目的 对比分析常见颈椎人工椎间盘假体尺寸与我国健康成人颈椎解剖学参数的关系,为国人颈椎椎间盘假体的设计提供参考.方法 2015年1月—2018年12月在泰州市人民医院接受颈椎CT平扫的健康成人130名,其中男78名、女52名,年龄为18.0～66.0(41.41±12.03)岁.使用影像存档与传输系统(PACS)对C3/C4/C5/C6/C7节段的解剖结构进行测量,测量参数包括椎体终板前后径(AP)、椎间隙高度(DH)、椎体前缘高度(ADH)、椎体后缘高度(PDH)、椎体终板横径(ML)及钩突间距(IDUP).分析不同节段、性别、年龄组各解剖学参数的差异,并与常见的8种假体尺寸进行对比分析.结果 共520个节段纳入分析,其中AP为(16.08±1.84)mm,DH为(5.73±1.00)mm,ADH为(3.88±1.11)mm,PDH为(2.83±0.94)mm,ML为(16.13±1.99)mm,IDUP为(23.68±2.55)mm,ML/AP为1.01±0.13.PDH在不同节段之间差异无统计学意义(P>0.05),其余各指标在不同节段之间的差异均有统计学意义(P<0.05);C3/C4和C5/C6节段的ADH,C5/C6和C6/C7节段的DH,C4/C5、C5/C6和C6/C7节段的PDH性别间差异无统计学意义(P>0.05),其余各节段的各指标性别间差异均有统计学意义(P<0.05);C5/C6和C6/C7节段的AP在不同年龄组间差异有统计学意义(P<0.05),其余各节段的各指标在不同年龄组间差异均无统计学意义(P>0.05).与常见的8种颈椎人工椎间盘假体尺寸的对比结果显示,假体AP、ML尺寸与研究对象椎体终板AP、ML测量值的匹配度不理想,假体高度与研究对象DH测量值匹配度较差.结论 常见的不同品牌假体尺寸与我国健康成人的颈椎解剖学参数匹配度不是很理想,未来可设计更符合国人解剖学特征的颈椎人工椎间盘假体.
目的 探讨骨钻漂移技术在经皮内镜腰椎间盘切除术(PE LD)治疗腰椎间盘突出症中的应用.方法 回顾性分析自2016-01-2016-12采用PELD治疗的77例腰椎间盘突出症,术中采用骨钻漂移技术.比较手术前后疼痛VAS评分、ODI指数,末次随访时按MacNab标准评价患者腰椎功能.结果 77例均获得12个月以上的随访,术后1例出现神经根变异,1例复发腰椎间盘突出,行对症治疗后均治愈.术后1d、术后3个月、术后12个月疼痛VAS评分、ODI指数评分均较术前比较明显降低,术后3个月、术后12个月疼痛VAS评分、ODI指数较术后1d低,差异有统计学意义(P＜0.05).术后3个月与术后12个月的疼痛VAS评分、ODI指数比较差异无统计学意义(P＞0.05).末次随访按MaCNab标准评定患者腰椎功能:优47例,良23,可5例,差2例.结论 PELD治疗腰椎间盘突出症具有创伤小、并发症少、术后恢复快等优点,术中采用骨钻漂移技术可以使术中操作拥有更广泛的操作和探查空间,同时可以避免术中神经损伤的发生.
Objective To study the clinicopathological features, diagnosis and surgical treatment of duodenal papilla neu-roendocrine tumors ( DPNETs) .Methods Clinical data of 3 DPNET patients and their surgical treatment outcome were ret-rospectively analyzed with related literatures reviewed.The patients were 68,66 and 52 years old.Main clinical symptoms included abdominal pain, diarrhea and upper gastrointestinal bleeding.Imaging studies of 2 cases revealed mass lesions in the descending part of duodenum.Esophagogastroduodenoscopy ( EGD) of the 3 cases indicated duodenal papilla lesions. Biopsies demonstrated neuroendocrine tumors by pathology. Results All patients underwent pancreaticoduodenectomy ( PD) .Pathological reports were G1 grade in 2 cases and G2 grade in 1 case.The patients were followed up after opera-tion.Of the 3 patients, two patients survived while the other patient died due to recurrence after 4 years and 8 months of surgery.Conclusion Duodenal papilla neuroendocrine tumor is relatively rare and does not have specific clinical manifesta-tions.Preoperative EGD is helpful for diagnosis.Surgical resection is the mainstay of treatment.
