颈前路植骨钢板内固定治疗创伤性枢椎前滑移

目的 评价C2、C3椎体间植骨、钢板内固定治疗创伤性枢椎前滑移的临床价值。方法 8例创伤性枢椎前滑移患行颈前路手术复位、椎间盘切除减压、自体髂骨植骨、钢板内固定术，平均随访1年，观察患术后颈椎生理高度、曲度重建和颈椎稳定性、运动情况。结果 8例患均获得完全的枢椎复位，C2、C3椎体在术后16周达到骨性融合，颈椎生理高度、曲度得以重建，旋转、屈伸功能良好，无钢板螺钉并发症。结论 颈前路钢板内固定是治疗创伤性枢椎前滑移的有效方法。     

人Heparanase基因真核和原核表达载体的构建及融合蛋白的表达

目的：构建人Heparanase基因的真核、原核表达载体，大肠杆菌表达其融合蛋白．方法：采用反转录．聚合酶链反应从人肝癌细胞株HepG2cDNA中，分别扩增出Heparanase编码基因，用限制性内切酶BamHI消化后，插入真核表达载体pcDNA3．1中，经酶切鉴定与测序证实后，连接成包括完整的人Heparanase基因ORF区的真核表达载体，以亚克隆法构建于原核表达载体pRSET的相应酶切位点，转化大肠杆菌BL21菌株，异丙基β-D硫代半乳糖苷(IPTG)诱导产生融合蛋白．结果：构建的人Heparanase基因表达载体经序列测定证实，与GenBank登录结果完全一致；双酶切鉴定证实，克隆基因正确插入载体pcDNA3．1及pRSET；SDS-PAGE证实融合蛋白表达成功．结论：成功构建了人Heparanase基因真核、原核表达载体，成功正确表达了6His／Heparanase融合蛋白     

应用颈椎椎间融合器27例的临床分析

目的分析颈椎椎间融合器（CFC）临床应用的疗效。方法对27例植入CFC的脊髓型颈椎病随访3个月～3年，平均1．8年，观察CFC临床应用疗效。结果本组术后均无发生严重的并发症。影像学资料证实脊髓和神经根减压明显，椎间融合器（Cage）融合良好。术后JOA评分均恢复至15分以上，无症状恶化或复发者。结论Cage融合固定术治疗颈椎病有手术创伤小、无供区并发症、术后恢复快及手术成功率高等优点。     

Surgical treatment of symptomatic degenerative lumbar spondylolisthesis by decompression and instrumented fusion

Degenerative spondylolisthesis is characterized by the slippage of one vertebral body over the one below, with association of intervertebral disc degeneration and degenerative arthritis of the facet joints, which cause spinal stenosis. The aim of this study was to evaluate the clinical and radiographic results of 22 patients with symptomatic degenerative spondylolisthesis, operated on by decompressive laminectomy and instrumented posterolateral fusion associated with interbody fusion (PLIF). Mean age at surgery was 64 years (range, 57–72). Clinical results were evaluated on a questionnaire at the last follow-up visit concerning postoperative low back and leg pain, restriction of daily life activities, and resumption of sports activity. Lumbar spine radiographs were used to evaluate the status of fixation devices, the reduction of the spondylolisthesis, the lumbar sagittal balance and the presence of spinal fusion. No intraoperative or postoperative complications were encountered. There were no superficial or deep infections, fixation device loosening, or hardware removal. Mean follow-up time was 4 years (range, 3–6 years). Clinical outcome was excellent or good in 19 patients and fair in 3 patients. Preoperatively, mean forward vertebral slipping on neutral lateral radiographs was 5 mm, while postoperatively it decreased to 3 mm. Preoperatively, mean sagittal motion was 3 mm and angular motion was 8°, while postoperatively these values decreased to 1 mm and 1°, respectively. This study demonstrated that spinal decompression followed by transpedicular instrumentation associated with PLIF technique is a valid surgical option for the treatment of degenerative spondylolisthesis with symptomatic spinal stenosis. Clinical outcome, intended as relief of pain and resumption of activity, was improved significantly and fusion rate was high.     

腹腔镜辅助与小切口技术行前路L4/5椎间融合术的比较

目的:评价腹腔镜辅助与小切口技术在前路腰椎间融合术中的应用价值。方法:1998年4月～2005年1月行L4/5前路腰椎间融合术52例,腹腔镜辅助下前路椎间融合手术23例(A组),其中男13例,女10例,平均年龄37.9±1.8岁;腰椎滑脱症14例,退变性椎间盘疾患4例,腰椎术后综合征5例。小切口经腹膜后前路椎间融合手术29例(B组),其中男16例,女13例,平均年龄37.4±1.6岁;腰椎滑脱症21例,退变性椎间盘疾患3例,腰椎术后综合征5例。对两组患者围手术期参数和并发症进行统计学分析比较。结果:A组与B组分别平均随访23.5个月和21.2个月,两组临床优良率、椎间高度维持和植骨融合率均无显著性差异(P>0.05),A组手术准备和操作时间明显长于B组(P<0.05),其住院时间、术中出血量与小切口组无统计学差异(P>0.05)。并发症:A组4例,发生率17.4%;B组3例,发生率10.3%,两组有显著性差异((P<0.05)。结论:应用腹腔镜辅助和小切口技术进行L4/5椎间融合都可以达到良好的临床治疗效果,但从并发症和技术上分析,采用小切口经腹膜后行L4/5椎间融合更为合理和微创,操作方便、快捷,不需特殊设备。     

医用硫酸钙在家兔腰椎融合模型中的成骨能力

[目的]通过与自体髂骨进行比较,评价医用硫酸钙单独应用的成骨能力,并探讨其可能的成骨机理。[方法]建立家兔腰椎后外侧融合模型,以自身作为对照,双侧横突间植骨,左侧植入硫酸钙颗粒,右侧植入自体髂骨。于术后3、6、12周行X线、CT及组织学检查。[结果]术后3周,硫酸钙尚可见残留颗粒,自体骨完全降解;植骨区域内均可见到大量的破骨细胞,并有血管纤维组织长入。术后6周,硫酸钙完全降解,影像学检查两者之间没有明显的差异,表现为局部骨密度增高,新骨成形;组织学检查两侧植骨区内均为大量的透明软骨形成,自体髂骨植骨区内可见散在的骨小梁结构。术后12周,组织学及影像学上二者没有任何的差别,两侧形成的骨组织与家兔的椎体骨组织结构相同。[结论]医用硫酸钙作为骨移植替代材料,除了具有良好的骨传导性外,硫酸钙可能还具有骨诱导性,其成骨能力与自体髂骨相当,医用硫酸钙单独应用可以取得良好的融合效果。     

退变性症状性腰椎侧凸的手术治疗

[目的]探讨后路椎管减压、椎弓根螺钉间断固定、椎间植骨融合、矢状位重建术式治疗退变性症状性腰椎侧凸的临床效果。[方法]1999年1月-2006年4月，采用经后路椎管减压、椎弓根螺钉间断固定、椎间植骨融合、矢状位重建术式治疗退变性症状性腰椎侧凸37例，男21例，女16例；年龄51—82岁，平均62．6岁。所有病例拍摄腰椎正侧位片及Bending片，常规备CT和MRI。根据患者下肢症状行全椎板或半椎板减压，神经根扩大，椎间植骨融合及椎弓根螺钉间断固定。[结果]本组病例均获随访（1—6年，平均2年零7个月），术后临床症状均明显缓解，按JOA评分，手术疗效优良率91．9％，侧凸平均矫正率54．8％。随访期间无明显矫正度数及椎间隙高度丢失，术后3个月、1年复查X片内置物无松动及断裂，植骨融合时间平均11．6周。[结论]对于退变性症状性腰椎侧凸患者：（1）采取个体化治疗，年龄不是绝对手术禁忌证，病程长短不是决定手术疗效的重要指标；（2）后路椎管减压、椎弓根螺钉间断固定、椎间植骨融合、矢状位重建术是安全有效的理想术式。     

枕骨大孔区腹侧脑膜瘤的显微手术技术探讨

目的探讨远外侧入路在治疗枕骨大孔区腹侧脑膜瘤中的应用。方法对14例脑膜瘤患者采用远外侧入路显微手术治疗,其中枕髁后入路8例,经部分枕髁入路3例,经C1、2关节面侧方联合部分枕髁入路2例,经完整枕髁入路1例。结果肿瘤全切11例,次全切除3例;1例行枕颈融合,无手术死亡病例。所有患者术后均未出现寰枕关节不稳定的症状,手术并发症主要是后组颅神经损伤、椎动脉损伤、脑脊液漏以及脑干缺血。结论远外侧入路是手术治疗下斜坡区和上段颈髓腹侧、腹外侧病变的理想入路,可以理想显露肿瘤及其基底部并减少术中出血,但手术操作比较复杂且具有一定的风险。     

On the Use of Paramagnetic Beads and Ferrofluids to Assess and Eliminate the Leukocytic Contribution to Oxygen Radical Generation by Human Sperm Suspensions

PROBLEM: To develop a methodology to determine a) the leukocytic contribution to reactive oxygen species generation by human sperm suspensions and b) the therapeutic value of removing these cellular contaminants. METHODS: Leukocytes were removed with paramagnetic beads or colloidal ferrofluids coated with anti-CD45 antibody. The sperm suspensions were monitored for oxidant generation by chemiluminescence, leukocyte contamination by immunocytochemistry, and fertilizing potential using zona-free hamster oocytes. RESULTS: Percoll®-prepared human sperm suspensions exhibited a competence for PMA-induced reactive oxygen species generation which was significantly correlated with leukocyte contamination. However, the purified spermatozoa remaining after paramagnetic bead treatment, also demonstrated an intrinsic capacity for PMA-responsive reactive oxygen species generation and, freed from the oxidative stress created by the leukocytes, exhibited a significantly enhanced capacity for sperm-oocyte fusion. CONCLUSIONS: Although human spermatozoa can generate reactive oxygen species, sperm function is inhibited by the additional oxidative stress created by contaminating leukocytes. Removal of these cells with paramagnetic beads enhances fertilizing potential.