新型脊椎滑脱固定器械的研制与临床应用

探讨新型脊柱固定器治疗脊椎滑脱的临床效果。方法自１９９０年７月用自行研制的脊柱固定器治疗脊椎滑脱１８例,术后观察临床效果及手术并发症。结果术后平均随访３．５年,临床疗效满意,除１例滑脱复发外,其他均复位满意,植骨愈合良好。未发现断钉、拔钉及螺钉松动病例。结论该器械具有手术方法简单,固定牢固和手术创伤小等优点。     

胸腰段脊柱椎弓根内固定手术的器械准备

胸腰段脊柱椎弓根内固定符合脊柱生物力学的三维固定 ,目前广泛应用于临床治疗脊柱骨折脱位、腰椎滑脱、脊柱畸形等。器械种类发展繁多 ,但其共同点均采用椎弓根螺钉 ,从后柱经椎弓根达椎体 ,所不同的是连接固定椎弓根螺钉的器械 ,大体可分为钉板系统、钉棒系统、钉棒钩复合系统。椎弓根系列器械准备原则基本相同。现就器械准备中的若干问题阐述如下。1　临床资料我院 1 995～ 1 999年经椎弓根钉治疗骨折、滑脱、侧弯畸形等 2 87例。其中男 1 94例 ,女 93例 ,年龄 1 3～ 68岁。病种与选用的内固定器械见表 1。表 1　病种与选用的内固定器械…     

新型脊柱固定器械治疗胸腰椎骨折的技术探讨

新型脊柱固定器械治疗胸腰椎骨折的技术探讨张功林葛宝丰荆浩张军华王世勇陈新曾述强王清１９８９年以来，作者针对脊柱椎弓根固定器械的缺点，设计一种新型脊柱固定器械，用于治疗胸腰椎骨折，取得满意效果，现报告如下：１器械结构１．１器械结构该器械结构简单，由主杆...     

CD HORIZONTM M8万向螺钉系统应用于胸腰段脊柱骨折前路内固定

目的 评价CD HORIZON^TMM8万向螺钉系统在胸腰段脊柱骨折前路内固定中的应用价值。方法 分析22例胸腰段骨折患者应用CD HORIZON^TMM8万向螺钉系统行前路减压，植骨，内固定情况。结果 患者椎体高度，后凸角，椎体移位均明显改善，效果良好，20例患者的神经功能恢复良好。结论 CD HORIZON^TMM8万向螺钉系统是一种有效的多用途新器械，可用于严重胸腰段骨折的内固定。     

SCOFIX器械整复固定治疗胸腰椎多节段脊柱骨折

目的:探讨应用SCOFIX器械整复固定治疗胸腰椎多节段脊柱骨折的临床疗效。方法:回顾性分析应用SCOFIX器械治疗的42例脊柱多节段骨折患者的临床资料,对术前与随访时的ASIA分级、感觉和运动评分,伤椎椎体中央高度的术后矫正率、随访时丢失率进行统计学分析。结果:平均随访2.5年,脊髓不完全性损伤病例ASIA分级提高1~2级,B、C级随访时与术前感觉及运动评分比较有显著性差异(P<0.05);脊髓完全性损伤病例(A级)ASIA分级无改善,感觉及运动评分较术前分别平均提高18.3分和13.9分。伤椎椎体中央高度矫正率为94.1%,随访时丢失率为8.0%。SCOFIX器械固定良好,无断钉及松动。结论:SCOFIX器械复位简便,适用于胸腰椎各个部位长、短节段的复位与固定。     

前路器械固定在脊柱结核中的应用

目的：探讨在脊柱结核中应用前路器械固定的可行性。方法：对34例前路病灶清除和内固定的脊柱结核病例进行回顾性分析：男13例，女21例。颈椎结核4例，胸椎结核13例，腰椎结核17例(包括胸腰段)。全部病例均进行术前和术后抗痨化疗。术中经前路彻底清除病灶，椎管减压，椎体间自体骨植骨，前路器械固定。结果：平均随访2．6年，死亡2例，失访4例，其余病例内固定物没有失效，椎体间植骨全部融合，脊柱后凸畸形矫正良好，切口无感染，没有结核复发的病例。结论：在脊柱结核中应用前路器械固定可有效矫正和预防脊柱后凸畸形，并为脊柱提供即刻稳定性，促进病灶愈合和骨性融合。     

现代脊柱内固定技术（续）

3　胸腰椎及腰椎3 .1　前路钢板3 .1.1　适应证　椎体骨折或肿瘤 ,前路减压植骨术。3 .1.2　手术步骤 (以Ｚ ｐｌａｔｅ为例 ) [15] 患者侧卧位 ,经胸、胸腹联合或腹膜外入路暴露拟切除椎体 ,切除椎体及其上、下方椎间盘 ,测量上、下方椎体横径并据此选择相应长度的螺钉和螺栓。选择下方椎体后下缘前、上方 8～ 10ｍｍ处及上方椎体后上缘前、下方 8～ 10ｍｍ作为进入点 (见图 9Ａ) ,钻孔后旋入螺栓 ,其角度应偏向前方 10°左右 (见图 9Ｂ)。以上、下位椎体的螺栓为支点用撑开器撑开复位 ,植入髂骨块 (见图 9Ｃ)。去除撑开器后置入相应规格的…     

金田前方脊柱固定器械用于胸腰部脊柱重建的适应证,手术方法及结果

金田前方脊柱固定器械用于胸腰部脊柱重建的适应证、手术方法及结果金田，清志译者按目前，存在于世界上的各种脊柱内固定器械据说有上千种之多，并且还不断有新的报告出现，在这上千种器械中真正被广泛接受、使用的并不多。金田器械（国际上通称为ＫａｎｅｄａＤｅｖｉｃ...     

A Retrospective Study of Five Clinical Criteria and One Age Criterion for Selective Prehospital Spinal Immobilization

Abstract Abstract Introduction: Full spinal immobilization of blunt trauma victims is a widely accepted prehospital measure, applied in order to prevent (further) damage to the spinal cord. However, looking at the marginal evidence that exists for the effectiveness of spinal immobilization, and the growing evidence for the negative effects following immobilization, a more selective protocol might be able to reduce possible morbidity and mortality as good as the present prehospital immobilization protocol. In a retrospective study, the sensitivity of a selective prehospital immobilization protocol that adds an age criterion to five clinical spine clearance criteria is examined. Materials and Methods: Based on ICD-9 codes, all patients admitted to the trauma center diagnosed with spinal fractures with or without spinal damage were identified. The sensitivity of the combination of five clinical criteria (reduced awareness, evidence of intoxication, neurological deficit, pain of the spine on palpation, (significant) distracting injury) and an age criterion (65 years or older at time of accident) was determined. If one or more criteria were positive, standard full immobilization would be indicated. The other patients would not have been immobilized. Results: A total of 238 blunt trauma victims primarily admitted to the trauma center were included for this study. Median age of the included patients was 39 years (range 5–98), with 32.8% female. A total of 236 had at least one positive criterion (sensitivity 99.2%). The two missed patients were male, 40 and 41 years old. Radiology showed a small fissure in the arch of C2, and a transverse process fracture of L3, respectively. Both patients were discharged the next day without complications or medical interventions. Conclusion: In this retrospective study, a selective protocol based on clinical criteria instead of trauma mechanism showed 99.2% sensitivity for spinal fractures with or without spinal cord damage. Based on this study and the current controversy surrounding spinal immobilization, a prospective study should be considered to evaluate the five clinical criteria and one age criterion in the prehospital setting.     

脊柱椎管损伤模型生物力学实验研究

目的：通过试验比较椎管创伤后产生不同的变化和各自的特点,构建一种精确模拟椎体骨折的测试模型,为临床手术提供科学依据。方法：研究应用冲击试验机测量人脊椎标本,分别测量不同冲击力的椎管直径的试验参数,进行分析。结果：发现在产生最小的脊柱破裂后增加冲击力和椎管骨质破裂应变有交互作用（R2=0．85,19〈0．05）。结论：逐步增量法是一种构建脊柱外伤的一种可靠的方法。     

新型脊柱固定器治疗胸腰椎骨折36例

目的　介绍一种新型脊柱固定器械 ,并报告其治疗胸腰椎骨折的疗效。方法　用此固定器械治疗胸腰椎骨折 3 6例。结果　此固定器械 ,根据临床需要 ,可行压缩、撑开、成角和中立位固定。结论　治疗效果满意。脊柱损伤只要有手术指征 ,手术时机甚为重要 ,应早期或立即手术 ,有利于脊柱骨折和椎管前方骨块的复位 ,早期也有利于神经功能的恢复。     

胫骨骨折手术固定方式的临床研究

目的：明确不同手术固定方式在胫骨不同骨折类型固定中的优缺点,方法：通过对行单侧外固定支架（UADF）,Grosse-Kempf钉,TCP三种不同器械固定的145例病人的骨折情况,手术资料及疗效行统计对比,结果：三者住院时间,骨愈合时间,关节功能无明显差异（P＞0．05）,手术时间,输血量及弃拐下地时间有差异（P＜05）,GK钉组切口感染率及固定失效率均低,结论：UADF最适用于严重开放性骨折,但稳定性差,TCP可应用于各部位骨折,尤其是靠近关系的骨折,但感染率,不愈合率及取钢板后再骨折率高,GK钉固定病人恢复快,并发症少,骨折翕合率高,最适合用于节段性及陈旧性骨折。     

鲁格氏棒横突固定法的实验研究和临床应用

取10具新鲜成年雄性家猪的脊柱标本,分两组观察鲁格氏棒经椎管行椎板固定和鲁格氏棒经横突椎板固定时,受破坏性屈曲力的数据,结果显示鲁格氏棒经椎管固定组在达1048.6（±20）N时,所固定的椎板发生骨折,部分钢丝断裂;鲁格氏棒经横突固定组达2058（±20）N时,仅发生棒弯曲,未发现任何部位骨折或钢丝断裂。临床治疗33例不稳定胸腰椎骨折脱位患者,术后X线片示骨折脱位复位满意,两周后患者可离床活动,随访2～2.5年未发现任何并发症。     

胫骨骨折三种固定器械的生物力学比较和临床研究

目的　明确不同固定器械在胫骨不同骨折类型固定中的优缺点 ,以指导临床应用。方法　 36具胫骨标本制成中段无缺损及有缺损骨折模型 ,行GD型单侧外固定支架、Grosse -kempf钉、TCP三种不同器械固定后 ,进行各项生物力学性能测试 ;选择上述三种器械固定的胫骨中段稳定及不稳定骨折临床病人各 6 0例 ,行临床疗效对比。结果　抗压刚度GK钉最强 ,弯曲刚度TCP最强 ,GD支架此二项刚度差 ,抗扭刚度三者差异不明显。临床GK钉组弃拐行走时间最早 ,但三者骨折愈合时间差异不明显。结论　胫骨骨折髓内固定较其它二种方法更能达到坚强固定且应力遮挡最小 ,髓内固定无论是生物力学还是临床应用均优越 ,髓外固定易产生应力遮挡 ,外固定支架生物力学性能较差 ,需延迟术后下地负重时间。     

Spinal fractures in patients with ankylosing spondylitis

Thirty-one consecutive patients with ankylosing spondylitis and spinal fractures were reviewed. There were 6 women and 25 men with a mean age of 60±11 years; 19 had cervical and 12 had thoracolumbar injuries. Of the patients with cervical fracture, two had an additional cervical fracture and one had an additional thoracic fracture. Three trauma mechanisms were identified: high-energy trauma in 13 patients, low-energy trauma in 13 and insufficiency fracture in 5. One-third of the patients suffered immediate neurological impairment, a further one-third developed neurological impairment before coming for treatment and only one-third remained intact. Two patients with thoracolumbar fractures had deteriorated neurologically due to displacements during surgery at other hospitals. All patients were treated operatively except the two patients with two-level cervical fractures, who were managed in halo vests. In the cervical spine both anterior and posterior approaches were employed. In the thoracolumbar spine the majority of the patients were initially treated using a posterior approach only. Complications were common. Of the 27 patients with neurological compromise, 10 had remained unchanged; 12 had improved one Frankel grade; 4 had improved by two Frankel grades; 1 had improved by four Frankel grades. We conclude that even minor trauma can cause fracture in an ankylosed spine. A high proportion of patients with spinal fractures and ankylosing spondylitis have neurological damage. The risk of late neurological deterioration is substantial. As the condition is very rare and the treatment is demanding and associated with a very high risk of complications, the treatment of these patients should be centralised in special spinal trauma units. A combined approach that stabilises the spine from both sides is probably beneficial.     

前路钛金属圆棒系统在治疗胸腰椎结核中的临床应用

目的探讨钛金属圆棒系统一期前路重建脊柱稳定的效果及意义.方法总结2000年1月～2002年5月期间收治14例胸腰椎结核患者,采用一期前路病灶清除、椎体间自体植骨并前路钛金属圆棒系统内固定治疗.结果经平均16个月的随访,14例患者脊柱结核均治愈,无局部结核复发,植骨全部骨性融合,融合时间平均为3.7个月,后凸矫正角度16°,无手术并发症.结论前路钛金属圆棒系统治疗胸腰椎结核是安全和有效的.