经口咽前路寰枢椎钢板内固定

对颅颈交界区畸形及其他病变引起的寰枢椎脱位伴脊髓压迫症需减压内固定，可根据不同情况选择不同的内固定方法，包括寰枢前路内固定、寰枢后路内固定或枕颈内固定，经口咽前路囊枢椎钢板内固定是新近发展起来的一种寰枢椎前路固定方法，用于治疗先天性疾患、外伤或类风湿性关节炎等所致的难复性寰枢椎脱位，但临床应用不多。     

难复型寰枢椎脱位经口咽入路手术治疗进展

对颅颈交界区畸形及其它病变引起的寰枢椎脱位伴脊髓压迫症需减压内固定,可根据不同的情况选择不同的内固定方法,包括寰枢前路内固定、寰枢后路内固定或枕颈内固定。经口咽前路寰枢椎钢板内固定是新近发展起来的一种寰枢椎前路固定方法,用于先天性疾患、外伤或类风湿性关节炎等所致的难复型寰枢椎脱位,但临床应用不多。虽然应用经口咽入路处理颅颈交界区腹侧病变已有近100年的历史,但由于此入路术野显露困难,手术风险较大,术后并发症严重等,至今未能广泛开展,本文就此入路手术治疗寰枢椎脱位近年的进展情况做一综述。     

内窥镜辅助下经口咽前路寰枢椎减压术

目的：探讨内窥镜辅助下经口咽前路寰枢椎减压术的临床效果。方法：1998年8月～2004年8月对38例陈旧性寰枢椎脱位患者采用内窥镜辅助下经口咽前入路减压术，其中18例行一期经口咽入路减压和后路枕颈内固定术：15例行经口咽前路寰枢椎复位钢板内固定术；5例不可复型仅行经口咽前入路减压术。结果：平均随访38个月（6～96个月）。术后患者临床症状均明显改善，上颈段脊髓减压改善率达89.3％。发生颅内感染1例，前路钢板松脱1例。结论：与常规减压方法相比，内窥镜辅助下经口咽前路寰枢椎减压手术创伤小，操作精细、准确，术中与助手可协同操作。     

经口咽前路寰枢椎复位钢板治疗难复性寰枢椎脱位疗效观察

目的 探讨和评价经口咽前路寰枢椎复位钢板(transoral atlantoaxial reduction plate,TARP)内固定术治疗难复性寰枢椎脱位的中期疗效.方法 2003年4月以来应用TARP手术治疗难复性寰枢椎脱位52例,观察患者的主观症状、客观体征和神经功能,进行X线摄片和MR检查,并按Symon和Lavender临床标准、JOA脊髓功能评分标准(17分法)和影像学脊髓受压减压评定标准对35例资料收集比较完整的患者,进行2～4年(平均3年)的随访,分析其中期疗效.结果 35例寰枢椎脱位术后均达解剖复位或接近解剖复位,33例无钢板松动或再脱位现象.按Symon和Lavender临床标准,术前的中型8例、重型15例和特重型12例中,完全恢复16例,轻型7例,中型8例,重型4例,临床显效率80%,有效率20%;脊髓功能术后改善率平均73.5%;颈髓减压改善率平均92.6%.仅早期发生2例钢板螺钉松脱,均为老年骨质疏松患者,1例重新行TARP翻修,另1例行后路枕颈固定均获得治愈.未发生神经、血管损伤及感染并发症.结论 经口咽前路寰枢椎复位钢板内固定术(TARP)是治疗难复性寰枢椎脱位很好的手术方法,具有较高的临床应用价值.     

一期前路松解后路椎弓根钉固定融合治疗难复性寰枢椎脱位

目的 探讨经口咽入路前路松解一期后路寰枢椎椎弓根钉内固定植骨融合治疗难复性寰枢椎前脱位的临床疗效,方法 2005年1月～2010年2月,采用经口咽入路前路松解,一期后路寰枢椎椎弓根钉内固定植骨融合治疗难复性寰枢椎脱位合并高位颈脊髓压迫共21例.男15例,女6例;年龄26～70岁,平均51岁;病程6～30年.陈旧性齿状突...     

我国上颈椎外科已跨入国际先进行列

上颈椎位于头颈交界部,毗邻生命中枢,部位狭小,解剖复杂,是外科治疗难度高、风险大的高危区.20世纪末,我国对寰枢椎脱位多采用保守治疗(如颅骨牵引、Halo支架固定)或Brooks钢丝[1]、Halifax椎板夹[2]、Apofix夹等非螺钉固定技术治疗,而对陈旧性难复性寰枢椎脱位几乎缺少良好对策.1986年刘景发等[3]采用经口咽寰椎前弓和枢椎齿状突切除行前路减压复位术治疗难复性寰枢椎脱位,后于1998年报道经口咽前路寰枢椎松解,术后持续牵引缓慢复位后,行头颈胸石膏外固定或后路枕颈或寰枢椎固定融合术来治疗难复性寰枢椎脱位[4].     

Cervifix内固定系统在治疗陈旧性寰枢椎脱位中的应用

目的：评价Cervifix内固定系统在治疗陈旧性寰枢椎脱位伴高位颈髓压迫症中的应用价值。方法:对25例陈旧性寰枢椎脱位伴高位颈髓压迫症的患者进行前后路一期寰枢椎减压或仅行后路或分期前后路减压植骨融合，并同时采用Cervifix枕颈内固定。结果：随访6－23个月，采用自拟的影像学脊髓减压评定标准和JOA 17分法脊髓功能评喧标准评定治疗效果，术后脊髓减压改善率平均为70．2％，脊髓功能改善率平均为68．4％。所有病例植骨均愈合，未发生内固定移动、断裂和神经损伤，发生椎动脉损伤1例。结论：Cervifix颈椎后路内固定系统具有较好的生物相容性和良好的生物力学稳定性，不影响MRI检查，有利于术后观察，便于量化计算出术后的脊髓减压改善率，是目前较理想的枕颈后路内固定器。     

两种不同手术方式治疗难复性寰枢椎脱位并颅底凹陷效果对比研究

目的 评价经颈前咽前路松解结合枕颈融合内固定术与单纯后路枕颈融合内固定术治疗难复性寰枢椎脱位并颅底凹陷的临床效果.方法 回顾性分析2015-01—2019-06郑州大学第一附属医院收治的32例难复性寰枢椎脱位并颅底凹陷患者的临床资料,按手术方式分为经颈前咽前路松解结合枕颈融合内固定术组(前后路联合组)和单纯后路枕颈融合...     

经颈前路松解后路融合一期手术治疗难复性寰枢椎半脱位

目的：探讨经颈前路松解后路融合一期手术治疗难复性寰枢椎脱位的方法及其可行性。方法：本组7例,男6例,女1例;年龄14～49岁,平均35岁。陈旧性齿突骨折例,横韧带断裂9例,同时合并有枕颈或颈椎先天性畸形6例。先天性寰枢椎半脱位8例,斜坡颅底型状突陷入症13例。根据术前临床分型安排前后路手术的顺序。经口咽前路松解：仰卧位维持头颅牵引,口腔常规清洁处理后,碘伏消毒面部、口腔及咽部。用Codmart口咽显露器撑开口腔及咽皱襞及软腭,充分显露咽后壁,纵行切开咽后壁诸层结构,分离显露寰椎前弓,用磨钻磨除环椎前弓、齿状突,予以脊髓前方的彻底减压：颈后路减压及内固定术：更换体位,置患者于俯卧位,维持头颅牵引,行枕颈后正中纵切口,分离显露枕骨背部、寰椎后结节和C2一C4棘突和椎板,若脊髓后方有压迫,则切除寰椎后结节减压,取髂骨块移植于枕颈部,遂行枕颈后方内固定。结果：42例获得6．24个月随访,平均随访19个月,观察手术前后的临床症状、体征。按JOA 17分法评定标准进行手术前后的颈髓功能评定,术后改善率=（术后总分－术前总分）÷（17－术前总分）×100％。结果显示,术后改善率为14．4％－100％,平均58．9％。术后40例枕颈骨性融合,所有病例均无内固定物折断、松动现象,1例患者3枚螺钉退出,1例患者2枚螺钉方法不佳。术后颈椎活动功能近期受到一定影响,通过功能练习和下位颈椎的活动功能代偿基本能满足生活需要。结论：经口咽前、后路一期手术治疗寰枢椎脱位伴脊髓压迫症效果良好。     

颈前路松解后路融合一期手术治疗难复性寰枢椎半脱位

目的：探讨经颈前路松解后路融合一期手术治疗难复性寰枢椎脱位的方法及其町行性。方法：本组7例，男6例，女1例；年龄14～49岁，平均35岁。陈旧性齿突骨折例，横韧带断裂9例，同时合并有枕颁或颈椎先天性畸形6例。先天性寰枢椎半脱位8例，斜坡颅底型状突陷入症13例。根据术前临床分型安排前后路于术的顺序。经口咽前路松解：仰卧位维持头颅牵引，口腔常规清洁处理后，碘伏消毒面部、口腔及咽部。用Codman口咽显露器撑开口腔及咽皱襞及软腭，充分显露咽后壁，纵行切开咽后壁诸层结构，分离显露寰椎前弓，用磨钻磨除环椎前弓、齿状突，予以脊髓前方的彻底减压：颈后路减压及内固定术：更换体位，置患者于俯卧位，维持头颅牵引，行枕颈后正中纵切口，分离显露枕骨背部、寰椎后结节和C2～C4棘突和椎板，若脊髓后方有压迫，则切除寰椎后结节减压，取髂骨块移植于枕颈部，遂行枕颈后方内固定。结果：42例获得6～24个月随访，平均随访19个月，观察手术前后的临床症状、体征。按JOA17分法评定标准进行手术前后的颈髓功能评定，术后改善率=（术后总分-术前总分）÷（17-术前总分）×100％。结果显示，术后改善率为14．4％～100％，平均58．9％。术后40例枕颈骨性融合，所有病例均无内固定物折断、松动现象，1例患者3枚螺钉退出，1例患者2枚螺钉方法不佳。术后颈椎活动功能近期受到一定影响，通过功能练习和下位颈椎的活动功能代偿基本能满足生活需要。结论：经口咽前、后路一期手术治疗寰枢椎脱化伴脊髓压迫症效果良好。     

Neurophysiological recovery after open carpal tunnel decompression: comparison of simple decompression and decompression with epineurotomy

Two hundred and seventy-three patients with carpal tunnel syndrome without advanced neurophysiological changes (distal motor latency below 11 ms) were randomized to treatment by open carpal tunnel release with, or without, epineurotomy. Patients were examined clinically and by nerve conduction studies preoperatively and at 3, 6 and 12 months postoperatively. We found no statistically significant difference between simple decompression and decompression combined with epineurotomy with regard to either the clinical or the neurophysiological outcome.     

Spinal decompression with patient-specific guides

BACKGROUND CONTEXTPatient-specific instruments (PSI) have been well established in spine surgery for pedicle screw placement. However, its utility in spinal decompression surgery is yet to be investigated.PURPOSEThe purpose of this study was to investigate the feasibility and utility of PSI in spinal decompression surgery compared with conventional freehand (FH) technique for both expert and novice surgeons.STUDY DESIGNHuman cadaver study.METHODSThirty-two midline decompressions were performed on 4 fresh-frozen human cadavers. An expert spine surgeon and an orthopedic resident (novice) each performed 8 FH and 8 PSI-guided decompressions. Surgical time for each decompression method was measured. Postoperative decompression area, cranial decompression extent in relation to the intervertebral disc, and lateral recess bony overhang were measured on postoperative CT-scans. In the PSI-group, the decompression area and osteotomy accuracy were evaluated.RESULTSThe surgical time was similar in both techniques, with 07:25 min (PSI) versus 06:53 min (FH) for the expert surgeon and 12:36 min (PSI) vs. 11:54 (FH) for the novice surgeon. The postoperative cranial decompression extent and the lateral recess bony overhang did not differ between both techniques and surgeons. Further, the postoperative decompression area was significantly larger with the PSI than with the FH for the novice surgeon (477 vs. 305 mm²; p=.01), but no significant difference was found between both techniques for the expert surgeon. The execution of the decompression differed from the preoperative plan in the decompression area by 5%, and the osteotomy planes had an accuracy of 1–3 mm.CONCLUSIONPSI-guided decompression is feasible and accurate with similar procedure time to the standard FH technique in a cadaver model, which warrants further investigation in vivo. In comparison to the FH technique, a more extensive decompression was achieved with PSI in the novice surgeon's hands in this study.CLINICAL SIGNIFICANCEThe PSI-guided spinal decompression technique may be a useful alternative to FH decompression in certain situations. A special potential of the PSI technique could lie in the technical aid for novice surgeons and in situations with unconventional anatomy or pathologies such as deformity or tumor. This study serves as a starting point toward PSI-guided spinal decompression, but further in vivo investigations are necessary.     

应用赵春风减压系统旋转推进式环锯行颈前路减压融合术

目的 探讨应用赵春风减压系统（ZDS）旋转推进式环锯前路减压融合术治疗颈脊腹侧局限性压追的疗效。方法分析27例颈椎外伤，颈椎间盘突出症患者使用ZDS旋转推进式环锯行颈椎前路减压融合术治疗的结果。结果术后改善程度，优24例，良2例，有效1例。结论应用ZDS旋转推进式环锯行颈椎前路减压融合术治疗颈椎外伤、颈椎间盘突出症可获得较好的疗效，且操作简单，安全。     

Clinical experience with subxyphoid pericardial decompression

Between 1971 and 1981, 108 patients with pericardial effusion were treated by subxyphoid pericardial decompression. 68 patients (63%) had local anesthesia, while general anesthesia was used in 40 (37%). The total group included nonspecific (viral) pericarditis in 35 patients (32.4%), uremic pericarditis in 30 (27.8%); and 20 patients (18.5%) with a malignant etiology, traumatic in ten patients (9.3%), six patients (5.6%) following radiation for malignant disease, and seven patients (6.5%) due to other causes. Echocardiography was diagnostic in all cases. Acute cardiac tamponade necessitated pericardiocentesis as an initial procedure in seven patients (6.5%). Subxyphoid pericardial decompression included drainage of the pericardial fluid and performance of a 5 X 5 cm pericardial window and biopsy of all patients. There were two (1.8%) operative deaths in the general anesthesia group but none in the local anesthesia group. There were no major complication in the local anesthesia group, but one patient in the general anesthesia group, who was severely hypertensive preoperatively, developed hemiplegia on the left side. There were five recurrences (4.6%) requiring total pericardiectomy at a later date. Subxyphoid pericardial decompression under local anesthesia was seen to be a safe and effective procedure for primary decompression and diagnosis of acute or chronic pericardial effusion.     

Core decompression with marrow stem cells

Association of core decompression with technique of bone graft is frequent and many different techniques have been described. In this series, grafting was done with autologous bone marrow obtained from the iliac crest of patients operated for hips osteonecrosis. The bone marrow was harvested under general anesthesia. A beveled metal trocar of 6 to 8 cm in length and a bore of 1.5 mm was pushed deep into the cancellous bone. A 10-mL syringe that has been flushed with heparin is used to aspirate the marrow. Once the needle has been inserted to the desired depth, the tip is swept around a full circle in 45° steps, with the bevel pointing in different directions at each step. This procedure is continued until a sufficient quantity of bone marrow has been harvested (150 mL). All the marrow aspirated is discharged into a plastic collection bag containing ACD (acid citrate dextrose) anticoagulant solution. It is then filtered, to remove fat aggregates and clots. The aspirated marrow was reduced in volume by concentration and injected in the femoral head after core decompression with a small trocar. To measure the number of progenitor cells transplanted, we used the fibroblast colony forming unit as an indicator of the stromal cell activity and performed in vitro cultures of the fibroblast progenitor cells. The average volume of bone marrow aspiration was 147 mL ± 12 mL per hip. The number of progenitor cells was average 12.4 ± 3.4 per 10⁶ bone marrow nucleated cells and the number of nucleated cells was estimated to be 16.4 million cells per milliliter of bone marrow.     

Degenerative lumbar spondylolisthesis with spinal stenosis. A prospective study comparing decompression with decompression and intertransverse process arthrodesis

Fifty patients who had spinal stenosis associated with degenerative lumbar spondylolisthesis were prospectively studied clinically and radiographically to determine if concomitant intertransverse-process arthrodesis provided better results than decompressive laminectomy alone. There were thirty-six women and fourteen men. The mean age of the twenty-five patients who had had an arthrodesis was 63.5 years and that of the twenty-five patients who had not had an arthrodesis, sixty-five years. The level of the operation was between the fourth and fifth lumbar vertebrae in forty-one patients and between the third and fourth lumbar vertebrae in nine patients. The patients were followed for a mean of three years (range, 2.4 to four years). In the patients who had had a concomitant arthrodesis, the results were significantly better with respect to relief of pain in the back and lower limbs.     

单纯减压与减压后融合治疗单纯退变性腰椎管狭窄症疗效对比研究

【摘要】 目的 比较单纯椎管减压术和减压后器械内固定融合治疗无腰椎滑脱和失稳的退变性腰椎管狭窄症的临床疗效。方法 自2006年3月~2011年5月期间,在我院接受手术治疗的单纯退变性腰椎管狭窄症患者共63例,其中接受单纯选择性椎管减压术治疗的患者28例,接受椎管减压加器械内固定融合手术患者35例。手术前后分别使用腰椎JOA (Japanese Orthopedic Association) 评分、ODI(Oswestry Disability Index)评分和SF?鄄36(Short Form?鄄36)评分,评估两种术式的临床疗效。结果 两组患者术后1年均取得较好疗效。其中椎管减压加融合组患者术后ODI评分改善31.2分(P<0.001),由重度功能障碍改善至轻度功能障碍;单纯选择性椎管减压组术后ODI评分改善14.9分(P=0.004),由重度功能障碍改善至中度功能障碍;减压加融合组预后较单纯减压组显著改善(P<0.01),术后SF?鄄36评分得到相似结果。结论 手术治疗能极大地改善腰椎管狭窄患者的临床症状,椎管减压加融合术较单纯椎管减压术能更大程度改善该类患者的临床症状。