放大镜辅助与常规开放颈椎前路减压治疗脊髓型颈椎病临床效果的比较

目的 比较放大镜辅助下与常规开放颈椎前路减压治疗脊髓型颈椎病临床疗效的差别.方法 回顾性分析2009年6月至2012年9月间收治的59例脊髓型颈椎病患者,分别接受放大镜辅助下(A组)和常规开放(B组)颈椎椎体次全切除手术减压治疗29例和30例.通过比较两组病例的住院费用、术后住院天数、手术时间、术中出血量、并发症、手术前及随访时的神经功能JOA评分及改善率,评估两种手术方法的临床疗效. 结果 所有患者均获得随访3 ～39个月,平均(24.64±10.07)个月.两组患者术前JOA评分、术后住院天数、住院费用等方面比较差异均无统计学意义(P＞0.05).与B组比较,A组术中出血量明显减少,手术时间及术后并发症发生率明显降低,差异均有统计学意义(P＜0.05).随访时,A组JOA评分为14.76±1.35,高于B组的14.03±1.40(P ＜0.05),A组JOA改善率平均为(62.54±14.70)％,较B组的(51.68 ±14.75)％明显增加(P＜0.05);46例患者(A组21例,B组25例)进行了颈椎MRI复查,A组颈椎椎管及脊髓最狭窄处面积较术前分别增加(52.8±11.8)％和(43.3±15.6)％,均明显高于B组的(41.8±14.2)％和(21.4±7.8)％(P＜0.05). 结论 放大镜辅助下颈椎前路手术视野更清晰,可有效减少出血量,减少手术并发症,取得更好的临床效果.     

经皮股骨 GSH钉治疗累及髁间的股骨中下段粉碎骨折

目的寻求治疗累及髁间的股骨中下段骨折理想的内固定手术方法。方法对30例累及髁间的股骨中下段粉碎骨折采用在膝关节镜直视髁面、C臂透视骨折对位对线条件下的经皮GSH穿钉内固定术。结果本组病例,术中失血平均115毫升,无需植骨;术后一周患肢肿胀消退,关节活动超过90°;6月内均骨性愈合;18月随访膝关节活动平均125°,步态正常,无膝内外翻畸形及创伤性关节炎。结论在膝关节镜、C臂透视辅助下的闭合复位、经皮GSH穿钉技术是治疗累及髁间股骨中下段粉碎骨折的理想手术方法。     

CT三维重建椎弓根钉导航系统在胸椎手术中的应用

目的探讨CT三维重建椎弓根钉导航系统的使用方法和临床效果。方法自2003年5月至2004年5月在15例(80枚)胸椎弓根钉植入手术中使用CT三维重建椎弓根钉导航系统,其中上胸椎30枚,中下胸椎50枚。男10例,女5例;年龄13～76岁,平均47岁。胸椎肿瘤切除后重建5例,胸椎爆裂骨折4例,胸椎黄韧带骨化2例,胸椎侧凸4例。记录手术中螺钉植入时间、出血量。术中使用“C”型臂X线机拍摄正侧位X线片,术后进行CT扫描以了解内固定位置情况。结果每枚椎弓根钉从注册到植入完毕平均需要15min(10～20min)。术中出血量:胸椎肿瘤切除后重建平均1200ml,胸椎爆裂骨折后路固定平均800ml,胸椎黄韧带骨化切除平均300ml,胸椎侧凸平均500ml。椎弓根钉位置根据Andrew椎弓根螺钉CT位置分级标准进行分级,术后CT扫描显示80枚胸椎椎弓根钉中,位置Ⅰ级76枚(96%),Ⅱ级(突破椎弓根皮质≤2mm)2枚,Ⅲ级(突破皮质>2mm)2枚。Ⅱ、Ⅲ级的椎弓根钉均偏向椎弓根外侧,但术后均无神经刺激症状。结论CT三维重建导航系统可为术者虚拟三维的椎弓根钉植入环境,使椎弓根钉按预期的路径准确植入,提高了胸椎椎弓根钉植入的安全性和准确性。     

影像导航引导经皮椎弓根穿刺椎体成形术治疗骨质疏松骨折

目的探讨导航条件下经皮椎弓根穿刺椎体成形术方法与疗效。方法采用虚拟X线导航引导经皮椎体成形术治疗骨质疏松脆性骨折32例(48个椎体)，涉及1个椎体20例，同时涉及2个椎体8例，3个椎体4例。结果手术在导航指引下均获成功。疼痛强度VAS评分术后明显改善，注射椎体无塌陷，无严重并发症发生，术后44个椎体(92％)CT显示骨水泥分布在椎体内。结论在影像导航引导下，能提高经皮椎弓根穿刺的安全性，缩短术时，减少X线辐射。     

计算机虚拟X线影像导航定向技术在腰椎椎节稳定手术中的应用

目的:探讨影像导航技术在引导腰椎内植物手术中的应用.材料和方法:对40例下腰椎节失稳手术,采用导航下的椎弓钉加后路椎间钛笼植入技术.内植完成后即作X线正侧位摄片与导航路径进行吻合测量.结果:内植物位置理想,进钉点均差2.2mm(最大3mm),角度均差3°(最大5°);Cage深度均差1.8mm(最大3.2mm),轴线角度均差2°(最大4°).结论:导航的瞬时追踪功能,使术者的手术工具做到实时监测,内植物达到精确制导,操作形象而多维化,实时感强,是一种理想内植物引导模式.     

脊柱重建手术对胸腰椎转移瘤致脊髓功能障碍及疼痛的改善作用

目的：通过评价脊柱重建方法，探讨手术治疗脊柱转移瘤缓解患者的顽固性疼痛及恢复运动功能和脊柱稳定性的可行性。方法：对18例胸腰椎转移肿瘤分别采用前路，后路及前后路联合肿瘤病灶切除加人工椎体替代物辅助器械内固定稳定手术，术后配合相应放、化疗，平均随访18个月(6～48个月)。结果：18例患者手术前疼痛评分为7．0&;#177;2．3，手术后疼痛评分为3．0&;#177;2．6。其中14例患者(88％)得到明显缓解。11例由于疼痛或瘫痪而长期卧床的患者运动功能改善9例，其中恢复行走功能7例。4例有括约肌功能障碍的患者均得到改善。结论：手术治疗胸腰椎转移肿瘤与脊柱重建，能增强患者脊柱稳定性，恢复脊髓功能并有效缓解疼痛。     

颈腰椎综合征患者功能预后与手术时机及方案选择的关系

对46例颈腰椎综合征患者根据其症状和影像学检查分别行颈椎及腰椎手术，术后随访6个月～3年1个月，颈椎手术JOA评分由术前平均8分提高到术后平均13．5分，腰椎手术后症状明显缓解，对手术相关因素进行分析认为手术时机与方案的选择与预后有密切关系。     

改良二维影像导航引导椎体后凸成形术治疗多发性椎体压缩性骨折临床分析

Objective To explore clinlical outcomes of using improved computer-assisted fluoroscopic navi-gation to guide the percutaneous vertebroplasty to treat multiple osteoporotic spinal compression fractures. Methods Twenty-eight multiple osteoporotic spinal compression fractures patients with 73 painful vertebral body were got an-terio posterior,lateral and oblique radiographic imaging by using computer-assisted fluoroscopic navigation to imitate anterior- posterior. Lateral spinal and axial pedicle virtual image was obtained to guide the percutaneous kyphoplas-ty. Results All painful vertebral body were one-sided punctured,all percutaneous kyphoplasties were succeed by guiding with computer-assisted fluoroscopic navigation. Navigation virtual puncture needle image basically matched with reality view. PMMA dosage was 2.5 ～ 4 ml. Postioporational CT showed that the PMMA filled spinal focus very well. 11 cases completely relieved and 17 cases partially relieved. Conclusion Using improved computer-assisted fluoroscopic navigation to guide the PKP to treatment multiple osteoporotic spinal compression fractures decreases op-erative time and radiation injury. It is a safe,precise,minimally invasive method.     

改良二维影像导航引导椎体后凸成形术治疗多发性椎体压缩性骨折临床分析

Objective To explore clinlical outcomes of using improved computer-assisted fluoroscopic navi-gation to guide the percutaneous vertebroplasty to treat multiple osteoporotic spinal compression fractures. Methods Twenty-eight multiple osteoporotic spinal compression fractures patients with 73 painful vertebral body were got an-terio posterior,lateral and oblique radiographic imaging by using computer-assisted fluoroscopic navigation to imitate anterior- posterior. Lateral spinal and axial pedicle virtual image was obtained to guide the percutaneous kyphoplas-ty. Results All painful vertebral body were one-sided punctured,all percutaneous kyphoplasties were succeed by guiding with computer-assisted fluoroscopic navigation. Navigation virtual puncture needle image basically matched with reality view. PMMA dosage was 2.5 ～ 4 ml. Postioporational CT showed that the PMMA filled spinal focus very well. 11 cases completely relieved and 17 cases partially relieved. Conclusion Using improved computer-assisted fluoroscopic navigation to guide the PKP to treatment multiple osteoporotic spinal compression fractures decreases op-erative time and radiation injury. It is a safe,precise,minimally invasive method.     

改良二维影像导航引导椎体后凸成形术治疗多发性椎体压缩性骨折临床分析

Objective To explore clinlical outcomes of using improved computer-assisted fluoroscopic navi-gation to guide the percutaneous vertebroplasty to treat multiple osteoporotic spinal compression fractures. Methods Twenty-eight multiple osteoporotic spinal compression fractures patients with 73 painful vertebral body were got an-terio posterior,lateral and oblique radiographic imaging by using computer-assisted fluoroscopic navigation to imitate anterior- posterior. Lateral spinal and axial pedicle virtual image was obtained to guide the percutaneous kyphoplas-ty. Results All painful vertebral body were one-sided punctured,all percutaneous kyphoplasties were succeed by guiding with computer-assisted fluoroscopic navigation. Navigation virtual puncture needle image basically matched with reality view. PMMA dosage was 2.5 ～ 4 ml. Postioporational CT showed that the PMMA filled spinal focus very well. 11 cases completely relieved and 17 cases partially relieved. Conclusion Using improved computer-assisted fluoroscopic navigation to guide the PKP to treatment multiple osteoporotic spinal compression fractures decreases op-erative time and radiation injury. It is a safe,precise,minimally invasive method.