目的:探讨经第2骶椎骶髂(S2AI)螺钉内固定在成人退变性腰椎侧后凸畸形合并骨质疏松症(OP)患者矫形术中的应用效果.方法:收集2016年1月至2019年7月收治的35例成人腰椎侧后凸畸形合并OP患者的资料,男6例,女29例.术中固定至骶2水平(S2AI组)20例,其中男4例,女16例;固定至骶1水平(S1组)15例,其中男2例,女13例.术前、术后第7天及末次随访时,测量侧凸脊柱-骨盆参数,包括侧凸Cobb角、矢状面轴向距离(SVA)、冠状面平衡(C7 PL-CSVL)、骨盆倾斜和局部后凸(RK)Cobb角;并进行疼痛视觉模拟评分(VAS)和Oswe-stry功能障碍指数(ODI)评价.结果:两组患者年龄、手术时长、出血量、随访时间差异均无统计学意义(P>0.05).S2AI组末次随访时侧凸Cobb角(18.0±7.0)°,C7PL-CSVL(6.0±1.8)mm,骨盆倾斜(2.1±1.0)°,RK Cobb角(3.6±17.4)°,SVA(16.9±14.1)mm;与术前比较,上述指标均显著降低(P<0.05).两组患者术后第7天、末次随访时VAS和ODI均较术前降低(P<0.05).两组之间上述指标改善程度比较差异无统计学意义(P>0.05).患者术中均未出现SSEP及MEP信号的改变和丢失.术后随访中未发生退钉、断棒、PJK、DJK及脊柱失代偿.S2AI组术后并发症(螺钉松动和迟发性臀部疼痛)发生率2/20,S1组为11/15,S2AI组并发症发生率低于S1组(P=0.022).结论:应用S2AI螺钉内固定治疗成人腰椎侧后凸畸形合并OP,既能满足强化固定的需要,又可获得有效的矫形效果.

Background Turner syndrome (TS) is characterized as the complete or partial absence of one X chromosome and is an extremely rare disease affecting approximately 1:2500 live female births. Though the prevalence of osteoporosis among women with TS is estimated to be around 55-64% and they suffer more frequently from fractures than normal, few reports concerning TS patients with osteoporosis are able to be seen due to tiny number of patients. Case presentation Here, we report a rare case of TS with osteoporosis, who has undergone percutaneous vertebroplasty (PVP) seven times because of several vertebral compression fractures (VCFs). G-banded karyotype analysis was performed and the result was 45,X[43]/47,XXX[17], indicating that the patient was a mosaicism of TS karyotype and Trisomy X syndrome karyotype. TS is the underlying cause of low level of estrogen for this patient. The interaction of aging, estrogen deficiency and intestinal dysbacteriosis leads to her severe osteoporosis and multi-segmental VCFs. The aim of this report is to provide recommendations regarding the management of TS patients with osteoporosis by reviewing the clinical presentation of TS, the influence of estrogen deficiency in osteoporosis, etc. Conclusions Early diagnosis and hormone replacement treatment are essential for TS patients to prevent osteoporosis and reduce the risk of fractures. This is a rare case report describing TS patient with severe osteoporosis and VCFs.

Objective:To investigate and compare the clinical outcome of cortical bone trajectory (CBT) screws and traditional trajectory (TT) screws in treatment of single segment lumber degenerative patients with osteoporosis but without scoliosis or spondylolisthesis above degree I.Methods:From February 2017 to February 2019, a retrospective analysis was made of 52 female patients who underwent L 3/4 or L 4/5 lumbar fusion with CBT screws or TT screws, aged 40-71 years, and accompanied by osteopenia or osteoporosis and without spondylolisthesis or scoliosis above grade I. Among them, 22 received CBT screw operation (CBT group) and 30 received TT screw operation (TT group). The operation time, intraoperative blood loss, surgical incision length and surgical complications were compared between the two groups.On the 5th day after operation, lumbar spine X-rays and CT scans were used to observe the fusion device, internal fixation position, and the incidence of proximal articular process joint infiltration (FJV). At 3, 6, 12, and 24 months after surgery, the lumbar spine X-ray film was reviewed to evaluate bone graft fusion and internal fixation.The Oswestry dysfunction index (ODI) and pain visual analogue score (VAS) were compared between the two groups of patients before surgery and the last follow-up. Results:The operative time of CBT group and TT group was (125.7±16.0) min and (123.8±18.3) min respectively, the difference was not statistically significant ( t=0.389, P>0.05); the intraoperative blood loss of CBT group was (74±39.8) mL, less than that of TT group (129±45.3) mL, and the incision length of CBT group was (5.7±0.60) cm, shorter than that of TT group (8.4±0.92) cm, the difference was statistically significant ( t=4.548, 12.004, all P values < 0.05). Because of the poor fixation strength, one case in TT group ended up in using bone cement augmented pedicle screw in L 4.The remaining patients did not experience nail placement failure or cortical bone fracture fractures during surgical nail placement.No vascular or nerve damage was found in any patient. X-ray and CT scan of the lumbar spine were taken on the 5th day after operation, showing that the fusion cage and internal fixation were in good position; the incidence of FJV in CBT group was 9.09% (4/44), and was 58.33% (35/60) in TT group, the difference was statistically significant (χ 2=26.263, P<0.01). The symptoms of all patients were relieved after operation. The ODI and VAS scores of the last follow-up decreased significantly. There were no significant differences between two groups in VAS and ODI(all P values>0.05). The follow-up period was 5 to 24 months. The symptoms of all patients were relieved. Compared with that before operation, the scores of ODI and VAS in the last follow-up were lower, the difference was statistically significant ( t=16.549, 18.490, all P values<0.01), but there was no significant difference between the two groups (all P values>0.05). No screw looseness, detachment or cutting was found, and the screw, connecting rod and fuser were all in good position. Conclusions:Compared with TT screw, CBT screw has the same short-term effect in the treatment of single segment lumbar degenerative disease with osteopenia or osteoporosis but without scoliosis or spondylolisthesis above degree I. Moreover, CBT screw has better fixation strength and is more minimally invasive, which is worthy of clinical application.

目的分析小腿肌肉、肌腱损伤的超声特征,并评价其诊断价值。方法对29例下肢小腿肌肉、肌腱损伤行超声检查(US)的患者进行回顾性分析。结果完全性跟腱断裂2例,部分性跟腱断裂4例,发生在小腿中部的单纯性跖肌腱断裂1例,合并有肌肉撕裂者4例,慢性跖肌腱损伤2例。腓肠肌撕裂者2例,跖肌撕裂者3例。肌肉挫伤11例。结论用超声诊断小腿肌肉、肌腱损伤切实可行。对疑有下肢静脉血栓的患者,应加做下肢肌肉、肌腱的超声检查。