Primary epidural lumbar Ewing sarcoma presenting as cauda equina syndrome in an adult patient who underwent surgical decompression: A case report

Ewing sarcoma (ES) is a rare primary neoplasm in the lumbar adult spine and may mimic a benign tumor. In this case, after a patient's three-month history of lower back pain and rapidly progressing leg numbness and weakness, magnetic resonance imaging (MRI) showed a mass in the third lumbar vertebra. At a two-month follow-up, imaging showed a fracture, compression and lesion enlargement. Decompression and fixation confirmed ES, and the patient began combined radiotherapy and chemotherapy. Two months postoperatively, residual ES was suspected on MRI. The patient underwent a second surgery, and histopathology confirmed necrosis. A six-month follow-up after the first surgery showed no tumor recurrence. This case supports the inclusion of ES in the differential diagnosis of pathologic spinal fracture. Early decompression and spinal fixation are critical for preserving neurologic and spinal functions in ES complicated by a compression fracture. Combined adjuvant radiotherapy and chemotherapy remain the standard therapeutic strategy.     

采用椎弓根螺钉内固定治疗寰枢椎骨折脱位

[目的]探讨寰枢椎椎弓根螺钉技术治疗创伤性寰枢椎不稳的临床效果。[方法]2009年9月~2017年3月,对6例创伤性寰枢椎不稳患者采用颈椎后路寰枢椎椎弓根螺钉固定技术治疗。术前均常规行颅骨牵引,椎弓根进钉点位于寰椎椎弓两侧距后结节20 mm、后弓下缘2 mm,内倾5°~10°、头倾10°~15°,置入直径3.5 mm、长22~26 mm螺钉。枢椎螺钉的进钉点位于侧块内上象限,内倾约25°,头倾约25°置入直径3.5 mm、长24~28 mm螺钉。[结果]术中无血管及神经损伤。术后随访6~36个月,患者临床症状得到明显改善。术后检查显示螺钉位置良好,无内置物松动、断裂。术后12个月JOA评分为11.00~17.00分。[结论]寰枢椎椎弓根螺钉固定治疗创伤性寰枢椎不稳疗效满意。     

加味十全大补汤对老年股骨粗隆间骨折患者术后隐性失血及血糖水平的影响

目的:探讨加味十全大补汤对老年股骨粗隆间骨折患者术后隐性失血及血糖水平的影响。方法:选取120例老年股骨粗隆间骨折患者,随机分为两组,各60例。两组均行防旋型股骨近端髓内钉(PFNA),对照组术前不予以药物治疗,观察组术前3 d予以加味十全大补汤。统计两组住院时间、骨折愈合时间,对比术前、术后1 d、3 d、7 d血红蛋白(Hb)、红细胞比容(Hct)水平、隐性失血量、空腹血糖水平,并于术后6个月随访,观察髋关节恢复情况。结果:术后1 d、3 d、7 d,观察组Hb、Hct水平高于对照组(P<0.05)。观察组术后1～3 d、3～7 d隐性失血量分别为(245.74±88.26)ml、(188.26±70.12)ml,均少于对照组(288.67±90.94)ml、(245.94±75.36)ml(P<0.05)。术后1 d、3 d、7 d,观察组空腹血糖水平分别为(7.74±0.76)mmol/L、(6.26±0.52)mmol/L、(5.12±0.46)mmol/L均低于对照组(9.67±0.84)mmol/L、(7.94±0.66)mmol/L、(6.48±0.52)mmol/L(P<0.05)。观察组骨折愈合时间、住院时间短于对照组(P<0.05)。术后6个月随访,观察组髋关节功能恢复优良率91.38%与对照组84.21%,组间比较差异无统计学意义(P>0.05)。结论:加味十全大补汤治疗老年股骨粗隆间骨折患者,可纠正贫血,减少隐性失血量,加快骨折愈合,缩短住院时间,且对血糖水平影响较小。     

术前CT模拟指导俯卧位经皮微创骶髂螺钉内固定术的可行性分析

目的分析术前CT模拟指导俯卧位经皮微创骶髂螺钉内固定术的可行性。方法回顾性分析2017年1月-2019年1月河南省开封市中心医院收治的67例骨盆骨折损伤俯卧位行经皮微创骶髂螺钉内固定术患者的临床资料。男性38例,女性29例;年龄30~62岁,平均37.5岁;BMI 17.8~27.2kg/m^2,平均22.5kg/m^2。俯卧位行术前CT模拟指导经皮微创骶髂螺钉内固定术38例(CT模拟组),俯卧位行经皮微创骶髂螺钉内固定术29例(常规组)。比较两组患者置入螺钉数量、位置、长度与术前规划符合率,手术时间、术中透视时间、术中出血量、骨折愈合时间;比较两组患者术后6个月Majeed功能评分和并发症发生情况。结果CT模拟组患者置入螺钉数量和常规组相比,差异无统计学意义(P>0.05);CT模拟组位置、长度与术前规划符合率均为100%,均分别高于常规组的83%和87%,差异均有统计学意义(χ^2=7.179,P=0.007;χ^2=5.657,P=0.017);CT模拟组手术时间、术中透视时间以及骨折愈合时间较常规组缩短,术中出血量降低[(77.9±12.6)min vs.(90.4±13.3)min、(6.5±0.8)s vs.(7.2±0.9)s、(3.2±0.5)个月vs.(3.5±0.6)个月、(86.8±17.1)m L vs.(97.8±18.3)m L],差异有统计学意义(均P<0.05);术后6个月CT模拟组Majeed功能评分中疼痛、工作、坐、站立、性生活及总评分均高于常规组[(25.6±3.6)分vs.(23.6±3.3)分、(17.5±2.3)分vs.(16.3±2.2)分、(8.8±1.3)分vs.(8.1±1.2)分、(31.8±4.9)分vs.(29.4±4.5)分、(3.0±0.5)分vs.(2.8±0.5)分、(86.7±10.2)分vs.(80.2±9.8)分],差异有统计学意义(均P<0.05);CT模拟组并发症发生率为0,低于常规组17%,两组比较差异有统计学意义(P=0.025)。结论术前CT模拟用于指导俯卧位经皮微创骶髂螺钉内固定术可提高置入螺钉位置、长度的精准率,还具有手术时间短、术中出血量和射线辐射少、骨折愈合快、螺钉植入准确率高、并发症发生率低等优点,是一种精确、安全、有效的影像学辅助手段。     

医护一体化模式在胸腰椎骨折患者护理中的应用

目的探讨医护一体化模式在胸腰椎骨折患者护理中的应用效果。方法将46例胸腰椎骨折患者随机分为对照组(n=23)和观察组(n=23)。对照组采用常规护理,观察组在对照组基础上采用医护一体化模式,两组均连续护理14 d。对比两组患者的相关手术指标、护理前后VAS评分及并发症发生率。结果观察组的术中出血量少于对照组,手术时间、住院时间短于对照组(P均<0.05)。护理前,两组的VAS评分比较差异无统计学意义(P>0.05);护理后,两组的VAS评分低于护理前,且观察组的VAS评分低于对照组(P均<0.05)。观察组的并发症发生率为8.70%,明显低于对照组的34.78%(P <0.05)。结论医护一体化模式在胸腰椎骨折患者护理中的应用效果显著,可有效减轻患者的疼痛情况,减少术中出血量,缩短手术时间和住院时间,降低并发症发生率,值得临床推广应用。     

Posterior-Stabilized Antibiotic Cement Articulating Spacer With Endoskeleton-Reinforced Cam Reduces Rate of Post-Cam Mechanical Complications in Prosthetic Knee Infection: A Preliminary Study

BackgroundPosterior-stabilized antibiotic cement articulating spacers (PS spacers) reduce spacer mechanical complications in prosthetic knee infections (PKIs); however, joint dislocation after femoral cam fracture has been reported. We hypothesized that the rate of post-cam mechanical complications is lower in PS spacers with an endoskeleton-reinforced cam.MethodA retrospective study of PKIs using PS spacers with or without a Kirschner wire–reinforced cam (K-PS or nK-PS spacers, respectively) was conducted between 2015 and 2019. The rates of post-cam mechanical complications and reoperation, as well as risk factors for post or cam failure, were analyzed.ResultsThe cohort included 118 nK-PS and 49 K-PS spacers. All patients were followed up for 2 years. The rate of joint subluxation/dislocation after femoral cam fracture was lower in K-PS (0%) than in nK-PS spacers (17.8%; P = .002). The reoperation rate for spacer mechanical complications was lower in K-PS (0%) than in nK-PS spacers (11.9%; P = .008). The identified risk factors for femoral cam fractures were body mass index ≥25 kg/m², femoral spacer size ≤2, and surgical volume ≤12 resection arthroplasties per year.ConclusionThis preliminary study highlights that K-PS spacers have a lower rate of post-cam mechanical complications than nK-PS spacers. We recommend the use of PS spacers with endoskeleton-reinforced cam when treating PKIs performed by surgeons with lower surgical volumes, especially in patients with higher body mass index and smaller femoral spacer sizes.