成人腰椎峡部裂型滑脱症的微创治疗

Objective To investigate the clinical experiences and technical skills of adult isthmic spondylolisthesis. Methods Twenty-one patients with adult isthmic spondylolisthesis underwent minimally invasive surgery. There were 12 men and 9 women, with the mean age of 51.7 years. Isthmic spondylolisthe-sis occurred at the L4.5 in 7 patients, and at the L5S1 in 14 patients. According to Meyerding classification, 13 cases were of Grade Ⅰ, 7 of Grade Ⅱ, 1 of Grade Ⅲ. Under general anesthesia, guiding by fluoroscopy, the surgeries performed minimally invasive microendoscopic(METRx) techniques for posterior decompression, interbody cage fusion and novel Sextant-R percutaneous pedicle screw techniques for deformity reduction and fixation. Results Seventeen cases were followed up 1 year postoperatively. The average low back pain VAS reduced from preoperative 6.0±2.6 to postoperative 2.9±2.5. The average leg pain VAS decreased from preoperative 6.7±3.3 to postoperative 2.8±1.6. The average ODI decreased from preoperative 44.3% to post-operative 27.1%. The Nakai good and excellent rate was 90%. The mean operative time 170 min, blood loss 160 ml, and postoperative stay in bed 7.5 d. The sagittal spondylolisthesis rate significantly decreased from preoperative 35.5%±2.5% to postoperative 8.3%±7.5%. The lordotic angle from preoperative 11.5°±1.7° in-creased to postoperative 16.8°±9.5°; the intervertebral disc height from preoperative (5.4±2.5) mm increased to postoperative (9.1±3.0) mm. According to Lenke judgement for fusion, complete fusion rate was 76%, in-complete fusion rate was 12%, nonfusion rate was 12%. Conclusion The minimally invasive microendo-scopic (METRx) assisted with a novel Sextant-R percutaneous pedicle screw systems for deformity reduction and fixation to treat adult isthmic spondylolisthesis, is not only a minimally invasive and safe surgical tech-nique, also an effective treatment for deformity reduction and fixation.     

颈椎运动学的研究进展

颈椎运动学是研究颈椎节段之间运动的规律，是脊椎外科学的基础。了解颈椎运动学是理解颈椎正常功能和颈椎遭受疾患、创伤或外科手术后改变的生物力学基础。临床所见颈椎各种损伤对颈椎运动稳定性的影响，颈椎各种术式和内固定器疗效评价都涉及到颈椎运动学。并为临床诊断...     

新型微创经皮椎弓根螺钉内固定治疗胸腰椎骨折

Objective To assess the minimally invasive surgical therapeutic result of percutane-ous pedicle screw fixation using Sextant-R system in treating thoracolumbar fractures. Methods A to-tal of 36 patients with thoracolumbar fractures were divided into two groups, ie, Sextant-R pereutaneous pedicle screw fixation group (Sextant-R group, 14 patients) and open pedicle screw fixation group (open surgery group, 22 patients). A comparative study was done on surgical incision, operation duration, sur-gical blood loss and deformity correction. Results In Sextant-R group and open surgery group respec-tively, the incision size was (7.1±0. 9) cm and (16.8 ± 1.6) cm (P <0. 05), operation duration (1.1±0.7) hoursand (2.4 ±0.8) hours (P<0.05), surgical blood loss (89.3 ±12.1) ml and (325.0±123.6) ml (P < 0.01), surgical draining loss (12.6 ± 3.2) ml and (147.3 ± 36.1) ml (P < 0. 01), postoperative improvement of Cobb' s angle (4.5 ± 2.4)° and (1.0± 2.3)° (P < 0. 05), sag-ittal index (10.2 ± 10.1)° and (5.5 ± 8.6)° (P < 0.05) and anterior height of fracture vertebral body (85.0 ±7.0)% and (95.5 ±2.2)% (P <0.05). Conclusion Pereutaneous pediele screw fixation using Sextant-R system is a good minimally invasive surgical choice for patients with thoracolumbar frac-ture under strict control of surgical indications.     

新型微创经皮椎弓根螺钉内固定治疗胸腰椎骨折

Objective To assess the minimally invasive surgical therapeutic result of percutane-ous pedicle screw fixation using Sextant-R system in treating thoracolumbar fractures. Methods A to-tal of 36 patients with thoracolumbar fractures were divided into two groups, ie, Sextant-R pereutaneous pedicle screw fixation group (Sextant-R group, 14 patients) and open pedicle screw fixation group (open surgery group, 22 patients). A comparative study was done on surgical incision, operation duration, sur-gical blood loss and deformity correction. Results In Sextant-R group and open surgery group respec-tively, the incision size was (7.1±0. 9) cm and (16.8 ± 1.6) cm (P <0. 05), operation duration (1.1±0.7) hoursand (2.4 ±0.8) hours (P<0.05), surgical blood loss (89.3 ±12.1) ml and (325.0±123.6) ml (P < 0.01), surgical draining loss (12.6 ± 3.2) ml and (147.3 ± 36.1) ml (P < 0. 01), postoperative improvement of Cobb' s angle (4.5 ± 2.4)° and (1.0± 2.3)° (P < 0. 05), sag-ittal index (10.2 ± 10.1)° and (5.5 ± 8.6)° (P < 0.05) and anterior height of fracture vertebral body (85.0 ±7.0)% and (95.5 ±2.2)% (P <0.05). Conclusion Pereutaneous pediele screw fixation using Sextant-R system is a good minimally invasive surgical choice for patients with thoracolumbar frac-ture under strict control of surgical indications.     

小切口减压结合经皮椎弓根螺钉内固定治疗伴神经功能损害的胸腰椎骨折

【摘要】 目的：探讨小切口减压结合经皮椎弓根螺钉内固定治疗伴神经功能损害胸腰椎骨折的安全性及有效性。方法：2010年12月～2013年10月对18例伴神经功能损害的胸腰椎骨折患者在全麻下行经皮椎弓根螺钉置入、后正中小切口进行神经减压、椎间植骨融合、骨折复位固定术,并加装横连接（微创手术组）。其中男12例,女6例;年龄30~58岁,平均42.8岁;T12 3例,L1 6例,L2 4例,L3 5例;AO分型A3型3例,C1型14例,C2型2例;神经功能Frankel分级A级5例,B级9例,C级2例,D级2例。记录肌肉剥离切口长度、手术时间、术中出血量、术后引流量、术后伤口疼痛程度和镇痛药物使用情况及减压等并与同期20例传统开放手术患者（开放手术组）情况比较。结果：微创手术组肌肉剥离长度为6.9±1.2cm,术中出血量为538.3±188.7ml,术后引流量为116.4±55.0ml,术后伤口疼痛VAS评分为2.5±1.4分,术后镇痛药物使用比例为16.7%;开放手术组分别为18.6±2.8cm,735.8±252.2ml,233.5±95.8ml,4.4±1.8分和70.0%,两组比较差异均有统计学意义（P<0.05或P<0.01）。两组均无手术并发症发生,椎管得到有效减压。两组均获得最少6个月以上随访,两组不完全瘫患者术后均获得1级及以上神经功能恢复。结论：后正中小切口减压结合经皮椎弓根螺钉内固定术在确保良好神经减压的同时能够明显减少手术创伤,且能安放横连接,是治疗伴神经功能损害胸腰椎骨折安全、有效、微创的手术方法。     

腺病毒介导的心肌营养素1基因修饰大鼠神经干细胞

目的：以心肌营养素1基因修饰大鼠神经干细胞,为心肌营养素1基因修饰的神经干细胞移植治疗中枢神经系统损伤提供物质基础.方法：实验于2002-06/2003-06在第三军医大学野战外科研究所全军重点开放实验室进行.从Wistar大鼠胚胎海马和室管膜区组织分离、培养大鼠胚胎神经干细胞,以构建纯化好的重组腺病毒-心肌营养素1和重组腺病毒-增强绿色荧光蛋白载体转染神经干细胞.相差显微镜下直接观察细胞生长存活情况,应用免疫细胞化学和免疫荧光技术检测神经干细胞及其诱导后分化细胞的特异性蛋白巢蛋白、神经微丝蛋白、胶质纤维酸性蛋白,外源性Brdu和增强绿色荧光蛋白的掺入情况,并观察心肌营养素1基因在神经干细胞中的表达.结果：①从胚胎大鼠分离的神经干细胞可在体外多次传代,经细胞增殖标记物Brdu掺入实验证明神经干细胞具有分裂增殖能力.②检测神经干细胞标志物巢蛋白、神经元标志物神经微丝蛋白和胶质细胞标志物胶质纤维酸性蛋白,证实神经干细胞具有多向分化潜能.③重组腺病毒-心肌营养素1及重组腺病毒-增强绿色荧光蛋白转染神经干细胞后应用免疫组化和荧光示踪技术,检测到神经干细胞中心肌营养素1和报告基因增强绿色荧光蛋白表达明显持续增加.结论：①实验成功地分离和培养出大鼠神经干细胞,并在体外可多次传代增殖并可诱导分化为神经元和胶质细胞.②重组腺病毒-心肌营养素1和重组腺病毒-增强绿色荧光蛋白转染神经干细胞后,外源性心肌营养素1基因和增强绿色荧光蛋白在细胞中可持续稳定表达.     

新型微创经皮椎弓根螺钉内固定治疗胸腰椎骨折

Objective To assess the minimally invasive surgical therapeutic result of percutane-ous pedicle screw fixation using Sextant-R system in treating thoracolumbar fractures. Methods A to-tal of 36 patients with thoracolumbar fractures were divided into two groups, ie, Sextant-R pereutaneous pedicle screw fixation group (Sextant-R group, 14 patients) and open pedicle screw fixation group (open surgery group, 22 patients). A comparative study was done on surgical incision, operation duration, sur-gical blood loss and deformity correction. Results In Sextant-R group and open surgery group respec-tively, the incision size was (7.1±0. 9) cm and (16.8 ± 1.6) cm (P <0. 05), operation duration (1.1±0.7) hoursand (2.4 ±0.8) hours (P<0.05), surgical blood loss (89.3 ±12.1) ml and (325.0±123.6) ml (P < 0.01), surgical draining loss (12.6 ± 3.2) ml and (147.3 ± 36.1) ml (P < 0. 01), postoperative improvement of Cobb' s angle (4.5 ± 2.4)° and (1.0± 2.3)° (P < 0. 05), sag-ittal index (10.2 ± 10.1)° and (5.5 ± 8.6)° (P < 0.05) and anterior height of fracture vertebral body (85.0 ±7.0)% and (95.5 ±2.2)% (P <0.05). Conclusion Pereutaneous pediele screw fixation using Sextant-R system is a good minimally invasive surgical choice for patients with thoracolumbar frac-ture under strict control of surgical indications.     

TAT/CT-1及TAT/EGFP融合蛋白的表达与纯化及其在小鼠体内分布的观察

目的分别构建含蛋白转导域(protein transduction domain,PTD)TAT与小鼠心肌营养素-1(CT-1)及TAT与增强绿色荧光蛋白(enhanced green fluorescent protein,EGFP)融合基因片断的原核表达质粒TAT/CT-1及TAT/EGFP,利用大肠杆菌进行表达并纯化;观察融合蛋白在小鼠体内的分布.方法采用PCR及克隆技术将CT-1编码区基因以及EGFP基因分别与TAT连接到原核表达载体pGEX-4T3上.用IPTG诱导表达融合蛋白,谷胱甘肽琼脂糖4B纯化融合蛋白.小鼠尾静脉注射融合蛋白,脑、脊髓、肝、心肌等器官冰冻切片,免疫荧光观察融合蛋白的存在.结果目的片断CT-1及EGFP被有效的扩增,构建后质粒测序表明无PCR引起的突变,TAT/CT-1及TAT/EGFP在转化的大肠杆菌中获得高效表达,并成功纯化.脑、脊髓、肝、心肌等组织切片免疫荧光检测呈阳性.结论成功获得了有活性的TAT/CT-1及TAT/EGFP的基因表达产物;TAT可介导CT-1及EGFP由细胞外跨膜转导进入细胞内;为CT-1功能的进一步研究打下了基础.     

基于分类与回归树模型对创伤性颈脊髓损伤患者行气管切开的预测研究

目的在确认创伤性颈脊髓损伤(TCSCI)气管切开的危险因素的基础上, 构建分类与回归树(CART)模型以指导气管切开。方法回顾性分析2009年1月至2018年12月陆军军医大学新桥医院骨科收治的498例TCSCI患者资料, 男403例, 女86例;年龄(50.2±13.6)岁。其中气管切开69例, 未行气管切开420例。统计患者的性别、年龄、吸烟史、致伤原因、神经损伤平面(NLI)、美国脊髓损伤学会(ASIA)分级、创伤严重程度评分(ISS)、胸部损伤、既往肺部疾病、既往基础疾病、手术入路并进行单因素分析。通过二元logistic回归分析行气管切开的危险因素, 并在危险因素的基础上建立预测气管切开的CART。结果 logistic回归分析显示, 年龄>50岁(OR=4.744, 95%CI: 1.802～12.493,P=0.002)、NLI在C4及以上(OR=23.662, 95%CI: 8.449～66.268,P<0.001)、ASIA分级A级(OR=40.007, 95%CI: 12.992～123.193,P<0.001)及ISS>16分(OR=10....     

复发性腰椎间盘翻修术的微创术式选择与临床应用

目的 评价内镜辅助下微创腰椎间盘翻修术的临床效果,并比较单纯减压与椎间融合、椎弓根螺钉内固定的临床结果 .方法 共32例微创腰椎间盘翻修术患者,男22例,女10例,平均45.7岁.其中27例患者获得随访(随访率84.4%),平均随访25.5个月.临床患者被分为二组:内镜下单纯减压组(14例)和内镜下减压、椎间植骨融合、椎弓根螺钉内固定组(13例).疗效评定按照目测视觉类比评分法(VAS评分)和Nakai分级评定.结果 二组患者术后平均腰腿痛VAS指数显著降低,手术前后差异有显著(P<0.05)和极显著(P<0.01)统计学意义.根据Nakai分级;单纯减压组优良率92.8%,减压内固定组优良率85.5%.虽然二组优良率间比较无统计学意义(P=0.793),但单纯减压组的手术时间、术中出血量、术后下床时间和治疗费用都显著低于减压内固定组(P<0.05).结论 内镜下微创腰椎间盘翻修术非常有效和安全,内镜下单纯纤维瘢痕组织松解和椎间盘摘除减压是腰椎间盘翻修术的首选术式.