前、后路手术治疗寰枢关节脱位的临床疗效分析

目的观察前、后路手术治疗寰枢关节脱位的安全性及临床疗效。方法 2009年5月-2013年7月我科对10例可复型寰枢关节脱位患者施行后路寰枢椎椎弓根螺钉固定融合术,1例难复型寰枢关节脱位经口咽松解复位TARP钢板（transoral atlantoaxial reduction plate）内固定融合术。术后复查颈椎影像学,观察寰枢关节复位情况,按JOA（Japanese Orthopaedic Association Scores）评分标准行术前、后颈髓神经功能评分,观察手术并发症及植骨融合情况。结果全组病例均获得寰枢关节解剖复位,未发生椎动脉损伤、脊髓损伤、切口感染及脑脊液漏等并发症;全组病例随访时间为14∽31个月,平均23.3个月;术后颈髓神经功能改善率达54.0%;术后3-6个月X线片及CT显示植骨融合。结论前、后路手术治疗寰枢关节脱位安全可行,术后可获得良好的复位及神经功能改善。

舒适护理对脊柱前、后路手术患者血压、心率及护理满意度的影响价值评价

目的:研究评价对脊柱前、后路手术患者进行舒适护理干预,对患者血压、心率以及护理满意度的影响.方法:选择2016年12月-2017年12月期间在我院进行脊柱前、后路手术的患者作为样本研究资料,共有66例.依照计算机表法处理为2组,观察组(n=33例)进行舒适护理干预,对照组(n=33例)进行常规护理干预,比较2组患者的临床护理效果.结果:经过护理干预后,观察组患者的血压、心率以及护理满意度情况远远优于对照组患者,呈现出P<0.05的最终结局,具有探讨研究价值.结论:对脊柱前、后路手术患者进行舒适护理干预,具有明显的临床应用效果,可提升患者的护理满意度,改善患者的血压以及心率情况.

一期前路病灶清除钛网植骨后路内固定治疗胸腰椎结核并后凸畸形66例疗效观察

目的观察一期前路病灶清除钛网植骨后路内固定术治疗胸腰椎结核并后凸畸形的临床疗效。方法对66例胸腰椎结核并后凸畸形患者在术前进行至少3周正规抗结核药物治疗后行病灶清除、椎问植骨及后路内固定术，根据术后后凸畸形的矫正角度及Frankel分级评价效果。结果。对66例患者随访9～18（12±2）个月，所有患者无局部复发及窦道形成，术前术后Cobb角差异有统计学意义（P〈0．05），Frankel分级与术前比较均有1～3级恢复。结论一期前路病灶清除、钛网植骨、后路内固定手术具有病灶清除彻底，植骨融合内固定可靠，畸形矫正理想等优点。

Combined anterior and posterior surgery for treatment of cervical fracture-dislocation in patients with ankylosing spondylitis

Objective： To discuss the pathological characteristics of cervical spinal fracture complicating ankylosing spondylitis （AS） and the effect of combined anterior and posterior operation. Methods： Eighteen AS patients with traumatic cervical fracture-dislocation were treated operatively from January 2000 to January 2006. The symptom duration of AS was 14.5 years on average. Three cases had undergone osteotomy in lumbar spine. There were 4 cases of Grade A, 3 cases of Grade B, 9 cases of Grade C and 2 cases of Grade D according to Frankel＇s score. There were 15 cases of Grade III dislocation and 3 cases of Grade II. All patients underwent surgical procedures by combined anterior and posterior approach. Results： There were 4 anterior-posterior procedures, 8 anterior-posterior-anterior procedures and 6 posterior-anterior procedures. Seven patients had one stage operation and 11 cases underwent two stage surgeries. There was certain extent of neurological improvement in 14 incomplete paraplegic patients, but no improvement in 4 complete paraplegic patients. The follow-up period was 21.2 months on average and the time for bone fusion was 3.6 months. There were 4 complications during operation and a longterm complication in follow-up. Conclusions： The study suggests that anterior combined with posterior approach makes the spine stable and relieves the pressure immediately. It is a reasonable surgical strategy for treatment of cervical spinal fracture-dislocation with AS.