ABSTRACT
Objective To investigate the effect of decompression with long-segment (L) or short-segment (S) fusion on the outcomes of the surgical treatment for degenerative adult scoliosis (ADS) patiens.Methods A retrospective study on 32 patients treated in our department for ADS from April 2013 to May 2015 was carried out, including 12 male and 20 female (1 : 1.7).Their average age was 66.4 (range: 51-77 years).All patients underwent decompression and fusion surgeries through posterior approach.They were divided into long-segment fusion group (L) and short-segment fusion group (S) according to fusion range.During follow-ups (FU), clinical outcomes were assessed by means of visual analog scale (VAS) and Oswestry disability index (ODI).Radiographic evaluation on full-length standing film included coronal Cobb's angle, distant between C7plumb line and center sacral vertical line (C7PL-CSVL), thoracic kyphosis (TK) angle, lumbar lordosis (LL) angle, pelvic incidence (PI), and pelvic tilt (PT), PI-LL, sagittal vertical axis(SVA).Postoperative complications were also recorded.Results All patients were followed up for average 2.2 years (range:1.5-3.5 years).No significant difference of age or gender was found between two groups (L: 22, S:10) of patients (P=0.066, 0.182).As for the fusion segments, group L (6.3±1.5) was more than group S (2.9±0.3) (P=0.001).Operation time and blood loss of group L were statistically more than group S (P＜0.05).Postoperative VAS sores of back pain and leg pain as well as ODI were all improved significantly in two groups (P＜0.05).At the final FU, back pain VAS was more in group L than in group S (P＜0.05) , but no significant difference was found in leg pain VAS between two groups (P＞0.05);at the final FU, group L's ODI showed better functional recovery than group S's[(12.8±9.3)％ vs.(25.4±11.4)％, P＜0.05].With no obvious difference in the two groups (P＞0.05), coronal Cobb's angle corrected more satisfactional in group L than group S (P＜0.05).The same situation was found in C7-CSVL correction in two goup in FU (P＜0.05).Sagital balance was restored to normal alignment better in group L than group S, with increase of lumbar lordosis after surgery.The overall incidence of postoperative complications was 31.3％, including wound infection, cerebrospinal fluid leakage, transient neurological symptoms and internal fixed rod breakage, more common in group L than group S.Conclusions Decompression and fusion with internal fixation showed good clinical outcomes in the treatment of ADS.Long-segment fusion yielded better coronal and sagittal correction outcomes with higher peri-operation risks;however, short-segment fusion showed higher safety with relatively inferior correction effect.Appropriate fusion mode should be chose according to the patient's deformity features.
ABSTRACT
Objective To study the diagnosis and treatment results of the traumatic perforation of the esophagus.Methods Retrospective analysis was performed in 19 cases with the traumatic perforation of the esophagus hospitalized.Results Treatment options ranged from aggressive to conservative management.Repair of esophageal perforation was performed in 9 cases,cervical drainage in 2 cases and conservative treatment in 8 cases.17 cases recovered from the disease,making up 89.5%the mortality rate was 10.5%.Conclusion In order to increase the recovery rate and decrease the mortality.it is important to diagnose and treat the disease in it's early phases.
ABSTRACT
objective To analyze the causes of early complications following posterior lumbar spinal operations and to find out about the way for prevention and treatment of those complications. Methods From 1998 to 2002, 903 patients underwent posterior lumbar spinal operations ,there were 587 males and 316 females , with an average age of 36.7years (range, 18 to 78 years ). The diagnosis of patients included lumbar disc prolapse in 483, lumbar stenosis in 145, lumbar spondylolisthesis in 96, lumbar fracture in 94, lumbar instability in 27, lumbar tuberculosis in 15 spinal tumors in 24 and reoperation in 19. All patients were evaluated by the medical history, clinical examination and review of the imaging data, and then the surgical plan was made respectively according to clinical evaluation. Results Early complications of 78 complications within 2 weeks post-operatively occurred in 76 cases with the incidence of 8.6%(78/903), in-cluding of 49 males and 27 females with an average age of 44.6 years. The complications consisted of 50 nerve root irritations(64.1%, 50/78), most of which relieved at 4 to 30 days after treatment, 9 gastrointesti-nal symptoms(11.5%, 9/78), all of which disappeared at 3 to 10 days but 2 cases needed enema, 4 hematomas of incisional wound(5.1%, 4/78), 4 cerebrospinal fluid leakages(5.1%, 4/78), 3 urinary reten-tions(3.9%, 3/78), 2 deep infections(2.6%, 2/78), 2 deep vein thrombosis(2.6%, 2/78), 2 pulmonary em-bolisms(2.6%, 2/78),1 infection of urinary tract(1.3%) and 1 fatty liquidization(1.3%, 1/78). The opera-tional procedure possible leading to surgical complication were laminectomy, nerve root dissection and in-strumentation. Conclusion Early complications may determine the clinical result of the posterior lumbar spinal operations. Besides the skilled technique, thorough pre-operative planning, close observation and proper management after operation, and early post-operative rehabilitations are of great benefit to the pre-vention and treatment of the complications.