腰椎滑脱内固定术后并发症的分析

目的 回顾后路椎管减压，器械复位内固定术治疗腰椎滑脱的临床效果．探讨主要并发症的发生原因及应对措施。方法 回顾分析1997年1月～2002年12月间收治的190例采用后路椎管减压、器械复位内固定治疗的腰椎滑脱病例的手术及术后随访情况。男65例，女125例；年龄34～87岁．平均56．3岁．单节段滑脱175例．双节段滑脱15例。Ⅰ度滑脱148例(779％)．Ⅱ度滑脱42例(221％)，结果 190例中35例患者术后6个月后失随访，其余155例平均随访时间17.2个月(7～61个月)，190例患者术后6个月时滑脱节段维持解剖复位，后外侧植骨融合良好。围手术期并发症：硬膜撕裂1例，伤口并发症(感染、脂肪液化、不愈合)5例，切口血肿3例．术后一过性下肢神经症状13例．术后疼痛14例。远期并发症：持续下腰痛11例．持续下肢神经症状5例．内固定失败5例，假关节形成3例。6例接受翻修手术。结论 腰椎滑脱的后路复位内固定具有较好的临床效果，下肢神经症状、下腰痛及融合固定失败是主要并发症．应给予高度重视。     

腰椎后路单节段椎弓根螺钉内固定的三维有限元分析

目的 建立腰34节段的后路经椎弓根螺钉内固定的有限元模型,评估固定前后系统的应力变化,探讨后路内固定对腰椎和内固定器械的力学影响.方法 利用Pro/E三维建模软件模拟脊柱后路的钉棒内固定系统,MIMICS软件模拟手术实际操作,建立后路经椎弓根螺钉固定前后的腰3-4节段三维实体,导入有限元软件ABAQUS中建立三维有限元模型.采用腰4椎体做收敛性分析,建立5种不同网格划分数目的 腰4模型进行验证.分析椎体和螺钉系统在0.5 mPa轴向压力下的力学变化.结果 在均布压力下,腰4模型位移为0.00125815 mm,与基准位移的误差只有0.8167%,模型收敛性好.在轴向压力作用下,固定后的椎体、椎间盘和内固定的应力发生明显变化,椎间盘的应力集中部位由后外侧转向前外侧,固定椎体产生的应力明显减小,应力遮挡效应明显.螺钉根部的上下方,存在着明显的应力集中,且上一椎体固定的螺钉要比下一椎体的螺钉承受应力大.结论 利用计算机辅助系统和有限元分析结合的方法 ,可以模拟腰3-4节段后路椎弓根内固定手术,较直观地观察脊柱后路固定前后系统的力学变化.     

矫形支具对青春期特发性脊柱侧凸的治疗价值

青春期特发性脊柱侧凸（简称AIS），按照SRS（ScoliosisResearchSoci-ety）的定义，是指10岁以上，骨骼发育未成熟期间，脊柱向侧方弯曲>10°的脊柱畸形。它是引起脊柱畸形的最常见原因，对美国10～16岁青少年进行调查其发生率为1%～3%[1]。国内分别对北京、天津两地中小学生脊柱侧凸的患病率做了调查，结果分别为1.06%[2]和1.9%[3]。如何防止轻、中度的AIS进一步加重，是广大脊柱外科医生和矫形医生所面临的实际问题。应用矫形支具治疗AIS经历了一个艰难曲折的历程，目前人们普遍认为矫形支具可以有效地控制AIS的发展。一、AIS的…     

内固定应用于脊柱结核治疗的安全性探讨

Objective To investigate the efficiency and safety of instrumentation to treat spinal tu-berculosis. Methods Fifty-one patients of spinal tuberculosis were treated with one-stage or two-stage de-hridement, strut autografting, and anterior or posterior instrumentation with screw rod system, combined with one-year triple agents postoperative antituberculous chemotherapy from April 1985 to May 2005. There were 6 in cervical spine, 19 in thoracic spine, 16 in thoracolumbar spine and 10 in lumbosacral spine. The level of the lesion were 6 cases for single vertebrae, 30 for two vertebrae, 11 for three vertebrae and 4 for more than four vertebrae. All patients were given triple agents antituberculous chemotherapy at least two weeks before operation. The operative procedures included cervical anterior approaches in 6 cases for debridement, fusion and plate-screw fixation, upper lateral transthoracic procedures for debridement, fusion and screw rod fixation in 11, posterior debridement, fusion and transpedicular screw system fixation in 6, two-stage anterior and posterior operation in 18 cases. The instrumentation included 6 Luque, 3 Z-plate, 8 TSRH, 5 Ventrofix, 4 Kenada, 5 Moss-Miami, 6 Isola, 3 CDH, 2 Caspaz, 2 C-D, 1 Zielke, 1 Dick, 1 Oriell, 1 Ozion, 1 Zephir, 1 Tenor, and 1 USS. Results All patients were followed up prospectively for 3.2 to 23.5 years postoperatively. The back pain was obviously relieved postoperatively. Patients with neurological function deficiency im-proved. The solid fusion was achieved in all patients, except one patient due to tuberculosis recurrence. The major complication included one sinus formation and one case with temporary deterioration of neurological function, recovered with appropriate treatment. Average preoperative kyphosis angle was 34.17°, and that was 10.45° immediately after surgery. There was a 3.2° loss of kyphosis correction during follow-up period. Con-clusion Spinal tuberculosis treated with instrumentation is effective and safe.     

马凡综合征脊柱侧凸的手术治疗

目的探讨马凡综合征脊柱侧凸的临床表现和手术方法,评价其疗效.方法回顾性分析1990年1月～2002年11月手术治疗的马凡综合征脊柱侧凸患者10例.评价手术前后侧凸冠状面、矢状面Cobb角、躯干偏移、顶椎旋转度(Nash-Moe法)及顶椎偏距等的变化.结果全部病例术后随访时间4个月～3年,平均15个月.躯干偏移术前平均2.17(0.5～8.0)cm,术后平均1.41(0.5～3.5)cm;顶椎旋转度手术后平均改善1°;顶椎偏距术前平均4.57(1～8.1)cm,术后平均2.14(0～5.5)cm.侧凸主弯冠状面Cobb角术前平均88°(49°～110°),术后平均42°(10°～90°),矫正率为46.38%(18.18%～81.54%),最后一次随访平均46°(11°～96°),平均丢失4°.胸椎后凸术前平均20°(-10°～52°),术后平均23°(0°～35°),最后一次随访平均24°(0°～35°).5例胸腰段后凸畸形Cobb角由术前的平均后凸85°纠正至术后的平均后凸10°.共有3例发生了术后并发症,1例发生假关节予密切随访,1例出现右股前区皮肤麻木经对症治疗1周后消失,1例腰段失代偿者行后路翻修术后取得满意效果.结论马凡综合征脊柱侧凸易产生术后并发症,三维矫形器械可以对马凡综合征脊柱侧凸进行有效地矫正.手术治疗的要点是充分考虑矢状面畸形的矫形、注意腰段或腰骶段的硬脊膜扩张、良好的植骨融合以及术后确切的外固定.     

内固定应用于脊柱结核治疗的安全性探讨

Objective To investigate the efficiency and safety of instrumentation to treat spinal tu-berculosis. Methods Fifty-one patients of spinal tuberculosis were treated with one-stage or two-stage de-hridement, strut autografting, and anterior or posterior instrumentation with screw rod system, combined with one-year triple agents postoperative antituberculous chemotherapy from April 1985 to May 2005. There were 6 in cervical spine, 19 in thoracic spine, 16 in thoracolumbar spine and 10 in lumbosacral spine. The level of the lesion were 6 cases for single vertebrae, 30 for two vertebrae, 11 for three vertebrae and 4 for more than four vertebrae. All patients were given triple agents antituberculous chemotherapy at least two weeks before operation. The operative procedures included cervical anterior approaches in 6 cases for debridement, fusion and plate-screw fixation, upper lateral transthoracic procedures for debridement, fusion and screw rod fixation in 11, posterior debridement, fusion and transpedicular screw system fixation in 6, two-stage anterior and posterior operation in 18 cases. The instrumentation included 6 Luque, 3 Z-plate, 8 TSRH, 5 Ventrofix, 4 Kenada, 5 Moss-Miami, 6 Isola, 3 CDH, 2 Caspaz, 2 C-D, 1 Zielke, 1 Dick, 1 Oriell, 1 Ozion, 1 Zephir, 1 Tenor, and 1 USS. Results All patients were followed up prospectively for 3.2 to 23.5 years postoperatively. The back pain was obviously relieved postoperatively. Patients with neurological function deficiency im-proved. The solid fusion was achieved in all patients, except one patient due to tuberculosis recurrence. The major complication included one sinus formation and one case with temporary deterioration of neurological function, recovered with appropriate treatment. Average preoperative kyphosis angle was 34.17°, and that was 10.45° immediately after surgery. There was a 3.2° loss of kyphosis correction during follow-up period. Con-clusion Spinal tuberculosis treated with instrumentation is effective and safe.     

鸡松果体切除术后血清褪黑激素变化及其与脊柱侧凸发生的关系

特发性脊柱侧凸的病因至今不甚清楚,近年来,有些实验研究揭示,鸡松果体切除术后可导致脊柱侧凸。这一发现为揭示特发性脊柱侧凸的病因提供了新的启事。因为这种实验性脊柱侧凸的许多特点同样也发生在青少年特发性脊柱侧凸的过程中。松果体切除导致其产物即褪黑激素的减...     

肋骨结构性支撑植骨在脊柱侧凸前路矫形手术中应用的长期随访

[目的]评价肋骨结构性支撑植骨在青少年特发性脊柱侧凸前路矫形融合手术中应用的长期随访结果.[方法]回顾性分析术后随访时间超过4年的青少年特发性脊柱侧凸前路矫形手术病例30例,男3例,女27例;年龄12～ 17.5岁,平均14.3岁.侧凸类型包括PUMC Ⅰ b型5例、Ⅰc型5例、Ⅱd1型20例.全部病例均行前路矫形融合手术,植骨方式采用自体肋骨结构性支撑植骨.术前、术后及随访时摄脊柱站立位X线片,测量冠状面及矢状面Cobb角,并观察植骨融合情况,有无假关节形成及内置物并发症.[结果]随访4～10.2年,平均6.3年.融合弯冠状面矫形率术后平均为75.1％,末次随访时矫形丢失平均4.6°;固定融合节段冠状面矫形率术后平均为93.2％,末次随访时丢失平均2.1°;固定融合节段矢状面Cobb角术前与术后比较无显著性差异,末次随访时矫形丢失平均3.1°.13例胸腰段后凸患者术前后凸平均8.3°,术后矫正为前凸平均5.6°,末次随访时保持前凸平均3.7°.全部病例末次随访时均未见假关节形成或内置物并发症.[结论]肋骨结构性支撑植骨在青少年特发性脊柱侧凸前路矫形融合手术中能获得并维持良好的冠状面及矢状面矫形,且融合率高、远期矫形丢失少,是一种可靠、有效的植骨方法.     

初次全膝关节置换术后并发症及翻修手术的原因分析

目的 探讨初次全膝关节置换术后30 d内相关并发症发生情况及翻修手术的相关因素.方法 收集2001年1月至2012年12月在北京协和医院骨科进行初次全膝关节置换术患者的临床资料,假体均为固定平台假体,采用骨水泥固定,排除翻修病例及血友病关节炎患者.共有1 920例患者(2 779例次全膝关节置换手术)纳入研究,男性323例,女性1 607例;年龄25～86岁,平均(66±9)岁.骨关节炎1 720例(89.58％),类风湿关节炎168例(8.75％),强直性脊柱炎12例(0.63％),继发骨关节炎20例(1.04％).随访患者术后30 d内发生的主要系统并发症、局部并发症及发生的翻修手术及相关因素.结果 随访截至2013年12月,共有1 854例患者(2 693个关节)获得随访,失访率为3.44％.术后平均随访67个月,死亡3例.41例(2.21％)患者出现系统并发症,其中最常见的为呼吸系统并发症(0.49％,9/1 854)及心血管并发症(0.38％,7/1 854).术后经超声证实的症状性深静脉血栓形成发生率为3.02％ (56/1 854),其中7例发生肺栓塞.术后发生局部并发症24例(1.29％),包括伤口愈合不良、伤口感染、神经损伤.59个关节接受翻修手术治疗,常见原因包括感染后松动(1.19％,32/2 693)和术后关节僵硬(0.37％,10/2693).结论 初次全膝关节置换术后30 d内最常见系统并发症为呼吸系统及心血管系统并发症.感染后松动是术后翻修最常见的原因.