目的 观察氨甲环酸不同给药途径在单节段腰椎后路手术中的应用效果.方法 将南华大学附属南华医院脊柱外科2019年6月-2021年1月收治的90例腰椎间盘突出症患者随机分为静脉组、观察组各45例,静脉组于术前15 min给予1 g氨甲环酸静脉滴注,在行椎管减压前15 min给予1 g氨甲环酸静脉滴注;观察组术前15 min给予1 g氨甲环酸静脉滴注,另外在行椎管减压前15 min给予1 g氨甲环酸静脉滴注,关闭手术切口前再次给予1 g氨甲环酸配置100 mL生理盐水冲洗伤口,浸泡5 min,比较两组术中失血量和术后引流量,手术前后的红细胞压积(Hct)、血红蛋白(Hb)、活化的部分凝血活酶时间(APTT)以及D-二聚体(D-dimer)变化,输血情况以及并发症发生情况.结果 观察组术中出血量少于静脉组(P<0.05);术后1d,两组引流量无明显差异(P>0.05),观察组术后引流总量少于静脉组(P<0.05);术后1、2d,两组Hct和Hb均有下降,但观察组始终高于静脉组(P<0.05);观察组术后输血例数少于静脉组(P<0.05);两组并发症发生率差异无统计意义(P>0.05).结论 不同途径给予氨甲环酸能够对单节段腰椎后路手术患者术后失血情况产生不同影响,在术前、行椎管减压前以及关闭手术切口前均予以氨甲环酸的效果最好.

目的 建立山羊颈椎不稳定模型,测试新型弧形带终板环颈椎钛网的生物力学稳定性.方法 测量成年山羊颈椎的解剖学数据,选择适合山羊颈椎的新型弧形带终板环颈椎钛网.将保留关节囊、韧带及椎间盘的24只山羊颈椎骨性标本随机分成4组.A组(正常组,n=6)无特殊处理,B组切除C4部分椎体及上下椎间盘(模型组,n=6);在B组基础上,C组安装新型弧形颈椎钛网并予钢板螺钉辅助固定(实验组,n=6),D组安装传统直型钛网并予钢板螺钉辅助固定(对照组,n=6).测量4组标本在2.0N·m载荷下前屈、左右侧弯、左右旋转、后伸时活动范围(range of motion,ROM),测试其三维运动稳定性.测量C、D两组在200 N压缩力下的位移,计算其刚度,测试其术后整体标本的抗沉降能力.结果 A组各方向ROM均小于B组,A组各方向ROM均大于C组,C组前屈ROM小于D组(P＜0.05);C组刚度较D组高(P＜0.05);C组压缩位移较D组少(P＜0.05).结论 新型弧形钛网较直型钛网更加符合颈椎生理曲度,在颈椎最频繁的前屈活动上稳定性较传统钛网好,且短期应力下压缩位移较直型钛网少,术后抗沉降较直型钛网好,值得进一步实验及临床推广.

[目的]探讨氨甲环酸(Tranexamic acid,TXA)局部冲洗联合静脉滴注在腰椎后路手术中的应用价值.[方法]回顾性分析2018年11月至2019年9月在本院行腰椎后路手术的96例腰椎退行性病变患者的临床资料,根据是否使用TXA分成联合使用组(TXA局部冲洗联合静脉滴注)、局部使用组(TXA局部冲洗)和空白对照组(静脉和局部均不使用TXA),每组32例.比较三组术前、术后血红蛋白(Hb)值、血浆D-二聚体(D-D)值及日本骨科协会评分(Japanese Orthopaedic Association scores,JOA),记录术中出血量、手术时间、Fromme手术视野质量评分及术后引流量,计算总失液量,评估TXA对手术失血量、术中视野评分及手术疗效情况.[结果]所有患者术后均获得6个月的随访.联合使用组术中出血量、术后引流量、总失液量、手术时间及手术视野评分均低于局部使用组,而局部使用组低于空白对照组,其差异均有统计学意义(P＜0.05).三组术前、术后血浆D-D差异均无统计学意义(P＞0.05),联合使用组术后Hb值高于局部使用组,而局部使用组高于空白对照组,差异均有统计学意义(P＜0.05).联合使用组患者JOA评分改善率为72.9％,与局部使用组的70.5％及空白对照组的69.6％比较差异无统计学意义(P＞0.05).联合使用组患者置钉、减压时手术视野评分均明显低于局部使用组,而局部使用组低于空白对照组,其差异均有统计学意义(P＜0.05).三组患者术后2周均行双下肢静脉彩超检查,均未发生深静脉血栓;三组患者术后均未出现肺栓死、脑脊液漏、脑梗塞、癫痫等并发症.[结论]术中静脉联合局部使用TXA可降低腰椎后路手术患者总体失血量,改善术中视野评分,减少手术时间,值得临床推广应用.

Thoracolumbar fracture is familiar spinal injuries in the highenergy violence and traffic accidents, accounting for more than 50 percent of the total number of spinal fractures. Despite some thoracolumbar fractures patients who do not have neurologic dysfunction respond well to conservative treatment, short-segment pedicle screw fixation has been proven to be a more effective approach to resort vertebral height, correct kyphosis and stabilize fractures. In the past few years, minimally invasive percutaneous pedicle screw fixation (MIPPSF) as the alternative approach to treat the thoracolumbar fractures, aims to decrease the injury of soft tissue and perioperative complications. Originally used to treat degenerative spine diseases, the MIPPSF system have been demonstrated to be effective in decreasing blood loss and complications, avoiding muscle and tissue injury, and shortening the hospital stays and recovery times. Although there are similar advantages in treating the thoracolumbar fractures, the evidence is mostly limited to low-energy and low-level observational studies. In addition, the lack of long-term efficacy of the MIPPSF in treating the thoracolumbar fractures further limits the available evidence for this technique. Therefore, the purpose of our study is to compare the radiological and clinical results of thoracolumbar spine injury stabilized by standard open pedicle screw fixation (OPSF) and the MIPPSF system.We hypothesize thatMIPPSF technique will lead

为了对比微创经皮手术与开放手术椎弓根钉内固定治疗胸腰椎骨折的临床疗效,收集了104例胸腰椎骨折患者的临床资料进行回顾性分析.患者均采取椎弓根钉内固定术治疗,按采取的手术方法分为微创经皮手术组和开放手术组.所有患者术后均获得12～18个月的随访.结果显示,微创经皮手术组的切口长度、手术时间、出血量、术后3天VAS评分和不良切口愈合率均显著低于开放手术组,但术中X线透视次数显著多于开放手术组;两组术后1年骨折椎体前缘高度比值、Cobb's角、Oswestry功能障碍指数和内固定失败率无显著差异(P>0.05).因此微创经皮手术与开放手术椎弓根钉内固定治疗胸腰椎骨折,都可以获得满意的临床疗效.前者虽然存在较多的X线暴露的缺点,但创伤更小,适合在临床上推广应用.

Background: Whether the bone graft is needed in treating the displaced intra-articular calcaneal fractures (DIACFs) is still controversial. Therefore, in our study, we will explore the results of 2 approaches for the DIACFs surgical treatment. Methods: The present report follows the Consolidated Standards of Reporting Trials (CONSORT) guidelines. All patients will be assigned randomly into 2 different groups through tossing the coins. Three experienced surgeons are assigned randomly to each group to implement the surgeries utilizing any of the surgical approach. Assignments are concealed in a sealed opaque envelope. Patients who meet the following conditions will be included in this experiment: (1) DIACFs (greater than 2mm) involve Sanders Type IIC, Type IIB as well as some Type III; and (2) surgical treatment can be implemented within 7 days after injury. Some patients with obvious swelling can wait for 2 weeks before operation; (3) patients with closed fracture and; (4) unilateral fracture. In the 2 groups, the patients will follow the standard postoperative protocols. Patients are asked to finish 2 questionnaires, namely, American Orthopaedic Foot and Ankle Society score and short form 36. The ranges of motion of the ankle and the subtalar joint will be also measured. Postoperative complications such as deep infection, wound infection, and wound edge necrosis, the injury of sural nerve, and hematoma are recorded. Results: Our study can provide significant information on the necessity of bone graft in DIACFs internal fixation treatment.

目的 观察改良经皮椎体成形术(PVP)治疗胸腰椎骨质疏松性压缩骨折的临床疗效,为临床治疗该类疾病提供一定的参考.方法 对73例胸腰椎骨质疏松性压缩骨折患者采用改良PVP治疗.记录手术时间、术中出血量、骨水泥注入量与骨水泥渗漏情况;比较患者术前、术后Oswestry功能障碍指数(ODI)、JOA下腰痛评分、治疗总有效率.结果 手术时间30 ～ 65(43.70±8.06) min,出血量1～ 10 (4.44±1.96) mL,胸椎骨水泥注入量2～4(2.98±0.67) mL,腰椎骨水泥注入量3～ 5(4.24±0.52) mL.骨水泥椎旁渗漏29例,椎间盘内渗漏6例,无椎管内渗漏及肺栓塞.术后第3天及术后1年患者ODI及JOA评分均有明显改善,与术前比较差异有统计学意义(P＜0.05).术后第3天及术后1年总有效率分别为94.52％、91.78％.结论 改良PVP治疗胸腰椎骨质疏松性压缩骨折的疗效好,能有效缓解患者疼痛,改善生活质量.

BACKGROUND: The existing technique takes articular process and lateral mass as a reference mark. Due to differences of subjective judgment in operation and the impact of articular hyperplasia, some errors of screw entry point selection and serious complications such as vertebral artery or cervical spinal cord injury easily occurred, which limit the clinical application of the technique. At present, it is very important to select a constant reference mark of cervical pedicle screw entry point.OBJECTIVE: Three-dimensional reconstruction CT images were made to measure the relationship between the lower cervical pedicle screw entry point and "the lateral concave between articular process".METHODS: Three-dimensional reconstruction of CT scan was performed in 30 patients with cervical deformity, and the occurrence rate and morphological characteristics of "the lateral concave between articular process" were observed. The following parameters were determined on specific reconstructed CT image of C3-C7: (1) the distance between pedicle axis projection point in the posterior surface and the outer edge of lateral mass in transversal section through bilateral pedicle axis and (2) the distance between the point and "the lateral concave between articular process" in oblique sagittal section through homolateral pedicle axis. Mean value and standard deviation were counted and statistics difference was compared.RESULTS AND CONCLUSION: (1) "The lateral concave between articular process" in lower cervical vertebrae was a obvious and less constant proliferative anatomical landmark and its occurrence rate was 100%. (2) Using CT technology of 3D reconstruction, C3-C7 lower cervical transversal section through bilateral pedicle axis and oblique sagittal section through homolateral pedicle axis were successfully obtained. (3) In transversal section, the left and right distances between C3-C7 pedicle axis projection point in the posterior surface and the outer edge of lateral mass were (4.1±0.9)mm and (4.3±0.9) mm, and the difference was not statistically significant (P=0.609). Except for C3 and C7, C4 and C7,there was no significant difference in the measured values of the same side (P > 0.05). (4) In oblique sagittal section, the left and right distances between C3-C7 point and "the lateral concave between articular process" were (-0.3±1.7) mm and (-0.3±1.6) mm, and the difference was not statistically significant (P=0.916). Except for C3 and C4, there was significant difference in the measured values of the same side (P < 0.05). (5) The above results suggest that the lower cervical pedicle entry point and "the lateral concave between articular process" have a relatively constant orientation relationship in transversal section and a large variation in the sagittal section.

OBJECTIVE:To explore the imaging measurement and clinical significance of the angle between the axis of pedicle and the plane of lamina in lower cervical vertebra. Methods: Three dimensional reconstruction of CT scan was performed in 30 patients with cervical deformity, and the angle between the axis of pedicle and the plane of lamina was measured with the specific reconstructed CT image of C3-C7. Results: 1) The left and right transverse angle of C3-C7 between the axis of pedicle and the ipsilateral plane of lamina were 98.3°±6.3°, 98.0°±5.1°, 97.5°±6.9°, 95.1°±5.0°, 85.8°±5.4° and 96.7°±8.2°, 98.7°±7.1°, 97.8°±3.6°, 93.2°±6.2°, 86.8°±5.7°, respectively, which showed a gradual decreasing trend. Meanwhile the angle of C3-C6 was more than 90 degrees and C7 was less than 90 degrees. In addition to C6 with C3 and C7 with other segments, the rest of the differences between the sections was not statistically significant (all P>0.05). 2) The left and right transverse angle of C3-C7 between the axis of pedicle and the pedicle of vertebral arch of lamina were 0.2°±4.5°, 1.2°±7.2°, -0.8°±6.8°, -3.3°±5.4°, -14.7°±4.0° and -1.6°±5.4°, 1.9°±4.6°, -0.5°±6.0°, -4.6°±5.3°, -13.7°±3.4°, respectively, which showed a first increasing and then reducing trend. Meanwhile the angle of C4 was maximum angle. In addition to C6 with C3, C6 with C4, and C7 with other segments, the differences between the sections was not statistically significant (all P>0.05). 3) The left and right sagittal angle of C3-C7 between the axis of pedicle and the ipsilateral plane of lamina were 77.7°±7.6°, 77.0°±7.1°, 85.3°±8.4°, 94.1°±2.2°, 94.9°±3.8° and 78.5°±7.1°, 76.2°±6.2°, 86.4°±6.4°, 94.0°±2.7°, 95.6°±3.8°, respectively, which showed a gradual increasing trend. The angle of C3-C4 was less than 90 degrees. C5 showed large variation and C6-C7 was more than 90 degrees. In addition to C3 with C4 and C6 with C7, the differences between the sections was statistically significant (all P<0.05). There was no significant difference between the two sides of the above indexes (all P>0.05). Conclusion: In low cervical vertebra, there is a certain angle relationship between the axis of pedicle and the plane of lamina, which can provide reference for the clinical determination of angle of pedicle screw insertion.

Objective To explore the orientation relationships and changing rules of pedicle screw entry point (PSEP) on the posterior bony landmarks in middle-upper thoracic vertebrae in adults by measuring parameters of 3-D reconstruction CT images.Methods CT images of the middle-upper thoracic vertebrae from 30 healthy adults were used for 3-D reconstruction to observe the anatomical characteristics of posterior bony landmarks,including transverse process-lamina concave,superior ridge of transverse process and outer edge of the lamina.The following basic parameters,including PSEP-to-midline distance (PMD),transverse process-lamina concave-to-midline distance (CMD) and half lamina width (HLW),and target parameters,including PSEP-to-transverse process-lamina concave distance (PCD),entry point location ratio (EPLR) and PSEP-to-superior ridge of transverse process distance (PRD) were determined on reconstructed CT images from T1 to T10.The differences of bilateral measurements of all parameters and the differences of basic parameters were analyzed,and the changing rules of target parameters measurements from T1 to T10 were summarized.Results The transverse process-lamina concave,superior ridge of transverse process and outer edge of the lamina of middle-upper thoracic vertebral characterized by obvious and constant anatomical marks with less proliferative.The left and right PMD,CMD,HLW,PCD,EPLR,and PRD were (14.14±2.63) mm and (14.59±2.58) mm,(10.45±2.12) mm and (10.51±2.02) mm,(16.30±1.48) mm and (16.39±1.61) mm,(4.56±1.03) mm and (4.47±0.94) mm,0.35±0.26 and 0.33±0.30,and (-1.62±1.90) mm and (-1.63±1.44) mm,respectively.There was no significant difference in the measured values between the two sides of the above parameters (P＞0.05).Except that the difference between PMD and HLW in T2 was not significant (P＞0.05),the differences between basic parameters in the other segments were statistically significant (P＜0.05).PCD of T1 to T10 showed a trend of decrease first and then significant increases in T1,T2,T9,and T10 compared with in T3-T8 (P＜0.05).EPLR of T1-T10 showed a trend of increase first and then decrease,in which EPLIR in T1,T2 and T3 were significantly lower than in the following any segments (P＜0.01),and in the T4-T6 and T10 were significantly lower than in T7-TI9 (P＜0.01).PRD of T1-T10 showed a trend of increase first and then decrease,in which the PRD in T1,T2 and T3 were significantly lower than in the following any segments,and in the T4-T6 were lower than T7-T10 (P＜0.01).Conclusion There is constant orientation relationship and changing rules of PSEP in the middle-upper thoracic vertebrae on the posterior bony landmarks,such as transverse process-lamina concave,superior ridge of transverse process and outer edge of the lamina,and it can serve as a new clinical choice.

BACKGROUND: In the existing thoracic pedicle screw fixation technique, superior facet or combined with transverse process and the imaginary transverse and sagittal section are used as the reference mark of pedicle screw entry point and angle, respectively, which still remain controversial. Because of the effect of position deviation and subjective judgment during surgery, screw misplacement and severe complications often occur, which limit the clinical application and promotion of the technique. At present, it is very important to select a single bony mark, which is not affected by the patient's position, and is easy to judge, as the reference mark of screw entry point and angle. OBJECTIVE: To explore the feasibility of taking superior facet as a single bony mark to determine thoracic pedicle screw parameters in normal adults by measuring 3D reconstruction CT image and it's corresponding relationships. METHODS: 3D reconstruction CT images of the thoracic spine in 30 normal adults were selected and the basic parameters, entry angle parameters and entry depth parameters were directly determined on specific reconstructed CT images of T1-T12.The basic parameters included the vertical distance from the entry point to the midline, the vertical distance from the outer edge of superior facet to the midline and superior facet base width. Entry point parameters were indirectly calculated by the basic parameters, including transversal point-facet distance, entry point ratio and sagittal point-facet distance, which was the horizontal distance from entry point to outer edge of superior facet, the ratio of transversal point-facet distance to superior facet base width, and the longitudinal distance from entry point to the base of superior facet. Entry angle parameters included transversal axis-facet angle and sagittal axis-facet angle, which is the transversal and sagittal angle between the axis of pedicle and the surface of facet. Entry depth parameter included safety screw length, which is the distance from entry point to anterior vertebral cortex along the axis of pedicle. Mean and standard deviation were counted and statistics difference was compared. RESULTS AND CONCLUSION: (1) Using CT technology of 3D reconstruction, T1-T12thoracic transversal section through bilateral pedicle axis, transversal section through the base of the superior facet, which parallel to the bilateral pedicle axis, and oblique sagittal section through homolateral pedicle axis were successfully obtained. (2) The statistical results of the basic parameters were as follows: the left and right vertical distances between T1-T12from the entry point to the midline were (14.6±2.6) and (14.5±2.5) mm, the vertical distance from the outer edge of superior facet to the midline were (15.7±1.9) and (15.7±2.0) mm, and superior facet base width were (8.8±1.3) mm and (8.8±1.1) mm, respectively. There was no significant difference in the measured values between two sides of the above parameters (P=0.343, 0.214, 0.467). (3) The statistical results of pedicle screw parameters were as follows: the left and right transversal point-facet distance between T1-T12were (1.2±1.3) and (1.3±1.4) mm, entry point ratio were (14.3±17.0)% and (13.6±16.1)%, sagittal point-facet distance were (3.4±0.8) and (3.3±0.9) mm, transversal axis-facet angle were (92.4±4.7)° and (92.6±5.0)°, sagittal axis-facet angle were (91.8±4.1)° and (91.7±3.6)°, and safe screw length were (40.7±4.8) and (40.4±4.6) mm, respectively. There was no significant difference in the measured values between two sides of the above parameters (P=0.073, 0.084, 0.310, 0.265, 0.241, 0.175). (4) These results indicate that taking thoracic superior facet as a single anatomic landmark to determine pedicle screw parameters is simple and feasible in normal adults, and they correlate with each other, which can be used as a new method for choosing screw parameters.

Objective:To observe the clinical effects of targeted percutanous ozone ablation on lumbar disc herniation (LDH) patients with high intensity zone (HIZ) in lumbar disc annulus fibrosus on MRI T2 weighted imaging.Methods:136 LDH patients with HIZ in lumbar disc annulus fibrosus on MRI T2 were divided into two groups according to therapy methods.In group A,75 patients were injected with 2 ～5 mL of 40 μg/mL mixture of O3 and O2 after targeted percutanous puncturing under the guidance of X-Ray machine with C-type arm.In group B,61 patients were treated with conservative treatment.MacNab score criterion and Oswestry disability index (ODI) were used in assessment of the efficacy.Results:Except 24 patients,all the other cases were followed up for 18 ～ 44 months.At the postoperative 1st,2nd,3rd,6th,9th,12th and 18th month,according to MacNab score criterion,the effective rates were respectively 88.00 ％,90.67 ％,93.33 ％,89.39 ％,84.85 ％,78.13 ％ and 73.44 ％ in group A and respectively 68.85 ％,62.30 ％ 55.74 ％,61.82 ％,58.12 ％,54.17 ％ and 47.92 ％ in group B.There were significant differences between two groups at the same time point (P＜0.05).At the postoperative 12th and 18th month,ODI was lower in group A,and there was no significant difference between two time points (P＞0.05).But it was significant different with that preoperatively and in group B at the same time point (P＜0.05).Conclusion:Targeted percutanous ozone ablation is an effective method with stable clinical efficacy in treating LDH with HIZ in lumbar disc annulus fibrosus on MRI T2 weighted imaging.

Objective To investigate the clinical effects of minimal-invasive percutaneous pedicle screw fixation ( MIPPSF) in management of thoracolumbar fractures. Methods Eighty-nine patients with single-segment thoraco-lumbar fractures were divided into two groups according to the operative methods:MIPPSF group(Group A,n=36) and open pedicle screw fixation(OPSF) group(Group B,n=53). The incision length,operative time,blood loss,VAS on the 3rd day postoperatively,the fractured vertebral height ratio and Cobb′s angle in 1 year postoperatively were compared between two groups. The internal fixation failure rate and Oswestry disability index( ODI) in 1 year postop-eratively were evaluated. Results All the cases had been followed up for 12~18 months. Group A had shorter inci-sion length and operative time,lower blood loss and VAS on the 3rd day postoperatively and there were significant difference compared with group B(P<0. 05). The fractured vertebral height ratio,Cobb′s angle,internal fixation fail-ure rate and ODI in 1 year postoperatively had no significant difference between the two groups(P>0. 05). Conclu-sions In management of thoracolumbar fractures,MIPPSF can be minimal injury,meanwhile it can achieve the simi-lar clinical effects with OPSF.

目的 探讨椎间孔镜技术治疗极外侧型腰椎间盘突出症的近期疗效.方法 回顾性分析该院2011年7月-2013年3月23例极外侧型腰椎间盘突出症患者,均采用椎间孔镜技术治疗;年龄34 ～ 54岁,平均42.1岁;采用腰腿痛视觉模拟评分(VAS)测评入院时和椎间孔镜术后(术后即刻、术后1周、1个月、3个月及末次随访),末次随访采用改良MacNab标准评定临床疗效.结果 23例患者手术后随访9～18个月,平均12.6个月.所有患者腰痛、腿痛的VAS评分由术前的(6.87±1.38)和(8.58±1.42)分下降到术后末次随访时的(2.45±0.52)和(1.55±0.45)分,术后随访与术前比较差异均有显著性(P＜0.01).末次随访采用改良Macnab疗效评定标准评估,术后优良率均为91.3％,1例患者于术后出现腰背部疼痛,于卧床休息服用非甾体消炎药3d后症状消失.结论 椎间孔镜技术治疗极外侧型腰椎间盘突出症近期疗效明显.

目的 探讨行单侧椎弓根螺钉固定联合椎间融合术治疗腰椎间盘突出症的临床疗效.方法 回顾性分析本院2011年1月至2012年12月96例腰椎间盘突出症患者,均行单侧椎弓根螺钉固定联合椎间融合术;年龄42 ～ 68岁,平均52.3岁;采用腰腿痛视觉模拟评分测评入院时和单侧椎弓根螺钉固定联合椎间融合术后(术后1周、1个月、3个月及末次随访腰腿疼痛程度),末次随访采用改良MacNab标准评定临床疗效,并行CT检查了解椎间融合情况.结果 96例患者手术后随访12 ～ 30个月,平均18.6个月.所有患者均无神经损伤和脑脊液漏并发症发生.患者术后不同时期的VAS评分与术前比较差异均有统计学意义(P＜0.01).采用改良MacNab标准评价临床结果,优良率为94.79％.末次随访时行CT检查,均无内固定失效和椎间不融合发生,6例发生椎间融合器塌陷入终板,但无不适,考虑与骨质疏松或过早负重活动有关.结论 单侧椎弓根螺钉固定联合椎间融合治疗腰椎间盘突出症疗效满意,具有创伤小、并发症少、费用低的优点.

目的 探讨应用峡部植骨融合联合节段内钉-钩系统内固定术治疗青年腰椎峡部裂的临床疗效.方法 回顾性分析该院2010年7月～2013年3月15例青年腰椎峡部裂患者,均采用峡部植骨融合联合节段内钉-钩系统内固定术治疗;年龄16～32岁,平均23.3岁;采用腰痛视觉模拟评分测评入院时和峡部植骨融合联合节段内钉-钩系统内固定术后(术后3个月、6个月、1年及末次随访),末次随访采用改良MacNab标准评定临床疗效,并了解椎弓峡部融合情况.结果 15例患者手术后随访12～42个月,平均20.3个月.所有患者均无神经损伤并发症发生.患者术后不同时期的VAS评分与术前比较差异均有显著性(P＜0.01).采用改良MacNab标准评价临床结果,优良率为93.33％.末次随访时行CT检查,均无内固定失败和椎弓峡部不融合发生.1例患者术后出现髂骨取骨区疼痛,予以对症治疗后症状缓解.结论 峡部植骨融合联合节段内钉-钩系统内固定术治疗青年腰椎峡部裂疗效满意,具有融合率高,并发症少,不影响腰椎活动度的优点.

Objective:To investigate the clinical effect of cervical posterior unilateral expansive open -door laminoplasty with mini tita-nium plate fixation in the treatment of multilevel cervical spondylotic myelopathy .Methods:A retrospective analysis of our hospital from July 2009 to December 2012 21 cases of multilevel cervical spondylotic myelopathy patients , underwent cervical posterior unilateral expan-sive open-door laminoplasty with mini titanium plate fixation;age 47 to 68 years old, average 55.3 years old;preoperative and postoper-ative at last follow-up for patients with spinal cord function of Japanese Orthopaedic Association ( JOA) score, improvement rate of JOA score evaluation of postoperative neurological function improvement;VAS score of postoperative axial pain;at the last follow-up X-ray and MRI examination evaluation internal fixation position and spinal cord compression to improve the situation .Results:21 patients were followed up for 12~24 months after surgery , average 15.8 months.Nerve function were improved after surgery , JOA score from preopera-tive 8.3 ±2.2 to the last follow-up of 14.3 ±1.7 (P<0.01), the average improvement rate was 69%;2 cases of neck axis pain , the incidence rate was 9.52%, the average VAS score was 2.13 ±0.33 at last follow-up;at the last follow-up X-ray and MRI examina-tion showed mini titanium plate in good position , no loosening and fracture , had no door closed phenomenon .Conclusion:Cervical posteri-or unilateral expansive open -door laminoplasty with mini titanium plate fixation in the treatment of multilevel cervical spondylotic myelop -athy with satisfied effect , has the advantages of simple operation , reliable fixation , less complication .

目的：观察经椎旁肌间隙入路取出胸腰段椎弓根螺钉内固定系统的疗效。方法回顾分析本院行胸腰段椎弓根螺钉系统取出的56例患者，其中经传统后正中入路取出的患者27例，经椎旁肌间隙入路取出的患者29例。比较两组手术时间、术中出血量、术后引流量及术后并发症的发生率。结果与传统后正中入路比较，经椎旁肌间隙入路组平均手术时间(75±16 min vs 50±13 min)，术中出血量(183±63 mL vs 46±16 mL)均显著减少，且术后并发症发生率(33.33% vs 10.34%)显著降低(P＜0.05)。结论经椎旁肌间隙入路取出胸腰段椎弓根螺钉系统具有时间短、出血少、创伤小、恢复快，安全性高的特点。

Objective To investigate the curative effects of the percutaneous vertebroplasty in the elderly multiple os-teoporotic vertebral compression fractures. Methods 47 cases of our hospital from Jul 2009 to Sep 2013 were retrospectively analyzed,who had two or more times history of osteoporotic vertebral compression fractures,accepted percutaneous vertebroplasty and standard anti-osteoporosis drug therapy. Used a visual analogue score assessment at admission and after vertebroplasty , at last follow-up according to the modified Macnab criteria for the assessment of clinical efficacy. Results All the patients were successfully punctured. Operation time was 30~87 min,average 43 min.Injection of bone cement volume averaged 3.5ml(2~6ml). All patients' postoperative back pain were relieved or disappeared. All patients weared waistline at the next day could walk inde-pendently. Different periods of postoperative compared with the preoperative, VAS scores had significant difference (P<0.01). According to the modified Macnab criteria,the excellent and good rate was 95.74%. Followed-up for 3 to 48 months,the last fol-low-up of patients with vertebral fracture pain were without recurrence. Conclusion Percutaneous vertebroplasty for osteo-porotic elderly patients with multiple vertebral compression fractures has the characteristics of less trauma ,quicker recovery and fewer complications.

目的:评价经皮椎体形成术(PVP)治疗老年性骨质疏松性椎体压缩骨折(OVCF)的疗效.方法:对63例OVCF的患者采用PVP治疗.采用Oswestry功能障碍指数(ODI)与JOA下腰痛评分对患者手术前和术后1年随访期进行评分.结果:所有患者均穿刺成功,注射骨水泥2.6～5.8ml,平均3.5ml.29例发生骨水泥渗漏,均无不适症状.结论:PVP治疗OVCF疗效满意,能有效缓解疼痛,增加椎体强度,是有效的微创治疗方法.