Objective:To observe the clinical effect of posterior Hybrid technique in the treatment of cervical mixed type ossification of posterior longitudinal ligament.Method:The clinical data of 8 patients with mixed ossification of posterior longitudinal ligament of cervical spine treated by posterior Hybrid technique in our hospital from March 2015 to July 2017 were retrospectively analyzed.The operation time, intraoperative bleeding volume, fixed segment, visual analogue scale (VAS) and Japanese Orthopaedic Association (JOA) neurological function scores, neurological function improvement rate (RIS) and complications were recorded.Result:All patients were successfully operated, the operation time was ranging from 118 min to 182 min, the average was142.88 min;the intraoperative bleeding volume was ranging from 250 to 400 mL, the average was 325.00 mL.No complications such as spinal cord injury or cerebrospinal fluid leakage occurred during operation.1 cases patient was complicated with C5 nerve paralysis symptoms, which alleviated after 2 weeks of hormone and neurotrophic therapy, the symptoms disappeared.All patients wound were healing best and followed up for 6 to 9 months, the average was 7 months.The preoperative VAS score of neck was ranging from 7 to 9 scores, and the last follow-up VAS score was improved by 0 to 2 scores.The JOA score improved to different degrees, which was improved from8 to 12 scores (average 10.25 scores) before operation to 13 to 16 scores (average 15.13 scores) during the last follow-up.The neurological function improvement rate was ranging from 44.44％to 85.71％ (average 72.13％), of which 5 cases were excellent, 2 cases were good and 1 case was fair.No door-reclose was noted during the last follow-up.Conclusion:Cervical posterior Hybrid technique in the treatment of cervical mixed type ossification of posterior longitudinal ligament is safe and simple, with fewer complications and clinical effect is satisfactory.

目的:探讨颈椎后路单开门结合钛板内固定治疗多节段颈椎病的疗效.方法:选取107例多节段颈椎病患者的临床资料,所有患者均给予颈椎后路单开门结合钛板内固定治疗并术后随访6个月,分析临床疗效.结果:术后6个月患者的颈椎曲度、颈椎活动度与术前相比差异无统计学意义(P＞0.05);但术后6个月患者的神经功能(14.78±3.01)、疼痛度评分(1.35±1.04)与术前(8.98 ±2.90、4.09±1.34)相比均有所改善(P＜0.05),无感染、脊髓损伤、内定断裂等并发症的发生.结论:多节段颈椎病患者采用颈椎后路单开门结合钛板内固定治疗有效改善患者的神经症状及临床症状.

目的 比较三维透视C臂与普通C臂透视下经皮穿刺椎体成形术的手术效果及并发症.方法 2013年8月—2017年7月,采用三维透视C臂和普通C臂透视两种方式辅助,经皮穿刺椎体成形术治疗骨质疏松性单节段胸腰椎骨折282例,三维透视C臂组142例,普通C臂透视组140例.比较手术后胸腰痛视觉模拟评分(VAS法)与Cobb角变化、手术时间、术后骨水泥渗漏.结果 本组患者均获得随访,随访时间6～54个月,平均29(13,38)个月,无死亡病例.三维透视C臂组和普通C臂组术后的止痛效果无显著性差异(P>0.05),三维透视C臂组和普通C臂组术后Cobb角变化无显著性差异(P>0.05),三维透视C臂组和普通C臂组手术时间无显著性差异(P>0.05),三维透视C臂组和普通C臂组术后骨水泥渗漏有显著性差异(P<0.01).结论 三维透视C臂与普通C臂辅助下经皮穿刺椎体成形术均能取得良好效果,但三维透视C臂辅助下具有更少的骨水泥渗漏,手术更安全,值得临床推广.

Objective To investigate the clinical effects of surgical treatment of lower lumbar fracture with mini-incision via retroperitoneal anterior approach. Methods The data of 21 cases with serious lower lumbar burst fracture were analyzed retrospectively.

<正>笔者于2010年1月收治1例胸椎椎管内硬膜外自发性血肿。现报告如下。1病例报告患者男性,21岁,因双下肢麻木2 d,无力1 d入院。患者2 d前无明显诱因出现双下肢麻木,由双足底向上进行性发展至胸部,呈持续性不能缓解,1 d前始出现双下肢无力,伴尿潴留,胸部紧缩感,无肢体抽搐、神志不清、呼吸困难,无外伤史。

Objective To investigate the clinical effects of retroperitioneal anterior approach operation of lower lumbar fracture through limited incision.Methods Clinical data of 16 cases of serious lower lumbar burst fracture were analyzed retrospectively.The main injured segments were L3 in 9 cases,L4 in 6 cases and L5 in 1 cases.Fracture types according to AO classification were type A(compression) in 8 cases,type B(distraction) in 2 case and type C(retortion) in 6 cases.All the 16 cases were treated with retroperitioneal anterior decompression,bone graft fusion and internal fixation through limited incision.The imaging index of preoperation and postoperation as well as neurologic status of preoperation and 8 months of postoperation were compared respectively.Results All the cases had been followed up for an average of 16 months(8～50 months).The instant postoperative imaging index showed obvious improvement on the injured body height(from 43.31% preoperatively to 94.25%,P0.01) and the canal encroachment index(from 2.69 preoperatively to 0.19,P0.01).All those with neurologic deficit were improved above Asia grade one.Conclusion Retroperitioneal anterior decompression and internal fixation through limited incision are successful in treating serious lower lumbar burst fractures.

Objective To report the result of a newly-designed screw-plate system for the treatment of atlantoaxical instability.Methods Since January 2006 to December 2007,12 patients with instability of atlantoaxial join underwent reconstructive surgery using these systems.Three patients presented bridle laxation,three patients with congenital odontoid process disjugate,two patients with atlas fracture,two patients with odontoid process fracture,two patients with atlantoaxial luxation.Results 12 patients of atlantoaxial instability were followed up for the mean period of 16.3 months.All patients achieved solid bony fusion.Neither vertebral artery nor spinal cord was injuried.No implant failure was found.Conclusion Atlantoaxial and occipitocervical reconstruction by the newly-designed screw-plate system can provide sufficient correction of malalignment in occipitio atlantoaxial region and achieve high fusion rate.

Objective To explore the feasibility and clinical effect of the Video-assisted thoracoscopic and laparoscopic anterior suegery in the management of thoracolumbar burst frctures. Methods Patients with thoracolumbar burst frctures were managed by the Video-assisted thoracoscopic and laparoscopic anterior suegery from Sept. 2002 to Sept. 2007.There were 28 males and 13 females and the age of the patients were from 19 to 71 years old with an average of 41.5 years old. (Thoracoscopic surgery: The fracture located at T12 in10 and L1 in10 .The states of preoperative neurological function were complete paraplegia in 7cases and incomplete paraplegia in 13 cases. Laparoscopic surgery: The fracture located at T12 in8 and L1 in 13.The states of preoperative neurological function were complete paraplegia in 6 cases and incomplete paraplegia in15 cases).All cases were treated with anterior decompress,autograft and internal fixation with anterion plate fixation systems. Results The average time was 180 to 360 mins. The blood loss was 500 to 3000 ml. All patients were followed up for 6-40 months.The fracture fragements were cleaned thoroughly and vertecanal were decompressed entirely showing on CT films .All patients had successful fusion. One case was complicated leakage of cerebrospinal fluid and cured after one week. 8 case with complete paraplegia did not show any inprovement . 33 cases were inproved obviously in the function of the spinal cord. Conclusion The Video-assisted thoracoscopic and laparoscopic anterior suegery in the management of thoracolumbar burst frctures has more different clinical feasibility . It also is effective for vertebral canal decompression,graft and internal fixation .

Objective To explore the clinical efficacy of video-assisted thoracoscopic or laparoscopic surgery in the treatment of thoracolumbar spinal tuberculosis.Methods A total of 34 patients with thoracolumbar spinal tuberculosis,male 23,female 11,aged 4-72 years,mean age 39.2 years,were enrolled.All of these cases were treated with video-assisted thoracoscopic or laparoscopic surgery.All cases were performed anterior debridement,spinal cord decompression in patients with incomplete paraplegia,allograft bone fusion were performed in patients with massive bone defect and internal fixation with titanic nail-plate,nail-clavate system in cases of instability of the spine.Results The average operation time was 145 minutes(120-240 minutes).The average blood loss was 564 ml(150-1 750 ml).The patients were followed up from 1 to 5 years(average 2.8 years).Postoperative radiological evaluation revealed the focus had been cleaned thoroughly.The spinal cord had been decompressed completely.The intervertebral bone grafting grew well.No loosened internal fixations were found,patients with incomplete paralysis were completely recovered,post-operation recurrence was found and the secondary operation was performed in one of these patients with L4-L5 tuberculosis complicated by psoas and thigh abscess.Conclusion Video-assisted thoracoscopic or laparoscopic surgery in the treatment of thoracolumbar spinal tuberculosis is feasible for satisfactory focus cleaning,spinal cord decompression,allograft and internal fixation.It has the advantages of minimal injury and rapid recovery.

Objective To investigate the clinical effects of retroperitioneal anterior approach operation of thoracolumbar through limited incision.Methods Forty-six cases with a mean age of 41.5 years old ranging from 17 to 70 years old,were treated with retroperitioneal anterior approach operation of thoracolumbar through limited incision.Twenty-nine cases presented burst fractures,10 cases with tuberculosis,2 cases with unsteadiness spondylolisthesis,2 cases with necrosis and 3 cases with tumors.Results Retroperitioneal anterior approach through limited incision provided an excellent exposure,reduced the tissue damage,removed the piecemeal of fractured or tumor-invade body thoroughly,facilitated complete spinal canal decompression and bone graft fusion,avoided complications such as injury of blood vessel.Conclusion Retroperitioneal anterior approach operation of thoracolumbar through limited incision has such advantage as little invasion,high security and good efficacy.

目的 研究双侧骶神经交叉缝合治疗脊髓损伤后痉挛性膀胱的临床疗效.方法 利用患者截瘫平面以下健存的体反射-跟腱反射,通过双侧硬膜内骶神经前根交叉缝合,治疗8例脊髓损伤后痉挛性膀胱.结果 8例术后膀胱痉挛均明显缓解,膀胱贮尿及排尿功能均得到明显改善,经 1～19个月随访,8例膀胱容量、压力已达到或接近正常水平(P＜0.05).结论 双侧骶神经交叉缝合治疗脊髓损伤后痉挛性膀胱的近期疗效显著.

目的 报告后路寰枢椎侧块、枕颈钉板固定融合术治疗寰枢椎不稳定的疗效.方法 2006年1月至2007年12月,用特制螺钉及连接板固定寰枢椎、枕骨枢椎,治疗12 例寰枢关节不稳定的患者.其中横韧带松弛3 例,先天性齿突不连3 例,寰椎骨折2 例,齿状突粉碎骨折2 例,寰枢椎脱位2 例.结果 本组12 例获得5～28个月随访,平均16.3个月,均获得了骨性融合.没有神经、血管损伤和断钉、断板的病例.结论 后路使用螺钉、固定板的寰枢关节、枕颈固定融合术具有短节段固定作用,不仅疗效可靠,而且便于寰枢关节复位.

股骨骨折是下肢最常见的骨折之一.成人股骨骨折一般均需采用手术内同定治疗,内固定方法主要为髓内钉和钢板两大类,其中交锁髓内钉由于为髓内固定,创伤小,血运破坏少,骨折愈合率高达98～99.5%,近年来应用越来越普遍.从2002年8月以来,我们采用经股骨内侧切口交锁髓内钉治疗股骨中段骨折18例,取得了满意的疗效,现报告如下.

目的 探讨在腹腔镜辅助下,经腹膜后腰肌间隙入路的小切口对腰椎爆裂性骨折椎管减压、植骨、内固定手术的可行性.方法 13例腰椎爆裂性骨折,在腹腔镜辅助下经腹膜后腰肌间隙入路,应用腹腔镜、自制手术器械,进行椎档体爆裂性骨折并脊髓圆锥、马尾神经压迫症病例的椎管减压、植骨、内固定手术.结果 全部病例切口Ⅰ期愈合,椎管内骨块清除彻底,椎管减压充分,植骨块融合良好,内固定器无松动;1例L4椎体爆裂性骨折、马尾神经受压病例同时还伴有T6骨折、完全性截瘫,术后脊髓功能未恢复;4例圆锥、马尾神经受压,术后功能基本恢复.结论 腹腔镜辅助下经腹膜后腰肌间隙入路的小切口腰椎手术,可以完成椎体爆裂性骨折并脊髓圆锥、马尾神经压迫症的椎管减压、植骨、内固定术.

Objective To explore the methods and effects of surpracondylar femur type C fracture treated with retrograde intramedullary interlocking nail.Methods 47 acute surpracondylar femur fracture were treated with retrograde interlocking intramedullary nails.According to AO/ASIF classification system,there were 19 cases of type C1,22 type C2,6 type C3.47 cases were treated with open technique.Results The follow-up period ranged from 6 to 48 months,and the mean follow-up was 20 months.All fractures were healed,and the mean union time was 18 weeks.According to Neer's knee rating scale,the results were excellent in 23 cases,good in 14,fair in 8 and poor in 2,and the excellent and good rate was 77.72%.Conclusions It's an ideal method to treat surpracondylar femur fracture(type C1,C2)with retrograde interlocking intramedullary nail,but it is not as effective for type C3 fracture.

1997年1月～2004年5月,笔者根据损伤部位的不同、选择各种不同的皮瓣修复治疗手部软组织缺损21例,取得了满意的效果.

自2002年8月～2005年3月,应用腔镜辅助下行胸腰椎前路手术治疗胸腰椎骨折42例,其中应用超声切割止血刀26例,应用传统分离、结扎法8例,应用腔镜配置的电凝、电切法8例,结果表明应用超声切割止血刀在简化手术程序,缩短手术时间等方面效果最好,现报告如下.

Objective To explore the feasibility and clinical effect of the video-assisted thoracoscopic surgery transdiaphragmatic approach in the management of thoracolumbar burst fractures. Methods 22 patients with thoracolumbar burst fractures were managed by the video-assisted thoracoscopic surgery transdiaphragmatic approach from September 2002 to September 2004. There were 15 males and 7 females, and the age of the patients were from 28 to 71 years with an average of 39 years. The fracture located at T11 in 2, T12 in 10 and L1 in 10. The states of preoperative neurological function were complete paraplegia in 7 cases and incomplete paraplegia in 15 cases. All cases were treated with anterior decompression, autograft and internal fixation with anterior plate fixation systems. Results The average operation time was 230 mins (180 to 320 mins). The average blood loss was 900 ml (500 to 2000 ml). An average followed up period was 19.5 months (9 to 35 months) in all patients. The fracture fragments were cleaned thoroughly and the vertebral canal were decompressed entirely showing on CT films. All patients had successful fusion with an average of 3.8 months. One fixing screw was penetrated into intervertebral space in 1 case. It had been recorrected under a fluoroscopic machine. One case was complicated leakage of cerebrospinal fluid and cured after one week in a prone position. No pleural effusion, pneumothorax and diaphragmatic herniations encountered. 4 cases with complete paraplegia didn't show any improvement, 14 cases had improved obviously in the function of the spinal cord. Conclusion The video-assisted thoracoscopic surgery transdiaphragmatic approach in the management of thoracolumbar burst fractures was feasible, for satisfactory vertebral canal decompression, graft and internal fixation. Diaphragmatic opening and repair can be accomplished safely and effectively without special endoscopic instrumentation. It also precludes the need for retropleural-retroperitoneal and open thoracoabdominal approaches and thus avoids the associated significant morbidity.

Objective To discuss the application and surgical technique of anterior surgery with video-assisted thoracoscopic surgery for the treatment of thoracic spine and upper lumbar spine.Methods Five patients with tuberculosis underwent VATS for the cleaning of tuberculous focus:2 cases of TB in T 6,7and T 9,10were implanted primarily with auto-iliac bone and one case of TB in T12 L1 was implanted with CPC.Three cases of burst fracture in T 10,11and one case of old burst fracture in L1 accompanied with cauda equina syndrome were treated with decompression of spinal cord, auto-iliac bonegraft and plate screw internal fixation.Results All patients were followed up.The incision primary healing and clinical symptoms were improved significantly.The focus were cleaned thoroughly,the spinal cord was decompressed enough,the reduction was satisfactory,the internal fixation was stable and the position of grafted bones was good by X-ray and CT.Conclusion VATS is suitable for the patients with thoracic spine and upper lumbar spine TB and fracture accompanied with cauda equina syndrome and compression of spinal cord in focus cleaning,decompression of spinal cord,spinal anterior internal fixation.

目的探讨胸椎、上腰椎前路手术应用胸腔镜技术的可行性. 方法 5例胸、腰椎结核(T6～L2)行胸腔镜下结核病灶清除、植骨或非植骨术;3例椎体爆裂性骨折合并截瘫(T10～T12)及1例陈旧性椎体爆裂骨折合并马尾综合征(L1)行胸腔镜下脊髓减压、植骨、钢板螺丝钉内固定术;1例T3～4椎间盘突出伴脊髓压迫症行胸腔镜下减压融合术. 结果全部病例切口Ⅰ期愈合,CT或MRI显示病灶清除彻底,脊髓充分减压,除1例骨折复位、固定后仍有轻度成角畸形外,均复位满意,内固定可靠,位置良好. 结论胸椎、上腰椎疾患,不论是否并发脊髓、马尾神经压迫,都适宜在胸腔镜辅助下进行病灶清除术,必要时还可进行脊髓减压、脊柱前路植骨、内固定手术.