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OBJECTIVE:To investigate the effects of dexmedetomidine on neuron injury indexes,inflammatory factors and spinal cord function of cervical operation patients. METHODS:Totally of 112 patients underwent cervical operation of general anesthesia in our hospital during May 2015 to Nov. 2017 were divided into control group and dexmedetomidine group according to random number table,with 56 cases in each group. Anesthesia of both groups was totally maintained by intravenous anesthesia. Dexmedetomidine group was given intravenous infusion of Dexmeimidine hydrochloride injection with loading dose of 0.8 μg/kg and injection time of more than 10 min before anesthesia maintenance,and then was continuously pumped to 30 min before operation at the rate of 0.4 μg/(kg·h). The levels of neuron injury indexes (GFAP,NSE,MMP-9) and inflammatory factors (TNF-α,IL-6,IL-10)of 2 groups were observed before anesthesia induction(T0),1 h after operation(T1),1 d after operation (T2),7 d after operation (T3). Japanese Orthopedics Academy (JOA) scores of cervical vertebra were observed in 2 groups before operation and 7 d after operation,and VAS scores were also observed in 2 groups 1 d and 7 d after operation. The occurrence of ADR was recorded. RESULTS:Each 3 patients of 2 groups withdrew from the study,and each 53 patients of 2 groups completed the study. There was no statistical significance in neuron injury indexes or serum levels of inflammatory factors between 2 groups at T0 (P>0.05). At T1-T3,above indexes of both groups were significantly higher than at T0;the levels of GFAP,NSE,MMP-9,TNF-α and IL-6 in dexmedetomidine group were significantly lower than control group,while the level of IL-10 was significantly higher than control group,with statistical significance (P<0.05). There was no statistical significance in JOA score or VAS score between 2 groups before operation or 1 d after operation (P>0.05). Seven days after operation,JOA scores of 2 groups were increased significantly,while VAS scores were decreased significantly,with statistical significance(P<0.05);but there was no statistical significance between 2 groups (P>0.05). No obvious ADR was found in 2 groups. CONCLUSIONS:Additional use of dexmedetomidine before anesthesia maintenance can improve the serum levels of inflammatory factors in cervical operation patients,and relieve neuron spinal cord and injury to certain extent,but would not influence the safety of drug use.
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Objective@#To determine the feasibility and safety of anterior cervical decompression and fusion in severe cervical kyphosis treatment.@*Methods@#Totally 29 patients with severe cervical kyphosis(Cobb angle>50°) underwent anterior cervical decompression and fusion from June 2008 to May 2016 were studied retrospectively. There were 19 males and 10 females. The average age was 32.6 years ranging from 14 to 53 years. According to the etiology, 12 patients had iatrogenic deformity (11 had post-laminectomy cervical kyphosis, 1 had kyphosis due to anterior graft subsidence), 5 had neurofibromatosis, 4 had infective kyphosis, 8 had idiopathic cervical kyphosis. The curvature of cervical angle was measured by two-line Cobb method. The severity of cervical kyphosis was evaluated by kyphosis index (KI). Parameters including kyphosis levels, the apex of the kyphosis, C2-7 sagittal vertical axis(SVA) and T1 slope were also measured on lateral radiographs in the neutral position in each patient. The pre- and post-operative Japanese Orthopaedic Association(JOA) scores, visual analogue scale (VAS) of neek pain, neck disability index (NDI) and cervical alignment were compared. All patients were treated by skull traction. Motor evoked potential and somatosensory evoked potential were applied intraoperation as the spinal cord monitor.@*Results@#Skull traction was performed for an average of 6.3 days. The mean vertebral number in kyphotic region was 4.7. The average operation time was 155 minutes and blood loss was 135 ml. The preoperative C2-7Cobb angle was 46.6°±18.1° in average. It was reduced to 11.4°±6.4° in average after operation. The Cobb angle of operation region was 72.9°±19.6° in average before operation. It was reduced to 11.2°±6.4° in average after operation. The kyphosis region correction rate was 84.6%. The mean preoperative C2-7SVA changed from (3.8±14.6) mm to (12.6±7.8) mm postoperatively. The mean preoperative T1 slope changed from -10.6°±16.4° to 7.1°±14.9° postoperatively. The average postoperative C2-7 Cobb angle, Cobb angle of kyphosis region, KI, C2-7 SVA and T1 slope changed significantly compared with preoperation (F=12.700-218.200, all P<0.01). The average postoperative JOA, VAS and NDI scores improved significantly compared with preoperation (F=225.500, 217.900, 131.200, all P<0.01).@*Conclusion@#For severe cervical kyphosis, anterior correction is a safe and effective technique, sufficient decompression will be achieved.
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Objective To develop an autopsy table for the cervical surgery of the small animal to enhance the efficiency by regulating the angles during the operation to expose cervical vertebra adequately.Methods The autopsy table was composed of a table body,a head rack and a foot rack.The head rack was connected with the body by a loose-leaf shaft,which had a screw under a semi-cylindrical cushion put into a sliding slot of the cushion to regulate and fix its position.The table body had four straps at its comers to imobilize the extremities of the experimental animal,and some screws were used to adjust and position the straps to four oblique sliding slots.Results The autopsy table adapted itself to sizes of small animals,which gained advantages in exposure of operating field,short operating time,decreased intraoperative blood loss,head imobilization as well as reduced workload.Conclusion The autopsy table enhances surgery efficiency and safety and has easy operation and low cost,and thus is worthy promoting in the cervical experiment of small animals.
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Objective To develop an autopsy table for the cervical surgery of the small animal to enhance the efficiency by regulating the angles during the operation to expose cervical vertebra adequately.Methods The autopsy table was composed of a table body,a head rack and a foot rack.The head rack was connected with the body by a loose-leaf shaft,which had a screw under a semi-cylindrical cushion put into a sliding slot of the cushion to regulate and fix its position.The table body had four straps at its comers to imobilize the extremities of the experimental animal,and some screws were used to adjust and position the straps to four oblique sliding slots.Results The autopsy table adapted itself to sizes of small animals,which gained advantages in exposure of operating field,short operating time,decreased intraoperative blood loss,head imobilization as well as reduced workload.Conclusion The autopsy table enhances surgery efficiency and safety and has easy operation and low cost,and thus is worthy promoting in the cervical experiment of small animals.
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Objective To investigate the influence of preoperative training of pushing trachea and esophagus or not on cervical operation by anterior approach.Methods All patients were randomly divided into two groups:experimental group and control group (56 cases,respectively).Patients in the former group had no training of pushing trachea and esophagus,while patients in the latter group had,recording the data of surgery duration,operator's degree of satisfaction,blood loss,blood pressure,heart rate,and oxygen saturation during operation,hospital stay and cost.Meanwhile,we observed and compared the VAS scores and the complication rate etc.between two groups.Results There were no differences between two groups in surgery duration,operator's degree of satisfaction,blood loss,blood pressure,heart rate,and oxygen saturation during operation,hospital stay and cost,nor in the VAS scores and the throat-related complications rate.The hospital stay and cost of patients in experimental group were longer and higher than that of patients in control group,(7.3±1.6) d vs (5.8±1.4) d,(48 468.3±4 313.8) vs (45 228.4±4 124.6) yuan,t=5.280,4.062,P＜0.05.Conclusions Training of pushing trachea and esophagus has no influence in the throat-related complications rate,VAS scores and operator's degree of satisfaction.Instead,training of pushing trachea and esophagus increases hospital stay and cost and amount of nurse's work.So,it's not necessary to undertake the preoperative training before cervical operation by anterior.