颈前路植骨钢板内固定治疗创伤性枢椎滑脱

目的评价颈前路椎体间植骨钢板内固定治疗创伤性枢椎滑脱的临床效果。方法15例创伤性枢椎滑脱病人,行椎体复位、自体髂骨移植、颈前路钢板内固定。结果随访5～19个月,15例病人现均获得复位与骨融合,颈椎高度、生理曲度获得重建,活动良好,无并发症。结论颈前路复位、植骨钢板内固定是治疗创伤性枢椎滑脱的有效方法,尤其适用于枢椎椎体前缘骨折及椎体骨块突向椎管内、压迫脊髓神经者。     

颈前路植骨钢板内固定治疗创伤性枢椎前滑移

目的 评价C2、C3椎体间植骨、钢板内固定治疗创伤性枢椎前滑移的临床价值。方法 8例创伤性枢椎前滑移患行颈前路手术复位、椎间盘切除减压、自体髂骨植骨、钢板内固定术，平均随访1年，观察患术后颈椎生理高度、曲度重建和颈椎稳定性、运动情况。结果 8例患均获得完全的枢椎复位，C2、C3椎体在术后16周达到骨性融合，颈椎生理高度、曲度得以重建，旋转、屈伸功能良好，无钢板螺钉并发症。结论 颈前路钢板内固定是治疗创伤性枢椎前滑移的有效方法。     

脊柱

63例寰椎骨折诊治体会；颈前路植骨钢板内固定治疗创伤性枢椎滑脱；颈椎椎弓根钉在强直性脊柱炎颈椎骨折中的应用；金属框架固定行枕颈融合术的生物力学研究；Apofix椎板钩在齿状突骨折治疗中的应用。     

单节段创伤性下颈椎失稳征的前路植骨带锁钢板手术治疗

目的 观察并总结应用颈前路植骨融合加带锁钢板内固定手术，对24例单节段创伤性下颈椎失稳征的治疗效果。方法 应用颈前路减压植骨融合、带锁钢板内固定对24例单节段创伤性下颈椎失稳征患者进行手术治疗，病程2—52个月，平均10．3个月。平均随访14个月，依据Odom评分标准及截瘫指数ASIA评分进行手术效果评价。结果 应用Orion钢板7例，Zepllir钢板9例，AO钢板2例，Codman钢板6例。24例均获得骨性融合，术后椎间高度维持良好。总有效率91、7％，优良率83.3％。结论 经颈前路减压植骨带锁钢板内固定手术可获得即刻稳定，恢复并有效维持颈椎生理序列及椎间高度，各种颈前路带锁钢板治疗单节段创伤性下颈椎失稳征均可获得较高的移植骨融合率，临床效果满意。     

颈前路钢板联合聚醚醚酮椎间融合器治疗下颈椎创伤性滑脱的疗效观察

目的探讨和评价颈前路钢板联合聚醚醚酮椎间融合器治疗下颈椎创伤性滑脱的临床疗效。方法对22例下颈椎创伤性滑脱采用颈前路钢板联合聚醚醚酮椎间融合器治疗,术后随访观察手术椎节的稳定性、融合情况及神经功能改善情况。术前ASIA脊髓神经功能分级:C级15例,D级7例。结果随访6～18个月,手术节段稳定,术后4个月均获得骨性融合,术后ASIA脊髓神经功能分级:D级6例,E级16例。结论颈前路钢板联合聚醚醚酮椎间融合器治疗下颈椎创伤性滑脱,能够重建颈椎生理弯曲,有效维持椎间高度,获得即刻稳定,椎间植骨融合可靠,是治疗下颈椎创伤性滑脱的有效方法。     

前路钢板复合BMP2同种异体骨移植治疗无脊髓损伤型外伤性颈椎滑脱

目的 探讨颈前路减压、椎体间植骨支撑融合、钢板内固定术治疗无脊髓损伤型外伤性颈椎滑脱的手术方法 及疗效.方法 手术治疗50例无脊髓损伤型外伤性颈椎滑脱,采取复合BMP2同种异体骨移植支撑融合、钢板内固定术.结果 术后全部病例经随访观察,症状获得改善,加例完全恢复.植骨在3个月内牢固融合,术后6个月47例重返工作,3例残留手指麻木.颈椎椎间高度、生理曲度维持良好、无钢板、螺钉折断、滑脱等并发症.结论 颈前路减压、椎体间植骨融合、钢板内固定术治疗外伤性颈椎滑脱,临床疗效满意.植骨融合手术操作简单,钢板内固定术后颈椎即刻稳定,有助于早期功能锻炼,减少外固定时间,防止植骨块塌陷,保持椎问高度及颈椎的生理前曲,有利于提高手术远期效果.     

钢板螺钉内固定在枕颈融合中的应用

目的探讨钢板螺钉内固定在枕颈融合中应用的疗效。方法1999年3月-2003年7月，应用钢板螺钉内固定枕颈融合治疗难以复位的寰枢椎脱位并脊髓压迫11例，其中齿突陈旧性骨折并寰椎前脱位7例，齿突发育不良并寰椎后脱位4例。结果寰枢椎脱位获得不同程度的复位，脊髓压迫解除，神经功能明显改善，枕颈部3～5个月骨性融合。结论对于难以复位的寰枢椎脱位应用钢板螺钉内固定枕颈融合术，不但固定较牢固可靠、简便，有利于植骨融合，而且还有一定的复位作用。     

颈前路植骨融合钢板内固定术治疗不稳定Hangman骨折

目的：探讨颈前路植骨融合钢板内固定治疗不稳定Hangman骨折的疗效。方法：手术前常规行颅骨牵引,手术在颅骨牵引下进行,16例不稳定Hangman骨折均采用颈前路植骨融合钢板内固定治疗。结果：术后随访12～46个月,平均24个月。枢椎椎弓均获骨性愈合,无切口感染 无内固定松动、断裂,颈2～3椎间隙高度、颈椎生理曲度均恢复,颈椎活动无明显受限。结论：颈前路植骨融合钢板内固定治疗不稳定Hangman骨折具有固定确实、融合满意的优点,是治疗不稳定Hangman骨折的一种有效方法。     

上颈椎不稳前路内固定方式的选择

目的:探讨上颈椎不稳前路内固定手术方式的选择及治疗效果。方法:自2000年3月至2010年9月,采用寰枢椎前路内固定手术治疗上颈椎不稳83例,男59例,女24例;年龄20～68岁,平均42岁。其中齿状突螺钉内固定36例,寰枢椎前路经关节螺钉内固定16例,C2,3前路钢板内固定23例,齿状突螺钉联合寰枢椎经关节螺钉内固定5例,齿状突螺钉联合C2,3钢板内固定2例,寰枢椎经关节螺钉联合C2,3钢板内固定1例。结果:1例颈脊髓完全损伤患者,行寰枢椎经关节螺钉内固定,术后1个月死于肺部感染。其余病例获得随访,时间8个月～3年,平均15个月。无椎动脉及脊髓损伤,所有病例寰枢椎获得稳定。36例齿状突螺钉内固定及5例齿状突联合寰枢椎经关节螺钉内固定者,未植骨,齿状突骨性愈合。寰枢椎经关节螺钉内固定病例:1例并发肺部感染死亡;1例齿状突ⅡC型粉碎性骨折并寰枢关节前脱位,齿状突及植骨未骨性愈合,但寰枢关节纤维连接无不稳定表现;1例寰枢椎陈旧性前脱位Ⅰ期前路寰枢椎经关节螺钉内固定,Ⅱ期后路Brooks钢丝内固定后路植骨,寰枢椎骨性融合。其他病例均植骨并获骨性融合。结论:上颈椎不稳患者,根据不同的骨折及不稳类型,选择相应的前路内固定,可取得较好疗效。     

Orion钢板内固定治疗下颈椎骨折脱位

目的探讨颈前路Orion钢板治疗下颈椎骨折脱位的优点及疗效。方法对36例下颈椎骨折脱位的患者，其中交通事故伤16例，高处坠落伤10例，重物砸伤5例，摔伤5例。采用经前路伤椎椎体次全切除减压、复位、自体髂骨植骨及Orion钢板固定的方法进行手术治疗。结果术后全部病例经随访观察，大部分症状获得改善．植骨在3个月内牢固融合，11例恢复正常工作．13例生活自理。颈椎椎间高度、生理曲度维持良好，无钢板、螺钉折断、滑脱等并发症。结论对于下颈椎骨折脱位宜选用颈前路Orion钢板治疗，前路手术除可达减压、复位、恢复颈椎椎间高度和生理曲度外，更重要的是可重建颈椎即刻稳定性，防止继发性脊髓损伤。有利于神经功能恢复。     

Presenteeism and Absenteeism Before and After Total Hip and Knee Arthroplasty

BackgroundAbsenteeism is costly, yet evidence suggests that presenteeism—illness-related reduced productivity at work—is costlier. We quantified employed patients’ presenteeism and absenteeism before and after total joint arthroplasty (TJA).MethodsWe measured presenteeism (0-100 scale, 100 full performance) and absenteeism using the World Health Organization’s Health and Work Performance Questionnaire before and after TJA among a convenience sample of employed patients. We captured detailed information about employment and job characteristics and evaluated how and among whom presenteeism and absenteeism improved.ResultsIn total, 636 primary, unilateral TJA patients responded to an enrollment email, confirmed employment, and completed a preoperative survey (mean age: 62.1 years, 55.3% women). Full at-work performance was reported by 19.7%. Among 520 (81.8%) who responded to a 1-year follow-up, 473 (91.0%) were still employed, and 461 (88.7%) had resumed working. Among patients reporting at baseline and 1 year, average at-work performance improved from 80.7 to 89.4. A Wilcoxon signed-rank test indicated that postoperative performance was significantly higher than preoperative performance (P < .0001). The percentage of patients who reported full at-work performance increased from 20.9% to 36.8% (delta = 15.9%, 95% confidence interval = [10.0%, 21.9%], P < .0001). Presenteeism gains were concentrated among patients who reported declining work performance leading up to surgery. Average changes in absences were relatively small. Combined, the average monthly value lost by employers to presenteeism declined from 15.3% to 8.3% and to absenteeism from 16.9% to 15.5% (ie, mitigated loss of 8.4% of monthly value).ConclusionAmong employed patients before TJA, presenteeism and absenteeism were similarly costly. After, employed patients reported increased performance, concentrated among those with declining performance leading up to surgery.     

The German emergency and disaster medicine and management systemdhistory and present

As well for optimized emergency management in individual cases as for optimized mass medicine in disaster management, the principle of the medical doctors approaching the patient directly and timely, even close to the site of the incident, is a long-standing marker for quality of care and patient survival in Germany. Professional rescue and emergency forces, including medical services, are the “Golden Standard” of emergency management systems. Regulative laws, proper organization of resources, equipment, training and adequate delivery of medical measures are key factors in systematic approaches to manage emergencies and disasters alike and thus save lives. During disasters command, communication, coordination and cooperation are essential to cope with extreme situations, even more so in a globalized world. In this article, we describe the major historical milestones, the current state of the German system in emergency and disaster management and its integration into the broader European approach.     

Differences in Osteocyte Density and Bone Histomorphometry Between Men and Women and Between Healthy and Osteoporotic Subjects

Bone defects related to osteoporosis develop with increasing age and differ between males and females. It is currently thought that the bone remodeling process is supervised by osteocytes in a strain-dependent manner. We have shown an altered response of osteocytes from osteoporotic patients to mechanical loading, and osteocyte density is reduced in osteoporotic patients, which might relate to imperfect bone remodeling, leading to lack of bone mass and strength. Hence, information on osteocyte density will contribute to a better understanding of bone biology in males and females and to the assessment of osteoporosis. Osteocyte density as well as conventional histomorphometric parameters of trabecular bone were determined in cancellous iliac crest bone of healthy postmenopausal women and men and of osteoporotic women and men. Osteocyte density was higher in healthy females than in healthy males and lower in osteoporotic females than in healthy females. Bone mass was reduced in osteoporotic patients, both male and female. In females, trabecular number was reduced, whereas in males, trabecular thickness was reduced and eroded surface was increased. There were no correlations between the parameter groups bone architecture, bone formation, bone resorption, and osteocyte density. These results are consistent with impaired osteoblast function in osteoporotic patients and with a different mechanism of bone loss between men and women, in which osteocyte density might play a role. The reduced osteocyte numbers in female osteoporotic patients might relate to imperfect bone remodeling leading to lack of bone mass and strength. M. G. Mullender and S. D. Tan contributed equally to this work.     

肝内胆管囊腺瘤和囊腺癌的CT、MRI及病理表现

目的探讨肝内胆管囊腺瘤和囊腺癌的CT、MRI和病理特点。方法回顾性分析经手术病理证实的6例肝内胆管囊腺瘤和2例肝内胆管囊腺癌的影像及临床病理资料，将病变的影像表现与其病理大体形态及组织学表现作对照分析。结果6例肝内胆管囊腺瘤，女4例、男2例；2例肝内胆管囊腺癌均为女性病人；8例病人平均年龄55岁。所有病灶均表现为多房囊性肿块，肿瘤囊腔各分房内常为多种液体成分，在CT上可表现为不同密度、在MRI上可表现为不同信号强度。囊内出现多发大小不等的壁结节在胆管囊腺癌内更常见，囊内有分隔但无壁结节只见于胆管囊腺瘤。在7例CT扫描中，4例胆管囊腺瘤和1例胆管囊腺癌可见囊壁或分隔上钙化，囊壁、囊内分隔及囊内结节均为轻、中度延迟增强。肿瘤中出现卵巢样间质见于3例胆管囊腺瘤和1例胆管囊腺癌，且均为女性病人。结论肝内胆管囊腺瘤和囊腺癌是肝脏不常见的囊性肿瘤，影像上多房、囊内有分隔且各分房囊内密度或信号不一致，高度提示肝内胆管囊腺瘤或囊腺癌的诊断，如囊内伴有多发大小不等的结节，则进一步提示囊腺癌的可能。但影像学表现不能区分肿瘤中有无卵巢样间质。