目的:对腰椎单、双Cage置入加椎弓根钉内固定两种手术方法的生物力学进行比较,判断上述两种手术方法在生物力学上的优劣。方法:选取正常青壮年男性新鲜尸体的L4/5脊柱标本一具,进行横切扫描,利用三维重建软件M im ics建立椎弓根钉内固...目的:对腰椎单、双Cage置入加椎弓根钉内固定两种手术方法的生物力学进行比较,判断上述两种手术方法在生物力学上的优劣。方法:选取正常青壮年男性新鲜尸体的L4/5脊柱标本一具,进行横切扫描,利用三维重建软件M im ics建立椎弓根钉内固定有限元模型(模型1),单融合器置入加椎弓根螺钉内固定有限元模型(模型2)和双枚融合器植入加椎弓根螺钉内固定有限元模型(模型3);然后在模型上施加压缩、前屈、后伸载荷并测定在各种情况下螺钉和融合器上的应力,结果在excel软件上进行统计分析。结果:在所测的运动状态中,模型1的螺钉应力明显高于模型2和模型3(P<0.05),而模型2与模型3的螺钉应力的差异没有统计学意义(P>0.05);模型2的融合器压力高于模型3,其中在前屈及压缩状态下两者的差别有统计学意义(P<0.05),而后伸状态下差别无统计学意义(P>0.05)。结论:在所测的运动状态下,上述两种手术方法在生物力学上差异无显著性,应用椎弓根螺钉内固定加后路单枚椎间融合器斜行置入进行腰椎内固定融合的手术方法是可行的。展开更多
PURPOSE:Adequate oxygenation is necessary for anastomotic healing, and ischemia has been found to be one of the most important factors in anastomotic leakage. This study was designed to assess the value of early posto...PURPOSE:Adequate oxygenation is necessary for anastomotic healing, and ischemia has been found to be one of the most important factors in anastomotic leakage. This study was designed to assess the value of early postoperative intramucosal pH measurements for the prediction of anastomotic leakage in patients with colorectal anastomosis. METHODS: A prospective study of 90 patients with rectal or sigmoid cancer with primary anastomosis was conducted. In all patients intramucosal pH was determined by using tonometry at the anastomotic and gastric levels during the first 24 and 48 hours postoperatively. Seven other variables also were tested by univariate and multivariate analysis for any association with anastomotic leakage. RESULTS: The rate of clinical anastomotic leakage was 6.6 percent. Multivariate analysis showed that only the intramucosal pH at the anastomosis was an independent factor for the development of anastomotic leakage. The risk of leakage was 22 times higher in patients with an anastomotic intramucosal pH < 7.28 in the first 24 hours after surgery. CONCLUSIONS: Measurement of anastomotic intramucosal pH in the early postoperative period can more accurately predict the risk of anastomotic leakage and benefit those patients who would need additional measures to improve the viability of the anastomosis.展开更多
文摘目的:对腰椎单、双Cage置入加椎弓根钉内固定两种手术方法的生物力学进行比较,判断上述两种手术方法在生物力学上的优劣。方法:选取正常青壮年男性新鲜尸体的L4/5脊柱标本一具,进行横切扫描,利用三维重建软件M im ics建立椎弓根钉内固定有限元模型(模型1),单融合器置入加椎弓根螺钉内固定有限元模型(模型2)和双枚融合器植入加椎弓根螺钉内固定有限元模型(模型3);然后在模型上施加压缩、前屈、后伸载荷并测定在各种情况下螺钉和融合器上的应力,结果在excel软件上进行统计分析。结果:在所测的运动状态中,模型1的螺钉应力明显高于模型2和模型3(P<0.05),而模型2与模型3的螺钉应力的差异没有统计学意义(P>0.05);模型2的融合器压力高于模型3,其中在前屈及压缩状态下两者的差别有统计学意义(P<0.05),而后伸状态下差别无统计学意义(P>0.05)。结论:在所测的运动状态下,上述两种手术方法在生物力学上差异无显著性,应用椎弓根螺钉内固定加后路单枚椎间融合器斜行置入进行腰椎内固定融合的手术方法是可行的。
文摘PURPOSE:Adequate oxygenation is necessary for anastomotic healing, and ischemia has been found to be one of the most important factors in anastomotic leakage. This study was designed to assess the value of early postoperative intramucosal pH measurements for the prediction of anastomotic leakage in patients with colorectal anastomosis. METHODS: A prospective study of 90 patients with rectal or sigmoid cancer with primary anastomosis was conducted. In all patients intramucosal pH was determined by using tonometry at the anastomotic and gastric levels during the first 24 and 48 hours postoperatively. Seven other variables also were tested by univariate and multivariate analysis for any association with anastomotic leakage. RESULTS: The rate of clinical anastomotic leakage was 6.6 percent. Multivariate analysis showed that only the intramucosal pH at the anastomosis was an independent factor for the development of anastomotic leakage. The risk of leakage was 22 times higher in patients with an anastomotic intramucosal pH < 7.28 in the first 24 hours after surgery. CONCLUSIONS: Measurement of anastomotic intramucosal pH in the early postoperative period can more accurately predict the risk of anastomotic leakage and benefit those patients who would need additional measures to improve the viability of the anastomosis.
