弥漫性特发性骨质增生症的诊疗特点

目的探讨弥漫性特发性骨质增生症的临床诊断和治疗特点。方法回顾我院最近收治的1例弥漫性特发性骨质增生症的临床表现、诊断及治疗过程,复习国内外相关文献,了解该病的病因、病理、好发部位、诊断及治疗的方法和原则等。结果弥漫性特发性骨质增生症是一种以广泛骨质增生肥大及韧带、肌腱钙化为特征的疾病,该病主要表现为椎体前外侧缘的钙化、骨化及多个椎体骨桥的形成。治疗上主要是针对肌腱和肌腱附着处出现的钙化和骨化所引起的症状行对症处理。结论弥漫性特发性骨质增生症并不少见但却容易被临床医生所忽视,诊断该病主要依靠影像学方法,治疗主要是降低其并发症带来的危害,应该特别注意发生在颈椎的弥漫性特发性骨质增生症。     

不同方式固定尺骨鹰嘴骨折的病例对照研究

目的 ：比较采用克氏针加张力带钢丝、空心拉力螺钉及解剖型钢板3种不同内固定方式治疗尺骨鹰嘴骨折的疗效差异。方法：回顾自2010年1月至2012年1月共82例采用不同内固定方式治疗的尺骨鹰嘴骨折患者。采用张力带固定组35例（A组）,男19例,女16例;年龄32~49岁,平均（43.6±8.7）岁;骨折按Colton分型,Ⅰ型5例,ⅡA型3例,ⅡB型19例,ⅡC型8例,ⅡD型0例。空心拉力螺钉固定组20例（B组）,男13例,女7例;年龄27~50岁,平均（41.5±9.3）岁;骨折按Colton分型,Ⅰ型4例,ⅡA型4例,ⅡB型12例,ⅡC型0例,ⅡD型0例。解剖型钢板固定组27例（C组）,男15例,女12例;年龄30~55岁,平均（38.2±6.2）岁;骨折按Colton分型,Ⅰ型0例,ⅡA型0例,ⅡB型4例,ⅡC型13例,ⅡD型10例。比较各组骨折愈合时间、肘关节功能恢复情况及并发症。采用Broberg-Morrey评分系统评价3组肘关节功能。结果：患者术后均获随访,时间8~24个月,平均15个月,C组较A、B组骨折愈合时间长。术后肘关节屈伸、旋转活动度A、B组优于C组;根据Broberg-Morrey评分系统进行疗效评价,A、B组疗效优于C组。解剖型钢板固定组2例发生创口感染,6例有明显的局部异物感,1例骨折延迟愈合,1例异位骨化。张力带固定组和空心拉力螺钉固定组无创口感染,发生内固定松动失效分别为3例和2例,出现骨折延迟愈合分别为2例,皮肤滑囊形成及针尾外露破溃分别为6例和1例。结论：3种不同内固定方式对尺骨鹰嘴骨折的固定各有优缺点,应根据具体骨折类型选用合适的内固定方式。     

Coflex动态稳定装置在L5/S1退变性疾病中的应用

目的:探讨Coflex动态稳定装置在L5/S1退变性疾病中应用的可行性及其临床效果.方法:首先在腰椎CT像上测量100例(男女各50例)骶骨发育正常成人S1棘突的解剖参数和Coflex假体的大小,并进行比较.然后于2007年11月～2010年2月对46例腰椎退变性疾病患者在椎管减压后棘突间置入Coflex动态稳定装置,...     

小切口单侧固定的经椎间孔椎体间融合治疗下腰椎退行性疾病中期疗效评价

Objective To evaluate the mid-term clinical outcomes of minimally invasive transforaminal lumbar interbody fusion (TLIF) with unilateral pedicle screw fixation for lower lumbar degenerative diseases. Methods From April 2004 to December 2005, minimally invasive TLIF through paramedian approach with unilateral pedicle screw fixation was performed in a consecutive series of 43 patients, including 24 male and 19 female, aging from 38 to 71 years, with an average age of 49 years. The length of surgical incision was 3 cm. The operation level at L3.4 were 3 cases, L4.5 27 cases,L5-S1 13 cases and no case was at multilevel. Clinical outcomes were assessed by ODI scores and JOA questionnaires before and after operation. Operation time, intraoperative blood loss, incision status and complications were recorded. Radiological examination was obtained for each patient to assess the height of intervertebral space, postoperative intervertebral fusion conditions and the degeneration of adjacent segments. Results The mean operation time was 110 minutes, the mean blood loss was 150 ml and all the incisions were healed primarily. The follow-up time ranged from 36 to 58 months. The ODI scores decreased significantly from 60 ± 10 preoperatively to 12 ±4 postoperatively(P < 0. 01). The JOA scores were improved remarkably from 9. 6±2. 2 preoperatively to 23. 8±2.0 postoperatively ( P < 0. 01 ) and the proportion with optimal effect was 86%. The ventral and dorsal heights of intervertebral disc were significantly higher than those before operation ( P < 0. 01). The fusion rate was 94%. The incidence of adjacent segment degeneration was 17%. There were no complications such as secondary scoliosis, screw loosening, internal fixation failure and cage slippage. Conclusions The minimally invasive TLIF through paramedian approach with unilateral pedicle screw fixation is an effective and convenient method with little surgical trauma. The mid-term follow up results showed favorable outcomes in patients receiving this surgery.     

Coflex棘突间动力内固定装置治疗退行性腰椎管狭窄

目的：评价采用Coflex棘突间动力内固定装置治疗退行性腰椎管狭窄的疗效及其影像学变化。方法：2007年10月至2009年2月对诊断为退行性腰椎管狭窄的30例行Coflex棘突间动力内固定治疗。其中男17例,女13例;年龄39～65岁,平均45岁。手术在L4,5节段20例,L5S1节段9例,1例同时行L4,5、L5S1双节段治疗。所有患者手术前后均行Oswestry功能障碍指数评分（ODI）和日本骨科学会评分（JOA）。影像学观察指标包括X线中立位椎间隙腹、背侧高度,动力位手术节段上下两椎体的边缘与其相邻椎体的边缘连线的夹角变化;CT测量指标包括椎管面积、硬膜囊面积、椎管矢状径、硬膜囊横矢状径。手术采用椎板开窗或部分切除,椎管减压后棘突间植入Coflex装置。结果：随访5～19个月,ODI分值由术前的平均（62.41±10.38）分下降到平均（10.49±5.93）分（P〈0.01）,JOA分值由术前的平均（8.96±2.76）分提高到平均（25.36±1.55）分（P〈0.01）。3例术后疼痛改善不明显而需药物或封闭治疗,3例麻痹及感觉减退症状无改善,其余患者症状均获明显改善,未再出现间歇性跛行及神经根压迫症状。未发现与Colfex装置本身相关的并发症。X线检查椎间隙背侧高度明显增大,手术节段相邻椎体间运动幅度无明显增大。CT检查术后椎管内空间,硬膜囊面积均有所增加。结论：采用Coflex棘突间动力内固定治疗退行性腰椎管狭窄,短期相关并发症少,同时对增加椎管及硬膜囊面积,增加椎间隙后缘高度,防止相邻节段运动幅度增加以及预防邻椎病发生具有积极的作用。     

小切口单侧固定的经椎间孔椎体间融合治疗下腰椎退行性疾病中期疗效评价

Objective To evaluate the mid-term clinical outcomes of minimally invasive transforaminal lumbar interbody fusion (TLIF) with unilateral pedicle screw fixation for lower lumbar degenerative diseases. Methods From April 2004 to December 2005, minimally invasive TLIF through paramedian approach with unilateral pedicle screw fixation was performed in a consecutive series of 43 patients, including 24 male and 19 female, aging from 38 to 71 years, with an average age of 49 years. The length of surgical incision was 3 cm. The operation level at L3.4 were 3 cases, L4.5 27 cases,L5-S1 13 cases and no case was at multilevel. Clinical outcomes were assessed by ODI scores and JOA questionnaires before and after operation. Operation time, intraoperative blood loss, incision status and complications were recorded. Radiological examination was obtained for each patient to assess the height of intervertebral space, postoperative intervertebral fusion conditions and the degeneration of adjacent segments. Results The mean operation time was 110 minutes, the mean blood loss was 150 ml and all the incisions were healed primarily. The follow-up time ranged from 36 to 58 months. The ODI scores decreased significantly from 60 ± 10 preoperatively to 12 ±4 postoperatively(P < 0. 01). The JOA scores were improved remarkably from 9. 6±2. 2 preoperatively to 23. 8±2.0 postoperatively ( P < 0. 01 ) and the proportion with optimal effect was 86%. The ventral and dorsal heights of intervertebral disc were significantly higher than those before operation ( P < 0. 01). The fusion rate was 94%. The incidence of adjacent segment degeneration was 17%. There were no complications such as secondary scoliosis, screw loosening, internal fixation failure and cage slippage. Conclusions The minimally invasive TLIF through paramedian approach with unilateral pedicle screw fixation is an effective and convenient method with little surgical trauma. The mid-term follow up results showed favorable outcomes in patients receiving this surgery.     

棘突间动态内固定装置治疗腰痛的临床应用评价

目的 评价采用Coflex棘突间动态内固定植入术治疗腰痛的临床疗效及相关影像学改变.方法 2007年2月至2009年6月,对45例患者行Coflex棘突间内固定植入术,男26例,女19例;年龄45～70岁,平均51.4岁.治疗节段:L4.5 32例,L5S111例,L4.5、L5S1双节段2例.手术采用椎板开窗或部分切除,椎管减压后棘突间植入Coflex装置.按照Oswestry功能障碍指数(Oswestry disabi1ity index,ODI)和日本矫形外科学会(Japanese Orthopaedic Association,JOA)评分评价术前及术后随访时的临床疗效,计算恢复率.同时行影像学观察,包括椎间隙高度和椎间孔形态,手术节段椎体活动度和腰椎生理曲度,手术及相邻节段的MRI信号改变.结果 术后随访时间1O-34个月,平均24个月.ODI由术前62.82±10.42降至末次随访时11.80±3.35;JOA评分由9.00±2.63提高至24.65±1.86;最终疗效评价为显效的患者共40例,显效率为89%.L4.5、L5S1节段术后Cobb角分别为15.1°±3.9°和16.3°±3.8°,均较术前减小,生理曲度改善.L4.5节段椎体活动度(range of motion,ROM)由术前6.5°±1.5°增加至术后8.4°±2.6°,而L5S1节段ROM手术前后没有明显改变.无论是L4.5或是L5S1节段,末次随访时其椎间隙背侧高度、棘突顶距、椎间孔高度和椎间孔面积均较术前显著增加.结论 Coflex棘突间动态内固定中期随访临床疗效显著,并且保留了腰椎生理曲度和节段运动,增加并维持椎间隙高度和椎间孔面积,在手术节段椎间盘修复及防止相邻节段椎间盘退变等方面作用显著.