ABSTRACT
<p><b>OBJECTIVE</b>To explore the advantages of minimally invasive expandable in surgery of lumbar discectomy and interbody fusion and internal fixation.</p><p><b>METHODS</b>The clinical data of 48 patients who underwent lumbar discectomy and interbody fusion and internal fixation from January 2010 to March 2016 was retrospectively analyzed. According to the admission queue, the patients were randomly assigned into channel group (26 cases) or traditional group (22 cases). In channel group, surgical approach of minimally invasive expandable channel was applied, and in traditional group, open posterior operation approach (including posterior lumbar interbody fusion and transforaminal lumbar interbody fusion, etc.) was applied. In channel group, there were 20 males and 6 females, aged from 43 to 74 years with an average of(56.6±5.1) years; course of disease was ranged from 4 to 22 months with an average of (6.7±1.8) months; 1 case was complicated with diabetes, 6 cases were complicated with hypertensive disease, and 2 cases were complicated with arrhythmia. In traditional group, there were 15 males and 7 females, aged from 43 to 73 years with an average of(55.9±4.6) years; course of disease was ranged from 4 to 26 months with an average of (6.2±2.1) months; 2 cases were complicated with diabetes, 5 cases were complicated with hypertensive disease, and 1 case was complicated with arrhythmia. Operation time, bleeding volume, and hospitalization time were compared between two groups and visual analogue scale(VAS), Oswestry Disability Index(ODI), bone fusion information, and complications correlated with incision were observed in two groups.</p><p><b>RESULTS</b>All 48 patients were followed up for more than 6 months. Postoperative VAS and ODI were significantly improved (<0.01), but 3 and 6 months after operation, there was no significant difference in VAS between two groups, and ODI score of channel group was lower than that of traditional group(<0.01). Operation time, bleeding volume, hospitalization time in channel group respectively were (167.3±30.2) min, (786.8±147.8) ml, (12.3±2.4) d, and in traditional group were (197.5±48.7) min, (786.8±147.8) ml, (16.5±3.8) d, there was significant differences between two groups. There was no significant difference in fusion rate and fusion time between two groups. There were 4 cases and 7 cases developed incision related complications in channel group and traditional group, respectively. The difference between two groups was significant(<0.01).</p><p><b>CONCLUSIONS</b>Compared with conventional surgery minimally invasive lumbar discectomy and interbody fusion and internal fixation has advantages of less trauma, shorter operative time and better functional recovery.</p>
ABSTRACT
<p><b>OBJECTIVE</b>To study the efficacy and safety of multimodal prevention of postoperative venous thromboembolism for hip fractures.</p><p><b>METHODS</b>From March 2009 to July 2011, preoperatively, patients were assigned to two groups on the basis of an assessment of their risk factors. One hundred and twelve patients were considered to be low risk, involving 47 males and 65 females,with an average age of (72.40 +/- 13.29) years ranging from 42 to 88,and were managed with aspirin (100 mg once daily for 14 days) as well as intermittent gasing compression devices. Twenty-six patients were considered to be high risk, involving 12 males and 14 females with an average age of (78.50 +/- 12.76) years ranging from 65 to 84,and were managed with low-molecular-weight heparin (0.4 ml,subcutaneous injection once daily for 14 days) and intermittent gasing compression. All patients were underwent Doppler ultrasonography within 24 hours before hospital discharge. All patients were followed-up for 3 months postoperatively. The incidence of deep venous thrombosis of lower limb, pulmonary embolism, gastrointestinal hemorrhage were recorded.</p><p><b>RESULTS</b>Overall, there were no fatal pulmonary embolism, 1 case of symptomatic pulmonary emboli in low risk group, and none were detected in the high-risk group. Deep venous thrombosis was detected in association with 6 (6.25%) of the 112 procedures in the low-risk group and 2 (7.69%) of the 26 operations in the high-risk group. Paitents were selected in opened reduction and internal fixation, the quantity of bleeding, decrease of hemoglobin, hematoma rate, and gastrointestinal hemorrhage rate of low risk group were (538.10 +/- 390.20) ml, (30 +/- 19) g/L, 0, and 1 (1.03%) respectively; those of the high-risk group were (585.95 +/- 403.96) mL, (32 +/- 20) g/L,1 (4.76%), (4.76%), there were no significant different between the two groups, all P > 0.05.</p><p><b>CONCLUSION</b>There were no statistic significances between the aspirin as well as intermittent gasing compression devices and the low-molecular-weight heparin and intermittent gasing compression in preventing venous thromboembolism (VTE) in postoperative postoperative venous thromboembolism for hip fractures. However, there are potential advantages to reduce complications of bleeding and cardiovascular disease. Multimodal prevention of postoperative venous thromboembolism can protect postoperative patients with hip fractures.</p>