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101.
Anterior lumbar fusion using a hybrid interbody graft 总被引:3,自引:0,他引:3
Summary This is a radiographic report of 40 patients (20 men, 20 women) who underwent anterior lumbar interbody fusions (73 levels)
utilizing a “hybrid” interbody graft composed of femoral cortical allograft (FCA) bone and iliac crest cancellous autograft
bone. The average age at surgery was 38 years (range 17–64 years), and follow-up averaged 1.4 years (range 1.0–2.4 years).
Nineteen of the patients had undergone previous lumbar surgery. Thirty-two patients (63 levels) underwent anterior fusion
combined with some type of posterior fixation, and eight patients (10 levels) had no posterior fixation. Types of posterior
fixation included: for 20 patients (36 levels) Steffee variable screw placement fixation, for 10 patients (23 levels) translaminar
facet screws (TFS), for 1 patient (3 levels) Knodt rods and for 1 patient (1 level) facet screws. Based on the persistence
of lucent lines at the graft-host interface, three patients (one level each) were felt to have non-unions at their latest
follow-ups at 1.4, 1.5 and 2.0 years, respectively. Two of these patients had no posterior fixation, and the other had TFS
fixation. The overall fusion rate was 96% (70 of 73 levels). The fusion rate for all levels treated with posterior fixation
was 98% compared with 75% for those without fixation. Intervertebral disc heights (IVDH) were measured on all films and corrected
for magnification with computer assistance. On average, the IVDH was increased postoperatively but returned to preoperative
values at follow-up. IVDH loss was independent of the type of instrumentation used. No complications arose from the use of
the hybrid graft. Incorporation of the allograft portion of the graft is slow and was felt to be complete in only 7 of the
73 levels at follow-up. We conclude that the hybrid interbody graft technique is a safe and reliable method for performing
anterior lumbar interbody fusions and should be combined with some type of posterior fixation. Long-term follow-up will be
required to assess the behaviour of the allograft until incorporation is complete. 相似文献
102.
Summary The delayed onset of symptomatic pain following lumbar discography (with no immediate pain response) is described in six patients,
five with a minimum 2-year follow-up. It is usually seen in patients with nearly normal disc morphology who have incomplete
or discrete annular tears that are not filled at the time of injection. Later (2–12 h in this study), dye leakage occurs through
these lesions, thereby precipitating the discogenic pain This phenomenon may be missed and is probably more common than previously
believed due to early discharge from the hospital, the patient expecting discomfort after the invasive study (hence no complaint
is made), and the clinician being unaware of this delayed symptom, thereby not asking about it in follow-up. Close patient
questioning regarding a delayed onset of symptomatic pain after discography is, therefore, an essential element in diagnostic
information following this study. 相似文献
103.
F. A. Calvo O. Abuchaibe I. Azinovic E. Tangco J. Aristu R. Martínez F. Pardo J. Alvarez-Cienfuegos J. M. Berián 《European radiology》1992,2(1):29-34
Thirty patients with malignant tumours in the upper abdomen underwent surgery and intraoperalive radiation (IORT), using electron beam, to: the surgical bed, residual or unresected tumour. The technical aspects and results of this treatment are described. Renal, adrenal, bile duct and gastrointestinal tumours were treated. along with several other lesions. The surgical procedure consisted in 10 cases simply of exposure of the tumour for IORT and in 20 the tumour was resected. The TORT dose ranged from 10 to: 20 Gv. In 13 patients, external beam radiation was also given to: residual tumour or to: areas of high risk for recurrence. Chemotherapy was given to: 10 patients. Tolerance to: the combined treatment was acceptable; with few complications related to: IORT.The median follow-up and survival time 23 months (range 4-more than 70 months). Local tumour control rate (or tumour stabilisation) is 90%. Distant metastases developed in 19 patients (63%). The actuarial survival rate for the group projected at 70 months (maximum follow-up) is 37%. IORT in useful in the management of tumours arising in the upper abdominal organs, for palliation surgery or when resectability of the tumour is in doubt. Indications for IORT include patients with uncommon tumours of the upper abdomen who are not be candidates for standardised cancer treatment.Presented at the European Congress of Radiology, Vienna, September 15–20,1991 相似文献
104.
Early experience with laparoscopic abdominoperineal resection 总被引:4,自引:0,他引:4
Background: Laparoscopic abdominoperineal resection (LAPR) has not been fully evaluated as a technique in the treatment of rectal and
anal cancer or inflammatory bowel disease. The purpose of our study was to evaluate the early experience with laparoscopic
abdominoperineal resection at Washington University Medical Center.
Methods: A prospective analysis was performed on the first 21 patients undergoing the procedure at Washington University Medical Center.
Indications for surgery included rectal cancer (14 patients), anal squamous cell cancer (four patients), inflammatory bowel
disease (two patients), and anal melanoma (one patient).
Results: The procedure was converted to open procedure in four patients (19%). The mean (±SEM) operative time and blood loss for completed
and converted LAPR were 239 ± 11 min and 424 ± 43 ml, respectively. Postoperative hematocrit dropped a mean of 8.3% ± 1.2%
SEM; five patients required blood transfusion (24%). Wound complication occurred in four patients (19%; three perineal, one
trocar site). Bowel function returned after a mean of 3 days, and mean postoperative hospital stay for the completed LAPR
group was 5 days. Mild pain was experienced by 81% of patients (17/21) while 19% (4/21) noted moderate pain, usually of the
perineal wound. The mean duration of patient-controlled analgesia use was 2 days. During the 1–44-month follow-up, six patients
(29%) died from cancer (stage III or IV at operation) and only one patient developed local recurrence in the pelvis (5%).
There were no trocar-site implants of cancer. Furthermore, there was no relationship between prior abdominal operations, the
amount of blood loss, postoperative drop of hematocrit, or blood transfusion requirement and the length of hospitalization
or complication rates.
Conclusion: Laparoscopic abdominoperineal resection is a feasible alternative to the conventional open technique in both cancer and colitis
patients.
Received: 23 April 1996/Accepted: 8 July 1996 相似文献
105.
Background: Increasingly larger series of laparoscopic fundoplications (LF) are being reported. A well-documented advantage of the laparoscopic
approach is shortened hospital stay. Most centers report typical lengths of stay (LOS) for LF of 2–3 days. Our success with
LF with a LOS of 1 day led to an attempt at performing LF on an ambulatory basis.
Methods: Sixty-one consecutive patients with appropriate criteria for LF underwent surgery at our institution. Patients were counseled
by the authors as to the usual postop course and progression of diet. All patients received preemptive analgesia (PEA) consisting
of perioperative ketorolac and preincisional local infiltration with bupivicaine. Anesthetic management included induction
with propofol, high-dose inhalational anesthetics, minimizing administration of parenteral narcotics, and avoidance of reversal
of neuromuscular blockade. Immediate postop pain management included parenteral ketorolac and oral hydro- or oxycodone. All
patients were given oral fluids and soft solids after transfer from the recovery room to the postoperative observation unit.
Two patients were excluded from ambulatory consideration due to excessive driving distance from our hospital. Another two
were hospitalized for observation after experiencing intraoperative technical problems.
Results: Of 57 patients in whom same-day discharge was attempted, there were three failures requiring overnight hospitalization: All
were due to pain and nausea; one patient also suffered transient urinary retention. There were no adverse outcomes related
to early discharge, and there were no readmissions. One patient returned to the emergency room after delayed development of
urinary retention. Median time from conclusion of operation to discharge was less than 5 h. No patients expressed dissatisfaction
with early discharge on follow-up interview.
Conclusions: LF can be safely performed as an ambulatory procedure. Analgesic and anesthetic management should be tailored to minimize
nausea and provide adequate pain control.
Received: 1 April 1996/Accepted: 29 May 1997 相似文献
106.
107.
Two cases are reported in which, after ACL reconstruction with autologous hamstring grafts, tibial polylactide interference
screws migrated into the knee joint. Clinically, both patients presented with recurrent locking of the joint. In one case,
a broken 15 mm-long tip of the screw was found intra-articularly. In the other case, the whole screw had migrated into the
joint cavity. The degradation process of polylactic acid, operative technique and bone quality are discussed as possible reasons
for these complications. 相似文献
108.
109.
The initial treatment of congenital idiopathic talipes equinovarus (clubfoot) is most often nonsurgical. However, surgical treatment in the form of posteromedial release is often undertaken after failure of conservative measures. The prevalence of both immediate and long-term complications in surgically treated clubfeet has cultivated a renewed interest in nonsurgical treatment. The Ponseti method for treating clubfoot has seen a revived interest among those caring for infantile clubfeet. We report on our first 34 infants (57 clubfeet) treated by using the techniques and principles described by Ponseti. Using a standard scoring system, 54 of 57 clubfeet were successfully corrected without requiring posteromedial release. Only 2 patients (3 clubfeet) required extensive surgical correction. There were 6 relapses. In all recurrent cases, there was a lack of compliance with the straight-last shoe and foot abduction bar regimen. Based on this level of initial success, we believe that posteromedial release is no longer necessary for the majority of cases of congenital clubfeet. 相似文献
110.