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1.
Article in Chinese | WPRIM | ID: wpr-1021330

ABSTRACT

BACKGROUND:As a routine method after lumbar spine surgery,a drainage tube is convenient for postoperative bleeding drainage and management,and there is still no consensus on the choice of postoperative removal time for short-segment lumbar spine surgery with less risk. OBJECTIVE:To explore the effect of different drainage times on early clinical efficacy after short-segment lumbar fusion. METHODS:A prospective randomized controlled study was performed on 220 patients in the Affiliated Hospital of Southwest Medical University who underwent posterior lumbar interbody fusion for lumbar degenerative diseases from March 2017 to April 2021.According to the different drainage times,the patients were randomly divided into removal on the second day after operation(group A),removal on the third day after operation(group B),and removal after the observation method 24-hour drainage volume<30 mL(group C).The perioperative indicators and follow-up results of the three groups of patients were observed and compared. RESULTS AND CONCLUSION:(1)Because 7 patients were lost to follow-up,2 patients were excluded,and 211 patients were finally included(72 patients in group A,71 patients in group B,and 68 patients in group C).(2)The average drainage time of group C was 2.91 days.The postoperative drainage volume in group A was significantly less than that in groups B and C,and the difference was statistically significant(P<0.05).On day 3 after operation,the hematocrit value of group C was lower than that of group A and group B,and the difference was statistically significant(P<0.05).Postoperative activity time and hospital stay in group A were shorter than those in groups B and C,and the difference was statistically significant(P<0.05).(3)Four patients in group A,two patients in group B and three patients in group C received an allogeneic blood transfusion.There was no significant difference among the groups(P>0.05).(4)In terms of postoperative complications,there were no statistical differences in postoperative wound leakage and surgical site infection in all three groups(P>0.05).(5)All patients were followed up for more than 12 months.Visual analog scale score and Oswestry dysfunction index of the three groups of patients before discharge and at the last follow-up were significantly improved compared with those before surgery(P<0.05).There was no statistical significance among the groups(P>0.05).(6)It is indicated that the removal of the drainage tube on the second day after a posterior lumbar fusion can effectively reduce the time to get out of bed and hospital stay,without increasing the postoperative blood loss and the risk of complications.

2.
Article in Chinese | WPRIM | ID: wpr-1021931

ABSTRACT

BACKGROUND:Some patients with cervical spondylosis have not been fully corrected sagittal position balance after cervical surgery,and this continuous sagittal position imbalance may be an important reason for the poor long-term clinical outcome of patients. OBJECTIVE:To analyze the correlation between the cervical sagittal position balance parameters and their changes and the clinical efficacy of patients in the unbalanced state after anterior cervical decompression and fusion and to explore the necessity of surgical correction of sagittal balance in order to improve the clinical effect in the later stage. METHODS:A retrospective analysis was performed on 125 patients with cervical spondylosis who underwent anterior cervical decompression and fusion in the Department of Spinal Surgery of Affiliated Hospital of Southwest Medical University from July 2019 to July 2022.Follow-up patients had good postoperative recovery(neck disability index score less than 10%one week after surgery)and had complete follow-up data.According to the axial vertical distance(C2-7 SVA)in sagittal position one week after surgery,patients were divided into type I imbalance group(C2-7 SVA loss≤5 mm,n=27),type Ⅱ imbalance group(C2-7 SVA loss>5 mm,and≤10 mm,n=19),and type Ⅲ imbalance group(C2-7 SVA loss>10 mm,n=12),and non-unbalanced group(C2-7 SVA in the normal range,n=67).The changes of visual analog scale score and neck disability index were compared among groups postoperatively and the last follow-up,as well as the changes of imaging sagittal balance parameters C2-7 cobb angle,C2-7 SVA value,neck inclination angle,T1 inclination angle,and thoracic entrance angle.The correlation between the late clinical effect and postoperative cervical sagittal disequilibrium was explored. RESULTS AND CONCLUSION:(1)There was no statistical difference in general data among the four groups(P>0.05).All patients underwent successful surgery without serious complications and postoperative wound infection.The follow-up time was more than 1 year.(2)There was no significant difference in preoperative symptom score and clinical efficacy one week after surgery(P>0.05).At the last follow-up,pain visual analog scale score,neck disability index and C2-7 SVA were lower than those before surgery but higher than those one week after surgery(P<0.05).C2-7 cobb angle was increased compared with those before operation(P<0.05).T1 inclination angle was decreased compared with those before operation(P<0.05).(3)Pearson correlation test showed that the change of neck disability index was positively correlated with the change of C2-7 SVA(P<0.05).(4)It is indicated that anterior cervical decompression and fusion is effective in the treatment of cervical spondylosis,and can effectively relieve the symptoms of patients.Patients with more severe cervical sagittal disequilibrium after surgery had worse curative effect in the later period.Continuous sagittal disequilibrium in patients with cervical spondylosis after surgery is an important cause of poor curative effect in the later stage.Clinicians should pay more attention to the correction of cervical sagittal balance before and during surgery,formulate surgical strategies and plans according to sagittal balance parameters before surgery,and correct C2-7 SVA intraoperatively to the normal range.

3.
Journal of Chinese Physician ; (12): 394-397, 2020.
Article in Chinese | WPRIM | ID: wpr-867244

ABSTRACT

Objective:To investigate the clinical value of short segment fusion and long segment fusion combined with posterior pedicle screw system internal fixation in the treatment of degenerative scoliosis.Methods:74 patients with degenerative scoliosis who were treated in the Affiliated Hospital of Southwest Medical University from January 2014 to February 2018 were enrolled in the study. The patients were divided into group A and group B with a random number table of 37 cases each. Group A was treated with short segment fusion and posterior pedicle screw system internal fixation, while group B was with long segment fusion and posterior pedicle screw system internal fixation. The Cobb angle of scoliosis, the balance of coronal and sagittal plane of spine were observed before operation, 1 week after operation, 3 months after operation and 6 months after operation, and the incidence of early and long-term complications were counted.Results:The Cobb angle of scoliosis in group B was lower than that of group A at 1 week, 3 months and 6 months after operation ( P<0.05). There was no significant difference in the balance of coronal plane and sagittal plane between the two groups at 1 week and 3 months after operation ( P>0.05). There was significant difference in the balance of coronal plane and sagittal plane between the two groups at 6 months after operation ( P<0.05). There was no significant difference in the incidence of early postoperative complications between the two groups ( P>0.05). Conclusions:Long segment fusion and posterior pedicle screw system internal fixation can improve the Cobb angle and reduce the incidence of postoperative scoliosis, but it is easy to appear the imbalance of coronal and sagittal planes, which can be selected according to the actual situation.

4.
Chongqing Medicine ; (36): 1354-1356, 2018.
Article in Chinese | WPRIM | ID: wpr-691962

ABSTRACT

Objective To investigate the relationship between new vertebral fracture after percutaneous vertebroplasty (PVP) and insulin resistance (IR).Methods A total of 148 patients with osteoporotic vertebral compression fracture in our hospital from June 2013 to June 2016 were included,which were divided into the new fracture (NF) group and postoperative non-fracture control (NC) group.The patient's general information was collected.HOMA-IRindex was calculated by adopting the homeostatic model assessment formula,IR was defined as HOMA-IR≥1.73.The patients with IR were further divided into the low IR group (HO-MA-IR<2),middle IR group (HOMA-IR 2-6) and high IR group (HOMA-IR>6).The T value of bone mineral density (BMD) was tested by the dual-energy X-ray absorptiometry,and body mass index (BMI) was calculated according to height and weight.Results Excluding the patients losing follow-up,128 cases were finally included in this study.A total of 48 cases (37.5%) were suffered from new vertebral fracture during follow-up.The morbidity in the NF group was significantly higher than that in the NC group,moreover the HO-MA-IR value was significantly increased (P<0.05).The IR subgroup analysis showed that with the increasing of IR,the HOMA-IR value and incidence rate of new fracture was increased,however BMI had no statistical difference among 3 subgroups (P>0.05).The further Pearson correlation analysis showed that the HO-MA-IR value was negatively correlated with the T value (r=-0.361,P=0.027),and positively correlated with the incidence rate of new fracture (r=0.413,P=0.015).Conclusion The risk of new vertebral fracture occurrence after PVP in the patients with IR is increased,which could be considered as an anticipate risk factor.

5.
Article in Chinese | WPRIM | ID: wpr-513897

ABSTRACT

BACKGROUND: Studies have shown that osteoporosis often leads to a failure in pedicle screw fixation. Considering that the use of ordinary pedicle screw fixation cannot achieve a strong and stable fixation of the osteoporotic vertebra,special measures to strengthen the internal fixation is indispensable.OBJECTIVE: To evaluate the effect of bone cement augmentation combined with expandable pedicle screw fixation on the fixation strength of osteoporotic thoracolumbar vertebrae.METHODS: Twenty osteoporotic thoracolumbar vertebral specimens were randomly divided into four groups: conventional pedicle screw group implanted with normal pedicle screw, and the other three groups implanted with expandable pedicle screw. Bone cement augmentation with polymethylmethacrylate (PMMA) and calcium sulfate was done in the PMMA group and calcium sulfate group, respectively, followed by expandable pedicle screw implantation. No bone cement was used in the expandable pedicle screw group. The maximum axial pull-out strength and yield energy absorption value of the unilateral pedicle were detected, and the maximum removal torque of the contralateral pedicle was determined. Bone cement leakage after augmentation was observed.RESULTS AND CONCLUSION: Compared with the conventional pedicle screw group, the other three groups showed a significant increase in the maximum pull-out strength, maximum removal torque and yield energy absorption values (P 0.05). No leakage of bone cement was found in all the groups. To conclude, the combined use of expandable pedicle screw and can significantly enhance the stability of the osteoporotic thoracolumbar vertebrae, and the PMMA and calcium sulfate cements have similar effects.

6.
Article in Chinese | WPRIM | ID: wpr-485806

ABSTRACT

BACKGROUND:We built Sprague-Dawley rat models with mild, moderate, and severe spinal cord injuries to accord with the spinal cord injury types for basic empirical study, and consequently to further understand the microenvironmental change in Sprague-Dawley rats with spinal cord injury, and to provide help for clinical treatment. OBJECTIVE:To observe the changes in nerve function, pathological manifestation and motor sensory evoked potential in Alen’s models and Sprague-Dawley rats with complete spinal cord transection at different time points after spinal cord injury by simulating the microenviroment in Sprague-Dawley rats. METHODS: A total of 125 healthy adult female Sprague-Dawley rats were selected and randomly divided into group sham operation group, 100 gcf hit potential group (20 g×5 cm), 200 gcf hit potential (20 g×10 cm), 300 gcf hit potential group (20 g×15 cm), and spinal cord complete transection group with 25 rats in each group. At 1, 5, 7, 14 and 28 days after model establishment, the degree of spinal cord injury was identified by the BBB scores of motion function, motor evoked potential, and pathological section. RESULTS AND CONCLUSION:(1) Totaly 24 Sprague-Dawley rats died in the experiment. The death rate and the rate of complications were highest in the spinal cord complete transection group. The BBB score of each group was decreased. The BBB scores in every group increased as time went on. There were significant differences between each surgery group and the sham operation group at corresponding time points (P 0.05). (2) In each surgery group, the infiltration of inflammatory cels and obvious sweling of neurons were visible at 1 day after injury. Neural cels reduced with time prolonged. At 28 days after injury, a large number of astrocytes proliferated, scar and spinal cord cavity formed. Above symptoms were worse in the 300 gcf hit potential group and spinal cord complete transection group than in the 100 gcf and 200 gcf hit potential groups. (3) Significant differences in amplitude and latency were detectable between each surgery group and the sham operation group (P 0.05). Results confirmed that hit potential of 20 g×5 cm, 20 g×10 cm and 20 g×15 cm can simulate the microenvironment of Sprague-Dawley rats with mild, moderate and severe spinal cord injury. The rate of complication was lower in modified Alen’s model of different hit potentials than in models of spinal cord complete transection, and was more accorded with basic research.

7.
Chinese Journal of Trauma ; (12): 929-933, 2016.
Article in Chinese | WPRIM | ID: wpr-502596

ABSTRACT

Objective To investigate the characteristics and treatment effects in patients with spinal fractures associated with dural tears.Methods A retrospective analysis was made on 185 patients with spinal fractures presenting to hospital from February 2013 to February 2015.There were 103 males and 82 females,aged 17-73 years (mean,58 years).Causes of injury were high falls in 72 patients,traffic collisions in 58,hitting by heavy objects in 41,ground-level falls in 12,and collision events in two.Cervical spine fractures were seen in 65 patients,thoracic vertebra fractures in 51,and lumbosacral vertebral fractures 69.Neurologic deficit was assessed using the American Spinal Injury Association (ASIA) score,including grade A in 24 patients,grade B in 22,grade C in 26,grade D in 37 and grade E in 76.Eighty patients were managed by simply anterior surgery,97 by posterior surgery,and eight by anterior-posterior surgery.Twenty-one patients were found with dural tears (group A) and 164 patients without dural tears (group B).Incidence of dural tears in cervical,thoracic and lumbosacral vertebral fractures were recorded and compared.Preoperative neurologic deficit,laminar fracture and spinal canal encroachment rate were compared between groups.Neurological function and complications associated with dural repair were detected.Results In group A,ten patients were rated ASIA grade A,five grade B,three grade C,one grade D and two grade E.In group B,14 patients were rated ASIA grade A,17 grade B,23 grade C,36 grade D and 74 grade E.Group A accounted for 11% (7/65) of cervical,10% (5/51) of thoracic,and 13% (9/69) of lumbosacral spine fractures (P > 0.05).Nineteen patients (91%) in group A were complicated with neurological deficit,compared to ninety patients (54.9%) in group B (P < 0.01).Eighteen patients (86%) in group A had laminar fractures,compared to fifteen patients (9.1%) in group B (P < 0.01).In group A,rate of spinal canal encroachment was (62.3 ± 12.1)% and 17 patients (81%) showed spinal canal encroachment of greater than 50%.While in group B,rate of spinal canal encroachment was (36.2 ± 15.6)% and 25 patients (15.2%) showed spinal canal encroachment of greater than 50% (P < 0.01).For dural tears in group A,11 patients were treated by direct suturing,four by thoracolumbar fascia repair,three by artificial dural coverage and three by fibrin glue sealing.In group A,19 patients were followed up and one of them presented persistent cerebral spinal fluid leak that necessitated an irrigation and debridement to cure.ASIA score was improved from grade A to B in two patients,grade B to C in one,grade C to D in one and grade D to E in one at the final follow-up.Conclusions Majority patients with spinal fractures associated with dural tears exist severe neurologic deficit,spinal canal encroachment and laminar fractures.Incidence of dural tear in cervical,thoracic and lumbosacral vertebral fractures is similar.Incidence of complications related to dural tear repair is low,but the neurological function recovery is poor after operation.

8.
Article in Chinese | WPRIM | ID: wpr-479442

ABSTRACT

BACKGROUND:Tissue-engineered intervertebral disc has provided a new biological therapeutic approach for intervertebral disc degeneration. Tissue-engineered annulus fibrosus is one key step of constructing a complete tissue-engineered intervertebral disc. OBJECTIVE:To sum up the research progress of tissue-engineered annulus fibrosus from the folowing aspects: structural features, scaffold materials, seed cels. METHODS:PubMed database and Wanfang database (2000-2015) were retrieved by the key words of “tissue engineering, intervertebral disc, annulus fibrosus, seed cel, scaffold, construction” in Chinese and in English, respectively. According to inclusion and exclusion criteria, 48 literatures were involved for summarization. RESULTS AND CONCLUSION: Previous studies about tissue-engineered annulus fibrosus only focused on cel adhesion, proliferation and extracelular matrix secretion on the scaffold. Currently, tissue-engineered annulus fibrosus exhibit similar features to the natural annulus fibrosus in the folowing aspects: cel function, tissue structure and mechanical features, and relevant animal experiments have achieved certain results in animal experiments. However, it is stil difficult to build a tissue-engineered annulus fibrosus entirely similar to the natural one, and we need to further improve scaffold materials, culture conditions, colection of seed cels. The current strategies of annulus fibrosus construction stil focus on single phase of scaffold, and the biphasic scaffold and complete intervertebral disc scaffold wil be the trend of the researches. Technology of induced differentiation of stem cels provides a broach source of seed cels for tissue-engineered annulus fibrosus.

9.
Chongqing Medicine ; (36): 3201-3203, 2014.
Article in Chinese | WPRIM | ID: wpr-455971

ABSTRACT

Objective To investigate the clinical therapeutic effects of different surgical treatments on cervical spondylotic my-elopathy and the occurrence of postoperative complications .Methods 65 patients with cervical spondylotic myelopathy admitted in our department between January 2010 and January 2013 were retrospectively analyzed ;and among them ,31 underwent anterior cer-vical discectomy and fusion(ACDF) and 34 underwent anterior cervical corpectomy and fusion (ACCF);the general surgical condi-tions ,JOA scores and functional grades of Nurick ,incidences of dysphagia and so on in the patients of the two groups were investi-gated .Results The operative time and intra-operative blood loss of the patients of the ACDF group were better than those of the ACCF group[(88 .70 ± 9 .03)min ,(125 .46 ± 12 .62)min ,(94 .26 ± 10 .34)mL ,(133 .98 ± 12 .09)mL] ,and the differences were sta-tistically significant(P0 .05);but the differences between the preoperative and postoperative JOA scores and functional grade of Nurick in 6 months after the surgeries and those before the surgeries of the same groups were statistically significant (P<0 .05) .At the same observation time points ,the incidences of dysphagia and the thicknesses of soft tissue before the cervical vertebra in the operated segment of the observation group were all lower than those of the control group ,and the differences were statistically significant (P<0 .05);in the patients of either group ,no loosening ,translocation or non-fusion of the bone graft was observed .Conclusion The two surgeries in treatment of cervical spondylotic myelopathy van both obtain satisfying clinical therapeutic effects ,but ACDF has a lower incidence of postop-erative complications ,and doctors should choose a suitable surgery based on the actual conditions .

10.
Article in Chinese | WPRIM | ID: wpr-452128

ABSTRACT

Objective To investigate the effects of preemptive analgesia with parecoxib sodium on postoperative analgesia and delirium after nerve injury-free surgery for fracture of thoracic and lumbar vertebrae and to promote the postoperative rehabilitation of the patients. Method 80 patients meeting the criteria were selected. and randomly divided into observation group and control group.40 patients each group. The observation group used parecoxib sodium for preemptive analgesia. while the control group used sufentanil. and the analgesia effects and the incidences of delirium were observed. Results The differences in operative time and intra-operative blood loss between the patients of the two groups were statistically insignificant. In 2 h. 6 h. 12 h.24 h and 48 h after the surgery.the VAS score and the accumulative time of intravenous self-controlled analgesia pump being pressed of the observation group were significantly lower than those of the control group. and the differences were statistically significant (P<0.05). The first time for the patients of the observation group to press the intravenous self-controlled analgesia pump is (3.84±0.62) h after the surgery, is significantly later than that of the control group (1.05±0.47)h.and the difference is statistically significant (P<0.05). The incidence of delirium in 7 days after the surgery in the patients of the observation group was 10.00%. and is significantly lower than that of the control group (25.00%) (P<0.05). Conclusion Using parecoxib sodium for preemptive analgesia before nerve injury-free surgery for fracture of thoracic and lumbar vertebrae can elevate the postoperative analgesia effects of the patients.decrease the incidence of postoperative delirium, and is highly safe and consequently worthy of clinical application.

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