应用TSRH椎弓根钉系统治疗腰椎不稳症

目的：评价ＴＳＲＨ椎弓根钉系统在治疗腰椎不稳症中效果。方法：对２１例腰椎不稳症患者行ＴＳＲＨ椎根钉系统内固定手术,术后随诊分析。结果：２１例获平均２０．９个月的随访,植骨晤率为９５．２％,疗效满意。结论：ＴＳＲＨ椎弓根钉系统简单、固定牢靠,适用于腰椎不稳症的手术治疗。     

新型脊柱固定器械治疗胸腰椎骨折的技术探讨

新型脊柱固定器械治疗胸腰椎骨折的技术探讨张功林葛宝丰荆浩张军华王世勇陈新曾述强王清１９８９年以来，作者针对脊柱椎弓根固定器械的缺点，设计一种新型脊柱固定器械，用于治疗胸腰椎骨折，取得满意效果，现报告如下：１器械结构１．１器械结构该器械结构简单，由主杆...     

胸腰椎稳定性重建方法的改进

为了改进胸腰椎脱位的治疗方法，更好地重建脊柱稳定性，设计了一种新的脊柱固定器械，由滚花钉及连接板构成，并通过椎弓根进行的一种脊柱后路短节段固定方法，脊柱固定范围限制在两个椎体间。１９８９年～１９９５年，临床应用这种新器械矫正胸腰椎脱位１２例，经１～４年随访，畸形矫正满意，固定牢固。结果表明：该器械具有手术方法简单、固定牢固和手术创伤小等优点。认为，该项技术适用于胸腰椎稳定性的重建。     

TSRH内固定系统临床应用初步报告

目的：通过使用新的通用脊柱内固定器脊柱疾病,获得更好的疗效。方法：１９９７年８月－１９９９年３月共用ＴＳＲＨ系统手术治疗脊柱疾病１８例,平均年龄１７．２岁,术后随访２￣２１个月。结果：;特性脊柱侧凸１５例,矫正率在ＫｉｎｇⅡ型为６５．５％,ＫｉｎｇⅢ／Ⅳ为５７．３％;马凡氏综合征脊柱侧凸１例,矫正率６０％;强直性脊椎为驼背１例,矫正率８６．５％,所有病例植骨融合良好无假关节形成,无脊髓神经损伤,植     

HOIST器械与BAK联合应用治疗腰椎滑脱

目的 评价滑脱矫正固定器（HOIST器械）与椎问融合器（BAK）联合应用治疗腰椎滑脱的效果。方法 HOIST器械与BAK联合应用治疗21例腰椎滑脱患者,手术改进在于加强脊柱前中柱支撑及复位内固定,并针对手术方法及结构力学等进行分析。结果 平均随访28个月,所有患者滑脱均达到完全复位,临床症状消失,无严重并发症。结论 BAK植入脊柱前中柱符合生物力学要求,疗效满意。HOIST器械与BAK联合应用手术方法能达到滑脱精确复位、牢固的脊柱三柱固定并有效融合。     

脊柱侧凸矫正术中的神经损伤并发症

目的：分析脊柱侧凸矫正术中神经损伤的机理及防治措施。方法：５４例脊柱侧凸患者，男１８例，女３６例。Ｃ－Ｄ法矫正３３例，平均年龄１５．５岁，Ｃｏｂｂ角平均６６°；ＴＳＲＨ法矫正２１例，平均年龄１４岁，Ｃｏｂｂ角平均６８°。结果：Ｃ－Ｄ组矫正后Ｃｏｂｂ角减少至２６°，ＴＳＲＨ组减小至２８°。２例出现神经损伤（３．７％）。其中１例经唤醒试验发现神经损伤立即取出Ｃ－Ｄ棒，术后双下肢瘫痪。卧石膏床３个月，给予辅助性治疗，１年后基本恢复；另１例术中诱发电位显示波幅降低，但唤醒试验正常，术后右大腿有一过性感觉障碍，１周后恢复。结论：神经损伤应分为严重损伤和一过性损伤，前者应及时取出内固定器械，后者可严密观察。对畸形严重，尤其是双主弯者，不能一味追求矫正度数而忽视神经损伤的发生     

脊柱侧凸手术进展

近年来,脊柱侧凸的手术方法随着各种新器械的诞生而得以迅猛发展。本文旨在综述脊柱侧凸手术技术的进展,讨论各种器械的优缺点,并概述特发性脊柱侧凸手术适应证的选择。 脊柱侧凸手术器械的进展 60年代开始应用和推广的Harrington器械[1]已成为脊柱侧凸手术中最常见的矫形和内固定方法,它同时又成了评价其他器械的标准。哈氏系统经过25年临床检验,证明是有效的。 矢状面的总体平衡(即生理弧度)极为重要[2,3];腰椎前凸对外观与预防疼痛,对步行时能量消耗的减低都很重要。圆头哈氏棒在矫正侧凸时无法保留胸谁的生理后凸和腰椎的生理前凸,出现…     

经皮椎弓根植骨联合脊柱外固定微创治疗胸腰椎骨折

胸腰椎骨折的传统手术治疗主要是前路、前外侧入路、后路椎管减压,植骨融合,内固定术。手术创伤大、出血多、跨节段融合、脊柱活动度丢失。为减少创伤、保留脊柱活动度,我院研制了经皮椎弓根植骨器械和新型脊柱外固定器,自2005年2月至2007年6月应用经皮椎弓根植骨器械联合新型脊柱外固定器微创治疗胸腰椎骨折30例,取得了满意疗效,实现了微创非融合性固定治疗胸腰椎骨折的目的。     

腰椎滑脱症和胸腰椎骨折的内固定器研制及其临床应用

目的：为了提高脊柱内固定器的复位效果。方法：通过对腰椎滑脱症发病机理的探讨和３１８例胸腰椎骨折治疗的分析，作者设计了一种用于治疗腰椎滑脱症和胸腰椎骨折的新型内固定器（ＳＦ内固定器）。结果：经４２例胸腰椎骨折和１７例腰椎滑脱症临床应用，其中４１例获６个月以上随访（６～３８个月，平均１３．４个月），效果满意，操作简便，值得推广。     

前路器械固定在脊柱结核中的应用

目的：探讨在脊柱结核中应用前路器械固定的可行性。方法：对34例前路病灶清除和内固定的脊柱结核病例进行回顾性分析：男13例，女21例。颈椎结核4例，胸椎结核13例，腰椎结核17例(包括胸腰段)。全部病例均进行术前和术后抗痨化疗。术中经前路彻底清除病灶，椎管减压，椎体间自体骨植骨，前路器械固定。结果：平均随访2．6年，死亡2例，失访4例，其余病例内固定物没有失效，椎体间植骨全部融合，脊柱后凸畸形矫正良好，切口无感染，没有结核复发的病例。结论：在脊柱结核中应用前路器械固定可有效矫正和预防脊柱后凸畸形，并为脊柱提供即刻稳定性，促进病灶愈合和骨性融合。     

TSRH内固定治疗脊柱侧凸

目的　回顾性研究TSRH(TexasScottishRiteHospital)脊柱内固定系统在治疗脊柱侧凸的临床疗效。 方法　对 1998年 1月至 2 0 0 0年 12月手术治疗的 12 9例脊柱侧凸患者 ,总结其侧弯矫形、脊柱平衡、并发症及 3年以上的随访结果。根据手术方法不同 ,共分为 4组。A组 :单纯脊柱后路融合固定术 ;B组 :单纯脊柱前路融合固定术 ;C组 :分期前、后路融合固定术 ;D组 :Ⅰ期前、后路融合固定术。四组患者均应用TSRH内固定系统。手术时平均年龄 14 .2岁 (6～ 5 5岁 ) ,平均随访 34个月。结果　A组 :78例病人行单纯脊柱后路融合TSRH内固定 ,术后平均矫形率为6 3.4 %。随访 38个月 (2 4～ 5 0个月 ) ,平均矫形丢失 7°,矫形丢失率平均 9.5 %。本组并发症发生率为 12 .8% ,包括 3例脱钩 ,3例螺钉断裂 (共 6枚螺钉 ) ,1例术后侧弯失代偿 ,1例术后发生曲轴现象。B组 :2 2例患者行单纯脊柱前路融合、短节段TSRH内固定 ,平均矫形率为 74 .8%。平均随访 36个月 ,平均矫形率丢失 5 %。 2例发生一过性交感神经损伤。术后 6个月内均自然恢复。C组 :17例有 90°以上的侧弯 ,且Bending像上侧弯仍大于 7°的患者行前路松解 ,2～ 3周后再行后路融合TSRH内固定。本组平均手术时间 8.3h ,出血 935ml,输血 6 83ml,平均矫形 33.6°,矫     

Adolescent scar contracture scoliosis caused by back scalding during the infantile period

The study design was a retrospective study in adolescent scar contracture scoliosis caused by back scalding during the infantile period. The objective of the study was to investigate the pathogenesis, clinical manifestation and treatment of adolescent scar contracture scoliosis caused by back scalding during the infantile period. This condition seldom occurs and is not reported in current English literature. One patient was first treated with skin expansion, back scar excision and skin flap transfer, followed by anterior correction with TSRH instrumentation. Two patients were first treated with back scar excision and anterior spinal release. One patient was treated with posterior correction with TSRH instrumentation, and thoracoplasty was performed after 50 days in halo-wheelchair traction. The other patient was treated with posterior correction with TSRH instrumentation. No management of scalding was performed on the fourth patient. Anterior release and posterior correction were performed at an interval of 3 weeks. The deformities of four patients were well corrected. Trunk balance was restored and the pelvis leveled. The skin incision wounds healed well. Minor loss of correction was recorded during the last follow-up. Severe scar contracture caused by back scalding during the infantile period could lead to adolescent scoliosis. Its pathogenesis and clinical manifestation are different from the typical adolescent idiopathic scoliosis. The treatment of this kind of scoliosis should be individualized. The research was approved by the Ethics Committee of Nanjing University.     

第三代脊柱内固定系统在成人脊柱侧凸中应用的疗效评价

目的回顾分析TSRH、CD、ISOLA等第三代脊柱内固定系统在成人脊柱侧凸矫治中的应用并评价其疗效。方法1999年7月至2003年1月间运用TSRH、CD、ISOLA脊柱内固定系统治疗的35例成人脊柱侧凸患者,包括成人特发性脊柱侧凸及退变性脊柱侧凸。术前冠状面主弯Cobb角平均58 1°(42°~95°),采用前后路联合矫形或单纯后路矫形手术方法。平均随访20个月(10 ~48个月)。通过影像学资料对术前术后冠状面和矢状面的矫形效果对比分析并通过C7 椎体中点距骶骨中心垂线(CVSL)的距离来分析躯干平衡的重建,通过关于自我评估的问卷调查来获得患者主观治疗效果评价。结果所有患者术后外观矫形效果明显。总体冠状面主弯平均Cobb角矫正53 2%。末次随访冠状面Cobb角平均丢失4 3°。C7 中点距CVSL由术前的平均2 6cm矫正为术后的0 24cm。通过随访期间的问卷调查, 89 3%的患者对手术表示满意。2例术后气胸、血胸, 3例术后随访1年后仍主诉腰背部疼痛,其中2例为临近节段退变, 1例为假关节形成。结论对于成人脊柱侧凸,第三代脊柱内固定系统能得到冠状面上较高的矫正率、重建躯干平衡,并且可以获得患者较高的满意度,并发症较少。     

脊柱侧凸矫形术后并发肠系膜上动脉综合征

目的探讨在脊柱侧凸矫形术后并发肠系膜上动脉综合征的发病机制,分析总结该并发症在脊柱侧凸矫形术中的易发因素。方法回顾性研究1997年7月～2001年1月,采用三维去旋转矫形技术矫治各种脊柱侧凸430例,共发生肠系膜上动脉综合征5例,3例发生在脊柱侧凸前路松解术后颅骨-骨盆牵引过程中,2例发生在后路矫形术后。结果5例患者经禁食、胃肠减压、维持水电解质平衡、左侧卧位、暂停或减轻颅骨-骨盆牵引重量后症状逐渐缓解,5～7d后均痊愈。结论严重的脊柱侧凸,特别是后突型,术前躯干塌陷明显,估计术中脊柱伸展多、纠正百分比高或前路术后需快速大重量牵引的患者易并发肠系膜上动脉综合征。对此症只要早期诊断和及时处理,预后较好。     

多棒分段CD技术治疗严重复杂脊柱侧凸

目的：探讨多棒分段ＣＤ技术纠正严重复杂脊柱侧凸的疗效及原理。方法：１９９７年起治疗１６例严重脊柱侧凸患者,在后路纠正术中将侧凸分解成僵硬的顶椎区和上下相对柔软的终椎区,然后分段纠正。结果：无神经并发症,冠状面平均纠正百分比达６２％,明显高于哈氏等传统手术,脊柱在矢状面和冠状面的平衡重建满意。结论：本技术可在顶椎区和终椎区分别施加纠正力而获最大侧凸纠正,可使脊柱不在短时间内受到大幅度纠正造成的牵拉力,并在获侧凸最大纠正时,保持和重建脊柱平衡。     

ISOLA与TSRH技术治疗特发性脊柱侧凸的疗效比较

目的 探讨应用ISOLA及ISRH技术治疗特发性脊柱侧凸的临床疗效，分析各自相对通应症。方法 在1997年9月至2002年3月份间分别应用ISOLA(28例)及，TSRH(62例)技术治疗共90例特发性脊柱侧凸患者，对侧凸的矫正度、脊柱的平衡以及并发症等结果进行分析。结果 Cobb角小于65度的患者，ISOLA组矫正率率为67％，TSRH组矫正率为62％；Cobb角大于65度的患者．ISOLA组矫正率为59％，TSRH组矫止率为40％。结论 ISOLA及TSRH技术是治疗特发性脊柱侧凸的行之有效的矫形内固定方法对于脊柱侧凸角度超过65度，伴有脊柱侧后凸的患者，运用ISOLA技术矫正效果较好。     

Texas Scottish Rite Hospital instrumentation for correction of idiopathic scoliosis: short-term results

Summary In this prospective study 27 consecutive patients of an average age of 20±8 years suffering from idiopathic scoliosis were operated on using the Texas Scottish Rite Hospital (TSRH) instrumentation in the period from 1992 to 1995 and were evaluated at a minimum follow-up of 26 months postoperatively. Curvature correction, derotation of the apical vertebra, frontal and sagittal trunk balance, and L3–L4 and L4–L5 disc-space wedging were evaluated prepostoperatively and at the maximum follow-up of 54 months. The average correction of the thoracic and lumbar scolioses that was obtained immediately postoperatively averaged 41% and 51% respectively. An average 2–4° and 4–5° loss of correction was dependent on King type in the thoracic and lumbar scoliotic curves respectively was observed at the longest follow-up. Thoracic kyphosis and lumbar lordosis did not significantly change. No significant derotation of thoracic and lumbar apical vertebral rotation was achieved by TSRH but the preoperatively laterally shifted apical vertebra was translated by TSRH instrumentation towards the midline (p<0.001). The position of the T1, and C7 vertebrae in the sagital frontal plane was not significantly changed by TSRH instrumentation postoperatively. The preoperative wedging of the intervertebral spaces L3–L4 and L4–L5 was simultaneously significantly (p<0.01) reduced by TSRH with subsequent horizontalization of the L3, L4 and L5 vertebrae. No trunk decompensation, neurologic complications, infection or pseudarthroses occurred. Lumbar hook dislodgment occurred in the early post-operative period in two patients because of insufficient TSRH rod contouring at the beginning of our learning curve. TSRH is a safe instrumentation that corects idiopathic scoliosis satisfactorily, maintains frontal and sagittal vertebral balance by translating the apical vertebra towards the midline and simultaneously correcting the lowermost lumbar vertebral tilting without associated infection, neurologic complications or decompensation.      

Endoscopic instrumentation, correction, and fusion of idiopathic scoliosis.

BACKGROUND CONTEXT: Endoscopic techniques have been used since 1993 to treat thoracic disk disease. Thorascopic techniques evolved into means of treating not only disk disease but also correcting thoracic spinal deformity with instrumentation and fusion. PURPOSE: To evaluate the efficacy of endoscopic instrumentation, correction, and fusion of thoracic idiopathic scoliosis. STUDY DESIGN: A retrospective review of 50 patients who have undergone endoscopic instrumentation, correction, and fusion for scoliosis. PATIENT SAMPLE: Fifty consecutive patients undergoing treatment for primary thoracic idiopathic scoliosis. OUTCOME MEASURES: Evaluation of operative time, curve correction, and fusion rates were evaluated. METHODS: Fifty patients with the diagnosis of primary thoracic scoliosis underwent thoracoscopic techniques of instrumentation, correction, and fusion. On follow-up, the patients were evaluated for spinal alignment restoration, axial derotation, postoperative pain, rehabilitative time, and complications. RESULTS: The initial curve correction averaged 50%, improving to over 68% in the last 10 cases. Hypokyphosis correction averaged 21 degrees. Additionally, there has been a decrease in rehabilitation time, less time off work or school, and decreased blood loss and postoperative pain. There were 14 complications and no deaths recorded. The factors involved in a successful fusion include total diskectomy, complete cartilaginous end plate removal, and autogenous bone graft. CONCLUSIONS: The initial results of the thoracoscopic-assisted techniques for primary thoracic scoliosis are promising. As with most evolving techniques, surgical times are decreasing and rates of correction are improving.     

Biomechanical evaluation of anterior spinal instrumentation systems for scoliosis: in vitro fatigue simulation.

STUDY DESIGN: A biomechanical study was designed to assess the bone-screw interface fixation strength among five anterior spinal instrumentation systems for scoliosis before and after a fatigue simulation. OBJECTIVES: The objectives of the current study were twofold: 1) evaluate the static (initial) strength at the bone-screw interface and 2) evaluate dynamic (post fatigue) strength of the bone-screw interface after a fatigue simulation to investigate a possible mechanism for postoperative loss of correction. SUMMARY OF BACKGROUND DATA: Although the recent advancement of anterior instrumentation for scoliosis has permitted shorter fusion segments and improved surgical correction, the loss of correction over the instrumented segments still has been reported in one-rod systems. Little is known about the mechanism for loss of correction. METHODS: Twenty-five fresh-frozen calf spines (T6-L6) were used. A total of five instrumentation systems included the following: Anterior ISOLA (ISOLA), Bad Wildungen Metz (BWM), Texas Scottish Rite Hospital system (TSRH), Cotrel-Dubousset Hoph (CDH), and Kaneda Anterior Scoliosis System (KASS). Screw pullout and rotational tests in the sagittal plane using a single vertebra were performed to investigate bone-screw interface fixation strength before and after a fatigue simulation. To simulate cyclic loading that the spine could undergo in vivo, a fatigue simulation using compressive-flexion loading up to 24,000 cycles was carried out. RESULTS: Mean maximum tensile pullout force decreased in the following order: KASS > CDH > BWM > TSRH > ISOLA (F = 29.91, P < 0.0001). KASS blunt tip screw was 26% stronger in pullout force than KASS sharp tip screw (P < 0.05). The one-rod system demonstrated a positive correlation between pullout force and both bone mineral density and screw insertional torque. For fatigue analysis the rotational strength at the most cephalad and caudal segments significantly decreased after a fatigue simulation in the one-rod system (P < 0.05). The two-rod system showed no significant decrease after a fatigue simulation. CONCLUSIONS: Simulating the cyclic loading to the construct, screw loosening at the bone-screw interface was produced in the one-rod system. This screw loosening may elucidate one mechanism for loss of correction in the one-rod system. The two-rod system may have the potential to minimize the risk of loss of correction.     

90°以上脊柱侧凸的手术策略及方法

目的　探讨使用后路三维矫正技术治疗90°以上脊柱侧凸的手术策略,并评价其疗效。　方法　自1997年起治疗90°以上脊柱侧凸72例,其中特发性侧凸48例,非特发性侧凸24例。62例先行一期前路脊柱松解或支撑性融合或骨骺阻滞,术后Halo牵引14d,行二期后路三维矫正术（CD、CD-Horizon和TSRH）。另10例直接行一期后路矫正术。在后路手术中,对前突型胸椎侧凸,先从凹侧开始纠正;对腰椎侧凸、胸腰椎侧凸或后突型胸椎侧凸,则从凸侧开始纠正,按标准化去旋转原理或水平横向原理矫正32例,采用多棒分段技术矫正40例。　结果　72例患者无1例死亡;1例出现暂时性神经功能障碍,9例术中横突或关节突骨折。随访7～34个月,均未出现假关节或脱钩断棒,2例发生失偿。72例冠状面平均矫正58％,40例有术前矢状面形态异常者有32例完全达矢状面重建,余8例有56％纠正,术后身高增加4～15　cm。随访时间在1年以上的47例平均冠状面纠正丢失6°,矢状面无纠正丢失。　结论　后路三维矫正技术对严重脊柱侧凸可达到满意的纠正,对躯干平衡的重建更优;适当前路松解和多棒分段矫正技术以及SEP监护可减少神经并发症的发生。