Percutaneous vertebral augmentation (PVA) and percutaneous cement discoplasty (PCD) are two relatively new minimally invasive surgeries for symptomatic Schmorl's reported in recent decade. However, the clinical evidence for the effectiveness of these two surgeries is insufficient. The purpose of this study was to compare the biomechanical benefits and risks of the two surgeries in order to analyze their biomechanical differences and effectiveness. We reconstructed Five lumbar finite element models via computed tomography data, including control model, PVA-ideal model, PVA-nonideal model, PCD-ideal model, and PCD-nonideal model. The stress and strain of Schmorl's nodes, bone marrow edema zone (BMEZ), affected endplate, and the overall stability of segment were analyzed and compared. The validity of our models was confirmed. As a result, the PVA-ideal model can significantly reduce the stress of Schmorl's node and the strain of BMEZ, while this effect is inappreciable in PVA-nonideal model. The PCD-ideal model significantly reduced the strain of Schmorl's nodes and BMEZ, and significantly improve segmental stability, but also resulted in a significant increase in the stress of Schmorl's nodes, BMEZ and endplates. The PCD-nonideal model not only lacks blocking effect, but also sharply increases the strain of Schmorl's nodes and BMEZ. Thus, We recommend that both PVA and PCD surgeries in ideal distribution facilitated a more stable paranodular biomechanical microenvironment. However, due to the possibility of poor biomechanical outcomes caused by the non-ideal cement distribution, the non-ideal distribution of bone cement needs to be remedied in practice.

目的 观察风险主动自查与超前自纠管理模式在骨科手术安全管理中的应用效果.方法 该院2019年7—9月开展风险主动自查与超前自纠管理活动,开展前后各抽取骨科手术患者100例,开展期间无护理人员变动,比较护理人员风险管理能力评分、护理缺陷事件发生率及患者护理满意度评分.结果 活动开展后骨科手术室护理人员各项风险管理评分和患者各项护理满意度评分高于开展前,差异均有统计学意义(P<0.05);活动开展后护理缺陷事件发生率(2.0％)低于开展前(7.0％),但差异无统计学意义.结论 将风险主动自查与超前自纠管理模式应用于骨科手术室安全管理中,可提升护理人员风险管理能力,降低护理缺陷事件发生率,提高患者护理满意度.

Study design : Finite element simulation study. Objective : To compare the biomechanical effects of percutaneous vertebral augmentation (PVA) and percutaneous cement discoplasty (PCD) in patients with symptomatic Schmorl’s node combined with Modic change. Methods : CT data from a single patient was assembled into finite element models, from which we constructed four distinct surgical models, including PVA-ideal, PVA-nonideal, PCD-ideal, and PCD-nonideal, to compare the stress and strain differences of parapodular tissues. Results : The validity of our model was confirmed. PVA-ideal model showed a moderate reduction in the stress peak of the Schmorl’s node (0.48 vs. 0.81–0.89 Mpa) in the erect position. In the PCD-ideal model, the stress peak of the Schmorl’s node increased significantly when the spine was moved toward the lesion (3.99Mpa). Both PVA-ideal and PCD-ideal models showed global strain inhibition at the Schmorl’s node and BMEZ, which was attenuated in the non-ideal models. The PCD-ideal model significantly reduced segmental ROM (-76.8% to -59.3%) and significantly increases endplate stress (up to 220.8%), with no such effects seen in the PVA-ideal model. Conclusions : Both PVA-ideal and PCD-ideal models facilitated a more stable parapodular biomechanical microenvironment. The PVA-ideal model yielded minimal stress disturbance on the augmented or adjacent vertebral endplate but offered no improvement to segment stability. The PCD-ideal model provides adequate segment stability, but also carries a greater risk for adjacent vertebral fracture. As nonideal implementations of both surgeries can result in poor biomechanical outcomes, the surgical indications of PVA or PCD need to be carefully selected.

目的 探讨医疗失效模式与效应分析(HFMEA)管理模式对脊柱后路手术患者压疮的预防作用.方法 2019年1月至2020年12月在该院行脊柱后路手术的患者65例,按入院时间先后顺序分为对照组33例与观察组32例.对照组实施常规护理,观察组采用HFMEA管理模式的护理.比较两组压疮发生率及压疮分期、压疮恢复时间、术后72h压疮恢复程度、患者满意度.结果 观察组压疮发生率(6.3％)低于对照组(27.3％),压疮程度轻于对照组,压疮恢复时间短于对照组,术后72h压疮恢复评分高于对照组,整体满意率(100％)明显高于对照组(78.8％),差异均有统计学意义(P<0.05).结论 HFMEA管理模式可有效预防脊柱后路手术患者压疮发生,加快压疮患者的恢复,并提高患者满意度.

局部麻醉对患者机体的生理干预少,医疗费用低,术后恢复快,被越来越多地应用于临床.但因为局部麻醉手术中患者处于清醒状态,高龄患者更容易产生恐惧、焦虑心理[1].同时,心理高度恐惧的患者对疼痛的敏感性增高[2].细节护理可以显著提高手术室护理的质量,缓解手术室患者焦虑、抑郁情绪[3].因此,本研究探讨细节护理用于高龄脊柱骨折局部麻醉手术的效果,并观察对患者疼痛和焦虑的影响,现报道如下.