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1.
目的测量国人腰椎椎间盘(L_(1、2)~L_5S_1)MRI T2像横断面上多裂肌与最长肌间隙至棘突正中线的距离并进行统计学分析。方法选取自2013-01—2015-01行腰椎MRI检查的正常人,排除腰椎畸形及腰椎手术史。在腰椎MRI T2像横断面,测量L_(1、2)~L_5S_1椎间盘水平多裂肌弧形最凸点到棘突正中线距离,比较性别之间的差异。采用双变量相关分析各节段距离与身高、体重、体重指数、年龄的相关性。结果男性和女性在同一椎间盘水平多裂肌弧形最凸点到棘突正中线距离差异无统计学意义(P0.05)。L_(1、2)~L_5S_1椎间盘水平多裂肌弧形最凸点到棘突正中线距离差异有统计学意义(P0.05),但与身高、体重、体重指数及年龄没有相关性(P0.05)。结论腰椎椎旁肌间隙至棘突正中线距离不受身高、体重、体重指数及年龄的影响。采用Wiltse入路手术之前测量MRI T2像横断面上多裂肌弧形最凸点到棘突正中线距离有利于术者对患者个体差异作出判断,从而减少医源性损伤。  相似文献   

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显微椎间盘镜手术的应用解剖学   总被引:4,自引:0,他引:4  
目的 为MED手术操作提供解剖学依据。方法  2 0具成人尸体标本 ,测量下 3个腰椎棘突下缘点与下位椎板上缘距离、椎板间隙外缘点与后正中线、椎间盘与椎板下缘的距离及其生理成角。结果 L3 、L4、L5的棘突下缘点与下位椎板上缘关系及其椎间盘与相应椎板下缘关系均有位于其上方、下方和持平 3种 ,椎板间隙外缘点距后正中线平均 1 1~ 1 5cm。矢状面上 ,L3、4、L4、5和L5S1椎间盘多呈 8 5°± 4°、 11°± 6 3°和 2 7 8°± 6 9°的头倾角 ;工作通道外展角 ,L3、4为 13°± 3°,L4、5为17°± 3 5°,L5S1为 2 8 8°± 6 3°。结论 棘突下缘点可作为MED手术切口中心点 ,工作通道放置角度应与椎间盘的生理倾角相符。  相似文献   

3.
樊良  方国华 《颈腰痛杂志》2000,21(2):156-156
报告2例椎间孔外椎间盘突出症,并介绍脊柱旁路肌间隙经路摘除极外侧型椎间盘突出症突出髓核的手术方法,效果优良。临床资料 Jackson[1]将椎间盘突出症分为4型:中央型、后外型、椎间孔型、椎间孔外型,前两者统称椎管内型,后两者统称为极外侧型(椎管外型)。极外侧型所占比例极少,有报道仅占2%,而椎间孔外侧型更为少见,仅有0.1%。作者接诊2例,报告如下:手术方法 采用椎旁肌间隙入路:腰椎正中皮肤切口,棘突旁2cm切开骶棘肌筋膜,从内侧的多裂肌与外侧的最长肌和髂肋肌之间的肌间隙钝性分开进入直达关节突。用两个椎板拉钩分别顶在两个横突尖端…  相似文献   

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微创经椎间孔腰椎椎间融合术的应用解剖学研究   总被引:2,自引:2,他引:0       下载免费PDF全文
目的:探讨微创经椎间孔腰椎椎间融合(TLIF)术的解剖要点及手术方法.方法:在40套正常腰椎MRI片上测量与TUF手术人路相关的解剖学参数,包括:手术切口旁开中线距离(m)、手术路径长度(n)、手术通道倾斜角(α).根据测量结果在5具人尸体标本上模拟微创通道下TLIF,切除上下关节突后显露硬膜囊及上位出口神经根,用卡尺测量硬膜囊边缘以外的椎间盘宽度(a)及神经根下缘到人字缝顶点的距离(b).结果:手术切口距中线距离为3.78±1.38cm,手术通道内倾斜角平均15.8°±3.3°,不同腰椎节段无统计学差异(P>0.05).手术路径长度为5.89±2.14cm(4.98~7.62cm).在多裂肌和最长肌之间存在疏松软组织肌肉间隙,通过该间隙可以比较容易地将微创通道放置到小关节突附近.在微创通道下切除小关节突进入椎间孔获得的"矩形区域"可显露椎间盘的有效宽度分别为:L3/4 11.3±3.1mm,L4/5 13.1±2.6mm,L5/S1 14.1±3.8mm:各腰椎上位出口神经根下缘与同节段腰椎人字缝的距离分别为:L3/4 17.7±3.5mm,L4/5 16.7±3.8mm,L5/S1 15.6±4.0mm.结论:在椎膀肌存在一个天然的组织间隙,可以很容易将工作管道放置到小关节附近,在上下小关节下方有一个安全的椎间盘"矩形区域",在该区域内切除椎间盘和置人融合器时不需牵拉硬膜囊和神经根.  相似文献   

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【摘要】 目的:观察腰椎椎旁大血管走行情况及其与腰椎的位置关系,为腰椎后路手术提供指导。方法:选取50例在我院行腹部CT增强扫描患者的影像资料,其中男性34例,平均年龄53岁,平均身高174cm,平均体重68kg;女性16例,平均年龄54岁,平均身高167cm,平均体重63kg。采用PACS 11.0软件系统分别测量L1/2~L5/S1椎间盘水平椎旁大血管(腹主动脉、下腔静脉、髂动静脉及其分支)与椎体前、后面的相对位置关系,及其与椎体前、后面之间的距离。结果:男性椎旁动脉距椎体前、后面的距离分别为35.86±7.84mm、46.48±8.51mm;女性分别为32.15±6.03mm、41.57±6.72mm;男性椎旁动脉位于椎体前、后面的范围分别为10.87°±27.54°、7.61°±19.12°;女性分别为15.16°±31.85°、10.87°±22.48°;男性椎旁静脉距椎体前、后面的距离分别为35.86±7.84mm、46.48±8.51mm;女性分别为32.15±6.03mm、41.57±6.72mm;男性椎旁静脉位于椎体前、后面的范围分别为10.87°±27.54°、7.61°±19.12°;女性分别为15.16°±31.85°、10.87°±22.48°。男性椎旁动静脉距椎体前面和后面的距离均大于女性,差异均有显著性(P<0.05),而椎旁动静脉与椎体前、后面的相对位置关系男女之间无显著性差异(P>0.05)。腹主动脉分叉位置12例(24%)在L4椎体下半部,32例(64%)在L4/5椎间隙;髂总动脉分叉位置29例(58%)在L5/S1椎间隙,12例(24%)在S1椎体的上半部;髂总静脉汇合位置42例(84%)在L5椎体上半部;髂内外静脉汇合位置16例(33%)在L5/S1椎间隙,27例(53%)在L5椎体的下半部。结论:腰椎椎旁血管的分叉位置变异较大,女性椎旁动静脉距椎体前、后面距离更小,腰椎后路手术中咬除腰椎间盘时应该注意把握腰椎与椎旁血管的角度与距离,谨防误伤椎旁血管。  相似文献   

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目的:观察腰椎周围肌间隙的解剖学与影像学特点,为腰椎后路椎旁肌间隙入路的选择和操作提供形态学依据.方法:选取18具成人尸体湿性躯干标本,一侧行局部解剖观察腰椎周围肌肉及其毗邻结构,另一侧行模拟肌间隙手术入路,观察不同肌间隙的解剖构成及其显露腰椎相关结构的特点;同时选取30例健康志愿者的腰部MRI与CT图像,观察肌间隙的影像学显示特点.结果:Wiltse间隙位于多裂肌与最长肌之间,由脂肪及疏松结缔组织填充,无血管、神经穿行;通过该间隙可清晰显露腰椎关节突关节、椎间孔及横突;75.0%的CT片和93.3%的MRI片可显示Wiltse间隙.LIMP间隙位于最长肌与髂肋肌之间,由一层薄而透明的筋膜分隔两肌,69.4%标本可见脊神经后支的肌支穿行间隙内;该间隙可满意显露椎间孔区及椎弓根;41.6%的CT片和56.6%的MRI片可显示LIMP间隙.Watkins间隙位于髂肋肌与腰方肌之间,由腰背筋膜中层及少量脂肪分隔肌肉形成,75.0%标本可见脊神经后支的皮支及伴行血管走行;该间隙可满意显露椎间孔及椎体两侧;63.3%的CT片和86.6%的MRI片可显示Watkins间隙.结论:熟悉腰椎不同肌间隙的形态特点及穿行结构,术前影像学准确观测有助于椎旁肌间隙入路的选择与操作.  相似文献   

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[目的]比较椎旁肌间隙入路与传统入路在治疗胸腰段骨折中对多裂肌的影响.[方法]自2010年6月~2012年6月,共45例胸腰段骨折满足研究条件的随机分为椎旁肌间隙入路21例和传统正中手术入路24例,比较两组术前及术后1、3、5d肌酸激酶水平,术后6个月随访时行椎旁肌肌内静息肌电图评估及磁共振检查评估椎旁肌肉萎缩程度,16例患者取内固定行多裂肌组织学检查.[结果]肌酸激酶传统入路组术后高于椎旁肌间隙入路组,术后第1、3d差异具有统计学意义,第5d差异不具有统计学意义.6个月随访行多裂肌肌电图检查及磁共振检查,发现椎旁肌间隙入路组出现失神经纤颤电位少且MRI评分高,差异具有统计学意义(P<0.05),而术后组织学检查发现类似的结果.[结论]传统手术入路和和椎旁肌间隙入路对多裂肌均有损伤,但椎旁肌间隙入路对椎旁肌损伤小于传统手术入路.  相似文献   

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目的探讨椎旁肌群变化与腰椎间盘突出程度的相关性,为腰椎间盘突出症的预防和早期干预提供依据。方法自2017年10月-2018年10月,随机纳入60例于我科就诊的腰腿痛或坐骨神经痛患者,均予以腰椎MRI检查,获取腰椎各节段的T2加权像横截面图像,测量多裂肌、最长肌和腰大肌的相对横截面积(Relative cross-sectional area,RCSA)和脂肪浸润程度(Degree of fat infiltration,DFF),椎间盘突出程度采用Pfirrmann标准进行分级。统计相关测量数据,并采用Spearman系数进行椎旁肌群RCSA和DFF值与椎间盘Pfirrmann分级的相关性分析。结果①腰椎间盘的Pfirrmann分级越高,多裂肌、最长肌和腰大肌的RCSA值越低、DFF值越高,差异有显著统计学意义(P0.01)。②经Spearman相关系数分析,多裂肌、最长肌和腰大肌的RCSA值均与椎间盘突出程度呈较强的相关性(P0.01),DFF值则与之呈中等程度的相关性(P0.05)。结论椎旁肌群的退变与腰椎间盘突出程度密切相关。其中,多裂肌、腰大肌和最长肌的相对横截面积与其呈较强的相关性,而脂肪浸润程度则与之呈中等程度相关性。  相似文献   

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[目的]探寻腰椎间盘退变程度与腰椎旁肌肉群之间的关系。[方法]本研究包括患者组27例,为首次发生腰腿痛或未经过保守治疗的腰椎间盘突出症患者,平均年龄(22.33±1.64)岁;对照组25人,平均年龄(22.16±1.60)岁,为来院体检的健康人群。全部研究对象接受磁共振检查,按Pfirrmann标准对退变椎间盘进行分级,并在T2相上测量椎旁肌群与相应节段椎体间的横截面积比(MVr),脂肪浸润情况。[结果]患者组中的多裂肌群显著小于对照组(P=0.046),而最长肌、腰大肌在两组间无显著差异。患者组中的脂肪浸润等级显著高于对照组(P0.01)。在患者组中,脂肪浸润等级与椎间盘退变等级之间并不存在线性相关联系。椎旁肌群的MVr与椎间盘退变等级之间存在着中等的线性相关联系。[结论]腰椎多裂肌、最长肌、腰大肌与椎间盘突出程度之间存在着中等联系,其中多裂肌可能更为重要。椎间盘患者组中的腰椎旁肌群有更明显的脂肪浸润,然而脂肪浸润与椎间盘突出之间可能并不存在线性联系。  相似文献   

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目的探讨利用自行研制的一套腰椎微创手术器械,以多裂肌肌间隙入路直视下微创经椎间孔腰椎椎体融合术在腰椎翻修手术中的临床疗效。方法选择我院2010年11月至2011年11月收治的腰椎手术失败综合征行直视下微创腰椎翻修手术的患者12例进行回顾性分析,其中腰椎间盘突出症行单纯性椎板开窗减压髓核摘除术后6例,腰椎间盘突出伴腰椎不稳、腰椎滑脱行后路腰椎椎体融合术后4例,腰椎管狭窄后路椎板开窗减压术后2例;术前已进行一次手术的9例,二次手术的2例,三次手术的1例。本组共融合17节段,L4~54例,L5S13例,L4~5和L5S1双节段2例,L3~4和L4~5双节段3例;通过影像学资料和末次随访的临床表现进行改良Macnab标准疗效评定。结果所有病例均获得随访,随访时间6~18个月,平均(13±3.9)个月;依据改良Macnab标准进行疗效评定,12例中,优9例,良3例,可0例,差0例,优良率100%(12/12)。结论多裂肌肌间隙入路治疗腰椎手术失败综合征,降低了手术风险,减少了术后并发症。  相似文献   

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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.  相似文献   

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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.  相似文献   

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Subramaniam B  Pomposelli F  Talmor D  Park KW 《Anesthesia and analgesia》2005,100(5):1241-7, table of contents
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.  相似文献   

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A retrospective study of anesthetic and surgical techniques involved in 55 consecutive cases of tracheal and carinal resections completed from 2001 to 2007, is presented. The anesthetic maneuvers and surgical approach differed in relation with the site of the tracheal lesions (upper, middle, lower trachea or carinal), the degree of the obstruction, the emergency of the surgical intervention and the concomitant presence of the eso-tracheal fistula. Ventilatory support during anesthesia involved special equipment adapted to the particular techniques used in this type of surgery. Cross field intubation of trachea or a mainstem bronchus, and High Frequency Jet Ventilation-HFJV- have been frequently used. Perfect coordination of the anesthetic techniques with every surgical step is mandatory and for good long term results special anesthetic equipment and a good preoperative anesthetic and surgical assessment of the strategy is needed.  相似文献   

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