ABSTRACT
Objective To compare the surgical effects between minimally invasive anterior ondontoid screw fixation assisted by our self-designed odontoid guider and open anterior ondontoid screw fixation in the treatment of odontoid fractures of Anderson-D'Alonzo type Ⅱ.Methods From July 2011 to July 2016,28 adults with odontoid fracture of Anderson-D'Alonzo type Ⅱ were treated at Department Ⅱ of Spinal Surgery,Hospital of 89 Army Group of Chinese PLA.Of them,15 were treated by minimally invasive anterior ondontoid screw fixation assisted by our self-designed odontoid guider (guider group) while the other 13 by open anterior ondontoid screw fixation (open group).All the patients were male,aged from 31 to 59 years (average,42.7 years).The 2 groups were compared in terms of incision length,operation time,intraoperative bleeding,intraoperative fluoroscopic frequency and hospital stay.Results There were no significant differences between the 2 groups of patients in their preoperative general data,indicating they were compatible (P ＞ 0.05).All the patients were followed up for 12 to 45 months (average,22.1 months).The internal fixation was in good place and clinical union achieved in all the 28 patients.The incision length (2.2 ± 0.1 cm),operation time (45.0 ± 3.1 min),intraoperative bleeding (29.0 ± 2.3 mL) and intraoperative fluoroscopic frequency (15.5 ± 1.9 times) for the guider group were all significantly less than those (2.9 ±0.7 cm,61.6±3.8 min,51.6±3.9 mL and 21.7±3.2 times,respectively) for the open group (P ＜0.05),but there was no significant difference between the 2 groups in hospital stay (6.5 ± 0.5 d versus 6.5 ± 0.6 d) (P ＞ 0.05).Conclusion In the treatment of odontoid fractures of Anderson-D'Alonzo type Ⅱ,compared with open anterior ondontoid screw fixation,the minimally invasive anterior ondontoid screw fixation assisted by our self-designed odontoid guider may lead to a smaller incision,shorter operation time,less blood loss and a lower fluoroscopic frequency.
ABSTRACT
Objective To evaluate the effects of early tracheostomy and late tracheostomy on the prognosis of patients with cervical spinal cord injury,so as to provide evidence based guidance for the timing of tracheostomy.Methods Relevant literatures studying the timing of tracheostomy in patients with cervical spinal cord injury were searched in PubMed,Embase,Medline,Cochrane Library,Chinese Biological Medical Literature database (CBM),China National Knowledge Infrastructure database (CNKI),and VIP journal database with time range from journal establishment to March 2018.The retrieved articles were screened according to the inclusion and exclusion criteria.The article quality was rigorously evaluated according to the Newcastle-Ottawa scale (NOS).Meta analysis was conducted using Review Manager 5.3 software to compare the mechanical ventilation time,ICU stay,incidence of pneumonia,incidence of complications,and mortality between early and late tracheostomy in patients with cervical spinal cord injury.Results A total of eight articles of cohort study including 466 patients were included,with 241 patients in the early tracheostomy group and 225 patients in the late tracheostomy group.The eight articles were all determined as high quality studies according NOS.The results of Meta analysis showed that there were significant differences between the two groups in terms of the total mechanical ventilation time (MD =-12.28,95％ CI-20.09--4.47,P ＜ 0.01),post tracheostomy mechanical ventilation time (MD =-9.92,95％ CI-14.27--5.57,P ＜ 0.01),total ICU stay (MD =-10.30,95％ CI-17.12--3.47,P ＜ 0.01),post tracheostomy ICU stay (MD =-5.79,95％ CI -6.53--5.05,P ＜ 0.01),incidence of complications (RR =0.56,95％ CI 0.38-0.83,P ＜ 0.01),and mortality (RR =0.34,95％ CI 0.15-0.78,P ＜ 0.05).However,no significant differences were detected between the two groups in the incidence of total pneumonia (RR =0.77,95％ CI 0.57-1.05,P ＞0.05) and the incidence of post tracheostomy pneumonia (RR =0.80,95％ CI 0.51-1.26,P ＞0.05).Conclusion Early tracheostomy can shorten the mechanical ventilation time,ICU stay,incidence of complications,and mortality,but it cannot reduce the incidence of pneumonia.