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1.
Sci Rep ; 14(1): 12800, 2024 06 04.
Article in English | MEDLINE | ID: mdl-38834591

ABSTRACT

This study aims to observe the hemostatic and anti-inflammatory effects of intravenous administration of tranexamic acid (TXA) in dual segment posterior lumbar interbody fusion (PLIF). The data of 53 patients with lumbar disease treated with double-segment PLIF were included in this study. The observation group was received a single-dose intravenous of TXA (1 g/100 mL) 15 min before skin incision after general anesthesia. The control group was not received TXA. The observation indicators included postoperative activated partial prothrombin time (APTT), thrombin time (PT), thrombin time (TT), fibrinogen (FIB), platelets (PLT), and postoperative deep vein thrombosis in the lower limbs, surgical time, intraoperative bleeding volume, postoperative drainage volume, transfusion rate, postoperative hospital stay, red blood cell (RBC), hemoglobin (HB), hematocrit (HCT), C-reactive protein (CRP), and erythrocyte sedimentation rate (ESR) on the 1st, 4th, 7th, and last tested day after surgery. All patients successfully completed the operation, and there was no deep vein thrombosis after operation. There was no statistically significant difference in postoperative APTT, PT, TT, FIB, PLT, surgical time, and postoperative hospital stay between the two groups (p > 0.05). The intraoperative bleeding volume, postoperative drainage volume, and transfusion rate in the observation group were lower than those in the control group, and the differences were statistically significant (p < 0.05). There was no statistically significant difference in RBC, HB, HCT, CRP, and ESR between the two groups on the 1st, 4th, 7th, and last tested day after surgery (p > 0.05). Intravenous administration of TXA in dual segment PLIF does not affect coagulation function and can reduce bleeding volume, postoperative drainage volume, and transfusion rate. Moreover, it does not affect the postoperative inflammatory response.


Subject(s)
Spinal Fusion , Tranexamic Acid , Humans , Tranexamic Acid/administration & dosage , Female , Male , Middle Aged , Spinal Fusion/methods , Spinal Fusion/adverse effects , Case-Control Studies , Aged , Lumbar Vertebrae/surgery , Administration, Intravenous , Anti-Inflammatory Agents/administration & dosage , Anti-Inflammatory Agents/pharmacology , Hemostatics/administration & dosage , Hemostatics/pharmacology , Adult , Blood Loss, Surgical/prevention & control , Antifibrinolytic Agents/administration & dosage , Antifibrinolytic Agents/therapeutic use
2.
Sci Rep ; 14(1): 10997, 2024 05 14.
Article in English | MEDLINE | ID: mdl-38744855

ABSTRACT

Intravenous application of tranexamic acid (TXA) in posterior lumbar interbody fusion (PLIF) can effectively reduce blood loss without affecting coagulation function. However, it has not been reported whether preoperative use of anticoagulants may affect the efficacy of TXA in PLIF. The purpose of this study is to observe the effect of preoperative use of anticoagulants on coagulation indicators and blood loss after PLIF receiving intravenous unit dose TXA. A retrospective analysis was conducted on data from 53 patients with PLIF between 2020.11 and 2022.9, who received intravenous application of a unit dose of TXA (1 g/100 mL) 15 min before the skin incision after general anesthesia. Those who used anticoagulants within one week before surgery were recorded as the observation group, while those who did not use anticoagulants were recorded as the control group. The main observation indicators include surgical time, intraoperative blood loss, postoperative drainage volume, blood transfusion, and red blood cell (RBC), hemoglobin (HB), and hematocrit (HCT) measured on the 1st, 4th, 7th, and last-test postoperative days. Secondary observation indicators included postoperative incision healing, deep vein thrombosis of lower limbs, postoperative hospital stay, and activated partial thrombin time (APTT), prothrombin time (PT), thrombin time (TT), fibrinogen (FIB), and platelets (PLT) on the 1st and 4th days after surgery. The operation was successfully completed in both groups, the incision healed well after operation, and no lower limb deep vein thrombosis occurred. There was no significant difference in surgical time, intraoperative blood loss, postoperative drainage volume, and blood transfusion between the two groups (p > 0.05). There was no significant difference in the RBC, HB, and HCT measured on the 1st, 4th, 7th, and last-test postoperative days between the two groups (p > 0.05). There was no statistically significant difference in APTT, PT, TT, FIB and PLT between the two groups on the 1st and 4th postoperative days (p > 0.05). There was no significant difference in postoperative hospital stay between the two groups (p > 0.05). The use of anticoagulants within one week before surgery does not affect the hemostatic effect of intravenous unit dose TXA in PLIF.


Subject(s)
Anticoagulants , Blood Loss, Surgical , Tranexamic Acid , Humans , Tranexamic Acid/administration & dosage , Tranexamic Acid/therapeutic use , Female , Male , Middle Aged , Retrospective Studies , Case-Control Studies , Anticoagulants/administration & dosage , Anticoagulants/therapeutic use , Anticoagulants/pharmacology , Blood Loss, Surgical/prevention & control , Aged , Administration, Intravenous , Spinal Fusion/methods , Preoperative Care/methods , Antifibrinolytic Agents/administration & dosage , Antifibrinolytic Agents/therapeutic use , Blood Coagulation/drug effects
3.
Front Surg ; 10: 1120346, 2023.
Article in English | MEDLINE | ID: mdl-37325421

ABSTRACT

Background: Percutaneous vertebroplasty (PVP) is a common treatment for osteoporotic vertebral compression fracture (OVCF). Perioperative bleeding is usually rare, so there are few reports of shock. However, we developed shock after treating a case of OVCF of the 5th thoracic vertebra with PVP. Case presentation: An 80 years old female patient received PVP due to OVCF of the 5th thoracic vertebra. The operation was successfully completed and the patient returned to the ward safely after the operation. At 90 min after operation, she developed shock, which was induced by subcutaneous hemorrhage up to 1500 ml at the puncture site. Before using vascular embolization, transfusion and blood transfusion were used to maintain blood pressure, and local ice bag compression was used to reduce swelling and stop bleeding, which achieved successful hemostasis. She recovered and discharged after 15 days, with the hematoma having absorbed. There was no recurrence during the 17-month follow-up. Conclusion: Although PVP is considered to be a safe and effective method to treat OVCF, the possible hemorrhagic shock still needs to arouse the vigilance of surgeons.

4.
Sci Rep ; 13(1): 4714, 2023 03 22.
Article in English | MEDLINE | ID: mdl-36949108

ABSTRACT

There are few reports of intravenous unit-dose tranexamic acid (TXA) on the relationship between visible blood loss (VBL) and hidden blood loss (HBL) in posterior lumbar interbody fusion (PLIF). Therefore, the objective of this randomized, prospective, double-blind, single center study was to investigate the effect of intravenous unit-dose TXA on VBL and HBL in patients who underwent PLIF. Among 100 patients, 11 were excluded due to failue to comply with the study, 1 was excluded due to non-conpliance with the study, and 88 were eligible for inclusion in the study. 46 patients who treated with PLIF received unit-dose of TXA (1 g/100 mL) intravenously 15 min before skin incision after general anesthesia (observation group) and 42 patients were given 100 mL of normal saline (control group). The operation time, intraoperative blood loss, postoperative drainage, VBL, HBL, blood transfusion rate, and adverse events were recorded in the two groups. Besides, activated partial prothrombin time (APTT), prothrombin time (PT), thrombin time (TT), fibrinogen (FIB), platelets (PLT), red blood cells (RBC), hemoglobin (HB), hematocrit (HCT), C-reactive protein (CRP), erythrocyte sedimentation rate (ESR) on the 1st postoperative day; and RBC, HB, HCT, CRP, ESR on the 4th postoperative day were recorded. All 88 patients successfully completed the operation, the incision healed well, and there was no deep vein thrombosis of the lower extremity after operation. The intraoperative blood loss, postoperative drainage, VBL, HBL, and blood transfusion rate in the observation group were lower than those in the control group, and the differences were statistically significant (p < 0.05). There was no significant difference in operation time between the two groups (p > 0.05). There was no significant difference in postoperative APTT, PT, TT, FIB, PLT, RBC, HB, HCT, CRP and ESR between the two groups (p > 0.05). Intravenous unit-dose TXA is safe and feasible in PLIF, and it can effectively reduce perioperative VBL and HBL.


Subject(s)
Antifibrinolytic Agents , Hemostatics , Tranexamic Acid , Humans , Antifibrinolytic Agents/therapeutic use , Prospective Studies , Blood Loss, Surgical/prevention & control , C-Reactive Protein , Postoperative Hemorrhage/drug therapy
5.
Front Surg ; 9: 944499, 2022.
Article in English | MEDLINE | ID: mdl-36570806

ABSTRACT

Background: Cholesterol granuloma (CG) is a particular type of granulation tissue reaction. It is a very rare benign lesion characterized by swelling growth due to a large number of cholesterol crystals and foreign body giant cells. There has been no report of a CG of the femur. Case presentation: A 74-year-old woman suffered from pain and discomfort in the upper right knee for 10 years, which became aggravated for 10 days. She was diagnosed with CG of the right femur at our hospital and was treated with surgery. During the operation, a large amount of yellow-brown, oily, crystal structures was found. Postoperative pathology investigations confirmed the lesion as a CG. Postoperative follow-up was carried out for 15 months that confirmed the effect of treatment was satisfactory. Conclusions: CG of the femur is an extremely rare benign lesion. Surgical treatment can provide effective treatment results.

6.
Front Surg ; 9: 981069, 2022.
Article in English | MEDLINE | ID: mdl-36157404

ABSTRACT

Background: Diastematomyelia is a rare congenital spinal cord malformation, classified as type I or type II, with over half of the cases considered type I. However, type I diastematomyelia with breast abnormality and clubfoot is extremely rare in clinical practice. Case presentation: We admitted an 18-year-old female patient with type I diastematomyelia with breast abnormalities and clubfoot. She was underwent surgical treatment. After the surgical removal of the pressure-causing bone spur, the weakness of the right lower limb was significantly relieved. During the 22-month follow-up, there was no complication and no recurrence. Conclusion: Surgical removal of the pressure-causing bone spur can relieve symptoms in the lower limbs. However, further research is warranted to explore the breast abnormalities in patients with diastematomyelia.

7.
World J Clin Cases ; 10(21): 7531-7538, 2022 Jul 26.
Article in English | MEDLINE | ID: mdl-36157998

ABSTRACT

BACKGROUND: A patient with type III Kummell's disease had a ruptured posterior cortex of the fractured vertebral body, which caused spinal cord compression. An open surgery was considered the best choice of operation. However, the patient and her family refused open surgery and instead demanded a minimally invasive surgical treatment such as percutaneous vertebroplasty (PVP). After preoperative discussion, we finally adopted the novel therapy of traditional Chinese medicine manipulative reduction (TCMMR) combined with PVP. CASE SUMMARY: A patient with type III Kummell's disease exhibiting bone block-induced spinal cord compression was admitted to our hospital. She suffered from a variety of medical disorders but refused open surgery, and instead asked for PVP surgery. TCMMR, in parallel with PVP, was used to restore the height of the compressed vertebral body and reduce the symptoms of spinal cord compression by the bone block in order to strengthen the vertebral body and prevent further collapse. The surgery was very successful. The height of the compressed vertebra was restored, and the symptom of spinal cord compression by bone block was reduced successfully via TCMMR. The fractured vertebra was solidified by the PVP. The pain visual analog score declined from preoperative 7 scores to postoperative 2 scores, and the Frankel spinal cord scale increased from preoperative D degree to postoperative E degree. CONCLUSION: The new method has advantages in treating patients with type III Kummell's disease who cannot be treated with open surgery.

8.
World J Clin Cases ; 10(22): 7973-7981, 2022 Aug 06.
Article in English | MEDLINE | ID: mdl-36158505

ABSTRACT

BACKGROUND: Delayed arterial symptomatic epidural hematoma (SEH) on the 14th day after posterior lumbar interbody fusion (PLIF) is rare but it may lead to severe complications if not identified and treated in a timely manner. After diagnosis of the current case, early surgical removal of the hematoma and strict hemostasis treatment was accomplished. This case report highlights the importance of swift diagnosis and treatment in SEH patients. CASE SUMMARY: A 41-year-old male patient with a single-segment lumbar disc herniation underwent left-side PLIF. On the 14th post-operative day, the patient complained of lumbar incision pain with sudden onset accompanied by left limb radiation pain and aggravated cauda equina symptoms. Magnetic resonance imaging examination and a puncture blood draw at the incision site confirmed a delayed arterial SEH. Emergency surgical removal of the hematoma and hemostasis was performed. About 70 mL of hematoma was found in the left incision. Continuous bleeding was found in the anterior branch of the transverse process of the 4th lumbar artery in the muscle area about 2 cm below the transverse process of the 4th lumbar vertebra. A blood jet of about 10 cm in height was observed and bipolar electrocoagulation was used to stop the bleeding. Post-operative lumbar incision pain and left lower limb pain were relieved immediately and gradually disappeared. There was no recurrence during the 12-mo follow-up. CONCLUSION: For delayed arterial SEH on the 14th day after PLIF, preventive measures including pre-, intra- and post-operative prevention should be implemented.

9.
Front Surg ; 9: 977637, 2022.
Article in English | MEDLINE | ID: mdl-35990095

ABSTRACT

Background: Cervical nerve root cysts are rare and easily missed or misdiagnosed in clinical practice. Although conventional surgery is effective for cervical nerve root cysts, it is limited by the small surgical field of view and operating range, relatively difficult procedure, and incomplete cyst resection. Microscope-assisted magnification of the surgical field of vision reduces the difficulty and ensures complete cyst resection. Case presentation: A 58-year-old male patient was diagnosed with a cervical nerve root sleeve cyst on the right C7 vertebra with neurological symptoms. Microscope-assisted surgery was used as treatment. The cyst was completely removed by the microscope-assisted surgery, with satisfactory patient recovery. The surgery did not produce complications, such as spinal cord neurovascular injury, and the patient's symptoms disappeared quickly after surgery. During the 2-year follow-up, there was no complication and no recurrence. Conclusion: Microscope-assisted surgery in treatment of the C7 nerve root cyst could achieve a complete resection.

10.
BMC Surg ; 22(1): 212, 2022 Jun 02.
Article in English | MEDLINE | ID: mdl-35655166

ABSTRACT

BACKGROUND: A ruptured drainage tube which remains in the incision is a rare surgical complication. The usual mode of retrieval is to detach the suture and explore the pre-existing incisional wound. However, spinal endoscopy provides an alternative method for successful removal, avoiding the enlargement of the surgical wound. CASE REPORT: A 53-year-old male patient underwent open lumbar spine surgery for lumbar spondylolisthesis between the 5th lumbar and 1st sacral vertebral bodies. Prior to closure, two negative pressure ball drainage tubes were inserted, one of which broke during removal,beneath the fascia. Use of spinal endoscopy enabled the complete removal of the broken drainage tube. Both the original incisional and endoscopic wounds healed well without any sign of infection. CONCLUSIONS: The use of spinal endoscopy to remove the broken drainage tube is an alternative to open the surgical wound and should be took into account.


Subject(s)
Surgical Wound , Drainage , Endoscopy, Gastrointestinal , Humans , Male , Middle Aged , Neurosurgical Procedures , Sutures
11.
Front Surg ; 9: 1032376, 2022.
Article in English | MEDLINE | ID: mdl-36684362

ABSTRACT

Background: Tranexamic acid (TXA) has been used in posterior lumbar interbody fusion (PLIF) and reduces blood loss. However, it has not been reported whether it will continue to affect postoperative red blood cells (RBC), hemoglobin (HB), hematocrit (HCT), C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR). The purpose of this study was to observed the above indicators at different time after PLIF with unit dose intravenous (iv) TXA. Methods: The data of 44 patients treated by single-segment PLIF from 2020.11 to 2022.3 were retrospectively analyzed. Observation group was given a unit dose of ivTXA (1 g/100 mL) 15 min before skin incision after general anesthesia. Patients without TXA were recorded as control group. Main observation indicators include RBC, HB, HCT, CRP and ESR on the 1st, 4th, 7th and last tested day after surgery. Secondary observation indicators include postoperative activated partial thrombin time (APTT), prothrombin time (PT), thrombin time (TT), and fibrinogen (FIB); and operation time, intraoperative blood loss, postoperative drainage volume, incision healing, postoperative deep vein thrombosis and postoperative hospital stay. Results: The operation was successfully completed without related complications. At term of main observation indicators, RBC, HB and HCT remained relatively stable, while CRP and ESR fluctuated to some extent after PLIF. The RBC, HB and HCT in the observation group were higher than those in the control group with statistically significant (p < 0.05). Except the CRP of 7th postoperative day of the observation group was significantly lower than that of the control group (p < 0.05), there was no difference in other CRP and ESR between the two groups (p > 0.05). At term of secondary observation indicators, the intraoperative blood loss and postoperative drainage volume of the observation group were lower than those of the control group with statistically significant (p < 0.05). There was no significant difference in postoperative APTT, PT, TT, FIB, and operation time and postoperative hospital stay between the two groups (p > 0.05). Conclusion: The application of unit dose of ivTXA in PLIF can safely and effectively reduce blood loss. Meanwhile, it can also maintain higher RBC, HB, HCT levels without disturbing CRP and ESR levels after surgery.

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