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Objective:To investigate the mid-term clinical efficacy and imaging changes of Waveflex semi-rigid internal fixation system combined with posterior lumbar interbody fusion (PLIF) in the treatment of double segmental lumbar degenerative diseases.Methods:The data of 51 patients with lumbar degenerative diseases who underwent surgery from September 2014 to September 2015 were retrospectively analyzed, including 29 males and 22 females, aged 65.5±5.6 years (range 58-73 years). Preoperative intervertebral space degeneration grade by University of California at Los Angeles (UCLA) and Pfirrmann intervertebral disc degeneration grade were recorded. 23 cases of primary responsible segments were treated with decompression, fixation and fusion, and adjacent secondary responsible or degenerative segments were treated with Waveflex semi-rigid internal fixation (combined group); 28 cases of double segments were treated with decompression, fixation and fusion (fusion group). Disc height index (DHI) and intervertebral foramina height (IFH) of the semi-rigid fixation segments, DHI and IFH of the upper adjacent intervertebral space, and horizontal displacement of the upper adjacent vertebral body (HD) were measured on lateral X-ray films of lumbar spine; In the fusion group, DHI and IFH adjacent to the upper vertebral space and HD adjacent to the upper vertebral body were measured. The efficacy was evaluated by short-form McGill Pain Questionnaire (SF-MPQ) and Oswestry disability index (ODI).Results:51 cases were followed up for 5.4±0.3 years (range 5.2-6.3 years). The low back and leg pain and function in the combined group and fusion group were significantly improved compared with those before operation. SF-MPQ and ODI at 3 months, 1 year, 5 years after operation were significantly different from those before operation ( P<0.05). In the combined group, the DHI of semi-rigid internal fixation segments before operation and 3 months, 1 year, 5 years after operation were 37.8%±7.6%, 37.9%±7.4%, 36.5%±6.9% and 36.0%±7.1% respectively ( P>0.05); The IFH of semi-rigid internal fixation segments before operation and 3 months, 1 year, 5 years after operation were 21.5±2.8, 21.4±2.8, 20.4±2.7, 19.4±2.4 mm respectively ( P<0.05); The DHI of the upper segment adjacent to semi-rigid internal fixation before operation and 3 months, 1 year, 5 years after operation were 37.1%±9.3%, 36.8%±9.1%, 35.2%±9.1%, 33.9%±8.8% respectively ( P>0.05); The IFH of the upper segment adjacent to semi-rigid internal fixation before operation and 3 months, 1 year, 5 years after operation were 21.9±3.0, 21.4±3.0, 20.4±2.9, 19.5±2.7 mm, respectively ( P<0.05). The HD of upper vertebral body adjacent to semi-rigid internal fixation before operation and 3 months, 1 year, 5 years after operation were 2.2±0.7, 2.3±0.5, 2.5±0.5, 2.8±0.5 mm respectively ( P<0.05). At the last follow-up, one case of semi-rigid titanium rod fracture, one case of screw loosening at semi-rigid internal fixation segment, three cases with unsatisfied numbness relief, and 2 cases of facet joint spontaneous fusion at semi-rigid fixation segment occurred in the combined group. Conclusion:Waveflex semi-rigid internal fixation can protect the degenerative lumbar intervertebral disc, and delay the degeneration of semi-rigid internal fixation segment and adjacent upper segment after interbody fusion, but long-term follow-up and study are needed.
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Objective To determine the diagnostic accuracy of dual- source computed tomography coronary angiography (DSCT-CA) for detecting various degrees of coronary artery stenosis. Methods A total of 278 patients with coronary atherosclerotic heart disease (CHD) were selected for DSCT-CA examination. The coronary angiography (CAG) examination was carried out within 30 days in these patients. The result of CAG was used as the gold standard. The coronary artery stenosis of 50% and 75% was used as the sector. Based on the data of patients, DSCT-CA was calculated for quantitative assessment of the sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of coronary stenosis for the coronary blood vessels and coronary artery segments. Kappa consistence test was used to analyze the results of two methods. Results The 50%and 75%of coronary artery stenosis was used for the sector, based on the patients, the sensitivities of DSCT-CA were 99.6% and 99.1%, specificities were 84.2%, 89.6%, diagnostic accuracies were 98.6%and 97.5%, and the Kappa values were 0.88 and 0.91. Based on coronary vessels, the sensitivities were 92.0%and 96.9%, specificities were 89.9%and 94.8%, diagnostic accuracies were 91.0%and 95.8%, and the Kappa values were 0.88 and 0.92. Based on coronary artery segments, the sensitivities were 97.3%, 96.5%, specificities were 93.3%, 98.1%, diagnostic accuracies were 94.2%and 97.9%, and the Kappa values were 0.84 and 0.91. Conclusion Based on patient’s coronary artery analysis, DSCT-CA can accurately assess the different degrees of coronary stenosis, but based on the analysis of the coronary artery segment, the false-positive results may occur in the diagnosis of DACT-CA, which suggests that DSCT-CA can partly replace the CAG, still cannot completely replace the CAG.
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Acute-on-chronic liver failure (ACLF) is the most complicated form of liver failure among various types of liver failure. There are certain differences in the conception, etiology, and pathogenesis of ACLF between different regions. In recent years, ACLF has attracted attention of hepatologists all over the world, and some important progress has been made, which contributes to academic communication on ACLF, an early consensus on the diagnosis and treatment of ACLF, and eventually an increased survival rate in patients. This paper reviews the differences in conception between the Eastern and Western parts of the world, pathogenesis, treatment, and prognostic judgment of ACLF.
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Objective To study the effect of postoperative ileus of laparoscopic surgery versus open surgery for colorectal canc-er .Methods 220 patients of colorectal cancer were selected from October 2009 to June 2012 .The patients were randomly divided into the observation group(n=110 cases) and the control group(n=110 cases) .The patients of the observation group were treated with laparoscopic surgery ,and the patients of the control group were treated with conventional open surgery .The postoperative anal exhaust time and hospital stay time ,the incidence of postoperative ileus of the two groups were observed and compared .Results The postoperative anal exhaust time and hospital stay time of the patients after radical resection of left colon ,right colon and rectal cancer of the observation group were significantly less than that of the control group (P<0 .05) .The incidence of postoperative ileus of the observation group was 5 .45% (6/110 ) ,significantly lower than 11 .82% (13/110 ) of the control group ( P< 0 .05 ) . Conclusion Laparoscopic colorectal surgery is a minimally invasive surgery ,the patient′s trauma is smaller ,the postoperative re-covery is rapidly .The incidence of intestinal obstruction is smaller than that of the conventional open surgery .
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Objective To compare the clinical effects of vacuum sealing drainage and traditional method on subcutaneous effusion after spinal operation .Methods From June 2009 to June 2011 ,52 cases were randomly divided into 2 groups:group A(treat with vacuum sealing drainage) and group B(treat with traditional method ) .Comparing the cure rate ,wound healing time ,infection rete and satisfaction rate between two groups .Results All cured cases were followed up for 3 months ,all wounds achieved primary healing postoperatively ,and without recurrence .The cure rate was 92 .31% (24/26)in group A ,there was statistically significant difference compared with group B[69 .23% (18/26)](χ2 =4 .457 ,P<0 .05) .The wound healing time was(12 .13 ± 1 .39) d in group A ,and(17 .72 ± 1 .78) d in group B ,which showed statistically significant difference between two groups (t=11 .455 ,P<0 .05) . The satisfaction rate was 84 .62% (22/26)in group A ,and 61 .54% (15/26)in group B ,which showed statistically significant differ-ence between two groups(χ2 =4 .457 ,P<0 .05) .Conclusion The clinical effects of vacuum sealing drainage on subcutaneous effu-sion after spinal operation was obviously superior to traditional method ,and vacuum sealing drainage has advantages such as less pain ,more satisfaction in patients and less workload in medical staff .
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Objective To assess the feasibility, safety and efficacy of laparoscopic distal pancreatectomy (LDP) by comparing LDP with open distal pancreatectomy (ODP). Methods The clinical data of 68 patients with pancreatic body or tail diseases, who received distal pancreatectomy from May 2011 to February 2012, were retrospectively analyzed. LDP was performed in 16 cases and ODP in 52 cases. The baseline clinical data and the intraoperative and postoperative findings were compared between the two groups. Results There was no death in the two groups. The sex ratio, age, body mass index,tumor diameter and total hospital costs were not significantly different between the two groups. The incision length of LDP group was significantly shorter than that of ODP group (\[3.50±1.34\] cm vs \[17.94±2.12\] cm, P<0.001). The operative duration of LDP group was significantly longer than that of ODP group (\[145.63±56.80\] min vs \[87.21±32.06\] min,P<0.001). Postoperative hospital stay of LDP and ODP groups were (5.06±1.24) d and (8.06±2.53) d (P<0.001), time in bed after surgery were (1.31±0.68) d and (2.94±0.80) d (P<0.001), and postoperative fasting time were (1.31±0.57) d and (2.86±1.34) d (P<0.001), respectively. Estimated blood loss of LDP and ODP groups were (318.75±227.21) ml and (306.35±378.36) ml (P=0.898), respectively. Four patients had pancreatic leakages and 1 had peritoneal effusion in LDP group. Twelve patients had pancreatic leakages and 3 had peritoneal effusions in ODP group, with one having both pancreatic leakage and peritoneal effusion. There were no significant differences in the incidence of pancreatic leakage and peritoneal effusion between the two groups. The postoperative pain score was mainly 1-2 in LDP group and 2-3 in ODP group, with significant differences found between the two groups (P<0.001). Conclusion LDP is feasible and safe in treating benign or borderline disease of pancreatic body and tail. Compared to ODP,LDP has the advantage of less trauma and pain, quicker recovery without increasing the total costs.