目的 对比研究胸腰椎压缩骨折患者采取保守治疗与经皮椎体成形术治疗的临床疗效与应用价值.方法 选取2017年1月—2018年12月在兴化市第五人民医院接受治疗的胸腰椎压缩骨折患者80例,根据治疗方式差异进行分组,对照组(40例)采取保守治疗,观察组(40例)实施经皮椎体成形术治疗,对比两组患者治疗效果,记录各组患者恢复情况,评估两组患者治疗前后疼痛程度变化及椎体Cobb角、前缘高度变化,观察统计各组患者治疗后并发症总发生率.结果 观察组临床总有效率(95.00％)明显高于对照组,差异有统计学意义(x2=7.440,P＜0.05);观察组患者下床时间、住院总时间均明显短于对照组,VAS评分、Cobb角低于对照组,椎体前缘高度高于对照组,差异有统计学意义(P＜0.05);观察组患者并发症总发生率低于对照组,差异有统计学意义(P＜0.05).结论 胸腰椎压缩骨折患者在自身情况良好的状态下,首选经皮椎体成形术治疗,具有效果佳、术后患者恢复快、安全性高等优点,提倡推广运用.

主要论述《临床试验用药品信息系统管理专家共识》的起草背景、适用范围,以及试验用药品信息化管理系统的架构、配置、管理要求.从临床试验用药品管理的实际出发,对临床试验用药品的流转进行全程化、标准化、精准化和实时化的管理.促使临床试验用药品信息化管理能够实现试验用药品从申办者运输,研究中心接收、验收、入库、存储、出库、领用发放、用药、回收、返还、退回、销毁、留样(如适用)等全流程在线实时记录管理,提高药品管理规范性,保证数据的及时性、准确性、可靠性和可溯源性.

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.

目的 分析自发性椎管内硬膜外血肿(SSEH)的影像学特征及临床治疗效果.方法 回顾性分析2008年6月—2018年9月泰州市人民医院脊柱外科收治的SSEH患者临床资料,分析其影像学表现.采用硬膜外脊髓压迫(ESCC)分级评估硬膜外占位对硬膜囊及脊髓的压迫程度,美国脊髓损伤协会(ASIA)分级评估神经功能,疼痛视觉模拟量表(VAS)评分评估疼痛情况.结果 本研究共纳入12例患者,年龄25～74岁,中位年龄64.5岁.MRI显示SSEH大多呈梭形、椭圆形,且多位于脊髓侧后方或后方的硬膜外腔.血肿最多发于颈段(4例)或颈胸段(4例).血肿累及1～4个节段,平均2.6个节段.T1WI MRI上7例表现为等信号,4例表现为高信号,1例表现为低信号;T2WI MRI上10例表现为高/混杂信号,2例表现为低信号.血肿压迫脊髓程度(ESCC分级)与患者神经功能损伤程度(AISA分级)密切相关(r=0.85,P<0.01).7例患者行手术治疗,其中5例术后神经功能有所恢复,2例术前ASIA分级为A级的患者末次随访时仍为A级;5例采用非手术治疗,治疗后神经功能均有所恢复,VAS评分下降.结论 MRI是诊断SSEH的最佳检查方法.根据患者神经功能损伤及进展情形,可选择非手术治疗或尽早手术治疗.

骨嗜酸性肉芽肿是郎格罕氏细胞组织细胞增生症的一种类型[1].骨嗜酸性肉芽肿发病率低,好发于儿童,成人少见,于脊柱发病者更为少见[2].脊柱嗜酸性肉芽肿病变可侵犯单个或多个椎体,以单发多见[3].笔者于2016-12诊治成人颈椎嗜酸性肉芽肿1例,报道如下.

目的 探讨经椎间盘镜下减压、植骨、经皮椎弓根螺钉内固定治疗胸腰椎爆裂性骨折的临床疗效.方法 纳入2015年4月～2016年10月收治的42例胸腰椎爆裂性骨折患者,均为骨折块突入椎管且合并神经损伤.采用椎间盘镜下减压、植骨、经皮椎弓根螺钉内固定治疗,术后随访超过2年,评价手术疗效.结果 42例患者均顺利完成手术,手术时间(120.42±32.91)min,出血量(92.65±7.76)ml,住院时间(9.22±1.02)d;随访(2.32±0.27)年;术后1周、6个月、2年的VAS评分、Cobb角较术前均显著降低,伤椎前缘高度、椎管正中矢状径显著增加,差异有统计学意义(P<0.05),术后2年与术后1周、6个月的Cobb角、伤椎前缘高度比差异有统计学意义(P<0.05);术后2年ASIA分级较术前显著改善(P<0.05);术后3 d有1例患者出现浅表切口感染,1例术后5个月出现间歇性腰部疼痛,无内固定松动、脑脊液漏等严重并发症发生.结论 椎间盘镜下减压、植骨、经皮椎弓根螺钉内固定能获得有效的神经根及椎管减压效果,内固定稳固,矫正效果良好,手术创伤小,安全有效.

自发性腰椎黄韧带内血肿临床罕见,可造成神经根或硬膜囊受压,引起临床症状.本文报道1例自发性腰椎黄韧带内血肿引起神经根性症状患者的临床资料,采用MRI脊神经根成像技术获得诊断,手术治疗后压迫症状消失.

Objective To investigate the efficacy,perioperative complications and management strategy of transforaminal lumbar spinal system(TESSYS) in the treatment of prolapsed lumbar disc herniation. Methods From June 2014 to June 2016,a total of 28 subjects with prolapsed lumbar disc herniation were treated with TESSYS. The visual analogue scale(VAS) scores and Oswestry disability index(ODI) were recorded at pre-operation,immediate post-operation and follow-up period. Intraoperative and postoperative complications were analyzed,and the countermeasures were explored. Results The mean follow-up time was 11 months(3-24 months). The postoperative VAS scores and ODI were significantly lower than those of the preoperation(P<0.05). No serious neurological damage,spinal hematoma,infection and other serious complications occurred. Two patients suffered adverse effects immediately after surgery. One was improved by nonoperative treatment,and the other one underwent minimally invasive surgery again,and the final follow-up was satisfactory. Conclusion Prolapsed lumbar disc herniation can be effectively treated with TESSYS,but the complications may happen.The complications can be prevented and diminished by careful intraoperative procedure and strict perioperative management.

Objective To compare the clinical results between transforaminal lumbar interbody fusion(TLIF) through Wiltse paraspinal approach and traditional posterior lumbar interbody fusion(PLIF)in treatment of recurrent lumbar disc herniation(RLDH).Methods A retrospective analysis was conducted of the 41 patients with RLDH who had lumbar interbody fusion from January 2009 to June 2014.Among them 17 cases received TLIF through Wiltse paraspinal approach(group TLIF),and 24 cases received traditional PLIF(group PLIF).The patients in group PLIF had a tendency to have longer duration between initial discectomy and recurrent herniation.The two groups were compatible in preoperative clinical data(P>0.05).The perioperative data(duration of procedure,intraoperative blood loss,postoperative drainage,time to ambulation,length of hospital stay) and primary efficacy outcome(visual analog scale for back and leg pain-VAS,Oswestry Disability Index-ODI) were compared between 2 groups along with bony fusion(Criteria for interbody fusion assessment on post-operative computer tomography scans by Siepe et al) and complication.Results 41 patients were followed up for 24 to 60 months (mean,37.6 months).The operation time(115.6±24.5,110.0 min),intraoperative blood loss(229.1±61.1,250 mL),postoperative drainage(194.1±41.2,190.0 mL),time to ambulation(3.1±0.7,3.0 days),length of hospital stay(7.6±1.7,7.0 days) in group TLIF were significantly less than in group PLIF(P<0.001).The postoperative VAS scores and ODI were significantly lower in 2 groups than the preoperative ones(P<0.001),but there was no significant difference between 2 groups at the12 months and 24 months follow up postoperatively(P>0.05).6 cases had a dural tear in association with epidural fibrosis,1 case(4%) in group TLIF,5 cases(21%)in group PLIF,and these were treated by intra-operative repair.Cerebrospinal fluid leaks was found in2 cases in group PLIF postoperatively.1 patient from group PLIF suffered incisions fat colliquation.There was 3 cases of symptomatic adjacent segment disease in total,with 2 cases in group TLIF and 1 in group PLIF,expanded revision surgery was performed in thesepatients.Computer tomography scans revealed solid or complete interbody bony fusion at the last follow up in all cases.Conclusion TLIF through Wiltse paraspinal approach can achieve satisfactory clinical outcome in treatment of RLDH and it has several advantages including less invasive,lower incidence of complication such as intraoperative dural tear compared with traditional PLIF.

Objective To investigate the protective effects of etomidate on spinal cord of patients receiving cervical spine surgery.Methods The clinical data about 88 patients with spondylopathy who underwent cervical spine surgery in our hospital from October 2012 to October 2014 were retrospectively analyzed.According to random number table these patients were divided into two groups:observe group (etomidate, n =48) and control group (physiological saline, n =40).The vital signs during operation, inflammatory factors and the related indexes about spinal cord function in different time point before and after operation were observed and compared between two groups.Results The levels of MAP,HR in T2,T3 in observation group were significantly higher than those in control group ( P <0.05), however,the levels of CVP were significantly lower than those in control group ( P <0.05).The levels of CRP, PG-E2, TNF-αand IL-6 on 1d, 7d after operation in observation group were significantly lower than those in control group ( P <0.05).Moreover the levels of NSE, GFAP and MMP-9 on 1d, 7d after operation in observation group were significantly lower than those in control group,however, the JOA scores were significantly higher than those in control group ( P <0.05).Conclusion The etomidate has protective effects on spinal cord at certain extent during cervical spine surgery.

目的：通过对58例RockwoodⅢ型患者行钩钢板固定术后肩关节功能进行疗效评价，主要进行肩关节Constant评分，肩关节活动状态下VAS评分的观察，探讨钩钢板治疗ROCKWOODⅢ型肩锁关节脱位在男女病人之间的差异，试图明确钩钢板滞留阶段肩关节疼痛的原因。方法本院2002/03~2014/01期间收治的RockwoodⅢ型肩锁关节脱位患者，以钩钢板进行复位内固定治疗的患者共计58例，根据性别分为两组，其中男性组36例，女性组22例。分别于钩钢板取出前和钩钢板取出术4w进行活动状态下VAS评分测定和肩关节Constant评分。使用统计软件SPSS 20.0分析各观察点的组间差异以及各个观察点的纵向差异。结果肩关节活动状态下VAS评分及肩关节功能Constant评分在内固定取出术前组间有显著性差异；组间无差异。术前和术后比较各组内均有显著差异。结论钩钢板治疗RockwoodⅢ型肩锁关节脱位，钩钢板滞留是影响肩关节功能的重要因素，尤其对女性患者的影响较大，但在取出钩钢板后，所有患者均获得较优的肩关节功能。

目的:探讨早期跟骨牵引延期经胫骨前方皮质入路植骨内固定治疗Schatzker V、Ⅵ型复杂胫骨平台骨折的临床治疗效果.方法:2004年5月～2012年1月间31例复杂胫骨平台骨折患者,根据Schatzker分型V型19例、Ⅵ型12例,采用术前牵引复位,延期手术治疗结合术后早期膝关节功能康复训练的方法进行治疗.术中采用经胫骨前方骨皮质入路植骨恢复关节面,根据骨折的具体情况分别采用双接骨板、锁定板加空心螺钉等进行内固定.结果:31例患者均获得随访,平均随访时间14.3 (8～31)个月,全部获骨性愈合.骨折愈合时间平均6.4个月(4～9个月).术后30例患者软组织均一期闭合,1例发现胫前皮肤局部坏死,局部钢板外露,8个月骨折愈合后予以取出内固定后闭合创面.所有患者X线检查未见胫骨平台发生Ⅱ期塌陷,治疗效果参照Rasmussen膝关节功能评分标准,优17例、良10例、可2例、差2例,总优良率为87.1％.结论:对于Schatzker V、Ⅵ型胫骨平台复杂骨折,采用早期牵引,延期手术的方法可以充分保护局部软组织血运,降低手术难度,预防膝关节周围软组织挛缩,有效对胫骨平台进行解剖复位并获得牢固的固定,术后可早期恢复膝关节功能训练,具有临床疗效好、并发症低的特点.

患者 男性,43岁,主因“颈部疼痛伴四肢麻木1个月”于2010年12月19日入院.体检:身材矮小,“O”形腿,颈部有压痛、叩击痛,双上肢肘关节以下感觉减退,双侧屈肘、伸腕、伸肘肌肌力4+级,双手握力4级,双侧Hoffman征(+),双小腿内翻畸形,双足底感觉减退,左下肢伸膝肌、踝背伸肌、伸踇长肌、踝跖屈肌肌力4级,左侧膝、跟腱反射亢进,右下肢肌力5级.4年前有“左股骨颈骨折”病史,未予特殊处理.父母非近亲结婚,家族中母亲有类似“骨骼畸形”病史.

目的 探讨和分析不稳定性Hangman骨折的手术治疗方式及临床疗效.方法 对不稳定性Hangman骨折21例采用颈前路手术治疗12例,颈后路手术治疗6例,颈前后联合入路手术治疗3例.结果 本组获得随访7～40个月,骨折端复位满意、愈合好,植骨融合率为100％,未出现钛板松动等现象.结论 颈椎前路及后路手术均n可使不稳定性Hangman骨折获得良好的治疗效果,严重骨折脱位的Hangman骨折采用前后路联合入路的手术方式更为可靠.

BACKGROUND: During posterior screw-rod internal fixation of upper cervical spine, placement of atlas lateral mass screw is the key technology. OBJECTIVE: To summarize entrance point for screw insertion of posterior screw-rod internal fixation system in instable axis fractures. METHODS: From January 2007 to December 2010, nineteen patients with instable axis fractures, including 12 males and 7 females, with an average age of 49.5 years (range, 21-75 years), were treated with Vertex posterior screw-rod internal fixation. Atlas lateral masses screw and axis pedicle screw were performed in 6 cases for internal fixation. Atlas lateral masses screw, single axis pedicle screw and neck 3 lateral masses screw were performed in 3 cases for internal fixation. Atlas lateral masses screw, double axis pedicle screws and neck 3 lateral masses screw were performed in 1 case for internal fixation. Axis pedicle screw and neck 3 lateral masses screw were performed in 9 cases for internal fixation. Fusion technique was performed in all cases. RESULTS AND CONCLUSION: Nineteen patients were followed up from 7 to 43 months. All cases had satisfactory reduction and healing in the positions of axis fractures, fusion rate in the positions of bone grafts was 100%. There were no screw and rod breakage, and no iatrogenic injury of spinal cord and vertebral artery happened. The method for the treatment of instable axis fractures is little trauma and reliable fixation. The authors according to clinical experiences, entrance point for screw insertion are summarized as follows: ①The entrance point of atlas lateral masses screw is slightly outer side in the lateral mass midpoint, at the bottom 1/3 of vertebral arch. Direction of needle is inward and upward slightly tilted about 10° and 5°. ②The entrance point of axis pedicle screw is between the upper and lower articular surface of axial, the midpoint of the middle vertical line of subtalar joint. Direction of needle is inward and upward slightly tilted about 15°-20° and 25°. ③The entrance point of neck 3 lateral masses screw is 2 mm inside of lateral mass center. Direction of needle is inward and upward slightly tilted about 20°-25°.

Objective To patients suffering from malignant spinal primitive neuroectodermal tumor in patients with clinical manifestations and therapeutic effect analysis.Methods For extracting over a period of time in our hospital,8 patients suffering from malignant spinal primitive neuroectodermal tumor clinical diagnosed patients case,which can be divided into A,B two group,average each of 4 cases.The A group were treated by operation treatment method treatment;group B patients in A the basis of further chemotherapy treatment.Two groups of patients with an average survival rate,average discharge time of comparative analysis,and summarize its clinical manifestations.Results We found in the B group,the mean survival time,signi?cantly higher than that of A group patients,and the statistical difference is obvious(P<0.05);the group of patients with the average hospitalization time,significantly shorter than in the A group,and the difference is obvious(P<0.05).Conclusion To fully understand the suffering from malignant spinal primitive neuroectodermal tumor of the clinical manifestations of patients,can guarantee the clinical of the patients were more accurate diagnosis,effective treatment for further more time,the clinical operation plus chemotherapy on the patients treatment effect is very obvious,although occurs in patients with bone marrow transplantation common complications of radiotherapy and chemotherapy,but can make the survival time of patients,survival of patients with better security,can do for future clinical of the patients preferred method.

Objective To investigate the value of sucking blood from superior portion of the femoral head in predicting avascular necrosis of the femoral head(AVNFH).Methods Sixty-one patients with femoral neck fracture were treated with cannulatcd screws.According to the status of bleeding sucked through the holes of proximal cannulated screw,the patients were divided into groups of A(with abundant blood,51 cases)and B(blood circulation absence,10 cases).The incidence of AVNFH was recorded during averaged 41.1 months followed up.Results AVNFH developed in 11 cases(19.7%)of 61 cases.The incidence rate was 3.9% in group A and 100.0% in group B with the sensitivity of 83.0%,the specificity of 100.0% and positive predictive value of 100.0%.ConclusionThe status of bleeding sucked through the holes of proximal cannulated screw from the superior portion of the femoral head can be taken as a marker for predicting the development of AVNFH after femoral neck fracture.

Objective To investigate factors related to avascular necrosis of femoral head through a retrospective study of old patients with femoral neck fractures treated with cannulated screws.Methods One hundred and fifteen old patients with femoral neck fracture were admitted from January 2000 to January 2006 and treated with cannulated screws.We analyzed statistically the multiple factors:age,gender,Garden classification,time interval from injury to surgery,quality of reduction(Garden Index),and base disease by SPSS 10.0 statistic system.Results Factors that might have an impact on avascular necrosis of femoral head were ranked in the following likelihood sequence:Garden classification,age,time interval from injury to surgery,Garden Index and base disease.Gender was found to have little impact on the prognosis of femoral neck fracture.Conclusion Fracture displacement is the most critical factor that influences the prognosis.Time interval from injury to surgery and Garden Index,as important controllable factors,influence the prognosis of femoral neck fracture.High age and base disease will lead to increased incidences of avascular necrosis.

笔者于2005年5月收治儿童髌骨套状骨折1例,用国产可吸收聚-DL-乳酸(PDLLA)螺钉治疗,疗效优良. 1 病历资料 患者男,13岁,因跳高跃起时左膝突然疼痛,继而肿胀、屈伸障碍1 h就诊.入院时体检:意识清楚,左膝明显肿胀,触及髌骨高位,髌骨下极压痛明显,有凹陷,其下方触及"骨块"及骨擦音,主动伸膝时见股四头肌收缩,但髌韧带松弛,无伸膝动作发生.