腰椎后路非融合固定系统的临床应用

复习腰椎后路非融合固定系统的设计原理、临床应用及治疗效果等相关文献,与传统的脊柱融合术相比,应用非融合系统可获得很好的疗效,并可以减少邻近节段退变的发生率。     

同种异体骨与自体骨移植治疗青少年脊柱侧凸的比较研究

[目的]观察同种异体骨移植与自体骨移植治疗青少年脊柱侧凸的临床效果.[方法]对1996～2006年本科收治的63例青少年脊柱侧凸患者的临床资料,采用回顾性"病例-对照"研究方法进行分析,A组(同种异体骨移植组)32例,10～15岁,平均12.2岁;Cobb's角38°～113°,平均62°;B组(自体髂骨移植组)31例,年龄9～14岁,平均12.4岁;Cobb's角41°～105°,平均54°.所有患者均选择中华长城椎弓根内固定系统经后路矫正,术后定期随访并对临床效果进行评估.[结果]出院后2个月即开始随访,随访时间18～24个月,平均26个月;亦无严重并发症发生;A组的手术时间、失血量较B组患者减少,组间具有统计学意义(P＜0.01).[结论]两组患者具有相似的临床效果,在严格掌握适应证,充分术前准备、正确手术操作、及时术后处理的前提下,同种异体骨移植能够有效替代自体髂骨移植治疗青少年脊柱侧凸.     

Surgical strategy of one stage surgery of anterior release combined with posterior correction in treatment of severe scoliosis

Objective: Severe scoliosis refers to scoliosis with serious and stiff curve. It always combins with trunk imbalance in coronal and sagittal contour. Besides complex pathological changes, cardiopulmonary deficits and other concomitant diseases increase treatmental difficulties. So the treatment of severe scoliosis is always a great challenge to spine surgeon. Methods :Thirty-six patients with severe scoliosis received one stage posterior correction followed by anterior release during July 1997 to January 2003, including 9 males and 27 females. Mean age was 17.2 years. Of them, 33 was idiopathic scoliosis and 3 was neurofibromatosis scoliosis( Cobb angle: 85-116 degree); 20 cases were abnormal in sagital plane. Three-dimensional devised instrumentation were applied such as CD, CD-Horizon, TSRH or Isola in posterior procedure followed by anterior release during the same anesthesia. 31 cases of this group received thorac icplasty. Results: The correction in the frontal plane achieved an average of 48.5%. In the sagittal plane, the pathological shape of the spine was reduced and distinctly ameliorated. 80. 6% of the patients maintained or achieved balance of sagittal plane. There were no complications of severe neurological deficit, hook displacement, rod broken, and deep infection at follow-up. One case occurred traumatic pleurisy after operation and another appeared pseudarthrosis 2 years later. One case demonstrated imbalance 11 months after operation. One patient was presented loss of correction more than 10 degree at one year follow-up and 5.2 degree in average. Conclusion:The study indicates that the one stage posterior correction combined with anterior release in treatment of severe scoliosis can achieve satisfactory correction. Appropriate choice of cases, preoperational detailed assessment and application of SEP and wake-up test during operation can possibly reduce severe complication. The long-term outcomes still need further observation.     

Two-level posterior lumbar interbody fusion for degenerative disc disease: improved clinical outcome with restoration of lumbar lordosis

BACKGROUND CONTEXT: Although posterior lumbar interbody fusion (PLIF) for degenerative lumbar diseases is routine, there are few reports on double-level PLIF. PURPOSE: To evaluate the clinical outcomes of double-level PLIF. STUDY DESIGN/SETTING: A retrospective study of operated cases in Gifu, Japan. PATIENT SAMPLE: Nineteen patients (8 men and 11 women, 59.5+/-10.2 years) who underwent double-level PLIF between 1996 and 2001. OUTCOME MEASURES: Operation time, blood loss, complications, the Japanese Orthopaedic Association (JOA) score for back pain and lumbar sagittal alignment were evaluated. METHODS: Patients were examined retrospectively at follow-ups of 3.6+/-1.7 years. Primary diseases were spondylolisthesis, spinal canal stenosis, degenerative scoliosis and herniated intervertebral disc. Fusion areas were L3 to L5 in 15 cases and L4 to S1 in 4 cases. RESULTS: The mean JOA score increased from an initial score of 12.9+/-3.5 to 21.3+/-4.9 at the final follow-up. There was a positive correlation (R=0.718, p<.001) between the increase in lordotic angle and the increase in the JOA score. Several parameters suggested that the surgical invasiveness was not minimal. CONCLUSION: Double-level PLIF provided satisfactory results and preserved lumbar spine lordosis.     

Cervifix在陈旧性寰枢椎脱位并高位颈髓压迫症中的应用

目的:探讨Cervifix内固定系统治疗陈旧性寰枢椎脱位并脊髓不全损伤的价值。方法:36例陈旧性寰枢椎脱位并脊髓不全损伤行后路融合、Cervifix内固定。男23例、女13例,年龄15～62岁,平均38.3岁。陈旧性外伤21例,先天性畸形9例,类风湿性关节炎伴寰椎前脱位6例。结果:随访8～42个月,平均19个月。术后脊髓功能按JOA17分法评定,改善率为71.4％。全部患者均获骨性融合,内置物无松动、断裂及脊髓损伤加重等并发症。结论:Cervifix内固定可提供坚强有效的节段性固定,提高融合率。同时,可预防单纯减压融合术后早期失稳导致的高位脊髓损伤加重。     

中下段颈椎的应力松弛特性及前、后路手术对其的影响

目的 研究中下段颈椎的应力松弛特性，并评估椎间盘切除植骨术与椎板切开术对其影响。方法 6例新鲜尸体完整颈椎及手术后颈椎，在模拟生理状态下进行屈曲及伸展位的应力松弛实验。结果 在恒应变条件下，绘制术前及不同术式后的中下段颈椎的应力松弛函数及曲线；术后的中下段颈椎的应力和初始化应力比值G(t)比术前明显增大，前路椎间盘切除植骨术后的G(t)值比椎板切开术大，两者均有统计学意义。结论 在恒应变条件下，颈椎具有快速应力松弛敏感性，屈曲位比伸展位大。椎板成形术及颈椎前路椎间盘切除植骨术都使颈椎的应力松弛能力减弱，前路椎间盘切除植骨术的影响更大。     

后外侧融合对胸腰椎爆裂型骨折疗效的影响

目的 观察后外侧融合对预防胸腰椎爆裂型骨折短节段固定失败的作用及意义。方法 本组60例胸腰椎爆裂型骨折患者，A组30例均为我院收治患者，B组30例均为外院手术来我院复查的患者。A组行短节段内固定自体髂骨植骨、后外侧融合术；B组仅行短节段内固定，未植骨融合。平均随访16个月，在X线侧位片上测量Cobb角、伤椎后凸角及矢状面指数（SI），临床疗效评价采用下腰痛评分法（low back outcome score，LBOS）。结果 手术前、后两组间Cobb角、伤椎后凸角、SI比较，差异无统计学意义（P〉0．05），而末次随访时两组间Cobb角、伤椎后凸角、SI比较，差异有统计学意义（P〈0．01）。LBOS评分A组的优良率为73％（22／30），B组仅为43％（13／30）。结论 后外侧融合是降低内固定失败、减少纠正丢失等并发症的有效措施，只行内固定而不做植骨融合明显增高了并发症的发生率，是不恰当的手术方式。