经椎板开窗减压复位加经椎弓根植骨和内固定术治疗胸腰椎爆裂性骨折

目的分析经后路椎弓根内固定加经椎板开窗椎管减压和经椎弓根椎体植骨治疗胸腰椎爆裂性骨折的疗效。方法对28例胸腰椎新鲜爆裂性骨折,患者应用后路椎弓根内固定复位,椎板开窗减压+经伤椎椎弓根向椎体前缘植入自体骨及同种异体骨或人工骨。结果术后椎体高度及生理弧度恢复满意,经随访18个月,椎体高度无明显丢失,椎体无塌陷变形,无内固定松动、断裂。结论经后路椎弓根内固定+经椎板开窗减压复位+经椎弓根椎体植骨治疗胸腰椎新鲜爆裂性骨折,手术安全,效果满意,术后并发症低,远期脊柱稳定性好。     

经伤椎椎弓根植骨短节段内固定治疗中老年胸腰椎爆裂骨折

目的 分析经伤椎椎弓根植骨结合后路短节段椎弓根内固定治疗中老年胸腰椎爆裂骨折的临床疗效.方法 2009年3月至2011年1月,采用后路椎弓根内固定系统撑开复位结合经伤椎椎弓根植骨治疗中老年胸腰椎爆裂性骨折45例.男18 例,女27 例;年龄49.0～ 68.0岁,平均55.3岁.Denis分型均为爆裂性骨折,据Frankel分级：D级6例;E级39例.均为单节段椎体骨折,椎体骨折部位：T11 6例,T12 18例,L1 17例,L2 4例.伤后距手术时间0.5-6.0 d,平均2.8 d.结果 术后患者切口均Ⅰ期愈合.43例获随访,随访时间18.0-36.0个月,平均23.4个月.Frankel分级D级6例患者恢复至E级,37例E级患者无变化,与手术前比较所有患者术后1周,末次随访时椎体高度得到良好恢复,Cobb＇s角,伤椎前后缘相对高度也得到明显改善,随访期内未出现内固定并发症.结论 应用后路椎弓根系统内固定结合经伤椎椎弓根植骨术是治疗中老年胸腰椎爆裂性骨折的有效方法 之一.     

经伤椎椎弓根植骨植钉结合短节段椎弓根内固定治疗胸腰椎爆裂性骨折39例围术期护理

目的:探讨经伤椎椎弓根植骨椎体成形并植钉,结合短节段椎弓根内固定治疗胸腰椎爆裂性骨折围手术期的护理方法.方法:采用后路减压,经伤椎椎弓根填充自体骨颗粒,伤椎植入椎弓根钉,结合上下相邻椎体椎弓根钉内固定治疗胸腰椎爆裂性骨折39例.结果:术后患者临床症状有所改善,椎体高度恢复好,内固定无松动、断裂.结论经椎弓根椎体内植骨和伤椎椎弓根钉分散内固定的两者联合应用可降低后期内固定松动、断裂及矫正度丢失的发生率.围术期相关护理及健康教育能够保证该项技术的顺利实施.     

经伤椎椎弓根植骨结合后路内固定治疗胸腰椎爆裂性骨折短中期疗效分析

目的 分析经伤椎椎弓根植骨结合后路内固定治疗胸腰椎爆裂性骨折短中期临床疗效.方法 对31例胸腰椎爆裂性骨折患者(TLICS评分≥5)采取经伤椎椎弓根植骨结合后路内固定治疗.结果 术后均获随访,随访时间13～38个月,平均21个月,术后12周、12个月及终末随访期伤椎椎体恢复至正常95.5%以上,Cobb角丢失<3.2°,较术前差异有统计学意义(P＜0.05).结论 经伤椎椎弓根植骨结合后路内固定治疗胸腰椎爆裂性骨折,在恢复了椎体高度同时重建了脊柱稳定性,并有效的恢复了神经空间,减少了术后并发症.     

椎弓根钉治疗胸腰椎爆裂性骨折47例

目的:探讨经后路短节段椎弓根钉非融合内固定联合椎体自成形治疗胸腰椎爆裂性骨折的有效性。方法:对47例胸腰椎爆裂性骨折患者应用后路椎板小开窗,通过足形椎体打平器将骨块复位并塌陷,短节段椎弓根钉非融合内固定,术后佩戴腰围支具活动,术后10~15个月取出钉棒内固定系统。结果:47例椎体高度与正常椎体高度比值、Cobb角、椎管占位率及神经脊髓损伤按Frankel分级,术后及1.5年后随访,与术前相比差异有统计学意义(P<0.05)。结论:胸腰椎爆裂性骨折行短节段椎弓根钉非融合内固定,既能最大程度保留后柱结构,又能直接对骨折复位,减少椎体内空隙,加强了椎体强度,从而减少伤椎高度的丢失,有效防止腰椎后突畸形的发生。     

椎弓根完整度与胸腰椎爆裂性骨折内固定方式

目的:探讨伤椎椎弓根完整程度不同的胸腰椎爆裂性骨折经后路椎弓根钉内固定治疗的方法选择及疗效。方法:根据伤椎椎弓根解剖完整性,将32例胸腰椎爆裂性骨折分为3组,即无损伤(I组)、单侧损伤(II组)以及双侧损伤(III组),行后路减压、复位,分别给予6枚、5枚以及8枚椎弓根钉固定术,术后对椎体高度恢复及后凸畸形矫正情况进行随访。结果:随访12~36月,30例椎体高度恢复90%~98%,后凸成角畸形矫正;未见内固定断裂、螺钉拔出等。患者可早期佩戴支具下地行走,康复锻炼,随访满意。结论:胸腰椎爆裂性骨折后路内固定椎弓根钉的选择,应基于伤椎椎弓根的解剖完整性,避免应力集中,防止内固定失败。     

经伤椎椎弓根椎体植骨短节段内固定治疗胸腰椎爆裂骨折

目的探讨经伤椎椎弓根椎体植骨结合后路短节段内固定治疗胸腰椎不稳定爆裂骨折的临床疗效。方法应用椎弓根内固定系统治疗胸腰椎不稳定爆裂性骨折22例,同时经伤椎椎弓根椎体内植入骨粒,10例术中行后路椎板减压。结果本组获随访12~24个月,椎体高度和后凸角无明显丢失,无内固定松动、断裂。结论椎弓根内固定为脊柱提供早期稳定性,经椎弓根椎体内植骨使伤椎获得坚强愈合为脊柱提供长期稳定,两者相结合疗效满意。     

经椎弓根植骨治疗胸腰椎爆裂骨折

目的评估经椎弓根植骨在治疗胸腰椎爆裂性骨折中的作用。方法胸腰椎爆裂性骨折32例,采用后路短节段椎弓根复位内固定后,取自体髂骨剪成碎沫状,经伤椎椎弓根植入伤椎椎体内。术前、术后及随访期间拍摄胸腰椎X线片,测量伤椎高度与正常高度的比值、脊柱后凸Cobb角,对测量数据作统计学分析。结果术后伤椎中央高度、脊柱后凸Cobb角得到明显恢复,未发生内置物断裂和螺钉松动现象,随访期间无明显矫正度丢失。结论经伤椎椎弓根椎体内植骨是一种防止内固定失败和矫正度丢失的有效方法。     

椎弓根钉固定结合伤椎自体骨椎体成形和横突间植骨治疗胸腰椎爆裂骨折

目的 探讨椎弓根钉固定结合伤椎自体骨椎体成形和横突间植骨治疗胸腰椎爆裂性骨折的临床疗效.方法 采用后路椎弓根钉撑开复位后经伤椎单侧或双侧椎弓根自体骨植入椎体成形和横突间植骨治疗胸腰椎爆裂性骨折69例.结果 均顺利完成手术无症状性并发症发生.45例脊髓神经不完全损伤患者,按美国脊髓损伤学会标准评定,术后神经功能均有1级或1级以上恢复.术后末次随访测得椎体前、后缘及中央高度压缩率及Cobb角,与术前相比差异有统计学意义(P<0.05),而与术后即刻相比无统计学意义(P>0.05).骨折椎体高度恢复并维持良好,Cobb角有显著改善.结论 后路椎弓根钉撑开复位后经伤椎单侧或双侧椎弓根自体骨植入椎体成形和横突间植骨治疗胸腰椎爆裂性骨折是一种安全、有效的方法,它可重建并维持脊柱稳定性,提高疗效.     

经伤椎椎弓根植骨结合椎弓根螺钉治疗胸腰椎骨折远期疗效

目的 探讨经伤椎椎弓根植骨结合椎弓根螺钉治疗胸腰椎爆裂性骨折的远期疗效.方法 采用经伤椎椎弓根椎体内植骨结合后路短节段椎弓根螺钉内固定、椎管减压治疗胸腰椎爆裂性骨折62例.测量伤椎椎体前缘、中央及后缘高度压缩率变化,Cobb角改善情况;经伤椎椎弓根平面CT扫描,观察椎管减压及椎体内植骨融合情况.结果 术后全部患者经随访...     

Intubation with propofol augmented with intravenous lignocaine

Sixty patients of ASA grade 1 and aged 18 to 55 years were admitted to a double-blind study. Anaesthesia was induced with propofol 2.5 mg/kg after intravenous pretreatment with lignocaine 1.5 mg/kg or a similar volume of isotonic saline. The quality of subsequent tracheal intubation was graded and the pressor response to tracheal intubation assessed. There were no significant differences between treatment groups.     

510例腹腔镜联合纤维胆道镜胆总管切开取石术的临床应用

目的探讨腹腔镜联合纤维胆道镜治疗胆总管结石的可行性及临床应用价值。方法1998年～2007年对510例患者行腹腔镜胆总管切开取石(laparoscopic common duct exploration,LCDE),与同期300例开腹(opensurgery,OS)手术者比较。术前确诊者,术中直接行胆总管切开胆道镜取石;术前有黄疸史、胰腺炎史和(或)直接胆红素增高、胆系酶(AKP、GGT)增高者,或胆总管在0.8cm以上者行术中造影,明确有胆总管结石的切开胆总管胆道镜取石。405例置T管引流(留置T管组),105例行胆总管Ⅰ期缝合(I期缝合组)。结果手术均获成功,与OS组比较,手术时间、术中出血量、术后并发症发生率(胆瘘、出血)差异无统计学意义;住院日、术后镇痛药使用次数、腹腔或切口感染率、残石率明显减少。无中转开腹。30例T管引流口靠近肋弓而引起术后疼痛,2例术后2dT管才引流出胆汁。留置T管组有24例胆总管残余结石,3月后经胆道镜取石成功。留置T管组手术时间平均(110±15)min,平均术后住院8d;Ⅰ期缝合组手术时间(95±8)min,平均术后住院5d。结论LCDE是治疗胆总管结石安全、有效的方法,同样可起到创伤小、痛苦轻、恢复快、住院时间缩短等微创效果,如能在取净结石的情况下行胆总管Ⅰ期缝合,微创效果尤为明显。     

Clinical outcomes in patients with renal artery stenosis treated with stent placement with embolic protection compared with those treated with stent alone

Purpose: To compare the clinical outcomes in patients with chronic renal insufficiency (CRI) and renal artery stenosis (RAS) following renal artery (RA) stent placement with and without embolic protection device (EPD) usage. Materials and Methods: Eighteen patients who had RA stent placement with EPD were matched to control patients (RA stent only). Blood pressure, number of hypertensive medications, and estimated glomerular filtration rate (eGFR) at 3 months before the procedure and after 12 months were determined. An increase of ≥ 20% in eGFR at 12 months from baseline was defined as "improvement," decrease of ≥20% as "deterioration," and an eGFR change between those values as "stabilization" at 12 months. Results: At 12 months, stage 4 patients treated with EPD had significantly higher eGFR than controls (P = .01). There was no statistical difference in blood pressure outcomes between the 2 groups. Conclusions: Patients with stage 4 CRI did significantly better with EPD than those treated without it.     

腹腔镜与胆道镜联合取石术治疗肝内胆管结石的临床研究

目的:探讨腹腔镜联合胆道镜治疗肝内胆管结石的临床价值。方法:随机将80例肝内胆管结石患者分为2组,实验组(n=45)行腹腔镜联合胆道镜取石术,对照组(n=35)行单纯腹腔镜手术。结果:实验组45例手术均获成功,手术时间110～118 min,平均(160±15)min;术中出血量45～280 ml,平均(140±60)ml;住院6～8天,平均(7±2)天;42例结石完全取净,结石清除率93.3%,术后无一例发生胆漏、出血、脓肿等并发症。对照组手术时间130～220 min,平均(150±30)min;术中出血量80～350 ml,平均(180±75)ml;住院8～12天,平均(9±1)天;32例结石完全取净,结石清除率91.4%,术后2例发生胆漏。两组患者手术时间、术中出血量、住院时间差异有统计学意义(P<0.05),结石完全取净率及并发症发生率差异无统计学意义(P>0.05)。术后随访所有患者3～6个月,经胆道镜复查无一例复发。结论:腹腔镜术中联合胆道镜治疗肝内胆管结石安全有效,值得推广应用。     

Variables associated with survival in patients with invasive bladder cancer with and without surgery

We recorded the survival of 141 patients assessed for radical cystectomy, which included cardiopulmonary exercise testing. The median Kaplan-Meier survival estimates were: 1540 days for the whole cohort; 2200 days after cystectomy scheduled (n = 108); and 843 days without surgery. The mortality hazard remained double that expected for a matched general population, but survival was better in patients scheduled for surgery than those who were not: the mortality hazard ratio (95%CI) after cystectomy was 0.43 (0.26–0.73) the mortality hazard without surgery, p = 0.001. The mortality hazard ratios for the three-variable Bayesian Model Averaging survival model for all 141 patients were: referral for surgery (0.5); haemoglobin concentration (0.98); and efficiency of carbon dioxide output (1.05). Efficiency of carbon dioxide output was the single variable in the postoperative model (n = 108), mortality hazard 1.08 (per unit increase). The ratio of observed to expected peak oxygen consumption associated best with mortality in 33 patients not referred for surgery, hazard ratio 0.001. Our results can inform consultations with patients with invasive bladder cancer and suggest that interventions to increase fitness and haemoglobin may improve survival in patients who do and who do not undergo radical cystectomy.