一期单纯后路和前后联合入路病灶清除植骨内固定术治疗脊柱结核的临床疗效对比

目的对比一期单纯后路和前后联合入路病灶清除植骨内固定术治疗脊柱结核的临床疗效。方法回顾性分析2011年1月—2015年1月本院收治的71例胸腰椎结核患者资料,行一期后路病灶清除植骨内固定术治疗37例(A组),行一期前路病灶清除植骨并后路内固定术治疗34例(B组)。2组患者术前均给予标准抗结核治疗2~3周,记录手术时间、术中出血量、住院天数、并发症发生率,以及手术前后红细胞沉降率(ESR)、C反应蛋白(CRP)、Cobb角和美国脊髓损伤协会(ASIA)分级。结果所有手术顺利完成,术后随访8~22个月,平均随访14个月。2组在手术前后Cobb角、ESR、CRP、ASIA分级、Cobb角纠正度及术后并发症发生率方面的差异均无统计学意义(P0.05)。A组在手术时间、术中出血量及住院天数方面均低于B组,差异有统计学意义(P0.05)。末次随访时所有患者均获得骨性融合,未出现结核复发及内固定松动、断裂等并发症。结论一期单纯后路病灶清除植骨内固定与前路病灶清除植骨并后路内固定治疗胸腰椎结核均可取得满意疗效,但单纯后路在手术时间、术中出血量及住院天数上均低于前后路联合入路,有明显优势。     

一期前路病灶清除植骨内固定治疗胸腰椎结核临床观察

[目的] 探讨经前路病灶清除植骨一期前路/后路内固定术治疗胸腰椎结核的临床疗效.[方法] 对24例胸腰椎结核患者,经3～4周正规抗结核治疗,行前路病灶清除、椎间大块自体髂骨/肋骨植骨、一期前路/后路内固定术,术后继续抗结核治疗18～24个月.[结果] 1例脊柱结核复发(3%).23例植骨融合,植骨融合率为96.9%,植骨愈合时间 4～8个月(平均6个月).无窦道形成.脊柱后凸畸形平均矫正80%.[结论] 经前路病灶清除植骨一期前路/后路内固定术治疗胸腰椎结核能彻底清除结核病灶,对脊髓及神经根进行彻底减压,促进脊髓及神经功能恢复,矫正脊柱后凸畸形,同时一期建立和恢复脊柱的连续性和稳定性,促进脊柱植骨融合,提高脊柱结核的治愈率.     

三种腰椎结核手术方式的比较研究

目的比较不同手术方式治疗腰椎结核的疗效。方法回顾分析2003-02-2010-08收治的88例腰椎结核患者,其中23例行一期前路病灶清除植骨融合内固定术,简称前路手术组(A组);25例行一期前路病灶清除植骨融合后路内固定术,简称前后路联合手术组(B组);40例行一期后路病灶清除植骨融合内固定术,简称后路手术组(C组)。随访8~24个月,平均15个月。通过记录和观察三组患者的手术时间、术中出血量、住院天数及手术前后的Frankel分级、Cobb’s角、ESR值变化情况,进行相互比较分析。结果所有病例切口均I期愈合,无严重并发症发生。在平均手术时间、平均术中出血、平均住院天数上,A/C、B/C组比较有显著性差异(P<0.01),A/B组比较无明显差异(P>0.05)。三组术前术后的Frankel分级、Cobb’s角及ESR值变化程度比较无明显差异(P>0.05)。结论在严格把握手术适应证的基础上,一期后路病灶清除植骨融合内固定术治疗腰椎结核与前路及前后路联合术式均可获得较好的治疗效果,但后路术式手术时间短、出血少、住院时间短,是一种安全可行、更方便的手术方式。     

胸腰椎结核不同手术方式的临床疗效分析

目的 比较前路与后路病灶清除、椎间植骨融合内固定术以及一期后前联合固定加病灶清除植骨内固定术对胸、腰椎结核的临床疗效.方法 对2010年1月～2017年12月在汕头市中心医院骨外一科及骨外二科确诊为胸、腰椎结核并行手术治疗的48例患者进行回顾性分析.其中,23例行前路病灶清除、椎间植骨融合内固定术,19例患者行后路病灶清除、椎间植骨融合内固定术,6例患者行一期后前联合病灶清除、椎间植骨融合内固定术.结果 术后随访12-31个月.所有患者在最后一次随访时均已治愈,VAS评分、ASIA分级、WBC、CRP、ESR及SF-36评分、Cobb角对比术前均有显著改善(P<0.05).前路组的术中出血量显著多于后路组(P<0.05),两组患者在手术时间、临床治愈率、VAS评分、SF-36评分及实验室指标方面均无显著性差异(P>0.05);后前联合组由于例数较少,不做结果对比.结论 三种手术方式均为胸、腰椎结核的有效治疗方法.其中,后路手术在操作时间和手术出血、手术风险上具有相对优势,在符合适应证的情况下,可作为首选;一期后前联合手术既可达到坚强内固定,又可充分暴露和彻底清除病灶,但手术时间长、风险较大.     

一期前路病灶清除后路椎弓根螺钉内固定治疗胸腰椎结核

目的探讨一期前路病灶清除植骨内固定治疗胸腰椎结核的疗效。方法23例胸腰椎结核患者采用一期前路或侧前方入路病灶清除、植骨,后路椎弓根螺钉固定、椎板间植骨融合。根据术前、术后X线片和MRI分析脊柱后凸畸形的矫正、植骨融合以及脊髓损害的恢复情况。结果23例均获得随访,时间12～24个月,患者均未出现结核播散,植骨全部融合,在3—6个月均获得牢固愈合,后凸畸形得到矫正,无侧弯畸形,Cobb角术前平均为（37±11）°,术后为（17±5）°。患者全身状况良好,受损神经均有不同程度的恢复。结论对有明显椎体破坏及脊髓受损的胸腰椎结核患者行一期前路病灶清除植骨内固定术,能有效防止远期手术矫正脊柱后凸畸形不理想以及早期阻止脊髓的不可逆损害,为脊柱融合提供一个稳定的力学环埔。     

一期后路病灶清除植骨融合内固定治疗胸腰椎结核

目的:探讨一期后路病灶清除植骨融合内固定治疗胸腰椎结核的可行性及疗效,并与前后路联合手术相比较.方法:同顾分析2006年1月至2008年10月收治的67例胸腰椎结核患者,其中后路手术组(A组)38例.行一期后路病灶清除、植骨融合、内固定术;前后路联合手术组(B组)29例,行一期前路病灶清除、植骨融合、后路内固定术.评价两组患者的手术时间、术中出血量、住院天数及手术前后的ASIA分级、Cobb角、血沉变化情况,并进行比较分析.结果:A组手术时间平均为160.4±20.5min,术中出血平均为760.7±146.2ml,住院天数平均为13.6±3.2d;B组分别为231.4±27.3min、1023.8±197.9ml和18.7±3.6d,两组间比较有显著性差异(PO.05).结论:一期后路病灶清除、植骨融合、内固定术治疗胸腰椎结核与前后路联合术式均可获得较好的治疗效果,但后路术式手术时间短、出血少、住院时间短.     

短程化疗联合病灶清除一期植骨内固定术治疗胸腰椎结核疗效分析

目的探讨短程化疗联合病灶清除、一期植骨内固定治疗胸腰椎结核的疗效。方法采用短程化疗、病灶清除、一期植骨及前路或后路内固定术治疗70例胸腰椎结核患者。结果 70例均获随访,时间1~5(3.5±0.8)年。患者神经症状得到改善,植骨骨性融合,后凸畸形矫正较满意。结论短程化疗联合病灶清除、一期植骨及前路或后路内固定术,对患者神经功能的恢复、病椎的融合、脊柱稳定性的重建等方面治疗效果满意。     

治疗胸腰椎结核三种手术方式及两种内固定的比较研究

目的比较三种手术方式及前路或后路内固定治疗胸腰椎结核的临床疗效,为临床合理选择手术方式提供参考。方法回顾性分析我院收治且定期随访的139例胸腰椎结核患者的临床资料,其中34例行一期前路病灶清除植骨融合、内固定术(A组、前路内固定组);76例行一期前路病灶清除植骨融合、后路内固定术(B组、后路内固定组);29例行一期后路病灶清除植骨融合、内固定术(C组、后路内固定组)。比较三种手术方式的手术时间、术中出血量、住院天数、手术前后血沉以及两种内固定的后凸畸形矫正情况、植骨融合时间、内固定失败发生率。结果随访14~36个月,平均(18.2±8.6)个月,所有患者术后均恢复良好。平均手术时间,A组、C组明显短于B组(P0.05),A组、C组比较差异无统计学意义(P0.05);平均术中出血量,A组明显少于B组、C组(P0.05),B组、C组比较差异无统计学意义(P0.05)。三组间平均住院天数、手术前后血沉比较,差异无统计学意义(P0.05)。两种内固定植骨融合时间、内固定失败发生率无明显差异(P0.05),后路内固定组后凸畸形矫正及末次随访Cobb角丢失优于前路内固定组(P0.05)。结论不同手术方式治疗胸腰椎结核均可获得较满意的疗效,但在手术时间、术中出血量以及后凸畸形矫正情况上存在差异,临床上应根据具体情况合理选择手术方式。     

一期前路病灶清除钛网植骨融合内固定治疗胸腰椎多椎体结核

目的探讨采用一期前路病灶清除钛网植骨融合内固定术治疗胸腰椎多椎体结核的疗效。方法胸腰椎多椎体结核34例均采用一期前路病灶清除、钛网植骨融合、前路内固定。结果术后3个月VAS评分平均（2．5±1．2）分,较术前差异有统计学意义（P〈0．05）,术后1年Frankel分级平均恢复2．3级,术后后凸Cobb角平均（11±2．8）°,较术前差异有统计学意义（P〈O．05）。结论一期前路病灶清除钛网植骨融合内固定治疗胸腰椎多椎体结核可行且有效,能较好地清除病灶,解除脊髓压迫,矫正后凸畸形,重建脊柱稳定性,提高脊柱结核的治愈率。     

一期前路病灶清除植骨融合内固定治疗胸腰椎结核

目的总结一期前路病灶清除植骨融合内固定治疗胸腰椎结核的经验。方法采用一期前路病灶清除、自体植骨、前路内固定治疗胸腰椎结核19例。结果平均随访15个月,脊髓神经功能得到不同程度地恢复,术后平均5.2个月达满意植骨融合,无内固定失败和脊柱结核病灶复发,后凸畸形矫正满意,Cobb角平均23.4°,平均矫正21.3°。结论一期前路病灶清除植骨融合内固定术可使病变节段在术后即刻重建稳定性,为脊柱融合和结核病灶的静止提供良好的力学环境,是外科治疗脊柱结核安全、有效的方法。     

后外侧及内侧联合入路手术治疗三踝骨折

2008年3月～2011年1月,我科根据踝关节的解剖学特点,采用后外侧及内侧联合入路治疗三踝骨折12例,疗效满意,报道如下。1材料与方法1.1病例资料本组12例,男7例,女5例,年龄24～68(44±1.4)岁。骨折根据Lange-Hansen分型:旋后外旋型4例,     

Similar Superior Patient-Reported Outcome Measures for Anterior and Posterolateral Approaches After Total Hip Arthroplasty: Postoperative Patient-Reported Outcome Measure Improvement After 3 months in 12,774 Primary Total Hip Arthroplasties Using the Anterior,Anterolateral, Straight Lateral,or Posterolateral Approach

Background

Patient-reported outcome measures (PROMs) are used to evaluate the outcome of total hip arthroplasty (THA). We determined the effect of surgical approach on PROMs after primary THA.

肌间隙入路和传统入路在腰椎融合术中的对比研究

目的:比较经肌间隙入路和传统入路对腰椎融合手术患者的影响。方法:对2016年5月至2017年5月因腰椎间盘突出或MeyerdingⅡ度以内腰椎滑脱行2个节段以内腰椎融合手术治疗的70例患者进行回顾性分析。70例患者根据手术入路分为两组,肌间隙入路组35例,男18例,女17例,年龄(52±11)岁;传统入路组35例,男19例,女16例,年龄(51±14)岁。70例患者中包括腰椎间盘突出症38例,腰椎滑脱32例。记录两组患者的手术时间、术中出血量,术后引流量、腰腿痛VAS评分、外周血CK浓度以及MRI上多裂肌横截面积。结果:肌间隙入路组手术时间、术中出血量和术后引流量均少于传统入路组(P0.05)。术后7 d和3个月两组患者的VAS腰痛评分差异有统计学意义(P0.05);两组患者VAS腿痛评分,术后7 d差异无统计学意义(P0.05),术后3个月差异有统计学意义(P0.05)。术后1 d和3 d外周血CK浓度:肌间隙入路组分别为(400±103) U/L和(176±58) U/L,传统入路组分别为(598±57) U/L和(222±50) U/L,两组间差异有统计学意义(P0.05)。两组患者MRI上多裂肌横截面积:术前肌间隙入路组为(424±66) mm~2,传统入路组为(428±82)mm~2,组间差异无统计学意义(P=0.8);术后3个月肌间隙入路组为(347±73) mm~2,传统入路组为(239±78) mm~2,组间差异有统计学意义(P0.05)。结论:行腰椎融合手术,肌间隙入路与传统后正中入路相比,确实拥有手术时间短、对椎旁肌损伤小、术后腰腿痛缓解明显等优势,但在确定手术方案时,术者也应充分认识到Wiltse间隙在不同层面的解剖学差异可能对手术操作产生的影响。     

The Direct Anterior Approach is Associated With Early Revision Total Hip Arthroplasty

Background

The direct anterior approach for total hip arthroplasty (THA) has generated increased interest recently. The purpose of this study was to compare the duration to failure and reasons for revision of primary THA performed elsewhere and subsequently revised at our institution after the direct anterior vs other nonanterior surgical approaches to the hip.

Transoral vs. Endoscopic Endonasal Approach for Clival/Upper Cervical Chordoma

The surgical results of 18 cases of clival/upper cervical chordoma treated in the last decade via the endoscopic endonasal approach (EEA, 9 cases) and the transoral-transpalatal approach (TO-TPA, 9 cases) were compared. Each group showed the same incidence of subdural invasion, with 5 cases each. The superior (frontal base) and lateral surgical fields were wider by EEA, but the inferior view lower than the cranio-vertebral junction (CVJ) was wider by TO-TPA. Gross total removal was achieved in 3 cases in the EEA group, but in only 1 case in the TO-TPA group. Differences in radicality might be due to the extent of the lateral and subdural overview. However for large tumors extending below the CVJ, TO-TPA was the only viable approach for surgical removal. Surgical complications were higher in the EEA (4 cases) than the TO-TPA group (1 case), and were mainly caused by aggressive management of subdural invasion in the EEA group. Post-operative oral intake was earlier and the operative time was shorter in the EEA group. The surgical results were more radical and less invasive in the EEA group than the TO-TPA group. However in tumors extending below the CVJ, the surgical field in EEA was limited, indicating the need to use the transoral route or a combination of routes. A higher complication rate following subdural management was a negative factor that requires improvement in the EEA group and two-staged EEA followed by a transcranial approach may be considered for the cases with subdural invasion.     

Accessing the Basilar Artery Apex: Is the Temporopolar Transcavernous Route an Anatomically Advantageous Alternative?

The restricted operative field, difficulty of obtaining proximal vascular control, and close relationship to important anatomic structures limit approaches to basilar apex aneurysms. We used a cadaveric model to compare three surgical transcavernous routes to the basilar apex in the neutral configuration. Five cadaveric heads were dissected and analyzed. Working areas and length of exposure provided by the transcavernous (TC) approach via pterional, orbitozygomatic, and temporopolar (TP) routes were measured along with assessment of anatomic variation for the basilar apex region. In the pterional TC and orbitozygomatic TC approaches, the mean length of exposure of the basilar artery measured 6.9 and 7.2 mm, respectively (p = NS). The mean length of exposure in a TP TC approach increased to 9.3 mm (p < 0.05). Compared with the pterional and orbitozygomatic approaches, the TP TC approach provided a larger peribasilar area of exposure ipsilaterally and contralaterally (p < 0.05). The multiplanar working area related to the TP TC approach was 77.7 and 69.5% wider than for the pterional TC and orbitozygomatic TC, respectively. For a basilar apex in the neutral position, the TP TC approach may be advantageous, providing a wider working area for the basilar apex region, improving maneuverability for clip application, fine visualization of perforators, and better proximal control.     

Microsurgical anatomy and related techniques to an anterolateral transthoracic approach to thoracic disc herniations

The microsurgical anatomy and related techniques of a modified anterolateral transthoracic approach to the thoracic disc space is presented. This procedure was performed on at least three thoracic levels of 12 cadavers within a few hours after death. Such an approach allows a safe decompression of the spinal cord and roots under full visual control. There is minimal risk to radiculome-dullary vessels, minimal osteoligamental resection, and no compromise of stability of the spinal column. Therefore, this procedure does not require surgical stabilization of the spinal column, postoperative bracing, or prolonged bed rest. The difference between this approach and anterolateral transthoracic, posterolateral, and transpedicular approaches is discussed.     

单一入路手术治疗巨大侵袭性脊柱神经鞘瘤

目的探讨单一入路手术治疗巨大侵袭性脊柱神经鞘瘤的方法、疗效与安全性。方法回顾性分析自2013-01—2016-01采用单一入路手术治疗的11例巨大侵袭性脊柱神经鞘瘤。1例颈椎肿瘤行前路手术,2例颈椎肿瘤行后外侧入路手术。胸腰椎肿瘤4例中3例行后路手术,1例行前路手术。骶椎肿瘤4例行后路手术。结果本组手术时间120~290(210±55)min,术中出血量150~1 200(537±306)ml。1例S1神经根结扎后下肢肌力下降,双侧S4神经根结扎后出现二便功能障碍,术后半年逐渐恢复。本组均获得4~28(13.2±6.8)个月随访,所有患者均未发现肿瘤复发和转移,内固定位置良好。术前痛区VAS评分1~8(4.5±2.0)分,末次随访时VAS评分1~3(1.8±0.6)分;末次随访时疼痛较术前明显缓解,差异有统计学意义(P0.05)。术前7例有神经功能障碍者ASIA评分:左侧39~49(44.5±3.9)分,右侧40~49(45.7±3.0)分;末次随访ASIA评分:左侧42~49(46.7±2.5)分,右侧45~49(47.4±1.4)分;手术前后ASIA评分差异无统计学意义(P0.05)。结论单一入路手术能够完整切除巨大侵袭性脊柱神经鞘瘤,彻底减压并重建脊柱稳定性,疗效确切,并发症少。