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.     

5例胸腰段脊柱前路手术并发症分析

目的：分析胸腰段脊柱前路手术入路并发症，以提高胸腰段脊柱前路手术的水平，方法：对近4年来我科53例胸腰段脊柱前路手术出现的5例并发症进行回顾性分析，探讨并发症发生的原因。结果；本组病例1例发生腹膜后乳糜液漏，1例切口疝，1例气胸，2例深静脉血栓栓塞，经过积极治疗，全部治愈。结论：胸腰段脊柱前路手术并发症的发生大多数和术者对该段解剖知识，手术操作，认识程度和经验有关，可以避免或及早发现。     

脊神经节损伤与脊髓背角C-fos原癌基因表达

目的探讨脊神经节(DRG)不同损伤方式后,不同损伤时间的脊髓背角C-fos原癌基因蛋白表达情况,并探讨该蛋白表达程度与神经行为异常改变之间的关系.方法健康家兔42只随机分为手术对照组、机械性压迫组、炎性损伤组和正常对照组,制备相应的脊神经节损伤模型.术后检测动物神经行为改变,并对中枢神经伤害性刺激反应物C-fos原癌基因蛋白进行免疫组化检测分析.结果DRG损伤后1周,伤侧脊髓背角C-fos癌基因蛋白的阳性细胞数分别为手术对照组(47±17)、机械性压迫组(58±22)、炎性损伤组(55±20),均较正常对照组(28±18)显著增强(P＜0.05);术后2,4,8周3个实验组结果也比对照组显著增强(P＜0.05).结论 DRG损伤所导致动物脊髓背角伤害感受性神经元的过度兴奋,可能介导了神经细胞的兴奋性毒性损伤和伤肢的痛觉过敏.     

螺旋CT多平面重建对寰枢椎改良后路经关节螺钉内固定的意义

目的通过对正常人螺旋CT多平面重建检查，并对其行后路经关节螺钉内固定技术相关形态学参数的测量，为临床提供患者个体化手术相关信息。方法对60例正常人进行寰椎的螺旋CT检查，获取相关参数并进行分析。采用枢椎下关节突正中为进钉点模拟寰枢椎后路经关节螺钉内固定术，在螺旋CT重建上获得轴面和矢状面的正确倾斜角度。C2峡部高度和宽度，理想的螺钉长度，理想的螺钉矢状面和轴面倾斜度，以及理想的螺钉路径与椎动脉沟之问距离。结果C2峡部高度为（8．02±1．92）mm，峡部宽度（6．05±1．32）mm，理想的螺钉长度为（41．22±4．48）mm，螺钉矢状面倾斜度为53．87°±5．61°，与内向成角（14．81°±2．81°）。10侧（8％）峡部狭窄（宽度或高度小于5mm），测量其椎动脉沟与理想螺钉途径之间距离，有12例（10％）小于2．5mm，因此总共有22侧（18％）存在潜在椎动脉损伤风险。结论术前对每个患者行CT检查十分必要，能充分地了解个体的解剖结构，提高手术的安全性。     

胸腰椎术后胃肠功能紊乱的研究进展

胸腰椎手术病人因手术创伤、麻醉、术后卧床时间长、伤口疼痛等原因,导致术后出现腹胀、腹痛、便秘等胃肠道功能紊乱,且发生率高[1,2].胃肠道功能紊乱虽然没有器质性病变的基础,但会影响患者营养状况的改善,削弱其肠道屏障能力,从而导致住院时间延长、医疗费用增加和降低患者手术后的生活质量.因此,必须对此给予充分的重视,尽早预防和及时处理.     

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.     

后路腰椎间盘镜治疗多节段腰椎间盘突出症

目的探讨多节段腰椎间盘突出症的后路腰椎间盘镜(MED)手术治疗方法。方法回顾性分析2000年至2004年经MED治疗的45例多节段椎间盘突出症的临床资料。结果对45例患者共93个椎间盘进行了手术，平均住院时间14．8d，平均手术时间92min，平均手术出血量145ml，术后随访3个月至40个月，手术优良率为91．6％。结论多节段腰椎间盘突出症是MED手术治疗的相对适应证，相对于单节段的MED手术，术前定位和术中操作更困难，严格的病例选择和全面的术前分析，辅以熟练的手术操作，仍可获得较为满意的疗效。     

微创脊柱内镜技术的发展现状与展望

微创脊柱内镜技术是指在透视或导航的辅助下置入管道,在内镜直视下进行的手术操作。对脊柱结构的损伤较小,术中视野清晰、直观,可以很好地治疗各型椎间盘突出、椎管狭窄及椎体滑脱等。但由于内镜技术的手术技巧较难掌握,加上脊柱解剖结构的相对复杂性,使该技术的普及受到一定的限制。目前用于脊柱手术的内镜技术主要包括腹腔镜技术、胸腔镜技术及脊柱内镜技术等,本文针对上述内镜技术在微创脊柱手术中的发展现状及展望进行归纳和评述。     

地震截肢伤员合并急性肾功能衰竭再次手术一例

1病历资料`` 患者,男性,18岁.因"地震致双下肢挤压伤截肢术后4 d,发现肾功能异常1 d"由地震灾区转入我院.患者于汶川地震中双下肢被倒塌墙体砸伤,致双下肢挤压伤,在当地医院予以急诊截肢术.在医院留观时发现患者血尿素氮、肌酐进行性升高,同时伴有电解质紊乱而转入我院.入院体检:T 36.3℃,HR90次/min,R 20次/min,BP 140/90 mm Hg(1 mm Hg=0.133 kPa),全身多处皮肤擦伤,重度贫血貌,左侧下肢截肢平面在大腿中段,右侧下肢截肢平面在大腿中下1/3, 伤口分别留置4根"T"形管引流,引流物为血性液体,阴囊肿胀.     

骨科临床见习的带教体会

临床见习是医学理论联系实践的桥梁，在医学教学中起着承前启后的作用。学生是学习的主体，学习动机是学生学习的内在动力。临床带教是否成功的关键在于带教老师是否能激发学生学习的主动性，在学习过程中积极思考，更好的掌握临床技能。骨科在外科系统的教学中占有重要地位，其内容繁多、概念抽象、专业性强、专科检查复杂，令不少学生感到困难。现将有关临床见习的教学体会总结如下。