三叠转盘卡在颈椎椎弓根内固定术中的临床应用

目的探讨自创二三叠转盘卡在颈椎骨折脱位椎弓根内固定术的临床应用效果。方法2007年1月至2012年12月,基于国人颈椎解剖生理及影像学数据,自创三叠转盘卡。采用转盘卡定位对66例颈椎骨折脱位伴2节段以上脊髓损伤的患者实行颈椎侧块螺钉联合椎弓根螺钉治疗,其中男40例,女26例;年龄19—77岁,平均45岁。均行颈椎CT、MRI检查,颈髓损伤2节段36例,颈髓损伤2节段以上30例。损伤类型：32例一侧关节突骨折伴脱位,16例双侧关节突骨折伴脱位,18例椎板骨折脱位。脊髓功能评价：依据Frankel分级标准,A级19例,B级16例,C级16例,D级15例;人院平均JOA评分5．92分。结果术后随访3—24个月,平均13．5个月。术后颈椎完全复位65例,复位不完全1例。依据术前、术后JOA评分结果,术后改善率平均为62％;术后Frankel分级平均提高1级以上;椎弓根螺钉植人准确度为97．2％。结论颈椎椎弓根三叠转盘卡,在术中应用准确、安全、便捷,置钉准确率高,有利于患者脊髓神经功能的恢复,对颈椎椎弓根螺钉的置钉有较好的指导作用,为临床治疗提供了一种实用工具。     

加强科室质量管理 提高服务质量

目的探讨和科室质量管理小组在脊柱外科质量控制中的作用。方法积极落实三级查房制度;严格规范医疗护理文书书写;强化围手术期管理;加强6种特殊病人的管理;强调合理用药、合理检查、合理治疗;做好医、护、患、属沟通,强化医疗纠纷的防范与处理。结果科室质量管理小组实施质量控制达到了科室医疗、护理质量和患者、家属满意度明显提高的管理目标。结论通过开展科室质量管理小组活动,不仅解决了医疗护理质量控制中的实际问题,而且也增强了小组成员的质量意识及协作精神。     

经关节突螺钉固定治疗下颈椎退变性失稳的临床研究

目的：探讨经关节螺钉固定治疗在下颈椎退行性不稳的稳定性重建的疗效。方法：2008年8月-2010年8月,收集17例退行性下颈椎不稳症患者。15例确诊为单节段不稳。病变节段C3/4节段1例,C4/5节段2例,C5/6节段7例,C6/7节段5例。2例确诊为双节段不稳,均为C5/6、C6/7。所有患者均出现临床症状,表现为：颈肩痛、眩晕或神经根压迫征、或上述症状并存。17例患者均行经关节突螺钉固定手术。结果：全部病例随访,随访时间12～28个月,平均14.7个月。术前JOA评分为（8.43±1.36）、术后为（14.81±3.21）,差异有统计学意义（P〈0.01）。结论：经颈后路关节螺钉固定可以有效的重建下颈椎的稳定性。其手术效果确切,安全可靠。     

Complications from the surgical treatment of lumbar stenosis

Symptomatic lumbar spinal stenosis, with resultant neurogenic claudication, is a major source of pain and disability in modern societies. Surgical decompression has been shown to improve pain and disability, albeit with an increased risk of adverse events relative to non-operative care. In this review we discuss complications of lumbar stenosis surgery, including cerebrospinal fluid leak, iatrogenic instability, infection, epidural hematoma, as well as positioning-related and medical complications. An emphasis is placed on prevention, diagnosis, and management of these commonly-seen complications.     

Patient physiology influences the MRI-based vertebral bone quality score

BACKGROUND CONTEXTOsteoporosis is a critical issue affecting postmenopausal women and the aging population. A novel magnetic resonance imaging (MRI)-based vertebral bone quality (VBQ) score has been proposed as a method to identify poor bone quality and predict fragility fractures. The diagnostic accuracy of this tool is not well understood.PURPOSETo examine the ability of VBQ to predict osteoporosis and osteopenia, its correlation with dual-energy x-ray absorptiometry (DEXA), and the influence of patient-specific factors upon the score.STUDY DESIGNRetrospective cohort study.PATIENT SAMPLEPatients over the age of 18 with a DEXA scan and noncontrast, T1-weighted MRI of the lumbar spine completed within a 2-year period.OUTCOME MEASURESArea-under-curve (AUC) values of the VBQ score predicting osteopenia and osteoporosis when controlling for patient characteristics.METHODSPatients with noncontrast, T1-weighted MRIs of the lumbar spine and DEXA scans completed within a 2-year time frame were retrospectively reviewed. Patient demographics and medical risk factors for osteoporosis were identified and compared. VBQ scores were measured by two trained researchers and interrater reliability was calculated. Patients were separated into three groups defined by lowest DEXA T-score: Healthy Bone, Osteopenia, and Osteoporosis. analysis of variance, Kruskal-Wallis test, chi-square, t tests, Mann-Whitney U tests, and multivariate linear regression were performed to examine the relationship between patient characteristics, DEXA t-scores, and VBQ scores. Receiver operating characteristic analysis and AUC values were generated for the prediction of osteopenia and osteoporosis.RESULTSA total of 156 patients were included for analysis. Sufficient inter-rater reliability was determined for VBQ measures (intraclass correlation coefficient: 0.81). Most patients were female (83%), postmenopausal (81%), and had hyperlipidemia (64%). Patients with hyperlipidemia and healthy bone density by DEXA had elevated baseline VBQ scores (p<.001) reflective of values seen in osteopenia and osteoporosis. The AUC of the VBQ score predicting osteopenia and osteoporosis changed to be more concordant with DEXA results after controlling for hyperlipidemia (AUC=0.72, 0.70 vs. AUC=0.88, 0.89; p<.001). Sub-analysis of hyperlipidemia subtypes revealed that elevated high-density lipoprotein is associated with elevated VBQ scores.CONCLUSIONSHyperlipidemia increased the MRI-based VBQ score in our healthy bone population. The high signal intensities resembled values seen in osteopenia and osteoporosis, suggesting that physiologic variables which impact bone composition may influence the VBQ score. Specifically, elevated high-density lipoprotein may contribute to this. The microarchitectural changes and the clinical implications of these factors need further exploration.     

Revision surgery for adult spine deformity

Adult spinal deformity is a common problem that affects 60% of the population aged 65 and older and can be physically and mentally disabling. The primary focus of this chapter is to discuss the advances of revision spine surgery and the difficulties that spine surgeons encounter. Spine surgeries are demanding on the surgeon and on the patient with complication rates close to 40% and secondary spine surgeries becoming more prevalent. Complex medical patients also pose another inherent barrier to successful revision surgery. The following chapter outlines the process of revision surgery and current techniques.     

Postoperative spino-pelvic stereoradiography to predict adjacent segment disease

PurposeThe purpose of this study was to identify sagittal spinopelvic parameters predictive of adjacent segment disease (ASD) on postoperative whole spine weight-bearing stereoradiography.Materials and methodsA total of 84 patients with previous spinal fusion surgery and documented radiological follow-up with early weight-bearing postoperative whole spine stereoradiography (EOS® Imaging System) were retrospectively included. A pathological group of 42 patients (9 men, 33 women; mean age, 63.1 ± 11.5 [SD] years) who developed documented ASD (mean follow-up, 76.75 months; range: 31.5–158.5 months) was compared with a control group of 42 asymptomatic patients (7 men, 35 women; mean age, 60.9 ± 11.8 [SD] years) (mean follow-up, 115 months; range: 60–197 months) based on sagittal balance evaluation and routinely used spino-pelvic parameters. Comparisons were made using uni- and multivariate analyses.ResultsAt univariate analysis, patients with ASD had an anteriorly displaced sagittal vertical axis (CAM plumb line) and an inadequate lumbar lordosis (LL) in reference to pelvic incidence (PI) compared to controls. They also had higher C7 slope and C2-C7 offset. At multivariate analysis, C2-C7 offset (OR = 1.152; 95% CI: 1.056–1.256; P = 0.001) and a lack of LL (OR = 5.063; 95% CI: 1.139–22.498; P = 0.033) were significantly associated with ASD.ConclusionAnterior cervical imbalance, reflected by an increase in C2-C7 offset and insufficient restoration of LL are postoperative predictive factors of ASD on stereoradiography.