椎弓根定位在治疗胸腰椎骨折中的临床意义

目的参照椎弓根解剖标志定位，利于椎弓根螺钉准确置入，达到脊柱后路钉棒系统连接内固定器，以有效治疗胸腰椎骨折。方法传统手术方式：暴露椎板、椎弓根生理窝、关节突、副突、横突，于椎弓根生理窝外缘咬平骨皮质，用椎弓根锥经咬平的皮质处与椎体终板平行呈内倾10°～15°角钻入椎弓根，到达椎体中央前中柱，置入椎弓根螺钉与连接器固定。结果23例胸腰椎骨折手术病人，共138个椎弓根定位和椎弓根螺钉内固定。CR片结果显示：定位准确，达到预先设计定位要求。结论尽管有C臂引导定位，但参照椎弓根解剖标志定位仍有现实的临床应用意义。     

心电采集盒联合智能手机应用于PICC导管头端定位的效果评价

目的将心电采集盒联合智能手机应用于PICC导管头端定位,以期提高PICC导管头端的1次到位率。方法将180例行PICC置管的患者随机分为对照组和观察组,对照组采用超声引导结合MST下的PICC置管后拍X片确定导管头端位置,观察组在超声引导结合MST下的PICC置管时采用心电采集盒联合智能手机观察P波形态变化引导置管然后再拍X片确定导管头端位置。结果观察组PICC导管头端1次到位率为97.8%,显著高于对照组的90.0%(P0.05);2周内2组静脉炎发生率差异无统计学意义;观察组患者满意度为98.9%,显著高于对照组的91.1%(P0.05)。结论采用心电采集盒联合智能手机应用于PICC导管头端定位,不仅可提高PICC导管头端一次性到位率,减少医疗花费,而且可提高患者满意度,值得在临床推广。     

颈胸上段食管癌两种固定方式放疗摆位误差的对比研究

目的利用锥形束CT(CBCT)研究颈、胸上段食管癌使用颈肩膜、体膜两种固定方式放疗时的摆位误差,为临床治疗更优选择提供依据。方法随机选取66例拟行放射治疗的颈、胸上段食管癌患者,平均分成A、B两组。A组定位时采用热塑颈肩膜固定,B组采用热塑体膜固定。利用CBCT对每位患者首次治疗前摆位误差进行测量,然后使用SPSS17.0软件统计分析。结果 A组在左右(X)、头脚(Y)、前后(Z)方向上测量的摆位误差分别为(0.20±0.14)、(0.15±0.15)、(0.23±0.15)cm,而B组为(0.16±0.13)、(0.24±0.16)、(0.18±0.12)cm,A组误差数据优于B组,特别在头脚(Y)轴差异有统计学意义(P0.05)。结论颈肩膜固定技术可以减少颈、胸上端食管癌患者放疗中的摆位误差,操作简便易行,值得临床进一步推广应用。     

Accuracy of Implant Positioning for Minimally Invasive Total Knee Arthroplasty in Patients With Severe Varus Deformity

Minimally invasive surgery (MIS) in total knee arthroplasty (TKA) reportedly yields decreased patient morbidity and a rapid return of function, but how much deformity can be accepted for MIS-TKA remains unclear. This study investigated 238 knees from 218 consecutive patients who underwent MIS-TKA. Patients were divided into groups with tibiofemoral mechanical axis (TFM) 195° or greater and TFM less than 195°, then clinical and radiographic results were compared. Similar improvements in knee score at 3 months postoperatively were obtained in the both groups, whereas radiographic accuracy of the coronal alignment in the TFM ≥195° group was inferior to that in TFM <195° group. Postoperative TFM was significantly worsened in patients with lateral bowing angle of the femoral shaft (LBFS) 4° or greater, and 53% of patients in the TFM ≥195° group displayed LBFS 4° or greater, explaining the inferior radiographic accuracy in this group compared with the TFM <195° group. These results indicate that use of MIS techniques decreases radiographic accuracy, particularly in patients with severe genu varum and increased LBFS.     

The impact of intra-operative sternum vertical displacement on the sagittal curves of the spine

Patient positioning is an important step in spinal surgeries. Many surgical frames allow for lumbar lordosis modulation due to lower limb displacement, however, they do not include a feature which can modulate thoracic kyphosis. A sternum vertical displacer (SVD) prototype has been developed which can increase a subject’s thoracic kyphosis relative to the neutral prone position on a surgical frame. The kyphosis increase is obtained by lifting the subject’s torso off the thoracic cushions with a dedicated sternum cushion that can be displaced vertically. The objective of this study was to evaluate the impact of SVD utilization on the sagittal curves of the spine. Experimental testing was performed on six healthy volunteers. Lateral radiographs were taken in the neutral and sternum raised positions and then analyzed in order to compare the values of sagittal curves. The displacement of volunteers and surgical frame components between positions was recorded using an optoelectronic device. Finally, interface pressures between the volunteers and surgical frame cushions were recorded using a force sensing array. Average results show that passing from the neutral to sternum raised positions caused an increase of 53% in thoracic kyphosis and 24% in lumbar lordosis; both statistically significant. Sensors showed that the sternum was raised a total of 8 cm and that interface pressures were considerably higher in the raised position. The SVD provides a novel way of increasing a patient’s thoracic kyphosis intra-operatively which can be used to improve access to posterior vertebral elements and improve sagittal balance. It is recommended that its use should be limited in time due to the increase in interface pressures observed.     

模拟机对宫颈癌放射治疗摆位误差的研究

目的探讨盆腔源轴距照射的宫颈癌患者在治疗过程中的误差。方法选择首次放疗的宫颈癌患者20例,仰卧位,照射野侧缘在股骨头内1/3,根据肿瘤的范围上界在髂棘（腰椎4,5）水平,下界在耻骨联合下缘。将中心定为体厚的一半,根据射野灯在皮肤上的投影用画皮液描出射野方框,并在模拟机上采集照射野的定位图像,输入TPS制定放疗计划,然后实施治疗。放疗期间每1～2周在模拟机上按治疗条件复位,将验证体位重复性的校野图像与初次计划时的定位图像进行比较。结果通过20例患者的64次重复校野图像和初次定位图像的对比,得出同一解剖骨性标志点在X,Z轴方向上的位移值分别为（10.20±2.6）mm,（7.10±1.3）mm。结论利用模拟定位多次重复摆位采集校野图像来研究宫颈癌治疗过程中的摆位误差是简便、可行的。     

快速成型胸椎个体化导航模板精确度实验研究

目的：观察快速成型胸椎个体化导航模板的精确度,为快速成型个体化导航模板的临床使用提供参考。方法：选取12个完整的胸椎干燥骨标本,根据其CT扫描资料,利用计算机辅助设计及快速成型技术设计制作出相应的胸椎模型及个体化导航模板,通过个体化导航模板在胸椎标本及其模型上应用直径2．0mm的钻头模拟椎弓根螺钉置钉手术,直视观察钻头在椎弓根及椎体内的位置及走行方向。用精确度为0．02mm的游标卡尺对快速成型胸椎模型的精确性进行测量。结果：个体化导航模板和相应的胸椎标本及其模型后部解剖结构之间轮廓一致,贴附吻合良好,置入椎弓根进钉通道的钻头均完全位于椎弓根及椎体内,其走行方向和椎弓根的走行方向一致;所有胸椎模型和相应胸椎标本的解剖形态完全一致,胸椎标本和模型之间的误差范围在（0．49±0．28）mm之间。结论：虽然快速成型模型与实物之间有一定的误差,但其误差不影响对椎弓根准确定位及定向的精度要求。     

坐标定位划痕法在研究“细胞创面”愈合率中的应用

目的：改良传统“细胞创面”模型的制备方法,提高对“细胞创面”愈合率的统计的精确性。方法：在6孔板每一孔外底面用刀尖划上横纵坐标轴,用绿色记号笔在横轴的上、下方平行于横轴各画5条等距离的绿带。接种目的细胞,待其长满内表面时用1000μl微量移液器的吸头在纵轴的左、右平行于纵轴各划2条等距离的细胞缺损带。在观察时间点观察绿带与细胞缺损带重叠形成的“矩形区域”的宽度或面积,计算愈合率。结果：可以特定追踪观察每个“矩形区域”内“细胞创面”愈合率情况,且“矩形区域”的例数可以符合统计学要求。结论：坐标划痕法是一种较精确统计“细胞创面”愈合率可行的方法。