舒血宁联合敏使朗治疗椎-基底动脉供血不足疗效分析

目的:评价舒血宁联合敏使朗治疗椎-基底动脉供血不足(VBI)的临床疗效。方法:治疗组32例用舒血宁(银杏叶注射液)联合敏使朗(甲磺酸倍他司汀)治疗,对照组30例用低分子右旋糖酐加复方丹参联合尼莫地平片治疗。10天后分别观察2组临床症状,2~3周后观察TCD及血液流变学改善情况。结果:总有效率治疗组93.75%,对照组66.67%,两组比较有极显著性差异(P0.01);治疗前后TCD所示的平均血流速度改善情况,治疗组较对照组为优,两组有极显著性差异(P0.01);血液流变学的改善两组有显著性差异(P0.05)。结论:舒血宁联合敏使朗治疗VBI疗效确切。     

椎体成形术与保守治疗胸腰椎压缩性骨折的疗效比较

目的：比较经皮球囊椎体后凸成形术（PKP）与保守治疗胸腰椎压缩性骨折的近期临床疗效。方法：2006年8月~2009年12月我院骨科收治的胸腰椎压缩性骨折患者83例,分为2组,采用PKP治疗25例（手术组）,保守治疗58例（保守组）,进行追踪调查。结果：手术组的卧床天数、住院天数较保守组缩短,止痛效果、椎体高度恢复、Cobb角下降程度均优于保守组,2组比较P〈0.05,差异具有统计学意义。结论：PKP治疗胸腰椎压缩性骨折患者可迅速缓解疼痛,恢复病椎高度和纠正Cobb角;但医疗成本高,且远期疗效有待进一步研究;保守疗法虽止痛效果较慢,但疗效肯定,仍是一种简、便、廉的治疗方法。     

单侧椎弓根螺钉内固定联合经椎间孔椎间融合治疗骨质疏松性胸腰椎骨折疗效分析

【摘要】 目的 探讨单侧椎弓根螺钉内固定联合经椎间孔椎间融合治疗骨质疏松性胸腰椎骨折的临床疗效。方法 选取 2020 年 1 月至 2022 年 1 月驻马店魏道德骨科医院收治的 96 例骨质疏松性胸腰椎骨折患者作为研究对象, 按照不同治疗方法将其分为研究组 (45 例) 与常规组 (51 例), 研究组患者采用单侧椎弓根螺钉内固定联合经椎间孔椎间融合治疗, 常规组患者单纯采用单侧椎弓根螺钉内固定治疗, 对比观察两组患者手术相关指标、椎体解剖结构及功能、疼痛程度、并发症发生情况与再骨折情况。 结果 研究组患者术中出血量明显多于常规组 (t = 39.581, P<0.001), 术后下床活动时间、住院时间均明显长于常规组 ( t = 36.312、19.972, P均<0.001); 术后 12个月, 研究组患者伤椎椎体前缘高度明显高于常规组 ( t = 4.914, P< 0.001), 椎体压缩率、Cobb 角、受压面积均明显小于常规组 (t = 8.922、16.056、8.483, P 均<0.001), Oswestry 功能障碍指数 (ODI)评分及视觉模拟评分法 (VAS) 评分均明显低于常规组 ( t = 10.633、12.680, P 均<0.001); 术后随访 12 个月,研究组患者术后并发症发生率为 2.22%, 与常规组患者的术后并发症发生率 9.80%无明显差异 (χ2 = 2.345, P =0.126), 而再骨折率为 0%, 明显低于常规组患者的再骨折率 11.76% (χ2 = 5.647, P = 0.017)。 结论 单侧椎弓根螺钉内固定联合经椎间孔椎间融合治疗骨质疏松性胸腰椎骨折, 虽可延长术后下床活动时间及住院时间, 但能有效恢复伤椎椎体解剖结构, 提高椎体功能, 减轻患者疼痛, 降低再骨折率, 疗效显著, 值得临床推广应用。     

下颌角的CT三维重建模拟整形术

目的模拟下颌角整形术,将逆向工程原理应用于下颌角整形手术设计中。方法重建病人术前头部cT颅骨模型,测量相关数据并导入geomagic（V5）软件中,根据东方经典美丽分析面罩模拟下颌骨整形手术,比较原始模型与模拟后模型以确定截骨线和截骨量,最后重建术后CT模型,评价模拟手术效果。结果重建了不同状态下颌骨三维模型,利用模拟手术结果设计了实际手术方案。结论逆向工程原理对于设计下颌整形术方案有明显的临床应用价值。     

椎管麻醉后神经并发症的治疗性研究

目的 本研究通过对椎管麻醉后常见神经并发症的临床观察与预防性治疗,减少其发生,促进神经功能的早期恢复.方法 选择120例中下腹部手术行腰硬联合或硬膜外麻醉的术科病人,每组40例.Ⅰ组为术后常规镇痛组;Ⅱ组为术后常规预防治疗组;Ⅲ组为对照组.每大组根据穿刺置管时有无异感、胀痛等神经刺激症状分为两小组,每组20例.分别记录各组穿刺时的情况、血流动力学参数指标、术后神经功能障碍的发生、发展及处理情况.结果 Ⅱ组与Ⅰ组在术后一天的MAP、P比较明显提高(P＜0.05),Ⅲ组与Ⅰ组在术后一天的MAP、P比较有非常明显增加(P＜0.01).三组病人穿刺置管情况比较差异无显著性.Ⅱ组无1例发生术后神经功能障碍;穿刺置管时有无异感发生与术后神经功能障碍的发生没有直接的联系,穿刺置管时异感发生程度的轻重与术后神经功能障碍症状的严重程度和持续时间似有关联.发生术后神经功能障碍的病人经脱水及对症治疗均痊愈出院.结论 及时、早期、预防性的硬膜外腔治疗可以明显降低术后神经功能障碍的发生率,促进患者康复,且此方法非常便于麻醉医生的临床应用.     

椎弓根螺钉内固定治疗中上胸椎骨折的临床研究

目的探讨应用椎弓根螺钉内固定治疗不稳定中上胸椎骨折的安全性和可行性。方法2001年3月~2005年1月,采用椎弓根螺钉内固定治疗不稳定中上胸椎骨折21例,其中GSS固定15例,USS固定6例。结果21例均获随访,随访时间10~42个月,平均22·3个月,伤椎前缘高度由术前平均40%恢复至术后91%,术后CT示螺钉位置不良9枚,其中Ⅰ级6枚,Ⅱ级2枚,Ⅲ级1枚,术后无神经系统症状加重,无脑脊液漏。结论胸椎椎弓根螺钉固定治疗不稳定中上胸椎骨折可获得满意的复位,中上胸椎椎弓根螺钉固定有一定风险,根据术前脊柱正侧位X线片和CT片,正确选择螺钉直径及进针点、角度和深度及进钉方向,胸椎椎弓根螺钉在中上胸椎骨折中的应用是安全的。     

脊柱胸腰段应力分布与骨折相关性的三维有限元分析

【摘要】 目的：观察脊柱胸腰段骨折与椎体骨性结构及韧带间应力分布的相关性,探索脊柱胸腰段椎体骨折的力学机制。方法：招募8名健康男性青年志愿者,行脊柱全长X线片和CT检查排除脊柱畸形、肿瘤及骨病,对脊柱各椎体及股骨行骨密度测定排除骨质疏松。均行自T11椎体上终板至L2椎体下缘CT薄层扫描,将8名志愿者CT图像参数导入ABAQUS 2016软件中进行标准化,并进行有限元网格化构建。应用MIMICS 17.0、GEOMAGICS 15.0和PRO/ENGINEER 5.0软件处理,建立脊柱胸腰段有限元模型,测量模型相关参数,并验证模型有效性。在T11椎体上终板上加载竖直轴向载荷500N、附加扭矩10N·m模拟垂直压缩、前屈、后伸、左右侧屈、左右旋转7种运动状态,使用ABAQUS软件对有限元模型7种运动状态下的应力分布特点及变化规律进行分析,观察应力分布与脊柱胸腰段骨折的相关性。结果：建立的三维有限元模型共有309583个节点和428760个单元,包括4个椎体、3个椎间盘、前纵韧带、后纵韧带、横突间韧带、棘间韧带等结构。7种运动状态下的数据与文献报道的数据无明显偏差,模型有效。T11~L2椎体椎弓根截面积分别为135mm2、154mm2、105mm2、139.2mm2。应力云图结果显示各运动状态下高应力区存在于椎体的松质骨、椎弓根及其周围骨皮质。在垂直压缩状况下,T12椎体所受应力最大（617.4MPa）,前屈状态下T11所受应力最大（200.7MPa）,后伸、左右侧屈和左右旋转状态下L1椎体所受应力最大（314.2MPa、574.4MPa、626.2MPa、641.3MPa、527.1MPa）,且前屈体位时椎体所能承受的应力最小,左旋转时所能承受的应力最大。垂直压缩状况下T12椎体发生骨折, 前屈状态下T11发生骨折伴韧带损伤,后伸、左右侧屈和左右旋转状态下L1椎体发生骨折伴韧带损伤。骨折发生时,前纵韧带在后伸、左右侧屈状态下存在高应力区,后纵韧带在前屈状态下存在高应力区,横突间韧带和棘间韧带在前屈、左右侧屈、左右旋转状态下存在高应力区。结论：在构建包括重要韧带、椎间盘等软组织结构的脊柱胸腰段三维模型中,椎体松质骨、椎弓根及其周围骨皮质、韧带均存在高应力区,不同状态下所受应力最大椎体不同,发生骨折的椎体和韧带损伤也不同;L1椎弓根截面积最小,最易发生骨折。     

Clinical Efficacy and Safety of Controlled Distraction-Compression Technique Using Expandable Titanium Cage in Correction of Posttraumatic Kyphosis

ObjectiveTo investigate the clinical efficacy and safety of the controlled distraction-compression technique using an expandable titanium cage (ETC) in posttraumatic kyphosis (PTK). MethodsWe retrospectively studied and collected data on 20 patients with PTK. From January 2014 to December 2017, the controlled distraction-compression technique using ETC was consecutively performed in 20 patients with PTK of the thoracolumbar zone (range, 36–82 years). Among them, nine were males and 11 were females and the mean age was 61.5 years. The patients were followed regularly at 1, 3, 6, and 12 months, and the last follow-up was more than 2 years after surgery. ResultsThe mean follow-up period was 27.3±7.3 months (range, 14–48). The average operation time was 286.8±33.1 minutes (range, 225–365). The preoperative regional kyphotic angle (RKA) ranged from 35.6° to 70.6° with an average of 47.5°±8.1°. The immediate postoperative mean RKA was 5.9°±3.8° (86.2% correction rate, p=0.000), and at the last follow-up more than 2 years later, the mean RKA was 9.2°±4.9° (80.2% correction rate, p=0.000). The preoperative mean thoracolumbar kyphosis was 49.1°±9.2° and was corrected to an average of 8.8°±5.3° immediately after surgery (p=0.000). At the last follow-up, a correction of 11.9°±6.3° was obtained (p=0.000). The preoperative mean back visual analog scale (VAS) score was 7.9±0.8 and at the last follow-up, the VAS score was improved to a mean of 2.3±1.0 with a 70.9% correction rate (p=0.000). The preoperative mean Oswestry disability index (ODI) score was 32.3±6.9 (64.6%) and the last follow-up ODI score was improved to a mean of 6.85±2.9 (3.7%) with a 78.8% correction rate (p=0.000). The overall complication was 15%, with two of distal junctional fractures and one of proximal junctional kyphosis and screw loosening. However, there were no complications directly related to the operation. ConclusionPosterior vertebral column resection through the controlled distraction-compression technique using ETC showed safe and good results in terms of complications, and clinical and radiologic outcomes in PTK. However, to further evaluate the efficacy of this surgical procedure, more patients need long-term follow-up and there is a need to apply it to other diseases.     

Transvenous Doppler guidewire sonographic monitoring during treatment of a complex vertebral arteriovenous fistula associated with neurofibromatosis Type 1

A Doppler sonographic guidewire was used to monitor incremental changes in draining vein (DV) flow during endovascular occlusion of a complex vertebral arteriovenous fistula (AVF) in a patient with neurofibromatosis type 1. Transvenous monitoring of average peak velocity (APV) and the maximum-minus-minimum peak velocity (MxPV-MnPV) demonstrated a progression from a highly pulsatile, fast flow before embolization to a nonpulsatile, slow flow indicating a successful occlusion of the AVF (hemodynamic endpoint of treatment). Prior to this, apparent angiographic occlusion of the AVF was thought to signify a successful endpoint; however, persistently elevated values for APV and MxPV-MnPV in the DV signalled the presence of an additional contralateral arterial contribution. Transvenous monitoring of flow velocity appears to be ideally suited to establishing a hemodynamic endpoint of embolotherapy in the presence of complex arteriovenous shunting, as may occur with the vasculopathy of neurofibromatosis. Received: 30 December 1997 Accepted: 12 October 1998