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单开门椎板成形术联合椎间孔切开术与颈椎前路间盘切除融合术治疗伴发单侧神经根症状的脊髓型颈椎病的比较：短期疗效研究

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单开门椎板成形术联合椎间孔切开术与颈椎前路间盘切除融合术治疗...

作者： sandip kumar yadav 天津医科大学

学位级别：硕士

研究背景多节段脊髓神经根型颈椎病是指多节段脊髓受压,功能异常,同时引起伴有神经根直接受压而发生的一种疾病。最常见于大于55岁的年迈患者。最常见的原因为退行性骨关节炎和先天性狭窄,造成颈椎管、神经根管狭窄。其次为后纵韧带骨... 详细信息

研究背景多节段脊髓神经根型颈椎病是指多节段脊髓受压,功能异常,同时引起伴有神经根直接受压而发生的一种疾病。最常见于大于55岁的年迈患者。最常见的原因为退行性骨关节炎和先天性狭窄,造成颈椎管、神经根管狭窄。其次为后纵韧带骨化、黄韧带肥厚、创伤等原因。根据不同的脊髓功能障碍及其发病进程,MCM的患者症状可以为隐匿进行,也可能迅速致残。如病人可无症状或严重残疾。通常的表现是平衡,协调性差的损失,降低灵巧,无力,麻木,严重时会出现瘫痪。正常颈椎管在17-18mm(个别变异可能与性别相关),它具有充分的空间容纳神经根、硬脑膜、韧带和硬膜外脂肪。当因为退变等原因,椎管直径降至12-14mm时,即可能出现颈椎管狭窄及髓性症状。脊髓型颈椎病的病理生机制括静态因素,导致先天性或发育狭窄;和动态因素,如运动过程中脊柱微动可导致对脊髓的反复性损伤。手术减压是治疗的首选。目前相关文献报道,主要有两种术式：颈椎前路椎间盘切除术与融合术(ACDF)和椎板成形术。传统的后路椎板成形术并不能解除椎间孔狭窄对神经根的压迫,术后根性症状缓解不满意。而有报道前路手术并发症发生率高,主要为邻近节段椎间盘退变加速等。在本次研究中,我们比较了传统的单开门椎板成形术联合椎间孔切开术与前路间盘切除cage植入内固定术,两种术式的手术效果。目前为止,尚无该两种术式治疗混合型颈椎病(脊髓神经根型颈椎病)临床结果比较的研究。研究设计和目的这是一个单中心前瞻性临床对照研究。评估单开门椎板成形术联合椎间孔切开(Expansion Open-door Laminoplasty with Foraminotomy, EOLF)与前路间盘切除减压融合术(Anterior Discectomy and Fusion, ACDF)治疗脊髓神经根型型颈椎病的临床结果及影像学结果是否存在统计学差异评估从术前开始,随访1年。临床结果及影像学测量方法是确定诊断及评估手术效果及并发症的依据。材料与方法自2011年12月至2012年12月,60例(33例男性,27例女性,平均年龄58.6岁)多节段脊髓型颈椎病伴有单侧神经根型颈椎病患者被那入该项研究。分别为ACDF(前路间盘切除减压融合术组)和EOLF(单开门椎板成形术联合椎间孔切开组)。入选的53例病人中,ADF:EOLF:29/31,平均57.6岁。据影像学脊髓受压节段：C3/4C5/6,28例;C4/5-C6/7,32例。据影像学神经根受压节段：C3/4,3例;C4/5,11例;C5/6,22例;C6/7,8例;C4/5—C5/6,10例,C5/6-C6/7,6例。所有病例术后随访至少1年。入选标准： 1)因椎间盘退变突出引起的脊髓神经根型颈椎病;2)脊髓受压节段3个;3)单侧神经根受压症状;4)随访期≥1年。排除标准： 1)伴有后纵韧带骨化、黄韧带肥厚增生;2)后凸畸形>15°及节段失稳者;3)既往有颈椎外伤或手术史;4)临床表现为双侧神经根受压症状者。应用日本骨科协会(Japanese Orthopedic Association, JOA)评分系统评价颈椎病手术前后的功能情况;术前及术后1年椎体后缘切线法测量颈椎曲度及颈椎活动度：1,颈椎曲度：颈椎矢状位排列,根据中立位时侧位片上C2和C7椎体后缘切线夹角进行测定;2,颈椎活动度(Range of Motion, ROM):颈椎过屈位与过伸位活动度之和。此外术中的出血量、手术时间、术后并发症等均被记录。统计学分析应用SPSS19.0统计学软件进行处理,数据JOA评分及改善率以x±s表示,比较采用独立样本t检验。检验水准P<0.05为差异具有统计学意义。结果最初60例病人,其中5人失访,55例病人最后追踪纳入研究,EOLF组28例,平均年龄58.2±12.9岁。ACDF组27例,平均年龄56.8±11.7岁。与ACDF组比较,EOLF组表现为手术时间更短(178vs.144min)出血量更少(192vs.175mL),(P<0.05),且出现更少的并发症,两组术后1年随访时,JOA评分及改善率没有明显差异。ACDF组颈椎曲度由13.7到16.2°,而EOLF组14.6降到13.3°(P<0.05),两组((ACDF/EOLF)颈椎活动度比较57.4%versus74.7%(P<0.05). 结论：对多个节段退变的脊髓神经根型颈椎病,采用颈后路单开门椎管成形术联合椎间孔切开可取得良好的手术效果,且手术时间短,出血少,相对安全。将椎间孔后壁切开时,上下关节突内侧缘切除范围应≤50%.这样不仅缓解根性症状且不至于使脊椎失稳,我们希望其未来能进行类似的大样本量的前瞻性研究,增强我们研究数据的说服力,为外科医师制定手术方案提供更多依据。

关键词：多节段脊髓型颈椎病合并神经根颈椎病单开门椎管成形术联合椎间孔切开术前路间盘切除融合术前瞻性对比研究

胸椎黄韧带骨化合并后纵韧带骨化行单纯后路减压治疗的预后影响因素分析

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中华外科杂志 2012年第12期50卷 1076-1081页

作者：孙天威张黎龙张杭卢守亮 sandip kumar yadav 天津市人民医院脊柱外科 300121

目的研究胸椎黄韧带骨化症（OLF）合并后纵韧带骨化（OPLL）采用单纯后路减压手术治疗的预后影响因素。方法对2006年1月至2010年6月经手术治疗且完整随访的83例胸椎OLF合并OPLL患者资料进行回顾性分析，对可能影响患者预后的因素，如性... 详细信息

目的研究胸椎黄韧带骨化症（OLF）合并后纵韧带骨化（OPLL）采用单纯后路减压手术治疗的预后影响因素。方法对2006年1月至2010年6月经手术治疗且完整随访的83例胸椎OLF合并OPLL患者资料进行回顾性分析，对可能影响患者预后的因素，如性别、年龄、病程、术前及术后日本骨科协会（JOA）评分、病变节段、胸椎OPLL骨化类型、胸椎后凸角度、前方胸椎OPLL程度、胸椎OLF减压节段数、术前是否存在二便功能障碍、术后是否存在脑脊液漏及是否合并颈腰椎疾患等因素进行）（χ2检验和Logistic回归统计分析。结果根据术后JOA评分改善率分为优良组（58例）和不良组（25例），两组间年龄、术前JOA评分及病程等患者一般资料无统计学意义（P〉0．05）。在病变节段（χ2=6．290，P=0．043）、OPLL骨化类型（χ2=5．361，P=0．021）和术前存在二便功能障碍（χ2=27．711，P=0．000）等方面差异具有统计学意义；Logistic回归分析发现病变位于上段胸椎（P=0．044）、OPLL鸟嘴型（P=0．023）及术前存在二便功能障碍（P=0．009）与预后影响关系密切。术后24例（28．9％）患者出现脑脊液漏，3例患者术后早期出现深部感染，2例患者术后神经功能恶化。结论上胸段骨化症预后较好，但存在鸟嘴型OPLL、术前存在二便功能障碍的患者预后不良，跳跃性多节段骨化症及合并重度颈腰椎疾患是预后不良的影响因素。

关键词：黄韧带骨化,后纵韧带减压术,外科胸椎椎管狭窄预后

单开门椎管成形术与全椎板减压融合内固定术治疗脊髓型颈椎病的临床疗效比较

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中国修复重建外科杂志 2012年第10期26卷 1191-1196页

作者：张杭孙天威卢守亮李清江 sandip kumar yadav 天津医科大学天津市人民医院脊柱外科天津300070

目的探讨颈后路单开门椎管成形术与全椎板减压侧块螺钉植骨融合内固定术治疗脊髓型颈椎病的临床疗效。方法 2006年9月-2009年9月,对143例多节段(≥3个)脊髓型颈椎病患者分别采用颈后路单开门扩大椎管成形术(A组,87例)及全椎板减压侧块... 详细信息

目的探讨颈后路单开门椎管成形术与全椎板减压侧块螺钉植骨融合内固定术治疗脊髓型颈椎病的临床疗效。方法 2006年9月-2009年9月,对143例多节段(≥3个)脊髓型颈椎病患者分别采用颈后路单开门扩大椎管成形术(A组,87例)及全椎板减压侧块螺钉植骨融合内固定术(B组,56例)治疗,两组患者性别、年龄、病程、病变分型、病变节段等一般资料比较差异均无统计学意义(P>0.05),具有可比性。随访观察并比较两组患者手术时间、术中出血量、术后神经功能恢复[采用日本骨科协会(JOA)17分评分法]及手术并发症发生情况,并对两组患者手术前后颈椎曲率指数(cervical curvature index,CCI)、颈椎活动度(range of motion,ROM)及颈肩部疼痛[采用疼痛视觉模拟评分(VAS)及颈椎功能障碍指数量表(NDI)评分]等指标进行评估。结果两组患者手术时间和术中出血量比较差异均无统计学意义(P>0.05)。两组患者均获随访,随访时间18～30个月,平均24个月。A、B组术后分别有4例(4.60%)和5例(8.93%)出现C5神经根麻痹症状,比较差异无统计学意义(χ2=0.475,P=0.482)。两组术后均无深部感染、假关节形成及螺钉松动需再手术等并发症发生。A组患者术后均无椎板再关门发生;B组患者末次随访时无螺钉脱出、断裂及继发神经损伤等发生。末次随访时A、B组分别有35例(40.23%)和11例(19.64%)有颈部轴性症状,比较差异有统计学意义(χ2=6.612,P=0.009)。两组患者术前JOA评分、CCI、颈椎ROM及VAS评分比较差异均无统计学意义(P>0.05);末次随访时两组JOA评分、颈椎ROM、VAS评分及A组CCI均较术前有显著改善(P0.05);A组ROM大于B组,CCI小于B组,差异有统计学意义(P<0.05);末次随访时NDI评分,A组在疼痛程度、上举能力、工作、驾车、反应及总分方面均显著优于B组(P<0.05)。结论两种手术方式在术后神经功能改善率上无明显差异,全椎板减压植骨融合内固定术能有效缓解术前疼痛,但颈椎活动度降低较大;单开门椎管成形术并发症较少,近期疗效满意。

关键词：脊髓型颈椎病单开门椎管成形术全椎板减压融合轴性症状

Adaptive sampling for generalized probabilistic roadmaps

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控制理论与应用（英文版） 2012年第1期10卷 1-10页

作者： sandip kumar Suman CHAKRAVORTY Department of Aerospace Engineering Texas A&M University College Station

In this paper, an adaptive sampling strategy is presented for the generalized sampling-based motion plan- ner, generalized probabilistic roadmap （GPRM）. These planners are designed to account for stochastic map and model uncertainty and provide a feedback solution to the motion planning problem. Intelligently sampling in this framework can result in large speedups when compared to naive uniform sampling. By using the information of transition probabilities, encoded in these generalized planners, the proposed strategy biases sampling to improve the efficiency of sampling, and increase the overall success probability of GPRM. The strategy is used to solve the motion planning problem of a fully actuated point robot and a 3-DOF fixed-base manipulator on several maps of varying difficulty levels, and results show that the strategy helps solve the problem efficiently, while simultaneously increasing the success probability of the solution. Results also indicate that these rewards increase with an increase in map complexity.

关键词： Adaptive sampling GPRM Probabilistic roadmaps (PRM) Stochastic maps Model uncertainty Linkmanipulator

Application of Cole-Cole model to transformer oil-paper insulation considering distributed dielectric relaxation

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High Voltage 2019年第1期4卷 72-79页

作者： sandip kumar Ojha Prithwiraj Purkait Biswendu Chatterjee Sivaji Chakravorti Department of Electrical Engineering Haldia Institute of TechnologyHaldia721657West BengalIndia Department of Electrical Engineering St.Thomas'College of Engineering&TechnologyKolkata700023West BengalIndia Electrical Engineering Department Jadavpur UniversityKolkata700032West BengalIndia Electrical Engineering Department Currently at NIT Calicut on lien from Jadavpur UniversityKolkata700032West BengalIndia

Researchers have been exploring dielectric testing techniques both in time and frequency domain for insulation condition assessment of oil-paper insulated *** a practical dielectric system,dipoles are found to behave according to a distribution of elementary Debye relaxation *** distribution density functions have been proposed to characterise such many-body interaction ***-Cole diagrams can be one of the methods for studying the nature of frequency dependency of dielectric materials of complex ***-Cole plots are commonly used for characterising different materials such as dielectric mixtures,ionic liquids,cable insulating oil,polar liquids *** scope of its application for assessing transformer oil-paper insulation considering distributed relaxation process has not been explored *** present contribution discusses mathematical formulations used for transforming the experimentally obtained time domain dielectric response test data to distribution domain and further to frequency domain for obtaining the Cole-Cole *** about the influence of various operating conditions and insulation status on the Cole-Cole diagram have been reported in this *** of tests on field transformers are also *** paper attempts to employ the features of Cole-Cole diagrams as potential indicators for analysing condition of the oil-paper insulation considering distributed relaxation process.

关键词： properties structure process

Removal efficiency of fluoride by novel Mg-Cr-Cl layered double hydroxide by batch process from water

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Journal of Environmental Sciences 2013年第5期25卷 993-1000页

作者： sandip Mandal Swagatika Tripathy Tapswani Padhi Manoj kumar Sahu Raj Kishore Patel Department of Chemistry National Institute of TechnologyRourkela 769 008India

The fluoride ion removal from aqueous solution using synthesized Mg-Cr-Cl layered double hydroxide has been ***-Cr-Cl was characterized by X-ray powder diffraction,Fourier-transform infrared,thermo-gravimetric analysis,differential thermal analysis,and scanning electron *** experiments were carried out in batch mode as a function of adsorption dosages,contact time,pH,and initial fluoride concentration to get optimum adsorption *** adsorption kinetic study showed that the adsorption process followed first order *** fluoride removal was 88.5% and 77.4% at pH 7 with an adsorbent dose of 0.6 g/100 mL solution and initial fluoride concentration of 10 mg/L and 100 mg/L,*** equilibrium was established at 40 *** experiment data were fitted well with Langmuir isotherm with R 2 = *** constants were also measured and concluded that the adsorption process was spontaneous and endothermic in *** removal percentage decreased slowly with increasing *** process is suitable for industrial *** regeneration of the material is not possible.

关键词： layered double hydroxide(LDH) fluoride adsorbents

Impact of metal oxide nanoparticles on cotton(Gossypium hirsutum L.):a physiological perspective

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Journal of Cotton Research 2021年第2期4卷 169-187页

作者： SINGH BRAR Ravinderdeep kumar Avneesh KAUR Simranjeet SAHA sandip kumar Anuj kumar Sandeep Department of Chemistry Akal UniversityTalwandi SaboBathindaPunjab151302India Department of Botany Akal UniversityTalwandi SaboBathindaPunjab151302India Indian Agricultural Statistics Institute DelhiIndia

Cotton production substantiated a crucial part in the escalating economic development of many *** realize the increasing global demand for cotton,the emphasis should be laid on to improve cotton fiber growth and *** bioengineered transgenic cotton proved expedient in resolving inadequacies of conventional cotton,but still required improvements to encounter heightened demand of textile *** possible solution pertaining to this has been provided by nanoscience in the form of metal or metal oxide *** metal oxide nanoparticles have easy access to the various parts of cotton plants through its transportation system,and thus significantly influence several parameters relative to the growth and production of cotton *** review summarizes the distribution and accumulation of metal oxide nanoparticles in cotton plant and its impact on different plant growth-promoting factors,which resulted in the improved cotton yields.

关键词： Cotton Bt-transgenic Nanoparticles Metal oxide nanoparticles Phytohormones Superoxide dismutase Nutrient element

Analysis of risk factors contributing to road traffic accidents in a tertiary care hospital. A hospital based cross-sectional study

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Chinese Journal of Traumatology 2020年第3期23卷 159-162页

作者： sandip kumar Mahima Dhiraj kumar Srivastava Pradip Kharya Neha Sachan K.Kiran Department of Community Medicine UPUMSSaifaiEtawah206130India

Purpose: Road traffic accidents (RTAs) are a public health issue and cost a lot to individuals, families, communities and nations. Trauma care systems in India are at a nascent stage of development. There is gross disparity between trauma services available in various parts of the country. Rural area in India has inefficient services for trauma care, due to the varied topography, financial constraints, and lack of appropriate health infrastructure. The present study is to study the trends of occurrence of RTA cases by month, week and time of accident occurrence as well as to research the types of vehicle involved in accidents and other various risk factors related to ***: During 1st January 2017 to 31st December 2017, a hospital-based and cross-sectional study of RTA victims was conducted. The patients were admitted in emergency department of Uttar Pradesh University of Medical Sciences, Saifai, Etawah, when stabilized, they were shifted to the orthopaedics and surgery ***: In the study, 654 road accident victims were included, of which the majority were males (77.5%) and the most of them belonged to rural (67%). RTA victims according to the month of occurrence majority were found in January (12.5%) and evening was time of a day with maximum accidents (32.1%). Mortality cases of RTA victims based on type of road user and it shows decreasing trend of mortality of motor-cyclists (54.2%) followed by pedestrian (25.1%).Conclusion: There should be control over people driving vehicles under the influence of alcohol and drivers over-speeding and rash driving on urban roads as well as rural village roads.

关键词： Road traffic accidents Risk factors Tertiary care hospital

Pathological abnormalities in splenic vasculature in non-cirrhotic portal hypertension:Its relevance in the management of portal hypertension

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World Journal of Gastrointestinal Surgery 2020年第1期12卷 1-8页

作者： Shahana Gupta Biju Pottakkat Surendra kumar Verma Raja Kalayarasan sandip Chandrasekar A Ajith Ananthakrishna Pillai Department of Surgical Gastroenterology JIPMERPondicherry 605006India Department of Pathology JIPMERPondicherry 605006India Department of Cardiology JIPMERPondicherry 605006India

BACKGROUND Portal hypertension(PH)is associated with changes in vascular structure and function of the portosplenomesenteric system(PSMS).This is referred to as portal hypertensive *** abnormalities of PSMS has been described in the literature for cirrhotic *** portal pressure and hyperdynamic circulation are thought to be the underlying cause of this *** view of this,it is expected that pathological changes in splenic and portal vein similar to those reported in cirrhotic patients with PH may also be present in patients with non-cirrhotic PH(NCPH).AIM To investigate pathological abnormalities of splenic vein in patients with NCPH,and suggest its possible implications in the management of *** A prospective observational study was performed on 116 patients with NCPH[Extrahepatic portal vein obstruction(EHPVO):53 and non-cirrhotic portal fibrosis(NCPF):63]who underwent proximal splenorenal shunt(PSRS),interposition shunt or splenectomy with devascularization in JIPMER,Pondicherry,India,a tertiary level referral center,between *** patients were evaluated by Doppler study of PSMS,computed tomography portovenogram and upper gastrointestinal *** acoustic resonance forced impulse(ARFI)scan and abdomen ultrasound were done for all cases to exclude *** and histopathological assessment of the harvested splenic vein was performed in *** study group was divided into delayed and early presentation based on the median duration of symptoms(i.e.108 mo).RESULTS The study group comprising of 116 patients[77(66%)females and 39(34%)males]with NCPH had a median age of 22 *** duration of symptoms was 108 *** most common presentation in both EHPVO and NCPF patients was upper gastrointestinal bleeding(hematemesis and melena).The ARFI scan revealed a median score of 1.2(1.0-1.8)m/s for EHPVO and 1.5(0.9-2.8)m/s for *** was performed in 84 patients(two of whom underwent interpos

关键词： Portal hypertensive vasculopathy Non-cirrhotic portal hypertension Splenic vasculature Hyperdynamic circulation Shunt surgery