目的探讨对胸椎后纵韧带骨化（ossification of posterior longitudinal ligament,OPLL）合并黄韧带骨化（ossification of ligamentum flavum,OLF）患者行后路全椎板切除减压并椎弓根内固定治疗的临床疗效。方法回顾性研究2008年7月~2...目的探讨对胸椎后纵韧带骨化（ossification of posterior longitudinal ligament,OPLL）合并黄韧带骨化（ossification of ligamentum flavum,OLF）患者行后路全椎板切除减压并椎弓根内固定治疗的临床疗效。方法回顾性研究2008年7月~2013年4月,15例胸椎OPLL并OLF患者行后路全椎板切除减压并椎弓根内固定术治疗。分别统计患者一般情况、手术时间、出血量、卧床时间、术后并发症发生率、术前术后日本骨科学会（Japanese Orthopaedic Association,JOA）评分,并进行比较。结果平均随访38.7个月,患者术前、术后3个月及末次随访时JOA评分分别为3.9±1.2、8.1±2.2及10.3±2.5,差异具有统计学意义（P〈0.05）。术中1例患者出现脑脊液漏,术后1例患者出现浅表伤口感染,1例患者出现血肿。结论胸椎OPLL并OLF患者行全椎板切除减压并椎弓根内固定术治疗,可获得满意的临床疗效。但该术式容易造成严重脊髓损伤,对术者技巧要求较高。展开更多
目的分析体感诱发电位(SEP)监测在脊柱外科手术应用中的影响因素,探讨其预测指标,初步建立SEP指标波幅差值异常变化时出血量及平均动脉压的预测模型。方法回顾性分析接受多节段椎板切除减压手术的86例患者的SEP监测资料,以SEP波幅差值...目的分析体感诱发电位(SEP)监测在脊柱外科手术应用中的影响因素,探讨其预测指标,初步建立SEP指标波幅差值异常变化时出血量及平均动脉压的预测模型。方法回顾性分析接受多节段椎板切除减压手术的86例患者的SEP监测资料,以SEP波幅差值异常变化作为SEP受影响的指标,与性别、年龄、身高、体质量、平均动脉压范围、出血量、手术时间、皮下针电极导线长度、电磨钻应用情况、气磨钻应用情况、电动手术床电源接通情况等11个指标进行Pearson或Spearman相关分析及多元线性回归,筛选影响SEP的相关因素。结果 SEP指标(波幅差值P40/N50)和出血量(P<0.05)、平均动脉压波动范围(P<0.05)、电磨钻使用情况(P<0.05)、气磨钻使用情况(P<0.05)、电动手术床电源接通情况(P<0.05)5个因素存在相关关系,而与性别(P>0.05)、年龄(P>0.05)、身高(P>0.05)、体质量(P>0.05)、手术时间(P>0.05)、皮下针电极导线长度(P>0.05)不具有相关关系。平均动脉压<50 mm H(1 mm Hg g=0.133 k Pa)或在50 mm Hg左右波动时,以及出血量较多且>1 249 m L时,SEP的波幅将明显发生变化,接近甚至会低于基线水平,与术中脊髓、神经损伤表现相似。结论出血量、平均动脉压范围、电磨钻使用情况、气磨钻使用情况和电动手术床电源接通情况是SEP指标(P40/N50)的影响因素。展开更多
Objective： To compare the biomechanical effects between oblique Ban-pulling manipulation and lumbar erection-rotation manipulation in sitting position in treating lumbar intervertebral disc herniation （LIDH）. Meth...Objective： To compare the biomechanical effects between oblique Ban-pulling manipulation and lumbar erection-rotation manipulation in sitting position in treating lumbar intervertebral disc herniation （LIDH）. Methods： A three-dimensional finite element model of L3-S1 was developed to carry out a comparative study between oblique Ban-pulling manipulation and lumbar erection and rotation manipulation in sitting position. The disc protrusion was assumed to be on the rear left of L4 disc, and the manipulations were performed on the right side. The loading process was simulated by two steps, in the first step, only the compression loading was imposed, and in the second step, both the compression loading and axial rotation moment were imposed. The displacement and stress distribution in L4 disc were investigated. Results： The values of stress and displacement in the second step were lower than those in the first step in each manipulation. The stress and displacement differences between the two steps were respectively 1.79 times and 3.03 times larger in oblique Ban-pulling manipulation than those in lumbar erection-rotation manipulation in sitting position. Conclusion： Oblique Ban-pulling manipulation may result in a better biomechanical effect than lumbar erection-rotation manipulation in sitting position for LIDH.展开更多
文摘目的探讨对胸椎后纵韧带骨化（ossification of posterior longitudinal ligament,OPLL）合并黄韧带骨化（ossification of ligamentum flavum,OLF）患者行后路全椎板切除减压并椎弓根内固定治疗的临床疗效。方法回顾性研究2008年7月~2013年4月,15例胸椎OPLL并OLF患者行后路全椎板切除减压并椎弓根内固定术治疗。分别统计患者一般情况、手术时间、出血量、卧床时间、术后并发症发生率、术前术后日本骨科学会（Japanese Orthopaedic Association,JOA）评分,并进行比较。结果平均随访38.7个月,患者术前、术后3个月及末次随访时JOA评分分别为3.9±1.2、8.1±2.2及10.3±2.5,差异具有统计学意义（P〈0.05）。术中1例患者出现脑脊液漏,术后1例患者出现浅表伤口感染,1例患者出现血肿。结论胸椎OPLL并OLF患者行全椎板切除减压并椎弓根内固定术治疗,可获得满意的临床疗效。但该术式容易造成严重脊髓损伤,对术者技巧要求较高。
文摘目的分析体感诱发电位(SEP)监测在脊柱外科手术应用中的影响因素,探讨其预测指标,初步建立SEP指标波幅差值异常变化时出血量及平均动脉压的预测模型。方法回顾性分析接受多节段椎板切除减压手术的86例患者的SEP监测资料,以SEP波幅差值异常变化作为SEP受影响的指标,与性别、年龄、身高、体质量、平均动脉压范围、出血量、手术时间、皮下针电极导线长度、电磨钻应用情况、气磨钻应用情况、电动手术床电源接通情况等11个指标进行Pearson或Spearman相关分析及多元线性回归,筛选影响SEP的相关因素。结果 SEP指标(波幅差值P40/N50)和出血量(P<0.05)、平均动脉压波动范围(P<0.05)、电磨钻使用情况(P<0.05)、气磨钻使用情况(P<0.05)、电动手术床电源接通情况(P<0.05)5个因素存在相关关系,而与性别(P>0.05)、年龄(P>0.05)、身高(P>0.05)、体质量(P>0.05)、手术时间(P>0.05)、皮下针电极导线长度(P>0.05)不具有相关关系。平均动脉压<50 mm H(1 mm Hg g=0.133 k Pa)或在50 mm Hg左右波动时,以及出血量较多且>1 249 m L时,SEP的波幅将明显发生变化,接近甚至会低于基线水平,与术中脊髓、神经损伤表现相似。结论出血量、平均动脉压范围、电磨钻使用情况、气磨钻使用情况和电动手术床电源接通情况是SEP指标(P40/N50)的影响因素。
基金supported by Natural Science Foundation of Guangdong Province, China, No. 2014A030313392~~
文摘Objective： To compare the biomechanical effects between oblique Ban-pulling manipulation and lumbar erection-rotation manipulation in sitting position in treating lumbar intervertebral disc herniation （LIDH）. Methods： A three-dimensional finite element model of L3-S1 was developed to carry out a comparative study between oblique Ban-pulling manipulation and lumbar erection and rotation manipulation in sitting position. The disc protrusion was assumed to be on the rear left of L4 disc, and the manipulations were performed on the right side. The loading process was simulated by two steps, in the first step, only the compression loading was imposed, and in the second step, both the compression loading and axial rotation moment were imposed. The displacement and stress distribution in L4 disc were investigated. Results： The values of stress and displacement in the second step were lower than those in the first step in each manipulation. The stress and displacement differences between the two steps were respectively 1.79 times and 3.03 times larger in oblique Ban-pulling manipulation than those in lumbar erection-rotation manipulation in sitting position. Conclusion： Oblique Ban-pulling manipulation may result in a better biomechanical effect than lumbar erection-rotation manipulation in sitting position for LIDH.
