Accurate placement of pedicle screws is a key factor of spinal surgery. Investigation of a new real-time intra-operative monitoring method is an important area of clinical application research which makes a contribution to planting pedicle screw accurately. Porcine spines were chosen as experimental objects.The changes of reduced scattering coefficient (μ's) along normal puncture path, medial perforation path and lateral perforation path were measured and studied. A conclusion is drawn that there are two distinct peaks throughout the puncture process, appearing at the junction of cancellous bone and cortical bone, at the beginning and at the end, respectively. The reduced scattering coefficient is proved to be a good monitoring factor which can identify whether the screw is about to reach the critical position of the spine puncture. Moreover, the variation provides an important reference for spinal surgical navigation process.
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.
ObjectiveTo investigate the effect of acute non-isovolemic hemodilution (ANIH) on spinal surgery. MethodsFrom January 2012 to July 2013, 80 patients scheduled for spinal surgery were enrolled. The patients were randomized into four groups, with 20 in each group. Patients in group A were infused with Ringer's injection and polygeline for fluid loss, physiological needs and blood loss. In group B, the patients were infused with acute hypervolemic hemodilution. In group C, patients were infused with acute nomovolemic hemodilution. In group D, patients were infused with ANIH. The hemodynamics and arterial blood gas indexes were detected in all the patients. ResultsThe mean blood pressure in group A and C was significantly more stable than that in group B and D. The central vein pressure in group B and D was significantly higher than that in group A and C after hemodilution (P<0.05), while the hematocrit in group B and D was significantly lower than that in group A and C (P<0.05). Allogeneic blood transfusion was performed in group A and B, while it was not performed in group C and D. ConclusionANIH can reduce the volume of blood loss during spinal surgery, and it is safe.
【摘要】 目的 对骶正中动静脉的位置分布及变异进行解剖观察及实际测量其与周围重要结构的位置关系，为临床医师提高腰骶椎前路手术安全性提供必要的参考信息。 方法 收集2008年5月-2011年1月期间因疾病及意外死亡者新鲜人体尸体标本30例，对其进行解剖学研究，观察并测量骶正中动、静脉的发出点与走行，骶正中动、静脉的数量与缺失情况，以及骶正中动、静脉间的相互走行关系。 结果 ①骶正中动脉在主动脉发出以及走行的位置相对固定，无明显多支与缺失情况；骶正中动脉均为腹主动脉根部背侧发出，未见发出点位于左右髂总动脉。发出后行于左侧髂总静脉后方，跨过腰5/骶1椎间盘下行。骶正中静脉与骶正中动脉伴行的情况占总数的60.0%；②骶正中静脉多支常见，没有发现有骶正中静脉的缺失。1支的占总标本数的66.7%，2支的占30.0%，3支的占3.3%。 结论 当选择分叉下入路，应该特别注意骶正中动静脉的解剖位置。动脉的变异相对较小，而静脉的变异程度非常大，发出点变异，多支的情况多见，这些原因都造成了静脉容易损伤的原因，在手术中应该特别注意。【Abstract】 Objective To investigate the clinical significance of anatomical features of middle sacral artery and vein for lumbar-sacral spinal surgery. Methods We carried out anatomical research on 30 cadavers caused by diseases or accidents collected between May 2008 and January 2011. We dissected the vascular system anterior to lumbar vertebrae to learn their characteristics. The initial point of middle sacral artery and confluent point of veins, and the numbers of, and the companion relationship between middle sacral arteries and veins were chosen as the indexes to be measured. Results The middle sacral arteries started from the aorta, and their locations were relatively fixed without absence or multi-branches. All the middle sacral arteries derived from the dorsal side of abdominal artery root, and were not started from the common iliac artery. Then, the sacral arteries went at the back of left common iliac vein, and went down after traversing the inter-vertebral disk between the fifth lumbar and first sacral vertebra. About 60% of the middle sacral veins were accompanied with the arteries. Multi-branches of the middle sacral veins were frequently seen, and no absence was observed. One-branch, two-branch and three-branch middle sacral veins occupied 66.7%, 30.0% and 3.3% respectively out of the total. Conclusions When choosing downward branch approach during the operation, we should pay special attention to the anatomical locations of the middle sacral arteries and veins. Compared with the arteries, there are greater variations of the veins including variations of the confluent point and branches which can cause the veins to be quite vulnerable.
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.
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.
Objective To evaluate the current status of classification and repair methods for dural injury caused by spinal surgery or trauma, providing new strategies and ideas for the clinical repair of dural injury and the development of related materials. MethodsThe literature related to dural injury both at home and abroad in recent years was thoroughly reviewed and analyzed in order to draw meaningful conclusions. ResultsThere have been numerous retrospective studies on dural injury, but there is a scarcity of prospective and multi-center studies, resulting in a low level of evidence-based research. The incidence and risk factors of dural injury have primarily been studied in relation to common degenerative spinal diseases of the cervical and lumbar spine, with insufficient research on thoracic spine-related diseases. Currently, a universally recognized method for grading and classifying dural injury has not been established, which hampers the development of clinical guidelines for their repair. Furthermore, although there are repair materials and surgical strategies available to address clinical issues such as suture leakage and surgical repair of dural injury in complex locations, there is a lack of comprehensive clinical research and evidence-based data to validate their scientificity and reliability. ConclusionRegardless of the classification of dural injury, suture remains the most important repair method. It is important to further develop new patches or sealants that can meet clinical needs and reduce the difficulty of repair.
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。
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.