腰椎后路非融合固定系统的临床应用

复习腰椎后路非融合固定系统的设计原理、临床应用及治疗效果等相关文献,与传统的脊柱融合术相比,应用非融合系统可获得很好的疗效,并可以减少邻近节段退变的发生率。     

中医综合疗法治疗腰椎间盘突出症的临床观察

目的：观察中医综合治疗方式对腰椎闻盘突出症的临床治疗效果。方法：对近两年我院329例住院腰椎闻盘突出症患者进行针欠、推拿、牵引、中药等综合治疗。结果：治疗329例，显效108例，好转184例，无效37例，总有效率88．75％。结论：采用中医综合疗法治疗腰椎间盘突出症绝大部分病例明显有效，需要手术治疗的只占很小部分，保守疗法应该是腰椎间盘突出症首选的治疗方法。     

Vertebral body replacement system Synex in unstable burst fractures of the thoracic and lumbar spine

A prospective longitudinal study was performed to evaluate the vertebral body replacement system Synex associated with posterior fixation in unstable burst fractures of the lumbar and thoracic spine. Within 24 months, we treated 28 patients (average age, 41 years; range, 22–64 years; 14 women, 14 men) with acute unstable burst fractures without osteoporosis of the thoracolumbar region (n=16) and the thoracic (n=3) as well as the lumbar (n=9) spine in two stages (primary dorsal transpedicular stabilization and secondary vertebral body replacement). The complications were analyzed and the postoperative follow-up result was evaluated regarding stability, bone fusion, correction loss, pain and neurological status. One patient showed a transient irritation of the lumbosacral plexus and one patient had a superficial wound infection (complication rate, 7.1%). At the follow-up examination (mean follow-up, 13 months) only in two cases a minimal loss of correction (<5°) was measured. Radiologically, 27 patients showed secure bone fusions and all patients had stability of the osteosynthesis. Most of the patients stated no or just slight pain at follow-up. Only two patients with pain to a medium degree had to take painkillers. The vertebral body replacement system Synex seems to be a good alternative for vertebral body replacement in unstable burst fractures of the thoracic and lumbar spine since at present follow-up it shows a high rate of bone fusion and minimal loss of correction.     

腰椎融合术治疗原位复发性腰椎间盘突出症

目的探讨原位复发性腰椎间盘突出症再次手术的原因、手术方法及疗效。方法我院自2000年6月～2005年11月共收治17例原位复发性腰椎间盘突出症患者均采取椎板扩大开窗、椎间颗粒植骨融合、椎弓根钉内固定术,术后随访1～5年（平均19.7月）,进行回顾性分析。结果椎间植骨融合率为94.1%;按Macnab疗效评定标准,优良率为88.2%。结论原位复发性腰椎间盘突出症的主要原因是髓核组织摘除不彻底,神经根粘连,并伴随不同程度的椎管狭窄和腰椎不稳。明确诊断、严格掌握手术指征、认真细致地进行手术操作,可减少或避免手术并发症,取得优良的疗效。     

二次注射胶原酶治疗腰椎间盘突出症的临床研究

目的 讨论二次注射胶原酶治疗腰椎间盘突出症的可行性及适应证.方法 对82例行二次注射胶原酶治疗的腰椎间盘突出症患者进行随访并对其临床疗效进行总结分析.结果 82例患者随访3～12个月,疗效优51例,良13例,可8例,差10例,总优良率为78%,有效率为88%,本组患者无一例出现并发症.结论 只要严格掌握二次胶原酶注射治疗腰椎间盘突出症的适应证,做好术前、术中、术后的过敏反应预防措施,二次注射胶原酶治疗腰椎间盘突出症是安全有效的.     

A Decision Rule for Predicting Bacterial Meningitis in Children with Cerebrospinal Fluid Pleocytosis When Gram Stain Is Negative or Unavailable

Objectives:  Among children with cerebrospinal fluid (CSF) pleocytosis, the task of separating aseptic from bacterial meningitis is hampered when the CSF Gram stain result is unavailable, delayed, or negative. In this study, the authors derive and validate a clinical decision rule for use in this setting.
Methods:  This was a review of peripheral blood and CSF test results from 78 children (<19 years) presenting to Children's Hospital Columbus from 1998 to 2002. For those with a CSF leukocyte count of >7/μL, a rule was created for separating bacterial from viral meningitis that was based on routine laboratory tests, but excluded Gram stain. The rule was validated in 158 subjects seen at the same site (Columbus, 2002–2004) and in 871 subjects selected from a separate site (Boston, 1993–1999).
Results:  One point each (maximum, 6 points) was assigned for leukocytes >597/μL, neutrophils >74%, glucose <38 mg/dL, and protein >97 mg/dL in CSF and for leukocytes >17,000/mL and bands to neutrophils >11% in peripheral blood. Areas under receiver-operator-characteristic curves (AROCs) for the resultant score were 0.98 for the derivation set and 0.90 and 0.97, respectively, for validation sets from Columbus and Boston. Sensitivity and specificity pairs for the Boston data set were 100 and 44%, respectively, at a score of 0 and 97 and 81% at a score of 1. Likelihood ratios (LRs) increased from 0 at a score of 0 to 40 at a score of ≥4.
Conclusions:  Among children with CSF pleocytosis, a prediction score based on common tests of CSF and peripheral blood and intended for children with unavailable, negative, or delayed CSF Gram stain results has value for diagnosing bacterial meningitis.     

CT导向下医疗用臭氧治疗腰椎间盘突出症

目的观察CT导向下医用臭氧治疗腰椎间盘突出症的疗效。方法30例腰椎间盘突出症患者,术前均经CT或MRI检查证实。在CT导向下行臭氧消融治疗。盘内注入浓度为60μg/ml臭氧10-20 ml,退针出纤维环至椎间孔附近,注入浓度为40μg/ml臭氧5 ml。结果随访时间1-6个月,显效7例,有效18例,无效5例,总有效率为80.3%,未发生任何明显并发症。结论CT导向下医用臭氧局部注射是治疗腰椎间盘突出症的一种有效方法。     

整脊疗法对功能性消化不良患者胃动素、胃泌素的影响

目的：观察整脊疗法对功能性消化不良患者血浆胃动素（MTL）和血清胃泌素（GAS）含量的影响，并探讨整脊疗法对该病的作用机制。方法：将功能性消化不良60例患者按随机分配原则分为两组，治疗组采用整脊疗法治疗，对照组口服贝络纳治疗，观察血浆胃动素、血清胃泌素含量的变化。结果：整脊疗法能提高MTL水平（P〈0．01），降低GAS（P〈0．05），其作用与贝络纳相仿。结论：通过对功能性消化不良患者血浆胃动素、血清胃泌紊含量变化的观察，整脊疗法可能通过调节脑一肠轴的脊柱前神经节影响胃肠神经系统改变胃肠黏膜分泌MTL和GAS的含量，改善胃肠功能。     

胸腰椎病变CT监视下穿刺活检路径分析

目的探讨胸腰椎病变CT监视下穿刺活检中穿刺路径的选择方法。方法141例胸腰椎病变临床诊断不清患者，其中胸椎70例，腰椎71例。根据病变位于脊椎的不同部位选择合适的穿刺路径，于CT监视下穿刺取材。穿刺路径：经椎旁路径63例，经椎弓根路径45例，经肋椎关节路径11例，其他路径22例。结果141例中共有128例诊断正确，穿刺结果诊断正确率为90．8％。无并发症发生。结论胸腰椎病变穿刺路径的选择要根据病变的位置不同具体分析。总的原则是安全、取材量多、对患者损伤小。     

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。