颈前路减压植骨术治疗后纵韧带骨化症

目的：分析颈椎后纵韧带骨化症的前路减压融合手术效果。方法：对４３例短节段后纵韧带骨化症进行颈椎前路减压植骨手术,男３１例,女１２例,其中切除１个椎节１０例（Ｉ组）,２个椎节１４例（Ⅱ组）,３个椎节１９例（Ⅲ组）,采用ＪＯＡ评定标准及颈椎Ｘ线拍片进行评判。     

颈椎前路减压前纵韧带“Z”成形三梯级植骨术

我们对颈椎前路减压植骨的方法做了改进,创用了椎前筋膜及前纵韧带“Z”成形、三梯级骨块植骨法。临床应用7例,效果满意。 方　法 全麻。颈前外侧切口,显露椎前筋膜后,摄颈椎侧位片定位。两侧以颈长肌为界,用电刀将需融合部位的椎前筋膜与前纵韧带做多个 “Z”形切开。用锐利的骨膜剥离器将其向两侧剥离,与间盘连接处可用尖刃刀切剥,按徐印坎的方法钻孔与开窗。我们常将后纵韧带在钻孔时同时切断取除。特别注意:当环锯进入约1.5cm后需减轻压力,注意手感,轻轻来回旋动环锯。在前后两椎骨皮质完全锯断时,手下实感轻松,转动环锯时有钝挫感,此…     

颈椎间盘与后纵韧带上交感神经的解剖学观察及在颈椎间盘源性疼痛中作用的探讨

目的观察颈椎间盘及后纵韧带上交感神经的分布特点并探讨其在颈椎间盘源性疼痛中的作用。方法分别切取8只兔子颈椎间盘及颈椎后纵韧带，用冰冻切片-乙醛酸（SPG）法对其交感神经纤维进行特异性染色，荧光显微镜观察并辅以图像分析软件（Image-pro plus5．0）观察其分布特点。结果颈椎间盘外环有少量交感神经节后纤维，颈椎后纵韧带椎间盘区有大量密集的交感神经节后纤维，它们互相交叉成网状或排列成丛状，且有着复杂的三维空间联系。分布于后纵韧带浅层的交感神经较深层密集（P〈0．05）。结论分布于颈椎间盘外环及后纵韧带上的交感神经纤维是感受颈椎间盘紊乱、病变刺激的生理基础，可能在颈椎间盘源性疼痛发病中起着重要作用。     

颈椎后纵韧带总胶原、Ⅰ型和Ⅱ型胶原含量变化的研究

目的通过测量脊髓型颈椎病患者和正常对照组颈椎后纵韧带总胶原、Ⅰ型和Ⅱ型胶原含量，探讨颈椎后纵韧带在颈椎病发病机制中的意义。方法收集脊髓型颈椎病下位颈椎后纵韧带15例做实验组，同年龄段正常下位颈椎后纵韧带10例做对照组，Weossner法测定2组总胶原含量；酶联免疫吸附法测定Ⅰ型和Ⅱ型胶原含量：HE染色和Masson染色，对比观察后纵韧带的显微结构变化。结果实验组总胶原、Ⅰ型胶原含量低于对照组；实验组Ⅱ型胶原含量较对照组高；实验组Ⅰ型／Ⅱ型胶原比值明显低于对照组，差异有统计学意义（P〈0．05）；病理显示实验组弹力纤维、胶原纤维肿胀，排列紊乱。结论颈椎后纵韧带总胶原、Ⅰ型和Ⅱ型胶原代谢发生紊乱，与颈椎病发生发展有密切关系。     

颈椎挥鞭样损伤的MRI特征与临床意义

[目的]探讨颈椎挥鞭样损伤的MRI表现及其诊断价值.[方法]对30例手术治疗的急性颈椎挥鞭样损伤纳入研究,以手术结果为参照,从椎前筋膜、前纵韧带、椎间盘、椎骨、后纵韧带、颈髓、颈后韧带复合体、颈椎稳定性方面回顾性分析其MR表现.[结果]椎前筋膜出血水肿(27例,90％),MRI上表现为椎前筋膜增厚肿胀伴信号改变,于T1WI序列上呈稍低信号、等信号或稍高信号,于T2WI及STIR序列上呈高信号;颈椎前纵韧带断裂(27例,90％),手术显示47个断裂平面,MRI上27例显示33个断裂平面(70.2％),表现为线状或斑点状异常信号改变,T1WI序列上等信号、T2WI及STIR序列上高信号;椎间盘损伤(30例,100％),MRI显示形态信号改变;颈椎骨折(6例,20％),MRI全部显示;颈椎后纵韧带断裂(12例,40％),手术显示15个断裂层面,MRI上显示8例11个断裂层面(73.3％),表现为线状或斑点状异常信号改变,T1WI序列上等信号、T2WI及STIR序列上高信号;MRI上还显示颈椎骨挫伤(4例,13.3％);颈椎不稳(25例,83.3％);颈髓损伤(25例,83.3％);颈后韧带复合体损伤(25例,83.3％).[结论]颈椎挥鞭样损伤的MRI表现具有重要的临床诊断价值,与临床表现相结合可为临床诊断与治疗提供影像学依据.     

应力刺激对于后纵韧带骨化因子的影响

[目的]建立颈椎后路手术动物模型，增加后纵韧带的张力，检测后纵韧带中BMP-2及BMP-7的表达及水平，探讨机械应力刺激对后纵韧带骨化的作用机理。[方法]S-D大鼠100只，分为5组，每组20只，手术方式：（1）颈椎后路全椎板切除组；（2）颈椎后路全椎板切除＋肌肉切断组；（3）单纯椎旁肌止点切断组；（4）假手术组，仅作切口，剥离椎旁肌暴露；（5）对照组，不作任何处理。分别于术后1、2、4、8周，取实验动物手术节段后纵韧带标本，PCR方法检测BMP-2及BMP-7的表达水平。[结果]（1）颈椎手术后，全椎板切除＋肌肉切断组BMP-2，BMP-7水平上升最明显，与对照组比较有统计学差异；（2）颈椎后路全椎板切除组BMP-2，BMP-7水平水平上升，与对照组比较有统计学差异；（3）单纯椎旁肌止点切断组BMP@，BMP-7水平上升，与对照组比较有统计学差异；（4）假手术组BMP-2，BMP-7水平与对照组比较无明显变化。[结论]手术导致的机械刺激提高BMP-2，BMP-7在大鼠后纵韧带内的表达水平；认为虽然动物模型不能完全模拟人体情况，但是BMP-2，BMP-7在OPLL的早期可能具有始动作用，而BMP-7在后续的骨化过程中可能继续发挥作用。建议临床手术时应尽量采取微创，减少术后不稳增加后纵韧带的应力。     

颈椎间盘与后纵韧带上交感神经分布的特点及临床意义

目的观察颈椎间盘及后纵韧带上交感神经分布特点及其临床意义。方法按节段（C2／3、C3／4、C4／5、C5／6、C6／7）分别切取16只兔颈椎间盘及颈椎后纵韧带，其中8只通过NF200对其神经纤维进行荧光组织化学染色，另8只通过冰冻切片．乙醛酸（SPG）法对交感神经纤维进行染色，通过荧光显微镜观察及图像分析软件（Image—pro plus 5．0软件）描述分析其分布特点。结果在颈椎间盘纤维环外环分布有少量交感神经节后纤维。在颈椎后纵韧带上分布有大量交感神经节后纤维，主要呈网状分布，且以椎间盘区分布相对密集。分布于后纵韧带浅层的交感神经较深层密集，分布于C2／3、C3／4、C4／5的交感神经较C5／6、C6／7密集。结论颈椎间盘及后纵韧带上分布的交感神经可能是引发颈性眩晕的另一重要因素。     

过伸性颈椎颈髓损伤的诊断与治疗

报道４３例过伸性颈椎颈髓伤。所有病例进行了ＭＲＩ检查，结果示颈椎损伤的ＭＲＩ改变主要为：（１）椎前血肿形成和前纵韧带断裂；（２）椎体前缘撕脱性骨折；（３）椎间盘突出。颈髓损伤的ＭＲＩ包括：９１）水肿；（２）出血；（３）受压，多数闰同采用颈前咱砬压术，经６－６５个月，平均３８个月随访，获得满意疗效。     

单开门椎板成形微钛板固定治疗颈椎后纵韧带骨化症

目的：探讨单开门椎板成形微钛板固定治疗颈椎后纵韧带骨化症的临床疗效。方法回顾性分析2012-06-2013-06于我院接受手术治疗的颈椎后纵韧带骨化症患者48例,随机分为两组,两组分别记录手术时间、出血量,术后3个月、6个月、12个月,门诊复查颈椎X线、CT、MRI,测量椎管前后径指数,开门角度,评估椎管扩大率,采用JOA评分观察术后神经功能的恢复情况。结果钛板组：术前平均JOA评分为（8.4±1.7）,末次随访时为（13.6±2.2）,改善率为60.5%。传统组：术前平均JOA评分为（8.5±1.5）,末次随访时为（11.6±2.0）,改善率为50.5%。结论颈椎单开门椎板成形术中应用颈椎微钛板固定可有效维持术后开门角度,预防“再关门”出现,是治疗颈椎后纵韧带骨化症的有效方法。     

全椎板减压侧块螺钉内固定治疗颈椎后纵韧带骨化症的疗效分析

【摘要】 目的：探讨后路全椎板减压侧块螺钉内固定治疗颈椎后纵韧带骨化症的疗效。方法：32例颈椎后纵韧带骨化症患者,平均年龄57.5岁,分别行后路单开门椎管扩大椎板成形术（A组,17例）和全椎板减压侧块螺钉内固定术（B组,15例）治疗。随访观察并比较两组患者手术时间、术中出血量、术后神经功能恢复情况及手术并发症的发生情况,并对两组患者术后颈椎的生理曲度及颈项肩背部疼痛、僵硬等轴性症状进行评估。结果：A组患者术后均无椎板开门再闭发生,B组患者术后植骨均完全融合,无内固定脱出、断裂等并发症发生。随访12个月,J     

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.