2003′中国济南国际骨科（脊柱、关节）新进展研讨会暨学习班纪要

2003′中国济南国际骨科(脊柱、关节)新进展研讨会暨学习班于2003年3月12日至16日在山东省济南市举行。来自日本、台湾、香港的代表与中国大陆代表一起就脊柱外科与关节外科基础和临床等方面的最新进展进行了交流和讨论，还进行了现场手术演示。专题报告涉及上颈椎外科、颈椎病、腰椎间盘突出症、骶骨肿瘤、骨质疏松性骨折椎体成形、脊柱     

骨赘性吞咽困难的研究进展

引起吞咽困难的疾病较多．主要有食管癌、贲门痉挛、食管憩室症、弥漫性食管痉挛症、骨赘性吞咽困难等。骨赘性吞咽困难主要是由于颈椎间盘前突、椎体前缘骨赘、韧带钙化等颈椎退行性变直接压迫或刺激食管．导致吞咽时出现异物感或不畅等症状。也有学者称之为食管型颈椎病。由于非专业医师对本病认识不够或尚未认识，误诊率高达80％～90％以上。     

俄式内置脊柱矫正器治疗脊椎滑脱新技术

介绍俄式内置脊柱矫正器的构成及操作要点。上矫正器由椎板下金属钩、梳子钢叉及螺杆、螺母组成。可同椎板减压、椎间盘髓椎摘除术同时进行。认为脊椎滑脱无症状出现可不必治疗，经保守治疗无效，继续发展时应积极手术来建立脊柱的稳定和神经根减压，此项技术是治疗脊椎滑脱的一种新方法，便于临床推广。     

椎体松质骨的三维构筑学初步探讨

目的研究骨量和橙质骨显微结构的变化，与骨质疏松症骨折发生之间的关系。方法研究采用相对较为成熟的螺旋CT扫描三维重建，并借助工程学上的Euler定律，以活体无创三维成像方法，对小梁骨的结构和连接性作了观察和分析。结果随着年龄的增长，横向排列的骨小梁逐渐消失，纵向骨小梁变细，与周围的小梁逐步失去其连接性。二维横斯面图像在小梁连接性描述上有一定的局限性．这是因为小梁骨在垂直方向的走向并非是那幺有规律。由于松质骨的显微结构具有不同的类型．它们之间不能等同比较；结论三维结构连接性和连接密度的结果显示：板状型的小粱具有较高的连接密度和较小的连接性；而杆状型的小粱则连接密度较低和连接性较好。     

脊柱侧后凸畸形截骨矫形术的护理体会

脊柱侧后凸畸形表现为脊柱节段性后方及侧方成角畸形,其成因为椎体的先天性发育异常,分为Ⅰ型(椎体形成不良)、Ⅱ型(椎体分节不良)及Ⅲ型(混合型,椎体形成不良与分节不良同时存在)。Ⅲ型少见,其中Ⅰ型常易导致脊柱受压及截瘫。     

成人腰椎峡部裂型滑脱症的微创治疗

Objective To investigate the clinical experiences and technical skills of adult isthmic spondylolisthesis. Methods Twenty-one patients with adult isthmic spondylolisthesis underwent minimally invasive surgery. There were 12 men and 9 women, with the mean age of 51.7 years. Isthmic spondylolisthe-sis occurred at the L4.5 in 7 patients, and at the L5S1 in 14 patients. According to Meyerding classification, 13 cases were of Grade Ⅰ, 7 of Grade Ⅱ, 1 of Grade Ⅲ. Under general anesthesia, guiding by fluoroscopy, the surgeries performed minimally invasive microendoscopic(METRx) techniques for posterior decompression, interbody cage fusion and novel Sextant-R percutaneous pedicle screw techniques for deformity reduction and fixation. Results Seventeen cases were followed up 1 year postoperatively. The average low back pain VAS reduced from preoperative 6.0±2.6 to postoperative 2.9±2.5. The average leg pain VAS decreased from preoperative 6.7±3.3 to postoperative 2.8±1.6. The average ODI decreased from preoperative 44.3% to post-operative 27.1%. The Nakai good and excellent rate was 90%. The mean operative time 170 min, blood loss 160 ml, and postoperative stay in bed 7.5 d. The sagittal spondylolisthesis rate significantly decreased from preoperative 35.5%±2.5% to postoperative 8.3%±7.5%. The lordotic angle from preoperative 11.5°±1.7° in-creased to postoperative 16.8°±9.5°; the intervertebral disc height from preoperative (5.4±2.5) mm increased to postoperative (9.1±3.0) mm. According to Lenke judgement for fusion, complete fusion rate was 76%, in-complete fusion rate was 12%, nonfusion rate was 12%. Conclusion The minimally invasive microendo-scopic (METRx) assisted with a novel Sextant-R percutaneous pedicle screw systems for deformity reduction and fixation to treat adult isthmic spondylolisthesis, is not only a minimally invasive and safe surgical tech-nique, also an effective treatment for deformity reduction and fixation.     

360°环状减压、固定重建术治疗T4椎体血管瘤一例报告

患者 男，15岁。因双下肢麻木无力、行走不稳2个月，加重1周入院。查体：脊柱无畸形，活动无明显受限，T4棘突累压痛、叩击痛阳性。[第一段]     

椎体强化的生物力学回顾(上)

介绍：骨质疏松的椎体其强度和刚度都会降低，这就意味着椎体的破坏负荷与抵抗压缩变形的能力均降低。强度和刚度的降低量与骨质疏松的严重程度呈正比。因为这些特性与骨小梁的密度有很大的相关性。椎体压缩性骨折后强度和刚度值与骨折前相比进一步降低。其临床结果是：（1）骨质疏松导致椎体强度降低，继而导致最初的骨质疏松性骨折，骨折后的椎体有进一步压缩性骨折的倾向。[第一段]     

防止颈椎前路手术对脊髓与神经根的损伤

我院为颈椎病患者施行颈椎前路减压与椎体间融合术60例,其中遇到3例椎体后缘、椎间盘组织与后纵韧带紧密粘连,使手术操作颇感棘手,有2例发生轻度的脊髓与神经根损伤,现将经验与教训报道如下。 1 病例资料例1 男性,62岁。双上肢及右下肢麻