全脊椎切除术治疗脊柱肿瘤及稳定性重建

目的探讨全脊椎切除、融合及稳定性重建术在治疗全脊椎肿瘤中的必要性和可行性.方法对11例全脊椎肿瘤的患者行后路或联合前、后路Ⅰ期全脊椎切除、脊髓减压,并进行椎间植骨融及后路植骨融合、固定的手术.结果术后随访3个月～2年,7例神经功能丧失者,6例完全恢复,1例部分恢复,所有患者局部疼痛皆消失.1例术后出现一过性瘫痪加重.术后平均植骨融合时间为3个月.1例神经鞘瘤患者1年后复发并恶变.结论颈部全脊椎肿瘤,联合前、后路手术(肿瘤切除、植骨、内固定)可以彻底切除全脊椎肿瘤及稳定性重建;对胸、腰段脊椎肿瘤仅行后路手术便可彻底切除全脊椎肿瘤,并通过植骨及椎弓根钉系统内固定重建脊柱的稳定性.     

胸椎多节段骨折的手术治疗

胸椎骨折为高能损伤,多由强大暴力造成,常可合并胸廓及肺部损伤。脊髓损伤程度重且容易漏诊,目前对胸椎多节段骨折国内报道较少。2000年2月至2005年3月我们共手术治疗胸椎多节段骨折15例。现分析其临床资料,并报告如下。     

脊柱侧凸术中皮层体感诱发电位(CSEP)监护的应用价值

近年来国内外在脊柱侧凸手术治疗方法及临床疗效方面取得了很大进展。但手术的安全性一直是影响手术疗效的最大隐患。一旦发生脊髓损伤,后果严重且不易恢复。自2000年4月~2005年6月我们对29例脊柱侧凸患者行术中皮层体感诱发电位监护,以提高手术的安全性,效果满意。1资料与方法1.1临床资料本组患者29例,男性10例,女性19例,平均年龄15.8岁(13~20岁)。其中特发性脊柱侧凸18例,先天性半椎体畸形8例,脊髓纵裂并脊柱侧凸1例,胸椎管内脂肪瘤并脊柱侧凸1例,Chiari畸形并脊柱侧凸1例。手术方式:后路楔形截骨、矫形内固定术15例;单纯后路矫形内固定…     

个体化饮食干预对老年食管癌化疗患者的影响

目的探讨基于食物交换份法的个体化饮食干预对老年食管癌化疗患者的影响。方法选取2015年9月至2017年3月我院收治的156例食管癌化疗患者作为研究对象,按照入院顺序等分为对照组和观察组,对照组采用常规护理,观察组在对照组基础上实行基于食物交换份法的个体化指导。对比两组患者营养状况以及健康知识掌握情况。结果入院第1天两组患者各项营养状况比较差异无统计学意义(P0. 05),出院前1 d两组患者各项营养状况较入院第1天有显著改善(P 0. 05),且观察组患者各项营养状况改善程度显著优于对照组(P 0.05)。观察组患者健康知识掌握程度显著高于对照组(P 0. 05)。结论对老年食管癌化疗患者实施基于食物交换份法的个体化指导,有助于改善患者营养状况,提高健康知识掌握度,临床应用价值较大。     

完善我国国境口岸传染病应急防控体系的探讨

目的探讨完善我国国境口岸传染病应急防控体系的对策。方法对美国在预防和控制急性传染病方面的规划、监测体系、提高应急能力等方面进行研究,并对目前我国国境口岸传染病防控措施进行分析、评价。结果美国具有完善的突发公共卫生事件应急体系,能有效控制突发传染病的传播,而我国国境口岸传染病应急防控体系还存在不足。结论结合口岸实际情况,借鉴美国的经验,建立更为合理、有效的国境口岸传染病应急防控体系。     

硫酰氟对德国小蠊的时间-剂量-死亡率模型研究

在实验室熏蒸柜中,采用不同浓度硫酰氟对德国小蠊成虫进行熏蒸效果观察研究,运用时间-剂量-死亡率模型对10h内各处理组德国小蠊成虫累计死亡率随时间、剂量的变化进行拟合。结果表明:硫酰氟对德国小蠊成虫具有较强的急性毒性。硫酰氟熏蒸浓度为1.0g/m3、1.5g/m3、2.0g/m3、2.5g/m3和3.0g/m3熏蒸10h后,德国小蠊成虫的累计死亡率分别为4%、8%、72%、84%和100%,随着熏蒸时间的延长,硫酰氟半数致死浓度(即LC50)逐渐降低。熏蒸后10h的LC50和LC90估计值分别为1.95g/m3和2.44g/m3。     

胸腰椎肿瘤全脊椎切除术后的稳定性重建及其并发症

目的 探讨胸腰椎肿瘤全脊椎切除术后与稳定性重建相关的并发症.方法 1997年1月至2009年12月接受全脊椎切除术且随访及存活时间超过18个月的胸腰椎肿瘤患者34例,男20例,女14例;年龄15～72岁,平均43岁.胸椎27例,腰椎7例.脊柱转移瘤6例,原发骨肿瘤28例.全脊椎分块切除23例,整块切除11例.后路椎弓根钉棒系统短节段固定19例,长节段固定13例,短节段前路固定2例.前方椎体重建采用钛网植骨20例,钛网骨水泥7例,骨水泥填塞2例,单纯植骨2例,带加强环的钛网植骨1例,人工椎体植骨2例;后方碎块植骨26例,大块桥接植骨8例.结果 随访18～128个月,平均43个月.7例死亡.4例原发肿瘤行分块切除者复发,1例行整块切除者复发.25例椎体间植骨者融合不良5例.术后患椎上、下椎体间矢状面Cobb角平均-6°(-34.2°～15.5°),末次随访或翻修术前9.3°(-17.5°～57.2°),丢失16.0°(1.2°~65.4°),后方多节段固定者丢失14.1°(0.8°～36.5°),短节段固定者丢失21.5°(4-4°～65.4°).内固定断裂5例、内固定松动2例,钛网下沉6例、移位3例.人工椎体置换病例无明显下沉和移位.2例行前后路翻修,2例更换断棒,1例更换螺钉.结论 全脊椎切除术后与脊柱稳定性重建相关的并发症较多.后方长节段经椎弓根固定配合大块桥接植骨、前方应用人工椎体置换与植骨可使脊柱获得坚强的临时固定与长期融合.

Abstract：

Objective To investigate the spinal stability reconstruction and related complications after total spondylectomy for thoracolumbar tumors. Methods From January 1997 to December 2009, 34 cases with thoracolumbar tumors treated with total spondylectomy, including 20 males and 14 females with an average age of 43 years. The tumors were located in thoracic vertebra in 27 cases and lumbar vertebra in 7, including 6 spinal metastases and 28 primary tumors. The total spondylectomy was piecemeal in 23 cases and en bloc in 11. The reconstruction methods included posterior short-segment fixation in 19 cases, multi-segmental fixation in 13, anterior intervertebral fixation in 2, titanium mesh with auto-bone graft in 20 cases, titanium mesh with bone cement in 7, bone cement filling in 2, auto-bone strut graft in 2, titanium mesh with strengthened rings in 1, artificial vertebral body replacement in 2, posterior massive bone bridging graft in 8 and bone particles graft in 26. Results The mean follow-up time was 43 months. Seven patients died, 5 suffered recurrence. Poor grafted bone fusion was found in 5 cases. The intervertebral sagittal Cobb angle of adjacent vertebra was ??after operation, 9.3?at the end of follow-up or before revision operation. The average lost angle was 14.1?for cases with multi-segmental fixation, and 21.5?with short-segment fixation. Complications included internal fixation broken (5) and loosening (2), titanium mesh subsidence (6) and displacement (3). There were 5 revision surgeries. Conclusion There are relative more complications about spinal stability reconstruction after total spondylectomy. To achieve temporary stiff fixation and long-term fusion, the posterior multi-segment fixation and massive bone bridging graft combined with the anterior artificial vertebral body replacement are effective.     

枢椎椎板螺钉固定的解剖学与影像学测量比较

Objective To provide the anatomic and radiographic data, verify the clinical application of trans-lamina screws and evaluate the efficacy of our radiographic methods. Methods The anatomic and radiographic measurements of C2 vertebra were conducted on cadavers and living subjects. A total of 96 human adult cadavers and 112 volunteers without upper cervical abnormality were studied in this project. The minimal height (H1), thickness (T), length (L1) of C2 lamina, height of the root of lamina (H2), distance from the entry point to the lateral rim of lamina (L2) and to the lateral rim of lateral mass (L3) were bilaterally measured using calipers. The spino-laminar angles (angle A) were also included. All measurements were taken at the thinnest part of the lamina in the axial and coronal planes. Results The data of males were significantly higher than that of females (EM>P /EM><0.05) except angle A. There was no significant difference in the values of bilateral lamina between group A and group B (EM>P/EM> >0.05).The thickness of the vertebral lamina was less than 6mm in 45% of the specimens. The length of the lamina in all specimens was less than 2.5cm, while only 5% of the specimens had a >3cm distance from the entry point to the rim of lamina. The length from the entry point to the lateral rim of lateral mass ranged from 2.5cm to 4.6cm,with the length longer than 4cm was seen in 4% specimens. BR>Conclusion The preoperative radiographic evaluation is very important to determine the suitable size of screws. The radiographic measurement method we used is simple, accurate and reliable for preoperative measu     

急诊取儿童上消化道异物回顾性分析

目的 探讨急诊内镜下取儿童上消化道异物的方法、经验及预防措施.方法 回顾性分析1997年～2009年上消化道异物行急诊内镜治疗资料,进行归纳分析.结果 共行儿童急诊上消化道异物取出术45例,金属异物最多,共31例,占73.81%,其中硬币28例,占急诊的66.67%.22例异物在食管上段,6例在胃内,3例急诊未发现异物,占儿童异物的6.67%.结论 急诊内镜治疗儿童上消化道异物安全、有效,避免儿童将玩具,尤其是硬币放入嘴里,会明显减少儿童上消化道异物的发生.     

液压扩张肩关节治疗肩周炎32例

我们采用液压扩张法治疗肩周炎患者３２例，效果满意。现报告如下。临床资料：本组男１３例，女１９例；平均５８岁。３５个肩关节中，单关节炎２９例，双关节炎３例。患者取坐位或仰卧位，０．７５％碘酊消毒患肩３遍，铺无菌洞巾。操作者戴无菌乳胶手套。在患者肩峰、喙...