后路椎管减压钉-棒内固定治疗腰椎爆裂性骨折并不全瘫48例

[目的]探讨后路椎板开窗减压并钉-棒内固定治疗腰椎爆裂性骨折伴不全瘫的临床效果.[方法]对48例腰椎爆裂性骨折伴不全瘫患者采用后路椎板间开窗减压、椎弓根螺钉固定,椎板、关节突及横突间植骨治疗,其中单侧椎板开窗28例、双侧椎板开窗减压20例.随访椎管内减压情况、椎体高度和神经功能恢复情况.[结果]所有患者椎管减压允分,椎体前缘高度由术前平均48.5%矫正到术后93.2%,后凸角(Cobb's角)由术前的平均28.5°矫正到术后的平均6.5°.37例获得随访,随访时间10～24个月,平均15个月.神经功能按Frankel分级,术后有1～3级恢复,X线片未见椎体高度及脊柱成角加重.[结论]经后路椎管减压钉-棒固定治疗腰椎爆裂骨折伴不全瘫,可同时解决脊髓或/和神经根减压和脊梓稳定的问题,在正确选择适应证的情况下,可取得良好的治疗效果.     

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。     

椎弓根钉伤椎固定加椎板重建治疗胸腰椎爆裂性骨折

目的 观察椎板切除椎管减压经伤椎椎弓根钉复位内固定结合硬膜外植骨重建椎板方法治疗胸腰椎爆裂性骨折的早、中期疗效.方法对22例胸腰椎爆裂性骨折行后路椎板切除椎管减压经伤椎椎弓根钉复位内固定术,在减压区硬膜外及椎板间植骨重建椎板.结果术后1周伤椎前缘高度由术前的(37±18)％恢复至(85±6)％,术后3个月及末次随访时均...     

钛网在胸腰椎骨折椎板切除术后椎管成形中的应用价值

目的探讨胸腰椎骨折减压术后利用钛板+自体骨植骨重建椎板恢复椎板连续性和脊柱后柱稳定的方法。方法回顾性分析自2012-01—2015-01诊治的胸腰椎骨折48例,行后路椎板切除、钉棒系统内固定、钛网+自体骨植骨融合术治疗。结果本组获随访12~24个月,平均16个月。术后CT及X线片显示植骨融合较好,钛板稳定,过伸过曲位相邻椎体无失稳表现。结论胸腰椎骨折伴脊髓受压患者大多需要行后路椎板切除、椎管探查减压,术中小关节突、椎板及棘突、脊上或棘间韧带受到不同程度破坏和缺失,对脊柱后柱造成影响。利用钛网板结合自体骨植骨融合进行椎板成形,对术后脊柱重建及后柱稳定有良好效果。     

胸腰椎骨折并侧方移位的分度及治疗

[目的]探讨胸腰椎骨折并侧方移位的临床特点、分度及治疗方法。[方法]回顾性分析本院2004年1月～2009年12月收住的60例胸腰椎骨折并侧方移位的临床资料和治疗效果。[结果]胸腰椎骨折并侧方移位合并椎体前或后脱位51例(85.0%),伴有附件骨折50例(83.3%)。临床分度:Ⅰ度19例,Ⅱ度21例,Ⅲ度13例,Ⅳ度5例,Ⅴ度2例。50例胸椎或腰椎骨折并侧方移位伴或不伴脊髓神经损伤的患者均采用前路骨折复位,减压融合,钛板内固定术,其余胸腰段骨折并全瘫的10例患者采用后路骨折复位,椎板减压,钉棒系统内固定术。所有患者均获得满意复位,均无螺钉置入椎间隙,无钛板、螺钉折断、滑脱等手术并发症。38例不全瘫和6例无脊髓神经损伤的患者复位后无症状加重,16例全瘫患者复位后瘫痪平面未升高。术后随访24～52个月,平均36.9个月。全瘫患者和不全瘫患者均有不同程度地恢复,术后3～12个月植骨融合,完全融合53例,部分融合7例,无椎体高度丢失。[结论]胸腰椎骨折并侧方移位属于不稳定性骨折,并容易引起脊髓神经损伤,应早期进行前路或后路手术治疗。     

椎板减压与非椎板减压椎弓根螺钉间接复位治疗胸腰椎爆裂性骨折的疗效分析

[目的]探讨利用椎弓根螺钉复位椎板减压与非减压2种方法治疗胸腰椎爆裂性骨折的临床疗效.[方法]采用后路椎弓根螺钉内固定治疗胸腰椎爆裂性骨折126例.[结果]将已随访的96例病人中选择54例随机分为两组:椎板减压组(A)27例,非椎板减压组(B)27例,病例随访时间9个月～11年.A组:术中出血平均800 ml,手术时间平均180 min.非减压组:术中出血平均350 ml,手术时间平均115 min.[结论]两组病例在伤椎高度的恢复、Cobb角恢复无统计学差异(P>0.05);非椎板减压组术中出血、手术时间有明显的差异(P<0.05);故非椎板减压椎弓根螺钉间接复位治疗胸腰椎爆裂性骨折,对于一定的病人群体,不失为一种值得推广的手术方法.     

后路椎管减压结合椎旁肌间隙入路复位植骨内固定治疗胸腰段骨折伴神经损伤

[目的]探讨采用后路椎管减压结合椎旁肌间隙入路复位植骨内固定治疗胸腰段骨折伴神经损伤的优越性。[方法]本院2011年10月~2014年2月间,收治胸腰段骨折伴神经损伤患者42例,均采用后路椎板减压复位植骨内固定治疗,其中传统组24例采用传统术式(后正中入路)完成整个手术,改良组18例采用后正中入路减压结合椎旁肌间隙入路复位植骨内固定治疗。对两组手术切口长度、手术时间、术中失血量、手术效果加以对比分析。[结果]相对于传统组,改良组手术切口较小,手术时间较短,术中失血量较少,差异有统计学意义(P0.05),手术效果则无显著差异(P0.05)。[结论]采用后路椎管减压结合椎旁肌间隙入路复位植骨内固定治疗胸腰段骨折伴神经损伤是一种合理、微创的手术方式。     

后路经关节突人路微创减压植骨内固定术治疗胸腰段爆裂性骨折研究

[目的]通过对比研究观察后路经关节突入路微创减压植骨内固定术患者的手术疗效。[方法]2007年6月～2009年6月,选择胸腰段外伤性爆裂性骨折患者共62例,男47例,女15例,年龄22～41岁。按自愿的方式随机分为两组,常规后路全椎板减压植骨融合组(N=32例):伤椎临近节段椎弓根螺钉置入复位后路全椎板减压后外侧植骨融合术;经关节突入路微创减压植骨内固定组(N=30例):伤椎及临近上下节段椎弓根螺钉置入复位经关节突入路微创减压植骨融合内固定。[结果]所有患者均完成1年随访,主要观察指标为术后随访时胸腰段骨折术后矫正率、患者术后腰痛JOA评分,通过对比研究分析可见微创手术组效果明显优于常规手术组。[结论]后路经关节突入路微创减压植骨内固定术对于胸腰段爆裂性骨折有很好的治疗效果,用微创减压植骨内固定技术可以在减少手术创伤的同时达到较好的稳定脊柱的效果,此方面的研究是脊柱微创外科的一个热点。     

半椎板切除脊髓减压治疗胸腰椎爆裂骨折

目的探讨胸腰椎爆裂性骨折的有效手术方式。方法对21例胸腰椎爆裂性骨折的患者,采用后路伤椎半椎板切除脊髓前后减压,椎弓根钉系统复位内固定的方法进行治疗,术后定期复查CT和X线片。结果经过平均15个月随访,神经功能获1~3级恢复,脊柱结构、伤椎形态、椎管形态基本得到了恢复,无断钉。结论后路半椎板切除脊髓前后减压是治疗胸腰椎骨折的有效方法,操作简便,创伤小,对脊柱结构破坏小,临床效果好,值得推广。     

半椎板切除减压植骨融合内固定治疗腰椎结核

[目的]评价后路半椎板切除全椎管减压、病灶清除、同种异体骨植骨融合内固定术治疗腰椎结核的临床效果。[方法]自2010年3月~2013年10月,本院采用经后路半椎板切除全椎管减压、病灶清除、同种异体骨植骨融合内固定术治疗腰椎结核患者32例。[结果]术后患者症状较前明显改善。术后VAS、ESR、CRP及Cobb’s角改善明显,JOA优良率为90.6%;ODI优良率为93.7%;术后1年X线片示融合率为90.6%。[结论]采用后路半椎板切除全椎管减压、病灶清除、同种异体骨植骨融合内固定术治疗腰椎结核是一种安全、有效的手术策略。     

Perioperative and long-term morbidity and mortality after above-knee and below-knee amputations in diabetics and nondiabetics

We performed a retrospective review of a vascular surgery quality assurance database to evaluate the perioperative and long-term morbidity and mortality of above-knee amputations (AKA, n = 234) and below-knee amputations (BKA, n = 720) and to examine the effect of diabetes mellitus (DM) (181 of AKA and 606 of BKA patients). All patients in the database who had AKA or BKA from 1990 to May 2001 were included in the study. Perioperative 30-day cardiac morbidity and mortality and 3-yr and 10-yr mortality after AKA or BKA were assessed. The effect of DM on 30-day cardiac outcome was assessed by multivariate logistic regression and the effect on long-term survival was assessed by Cox regression analysis. The perioperative cardiac event rate (cardiac death or nonfatal myocardial infarction) was at least 6.8% after AKA and at most 3.6% after BKA. Median survival was significantly less after AKA (20 mo) than BKA (52 mo) (P < 0.001). DM was not a significant predictor of perioperative 30-day mortality (odds ratio, 0.76 [0.39-1.49]; P = 0.43) or 3-yr survival (Hazard ratio, 1.03 [0.86-1.24]; P = 0.72) but predicted 10-yr mortality (Hazard ratio, 1.34 [1.04-1.73]; P = 0.026). Significant predictors of the 30-day perioperative mortality were the site of amputation (odds ratio, 4.35 [2.56-7.14]; P < 0.001) and history of renal insufficiency (odds ratio, 2.15 [1.13-4.08]; P = 0.019). AKA should be triaged as a high-risk surgery while BKA is an intermediate-risk surgery. Long-term survival after AKA or BKA is poor, regardless of the presence of DM.     

Body composition assessment and methodology in nonathletic and athletic adolescent and adult males and females

The purpose of this review is to outline methodology for assessing body composition utilizing anthropometric and densitometric techniques. The objective of body composition assessment is to measure body fat and lean body mass. The quantity of these components varies due to growth, physical activity, dietary regimens, and aging. Anthropometric techniques incorporate selected skinfolds, circumferences, skeletal widths, or other variables to estimate body composition within k2.0-4.0%. These techniques are adequate for field testing of groups or individuals, but are population specific. Densitometry measures body volume irrespective of physique, sex, or age. This laboratory technique estimates body composition within 1.0-2.0%, is more difficult to administer, but is not population specific. Some limitation exists with any present technique due to biological variability and incomplete research of reference body composition in children, females, and the aged. J Orthop Sports Phys Ther 1984;5(6):336-347.     

Postoperative nausea and vomiting and opioid-induced nausea and vomiting: guidelines for prevention and treatment

Postoperative nausea and vomiting (PONV) causes patient discomfort, lowers patient satisfaction, and increases care requirements. Opioid-induced nausea and vomiting (OINV) may also occur if opioids are used to treat postoperative pain. These guidelines aim to provide recommendations for the prevention and treatment of both problems. A working group was established in accordance with the charter of the Sociedad Espa?ola de Anestesiología y Reanimación. The group undertook the critical appraisal of articles relevant to the management of PONV and OINV in adults and children early and late in the perioperative period. Discussions led to recommendations, summarized as follows: 1) Risk for PONV should be assessed in all patients undergoing surgery; 2 easy-to-use scales are useful for risk assessment: the Apfel scale for adults and the Eberhart scale for children. 2) Measures to reduce baseline risk should be used for adults at moderate or high risk and all children. 3) Pharmacologic prophylaxis with 1 drug is useful for patients at low risk (Apfel or Eberhart 1) who are to receive general anesthesia; patients with higher levels of risk should receive prophylaxis with 2 or more drugs and baseline risk should be reduced (multimodal approach). 4) Dexamethasone, droperidol, and ondansetron (or other setrons) have similar levels of efficacy; drug choice should be made based on individual patient factors. 5) The drug prescribed for treating PONV should preferably be different from the one used for prophylaxis; ondansetron is the most effective drug for treating PONV. 6) Risk for PONV should be assessed before discharge after outpatient surgery or on the ward for hospitalized patients; there is no evidence that late preventive strategies are effective. 7) The drug of choice for preventing OINV is droperidol.     

Similarities and differences between female and male sexual functions and dysfunctions

Men and women have 23 pairs of chromosomes. They share 22 of them. In physiologic conditions they differ systematically in only one pair, the sexual one. Females (normally) have what is called an “XX” on the 23rd pair of chromosomes, whereas males have an “XY” pair. The striking sexual differences –anatomic, functional, reproductive, psychological and sociocultural - between men and women depends on or derive from the difference in one critical chromosome out of 46, which contains on average 2% of all the genetic code. Biochemical, neuroendocrine, hormonal, vascular, nervous, and metabolic similarities that both sexes share, based on the common 45 chromosomes and related biologically determined similarities contributing to the secret sexual symmetry between genders, is reviewed. Furthermore the role of the genetically determined brain and somatic gender dymorphism, contributing to gender sexual differences is analyzed. Neuroplasticity and psychoplasticity are praised as basic mechanisms that bridge together and re-shape the individual biological and psychological world through the continuous interaction with the environment. Enhancement of sexual differences in behaviour, meaning of, and motivation to sex by cultural constructs, by religious and social dynamics, and the continuous interaction of each person with a usually role-polarized society during the whole life span will be finally acknowledged. To contribute to a better understanding of the shared biological sexual similarities between genders and their dialectic and continuous relation with biological and socioculturally related sexual differences is the ultimate goal of this introductory article and the following papers of the series.