先天性脊柱畸形是指各种原因引起的先天性椎骨发育不良,包括椎体形成不全、椎体分节障碍以及混合畸形等,严重的脊柱畸形影响脏器功能,严重影响生活质量[1-3].重度先天性脊柱畸形通常指脊柱侧弯或后凸畸形角度大于90°[4],椎体结构较正常椎体存在较大变异,给手术带来很大困难与风险.全脊椎截骨术(vertebral column resection,VCR)的出现相较于传统截骨方式大大提高了截骨的畸形矫正率,但因其手术技术难度较高、风险大、出血较多,临床应用有诸多限制.头盆环牵引的阶梯治疗可以提高手术矫形效果,并控制手术风险,减少出血量[5].为此杭州市萧山区中医院脊柱外科采用一期头盆环牵引二期截骨矫形手术的方式治疗重度先天性脊柱畸形,现报道如下.

Objective:To explore the early outcomes surgical treatment with growing rod for idiopathic early-onset scoliosis (IEOS).Methods:Data of 11 patients with IEOS who had surgical treatment from February 2017 to December 2018 were retrospectively analyzed. There were 4 males and 7 females aged 6.45±1.63 at the time of the first operation, with preoperative Cobb angle of 74.74°±6.48° (range, 66.12°-87.85°). The imaging data and clinical data before operation, after operation instantly, 1 month after operation, 1 year after operation and 2 years after operation, and surgical-related complications were analyzed and recorded.Results:All the 11 patients were followed up for 28.82±4.77 months. The Cobb angle was 74.74°±6.48° before the initial implantation of internal fixation, and decreased to 30.30°±4.04° immediately after the operation, 30.39°±4.49° 1 month after the operation, 26.93°±3.09° 1 year after the operation, and 28.36°±2.98° 2 years after the operation. The correction rate was 61.82%±4.85% 2 years after operation. The height of T 1-T 12 thoracic vertebra was 13.69±2.05 cm before surgery, and increased to 20.74±3.10 cm immediately after surgery, and was 20.85±3.62 cm 1 month after surgery, 21.49±3.56 cm 1 year after surgery, and 22.54±3.63 cm 2 years after surgery. The height of T 1-S 1 vertebral body was 24.21±3.20 cm before surgery, and increased to 31.04±3.79 cm immediately after surgery, and was 30.85±3.64 cm 1 month after surgery, 32.91±3.24 cm 1 year after surgery, and 34.46±3.28 cm 2 years after surgery. Preoperative apical vertebral translation (AVT) was 7.45±2.00 cm before the initial operation, and shortened to 2.04±0.67 cm immediately after the operation, 2.07±0.70 cm 1 month after the operation, 2.24±0.57 cm 1 year after the operation, and 2.11±0.82 cm 2 years after the operation. There were statistically significant differences in the above indexes before surgery, 1 month after surgery, 1 year after surgery and 2 years after surgery. Compared with preoperation, pulmonary function FEV1 and FVC increased to 1.28±0.13 L and 1.49±0.10 L, respectively, 1 year after surgery, and 1.34±0.13 L and 1.54±0.12 L, respectively, 2 years after surgery. Pulmonary function was significantly improved 1 year after surgery, and pulmonary FVC was positively correlated with T 1-T 12 thoracic vertebral height ( r=0.838, P< 0.001). 13 complications were found in the 11 patients, including 2 cases of proximal screws loosening, 1 case of proximal junction kyphosis, 1 case of titanium rod fracture, 3 cases of skin swelling cause by internal fixation, and 6 cases of subcutaneous effusion, with good results after timely treatment. Conclusion:The traditional growing rod can effectively control the progression of deformity in patients with IEOS, maintain the growth and development of trunk, and promote the development and maturation of lung function.

患者,男,72岁,因"腰痛1余年,加重伴左下肢放射痛4个多月"于2019年6月27日收住入院.患者1年前在挑担后出现腰部疼痛,疼痛无昼夜差异,夜间无潮热盗汗,无双下肢放射痛或麻木及间歇性跛行,无咳嗽咳痰、胸闷气急及腹痛腹胀,外院多次就诊对症治疗后腰痛症状缓解,4个多月前感腰痛症状加重,伴左下肢放射痛,久坐或长时间行走后左下肢放射痛加重,偶有双下肢麻木感,无双足跛行,遂来我院骨科门诊就诊,门诊拟"腰椎间盘突出症"收住入院.

目的 探讨自制血管保护套联合负压封闭引流(VAC)治疗兔下肢血管裸露创面的有效性.方法 清洁级新西兰兔24只,采用随机数字表法分为模型组、VAC组、联合治疗组,每组8只.切除右大腿内侧3 cm×4 cm皮肤和部分筋膜,构建血管裸露创面模型.模型组常规包扎换药治疗,VAC组予-120 mmHg压力吸引治疗,联合治疗组予自制血管保护套覆盖血管后以-120 mmHg压力吸引治疗,于治疗后第7、14天比较各组创面大体情况、镜下血管形态、创面愈合率以及新生血管相关基因表达情况.结果 治疗后第14天联合治疗组创面肉芽生长及血管受压情况优于VAC组和模型组.治疗后第7、14天联合治疗组创面愈合率均高于VAC组和模型组,创面组织新生血管血管内皮生长因子、血小板衍生生长因子、血小板内皮细胞黏附分子1、酪氨酸激酶受体Eph亚族的配体表达水平均高于VAC组和模型组,差异均有统计学意义(均P<0.05).结论 自制血管保护套联合VAC治疗可有效避免裸露血管受压,并可通过改善局部血供加速创面愈合.

根性坐骨神经痛是临床最常见疾病之一,它是指腰骶神经根在椎管内遭受外部压迫或者各种刺激后引起疼痛,其特点为疼痛明显,以坐骨神经近端为主,椎旁有明显压痛点并沿坐骨神经向下肢放射,咳嗽等增加腹压动作可加重疼痛.腰椎间盘突出是引起根性坐骨神经痛最常见的病因[1].笔者采用水针联合中医综合疗法治疗腰椎间盘突出症引起根性坐骨神经痛患者90例,临床效果明显,现报道如下.