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<p><b>OBJECTIVE</b>To explore the features and treatment strategy of delayed infection of proximal junctional zone after posterior spinal internal fixation.</p><p><b>METHODS</b>The clinical data of 1325 patients underwent posterior spinal internal fixation were retrospectively analyzed. Delayed infection occurred in 10 patients, among which 4 infections occurred at the proximal junction (non-operative site). And these 4 patients were treated with combined broad-spectrum antibiotics. Their clinical symptoms and signs, lab tests, MRI findings, pathology findings, and clinical effects were analyzed.</p><p><b>RESULTS</b>All four patients were followed up from 6 months to 4 years. No infection recurrence was found. All patients obtained satisfactory results after hospital discharge. No nerve injury was found. One patient developed kyphosis in the proximal junctional zone 2 years after the operation. According to the criteria of N.Nakano and T.Nakano, 3 cases obtained excellent results, while 1 poor.</p><p><b>CONCLUSIONS</b>The incidence rate of delayed infections was rare after spinal operation. Delayed infections occurred in proximal junctional zone may be attributed to the stress concentration of adjacent segments after fixation and the degeneration of adjacent segments, thus forming inflammation areas. For refractory lumbar and back pains, an elevated blood sedimentation rate, C-reactive protein level, MRI manifestation and focal pathology would be helpful for establishing a definite diagnosis. Full course of combined broad-spectrum antibiotics in treating the infection can lead to satisfactory clinical results.</p>
Subject(s)
Humans , Back Pain , Fracture Fixation, Internal , Kyphosis , Lumbar Vertebrae , Lumbosacral Region , Retrospective Studies , Spinal Fusion , Surgical Wound Infection , Drug Therapy , Epidemiology , Treatment OutcomeABSTRACT
Objective To analyze the effect of evidence based practice on feeding after spinal operation. Methods To formulate an answerable question, find the best available evidence, appraise the evidence and formulate the recommendations by using the method of evidence-based medicine. A total of 60 postoperative patients who received spinal operation were divided into observation group and control group (30 cases in each group). Those patients in control group received the routine diet guidance and the guidelines for the standardization of intake and consumption after spinal cord surgery were used for patients in observation group. The outcomes were evaluated by postoperative recovery and complications of patients after spinal operation. Results There were no significant difference in the incidence of nausea, vomiting , bloating and celialgia in the 5 hours after surgery and 2 hours after feeding between the two groups (P>0.05). The incidence of thirst and hunger in the 5 hours after surgery in observation group were 3.33％(1/30) and 13.33％(4/30).The incidence of thirst and hunger in the 5 hours after surgery in control group were 80.00％(24/30) and 83.33％(25/30). There were statistically significant in the incidence of thirst and hunger in the 5 hours after surgery between the two groups (χ2=36.27, 24.09, P<0.05). There were not statistically significant in the time of anal exsufflation and first defecation time between the two groups(P>0.05). Conclusions Evidence-based practice in the use of guidelines for the standardization of intake and consumption after spinal cord surgery can guide clinical practice.
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Objective To explore the effect of lidocaine with intravenous infusion on the postoperative inflammatory factors and cognitive dysfumction for elderly patients undergoing spinal operation.Method 80 elderly patients undergoing spinal operation in Central hospital of Baoji were enrolled from Janua-y 2015 to January 2016,of which patients divided into two groups randomly,control group (n =40) accepted routine general anesthesia,and study group (n =40) adopted intravenous lidocaine based on the patiems in control group,comparing the MMSE score and the incidence of postoperative cognitive dysfunction (POCD) with before operation,detecting and analyzing the difference of inflammatory and immunity factors.Results The MMSE score of the study group after three days of operation was significantly lower than that of the control group,the difference was statistically significant (P ＜ 0.05).The incidence of POCD in the study group was significantly lower than that in the control group,the difference was statistically significant (P ＜ 0.05).The serum levels of IgA,IgM and IgG in the study group after seven days of operation were significantly higher than those in the control group,the difference was statistically significant (P ＜ 0.05).After three days and seven days postoperatively,the serum levels of interleukin-6 (IL-6) in the study group were significantly lower than those in the control group,the difference was statistically significant (P ＜ 0.05).And there was no significance of TNF-α between two groups at any time point.Conclusions Intravenous lidocaine for patients undergoing spinal operation could inhibit the inflammatory response,improve the function of immunity,and decrease the incidence of POCD,which deserved popularization in clinic.
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Objective To explore the effect of lidocaine with intravenous infusion on the postoperative inflammatory factors and cognitive dysfumction for elderly patients undergoing spinal operation.Method 80 elderly patients undergoing spinal operation in Central hospital of Baoji were enrolled from Janua-y 2015 to January 2016,of which patients divided into two groups randomly,control group (n =40) accepted routine general anesthesia,and study group (n =40) adopted intravenous lidocaine based on the patiems in control group,comparing the MMSE score and the incidence of postoperative cognitive dysfunction (POCD) with before operation,detecting and analyzing the difference of inflammatory and immunity factors.Results The MMSE score of the study group after three days of operation was significantly lower than that of the control group,the difference was statistically significant (P ＜ 0.05).The incidence of POCD in the study group was significantly lower than that in the control group,the difference was statistically significant (P ＜ 0.05).The serum levels of IgA,IgM and IgG in the study group after seven days of operation were significantly higher than those in the control group,the difference was statistically significant (P ＜ 0.05).After three days and seven days postoperatively,the serum levels of interleukin-6 (IL-6) in the study group were significantly lower than those in the control group,the difference was statistically significant (P ＜ 0.05).And there was no significance of TNF-α between two groups at any time point.Conclusions Intravenous lidocaine for patients undergoing spinal operation could inhibit the inflammatory response,improve the function of immunity,and decrease the incidence of POCD,which deserved popularization in clinic.
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Objective To investigate the readiness for hospital discharge of patients who had undergone spinal operation at West China Hospital, Sichuan University, to guide the medical care and health education. Methods A total of 164 patients after spinal operation who have readying to discharge were selected and investigated by General Information Questionnaire, Activity of Daily Life Scale and Readiness for Hospital Discharge Scale. Apply the Excel for data inputting, SPSS19.0 for statistical analysis and choose rate, x±s and so on for statistical description according to the types of data. Results Of all the 164 patients, 47 cases (28.7%) weren′t well prepared, 117 cases (71.3%) were well prepared;the score of Readiness for Hospital Discharge Scale was (142.38±34.23 points and the average score of all the articles was (7.12±1.72) points. Conclusions The readiness for hospital discharge score of patients who had undergone a spinal operation at West China Hospital, Sichuan University is low and their readiness for hospital discharge is inadequate. Medical staff can improve the patients′readiness for hospital discharge by strengthening health guidance in order to promote the recovery of patients.
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Objective To report a method of handling dural injury with cerebrospinal fluid leakage during the spinal operation process and analyze its effect,to comparatively analyze with the existing methods and to find a better way processing this problem.Methods A total of 36 patients with dural injury and cerebrospinal fluid leakage during the spinal operation process were collected.Among these clinical cases,there were 15 males,21 females,age ranged from 26 to 78 years old,average 58 years old.During the spinal operation process,the injured dura was sutured or repaired.After that,the dural wound was glued with a piece of muscle or fascia by a kind of medical glue named KangPaiTe.After the operation,broad -spectrum antibiotics and timely fresh dressing changing for the wound were applied.The nature and volume of the drainage fluid was documented and analyzed.When the volume of the drainage fluid was below 50mL per day,the drainage tube was pulled away,and the incision of the drainage tube was sutured again.Results The cerebrospinal fluid leakage lasted from 0 day to 4 days,average 1.5 days;the drainage tube was placed from 1 day to 5 days,average 2 days;no wound infection and other complications occurred among all the clini-cal cases included in this study.Conclusion After the injured dura was sutured or repaired,gluing the dural wound with a slice of muscle or fascia by a kind of medical glue named Kangpaite is a better method of handling dural injury with cerebrospinal fluid leakage.