经口咽下颌骨劈开入路处理上颈椎或上、下颈椎腹侧病变

目的：探讨经口咽下颌骨劈开入路处理上颈椎或上、下颈椎腹侧病变的临床效果。方法：采用经口咽唇面下颌骨劈开入路处理伴有下颌关节僵直的陈旧性寰枢椎脱位1例，行TARP钢板内固定术；处理枢椎体肿瘤1例，行C2椎体肿瘤切除，异形钛网笼置入重建椎体，同期行后路C1～C3椎弓根钉棒植骨内固定术。采用经口、舌、唇面下颌骨劈开入路处理C1～C5肿瘤1例，行肿瘤切除，异形钛网笼置入重建C2～C4椎体，同期后路C1～C5附件肿瘤切除．枕颈植骨融合内固定术。随访观察治疗效果。结果：病变部位显露满意，顺利完成手术操作。随访12～24个月。2例肿瘤患者的肿瘤切除彻底，前路椎体重建满意，后路内固定稳妥，临床症状消失，行走正常；1例寰枢椎陈旧性脱位患者的寰枢椎达解剖复位，颈髓减压充分，C1～C2前路内固定稳妥，临床症状消失。结论：经口咽下颌骨劈开扩大入路适合于处理同时累及上下颈椎的腹侧病变或患者张口困难的上颈椎腹侧病变。     

脊柱转移瘤病椎切除及稳定性重建

目的 探讨脊柱转移瘤切除、融合及稳定性重建在治疗转移性脊柱肿瘤中的必要性和可行性.方法 2002年6月-2007年8月对11例脊柱转移瘤患者行前路病椎切除自体髂骨植骨钛板内固定术或联合后路椎板切除减压术治疗,随访观察患者术后局部疼痛缓解,脊髓神经功能恢复及脊柱稳定性情况.结果 术后颈肩腰背痛及放射痛基本缓解,早期开始肢体功能锻炼,术后3～5周佩戴支具离床活动.随访5个月～2年,患者神经压迫症状明显改善.内固定物无松动、断钉现象,椎体尤塌陷结论前路手术切除病变椎体并自体髂骨植骨前路钛板内固定重建脊柱稳定性或联合后路椎板切除减压治疗脊柱转移瘤是可行性的,可提高患者生存期内的生活质量.     

脊柱活动节段脊索瘤的外科治疗及其预后(附15例报告)

[目的]探讨脊柱活动节段脊索瘤外科治疗方式与疗效。[方法]对接受手术治疗的15例脊柱活动节段脊索瘤病人的临床资料进行回顾性分析。根据肿瘤WBB（Weinstein-Boriani-Biagini）分期，肿瘤主要位于椎体范围内，即4～9扇区内7例，累及椎体且超过一侧4扇区或9扇区4例，同时超过两侧4扇区和9扇区4例；肿瘤侵及A-D层13例，A—C层2例；单椎节骨质破坏9例，2个椎节骨质破坏5例，累及3个椎节1例。手术行椎体或矢状切除10例，全脊椎切除5例。后路重建4例（4例病灶均位于上颈椎），前路重建3例，前后联合重建8例。术中取大块自体骨（髂骨或肋骨）或钛网＋植骨块融合9例，钛网＋骨水泥填塞支撑6例。术后均辅以瘤灶局部放疗。[结果]患者术后临床症状改善明显，神经功能恢复满意，植骨融合率100％。随访14～123个月，平均56．2个月，局部复发7例，死亡4例，未见远处转移病例。[结论]脊柱活动节段脊索瘤临床发病较少，早期症状不典型。应注重肿瘤的早期诊断与治疗。手术切除是治疗脊柱脊索瘤的主要手段，全脊椎切除能明显降低复发率。术后辅助以肿瘤病灶局部放疗对抑制肿瘤复发或进展有积极作用。     

前、后联合入路全脊椎切除附加内固定治疗颈椎骨肿瘤39例报告

目的探讨对颈椎骨肿瘤采用前后联合入路全脊椎切除、内固定重建技术的疗效及其预后。方法1998年10月至2003年10月,对39例颈椎(C3-7)骨肿瘤患者实施全脊柱切除术。其中原发性骨肿瘤34例,包括骨巨细胞瘤14例,浆细胞瘤6例,神经鞘瘤(侵及椎体)1例,软骨肉瘤4例,骨母细胞瘤4例,恶性神经鞘瘤2例,动脉瘤样骨囊肿2例,脊索瘤1例;转移性肿瘤5例,原发灶来源于甲状腺癌、前列腺癌各2例,肺癌1例。经前后联合入路行单椎节切除29例、双椎节切除7例、3个椎节切除3例。经一期或二期前后联合入路行肿瘤切除与内固定重建。前路采用钛网植骨加AO、Orion、Zephir或者Codman等带锁钢板内固定,后路Cervifix、AXIS内固定重建。结果术后随访6个月至5年,绝大多数患者术后近期疗效较满意,局部疼痛和神经症状均有不同程度改善或缓解,19例脊髓神经功能完全恢复。1例术后出现一过性瘫痪加重,1例恶性神经鞘瘤术后1年局部复发,1例转移癌患者于术后25个月因全身衰竭死亡。结论全脊椎切除能显著降低颈椎原发性骨肿瘤局部复发率,改善脊髓神经功能,提高手术疗效。     

颈椎椎管内外生长的哑铃型肿瘤的手术治疗

目的探讨颈椎椎管内外生长的哑铃型肿瘤的显微外科手术及颈椎前路减压钛网植入锁定钢板内固定和颈椎后路侧块螺钉钢板固定两者联合治疗的方法和特点。方法分析13例颈段哑铃型椎管内肿瘤病人的临床特点、影像学特征、显微手术及颈椎前路减压钛网植入锁定钢板内固定和颈椎后路侧块螺钉钢板固定两者联合治疗的方法与治疗结果。结果 13例患者术前MRI检查明确诊断,CT颈椎重建明确肿瘤相邻颈椎椎体及其附件的破坏程度。所有患者均行显微手术切除肿瘤,同时行颈椎前路减压钛网植入锁定钢板内固定加颈椎后路侧块螺钉钢板固定的方法。肿瘤全切11例,部分切除2例,所有患者术后颈椎稳定性良好。结论颈椎椎管内外生长的哑铃型肿瘤往往伴有不同程度的椎体及其附件的破坏,单纯切除肿瘤会造成颈椎稳定性受损,患者需要行颈椎前路减压钛网植入锁定钢板内固定和颈椎后路侧块螺钉钢板固定两者联合治疗的方法,以防术后颈椎不稳而造成脊髓压迫。     

脊柱肿瘤的全脊椎切除术及脊柱稳定性重建

目的探讨对脊柱肿瘤行全脊椎切除术的可行性与临床价值,以及重建脊柱稳定性的可靠方法。方法对27例椎体和附件结构均遭破坏的脊柱肿瘤采用全脊椎切除及内固定重建技术进行治疗,其中包括上颈椎至下腰椎的良、恶性及转移性肿瘤,手术切除1～3节脊椎。结果23例获完整随访,随访时间7～96个月(平均25个月)。1例L5恶性神经纤维瘤及1例C6,7巨细胞瘤于术后10个月及12个月复发,患者放弃治疗;1例C2～4脊索瘤术后1年复发,再次手术效果良好;其余20例未见复发。25例术前伴神经功能损害者,术后有23例获显著改善。结论全脊椎切除术为治疗全脊椎受累脊柱肿瘤的有效方法;切除1～3节脊椎的脊柱可由相应内固定系统进行可靠的稳定性重建。     

颈椎转移瘤外科治疗效果及不同术式选择策略

目的 探讨不同解剖节段颈椎转移瘤外科治疗术式选择策略及疗效.方法 回顾性分析20018月至2009年接受手术治疗的31例颈椎转移瘤患者的临床资料,将颈椎按照解剖特点分为上颈椎(C1,C2)和下颈椎及颈胸段(C3～T1).分别对患者的疼痛程度、神经功能、预期生存时间和一般状态进行评价.分析患者术后的症状改善、生存时间及术式选择的特点.结果 31例患者中24例获得随访,患者颈痛症状和生活质量明显改善,术后中位生存时间为45个月.依解剖特点不同采用不同的术式:C1,C2转移瘤患者根据手术方式不同分为后路枕颈固定联合125I放射性粒子植入组(粒子植入组)和其他外科治疗组,粒子植入组术后中位生存时间(48.0±27.0)个月长于其他外科治疗组(22.0±8.3)个月.C3～T1转移瘤患者根据手术方式不同分为前路椎体切除组和前后路联合切除组,前后路联合切除组术后中位生存时间45.0个月长于前路椎体切除组18.0个月.结论 外科治疗能有效地缓解颈椎转移瘤患者的疼痛症状、维持或改善神经功能、提高生活质量.上颈椎转移瘤外科治疗以稳定为主,常选择后路枕颈固定术,联合放射性粒子植入有助于局部病灶的控制.下颈椎及颈胸段转移瘤外科治疗以前路椎体次全切除、内固定为主,满足相应条件者可行前后联合入路全脊椎切除术.     

内窥镜辅助下前路上颈椎肿瘤切除与稳定性重建

目的:探讨前路内窥镜辅助下经颈动脉三角C1～C2肿瘤切除、稳定性重建和后路内固定的手术特点以及临床治疗效果。方法:2006年1月～2009年12月收治8例上颈椎肿瘤患者,男性5例,女性3例,年龄16～51岁,平均35.6岁。枕颈部疼痛不适5例,合并神经症状3例(Frankel分级C级1例,D级2例)。均以枢椎椎体破坏为主,同时累及枢椎后柱者3例,累及寰椎前弓者1例。浆细胞瘤3例,转移癌2例,骨软骨瘤1例,嗜酸性肉芽肿1例,动脉瘤样骨囊肿1例。采用一期后路内固定植骨联合前路内窥镜辅助下肿瘤切除自体髂骨植骨重建,术后良性病变患者定期随访观察,原发恶性肿瘤及转移癌患者行辅助放疗或化疗。对所有患者临床资料进行回顾性分析。结果:围手术期无严重并发症发生。随访9个月～4年,平均24个月,CT证实植骨获得满意融合。3例术前伴有神经功能损害者末次随访时Frankel分级各改善1级。1例转移癌患者于术后11个月时死于肺癌,另1例转移癌患者术后9个月复发并出现多个椎体转移,1例浆细胞瘤患者术后17个月随访时转为多发性骨髓瘤,其余5例患者未见肿瘤复发或转移。结论:前路内窥镜辅助下切除上颈椎肿瘤、稳定性重建并后路内固定能够在一定程度上克服传统手术显露困难的缺点,减少手术并发症,但如何完成肿瘤一期彻底或整块切除还有待进一步研究。     

一期经口前路肿瘤切除和前后路椎体重建治疗枢椎骨巨细胞瘤

目的：探讨枢椎肿瘤切除和椎体重建的新方法.方法：采用经口咽入路枢椎体肿瘤切除,改良异形钛笼重建椎体,同期后路寰椎椎弓根和第三颈椎侧块钉棒固定植骨融合治疗枢椎体骨巨细胞瘤,并辅以放疗.结果：术后患者临床症状立即消失,行走正常,影像学示肿瘤切除干净,脊椎重建固定稳妥.结论：一期经口前路联合后路行枢椎肿瘤切除椎体重建是治疗枢椎肿瘤的可行方法,但远期疗效有待观察.     

胸腔镜辅助下前路手术治疗胸椎肿瘤

目的：探讨在胸腔镜辅助下行胸椎转移性肿瘤前路手术切除的方法及效果。方法：在胸腔镜辅助下对11例胸椎转移瘤患者行病椎切除及椎体重建术，术前神经功能ASIA分级A级1例，C级6例，D级4例。7例行病椎切除及钢板骨水泥椎体重建术；4例行病椎切除、钢板骨水泥椎体重建及内固定术。结果：手术均获成功，术中肿瘤切除满意，术后影像学显示内固定固定确切。随访4～14个月，平均8个月，胸背痛均完全消失．术后神经功能除1例A级无恢复外，其余均明显恢复；1例冈肿瘤脑转移4个月死亡，其余患者存活8个月以上．其中1例乳腺癌术后多椎体转移患者手术后14个月随访时仍存活。结论：在胸腔镜辅助下行胸椎转移肿瘤切除椎体重建术安全、有效，可提高患者的生活质量。     

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.