椎弓根钉复位固定及两种融合方式治疗腰椎滑脱疗效比较

目的比较椎弓根钉后路固定联合椎体间植骨融合或椎间cage加后外侧植骨融合两种融合方式治疗腰椎滑脱的疗效差异。方法对腰椎滑脱51例行椎弓根钉后路固定联合椎体间植骨融合治疗27例(A组),行椎弓根钉后路固定联合椎间cage加后外侧植骨融合治疗24例(B组)。结果两组术后JOA评分、滑脱角、滑移率较术前差异有统计学意义(P<0.05),两组之间差异无统计学意义(P>0.05)。两组术中出血量、手术时间、术后椎间隙高度、术后融合率比较差异有统计学意义(P<0.05)。结论椎弓根钉后路固定联合椎间cage加后外侧植骨融合治疗腰椎滑脱在术后椎间隙高度维持、融合率较椎体间植骨融合有一定优势。     

斜外侧椎间融合术融合器沉降对腰椎生物力学影响的有限元分析

目的:应用三维有限元法分析椎间融合器(cage)沉降对斜外侧椎间融合术(oblique lateral interbody fusion,OLIF)术后腰椎生物力学的影响.方法:根据1例健康成年人腰椎CT扫描数据构建正常腰椎L3～L5节段三维有限元模型,模拟进行L4/5节段OLIF手术,根据cage沉降陷入椎体程度(0...     

腰椎滑脱复位系统加椎间融合器在成人腰椎滑脱治疗中的应用

目的 :通过对 3 2例成人腰椎滑脱症的治疗 ,探讨腰椎滑脱复位系统加椎间融合器在成人腰椎滑脱症中的治疗作用 ,阐述滑脱复位的临床意义。方法 :2 0 0 0年 3月～ 2 0 0 2年 3月 ,我们收治成人滑脱症 3 2例患者 ,其中男 15例 ,女 17例 ;年龄 40～ 67岁 ,平均 5 2岁 ;滑脱类型 ,发育不良伴峡部裂 2 3例 ,退行性 8例 ,创伤性 1例 ;滑脱程度 °～ °,滑脱角最大 10°。临床均有半年以上腰痛、跛行、神经根性症状且保守治疗无效。所有患者均行后路椎体融合术 ,使用腰椎滑脱复位系统加椎间融合器治疗。结果 :本组 3 2例病人随访 3～ 2 4个月 ,平均 12个月 ,所有患者滑脱椎体均维持复位 ,椎体融合良好 ,术后症状消失 2 9例 ,仍有部分症状 3例 ,患者术后症状满意率 90 .6%。结论 :成人腰椎滑脱使用腰椎复位系统加椎间融合器 ,行经腰椎后路椎体间融合术 ,能充分完成后路减压 ,椎体间复位 ,并能保证可靠的融合 ,不失为一种较为理想的治疗腰椎滑脱症的术式     

微创手术与开放手术治疗Meyerding Ⅱ～Ⅴ度腰椎滑脱症的中期疗效分析

目的 评估MeyerdingⅡ～Ⅴ度腰椎滑脱症微创手术与开放手术的中期临床疗效,以及原位融合与复位融合对预后的影响。方法 回顾性分析自2010-01—2015-09手术治疗的139例MeyerdingⅡ～Ⅴ度腰椎滑脱症,42例接受微创经椎间孔入路腰椎椎间融合手术治疗（微创手术组）;97例接受开放手术治疗（开放手术组）,其中63例经椎间孔入路腰椎椎间融合术,34例后路腰椎椎间融合术。微创手术组18例滑脱椎体原位融合（微创原位融合组）,24例滑脱椎体复位融合（微创复位融合组）。开放手术组29例滑脱椎体原位融合（开放原位融合组）,68例滑脱椎体复位融合（开放复位融合组）。结果 微创手术组术后5年疼痛VAS评分、ODI指数高于开放手术组（P<0.05）,两组椎间骨性融合率、并发症发生率差异无统计学意义（P>0.05）。微创复位融合组术后5年疼痛VAS评分、ODI指数、并发症发生率明显高于微创原位融合组（P<0.05）,两组椎间骨性融合率差异无统计学意义（P>0.05）。开放原位融合组术后5年疼痛VAS评分、ODI指数高于开放复位融合组,椎间骨性融合率低于开放复位融合组,...     

后路椎体间融合治疗严重腰椎管狭窄症初步报告

目的:探讨后路椎体间融合治疗严重腰椎管狭窄症的优越性。方法:采用全椎板切除后路椎体间植入聚醚醚酮(poly-ether-ether-ketone,PEEK)cage治疗20例严重腰椎管狭窄症患者。结果:随访1年~1年4个月,近期疗效满意,未产生术中及术后并发症。结论:全椎板切除后路椎体间融合术不仅可实现充分减压,而且可以预防继发性腰椎不稳的产生。     

单枚cage单侧椎弓根螺钉内固定术治疗退行性腰椎不稳

目的:探讨后路单枚cage单侧椎弓根钉内固定术治疗退行性腰椎不稳的临床效果.方法:采用后路椎弓根钉及椎间融合器治疗需行内固定融合手术的退行性腰椎不稳患者(均有腰痛及一侧下肢疼痛)51例,男32例,女19例,年龄41～72岁.单节段47例,其中L3/4 1例,L4/5 25例,L5/S1 21例;双节段4例,其中L3/4和L4/5 1例,L4/5和L5/S1 3例.手术方法均采用单侧显露症状侧椎板及关节突,单侧置入椎弓根钉,经椎间孔入路(TLIF手术)切除椎间盘及软骨终板,植骨后放入单枚cage.根据日本JOA评分法评估术后疗效,结果:手术时间单节段平均100min,双节段平均150min.术中出血90～430ml,其中单节段平均140ml,双节段24Oml.术前JOA评分平均11分,术后1年时平均25分.优38例(74.51%),良10例(19.61%),可2例(3.92%),差1例(1.96%),优良率为94.12%.经1～2.5年随访,所有患者椎体间融合良好,未发现断钉及cage移位.结论:单侧椎弓根钉及cage内固定术,手术方法简单,出血少、手术时间短,对脊柱结构破坏少,是治疗退行性腰椎不稳可供选择的较好方法.     

后路椎体间植骨融合椎弓根钉内固定治疗腰椎滑脱症

目的　报告后路椎体间植骨融合椎弓根钉内固定术治疗腰椎滑脱症的疗效。方法　应用后路椎体间植骨融合椎弓根钉内固定治疗腰椎滑脱症 2 8例 ,其中 10例为峡部裂性 ,18例为退行性。 度滑脱 18个节段 , 度滑脱 10个节段 ;男 6例 ,女 2 2例 ;年龄 4 1～ 5 7岁 ,平均 4 5 .6岁 ,椎间植骨块均为自体髂骨。根据手术前后的 X线平片和 JOA评分 ,判定后路腰椎间植骨的融合率和临床效果。结果　随访 12～ 4 0个月 ,平均 2 5 .8个月 ,经 X线检查 ,2 8个椎间隙的融合率为96 .5 % ,JOA评分计算的术后综合改善率为 91.2 %平均椎间高度由术前 4 .2 mm恢复至 11.6 mm。结论　后路椎体间自体髂骨植骨融合椎弓根钉内固定治疗腰椎滑脱症可以取得良好的复位和固定 ,恢复和维持椎间高度 ,高融合率和综合改善率等效果。     

单枚融合器附加椎弓根螺钉系统在腰椎滑脱治疗中的应用

目的探索以单枚椎间融合器后斜向植入附加椎弓根螺钉系统内固定的后路腰椎椎体间融合术治疗腰椎滑脱症.方法1997年7月～2000年8月,我们收治了各类腰椎滑脱症65例患者(男32例,女33例.年龄28～58岁,平均43岁).其中,峡部型滑脱症(Ⅰ～Ⅱ°)26例,退行性滑脱症25例,腰椎后路减压术后滑脱症7例,发育不良性腰椎滑脱症5例,外伤性滑脱症2例.均有一年以上的下腰痛和/或下肢根性症状且保守治疗无效.所有患者均在减压的基础上行病变节段的单枚螺纹式椎间融合器(BAK)的后斜向植入并附加用椎弓根螺钉系统内固定.结果65例中有59例平均随访达18月,皆达到临床融合.临床效果评价优42例,良14例,无改善3例,差0例.患者主观评定满意41例,基本满意15例,可3例所有患者均无融合器的移位及椎弓根螺钉松动,患者主观满意率93%.结论经侧后方斜向植入单枚螺纹状椎间融合器并附加椎弓根螺钉内固定的后路腰椎椎体间融合术式能充分完成后路减压,并能保证可靠的融合,适用于滑脱程度严重、滑脱倾向大的患者,不失为一种比较理想的治疗各种腰椎滑脱症的术式.     

TLIF技术治疗腰椎滑脱的疗效分析

目的探讨经椎间孔椎体间融合（transforaminal lumbar interbody fusion,TLIF）治疗腰椎滑脱的疗效。方法2004年8月至2007年2月应用TLIF技术治疗Ⅰ～Ⅱ度腰椎滑脱患者39例,男25例,女14例;年龄34～65岁,平均53岁。将19例使用cage融合器患者分为A组,20例采用自体骨为B组。采用Nakai评分标准评价治疗效果。通过腰椎侧位片测量术前、术后2周及术后6个月椎体滑移距离、腰椎前凸角、椎间隙高度,判断骨融合情况。结果随访12～28个月。A组优9例,良7例,可3例,优良率为84.21%。B组优10例,良7例,可2例,差1例,优良率为85%。两组间优良率无统计学差异（方差分析,P〉0.05）。椎体滑移距离、腰椎生理前凸角及椎间隙高度术前与术后2周比较,差异均有统计学意义（P〈0.05）;术后2周与术后6个月比较,差异均无统计学意义（P〉0.05）。患者术后5～11个月植骨均融合,平均7.3个月。内固定材料无松动、断裂,Cage融合器位置及形态正常。结论TLIF技术治疗腰椎滑脱能够明显缓解患者症状及改善相关功能障碍,提高脊柱的融合率,是治疗腰椎滑脱症的一种理想方法。     

椎弓根螺钉加椎间植骨融合器治疗腰椎滑脱症的远期疗效分析

目的:探讨椎弓根螺钉系统加椎间植骨融合器(cage)治疗峡部不连性腰椎滑脱症的远期疗效。方法:1996年10月～2002年1月收治的峡部不连性腰椎滑脱症患者中资料齐全的82例,均在椎弓根螺钉系统作滑脱复位后加cage行椎间融合固定。58例为1枚cage从后斜向前呈45°置入,24例为2枚cage从后向前垂直置入。随访时观察固定节段的椎体间有无位移、滑脱有否复发,测量术前、术后2周及随访时固定椎间隙的高度与近心端第二椎间隙高度比值的变化。结果:随访24～86个月,平均36个月。根据Nakai评分标准,优良率为79.3%。19例Ⅰ度腰椎滑脱患者术后全部解剖复位;47例Ⅱ度滑脱患者5例留有Ⅰ度滑脱;16例Ⅲ度滑脱患者4例留有Ⅰ度滑脱。至随访时,使用1枚cage或2枚cage所固定的椎间隙高度与近心端第二椎间隙高度的比值较术后2周时的比值减低,但统计学上无显著性差异,滑脱无复发。结论:使用椎弓根螺钉加cage治疗腰椎滑脱症可减少术后折钉和滑脱复发的问题,是治疗腰椎滑脱症比较理想的手术方式。1枚cage即可以达到稳定椎间的作用。     

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.