颈前路钛网植骨及带锁钢板固定治疗下颈椎骨折

目的评价颈椎前路钛网植骨及带锁钢板固定治疗下颈椎骨折的临床应用价值。方法 2005年5月～2012年12月共收治下颈椎压缩性及爆裂性骨折患者32例,其中颈脊髓损伤患者28例,采用前路减压复位椎体次全切除、钛网植骨及带锁钢板固定方法一期手术治疗。按照Frankel评分系统对神经功能恢复情况进行评价,以X线片测量的Cobb角、"D"值改变评价复位效果、观察融合节段曲度及颈椎生理曲度重建和维持情况。结果不完全脊髓损伤患者Frankel评分恢复平均1级以上。Cobb角、"D"值测量统计表明术前与术后差异有统计学意义(P<0.05),术后即刻与术后随访差异无统计学意义(P>0.05)。结论颈前路钛网植骨及带锁钢板固定治疗下颈椎骨折临床疗效满意,能重建和维持颈椎生理曲度。     

椎体切除植骨融合内固定治疗颈胸交界椎体转移瘤

目的探讨经前路切除颈胸交界椎体转移瘤,采用钛网植骨加钢板内固定重建椎体的临床应用价值。方法行前路椎体切除,钛网自体髂骨植骨融合,钢板内固定治疗12例颈胸交界椎体转移瘤。结果 12例均获得随访。随访时间6～49个月,平均18个月。全部病例植骨融合满意,局部肿瘤无复发,内固定物无断裂、松动、滑脱等并发症。伴有神经功能障碍者,其神经功能均有不同程度的恢复。结论经前路切除转移瘤椎体,钛网植骨加钢板重建切除后椎体,可即刻保证固定节段稳定性。植骨融合良好,明显改善神经功能,对提高该类患者生活质量、延长患者生命有很大的作用。     

一期前路病灶清除钛网植骨融合内固定治疗胸腰椎多椎体结核

目的探讨采用一期前路病灶清除钛网植骨融合内固定术治疗胸腰椎多椎体结核的疗效。方法胸腰椎多椎体结核34例均采用一期前路病灶清除、钛网植骨融合、前路内固定。结果术后3个月VAS评分平均（2．5±1．2）分,较术前差异有统计学意义（P〈0．05）,术后1年Frankel分级平均恢复2．3级,术后后凸Cobb角平均（11±2．8）°,较术前差异有统计学意义（P〈O．05）。结论一期前路病灶清除钛网植骨融合内固定治疗胸腰椎多椎体结核可行且有效,能较好地清除病灶,解除脊髓压迫,矫正后凸畸形,重建脊柱稳定性,提高脊柱结核的治愈率。     

颈前路减压术后颈椎重建的研究进展

颈前路减压后重建颈椎生理曲度、椎间高度及稳定性对保证手术疗效、避免手术并发症较为重要.文中综述了颈前路经间隙椎间盘切除减压和椎体次全切减压后的颈椎重建.经间隙减压后颈椎重建有单纯骨块植骨、骨块植骨钛板内固定、椎间融合器植骨、椎间融合器植骨钛板内固定以及颈椎人工椎间盘置换;椎体次全切减压颈椎重建有单纯骨块植骨、骨块植骨钛板内固定、钛网植骨钛板内固定、椎间融合器和钛网植骨钛板内固定.颈椎融合术后部分患者存在椎间高度丢失和植骨不融合是两个主要的问题.人工椎间盘可保留椎节运动,但适应证较窄.颈椎彻底减压后应选择最合适的方式重建颈椎椎间高度和稳定性.     

前路手术治疗中段颈椎单发转移性肿瘤

目的探讨前路手术治疗中段颈椎单发转移性肿瘤的疗效。方法对10例颈椎单发转移性肿瘤的患者采用前路病椎椎体切除减压、钛网加钛板内固定的手术方法治疗,比较术后,术后3月及末次随访时颈部疼痛的VAS评分和神经功能Frankel分级,随访复查影像学颈椎稳定情况和局部复发情况。结果术前和术后3个月颈部疼痛的VAS评分分别为7.5+0.7和1.7+1.4。两者差异有统计学意义,术前Frankel分级为c级4例,d级6例。术后Frankel分级改善1-2级。结论前路椎体切除,钛网加钛板内固定治疗中段颈椎单发转移性肿瘤患者具有疼痛症状改善明显,充分解除脊髓压迫改善神经功能,重建颈椎稳定性的优点,且取得疗效均满意。     

椎间盘及部分椎体切除加钛网植骨钛板内固定术治疗单节段颈椎椎间盘突出伴椎体后缘骨赘

目的 评价颈椎椎间盘及相邻椎体部分切除加钛网植骨钛板内固定术治疗单节段颈椎椎间盘退变突出伴相邻椎体后缘骨赘的疗效. 方法 应用颈椎椎间盘及相邻椎体部分切除加钛网植骨钛板内固定术治疗单节段颈椎椎间盘退变突出伴相邻椎体后缘骨赘22例.取颈椎前路手术切口,术中仅切除突出的椎间盘及相邻椎体的1/3～ 1/2,使脊髓得到彻底的减压.再用填满碎骨的钛网植于骨缺损处加用钛板螺丝钉内固定,固定范围仅限于相邻椎体.术前和术后通过神经功能JOA评分、颈部轴性症状、颈椎动态侧位片和颈椎MRI比较临床疗效. 结果 均获随访,平均15(6 ～24)个月,术后JOA评分优良率86.4％,颈部轴性症状减轻,脊髓功能明显得到恢复.颈椎活动度良好.X线检查见钛网植骨及钛板内固定良好,未见不稳现象.MRI示颈髓压迫解除. 结论 颈椎椎间盘及相邻椎体部分切除加钛网植骨钛板内固定术治疗单节段颈椎椎间盘突出伴相邻椎体骨赘效果显著,可最大限度地保留颈椎节段的活动度.     

早期前路减压植骨融合ORION钛板内固定治疗下颈椎骨折

目的 探讨1995年以来收治的49例颈前路椎体次全切除减压、自体髂骨移植及ORION颈椎前路钛板内固定治疗下颈椎骨折及骨折脱位患者的临床疗效.方法 对骨折脱位者均Halo头环牵引复位后即行颈前路开槽式椎体次全切除减压、植骨融合、ORION钛板内固定,伴脊髓损伤者应用甲基强的松龙及脱水剂1～3d后手术,术后行X线检查,46例获得随访.结果 经6个月～2年随访,骨折脱位复位满意,内固定牢固,植骨在术后3个月获得骨性融合,神经系统症状均有不同程度的改善,1例因术后1年患褥疮并发多器官功能衰竭死亡,无1例发生ORION钛板断裂或螺钉松动、脱出.结论 颈前路减压、植骨后辅以ORION钛板内固定使融合节段达到术后即刻稳定,更有利于植骨节段的融合及颈椎曲度的重建,是治疗下颈椎损伤的有效方法.     

脊柱转移瘤病椎切除及稳定性重建

目的 探讨脊柱转移瘤切除、融合及稳定性重建在治疗转移性脊柱肿瘤中的必要性和可行性.方法 2002年6月-2007年8月对11例脊柱转移瘤患者行前路病椎切除自体髂骨植骨钛板内固定术或联合后路椎板切除减压术治疗,随访观察患者术后局部疼痛缓解,脊髓神经功能恢复及脊柱稳定性情况.结果 术后颈肩腰背痛及放射痛基本缓解,早期开始肢体功能锻炼,术后3～5周佩戴支具离床活动.随访5个月～2年,患者神经压迫症状明显改善.内固定物无松动、断钉现象,椎体尤塌陷结论前路手术切除病变椎体并自体髂骨植骨前路钛板内固定重建脊柱稳定性或联合后路椎板切除减压治疗脊柱转移瘤是可行性的,可提高患者生存期内的生活质量.     

颈前路保留中部椎体的分段减压治疗多节段颈椎病

目的通过比较,评价颈椎前路分段减压、保留中部椎体、钛网植骨长钛板内固定治疗多节段颈椎病的疗效和应用价值。方法采用颈前路长节段减压治疗多节段颈椎病21例,分段减压治疗32例。根据影像学检查评估术后内固定的并发症、植骨融合率、颈椎生理曲度的恢复和重建,根据JOA评分评估神经功能改善率。结果长节段减压组有4例出现内固定并发症,主要为钛网和螺钉的松动脱落;分段减压组未出现并发症。术后6个月长节段减压组有4例钛网植骨未达到骨性融合,分段减压组均达到融合。术前与术后比较Cobb角的改善,分段减压组明显优于长节段减压组(P<0.05)。JOA评分两组无明显差别(P>0.05)。结论采用颈前路保留中部椎体分段减压、钛网植骨长钛板固定、术后外固定保护治疗多节段颈椎病,可有效地进行颈前路融合、改善颈椎生理曲度,促进神经功能恢复。     

一期前路病灶清除钛网植骨融合内固定治疗下颈椎结核

目的总结一期前路病灶清除钛网植骨融合内固定治疗颈椎结核的临床疗效。方法 2008年7月至2011年12月,采用一期前路病灶清除钛网植骨融合内固定治疗下颈椎结核15例,男9例,女6例;年龄32~71岁,平均55岁。病灶累及两个椎体者11例,其中C3~41例,C4~52例,C5~64例,C6~74例;累及3个椎体者4例,均为C5~7。颈椎后凸Cobb角为22°~46°,平均35°。神经功能按Frankel分级,B级2例,C级3例,D级8例,E级2例。术前抗结核药物治疗2周以上,术后继续抗结核治疗12~18个月。随访观察患者临床症状改善和植骨融合情况。结果手术均顺利完成,术中无大血管、脊髓、食道、气管损伤。切口均一期愈合,未发生感染及窦道形成。随访20~60个月,平均30.6个月。患者临床症状及神经功能有不同程度恢复,神经功能1例B级恢复至D级,其余均达E级。术后末次随访后凸Cobb角0°~5°,平均2.6°,较术前明显减少,差异有统计学意义(P0.01)。患者植骨均完全融合,融合时间3~5个月,平均3.5个月,无内固定松动、脱落、折断、结核复发等并发症。结论在规范抗结核治疗的基础上,一期前路病灶清除钛网植骨融合内固定是治疗下颈椎结核的有效方法 。     

Body composition assessment and methodology in nonathletic and athletic adolescent and adult males and females

The purpose of this review is to outline methodology for assessing body composition utilizing anthropometric and densitometric techniques. The objective of body composition assessment is to measure body fat and lean body mass. The quantity of these components varies due to growth, physical activity, dietary regimens, and aging. Anthropometric techniques incorporate selected skinfolds, circumferences, skeletal widths, or other variables to estimate body composition within k2.0-4.0%. These techniques are adequate for field testing of groups or individuals, but are population specific. Densitometry measures body volume irrespective of physique, sex, or age. This laboratory technique estimates body composition within 1.0-2.0%, is more difficult to administer, but is not population specific. Some limitation exists with any present technique due to biological variability and incomplete research of reference body composition in children, females, and the aged. J Orthop Sports Phys Ther 1984;5(6):336-347.     

Perioperative and long-term morbidity and mortality after above-knee and below-knee amputations in diabetics and nondiabetics

We performed a retrospective review of a vascular surgery quality assurance database to evaluate the perioperative and long-term morbidity and mortality of above-knee amputations (AKA, n = 234) and below-knee amputations (BKA, n = 720) and to examine the effect of diabetes mellitus (DM) (181 of AKA and 606 of BKA patients). All patients in the database who had AKA or BKA from 1990 to May 2001 were included in the study. Perioperative 30-day cardiac morbidity and mortality and 3-yr and 10-yr mortality after AKA or BKA were assessed. The effect of DM on 30-day cardiac outcome was assessed by multivariate logistic regression and the effect on long-term survival was assessed by Cox regression analysis. The perioperative cardiac event rate (cardiac death or nonfatal myocardial infarction) was at least 6.8% after AKA and at most 3.6% after BKA. Median survival was significantly less after AKA (20 mo) than BKA (52 mo) (P < 0.001). DM was not a significant predictor of perioperative 30-day mortality (odds ratio, 0.76 [0.39-1.49]; P = 0.43) or 3-yr survival (Hazard ratio, 1.03 [0.86-1.24]; P = 0.72) but predicted 10-yr mortality (Hazard ratio, 1.34 [1.04-1.73]; P = 0.026). Significant predictors of the 30-day perioperative mortality were the site of amputation (odds ratio, 4.35 [2.56-7.14]; P < 0.001) and history of renal insufficiency (odds ratio, 2.15 [1.13-4.08]; P = 0.019). AKA should be triaged as a high-risk surgery while BKA is an intermediate-risk surgery. Long-term survival after AKA or BKA is poor, regardless of the presence of DM.     

Postoperative nausea and vomiting and opioid-induced nausea and vomiting: guidelines for prevention and treatment

Postoperative nausea and vomiting (PONV) causes patient discomfort, lowers patient satisfaction, and increases care requirements. Opioid-induced nausea and vomiting (OINV) may also occur if opioids are used to treat postoperative pain. These guidelines aim to provide recommendations for the prevention and treatment of both problems. A working group was established in accordance with the charter of the Sociedad Espa?ola de Anestesiología y Reanimación. The group undertook the critical appraisal of articles relevant to the management of PONV and OINV in adults and children early and late in the perioperative period. Discussions led to recommendations, summarized as follows: 1) Risk for PONV should be assessed in all patients undergoing surgery; 2 easy-to-use scales are useful for risk assessment: the Apfel scale for adults and the Eberhart scale for children. 2) Measures to reduce baseline risk should be used for adults at moderate or high risk and all children. 3) Pharmacologic prophylaxis with 1 drug is useful for patients at low risk (Apfel or Eberhart 1) who are to receive general anesthesia; patients with higher levels of risk should receive prophylaxis with 2 or more drugs and baseline risk should be reduced (multimodal approach). 4) Dexamethasone, droperidol, and ondansetron (or other setrons) have similar levels of efficacy; drug choice should be made based on individual patient factors. 5) The drug prescribed for treating PONV should preferably be different from the one used for prophylaxis; ondansetron is the most effective drug for treating PONV. 6) Risk for PONV should be assessed before discharge after outpatient surgery or on the ward for hospitalized patients; there is no evidence that late preventive strategies are effective. 7) The drug of choice for preventing OINV is droperidol.