【摘要】 目的 探讨经皮脊柱后凸成形手术中骨水泥的应用疗效。 方法 2008年10月-2010年10月，应用注射用Ⅲ型丙烯酸树脂骨水泥及其椎体成形系统，采取经皮脊柱后凸成形术治疗40例椎体疾病患者。其中男5例，女35例；年龄53～84岁，平均65岁。老年骨质疏松性椎体压缩骨折37例，椎体恶性肿瘤2例，椎体血管瘤1例。采用视觉模拟评分（visual analogue scale，VAS）对患者手术前后疼痛程度的改善情况进行评分统计，并观察术中及术后并发症的发生情况。 结果 患者出院前行脊柱正、侧位透视，发现椎体内骨水泥分布良好；3例有少量骨水泥向椎体外渗漏现象，但均无临床症状。所有患者获随访1～12个月，平均8个月。腰背部疼痛均明显缓解或消失，日常生活质量大大提高。术前VAS评分为（8.30±0.48）分，术后3 d、1个月及末次随访时VAS评分分别为（3.11±0.41）、（2.50±0.36）、（2.50±0.36）分，与术前比较差异均有统计学意义（Plt;0.05）。 结论 骨水泥应用于经皮脊柱后凸成形手术中可取得很好疗效，固化的骨水泥对脊柱起到很好的支撑、稳定作用。【Abstract】 Objective To assess the clinical effect of using bone cement in percutaneous kyphoplasty. Methods From October 2008 to October 2010, type Ⅲ Acrylic resin bone cement and the system of vertebroplasty were used in percutaneous kyphoplasty (PKP) to treat 40 patients. There were 5 males and 35 females with an average of 65 years old (53-84 years). There were 37 older patients with osteoporotic vertebral compression fracture, 2 cases of vertebral tumor and one hemangioma. Visual analogue scale (VAS) was used to evaluate the pain before and after the operation. The complications in and after the operation were also recorded. Results Before discharge, posterior-anterior and lateral X-ray films were taken to evaluate the distribution of bone cement. Three patients showed a little bone cement leakage from the vertebral body, but no clinical symptoms were found. All patients were followed for 1 to 12 months with an average of 8 months. Pain in the back decreased obviously or disappeared, and the qualities of daily life were improved greatly. The score of VAS was (8.30±0.48) before the operation, and (3.11±0.41), (2.50±0.36), and (2.50±0.36) 3 days, 1 month after the operation, and during the last follow-up, respectively. Significant differences were found between the VAS score before and after operation (Plt;0.05). Conclusions Good results can be expected when bone cement is used in percutaneous kyphoplasty. Solidified bone cement can effectively support and stablize the spinal column.
目的:探讨公共突发事件中大批量收治伤员时的骨科护理管理流程。方法:对汶川地震期间,四川大学华西医院骨科收治1 410名骨科地震伤员时包括紧急组织管理、护理人力资源管理、护理流程革新以及信息管理等的护理管理进行总结、分析、评价。结果:通过高效的护理应急管理,保证了在汶川地震灾害救援中的医疗、护理质量,提高了伤员的整体救护水平。结论:医院建立有效的应急管理体系,通过各部门配合,再造护理管理流程,在灾害医疗救援中具有重要意义。
Objective To study the correlation between the cervical posture in the cervical disc replacement (CDR) and the cervical curve restoration in neutral position after surgery. Methods Between January 2008 and August 2010, 51 patients underwent single segmental PRESTIGE LP replacement, and the clinical data were retrospectively analyzed. During the surgery, the patient was supinely placed and the lordosis of the cervical spine was mantained with a pillow placed beneath the neck. Of them, 28 were male and 23 were female, aged 30-64 years (mean, 45 years); 32 were diagnosed as having cervical spondylotic myelopathy, 7 having radiculopathy, and 12 having myelopathy and radiculopathy. The disease duration was 3-48 months (mean, 15 months). CDR was performed at C4, 5 in 5 cases, at C5, 6 in 42 cases, and at C6, 7 in 4 cases. The Cobb angles of the cervical alignment, targeted functional spinal unit (FSU), and targeted disc were measured by sagittal X-ray film of the cervical spine in neutral position before and after surgery, as well as the intraoperative C-arm fluroscopy of the cervical spine. Linear correlation and regression were performed to analyze the relation between cervical Cobb angle difference at intraoperation and improvement of the Cobb angles at 3 months after operation. Results The cervical Cobb angles at intraoperation and 3 months after operation were larger than those at preoperation (P lt; 0.05). The difference of the Cobb angle between intra- and pre-operation was (6.72 ± 9.13)° on cervical alignment, (2.10 ± 5.12)° on targeted FSU, and (3.33 ± 3.75)° on targeted disc. At 3 months after operation, the Cobb angle improvement of the cervical alignment, targeted FSU, and targeted disc was (6.30 ± 7.28), (3.99 ± 5.37), and (4.29 ± 5.36)°, respectively. There was no significant difference in the Cobb angle improvement between the targeted FSU and the targeted disc (t= — 0.391, P=0.698), and between the targeted disc and the cervical alignment (t= — 1.917, P=0.061), but significant difference was found between the targeted FSU and the cervical alignment (t= — 2.623, P=0.012). The linear correlation between the Cobb angle difference and the Cobb angle improvement of the cervical spine was observed (P lt; 0.05). Conclusion A slightly lordotic cervical posture during CDR is an important factor to maintaining normal physiological lordosis of the cervical spine after surgery.