前路带锁钢板治疗多节段颈椎骨析

目的研究并评价前路带锁钢板治疗多节段颈椎骨折的方法，方法对20倒颈椎多节段骨折患着采用前路减压、取髂骨植骨、前路带锁钢板内固定治疗。结果19例取得骨性融合，融合率95％。结论颈椎前路带锁钢板能为固定节段椎悼提供可靠的稳定性．是一种治疗多节段颈椎骨折的可靠方珐。     

全髋关节置换术的随访体会

人工髋关节有一定的使用期限，且大多数行全髋关节置换术的患者为中老年人，骨质条件随着年龄的增长逐渐变差，可能出现脱位、骨折、磨损、松动等远期并发症，需定期复查。另一方面，虽然国外关于人工关节治疗的随访报道较多，但目前国内仍缺乏中远期报道，且国人在身体特点及生活习惯等方面与西方国家存在一定差异，全髋关节置换术后的中远期效果是否与国外相似还需进一步研究。因此，南方医科大学南方医院脊柱骨病外科对1996～2002年在该行全髋关节置换术的患者进行随访。     

特巨大型游离型腰椎间盘突出症一例报告

患者 男，56岁，因腰痛伴双下肢麻痛1个月入院。患者发病前有腰部扭伤史，保守治疗效果欠佳；入院前1d出现大小便困难，但仍可自主排尿（便）。查体：跛行，腰明显右侧凸，L4棘突压痛、叩击痛，双侧旁开约1.5cm处有压痛，并向双下肢放射。     

The results of cementless Zweymüller hip system: 5 to 11 years follow-up study

Objective To analyze the intermediate-term results associated with the use of Zweymüller hip system. Methods Review the 116 cases (142 hips) who were treated with total hip replacement from 1996 to 2002 by a single surgeon using cementless Zweymüller hip systems. Results Sixty-one cases (77 hips) were followed up, 50 cases (64 hips) were evaluated both clinically and radiographically while 5 cases (6 hips) and 6 cases (7 hips) were only evaluated clinically and radiographically respectively. The average follow-up period was 7.3 years(range 5 to 11 years). The mean preoperative Harris Hip Score was 46 while the mean postoperative Harris Hip Score was 93. Distal cortical hypertrophy and medullary sclerosis were observed in 30 hips(42.3%) and 33 hips(46.5%) respectively. Heterotopic ossification arose in 45 hips (63.4%). Radiolucent lines occured in 27 stems(38.0%) but in no cups. Radiolucent lines were mosdy observed in Gruen zones 1. Osteolysis occured in 7 cups (9.9%) and 18 stems (25.4%). Osteolysis was mostly observed in Delee Zone 3 and Green zone 7. In the distal Gruen zones 3, 4 and 5, no radiolucent line or osteolysis was observed. No hips had been revised, 3 cups needed revision surgery because of aseptic loosening. Conclusion The 5-11 years follow-up results are satisfactory, but osteolysis is common     

正确认识脊柱结核病灶清除术

脊柱结核是全身结核病的局部表现，有效的抗结核药物化疗是治疗脊柱结核的基石或核心．手术只是辅助治疗方式。但是，对于具有手术适应证的患者，积极手术治疗可以有效缩短治疗周期．促进结核病灶愈合，减少伤残，提高生命质量。因此，手术是治疗脊柱结核的重要手段。随着对脊柱节段稳定性认识的深入，以内固定应用为特征的外科术式广泛应用于脊柱结核的治疗，取得了显著的临床效果。     

经皮椎体成形术在脊柱转移瘤治疗中的应用

目的 探讨经皮椎体成形术在脊柱转移瘤中的镇痛治疗效果.方法 对有15例明显脊柱疼痛表现的脊柱转移瘤患者进行了经皮椎体成形术.结果 15例共20个椎体施行椎体成形,平均每椎体注射骨水泥3.5～4 ml.术后1～3 d,患者疼痛症状均有缓解,平均随访6个月,随访期末,5例明显缓解(VAS平均2分),8例中等度缓解(VAS平均4分),2例部分缓解(VAS平均6分),2例再次出现疼痛,术中和术后无严重并发症发生.结论 经皮椎体成形术可作为脊柱转移瘤缓解疼痛的有效方法之一.     

脊髓型颈椎病前路手术的远期疗效分析

目的探讨脊髓型颈椎病前路减压术后远期疗效和可能的影响因素。方法回顾分析我院1992年1月—2000年12月开展并获得长期(5年以上)随访的脊髓型颈椎病前路手术116例,其中男80例,女36例,年龄36～76岁,平均51岁,术前病程2个月～20年,平均19个月。病变累及节段:单节段65例(56．0％);双节段44例(37．9％);三节段7例(6．0％)。发病过程:缓慢发病98例,无诱因突然发病并迅速加重18例。采用以下三种前路术式:前路减压+自体髂骨植骨融合术;前路减压+TFC椎间融合术;前路减压+自体髂骨植骨融合+前路钛板内固定术。采用日本骨科学会制定的JOA评分系统评定患者神经功能恢复情况,对术后远期疗效和相关影响因素进行分析。结果平均随访时间7年3个月(5～12年)。JOA评分术前(9．34±1．81)分,术后2周(10．35±1．85)分,末次随访(14．09±1．90)分,术后改善率63．2％。术后疗效评价:优27例(23．3％),良47例(40．5％),可23例(19．8％),差19例(16．4％),优良率63．8％。经多因素回归分析,手术疗效与发病年龄、病程、神经功能损伤严重程度、病变的范围(节段数)密切相关,而与选择融合和固定方式无关。结论脊髓型颈椎病一经确诊后应严密观察,早期采取前路减压和稳定手术可获得较好的长期疗效。     

CT导引下穿刺活检对骨盆肿瘤的诊断价值

目的 评估CT 导引细针穿刺在骨盆肿瘤活检中的临床应用价值.方法 回顾性研究32例CT导引下穿刺活检骨盆肿瘤病例,男23 例,女9例.年龄16～70岁,平均42.5 岁.肿瘤大小5～20 cm(小于10 cm者15例,大于10 cm者17例),按肿瘤发生部位骨盆Ⅰ区肿瘤14例,Ⅱ区肿瘤13例, Ⅲ区肿瘤4例,Ⅳ区肿瘤1例.患者就诊症状多为髂骶部疼痛或包块.术前均作CT平扫和增强扫描.穿刺活检的要点为选择最佳层面和进针点.活检标本送病例科作细胞病理学检查.结果 32例均安全地穿刺到病变内取出病理标本,无严重并发症发生.病理学检查32例均为恶性肿瘤,经手术证实或临床检查、随访证实穿刺准确率及正确率均为100%.结论 CT导引经皮穿刺活检骨盆肿瘤是一种安全有效、并发症发生率低的诊断和鉴别诊断方法.     

The results of cementless Zweymüller hip system: 5 to 11 years follow-up study

Objective To analyze the intermediate-term results associated with the use of Zweymüller hip system. Methods Review the 116 cases (142 hips) who were treated with total hip replacement from 1996 to 2002 by a single surgeon using cementless Zweymüller hip systems. Results Sixty-one cases (77 hips) were followed up, 50 cases (64 hips) were evaluated both clinically and radiographically while 5 cases (6 hips) and 6 cases (7 hips) were only evaluated clinically and radiographically respectively. The average follow-up period was 7.3 years(range 5 to 11 years). The mean preoperative Harris Hip Score was 46 while the mean postoperative Harris Hip Score was 93. Distal cortical hypertrophy and medullary sclerosis were observed in 30 hips(42.3%) and 33 hips(46.5%) respectively. Heterotopic ossification arose in 45 hips (63.4%). Radiolucent lines occured in 27 stems(38.0%) but in no cups. Radiolucent lines were mosdy observed in Gruen zones 1. Osteolysis occured in 7 cups (9.9%) and 18 stems (25.4%). Osteolysis was mostly observed in Delee Zone 3 and Green zone 7. In the distal Gruen zones 3, 4 and 5, no radiolucent line or osteolysis was observed. No hips had been revised, 3 cups needed revision surgery because of aseptic loosening. Conclusion The 5-11 years follow-up results are satisfactory, but osteolysis is common     

复合振动治疗卵巢切除大鼠骨质疏松的初步试验研究

目的探讨复合振动对卵巢切除SD大鼠骨质疏松模型的治疗作用。方法3月龄SD雌性未育大鼠随机分为对照组、治疗1组和治疗2组,每组8只。12月龄雌性经产大鼠随机分为对照组和治疗组,每组8只。治疗组、治疗1组、治疗2组大鼠切除卵巢,制备骨质疏松大鼠模型。所有对照组不进行振动干预,置于与振动组相同噪音环境,治疗1组振动45-55 Hz,0.05-0.1 g;治疗2组振动45-55 Hz,0.12-0.21 g;治疗组振动45-55 Hz,0.12-0.21 g。每次振动20 min,每天1次,每周5次,休息间隔不大于2 d,共13 w。实验前后分别测定大鼠腰椎、股骨骨密度,实验结束时测骨钙素等骨转换标志物。结果青年鼠腰椎、股骨骨密度以及老龄鼠腰椎骨密度显著性增加,但骨转换标志各组无统计学差异。结论一定的复合振动可以增加SD大鼠卵巢切除骨质疏松模型腰椎、股骨骨密度,对骨质疏松具有一定的治疗作用。