2017年上海长征医院史建刚教授团队首次报道颈椎前路椎体-后纵韧带骨化物复合体可控前移融合术(ante-rior controllable antedisplacement and fusion,ACAF)治疗严重颈椎后纵韧带骨化症(ossification of posterior longitu-dinal ligament,OPLL)[1],其可在不切除骨化物的前提下实现脊髓原位减压,已被证明是一种安全有效的治疗严重颈椎OPLL的新型前路减压术式[2-5].然而,目前尚无系统地针对ACAF手术制定的器械,如钛板、螺钉及提拉工具等,尤其是对于提拉工具,仍需要进一步的改进[6].我们团队在早期开展ACAF的过程中,发现使用高速磨钻或超声骨刀开槽后游离椎体-后纵韧带骨化物复合体(vertebrae-OPLL complex,VOC)不彻底,导致不能顺利地完成前移提拉,而在进一步开槽游离椎体的过程中又会增加对神经的干扰,从而导致术后神经根损伤的症状.基于此,我们开发了带线锚钉辅助提拉VOC的方法,在临床应用中取得满意疗效,现对其总结报道.

目的 探讨3D打印定位导航模板辅助置钉在脊柱畸形矫形术中应用的可行性,并评估置钉的准确性与安全性.方法 回顾性分析2020年4月—2021年4月北京大学深圳医院收治的因脊柱畸形接受3D定位导航模板辅助置钉矫形术治疗的9例患者临床资料.通过术前规划确定钉道和螺钉尺寸,所有患者术中均使用3D打印定位导航模板辅助置钉,术后复查CT平扫及三维重建,采用Mobbs-Raley分级对螺钉位置进行评估,并分析置钉相关并发症发生情况.结果 所有手术顺利完成.共置入椎弓根螺钉118枚,其中34枚穿破椎弓根皮质,9枚穿破椎体外缘.0级螺钉75枚,1级螺钉24枚,2级螺钉19枚,置钉准确率为63.6％,置钉安全率为83.9％.所有患者均未发生神经、血管损伤等相关并发症,无患者行翻修手术.结论 3D打印定位导航模板辅助置钉在脊柱畸形矫形术中有良好的应用价值,置钉准确性和安全性较高.

腰椎峡部裂是指一侧或两侧峡部骨质不连续,在一般人群中发生率为6％,男女比例为2:1[1].腰椎峡部裂是引起青少年腰背痛的常见原因,与腰椎反复过伸及旋转活动密切相关[2-5].有研究[6]表明,青少年腰椎峡部裂有一定遗传倾向.大部分有症状的青少年腰椎峡部裂患者可通过规范的非手术治疗恢复日常生活和运动,尤其对于发现较早的单纯性腰椎峡部裂应首先考虑非手术治疗[7-9].目前腰椎峡部裂非手术治疗包括系统物理治疗、腰背肌锻炼、佩戴支具及封闭治疗等[10].

目的 研究低频脉冲电穴位刺激对腰椎术后患者自主排尿的影响.方法 选取2015年5月～2016年12月,在北京大学深圳医院脊柱外科全麻下行2个节段腰椎手术的患者100例.根据患者的入院顺序分为对照组与观察组,各50例.所有患者均在手术前后进行腰椎手术常规护理.对照组患者在拔除尿管后进行常规诱导排尿护理干预,观察组患者则在对照组的基础上予以低频脉冲电穴位刺激干预.比较两组患者术后尿管留置的时间、术后第一次拔除尿管后再次导尿的次数、术后拔除尿管后第一次自主排尿后的残余尿量,观察两组患者护理干预前后心理状况、满意度以及生活质量情况.结果 观察组患者的尿管留置的时间、再次导尿次数、自主排尿后的残余尿量分别为(28.8±3.5)h、(0.3±0.1)次、(52.4±12.4)mL,均低于对照组的(88.2±24.7)h、(0.5±0.2)次、(86.6±25.0)mL,差异均有高度统计学意义(P＜0.01);护理干预后观察组患者焦虑自评量表、抑郁自评量表评分分别为(23.8±5.1)、(19.2±3.4)分,均低于对照组的(32.4±6.0)、(30.4±4.5)分,差异均有高度统计学意义(P＜ 0.01);观察组患者满意度为92.00％,高于对照组的76.00％,差异有统计学意义(P＜ 0.05);护理干预后观察组患者生理功能、生理职能、躯体疼痛、社会功能、精力、情感职能、精神健康和总体健康的SF-36评分均高于对照组,差异均有高度统计学意义(P＜0.01).结论 低频脉冲电穴位刺激能促进腰椎术后患者自主排尿,且有利于改善患者心理状况,提高满意度以及生活质量.

目的 探讨可吸收止血流体明胶在腰椎后路椎间融合术中控制出血的有效性和安全性.方法 选取我科2016年10月至2017年10月期间因腰椎管狭窄症,行单节段腰椎后路减压椎间融合植骨内固定术的患者共96例,分为试验组和对照组,每组分别为48例.对照组采用常规外科手术方法止血,试验组术中除常规外科止血外,同时使用可吸收止血流体明胶.通过对比两组患者的手术时间、术中出血量、术后引流量,术后感染的发生情况等综合评价两组患者的治疗效果.结果 试验组应用可吸收止血流体明胶后,其术中出血量(180.7±15.6)mL、手术时间(95.6±13.8) min,均少于对照组术中出血量(216.8±19.2) ml、手术时间(103.7±18.9) min,差异有统计学意义(P＜0.05);试验组术后第1、2、3天的引流量分别为(186.8±29.2)mL、(286.7±27.1) mL、(320.7±30.2) mL,与对照组(210.8±36.1) mL、(315.5±20.5) mL、(372,8±22.2) mL相比,差异有统计学意义(P＜0.05).术后伤口发生感染的情况,试验组发生率为2/48,对照组发生率为3/48,无统计学差异(P＞0.05).结论 流体明胶可减少手术时间、术中出血量以及术后引流量,并不增加伤口感染的风险.它是一种安全、有效的止血剂,在腰椎后路手术中有其应用价值.

Objective To observe the effects of creatine phosphate sodium on delirium after major orthopedic surgeries in elderly patients.Methods The 80 elderly patients scheduled for selective major orthopedic surgeries were randomly divided into observation group (40 patients) and control group (40 patients).The former were given creatine phosphate sodium 1 g introvenously at 30 min preoperatively and at 1,2,3 d postoperatively,respectively,and the latter were given the same-volume saline instead.All patients were tested with the confusion assessment method Chinese reversion (CAM-CR),delirium rating scale (DRS-R-98),mini-mental state examination (MMSE),at the day before operation and everyday from d 1 to d 7 postoperatively.Results Postoperative delirium was detected in 6 patients (15%) in observation group,and 14 patients (35%) in control group,the incidence rate of postoperative delirium in observation group was significantly lower,compared with control group (P<0.05).The average hospitalization time postoperatively was(9.10±1.96) d in observation group,and(12.65±2.61)d in control group,the average hospitalization time postoperatively in observation group was significantly shorter,compared with control group (P<0.05).There was no statistically significant difference of CAM-CR scores,DRS-R-98 severity scores,DRS-R-98 total scores and MMSE scores between the two groups at the day before operation and the 1,2,6,7 d postoperatively (P>0.05).Compared with control group,the CAM-CR scores and DRS-R-98 severity scores,DRS-R-98 total scores in observation group were significantly lower at the 3~5 d postoperatively (P<0.05),and the scores of MMSE were significantly higher at the 3~5 d postoperatively (P<0.05).Conclusions Creatine phosphate sodium can decrease the incidence of delirium after major orthopedic surgeries in elderly patients,alleviate the severity of delirium after surgery,and enhance the rehabilitation after surgery.

Objectives:To compare the difference of the enhancing effect of electronic acupuncture and low frequency pulse acupoint stimulation on the urination potential in a rabbit urinary retention model.Methods:40 male New Zealand rabbits were used and randomly divided into normal group(n=10),control group(n=10),electronic acupuncture group(EA group,n=10) and low frequency group(n=10).Under the condition of general anesthesia,four groups of animals were inserted transurethral tube,suction empty bladder with a syringe,at a speed of 50ml/h to the bladder perfusion physiological saline,in 50min reperfusion,control group EA group and low frequency group at the same time at a speed of 20ml/h uniform intravenous 0.05％ mountain scopolamine 10ml model type weakening in function of forced urinous muscle,bladder,and normal group,constant intravenous injection amount of saline solution.Interventions:when the bladder perfusion(90min),taking in A hole on one side and three Yin meridians stimulated,time to 20min EA group on the acupuncture needle retaining needle,electric acupuncture apparatus and connections,2Hz frequency current of 0.6A constant stimulation was used.The low frequency group attached electrodes to the acupuncture points,which were connected to the frequency of 20-100Hz of the TERESA nerve body instrument,which stimulated the width of the pulse width of 100 to 500μs.No stimulus was used in control group and normal group,the rest for 20min;physiological signal acquisition system instrument was used to measure four groups of animals when the bladder perfusion(before intervention) over at the end of the intervention,and the end of intervention measures immediately from the urine tube average urination urine speed (5min).Results:Intervention measures four groups of animals before the pressure on the bladder and low frequency group (12.6±1.5cmH2O),EA group (13.5±1.6cm H2O),in control group (12.5±1.5cmH2O) was significantly lower than normal group (16.7±3.2cmH2O).After intervention measures,low frequencygroup(16.8±1.6cmH2O) was significantly higher than control group (11.6±1.4cmH2O),which was also higher than the group with the end of bladder perfusion(before intervention).Micturition speed comparison showed low frequency group (106.2±10.2 drops/min),EA group (102.3±10.5 drops/min),normal group(105.7±11.4 drops/min) were significantly higher than control group(84.4±9.7 drops/min)(all P＜0.05);in the low frequency group and EA group,the inside bladder pressure and average micturition speed showed no statistical significance(P＞0.05).Conclusions:Both the electric acupuncture and low frequency pulse acupoint stimulation are effective to improve the urination of urinary retention in rabbits;low frequency pulse acupoint stimulation is easily accessible without invasive operations which is more suitable for extensively clinical application.

纤维连接蛋白肾小球病,也称纤维连接蛋白沉积肾小球病(glomerulopathy with fibronectin deposits,GFND),是近年来才被认识的一种遗传性肾小球病,其发病较为罕见.据不完全统计,自1980年以来,全世界共报道了约13个家系,患者总数约48人[1～10].