目的 评估早期和晚期减压固定对胸腰段骨折合并脊髓损伤预后的改善情况.方法 对 2010年 1 月至 2018 年 12 月,T11～L2 发生创伤性脊髓损伤的 320 例患者进行回顾性分析,男 227 例,女 93 例,平均年龄(32.55±11.43)岁.对伤后 24 h 内接受早期手术(组 1,n = 145)、24～72 h 内接受手术(组 2,n = 46)和伤后 72 h 以上接受手术(组 3,n = 34)的患者进行分组分析.比较术后 1 年时 Frankel 分级的变化.结果 组 1 有 81 例、组 2 有 46 例、组 3 有 34 例患者的 Frankel 分级改善≥1 级(P<0.001).组 1 有 33 例、组 2 有 13 例、组 3 有 11 例患者的 Frankel 分级改善≥2 级(P = 0.070).Logistic 回归分析显示,早期手术和初始脊髓损伤程度与神经功能预后显著相关(P<0.001).结论 手术减压越早预后越好,72 h 内为有效手术减压的窗口期,在此期间,手术减压可能对不完全脊髓损伤具有保护作用.

[目的]探讨阿仑膦酸钠(alendronate,AL)和特立帕肽(teriparatide,TPTD)对双足鼠脊柱侧弯进展的作用.[方法]将45只C57BL/6J雌性4周龄小鼠行双前肢和尾离断,建立双足鼠脊柱侧弯模型,随机分为3组,每组15只.对照组、AL组和TPTD组,分别给予生理盐水、AL和TPTD,连续12周.行影像和骨密度(bone mineral density,BMD)检测.[结果]随时间推移,三组动物Cobb角均显著增加(P＜0.05).术后8周和12周,脊柱侧弯Cobb角由大至小依次为:对照组＞AL组＞TPTD组,总体差异有统计学意义(P＜0.05);两两比较,对照组的Cobb角显著大于AL组和TPTD组(P＜0.05),而AL组与TPTD组间差异无统计学意义(P＞0.05).随时间推移,三组动物BMD均显著增加(P＜0.05).术后4、8和12周BMD值由低至高均为:对照组＜AL组＜TPTD组,总体差异有统计学意义(P＜0.05).两两比较方面,对照组的BMD与AL组和TPTD组的差异均有统计学意义(P＜0.05),而AL组与TPTD组间的BMD差异均无统计学(P＞0.05).[结论]在双足鼠脊柱侧弯模型早期给予AL和TPTD可有效减小鼠脊柱侧弯Cobb角,同时增加生长期小鼠脊柱BMD值.

背景:过去强直性脊柱后凸矫形往往注重局部畸形的矫正,忽略对于矢状面平衡的重建.目的:应用计算机辅助软件建立强直性脊柱炎后凸三维有限元模型,基于肺门-髋轴法重建脊柱矢状面平衡,设计个性化手术截骨方案,并模拟全脊椎截骨手术操作,计算分析其生物力学特性,并与两种未重建脊柱矢状面平衡模型进行对比.方法:收集来自新疆医科大学第六附属医院1例强直性脊柱炎后凸住院患者的CT数据,根据301分型确定后凸畸形为ⅢA型,将CT数据导入计算机建模软件中,建立强直性脊柱后凸畸形三维有限元模型.设计3种不同全脊椎截骨(VCR)手术方案的模型,分别为VCR30°,VCR32.2°和VCR40°,其中VCR32.2°使用肺门-髋轴测量方法测量L3预截骨角度为32.2°,另外构建2个未重建脊柱矢状面平衡模型,其中VCR30°设置为截骨角度为30°,VCR40°设置截骨角度为40°,在构建完成的3个模型上模拟全脊椎截骨术进行截骨,并对截骨矫形后3个模型的脊柱位移、钉棒系统、钛笼和截骨面进行有限元计算.结果 与结论:①总位移和24个椎体位移大小排序如下:VCR40°>VCR30°>VCR32.2°,VCR40°明显高于VCR32.2°,VCR30°和VCR32.2°两者由于截骨角度差异小,位移差距不显著;椎弓根螺钉、钛棒、钛笼以及截骨接触面的应力分布趋势;②不论是钉棒应力,还是钛笼应力,VCR40°都要高于其他2个模型和平均值,并且差异明显,VCR32.3°在3种模型中应力最小,也低于平均值,并且各节段等效应力分布均匀,没有出现应力集中的现象;③结果 证实,基于肺门-髋轴法重建脊柱矢状面平衡能够增加术后脊柱稳定性,且内固定应力分布更低,是一种合理、科学的手术方案设计.

背景:强直性脊柱炎后凸主要表现为矢状位畸形,截骨角度是术前需要解决的关键问题之一,矫正角度不足以及矫正过度都可能造成脊柱矢状位的二次失衡.目的:应用计算机辅助软件建立强直性脊柱炎后凸三维有限元模型,基于骨盆矢状位参数设计个性化手术截骨方案恢复矢状面平衡,并分析其生物力学特性.方法:收集新疆医科大学第六附属医院1例强直性脊柱炎后凸住院患者C1至骶尾骨的CT数据,根据301分型确定后凸畸形为ⅢA型.将CT数据导入计算机建模软件中,建立强直性脊柱后凸畸形三维有限元模型,测量骨盆入射角、骨盆倾斜角数值,并通过骨盆入射角计算出理论骨盆倾斜角角度.设计两种不同截骨方案的模型,其中模型2使用肺门-髋轴测量方法(重建矢状面平衡)测量L3预截骨角度为32.2°,模型1则在未重建矢状面平衡下设置截骨角度为40°,在构建完成的两个模型上模拟去松质骨截骨术,并对截骨矫形后模型的钉棒系统、截骨面进行有限元计算.结果 与结论:①有限元分析结果显示,在脊柱前屈工况下,6个固定节段中除S1节段外,其他5个固定节段模型1的螺钉应力均要高于模型2,钛棒和接骨面应力亦是如此;②在脊柱后伸工况中,由于截骨角度过大导致患者重心后移,使两者应力差异更加明显,其中差距最大的为L4节段螺钉,模型1明显高于模型2,差异为149.69 MPa;③截骨面的应力图显示,应力主要集中于截骨面的后方,而前方的应力普遍在12 MPa以下;④提示基于骨盆矢状位参数设计个性化截骨方案恢复强直性脊柱后凸矢状面平衡是合理、科学的,可在保证矫形效果的同时降低应力分布.

目的:探讨3D打印联合PBL与EBL教学在骨科临床教学中的效果.方法:随机选取我院在2018年10月至2020年12月期间的60名骨科临床实习生,将其分为对照组(n=30)与观察组(n=30),前者采取传统的教学方式,后者则采取3D打印联合PBL与EBL教学方式,对比两组的教学效果.结果:(1)就两组骨科临床实习生的各项成绩对比结果可知,观察组均远远优于对照组(P<0.05);(2)就两组骨科临床实习生对各自教学模式的评定分数对比可知,观察组均明显高于对照组(P<0.05).结论:和传统的教学方式对比,3D打印联合PBL与EBL教学三者其有着十分明显的优势,不仅可以增加学生的知识储备量,提高基本医学技能,还可以充分的提高学生的主动性以及积极性,有利于医学人才的培育,值得推广使用.

目的 整理分析32例主胸弯型青少年特发性脊柱侧凸(Lenke 1型AIS)患者术前影像学资料,探索该类型患者脊柱-骨盆整体矢状位序列的相关性.方法 Lenke 1型AIS患者拍摄站立位全脊柱站立位正侧位X线片以及左右侧屈位片(Bending位片),测量并记录站立位及Bending位冠状位Cobb角、颈椎矢状位曲度(C2-C7 Cobb角)、胸椎后凸角(T5-T12 Cobb角,TK)、腰椎前凸角(L1-L5 Cobb角,LL)、骨盆参数:骨盆入射角(Pelvic Incidence,PI)、骶骨倾斜角(Sacrum Slop,SS)、骨盆倾斜角(Pelvic Tilt,PT)、C7-S1及C2-C7 SVA(Sagittal Vertical Axis)、胸1倾斜角(T1 slope),选取30例健康青少年拍摄站立位全脊柱全长正侧位片测量颈椎矢状位曲度(C2-C7 Cobb角),分析两变量Pearson相关性分析及t检验作为统计方法分析统计学差异.结果 本组侧凸患者与健康青少年相比,C2-C7 Cobb角显著性增大(P<0.05).Lenke 1型AIS患者中颈椎后凸组,T5-T12 Cobb角显著降低(P<0.05),胸椎后凸角度C2-C7 Cobb角显著增大(P<0.05).C2-C7 Cobb与T5-T12 Cobb角呈负相关(P=0.008),与L1-L5 Cobb角呈正相关(P=0.005).C2-C7 Cobb角与冠状位Cobb角度、PI、SS、PT、C7-S1 SVA未见相关性(P>0.05).结论 Lenke 1型AIS患者颈椎矢状位序列异常者高于正常青少年组,颈椎矢状位序列与TK、T1 slope,而与胸腰椎冠状位角度及骨盆参数无关.

目的 比较腰椎间盘退变与超早期腰椎结核的MRI表现,从而达到鉴别的目的 .方法 收集20例为经手术后证实或者穿刺后被证实为腰椎间盘退变患者,20例为临床证实的脊柱结核,分析比较其MRI征象.结果 腰椎间盘早期退行性变与早期腰椎结核不同点表现在:①临床表现:腰椎间盘退变早期往往有下腰部疼痛,而椎体结核早期可无明显临床症状;②椎间盘改变:早期椎间盘退变就有信号的改变,包括终板退变和髓核退变.而椎体结核早期无明显改变,中后期椎间盘才会有改变;③相邻椎体骨质改变上:早期椎间盘退变相邻骨质无明显破坏,而早期结核可见椎体上下缘邻近终板部位虫蚀状、蜂窝状或小片状骨质破坏,骨破坏区周围伴有不同程度的炎性水肿;④椎旁软组织改变上:早期椎间盘退变无椎旁软组织改变,而早期腰椎结核可见椎旁和后方软组织肿胀.结论 早期椎间盘退变与早期腰椎结核各有一定MRI特点,鉴别有一定困难,需仔细鉴别.

目的 探讨无骨折脱位型颈椎脊髓损伤的治疗方案.方法 回顾性分析自2010-07-2015-03诊治的42例无骨折脱位型颈椎脊髓损伤,12例采用非手术治疗,19例采用颈椎前路椎间盘切除融合术或颈椎前路椎体次全切除融合术治疗,11例采用颈椎后路单开门扩大椎管减压术治疗.16例在受伤后7d内进行手术,14例在受伤7d后进行手术.结果 42例均顺利完成治疗,随访时间平均51.4(48～66)个月.前路内固定手术植骨均融合,后路手术减压后均未出现“关门”现象,术后均未出现内固定松动、脱位和断裂等并发症.末次随访时采用手术治疗患者JOA评分较采用非手术治疗患者高,术后3d及末次随访时损伤7d内手术者JOA评分较损伤7d后手术者高,差异有统计学意义(P＜0.05).末次随访时Frankel等级:C级1例,D级8例,E级33例;末次随访时Frankel等级较治疗前改善,差异有统计学意义(P＜0.05).结论 无骨折脱位型颈椎脊髓损伤早期手术可直接解除脊髓压迫并取得满意的临床疗效,值得临床推广.

目的:探讨有限减压植骨融合术和椎板切除减压融合内固定术治疗老年退变性腰椎管狭窄症的效果.方法:选取2017年1月-2018年1月笔者所在科室收治的老年退变性腰椎管狭窄症患者60例,按照随机数字表法分为A、B组,各30例.A组采取有限减压植骨融合术治疗,B组采取椎板切除减压融合内固定术治疗.对两组术中出血量、手术持续时间及下肢疼痛评分(JOA)优良率进行比较.结果:A组术中出血量少于B组,手术持续时间短于B组,差异均有统计学意义(P<0.05);A组JOA评分优良率为83.33％,B组JOA评分优良率为86.67％,两组JOA评分优良率比较,差异无统计学意义(P>0.05).结论:有限减压植骨融合术和椎板切除减压融合内固定术治疗老年退变性腰椎管狭窄症均具有良好的效果,但前者术中出血量更少,手术持续时间更短,值得临床应用.

BACKGROUND:In recent years, with the continuously improving of the fixation systems and technology, conducting anterior cervical decompression bone graft accompanying with anterior plate fixation have been accepted by most scholars, however, the complications related to this also appeared constantly. In view of this, the zero notch interbody fusion plate (Zero-P) has been approved for the clinical treatment of cervical degenerative disease. OBJECTIVE:To discuss the early application effect of Zero-p on anterior cervical decompression and fusion. METHODS:The study enrol ed 22 patients who underwent anterior cervical decompression and fusion with Zero-P between February and December 2014. The number of Zero-P implanted in the C3-4, C4-5, C5-6 was 1, 3 and 18 respectively. Pain and neurological improvement were evaluated using Visual Analog Scales score and Japanese Orthopaedic Association (JOA) score for al the patients after operation. The X-ray plain of lateral and flexion-extension lateral of cervical vertebra were shot. The degradation degree was judged based on the measurement results from the cervical lateral X-ray films about the ratio of cephalad and caudal adjacent intervertebral space to vertebral body height, and adjacent segments osteoarthritis situation. The abnormal activity at the surgical spaces was observed by the extension and flexion lateral X-ray plain. RESULTS AND CONCLUSION:Twenty-two patients obtained fol ow up for 10-28 months. 2 patients had dysphagia on the fourth day and the fifth day after operation (extremely mild). The symptom disappeared within 2 weeks after treatment. The Visual Analog Scales score was significantly lower compared with preoperation (P<0.05), the JOA score was significantly higher than that before operation (P<0.05) , the cervical Cobb angle was significantly higher than that before operation (P<0.05). There were no significant differences statistical y in comparison of the Visual Analog Scales score, JOA score and cervical Cobb angle at different time points after operation (P>0.05). In cephalad adjacent intervertebral space, 3 cases had developed hyperosteogeny (first level). In caudal adjacent intervertebral space, 1 had developed hyperosteogeny (first level). There was no significant difference in the hyperosteogeny between cephalad adjacent intervertebral space and caudal adjacent intervertebral space (P>0.05). There was no significant difference in the R value in cephalad adjacent intervertebral space and caudal adjacent intervertebral space between preoperation and postoperation (P>0.05). During the fol ow-up, no abnormal activity at the surgical spaces and implant displacement was observed. These results suggest that using Zero-p in the treatment of monosegmental disc disease has significant effect, can effectively improve the cervical curvature and establish good cervical stability. The incidence of postoperative dysphagia is low. The degeneration of adjacent segments after treatment was not increased in early stage.

BACKGROUND: Cervical expansive unilateral open-door laminoplasty has obtained definite curative effects in treatment of cervical spondylosis in the clinic. OBJECTIVE: To summarize the effects of cervical expansive unilateral open-door laminoplasty for cervical spondylosis from the evolution of surgeries, the advantages and disadvantages of each surgery and postoperative complications. METHODS: Unilateral open-door, expansive laminoplasty, indications, and postoperative complications were key words. Computer was used to search VIP journal full-text database and PubMed database, and 65 articles were used for further analysis. RESULTS AND CONCLUSION: Cervical expansive unilateral open-door laminoplasty for multi-segmental cervical spondylotic myelopathy, ossification of posterior longitudinal ligament and spinal cord injury without radiographic spinal fracture and dislocation combined with spinal stenosis had obtained affirmative outcomes. Clinicians should carefully select operation mode and be conscious to prevent postoperative complications.