In accordance with the trans-lamina cribrosa pressure difference theory, decreasing the trans-lamina cribrosa pressure difference can re- lieve glaucomatous optic neuropathy. Increased intracranial pressure can also r...In accordance with the trans-lamina cribrosa pressure difference theory, decreasing the trans-lamina cribrosa pressure difference can re- lieve glaucomatous optic neuropathy. Increased intracranial pressure can also reduce optic nerve damage in glaucoma patients, and a safe, effective and noninvasive way to achieve this is by increasing the intra-abdominal pressure. The purpose of this study was to observe the changes in orbital subarachnoid space width and intraocular pressure at elevated intra-abdominal pressure. An inflatable abdominal belt was tied to each of 15 healthy volunteers, aged 22-30 years （12 females and 3 males）, at the navel level, without applying pressure to the abdomen, before they laid in the magnetic resonance imaging machine. The baseline orbital subarachnoid space width around the optic nerve was measured by magnetic resonance imaging at 1, 3, 9, and 15 mm behind the globe. The abdominal belt was inflated to increase the pressure to 40 mmHg （1 mmHg = 0.133 kPa）, then the orbital subarachnoid space width was measured every 10 minutes for 2 hours. After removal of the pressure, the measurement was repeated 10 and 20 minutes later. In a separate trial, the intraocular pressure was measured for all the subjects at the same time points, before, during and after elevated intra-abdominal pressure. Results showed that the baseline mean orbital subarachnoid space width was 0.88 ＋ 0.1 mm （range： 0.77-1.05 mm）, 0.77 ＋ 0.11 mm （range： 0.60-0.94 mm）, 0.70 ＋ 0.08 mm （range： 0.62-0.80 ram）, and 0.68 _＋ 0.08 mm （range： 0.57-0.77 mm） at 1, 3, 9, and 15 mm behind the globe, respectively. During the elevated intra-abdominal pressure, the orbital subarachnoid space width increased from the baseline and dilation of the optic nerve sheath was significant at 1, 3 and 9 mm behind the globe. After decompression of the abdominal pressure, the orbital subarachnoid space width normalized and returned to the baseline value. There was no significant difference in the intraocular pressure before, during and after the intra-abdominal pressure elevation. These results verified that the increased intra-abdominal pressure widens the orbital subarachnoid space in this acute trial, but does not alter the intraocular pressure, indicating that intraocular pressure is not affected by rapid increased in- tra-abdominal pressure. This study was registered in the Chinese Clinical Trial Registry （registration number： ChiCTR-ONRC-14004947）.展开更多
目的 :探讨后路通道下椎管减压联合经皮椎弓根螺钉固定(微创组)与开放式椎管减压椎弓根螺钉固定(开放组)治疗伴神经损伤的胸腰椎骨折的疗效。方法:纳入2013年1月~2016年3月行手术治疗的伴神经损伤的胸腰椎骨折患者共66例,微创组31例,男2...目的 :探讨后路通道下椎管减压联合经皮椎弓根螺钉固定(微创组)与开放式椎管减压椎弓根螺钉固定(开放组)治疗伴神经损伤的胸腰椎骨折的疗效。方法:纳入2013年1月~2016年3月行手术治疗的伴神经损伤的胸腰椎骨折患者共66例,微创组31例,男23例,女8例;开放组35例,男25例,女10例。整理分析两组病例基础临床资料(年龄、性别比、受伤机制、伤椎分布、Denis分型、ASIA分级及术前VAS评分)、术后及各阶段随访的影像学参数(伤椎椎管通畅率、伤椎前缘高度百分比、Cobb角)。结果:两组间基础临床资料比较无显著性差异(P>0.05)。两组神经损伤恢复良好,无严重手术相关并发症。微创组随访26.58±5.98(14~38)个月,开放组为27.09±6.73(16~44)个月(P>0.05)。两组手术时间、植骨量无统计学差异(P>0.05);但术中出血(359.68±159.22ml vs 514.86±246.09ml)、自体血回输(7 vs 17例)、止痛药使用(12 vs 23例)、住院时间(9.48±2.72d vs 11.51±3.27d)及术后1周VAS评分(3.77±1.28 vs 4.97±1.44分)微创组均优于开放组,差异有统计学意义(P<0.05)。两组术后1周、术后3个月、末次随访时椎管通畅率、伤椎椎体前缘高度百分比、矢状面Cobb角分别较术前改善,差异有显著性(P<0.05);但术前、术后1周、术后3个月、末次随访时椎管通畅率、伤椎椎体前缘高度百分比、矢状面Cobb角两组间比较均无显著性差异(P>0.05)。结论:针对严重椎管狭窄伴神经损伤的胸腰椎骨折病例,微创置钉联合小切口入路椎板减压植骨内固定术与传统开放术式均取得了良好的疗效。微创术式在减少手术创伤、出血量、住院时间等方面更具优势。展开更多
目的探讨微创小切口下开窗减压联合经皮椎弓根螺钉内固定术对胸腰椎骨折合并神经损伤患者的疗效.方法选取胸腰椎爆裂性骨折患者72例,根据手术方式分为微创组34例、开放组38例.记录围术期指标;分别于术前、术后行影像学检查,记录伤椎椎...目的探讨微创小切口下开窗减压联合经皮椎弓根螺钉内固定术对胸腰椎骨折合并神经损伤患者的疗效.方法选取胸腰椎爆裂性骨折患者72例,根据手术方式分为微创组34例、开放组38例.记录围术期指标;分别于术前、术后行影像学检查,记录伤椎椎管通畅率、伤椎前缘高度、矢状面Cobb角;分别于术前和末次随访时进行ASIA神经功能分级;观察术后并发症发生情况.结果微创组住院时间明显短于开放组,术中出血量、术中自体血回输率、术后引流量明显低于开放组,差异具有统计学意义(P<0.05).两组患者术后7 d VAS评分较术前均明显降低,且微创组明显低于开放组,差异具有统计学意义(P<0.01).两组患者术后7 d、术后6个月、末次随访时的椎管通畅率、伤椎前缘高度、矢状面Cobb角度均较术前明显改善,差异具有统计学意义(P<0.05);但各时间点椎管通畅率、伤椎前缘高度、矢状面Cobb角度在两组间差异无统计学意义(P>0.05).末次随访时神经功能恢复水平在两组间差异无统计学意义(P>0.05).两组术后均无并发症发生.结论两种手术对胸腰椎骨折合并神经损伤患者均有较好疗效,微创手术可降低患者术中出血量和术后疼痛感,缩短住院时间.展开更多
目的探讨经钩椎关节及前椎板间隙入路松解交锁关节突联合颈椎前路植骨融合内固定治疗交锁性下颈椎骨折脱位的临床疗效。方法回顾分析2013年1月—2015年6月收治的12例交锁性下颈椎骨折脱位患者临床资料。男7例,女5例;年龄25~59岁,平均38....目的探讨经钩椎关节及前椎板间隙入路松解交锁关节突联合颈椎前路植骨融合内固定治疗交锁性下颈椎骨折脱位的临床疗效。方法回顾分析2013年1月—2015年6月收治的12例交锁性下颈椎骨折脱位患者临床资料。男7例,女5例;年龄25~59岁,平均38.4岁。病程9.6 h~100 d,平均7.3 d。单侧交锁8例,双侧交锁4例;陈旧性4例,新鲜8例。损伤节段:C_(3、4)2例,C_(4、5)5例,C_(5、6)3例,C_(6、7)2例。滑脱程度Meyerding分度为Ⅰ度9例,Ⅱ度3例。神经功能按美国脊髓损伤协会(ASIA)分级:C级2例,D级6例,E级4例。采用经钩椎关节及前椎板间隙入路松解交锁关节突联合颈椎前路植骨融合内固定治疗。手术前后采用ASIA分级评价神经功能,疼痛视觉模拟评分(VAS)、改良日本骨科协会评分、颈椎功能障碍指数(NDI)评分评价临床疗效,摄X线片测量融合节段前凸Cobb角;术后6个月评价椎间植骨融合情况。结果手术时间平均78.30 min,术中出血量平均167.30 m L,术后引流量平均58.12 m L。术中、术后未予以输血处理。术中无大血管、食管、气管意外损伤;术后无喉头水肿、吞咽困难、声音嘶哑、脑脊液漏发生;无脊髓损伤、神经根损伤加重发生;切口Ⅰ期愈合,无感染发生。12例均获随访,随访时间15~20个月,平均16.5个月。术后患者神经损伤症状及功能均较术前明显改善,术后6个月复查颈椎X线片示,Cage或植骨块无移位、断裂,螺钉无松动、脱离,椎间植骨融合率达100%。末次随访时ASIA分级、融合节段前凸Cobb角、颈痛VAS评分、改良JOA评分及NDI评分均较术前明显改善(P<0.05)。结论经钩椎关节及前椎板间隙入路松解交锁关节突联合颈椎前路植骨融合内固定治疗交锁性下颈椎骨折脱位临床疗效明确,使损伤节段获得满意复位、即刻稳定和重建、充分减压,可有效防止脊髓二次损伤。展开更多
文摘In accordance with the trans-lamina cribrosa pressure difference theory, decreasing the trans-lamina cribrosa pressure difference can re- lieve glaucomatous optic neuropathy. Increased intracranial pressure can also reduce optic nerve damage in glaucoma patients, and a safe, effective and noninvasive way to achieve this is by increasing the intra-abdominal pressure. The purpose of this study was to observe the changes in orbital subarachnoid space width and intraocular pressure at elevated intra-abdominal pressure. An inflatable abdominal belt was tied to each of 15 healthy volunteers, aged 22-30 years （12 females and 3 males）, at the navel level, without applying pressure to the abdomen, before they laid in the magnetic resonance imaging machine. The baseline orbital subarachnoid space width around the optic nerve was measured by magnetic resonance imaging at 1, 3, 9, and 15 mm behind the globe. The abdominal belt was inflated to increase the pressure to 40 mmHg （1 mmHg = 0.133 kPa）, then the orbital subarachnoid space width was measured every 10 minutes for 2 hours. After removal of the pressure, the measurement was repeated 10 and 20 minutes later. In a separate trial, the intraocular pressure was measured for all the subjects at the same time points, before, during and after elevated intra-abdominal pressure. Results showed that the baseline mean orbital subarachnoid space width was 0.88 ＋ 0.1 mm （range： 0.77-1.05 mm）, 0.77 ＋ 0.11 mm （range： 0.60-0.94 mm）, 0.70 ＋ 0.08 mm （range： 0.62-0.80 ram）, and 0.68 _＋ 0.08 mm （range： 0.57-0.77 mm） at 1, 3, 9, and 15 mm behind the globe, respectively. During the elevated intra-abdominal pressure, the orbital subarachnoid space width increased from the baseline and dilation of the optic nerve sheath was significant at 1, 3 and 9 mm behind the globe. After decompression of the abdominal pressure, the orbital subarachnoid space width normalized and returned to the baseline value. There was no significant difference in the intraocular pressure before, during and after the intra-abdominal pressure elevation. These results verified that the increased intra-abdominal pressure widens the orbital subarachnoid space in this acute trial, but does not alter the intraocular pressure, indicating that intraocular pressure is not affected by rapid increased in- tra-abdominal pressure. This study was registered in the Chinese Clinical Trial Registry （registration number： ChiCTR-ONRC-14004947）.
文摘目的 :探讨后路通道下椎管减压联合经皮椎弓根螺钉固定(微创组)与开放式椎管减压椎弓根螺钉固定(开放组)治疗伴神经损伤的胸腰椎骨折的疗效。方法:纳入2013年1月~2016年3月行手术治疗的伴神经损伤的胸腰椎骨折患者共66例,微创组31例,男23例,女8例;开放组35例,男25例,女10例。整理分析两组病例基础临床资料(年龄、性别比、受伤机制、伤椎分布、Denis分型、ASIA分级及术前VAS评分)、术后及各阶段随访的影像学参数(伤椎椎管通畅率、伤椎前缘高度百分比、Cobb角)。结果:两组间基础临床资料比较无显著性差异(P>0.05)。两组神经损伤恢复良好,无严重手术相关并发症。微创组随访26.58±5.98(14~38)个月,开放组为27.09±6.73(16~44)个月(P>0.05)。两组手术时间、植骨量无统计学差异(P>0.05);但术中出血(359.68±159.22ml vs 514.86±246.09ml)、自体血回输(7 vs 17例)、止痛药使用(12 vs 23例)、住院时间(9.48±2.72d vs 11.51±3.27d)及术后1周VAS评分(3.77±1.28 vs 4.97±1.44分)微创组均优于开放组,差异有统计学意义(P<0.05)。两组术后1周、术后3个月、末次随访时椎管通畅率、伤椎椎体前缘高度百分比、矢状面Cobb角分别较术前改善,差异有显著性(P<0.05);但术前、术后1周、术后3个月、末次随访时椎管通畅率、伤椎椎体前缘高度百分比、矢状面Cobb角两组间比较均无显著性差异(P>0.05)。结论:针对严重椎管狭窄伴神经损伤的胸腰椎骨折病例,微创置钉联合小切口入路椎板减压植骨内固定术与传统开放术式均取得了良好的疗效。微创术式在减少手术创伤、出血量、住院时间等方面更具优势。
文摘目的探讨微创小切口下开窗减压联合经皮椎弓根螺钉内固定术对胸腰椎骨折合并神经损伤患者的疗效.方法选取胸腰椎爆裂性骨折患者72例,根据手术方式分为微创组34例、开放组38例.记录围术期指标;分别于术前、术后行影像学检查,记录伤椎椎管通畅率、伤椎前缘高度、矢状面Cobb角;分别于术前和末次随访时进行ASIA神经功能分级;观察术后并发症发生情况.结果微创组住院时间明显短于开放组,术中出血量、术中自体血回输率、术后引流量明显低于开放组,差异具有统计学意义(P<0.05).两组患者术后7 d VAS评分较术前均明显降低,且微创组明显低于开放组,差异具有统计学意义(P<0.01).两组患者术后7 d、术后6个月、末次随访时的椎管通畅率、伤椎前缘高度、矢状面Cobb角度均较术前明显改善,差异具有统计学意义(P<0.05);但各时间点椎管通畅率、伤椎前缘高度、矢状面Cobb角度在两组间差异无统计学意义(P>0.05).末次随访时神经功能恢复水平在两组间差异无统计学意义(P>0.05).两组术后均无并发症发生.结论两种手术对胸腰椎骨折合并神经损伤患者均有较好疗效,微创手术可降低患者术中出血量和术后疼痛感,缩短住院时间.
文摘目的探讨经钩椎关节及前椎板间隙入路松解交锁关节突联合颈椎前路植骨融合内固定治疗交锁性下颈椎骨折脱位的临床疗效。方法回顾分析2013年1月—2015年6月收治的12例交锁性下颈椎骨折脱位患者临床资料。男7例,女5例;年龄25~59岁,平均38.4岁。病程9.6 h~100 d,平均7.3 d。单侧交锁8例,双侧交锁4例;陈旧性4例,新鲜8例。损伤节段:C_(3、4)2例,C_(4、5)5例,C_(5、6)3例,C_(6、7)2例。滑脱程度Meyerding分度为Ⅰ度9例,Ⅱ度3例。神经功能按美国脊髓损伤协会(ASIA)分级:C级2例,D级6例,E级4例。采用经钩椎关节及前椎板间隙入路松解交锁关节突联合颈椎前路植骨融合内固定治疗。手术前后采用ASIA分级评价神经功能,疼痛视觉模拟评分(VAS)、改良日本骨科协会评分、颈椎功能障碍指数(NDI)评分评价临床疗效,摄X线片测量融合节段前凸Cobb角;术后6个月评价椎间植骨融合情况。结果手术时间平均78.30 min,术中出血量平均167.30 m L,术后引流量平均58.12 m L。术中、术后未予以输血处理。术中无大血管、食管、气管意外损伤;术后无喉头水肿、吞咽困难、声音嘶哑、脑脊液漏发生;无脊髓损伤、神经根损伤加重发生;切口Ⅰ期愈合,无感染发生。12例均获随访,随访时间15~20个月,平均16.5个月。术后患者神经损伤症状及功能均较术前明显改善,术后6个月复查颈椎X线片示,Cage或植骨块无移位、断裂,螺钉无松动、脱离,椎间植骨融合率达100%。末次随访时ASIA分级、融合节段前凸Cobb角、颈痛VAS评分、改良JOA评分及NDI评分均较术前明显改善(P<0.05)。结论经钩椎关节及前椎板间隙入路松解交锁关节突联合颈椎前路植骨融合内固定治疗交锁性下颈椎骨折脱位临床疗效明确,使损伤节段获得满意复位、即刻稳定和重建、充分减压,可有效防止脊髓二次损伤。
