选择性椎管减压术治疗腰椎管狭窄症56例临床探讨

目的:探讨选择性椎管减压术治疗腰椎管狭窄症的临床效果。方法:根据术前检查,对腰椎管狭窄症56例选择经后正中切口一侧或两侧棘突旁入路,选择性部分椎板、椎小关节节段性减压。结果:术后随访6~40个月,平均20个月,56例中,优37例,良12例,中5例,差2例,优良率85.71%。均达到了症状完全或大部缓解,使患者早期即能恢复日常活动。结论:本术式既起到椎管彻底减压的目的,又尽可能保留了脊柱后柱结构的完整性和稳定性,减少椎管减压术后综合征的发生。     

一种新型颈椎椎弓根置钉定位器的研制

介绍一种可三维调节的颈椎椎弓根置钉定位器,该装置作为钻模应用于颈椎椎弓根的钻孔定位,实现个体化置钉。给出了设计原理、使用方法,推导出椎弓根术前影像学数据与定位器钻套调整角的关系,并编制了计算应用软件。进行了功能评价和误差分析。     

Socioeconomic impact of children's burns—A pilot study

ObjectiveThis pilot study aimed to gain empirical data on the social and economic impacts of child burns on children and parents, in the context of the outpatient setting.MethodA questionnaire was completed by 52 parents of paediatric patients attending the burns outpatient department at Queen Victoria Hospital (QVH), East Grinstead, for at least the third time. Children's medical notes were used to extract demographic and medical data. Quantitative data was analyzed statistically and qualitative data was analyzed manually using content analysis.ResultsThe financial burden related to the injury posed the greatest impact on parents, and was mainly associated with making the journey to the hospital, with lower income households being most affected. Self-employed parents and those who had to attend more than 6 hospital appointments also ran into difficulties. On the whole, there was not a considerable social impact on the burn-injured child, which may reflect the minor nature of burns in this study (mean depth partial thickness, median TBSA 1.0%).ConclusionParents were shown to perceive a greater impact from their child's burn injury than their child. Certain groups of parents were identified as requiring additional support following the burn injury.     

温针灸配合手法治疗第三腰椎横突综合征

目的：探讨温针灸配合手法治疗第三腰椎横突综合征的疗效.方法：将100例第三腰椎横突综合征患者随机分为对照组（50例）和治疗组（50例）,治疗组采用温针灸配合手法治疗,对照组则单纯采用针灸治疗,一个疗程后观察疗效.结果：治疗组治愈率高于对照组（P＜0.01）,两组总有效率无显著性差异（P＞0.05）.结论：温针灸配合手法治疗第三腰椎横突综合征疗效显著.     

Relationship among Cervical Spine Degeneration,Head and Neck postures,and Myofascial Pain in Masticatory and Cervical Muscles in Elderly with Temporomandibular Disorder

ObjectivesThe aim of the study was to verify associations among degenerative changes in the cervical spine, head and neck postures, and myofascial pain in the craniocervical musculature in elderly with myofascial temporomandibular disorders (TMDs).MethodsA total of 120 participants (mean age, 68.3 ± 7.5 years) were included: 45 participants had no signs of orofacial or cervical pain, 26 participants had myofascial TMD only (mTMD), and 49 participants had both myofascial TMD and cervical pain (cerTMD). Participants were diagnosed according to the Research Diagnostic Criteria for Temporomandibular Disorders. Cervical spine degeneration and head and neck postures were identified using the lateral cephalogram. Myofascial trigger points (TrPs) were evaluated in the temporalis, masseter, trapezius, sternocleidomastoid, sub-occipitalis, and splenius capitis muscles. Relationships among number of TrPs, head postures, and cervical degeneration were investigated using repeated-measure analysis of variance and Pearson’s correlation coefficient.ResultsThe cerTMD showed higher number of active TrPs in the masticatory and cervical muscles, greater forward head posture, and more severe degenerative changes in the cervical spine than mTMD did. The degenerative changes in each level of the cervical spine had complex interactions with head postures. Cervical degeneration, particularly at level of second to third vertebra appeared to be linked to the development of active TrPs in the masticatory and cervical muscles.ConclusionsThe results of this study demonstrated that degenerative changes in the cervical spine were related to altered head postures and the development of active TrPs in the craniocervical musculature in elderly with myofascial TMD.     

Thoracic vertebra interbody fusion surgery with robotic assisted system in a swine model

Minimally invasive procedures have been increasing in spine surgery, and interest in robotic systems has inclined. In this study, we aimed to evaluate feasibility of a robotic-assisted thoracic spine interbody fusion in a swine model. Neurosurgeons performed the surgical procedures with robotic surgery certificates on the Da Vinci Xi Surgical System. Surgical approaches were applied using four ports while the swine was in the left lateral position. The surgical procedure was accomplished in 70 min including positioning and preparation of robotic system (20 min), placement of ports and thoracic dissection and confirmation of level with the C-arm system (10 min), discectomy and cage insertion (15 min), control of cage position via the C-arm system and closure (10 min). This study showed the anterior thoracic approach with robotic surgery is safe and feasible with providing a wide working area and high image quality.     

多裂肌间隙入路与经皮入路联合伤椎置钉治疗无神经损伤的胸腰段椎体骨折的对比研究

目的 探讨多裂肌间隙入路和经皮入路分别联合伤椎置钉治疗无神经损伤胸腰段椎体骨折的临床疗效。方法 回顾性分析苏州大学附属第一医院2015年1月-2018年1月采用多裂肌间隙入路和经皮入路分别联合伤椎置钉治疗无神经损伤的胸腰段椎体骨折的52例患者的临床资料。经多裂肌间隙入路患者25例(A组),男19例、女6例,年龄35~67 (49.84±9.11)岁;经皮入路患者27例(B组),男20例、女7例,年龄21~66(48.44±11.02)岁。比较两组患者一般资料,以及手术出血量、手术时间、术后镇痛药物使用率、术后下地时间及术后住院时间;手术前后不同时间点的腰背部疼痛视觉模拟评分(VAS);比较两组手术前、术后下地前及术后12个月时伤椎前缘高度比值和矢状位Cobb角变化。结果 两组患者一般资料比较差异均无统计学意义(P值均＞0.05)。均顺利完成手术,术后随访12个月。A组的手术时间、术后下地时间分别为120(90,136)min、2(1,3)d,均短于B组的144(110,220)min、4(2,5)d,差异均有统计学意义(P值均＜0.05);A组术后使用镇痛药物例数(2例)少于B组(15例),差异有统计学意义(P＜0.05);两组患者手术出血量、术后住院时间差异均无统计学意义(P值均＞0.05)。两组患者术后VAS评分均较术前有明显改善,差异均有统计学意义(P值均＜0.01);A、B组间术前、术后12个月VAS评分比较,差异均无统计学意义(P值均＞0.05),但术后第3天VAS评分比较,A组低于B组,差异有统计学意义(P＜0.05)。两组患者术后下地前及术后12个月伤椎前缘高度比值、矢状面Cobb角较术前改善明显,差异均有统计学意义(P值均＜0.05),但两组间同时间点伤椎前缘高度比值和矢状面Cobb角比较差异均无统计学意义(P值均＞0.05)。结论 多裂肌间隙入路和经皮入路分别联合伤椎置钉治疗无神经损伤的胸腰段椎体骨折均取得良好疗效,在改善骨折畸形及远期腰背部疼痛上无明显差异,但经皮入路手术时间更长、术后短期腰背部疼痛更严重、下地时间更晚,相较于多裂肌间隙入路手术并不具有明显优势。     

长臂单轴椎弓根螺钉在单纯性胸腰椎压缩性骨折复位固定中的应用及对肌肉损伤的影响

目的分析长臂单轴椎弓根螺钉经 Wiltse入路在单纯性胸腰椎压缩性骨折中的应用效果及对肌肉损伤的影响。方法选取自 2018年 1月至 2020年 8月周口市中心医院收治的单纯性胸腰椎压缩性骨折病人 87例，根据复位固定术式不同，分为观察组 38例、对照组 49例，其中观察组采取长臂单轴椎弓根螺钉经 Wiltse入路，对照组采取 AF系统经传统后正中入路。记录两组病人围术期指标、手术前后血清肌肉损伤指标［肌酸激酶( CK)、肌红蛋白( Mb)］变化；采用疼痛视觉模拟评分( VAS)评价病人不同时间节点疼痛水平；经胸腰椎正侧位片检查获取伤椎原始高度( H0)、术前及术后 1周伤椎椎体前缘高度( H1H2)，计算术前、术后 1周伤椎相对高度( H1/H0、H2/H0)及伤椎复位率，并测量矢状位 Cobb角变化；随访 3个月，采用 Oswestry功能障、碍指数( ODI)评价功能障碍情况，并统计手术相关并发症。结果观察组手术时长、术中失血量、术后引流量及首次下床活动时间均明显短于或低于对照组( P<0.05)。术后 3d，两组血清 CK、Mb水平均较术前升高( P<0.05)，且观察组血清 CK、Mb水平     

Current evidence on where to end a fusion within the thoracolumbar junction most preferably – A systematic literature review

Proximal junctional kyphosis (PJK) is one main complication in the surgical treatment of adult spinal deformities. Ending within the thoracolumbar junction (TLJ) should but cannot always be avoided to reduce the risk for PJK. With this systematic review we sought to define the most preferable vertebra within the TLJ to minimize the risk for PJK and establish recommendations based on our findings. We conducted a systematic literature review by scanning the MEDLINE database in accordance with the PRISMA criteria. All articles addressing primary long-distance dorsal thoracolumbar fusion of at least three segments to treat adult spinal deformities were included. 1385 articles were identified and three were included to this review. The first study showed significantly higher rates of PJK in patients where the construct was extended to T7 or higher when compared to an ending at T11 to L1. The second article stated that an expansion to the TLJ resulted in significantly less surgical revisions due to PJK reduction. On the other hand, the third article found that a fusion of the whole thoracic spine reduces the PJK incidence postoperatively. Even though the most favorable vertebra within the TLJ to avoid PJK best could not yet be determined, our study identifies several principles that represent the current state of evidence for surgical treatment of adult scoliosis. Proper preoperative decision making based on thorough analysis and interpretation of the patient's sagittal alignment parameters can improve the individual outcome critically.