ABSTRACT
BACKGROUND: Proximal junctional kyphosis is a common complication after spinal deformity surgery, which can lead to a variety of adverse clinical outcomes. Therefore, it is necessary to analyze the risk factors that may lead to proximal junctional kyphosis after surgery, in order to expand our understanding of proximal junctional kyphosis and provide guidance for its prevention. OBJECTIVE: To evaluate the risk factors of proximal junctional kyphosis after spinal deformity surgery using meta-analysis. METHODS: A systematic literature search was performed using PubMed, EMbase, Cochrane, CNKI and Wanfang Medical Database (up to May 2019). The quality of literatures was assessed and selected according to the inclusion criteria and exclusion criteria. Relevant data were extracted. RevMan 5.3 software was used for data analysis and the data were dealt by meta-analysis. The meta-analysis results were evaluated. RESULTS AND CONCLUSION: (1) This study included 26 studies involving 4 498 patients of whom 921 with proximal junctional kyphosis. The incidence of proximal junctional kyphosis after spinal orthopedic surgery was 25%. (2) There were significant differences between the proximal junctional kyphosis and non-proximal junctional kyphosis groups in age, body mass index, osteoporosis, number of surgical vertebral bodies, the upper instrumented vertebra to the thoracolumbar segment (T10-L1), the lower instrumented vertebra to the sacrum/pelvis/ilium, postoperative proximal kyphosis angle, lumbar lordosis and sagittal vertical axis, changes in proximal kyphosis angle, lumbar lordosis and sagittal vertical axis (P 0.05). (4) Our meta-analysis showed that age, body mass index, osteoporosis, the number of operative vertebrae > 5 at fixation segment, the upper instrumented vertebra internal fixation to thoracolumbar segment (T10-L1), the lower instrumented vertebra fixation to sacrum/pelvis/ilium, postoperative proximal kyphosis angle, lumbar lordosis and sagittal vertical axis, changes in proximal kyphosis angle, lumbar lordosis and sagittal vertical axis were the main risk factors for proximal junctional kyphosis. The incidence of proximal junctional kyphosis can be reduced by intervening the high-risk population and making the suitable surgical procedures. Proximal junctional kyphosis was due to a variety of non-surgical and surgical factors. More rigorous epidemiological studies are needed to provide reliable evidence for reducing the incidence of proximal junctional kyphosis.
ABSTRACT
Objective To evaluate the efficiency of dezocine combined with sufentanil on postoertive analgesia for spinal deformity sur-gery.Methods Divided the 90 patients who were admitted into our hospital from January 2013 to September 2015 into three groups by ran-dom single blind method,namely the dezocine group,the sufentanil group and the combined group,with 30 cases in each group.All the pa-tients underwnet propofol and sevoflurane static absorption compound anesthesia,and they were given continuous intravenous analgesia with different drugs after the surgery.Their visual analogue scale (VAS)score,sedation scale (SS)score,adverse reaction,total PCIA times,ef-fective PCIA times,respiratory rate and arterial blood gas were measured at 2,6,24,48 hours after operation.Results The VAS score of the combined group was lower than that of the dezocine group (P <0.05).The combined group was significantly superior to the dezocine group and the sufentanil group in SS score and adverse reactions.At 24 and 48 hours after surgery,SaO2 and PaO2 in the combined group were higher than those in sufentanil group (P <0.05).PaCO2 in the combined group was lower than that in the dezocine group and the sufentanil group(P <0.05).Conclusion Dezocine combined with sufentanil is a more efficiency way with less adverse reaction on postoperative anal-gesia for spinal deformity surgery,and it is an ideal way of analgesia.
ABSTRACT
PURPOSE: Complications are quite common in surgery to correct spinal deformities due to the long duration under anesthesia and massive blood loss. The aim of this study was to evaluate and compare the effectiveness of Aprotinin in spinal deformity surgery. MATERIALS AND METHODS: Fifty-nine patients who underwent spinal deformity surgery were analyzed. Thirty-two patients were administered Aprotinin, and 27 control patients were not. The Pre- and Post- operative hemoglobin and hematocrit, blood loss, transfusion requirements, operative time, postoperative blood loss through suction drains and duration of suction drains were measured in both groups. RESULTS: There were no differences in age, gender, height, weight, hemodynamic indices, postoperative blood loss through the suction drains and the duration of the suction drains between the two groups. Intraoperative blood loss, transfusion and operative time were 1,345+/-425 cc, 1,008+/-721 cc, and 247 minutes in the Aprotinin (+) group and 2,070+/-1,276 cc, 2,552+/-2,791 cc, and 279 minutes in the Aprotinin (-) group, respectively. The postoperative hemoglobin and hematocrit levels were also significantly different (12.9+/-1 cc and 38.3+/-3.1% in the Aprotinin (+) group, and 11.9+/-1.8 cc and 35+/-5.5% in the Aprotinin (-) group, respectively). CONCLUSION: There was significantly less intraoperative blood loss, transfusion and surgery time in the group administered Aprotinin. Therefore, Aprotinin can be used in spinal deformity surgery that has a high risk of massive blood loss.