[CT-based assessment score after ventral spondylodesis for thoracolumbar spine fracture]. / CT-basierter Auswertungsscore nach ventraler Spondylodese bei thorakolumbalen Wirbelfrakturen.

BACKGROUND: Dorsoventral stabilization is a common procedure to treat thoracolumbar spine fractures. Especially in respect of the evaluation of alternative procedures to autogenous bone graft, a standardized evaluation score for ventral spondylodesis is necessary. PATIENTS AND METHODS: In a group of 44 patients a follow-up CT scan was evaluated with a standardized scoring system by four different independent evaluators (a trauma surgeon, an orthopedic surgeon, and two radiologists). The score is based on the morphologic classification of the region between graft and vertebral body. It allows a classification of the spondylodesis as sufficient, partial, and not sufficient. RESULTS: The statistical evaluation of the classification of the different evaluators shows very good interobserver agreement in monosegmental fusion and good agreement in bisegmental fusion. CONCLUSION: The demonstrated score is easy to handle, does not need special equipment for CT scans, and shows good interobserver agreement in the classification of spinal fusion after ventral spondylodesis for thoracolumbar spine fracture.

The effect of ventilation on aortic blood gases during left ventricular ejection before separation from cardiopulmonary bypass.

The time to begin ventilating a cardiac surgical patient recovering from hyperkalemic arrest is controversial. Those who advocate ventilating as soon as the left ventricle begins to eject believe that blood ejected from the left ventricle is likely to be hypoxic since it perfuses collapsed, nonventilated alveoli and that this may be the major blood supply perfusing the coronary arteries. The present study attempts to answer this question by sampling blood gases from the aorta in proximity to the coronary ostia in patients both before and after ventilation. Ten patients undergoing coronary artery bypass grafting using the left internal mammary artery were studied. Each patient served as his own control. Distal anastomoses were placed under hyperkalemic, hypothermic cardiac arrest. The aorta was unclamped, and an intrinsic or paced heart rate of 70 beats per minute was achieved. The heart was allowed to eject to a pulse pressure of 20 to 40 mmHg. Rectal temperatures were between 32 degrees C and 34 degrees C. Blood gases were drawn simultaneously from the proximal aortic root, radial artery, pulmonary artery, and the venous circuit of the cardiopulmonary bypass (CPB) machine. The lungs were then twice inflated with a sustained positive pressure of 30 cm H2O, and the patient was ventilated (10 mL/kg tidal volume, FIO2 1.0, 10 breaths per minute) for two minutes. Another set of blood gases was then obtained. Filling pressures, aortic systolic and diastolic pressures, and CPB flows were kept constant for both sets of samples. There was no significant difference in aortic root PaO2 attributable to ventilation. PCO2 was significantly lower, and pH was significantly higher in the ventilated group.(ABSTRACT TRUNCATED AT 250 WORDS)