椎板减压与非椎板减压椎弓根螺钉间接复位治疗胸腰椎爆裂性骨折的疗效分析

[目的]探讨利用椎弓根螺钉复位椎板减压与非减压2种方法治疗胸腰椎爆裂性骨折的临床疗效.[方法]采用后路椎弓根螺钉内固定治疗胸腰椎爆裂性骨折126例.[结果]将已随访的96例病人中选择54例随机分为两组:椎板减压组(A)27例,非椎板减压组(B)27例,病例随访时间9个月～11年.A组:术中出血平均800 ml,手术时间平均180 min.非减压组:术中出血平均350 ml,手术时间平均115 min.[结论]两组病例在伤椎高度的恢复、Cobb角恢复无统计学差异(P>0.05);非椎板减压组术中出血、手术时间有明显的差异(P<0.05);故非椎板减压椎弓根螺钉间接复位治疗胸腰椎爆裂性骨折,对于一定的病人群体,不失为一种值得推广的手术方法.     

钉棒系统加自体骨移植治疗胸腰椎压缩性骨折的疗效观察

[目的]应用椎弓根钉棒系统加自体骨移植治疗胸腰椎压缩性骨折与单纯采用内固定钉棒系统进行比较，寻找一种适合人体胸腰椎压缩性骨折的治疗方法。[方法]采用内固定钉棒系统同时行椎板减压共治疗126例胸腰椎骨折病人，其中54例患者在骨折椎体复位后经椎弓根植入自体骨碎块。[结果]54例胸腰椎骨折病人术后X线证实椎弓根钉位置好，伤椎复位及外形好。术后神经症状减轻或无加重现象。经8个月～3a6个月随访，症状明显减轻。X线证实伤椎内植骨者比单纯钉棒复位者矫正度数丢失明显减少。[结论]采用椎弓根钉棒系统加自体骨移植治疗胸腰椎压缩性骨折能有效维持椎体高度，使内固定螺丝钉断钉率显著降低。防止远期脊柱后凸畸形，减少伤部椎管内神经的继发性损伤。     

胸腰椎骨折后路间接复位与开窗推顶复位对椎管内骨折块的影响

目的探讨胸腰椎骨折后路间接复位与开窗推顶复位对椎管内骨折块的影响。方法用后路椎弓根螺钉器械复位内固定治疗无神经损伤的胸腰椎骨折64例,28例采用间接复位,36例通过椎板间开窗用骨块推顶器推顶复位,测量术前术后伤椎椎管狭窄率、椎体前高、椎体后高及胸腰段后凸角。结果术前术后各项指标两组间比较差别均无显著性(P0.05)。有5枚螺钉突破椎弓外侧壁,无神经并发症。结论对无神经损伤的胸腰椎骨折,若椎管狭窄率小于50%,则无需打开椎管,间接复位可对椎管进行有效的减压。     

小切口后路椎弓根内固定治疗胸腰椎骨折

目的探讨经小切口后路椎弓根内固定治疗胸腰椎骨折的可行性及临床疗效。方法对本组24例单纯胸腰椎骨折、无需进行椎板减压的患者,在C型臂X线机下定位病椎上下相邻椎体椎弓根根部,作4个1.5cm长的切口,固定与复位均在这4个小切口内完成。结果所有病例均获随访,时间9～20个月,平均14个月;术后伤椎平均高度（百分比）,椎间隙高度和后凸Cobb＇s角,椎管堵塞指数各项指标与术前相比较,差异有显著性（P〈0.01）。手术时间约1.5小时,出血量约70ml。结论经小切口后路椎弓根钉内固定治疗胸腰椎骨折疗效确切,是一种创伤小、操作简单、固定可靠,且出血少、疼痛轻、恢复快、住院时间短的手术方法。     

微创技术治疗胸腰椎骨折

目的研究微创技术治疗脊柱骨折的适应证和疗效。方法选择10例单纯胸腰椎骨折、损伤平面以下无神经功能损害、无需进行椎板减压的患者，在C臂X线机下定位病椎椎弓根根部，做4个1.5cm长的切口，固定与复位均在这4个小切口内完成。结果所有患者均恢复惟体高度并矫正后凸畸形。手术时间约1．5h，出血量约50ml。结论微创技术治疗脊柱骨折适用于单纯胸腰椎骨折、损伤平面以下无神经功能损害、无需进行椎板减压的患者，优点是创伤小、术后康复快。     

手法复位经皮椎弓根内固定术在胸腰椎骨折中的应用

目的探讨应用手法复位经皮椎弓根内固定技术治疗胸腰椎骨折的疗效。方法胸腰椎骨折36例,使用长尾椎弓根固定系统,在骨折节段相邻椎体椎弓根电视透视定位后,皮肤处作4个长约1.5cm纵形切口,电视透视监视下,置入椎弓根螺钉,置棒,手法复位后,锁紧螺钉。结果平均手术时间60min,手术出血量平均60ml。术中未发生椎弓根钉误入椎管、脊髓或马尾神经损伤等并发症。结论手法复位经皮椎弓根内固定技术可使不稳定胸腰椎骨折获得较满意复位及较坚强内固定,手术操作简便,创伤及痛苦小,患者康复快。     

经皮椎弓根内固定术在胸腰椎骨折中的应用

[目的]应用经皮椎弓根内固定技术治疗胸腰椎骨折。[方法]本组病例全部使用丹历·枢法模公司生产的CotrelDuboussetHorizon(CDH)椎弓根内固定系统。在骨折节段上、下相邻椎弓根皮肤处作4个1.5cm长纵形切口,电视透视监视下,钻入椎弓根螺钉,从一端切口纵形将固定棒置入肌纤维间隙内,棒的两端置入上、下2枚椎弓根钉的槽口内,拧入固定螺钉,初步固定,撑开复位并矫正屈曲畸形。[结果]手术出血量平均85ml。住院时间平均10d。平均骨折愈合时间术后10周。术中未发生椎弓根钉误入椎管、脊神经或马尾神经损伤并发症。[结论]经皮椎弓根内固定技术可使不稳定胸腰椎骨折获得坚强固定,手术操作简单安全,创伤轻、痛苦小,患者康复快。     

椎旁肌间隙入路经椎弓根内固定治疗胸腰椎骨折

目的探讨胸腰椎后路经椎旁肌间隙入路椎弓根螺钉内固定治疗胸腰椎骨折中的临床应用价值。方法自2009年1月至2010年12月采用椎旁肌间隙入路椎弓根螺钉内固定治疗胸腰椎骨折31例,全部病例均采用两侧钝性分离最长肌和多裂肌间隙显露关节突,置入椎弓根螺钉并复位内固定。结果本组平均手术时间100 min,平均术中出血量140 mL,平均术后引流量60 mL,无血肿及术后感染。19例经6～12个月随访,无腰背痛,效果优良。结论椎旁肌间隙入路用于后路椎弓根螺钉固定技术,具有创伤小、出血少、手术时间短、术后恢复快等优点,在治疗无需椎管减压的胸腰椎骨折时可作为首选的手术方法。     

单节段椎弓根螺钉内固定治疗胸腰椎骨折的进展

随着现代工业及交通运输业的迅猛发展,脊柱损伤特别是胸腰椎损伤的发生率明显上升。短节段椎弓根螺钉内固定术（short-segment pedicle instrumentation,SSPI）作为治疗胸腰椎爆裂骨折的主要手术方法被广泛应用于临床[1、2]。近年来,有学者提出应用单节段椎弓根螺钉内固定术（mono-segment pedicle instrumentation,MSPI）治疗胸腰椎骨折[3~7],通过将椎弓根螺钉置入伤椎及相邻椎体,对骨折椎体直接复位、固定,达到重建脊柱稳定性、减少融合节段及术后并发症的目的。现就单节段椎弓根螺钉固定治疗胸腰椎骨折的理论基础及临床应用综述如下。     

微创经皮椎弓根螺钉内固定术治疗胸腰椎骨折

目的探讨微创经皮椎弓根螺钉内固定术治疗胸腰椎骨折的可行性及其疗效。方法自2003年9月至2007年9月，选择15例损伤平面以下无神经功能损害，无需进行椎板减压的单纯胸腰椎骨折患者，在C臂X线机定位下确定需要固定的椎弓根根部，做4个1．5cm长的切口，固定与复位均在4个小切口内完成。结果所有病例均获随访，时间10～30个月，平均18个月。术后患者均恢复椎体高度并矫正椎体后凸畸形。手术时间约1．5h，出血量约80mL。结论微创经皮椎弓根螺钉内固定技术操作简便、安全可靠，具有创伤小、出血少、疼痛轻、恢复快、住院时间短等优点。     

Countercurrent system

Urinary concentration is achieved by countercurrent multiplication in the inner medulla. The single effect in the outer medulla is active NaCl absorption from the thick ascending limb. While the single effect in the inner medulla is not definitively established, the majority of experimental data favors passive NaCl absorption from the thin ascending limb. Continued experimental studies in inner medullary nephron segments will be needed to elucidate fully the process of urinary concentration.     

Renin-angiotensin system

Renin, a protease that cleaves the prohormone angiotensinogen thereby releasing angiotensin I, plays a major role in regulating blood pressure and electrolyte balance. Although renin is synthesized mainly in the cortical cells of the kidney, the presence of renin or reninlike activity has been recognized in various extrarenal tissues of humans and animals, including such reproductive organs as LH-containing cells of the anterior pituitary, placentral trophoblasts, and Leydig cells of the male gonad. It has also been learned that the renin in these extrarenal tissues generates angiotensins locally, which may interact with angiotensin II receptors in a paracrine or autocrine manner. However, the precise roles of the renin-angiotensin system in extrarenal tissue are not yet understood. We demonstrated the renin-angiotensin system in human testis by measuring the plasma renin activity (PRA), plasma angiotensin II (PAII), and testosterone in the internal spermatic vein (ISV) simultaneously after treatment with hCG, and elucidated the relationship between the renin-angiotensin system and sex steroids from Leydig cells of the male gonad.     

Trauma system evaluation using the fatality analysis reporting system

BACKGROUND: The Fatality Analysis Reporting System (FARS) has recorded detailed data on fatal traffic crashes since 1975. At least three prior studies have used declining mortality rates derived from FARS as evidence of regional trauma system effectiveness. METHODS: FARS and census data were obtained at no cost through the Internet. Previously published studies were replicated graphically including data from additional years before and after the previously reported time periods, and with rates also calculated for control populations. RESULTS: The association of trauma system organization with observed decreases in mortality rates was less convincing when all available data were displayed and other potential factors were considered. Death after traffic crashes, and especially death in hospitals, is becoming less frequent throughout the country. CONCLUSION: FARS is an excellent resource available to all injury researchers, but provides little evidence that some regions have decreased traffic mortality more than others because of trauma systems.     

Polysegmental Dynesys system

Introduction

The advantages of using the Dynesys System are claimed to be sufficient and polysegmental dorsal stabilization of the spine while preserving a certain amount of motion.

Materials and methods

In this study 20?patients with a polysegmental spinal pathology were treated with polysegmental decompression and using the Dynesys Dynamic Stabilization system. None of the patients had had spinal surgery previously. Bone density was measured in all patients preoperatively.

Results

All 20?patients were followed up for an average of 11.8?months postoperatively. The ability to walk was improved from 581.5?m to 1640.0?m after surgery. Complications observed were one leakage of the dura and one hypertensive crisis. Implant loosening was observed in one female patient, which was revised and dorso-ventral fusion was carried out.

Conclusions

The use of the Dynesys Dynamic Stabilization system is a reasonable treatment in patients with polysegmental pathology of the spine. However, the system does not allow restoration of extensive malalignments or deformities of the spine.     

The immune system

The immune system provides the body with both non-specific and specific defence against pathogens. It can recognize foreign from self. The immune system is composed of lines of defence and can mount responses by cellular and humoral mechanisms. It also has memory, allowing a quicker and heightened response on subsequent exposure. It achieves these effects by a complex interaction between the clotting, complement and kinin systems, endothelial cells and the cells and proteins of the immune system.