胸椎黄韧带骨化症患者围手术期护理

目的：总结胸椎黄韧带骨化症（OLF）患者围手术期护理，促进患者早日康复。方法：对18例OLF患者针对性地做好术前心理护理、适应性训练，术后严密观察双下肢感觉运动变化，做好体位、脑脊液漏的护理，康复训练及并发症的预防。结果：提高了患者生存质量。结论：OLF手术复杂、难度大，充分的围手术期护理是提高手术成功率和减少并发症的关键。     

手术治疗胸椎黄韧带骨化症的护理

随着脊髓造影、ＣＴ、ＭＲＩ检查的不断发展 ,黄韧带骨化症 (ＯＬＦ)已被公认为是一种独立的临床性疾病 ,并引起人们的关注[1] 。胸椎黄韧带骨化症目前发病机制不清 ,可能与慢性退行性变、炎症、氟代谢等有关 ,是导致椎管狭窄、脊髓受压的重要原因之一。目前认为手术是治疗胸椎黄韧带骨化症的唯一方法[2 ] 。现将护理体会介绍如下 :1　临床资料本组病例中男性 12例 ,女性 2例 ,年龄最小 2 6岁 ,最大 6 5岁 ,平均 4 2岁。病程最长 15年 ,最短 5月 ,临床主要症状 :胸腹部紧束感 4例 ,一侧或双侧腰腿痛 5例 ,肢体麻木 14例 ,无力 7例 ,间歇性跛…     

全椎板切除椎管减压术治疗胸椎黄韧带骨化症29例围术期护理

目的：探讨全椎板切除椎管减压术治疗胸椎黄韧带骨化症的护理方法。方法：对29例胸椎黄韧带骨化症患者有针对性地做好术前准备、心理护理、症状护理、适应性训练,术后严密观察双下肢感觉运动变化、切口引流情况,预防下肢深静脉血栓形成、脑脊液漏等并发症,并进行康复训练指导。结果：本组29例术后症状立即缓解,2例经8d与10d加重期后逐渐缓解,1例并发脑脊液漏,经治疗后痊愈。结论：全椎板切除椎管减压术治疗胸椎黄韧带骨化症难度大,围术期实施有效的护理干预是提高手术成功率和降低并发症发生率的重要保证。     

全椎板切除椎管减压术治疗胸椎黄韧带骨化症29例围术期护理

目的:探讨全椎板切除椎管减压术治疗胸椎黄韧带骨化症的护理方法。方法:对29例胸椎黄韧带骨化症患者有针对性地做好术前准备、心理护理、症状护理、适应性训练,术后严密观察双下肢感觉运动变化、切口引流情况,预防下肢深静脉血栓形成、脑脊液漏等并发症,并进行康复训练指导。结果:本组29例术后症状立即缓解,2例经8 d与10 d加重期后逐渐缓解,1例并发脑脊液漏,经治疗后痊愈。结论:全椎板切除椎管减压术治疗胸椎黄韧带骨化症难度大,围术期实施有效的护理干预是提高手术成功率和降低并发症发生率的重要保证。     

胸椎黄韧带骨化症的诊断与治疗

目的:研究胸椎黄韧带骨化症的诊断与治疗。方法:分析对比23例患者的临床表现、影像学检查和手术方法。结果:23例胸椎黄韧带骨化症患者行后路全椎板切除椎管减压术,随访时间平均2.3年,结果优11例,良7例,可2例,差3例,优良率87%,有效率91.3%。结论:CT和MRI是诊断胸椎黄韧带骨化症最直接和最可靠的手段,但要结合临床,手术是治疗胸椎黄韧带骨化症最有效的方法。     

后路椎板减压术治疗胸椎黄韧带骨化症的围手术期护理

胸椎黄韧带骨化症（Ossification of thoracic ligamentum flavum，OTLF）是导致胸椎管狭窄的重要原因之一,其发病原因及机制尚不十分明确，临床症状无特征性，MRI结合CT或CTM是诊断OTLF的常用方法，手术减压是唯一有效的治疗方法。对胸椎管实施减压术比腰椎颈椎的危险性大，发生并发症的机会多。我院2003年2月～2011年5月共收治37例OTLF病例，均实施了手术治疗，经过精心护理，效果较好。现将围手术期护理报告如下。     

颈椎后纵韧带骨化症患者围术期护理体会

颈椎后纵韧带骨化症(ossification of posteriorlongitudinal ligament,OPLL)最早由Tsukimoto(1960)根据尸体标本解剖结果进行描述[1],是指随着年龄的增长,在诸多因素的作用下,颈椎后纵韧带组织中新生异位骨结构形成并逐渐发生骨化,导致椎管、椎间孔狭窄,压迫脊髓和神经根[2],往往需手术治疗,且预后差异很大.     

胸椎黄韧带骨化症的手术治疗

目的 :探讨胸椎黄韧带骨化症的手术治疗方法与技巧 ,以提高胸椎黄韧带骨化症的诊疗水平。方法 :胸椎黄韧带骨化症 2 1例 ,均行胸椎后路节段全椎板切除椎管扩大脊髓减压术。结果 :本组术后平均随访 1 5a ,优 16例 ( 76 2 %) ,良 5例 ( 2 3 8%)。疗效满意。结论 :早期诊断并尽早手术是治疗胸椎黄韧带骨化症的关键。     

胸椎黄韧带骨化手术的中短期疗效

目的：回顾总结胸椎黄韧带骨化致胸髓病变患者的临床资料,探讨减压手术的中短期疗效。方法：患者23例（女性9例,男性14例）,平均年龄55.1±7.2岁。每例患者均由磁共振成像明确诊断,术前均有下肢功能障碍。大多数患者同时并发其他脊柱病变。所有患者均行减压手术,在低于胸10节段的病例,同时进行椎弓根螺钉内固定,后外侧植骨融合术。采用日本矫形外科协会（JOA）评分对手术疗效进行评价。结果：所有患者术后1年都得到随访,目前已有8例随访超过6年。JOA评分均值由术前的5.6提高到术后1年的8.8,平均恢复率为57.8%。结论：手术是胸椎黄韧带骨化引起脊髓病变后唯一有效的治疗方法,避免损伤胸髓是手术的关键。手术的短期疗效相对较好,但中期有症状加重的趋势。     

躯体感觉诱发电位术中监护在胸椎黄韧带骨化症手术中的应用

目的探讨躯体感觉诱发电位（SEP）监护在胸椎黄韧带骨化症手术中的作用及意义,提高对胸椎黄韧带骨化症手术治疗水平。方法在SEP监护下,对18例无神经功能损伤及有部分神经功能损伤的胸椎黄韧带骨化症患者进行手术。结果11例未达到监护临界值,5例超过临界值发出警告,接受警告后调整手术过程,术后16例均未发生脊髓功能的进一步损害。结论SEP术中监护在胸椎黄韧带骨化症手术中判断脊髓损伤准确可靠,值得推广应用。     

椎管成形术在胸椎黄韧带骨化症中的初步应用

【目的】评价椎管成形术治疗胸椎黄韧带骨化症的安全性和有效性。【方法】对11例胸椎黄韧带骨化症患者采用后路椎板减压椎管成形术治疗,用Frankel方法评价患者的神经功能恢复情况,X线片和CT评价内植物位置和椎管减压效果。【结果】本组手术时间140～230min（平均170min）,术中出血4001500mL（平均800mL）。所有病例均获随访,随访时间6～24个月（平均13个月）,优5例,良3例,改善2例,差1例。1例伤口二期缝合,2例脑脊液漏。【结论】椎管成形术治疗胸椎黄韧带骨化症操作简单,安全可靠且可减少远期并发症。     

X线检查在黄韧带骨化症诊断中的价值

目的:探讨X线检查在诊断黄韧带骨化症中的作用.方法:对56例黄韧带骨化症的X线表现进行回顾性分析.结果:黄韧带骨化症X线特征为多节段受累,胸腰段多见,多为边疆性,多合并后纵韧带骨化,结论:X线检查对于防止漏,误诊和定位在诊断黄韧带骨化症中有其特殊的地位.     

临床护理路径在腰椎管狭窄症患者围手术期中的应用

目的探讨临床护理路径应用于腰椎管狭窄患者围手术期的效果。方法成立临床护理路径管理小组,选择患者随机分组后制定出恰当的临床护理路径。对照组患者接受常规护理,观察组根据制定的临床护理路径进行护理。结果采用临床路径护理的观察组其输液期间输液通道重复建立和静脉炎的发生率低于对照组,并且卧床期间观察组患者并发症的发生率亦低于对照组。结论临床护理路径能显著提高腰椎椎管狭窄患者围术期的护理质量,较少并发症发生,使患者得到最佳的医疗护理服务。     

Lumbar Spinal Stenosis: Therapeutic Options Review

Lumbar spinal stenosis (LSS) functionally impacts significant numbers of Americans per year. Current estimates place the number of Americans suffering from senescent lumbar spinal stenosis at 400,000. The prevalence of this disorder in patients ranging from 60 to 69 years of age is very high. Forty‐seven percent of this age group have mild to moderate stenosis, and 19.7% have severe stenosis. As the baby boomer generation gets older, 10,000 individuals attain the age of 65 years every day in United States. LSS is becoming very common and will be a major healthcare issue as the population ages. Although LSS is not life threatening, it can cause substantial disability with limitations to performing daily activities, and thus, the associated negative impact on quality of life (QOL). This article reviews the pathophysiology and current treatment options for LSS, focusing on evidence‐based treatment options.     

Thoracic ossification of the ligamentum flavum causing Brown-Séquard syndrome: a case report and literature review

Brown-Séquard syndrome (BSS) has many etiologies, including penetrating trauma, extramedullary tumors, and disc herniation. However, thoracic ossification of the ligamentum flavum (OLF) is an extremely rare cause of this syndrome. A 46-year-old woman with motor weakness in her right lower extremity and urinary retention was admitted to our department. Based on the results of physical examination, computed tomography, and magnetic resonance imaging, a diagnosis of BSS with OLF was considered. The patient underwent urgent conservative treatment. BSS is a rare condition characterized by hemisection or hemicompression of the spinal marrow. The herein-described case of incomplete BSS due to OLF responded to conservative treatment. However, the successful nonoperative management of this case is insufficient evidence to consider it as the standard of care. Therefore, emergency laminectomy decompression remains the standard of care for BSS.     

Functional and Patient‐Reported Outcomes in Symptomatic Lumbar Spinal Stenosis Following Percutaneous Decompression

Background: Neurogenic claudication due to symptomatic lumbar spinal stenosis (LSS) is a painful condition causing significant functional disability. While the cause of LSS is multifactorial, thickened ligamentum flavum (LF) accounts for up to 85% of spinal canal narrowing. mild percutaneous lumbar decompression allows debulking of the hypertrophic LF while avoiding the morbidities frequently associated with more invasive surgical procedures. Methods: In this prospective case series study, consecutive LSS patients presenting with neurogenic claudication were treated with percutaneous lumbar decompression. Efficacy was evaluated using the Pain Disability Index (PDI) and Roland‐Morris Disability Questionnaire. Pre‐ and postprocedure Standing Time, Walking Distance, and Visual Analog Score (VAS) were also monitored. Significant device‐ or procedure‐related adverse events were reported. Results: The mild procedure was successfully performed on forty patients. At twelve months, both PDI and Roland‐Morris showed significant improvement of 22.6 points (ANOVA, P < 0.0001) and 7.7 points (ANOVA, P < 0.0001), respectively. Walking Distance, Standing Time, and VAS improvements were also statistically significant, increasing from 246 to 3,956 feet (ANOVA, P < 0.0001), 8 to 56 minutes (ANOVA, P < 0.0001), and 7.1 to 3.6 points (ANOVA, P < 0.0001), respectively. Tukey HSD test found improvement in all 5‐outcome measures to be significant from baseline at each follow‐up interval. No significant device‐ or procedure‐related adverse events were reported. Conclusion: This study demonstrated significant functional improvement as well as decreased disability secondary to neurogenic claudication after mild procedure. Safety, cost‐effectiveness, and quality‐of‐life outcomes are best compared with comprehensive medical management in a randomized controlled fashion and, where ethical, to open lumbar decompression surgery.     

Long‐Term Results of Percutaneous Lumbar Decompression mild® for Spinal Stenosis

Background: Lumbar spinal stenosis (LSS) generally occurs from a combination of degenerative changes occurring in the lumbar spine. These include hypertrophy of ligamentum flavum, facet joint arthritic changes and bulging of the intervertebral disk. Spinal stenosis leads to compression of the lumbar neural elements (cauda equina), which manifests as low back and leg pain especially on standing and walking known as “neurogenic claudication.” Current treatment options for LSS are varied. Conservative management, including physical therapy with/without epidural steroid injections, may be adequate for mild stenosis. Surgical decompression is reserved for severe cases and results in variable degrees of success. Patients with moderate‐to‐severe LSS having ligamentum flavum hypertrophy as a key contributor are generally inappropriately treated or undertreated. This is due to ineffectiveness of conservative therapy and possibility that major surgical compression might be too aggressive. Percutaneous decompression offers a possible solution for this patient population. Methods: One‐year follow‐up study was conducted at 11 U.S. sites. Study cohort included 58 mild^® percutaneous decompression patients who underwent 170 procedures, the majority treated bilaterally at one or two lumbar levels. Outcome measures included the visual analog scale (VAS), Oswestry Disability Index (ODI), Zurich Claudication Questionnaire (ZCQ), and SF‐12v2^® Health Survey. Results: No major mild^® device or procedure‐related complications were reported. One‐year data showed significant reduction of pain as measured by VAS. Improvement in physical functionality, mobility, and disability was significant as measured by ZCQ, SF‐12v2, and ODI. Conclusions: At 1 year this 58‐patient cohort demonstrated continued excellent safety profile of the mild^® procedure and equally important, showed long‐term pain relief and improved functionality.     

老年退行性腰椎管狭窄症伴糖尿病患者手术的护理

退行性腰椎管狭窄症、糖尿病发病率逐年上升,而且两病伴发的情况日益增多。糖尿病的治疗常以运动治疗为基础,但患有退行性腰椎管狭窄症的老年患者的活动常被严重限制。因此,如上述两种疾病伴发,则患者的病情会不断加重,甚至丧失自理能力。脊柱外科手术技术的发展,给退行性腰椎管狭窄症伴糖尿病患者的治疗创造了条件。