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991.
目的:研究与斜坡区、桥小脑角区、及颈静脉孔外侧区手术入路有关的骨性结构,探讨其定位解剖和临床意义。方法:20具干性成人头颅标本,移去颅盖骨,观察、测量颅后窝内外面有关骨性结构。结果:硬脑膜窦角(STP)点距内耳门距离左侧(32.99±2.72)mm、右侧(37.84±2.58)mm,距颈静脉孔距离左侧(35.27±3.25)mm、右侧(34.63±3.25)mm。颈静脉孔上方约5mm为内耳门,下方约20mm为舌下神经管内口,前方为斜坡区。内耳门、颈静脉孔、舌下神经管内口三者近似在一条直线上。乳突尖距颈静脉孔距离左侧(22.62±1.90)mm、右侧(22.33±2.30)mm,距枕髁后外缘距离左侧(29.42±2.15)mm、右侧(29.08±2.29)mm,距枕大孔距离左侧(39.39±2.03)mm、右侧(38.47±1.96)mm。结论:STP点、颈静脉孔、内耳门是颅后窝内面重要骨性结构,乳突是颅后窝底外侧一个重要骨性标志结构;STP点、内耳门、颈静脉孔、乳突尖可作为颅后窝手术重要的定位标志。 相似文献
992.
Y. Uchino N. Hirai S. Watanabe 《Experimental brain research. Experimentelle Hirnforschung. Expérimentation cérébrale》1978,32(3):377-388
Summary In the anesthetized cat, the posterior canal nerve (PCN) was stimulated by electric pulses and synaptic responses were recorded intracellularly in the three antagonistic pairs of extraocular motoneurons. Pure reciprocal effects were obtained in the motoneurons innervating the antagonistic pair of ipsilateral oblique muscles and the antagonistic pair of contralateral vertical rectus muscles. These responses consisted of low threshold disynaptic excitatory postsynaptic potentials (EPSPs) in either the contralateral superior oblique (c-SO) (trochlear) or contralateral inferior rectus (c-IR) motoneurons and of disynaptic inhibitory postsynaptic potentials (IPSPs) in either the ipsilateral inferior oblique (i-IO) or ipsilateral superior rectus (i-SR) motoneurons. In addition, disynaptic IPSPs were also found in (i-SO) motoneurons. Mixtures of low threshold (dior trisynaptic) EPSPs and IPSPs were found in all other extraocular motoneurons except for the contralateral lateral rectus (c-LR) motoneurons. These results may afford a basis for the characteristic eye movements induced by vertical canal nerve stimulation. 相似文献
993.
A. Bhuller J. R. Sañudo D. Choi P. H. Abrahams 《Surgical and radiologic anatomy : SRA》1998,20(2):109-112
This anatomic study describes the course and intracranial relations of the hypoglossal n. in 32 cadavers. The rootlets of the nerve emerged as a fan-shaped distribution (23.44%) or in two bundles (76.56%) and converged towards the hypoglossal canal in the subarachnoid space before piercing the dura mater. In 76.57% of cases the rootlets pierced the dura mater in two separate apertures, less commonly through the same aperture (21.87%), and in rare cases through three individual apertures, as in one of our cases. The distance between the two apertures varied from 0.6 mm to 8.7 mm. Commonly, the two bundles converged together and left the skull through one foramen in the skull. However, in some cases (28.12%), the hypoglossal canal was divided in two by a small bony spicule. In 23.45% of cases the initial course of the posterior inferior cerebellar a. (PICA) passed between the two bundles of the hypoglossal n. before ascending towards the lateral border of the fourth ventricle. 相似文献
994.
目的 系统性对比评价斜外侧入路椎间融合术(OLIF)与后入路椎体融合术(PLIF)在治疗腰椎退行性疾病中的临床疗效。方法 在中国知网数据库、万方数据库、维普数据库以及PubMed数据库、Cochrane数据库,以“斜外侧椎间融合术”“后入路椎间融合术”和 “oblique lumbar interbody fusion” “oblique lateral interbody fusion” “anterior to psoas” “posterior lumbar interbody fusion”为关键词,计算机检索2010年1月-2019年9月国内外已发表关于OLIF与PLIF对比的病例对照研究或随机对照研究的中英文文献,严格评价文献质量,并提取相关数据,运用RevMan 5.3软件对手术时间、术中出血量、住院时间、疼痛视觉模拟评分(VAS)、Oswestry功能障碍指数(ODI)、椎间隙高度(IDH)、腰椎前凸角(LL),以及手术并发症情况进行Meta分析。结果 纳入10篇研究共580例患者,其中经OLIF手术276例,经PLIF手术304例。1项随机对照研究,Cochrane偏倚风险评估为低风险;9项病例对照研究纽卡斯尔-渥太华评分(NOS),其中高质量6项、较高质量3项。Meta分析结果显示,OLIF较PLIF平均手术时间短(WMD=-84.02,95% CI -118.29~-49.74,P<0.01),平均术中出血量少(WMD=-269.12, 95% CI -319.84~-218.41,P<0.01),平均住院时间短(WMD=-3.29, 95% CI -4.70~-1.89, P<0.01),术后IDH恢复更高(WMD=1.11, 95% CI 0.44~1.77, P<0.01),差异均有统计学意义;而术后ODI(WMD=0.16, 95% CI -1.98~2.30, P>0.05)、VAS(WMD=0.02, 95% CI -0.52~0.56, P>0.05)、LL(WMD=0.77, 95% CI -0.40~1.94, P>0.05)、并发症发生情况(OR=0.91, 95% CI 0.50~1.64, P>0.05),OLIF和PLIF比较差异均无统计学意义。结论 OLIF与PLIF应用于椎体间融合术均能取得良好的临床疗效,但OLIF手术时间、术中出血量、住院时间更低,术后IDH恢复更高,有更大优势。 相似文献
995.
[摘要] 目的 探讨全髋关节置换术治疗强直性髋关节炎的疗效与治疗体会。方法 我院关节科2007年3月~2013年3月共运用全髋关节置换术治疗强直性脊柱炎患者并发的强直性髋关节炎56例(96髋),男55例,女1例,年龄(18~42)岁,平均25.6岁,其中髋关节骨性融合34髋,纤维融合62髋。病程(5.8~27.6)年,56例患者中贫血21例,其中轻度贫血14例。伴随骨质疏松34例。除去3例失败患者,纳入53例(92髋)进行术前及术后1年的评估,比较术前及术后1年的变化,并观察强直性髋关节炎进行置换的影响因素。结果 本组患者均运用我院关节科电子随访病例系统进行跟踪随访并进行功能评定。随访时间(1.4~7.2)年,平均3.7年。随访的53例(92髋)患者术前髋关节总活动度平均(36.2±12.1)°,Harris评分平均(23.2±10.2)分;术后1年髋关节总活动度平均(183.4±17.6)度,Harris评分平均(78.6±6.9)分;髋关节总活动度术后1年与术前比较(P<0.01),Harris评分术后1年与术前比较(P<0.01),差异均有统计学意义。3例失败病例中1例松动,1例脱位,1例感染,松动和感染病例进行了翻修术,脱位病例进行了复位,目前随访均良好。结论 强直性髋关节炎行全髋关节置换时全面的评估和精湛的技术是手术成功的关键。 相似文献
996.
Genevieve Hill Srinidhi Nagaraja Behrooz A. Akbarnia Jeff Pawelek Paul Sponseller Peter Sturm John Emans Pablo Bonangelino Joshua Cockrum William Kane Maureen Dreher 《The spine journal》2017,17(10):1506-1518
Background Context
Growing rod constructs are an important contribution for treating patients with early-onset scoliosis. These devices experience high failure rates, including rod fractures.Purpose
The objective of this study was to identify the failure mechanism of retrieved growing rods, and to identify differences between patients with failed and intact constructs.Study Design/Setting
Growing rod patients who had implant removal and were previously enrolled in a multicenter registry were eligible for this study.Patient Sample
Forty dual-rod constructs were retrieved from 36 patients across four centers, and 34 of those constructs met the inclusion criteria. Eighteen constructs failed due to rod fracture. Sixteen intact constructs were removed due to final fusion (n=7), implant exchange (n=5), infection (n=2), or implant prominence (n=2).Outcome Measures
Analyses of clinical registry data, radiographs, and retrievals were the outcome measures.Methods
Retrievals were analyzed with microscopic imaging (optical and scanning electron microscopy) for areas of mechanical failure, damage, and corrosion. Failure analyses were conducted on the fracture surfaces to identify failure mechanism(s). Statistical analyses were performed to determine significant differences between the failed and intact groups.Results
The failed rods fractured due to bending fatigue under flexion motion. Construct configuration and loading dictate high bending stresses at three distinct locations along the construct: (1) mid-construct, (2) adjacent to the tandem connector, or (3) adjacent to the distal anchor foundation. In addition, high torques used to insert set screws may create an initiation point for fatigue. Syndromic scoliosis, prior rod fractures, increase in patient weight, and rigid constructs consisting of tandem connectors and multiple crosslinks were associated with failure.Conclusion
This is the first study to examine retrieved, failed growing rod implants across multiple centers. Our analysis found that rod fractures are due to bending fatigue, and that stress concentrations play an important role in rod fractures. Recommendations are made on surgical techniques, such as the use of torque-limiting wrenches or not exceeding the prescribed torques. Additional recommendations include frequent rod replacement in select patients during scheduled surgeries. 相似文献997.
Insa Janssen Yu-Mi Ryang Jens Gempt Stefanie Bette Julia Gerhardt Jan S. Kirschke Bernhard Meyer 《The spine journal》2017,17(6):837-844
Background
Cement-augmented pedicle screw instrumentation (CAPSI) of the thoracolumbar spine is indicated in osteoporosis or osteopenia to improve pullout strength and biomechanical stability of pedicle screws (PS). Only a few studies report on the incidence of pulmonary cement embolism or other complications associated with CAPSI.Purpose
The aim of this retrospective study was to assess the rate of CAPSI-associated complications.Study Design
Retrospective cohort study.Patient Sample
Patients who underwent CAPSI due to spinal tumors or degenerative spine disease.Outcome Measures
Cement leakage, pulmonary cement embolism (PCE), mortality rate.Methods
Our clinical database was reviewed for patients who underwent CAPSI between January 2012 and June 2015. A total of 165 patients (mean age 71±11.2; range: 46 to 93 years; m=62, f=103) were included. Indications were osteoporotic fractures (n=40), spinal metastases (n=57), degenerative (n=49) or infectious spine disease (n=5), and traumatic vertebral fractures (n=14) with an associated osteoporosis. Every patient received between 2 and 21 (mean 8±3.3) cement-augmented pedicle screws in the thoracolumbar and lumbosacral spine. Both intraoperative cement leakage in prevertebral veins, the inferior vena cava, and/or pulmonary arteries, and leakage detected on postoperative imaging were evaluated. We assessed the incidence of clinically symptomatic and asymptomatic events.Results
In 29 of 31 patients with intraoperative suspicion of cement leakage into prevertebral veins or the inferior vena cava on lateral fluoroscopy, which were without hemodynamic relevance, cement extrusion was confirmed on postoperative X-ray or computed tomography (CT) scan. In three of eight patients with suspicion of PCE, PCE was verified on thoracic CT. Four patients experienced life-threatening intraoperative hemodynamic reactions, either due to cement embolism (n=2; 1.2%) or anaphylactic shock (n=2; 1.2%) with need for intraoperative cardiopulmonary resuscitation in three cases. Two patients died due to fulminant PCE. Three patients with dyspnea 1 day after surgery were also confirmed with PCE on chest CT. In five patients, an asymptomatic PCE was found incidentally on postoperative imaging. In addition, 68 patients with cement leakage into prevertebral veins or the ascending cava vein were found incidentally on postoperative spine X-ray or CT. Two of 10 patients with intraspinal epidural cement leakage required revision surgery. One hundred ten of 165 patients (66.7%) had clinically asymptomatic cement leakage. Thirteen patients had PCE (7.9%), of whom five (3.0%) were symptomatic. Two patients experienced intraoperative cement-induced anaphylaxis (1.2%). The overall symptomatic complication rate was 5.5% (n=9). The 30-day mortality rate was 1.8% (n=3).Conclusions
CAPSI bears a high risk of asymptomatic cement leakage. The risk for associated severe complications was also relatively high and probably underestimated considering the retrospective nature of the present study. A strict indication for cement augmentation, especially in patients with cardiac predisposition, should be the consequence. We doubt that technical aspects of cement application and/or different types of cement are capable of reducing the risk of these complications substantially. 相似文献998.
Tobias Lange Werner Schmoelz Georg Gosheger Martin Eichinger Christian H. Heinrichs Albert Schulze Boevingloh Tobias L. Schulte 《The spine journal》2017,17(8):1148-1155
Background Context
Proximal junctional kyphosis (PJK) is a challenging complication after rigid posterior instrumentation (RI) of the spine. Several risk factors have been described in literature so far, including the rigidity of the cranial aspect of the implant.Purpose
The aim of this biomechanical study was to compare different proximal implants designed to gradually reduce the stiffness between the instrumented and non-instrumented spine.Study Design/Setting
This is a biomechanical study.Methods
Eight calf lumbar spines (L2–L6) underwent RI with a titanium pedicle screw rod construct at L4–L6. The proximal transition segment (L3–L4) was instrumented stepwise with different supplementary implants—spinal bands (SB), cerclage wires (CW), hybrid rods (HR), hinged pedicle screws (HPS), or lamina hooks (LH)—and compared with an all-pedicle screw construct (APS). The flexibility of each segment (L2–L6) was tested with pure moments of ±10.0?Nm in the native state and for each implant at L3–L4, and the segmental range of motion (ROM) was evaluated.Results
On flexion and extension, the native uninstrumented L3–L4 segment showed a mean ROM of 7.3°. The CW reduced the mean ROM to 42.5%, SB to 41.1%, HR to 13.7%, HPS to 12.3%, LH to 6.8%, and APS to 12.3%. On lateral bending, the native segment L3–L4 showed a mean ROM of 15°. The CW reduced the mean ROM to 58.0%, SB to 78.0%, HR to 6.7%, HPS to 6.7%, LH to 10.0%, and APS to 3.3%. On axial rotation, the uninstrumented L3–L4 segment showed a mean ROM of 2.7°. The CW reduced the mean ROM to 55.6%, SB to 77.8%, HR to 55.6%, HPS to 55.6%, LH to 29.6%, and APS to 37.0%.Conclusions
Using CW or SB at the proximal transition segment of a long RI reduced rigidity by about 60% in relation to flexion and extension in that segment, whereas the other implants tested had a high degree of rigidity comparable with APS. Clinical randomized controlled trials are needed to elucidate whether this strategy might be effective for preventing PJK. 相似文献999.
Norihiro Nishida Tsukasa Kanchiku Yoshihiko Kato Yasuaki Imajo Hidenori Suzuki Yuichiro Yoshida 《The journal of spinal cord medicine》2017,40(1):93-99
Objective: Decompression procedures for cervical myelopathy of ossification of the posterior longitudinal ligament (OPLL) are anterior decompression with fusion, laminoplasty, and posterior decompression with fusion. Preoperative and postoperative stress analyses were performed for compression from hill-shaped cervical OPLL using 3-dimensional finite element method (FEM) spinal cord models.Methods: Three FEM models of vertebral arch, OPLL, and spinal cord were used to develop preoperative compression models of the spinal cord to which 10%, 20%, and 30% compression was applied; a posterior compression with fusion model of the posteriorly shifted vertebral arch; an advanced kyphosis model following posterior decompression with the spinal cord stretched in the kyphotic direction; and a combined model of advanced kyphosis following posterior decompression and intervertebral mobility. The combined model had discontinuity in the middle of OPLL, assuming the presence of residual intervertebral mobility at the level of maximum cord compression, and the spinal cord was mobile according to flexion of vertebral bodies by 5°, 10°, and 15°.Results: In the preoperative compression model, intraspinal stress increased as compression increased. In the posterior decompression with fusion model, intraspinal stress decreased, but partially persisted under 30% compression. In the advanced kyphosis model, intraspinal stress increased again. As anterior compression was higher, the stress increased more. In the advanced kyphosis +?intervertebral mobility model, intraspinal stress increased more than in the only advanced kyphosis model following decompression. Intraspinal stress increased more as intervertebral mobility increased.Conclusion: In high residual compression or instability after posterior decompression, anterior decompression with fusion or posterior decompression with instrumented fusion should be considered. 相似文献
1000.