椎弓根内固定一期前后路TFC椎体融合治疗腰椎滑脱

目的 探讨采用椎弓根内固定及椎间融合技术治疗腰椎滑脱的方法。方法 腰椎滑脱患者２６例,男１４例,女１２例;采ＲＦ及ＳＯＣＯＮ椎弓根内固定器,Ⅰ期行前路和后路植骨及ＴＦＣ椎体融合治疗腰椎滑脱,其中,采用ＲＦ内固定 时行ＴＦＣ椎体后路融合６例,采用ＳＯＣＯＮ同时加ＴＦＣ椎体后路融合１５例;余５例均行ＲＦ加Ⅰ期前路异体骨环加自体松质骨植骨融合。结果 本ＴＦＣ椎体后路融合１５例;余５例均行ＲＦ加Ⅰ期前路异     

腰椎滑脱症手术治疗体会

目的 提高腰椎滑脱症手术复位和后路一次椎体间植骨融合率。方法 对行Ｓｔｅｆｆｅｅ椎弓根螺钉系统、ＲＦ系统、ＳＦ内固定装置复位内固定加植骨融合术治疗的腰椎滑脱２０例进行观察,对比分析术前和术后症状、体征和影像学改变。结果 ２０例均获满意复位,椎间植骨融合。结论 应用具有提拉作用的椎弓根螺钉系统固定滑脱腰椎＋滑脱椎椎间植骨融合是较理想的治疗方法。     

骨盆牵引加Steffee钢板植骨治疗腰椎滑脱症

目的：探讨提高腰椎滑脱症治疗效果的手段。方法：对４４例腰椎滑脱症患者术前采用充分的骨盆牵引后,应用Ｓｔｅｆｆｅｅ钢板加椎体间植骨融合术进行治疗。结果：４４例患者经３～３０个月的随访显示,椎体的滑移行到满意复位,椎体间植骨全部融合,临床症状消失或改善。结论：Ｓｔｅｆｆｅｅ钢板加椎体间植骨融合术作为腰椎滑脱症的主要治疗手段,术前骨盆牵引对增加复位的成功率,提高治疗效果有重要的辅助作用。     

复合骨环行前路腰椎椎间融合术治疗腰椎滑脱症

目的 应用复合骨环行前路腰椎椎间融合术治疗腰椎滑脱症。方法 本组患者共１４例,男６例,女８例;年龄４０～５６岁,平均４６岁。Ⅱ度滑脱者１０个节段,Ⅰ度滑脱者５个节段。所选用的后路复位内固定中,ＲＦ钉１０例,短Ｈａｒｒｉｎｇｔｏｎ棒４例。椎间植植骨材料为同种异本冷冻干燥骨皮质骨环加自体松质骨（简称复合骨环）。根据手术前后的Ｘ线片和ＪＯＡ评分,判定前路腰椎椎间植骨的骨融合率和临床效果。结果 随访７～４     

经前路椎体间植骨融合治疗腰椎滑脱

目的：总结分析６８例经前路椎体间植骨融合术,探讨其治疗腰椎滑脱的效果。材料方法：对６８例有下腰痛症状的滑脱患者经前路行椎体间植骨融合术,其中男３６例,女３２例;年龄３６～６４岁,平均４５．３岁。按Ｍｅｙｅｒｄｉｎｇ分类法,Ⅰ度２９例,Ⅱ度３９全;滑脱部位Ｌ４～５５２例,Ｌ５～Ｓ１１６例。左下腹斜切口腹膜外进入,切除融合间隙之椎间盘,切除椎体软骨板,髂骨取骨植入椎间隙融合。结果：经１年以上随访６６例植骨融合（融合率９７％）,５２例原下腰痛症状消失,行正自如,复原工作或家务劳作;１２例能消失,但阴雨天或劳累后仍有酸胀不适;２例仍有下腰酸痛,但较术前明显改善;２例植骨块松动,症状无改善。优良率９４％。结论：经前路椎间融合,植骨充分,融合率高,在排除椎间盘突出、椎管狭窄等马尾神经根受压的情况下,遇Ｌ４～５滑脱者应推崇经     

椎体后缘切除椎体间植骨融合术治疗腰椎滑脱5例报告

椎体后缘切除椎体间植骨融合术治疗腰椎滑脱５例报告王栓科，张祥生１９９２年以来，采用后外侧入路椎体后缘切除椎体间植骨融合术治疗腰椎滑脱５例，经１～２．５年随访观察，疗效优良。本组男２例，女３例，平均年龄４６．４岁。Ｌ４滑脱２例，Ｌ５滑脱３例；Ⅰ度滑脱１...     

腰椎后是融合和BAK椎体间融合的疗效比较

目的 证明BAK椎体间融合优于后外侧融合。方法 腰椎滑脱26例采用Steffee钢板和后外侧融合与腰椎滑脱16例采用Silhouetle脊柱棒系统对腰椎滑脱复位固定和BAK椎间植骨融合器椎间植骨融合，比较它们的融合、复位和临床结果。结果 后外侧融合26例随诊6－36个月，临床融合率80.8%(21/26)，滑脱复位率61％（16／26），临床疗效：优9例，良9例，可3例，差5例，优良率69％。BAK椎体间融合16例患者随诊6－20个月。临床融合率为93.7%(15/16)，滑脱复位率为87.5%（14／16），临床疗效：优9例，良5例，可2例，优良率90％。结论 对腰椎滑脱的复位固定，Silhouetle脊柱棒系统较Steffee钢板有较多优点，与后外侧融合比较，BAK椎间融合器植入椎间隙后，椎体界面间固定，椎间隙无塌陷，无植骨吸收，能增大和维持椎间隙和椎间孔高度，间接扩大侧隐窝和恢复脊柱生理曲度，有较大的植骨床，有利于植骨融合，使患者早期下床。近期随访结果表明，Silhouetle脊柱棒系统固定和BAK椎间植骨融合器椎间植骨融合的临床疗效明显优于Steffee钢板固定和后外侧融合。     

Steffee钢板内固定手术治疗腰椎滑脱

目的探讨Ｓｔｅｆｆｅｅ钢板内固定手术治疗腰椎滑脱的疗效。方法 采用椎管减压，Ｓｔｅｆｆｅｅ钢板复位内固定，横突间植骨融合术治疗腰椎滑脱６１例。结果 ２６例得到完全复位，３５例部分复位，无手术并发症。术后随访５２例，随访时间平均２．８年，优良率为９０．４％。结论Ｓｔｅｆｆｅｅ钢板拉力大，能使滑脱椎体复位，同时有利于椎管探查及扩大减压，并且固定可靠，可明显提高脊柱融合率。     

RF内固定治疗腰椎椎弓峡部不连伴腰椎滑脱症

目的 探讨RF内固定治疗腰椎椎弓峡部不连腰椎滑脱症的疗效。方法 采用后路RF复位、椎管减压、峡部、上下关节突及部分椎板植骨内固定治疗30例。结果 30例滑脱均完全复位。骨性融合率100％。根部疼痛及日常功能情况分级,疗效优良率达90％。结论 RF内固定治疗腰椎椎弓峡部不连伴腰椎滑脱症,应常规作神经根探查;锥管减压须充分;有效的内固定,滑脱完全复位;有充分植骨床面积（峡部、上下关节突关节及部分椎板）和认真的植骨床粗糙面准备及植骨材料的适当放置,以获得骨性融合。这样才能保证疗效优良。     

鲁格氏装置或椎弓根螺钉斯太福钢板内固定治疗腰椎滑脱

本文报导应用鲁格氏装置或椎弓根钉steffee钢板内固定加植骨融合治疗真性腰椎滑脱32例,滑脱纠正率达70％,植骨融合率95％。内固定一方面使滑脱椎体复位,扩大椎管容积,解除椎管狭窄症状。另一方面提高了植骨融合率。术后随访1～6年,治疗效果良好。     

RF与圆柱状骨笼椎间融合治疗腰椎滑脱

腰椎滑脱临床并非罕见 ,对其治疗既往多应用游离椎弓切除减压 ,以椎弓根螺钉系统复位固定 ,同时用碎骨条植入横突间或椎体间融合 ,然临床并发症较多 ,少数病例术中复位良好 ,但术后却发生螺钉断裂、拔出及松动或滑脱的椎体复位后再滑脱 ,造成手术失败。基于上述问题 ,我们采用后方入路椎体圆柱状骨笼椎间植骨融合同时行ＲＦ系统复位固定 ,临床应用 6例 ,有效解决了上述并发症 ,现报告如下。1　临床资料　　本组患者共 6例 ,男 4例 ,女 2例 ;年龄 2 4～ 5 7岁 ,平均 33岁。病程最短 9个月 ,最长 2 2年 ,平均 4年 3个月。均有腰痛和神经痛 ,其…     

Prevention of dressing slippage under an elastic bandage.

A technique is described to prevent the shift in position of dressing materials by applying a double-sided adhesive tape between the skin and the elastic bandage. This technique also prevents a shift in position of a pressure garment, especially when applied around joints on the extremities.     

Pouch enlargement and band slippage: two different entities

Background Pouch enlargement and band slippage are the most common late complications of laparoscopic adjustable gastric banding (LAGB). Often, confusion exists among surgeons regarding the denomination or even the treatment of these two different entities. This study aimed to establish the differences in clinical presentation, radiologic features, and management between pouch enlargement and band slippage. The authors hypothesized that pouch enlargement can be managed nonoperatively (via band deflation), that band slippage is an acute complication requiring surgical treatment, and that tailored adjustment allows earlier diagnosis of pouch enlargement in asymptomatic patients. Methods From March 2001 to December 2004, 516 patients underwent LAGB placement. Barium swallow was performed preoperatively, postoperatively, and during band adjustments (“tailored adjustment”). Pouch enlargement was defined as dilation of the pouch, and band slippage was considered when band and stomach were prolapsed. Four radiologic types of pouch enlargement were considered: band 45°, band 45° with covering of the band, band 0°, and band smaller than 0°. Results A total of 1,600 barium swallows were performed with 516 patients. As a result, pouch enlargement was diagnosed for 61 patients (12%) and band slippage for 12 patients (2%). Conclusion In this study, pouch enlargement was found to be a chronic complication that can be managed conservatively with a 77% success rate. Tailored adjustment allows early diagnosis of pouch enlargement, thus preventing adjustments in patients with undiagnosed pouch enlargement. Surgical treatment should be considered when medical treatment fails. By comparison, band slippage is an acute complication that requires surgical treatment in every case (100%).     

Progressive slippage after pinning for slipped capital femoral epiphysis

The authors retrospectively reviewed seven cases of progressive slipped capital femoral epiphysis after screw fixation. All seven patients initially presented with chronic symptoms, and five had an acute exacerbation of symptoms with the appearance of an acute-on-chronic slip. Of the other two, one had obvious motion at the proximal femoral physis and the other had increased symptoms but did not have an obvious acute slip radiographically. All underwent percutaneous screw fixation. In four patients a single screw was placed, and in three patients two screws were placed. No patient became symptom-free after surgery. Slip progression was noted on average 5 months after treatment. Radiographs in all patients revealed an increase in slip severity and loss of screw purchase in the femoral neck while fixation in the proximal femoral epiphysis remained secure. One patient had hypothyroidism and another Cushing disease, both diagnosed after the slipped epiphysis. Slips occurring in children with underlying endocrinopathies, and unstable slips in children with a history of antecedent knee or hip pain (commonly called an acute-on-chronic slip) may be susceptible to screw fixation failure. In such patients, close radiographic follow-up, particularly in the presence of continued symptoms, is required to document slip progression and fixation failure as soon as possible.     

脊柱撑开复位内固定器治疗椎体滑移的疗效

目的探讨脊柱撑开复位内固定器（DRFS）治疗椎体滑移的临床疗效。方法对27例椎体滑移Ⅰ～Ⅱ度患者采用DRFS内固定＋后外侧植骨融合。结果全部患者平均随访25个月，下腰痛症状12例完全消失，13例大部消失，2例略有改善。腰椎X线片复查：椎体复位良好，植骨融合良好。发生长期足趾背伸无力3例，钢板断裂1例。根据Henderson标准进行临床评价：优12例，良13例，可2例。结论DRFS内固定＋后外侧植骨融合是治疗椎体滑移的一种简便、有效方法。