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Combined Mini-open Anterior Apical Vertebral Excision and Posterior Correction for Severe and Rigid Scoliosis

目的　探討前路小切口頂椎切除聯合后路矯形手術治療重度僵硬性脊柱側凸的可行性及療效。 方法　2009 年7月－2010年9月，采用前路小切口頂椎切除聯合后路矯形手術治療重度僵硬性脊柱側凸18例。其中男9例，女9例，年齡10～24歲，平均14.5歲。其中15 例特發性脊柱側凸（Lenke 2型6例，Lenke 3型1例，Lenke 4型8例），2 例脊髓空洞合并脊柱側凸，1 例Chiari畸形合并脊柱側凸。術前剃刀背高度（6.8 ± 2.3）cm，主胸彎Cobb角（99.6 ±10.0）°，主胸彎頂椎偏距（7.3 ± 1.3）cm。 結果　前路手術切口10～13 cm，平均（11.4 ± 1.0）cm；前路手術時間170～300 min，平均（215.3 ± 36.8）min；失血量300～1 300 mL，平均（662.5 ± 274.8） mL。所有患者隨訪25～39個月，平均30.7個月。末次隨訪時，剃刀背高度（1.0 ± 0.6）cm，矯正率86.7%；主胸彎Cobb角（31.4 ± 11.4）°，矯正率68.7%；主胸彎頂椎偏距（2.2 ± 0.9） cm，矯正率69.6%。上胸彎、胸腰彎/腰彎的Cobb 角及頂椎偏距亦明顯矯正，冠狀面及矢狀面平衡與術前相比，差異無統計學意義（P＞0.05）。未發生神經系統并發癥，1例患者在前路手術后入ICU行呼吸支持治療12 h，1例患者出現椎弓根螺釘穿透椎弓根上壁，2例患者出現鈦網位置不佳，隨訪未見鈦網位置改變。 結論　采用前路小切口頂椎切除聯合后路矯形治療重度僵硬性脊柱側凸安全可行，矯形效果滿意。

Multi slice CT spiral and MRI Performance of Spinal Giant Cell Tumor (6 Cases’ Reports)

目的:明確脊柱骨巨細胞瘤的多層螺旋CT、MRI表現。方法:回顧性分析經病理證實的脊柱骨巨細胞瘤6例(男5例,女1例,年齡21～40歲,平均32歲)。6例CT檢查,3例有MRI檢查。結果:發生于胸椎3例,腰椎1例,骶椎2例。CT主要表現為膨脹性溶骨性破壞和較大軟組織腫塊;MRI表現T1加權成像為低等信號,T2加權成像為高低混雜信號特點,可顯示瘤內壞死、囊變、出血等。結論:脊柱骨巨細胞瘤具有侵襲性強、生長活躍、易復發等特點,結合CT、MRI檢查可對該病做出及時診斷,且對臨床分期、手術方案制訂及術后定期隨訪有重要價值。

丙型副傷寒沙門菌致脊柱骨髓炎一例

Brief history and application prospect of robotic spine surgery

Spinal robotics has rounded out twenty years in clinical, is mainly used for pedicle screw placement at present, can significantly increase the accuracy of screw placement and reduce radiation exposure to the patient and the surgeon. In the future, haptic feedback, automatic collision avoidance, and other technologies will further expand its application to complete precise operations such as decompression and correction, providing safety guarantee for the implementation of complex spinal surgery.

Delirium Syndrome after Spinal Surgery

目的:分析脊柱外科患者術后并發譫妄綜合征的原因,總結其診斷、預防、治療。方法:回顧性分析我科2008年10月至2009年4月脊柱手術167例,其中11例患者術后發生譫妄綜合征。結果:11例患者均給予氟哌啶醇5mg im bid治療,平均使用5.6天,癥狀緩解;并獲3~6月隨訪,無一例復發譫妄綜合征。結論:譫妄綜合征是脊柱外科患者術后常見并發癥,其發生與年齡,性別,低血糖等有關,目前治療首選氟哌啶醇。

Clinical Feature and Treatment of Spinal Fractures with Multiple Injury in “5·12” Wenchuan Earthquake

目的:總結汶川大地震期間合并有多發傷的脊柱骨折的臨床特點和治療經驗。方法:回顧分析汶川大地震期間四川大學華西醫院收治的281例脊柱骨折,其中223例合并有多發傷,分析其臨床特點和治療方式。結果:223例合并多發傷的脊柱骨折中單純椎體骨折138例,單純附件損傷37例,椎體+附件骨折48例;平均年齡43.45±14.05歲;椎體分布以下胸段和腰段為主,胸腰段占60%左右;致傷原因中砸傷占82.1%;脊柱手術治療35例,占需手術治療的27.8%;合并傷共267例次;嚴重并發癥127例次;合并脊髓或馬尾神經損傷101例,占45.3%,有15例在搬運中發生脊髓損傷。結論:汶川大地震發生在山區,地震烈度高,傷員多為復合傷,存在嚴重的并發癥,受累椎體多,治療的重點首先放在處理開放傷、感染、并發癥上,影響了脊柱骨折的治療;早期救援時正確施救才能有效防范繼發性脊髓損傷。

Bilateral percutaneous balloon kyphoplasty through unilateral transverse process-extrapedicular approach for osteoporotic vertebral compression fracture of lumbar

ObjectiveTo evaluate the feasibility and short-term effectiveness of bilateral percutaneous balloon kyphoplasty through unilateral transverse process-extrapedicular approach for osteoporotic vertebral compression fracture (OVCF) of lumbar.MethodsA retrospective analysis was made on the clinical data of 93 patients with OVCF of lumbar who met the selection criteria between January 2018 and June 2019. According to the different surgical methods, they were divided into group A (44 cases, treated with bilateral percutaneous balloon kyphoplasty through unilateral transverse process-extrapedicular approach) and group B [49 cases, treated with percutaneous kyphoplasty (PKP) via bilateral transpedicle approach]. There was no significant difference in gender, age, body mass index, T value of bone mineral density, injury cause, fractured level, time from injury to operation, comorbidities, and preoperative Cobb angle of injured vertebra, visual analogue scale (VAS) score, and Oswestry disability index (ODI) between the two groups (P>0.05). The operation time, intraoperative fluoroscopy times, bone cement injection amount, and incidence of bone cement leakage were recorded and compared between the two groups; Cobb angle of the injured vertebrae, VAS score, and ODI were measured before operation, at 2 days and 1 year after operation. The contralateral distribution ratio of bone cement was calculated according to the anteroposterior X-ray film at 2 days after operation.ResultsThe operation time and the intraoperative fluoroscopy times in group A were significantly less than those in group B (P<0.05). There was no bone cement adverse reactions, cardiac and cerebrovascular adverse events, and no complications such as puncture needles erroneously inserted into the spinal canal and nerve injuries occurred in the two groups. Bone cement leakage occurred in 6 cases and 8 cases in groups A and B, respectively, all of which were asymptomatic paravertebral or intervertebral leakage, and no intraspinal leakage occurred; the bone cement injection amount and incidence of bone cement leakage between the two groups showed no significant differences (P>0.05). The contralateral distribution ratio of bone cement in group A was significantly lower than that in group B (t=2.685, P=0.009). Patients in both groups were followed up 12-20 months, with an average of 15.3 months. The Cobb angle of the injured vertebrae, VAS score, and ODI in the two groups were significantly improved at 2 days after operation, however, the Cobb angle of the injured vertebra at 1 year after operation was significantly lost when compared with the 2 days after operation, the VAS score and ODI at 1 year after operation were significantly further improved when compared with the 2 days after operation, the differences were all significant (P<0.05). There was no significant difference in the Cobb angle of the injured vertebrae, VAS score, and ODI between the two groups at each time point after operation (P>0.05).ConclusionBilateral percutaneous balloon kyphoplasty through unilateral transverse process-extrapedicular approach is comparable to bilateral PKP in short-term effectiveness with regard to fracture reduction, reduction maintenance, pain relief, and functional improvement. It has great advantages in reducing operation time and radiation exposure, although it is inferior in bone cement distribution.

Lower Anterior Cervical Approach Combined with Presternum-splitting Approach for Cervicothoracic Junction Spinal Tuberculosis

【摘要】　目的　探討低位下頸椎前方入路聯合胸骨柄劈開術治療頸胸段脊柱結核的手術方式及術后療效。　方法　2002年3月-2009年7月收治頸胸段脊柱結核16例，男11例，女5例；年齡18~52歲，平均38歲。其中位于頸6-胸1者2例，頸7-胸1者5例，胸1-2者4例，胸2-3者3例，胸1-3者2例。神經功能Frankel分級為：B級4例，C級7例，D級3例，E級2例。手術行低位下頸椎前方入路聯合胸骨柄劈開術，術中徹底清除結核肉芽組織、膿液、死骨并進行脊髓減壓，取自體髂骨塊植骨重建中前柱、前方鈦板內固定。術后佩戴頭頸胸支具6個月，正規抗癆18個月。術前后凸Cobb角為25~60°，平均為37.5°。　結果　全部患者均獲得隨訪，隨訪時間2~8年，平均3年。均獲得骨性融合，融合時間為5～8個月，無螺釘松動、脫落及鋼板斷裂等并發癥發生。神經功能恢復按Frankel分級，平均改善3.6個級別；結核病變無復發，術后后凸Cobb角明顯改善，為15～35°，平均22.6°，末次隨訪后凸角無明顯丟失。1例術后出現暫時性聲音嘶啞，術后1個月恢復。　結論　低位下頸椎前方入路聯合胸骨柄劈開術治療頸胸段脊柱結核，病灶顯露充分，植骨內固定，重建脊柱穩定性，矯正后凸畸形可靠。【Abstract】　Objective　To explore the clinical characteristics of cervico-thoracic junction spinal tuberculosis (CTJST) and to observe the therapeutic effect of lower anterior cervical approach combined with presternum-splitting approach on CTJST. 　Methods　The clinical data of 16 patients with cervicothoracic junction spinal tuberculosis from Match 2002 to July 2008 were retrospectively analyzed. According to the Frankel grades, four patients were in grade B, seven were in grade C, three were in grade D, and two were in grade E. There were 11 males and five females with a average age of 38 years ranging from 18 to 52 years. All patients underwent radical excision of epidural granulation tissue/abscess and necrotic bone, whilst a proper tricortical iliac crest autograft and anterior titanium plate were placed to reconstruct the anteromedian spinal column, followed by chemotherapy for 18 months and immobilization in a brace for six months. The mean Cobb angle was 37.5° (ranged from 25° to 60°) before surgery.　Results　All patients were followed up for two to eight years (three years on average), and got complete bone fusion within five to eight months postoperatively. There were no pull out and breakage of screws or plates.Spinal cord functional recovery improved on average 3.6 degree according Frankel standard, without recurrence of the disease or loss of Cobb angle till the last follow up. There was a statistically significant improvement in the Cobb angles from 22.6° to 37.5° (Plt;0.01) in average. However, two patients appeared transient hoarse voice after surgery, and the symptoms were alleviated one month after the operation.　Conclusion　Lower anterior cervical approach combined with presternum-splitting approach for CTJST may provide adequate exposure to the lesion, keep the bone graft with internal fixation and spinal stability, and correct the kyphosis.

FAILURE AND PREVENTION OF RECONSTRUCTION IN ANTERIOR STABILITY OF SPINE BY DUAL BLADE PLATE

Abstract Dual-blade plate is widely used in reconstruction of anterior stability of spine. Two hundred and ninety-eight cases were followed up since 1984. Among them, 181 cases were fractureof thoracolumbar spine; 63 cases were tuberculosis of thoracolumbar spine; 43 cases were tumor of thoracolumbar spine; 5 cases were spondylisthesis of lumbar spine; 2 cases were ankylosing spondylitis accompanied with gibbosity; 2 cases were adolescent vertebral epiphysis; I case was hemivertebra; I case was dysplasia of the first lumbar vertebra acompanied with gibbosity. Most cases were successful following operation, but in some cases, the results were unsuccessful, mainly due to the position of the dualblade plate in the vertebral body was not satisfactory. The mistakes most commonly occurred were one or two blades, or a part of the blade going into the intervertebral space, and less commonly seen was deviation of the dual -blade plate from itscorrect orientation or a little side-bent of the blade. Split of the vertebra and fall off of the dual-blade plate were happened in few cases. The causeswere analyzed and ways of prevention were provided in this article.

三維矯形內固定治療成人特發性脊柱側凸

目的 探討成人特發性脊柱側凸的治療方法及臨床效果。方法 2003年2月～2005年11月，采用脊柱三維矯形技術治療特發性脊柱側凸12例，男4例，女8例；年齡21～35歲。其中腰彎5例，Cobb角46～65°；長胸彎4例，Cobb角85～102°；胸腰彎3例，Cobb角96～108°。以疼痛為主要癥狀8例，以畸形為主要癥狀4例。無明顯神經癥狀。術前常規攝X線片，均有冠狀面上的脊柱側凸及椎體的旋轉，矢狀面上的胸腰椎生理曲度的異常改變，MRI檢查均無明顯的脊柱脊髓異常表現。結果 12例術后均無神經損傷及并發癥出現。5例腰彎患者Cobb角4～15°，平均糾正率84.7%；矢狀面曲度25～40°；身高增長2～4 cm。4例長胸彎患者Cobb角28～43°，平均糾正率60.8%；3例胸腰彎患者Cobb角25～34°，平均糾正率71.3%。長胸彎及胸腰彎患者矢狀面上交界性后凸全部糾正至正常，胸椎后凸及腰椎前凸均在正常范圍之內，增長身高5.0～8.5 cm，平均6.6 cm。12例獲隨訪7～31個月，均無斷釘、斷棒、脫鉤、脫釘等現象及假關節形成，1年以上復查患者全部骨性融合，糾正丟失5%。結論 三維矯形內固定治療特發性脊柱側凸，重建軀干平衡，效果滿意，術中應用體感誘發電位監護及喚醒試驗預防神經并發癥的發生。