新型颈椎3D打印多孔椎间融合器的三维有限元分析

背景:颈椎前路椎间盘切除减压融合内固定已成为目前临床上常用的手术,但是传统融合器的上下弧度难以与上下终板保持完全一致,容易引起椎间融合器沉降等一系列相关并发症,作者所在课题组研究出与上下终板保持一致的新型颈椎3D打印多孔椎间融合器.目的:通过三维有限元分析法评价新型颈椎3D打印多孔椎间融合器的力学特点,为临床应用和进一...     

后路椎体间植入物固定植骨融合治疗腰椎滑脱症

目的：对后方入路椎体间植入物固定植骨治疗腰椎滑脱症的临床应用进行初步报告,探讨此项技术的手术要点和早期临床效果。方法：自１９９６年１月至１９９８年３月,对２１例腰椎滑脱患者行后方入路椎体间植入物固定植骨融合、椎弓根螺钉内固定。随访１０个月～３年１个月,平均２年３个月。结合临床症状改善程度、工作能力和Ｘ线片上植骨融合程度综合进行疗效评定。结果：疗效优１６例,良３例,可２例,优良率９０．４％。结论：从一个切口入路行椎体间植入物固定植骨融合、椎弓根螺钉内固定术,能对前柱和后柱同时起稳定作用,有利于滑脱的复位和维持正常的腰椎前凸,符合腰椎的生物力学要求。     

椎体间螺纹融合器在下腰椎融合的应用

目的：报道应用椎体间螺纹融合器（ｔｈｒｅａｄｅｄｆｕｓｉｏｎｃａｇｅ,ＴＦＣ）治疗下腰椎疾病的临床结果,并对其适应证、融合方式、并发症防治进行讨论。方法：回顾分析了４８例应用ＴＦＣ治疗腰椎不稳或滑脱患者的临床资料。单纯ＴＦＣ融合２６例,ＴＦＣ＋节段性内固定２２例;后路椎间融合４４例,前路椎间融合３例,侧前路椎间融合１例。结果：术后经６～２１个月随访,临床疗效优良率９２％（优７９５％,良１２．５％）,骨融合率９８％,伤口感染１例,短时神经功能障碍２例。结论：ＴＦＣ融合术是治疗下腰椎不稳或滑脱的一种有效手段。     

RF与圆柱状自体骨块椎间融合治疗脊椎滑脱

目的：探讨ＲＦ椎弓根螺钉系统与圆柱状自体骨块椎间植骨融合治疗脊椎滑脱的方法。方法：对２３例脊椎滑脱症患者的神经受压部位针对性地彻底减压,并用ＲＦ椎弓根螺钉系统对滑脱的脊椎进行复位固定,恢复脊椎的正常解剖结构,自髂嵴后部取圆柱状骨块嵌入椎间植骨。结果：术后随访６个月～５年８个月,平均３年６个月;滑脱复位８０％～１００％;４个月后均达骨性愈合,无固定螺钉松动、断裂及再滑脱现象。结论：ＲＦ椎弓根螺钉系统固定与圆柱状自体骨块椎间植骨融合治疗脊椎滑脱可有效减少固定螺钉松动、折断及再滑脱等并发症。     

仿真椎管镜诊断腰椎间盘突出症的初步探讨

目的：寻找一种能在椎管内直视观察椎间盘突出变化的有效方法,进而指导治疗。方法：在椎管内注射造影剂后使用ＣＴ扫描,应用Ｎａｖｉｇａｔｏｒ等软件处理,形成椎管内的动态三维图象。通过仿真镜头的移动来观察椎管、椎间盘、马尾神经及神经根孔的变化,分析仿真椎管镜下椎间盘突出的特点。结果：临床观察２４例患者全部经过手术证实,仿真椎管镜可从椎管内清楚地观察到椎管内的形态,椎间盘突出的状态,尤其是神经根管及硬膜外压迫的立体形态。结论：仿真椎管镜能有效地诊断椎间盘突出,特别对马尾神经压迫和根管压迫的观察明显优于脊髓造影和ＣＴＭ检查,是诊断椎间盘突出症并能推测预后的一种有效方法。     

Can autologous bone culture predict spinal fusion capacity?

The capacity of the individual patient to initiate osteoblast proliferation as a predictor for successful lumbar spinal fusion has not yet been reported. The objectives of this study were, first, to analyze the relationship between in vitro osteoblast proliferation and clinical bony fusion in the individual patient in order to predict the fusion outcome and, second, to measure the effect of preoperative tobacco smoking on osteoblast proliferation. Sixty-one patients (mean age 46 years) underwent posterolateral lumbar fusion in the period 1994–1995. Thirty-eight patients received CD pedicle screw implants and 23 received posterolateral fusions alone. During surgery, autogenous iliac bone was harvested and 1 g of trabecular bone without blood or bone marrow was then isolated for cell culturing. The cultures were classified as excellent (confluence within 4 weeks), good (confluence between 4 and 6 weeks) and poor (no or poor growth). Spine fusion was evaluated by two independent observers from plain anterior-posterior, lateral, and flexion/extension radiographs taken 1 year postoperatively, and the functional outcome was measured by the Dallas Pain Questionnaire (DPQ). Twenty-three patients had excellent, 19 good, and 19 poor in vitro osteoblast proliferation. Bony fusion was obtained in 77% of patients: 83% in the CD instrumentation group and 70% in the non-instrumentation group (NS). There was no significant correlation between osteoblast proliferation and spinal fusion or functional outcomes when analyzing the CD instrumentation and non-instrumentation groups together or separately. Elderly patients had a significantly poorer osteoblast proliferation than younger patients (P < 0.008). Preoperative tobacco consumption had no discernible effect on osteoblast proliferation, and no correlation between smoking and fusion was found. Further refinement of autologous osteoblast culturing may provide a biological tool for selection of patients who require biological enhancement of their bone fusion capacity. The poorer osteoblast proliferation related to advanced age supports the important negative biological influence of age on bony fusion. However, with more sensitive testing and better discrimination, other results are possible – or can in any event not be excluded. Received: 17 April 1998 Revised: 10 September 1998 Accepted: 12 October 1998     

旋转对实验性颈椎间盘突出影响的研究

目的采用几种常用的旋转手法观察对实验性颈椎间盘突出的影响。方法将制成颈椎间盘突出模型的尸体标本固定在生物材料实验机（ＭａｔｅｒｉａｌＴｅｓｔＳｙｓｔｅｍ）上,在不同牵引重量和旋转角度作用的同时,观察突出髓核的变化情况。结果在各种实验状态下旋转颈椎标本时,突出的髓核均无明显地增大。结论适度的旋转手法对无明显退变的患者是比较安全的。     

肌电图检查对颈椎间盘突出症的诊断价值

目的：颈椎间盘突出症为临床常见病,为准确定位依断,我们采用由单一脊神经后支支配的颈棘间肌等颈部深层肌群肌电图检查法,对颈椎间盘突出症患者进行定位诊断。方法：对３４例经临床和影学检查确认为颈椎间盘突出的患者,进行颈部深层肌肌电图测定。结果：与临床及影像学诊断的符合率９７％。颈部深层肌异常电位３３例,其中失神经电位２８例,阳性率８２．３％。Ｃ５－６椎间盘突出为其肌电图异常电位发生率也最高。结论：异常电     

腰间盘突出物上摘除切式的改进及其意义

目的：搪塞腰间盘突出症术后腰膜囊、神经根前方粘连受突出物上切口的影响。方法：对１１７例患者采用改良和传统两种切式,并经肉眼观察、比较。结果：切口改进后,局部光滑,无宽大腔隙与会传统切式不同。结论：改进切口对预防或减轻硬膜囊前方粘连可能有一定价值。     

轴位牵引下直腿抬高试验在腰椎间盘突出切吸术中的应用价值

目的 在术前区别可逆性及不可逆性腰椎间盘突出症,明确经皮穿刺椎间盘切吸术适应证,提高ＡＰＬＤ手术优良率。方法 将轴位牵引下直腿抬高试验引入ＡＰＬＤ术前检查中,将８６例适合ＡＰＬＤ患者分为应用ＡＴ－ＳＬＲＴ前,后两组进行疗效比较。结果 应用ＡＴ－ＳＬＲＴ前组手术优良率９０．６％,应用ＡＴ－ＳＬＲＴ后组优良率１００％。结论ＡＴ－ＳＬＲＴ能为ＡＰＬＤ术前筛选,预测ＡＰＬＤ术后疗效提供较准确的参考依据,具