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Spine J:瘫痪患者行手术,有助于驾车安全

2015-05-13 MedSci MedSci原创

背景:已有多项研究报道了数种手术对患者术后驾驶反应时间(DRT/driving reaction time)的影响。然而作为脊柱疾病中最常见的一种:腰椎间盘突出症,其手术对驾驶反应时间的影响却从未被报道过。 目的:分析腰椎间盘突出症引起的左侧或右侧瘫痪患者术前及术后驾驶反应时间的差距。 方法:本实验为前瞻性临床对照试验,纳入者均为即将进行腰椎间盘手术的患者。本实验所考察的指


背景:已有多项研究报道了数种手术对患者术后驾驶反应时间(DRT/driving reaction time)的影响。然而作为脊柱疾病中最常见的一种:腰椎间盘突出症,其手术对驾驶反应时间的影响却从未被报道过。

目的:分析腰椎间盘突出症引起的左侧或右侧瘫痪患者术前及术后驾驶反应时间的差距。

方法:本实验为前瞻性临床对照试验,纳入者均为即将进行腰椎间盘手术的患者。本实验所考察的指标为腰椎间盘突出症引起的瘫痪和腰椎间盘手术分别对驾驶反应时间造成的影响。连续42位患者(平均50.3岁)在术前1天,出院前及术后5周接受了测试。

除了驾驶反应时间之外,记录指标还包括用视觉模拟评分法(VAS/visual analogue scale)记录的腰腿痛的程度,疼痛的治疗方法以及患者驾驶的频率。驾驶反应时间由自制的汽车模拟器测试,当受试者踩下油门时,测试绿灯亮。然后观察者(在受试者看不见的地方)打开红灯,此时要求受试者尽可能快的踩下刹车,这之间的时间间隔即为驾驶反应时间。



结果:数据显示左侧或右侧瘫痪患者在接受手术后驾驶反应时间均有明显改善。右侧瘫组中,术前的驾驶反应时间是761ms,出院前是711ms,术后5周是645ms。左侧组中,术前的驾驶反应时间是651ms,出院前是592ms,术后5周是569ms。在术前组与术后5周两组中,左侧瘫与右侧瘫之间的患者之间有显著差异。腰腿痛的VAS评分、疼痛的治疗方案、以及驾驶技术与驾驶反应时间之间没有明显的联系。




结论:左侧瘫和右侧瘫的患者在术后的驾驶反应时间均有明显改善,说明了手术的积极作用。因为目前对于何为安全的驾驶反应时间阈值仍有争议,所以单单以术后短时间内患者的驾驶反应时间就能得到明显改善来说,出院后驾驶应该是安全的。同时,医师也应当告知患者相关的危险性。当然在现实情况中,驾驶安全不仅仅由驾驶反应时间一个参数决定,驾驶反应时间这个概念也需要进一步讨论,相关的实验仍需要进一步完善。

原始出处:

Thaler M1, Lechner R2, Foedinger B2, Haid C2, Kavakebi P3, Galiano K3, Obwegeser A3.Driving reaction time before and after surgery for disc herniation in patients with preoperative paresis.Spine J. 2015 May 1;15(5):918-22. doi: 10.1016/j.spinee.2013.06.052. Epub 2013 Aug 28.

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  1. [GetPortalCommentsPageByObjectIdResponse(id=1699371, encodeId=27ea16993e158, content=<a href='/topic/show?id=f5821661e14' target=_blank style='color:#2F92EE;'>#Spine#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=60, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=16617, encryptionId=f5821661e14, topicName=Spine)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=ba5829925263, createdName=mgqwxj, createdTime=Thu May 14 17:54:00 CST 2015, time=2015-05-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=36580, encodeId=010d365808e, content=很用心意啊, beContent=null, objectType=article, channel=null, level=null, likeNumber=105, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=75bb1617091, createdName=Bobby7868, createdTime=Wed Sep 09 13:42:00 CST 2015, time=2015-09-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1442959, encodeId=206714429597c, content=<a href='/topic/show?id=fe69e126189' target=_blank style='color:#2F92EE;'>#瘫痪#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=66, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=71261, encryptionId=fe69e126189, topicName=瘫痪)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=45265003536, createdName=ms1948154235210413, createdTime=Fri May 15 00:54:00 CST 2015, time=2015-05-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=23327, encodeId=03f72332e4c, content=看看, beContent=null, objectType=article, channel=null, level=null, likeNumber=156, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=ee0d1618732, createdName=huaxipanxing, createdTime=Wed May 13 20:18:00 CST 2015, time=2015-05-13, status=1, ipAttribution=)]
    2015-05-14 mgqwxj
  2. [GetPortalCommentsPageByObjectIdResponse(id=1699371, encodeId=27ea16993e158, content=<a href='/topic/show?id=f5821661e14' target=_blank style='color:#2F92EE;'>#Spine#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=60, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=16617, encryptionId=f5821661e14, topicName=Spine)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=ba5829925263, createdName=mgqwxj, createdTime=Thu May 14 17:54:00 CST 2015, time=2015-05-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=36580, encodeId=010d365808e, content=很用心意啊, beContent=null, objectType=article, channel=null, level=null, likeNumber=105, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=75bb1617091, createdName=Bobby7868, createdTime=Wed Sep 09 13:42:00 CST 2015, time=2015-09-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1442959, encodeId=206714429597c, content=<a href='/topic/show?id=fe69e126189' target=_blank style='color:#2F92EE;'>#瘫痪#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=66, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=71261, encryptionId=fe69e126189, topicName=瘫痪)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=45265003536, createdName=ms1948154235210413, createdTime=Fri May 15 00:54:00 CST 2015, time=2015-05-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=23327, encodeId=03f72332e4c, content=看看, beContent=null, objectType=article, channel=null, level=null, likeNumber=156, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=ee0d1618732, createdName=huaxipanxing, createdTime=Wed May 13 20:18:00 CST 2015, time=2015-05-13, status=1, ipAttribution=)]
    2015-09-09 Bobby7868

    很用心意啊

    0

  3. [GetPortalCommentsPageByObjectIdResponse(id=1699371, encodeId=27ea16993e158, content=<a href='/topic/show?id=f5821661e14' target=_blank style='color:#2F92EE;'>#Spine#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=60, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=16617, encryptionId=f5821661e14, topicName=Spine)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=ba5829925263, createdName=mgqwxj, createdTime=Thu May 14 17:54:00 CST 2015, time=2015-05-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=36580, encodeId=010d365808e, content=很用心意啊, beContent=null, objectType=article, channel=null, level=null, likeNumber=105, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=75bb1617091, createdName=Bobby7868, createdTime=Wed Sep 09 13:42:00 CST 2015, time=2015-09-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1442959, encodeId=206714429597c, content=<a href='/topic/show?id=fe69e126189' target=_blank style='color:#2F92EE;'>#瘫痪#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=66, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=71261, encryptionId=fe69e126189, topicName=瘫痪)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=45265003536, createdName=ms1948154235210413, createdTime=Fri May 15 00:54:00 CST 2015, time=2015-05-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=23327, encodeId=03f72332e4c, content=看看, beContent=null, objectType=article, channel=null, level=null, likeNumber=156, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=ee0d1618732, createdName=huaxipanxing, createdTime=Wed May 13 20:18:00 CST 2015, time=2015-05-13, status=1, ipAttribution=)]
  4. [GetPortalCommentsPageByObjectIdResponse(id=1699371, encodeId=27ea16993e158, content=<a href='/topic/show?id=f5821661e14' target=_blank style='color:#2F92EE;'>#Spine#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=60, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=16617, encryptionId=f5821661e14, topicName=Spine)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=ba5829925263, createdName=mgqwxj, createdTime=Thu May 14 17:54:00 CST 2015, time=2015-05-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=36580, encodeId=010d365808e, content=很用心意啊, beContent=null, objectType=article, channel=null, level=null, likeNumber=105, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=75bb1617091, createdName=Bobby7868, createdTime=Wed Sep 09 13:42:00 CST 2015, time=2015-09-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1442959, encodeId=206714429597c, content=<a href='/topic/show?id=fe69e126189' target=_blank style='color:#2F92EE;'>#瘫痪#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=66, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=71261, encryptionId=fe69e126189, topicName=瘫痪)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=45265003536, createdName=ms1948154235210413, createdTime=Fri May 15 00:54:00 CST 2015, time=2015-05-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=23327, encodeId=03f72332e4c, content=看看, beContent=null, objectType=article, channel=null, level=null, likeNumber=156, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=ee0d1618732, createdName=huaxipanxing, createdTime=Wed May 13 20:18:00 CST 2015, time=2015-05-13, status=1, ipAttribution=)]
    2015-05-13 huaxipanxing

    看看

    0

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