【摘要】 目的 研究棘突頂端上下緣與椎弓根中心點(diǎn)水平面垂直距離的關(guān)系,為微創(chuàng)胸腰段脊柱內(nèi)固定術(shù)椎弓根的體表定位提供實(shí)驗(yàn)依據(jù)?!》椒ā?0具完整脊柱骨標(biāo)本,測(cè)量標(biāo)本兩側(cè)胸11~腰2椎弓根中心點(diǎn)與棘突旁開(kāi)距離(CO)、棘突上、下緣至椎弓根中心點(diǎn)水平面垂直距離(AC、BC),以棘突頂端的上、下緣為參照點(diǎn)確定椎弓根的最佳體表投影點(diǎn)。選取20例無(wú)神經(jīng)癥狀的單節(jié)段椎體骨折男性患者;年齡23~54歲,平均37.6歲。損傷部位:胸11、胸12、腰1、腰2骨折椎體各5例。以棘突頂端上緣點(diǎn)為確定椎弓根中心的參考點(diǎn),行經(jīng)皮椎弓根螺釘固定,分別測(cè)定術(shù)前、術(shù)后相應(yīng)椎體Cobb角?!〗Y(jié)果 男、女性各椎體左右兩側(cè)CO、AC、BC比較差異均無(wú)統(tǒng)計(jì)學(xué)意義(Pgt;0.05)。男女組間相同椎體CO和BO及胸11、胸12椎體的AC比較差異均有統(tǒng)計(jì)學(xué)意義(Plt;0.05),腰1、腰2椎體的AC比較差異無(wú)統(tǒng)計(jì)學(xué)意義(Pgt;0.05)。男性或女性胸11~腰2的CO依次變大、AC和BC逐漸減小,各椎體間比較差異均有統(tǒng)計(jì)學(xué)意義(Plt;0.01)。臨床應(yīng)用顯示,術(shù)前、術(shù)后相應(yīng)椎體Cobb角比較,差異均有統(tǒng)計(jì)學(xué)意義(Plt;0.05)?!〗Y(jié)論 棘突頂端上緣為確定椎弓根中心點(diǎn)的最佳參照點(diǎn),微創(chuàng)脊柱內(nèi)固定術(shù)體表定位椎弓根時(shí)應(yīng)根據(jù)性別和具體骨折椎體確定進(jìn)針點(diǎn)。【Abstract】 Objective To study the anatomic distances from the upper and lower edges of the spinous process peak to the horizontal plane of the center of pedicle of vertebral arch, to provide assistance for the percutaneous positioning of the pedicle of vertebral arch in minimally-invasive transpedicular internal fixation for the thoracic and lumbar vertebrae. Methods We studied 20 integral thoraco-lumbar vertebrae samples, and the distance between the vertical plane including the upper and lower points of the spinous process peak and the horizontal plane of the center of pedicle of vertebral arch was measured and marked as CO. We also measured the distances from the upper and lower points of the spinous process peak to the horizontal plane of the center of pedicle of vertebral arch and marked them as AC and BC respectively. The upper and lower points of the spinous process peak were designated as reference points to define the optimal body surface projective point of the pedicle of vertebral arch. Twenty male patients with single segmental fractured vertebral body and without nervous symptoms were selected. The age of the patients were ranged from 23 to 54 years old, averaging at 37.6. The fractured vertebral bodies included T11, T12, L1, and L2 with 5 cases for each of them. The percutaneous transpedicular internal fixation was carried out with the upper point of the spinous process peak as the reference point to define the body surface projective point of the pedicle of vertebral arch and the preoperative and postoperative Cobb angle of each fractured vertebral body were measured. Results There was no significant differences in CO, AC and BC on both sides between male and female (Pgt;0.05). Statistical difference existed between male and female in CO and BO of the same vertebra, and AC of T11 and T12 (Plt;0.05), while AC of L1 and L2 had no significant difference (Pgt;0.05). In both males and females, CO of the vertebrae from T11 to L2 increased, while AC and BC decreased, and there was a significant difference among different vertebrae (Plt;0.01). Clinical application showed there was a significant difference between the Cobb angle before operation and that after operation (Plt;0.05). Conclusion The upper point of the spinous process peak is the best reference point to define the center of pedicle of vertebral arch. Deciding on the needle insertion spot should be based on gender and specific vertebral body, when minimally-invasive transpedicular internal fixation is performed to define the body surface projective point of the pedicle of vertebral arch.
目的探討人工全髖關(guān)節(jié)置換術(shù)(total hip arthroplasty,THA)治療髖臼骨折繼發(fā)創(chuàng)傷性關(guān)節(jié)炎的近期療效。方法回顧分析2004年1月-2012年3月,接受THA治療的12例13髖髖臼骨折繼發(fā)創(chuàng)傷性關(guān)節(jié)炎患者臨床資料。其中男6例,女6例;年齡40~68歲,平均55.6歲。左髖5例,右髖6例;雙髖1例。髖臼骨折至THA時(shí)間為12~240個(gè)月,平均65.7個(gè)月。術(shù)前髖關(guān)節(jié)Harris評(píng)分為(48.8 ± 9.5)分。 結(jié)果術(shù)后切口均Ⅰ期愈合,無(wú)下肢深靜脈血栓形成、感染等并發(fā)癥發(fā)生。術(shù)后10例10髖獲隨訪,隨訪時(shí)間1~7年,平均4.8年。末次隨訪時(shí)Harris評(píng)分為(86.5 ± 8.6)分,與術(shù)前比較差異有統(tǒng)計(jì)學(xué)意義(t=10.520,P=0.006)。 X線片復(fù)查示,髖臼假體無(wú)不穩(wěn)定發(fā)生,1髖股骨柄假體下沉2 mm,2髖發(fā)生假體周圍骨溶解。2髖發(fā)生異位骨化,根據(jù)Brooker分級(jí)標(biāo)準(zhǔn)Ⅰ、Ⅱ級(jí)各1例。 結(jié)論THA治療髖臼骨折繼發(fā)創(chuàng)傷性關(guān)節(jié)炎可獲滿意近期療效,其中術(shù)前嚴(yán)格適應(yīng)證選擇、病理評(píng)估與合適的髖臼重建方法是獲得良好療效的關(guān)鍵。