Thirty-day Postoperative Complications following Primary Total Knee Arthroplasty: A Retrospective Study of Incidence and Risk Factors at a Single Center in China / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Total knee arthroplasty (TKA) may be associated with serious complications that adversely affect outcomes and increase the likelihood of disability. However, few studies with sufficient sample size have reported postoperative complications following TKA among Chinese patients. This study aimed to evaluate complications of TKA within 30 postoperative days and to identify the related risk factors.</p><p><b>METHODS</b>A retrospective complication-based analysis of TKA using the arthroplasty registry between 2008 and 2013 was performed by summarizing complications of TKA within 30 postoperative days. Multivariate logistic regression was used to identify the predicting factors for complications 30 days after operation.</p><p><b>RESULTS</b>A total of 1542 patients underwent 2254 primary TKA between January 2008 and December 2013. A total of 137 complications occurred within 30 days after operation with an incidence rate of 6.1%. The incidence rate of major systemic complications within postoperative 30 days was 2.3%, with cardiovascular and respiratory complications as the most common complications. The incidence rates of deep venous thrombosis (DVT) and local complications were 2.4% and 1.0%, respectively. The 30-day postoperative mortality rate was 0.1% (3/2254). Multivariate logistic regression analyses identified body mass index (BMI) of ≥30.0 kg/m2 (odds ratio [OR]: 1.47) and age ≥80 years (OR: 1.87) as significant risk factors for postoperative systemic complications. A BMI of ≥30.0 kg/m2 was a significant risk factor for DVT (OR: 2.86) and other complications (OR: 2.11). The comorbidity of diabetes was a risk factor for postoperative mortality (OR: 19.20).</p><p><b>CONCLUSIONS</b>This study highlighted complications with cardiac and respiratory origins as the most common complications within 30 postoperative days following primary TKA. The BMI of ≥30.0 kg/m2 and age ≥80 years were significant risk factors for 30-day postoperative complications.</p>

Outcome of the treatment of osteonecrosis of femoral head using the core decompression with bone impaction grafting / 中国医学科学院学报

<p><b>OBJECTIVE</b>To evaluate the outcome of core decompression with bone impaction grafting for the treatment of osteonecrosis of femoral head.</p><p><b>METHODS</b>Totally 39 cases (46 hips) of osteonecrosis of femoral head were treated with core decompression and impaction bone grafting. According to the Association Research Circulation Osseous (ARCO) system, 3 hips were graded for stage 1,16 for stage 2a,7 for 2b,11 for 2c, and 9 for 3.The Harris hip score (HHS) was evaluated before operation and at the latest follow-up.</p><p><b>RESULTS</b>In all these patients, 22 hips had hormone-related lesions, 11 had alcohol-related lesions, and 13 had idiopathic lesions. The average HHS was changed from (66 ± 6.6) before surgery to (80.2 ± 9.7) after surgery during an average follow-up of 26 months(from 9 to 48 months). The postoperative HHS showed no significant difference among osteonecrosis of femoral head due to different etiologies.Also,the postoperative HHS and clinical effectiveness were not significantly different among patients with different preoperative stages.The postoperative outcome was excellent in 7 cases, good in 23 cases, mild in 4 cases,and poor in 12 cases. The rate of excellent and good was 65% in this series,with 78% for patients with early stages and 52.6% for those with grade 2c or higher lesions. The femoral head collapsed in 7 cases,and 5 of which were preoperatively graded as in stage 2c and higher. The postoperative complications included intertrochanteric fracture (n=1) and infection (n=1). Four hips were converted to total hip arthroplasty. All of other hips had no obvious progression of osteonecrosis.</p><p><b>CONCLUSIONS</b>Core decompression with bone impaction allografting is effective for the treatment of osteonecrosis of femoral head. Patients with lesions in earlier ARCO stages can have better outcomes.</p>

Surgical treatment of diffuse pigmented villonodular synovitis of the knee / 中国医学科学院学报

<p><b>OBJECTIVE</b>To compare the roles of open synovectomy and arthroscopic synovectomy in the treatment of diffuse pigmented villonodular synovitis (D-PVNS).</p><p><b>METHODS</b>Forty-seven patients suffered from D-PVNS of knee joint who underwent surgical treatment with complete follow-up data from March 1994 to October 2013 were retrospectively analyzed. All patients were divided into two groups as open synovectomy group (n=17) and arthroscopic synovectomy group (n=30) according to the surgical procedure. Routine radiation therapy was applied in both groups after the surgery. The mean follow-up period wa s(15.7 ± 16.3) months (range:10-30 month). The range of motion, International Knee Documentation Committee (IKDC) score and Lysholm score before the surgery and at the final follow-up were compared respectively.</p><p><b>RESULTS</b>Recurrence was noted in 8 patients (17.0%), among whom 3 were from the open synovectomy group and 5 from the arthroscopic synovectomy group, resulting a recurrence rate of 17.6% and 16.7%, respectively, in these two groups (P>0.05). The range of motion,IKDC score, and Lysholm score at final follow-up and before the operation were (97.5 ± 14.3)℃ vs.(69.7 ± 12.6)℃, (74.5 ±6.1) vs. (38.6 ± 5.4) scores, and (77.5 ± 5.8) vs. (42.4 ± 4.6)scores, respectively, in the open synovectomy group,and were (128.6 ± 13.9)℃ vs. (64.9 ± 13.2)℃, (87.4 ± 6.7) vs. (37.2 ± 4.9)scores, and (86.2 ± 6.2) vs. (41.9 ± 5.3) cores, respectively, in the arthroscopic synovectomy group (all P<0.05). Obviously,the range of motion,IKDC score, and Lysholm score at the final follow-up were significantly superior to the pre-operative findings, and were also significantly better in the arthroscopic synovectomy group than in the open synovectomy group (P<0.05).</p><p><b>CONCLUSIONS</b>Open synovetomy and arthroscopic synovetomy have similar recurrent rates in treating D-PVNS of the knee joint, while the latter has better postoperative range of motion and functional scores. Thus, arthroscopic synovectomy is a better option for the surgical treatment of D-PVNS.</p>

Comparison of Clinical Influence of Intramedullary versus Extramedullary Alignment Guides on Total Knee Arthroplasty / 中国医学科学院学报

<p><b>UNLABELLED</b>Objective: To compare the clinical influence of intramedullary versus extramedullary alignment guides on total knee arthroplasty (TKA) in terms of alignment of the lower limbs,intraoperative tourniquet time,and postoperative complications.</p><p><b>METHODS</b>We retrospectively analyzed the clinical data of 105 patients(210 knees)undergoing bilateral TKA from February 2012 to November 2013. All patients were divided to two groups:40 [age:(66.65 ± 9.57)years] were implanted using intramedullary guides on the tibia and 65 [age:(65.29±9.27)years] were implanted using extramedullary guides on the tibia. Alignment of lower limb,tibial component angle in the sagittal plane,tourniquet time,and postoperative complications were compared.</p><p><b>RESULTS</b>The gender ratio,age,height,weight,body mass index,and preoperative alignment of lower limbs were not significantly different between these two groups (all P>0.05). The average coronal alignment of lower extremity was (179.69 ± 2.91)° in the intramedullary guides group and (178.26 ± 3.38)° in the extramedullary guides group (P=0.002). The alignment of lower limbs on neutral and valgus position were found in 68 cases(85.00%)in the intramedullary group and in 94 cases (72.31%) in extramedullary group (P=0.033) ;the tourniquet time was (79.46 ± 12.06) min in the intramedullary group and (84.68 ± 8.02) min in the extramedullary group (P=0.001); the postoperative complication rate was 6.25% in intramedullary group and 3.07% in extramedullary group (P=0.279).</p><p><b>CONCLUSION</b>Alignment and tourniquet time can be significantly improved by the intramedullary instrumentation,while the incidence of complications associated with intramedullary instrumentation is higher than extramedullary instrumentation.</p>

Effect of ulinastatin on liver function of patients after bilateral total knee arthroplasty / 中国医学科学院学报

<p><b>OBJECTIVE</b>To investigate the effect of ulinastatin, a urinary trypsin inhibitor, on the postoperative liver function in patients who have received bilateral total knee arthroplasty (TKA) under pneumatic tourniquet.</p><p><b>METHODS</b>Totally 40 patients who were scheduled to receive bilateral TKA under thigh tourniquet were randomly assigned into trial group (U group, receiving intravenous ulinastatin) and control group (C group, receiving natural saline). All patients received the same general anesthesia and postoperative analgesia. The plasma concentrations of alanine transaminase (ALT), total bilirubin (TBil), and direct bilirubin (DBil) were recorded and compared preoperatively and 4, 24, 48, and 72 hours after the surgery.</p><p><b>RESULTS</b>The demographic data were not significantly different between these two groups (P>0.05). The ALT was not significantly changed after the surgery in the C group (P>0.05) but was significantly decreased 48 hours (P=0.002) and 72 hours (P=0.001) after the surgery in the U group. TBil and DBil were significantly increased 48 hours (P=0.012, P=0.000) and 72 hours (P=0.000, P=0.000) after the surgery in C group, while only that at 48 hours (P=0.010, P=0.038) was significantly increased in the U group. ALT 4 hours (P=0.026), 48 hours (P=0.013), 72 hours (P=0.004) after the surgery were significantly lower in the U group than those in C group. TBil at the 72 hours postoperatively in U group was significantly lower than that in C group (P=0.036). DBil was not significantly different between C group and U group at all time points (all P>0.05).</p><p><b>CONCLUSION</b>The application of ulinastatin in bilateral TKA can protect postoperative liver function.</p>

The microbiology and antimicrobial susceptibility of the infected knee arthroplasty / 中华外科杂志

<p><b>OBJECTIVES</b>To describe the microbiology, antimicrobial susceptibility of patients proven prosthetic joint infection (PJI) after primary total knee arthroplasty (TKA)and to provide reference for the diagnosis and treatment of this complication.</p><p><b>METHODS</b>The medical data of the patients with infected knee arthroplasty, who were managed with revision surgery between January 1995 to December 2011 were reviewed. Twenty-nine cases were identified and majority of the patients were female (23/29). Diagnosis of PJI after primary TKA was between 1 week and 10 years (average 24.3 months). The microbiology and antimicrobial susceptibility were analyzed.</p><p><b>RESULT</b>The overall positive rate of cultures was 65.5% (19/29). The most common organisms identified were Coagulase-negative Staphylococcus (CNS) (7/19) and Staphylococcus Aureus (SA) (5/19). Rare pathogens of Mycobacterium (2/19) and fungi (1/19) were also identified. Vancomycin was the most effective antibiotics with overall sensitivity rates of 100%.Resistant and rare pathogens were all in type IV infection.</p><p><b>CONCLUSIONS</b>Gram-positive bacterias are the main pathogen, resistant and rare pathogens should be payed attention to. Antibiotic treatment for infected TKA should be based on the results of drug susceptibility. Vancomycin allows infected knee arthroplasties before the result.</p>

Etiological and clinical analysis of osteonecrosis of the femoral head in Chinese patients / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Many potential causative factors are related to the initiation and progression of osteonecrosis of the femoral head. The aim of this research was to investigate the etiology and clinical features of osteonecrosis of the femoral head in Chinese patients.</p><p><b>METHODS</b>From January 1990 to July 2011, 643 cases of osteonecrosis of the femoral head were investigated retrospectively to analyze the potential causative factors, age, gender, latency period, time from the onset of pain to diagnosis, and Association Research Circulation Osseous stage.</p><p><b>RESULTS</b>Of 643 cases, 315 cases were bilateral and 328 cases were unilateral, with an average age of (47.55 ± 15.27) years. In the steroid-induced group, the average age at symptom onset was (41.80 ± 15.47) years, and the median duration from taking steroid to the onset of pain was 36 months. The underlying diseases in the steroid-induced osteonecrosis of the femoral head group consisted of autoimmune and other diseases, of which systemic lupus erythematosus was the most common. In the alcohol-induced group, the average age at onset of symptoms was (48.06 ± 11.90) years and the median time of habitual alcohol use was 240 months. In the traumatic group, the average age was (51.43 ± 14.23) years and the median time from trauma to the onset of pain was 20 months. In the idiopathic group, the average age was (50.33 ± 15.88) years. Of the total of 958 hips, 647 were at stage III or IV. The stage at diagnosis was earlier in the steroid-induced group than in the alcohol-induced, traumatic, or idiopathic groups.</p><p><b>CONCLUSIONS</b>Steroid use is the most common cause for osteonecrosis of the femoral head in this study. The age at diagnosis, time from the onset of pain to diagnosis, and stage were significantly earlier in the steroid-induced group.</p>

Case-control study on influence of femoral neck fracture on deep venous thrombosis in patients undergoing prosthetic hip surgery / 中国骨伤

<p><b>OBJECTIVE</b>To investigate the association between femoral neck fracture and deep vein thrombosis (DVT) in patients undergoing prosthetic hip surgery.</p><p><b>METHODS</b>The data of patients who underwent prosthetic hip surgery from January 2005 to July 2010 were collected, the cases were included into the study after exclusion of those could not be suitable for the study. The patients with diagnosis of deep-vein thrombosis (DVT) were identified together as the case group, and the patients without DVT were selected randomly and matched with frequency as the control group. The matching characteristics included age, gender and body weight. The patients with femoral neck fracture were counted in both case and control group. The odds ratio was calculated and the exposure rate of both group were compared.</p><p><b>RESULTS</b>There were total 670 patients underwent prosthetic hip surgery during the period, and after exclusion,the data of 408 patients were collected into the study. There were 13 patients in the case group (4 males and 9 females, ranging in age fram 57 to 91 years), all of them suffering from femoral neck fracture and the exposure rate was 100.0% (13/13). There were 52 patients in the control group (18 males and 34 females, ranging in age from 57 to 91 years), 39 of them suffering from femoral neck fracture, the exposure rate was 75.0% (39/52); there was no statistically significant difference in exposure rate of two groups.</p><p><b>CONCLUSION</b>The diagnosis of femoral neck fracture is not the independent risk factor for postoperative DVT of prosthetic hip surgery. The epidemiologic characteristics of femoral neck fracture indicate that the patients are in high risk of DVT, who meanwhile are the most of patients undergoing the prosthetic hip surgery. Though the surgery itself is a risk of DVT, it can reduce the risks for patients with femoral neck fracture through some therapeutic effects.</p>

Treatment of severe bone deficiency in acetabular revision surgery using a reinforcement device and bone grafting / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Severe acetabular bone deficiency is a major challenge in acetabular revision surgery. Most cases require reconstruction of the acetabulum with bone grafting and a reinforcement device. The purpose of this study was to evaluate the results of this procedure for severe acetabular bone deficiency in acetabular revision surgery.</p><p><b>METHODS</b>This study involved 12 patients (2 males and 10 females) with severe acetabular bone defects who underwent implantation of a reinforcement device (ring or cage) and bone grafting between February 2003 and October 2008. Using the Paprosky classification, 2 cases were Paprosky IIC, 6 were IIIA, and 4 were IIIB. The mean age at the time of surgery was 63.0 years (range, 46 - 78 years). During revision surgery, a reinforcement ring was implanted in 6 patients, and a cage in 6 patients. The clinical and radiographic results were evaluated retrospectively. The mean duration of follow-up was 37 months (range, 9 - 71 months).</p><p><b>RESULTS</b>The average Harris Hip Score improved from 35.2 preoperatively to 82.9 at the time of the final follow-up visit. The results were excellent in 8 hips (66.7%), good in 2 (16.7%), and fair in 2 (16.7%). Osteolysis was found in 1 case, but did not worsen. Three patients had yellow wound effusion, with healing after administration of dressing changes, debridement, and antibiotics. Dislocation occurred in a 62-year-old woman. Closed reduction was performed, and dislocation did not recur. There was no evidence of intraoperative acetabular fracture, nerve injury, ectopic ossification, aseptic loosening, or infection.</p><p><b>CONCLUSION</b>Reconstruction with a reinforcement device and bone grafting is an effective approach to the treatment of acetabular bone deficiency in acetabular revision surgery, given proper indications and technique.</p>

Acetabular revision arthroplasty using antiprotrusio cage / 中华外科杂志

<p><b>OBJECTIVE</b>To study the efficacy of acetabular antiprotrusio cage for the reconstruction of acetabular bone defect in revision hip arthroplasty.</p><p><b>METHODS</b>Twelve cases of severe acetabular bone defect after total hip arthroplasty were revised with antiprotrusio cage and bone grafting from February 2003 to October 2008. Clinical and radiological data before and after revision surgery were collected and compared for assessment.</p><p><b>RESULTS</b>The classification of acetabular bone defect of this group of patients according to Paprosky classification was: 2 cases of type IIB, 6 cases of type IIIA and 4 cases of type IIIB. The average postoperative follow-up period was 37 months (9 - 71 months). Mean Harris score of all cases was 35.2 before revision surgery, 80.9 at the first time follow-up and 84.6 at latest follow-up. There were no prosthesis loosening and breakage. There was mild radiolucent line in Delee & Charnley III zone of the acetabulum in one patient 6 month after revision, but no deterioration was found during further follow-up. No further revision was needed in this group of patients during the follow-up.</p><p><b>CONCLUSIONS</b>Reconstruction of acetabular bone defect using antiprotrusio cage and bone grafting is a useful method to restore the bone defect and stability of the acetabulum. The outcome via short to middle term follow-up is encouraging.</p>

Comparison of the influences of continuous femoral nerve block and patient controlled intravenous analgesia on total knee arthroplasty / 中国医学科学院学报

<p><b>OBJECTIVE</b>To assess the influences of continuous femoral nerve block (CFNB) and patient-controlled intravenous analgesia (PCIA) on postoperative pain scores,knee rehabilitation,and stress response after total knee arthroplasty (TKA).</p><p><b>METHODS</b>Totally 32 adult patients scheduled for elective total knee arthroplasty were equally randomized into CFNB group or PCIA group. Intraoperative hemodynamics and fentanyl dose were recorded. Pain was assessed at rest and during continuous passive motion (CPM) using a visual analog scale at post-anesthesia care unit (PACU) and 4, 8, 12, 24, and 48 hours postoperatively. Morphine consumption was also recorded. As indicators of stress and inflammatory response,the leukocyte count, serum lactic acid, blood glucose, serum C-reactive protein (CRP), and serum cortisol were determined on admission, to operation room, immediately after skin incision, before extubation,on post-operation day 1 (POD1), and on POD2.</p><p><b>RESULTS</b>CFNB group showed significantly lower heart rate compared with PCIA group 60 minutes and 90 minutes intraoperatively (Pü0.05). Intraoperative consumption of fentanyl was significantly lower in CFNB group (137.5∓44.4) μg than in PCIA group (264.1∓67.1) μg (Pü0.01). The CFNB group showed significantly lower VAS scores both at rest and during CPM compared with PCIA group at all time points (Pü0.05). Morphine consumption was significantly lower in CFNB group than in PCIA group at different time points (Pü0.05 or Pü0.01). The maximal continuous passive motion amplitude of CFNB group were significantly larger than that of PCIA group on POD1 [(55.0∓9.4) vs.(44.6∓9.9), P[(76.3∓11.0) vs. (67.5∓10.3), P<0.05]. The incidences of somnolence and nausea/vomiting in CFNB group were 37.5% and 37.5%, respectively,which were significantly lower than those of PCIA group (75.0% and 81.3%) (Pü0.05). Patient satisfaction scores on anesthesia and post-operative analgesia was significantly higher in CFNB group than in PCIA group (93.1∓7.9 vs. 79.1∓11.9, respectively) (Pü0.05).</p><p><b>CONCLUSION</b>After TKA,CFNB technique provides more stable intraoperative hemodynamics than PCIA, with better pain relief,faster postoperative knee rehabilitation,less side effects,and higher patient satisfaction.</p>

Comparison of perioperative complications between simultaneous and staged bilateral total knee arthroplasty / 中华外科杂志

<p><b>OBJECTIVE</b>To compare the rates of perioperative complications in matched patients undergoing simultaneous bilateral total knee arthroplasty, or staged bilateral total knee arthroplasty.</p><p><b>METHODS</b>A total of 219 cases of bilateral total knee arthroplasty were performed from October 1996 to October 2006. It consisted 171 simultaneous and 48 staged (group B) bilateral total knee arthroplasty. Forty-eight patients were matched with group B for age and sex from simultaneous group (group A). A retrospective review of each group was conducted to compare the rates of perioperative complications.</p><p><b>RESULTS</b>No significant differences between the two matched groups were found with regard to preoperative co-morbidities (P > 0.05). The percentage of patients who had cardiovascular and cerebrovascular complications was significantly higher in the simultaneous group than in the staged group (P < 0.05).</p><p><b>CONCLUSIONS</b>Preoperative health status must be assessed carefully. Patients must be fully informed of the risks of simultaneous bilateral total knee arthroplasty before surgery. Active prevention of perioperative complications must be applied after surgery.</p>

Perioperative management in hemophilic arthropathy / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate the clinical results and improve perioperative management in patients with hemophilic arthropathy.</p><p><b>METHODS</b>From May 2002 to March 2007, 20 patients with hemophilic arthropathy were admitted. Fourteen patients (20 knees) were performed total knee arthroplasty, and 6 patients (8 hips) were performed total hip arthroplasty, while 2 patients were performed ankle arthrodesis. The average preoperative HSS score, hip Harris score and ankle AOFAS score were 83, 89 and 78 points respectively.</p><p><b>RESULTS</b>All patients had been followed up, and the mean time was 27.3 months. The average postoperative knee HSS score increased to 83 points, and hip Harris score increased to 89 points, while the AOFAS score increased to 78 points. Delayed bleeding and deep venous thrombosis and late infection with loose prosthesis occurred in one case respectively.</p><p><b>CONCLUSIONS</b>Arthroplasty and arthrodesis are promising for severe hemophilic arthropathy to obtain pain relief and functional improvement Correct perioperative management is the key to successful treatment in hemophilic arthropathy.</p>

Expression of collagen type I in the articular processes of apex from adolescent idiopathic scoliosis patients / 中国医学科学院学报

<p><b>OBJECTIVE</b>To investigate the characteristic of the expression of collagen type I in the articular processes of apex from adolescent idiopathic scoliosis (AIS) patients.</p><p><b>METHODS</b>The apical processes of 11 AIS patients were collected. The techniques of HE staining and In-cell Western were adopted in this research. We studied the pathological changes of the apical processes and collected and cultured the osteoblast from the apical processes on both sides in vitro separately. After cell identification, we compared the secretion of collagen type I in the osteoblast from concave side to that of convex side.</p><p><b>RESULTS</b>The cartilages of the apical processes showed some signs of regression. The secretion of collagen type I of the osteoblast in vitro from the concave side of the apical articular process was significantly higher than that from the convex side (P < 0.05).</p><p><b>CONCLUSION</b>Significant difference of the gene expression of the osteoblasts from the apical process exists between the concave side and the convex side.</p>

The correlation between preoperative pulmonary function and postoperative pulmonary complications in the surgical treatment of scoliosis / 中华外科杂志

<p><b>OBJECTIVES</b>To evaluate the incidence of immediate postoperative pulmonary complications and their correlation to preoperative pulmonary function tests (PFTs), preoperative pulmonary symptoms and surgical approaches.</p><p><b>METHODS</b>The case records of 298 patients, who underwent anterior or posterior fusion, were reviewed. Preoperative PFTs were recorded and abnormal PFTs were defined as forced vital capacity (FVC) is less than 80% of FVC predicted. Preoperative pulmonary symptoms (breathless on exertion) were noted, and postoperative pulmonary complications were defined when the presence of atelectasis, infiltrates, pneumothorax, hemothorax, pneumonia or requirement of postoperative ventilatory support was noted.</p><p><b>RESULTS</b>The mean age of this group was 16.4 years (range from 6-62 years). The average coronal Cobb angle was 73.26 degrees (range from 45 degrees-141 degrees ). Of all the patients, 115 patients had normal preoperative PFTs, the other 183 cases had abnormal PFTs. Nineteen cases of all the patients were found with postoperative pulmonary complications including postoperative ventilatory support in 6 cases, atelectasis in 4 cases, infiltration in 2 cases, pneumothorax in 3 cases, pneumonia in 3 cases and hypoxemia in 1 case. The incidence of postoperative pulmonary complication was 6.4% in all the patients, while 18.99% in the 79 patients with thoracotomy and 1.85% in the 216 patients without. The correlation between postoperative pulmonary complications and the surgical approach was statistically significant (P=0.0000). When the patients were classified into 3 groups: 60%< FVCR <80%, 40%< FVCR <60%, FVCR <40%, the incidence of postoperative pulmonary complications were 2.72% (3/110), 7.40% (4/54) and 31.6% (6/19) respectively, which showed an increasing complication incidence. In the 115 patients with normal PFTs, 3 patients had preoperative pulmonary symptoms (2.68%), while 14 of the 183 patients with abnormal PFTs had preoperative pulmonary symptoms (7.65%). The correlation between presence of preoperative respiratory symptoms and abnormal results on PFTs was statistically significant (P=0.01). No significant correlation was found between preoperative respiratory symptoms and postoperative pulmonary complications (P=0.52).</p><p><b>CONCLUSIONS</b>The incidence of postoperative pulmonary complications increases with the deterioration of PFTs. The posterior procedure has a very low incidence of postoperative pulmonary possibility of complications, but a transthoracic procedure increases the complications significantly. Preoperative respiratory symptoms usually predict abnormal results of PFTs but have no correlation with postoperative pulmonary complication.</p>