中西医结合治疗以餐后血糖升高为主的2型糖尿病56例临床观察

目的：探讨中西医结合治疗以餐后血糖升高为主的2型糖尿病临床疗效。方法：将112例2型糖尿病患者按就诊顺序随机分为2组,对照组56例采用西医常规治疗,治疗组56例在对照组治疗基础上加服加味生脉饮并随症加减,每天1剂,水煎分2次温服。2组均14天为1个疗程,2个疗程后统计疗效。结果：对照组显效率48．2％,总有效率78．6％;治疗组显效率60．7％,总有效率94．6％。2组显效率、总有效率相比差异有统计学意义（P＜0．05）。结论：中西医结合治疗以餐后血糖升高为主的2型糖尿病疗效优于单纯西医治疗,疗效确切,值得临床推广。     

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.     

不同长度的下颈椎经关节螺钉侧位X线片评价

目的评价侧位X线片在了解下颈椎经关节螺钉固定中不同长度螺钉钉尖安全位置的作用。方法选用7具尸体颈椎标本,从C3、4~C5、6直视下依次置入经关节螺钉,分别置入螺钉钉尖仅为四层皮质固定(0mm)和超出皮质2、4、6mm各42枚,分别摄标本侧位X线片。根据X线片,将每个椎体分为前Ⅰ、Ⅰ、Ⅱ、Ⅲ和Ⅳ区。逐一记录螺钉钉尖在X线片上相应椎体各区的位置。结果共有87枚螺钉位于前Ⅰ区,其中42枚是当螺钉钉尖为四层皮质固定时(100%);37枚是当钉尖超出下位椎体上关节突侧前方皮质2mm时(88%);8枚是当钉尖超出4mm时(19%)。共有71枚螺钉位于Ⅰ区,其中5枚是当钉尖超出2mm时(2%);34枚是当钉尖超出4mm时(80%);32枚是当钉尖超出6mm时(76%)。10枚位于Ⅱ区的螺钉均是当钉尖超出6mm时的投影。没有发现螺钉钉尖位于Ⅲ区和Ⅳ区。不同长度的经关节螺钉钉尖在侧位X线片上的投影位置在颈椎各节段间差异无统计学意义(P>0.05)。结论在评价下颈椎经关节螺钉固定中不同长度的螺钉钉尖安全位置方面,侧位X线片有一定意义。下颈椎经关节螺钉理想长度的钉尖位置应该位于前Ⅰ区。     

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.     

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.     

胸椎骨折伴胸骨骨折9例分析

目的对胸椎骨折伴发胸骨骨折进行初步探讨与分析。方法自2001年11月至2006年l0月，共收治胸椎骨折伴胸骨骨折患者9例，全部病例行X线、CT及MRI检查。根据患者年龄、性别、受伤原因、胸骨骨折部位、胸椎损伤节段及类型、脊髓损伤程度及其他合并伤等资料均作为相关信息列入分析。结果损伤原因以交通伤和坠落伤为主，3例为多节段骨折，9例合并多发创伤或多发骨折。脊髓损伤发生率高，损伤程度严重。结论胸椎骨折伴胸骨骨折的临床特点为致伤暴力强大，脊柱骨折、脊髓损伤严重，合并多发伤发生率高。胸骨是胸廓环的重要组成结构，并在维持胸椎的稳定性中发挥着重要的作用。     

经口咽入路钢板内固定治疗不稳定性寰椎骨折

目的:分析应用经口咽入路钢板内固定治疗不稳定性寰椎骨折的临床疗效及安全性。方法:2007年7月至2011年6月,应用经口咽入路钢板内固定治疗不稳定性寰椎骨折8例,男6例,女2例;年龄23～48岁,平均39.5岁;高处坠落伤5例,交通伤3例。双侧寰椎前弓骨折(前1/2 Jefferson骨折,Landells type Ⅰ)3例,单侧寰椎前后弓双骨折(半环Jefferson骨折,Landells typeⅡ)3例,双侧寰椎前后弓双骨折伴单侧侧块骨折(Landells typeⅢ)2例。结果:所有患者获得随访,时间6～24个月,平均13个月。患者的临床症状均得到不同程度的改善。平均手术时间为98min(80～140min);平均出血量为200ml(100～300ml);平均透视时间55s;术中术后均未发生神经、椎动脉损伤和其他手术相关并发症。复查X线片及CT,未发现患者上颈椎失稳或复位丢失,螺钉位置良好,无松动、断钉。结论:经口咽入路采用寰椎侧块螺钉固定钢板重建寰椎前环是治疗不稳定性寰椎骨折的一种可靠及安全的方法。它既保持了寰枢关节的旋转运动功能,同时又恢复了寰枕关节和寰枢关节的协调运动。     

后路棘旁双切口单节段椎弓根钉固定治疗胸腰椎骨折

目的 探讨后路双侧棘旁切口肌间隙入路,单节段椎弓根钉内固定治疗胸腰椎骨折的临床疗效.方法 自2008年12月～2010年12月采用后路双侧棘旁切口肌间隙入路、切开复位单节段椎弓根钉内固定治疗胸腰椎骨折40例.结果 本组术后X线片测量骨折椎前缘压缩百分比从术前(42.0±3.2)％恢复至(7.9±1.1)％(P＜0.05);骨折椎后凸畸形Cobb角从术前(24.1±3.1)°恢复至(5.1±1.2)°(P＜0.05).所有患者获随访7～27个月,患者腰背部疼痛均明显改善,骨折均于术后3个月愈合,无内固定失败、断裂和松动.结论 后路双侧棘旁切口肌间隙入路、切开复位单节段椎弓根钉固定可以有效治疗胸腰椎骨折,但应严格掌握手术适应证.     

中西医结合治疗高血压病阴虚阳亢型 48 例临床观察

目的观察中西医结合治疗高血压病阴虚阳亢型的临床疗效。方法96例高血压病阴虚阳亢型患者随机分两组,对照组48例采用西医常规治疗,治疗组48例在常规西医治疗的基础上加用加味天麻钩藤饮,并随症加减。20d一个疗程,治疗1个疗程后,观察两组的血压、中医症候的改善情况及不良反应。结果对照组及治疗组所有96例患者血压均降至正常范围内,均为显效,两组差异无统计学意义。在症状改善方面,治疗组显效37例,有效10例,无效1例,显效率77．1％,总有效率97．9％;对照组显效18例,有效16例,无效14例,显效率37．5％,总有效率70．8％,治疗组的显效率及总有效率明显高于对照组,差异有统计学意义（P〈0．05）。结论中西医结合治疗高血压病阴虚阳亢型,在降低血压、消除症状、改善生活质量方面疗效显著,值得临床推广应用。     

治疗Schatzker Ⅴ、Ⅵ型胫骨平台骨折手术方法的选择

目的 探讨双钢板固定术和经皮复位外固定术治疗SchatzkerⅤ、Ⅵ型胫骨平台骨折的临床疗效.方法 2003年3月至2005年5月,根据软组织损伤程度,分别采用双钢板固定植骨术或经皮复位有限固定术治疗SchatzkerⅤ、Ⅵ型胫骨平台骨折33 例.结果 术后33 例获得随访,随访8～26个月,平均16个月.参照Merchant评分,优16 例,良12 例,可5 例,优良率为85%.结论 治疗胫骨平台骨折应重视软组织损伤程度的评估.软组织损伤较轻者可采用切开复位双钢板固定植骨术,软组织损伤严重者应行经皮复位有限内固定结合外固定术.采用适当手术方法,可减少软组织并发症,使骨折固定长期的稳定性良好,关节功能恢复满意.