经皮内镜椎间孔入路结合椎板间入路椎间盘切除术治疗多节段腰椎间盘突出症的近期疗效观察

多节段腰椎间盘突出症在临床上并不少见，其中以L4／5椎间盘突出合并L5／S1椎间盘突出最为常见。笔者尝试在经皮内镜下一期联合椎间孔入路及椎板间入路切除 L4／5（椎间孔入路）和 L5／S1（椎板间入路）椎间盘组织，近期疗效满意，现报道如下。     

改良法制备异种脱蛋白骨复合重组人骨形态发生蛋白支架修复长骨大段骨缺损

BACKGROUND: For its extensive sources and specific biological characteristics, heterogeneous deproteinized bone (DPB) as the tissue-engineered scaffold material gets a good application prospect in repair of large segmental bone defects.OBJECTIVE: To prepare scaffold material by compositing modified heterogeneous DPB with recombinant human bone morphogenetic protein 2 (rhBMP2) and evaluate the osteogenic ability in repairing large segmental long bone defects in large-sized animals.METHODS: Twenty-four goats were randomly and evenly divided into three groups: DPB, autologous bone, and DPB+rhBMP2. Bone defects (20% in length) were made in the middle and lower segments of the right tibia of each goat, and according to group design,different bone grafts were implanted and fixed using semi-ring slot external fixer. At 4-24 weeks after surgery, X-ray examination was performed once every other 4 weeks. At 24 weeks after surgery, newly formed bones were taken out for determining the repair effects of bone defects through duat-energy X-ray analysis, histological observation, and biomechanical analysis.RESULTS AND CONCLUSION: The prepared DPB exhibited a three-dimensional porous structure, with a porosity of (78.5±6.45)% and pore size of (472.5±7.02) μm. Time-dependent bone repair was found in each group. Results regarding anti-compression test, three-point anti-bend test, and anti-torsion test were greatest in the autologous bone group, followed by the DPB+rhBMP2 group, and lastly the DPB group. There were no significant differences in tibial bone density, bone mineral content,anti-compression pressure and ultimate pressure, anti-bending load and ultimate toad, anti-torsion torque and ultimate torque between autologous bone group, DPB+rhBMP2 group and normal bone control group. These findings indicate that modified heterogeneous DPB composited with rhBMP2 has osteogenic ability equivalent to autologous bone in repairing large segmental long bone defects in goat tibias. Therefore, it can be applied as tissue-engineered scaffold material.     

胫骨下干骺端截骨延长术(附13例报告)

胫骨干骺端截骨延长术是八十年初对肢体延长方面研究的一种新的治疗方法,适用于各种原因所引起的一侧下肢短缩畸形。Monticelli于1983年6月报道了经干骺端骨皮质切开延长术30例,国内李起鸿等于1986年报道了胫骨干骺端截骨延长术50例,疗效均佳。我们于1984年11月始开展此项手术,共做13例,并在适应证及技术操作上作了适当改进,现报道如下。手术适应证本术式主要适用于小儿麻痹后遗症所致的下肢短缩畸形: 一.一侧下肢短缩在4cm以上者(4cm     

改良股四头肌成形术后CPM治疗伸直型膝关节僵硬

膝关节周围的骨折,手术或非手术后石膏托固定时间过长或功能锻炼不当均可导致关节僵硬、疼痛及迟发退行性变、废用性骨和肌肉萎缩。我院1989－1996年采用改良股四头肌成形术后CPM治疗伸直型膝关节僵硬刀例,取得满意效果,报告如下。豆;临床资料本组27例,男性22例,女性5例,年龄20－40岁。病因：股骨下段骨折钢扳内固定术后6例,股骨踝上骨折克氏针内固定十石膏托外固定术后4例,股骨踝间骨折螺丝钉内固定术后2例,股骨躲上截骨术后2例,骸骨骨折术后5例,股骨下段骨折合并躲间骨折术后5例,滚骨骨折合并股骨下段骨折3例。创伤至手术…     

腰骶部椎管内蛛网膜硬脊膜囊肿的命名、诊断与治疗(附术后随访8例报告)

腰骶部椎管内蛛网膜硬脊膜囊肿少见,本文报告术后随访8例,并结合有关文献复习,就其命名、诊断与治疗等相关问题进行了探讨。作者认为该病症状多不典型,体征少,但久站、久走后病情可加重。如不认真寻问病史,反复细致的物理检查,极易与腰骶部其它疾病相混,发生误诊。该病的最后确诊颈椎管造影或MRI检查。确诊后一般应手术治疗。只要操作认真、细致,术后疗效均佳。文内对该病的诊断治疗的其它相关问题及关于该病命名亦进行了初探．腰骶部椎管内蛛网膜硬脊膜囊肿的命名、诊断与治疗(附术后随访8例报告)@张美心$贵州省人民医院!550002…     

异种脱蛋白骨修复长骨大段骨缺损实验研究

目的研究改良法制备的异种脱蛋白骨（deproteinated bone,DPB）作为组织工程支架材料修复大动物长骨大段缺损24周后新生骨的生物力学变化。方法山羊18只,采用完全随机设计法分为正常骨对照组、自体骨组和实验组,每组6只,在自体骨组和实验组每只山羊右侧胫骨中下段造成胫骨总长度20％骨膜和骨缺损,正常骨对照组不截骨,其余2组分别在缺损处植入自体骨、DPB＋自体MSCs＋rhBMP2,采用半环槽外固定,术后24周取手术侧胫骨进行生物力学检测。结果术后24周,正常骨对照组、自体骨组和实验组新骨生物力学相比无统计学差异（P〉0．05）。结论改良法制备的异种DPB复合物作为组织工程支架材料修复大动物长骨大段缺损形成的新骨,其生物力学与正常骨对照组、自体骨组相当,可作为骨移植材料试应用于临床。     

手术治疗胸椎结核：（附114例分析）

我科于1970年至1992年间,手术治疗脊柱结核243例,其中胸椎结核114例。该114例采用三种术式,79例获得随访。现结合有关资料对手术疗效进行分析。     

第二颈椎椎弓骨折二例报告

第二颈椎椎弓骨折临床称枢椎椎弓骨折或Hangman骨折，骨折时椎体可发生脱位，故又称创伤性枢椎滑脱。我科近来收治2例患者报告如下：例1男，45岁，驾驶员。因车祸伤1小时，于1993年3月10日入院，车祸时颇顶部撞出挡风玻璃，当即昏迷数分钟。清醒后呕吐一次，感颈部疼痛，活动受限。查：BP16／llkPa，神清，颅神经检查无异常发现。右额部皮肤裂伤，颈部软组织广泛压痛，活动受限。四肢运动感觉正常，病理征（一）。以“脑震荡”、“脑挫伤’往院。1周后脑外伤好转，颈部疼痛明显，伴头晕、视力模糊。头颅CT扫描排除脑挫伤、颈椎片示“C2椎…     

骨骼外固定架与皮瓣移植治疗严重开放性、粉碎性胫腓骨骨折

采用骨骼外固定架与皮瓣移植治疗严重开放性、粉碎性胫腓骨骨折共23例;应用筋膜皮瓣、腓肠肌皮瓣、吻合血管的髂骨复合皮瓣移植Ⅰ期覆盖创面。17例获得随访,平均随访时间13个月,平均骨愈合时间为110天。作者认为:认真清创,采用外固定架复位固定骨折,选择皮瓣移植修复创面缺损,是一种较好的治疗方法。     

Hangman骨折2例报告

Ｈａｎｇｍａｎ骨折２例报告周焯家，张美心，赵筑川Ｈａｎｇｍａｎ骨折是临床较少见的一种颈椎损伤，易漏误诊，自１９９３年５月以来，我院收治２例，经随访疗效满意。例１，男性，４５岁，驾驶员。因车祸伤１ｈ，于１９９３年３月１０日入院。车祸时额顶部撞出挡风玻璃...