Posterior lumbar interbody fusion: an old concept with new techniques.

The estimated cumulative cost of health care attributable to back pain exceeds 25 billion dollars per year in the United States, and more than 200,000 spine fusion procedures are performed each year in an effort to relieve discogenic back pain and instability. These numbers are projected to rise in the face of our aging population. As new interbody grafting sources have been developed, posterior lumbar interbody fusion (PLIF) is being used with increasing frequency. PLIF was once a procedure that required extensive dissection of the musculoligamentous complex of the dorsal spine. Advances in surgical technique and technology now allow access to spinal structures with minimal trauma to surrounding tissue. Knowledge of the various fusion procedures can assist nurses caring for the unique needs of patients undergoing spinal surgery.     

Cystic fibrosis: an alternative approach.

Sometimes hospital is the best place for patients with cystic fibrosis, says Lyz Warren. Here she describes the choices available to children and parents on a unit which follows the philosophy adopted by The Children's Trust.     

颈前路分节段减压植骨融合术治疗多节段颈椎病：3种方法移植骨融合率的比较

背景：多节段颈椎病的传统治疗方法前路长节段减压存在着手术创伤大、难度高、植骨融合率低等的不足，影响术后疗效。 目的：比较3种不同方式的前路手术治疗多节段颈椎病的临床效果。 设计：对比观察。 单位：解放军第二军医大学长征医院骨科。 对象：选择1999—06／2003—06解放军第二军医大学长征医院骨科手术治疗的三间隙连续节段病变的多节段颈椎病患者36例，男25例，女11例；年龄35～62岁；病程3～26个月。根据临床表现及影像学检查结果诊断为多节段颈椎病；均不伴有连续型后纵韧带骨化及黄韧带骨化；患者及家属均对手术方案知情同意。 方法：所有病例植骨均采用自体骨植骨。取自体髂骨或将咬除椎体的松质骨填充入钛网或Cage内，所用钛网或Cage为钛材质，具有强度高，耐腐蚀、生物相容性好等特点。按照手术方式分为3组：①长节段减压组11例，其中4例为长钛网植骨，7例为自体髂骨植骨。行两椎体次全切除长节段植骨融合内固定术。②分节段减压组16例，其中12例为钛网＋Cage植骨，4例为自体骨＋Cage植骨。行单间隙减压＋单椎体次全切除植骨融合内固定术。③三间隙减压组9例。不作椎体的次全切除，仅行多个椎间盘切除减压，减压后，应用3个cage内填充人工骨或自体骨植入。 主要观察指标：所有病例于术后1周内及3，6，12个月复查颈椎正侧位、伸屈侧位片。以日本骨科协会（JOA）评分法评价术前、术后3个月神经功能，该评分总分17分，分数越高表明神经功能越好。分别记录3组患者的手术时间、术中出血量、住院时间、住院费用、术后3个月时植骨融合情况、术后3个月JOA评分较术前提高分数。术后采用复诊的方式进行术后并发症发生情况的观察。 结果：多节段颈椎病患者36例均进入结果分析。分节段减压组和三间隙减压组患者平均手术时间、术中平均出血量、平均住院时间均明显少于，短于长节段减压组（P〈0．05），平均住院费用明显高于长节段减压组（P〈0．05）。分节段减压组、三间隙减压组和长节段减压组术后JOA评分提高分数和植骨融合率相近（P〉0．05）。 结论：综合植骨融合率、神经功能恢复情况、手术时间、术中出血量、住院时间多种因素，3种术式中以颈前路分节段减压植骨融合术为治疗多节段颈椎病的手术方式较佳方案。     

应用自制异种骨椎间融合器行颈椎前路椎体间融合的生物力学评价：即刻稳定效果及自身强度

目的:自体髂骨移植与钛合金Cage在颈椎椎体间融合手术中的应用存在较多并发症,为弥补其不足,自行研制出一种并发症少的生物型融合器,通过在成人新鲜颈椎标本上模拟临床术式放置异种骨椎间融合器,验证其置入后的稳定性及自身强度。方法:实验于2005-06/2006-07在吉林大学机械科学与工程学院力学实验室完成。取16具新鲜成年男性C1~7颈椎标本,分为3组:①正常组:完整C1~7。②对照1组:模拟前路间盘C5~6摘除置1枚融合器。③对照2组:模拟前路间盘C5~6、C6~7摘除置2枚融合器。3组均进行稳定性实验和黏弹性实验,观察在不同应力下前屈、后伸、垂直压缩、扭转时位移距离,颈椎移位时融合器最大拔出力,脊柱压缩应力与时间,脊柱施加应力后时间与应变量。结果:①在颈椎前屈及后伸状态下对照1,2组较正常组位移小但差异不显著(P>0.05)。②垂直压缩实验结果显示在最大载荷为500N力作用下对照1,2组位移较正常组小,但差异不显著(P>0.05)。③颈椎移位时拔出力实验结果表明,植入椎间的融合器最大拔出力为1.85kN。④在200N·cm扭矩作用下,对照1,2组扭转角较正常组小,但差异不显著(P>0.05)。⑤对照1,2组7200s,应力松弛量和蠕变量小于正常组,但差异不显著(P>0.05)。结论:自制异种骨椎间融合器具有足够的支撑、抗滑、维持或增加椎间隙高度的功能,符合生物力学及临床要求。     

Analysis of the two-team approach to anterior spinal fusion

An anterior approach to the spine via a thoracoabdominal incision offers the surgeon many advantages. The major vascular structures are visualized, stabilization of a long segment of the spine is strong, and recovery is speedy. Nevertheless, this is a major operation and one with potential morbidity and mortality. At Children's Hospital of New Orleans, the Pediatric Surgery and Pediatric Orthopedic Surgery Services work together to reduce these risks and in so doing maintain an acceptable morbidity. With this two-team approach; we operated on the spines of 39 patients between 1978 and 1988. The most common indications for operation included idiopathic scoliosis, neuromuscular disease, and congenital abnormalities. A thoracoabdominal approach was used in 32 patients, a thoracic approach in four patients, and an abdominal approach in three patients. Twenty-nine patients experienced 65 complications; 45 of these complications were respiratory in nature. There were no postoperative deaths. Factors unrelated to the incidence of postoperative complications included age, volume of crystalloid infused during operation, volume of blood replacement, and length of anesthesia.     

Less invasive anterior fusion of the cervical spine

Summary

Trauma, degenerative and inflammatory diseases, or tumours may destabilise and deform the cervical spine, causing compression of the spinal cord and/or the nerve roots. The goals of surgical therapy are decompression of the neurostructures and restoration of the physiological alignment, along with stabilisation by fusion and fixation of the affected vertebrae. ‘Minimally invasive’ defines an effective surgical treatment with the least morbidity for the patient. The combined use of computed tomography (CT) and MRI, microsurgical techniques, intra-operative fluoroscopy and devices for internal fixation (plates and screws) has significantly improved the outcome. Nowadays bone graft substitutes, endoscopy and image-guided navigation are being introduced for clinical use, in order to reduce the surgical morbidity even further. Benefits of this evolution are: surgical procedures tailored for different pathologies; early mobilisation and rehabilitation, especially of elderly patients. Disadvantages are: a rapidly increasing number of operative procedures with a demanding learning curve, which have to be performed at specially qualified centres; and increasing sophistication (as a potential source of error) of the surgical equipment. A more balanced cooperation between industry and clinicians, along with an ethical agreement on how much surgery should be done, has become mandatory.     

Goethean science: an alternative approach

This paper considers the science of the poet Goethe as furnishing a complementary epistemology for complementary and alternative medicine (CAM), standing alongside and very different from conventional scientific methodology. Through reference to key texts it explores the phenomenological "science of qualities" that aims to allow the scientist, through robust training, to appreciate and intuit the wholeness inherent in nature, so that Goethe could claim the human being to be the most sensitive instrument. Goethe's color theory-a challenge to Newtonian thinking-and his study of plants are explored to illustrate a profoundly different way of looking at nature that celebrates the subjective and relational as a route to perceiving the whole. Ideas toward application of Goethe's approach within CAM are considered and the relevance of this approach as an alternative methodological enquiry toward consideration of wholeness and healing are offered.     

Thermoplastic Minerva body jacket--a practical alternative to current methods of cervical spine stabilization. A clinical report

The halo body jacket and plaster Minerva body jacket have been the preferred orthoses when maximal stabilization of the cervical spine is required. This report identifies some disadvantages of these orthoses, introduces the thermoplastic Minerva body jacket (TMBJ), and discusses its advantages in the rehabilitation of patients with cervical spine instability. A preliminary roentgenographic study was conducted to evaluate the cervical spine motion of five male subjects wearing the TMBJ. The TMBJ, in addition to providing comparable cervical spine stability, offers several advantages over current methods of stabilization.     

Q-methodology: an alternative approach to research in nurse education

An understanding of student experiences and perspectives are central to the delivery of quality nurse education programmes; implicit with this is a need to understand the attributes and characteristics of such individuals, their subjectivity. Traditional such inquiry has taken the form of questionnaires or interviews and focus groups. Q-methodology is offered as an alternative approach which provides insight into, and a method for studying, individual subjectivity through the use of factor analysis. Within Q-methodology, individuals are asked to rank-order (Q-sort) statements, which are then intercorrelated and subjected to factor analysis. In this way groups of individuals holding similar expressed subjectivities are identified. The factors are interpreted to provide an understanding of underlying subjectivities. This paper explores the theoretical underpinnings of Q-methodology and its application as a research method in the field of nurse education, providing a brief illustration of its use in mental health nurse education.     

颈椎前路手术治疗颈椎病的康复护理

颈椎前路手术比后路手术有很多优点,如出血少、软组织损伤轻、感染率低、神经后遗症少[1],便于术中呼吸、循环的管理,病人易于耐受[2],是目前治疗颈椎疾病可靠而有效的方法之一。为了解康复护理对该方法治疗颈椎病病人围术期的作用及康复效果,我科于2003年1月—2006年1月,对行颈椎前路手术治疗颈椎病87例,在围术期进行系统康复护理,疗效满意。现报告如下。1临床资料本组87例,其中男64例,女23例;年龄34岁～78岁(53.62岁±12.56岁);病程6个月～72个月;住院12d～43d,平均18.6d。脊髓型颈椎病36例,其中伴颈后纵韧带骨化症13例;神经根型颈椎病46…     

颈椎前路手术治疗颈椎病的康复护理

颈椎前路手术比后路手术有很多优点，如出血少、软组织损伤轻、感染率低、神经后遗症少，便于术中呼吸、循环的管理，病人易于耐受，是目前治疗颈椎疾病可靠而有效的方法之一。为了解康复护理对该方法治疗颈椎病病人围术期的作用及康复效果，我科于2003年1月-2006年1月，对行颈椎前路手术治疗颈椎病87例，在围术期进行系统康复护理，疗效满意。现报告如下。     

内窥镜下前路颈椎间盘切除碳素纤维Cage置入治疗颈椎病25例

背景:自1955年Robinson和Smith首次应用颈前路椎间盘切除、椎间融合以来,该技术取得了良好的临床效果.当前,内窥镜途径在治疗颈椎病方面有较好的临床效果,且Cage在临床上亦有较广泛的应用.目的:观察内镜技术结合碳素纤维cage置入由前路治疗颈椎病的效果.设计、时间及地点:回顾性病例分析,病例来自2003-01/2008-07南华大学附属第一医院脊柱外科.对象:选择南华大学附属第一医院脊柱外科收治的颈椎病患者25例,男15例,女10例;年龄33～58岁,平均39岁.每例患者均有不同程度的一侧肢体疼痛、麻木或乏力.在MRI上,20例患者表现为单个节段的颈椎间盘退变,5例为2个节段的退变.方法:25例患者均进行内窥镜下前路颈椎间盘切除、碳素纤维Cage置入,并在手术操作、神经症状及置入后并发症方面作了回顾性分析.置入后处理同常规的颈前路手术.主要观察指标:依据JOA评分系统评价患者神经症状的改善程度,置入后影像资料(包括生理曲度、融合情况等).结果:25例患者均顺利完成置入,置入时间80～225 min.置入后住院时间6～10 d,平均7d.置入前JOA评分为4～9分,置入后8～16分,平均改善率45.6%.所有患者均获得随访,平均随访18个月.术后复查颈椎正侧位X射线平片示cage位置良好,未出现移位.无血管损伤及感染情况出现.25例患者中2例出现了椎间隙塌陷,1例出现一过性声音嘶哑,未见其他并发症.结论:内窥镜下前路颈椎间盘切除碳素纤维cage置入治疗颈椎病具有微创、减压充分、植骨融合满意等优点,可显著减轻患者手术前的临床症状.     

椎间融合与环周融合结合椎弓根钉内固定置入治疗成人腰椎滑脱:效果优于后外侧融合吗?

目的:对比观察后外侧融合、椎体间融合与环周融合结合椎弓根内固定治疗成人腰椎滑脱症的疗效.方法:回顾性分析2004-01/2008-05苏州大学附属第一医院收治的腰椎滑脱患者75例,男22例,女53例.年龄49～70岁,平均53.3岁;L4滑脱47例,L5滑脱28例;Ⅰ度滑脱5例,Ⅱ度滑脱24例,Ⅲ度37例,Ⅳ度滑脱g例.75例患者中后外侧融合结合椎弓根内固定治疗21例,椎体间融合结合椎弓根内固定治疗26例,环周融合结合椎弓根内固定治疗28例.对比分析3组患者内固定后随访时满意率与植骨融合率.结果:75例患者均获得随访,随访时间6个月～3年.后外侧融合组融合率57%,临床疗效满意率62%;椎体间融合组融合率85%,疗效满意率为89%;环周融合组融合率89%,临床疗效满意率93%;椎体回融合组与环周融合组融合率和疗效满意率相比,差异无显著性意义(P>0.05),椎体间融合组与环周融合组明显优于后外侧融合组(P<0.05).结论:椎体间融合与环周融合结合椎弓根钉内固定置入治疗成人腰椎滑脱症疗效相同,优于后外侧融合.     

两种固定融合系统在颈椎前路椎间盘切除融合手术中的应用比较

目的 比较2种固定融合系统在颈椎前路椎间盘切除融合术(ACDF)中的疗效和安全性.方法 回顾性分析2017年3月至2019年3月首都医科大学附属北京友谊医院收治的58例行ACDF手术患者临床资料,根据手术方式不同分为2组,手术分别应用钛制钢板联合cage融合器(PG组)31例(35融合节段),零切迹Zero-P固定融合...