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Objective:To investigate the safety and efficacy of the modified transcutaneous endoscopic spine system (TESSYS) with full visual foramen plasty and percutaneous endoscopic discectomy (PTED) in the treatment of lumbar disc herniation and lumbar spinal stenosis.Methods:A case-control study was conducted to analyze the clinical data of 68 patients with single segment lumbar disc herniation and lumbar spinal stenosis treated with visual endoscopic foraminal plasty and modified TESSYS technique and intervertebral foraminal fusion from April 2020 to March 2021. According to the operation method, 38 cases were divided into two groups: pted group (38 cases) and TLIF group (30 cases). Independent sample t-test was used to compare the incision length, bleeding volume, operation time, time to go down and hospital stay between the two groups. Visual analog scale (VAS) scores and Oswestry disability index (ODI) scores were measured repeatedly. The differences between preoperative and postoperative 7 days and 1, 3, 6 months were analyzed and compared by generalized estimation equation. Rank sum test was performed in combination with the modified MacNab standard in the last follow-up. The excellent and good rate was compared between groups χ 2. Test and evaluate the curative effect. Results:The postoperative follow-up was 8.5-14.0 months. The incision length (1.25±0.33) cm, operation time (119.45±14.95), blood loss (24.03±8.62) mL, downtime time (1.42±0.50) d, and hospital stay (3.39±0.55) d in the PTED group were all higher than those in the TLIF group ((14.37±2.91) cm, (140.53±16.16) min, (158.00±51.35) mL, (3.20±0.96) d, (7.33±0.55) d) had obvious advantages ( t values were 24.56, 5.57, 14.13, 9.20, and 29.48, respectively; all P<0.001). The VAS scores and ODI scores of the two groups after operation were significantly improved compared with those before operation (all P<0.001), and with the passage of time, the VAS scores and ODI scores of the two groups of patients from 7 days to 6 months after operation by month were significantly decreased ( P<0.001). However, there was no significant difference between the two groups in VAS score from 1 week to 6 months after operation: P7d=0.997, P1 month=0.139, P3 month=0.057, P6 month=0.539, all P>0.05. There was no significant difference in ODI scores between time points (ODI: P7d=0.278, P1 month=0.442, P3 month=0.963, P6 month=0.278, all P>0.05). There was no significant difference between the two groups in terms of clinical efficacy and excellent and good rate evaluated by modified MacNab criteria at the last follow-up ( Z=0.09, P=0.927; χ 2=0.92, P=0.761). Conclusion:The short-term curative effect of full visual endoscopic foraminal plasty and modified TESSYS technique in the treatment of single level lumbar disc herniation and lumbar spinal stenosis is close to that of classical foraminal interbody fusion, and has certain advantages.
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Objective:To compare the effect of percutaneous kyphoplasty (PKP) combined with zoledronic acid at different times in the treatment of osteoporotic vertebral compression fractures (OVCF).Methods:The clinical data of 110 patients with OVCF from January 2018 to June 2019 in the Hospital of Shunyi District Beijing were retrospectively analyzed. All patients were treated with PKP. Among them, 55 patients were given zoledronic acid on the second day after surgery (synchronization group), and 55 patients were given zoledronic acid 1 month after surgery (non-synchronization group). X-Ray examination was performed before and 1 year after surgery, and the vertebral recovery related indexes of compression fracture vertebral body were measured, including anterior border height of vertebral body, posterior border height of vertebral body, kyphotic angle and local Cobb angle; the degree of dysfunction was evaluated by Oswestry dysfunction index (ODI); the bone density of hip bone was detected; the serum alkaline phosphatase (ALP), osteocalcin and type Ⅰ collagen cross-linked C-terminal peptide (CTX-1) were detected. The patients were followed up for 1 year, and the recurrence of vertebral compression fractures was record.Results:There were no statistical differences in anterior border height of vertebral body, posterior border height of vertebral body, kyphotic angle and local Cobb angle before surgery and 1 year after surgery between 2 groups ( P>0.05). Compared with those before surgery, the anterior border height of vertebral body and posterior border height of vertebral body 1 year after surgery in 2 groups were significantly higher, the kyphotic angle and local Cobb angle were significantly lower, and there were statistical differences ( P<0.01). The ODI 1 year after surgery in synchronization group was significantly lower than that in non-synchronization group: (11.30 ± 1.53) scores vs. (14.27 ± 1.78) scores, and there was statistical difference ( P<0.01). The bone density of hip bone 1 year after surgery in synchronization group was significantly higher than that in non-synchronization group, and there was statistical difference ( P<0.01). The serum ALP and CTX-1 1 year after surgery in synchronization group were significantly lower than those in non-synchronization group: (74.93 ± 8.63) U/L vs. (78.77 ± 9.41) U/L and (0.24 ± 0.03) ng/L vs. (0.29 ± 0.03) ng/L, the osteocalcin was significantly higher than that in non-synchronization group: (9.63 ± 1.14) ng/L vs. (7.97 ± 0.85) ng/L, and there were statistical differences ( P<0.01 or <0.05). All patients were followed up for 1 year, and no recurrence of vertebral compression fractures was found. Conclusions:The synchronization zoledronic acid after PKP has more advantages in improving the condition and bone metabolism in patients with OVCF.
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Objective： To study the application of DSA in the diagnosis and treatment of ENT diseases. Methods： The diagnostic and therapeutic roles of DSA in ENT patients admitted from November 1995 to December 1999 were retrospectively studied. Results： Therapeutic vascular embolization using DSA was performed in 9/10 patients with severe epistaxis. The treatment was successful in 8/9 patients with a successful rate of 88.89%; embolization of tumor supplying vessels using DSA as a preoperative measure for reducing operative blood loss in 3 patients with nasopharyngeal fibrohemangioma obtained a total success; diagnosis was clarified in 2 patients using DSA. No patients were with severe complications. Conclusion： DSA is not only a safe and effective measure for diagnosis and therapy, but also effective in differential diagnosis of space occupying lesions. Preoperative selective embolization of tumor supplying arteries can reduce operative blood loss.
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Objective To explore the safety and success rate of endovascular intervention in the treatment of Budd-Chiari syndrome. Methods Double balloon-catheters were inserted into proximal and distal of the obstructive segments in inferior vena cava of 18 cases of Budd-Chiari syndrome respectively. The balloon was filled with contrast medium. Perforation in the obstructive segments was done by hard core through a balloon-catheter, using another one as a guide. Results The length of obstructive segments in inferior vena cava ranged from 1.2cm to 8.0cm. In the 18 cases of Budd-Chiari syndrome, 15 obstructive segments were perforated successfully(83.3%), of whom 6 cases were performed by single balloon-catheters with acute pericardial wadding in 1 case and 9 cases by double balloon-catheters without vessels damage and bleeding. Conclusions The membrane perforation induced by double balloon-catheters is a key process of endovascular interventive technique in the treatment of Budd-Chiari syndrome.
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Objective To evaluate the efficacy of percutaneous vertebroplasty for treating the vertebral compression fractures and vertebral metastatic neoplasms, and to assess its clinical curative effects Methods Among 81 cases (47 men and 34 women; ages 35～84, mean age 61 2 years), 110 vertebrae with metastatic neoplasms (61 cases) or vertebral osteoporosis (20 cases) were infused with methacrylate guided by DSA Effect of the operations was observed closely after the procedures Results The procedures were successful in all the involved patients and no significant complications were noted clinically Among the 61 patients treated for malignancies, 58 showed marked pain relief and 3 moderate pain relief 20 patients with vertebral osteoporosis demonstrated complete pain relief The cement leakage observed on radiographs included slight leakage to the adjacent disc (6 of 110, 5 5%), the epidural fat (8 of 110, 7 3%), the perivertebral venous plexus (2 of 110, 1 8%), and the paravertebral soft tissues (2 of 110, 1 8%) Conclusion Percutaneous vertebroplasty can significantly relieve the pain in patients with osteoporotic fractures caused by the malignancies and the vertebral osteoporosis We suggest that slight PMM leaks, when not symptomatic, should not be considered as complications
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ObjectiveTo evaluate the effect of interventional endovascular treatment for Budd-Chiari syndrome. MethodsIn 15 cases of Budd-Chiari syndrome, repatency of the obstructive inferior vena cava was successfully carried out by percutaneous transluminal balloon dilatation first, and then self-expanding stents was placed in 13 patients. In 4 patients with complete obliteration of the hepatic veins, "H" graft mesocaval shunts were performed one week later. ResultsMild heart dysfunction occurred in one case after endovascular intervention.Patients were followed-up from 2 to 42 months postoperatively. Except one re-stenosis distal to the stent, no stent migration and thromboembolization in shunting grafts occurred. The symptoms of portosystemic hypertension were relieved significantly. Conclusions Budd-Chiari syndrome could be effectively treated by interventional endovascular procedures.