胸腰椎骨折内固定取出后严重脊柱后凸的再次手术矫治

目的　总结胸腰椎骨折内固定取出后发生严重脊柱后凸畸形患者再次行脊椎截骨和椎弓根钉内固定治疗的经验。方法　对 4例患者脊椎后凸发生的原因、脊椎截骨和再次椎弓根内固定的方法、手术适应证等进行分析。结果　Cobb角由术前 72°矫正到术后 8° ,无并发症发生。经 12个月以上随访 ,后凸无复发。结论　椎弓根钉内固定取出时间过早和脊柱后路融合术失败是胸腰椎骨折术后发生严重脊柱后凸的主要原因 ;再次行脊椎截骨、椎弓根钉内固定矫治手术设计合理 ,安全可靠     

椎弓根钉内固定结合经椎弓根椎体内植骨治疗胸腰椎骨折

目的探讨椎弓根钉复位固定结合经椎弓根椎体内植骨术治疗胸腰椎骨折的方法和疗效。方法自2006年3月至2009年9月,我科对48例胸腰椎骨折采用椎弓根钉内固定结合经椎弓根椎体内植骨治疗。术后随访并评估此方法的临床疗效。结果本组均获随访,随访时间12-38个月,平均18．3个月。随访均未出现明显椎体高度再度丢失,无一例发生内固定断裂、松动。结论椎弓根钉内固定结合经椎弓根椎体内植骨治疗胸腰椎骨折,可有效消除伤椎的蛋壳效应,可减少椎体高度再丢失及内固定断裂、松动等并发症,值得临床应用。     

椎弓根钉内固定结合植骨治疗胸腰椎骨折的临床效果分析

目的探讨椎弓根钉内固定结合植骨治疗胸腰椎骨折的临床疗效。方法将60例胸腰椎骨折患者随机分为治疗组(30例)和对照组(30例);治疗组采用椎弓根钉内固定结合植骨治疗;对照组仅给予椎弓根钉内固定治疗,比较2组患者的临床效果。结果术后经6～12个月的随访,治疗组椎弓根螺钉无断裂,l例松动,神经功能都恢复良好。对照组椎弓根螺钉1例断裂,3例松动,神经功能恢复情况19例效果欠佳。2组比较,差异具有统计学意义(P<0.05)。结论椎弓根钉内固定结合植骨治疗胸腰椎骨折,固定牢固,是脊柱固定的一种较好的手术方法,值得临床推广应用。     

椎弓根钉固定结合骨屑填充椎体成形术治疗胸腰椎骨折

目的探讨椎弓根钉复位固定结合骨屑填充椎体成形术治疗胸腰椎骨折的方法和疗效。方法自2005年1月～2007年4月,对23例胸腰椎骨折采用椎弓根钉复位、固定后,自体骨屑填充的方法治疗。术后随访并评估此方法的临床疗效。结果随访均未出现明显椎体高度再度丢失,无一例发生内固定断裂、松动。结论椎弓根钉复位、固定后采用自体骨屑填充植骨,可减少椎体高度再丢失及内固定断裂、松动等并发症。     

椎弓根钉内固定系统治疗胸腰椎骨折

目的 探讨椎弓根钉内固定系统治疗胸腰椎骨折的临床疗效.方法 回顾性分析42例经椎弓根钉内固定系统治疗的胸腰椎不稳性骨折或脱位患者手术前后临床表现、X线和CT扫描的结果.结果 随防时间为2个月至3年,椎体高度完全恢复34例,恢复程度＞90%者6例,＞80%者2例.按Frankel标准,术前不全瘫患者术后神经功能均有不同程度的恢复.结论 椎弓根钉内固定系统是治疗胸腰椎骨折的好方法.     

单节段椎弓根钉复位固定治疗胸腰椎骨折患者的护理

目的探讨后路单节段椎弓根钉固定治疗胸腰椎骨折的护理。方法对81例胸腰椎骨折患者予单节段椎弓根钉复位固定治疗，围术期做好心理疏导、体位护理、脊髓神经功能的观察与治疗，脊髓神经功能的观察，肺部并发症护理、功能锻炼、佩戴支具与离床活动、出院指导等。结果81例患者未发生护理并发症，随访12～35个月，无1例内固定断裂或松动，全部获得骨性融合。结论对后路单节段椎弓根钉复位固定治疗胸腰椎骨折患者采取有效的护理。可保证及促进患者早日康复，提高手术成功率。     

单节段椎弓根钉复位固定治疗胸腰椎骨折患者的护理

目的 探讨后路单节段椎弓根钉固定治疗胸腰椎骨折的护理.方法 对81例胸腰椎骨折惠者予单节段椎弓根钉复位固定治疗,围术期做好心理疏导、体位护理、脊髓神经功能的观察与治疗,脊髓神经功能的观察,肺部并发症护理、功能锻炼、佩戴支具与离床活动、出院指导等.结果 81例患者未发生护理并发症,随访12～35个月,无1例内固定断裂或松动,全部获得骨性融合.结论 对后路单节段椎弓根钉复位固定治疗胸腰椎骨折患者采取有效的护理,可保证及促进患者早日康复,提高手术成功率.     

后路椎弓根螺钉固定治疗胸腰椎骨折的并发症的防治

目的回顾分析应用椎弓根螺钉固定技术治疗胸腰椎骨折发生的并发症原因,探讨其防治方法。方法回顾分析2003年4月-2006年10月应用椎弓根螺钉固定技术治疗胸腰椎骨折的患者486例,共发生各类手术并发症45例,针对不同原因采取相应补救方法,观察术后疗效并探讨预防措施。结果早期手术并发症13例,包括切口感染5例、椎弓根螺钉位置不良6例及下肢深静脉血栓形成2例;晚期并发症32例,包括椎弓根螺钉断裂20例、椎弓根螺钉松动4例、连接杆断裂3例、钉杆连接松动3例、神经减压不彻底2例。其中20例进行内固定翻修手术,更换椎弓根螺钉12例,更换连接杆3例,调整紧固钉杆连接装置3例,再次前路减压2例。结论椎弓根螺钉固定技术治疗胸腰椎骨折的并发症的发生主要与手术操作不当、忽视植骨融合的质与量以及手术方式选择错误有关,再次手术只要处理方法得当仍能取得满意疗效。     

对比单侧伤椎置钉与跨伤椎椎弓根内固定治疗胸腰椎骨折的效果

目的比较胸腰椎骨折采用单侧伤椎置钉与跨伤椎椎弓根内固定治疗的临床效果。方法 104例胸腰椎骨折患者采用数字表法根据手术方式不同随机分成两组,50例患者实施跨伤椎椎弓根内固定术,54例患者实施单侧伤椎置钉术。对比两种术式的临床治疗效果。结果所有患者术后随访1年,术后脊髓神经功能无损伤加重,单侧伤椎置钉组术后Cobb角、矫正率、术后椎管面积改善值均明显优于跨伤椎椎弓根内固定组,差异有统计学意义(P0.05)。最后一次随访调查发现,单侧伤椎置钉组术后远期丢失率和内固定失效率和跨伤椎椎弓根内固定组比较明显较低,差异有统计学意义(P0.05)。结论单侧伤椎置钉治疗胸腰椎骨折的临床效果确切,术前要严格控制手术适应证,术中谨慎操作,可有效减少术后并发症。但由于单侧伤椎置钉手术的适应证较窄,还需要进一步深入研究。     

骨盆牵引联合后路椎弓根钉固定治疗胸腰椎骨折效果观察

目的观察骨盆牵引联合后路椎弓根钉系统内固定治疗胸腰椎骨折的效果。方法选取50例接受后路椎弓根钉系统内固定术治的胸腰椎骨折患者,随机分为2组,每组25例。观察组术前先给予骨盆牵引2 d,对照组术前不行骨盆牵引治疗。比较2组的治疗效果。结果 2组患者均顺利完成手术。术后经12个月随访,2组患者的伤椎椎体高度和脊柱后凸Cobb角均较术前明显改善,但观察组患者的改善程度明显优于对照组,差异均有统计学意义(P0.05)。随访期间2组患者均未发生椎弓根螺钉弯曲、折断、松动等并发症。结论对胸腰椎骨折患者,在实施后路椎弓根钉系统内固定术前,先给予短期骨盆牵引,可防止伤椎被进一步压缩,能有效恢复椎体高度和脊柱后凸Cobb角,效果确切。     

胸腰椎骨折椎弓根内固定断裂与植骨融合方式的相关性分析

[目的]探讨胸腰椎骨折椎弓根螺钉内固定系统内固定术后,椎弓根螺钉断裂与植骨融合方式之间的关系,以探讨胸腰椎骨折植骨融合的最佳方式。[方法]回顾性研究1995年5月~2005年12月本院脊柱外科收治的胸腰椎骨折病人197例,其中A组单纯内固定(不植骨)患者14例,B组“H”形椎板植骨21例,C组横突间植骨67例,D组椎间、椎内联合横突间植骨95例。[结果]术后随访6~32个月,内固定断裂12例,其中A组4例,B组3例,C组5例,D组0例,4组中D组内固定断裂率显著低于其他3组(P<0.05)。[结论]椎间、椎体内联合横突间植骨重建脊柱三柱的稳定性,符合人体生物力学原理,能有效降低内固定断裂的发生。     

On the measurement of the functional properties of the CFTR

A number of methods are currently employed to assess the functional properties of CFTR channels and their response to pharmacological potentiators, correction of the defective CFTR trafficking, and vectorial introduction of new proteins. Here we review the most common methods used to assess CFTR channel function. The suitability of each technique to various experimental conditions is discussed.     

The Measurement of the Inclination Angle of the Hamate and Analysis of the Inclination Angle for the Rotation Deformity of the Little Finger in the Fixation of the Carpometacarpal Joint

ObjectiveComplex base fractures of the fifth metacarpal bone and dislocation of the fifth carpometacarpal joint are more prone to internal rotation deformity of the little finger sequence after fixation with a transarticular plate. In the past, we have neglected that there is actually a certain angle of external rotation in the hamate surface of transarticular fixation. This study measured the inclination angle of the hamate surface relative to the fifth metacarpal surface for clinical reference.MethodsIn a prospective single‐center study, we investigated the tilt angle of 60 normal hamates. The study included thin‐layer computed tomography (CT) data from 60 patients from the orthopaedic clinic and inpatient unit from January 2017 to March 2020, including 34 men and 26 women who were 15~59 years old, average 35 years old. The CT data of 60 cases in Dicom format of the hand was input into Mimics and 3‐Matics software for three‐dimensional (3D) reconstruction and measuring the angle α between hamate surface and the fifth metacarpal surface. According to the possible placement of the transarticular plate on the fifth metacarpal surface, we measured the angle β between the hamate surface 1 and the fifth metacarpal surface and the angle γ between the hamate surface 2 and the fifth metacarpal surface.ResultsThe average angle between the hamate surface and the fifth metacarpal surface was 11.66°. The hamate surfaces 1 and 2 have an external rotation angle of 7.30° and 7.51° on average with respect to the fifth metacarpal surface, respectively. There is no statistically significant difference in the angles between the two groups (P > 0.05).ConclusionsThe horizontal angle of the dorsal side of the hamate is different from the back of the fifth metacarpal surface, and the hamate has a certain external rotation angle with respect to the fifth metacarpal surface. No matter how the transarticular plate is placed, the plate always has a certain external rotation angle relative to the fifth metacarpal surface. When the fixation is across the fifth carpometacarpal joint, if the plate does not twist and shape, it will inevitably cause internal rotation of the fifth metacarpal, resulting in internal rotation deformity of the little finger sequence.     

静脉输注甘露醇开放血脑屏障对抗生素透过血脑屏障的影响

目的　通过快速静脉输注甘露醇可逆性开放血脑屏障 (BBB) ,探知此方法能否增加抗生素透过BBB的量 ,在何时达到最高峰 ,其通透量增加后临床上有无不良反应。方法　采用自身配伍设计 ,共 6个样本组。对照组仅使用抗生素 ;其余 5组分别在使用甘露醇前 60、3 0min ,同时使用甘露醇后 3 0、60min使用抗生素 ,各组皆取使用抗生素后 1h的脑脊液测其抗生素浓度。抗生素选用头孢三嗪。结果　测量值经过q检验 ,经 2 0 %甘露醇处理前后的CSF中的头孢三嗪浓度差异有非常显著性。全组患者经临床观察未出现神经系统的不良反应。结论　经静脉快速输注2 0 %甘露醇后可以使透过BBB的水溶性抗生素的量增加 ,两者使用的顺序是在抗生素使用 3 0min内即给予甘露醇快速滴注。该方法不会增加低神经毒性抗生素在中枢神经系统的不良反应。     

Preservation of the pylorus and resection of the head of the pancreas

The historical evolution of the pylorus-preservation resection of the head of the pancreas is traced from the first resections early in this century to relative standardization of the operation, to a lowering of the operative mortality, and to an interest in improving nutritional status after resection. There are many theoretical advantages for the function of the upper gastrointestinal tract after pylorus and gastric preservation, such as maintenance of gastric capacitance and equilibration of osmotic pressure in gastric digestants, foodstuff digestion and absorption, and bowel motility. After the pylorus-preserving resection, gastric emptying is normal, pyloric function to prevent duodenal reflux is often normal, and gastric acids and serum levels of duodenal hormones are at normal levels, whereas after standard pancreatoduodenectomy, all of these are often abnormal. No prospective blinded studies have been published comparing nutritional values after the two operative procedures, but evidence is presented of a satisfactory result with regard to gastric capacitance, body weight gain, and lack of postgastrectomy symptoms. An undoubted advantage of the pylorus-preserving feature is a simplification of the operation. These gains are achieved without increase in operative mortality, without increase in the incidence of jejunal ulcer, and without theoretical or actual decrease in value of the procedure as a cancer operation, except in patients with duodenal carcinoma proximal to the ampulla of Vater.     

下颌全牙弓后移量及最后界的测量

目的：研究下颌牙弓的有效后移量及找寻下颌牙弓移动的后界。方法：选取涉及拔除下颌第三磨牙或下颌第三磨牙缺失的病例18例（男6例,女12例）。采用种植支抗牵引下牙弓向远中,治疗完成时所有病例均明确到达下颌牙弓后界,即下颌第二磨牙远中到达下颌升支前缘软组织交界处。应用治疗前后的曲断片测量下颌第二磨牙远中到升支前缘的距离。结果：下颌第二磨牙后移量为（3.49±1.21）mm;治疗后磨牙后间隙的长度为（4.43±0.97）mm。结论：下颌牙弓可确定性地实现整体后移;最大后移量由磨牙后间隙的长度决定;其最后界止于下颌第二磨牙远中与下颌升支前缘软组织交界处。     

Preservation of the pylorus in resection of the head of the pancreas

Whipple's pancreatoduodenectomy was the standard operation for diseases of the head of the pancreas for more than 40 years, but the results were vitiated in part by poor gastrointestinal function and malnutrition. Reintroduced in 1978, pylorus-preserving proximal pancreatoduodenectomy (PPPP) has had an increasing impact on pancreatic surgery as its benefits have been recognized: improved nutritional status, decreased incidence of postgastrectomy syndromes, and a technically easier operation. Postoperative mortality rates and 5-year survival rates are comparable with those of the classic Whipple procedure. PPPP is indicated for most patients with chronic pancreatitis of the pancreatic head. It is also appropriate for patients with periampullary cancer and for those with pancreatic cancer arising from the lower part of ‘the head and the uncinate process. More than 650 patients have now undergone PPPP: 31% for chronic pancreatitis and 66% for periampullary and pancreatic cancers. We assess the indications for PPPP, outline the operation, and review the results.