Cobb角大于40°的青少年特发性脊柱侧凸患者的小脑扁桃体位置分析

目的探讨小脑扁桃体位置在临床诊治大弯度青少年特发性脊柱侧凸(adolescent idio-pathic scoliosis,AIS)中的意义。方法AIS患者203例,男27例,女176例;年龄平均(14.6±1.6)岁;Cobb角平均55.3°±16.6°。对照组86例,男、女各43例,年龄平均(15.7±1.8)岁,均未患有大脑、中脑、小脑、脊髓病变及脊柱侧凸、后凸和脊柱发育异常等。在MRI图像上测量AIS患者和对照组青少年的小脑扁桃体位置,分析二组之间的差异,以及年龄和性别对小脑扁桃体位置的影响。在AIS组内分析不同侧凸角度和侧凸类型患者的小脑扁桃体位置的差异。结果AIS患者的小脑扁桃体平均位置明显低于对照组(分别为枕骨大孔上0.9mm和2.9mm)。AIS患者中小脑扁桃体异位的发生率(34.5%)明显高于正常对照组(5.8%)。年龄、性别和Cobb角对小脑扁桃体位置均无显著的影响。在不同的侧凸类型中,双胸弯AIS患者小脑扁桃体异位的发生率(62.5%)最高。腰部侧凸的患者中小脑扁桃体异位发生率显著低于胸和胸腰部侧凸的患者。结论大弯度AIS患者的小脑扁桃体位置明显低于正常对照组,小脑扁桃体异位的发生率明显高于正常对照组。小脑扁桃体异位低于枕骨大孔2mm为异常,而在中国大陆此比例极低。AIS患者小脑扁桃体异位的发生可能与侧凸类型存在一定的关联。     

青少年特发性脊柱侧凸患者小脑扁桃体位置与异常体感诱发电位的相关性分析

目的 探讨青少年特发性脊柱侧凸(AIS)患者小脑扁桃体位置与异常体感诱发电位(SEP)的相关性,分析其在AIS临床诊治中的意义.方法 对171例AIS患者行MRI扫描和胫后神经SEP检查;并以45名年龄匹配的健康青少年的胫后神经SEP作为正常值参考对照.在MRI图像上测量AIS患者的小脑扁桃体位置.小脑扁桃体位置低于枕骨大孔前后缘骨皮质的最低点之间的连线定义为小脑扁桃体异位.SEP波形消失、峰潜伏期延长及峰潜伏期不对称定义为SEP异常的标准.分别计算AIS患者小脑扁桃体异位发生率及SEP异常率,并分析小脑扁桃体异位与SEP异常的相关性.分析小脑扁桃体异位与SEP异常对侧凸严重程度的影响.结果 171例AIS患者中小脑扁桃体异位者总共有63例(36.8%),SEP异常者共有62例(36.3%).根据不同侧凸严重程度分组分析,结果提示小脑扁桃体异位和SEP异常均与侧凸严重程度无关,小脑扁桃体异位与SEP异常无明显相关,P值均>0.05.结论 部分AIS患者存在小脑扁桃体异位或躯体感觉传导通路异常,两者之间并无相关性,可能与AIS的不同发病机制有关.     

特发性脊柱侧凸患者体感诱发电位研究

特发性脊柱侧凸存在多种解剖畸形,对心肺生理功能影响已有较多研究报告。为探讨脊柱侧凸对脊髓生理功能的影响,作者观察了Ｃｏｂｂ角６０°以上特发性脊柱侧凸患者体感诱发电位的变化。临床资料脊柱侧凸患者６８例,男３６例,女３２例,平均年龄１８６岁（１２～３６...     

青少年脊柱侧凸畸形患者超声心动图异常分析:特发性脊柱侧凸与先天性脊柱侧凸的比较

背景:脊柱畸形患者可合并有超声心动图(ultrasonic cardiography,UCG)结果异常,但文献中缺乏特发性脊柱侧凸(idiopathic scoliosis,IS)与先天性脊柱侧凸(congenital scoliosis,CS)患者UCG异常的比较.目的:比较青少年IS患者与CS患者UCG结果异常的发...     

Chiari畸形Ⅰ型患者小脑扁桃体下疝程度及脊髓空洞形态与后颅窝容积的相关性

目的:分析Chiari畸形Ⅰ型(Chiari malformation typeⅠ,CMⅠ)患者小脑扁桃体下疝程度及脊髓空洞形态与后颅窝线性容积的关系,探讨影响小脑扁桃体下疝程度的后颅窝解剖学因素。方法:2003年6月~2011年6月在我科接受治疗并符合入选标准的CMⅠ患者共59例,男34例,女25例,年龄16~20岁,平均17.9岁,Risser征5级,均有完整MRI资料(包括头枕部及全脊髓矢状面扫描图像);均无颅内占位性病变、颅骨破坏、后颅窝手术史或获得性Chiari畸形。均伴有不同形态的脊髓空洞,55例(93.2%)伴有不同程度的脊柱侧凸畸形。在MRI T1加权像正中矢状位扫描层面上评估患者的小脑扁桃体下疝程度和脊髓空洞类型;测量后颅窝斜坡长度、枕骨大孔前后径、枕骨鳞部长度、后颅窝矢状径、后颅窝高径和斜坡倾斜角。将CMⅠ患者按照小脑扁桃体下疝严重程度分为三度:Ⅰ度,小脑扁桃体下缘超过枕骨大孔水平5mm但没有到达C1后弓上缘;Ⅱ度,小脑扁桃体下缘尾向移位超过C1后弓上缘但未超过C1后弓下缘;Ⅲ度,小脑扁桃体下缘尾向移位超过C1后弓下缘。依据脊髓空洞类型分为膨胀型、念珠型、细长型和局限型四组。比较不同组间后颅窝线性容积的差异,并对相关指标进行相关性分析。结果:Ⅰ度扁桃体下疝CMⅠ患者的后颅窝斜坡长度明显大于Ⅱ、Ⅲ度扁桃体下疝CMⅠ患者(P<0.05),Ⅲ度扁桃体下疝患者的斜坡倾斜角较Ⅰ、Ⅱ度患者明显减小(P<0.05),其余指标三组间无显著性差异;CMⅠ患者的斜坡倾斜角与小脑扁桃体下疝程度之间存在显著性负相关关系(r=-0.626,P=0.005)。膨胀型脊髓空洞患者的斜坡倾斜角显著小于其他类型的脊髓空洞患者(P<0.05),其余指标各类型之间无显著性差异。结论:后颅窝斜坡短平可能是促使CMⅠ患者小脑扁桃体下疝加重的重要因素之一,同时对CMⅠ患者的脊髓空洞的形成和发展也存在影响。     

青少年特发性脊柱侧凸患者骨密度的研究进展

青少年特发性脊柱侧凸(adolescent idiopathic scol-iosis,AIS)是发生于青春发育期前后的脊柱结构性侧凸畸形,是一种最常见的脊柱侧凸畸形,     

青少年特发性脊柱侧凸患者骨密度变化的分析

目的 :探 讨青 少年 特 发性 脊柱 侧 凸患 者的 骨 密度 变化 规 律。方 法:应用 双 能 X 线骨 密 度吸 收仪 测 定 101例特 发 性 脊 柱侧 凸 患 者 腰椎 (L2￣L4)和 股 骨 近 端 (股 骨 颈 、大 转 子 、W ard's 三 角 )的 骨 密 度 ,结 合 脊 柱 侧 凸 严 重程度 进行 分 析,并 与 62名 同 年龄 段正 常 青少 年骨 密 度进 行比 较 。结 果:特发 性脊 柱 侧凸 患者 所 测各 部位 的 骨密度均 明显 低 于正 常对 照 组(P<0.05),腰 椎 骨 密 度的 降 低 比 股骨 明 显 ,股 骨 近 端 的三 个 部 位 ,以 W ard's 三 角的 骨密度 降低 尤 为显 著。有 75.2% 的 特发 性脊 柱 侧凸 患者 发生 骨 密度 降低 ,其 中 26.7% 发 生骨 量 减少 , 48.5% 符 合骨质疏 松症 的 诊断 标准 ;但 其骨 密 度的 降低 程 度与 侧凸 严 重程 度无 明 显相 关性 。 结论 :青 少年 特 发性 脊 柱 侧凸 患者存 在着 骨 密度 的降 低 ,其与 侧 凸的 严重 程 度无 关,可能 与 特发 性脊 柱 侧凸 的发 病 机理 有关 。     

特发性脊柱侧凸矫形前后椎管长度的观察

目的:探讨特发性脊柱侧凸矫形前后椎管长度的改变与侧凸类型、矫形手段、严重程度等因素的相关性。研究对象与方法:回顾各型脊柱侧凸(共32例)术前及术后X线片,以T_1～S_1椎体的质心连线代表椎管长度,进行测量与比较。结果:术后椎管获得延长的侧凸及手术类型从多到少排列依次有:KingⅢ型(Cobb角>90°)前路松解联合后路矫形内固定;King Ⅱ型(Cobb角45～90°)后路矫形;KingⅢ型(Cobb角45～90°)后路矫形;KingⅣ型侧凸后路矫形内固定。术后椎管缩短的侧凸及手术类型有:King Ⅰ型侧凸、KingⅤ型侧凸及胸腰椎双侧凸经后路矫形,胸腰段侧凸前路矫形。结论:并非所有类型的侧凸在矫形术中均可出现椎管的延长。而采用何种矫形方式可能是矫形后椎管是否发生延长的关键。     

先天性脊柱侧凸与特发性脊柱侧凸伴发心脏异常对比：438例回顾性分析

目的：对比分析先天性脊柱侧凸（CS）与特发性脊柱侧凸（IS）伴发心脏异常情况。方法：回顾分析2018年1月至2021年1月收治的CS与IS患者的超声心动图及心电图结果。结果：研究共纳入438例患者,CS组164例,IS组274例。CS组伴动脉型肺动脉高压、右房增大及电轴右偏比例高于IS组,CS组平均肺动脉内径大于IS组（P<0.05）。动脉型肺动脉高压在主胸弯患者中的比例高于主腰弯患者;在早发性脊柱侧凸（EOS）中的比例高于非EOS。IS组瓣膜病发病率（28.8%∶20.1%,P=0.043）、二尖瓣对合异常发生率（9.1%∶4.3%,P=0.047）均高于CS组。CS、IS患者先天性心血管病发病率分别为11.0%和6.9%,差异无统计学意义（P=0.141）。结论：IS患者与CS患者先天性心血管病发病率相当。IS患者的瓣膜病发病率高于CS患者。CS患者的动脉型肺动脉高压及其继发的右心改变高于IS患者,且与主胸弯及EOS正相关。     

青少年特发性脊柱侧凸患者脊柱柔韧性的影响因素

目的:探讨青少年特发性脊柱侧凸(adolescent idiopathic scoliosis,AIS)患者脊柱柔韧性的可能影响因素.方法:选取2006年12月～2008年4月在我院脊柱外科手术治疗的204例AIS患者,男性36例,女性168例,平均年龄15.0岁;平均Cobb角50.1°;平均Risser征3.4度;主弯跨度平均6.8个椎体;主弯顶椎旋转度平均2.0度.摄站立位全脊柱正侧位及仰卧左右侧屈位X线片,计算主弯柔韧性.采用相关分析研究各临床指标与主弯柔韧性的相关性.结果:女性AIS患者的脊柱柔韧性明显高于男性(P<0.05);胸腰弯组和腰弯组AIS患者的脊柱柔韧性显著大于胸弯组(P<0.05),胸腰弯和腰弯组之间无显著性差异(P>0.05).女性AIS患者中的年龄及主弯Cobb角(站立位与侧屈位)均与脊柱柔韧性显著负相关(P<0.05),且胸弯女性AIS患者的月经初潮至手术时间及顶椎旋转度也与脊柱柔韧性显著负相关(P<0.05).男性胸弯AIS患者中侧屈位主弯Cobb角、胸腰弯/腰弯组中主弯Cobb角(站立位与侧屈位)均与脊柱柔韧性显著负相关(P<0.05).主弯跨度及Risser征与脊柱柔韧性均无明显相关性(P>0.05).结论:女性AIS患者脊住柔韧性受年龄、月经初潮至手术时间、主弯Cobb角(站立位与侧屈位)、弯型及顶椎旋转度等因素影响;男性AIS患者的脊柱侧凸柔韧性主要受主弯Cobb角及弯型影响.     

后路一期半椎体切除治疗脊柱上胸段侧后凸畸形

目的:观察后路一期半椎体切除、内固定植骨融合治疗上胸段侧后凸畸形的临床效果。方法 :2005年12月～2010年2月我院共收治半椎体所致脊柱上胸段侧后凸畸形患者8例,男4例,女4例;年龄11～15岁,平均13岁。3例患者合并神经系统症状。均行后路一期半椎体切除内固定植骨融合术,术前、术后和随访时拍摄站立位脊柱正侧位X线片,测量冠状面与矢状面局部后凸Cobb角;记录围手术期并发症;通过JOA评分评价术前、术后1周及末次随访时神经系统症状的改善情况。结果:全部病例随访6～50个月,平均22.8个月。手术时间150～420min,平均278min。术中出血量500～3500ml,平均1787ml。固定融合节段4～11节,平均8.5节。冠状面局部侧凸Cobb角由术前平均45.5°矫正至术后1周的14.4°;矢状面局部后凸Cobb角由术前平均47.9°矫正至术后1周的21.6°;3例合并神经系统损伤患者平均JOA评分由术前5分提高到末次随访时的8分。1例连接器固定患者术后10个月随访时发现细棒断裂,翻修后随访24个月效果良好。结论:对于先天性脊柱上胸段畸形,后路一期半椎体切除、内固定植骨融合术可取得良好的治疗效果。     

Comparison of anterior and posterior double-rod instrumentation for thoracic idiopathic scoliosis: results of 141 patients

Ventral derotation spondylodesis, according to Zielke, achieves good results in operative treatment of idiopathic thoracic scolioses. Corrections of scoliotic major and secondary curve as well as derotation of the spine are reliably performed. The high rate of rod fractures with subsequent correction loss as well as a proportionate kyphogenic effect represents a problem. By keeping to the correcting principle, anterior double-rod instrumentation (Halm-Zielke Instrumentation) is to be stable in a similar way as posterior double-rod systems. Thus, it is done to facilitate brace-free postoperative care and to prevent excessive kyphotic pattern of the spine. In this prospective study, we retrospectively collected data. We performed radiological follow-up of two groups of patients with idiopathic thoracic scoliosis (King II, III and IV) undergoing an operation with posterior approach (USS instrumentation, posterior group, n=104) in 1997 and 1998 or being corrected with an anterior fusion (Halm-Zielke instrumentation, anterior group, n=37) between 2000 and 2001. Mean age of all patients for operation was 15±4 years. Follow-up was performed after 4±2 years on average. Preoperative measurements of the major and secondary curve, the lateral profile, rotation and frontal balance (C7 to S1) did not show any significant differences apart from a more severe scoliotic curve in the lumbar spine for the anterior group with appropriately higher lumbar rotation. During follow-up we noticed similar corrections of the thoracic major and lumbar curve in both groups ranging from 49 to 56%. In case of hypokyphotic (T4–T12≤20°) scoliosis a kyphogenic effect on the thoracic spine was achieved with both surgical methods. Hyperkyphotic (T4–T12≥40°) scolioses were flattened by posterior spinal fusion; the effect of anterior spinal fusion was not significant. Correction of thoracic and lumbar rotation in the anterior group by 37 or 30% was more significant than in the posterior group by 27 or 20%. There was no impact of anterior technique on the balance of the spine whereas the latter shifted by an average of 7 mm to the left in the posterior group. The number of fused segments was significantly smaller in the anterior group with 7±1 vertebral bodies (posterior, 11±1 vertebral bodies). Rates of complication were identical with 11 or 12% in both groups during follow-up. Anterior and posterior double-rod instrumentations result in comparable corrections for idiopathic thoracic scoliosis of the major and secondary curve. In case of posterior technique, however, four vertebral bodies less were integrated in spondylodesis on average. Balance of the spine did not change after anterior spondylodesis; however, it declined by using the posterior technique. Augmentation of the anterior threaded rod combined with a solid second rod significantly decreases the rate of implant breakages and reliably reduces consecutive correction losses.     

Combined anterior and posterior instrumentation in severe and rigid idiopathic scoliosis

A prospective clinical and radiographic evaluation of 33 consecutive patients with severe and rigid idiopathic scoliosis (average Cobb angle 93°, flexibility on bending films 23%) were treated with combined anterior and posterior instrumentation with a minimum follow-up of 2 years. All patients underwent anterior release and VDS-Zielke Instrumentation of the primary curve. In highly rigid scoliosis, this was preceded by a posterior release. Finally, posterior correction and fusion with a multiple hook and pedicle screw construct was performed. Thirty patients were operated in one stage, three patients in two stages. Preoperative curves ranged from 80 to 122° Cobb angle. Frontal plane correction of the primary curve averaged 67% with an average loss of correction of 2°. The apical vertebral rotation of the primary curve was corrected by 49%. In all but three patients, sagittal alignment was restored. There were no neurological complications, deep wound infections or pseudarthrosis. Combined anterior and posterior instrumentation is safe and enables an effective three-dimensional curve correction in severe and rigid idiopathic scoliosis.     

Unusual presentation of osteoblastoma in a patient with idiopathic scoliosis after posterior spinal fusion

BACKGROUND CONTEXT: Few studies have described the diagnosis of osteoblastoma of the spine as a cause of scoliosis. These reports have described the tumor in conjunction with initial presentation of painful scoliosis. This case report presents a case of osteoblastoma 9 years removed from diagnosis and fusion of idiopathic scoliosis in the thoracic spine. PURPOSE: To report the late presentation of an osteoblastoma of the thoracic spine 9 years after posterior spinal fusion for scoliosis. STUDY DESIGN: Case report. METHODS: A 25-year-old man presented with thoracolumbar back pain and progressive neurological deficit 9 years after posterior spinal fusion for idiopathic scoliosis. Magnetic resonance imaging of the thoracic spine indicated the presence of a mass in the spinal canal causing cord compression. The patient underwent decompression with resection of the mass which was found to be an aggressive osteoblastoma. RESULTS: The patient enjoyed a full neurological recovery and has subsequently developed a recurrence at 13 months. CONCLUSIONS: We present osteoblastoma as a possible cause of low back pain and neurological deficit postfusion that should be considered in a differential diagnosis.     

Gait analysis in patients with idiopathic scoliosis

Introduction The goal of this study was to observe scoliotic subjects during level walking to identify asymmetries—which may be related to a neurological dysfunction or the spinal deformity itself—and to correlate these to the severity of the scoliotic curve.Methods We assessed the gait pattern of ten females (median age 14.4) with idiopathic scoliosis characterised by a left-lumbar and a right-thoracic curve component. Gait analysis consisted of 3D kinematic (VICON) and kinetic (Kistler force plates) measurements. The 3D-segment positions of the head, trunk and pelvis, as well as the individual joint angles of the upper and lower extremities, were computed during walking and static standing. Calculation of pertinent kinetic and kinematic parameters allowed statistical comparison.Results All subjects walked at a normal velocity (median: 1.22 m/s; range:1.08–1.30 m/s; height-adjusted velocity: 0.75 m/s; range: 0.62–0.88 m/s). The timing of the individual gait phases was normal and symmetrical for the whole group. Sagittal plane hip, knee and ankle motion followed a physiological pattern. Significant asymmetry was observed in the trunks rotational behaviour in the transverse plane. During gait, the pelvis and the head rotated symmetrically to the line of progression, whereas trunk rotation was asymmetric, with increased relative forward rotation of the right upper body in relation to the pelvis. This produced a torsional offset to the line of progression. Minimal torsion (at right heel strike) measured: median 1.0° (range: 5.1°–8.3°), and maximal torsion (at left heel strike) measured 11.4° (range 6.9°–17.9°). The magnitude of the torsional offset during gait correlated to the severity of the thoracic deformity and to the standing posture, whereas the range of the rotational movement was not affected by the severity of the deformity. The ground reaction forces revealed a significant asymmetry of [Msz], the free rotational moment around the vertical axis going through the point of equivalent force application. On the right side, the initial endo-rotational moment was lower, followed by a higher exo-rotational moment than on the left. All the other force parameters (vertical, medio–lateral, anterior–posterior), did not show a significant side difference for the whole group. The use of a brace stiffened torsional motion. However the torsional offset and the asymmetry of the free rotational moment remained unchanged.Conclusion The most significant and marked asymmetry was seen in the transverse plane, denoted as a torsional offset of the upper trunk in relation to the symmetrically rotating pelvis. This motion pattern was reflected by a ground-reaction-force asymmetry of the free rotational moment. Further studies are needed to investigate whether this behaviour is solely an expression of the structural deformity or whether it could enhance the progression of the torsional deformity.No financial assistance was provided for this work     

Risk factor analysis of proximal junctional kyphosis after posterior fusion in patients with idiopathic scoliosis

Study design

A retrospective analysis of 150 adolescents who underwent spinal fusion for idiopathic scoliosis.

Objective

To analyse the incidence of the postoperative proximal junctional kyphosis after posterior fusion to the upper thoracic vertebra in adolescents with idiopathic scoliosis and to explore its risk factors.

Summary of background data

The reported incidence of the proximal junctional kyphosis after the posterior fusion in patients with idiopathic scoliosis varies depending on surgical methods and strategies adopted by the institution.

Methods

The changes in the Cobb angle of the proximal junctional kyphosis on the lateral spine X-ray were measured and the presence of PJK was recorded. The risk factors were screened using statistical analysis.

Results

PJK occurred in 35 out of 123 patients with an overall incidence of 28%. Among them, 28 patients (80%) experienced PJK within 1.5 years after surgery. The PJK-inducing factors included greater than 10° intraoperative decrease in thoracic kyphosis, thoracoplasty, the use of a pedicle screw at the top vertebra, autogenous bone graft and fusion to the lower lumbar vertebra (below L2).

Conclusions

There is a high incidence of postoperative proximal junctional kyphosis after posterior fusion to the upper thoracic vertebra within 1.5 years after surgery in adolescents with idiopathic scoliosis. In order to reduce its incidence, the risk factors for PJK should be carefully evaluated before surgery.     

前路胸腔镜下松解联合后路矫形对特发性脊柱侧凸患者肺功能早期影响的研究

目的研究前路胸腔镜下脊柱松解联合后路矫形术对特发性脊柱侧凸(idiopathic scoliosis,IS)患者肺功能早期影响。方法对2004年4月-2008年6月行前路胸腔镜下松解联合后路矫形手术治疗的21例IS患者肺功能进行评估。男9例,女12例;年龄12～24岁,平均15.6岁。左侧凸2例,右侧凸19例。Lenke分型:Ⅰ型12例,Ⅱ型9例。发现脊柱侧凸1年6个月～9年,平均2.5年。胸椎冠状面Cobb角为65～125°,平均为79.6°。于术前及术后6个月行肺功能检测,包括肺容量、通气功能、胸廓顺应性三部分。结果前路胸腔镜下松解术中胸腔开放时间为90～150 min,平均127 min。术后切口均Ⅰ期愈合,无胸腔内感染发生。后路矫形术完成后1周患者冠状面Cobb角为36～75°,平均43.7°。术后患者均获随访,随访时间6～36个月,平均13.5个月。术后6个月时,患者肺活量及最大通气量均较术前显著提高(P<0.05),但实测值占预计值的百分比较术前无明显变化(P>0.05);功能残气量较术前下降(P<0.05);残气量实测值及与预计值的百分比均较术前下降(P<0.05)。第1秒用力呼气肺活量及其与用力呼气肺活量比值与术前比较无明显改善(P>0.05),最大自主通气量较术前显著上升(P<0.05)。患者总气道阻力、吸入气道阻力及呼出气道阻力均较术前显著下降(P<0.05)。结论前路胸腔镜下脊柱松解联合后路矫形术对IS患者胸腔有一定干扰,但矫形后随着胸腔形态变化和软组织松解,术后早期患者肺容量、通气功能、胸廓顺应性均得到不同程度改善,肺储备能力提高,但远期肺功能情况仍需进一步观察。     

特发性脊柱侧凸后路矫形术后两种引流方式的对比观察

【摘要】 目的：观察特发性脊柱侧凸患者后路矫形术后皮下引流与肌层下引流情况,比较两种引流方式的效果。方法：2005年2月~2007年9月在我院行后路脊柱侧凸矫形同种异体骨植骨融合内固定术患者89例,其中放置皮下引流组（A组）42例,放置肌层下引流组（B组）47例。收集两组患者围手术期数据,包括人口统计学资料（年龄、性别、身高、体重及身体质量指数）、术前侧凸分型与主弯Cobb角、术中资料（手术时间、估计失血量、自体血回输量、输异体红细胞悬液及术中融合节段）、术后切口引流量、术后输血量、术后发热时间与72h体温峰值、术后置管时间及出院时切口愈合等级,对所得数据进行统计学分析。结果：两组患者人口统计学资料、术前主弯Cobb角、主要侧凸类型比例和术中资料差异均无统计学意义（P>0.05）。术后A组平均引流量为26.67±26.61ml（0~90ml）,平均输血量为红细胞悬液0.76±1.34U（0~5U）,平均发热天数为2.14±1.39d（0~6d）,72h体温峰值为37.95±0.53℃（37.3~39.3℃）,平均置管时间为1.86±0.36d（1~2d）;术后B组平均引流量为1343.13±555.41ml（700~2350ml）,平均输血量为红细胞悬液2.44±2.00U（0~5.5U）,平均发热天数为1.75±1.24d（0~4d）,72h体温峰值为37.82±0.44℃（37.3~38.7℃）,平均置管时间为5.13±1.20d（3~7d）。两组术后切口引流量、置管时间及术后输血量差异均有统计学意义（P<0.05）,但两组术后发热天数、72h体温峰值及切口愈合等级差异均无统计学意义（P>0.05）,且均未出现切口感染。结论：特发性脊柱侧凸后路矫形术后放置皮下引流与肌层下引流相比,前者能够减少术后切口引流量、置管时间及术后输血量,同时未增加切口感染率,是一种较为安全的方法,具有一定的临床应用价值。     

The position of the patient during neurosurgical procedures on the posterior fossa

Summary Different parameters were measured on patients in six different positions during infratentorial surgery. One group of data served to prove that such patients were in a steady-state as far as their cardiovascular and ventilatory function was concerned. The other measured parameters concerned the intracranial pressure, the intracranial venous pressure and the cerebral perfusion pressure. It appeared from the comparison of these data, that the lateral sitting (45°) position had important advantages and that in this position the possibility of unfavourable features (such as air-embolism) was minimized.