CT引导下经皮经椎弓根脊椎肿瘤穿刺活检

目的探讨在CT引导下经皮经椎弓根行脊椎肿瘤穿刺活检的价值。方法CT引导下选择最佳穿刺点、穿刺角度及深度并随时调整,以确保整个穿刺过程在病变的椎弓根内及椎体内完成。结果所有病例均未发生穿刺并发症。11例所取组织量可满足病理检查要求。1例取材量不足而未能得出满意诊断结果。结论CT引导下经椎弓根行脊椎肿瘤穿刺活检取材准确,操作安全可靠。     

巨大型腰椎间盘突出症两种手术方案的疗效比较

目的对比观察椎板切除、椎间盘切除加cage植骨椎间融合结合椎弓根系统内固定术与椎板切除加髓核摘除术治疗巨大型腰椎间盘突出症的临床疗效。方法 106例单间隙、巨大型腰椎间盘突出症根据手术方式不同分为两组(各53例),A组行椎板切除、椎间盘切除加cage植骨椎间融合并椎弓根系统内固定术,B组行椎板切除加髓核摘除术,应用Macnab标准评定疗效,观察腰腿痛复发及骨性融合情况。结果两组患者出血量、手术时间、卧床时间差异有统计学意义(P<0.05);手术效果按照改良Macnab标准评定:术后6个月:A组优良率为90.57%,B组优良率为66.04%,两组差异有统计学意义(P<0.05)。末次随访:A组优良率为84.91%,B组优良率为50.93%,两组差异有统计学意义(P<0.05)。结论在严格选择手术适应证的情况下,行椎板切除加cage植骨椎间融合结合椎弓根系统内固定术的近中期临床疗效满意,该方法具有固定可靠、术后恢复快、复发腰腿痛少等优点。     

退变性腰椎不稳症手术治疗的疗效分析

目的:探讨退变性腰椎不稳症手术治疗的疗效。方法:随访我院60例腰椎不稳症患者运用椎板扩大开窗或全椎板切除减压,摘除髓核,椎体间植骨,后路钉棒系统加压内固定及腰椎间融合术。结果:术后随访半年到3.5年,平均12个月,复查X线示骨性融合,2例出现断钉及松动现象,患者症状完全消失48例,基本消失7例,无明显缓解5例(可3例,差2例)。根据日本骨科学会(JOA)评分法,优良率91.3%。结论:椎弓根螺钉内固定加椎管减压,椎体间植骨融合可使不稳节段即刻稳定,骨性融合率高,是治疗腰椎不稳症的较好方法。     

CT引导下经椎弓根穿刺活检对椎体病变的诊断价值

目的 :评价CT引导下经椎弓根穿刺活检对椎体病变的诊断价值。方法 :回顾性分析 17例椎体病变经椎弓根穿刺活检的病理结果 ,随访结果 ,外科手术结果及穿刺并发症。结果 :恶性病变总的穿刺成功率为 10 0 % (10 / 10 ) ,其中首次穿刺成功率为 80 % (8/ 10 ) ,第二次穿刺成功率为 10 0 % (2 / 2 ) ;良性病变穿刺成功率为 5 7 1% (4/ 7) ;所有病例均未发生严重穿刺并发症。结论 :CT引导下经椎弓根穿刺活检对椎体病变的诊断有较高的准确性 ,并发症较低 ,值得推广。     

经椎弓根植骨和椎体成形术治疗胸腰椎爆裂性骨折

目的 探讨经椎弓根植骨和椎体成形术治疗胸腰椎爆裂性骨折的方法和效果。方法 采用经椎弓根植骨椎体成形术治疗胸腰椎爆裂骨折24例并与同期同类骨折31例作比较性研究。结果 治疗组24例有1例螺钉松动,松动率4％,无断钉。对照组31例有8例内固定不同程度松动,松动率25％,2例断钉,断钉率6％。治疗组,对照组在前后缘高度的恢复,术前术后Cobb角的纠正,螺钉松动,断钉率等项指标中均存在着显著性差异(P<0.05)。结论 经椎弓根椎体植骨成形术重建了椎体高度,增加了脊柱前柱的抗压稳定性,使病人能早期活动,减少内固定物因应力过大造成的断钉、松动、椎体再压缩等并发症。     

Erfahrungen mit dem VSP-system nach steffee bei frakturen der brust- und lendenwirbelsäule

Zusammenfassung Das Variable-Screw-Placement-(VSP)-System nach Steffee wurde erstmals 1982 in der orthopädischen Chirurgie angewandt. Diese winkelstabile Platten-Schrauben-Kombination fand in den letzten Jahren auch in der Unfallchirurgie zunehmend Verwendung. In den Jahren 1989 bis 1991 wurden an der Universitätsklinik fur Chirurgie Graz, Department für Unfallchirurgie, 20 Patienten mit diesem Implantat versorgt und das Metall wurde bereits bei 15 dieser Patienten nach durchschnittlich einem Jahr wieder entfernt. Spätresulta-te und vergleichende Ergebnisse mit anderen Implantaten werden vorgestellt.

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Experience with the steffee VSP system for stabilization of fractures of the thoracic and lumbar spine

The variable screw placement (VSP) system was first used in orthopaedic surgery. In recent years, this rigid screw-plate system has been implanted with increasing frequency in patients with traumatic instabilities of the thoracolumbar spine. At the University Hospital in Graz, 20 patients have been operated on in the Department of Surgery using this system, and 15 of them have been followed up some months after the hardware removal. The results are compared with those achieved in patients whose instabilities were stabilized with other implants.

     

治疗骨质疏松防止椎弓根钉松动

目的 椎弓根钉固定系统是目前临床上应用最多的脊椎后路内固定的方法。但与之相关的并发症也见增多，其中螺钉松动导致内固定失败，假关节形成是主要的并发症。其原因为针-骨界面的连接不牢固所致。有关的研究报道证明骨密度与螺钉的最大轴向拔出力有正相关的关系。因此骨密度对椎弓根钉的稳定具有重要影响。我们对58例胸腰段骨折的病人应用DPX—IQ型双能X骨密度仪进行密度检测，对其中46例骨密度降低或骨质疏松的病人，在进行手术内固定的同时采用联合用药方式治疗骨质疏松，使病人骨量明显增加，46例中椎弓根钉松动的2例，没有拔钉现象发生。     

Brown-Sequard syndrome revealing intradural thoracic disc herniation

Brown-Sequard syndrome (BSS) is a rare form of severe myelopathy characterised by a clinical picture reflecting hemisection of the spinal cord. This syndrome is mostly due to a penetrating injury to the spine but many other non-traumatic causes have been described. Intradural thoracic disc herniation (TDH) is one of the rare aetiologies of this syndrome. Despite progress in imaging techniques, diagnosis and treatment remain difficult. We retrospectively reviewed one of the largest reported series of six patients with BSS revealing intradural TDH between 2003 and 2007. There was a marked female predominance and the mean age was 44 years. Before surgery, half of the patients had a severe neurological deficit. The mean duration of symptoms until surgery was 8.5 months (range 0.5–24 months). Spine magnetic resonance imaging (MRI) or spine computer tomography scan showed calcified TDH between T5–T6 and T9–T10. The intradural location of the thoracic herniation was strongly suspected from the clinical data. All the patients underwent posterolateral transpedicular surgery with an operative microscope to open the dura mater. The intradural location of the herniation was overlooked in one case and the patient underwent a second procedure. The dura mater was carefully closed. Two patients’ condition worsened immediately after the surgery before slowly improving. All the other patients improved their neurological status immediately after the surgery and at 12 months follow-up. BSS with TDH on the spine MRI scan may be a warning symptom of the intradural location of the herniated disc. In such cases, spine surgeons are advised to use an operative magnification and to open the dura mater to avoid missing this potentially curable cause of severe myelopathy.     

经伤椎椎弓根椎体内植骨内固定治疗胸腰椎骨折80例的疗效分析

目的:探讨经伤椎椎弓根植骨结合内固定治疗胸腰椎骨折的临床疗效。方法:80例外伤患者全部行经伤椎椎弓根植骨和椎弓根内固定术治疗胸腰椎骨折,分别测量术前、术后2周及去内固定后3个月患者的椎体高度和脊柱后凸角,统计学数据分析。结果:平均随访16.5个月,按Frankel分级脊髓功能恢复提高0～3级,椎体前缘高度增加46.9%,术后后凸Cobb角由术前平均21.9°恢复到3.2°。全部患者内固定无断裂、无感染、无神经症状加重等并发症发生。结论:经伤椎椎弓根植骨联合椎弓根内固定可重建伤椎高度和防止后期矫正度丢失。     

中重度胸腰椎爆裂骨折治疗的长期疗效观察

目的通过46例中重度胸腰椎爆裂骨折的长期随访研究,探讨后路半环式或全环式椎管减压、经伤椎椎弓根椎体内植骨这一术式的临床疗效。方法本组46例中重度胸腰椎爆裂骨折,根据伤椎三柱损伤和破坏的不同程度,分别选择后路半环式或全环式椎管减压、经伤椎椎弓根椎体内植骨。2例陈旧性椎体爆裂骨折合并脊髓或神经根不完全损伤,同时伴有后凸畸形〉30°,采用楔形截骨＋环状减压。通过长期随访观察术后患者神经功能改善和恢复情况;通过术前术后及长期随访CT和X线观察分析伤椎植骨愈合情况,椎体高度和后凸角变化情况。结果半环式或全环式椎管直接减压,椎管容积恢复接近或大于正常椎管。平均两年半左右,椎体内植骨与周围骨组织融合,椎管基本完成重塑形。伤椎前缘高度及脊柱后凸角明显改善。两侧同时经椎弓根伤椎植骨组,术后即刻与长期随访脊柱后凸角比较无明显差异;经一侧椎弓根伤椎植骨组,术后即刻与取出内固定后长期随访伤椎楔变角、伤椎前后缘高度比、脊柱后凸角矫正平均分别丢失1.00°、1.03%和6.07°。除4例术前ASIA神经功能分级A级患者术后功能未恢复,其余A、B、C、D级患者均有1～3级恢复。本组病例无内固定松动、断钉、断棒及继发神经功能损伤。结论后路半环式或全环式椎管减压可以达到直接减压,减压后的椎管有重新塑形功能,大约在一年到一年半左右完成重塑形。伤椎椎体内植骨最终和周围骨组织融合,对维持前柱高度,恢复伤椎形态、防止后期矫正角度及椎体高度的再丢失,避免继发椎管狭窄起到积极作用。