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Spinal surgery is a technically demanding and challenging procedure because of the complicated anatomical structures of the spine and its proximity to several important tissues. Surgical landmarks and fluoroscopy have been used for pedicle screw insertion but are found to produce inaccuracies in placement. Improving the safety and accuracy of spinal surgery has increasingly become a clinical concern. Computerassisted navigation is an extension and application of precision medicine in orthopaedic surgery and has significantly improved the accuracy of spinal surgery. However, no clinical guidelines have been published for this relatively new and fast-growing technique, thus potentially limiting its adoption. In accordance with the consensus of consultant specialists, literature reviews, and our local experience, these guidelines include the basic concepts of the navigation system, workflow of navigation-assisted spinal surgery, some common pitfalls, and recommended solutions. This work helps to standardize navigation-assisted spinal surgery, improve its clinical efficiency and precision, and shorten the clinical learning curve.
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<p><b>OBJECTIVE</b>To explore the risk factors of pulmonary infection after D2 radical gastrectomy of gastric cancer in order to guide clinical measures to reduce the incidence of pulmonary infection.</p><p><b>METHODS</b>Clinical data of 371 patients undergoing D2 radical gastrectomy at Division 2 of Gastrointestinal Cancer Center from October 2014 to October 2016 were collected for retrospective cohort study. Associated risk factors of pulmonary infection after D2 radical gastrectomy of gastric cancer were analyzed. Diagnosis criteria of pulmonary infection: occurrence of new pulmonary rales; new infiltrative change or consolidation in chest by imaging examination; with at least one of the following: temperature ≥38.5centi-degree, emergence of new purulent sputum or sputum character change, isolated pathogens from bronchial brush biopsy or tracheal secretion culture.</p><p><b>RESULTS</b>Of 371 patients, 265 were males and 106 were females. The average age was 59.1(22-80) years old. There were 38(10.2%) cases of pulmonary infection after radical resection of gastric cancer. Univariate analysis showed that smoking history, intra-operative blood loss ≥200 ml, total gastrectomy, and gastric intubation ≥6 d were associated with pulmonary infection after D2 radical gastrectomy (all P<0.05). Six cases quitted smoking 2 weeks before operation with pulmonary infection incidence of 8.1%(6/74), and 16 patients did not quit smoking 2 weeks before operation with pulmonary infection incidence of 21.1%(16/76), and the difference was statistically significant (χ=4.0387, P=0.0445). Multivariate Logistic regression analysis showed that postoperative gastric intubation ≥6 d (OR=4.335, 95%CI: 1.088 to 4.586, P=0.05), smoking history (OR=3.469, 95%CI: 1.056 to 5.252, P=0.043) and intra-operative blood loss ≥200 ml (OR=3.931, 95%CI: 1.350 to 10.574, P=0.013) were independent risk factors of pulmonary infection after D2 radical gastrectomy of gastric cancer.</p><p><b>CONCLUSION</b>For gastric cancer patients undergoing D2 radical gastrtectomy with smoking history, greater blood loss during operation and postoperative gastric intubation ≥6 d, surgeons must pay attention to the prevention of postoperative pulmonary infection.</p>
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High-competence specialists are elites among health professionals.By means of the authoritative training system,the hospital took such measures as,strengthened management,rotary training without fixed posts,and cross training.Efforts of 8 years have helped the hospital to establish a high-competence specialists team,a good academic atmosphere,and enhanced capacity of disciplines. Key experiences of the hospital in this process include well-identified objectives,well-designed training programs, strict supervision of training process, and establishment of long-term management mechanism.
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<p><b>BACKGROUND</b>Percutaneous pedicle screw use has a high rate of cranial facet joint violations (FVs) because of the facet joint being indirectly visualized. Computer-assisted navigation shows the anatomic structures clearly, and may help to lower the rate of FVs during pedicle screw insertion. This study used computed tomography (CT) to evaluate and compare the incidence of FVs between percutaneous and open surgeries employing computer-assisted navigation for the implantation of pedicle screw instrumentation during lumbar fusions.</p><p><b>METHODS</b>A prospective study, including 142 patients having lumbar and lumbosacral fusion, was conducted between January 2013 and April 2014. All patients had bilateral posterior pedicle screw-rod instrumentation (top-loading screws) implanted by the same group of surgeons; intraoperative 3-dimensional computer navigation was used during the procedures. All patients underwent CT examinations within 6 months postoperation. The CT scans were independently reviewed by three reviewers blinded to the technique used.</p><p><b>RESULTS</b>The cohort comprised 68 percutaneous and 74 open cases (136 and 148 superior-level pedicle screw placements, respectively). Overall, superior-level FVs occurred in 20 patients (20/142, 14.1%), involving 27 top screws (27/284, 9.5%). The percutaneous technique (7.4% of patients, 3.7% of top screws) had a significantly lower violation rate than the open procedure (20.3% of patients, 14.9% of top screws). The open group also had significantly more serious violations than did the percutaneous group. Both groups had a higher violation rate when the cranial fixation involved the L5. A 1-level open procedure had a higher violation rate than did the 2- and 3-level surgeries.</p><p><b>CONCLUSIONS</b>With computer-assisted navigation, the placement of top-loading percutaneous screws carries a lower risk of adjacent-FVs than does the open technique; when FVs occur, they tend to be less serious. Performing a single-level open lumbar fusion, or the fusion of the L5-S1 segment, requires caution to avoid cranial adjacent FVs.</p>
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Aged , Female , Humans , Male , Middle Aged , Lumbar Vertebrae , General Surgery , Minimally Invasive Surgical Procedures , Pedicle Screws , Prospective Studies , Zygapophyseal Joint , General SurgeryABSTRACT
Objective To evaluate the mid-term tollow-up results of cervical artificial disc replacement (CADR) for cervical degenerative disc disease,and to explore whether it can reduce the occurrence of adjacent segment degeneration (ASD).Methods A prospective comparative study of 93 patients who underwent CADR or anterior cervical decompression and fusion (ACDF) for cervical degenerative disc disease were conducted.All patients were followed up for more than 6 years.The Japanese Orthopaedic Association (JOA) score,neck disability index (NDI),Odom's scale,X-rays and magnetic resonance imaging (MRI) were used to evaluate the clinical and radiologic results.Results Twenty eight patients who underwent CADR and 35 patients who underwent ACDF had complete follow-up data.At final follow-up,the JOA score and NDI improved significantly in both groups.Between the two groups,there was no significant difference in terms of JOA score,NDI and Odom's scale.The sagittal alignment was well maintained in both groups.The total cervical spine range of motion (ROM) had no significant change for the CADR group,whereas,it significantly decreased for the ACDF group.The ROM at the replacement level of CADR patients decreased from 9.5° ± 3.7° before operation to 7.0° ± 3.0° 3 months after operation,and it was maintained to 6.6° ± 4.1° at final follow-up without significant decrease.Lateral radiographs and T2-weighted MRI showed the incidence of ASD in CADR group was significantly lower than that in ACDF group.Conclusion The six-year follow-up results of CADR are basically satisfactory.Compared with ACDF,it could better preserve physiological motion and biomechanics of cervical spine,and reduce the incidence of ASD.
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ObjectiveTo explore the bone anabolic effects after a single local injection of simvastatin into femoral cavities of osteoporotic rats.MethodsThirty-six female SD rats(3 months old,body weight 250-300 g) were ovariectomized(OVX) and low-calcium-diet fed for 3 months,OVX rats were randomized into 3 groups(n=12).Left femurs of group A,B and C were injected with 0,5 and 10 mg simvastatin,respectively.Half of the rats in each group were randomly euthanized separately 1 and 5 months after simvastatin injection.Left femurs were taken out for bone mineral density (BMD) assessment with dual energy X-ray absorptiometry,bone histomorphometic changes were analysized by Micro-CT,and two kinds of biomechanical tests were used to evaluate the osteogenic effects.ResultsOne and five months after injection,BMD in mid-diaphysis significantly increased in simvastatin-injected groups compared to the control group.For Micro-CT analysis,significant increase in total bone volume/total tissue volume,cortical wall thickness,trabecular thickness,trabecular number,and a significant decrease in trabecular spacing were observed in simvastatin-injected groups compared to the control group.For both biomechanics (the three-pointbreaking test of condyles and axial compressive testing of proximal femur),the values were significantly higher in simvastatin-injected groups than the control group.ConclusionLocal simvastatin treatment showed a positive effect on improving mechanical strength,structure of osteopenic femurs and BMD.Our findings may provide a new strategy for the prevention and treatment of osteoporosis,especially for osteoporotic fractures.