健侧C7移位与下干直接缝合治疗全臂丛神经损伤

全臂丛神经撕脱伤的治疗仍以神经移位为主,其治疗效果尤其是手功能的恢复至今仍不满意.2005年1月-2006年10月,我院对5例全臂丛神经撕脱伤患者采用多组神经移位术,其中采用健侧C7神经根经椎体前通路与患侧臂丛下干直接缝合,重建患肢屈腕、指功能.     

前交叉韧带重建术中经胫骨的股骨隧道足迹定位方法改进及术后骨道评估

 目的 探讨前交叉韧带重建术中经胫骨的股骨隧道足迹定位方法的改进及术后骨道位置评估。 方法 分析2007 -06至2010-01于武警总医院行自体半腱肌腱和股薄肌腱单束重建前交叉韧带手术患者196例,应用改进的方法进行关节镜下经胫骨的股骨隧道足迹定位,并应用国际膝关节文献委员会（international knee documentation commitee, IKDC）评分及术后MRI行骨道位置评估的资料。 结果 经随访10～36个月,患者的前抽屉试验及Lachman试验均为阴性,IKDC评分情况均较术前差异有统计学意义( P <0.05) ,采用矢状位上关节线与移植肌腱的夹角(the angle between the joint line and the graft on the sagittal view,JGS)和冠状位上关节线与移植肌腱的夹角(the angle between the joint line and the graft  on the coronal image,JGC) ,对术后6个月及正常侧膝关节MRI行骨道位置评估,重建的前交叉韧带的位置与正常对照组的位置差异无统计学意义（ P >0.05）。 结论 单束重建前交叉韧带时,改进的经胫骨的股骨隧道的足迹定位方法是理想的股骨隧道定位方法,患者关节稳定性与功能均得到显著改善;采用JGS和JGC对骨道位置进行评估可较客观、准确地反映股骨隧道定位情况,骨隧道位置与临床效果相关。     

臂丛神经根性撕脱伤14例临床观察

随着现代交通的不断发展，由交通事故引起的臂丛神经损伤也越来越多，特别是根性撕脱伤治疗康复时间较长，疗效尚不满意，还有很多技术上的问题亟待解决。我们近年来共收治臂丛神经损伤32例，其中根性撕脱伤14例，现报告如下。     

改良后侧入路手术治疗肩胛颈盂骨折

目的探讨肩胛颈盂骨折的改良后侧入路的手术治疗方法及疗效。方法对2004年6月以来收治的经改良后侧入路切开复位内固定治疗26例肩胛颈盂骨折患者进行分析。均为男性,左侧17例,右侧9例。肩胛颈骨折21例,肩胛盂骨折5例。手术取后侧改良切口,上肢外展上举,沿肩峰略偏向内至肩胛下角作弧形切口,将三角肌下缘的肌筋膜切开,松解三角肌并将其向上拉开,在冈下肌与小圆肌间隙进入,显露肩胛骨腋缘直至颈盂部。根据情况用重建钢板或拉力螺钉固定。结果随访3个月～4年,平均2.6年。均获得骨性愈合,按Hardegger标准疗效评定:优15例,良5例,中1例,差5例。结论经改良后侧入路治疗肩胛颈盂部骨折是安全可靠疗效肯定的方法。     

后路截骨矫形螺钉置入内固定修复胸腰段僵硬性角状后凸畸形：中期随访评价

BACKGROUND: During spinal orthopedic repair, the main difficulty is to maximize the correction of the deformity, simultaneously, to reduce the incidence of trauma and complications, especially to avoid the corresponding spinal nerve injury.OBJECTIVE: To evaluate the curative effect of one-stage posterior pedicle subtraction osteotomy of apical vertebra with transpedicular instrumentation in the treatment of rigid angular kyphosis of thoracolumbar spine.METHODS: We retrospectively analyzed the data of 42 cases of rigid angular kyphosis of thoracolumbar spine that were treated by one-stage posterior pedicle subtraction osteotomy of apical vertebra with transpedicular instrumentation. All patients received detailed imaging examination before and after operation. Kyphosis angle, Frankel grading and perioperative complications were recorded in all patients. X-ray films or CT films showed the bone graft fusion during follow-up.RESULTS AND CONCLUSION:Patients were followed up for 10-36 months after treatment. The average time of bone graft fusion was 5.1 months. Cobb’s angle of kyphosis was corrected from 78.4° (38°-110°) preoperatively to 7°(-8°-24°) at 10 days after treatment. The correction rate was 90%. The average angle during final follow-up was 7.9°, with an average loss of 0.9°. In 16 paresis patients, Frankel grading results showed grade B in 0 case, grade C in 3 cases, grade D in 5 cases, and grade E in 8 cases during final follow-up, showing significant improvement as compared with that pre-treatment (P < 0.05). Among 42 patients, 5 cases had complications. At 7 months after treatment, there were screw and titanium rod loosening at the distal end of the fusion segment in 1 case, cerebrospinal fluid leakage in 2 cases, transient double lower limb weakness in 1 case, pain in one side of lower limb in 1 case, and no severe complications appeared. These results verified that one-stage posterior pedicle subtraction osteotomy of apical vertebra with transpedicular instrumentation could achieve satisfactory clinical outcomes in rigid angular kyphosis of thoracolumbar spine. The internal fixation was stable and with a high fusion rate and few complications. The medium-term effect was satisfactory.  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     

特殊透刺联合雷火灸治疗周围性面瘫疗效及对患者血清MDA、SOD的影响

目的:分析特殊透刺联合雷火灸治疗周围性面瘫的疗效及对患者血清丙二醛(MDA)、超氧化物歧化酶(SOD)的影响.方法:选择90例周围性面瘫患者为研究对象,依据随机数字表法均分为两组,对照组45例患者予以雷火灸疗法,观察组45例患者予以特殊透刺联合雷火灸疗法;观察两组临床疗效、肌电图检查、血清因子及评分类指标.结果:观察组...     

靶向椎间孔成形减压术治疗游离型腰椎间盘突出合并神经根管狭窄症

目的探讨经皮椎间孔镜下行靶向椎间孔成形减压术治疗游离型腰椎间盘突出合并神经根管狭窄症的临床疗效。方法选取2016年10月-2017年12月赤峰市医院脊柱外科收治的30例游离型腰椎间盘突出合并神经根管狭窄症患者。所有患者均在经皮椎间孔镜下行靶向椎间孔成形减压术。记录术前1 d、术后2 d及术后3个月患者腰痛与腿痛视觉模拟评分(VAS)和Oswestry功能障碍指数(ODI),术后2 d及术后3个月采用改良Macnab标准评估手术疗效。结果所有患者均顺利完成治疗,手术时间为65~200 min,平均90 min。术中出血量为15~135 ml,平均55 ml。卧床时间均不超过24 h,平均住院日为5 d。术前1 d腰痛及腿痛VAS评分为(6.57±1.96)和(7.03±1.75)分,术后第2天腰痛及腿痛VAS评分为(2.03±0.96)和(1.97±1.07)分,术后3个月腰痛及腿痛VAS评分为(1.83±0.95)和(1.77±1.04)分,术前1 d、术后2 d及术后3个月ODI指数分别为(70.42±3.55)%、(22.56±0.72)%和(22.69±0.70)%。可以看出术后3个月和术后2 d较术前1 d各项指标均有改善,差异有统计学意义(P 0.05)。应用改良Macnab标准评定疗效,在临床疗效上,术后3个月患者的优良率为96.67%。明显优于术后2 d的优良率73.33%,两组比较差异有统计学意义(P 0.05)。结论经皮椎间孔镜下靶向椎间孔成形减压术是治疗游离型腰椎间盘突出合并神经根管狭窄症的微创、有效、安全的手术方式之一。