[目的]采用尸体标本测试枢椎椎板螺钉联合新型寰椎椎板钩内固定系统的生物力学稳定性.[方法]采用6具新鲜尸体颈椎标本(C0-3),分别测试完整标本模型(完整组)、寰枢椎不稳标本模型(失稳组)、双侧寰枢椎经关节螺钉联合Gallie固定植骨模型(bTFS+G组)、双侧寰枢椎经关节螺钉联合新型寰椎椎板钩固定植骨模型(bTFS+H组)、一侧寰枢椎经关节螺钉与对侧枢椎椎板螺钉联合新型寰椎椎板钩非对称固定植骨模型(非对称组),在1.5Nm载荷下,C1/2节段的前后屈伸、左右侧屈、轴向旋转下的活动范围.[结果]三种内固定组模型的ROM较完整组与失稳组模型显著减小,差异有统计学意义(P＜0.05).三种内固定组中:bTFS+G固定组在前后屈伸和左右侧屈方向上具有最小的ROM,bTFS+H内固定组在轴向旋转运动方向上有最小的ROM.非对称内固定组ROM在前后屈伸、左右侧屈、轴向旋转方向上均较另外两组大,但差异均无统计学意义(P＞0.05).[结论]寰枢椎经关节螺钉与对侧枢椎椎板螺钉联合新型寰椎椎板钩非对称固定植骨可提供良好的生物力学稳定性.

目的：应用CT螺旋扫描影像，实体观察临床芒针深刺腰夹脊穴时针体与肌体相关组织的关系，从而综合分析芒针深刺腰夹脊穴的安全因素。方法：选择芒针深刺腰夹脊穴治疗的病例，进针完成后不出针实时做CT螺旋扫描，观察研究针体周围的组织结构，并分析安全因素。结果：本组30例，针刺深度75～100 mm，均可见有针体穿过腰部组织，其中多见针体接近腰脊神经根，明确针尖与相关腰脊神经根的位置关系。结论：芒针深刺腰夹脊穴产生肢体放电感时，与针体刺激腰脊神经根有关，同时遵芒针操作原则（缓慢进针、小幅捻转、忌提插），深刺腰夹脊穴是安全的。

目的探讨芒针治疗腰椎间盘突出症的疗效。方法选50例患者作为芒针组，50例患者作为毫针组。毫针组予以常用的毫针刺法，芒针组主穴予以芒针刺法。结果2组患者治疗前后腰椎功能评分皆有明显提高，每组治疗前后比较的差异都有统计学意义（ P ＜0．05），2组治疗后组间比较的差异也有统计学意义（ P ＜0．05）。芒针组愈显率为88．0％，毫针组愈显率70．0％，2组患者治疗后愈显率比较差异有统计学意义（ P ＜0．05）。结论 CT 引导芒针深刺夹脊穴是治疗腰椎间盘突出症的有效方法。

Objective:To investigate the clinical applications of small incision fenestration minimally in-vasive surgery combined with lumbar laminectomy and fusion fixation in treatment of lumbar disc herniation with lumbar instability .Method:A total of 80 patients of lumbar disc herniation with lumbar instability were divided into two groups according to different operation .The group A had the small incision fenestration mini-mally invasive surgery combined with lumbar fixation and fusion , and the group B had the lumbar laminecto-my surgery combined with internal fixation and fusion .Result:The incision length , operative time , blood loss and bed time of the patients in group A were less than those in group B , the difference was statistically signif-icant (P <0.05);after surgery, the efficiency of the surgery and the number of patients whose ODI scores improved 35 points in group A were significantly higher than that in the group B after six months , the inci-dence of nerve root injury was lower than in group B , the difference was statistically significant ( P <0.05) . Conclusion:Small incision fenestration minimally invasive surgery combined with lumbar laminectomy and fusion fixation treatment has shorter operation time , milder trauma , higher fusion rate , quicker recovery , etc, it is worthy of clinical application .

Objective To compare clinical efficacy of traditional transforaminal lumbar interbody fusion ( TLIF) with modified TLIF treatment in elderly lateral lumbar disc herniation. Methods 50 cases of lateral lumbar disc hernia-tion in elderly patients were randomly divided into observation group and control group. 25 patients were in the control group using traditional TLIF surgery, observation group were treated with improved TLIF surgery, the two groups were compared surgery pain improved, intraoperative and postoperative recovery. Results The observation group was compared with the control group, which showed shorter operative time, blood loss decreased, ambulation after a short time, reduced costs ( P<0. 01 ) . 3 months after surgery, the two groups of patients′ VAS scores and preoperative JOA scores were significantly improved ( P<0. 01 ) , but there was no significant difference between the two groups (P>0. 05). Patients were followed up for 12 months, the rate of fusion patients were not significantly different (P>0. 05), but the observation group were better than the control group in JOA improved classification (P <0. 05). Conclusions Modified TLIF reduces the paraspinal soft tissue surgery destruction, trauma and has shorter operative time, and postoperative higher stability.

患者男性,36岁.主因头晕、头痛、右侧上肢酸麻乏力、活动后加重来我院就诊.查体:左上肢血压100/80 mm Hg(1mm Hg=0.133 kPa),右上肢血压75/60 mm Hg,右侧桡动脉搏动减弱.否认高血压、糖尿病、吸烟史.颈动脉彩色超声示:右侧锁骨下动脉起始部管腔内可见条带状高回声结构自前后管壁凸向管腔,近中央部厚约1.9mm,近管腔基底部较厚处约4.7 mm,不随血流移动,原始管腔径约20.9 mm,残余管径约2.1 mm。

目的 探讨慢性膝关节压痛部位与针对性治疗关系及效果.方法 对我院骨科镇痛门诊436例慢性膝关节痛患者(共490侧患肢)进行膝关节压痛部位统计,并针对不同压痛部及其提示不同致病机理进行针对性治疗,观察疗效.结果 490侧患肢按8种压痛部位分布共593个压痛部位,以髌骨下,胫内侧关节间隙及副韧带附着点所占比例最高,分别约占疼痛肢体的32.2%(158侧)、22.4%(110侧)、31.6%(155侧).单纯药物治疗208侧,采用封闭治疗259侧,手术23侧.手术病例中髌下脂肪垫松解手术5侧,关节镜手术18侧.490侧患肢治疗前疼痛分级Ⅰ级178侧,Ⅱ级280侧,Ⅲ级32侧;治疗后0级203侧,Ⅰ级232侧,Ⅱ级52侧,Ⅲ级3侧.功能治疗前0级37侧,Ⅰ级195侧,Ⅱ级247侧,Ⅲ级11侧,治疗后0级198侧,Ⅰ级228侧,Ⅱ级57侧,Ⅲ级7侧.治疗后总体疼痛缓解203侧,改善281侧,有效率98.8%,453侧功能障碍患肢治疗后改善387侧,总体有效率85.4%,治疗后疼痛及功能均有明显改善.结论 慢性膝关节疼痛不同的压痛部位常提示不同的致痛因素,对不同压痛部位进行病因分析并针对性处理具有重要的临床意义.

目的探讨平片无张力修补术治疗腹股沟疝的疗效。方法采用国产聚丙烯疝补片,对66例腹股沟疝患者行平片无张力修补术治疗,观察术后恢复情况、并发症及复发率。结果手术时间平均50 min,术后6 h可下床活动,术后2周恢复到术前的工作及生活状态,术后随访53例,复发1例。结论平片无张力修补术符合腹股沟管的解剖结构,具有术后疼痛轻、恢复快、住院时间短、复发率低及手术适应证宽等优点。