双侧椎动脉颈段完全栓塞早期对兔颈髓血流的影响

目的 :研究椎动脉颈段栓塞对颈髓血流量的影响。方法 :结扎兔双侧C6、C7处椎动脉 ,在术后 4、 8、2 4h观察行为学、细胞形态学 ,并采用激光多普勒血流测定仪测定颈髓血流。结果 :术后 4、 8、 2 4h组颈髓血流量明显下降 ,8、 2 4h组呈急性缺血性改变。结论 :椎动脉供血区血流量减少可导致颈髓相应区域急性缺血损伤。     

上胸椎肿瘤手术治疗后的椎体重建

目的 :探讨上胸段脊柱肿瘤椎体切除手术治疗后椎体的重建方法。方法 :对 19例侵犯椎体的上胸椎肿瘤经不同途径前入路切除肿瘤后 ,应用髂骨植骨 1例、肋骨植骨 6例、钛网植骨 8例、人工椎体 5例进行椎体重建替代 ,并辅以前路内固定系统行邻近椎节固定。随访 1～ 43个月。结果 :各种方式植骨进行重建 19例患者均安全度过围手术期 ,患者 1个月后均可坐起进食。 17例术后神经功能有不同程度改善 ,2例无明显改善。均无明显椎体替代物下沉现象 ,无断钉及内固定脱落。结论 :上胸椎肿瘤椎体切除术后应用髂骨、肋骨、钛网、人工椎体进行重建替代 ,均可良好恢复术后椎体高度及脊柱的稳定性。人工椎体的应用能进一步缩短患者卧床时间。     

耳软骨在二次隆鼻术及鼻尖成形术中的应用

目的：探索二次隆鼻术及鼻尖成形术的方法。方法：采用鼻小柱“飞鸟”形切口加鼻翼软骨缘切口,切开分离皮肤、皮下组织,显露假体并取出,分离两侧鼻翼软骨及侧鼻软骨等,将取下的耳软骨缝合固定于新雕刻假体的顶部及短壁上,插入鼻背固定,缝合双侧穹窿部鼻翼软骨,缝合切口。结果：自2010年6月～2013年6月对46例不满意隆鼻术行二次隆鼻及鼻尖成形术,获得满意的手术效果。术后鼻尖形态自然、鼻长度延长、高度增加、歪鼻也得到矫正等。结论：用自体耳软骨及硅胶假体行二次隆鼻术及鼻尖整形术,能解决鼻尖不良形态,矫正鼻偏斜、鼻孔外露、增加鼻长度,获得鼻部整体形态自然协调的效果,是一种理想的手术方法。     

Vertebroplasty increases compression of adjacent IVDs and vertebrae in osteoporotic spines

Background contextApproximately 25% of vertebroplasty patients experience subsequent fractures within 1 year of treatment, and vertebrae adjacent to the cemented level are up to three times more likely to fracture than those further away. The increased risk of adjacent fractures postaugmentation raises concerns that treatment of osteoporotic compression fractures with vertebroplasty may negatively impact spine biomechanics.PurposeTo quantify the biomechanical effects of vertebroplasty on adjacent intervertebral discs (IVDs) and vertebral bodies (VBs).Study designA biomechanics study was conducted using cadaveric thoracolumbar spinal columns from elderly women (age range, 51–98 years).MethodsFive level motion segments (T11–L3) were assigned to a vertebroplasty treated or untreated control group (n=10/group) such that bone mineral density (BMD), trabecular architecture, and age were similar between groups. Compression fractures were created in the L1 vertebra of all specimens, and polymethylmethacrylate bone cement was injected into the fractured vertebra of vertebroplasty specimens. All spine segments underwent cyclic axial compression for 115,000 cycles. Microcomputed tomography imaging was performed before and after cyclic loading to quantify compression in adjacent VBs and IVDs.ResultsCyclic loading increased strains 3% on average in the vertebroplasty group when compared with controls after 115,000 cycles. This global strain manifested locally as approximately fourfold more compression in the superior VB (T12) and two- to fourfold higher axial and circumferential deformations in the superior IVD (T12–L1) of vertebroplasty-treated specimens when compared with untreated controls. Low BMD and high cement fill were significant factors that explained the increased strain in the vertebroplasty-treated group.ConclusionsThese data indicate that vertebroplasty alters spine biomechanics resulting in increased compression of adjacent VB and IVD in severely osteoporotic women and may be the basis for clinical reports of adjacent fractures after vertebroplasty.     

椎动脉起始处闭塞患者缺血性卒中的发生率分析

目的随访椎动脉起始处闭塞患者的缺血性脑卒中发生率与死亡率。方法 156例经数字减影血管造影术(digital subtraction angiography,DSA)证实的单侧椎动脉起始部闭塞患者,根据患者有无缺血性脑血管病症状分为有症状组(n=98)和无症状组(n=58),对患者进行随访,至少2年,观察新发症状性脑梗死、任何原因死亡。结果椎动脉起始处闭塞患者平均年新发脑梗死发生率为5.1%,平均年死亡率为0.4%。有症状组累积新发脑梗死发生率和无症状组比较差异无显著性(P0.05);Kaplan-Meier曲线显示,有症状组终点事件发生率与无症状组差异无显著性(P=0.690);两组间侧支循环开放比率差异无显著性(23.5%vs 27.6%,P=0.566),无新发与新发脑梗死侧支循环的开放比率差异无显著性(35.7%vs22.7%,P=0.148)。结论单侧椎动脉起始部闭塞的患者年新发脑梗死发生率为5.1%,预后相对较好。     

Complications associated with cervical vertebral body replacement with expandable titanium cages

Our aim was to analyze complications and risk factors for cervical vertebral body replacement (VBR) with expandable titanium cages (ETC). Fifty patients; 22 women and 28 men, mean age 61 years, undergoing cervical VBR from 2010 to 2015 were analyzed. Complications were stratified by hardware-association (HA). Univariate and multivariate logistic regression was used to identify independent risk factors. Single, two and three level corpectomies were performed in 32, 15 and 3 patients respectively. A circumferential approach was necessary in 16 cases. At mean follow-up (7.3 months) 66% of patients had recovered. Radiological data showed a significant distraction (2.60 mm, p < 0.0001) and lordosis (5°, p = 0.001). Twenty-three patients experienced 42 complications; 18 HA, 24 non-HA and 24% needed revision surgery. The number of corpectomy levels and surgical approach significantly correlated with the risk of complications (p = 0.001), especially non-HA complications (p = 0.002). On multivariate analysis, only the number of corpectomy levels (p < 0.02, odds ratio 5.48, 95% CI 1.31–22.91) was a significant predictor of complications. We conclude that ETC are efficacious devices for cervical spine VBR, however, when used for more than 1 level, the corpectomy complication rate significantly increases.     

骨质疏松与恶性骨质破坏致椎体压缩性骨折的CT磁共振成像影像特点及鉴别诊断

目的 探究采用CT、磁共振成像(MRI)鉴别诊断骨质疏松与恶性骨破坏导致的椎体压缩性骨折的临床疗效.方法 选择2019年12月至2020年12月经临床诊疗证实为骨质疏松及恶性骨质破坏致脊椎骨折的患者76例,分为2组:A组(骨质疏松改变并伴有压缩性骨折,36例),B组(恶性骨破坏致压缩性骨折,40例).对比2组患者椎体、...     

纳米羟基磷灰石/聚酰胺66复合人工椎体在颈椎病前路椎体次全切除术中的临床应用

目的 探讨纳米羟基磷灰石/聚酰胺66(n-HA/PA66)复合人工椎体在颈椎前路次全切除术中应用的短中期临床疗效.方法 自2008年5月～2009年6月对44例脊髓型颈椎病行前路椎体次全切除、椎管减压、n-HA/PA66复合人工椎体植骨融合+钢板内固定术治疗,以JOA评分改善率评价神经功能恢复情况,并依据X线片判断椎间稳定性和融合情况.结果 本组无术中并发症,伤口均一期愈合.患者获随访12～26个月,平均18个月,症状均明显改善,JOA评分由术前(6.4±1.8)分提高到术后(15.2±1.5)分,JOA改善率83.0％,优良率86.4％,问卷调查满意度97.6％.X线检查证实无人工椎体移位、下沉,融合率100％.结论 n-HA/PA66复合人工椎体具有良好的生物相容性及安全性,是一种较理想的骨移植材料,适用于颈椎病前路次全切除术中.     

颈椎手术中并发椎动脉损伤的诊断与治疗

 目的 探讨颈椎手术中并发椎动脉损伤的发生原因、治疗及预防。方法 回顾性分析2002年10月至2012年4月颈椎手术中并发椎动脉损伤的7例患者资料,男6例,女1例;年龄23～65岁,平均48.9岁;脊髓型颈椎病5例,颈椎外伤合并C^4,5半脱位1例,氟骨症致颈椎管狭窄1例。椎动脉损伤均为单侧,左侧4例,右侧3例。分析颈椎手术中并发椎动脉损伤的原因、处理过程及预后。结果颈椎前路手术4例,其中2例用环钻减压时偏离中线损伤椎动脉,1例切除椎间盘时刮匙过于偏外损伤椎动脉,1例颈椎外伤患者由于Ｃ^4,5半脱位造成椎动脉迂曲,减压时冲击式咬骨钳损伤椎动脉。颈椎后路手术3例,其中2例为行C4侧块螺钉固定时钻头偏外损伤椎动脉;1例氟骨症致颈椎管狭窄者在切除寰椎后弓时咬骨钳损伤椎动脉,术中出现椎动脉损伤后,迅速填塞压迫止血并关闭伤口,但术后4周发生迟发性出血,采用椎动脉栓塞止血及颈后路血肿清除术治疗。7例患者均未发生脑梗塞,其中2例患者术后出现一过性头晕。结论 椎动脉损伤是颈椎手术的严重并发症,其损伤原因与手术失误、解剖变异等有关;采用直接压迫及椎动脉栓塞治疗效果确切。