Iso-C 3D导航系统下椎弓根钉内固定治疗颈椎骨折脱位

[目的]探讨在Iso-C 3D导航系统下行椎弓根螺钉内固定治疗颈椎骨折、脱位的临床意义。[方法]在Iso-C 3D导航系统下,应用椎弓根螺钉内固定治疗颈椎骨折、脱位共31例,观察临床疗效及置钉的准确性。[结果]本组31例中,共置入136枚椎弓根螺钉。术后X线片显示,颈椎骨折脱位复位均满意,颈椎生理曲度恢复良好。术后CT显示,136枚椎弓根螺钉中,有6枚螺钉穿破椎弓根,穿透皮质率4.4%,但均未造成脊髓、神经、血管压迫等。经随访,X线显示所有病例融合区均骨性愈合,无1例出现断钉及内置物松动现象。合并脊髓损伤的患者,术后神经功能均有不同程度的恢复。[结论]椎弓根螺钉技术稳定性良好,具有优越的生物力学性能,为颈椎骨折脱位行后路内固定提供了一种安全有效的方法,在Iso-C 3D导航下行颈椎椎弓根螺钉内固定手术,能显著提高椎弓根螺钉置入的准确性和安全性。     

应用TSRH椎弓根钉系统治疗腰椎不稳症

目的：评价ＴＳＲＨ椎弓根钉系统在治疗腰椎不稳症中效果。方法：对２１例腰椎不稳症患者行ＴＳＲＨ椎根钉系统内固定手术,术后随诊分析。结果：２１例获平均２０．９个月的随访,植骨晤率为９５．２％,疗效满意。结论：ＴＳＲＨ椎弓根钉系统简单、固定牢靠,适用于腰椎不稳症的手术治疗。     

椎弓根钉结合椎体成形术治疗椎体压缩性骨折

目的 采用后路椎弓根钉内固定,结合碳酸化羟基磷灰石水泥椎体成形术治疗椎体压缩性骨折,并在围手术期内对该手术方法及安全性进行观察研究.方法 自2003年10月-2005年12月对37例椎体压缩性骨折采用后路椎弓根钉内固定 碳酸化羟基磷灰石水泥椎体成形术.术中通过短节段椎弓根钉复位撑开骨折椎体,经病椎的椎弓根利用注射器将碳酸化羟基磷灰石水泥注入撑开的病椎中前柱,观察其治疗效果.结果 所有患者均获得随访,随访时间8～23 个月,所有患者术后均无神经症状或原有神经症状加剧,无肺栓塞等发生,伤口均一期愈合;所有患者椎体内植入碳酸化羟基磷灰石水泥后无排斥反应,无一例远期内固定失败.结论 经椎弓根后路内固定结合椎体成形术是一种有效的治疗椎体压缩性骨折的方法,尤其能有效防止金属内固定的失败.     

经伤椎椎弓根螺钉治疗胸腰椎骨折

2007年8月～2010年8月,我们对45例胸腰椎骨折患者行伤椎椎弓根螺钉内固定的治疗,经12～24个月随访,椎体的高度及后凸畸形矫正满意,效果良好。1材料与方法1.1病例资料本组45例,男38例,女7例,年龄21～65(45.8±7.8)岁。T104例,T115例,T122例,L115例,L210     

骨质疏松患者脊柱内固定技术的进展

近年来骨质疏松性脊柱内固定技术研究有了新的进展,椎弓根螺钉强化技术是目前临床上提高螺钉稳定性的主要技术之一。椎弓根螺钉设计研究热点从螺钉的长度、大小与把持力相关性研究逐渐转向设计更佳螺钉形态并与骨水泥强化技术相结合的研究;脊柱融合理念及技术措施都是更加强调脊柱的整体平衡;临床上攻丝是否能提高椎弓根螺钉的旋入扭矩和把持力仍有争论。该文就骨质疏松患者脊柱内固定技术的进展进行综述。     

经伤椎置钉单节段椎弓根钉治疗胸腰段骨折

目的探讨经伤椎置钉单节段椎弓根钉治疗胸腰椎骨折的适应症及临床疗效。方法 2008年7月至2010年7月,对14例胸腰椎骨折采用后路单节段伤椎椎弓根螺钉内固定、经伤椎植骨融合。经过5～29（平均16.8）个月随访,随访内容有术前后VAS疼痛评分、神经功能ASIA评分、术前、术后随访时椎体的高度、伤椎的后凸畸形,内固定物的状况。结果所有患者均得到随访,术后VAS疼痛分级平均0-1分,其中0分8人,1分6人,无需服药治疗。神经功能均恢复至正常;X线检查术后椎体高度恢复满意,术后伤椎高度恢复了96%,随访椎体高度丢失0.4mm,丢失率为1.4%。无内固定物断裂、松动、脱出,所有病例均获得骨性融合,无假关节形成。结论选择好适应证,后路单节段伤椎内固定是治疗胸腰段骨折的有效方法之一。     

O型臂导航系统辅助胸椎椎弓根螺钉置入的准确性及学习曲线

目的:探究应用O型臂导航系统辅助胸椎椎弓根螺钉置入的准确性及其学习曲线.方法:回顾性分析2015年5月～2018年5月我院行胸椎内固定手术的患者临床资料109例,其中男性49例,女性60例,年龄53.5±12.3岁(27～77岁).根据是否使用O型臂导航系统辅助置钉分为导航组(A组,n=66)和非导航组(B组,n=43...     

Role of early minimal-invasive spine fixation in acute thoracic and lumbar spine trauma

Polytraumatized patients following a severe trauma suffer from substantial disturbances of the immune system. Secondary organ dysfunction syndromes due to early hyperinflammation and late immunparalysis contribute to adverse outcome. Consequently the principle of damage control surgery / orthopedics developed in the last two decades to limit secondary iatrogenic insult in these patients. New percutaneous internal fixators provide implants for a damage control approach of spinal trauma in polytraumatized patients. The goal of this study is to evaluate the feasibility of minimal-invasive instrumentation in the setting of minor and major trauma and to discuss the potential benefits and drawbacks of this procedure.

Materials and Methods:

The present study is a prospective analysis of 76 consecutive patients (mean age 53.3 years) with thoracolumbar spine fractures following major or minor trauma from August 2003 to January 2007 who were subjected to minimal-invasive dorsal instrumentation using CD Horizon^® Sextant™ Rod Insertion System and Longitude™ Rod Insertion System (Medtronic^® Sofamor Danek). Perioperative and postoperative outcome measures including e.g. local and systemic complications were assessed and discussed.

Results:

Forty-nine patients (64.5%) suffered from minor trauma (Injury Severity Score <16). Polytraumatized patients (n=27; 35.5%) had associated chest (n=20) and traumatic brain injuries (n=22). For mono- and bisegmental dorsal instrumentation the Sextant™ was used in 60 patients, whereas in 16 longer ranging instrumentations the (prototype) Longitude™ system was implanted. Operation time was substantially lower than in conventional approach at minimum 22.5 min for Sextant and 36.2 min for Longitude™, respectively. Geriatric patients with high perioperative risk according to ASA classification benefited from the less invasive approach and lack of approach-related complications including no substantial blood loss.

Conclusion:

Low rate of approach-related complications in association with short operation time and virtually no blood loss is beneficial in the setting of polytraumatized patients regarding damage control orthopedics, as well as in geriatric patients with high perioperative risk. The minimal-invasive instrumentation of the spine is associated with beneficial outcome in a selected patient population.     

胸腰椎经皮椎弓根螺钉置钉的准确性分析

目的:分析胸腰椎经皮椎弓根螺钉固定术的置钉准确性.方法:回顾分析2010年7月～2012年12月我院53例胸腰椎经皮椎弓根螺钉固定术患者,男31例,女22例;年龄18～73岁,平均51.2岁.腰椎退变性疾病24例,胸腰椎骨折29例.置钉节段为T8～S1.根据术后CT轴位扫描图像以及患者是否出现椎弓根螺钉相关并发症,将椎弓根螺钉位置分级:0级,螺钉位于椎弓根皮质内;1级,螺钉突破椎弓根骨壁但≤2mm;2级,螺钉突破椎弓根骨壁＞2mm,但无神经受压等症状;3级,出现螺钉相关并发症.结果:共置入椎弓根螺钉212枚,平均4.0枚/例.212枚螺钉中,0级175枚(82.5％);1级32枚(15.1％);2级4枚(1.9％);3级1枚(0.5％),患者出现神经受压症状,行翻修术.37枚位置不佳的螺钉中,24枚向内侧切出椎弓根,13枚向外侧切出.结论:胸腰椎经皮椎弓根螺钉固定技术虽置钉位置欠佳率较高,但很少发生2级以上置钉位置不佳者.     

A review of paediatric cervical spinal trauma

Significant spinal trauma in the paediatric population is uncommon. Cervical spine injuries account for approximately 1.5% of injuries. In paediatric patients a far higher proportion of injuries that affect the spinal column occur in the cervical spine in comparison with adults. The assessment of paediatric spinal injuries and radiographs can be challenging even for experts. This is due to a combination of the evolving osseous anatomy and the increase in ligamentous injury. This article looks at the initial assessment and management of injuries. It also presents some of the common radiographic measurements which can be used to assess spinal injuries, paediatric specific injuries of the spine and common variants confused with fractures.     

椎弓根钉辅助下后外侧融合在退变性腰椎管狭窄症手术中的应用

目的探讨退行性腰椎管狭窄症(degenerativelumbarspinestenosisDLSS)的特点、椎弓根钉辅助下的后外侧融合手术要点及其在退变性腰椎管狭窄症减压术中的作用和意义。方法回顾性分析2000年1月～2003年12月间59例腰椎管狭窄症患者的临床症状、椎管减压和椎弓根钉辅助下的后外侧植骨融合的手术和术后随访情况,手术结果通过问卷式调查由患者进行自我评价,评价内容分为:腰痛、腿痛、日常活动水平、是否服用止痛药物四个方面进行。结果59例患者随访6～48个月,平均22.5个月,8例患者1年后失访。其中治疗效果优21例(35.6%),良32例(54.2%),可4例(6.8%),差2例(3.4%)。术中术后的并发症主要有:神经根损伤、硬膜囊撕裂、FBSS(FailedBackSurgerySyndrome)、ASD(AdjacentSegmentDisease)、椎弓根钉断裂等。结论DLSS包括多部位狭窄性病理改变,术中减压应当按照一定的步骤全面减压。椎弓根钉辅助后外侧融合可以提供腰椎即刻稳定,提高了远期融合率,使得滑脱椎体复位并保持椎间高度,减少椎管狭窄的进展和再发,从而提高手术的治疗效果。     

IsoC-3D实时定位导航系统引导植入腰椎椎弓根螺钉34例

目的:探讨IsoC-3D实时定位导航系统在腰椎椎弓根螺钉植入手术过程中的应用.方法:对腰椎滑脱、腰椎失稳、脊柱侧弯、腰椎骨折共34例在IsoC-3D实时定位导航系统引导下完成椎弓根螺钉的植入,共植入椎弓根螺钉132枚,术后进行X线平片及CT扫描掌握螺钉的方向和位置.结果:132枚椎弓根螺钉均未穿破椎弓根,椎弓根螺钉的方向、深度、位置均相当理想,全部病例无硬膜、神经根损伤.结论:IsoC-3D实时定位导航系统可以准确引导腰椎椎弓根螺钉的植入,避免椎弓根螺钉植入相关的并发症.     

快速成型导航模板在脊柱外科的应用研究

脊柱外科常规的影像检查常难以清楚地观察病变局部,最常用的徒手置钉法术中并发症风险高,手术时间长,且术中透视量大。快速成型导航模板为椎弓根螺钉的置入提供了新的方法,使复杂手术简单化,提高置钉准确性,保证手术快速安全。现介绍快速成型导航模板的原理及制作过程,综述其在颈椎、胸椎、腰椎及复杂脊柱畸形手术方面的研究进展,总结不足并展望其应用前景。     

颈椎外伤前路手术中体感诱发电位监护应用

目的探讨体感诱发电位(somatosensory evoked potential,SSEP)在颈椎外伤前路手术中的作用。方法 2008-07-2015-02收治颈椎外伤前路手术患者53例,年龄16~69岁,男44例,女9例。对照组(33例)无SSEP监护,监护组20例。在麻醉诱导后摆放体位前确立SSEP基线,波幅降低50%或潜伏期延长10%为报警标准。记录SSEP报警因素、改善措施及有无医源性神经损伤。计算SSEP监护神经损伤的敏感性和特异性。结果 53例病人术后未出现新的神经损伤。SSEP监护颈椎外伤前路手术中神经损伤的敏感性和特异性为100%。结论在颈椎外伤前路手术中SSEP监护医源性神经损伤是有意义的。     

Indications for surgery in upper cervical spine injury

20% of all spine injuries are cervical spine injuries. Surgical treatment of these injuries must take into account the great mobility of this part of the spinal column. Therefore, biomechanical aspects must be considered, especially in the upper cervical spine — C1 and C2. Describing our own therapeutical regimen in 35 patients with unstable upper cervical spine injuries we explain the biomechanical background and review the literature. It becomes evident that ventral approaches are superior to dorsal techniques for decompression, reposition, and stabilization with minimal loss of mobility.     

Endoscopic treatment of spinal trauma at the thoracolumbar junction

Attempts of treating unstable fractures of the thoracolumbar junction by posterior reduction and fixation alone often result in a significant loss of correction, especially in lesions where a severe destruction of the vertebral body and the intervertebral disc is present. The conventional open approaches like classic thoraco-phreno-lumbotomy produces additional iatrogenic trauma at the lateral chest and abdominal wall which not rarely leads to intercostal neuralgia, as well as post-thoracotomy syndromes. The endoscopic trans-diaphragmatic approach described below opens up the whole thoracolumbar junction to a minimally invasive procedure allowing one to perform all the procedures needed for a full reconstruction of the anterior column of the spine like corpectomy, decompression, vertebral body replacement and anterior plating. The key to address also the subdiaphragmal and retroperitoneal section of the thoracolumbar junction is a partial detachment of the diaphragm which runs along the attachment at the spine and the ribs. The technique was published first in 1998 and has been used now in 650 endoscopic procedures at the thoracolumbar junction out of a total of more than 1300 thoracoscopic operations of the spine in the BG Unfallklinik Murnau, Germany since 1996.     

基于影像归档和通信系统的下颈椎椎管旁螺钉相关参数三维测量及可行性研究

目的 应用影像归档和通信系统测量下颈椎椎管旁螺钉（paravertebral foramen screw, PVFS）相关参数并探讨其可行性。方法 按时间先后选取2016年12月至2017年12月因颈椎退变或外伤于我院行颈椎手术的病人100例,收集上传至PACS的颈椎三维CT数据,分别测量C₃~C₆侧块螺钉和椎管旁螺钉的钉道长度,并进行比较分析。结果 C₃~C₆椎管旁螺钉10°和15°误差范围内的安全钉道长度分别为（12.54±1.16） mm、（11.76±1.11） mm,而侧块螺钉的钉道长度和有效钉道长度分别为（14.58±1.20） mm、（12.83±1.21） mm。对于C₃~C₆椎体,椎管旁螺钉10°、15°误差范围内的钉道长度与侧块螺钉的钉道长度相比,差异均有统计学意义（P均＜0.05）,但是与侧块螺钉的有效钉道长度是接近的。结论 下颈椎椎管旁螺钉安全固定长度可等同于侧块螺钉固定有效长度,且其方法安全合理,基于影像学角度探究而言,下颈椎椎管旁螺钉具有临床应用的可行性。