Morphometric analysis of the thoracic and lumbar spine in Japanese on the use of pedicle screws

The pedicle screw and hook have become popular instruments in treating spinal deformity and disease. This study gathered morphological data on thoracic and lumbar spines in a Japanese population that should serve as useful reference for posterior instrumentation surgery. One hundred and three dry bones were used to investigate the morphology of pedicle and facet in thoracic and lumbar spines. Measurements included the diameter and axial length of pedicle from T8 to L5, height and width of facets and thickness of articular processes from T1 to T12, and axial angle of pedicle from T1 to L5. The diameter and axial length of pedicle were smallest at T8, diameter was largest at L5 and axial length was largest at L3. Height of facets and thickness of articular processes were largest at T12. Men tended to have larger pedicles and facets than women. Transverse angle of pedicle was smallest at T12. These precise data may provide useful information when performing posterior instrumentation surgery and when developing new spinal implant systems for Asians.     

尾部悬吊大鼠胸主动脉、肺动脉超微结构变化的动态观察

目的观察模拟微重力时大小循环动脉血管超微结构重塑随时间变化的差异,为微重力后立位耐力降低的机制研究积累资料。方法用透射电镜观察-30°尾部悬吊7d(TS7组)、14d(TS14组)及对照组大鼠胸主动脉、肺动脉壁超微结构的变化。结果TS7组胸主动脉内皮细胞表面出现绒毛状突起,部分线粒体空泡变性,内皮下基膜有分层,内弹力板较厚,且厚度不均匀,内弹力板下出现大量的胶原纤维;TS14组胸主动脉内皮细胞变性较明显,部分内皮细胞基质致密化,基膜复层化,内弹力板有破碎,弹力纤维增多。TS7组肺动脉部分内皮细胞突起,细胞内出现脂滴,内皮细胞基膜出现分层状改变,弹力板变薄、断裂,其下方可见收缩型平滑肌及合成型平滑肌细胞;TS14组肺动脉内皮细胞空泡变性较明显,内弹力板未见明显改变,弹力板内外均可见较多的胶原纤维和弹力纤维,内弹力板下方以收缩型平滑肌为主。结论TS7组大鼠胸主动脉和肺动脉出现损伤和增殖并存,以肺动脉较明显;TS14组肺动脉趋于形成新的稳定结构,而胸主动脉新稳定结构还未形成。模拟微重力时大小循环血管发生了结构重塑,大小循环血管重塑的时间过程不同归因于模拟微重力初期由下体转移而来的体液进入大小循环高峰期的时间差。     

糖尿病小鼠胸主动脉环对血管收缩剂和内皮依赖性舒张剂反应的变化

目的：探讨糖尿病（DM）小鼠在不同时期离体胸主动脉环对血管收缩剂和内皮依赖性舒张剂反应的变化。 方法： 用腹腔注射链脲佐菌素（STZ）40 mg/kg诱导C57BL/6J小鼠产生糖尿病，在17、22和28周分批处死糖尿病和同年龄对照（control）组小鼠，测定其离体胸主动脉环对血管收缩剂：苯肾上腺素（PE）、60 mmol/L KCl的反应及对内皮依赖性舒张剂乙酰胆碱（ACh）的反应。 结果： DM组小鼠2周后空腹血糖≥11.1 mol/L并在整个实验过程中维持这一水平，显著高于control组，而体重显著低于control组；17、22和28周DM组胸主动脉环对PE的反应性分别高于、接近、高于control组，各时期对60 mmol/L KCl都表现高于control组；17、22和28周DM组胸主动脉环对ACh的反应性分别高于、接近、低于control组。 结论： DM组小鼠胸主动脉环对血管收缩剂的反应增强，而内皮功能先代偿性增强，然后降低，表现为内皮损伤。     

Thoracic duct lymph and PEEP studies in anaesthetized dogs

PEEP impedes thoracic duct drainage (LF). This can be counteracted by a thoracic duct fistula. Consequently, lung oedema (LOE) should develop during PEEP more slowly with LF at atmospheric pressure (LF_AP) than with LF against jugular venous pressure (LF_JVP). In 12 anaesthetized dogs LOE was produced by Ringer's solution i.v. (2.5 ml/min per kg) for 6 h during PEEP (10 mmHg) with either LF_AP or LF_JVP. Ringer's+PEEP greatly increased aortic, pulmonary artery and wedge pressures, JVP, and cardiac output. Colloid osmotic pressures in plasma and lymph were drastically reduced, pulmonary effective filtration pressure (EFP) rose by about 20 mmHg. LF_JVP increased 7-fold, LF_AP about 19-fold, the respective loss of plasma proteins was 1.83 and 1.06 g/kg during 6 h. Thermal-dye extravascular lung water showed an increment of 68 with LF_JVP versus 43 l/h/g per mmHg with LF_AP. Final lung water content was at any EFP (12.8–31.9 mmHg) lower with LF_AP than with LF_JVP amounting 512 with LF_JVP versus 377 l/g/per mmHg with LF_AP. LF_AP decreased the development of LOE during PEEP by bypassing the PEEP-induced high JVP and thus facilitating the removal of interstitial fluid. It is hypothesized that a thoracic duct fistula might aid the treatment of patients with LOE due to ARDS and therefore requiring high levels of PEEP.     

乳腺癌改良根治术中应用超声引导下TPVB复合全身麻醉对患者术后认知功能的影响

目的：探讨乳腺癌改良根治术中应用超声引导下胸椎旁神经阻滞（TPVB）复合全身麻醉对患者术后认知功能的影响。方法：选择信阳市中心医院2020年1月至2021年12月期间收治的56例乳腺癌改良根治术患者,以随机数字表法分为观察组（超声引导下TPVB联合全身麻醉）和对照组（全身麻醉）,各28例。比较两组患者的麻醉前（T0）、切皮时（T1）、手术开始60 min(T2)、术毕时（T3）的血流动力学指标变化情况,记录术中两组患者的麻醉药物用量,记录术前、术后1 d两组患者的神经功能状况,比较两组术后不良反应发生情况。结果：T1～T3时观察组患者的平均动脉压（MAP）、心率（HR）与T0时比较,差异无统计学意义（P> 0.05）;T1～T3时对照组患者的MAP、HR高于T0时,差异具有统计学意义（P <0.05）;T1～T3时观察组患者的MAP、HR低于同时段对照组,差异具有统计学意义（P <0.05）。观察组患者的术中丙泊酚、瑞芬太尼用量低于对照组,差异具有统计学意义（P <0.05）。术后1 d两组患者的简易智力状态检查量表（MMSE）评分均低于术前,且术后1 d观察组...     

胸腔镜辅助下侧前路减压融合术治疗腰椎间盘突出症伴椎体后缘骨软骨病

目的探讨胸腔镜辅助下侧前路减压融合术治疗胸腰段或高位腰椎间盘突出症(lumbar disc herniation,LDH)伴椎体后缘骨软骨病(vertebral osteochondrosis,VO)的可行性及其临床效果。方法回顾性分析2017年12月至2019年12月采用胸腔镜辅助下侧前路减压融合术治疗胸腰段或高位LDH伴VO 10例患者的病历资料,男6例,女4例;年龄37~65岁,平均49.2岁。手术节段均为单节段,累及T₁₂L₁节段5例、L_1,2节段2例、L_2,3节段3例。4例患者为单纯胸腰段或高位LDH伴VO;6例患者合并黄韧带增生、骨化致椎管狭窄或后凸畸形,联合后路减压内固定术或矫形手术。主要观察指标为疼痛视觉模拟评分(visual analogue scale,VAS)、Oswestry功能障碍指数(Oswestry disability index,ODI)及椎间隙前、后缘高度,根据改良MacNab标准评估临床疗效。结果10例患者均顺利完成手术,术中在胸腔镜辅助下能清晰显露并彻底去除突出的椎间盘和骨化物,脊髓、神经根和硬膜囊得到充分减压。手术时间(115.4±23.8)min(范围70~180 min);术中失血量(122.6±21.3)ml(范围40~310 ml)。术后随访时间为12~36个月,平均21.6个月。末次随访时10例患者VAS评分由术前(7.2±1.9)分降至(1.8±1.1)分,ODI由术前64.3%±13.9%降至16.3%±5.1%,椎间隙前缘高度由术前(7.8±1.5)mm改善至(11.9±2.3)mm,椎间隙后缘高度由术前(4.5±1.1)mm改善至(7.4±1.6)mm,差异均有统计学意义(P<0.05)。末次随访时改良MacNab疗效评定为优9例、良1例。结论胸腔镜辅助下侧前路减压融合术治疗胸腰段或高位LDH伴VO,可提供清晰的手术视野,能够充分显露、彻底去除突出的椎间盘及骨化物,术后近期疗效满意。     

Soft tissue aneurysmal bone cyst of left hemithorax with review of literature

Soft tissue aneurysmal bone cysts (STABCs) are extremely rare extraosseous counterpart of aneurysmal bone cyst (ABC), with close resemblance to histo-morphologic characteristics of ABC. Here we would like to report a 13-year-old female patient, who presented with a large mass, occupying the entire left hemithorax. Patient underwent resection of the thoracic mass. On histopathological examination, it was found to be a soft tissue ABC. It is a very rare tumor and until date 28 cases have been reported in English literature, to the best of our knowledge. On review of the literature, we found this to be the first case of STABC reported in thoracic cavity. The objective of this case presentation is to provide information regarding clinical presentation, radiological and pathological features, and course of management for this rare disease. Soft tissue ABCs are a new class of tumors, so more extensive research is required to establish standard guidelines for their diagnosis and management, to yield better prognosis.     

Pulmonary contusions in patients with rib fractures: The need to better classify a common injury

BackgroundPulmonary contusions are common injuries. Computed tomography reveals vast contused lung volume spectrum, yet pulmonary contusions are defined dichotomously (unilateral vs bilateral). We assessed whether there is stepwise increased risk of pulmonary complications among patients without, with unilateral, and with bilateral pulmonary contusion.MethodsWe identified adults admitted with rib fractures using the largest US inpatient database. After propensity-score-matching patients without vs with unilateral vs bilateral pulmonary contusions and adjusting for residual confounders, we compared risk for pneumonia, ventilator-associated pneumonia (VAP), respiratory failure, intubation, and mortality.ResultsAmong 148,140 encounters of adults with multiple rib fractures, 19% had concomitant pulmonary contusions. Matched patients with pulmonary contusions had increased risk of pneumonia 19% [95%CI:16–33%], respiratory failure 40% [95%CI: 31–50%], and intubation 46% [95%CI: 33–61%]. Delineation showed bilateral contusions, not unilateral contusions, attributed to increased risk of complications.ConclusionsThere is likely a correlation between contused lung volume and risk of pulmonary complications; dichotomously classifying pulmonary contusions is insufficient. Better understanding this correlation requires establishing the clinically significant contusion volume and a correspondingly refined classification system.