Objective To investigate the status of self-perceived burden (SPB) in patients undergoing spine surgery and to explore its influencing factors, in ordering to provide a basis for formulating corresponding nursing interventions. Methods A cross-sectional survey was conducted on patients undergoing spine surgery in Department of Orthopedic Surgery, West China Hospital of Sichuan University between May and August 2024. The patient general information questionnaire, the patient SPB Scale, the Barthel Index, the Medical Coping Modes Questionnaire, and the Social Support Rating Scale were used to investigate the SPB status and its influencing factors in patients undergoing spine surgery. Results A total of 230 patients were included. There were 113 cases in the non-SPB group and 117 cases in the SPB group. There were statistically significant differences in age, marital status, occupation, payment method, the number of family, disease diagnosis, Barthel Index score, caregiver identity, and caregiver gender between the two groups of patients (P<0.05). Among 117 patients with SPB, 83 (36.09%) had mild SPB, 27 (11.74%) had moderate SPB, and 7 (3.04%) had severe SPB. The average SPB scores for mild, moderate, and severe patients were (24.06±2.92), (33.07±2.87), and (44.86±4.56) points, respectively. The results of binary logistic stepwise regression analysis showed that the patient’s marital status, disease diagnosis, and caregiver gender were independent influencing factors for SPB in patients undergoing spine surgery (P<0.05). Conclusion The SPB of patients undergoing spine surgery is at a mild to moderate level, which is affected by factors such as marital status, disease diagnosis, and caregiver gender.
目的 探讨急性扩容联合控制性降压在脊柱手术的应用。 方法 2007年7月-2009年1月，60例择期脊柱手术患者随机分成3组:A组：对照组；B组：急性扩容组；C组：急性扩容联合控制性降压组。A组输林格氏液15 mL/kg，诱导前30 min输入1/2，另1/2在2~3 h内输完。B组在A组基础上，诱导后30~45 min输入20 mL/kg 6%羟乙基淀粉。C组在B组基础上，持续泵注硝酸甘油0.5~10.0 μg/（kg•min）控制血压，同时增加输液量，增加有效循环血容量；止血后，缝合切口前，静脉注射速尿2~5 mg。 结果 A组平均血压无B、C组稳定，B、C组中心静脉压扩容后显著增加（Plt;0.05），红细胞压积显著降低（Plt;0.05）；C组出血量最少（Plt;0.05）。 结论 急性扩容联合控制性降压在脊柱手术中应用安全，可以大大减少出血量。
ObjectiveTo investigate the status of urination in post-spineoperative (cervical thoracic and lumber verteb) patients under the enhanced recovery after surgery (ERAS) mode.MethodsPatients who were admitted to the West China Hospital of Sichuan University from October 2018 to February 2019 were enrolled. The urination status of the patients was collected by using questionnaires. All patients were divided into normal urinating group, induced urinating group and catheterization group according to their urination status after returning to the ward.ResultsA total of 106 patients were included, including 78 (73.6%) who urinated smoothly [the first urinating time (72.18±36.33) min], 20 (18.9%) who urinated after induction [the first urinating time (81.50±41.68) min], and 8 (7.5%) who received catheters after induction failure [the first urinating time (162.50±84.52) min]. The different operation, operation time, position of urination, and postoperative pain degree affecting the placement of urethral catheter differed from each other significantly (P<0.05). Among the three groups, the differences were statistically significant in operation time, operation methods, position of urination (except for the induced urination group vs. catheterization group) and postoperative pain degree (except for the induced urination group vs. catheterization group) in pairs (P<0.05). There was no significant difference in other factors among three groups in pairs (P>0.05).ConclusionsMost post-spineoperative patients can autonomously urinate without catheter under the ERAS mode, which bases on operation methods, operation time, and the first urinating posture after the surgery. Early attention should be paid to patients with dysuresia to promote their early rehabilitation.
目的：探讨硝普钠控制性降压在脊柱手术中的临床应用。方法：72例拟在全麻下行脊柱手术患者随机分成两组：观察组（硝普钠组，n=36）与对照组（n=36）。所有患者均静脉注射咪唑安定0.1mg·kg-1、丙泊酚2mg·kg-1、芬太尼2μg·kg-1和采用预注给药的阿曲库铵进行气管内插管，以异氟醚或氨氟醚、阿曲库铵和芬太尼维持麻醉。观察组在手术进入椎体前3～5min由输液泵输入001％硝普钠，控制速度使收缩压维持于60～80mmHg的范围。记录两组出血量、输血量、输液量、手术时间，术后1h血红蛋白与术前血红蛋白等。结果：两组患者基本情况、手术类型、晶体液、胶体液输入量无统计学差异；观察组术中失血量和输血量均明显少于对照组，且手术时间明显缩短；两组术后1h血红蛋白与术前比较均有所下降，但差异无显著性。结论：脊柱手术中采用硝普钠控制性降压效果安全、可靠，可明显减少术中出血量及输血量，缩短手术时间。
ObjectiveTo review the research progress of total endoscopic minimally invasive technique in treating cervical nerve root canal stenosis (CNRCS).MethodsThe related literature at home and abroad was extensively reviewed. The research history, current situation, research progress, advantages and disadvantages of minimally invasive treatment of CNRCS under total endoscope were summarized.ResultsIn recent years, with the continuous development of minimally invasive technique of total endoscope in spine surgery, the surgical treatment methods are also constantly innovated. Compared with the traditional open surgery, minimally invasive treatment of CNRCS under total endoscope can obtain better effectiveness, keep the stability of the cervical segment to the maximum extent, reduce the impact on the activity of the cervical spine and the occurrence of related surgical complications, which is an effective minimally invasive technology.ConclusionThe minimally invasive treatment of CNRCS under total endoscope has achieved some results, which is expected to be one of the indispensable means to treat CNRCS, but it still needs to be improved.
Objective To analyze the early effectiveness of unilateral biportal endoscopic discectomy (UBED) combined with annulus fibrosus suture in the treatment of lumbar disc herniation (LDH). Methods The clinical data of 19 patients with LDH treated with UBED and annulus fibrosus suture between October 2020 and October 2021 were retrospectively analyzed. There were 12 males and 7 females with an average age of 39.1 years (range, 26-59 years). The operative segment was L4, 5 in 13 cases, and L5, S1 in 6 cases. The mean disease duration was 6.7 months (range, 3-15 months). Preoperative neurological examination showed that muscle strength, sensation, and tendon reflex weakened or disappeared in varying degrees. Single annulus fibrosus suture (14 cases) or anchor assisted annulus fibrosus suture (5 cases) was selected according to the location of annulus fibrosus tears. Visual analogue scale (VAS) score was used to assess the low back and leg pain before operation and at 3 days, 3 months, and 6 months after operation. Oswestry disability index (ODI) was used to evaluate the function recovery of lumbar spine before operation and at 3 days, 3 months, and 6 months after operation. At 3 days and 3 months after operation, MRI was used to examine the removal of nucleus pulposus and decompression of nerve root. MacNab criteria was used to evaluate the effectiveness at 6 months after operation and the recovery of nerve root function was recorded. Results All operations were successfully completed with a mean operation time of 52.7 minutes (range, 40-75 minutes). There was no complication such as nerve injury, spinal cord hypertension syndrome, or dural sac tear during operation, and no complication such as infection, aggravation of nerve damage, or cerebrospinal fluid leakage after operation. All the patients were followed up 6-10 months (mean, 8.2 months). Postoperative MRI showed that the herniated disc was completely removed and nerve roots were fully decompressed. During the follow-up, there was no recurrence of disc herniation. The VAS scores of low back pain and leg pain and ODI at each time point after operation significantly improved when compared with those before operation, and those at 6 months after operation further improved than those at 3 days and 3 months after operation, all showing significant differences (P<0.05). At 6 months after operation, MacNab standard was used to evaluate the effectiveness, and the results were excellent in 14 cases, good in 4 cases, and fair in 1 case, with an excellent and good rate of 94.7%. Neurological examination showed that the sensation and muscle strength of the affected nerve root innervated area recovered significantly when compared with those before operation (P<0.05); the recovery of tendon reflex was not obvious, showing no significant difference when compared with that before operation (P>0.05). ConclusionUBED combined with annulus fibrosus suture is a safe and effective technique for LDH and early effectiveness is satisfactory.
目的:分析脊柱外科患者术后并发谵妄综合征的原因,总结其诊断、预防、治疗。方法:回顾性分析我科2008年10月至2009年4月脊柱手术167例,其中11例患者术后发生谵妄综合征。结果:11例患者均给予氟哌啶醇5mg im bid治疗,平均使用5.6天,症状缓解;并获3~6月随访,无一例复发谵妄综合征。结论:谵妄综合征是脊柱外科患者术后常见并发症,其发生与年龄,性别,低血糖等有关,目前治疗首选氟哌啶醇。
Objective To review the application status, clinical advantages, and complications of unilateral biportal endoscopy (UBE) technique and explore its future development direction. Methods By reviewing recent domestic and international literature, the evolution history of UBE technique, its surgical advantages, and its application effectiveness in various spinal diseases were analyzed, providing a comprehensive review. Results UBE technique, with its unique dual-channel design, provides a clearer surgical field and more flexible operating space, significantly reduces surgical trauma and postoperative recovery time. UBE technique has demonstrated high safety and effectiveness in the treatment of lumbar disc herniation, spinal stenosis, lumbar instability, and cervical spondylosis. Additionally, the complication incidence of UBE surgery is lower than that of traditional open surgery. Conclusion In recent years, UBE technique has shown good clinical application prospects and efficacy, but further technical optimization and large-scale clinical research are still needed to ensure the safety and effectiveness. In the future, the combination of UBE technique and intelligent medical and surgical robotics technology is expected to promote the further development of spinal surgery.
【Abstract】 Objective To investigate the surgical management of dural injuries and postoperative cerebrospinal fluid(CSF) fistulas in spinal surgeries and to observe cl inical outcomes, since intraoperative injury of dura mater and postoperative CSF fistulas are common compl ications of spinal surgeries. Methods A retrospective research was designed and 405 patients with complete data who underwent spinal surgeries between June 2002 and March 2006 were acquired, including 298 cases of male and 107 cases of female, with the mean age of 46.2 years (ranging from 11 years to 78 years). The course of disease lasted from 3 months to 5 years. A total of 28 cases of intraoperative dural injuries and durotomies (28/405, 6.91%) were recorded, including 3 cases of cervical spinal surgery (3/152, 1.97%), 19 cases of thoracic and lumbar spinal surgery (19/239, 7.95%) and 6 cases of sacral surgery (6/14, 42.86%). CSF fistulas occurred in 6 cases of 28 patients. There were 2 cases in which no intraoperative dural injury was detected but CSF fistulas occurred after operation. The incidence of postoperative CSF fistula was 1.98% (8/405). Surgical management included closure of breach in the dura mater, oversewing every layer of the wound, bed rest and compression dressing and so on. Cl inical outcomes of surgical management were recorded. Results The average followup lasted for 1 year and 5 months (ranging from 3 months to 4 years). Preoperative symptoms remitted to different extents There were 8 cases of postoperative CSF fistula which were cured ultimately. A total of 6 cases of CSF fistulas from dorsal injuries of dura mater were treated mainly by bed rest, compression dressing and reoperations, while 2 cases of fistulas from ventral and lateral injuries of dura mater were treated by additional continuous cerebrospinal fluid drainage using a lumbar subarachnoid catheter. One case of central nervous system infection occurred and was treated successfully by multi-discipl inary disposal. Conclusion Timely and correct surgical intervention and postoperative management can help to heal dural injuries in spinal surgeries and can prevent occurrence of postoperative CSF fistulas.