空心加压螺钉内固定治疗股骨颈骨折体会

2001年10月～2003年9月,我院应用空心加压螺钉治疗新鲜股骨颈骨折46例,效果满意.1材料与方法 1．1病例资料本组46例，男29例，女17例，年龄17～62岁。左侧22例，右侧24例。股骨颈骨折按Garden分型：Ⅱ型10例，Ⅲ型27例，Ⅳ型9例。均为新鲜骨折，伤后至手术时间平均3．7（1～17）d。     

Oblique transcorporeal approach to anteriorly located lesions in the cervical spinal canal

Summary The technique of obliquely drilling out the postero-lateral part of the cervical vertebral bodies is described. It uses the antero-lateral (retro carotico-jugular) approach to control and displace the vertebral artery postero-laterally and to expose the lateral aspect of the vertebral bodies. It provides, through a wide field and with minimal retraction of the carotid artery and the internal jugular vein, an extensive view of the anterior aspect of the spinal cord. It has already been used to treat 15 anterior lesions compressing the spinal cord including neurinomas and osteophytes.     

骨桥栓桩与界面螺钉固定前交叉韧带重建移植物胫骨端的临床价值对比

对比骨桥栓桩与界面螺钉在膝关节前交叉韧带断裂重建术中的临床价值。方法 回顾性分析2019年7月—2020年12月我院700例在关节镜下行前交叉韧带重建手术的患者,股骨隧道均以横穿钉固定。按移植物胫骨端固定方式分为骨桥栓桩组（380例）及界面螺钉组（320例）。对比两组手术时间、切口长度、住院时间及费用;比较两组术后3个月、12个月胫骨隧道大小、膝关节功能Lyshlom评分及术后12个月关节松弛度。结果 两组患者手术时间、胫骨端切口长度、住院时间比较差异均无统计学意义（P＞0.05）,但骨桥栓桩组手术费用显著低于界面螺钉组（P＜0.05）。术后3个月、12个月两组患者胫骨隧道大小、膝关节功能Lyshlom评分及关节松弛度比较差异均无统计学意义（P＞0.05）,但随着时间的延长,两组患者隧道均有不同程度的扩大（P＜0.05）。结论 对于行关节镜下前交叉韧带重建术的患者,采用骨桥栓桩胫骨端固定方式可取得与界面螺钉固定相当的临床效果,但骨桥栓桩固定更具医疗经济优势,是一种可广泛推广的胫骨端固定方法     

Retrospective analysis of fetal vertebral defects: Associated anomalies,etiologies, and outcome

Our objectives were to describe fetal cases of vertebral defects (VD), assess the diagnostic yield of fetal chromosomal analysis for VD and determine which investigations should be performed when evaluating fetal VD. We performed a retrospective chart review for fetuses with VD seen between 2006 and 2015. Cases were identified from CHU Sainte‐Justine's prenatal clinic visits, postmortem fetal skeletal surveys, and medical records. Cases with neural tube defects were excluded. Sixty‐six fetuses with VD were identified at a mean gestational age of 20 weeks. Forty‐seven (71.2%) had associated antenatal anomalies, most commonly genitourinary, skeletal/limb, and cardiac anomalies. Thirteen mothers (19.7%) had pregestational diabetes (95% CI [10.1%–29.3%]). Fifty‐three cases had chromosomal analysis. Three had abnormal results (5.6%): trisomy 13, trisomy 22, and 9q33.1q34.11 deletion. Thirty‐four (51.5%) pregnancies were terminated, one led to intrauterine fetal demise and 31 (46.9%) continued to term. Of 27 children who survived the neonatal period, 21 had congenital scoliosis and 3 had spondylocostal dysostosis. Seven had developmental delay. In conclusion, prenatal evaluation of fetuses with VD should include detailed morphological assessment (including fetal echocardiogram), maternal diabetes screening, and chromosomal microarray if non‐isolated. Our findings provide guidance about management and counseling after a diagnosis of fetal VD.     

C7神经移位椎管内吻合腰神经前根重建截瘫屈髋伸膝功能的应用解剖

目的:为C7神经移位椎管内吻合腰神经前根重建截瘫患者屈髋伸膝功能提供解剖学基础。方法:在20例成人尸体标本上,观测L1阶段椎管内L1～4神经前根排列及纤维数、C7神经转移路径距离及坐骨神经可切取长度及远端纤维数。结果:一侧C7神经经椎体前通路跨越椎体中线的长度为(2.4±0.58)cm,可与对侧C7神经编织成束。在L1节段,L1～4神经前支可辨认并能编织成束供吻合。胫神经和腓总神经可切取长度(52.35±2.60)cm,(48.20±2.37)cm能够满足C7至L1段椎管的距离(48.35±3.36)cm。一侧胫神经和腓总神经远端纤维数(26856±112),(25700±156)大于一侧腰L1～4神经前支纤维数(20766±354)。结论:坐骨神经可选择为颈7神经移位重建截瘫下肢功能的桥接神经,双侧C7神经可经椎体前通路编织成束作为动力神经源,在L1阶段椎管内吻合L1～4腰神经前根的具有可行性。     

Frontonasal dysplasia in the Klippel-Feil syndrome: A new associated malformation

This paper describes an 8-year-old girl with Klippel-Feil syndrome (KFS) associated with frontonasal dysplasia, Sprengel deformity and postaxial polydactyly. These findings are tentatively explained on the basis of a single mutant gene for KFS with broad action in the morphogenesis of the skeletal system.     

股骨粗隆间骨折合并同侧股骨干骨折的手术治疗

目的探讨股骨粗隆间骨折合并同侧股骨干骨折的手术治疗方法及疗效。方法回顾分析我院自1998年1月至2005年12月收治股骨粗隆间骨折合并同侧股骨干骨折患者18例，全部病例均采用手术切开复位内固定，股骨粗隆间骨折应用动力髋内固定，股骨干骨折采用记忆合金环抱器内固定。结果术后随访2～8年，平均4．2年。全部病例均获骨性愈合，疗效满意。结论股骨粗隆间骨折合并同侧股骨干骨折在下肢骨折中相对较少，但处理较为复杂和困难，治疗有一定难度，使用动力髋与记忆合金环抱器同时进行内固定，方法简单，固定牢靠，患肢可早期进行功能锻炼，这种方法是治疗单侧肢体多处骨折较好的方法之一。     

胸腰椎椎弓根的解剖学测量及其临床意义

目的　观测胸腰椎椎弓根形态结构特征 ,为临床提供解剖学参数。方法　测量 31例成年男性椎骨T1～L5的横径、矢径、椎弓根间距及椎弓根通道长度。结果　横径 :T1～T6逐渐变小 ,T6～T12 逐渐增大 ,L1和L2 小于T12 ,L2 ～L5逐渐增大 ;矢径 :T1～T3 逐渐增大 ,T4～T7均小于T3 和T8,T7～T12 又逐渐增大 ,L1～L3 逐渐变小 ,L3 ～L5又逐渐增大 ,T1～L5均明显大于其横径 (P <0 0 1) ;模仿弓根通道长 :T1～T10 逐渐增长 ,T11和T12 均较T10 和L1短 ,L1～L4逐渐增长 ,L5较L4短 ;椎弓根间距 :T1～T4逐渐变窄 ,T5～L5逐渐增宽 ;左右侧比较无显著性差异 (P >0 0 5 )。结论　进行椎弓根螺钉固定时应根据不同节段椎弓根形态特点 ,结合影像学资料 ,选择相应的螺钉直径、长度、进钉部位及方向。     

脊柱侧凸患者椎弓根形态变化与椎弓根外固定术的应用

目的：观测脊柱侧凸患者胸椎弓根等结构的形态变化，于脊柱侧凸矫形术中应用自行设计的胸椎椎弓根外内固定技术，探讨其临床意义。方法：对30例脊柱侧凸患者行术前CT扫描，观测椎弓根形态变化及椎体旋转程度，主动脉位置变化等；对过窄或变形严重的椎弓根行胸椎椎弓根根外内固定，观察效果。结果：CT扫描发现，侧凸患者凹侧椎弓根直径明显窄于凸侧椎弓根直径，差异具有显著统计学意义（P〈0．05）。凹侧及凸侧椎弓根直径都明显小于相应肋骨．椎弓根单元直径，差异具有显著统计学意义（P〈0．05）。椎体呈楔形变，主动脉位置相对向后外侧移位；临床选择5例侧凸病人共24个胸椎弓根过细（小于2mm）或变形严重不适合经椎弓根内固定，而对这部分椎弓根行椎弓根根外内固定取得满意效果，无神经血管并发症发生，经3，6及12个月随访无螺钉拔出或松动，无矫正度丢失。结论：脊柱侧凸病人椎弓根等结构的形态发生了改变；在脊柱侧凸病人中应用胸椎椎弓根根外内固定技术具有操作简单安全、固定牢固可靠等优点，具有临床实用价值。     

以第四腰血管为蒂髂骨瓣转移修复腰椎缺损的应用解剖

在40侧灌注红色乳胶和2侧灌注碳素墨汁的成年尸体上对第四腰血管进行了观察和测量.第四腰动脉外径为3.0mm;主干长5.7cm,腹侧支动脉外径为1.4mm;长6.7cm,背侧支外径为1.4mm;长1.4cm.依据解剖学观察结果,设计了以第四腰血管为蒂髂骨瓣移植修复腰段椎体缺损的新术式,并对术中有关应用解剖学要点进行了讨论.