脊柱骨盆固定治疗骶骨骨折合并神经损伤

目的:探讨骶骨骨折合并神经损伤的诊断及手术治疗。方法:对骶骨骨折合并神经损伤的5例患者早期行后路骶椎管减压:神经根探查松解,GSS内固定手术,术后随访3～36个月,平均21.3个月。结果:骨折临床愈合时间为2～3个月,平均2.3个月。优良率80%。结论:使用GSS治疗骶骨骨折合并神经损伤,具有固定可靠、复位满意等优点,是较理想的治疗方法。     

脊柱骨盆固定术治疗不稳定骨盆骨折合并骶骨骨折

目的探讨脊柱骨盆固定术对骨盆骨折合并骶骨骨折的治疗效果。方法回顾性分析2007年1月～2010年12月,经治疗有完整资料及获得随访的骨盆骨折合并骶骨骨折患者16例。均采用骨盆前环开放复位内固定,骶骨后路脊柱骨盆固定术。结果 2例出现前侧切口脂肪液化,1例出现后侧切口部分浅表坏死,经换药后愈合。术后随访6～72个月,按Mjeed疗效评价标准:优9例,良4例,可2例,差1例。结论脊柱骨盆固定术能有效复位、固定骶骨骨折;骨盆前后环联合固定能提高骨折复位、固定的质量;若发现腰骶神经根损伤,宜早期手术减压治疗。     

3例创伤性脊柱骨盆分离的手术治疗

[目的]探讨创伤性脊柱骨盆分离发生的原因和手术治疗方法。[方法]对3例骶骨骨折伴马尾神经损伤病例使用后路减压，重建钢板内固定：[结果]骨折均一期愈合，1例马尾神经损伤恢复不全，足跖曲不全，治愈率2／3（66．7％）。[结论]创伤性脊柱骨盆分离是骶骨骨折严重类型，发生原因特殊，有效内固定有利于神经恢复。     

右侧桡骨发育不全合并法乐四联症1例报告

1 病例患者;男,4个月,出生后发现右前臂逐渐向桡侧弯曲畸形入院,无家族遗传病史,无产伤史.查体:一般情况好,无紫绀,胸骨左缘第二、三助间可闻及Ⅱ级收缩期吹风样杂音,肺、腹部无特殊.脊柱无畸形,右前臂远端1/3及手向桡侧弯曲,与前臂上段成60°,被动活动能使其角度消失,左前臂无畸形.右前臂X片示:右桡骨部分缺如,右尺骨缩短.心脏彩色B超示:膜周部室缺,主动脉骑跨40%,右室流出道狭窄,右室肥大.临床诊断:①右侧桡     

骨盆损伤中移位骶骨骨折的手术治疗

目的 探讨不稳定型骨盆损伤中移位骶骨骨折的手术方法及治疗效果.方法 对2000年9月至2007年9月收治的33例伴有骶骨骨折的骨盆损伤患者行手术治疗.根据AO/OTA的分型方法,骨盆B型损伤5例,C型28例.根据Denis的分型方法,骶骨I型骨折13例、Ⅱ型11例、Ⅲ型9例.其中早期合并原发性神经损伤23例.骶骨骨折应用张力带钢板固定1例;脊柱椎弓根钉棒系统经骨盆后方沿双侧髂嵴横向固定10例,经L_(4,5)或L_5S_1及双侧髂嵴后方纵向固定16例;骶髂螺钉固定3例;骶骨棒固定2例;骶髂螺钉联合骶骨棒固定1例.术中间期行椎板切除、马尾神经减压11例,二期行神经松解、骶前孔扩大术2例.结果 术后随访12～82个月,平均27.3个月.根据Majeed疗效标准,优17例、良7例、可2例、差7例.骶骨I型骨折疗效优良率为92.3%、Ⅱ型为72.7%、Ⅲ型为44.4%.神经损伤恢复情况在手术治疗组中优6例、良4例、无变化3例;在非手术治疗组中优6例、良1例、无变化3例.术后并发症包括腰骶部切口深部感染2例,腰骶僵硬不适2例.神经损伤一过性加重4例,迟发性骶神经损伤3例.结论 手术治疗是改善骶骨骨折复位质量的重要途径,骨盆前、后环损伤的联合制动是提高骨折内同定强度的有效方法.对手术指征明确的骶神经损伤,早期定位减压有助于其功能恢复.     

低温低压麻醉下脊柱骨盆肿瘤手术3例报告

脊柱骨盆肿瘤切除,常因术中出血过多,增加了手术困难。特别是椎体血管瘤合并截瘫,因出血无法控制而列为手术禁忌症。近年来我们应用低温低压麻醉技术,控制术中出血,成功地施行了椎体血管瘤等失血过多的手术3例。现报告如下:     

手术治疗耻骨联合分离合并耻骨上下枝骨折1例报告

骨盆骨折多由于直接暴力所造成的。侧方挤压损伤多局限于耻骨支和耻骨联合处,骨盆骨折传统的治疗手段是骨盆帆布兜悬吊或骨盆兜夹扳固定,卧床需6～8周即可,传统的治疗方法对骨盆环完整性效果较好。本例骨盆骨折为一例耻骨上枝骨折另一侧耻骨上下支骨折合并耻骨联合分离旋转移位,保守治疗很难     

腰骶纤维织炎合并骶骨骨折1例报告

患者,女,57岁,因腰痛伴右下肢麻木8个月,加重1个月来诊。患者于8个月前不明原因出现腰痛伴右下肢麻木,多方求治,效差;曾在院外按“腰椎间盘突出症”行手法整复处理,自觉腰痛突然加重,伴腰骶酸胀,束带感,继之双下肢无力,不能久站久行,夜间疼痛明显,遂至北京积水潭医院就诊,按“1.腰椎间盘突出症2.骨质疏松”给予药物治疗,病情不缓解。查体:痛苦面容,双手扶腰,“板状腰”外形,触诊两侧腰肌紧张,腰骶弥漫压痛,腰4棘突右旁开(1cm)压痛伴右下肢放射痛,双直腿抬高90度。深浅感觉正常,生理反射存在,病理反射未引出。腰椎X片示脊柱生理弯曲变直,序…     

骨盆损伤中骶骨骨折微创治疗的初步报告

目的探讨锁定钢板(LCP)微创治疗不稳定性骨盆损伤中DenisⅡ型骶骨骨折的疗效。方法采用后路小切口LCP治疗骨盆损伤中的DenisⅡ型骶骨骨折15例,对疗效、并发症等进行分析。结果随访6～18个月,无血管、神经损伤,术后复查未发现内固定松动、断裂,无骨盆环明显畸形、骨折不愈合、双下肢不等长。术后发生后侧切口表浅感染2例,深部感染1例。结论 LCP微创治疗不稳定性骨盆损伤中DenisⅡ型骶骨骨折方法简单、安全、实用,疗效好。     

Surgical treatment of a femoral agenesis: a case report

We report a case of severe femoral agenesia in an adult and propose a new surgical approach facilitating prosthesis fitting. The procedure involves insertion of a total hip arthroplasty, arthrodesis of the knee and amputation of the foot. The final prosthesis fits on the crural area with weight bearing on the ischiatic region, the lesser pelvis, and the articulated knee. Outcome was satisfactory at one year in our patient. Other surgical alternatives are presented.     

Surgical treatment the sacral fracture in childhood: case report and literature overview

Fractures of the sacrum in children are rare. In the 17 cases described in the past 25 years, surgery was indicated only for treatment of the consequences of the primary injury. We present the case of a 10-year-old girl who sustained the following injuries as a result of a fall from a swing: posterior angulation of S2/3 with suspected injury of anterior ligamentous structures, fracture of the proximal part of the S4 body with a displacement by the bone width anteriorly and contraction of 5 mm, posterior angulation of S5/Co1 also with a suspected injury of anterior ligamentous structures. After an unsuccessful attempt at closed reduction, open reduction and fixation by two K-wires was indicated. The fracture healed in 8 weeks. Two years after the treatment, the patient is without complaints and limitations. The question is whether surgery was necessary for treatment of this fracture or whether spontaneous healing and subsequent remodelling of the sacral bone in such a young patient may be expected which would be also fully satisfactory. In our view, the described surgical treatment was appropriate and is definitely indicated for patients with a similar injury associated with a neural lesion.     

Surgical treatment of sacral perineural cyst--case report

A 67-year-old man presented with persistent penis and scrotum pain due to S-2 and S-3 radiculopathy caused by a sacral perineural cyst. The cyst was treated with microsurgical partial cyst removal and cyst wall imbrication, together with closure of the point through which cerebrospinal fluid (CSF) flowed from the subarachnoid space into the cyst cavity. His pain resolved without recurrence of the cyst or complications. Symptomatic perineural cysts are quite rare. Surgical closure of the point through which CSF flows from the subarachnoid space into the cyst cavity is the most important intervention for symptomatic perineural cysts. If the source of CSF leakage cannot be detected, placement of a cyst-subarachnoid shunt should be considered in addition to partial cyst removal and cyst wall imbrication.     

An experience with augmentation sigmoid cystoplasty for urinary incontinence caused by sacral agenesis: a case report]

Sacral agenesis is an uncommon disease. About 50 cases have been reported in Japan since 1929. Neurogenic bladder is often accompanied with the disease. The patient was a 26-year-old man who had suffered from persistent urinary incontinence since his childhood. Kidney-ureter-bladder (KUB) revealed Type IV sacral agenesis according to the classification by Renshaw. The upper urinary tract remained normal. Urodynamics study showed a low compliance bladder with low urethral pressure. Pharmacotherapy failed to improve his continence. Augmentation sigmoid-cystoplasty was undertaken to enlarge vesical capacity and it has successfully overcome his urinary incontinence. Clinical aspects of sacral agenesis are discussed focusing on urological problems.     

A case of sacral agenesis coexisting with Goldenhar syndrome]

A case of two coexisting embryopathies has been described. The deformities within the sacral bone and systemic anomalies led to the diagnosis of sacral agenesis; Goldenhar syndrome has been differentiated with other disturbances of branchial arches formation.     

Surgical treatment of pancreatic cholera: a case report

After surgical resection for rectosigmoid carcinoma a 63-year-old man had secretory diarrhea causing severe metabolic acidosis, hypokalemia, hypercalcemia and dehydration. Subsequent investigations revealed a mass measuring 4 × 5 cm in the uncinate process of the pancreas and an elevated vasoactive intestinal polypeptide concentration. The diarrhea responded to treatment with the somatostatin analogue, Sandostatin, and remained under control during a prolonged preoperative period. The patient underwent a Whipple procedure with immediate lessening of his diarrhea. This report illustrates a classic case of vipoma and demonstrates the need to consider this condition in the differential diagnosis of secretory diarrhea, even in the presence of other gastrointestinal lesions. The effectiveness of somatostatin analogues in stabilizing the diarrhea preoperatively is also well illustrated.     

Surgical treatment of ossified cephalhematoma: a case report

We report a surgical case of ossified cephalhematoma which caused deformity of the skull. A boy was delivered with the aid of vacuum extractor at 40 gestational weeks. He presented with a big cephalhematoma in the left parietal region, and it remained and calcificated after 3 months. He was admitted after being diagnosed with ossified cephalhematoma. Plain skull radiograph showed a marginated radiolucent lesion with a protrusive outer table and a slightly invaginated inner table in the left parietal region. Plain CT scan showed a low density lesion between bony layers and the depressed inner table with irregular thickening. 3D-CT shows bony protrusion of the left parietal bone with thinning in the center. Magnetic resonance imaging revealed an old hematoma in the protruding bone and compression of the parietal lobe by the inner table. For cosmetic reasons and relief of compression of the brain, cranioplasty was performed at 7 months. The protruding bone was removed totally and was arranged to fit in the convex after being cut in pieces. Using bioabsorbable mini plates and screws, the bone was fixed firmly. For cranioplasty of a child, absorbable plates and screws are useful because of their non-interference with growth of the skull.     

骶骨脊索瘤的靶血管栓塞和手术治疗

目的　对手术结合靶血管栓塞治疗骶骨脊索瘤的疗效进行分析和总结。方法　 15例原发性骶骨肿瘤行靶血管栓塞 ,栓塞后平均 1.5d行骶尾部后方入路手术。结果　术中出血量明显减少 ,平均 10 38ml(4 0 0～ 16 0 0ml) ,术后引流量 6 0 0ml(4 0 0～ 12 5 0ml) ,术后输血量平均 2 2 5ml(0～ 80 0ml) ,栓塞后 1d内术中出血量明显少于栓塞 1d后手术者。术后随访时间 1～ 10年 (平均 4 .1年 ) ,局部复发 4例 (2 6 .7% ) ,平均复发时间 2 .5 4年 ,无 1例出现远处转移。结论　术前肿瘤血管栓塞可以大大减少术中出血量 ,使术野清晰 ,术前经动脉栓塞骶骨脊索瘤后采用单纯的骶后方入路可以满意的完全切除骶骨脊索瘤