显微镜下颈前路经颈椎间隙减压的手术技巧

[摘要]目的探讨显微镜下经椎间隙颈前路减压技术,总结手术技巧。方法2000年6月至2005年12月间于显微镜下共行颈前路经椎间隙减压术271例,均为颈椎间盘突出患者,其中单间隙178例、双间隙71例、三间隙22例。所有患者影像显示脊髓前方压迫、压迫程度轻到中度及轻度髓内改变。主要设备为脊柱外科专用手术显微镜和高速磨钻。高速磨钻磨除纤维环和部分椎体后壁,显露清理变性髓核,钩形剥离子提起后纵韧带后切断,再切除残余的后纵韧带及椎体后缘骨赘。结果271例手术无脊髓、神经、血管损伤并发症。手术时间(62±12.4) min,失血 (126±29.4) ml,下地时间为术后(1.8±0.4) d。所有患者术后神经功能均有不同程度改善,功能改善率优69例,良157例,中27例,差18例。结论经椎间隙减压适用于椎间隙平面的病变,显微镜下精细操作及高速磨钻有利于手术成功,术后椎间隙结构更符合颈椎生物力学特性。     

经椎旁肌间隙入路治疗胸腰椎椎间孔哑铃形肿瘤

目的 探讨经椎旁肌间隙入路切除胸腰椎椎间孔哑铃形肿瘤的手术方法和效果。方法2003年1月至2009年6月共收集胸腰段哑铃形肿瘤患者32例：神经鞘瘤23例,神经纤维瘤6例,神经纤维瘤病3例。手术采用胸腰椎后路经椎旁肌间隙入路,术中分离多裂肌和最长肌间隙,切除关节突关节后,暴露椎间孔内外的肿瘤,完整切除肿瘤。必要时可经椎弓根螺钉内固定和脊柱植骨融合术重建脊柱稳定性。所有患者获得随访。结果 所有肿瘤均全切除,其中23例行内固定重建脊柱稳定性。神经功能均有改善。术后随访8个月至6年,平均32个月。无内固定松动、断裂,无脊柱后凸、侧凸等畸形。结论 以椎间孔及椎间孔外部分为主的腰椎椎间孔哑铃形肿瘤,可采用经椎旁肌间隙入路椎间孔切开切除,必要时用椎弓根螺钉固定、椎间植骨融合,重建脊柱稳定性。此方法具有肿瘤暴露好、术中出血少、术后可早期下床活动、兼顾脊柱稳定性等优点。     

大鼠异体肢体移植术后急性排斥反应阶段血管内皮细胞ICAM-1表达的动态变化

Objective To investigate the dynamic changes of intercellular adhesion molecule-1 (ICAM-1) expression in endothelial cells (EC) during hindlimb allograft acute rejection in rats and the inhibitory effect of cyclospofine A (CsA) on the acute rejection. Methods The rat model of hindlimb allograft was developed. The rats were randomly divided into following groups: control group (Wistar→Wistar), rejection group ( Sprague-Dawley→Wistar) and CsA-treated group (Sprague-Dawley→Wistar). At postoperative day 1, day 4 and day 7samples of the femoral artery from the allograft limb were harvested to observe the pathologic changes. ICAM-1 expression in EC was quantified using immunohistochemical assay. Results Slight swelling and weak ICAM-1expression of EC were observed in the control group. In the rejection groups, obvious EC swelling and massive lymphocyte infiltration were seen. ICAM-1 expression in EC was significantly stronger and elevated. In CsA-group only mild infiltration of lymphocytes was seen and ICAM-I expression in EC was also much weaker.Conclusion During rat hindlimb allograft acute rejection the expression of ICAM-1 in EC was closely related to the occurrence and development of acute rejection. CsA could reduce the expression of ICAM-1 in EC and hence inhibit acute rejection of composite allograft.     

颈椎术后并发急性精神障碍的原因分析及护理对策

手术后急性精神障碍是指在手术后数天内发生,在意识、认知、记忆、定向以及睡眠等方面的紊乱,是一种可逆的、具有波动性的急性精神紊乱综合征,通常又称术后认知障碍、术后谵妄等[1].它可导致康复延迟,并发症和病死率增加,以及住院时间延长和医疗费用增加,而且是术后其他严重并发症的早期症状[2].我院脊柱外科2005年1月-2007年3月共有125例患者在我科接受颈椎前路或者后路手术,其中手术后出现急性精神障碍患者9例,经药物治疗及心理护理后均获痊愈,为探讨颈椎术后并发精神障碍的因素及护理对策,现将患者资料分析如下.     

大鼠异体肢体移植术后急性排斥反应阶段血管内皮细胞ICAM-1表达的动态变化

Objective To investigate the dynamic changes of intercellular adhesion molecule-1 (ICAM-1) expression in endothelial cells (EC) during hindlimb allograft acute rejection in rats and the inhibitory effect of cyclospofine A (CsA) on the acute rejection. Methods The rat model of hindlimb allograft was developed. The rats were randomly divided into following groups: control group (Wistar→Wistar), rejection group ( Sprague-Dawley→Wistar) and CsA-treated group (Sprague-Dawley→Wistar). At postoperative day 1, day 4 and day 7samples of the femoral artery from the allograft limb were harvested to observe the pathologic changes. ICAM-1 expression in EC was quantified using immunohistochemical assay. Results Slight swelling and weak ICAM-1expression of EC were observed in the control group. In the rejection groups, obvious EC swelling and massive lymphocyte infiltration were seen. ICAM-1 expression in EC was significantly stronger and elevated. In CsA-group only mild infiltration of lymphocytes was seen and ICAM-I expression in EC was also much weaker.Conclusion During rat hindlimb allograft acute rejection the expression of ICAM-1 in EC was closely related to the occurrence and development of acute rejection. CsA could reduce the expression of ICAM-1 in EC and hence inhibit acute rejection of composite allograft.     

高乌甲素用于病人自控镇痛的效果观察

术后疼痛是围术期诸多重要问题之一,许多研究表明,病人自控镇痛(pa-tient-controlledanalgesia,PCA)不仅能够提供良好的镇痛效果,而且可减少术后有关并发症,有利于病人早期恢复犤1犦。本文以曲马多作为对照,评价高乌甲素应用于静脉病人自控镇痛(PCIA)的临床效果与安全性。现报道如下。1临床资料1.1一般资料:选择择期手术100例,ASAⅠ～Ⅱ;男48例,女52例;年龄18～76岁,平均49±8.4岁。其中双下肢骨折内固定术21例、甲状腺腺癌清扫术16例、乙状结肠、直肠手术28例、妇科手术6例、乳癌根治术27例、胆道手术2例。随机分成两组,Ⅰ组为高乌甲素…     

盐酸乙哌立松联合塞来昔布治疗颈肩腰背痛75例疗效分析

目的评价盐酸乙哌立松联合应用塞来昔布对常见颈肩腰背痛的临床疗效。方法收集150例门诊颈肩腰背痛患者,随机分成单用药组(单独口服塞来昔布)和联合用药组(盐酸乙哌立松联合塞来昔布),采用VAS方法进行疗效评价,并观察2组的不良反应。结果联合用药组的总有效率为84%,显著高于单用药组的65.33%(P<0.05);联合用药组对急慢性颈肩软组织劳损、肩关节周围炎和急慢性腰肌劳损引起疼痛的疗效优于单用药组,但对腰椎间盘突出症引起疼痛的疗效与单用药组相当。2组发生不良反应的患者均为1例(1.33%)。结论盐酸乙哌立松联合塞来昔布治疗颈肩腰背痛可获得较好的镇痛疗效,优于单纯应用塞来昔布胶囊。     

颈椎管内外哑铃型肿瘤围手术期的阶段性健康教育

颈椎管内外哑铃型肿瘤是指起源于颈椎神经鞘膜或神经纤维组织的肿瘤,易导致颈髓、神经根、血管的压迫或破坏,具有较高的致残率和死亡率。为使病人减少术后并发症,我院对2000年1月￣2006年2月收治的27例颈椎管内外哑铃型肿瘤患者进行阶段性健康教育和效果评价,取得了满意效果,现报道如下:     

颈椎前路选择性单间隙减压植骨融合治疗脊髓型颈椎病

目的探讨颈椎前路选择性单间隙减压植骨融合治疗跳跃性脊髓受压颈椎病的临床疗效。方法对18例脊髓型颈椎病患者行颈椎前路选择性减压植骨融合术,术后随访3~10个月。结果依据JOA评定标准,优14例,良2例,好转1例,无效1例,优良率89%,术后6个月植骨融合率达100%,术后无Soliscage松动及植骨不愈合现象。结论颈前路选择性Soliscage治疗脊髓型颈椎病创伤小,保留了颈椎运动节段的不必要损失,提高了植骨愈合率,减少了并发症。     

甲泼尼龙在脊柱围手术期中的预防性应用

目的探讨甲泼尼龙（MP）在脊髓减压手术围手术期的预防性应用价值及其与术后神经功能恢复之间的相关性。方法96例患者，包括脊髓型颈椎病40例，脊柱椎管内肿瘤27例，颈胸椎的韧带骨化29例。患者根据不同剂量和用法分为4组，A组：术前0．5h应用MP；B组：术中减压开始后应用MP；C组：患者回病房后开始应用MP；D组：术中、术后均未应用MP，使用常规甘露醇脱水。结果A、B组与D组相比，神经功能恢复有显著性差异；C组与D组比较无显著性差异。所有患者均未发生创口感染、肺部感染和应激性溃疡等并发症。结论术前和术中应用MP能明显提高脊髓型颈椎病、脊柱椎管内肿瘤和韧带骨化性疾病等脊髓减压手术患者术后神经功能的恢复率和手术的安全性。