骨科
词汇介绍
拓展阅读
解析
laminectomy 英 /,læmɪ'nektəmɪ/ 美 /,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。1900年Sachs和Frankel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
①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。
②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。
③先天畸形 如脊柱裂、脊膜膨出等。
④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。
⑤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
①手术部位有感染或褥疮。
②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
①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。
②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。
③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。
④有截瘫者应按截瘫护理。
⑤高颈段手术后，有时可发生中枢性高热，应及时处理。
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.
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