单侧与双侧生长棒治疗早发性脊柱侧凸近期疗效的对比研究

目的探讨单侧与双侧生长棒治疗早发性脊柱侧凸的近期疗效。方法选取我院2007年2月～2011年6月收治的早发性脊柱侧凸患儿28例,根据患儿采用的治疗方法将其分为两组,采用单侧生长棒治疗患儿12例为对照组,采用双侧生长棒治疗患儿16例为观察组,比较两组患儿治疗后的近期疗效。结果治疗后,观察组与对照组的冠状位Cobb角和矢状位Cobb角均明显减小,观察组冠状位Cobb角和矢状位Cobb角均明显小于对照组,观察组冠状位矫正率、矢状位矫正率、C7～S1增高度均明显高于对照组,差异均有统计学意义(P<0.05)。观察组手术时间、术中出血量均高于对照组,观察组住院时间少于对照组,观察组术后并发症发生率(25.0%)高于对照组(16.7%),差异均无统计学意义(P>0.05)。结论生长棒用于治疗早发性脊柱侧凸具有显著的近期疗效,双侧生长棒治疗的临床疗效明显好于单侧生长棒,不仅冠状位与矢状位的矫正率较高,并发症的发生率也较低,值得临床推广使用。     

单侧与双侧生长棒技术治疗早期脊柱侧凸的疗效比较

目的比较单侧与双侧生长棒技术治疗早发性脊柱侧凸(EOS)的临床疗效。方法将2009年2月至2012年2月广州军区广州总医院附属157医院收治的34例EOS患儿按随机数字表法分为两组:对照组(17例)采用单侧生长棒技术治疗,观察组(17例)采用双侧生长棒技术治疗。观察和比较两组患儿的临床疗效。结果两组EOS患儿在手术时间、术中出血量、住院时间及术后并发症方面比较差异均无统计学意义(P>0.05);两组EOS患儿治疗后冠状位Cobb角和矢状位Cobb角均显著小于治疗前,且观察组较对照组减小更为显著(P<0.05);观察组冠状位矫正率、矢状位矫正率及C7-S1增高度均显著高于对照组(P<0.05)。结论生长棒治疗EOS疗效显著,双侧生长棒疗效显著优于单侧生长棒,冠状位与矢状位的矫正率较高。     

COA: 生长棒治疗早发性脊柱侧凸的肺功能变化

作者：姜宇,赵宇,王以朋,邱贵兴,翁习生,李晔 背景：早发性脊柱侧凸的患者常发生呼吸功能障碍。目前尚无关于生长棒手术治疗EOS后肺功能变化的报道。 方法：2002年9月至2009年9月,我院8例生长棒技术治疗早发性脊柱侧凸患者。男2例,女6例,其中7例为先天性脊柱侧凸,1例为神经肌肉型脊柱侧凸。4例已完成最终融合手术(组1),4例未完成最终融合术（组2）。记录每次术前用力肺活量（FVC）、一秒钟用力呼气容积（FEV1）、Cobb’s角、C7-S1距离,分析FVC、FVC/FVC预测值百分比、FEV1及FEV1、FEV1预测值百分比变化,并分析FVC变化与Cobb’s角变化及C7-S1距离变化间的相关性。 结果：已完成最终融合组中FVC与FEV1均增高,其中FVC增高具有显著性差异（P=0.01）;FEV1增高但无统计学差异（P=0.05）。未完成最终融合组中FVC与FEV1均增高,FVC增高具有统计学差异（P =0.04）; FEV1增高具有统计学差异（P=0.02）。两组病例的FVC/FVC预测值百分比及FEV1预测值百分比变化均无统计学意义。所有病例FVC变化与Cobb’s角变化无明显相关性（P=0.10）,与C7-S1距离变化值无明显相关性（P=0.41）。 结论：生长棒技术治疗早发性脊柱侧凸术后肺功能得到改善,其肺功能的改变与Cobb’s角变化及C7-S1距离变化无明显相关性。     

生长棒技术治疗早发性脊柱侧凸术后的肺功能变化研究

目的探讨生长棒技术治疗早发性脊柱侧凸术后的肺功能变化研究。方法选取该院2010年10月—2012年12月收治的早发性脊柱侧凸的患者20例,进行生长棒技术治疗,观察患者术后疗效及肺功能的改变情况。结果使用生长棒技术治疗后,患者脊柱侧凸有较显著的改变。且经过随访18个月后,观察患儿的肺功能发现,FEV1/FVC(%)由治疗前的(43.34±10.11)上升到治疗后的(53.43±12.22)且FEV1%预计值由治疗前的(50.91±12.13)上升到治疗后的(72.13±14.21),与治疗前相比,差异有统计学意义(P<0.05)。且患儿呼吸症状有着明显的改善。结论生长棒技术治疗早发性脊柱侧凸效果较好,且有助于改善患者的肺功能,值得临床进一步探索和研究。     

应用钉-棒系统治疗退行性脊柱侧弯的疗效分析

目的回顾分析钉-棒系统内固定＋植骨融合治疗退行性脊柱侧凸矫治中的疗效。方法2004-01～2007-12间运用TSRH、CD脊柱内固定系统＋植骨融合治疗的42例退行性脊柱侧凸患者。采用后路矫形手术方法。术后随访6～25个月（平均15个月）。通过对术前术后影像学资料进行分析,比较冠状面和矢状面的矫形效果并通过c7椎体中点距骶骨中心垂线（CVSL）的距离来分析躯干平衡的重建,并随访术后疼痛是否缓解以及功能的恢复。结果所有患者术后外观矫形效果明显。侧凸术后主弯矫正率平均68．7％。末次随访主弯冠状面Cobb角平均丢失4．6°。C7中点距CVSL由术前平均2．7cm矫正为术后0．26cm。23例腰背疼痛的患者中17例术后得以缓解,31例患者术后参加正常的生活工作。结论钉棒系统＋植骨融合治疗退行性脊柱侧弯可得到冠状面上较高的矫正率、重建躯干平衡,有效矫正脊柱侧弯,术后功能恢复满意。     

3种内固定系统矫正特发性脊柱侧凸的疗效分析

目的:回顾性研究钉-棒系统矫正特发性脊柱侧凸的临床效果。方法:分别采用钩-棒、钉-钩-棒、钉-棒系统对469例特发性脊柱侧凸患者进行矫正,并对随访3年以上的303例分为3组,对其矫正效果、并发症进行对比研究。结果:钉-棒系统手术时间、出血量明显少于前两组。冠状面、矢状面的矫正中钉-棒系统明显优于前两组。术后钉-棒系统断棒、失代偿及假关节的发生明显低于前两组。结论:全椎弓根螺钉系统具有良好的三维矫正控制力,矫正效果良好,并发症少。     

生长阀双棒内固定技术治疗低龄儿童严重脊柱侧凸的初步疗效

【目的】 评价定期撑开的生长阀双棒内固定技术治疗较早发生的儿童脊柱侧凸的初步结果。【方法】 回顾性分析2004年11月至2009年3月行生长阀双棒内固定技术的早发的儿童脊柱侧凸患者,共11例,男1例,女10例。10例采用Isola生长阀,1例采用TSRH Domino延长器。初次手术年龄平均6.1岁（2.1－10.9岁）,Risser 征均为0度;胸弯8例,胸腰弯3例;先天性脊柱侧凸10例,神经肌肉性脊柱侧凸1例。全部病例平均撑开手术次数为1.8次（1－4次）。术前术后进行X线片上的影像学测量,进行对比研究。【结果】初次术前主弯Cobb角67.64±11.43°,柔韧性为27.00±10.55（％）,胸后凸为31.00±22.40°,腰前凸为48.09±14.96°,躯干偏移为2.00±1.73 cm ,T1-S1长度为25.47±6.16 cm（17.1-36.3cm）;初次术后主弯Cobb角为34.64±8.26°,胸后凸为23.00±8.06°,腰前凸为38.91±10.74°,躯干偏移为1.49±1.31 cm, T1-S1高度为28.84±5.69 cm。初次手术后的矫正率47.15±16.48（％）,初次手术前后T1-S1高度的增加为3.37±1.62cm。最后一次术后主弯Cobb角为36.82±11.76°,胸后凸为27.18±8.97°,腰前凸为41.73±11.13°,躯干偏移为1.11±1.29cm,T1-S1高度为31.29±4.50cm,最后一次术后的矫正率为44.73±19.43（％）,最后一次术后与术前T1-S1高度的增加为5.82±2.21cm 。撑开治疗期间T1-S1生长平均1.6 cm/年（1.1-2.7cm/年）。有5例出现并发症（45.5％）,3例近端锚定点脱钩,1例近端锚定点椎弓根螺钉脱出,1例断棒。全部进行翻修术同时行撑开手术,均获得满意效果。【结论】定期撑开的生长阀双棒内固定技术,可以在矫形、控制畸形发展的同时,允许脊柱纵向的生长,对较早发生的儿童严重脊柱侧凸疗效满意。但并发症发生率较高,需要密切随访。     

儿童严重脊柱侧凸的生长阀双棒内固定治疗

目的探讨早发的儿童严重脊柱侧凸采用生长阀双棒内固定治疗的临床疗效。方法选择2006年11月~2011年3月我科收治入院的早发的严重脊柱侧凸儿童10例临床资料进行回顾性分析,10例患儿中9例采用lsola生长阀固定,1例采用TSRH生长阀固定;撑开1~4次,平均1.8次;随访10~24个月,平均(15.2±2.5)个月。结果术前主弯Cobb角(67.64±11.43)°,胸后凸(31.00±22.40)°,躯干偏移(2.00±1.43)cm,T1~S1高度(25.47±6.16)cm;初次术后主弯Cobb角(34.64±8.26)°,胸后凸(23.00±8.06)°,躯干偏移(1.49±1.21)cm,T1~S1高度(28.84±5.69)cm;末次术后主弯Cobb角(36.82±11.76)°,胸后凸(27.18±8.97)°,躯干偏移(1.11±0.29)cm,T1~S1高度(31.29±4.50)cm。术前、初次术后和末次术后主弯侧凸角比较差异有统计学意义(P<0.05)。初次手术矫正率(47.15±16.48)%,T1~S1高度增加(3.37±1.62)cm;末次手术矫正率(44.73±19.43)%,T1~S1高度增加(5.82±2.21)cm。治疗期间T1~S1每年平均生长1.6 cm(1.1~2.7 cm)。5例出现并发症(3例脱钩,1例椎弓根螺钉脱出,1例断棒)。结论生长阀双棒内固定技术允许脊柱纵向生长,同时起到矫形和控制畸形发展的作用,但术后并发症发生率较高。     

单侧哈氏棒加节段椎板下钢丝矫正治疗脊柱侧凸

我院脊柱外科自 1 996年以来 ,先后收治脊柱侧凸患者 9例 (含特发性和先天性半椎体畸形 ) ,早期采用单侧哈氏棒矫正 ,效果不理想 ,改用单侧哈氏棒直接加用节段椎板下钢丝矫正固定后 ,内固定物的稳定性和矫正度均明显提高。通过复习有关论文资料 ,分析病例 ,对此种术式进行分析 ,并探讨可能的改进措施。1　临床资料本组病例 9例 ,其中男 7例 ,女 2例 ,年龄 1 2～2 5岁 ,平均 1 5 .3岁 ,其中先天性半椎体畸形所致脊柱侧凸 2例 ,特发性脊柱侧凸 7例。术前均进行 1～2周牵引。手术方法及矫正情况 :早期 3例特发性脊柱侧凸患者 ,行单侧哈氏棒矫形…     

椎弓根螺钉技术治疗胸椎脊柱侧凸并发症分析

目的：探讨椎弓根螺钉技术治疗胸椎脊柱侧凸畸形并发症的发生及防治。 方法：自1994年3月到2005年3月应用徒手法螺钉植入技术进行后路椎弓根螺钉钉棒系统治疗脊柱侧凸畸形183例,其中青少年特发性脊柱侧凸110例,成人脊柱侧凸32例,先天性脊柱侧凸28例,马方综合征合并脊柱侧凸7例,其他原因引起的脊柱侧凸6例。所有患者均进行术前、术后及随访期脊柱侧凸Cobb角的测量,根据测量结果计算矫形率,并统计分析围手术期及随访期并发症的发生率。 结果：本组病例畸形矫正率为72%,矫形效果与文献报道的钩棒系统比较有一定的优势;本组病人围手术期并发症发生率为8.4%（术中椎弓根爆裂1.5%,术后感染3.8%,肺部并发症1.6%,一过性神经损害0.5%,失血性休克1%）;随访期并发症发生率为3.6%（迟发感染0.5%,内固定松动断裂1%,矫形显著丢失或畸形加重1.6%,一过性神经损害0.5%）。与文献报道的钩棒系统比较,围手术期并发症发生率低、矫形丢失不显著、永久性损害少、内固定相关并发症发生率低。 结论：后路钉棒系统治疗各种脊柱侧凸畸形并发症发生率低,熟练掌握椎弓根螺钉技术并熟悉椎弓根及其邻近组织的解剖,同时进行术中脊髓功能监护,能有效地防治椎弓根螺钉技术治疗胸椎脊柱侧凸畸形并发症的发生。     

Comparison of initial efficacy between single and dual growing rods in treatment of early onset scoliosis

Background  Initial results for the use of single and dual growing rod techniques in the treatment of early onset scoliosis (EOS) has been seldom documented. The aim of this research was to investigate the initial efficacy of single and dual growing rods in treatment of EOS.

Methods  A retrospective study of 25 early onset scoliosis cases treated with growing rod technique between November 2002 and May 2010 was performed, including six cases in the single growing rod group and 19 cases in the dual growing rod group. Operation time, intra-operative bleeding, correction rate, changes in C7–S1 distance, and incidence of complications of the first operation were compared for the two techniques.

Results  The average post-operative follow-up duration was 31.9 months. There was no statistical difference observed between operation time, intra-operative bleeding, and complication incidence between the single and dual growing rod groups. In addition, no statistical difference was observed in the pre-operative coronal Cobb’s angle (P >0.05), or in the pre-operative sagittal Cobb’s angle between both groups (P >0.05). The correction rate of the dual growing rod group was significantly superior to that of the single growing rod group in the coronal plane (P <0.01), but not in the sagittal plane (P >0.05). The C7–S1 distance in the dual growing rod group was significantly larger than that in the single growing rod group (P <0.05).

Conclusions  The growing rod technique is an effective option for surgical treatment of EOS. The dual growing rod technique shows relative superiority in the correction outcome as compared to the single growing rod technique.

     

Lung function after growing rod surgery for progressive early-onset scoliosis: a preliminary study

Background  Pulmonary problems often occur in patients with early-onset scoliosis (EOS). However, lung function in patients with EOS after growing rod surgery has not been documented. The aim of this study was to investigate lung function after the treatment for EOS with growing rod and its possible correlative factors.

Methods  Eight patients with EOS were treated with growing rod surgery at Peking Union Medical College Hospital from September 2002 to September 2009. Four patients had finished the final fusion surgery (group 1), and the other 4 (group 2) were in the process of periodic lengthening. Preoperative forced vital capacity (FVC), ratio of FVC to predicted FVC, forced expiratory volume in 1 second (FEV1), ratio of FEV1 to predicted FEV1, and radiographic measurements of Cobb’s angle and C7–S1 distance were recorded. Lung function changes and correlations between lung function changes and radiographic changes (Cobb’s angle and C7–S1 distance) were analyzed.

Results  In group 1, FVC and FEV1 both increased. FVC showed a significant difference (P=0.01), but FEV1 did not (P =0.05). In group 2, FVC and FEV1 also increased, and both showed a significant difference (P=0.04 and P=0.02, respectively). Ratio of FVC to predicted FVC and ratio of FEV1 to predicted FEV1 changed similarly and did not show statistical differences in the 2 groups. There were no significant correlations between lung function changes and radiographic changes (Cobb’s angle and C7–S1 distance) (P=0.10 and P=0.41, respectively).

Conclusions  Lung function increases after growing rod surgery in patients with EOS. Lung function changes do not correlate with Cobb’s angle changes or C7–S1 distance changes.

     

儿童下肢生长性疼痛病因及治疗

本文经过210例儿童生长痛的治疗和110例随诊观察,对本病的病因和治疗进行研究,认为本病与臂部、股外侧皮神经受压、肌肉附丽点过度牵拉、胫骨内旋及低钙等有关。经去除病因和适当治疗后,远期疗效达90％。     

国产碱性成纤维细胞生长因子治疗角膜病的初步观察

通过临床应用国产碱性成纤维细胞生长因于（BasicFibroblastCrowthFactor．BFG）滴眼液治疗89例角膜病患者的观察，治愈73例（82％），好转11例（12．4％），总有效率为94．4％。结果表明对角膜上皮的愈合有显著的促进作用。BFGF对治疗点状角膜炎、角膜损伤、单疱病毒性角膜炎浅层型有提高疗效，缩短疗程的作用，为治疗角膜病开辟了新的途径，值得推广应用。初步观察过程未发现全身和局部的毒副作用。     

优美特宫颈扩张棒用于扩张宫颈口的临床研究

目的探讨优美特宫颈扩张棒（以下称优美特）的有效性、安全性及使用方法。方法选择门诊收治的置、取宫内节育器（intrauterine device,IUD）、妊娠10周内负压吸引人工流产术术前需扩张宫颈口的受术者221例,随机分为两组,分别使用优美特和宫术宁胶棒（以下称宫术宁）,术后20 d进行随访。结果优美特组扩张有效率高于宫术宁组（P〈0.05）;扩张后宫颈口松弛度和扩张前、后宫颈口松弛度差值,优美特组均优于宫术宁组（P〈0.05）;置入时疼痛率优美特组低于宫术宁组（P〈0.05）;两组均无宫颈损伤等不良反应,术后随访无与使用扩张宫颈口产品关联的不良事件。结论优美特扩张宫颈口效果良好、安全可靠、不良反应少,对不同时期妇女扩张宫颈口均有效;产品操作简便,适用于基层医院。     

Primary effect of dual growing rod technique for the treatment of severe scoliosis in young children

Background Treatment of rapidly progressing scoliosis in young children is a challenge for spine surgeons. Some surgeons had begun to use dual growing rod technique for treatment of rapidly progressing scoliosis in young children and had achieved acceptable results. The aim of this study was to determine the primary results and complications of this new technique in China. Methods Eleven children suffering from rapidly progressing scoliosis were treated with dual growing rod technique between November 2004 and March 2009 at Peking Union Medical College Hospital （PUMCH）. There were 10 females and 1 male in the group with Risser sign of 0 grade. The mean age at initial surgery was 6.1 years （range, 2.1-10.9 years）. Ten patients were diagnosed as congenital scoliosis and 1 patient neuromuscular scoliosis. All the patients had 1-4 lengthening procedures （mean, 1.8 procedures） after the initial surgeries. The radiographic results of all the patients were investigated. Results The coronal Cobb angle of scoliosis improved from （67.64±11.43）% to （34.64±8.26）% after initial surgery with the correction rate observed at （47.15±16.48）%. The coronal trunk shift improved from （2.00±1.73） cm to （1.49±1.31） cm after initial surgery. The T1-S1 height increased from （25.47±6.16） cm to （28.84±5.69） cm after initial surgery. The coronal Cobb angle of scoliosis was （36.82±11.76）% and the coronal trunk shift was （1.11±1.29） cm after the most recent lengthening procedure with the most recent correction rate observed at （44.73±19.43）%. The T1-S1 height was （31.29±4.50） cm after the most recent lengthening procedure with an average T1-S1 length increase of 1.6 （range, 1.0-2.7） cm per year during the lengthening period. The sagittal balance was maintained. Five of the total patients （45.5%） had complications including： hook displacement, pedical screw loosening, and broken rod. We performed revision surgeries with simultaneous lengthening procedures in all 5 cases with satisfactory results. Conclusions The dual growing rod technique was useful in the management of rapidly progressing scoliosis in young children. This technique could control severe scoliosis, allow for spinal growth, and maintain the coronal and sagittal balance. But the technique has high complications requiring strict and regular follow-up.     

用生化编码法鉴定155株临床非发酵菌

用生化编码法对临床155株非发酵菌进行了鉴定,分析了引起临床感染的非发酵菌菌种,并和传统的生化反应系列作了比较,肯定了生化编码法的优点及鉴定中应注意的问题。探讨了铜绿假单胞菌的生化特点和药物敏感试验,证明许多用传统生化系列很难定种的非发酵菌用生化编码法可以定种。     

解脲支原体的生长条件研究

目的　探讨解脲支原体 (Uu)在液体培养基中的最佳营养条件和在固体培养基上形成菌落的最佳气体条件。方法　采用不同的pH值、不同的酵母及小牛血清含量配制解脲支原体培养基 ,将法国Merieum生产的培养基作对比研究。结果　解脲支原体生长最适pH值为 6.0～ 6.5 ;10 %酵母提取液、10 %小牛血清能加速解脲支原体的生长 ,90 %N2 、5 %～ 10 %CO2 能促进解脲支原体菌落生长。结论　本研究为改进解脲支原体的培养质量、开发高效的支原体培养基及药敏检测板提供实验依据     

青春双歧杆菌耐氧菌株的筛选及生长条件研究

目的:通过自制培养基筛选耐氧双歧杆菌,并对此菌的生长特性进行研究。方法:将耐氧菌株接种于自制的增菌培养基和胰蛋白胨大豆肉汤培养基中,分别在CO2、需氧环境中37℃培养,于不同时间取样测定吸光值,绘制生长曲线,对细菌进行平板计数并对其形态菌落进行观察。结果:耐氧双歧杆菌在CO2、需氧环境中均能生长,但生长速度、最高活菌数、形态和菌落特征不同,在CO2环境中生长较好。结论:耐氧双歧杆菌在CO2、需氧环境中均能生长。