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吻合血管的皮瓣急诊修复手外伤

改良腰椎后路椎间植骨融合术治疗退变性腰椎失稳

目的  总结改良腰椎后路椎间植骨融合术（posterior  lumbar  interbody  fusion，PLIF）治疗退变性腰椎失稳的疗效。  方法   2006 年 5 月－ 2008 年 1 月，采用改良 PLIF 治疗退变性腰椎失稳患者 36 例。男 21 例，女 15 例；年龄 38 ～ 61 岁，平均 48.7 岁。病程 6 ～ 26 个月。病变位于 L3、 4 2 例， L4、 5 16 例， L5、 S1 13 例， L4 ～ 5、 S1 5 例。术后定期随访评估临床疗效、植骨融合率和椎间隙高度。  结果  1例术后1周出现切口急性金黄色葡萄球菌感染，对症治疗后痊愈；余 35 例切口Ⅰ期愈合。36 例均获随访，随访时间 16 ～ 26 个月，平均 18 个月。术后 1 年薄层螺旋 CT 扫描三维重建可见完全的骨小梁连接，达骨性融合。术前椎间隙高度为（9.5 ± 1.2）mm，术后 7 d 为（11.2 ± 1.1）mm，末次随访时为（11.0 ± 1.1）mm，手术前后比较差异均有统计学意义（P lt; 0.01），术后 7 d 与末次随访比较差异无统计学意义（P gt; 0.05）。采用日本骨科协会（JOA）下腰痛评分标准，获优 29 例，良 5 例，中 2 例，优良率 94.4%。  结论  改良 PLIF 治疗退变性腰椎失稳最大限度保留了后柱结构，创伤小，植骨融合率高，椎间隙高度维持良好，临床疗效满意。

TREATMENT OF MULTI-LEVEL CERVICAL SPONDYLOTIC MYELOPATHY BY ANTERIOR SEGMENTAL DECOMPRESSION AND AUTOGRAFT FUSION

Objective To evaluate the cl inical effects of anterior segmental decompression and autograft fusion in treating multi-level cervical spondylotic myelopathy (CSM). Methods Between January 2007 and May 2009, 23 patients with multi-level CSM were treated with anterior segmental decompression, autograft fusion, and internal fixation. There were 16 males and 7 females with an average age of 58 years (range, 49-70 years). Consecutive 3 segments of C3,4, C4, 5, and C5, 6 involvedin 15 cases and C4, 5, C5, 6, and C6, 7 in 8 cases. All patients suffered sensory dysfunction in l imbs and trunk, hyperactivity of tendon reflexes of both lower extremities, walking with l imp, and weakening of hand grip. Cervical MRI showed degeneration and protrusion of intervertebral disc and compression of cervical cord. The disease duration was 6 to 28 months (12.5 months on average). Japanese Orthopaedic Association (JOA) score system was adopted for therapeutic efficacy evaluation. JOA scores were recorded preoperatively, 1 week, 3 months, and 12 months postoperatively. Results Dura tear occurred in 1 case and was treated by fill ing with gelatinsponge during operation; no cerebrospinal fluid leakage was observed after operation. All the incisions healed by first intention. All cases were followed up 12 to 24 months (15.1 months on average), and no vertebral artery injury or recurrent laryngeal nerve injury occurred. The nervous symptoms in all cases were improved significantly within 1 week after operation. Lower l imb muscle strength increased, upper l imb abnormal sensation disappeared, and l imb moved more agile. A 2-mm collapses of titanium mesh into upper terminal plate were found in 1 case and did not aggravated during followup.The other internal fixator was in appropriate situation, and the fusion rate was 100%. The JOA score increased from 9.1 ±0.3 preoperatively to 14.3 ± 0.4 at 12 months postoperatively with an improvement rate of 65.8% ± 0.2%, showing significant difference (P lt; 0.01). According to Odom evaluation scale, the results were excellent in 10 cases, good in 8 cases, fair in 4 cases, and poor in 1 case. Conclusion Anterior segmental decompression and autograft fusion is a recommendable technique for multi-level CSM, which can make full decompression, conserve the stabil ity of cervical cord, and has high fusion rate.