Steel bar penetrating cervical spinal canal without neurological injury:A case report

BACKGROUND We report a rare case of cervical spinal canal penetrating trauma and review the relevant literatures.CASE SUMMARY A 58-year-old male patient was admitted to the emergency department with a steel bar penetrating the neck,without signs of neurological deficit.Computed tomography(CT)demonstrated that the steel bar had penetrated the cervical spinal canal at the C6–7 level,causing C6 and C7 vertebral body fracture,C6 left lamina fracture,left facet joint fracture,and penetration of the cervical spinal cord.The steel bar was successfully removed through an open surgical procedure by a multidisciplinary team.During the surgery,we found that the cervical vertebra,cervical spinal canal and cervical spinal cord were all severely injured.Postoperative CT demonstrated severe penetration of the cervical spinal canal but the patient returned to a fully functional level without any neurological deficits.CONCLUSION Even with a serious cervical spinal canal penetrating trauma,the patient could resume normal work and life after appropriate treatment.

Surgical Management of Lumbar Spinal Canal Stenosis with Instrumentation at the Yaounde Central Hospital: Comparison of Unilateral versus Bilateral Pedicle Screw Fixation Combined with Transforaminal Lumbar Interbody Fusion

Introduction: The choice of adopting unilateral pedicle screw fixation or using bilateral pedicle screw fixation in lumbar spinal stenosis remains controversial. In our context, very few studies have been performed comparing the clinical effectiveness of unilateral versus bilateral fixation in the surgical management of lumbar spinal canal stenosis. Objective: Evaluate the impact on quality of life and clinical efficacy of unilateral spondylodesis compared to bilateral spondylodesis in the surgical management of lumbar spinal canal stenosis at the Yaounde Central Hospital. Methods: This was a retrospective descriptive cross-sectional study for a period of 4 years, from June 2015 to June 2019. It involved all patients operated for lumbar canal stenosis and who underwent spondylodesis or spinal fusion at the neurosurgery department of the Yaounde Central Hospital. Results: A total of 68 participants were recruited during our study period. 32 (47%) of the study population were in the 50 - 60 age group, with a mean age of 56.98 years ranging from 41 to 75 years. Females, housewives and farmers were the most affected. In our study, 72% of patients had unilateral spondylodesis and 28% had bilateral fusion. Preoperatively, 71% of patients had insurmountable pain, refractory to medical treatment. At 3 months postoperatively, 73.7% of patients with bilateral setup had moderate pain compared to 69% of those with unilateral setup. At 6 months postoperatively, 79% of patients with bilateral fusion had mild pain compared to 82% of patients with unilateral setup. At 1 year postoperatively, all patients had mild pain. Preoperatively, 66.2% of patients were unable to walk and 19.1% of patients were bedridden according to the Oswestry score. At 3 months postoperatively, 10.2% of patients with unilateral setup were unable to walk compared to 10.5% of patients with bilateral fixation, while 67.3% of patients with unilateral fixation had moderate disability compared to 52.6% of patients with bilateral fixation. At 6 months postoperatively, 51% of patients with unilateral setup had moderate disability compared to 47.4% of patients with bilateral fixation, while 42.9% of patients with unilateral fixation had mild disability compared to 42.1% of patients with bilateral fixation. At 1 year postoperatively, 81.6% of patients who underwent unilateral fixation had only mild disability compared to 73.7% of patients with bilateral fixation. Conclusion: The assessment of quality of life according to the set-up used shows similar results at 3 months, 6 months and 1 year, with no statistically significant differences. Single-sided pedicle screw fixation combined with transforaminal lumbar interbody fusion or mounting has the advantage of being faster, with less bleeding and is less expensive compared to bilateral fixation.

Prevotella oris-caused meningitis and spinal canal infection:A case report

BACKGROUND Prevotella oris-induced meningitis and Prevotella oris-induced meningitis concomitant with spinal canal infection are extremely rare.To the best of our knowledge,only 1 case of Prevotella oris-induced central system infection has been reported.This is the second report on meningitis combined with spinal canal infection due to Prevotella oris.CASE SUMMARY We report a case of a 9-year-old boy suffering from meningitis and spinal canal infection.The patient presented to the neurosurgery department with lumbosacral pain for 1 mo and headache and vomiting for 1 d.He had been treated with cephalosporin and nonsteroidal anti-inflammatory drugs for fever,otalgia and pharyngalgia in a local hospital 2 mo prior to this admission.During hospitalization,magnetic resonance imaging suggested meningitis and L3-S1 lumbosacral dural sac infection.The cerebrospinal fluid and blood cultures were negative,but the cerebrospinal fluid specimen indicated the presence of Prevotella oris by metagenomic next-generation sequencing.Previous cases of Prevotella oris infection were retrieved from PubMed to characterize the clinicopathological features and identify the prognostic factors and related antimicrobial treatment of infection due to Prevotella oris.CONCLUSION This report shed light on the characteristics of Prevotella oris infection and highlighted the role of metagenomic next-generation sequencing in pathogen detection.

Correlation study between the changes of motor evoked potential and the improvement of spinal canal volume in minimally invasive transforaminal lumbar interbody fusion

Objective:To analyze the correlation between the amplitude changes of motor evoked potential(MEP),the 3D volume changes of spinal canal measuring by postoperative CT and the improvement rate of clinical symptoms after the spinal canal decompression in minimally invasive transforaminal lumbar interbody fusion(MIS-TLIF),and to explore the predictive value of the changes of both MEP amplitude and spinal canal volume in the assessment of long-term clinical prognosis in MIS-TLIF.Methods:A retrospective study of 68 patients with L4/5 spinal stenosis treated with MIS-TLIF was performed.The changes of both intraoperative MEP amplitude and 3D spinal canal volume during the spinal canal decompression,as well as the visual analogue scale(VAS)and Oswestry dysfunction index(ODI)scores in the long-term follow-up were all recorded.Results:The values of intraoperative MEP amplitude was 159.04%higher in 68 patients with MIS-TLIF after spinal canal decompression(P<0.01).The 3 postoperative 3D spinal canal volume(4.89±1.27)cm increased by 31.22%in comparison 3 with preoperative date(3.78±1.08)cm(P<0.01).The VAS and ODI scores were improved to 78.55%and 80.60%,respectively at the last follow-up(P<0.01).The improvement rate of MEP amplitude on the decompression side was positively correlated with the improvement rate of postoperative spinal canal volume(r=0.272,P=0.025).The improvement rate of postoperative spinal canal volume was positively correlated with the improvement rate of VAS and ODI at the last follow-up(r=0.656,r=0.490,P<0.01).Moreover,the improvement rate of MEP amplitude on the decompression side was also positively correlated with the improvement rate of VAS and ODI at the last follow-up(r=0.322 and 0.235,respectively,P<0.05).Conclusion:The increase of MEP amplitude after spinal canal decompression in patients with lumbar spinal stenosis treated by MIS-TLIF was closely correlated with both of the increase of spinal canal volume and the improvement of clinical symptoms.Therefore,MEP amplitude monitoring was not only the one of the important monitoring methods for predicting the prognosis of MIS-TLIF but also the reliably predictive value in the long-term clinical prognosis in MIS-TLIF.

Changes in neurological and pathological outcomes in a modified rat spinal cord injury model with closed canal

Most animal spinal cord injury models involve a laminectomy,such as the weight drop model or the transection model.However,in clinical practice,many patients undergo spinal cord injury while maintaining a relatively complete spinal canal.Thus,open spinal cord injury models often do not simulate real injuries,and few previous studies have investigated whether having a closed spinal canal after a primary spinal cord injury may influence secondary processes.Therefore,we aimed to assess the differences in neurological dysfunction and pathological changes between rat spinal cord injury models with closed and open spinal canals.Sprague-Dawley rats were randomly divided into three groups.In the sham group,the tunnel was expanded only,without inserting a screw into the spinal canal.In the spinal cord injury with open canal group,a screw was inserted into the spinal canal to cause spinal cord injury for 5 minutes,and then the screw was pulled out,leaving a hole in the vertebral plate.In the spinal cord injury with closed canal group,after inserting a screw into the spinal canal for 5 minutes,the screw was pulled out by approximately 1.5 mm and the flat end of the screw remained in the hole in the vertebral plate so that the spinal canal remained closed;this group was the modified model,which used a screw both to compress the spinal cord and to seal the spinal canal.At 7 days post-operation,the Basso-Beattie-Bresnahan scale was used to measure changes in neurological outcomes.Hematoxylin-eosin staining was used to assess histopathology.To evaluate the degree of local secondary hypoxia,immunohistochemical staining and western blot assays were applied to detect the expression of hypoxia-inducible factor 1α(HIF-1α)and vascular endothelial growth factor(VEGF).Compared with the spinal cord injury with open canal group,in the closed canal group the Basso-Beattie-Bresnahan scores were lower,cell morphology was more irregular,the percentage of morphologically normal neurons was lower,the percentages of HIF-1α-and VEGF-immunoreactive cells were higher,and HIF-1αand VEGF protein expression was also higher.In conclusion,we successfully established a rat spinal cord injury model with closed canal.This model could result in more serious neurological dysfunction and histopathological changes than in open canal models.All experimental procedures were approved by the Institutional Animal Care Committee of Shanghai Ninth People’s Hospital,Shanghai Jiao Tong University School of Medicine,China(approval No.HKDL201810)on January 30,2018.

The Integration and Communication of Regional Culture in Canal Landscape Planning and Design:A Case Study of the Grand Canal in the Gaomin Temple Section of Yangzhou

The Grand Canal is the cultural source of Yangzhou's historical development. The heritage and development of the canal culture are conducive to enhancing the image of Yangzhou, building cultural brands, and enhancing core competitiveness. Taking the canal in the Gaomin Temple section of Yangzhou for example, this study was based on the regional canal culture and the humanistic characteristics of Gaomin Temple, and explored the unique cultural communication mode of the important landscape node of the canal. Through the analysis of the status and development of the landscape of the section, this study concluded corresponding cultural orientation content and direction, and analyzed the integration and communication ideas of regional culture in landscape planning and design, in order to provide a reference for the promotion of cultural brands in the canal city of Yangzhou.

Gout: A Possible Cause of Lumbal Canal Stenosis. Cases Report in Sub-Saharan Area and Literature Review

Introduction: Gout is defined as an arthritic condition resulting from the deposition of monosodium urate crystals in and/or around joints, following long-standing hyperuricemia. This may cause gouty arthritis in joints and tophi in soft tissues. Spinal gout is rare and never mentioned in our context. It can appear as acute back pain, radiculopathy, spinal cord compression, spondylodiscitis or neoplasic/infectious epiduritis. Our aim was to share our surgical experience and proceed of a Literature review. Cases Presentation: Between January and August 2022, two patients male were surgically cared, aged of 42 and 60 years old. The gout was unknown in the youngest and poorly followed in the eldest. There was no past medical history of tuberculosis or immunodeficiency in both. The early diagnosis retained was unspecific lumbar spondylodiscitis due to clinical features: Patients complained both of lower back pain with initial fever. It was of a progressive left L5S1 deficit with erectile defect and dysuria in the first case and a progressive paraplegia without sphincter disorders in the second case. We proceeded with a lumbar laminectomy with a biopsy on both patients. The spinal tophus was ligamentous in one case and arthro-ligamentous in the other. There was a progressive motor recovery from postoperative Day-2 till postoperative Month-1. A probabilistic antituberculosis treatment was promptly initiated postoperatively based on radioclinic features while waiting for histologic proof. The Polymerase Chain Reaction (PCR) of Mycobacterium tuberculosis was negative and the histology was of a chronic calcified osteitis with dense fibrosis in both. The anti-gout treatment was implemented after 15 days with blood test evidence. A rheumatologic follow-up was also initiated and adjuvant physio-therapy. The results were very satisfactory from 4 - 6 months with independent walking. Discussion Conclusion: Spinal Gout may be suggested in 40-male-old faced with any acute rachialgia with neuro deficit with dubious neuro-imaging.

Primary thoracolumbar intraspinal malignant melanoma:A case report

BACKGROUND Primary intraspinal malignant melanoma is a very rare tumor that most often occurs in the cervical,thoracic,or thoracolumbar segment.CASE SUMMARY A rare case of primary thoracolumbar malignant melanoma is described.A 45-year-old female patient complained of low back pain with numbness and fatigue in both lower limbs.MR revealed an intradural space-occupying lesion at the thoracic 12 to lumbar 1 level.The tumor was partially excised,and a malignant melanoma was confirmed by histopathology.CONCLUSION Primary intraspinal malignant melanoma has rarely been reported,and surgical resection and related characteristics and diagnoses have been discussed.

Biometrics of the Cervical Spinal Canal and Cord by Computer Tomography in Togo

Studies on the canal dimensions of the cervical spinal are rare in Africa. The aim of this study is to provide normal values of the cervical spinal canal and spinal cord dimensions of adult people in Togo. It was about a twelve-year prospective study conducted in the main Hospitals of Campus Teaching Hospital. This study involved people of more than 18 years who neither presented any clinical sign nor rachis defect. The distances measured were antero-posterior 1 (APD1) and inter-pedicular (IPD) of the cervical spinal canal, the antero-posterior 2 (APD2) and the transverse (TD) diameters of the cervical spinal cord, followed with APD2/APD1 (R1) and TD/IPD (R2) research reports. The mean age was 38 +/- 9.34 years old. The average of APD1 of the cervical spinal canal stood at 15.41 ± 0.55 mm, with a minimum of 10.48 ± 0.57 mm and a maximum of 25.00 ± 2.60 mm. The IPD average stood at 23.27 ± 1.67 mm with a minimal average of 13.68 ± 1.46 mm and a maximal average of 33.68 ± 1.46 mm. The average of DAP2 was 11.66 ± 0.66 mm, with a minimum of 10.7 ± 0.66 mm and a maximum of 12.77 ± 0.66 mm. The DT average stood at 15.55 ± 1.54 mm, with a minimal average of 14.03 ± 2.43 mm and a maximal average of 17.63 ± 1.82 mm. The ratio R1 (APD2/APD1) average was 0.80 ± 0.04, with a minimum of 0.76 ± 0.06 and a maximum of 0.85 ± 0.07. The ratio R2 (TD/IPD) average stood at 0.69 ± 0.14, with a minimum of 0.5 ± 0.12 and a maximum of 0.84 ± 0.08. The cervical spinal canal and the cervical spinal cord diameters in Togo are not significantly different from those described above.

Mechanical properties of nerve roots and rami radiculares isolated from fresh pig spinal cords

No reports have described experiments designed to determine the strength characteristics of spinal nerve roots and rami radiculares for the purpose of explaining the complexity of symptoms of medullary cone lesions and cauda equina syndrome. In this study, to explain the pathogenesis of cauda equina syndrome, monoaxial tensile tests were performed to determine the strength characteristics of spinal nerve roots and rami radiculares, and analysis was conducted to evaluate the stress-strain relationship and strength characteristics. Using the same tensile test device, the nerve root and ramus radiculares isolated from the spinal cords of pigs were subjected to the tensile test and stress relaxation test at load strain rates of 0.1, 1, 10, and 100 s-1 under identical settings. The tensile strength of the nerve root was not rate dependent, while the ramus radiculares tensile strength tended to decrease as the strain rate increased. These findings provide important insights into cauda equina symptoms, radiculopathy, and clinical symptoms of the medullary cone.

Rehabilitation intervention of cervical spondylotic myelopathy combined with thoracic spinal canal stenosis

Objective To investigate diagnosis and treatment characters of cervical spondylotic myelopathy combined with thoracic spinal stenosis, and to analysis effective pathway of spinal function recovery. Methods We took respective analysis on diagnosis, treatment and recovery results of 12 cases, whose symptoms, signs and MR were explicit. Results Follow ups times were from 9 months to 5 years and 8 months. Nerve function of 8 cases recovered completely or nearly completely; that of 2 cases improved apparently and that of 2 cases improved slightly. Conclusion Detailed disease history collection, particular body examination and MR reading are very important to early diagnosis of cervical spondylotic myelopathy combined with thoracic spinal stenosis. Early operation combined with cervical and thoracic spinal canal decompression at same time or at different stages is the single effective method to patients’ function recovery.

Microsurgical treatment of neurilemmoma in upper cervical spinal canal:59 cases report

Objective To explore surgical techniques and curative effects of microsurgical treatment for neuriemmoma in upper cervical spinal canal. Methods Form Jan. 2004 to Nov. 2007. 59 cases of schwannoma was resected through microoperation, the operation was conducted through a posteromedial approach,using German Laika microscope resection

椎管内肿瘤术后患者早期功能康复相关影响因素分析

目的:探讨椎管内肿瘤术后患者早期功能康复相关影响因素,提高临床疗效。方法:回顾性分析2018年12月至2022年11月我院80例椎管内肿瘤患者临床资料,其中男性39例,女性41例,年龄25~73岁,平均年龄(51.33±11.71)岁。利用SPSS 25.0软件进行统计分析,首先对所有变量按相应检验方法进行单因素分析,再将单因素分析统计中有显著性差异(P<0.05)的指标进行多因素Logistic回归分析,得出可能影响椎管内肿瘤术后患者早期功能康复的独立危险因素。结果:单因素分析显示,视觉模拟(VAS)评分(P=0.042)、Oswestry功能障碍指数(ODI)(P=0.046)、营养状况(P=0.019)、内固定物(P=0.000)、手术方式(P=0.000)、脑脊液漏(P=0.033)、椎管内肿瘤部位(P=0.000)、留置管路(P=0.044)、脊神经功能(P=0.049)、糖尿病(P=0.048)、肢体肌力(P=0.002)差异均有统计学意义;Logistic回归分析显示,VAS评分(P=0.039)、ODI(P=0.025)、内固定物(P=0.016)、手术方式(P=0.037)、椎管内肿瘤部位(P=0.004)、留置管路(P=0.028)、脊神经功能(P=0.049)差异均有统计学意义。结论:VAS评分、ODI、营养状况、内固定物、手术方式、脑脊液漏、椎管内肿瘤部位、留置管路、脊神经功能、糖尿病、肢体肌力均为椎管内肿瘤术后患者早期功能康复的影响因素;其中VAS评分、ODI、内固定物、手术方式、椎管内肿瘤部位、留置管路、脊神经功能为该类患者早期功能康复的独立影响因素。

床旁超声评估早期新生儿的脊髓和椎管发育

目的探讨床旁超声在早期新生儿脊髓和椎管发育中的临床价值。方法收集2022年1月—8月兰州大学第二医院125例新生儿的临床资料,包括母亲的分娩次数、分娩方式、新生儿的胎龄、性别、出生天数、身高、体重、头围、胸围,并用床旁超声测量颈、胸、腰椎脊髓和椎管前后径。按其胎龄分为早产儿组(32~36^(+6)周,30例)、早期足月儿组(37~38^(+6)周,39例)和完全足月儿组(39~40^(+6)周,56例)。比较脊髓和椎管前后径的组间差异及与临床资料的相关性,进一步观察脊髓和椎管前后径随胎龄变化的规律。结果完全足月儿组、早期足月儿组的脊髓和椎管前后径均大于早产儿组(P<0.05)。早期新生儿的脊髓和椎管前后径与胎龄、身高、体重、头围、胸围呈正相关,尤其早产儿组与胎龄明显相关(P<0.05)。脊髓和椎管发育无性别差异。结论床旁超声可以显示早期新生儿的脊髓和椎管前后径随胎龄而变化,其参考值将有助于评估新生儿的脊髓损伤。

单边双通道内镜与Delta大通道内镜技术治疗L5/S1椎间盘突出并椎管狭窄的临床疗效分析

目的 探讨Delta大通道内镜技术与单边双通道内镜技术(unilateral biportal endoscopy, UBE)治疗L5/S1单节段椎间盘突出并椎管狭窄的疗效。方法 回顾性分析2018年1月至2022年8月手术治疗的60例L5/S1单节段腰椎间盘突出并椎管狭窄患者的临床资料,其中32例采用Delta大通道内镜技术行经皮椎板间入路内镜下椎间盘切除术(Delta内镜组),28例采用UBE内镜技术行椎管减压髓核摘除术(UBE组)。比较两组围手术期指标、腰腿痛VAS评分、 ODI及并发症情况,末次随访时按Macnab标准评价疗效。结果 两组患者均顺利完成手术。Delta内镜组术中出血量少于UBE组,手术时间、住院时间短于UBE组(P<0.001)。两组患者术后腰腿痛VAS评分及ODI均较术前明显降低,且Delta内镜组术后3 d腰痛VAS评分及术后1月腿痛VAS评分均低于UBE组(P<0.05)。术后随访6个月,末次随访按Macnab标准评价疗效:Delta内镜组优30例,可2例,优良率为93.75%;UBE组优27例,可1例,优良率为96.43%;组间比较差异无统计学意义(P>0.05)。Delta内镜组硬膜撕裂1例,因撕裂处较小仅严密缝合手术切口;UBE组出现腿部疼痛加重1例。结论 Delta大通道内镜技术与UBE治疗L5/S1单节段椎间盘突出并椎管狭窄均可获得良好的近期效果,但Delta内镜手术术中出血少,软组织损伤小,操作时间短,术后短期疼痛缓解明显,患者恢复快,而UBE适应证范围相对广泛。

胸腰段椎管硬膜外囊肿显微手术中尾端技术应用(附12例分析)

目的:探究显微镜下胸腰段椎管内硬膜外脊膜囊肿(spinal extradural meningeal cysts,SEMC)瘘口修补结合囊肿尾端技术处理的疗效和临床应用的可推广性。方法:回顾经电生理监测显微手术胸腰段SEMC瘘口修补结合囊肿尾端技术(切除囊肿尾端囊袋、囊肿尾端与正常硬脊膜交界处微小切口贯通脑脊液后常规缝合)的12例患者资料,结合文献传统手术方法进行分析。结果:平均随访14个月期间影像学囊肿完全消失9例,大部分消失1例,椎间孔内侧残留囊肿2例,无1例存在硬膜囊受压表现,无复发病例。术前腰背痛和/或下肢痛11例,出院时疼痛缓解或消失,随访3个月后疼痛改变与出院时比较差异无统计学意义。患者下肢无力及排尿功能障碍逐渐恢复,术后未出现新的神经功能缺失。椎板棘突解剖复位良好、无椎管狭窄和畸形病例。结论:电生理监测显微手术胸腰段SEMC瘘口修补结合囊肿尾端技术可以有效解决活瓣问题,闭合囊肿,无明显并发症,临床可行。

超声引导定位下椎管内麻醉在肥胖妊高症患者剖宫产中的应用效果

目的探讨肥胖妊高症患者剖宫产中应用超声引导定位下椎管内麻醉的临床效果。方法纳入保定市妇幼保健院2020年1月至2022年7月收治的肥胖妊高症患者80例为研究对象,随机分2组,每组40例。研究组实施超声引导定位下椎管内麻醉,对照组采用传统触诊定位下椎管内麻醉,比较2组穿刺情况、麻醉效果、生命体征相关指标、新生儿Apgar评分和并发症。结果研究组麻醉前准备时间、麻醉穿刺时间和麻醉起效时间均短于对照组,穿刺次数少于对照组(P<0.05)。研究组麻醉效果优于对照组(P<0.05)。麻醉用药后10 min,研究组心率、收缩压和舒张压均低于对照组,研究组生命体征较对照组更稳(P<0.05)。研究组新生儿娩出后1 min、5 min和10 min的Apgar评分均高于对照组(P<0.05)。研究组神经刺激、硬膜外置管出血等并发症发生率为2.50%,低于对照组的20.00%(P<0.05)。结论肥胖妊高症患者剖宫产中应用超声引导定位下椎管内麻醉能提高麻醉穿刺成功率,降低患者应激反应,减少并发症,提高新生儿Apgar评分和麻醉效果。

不同负压引流方式联合氨甲环酸对颈椎后路单开门手术病人失血量、引流量及并发症的影响

目的探究不同负压引流方式联合氨甲环酸对颈椎后路单开门手术的多节段脊髓型颈椎病病人失血量、引流量及并发症的影响。方法按照研究目标设定的纳入、排除标准,将2018年10月至2020年10月沧州中西医结合医院接受颈椎后路单开门手术的多节段脊髓型颈椎病病人182例作为研究对象进行回顾性研究,根据负压引流情况分为A组(持续负压引流联合氨甲环酸,46例)、B组(间断负压引流联合氨甲环酸,46例)、C组(持续负压引流,不使用氨甲环酸,45例)及D组(间断负压引流,不使用氨甲环酸,45例)。对比四组病人手术时间、总失血量、术后引流量、术后72 h血红蛋白水平,生化指标[活化部分凝血活酶时间(APTT)、凝血酶原时间(PT)、纤维蛋白原(Fib)],术后疼痛视觉模拟评分(VAS)及日本骨科协会评估治疗分数(JOA)评分。结果手术后,四组手术时间、总失血量比较差异无统计学意义(P>0.05),四组术后24 h引流量[A组(191.21±22.38)mL、B组(175.34±17.85)mL、C组(205.62±20.78)mL、D组(210.43±20.14)mL]、术后隐性失血量[A组(275.37±30.12)mL、B组(251.42±26.12)mL、C组(321.47±35.62)mL、D组(296.78±32.14)mL]、引流管留置时间[A组(1.85±0.51)d、B组(1.45±0.42)d、C组(2.32±0.65)d、D组(2.78±0.78)d]比较差异有统计学意义(P<0.05),其中B组最优,其次为A组。四组术后72 h血红蛋白水平[A组(112.43±12.57)g/L、B组(120.53±17.85)g/L、C组(103.47±10.78)g/L、D组(102.58±11.12)g/L]均明显降低(P<0.05),但是B组下降最少,其次为A组。四组血清APTT、PT、Fib水平差值比较差异有统计学意义(P<0.05),其中A组各指标变化最明显,B组血清APTT水平变化最小;四组VAS评分与JOA评分比较差异无统计学意义(P>0.05);四组发热、脑脊液漏、血肿压迫脊髓、下肢深静脉血栓、心血管事件等并发症发生情况比较差异无统计学意义(P>0.05)。结论颈椎后路单开门手术中应用间断负压引流联合氨甲环酸利于手术时间缩短,并减少术后引流量及隐性失血量,改善血红蛋白水平。

退行性腰椎侧凸椎管形态学特征及其与脊柱-骨盆参数的相关性分析

目的 测量退行性腰椎侧凸(degenerative lumbar scoliosis,DLS)患者椎管形态学参数,分析其变化规律及其与脊柱-骨盆参数的相关性。方法 收集DLS患者50例,分别在X线、CT及MRI上测量腰弯Cobb角、腰椎前凸角、顶椎位置、顶椎偏移距离、顶椎旋转度、顶椎侧方和前方滑移距离、骨盆投射角(pelvic incidence,PI)、骨盆倾斜角(pelvic tilt,PT)、骶骨倾斜角(sacral slope,SS)、凹侧和凸侧椎间孔高度、宽度和横截面积、硬膜囊横截面积、横径和前后径,分析椎管形态学变化规律及其与脊柱-骨盆参数的相关性。结果DLS患者的顶椎位于L_(2)~L_(3)椎体;其椎管相关参数最小处均位于L_(4/5)节段;椎间孔相关参数最小处均位于L_(2/3)节段。DLS患者L_(2/3)水平椎管及椎间孔的形态学参数与年龄、腰弯Cobb角及顶椎偏移距离存在相关性(P<0.05);而L_(5)/S_(1)水平椎间孔的形态学参数与PI、SS存在相关性(P<0.05)。结论 DLS患者椎管最狭窄处多位于L_(4/5)节段,而椎间孔最狭窄处多位于L_(2/3)节段。顶椎区椎管狭窄程度、椎间孔狭窄程度与脊柱-骨盆参数之间存在一定的相关性。

床旁即时超声(PoCUS)实时引导颈椎管内外沟通性神经鞘瘤显微切除术1例

患者男,51岁,头颈部疼痛6个月,休息后稍减轻,无放射痛,偶感右手指尖麻木;外院颈部MRI示C5左旁结节样异常信号;4年前曾接受“甲状腺部分切除术”。查体及实验室检查未见明显异常。颈椎平扫+增强MRI示C5~C6左前方神经根走行区15 mm×16 mm×17 mm类圆形异常信号,边界清晰,呈T1WI等信号、T2WI稍高信号,增强后明显欠均匀强化(图1A),考虑神经鞘瘤。