目的总结肝部分切除及胆肠内引流治疗肝胆管结石的经验。方法回顾性分析2002年1月～2012年1月苏州大学附属第一医院肝部分切除及胆肠内引流治疗肝胆管结石100例的临床资料，统计患者的年龄、性别、胆道手术史、临床表现、并发病、结石的分布、术式、术后并发症情况及治疗效果。结果100例中发生术后并发症11例（11%），手术死亡1例（1%），80例获得2～8年随访，随访率80%，疗效优良率80%，残石率15%，结石复发率5%。结论肝部分切除及胆肠内引流是治疗肝胆管结石的重要方法，术中健侧肝脏血管的保留及T管的放置具有相当重要的意义。
Objective To evaluate the effect of double tractors swing microendoscopic discectomy technique in multisegmental lumbar disc herniation.Methods From December 2006 to November 2009,153 patients with multisegmental lumbar disc herniation were
目的 探讨后路椎间盘镜技术治疗高位腰椎间盘突出症的手术技巧及疗效.方法 2000年3月至2010年10月应用后路椎间盘镜技术治疗高位腰椎间盘突出症患者16例.手术节段:第12胸椎~第1腰椎4例,第1~2腰椎5例,第2~3腰椎7例;单侧开窗14例,双侧开窗2例.采用Macnab评分标准评定疗效.结果 术后随访15 d~24个月,平均12个月.单侧手术时间平均40 min,出血量平均75 ml;术后1～3 d下床活动;无神经损伤及感染等并发症发生.疗效:优12例,良3例,可1例.结论 后路椎间盘镜技术治疗高位腰椎间盘突出症创伤小、恢复快、疗效优良。
Background: Pedicle screw fixation, as a commonly used technique, can provide super bio-mechanical effect. Various guiding methods have been employed including computer aided surgery navigation system (CASNS). However, none of them can ensure absolute accuracy, and malpositioning may result in disastrous consequence. Objective: To perform pedicle guide-wire placement with pedicle standard axis view (PSAV) using Frameless Spinal Navigation Surgery Robot (FSNSR) so as to explore a high accurate and easily tackled transpedicular placement technique. Methods: A total of 6 human lumbar spines vertebras (L1 to L5) were used. All specimens underwent pre-intervention CT scanning, and the angle (α) between pedicle centre axis and vertebra body sagittal plane (m plane) and the angle (β) between the axis and superior surface of vertebra body (s plane) were measured, respectively. During the operation, a standard posterior-anterior fluoroscopic image of target vertebra was obtained; the PSAV was acquired via C-arm rotation according to α and β; the guide-wire was inserted into the centre of approximate circular projection of pedicle by teleoperating FSNSR. After surgery, each vertebra underwent vertebra body axial and lateral radiographs as well as CT scans to assess guide-wire trajectory and excursion between post/preoperative α and β. Results And Conclusion: A total of 60 guide-wires were successfully inserted. All guide-wires were confirmed in the core of the pedicle by axial and lateral X-ray, as well as CT scanning. None of the guide-wire trajectory was found to contract or perforate the pedicle wall. FSNSR guide-wire placement with PSAV is a novel, safe and accurate transpedicular placement technique, which can reduce or prevent radiation exposure.
目的 比较椎管镜下B-Twin融合术治疗复发性腰椎间盘突出症时,患者手术前后影像学指标及临床疗效间的差异.方法 对2006年至2008年入院行上述手术方法治疗的30例复发性腰椎间盘突出症患者进行随访.比较其手术前后影像学指标及临床疗效指标的变化以及术后植骨融合率情况.结果 随访3～24个月(平均18个月),所有手术均获成功.所有患者所有节段均获骨性融合,未见融合器后移及沉陷,无并发感染.JOA评分:优18例,良8例,总优良率86.6%.滑脱率、复位率术后与术前比较有明显改善(P＜0.01);椎间高度术前、术后相比差异有统计学意义(P＜0.01).结论 椎管镜下B-Twin融合术治疗复发性腰椎间盘突出症效果优良,长期疗效随访优势明显,是效果优良的微创技术。
目的 探讨寰枢椎椎弓根钉棒系统固定植骨融合治疗上颈椎不稳的临床价值和疗效.方法 在局麻下,经后路对11例(男6例女5例;年龄15～65岁,平均31岁)上颈椎不稳(包括骨折,脱位,先天畸形,上颈椎肿瘤)患者施行了寰枢椎椎弓根钉棒固定,并行骨诱导活性材料(BMP)植骨.寰椎椎弓根钉进钉点位于枢椎下关节突内外侧缘中线与襄椎后弓上缘交点下方约3 mm处,钉道内倾10°,头倾5°;枢椎椎弓根钉进钉点位于枢椎侧块内上象限中点,钉道内倾约25°,头倾约25°.螺钉直径为3.0 mm或3.5 mm,寰枢椎钉长24～32 mm.结果 手术时间60～120 min,平均手术时间100 min.术中未损伤椎动脉、脊髓等重要组织结构.术后随访6～24个月,平均12.5个月.X线及CT复查示螺钉位置良好,未见断钉现象,MRI示神经压迫解除,术后3～6个月(平均4.2个月)植骨达到满意融合.术前合并神经症状10例,术后症状消失或基本消失9例,症状改善1例.结论 对于寰枢椎骨折脱位、畸形、肿瘤等引起的上颈椎不稳,在局麻下行后路寰枢椎椎弓根钉棒系统固定并发症少,固定可靠,疗效确切.
