目的 观察低温等离子射频消融髓核成形术治疗颈性眩晕的临床疗效.方法 37例颈性眩晕患者(共87个颈椎间盘)进行低温等离子射频消融髓核成形术.分析患者术前和术后VAS分值的变化,评价患者临床疗效.结果 37例患者术前VAS分值为(6.76±0.52),术后1年VAS分值为(2.95±0.63),差异有统计学意义(P＜0.01).术后1年有效率为86.5％.结论 低温等离子射频消融髓核成形治疗颈性眩晕安全、有效.

目的 回顾性分析成人胸椎结核的手术方法及疗效,探讨胸椎结核术式选择的适应证.方法 2001年1月至2010年12月采用不同手术方法治疗成年胸椎结核患者1 12例,81例非跳跃性结核患者获得平均37( 17～72)个月的随访.其中有23例合并脊髓功能障碍.根据病灶部位和病变程度采用5种手术方式:A组(18例),胸廓内胸膜外病灶清除、植骨融合内固定术；B组(21例),经胸病灶清除、植骨融合内固定术；C组(10例),胸膜外经肋横突入路病灶清除、植骨融合内固定术；D组(27例),后路固定一期或二期前路经胸或胸膜外病灶清除、植骨融合内固定术；E组(5例),上胸段结核胸骨柄或胸骨劈开入路病灶清除、植骨融合内固定术.结果 (1)手术时间和出血量:手术平均时间A,B,C,D,E组分别为3.5,3.0,3.0,4.5,4.0h;术中平均出血量A,B,C,D,E组分别为350,450,300,640,600ml.(2)脊柱后凸畸形矫正率:A组(47.5±11.8)％,B组(46.9±10.2)％,C组(59.9±17.4)％,D组(61.7±18.6)％,E组(44.1±8.7)％.(3)末次随访时矫正角度丢失率:A组(64.2±19.1)％,B组( 63.8±18.1)％,C组(56.9±11.8)％,D组(53.6±15.6)％,E组(63.5±17.1)％.23例伴有脊髓压迫症状的患者中神经功能Frankel分级至少提高了一级.结论 胸椎结核的术式选择应根据病变的部位、范围以及患者的一般状态而定.老龄患者由于体质差,最好采用胸膜外经肋横突入路病灶清除、植骨融合内固定术.后路固定在矫正脊柱后凸畸形及维持矫形方面要优于前路固定.

Objective:To investigate the surgical procedures and their outcomes for spinal tuberculosis(TB) in adults.Method:Between January 2004 and December 2009,241 adult patients with thoracolumbar and lumbosacral TB undergoing different surgical procedures were reviewed retrospectively.A total of 181 patients with multiple-level continuous spinal TB were followed up for 22-72 months(mean,37 months).Of 25 patients with neurological deficit,there were 14 Frankel D and 11 Frankel C.The involved vertebrae included 4 continuous vertebrae in 11(thoracic),3 continuous vertebrae in 45,2 continuous vertebrae in 98,and 1 vertebra in 27 cases.It showed obvious defect in 132 patients and paraspinal abscess in 153 cases by CT and MRI examination.The kyphosis Cobb angle ranged from-23° to 30° in 104 cases,31° to 60° in 49 cases and 61° to 70° in 28 cases.Erythrocyte sedimentation rates(ESR) raised in 169 cases.All patients were divided into 4 groups according to site and extent of the lesion.Group A included 74 cases who underwent anterior radical debridement and instrumentation.Group B included 70 cases who underwent posterior instrumentation and interlaminar bone graft plus anterior radical debridement and strut graft either by one-stage or two-stage.Group C included 10 cases who underwent front side radical debridment,strut graft and posterior instrumentation in thoracic or thoracolumbar spine.Group D included 27 cases who underwent single-stage posterior debridement and instrumentation.Emergency surgery was performed in 25 patients with neurological impairment following short term chemotherapy prior 6-18h before surgery.The chemotherapy medicine was administered to the remaining 156 cases over 3 weeks before surgery and continued till 12 months after operation.Result:The average operation time and blood loss were 3.5h and 450ml in group A,4.5h and 640ml in group B,3.0h and 350ml in group C and group D.Severe complications were not noted in each group.ESR returned to normal 8-12 weeks after operation.Kyphosis was corrected by(47.5±11.8)% in group A,(61.5±18.6)% in group B,(58.7±15.9)% in group C and(59.9±17.4)% in group D,with loss of correction at final follow-up of(64.8±19.3)% in group A,(53.6±15.6)% in group B,(56.9±11.8)% in group C and(54.9±15.4)% in group D.And at final follow-up,18 cases had Frankel level improved 1 level,and 7 cases had it improved 2 levels.Sinus was found in the each of Group A,B and C at half a month,one month and one and a half months respectively,which was healed by proper intervention 1-2 months later.Instrument loosening was found in 1 patient of group A one year later,however no intervention was performed due to evidenced fusion.No recurrence was observed at final follow-up in all groups.Conclusion:Different surgical approaches are indicated for debridement,decompression and kyphosis correction,which are reliable for spinal tuberculosis.Posterior approach is superior than anterior approach due to its deformity correction and maintaining of correction.

Objective To investigate the surgical treatment and clinical outcome evaluation postop- eratively of spinal tuberculosis in patients who underwent one-stage focus debridement, auto-bone grafting and internal fixation combined with anti-tuberculosis chemotherapy. Methods Seventy-four adult patients with spinal tuberculosis were diagnosed clinically, histologically and bacteriologically. Seventeen patients suffered neurological deficit, including 12 cases for Frankel D,5 cases for Frankel C. The tuberculosis focus were located either in cervical spine, thoracic spine or in lumbar spine. CT or MR shew obvious dad bone, cold abseess,and kyphosis deformity. Surgical procedures included anterior debridement and auto-bone grafting, one-stage anterior or posterior instrumentation. All patients underwent 10 to12 months chemothera- py before and after operation. Clinical effect, deformity correction and focus heeling were evaluated at fol- low-up period. Results The average ESR was 81.5 mm/1h,average CRP was 41.6 mg/L, and 51 patients have active spinal tuberculosis in this series before chemotherapy. After four weeks anti-tuberculosis chemotherapy, the average ESR decreased to 43.8 mm/1h,the average CRP decreased to 27.4 mg/L.Tuber- culosis symptoms and local pain relived in all patients, and ESR or CRP became normal two months postop- eratively. Average fusion times was about 4.3 months for one-segment and 6.7 months for two-segment,the deformity was corrected to mean 74.9%, and focus healing was achieved in 97.3% patients. There are 3 pa- tients walked with crutch, the others in this group walked normally 12 months postoperatively. Conclusions Surgical strategies of spinal tuberculosis are of radical focus debridement, neurological decompression, spinal stabilization, improving outcome and shortening chemotherapy course. Rational chemotherapy is essential for spinal tuberculosis treatment, and adequate preparation before surgery is precondition of success. The evalu- ation of outcome parameters is of significance in focus prognosis,

Objective To evaluate the effect of surgery and its clinical outcome in treating pa- tients with lumbosacral spine tuberculosis.Methods Retrospective analysis was conducted to ana- lyze the treatment outcome of 53 patients with lumbosacral spine tuberculosis.Among them,37 pa- tients received surgical treatment(with 21 patients had anterior debridement and auto-grafting;16 patients had posterior debridement and auto-grafting.All patients had standard anti-tuberculosis chemotherapy for 9-12 months.Results Low-back pain in the 37 patients was relived substantially or disappeared 4 weeks after the operation.Weight was gained in 34 patients and ESR in majority of patients became normal 6 weeks after the operation.Focus was absorbed in 36 patients 12 months after operation.Focus was not absorbed in 1 patient with the internal auto-grafting becoming loose Average fusion duration was 4 months for one-segment and 6 months for two-segment.Focus was absorbed in 36 patients.Conclusions Surgical strategy of spinal tuberculosis in lumbosacral region is based on focus character.Anterior approach is appropriate for lesions debridement and bone graft,and posterior is essential for stabilization because anterior internal fixation is difficult.Poste- rior debridement is indicated for lesions localized in vertebral body and disc,and simultaneously the bone graft and internal fixation are operated.

Objective:To investigate the effect of self-made prescription Qingchengsan in the treatment of 686 servicemen with eczema in Sichuan Province. Method: 686 diagnosed patients with eczema were divided into two groups, 468 cases in therapeutic group and 218 cases in the control group. Compound Dexamethasone Acetate Cream was given to the control group and Qingchengsan was given to the therapeutic group at external application, for twice a day, and for two weeks as a treatment course. Result: The total effective rate in therapeutic group (97.4%) was significantly higher (P<0.05) than that of the control group (85.3%). After treatment, the score on itching degree and size of skin rash in both groups improved significantly (P<0.01). The score on itching degree and size of skin rash in therapeutic group improved significantly (P<0.05) compared with that of the control group. Conclusion: Self-made Qingchengsan showed a good result in the treatment of patients with eczema in earthquake area in Sichuan Province.

目的 评估腰骶段脊柱结核的手术方法和临床疗效.方法 回顾性分析1997年3月-2004年3月收治的53例腰骶段脊柱结核患者的疗效,其中有37例接受手术治疗(21例接受一期前路病灶清除植骨并后路内固定,16例接受后路病灶清除植骨经椎弓根内固定),手术患者正规抗结核药物化疗9～12个月.结果 术后4周37例手术患者腰骶部疼痛明显缓解或消失,术后6周34例患者体质量明显增加,血红细胞沉降率趋于正常.有36例患者术后12个月病灶治愈,1例患者病灶不愈合伴内固定松动.单节段植骨融合时间平均4.7个月,双节段平均6.3 个月.结论 腰骶段结核前路清除病灶和植骨不困难,但内固定安放困难,需联合后路内固定才能保证植骨块的稳定.后路手术能够清除局限于椎间盘和椎管内的病灶,同期完成植骨和内固定.

Objective To observe the drug resistance of mycobacterium tuberculosis(M.TB),and to discuss the individualized treatment of cervical spinal tuberculosis.Methods Thirty-one cases of cervical spinal tuberculosis treated with anterior radical debridement,decompression and inter fixation from January 2002 to December 2006 were included(at least 1 year follow-up).Liquor puris were got in the operation and were confirmed by pathology.The sensitive of M.TB example for 14 kinds of antituberculotic were detected.And the mutation of drug resistance gene was detected by PCR-SSCP.Postoperative patients were dealed with 6~9 months chemo for no drug resistance,12 months chemo for mono-drug resistance,and 18 months chemo for multi-drug resistance.The mean follow-up was 3.2 years(range 1~5 years).Results Total drug resistance rate was 54.8%,and 25.8% for multi-drug resistance.The genetic mutation rate of 5 kinds of drug resistance gene(katG,rpoB,rpsL,embB,pncA)was 88.1%,and no genetic mutation was found in sensitive samples.The rate of primary healing was 93.5%,and total rate was 96.8%.Conclusion There are intimate correlations between the M.TB drug resistance and genetic mutation.On the base of effective individual chemotherapy,a good effect can be obtained of cervical spinal tuberculosis treatment with radical debridement and inter fixation.

OBJECTIVE:To investigate perioperative features and results of surgical treatment of spinal tuberculosis in aged.METHODS:Review the clinical data of 36 aged with spinal tuberculosis from May 1998 to June 2005 retrospectively. The average age was 70.2 years. The sites of infection included 3 cervical, 9 thoracic, 13 thoracolumbar and 11 lumbar. 28 patients suffered 1 or more complications at least and among of them, there were 18 patients have cerebral or heart vascular disease, 16 patients have diabetes mellitus. Before operation, all patients consulted with internal stuff for the proper treatment of concomitant disease. The surgical procedures include: CT guided percutaneous catheter drainage in 3 patients, anterior debridement and bony grafting with anterior instrumentation fixation in 12 patients, anterior debridement and bony grafting with posterior fixation in 5 patients, posterolateral costotransversectomy debridement and interbody fusion with posterior fixation in 7 patients, posterior debridement and posterior fixation in 9 patients. The mean followed-up period was 3 years and 10 months (from 1.5 to 6 years).RESULTS:One died at two week after the operation. Tuberculous infection was controlled in other patients and no recurrence. Two patients died because of myocardial infarction and cerebral hemorrhage respectively at 1.5 and 2.5 years after operation. Bone fusion was achieved in 31 patients. The deformity was partial corrected at the final follow-up. Among 20 cases with neurologic deficit, 11 cases were completely recovered, 5 cases were partly improved.CONCLUSIONS:If the associated disorders and postoperative complications are properly handled, aged patients can endure surgical treatment for spinal tuberculosis. Instrumentation fixation provides adequate stability and promote recovery.

目的通过分析儿童颈椎结核的临床特点,探讨其鉴别诊断及外科治疗选择,并对外科干预的病例进行疗效分析。方法2002年1月至2005年7月手术治疗11例儿童颈椎结核病例,男6例,女5例;年龄2～11岁,平均6.2岁。病灶累及2椎体7例(C2,3,2例;C5,6,3例;C6,7,2例);累及3椎体4例(C4～6、C5～7各2例)。均经前路行病灶清除减压,单纯病灶清除+外固定7例(石膏外固定2例,Halo-Vest外固定5例);病灶清除+植骨融合+外固定4例(石膏外固定、Halo-Vest外固定各2例)。术前、术后即刻、术后1年以上随访时均评价X线片ARA角(通过C2、C7椎体后缘分别作直线的交角)、颈脊髓功能(以40分法评定)及红细胞沉降率指标。结果经1～4年随访(平均2.3年),所有病例均治愈,随访期内无复发,未发现明显短颈及颈椎后凸畸形。术前与术后随访的颈脊髓功能及红细胞沉降率相比较,差异有统计学意义(P<0.05);未植骨组术前(9.02°+7.89°)、术后即刻(10.88°+7.50°)与术后随访(11.10°+7.21°)的ARA角相比较,差异均无统计学意义(P>0.05);植骨融合组术前(8.08°+7.60°)与术后即刻(14.12°+8.60°)、术前与术后随访(14.23°+8.90°)的ARA角相比较,差异均有统计学意义(P<0.05),术后即刻与术后随访的ARA角相比较,差异无统计学意义(P>0.05)。结论儿童颈椎结核多以患儿颈部疼痛不适、活动受限为首发症状,应重视其早期诊断及规范抗结核。在规范抗结核治疗的基础上,应用病灶清除联合限期确切的外固定治疗的临床疗效满意。术中窦道造影检查有助于了解病灶范围,指导手术方案。

目的探讨经皮穿刺、球囊扩张椎体成形术治疗老年骨质疏松性脊柱压缩骨折的疗效.方法随访老年骨质疏松性脊柱压缩骨折患者13例,男5例,女8例,年龄61～78岁,平均67岁,伤椎T11 2例,T12 5例,L1 3例,L2 2例,1例为T10～L1 4个椎体.在C型臂X线机或导航系统下,采用经皮穿刺,在椎弓根建立4.5mm直径的管性通道,将耐高压可扩张球囊置入伤椎,高压注入造影剂使球囊扩张,将松质骨向两侧终板挤压,抬高椎体,X线确认椎体高度恢复或终板变形,记录球囊压力以及容量,抽出造影剂,并取出球囊,将计算好的同体积等温固化骨水泥注入扩张产生的空腔,待骨水泥固化后,拔除工作套管,手术完成. 结果 13例患者术后腰背部疼痛基本消失,6～8h后可以离床活动,术后X线确认压缩骨折椎体基本复位,后凸畸形平均矫正14°(10°～28°),术后随诊1～12个月,腰背痛无复发,伤椎高度无丢失.结论经皮穿刺、球囊扩张椎体成形术作为治疗老年骨质疏松脊柱压缩骨折的一种新型微创技术,操作简便,能够迅速缓解疼痛,改善功能.

为探讨有效的腰椎间盘内紊乱的诊断与治疗方案,对18例患者的诊治过程进行了回顾性分析研究.该组病例经2～4年的随访,疗效满意.认为椎间盘造影术和磁共振检查是诊断椎间盘内紊乱的有效手段,前路椎体间植骨融合术适于神经根未受累者,后路开窗减压和后外侧植骨融合术适于合并神经根受累者.

目的探讨退变性腰椎侧凸合并腰椎管狭窄的手术方法.方法对43例适应芝患者进行椎板切除减压、CD器械矫正和后外侧融合术,术后观察疼痛改善率和测量畸形矫正率.结果术后1年腰腿疼痛较术前平均改善76.2%±8.3%,腰椎冠状面矫正率为47.2%±6.3%,矢状面矫正率为36.4%±5.7%.术后3年腰腿疼痛较术前平均改善74.8%±6.9%,腰椎冠状面和矢状面矫形丢失不明显.结论手术治疗退变性腰椎侧凸合并腰椎管狭窄时,应重视矫正腰椎侧凸和后凸畸形、改善腰椎力学平衡,以提高术后中远期临床疗效.

目的:探讨应用后路椎弓根系统内固定加前路植骨融合术治疗胸腰椎结核的临床效果.方法:回顾总结1995年3月至2000年3月行后路椎弓根系统内固定同期前路植骨融合的胸腰椎结核患者35例,包括植骨融合率、截瘫恢复情况和后凸畸形矫正状况.随访时间1.5～5年,平均3.4年.结果:术后1～1.5年所有患者均显示骨性融合;28例合并截瘫患者中,症状改善26例,改善率92.9%;术后后凸畸形平均矫正29.7°,1.5～5年后随访,后凸角度平均丢失2.9°.结论:后路椎弓根系统内固定加前路植骨融合能加强脊柱的稳定性,促进骨融合和截瘫恢复,矫正后凸畸形.

对胸腰椎结核34例行后路椎弓根器械内固定、一期或二期经前路病灶清除植骨术,术后抗结核药物治疗9个月,并随访3～5年.术后2～4周患者腰背部疼痛缓解, 4～8周红细胞沉降率基本正常.术后 4～6个月椎间植骨融合,脊柱后凸平均矫正15°.抗结核药物治疗结束后随访2～4年,结核病灶无复发.作者认为脊柱结核手术中应用椎弓根器械固定,术后能立即恢复脊柱稳定性,免除患者长期卧床之苦,且脊柱后凸矫正理想.经椎弓根内固定能够促进结核病灶愈合和提高脊柱结核治愈率.

目的探讨发育性腰椎管狭窄合并椎间盘突出症的新术式.方法采用棘突截骨椎管成形术治疗34例发育性腰椎管狭窄合并椎间盘突出患者,术后随访4年,进行Oswestry疗效评分和椎管直径CT测量.结果本组术后1年疗效优良率为83.9%,术后4年优良率为81.5%,疗效下降不显著(P＞0.05).术后1年腰椎CT显示椎管直径显著增加,87%的棘突截骨后能原位融合.结论棘突截骨椎管成形术操作简单,减压充分,腰椎破坏小.该术式治疗发育性腰椎管狭窄合并椎间盘突出症患者,术后近中期临床与影象学评估满意.

Objective To evaluate the surgical techniques and outcomes for complex stenosis of lumbar spine Methods Laminectomy and posterolateral fusion were performed in 21 patients. Laminectomy and inter-body fusion with instrumentation were performed in 22 patients. The surgical outcomes were evaluated with Oswestry Disability Index and radiological findings from one to four years postoperatively. Results The satisfactory clinical results was achieved in 81.0% of the patients with posterolateral fusion and in 81.8% of the patients undergone interbody fusion one year after surgery. The rate of satisfactory clinical results dropped to 72. 2% in posterolateral fusion group,however it was maintained in 78.9% of the cases undergone interbody fusion groups four years after surgery. Conclusion The short-term outcomes of posterolateral fusion,interbody fusion with instrumentation for complex steneosis of lumbar spine were equally satisfactory in both groups. The medium-term surgical outcomes was maintained in patients treated by instrumented fusion,however it was deteriorated in patients with decompression fusion.

患者男性,27岁.子弹自左小腿内侧上部胫骨后射入,并向下外前方走行25 cm击断腓骨穿出体外,两月后,左足趾渐出现爪状畸形,足底前外侧出现1.0 cm×1.5 cm溃疡反复不愈而入院.查体:左小腿表浅静脉曲张充盈,中部可闻及连续性杂音,足底皮肤痛觉减退,以外侧为甚.肌电图示胫神经损伤.诊断:①胫神经损伤(不完全性);②胫后动静脉瘘.并在硬膜外麻醉下手术,术中见:胫神经纤维断裂1/4,并与比目鱼肌粘连;胫后静脉增粗,在比目鱼肌腱弓下可触及明显震颤.分离见胫后动静脉形成单纯交通孔道样瘘.故行胫神经粘连松解、外膜缝合和胫后动静脉四头结扎术.结扎术后,患肢外侧仍可闻及连续性杂音,考虑腓动静脉瘘的可能.为防止肢体坏死,决定二期处理.

为了探讨应用后路椎弓根系统内固定加椎板植骨融合治疗脊柱结核合并截瘫的临床效果,观察了解放军第309医院行后路椎弓根系统内固定加椎板植骨融合治疗脊柱结核合并截瘫的患者17例.随访时间1.5～4年,平均2年.结果显示,术后2～3周,16例病人的神经症状开始恢复.术后6个月复查,完全恢复9例,不完全恢复7例.7例不完全恢复者最近一次随访2例完全恢复,ASIA神经功能分级3例达D级,2例达C级,截瘫恢复率92.9%.提示,后路椎弓根系统内固定加椎板植骨融合可加强脊柱的稳定性,促进截瘫恢复,防止复发.

患者男性,15岁.1995年9月因左小腿中1/3前内侧有一肿物.疑为血管瘤,在当地医院行左动脉造影检查术,所用造影剂不详,未发现异常影像,故未进一步治疗.胫前肿物自然消失.然而造影后却发现左小腿渐肿胀,左足出现下垂畸形,并逐年加重.于1999年11月收住我院诊治.