Predictors for work incapacity continuing after disc surgery.

OBJECTIVES: This study was carried out to provide information on and identify factors about the fitness for work 12 months after disc herniation surgery. In addition a predictive tool for this outcome was developed. METHODS: A selected patient population (N = 177) operated on for lumbar disc herniation from September 1995 until May 1996 was evaluated by medical advisers of a sickness fund. The patients were submitted to a standardized interview about their personal, social, medical, professional, and psychological status. To assess the functional status of the lumbar spine, a standardized clinical examination was used. RESULTS: Eighty-five percent of the patients were employed 1 year after surgery. The most important predictors at 6 weeks after intervention were the estimation of pain according to a visual analogue scale, the patient's prediction of his possibilities to resume work, the Oswestry disability index score, and the Zung depression score. Of the clinical factors, nonorganic signs and sensory disturbances after surgery were negative prognosticators for long-lasting disability. Using the Oswestry score, the Zung score, the patient's own prediction, the score on the Social Readjustment Rating Scale, and the score on the Modified Somatic Perception Questionnaire, 86% of the poor outcomes could be correctly classified. CONCLUSIONS: The Oswestry disability scale and the Zung depression scale should be included in the routine postoperative assessment after disc surgery and the patient's own prediction of his possibility for fitness for work should be taken seriously. If a poor outcome is predicted, the patient is in need of rehabilitation and should be guided more intensely.     

攀枝花市某三甲医院腰椎间盘突出患者住院费用因子分析

目的探讨腰椎间盘住院患者医疗费用的主要支配因子,为控制住院患者的医疗费用过度增长提供参考依据。方法以攀枝花市某三甲医院骨科2018年就诊的腰椎间盘突出患者954例作为研究样本,使用因子分析法分析各项医疗费用。结果医疗服务药品因子、诊断相关因子、材料血液制品因子和检查手术因子是支配腰椎间盘突出患者住院费用的四个公因子。结论控制医疗费用的过度增长,根据支配因子,应着力控制材料费和药费。     

腰椎间盘突出症术后的早期医疗护理观察

目的观察腰椎间盘突出症术后早期医疗护理的效果。方法对41例采用手术治疗的腰椎间盘突出症患者进行系统的术后的早期医疗护理,根据中国康复医学诊疗规范制定的下腰痛评价标准评定疗效。结果优32例,良8例,可1例,差0例,优良率97.22%。结论积极的术后早期医疗护理对于预防并发症、提高术后功能恢复有重要作用。     

Trends in the number of Arabs with intellectual disability in residential care in Israel 1998-2006

Life expectancy for persons with intellectual disability has increased over the past 100 years, and today is closer to the life expectancy of the general population (except for Down syndrome). In this study, we looked at trends in the numbers of Arab persons with intellectual disability living in residential care centers in Israel. Analysis of annual questionnaires to the medical clinics in all residential care centers for the period 1998-2006 revealed that the Arab population had increased from 749 to 921 persons in 13 residential care centers (13.5% of the total residential care population). Of the 921 persons in 2006, 58 were children aged 0-9 years and 260 were aged 10-19 years, with the majority having severe or profound intellectual disability. The increase in the number over time can been seen as a longer life expectancy in this population; the lower than expected numbers in residential care can be seen as a result of children staying at home with their families for a longer time than in the Jewish population.     

X线摄影诊断腰椎间盘突出症30例

目的探讨腰椎间盘突出症腰椎x线片的影像学特点及临床意义。方法本院经手术确诊为腰椎间盘突出症患者30例,对其x线资料进行回顾性分析,总结腰间盘突出症的x线特点。结果本组30例患者中,24例表现为椎间隙前窄后宽或宽窄一致,占80％,21例表现为突出间盘相邻椎体缘的硬化和唇样增生,占70％,20例表现为腰椎曲度变化,占66．67％,18例表现为椎体后缘后翘,占60％,18例表现为许莫氏结节,占60％。CT检查对腰间盘突出症诊断的确诊率高于x线检查,差异有统计学意义（P〈0．001）。结论CT检查优于x线检查,对手术方式的选择有重要意义。在基层医院,x线片检查仍然对诊断腰间盘突出症有重要的价值和意义。     

山西省农村育龄妇女优生健康检查服务利用及需求调查

目的:了解山西省农村育龄妇女优生健康检查服务利用与需求情况。方法:于2011年4月1日～5月31日采用随机整群抽样的方法,用自制结构式问卷进行入户调查。结果:共调查1978名育龄妇女,收回有效问卷1865份。调查对象对优生保健相关知识的知晓率>70.0%,92.5%认为有必要做孕前检查,但实际参检率仅为39.7%;婚检率为6.2%;91.6%的调查对象都做过产前检查,平均产前检查4.2次,其中B超检查率为84.9%,做过≥3次者占45.7%,多数被调查妇女希望能够获得更多的优生保健服务。结论:山西省农村育龄妇女对优生保健知识的知晓率较高,优生保健服务利用情况不理想,优生保健服务需求较强烈。     

Age-related geriatric medicine: relevance of special skills of geriatric medicine to elderly people admitted to hospital as medical emergencies.

This study was carried out to find out how many patients aged 75 and over admitted to hospital as medical emergencies had features appropriate to care by physicians in geriatric medicine and to examine the extent of use of specialist facilities by these patients. The purpose was to examine criticisms of age-related admission policies which have focused on misplacement of patients with single diagnoses and lack of access to specialist care. An analysis was made of admission, process and discharge characteristics relevant to the special skills of geriatric medicine, multiple pathology and use of specialist services by 554 patients aged 75 and over. These were collected prospectively, consecutively admitted as medical emergencies via the accident and emergency department of a large district general hospital with an age-related (75 and over) medical admissions policy. 84 patients (15%) had single pathology and no characteristics suggesting the need for specialist geriatric care. 177 (32%) had single pathology and one or more specialized characteristics. 66 (12%) had multiple pathology alone. 227 (41%) had multiple pathology and specialized characteristics. There were 142 specialist referrals in 121 patients (22% of the whole sample). We concluded that the special skills of general physicians specializing in the medical and associated community problems of elderly people are highly relevant to patients aged 75 and over presenting as medical emergencies. There was no evidence of lack of involvement of specialists in their care.     

老年性腰椎间盘突出伴椎管狭窄症手术疗效分析

目的探讨老年性椎间盘突出伴腰椎管狭窄症的手术方法及疗效。方法回顾性分析2006年9月～2008,年12月收治的17例65岁以上椎间盘突出伴腰椎管狭窄症患者的临床资料,均采用全椎板减压、椎弓根内固定及椎间关节、横突间用自体骨进行融合,5例使用椎间融合器。结果17例随访4～25个月,平均14个月。临床疗效：优13例,良3例,可1例,优良率94％。结论腰椎管减压、固定、植骨有助于老年腰椎管狭窄症患者神经功能的恢复。     

认知疗法在腰椎间盘突出症护理中的应用

目的研究认知疗法在腰椎间盘突出症患者中的应用价值,以及认知疗法相应的护理方法。方法收集观察2013年2月²014年3月腰椎间盘突出症患者262例,采用认知疗法干预方法实施护理,与往年进行常规护理的同类患者相互对照。比较两组患者的腰间盘突出症相关知识知晓率和出院后医嘱依从性。结果两组患者治疗前疼痛评分及焦虑状态比较,u值为0.074 2、0.410 1,无统计学差异(p>0.05),治疗1 w及2 w后疼痛评分和焦虑程度比较,u值分别为2.239 6、2.390 1及5.201 8、2.837 1,差异均有统计学意义(p<0.01),观察组疼痛及焦虑程度缓解明显优于对照组;观察组的总有效率为88.93%,对照组的总有效率为86.26%,两组总体疗效存在明显差异(p<0.05);观察组护理满意度为(98.32±2.68)分,对照组(93.11±1.54)分,差异有显著性意义(p<0.01)。结论系统化、有针对性的腰间盘突出症认知疗法护理可明显重塑患者自信及提高对疾病疼痛的适应,能够有效地提高治疗效率,提升患者满意度,是促进腰间盘突出患者康复的有效方法。     

康复护理结合针灸理疗治疗腰椎间盘突出症临床疗效观察

目的 探讨康复护理联合针灸理疗对腰椎间盘突出症的疗效.方法 将78例患者腰椎间盘突出症患者随机分为2组,对照组给予针灸理疗,实验组在对照组基础上给予康复护理,比较护理效果.结果 实验组患者生活质量高于对照组,P＜0.05.结论 对腰椎间盘突出症患者加强康复护理工作有助于提高治疗效果.     

经皮激光椎间盘减压术治疗多节段腰椎间盘突出症

目的 探讨经皮激光椎间盘减压术(PLDD)治疗多节段腰椎间盘突出症的临床策略及疗效.方法 2005年12月至2008年12月收治56例多节段腰椎间盘突出症患者.局部麻醉下,应用Nd:YAG激光治疗,术中在数字减影血管造影(DSA)机透视下定位,光纤由浅入深插入烧灼,每次发射1 s,间歇1 s,单节段激光总量400～800 J.于术前、术后3个月进行视觉模拟疼痛量表(VAS)及奥斯维斯失能指数(ODI)评分,末次随访时采用改良Macnab标准评价临床疗效.结果 56例患者随访6～36个月,平均18个月,ODI评分由术前的(31.10±2.92)分改善至术后的(11.80±2.62)分(t=3.067,P＜0.01);VAS评分由术前的(7.00±1.41)分改善至术后的(3.00±0.81)分(t=2.802,P＜0.01).优36例,良10例,可8例,差2例,优良率82.1%(46/56).无椎间盘感染、腰大肌血肿、神经根和血管损伤等并发症.结论 PLDD治疗多节段腰椎间盘突出症临床疗效良好,手术安全,耗时短,术后恢复快.     

螺旋CT检查在腰椎间盘突出的应用探讨

目的：评价螺旋CT在诊断腰椎间盘突出症中的价值.方法：对80例CT诊断为腰椎间盘突出症患者的CT资料进行回顾性分析.结果：本组腰椎间盘突出好发于L4～5和L5 ～S1椎间隙,突出方向以中央型和侧突型多见,突出程度以突出型多见.其主要CT征象表现：①髓核向椎管内突出在椎体后缘或外侧缘形成外凸的软组织影;②硬膜囊受压变形;③神经根受压或堙没,神经移位或变粗;④椎间盘突出钙化影;⑤Schmorl结节形成和真空现象.结论：CT能清楚显示腰椎间盘突出及其方向、大小、程度以及硬膜囊、神经根受压情况,是诊断腰椎间盘突出症的首选方法.     

Assessment of constipation management in long-term care patients

OBJECTIVES: To determine the prevalence of diagnosed constipation among nursing home patients; to assess the prevalence of routine (at least one time per week for 4 consecutive weeks) laxative use; and to investigate prescribing practices. DESIGN: A retrospective multi-center medical record evaluation. SETTING: Any one of 25 nursing facilities representative of a long-term care pharmaceutical provider's geographical coverage. PARTICIPANTS: All patients under the age of 65, and/or who had resided in the facility for less than 4 weeks, and/or who were placed in a specialty care bed (eg, Alzheimer's disease, hospice, HIV/AIDS) were excluded. RESULTS: A total of 712 resident charts meeting initial inclusion criteria were screened, 392 (55%) of which had a documented diagnosis of constipation and/or routine laxative use. Approximately 28% (CI +/- 3.3) of residents had a documented diagnosis of constipation. The rate of laxative use within the same sample population of 712 patients was 53.8% (CI +/- 3.7). Of the 392 patients with a diagnosis of constipation and/or routine laxative use, over 72% had at least one diagnosis or medication known to precipitate constipation. The most commonly prescribed laxatives were stool softeners (26.2%), saline laxatives (18.4%) and stimulant/irritant laxatives (15.6%). Almost half of the laxative users were prescribed more than one agent. CONCLUSION: This study supports the concern that there is often a gap between documentation of symptoms and constipation treatment decisions. No correlation was found between the specific laxative prescribed and the presence or absence of a documented diagnosis of constipation. Treatment decisions should be based on thorough examination and individualized patient needs. Furthermore, there is a need to increase monitoring for drug effectiveness.     

Short-stay hospitalization of elderly persons: first step toward institutionalization?

One month outcome after hospitalization was studied in 1695 persons aged 75 and over, living in the community and admitted to acute care medical units: only 9.6% of them were then institutionalized. Returning home requires a high level of independence for feeding, mental status and continence. The level of dependence of institutionalized patients was particularly high for dressing or bathing, technical care, mental status and security. A multivariate analysis showed that the only independent predictors of institutionalization were: sex, living alone, mental status and hospital type. The role played by physical disability must be counterbalanced by the effective physical assistance, brought to the elderly by institutional or informal home care after hospitalization. These results allow early identification of persons at high risk of institutionalization.     

Patients' condition one year following surgery for a lumbosacral radicular syndrome

In 492 patients with a lumbosacral radicular syndrome caused by a lumbar intervertebral disc herniation or by a stenosis of the lumbar spinal canal, the situation 1 year after a root decompressing operation was compared with the situation before surgery. About 75% of the patients reported satisfactory improvement, while about 10% were not satisfied. The judgement of the physicians is somewhat more favourable: 80% and 5%, respectively. The best results are obtained in patients in whom the preoperative diagnosis of lumbar disc herniation is highly probable; the worst results are obtained in patients undergoing a second operation. Back pain, sometimes serious, persists after surgery in about 50% of the patients. Such persistent back pain occurs most frequently in patients with a lumbar canal stenosis; one-third even mention a postoperative increase in back pain. About 50% of the patients who were on sick leave before operation resumed work afterwards.     

腰椎间融合单侧及双侧内固定术对腰椎间盘突出症的疗效对比探究

目的：对比腰椎间融合单侧及双侧内固定术对腰椎间盘突出症的疗效,探究更为有效、可靠的治疗方式。方法：选取腰椎间盘突出症患者112例,按照手术方式不同随机将其分为单侧组及双侧组,每组56例,分别采取腰椎间融合单侧或双侧内固定治疗,对比两组患者的手术情况及治疗效果。结果：单侧组手术时间、术中出血量及住院费用低于双侧组,差异有统计学意义（t=8.857,t=9.620,t=12.338;P〈0.05）;两组住院时间比较无明显差异;两组患者治疗后疼痛视觉模拟评分（VAS）及Oswestry功能障碍指数（ODI）均显著下降（t=28.223,t=24.899,t=25.013,t=20.475;P〈0.05）,其治疗前后VAS及ODI组间对比均无明显差异;两组患者均获得有效随访,单侧组末次随访椎间融合率为89.3%,双侧组椎间融合率为92.9%;单侧组随访未见明显并发症,双侧组随访发现1例椎间融合器内植骨部分吸收,1例出现突出对侧根性症状。结论：腰椎间单侧及双侧内固定均能够有效改善患者腰椎间盘突出症疼痛症状,且具有良好的椎间融合度,安全性较高;而单侧内固定手术时间更短、出血量更少且患者负担更小,对于需手术治疗的严重腰椎间盘突出症患者可使用腰椎间融合单侧内固定治疗。     

Physical functioning in elderly Europeans: 10 year changes in the north and south: the HALE project

OBJECTIVES: To examine age related changes in physical functioning in elderly men and women. DESIGN: Prospective, population based study. SETTING: Population of 15 rural and urban centres in 10 European countries. PARTICIPANTS: Altogether 3496 men and women born between 1900 and 1920 who participated in the baseline survey of the HALE project in 1988-1991. The study population was examined again about five (in 1993-1995) and 10 (in 1999-2001) years after the baseline examination. MAIN OUTCOME MEASURES: Physical functioning was measured by means of a self administered questionnaire of activities of daily living (ADL). Dichotomised prevalence of disability and need for help in self care and mobility ADL were used as dependent variables in the analyses. RESULTS: Prevalence of disability and need for help tended to be higher in women than in men and in mobility abilities than in self care activities. Disability and need for help increased with advancing age but ameliorated over time from one birth cohort to another. In longitudinal analyses this beneficial time trend was independent of the effect of age, study, and region in self care disability in men and women (OR 0.85, 95% CI 0.75 to 0.97 and OR 0.64, 95% CI 0.43 to 0.97, respectively) and self care need for help in men (OR 0.83, 95% CI 0.70 to 0.96). Mobility disability among men and self care disability among women decreased more in the south than in the north. CONCLUSION: While European populations are aging, the proportions of elderly people with disability are decreasing. These results suggest that dynamics of functioning may differ across cultures. Future studies are needed to clarify which potentially modifiable and culturally determined factors protect against functional decline.     

机构养老的老年人医养结合服务需求分析——基于日常生活能力评估

目的:了解河南省不同失能等级老年人的医养需求特点,为未来机构养老的发展提出合理化建议.方法:采用多阶段整群抽样方法,在河南省抽取57家养老机构,对入住老年人进行面对面问卷调查.结果:医疗服务方面,老年人相对更需要医疗巡诊、临床治疗、医学护理服务;健康管理方面,更需要建立健康档案、健康体检;生活服务方面,更需要助浴、助厕...     

CT检测联合核磁共振成像在腰椎间盘突出治疗效果评价中的应用

目的:分析CT检测联合核磁共振成像在腰椎间盘突出治疗效果评价中的应用效果。方法:选取2019年2月~2019年9月本院接收的29例腰椎间盘突出患者开展研究,首先对患者进行CT检查,如果检查结果与患者的临床症状不符合,则对不符合患者继续采用核磁共振成像技术进行检查,基于检查结果制定相应的手术治疗方案。观察患者的检测病变情况、手术治疗前后患者的椎间隙高度、硬膜外压痕矢径、日本矫形外科协会评分以及视觉模拟评分。结果:椎间盘膨出患者和椎间盘突出患者分别为11例和18例。治疗后患者的椎间隙高度、硬膜外压痕矢径、日本矫形外科协会评分和视觉模拟评分均优于治疗前,组间差异具有统计学意义(P<0.05)。结论:对腰椎间盘突出患者在治疗中应用CT联合核磁共振成像技术进行诊断,可作为手术治疗效果评价的客观指标。     

导航下腰椎椎弓根钉内固定加椎间盘融合术手术配合

目的探讨导航引导下腰椎椎弓根内固定术治疗退行性腰椎病变患者的手术期护理。方法回顾性分析38例导航引导下腰椎椎弓根内固定加椎间盘融合术中手术护理,导航手术配合的方法、手术中配合的要点,包括巡回护士手术配合和洗手护士手术配合。结果38例退行性腰椎病变患者共植入椎弓根钉螺钉166枚,得到的植入物实际影像图与导航虚拟手术路径图重叠,椎弓钉完整在椎弓根内为92%,手术效果优良率90%,无螺钉松动断裂,无硬脊膜损伤及马尾神经牵拉损伤并发症。结论导航下腰椎椎弓根钉固定术加椎间盘融合手术是一种更加安全、有效的手术方法。熟炼掌握配合要点、手术步骤方能保证手术顺利完成,达到最佳的护理效果。