[目的]探讨阿仑膦酸钠(alendronate,AL)和特立帕肽(teriparatide,TPTD)对双足鼠脊柱侧弯进展的作用.[方法]将45只C57BL/6J雌性4周龄小鼠行双前肢和尾离断,建立双足鼠脊柱侧弯模型,随机分为3组,每组15只.对照组、AL组和TPTD组,分别给予生理盐水、AL和TPTD,连续12周.行影像和骨密度(bone mineral density,BMD)检测.[结果]随时间推移,三组动物Cobb角均显著增加(P＜0.05).术后8周和12周,脊柱侧弯Cobb角由大至小依次为:对照组＞AL组＞TPTD组,总体差异有统计学意义(P＜0.05);两两比较,对照组的Cobb角显著大于AL组和TPTD组(P＜0.05),而AL组与TPTD组间差异无统计学意义(P＞0.05).随时间推移,三组动物BMD均显著增加(P＜0.05).术后4、8和12周BMD值由低至高均为:对照组＜AL组＜TPTD组,总体差异有统计学意义(P＜0.05).两两比较方面,对照组的BMD与AL组和TPTD组的差异均有统计学意义(P＜0.05),而AL组与TPTD组间的BMD差异均无统计学(P＞0.05).[结论]在双足鼠脊柱侧弯模型早期给予AL和TPTD可有效减小鼠脊柱侧弯Cobb角,同时增加生长期小鼠脊柱BMD值.

BACKGROUND: Kyphosis in ankylosing spondylitis is a kind of spinal sagittal imbalance; due to center of gravity displaced and complicated biomechanical properties of the spine, the spinal biomechanics after kyphosis correction is little reported. OBJECTIVE: To establish a three-dimensional finite element model of the spine after osteotomy for kyphosis. METHODS: A three-dimensional finite element model of kyphosis in ankylosing spondylitis was established, simulating three kinds of osteotomy orthopedic programs (osteotomy angle in 20°, 30° and 40°), and the orthopedic effect and biomechanics were analyzed.RESULTS AND CONCLUSION: (1) The three-dimensional finite element model of finite element model of kyphosis in ankylosing spondylitis was established successfully, and simulated three kinds of osteotomy orthopedic programs at the angles of 20°, 30°, and 40°. (2) The best osteotomy angle was 30°, the stress distribution was less, and the stress on the T12, L1, L2, L4, L5, S1and rod was 7.346 1, 11.952, 72.783, 81.368, 28.144, 41.114, and 109.69 MPa, respectively. (3) Under 30°osteotomy angle, the postoperative Cobb angle is 1.4°, which not only obtains better orthopedic effect, but also reduces the incidence of complications caused by stress concentration.

目的 探讨以PDCA质量循环管理模式联合PBL教学方法在骨外科住院医师规范化培训中的教学效果.方法 选择新疆医科大学第六附属医院2016-2017级骨外科住院医师规范化培训医师,随机分为PDCA循环联合PBL教学联合组和传统教学对照组,各40人,比较教学结束时两组规培生的理论知识、临床操作与思维有无差异.结果 理论方知识笔试方面,联合组(87.56±3.12)分,对照组(82.27±4.25)分,成绩分别有统计学差异(P<0.05),在临床操作及思维分析方面,联合组表现优良率为67.2％,而对照组仅为52.5％,且差异有统计学意义(P<0.05).结论 相对于传统教学方法,PDCA循环结合PBL教学法对提高骨外科住培生的理论知识掌握、临床操作及诊疗技能有较好的效果,有一定的推广和应用价值.

BACKGROUND: The effect of pediclesubtraction osteotomy is obvious, and the incidence of correction degree loss is low. So, it has been the first choice for the correction of ankylosing spondylitis with kyphotic deformity. OBJECTIVE: To establish a three-dimensional finite element model of ankylosing spondylitis with kyphotic deformity by computer aided software, and to analyze the biomechanical characteristics.METHODS: A ankylosing spondylitis patient with kyphotic deformity was selected, and spinal full-length anteroposterior images were photographed, and the patient received magnetic resonance imaging. A three-dimensional model of ankylosing spondylitis with kyphotic deformity was established, and then a three-dimensional finite element model of ankylosing spondylitis with kyphotic deformity was generated. Three different types of models were established for three different surgeries at the osteotomy angle of 20°, 30° and 40°. Correction effect and biomechanics were analyzed. RESULTS AND CONCLUSION: (1) A three-dimensional finite element model of ankylosing spondylitis with kyphotic deformity was successfully established at the osteotomy angle of 20°, 30° and 40°. The maximum principal stresses of three different screw titanium rods were 54.632, 194.230, 394.860 Mpa. (2) Three different surgeries were successfully simulated. The correction degree of the model 3 was optimal, but the stress distribution was large; displacement was obvious. After internal fixation, the complications of stability and internal fixation failure increased. The model 2 had good correction degree, appropriate stress distribution, and decreased complications of fixation failure.

BACKGROUND: Patients with severe ankylosing kyphosis are often treated with orthopedic osteotomy, but with high surgical risk, treatment schemes are individualized, and the biological morphology and mechanical properties of the deformed spine are complex. Meanwhile, the finite element model is more adaptable for biomechanical analysis of the spinal deformity. However, its application in the treatment of ankylosing kyphosis in China was little reported.OBJECTIVE: To establish an ankylosing kyphosis finite element model so as to investigate the relationship between different osteotomy methods and the deformation and stress distribution of the spine.METHODS: A three-dimensional finite element model of ankylosing kyphosis was established, and then imported into ANASYS software, to simulate vertebral column decancellation and vertebral column resection at T12 and L1 levels,respectively. The vertebrae and screw were loaded with the same load, and deformation and stress nephograms were obtained.RESULTS AND CONCLUSION: (1) The deformation of the osteotomy at T12 level was significantly larger than that at L1 level. (2) The stress distribution of the decancellation osteotomy concentrated on the pedicle screw and titanium bar; the stress concentration of vertebral column resection was the intervertebral cage. (3) Individualized surgical treatment of ankylosing kyphosis may influence the selection of the osteotomy segment and osteotomy operation. The osteotomy segment may affect the stability of the spine, and stress distribution of internal fixation is likely related to the method of internal fixation. (4) This conclusion may provide theoretical reference for the biomechanical study of analysing ankylosing kyphosis.

目的:对于上位腰椎不稳同时合并有下腰椎椎管狭窄的患者进行后路减压植骨内固定术后的临床疗效分析.方法:2004年10月～2008年10月手术治疗高位腰椎不稳合并下腰椎管狭窄患者40例均行一期后路多阶段腰椎内固定加椎管扩大减压椎体间融合器融合术治疗.结果:术中未有血管、神经等副损伤.后路椎弓根螺钉复位固定、椎管减压、椎间融合器融合术平均手术时间130 min,出血量约400 ml,术后所有患者全部下腰部疼痛及单侧沿坐骨神经放射性疼痛,均较术前明显减轻.40例患者平均随访36个月～60个月,平均48个月.随访患者临床症状均消失或大部分消失,无一例内固定松动及断裂,融合节段均骨性融合.结论:对于上位腰椎不稳同时合并有下腰椎椎管狭窄的患者一期进行后路手术,手术疗效肯定,术后效果满意.

[目的]研究经右侧颈前路切口清理结核自取髂骨植骨前路钛板固定治疗颈椎结核的手术方法、疗效及5年随访结果.[方法]收集2008年4月～2013年4月全部采用右侧颈前路病灶清除自体髂骨植骨内固定治疗颈椎结核病例,共10例,平均31岁.C45例,C53例,C62例.所有病例均采用一期病灶清除髂骨植骨内固定术,抗结核治疗9～12个月.[结果]平均随访30个月.颈椎生理弧度得以恢复,术后随访未见矫正角度明显丢失;神经功能恢复良好;术后3～6个月植骨融合,内固定器械无断裂,无结核病灶局部复发.[结论]在抗痨治疗的基础上,右侧颈前路手术清除结核病灶取髂骨钛板固定治疗中下颈椎结核,恢复病灶破坏椎体的高度、同时达到矫正后凸畸形的目的、解除结核病灶对脊髓神经的压迫、重建颈椎的稳定,有利于结核病灶的愈合.

Objective To discuss the clinical effect of simple posterior distraction and reduction for thoracolumbar burst fracture. Methods A total of 15 patients with thoracolumbar burst fracture enrolled in hospital from February 2012 to February2013 were without expression of spinal cord and cauda equina injury by preoperative physical examination and electromyography(EMG). Simple posterior distraction reduction and internal fixation was adopted and structure simple posterior distraction was used to restore the vertebral height and avoid injuring cauda equina and nerve root again without decompressing spinal canal indirectly. Results 15 patients were followed up for 3-36 months with average of 18 months,no vascular and neurological complications,broken nails,screws loosening and nonunion occurred. Conclusion After postoperative reexamination of the 15patients,the vertebral height restore satisfactorily,Cobb angle of kyphosis decrease significantly,all patients are fracture reduction with vertebral canal volume recovered or mostly recovered,and neural functional recovery is better,which show that the posterior distraction reduction fixation for thoracolumbar burst fracture is feasible.