池氏棒治疗特发性脊柱侧弯长期随访结果

目的　分析经椎弓根螺钉固定矫正治疗特发性脊柱侧弯长期随访矫正角度丢失的程度与原因。方法 15 0例经椎弓根螺钉固定 ,85例随访 3～ 11.4年 (平均 8.6年 ) ,术前、术后及随访的X片对比 ,分析矫正角度丢失与融合节段选择、侧凸类型等之间的关系。结果长期随访结果 ,随诊 3～ 7年 39例 ,7～ 9年 17例 ,9年以上 2 9例。丢失 0～ 5°5 1例 (6 0 % ) ,6～ 10° 9例 (10 .6 % ) ,11～ 2 0° 13例 (15 .2 % ) ,2 1～ 30° 9例 (10 .6 % ) ,31°以上 3例 (3.6 % )。丢失角度与断棒、脱钉、断钉、弯钉、融合节段选择有明显关系 ;同年龄、侧弯类型无明显关系。结论优良的内固定器械和融合节段的选择是防止矫正度丢失的关键 ;提高融合技术是减少假关节和矫正度丢失的主要方法。     

改良枢椎椎板螺钉置钉方法的临床应用

目的设计一种改良的枢椎椎板螺钉置钉方法并应用于临床,使螺钉置入更简单、更准确。方法改良枢椎椎板螺钉置钉方法的进钉点仍为棘突和椎板的交界处,但在椎板中份用磨钻磨除少许皮质开窗,用刮匙刮除松质骨,保留椎板内板,用手钻沿着枢椎椎板钻孔,在直视下通过开窗处,再继续向前钻入,探针探查钉道并攻丝后置入直径3.5~4.0 mm、长度24~30 mm螺钉。临床应用26例,其中男17例,女9例,平均年龄56.7岁。结果共置入42枚枢椎椎板螺钉,螺钉平均长度为27.1 mm(24~30 mm),术中无需透视,术中和术后无明显技术相关的并发症发生。术后即刻或随访CT示椎板螺钉位置正确,均位于椎板间。全组病例平均随访13.4个月,未发生螺钉松动、脱出或断裂。结论改良的枢椎椎板螺钉置入技术操作简单,无需透视,并保证了螺钉处于正确位置。     

脊髓线预测颈椎后路开门术后脊髓减压效果的临床研究

Objectives To report a new index (the SC-line) and a new classification for predicting of postoperative spinal cord decompression after cervical laminoplasty. Methods From March 2008 to August 2009, MRI images of 25 patients treated with cervical laminoplasty were retrospectively studied.Using T2-weighted images of the cervical spine, point A was anterior point of the spinal cord at inferior endplate level of cranial compressed vertebra. Point B was anterior point of the spinal cord at superior endplate level of caudal compressed vertebra. The SC-line was defined as a line that connects A and B.Posterior surface of compressor at compression level did not exceed the line in Type Ⅰ , connected the line in Type Ⅱ , and exceeded it in Type Ⅲ . Twenty-five patients who underwent cervical laminoplasty were classified into 3 groups according to the SC-line classification. The posterior shift of the spinal cord after the posterior decompression procedure was evaluated by using a modified gradation of degree of anterior spinal cord compression by MRI finding. The relationship between the degree of anterior spinal cord compression after surgery and the SC-line types were analyzed. Results Preoperative cervical SC-line classification showed high correlations to the degree of spinal cord decompression. There were 3. 82 ± 0. 39 points in Type Ⅰ before surgery, 3. 90 ±0. 32 points in Type Ⅱ , and 4. 00 ±0. 00 points in Type Ⅲ , respectively. After surgery, there were 1. 15 ±0. 50 points in Type Ⅰ , 2. 70 ±0. 48 points in Type Ⅱ , and 3. 50 ±0. 55 points in Type Ⅲ, respectively. Significant differences were found between each Type ( F = 42. 49, P ＜ 0. 01; Type Ⅰ vs. Type Ⅱ : P＜0. 01;Type Ⅰvs. Type Ⅲ: P ＜0. 01;Type Ⅱ vs. Type Ⅲ: P =0.038). Conclusion SC-line can be used to predict the degree of postoperative spinal cord decompression following cervical laminoplasty.     

深覆牙合与正常牙合人群舌姿势位特征的比较研究

目的:研究深覆牙合及正常牙合人群在舌姿势位时的舌矢状向的大小及舌位特征。方法:利用舌背硫酸钡造影法,对受试者拍摄有特殊显影的舌姿势位的侧位片,定位舌体的位置及舌体的高度及长度,比较深覆牙合与正常牙合的差异性。结果:深覆牙合人群的舌前中部都较低位,舌前部也较为后缩,舌长度及高度也较正常牙合稍小,差异有显著性。结论:深覆牙合与正常牙合人群存在不同的舌姿势位特征,这可能与错牙合本身存在一定的因果关系。     

Study on equilibrium and stabilization of mandibular intercuspal position in Class Ⅱ Division Ⅰ malocclusions

Objective To analyze the dynamic occlusal contacts in ClassⅡDivision Ⅰ Malocclusions during mandibular movement from muscular contact position(MCP)to intercuspal position(ICP),and to investigate the equilibrium and stabilization of ICP as well as dental morphological factors related to the MCP-ICP discrepancy.Methods 60 subjects with Class Ⅱ Division Ⅰ Malocclusions with no history of orthodontic treatment were employed.T-scan Ⅱ system was used to record and analyze the dynamic occlusal contacts during mandibular movement from MCP to ICP.Dental morphological data were determined by measuring plaster mold.SPSS 12.0 was used for statistics.Resuits There was no significant difference among three repeated measurements of the vertical distance from the center of occlusive force to the midline,D-value of occlusive force between the right and the left side,the numbers of occlusal contacts in the intercuspal position.Significant difference of the posterior arch-widths was observed between the group with and without ICP-MCP discrepancy.There was no significant difference between the groups in the depth fluency of curve of spee,and index of molar relationship.Conclusions Class Ⅱ Division Ⅰ Malocclusions is characterized by stability with intercupided occlusion.ICP-MCP discrepancy maybe associate with abnormal posterior arch-width,and is independent of the vertical and sagittal discrepancy.     

胸腰椎损伤影像学三维定位综合分类的建议

目的 :探讨胸腰椎损伤后影像学三维定位综合分类的方法。方法 :对 2 2 7例胸腰椎损伤患者的X线片、CT片于矢状面、额状面、水平面上对椎体、椎管、附件结构损伤状况进行测量研究 ,探讨不同骨折类型与损伤层面、椎管占位状态及三柱损伤的关系 ,并用一种简明的文字清楚表达其内涵。结果 :爆裂损伤以Ⅰ、Ⅱ、Ⅲ层面损伤 ,中央椎管占位 ,三柱均损伤为著 ;压缩骨折以Ⅰ、Ⅱ层面损伤 ,前柱损伤为著 ,无明显椎管占位 ;骨折脱位型以Ⅰ、Ⅱ、Ⅳ层面损伤最多 ,椎管占位指数最高。结论 :用简明文字表达胸腰椎损伤的三维定位综合分类方法可减少命名的复杂性和混乱性 ,为临床选择治疗方案提供可靠依据。     

脊柱前中柱稳定性对椎弓根螺钉内固定器前屈压缩刚度的影响及其意义

目的 分析脊柱前中柱稳定性对椎弓根螺钉内固定器固定后前屈压缩刚度的影响,并探讨其临床意义。方法 收集7具新鲜猪T_(10)～L_4节段胸腰椎脊柱标本,“Ⅴ”形切除L_1椎体并压缩至闭合,造成前中柱不稳,模拟L_1骨折后安放AF椎弓根内固定器,进行前屈-压缩测试,分别计算完整标本、损伤标本和内固定后标本的前屈-压缩刚度。结果 完整标本、损伤标本和固定后标本的前屈-压缩刚度分别为413.9±118.6N/mm、136.6±31.6N/mm、240.5±51.4N/mm。相互间差异显著 (P<0.001)。结论 脊柱前中柱失稳后,经椎弓根螺钉内固定器械固定不能使其恢复到正常的机械力学性质,特别是前屈-压缩方向上。胸腰椎脊柱骨折经椎弓根螺钉系统固定后恢复前中柱的机械力学性质,减少其载荷分享是防止术后角度丢失,避免内固定器械固定失败的关键。     

单侧经皮关节突椎弓根螺钉联合对侧钉棒固定与双侧钉棒固定治疗腰椎退行性疾病的比较

目的:比较单侧经皮关节突椎弓根螺钉联合对侧钉棒固定与双侧钉棒系统固定治疗下腰椎退行性疾病的疗效。方法:2009年1月至2012年6月,收治46例下腰椎退变性疾病患者,男30例,女16例;年龄32~71岁,平均51.5岁;单节段40例,双节段6例。按固定方式不同分成两组:其中采取单侧经皮关节突椎弓根螺钉联合对侧钉棒固定治疗22例(A组),采用双侧钉棒系统固定治疗24例(B组)。比较两种术式术中失血量、手术时间等情况,同时对手术前后腰椎Oswestry功能障碍指数(ODI)评分、日本骨科协会(JOA)评分进行比较,评估患者的症状缓解情况。结果:所有患者获得随访,时间1~3年,平均22个月。两组中各有1例不能明确外,其余均获得骨性融合,未出现内植物移位或断裂等并发症;手术时间和出血量A组优于B组(P0.05);两组患者ODI评分及JOA评分较术前均得到明显改善(P0.05),但两组间差异无统计学意义(P0.05)。结论:对无严重不稳的下腰椎退变性疾病患者,两种内固定方法的效果相似,同时单侧经皮关节突椎弓根螺钉联合对侧钉棒固定术具有创伤小、手术时间短、术中失血量少等优点,是一种安全、可行的手术方法。     

Baumann角测量预测肱骨髁上骨折肘内翻的研究

目的研究Ｂａｕｍａｎｎ角的正常值及影响因素,并应用于临床,降低肱骨髁上骨折肘内翻的发生率．方法分别测量２～１２岁正常儿童１１０人,２０４肘的Ｂａｕｍａｎｎ角（Ｂ角）和提携角（Ｃ角）．在肱骨髁上骨折模型上,肱骨远端在内倾、屈曲、旋转三维状态下分别摄Ｘ线片测Ｂ角改变．并前瞻性研究５５例儿童肱骨髁上骨折,对整复后Ｂ角增大预测可能会发生肘内翻的病人,重新进行整复直至满意．结果Ｂ角平均７０．５±５．３５°,Ｃ角平均９．８１±４．２９°．Ｂ角与Ｃ角有非常显著的负相关（ｒ＝－０．３０８,Ｐ＜０．０１）．Ｂ角增加０．５～０．７°,Ｃ角约减少１°．骨折远端在三维状态下,远端内倾对Ｂ角影响最大,屈曲次之,旋转最小．５５例中２４例整复后Ｂ角增大１～１４°,平均８．８°．对增大５°以上２０例,均重新进行了整复固定．随访发现Ｃ角较对侧减小２～４°４例,４～６°３例,１５°１例,仅１例出现６°肘内翻畸形（１．８１％）．结论测量Ｂ角能准确预测提携角,对早期诊断肱骨髁上骨折肘内翻,降低肘内翻发生率具有重大意义．