook, the experience of living with a heart transplant needs to be understood as a chronic condition. Twenty-nine recipients who were a minimum of 5 months post-transplantation (mean 22 months) and 23 significant others were interviewed twice 6 months apart using close-ended and open-ended questions developed from the Common Sense Model of health beliefs. Results suggest that although life improved for the majority post-transplantation, recipients continue to experience work problems, financial burdens, family role changes, lifestyle changes, and side effects associated with long-term drug treatment.     

综合治疗中晚期胰头癌38例体会

目的 探讨中晚期胰头癌综合治疗效果。方法 对我院2001年1月至2007年10月无法手术切除的38例中晚期胰头癌行高位肝胆管空肠吻合术和胃空肠吻合术，术中同时行肿瘤局部无水酒精消融和腹腔神经丛无水酒精阻滞及区域动脉置管皮下埋泵术后化疗等综合治疗（简称为综合组），并就治疗效果与同期单纯行胆肠内引流治疗（简称为单纯组）的39例病人进行对比分析。结果 综合治疗组病例未增加手术并发症，术后疼痛缓解率和肿瘤缓解率有显著性提高，综合组半年、1年、2年生存率为94．37％、51．62％和7．02％。单纯组半年、1年、2年生存率为61.8％、17．34％和0。结论 综合治疗有助于延长中晚期胰腺癌病人的生存期和减轻病人疼痛、提高病人生活质量。     

Quality of life in patients with osteoporosis

Complaints regarding, and morbidity of, osteoporosis are caused by fractures which are associated with pain and decrease of physical function, social function, and well-being. These are aspects of quality of life. Health-related quality of life covers physical, mental, and social well-being. Quality of life may be measured for evaluation of treatment effects in clinical trials, for the assessment of the burden of the disease of osteoporosis, and for estimates of the cost-effectiveness of different treatment scenarios in health care policy. Quality of life has been measured in patients with osteoporosis with generic questionnaires such as SF-36 and EQ-5D, which can be used in many diseases, or with one of the six available osteoporotic-specific questionnaires, e.g., Qualeffo-41 or OPAQ. Every questionnaire has to be validated to assess psychometric properties and discrimination power between patients with osteoporosis and control subjects. The value attached to specific health states (utility) can be assessed with some generic instruments or by systematic questioning of the patient, e.g., the time-trade-off method. This results in one value for health status ranging from 0 (death) to 1 (perfect health). Utility values can be used to calculate loss of quality-adjusted life years (QALY). Most data have been obtained in patients with prevalent vertebral fractures. Scores of specific and generic questionnaires showed significant loss of quality of life with prevalent vertebral fractures. In addition, studies with Qualeffo-41 and OPAQ showed a deteriorating quality of life with increasing number of vertebral fractures. Lumbar fractures had more impact on quality of life than thoracic fractures. Incident vertebral fractures were also associated with a decrease of quality of life especially in the physical function domain. This applied to clinical incident vertebral fractures as well as to subclinical fractures to a lesser degree. Loss of quality of life following hip fracture has been documented with generic and osteoporosis-specific questionnaires. A considerable loss was observed in the 1st year with some improvement in the 2nd year, but not to baseline values. Quality of life depended on comorbidity, mobility, activities of daily life (ADL)–independence, and fracture complaints. Utility loss has been observed following hip fracture, especially disabling hip fracture, hip and vertebral fracture combined, or multiple vertebral fractures. Utility following osteoporotic fractures has been valued by patients, the healthy elderly, and panels of experts. The healthy elderly gave the worse quality-of-life scores (lower utility) to various hip fractures than patients with hip fractures themselves. In conclusion, suitable instruments exist for measuring quality of life in patients with osteoporotic fractures. These instruments are useful for clinical trials and for assessment of the burden of disease.     

静脉动脉化再植拇指完全离断

目的 报道静脉动脉化再植拇指完全离断的新方法。方法 1999—2002年在5例拇指完全离断再植手术中，因指动脉严重损伤或多次吻合指动脉失败后，将近侧动脉与断指的一条静脉吻合作为供血通路，近侧的静脉与断指的另几条静脉吻合作为回血通路。结果 5例再植拇指全部成活，早期病例完全恢复了良好的功能。结论 静脉动脉化是一种拇指离断再植的新方法，操作简便，效果可靠，值得推广应用。     

缝匠肌髂骨(膜)瓣修复股骨颈骨折及头坏死——解剖学研究及临床观察

通过30例标本对缝匠肌端及其附着髂骨部血供的解剖学观察,并设计应用缝匠肌髂骨(膜)瓣转位修复股骨颈骨折和股骨头缺血性坏死。自1986年开始在临床应用,治疗股骨头缺血性坏死X例,陈旧性股骨颈骨折10例,新鲜股骨颈骨折4例,骨折愈合时间为12～14周,股骨头缺血坏死4～6月均有改善。作者认为该肌骨瓣具有血供可靠,操作简单,创伤小和效果可靠等优点。     

重肾双输尿管并发上位肾积水3例误诊分析

目的：分析重肾双输尿管并发上位肾积水误诊原因，探讨临床不典型囊肿、肾上腺囊肿的诊断方法。方法：回顾性分析３例重肾双输尿管并发上位肾积水误诊的临床资料。结果：左侧２例、右侧１例。均行手术治疗，术中发现为重肾双输尿管上位肾积水，解除梗阴因素并行整形，术后半年随访，无复发。结论：诊断肾囊肿、肾上腺囊肿时应考虑本病并进行相应检查；对于肾囊肿、肾上腺囊肿穿刺注射无水乙醇应慎重。     

带旋股外侧动脉升支阔筋膜张肌髂骨瓣转位术的解剖及其应用

通过20例解剖标本旋股外侧动脉升支与阔筋膜张肌的血供解剖学观测,作者设计了带升支的阔筋膜张肌髂骨瓣、转位植骨修复股骨颈骨折和股骨头缺血性坏死的术式。自1987年以来,临床共施术9例,并经8个月～4年的临床随访,均获得满意效果。