Halo牵引技术在重度脊柱畸形中的应用进展

重度脊柱畸形的治疗一直是脊柱外科面临的挑战，由于该类患者多合并心肺功能障碍，严重畸形又导致脊柱僵硬，使得手术矫形难度大、手术时间长和失血量大，患者围手术期各种并发症发生率明显增加[1]。由于术前牵引不但可以增加脊柱、胸廓和脊柱前方结构的柔韧性，还可以改善患者心肺和消化功能、了解牵引状态下脊髓耐受能力及神经并发症的发生情况，因此越来越多的学者采用牵引技术辅助治疗重度脊柱畸形[2-3]。现就目前临床上应用多的Halo牵引技术综述如下。

椎间盘退行性疾病生物治疗研究的进展

椎间盘退行性疾病( degenerative disc diseases，DDD )是一类常见的，可引起椎间盘突出、椎管狭窄、退变性滑脱以及退变性脊柱侧弯的疾病，通常伴随慢性下腰痛等症状，严重影响患者的日常工作及生活。目前，对 DDD 的治疗一般包括药物等保守治疗和手术治疗，目的在于缓解症状及提高患者生活质量，但是现有的治疗方案仅缓解了患者的症状，却难以恢复其椎间盘的结构和功能。现在，越来越多的医生认为通过对 DDD 患者进行生物治疗，不仅可以缓解症状，而且生物治疗可以早期阻止甚至逆转椎间盘退变并恢复其生物学功能，这使得生物治疗有望成为DDD 的主要治疗手段。现将近年来椎间盘退行性疾病的生物治疗研究成果综述如下。

脊柱关节炎分类标准的演变

脊柱关节炎( spodyloarthritis，SPA )是一组互相关联的，通常侵犯脊柱、外周关节、关节周围结构的多系统炎性疾病，包括强直性脊柱炎( ankylosing spondylitis， AS )、银屑病关节炎( psoriatic arthritis，PSA )、反应性关节炎( reactive arthritis，REA )、赖特综合征( Reiter’s syndrome，RS )、炎性肠病关节炎( inflammatory bowel disease arthritis )、幼年发病的脊柱关节病以及分类未定的脊柱关节病。

年龄与脊柱骨巨细胞瘤预后关系的研究进展

骨巨细胞瘤(GCT)是一种有局部侵袭性的良性骨肿瘤。女性较男性多见，并且好发于20～40岁的青壮年[1-3]。骨巨细胞瘤的生物学行为较特殊，术后易复发。目前临床实践中常从肿瘤影像或病理等方面来分析其生物学行为，并对其预后进行判断。而以往骨巨细胞瘤的研究报道，不同年龄段患者术后复发率存在差异[4-5]，提示年龄可能是影响骨巨细胞瘤生物学行为及预后的因素。但由于以往的研究多为全身骨骼骨巨细胞瘤的病例，并未明确反映出年龄与脊柱骨巨细胞瘤复发之间的关系。

骶椎隐球菌骨髓炎一例报告

骶椎隐球菌骨髓炎临床上非常罕见，容易误诊为骶椎原发性肿瘤和转移瘤。2012年我院收治1例骶椎隐球菌骨髓炎，现报道如下。

重视重度脊柱畸形矫形中的神经并发症

脊髓或神经的损伤是脊柱侧凸手术的严重并发症，其后果往往是灾难性的。随着对脊柱畸形矫形和内固定能力的提高，尤其自应用三维内固定装置矫正脊柱侧凸以来，脊柱矫形手术，尤其是重度脊柱畸形矫正手术相关的神经并发症成为脊柱矫形外科医生关注的重点。

严格掌握原发性脊柱肿瘤全脊椎整块切除的适应证

原发性脊柱肿瘤相对少见，约占所有脊柱肿瘤的20%，全身骨肿瘤的6. 6%～8. 8%[1]。尽管原发性脊柱肿瘤的诊治原则与四肢骨肿瘤基本相同，但由于脊柱解剖复杂，毗邻脊髓神经、大血管及重要脏器结构，其外科切除难度较大、风险较高，既往多采用次全切除方式，局部复发率居高不下，治疗效果远不如四肢骨肿瘤。近20年来，随着脊柱外科技术的不断进步、脊柱内固定与重建器械的飞速发展及肿瘤学认识的逐步融入，脊柱肿瘤的治疗由过去的简单椎板切除、减压到现在的全脊椎切除，由过去的分块切除到现在的整块切除，使得脊柱肿瘤的临床疗效明显提高。

第一届全国脊柱外科青年医师暨脊柱脊髓护理学术论坛会议纪要

为进一步促进我国脊柱外科青年医师和护理同道们的学术交流，由中国康复医学会脊柱脊髓损伤专业委员会第一届青年委员会和护理学组主办、中南大学湘雅二医院脊柱外科承办的第一届全国脊柱外科青年医师暨脊柱脊髓护理学术论坛于2014年1月10日至11日在湖南长沙顺利召开。来自国内300余名专家与代表参加了此次学术盛会。在本次会议上，国内众多著名脊柱外科与护理专家、青年技术骨干齐聚一堂，采取主题演讲和专题报告等形式，就脊柱外科和护理领域中的焦点问题展开了热烈研讨。

医者当怀一颗好奇之心--兼评：骶椎隐球菌骨髓炎一例报告

常言道：医者仁心，也就是说医生需要有高尚的医德，正如古语“心不近佛不可为医”。现代社会，作为一名优秀的医生，除了有德，还要有术，又如“才不近仙不可为医”。如何拥有高超的医术？答案一定包含很多，但笔者以为，常怀一颗好奇心，也是其中的一个要素。

Lateral bending of the trunk has been specifically identified as a high risk factor for lower back disorders. However, few studies have presented in vivo kinematic data of the trunk while performing functional lateral bending tasks. Five healthy male subjects performed lateral lifting and lowering tasks under loading condition ranging from light (2kg) to 100% of a maximum (ML) at a controlled velocity. Single lowering tasks were also performed at 125% and 150% of ML. Video based movement analysis was used to determine kinematics of the trunk, pelvis, shoulders and neck in the frontal plane. Centre of pressure (COP) data was also obtained from a force platform on which the subjects stood when performing the lifting and lowering tasks. Kinematics of the trunk revealed a smooth and relatively large change in angular displacement (between 69°to 55°) toward the unloaded side during the lifting phase. Trunk angular displacement significantly decreased with increasing lifting load. The trunk was additionally divided into four segments representing the lower and upper lumbar regions and the lower and upper thoracic regions. The greatest displacement in these segments took place at the upper lumbar and lower thoracic regions (ranging from 29°to 22°and 23°to 17°, respectively) with the least displacement occurring in the lower lumbar and upper thoracic regions (approx. 6° and 5°, respectively). Both the upper lumbar and lower thoracic segments showed significant decreases in angular displacement with increasing load. During the single lowering trials the trunk rotated toward the loaded side with slightly less magnitude to that recorded during the lowering phase of the heaviest lifting and lowering conditions. Angular displacements of the upper lumbar and lower thoracic segments also decreased with increasing load in single lowering. Identified changes in the COP displacement were also correlated to increasing lifting and lowering load. The main findings of this study indicate that it is the central sections of the trunk that have the greatest motion during

Objective Cervical hollow threaded fixator (CHTY)was designed and applied to stabilize tha cervical spine following anterior decompression due to cervical spondylosis or acute cervical disc herniation.Methods Medical use titanium alloy with no magnetism was made into a hollow threaded structure with holes on the wall of the fixator. Forly-two patients with cervical spondylosis and acute cervical disc herniation were stabilized using the CHTF technique after anterior decompression. X-ray films and CT scans were taken after the oberation to observe the stability ann fusion rate of the segments.Results Patients were allowed to walk one day after the operation and were followed up for 6 to 36 months.The operated segments were stable and solid fusion was observed 3-6 months after surgery.Conclusions Immediate stability of the operated segments can be obtained using the CHTF technique.Patients ware easy to manage after5 the operation and returned to their jobs in a short time.The CHTF technique is safe and simpa to perfoirme and eliminates the complications of an autograft.It may be an alternative to traditional cervical interbody fusion with bone graft.

可调式中空人工椎体置换缓解脊柱转移性肿瘤疼痛及恢复脊髓功能障碍的观察

Objective To observe the results of the metastasis of spinal vertebra treated by replacedment with the adjustable hollow artificial vertebral body.Method An adjustable hollow artificial vertebral body made from medial used titanium.12 patients with the metastasis of vertebral body were treated by this technique.The relief of the pain of function of spinal cord were moinitored.The stability of the operated segments was observed.Results The patients were followed up from 6 to 34 months.The neurological functions were improved markedly,esp.for the pain relieving.The implants were stalbe and the reconstruction of the segment highness was observed on the X ray films.Conclusion The height of anterior column and the stability of the operated segments can be reconstructed by implanting the adjustable hollow artificial vertebral body.This technique may be an alternative method for the management of the metastasis in spinal vertebral body.

Accuracy of CT-guided biopsies in158patients with thoracic spinal lesions

The long-term effect of minimal invasive TLIF technique in reducing postoperative low-back pain