本文選題：無張力 + 撐開器��； 參考：《西南醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:評(píng)價(jià)一種自行制作的無張力撐開器及剝離器在脊髓腹側(cè)腫瘤顯微手術(shù)中的應(yīng)用的安全性和有效。方法:在13例脊髓腹側(cè)腫瘤患者的顯微切除手術(shù)過程中使用自行制作的無張力撐開器及剝離器,并回顧性分析12例常規(guī)使用金屬神經(jīng)剝離器及棉片的病例,對(duì)比手術(shù)的效果及恢復(fù)情況。制作方法:制作無張力撐開器:使用腰穿腦脊液測(cè)壓管一根并將其下端減去使之成為一根直的測(cè)壓管,并將其剪去一端使之成為22cm長(zhǎng);剪裁一個(gè)一次性輸液器,選取輸液管和漏斗備用。使用6號(hào)手術(shù)手套,剪裁小指指套使之成為一個(gè)約直徑1cm的半球形,將這個(gè)半球形與輸液器的輸液管連接,而這個(gè)輸液管的另一端與測(cè)壓管的一端連接在一起使之成為不漏水的水囊。另一端使用輸液器的漏斗與測(cè)壓管的另一端相連,形成一個(gè)封閉的系統(tǒng)。制作無張力剝離器:使用腰穿腦脊液測(cè)壓管一根并將其下端減去使之成為一根直的測(cè)壓管,并將其剪去一端使之成為22cm長(zhǎng);剪裁一個(gè)一次性輸液器,選取輸液管和漏斗備用。使用6號(hào)手術(shù)手套,剪裁小指指套使之成為一個(gè)約直徑1cm的半球形,測(cè)壓管的一端連接在一起使之成為不漏水的水囊。另一端使用輸液器的漏斗與測(cè)壓管的另一端相連,形成一個(gè)封閉的系統(tǒng)。將自制的無張力撐開器用手套制成的水囊置于腫瘤上下兩端的脊髓和硬膜之間,緩緩打開開關(guān)并逐漸將測(cè)壓管豎直,調(diào)整測(cè)壓管的高度,使測(cè)壓管內(nèi)水柱高度不超過20cm水柱。從而達(dá)到顯露腫瘤的目的。結(jié)果:13例腫瘤顯露滿意,并且都做到了全切除,11例術(shù)后神經(jīng)功能逐漸恢復(fù),尤其是其中有一例上頸段腫瘤,術(shù)后癥狀改善明顯,以下肢無力恢復(fù)最為明顯,9例下肢無力患者均有肌力的明顯恢復(fù)。無手術(shù)死亡病例,術(shù)后隨訪6個(gè)月,無復(fù)發(fā)及脊柱畸形。與回顧性資料相比較,使用JOA評(píng)分,與回顧性資料相比較術(shù)后改善率,P0.05,有統(tǒng)計(jì)學(xué)意義,可以認(rèn)為實(shí)驗(yàn)組術(shù)后改善率占優(yōu)勢(shì)。結(jié)論:和傳統(tǒng)的器械相比,使用這種無張力撐開器及剝離器在脊髓腹側(cè)顯微手術(shù)中,可以使顯露更佳,更有利于完成手術(shù),安全有效。
[Abstract]:Objective: to evaluate the safety and effectiveness of a self-made tension-free distractor and dissection in microsurgery for ventral spinal cord tumors. Methods: thirteen patients with ventral spinal cord tumor were treated with self-made tension-free distraction apparatus and dissecting apparatus, and 12 cases with conventional use of metal nerve dissecting apparatus and cotton slice were analyzed retrospectively. The effect and recovery of the operation were compared. How to make a tensionless distractor: use a lumbar puncture cerebrospinal fluid manometry tube and subtract it into a straight barometric tube at the lower end, and cut off one end to make it 22cm long; cut a disposable infusion tube. Select infusion tube and funnel to reserve. Using the surgical glove No. 6, the little finger sleeve is cut to make it a hemispherical shape about the diameter of 1cm, which is connected to the infusion tube of the infusion device. The other end of the infusion tube is connected to one end of the barometric tube to make it a watertight bag. The funnel at the other end of the transfusion is connected to the other end of the barometer to form a closed system. Make a tensionless stripper: use a lumbar puncture cerebrospinal fluid manometry tube and subtract it into a straight barometric tube, and cut off one end to make it 22cm long; cut a disposable infusion device and select the infusion tube and funnel to reserve. Using surgical glove No. 6, the little finger sleeve is cut to make it a hemispherical shape about the diameter of 1cm, and one end of the pressure tube is connected together to make it a watertight sac. The funnel at the other end of the transfusion is connected to the other end of the barometer to form a closed system. The water sac made with gloves made by ourselves is placed between the spinal cord and dura of the upper and lower ends of the tumor, slowly opening the switch and gradually straightening the pressure measuring tube, adjusting the height of the pressure measuring tube, so that the water column height in the pressure measuring tube does not exceed the 20cm water column. In order to achieve the purpose of exposing the tumor. Results 13 cases of tumors showed satisfactory exposure, and all of them achieved total excision in 11 cases. The neurological function recovered gradually after operation, especially in one case of upper cervical segment tumor, and the symptoms were improved obviously after operation. The recovery of lower extremity weakness was most obvious in 9 patients with lower extremity weakness. No postoperative death, 6 months follow-up, no recurrence and spinal deformity. Compared with the retrospective data, the improvement rate of JOA score was significantly higher than that of the retrospective data (P 0.05), and the improvement rate of the experimental group was higher than that of the control group. Conclusion: compared with the traditional instruments, the use of the tension-free distractor and dissection device in the ventral spinal cord microsurgery can make it more exposed, more conducive to the completion of the operation, safe and effective.
【學(xué)位授予單位】：西南醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R739.42

【參考文獻(xiàn)】

相關(guān)期刊論文 前10條

1 菅鳳增;;脊柱穩(wěn)定性與脊柱內(nèi)固定[J];中華神經(jīng)外科雜志;2013年09期

2 王貴懷;;脊髓腫瘤的診療現(xiàn)狀[J];中國(guó)微侵襲神經(jīng)外科雜志;2010年03期

3 謝京城;王振宇;馬長(zhǎng)城;李振東;劉彬;陳曉東;;660例椎管內(nèi)腫瘤的手術(shù)治療[J];中國(guó)微創(chuàng)外科雜志;2009年10期

4 劉衛(wèi)華;李鑫;;經(jīng)皮前路寰樞關(guān)節(jié)螺釘內(nèi)固定術(shù)的應(yīng)用解剖學(xué)研究[J];四川醫(yī)學(xué);2009年06期

5 王勝;徐華梓;池永龍;林焱;黃其杉;毛方敏;王向陽(yáng);倪文飛;;內(nèi)鏡下上頸椎前方咽后入路的應(yīng)用解剖學(xué)研究[J];中華顯微外科雜志;2007年06期

6 石志才;張曄;白玉樹;毛寧方;章篩林;栗景峰;傅強(qiáng);連小峰;;脊柱手術(shù)中脊髓損傷的危險(xiǎn)因素分析及其預(yù)防策略[J];脊柱外科雜志;2007年03期

7 宮明智;張麗;邢德國(guó);劉中浩;尹志勝;;手術(shù)前應(yīng)用七葉皂苷鈉對(duì)大鼠脊髓牽拉損傷后的行為及誘發(fā)電位的影響[J];山東大學(xué)學(xué)報(bào)(醫(yī)學(xué)版);2006年05期

8 吳昊天,吳月欣,李增炎,張英澤,王鵬程;脊髓受壓時(shí)間與損傷程度的相關(guān)性研究[J];中華物理醫(yī)學(xué)與康復(fù)雜志;2005年02期

9 幸永明,王振林,陳昌偉,李重茂,趙國(guó)強(qiáng),趙宏;醫(yī)源性脊髓神經(jīng)損傷的預(yù)防與治療[J];中國(guó)矯形外科雜志;2005年04期

10 劉e，

本文編號(hào)：1922460