应用RF-Ⅱ型椎弓根螺钉系统整复椎间植骨治疗腰椎滑脱症

随着对腰椎滑脱认识的不断提高和椎弓根螺钉内固定技术的发展，腰椎滑脱症的手术疗效有了很大提高。我院自2000年1月～2005年12月应用RF-Ⅱ型椎弓根螺钉系统复位加自体骨椎体间植骨融合治疗腰椎滑脱症患者21例，疗效满意，报告如下。     

RF-Ⅱ型椎弓根螺钉系统复位内固定并后路椎体间植骨融合治疗腰椎滑脱

自1998年4月-2001年8月应用RF-Ⅱ型椎弓根螺钉系统复位内固定井后路腰椎体间植骨融合治疗腰椎滑脱24例．取得满意效果．报告如下。     

椎体间植骨结合RF系统治疗腰椎滑脱症

腰椎滑脱症是指腰椎前滑后形成的椎管狭窄，神经孔狭窄等病理变化，而引起的神经系统症状，分为真性滑脱和假性滑脱。自2001年12月～2002年6月，作者采用椎体间植骨结合RF系统治疗腰椎滑脱症30例，疗效满意，分析报告如下。     

RF-Ⅱ型椎弓根螺钉在腰椎滑脱中的应用

近１０年发展起来的椎弓根螺钉系统的应用使脊椎滑脱的平均复位率超过７５％〔１〕。我院自１９９３年开始应用ＲＦ－Ⅱ型椎弓根螺钉系统治疗腰椎滑脱，对术后获得１０个月至３年随访的４０例进行分析，优良率达９５％。临床资料本组男２４例，女１６例；年龄３４～７２岁...     

后路椎体间植骨同时椎弓根内固定治疗峡部裂腰椎滑脱

[目的]探讨后路椎体间自体植骨同时椎弓根内固定治疗Ⅰ～Ⅱ度峡部裂腰椎滑脱的疗效。[方法]采用腰椎后侧入路椎管减压、椎体间自体植骨融合同时椎弓根内固定，术后腰围固定3个月。[结果]43例患者术后随访6～30个月，椎体间骨性融合率为90．7％，临床疗效优良率为88．37％。[结论]椎体间自体植骨同时椎弓根内固定是治疗Ⅰ～Ⅱ度峡部裂腰椎滑脱症的理想手术方法。     

椎弓根螺钉固定并椎体间植骨治疗腰椎滑脱症

目的评价经后路椎弓根钉内固定并腰椎椎体间植骨融合术治疗腰椎滑脱的临床疗效。方法本组采用后路椎弓根螺钉将滑脱椎体提拉复位,椎板减压,自体髂骨椎间植骨融合治疗腰椎滑脱症38例。从滑脱复位结果、融合的成功率、术前术后进行视觉疼痛评分、弯腰功能评分以及并发症等方面进行评价。结果38例患者平均随访1年6个月。滑脱距离由术前（36．45±15．12）％恢复至术后的（8．24±4．11）％,（P〈0．05）。全部病例均获得融合,融合率100％。术前视觉疼痛评分和弯腰功能评分分别是（6．3±2．6）分和（23．6±15．4）分,术后随访时为（2．4±1．6）分（P〈0．01）和（48．2±19．2）分（P〈0．01）,38例患者中35例手术效果优良,优良率为92．11％。并发症共3例,1例术后出现脑脊液漏,2例术后出现单侧沿坐骨神经根性放射痛,术后2周症状消失,未出现椎弓根螺钉松动或断裂,无神经损伤等并发症。结论本组采用椎管减压,椎体复位,椎弓根钉内固定并自体髂骨椎间植骨融合治疗腰椎滑脱,具有复位率、融合率高,疗效确切的特点,减少了腰椎术后综合征的发生率。     

椎弓根螺钉内固定加椎体植骨治疗腰椎不稳

目的评价椎弓根螺钉内固定加椎体后外侧植骨融合在治疗腰椎不稳症的临床疗效。方法对65例腰椎不稳症患者通过椎弓根螺钉内固定加椎体后外侧植骨融合治疗，评价临床效果。结果术后随访24个月，65例患者原有的临床症状大部分消失，优良率达90．80%。57例达到骨性融合标准，融合率达87．7％，8例融合欠佳，但原症状明显改善，无1例断钉退钉现象。结论椎弓根螺钉内固定加椎体后外侧植骨融合，可使不稳节段达到即刻稳定，骨性融合率高，手术操作简单，临床疗效好，是治疗腰椎不稳症较好的方法。     

椎弓根螺钉复位内固定、椎间植骨融合治疗腰椎滑脱症

目的探讨椎弓根螺钉复位内固定、椎间植骨融合治疗腰椎滑脱症的疗效。方法对42例腰椎滑脱症患者采用椎弓根螺钉复位内固定、椎间植骨融合术,通过随访进行疗效评定。结果42例随访6-40个月,参照海涌等临床疗效评估标准：优23例,良14例,可5例。所有患者椎体间植骨均融合良好,复位无丢失。内固定未见松动、断裂。结论椎弓根螺钉复位内固定、椎间植骨融合术治疗腰椎滑脱症,临床效果满意,植骨融合率高,是一种治疗腰椎滑脱症较为理想的术式。     

后路自体椎间植骨结合RF-Ⅱ椎弓根螺钉系统治疗腰椎滑脱症

目的 探讨经后路自体椎间植骨及RF-Ⅱ椎弓根螺钉系统内固定治疗腰椎滑脱症的临床效果.方法 对32例腰椎滑脱症经后路椎管减压,采用RF-Ⅱ椎弓根螺钉系统进行复位固定,椎间植骨融合.结果 32例随访均超过12个月,优良率90.6%,6～12个月后复查X线均显示椎间骨性融合.结论 经后路手术采用RF-Ⅱ椎弓根螺钉系统能使腰椎滑脱得到较为确实的复位和固定,脊柱融合率高,临床效果满意.     

RF系统加椎体间和横突间植骨治疗腰椎滑脱症

目的：讨论手术治疗腰椎滑脱症的有效方法。方法：对17例病人采用Reduction Fixation(RF)系统加椎体间和横突间植骨的手术方法治疗。结果：全部病人随访6－48个月，17例病人结果均优良，结论：本术式是治疗腰椎滑脱症的有效方法。     

Combined Nonablative Rejuvenation Techniques

Background:. Nonablative technologies have been used for fine lines and improvement of skin texture without significant downtime. Nonablative technologies may also be used in combination.
Objective:. To present a brief review on nonablative technologies and discuss using nonablative procedures in combination and with other adjunctive therapies.
Materials and Methods. A review of the literature was done to identify combination nonablative studies. We also discuss our own experience in combining these procedures.
Results. Various nonablative technologies can be used together, often with better outcomes and fewer treatments.
Conclusion:. Nonablative and adjunctive treatments should be performed in combination to optimize the results. Much of the information in this publication is from personal experience and expresses the opinions of these authors while citing relevant literature and studies.     

Techniques for Reconstruction of Perialar and Perialar-Nasal Ala Combined Defects

BACKGROUND: The nasal ala and perialar areas involve junctions with the nose, cheeks, and lips. Following Mohs surgery, defects in this area often extend across one or more creases or folds, thus requiring repair of more than one reconstructive subunit. OBJECTIVE: Our goal is to present various reconstructive techniques required to obtain aesthetic results. METHODS: Defects and reconstructions will be illustrated to demonstrate techniques and results. Emphasis will be on selection of techniques and documentation of results. RESULTS: Examples include various flap procedures (advancement, rotation, pedicle, interpolation, transposition), full-thickness and composite grafting, second intention healing, and combinations thereof. CONCLUSIONS: Thoughtful application of the various techniques will help to maximally camouflage scars and avoid maneuvers which would result in bridging and/or blunting of creases and folds.     

Refined mapping of the renal failure RF-3 quantitative trait locus

Rf-3, a quantitative trait locus (QTL) on rat chromosome 3, affects the development of CKD in Fawn-Hooded Hypertensive (FHH) rats. This QTL spans 110 Mb and approximately 1400 genes; therefore, narrowing the position of this locus is necessary to elucidate potential candidate genes. Here, we used congenic models and comparative genomics to refine the Rf-3 candidate region. We generated congenic lines carrying smaller intervals (subcongenics) of the Rf-3 region and used these lines to reduce the Rf-3 candidate region by 94% (to 7.1 Mb). We used comparative genomics to identify QTL for both nephropathy and albuminuria in the syntenic region of this interval for both human and mouse. We also used the overlapping homologous regions to reduce the number of likely positional candidate genes to 13 known or predicted genes. By combining congenic models and cross-species studies, we narrowed the list of candidate genes to a level that we could sequence the whole interval to further identify the causative gene in future studies.     

腰椎滑移:以RF-Ⅱ型椎弓根螺钉复位固定的持骨力及相关因素研究

目的：分析以RF-Ⅱ型椎弓根螺钉系统复位固定滑移椎体后，在特定时间内该系统对病椎维持复位的稳定性，及影响该系统稳定性的相关因素。方法：回顾性研究自1995年4月～1999年12月间共86例，均采用RF-Ⅱ型椎弓根螺钉行复位固定术。根据融合部位不同分成两组：椎间植骨组和峡部植骨组。所有患者术后定期随访，通过标准X线片测量术前及术后各时点病椎滑移度数，并设定和量化4个相关因素即：术前滑移度数，螺钉植入准确度及术后初始滑移度数和术后活动量。经统计学处理后分析术后复位丢失与时间的关系，两组间的差别及与各相关因素的相关度。结果：术后6个月内复位有缓慢丢失倾向，但总体丢失率不大，且两组间无显著性差异，但丢失率与两因素(术后初始滑移度和螺钉植入准确率)的相关性在椎间植骨组要明显大于峡部植骨组。结论：(1)该系统具有较强持骨力；(2)植骨在6个月时初步达到骨性融合；(3)在椎间植骨组，更强调植入螺钉的准确度和病椎尽量复位。     

后路经关节螺钉联合Brook融合术治疗陈旧性齿状突骨折

目的 介绍一种后路内固定治疗陈旧性齿状突骨折的手术方式。方法 对8例陈旧性齿状突骨折采用后路C1，2经关节螺钉联合Brooks融合术治疗。结果 8例中7例共放置经关节螺钉14枚，1例因C2单侧椎板上缘劈裂仅行Brooks融合术，术中无椎动脉硬脊膜破裂和脊髓损伤等并发症。随访3～32个月，植骨全部融合。结论 后路经关节螺钉联合Brooks融合术是治疗陈旧性齿状突骨折的有效方法，可提供有效的固定和提高植骨融合率。     

RF-Ⅱ型系统内固定、椎体间植骨治疗腰椎滑脱24例体会

目的总结RF-Ⅱ型系统内固定、椎体间植骨治疗腰椎滑脱、恢复腰椎的生理曲度及增加脊柱稳定性的效果. 方法采用RF-Ⅱ型系统对24例腰椎滑脱并椎管狭窄患者行滑椎固定、椎管减压、椎体间植骨融合. 结果按照术后症状、功能改善综合评价标准,本组优14例,良9例,可1例,优良率为95.8%,椎体复位率100%,无神经根损伤、内固定松动及矫正丢失,椎体间融合良好. 结论 RF-Ⅱ型系统是治疗腰椎滑脱并椎管狭窄症的较好方法.     

Grading Facial Nerve Function Following Combined Static and Mimetic Surgical Techniques

Objective To present a grading scale to assess the functional recovery of the facial nerve in patients who have undergone mimetic and static surgical techniques for facial reanimation.Study design This is a proposed new facial nerve grading system that will be demonstrated with specific case presentations. All patients underwent a variety of neural grafting, microvascular free-flap reconstruction, or surgical static procedures.Results The proposed facial nerve grading scale is one that has not been described previously in the literature and is applicable to a unique patient population. Its ease of use in this patient population will allow otolaryngologists to assess facial recovery accurately and quickly in cases where the facial nerve is not anatomically intact.Conclusion The proposed facial recovery grading scale provides an efficient means of grading facial recovery for a unique group of patients who previously could not be followed. The proposed scale is practical and easy to use in a clinical setting.     

Single Stage Reconstruction of Complex Anterior Urethral Strictures: Combined Tissue Transfer Techniques

Purpose

Reconstruction of most urethral strictures is possible with anastomotic, graft or skin flap procedures alone. We describe the combination of tissue transfer techniques to preserve the urethral plate and reconstruct long and complex urethral strictures in 1 stage.

Materials and Methods

We reviewed the results in 25 patients who underwent anterior urethroplasty requiring more than 1 tissue transfer technique to achieve urethral reconstruction in 1 stage.

Results

Outcome was excellent in 22 patients (88%). Seven patients with pan-urethral strictures (mean length 19 cm.) required a fasciocutaneous flap combined with a buccal mucosa, bladder epithelium or skin graft. A total of 13 patients with focally dense strictures underwent excision of the most severe portion of the stricture with dorsal reapproximation, thereby improving the quality of the urethral plate and allowing simultaneous flap or graft onlay reconstruction. Five patients with multiple separate strictures required a distal onlay fasciocutaneous flap with excision and end-to-end anastomosis of a separate, more proximal stricture.

Conclusions

A thorough knowledge of the vascular supply of the urethra allowed creative application of different tissue transfer techniques, enabling 1-stage reconstruction of complex urethral strictures. An excellent outcome was achieved by preserving or revising the urethral plate and avoiding the problems associated with hair-bearing flaps and 2-stage procedures.     

A Ruptured Pancreaticoduodenal Artery Aneurysm Repaired by Combined Endovascular and Open Techniques

Aneurysms of the pancreaticoduodenal arteries (PDA) are rare, accounting for <2% of all visceral aneurysms. An association with celiac artery stenosis has been reported. Many present with rupture, and a high mortality can be expected. Treatment is therefore challenging. Arterial ligation, anuerysmectomy, or bypass has been the mainstay of treatment. We recently treated a patient (who had no celiac axis) with a ruptured PDA aneurysm with combined open and endovascular techniques. A 46-year-old man was transferred to our hospital with a 1-day history of abdominal pain and syncope. On admission, an abdominal and pelvis computerized tomographic (CT) scan identified a large mesenteric hematoma, a 1.9 cm PDA aneurysm, and an occluded celiac axis. Mesenteric angiography revealed no active aneurysm leak and a stenotic superior mesenteric artery (SMA) origin. All hepatic blood flow originated from the stenotic SMA via markedly enlarged PDA collaterals. The patient was brought to the operating room, where absence of the celiac axis was confirmed. An aorto-to-proper hepatic and SMA bypass was performed using a bifurcated polyester graft. The next day, the patient was brought to the angiography suite, where the PDA aneurysm was coiled. Postprocedure CT scans confirmed thrombosis of the aneurysm. Ruptured mesenteric artery aneurysms are a challenging problem for the vascular surgeon. PDA aneurysms are rare and often occur in an unfavorable location. There appears to be an association with anatomic anomalies of the mesenteric circulation. Prompt invasive and noninvasive diagnostic studies aid in the definitive management of this often fatal problem. Combined endovascular and open techniques can be used for successful treatment.     

RF-Ⅱ系统治疗腰椎滑脱症的远期疗效

目的:总结RF-Ⅱ系统治疗腰椎滑脱症术后的远期疗效。方法:对接受RF-Ⅱ系统治疗腰椎滑脱症3年以上的患者进行问卷调查及影像学检查,并就患者的疼痛、功能状况以及影像学检查结果进行分析。结果:56例患者获得3～9年（平均5年8个月）随访,按疼痛、体征和功能状况评价,优良率为92.8％,患者满意率为 67.8％。9.4％的椎弓根螺钉弯曲或折断,6.2％的钉杆角度减小,但均未出现复位丢失现象,仅有椎间隙高度和角度的不同程度改变。结论:应用RF-Ⅱ治疗腰椎滑脱症长期疗效肯定,维持复位好;椎间植骨融合可能是进一步减少远期并发症的重要方法。