CT导向下经皮穿刺臭氧椎间盘内注射治疗腰间盘突出症

1988年,意大利Verga首先提倡在椎旁注射臭氧以治疗椎间盘突出引起的腰腿痛。近10年来,该技术在欧洲,尤其是意大利、法国、德国等国家兴起。我科2007年3月～2007年12月采用CT导向下经皮穿刺臭氧椎间盘内注射治疗腰椎间盘突出症87例,取得了良好的效果,现报道如下。     

腰椎间盘术后椎间隙感染的早期诊断治疗

目的: 探讨椎间盘术后椎间隙感染的发病特点及防治方法。方法: 对本院 641例椎间盘摘除术中的 7例腰椎间隙感染的病例分析回顾总结。结果: 感染与病人基础条件差、术前抗炎准备不足、术中组织损伤多等因素有关, 7例病人均有腰腿痛加剧, 血沉加快。结论: 严格的术前准备, 术中减少副损伤, 术后早诊断, 严格制动, 足量抗生素长期应用有效。     

两种减压植入内固定方式治疗颈椎管狭窄症：C5神经根麻痹及稳定性

背景：有部分学者认为颈椎管狭窄症减压植入内固定后神经根麻痹与颈椎稳定性以及颈椎生理曲度有关,目前还存在争议。 目的：探讨颈椎管狭窄症后路全椎板减压侧块内固定与单开门减压椎管扩大成形治疗后C₅神经根麻痹及稳定性。 方法：选取29例颈椎管狭窄症患者进行后路减压植入物内固定治疗。方法①：颈椎管狭窄症后路全椎板减压侧块内固定,在C_3-6侧块以及C₇椎弓根钉内固定,关节突关节处造成粗糙面。方法②：根椐治疗前对正侧位平片及动力位片结合MRI、CT影像学图片,明确不稳定的节段,给予相应节段侧块内固定、椎板行单开门减压,椎管扩大成形治疗。 结果与结论：29例颈椎管狭窄症患者随访8个月-2.3年,采用后路全椎板减压侧块内固定治疗的患者14例,植入后早期出现C₅神经根麻痹2例,远期症状复发出现不全瘫3例,二次手术行瘢痕切除减压治疗;采用单开门减压椎管扩大成形治疗的患者15例,治疗后出现C₅神经根麻痹肩外展功能不良1例,无治疗前症状复发病例。神经根麻痹最短6周,最长9个月均恢复。颈椎管狭窄症后路减压植入物内固定后,C₅神经根麻痹与节段稳定性、颈椎生理曲度、椎管减压程度、脊髓漂移范围是否相关以及发生程度、远期因瘢痕致再度出现椎管狭窄,两种治疗方式的区别是否有意义,目前病例数有限,有待病例及临床经验的积累与观察。     

跗骨窦入路空心钉固定术治疗SandersⅡ型跟骨骨折

背景:微创治疗跟骨骨折渐成趋势,通过跗骨窦入路空心螺钉内固定治疗SandersⅡ型跟骨骨折的方法和疗效值得探讨。目的:探讨跗骨窦入路空心螺钉内固定治疗跟骨SandersⅡ型骨折的手术方法和临床疗效。方法:采用跗骨窦入路经载距突空心螺钉内固定治疗35例跟骨骨折患者,男21例,女14例;年龄23~58岁,平均(45.4±6.9)岁;左侧23例,右侧12例;骨折按Sanders分型:ⅡA型17例,ⅡB型18例。测量记录患者术前术后B?hler角和Gissane角,观察关节面的恢复情况。按照美国足踝外科协会Maryland足部评分标准评价足部功能恢复效果。结果:本组患者均获得随访,随访时间6~12个月,平均(9.5±1.9)个月。骨折均愈合,愈合时间8~12周,平均(9.8±1.5)周。无切口并发症发生。B?hler角术前平均15.2°±2.6°,术后平均30.7°±3.2°;Gissane角术前平均95.9°±4.0°,术后平均125.2°±11.6°,手术前后比较差异均有统计学意义(P<0.05)。按Maryland足部评分系统进行功能评定:优24例,良9例,可2例,优良率为94.3%。结论:跗骨窦入路经载距突空心螺钉内固定治疗跟骨SandersⅡ型骨折,组织剥离少,可以很好地恢复跟距关节面平整,跟骨的宽度、B?hler角及Gissane角均得到良好的恢复,值得临床推广应用。     

后路环形减压治疗高位腰椎间盘突出症临床疗效观察

目的观察经后路环形减压、腰椎间盘切除、椎体间植骨+后外侧植骨(横突间植骨)、双侧椎弓根钉内固定治疗高位腰椎间盘突出症的临床疗效。方法自2008-03—2011-10收治单节段高位腰椎间盘突出症13例,均接受后路环形减压、腰椎间盘切除、椎体间植骨+后外侧植骨(横突间植骨)、双侧椎弓根钉内固定治疗。结果手术时间120~210 min,平均160 min;术中出血350~1 500 ml,平均650 ml。术中出现硬膜损伤脑脊液漏1例,常压引流+局部加压后痊愈。13例均获得1年以上随访。术前VAS、JOA评分分别为(7.2±0.6)、(10.7±2.3)分,术后1年时VAS、JOA评分分别为(2.1±0.8)、(24.7±1.3)分,术后较术前均有明显改善,差异有统计学意义(P<0.05)。无植骨不融合,内置物位置佳,无松动、脱出。结论经后路环形减压、腰椎间盘切除、椎体间植骨+后外侧植骨(横突间植骨)、双侧椎弓根钉内固定治疗高位腰椎间盘突出症可获得较满意疗效。     

膝关节创伤骨折的MRI诊断临床价值核心研究

目的:探讨MRI检查对膝关节创伤骨折的诊断价值.方法:选取我院于2018年7月-2019年5月期间收治的51例疑似膝关节创伤骨折患者作为本次研究对象,入选患者均接受MRI检查,记录其MRI检查结果、手术或随访确诊结果.结果:51例疑似膝关节创伤骨折患者中,经手术或随访证实为膝关节创伤骨折88.24%、MRI对膝关节创伤骨折检出率为86.27%(P>0.05);MRI对膝关节创伤骨折诊断敏感性93.33%、特异性83.33%.结论:MRI对膝关节创伤骨折的诊断敏感性及特异性均较高,将其应用于膝关节创伤骨折诊断价值显著.     

金属植入物固定与修复新鲜不稳定型桡骨远端骨折合并腕舟状骨骨折：半年随访

BACKGROUND: Healing time and plaster used in fixed position and fixed time are different between distal radius fractures and scaphoid fracture. When both fractures occur simultaneously, you cannot choose a fixed position and determine a fixed time. One-stage internal fixation for the distal radial fractures and scaphoid fractures simultaneously can obtain a good function.  OBJECTIVE: To retrospectively analyze the effects of titanium locking compression plate and Herbert screw fixation for fresh unstable distal radial fractures with scaphoid fracture. METHODS: A total of 12 patients with fresh unstable distal radial fractures combined with scaphoid fracture were treated in the Shanxi Dayi Hospital from November 2011 to June 2014. All cases received open reduction and locking compression plate fixation of the distal radius, open reduction of scaphoid fracture or percutaneous Herbert screw fixation. Fracture healing was observed during follow-up. At 6 months after treatment, wrist joint function was evaluated with modified McBride score. Range of motion of palmar flexion, dorsiflexion, ulnar deviation, radial deviation, pronation and supination and grip strength were measured. The distal radial shortening (difference in height of styloid process of radius and ulna), and angles of ulnar deviation and palmar tilt were measured with X-ray films. The data of healthy side and affected side were compared. RESULTS AND CONCLUSION: (1) 12 cases were followed up for 6-24 months. (2) The distal radius and scaphoid fractures healed. The healing time of distal radius was 6-12 weeks, with an average of seven weeks. Healing time of scaphoid fracture was 3-6 months, with an average of 4.2 months. (3) Wrist score was evaluated using modified McBride scoring criteria at 6 months after treatment. There were excellent in 5 cases, good in 6 cases, and average in 1 case, with the excellent and good rate of 92%. (4) No significant difference in range of motion of palmar flexion, dorsiflexion, ulnar deviation, radial deviation, pronation and supination and grip strength, angles of ulnar deviation and palmar tilt, difference in height of styloid process of radius and ulna and modified McBride score was detected between healthy side and affected side (P > 0.05). (5) The median nerve injury in two patients was recovered within 6 months after postoperative exploration decompression. No complications appeared, such as infection, dorsal muscle tendon irritation symptoms, carpal tunnel syndrome, and internal fixation failure. (6) These findings confirm that fresh unstable distal radial fractures with scaphoid fractures can be treated with open reduction of the distal radius and locking plate fixation, open reduction of scaphoid bone or percutaneous Herbert screw fixation, with reliable fixation, high fracture healing rate, and good wrist function recovery rate; the repair effect is satisfactory.      

Gamma钉与锁定钛板修复老年不稳定型股骨转子间骨折：髋关节功能对比

背景：随着股骨转子间骨折内固定方式选择的多样化,同一种类型骨折的内固定方式往往根据术者的习惯选择,无统一标准。 目的：比较Gamma钉和股骨近端解剖锁定钛板置入内固定修复老年不稳定型股骨转子间骨折的优劣。 方法：武警山西总队医院2009年4月至2012年9月对94例老年不稳定型股骨转子间骨折行内固定治疗,根据内固定方案分为两组,其中Gamma钉组46例,股骨近端锁定板组48例。从切口长度、术中出血量、手术时间、治疗后髋关节功能恢复情况、负重时间及并发症等方面对两种内固定方法进行对比分析。 结果与结论：两种内固定方式在切口长度、术中出血量、治疗后负重时间及并发症方面比较,Gamma钉优于股骨近端锁定板,差异有显著性意义(P < 0.05);两组患者手术时间差异无显著性意义(P > 0.05)。治疗后1年髋关节功能Gamma钉组优良率为96%(44/46),股骨近端锁定板组优良率为92%(44/48),两组差异无显著性意义(P > 0.05)。提示Gamma钉和股骨近端解剖锁定钛板置入内固定修复不稳定型股骨转子间骨折均能实现良好的髋关节功能恢复,但Gamma钉在切口长度、术中出血量、治疗后并发症及负重时间等方面优势明显。中国组织工程研究杂志出版内容重点：人工关节;骨植入物;脊柱;骨折;内固定;数字化骨科;组织工程