目的：比较单侧椎间融合椎弓根螺钉内固定与MIS-TLIF术式治疗腰椎间盘突出症的近期临床效果。方法：对2008年6月至2013年3月收治的39例椎间盘突出症患者的临床资料进行回顾性分析,男22例,女17例;年龄45～75岁,平均56.9岁。病变节段：L3,...目的：比较单侧椎间融合椎弓根螺钉内固定与MIS-TLIF术式治疗腰椎间盘突出症的近期临床效果。方法：对2008年6月至2013年3月收治的39例椎间盘突出症患者的临床资料进行回顾性分析,男22例,女17例;年龄45～75岁,平均56.9岁。病变节段：L3,4 3例,L4,5 15例,L5S1 21例。其中21例行单边固定融合术（单边固定融合组）,18例行MIS-TLIF术式（MIS-TLIF组）.比较两组患者的手术时间、失血量、术中透视次数及住院天数。术后随访时定期行影像学检查并记录两组患者VAS、ODI评分,末次随访按改良Macnab标准评定临床疗效。结果：两组患者均顺利完成手术,术中术后无严重并发症。单边固定融合组患者的平均手术时间、透视次数分别为（95±25） min、（4.2±0.4）次,明显少于MIS-TLIF组的（120±35 ） min 及（10.1±3.9）次（P〈0.05）.MIS-TLIF组患者的平均失血量、住院时间分别为（75±45） ml、（7.2±2.2） d,显着低于单边固定融合组的（165±60） ml 及（11.0±3.7） d （P〈0.01）.所有患者获得随访,时间12～45个月,平均29.5个月。术后随访期间的VAS、ODI评分较术前显着改善（P〈0.001）,组间比较差异无统计学意义（P〉0.05）.术后影像学检查提示内固定、融合器在位,术后1年CT图像提示两组患者均获得骨性融合。末次随访时两组患者的Macnab疗效评级差异无统计学意义（P〉0.05）.结论：对于腰椎间盘突出症的治疗,只要适应证选择正确,单边固定融合术与MIS-TLIF均能达到满意的临床效果。展开更多
Objective： To evaluate the biomechanical performance of vertebroplasty using calcium sulfate cement for thoracolumbar burst fractures. Methods： Sixteen bovine thoracolumbar spines （TH- L1 ） were divided into 4 gr...Objective： To evaluate the biomechanical performance of vertebroplasty using calcium sulfate cement for thoracolumbar burst fractures. Methods： Sixteen bovine thoracolumbar spines （TH- L1 ） were divided into 4 groups （ A, B, C and D）. After burst-fracture model was created, 12 vertebral bodies in Groups A, B and C were augmented with calcium sulfate cement （ CSC ）, calcium phosphate cement （ CPC ） and polymethylmethacrylate （ PMMA ） bone cement, respectively. Each anterior vertebral body height was measured with a caliper at 4 time points： intact conditions （Hint）, post-fracture （ HFr）, post-reduction （HRe） and post-vertebroplasty （HVP）. The f＇dling volume of 3 different bone cements was also measured. Each vertebral body was compressed at 0. 5 mm/s using a hinged plating system on a materials testing machine to 50 % of the postvertebroplasty height to determine strength and stiffness. Difference was checked using t test or One-way ANOVA. Results： The average strike energy was 66. 2 J. Vertebroplasty with different cements could sustain vertebral height. The average f＇dling volume of bone cement in 3 groups was 4.35 ml （ CSC ）, 3.72 nd（ CPC ） and 3.95 ml （PMMA）, respectively, and there was no statistically significant difference among them （ P 〉0.05 ）. Vertebroplasty with PMMA completely restored strength （116%） and stiffness （105%）. CSC or CPC partly recovered vertebral strength and stiffness. However, greater strength restoration was got with CSC （ 1 659 N） as compared with CPC （1 011N, P〈0.01 ）. Regarding stiffness, differences between CSC （ 140 N/ram ±40 N/nan） and the other two bone cements （ CPC ：148 N/nun ±33 N/nun, PMMA.236 N/mm ＋97/N/mm） were not significant （P〉0.05）. Conclusions： For a burst-fracture of calf spine, use of CSC for vertebroplasty yields similar vertebral stiffness as compared with PMMA or CPC. Although augmentation with CSC partly obtains the normal strength, this treatment still can be applied in thocacoloumbar burst fractures with other instrumental devices in light of its bioactivation.展开更多
文摘目的：比较单侧椎间融合椎弓根螺钉内固定与MIS-TLIF术式治疗腰椎间盘突出症的近期临床效果。方法：对2008年6月至2013年3月收治的39例椎间盘突出症患者的临床资料进行回顾性分析,男22例,女17例;年龄45～75岁,平均56.9岁。病变节段：L3,4 3例,L4,5 15例,L5S1 21例。其中21例行单边固定融合术（单边固定融合组）,18例行MIS-TLIF术式（MIS-TLIF组）.比较两组患者的手术时间、失血量、术中透视次数及住院天数。术后随访时定期行影像学检查并记录两组患者VAS、ODI评分,末次随访按改良Macnab标准评定临床疗效。结果：两组患者均顺利完成手术,术中术后无严重并发症。单边固定融合组患者的平均手术时间、透视次数分别为（95±25） min、（4.2±0.4）次,明显少于MIS-TLIF组的（120±35 ） min 及（10.1±3.9）次（P〈0.05）.MIS-TLIF组患者的平均失血量、住院时间分别为（75±45） ml、（7.2±2.2） d,显着低于单边固定融合组的（165±60） ml 及（11.0±3.7） d （P〈0.01）.所有患者获得随访,时间12～45个月,平均29.5个月。术后随访期间的VAS、ODI评分较术前显着改善（P〈0.001）,组间比较差异无统计学意义（P〉0.05）.术后影像学检查提示内固定、融合器在位,术后1年CT图像提示两组患者均获得骨性融合。末次随访时两组患者的Macnab疗效评级差异无统计学意义（P〉0.05）.结论：对于腰椎间盘突出症的治疗,只要适应证选择正确,单边固定融合术与MIS-TLIF均能达到满意的临床效果。
基金"135"Program Foundation for Key Medical Faculties,Jiangsu Provincial Department of Public Health(K0618)
文摘Objective： To evaluate the biomechanical performance of vertebroplasty using calcium sulfate cement for thoracolumbar burst fractures. Methods： Sixteen bovine thoracolumbar spines （TH- L1 ） were divided into 4 groups （ A, B, C and D）. After burst-fracture model was created, 12 vertebral bodies in Groups A, B and C were augmented with calcium sulfate cement （ CSC ）, calcium phosphate cement （ CPC ） and polymethylmethacrylate （ PMMA ） bone cement, respectively. Each anterior vertebral body height was measured with a caliper at 4 time points： intact conditions （Hint）, post-fracture （ HFr）, post-reduction （HRe） and post-vertebroplasty （HVP）. The f＇dling volume of 3 different bone cements was also measured. Each vertebral body was compressed at 0. 5 mm/s using a hinged plating system on a materials testing machine to 50 % of the postvertebroplasty height to determine strength and stiffness. Difference was checked using t test or One-way ANOVA. Results： The average strike energy was 66. 2 J. Vertebroplasty with different cements could sustain vertebral height. The average f＇dling volume of bone cement in 3 groups was 4.35 ml （ CSC ）, 3.72 nd（ CPC ） and 3.95 ml （PMMA）, respectively, and there was no statistically significant difference among them （ P 〉0.05 ）. Vertebroplasty with PMMA completely restored strength （116%） and stiffness （105%）. CSC or CPC partly recovered vertebral strength and stiffness. However, greater strength restoration was got with CSC （ 1 659 N） as compared with CPC （1 011N, P〈0.01 ）. Regarding stiffness, differences between CSC （ 140 N/ram ±40 N/nan） and the other two bone cements （ CPC ：148 N/nun ±33 N/nun, PMMA.236 N/mm ＋97/N/mm） were not significant （P〉0.05）. Conclusions： For a burst-fracture of calf spine, use of CSC for vertebroplasty yields similar vertebral stiffness as compared with PMMA or CPC. Although augmentation with CSC partly obtains the normal strength, this treatment still can be applied in thocacoloumbar burst fractures with other instrumental devices in light of its bioactivation.
