针刀治疗坐骨神经盆壁通道狭窄症的手术入路研究

目的:研究针刀治疗坐骨神经盆壁通道狭窄症的手术入路。方法:在30侧成年尸体的臀区观测了坐骨神经出梨状肌下孔后的横径、纵径及其盆壁通道的构成、大小、长度等;梨状肌出盆处的宽度、厚度、上下缘距体表的距离;以及上述结构相应的表面解剖观测。结果:测得坐骨神经出梨状肌下孔处(通道起点)的横径为(15.01±3.56)mm,纵径为(4.69±1.75)mm;平股方肌下缘处横径(14.02±2.15)mm,纵径为(4.06±1.17)mm。测得通道长(65.35±7.81)mm,通道起点与棘角线的距离为(53.12±7.72)mm。测得梨状肌出盆处的宽度为(33.03±3.06)mm,厚度为(13.68±3.57)mm。结论:据此讨论明确了形成坐骨神经盆壁通道狭窄症的解剖学机制,同时注意针刀进刀时不应使刀口线垂直于坐骨神经干划切,进刀抵达病灶后应使针刀体稍偏神经干的外侧操作,以免损伤结构。     

MRI评价退行性颈椎管狭窄的临床价值

目的分析退行性颈椎管狭窄(DCSS)的MRI表现特征,探讨MRI的临床实用价值。方法回顾性分析经临床和影像学检查确诊的43例DCSS患者的MRI表现,测量纤维性椎管矢状径、横径,计算压迫率,测量椎管最狭窄处脊髓的矢状径及横径,并计算与该部位的椎管矢状径、横径的比值,测量椎管狭窄处脊髓前间隙,观察椎间盘、前纵韧带、后纵韧带、黄韧带等的变化情况。结果43例患者纤维性椎管的平均矢状径为7.02±1.56mm,横径为17.64±2.11mm,平均压迫率为(39.79±8.14)%,椎管最窄处脊髓矢状径为5.46±0.97mm,与椎管矢状径比值为0.798±0.133,椎管横径为12.66±1.01mm,与椎管横径比值为0.724±0.071。椎管狭窄处脊髓前间隙平均值为0.14±0.35mm。所有患者均伴有颈椎退行性改变,其中椎间盘突出、膨出、变性多见(155/215),16例患者出现黄韧带增厚,13例患者出现后纵韧带增厚。结论DCSS的MRI表现具有一定的特征性,通过分析影像表现,可以明确疾病的诊断,对疾病的治疗有指导意义。     

腰神经后外支卡压症针刀手术入路研究

目的研究腰神经后外支卡压症的解剖学机制以及针刀治疗腰神经后外支卡压症的手术入路.方法在15具成年尸体的腰背部解剖观测腰神经后外支及其通过的腰椎横突背骨纤维管的解剖结构,并进行骨纤维管的表面解剖测量.结果测得腰神经后外支直径1.07±0.17mm;腰神经横突背骨纤维管的横径2.13～3.92mm,纵径1.08～1.97mm,后外支骨纤维管距体表深度34.17～41.64mm,骨纤维管长轴与后中线夹角约40°～50°.结论(1)在正常情况下腰椎横突背骨纤维管有制约保护腰神经后外支的作用,但在损伤变形后却成为腰神经后外支卡压症主要致病因素.(2)根据解剖观测设计了较合理的针刀治疗后外支卡压症的手术入路并指出了手术中应注意避免损伤的结构,供临床治疗参考.     

跖跗关节骨性结构的解剖及临床意义

目的通过对跖跗关节骨性结构的观察、测量,探讨跖跗关节骨性结构稳定的解剖学基础,及其活动度的临床意义。并为临床跖跗关节损伤的治疗提供理论依据。方法对12个成人足标本进行解剖、测量。测量第1—5跖跗关节面横径、纵径及深度;分别测量榫孔内、外侧缘的深度。结果（1）榫卯样结构内侧径（10．02±1．22）mm,外侧径（9．92±1．17）mm;（2）跖跗关节面的关节面深度：第1跖骨（0．98±0．15）mm,第2跖骨（0．02±0．02）mm,第3跖骨（0．01±0．01）mm,第4跖骨（1．32±0．15）mm,第5跖骨（1．46±0．17）mm;（3）跖跗关节远侧端关节面横径、纵径：第1跖骨关节面横径（17．25±1．01）mm,纵径（28．64±1．75）mm;第2跖骨关节面横径（15．24±1．13）mm,纵径（20．46±2．31）mm;第3跖骨关节面横径（13．30＋2．27）inln,纵径（19．12v1．57）mm;第4跖骨关节面横径（11．80±1．23）mm,纵径（17．17＋1．84）mm;第5跖骨关节面横径（18．66±2．80）mm,纵径（is．80±2．66）mm;（4）跖跗关节近侧端关节面横径、纵径：内侧楔骨关节面横径（15．9±1．52）mm,纵径（26．02±3．23）mm;中间楔骨关节面横径（13．07±1．25）mm,纵径（21．09±1．12）mm;外侧楔骨关节面横径（14．18±1．45）mm,纵径（20．15±1．95）mm;骰骨关节面横径（24．95±2．83）mm,纵径f17．72±1．37）mm。结论（1）跖跗关节的榫卯样结构,尤其是榫孔内、外侧缘的深度,是跖跗关节稳定的关键因素：（2）跖跗关节的关节面深度很浅,接近于平面关节,仅第4,5跖跗关节在矢状面和水平面有一定的活动度．手术治疗一期尽可能保留此关节。     

内窥镜下经口咽入路寰枢椎手术的可行性研究

目的探讨内窥镜下经口咽入路进行寰枢椎手术的可行性。方法测量50套寰枢椎标本的寰椎前弓长度,枢椎齿突高度、最大横径及矢状径,枢椎上关节面最大横径及矢状径。在20具完整头颈部标本上分别按传统及内窥镜下方法行寰枢椎模拟手术,手术完成后将标本解剖,研究内窥镜下经口咽入路的手术方法、减压效果及手术“安全区域”。结果寰椎前弓长度为(19.8±2.3)mm,齿突高度为(15.9±1.9)mm、最大横径为(10.5±0.6)mm、最大矢状径为(11.5±1.9)mm,枢椎上关节面最大横径为(15.1±1.6)mm、最大矢状径为(17.7±1.3)mm,均满足内窥镜下手术要求。内窥镜下寰枢椎手术可以寰椎前结节为定位标记,行寰椎前弓、齿突切除,侧块关节面打磨。寰椎前弓切除可采用由寰椎前结节向两侧磨除或前结节两侧磨断后完整摘除前结节两种方法;齿突则由尖部向下顺行磨削切除;打磨侧块关节面时需平移或倾斜工作通道,关节面打磨宽度应在12mm以内,深度不宜超过10mm。内窥镜下手术减压范围宽度(14.8±0.8)mm,高度(16.1±0.7)mm,深度(19.1±1.0)mm,与传统组差异无显著性。内窥镜下经口咽入路寰枢椎手术的“安全区域”位于寰枢椎前面,近似矩形,宽(45.9±3.6)mm、高(29.4±2.5)mm。结论内窥镜下经口咽入路行寰枢椎手术对局部解剖结构显露清晰,操作精细,     

超低位直肠前切除术中会阴前平面的应用解剖研究

目的 对超低位直肠前切除术涉及的会阴前平面及相邻组织结构进行局部解剖研究.方法 对16具带下肢的男性半骨盆矢状位标本进行解剖,测量并记录直肠前壁与尿道膜部距离、会阴体头侧宽度、会阴体尾侧宽度、会阴体厚度、耻骨直肠肌厚度、直肠前壁处及后壁处耻骨直肠肌上缘与齿状线距离以及盆膈裂孔宽度等8项指标.结果 在16具标本中均可清晰找到会阴前平面.直肠前壁与尿道膜部距离(rectum-urethra,R-U)的中位数为14(10～17)mm.会阴体轮廓呈梯形,头侧窄,尾侧宽,头侧宽度(width of cranial perineal body)的中位数为8(6～9)mm,尾侧宽度(width of caudal perineal body)的中位数为21(18～23)mm.会阴体厚度(thickness of perineal body)的中位数为20.5(17～23)mm.耻骨直肠肌厚度(thickness of puborectalis)的中位数为12(10～16)mm.直肠前壁处耻骨直肠肌上缘与齿状线距离[puborectalis-dental line(anterior wall of rectum)]的中位数为25(21～27)mm,直肠后壁处耻骨直肠肌上缘与齿状线距离[puborectalis-dental line(posterior wall of rectum)]的中位数为20(16～23)mm.盆膈裂孔的宽度(width of pelvic diaphragm)的中位数为8(6～10)mm.结论 会阴前平面清晰存在,经此平面可以利用长约20 mm的最远端直肠,提高低位直肠癌手术的保肛率.     

髋臼前壁厚度的解剖学测量及其意义

目的 研究正常成人髋臼前壁臼前壁的解剖厚度,为髋臼前/壁骨折术中预防内固定进入关节提供依据.方法 解剖男女各8具成人新鲜冷冻尸体骨盆标本,对髋臼前柱壁采用"3-6"分割法,于交点处垂直于髋臼前壁逐个钻孔,分别测量不同分割点髋臼前壁厚度以及髋臼前柱壁宽度、髋臼直径及深度.结果 根据"3-6"分割法,髋臼前壁内1/3各分割点厚度波于:男(24.09±2.69)～(15.38±2.58)mm,女(22.99±2.16)～(14.77±1.82)mm;前壁外1/3各分割点厚度动于:男(20.44±2.28)～(10.50±1.08)mm,女(19.84±2.16)～(10.39±0.99)mm.结论 根据"3-6"分割法便于估计髋臼前壁不同进针点的厚度,对于髋臼前壁骨折重建术中避免内固定物进入关节有重要的指导意义.     

人工寰齿关节设计依据及可行性分析

目的:通过解剖和X线观察,测量国人寰齿关节以获取形态学参数,为研制能替代寰齿关节功能的人工寰齿关节提供解剖数据。方法:用电子游标卡尺和量角器测量32套正常成年人寰齿关节新鲜标本的相关参数,包括寰椎前弓宽度、前弓下缘与C2上关节面前缘间距、枢椎侧块内缘与齿状突外缘间距、寰椎前结节厚度和高度、寰椎侧块中点高度和长度、寰椎侧块宽度、齿状突高度、齿状突横径和前后径、齿状突后倾角和齿面角等23项内容。并进行统计学分析,为研制人工寰齿关节提供形态学参数范围。据此设计仿生人工寰齿关节,在3具成人尸体标本进行模拟人工寰齿关节置入手术。结果:测得寰椎前弓宽度平均为(20.45±1.53)mm,前弓下缘与C2上关节面前缘间距平均为(2.12±1.22)mm,枢椎侧块内缘与齿状突外缘间距平均(2.51±2.18)mm,寰椎前结节厚度和高度分别平均为(9.43±1.93)mm和(10.23±1.32)mm,寰椎侧块中点高度和宽度分别平均(13.68±1.38)mm和(12.98±1.52)mm,齿状突高度平均为(15.25±2.11)mm,齿状突横径和前后径平均分别为(9.69±1.38)mm和(11.26±1.02)mm,齿状突后倾角平均为(12.23±4.27)°、齿面角平均为(65.48±2.17)°。人工关节由寰椎部件、枢椎部件和配件构成。模拟手术中无椎动脉损伤和假体压迫脊髓。结论:人工寰齿关节的研制在形态学上具有可行性。人工寰齿关节的研制是既能重建寰枢关节稳定性,又能保留寰枢关节旋转功能的可行性技术。为了安放牢固、操作方便、保持运动功能以及避免副损伤,各部件参数有一定的选取范围。     

胸椎椎弓根-肋骨复合体的解剖及影像学研究

目的 探讨胸椎椎弓根-肋骨复合体的解剖结构影像学特点及其临床意义.方法 取4具成人新鲜尸体胸椎脊柱标本.主要测量参数(数据)包括:椎弓根及椎弓根-肋骨复合体的横径、螺钉最长值、矢状角,以及椎弓根、椎弓根-肋骨复合体以及椎弓根-肋骨重叠的纵径.测量中将尸体标本与CT影像测量(含二维、三维重建)相结合.结果 椎弓根-肋骨复合体是一立体结构,椎弓根与肋骨不在同一平面,且两者位置关系随不同节段而发生变化.椎弓根-肋骨复合体纵径值T1最小,为(12.6±0.8)mm,T11最大,为(16.9±1.1)mm.椎弓根-肋骨重叠纵径值T1最小,为(7.2±0.3)mm,T10最大,为(11.8±1.0)mm.椎弓根纵径与椎弓根-肋骨复合体纵径间差异无统计学意义(P＞0.05),椎弓根纵径、椎弓根-肋骨复合体纵径均与椎弓根-肋骨重叠纵径间差异有统计学意义(P＜0.05).结论 椎弓根-肋骨复合体是一较复杂的立体结构,椎弓根-肋骨重叠纵径应被视为该复合体的真实或有效纵径.     

睾丸测量板的设计及应用

近年来随着男性学的发展,对睾丸测量方法的研究日益增多。目前国内外有卡尺式、Schirrens剪式、Frader模型式和两半球挤压式等。我们设计出睾丸测量板,临床实用、方便。一、材料与设计用25×20cm长方形、厚约0.5mm之硬质塑料薄板,按表1尺寸(纵径与横径之比为5:3),加工出椭圆形孔洞。孔洞容积计算公式为纵径×横径×厚π/6(ml)。由于孔洞纵径与横径之乘积与孔洞的号数近似,故以纵径×横径之积表示孔洞容积。     

Surgical anatomy of the sciatic nerve: A meta‐analysis

The sciatic nerve has varying anatomy with respect to the piriformis muscle. Understanding this variant anatomy is vital to avoiding iatrogenic nerve injuries. A comprehensive electronic database search was performed to identify articles reporting the prevalence of anatomical variations or morphometric data of the sciatic nerve. The data found was extracted and pooled into a meta‐analysis. A total of 45 studies (n = 7068 lower limbs) were included in the meta‐analysis on the sciatic nerve variations with respect to the piriformis muscle. The normal Type A variation, where the sciatic nerve exits the pelvis as a single entity below the piriformis muscle, was most common with a pooled prevalence of 85.2% (95%CI: 78.4–87.0). This was followed by Type B with a pooled prevalence of 9.8% (95%CI: 6.5–13.2), where the sciatic nerve bifurcated in the pelvis with the exiting common peroneal nerve piercing, and the tibial nerve coursing below the piriformis muscle. In morphometric analysis, we found that the pooled mean width of the sciatic nerve at the lower margin of the piriformis muscle was 15.55 mm. The pooled mean distance of sciatic nerve bifurcation from the popliteal fossa was 65.43 mm. The sciatic nerve deviates from its normal course of pelvic exit in almost 15% of cases. As such we recommend that a thorough assessment of sciatic nerve variants needs to be considered when performing procedures in the pelvic and gluteal regions in order to reduce the risk of iatrogenic injury. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 34:1820–1827, 2016.     

Piriformis Syndrome: Anatomic Considerations, a New Injection Technique, and a Review of the Literature

Background: Piriformis syndrome can be caused by anatomic abnormalities. The treatments of piriformis syndrome include the injection of steroid into the piriformis muscle and near the area of the sciatic nerve. These techniques use either fluoroscopy and muscle electromyography to identify the piriformis muscle or a nerve stimulator to stimulate the sciatic nerve.

Methods: The authors performed a cadaver study and noted anatomic variations of the piriformis muscle and sciatic nerve. To standardize their technique of injection, they also noted the distance from the lower border of the sacroiliac joint (SIJ) to the sciatic nerve. They retrospectively reviewed the charts of 19 patients who had received piriformis muscle injections, noting the site of needle insertion in terms of the distance from the lower border of the SIJ and the depth of needle insertion at which the motor response of the foot was elicited. The authors tabulated the response of the patients to the injection, any associated diagnoses, and previous treatments that these patients had before the injection. Finally, they reviewed the literature on piriformis syndrome, a rare cause of buttock pain and sciatica.

Results: In the cadavers, the distance from the lower border of the SIJ to the sciatic nerve was 2.9 +/- 0.6 (1.8-3.7) cm laterally and 0.7 +/- 0.7 (0.0-2.5) cm caudally. In 65 specimens, the sciatic nerve passed anterior and inferior to the piriformis. In one specimen, the muscle was bipartite and the two components of the sciatic nerve were separate, with the tibial nerve passing below the piriformis and the peroneal nerve passing between the two components of the muscle. In the patients who received the injections, the site of needle insertion was 1.5 +/- 0.8 (0.4-3.0) cm lateral and 1.2 +/- 0.6 (0.5-2.0) cm caudal to the lower border of the SIJ as seen on fluoroscopy. The needle was inserted at a depth of 9.2 +/- 1.5 (7.5-13.0) cm to stimulate the sciatic nerve. Patients had comorbid etiologies including herniated disc, failed back surgery syndrome, spinal stenosis, facet syndrome, SIJ dysfunction, and complex regional pain syndrome. Sixteen of the 19 patients responded to the injection, their improvements ranged from a few hours to 3 months.     

Piriformis syndrome: anatomic considerations,a new injection technique,and a review of the literature

BACKGROUND: Piriformis syndrome can be caused by anatomic abnormalities. The treatments of piriformis syndrome include the injection of steroid into the piriformis muscle and near the area of the sciatic nerve. These techniques use either fluoroscopy and muscle electromyography to identify the piriformis muscle or a nerve stimulator to stimulate the sciatic nerve. METHODS: The authors performed a cadaver study and noted anatomic variations of the piriformis muscle and sciatic nerve. To standardize their technique of injection, they also noted the distance from the lower border of the sacroiliac joint (SIJ) to the sciatic nerve. They retrospectively reviewed the charts of 19 patients who had received piriformis muscle injections, noting the site of needle insertion in terms of the distance from the lower border of the SIJ and the depth of needle insertion at which the motor response of the foot was elicited. The authors tabulated the response of the patients to the injection, any associated diagnoses, and previous treatments that these patients had before the injection. Finally, they reviewed the literature on piriformis syndrome, a rare cause of buttock pain and sciatica. RESULTS: In the cadavers, the distance from the lower border of the SIJ to the sciatic nerve was 2.9 +/- 0.6 (1.8-3.7) cm laterally and 0.7 +/- 0.7 (0.0-2.5) cm caudally. In 65 specimens, the sciatic nerve passed anterior and inferior to the piriformis. In one specimen, the muscle was bipartite and the two components of the sciatic nerve were separate, with the tibial nerve passing below the piriformis and the peroneal nerve passing between the two components of the muscle. In the patients who received the injections, the site of needle insertion was 1.5 +/- 0.8 (0.4-3.0) cm lateral and 1.2 +/- 0.6 (0.5-2.0) cm caudal to the lower border of the SIJ as seen on fluoroscopy. The needle was inserted at a depth of 9.2 +/- 1.5 (7.5-13.0) cm to stimulate the sciatic nerve. Patients had comorbid etiologies including herniated disc, failed back surgery syndrome, spinal stenosis, facet syndrome, SIJ dysfunction, and complex regional pain syndrome. Sixteen of the 19 patients responded to the injection, their improvements ranged from a few hours to 3 months. CONCLUSIONS: Anatomic abnormalities causing piriformis syndrome are rare. The technique used in the current study was successful in injecting the medications near the area of the sciatic nerve and into the piriformis muscle.     

小牛胸腰椎解剖、生物力学研究及其临床意义

目的　测量小牛胸腰椎相关解剖数据并测试其生物力学性能 ,探讨其作为胸腰椎前路内固定模型的可行性。方法　采集 1周以内的新鲜小牛胸腰椎脊柱标本 2 0具 ,测量椎体及椎间盘的最大横径、矢状径和前部高度。测试屈曲、伸展、侧屈及扭转状态下的载荷 -应变、载荷 -位移关系以及最大载荷时的应力强度及轴向刚度 ,并进行极限力学性能测试。结果　小牛胸腰椎椎体及椎间盘矢径、横径、高度自T10 至L5逐渐递增 ,椎体横径与矢径之比约为 1∶1,其T10 ～L5段椎间盘高度之和与椎体高度比值为 1∶0 .9。小牛胸腰椎载荷 -应变及载荷 -位移关系呈线性变化 ,生理载荷下屈曲、伸展及侧屈状态下的应力强度分别为 (2 .86± 0 .2 4 )N/mm2 ,(2 .17± 0 .2 0 )N/mm2 ,(5 .2 9± 0 .5 0 )N/mm2 。屈曲、伸展、侧屈及扭转状态下的轴向刚度分别为 (37.13± 4 .30 )N/mm ,(35 .38± 4 .2 0 )N/mm ,(34.5 6± 4 .2 0 )N/mm ,(5 1.6 9± 1.6 2 )N/mm。结论　小牛胸腰椎形态及大小可满足前路内固定模型的需要 ,以小牛标本作为体外非破坏性生物力学实验模型具有可行性。     

快速成像序列在常规MRI导向下肝脏病变介入治疗中的初步应用

目的研究MRI兼容性穿刺针在快速成像序列中的显示以及常规MRI导向下肝脏介入的初步临床应用。方法将MRI兼容性穿刺针（19.5G,COOK）插入离体新鲜猪肝中,在0.5T中场超导常规MRI中成像,穿刺针与主磁场方向（B0）分别成角0°、30°、60°、90°,采用FSET2WI、FSET1WI、FE序列行冠状位、矢状位及轴位扫描,测量图像上穿刺针直径。5例患者在常规1.5TMRI引导下行经皮穿刺介入治疗,2例为肝囊肿抽吸硬化治疗,另3例共11个肝癌病灶行125I放射性粒子植入治疗。结果在各扫描序列中,穿刺针均显示为信号缺失。在与B0成角0°、30°、60°、90°时显示的穿刺针直径分别为（2.38±0.42）mm、（3.72±1.24）mm、（6.27±1.92）mm、（11.3±1.78）mm（P〈0.05）;采用FSET2WI及FSET1WI序列获取的穿刺针直径分别为（4.52±3.87）mm及（4.74±3.68）mm（P〉0.05）;FE序列扫描显示的穿刺针直径为（8.26±4.37）mm,与FSE序列显示的穿刺针直径之间的差异有统计学意义（P〈0.05）。5例MRI导向下治疗均顺利完成,穿刺针显示清晰。结论常规MRIFSE、梯度回波等快速成像序列具备一定的组织分辨力和时间分辨力,能有效引导肝脏介入操作。     

Safe Supra‐Acetabular Pin Insertion in Relation to Intraosseous Depth

In pelvic fractures, dysfunction of the pelvic ring is often stabilized with supra‐acetabular pin insertion. In existing literature, there are heterogeneous indications on proper pins selection and inclinations. Therefore, this study aimed to quantify the narrowing of safe pin corridors in the transverse and sagittal planes with increments of intraosseous screw depths. A computer algorithm created cross‐sections over three‐dimensional pelvic reconstructions at sagittal inclinations from 45° cranial to 45° caudal in 5° increments. Templates of screw depths spanning 60–120 mm in 15 mm increments were disposed in the transverse plane from 45° medial to 45° lateral. Each intraosseous screw depth and transverse angle were evaluated for intraosseous containment to evaluate ranges narrowing with increasing screw depths. The 60‐mm depth resulted in the largest sagittal range (60.9° ± 6.9°) and transverse range (27.5° ± 4.1°) at 30° caudal. Increasing depths by 15 mm resulted in ranges being significantly different from one another (p < 0.01). The sagittal plane of 20° cranial had the highest frequency of insertion for all depths, while transverse ranges were narrowed (p < 0.01). Bisecting angles were similar for sagittal planes 20° cranial to 30° caudal with an average of 27.9° ± 1.2° (p ≥ 0.115). In conclusion, while 60 mm depths can be inserted with the highest discretion, 15 mm increments in depth significantly reduce safe ranges. Screws depths above 90 mm have low frequencies of insertion, should be inserted more cranially and must be considered prone to breaching. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 37:1790–1797, 2019     

Centerpiece钛板内固定在单开门颈椎管扩大成形术中的应用

目的:探讨Centerpiece钛板内固定在单开门颈椎管扩大成形术的临床应用。方法:自2009年1月至2010年12月采用单开门颈椎管扩大成形Centerpiece内固定术治疗颈椎管狭窄症患者25例,男16例,女9例;年龄44～75岁,平均(57.2±6.7)岁。其中多节段脊髓型颈椎病8例,颈椎后纵韧带骨化症12例,发育性颈椎管狭窄症5例。以JOA评分(17分法)及其改善率评价术后神经功能改善情况;术后复查颈椎X线、CT,在术前及术后6个月的颈椎侧位X线片上测量C5节段椎管矢状径,计算椎管扩大率,评价椎管扩大和维持情况及门轴侧骨融合情况。结果:手术时间为(165.5±35.6)min;术中出血量为(325.0±75.1)ml。随访时间6～18个月,平均(7.3±3.8)个月。术前JOA评分为9.3±1.1;术后6个月为14.7±2.1(t=4.12,P<0.05),JOA改善率为(64.5±10.2)%。术后随访X线片及CT示椎管扩大满意,门轴侧均骨性愈合,均未见椎板塌陷和再关门现象,术前C5节段椎管矢状径为(9.0±1.5)mm,术后6个月为(14.3±2.0)mm(t=7.61,P<0.05),椎管扩大率为(67.6±11.8)%。结论:Centerpiece钛板内固定应用在单开门颈椎管扩大成形术中是安全有效的,在抬起椎板获得即刻稳定的同时,可以恢复椎管的完整性。     

针刀松解法治疗第3腰椎横突综合征的 随机对照试验

目的:从生物力学角度探讨针刀松解法对第3腰椎横突综合征的治疗效果.方法:2007年3～12月,采用随机数字表将第3腰椎横突综合征患者分为针刀治疗组34例和电针对照组35例,分别进行针刀、电针治疗,各治疗3周.治疗组男12例,女22例;平均年龄(42.33±7.86)岁.对照组男16例,女19例;平均年龄(44.73±10.34)岁.治疗前、后分别对下肢生物力学、局部张力及压痛指数进行观察,按"JOA下腰痛评分系统"进行疗效评价.结果:完成试验者共60例,治疗组经针刀治疗,其软组织局部张力明显低于对照组(P=0.000 04),治疗组患者步态稳定性明显强于对照组,压痛指数治疗组改善较大.在疗效评价上,治疗组治疗结果为优18例,良9例,可3例,差0例.结论:针刀松解法可明显起到减张、镇痛作用,对第3腰椎横突综合征症状及体征的改善优于电针对照组,且疗效安全可靠.     

Anatomical feasibility of the anterior obturator nerve transfer to restore bowel and bladder function

Total sacrectomies are radical procedures required to treat tumorigenic processes involving the sacrum. The purpose of our anatomical study was to assess the feasibility of a novel nerve transfer involving the anterior obturator nerve to the pudendal and pelvic nerves to the rectum and bladder. Anterior dissection of the obturator nerve was performed in eight hemipelvis cadaver specimens. The common obturator nerve branched into the anterior and posterior at the level of the obturator foramen. The anterior branch then divided into two separate branches (adductor longus and gracilis). The branch to the gracilis was on average longer and also larger than the branch to the adductor longus (8.7 ± 2.1 cm vs. 6.7 ± 2.6 cm in length and 2.6 ± 0.2 mm vs 1.8 ± 0.4 mm in diameter). Each branch of the anterior obturator was long enough to reach the pelvic nerves. The novel transfer of the anterior branch of the obturator nerve to reinnervate the bladder and bowel is anatomically feasible. This represents a promising option with minimal donor site deficit. © 2014 Wiley Periodicals, Inc. Microsurgery 34:459–463, 2014.