Z-plate前路重建胸腰椎稳定围手术期管理

目的：探讨胸腰椎前路Z-plate钢板固定的护理特点。方法：因手术入路特殊性，从经胸、经腹、以及腹膜后入路等方面，加强围手术期护理管理。结果：ll例手术无呼吸道、泌尿道和褥疮等并发症。结论：根据胸腰椎前路手术的特点，采取针对性的护理措施，是获得良好疗效的保证。     

下腰椎围手术期并发症

目的: 系统回顾分析下腰椎手术中、手术后短期并发症, 并探讨其治疗方法。方法:调查1995~2003年收治下腰椎手术患者599例的临床资料, 对其2周内所发生的并发症进行分析, 其中男.367例,女232例, 平均年龄45 5岁(21~81岁), 术前诊断主要依据术前症状、体征、影像学检查, 并对不同疾患、不同手术方式进行分类、统计。结果: 599例患者中, 2周内发生并发症者62例(10 .4% ), 主要包括神经症状加重1例,神经根刺激症状32例(占并发症的48. 4%。多数患者通过对症处理、神经营养药物的应用, 于2周内缓解), 腹胀等消化道症状8例(13. 1% ), 对症处理症状缓解, 其余为切口血肿4例(6 .6% ), 脑脊液漏3例(4. 8% ), 尿潴留2例(3. 3% ), 切口感染1例( 1 .9% ), 血栓形成2例( 3. 3% ), 泌尿系感染3例( 4. 8% ), 脂肪液化6例(9 .7% ), 系统处理得以恢复。结论: 只要遵循严格的手术适应证, 操作慎重, 早期观察并及时处理, 将极大地避免相应并发症。     

腰椎前路椎间融合术的研究进展

自 O'Brien[1]报告 腰椎 前 路椎 间融 合 术(anterior lum barintervertebral fusion,ALIF)以 来 ,人 们 对 脊 柱 融 合 的 生 物学 和 生 物 力 学 的 研 究 和 认 识 不 断 深 入 ,ALIF 在 退 行 性 腰椎 疾患 中 的应 用也 越 来越 多。近 年来 椎 间融 合材 料 和手 术技 术发 展 也较 快 。现 就 腰 椎 前路 椎 间 融 合术 的 融 合 材料 、融 合方 式 、适应 证 、手 术入 路、并发 症等 方 面作 一综 述 。1椎 间融 合材 料 Evans[2]认 为 融 合 材 料 应 满 足 下 列 要 求 :(1)机 械 强 度应 高于 通 过椎 间 盘 的压 应 …     

腰椎滑脱患者行微创腰椎前路融合术的手术配合

对8例腰椎滑脱患者采用微创腹膜外入路腰椎前路融合术。结果手术均顺利完成，术中出血量均〈100ml；术后24-48h即可下床活动，疼痛症状明显减轻；术后住院7～14d出院；随访20个月，6例滑脱椎体基本复位，椎间融合器稳固，2例症状明显改善。提示采用微创腹膜外入路施行腰椎椎间融合术．并发症的发生率较低，手术时间短，对患者损伤小，恢复较快。护士须提前熟悉手术程序，做好器械及物品的准备，术中严密观察生命体征，根据手术步骤及时传递所需器械，为手术顺利进行奠定基础。     

腰椎滑脱患者行微创腰椎前路融合术的手术配合

对8例腰椎滑脱患者采用微创腹膜外入路腰椎前路融合术.结果 手术均顺利完成,术中出血量均＜100 ml;术后24～48 h即可下床活动,疼痛症状明显减轻;术后住院7～14 d出院;随访20个月,6例滑脱椎体基本复位,椎间融合器稳固,2例症状明显改善.提示采用微创腹膜外入路施行腰椎椎间融合术,并发症的发生率较低,手术时间短,对患者损伤小,恢复较快.护士须提前熟悉手术程序,做好器械及物品的准备,术中严密观察生命体征,根据手术步骤及时传递所需器械,为手术顺利进行奠定基础.     

胸腰椎前路手术的并发症

近年来,胸腰椎前路手术已在脊柱创伤重建、退行性病变、后路手术失败、畸形矫正、肿瘤、感染性病变等治疗中广泛开展,且获得公认的治疗效果。根据病变节段的高低,胸腰椎前路手术可分为胸椎前路、胸腰联合入路、腰椎前路。根据术中是否进入胸腔、腹腔,又可分为经胸腔、腹腔入路,     

围手术期综合救治对颈前路手术并发症的影响

颈椎伤病致颈髓损伤是极具破坏性损伤，常常危及生命。颈前路减压植骨内固定是治疗颈椎伤病重要而有效的手术方法。围手术期综合救治对颈前路手术良好实施、促进颈髓神经功能恢复、有效防止各种并发症发生具有重要作用。现将自2004年3月-2006年1月开展的16例颈前路手术围手术期综合救治情况作如下分析。     

腹腔镜下前路腰椎融合术

目的分析腹腔镜下前路腰椎融合术的疗效。方法2000年12月～2002年12月,应用腹腔镜行腰椎间盘切除及植骨融合术23例。男9例,女14例;年龄46～66岁,平均52岁。腰椎滑脱症18例,其中Ⅰ度16例、Ⅱ度2例;腰椎不稳3例;椎间盘变性2例。患者症状为反复的腰痛,伴下肢放射痛。行L4,5节段融合13例,L5S1节段10例。功能评估采用OswestryDisabilityIndex(ODI),统计患者术前、术后2周、3个月、6个月、12个月的ODI评分。术后即刻、3个月、6个月、12个月摄X线片,观察椎体的融合情况和Cage有无下沉。结果手术时间为50～180min,平均120min;术中出血量为50～300ml,平均80ml。术中发生并发症2例,1例为镜下定位错误,1例为小血管出血。术后全部病例随访12～24个月,平均16.6个月。ODI评分手术前为(35.25±5.36)分,术后2周为(41.77±11.43)分,3个月为(45.14±7.35)分,6个月为(44.87±3.56)分,12个月为(46.35±5.48)分,术后各时限与术前比较差异均有显著性(P<0.05)。22例术后3个月植骨融合,1例6个月融合。1例术后3个月发现相邻椎体滑移2mm,6个月时融合。2例术后3个月椎间高度丢失1mm。未发生大血管损伤、内植物松动、脱落及逆向射精等并发症。结论腹腔镜下腰椎融合术适用于腰椎不稳、局限节段的椎间盘变性及Ⅱ度以下腰椎滑脱患者。手     

胸腰椎前路手术并发症分析和对策

[目的]探讨胸腰椎前路手术并发症的原因及防治对策.[方法]回顾性分析2000年1月～2007年12月本院收治的260例应用胸腰椎前路手术的并发症.[结果]随访12个月～6年,平均51.4个月,260例中,5例脊柱转移瘤患者分别于术后7个月、9个月、16个月、2年、3年因全身转移致呼吸衰竭死亡,其余255例患者,36例出现9种37例次(1例L4非何杰金式淋巴瘤出现神经根损伤和定位、置钉失误)术中、术后并发症.术中大出血2例;血、气胸5例;脊髓损伤1例;神经根损伤3例;输尿管损伤1例;定位、置钉失误6例;骨折复位不良1例;植骨不愈合2例;交感神经损伤15例,均经积极有效处理后恢复满意.[结论]预防胸腰椎前路手术并发症的关键是充分认识胸腰椎的解剖特点和内固定系统结构特点,术中暴露清楚和熟练操作技术,及时有效的治疗可获得满意结果.     

颈椎前路围手术期护理

目的对临床接受颈椎前路手术的患者在整个围手术期的护理措施进行分析,并总结相关护理体会。方法抽取22例笔者所在医院就诊的患有颈椎疾病的临床确诊患者病例,对其实施颈椎前路手术治疗,对患者在围手术期内的护理措施和相关护理体会进行总结。结果术前对患者进行常规准备、心理护理、气管食管推移训练、体位训练、佩戴颈托等护理;术后对患者进行常规监测、体位护理、饮食护理、切口护理、康复锻炼等护理,所有患者的手术均顺利完成,并均在预计的时间内康复出院。结论对接受颈椎前路手术的颈椎病患者在患者的围手术期为其提供有针对性的护理服务,可以有效保证患者的手术顺利完成,确保手术达到预期的治疗效果,促进患者迅速恢复,在今后的临床护理工作中应该给予充分的重视。     

Biomechanical comparison of anterior lumbar interbody fusion and transforaminal lumbar interbody fusion

STUDY DESIGN: An in vitro biomechanical comparison of 2 fusion techniques, anterior lumbar interbody fusion (ALIF) and transforaminal lumbar interbody fusion (TLIF), on cadaveric human spines. OBJECTIVE: To compare the immediate construct stability, in terms of range of motion (ROM) and neutral zone, of ALIF, including 2 separate approaches, and TLIF procedures with posterior titanium rod fixation. SUMMARY OF BACKGROUND DATA: Both ALIF and TLIF have been used to treat chronic low back pain and instability. In many cases, the choice between these 2 techniques is based only on personal preference. No biomechanical performance comparison between these 2 fusion techniques is available to assist surgical decision. METHODS: Twelve cadaveric lumbar motion segments were loaded sinusoidally at 0.05 Hz and 5 Nm in unconstrained axial rotation, lateral bending and flexion extension. Specimens were randomly divided into 2 groups with 6 in each group. One group was assigned for TLIF whereas the other group for ALIF. In the ALIF group, there were 3 steps. First, the lateral ALIF procedure with the anterior longitudinal ligament (ALL) intact was performed. Afterwards, the ALL was cut without removing the ALIF cage. Finally, another appropriately sized ALIF cage was inserted anteriorly. Biomechanical tests were conducted after each step. RESULTS: In the ALIF group, the lateral ALIF and subsequent anterior ALIF reduced segmental motion significantly (P=0.03) under all loading conditions. Removing the ALL increased ROM by 59% and 142% in axial rotation and flexion extension, respectively (P=0.03). The anterior ALIF approach was able to achieve similar biomechanical stability of the lateral approach in lateral bending and flexion extension (P>0.05) under all loading conditions. The TLIF procedure significantly reduced the range of motion compared with the intact state (P=0.03). However, no statistical difference was detected between the TLIF group and the ALIF group (P>0.05). CONCLUSIONS: Both ALIF and TLIF procedures combined with posterior instrumentation significantly improved construct stability of intact spinal motion segments. However, there was no statistical difference between these 2 fusion techniques. The 2 ALIF approaches (lateral and anterior) also had similar construct stability even though anterior longitudinal ligament severing significantly reduced stability.     

Posterior and anterior lumbar interbody fusion

Posterior Lumbar Interbody Fusion (PLIF) may be indicated for intractable back pain, as it maintains adequate distraction of the intervertebral space thus relieving pressure on the nerve root. Iliac crest autografts, allografts and porous metallic cages are used.Success rates of above 90% have been reported, but complications due to the operative approach have been described. While biomechanically PLIF is superior to simple disc excision in relieving intractable back pain, the procedure is technically difficult in the presence of scar tissue from previous surgery. A proper understanding of operative principles and appropriate patient selection is essential to achieve good results. As an alternative technique, Anterior Lumbar Interbody Fusion (ALIF) has advocates.     

Arterial complications following anterior lumbar interbody fusion: report of eight cases

The objective of this study is to report eight cases of arterial complication following anterior lumbar interbody fusion (ALIF) and to analyze the data in order to identify possible risk factors. The authors have encountered six cases of common iliac artery occlusion and two cases of acute vasospasm as a complication of ALIF using two different approaches to spine: hypogastric-midline-transperitoneal approach at one center and minimally invasive muscle-sparing retroperitoneal approach at the other. All cases involved surgery at the L4-L5 level. All patients were smokers, and three had an existing history of vascular disease. The left iliac and common femoral arteries were involved in seven cases, while the right common iliac was involved in one case. Five patients had thromboembolism, one patient had an intimal tear and two had functional vasospasm. Circulation to the lower limb was restored by thrombectomy (five patients) and arterioplasty for the intimal tear (one patient). One of the vasospasm cases was explored (false-positive), while the other was treated conservatively. One of the patients with thrombosis developed rhabdomyolysis resulting in fatal acidosis. All but the first case at each center was diagnosed either intraoperatively or within 2 h of surgery. We believe that awareness of this potentially serious complication will lead to precautionary measures for prevention of the problem as well as early diagnosis and management of the complication if it does occur. Intraoperative monitoring of lower limb blood flow by measuring the toe oxygenation with a pulse oxymeter can prove to be helpful in early diagnosis.     

Single position lateral decubitus anterior lumbar interbody fusion (ALIF) and posterior fusion reduces complications and improves perioperative outcomes compared with traditional anterior-posterior lumbar fusion

BACKGROUND CONTEXTLateral decubitus single position anterior-posterior (AP) fusion utilizing anterior lumbar interbody fusion and percutaneous posterior fixation is a novel, minimally invasive surgical technique. Single position lumbar surgery (SPLS) with anterior lumbar interbody fusion (ALIF) or lateral lumbar interbody fusion (LLIF) has been shown to be a safe, effective technique. This study directly compares perioperative outcomes of SPLS with lateral ALIF vs. traditional supine ALIF with repositioning (FLIP) for degenerative pathologies.PURPOSETo determine if SPLS with lateral ALIF improves perioperative outcomes compared to FLIP with supine ALIF.STUDY DESIGN/SETTINGMulticenter retrospective cohort study.PATIENT SAMPLEPatients undergoing primary AP fusions with ALIF at 5 institutions from 2015 to 2020.OUTCOME MEASURESLevels fused, inclusion of L4-L5, L5-S1, radiation dosage, operative time, estimated blood loss (EBL), length of stay (LOS), perioperative complications. Radiographic analysis included lumbar lordosis (LL), pelvic incidence (PI), and PI-LL mismatch.METHODSRetrospective analysis of primary ALIFs with bilateral percutaneous pedicle screw fixation between L4-S1 over 5 years at 5 institutions. Patients were grouped as FLIP or SPLS. Demographic, procedural, perioperative, and radiographic outcome measures were compared using independent samples t-tests and chi-squared analyses with significance set at p <.05. Cohorts were propensity-matched for demographic or procedural differences.RESULTSA total of 321 patients were included; 124 SPS and 197 Flip patients. Propensity-matching yielded 248 patients: 124 SPLS and 124 FLIP. The SPLS cohort demonstrated significantly reduced operative time (132.95±77.45 vs. 261.79±91.65 min; p <0.001), EBL (120.44±217.08 vs. 224.29±243.99 mL; p <.001), LOS (2.07±1.26 vs. 3.47±1.40 days; p <.001), and rate of perioperative ileus (0.00% vs. 6.45%; p =.005). Radiation dose (39.79±31.66 vs. 37.54±35.85 mGy; p =.719) and perioperative complications including vascular injury (1.61% vs. 1.61%; p =.000), retrograde ejaculation (0.00% vs. 0.81%, p =.328), abdominal wall (0.81% vs. 2.42%; p =.338), neuropraxia (1.61% vs. 0.81%; p =.532), persistent motor deficit (0.00% vs. 1.61%; p =.166), wound complications (1.61% vs. 1.61%; p =.000), or VTE (0.81% vs. 0.81%; p =.972) were similar. No difference was seen in 90-day return to OR. Similar results were noted in sub-analyses of single-level L4-L5 or L5-S1 fusions. On radiographic analysis, the SPLS cohort had greater changes in LL (4.23±11.14 vs. 0.43±8.07 deg; p =.005) and PI-LL mismatch (-4.78±8.77 vs. -0.39±7.51 deg; p =.002).CONCLUSIONSSingle position lateral ALIF with percutaneous posterior fixation improves operative time, EBL, LOS, rate of ileus, and maintains safety compared to supine ALIF with prone percutaneous pedicle screws between L4-S1.     

微创小切口侧前方腰椎间融合术治疗腰椎退变性疾病的近期疗效和围手术期并发症

目的:评估微创小切口侧前方腰椎间融合术(mini-open lateral-anterior lumbar interbody fusion,La LIF)治疗腰椎退变性疾病的近期疗效和围手术期并发症。方法:分析2016年4月~2017年5月应用La LIF治疗的63例(94个节段)腰椎退变性疾病患者的资料,男23例,女40例,年龄42~86岁(61±15岁)。腰椎间盘突出症8例,腰椎管狭窄症40例,腰椎滑脱症7例,成人退变性侧凸症8例。融合节段为单节段38例,双节段20例,3节段4例,4节段1例。L1/2 3例,L2/3 7例,L3/4 31例,L4/5 53例。不附加内固定即独立的(stand alone)La LIF共56例;同时行二期后路内固定术7例,其中2例非计划内后路手术(1例腰椎管狭窄症因术中终板损伤而行后路内固定术,1例腰椎间盘突出症因术后cage下沉及症状缓解不满意而二期在外院行后路腰椎椎弓根内固定术),另5例退变性侧凸症行计划内后路减压或不减压椎弓根内固定术。记录手术时间、术中出血量、术后并发症,比较术前、术后1个月、术后3个月和末次随访时的腰痛VAS评分及Oswestry功能障碍指数(ODI),比较术前及末次随访时SF-36评分及X线片上手术节段椎间孔高度(intervertebral foramen height,FH)、椎间隙高度(intervertebral disc height,DH)和椎间孔面积(intervertebral foramen area,FA)。结果:63例患者完成随访,随访时间6.0±1.2个月(4~8个月)。单节段平均手术时间81±12min,平均术中出血量30±10ml;双节段平均手术时间130±21min,平均术中出血量50±12ml;3节段平均手术时间198±25min,平均术中出血量150±20ml;4节段手术时间220min,术中出血量300ml。术中出现静脉损伤1例,腹膜损伤1例,终板损伤2例(共3个节段)。术后1例出现切口红肿,对症治疗后缓解;4例出现一过性大腿前方疼痛或感觉异常,均在术后1个月内消失;1例出现下肢乏力,8周恢复正常。术后随访融合器下沉2例,融合器轻度移位8例。无病例因内置物失败、重要脏器损伤、术区感染等并发症而需行翻修手术。所有患者症状在随访过程中均逐渐改善,术后1个月、3个月及末次随访时VAS评分及ODI与术前比较均显著性改善(P0.05)。末次随访时SF-36评分较术前显著性改善(P0.05)。末次随访时手术节段FH、DH和FA较术前均显著性增加(P0.05)。结论:小切口La LIF作为一种微创腰椎融合术式,创伤小,出血少,手术时间短,围手术期并发症少,在治疗腰椎退变性疾病中具有较好的应用价值,严格选择手术适应证,不附加内固定的La LIF可取得较好临床效果。     

Anterior lumbar interbody fusion surgical complications.

Complications of anterior lumbar fusion may be divided into several categories. The first of these is complications related to patient selection, the second is visceral complications, and the third is vascular complications. Complications of anterior lumbar fusion and complications of interbody fusion technique occur at the graft site and the donor site.     

前路腰椎椎体间融合术的生物力学研究

前路腰椎椎体间融合术(ALIF)具有诸多优势,临床应用越来越多.关于ALIF的生物力学稳定性研究国外开展较多,但结果并不完全一致.应根据不同需要合理选择ALIF试验模型,人类尸体,动物尸体、有限元模型、其他替代模型等各有优缺点.单纯ALIF术后椎间获得即刻稳定性是根据"撑开一压缩"原理.前路椎间植入融合器后能够增加除了后伸动作以外的其他各方向稳定性,目前大多数关于ALIF的生物力学测试均针对即刻稳定性,然而融合器植入椎间隙后纤维环弹性逐渐丧失及融合器陷入终板内均会使椎间稳定性逐渐降低,因此椎间融合稳定性还取决于界面骨长入速度等术后因素.影响ALIF稳定性的因素有预负荷、辅助内固定、相邻椎体骨质量等.     

Acute pancreatitis complicating anterior lumbar interbody fusion

Postoperative pancreatitis may occur following surgery in regions remote from the pancreas and the biliary tree. Though uncommon, it carries a high mortality rate. Pancreatitis complicating spinal surgery is extremely rare. This report describes a case of acute pancreatitis following an anterior lumbar interbody fusion and discusses the possible mechanisms of pancreatic cellular injury. Received: 17 May 1999/Revised: 6 December 1999/Accepted: 16 December 1999