椎管内原发肿瘤的手术治疗

目的:探讨椎管内原发肿瘤的临床诊断和手术治疗效果。方法:总结我院2002年2月～2005年10月收治的30例椎管内原发肿瘤患者的临床表现、影像学资料、手术方式以及手术前后患者脊髓神经功能改善的情况。结果:椎管内原发肿瘤患者主要临床表现为腰背痛、四肢感觉异常、运动和括约肌功能障碍。MRI均显示椎管内占位,脊髓有受压征象。均行手术治疗,21例患者肿瘤完整切除,9例大部切除。术后均经病理证实为椎管内良性肿瘤,其中神经鞘瘤15例,神经纤维瘤10例,脊膜瘤5例。除1例术后出现不完全瘫痪外,其他患者术后临床症状及神经功能均有明显恢复。结论:影像学检查对椎管内原发肿瘤有较高的检出率,MRI检查对明确病变性质和部位有重要意义,最终确诊依赖于病理诊断。椎管内原发肿瘤如能早期发现、诊断和手术治疗,临床效果好。     

一期前后联合手术减压固定治疗严重下颈椎疾病

目的:对严重下颈椎疾病,包括骨折脱位、脊髓型颈椎病及颈椎后纵韧带骨化症采取一期前后联合手术治疗,探讨该疗法的可行性和疗效。方法:本组48例中男35例,女13例;年龄21~75岁,平均48岁。严重下颈椎骨折脱位16例,伤后至手术时间5 d~3周;钳夹脊髓型颈椎病(脊髓夹持型颈椎病)19例;严重颈椎后纵韧带骨化症13例。本组均采用全麻下一期前后路联合减压,前路带锁钢板固定,自体植骨或钛网加自体骨移植。本组前路采用O rion带锁钢板17例,AO带锁钢板3例,Zephir带锁钢板28例;前路减压后采用自体骨移植9例,采用钛网加自体骨移植39例。后路采用Axis钛板螺钉固定45例,Vertex系统3例,其中采用侧块螺钉9例,颈椎椎弓根螺钉39例。结果:随访6~36个月,经椎弓根螺钉固定者术后经斜位及CT检查发现有7个椎弓根螺钉位置稍差,其中6枚穿破外侧皮质,1枚穿破内侧皮质,但无神经血管并发症。假关节形成1例,而且1枚螺钉断裂。钳夹型颈椎病19例和后纵韧带骨化症13例,术后疗效按JOA评分标准评定,术后1周及1、3、6个月评分均较术前增加(P<0.05)。结论:严重下颈椎疾病采用一期前后联合手术治疗是可行的,术后稳定性好,患者康复快。     

下颈椎经关节螺钉联合侧块或椎弓根螺钉固定的效果

Objective To discuss the effect of transarticular screws combined with lateral mass screws or pedicle screws through posterior approach in the lower cervical spine. Methods From February 2003 to October 2007, 22 patients were treated using transarticular screws internal fixation combined with lateral mass screws or pedicle screws in Axis plating system and Vertex system. There were cervical fracture and dislocation in 13 patients, ossification of the posterior longitudinal ligament in 4, cervical canal stenosis associated with dentoid process fracture in 1, and cervical disc herniation associated with cervical stenosis in 4 patients. Lamina or facet bone grafting were used to achieve a long-term stability, with decompression and anterior approach or not. The starting point for screw insertion was located 1 mm medial to the midpoint of the lateral mass and the direction of the screw was 40° caudally in the sagittal plane and 20° laterally in the axial plane. Results All screws insertion was successful. A total of 45 transarticular screws were inserted, with 2 in C4,5, 39 in C5,6 and 4 in C6,7. A total of 12 lateral mass screws were inserted, with 6 in C3 and 6 in C4. A total of 41 pedicle screws were inserted, with 4 in C2, 2 in C3 and 6 in C4, 21 in C7 and 8 in T1. There was no complication related to screw insertion, such as injury to the vertebral artery, nerve roots or spine cord. The follow-up period ranged from 10 months to 3 years and 8 months (mean 17 months). All cases got bone fusion. Only one instance of screw partial backout was identified, but fusion was achieved in all pa-tients. In the follow-up period, only one instance of screw partial backout was identified, but fusion was achieved in all patients. Conclusion The combined use of transarticular screws and lateral mass screws or pedicle screws fixation in the lower cervical spine can enlarge the advantages of strong stability,relatively simple, and reduce operating risk when performed appropriately.     

微创通道下单侧TLIF联合对侧肌间隙入路置钉治疗腰椎间盘突出症疗效观察

目的探讨MAST Quadrant微创通道下单侧经椎间孔腰椎椎体间融合术(TLIF)联合对侧肌间隙入路置钉治疗腰椎间盘突出症疗效观察。方法回顾性分析自2008年2月~2011年10月,采用Quadrant微创通道下单侧TLIF联合对侧肌间隙入路置钉治疗89例腰椎间盘突出症。结果手术时间90~185 min,平均125.7 min;术中出血量300~550 ml,平均390 ml;切口均一期愈合。术后随访12~28个月,平均15.2个月;末次随访VAS评分为(1.6±1.2)分,与术前比较差异有统计学意义(P<0.05)。随访期间未见椎弓根钉内固定系统松动、断裂或移位。结论 Quadrant微创通道下单侧TLIF联合对侧肌间隙入路置钉技术是一种治疗腰椎间盘突出症的安全、有效的微创手术方式。     

胸椎后路经关节螺钉固定的可行性研究

目的:明确胸椎后路经关节螺钉固定的解剖学可行性和技术参数,为临床应用提供参考。方法:2009年9月至2009年12月,取20具胸椎标本,男12具,女8具,仔细解剖颈部的后侧和前侧方,以清楚地暴露胸椎椎板和椎弓根。以椎板下缘向上,外缘向内各7mm为进钉点,在T1,2,T5,6,T9,10直视下置入经关节螺钉,通过CT重建,测量经关节螺钉内固定进钉角度和钉道长度。结果:胸椎后路经关节螺钉均成功置入,螺钉固定方向在矢状面呈尾倾,冠状面呈外倾。经关节螺钉固定的平均角度在矢状面尾倾(52.6±5.9)°,在冠状面外倾(12.4±2.9)°。螺钉钉道长度(22.5±1.9)mm,各固定节段间角度略有不同,差异无统计学意义(P>0.5),但上、中、下不同胸椎节段之间的钉道长度差异有统计学意义(P<0.01)。结论:胸椎后路经关节螺钉具有解剖学可行性,可以作为胸椎椎弓根螺钉固定的一种补充内固定方法,但置钉时要求较高的准确性。     

加味归脾汤治疗失眠症50例

目的 :观察加味归脾汤治疗失眠症的效果。方法 :治疗组选用加味归脾汤治疗失眠症 5 0例 ;对照组给予舒乐安定片治疗失眠症 2 5例。结果 :治疗组总有效率 96% ;对照组总有效率 64%。提示 :加味归脾汤治疗失眠症疗效优于舒乐安定片 ( P<0 .0 1 )值得推广。     

前环固定结合后环TSRH固定治疗不稳定性骨盆骨折

目的总结骨盆骨折的治疗经验。方法回顾性总结了2001~2004年收治的资料完整的B型及C型骨盆骨折68例,治疗采用前环重建钢板、或耻骨空心螺钉固定,后环采用TSRH固定。结果68例获平均18个月随访,均骨性愈合,骨盆畸形均得以纠正,无下肢不等长,治愈率为94·5%。结论不稳定性骨盆骨折在固定前环的同时,还应进行后环的固定,TSRH在骨盆后环的固定中有较好的疗效,适用于B型骨盆骨折及C型、C型和C型骨盆骨折的内固定治疗。