老年脊髓型颈椎病合并发育性颈椎管狭窄的手术疗效分析

目的 探讨老年脊髓型颈椎病与发育颈椎管狭窄在临床发病的关系及手术疗效。方法 对31例65～79岁脊髓型颈椎病合并发育性颈椎管狭窄的老年患者进行手术治疗，均行后路单开门椎管成形术，术前、术后采用JOA评分标准进行评定。结果 31例中，28例获得随访，平均随访时间28.7个月，术前JOA评分4～11分，平均7．8分，术后JOA评分8～16分，平均11．2分，平均改善率57．8％，优7例，良11例，可9例，差2例。结论 老年脊髓型颈椎病合并发育性颈椎管狭窄患者全身多器官功能退化，但只要治疗选择适当，仍可取得较好的疗效，高龄并非手术禁忌证。     

氟骨症颈椎管狭窄症的手术治疗

目的探讨氟骨症所致的重度颈椎管狭窄症的临床特点和手术治疗的注意事项。方法依据饮水史，氟斑牙和前臂骨间膜钙化3项指标结合颈脊髓受压的症状，体征和MRI检查共确诊氟骨症颈椎管狭窄症病例49例，采用后入路全椎板切除减压术治疗，对患者的术前和术后神经功能状况采用日本骨科学会标准进行评分，并对两组数据作统计分析。结果患者术后神经功能明显改善，优良率达到85．7％，无严重并发症出现。结论氟骨症导致重度颈椎管狭窄，往往合并有广泛的后纵韧带与黄韧带的骨化．早期手术全椎板减压．必要时神经根通道扩大才能减少并发症．提高疗效。     

老年颈椎椎管狭窄患者一期颈椎前后路手术围手术期麻醉管理体会

自1997年5月以来,我院对22例老年颈椎椎管狭窄患者于气管插管全麻下行一期颈椎前后路手术,现将围手术期麻醉管理体会报告如下。     

老年腹部外科疾病围手术期的护理

老年人腹部外科疾病引起的并发症明显高于青壮年人。这是由于老年人抗病能力降低、重要器官机能代偿能力减弱外，还并存心、脑、肾及内分泌等疾病。因此做好老年腹部外科疾病围手术期护理十分重要。     

后路手术治疗颈椎管狭窄合并颈椎间盘突出56例临床分析

1996年 2月～ 2 0 0 1年 2月 ,我们手术治疗颈椎管狭窄合并颈椎间盘突出 56例 ,效果满意。现报告如下。一般资料 :本组男 30例 ,女 2 6例 ,年龄 39～ 74岁 ,平均52岁。病程 6个月～ 6年 ,平均 2 5年。按日本骨科学会(ＪＯＡ)颈椎病疗效评定标准 ,术前术后分别给患者评分。病情     

椎板棘突翻转回植和双侧神经根管扩大术治疗颈椎管狭窄

目的 探讨椎板切开后部分椎管后壁缺损及固定等难题,防止椎板移位及再关门。方法 用微型风动摆锯沿关节突内侧切开两侧椎板,将椎板、棘突和黄韧带复合体整块取下。再行两侧神经根管内口扩大术及脊髓前外侧减压术。然后将椎板、棘突和黄韧带复合体翻转回植。结果 3例病人术后3个月和半年复查X线片和CT显示：椎板骨性融合,颈椎活动度好。平均随访31月,临床症状无复发。结论 通过侧翻棘突椎板黄韧带复合体可以增加椎管的矢状径。侧翻后椎管后壁覆盖充分,有效保护脊髓,防止术后的瘢痕再压迫。两侧骨性融合后可以增加脊柱后柱的支持作用,从而增加脊柱后方的稳定性,维持正常的颈椎前凸,防止由于椎板广泛切除后所产生的鹅颈畸形。     

颈椎次全切除,椎间盘摘除和植骨融合术治疗颈椎管狭窄症并椎间盘突出症

近3年来,我们对18例颈椎间盘突出症并椎管狭窄症患者(不包括单纯椎间盘突出或颈椎管狭窄,或颈部急性外伤者)施行颈椎次全切除椎间盘摘除和植骨融合术,近期疗效满意,远期疗效尚在观察中。     

低肺功能老年肺癌患者的外科治疗及围手术期处理

目的探讨低肺功能老年肺癌患者外科治疗的适应证、手术方式及围手术期处理。方法回顾性分析手术治疗的42例70岁以上低肺功能肺癌患者的临床资料。按其肺功能分为轻度、中度及重度呼吸功能障碍三组，比较术后呼吸衰竭、心律失常等并发症的发生率，重点观察重度肺功能障碍组。结果重度呼吸功能障碍组术后死亡1例，其呼吸衰竭及心律失常等并发症的发生率高于轻度、中度呼吸功能障碍组。结论手术技术的提高和术后呼吸机辅助呼吸的应用，对低肺功能老年肺癌患者可相对扩大手术适应证。     

先天性主动脉瓣狭窄的外科治疗

我院自1984年7月至1995年3月共收治48例先天性主动脉瓣狭窄患者，其中30例行外科治疗，占62．5％。22例主动脉瓣替换术（73．3％）中，同种动脉瓣13例，机械瓣9例。主动脉瓣交界切开术8例。术后随访1月至9年，每半年一次。治疗效果：术后早期死亡2例，死亡率6．7％；晚期死亡1例，术后1年死于感染性心内膜炎，占33％；27例随诊良好。结合先天性主动脉瓣狭窄的临床征象，对其诊断及外科治疗进行讨论。     

手术治疗下颈椎骨折脱位并脊髓损伤68例临床分析

目的探讨下颈椎骨折脱位并脊髓损伤的手术入路选择及观察手术治疗的临床疗效。方法对2005-01～2009-01间68例下颈椎骨折脱位伴颈髓损伤患者进行手术治疗,前路减压复位植骨及颈椎带锁钛钢板固定51例,后路切开复位侧块钢板固定12例,前后路联合手术减压复位固定严重骨折脱位5例。结果所有患者获得随访,时间6～28个月,平均11.8个月,植骨于3个月左右均获得骨性融合,颈椎椎间高度、生理曲度及颈椎稳定性维持良好,按Frankel分级,神经功能有3例无恢复,其余病例至少有1～3级以上的恢复或改善。结论采用前路、后路或前后路联合入路手术治疗下颈椎骨折脱位均可使损伤节段获得早期稳定,根据颈椎损伤机理、损伤部位及类型采取适合的手术入路是手术成功的关键。     

多层螺旋CT及三维成像对老年颈椎椎管狭窄的诊断价值

目的探讨三维CT对老年颈椎椎管狭窄的诊断价值。方法对32例行颈部或颈椎检查的病人进行多层螺旋CT横断扫描，扫描后对图像行薄层重建，并传至工作站，应用轴位、多平面成像（MPR）、表面遮盖成像（SSD）、容积成像（VR）及仿真内镜（VE）等方法对有颈椎椎管狭窄的病例图像进行分析。结果32例患者中，18例患者颈椎椎管大小和形态正常，14例病人颈椎椎管均不同程度狭窄，通过不同形式的成像方式可以观察到病变，其中包括骨质增生和椎间盘脱出两种情况，在14例椎管狭窄的病人中，观察到骨质增生38处，颈间盘脱出8处；对于骨质增生的情况，在轴位像上观察到30处，冠状位像上观察到3处，矢状位像上观察到38处，三维图像上观察到21处，仿真内镜像上观察到15处，颈间盘脱出的表现仅能在轴位像上显示。结论多层螺旋CT及三维成像能提供老年性椎管狭窄的精细情况，对颈椎椎管狭窄能立体、直观、全面地展示其原因及程度，为临床治疗提供更充分的信息。     

Risk of cervical myelopathy in rheumatoid arthritis patients with neck pain

BackgroundCervical spine (CS) evaluation in rheumatoid arthritis (RA) is challenging since subtle neurological insult is usually masked by the severe peripheral joint affection or muscle atrophy. Neglected CS lesions could end up with cervical myelopathy. Magnetic resonance imaging (MRI) has been the modality of choice in assessing CS in RA.Aim of the workTo evaluate CS in RA using MRI and detect the risk factors for its involvement.Patients and methodsForty RA patients with neck pain were assessed using disease activity score (DAS28), Ranawat classification of rheumatoid myelopathy, simple erosion narrowing score (SENS), bilateral hand and wrist musculoskeletal ultrasound (MSKUS) for early erosion detection and CS MRI.ResultsThe mean age of patients was 44.3 ± 10.1 years, disease duration 7.9 ± 6.6 years and the DAS28 was 4.8 ± 1.6. 70% of patients were in Ranawat class I, 30% in class II, and none in class III. 70% of patients had CS lesions where synovitis occurred in 67.5% of patients, odontoid erosions in 15%, atlanto-axial marrow edema in 5%, atlanto-occipital marrow edema in 5% and none had atlanto-axial subluxation (AAS), subaxial subluxation (SAS), spinal cord/brain stem compression. CS involvement was significantly related to peripheral joint erosion, high SENS and positive RF (p = 0.01, p < 0.0001, p < 0.0001 respectively).ConclusionCS involvement is remarkable in RA especially in those with peripheral joint erosions, high SENS and positive RF. RA patients with persistent neck pain, even in absence of objective neurological deficit should be evaluated early for detection and management of CS lesions before irreversible neurological damage takes place.     

椎间孔镜技术与开放手术在治疗伴有骨质疏松的腰椎管狭窄症的疗效及安全性比较

目的比较椎间孔镜技术（TESSYS）与传统开放手术在治疗伴有骨质疏松的腰椎管狭窄症患者的疗效及安全性。方法从2010年3月至2013年9月武警北京市总队第三医院收治伴有骨质疏松的腰椎管狭窄症患者78例,其中43例选择TESSYS法治疗,35例选择传统开放手术治疗。术前、术后及末次随访时采用视觉模拟评分法（VAS）评估疼痛程度,术前、术后及末次随访采用日本矫形外科联合会下腰痛评分系统（JOA）评估腰椎功能改善情况。比较两组手术时间、出血量和并发症发生率。结果两组患者术前VAS和JOA评分的差异无统计学意义（P〉0．05）,术后VAS评分均显著下降（P〈0．05）,JOA评分均显著升高（P〈0．05）,且两组间VAS和JOA评分的差异无统计学意义（P〉0．05）;而TESSYS组的手术时间、出血量和并发症发生率显著少于开放手术组（P〈0．05）。结论与传统开放手术相比,TESSYS治疗伴有骨质疏松的腰椎管狭窄症疗效虽相当,但是安全性更高,具有手术时间短、出血量少,并发症少的优点。     

先天性主动脉瓣下狭窄103例的外科治疗

目的 总结分析先天性主动脉瓣下狭窄103例手术治疗的临床经验。方法 1988年1月～2006年6月,手术治疗先天性主动脉瓣下狭窄103例,其中,隔膜型狭窄97例,管型狭窄6例。在体外循环下,行单纯狭窄隔膜或肌纤维环切除术92例,左心室流出道肌肉部分切削或切开21例,29例合并主动脉瓣病变者行主动脉瓣替换术,同期矫治其它合并畸形。结果 ①本组早期死亡2例,病死率1.94%,其中1例因术后严重心律失常,心搏骤停,抢救无效死亡,另1例因术后严重低心输出量综合征死亡。其余101例患者,经治疗,痊愈出院,其中84例患者术后心脏杂音消失;②术前、术后早期压差比较,术后早期跨左心室流出道压力阶差（left ventricular outflow tract gradient,LVOTG）为0～16（4.9±3.4）mmHg;与术前LVOTG比较,差异有统计学意义（P〈0.001）。结论 先天性主动脉瓣下狭窄—经诊断宜尽早手术治疗,根据其病理解剖特点选择不同的手术方法,如切除隔膜或纤维环,必要时加部分肌肉切开（或）切除术,以便彻底解除狭窄,避免并发症。     

后路颈椎管扩大成形钛板固定术与传统单开门椎管扩大成形术治疗发育性颈椎管狭窄症的对比研究

目的比较观察后路颈椎管扩大成形钛板固定术与传统单开门椎管扩大成形术治疗发育性颈椎管狭窄症的临床疗效。方法回顾分析49例发育性颈椎管狭窄症患者的临床资料,随机分为两组,其中观察组25例采用钛板固定,对照组24例采用丝线悬挂,对比分析两组患者手术情况,术后症状改善情况JOA评分,末次随访术后椎板开门角度,脊髓后移距离,术后测量颈椎曲度的改变,轴性症状发生率,以及观察手术时间、术中出血量对比情况。结果经术后6个月~3年的随访,观察组术后6个月JOA评分改善率为(62.5±16.0)%,对照组为(59.2±9.8)%,两组比较差异无统计学意义(P0.05)。观察组椎板开门角度为(43.6±3.5)°,对照组为(40.5±4.1)°,两组比较差异有统计学意义(P0.05)。观察组末次随访时脊髓平均后移距离(2.97±1.8)mm,对照组为(2.96±1.7)mm,两组比较差异无统计学意义(P0.05)。观察组术后6个月颈椎曲度为(18.6±4.8)°,与术前(18.3±4.8)°比较差异无统计学意义(P0.05);对照组术后6个月颈椎曲度为(17.0±5.6)°,与术前(19.9±6.2)°比较差异无统计学意义(P0.05);观察组术后6个月轴性症状发生率为12.0%,明显低于对照组的41.7%,两组比较差异有统计学意义(P0.05)。两组患者无一例出现C5神经根麻痹。结论后路颈椎管扩大成形钛板固定术与传统单开门椎管扩大成形术皆为治疗发育性颈椎管狭窄症的有效术式,但后路颈椎管扩大成形钛板固定术更能降低术后再关门及术后轴性症状的发生率,是治疗发育性颈椎管狭窄症的一种有效治疗术式。     

老年退行性腰椎管狭窄症的外科治疗

目的探讨外科治疗老年退行性腰椎管狭窄症的方法及疗效。方法回顾性分析2003年2月至2006年4月中山医院骨科收治的70岁及以上退行性腰椎管狭窄症患者137例,男92例,女45例;年龄70～81岁,平均75.6±6.2岁;病史3～8年,平均5.3±0.4年。41例患者术前合并一种或多种内科疾病,所有病人术前均经内科治疗,病情稳定3个月以上后方行手术。112例行单纯全椎板或部分椎板切除减压术;25例采用椎板减压＋椎弓根固定＋椎间植骨融合术。结果围手术期并发症12例,经对症处理及内科联合治疗后好转,无围手术期死亡病例。本组平均随访时间2年6个月,Oswestry评分术前为62.42±11.36,术后为17.25±5.62。所有患者术后神经受压症状均有改善,连续行走从术前不足15min到术后至少30min。结论手术治疗有助于老年退行性腰椎管狭窄症患者神经功能的恢复,术前积极治疗合并症可以降低围手术期风险。     

The serpentine pattern on MRI as an early prognostic factor after fusion for lumbar spinal stenosis

This study aimed to determine the relationship between the serpentine pattern nerve roots (SNR) and prognosis after lumbar fusion for lumbar spinal stenosis (LSS) by comparing clinical outcomes in patients with or without a serpentine pattern. LSS patients with neurological symptoms often present with SNRs. Several studies have shown that LLS symptoms are worse in patients with SNRs. However, the relationship between SNR and outcome after spinal fusion surgery has not yet been established. A total of 332 patients who underwent spinal fusion surgery between January 1, 2010, and December 31, 2019, were enrolled. Patients were divided into those with a serpentine pattern (S group) and those without a serpentine pattern (N group). The prognosis of the 2 groups was compared using visual analog scale (VAS), Oswestry disability index, claudication distance, medication dose for leg dysesthesia, and glucose tolerance. A total of 113 patients had a serpentine pattern, while the remaining 219 did not. Symptom duration and presence of diabetes mellitus were significantly different between the 2 groups (N = 25.4, S = 32.6, P < .05). Changes in the VAS score for lower extremity pain between the 2 groups at 1 year after surgery showed that patients without a serpentine pattern had significantly better outcomes than those with a serpentine pattern (N: 2.7 ± 1.1 vs S: 4.1 ± 1.3; P < .001), despite the score change at 1 month showing no difference (N: 3.5 ± 0.9 vs S: 3.8 ± 1.0; P = .09). SNRs on MRI are more prevalent in diabetic patients and are a negative prognostic factor in lumbar fusion surgery for LSS. Our insights may help physicians decide the optimal surgical plan and predict the postoperative prognosis of patients with LSS.     

经皮椎间孔镜椎板间入路与椎间孔入路治疗腰椎管狭窄症

腰椎管狭窄症是老年人常见病、多发病。手术方式包括开放手术和微创手术。椎间孔镜以其创口小、疼痛轻及恢复快的特点已成为目前治疗腰椎管狭窄症的微创手术首选器械。其手术入路主要分为经皮椎板间入路和经皮椎间孔入路,然而这两种手术入路各有优缺点及适应证。在实际的临床工作中选择椎间孔镜治疗腰椎管狭窄症时,对不同病理类型的腰椎管狭窄症选用合适的手术入路进行治疗,是达到良好手术效果的前提。     

Usefulness of preoperative Short Form-36 Mental Component Score as a prognostic factor in patients who underwent decompression surgery for degenerative lumbar spinal stenosis

Physical factors such as frequency of low back pain, sensory abnormalities in the lower extremities, smoking history before surgery, and preoperative mental health status as predictors of operative outcomes have been growing as areas of interest in the field of degenerative lumbar spinal stenosis (DLSS). This study aimed to investigate the correlation between the preoperative Short Form-36 Mental Component Score (SF-36 MCS) and long-term prognosis after decompression surgery for DLSS. In total, 198 patients were enrolled in this study. The Oswestry Disability Index (ODI) and Rolland Morris Disability Questionnaire (RMDQ) were used to evaluate spinal functional outcomes. The SF-36 questionnaire was used and analyzed by classifying it into physical component score (PCS) and mental component score (MCS). The SF-36 MCS was divided into role limitations caused by emotional problems, social functioning, vitality, and emotional well-being. In the correlation between preoperative MCS and ODI improvement, the r value was −0.595 (P < .05) at 12 months postoperatively. ODI improvement at 12 months after decompression surgery showed a statistically significant and strong negative correlation with preoperative MCS. In the correlation between preoperative MCS and RMDQ improvement, the r value was −0.544 (P < .05) at 12 months postoperatively. Therefore, RMDQ improvement 12 months after decompression surgery showed a strong negative correlation with preoperative MCS. Regarding the correlation between preoperative MCS and SF-36 PCS improvement, the r values were 0.321 (P < .05) at 6 months postoperatively and 0.343 (P < .05) at 12 months postoperatively. Therefore, SF-36 PCS improvement at 6 and 12 months after decompression surgery showed a strong positive correlation with preoperative SF-36 MCS scores. Preoperative SF-36 MCS is a factor that can predict the prognosis of patients who underwent decompression surgery for lumbar spinal stenosis for at least 1 year postoperatively.