目的 利用头颈、仿真人和肺部模体检测射波刀IGRT治疗脊柱追踪时仰卧与俯卧位照射精度并进行对比分析,为俯卧位脊柱追踪的应用提供参考数据.方法 用CT对装有胶片的头颈、仿真人和肺部模体分别进行仰卧和俯卧位扫描,然后利用治疗计划系统分别设计仰卧和俯卧位模体计划,执行模体计划.利用E2E软件分析照射精度,对比这种两种卧姿的照射精度.结果 仰卧与俯卧位精度检测结果,颈椎的追踪精度分别为0.77和0.87 mm,胸椎的为0.78和0.76 mm,腰椎的为0.89和0.80 mm,骶椎的为1.90和2.27 mm,4个不同椎体仰卧与俯卧位精度偏差分别为:0.01、0.02、0.09和0.37 mm.结论 对于这三种静态模体,颈椎、胸椎、腰椎和骶椎仰卧与俯卧位脊柱追踪精度偏差很小,可以认为具有同等的照射精度.

Objective To design an atlantoaxial lateral mass fusion cage and evaluate its biomechanical stability when it is combined with atlantoaxial vertebral pedicle screw fixation.Methods Forty-six sets of CT 3D reconstruction pieces of the normal atlantoaxial junction were chosen to measure sagittal diameter and transverse diameter of atlantoaxial lateral mass joint,sagittal diameter and transverse diameter of epistropheus lateral mass and space height of atlantoaxial lateral mass joint.An atlantoaxial lateral mass fusion cage was designed on this basis.Six fresh human cadaveric cervical spines (C0-C4) were used as samples to measure 3D motion range of C1,and 2 segments under 1.5 N · m load.3D motion range of samples under the following situations was measured at random:intact state,unstable state (ligament around odontoid process was cut off),fixation with atlantoaxial joint screw+Gallie steel wire,atlantoaxial pedicle screw,atlantoaxial lateral mass joint fusion cage+atlantoaxial vertebral pedicle screw.Results Corresponding width/length of fusion cage is 8/11,9/12,10/13 mm,respectively,and the height is designed to 3.5,4.0,and 4.5 mm,respectively.The motion range of three internal fixation methods is less than that under intact state and unstable state.The difference has statistical significance.The C1+C2+cage fixation produces the least motion range in lateral bending and axial rotation directions and generates the highest motion range in flexion/extension direction.But,the difference has no statistical significance.Conclusion The C1+C2+cage internal fixation technique has similar stability with common atlantoaxial intemal fixation method and can provide extra atlantoaxial fusion spots.Thus,it may be a feasible alternative for atlantoaxial fusion when the posterior arch of the atlas is absent.

目的 总结逆行半比目鱼肌带蒂肌瓣修复小腿远端软组织缺损的临床应用结果.方法 2006年10月～2012年10月,应用逆行半比目鱼肌带蒂肌瓣修复12例小腿远端软组织缺损,年龄16～42岁(平均35岁).肌瓣表面行一期中厚网状游离植皮,供区直接缝合.结果 所有的肌瓣全部成活,取得了满意的临床效果.随访1.5～3.5年,平均2.5年,8例伴有胫骨骨折者骨折全部愈合.结论 逆行半比目鱼肌带蒂肌瓣具有血管解剖恒定、血运丰富以及操作简单等优点,适宜修复小腿远端软组织缺损.

Objective To observe the therapeutic effects and comphcations of treatment by using transcatheter arterial chemombolization(TACE) combined with functional splenic embolization(FSE) on patients with primary hepatocelluar carcinoma (HCC) combinded with hypersplenism.Methods Eighty HCC patients with hypersplenism were randomly divided into two groups by computer program.Observation group was treated with TACE and FSE,while control group was treated by only TACE.The iodine oil deposition,blood routine parameters and related complications were observed.Results (1) After one-month' s treatment,abdominal CT scan showed that 38 cases(79.17％) of patients in the observation group and 27 cases (84.38％) of patients in control group had iodine oil deposition in over 50％ of the tumor area.(2) The white blood cell counting in observation group were (7.65 ± 2.3) × 109/L,(5.89 ± 1.9) × 109/L,(5.02 ± 1.7) × 109/L in the follow-up examination 1 week,1month and 3 month after splenic embolization,respectively,which were significantly increased from the preoperative level of (2.21 ± 1.1) × 109/L(P ＜ 0.05).Platelets counting were (93 ± 29)× 109/L,(127 ± 32) × 109/L and (119 ± 26) × 109/L in observation group at 1 week,1 month and 3 month after splenic embolization,respectively,which were significantly higher than the preoperative level of (39 ± 20)× 109/L (P ＜ 0.05).In the control group,there were no statistically significant difference between the preoperative and postoperative levels (P ＞ 0.05).(3) Both of the the two groups showed no serious complications.Conclusion TACE combined with FSE is a safe and an effective method to treat hypersplenism combined in HCC patients.

Objective To investigate the radiographic classification and presentation of atypical spinal tuberculosis in adults.Methods Data of 45 consecutive patients who had suffered from atypical spinal tuberculosis confirmed by surgical interventions and pathologic examinations at our department from February 2000 to August 2012 were retrospectively analyzed.There were 29 males and 16 females,aged from 20 to 71 years (mean,46.2 years).Twenty-five patients presented with low-grade fever,lassitude and loss of weight,and the other 20 patients denied the constitutional symptoms of tuberculosis.An increased erythrocyte sedimentation rate (range,25-107 mm/1 h) was found in 37 patients.All patients were investigated by the following imaging resources:plain X-rays,CT scan and MRI.3D reconstruction CT was performed in 12 patients and PET-CT was performed in 2 patients.All patients were treated surgically and confirmed by pathologic examinations and 3 patients had undergone CT-guided biopsy.Results Atypical spinal tuberculosis presented in different radiographic presentation forms.Nine patients had involvement of a single vertebral body,which was depicted with nonuniformly increased signal intensity on T2-weighted MR images.CT scan showed irregular bony destruction in old patients and solitary osteolytic lesion with well-defined margins in young adults.There were 2 cases of isolated affection in the posterior elements (vertebral appendages type),and the involved vertebral appendages demonstrated hyperintense signal on T2-weighted MR images and bony destruction on CT scan.There were 8 cases of simultaneous affection in the anterior and posterior element of one vertebra (circumferential vertebral involvement type),and CT scan showed multiple bony destruction in vertebral body and neural arch.There were 5 cases of affection in disc (intervertebral disc involvement type),which presented decreased signal in MRI and protruding disc pressing the dural sac could be found.There were 14 cases of multiple vertebral tuberculosis in continuity (contiguous spinal tuberculosis),which presented multiple tuberculosis lesions on 3D-CT.There were 7 cases of multiple vertebral tuberculosis in noncontinuity (noncontiguous spinal tuberculosis),which presented destructive tubercular lesions affected different levels in different regions of the spine on MRI.Conclusion Atypical spinal tuberculosis had multiply radiographic presentation forms and atypical radiographic features.Worm-eaten destruction of bone or vertebral endplate,marrow edema and increased signal intensity of paraspinal ligament are features of radiographic presentation in diagnosis of atypical spinal tuberculosis.

目的:通过回顾性分析齿状突骨折不同术式的疗效,从而指导后期临床治疗.方法:回顾分析齿状突骨折26例,对比观察前、后路手术时间、出血量、平均住院时间及术后疼痛数字评分、颈椎功能障碍指数评分(NDI)等指标.结果:前路齿状突螺钉内固定手术时间105.7± 35.3 min、出血量62.1± 18.5 mL、平均住院时间7.0± 1.9天、疼痛数字评分3.6± 1.7分、NDI 24.3％± 11.7％,后路寰枢椎融合手术时间148.2± 36.2 min、出血量338.4± 143.3 mL、平均住院时间11.2± 2.1天、疼痛数字评分5.1± 1.4分、NDI33.6％± 13.4％.结论:前路齿状突螺钉内固定术具有手术时间短、出血少、平均住院时间短、疼痛数字评分低、对颈椎活动功能影响小等优势,而后路寰枢椎融合术具有手术适应范围广、手术操作难度小等优势,而其对颈椎活动功能影响较大.

In order to guarantee the safety and accuracy of the whole treating process as well as better link up of each section during the treatment, we did research in order to establish a project concerning the process quality control (PQC) of treating liver cancer with CyberKnife. From the safety and accuracy point of view, we divided the whole process of treating liver cancer with CyberKnife into ten links, i.e. the registration of patients' information, the im plantation of fiducial markers, fixation of body posture, CT localization, target delineation, design of the treatment plan, quality assurance in physics, implementation of the treatment plan, inspection on the correctness and data archiving. We analyzed the possible mistakes in each link and the consequences brought by them. To smoothly connect all the links, a special part "Attention" was added between every two links. Various wrong operations which may influence the safety and accuracy of treatment were illustrated, and the consequences brought by them were also ex plained. The "Attention" part among links offers important information for the next step, and gives us reminding and warnings. The project of quality control covers all the important links when treating liver cancer with Cy berKnife. It offers regulations, reminding and warning for us so that the safety and accuracy of treatment can be guaranteed, and the work of all staff could be closely connected.

患者男,42岁.因车祸致右小腿软组织缺损1周入院.检查:右小腿中、下段前侧大面积软组织缺损(15 cm×9 cm),伴有胫骨与肌腱外露,胫前动脉损伤,胫后动脉完好.由于小腿后侧也有损伤,局部无可供转移的皮瓣也不适宜行吻合血管的皮瓣移植.治疗方法:先行受区创面清创,缝合部分创面.用VSD治疗1周,创面明显缩小,仅遗留前内侧6 cm×5 cm骨外露创面.然后,行健侧胫骨后缘内侧纵行切口,分离比目鱼肌与跟腱的附着,从下向上分离内侧半比目鱼肌.保护好胫后动脉发至比目鱼肌上端的血管分支,比受区创面稍大,尽量向远端切取内侧半比目鱼肌.将双小腿平行并拢并行外固定支架固定,用肌瓣修复对侧胫骨中段骨外露创面,缝合健侧切口,从股部取中厚皮片,行肌瓣表面网孔状植皮。

Objective To investigate the effect of transjugular intrahepatic portosystemic shunt (TIPS) on gastrointestinal bleed-ing due to advanced-stage hepatocellular carcinoma complicated by portal vein embolus. Methods Four patients with acute upper gastrointestinal bleeding were diagnosed with portal vein cancer embolus by contrast-enhanced CT and MRI scanning of the abdomen, of whom 3 patients were complicated by wide embolus formation in superior mesenteric vein (including 1 patient with spleen vein embolus formation). Hemostatic treatment by TIPS was undertaken and the stents were placed where distal embolus could be observed by angiogra-phy. Results After undergoing TIPS, no re-bleeding was found in 3 patients followed up for 4-6 weeks and 1 patient followed up for 8 weeks, and abdominal symptoms were obviously relieved or disappeared. Conclusions TIPS is a safe and effective way to treat gas-trointestinal bleeding due to hepatocellular carcinoma complicated by portal vein embolus, and is worthy of promotion.

Objective To summarize clinical application of the repair soft tissue defect of the foot with the pedicle perfo-rators flaps of the posterior tibial artery. Methods Nine pedicle perforators flaps of the posterior tibial artery were used to re-pair soft tissue defect in the foot. They ranged in age from 16 to 52 years(mean,35y). The sizes of soft tissue defect ranged from 5. 5 cm × 3. 5 cm to 13 cm × 6. 0 cm. The donor sites of the flaps were closed by a meshed full thickness skin graft. Three cases with saphenous nerve of the flap was anastomosed to the sural nerve at the foot. Results All flaps had survived com-pletely and satisfactory clinical results were obtained. The follow-up period ranged from 1. 5 to 4 years(mean,2. 5 y). The flaps recovered from sensate. The two-point discriminations of the flaps ranged from 6 mm to 9 mm. No ulceration was found at the recipient site. Conclusion The advantages of the perforators flaps of the posterior tibial artery include a constant vascular anastomy,highly vascularity,simple procedure and suitable for repair of soft tissue defect in the foot.

Abjective:Review the important quality assurance testing results of the 4th generation CyberKnife in these two years,gather related statistics and evaluate the various function of CyerKnife.Methods:Between January 2011 and January 2013,the CyberKnife operated normally for 443 days,stayed out of service 24 days for corrective maintenance and 57 days for breakdown.We reviewed the testing results of CyberKnife during these two years,including the items of dose rate,consistency of dose delivery,automatic quality assurance,TPR20/10,flatness,symmetry,penumbra,accuracy of dose delivery,E2E test,and the test of image center.Results:The dose rate was 725 MU/min-810 MU/min;the test on consistency of dose delivery had results surpassing 2% for 31 times(7.0%),which requires calibration;the value of TPR20/10were between 0.663-0.678;the results of AQA test had overall deviation larger than 0.8 mm for 13 times(9.2%);the value of penumbra of field size were among 3.20 mm-3.51 mm;the testing result of dose delivery:2.34%-4.55%;one of the 15 times of E2E test had the result surpassing rated value;the deviation of image center was kept within 1 mm.Conclusions:The dose rate,TPR20/10,flatness,symmetry,penumbra,accuracy of dose delivery,consistency of image center were stable,and all the testing results were within rated range.The deviation probability of dose delivery was 7%.The results of AQA and E2E test all surpassed rated value,so we need to find out the reasons causing the decline of CyberKnife's accuracy.

Objective To investigate the effect of transjugular intrahepatic portosystemic stent shunt (TIPS) on gastrointestinal bleeding after portal hypertension and portal vein wide embolism.Methods Three patients with acute upper gastrointestinal bleeding were diagnosed by CT with wide embolus formation in portal vein and superior mesenteric vein,of which,1 case was with spleen vein embolism formation.TIPS hemostatic treatment was applied to stop bleeding,and stents was placed where distal embolus can be observed by angiography.Results After TIPS treatment,no patients were re-bleeding during following-up periods (4-6 weeks).Uncomfortable symptoms of 3 cases were disappeared.Conclusion TIPS was a safe and effective way to treat gastrointestinal bleeding caused by portal hypertension and wide embolus formation.

患者男,46岁.囚车祸致右膝部软组织缺损3周入院.检查:右膝前外侧有12 cm×9 cm软组织缺损创面,髌骨前外侧2/3外露,股四头肌腱与髌韧带部分外露,创面有部分炎性与坏死组织(图1). 一、手术方法 行常规创面清创后,比受区创面稍大,以髂前上棘至髌骨外上缘连线中点稍偏上设计股前外侧皮瓣,术前用多普勒血流探测仪测定旋股外侧降支血管穿支点[1-2],并将其设计在皮瓣中下部.

<正>0引言射波刀(cyberknife stereotactic radiosurgery system)全称立体定位射波手术平台,是新型的全身肿瘤放射治疗设备。最新一代射波刀为第四代射波刀,照射节点增加至100个,每个节点有12个投射方向,最多可形成1200条射束[1]。

目的:通过测量未安装和已安装DAVID系统两种情况下加速器射束的参数,分析DAVID系统对射束的影响。方法:西门子ARTISTE直线加速器,配备160叶多叶光栅,选择6 MV的X线。多丝电离室（DAVID）,型号为T34084。利用三维水箱、半导体探测器等仪器测量未安装和已安装DAVID系统两种条件下PDD、profile、TPR20/10和水下5 cm吸收剂量,分析DAVID系统对加速器射线束PDD、平坦度、对称性、射线质的影响,并计算出DAVID系统的衰减系数。结果:无和有DAVID两种条件下,5 cm×5 cm、10 cm×10 cm和20 cm×20 cm三个射野R100偏差在0.6 mm~1.3 mm,R80偏差在0.13 mm~0.66 mm,R50偏差在0.38 mm~1.12 mm;40 cm×40 cm的射野R100、R80和R50的偏差分别为3.12 mm、3.31mm和2.04 mm;QI的偏差分别为0.0020、0.0045、0.0101、0.0061;x和y方向平坦度偏差在0.10%~0.58%,对称性偏差在0.04%~0.26%;TPR20/10的偏差0.002。射线穿过DAVID,使剂量衰减了7.67%。结论:DAVID系统的复杂结构和材料对6MV的X射线束的PDD、对称性、平坦度和TPR20/10影响甚微,最主要的是射线经过DAVID系统造成了剂量的衰减。

Objective: The purpose of this study is to explore the surgical method and clinical effects of Halo-vest assisted anterior approach operation for the treatment of cervical spine tuberculosis complicated with kyphosis.Methods: 12 patients suffered from cervical spine tuberculosis complicated with kyphosis were managed in our department from October 2004 to September 2010.The preoperative Cobb angle was 34°(range from 20°to 42°).Before operation,all patients accepted anti-tuberculosis chemotherapy for 2-4 weeks.The patients with cervical kyphosis were treated by Halo-vest and the spinal deformity was corrected before operation.All patients were treated by anterior debridement and fusion with internal fixation.Anti-tuberculosis chemotherapy was performed for 12 to 24 months.Results: The average duration of follow-up was 26 months(range from 12 to 48 months).All the patients stood surgery well.The kyphosis deformity was corrected and the normal cervical lordosis was maintained without associated complication.The neural symptoms were improved.All cases had bony fusion in 3-6 months.There were no plates and screws complications and Halo-vest associated complica-tions.No recurrence of tuberculosis was noted at final follow-up.Conclusion: Application of Halo-vest can correct the cervical kyphosis and maintain normal cervical lordosis.When kyphosis was corrected,the risk of spinal cord injury in the operation can be reduced.Ante-rior debridement and internal fixation assisted with Halo-vest is a safe and effective method for treatment of the cervical tuberculosis complicated with kyphosis.

Objective: To compare the efficacy of one-stage posterior hemivertebra resection and short segment bone graft internal fixation with one-stage anterior hemivertebra resection and short segment bone graft internal fixation on the treatment of congenital hemivertebrae deformation.Methods: Forty-six patients,coming from the department of spine surgery,Lanzhou General Hospital of Lanzhou Military Command,were randomly divided into two groups.Twenty-three patients in one group were treated by one-stage posterior hemivertebra resection and short segment bone graft internal fixation.The rest 23 patients were treated by one-stage anterior hemivertebra resection and short segment bone graft internal fixation.The parameter for assessment included operation time,intraoperative blood loss,hospital stay days,pre-and postoperative 6 months scoliotic Cobb angle,kyphotic Cobb angle and rectificatory rate.Results: There was significantly statistical difference between operation time,intraoperative blood loss,hospitalization,pre and postoperative six months scoliotic Cobb angle,kyphotic Cobb angle and rectificatory rate.Conclusion: One-stage posterior hemivertebra resection and short segment bone graft internal fixation is superior to one-stage anterior hemivertebra resection and short segment bone graft internal fixation in the correction of kyphosis,which has less trauma and recovered soon.

OBJECTIVE:To summarize clinical application results of repairing soft tissue defect in lower leg with a bridge shaped medial hemisleus muscle flap pedicle transplantation.METHODS:From January 2008 to January 2012,12 patients with soft-tissue defect in lower leg underwent reconstruction with a bridge shaped medial hemisleus muscle flap pedicle transplantation. There were 8 males and 4 females with an average age of 34 years old ranging from 22 to 50 years old. Time after injury was from 2 to 12 weeks (means, 3.5 weeks ). The immediate coverage of the muscle flaps were performed by a meshed split-thickness skin graft. The donor site was closed directly.RESULTS:All the muscle flaps had survived completely. Follow-up period ranged form 1.8 to 4.0 years (means, 2.8 years) postoperatively. The tibia and fibula fractures were confirmed healing. A good contour was confirmed at the recipient area. The results were evaluated with LEM questionnaire, excellent results were obtained in 6 cases, good in 5 cases and fair in 1 case. Satisfactory clinical results were obtained in 11 cases.CONCLUSION:This technique is particularly useful for repairing soft tissue defect in the injured leg when only one vessel remains, and can reduce injury to donor site.

目的探讨经导管动脉化疗栓塞(TACE)联合射波刀治疗肝癌的临床效果。方法分析收治的肝癌患者80例临床资料进行分析,依据治疗方式不同进行分组,对照组(单纯TACE治疗组)40例和观察组(TACE联合射波刀治疗组)40例。对比观察两组疗效。结果观察组肝癌患者生活质量评分和临床治疗总缓解率均优于对照组,差异有显著性(P<0.05)。结论 TACE联合射波刀治疗肝癌可以明显改善患者生活质量,提高临床疗效。

<正>腰骶椎结核发病率较低,约占脊柱结核的2%～3%,但腰骶椎局部解剖较为复杂,生物力学性质特殊,广泛显露较为困难,外科治疗棘手[1-2]。手术治疗的目的是彻底清除病灶、解除神经压迫、重建脊柱稳定、尽早恢复脊柱功能[3-6]。2008年5月至2011年2月,我们采用髂骨上经腹膜外入路行结核病灶清除、取自体髂骨植骨、前路椎体钉棒内固定治疗腰骶椎结核5