脊柱前路手术入路

脊柱外科的手术治疗可经不同的入路来完成 ,而对手术入路的选择常取决于脊柱外科医师的手术技能。脊柱前路手术已作为许多脊柱疾患的常规治疗方法而逐渐普及 ,本文就脊柱前路手术的入路及术中、术后应注意的事项进行介绍。1　枕颈部 (枕骨～颈 3)1 1　经口入路沿咽后壁正中纵行切开 ,即可显露颅底至颈 3椎体 (图 1) ,必要时还可切开悬雍垂及软腭以便向上扩大显露。用刮匙和骨膜剥离器剥离枕骨斜坡、寰椎前弓、齿状突基底部和枢椎椎体前方的软组织 ,用磨钻和咬骨钳仔细切除寰椎前弓的下 1/3～ 2 /3以使齿状突基底部得到满意显露 ,同时还应注…     

脊柱前路手术与内固定融合

脊柱前路手术与内固定融合肖映波，黄继义，刘仁孝我院骨科从１９８６年初开展脊柱前路手术，应用华西医大骨科设计的椎体间固定钉［１］作内固定，同时作椎体间嵌入植骨融合，至１９９２年底共用于骨折３１例、结核２２例、肿瘤６例。该内固定钉应用灵活、固定可靠、后凸...     

先天性胆道疾病的手术适应证与手术时机

先天性胆道疾病的手术适应证与手术时机中山医科大学附属一院肝胆外科（５１００８０）黄洁夫大多数先天性胆道疾病常在新生儿及婴幼儿时期即产生临床症状，直接威胁到患儿的生命，往往必须采取某种形式的外科手术治疗。如何确定手术适应证及选择手术时机以取得较好的疗效...     

重视脊柱外科技术在临床中的适应证

近十几年来,随着脊柱生物力学和内置物的发展,手术技术的提高,脊柱外科取得了突飞猛进的发展,特别是一些过去认为部位特殊、手术风险高、并发症高的疾病,目前得到了有效解决。《中国骨伤》本期刊登有关《一期前后路手术减压固定治疗严重下颈椎疾病》等几篇文章便颇有代表性。1一期前后联合入路治疗下颈椎疾患通过《一期前后路手术减压固定治疗严重下颈椎疾病》一文评价了一期前后路手术可行性与安全性。颈椎一期前后路联合手术是将平时的颈椎前路手术和颈后路手术一期完成,单个手术技术并无改变。主要的难度在于手术创伤增加、一期手术时仰…     

严格脊柱内固定适应证,提高翻修手术效果

脊柱外科的核心理论是清除病变、矫正畸形、解除神经压迫并恢复和重建脊柱生理功能，脊柱生物力学和生理解剖功能的重建或(和)恢复是各种技术要达到的目标。20世纪90年代后期，我国脊柱外科各种器材和技术经历了高速引进、高速发展的时期。尤其是AO新理念、新技术的广泛普及，为我国骨科尤其脊柱外科的发展提供了良好的契机。在我国各大城市的相关医院逐步开始采用现代先进的内固定技术，取得了卓有成效的结果，并产生相     

颈胸段脊柱肿瘤的前路手术治疗

目的：探讨颈胸段脊柱肿瘤前路不同手术入路、肿瘤切除和重建术式。方法：总结我院自1998年1月－2000年12月收治31例颈胸段脊柱肿瘤的临床表现、各种手术途径、术式及其预后。结果：术后随访3－36个月,30例患者术后神经功能有所改善。2例转移性腺癌患者分别于术后13个月和16个月因全身多处转移,全身衰竭死亡。2例患者分别于术后8、13个月局部复发。结论：应根据肿瘤的部位、范围选择相应的手术途径、肿瘤切除术式和前路重建方法。     

腰椎间盘突出症的量化手术适应证

回顾１０３例手术证实的腰椎间盘突出症，将诊断依据标准化计分，试图找到比较适用而标准的手术适应证，从分档的疗效评定结果可以看出：计分大于１５分者有明显的手术指征；计分９至１５分者有手术指征，但应谨慎；而计分小于９分者，应慎之又慎，为手术的相对禁忌证。     

小儿脊柱侧凸置入器械取出的适应证

小儿脊柱侧凸和后凸弧度超过Ｃｏｂｂ角４０°时往往需要器械矫正和脊柱融合术。矫正畸形后在特定条件下偶需取出置入器械。这样不但丧失了矫正的作用力,而且用于脊柱融合、巩固矫形效果的植骨块的作用也大为减弱,对此我们感到应明确取出置入器械的适应证,以指导工作。临床资料１９８０年５月～１９９８年５月,１８年间共手术治疗脊柱畸形１６６４例,取出置入器械者５７例,其中男２４例,女３３例,平均年龄１０岁,平均在手术后１年８个月取出。４６例为先天性脊柱侧凸,８例为特发性脊柱侧凸,１例为脊柱后凸畸形,２例为神经纤维瘤…     

Chylous injury following anterior spinal surgery: Case reports

Chylous leakage is an unusual complication following anterior spinal surgery. This leakage can occur as a result of traumatic injury to the thoracic duct, the cisterna chyli, or the retroperitoneal lymphatic vessels. The authors present case reports of three patients who underwent anterior spinal surgical procedures in advertently complicated by an injury to the lymphatic system. All patients were managed nonoperatively with tube drainage and hyperalimentation and had uneventful recoveries.     

Computer-assisted anterior spinal surgery for a case of recurrent giant cell tumor

 A computer-assisted image guidance system has recently been used for posterior spinal surgery. We applied this system to anterior revision surgery of the cervicothoracic junction for a patient with recurrent thoracic spinal giant cell tumor. Anterior computer-assisted spinal surgery was achieved by attaching reference markers to threaded pins inserted into a vertebral body. The locations of anatomic structures in the surgical field of this patient were difficult to identify because of previous surgery. Both accurate resection of the tumor and anterior fusion with iliac bone autograft between C6 and T3 were successfully performed using a computer-assisted image guidance system. This system is useful for anterior spinal surgery because it enables a surgeon to perform safe and accurate surgery. Received: May 28, 2001 / Accepted: January 8, 2002     

Comparison of minimal access and traditional anterior spinal surgery in managing infectious spondylitis: a minimum 2-year follow-up

Background contextTraditional anterior spinal surgery (TASS) for the thoracolumbar spine is associated with significant morbidities. To avoid excessive tissue damage, minimal access spinal surgery (MASS) has been developed to treat a variety of anterior spinal disorders at the authors' institution. No previous reports comparing the outcomes of MASS and TASS for the treatment of infectious spondylitis were noted in the literature, to our knowledge.PurposeThe aim of this study was to investigate the outcomes of MASS in managing infectious spondylitis and compare the results to TASS with a minimum follow-up of 2 years.Study designA retrospective comparative cohort study in a single center.Patient sampleForty patients with thoracic or lumbar infectious spondylitis who underwent anterior spinal surgery were enrolled.Outcome measuresPerioperative data including operative time, estimated blood loss, packed red blood cell transfusion, postoperative tube drainage, need for intensive care, and length of hospital stay. Postoperative complications were classified according to the Clavien-Dindo system. Fusion grade was assessed by plain radiographs on the basis of Burkus criteria.MethodsBetween January 2002 and June 2010, all enrolled patients were collected via the Spine Operation Registry of the authors' institution. There were 23 MASS patients and 17 TASS patients. The average follow-up was 4.2 years (range, 2–9 years).ResultsThe mean estimated blood loss in MASS and TASS groups was 521.7 versus 979.4 mL (p=.007), intraoperative transfusion of packed red blood cells was 0.9 versus 2.7 units (p=.019), the amount of postoperative tube drainage was 235.2 versus 454.3 mL (p=.005), the number of patients requiring postoperative intensive care was 2 versus 7 (p=.023), and length of hospital stay was 15.4 versus 22.9, respectively (p=.043). The overall complication rate in the MASS group was 17% and 59% in the TASS group (p=.007). No major complications occurred in the MASS group, whereas four occurred in the TASS group (p=.026). Bone graft union was achieved in 38 of 39 survival patients (97%), with no difference between the groups. One patient in TASS had a pseudarthrosis and needed a posterior instrumented fusion.ConclusionsMinimal access spinal surgery has been suggested to be an effective and safe technique in treating thoracic and lumbar infectious spondylitis. Minimal access spinal surgery did not need endoscopic equipments or complex surgical instruments. Furthermore, in comparison to TASS, MASS resulted in a reduced blood transfusion amount, decreased intensive care unit stay, reduced overall length of stay, and reduced surgical complication rate. Nevertheless, the risks may be increased in performing MASS on patients with multilevel involvement, which could be associated with high vascularity, alternated vascular anatomy, increased soft-tissue edema, and adhesion.     

A new table-fixed soft tissue retractor for the anterior cervical spinal surgery

Summary Since surgeons sometimes encounter difficulty in keeping self-retaining soft tissue retractors in the proper position for anterior cervical spinal surgery, we have developed a new, simple soft tissue retractor system, which is fixed to the side rails of the operating table via retractor stands. All three joints of the retractor can be tightened simultaneously with a single handle. Each of two retractor blades can keep its position independent of the other thereby maintaining a well-exposed operative field for a long period of time. Fine adjustments of the blade position, after fixation of the retractors, is possible by sliding the head of the blade assembly along the axis of a ratchet mechanism. We have used these retractors in 43 surgical exposures, including 35 for anterior cervical fusion, 2 for posterior thoraco-lumbar decompression, and 6 for carotid endarterectomy. There have been no complications related to tissue damage.     

Anaesthesia for major spinal surgery

Major spinal surgery is performed for a wide variety of conditions including degenerative diseases, scoliosis and autoimmune diseases. Anaesthesia often presents several challenges to the anaesthetist. Careful pre-anaesthetic assessment and planning is important as patients may have multiple comorbidities. Important perioperative issues to consider include aspects of airway management, neurophysiological monitoring, patient positioning, blood conservation strategies, pain management and specific complications such as perioperative visual loss.     

Myotonia dystrophica and spinal surgery

Two cases of patients suffering from the congenital form of myotonia dystrophica under going spinal surgery are presented. Both patients had major complications, including cardiac arrhythmias, postoperative wound infection and more minor complications, such as sedation and opioid sensitivity. However, the most notable complication resulting in long-term morbidity was the deterioration of bulbar muscular function in one of the patients. This resulted in recurrent aspiration pneumonia and the need for a tracheostomy. This serious complication has not previously been reported following surgery.     

Anaesthesia for major spinal surgery

Major spinal surgery is indicated in a variety of conditions, including degenerative and autoimmune diseases, cord compression, scoliosis and acute spinal cord injuries. Careful pre-anaesthetic assessment and planning is vital. In the era of the COVID-19 pandemic, close collaboration with the surgical team is essential in determining the optimal timing of surgery. Important perioperative considerations include airway management, patient positioning, neurophysiological monitoring, blood conservative strategies, pain management and specific complications such as perioperative visual loss.     

Minimally invasive spinal surgery

Minimally invasive surgery offers quicker recovery and less morbidity for our patients through smaller surgical wounds and less tissue trauma. Although minimally invasive surgery has progressed in other fields of surgery for many years, spine surgeons have not previously embraced this philosophy for the various reasons discussed. However, minimally invasive spinal surgery has gained much interest in recent years. With the advent of new instrumentation, technology, and techniques, the promise of minimally invasive surgery in the spinal arena has become a reality. With the use of the microscope, navigational tools, newly developed canula for retraction, and image-guided percutenous pedicle screw systems, we can accomplish the same surgical procedures as currently used through smaller wounds and with greater precision. Nevertheless, all new technology does offer us an initial challenge of steep learning curves. Minimally invasive should not equate to minimal and inadequate treatment for our patients. Furthermore, careful analysis of this new technique is underway to assess its true advantages as compared with our current and proven techniques.     

Interest of porous biomaterials in spinal surgery

PURPOSE OF THE STUDY: The aim of this work was to study the behavior of porous alumina ceramic cages in spinal cervical surgery, with or without plate fixation as needed. MATERIAL AND METHODS: The population included 61 patients who underwent spinal surgery between May 1999 and October 2003. There were 48 women and 13 men, mean age 49 years at surgery. 74 implants were used, among them 71 were interbody cages. Ten patients were operated at two levels; C5-C6 and C6-C7 were most frequently instrumented. Patients were reviewed at 1 month, 3 months and 6 months, and, whenever possible more after. Clinical and radiological data were available for all patients. RESULTS: Mean follow-up was 7.2 months. Postoperative clinical data included assessment of neck and arm pain, using a visual analogic scale and fusion status determined by the presence of trabecular bridging bone and the disappearance of lucent lines around the implant on plain anteroposterior and lateral cervical radiographs. Two patients required another intervention, allowing intra-operative assessment of the quality of fusion. Clinical results were in agreement with the usual outcome reported in the literature with 54% of patients free of postoperative neck or arm pain and restriction of function mild or absent in 88%. Bone healing was achieved at 6 months on the average in 58 cases and in all patients at 12 months, including the two patients who required revision. DISCUSSION: The porous alumine cage is a reliable biocompatible and mechanically stable element helpful for achieving bone healing. Integration into bone tissue was radiographically satisfactory. This kind of implant appears to be an attractive alternative in spinal cervical surgery, avoiding donor graft site complications.     

纳米羟基磷灰石/聚酰胺66椎体支撑体在脊柱前柱手术重建中的应用

[目的]探讨纳米羟基磷灰石/聚酰胺66(nano-hydroxyapatite polyamide66,n-HA/PA66)椎体支撑体在脊柱前柱手术重建中应用的临床治疗效果。[方法]2008年1月～2010年10月采用n-HA/PA66椎体支撑体行脊柱前柱重建手术434例,男332例,女102例,年龄18～72岁,平均43.2岁;颈椎骨折84例,胸腰椎骨折202例,脊髓型颈椎病148例。随访以脊髓神经功能Frankel分级和日本矫形外科学会(japan orthopaedic association,JOA)评分改善率评价患者神经功能恢复情况;复查X线片及三维CT了解术后脊柱序列恢复情况,评估支撑体融合以及下沉移位情况。[结果]395例患者获得随访,随访时间3～24个月,平均11.4个月。末次随访时,颈椎骨折和胸腰椎骨折患者中,分别有16例和17例完全性脊髓损伤患者术后脊髓功能无恢复,其余Frankel分级分别平均提高1.1级和1.3级;颈椎病患者术后3个月及末次随访JOA改善率76.7%、80.8%。影像学检查显示术后脊柱高度、曲度基本恢复正常;颈椎骨折与颈椎病患者术后3个月时支撑体全部融合(融合率100%...