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.     

老年人外伤性脊柱骨折的临床特点

目的:分析老年人外伤性脊柱骨折的临床特点,提高老年人外伤性脊柱骨折的预防及救治水平。方法:2002年1月～2011年12月我院收治老年人外伤性脊柱骨折患者271例,其中男129例,女142例,年龄60～89岁,平均68.8岁,分析其年龄与性别分布情况、骨折原因、骨折节段、创伤严重度评分(injury severity scores,ISS)、脊髓损伤程度ASIA分级、多发性脊柱骨折及合并伤发生率。结果 :年龄分布主要集中在60～69岁,占60.1%(163/271)。摔伤是主要致伤原因,占44.6%(121/271)。男性高处坠落伤及重物砸伤比例较女性患者高,女性患者摔伤比例较男性高,差异有统计学意义(P<0.05)。426个损伤节段中胸椎及腰椎占80.8%(344/426),其中胸腰段(T11～L2)占53.3%(227/426)。男性患者较女性患者有较高的颈椎骨折比例、脊髓损伤发生率、合并症发生率和创伤严重度评分(ISS),差异有统计学意义(P<0.05)。女性患者较男性患者有较高的胸椎及胸腰段椎体骨折比例,差异有统计学意义(P<0.05)。男性患者多发性脊柱骨折最常见原因为高处坠落伤,女性患者为摔伤。脊髓损伤按ASIA分级,A级、B级、C级、D级分别占7.0%(19/271)、1.8%(5/271)、4.8%(13/271)和18.1%(49/271)。男性患者脊髓损伤分级A级占13.2%(17/129),女性患者为0.8%(2/237),两者差异有统计学意义(P<0.05)。结论:老年人外伤性脊柱骨折的致伤原因、多发性脊柱骨折原因、骨折节段、脊髓损伤分级等方面存在明显的性别差异,应根据其性别差异特点对老年人外伤性脊柱骨折进行防治。     

神经根型颈椎病行前路颈椎间盘切除植骨融合内固定术后癔症性瘫痪1例报告

癔症性瘫痪主要为患者受到创伤或者刺激时,由于心理因素所致的瘫痪.区别癔症性瘫痪与器质性病因所致瘫痪在临床中非常重要.特别是在患者有创伤或手术而引起的致瘫性风险存在时.对于神经根性颈椎病行颈椎前路椎间盘切除植骨融合内固定手术(anterior cervical discectomy and fusion,ACDF)是一种经典有效的手术方式,而术后一项严重的并发症即为脊髓或神经根损伤所致瘫痪.但术后癔症性瘫痪者极为少见,我们遇到神经根性颈椎病行ACDF术后癔症性瘫痪患者1例,报道如下.     

腺病毒介导的BDNF基因脊髓内转移对神经根损伤后神经元内酶的影响

目的 观察神经根损伤后进行BDNF基因治疗对神经元的保护作用。方法 在神经根缝合基础上，通过无创注射将复制缺陷重组腺病毒载体直接转移至大鼠神经根损伤部相应的脊髓腹角。分别于术后l、3、7、L4、28d比色法测定AChE和ACP酶活性的变化。结果 AXCA—BDNF组伤后AChE比活性高于损伤组，而ACP活性均低于损伤组。AXCA—BDNF能够降低酶的变化幅度。结论 神经根重建结合BDNF基因治疗可明显减轻神经元的损伤程度，是一种新的有效的治疗方法。     

前肢功能训练对大鼠脊髓损伤后可塑性变化功能恢复和运动诱发电位的作用

目的 观察前肢功能训练对大鼠脊髓损伤(spinal cord injury，SCI)后可塑性变化、功能恢复和运动诱发电位的作用。方法 在立体定位仪的引导下，致伤大鼠双侧红核和皮质脊髓背侧束(dCST)后，对大鼠行前肢功能训练8周。改进后的大鼠前肢食物小球抓取动作评分标准评定大鼠前肢功能，生物素化葡聚糖胺示踪皮质脊髓腹侧束(vCST)的出芽情况，同时行运动诱发电位(MEP)检测。结果 大鼠前肢功能训练可诱导vCST出芽增加，同时伴有大鼠前肢运动功能和MEPP1、N1波波幅的恢复。结论 大鼠前肢功能训练可增强SCI后的可塑性变化，并促进运动功能的恢复。     

改良肩后入路手术治疗肩胛骨骨折

目的　介绍肩胛骨骨折手术的改良后入路,分析手术治疗肩胛骨骨折的临床发现和结果。方法　11例肩胛骨骨折接受改良后入路切开复位内固定手术,其中5例肩胛盂骨折,3例肩胛颈骨折,2例肩胛体骨折,1例肩胛颈、盂和体部复杂型骨折。术后随访5～6 8个月,平均2 3.9个月。按Constant和Murley提出的评分方法评价患肩功能。结果　7例优,2例良,2例可。7例无肩部疼痛,7例肩部外展和屈曲>130°,外展肌力4 ～5级;6例恢复伤前工作,2例主妇能够完成家务。本组病例无术后并发症。结论　改良肩后入路是一种治疗肩胛骨骨折的有效手术入路,切开复位内固定及其术后早期康复锻炼,能够成功防止肩胛骨骨折并发肩部疼痛、僵硬和功能障碍。     

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.     

Percutaneous pedicle screw fixation through the pedicle of fractured vertebra in the treatment of type A thoracolumbar fractures using Sextant system: an analysis of 38 cases

Objective： To prospectively evaluate the feasibility, safety and efficacy of the percutaneous pedicle screw fixation through the pedicle of fractured vertebra in the treatment of type A thoracolumbar fractures using Sextant system in the retrospective non-randomized case-control study. Methods： Atotal of 38 consecutive non-randomized patients with type A thoracolumbar fractures, which had been stabilized posteriorly from December 2006 to March 2009, were examined retrospectively more than 9 months after surgery. Twenty-one patients had been treated conventionally with open pedicle screw fixation （OPSF） and 17 patients received minimally invasive treatment with Sextant percutaneous pedicle screw fixation （SPPSF）. As a method of evaluation, the incision size, the intraoperation and post- operative volume of blood loss, operation time, postoperative hospital stay, blood transfusion, the radiological assessment of the sagittal Cobb＇s angle, vertebral body angle and vertebral body height were recorded and compared. Results： All patients were followed up for 8-24 months （average 11.6 months）. There were significant differences in the incision size, surgical blood loss, surgical draining Joss, operation time, hospital stay after operation, blood transfusion, the proportion of antalgic supplement and postoperative incisional VAS between the two groups （P〈0.05）. Mean preoperative kyphotic deformity was 16.0° and improved by 9.3° after surgery in OPSF group, but 15.2° and 10.3° respectively in SPPSF group. Mean preoperative angle of the fractured vertebral body was 15.9°and improved by 7.9° after surgery in OPSF group, but 14.9° and 6.6° respectively in SPPSF group. Mean anterior vertebral body height （% of normal） was 67.3% before surgery and 95.8% after surgery, but 69.1% and 90.1% respectively in SPPSF group. Mean posterior vertebral body height （% of normal） was 93.3% before surgery and 99.5% after surgery, but 88.9% and 93.3% respectively in SPPSF group. Among the patients whose 9-month follow-up films were available, 3.0° ofkyphosis correction was lost in OPSF group, but 3.2° in SPPSF group. And 1.0°of the angle of the fractured vertebral body correction was lost in OPSF group, but 1.5°in SPPSF group. Then 3.0% of the anterior vertebral body height correction was lost in OPSF group, but 2.2% in SPPSF group. And 3.0% of the posterior vertebral body height correction was lost in OPSF group, but 2.5% in SPPSF group. The sagittal Cobb＇s angle, vertebral body angle and anterior height of the fractured vertebra were all significantly different in each group before and after operation （P〈0.05）. There were no significant differences in the postoperative sagittal Cobb＇s angle, vertebral body angle and the improvement of the vertebral body height and the kyphotic deformity correction between OPSF and SPPSF groups （P〉0.05）, but there was significant difference in the postoperative anterior height of the fractured vertebra between the two groups （P〈0.05）. Conclusion： The percutaneous pedicle screw fixation through the pedicle of fractured vertebra using Sextant system is a good minimally-invasive surgical therapeutic choice for patients with type A thoracolumbar fracture except for that the SPPSF has a little insufficiency in resuming the anterior height of the fractured vertebra compared with OPSF.     

椎间孔镜YESS与TESSYS技术治疗腰椎间盘突出症

目的 探讨椎间孔镜YESS(Yeung endoscopic spine system)和TESSYS(transforaminal en-doscopic spine system)技术治疗腰椎间盘突出症的适应证、手术技巧及临床效果.方法 2005年9月至2008年5月,201例腰椎间盘突出症患者分别采用YESS(150例)和TESSYS(51例)椎间孔镜手术治疗.男122例,女79例;年龄17～79岁,平均33.5岁.疗效评定依据疼痛视觉模拟评分(visual analogue score,VAS)和Nakai分级法.结果 162例(80.6%)获得随访,YESS手术组119例(79.3%)、TESSYS手术组43例(84.3%).随访3～36个月,平均12.5个月.YESS手术组术前腿痛VAS评分(8.4±2.1)分,术后1年(2.4±0.8)分,差异有统计学意义;TESSYS手术组术前腿痛VAS评分(8.6±2.3)分,术后1年(2.6±1.3)分,差异有统计学意义.YESS手术组优良率87.5%,TESSYS手术组88.4%.两组均无永久性神经根损伤、大血管损伤和硬脊膜囊撕裂等并发症.YESS手术组6例术后无效,4例术后复发者行翻修术;TESSYS手术组1例术后无效,2例术后复发者行翻修术.结论 椎间孔镜手术治疗腰椎间盘突出症安全、有效.根据不同类型和不同部佗,正确选择YESS技术或TESSYS技术是手术成功的关键.     

显微内镜手术治疗极外侧型腰椎间盘突出症

目的介绍显微内镜手术治疗极外侧型腰椎间盘突出症的方法,分析其临床效果。方法16例极外侧型腰椎间盘突出症(椎间孔内型7例,椎间孔外型9例)接受显微内镜手术。5例椎间孔内型采用常规显微内镜椎间盘髓核摘除术入路,切除部分椎板、椎弓峡部和小关节。2例椎间孔内型采用经关节突入路,使用X-tube工作通道,切除大部分关节突。9例椎间孔外型采用横突间入路,工作导管置于横突间,部分切断横突间韧带。所有手术均需找到受压神经根并松解,切除突出椎间盘。结果术后平均随访8·3个月,采用改良MacNab标准评定临床结果,优12例,良3例,可1例。平均住院日13·8d,平均手术时间78min,平均术中出血68ml。结论显微内镜手术治疗极外侧腰椎间盘突出症具有小切口和组织损伤轻的优点,能够充分直接探查松解神经根压迫。