【摘 要】 目的 總結人工全髖關節(jié)置換術中假體即刻翻修的原因和處理經(jīng)驗，為臨床提供參考。 方 法 1996 年5 月－ 2005 年5 月，對行全髖關節(jié)置換的9 例患者行假體即刻翻修術。其中男5 例，女4 例；年齡51 ～ 73 歲。病因：股骨頭缺血壞死4 例，股骨頸頭下型骨折移位2 例，髖關節(jié)融合1 例，人工假體松動下沉2 例。術前Harris 評分為（39.6 ±8.4）分。行假體即刻翻修的原因：假體周圍骨折4 例，股骨假體因骨水泥異常凝固未放置到位2 例，髖臼杯位置錯誤3 例。 結 果 手術時間3 ～ 6 h，平均4.5 h；術中出血600 ～ 1 400 mL，平均920 mL。傷口均Ⅰ期愈合，住院時間15 ～ 30 d，平均21 d。術后并發(fā)癥：局部血腫2 例，髖關節(jié)脫位1 例，肺部感染2 例。9 例均獲隨訪2 ～ 10 年，平均5.1 年。股骨假體周圍骨折均愈合，未發(fā)生脫位和再翻修手術。術后Harris 評分為（89.3 ± 3.7）分，與術前比較差異有統(tǒng)計學意義（P lt;0.05）。 結論 術中即刻翻修應謹慎，根據(jù)具體情況，可采取更換加長柄股骨假體、股骨遠端周圍鋼絲捆扎或記憶合金抱骨器，以及植骨和調整髖臼杯位置等方法。
【摘要】 目的 研究棘突頂端上下緣與椎弓根中心點水平面垂直距離的關系，為微創(chuàng)胸腰段脊柱內固定術椎弓根的體表定位提供實驗依據(jù)?！》椒ā?0具完整脊柱骨標本，測量標本兩側胸11~腰2椎弓根中心點與棘突旁開距離（CO）、棘突上、下緣至椎弓根中心點水平面垂直距離（AC、BC），以棘突頂端的上、下緣為參照點確定椎弓根的最佳體表投影點。選取20例無神經(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。以棘突頂端上緣點為確定椎弓根中心的參考點，行經(jīng)皮椎弓根螺釘固定，分別測定術前、術后相應椎體Cobb角?！〗Y果 男、女性各椎體左右兩側CO、AC、BC比較差異均無統(tǒng)計學意義（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)計學意義（Plt;0.05），腰1、腰2椎體的AC比較差異無統(tǒng)計學意義（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)計學意義（Plt;0.01）。臨床應用顯示，術前、術后相應椎體Cobb角比較，差異均有統(tǒng)計學意義（Plt;0.05）?！〗Y論 棘突頂端上緣為確定椎弓根中心點的最佳參照點，微創(chuàng)脊柱內固定術體表定位椎弓根時應根據(jù)性別和具體骨折椎體確定進針點?！続bstract】 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.