改良应用股骨髓腔绞刀行腰椎椎间植骨融合术

目的探讨应用普通股骨髓腔扩大绞刀代替专用的椎间植骨器械,进行腰椎后路椎间植骨融合术的临床经验体会,评估治疗效果。方法对我院34例应用股骨髓腔绞刀进行腰椎后路椎间植骨融合术的病例资料,进行回顾性分析。结果本组34例无围手术期硬膜及神经根损伤,无伤感染和和植骨块松脱。随访5～6年,植骨全部于6～8个月愈合,无一例植骨塌陷。按Machnab标准评定：优21例,良11例,可2例,差0例,优良率94.12%。结论改良应用股骨髓腔扩大绞刀代替专用的椎间植骨器械,作椎间植骨床的准备,效果满意,安全方便。     

Nonoperatively treated burst fractures of the thoracic and lumbar spine in adults: a 23- to 41-year follow-up

BACKGROUND CONTEXT: Several studies report a favorable short-term outcome after nonoperatively treated two-column thoracic or lumbar burst fractures in patients without neurological deficits. Few reports have described the long-term clinical and radiological outcome after these fractures, and none have, to our knowledge, specifically evaluated the long-term outcome of the discs adjacent to the fractured vertebra, often damaged at injury and possibly at an increased risk of height reduction and degeneration with subsequent chronic back pain. PURPOSE: To evaluate the long-term clinical and radiological outcome after nonoperatively treated thoracic or lumbar burst fractures in adults, with special attention to posttraumatic radiological disc height reduction. STUDY DESIGN: Case series. PATIENT SAMPLE: Sixteen men with a mean age of 31 years (range, 19-44) and 11 women with a mean age of 40 years (range, 23-61) had sustained a thoracic or lumbar burst fracture during the years 1965 to 1973. Four had sustained a burst fracture Denis type A, 18 a Denis type B, 1 a Denis type C, and 4 a Denis type E. Seven of these patients had neurological deficits at injury, all retrospectively classified as Frankel D. OUTCOME MEASURES: The clinical outcome was evaluated subjectively with Oswestry score and questions regarding work capacity and objectively with the Frankel scale. The radiological outcome was evaluated with measurements of local kyphosis over the fractured segment, ratios of anterior and posterior vertebral body heights, adjacent disc heights, pedicle widths, sagittal width of the spinal canal, and lateral and anteroposterior displacement. METHODS: From the radiographical archives of an emergency hospital, all patients with a nonoperatively treated thoracic or lumbar burst fracture during the years 1965 to 1973 were registered. The fracture type, localization, primary treatment, and outcome were evaluated from the old radiographs, referrals, and reports. Twenty-seven individuals were clinically and radiologically evaluated a mean of 27 years (range, 23-41) after the injury. RESULTS: At follow-up, 21 former patients reported no or minimal back pain or disability (Oswestry Score mean 4; range, 0-16), whereas 6 former patients (of whom 3 were classified as Frankel D at baseline) reported moderate or severe disability (Oswestry Score mean 39; range, 26-54). Six former patients were classified as Frankel D, and the rest as Frankel E. Local kyphosis had increased by a mean of 3 degrees (p<.05), whereas the discs adjacent to the fractured vertebrae remained unchanged in height during the follow-up. CONCLUSIONS: Nonoperatively treated burst fractures of the thoracic or lumbar spine in adults with or without minor neurological deficits have a predominantly favorable long-term outcome, and there seems to be no increased risk for subsequent disc height reduction in the adjacent discs.     

经皮等离子消融髓核成形术治疗腰椎间盘突出症: 28例随访报告

目的 探讨腰椎间盘突出症的治疗方法。方法经体格检查，CT和／或MRI检查确诊的腰椎间盘突出症患者28例，采用等离子消融髓核成形术治疗，以Prolo功能和经济结果评定法和VAS评分评定疗效。结果髓核成形组总体治疗成功率82．1％；平均住院时间7．6天，复发率10．8％。并发椎间盘炎1例，进行腰椎融合术后治愈。结论髓核成形术治疗腰椎间盘突出症的满意率较高，复发率低，住院治疗时间短，创伤小，不影响再次手术治疗。髓核成形术是一种安全、有效的治疗腰椎间盘突出症的微创介入治疗新方法。     

椎间盘镜系统治疗腰椎间盘突出症550例

目的探讨椎间盘镜系统治疗腰椎间盘突出症的疗效. 方法改进部分手术器械,采用膝胸坐位,穿刺黄韧带进入椎管等方法,应用METRx进行腰椎间盘取出术550例. 结果随访6～36个月,平均21个月,疗效参考Nakai标准,优478例 (86.9%),良60例(10.9%),可6例(1.1%),差6例(1.1%).疗效差6例再次镜下扩大侧隐窝清理残留髓核疗效转良. 结论 METRx下行腰椎间盘取出术,创伤小、安全、疗效好,值得推广.     

ANALYSIS OF BURIED BUMPER SYNDROME AFTER PERCUTANEOUS ENDOSCOPIC GASTROSTOMY DUE TO USE OF A BUTTON‐TYPE KIT

Background: Buried bumper syndrome (BBS) is a rare complication of percutaneous endoscopic gastrostomy (PEG). Along with the widespread use of the button‐type kit, BBS is encountered frequently. Methods: In the present study, we examined causes and treatments for BBS among 1400 patients who had undergone PEG. Results: The causes of BBS after PEG were classified into two categories: early causes consisted of wound infection, inappropriate size of kit and severe lordosis, while late causes were inappropriate exchange of kit, rough management or weight gain. The treatments for BBS could be determined by the degree of wound infection, fistula and burial of the bumper. Conclusion: We prepared a flowchart for replacement, by which BBS can be managed safely and quickly without surgical or endoscopic intervention.     

Minimum incision endoscopic nephrectomy for giant hydronephrosis

Five consecutive patients with symptomatic giant hydronephrosis underwent minimum incision endoscopic nephrectomy. The originally huge renal specimen was retroperitoneally mobilized using both of endoscopy and direct vision, without the use of trocar ports or gas insufflation, via a single minimum incision that narrowly permitted extraction of the specimen. The specimen was successfully extracted from the incision in all patients. Technically, proper deflation of the hydronephrotic sac facilitates mobilization and enables extraction of the specimen. Median (range) size of incision, operative time, and estimated blood loss were 4 cm (3-5), 205 min (156-222), and 210 mL (110-350), respectively. No patient required blood transfusion or encountered operative complications. Postoperative convalescence was short and uneventful; all patients resumed oral intake and ambulance on the day following surgery, and were physically dischargeable from hospital after 2-3 postoperative days. Thus, this technique is a feasible, minimally invasive and safe procedure for symptomatic giant hydronephrosis.     

Sequential bilateral minimum incision endoscopic radical nephrectomy in dialysis patients with bilateral renal cell carcinomas

Since 1998, we have performed minimum incision endoscopic surgery (MIES) for renal cell carcinoma (RCC). For seven dialysis patients with bilateral RCC, we have performed sequential bilateral MIES radical nephrectomy. It was carried out by retroperitoneal approach through a single minimum incision that narrowly permitted extraction of the specimen using endoscopy and direct stereovision, without trocar ports, without gas insufflation and without the insertion of the hands of operators into the operative field. Although six of the seven patients had multiple complications in addition to chronic renal failure (CRF), bilateral kidneys were successfully removed by sequential MIES radical nephrectomy without major operative complication. Postoperative recovery was prompt with all patients resuming oral feeding and walking by the second postoperative day. Sequential bilateral MIES radical nephrectomy, leaving the peritoneal cavity intact and without imposing circulatory stress caused by gas insufflation, is a feasible treatment for bilateral RCCs in dialysis patients.     

Percutaneous nephrolithotomy of a staghorn stone in thoracic ectopic kidney

Congenital thoracic ectopic kidney is a very rare developmental anomaly and the rarest form of all ectopic kidneys. It is usually asymptomatic and discovered incidentally on routine chest radiography. Herein we reported the first case of staghorn stone in a thoracic kidney managed successfully by percutaneous nephrolithotomy.     

椎弓根固定结合椎体成形术治疗胸腰椎爆裂骨折

目的探讨椎弓根固定结合经椎弓根椎体内植骨行椎体成形术治疗胸腰椎爆裂骨折的疗效。方法采用椎管环形减压、短节段椎弓根螺钉系统固定结合经椎弓根椎体内植骨治疗胸腰椎爆裂骨折116例,其中93例获得随访。术前及术后随访行X线和CT检查,测量伤椎椎体中央高度值,比较植骨后椎体高度的恢复程度,同时观察植骨融合情况。采用配对t检验方法进行统计学分析。结果93例患者术后平均随访24.2个月,90%以上患者伤椎椎体高度恢复并维持良好,无塌陷。伤椎椎体中央高度值犤T12(3.14±0.41)cm,L1(3.33±0.34)cm犦与正常值犤(T12(3.26±0.38)cm,L1(3.47±0.61)cm)犦比较,差异无显著性意义(P>0.05)。未出现植骨操作引起的神经血管并发症。CT显示椎体内植骨块边缘模糊,融合良好,植骨块无吸收现象。结论后路椎管环形减压及内固定时,经伤椎椎弓根进行椎体内植骨行椎体成形术可恢复伤椎椎体高度,重建前、中柱的稳定性,预防术后椎体塌陷的发生。     

窥视下尿道内切开术治疗尿道狭窄或闭锁

采用窥视下尿道内切开术治疗尿道狭窄或闭锁５３例，其中４８例治疗成功。狭窄闭锁段≤３ｃｍ者，单纯冷刀切开即可；＞３ｃｍ者，冷刀切开后需加电刀切除疤痕组织，扩大尿道，尿道内皮管植入。３６例患者术后随访１～８年（平均４年６个月），２７例排尿通畅，尿流率和性功能正常。本文就操作要点和并发症防治等进行了详细讨论。