经皮椎间孔镜TESSYS技术治疗中央型腰椎间盘突出症

目的评价椎间孔镜TESSYS技术治疗中央型腰椎间盘突出症的疗效。方法河北医科大学第三医院脊柱外科自2011年1月至2013年7月共应用经皮椎间孔镜TESSYS技术治疗中央型腰椎间盘突出症69例,疗效评价采用视觉疼痛模拟评分(VAS)、JOA及MacNab评分法评定。结果 69例中央型腰椎间盘突出症患者中,67例获得随访,平均随访时间3~33个月,平均11.6个月;术前下肢VAS评分(7.12±0.70),术后1年下肢VAS评分(2.27±0.74),差异有统计学意义(P0.05)。JOA评分由术前的(13.7±0.87)升高到术后的(22.1±0.79),差异有统计学意义(P0.05)。本组患者均未出现手术并发症,1例术后患者症状无明显改善,择期行全椎板切除联合植骨融合内固定手术治疗,2例L5-S1突出,由于髂嵴过高,阻挡手术入路,术中改行后路椎间盘镜治疗,3例患者术后复发,择期行全椎板切除联合植骨融合内固定手术治疗。整体优良率83.5%。结论应用椎间孔镜TESSYS技术治疗中央型腰椎间盘突出症安全、有效,严格掌握手术适应证是手术成功的关键和疗效的保障。     

比较影像学在核医学教学中的应用

目的：探讨比较影像教学法在核医学教学中的应用价值。方法：选择蚌埠医学院2010级临床医学专业学生作为研究对象,以大班为单位随机分为传统教学法组和比较影像教学法组。以考试成绩、问卷调查作为评价指标,比较2组的教学效果。结果：比较影像教学法组的教学效果和考试成绩明显好于传统教学法组（P〈0.01）。结论：将比较影像教学法引入核医学教学,有助于激发学生的学习兴趣,提高学习效率,使学生掌握不同影像检查手段的合理选择和优化组合,为以后的临床实习及工作打下良好的基础。     

Bryan颈人工椎间盘置换术失败原因分析

Objective To analyze the failed Bryan cervical disc arthroplasty and to improve its re-sults. Methods From October 2004 to October 2007, 48 patients underwent Bryan cervical disc arthro-plasty. All patients were followed up 2 to 38 months(mean 18 months). Among them, 4 failed cases were an-alyzed, which include 1 male and 3 females, with the age of 42, 51, 40, 49 years. Results Case 1 reported the brachial plexus injury as the result of the patient's shoulders being overstretched while fixing his position during operation, the muscular power of both upper extremities declining to degree Ⅱ and Ⅲ upon operation completion, which was restored to degree 4 when discharged from hospital (45 days after operation). Case 2 reported the compression on the spinal cord as the result of failure to remove the ossification of posterior lon-gitudinal ligament (OPLL) which had been identified by the preoperative CT; the patient complained of no release of symptoms after the operation and postoperative CT showed that compression still existed. Case 3 reported incomplete spinal cord injury caused by massive bleeding during decompression, a function of ex-tremely small vertebral canal anteroposterior diameter (5 mm shown in preoperative MRI); the muscular pow-er of left extremity dropped to degree 0 upon operation completion; the patient could walk with crutch 10 days after operation. Case 4 reported'heterotopic ossification (OP) which occurred 1 year after operation and became deteriorated 2 years later, but did not affect the motion of prosthesis. Conclusion Bryan disc arthroplasty is being extensively used as an effective procedure for decompression and reconstruction of the cervical disc. Excellent clinical results are related to strict selection of indications, perioperative manage-ment, and the experience and surgical technique of the surgeon are also important to the final outcome.     

腰椎间盘突出症手术疗效与突出类型及纤维环完整性的关系

目的探讨腰椎间盘突出症手术疗效与突出类型及纤维环完整性的关系。方法回顾性分析经后路椎板开窗髓核摘除术治疗的260例腰椎间盘突出症患者的疗效。病例选择条件:均为下腰椎单节段突出,侧突型(单侧坐骨神经症状),不伴有椎管狭窄。随访6～14年,平均8.5年。根据术中所见椎间盘突出的髓核形态及纤维环破损大小,将椎间盘突出症分为四种类型,并对不同类型的术后疗效进行统计学分析比较。结果椎间盘髓核突出较大、纤维环破损较小者,术后疗效佳,复发率低;反之,髓核突出较小或纤维环破损大者,术后疗效差,复发率高。结论腰椎间盘突出症的手术效果与椎间盘突出类型及纤维环的完整性有密切的联系。对临床症状较轻、间盘突出较小且突出物基底较宽的患者应尽量避免开放式手术。椎间盘突出摘除术中除应注意保持脊柱骨性结构的稳定性,还应尽量避免过多地破坏椎间盘纤维环的完整性。     

硫酸镁对继发性脊髓损伤保护作用的实验研究

目的：探讨硫酸镁对继发性脊髓损伤的保护作用及其作用机制。方法：选健康新西兰大白兔36只，随机分为3组：A组为正常组，仅行L1～L3椎板减压；B组和C组分别为对照组和治疗组，行L1～L3椎板减压后采用Allen’s重物打击法致伤脊髓．伤后30min时B组经腹腔注射蒸馏水600mg／kg，C组经腹腔注射硫酸镁600mg／kg。48h后切取伤段脊髓组织分别测定水、钙、镁含量，观察局部组织病理学改变、超微结构变化及单位面积凋亡细胞数。结果：与A组比较，B、C组伤段脊髓组织水、钙含量增多，镁含量减少，组织病理学改变及超微结构破坏严重，细胞凋亡数上升，且C组较对B组轻。结论：早期应用硫酸镁治疗可减轻脊髓损伤后的继发性损伤。     

塞来昔布和萘普生治疗类风湿性关节炎的临床疗效比较

类风湿性关节炎(RA)是一种常见病，多发病，若治疗不及时可导致关节完全强直等肢体严重畸形。非甾体类抗炎药(NSAIDS)是治疗本病的基本药物，疾病的早中期，仍以药物治疗为主，在众多本类药物中，我们选择了塞来昔布和萘普生进行临床研究。     

电视胸腔镜在脊柱胸段中的应用

1910年Jacobaeus报道使用胸腔镜分离结核性黏连，至今已有90余年的历史，由于图像传导的问题，该项技术的应用受到了限制。Lewis等于1991年首次报道电视辅助胸腔镜外科(video-assisted thomcoscopic surgerg，VATS)之后，该项技术又受到了人们的关注。Mack等于1993年首次报道了利用VATS技术治疗脊柱疾病及损伤。     

Bryan颈人工椎间盘置换术失败原因分析

Objective To analyze the failed Bryan cervical disc arthroplasty and to improve its re-sults. Methods From October 2004 to October 2007, 48 patients underwent Bryan cervical disc arthro-plasty. All patients were followed up 2 to 38 months(mean 18 months). Among them, 4 failed cases were an-alyzed, which include 1 male and 3 females, with the age of 42, 51, 40, 49 years. Results Case 1 reported the brachial plexus injury as the result of the patient's shoulders being overstretched while fixing his position during operation, the muscular power of both upper extremities declining to degree Ⅱ and Ⅲ upon operation completion, which was restored to degree 4 when discharged from hospital (45 days after operation). Case 2 reported the compression on the spinal cord as the result of failure to remove the ossification of posterior lon-gitudinal ligament (OPLL) which had been identified by the preoperative CT; the patient complained of no release of symptoms after the operation and postoperative CT showed that compression still existed. Case 3 reported incomplete spinal cord injury caused by massive bleeding during decompression, a function of ex-tremely small vertebral canal anteroposterior diameter (5 mm shown in preoperative MRI); the muscular pow-er of left extremity dropped to degree 0 upon operation completion; the patient could walk with crutch 10 days after operation. Case 4 reported'heterotopic ossification (OP) which occurred 1 year after operation and became deteriorated 2 years later, but did not affect the motion of prosthesis. Conclusion Bryan disc arthroplasty is being extensively used as an effective procedure for decompression and reconstruction of the cervical disc. Excellent clinical results are related to strict selection of indications, perioperative manage-ment, and the experience and surgical technique of the surgeon are also important to the final outcome.     

药物洗脱支架术后双联抗血小板药物应用二年与一年的比较

目的对比置入药物洗脱支架（DES）后双联抗血小板治疗2年相比1年能否降低主要不良心血管事件。方法入选2006年1月至2007年12月行DES的患者221例,按照双联抗血小板治疗1年和2年分为2组,初级终点为主要不良心皿管事件（心源性死亡、非致命性心肌梗死、靶血管再次血运重建的联合终点）。结果截止至2009年12月的随访结果显示服用氯吡格雷1年组和2年组的主要不良心血管事件发牛率分别为4．3％和4．7％,P=0．80。结论置入DES术后延长双联抗血小板治疗时间至2年相比1年并未降低主要不良心血管事件。     

经关节突减压植骨内固定术治疗胸腰段椎间盘突出症疗效观察

目的观察后路经关节突减压植骨融合固定术治疗胸腰段椎间盘突症的临床疗效。方法对16例胸腰段椎间盘突出症患者进行后路经关节突切除减压植骨融合内固定术治疗,采用日本骨科协会(JOA)评分法及Otani评分系统评定手术疗效。结果所有手术均顺利完成,平均手术时间175.2 min;术中平均出血量630.5 mL;术中3例患者因硬膜撕裂发生脑脊液漏,给予缝合及修补后愈合。JOA评分由术前的(6.3±2.0)分,恢复为术后3个月的(9.2±2.8)分以及末次随访时的(9.6±3.1)分,神经功能改善率达70%;术后随访15~32个月,随访期间无内固定物松动、移位及脊柱不稳发生;末次随访时根据Otanni评分获优8例,良4例,可3例,差1例,优良率为75%。结论后路经关节突减压植骨内固定术作为治疗胸腰段椎间盘突出症的一种有效术式,在脊髓获得充分减压的同时能有效维持脊柱的稳定性。