目的:分析颈脊髓中央损伤综合征(central cord syndrome,CCS)手术治疗的预后及相关影响因素.方法:回顾性分析2017年1月～2019年12月在我院骨科经手术治疗的CCS病例,收集所有患者的年龄、性别、致伤原因、入院时美国脊髓损伤协会(American Spinal Injury Association,ASIA)运动评分、ASIA感觉(针刺觉)评分、日本骨科协会(Japanese Orthopaedic Association,JOA)评分、手内肌肌力评分及影像学资料信息[包括椎前高信号、后方韧带复合体、椎间盘突出、后纵韧带骨化、髓内高信号范围、椎管最狭窄处矢状径、椎管最狭窄处百分比(maximum canal compromise,MCC)和脊髓最大受压百分比(maximum spinal cord compression,MSCC)等]、受伤至手术时间、手术方式、住院时间、随访时ASIA神经功能评分、随访时JOA评分等资料,评估患者神经功能改善情况;将JOA评分改善率＞50％定义为预后好,≤50％定义为预后差,分析影响手术治疗预后的相关因素.结果:共纳入48例CCS患者,其中男性36例(75％),女性12例(25％),年龄54.76±9.78岁.入院时ASIA运动评分67.23±21.98分,ASIA感觉评分96.58±13.39分;JOA评分9.19±3.08分,手内肌肌力评分7.04±4.50分.19例(39.58％)存在病理征.伤后5.46±2.10d接受手术治疗,其中前路手术21例,后路手术27例.术后随访12～34个月,所有患者均未发生明显手术相关并发症或神经功能恶化,末次随访时ASIA运动评分89.67±13.65分,ASIA感觉评分104.88±7.94分,JOA评分13.73±3.25分,较入院时均有不同程度的提高(P＜0.05).多元回归分析显示ASIA运动评分、ASIA感觉评分和JOA评分的改善率与后纵韧带骨化(β=-0.447、P＜0.001;β=0.524、P=0.001;β=-0.196、P＜0.001)和入院 ASIA 感觉评分(β=0.526、P=0.011;β=0.894、P=0.02;β=-0.784、P＜0.001)有显著相关性.预后好与预后差患者的年龄、椎前高信号、后纵韧带骨化、椎管最狭窄处矢状径、MCC、入院手内肌评分、入院ASIA运动评分和入院JOA评分有统计学差异(P＜0.05),多元回归分析显示良好预后(JOA评分改善率＞50％)与年龄(β=5.889、P=0.015)、椎前高信号(β=15.799、P＜0.001)、MCC(β=6.747、P=0.009)、入院手内肌评分(β=9.012、P=0.003)、入院ASIA运动评分(β=4.837、P=0.028)、入院ASIA感觉评分(β=5.205、P=0.023)和入院JOA评分(β=6.446、P=0.011)存在显著相关性.受试者工作特征(receiver operating characteristic,ROC)曲线分析显示无椎前高信号[曲线下面积(area under curve,AUC)=0.756,95％CI 0.585～0.928,P=0.006]、MCC＜45.41％(AUC=0.731,95％CI 0.566～0.896,P=0.010)、入院手内肌评分＞11 分 AUC=0.77,95％CI 0.628～0.913,P=0.003)、入院 ASIA 运动评分＞75 分(AUC=0.804,95％CI 0.683～0.924,P=0.001)、入院JOA评分＞8.59分(AUC=0.755,95％CI 0.614～0.897,P=0.005)可作为良好预后的预测因子.结论:手术治疗CCS安全有效,无椎前高信号、MCC低(＜45.41％)、入院手内肌评分高(＞11分)、入院ASIA运动评分高(＞75分)和入院JOA评分高(＞8.59分)是CCS患者手术预后良好的预测因子.

颈脊髓中央损伤综合征(central cord syndrome,CCS)是颈脊髓损伤的一种类型,英国医生William Thorburn于1887年首先报道了此类病例[1].1954年美国医生Richard Schneider[2]在借鉴了前述病例的基础上,报道了一组特殊类型的颈脊髓损伤病例,即手部受累明显重于上臂和下肢,首次提出了急性颈脊髓中央损伤综合征(syndrome of acute central cervical cord injury)的概念,即上肢运动神经损伤重于下肢,损伤平面以下不同程度的感觉障碍;同时认为该类型脊髓损伤是由于颈椎过伸损伤而致.

Ankylosing spondylitis (AS) combined with spinal fractures with thoracic and lumbar fracture as the most common type shows characteristics of unstable fracture, high incidence of nerve injury, high mortality and high disability rate. The diagnosis may be missed because it is mostly caused by low-energy injury, when spinal rigidity and osteoporosis have a great impact on the accuracy of imaging examination. At the same time, the treatment choices are controversial, with no relevant specifications. Non-operative treatments can easily lead to bone nonunion, pseudoarthrosis and delayed nerve injury, while surgeries may be failed due to internal fixation failure. At present, there are no evidence-based guidelines for the diagnosis and treatment of AS combined with thoracic and lumbar fracture. In this context, the Spinal Trauma Academic Group of Orthopedics Branch of Chinese Medical Doctor Association organized experts to formulate the Clinical guideline for the diagnosis and treatment of adult ankylosing spondylitis combined with thoracolumbar fracture ( version 2023) by following the principles of evidence-based medicine and systematically review related literatures. Ten recommendations on the diagnosis, imaging evaluation, classification and treatment of AS combined with thoracic and lumbar fracture were put forward, aiming to standardize the clinical diagnosis and treatment of such disorder.

The acute combination fractures of the atlas and axis in adults have a higher rate of neurological injury and early death compared with atlas or axial fractures alone. Currently, the diagnosis and treatment choices of acute combination fractures of the atlas and axis in adults are controversial because of the lack of standards for implementation. Non-operative treatments have a high incidence of bone nonunion and complications, while surgeries may easily lead to the injury of the vertebral artery, spinal cord and nerve root. At present, there are no evidence-based Chinese guidelines for the diagnosis and treatment of acute combination fractures of the atlas and axis in adults. To provide orthopedic surgeons with the most up-to-date and effective information in treating acute combination fractures of the atlas and axis in adults, the Spinal Trauma Group of Orthopedic Branch of Chinese Medical Doctor Association organized experts in the field of spinal trauma to develop the Evidence-based guideline for clinical diagnosis and treatment of acute combination fractures of the atlas and axis in adults ( version 2023) by referring to the "Management of acute combination fractures of the atlas and axis in adults" published by American Association of Neurological Surgeons (AANS)/Congress of Neurological Surgeons (CNS) in 2013 and the relevant Chinese and English literatures. Ten recommendations were made concerning the radiological diagnosis, stability judgment, treatment rules, treatment options and complications based on medical evidence, aiming to provide a reference for the diagnosis and treatment of acute combination fractures of the atlas and axis in adults.

目的 调查分析训练伤导致的腰椎峡部裂的发生原因,为降低腰椎峡部裂发生率提供理论依据.方法 对2016年1月—2021年3月解放军总医院第七医学中心收治的因训练导致腰椎峡部裂的234例患者进行问卷调查,记录患者身高、体质量、日常训练项目、训练强度、受伤时姿势、受伤时从事的训练项目、骨折部位等资料,并进行统计学分析,总结腰椎峡部裂的好发部位、危险因素等.结果 训练导致的腰椎峡部裂好发于L5(发生率为85.0％),发生率显著高于L3、L4,差异均有统计学意义(P<0.05).负重行进和负重蹲起造成腰椎峡部裂的发生率显著升高.受伤瞬间腰部姿势:后伸102例(43.6％),前屈49例(20.9％),旋转39例(16.7％),侧曲12例(5.1％),不确定32例(13.7％),训练中腰椎在后伸状态下更容易发生峡部裂.结论 腰椎在后伸状态下峡部剪切力增大,负重会造成峡部剪切力进一步增大而导致骨折,负重行进及负重蹲起是最易造成腰椎峡部裂的训练项目.

Background Patients who do not respond to conservative treatment of the isthmus are often treated with surgery. We used direct repair plus intersegment pedicle screw fixation for the treatment of lumbar spondylolysis. The aim of this observational study was to assess the effects of this technique and evaluate various risk factors potentially predicting the probability of disc and facet joint degeneration after instrumentation. Methods The study included 54 male L5 spondylolysis patients who underwent pars repair and intersegment fixation using pedicle screws. Bony union was evaluated using reconstruction images of computed tomography. Radiographic changes, including disc height, vertebral slip, facet joint and disc degeneration in the grade of adjacent and fixed segments, were determined from before to final follow-up. Logistic regression analysis was performed to identify factors associated with the incidence of disc and facet joint degeneration. Results Bony union was achieved in all cases. Logistic regression analysis revealed that instrumentation durations of greater than 15.5 months and 21.0 months were significant risk factors for the incidence of L4/5 and L5S1 facet degeneration, respectively. Conclusions Intersegmental pedicle screw fixation provides good surgical outcomes and good isthmic bony union rates in patients with lumbar spondylolysis. The duration of fixation was confirmed as a risk factor for facet joint degeneration. Once bony union is achieved, instrument removal should be recommended.

Study Design: A retrospective study. Objective: The aim of this study was to evaluate the clinical and radiographic effect of recombinant human bone morphogenetic protein-2 (rhBMP-2) in pars repair of lumbar spondylolysis. Summary of Background Data: BMP-2 is a growth factor that plays a role in the formation of bone and promotes bone healing. However, few studies of using rhBMP-2 in pars repair have been reported. Methods: Direct pars repair and pedicle screw fixation was performed, which were added with 1 mg of rhBMP-2 and iliac crest bone graft in the study group (rhBMP-2 group, n = 32) and iliac crest bone graft alone in the autograft group (n = 36). Patients completed the visual analog scale and the Oswestry Disability Index preoperation, 3, 6, and 12 months after the operation. Computed tomography scans with axial and sagittal reconstructions were performed at 6, 9, 12, 18, and 24 months postoperatively. Results: Baseline demographic data showed no significant difference between 2 groups. There were significant differences for the Oswestry Disability Index score at 3 and 6 months postoperatively, which were higher in the autograft group. There was no significant difference between the groups with respect to the overall union status. As for union speed, the trabecular bone appeared earlier and union rates were higher in rhBMP-2 group than in the autograft group at 9, and 12 months postoperatively. No complications were identified in either group. One case in the rhBMP-2 group and 2 cases in the autograft group underwent revision surgery. Conclusion: Compared with iliac crest bone graft alone, the use of rhBMP-2 can accelerate fusion in pars repair for young patients with spondylolysis. The union rates were significantly different at 9 and 12 months after surgery. This study showed no clinical difference when adding rhBMP-2 compared with iliac crest bone graft alone.

Background:Spinal surgery is associated with severe pain within the first few days after surgery. Opioids are commonly used to control postoperative pain, but these can lead to postoperative nausea and vomiting (PONV). Therefore, use of more effective and better-tolerated agents would be beneficial for these patients. Serotonin receptor antagonists, such as ramosetron, have been used to reduce PONV in patients receiving anesthesia. Objective:We conducted a meta-analysis of published randomized controlled trials (RCTs) to compare the efficacy and tolerance of ramosetron to prevent PONV after spinal surgery. Methods:Medline, Embase, Cochrane Library, and Science Citation Index databases were systematically searched for relevant RCT articles published between January 1979 and November 2020. Full text articles restricted to English language that described RCTs comparing the use of ramosetron with other serotonin antagonists to treat PONV following spinal surgery in adult patients were considered for meta-analysis. Two reviewers independently performed study selection, quality assessment, and data extraction of all articles. Differences were resolved by a third reviewer. Results:The search identified 88 potentially relevant articles, of which only 3 met our selection criteria. Study drugs were administered at the end of spinal surgery in all 3 included articles. The meta-analysis revealed that ramosetron (0.3 mg) reduced the pain score (mean difference = -0.66; 95% CI -1.02 to -0.30), lowered the risk of PONV (risk ratio = 0.86; 95% CI, 0.76-0.97), and postoperative vomiting (risk ratio = 0.32; 95% CI, 0.17-0.60), and limited the use of rescue antiemetics (risk ratio = 0.66; 95% CI, 0.45-0.96) after spinal surgery. However, there were no significant differences in the incidence of postoperative nausea, the use of rescue pain medications, the number of rescue analgesics required, and the risk of discontinuation of patient-controlled analgesia between ramosetron and palonosetron (0.075 mg) or ondansetron (4 mg). There were no statistically significant differences in the risk of adverse events among the 3 medications. Conclusions:This meta-analysis of 3 RCTs showed that ramosetron reduced the risk of PONV and POV, limited the use of rescue antiemetics, reduced the postoperative pain score, and did not increase the risk of discontinuing patient-controlled analgesia compared with palonosetron or ondansetron after spinal surgery in 3 RCTs. Therefore, this meta-analysis indicates that ramosetron is an effective and well tolerated antiemetic that can be used to prevent PONV following spinal surgery in adult patients. PROSPERO identifier: CRD42020223596 (Curr Ther Res Clin Exp. 2022; 83:XXX-XXX)© 2022 Elsevier HS Journals, Inc.

BACKGROUND:When symptomatic spondylolysis fail to respond to nonoperative treatment, surgical management may be required. A number of techniques have been described for repair by intrasegmental fixation with good results; however, there are still some problems. We reported a repair technique with temporary intersegmental pedicle screw fixation and autogenous iliac crest graft. The aim of present study is to assess the clinical outcomes of L5 symptomatic spondylolysis with this technique.METHODS:A retrospective analysis of 128 patients with L5 spondylolysis treated with this method was performed. According to CT scan, the spondylolysis were classified into 3 categories: line, intermediate, and sclerosis type. The diagnostic block test of L5 bilateral pars defect was done in all patients preoperatively. The sagittal and axial CT images were used to determine the bone union. The healing time, complications, number of spina bifida occulta, Japanese Orthopedic Association (JOA) score, and VAS for back pain were recorded. After fixation removal, the rate of ROM preservation at L5S1 was calculated.RESULTS:There were 97 patients (194 pars) followed with mean follow-up of 23 months (range, 12-36 months). The union rate of pars was 82.0% at 12 months and 94.3% at 24 months postoperatively. Low back pain VAS significantly (P < 0.05) improved from preoperative mean value of 7.2 to 1.3 at the final follow-up postoperatively (P < 0.05). JOA score increased significantly postoperatively (P < 0.05) with average improvement rate of 79.3%. The rates of L5S1 ROM preservation were 79.8% and 64.0% after fixation removal at 1 and 2 years postoperatively. There were 3 patients of delayed incision healing without other complications.CONCLUSIONS:Although sacrificing L5S1 segment motion temporarily, more stability was obtained with intersegmental fixation. This technique is reliable for spondylolysis repair which has satisfactory symptom relief, high healing rate, low incidence of complications, and preserve a large part of ROM for fixed segment.

经过长期的临床实践,我们目前已经对青少年特发性脊柱侧凸(AIS)畸形有了较为系统的认识,尤其是通过King分型和Lenke分型等,分析总结了各种类型的AIS的特点,并制订了相应的手术策略,取得了较为肯定的临床疗效,成功的植骨融合内固定手术是AIS畸形矫正和维持远期疗效的关键所在[1].但是,在畸形得到矫正的同时,牺牲了手术节段的运动功能,这是目前不得不面对的现实问题.对于畸形位于胸椎的病例,由于其生理状态下的运动范围很小,因此矫正畸形的同时,注意冠矢状位的平衡,融合术后对患者的整体功能影响并不大;但对于胸腰段或腰椎畸形患者(如Lenke 5),如能在矫形的同时尽量保留脊柱的部分运动功能,对于患者脊柱的整体成熟发育、日常生活能力等方面将有良好的作用[2].

目的:评估后路减压Dynesys动态内固定治疗腰椎退变性疾病的长期临床疗效.方法:收集2008年7月～2013年12月在我院采用后路减压Dynesys动态内固定治疗的腰椎退变性疾病患者的临床资料,其中163例患者获得78～144个月(95.4±15.6个月)随访,男97例,女66例;年龄31～60岁(43.5±11.7岁).单节段固定117例,双节段固定42例,三节段固定4例.比较患者术前、术后3个月和末次随访时的Oswestry功能障碍指数(Oswestry disability index,ODI)和腰腿痛视觉模拟量表(visual analogue scale,VAS)评分;在术前、术后3个月和末次随访时的腰椎正侧位和前屈后伸位X线片上测量手术节段和上位邻近节段活动度(range of motion,ROM)及椎间高度,评估影像学和症状学邻近节段退变(adjacent segment degeneration,ASD)发生情况以及内固定相关并发症.结果:术后3个月及末次随访时的ODI和VAS评分均较术前显著性改善(P＜0.05),末次随访时与术后3个月时比较差异亦有统计学意义(P＜0.05).术前、术后3个月和末次随访时手术节段的ROM分别为7.8°±2.1°、4.6°±1.4°和3.9°±1.5°,手术节段椎间高度分别为12.1±2.9mm、12.8±3.5mm和10.9±2.8mm,上位邻近节段ROM分别为8.3°±1.9°、9.2°±2.7°和10.2°±2.8°,术后3个月及末次随访时与术前比较、末次随访时和术后3个月比较均有统计学差异(P＜0.05);上位邻近节段椎间高度分别为12.7±3.1 mm、12.6±3.2mm和12.1±2.8mm,差异均无统计学意义(P＞0.05).末次随访时32例(19.6％)患者手术节段ROM小于4°(临床融合组),131例(80.4％)大于4°(非融合组),两组患者术前、术后3个月和末次随访时的VAS评分和ODI均无统计学意义(P＞0.05).末次随访时30例(18.4％)患者出现影像学ASD;2例(1.2％)患者出现症状学ASD,其中1例行翻修手术,另1例行保守治疗.1例患者术后2个月出现术区深部感染,抗感染治疗后痊愈;6例患者在术后5年随访时出现单侧螺钉松动,均未行手术治疗.2例患者出现椎弓根螺钉断裂,无不适症状未给予翻修手术.所有患者均无手术节段症状复发.结论:后路减压Dynesys动态内固定治疗腰椎退变性疾病可获得良好的长期临床疗效,并能保留手术节段部分活动度.

目的 评估术前低蛋白血症与高龄患者腰椎融合术后并发症的相关性.方法 回顾性分析2013年1月至2014年12月,89例因腰椎退行性疾病在我院接受腰椎后路融合术的75岁以上患者临床资料,其中男41例,女48例;年龄75～87岁,平均(78.9±3.0)岁.根据术前血清白蛋白的水平(以35 g/L为界)分为低蛋白组(n=23)和正常组(n=66).比较两组患者术前合并症和术后3个月内并发症的发生情况,采用回归分析评估低蛋白血症与高龄患者腰椎融合术后并发症的相关性.结果 本组平均随访时间(27.9±7.2)个月,低蛋白组和正常组术后总并发症发生率分别为43.5％(10/23)和19.7％(13/66),差异有统计学意义(P=0.02).低蛋白组非手术并发症和泌尿系感染发生率分别为39.1％(9/23)和26.1％(6/23),均高于正常组的18.2％(12/66)和7.6％(5/66)(P=0.04和P=0.02).两组术后住院>14天患者比例分别为43.5％(10/23)和21.2％(14/66)(P=0.04).回归分析结果显示,相对于正常组,低蛋白血症组患者术后总并发症发生风险为3.14[95％CI:1.13～8.73,P=0.03],非手术并发症风险为2.89(95％CI:1.02～8.23,P=0.04),泌尿系感染风险为4.31(95％CI:1.17～15.85,P=0.03),术后住院时间>14天风险为5.78(95％CI:2.07～16.09,P=0.01).结论 低蛋白血症是高龄患者腰椎融合术并发症的独立危险因素,低蛋白血症能够增加术后总并发症、非手术并发症、泌尿系感染以及术后住院时间>14天的风险.

[目的]比较单开门椎板成形术中采用与不采用椎间孔切开的临床结果.[方法] 2015年1月～2019年6月,对68例混合型颈椎病患者行后路单开门椎板成形术,其中,早期的38例行单纯单开门成形术(非切开组),后期的30例行单开门成形联合椎间孔切开术(切开组).比较两组患者围手术期、随访与影像资料.[结果]两组患者均顺利手术,术中无血管、神经损伤.早期并发症方面,切开组30例中,仅1例(3.33％)出现术后脑脊液漏;非切开组38例中,7例(18.42％)出现肩背轴性疼痛症状,6例出现(15.79％)C5神经根病,两组间差异有统计学意义(P＜0.05).随时间推移,两组患者的颈痛和上肢痛VAS评分均显著下降(P＜0.05),而JOA评分均显著增加(P＜0.05).术后各时间点切开组的上肢痛VAS评分均显著优于非切开组(P＜0.05).影像方面,末次随访时两组患者椎管矢状径均较术前显著增加(P＜0.05);未次随访时切开组神经根管直径较术前显著增加(P＜0.05).[结论]椎间孔切开可有效减少单开门椎板成形术后C5神经根麻痹,改善根性症状.

Objective:To investigate the complications and prevention strategies of Dynesys stabilization in the treatment of lumbar degenerative disease.Methods:Two hundred and forty-three patients underwent lumbar spine stabilization with Dynesys owing to lumbar degenerative disease were retrospectively analyzed from July 2008 to December 2016. The mean follow-up time was 5.6 years (48-148 months). There were 152 patients with lumbar disc herniation and 91 patients with lumbar spinal stenosis. 167 cases underwent single-level operation, 71 cases underwent two-level operation, and 5 cases underwent three-level operation. All patients had low back pain, radiating pain in the lower extremities, and/or intermittent claudication. Clinical outcomes were evaluated using Oswestry disability index (ODI) and visual analogue scale (VAS). The occurrence of perioperative complications (with in 3 months) and postoperative complications (after 3 months) after the operation were recorded and analyzed. Radiographic adjacent segment degeneration (ASD) was evaluate dusing University of California at Los Angeles Grading Scale (UCLA).Results:All patients underwent surgery successfully. ODI score of patients improved from 55.1%±16.8% preoperatively to 15.6%±5.8% at the final follow-up, the difference was statistically significant ( t=34.6, P<0.01). VAS score decreased from 6.4±2.3 preoperatively to 1.1±0.4 at the final follow-up, the difference was also statistically significant ( t=35.4, P<0.01). There were 25 cases (10.29%) with complications, and 3 cases (1.23%) underwent secondary operation. Perioperative complications occurred in 13 patients (5.35%), including 5 cases of cerebros pinal fluid leakage, 5 cases of poor wound healing (2.06%), and 3 cases of deep wound infection (1.23%). Twelve patients (4.94%) had long-term postoperative complications, including 6 patients (2.47%) of unilateral screw loosening at the 5-year follow-up, 3 patients (1.23%) of screw fracture, and 3 patients (1.23%) of symptomatic ASD, among whom 2 patients underwent secondary operation, and 1 patient underwent conservative treatment. There was no recurrence at the operated segments in all patients. At the final follow-up, 41 patients (16.87%) had radiographic ASD. The UCLA score atthe final follow-up was significantly different from that preoperatively ( Z=2.60, P=0.01). Conclusion:Dynesys dynamic system combined with decompression in the treatment of degenerative lumbar spine diseases can achieve good long-term clinical outcome, with low incidence of complications and ASD.

背景:腰椎开窗减压髓核摘除术在临床应用多年,疗效确切;但术后仍然存在一些并发症及不良反应.目的:研究加速康复外科(enhanced recovery after surgery,ERAS)在青年患者腰椎开窗减压椎间盘髓核摘除术中的应用效果.方法:前瞻性对2017年12月至2018年11月于我科因单节段腰椎间盘突出而行腰椎开窗减压椎间盘髓核摘除术的患者随机进行分组:ERAS组(36例)和对照组(36例).ERAS组进行加速康复的干预,对照组进行常规围手术期处理.ERAS措施包括:术前宣教;术前饮食管理;氨甲环酸注射液的使用;显微镜下行椎管内操作;切口内引流管管理;切口缝合前皮下给予0.25％布比卡因行局部长效麻醉;尿管管理;围手术期限制补液量;早期功能锻炼等.对比分析两组患者术前、术后及末次随访时腰痛及下肢疼痛的VAS、ODI评分,术后阿片类镇痛药物使用量,手术时间,出血量,切口长度,下地时间,术后住院时间,手术相关并发症等;使用Likert 10级量表评估术后及末次随访时患者对治疗的满意度.结果:ERAS组术后早期VAS评分、术后恶心呕吐、泌尿系感染发生率、阿片类药物使用量、术后平均住院时间均低于对照组,差异有统计学意义(P<0.05).ERAS组患者术后早期满意度明显高于对照组,差异具有统计学意义(P<0.05).而两组在手术时间、切口长度、术中出血量等无统计学差异.结论:通过ERAS措施的实施,可以提高腰椎开窗减压椎间盘髓核摘除术患者的术后舒适度,缩短患者术后住院时间、减轻患者术后疼痛、降低术后并发症发生率及阿片类药物的使用,值得在脊柱外科临床推广.

目的 评估短节段减压固定术治疗老年退行性脊柱侧凸合并腰椎管狭窄的临床疗效.方法 回顾性分析2014年1月至2017年12月,我院采用后路短节段(<3节段)固定融合手术治疗的59例老年(>65岁)退行性脊柱侧凸合并腰椎管狭窄患者,根据Berjano分型分为Ⅰ型组(40例)和Ⅱ型组(19例).患者年龄65～88岁,平均75.4岁,随访时间18～36个月,平均25.1个月.记录患者手术时间、术中失血量、术后并发症的发生情况,评估两组患者术前、术后随访时腰部和下肢的疼痛视觉模拟评分(visual analogue scale,VAS)和Oswestry功能障碍指数(oswestry disability index,ODI),比较术前和术后随访时患者侧凸Cobb's角、脊柱矢状位平衡(sagittal vertical axis,SVA)和腰椎前凸角(lumbar lordosis,LL)的变化情况.结果 两组患者年龄、性别、随访时间、术前神经根阻滞患者数、手术时间、术中失血量差异均无统计学意义(P>0.05),组间手术节段差异有统计学意义(χ2=5.09,P=0.02).末次随访时两组患者腰部和下肢VAS以及ODI均较术前明显改善,差异有统计学意义(P<0.05),组间差异无统计学意义(P>0.05).BerjanoⅠ型和Ⅱ型患者侧凸Cobb's角分别由术前的(17.2±3.5)° 和(19.1±4.2)° 降至术后3个月时的(10.3±2.7)° 和(10.5±3.1)°,而末次随访时分别增加至(14.3±2.9)° 和(15.2±3.9)°,与术前相比差异均有统计学意义(FⅠ=51.5,P<0.01;FⅡ=25.5,P<0.01),而SVA和LL术前、术后无显著变化(P>0.05).两组共有20例(33.9％)出现并发症,其中围术期并发症15例,远期并发症5例,两组间差异无统计学意义(P>0.05).结论 短节段减压固定手术治疗BerjanoⅠ型和Ⅱ型老年退行性脊柱侧凸合并腰椎管狭窄,具有满意的短期临床疗效,能够改善侧凸畸形.

椎间融合器(interbody fusion cage)联合椎弓根钉棒系统实施腰椎后路减压融合内固定术是治疗腰椎退变性疾病如腰椎管狭窄症、腰椎滑脱症、腰椎间盘突出症合并腰椎不稳等的常用手术方法,包括后路腰椎椎间融合术(posterior lumbar interbody fusion,PLIF)和经椎间孔入路腰椎椎间融合术(trans-foraminal interbody fusion,TLIF),取得了良好的效果.但是有0.9％～4.7％的腰椎后路手术患者由于椎间融合器应用不规范,术后出现椎间融合器相关并发症,给后续治疗带来困难[1～5].为了正确规范地应用椎间融合器,减少椎间融合器相关并发症的发生,《中国脊柱脊髓杂志》编辑部组织的国脊沙龙邀请20余位脊柱外科专家,在循证医学的基础上,经多轮专家讨论,形成以下共识,供脊柱外科医师参考.

[目的]比较单纯自体与自体骨混合骨形态蛋白(BMP)原位植入修复青年腰椎峡部裂的临床效果.[方法]回顾分析2015年1月～2019年6月,本科手术治疗的80例腰椎峡部裂患者.原位清创后,40例于峡部单纯植入自体骨,40例植入自体骨混合BMP,均给予节段间椎弓根钉固定.比较两组患者围手术期、随访和影像资料.[结果]两组患者均顺利完成手术,均无严重并发症.随访18个月以上,随时间推移,两组患者VAS和ODI评分均显著减少(P＜0.05);相应时间点,两组间VAS和ODI评分的差异均无统计学意义(P＞0.05).影像方面,随时间推移,两组患者峡部愈合率均显著增加(P＜0.05).术后3、6和12个月时,BMP组的峡部骨性愈合率显著高于自体骨组(P＜0.05);术后18个月,BMP组的峡部骨性愈合率仍高于自体骨组,但差异已无统计学意义(P＞0.05).[结论]青少年腰椎峡部裂采用峡部原位自体髂骨植骨合并BMP可以有效促进峡部骨愈合.