胸腰椎爆裂骨折手术治疗的研究进展

脊柱骨折年发病率约64/100000[1]。随着交通、工业建筑事故的不断增加，胸腰椎骨折的发病率呈逐年上升趋势。脊柱胸腰段( T11～L2)处于相对固定的后凸脊柱与活动的前凸脊柱的转换区域，应力相对集中而容易受到传导暴力的直接损伤[2]，该部位骨折约占脊柱创伤75%～95%，椎体发生爆裂骨折后，后缘骨折块往往突入椎管导致脊髓或马尾损伤。近年来，随着影像学、生物力学对胸腰椎骨折研究的不断深入，在治疗方面也出现了许多新理论、新技术，但手术与否、手术时机、手术入路、术式的选择方面，仍有争议；现将研究状况综述如下。

甲状腺滤泡癌多发胸椎转移一例

分化型甲状腺癌包括甲状腺乳头癌和滤泡癌，其中甲状腺滤泡癌生长缓慢，其发病率远低于甲状腺乳头癌，而且体积小、生长缓慢，常无明显的局部恶性表现。然而Do等[1]研究发现甲状腺滤泡癌的骨转移发生率(6. 8%)明显高于甲状腺乳头癌的骨转移发生率(0. 4%)。临床上甲状腺滤泡癌骨转移的好发部位以肋骨、髂骨和胸骨多见，以溶骨性病变为主。骨转移会引发骨痛、病理性骨折和脊髓压迫等并发症，患者的生活质量将受到严重的影响[2]。同时，甲状腺滤泡癌骨转移患者的10年生存率为13%～21%[3]。因此，对甲状腺滤泡癌骨转移的早期诊断和治疗非常重要。2013年12月9日，我科收治1例甲状腺滤泡癌多发胸椎转移病例，现报道如下。

强直性脊柱炎胸腰段后凸畸形矫形设计的关键问题

强直性脊柱炎( ankylosing spondylitis，AS )胸腰段后凸畸形截骨矫形时需关注两方面的问题，一是矢状面脊柱-骨盆平衡的重建；二是颌眉角正确角度的矫正[1-4]。

交感神经型颈椎病及相关疾病的系统康复

INTRODUCTIONThere are many symptoms of sympathetic nerve type of cervical spondylopathy, most of which are subjective symptoms and one of the most common symptom is flustered, chest distress. Disease condition is often prolonged, main symptoms of disturbance of posterior thoracic vertebrae joints are back pain and chest distress. Diagnosis of both diseases are mainly according to clinical manifestation, but some symptoms aren't typical and often missed or misdiagnosed. Some patients with disturbance of posterior thoracic vertebrae don' t present with obvious back pain but chest distress, If complicated with cervical spondylopathy, all symptoms are explained with cervical spondylopathy and disturbance of posterior thoracic vertebrae joints is neglected that will lead to prolongation.

BACKGROUND:Though the effects of conservative or traditional open reduction and internal fixation in the treatment of thoracolumbar fractures are reliable and satisfactory for most cases, two methods also have shortages. Minimal-invasive percutaneous pedicle screw system provides a new available method. OBJECTIVE:To investigate the clinical effect of Sextant percutaneous pedicle screw system in the treatment of thoracolumbar fractures. METHODS:A total of 55 patients, who had undergone percutaneous pedicle screw fixation using Sextant system (25 patients) or traditional open internal fixation (30 patients) for single-level vertebral body compression fractures in Department of Orthopedics of Renmin Hospital of Wuhan University from February 2011 to January 2013, were enrol ed in this study. RESULTS AND CONCLUSION:Except two patients in traditional open internal fixation group were lost after discharge, al other patients were fol owed up for 8-14 months. Operative time, intraoperative blood loss, postoperative drainage amount and hospital day were better in percutaneous pedicle screw fixation group than in the traditional open internal fixation group (P<0.05). Compared with preoperation, the sagittal Cobb angle, visual analogue scale and Oswestry disability index after operation were significantly lower (P<0.05), while anterior vertebral body height ratio was significantly higher in each group (P<0.05). No significant difference was found in terms of correction loss and Oswestry disability index between two groups at 8 months after operation (P>0.05). The results show that percutaneous pedicle screw fixation using Sextant system has a satisfactory outcome in the treatment of thoracolumbar fractures. However, obeying indication strictly is very important for clinical application.

右位胸主动脉变异1例

在对1例患者进行胸部CT检查时发现,其主动脉弓转位不全,形成右弓右降主动脉畸形,经检索此类变异极为少见,现报道如下:

磁共振对胸椎黄韧带肥厚的诊断价值

黄韧带肥厚(thicking of ligamentum flavum,TLF)是引起胸椎椎管狭窄以及脊髓、神经根压迫症状的主要原因之一[1～3].CT、MRI的广泛应用对诊断该病提供了新的手段.本文对154例TLF患者的MRI表现进行了回顾性分析,探讨MRI的诊断价值.