颈椎单侧关节突交锁的治疗选择

目的 探讨颈椎单侧关节突交锁的不同治疗方法选择.方法 32例颈椎单侧关节突交锁,行头颅牵引复位成功8例,其中3例维持牵引1个月后改行头颈胸石膏固定,余5例行前路减压植骨融合内固定术.23例牵引失败,其中14例行前路切开复位、椎间盘切除植骨融合内固定术;3例前路复位失败行椎间盘切除加椎体次全切除减压植骨内固定术,1例前路复位失败改行后路切开复位后再前方植骨内固定术;3例行后路切开复位侧块内固定植骨融合术,2例行后路切开复位减压、前路椎间盘切除减压植骨内固定术.1例由于漏诊,伤后8个月行前路减压植骨融合术.结果 平均随访18个月.发现颈椎不稳2例,均为仅行牵引复位,未做融合术者.颈前路手术者植骨块术后12周均获骨性融合.颈椎生理曲度及椎间隙高度恢复较好.无内固定并发症,亦无治疗中神经并发症.结论 下颈椎单侧关节突交锁的治疗需要综合考虑多方面的因素,包括是否伴有椎间盘损伤、是否合并后柱骨折、脊髓压迫及损伤情况.对伴有创伤性颈椎间盘突出的单侧关节突交锁者,前路减压复位稳定术是首选方法,对于不伴椎间盘突出者,可试行牵引复位或直接后路切开复位固定.     

下颈椎骨折脱位并关节突交锁的手术方式选择

目的 探讨下颈椎骨折脱位伴关节突交锁的手术方式选择.方法 对68例下颈椎骨折脱位合并关节突交锁患者的临床资料进行回顾性分析.其中单侧小关节脱位33例,双侧小关节脱位35例.美国脊髓损伤协会(ASIA)评分:A级5例,B级11例,C级9例,D级10例.所有患者均于术前行颅骨牵引,关节突交锁复位的则行前路减压植骨融合内固定术治疗;否则行后路切开撬拨复位或关节突切除复位固定、前路植骨融合内固定术.结果 术中均无大血管、气管、食管、脊髓意外损伤.平均随访41.5个月,所有患者均复位良好,颈椎椎间高度和生理曲度维持良好,术后6个月后植骨全部融合,无钢板螺钉并发症.不完全性脊髓损伤患者术后神经功能均有一定恢复.结论 手术治疗下颈椎骨折脱位并关节突交锁疗效确切,根据损伤的具体类型采用适合的手术方式是手术成功的关键.     

经关节突螺钉固定治疗下颈椎脱位

目的评价经关节突螺钉技术治疗下颈椎脱位的效果。方法治疗颈椎骨折脱位患者54例,后路使用经关节突螺钉固定,前路减压植骨钢板固定。螺钉入钉点位于上位节段侧块背面中心点偏内上方,向外下方钻孔,外倾25°~30°,下倾30°~40°。钻透上下关节突,拧入3.5 mm钛合金皮质骨螺钉,螺钉长度16~20 mm。小关节间植骨融合。结果随访14~24个月,平均18.8个月。颈椎弧度无丢失,无螺钉松动及神经血管并发症,小关节间植骨全部愈合。结论下颈椎经关节突螺钉安全性好,螺钉抗拔出强度佳,固定确实,固定节段少,植骨融合率高;使用范围广,可用于C6/7节段。但建议结合钢板使用,小关节间隙必须植骨。     

后-前路联合手术治疗下颈椎骨折脱位伴关节突交锁

目的探讨经后-前路联合手术治疗下颈椎骨折脱位、关节突交锁伴不全四肢瘫的疗效。方法44例下颈椎骨折脱位、关节突交锁伴不全四肢瘫患者,先侧卧位局部麻醉,经后正中切口暴露脱位节段的上椎板上缘至下椎板下缘,采用撬拨复位技术解除关节突的交锁;复位后可做两节段的侧块螺钉固定或棘突问钛线缆、钢丝固定(Stauffer法);然后变换体位为仰卧位,全身麻醉下经颈椎前路清除脱位椎间的椎间盘、上下终板,常规髂骨块植骨融合、钢板内固定。结果无围手术期死亡,无切口感染、喉返神经麻痹、内固定相关并发症,伤口均I/甲愈合。术后X线片示所有患者的脱位均完全矫正,无残留小关节半脱位和后凸畸形;未出现脊髓和(或)神经损伤加重者;术后14 d时改良Frankel分级明显改善。结论采用局部麻醉下后路切开复位固定再前路联合手术治疗下颈椎骨折脱位、关节突交锁伴不全四肢瘫是一种安全有效的方法,其优点为时间短、创伤小等。     

“坐立式”Ⅰ期前后联合入路颈椎三维重建术治疗颈椎骨折脱位一例

颈椎骨折脱位由于外伤导致颈椎序列异常、不稳,多伴有颈脊髓损伤.治疗原则是通过牵引复位或手术恢复颈椎正常序列、解除脊髓压迫并重建颈椎的稳定性.手术方式国内外尚无统一标准,一般依据具体损伤情况和术前牵引复位情况选择单纯前路、单纯后路或前后联合入路手术[1].对伴有颈椎后侧关节突关节骨折、绞锁,特别是单侧关节突关节绞锁,牵引复位尤其困难.因此,为了达到解剖复位目的,且最大限度保护脊髓功能免受损害,对于难复性颈椎骨折脱位,常需前路、后路、再前路序贯手术,术中必须多次变换患者体位,不仅增加了手术时间及手术难度,且前路与后路手术之间无协同作用,不利于复位,前后路所用内固定器械之间还可能相互产生影响.     

三种不同下颈椎后路内固定螺钉置入法安全性评价

笔者评价不同置钉方法的准确性及安全性。材料与方法　 (1)标本制备 :5具新鲜颈椎尸体标本截取Ｃ2 ～Ｃ7节段 ,剔除肌肉 ,保留骨、关节及韧带组织和关节囊 ,术前每个颈椎标本均摄正、侧、斜位Ｘ线片 ,并行ＣＴ扫描。 (2 )手术方法 :①侧块螺钉Ｍａｇｅｒｌ法 :进钉点位于侧块后壁中点内上方 ,外倾 30°、平行上关节面钻孔 ,钻透对侧皮质 ,测深后再拧入 3.5ｍｍ皮质骨螺钉。②自行设计螺钉置入法 :进钉点位于侧块后壁外下缘 ,头倾40°、内倾 40°～ 5 0°钻孔 ,钻至侧块与椎弓根交界处 ,测深后拧入 3 .5ｍｍ皮质骨螺钉。③椎弓根螺钉置入法 :…     

颈椎单侧关节突交锁损伤机制与临床诊治

目的 研究颈椎单侧关节突交锁的损伤机制及临床诊治。方法 两具新鲜成人颈椎标本,采用ＣＭＴ４１０４型电子多功能试验机,分别在侧屈旋转和前屈旋转载荷下模拟颈椎小关节突交锁。并对１１例颈椎单侧关节突交锁患者的诊治情况进行分析。结果 颈椎在侧屈１１７０Ｎ、扭转１５０Ｎ,前屈２０００Ｎ、扭转１２０Ｎ的载荷下均可导致单侧小关节突交锁。但前者比后者容易发生,所需的暴力较小,伴随的损伤较轻。１１例患者中,误诊２     

前路手术治疗颈椎骨折、脱位并关节突交锁

颈椎骨折、脱位并关节突交锁在严重颈椎损伤中经常发生,因损伤严重及复位困难易致颈椎不稳和颈髓损伤,对患者造成极大痛苦.但颈椎骨折,脱位并关节突交锁是否应早期手术治疗及采取何种手术方式尚有争论.笔者自1999年1月至2006年12月对我院收治的35例颈椎骨折、脱位并关节突交锁患者进行早期前路手术治疗,疗效满意.现报告如下.     

基于CT二维图像的分类复位手术治疗下颈椎单节段关节突脱位

目的探讨基于CT二维图像的分类复位手术治疗下颈椎单节段关节突脱位的疗效。方法采用回顾性病例系列研究分析2015年1月至2022年10月郑州市骨科医院收治的105例下颈椎单节段关节突脱位患者临床资料, 其中男63例, 女42例;年龄22～78岁[(47.5±3.6)岁]。术前美国脊髓损伤协会(ASIA)分级:A级23例, B级45例, C级22例, D级15例, E级0例。基于CT二维图像, 根据下颈椎前后结构是否连续, 后方关节突有无活动进行手术入路分类。下颈椎前后结构连续及后方关节突可活动, 行颈椎前路手术;下颈椎前后结构连续性中断或后方关节突融合, 行后路关节突切除术加颈椎前路手术。根据上关节突下角的位置对关节突脱位进行分型, 并选择相应的复位技术:A型位于背侧, 给予颅骨牵引或手法复位;B型位于顶端, 给予颅骨牵引加撬拨复位;C型位于腹侧, 给予颅骨牵引加撬拨助推复位。如果同1例患者的两个关节突脱位存在不同类型, 按照C型>B型>A型的原则优先处理。记录关节突复位成功率、手术时间、术中出血量。比较术前、术后3个月及末次随访时颈椎椎间隙高度和Cobb角以评估颈椎生理曲度...     

寰椎侧块置钉安全区域的建立及其应用

目的利用寰枢椎影像学测量建立寰椎侧块螺钉进钉安全区域并指导手术操作。方法30例形态正常的寰枢椎行CT薄层扫描和三维重建,置钉空间(SAS)定义为CT横断面上横突孔内缘切线与椎管切线这两条平行线间的距离,测量0°、10°内倾角的置钉空间值(分别为SAS1、SAS2)及置钉区域；CT测量13例患者术后的置钉位置。结果内倾0°时SAS1为(7．81±1．28)mm,内倾10°时SAS2则为(9．69±1．23)mm,两者差异有统计学意义(P＜0．01)；SAS1寰椎椎弓根中线至后正中线的距离与枢椎下关节突中线至后正中线的距离差异无统计学意义；当内倾角为10°时,SAS2中线在后弓的位点移至SAS1寰椎椎弓根中线位点外侧约2．0 mm处。13例患者共26枚寰椎侧块螺钉均准确置入,未穿破骨皮质、突入椎管内或损伤血管神经。结论寰椎侧块螺钉置钉存在安全区域,内倾10°时可以获得更宽的置钉空间。实施寰椎侧块螺钉固定术之前,需要对寰椎横断面CT图像等进行测量,确定置钉的安全区域。     

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.     

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.     

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).     

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.