双上肢牵引固定装置的研制与应用效果评价
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摘要
目的:研制双上肢牵引固定装置,用于下颈椎手术中,以牵引患者手臂使肩部下移,避免下颈椎在透视与定位中被肩部遮挡,为术中透视下颈椎提供便利。方法:选取65例行颈椎前路手术的患者,按照随机数表法将其分成对照组(33例)和观察组(32例),对照组应用传统的固定方式,观察组采用双上肢牵引固定装置,分析比较两组患者术中双上肢牵引效果。结果:通过对两组患者X射线片的对比,观察组自然显露目标椎间盘有效率为100.0%,对照组有效率为21.2%,观察组采用双上肢牵引固定装置的有效率优于传统的固定方式,其差异有统计学意义(x2=42.020,P<0.05)。结论:双上肢牵引固定装置是一种新型的辅助装置,可以帮助医生获得更好的手术体位。通过牵拉患者的双臂使双肩下移,得到下颈椎的透视视野,为手术中的定位和暴露提供了方便。
Objective: To research and develop a fixation device of double upper limb traction for using in inferior cervical vertebra surgery so as to move patients' shoulders down by implementing traction for their arms, and avoid their inferior cervical vertebra were sheltered by shoulders in fluoroscopy and positioning, and provide convenience for intraoperative fluoroscopy of inferior cervical spine. Methods: 65 patients who underwent cervical surgery by anterior approach were selected and divided into control group(33 cases) and observation group(32 cases) according to random number table method. The control group received traditional fixation method, and the observation group received fixation device of double upper limb traction. The effects of intraoperative double upper limb traction between the two groups were analyzed and compared. Results: The comparison results of X-ray radiography of two groups indicated that the effective rate of target intervertebral disc with natural exposure was 100.0% in observation group and that was 21.2% in control group. Besides, the efficacy and safety of fixation device of double upper limb traction of observation group were significant better than those of traditional fixation method(x2=42.020, P<0.05). Conclusion: The fixation device of double upper limb traction is a new type of auxiliary device. And it can help doctors to obtain better surgical position. By pulling the arms of patients to move their shoulders down, a fluoroscopic field of inferior cervical vertebra can be obtained, and it provides convenience for intraoperative positioning and exposure.
Objective: To research and develop a fixation device of double upper limb traction for using in inferior cervical vertebra surgery so as to move patients' shoulders down by implementing traction for their arms, and avoid their inferior cervical vertebra were sheltered by shoulders in fluoroscopy and positioning, and provide convenience for intraoperative fluoroscopy of inferior cervical spine. Methods: 65 patients who underwent cervical surgery by anterior approach were selected and divided into control group(33 cases) and observation group(32 cases) according to random number table method. The control group received traditional fixation method, and the observation group received fixation device of double upper limb traction. The effects of intraoperative double upper limb traction between the two groups were analyzed and compared. Results: The comparison results of X-ray radiography of two groups indicated that the effective rate of target intervertebral disc with natural exposure was 100.0% in observation group and that was 21.2% in control group. Besides, the efficacy and safety of fixation device of double upper limb traction of observation group were significant better than those of traditional fixation method(x2=42.020, P<0.05). Conclusion: The fixation device of double upper limb traction is a new type of auxiliary device. And it can help doctors to obtain better surgical position. By pulling the arms of patients to move their shoulders down, a fluoroscopic field of inferior cervical vertebra can be obtained, and it provides convenience for intraoperative positioning and exposure.
引文
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[10]徐宝山,马信龙,杨强,等.可动式椎间盘镜下保留后韧带复合体的颈椎管扩大成形术的设计与临床应用[J].天津医药,2017,45(4):409-412.
[11]张春霖,朱红鹤,苗森,等.脊柱导航手术机器人寰枢椎椎弓根的双置入方法[J].中国组织工程研究,2011,15(13):2313-2316.
[2]姜立义,王峰,高宗伯.一次性前后路手术在颈椎管狭窄并颈椎过伸性损伤中的应用[J].中国实用医药,2012,7(15):136-137.
[3]Wang T,Wang H,Liu S,et al.Anterior cervical discectomy and fusion versus anterior cervical corpectomy and fusion in multilevel cervical spondylotic myelopathy:a meta-analysis[J].Medicine,2016,95(49):e5437.
[4]Kast E,Mohr K,Richter HP,et al.Complications of transpedicular screw fixation in the cervical spine[J].European Spine J,2006,15(3):327-334.
[5]田伟,刘亚军,刘波,等.计算机导航在脊柱外科手术应用实验和临床研究[J].中华骨科杂志,2006,26(10):671-675.
[6]郭卫春,黄文俊,汪光晔.计算机辅助导航技术在骨科中的应用进展[J].中国医药导报,2016,13(3):55-59.
[7]Bhalla A,Rolfe KW.Inadequate Surgical Decompression in Patients with Cervical Myelopathy:a Retrospective Review[J].Global Spine J,2016,6(6):542-547.
[8]Nakagawa H,Saito K,Mitsugi T,et al.Microdiscectomy and foraminotomy in cervical spondylotic myelopathy and radiculopathy:anterior versus posterior,microendoscopic surgery versus mini-open microsurgery[J].World Neurosurgery,2014,81(2):292-293.
[9]徐宝山,马信龙,杨强,等.可动式椎间盘镜下MED-TLIF的设计与临床应用[J].天津医药,2016,44(7):910-913.
[10]徐宝山,马信龙,杨强,等.可动式椎间盘镜下保留后韧带复合体的颈椎管扩大成形术的设计与临床应用[J].天津医药,2017,45(4):409-412.
[11]张春霖,朱红鹤,苗森,等.脊柱导航手术机器人寰枢椎椎弓根的双置入方法[J].中国组织工程研究,2011,15(13):2313-2316.