两种后路矫形术对脊柱侧后凸患者肺功能影响的观察

目的观察经后路全脊椎切除联合椎弓根钉棒矫形与单纯钉棒系统矫形两种术式,治疗伴有显著通气功能障碍的脊柱侧后凸患者术后的肺功能变化情况。方法回顾性分析2004-06-2008-01行后路手术治疗16例伴有中、重度通气功能障碍的侧后凸畸形患者。术前以用力肺活量（FVC）与FEV1值评价通气功能损害。依据畸形严重程度及僵硬度,选择经后路全脊椎切除并椎弓根钉棒矫形术或单纯椎弓根钉棒矫形,术后复查肺功能,定期随访。结果全脊椎切除组侧凸及后凸矫正率分别达到68.5%和76.7%,单纯钉棒矫形侧凸及后凸矫正率分别为53.1%和48.0%,术后6个月患者肺功能参数较术前均有提高,且全脊椎切除组矫形率及通气改善均优于单纯后路钉棒矫形组。全脊椎切除组并发症发生率较高。结论后路矫形有助于严重侧后凸患者早期改善其肺通气功能,经后路全脊椎切除术能获得良好的矫形和肺功能改善。     

青少年特发性脊柱侧凸中胸弯和胸腰弯的矢状面序列分析：这两个侧弯类型有何不同之处

作者对青少年特发性脊柱侧凸的影像学数据进行了回顾性分析。目的是为了观察青少年特发性脊柱侧凸患者的胸弯和胸腰弯的矢状面序列是否存在差异。脊柱前部的过度生长可能是胸段脊柱侧凸的病理机制。目前已知矢状面序列的变化在青少年特发性脊柱侧凸的发展中起重要作用，而骨盆参数和矢状面序列之间存在某种关系，因此作者推测在青少年特发性脊柱侧凸的不同类型中，     

两种途径的椎体后凸成形术治疗老年脆性椎体骨折中远期疗效分析

目的:评估单侧与双侧椎体后凸成形术治疗老年脆性椎体骨折患者中远期的临床疗效。方法 :回顾性分析2008年1月至2010年1月单双侧椎体后凸成形术治疗老年脆性椎体骨折的临床资料,按统一的纳入、排除标准纳入临床研究的患者104例,男44例,女60例,按术中途径分为单侧组(手术运用单侧椎弓根途径行PKP治疗的患者)和双侧组(手术运用双侧椎弓根途径行PKP治疗的患者),分别于术前及术后3 d、3个月、1年、3年、末次随访进行VAS评分、Cobb角改善、椎体前后缘高度变化等指标对比,评估两组的疗效和安全性。结果 :所有患者手术顺利,单侧组手术时间、骨水泥注入量较双侧组少(P0.05);两组术后VAS评分均较术前明显降低(P0.05),椎体前后缘高度及局部Cobb角较术前均有显著恢复(P0.05),而术后各时间点两组间VAS评分、Cobb角改善、椎体前后缘高度比较差异均无统计学意义(P0.05)。并发症方面:骨水泥渗漏12例(11.5%),椎体再次骨折5例(4.8%),脑脊液漏2例(1.9%),神经根刺激症状3例(2.9%),均为一过性,对症治疗后缓解。结论 :单侧与双侧椎体后凸成形术治疗老年脆性椎体骨折中长期疗效均安全、满意,可作为一种微创治疗手段推广,而单侧椎弓根途径椎体后凸成形术手术时间较短、创伤相对较少,是更理想的方式。     

两种术式治疗骨质疏松压缩骨折的疗效比较

目的探讨经皮椎体后凸成形术(PKP)与经皮椎体成形术(PVP)治疗骨质疏松压缩骨折的有效性及安全性。方法将150例骨质疏松压缩骨折患者随机分为PVP组(采用PVP治疗)和PKP组(采用PKP治疗),每组75例。比较两组患者疗效及畸形矫正情况。结果患者均获得15个月随访。手术时间及骨水泥渗漏个数PKP组短(少)于PVP组(P 0. 05),骨水泥注入量及术后伤椎高度增加PKP组多于PVP组(P 0. 05)。术后3 d,伤椎椎体前、中部高度PKP组均高于PVP组(P 0. 05)。术后6个月、1年,VAS评分、伤椎Cobb角水平两组均较术前降低(P 0. 05),PKP组均低于PVP组(P 0. 05)。结论采用PKP与PVP治疗骨质疏松压缩骨折患者均能获得较好的疗效,促进患者康复,但PKP疗效优于PVP。     

休门氏病后凸畸形下端椎、首个前凸椎与矢状面稳定椎的相互关系分析

目的:探讨休门氏病后凸畸形的下端椎(lower end vertebra,LEV)、首个前凸椎(first lordotic vertebra,FLV)与矢状面稳定椎(sagittal stable vertebra,SSV)的相互关系。方法:2003年1月～2008年12月收治休门氏病胸椎或胸腰椎后凸畸形患者26例,男17例,女9例;年龄14～53岁,平均22.1岁;胸椎后凸17例,胸腰椎后凸9例。在站立位全脊柱侧位X线片上测量LEV、FLV和SSV。根据测量结果,统计分析LEV、FLV和SSV之间的相互关系。结果:17例胸椎后凸中,LEV=FLV3例,LEV=FLV-112例,LEV=FLV-22例;FLV=SSV6例,FLV=SSV-18例,FLV=SSV-23例;LEV=SSV1例,LEV=SSV-14例,LEV=SSV-211例,LEV=SSV-31例。9例胸腰椎后凸中,LEV=FLV3例,LEV=FLV-16例;FLV=SSV3例,FLV=SSV-16例;LEV=SSV-16例,LEV=SSV-23例。结论:休门氏病胸椎或胸腰椎后凸畸形患者远端融合水平延至SSV与固定到FLV相比,绝大多数情况下并不增加融合节段或仅增加1个节段。     

两种椎体成形术治疗老年脊柱压缩骨折的疗效比较

目的 比较经皮椎体后凸成形术(PKP)与经皮椎体成形术(PVP)治疗老年脊柱压缩骨折的疗效.方法 将159例老年脊柱压缩骨折患者按照随机数字表法分为对照组(79例,采用PVP治疗)和观察组(80例,采用PKP治疗).记录两组手术时间、透视次数、术中透视时间,比较两组手术前后疼痛VAS评分、Cobb角、椎体高度百分比,采...     

两种术式治疗老年骨质疏松性椎体压缩性骨折的疗效比较

目的探讨椎体成形术(PVP)和椎体后凸成形术(PKP)治疗老年骨质疏松性椎体压缩性骨折(OVCF)的临床疗效。方法将112例OVCF患者根据入院先后顺序分成PVP单侧穿刺组(32例)、PVP双侧穿刺组(28例)、PKP单侧穿刺组(27例)、PKP双侧穿刺组(25例)。比较4组间手术时间、骨水泥渗漏率、椎体前缘高度比、住院天数、手术前后疼痛VAS评分。结果 112例患者均获得随访,时间6～13个月。手术时间:PVP单侧穿刺组与双侧穿刺组比较差异无统计学意义(P 0. 05),PKP单侧穿刺组与双侧穿刺组比较差异有统计学意义(P 0. 01),且PVP两组与PKP两组间比较差异均有统计学意义(P 0. 01)。骨水泥渗漏率、椎体前缘高度比:PVP两组间比较差异无统计学意义(P 0. 05),PKP两组间比较差异无统计学意义(P0. 05),但PVP两组与PKP两组间比较差异有统计学意义(P 0. 01)。住院天数、手术前后VAS评分4组间比较差异均无统计学意义(P 0. 05)。结论 OVCF采用PVP与PKP治疗疗效均满意。PVP手术时间短、费用低,但骨水泥渗漏率偏高,不能恢复压缩椎体高度; PKP骨水泥渗漏率低,利于恢复压缩椎体高度,但手术时间长、费用高。     

强直性脊柱炎胸腰椎后凸畸形两种截骨矫形术式的疗效比较

目的探讨治疗强直性脊柱炎胸腰椎后凸畸形的两种截骨矫形术式、截骨范围及内固定范围的选择。方法共54例,男49例,女5例;年龄25～56岁,平均36岁。其中多节段经关节突“V”形截骨23例(A组),单节段经椎弓根椎体截骨31例(B组)。结果术后无感染、死亡发生;术中硬脊膜破裂2例(A组和B组各1例),椎弓根骨折1例(A组);术后下肢短暂性麻木2例(B组),肠系膜上动脉综合征1例(A组)。术后平均矫正度:行多节段经关节突“V”形截骨者为44°,单节段经椎弓根椎体截骨者为36°。随访11～45个月,平均20个月,A组矫正度丢失平均为6°,B组为3°,但均达骨性融合。A组有1例发生椎弓根螺钉早期松动。A、B两组患者主观满意率分别为95.7%和93.5%。结论以上两种截骨方式治疗强直性脊柱炎胸腰椎后凸畸形的临床效果相似,可根据脊柱前柱是否完全骨化来选择术式。偏心椎板钩的使用是解决术中内固定困难的有效方法。     

以脊柱侧凸为首发症状的青少年不典型腰椎间盘突出症诊治分析

目的 回顾性分析以脊柱侧凸为首诊的青少年不典型腰椎间盘突出症的临床特征及治疗策略.方法 自1998至2007年,共收治以脊柱侧凸为首诊的青少年腰椎间盘突出症患者19例,其中男性10例,女性9例,年龄14～20岁.腰椎间盘突出部位为L4,5> 10例,L5>S1>7例,L4>～S1>2例.脊柱侧凸Cobb角23°～38°,C7>铅垂线到骶骨正中线的距离平均4.7 cm.本组患者均行经后路椎板开窗髓核摘除术,术后骨盆带牵引3周.3周后摄片复查,如脊柱侧凸消失或好转,则逐步恢复日常生活;如侧凸改善不明显,即行牵引下矫形石膏外制动1个月.结果 14例(73.7%)患者的腰椎间盘突出位于腰弯凸侧,5例(26.3%)患者的椎间盘突出位于腰弯凹侧,腰弯方向与腰椎间盘突出侧别之间具有边缘相关性(P=0.07).本组患者术后下肢麻木不适感或放射性疼痛均消失.术后3周摄全脊柱X线片复查,脊柱侧凸Cobb角平均14°,C7>铅垂线到骶骨正中线的距离平均2.2 cm.平均随访21个月,患者均恢复正常学习和生活.无腰痛,无下肢疼痛、麻木等症状复发,脊柱侧凸的自发性纠正均无明显丢失.结论 以脊柱侧凸为首诊的青少年腰椎间盘突出症缺少成人腰椎间盘突出症的典型临床特征,易被误诊.早期诊断、及时正确处理,临床疗效满意.     

术后持续镇痛对胃肠功能恢复的影响

为探讨术后持续镇痛对胃肠功能恢复的影响,将120例择期大、中型腹部手术后的病人随机分成两组,实验组(60例)采用硬膜外持续镇痛,对照组(60例)采用间断肌内注射镇痛剂,观察并记录肠鸣音恢复时间、肛门排气时间.结果:实验组肠鸣音恢复时间为(50.50±2.48) h,对照组为(43.58±3.86) h;实验组肛门排气时间为(58.54±2.47) h,对照组为(51.27±3.80) h,两组比较,差异无显著性(均P＞0.05).表明术后持续镇痛不影响胃肠功能的恢复.     

吻合器治疗直肠前突合并重度痔22例临床报告

目的：评估吻合器直肠黏膜环形切除固定术（PPH）在治疗直肠前突合并重度痔的临床应用价值。方法：利用吻合器对22例直肠前突合并重度痔的患者行手术治疗。结果：手术时间平均15min，手术后平均住院5d，100％病人对手术效果满意。结论：吻合器治疗直肠前突合并痔是一种方法简单、安全有效、恢复快、痛苦少、无复发等优点的新方法。     

连续腰麻用于肾移植手术的临床观察

目的 通过比较在肾移植手术中应用腰麻-硬膜外联合麻醉和连续腰麻的临床效果,探讨连续腰麻用于此类手术的可行性和安全性.方法 选择拟行肾移植手术患者60例,随机分为腰麻-硬膜外联合麻醉组(A组)和连续腰麻组(B组),每组30例.A组经腰麻针注入0.75%罗哌卡因2 mL后,向头侧置入硬膜外导管,术中根据麻醉需求经硬膜外导管追加0.75%罗哌卡因10 mL;B组,经Spinocath导管于蛛网膜下腔注入0.75%罗哌卡因2 mL,术中根据麻醉需求经Spinocath导管追加0.75%罗哌卡因1 mL.观察2组麻醉效果及患者术中生命体征的变化.结果 A、B组均顺利完成手术;2组术中循环功能指标与麻醉前基础值相比均无显著性差异;术后2组均未发现麻醉相关并发症;B组在麻醉平面控制及麻醉维持方面优于A组.结论 在肾移植手术中,应用Spinocath导管行连续腰麻是安全、可行的.     

我国两种髋关节功能评定方法的临床比较研究

本文通过对178例施行人工髋关节置换术的患者进行随访,获得完整随访资料86例。采用国内两种髋关节功能评定方法(北京标准和北戴河标准),进行功能评定和统计学比较。结果提示:功能评定之前,宜按Charnley标准将原有行走能力分为A、B、C三类;两种评分标准具有可比性;北戴河标准能更准确、客观地反映髋关节的实际情况。     

连续生产低聚果糖的最佳操作参数

以海藻酸钙为载体包埋黑曲霉AS0 0 2 3孢子 ,培养后得到固定化增殖细胞 .将此固定化增殖细胞填入填充床反应器中以用于连续化生产低聚果糖 .研究了连续操作时的最佳工艺参数 .结果表明 ,在D 3 .5cm× 50cm的小型夹套层析柱上 ,最佳操作参数为 pH 6.5,50℃ ,体积流量 1 .3mL/min ;扩大到D 5.5cm× 1 0 0cm中型填充床反应器中 ,确定其最佳操作参数为 pH 6.5,50℃ ,体积流量 6.0mL/min ;在此条件下所得产品中低聚果糖质量分数达 53 % ,并且连续反应 1 7d低聚果糖质量分数保持在 50 %以上 .     

The Index of Motor Current Amplitude Has Feasibility in Control for Continuous Flow Pumps and Evaluation of Left Ventricular Function

The index of motor current amplitude (ICA) has feasibility in continuous-flow ventricular assist device control. It can demonstrate the safe range of pump speed, which exists between the starting point of total assistance (t-point) and the starting point of sucking (s-point). The objective of this study was to investigate how the ICA characteristic curve changes with each condition of contractility, preload, and afterload changes. We changed preload, afterload, and contractility of closed-mock circulation and plotted the change of the ICA value against pump speed. Then the shift of ICA characteristic curve against the change of each condition was considered. When preload increased, ICA characteristic curves showed the expansion of a safe range. When afterload increased, ICA characteristic curves were shifted to the high rotation side, slightly narrowing a safe range. When contractility increased, ICA characteristic curves showed the shift of a convex above to narrowing of a safe range. As these shift patterns were observed even when the driving conditions of a circuit changed, reproducibility was checked. Understanding the feature of a shift pattern of ICA characteristic curves correctly, a possibility that change of the heart function could be predicted by change of ICA value and a possibility for a flexible control method based on ICA, according to hemodynamic state, were suggested.     

连续性血液净化治疗多脏器功能衰竭九例临床观察

目的 探讨连续性血液净化对多脏器功能衰竭的抢救与治疗.方法 在常规治疗基础上给予连续性血液净化治疗.结果 治疗前、后血肌酐、谷丙转氨酶、肌酸磷酸激酶比较差异有学意义(P均<0.05).结论 连续性血液净化治疗对多脏器功能衰竭的抢救有重要作用.     

Continuous sciatic block for leg and foot surgery in 160 children

BACKGROUND: The aim of this study was to assess the safety and efficacy of continuous sciatic block for lower limb surgery in children. METHODS: A total of 160 pediatric patients aged 4 months to 12 years weighing 3.5-50 kg, were given continuous sciatic block plus single shot 3-in-1 block for leg and foot surgery. After general anesthesia, the sciatic nerve was located by using loss of resistance to saline by the mid-thigh approach. An 18 gauge epidural needle was introduced at the junction of the proximal two-third with the distal one-third of a line extending from the apex of popliteal triangle to the midpoint of the line joining the greater trochanter and the ischial tuberosity. A 20 g catheter was threaded through the needle for 5-10 cm and 0.25% bupivacaine 0.75 ml.kg(-1) was injected. A single shot 3-in-1 block was also given to facilitate the use of a tourniquet with 0.25% bupivacaine 0.25 ml. In 20 patients a nerve stimulator was used in addition to loss of resistance. The intraoperative sedation comprised propofol and ketamine infusions and 50% nitrous oxide in oxygen by LMA. RESULTS: Eight-two percent of patients showed no response to surgery; 14% patients showed some response to the medial incision over the ankle and needed additional bolus doses of ketamine and propofol. Block was considered to have failed in 4% who required an increase in propofol and ketamine infusions. A total of 154 patients had good postoperative pain relief for 72 h with continuous infusion of 0.05% bupivacaine. The other six were given oral codeine and diclofenac. There were no complications attributable to sciatic block in any patient. CONCLUSIONS: Sciatic block with a single shot 3-in-1 block for tourniquet pain and light general anesthesia provides good intraoperative conditions for leg and foot surgery and adequate postoperative pain relief. Additional sedation to minimize the discomfort of a cast may be a consideration in the first 24 h.     

Continuous treatment modalities in acute renal failure

Continuous treatment modalities have become well establishedin the treatment of severely ill patients with acute renal failuresince the introduction of continuous arteriovenous haemofiltration.However, this simple blood-pressure-driven treatment often failsto control azotaemia, especially in haemodynamically unstablepatients with hypercatabolism. The common feature of furtherdevelopments in continuous treatment modalities, such as continuousarteriovenous haemodialysis, venovenous haemofiltration, orvenovenous haemodialysis is their higher efficacy in controllingazotaemia. Venovenous forms of treatment involve considerablyhigher technical requirements. The main advantages of continuous forms of treatment as opposedto intermittent haemodialysis are greater haemodynamic stabilityand the possibility of adapting nutrition without restrictionto the needs of the critically ill. The uninterrupted necessityfor anticoagulants is the most important disadvantage. The questionof whether patients may profit from the continuous eliminationof mediators involved in acute renal or multiple organ failureis still open. In retrospective analysis continuous methods appear to reducemortality in acute renal failure, but prospective randomizedstudies are necessary to clearly demon strate a benefit of thesemethods as opposed to intermittent haemodialysis.     

基于Ahmadi模式的延续护理在颌面手术患者术后的应用分析

目的:探究基于Ahmadi模式的延续护理在颌面手术患者术后的应用.方法:随机选取2018年9月-2020年10月进行颌面手术的82例患者作为研究对象,随机分为观察组和对照组,每组41例.对照组实施传统护理干预,观察组在此基础上引入基于Ahmadi模式的延续护理进行干预.通过Zung焦虑自评量表(Self-rating ...