Objective To evaluate and compare the relation of the cl inical results of expansion of open-door cervical laminoplasty (EOLP), C5 nerve root palsy in hinge side, and reclose of the opened laminae with different angles in lamina opendoor.Methods Between July 2006 and January 2009, 198 patients with cervical myelopathy were treated by EOLP. Accordingto different opening angles which were measured by CT scan after operation, the patients were divided into group A (gt; 30°, 76 patients including 44 males and 32 females) and group B (15-30°, 122 patients including 71 males and 51 females). There was no significant difference in gender, age, disease duration, and segmental lesions between 2 groups (P gt; 0.05). The Japanese Orthopaedic Association (JOA) score before and after operation was used for neurological assessment and improvement rate, and the postoperative C5 nerve root palsy and reclose of the opened laminae were recorded. Results There was no significant difference in operation time, bleeding volume, and hospital ization days between 2 groups (P gt; 0.05). After 3 weeks of operation, C5 nerve root palsy in the hinge side occurred in 7 patients (9.2%) of group A, and in 2 patients (1.6%) of group B, were restored after symptomatic treatment, showing significant difference between 2 groups (χ2= 4.568, P= 0.033). All patients were followed up 24 to 48 months. Between group A and group B, no significant difference was found in JOA improvement rate at 24 months after operation (P gt; 0.05), and in JOA score at preoperation and at 24 months after operation (P gt; 0.05), but JOA score was significantly improved at 24 months after operation when compared with preoperative score in the same group (P lt; 0.05). The function of l imb l ifting restored in 9 cases of C5 nerve root palsy at 24 months after operation; CT examination revealed that no reclose occured in group A and reclose occurred in 4 cases (3.3%) of group B, but no persistent symptoms or worsen situationwere found during follow-up. Conclusion Different angles in lamina open-door have the same cl inical result; C5 nerve palsy has good prognosis. The opening angle between 15° and 30° will reduce the incidence of C5 nerve root palsy in the hinge side, but the open side should be firmly fixed to prevent further reclose of the opened laminae.
【摘要】 目的 探討脊柱外科手術患者術后發生譫妄的危險因素和有效防治措施。 方法 2007年1月-2009年10月應用ICU譫妄診斷的意識狀態評估法觀察1 835例脊柱外科術后患者。對于發生術后譫妄的患者隨機分為治療組和未治療組，治療組于譫妄診斷明確時即靜脈注射氟哌利多5 mg。 結果 術后3 d，136例發生譫妄，譫妄發生率為7.41%。篩選出術后譫妄的可能高危因素包括高齡、術前合并高血壓、術前合并糖尿病、術中出血量gt;600 mL、手術時間gt;4 h、術中應用激素、術后電解質紊亂和低氧血癥、術后疼痛。發生譫妄的患者中，治療組（68例）住院時間短于未治療組（68例），差異有統計學意義（Plt;0.05）。 結論 高齡，術前合并高血壓、糖尿病，術中出血量gt;600 mL，手術時間gt;4 h，術中應用激素，術后電解質紊亂、低氧血癥及疼痛是脊柱外科手術患者術后發生譫妄的主要高危因素。氟哌利多治療術后譫妄有效。【Abstract】 Objective To analyze the related factors influencing postoperative phrenitis in patients who have undergone spine surgery. Methods Postoperative phrenitis was evaluated with the confusion assessment method for the intensive care unit in 1 835 patients underwent spine surgery between January 2007 and October 2009. All the patients with postoperative phrenitis were randomly divided into two groups: treatment group and control group. The patients in treatment group underwent intravenous injection with droperidol (5 mg). Results Three days after the operation, 136 patients were diagnosed with postoperative phrenitis. The pre-operative complications of hypertension and diabetes, hemorrhage amount (gt;600 mL) during the operation, operative time (gt;4 hours), hormone usage during the operation, postoperative electrolyte disturbances, hyoxemia and pain were the factors influencing the morbidity of postoperative phrenitis. The length of hospital stay was shorter in the treatment group than that in the control group (Plt;0.05). Conclusions Senility, pre-operative complications of hypertension and diabetes, hemorrhage amount (gt;600 mL) during the operation, operative time (gt;4 hours), hormone usage during the operation, postoperative electrolyte disturbances, hyoxemia and pain were the factors influencing the morbidity of postoperative phrenitis. Droperidol is effective on postoperative phrenitis.