计算机体层成像多平面重建在评价椎间融合中的作用

目的 探讨计算机体层成像多平面重建(CTMPR)在评价椎间融合中的作用,寻找定量评价椎间融合的新方法.方法 13例行腰椎间融合的患者术后1周、3个月、6个月行CTMPR,行椎间融合器(Cage)内植骨CT值定量测量.结果 术后1周Cage内植骨CT值为(619.52±26.97)Hu,术后3个月为(628.69±42.60)Hu,术后6个月为(657.77±37.43)Hu.术后1周与术后3个月相比无显著性差异,与术后6个月相比有显著性差异.结论 CT值的测量在椎间融合的判断中具有高准确性.     

注射型磷酸钙骨水泥在椎体成形术中的组织学研究

目的 模仿椎体成形术观察注射型磷酸钙骨水泥(CPC)／聚甲基丙烯酸甲（polymethylmethacrylate，PMMA)植入椎体后的微观结构变化。方法 将PMMA和CPC植入到犬椎体，通过X线、CT、光镜、扫描电镜观察二种材料与椎体界面间的微观结构变化。结果 PMMA与椎体之间的结合是单纯的机械连接未能达到生物机械固定，CPC与骨界面间无排异反应的表现，是直接的骨小梁与生物材料之间的生物连接，CPC与椎体之间的结合是生物连接可达到生物机械固定的目的。结论 磷酸钙骨水泥是椎体成形术中治疗胸腰椎爆裂骨折一种比较理想的材料。     

杂交分离手术治疗伴有脊髓压迫症状的胸腰椎转移瘤的疗效观察

目的:评估杂交分离手术治疗伴有脊髓压迫症状的胸腰椎转移瘤的临床疗效。方法 :回顾性分析2013年6月～2018年6月我院收治的28例因伴有脊髓压迫症状的胸腰椎转移瘤行手术治疗患者的临床资料,其中男18例,女10例,年龄57.0±10.8岁(41～77岁)。原发肿瘤类型:肺腺癌12例,肺鳞癌2例,肺神经内分泌癌1例,直肠腺癌6例,肾透明细胞癌3例,乳腺癌2例,肝细胞癌1例,前列腺癌1例。肿瘤侵犯脊柱部位:单发胸椎转移13例、腰椎转移11例,多发胸椎转移2例、腰椎转移1例,胸腰椎转移1例。术前Frankel分级A级1例,B级5例,C级6例,D级16例;疼痛视觉模拟评分(visual analogue scale,VAS)为7.3±0.8分;Tomita评分5.9±0.9分(4～7分);硬膜外脊髓压迫(epidural spinal cord compression,ESCC)评分1b级3例,1c级9例,2级8例,3级8例。均行杂交分离手术,具体方法包括后入路椎体肿瘤部分切除减压、骨水泥钛网支撑、骨水泥填充封闭、椎弓根螺钉内固定术。统计手术时间、术中出血量、术后住院天数,术后即刻及术后3个月时的Frankel分级,术后7d及术后3个月时的VAS评分,美国东部肿瘤协作组(Eastern Cooperative Oncology Group,ECOG)体力状况评分,术中和术后相关并发症情况以及患者生存期。结果 :手术时间为202.0±34.7min(140～285min),术中出血量为819.6±150.0ml(500～1100ml),术后住院日为13.2±3.9d(7～22d)。术中及术后并发症:脑脊液漏3例,切口感染3例,尿路感染1例,肺部感染1例,术后急性神经根刺激症状3例,随访至12个月时发生钛网移位1例。术后7d、3个月VAS评分及ECOG评分与术前比较均有显著性改善(P0.05)。中位随访时间为20.5个月(6～42个月),平均随访时间为21.3±10.0个月,至末次随访有6例存活,其中1例于术后30个月时出现椎体新发转移,行二次手术后仍带瘤生存,至末次随访时存活时间为38个月。结论:杂交分离手术治疗伴有脊髓压迫症状的胸腰椎转移瘤能够明显减轻脊髓压迫,改善患者神经功能,缓解疼痛,提高生活质量。     

聚内消旋乳酸椎间融合器的生物力学测试

目的 研制用聚内消旋乳酸(PDLLA)制成椎间融合器,通过动物实验,考察其生物力学变化情况,为进一步加以改进和临床应用提供动物实验的基础.方法 通过光镜观察椎间植骨融合情况.通过生物力学测试,检测脊柱融合的不同阶段,使用可降解椎间融合器引起的椎间融合的生物力学变化.结果 椎间植骨融合良好.材料本身的力学强度高于骨组织,因此,早期的力学结果显示其抗压、抗扭强度均明显高于对照组.后期随着材料的降解,其力学特性也随之改变,逐渐与对照组结果相近.结论 材料对植骨融合无负面影响.PDLLA材料在椎间植骨融合过程中,可提供足够的力学强度.保证植骨部位的融合,避免塌陷.     

注射型磷酸钙骨水泥和PMMA在椎体成形术中的生物力学研究

目的模仿椎体成形术观察注射型磷酸钙骨水泥(calcium phosphate cement CPC)/聚甲基丙烯酸甲酯(polymethylmethacrylate,PMMA)植入椎体后的生物力学改变.方法将PMMA和CPC通过手术植入到犬椎体,经过8周和16周后分别取材,行X线、CT检查,并测定不同时间椎体的轴向抗压强度和抗扭转强度.结果(1)植入早期,PMMA的抗压强度明显高于正常椎体和CPC(P＜0.01),CPC的抗压强度明显低于正常椎体和PMMA(P＜0.01).术后8周显示,PMMA的抗压强度有所下降(P＜0.01=0.009),CPC的抗压强度有所上升(P＜0.05=0.034),但与正常椎体相比仍差别显著.术后16周显示PMMA抗压强度继续下降(P＞0.05=0.710),CPC的抗压强度继续上升(P＞0.05=0.648),与正常椎体相比无显著性差异.(2)植入早期,PMMA的抗扭转强度明显高于正常椎体和CPC(P＜0.05=0.03),CPC的抗扭强度明显低于正常椎体和PMMA(P＜0.05=0.02).术后8周显示,PMMA的抗扭强度有所下降,但与正常椎体相比仍差别显著(P＜0.05=0.045),CPC的抗压强度有所上升与正常椎体相比差异不显著(P＞0.05=0.078).术后16周显示PMMA抗压强度继续下降(P＞0.05=0.137),CPC的抗压强度继续上升,与正常椎体相比无显著性差异(P＞0.05=0.847).结论磷酸钙骨水泥是椎体成形术中治疗椎体压缩性骨折和胸腰椎爆裂骨折一种比较理想的材料,注入到椎体后,其生物力学强度有逐渐增强的趋势,而PMMA是机械固定,其生物力学强度有逐渐减弱的趋势.     

成人腰椎峡部裂型滑脱症的微创治疗

Objective To investigate the clinical experiences and technical skills of adult isthmic spondylolisthesis. Methods Twenty-one patients with adult isthmic spondylolisthesis underwent minimally invasive surgery. There were 12 men and 9 women, with the mean age of 51.7 years. Isthmic spondylolisthe-sis occurred at the L4.5 in 7 patients, and at the L5S1 in 14 patients. According to Meyerding classification, 13 cases were of Grade Ⅰ, 7 of Grade Ⅱ, 1 of Grade Ⅲ. Under general anesthesia, guiding by fluoroscopy, the surgeries performed minimally invasive microendoscopic(METRx) techniques for posterior decompression, interbody cage fusion and novel Sextant-R percutaneous pedicle screw techniques for deformity reduction and fixation. Results Seventeen cases were followed up 1 year postoperatively. The average low back pain VAS reduced from preoperative 6.0±2.6 to postoperative 2.9±2.5. The average leg pain VAS decreased from preoperative 6.7±3.3 to postoperative 2.8±1.6. The average ODI decreased from preoperative 44.3% to post-operative 27.1%. The Nakai good and excellent rate was 90%. The mean operative time 170 min, blood loss 160 ml, and postoperative stay in bed 7.5 d. The sagittal spondylolisthesis rate significantly decreased from preoperative 35.5%±2.5% to postoperative 8.3%±7.5%. The lordotic angle from preoperative 11.5°±1.7° in-creased to postoperative 16.8°±9.5°; the intervertebral disc height from preoperative (5.4±2.5) mm increased to postoperative (9.1±3.0) mm. According to Lenke judgement for fusion, complete fusion rate was 76%, in-complete fusion rate was 12%, nonfusion rate was 12%. Conclusion The minimally invasive microendo-scopic (METRx) assisted with a novel Sextant-R percutaneous pedicle screw systems for deformity reduction and fixation to treat adult isthmic spondylolisthesis, is not only a minimally invasive and safe surgical tech-nique, also an effective treatment for deformity reduction and fixation.     

成人腰椎峡部裂型滑脱症的微创治疗

Objective To investigate the clinical experiences and technical skills of adult isthmic spondylolisthesis. Methods Twenty-one patients with adult isthmic spondylolisthesis underwent minimally invasive surgery. There were 12 men and 9 women, with the mean age of 51.7 years. Isthmic spondylolisthe-sis occurred at the L4.5 in 7 patients, and at the L5S1 in 14 patients. According to Meyerding classification, 13 cases were of Grade Ⅰ, 7 of Grade Ⅱ, 1 of Grade Ⅲ. Under general anesthesia, guiding by fluoroscopy, the surgeries performed minimally invasive microendoscopic(METRx) techniques for posterior decompression, interbody cage fusion and novel Sextant-R percutaneous pedicle screw techniques for deformity reduction and fixation. Results Seventeen cases were followed up 1 year postoperatively. The average low back pain VAS reduced from preoperative 6.0±2.6 to postoperative 2.9±2.5. The average leg pain VAS decreased from preoperative 6.7±3.3 to postoperative 2.8±1.6. The average ODI decreased from preoperative 44.3% to post-operative 27.1%. The Nakai good and excellent rate was 90%. The mean operative time 170 min, blood loss 160 ml, and postoperative stay in bed 7.5 d. The sagittal spondylolisthesis rate significantly decreased from preoperative 35.5%±2.5% to postoperative 8.3%±7.5%. The lordotic angle from preoperative 11.5°±1.7° in-creased to postoperative 16.8°±9.5°; the intervertebral disc height from preoperative (5.4±2.5) mm increased to postoperative (9.1±3.0) mm. According to Lenke judgement for fusion, complete fusion rate was 76%, in-complete fusion rate was 12%, nonfusion rate was 12%. Conclusion The minimally invasive microendo-scopic (METRx) assisted with a novel Sextant-R percutaneous pedicle screw systems for deformity reduction and fixation to treat adult isthmic spondylolisthesis, is not only a minimally invasive and safe surgical tech-nique, also an effective treatment for deformity reduction and fixation.     

VEGF在骨折愈合过程中对Ⅷ因子相关抗原表达变化影响的实验研究

目的 研究血管内皮生长因子（VEGF）在骨折愈合过程中骨折端对Ⅷ因子相关抗原含量变化的影响，以确定VEGF对骨折端血管重建中的作用。方法 用105只大耳白制作桡骨骨折模型，随机分为对照组、应用VEGF组、拮抗VEGF组，分别于伤后不同时间利用Western blot方法测定各组动物骨折端Ⅷ因子相关抗原含量变化。结果 应用外源性VEGF后，骨折端Ⅷ因子相关抗原含量明显增加；拮抗VEGF则使骨折端Ⅷ因子相关抗原含量明显下降。结论 VEGF对骨折愈合过程中的血管重建具有重要作用，并可能作为一种重要因子参与了骨折愈合的修复过程。     

大重量颅骨牵引复位下颈椎小关节突脱位的机理

目的　探讨大重量颅骨牵引复位下颈椎小关节突脱位的可行性及临床效果。方法　本组 6 4例 ,男 4 8例 ,女 16例 ,年龄 18～ 5 2岁 ,平均 31岁。单侧小关节突脱位 19例 ,双侧小关节突脱位 4 5例。采用Gardner颅骨牵引在X线透视监视下行闭合复位 ,牵引重量从 4 5kg始 ,每间隔 15～ 30min增加 2 5～ 4 5kg ,至复位成功为止。结果　 6 4例中 ,6 0例复位成功 ,4例不成功 ,成功率为 93%。复位牵引重量为 18～ 4 0 5kg,平均 2 7 5kg。不全瘫患者均有不同程度恢复 ,7例神经功能正常者复位后均无损伤 ,无一例出现神经功能恶化。 4例不成功者中 ,1例系呼吸困难 ,1例系关节突骨折 ,1例系陈旧性脱位 ,1例因不能耐受大重量颅骨牵引而终止复位。结论　大重量颅骨牵引复位可显著提高复位成功率 ,且不会加重脊髓损伤