钉钩联合使用预防胸腰椎骨折术后纠正丢失的远期临床效果

目的　使用钉钩联合的经椎弓根短节段内固定治疗胸腰椎骨折 ,探讨该技术预防胸腰椎骨折术后纠正丢失的生物力学基础和远期临床效果。　方法　回顾 1997年 7月至 2 0 0 2年12月采用椎弓根钉 -椎板钩联合短节段内固定治疗的胸腰椎骨折 98例中随访时间超过 2年的 6 4例患者。本组均在伤后平均 3.2d获得手术治疗。CD或CD -Horizon器械内固定 4 1例 ,TSRH器械内固定 2 3例。远期疗效的评估包括椎体高度恢复率的维持、矢状面后凸校正Cobb角及额状面Cobb角纠正的丢失率。　结果　本组无死亡 ,1例术后神经损害加重 (1周后恢复至术前水平 ) ,2例术后深部感染。术后椎体高度压缩纠正率和额状面Cobb角纠正率分别为 89.0 %和 10 0 .0 % ,矢状面后凸校正Cobb角由术前平均 31°纠正为 - 1°。随访时间为 2 4～ 6 2个月 ,无脱钩和断棒 ,有肯定假关节 1例 ,可疑假关节 2例 ,平均椎体高度纠正丢失率为 8.6 % ,而后凸纠正丢失平均为 4°。结论　钉钩联合使用的经椎弓根短节段内固定治疗胸腰椎骨折 ,可满意重建胸腰段的矢状面形态 ,有效预防胸腰椎骨折术后远期纠正丢失及内固定松动、断裂。     

短节段通用脊柱系统内固定加伤椎内植骨治疗胸腰椎不稳定骨折

目的探讨应用短节段通用脊柱系统（USS）骨折内固定术及伤椎内植骨治疗胸腰椎不稳定骨折的临床疗效。方法对40例急性单节段胸腰椎不稳定骨折行后路短节段USS骨折内固定术及伤椎内植骨,对患者手术前后的椎体高度、Cobb’s角进行比较,观察术后1年内固定材料有无松动、断裂,椎体内及椎板间植骨融合情况,神经功能恢复情况。结果 40例患者术后1周、1年伤椎前后缘高度比值、Cobb’s角较术前均明显改善,差异有统计学意义（P〈0.05）,术后1周与1年上述指标比较差异均无统计学意义（P〉0.05）,术后1年未见内固定材料松动、断裂,椎体内及椎板间植骨均骨性融合,有5例神经功能较术前好转。结论短节段USS骨折内固定术及伤椎内植骨治疗胸腰椎不稳定骨折,椎体内及椎板间植骨融合率高,能有效防止术后矫正角度丢失及内固定失败。     

伤椎置钉短节段内固定治疗单节段胸腰椎爆裂骨折

目的评估伤椎置钉后路短节段固定治疗单节段胸腰椎爆裂性骨折的临床疗效及影像学结果。方法回顾分析2008年5月~2014年5月采用伤椎置钉后路短节段固定治疗的胸腰椎爆裂性骨折且随访资料完整者68例,其中男性51例,女性17例;年龄18~62岁。评估患者术后并发症、Oswestry功能障碍指数(ODI)、术后伤椎高度矫正率、伤椎高度矫正丢失率、术后Cobb角矫正率、Cobb角矫正丢失率。结果所有患者均获得随访,时间12~94(平均47.3)个月。共3例(4.3%)患者出现术后并发症,其中切口浅表感染1例、螺钉穿透椎弓根内侧皮质2例,无一例内固定断裂。末次随访时,ODI为19.8%~29.2%[(24.4±7.6)%]、伤椎高度矫正率为91.3%~100%[(96.8±5.9)%],伤椎高度矫正丢失率为4.1%~8.2%[(7.6±2.4)%],Cobb角矫正率为83.6%~97.2%[(86.2±4.1)%]及Cobb角矫正丢失率为2.1%~6.7%[(5.8±3.4)%]。结论采用后路短节段椎弓根螺钉治疗胸腰椎爆裂性骨折时,伤椎置钉有利于恢复和维持伤椎高度、防止后凸畸形矫正及椎体高度丢失。     

伤椎固定在严重胸腰椎骨折中的应用

目的探讨在严重胸腰椎骨折中应用短节段椎弓根螺钉系统加伤椎固定的方法和效果。方法回顾了我院2003年5月-2008年1月,对严重胸腰椎骨折采用短节段椎弓根螺钉系统加伤椎固定方法治疗41例。术前骨折椎体前缘高度平均丢失53%（37%-82%）,Cobb角平均29.6°（17°-39°）,均在伤后2周内手术。结果所有病例均获得随访,平均随访时间9.7个月（6-29个月）。影像学资料显示伤椎前缘高度恢复至92%（87%-96%）,术后Cobb角平均为5.6°（3°-10°）,植骨均愈合、椎体脱位纠正,复位良好。结论对严重胸腰椎骨折应用伤椎椎弓根螺钉固定可以增强后路短节段内固定系统的牢固性,有利于维持矫正效果、减少后凸畸形。     

单椎间隙融合内固定术治疗胸腰椎骨折

目的：探讨单椎间融合内固定术治疗胸腰椎骨折的可行性及临床疗效观察。方法：回顾性分析2007年1月-2008年6月我科应用单椎间隙融合术治疗的24例胸腰椎骨折患者,比较手术前后椎管狭窄率,伤椎椎体高度降低、矢状面Cobb角、神经功能恢复等情况。结果：随访6～24个月,平均9．6个月,无内固定失败,椎间植骨融合良好。术后1w及术后末次随访,伤椎椎体高度降低、椎管狭窄率较术前均明显改善（P〈0．05）;术后末次随访与术后1w比较无显著性差异（P〉0．05）;术后9个月16例患者有不同程度的神经功能恢复。结论：采用单椎间隙融合内固定结合椎间骨治疗胸腰椎单椎体骨折创伤较小,固定节段少,能有效防止复位丢失,是治疗胸腰椎单椎体骨折的有效方法之一。     

经椎弓根植入生物人工材料骨诱导人工骨加内固定治疗骨质疏松性胸腰段骨折

目的 探讨经椎弓根植入生物人工材料(biological artificial material,BAM)骨诱导人工骨结合椎弓根螺钉内固定治疗骨质疏松性胸腰段骨折的临床疗效.方法 选择2005 -2010年收治的72例骨质疏松性胸腰段骨折患者.采用经椎弓根撬拨复位、BAM骨诱导人工骨植入、后路椎弓根螺钉内固定治疗.收集患者资料并进行随访,所有患者术前、术后以及随访期间行脊柱正、侧位X线片检查,测量伤椎椎体前后缘高度、胸腰段后凸Cobb角、前后椎体高度比.采用美国脊髓损伤协会(ASIA)分级评估神经功能恢复情况,视觉模拟评分(visual analog scale,VAS)评估腰背部疼痛.结果 患者随访12 -28个月,平均18.3个月.患者均获骨性愈合,未发生人工骨移植物排斥反应或内固定松动断裂等并发症,椎体高度及畸形矫正度无明显丧失.除2例Frankel A级患者神经功能无恢复外,其余患者神经功能明显改善.VAS由术前(8.4±2.5)分降至末次随访时的(2.2±1.6)分,患者腰背部疼痛明显缓解.结论 经椎弓根植骨内固定术是治疗骨质疏松性胸腰段骨折有效合理、简单易行的方法,植入的BAM骨诱导人工骨具备良好的生物学和力学性能.     

骨水泥强化椎弓根螺钉固定治疗骨质疏松性胸腰椎骨折的临床效果观察

目的 评价骨水泥强化椎弓根螺钉固定治疗骨质疏松性胸腰椎骨折的临床效果.方法 对2013年6月-2014年12月收治的53例骨质疏松性胸腰椎骨折患者进行骨水泥强化椎弓根螺钉固定治疗,所有患者术前骨密度检测T值均≤–2.5,术中均于伤椎邻近椎体注射1.5ml骨水泥强化椎弓根螺钉,术前和术后均给予抗骨质疏松治疗.观察和记录患者围术期基本情况及并发症发生情况.记录术前、术后1周和末次随访时患者疼痛视觉模拟评分(VAS)和神经功能情况(ASIA分级),测量术前、术后1周和末次随访时的伤椎前缘压缩率、伤椎后缘压缩率、椎管狭窄率和Cobb角.结果 53例患者均顺利完成手术,手术时间90~140min,出血量150~350ml;术中无神经损伤,无硬膜撕裂,无明显骨水泥渗漏和螺钉松动.所有患者均获随访,随访时间12~30个月.患者术后神经功能较术前有明显恢复.末次随访X线片及CT示椎体骨折均愈合,内固定位置良好,未见明显松动迹象,未见明显骨水泥渗漏.术后1周和末次随访时的VAS评分、伤椎前缘压缩率、伤椎后缘压缩率、椎管狭窄率、Cobb角与术前比较差异均有统计学意义(P<0.05),而术后1周与末次随访时比较差异均无统计学意义(P>0.05).结论 骨水泥强化椎弓根螺钉固定术能有效强化骨质疏松条件下内固定的初始稳定性,恢复骨折椎体的高度,减轻椎管内压迫,有利于后凸畸形的矫正和神经功能的恢复,并能很好地维持骨质疏松条件下内固定的远期稳定性和骨折椎体的高度,显著降低了远期螺钉松动和椎体塌陷的风险.     

伤椎置钉短节段固定治疗A型胸腰椎骨折的疗效评价

目的探讨经伤椎短节段固定治疗A型胸腰椎骨折疗效。方法回顾性分析2009年6月~2014年6月收治的A型(新AO分型)胸腰椎骨折患者共58例,所有患者手术方法均为麻醉下牵引推压复位后经伤椎短节段椎弓根螺钉固定。统计手术时间、术中出血量及术后引流量,评估患者术前与术后1周、术后3个月、1年随访时胸腰椎疼痛的视觉模拟评分(VAS)、椎体高度变化、椎间角矫正情况,利用SPSS14.0进行统计分析。结果 58例患者均获得1年的随访,平均18.2个月,手术时间平均92.3min,术中出血量平均251m L,术后引流量平均189m L,与术前比较,术后伤椎前缘高度明显增加,椎间角明显减小,VAS评分明显改善(P均0.05);术后1周、术后3个月、术后1年椎体前缘高度比较无统计学差异(P0.05)。结论经伤椎短节段置钉治疗A型胸腰椎骨折能有效重建椎体高度,且远期疗效确切,值得临床推广应用。     

经伤椎椎弓根椎体内植骨治疗胸腰椎骨折

目的探讨经椎弓根体内植骨治疗胸腰椎骨折的临床疗效。方法采用经椎弓根椎体内植骨,结合短节段椎弓根螺钉系统固定治疗胸腰椎骨折16例,以获得椎体前中柱的支撑。结果本组16例均获随访,术后椎体前后缘高度、脊柱生理曲度、神经功能恢复满意,无一例断钉现象。结论经椎弓根内固定结合伤椎椎体内植骨重建了椎体高度,增加了脊柱前中柱的稳定性,在减少迟发性腰背痛、Cobb角矫正度、内固定松动折断等并发症方面有明显效果。     

椎弓根钉固定硫酸钙人工骨椎体成形术治疗胸腰椎骨折

目的探讨椎弓根钉复位内固定结合注射用硫酸钙人工骨椎体成形术治疗胸腰椎骨折的经验。方法2005年10月—2007年6月对13例胸腰椎骨折患者应用后路短节段椎弓根钉复位内固定后,在C形臂X线透视下用注射型硫酸钙人工骨(CSC)经伤椎椎弓根行椎体成形术。所有患者于术前、术后行X线和CT检查,术后随访8~16个月,平均13个月。结果13例患者手术均获成功,无神经根损伤加重或出现新的神经压迫症状,术后12周左右人工骨基本吸收,无伤椎塌陷加重,无内固定失败病例。结论后路短节段椎弓根内固定结合注射用硫酸钙椎体成形术治疗胸腰椎爆裂骨折安全性高,能减少内固定失败及椎体高度丢失等并发症。     

Knee injury and Osteoarthritis Outcome Score (KOOS) - validation of a Swedish version

The Knee injury and Osteoarthritis Outcome Score (KOOS) is a self-administered instrument measuring outcome after knee injury at impairment, disability, and handicap level in five subscales. Reliability, validity, and responsiveness of a Swedish version was assessed in 142 patients who underwent arthroscopy because of injury to the menisci, anterior cruciate ligament, or cartilage of the knee. The clinimetric properties were found to be good and comparable to the American version of the KOOS. Comparison to the Short Form-36 and the Lysholm knee scoring scale revealed expected correlations and construct validity. Item by item, symptoms and functional limitations were compared between diagnostic groups. High responsiveness was found three months after arthroscopic partial meniscectomy for all subscales but Activities of Daily Living.     

The acutely limping child

Acute limping may be the result of multiple pathologies in children. The differential diagnosis varies based on the age of the child. Irrespective of age, the initial imaging work-up includes AP and frog leg radiographs of the pelvis and ultrasound; MRI may sometimes be helpful. In children less than 3 years, infections and trauma are most frequent. MRI is the imaging modality of choice when osteomyelitis is clinically suspected. Between the ages of 3 and 10 years, transient synovitis of the hip and Legg-Calvé-Perthes disease are main considerations but infection, inflammation and focal bony lesions are also considered. In children over 10 years, slipped capital femoral epiphysis also is considered.     

Do Balance Board Training Programs Reduce the Risk of Ankle Sprains in Athletes?

Introduction Ankle sprains are the most common musculo-skeletal injury that occurs in athletes,particularly in sports that require jumping and landing on one foot such as soccer,and basketball(1-4).These injuries often result in significant time loss from participation,long-term disability,and have a major impact on health care costs and resources(5-8).     

High Intensity Interval Training:New Insights

KEY POINTS ·High-intensity interval training(HIT)is characterized by repeated sessions of relatively brief，intermittent exercise.often performed with an“a11 out”effort or at an intensity close to that which elicits peak oxygen uptake(i.e.，≥90%of VO2 peak).     

Endovascular management of carotid-cavernous fistulas

Objective To investigate endovascular treatment of traumatic direct carotid-cavernous fistulas （CCF） and their complications such as pseudoaneurysms. Methods： Over a five-year period, 22 patients with traumatic direct CCFs were treated endovascularly in our institution. Thirteen patients were treated once with the result of CCF occluded, 8 twice and 1 three times. Treatment modalities included balloon occlusion of the CCF, sacrifice of the ipsilateral internal carotid artery with detachable balloon, coll embolization of the cavernous sinus and secondary pseudoaneurysms, and covered-stem management of the pseudoaneurysms. Results All the direct CCFs were successfully managed endovascularly. Four patients developed a pseudoaneurysm after the occlusion of the CCF with an incidence of pseudoaneurysm formation of 18.2% （4/22）. A total number of 8 patients experienced permanent occlusion of the ICA with a rate of ICA occlusion reaching 36.4% （8/22）. Followed up through telephone consultation from 6 months to 5 years, all did well with no recurrence of CCF symptoms and signs. Conclusion Traumatic direct CCFs can be successfully managed with endovascular means. The pseudoaneurysms secondary to the occlusion of the CCFs can be occluded with stent-assisted coiling and implantation of covered stents.     

Developmental validation of the PowerPlex(®) ESI 16 and PowerPlex(®) ESI 17 Systems: STR multiplexes for the new European standard

In response to the ENFSI and EDNAP groups’ call for new STR multiplexes for Europe, Promega^® developed a suite of four new DNA profiling kits. This paper describes the developmental validation study performed on the PowerPlex^® ESI 16 (European Standard Investigator 16) and the PowerPlex^® ESI 17 Systems. The PowerPlex^® ESI 16 System combines the 11 loci compatible with the UK National DNA Database^®, contained within the AmpFlSTR^® SGM Plus^® PCR Amplification Kit, with five additional loci: D2S441, D10S1248, D22S1045, D1S1656 and D12S391. The multiplex was designed to reduce the amplicon size of the loci found in the AmpFlSTR^® SGM Plus^® kit. This design facilitates increased robustness and amplification success for the loci used in the national DNA databases created in many countries, when analyzing degraded DNA samples. The PowerPlex^® ESI 17 System amplifies the same loci as the PowerPlex^® ESI 16 System, but with the addition of a primer pair for the SE33 locus. Tests were designed to address the developmental validation guidelines issued by the Scientific Working Group on DNA Analysis Methods (SWGDAM), and those of the DNA Advisory Board (DAB). Samples processed include DNA mixtures, PCR reactions spiked with inhibitors, a sensitivity series, and 306 United Kingdom donor samples to determine concordance with data generated with the AmpFlSTR^® SGM Plus^® kit. Allele frequencies from 242 white Caucasian samples collected in the United Kingdom are also presented. The PowerPlex^® ESI 16 and ESI 17 Systems are robust and sensitive tools, suitable for the analysis of forensic DNA samples. Full profiles were routinely observed with 62.5 pg of a fully heterozygous single source DNA template. This high level of sensitivity was found to impact on mixture analyses, where 54–86% of unique minor contributor alleles were routinely observed in a 1:19 mixture ratio. Improved sensitivity combined with the robustness afforded by smaller amplicons has substantially improved the quantity of data obtained from degraded samples, and the improved chemistry confers exceptional tolerance to high levels of laboratory prepared inhibitors.     

Prevalence and severity of hip and groin pain in sub‐elite male football: a cross‐sectional cohort study of 695 players

The purpose of this study was twofold: (a) to investigate the prevalence of hip and groin pain in sub‐elite male adult football in Denmark and (b) to explore the association between prevalence and duration of hip and groin pain in the previous season with the Copenhagen Hip and Groin Outcome Score (HAGOS) in the beginning of the new season. In total 695 respondents from 40 teams (Division 1–4) were included. Players completed in the beginning of the new season (July–Sept 2011) a self‐reported paper questionnaire on hip and/or groin pain during the previous season and HAGOS. In total 49% (95% CI: 45–52%) reported hip and/or groin pain during the previous season. Of these, 31% (95% CI: 26–36%) reported pain for >6 weeks. Players with the longest duration of pain during the previous season had the lowest HAGOS scores, when assessed at the beginning of the new season, P < 0.001. This study documents that half of sub‐elite male adult football players report pain in the hip and/or groin during a football season. The football players with the longest duration of pain in previous season displayed the lowest HAGOS scores in the beginning of the new season.     

Bronchial stump fistula :treatment with covered retrievable hinged metallic stents-preliminary clinical experience

Objective To evaluate the preliminaily clinical efficacy and retrievability of a retrievable hinged covered metallic stent in the treatment of the bronchial stump fistula （BSF）. Methods Between April 2003 and March 2005, 8 patients with bronchial stump fistula after pneumonectomy or lobectomy were treated with two types （A and B） of retrievable hinged covered metallic stents. Type A stent was placed in 6 patients and type B in 2 under fluoroscopic guidance. The stent was removed with a retrieval set when BSF was healed or complications occurred. Results Stent placement in the bronchial tree was technically successful in all patients, without procedure-related complications. Immediate closure of the BSF was achieved in all patients after the procedure. Stents were removed from all patients but one. Removal of the stents was difficult in two patients due to tissue hyperplasia. Patients were followed up for 6 - 21 months. Placement of the stents remained stable in all patients except one due to severe cough. Permanent closure of BSF was achieved in 7 （87.5%） of 8 patients. Conclusion Use of a retrievable hinged covered expandable metallic stent is a simple, safe, and effective procedure for closure of the BSF. Retrieval of the stent seems to be feasible. （J Intervent Radiol, 2007, 16： 253-257）