经峡部外缘入路行椎间孔或椎间孔外型腰椎间盘突出摘除术

近年来随着ＣＴ和ＭＲＩ影像技术的发展,腰椎间孔和椎间孔外型椎间盘突出症逐渐被重视起来。它是腰椎间盘脱出在椎弓根内外缘之间或外缘以外,压迫相应节段神经根而引起的一系列症状和体征,亦称之为极外侧腰椎间盘突出症。其临床表现、影像学特征及手术治疗方法与典型的腰椎间盘突出症都有不同。１　临床资料１－１　一般资料１９９６年２月～１９９８年２月经椎板峡部外缘手术入路切除椎间孔或椎间孔外型腰椎间盘突出症１６例,男性１１例,女性５例,年龄２１～５５岁,平均３９－８岁,有外伤史１２例。病程２～４６个月,平均２８－７…     

极外型腰椎间盘突出症手术入路

Ｊａｃｋｓｏｎ[1] 将腰椎间盘突出分为 4型 :中央型、后外型、椎间孔型和椎间孔外型。目前绝大多数作者同意将椎间孔型和椎间孔外型统称为极外型腰椎间盘突出症。极外型腰椎间盘突出症发生率低 ,近10年作者遇到 7例 ,其中 6例手术治疗。突出位于椎间孔内的 3例采用椎管内入路 ,突出位于椎间孔外的 3例采用椎旁肌间隙入路 ,手术效果优良。作者就极外型腰椎间盘突出症的手术入路作一介绍。1　手术入路的选择术前应反复查体确定哪一节段的神经根受累。仔细阅读腰椎Ｘ线片、ＣＴ和ＭＲＩ图片 ,精确确定椎间盘突出是位于椎间孔内还是椎间孔外 ,…     

椎间孔型腰椎间盘突出症手术治疗18例

目的：研究椎间孔型腰椎间盘突出症的临床特点和手术方法。方法：对１８例椎间孔型腰椎间盘突出症患者行手术治疗,其中棘突椎板切除术３例,单侧显露棘突悬留式腰椎管扩大术加一侧部分关节突切除术４例,单侧显露棘突悬留式腰椎管扩大术加一侧关节突全部切除８例,经腹膜外前路椎间盘切除术３例。结果：本组１８例经６￣４８个月随访,总优良率达８３．３％。结论：椎间孔型腰椎间盘突出症的症状较重,多数需手术治疗,应根据ＣＴ诊     

椎间孔型腰椎间盘突出症的外科治疗

椎间孔型腰椎间盘突出症在临床上并不少见〔１〕。有学者认为〔２〕本病症状重,保守治疗效果差,应积极手术治疗。我们自１９９１年９月～１９９７年３月间共手术治疗８６９例腰椎间盘突出,发现椎间孔型椎间盘突出症２２例,占同期的２５％,通过手术治疗,获得满意效...     

显微内窥镜下微创治疗椎间孔外型腰椎间盘突出症

目的探讨显微内窥镜下微创治疗椎间孔外型腰椎间盘突出症的可行性。方法对15例椎间孔外型腰椎间盘突出症手术患者进行回顾性分析。突出间隙:L3~46例,L4~59例。手术选择后侧旁正中入路,采用MED系统完成神经根探查、减压和椎间盘髓核摘除。结果15例术后随访6~12个月,平均8·3个月。采用改良Macnab标准评价:优8例,良5例,可2例,优良率86·7%。结论显微内窥镜下微创经后侧旁正中入路治疗椎间孔外型腰椎间盘突出症具有创伤小、手术时间短、恢复快等特点,是一种安全有效的手术方法。     

双“L”形椎板截骨开窗入路治疗腰椎间盘突出症伴侧隐窝狭窄

双“Ｌ”形椎板截骨开窗入路治疗腰椎间盘突出症伴侧隐窝狭窄王吉兴，金大地从１９９０年１月～１９９３年９月，作者采用双“Ｌ”形椎板截骨开窗入路治疗腰椎间盘突出症伴侧隐窝狭窄１０６例，经１～３年９个月随访，优良率为９６．２％，现报告如下。１一般资料１０６例...     

极外侧型腰椎间盘突出症的诊断与治疗

目的 探讨极外侧型腰椎间盘突出症的诊断与治疗方法。方法回顾分析1999年1月～2004年1月收治16例极外侧型腰椎间盘突出症患者资料。其中椎间孔型8例，椎间孔外型2例，椎间孔内外混合型6例。L2.3 1例，L3,4 5例，L4,5例，L5、S1 2例。CT扫描显示在相应椎间孔内、椎间孔外、椎间孔内外有与椎间盘相同的CT值密度影像。手术采用椎板间入路10例，椎板侧方入路3例，椎板间和椎板侧方联合入路3例。结果术后16例均获随访6个月～5年，平均9个月。根据中华骨科学会脊柱组腰背痛手术评定标准：优8例，良5例，可3例。术后CT显示相应节段椎间盘突向椎间孔或椎间孔外的占位消失，同节段神经根压迫解除。结论CT是目前诊断腰椎间盘突出症的较好方法。手术入路应依突出椎间盘组织占位、病理类型及是否合并椎管内病变而定。     

椎间孔入路与椎板间入路脊柱内镜手术对腰椎间盘突出症合并侧隐窝狭窄的临床疗效分析

目的 研究经椎间孔入路和经椎板间入路治疗腰椎间盘突出症合并侧隐窝狭窄的疗效。方法 收集该院自2017年1月～2020年10月住院治疗的腰椎间盘突出症合并单侧隐窝狭窄135例患者的临床资料,根据不同手术入路分为两组：椎间孔组74例采用经椎间孔入路脊柱内镜手术治疗,椎板间组61例采用经椎板间入路脊柱内镜手术治疗。对两组患者的疗效指标进行比较。结果 两组患者术后1个月、6个月的VAS评分和ODI指数均较术前明显降低(P<0.05),但组间差异无统计学意义(P>0.05)。椎间孔组的手术时间明显长于椎板间组(P<0.05),手术透视次数明显多于椎板间组(P<0.05)。结论 经椎间孔入路和经椎板间入路内镜手术治疗腰椎间盘突出症合并侧隐窝狭窄均能取得较好疗效,但经椎板间入路手术相对更易操作,能够明显减少术中透视次数,缩短手术时间。     

不同入路经皮椎间孔镜下髓核摘除术治疗腰椎间盘突出症效果分析

目的探讨不同椎板间入路经皮椎间孔镜下髓核摘除术治疗腰椎间盘突出症中的效果。方法随机将97例接受经皮椎间孔镜下髓核摘除术的腰椎间盘突出症患者分为2组。对照组48例经椎间孔侧后方入路,观察组49例经后路椎板间入路。比较2组手术效果、术中出血量、手术时间及手术前后疼痛评分(VAS)。结果 2组治疗优良率比较差异无统计学意义(P0.05)。观察组术中出血量及手术时间均优于对照组,VAS评分低于对照组,差异具有统计学意义(P0.05)。结论经椎间孔侧后方和经后路椎板间入路经皮椎间孔镜下髓核摘除术治疗腰椎间盘突出症均效果肯定。其中后路椎板间入路手术时间短,术中出血量少,疼痛缓解明显。     

极外侧腰椎间盘突出症的CT分型与手术方法选择

目的：分析极外侧腰椎间盘突出的ＣＴ表现并分型,探讨各型特点、术式选择及临床疗效。方法：作者对极外侧型腰椎间盘突出症ＣＴ资料进行综合分析,认为可参照椎弓根位置,将其分为２型：Ⅰ型：椎间孔型,Ⅱ型：椎间孔外型。Ⅰ型中又将椎间盘突出近椎间孔内侧口或外侧口者分为Ⅰａ、Ⅰｂ２个亚型。Ⅰａ型手术取椎板间入路,Ⅰｂ、Ⅱ型取椎板侧方入路,部分合并后外侧椎间盘突出者同时行椎板开窗。Ⅰｂ、Ⅱ型如合并椎体滑脱或不宜从后路手术者取前侧腹膜外术式。结果：手术治疗１６例,经３个月～３年随访,结果参考Ｎａｋａｌ分级示优１０例,良５例,总优良率９３７％。结论：依据ＣＴ分型,合理选择术式,使手术具有创伤小,效果好,对腰椎稳定性影响小等优点。     

Body composition assessment and methodology in nonathletic and athletic adolescent and adult males and females

The purpose of this review is to outline methodology for assessing body composition utilizing anthropometric and densitometric techniques. The objective of body composition assessment is to measure body fat and lean body mass. The quantity of these components varies due to growth, physical activity, dietary regimens, and aging. Anthropometric techniques incorporate selected skinfolds, circumferences, skeletal widths, or other variables to estimate body composition within k2.0-4.0%. These techniques are adequate for field testing of groups or individuals, but are population specific. Densitometry measures body volume irrespective of physique, sex, or age. This laboratory technique estimates body composition within 1.0-2.0%, is more difficult to administer, but is not population specific. Some limitation exists with any present technique due to biological variability and incomplete research of reference body composition in children, females, and the aged. J Orthop Sports Phys Ther 1984;5(6):336-347.     

Perioperative and long-term morbidity and mortality after above-knee and below-knee amputations in diabetics and nondiabetics

We performed a retrospective review of a vascular surgery quality assurance database to evaluate the perioperative and long-term morbidity and mortality of above-knee amputations (AKA, n = 234) and below-knee amputations (BKA, n = 720) and to examine the effect of diabetes mellitus (DM) (181 of AKA and 606 of BKA patients). All patients in the database who had AKA or BKA from 1990 to May 2001 were included in the study. Perioperative 30-day cardiac morbidity and mortality and 3-yr and 10-yr mortality after AKA or BKA were assessed. The effect of DM on 30-day cardiac outcome was assessed by multivariate logistic regression and the effect on long-term survival was assessed by Cox regression analysis. The perioperative cardiac event rate (cardiac death or nonfatal myocardial infarction) was at least 6.8% after AKA and at most 3.6% after BKA. Median survival was significantly less after AKA (20 mo) than BKA (52 mo) (P < 0.001). DM was not a significant predictor of perioperative 30-day mortality (odds ratio, 0.76 [0.39-1.49]; P = 0.43) or 3-yr survival (Hazard ratio, 1.03 [0.86-1.24]; P = 0.72) but predicted 10-yr mortality (Hazard ratio, 1.34 [1.04-1.73]; P = 0.026). Significant predictors of the 30-day perioperative mortality were the site of amputation (odds ratio, 4.35 [2.56-7.14]; P < 0.001) and history of renal insufficiency (odds ratio, 2.15 [1.13-4.08]; P = 0.019). AKA should be triaged as a high-risk surgery while BKA is an intermediate-risk surgery. Long-term survival after AKA or BKA is poor, regardless of the presence of DM.     

Postoperative nausea and vomiting and opioid-induced nausea and vomiting: guidelines for prevention and treatment

Postoperative nausea and vomiting (PONV) causes patient discomfort, lowers patient satisfaction, and increases care requirements. Opioid-induced nausea and vomiting (OINV) may also occur if opioids are used to treat postoperative pain. These guidelines aim to provide recommendations for the prevention and treatment of both problems. A working group was established in accordance with the charter of the Sociedad Espa?ola de Anestesiología y Reanimación. The group undertook the critical appraisal of articles relevant to the management of PONV and OINV in adults and children early and late in the perioperative period. Discussions led to recommendations, summarized as follows: 1) Risk for PONV should be assessed in all patients undergoing surgery; 2 easy-to-use scales are useful for risk assessment: the Apfel scale for adults and the Eberhart scale for children. 2) Measures to reduce baseline risk should be used for adults at moderate or high risk and all children. 3) Pharmacologic prophylaxis with 1 drug is useful for patients at low risk (Apfel or Eberhart 1) who are to receive general anesthesia; patients with higher levels of risk should receive prophylaxis with 2 or more drugs and baseline risk should be reduced (multimodal approach). 4) Dexamethasone, droperidol, and ondansetron (or other setrons) have similar levels of efficacy; drug choice should be made based on individual patient factors. 5) The drug prescribed for treating PONV should preferably be different from the one used for prophylaxis; ondansetron is the most effective drug for treating PONV. 6) Risk for PONV should be assessed before discharge after outpatient surgery or on the ward for hospitalized patients; there is no evidence that late preventive strategies are effective. 7) The drug of choice for preventing OINV is droperidol.