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首页 > 医学词汇大全 > Laminectomy
Laminectomy

骨科

关键词骨科 治疗方法 椎管病变

词汇介绍

拓展阅读

解析

laminectomy  /,læmɪ'nektəmɪ/   /,læmɪ'nɛktəmi/      

释义   n. [外科] 椎板切除术

例句   In patients with cervical stenosis with myelopathy, posterior instrumentation following cervical laminectomy has been shown to reduce the incidence of postoperative instability and kyphosis. 颈椎脊髓病致椎管狭窄的患者,椎板切除后路固定可以减少术后不稳及后凸畸形发生。


概述

概述


椎板切除术的目的是探明椎管内病变的性质和程度,进行椎管内病变的手术治疗,也用于解除椎管的压迫物,使受压的脊髓或神经根恢复其功能,消除症状。1900SachsFrankel首先报告用全椎板切除术治疗椎管狭窄症,由于疗效较好,得到人们认可并被广泛应用。


适应征


脊髓压迫症,椎管内的肿瘤和其他占位性病变,脊柱骨折、脱位或其他损伤所引起的脊髓或马尾神经受压,椎管内感染性病灶,如硬脊膜外脓肿、硬脊膜下积脓和炎性肉芽肿(特异性、非特异性),损伤或炎症后的粘连,椎管内寄生虫病,椎管内异物等。


需手术治疗的椎管内血管性病变,如脊髓血管畸形,海绵状畸形等。


先天畸形  如脊柱裂、脊膜膨出等。


需行脊髓或脊神经手术时,如脊髓空洞分流术,脊髓神经束或脊神经根切断术。


增生性或肥大性脊椎病引起椎管狭窄或神经根受压者,如颈椎病、椎间盘突出症等。


禁忌症


手术部位有感染或褥疮。


全身情况较差,或身体主要脏器功能障碍,不能耐受手术。


术后处理  


术后仰卧或侧卧,最好卧硬板床。翻身时应使身体平直,避免扭曲。


术后应严密观察有无肢体功能障碍加重,感觉平面有无上升下降,如有上升,表明脊髓功能有进一步损害,应积极找出原因,及时处理。颈椎手术者应密切注意呼吸情况。


注意创口引流有无脑脊液流出,如脑脊液流出较多,应考虑提前拔除引流。一般引流在术后24-48h拔除。


有截瘫者应按截瘫护理。


高颈段手术后,有时可发生中枢性高热,应及时处理。


Optimizing the Volume-Value Relationship in Laminectomy An Evidence-Based Analysis of Outcomes and Economies of Scale复制标题

优化椎板切除术的体积-价值关系: 结局和规模经济的循证分析

发表时间:2019-05-01

影响指数:3.1

作者: Frankel William C

期刊:SPINE

Age-associated degenerative disease of the spine is highly prevalent in the United States, and is the most common indication for spinal surgery in patients 65 years of age and older. Estimates of the direct costs associated with spine surgery have been reported as high as $100 billion. Given its rising utility and high associated costs, laminectomy represents an ideal candidate for value-based analysis. Value in the context of health care can be defined as the proportion of the beneficial outcomes provided by a health care service to the cost of rendering that service. Market and regulatory forces have pushed current surgical practice towards a more value-based bundled payment model focused on value alignment.Analyses of several surgical procedures have revealed that higher surgeon and hospital volumes are correlated with improved patient outcomes–whether via additional surgeon experience, streamlined surgical protocols, or comprehensive multi-disciplinary care teams. Additionally, higher volume surgeons and hospitals are able to render these improved outcomes at a lower cost, a well described phenomenon in business management referred to as “economies of scale.” The relationship between procedural volume and value of care delivered has been increasingly investigated in the setting of spinal decompression surgery. To our knowledge, only one previous study by Schoenfeld, et al. has used data-driven methodology to establish volume benchmarks for surgeons and hospitals performing spinal decompression surgery, although this study was limited by producing only a single threshold. At present, there remains a need for determining additional evidence-based volume thresholds in the setting of laminectomy in order to stratify surgeons and hospitals into multiple volume categories and ultimately provide a clinically translatable volume-value relationship for laminectomy.

译文

年龄相关的脊柱退行性疾病在美国非常普遍,并且是65岁及以上患者脊柱手术的最常见适应症。据报道,与脊柱手术相关的直接成本估计高达1000亿美元。鉴于其实用性和相关成本的增加,椎板切除术是基于价值的分析的理想候选者。医疗保健背景下的价值可以定义为医疗保健服务提供的有益结果与提供该服务的成本的比例。市场和监管部门已将当前的外科手术推向了一种更注重价值结合的基于价值的捆绑式支付模式。对几种外科手术程序的分析表明,无论是通过额外的外科医生经验,简化的手术方案还是全面的多学科护理团队,更高的外科医生和医院数量都与患者预后的改善相关。此外,更高容量的外科医生和医院能够以更低的成本实现这些改善的结果,这是业务管理中被称为“规模经济”的良好描述的现象。程序量和提供的护理价值之间的关系越来越多地被调查。脊柱减压手术的设置。据我们所知,Schoenfeld等人之前只有一项研究。他曾使用数据驱动的方法为外科医生和医院进行脊柱减压手术建立了量基准,尽管这项研究仅限于产生一个阈值。目前,仍然需要在椎板切除术中确定额外的基于证据的体积阈值,以便将外科医生和医院分层为多个体积类别,并最终为椎板切除术提供临床可翻译的体积 - 值关系。

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