ABSTRACT
OBJECTIVE: Tranexamic acid as a synthetic antifibrinolytic agent has been used in hip replacement, gastrointestinal surgery, neurosurgery, obstetrics and gynecology, cardiac surgery, and various nasal operations to reduce bleeding. In recent years, tranexamic acid has also been used in spinal surgery. Meta-analysis was used to evaluate whether intraoperative intravenous tranexamic acid reduced the incidence of perioperative bleeding and transfusion events in multilevel posterior spinal surgery compared with placebo. METHODS: The randomized controlled trials of tranexamic acid in the use of PubMed, Cochrane Library and EMBASE in multi-segment posterior spinal surgery were searched by computer. Tranexamic acid was used intravenously in the experimental group and placebo was used in the control group. Two reviewers screened all the retrieved literature according to the inclusion and exclusion criteria. The literature quality was evaluated with the modified Jadad scale and meta-analysis was performed with the Review Manager 5.3 software. RESULTS: (1) A total of nine randomized controlled trials were included in this study. The score of the modified Jadad scale showed 7 points in 6 articles, 6 points in 1 article, 4 points in 1 article and 3 points in 1 article. (2) Meta-analysis showed that the amount of postoperative drainage, intraoperative blood loss, intraoperative erythrocyte recovery, incidence of transfusion events, and total perioperative blood loss in the tranexamic acid group were all lower than those in the placebo group [MD=-102.70, 95%CI(-141.25,-64.15), Z=5.22, P 0.05). CONCLUSION: Intravenous tranexamic acid can reduce the total perioperative blood loss, intraoperative blood loss, postoperative drainage, intraoperative erythrocyte recovery and the incidence of transfusion events in posterior spinal multilevel surgery. However, due to the limited quantity and quality of the included studies, the above conclusions still need to be verified by more high-quality large-sample studies.
ABSTRACT
BACKGROUND: Thoracolumbar fracture is most common seen in spinal fractures. The paraspinal muscle is subjected to extensive detachment and traction in traditional posterior approach, so the muscular ischemia and denervation lead to muscle atrophy further inducing intractable low back pain. Thereafter, minimally invasive spinal surgery becomes more and more popular.OBJECTIVE: To investigate the clinical efficacy of pedicle screw fixation through Wiltse approach combined with injectable calcium sulfate bone cement for single-level thoracolumbar fracture.METHODS: Clinical data of 52 patients with single-level thoracolumbar fracture without nerve injury were analyzed retrospectively, and were then assigned to observation (n=28) and control groups (n=24) according to the treatment method. The patients in the observation group were treated with pedicle screw fixation through Wiltse approach plus implanted with injectable calcium sulfate bone cement, and those in the control group were subjected to pedicle screw fixation through posterior approach plus implanted with injectable calcium sulfate bone cement. The operation time, blood loss and hospitalization time were compared between two groups. The low back pain was observed at baseline, 1 week and 3 months postoperatively, and the percentage of anterior vertebral height revealed on X-ray was observed at baseline, before ambulation, and during last follow-up. Moreover, the complications, loosening and rupture of the screws were recorded.RESULTS AND CONCLUSION: (1) All patients were followed up, and the follow-up time was 16-24 months. (2) The operation time, blood loss and hospitalization time in the observation group were significantly less than those in the control group (P < 0.05). (3) The postoperative visual analogue scale scores in the two groups were significantly lower than those before surgery, and the scores showed significant differences between two groups (P < 0.05). (4) The percentage of anterior vertebral height before ambulation and during last follow-up in the two groups was significantly improved, and the percentage showed significant difference between two groups at each time point (P < 0.05). (5) These findings suggest that based on strict indications, the pedicle screw fixation through Wiltse approach combined with injectable calcium sulfate bone cement is safe for single-level thoracolumbar fracture, which restores the anterior vertebral height rapidly, alleviates pain and exhibits satisfactory long-term efficacy. Furthermore, it holds shorter operation time and less blood loss than the traditional approach.
ABSTRACT
BACKGROUND:Percutaneous pedicle screw fixation has been applied in the treatment of thoracolumbar fracture,and has achieved satisfactory clinical efficacy.Injectable calcium sulfate holds good biocompatibility,degradability and fast curing.OBJECTIVE:To explore the clinical efficacy of percutaneous pedicle screw fixation combined with calcium sulfate cement for single-level thoracolumbar fracture.METHODS:Clinical data of 40 patients with single-level thoracolumbar fracture without nerve injury were analyzed retrospectively.All fractured vertebrae were compressed more than 30％ and at least one pedicle was complete.All patients were treated with percutaneous pedicle screw fixation combined with calcium sulfate cement.The Visual Analog Scale and Oswestry Disability Index scores were recorded at baseline,3 months postoperatively and last follow-up;the height of the fractured vertebra body and sagittal Cobb angle were measured on X-ray;the patient's satisfaction and healing rate were recorded.RESULTS AND CONCLUSION:(1) The Oswestry Disability Index at 3 months postoperatively and last follow-up was 16.3％ and 4.4％,respectively.Compared with baseline,the Cobb angle and Visual Analog Scale scores were significantly reduced,and height of the fractured vertebra body was significantly increased after surgery (P ＜ 0.01).(3) The healing rate at last follow-up was 95％,nonunion was not found,and the patients' satisfaction reached 95％.(4) The loss of vertebral height and Cobb angle was found at last follow-up compared with 3 months postoperatively,but had no significant difference (P ＞ 0.05).(5) These results indicate that percutaneous pedicle screw fixation combined with calcium sulfate cement is safe and reliable for single-level thoraclumbar fracture,which not only restores the vertebral height and relieves pain,but also has satisfactory long-term curative efficacy and high healing rate.
ABSTRACT
BACKGROUND:Studies have shown that arthroscopic al-inside technology for meniscus repair has achieved good outcomes, and arthroscopic suture combined with sodium hyaluronate has an important role in the cartilage repair. OBJECTIVE:To observe the therapeutic effect of arthroscopic al-inside suture repair combined with sodium hyaluronate injection in the repair of discoid meniscus tears. METHODS:Twenty-two patients with discoid meniscus injury were subjected to arthroscopic al-inside suture repair combined with sodium hyaluronate injection. Al cases were confirmed to have attached edge relaxation or longitudinal crack in operation. After repair, effective rehabilitation training was done. RESULTS AND CONCLUSION:The operations for the 22 cases were al successful and there was no complication. Al patients were fol owed up for over 18 months. According to Ikenchi’s method (Lysholm knee score criterion), 11 cases were rated excel ent, 8 were rated good, and 3 were rated fair, with an excel ent/good rate of 86.36%. It is demonstrated that the al-inside suture repair under the guide of arthroscopy in discoid meniscus cases can remain the most appropriate anatomical structure of the meniscus that can play an effective function, and has the advantage of minimal invasion. Arthroscopic al-inside suture repair combined with intra-articular injection of sodium hyaluronate and standard rehabilitation training result in a lower complication rate and effectively promotes the meniscus repair.
ABSTRACT
BACKGROUND:Numerous studies have shown that air wave pressure therapy plays an important role in prevention of deep venous thrombosis of lower limb after a major operation on the hip. OBJECTIVE:To explore the efficacy of air wave pressure therapy on deep vein thrombosis of the lower extremity in patients with total knee arthroplasty. METHODS:A total of 80 patients with total knee arthroplasty were randomly divided into experimental group and control group. Patients in the control group were treated only with conventional method to help the patient massage the lower extremity by the nurse and combined with active functional exercise;patients in the experimental group were treated with air wave pressure therapy at 2 days postoperatively, and were also treated with conventional method to help the patient massage the lower extremity by the nurse and combined with active functional exercise. Swel ing index, coagulation index and the number of patients with deep venous thrombosis of the lower extremity were recorded in both groups. RESULTS AND CONCLUSION:At 2 weeks after treatment, swel ing index, coagulation index and the number of patients with deep venous thrombosis of the lower extremity were significantly reduced in the experimental group, and its effects were significantly better than those in the control group (P<0.05). Early use of air wave pressure therapy after total knee arthroplasty can al eviate limb swel ing effectively and have obvious advantages in improving coagulation index and blood coagulation condition and in preventing deep vein thrombosis of the lower extremity after total knee arthroplasty.