青壮年腰椎峡部不连性滑脱行椎间融合手术的疗效分析

目的探讨青壮年腰椎峡部不连性滑脱采用椎间融合手术的疗效。方法回顾2012年1月-2017年1月采用椎间融合及短节段钉棒固定手术治疗的青壮年腰椎峡部不连患者31例,随访前后采用JOA评分及VAS评分进行疗效评价,通过影像学资料评估滑脱率、滑脱角和椎间隙高度在治疗前后的改变。结果所有患者均获得12～24个月的完整随访,术后JOA、VAS评分较治疗前显著改善,差异有统计学意义(P0.05);术后腰椎椎体滑脱率、滑脱角、椎间隙高度较术前明显改善或恢复,差异有统计学意义(P0.05)。X线片及CT复查示融合位置均获骨性愈合;随访期间无继发性椎体滑脱,无下肢神经症状加重,无椎弓根钉及融合器断裂或松动发生。结论椎间融合联合短节段固定手术治疗青壮年腰椎峡部不连性滑脱,可使滑脱腰椎基本复位,腰椎滑脱角明显减少,椎间隙高度基本恢复,是青壮年腰椎峡部不连性滑脱的有效治疗方案。     

后路腰椎椎体间融合与经椎间孔腰椎椎体间融合治疗退行性腰椎滑脱与不稳疗效比较

目的比较后路腰椎椎体间融合(PLIF)与经椎间孔腰椎椎体间融合(TLIF)手术治疗退行性脊柱滑脱与不稳的疗效。方法 162例退行性脊柱疾病患者中,86例行PLIF术,76例行TLIF术。比较两组手术时间、出血量,观察术前术后滑脱复位、椎间隙及椎间孔高度变化,使用ODI、VAS评分方法对患者术前术后情况进行评估,按照影像学Brantigan和Steffee标准评价植骨融合情况,同时记录并发症及其转归。结果与PLIF组比较,TLIF组手术时间短、失血量少、手术并发症少(P<0.05),而滑脱复位、椎间隙及椎间孔高度变化、ODI、VAS评分、ODI改善率、植骨融合率无明显差别(P>0.05)。结论 PLIF与TLIF均为手术治疗退行性脊柱滑脱与不稳的有效方法,而TLIF手术时间短、失血量少,并发症少。     

椎间融合器与椎弓根钉固定治疗腰椎滑脱症的比较研究

目的比较椎间融合器与椎弓根钉固定单独应用及二者联合应用治疗腰椎滑脱症的效果。方法102例腰椎滑脱症患者根据治疗方法不同分为3组:椎间融合器、椎弓根钉固定组(A组),单纯椎弓根钉固定组(B组),椎间融合器组(C组),3组均行椎间及后外侧植骨。对3组术前、术后和随访时JOA评分、滑脱率、复位率、滑脱角、椎间隙高度、椎间孔高度及并发症进行对比研究。结果3组术后较术前各项指标有明显改善(P<0.01);随访发现:B组、C组的复位率、滑脱角、椎间隙高度、椎间孔高度丢失程度较A组明显(P<0.05);B组、C组植骨融合失败率高(P<0.05);JOA评分A组优良率为93%,优于其他两组(P<0.05)。结论椎间融合器加椎弓根钉系统固定治疗腰椎滑脱症临床疗效肯定,并发症相对较少。     

椎间融合器在腰椎滑脱症手术治疗中的应用

目的通过对36例腰椎滑脱使用Cage治疗的临床分析,探讨其在腰椎滑脱中的治疗作用。方法36例采用后路椎管减压Cage椎间融合器联合椎弓根螺钉系统作为治疗组,30例采用单纯椎弓根螺钉内固定后外侧植骨融合作为对照组,对比两者的疗效。结果治疗组平均随访24个月,对照组平均随访27个月,治疗组与对照组比较具有以下优势：①在术后、最终随访时能明显增加腰椎的椎间隙高度、相对椎间隙高度、复位率,降低滑脱率;②明显提高术后1、2年骨性融合率、降低断钉率;③明显提高术后JOA评分。结论椎间融合器在腰椎滑脱症手术治疗中具有能有效增大椎间隙高度、提高融合率、降低断钉率、有效复位、改善症状,保持节段稳定性的优点,不失为一种比较理想的治疗腰椎滑脱症的手术方式,且疗效满意。     

腰椎后是融合和BAK椎体间融合的疗效比较

目的 证明BAK椎体间融合优于后外侧融合。方法 腰椎滑脱26例采用Steffee钢板和后外侧融合与腰椎滑脱16例采用Silhouetle脊柱棒系统对腰椎滑脱复位固定和BAK椎间植骨融合器椎间植骨融合，比较它们的融合、复位和临床结果。结果 后外侧融合26例随诊6－36个月，临床融合率80.8%(21/26)，滑脱复位率61％（16／26），临床疗效：优9例，良9例，可3例，差5例，优良率69％。BAK椎体间融合16例患者随诊6－20个月。临床融合率为93.7%(15/16)，滑脱复位率为87.5%（14／16），临床疗效：优9例，良5例，可2例，优良率90％。结论 对腰椎滑脱的复位固定，Silhouetle脊柱棒系统较Steffee钢板有较多优点，与后外侧融合比较，BAK椎间融合器植入椎间隙后，椎体界面间固定，椎间隙无塌陷，无植骨吸收，能增大和维持椎间隙和椎间孔高度，间接扩大侧隐窝和恢复脊柱生理曲度，有较大的植骨床，有利于植骨融合，使患者早期下床。近期随访结果表明，Silhouetle脊柱棒系统固定和BAK椎间植骨融合器椎间植骨融合的临床疗效明显优于Steffee钢板固定和后外侧融合。     

改良经椎间孔腰椎椎间融合术治疗退变性腰椎滑脱的疗效评价

目的评估改良经椎间孔腰椎椎间融合术(TLIF)治疗退变性腰椎滑脱(DLS)的临床疗效。方法采用改良TLIF治疗DLS患者32例。手术前后采用Denis疼痛与工作量表评估临床疗效;测量手术前后的腰椎滑脱率、滑脱角、椎间隙高度和腰椎前凸角,并行影像学评估;采用Macnab标准综合评定优良率。结果 32例均获随访,时间2~4(2.8±0.2)年。术后Denis疼痛与工作量表分布较术前明显改善(P0.05)。术后2~3 d、3个月、6个月和1年的腰椎滑脱率、滑脱角、椎间隙高度、腰椎前凸角均较术前明显改善(P0.05);术后不同时间点的腰椎滑脱率、滑脱角、椎间隙高度、腰椎前凸角比较差异均无统计学意义(P0.05)。术后1年影像学检查见椎间及后侧植骨区成熟骨桥生长。Macnab评定:优14例,良16例,可2例,优良率93.8%。结论改良TLIF治疗DLS具有创伤小,能提供理想的复位、满意的临床疗效和融合率。     

两种融合手术治疗腰椎滑脱症的影像学及临床疗效比较

目的 比较腰椎后路椎体间融合术(posterior lumbar interbody fusion,PLIF)和腰椎后外侧融合术(posterolateral lumbar fusion,PLF)治疗腰椎滑脱症患者手术前后及随访时影像学指标及临床疗效间的差异.方法 对2004年6月至2006年12月分别行上述两种手术治疗的113例腰椎滑脱症患者进行回顾性分析,PLIF组60例,PLF组53例.术前在腰椎侧佗X线片上测量椎间高度、滑脱率、节段角度、椎间孔面积等影像学指标,并采用Oswestry功能障碍指数(Oswestry disability index,ODI)、视觉模拟标尺(visual analogue scale,VAS)评分以及临床疗效主观评价表等指标对患者进行症状评分;术后即刻对卜述指标进行重复测量.并坚持随访,分别计算两组滑脱复位率和融合率.结果 两组平均手术时间及术中出血量分别为PLIF:(194.3±54.7)min.(402.2±123.9)ml;PLF:(179.3±45.7)min,(367.2±102.3)ml,差异均无统计学意义;术后PLIF组椎间高度、滑脱率、节段角度、椎间孔面积等影像学指标的恢复与维持均优于PLF组,末次随访时两组融合率分别为96.7%、88.6%(P=0.099);两组患者术后即刻及术后1年腰痛、腿痛VAS评分和Odl评分均较术前明显改善,临床疗效主观评价优秀率分别为56.7%(PLIF)与37.7%(PLF).结论 与PLF相比,PLIF对腰椎滑脱的矫正、椎间高度的维持、生理曲度的恢复以及椎间孔面积的扩大等指标均有显著的优越性,其临床疗效主观评价优秀率亦高于PLF组.     

椎间融合器与椎弓根固定加后外侧植骨治疗腰椎滑脱症

目的:探讨椎间融合器与椎弓根固定加后外侧植骨治疗腰椎滑脱症的效果。方法:1999年1月～2002年5月间89例腰椎滑脱症患者分为椎间融合器加椎弓根钉系统固定组(A组),单纯椎弓根固定组(B组),均行后外侧植骨。对二组术前、术后和随访时JOA评分、滑脱率、复位率、滑脱角、椎间隙高度、椎间孔高度及并发症进行对比研究。结果:89例平均随访22个月(12～52月),二组术后较术前各项指标有明显改善(P<0.01);A组椎间隙、椎间孔高度改善优于B组(P<0.05);B组复位率、滑脱角、椎间隙高度、椎间孔高度均明显丢失,10.3%的患者植骨融合失败或滑脱复发,3.4%的患者出现内固定断裂或松动。JOA评分A组优良率为93%,优于B组(P<0.01)。结论:椎间融合器加椎弓根钉系统固定治疗腰椎滑脱症优于单纯椎弓根系统治疗组。     

椎间融合器与椎弓根系统复位固定治疗腰椎滑脱症

目的:总结椎间融合器加椎弓根系统复位固定治疗腰椎滑脱的适应证、疗效及并发症。方法:1999年3月~2002年5月间对31例腰椎滑脱患者行椎间融合器加椎弓根系统复位固定、后外侧融合手术治疗,观察术前、术后和随访期间Taillard指数、Boxall指数、滑脱角、腰椎生理前凸角、椎间隙高度指数的变化;同时观察临床疗效及融合率。结果:31例平均随访19个月(6~36个月),术前与术后的Taillard指数、Boxall指数、滑脱角、腰椎生理前凸角、椎间隙高度指数有显著性差异(P<0.01);术后与随访时比较无显著性差异。优良率为93.55%,融合率为100%。并发症有硬膜损伤致脑积液漏1例,cage位置不佳1例,L5神经根损伤1例,无断钉和断棒现象。结论:椎间融合器加椎弓根系统复位固定、后外侧融合手术治疗腰椎滑脱近期疗效满意,能克服单纯使用cage治疗腰椎滑脱所引起的并发症。     

两种椎间植骨融合方式治疗腰椎滑脱的临床疗效的分析

目的比较两种椎间植骨融合方式治疗腰椎滑脱的临床疗效。方法分析我院脊柱外科2012-10-2013-10收治的60例腰椎滑脱症患者的临床资料,其中30例行椎弓根螺钉内固定椎间单纯自体骨植骨融合(A组),30例行椎弓根螺钉内固定椎间融合器(Cage)融合(B组)。其中两组患者的年龄、性别、病程、滑脱节段及程度等比较,均无统计学差异(P0.05),具有可比性。比较两组手术时间、术中出血量、植骨融合率、融合时间、椎间隙高度、椎间孔高度、术后1个月滑脱复位率、终末随访时复位丢失率、临床治疗效果及两组终末随访时的断钉率。结果 B组手术时间长于A组(P0.05),且术中出血量较A组增加(P0.05)。A组患者获随访12~24个月,B组15~22个月。术前及终末随访时两组间JOA评分比较,均无统计学差异(P0.05)。两组术后1个月滑脱复位率比较无显著性差异(P0.05),终末随访时复位丢失率比较有统计学差异(P0.05)。复查X线片及三维CT显示,两组终末随访时植骨融合率无统计学差异(P0.05),A组植骨融合时间较长,两组比较有统计学差异(P0.05);术后1个月两组椎间孔及椎间隙高度比较无统计学差异,但终末随访时B组椎间隙及椎间孔高度均高于A组,差异有统计学意义(P0.05)。终末随访时B组断钉率明显低于A组。结论在椎弓根系统内固定基础上采用Cage植骨融合治疗腰椎滑脱症的治疗效果及植骨融合率与椎间单纯自体骨植骨治疗相近,但终末随访时Cage组的融合时间较短,复位丢失率、椎间隙和椎间孔高度的维持及断钉率的比较均优于椎间单纯自体骨植骨。     

Vasopressor hormone response following mesenteric traction during major abdominal surgery

Background : We investigated the vasopressor hormone response following mesenteric traction (MT) with hypotension due to prostacyclin (PGI₂) release in patients undergoing abdominal surgery with a combined general and epidural anesthesia. Methods : In a prospective, randomized, placebo-controlled study we administered 400 mg ibuprofen (i.v.) in 42 patients scheduled for abdominal surgery. General anesthesia was combined with epidural anesthesia (T4-L1). Before as well as 5, 15, 30, 45, and 90 min after MT we recorded plasma osmolality, hemodynamics and measured 6-keto-PGFlα (stabile metabolite of PGI₂), TXB₂ (stabile metabolite of thromboxane A₂) active renin, and arginine vasopressin (AVP) plasma concentrations by radioimmunoassay. Catecholamine levels were assessed by high-pressure liquid chromatography (HPLC) with electrochemical detection. Results : Following MT, arterial hypotension occurred along with a substantial PGI₂ release. This was completely abolished by ibuprofen administration. Although plasma levels of 6-keto-PGF_1α (1133 (708) vs. 60 (3) ng/L, median (median absolute deviation), P=0.0001, placebo vs. ibuprofen) remained significantly elevated, blood pressure was restored within 30 min after MT in the placebo group. At the same point in time plasma concentrations of TXB² (164 (87) vs. 58 (1) ng/L, P=0.0001), epinephrine (46 (33) vs. 14 (6) ng/L, P=0.001), AVP (41 ± (18) vs. 12 (7) ng/L, P=0.0004), and active renin (27 (12) vs. 12 (4) ng/L, P = 0.001) were significantly higher in placebo-treated patients. Conclusion : Under combined general and epidural anesthesia arterial hypotension following MT due to endogenous PGI₂ release is associated with enhanced release of AVP, active renin, epinephrine and thromboxane A₂, presumably contributing to hemodynamic stability within 30 min after MT.     

A Teaspoon Pump for Pumping Blood with High Hydraulic Efficiency and Low Hemolysis Potential

Abstract: Virtually all blood pumps contain some kind of rubbing, sliding, closely moving machinery surfaces that are exposed to the blood being pumped. These valves, internal bearings, magnetic bearing position sensors, and shaft seals cause most of the problems with blood pumps. The original teaspoon pump design prevented the rubbing, sliding machinery surfaces from contacting the blood. However, the hydraulic efficiency was low because the blood was able to "slip around" the rotating impeller so that the blood itself never rotated fast enough to develop adequate pressure. An improved teaspoon blood pump has been designed and tested and has shown acceptable hydraulic performance and low hemolysis potential. The new pump uses a nonrotating "swinging" hose as the pump impeller. The fluid enters the pump through the center of the swinging hose; therefore, there can be no fluid slip between the revolving blood and the revolving impeller. The new pump uses an impeller that is comparable to a flexible garden hose. If the free end of the hose were swung around in a circle like half of a jump rope, the fluid inside the hose would rotate and develop pressure even though the hose impeller itself did not "rotate"; therefore, no rotating shaft seal or internal bearings are required.     

Microspheres Based Detoxification System: A New Method in Convective Blood Purification

Abstract: A variety of protein-bound or hydrophobic substances, accumulating as a result of pathologic conditions such as exogenous or endogenous intoxications, are removed poorly by conventional detoxification methods because of low accessibility (hemodialysis), insufficient adsorption capabilities (hemosorption), low efficiency (peritoneal dialysis), or economic limitations (high-volume plasmapheresis). Combining advantages of existing methods with microspheric technology, a module-based system was designed. Major operating parameters of the latter can be modified to allow for adjustment to individual clinical situations. An extracorporeal blood circuit including a plasmafilter is combined with a secondary high-velocity plasma circuit driven by a centrifugal pump. Different microspheric adsorbers can be combined in one circuit or applied in sequence. Thus, a prolonged treatment can be tailored using specially designed selective adsorber materials. Comparing this system with existing methods (high-flux hemodialysis, molecular adsorbent recycling system), results from our in vitro studies and animal experiments demonstrate the superior efficiency of substance removal.     

Tissue perfusion in relation to cardiac output during continuous positive-pressure ventilation and administration of propranolol or verapamil

Background : Our objective was to determine whether administration of propranolol or verapamil modifies the hemodynamic adaptation to continuous positive-pressure ventilation (CPPV), in particular the regional distribution of cardiac output (CO).
Methods : General hemodynamics and regional blood flows assessed by microsphere technique (15 (μm) were recorded in 16 anesthetized pigs during spontaneous breathing (SB) and CPPV with 8 cm H₂O end-expiratory pressure (CPPV8) before and after intravenous administration of propranolol (0.3 mg · kg⁻¹ followed by 0.15 mg · kg⁻¹ · h⁻¹, n=8) or verapamil (0.1 mg · kg⁻¹ followed by 0.3 mg · kg⁻¹ · h⁻¹, n=8).
Results : CPPV8 depressed CO by 25% without shifts in its relative distribution with the exception of a noteworthy increase in adrenal perfusion. Propranolol increased arterial blood pressure, and due to a fall in heart rate, CO dropped by 25%. The kidneys and, to a lesser extent, the splanchic region and central nervous system received increased fractions of the remaining CO at the expense of skeletal muscle flow. Similar patterns were seen during SB and CPPV8 such that the combination of propranolol and CPPV8 depressed CO by 50%. The circulatory effects of verapamil were less evident but myocardial perfusion tended to increase.
Conclusions : The combination of propranolol or verapamil with CPPV does not result in any specific hemodynamic interaction in anesthetized pigs, except that the combined effect of propranolol and CPPV may severely reduce CO.     

Volatile anaesthetics reduce adhesion of blood platelets under low-flow conditions in the coronary system of isolated guinea pig hearts

Background : Inhibitory effects of volatile anaesthetics on platelet aggregation have been demonstrated in several studies. However, the influence of volatile anaesthetics on intracoronary platelet adhesion has not been elucidated so far.
Methods : Isolated hearts of guinea pigs were perfused with buffer in the absence or presence of volatile anaesthetics (0.5 and 1 MAC) at constant coronary flow rates of 5 ml/min for 25 min, then 1 ml/min for 30 min and again 5 ml/min for 10 min. Before, during and after low-flow perfusion, a bolus of human platelets was applied into the coronary system. To simulate thrombogenic conditions, 0.3 U/ml human thrombin was infused during low-flow perfusion and reperfusion. The number of platelets sequestered to the endothelium was calculated from the difference between coronary in- and output of platelets. The myocardial production of lactate and consumption of pyruvate and coronary perfusion pressure were also determined.
Results : At a flow rate of 5 ml/min only about 3% of the applied platelets did not emerge from the coronary system, in any group. In contrast, 13.1±1.2% (mean±SEM) of infused platelets became adherent in low-flow perfusion in the control group without anaesthetic. The adherence was reduced with each 1 MAC isoflurane (to 6.2±1.2%), sevoflurane (to 4.4±0.9%) or halothane (to 3.2±1.5%) (each P <0.05 vs. control). Volatile anaesthetic, 0.5 MAC, did not inhibit platelet adhesion to a statistically significant extent in any case. Perfusion pressure and metabolic parameters were not statistically different between the control and the hearts exposed to anaesthetics.
Conclusion : Volatile anaesthetics in a concentration of 1 MAC can reduce the adhesion of platelets in the coronary system under reduced flow conditions. This action does not arise from vasodilation or inhibition of ischaemic stress.     

Bariatric Surgery in Some "Central and East-European (former Eastern bloc)"Countries - Current Status and Prediction for the Next Millennium

Background: Obesity is increasing globallly, including in the formerly "Eastern Bloc" countries. Methods: A survey was made of obesity and bariatric surgery. Results: In the 8 East and Central European countries studied, with total population 300 million, roughly 43% of the population was overweight (BMI 25-30), 23% obese (BMI > 30), with about 15 million people morbidly obese (BMI > 40). From 0-10 morbidly obese individuals/100,000/year undergo bariatric surgery. Conclusion: Most countries were found to provide inadequate treatment for obesity.The majority of the morbidly obese are not treated effectively. However, health-care awareness of obesity and bariatric surgeons are slowly increasing.     

Synergistic interaction between the effects of propofol and midazolam with fentanyl on phrenic nerve activity in rabbits

Background: It has been shown that the depressive effects of both propofol and midazolam on consciousness are synergistic with opioids, but the nature of their interactions on other physiological systems, e. g. respiration, has not been fully investigated. The present study examined the effect of propofol and midazolam alone and in combination with fentanyl on phrenic nerve activity (PNA) and whether such interactions are additive or synergistic. Methods: PNA was recorded in 27 anaesthetised and artificially ventilated rabbits. In three groups, propofol, fentanyl and midazolam were administered intravenously in incremental doses to construct dose-response curves for the depressant effects of each one on PNA. In another two groups, the effect of pretreatment with either fentanyl 1 μg · kg^?1 i. v. or midazolam 0.05 mg · kg^?1 i. v. on the effects of propofol and fentanyl respectively on PNA were studied. Results: Propofol and fentanyl caused a dose-dependent depression of PNA with complete abolition at the highest total doses of 16 mg · kg^?1 i. v. and 32 μg · kg^?1 i. v., respectively. In contrast, midazolam in incremental doses to a total of 0.8 mg · kg^?1 reduced mean PNA by 63%, but approximately 12% of PNA remained at a total dose as high as 6.4 mg · kg^?1. The mean ED₅₀s, calculated from dose-response curves, were 5.4 mg · kg^?1, 3.9 μg · kg^?1 and 0.4 mg · kg^?1 for propofol, fentanyl and midazolam, respectively. Initial doses of either fentanyl 1 μg · kg^?1 i. v. or midazolam 0.05 mg · kg^?1 i. v. acted synergistically with subsequent doses of either propofol or fentanyl to abolish PNA at total doses of 8 mg · kg^?1 and 8 μg · kg^?1, respectively. Conclusion: Fentanyl has a synergistic interaction with both propofol and midazolam on PNA and hence potentially on respiration.     

Influence of dopexamine hydrochloride on haemodynamics and regulators of circulation in patients undergoing major abdominal surgery

Background: Catecholaminergic support is often used to improve haemodynamics in patients undergoing major abdominal surgery. Dopexamine is a synthetic vasoactive catecholamine with beneficial microcirculatory properties. Methods: The influence of perioperative administration of dopexamine on cardiorespiratory data and important regulators of macro- and microcirculation were studied in 30 patients undergoing Whipple pancreaticduodenectomy. The patients received randomized and blinded either 2 μg · kg^?1 · min^?1 of dopexamine (n=15) or placebo (n=15, control group). The infusion was started after induction of anaesthesia and continued until the morning of the first postoperative day. Endothelin-1 (ET-1), vasopressin, atrial natriuretic peptide (ANP), and catecholamine plasma levels were measured from arterial blood samples. Measurements were carried out after induction of anaesthesia, 2 h after onset of surgery, at the end of surgery, 2 h after surgery, and on the morning of the first postoperative day. Results: Cardiac index (CI) increased significantly in the dopexamine group (from 2.61±0.41 to 4.57±0.78 1 · min^?1 · m^?2) and remained elevated until the morning of the first postoperative day. Oxygen delivery index (DO₂I) and oxygen consumption index (VO₂I) were also significantly increased in the dopexamine group (DO₂I: from 416±91 to 717±110 ml/m² · m²; VO₂I: from 98±25 to 157±22 ml/m² · m²), being significantly higher than in the control group. pHi remained stable only in the dopexamine patients, indicating adequate splanchnic perfusion. Vasopressive regulators of circulation increased significantly only in the untreated control patients (vasopressin: from 4.37±1.1 to 35.9±12.1 pg/ml; ET-1: from 2.88±0.91 to 6.91±1.20 pg/ml). Conclusion: Patients undergoing major abdominal surgery may profit from prophylactic perioperative administration of dopexamine hydrochloride in the form of improved haemodynamics and oxygenation as well as beneficial influence on important regulators of organ blood flow.     

Immunomodulation in Transplantation with Photopheresis

Abstract: Photopheresis is a technique in which peripheral blood mononuclear cells, in the presence of a photoacti-vatable compound, are exposed extracorporeally to ultraviolet A light and reinfused, inducing a host autoregula-tory immune response. Experimental work and ongoing clinical studies are helping to define the role of this novel, safe, and non-toxic immunomodulating technology in the field of transplantation.