目的 探讨在通道下后方经椎间孔入路行病灶清除联合椎间植骨内固定术治疗腰椎结核的临床疗效.方法 收集2013年1月至2019年3月解放军总医院第八医学中心骨科收治的资料完整的采用通道下后方经椎间孔入路行病灶清除联合椎间植骨内固定术治疗的56例腰椎结核患者.患者病程2～6个月,平均(3.4±1.1)个月;均为1个椎间盘及对应椎体受累.通过对患者手术时间、术中出血量、手术前后血红细胞沉降率(ESR)、C反应蛋白(CRP)水平、疼痛视觉模拟评分(VAS)、Oswestry功能障碍指数(ODI)、美国脊柱损伤协会(ASIA)分级、腰椎矢状位曲度(即病变部位前凸角度)变化、术后植骨融合情况和并发症发生情况进行统计分析,评价手术治疗效果.结果 56例患者随访18～48个月,平均(21.5±5.8)个月;手术时间90～180 min,平均手术时间(124.5±26.2) min;术中出血量150～400 ml,平均出血量(248.4±46.7) ml.所有患者切口均一期愈合,2例术后1～2个月出现切口处窦道形成,经换药后愈合.至抗结核治疗结束时,56例患者ESR及CRP均恢复正常.至末次随访时,所有患者病灶均治愈,无复发患者;VAS评分、ODI、病变部位前凸角度分别为(0.68±0.15)分、(9.45±1.72)％和(5.40±1.40)°,较术前的(7.46±1.45)分、(75.84±9.61)％和(2.80±0.60)°均得到明显改善,差异均有统计学意义(t=34.805,P＜0.001;t=50.889,P＜0.001;t=-12.774,P＜0.001).4例ASIA分级为D级的截瘫者恢复至E级.56例患者术后6～10个月[平均(7.5±1.2)个月]植骨均获得骨性融合,随访期间无内固定物松动、断裂及移位等并发症发生.结论 在通道下后方经椎间孔入路行病灶清除联合椎间植骨内固定术治疗腰椎结核疗效确切,是一种治疗腰椎结核微创可行的方法.

回顾性分析解放军总医院第八医学中心脊柱微创外科2017年1月至2019年7月收治的135例脊柱结核手术患者.其中,2017年1月至2018年6月对就诊的72例脊柱结核手术患者术后进行常规护理干预;2018年7月至2019年7月对就诊的63例脊柱结核患者术后进行"三联"放松训练治疗,包括腹式呼吸、想象、肌肉联合的放松训练.采用系统随机抽签法从常规护理干预和"三联"放松训练干预中各选取40例作为对照组和观察组.观察组术后3d、术后1周VAS疼痛评分分别为(4.22±0.81)分和(2.22±0.72)分,均明显低于对照组[分别为(4.98±1.12)分和(2.98±1.04)分],差异均有统计学意义(t=3.478,P=0.001;t=3.800,P=0.000).术后2周观察组患者焦虑自评量表及抑郁自评量表评分分别为(44.68±3.47)分和(44.74±3.53)分,均明显优于对照组[分别为(47.84±3.58)分和(47.17±3.50)分],差异均有统计学意义(t=4.009,P=0.000;t=3.092,P=0.003).观察组术后2周PSQI评分及术后24、48 h睡眠时间分别为(5.65±2.40)分、(5.92±0.76)h、(6.47±0.96)h,均明显优于对照组[分别为(6.98±1.12)分、(5.44±0.71)h、(5.71±0.81) h],差异均有统计学意义(t=3.176,P=0.002;t=2.919,P=0.005;t=3.827,P=0.000).研究结果显示,脊柱结核患者术后进行"三联"放松训练能够减轻术后患者的疼痛,改善患者的心理压力,提高睡眠质量.

本研究探讨脊柱结核不全瘫患者多层螺旋CT(MSCT)影像表现及临床意义.选取脊柱结核术前不全瘫患者72例作为观察组,其中Frankel脊髓损伤分级:B级24例,C级27例,D级21例,同时选取肌力正常的脊柱结核患者90例作为对照组,分析比较两组患者MSCT影像特征差异.观察组3个及以上椎体受损比例、病变椎体胸段以上分布比例明显高于对照组(P＜0.05);观察组骨性椎管不完整、椎体总高度丢失≥1个椎体、椎旁脓肿及致压物压迫椎管、压迫椎间孔比例及后凸Cobb角明显高于对照组(P＜0.05);观察组Frankel分级B级患者骨性椎管不完整比例为37.50％,显著高于C级和D级患者(P＜0.05);观察组Frankel分级B级患者椎旁脓肿及致压物压迫椎管比例、压迫椎间孔比例及后凸Cobb角高于D级患者(P＜0.05).与肌力正常的脊柱结核比较,脊柱结核术前不全瘫患者MSCT影像有所差异,在不同Frankel分级间同样有一定差异.

Macrophages (Mφs) are master regulators of the immune response and may serve as therapeutic targets in aging societies. This study aimed to determine the function of M1Mφ-exosomes (Exos) in the development of osteoporosis (OP) and the involvement of microRNA (miR)-98 and dual specificity phosphatase 1 (DUSP1). A murine model of OP was established using ovariectomies (OVX). Bone loss was observed in OVX-treated mice, as manifested by reduced bone mineral density and decreased number of bone trabecula. The bone loss was further aggravated by treatment with M1Mφ-Exos. Exos also suppressed osteogenic differentiation of MC3T3-E1 cells. miRNA microarray analysis revealed that the miR-98 level was notably upregulated in cells after Exo treatment, and DUSP1 was confirmed as a target of miR-98. Meanwhile, downregulation of miR-98 or upregulation of DUSP1 restored the osteogenic differentiation ability of MC3T3-E1 cells. In addition, upregulation of DUSP1 reduced bone loss in murine bone tissues and suppressed JNK phosphorylation. In summary, M1Mφ-derived exosomal miR-98 exacerbates bone loss and OP by downregulating DUSP1 and activating the JNK signaling pathway. miR-98 may therefore serve as a therapeutic target in OP management.

Background: Surgeons have been successfully handle with spinal tuberculosis via conservative or surgical treatment. However, There are quite few classifications or scoring systems concerning spinal tuberculosis to guide the surgeons to manage the complicated pattern of spinal tuberculosis. The purpose of this study is to design a practical, yet comprehensive, severity scoring system for spinal tuberculosis that helps in clinical decision-making in terms of the need for operative versus non-operative management.Methods: A group of 129 spinal tuberculosis cases (70 male and 59 female patients) successfully treated and followed up for at least 2 years were retrospectively reviewed. Clinical spine experts from our institutions were gathered to confirm the information they considered pivotal in the communication of spinal tuberculosis and the clinical decision-making process. Typical spinal tuberculosis patterns were reviewed and reconsidered in view of these essential characteristics. An initial validation process to determine the reliability and validity of this system was also undertaken. Results: A new severity scoring system was designed based on three essential characteristics: 1) the stability of spinal infectious segments determined by imaging appearance, 2) the cause of spinal cord compression and the severity of neurologic deficit, and 3) the efficacy of the anti-tuberculosis drug therapy. A severity score was calculated from these characteristics, which divided patients into surgical and nonsurgical treatment groups. Conclusions: The severity scoring system comprehensively considers features cited in the literature including prediction of spinal stability and kyphosis deformity progression, identification of neurologic compromise and characteristics of mechanical compression of spinal cord. This classification system is intended to facilitate clinical decision-making in the management of adult spinal tuberculosis (from C3 to L5 segments) . The severity scoring system may help to improve the communication among spine surgeons. Further studies are needed to determine the reliability and validity of this system.

目的 探讨倒退抗阻力运动对中老年脊柱结核并发骨质疏松患者术后康复效果.方法 从2014年5月至2016年9月入住解放军总医院第八医学中心(原解放军第三○九医院)脊柱微创科的中老年脊柱结核并发骨质疏松患者共108例中,采用抽签法随机选取中老年脊柱结核并发骨质疏松患者40例纳入对照组;从2016年10月至2018年5月入住解放军总医院第八医学中心(原解放军第三○九医院)脊柱微创科的中老年脊柱结核并发骨质疏松患者共92例中,采用抽签法随机选取中老年脊柱结核并发骨质疏松患者40例患者纳入观察组.对照组患者在脊柱结核病灶清除植骨固定术后进行常规功能锻炼,观察组在对照组运动训练基础上术后第14天在患者CT检查显示钢板固定良好情况下,协助患者佩戴合适支具后进行倒退抗阻力运动.比较两组患者出院1、3、6个月的功能障碍指数(ODI)、椎间植骨块融合达Ⅱ级程度、功能恢复达Ⅰ级程度、右股骨颈骨密度值.结果 观察组中老年脊柱结核并发骨质疏松患者术后ODI值:出院1个月为(10.35±3.26)分、3个月为(8.86±2.94)分和6个月为(6.78±2.84)分,低于对照组[出院1个月为(12.34±3.56)分、3个月为(10.95±3.12)分和6个月为(8.94±2.76)分],差异均有统计学意义(t值分别为2.607、3.083、3.449,P值分别为0.005、0.001、0.000).观察组中老年脊柱结核并发骨质疏松患者术后椎间植骨块融合达Ⅱ级程度:出院1个月有5例(12.5％)、3个月有30例(75.0％)和6个月有40例(100.0％),优于对照组[出院1个月有0例(0.0％)、3个月有20例(50.0％)和6个月有34例(85.0％)],差异均有统计学意义(x2值分别为5.333、5.333、6.486,P值分别为0.021、0.021、0.011).观察组中老年脊柱结核并发骨质疏松患者术后功能恢复Ⅰ级程度情况:出院1个月有5例(12.5％)、3个月有15例(37.5％)和6个月有35例(87.5％),优于对照组[出院1个月有0例(0.0％)、3个月有6例(15.0％)和6个月有26例(70.0％)],差异均有统计学意义(x2值分别为5.333、5.230、5.591,P值分别为0.021、0.022、0.018).观察组中老年脊柱结核并发骨质疏松患者术后右股骨颈骨密度检测结果:出院1个月为(0.45±0.02) g/cm2、3个月为(0.47±0.02) g/cm2和6个月为(0.47±0.03) g/cm2,对照组[出院1个月(0.46±0.01) g/cm2、3个月(0.46±0.03) g/cm2和6个月(0.46±0.02) g/cm2],两组比较,出院1个月差异无统计学意义(t=0.682,P=0.248),出院3个月和6个月差异均有统计学意义(t值分别为1.701、1.682,P值分别为0.046、0.048).结论 倒退抗阻力运动干预有利于术后功能恢复、椎间植骨块融合恢复、右股骨颈骨密度增长,可促进患者康复.

目的 探讨一期可降解支架负载刃厚皮联合负压创面治技术治疗创伤后四肢骨或肌腱外露的临床疗效.方法 2016年9月—2018年9月解放军总医院第八医学中心骨科收治四肢创伤后肌腱或骨外露患者30例,随机数字表法分为分期组(15例)与一期组(15例).分期组采用分期可降解支架(皮耐克,日本Gunze Limited公司)负载刃厚皮覆盖治疗,男性13例,女性2例;年龄25～72岁,平均67.6岁;道路交通伤6例,高处坠落伤4例,击打伤5例.一期组采用可降解支架和刃厚皮联合覆盖创面,并同时进行负压创面治疗,男性12例,女性3例;年龄25～71岁,平均66.7岁;道路交通伤5例,高处坠落伤6例,击打伤4例.比较两组患者修复效果、移植次数、间隔时间、种植表皮存活情况、温哥华瘢痕(VSS)评分.结果 一期组与分期组比较,移植1次概率为80.0％vs.66.7％,移植2次概率为20.0％vs.33.3％,治疗总时间为(19.3±6.7)d vs.(24.5±5.1)d,种植表皮存活情况为(96.2±5.4)％vs.(93.3±5.3)％,VSS评分为(4.0±1.8)分vs.(5.6±1.2)分,差异均有统计学意义(P<0.05).结论 创伤后四肢骨或肌腱外露治疗中,一期可降解支架负载刃厚皮联合VSD技术的修复效果显著,可在临床广泛应用.

[目的]采用超声造影定量分析负压封闭引流技术对软组织创面血流灌注的改善情况,并探讨该技术的可能作用机理.[方法]8只免制备背部两处深层软组织缺损创面模型,分别给予间断VSD负压吸引和纱布覆盖,2d后采用超声造影技术定量分析两组创面床内血流绝对峰值强度(API)、血流增强时间(TTP)、血流增强相对速度(ES)和以曲线下面积表示(AUC)的血流灌注量的变化.[结果]治疗2d后,VSD组血流绝对峰值增大(P＜0.05),而纱布组减小(P＜0.05),VSD组的血流绝对峰值强度显著高于无菌纱布组[(13.43±1.53)dB vs(3.55±0.70) dB,P＜0.05].VSD组血流达峰时间(TTP)治疗前后无明显改变(P=0.635),而纱布组2d后TTP显著延长(P＜0.05),VSD组的TTP显著短于纱布组[(4.20±0.64)s vs (5.34±0.53)s,P＜0.05].2d后VSD组ES较治疗前明显增大(P＜0.05);而纱布组ES较治疗前明显减小(P＜0.05).治疗后VSD组与纱布组比较,VSD组ES明显大于纱布组[(3.27±0.60) m/svs (0.67±0.14),P＜0.05].2d后VSD组血流灌注量(AUC)增加(P＜0.05),而纱布组AUC减小(P＜0.05),VSD组的AUC明显高于无菌纱布组[(247.56±53.75) dB×s vs (64.18±7.91) dB×s,P＜0.05].[方论]通过超声造影的定量分析,证明负压封闭引流技术能够有效改善创面深层软组织的血液灌注,这可能是该技术修复创面的重要机制之一.

目的 探讨一期人工真皮负载自体刃厚皮移植联合负压创面治疗对骨/肌腱外露创面的修复效果.方法 回顾性分析本院2016年3月至2018年3月收治的15例四肢创伤后骨/肌腱外露患者的临床资料,所有患者均行一期人工真皮负载自体刃厚皮移植联合负压创面治疗,观察患者创面愈合情况.结果 15例患者供皮区愈合时间为(15.2±2.3)d,创面愈合时间为(19.4±2.5)d;术后3个月,所有患者创面移植皮片均存活,创面愈合可,外观大体平整.结论 一期人工真皮负载自体刃厚皮移植联合负压创面治疗对骨/肌腱外露创面的修复效果良好.

负压创面疗法治疗铜绿假单胞菌感染创面的有效性已在临床上得到验证,但其作用机制尚未完全明确.对其作用机制的深入理解,不但有助于改进其设计和功能,也有助于进一步提高临床治疗效果.因此,本文就近年来负压创面疗法治疗铜绿假单胞菌感染创面作用机制的最新研究进展作一综述,具体包括:细菌数量变化、生物膜结构改变、细菌毒力减弱、炎症反应调控等机制以及辅助其他抗菌治疗方法提升杀菌效果等.

目的 探讨脊柱结核患者术后行疼痛护理干预的临床效果.方法 采用随机抽签法选取2016年1月至2017年6月于解放军总医院第八医学中心脊柱微创科就诊的40例脊柱结核患者作为对照组;选取2017年7月至2019年1月于解放军总医院第八医学中心脊柱微创科就诊的40例脊柱结核患者作为观察组.对照组患者于手术后实施常规护理,观察组患者于术后在常规护理基础上实施疼痛护理干预,比较两组患者术后3d、术后1周疼痛程度和舒适度,伤口愈合时间,术后住院时间,术后并发症发生情况.结果 观察组术后3d、术后1周视觉模拟评分法(VAS)疼痛评分分别为(4.22±0.81)分、(2.22±0.81)分,均明显低于对照组[分别为(4.98±1.12)分、(2.98±1.12)分],差异均有统计学意义(t值均为3.48,P值均为0.000).观察组术后3d、术后1周舒适度的VAS评分分别为(4.48±0.41)分、(2.20±0.80)分,均明显低于对照组[分别为(4.92±0.98)分、(2.96±1.12)分],差异均有统计学意义(t值分别为2.62、3.49,P值分别为0.005、0.000).观察组术后伤口愈合时间、术后住院时间分别为(13.46±1.38)d、(13.49±1.87)d,均明显短于对照组[分别为(14.76±1.92)d、(14.86±2.54)d],差异均有统计学意义(t值分别为3.48、2.75,P值分别为0.000、0.003).观察组术后并发症发生率为5.0％(2/40),明显低于对照组的25.0％(10/40),差异有统计学意义(x2=6.28,P=0.012).结论 脊柱结核患者术后行疼痛护理干预可减轻患者疼痛,提升生理舒适感,减少并发症,并促使其早期伤愈出院.

目的 探讨开放性骨折患者术后切口感染病原菌、药敏分析、炎症因子预测价值及负压创面治疗之后的动态变化.方法 选取2016年1月至2018年12月收治的310例开放性骨折患者为研究对象,观察感染组患者术后切口感染情况及病原菌分布、并分析主要病原菌耐药情况,比较术后切口感染患者与未感染患者炎症因子水平,并采用受试者工作特征曲线(ROC)下面积(AUC)比较炎症因子对术后切口感染的预测价值.之后用负压创面治疗对感染切口进行治疗,动态观察创面愈合及炎症因子指标.结果 术后发生切口感染的患者共有23例(7.42％);培养分离病原菌32株,其中革兰阴性菌18株,主要有铜绿假单胞菌、大肠埃希菌和鲍氏不动杆菌,革兰阳性菌12株,主要有金黄色葡萄球菌、溶血葡萄球菌和表皮葡萄球菌,真菌2株,主要是白假丝酵母.革兰阴性菌对头孢吡肟、头孢曲松和头孢他定耐药率较强,对美罗培南、亚胺培南和氨曲南敏感性较强.革兰阳性菌对青霉素和红霉素耐药率较强,金黄色葡萄球菌对四环素敏感性较强,溶血葡萄球菌对左氧氟沙星敏感性较强.术后切口感染患者降钙素原(PCT)、白介素(IL)-6、超敏C反应蛋白(hs-CRP)和红细胞沉降率(ESR)水平明显高于未感染组(P＜0.05);ESR、hs-CRP、IL-6和PCT对术后切口感染的AUC值分别为0.810、0.873、0.917和0.854.通过负压创面治疗,患者创面感染均得到有效控制,且验证指标都呈明显降低趋势.结论 开放性骨折患者术后切口感染主要以革兰氏阴性菌为主,革兰氏阳性菌其次,对切口感染患者实施抗菌药时,应严格按照耐药试验结果合理应用抗菌药;此外切口感染患者炎症因子水平明显高于未感染者,对判断患者术后是否感染病原菌具有一定的预测价值.同时负压创面治疗对此类患者有效,各炎症指标在治疗后明显减低.

目的 探讨早期移乘训练(床-轮椅)对老年脊柱结核病灶清除植骨固定术后患者康复的效果.方法 选择2015年2月至2018年3月入住解放军第三O九医院骨科中心脊柱微创科室的脊柱结核患者,年龄范围为60～70岁,并采取病灶清除植骨固定手术方式治疗,共80例患者纳入本研究.将入院时间2015年2月至2016年8月收治的40例患者作为对照组,2016年9月至2018年3月收治的40例患者作为观察组.对照组患者在脊柱结核病灶清除植骨固定术后进行常规床上功能锻炼,术后16d佩戴支具进行负重站立训练;观察组在对照组常规床上功能锻炼基础上,术后第3天在患者生命体征良好的情况下,由医生和家属协助患者进行移乘(床-轮椅)运动.比较两组患者术后2周血清白蛋白、血红蛋白、体质量指数等指标,以及躯体活动能力及术后住院时间.结果 观察组老年脊柱结核病灶清除植骨固定术后2周患者血清白蛋白、血红蛋白、体质量指数分别为(39.51±3.51) g/L、(122.11±10.14) g/L、20.16±2.84],优于对照组(36.33±3.43) g/L、(115.29±12.61) g/L、18.57±2.76],差异均有统计学意义(t值分别为4.10、2.67、2.54,P值分别为0.000、0.009、0.013).术后2周观察组能够经常步行的患者有28例(70.0％),高于对照组的17例(42.5％),差异有统计学意义(x2=6.15,P=0.013).观察组术后住院时间为(17.3±2.0)d,明显少于对照组的(18.6±0.8)d,差异有统计学意义(t=3.82,P=0.000).结论 早期进行移乘训练(床-轮椅)可促进患者康复,减少住院时间,降低患者的住院费用.

Symptomatic postoperative spinal epidural hematoma (SEH) and spontaneous spinal epidural hematoma (SSEH) are both rare conditions, and recurrent SEH occurs even less frequently. Therefore, we describe a case of symptomatic postoperative SEH after surgical evacuation of SSEH, which was diagnosed using magnetic resonance imaging (MRI) and managed with negative pressure wound therapy (NPWT). The authors classified the reported recurrent SEHs into two types based on the cause of their previous hematoma, which can be classified as spontaneous or postoperative. The characteristics, diagnosis, managements, and results of recurrent SEHs were analyzed. The authors suggest that the postoperative SEH in the Type II will be treated with NPWT, and the new classification will be helpful for prognosis, diagnosis, and management of the recurrent SEHs.

负压创面疗法联合滴注冲洗是一种新型的负压创面治疗技术.近年来,负压创面疗法联合滴注冲洗已应用于全身各部位、各种类型的难愈合创面.本文主要综述负压创面疗法联合滴注冲洗在骨科的临床应用及具体治疗参数.

OBJECTIVE:To compare two kinds of method for treating lumbar tuberculosis with psoas abscess, to provide reference for clinical reasonable select of therapy treatment. METHODS:From January 2010 to January 2013,42 patients with lumbar tuberculosis combined with psoas abscess with obvious surgical indications were enrolled, including 24 males and 18 females with an average age of (38.5 ± 10.2) years old ranging from 21 to 63 years old. All patients were followed up for 18 to 24 months with an average of 20.9 months. Twenty-two patients underwent posterior vertebral body lesions cleared, bone graft fusion and internal fixation and percutaneous puncture catheter drainage for treatment of psoas major abscess as group A, and twenty patients underwent one-stage extraperitoneal approach to remove abscess, posterior vertebral body lesions cleared, bone graft fusion and internal fixation as group B. The operative time, loss of blood, length of hospital stay, clinical cure rate and other clinical results for the two groups were analyzed and compared. RESULTS:The loss of blood was (452.3 ± 137.6) ml in group A and (603.5 ± 99.6) ml in group B, there was significant statistical difference (P < 0.05). The time of operation was (193.6 ± 91.2) min in group A and (230.5 ± 56.6) min in group B, there was significant statistical difference (P < 0.05). The time of operation and the loss of blood in group A were obviously less than which in group B. In group A 20 cases were cured and 2 cases relapsed, 19 cases were cured and 1 case relapsed in group B, there was no significant statistical differences between two groups regarding cure rate with chi-square test (χ² = 0.000, P = 1.000). All patients in two groups obtained good clinical curative effect. There were no significant statistical difference between two groups regarding for length of hospital stay with t-test (P > 0.05). CONCLUSION:Lumbar spinal tuberculosis with psoas abscess is not absolute indications for anterior open operation. Compared with the combined anterior and posterior surgical procedure, the percutaneous puncture catheter drainage combined with posterior debridement, interbody fusion and internal fixation can achieve the same clinical effect but less trauma for the patients.

目的 探讨一期后路病灶清除、双侧单髂骨短钉的髂腰固定融合术治疗腰5骶1椎体结核的临床疗效.方法 收集2009年1月至2014年1月解放军第三○九医院收治的腰5骶1椎体结核患者23例.其中男14例,女9例,年龄20～56岁,平均(37.3±11.1)岁.均行后路病灶清除、植骨融合内固定术,内固定方式采取腰椎椎弓根螺钉联合双侧单髂骨短钉的髂腰固定术,术后随访18个月.比较术前、术后1周及末次随访时血红细胞沉降率(ESR)、C反应蛋白(CRP)、疼痛视觉模拟评分(VAS)、美国脊柱损伤协会脊髓损伤神经功能分级(简称“ASIA分级”)及腰骶角变化情况,定期随访观察临床疗效及Bridwell骨融合情况.结果 手术时间平均(203.3±20.7)min;出血量(652.1±127.5) ml;末次随访时ESR、CRP、VAS评分分别为(4.24±1.86)m m/1 h、(0.95±0.54) mg/L、(0.91±0.67)分,均明显低于术前[分别为(36.51±5.49) mm/1 h、(29.34±17.26) mg/L、(7.13±1.54)分]及术后1周[分别为(37.13±8.11) mm/1 h、(31.23±3.57) mg/L、(2.26±0.62)分],差异均有统计学意义(F=1129.76,P＜0.001;F=243.60,P＜0.001;F=156.17,P＜0.001);末次随访时23例患者均获得骨性愈合,神经损伤ASIA分级20例恢复至E级、3例恢复至D级;腰骶角术后1周[(29.31±3.62)°]较术前[(22.45±4.38)°]明显增大,差异有统计学意义(t=-6.06,P＜0.001),末次随访时腰骶角[(27.40±3.43)°]有所丢失,但与术前相比差异仍有统计学意义(t=-4.37,P＜0.001).术中未发生血管、神经功能损伤等并发症,术后无感染、内固定失败等患者.结论 应用双侧单髂骨短钉的髂腰固定融合术能为部分腰5骶1椎体结核患者提供持续有效的脊柱稳定,并具有手术时间短、出血量少、并发症少等优点.

Study Design. A single-center, retrospective, consecutive case series. Objective. To evaluate the spontaneous development of cosmetic shoulder balance (SDCSB) after surgery and to investigate the feasibility of shorter segment fusion in adolescent idiopathic scoliosis (AIS) with Lenke I curve. Summary of Background Data. Upper instrumented vertebrae (UIV) at a more proximal level are always chosen to keep postoperative shoulder balance in AIS. In the guidelines of Rose and Lenke proposed in 2007, for Lenke I right thoracic curves, UIV should be T4 or T5 when the right shoulder is elevated preoperatively, T4 or T3 if the shoulders are level, and T2 when the left shoulder is elevated. Cosmetic shoulder balance (CSB), however, corrects and improves itself postoperatively. Methods. Seventy-five consecutive AIS patients with Lenke I curves were followed up for 2 to 5 years postoperatively. Twenty patients (26.7%) selected UIV at the caudal levels in the guidelines of Rose and Lenke (T5 when patients were with right shoulder elevated preoperatively, T4 when patients were with even shoulders preoperatively). Forty-two patients (56.0%) selected UIV at more caudal levels than those suggested by the guidelines. In this study, UIV at the caudal levels in the guidelines and UIV at more caudal levels than those suggested by the guidelines were shorter segment fusion. CSB was measured from photographs. Spinal Appearance Questionnaire (SAQ) was acquired for subjective evaluation of shoulder balance. Results. At last follow-up, the main thoracic curve was 19.5° ± 10.4°, the coronal balance improved to 0.7 ± 0.6 cm, and T2-T12 kyphosis was 34.4° ± 10.8°. At preoperation, immediate postoperation, and last follow-up, the measurements of CSB were 1.1 ± 0.7 cm (range: −2.4 to 1.7 cm), 0.9 ± 0.6 cm (range: −0.8 to 3.1 cm), and 0.6 ± 0.4 cm (range: −0.6 to 1.5 cm). At the three time points, numbers of patients with −1.0 cm < CSB < 1.0 cm were 28 (37.3%), 46 (61.3%), and 70 (93.3%), respectively. There was significant difference between the measurements of CSB at immediate postoperation and at last follow-up (t = 3.6, P < 0.001). At last follow-up, 74 (98.7%) patients perceived even shoulders in SAQ. Conclusion. SDCSB plays an important role in regaining shoulder balance after surgery in AIS. The shorter segment fusion is feasible in treating AIS patients with Lenke I curves. Level of Evidence: 4

目的 比较横突间入路腰椎椎体间融合术(ILIF)与经椎间孔腰椎体间融合术(TLIF)行病灶清除、椎间融合内固定术治疗腰椎结核和布鲁杆菌病性脊柱炎的疗效.方法 自2010-08-2013-08共采用ILIF治疗腰椎结核和布鲁杆菌病性脊柱炎38例,与之前采用TLIF手术治疗此类患者39例进行比较,分析2种术式在手术时间,术中出血量,疼痛视觉模拟VAS评分,Oswestry功能障碍指数(ODI)和术后并发症的差异.结果 2组手术时间、术中出血量比较差异无统计学意义(P＞0.05),术后VAS、ODI评分比较差异有统计学意义(P＜0.01).结论 ILIF治疗腰椎结核和布鲁杆菌病性脊柱炎的适应证较TLIF有限,仅适合于腰痛为主、无根性和马尾神经压迫症状、病变局限于椎间隙和相邻椎体终板者.其优点是可保留椎管的结构和生物力学完整性,避免病灶与椎管相通,损伤小、术后恢复快.