1例严重腰骶段后凸畸形患者围手术期的护理

腰骶段后凸畸形在临床上并不常见,因为结核病导致的腰骶段后凸严重畸形更是罕见。因结核造成腰骶段骨质破坏,解剖结构改变,给手术带来很大风险,治疗有一定难度,使护理极具挑战性,到目前为止,文献少有报道。2006年9月,我科收治1例因结核病导致的严重腰骶段后凸畸形病例,行手术治     

1例严重腰骶段后凸畸形患者围手术期的护理

腰骶段后凸畸形在临床上并不常见,因为结核病导致的腰骶段后凸严重畸形更是罕见.因结核造成腰骶段骨质破坏,解剖结构改变,给手术带来很大风险,治疗有一定难度,使护理极具挑战性,到目前为止,文献少有报道.2006年9月,我科收治1例因结核病导致的严重腰骶段后凸畸形病例,行手术治疗,经康复护理,2周痊愈出院.现将其护理方面的经验报道如下.……     

后路半椎体切除固定矫形治疗胸腰椎半椎体畸形

目的:观察和评价先天性胸腰椎半椎体引起的侧后凸畸形经后路Ⅰ期半椎体切除、椎弓根内固定矫形的初期手术效果。方法:9例胸腰椎先天性半椎体引起的侧后凸畸形患者行经后路Ⅰ期半椎体切除及节段性椎弓根系统内固定矫形。随访7个月~2年(平均1年4个月)。术前、术后及随访时摄站立位脊柱全长正侧位片进行观察。结果:术后平均侧凸角度由52.3°改善至14.6°,侧凸矫正率72%;平均后凸畸形由29.6°矫正至12.1°,后凸矫正率59.1%;平均躯干侧移从18.3 mm矫正至4 mm。术后6个月侧凸矫正丢失平均3°,后凸矫正丢失平均2°,最大矫正丢失不超过7°。平均手术时间3 h 10 min(2~4.5 h)。术后1例出现脑脊液漏,1例术后感觉下肢麻木,应用脱水剂4 d后消失。术后2~4个月9例均获坚强融合。结论:由先天性半椎体所引起的胸腰椎脊柱侧后凸畸形可经Ⅰ期后路半椎体切除和节段性椎弓根系统内固定矫形而获得满意的矫形效果。手术适应证为由胸椎或胸腰段半椎体畸形所引起的青少年患者的结构性侧后凸畸形。     

腰骶椎结核一期前后路手术的围术期护理

目的：探讨一期前后路治疗腰骶段脊柱结核的围术期护理经验。方法对156例腰骶椎结核患者采用一期前后路手术治疗,术前做好心理指导、药物治疗与术前训练,术中术后加强体位护理、病情观察、并发症护理和功能锻炼指导,出院后予以电话追踪随访。结果经过合理规范的护理措施,本组156例腰骶椎结核患者中,140例患者术后近期疗效满意,一些常见并发症均通过密切观察、精细护理得到及时改善和缓解。在术后平均1．5年的随访中,6例复发再次手术,10例仍有大小便功能障碍,均进行术后的康复锻炼,患者均取得较好的效果。结论合理规范的护理措施及康复护理方法,术前术后的抗结核药物用药指导,全程细致的心理干预,对减少患者围手术期并发症,促进患者康复极为重要。     

10例前路后凸顶椎前移方法矫正脊柱结核伴严重后凸畸形病人的围手术期护理

目的: 探讨前路后凸顶椎前移方法矫正脊柱结核严重后凸畸形病人的围手术期护理方法.方法: 对10例进行前路后凸顶椎前移方法矫正脊柱结核严重后凸畸形的患者做好心理康复指导、饮食及用药指导、呼吸功能康复训练、术后体位训练、脊髓功能观察、肢体功能康复锻炼及详尽的出院指导.结果: 进行系统全面的围手术期护理后,患者无一例并发症发生.结论: 针对脊柱结核严重后凸畸形的患者的特点,采取相应的护理措施,对减少术后并发症,促进病员早期康复,提高术后生存质量有重要意义.     

陈旧性胸腰段骨折继发后凸畸形前后路手术对比研究

目的评估陈旧性胸腰段骨折继发后凸畸形两种术式的治疗效果。方法回顾总结2003年5月—2009年8月我院诊治的40例陈旧性胸腰段骨折继发后凸畸形病人,行前路手术者18例,后路手术者22例。比较两种术式的临床疗效。结果两种术式都获得比较理想的临床结果,术后随访除1例全瘫病人无任何恢复外,其他病例都有不同程度的神经功能恢复及症状缓解,两种术式之间比较无明显差异。结论对于脊髓神经功能的恢复和COBB角的改善,前路和后路手术均获满意疗效。     

105例严重脊柱侧后凸畸形患者三柱截骨矫形术围手术期的护理要点

目的 总结严重脊柱侧后凸畸形患者行脊柱后路三柱截骨矫形手术的围手术期护理要点.方法 通过回顾105例严重脊柱侧后凸畸形患者的围手术期护理过程,总结对该类患者的护理评估、观察要点和专科护理干预措施.对于患者的护理包括术前认真访视,评估患者心肺功能,指导患者进行唤醒试验训练;术中保障静脉通路通畅,密切监测神经功能,协助顺利...     

脊柱侧凸矫形术围术期护理干预

[目的]探讨脊柱侧凸矫形术围手术期的护理干预要点.[方法]总结168例脊柱侧凸矫形术患者术前心理护理、饮食指导、肺功能锻炼、脊柱柔韧性功能锻炼和牵引护理及术后生命体征、脊髓神经功能观察以及胃肠道、体位管理和功能康复要点.[结果]168例脊柱侧凸矫形术患者手术疗效显著,均安全度过围手术期,无护理并发症发生.[结论]对脊柱侧凸患者围手术期进行正确综合护理干预,是保证手术安全、避免术后并发症、促使患者术后早日康复的重要举措.     

老年骨质疏松性椎体压缩骨折行椎体后凸成形术围手术期的护理

目的:总结经皮椎体后凸成形术治疗老年骨质疏松性压缩骨折的围手术期护理方法。方法:选取我科收治的轻微摔伤所致老年骨质疏松性椎体压缩骨折患者43例,接受经皮椎体后凸成形术,术前给予心理护理,术前准备,术后监测生命体征,观察并发症情况及早期康复锻炼并给予出院指导。结果:43例患者手术有效率100%,经精心护理,无护理相关并发症发生。结论:经皮椎体后凸成形术治疗老年骨质疏松性椎体压缩骨折创伤小,疗效可靠,术前充分的护理准备及术后的科学护理是手术疗效满意的重要保证。     

脊椎结核伴角状后凸畸形11例治疗分析

目的:探讨一期后路病灶清除,全脊椎切除前方垫高逐步矫形治疗脊椎结核角状后凸畸形临床疗效及安全性.方法:脊柱结核伴角状后凸畸形病例11例,男7例,女4例;年龄19 ～ 59岁;病变位于胸椎2例,胸腰段7例,腰椎2例;术前矢状位cobb角36～110°,并神经功能损害9例,Frankel分级D级6例,C级3例,用一期后路病灶清除,在椎弓根钉棒系统内固定及全脊椎切除基础上,多次换棒椎体前方垫高逐步矫形的方法治疗,随访观察治疗效果.结果:手术时间240 ～ 360 min,术中出血900～2 500 mL,脊髓短缩≤1 cm,脊柱恢复到生理曲度,平均cobb角矫正67.9.神经功能获得1级以上的改善.结论:对脊柱结核并角状后凸畸形的患者一期行后路病灶清除,在内固定下行全脊椎切除矫形的治疗效果满意,前方垫高逐步矫形是手术安全的关键,钛网周围的颗粒植骨可以促进植骨融合.     

Thoracic kyphosis affects spinal loads and trunk muscle force

BACKGROUND AND PURPOSE: Patients with increased thoracic curvature often come to physical therapists for management of spinal pain and disorders. Although treatment approaches are aimed at normalizing or minimizing progression of kyphosis, the biomechanical rationales remain unsubstantiated. SUBJECTS: Forty-four subjects (mean age [+/-SD]=62.3+/-7.1 years) were dichotomized into high kyphosis and low kyphosis groups. METHODS: Lateral standing radiographs and photographs were captured and then digitized. These data were input into biomechanical models to estimate net segmental loading from T2-L5 as well as trunk muscle forces. RESULTS: The high kyphosis group demonstrated significantly greater normalized flexion moments and net compression and shear forces. Trunk muscle forces also were significantly greater in the high kyphosis group. A strong relationship existed between thoracic curvature and net segmental loads (r =.85-.93) and between thoracic curvature and muscle forces (r =.70-.82). DISCUSSION AND CONCLUSION: This study provides biomechanical evidence that increases in thoracic kyphosis are associated with significantly higher multisegmental spinal loads and trunk muscle forces in upright stance. These factors are likely to accelerate degenerative processes in spinal motion segments and contribute to the development of dysfunction and pain.     

Thoracic kyphosis and mobility: the effect of age

A profile of thoracic kyphosis and range of motion in all directions has been documented in an ageing population of 120 normal adult females. Kyphosis and sagittal plane movement were measured with an inclinometer, frontal plane movement with Myrin goniometers, and horizontal plane movement with a modified lumbar rotameter.

The angle of kyphosis increased significantly with age (p< 0.001), ranging from 41 ± 9° in subjects in their 3rd decade to 60 ± 10° in subjects over 70 years. Significant changes in angle of kyphosis occurred only after the 5th decade. Range of thoracic spine movement decreased significantly with age in all directions in which measurements were made (p< 0.001). Statistical analysis of the results obtained suggests that ageing restricts movements of the thoracic spine more rapidly in some directions than in others     

Scheuermann's thoracic kyphosis in the adolescent patient

Scheuermann's thoracic kyphosis is a condition characterized by increased posterior rounding of the thoracic spine in association with structural deformity of the vertebral elements. It is a structural deformity of the spine that is classically characterized by anterior wedging of 5° or more of 3 adjacent thoracic vertebral bodies with kyphosis measuring greater than 45° between T5 and T12. The cause of the deformity remains unknown but it is believed to be multifactorial, and it likely has a genetic component as well. Most adolescent patients seek orthopaedic evaluation for increased rounding and deformity of the thoracic spine that is occasionally associated with back pain. Parental concerns are also often related to the cosmetic deformity and the progressive nature of the condition. Bracing has been demonstrated to be an effective nonsurgical treatment modality for the skeletally immature child and/or adolescent with a progressive deformity. Operative management has been advocated for adolescents with progressive kyphosis measuring over 70°, for those who have had progression despite bracing, for patients with intractable back pain, and also for patients with unacceptable cosmetic deformity. Surgical options include posterior spinal arthrodesis with or without anterior spinal release via thoractomy or video-assisted thoracoscopic surgery (VATS). This article will review the diagnosis, pathophysiology, physical examination findings, and the nonoperative and surgical treatment options for adolescent patients with Scheuermann's kyphosis of the thoracic spine.     

钛网及植骨融合修复中重度脊柱后凸畸形

背景：有学者提出的经前路矫正脊柱结核后凸畸形和解除脊髓压迫的治疗方法,可能会有植骨块塌陷、吸收或断裂的并发症。研究证实,通过一期前后路联合内固定可增加对后凸畸形的矫正力量,避免出现植骨并发症、降低假关节的形成并有助于患者早期下地活动及功能恢复。目的：分析评价2个或多个节段受累伴中重度后凸畸形的脊柱结核患者,一期行前后路病灶清除、植骨融合内固定矫正后凸畸形的临床疗效。方法：回顾性分析20例脊柱胸腰段有2个或更多节段受累的结核患者,一期行后路内固定融合并前路病灶清除钛网融合内固定。所有患者内固定后持续9个月抗结核化疗,最初3个月采用四联抗结核药物,后6个月采用三联抗结核药物。随访时测量后凸角度,评价患者融合情况、神经病变和功能恢复状况。结果与结论：所有患者随访均超过37个月。所有患者均获得牢固节段融合重返工作岗位。内固定治疗后15例（75％）的患者仅残留局部轻度疼痛,3例（15％）活动受限明显。内固定前11例有神经功能障碍,内固定后9例神经功能完全恢复正常。后凸角度平均矫正了35．1。（84．8％）（P〈0．001）,在随访期间矫正丢失差异无显著性意义（P〉0．05）,未出现内固定及植骨相应并发症。结果表明,对于2个或更多节段受累伴有中重度后凸畸形的脊柱结核患者,应环形融合,即一期前后路联合内固定融合治疗。可获得更大矫正,有助于患者早期下地活动,稳定病变节段,而且可以长期有效地维持矫正效果。     

Lung function in relation to thoracic spinal mobility and kyphosis

Mobility and kyphosis of the thoracic spine were correlated with lung function in 185 men and 87 women not suffering from respiratory disease. Curvatures of the spine were measured goniometrically with inclinometers and a compass, and lung function by spirometry. Vital capacity and forced expiratory volume in 1 sec had significant positive correlations only with forward and lateral flexion. The strongest correlations were with forward flexion (r = 0.16 to 0.24, p less than 0.05). The results and possible advantages of mobilizing the thoracic spine in pathological conditions of the lungs and the spine are discussed.     

Progressive cervical kyphosis associated with botulinum toxin injection

Weakness of the neck extensors can lead to "dropped head syndrome", a condition of progressive cervical kyphosis in which a patient is unable to hold their head up against the force of gravity. This condition can be associated with structural abnormalities of the spine as found in ankylosing spondylitis and vertebral fractures. Neuromuscular disorders, such as myasthenia gravis, muscular dystrophies, inflammatory myopathies, and motor neuron disorders such as amyotrophic lateral sclerosis (ALS) have also been reported as etiologies of dropped head syndrome. In this article, we describe an elderly woman with rapidly progressive cervical kyphosis following an injection of botulinum toxin A into her neck extensor musculature.     

微创椎体后凸成形术病人的护理

随着社会的老龄化,骨质疏松椎体压缩骨折的发病率逐年上升,传统的治疗主要为保守治疗和卧床休息,该病引起的疼痛、脊柱畸形可使病人肺活量下降、食欲减退、睡眠受影响、活动量减少,形成恶性循环,导致并发症的发生[1].微创椎体后凸成形术主要适用于治疗骨质疏松性椎体压缩性骨折,尤其是经过保守治疗没有效果或者疼痛加重的情况和不宜长期卧床者,微创椎体后凸成形术创伤小、病人恢复快,不仅具有快速止痛和稳定脊柱的作用,还可恢复塌陷椎体高度,矫正后凸畸形[2].