Objective To study the cl inical effects of modified Galveston technology in the treatment of lumbosacral tuberculosis. Methods From January 2001 to May 2008, 19 patients with lumbosacral tuberculosis were treated, including13 males and 6 females aged 21-58 years old (average 38 years old). The course of disease was 8-22 months. The tuberculosis was at the L4-S1 level in 3 cases, the L5, S1 level in 10 cases, the L5-S2 level in 5 cases, and the S1, 2 level in 1 case. Seven cases were compl icated with neural symptom of the lower l imbs, 3 cases of them were grade C and 4 cases were grade D according to the Frankel scale of nerve function. The preoperative JOA score of lower back pain was 5-22 (average 19). Six cases were compl icated with il iac abscess, 3 cases with psoas abscess, 3 cases with sacroil iac joint tuberculosis, and 2 cases with pulmonary tuberculosis. For 12 patients, the operation of modified Galveston internal fixation via the posterior approach, focus debridement via vertebral canal, and interbody fusion with autogeneous il iac bone fragment grafting was performed; for 7 cases, the operation of modified Galveston internal fixation via the posterior approach, vertebral lamina fusion with autogeneous il iac bone fragment grafting, and anterior focus debridement was performed. Results The incision of 18 cases was healed by first intention, and 1 case had sinus 3 weeks after operation and healed 3 months after operation. Nineteen patients were followed up for 12-82 months (average 21 months). There was no recurrence of the local tuberculosis, and the common toxic symptom of tuberculosis disappeared 6-12 months after operation. All the patients achieved bony fusion 4-6 months postoperatively, and 3 patients with sacroil iac joint tuberculosis achieved sacroil iac joint fusion. For those 7 patients with combinations of the neural symptomof the lower l imbs, the symptoms disappeared and their Frankel scales were improved to grade E. The JOA score of low back pain at the final follow-up was 22-29 (average 26). There was a significant difference between preoperation and postoperation (P lt; 0.05). Conclusion The modified Galveston technology is helpful to reconstruct the stabil ity of lumbosacral vertebrae, improve bony fusion rate, reduce the postoperative in-bed time.
【摘要】 目的 分析成都市近年一线抗结核药的耐药状况，为耐药结核病预防控制提供依据。 方法 对成都市2007年1月-2009年12月就诊的结核患者，临床分离株培养鉴定为结核分枝杆菌的菌株采用绝对浓度法进行一线抗结核药:链霉素（SM）、异烟肼（INH）、利福平（RF）、乙胺丁醇（EMB）耐药性检测，分析结核分枝杆菌的耐药情况。 结果 1 235例结核患者中，总耐药率和总耐多药率分别为28.83%、14.01%，初始耐药率和获得性耐药率分别为12.82%、61.27%。近3年耐多药率有下降趋势，但获得性耐药率呈逐年上升趋势。 结论 成都市结核耐药状况仍然比较严重，进一步加强耐药结核的监测和控制非常重要。【Abstract】 Objective To analyze the drug resistant treating mycobacterium tuberculosis (MTB) in Chengdu in recent three years, and to provide the evidence for tuberculosis controlling. Methods The patients with MTB diagnosed from January 2007 to December 2009 in Chengdu were enrolled. Absolute concentration method was used to test the drug-resistance of streptomycin (SM), isoniazide (INH), rifampicin (RFP), and ethambutol (EMB). Results The total rate of drug resistance and multi-drug resistance were 28.83% and 14.01% respectively. The rates of initial drug resistance and the acquired drug resistance were 12.88% and 61.27% respectively. Multi-drug resistance rate showed a downward trend, but the rate of acquired drug resistance increased gradually. Conclusion The situation of drug resistance of tuberculosis in Chengdu is still serious, and it′s very important to further monitor and control the drug resistance treating tuberculosis.
ObjectiveTo compare the effect of percutaneous kyphoplasty (PKP) with different phases bone cement for treatment of osteoporotic vertebral compression fracture (OVCF).MethodsThe clinical data of 219 OVCF patients who treated with PKP and met the selection criteria between June 2016 and May 2018 were retrospectively analyzed. According to the different time of intraoperative injection of bone cement, they were divided into observation group [116 cases, intraoperative injection of polymethyl methacrylate (PMMA) bone cement in low-viscosity wet-sand phase)] and control group (103 cases, intraoperative injection of PMMA bone cement in low-viscosity wire-drawing phase). There was no significance in general date of gender, age, disease duration, body mass index, bone mineral density T value, fracture vertebral body, preoperative fracture severity of the responsible vertebral body, anterior height ratio of the responsible vertebral body, preoperative pain visual analogue scale (VAS) score, and Oswestry disability index (ODI) between the two groups (P>0.05). The VAS score and ODI score were used to evaluate the improvement of patients’ symptoms at immediate, 2 days, 3 months after operation and at last follow-up. At 1 day, 3 months after operation, and at last follow-up, X-ray film and CT of spine were reexamined to observe the distribution of bone cement in the vertebral body, bone cement leakage, and other complications. During the follow-up, the refracture rate of the responsible vertebral body and the fracture rate of the adjacent vertebral body were recorded.ResultsThe injection amount of bone cement in the observation group and control group were (4.53±0.45) mL and (4.49±0.57) mL, respectively, showing no significant difference between the two groups (t=1.018, P=0.310). Patients in both groups were followed up 6-18 months (mean, 13.3 months). There were 95 cases (81.9%) and 72 cases (69.9%) of the bone cement distribution range more than 49% of the cross-sectional area of the vertebral body in the observation group and the control group, respectively, showing significant difference in the incidence between the two groups (χ2=4.334, P=0.037). The VAS score and ODI score of the postoperative time points were significantly improved compared with those before operation (P<0.05), and there were significant differences among the postoperative time points (P<0.05). The VAS score and ODI score of the observation group were significantly better than those of the control group (P<0.05) at immediate, 2 days, and 3 months after operation, and there was no significant difference between the two groups at last follow-up (P>0.05). At 1 day after operation, the cement leakage occurred in 18 cases of the observation group (8 cases of venous leakage, 6 cases of paravertebral leakage, 4 cases of intradiscal leakage) and in 22 cases of the control group (9 cases of venous leakage, 8 cases of paravertebral leakage, 5 cases of intradiscal leakage). There was no significant difference between the two groups (P>0.05). During the follow-up, 5 cases (4.3%) in the observation group, 12 cases (11.7%) in the control group had responsible vertebral refracture, and 6 cases (5.2%) in the observation group and 14 cases (13.6%) in the control group had adjacent vertebral fracture, the differences were significant (χ2=4.105, P=0.043; χ2=4.661, P=0.031).ConclusionBone cement injection with wet-sand phase in PKP is beneficial for the bone cement evenly distributed, strengthening the responsible vertebral, relieving the short-term pain after operation, decreasing the rate of responsible vertebral refracture and adjacent vertebral fracture without increasing the incidence of relevant complications and can enhance the effectiveness.
目的 探讨躯体感觉诱发电位（SEP）在颈脊髓损伤术前、术中监测的意义。 方法 纳入2010年1月－2012年4月治疗的241例颈脊髓损伤患者，术前按美国脊柱脊髓损伤协会（ASIA）评分并分级，确定损伤平面。术前与术中SEP监测，分析不同损伤分级以及不同损伤平面术前的波幅及潜伏期的差异，术中SEP监测以波幅下降＞50%和或潜伏期延长＞10%为预警标准。 结果 各损伤分级组术前SEP监测：A级组SEP波消失，呈一直线，而B、C、D、E级组均测出SEP波形，根据是否可测出SEP波形，可将A级与B、C、D、E及组区别。B、C、D级组之间波幅和潜伏期均无统计学意义（P＞0.05）。E级组较B、C、D级组波幅增高、潜伏期缩短，差异有统计学意义（P＜0.05）；不完全性颈脊髓损伤组内不同损伤平面组之间波幅和潜伏期差异均无统计学意义（P＞0.05）。术中SEP对脊髓功能损伤监测的灵敏度83.3%、特异度98.7%。其中术中：SEP阳性8例，真阳性5例，4例术者处理后波幅及潜伏期回复至正常范围，术后无新的神经功能损伤，另1例术者采取各种处理后波幅及潜伏期无恢复，术后神经功能损伤较术前加重；假阳性3例，1例麻醉师给予升高血压后波形恢复至正常，另2例经麻醉师调整麻醉深度后波形恢复正常，此3例术后无新的神经功能损伤。SEP阴性233例，真阴性232例，术后无新的神经功能损伤；假阴性1例，患者术中、术后波形未见异常，术后运动功能损伤程度较术前加重。 结论 ① SEP能准确评估完全性和不完性颈脊髓损伤，但对不完全性颈脊髓损伤的损伤程度不能作出准确评估、也不能区分颈脊髓损伤的损伤平面；② 术中SEP监测能较好地反映颈脊髓功能完整性，对减少颈脊髓损伤术中发生医源性颈脊髓损伤风险具有重要意义。