目的 探讨改良TESSYS技术治疗腰椎神经根管狭窄症的安全性和有效性.方法 对57例诊断为腰椎神经根管狭窄的患者采用改良TESSYS技术行腰椎神经根管减压术治疗,分别进行术前、出院时、术后3个月及末次随访VAS和ODI评分,评价疗效.结果 术后患者的VAS和ODI评分均逐渐降低,术后各时段与术前相比较差异均有统计学意义(P＜0.01),术后各时段之间比较差异也均有统计学意义(P＜0.01).根据ODI评分改善率分级,末次随访优良率为87.7％,有效率为94.7％.结论改良TESSYS技术治疗腰椎神经根管狭窄症减压充分、彻底,近期疗效满意,是一种安全、有效的微创术式.

目的 评估保守方法治疗脊柱结核的疗效,初步探讨保守方法治疗脊柱结核的适应证.方法 总结解放军第三○九医院骨科2007年1月至2012年1月资料完整的经临床病史、体格检查、影像学和实验室检查、试验性抗结核治疗或影像引导下穿刺活检及细菌学检查确诊为脊柱结核,开始治疗时选择保守方法治疗的54例患者的临床特点、治疗方法及结果.54例患者采用口服抗结核药物治疗的方式,需要在标准化疗方案的基础上,根据症状缓解情况、实验室及影像学检查结果进行调整.抗结核治疗时间9～18个月,服药期间观察患者临床症状缓解情况,影像学检查判断病灶愈合、脊椎生理曲度改变情况,定期复查肝肾功能、血红细胞沉降率(ESR)、C反应蛋白(CRP),根据疗效情况调整治疗疗程.随访时间1.5～5.5年,平均(3.0±0.8)年.结果 54例患者中49例患者通过保守治疗病灶愈合,其中45例局部疼痛消失,4例轻微背痛,不需服用止痛药物;49例患者中的32例X线或CT片显示椎间骨性融合,17例显示纤维愈合;49例脊柱局部后凸角度平均增加(5.5±0.8)°;47例ESR、CRP下降至正常范围(正常标准:男性ESR＜15 mm/1 h,女性＜20 mm/1 h;CRP＜5 μg/L);18例治疗期间出现药物不良反应,通过减量或停用抗结核药物等治疗恢复正常.54例患者中5例分别因为治疗期间疼痛加重、出现神经损害症状或后凸畸形明显加重而选择手术治疗.结论 对于局部疼痛不严重、不伴畸形或神经损害、对抗结核药物敏感的脊柱结核患者,可通过保守治疗达到良好效果.

目的探讨髋关节置换术后感染一期翻修术的方法,分析近期随访疗效。方法 2006-03-2010-06施行髋关节置换术后感染一期翻修术12例。结果 2例手术失败,1例术后8个月出现炎症反应经抗生素治疗消失,其余在随访期间均无感染复发。结论髋关节置换术后感染一期翻修术,术后平均3a的随访效果良好,治疗期短,费用低,长期结果需进一步观察。

目的通过与传统双侧入路对比研究,探讨单一入路治疗髋臼双柱骨折的疗效。方法 2002-04-2008-12手术治疗髋臼双柱骨折98例,其中单一入路59例,双入路39例。结果两组在满意复位率和髋关节功能优良率方面差异无统计学意义,但在手术时间与出血量方面差异有统计学意义。结论有选择的利用单一入路代替双侧入路治疗髋臼双柱骨折,简化了手术步骤,减少了术中出血及术后并发症。

Objective To investigate the surgical treatment and clinical outcome evaluation postop- eratively of spinal tuberculosis in patients who underwent one-stage focus debridement, auto-bone grafting and internal fixation combined with anti-tuberculosis chemotherapy. Methods Seventy-four adult patients with spinal tuberculosis were diagnosed clinically, histologically and bacteriologically. Seventeen patients suffered neurological deficit, including 12 cases for Frankel D,5 cases for Frankel C. The tuberculosis focus were located either in cervical spine, thoracic spine or in lumbar spine. CT or MR shew obvious dad bone, cold abseess,and kyphosis deformity. Surgical procedures included anterior debridement and auto-bone grafting, one-stage anterior or posterior instrumentation. All patients underwent 10 to12 months chemothera- py before and after operation. Clinical effect, deformity correction and focus heeling were evaluated at fol- low-up period. Results The average ESR was 81.5 mm/1h,average CRP was 41.6 mg/L, and 51 patients have active spinal tuberculosis in this series before chemotherapy. After four weeks anti-tuberculosis chemotherapy, the average ESR decreased to 43.8 mm/1h,the average CRP decreased to 27.4 mg/L.Tuber- culosis symptoms and local pain relived in all patients, and ESR or CRP became normal two months postop- eratively. Average fusion times was about 4.3 months for one-segment and 6.7 months for two-segment,the deformity was corrected to mean 74.9%, and focus healing was achieved in 97.3% patients. There are 3 pa- tients walked with crutch, the others in this group walked normally 12 months postoperatively. Conclusions Surgical strategies of spinal tuberculosis are of radical focus debridement, neurological decompression, spinal stabilization, improving outcome and shortening chemotherapy course. Rational chemotherapy is essential for spinal tuberculosis treatment, and adequate preparation before surgery is precondition of success. The evalu- ation of outcome parameters is of significance in focus prognosis,

2000年11月-2003年3月,笔者应用可吸收螺钉治疗关节周围骨折及肩锁关节脱位96例,效果满意,报道如下. 1 临床资料