A retrospective study on risk factors associated with postoperative delirium in elderly patients with spinal operation / 中国骨伤

OBJECTIVE@#To investigate the incidence and risk factors of delirium after spinal surgery in elderly patients.@*METHODS@#A retrospective analysis was performed on 436 patients with spinal surgery from January 2016 to November 2018. According to delirium occurrancy after the operation, 436 cases were divided into two groups:delirium group and non-delirium group. Body mass index(BMI), history of diabetes, history of coronary heart disease, history of chronic obstructive pulmonary disease (COPD), preoperative white blood cell count, preoperative erythrocyte volume, preoperative hemoglobin level, operation mode, operation time, anesthesia time, American Association of Anesthesiologists(ANA)(ASA) score, cardiac function grading(NYHA), intraoperative blood loss, intraoperative blood transfusion, intraoperative fentanyl, propofol and Dizocine dosage, postoperative white blood cell count, postoperative erythrocyte volume, postoperative hemoglobin level, postoperative electrolytes (sodium, potassium) and univariate logistic regression analysis were used to analyze the risk factors. The independent risk factors were further investigated by multivariate Logistic regression analysis.@*RESULTS@#Among 436 cases, 112 elderly patients had postoperative delirium, the incidence of delirium was about 25.68%. The age, preoperative leukocyte count, erythrocyte specific volume, postoperative hemoglobin level in delirium group and non-delirium group were measured. There were significant differences in the postoperative sodium concentration, anesthesia time, ASA score, cardiac function grading, blood loss during operation, postoperative use of Dizocine, history of diabetes, history of coronary heart disease and history of COPD (2, the use of Dizocine analgesic and the patients with COPD are the independent risk factors of postoperative delirium.

Application of sacral rod fixation for the treatment of lumbosacral segment tuberculosis / 中国骨伤

<p><b>OBJECTIVE</b>To evaluate the clinical outcomes of primary anterior radical debridement, bone autograft, and sacral rod fixation for the treatment of tuberculosis of the lumbosacral segment.</p><p><b>METHODS</b>From March 2004 to November 2008,11 patients with tuberculosis of the lumbosacral segments received antituberculosis medications for 2 to 3 weeks before anterior radical debridement, autologous iliac bone grafting, and internal sacral rod fixation. Among the patients, 5 patients were male and 6 patients were female, with an average age of (44.45 +/- 8.50) years (ranged from 29 to 56 years). The average time from stage of onset to operation was 11 months (ranged from 8 to 15 months). All the patients presented with various degrees of lower back pain; one patient experienced preoperative lower extremity radicular pain, while 2 patients experienced saddle area anaesthesia. However, only 6 patients exhibited mild to moderate tuberculous toxic reactions. All the patients were evaluated by plain radiography, computed tomography (CT), and magnetic resonance imaging (MRI). The diagnosis of tuberculosis was made with reference to clinical and radiological findings. Surgery was performed when the toxic symptoms of tuberculosis were controlled and erythrocyte sedimentation rates (ESR) decreased to (37.2 +/- 9.6) mm/h (25 to 54 mm/h). Lumbosacral angle, visual analogue scale (VAS) scores, ESR, and neurological performance were assessed before and after surgery.</p><p><b>RESULTS</b>All surgical procedures were performed successfully without intra or postoperative complications. There were no instances of spinal tuberculosis recurrence. Patients were followed up for a mean of (19.64 +/- 5.43) months. The mean lumbosacral angle significantly increased from the preoperative mean (12.9 +/- 5.0) degrees to postoperative (21.5 +/- 6.1) degrees and at final follow-up (20.1 +/- 5.2) degrees (P < 0.001). The mean VAS scores and ESR significantly decreased from preoperative (7.3 +/- 1.2) score and (37.2 +/- 9.6) mm/h respectively to final follow-up (0.6 +/- 0.5) score and (10.5 +/- 2.3) mm/h respectively (P < 0.001). Bone fusion occurred in all patients at a mean of (9.0 +/- 1.9) months (ranged 6 to 12 months) after surgery. Three patients who had impaired neurological performance before surgery had normal neurological performance after surgery.</p><p><b>CONCLUSION</b>Our findings suggest that anterior radical debridement, interbody fusion, and sacral rod fixation can be an effective treatment option for lumbosacral segment tuberculosis.</p>

Comparison of survival rate in two kinds of lesser saphenous sural pedicled fasciocutanous flaps / 上海第二医科大学学报

Objective To compare the survival rate of two kinds of neurovenofasciocutaneous flaps and investigate the venous reverse flow of flaps.MethodsTen New Zealand White rabbits were randomly allocated into 2 groups of 10 flaps(group A: the lesser saphenous sural pedicled fasciocutanous flaps,blood supply provided with perforator arteries;group B: the lesser saphenous sural pedicled fasciocutanous flaps,blood supply provided with axial type artery).The survival rate of flaps in two groups was observed.Pedicles of flaps were harvested and examined histologically.ResultsThe survival rate of flaps in group A was significantly lower than that in group B[(15.2?16.7)% vs(94.1?6.4)%,P