ABSTRACT
<p><b>OBJECTIVE</b>To compare the therapeutic effect of posterior lumbar interbody fusion by single and double B-Twin expandable spinal spacer with micro endoscopic discectomy (MED) for lumbar intervertebral disc protrusion accompanying degenerative instability.</p><p><b>METHODS</b>From March 2006 to May 2008, 45 patients with lumbar intervertebral disc protrusion accompanying degenerative instability were admitted and managed with posterior lumbar interbody fusion by B-Twin expandable spinal spacer with MED. The patients were randomly assigned to treatment with single B-Twin (Single group, n = 24) or double B-Twin (Double group, n = 21). There were 16 males and 8 females, with an average age of 45.5 years (43 - 60 years) in Single group; 13 males and 8 females, with an average age of 43.7 years (44-61 years) in Double group. All the cases suffered from only one level disc protrusion, L(3-4) 2 cases, L(4-5) 29 cases and L₅-S₁ 14 cases. Clinical outcomes were evaluated with surgical time, blood loss, visual analogue scale (VAS) scores preoperatively, 1, 3, 6 month postoperatively. Oswestry disability questionnaire (ODI) of the preoperative, 1 month postoperative, and latest follow-up and the disk space heights.</p><p><b>RESULTS</b>Forty three patients were followed-up for 1 to 3 years after surgery. The mean surgical time of Double group was longer than Single group [(152 ± 32) min vs. (91 ± 15) min, P < 0.01]. The average blood loss in Double group was more than that in Single group [(146 ± 73) ml vs. (95 ± 58) ml, P < 0.01]. The mean time of hospital stay in Single group was similar to that in Double group [(11.0 ± 3.2) d vs. (10.9 ± 3.3) d, P > 0.05]. Both groups could keep the disk space heights till the last follow-up [(7.7 ± 1.8) mm vs. (8.5 ± 1.7) mm]. In the 6 months follow-up post operation, the VAS score decreased from (8.1 ± 1.8) to (2.0 ± 1.0) in Single group, and (8.1 ± 1.9) to (2.1 ± 1.0) in Double group. At the last follow-up, the ODI decreased from (36 ± 7)% to (10 ± 4)% in Single group and (37 ± 6)% to (9 ± 4)% in Double group, but there was no significant difference between the two groups (P > 0.05). All the cases achieved fusion at the last follow-up, 3 patients in Single group and 2 patients in Double group suffered from intractable low back pain. One of the fins broke in one patient without any uncomfortable feeling.</p><p><b>CONCLUSIONS</b>Compared with the management of lumbar intervertebral disc protrusion accompanying degenerative instability by double B-Twin expandable spinal spacer with micro endoscopic discectomy, the single B-twin can get similar clinical outcomes, but shorter surgical time, less blood loss and less medical costs.</p>
Subject(s)
Adult , Female , Humans , Male , Middle Aged , Endoscopy , Follow-Up Studies , Intervertebral Disc Displacement , General Surgery , Lumbar Vertebrae , Prospective Studies , Spinal Fusion , Methods , Treatment OutcomeABSTRACT
<p><b>OBJECTIVE</b>To assess the predictive value of heart rate turbulence (HRT) in patients with acute myocardial infarction.</p><p><b>METHODS</b>One hundred and twenty-five patients with acute myocardial infarction were enrolled in this study. During the period from 6 to 21 days after onset of acute myocardial infarction, they were undergone 24-hour Holter recordings to collect the mean RR interval and heart rate variability (HRV) SDNN. The Holter files were processed with software of "HRT! View V0.60-1" to obtain the value of Turbulence Onset (TO) and Turbulence Slope (TS) and the value of "heart rate variability (HRV) SDNN". LVEF and EDD were measured by Ultrasonic Cardiography. Endpoint of follow-up was cardiac death. According to the results, patients were divided into two groups (the "survivors" and the "nonsurvivors"). The predictive value for high-risk patients with acute myocardial infarction was assessed by variables between the two groups.</p><p><b>RESULTS</b>In the period of follow-up (mean 225.4 +/- 99.8 days), 14 patients died and 111 patients survived. In the univariate Cox regression analysis, "TS" was a strong univariate predictor of mortality (hazard ratio 11.46, P < 0.01); "TO" was a relatively weak predictor and the hazard ratio was 2.76 (P > 0.05). Combination of abnormal TO and abnormal TS was the strongest mortality predictor (hazard ratio 26.70, P < 0.01); in the multivariate Cox regression analysis, TS < or = 2.5 ms/RR and EDD > or = 5.6 cm were the independent predictors of mortality with hazard ratios 9.49 (P < 0.01) and 3.64 (P < 0.05), respectively.</p><p><b>CONCLUSIONS</b>The absence of the heart rate turbulence after ventricular premature beats is a very potent post-infarction risk predictor which is independent of and stronger than other known risk predictors.</p>