体重对腰椎后路开窗减压手术疗效的影响

目的对不同体重老年腰椎管狭窄患者行单纯腰椎后路开窗减压手术,并评价其治疗效果。方法回顾性分析1996年12月～2002年12月间145例因老年腰椎管狭窄而采用单纯腰椎后路开窗减压手术治疗患者的病例资料,结合问卷调查患者对手术的满意程度,比较不同体重患者住院期间及术后症状改善情况,评估手术疗效。结果不同体重患者术后腰腿疼痛明显缓解、日常生活质量改善,患者对手术的满意率达67.59%。而且患者的各种统计数据表明,不同体重组之间差异无显著性意义(P>0.05)。结论体重在一定程度上影响老年腰椎管狭窄患者的手术治疗结果。单纯腰椎后路开窗减压手术,可以达到较为理想的治疗效果。     

颈椎前路减压术治疗脊髓型颈椎病

目的探讨脊髓型颈椎病的手术疗效。方法对诊断明确症状较重的12例脊髓型颈椎病患者采用前路减压、植骨融合、钛板内固定。结果所有病例随访6~18个月,术后3个月椎间植骨达骨性融合,症状消失或明显改善,除1例钢板松动术后第5天再次手术外,未见食道损伤、喉返神经损伤等并发症。结论颈椎前路手术治疗脊髓型颈椎病具有减压彻底、融合率高、内固定牢靠的优点,虽手术风险较大,但如操作细致,仍可避免一些并发症的发生。     

枕下乙状窦后锁孔入路三叉神经内镜解剖学研究

目的 为经枕下乙状窦后锁孔入路行神经内镜三叉神经痛微血管减压术提供解剖学依据。方法 测量28具干性颅骨表面标志位置关系，确定枕下乙状窦后锁孔位置；在15具尸头上采用内镜模拟手术，观察入路中主要神经、血管等解剖标志的分支、变异情况和周期毗邻关系。结果 ①以星点-乳突尖连线中点为圆心作2.0cm直径的骨窗，可以充分显露桥小脑角区。②采用不同角度内用神经内镜可以减少对脑神经、脑干、小脑的牵拉，能够更好地显露小脑角结构，准确确定责任血管。     

Segmental fixation with U-shaped rod in the treatment of spondylolisthesis

Summary From 1987 to 1990 the authors treated 20 cases of spondylolisthesis by an improved operative procedure including excision of the medial part of the superior articular processes of the slipped vertebra, excision of the soft tissue between the ununited isthmi, and excision of the ligamentum flavum between the intervertebral space above the slipped segment. In some instances the lower portion of the lamina over the slipped vertebra should be resected. A U-shaped rod was used to hold sublaminar fixation of two segments above and below the slipped vertebra, with the slipped vertebra spared. Utilizing the U-shaped rod as support, bone strips were placed along the lateral and anterior sides of the rod to bridge the gap between the laminae of the displaced vertebra. Other bone grafts were focused on the facet joints. The patients were allowed ambulation early postoperatively. 19 cases could be evaluated at preliminary follow-up. All showed satisfactory results.     

The abnormal anatomy of cleft lip and its correction

Summary The importance of the premaxillary position, size and shape in the development of the face and nose is discussed. The anthropological development of the premaxilla is studied. These factors are to be considered when cleft lip repairs are being planned and developed. Several cases are presented and discussed.     

颈椎前路钢板在脊髓型颈椎病前路手术中的作用

目的 评价内固定在脊髓型颈椎病前路减压中的作用。方法 143例脊髓型颈椎病患者经前路减压后自体髂骨植骨，带锁钢板内固定。获得随访病例132例，随访时间平均20个月，观察术后神经功能恢复情况，植骨融合率，椎间高度及颈椎生理曲度恢复情况。结果 单节段与两节段病变者术后3月均获得骨性愈合，融合率为100％，16例3节段病变者融合体为81．3％，内固定并发症为5／132(3．8％)。术后椎间高度与生理曲度均获得满意重建。JOA记分平均改善率65．8％。结论 在脊髓型颈椎病前路减压手术中应用带锁钢板内固定可有效维持椎间高度和生理曲度，并有助于后路间接减压。     

颈椎椎体次全切除钛网钉板系统的临床应用

目的探讨颈椎前路椎体次全切除钛网钉板植骨融合的临床效果。方法自2001年3月～2003年3月间应用颈前路椎体次全切除钛网植骨融合及钉板固定治疗颈椎管狭窄性疾病22例，其中4例患者行2椎体次全切除3节椎间隙减压手术。术后观察减压、固定、融合及神经功能恢复情况，并行X线摄片或CT扫描检查。结果患者获6～12个月随访，神经功能得到不同程度改善，无加重情况。椎间隙高度无丢失、无成角，均获得骨性融合。术后3d在颈围领固定下下床活动，4周后可恢复较轻工作。结论此术式可避免传统手术方法的缺点，即不取自体髂骨，融合率高，稳定性好，并减压彻底，疗效好，是一种值得推广的新技术。     

应用联合减压术治疗中晚期脑疝疗效观察

目的　观察联合减压术治疗特重型颅脑损伤合并嵌顿性脑疝的效果。方法　将 97例格拉斯哥昏迷评分 (GCS) 3～ 5分的特重型颅脑损伤合并嵌顿性脑疝患者随机分为两组 ,分别采用联合减压术 (46例 )与常规骨瓣开颅术 (5 1例 )治疗 ,术后两组均经常规治疗。随访 1～ 32个月 ,平均 7个月。比较两组患者临床疗效、颅内压变化及并发症发生率。结果　联合减压治疗组有效率为 80 .4 % (37/ 4 6例 ) ,其中恢复良好、中残2 7例 (占 5 8.7% ) ,重残 10例 (占 2 1.7% ) ,死亡 9例 (占 19.6 % ) ;常规骨瓣开颅术对照组有效率为 33.4 %(17/ 5 1例 ) ,其中恢复良好、中残 6例 (占 11.8% ) ,重残 11例 (占 2 1.6 % ) ,死亡 34例 (占 6 6 .6 % ) ,两组有效率和病死率比较差异均有显著性 (P均 <0 .0 1)。联合减压治疗组患者颅内压下降速度和程度优于常规骨瓣开颅术对照组 (P<0 .0 5 )。联合减压治疗组患者的急性脑膨出、切口疝、切口脑脊液漏、外伤性癫疒间及术后枕叶脑梗死发生率均明显低于常规骨瓣开颅术对照组 (P<0 .0 5或 P<0 .0 1) ,但两组术后颅内感染发生率差异无显著性 (P>0 .0 5 )。结论　联合减压术治疗特重脑损伤合并嵌顿性脑疝患者的疗效优于常规骨瓣开颅术。     

Spinal cord restitution following compression injuries in rats

Spinal cord compression injuries were produced in rats by applying weights to a plate 2.2 x 50 mm in size, placed on the exposed midthoracic dura covering the spinal cord. The influence of force and duration of compression was studied by using 3 different weights, 20, 35 and 50 g, applied for 1, 5 and 10 min. Postoperative neurological function was tested by the inclined plane method and the rats were observed for 3 weeks. Neurological impairment increased with force and duration of compression. It is therefore reasonable to conclude that patients suffering from spinal cord injury should be investigated immediately for signs of persistent cord compression. If this is present, early decompression might be of value, although nothing is known in man concerning the limits of force and duration of compression permitting postoperative neurological recovery.     

颈前路带锁钛板在脊髓型颈椎病手术中的应用

目的评价脊髓型颈椎病前路减压后应用带锁钛板内固定的价值。方法对51例脊髓型颈椎病患者采用前路减压、取自体髂骨植骨和颈椎带锁钛板内固定治疗。结果随访43例,平均随访时间2a,术后3个月植骨块获得骨性融合,颈椎椎间高度和生理曲度维持满意,感觉、肌力明显恢复,钛板及螺钉无松动及断裂现象。结论脊髓型颈椎病前路减压术后应用带锁钛板内固定能促使植骨块融合,有效地维持椎间高度和颈椎生理曲度,有较高的应用价值。