历史文化街区是活态的文化遗产,不仅体现着城市的建筑风貌,更能唤起人们的乡土情怀和城市认同.泰州拥有丰富的历史文化街区资源,但保护修复工作还存在着规划前瞻性不够、开发理念落后、推进工作滞后等问题,需要进一步坚持科学规划,推进建筑和人文风貌统筹保护开发,彰显泰州独有历史文化特色,加强管理与宣传,推进内涵挖掘与文化创新.

城市精神的研究背景及其重要性 城市精神 "是一个城市从表面到内在显示出的地域性群体精神."城市精神作为一个城市在长期发展过程中,受历史、地域、风俗等诸多因素共同作用而形成的独具特质的精神品格,对城市可持续发展有着重要的影响力.城市精神传承历史底蕴,凝聚时代精神,是市民广泛认同的精神纽带,是城市发展的精髓和灵魂.城市精神作为市民广泛认同的文化旗帜,能起到凝聚各方力量、提升积极性的作用.

Objective To evaluate the accuracy of percutaneous pedicle screws in thoracic and lumbar spine by computer tomography. Methods 85 patients treated with percutaneous pedicle screw instrumentation in thoracic and / or lumbar spine were analyzed. The segments of pedicle screw insertion ranged from T6 to S1. The pedicle screw accuracy was graded by CT analysis scans,according to the occurrence of screw-related complications. Grade 0: screw within cortex of pedicle; Grade 1: screw thread breach of pedicle wall ≤2mm; grade 2: significant screw-related breach 2mm with no neurological compromise; grade 3: screw related complications. Results All the 380 screws were inserted in the 85 patients. There were 80 thoracic pedicle screws,280 lumbar pedicle screws,and 20 sacral( S1) pedicle screws. The placement of pedicle screws after the operation by CT scanning: 17 pedicle screws encroached the pedicle from the lateral wall,10 pedicle screws encroached the pedicle from the medial wall,while 4 from the up wall and 2 from the lower wall. The total rate of inaccuratly placed pedicle screws was 8. 7%. Among the 380 screws,347( 91. 3%) were graded grade 0,24( 6. 3%) into grade 1,8( 2. 1%) into grade 2 by Mobbs-Raley classification standard. Only one patient( 0. 3%) with grade 3 in one screw developed neurological compromises and relieved after revision surgery. Conclusions The accuracy rate of percutaneous pedicle screw insertion in thoracic and lumbar spine is relatively high,inaccurate screws with grade 2 and above rarely occur. It is a valuable technique.

目的：采用 CT 评价经皮椎弓根螺钉置入的准确性。方法回顾性分析2010年3月至2013年6月我院脊柱外科收治的胸腰椎骨折及腰椎退变性疾病患者资料，共140例患者，男76例，女64例；年龄21~74岁，平均45.1岁。均采用后路椎弓根钉内固定治疗，共置钉596根，其中经皮置钉264根，开放置钉332根。术后应用 CT 扫描及相关软件测量分析，采用 Mobbs-Raley 简易分级标准评估螺钉置入的准确性，0级：螺钉完全在椎弓根皮质内；1级：螺钉螺纹穿透椎弓根壁小于2 mm；2级：穿透椎弓根壁大于2 mm，但无神经损伤；3级：穿透并伴有并发症，包括椎弓根骨折，螺钉穿透导致前侧血管、神经损伤，穿透导致内侧或外侧神经损伤后遗留症状等。结果共置钉596根，术后 CT扫描52枚螺钉穿破椎弓根皮质，总体不良置钉率8.7％；开放置钉332根，未穿破301枚，穿破31枚，1级20根，2级10根，3级1根，准确率90.7％；经皮置钉264根，未穿破243枚，穿破21枚，1级16根，2级5根，3级0根，准确率92.0％。两组准确性差异无统计学意义（P ﹥0.05），但2级以上穿破有统计学意义（P ﹤0.05）。结论经皮椎弓根螺钉置入的安全性优于开放置钉，适宜在胸腰椎创伤及疾患的手术治疗中广泛应用。

Orthopaedic involvement is the most common clinical presentation of Neurofibromatosis type 1 (NF-1) patients with the spinal abnormalities more frequently affected. In the spinal deformities of NF-1 patients, despite the scoliosis is the most frequent finding, several distinctive radiographic features, such as dural ectasia, defective pedicles, and spondylolisthesis, are relatively less common. Here, we reported a 16-year-old boy diagnosed with NF-1 who presented with dural ectasia, defective pedicles, and spondylolisthesis concomitantly, described the surgical treatment and provided a literature review. The boy complained of low back and leg pain for two months. On clinical examination, the patient showed multiple café au lait spots on his back and no neurological deficit. He had a family history of neurofibromatosis as his father suffering from NF-1. Imaging results demonstrated mild scoliosis, posterior scalloping of the lumber spine, L5 spondylolisthesis on plain radiographs, and marked dural ectasia of L3-L5 on MRI. Furthermore, the CT scan showed presence of thin pedicles at L3, bilateral symmetrical pedicle clefts at L4, and pars interarticularis fractures at L5. The patient received a long level posterior fusion from L1 to S1 with pedicle screws. Iliac crest autogenous graft mixed with artificial bone were used to achieve solid arthrodesis. At nine-month follow-up, the patient was asymptomatic and able to live a normal life. Our observation demonstrated that familiarity with those distinctive features in NF-1 patients could be contributed to making an early diagnosis and optimizing treatment.

Objective To explore the clinical effect of the percutaneous pedicle screw fixation in the treatment of thoracolumbar fractures. Methods From March 2010 to June 2013, a total of 49 cases suffering from fresh single thoracolumbar fracture type A(according to Magerl type) were retrospectively analyzed. Twenty-three cases received percutaneous minimally invasive surgery, as group A; 26 cases underwent the traditional open surgery as group B. Results Incision length was(7.5±0.9)cm in group A, and(12.7±1.3)cm in group B(P 0.01); operative time was(90.9±12.1)min in group A, and(123.6±16.6)min in group B(P 0.01); blood loss was(60.6±21.8)ml in group A, and(342.7±60.2)ml in group B(P 0.01); postoperative drainage was(16.3±4.6)ml in group A, and(124.2±21.8)ml in group B(P 0.01); hospital stay was(15.3±2.7)d in group A, and(18.0±2.9)d in group B, the difference was statistically significant(P 0.05). Three days, three weeks, three months, half year after operation, pain was significantly reducedin minimally invasive group, differences at the same time compared with the traditional open surgery group were statistically significant( P 0.05). Conclusion Minimally invasive percutaneous pedicle screws without decompression pressure in the treatment of thoracolumbar fractures has better clinical curative effect than open surgery, with a small incision, less bleeding, shorter hospitalization time, small tissue injury,less postoperative pain, quicker recovery.

在现实司法中,外部的干扰与内在的缺陷使能动司法与善意司法面临一种困境.摆脱困境,需要能动司法与善意司法的嵌入与融合:善意司法表现在司法动机、目的、行为等方面,能动司法表现在司法解释、司法参与、司法矫正等方面.因此,只有以善意适法、公平正义为目标改善司法形象,以能力提升、能动司法为目标提高司法水平,以尊重良俗、德法互济为目标完善司法机制,提升司法公信力,使司法成为法治前行的力量,才能实现法治对司法进步的期待.

椎间盘退变性疾病(DDD)是一类具有高发病率及高致残率的疾病，如颈椎病、腰椎间盘突出症和腰椎不稳等，严重影响患者生活质量。椎间盘退变一旦发生则难以逆转。目前国内外治疗DDD的措施主要有药物、物理疗法、开放手术及微创手术，这些方法虽然能缓解临床症状，但也均为对症性治疗，不能从根本上治疗并阻止椎间盘退变。因此DDD的理想外科治疗方法是重建和修复退变的椎间盘。椎间盘组织工程学是近年来发展起来的一项新兴技术，其目的是通过在体外构建出组织工程椎间盘，从而修复替代退变的椎间盘组织。组织工程包括三个方面：种子细胞、支架材料及生长因子。支架材料为体外构建椎间盘组织提供三维的细胞生长支架，使细胞间形成适宜的空间分布和细胞联系，维持细胞的定向分化，它在椎间盘组织工程中起着替代细胞外基质或组织器官基质的作用。笔者就椎间盘组织工程支架材料的研究进展综述如下。

Objective To evaluate the safety and effectiveness of unilateral interbody decompression fusion and internal fixation combined with contralateral percutaneous pedicle screw fixation through the Quadrant channel in the treatment of lumbar degenerative disc disease.Methods 20 patients were enrolled between September 2009 and December 2012. There were 12 females and 8 males. Their mean age was 57. 5(range 45 ~66),with the mean duration of 36. 5(range 24 ~96)months. Among these patients,there were 11 cases of lumbar disc herniation,4 cases of recurrent lumbar disc herniation,3 cases of lumbar disc herniation conbined with degenerative spondylolisthesis(degree I)and 2 cases of lumbar disc herniation conbined with instability. The average lumbar pain Visual Analog Scale(VAS)before surgery was(6. 5 ±1. 1). Results The average operative time wa(s 150 ±20)min. Mean blood loss during operation wa(s 340 ±90)mL. Postoperative hospital stay averaged (11. 0 ±3. 5)d. The incision were healed in stage I. At last follow-up,all patients were available for evaluation,and mean follow- up was 15. 2(range 6 ~20)months. Mean VAS was(1. 4 ±2. 2)at the final follow-up,which was significantly improved as compared to preoperation(P ﹤0. 05). At the 6 month follow-up,interbody bony fusion was investigated,and no cases of pedicle screw loosening,fracture or displacement was detected as shown by X-ray. According to Modified Macnab scale,18 patients had excellent outcomes,and 2 had good outcomes. Conclusion Unilateral interbody decompression fusion and internal fixation combined with contralateral percutaneous pedicle screw fixation through the Quadrant channel is a minimally invasive surgery which is available for clinical choice for patients with single segmental lesions and need only a unilateral operation to complete decompression and interbody fusion.

目的 探讨应用Quadrant微创可扩张工作通道下减压植骨融合内固定治疗腰椎间盘突出症的方法及疗效.方法 采用该技术治疗腰椎间盘突出症26例.结果 本组获得随访6～15个月,术前、术后1个月及末次随访时的VAS、ODI评分比较差异有统计学意义.末次随访时临床效果评定:优12例,良11例,可3例,优良率88.5％.结论 采用该技术治疗腰椎间盘突出症具有安全、创伤小、术后卧床时间短、疗效高、恢复快等优点,值得推广应用.

Resolve remove conflict,some local advance "sunshine taken",through system innovation,mechanism innovation so that the demolition work has made great achievements,but undeniable,as a new system,continues to exist the space that the system innovates,need to be perfected further"sunshine taken"mechanism,to firmly establish the win-win concept,scientific determination of compensation standard standardized work procedures,excellent construction,demolition team,ensure the harmonious buildings and city construction.

Objective: To explore the experiences in nursing care during surgery of lumbar canal decompression,interbody fusion and percutaneous pedicle screw fixation through the posterior lumbar Quadrant expanded channels for the treatment of degenerative lumbar disorders.Methods: Retrospective analysis of 42 cases of Lumbar minimally invasive fusion and fixation surgery of our hospital carried out in 2012,summarizing the record of surgery,putting forward step-by-step care measures in the preoperative,and intraoperative,pointing out all key aspects of the specific matters.Results: All 42 cases turned out uneventful during the operation,none of them needed open surgery or had complication occurred.The incisions achieved primary healing in all cases.Conclusion: The surgery of lumbar minimally invasive fusion and fixation is less traumatic to soft tissue,causes less hemorrhage and results in faster recovery in function after the surgery.Good nursing coordination is an integral part to ensure patient safety and improve surgery efficiency.

目的:探讨旋转式生物反应器(RCCS)对髓核细胞功能表达和组织工程髓核结构的影响。方法:将体外扩增培养的兔髓核细胞接种于聚乳酸-羟基乙酸共聚物(PLGA)支架上。治疗组在RCCS内培养,对照组静态培养。培养4周后取出细胞与支架复合物,行大体标本观察、组织学和免疫组织化学染色观察。结果:RCCS下构建的组织工程髓核的厚度、大小及组织弹性好于对照组,Ⅱ型胶原免疫组化染色面积百分比明显高于对照组(15.0±4.6比6.5±2.2),差异有统计学意义(P<0.05)。结论:旋转式生物反应器能促进髓核细胞增加Ⅱ型胶原的分泌,有利于在体外构建组织工程髓核。

患者 男性,43岁,主因“颈部疼痛伴四肢麻木1个月”于2010年12月19日入院.体检:身材矮小,“O”形腿,颈部有压痛、叩击痛,双上肢肘关节以下感觉减退,双侧屈肘、伸腕、伸肘肌肌力4+级,双手握力4级,双侧Hoffman征(+),双小腿内翻畸形,双足底感觉减退,左下肢伸膝肌、踝背伸肌、伸踇长肌、踝跖屈肌肌力4级,左侧膝、跟腱反射亢进,右下肢肌力5级.4年前有“左股骨颈骨折”病史,未予特殊处理.父母非近亲结婚,家族中母亲有类似“骨骼畸形”病史.

Background:The enhancement of the new implant materials and improved intraoperative imaging has led to the development of novel minimally invasive surgical techniques for the treatment of spinal trauma. Objective:The aim of the study is to explore the feasibility and effect of the mini-invasive percutaneous pedicle screw fixation for the patients with thoracolumbar fracture using multi-level Sextant or Viper system. Methods:From June 2009 to June 2011,28 thoracolumbar fracture patients without neural impairment were selected.They were divided into 2 groups:12 cases(8 males and 4 females,age 38.5±7.2)were included in the multi-level Sextant or Viper percutaneous pedicle screw fixation group and 16 cases(12 males and 4 females,age 41.3±9.1)were in the open pedicle screw fixation group.Perioperative parameter,pre and post operative imaging index,visual analog scale(VAS)and modified Macnab evaluation standard were compared. Results:All cases were followed up from 6 to 15 months(mean 12.5±5.4 months).There were significant differences in the surgical blood loss,surgical draining loss,hospital stay postoperative,VAS score and clinical response between the two groups (P<0.05).The Cobb's angle and anterior height of the fracture vertebral body were all significantly different between pre- operation and post-operation in each group(P<0.05).There was no significant difference in incision size,surgical time, postoperative improvement of Cobb angle,anterior height of the fracture vertebral body and accuracy of pedicle screw placement in the two groups. Conclusions:The mini-invasive percutaneous pedicle screw fixation for fractured vertebra using multi-level Viper system is a goodtherapeutic choice for patients with thoracolumbar fracture.This method is with less blood loss and trauma and can provide quicker recovery and shorter stay in hospital and comparable result of the traditional open operation.

Objective To evaluate the effect of posterior lumbar inter-body fusion (PLIF) assisted by Mast Quadrant system in treatment of lumbar disc herniation. Methods A retrospective investigation was carried in 45 patients. The 45 cases of lumbar disc herniation were treated with posterior lumbar inter-body fusion via MAST Quadrant retractor. There were 25 males and 20 females, average age 54 years. Results All patients were followed up 12 months on average. The VAS score showed significant difference when compared with that of pre-operation (P〈0.05). JOA criteria, the surgical outcomes were effective. Conclusion PLIF assisted by Mast Quadrant system for the management of lumbar disc herniation is a safe, effective, and minimally invasive surgical technique.

<正>2004年2月～2011年6月,我科手术治疗12例股骨外髁冠状面骨折患者,疗效满意。1材料与方法1.1病例资料本组12例,男9例,女3例,年龄20～57岁。其中2例合并胫骨平台骨折,1例合并前交叉韧带股骨

背景:随着新型内固定器械的出现及影像学技术的发展,微创脊柱外科技术已经越来越广泛的应用于脊柱创伤的治疗.目的:探讨经皮附加伤椎椎弓根螺钉内固定术治疗无神经损伤的胸腰椎骨折的可行性及疗效.方法:选择2009年6月至2011年6月在我科住院治疗的28例无神经功能损害的胸腰椎骨折患者,采用附加伤椎椎弓根螺钉固定技术,分别给予Sextant或Viper经皮椎弓根螺钉内固定(微创组)[共12例,男8例,女4例,年龄(38.5±7.2)岁]和传统切开内固定组(开放组)[共16例,男12例,女4例,年龄(41.3±9.1)岁],比较围手术期参数、影像学指标、视觉模拟评分法(VAS)及疗效情况(改良MacNab疗效评定标准).结果:所有患者均获得随访,随访时间为6～15个月,平均(12.5±5.4)个月.微创组较开放组不仅住院时间明显缩短,术中出血、术后伤口引流量显著减少,而且肌酸激酶升高程度明显减低,术后腰背部疼痛明显减轻,术后功能恢复明显(P＜0.05).所有患者术后Cobb角和伤椎椎体前缘高度较术前均有显著恢复(P＜0.05),但两组手术前后比较无差异(P＞0.05).两组椎弓根钉置人准确率比较无差异(P＞0.05).结论:经皮附加伤椎椎弓根螺钉内固定技术具有创伤小、出血少、恢复快等优点,对伤椎畸形矫正程度与传统开放手术相当,是治疗无神经损伤的胸腰椎骨折的较好选择.

目的:探讨影响骨质疏松性椎体压缩骨折经皮椎体后凸成形术后发生伤椎相邻椎体骨折的临床因素。方法:对212例经皮椎体后凸成形术治疗骨质疏松性椎体压缩骨折患者的临床资料进行回顾性研究。应用Logistic回归多因素分析。结果:仅5个指标影响术后发生相邻椎体骨折,根据标准化回归系数,影响力大小依次是术后Cobb角(b′=-1.255)、术后椎体高度(b′=1.089)、性别(b′=1.018)、骨水泥注射量(b′=-0.908)、抗骨质疏松治疗(b′=0.688)。结论:术后Cobb角、术后椎体高度、性别、骨水泥注射量、抗骨质疏松治疗显著影响术后伤椎相邻椎体骨折。

目的 探讨经皮椎体后凸成形术(PKP)治疗骨质疏松性胸腰椎爆裂性骨折的临床疗效.方法 对骨质疏松性胸腰椎爆裂性骨折38例(42椎)患者行PKP,手术采用经双侧椎弓根入路行球囊扩张磷酸钙骨水泥注射,手术前后行WHO疼痛标准评分、椎体高度及Cobb角测量,进行统计分析.结果 所有患者随访6～20个月,根据WHO标准评分,术后35例后背痛完全缓解(CR),3例疼痛部分缓解(PR),有效率92.1％.椎体前缘高度由术前的(18.6±2.5)mm恢复到术后的(24.0±2.6)mm(P＜0.01)；椎体中部高度由术前的(19.3±3.0)mm恢复到术后的(24.8±2.7)mm(P＜0.01)；Cobb角由术前的(9.5±6.0)度矫正到术后的(9.7±6.2)度(P＜0.01).结论 PKP在治疗骨质疏松性胸、腰椎爆裂性骨折时,能有效缓解腰背痛及恢复椎体高度和形态.