骨科手术导航系统引导腰椎椎弓根螺钉植入的效果

目的探讨C型臂X线透视电子计算机辅助导航系统在腰椎椎弓根螺钉植入手术过程中的应用.方法对腰椎滑脱4例,因腰椎间盘突出症、腰椎退型性改变等原因引起的腰椎失稳患者11例,共15例在骨科手术导航系统引导下完成椎弓根螺钉的植入,共植入椎弓根螺钉68枚,术后进行X线平片及CT薄层扫描掌握螺钉的方向和位置.结果68枚椎弓根螺钉均未穿破椎弓根,椎弓根螺钉的方向、深度、位置均相当理想,全部病例无硬膜、神经根损伤.结论骨科手术导航系统可以准确引导腰椎椎弓根螺钉的植入,避免椎弓根螺钉植入相关的并发症.     

计算机导航技术在脊柱椎弓根钉固定中的应用

目的 探讨术前CT扫描三维虚拟图像导航技术在脊柱椎弓根螺钉固定术中的应用价值.方法 95例行脊柱椎弓根螺钉固定术的患者,随机分为两组,一组在计算机导航技术辅助下植入椎弓根螺钉(导航组),一组采用传统的解剖标志法结合术中透视定位植入椎弓根螺钉(常规组).比较两组间的螺钉钉道准备时间、螺钉位置的优良率和术后并发症的发生率.结果 导航组36例患者共植入椎弓根螺钉206枚,其中优169枚(82.0%)、良29枚(14.1%)、差8枚(3.9%),优良率96.1%.有9例患者因故未能行导航.常规组50例患者共植入椎弓根螺钉285枚,其中优257枚(90.2%)、良28枚(9.8%),无位置差的螺钉,优良率100.0%.两组螺钉优良率间差异无统计学意义(P>0.05).螺钉钉道准备时间导航组为(9360±22)s,常规组为(56±8)s,两组差异有统计学意义(P<0.001).两组患者术后均无并发症发生.结论 术前CT扫描三维虚拟图像导航技术与传统解剖标志定位法植入椎弓根螺钉的精度无明显差异;且延长了手术时间,其在脊柱椎弓根螺钉固定中的应用价值有限.     

SpineNav-01手术导航系统辅助脊柱椎弓根螺钉置入的临床研究

 目的  比较计算机手术导航系统SpineNav-01辅助手术与传统X线透视辅助手术在辅助胸、腰骶椎椎弓根螺钉置入手术中的准确性和安全性,评价该手术导航系统在临床应用中的效果。 方法 纳入33例接受椎弓根螺钉内固定手术的患者,收集临床及影像学资料。按辅助手术方式的不同分成两组:传统组,螺钉置入在X线透视辅助下完成;导航组,螺钉置入在基于术前三维CT数据的手术导航系统辅助下完成。术后三维CT评价两组螺钉的位置情况,比较两组螺钉置入的准确性和安全性,记录每枚螺钉置入时间、置钉相关并发症,导航组另记录注册时间。结果 两组间年龄、性别以及螺钉节段分布情况差异无统计学意义。传统组共置入108枚螺钉,其中胸椎22枚,腰、骶椎86枚,准确率为73.1% (79/108),安全率为96.3% (104/108),出现神经相关并发症2例,1例接受翻修手术;导航组共置入108枚螺钉,其中胸椎30枚,腰、骶椎78枚,准确率为87.0% (94/108),安全率为100% (108/108),出现神经相关并发症1例。两组间螺钉置入准确率及安全率比较,差异有统计学意义 (P<0.05),导航组螺钉置入准确性及安全性优于传统组。传统组每枚螺钉置入时间为2～5 min,平均3.2 min;导航组每枚螺钉置入时间为1～4 min,平均2.2 min;导航组共注册25次,每次注册时间3～9 min,平均4.8 min。 结论 基于术前三维CT数据的SpineNav-01手术导航系统能显著提高胸、腰椎椎弓根螺钉置钉的准确性和安全性。     

徒手置入277枚腰椎椎弓根螺钉的临床分析

目的 探讨徒手置入腰椎椎弓根螺钉的手术技巧,以便准确、可靠的徒手置入腰椎椎弓根螺钉.方法 2007年4月至2009年4月对骨折、滑脱、椎管狭窄等不同情况的腰椎徒手进行椎弓根钉置入共277枚,记录置钉过程中穿破椎弓根皮质的部位、螺钉松动的原因、有无术中并发症等.术后评价螺钉位置,观察有无术后并发症的发生.结果 术后复查正侧位X线片,优良率为95.3%.置钉过程中发生椎弓根皮质穿破22枚,总发生率为7.94%,不同节段腰椎之间发生率的差异无统计学意义(P＞0.05).术中因开路器改道、螺钉植入后发生螺钉松动3枚,因骨质疏松致螺钉松动2枚.术中未发生神经、血管、脏器损伤及脑脊液漏等并发症.术后观察无螺钉滑脱病例,无瘫痪加重病例,无神经、血管、脏器损伤病例.结论 熟悉腰椎椎弓根螺钉植入的每一个步骤及影响因素,徒手置入过程中重视手感并及时采取应对策略进行调整,可以获得安全、满意的置钉效果.     

骨科手术导航系统在椎弓根螺钉固定术中的应用

目的探讨骨科手术导航系统在椎弓根螺钉固定术中的应用效果。方法选取该院2012年1月—2013年1月拟行椎弓根螺钉固定术患者60例,随机分成观察组和对照组,观察组术中应用骨科手术导航系统,对照组常规X线透视下行手术操作,术后两组患者均进行X线片检查,确定螺钉置入情况,观察两组患者近期并发症。结果观察组患者出现早期并发症1例,共置入110枚螺钉,其中106枚置入位置准确,术后随访1～3个月,未见近期并发症病例,与对照组比较差异有统计学意义(P<0.05)。结论在椎弓根螺钉固定术中应用骨科手术导航系统能够显著提升螺钉置入位置的准确性,降低手术并发症,避免放射线对患者机体带来的损害,为椎弓根螺钉固定术的安全化和精确化发展提供了可靠保证。     

三维重建数字骨科技术辅助胸腰椎椎弓根螺钉徒手置钉准确性的应用研究

目的:探讨利用三维重建数字骨科技术辅助胸腰椎椎弓根螺钉徒手置钉的临床应用效果。方法:选取胸腰椎骨折需要进行椎弓根固定的患者共76例,随机将患者分为两组,对照组采取透视定位植入,观察组采用三维重建数字骨科技术结合术中透视定位。记录两组患者的手术治疗各项指标:术中出血量、完成钉道准备时间、置入成功率、置入准确率。结果:观察组置入成功率、置入准确率均明显高于对照组,两组比较,差异具有统计学意义(P<0.05);观察组术中出血量少于对照组,完成钉道准备时间短于对照组,两组比较差异具有统计学意义(P<0.05)。结论:三维重建数字骨科技术辅助胸腰椎椎弓根螺钉徒手置钉可确定椎弓根螺钉在椎板后方的进钉点,寻找出最佳钉道的位置,钉道准备时间短,手术出血量少,具有较高的安全性。     

术中三维导航引导的腰椎弓根螺钉植入效果分析

目的 探讨术中三维影像脊柱导航引导下植人腰椎弓根螺钉的效果.方法 2003年9月至2006年12月收治各类腰椎需行椎弓根螺钉内固定患者401例,分别采用术中三维影像脊柱导航(A组)和传统X线透视法(B组)行椎弓根螺钉内固定,同时采用术中三维影像系统评估螺钉位置的精确性;分析比较两组螺钉位置、平均每枚螺钉植入时间、手术时间、出血量和近期并发症.结果 A组(95.3%)螺钉位置优良率明显高于B组(84.1%),平均螺钉植入时间、手术时间、出血量低于B组;A、B两组分别为(3.7±0.6)min和(7.8±2.3)min、(134±48)min和(179±62)min、(272±153)ml和(455±289)ml.A组未发现螺钉植入相关的并发症.结论 术中三维影像脊柱导航使腰椎弓根螺钉植入更精确、快速和安全,减少螺钉相关并发症的发生,降低患者和医生X线被动辐射.为腰椎脊柱手术精确化、微创化、安全化发展提供了一种可靠的选择.     

CT三维导航系统辅助胸椎椎弓根钉治疗胸椎骨折

目的 探讨CT三维导航技术在胸椎椎弓根钉植入手术中的应用方法和植钉准确性.方法 采用CT三维导航技术对24例胸椎骨折患者行椎弓根钉(102枚)植入手术进行立体引导,术后行CT内固定层面扫描,观察椎弓根螺钉植入的准确性.同时总结C臂机透视引导下22例胸椎骨折椎弓根钉(98)的植钉准确性,并与CT三维导航引导组进行对比分析.结果 术后CT扫描显示CT三维导航组102枚胸椎椎弓根钉I级99枚(97.1%),Ⅱ级(突破椎弓根皮质≤2 mm)3枚,Ⅲ级(突破椎弓根皮质>2 mm)0枚.Ⅱ级有1枚螺钉位置偏于椎弓根内侧,其余均偏在椎弓根外侧.c臂机透视组98枚胸椎椎弓根钉I级88枚(89.8%),Ⅱ级8枚,Ⅲ级2枚.Ⅱ级和Ⅲ级所有螺钉位置偏于椎弓根外侧,Ⅲ级中一例患者出现顽固性胸背痛.余两组临床无神经损伤症状.两组I级差异有统计学意义(P<0.05).结论 计算机辅助导航技术利用CT三维重建影像进行术中导航给术者提供即时的,多维的清晰图像,准确地按照计算机设计的精确进钉路线进行手术内固定.提高了胸椎椎弓根钉植入的安全性和精确性.     

CT导航技术在椎弓根螺钉内固定术中的应用（附32例临床报告）

目的：探讨CT导航技术应用于椎弓根螺钉固定术的优势与疗效。方法：对32例胸腰椎、腰椎滑脱伴脊柱不稳的患者,采用CT导航技术行椎弓根钉固定术。按照螺钉是否穿透椎弓根及穿透程度,参考Richter分类法进行评估。结果：手术顺利完成,螺钉位置准确,只有2枚螺钉突出皮质外且~〈2mm,未发生血管和神经损伤并发症。结论：CT导航辅助椎弓根螺钉内固定是一项安全和精度较高的手术方法,值得临床应用。     

基于C形臂X 光机透视的手术导航系统在椎弓根螺钉植入的应用

目的研究基于C形臂X光机透视的手术导航系统在椎弓根螺钉植入过程中的应用。方法分别使用基于C形臂X光机透视的手术导航技术及传统C形臂X光机透视定位技术,在4具脊柱尸体标本上植入48枚椎弓根螺钉。并进行CT扫描了解椎弓根位置。测量所有螺钉与椎弓根皮质的距离。按照螺钉偏差情况将螺钉位置分为4级。完全位于椎弓根内为A级,破出椎弓根皮质但不超过2mm为B级,破出椎弓根皮质2-4mm为C级,破出椎弓根皮质4mm为D级。结果使用基于C形臂X光机透视的手术导航技术植入的48枚螺钉中,总共有2例螺钉出现偏差。其中1例B级,1例C级。46枚(95.8%)位于椎弓根内,2枚(4.2%)出现偏差,使用传统C形臂X光机透视定位方法植入48枚螺钉,其中有9例破出椎弓根皮质。5例B级,3例C级,1例D级。39枚(81.2%)位于椎弓根内,9枚(18.8%)出现偏差。结论本套导航系统利用普通的C形臂X光机,可以引导椎弓根螺钉准确植入,偏差率很低,并可大大减少X射线辐射。     

APPLICATION OF LORNOXICAM TO PATIENT-CONTROLLED ANALGESIA IN PATIENTS UNDERGOING ABDOMINAL SURGERIES

FOR anesthesiologis s ,treatingpostoperativepainhas alwaysbeen a problem.Althoughopioidshave been provedtobe effective,theirsideeffectscouldnotbeignored.With thedevelopmentofscienceand pharmacology,many drugs with aspectsof satisfactoryanalgesicefficacyand couldbe welltoleratedby patientshave been developed.And lornoxicamisone of them, which isa non-steroidalanti-inflammatorydrug (NSAID ), with analgesic, anti-infl-ammatory,andantipyreticproperties.Itseliminationhalf-time(3 to 5 hours) isle…     

Acupuncture Treatment of Vomiting

CASE HISTORY A female patient, 46 years old, head of the foreign affairs department of a certain university in Beijing, paid her first visit on October 9, 2006, with the chief complaint of vomiting for one month. She got vomiting after meals in early September. Before that, she had discomfortable sensation in the stomach due to angry with others, but she didn't pay much attention. Later, it developed into vomiting after eating. After the vomiting, the discomfort would be relieved, but with slight hypodynamia. She was once diagnosed as having 'neurogenic vomiting'. Having taken some western and Chinese drugs, the above symptoms were a little bit improved, but she would have nausea upon eating and with regurgitation. Because of the fear for vomiting, she did not dare to have food intake, with body weight reduction of 6 kilos in one month.     

Qiu Baoguo''''s Experience in Treating Consumptive Syndromes after Radio-Chemotherapies

Radiotherapy and chemotherapy are the important modern medical therapies for malignant tumors,yet they can also bring about serious local and systemic toxic side reactions so to decrease the patient;'s life quality,manifested by a series of consumptive symptoms.Having engaged in the combined work of Chinese and western medicine for nearly 50 years,the research fellow Qiu Baoguo in Henan Provincial Academy of TCM has developed his unique views on the TCM study of consumptive syndromes.The author of this essay had once the fortune tO follow Dr.Qiu in clinic,and specially would like to introduce in the following Dr.Qiu's experience in treating consumptive syndromes after radio-chemotherapies for patients with malignant tumor.     

Insomnia Due to Deficiency of Both the Heart and Spleen Treated by Acupuncture-Moxibustion and Chinese Tuina

OBJECTIVE: To observe therapeutic effects of the comprehensive therapy of acupuncture-moxibustion and Chinese Tuina for treatment of insomnia due to deficiency of both the heart and spleen. METHODS: 92 cases were divided randomly into the treatment group (treated by acupuncture-moxibustion and Chinese Tuina) and the control group (treated by acupuncture-moxibustion). RESULTS: The therapeutic effect of the treatment group was obviously superior to that of the control group (the CHI2 test showed P < 0.01). CONCLUSIONS: The comprehensive therapy of acupuncture-moxibustion and Chinese Tuina can give marked therapeutic effects for treatment of insomnia due to deficiency of both the heart and spleen.     

Analysis of CK-19,PDX-1,Nestin,Ngn3 in different donor islet purity in rats

Objective: To investigate if there are the CK-19, PDX-1, Nestin, Ngn3 positive cells in the donor islets of different purity in rats. Methods: Thirty male adult SD rats were randomly divided into 3 groups. Islets were isolated using digestion by ductal injection of collagenase. Group Ⅰ (n=10): Separating cell preparations were not purified, Group Ⅱ(n=10): Islet sediment was purified with 25% Ficoll400 ,Group Ⅲ (n=10): Islet sediment was purified with 25% and 11% Ficoll-400. The levels of protein of CK-19, PDX-1, Nestin and Ngn3 were detected by immunohistochemistry and the mRNA of CK-19, PDX-1, Nestin, Ngn3 was amplified by RT-PCR. Results: After two different purification methods applied, three islet preparations of different purities were obtained. The difference of islet purity was significant among various groups (P＜0.05). Compared with group Ⅱ and group Ⅲ,the protein and mRNA of CK-19, PDX-1, Nestin,Ngn3 were both higher in group Ⅰ; group Ⅲ was poorly expressed. Conclusions: The three different islet purity donor islet have different CK-19, PDX-1, Nestin, Ngn3 positive cells within them, indicating that there are some islet stem cells in the purified donor islet.     

Dr.Zhang Ren''''s Experience in the Acupuncture Treatment of Different Diseases with the Same Therapeutic Principle

Dr.Zhang Ren,the chief physician,is the chairman of Shanghai Acupuncture and Moxibustion Association.Having been engaged in medicine for about 40 years,he is experienced in treating various intractable diseases.In his long years of clinical practice,he advocates taking the TCM differentiation as the basis to seek for the acupuncture method for treatment of modern intractable diseases.The author of this essay had the fortune to follow Dr.Zhang in study.The following is a summary of Dr.Zhang's experience in the acupuncture treatment for different intractable diseases with the same therapeutic principle.     

Luo Lingjie''''s Experience in Treating Chronic Nephropathy

In treating chronic nephropathy,Luo Lingjie,a chief physician,pays attention to regulating the balance between yin and yang,treating infection if present,and removing pathogenic factors.He prescribes gentle drugs and uses carefully strongly warming-tonifying ones,emphasizes the importance of persuading the patient to persist in treatment with medication and nurse one's health for recuperation,and is good at combined use of TCM and western medicine therapy and brings the merits of various therapies into full play,with obvious theraoeutic effects.     

Acupuncture Combined with Spinal Tui Na for Treatment of Primary Dysmenorrhea in 30 Cases

Objective: To observe the therapeutic effects in acupunture treatment of primary dysmenorrhea combined with spinal Tui Na, and study its mechanism. Methods: Thirty cases of the treatment group were treated by acupuncture combined with spinal Tui Na, and thirty cases in the control group were treated by routine acupuncture. Results: The total effective rate was 93.3% in the treatment group, and 73.3% in the control group, with a significant difference between the two groups (P<0.05). Conclusions: Acupuncture combined with spinal Tui Na has good prospects for treatment of primary dysmenorrhea.