导航引导下后路腰椎椎弓根螺钉内固定的手术配合

随着社会老年化及工作强度增大 ,腰椎滑脱症也为常见病 ,治疗方法颇多[1] ,传统手术方式需要剥离较多肌肉软组织 ,刀口长、软组织损伤大、术后恢复慢 ,在施行手术时只有X线透视辅助定位 ,但长时间辐射对患者及医生带来显著危险 ,而且传统置钉方式容易造成人为误差甚至损害神经根。而导航技术大大提高手术效率和安全性 ,使手术更快、更准、更安全 ,无论给医生还是患者都带来极大益处。现将手术配合要点及体会介绍如下。1　临床资料我院于 2 0 0 3年开展首例导航条件下的腰椎稳定手术 ,2 0 0 3年 6月至今共4 6例 ,其中男 2 0例 ,女 2 6例 ;年…     

带锁髓内钉固定对胫骨下段骨折的治疗效果及对骨折愈合情况的影响

目的 探讨微创经皮钢板内固定与带锁髓内钉固定对胫骨下段骨折患者的临床疗效。方法 选取2018年6月至2019年12月广州市第一人民医院收治的67例胫骨下段骨折患者为研究对象,采用随机数字表法分为对照组（33例）和观察组（34例）。对照组接受微创经皮钢板内固定治疗,观察组接受带锁髓内钉固定治疗。比较两组患者的手术指标,随访18个月的骨折愈合效果和并发症发生情况。结果 观察组的手术时间及术后下地时间短于对照组,术中出血量少于对照组,手术切口长度短于对照组,差异有统计学意义（P<0.05）。随访18个月,观察组患者的骨折愈合优良率高于对照组,并发症总发生率低于对照组,差异有统计学意义（P<0.05）。结论 与微创经皮钢板内固定相比,带锁髓内钉固定治疗胫骨下段骨折患者效果更佳,手术效果更好,患者恢复更快,且并发症较少。     

Ⅰ期后前路联合手术治疗闭合难复性下颈椎骨折脱位

目的探讨下颈椎骨折脱位的手术方法和疗效。方法采用Ⅰ期联合后前入路360。施行骨折复位＋脊髓减压＋内固定重建术，治疗难复性下颈椎骨折脱位20例，颈脊髓损伤程度按Frankle分级，A级7例，B级5例，C级6例，D级2例。结果术后Mill示椎管减压彻底；随访10～24个月，损伤节段内固定可靠；脊髓功能Frankle分级平均提高1～2级；椎节3个月内融合。结论Ⅰ期颈椎后前路联合手术解决脊髓前后压迫，其中后路手术使骨折脱位容易复位，特别是对有关节交锁病例；前路可解决脊髓前方的压迫，前方植骨＋钛板内固定可恢复椎问高度，重建颈椎前柱结构，使损伤节段获得早期稳定，有利脊髓功能恢复。     

改良二维影像导航引导椎体后凸成形术治疗多发性椎体压缩性骨折临床分析

Objective To explore clinlical outcomes of using improved computer-assisted fluoroscopic navi-gation to guide the percutaneous vertebroplasty to treat multiple osteoporotic spinal compression fractures. Methods Twenty-eight multiple osteoporotic spinal compression fractures patients with 73 painful vertebral body were got an-terio posterior,lateral and oblique radiographic imaging by using computer-assisted fluoroscopic navigation to imitate anterior- posterior. Lateral spinal and axial pedicle virtual image was obtained to guide the percutaneous kyphoplas-ty. Results All painful vertebral body were one-sided punctured,all percutaneous kyphoplasties were succeed by guiding with computer-assisted fluoroscopic navigation. Navigation virtual puncture needle image basically matched with reality view. PMMA dosage was 2.5 ～ 4 ml. Postioporational CT showed that the PMMA filled spinal focus very well. 11 cases completely relieved and 17 cases partially relieved. Conclusion Using improved computer-assisted fluoroscopic navigation to guide the PKP to treatment multiple osteoporotic spinal compression fractures decreases op-erative time and radiation injury. It is a safe,precise,minimally invasive method.     

改良二维影像导航引导椎体后凸成形术治疗多发性椎体压缩性骨折临床分析

Objective To explore clinlical outcomes of using improved computer-assisted fluoroscopic navi-gation to guide the percutaneous vertebroplasty to treat multiple osteoporotic spinal compression fractures. Methods Twenty-eight multiple osteoporotic spinal compression fractures patients with 73 painful vertebral body were got an-terio posterior,lateral and oblique radiographic imaging by using computer-assisted fluoroscopic navigation to imitate anterior- posterior. Lateral spinal and axial pedicle virtual image was obtained to guide the percutaneous kyphoplas-ty. Results All painful vertebral body were one-sided punctured,all percutaneous kyphoplasties were succeed by guiding with computer-assisted fluoroscopic navigation. Navigation virtual puncture needle image basically matched with reality view. PMMA dosage was 2.5 ～ 4 ml. Postioporational CT showed that the PMMA filled spinal focus very well. 11 cases completely relieved and 17 cases partially relieved. Conclusion Using improved computer-assisted fluoroscopic navigation to guide the PKP to treatment multiple osteoporotic spinal compression fractures decreases op-erative time and radiation injury. It is a safe,precise,minimally invasive method.     

撑开型椎间融合器治疗腰椎椎体后缘离断症临床分析

目的探讨撑开型椎间融合器治疗腰椎椎体后缘离断症临床疗效。方法对21例腰椎后缘离断症使用撑开型椎间融合器进行手术治疗。采用Oswestry功能障碍指数(ODI)对患者症状进行评定,观察融合率和并发症。结果 21例均获12～39个月随访,融合率100%。术后优良率及末次随访优良率分别为92.8%及91.1%,未发生融合器脱出、塌陷、移位等并发症。结论撑开型椎间融合器治疗腰椎椎体后缘离断症,腰椎生物力学功能恢复好,无须辅助后路椎弓钉固定即可达到即刻的腰椎稳定性。     

CT三维重建椎弓根钉导航系统在胸椎手术中的应用

目的探讨CT三维重建椎弓根钉导航系统的使用方法和临床效果。方法自2003年5月至2004年5月在15例(80枚)胸椎弓根钉植入手术中使用CT三维重建椎弓根钉导航系统,其中上胸椎30枚,中下胸椎50枚。男10例,女5例;年龄13～76岁,平均47岁。胸椎肿瘤切除后重建5例,胸椎爆裂骨折4例,胸椎黄韧带骨化2例,胸椎侧凸4例。记录手术中螺钉植入时间、出血量。术中使用“C”型臂X线机拍摄正侧位X线片,术后进行CT扫描以了解内固定位置情况。结果每枚椎弓根钉从注册到植入完毕平均需要15min(10～20min)。术中出血量:胸椎肿瘤切除后重建平均1200ml,胸椎爆裂骨折后路固定平均800ml,胸椎黄韧带骨化切除平均300ml,胸椎侧凸平均500ml。椎弓根钉位置根据Andrew椎弓根螺钉CT位置分级标准进行分级,术后CT扫描显示80枚胸椎椎弓根钉中,位置Ⅰ级76枚(96%),Ⅱ级(突破椎弓根皮质≤2mm)2枚,Ⅲ级(突破皮质>2mm)2枚。Ⅱ、Ⅲ级的椎弓根钉均偏向椎弓根外侧,但术后均无神经刺激症状。结论CT三维重建导航系统可为术者虚拟三维的椎弓根钉植入环境,使椎弓根钉按预期的路径准确植入,提高了胸椎椎弓根钉植入的安全性和准确性。     

踝部骨折40例手术治疗

目的：总结60例踝部骨折治疗效果。方法：松质骨加压螺钉，配合必要的特型钢板内固定。结果：41例得到随访，时间6-28个月，优良率91%。结论：踝部骨折应尽早手术。解剖复位，坚强内固定和早期功能锻炼。     

改良二维影像导航引导椎体后凸成形术治疗多发性椎体压缩性骨折临床分析

Objective To explore clinlical outcomes of using improved computer-assisted fluoroscopic navi-gation to guide the percutaneous vertebroplasty to treat multiple osteoporotic spinal compression fractures. Methods Twenty-eight multiple osteoporotic spinal compression fractures patients with 73 painful vertebral body were got an-terio posterior,lateral and oblique radiographic imaging by using computer-assisted fluoroscopic navigation to imitate anterior- posterior. Lateral spinal and axial pedicle virtual image was obtained to guide the percutaneous kyphoplas-ty. Results All painful vertebral body were one-sided punctured,all percutaneous kyphoplasties were succeed by guiding with computer-assisted fluoroscopic navigation. Navigation virtual puncture needle image basically matched with reality view. PMMA dosage was 2.5 ～ 4 ml. Postioporational CT showed that the PMMA filled spinal focus very well. 11 cases completely relieved and 17 cases partially relieved. Conclusion Using improved computer-assisted fluoroscopic navigation to guide the PKP to treatment multiple osteoporotic spinal compression fractures decreases op-erative time and radiation injury. It is a safe,precise,minimally invasive method.