顶椎区多棒矫形联合远端脊柱后柱截骨治疗重度特发性脊柱侧凸的疗效分析

目的 探讨顶椎区多棒矫形联合远端脊柱后柱截骨术（posterior column osteotomy,PCO）治疗重度特发性脊柱侧凸的临床疗效及安全性。方法 回顾性分析我院2014年2月至2020年2月行后路手术、随访时间超过2年的重度特发性脊柱侧凸（Cobb角≥90°）病人共48例,所有病人均行远端PCO截骨,依据矫形情况分为顶椎区多棒矫形组（21例）和传统双棒矫形组（27例）,在术前、术后和末次随访时进行影像学和脊柱侧凸研究学会-22简明量表调查问卷（Scoliosis Research Society questionnaires-22,SRS-22）评估,比较两组的影像学参数、手术时间、出血量和并发症等,分析其疗效和安全性。结果 双棒矫形组随访（37.2±8.8）个月,多棒矫形组随访（31.6±7.6）个月。传统双棒矫形组手术时间为（430.8±79.1） min,长于多棒矫形组的（331.2±97.3） min,差异有统计学意义（P=0.037）。两组病人术后冠状面和矢状面参数均较术前显著改善,差异有统计学意义（P＜0.05）。末次随访时,多棒矫形组的矢状面矫形丢失显著高于双棒矫形组（3.7°±0.9° vs. 2.3°±1.0°）,椎弓根螺钉拔出发生率显著低于双棒矫形组（4.8% vs. 29.6%）,差异有统计学意义（P＜0.05）。结论 与传统双棒比较,顶椎区多棒矫形技术联合远端PCO截骨具有相似的矫形效果,手术流程更简便,术中螺钉拔出率低,对于重度特发性脊柱侧凸,是一种安全有效的手术方法,但矢状面矫形丢失需要长期随访关注。     

Evaluation of the Avoximeter: precision, long-term stability, linearity, and use without heparin

Objectives. Because the AVOXimeter uses disposable cuvettes and makesits measurements directly in whole blood without first hemolyzing the sample,it does not need the care and maintenance that conventional co-oximetersrequire, it operates faster than conventional co-oximeters, and it is lessexpensive. Therefore, the objectives of this study were (1) to evaluate theprecision and linearity of the AVOXimeters measurements of totalhemoglobin concentration and oxyhemoglobin saturation; (2) to assess itslong-term stability and thus the required interval for re-calibration; (3) todetermine whether measurements can be made without anticoagulants; and (4) toassess the feasibility of storing blood samples in the disposable cuvettes.Methods. Measurements made by the test instrument were compared withthose of conventional co-oximeters or with standardized hemoglobin solutions.Blood samples were also collected with and without heparin to determinewhether anticoagulation is necessary. Results. Our tests confirmed thespecified precision of 0.3 g/dl for total hemoglobin and 0.5% foroxyhemoglobin. The results also showed that these measurements were linearwhen compared with a conventional co-oximeter, and they were consistent withthe specified accuracy of 0.45 g/dl for total hemoglobin and 1% foroxyhemoglobin. Weekly checks with control solutions showed that the instrumentholds its calibration for a year or more. Although treating syringes withheparin caused dilution errors, heparin did not affect the measurements whendilution was avoided. When blood samples were placed in disposable cuvettesand read repeatedly at 1-min intervals for 20 min, the readings driftedappreciably away from the original value. This drift occurred so slowly thatreadings taken at the first and second minute after the cuvette was filledwere within 1 or 2% of the original reading. Conclusions. In ourexperience, the test instrument was simple and easy to operate. It met thespecifications for precision and accuracy, its measurements were highlylinear, and it maintained a stable calibration for one year. If the cuvettesare filled as soon as blood is drawn, anticoagulation is unnecessary. However,the cuvettes should be read with 1 min of filling the cuvette.     

Irreducible traumatic posterior dislocations of the hip

Posterior dislocation is the most common form of traumatic dislocation of the hip. It is usually the result of severe force applied to the flexed knee of a sitting occupant of a car involved in a high-speed accident. Closed reduction is usually successful; however, failed or irreducible dislocations occur in 3–16% of patients and may be complete or incomplete. We discuss three patients in whom closed reduction was unsuccessful, each with a different cause: buttonhole tear of the posterior capsule, interposition of the piriformis muscle, and dislodgement of an osteocartilaginous fragment into the hip joint.     

Toward Next Generation Clinical Diagnostic Instruments: Scaling and New Processing Paradigms

Looking toward future clinical diagnostic instruments, there is little debate as to the features that need improvement over the current state-of-the-art. Increasing the speed and sensitivity of the assays, while reducing costs are clear goals. Recently, it has become possible to microminiaturize fluidic and sensing components using micromachining and precision injection molding. There has been a large amount of interest and effort in the area of miniaturization of such systems, yet not all of the properties of fluidics and sensing methods improve as they are drastically reduced in size. It is clear that implementing miniaturized diagnostic instruments is not a matter of simply shrinking their conventional counterparts, nor of automating existing manual procedures. What is required to harness the full potential of scaling technologies is the use of design methods that take into account scaling effects and the development of completely new processing approaches. Beginning with a general overview of the relevant scaling principles, sample preparation and detection approaches are addressed in this context.     

Apical limit of root canal instrumentation and obturation, part 2. A histological study

The results of an in vivo histological study involving apical and periapical tissues following root canal therapy after different observation periods demonstrated the most favourable histological conditions when the instrumentation and obturation remained at or short of the apical constriction. This was the case in the presence of vital or necrotic pulps, also when bacteria had penetrated the foramen and were present in the periapical tissues. When the sealer and/or the gutta-percha was extruded into the periapical tissue, the lateral canals and the apical ramifications, there was always a severe inflammatory reaction including a foreign body reaction despite a clinical absence of pain.     

Surgical treatment of posterior cruciate ligament and posterolateral corner injuries. An anatomical, biomechanical and clinical review

The posterior cruciate ligament has become an increasingly popular subject of orthopaedic research and debate. While biomechanical studies have shown its role as major stabilizer of the knee, clinical studies have shown its increasing incidence. Furthermore, injuries to posterolateral structures are frequently encountered and failure to recognize and treat this associated injury may lead to stretching or failure of the cruciate reconstruction. Surgical reconstruction of isolated/combined injuries is now more effective than before and different technical options are now available for the surgeon, even if much work remains ahead of us as we try to understand how to successfully treat these complex knee injuries.     

脊髓夹持型颈椎病前后路手术的疗效分析

目的分析颈前后路手术治疗脊髓夹持型颈椎病的疗效.方法回顾我院15年来收治脊髓型颈椎病306例,其中脊髓夹持型34例,27例前路减压植骨融合,7例后路椎管扩大,全部病例获得随访.按照JOA评分评定术前和术后神经功能状态.结果前路减压植骨融合27例,优14例,良5例,好转8例,优良率70%.后路椎管扩大7例,优2例,良1例,好转4例,优良率40.3%.结论颈前路减压植骨融合,直接解除脊髓前方的压迫,应作为首选术式.对于多节段(3个节段以上)病变或合并连续型后纵韧带钙化、黄韧带肥厚或合并发育性颈椎管狭窄,仍宜选择后路椎管扩大减压或二期前后路减压术.     

颅后窝内外面有关骨性结构的应用解剖学研究

目的:研究与斜坡区、桥小脑角区、及颈静脉孔外侧区手术入路有关的骨性结构,探讨其定位解剖和临床意义。方法:20具干性成人头颅标本,移去颅盖骨,观察、测量颅后窝内外面有关骨性结构。结果:硬脑膜窦角(STP)点距内耳门距离左侧(32.99±2.72)mm、右侧(37.84±2.58)mm,距颈静脉孔距离左侧(35.27±3.25)mm、右侧(34.63±3.25)mm。颈静脉孔上方约5mm为内耳门,下方约20mm为舌下神经管内口,前方为斜坡区。内耳门、颈静脉孔、舌下神经管内口三者近似在一条直线上。乳突尖距颈静脉孔距离左侧(22.62±1.90)mm、右侧(22.33±2.30)mm,距枕髁后外缘距离左侧(29.42±2.15)mm、右侧(29.08±2.29)mm,距枕大孔距离左侧(39.39±2.03)mm、右侧(38.47±1.96)mm。结论:STP点、颈静脉孔、内耳门是颅后窝内面重要骨性结构,乳突是颅后窝底外侧一个重要骨性标志结构;STP点、内耳门、颈静脉孔、乳突尖可作为颅后窝手术重要的定位标志。     

Vestibulo-ocular reflex from the posterior canal nerve to extraocular motoneurons in the cat

Summary In the anesthetized cat, the posterior canal nerve (PCN) was stimulated by electric pulses and synaptic responses were recorded intracellularly in the three antagonistic pairs of extraocular motoneurons. Pure reciprocal effects were obtained in the motoneurons innervating the antagonistic pair of ipsilateral oblique muscles and the antagonistic pair of contralateral vertical rectus muscles. These responses consisted of low threshold disynaptic excitatory postsynaptic potentials (EPSPs) in either the contralateral superior oblique (c-SO) (trochlear) or contralateral inferior rectus (c-IR) motoneurons and of disynaptic inhibitory postsynaptic potentials (IPSPs) in either the ipsilateral inferior oblique (i-IO) or ipsilateral superior rectus (i-SR) motoneurons. In addition, disynaptic IPSPs were also found in (i-SO) motoneurons. Mixtures of low threshold (dior trisynaptic) EPSPs and IPSPs were found in all other extraocular motoneurons except for the contralateral lateral rectus (c-LR) motoneurons. These results may afford a basis for the characteristic eye movements induced by vertical canal nerve stimulation.