后路椎体间融合术后融合器脱出的原因及其翻修术

目的：探讨后路椎体间融合术后融合器脱出的原因及其翻修方法。方法：10例后路椎体间融合术后融合器脱出行翻修术的病例，其中腰椎滑脱症5例，腰椎管狭窄症3例，腰椎间盘突出症2例。手术节段为L4／54例，L5／S1 3例，L4／5＋L5／S1 3例；融合器应用BAK（旋入型）7例，聚醚醚酮矩形融合器（PEEK）2例，钛金属矩形融合器1例。于首次术后1～90d内行翻修术。就其脱出原因，再次手术方法及疗效进行分析。结果：融合器脱出的原因：矩形融合器中2例型号太小，1例放置位置偏后；旋入型融合器1例定位错误，其余大都因两枚融合器之间发生碰撞挤压所致。翻修术后获得完整随访资料者8例，随访时间10-36个月，平均17个月，均得到融合，无融合器再次移位或脱出以及内同定的断裂，1例伴有足下垂者遗留患足背伸肌力减弱，其余病例神经症状消除。结论：后路腰椎椎体间融合术后融合器脱出的可能原因有融合器型号偏小导致椎间隙撑开不够，放置位置偏后，两枚融合器不对称或距离太近发生碰撞等。早期、积极的手术翻修能取得较好的疗效。     

钛对大肠杆菌生长影响的实验研究

以草酸钛钾溶液为受试物，用无菌操作法在不同浓度试验水样及不含钛的对照水样中加入大肠杆菌稀释液1ml（含菌300个），观察6小时和1－7天的细菌生长情况。结果各受试组与对照组比较，10.0mg／L和1．0mg／L组接触6小时至7天大肠杆菌生长均有明显的抑制作用；0．1mg／L组接触6－24小时显示抑制作用，但第4天开始菌落减少的速度比对照组缓慢。提示钛对大肠杆菌的生长有抑制作用，其作用阈浓度为1．0mg／L，阈下浓度为0，1mg／L。     

Effects of neurosurgical titanium mesh on radiation dose

The purpose of this study was to determine the dosimetric impact of a neurosurgical titanium mesh in patients treated with 6- and 18-MV photon beams. The effects of a 0.4-mm-thick titanium mesh on the dose profile at 3 regions within a solid water phantom were measured using extended dose range-2 (EDR2) film for 6- and 18-MV photon beams. All measurements were performed with the titanium mesh placed at a depth of 1.5 cm in the phantom. Films were exposed immediately above the mesh, immediately below the mesh, and at a depth of 5 cm from the surface of the phantom. The films were scanned using a scanning densitometer. In the region directly above the titanium mesh, there was an increase in dose of 7.1% for 6-MV photons and 4.9% for 18-MV photons. Directly below the titanium mesh, there was an average decrease in dose of 1.5% for 6-MV photons and an increase of 1.0% for 18-MV photons. At 5-cm depth, for 6- and 18-MV photons, there was a decrease in dose of 2.2% and 0.6%, respectively. We concluded that for cranial irradiation with high-energy photons, the dosimetric impact of a 0.4-mm titanium mesh is small and does not require modification in treatment parameters.     

A review of incisional hernia repairs: preoperative weight loss and selective use of the mesh repair

At the Shouldice Clinic pre-operative weight loss is used prior to incisional hernia repairs. Mesh repair is selectively used, based on specific hernia characteristics. A series of 236 patients were reviewed and followed up for 36 months. Data were available on 188 patients (80%). There were 15 recurrences (8%). The number of obese patients was reduced from 67 (35.6%) to 25 (13.3%) through the weight loss program. The hernia diameter, gastrointestinal complications, and surgical site infection were significantly related to recurrence but not the type of repair, obesity, location, or previous recurrences. The risk factors of incisional hernias include size, intestinal complications and infections. A selective use has a comparable result to the exclusive use of mesh repair. Weight reduction has yet to be shown to affect the rate of recurrence, and further prospective studies are required.     

经后路钛网椎板成形侧块内固定术治疗脊髓型颈椎病的疗效观察

目的 观察后路钛网椎板成形侧块内固定加植骨术治疗脊髓型颈椎病的临床效果。方法 自1999年至今，共有16例脊髓型颈椎病患者经后路钛网椎板成形侧块内固定加植骨术治疗，对治疗结果进行临床及X线评定。结果 通过平均2年5个月的随访，所有病例都得到了改善，其中优6例、良8例、可2例，优良率为93．8％；术后椎管矢状径平均增加4．2mm，钛网无位置变化，并已被再生骨固定。结论 在进行后路减压的同时，钛网椎板成形及侧块内固定，尤其适用于有节段性不稳的脊髓型颈椎病并椎管狭窄、后纵韧带骨化症的治疗。     

Parapubic hernia: case report and review of the literature

Parapubic hernia is considered rare, with 18 hernias described in five articles published since 1971. The hernia results from iatrogenically or traumatically detached rectus abdominis muscles at the pubic bone and presents a therapeutic challenge because there is no strong aponeurotic anchoring structure in the defect's caudal aspect. We describe a patient with a large parapubic hernia repaired by a combined preperitoneal and onlay prosthetic method. This report adds another dimension to the prosthetic repair options in parapubic hernias and illustrates the effectiveness of the tension-free repair principle in their definitive management. Electronic Publication     

颈椎椎体次全切除钛网钉板系统的临床应用

目的探讨颈椎前路椎体次全切除钛网钉板植骨融合的临床效果。方法自2001年3月～2003年3月间应用颈前路椎体次全切除钛网植骨融合及钉板固定治疗颈椎管狭窄性疾病22例，其中4例患者行2椎体次全切除3节椎间隙减压手术。术后观察减压、固定、融合及神经功能恢复情况，并行X线摄片或CT扫描检查。结果患者获6～12个月随访，神经功能得到不同程度改善，无加重情况。椎间隙高度无丢失、无成角，均获得骨性融合。术后3d在颈围领固定下下床活动，4周后可恢复较轻工作。结论此术式可避免传统手术方法的缺点，即不取自体髂骨，融合率高，稳定性好，并减压彻底，疗效好，是一种值得推广的新技术。     

Reactions in rat gluteal muscle to titanium implants

A new approach to the analysis of tissue-implant interaction is presented using rat gluteal muscle as implantation site and using monoclonal antibodies to identify and quantify cells around the implant. The method can be used for comparative studies on biocompatibility. In this methodological investigation, pure titanium (Ti) was studied, revealing an initial response of macrophages, followed by the formation of a fibrous membrane, in which, even at 50 and 70 d, la-expressing cells and suppressor T-lymphocytes were present.