单开门棘突重建颈椎管扩大成形术治疗无骨折脱位型颈脊髓损伤

目的 探讨单开门棘突重建颈椎管扩大成形术治疗无骨折脱位型颈脊髓损伤的疗效。方法 无骨折脱位型颈脊髓损伤15例，均行单开门棘突重建颈椎管扩大成形术。采用JOA、Frankel分级及影像学进行疗效评价。结果 平均随访2年5个月，JOA评分术后改善率为35．83％，Frankel分级B→C1例，C→C2例，C→D7例，D→D2例，D→E3例。影像学检查示15例颈椎生理屈度正常，未发现有再“关门”及不稳定现象。结论 单开门棘突重建颈椎管扩大成形术由于重建了颈后方韧带复合体，对于改善和维持颈椎的生理曲度、稳定性方面具有重要的临床意义。     

经皮激光椎间盘减压术治疗颈性眩晕围手术期护理

目的探讨经皮激光椎间盘减压术(percutaneous laser disc decompression,PLDD)治疗颈性眩晕围手术期护理工作的重要意义。方法对23例颈性眩晕患者进行了术前心理护理、体位训练,术后常规观察、特殊护理指导及健康宣教。结果23例患者都能较好地配合手术医师安全度过手术期,术后无一例出现任何并发症。术后采用MacNab评价标准进行了临床评价,优良率为91.30%。结论高度重视PLDD治疗颈性眩晕围手术期的护理工作是手术顺利进行、术后并发症减少、手术成功率提高的重要保证     

单、双开门颈椎板成形术后重建韧带复合体部分生物力学特性的比较研究

目的比较单、双开门颈椎板成形术后重建后方韧带复合体部分生物力学特性的差异。方法新鲜山羊颈椎标本24具,随机分成3组,每组8具。A组：完整标本组,保留颈后方项韧带、伸肌等伸颈结构,切除前方结构;B组：在A组基础上行单开门颈椎板成形术后重建后方韧带复合体;C组：在A组基础上行双开门颈椎板成形术后重建后方韧带复合体。在电子万能试验机上行生物力学实验,测试项目包括三点折弯实验、轴向拉伸实验和压缩实验。分析比较3组间的差异性。结果三点折弯实验：标本变直时的位移、加载力,A、B、C3组间差异无统计学意义（P〉0．05）。拉伸实验：各拉伸负荷下与变直时的位移,A、B、C3组间差异无统计学意义（P〉0．05）。压缩实验中,A、B、C3组间差异无统计学意义（P〉0．05）。结论单、双开门颈椎板成形术后重建颈后方韧带复合体组标本都最大限度保留了颈后方韧带复合体的功能。在对抗颈椎变直和前屈的应力方面,二者无明显差别。     

组合性手术治疗脊柱裂后遗踝足畸形

目的:探讨脊柱裂后遗踝足畸形的外科治疗策略以及不同踝足的畸形手术组合方法及其疗效。方法:回顾性分析1990年1月至2009年7月收治的107例脊柱裂后遗踝足部畸形患者的病例资料。其中男44例,女63例;年龄1.3～52岁,平均17.7岁;双踝足畸形58例,单侧49例(左侧22例,右侧27例)。马蹄足畸形类99足,行跟腱延长及肌腱移位术;跟行足畸形类25足,行踝前肌腱松解及肌腱移位术;内外翻足畸形类17足,行肌腱移位及跟骨截骨术;连枷足畸形15足,行跟距关节融合及跟腱短缩术;爪形趾畸形9足,行趾间关节融合或Ilizarov技术牵拉矫正。采用AOFAS综合评分系统从主观疼痛感觉、客观功能检查等方面评定疗效。结果:107例中79例127足获得随访,时间48～180个月,平均64个月。根据AOFAS综合评分系统,结果优89足,良26足,中9足,差3足。结论:脊柱裂踝足畸形外科治疗策略包括矫正畸形、平衡肌力、稳定关节和保留足的弹性4个基本原则。针对不同类型足畸形,采用相应的组合性手术方案进行治疗,不但可以有效的矫正畸形,而且能改善患者的行走功能,获得满意的疗效。     

不同参数Nd:YAG激光对椎间盘髓核组织消融能力的实验研究

目的:比较不同参数Nd:YAG激光(1064nm)对髓核组织的消融能力。方法:新鲜山羊腰椎标本制作成脊柱功能单位144个,随机分为18组,每组8个。前9组采用间断发射激光行髓核消融术(A方法),消融总能量和脉冲频率分别为250J/10Hz(A1组)、250J/20Hz(A2组)、250J/30Hz(A3组),500J/10Hz(A4组)、500J/20Hz(A5组)、500J/30Hz(A6组),750J/10Hz(A7组)、750J/20Hz(A8组)、750J/30Hz(A9组);后9组采用连续发射激光行髓核消融术(B方法),消融总能量和脉冲频率分别与A方法各组对应。采用1064nm Nd:YAG激光,脉宽0.4ms,激光发射功率为10W。A方法激光每次发射持续时间1s,再次重复发射的间歇时间1s。测量消融前后标本的质量,并用游标卡尺测量汽化腔大小。结果:A方法在相同总能量条件下,脉冲频率20Hz时,消融量及汽化腔长、宽轴大于10Hz与30Hz组;脉冲频率相同条件下,能量750J时的消融量和汽化腔长、宽轴大于250J与500J组;频率与能量无交互作用。B方法在脉冲频率相同条件,能量750J时的消融量和汽化腔宽轴均大于250J与500J组,频率与能量无交互作用;频率20Hz、能量750J时,汽化腔长轴最大。相同参数激光消融量除750J/30Hz时B方法大于A方法,其余各组两种方法均无统计学差异;汽化腔长轴250J/30Hz、750J/20Hz、750J/30Hz时两种方法比较无统计学差异,其余各组汽化腔长轴B方法均大于A方法;汽化腔宽轴500J/10Hz、500J/30Hz时B方法大于A方法,其余各组两种方法比较无统计学差异。结论:相同参数下,Nd:YAG激光发射方式影响激光对山羊髓核的消融量及汽化腔形态。相同发射方式下改变激光参数可影响激光的消融能力,相同能量下,激光脉冲频率影响激光的消融能力;相同脉冲频率下,激光能量越大消融能力越强。     

The influence of cervical spine position on the three anterior endoscopic approaches to the craniovertebral junction: an imaging study

Background contextThree endoscopic anterior approaches, the transnasal, transoral, and transcervical approaches, are used for ventral lesions of the craniovertebral junction and have been compared regarding surgical working distances and approach angles. However, how the position of the cervical spine influences the depths of surgical corridors and approach angles for the three approaches has not been evaluated.PurposeTo evaluate the depths of surgical corridors and the approach angles for the three endoscopic approaches, taking the influence of cervical spine position into account.Study designA radiographic study comparing three anterior endoscopic approaches to the craniovertebral junction.Patient sampleCervical extension and flexion radiographs for 34 patients and cross-sectional computed tomography scans for 30 additional patients were assessed.Outcome measuresThe depths of the surgical corridors and the approach angles for the three endoscopic approaches in the midsagittal planes.MethodsWe determined the mean angles of the surgical trajectories for the endoscopic transoral and transcervical approaches on cervical extension and flexion radiographs. In addition, we measured the depths of the surgical corridors and the approach angles for the three approaches in the midsagittal plane.ResultsThe average depths of surgical corridors were as follows: endonasal, 93.65 mm; transoral, 85.27 mm; transcervical, 62.97 mm (in extension). The average approach angles were as follows: endonasal, 31.22°; transoral, 30.87°; transcervical, 36.58° (in extension).ConclusionsThe position of the cervical spine does not influence the surgical convenience of the endoscopic transnasal approach, but it can influence the endoscopic transoral and transcervical approaches, especially the latter. The endoscopic transcervical approach offers several advantages over the endoscopic transoral and endonasal approaches.     

远端半针Ilizarov外固定器结合微创截骨术治疗膝内翻畸形

 目的 探讨远端半针Ilizarov外固定器结合微创截骨术矫治膝内翻畸形的临床疗效。方法 回顾性分析2002年2月至2010年5月收治的31例膝内翻畸形患者的病例,男8例,女23例;年龄18~69岁,平均35.6岁;单侧6例,双侧25例,共56膝。术前膝内翻角度为7.7°~38.2°,平均17.0°±8.8°。根据美国膝关节关节协会评分（knee society score, KSS）为34~100分,平均（86.2±18.5）分。确定成角旋转中心与截骨矫形的位置,在胫骨畸形交点处用微创截骨器截骨,腓骨在头下截骨。安装术前已组装好的Ilizarov外固定器,通过调整伸缩内、外侧支架螺杆的长度渐进矫正内翻畸形。采用X线检查及膝关节KSS临床评分,结合行走时自我感觉及有无并发症等4项内容综合评价临床疗效。结果 患者佩戴Ilizarov外固定器的时间为9~20周,平均12周;随访时间14~50.4个月,平均30.5个月。末次随访时膝内翻角度为-3°~2.4°,平均1.7°±0.9°;膝关节KSS评分为75~100分,平均（96.1±7.7）分,其中优49例,良6例,可1例,优良率为98.2%（55/56）。11例患者术后早期发生轻度针道感染,经常规换药后感染控制;3例术后发生针道松动,经更换针道后恢复固定强度。结论 远端半针Ilizarov外固定器结合微创截骨术矫治膝内翻畸形具有微创、安全、动态矫形及符合美学要求的特点,临床效果满意。     

Electromyographic activity of rectus capitis posterior minor muscles associated with voluntary retraction of the head

Background contextThe functional role of rectus capitis posterior minor (RCPm) muscles is not well defined. To the best of our knowledge, electromyographic (EMG) data from RCPm muscles in humans have never been collected and analyzed.PurposeTo test the null hypothesis that there will be no difference in normalized levels of EMG activity measured from RCPm muscles with the head in a neutral position and with the head in a retracted position.Study designA repeated measures design intended to quantify normalized levels of EMG activity measured from RCPm muscles.MethodsDisposable 25-gauge, bipolar fine wire hooked electrodes were used to collect EMG data from both right and left RCPm muscles from 17 asymptomatic subjects. Data were collected while subjects performed five trials with the head maintained in a neutral position; performed three maximal voluntary isometric contraction efforts; performed four trials with the head maintained in a retracted position. Mixed effects beta regression models were used to analyze the data.ResultsNormalized EMG activity of RCPm muscles collected with the subject's head held in a retracted position was significantly higher (p<.0001) than normalized EMG activity collected with the subject's head held in a self-selected, neutral position.ConclusionsRectus capitis posterior minor muscles are active when the head is held in a neutral position and show a significant increase in activity when the head is held in a retracted position.