Effect of shortening drainage time for patients with dural tears after posterior spinal surgery / 局解手术学杂志

Objective To study the clinical effects of shortening the drainage time for patients with dural tears after posterior spinal sur -gery.Methods A total of 120 patients with dural tears after posterior spinal surgery were randomly divided into study group and control group,60 patients in each group .Patients in control group had wound drainage tubes removed after 5 days and patients in study group had wound drainage tubes removed after 3 days.The disappearance time of leakage ,incision healing time and complication rate were compared between two groups.Results The disappearance time of leakage in study group was (13.7 ±3.8)days which was significantly less than (20.0 ±5.1)days in control group(P<0.05).The incision healing time in study group was (22.7 ±4.9)days which has no significant difference with (23.9 ± 5.7)days in control group.The postoperative infection rate was 3.3%(2/60) which was significantly less than 20.0%(12/60) in control group(P<0.01).Conclusion Shortening drainage time can decrease the disappearance time of leakage and postoperative infection rate .

The Incidence and Management of Dural Tears and Cerebrospinal Fluid Leakage during Corrective Osteotomy for Ankylosing Spondylitis with Kyphotic Deformity

OBJECTIVE: To present the incidence and management of dural tears and cerebrospinal fluid leakage during corrective osteotomy [Pedicle Subtraction Osteotomy (PSO) or Smith-Petersen Osteotomy (SPO)] for ankylosing spondylitis with kyphotic deformity. METHODS: A retrospective study was performed for ankylosing spondylitis patients with fixed sagittal imbalance, who had undergone corrective osteotomy (PSO or SPO) at lumbar level. 87 patients were included in this study. 55 patients underwent PSO, 32 patients underwent SPO. The mean age of the patients at the time of surgery was 41.7 years (21-70 years). Of the 87 patients, 15 patients had intraoperative dural tears. RESULTS: The overall incidence of dural tears was 17.2%. The incidence of dural tears during PSO was 20.0%, SPO was 12.5%. There was significant difference in the incidence of dural tears based on surgical procedures (PSO vs. SPO) (p<0.05). The dural tears ranged in size from 12 to 221 mm2. A nine of 15 patients had the relatively small dural tears, underwent direct repair via watertight closure. The remaining 6 patients had the large dural tears, consequently direct repair was impossible. The large dural tears were repaired with an on-lay graft of muscle, fascia or fat harvested from the adjacent operation site. All patients had a successful repair with no patient requiring reoperation for the cerebrospinal fluid leak. CONCLUSION: The overall incidence of dural tears during PSO or SPO for ankylosing spondylitis with kyphotic deformity was 17.2%. The risk factor of dural tears was complexity of surgery. All dural tears were repaired primarily using direct suture, muscle, fascia or fat graft.

Microendoscopic lumbar discectomy：a learning curve and experience of first 100 cases / 实用医学杂志

Objective To analyze the learning curve of microendoscopic lumbar discectomy (MED) and summarize the operative experience. Methods From July 2010 to March 2012, the first 100 patients with single level lumbar disc herniation managed with MED were divided into chronological groups (A, B, C and D), 30 patients in group A, B, C and 10 patients in group D. The comparsons were conducted in terms of operative time , estimated blood loss , number of cases with transition from MED to open surgey or for reoperation , rate of complications and postoperative efficacy. Results The mean operative time and the mean estimated blood loss in each group was valuated respectively. In group A , the operative time and estimated blood loss were significantly decreased as compared with those in group B, C and D respectively (P 0.05). There were 6 complications in group A, 1 complication in group B and C respectively and no complication in group D. The leg pain visual analogue scale and Oswestry disability index at the first month and the twelfth month postoperatively were all improved respectively as compared with those preoperatively (P < 0.01). Conclusion The learning curve of microendoscopic lumbar discectomy generally may reach the plateau when about 30 cases are operated on. The key procedure to pass over the learning curve includes puncture and location , flavectomy , anatomy mark identification, and precaution of damage in dural sac.