Retrospective study of complication of interspinous implants for degenerative lumbar disease / 中华外科杂志

<p><b>OBJECTIVE</b>To summarize and analyze the complications of interspinous implants for degenerative lumbar disease.</p><p><b>METHODS</b>From September 2007 to September 2011, 177 cases with degenerative lumbar diseases were treated with interspinous implants. There were 99 male patients and 78 female patients, the average age was 44.5 years (26 - 71 years). According to the application interspinous dynamic stabilization system type were divided into the Wallis group (136 cases) and Coflex group (41 cases). The clinical results were assessed by visual analog scale (VAS) of pain on lumbar and lower limbers, lumbar Japanese Orthopedic Association (JOA) score and Prolo functional score. The radiological results including segmental lodosis and segement movement degree were assessed by lumbar X ray and dynamic X ray. Summarize and analyze the complications both during operation and post operation. Quantitative datas were compared by paried-samples t test and complication rate was compared by χ(2) test.</p><p><b>RESULTS</b>There were 168 cases had completed follow-up and the average time was 34.7 months (3 - 50 months). In the final follow-up, lumbar pain VAS, lower limber pain VAS, lumbar JOA score and Prolo functional score were better than pre-operation (t = 10.7, 7.9, 13.4 and 8.8, P < 0.01). Segment lodosis angles was 14° ± 4° which was less than pre-operation 19° ± 4° (t = 9.4, P < 0.01).Segment movement degree was larger in Coflex group (12.6° ± 3.1°) than in Wallis group (9.7° ± 2.7°) (t = 8.6, P < 0.05). Complication rate was 10.7% (18/168), which of Wallis group was 6.2% (8/130) and Coflex group was 26.3% (10/38) (χ(2) = 12.5, P < 0.01). In Wallis group, there were 3 cases with dura tear and cerebrospinal fluid leakage, 1 case with nerve root injury and foot drop, 2 cases with spacer breakage when implantation and change the implants and 2 cases with recurrence of lumbar disc herniation. In Coflex group, there was 1 case with dura tear and cerebrospinal fluid leakage, 2 cases with mild displacement post operation, 1 case with debridement for aseptic wound exudates, 1 case with implant removal for breakage 1 week post operation, 4 cases with recurrence of lumbar disc herniation and 1 case with lumbar disc herniation 6 months post operation of lumbar stenosis.</p><p><b>CONCLUSIONS</b>The application of interspinous implants for degenerative lumbar diseases is effective and relative safe, but would suffer from the risk of complications.</p>

Retrospective study of combined application of interspinous process fixation system and rigid fixation system for degenerative lumbar diseases / 中华外科杂志

<p><b>OBJECTIVE</b>To assess the efficacy and safety of combined application of interspinous process fixation system and rigid fixation system for degenerative lumbar diseases.</p><p><b>METHODS</b>From September 2007 to September 2008, 16 cases with degenerative lumbar diseases were treated with combined application of interspinous process fixation system and rigid fixation system. The clinical results were assessed by VAS of pain of lumbar and lower limbs, lumbar JOA score and Prolo functional score. The radiological results including implant position (interspinous process, pedicle screws and plates), spinous process fracture, segmental range of motion (the non-fusion fixation segment, and the intermediate segments between fused and non-fused segments) which were assessed by lumbar static and dynamic X rays.</p><p><b>RESULTS</b>All 16 cases obtained an average follow-up of 17.6 months. At final follow up, lumbar VAS, lower limbers VAS, lumbar JOA score and Prolo functional score were significant improved than those of pre-operation (lumbar VAS: 1.9 +/- 1.4 vs. 4.5 +/- 3.1; lower limbs VAS: 1.7 +/- 1.2 vs. 6.3 +/- 2.9; lumbar JOA score: 22.8 +/- 3.3 vs. 12.5 +/- 4.7; Prolo functional score: 8.3 +/- 1.2 vs. 4.0 +/- 2.3). Range of motion of the non-fusion fixation segment was (9.8 +/- 4.2) degrees and that of the intermediate segments between fused and non-fused segments was (13.2 +/- 3.5) degrees .</p><p><b>CONCLUSIONS</b>Combined application of interspinous process fixation system and rigid fixation system for degenerative lumbar diseases provides a new idea to avoid the multi-segment fusion fixation and pertinent potential problems. Short-term clinical results are successful.</p>

Influence factors of adjacent segment degeneration after instrumented lumbar fusion / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the influence factors of adjacent segment degeneration (ASD) after instrumented lumbar fusion.</p><p><b>METHODS</b>Thirty-three patients who had undergone an instrumented lumbar fusion from March 1998 to May 2002 were reviewed. The incidence, age, position, radiographic characteristics and clinical manifestations of ASD were studied. Then the relations between "floating fusion" and ASD were compared, the range of fusion and ASD and investigated the incidences of different adjacent segments.</p><p><b>RESULTS</b>The mean follow-up period for the patients was 4 years and 7 months (24 - 82 months). Adjacent segment degeneration mainly occurred in patients older than 60. Ten patients (10%) were found to have radiographic characteristics of ASD. Nine of the ten patients had ASD at cranial segments. Using "floating fusion" or not did not show difference in the risk of ASD. There was a trend of more ASDs after long-segment fusion than short-segment fusion. As an adjacent segment, L(2)/L(3) had a high risk of ASD, while L(5)/S(1) had a much lower risk.</p><p><b>CONCLUSIONS</b>The cranial segment has a higher degeneration risk than the caudal segment. If L(2)/L(3) has degenerative appearance and has chance to be the adjacent segment, we'd better fuse it. If there is no evidence of obvious degeneration, L(5)/S(1) should not be fused. During instrumented lumbar fusion, long-segment fusion should be avoided if possible.</p>

The effect of Shen-Fu on gastrointestinal tract injury and its potential mechanism during cardio-pulmonary bypass in patients undergoing cardiac surgery / 中华创伤杂志(英文版)

<p><b>OBJECTIVE</b>To investigate the effect of Shen-Fu (SF) injection on gastrointestinal tract injury and its potential mechanism.</p><p><b>METHODS</b>Thirty-eight patients undergoing elective open heart surgery were assigned to Group C (control group, n=18) and Group SF (n=20) randomly. In Group SF, the patients received intravenous injection of SF (0.5 ml/kg) at the beginning of the surgery followed by a continuous infusion of 100 ml SF (1.0 ml/kg) solution diluted by saline at a rate of 0.004 ml x Kg(-1) x min(-1) with a Grasby pump. The control group was injected with normal saline in the same volume. Gastric intramucosal pH (pHi), activity of blood diamine oxidase (DAO), and concentrations of blood LPS and IL-6 were measured before CPB (S0) and 1 h (S1) and 2 h (S2) after aortic declamping, respectively.</p><p><b>RESULTS</b>In Group C, pHi value was significantly lower at S1 and S2 than at S0 (mean P<0.01) and blood DAO and concentrations of LPS and IL-6 were significantly higher at S1 and S2 than at S0 (mean P<0.01). In Group SF, pHi was obviously lower at S1 and S2 than at S0 (P<0.05) but LPS and IL-6 levels and DAO were higher at S0 (mean P<0.05). Blood DAO and LPS level demonstrated significant negative correlations with pHi (mean P<0.01) while LPS concentration showed a positive correlation with blood DAO (P<0.01) and IL-6 concentration (P<0.05). At S1 and S2 after aortic declamping, the levels of pHi were higher in Group SF than in Group C (mean P<0.01 ) but DAO and LPS and IL-6 levels were significantly lower in Group SF than in Group C (P<0.01).</p><p><b>CONCLUSIONS</b>SF has a protective effect on gastrointestinal tract and can reduce inflammatory actions.</p>