钛网及同种异体骨植骨结合内固定治疗脊柱结核：23例随访验证

背景：植骨内固定治疗脊柱结核容易出现植骨块滑移、骨折、吸收或突入椎管引起神经症状,从而导致脊柱不稳。钛网为强度非常高的圆桶状,其边缘以锯齿状与椎体接触,具有显著防滑移作用。 目的：探讨钛网植入内固定结合同种异体骨植骨治疗胸腰椎脊柱结核的临床效果。 方法：选择胸腰椎结核患者23例,男12例,女11例,年龄13~55岁。采用一期病灶清除,前和/或后路椎弓根系统置入内固定,钛网及同种异体骨联合应用植入治疗,术后观察伤口愈合、结核中毒症状及神经功能恢复,固定融合及复发情况。 结果与结论：23例患者获得1~3年随访,伤口均一期愈合,结核中毒症状明显改善或消失,神经功能完全恢复,内固定无松动、断裂,植骨无移动、折断、吸收,无后突畸形发生,固定融合情况良好,无结核复发迹象,6~12周带支具下床活动,6个月恢复正常生活及工作。证实脊柱结核病灶一期清除后,应用钛网及同种异体骨植骨结合内固定置入治疗能使脊柱获得即刻及远期的稳定,纠正后凸畸形,促进椎体间植骨融合,是目前治疗脊柱结核的一种安全有效的治疗方法。     

纳米人工骨在颈椎前路植骨融合术中的应用

目的：评估颈前路植骨融合中应用纳米人工骨后临床症状的改善和影像学变化。 方法：2005-06/2006-06辽宁医学院附属第一医院骨科收治脊髓型颈椎病26例,混合型颈椎病5例,颈椎创伤脱位29例,均采用纳米人工骨替代自体髂骨进行60例颈椎前路椎体次全切减压植骨融合钛板内固定。植入前根据临床症状行神经功能JOA评分,并予颈椎X射线、CT、MRI等检查。植入后1周、3个月、6个月、1年、1年半随访情况定期复查,行神经功能JOA评分,X射线检查分析椎体高度,颈椎生理曲度等,并将植入前后情况比较分析。 结果：60例患者随访≥3个月,植入后均未见过敏及毒性反应,切口愈合均良好。植入后定期拍片复查,可见颈椎骨折者伤椎高度恢复,颈椎病患者未发现伤椎高度丢失,颈椎椎间角和颈前屈基本正常,内固定位置良好,未发现内固定松动、移位等现象。植入前X射线片及磁共振可见C4~5椎体脱位,脊髓受压;植入后3个月X射线可见骨折复位良好,内固定可靠。植入后神经功能JOA评分有明显提高,随访3个月者JOA评分由植入前(9.78±3.15)分增加到(15.25±2.79)分。 结论：纳米人工骨在颈椎前路植骨融合术中效果良好,可以替代自体骨应用于颈椎前路植骨融合。     

钛质外科网和纳米仿生骨在颈椎前路减压融合中的应用*

摘要 背景：纳米羟基磷灰石/聚酰胺作为新型植骨材料,应用于颈椎前路减压融合中,不仅可以减少患者取骨带来的并发症,而且具有稳定的植骨融合率。 目的：比较钛网和纳米羟基磷灰石/聚酰胺应用于颈椎前路减压融合治疗脊髓型颈椎病的临床效果。 方法：对确诊的48例脊髓型颈椎病患者行颈前路椎体次全切减压融合钛板内固定。其中26例行钛网植骨,22例行纳米羟基磷灰石/聚酰胺仿生骨植骨,采用JOA评分法评价神经功能的恢复,测量cobb角评价融合节段曲度。 结果与结论：48例患者均获得随访,随访时间6~14个月。置入后3个月JOA评分较置入前明显改善,两组对比JOA评分差异无显著性意义;置入后3,6个月钛网组及仿生骨组融合节段cobb角相对于置入后即刻变化差异有显著性意义,两组对比差异无显著性意义;置入后3个月钛网组2例患者出现钛网沉降,融合节段椎间高度丢失。结果表明纳米羟基磷灰石/聚酰胺仿生骨作为颈椎前路融合植骨材料,融合率高,可以有效保持颈椎生理曲度及椎间高度,长期效果有待进一步观察。 关键词：颈椎病;钛质外科网;纳米羟基磷灰石/聚酰胺;前路植骨融合;生物相容性 doi:10.3969/j.issn.1673-8225.2011.03.008     

去骨瓣减压术在高血压脑出血手术治疗中的应用

目的探讨去骨瓣减压术治疗高血压脑出血的临床疗效与安全性。方法收集2008-01—2014-06我院行血肿清除术联合去骨瓣减压术治疗的高血压脑出血患者55例作为观察组,同期行单纯血肿清除术治疗者43例作为对照组,比较2组临床疗效。结果观察组优良率为65.5%,显著高于对照组的34.9%;治疗后2组NIHSS评分均显著降低,且观察组显著低于对照组(P0.05);观察组ADL分级显著低于对照组(P0.05)。结论去骨瓣减压术治疗高血压脑出血有利于改善患者的神经功能缺损症状与日常生活活动能力,疗效显著,值得推广应用。     

标准外伤大骨瓣减压术在重型颅脑损伤 救治中的应用体会

目的 总结标准外伤大骨瓣减压术治疗重型颅脑损伤的经验。方法 回顾性分析2015年7月至2016年8月手术治疗的103例重型颅脑损伤的临床资料，其中标准外伤大骨瓣减压术治疗50例（观察组），常规骨瓣减压术治疗53例（对照组）。结果 两组术前颅内压无统计学差异（P>0.05）。两组术后1、3、7 d颅内压较术前均明显降低（P<0.05），而且，观察组明显低于对照组（P<0.05）。观察组术后并发症总发生率（18.0%）显著低于对照组（35.8%；P<0.05）。观察组术后6个月恢复良好率（52.0%）明显高于对照组（32.1%；P<0.05）。结论 标准外伤大骨瓣减压术在重型颅脑损伤中的应用增加救治成功率，降低并发症发生率，改善预后，效果优于常规骨瓣减压术。     

控制性减压技术在老年重型、特重型颅脑损伤去骨瓣减压术中的应用

目的 探讨控制性减压技术在老年重型、特重型颅脑损伤（TBI）去骨瓣减压术中的应用效果。方法 回顾性分析2016年12月至2019年12月收治的96例老年重型、特重型TBI的临床资料。均采用大骨瓣减压术治疗,其中48例术中采用控制性减压技术（观察组）,48例未采用（对照组）。结果 去骨瓣前,观察组颅内压[（35.37±2.07）mmHg]与对照组[（35.24±1.72）mmHg]无统计学差异（P>0.05）;去骨瓣后,观察组颅内压[（20.87±1.40）mmHg]与对照组颅内压[（28.75±1.53）mmHg]较去骨瓣前均明显降低（P<0.05）,而且,观察组明显低于对照组（P<0.05）。术后1 d,观察组GCS评分[（6.28±0.73）分]明显高于对照组[（4.12±0.69）分;P<0.05];术后1个月,观察组Barthel指数[（76.81±5.54）分]明显高于对照组[（68.17±6.02）分;P<0.05]。术后观察组并发症总发生率（16.7%,8/48）明显低于对照组（47.9%,23/48;P<0.05）。结论 对于老年重型、特重型TBI,去骨瓣减压术是有效的,术中运用控制性减压技术可明显降低术后并发症发生率,改善病人预后     

自体筋膜硬膜成形术在去骨瓣减压术中的应用

<正>额颞去骨瓣减压术是降低颅内压、抢救脑疝的常用术式,此术式大多需要切开硬脑膜清除颅内病变[1]。对于切开的硬脑膜处理方法有多种。我们应用额颞自体筋膜做水密闭硬膜成形术,经无创颅内压监测及随访统计发现手术效果确实且并发症少。一、对象与方法1.一般资料:2011年6月至2013年3月,中国医科大学附属第四医院神经外科因颅内压增高行额颞去骨瓣减压术加自体筋膜硬膜成形术共41例。男29例,女12例。年龄19~     

翻转颞深筋膜在幕上开颅减压中的应用

目的探讨在颅脑损伤幕上开颅减压手术中,采用翻转颞深筋膜修补硬脑膜的可行性及实用价值。方法我院收治的36例颅脑损伤手术的患者,以减速伤为主,病灶主要位于额颞部或交界处,采用冠状切口、扩大翼点入路或标准大骨瓣减压入路,进行去骨瓣减压、硬脑膜作倒“T”形切开、血肿清除或内减压手术,硬脑膜用翻转颞深筋膜进行修补。结果出现脑脊液漏合并切口感染1例,皮下积液4例；死亡3例,生存33例。生存者均行1～6月随访,没有出现颅脑损伤术后所具有的头痛和神经系统体征等以外的症状和体征。术后有一部分患者来院行颅骨修补手术,再次手术发现：头皮解剖层次清楚,颞深筋膜与硬脑膜之间愈合良好。进一步病理(显微镜、电镜)证实：颞深筋膜无变性、坏死等改变。结论翻转的颞深筋膜是自体同部位组织,位于头皮与颞肌之间,与硬脑膜组织结构相同,有足够大的面积和较好的血运。在不损伤颞肌的情况下,用翻转的颞深筋膜修补硬脑膜,恢复了头皮的基本结构层次．起到充分缓解颅内高压和维持颅内环境稳定作用；经过再次手术、病理证明翻转的颞深筋膜成活、无变性,与硬脑膜愈合良好；翻转颞深筋膜修补硬脑膜为颅骨修补提供良好的组织解剖基础,减少对脑的损伤,也缩短下次手术时间,减少医疗成本和患者经济负担。采用本术式治疗病灶主要位于额颞部或交界处的颅脑损伤,可行、实用,并发症少,对患者损伤小,没有潜在的危害,值得应用和推广。     

乳胶垫片在去骨瓣减压手术中的应用

去骨瓣减压术是用于治疗急性幕上颅内血肿和脑挫裂伤、防治恶性颅内高压常用的一种手术方式,而后期在颅骨修补时,由于皮瓣和脑表面往往粘连十分紧密,造成皮瓣剥离困难,并容易造成脑皮层损伤等一系列问题.而我科在去骨瓣减压手术时采用皮瓣下放置乳胶垫片方法,成功解决了上述问题,取得良好效果,现报告如下.     

Non-union after a two-level anterior cervical decompression and fusion with Surgibone™

Numerous alternative implants have been proposed for cervical fusion, including bovine bone. We report a case of a two level cervical interbody fusion for degenerative disc disease using bovine dowels of Unilab Surgibonetrade mark. We describe the clinical evolution and histological examination after failure of the procedure due to non-union of the Surgibone implants. Alternative grafting substitutes are discussed with respect to their immunological, cytotoxic and osteoinductive aspects. Based on a literature review we conclude that allografts have a significantly better cytological biocompatibility than Surgibonetrade mark and allow a higher fusion rate. The ideal graft remains autologous bone.     

骨屑粘合回植之颈椎管前路减压术

目的:提高前路颈椎手术的疗效及减少创伤。方法:采用改良前人路颈椎管减压术中自体骨碎、屑粘合回植术,取代了传统的操作方法和自体骨块移植。结果:本组30例次手术效果,脊髓神经功能恢复优良者28例(高达93.3％),好转者2例(占6.7％),总有效率达到100％。骨性愈合率100％。结论:改良法前入路减压对于严重脊髓受压或伴有神经根和(或)椎动脉压迫者更为有用。用医用胶粘结自体骨碎、屑回植,创伤性小,更符合生理,更容易实施,愈合更加迅速,这将可完全取代自体髂骨块移植。     

Three-level anterior cervical discectomy and fusion with self-locking stand-alone polyetheretherketone cages

Anterior cervical plating is regarded as standard practice after multilevel anterior cervical discectomy and fusion. However, plate implantation in the anterior cervical spine poses a substantial risk of hardware-related complications. We retrospectively analyzed the efficacy and outcomes of 15 consecutive patients treated with a 3-level anterior cervical fusion using self-locking stand-alone polyetheretherketone (PEEK) cages. Patients were evaluated preoperatively and postoperatively using the Japanese Orthopedic Association (JOA) scale scores and radiographs. Clinical results were assessed using Odom’s criteria. The mean JOA score (± standard deviation) improved significantly from 7.3 ± 1.5 points to 14.1 ± 1.3 points (p < 0.05) at the final follow-up. The outcomes were excellent for four patients (26.7%), good for nine patients (60%) and fair for two patients (13.3%). None of the patients experienced a poor clinical outcome. Thirteen patients achieved a solid fusion, after an average time of 5.7 months. The radiographic fusion rate of this procedure was 93.3%. Of 45 cages inserted in total, only four (8.89%) cages, in three patients, were found to have subsided. The degree of spinal curvature before surgery differed significantly from that immediately after surgery, and from that at the final follow-up examination (p < 0.05). Self-locking stand-alone PEEK cages packed with excised local osteophytes and calcium sulfate are safe and effective. This procedure can effectively restore cervical lordosis, obviate the complications related to graft harvest and screw-plate fixation, and lead to satisfactory outcomes.     

Effect of posterior subsidence on cervical alignment after anterior cervical corpectomy and reconstruction using titanium mesh cages in degenerative cervical disease

Subsidence after anterior cervical reconstruction using a titanium mesh cage (TMC) has been a matter of debate. The authors investigated and analyzed subsidence and its effect on clinical and radiologic parameters after cervical reconstruction using a TMC for degenerative cervical disease. Thirty consecutive patients with degenerative cervical spine disorders underwent anterior cervical corpectomy followed by reconstruction with TMC. Twenty-four patients underwent a single-level corpectomy, and six patients underwent a two-level corpectomy. Clinical outcomes were assessed using a Visual Analogue Scale (VAS), the Japanese Orthopedic Association (JOA) score and the Neck Disability Index (NDI). Fusion status, anterior and posterior subsidence of the TMC, segmental angle (SA) and cervical sagittal angle (CSA) were assessed by lateral and flexion-extension radiographs of the neck. The mean follow-up period was 27.6 months (range, 24 to 49 months). The VAS, NDI and JOA scores were all significantly improved at the last follow-up. No instances of radiolucency or motion-related pseudoarthrosis were detected on radiographic analysis, yielding a fusion rate of 100%. Subsidence occurred in 28 of 30 patients (93.3%). The average anterior subsidence of the cage was 1.4 ± 0.9 mm, and the average posterior subsidence was 2.9 ± 1.2 mm. The SA and CSA at the final follow-up were significantly increased toward a lordotic angle. Anterior cervical reconstruction using TMC and plating in patients with cervical degenerative disease provides good clinical and radiologic outcomes. Cage subsidence occurred frequently, especially at the posterior part of the cage. Despite the prominent posterior subsidence of the TMC, SA and CSA were improved on final follow-up radiographs, suggesting that posterior subsidence may contribute to cervical lordosis.     

比较纳米羟基磷灰石/聚酰胺66人工椎体与自体髂骨在颈椎前路减压融合中的应用

摘要 背景：目前用于颈椎前路重建的材料较多,如自体髂骨、同种异体骨、钛网等,但各种材料均存在一定的不足。纳米羟基磷灰石/聚酰胺66人工椎体具有良好的生物相容性及生物安全性,是一种比较理想的椎体植骨替代材料。 目的：评估纳米羟基磷灰石/聚酰胺66人工椎体应用于颈椎前路减压融合治疗脊髓型颈椎病的临床效果,并与自体髂骨进行对比。 方法：2009-01/2010-03对40例脊髓型颈椎病患者行颈前路椎体次全切减压融合钛板内固定。22例行纳米羟基磷灰石/聚酰胺66人工椎体植骨,18例行自体髂骨块植骨,采用JOA评分法评价神经功能的恢复情况,测量Cobb角评价融合节段曲度以及融合节段椎体前缘、后缘高度。 结果与结论：患者均获得 6~14个月随访,JOA评分较治疗前明显改善。人工椎体组及自体髂骨组融合节段后缘高度和前凸Cobb角治疗后3个月与治疗后即刻差值、治疗后6个月与治疗后3个月差值差异均有显著性意义(P < 0.01)。根据融合标准,治疗后6个月两组融合情况差异无显著性意义(P > 0.05)。提示纳米羟基磷灰石/聚酰胺66人工椎体作为颈椎前路植骨材料,融合率同自体髂骨相似,可以有效保持颈椎生理曲度及椎间高度,长期效果有待进一步观察。 关键词：纳米羟基磷灰石/聚酰胺;颈椎病;自体髂骨;前路植骨融合;Cobb角 doi:10.3969/j.issn.1673-8225.2011.12.026     

枕颈内固定与植骨融合治疗先天性复杂寰枕畸形

目的 探讨枕颈内固定并植骨融合治疗先天性复杂寰枕畸形的疗效.方法 回顾性分析21例复杂寰枕畸形患者,其中17例行后颅窝减压+枕颈植骨固定融合术,4例行经口咽寰枢椎间软组织及骨性组织切除减压,齿状突复位减压+后路后颅窝枕骨大孔减压术+枕颈植骨固定融合术;术后随访3个月至3年.结果 寰枢脱位并存在延颈髓腹、背侧受压者,选择经口咽寰枢椎间软组织及骨性组织切除减压齿状突复位减压+后路后颅窝枕骨大孔减压术+枕颈植骨固定融合术,疗效满意.硬脑膜扩大修补与否及小脑扁桃体切除术与否与最终远期疗效无关;伴有多节段脊髓空洞症者行脊髓空洞“T”管蛛网膜下腔引流.本组治愈14例,有效7例.结论 针对Chiari畸形解剖变异大的特点以及合并症形成的机制,选择不同的手术方案,提高手术治疗的远期疗效.     

A multicenter retrospective research of anterior debridement,decompression, bone grafting,and instrumentation for cervical tuberculosis

ABSTRACT

Objective: To observe the clinical effect of anterior debridement, decompression, bone grafting, and instrumentation for cervical spinal tuberculosis in four hospitals.

Materials and Methods: This research retrospectively analyzed 146 patients with cervical spinal tuberculosis who were treated by anterior debridement, decompression, bone grafting, and instrumentation in four institutions between January 2000 and January 2015. There were 68 males and 78 females with an average age of 31.32 ± 11.69 years. All patients received chemotherapy for 18 months after surgery, and fixed by brace for 3 months. Clinical outcome, laboratory indexes and radiological results were analyzed to evaluate the efficacy of anterior approach surgery in the treatment of cervical spinal tuberculosis.

Results: All cases were followed up about 18 to 52 months later (average 24 months). At the last follow-up, all patients obtained bone fusion, pain relief and neurological recovery. There was no recurrence in any of the patients, and no complications related to internal fixation. There were statistically significant differences before and after treatment in terms of Visual analog scale (VAS), Neck disability index (NDI) and Japanese Orthopedic Association (JOA)(P < 0.05). During the last follow-up examination, in 83 patients with neurological deficit, 78 patients improved. The kyphosis was significantly improved postoperatively (P < 0.05). At the last follow-up, the Cobb angle had some degree of correction loss, but the difference was not statistically significant.

Conclusion: Our study suggests that one-stage anterior debridement, decompression, bone grafting, and instrumentation are safe and effective methods in the surgical management of cervical spinal tuberculosis.

Abbreviation: VAS: Visual Analog Scale; JOA: Japanese Orthopaedic Association; NDI: Neck Disability Index; ESR: Erythrocyte Sedimentation Rate; ASIA: American Spinal Injury Association; TB: Tuberculosis     

Orion钢板结合钛网植骨在不稳定型颈椎疾病中的应用

目的：总结分析钛网结合Orion钢板内固定治疗不稳定型颈椎疾病的临床效果。 方法：由作者检索1990/2008 PubMed数据及万方数据库有关Orion钢板结合钛网植骨治疗不稳定型颈椎疾病方面的文献,英文检索词为“cervical vertebrae,Orion anterior plate,titanium mesh,spinal fusion”,中文检索词为“颈椎,Orion前路钢板,钛网,脊柱融合”。排除重复性研究。计算机初检得到54篇文献,根据纳入标准保留13篇进一步归纳总结。结果：Orion颈椎前路钢板联合钛网植骨在治疗不稳定型颈椎疾病时可以重建颈椎前柱,有效保持颈椎的生理弯曲和椎间隙的高度,防止远期颈椎的不稳定和后凸畸形,提升椎间孔的高度和容量促进神经根症状的恢复,同时避免了自体骨移植时的供骨区的并发症,较传统的自体骨有着突出的优点,而带锁钢板又可有效避免滑脱所造成的后果,弥补了单独应用钛网在颈椎后伸运动时的不稳定现象,使各个方面的稳定性得到了加强,是一种较为理想的颈椎前路内固定方法。 结论：应用Orion颈椎前路钢板内固定结合钛网植骨治疗不稳定型颈椎疾病是一种较为理想的颈椎前路内固定方法。     

前路钢板加钛网融合金属置入物治疗颈椎骨折脱位23例：X射线及1年随访评价★

回顾性分析2005-01/2008-01解放军第309医院骨科收治的采用前路带锁钢板系统加钛质网笼内植骨融合置入治疗的23例外伤性颈椎骨折脱位患者，男16例，女7例；年龄25~65岁，平均41.9岁。评价前路带锁钢板系统加钛质网笼内植骨融合治疗颈椎骨折脱位的临床疗效及应用价值。以JOA评分系统分别评价患者置入前、置入后即刻、置入后随访情况，以评判手术减压效果；并分别摄置入前、置入后即刻、置入后随访X射线平片，以Cobb角测量融合节段的前凸(或后凸)，以D值(齿状突到C7后下缘连线与C4后下缘垂直距离)评价颈椎的前凸(或后凸)，评判重建和维持颈椎生理曲度的疗效。23例患者均获得随访，随访时间1~3年，平均20.5个月。所有病例均获临床稳定，置入前JOA评分、Cobb角及D值与置入后即刻，置入后随访相比，差异均有显著性意义(P < 0.05)；置入后即刻与置入后随访之Cobb角及D值差异无显著性意义(P > 0.05)，但置入后随访之JOA评分较置入后即刻仍有改善(P < 0.05)。随访1年以上平均改善率为63%。提示应用前路带锁钢板系统加钛质网笼内植骨融合治疗颈椎骨折脱位，在恢复和维持颈椎生理曲度方面疗效满意。