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find Author "杨学军" 7 results
  • 成人胸椎无骨折脱位型脊髓损伤的临床诊治及损伤机制探讨

    目的 总结成人胸椎无骨折脱位型脊髓损伤(spinal cord injury without radiographic abnormality,SCIWORA)的临床诊治方法,并分析其损伤机制。 方法 2008 年3 月- 2009 年9 月收治3 例成人胸椎SCIWORA患者,影像学检查均未见胸椎骨折脱位。其中1 例车祸伤致胸脊髓损伤合并双侧多发肋骨骨折、创伤性湿肺、血气胸、肩胛骨骨折;1 例胸背部重物打击伤致胸脊髓损伤;1 例高处坠落伤致胸脊髓损伤合并L3 椎体爆裂骨折、左侧股骨干粉碎性骨折。脊髓损伤治疗包括给予大剂量激素、脱水剂、神经营养药物,同时积极处理合并伤。 结果 1 例车祸伤患者治疗14 个月后双下肢肌力、感觉均恢复正常,Frankel 分级由C 级恢复至E 级。1 例胸背部打击伤患者随访17 个月,感觉减弱平面下降,部分肌力恢复,Frankel 分级由B 级恢复至C 级。1 例坠落伤患者随访11 个月,脊髓损伤完全恢复,Frankel 分级由D级恢复至E 级。 结论 胸神经根牵拉胸脊髓、胸脊髓局部血管破裂出血、马尾神经牵拉脊髓均可造成SCIWORA。

    Release date:2016-08-31 05:49 Export PDF Favorites Scan
  • FUNCTION RECONSTRUCTION OF ANTERIOR AND MIDDLE COLUMN IN THORACOLUMBAR SPINAL TUBERCULOSIS BY ONE-STAGE ANTERIOR RADICAL DEBRIDEMENT

    Objective To summarize the effect of one-stage anterior debridement of infection in function reconstruction of anterior and middle column for the treatment of thoracolumbar spinal tuberculosis. Methods From January 2001 to January 2007, 65 patients with thoracolumbar spinal tuberculosis were treated with one-stage anterior debridement, decompression, autogenous bone grafts and internal fixation. There were 43 males and 22 females with an average age of 40.2 years (range, 19-64 years), including 18 cases of thoracic tuberculosis (T4-10), 44 cases of thoracolumbar tuberculosis (T11-L2) and 3 cases of lumbar tuberculosis (L3-5). The disease course was 3 months to 10 years (median 10 months). One segment was involved in 7 cases, two segments in 54 cases and three segments in 4 cases. In 14 cases with spinalcord injury, there were 5 cases of grade C and 9 cases of grade D according to Frankel classification. The kyphotic Cobb angle was 20-65° (41° on average). Results The operative time was 120-210 minutes (170 minutes on average), and the blood loss was 300-1 500 mL (600 mL on average). Fifty-eight patients were followed up for 1-6 years (23 months on average). Abscess occurred in 2 cases at 40 days and 3 months, and healed after symptomatic management. The other incisions achieved heal ing by first intention. The X-ray films showed bony fusion 4-12 months (6 months on average) after operation. No tuberculosis recurred. At 12 months after operation, pain disappeared, and there were 7 cases of grade D and 7 cases of grade E according to Frankel classification. The kyphotic Cobb angle was 0-33° (24° on average), showing statistically significant difference (P lt; 0.05) when compared with preoperation. Conclusion Early reconstruction of load-bearing function and stabil ity of anterior and middle column in the treatment of spinal tuberculosis is great significant. The appl ication of one-stage anterior surgery with debridement, decompression, autogenous bone grafts and internal fixation in the operative treatment of thoracolumbar tuberculosis is safe and effective after a rigorous anti-tuberculosis treatment.

    Release date:2016-08-31 05:47 Export PDF Favorites Scan
  • PEDICLE SCREW FIXATION AND ALLOGRAFT BONE IN POSTERIOR SPINAL FUSION FOR TREATMENT OF THORACOLUMBAR VERTEBRAL FRACTURES/

    Objective To investigate the efficacy of the pedicle screw fixation and allograft bone in posterior spinal fusion for the treatment of thoracolumbar vertebral fractures. Methods From September 2006 to March 2008, 105 cases of thoracolumbar vertebral fractures were treated with allograft bone in posterior spinal fusion after the pedicle screw fixation,including 75 males and 30 males aged 15-65 years (mean 37 years). The mixture which consisted of spinous process and vertebral plate sclerotin and homogeneity variant bone was used as bone graft to implant into articular process and processus transversus space or vertebral plate space. The time from injury to surgery varied from 8 hours to 21 days, with an average of 3 days. There were 52 cases of fall ing injuries from height, 35 cases of traffic accident injuries, 11 cases of bruise injuries and 7 cases of tumbl ing injuries. Before operation, the primary cl inical symptoms of patients included local pain combined with l imitation of activity, 30 cases compl icated by various degrees of spinal cord and nerve root functional disturbance. According to Mcaffee classification, there were 7 cases of flexion depressed fractures, 86 cases of blow-out fractures, 9 cases of Chance fractures and 3 cases of dislocation-fracture. According to Frankel grade, there were 11 cases of grade A, 2 cases of grade B, 7 cases of grade C, 10 cases of grade D and 75 cases of grade E. The X-ray examination of all patients denoted that the bodies of injuryed vertebra were compressed and wedge-shaped, and the CT scan showed that 98 cases had spinal stenosis. After 2 weeeks and 3, 6, 12 months, the X-ray films were taken to evaluate bone graft fusion. The Cobb angle was measured. The recovery of nerve function was analyzed. Results The operation time was 55-180 minutes (mean 90 minutes) and the blood loss was 100-900 mL (mean 200 mL). All patients achieved heal ing by first intention with no compl ication. After operation, 93 cases were followed up for 6-15 months with an average of 11 months. Except for 11 patients who were at grade A before operation, one to two grade recover was observed in other patients. The average Cobb angle of injury segment was improved from preoperative 32.1° to postoperative 5.2°. The height of anterior border of injuried vertebral body was recovered from the preoperative average compressed remaining height 61.5% to postoperative 96.8%. The vestigial degree of canal is spinal is anteroposterior diameter was recovered from preoperative 65.7% to postoperative 89.9%. Imageology examination showed that all the patient achieved bone union within 6 months. The fusion rate of bone graft in spinal fusion was 100%. No loosening and breaking of nails occurred. Conclusion Pedicle fixators can restore and fix the thoracolumbar fractures, and the combination of autograft and allograft bone transplantation is a safe, rel iable and effective method.

    Release date:2016-09-01 09:06 Export PDF Favorites Scan
  • 后路截骨矫形内固定治疗青少年胸椎半椎体合并脊髓纵裂脊柱侧凸畸形

    目的 总结青少年胸椎半椎体合并脊髓纵裂的手术治疗方法。 方法 2003 年1 月- 2007 年12 月,应用一期后路半椎体、骨嵴切除,椎弓根钉棒系统内固定、自体骨植骨融合治疗下胸椎脊柱侧凸合并脊髓纵裂患者15 例。其中男6 例,女9 例;年龄16 ~ 24 岁,平均21.2 岁。均为先天性完全分节半椎体,脊髓纵裂均位于半椎体。病椎位于T11 3 例,T12 12 例。病程9 ~ 61 个月,平均22 个月。术前侧凸Cobb 角48.6 ~ 106.4°,平均52.3°。 结果 术中无脊液漏,无胸膜损伤。切口Ⅰ期愈合14 例;1 例发生感染,经抗炎、切口换药后愈合。15 例均获随访,随访时间9 ~ 45 个月,平均34 个月。术后10 个月Cobb 角0 ~ 14°,平均10.2°,矫正率平均76.3%,术后脊柱畸形明显改善。术后X 线片示患者均获良好骨融合,融合时间3 ~ 5 个月。无内固定失败及假关节形成。 结论 一期后路手术截除半椎体及纵裂骨嵴可达到脊柱矫形目的,同时完成截骨间隙植骨融合以重建脊柱稳定性,是一种治疗完全分节的胸椎半椎体合并脊髓纵裂脊柱侧凸畸形的有效方 法。

    Release date:2016-09-01 09:07 Export PDF Favorites Scan
  • COMBINATION OF INTENSIFIED ANTI-TUBERCULOSIS WITH OPERATION FOR TREATMENT OF THORACOLUMBAR TUBERCULOSIS

    Objective To evaluate the cl inical significance of the combination of intensified anti-tuberculosis treatment, posterior transpedicular screw system internal fixation, intertransverse bone grafting, and anterior approach focus debridement for the treatment of thoracolumbar tuberculosis. Methods From January 2005 to December 2007, 20 patients with thoracolumbar tuberculosis (T10-L3) were treated. There were 13 males and 7 females aged 21-64 years old (average 44 years old). The course of disease was 3 months to 3 years (average 10 months). The focus involved single vertebrae bodies in 8 cases, two vertebrae bodies in 9 cases, and three vertebrae bodies in 3 cases. The preoperative Cobb angle was 9-35° (average 26.7°). The neurological function was evaluated according to the Frankel grading criterion, there were 2 cases of grade B, 5 of grade C, 7 of grade D, and 6 of grade E. Vertebral body defect index score: 9 cases of 1-2 points, 7 cases of 2-3 points, and 4 cases above 3 points. After receiving the systemic five-drug treatment of anti-tuberculosis for 2-3 weeks, the patients underwent the posterior transpedicular screw system internal fixation and intertransverse bone grafting, and then received tuberculosis focus debridement via anterior approach, nerve decompression, and bone grafting fusion. Results The time of operation averaged 210 minutes and the mean blood loss during operation was 650 mL. Postoperatively, 2 patients had mild belting sensation in their thorax and 2 patients had mild pneumothorax. Their symptoms rel ived 2-3 weeks later without specific treatment. All the patients were followed up for 12-23 months. X-ray films showed that all the patients achieved successful bony fusion 6-18 months after operation, and the Cobb angle was 7-21° (average 15.2°) 12 months after operation without aggravation. The Frankel gradingsystem was used to assess the postoperative neurological function, 1 patient in grade B before operation was improved to grade C after operation, 1 patient in grade B was improved to grade D, 1 patient in grade C was improved to grade D, 4 patients in grade B were improved to grade E, and 7 patients in grade D were improved to grade E. All of the incisions healed and erythrocyte sedimentation rate became normal 2 weeks to 3 months after operation. All the patients showed no obvious abnormity in l iver and kidney function. There was no recurrence of tuberculosis. Conclusion It seems that the systemic drug treatment of antituberculosis before and after operation, the thorough debridement of focus during operation, and the effective and rel iable wayto reconstruct for the spinal stabil ity are the key points for the treatment of spinal tuberculosis.

    Release date:2016-09-01 09:08 Export PDF Favorites Scan
  • 后路单节段楔形截骨联合短节段椎弓根内固定系统治疗脊柱后凸畸形

    目的 总结后路单节段截骨联合短节段椎弓根内固定系统治疗脊柱后凸畸形的临床疗效。方法 2001 年5 月- 2004 年1 月,采用后路单节段楔形截骨联合AF 内固定系统治疗脊柱后凸畸形患者15 例。男10 例,女5 例;年龄17 ~ 64 岁。病程10 个月~ 3 年。结核性后凸畸形9 例,骨折继发性后凸畸形4 例,发育性后凸畸形2 例。病变椎体:T5 ~ 10 4 例,T11 ~ L2 9 例,L3、L4 各1 例。术前Cobb 角为47 ~ 81°,平均61°。神经功能按Frankel 分级:A 级、C 级各1 例,D 级4 例,E 级2 例;余7 例有程度不同的神经根病损症状和体征。 结果 术后15 例均获随访,随访时间14 ~ 48 个月,平均27 个月。术后Cobb 角为0 ~ 55°,平均30°。后凸畸形明显改善,矫正率为32% ~ 100%,平均68%。Frankel 分级:A 级、D 级各1 例,E 级6 例;7 例神经根病损患者症状体征均恢复正常。X 线片示患者术后4 ~ 5 个月植骨融合。1 例术后2 年出现迟发性切口感染,取出内植物后愈合,其余患者未发现内植物松动、断裂、假关节形成等并发症。 结论 对于局限性胸腰段脊柱后凸畸形,单节段楔形截骨术能够较好地解除脊髓神经根的压迫或牵张、矫正畸形和重建脊柱的稳定性。

    Release date:2016-09-01 09:19 Export PDF Favorites Scan
  • POSTERIOR LUMBAR INTERBODY FUSION FOR DOUBLE-SEGMENTAL BILATERAL ISTHMIC LUMBAR SPONDYLOLISTHESIS

    ObjectiveTo explore the effectiveness of posterior lumbar interbody fusion in the treatment of double-segmental bilateral isthmic lumbar spondylolisthesis. MethodsBetween February 2008 and December 2013, 17 patients with double-segmental bilateral isthmic lumbar spondylolisthesis were treated with posterior lumbar interbody fusion. There were 12 males and 5 females, with an age ranged 48-69 years (mean, 55.4 years). The disease duration ranged from 11 months to 17 years (median, 22 months). According to the Meyerding classification, 30 vertebrea were rated as degree I, 3 as degree Ⅱ, and 1 as degree Ⅲ. L4, 5 was involved in 14 cases and L3, 4 in 3 cases. The preoperative visual analogue scale (VAS) score was 8.6±3.2. ResultsCerebrospinal fluid leakage occurred in 2 cases because of intraoperative dural tear; primary healing of incision was obtained, with no operation related complication in the other patients. The patients were followed up 1-6 years (mean, 3.4 years). At last follow-up, VAS score was decreased significantly to 1.1±0.4, showing significant difference when compared with preoperative score (t=7.652, P=0.008). X-ray films showed that slippage vertebral body obtained different degree of reduction, with a complete reduction rate of 85% (29/34) at 1 week after operation. All patients achieved bony union at 6-12 months (mean, 7.4 months). According to the Lenke classification, 13 cases were rated as grade A and 4 cases as grade B. No internal fixation loosening and fracture were observed during the follow-up. Intervertebral disc height was maintained, no loss of spondylolisthesis reduction was found. ConclusionIt can obtain satisfactory clinical result to use spinal canal decompression by posterior approach, and screw fixation for posterior fusion in treatment of double-segmental bilateral isthmic lumbar spondylolisthesis. The key points to successful operation include accurate insertion of screw, effective decompression, distraction before reduction, rational use of pulling screws, and interbody fusion.

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