颈椎前路减压复位治疗下颈椎骨折脱位伴关节突交锁27例疗效观察

目的:探讨下颈椎骨折脱位伴关节突交锁的治疗方法及价值。方法:采取颅骨牵引,早期全麻下颈椎前路复位减压、植骨融合内固定术治疗下颈椎骨折脱位伴关节突交锁27例,其中9例行前路撬拨复位,2例行同期后路解锁复位。术后随访3～12个月,定期X线片观察损伤节段的稳定性和融合情况,依脊髓功能损伤分级判定脊髓功能恢复情况。结果:术后颈椎恢复正常序列、曲度及椎体高度,植骨在3～6个月融合,无内固定松动、断裂等并发症;术后3、6和12个月随访神经功能脊髓功能损伤分级标准分别改善1~2级。结论:颅骨牵引结合早期颈前路减压、复位、植骨融合内固定治疗下颈椎骨折脱位伴关节突交锁是相对安全有效的治疗方法;早期手术可促进脊髓功能恢复,并可避免因并发症而错过手术时机。     

陈旧性无脊髓损伤AllenⅠ度下颈椎脱位的手术治疗

目的探讨陈旧性无脊髓损伤AllenⅠ度下颈椎脱位的治疗策略和手术疗效。方法回顾性分析2005年7月-2010年1月手术治疗的陈旧性无脊髓损伤AllenⅠ度下颈椎脱位患者21例。单侧关节突交锁9例,双侧关节突交锁2例。全部病例均行单纯前路椎间盘切除松解复位内固定椎间植骨融合。结果术后患者均获得随访,时间13～30个月,平均21个月。症状均获得改善,其中19例症状完全消失。7例获得完全复位,14例遗留轻度椎间移位。颈椎生理曲度和椎间高度维持良好。植骨均获融合,未出现内固定失效和脊髓损伤等并发症。结论单纯前路复位及内固定椎间植骨融合术治疗陈旧性无脊髓损伤AllenⅠ度下颈椎脱位可获得满意的临床效果,是一种值得推荐的术式。     

无脊髓损伤型下颈椎骨折脱位的临床研究

目的 探讨无脊髓损伤型下颈椎骨折脱位的治疗方法和疗效.方法 对32例无脊髓损伤型下颈椎骨折脱位的患者,其中新鲜损伤25例,陈旧性损伤7例,采用持续颅骨牵引,经前路或前后路联合减压、复位、自体髂骨植骨、前路带锁钢板内固定进行手术治疗.结果 本组32例患者术后均无脊髓损伤加重,神经根症状获得改善;骨折脱位完全复位;随访3～12(7.8±0.3)个月,植骨完全融合,颈椎椎间高度、生理曲度及颈椎稳定性维持良好.结论 对于无脊髓损伤型下颈椎骨折脱位,应持续颅骨牵引预防继发性脊髓损伤;手术应以前路手术为基础,达到减压、复位、恢复颈椎椎间高度和生理曲度及重建颈椎即刻稳定性的治疗目的 ;对于术前不能复位的患者,应首先应用后路手术解除后路阻碍复位因素,协助前路手术时复位骨折.     

前后路联合减压内固定治疗颈椎骨折脱位

目前临床上颈椎骨折脱位的治疗多采用牵引复位、颈椎后路减压固定术、颈椎前路减压植骨固定术。对于骨折脱位所造成的脊髓前后方同时受压,颈椎前后柱均遭到严重破坏,以及颈椎骨折脱位牵引复位失败或陈旧性脱位的患者,上述手术方法均无法彻底减压,解除脊髓压迫,恢复脊柱正常序列及重建稳定性。且在复位过程中存在加重脊髓神经功能损伤的可能。我院自2003年7月采用颈椎前路减压植骨带锁钢板螺丝钉固定联合后路减压复位植骨侧块钢板固定的方法治疗颈椎骨折脱位11例,效果满意,报告如下。     

无脊髓损伤的严重下颈椎骨折脱位的手术治疗

目的 探讨无脊髓损伤的严重下颈椎骨折脱位的手术治疗方法 .方法 对21例牵引复位失败的无脊髓损伤的严重下颈椎骨折脱位患者,首先俯卧往后路切开复位,短节段的侧决螺钉或棘突间钢丝固定;陈旧骨折脱位,需行脱位小关节的上关节突部分切除及黄韧带切除.不固定.然后再行前路切开椎体减压,髂骨植骨或钛网植骨钢板内固定.术后一周带颈托下地行走.结果 本组21例脱位完全复位,无脊髓损伤发生,随访8～24个月,平均16月,植骨完全融合,无假关节、骨不连发生,颈椎椎间高度、生理曲度及颈椎稳定性维持良好.结论 对于无脊髓损伤的下颈椎骨折脱位宜采用一期前后路联合于术切开复位内固定,最大限度保留活动节段,恢复颈椎椎间高度和生理曲度,重建颈椎即刻稳定性,对防止继发性脊髓损伤有极其重要的作用.     

后路微创手术治疗难复性下颈椎关节突脱位

下颈椎关节突脱位损伤严重,最常用的复位方法为颅骨牵引闭合复位,其次是切开复位,因各种原因导致的复位失败称之为难复性下颈椎关节突脱位。自2000年6月至2006年8月,我院共收治难复性下颈椎关节突脱位15例,对其中脊髓后方无压迫的11例一期行后路微创解锁，前路减压、复位、植骨内固定术，效果良好，现报道如下。     

全麻下颅骨牵引复位配合颈前路减压融合治疗下颈椎骨折脱位伴关节突交锁

目的 探讨全麻下颅骨牵引复位配合颈前路减压融合治疗下颈椎骨折脱位伴关节突交锁的临床效果.方法 回顾性分析2010年3月至2013年3月我院收治的60例下颈椎骨折脱位伴关节突交锁患者的临床资料.其中单侧小关节突交锁23例,双侧小关节突交锁37例.56例合并脊髓损伤,神经功能按美国脊髓损伤学会的分类标准(ASIA)[1]:A型5例,B型21例,C型23例,D型7例.所有患者入院生命体征平稳后立即在全麻下行颅骨牵引,复位后行前路减压Cage融合钛板内固定术或损伤节段椎体次全切钛网植入植骨钛板内固定术.结果 本组病例中,53例获得完全复位,成功率88.33％,7例达到90％复位,复位效果尚满意.所有患者完全复位,无大血管、食管意外损伤;5例术后出现轻度吞咽困难、声音嘶哑,予以激素、雾化治疗后逐渐恢复;2例ASIA A级患者于术后15、19 d死于肺部感染、呼吸衰竭.余58例患者均获得18 ～ 30个月随访,平均24个月.按ASIA分型,3例A型治疗前后无变化;B型21例,转为C型13例、D型5例;C型23例,转为D型13例,E型8例;D型7例,均转为E型.结论 全麻下颅骨牵引复位配合颈前路减压融合治疗下颈椎骨折脱位伴关节突交锁是相对安全、有效的治疗方法.     

前后路减压固定植骨治疗下颈椎骨折脱位伴绞锁

目的探讨前后路减压固定植骨治疗下颈椎骨折脱位伴绞锁的临床疗效。方法回顾性分析行后路复位椎弓根钉内固定＋后路椎板植骨＋前路减压椎间钛网植骨并钢板内固定术治疗的18例下颈椎骨折脱位伴绞锁患者的临床资料。结果本组18例均手术成功,无一例出现神经损伤加重及死亡,术后无严重手术并发症发生。神经功能恢复按ASIA分级：A级5例,B级6例,C级3例,D级4例。结论对下颈椎骨折脱位伴绞锁患者早期行前后路复位内固定植骨,有利于解除脊髓的压迫状态,恢复正常的颈椎序列,有利于神经功能的恢复及早期康复训练。     

24h内行颈前路手术治疗下颈椎骨折脱位伴关节突绞锁

目的总结24 h内行颈前路手术治疗下颈椎骨折脱位伴关节突绞锁的临床疗效。方法 2012年1月至2016年9月采用24 h内行颈前路手术治疗30名下颈椎骨折脱位伴关节突绞锁患者,其中单侧关节突绞锁14例,双侧关节突绞锁16例,记录关节突关节复位所需时间、手术时间、出血量,并定期随访,通过测量椎间隙高度及Lenke分级评估椎间植骨融合情况,通过手术前后ASIS分级评估神经功能,根据JOA评分评估脊髓功能恢复情况。结果 30例患者均在24 h内顺利完成手术,手术时间为(45±8)min,术中出血量为(30±5)ml,切口均Ⅰ/甲愈合。于术后定期复查X线及CT,提示椎间隙高度维持稳定,植骨融合程度良好。ASIS分级除3例A级功能未改善外,其余较术前提高1~2级,术后3个月JOA得分较术前增加(P<0.05)。结论 24 h内行颈前路手术能够尽早解除脊髓压迫,使下颈椎骨折脱位伴关节突绞锁复位,恢复椎管容积,为脊髓功能恢复及减少并发症提供了解剖学基础。     

前路复位与重建手术治疗外伤性下颈椎小关节交锁

目的探讨经前路手术复位治疗外伤性下颈椎小关节交锁的临床疗效。方法2001年6月～2006年1月采用前路手术治疗外伤性下颈椎小关节交锁26例。所有患者均有小关节交锁及椎间盘损伤,通过前路椎间撑开自体髂骨植入,行钢板内固定。结果25例采用前路椎间撑开植骨内固定,1例因前路无法复位而行后路解锁内固定 前路植骨内固定,所有病例均获得满意的复位与良好的颈椎序列。结论通过前路椎间撑开植骨固定能使颈椎得到良好的复位与序列。     

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.