【摘要】 目的 探讨腰部放置衬垫物对经皮冠状动脉介入手术后卧床患者的作用。 方法 选取2008年7〖CD3/5〗12月于我科行经皮冠状动脉介入手术后50例患者,随机分为试验组25例和对照组 25 例。试验组在常规护理基础上予腰部放置衬垫物,对照组25例予常规护理,手术次日对患者进行视觉模拟量表测试方法(VAS)评分。 结果 试验组VAS评分秩和检验低于对照组,差异有统计学意义(Plt;0001);两组除烦躁外其他并发症无显著差异。 结论 冠状动脉介入手术后患者在平卧位制动时予腰椎弯曲处放置衬垫物可降低患者腰部疼痛程度。【Abstract】 Objective To investigate the effects of lumbar pad on bed patients who uhderwent percutaneous coronary intervention operation. Methods The 50 patients who uhderwent percutaneous coronary intervention operation in our deparment from July to December 2008，then randomly divided into experimental group(25 patients)and control group(25 patients). Control group were received conventional care，the experimental group were received lumbar pad based on the conventional care. The second day after operation，the patients were scored by visual analog scale test method (VAS). Results The VAS scores of experimental group was lower than control group，the difference was statistically significant (Plt;0001). The differences of other complications between two groups except fidgety were not statistically significant. Conclusions Coronary intervention after surgery，the patients in peripharyngeal braking to bend lumbar pad material can reduce the waist ache degree.
Lumbar spondylolisthesis is a common condition in spinal surgery, which is often characterized by lower back and leg pain and numbness. There are various treatment methods for this condition, and different treatment plans should be adopted according to different situations. Traditional open surgery methods are relatively traumatic and have longer recovery times, while minimally invasive spine techniques have advantages such as smaller incisions, less bleeding, higher fusion rates, and faster recovery. This review summarizes the relevant literature on the application of minimally invasive techniques in the treatment of lumbar spondylolisthesis in recent years, analyzes and compares the advantages and disadvantages of different approaches and endoscopic techniques, as well as reduction, decompression, and fusion effects. The aim is to provide reference for surgeons in selecting surgical procedures for the treatment of lumbar spondylolisthesis.
ObjectiveTo analyze the relationship between the bone mineral density (BMD) and lumbar intervertebral disc degeneration in rhesus macaques by using T1ρ-MRI. MethodsTwenty female rhesus macaques at the age of 10.9 years on average (rang, 4-20 years) were selected. The lumbar intervertebral discs were classified by Pfirrmann grading system and the T1ρ relaxation time (T1ρ value) was examined by using MRI (Philips 1.5 Tesla), and then BMD values of the L4,5 vertebrae and femoral ward's triangle were detected by using Osteocore dual energy X-ray absorptiometry. Finally, the relationship of T1ρ value of the lumbar intervertebral discs and Pfirrmann grading with age, weight, BMD of lumbar vertebrae and femoral ward's triangle was analyzed. ResultsThe BMD values of lumbar vertebrae and femoral ward's triangle were (0.64±0.17) g/cm2 and (0.67±0.19) g/cm2 respectively, showing no significant difference (t=2.893, P=0.128). According to Pfirrmann grading system, there were 7 cases of grade I, 8 cases of grade Ⅱ, and 5 cases of grade Ⅲ at L4,5 intervertebral discs. The T1ρ value of the lumbar intervertebral disc was (104.08±18.65) ms; the T1ρ values of grades I, Ⅱ, and Ⅲ were (121.31±13.44), (104.73±15.01), and (77.41±11.87) ms, respectively. There was a negative correlation between T1ρ value and the age and the BMD of lumbar vertebrae and femoral ward's triangle. There was a positive correlation between Pfirrmann grading and the variables as listed above. Significant negative linear correlation was also observed between T1ρ value and Pfirrmann grading. ConclusionThe T1ρ value is a reliable index when quantifying lumbar intervertebral disc degeneration, and there is a significant positive correlation between BMD and lumbar intervertebral disc degeneration in rhesus macaques.
ObjectiveTo analyze the effectiveness of direct screw repair for lumbar spondylolysis by using intraoperative O-arm based navigation and microendoscopic techniques. MethodsBetween February 2012 and May 2014, 11 consecutive patients with lumbar spondylolysis were treated with Buck's procedure by the aid of intraoperative O-arm based navigation and minimally invasive approach. The debridement and autograft of pars interarticularis defects was performed under microendoscopy. There were 7 males and 4 females, with an average age of 28.4 years (range, 19-47 years) and an average disease duration of 10.5 months (range, 8-23 months); no nerve symptoms or signs of lower limb was observed. The radiological examinations showed single level bilateral lumbar spondylolysis without obvious disc degeneration, lumbar instability, or spondylolisthesis. Isthmic injury located at L4 in 2 cases and at L5 in 9 cases. Of 11 patients, 7 were rated as grade 2 disc degeneration, and 4 as grade 3 disc degeneration according to the modified Pfirrmann classification system. The operation time, intraoperative blood loss, and complications were recorded. The fluoroscopic examinations were performed to assess defect repair and screw position. Visual analogue scale (VAS) score was used to evaluate the improvement of low back pain. ResultsThe average operation time was 147.6 minutes (range, 126-183 minutes). The average blood loss was 54.9 mL (range, 40-85 mL). Primary healing of incision was obtained. There was no complication of nerve root injury, dural tear, or infection. Three patients had pain at donor site postoperatively, and pain disappeared within 3 weeks. The average follow-up duration was 15.7 months (range, 10-23 months). VAS score of low back pain was significantly decreased from preoperative 7.1±2.3 to 1.8±0.4 at last follow-up (t=13.42, P=0.01). Of 22 isthmic bone grafting, bilateral isthmic bony fusion was achieved in 7 patients and unilateral isthmic bony fusion in 3 patients at 6-10 months (mean, 7.9 months). One patient failed bilateral isthmic bony fusion, and had bony resorption. ConclusionDebridement, autograft, and percutaneous intralaminar screw fixation by microendoscopy and O-arm based navigation may provide safe and effective treatment for spondylolysis. Minimally invasive direct repair can obtain satisfactory effectiveness.
Objective To evaluate the effectiveness of ISOBAR TTL dynamic stabilization with pars bone grafting for the treatment of lumbar spondylolysis. Methods A retrospective analysis was made the clinical data of 26 patients with lumbar spondylolysis who received ISOBAR TTL dynamic stabilization with pars bone grafting between September 2009 and March 2014. There were 14 males and 12 females, with a mean age of 31 years (range, 19-47 years). The disease duration ranged from 9 to 60 months (mean, 16 months). Preoperative lumbar anteroposterior and lateral X-ray films, CT three-dimensional reconstruction, and MRI scans were performed to identify the location of pars defect. The involved levels were L4 in 9 cases and L5 in 17 cases. There were 10 cases of pure spondylolysis and 16 cases of spondylolysis accompanied with I degree slipping. The clinical outcome was assessed by visual analogue scale (VAS) and Oswestry disability index (ODI) scores at preoperation and 1 week, 3 months, 6 months after operation, and at last follow-up. The lumbar CT three-dimensional reconstruction was obtained at 6 months after operation to evaluate bone fusion of the pars. The adjacent segment degeneration was assessed by the University of California at Los Angeles (UCLA) grading scale at preoperation and last follow-up. Results All incisions healed by first intention; no infection, cerebrospinal fluid leakage, or pain at iliac crest donor site occurred. Twenty-six patients were followed up 2-5 years (mean, 36.5 months). No secondary spondylolisthesis, internal fixation loosening and breakage were found during follow-up. The postoperative VAS and ODI scores showed significant differences (P<0.05) when compared with preoperative scores, and the scores at 3 months, 6 months, and last follow-up were significantly better than that at 1 week (P<0.05), but no significant difference was shown between the other time points after operation (P>0.05). The CT three-dimensional reconstruction indicated satisfactory union at the pars in 23 cases (88.5%) at 6 months after operation. Of the 3 nonunion patients, good union was obtained in 1 patient at 1 year after operation; nonunion was observed in 2 patients at last follow-up, but low back pain was obviously alleviated. According to the UCLA grading scale, 20 cases were rated as grade I and 6 cases as grade II at last follow-up, which was the same as preoperative grade and indicated no adjacent segment degeneration. Conclusion It is safe and effective to use the ISOBAR TTL dynamic stabilization with pars bone grafting technique to treat lumbar spondylolysis with or without degree I slipping. The fusion rate is satisfactory, and adjacent segment degeneration can be slowed down after lumbar fusion surgery.
Objective To review the current development of the dynamic stabilization devices and their biomechanics as well as clinical application.Methods The related biomedical research papers at home and abroad were consulted and analyzed Results There were obvious advances in the theoretic foundation and the clinical application in treatment of the degenerative lumbar disorders with the dynamic stabilization devices, especially with the nonfusion dynamic stabilization devices. Conclusion The effectiveness of the dynamic stabilization devices have attracted more and more biomedical researchers, especially the posterior dynamic stabilization device, which has provided a new approach to treatment of the degenerative lumbar disorders.
ObjectiveTo evaluate early effectiveness of posterior 180-degree decompression via unilateral biportal endoscopy (UBE) in the treatment of lumbar spinal stenosis (LSS) combined with Michigan State University (MSU)-1 lumbar disc herniation (LDH). MethodsA retrospective analysis was conducted on clinical data from 33 patients with LSS combined with MSU-1 LDH, who met selection criteria and were treated between March 2022 and January 2024. All patients underwent UBE-assisted 180-degree spinal canal decompression. The cohort comprised 17 males and 16 females, aged 37-82 years (mean, 67.1 years). Preoperative presentations included bilateral lower limbs intermittent claudication and radiating pain, with disease duration ranging from 5 to 13 months (mean, 8.5 months). Affected segments included L3, 4 in 4 cases, L4, 5 in 28 cases, and L5, S1 in 1 case. LSS was rated as Schizas grade A in 4 cases, grade B in 5 cases, grade C in 13 cases, and grade D in 11 cases. LDH was categorized as MSU-1A in 24 cases, MSU-1B in 2 cases, and MSU-1AB in 7 cases. Intraoperative parameters (operation time, blood loss) and postoperative hospitalization length were recorded. The visual analogue scale (VAS) score and Oswestry Disability Index (ODI) were used to assess the lower limb pain and functional outcomes after operation. Clinical efficacy was evaluated at last follow-up via modified MacNab criteria. Quantitative radiological assessments included dural sac cross-sectional area (DSCA) measurements and spinal stenosis grading on lumbar MRI. Morphological classification of lumbar canal stenosis was determined according to the Schizas grading, categorized into four grades. Results The operation time was 60.4-90.8 minutes (mean, 80.3 minutes) and intraoperative blood loss was 13-47 mL (mean, 29.9 mL). The postoperative hospitalization length was 3-5 days (mean, 3.8 days). All patients were followed up 12-16 months (mean, 13.8 months). The VAS score and ODI improved at immediate and 3, 6, and 12 months after operation compared to before operation, and the differences between different time points were significant (P<0.05). At last follow-up, the clinical efficacy assessed by the modified MacNab criteria were graded as excellent in 23 cases, good in 9 cases, and poor in 1 case, with an excellent and good rate of 96.97%. Postoperative lumbar MRI revealed the significant decompression of the dural sac in 32 cases, with 1 case showing inadequate dural expansion. DSCA measurements confirmed progressive enlargement and stenosis reduction over time. The differences were significant (P<0.05) before operation, immediately after operation, and at 6 months after operation. At 6 months after operation, Schizas grading of spinal stenosis improved to grade A in 27 cases and grade B in 6 cases. ConclusionPosterior 180-degree decompression via UBE is a safe and feasible strategy for treating LSS combined with MSU-1 LDH, achieving effective neural decompression while preserving intervertebral disc integrity.
Objective To investigate the surgicalmethod and perioperative treatment for senile lumbar disease accompanied by internal disease. Methods From June 2000 to December 2003,the complete neurological and physical examinations were performed on the patients before operation, as treatment of internal diseases could improve the patients’ conditions. Lumbar operations were performed on 125 patients, among whom 23 had simple lumbardisc herniation, 13 had lumbar spine stenosis, 81 had lumbar disc herniation with lumbar spine stenosis, and 8 had spondylolisthesis.The JOA score was 116±2.5. There were 3 patients undergoing fenerstration+discectomy, 16 undergoing semilaminectomy+discectomy,82 undergoing total-laminectomy+disectomy, 5 undergoing total-laminectomy+disectomy+pedicle fixation, 11 undergoing lamina decompression+nerve-root pathyway decompression, and 8 undergoing pedicle screw fixation+bone graft and fusion in spondylolisthesis. Results With an effective medical treatment, the internal disease produced little effect on the operation. Improved functions and bone fusions were observed after- operation. According to the JOA standards, the average alleviation rate was 87.9%. Conclusion Early neurological examination and proper treatment of internal diseases are the keys to the successful operation on the senile patients with lumbar disease. Radiological data are important in avoidance of mistaken diagnosis.
ObjectiveTo investigate the effectiveness of U-shape titanium screw-rod fixation system with bone autografting for lumbar spondylolysis of young adults. MethodsBetween January 2008 and December 2011, 32 patients with lumbar spondylolysis underwent U-shape titanium screw-rod fixation system with bone autografting. All patients were male with an average age of 22 years (range, 19-32 years). The disease duration ranged from 3 to 24 months (mean, 14 months). L3 was involved in spondylolysis in 2 cases, L4 in 10 cases, and L5 in 20 cases. The preoperative visual analogue scale (VAS) and Oswestry disability index (ODI) scores were 8.0±1.1 and 75.3±11.2, respectively. ResultsThe operation time was 80-120 minutes (mean, 85 minutes), and the blood loss was 150-250 mL (mean, 210 mL). Primary healing of incision was obtained in all patients without complications of infection and nerve symptom. Thirty-two patients were followed up 12-24 months (mean, 14 months). Low back pain was significantly alleviated after operation. The VAS and ODI scores at 3 months after operation were 1.0±0.5 and 17.6±3.4, respectively, showing significant differences when compared with preoperative ones (t=30.523,P=0.000;t=45.312,P=0.000). X-ray films and CT showed bone fusion in the area of isthmus defects, with the bone fusion time of 6-12 months (mean, 9 months). During follow-up, no secondary lumbar spondyloly, adjacent segment degeneration, or loosening or breaking of internal fixator was found. ConclusionThe U-shape titanium screw-rod fixation system with bone autografting is a reliable treatment for lumbar spondylolysis of young adults because of a high fusion rate, minimal invasive, and maximum retention of lumbar range of motion.
Objective To evaluate the effectiveness of lumbar interbody fusion impacted bone grafts combined with regrafting in situ with spinous process and vertebral plate complex and pedicle screw fixation for lumbar degenerative instabil ity. Methods Between January 1998 and October 2010, 48 patients with lumbar degenerative instabil ity were treated by posterior decompression, lumbar interbody fusion impacted bone grafts combined with regrafting in situ with spinous processand vertebral plate complex and pedicle screw fixation. There were 26 males and 22 females, aged 52-76 years (mean, 62.4 years). The disease duration was 7 months to 25 years (mean, 6.5 years). One segmental instabil ity was located at L3, 4 in 1 case, at L4, 5 in 10 cases, and at L5, S1 in 11 cases; multi-segmental instabil ity was located at L3, 4, L4, 5, and L5, S1 in 5 cases, at L2, 3 and L3, 4 in 2 cases, at L3, 4 and L4, 5 in 10 cases, and at L4, 5 and L5, S1 in 9 cases. Of 48 patients, 32 complicated by lumbar disc herniation, 46 by lumbar spinal stenosis, and 16 by degenerative scol iosis. The cl inical results were evaluated by the Japanese Orthopaedic Association (JOA) score, recovery rate, disc height, and lumbar lordosis angles. Results The incisions obtained healing by first intention after operation. No nerve injury, rod or screw breakage, and infection occurred during and after operation. All 48 patients were followed up 1 to 6 years. The fusion time was 12-18 weeks (mean, 16.2 weeks). Vertebra sl i pping or degenerative scol iosis was corrected, and spinal column series became normal. At preoperation, 6 months after operation, and last follow-up, the disc heights were (5.2 ± 2.3), (11.9 ± 2.0), and (11.6 ± 2.1) mm, respectively; the JOA scores were 3.2 ± 2.1, 12.8 ± 1.6, and 13.6 ± 1.2, respectively; and the lumbar lordosis angles were (—20.5 ± 10.5), (30.5 ± 8.5), and (31.2 ± 5.6)°, respectively. The JOA scores, disc heights, and lumbar lordosis angles were significantly improved at 6 months after operation and last follow-up when compared with preoperative ones (P lt; 0.05), but no significant difference was found between 6 months after operation and last follow-up (P gt; 0.05). The recovery rate of JOA was excellent in 36 cases, good in 10 cases, and fair in 2 cases at 6 months after operation, with an excellent and good rate of 95.8%. Conclusion Lumbar interbody fusion impacted bone grafts combined with regrafting in situ with spinous process and vertebral plate complex and pedicle crew fixation for lumbar degenerative instabil ity can restore and maintain the intervertebral disc height effectively with high fusion rate. It is a plasty close to anatomic reconstruction.