[目的]比较多节段经椎间孔椎体间融合(transforaminal lumbar interbody fusion,TLIF)3种引流方式临床疗效.[方法]2019年7月—2021年6月在本科行TLIF治疗的多节段腰椎退变104例患者采用随机数字表法分为三组,于TLIF术后分别给予3种引流,其中,34例行间断负压引流,37例行持续负压引流,33例行常压引流.比较三组早期及随访结果.[结果]所有患者均顺利完成手术,三组手术时间、术中出血量差异无统计学意义(P＞0.05),持续负压组第1d和术后总引流量,以及引流管留置时间显著大于其他两组(P＜0.05);常压组伤口敷料渗血次数显著多于其他两组(P＜0.05).随时间推移.三组患者腿痛VAS评分、ODI评分、JOA评分均显著改善(P＜0.05),相应时间点,三组间上述评分的差异均无统计学意义(P＞0.05).[结论]多节段TLIF术后采用间断负压引流可以明显减少引流量和伤口渗血,缩短引流时间,是一种安全有效的方式.

Objective:To analyze the effects of different courses of hyperbaric oxygen combined with sertraline on sleep disorders and serum neurologic injury factors in patients after cerebral hemorrhage.Methods:A total of 120 patients with sleep disorders after cerebral hemorrhage were divided into control group ( n=60) and observation group ( n=60) by random number table method. The control group was treated with sertraline only, while the observation group was treated with hyperbaric oxygen on the basis of the treatment in the control group. The sleep quality, clinical efficacy, the levels of serum neuron-specific enolase (NSE), intercellular adhesion molecule-1 (ICAM-1), and tumor necrosis factor-α (TNF-α) before and 10, 20, and 30 d after treatment were compared between the two groups. Results:The scores of Pittsburgh sleep quality index (PSQI) of the observation group were significantly lower than those of the control group at every time point of treatment ( P<0.05); the total sleep time, total deep sleep time, total light sleep time, and rapid eye movement (REM) sleep time of the observation group were significantly longer than those of the control group ( P<0.05); and the sleep latency of the observation group was significantly shorter than that of the control group ( P<0.05). With the prolongation of the treatment course, the PSQI scores of both groups showed decreasing trends ( P<0.05); the total sleep time, total deep sleep time, total light sleep time, and REM sleep time of both groups tended to prolong ( P<0.05); and the sleep latency tended to be shorter ( P<0.05). The total effective rate of the observation group was significantly higher than that of the control group at 10, 20, and 30 d after treatment ( P<0.05). With the prolongation of the treatment course, the total effective rates of the two groups showed increasing trends ( P<0.05); the levels of serum NSE, ICAM-1, and TNF-α in the observation group were significantly lower than those in the control group at every time point of treatment ( P<0.05); and with the prolongation of the treatment course, the above indicators of the two groups showed decreasing trends ( P<0.05). Conclusion:Hyperbaric oxygen therapy combined with sertraline can improve the sleep quality and clinical efficacy of patients after cerebral hemorrhage with sleep disorders.

目的 比较经皮椎体成形术(Percutaneous vertebro plasty,PVP)与经皮椎体后凸成形术(Percutaneous kyphoplasty,PKP)治疗骨质疏松性椎体压缩骨折的临床疗效.方法 回顾性分析自2016-01-2020-11诊治的82例骨质疏松性椎体压缩骨折,41例采用PKP治疗(PKP组),41例采用PVP治疗(PVP组),比较2组手术时间、骨水泥注入量、骨水泥渗漏情况,比较2组术后3个月疼痛VAS评分、ODI指数、伤椎前缘高度、伤椎Cobb角.结果 2组均顺利完成手术并获得至少3个月的随访.PKP组骨水泥注入量较PVP组多,骨水泥渗漏数较PVP组少,手术时间较PVP组长,差异有统计学意义(P＜0.05).术后3个月2组疼痛VAS评分、ODI指数比较差异无统计学意义(P＞0.05);PKP组伤椎前缘高度较PVP组大,伤椎Cobb角较PVP组小,差异有统计学意义(P＜0.05).结论 骨质疏松性椎体压缩骨折采用PVP与PKP治疗均能显著减轻疼痛并促进术后快速康复,PKP在恢复伤椎高度、矫正椎体后凸畸形的效果优于PVP,且能减少骨水泥渗漏率.

对健步关节胶囊治疗退行性骨性关节炎的疗效进行临床评价.112例患者经知情同意分为治疗组和对照组,各56例.治疗组口服健步关节胶囊0.9 g/次,3次/d,治疗2周;对照组口服布洛芬0.2 g/次,3次/d,治疗2周.2组治疗期间均停用其他药物,观察2组的疗效和不良反应.治疗组临床总有效率为85.7%,不良反应小,与对照组(总有效率83.9%)比较,有良好的治疗效果.健步关节胶囊具有疗效确切、服用方便、胃肠道安全性强等优点,适合患者较长时间服用.

Objective To explore effects of percutaneous poking reduction combined with cannulated compression screw in the treatment of calcaneal fractures.Methods Twenty-six cases of calcaneal fractures were treated with percutaneous poking reduction combined with cannulated compression screw in our hospital from January 2005 to December 2009.Results All the patients had medical followed-ups for 6-18 months.Assessed with the Maryland foot score,17 cases were most effective and 7 cases were fairly effective,with a total most effective and fairly effective rate of 92.3%.Conclusion Treatment of calcaneal fractures with percutaneous poking reduction combined with cannulated compression screw had the following advantages: short operation time,minimal surgical intervention,effective prevention of complication often involved with open reduction in the treatment of calcaneal fractures.This treatment profile could produce good effects on calaneal fracture type II and III with minimal depression of facet according to Sanders classification.

Objective To study the clinical outcome of mini-invasive artificial femoral head replacement through anterolateral approach for the aged patients (>80 years) in the treatment of femoral neck fracture. Methods From August 2004 to December 2008,38 cases of displaced femoral neck fracture over 80 years old were randomized into two groups. In group A (18 cases),mini-invasive artificial femoral head replacement was performed through anterolateral approach,and in group B (20 cases),through posterolateral approach. The operative time,incision length,intraoperative blood loss,12-h drainage after operation,and transfusion were analyzed and compared. Results Thirty-eight cases were followed up for 6-10 weeks (mean 8 weeks). The operative time was similar in two groups. The incision length in group A was shorter than that in group B. The intraoperative blood loss,12-h drainage after operation and transfusion in group A were less than those in group B. Conclusion Mini-invasive artificial femoral head replacement through lateral approach has the advantages of reducing blood loss,transfusion,invasion and accelerating rehabilitation,especially for the aged patients.

目的探讨外侧小切口人工股骨头置换治疗高龄股骨颈骨折的可行性和治疗效果。方法自2003年4月～2004年12月,对18例80岁以上移位型股骨颈骨折患者施行微创小切口人工股骨头置换治疗,并采用Harris评分标准及不同时期髋关节正侧位排片进行评估。结果平均手术切口长度8.2cm,术中出血量325ml,手术时间72min,术后12h引流量195ml。输血12例,平均输血量380ml。优4例,良10例,可3例,差1例,优良率达78%。结论人工股骨头置换治疗高龄股骨颈骨折效果满意,围手术期处理至关重要。

目的探讨采用颈前路后纵韧带切除、髓核摘除加融合固定术治疗游离型颈椎间盘脱出症的疗效。方法自2002年3月～2006年6月,采用颈前路经椎体后缘后纵韧带边缘处进入椎管的后纵韧带切除或切开取核加固定融合新方法治疗游离型颈椎间盘脱出症19例。随访6～51个月,对其术后疗效、X线平片及MRI检查进行分析评定。结果根据临床疗效评定标准:优12例,良7例。结论对于游离型颈椎间盘脱出症,应作后纵韧带切除、摘除游离的髓核以提高手术疗效。采用颈前路后纵韧带边缘处进入椎管的后纵韧带切除或切开取核的方法,操作较简单、安全。

目前显微内窥镜(microendoscop,MED)治疗腰椎间盘突出症的文献报告较多,其优越性也被越来越多的骨科医生所认同,随着临床实践的不断深入及手术操作日趋完善熟练,其适应证也逐渐扩大[1,2].亦有MED治疗神经根管狭窄症的报告[3],但对腰椎间盘突出症合并神经根管狭窄的专门报告较少.

目前显微椎间盘镜手术(microsurgical enucleation discectomy,MED)微创治疗腰椎间盘突出症的文献报告较多,其优越性也被越来越多的骨科医生所认同,随着临床实践的不断深入及手术操作日趋完善成熟,其适应证也逐渐扩大.我院自2002年10月至2003年10月经MED治疗船员腰椎间盘突出症19例.报道如下.

目的:探讨采用椎管次环状侧前方减压植骨的基础上加椎弓根螺钉内固定治疗陈旧性胸腰段骨折不全瘫的疗效.方法:对19例陈旧性胸腰段骨折不全瘫患者行次环状侧前方减压植骨加椎弓根钉内固定治疗,经术后6～36个月(平均15个月)随访并对其临床疗效、植骨融合率、畸形矫正等进行了分析.结果:术后症状缓解,脊髓功能明显改善占84.2%(16/19),未发现断钉、松动.结论:次环状侧前方减压植骨加RF/AF椎弓根钉内固定治疗陈旧胸腰段骨折不全瘫,具有减压充分、能纠正后凸畸形及术后脊柱稳定性好、能早期活动等优点.

Objective To evaluate the effect of Microendoscopic Discectomy ( MED) on the treatment of lumbar disc her-niation. Methods 58 patients with lumbar disc hemiation had been treated with MED since October 2002. Among them, 18 patients with lumbar disc hemiation were associated with canal stenosis of nerve root. The patients were followed up for 4-13 months. Results According to the clinical standard of evaluation, 31 cases were rated as excellent and 26 were rated as good. 1 case showed some improvement after the treatment. Conclusion MED was not only suitable for the treatment of lumbar disc hemiation, but also effective in lumbar disc hemiation with canal stenosis of nerve root . It also had advantages in safety, less lesion, quick recovery, etc.

Objective: To explore the application and indication of preoperative autologous blood donation for orthopedic surgery. Methods: Preoperative blood transfusion program was employed for 40 orthopedic patients. An observation was made on the changes in Hb, RBC, HCT, both preoperatively and 2 days, 1 week, 2 weeks after surgery. Adverse reaction and complication after blood transfusion were also recorded. Results: The total amount of autotransfusion was 15 600 ml, which accounted for 84.8% of the total blood transfusion during surgery. 35 patients (87.5%) were autotransfused, while the other 5 (12.5%) required additional homologous blood. No adverse reaction or complication occurred in all patients. Conclusion: Preoperative autologous transfusion is safe and effective. The patients with an amount of bleeding estimated to be below 600 ml or with a blood preparation required during surgery are suitable for preoperative autologous blood donation.

目的 :评价HLA B2 7检测在强直性脊柱炎 （AS）临床诊断中的作用。方法 :对怀疑患有AS及其相关疾病的 12 0人作HLA B2 7检测 ,采用纽约标准改良的AS诊断标准作为本研究的AS诊断标准。结果 :本组受检 12 0例中 ,HLA B2 7（+）5 6例 ,占受检总数的 4 6 .6 7% ,按本研究改良标准诊断为AS 5 3例 ,其中HLA B2 7（+） 4 8例。本组 16周岁以下 13例受检者 ,HLA B2 7（+） 7例均符合JAS诊断标准。结论 :HLA B2 7检测对提高AS的诊断率和对轻型、早期AS病例的发现具有临床诊断价值

应用术中肌电电生理检测技术指导周围神经损伤手术，效果满意，是一种临床应用的新方法［1，2］。从1994年7月～1995年5月共做了12例，效果好，现报告如下。资料与方法、一般资料：本组12例，男性10例，女性2例。年龄14～57岁，平均30.5岁。其中臂丛神经损伤行健侧颈7移位术后1例；上臂桡神经损伤1例；上臂、腕部、手掌部正中神经损伤各1例；肘管尺神经卡压1例；前臂桡神经深支卡压2例；前臂正中、尺神经深支损伤1例；腕部、手掌尺神经损伤修复后3例。、方法：采用Esaote Phasis数字式智能化肌电及诱发电位测试系统作为术中持续肌电监测仪器。(1)受检神经系不完全损伤或断伤后已行缝合，神经连续性尚存，但神经周围瘢痕或神经瘤形成影响神经再生。将记录电极插入相应神经支配肌，刺激电极刺激受检神经，减小刺激强度至肌肉收缩不影响神经显微手术操作。在持续刺激，肌电监测显微镜下松解神经，并观察记录显示运动神经传导速度(MNCV)、潜伏期(Lat)、波幅(A mp)的改变情况。(2)神经卡压综合征患者，亦在肌电监测显微镜下松解运动神经。

目的:评价选择性脊神经后根切断术在轻型痉挛性脑性瘫痪的治疗作用.方法:采用腰后路跳跃式椎板切除44例,术前经系统康复训练8例,术后行康复训练44例.结果:随访3～28月,36例患者肌张力明显降低,病理反射完全消失,功能改善满意.结论:选择性脊神经后根切断术对轻型痉挛性脑性瘫痪能有效地降低肌张力,结合术前术后系统康复训练与软组织矫形术,对提高疗效能起到明显的作用.