Objective To establish the mode of anterior cervical surgery in outpatient setting, and evaluate its preliminary effectiveness. Methods A clinical data of patients who underwent anterior cervical surgery between January 2022 and September 2022 and met the selection criteria was retrospectively analyzed. The surgeries were performed in outpatient setting (n=35, outpatient setting group) or in inpatient setting (n=35, inpatient setting group). There was no significant difference between the two groups (P>0.05) in age, gender, body mass index, smoking, history of alcohol drinking, disease type, the number of surgical levels, operation mode, as well as preoperative Japanese Orthopaedic Association (JOA) score, visual analogue scale score of neck pain (VAS-neck), and visual analogue scale score of upper limb pain (VAS-arm). The operation time, intraoperative blood loss, total hospital stay, postoperative hospital stay, and hospital expenses of the two groups were recorded; JOA score, VAS-neck score, and VAS-arm score were recorded before and immediately after operation, and the differences of the above indexes between pre- and post-operation were calculated. Before discharge, the patient was asked to score satisfaction with a score of 1-10. Results The total hospital stay, postoperative hospital stay, and hospital expenses were significantly lower in the outpatient setting group than in the inpatient setting group (P<0.05). The satisfaction of patients was significantly higher in the outpatient setting group than in the inpatient setting group (P<0.05). There was no significant difference between the two groups in operation time and intraoperative blood loss (P>0.05). The JOA score, VAS-neck score, and VAS-arm score of the two groups significantly improved at immediate after operation when compared with those before operation (P<0.05). There was no significant difference in the improvement of the above scores between the two groups (P>0.05). The patients were followed up (6.67±1.04) months in the outpatient setting group and (5.95±1.90) months in the inpatient setting group, with no significant difference (t=0.089, P=0.929). No surgical complications, such as delayed hematoma, delayed infection, delayed neurological damage, and esophageal fistula, occurred in the two groups. Conclusion The safety and efficiency of anterior cervical surgery performed in outpatient setting were comparable to that performed in inpatient setting. Outpatient surgery mode can significantly shorten the postoperative hospital stay, reduce hospital expenses, and improve the patients’ medical experience. The key points of the outpatient mode of anterior cervical surgery are minimizing damage, complete hemostasis, no drainage placement, and fine perioperative management.
ObjectiveTo explore the effectiveness and safety of tranexamic acid (TXA) in anterior approach surgery for thoracolumbar fractures.MethodsFrom January 2017 to January 2020, a total of 68 thoracolumbar fracture patients undergoing anterior approach surgery were included and randomly divided into TXA group (n=33) and control group (n=35). Patients in the TXA group were given a dose of 15 mg/kg of TXA by intravenous infusion during 30 min before skin incision and an additional 15 mg/kg of TXA intravenously at 8 h after the first infusion, while the ones in the control group were given 15 mg/kg of normal saline at the same time. Basic data of the patients were collected. The hemoglobin concentration, hematocrit, coagulation and fibrinolysis indexes of the patients were monitored preoperatively, 24-hour postoperatively, and 72-hour postoperatively. The intraoperative blood loss and wound drainage of the patients were recorded. The incidence of blood transfusion and thrombotic events were collected. Statistical analysis was performed.ResultsThere was no significant difference in age, sex, body mass index, operation time, fracture location distribution, anesthesia classification of American Society of Anesthesiologists, neurologic grade of American Spinal Injury Association, injury time, or length of hospital stay between the two groups (P>0.05). Compared with those in the control group, the total blood loss [(1 398.49±312.24) vs. (1 642.30±357.78) mL, P=0.003], intraoperative blood loss [(432.83±74.76) vs. (486.31±86.51) mL, P=0.008], and wound drainage [(276.73±89.42) vs. (389.24±125.71) mL, P<0.001] in the TXA group reduced. No statistically significant difference was found between the two groups in the preoperative hemoglobin or hematocrit (P>0.05), but the 24-hour postoperative hemoglobin concentration [(112.67±20.59) vs. (102.64±19.41) g/L, P=0.042] and hematocrit [(32.25±4.12)% vs. (30.13±4.28)%, P=0.042] in the TXA group were higher than those in the control group. The incidence of allogeneic blood transfusion in the TXA group was lower than that in the control group (6.1% vs. 25.7%, P<0.05). There was no statistically significant difference in preoperative, 24-hour postoperative, or 72-hour postoperative prothrombin time, international standardized ratio, activated partial prothrombin time, platelet count, fibrinogen, d-dimer, or fibrinogen degradation products between the two groups (P>0.05), and no thrombotic complications were found.ConclusionTXA has good efficacy and safety in the anterior approach surgery for thoracolumbar fractures.
ObjectiveTo explore the effectiveness of stage I anterior approach debridement and autologous iliac crest graft with single self-locked titanium plate internal fixation for the treatment of lumbosacral tuberculosis. MethodsSeven cases of lumbosacral tuberculosis were treated by stage I anterior approach debridement, autologous iliac crest graft, and single self-locked titanium plate internal fixation between February 2010 and October 2014. There were 5 males and 2 females, aged 18-65 years (mean, 41.6 years). The disease duration was 5-21 months (mean, 8 months). The patients had signs and symptoms of pain in lumbosacral region, radiating pain in unilateral lower limb or bilateral lower limbs, decreased muscular strength and disorders of superficial sensation. According to Frankel classification for spinal injury, 1 case was rated as grade C, 3 cases as grade D, and 3 cases as grade E. Preoperative imaging examination suggested L5, S1 lesions in line with the manifestations of tuberculosis; the lumbosacral angle was 16.4-28.5° (mean, 18.6°). The erythrocyte sedimentation rate was 28-105 mm/1 hour (mean, 61 mm/1 hour). All patients received 4-drug antituberculosis therapy. ResultsAll patients underwent the operation successfully and all incisions healed at stage I, without relevant complication. All patients were followed up 14-70 months (mean, 25.6 months). All symptoms of tuberculosis disappeared and the erythrocyte sedimentation rate returned to normal. At last follow-up, Frankel classification was returned to E from D in 3 cases, returned to D from C in 1 case. Two cases suffered from pains in the lumbosacral region and at the donor site, 1 case suffered from upper abdominal discomfort and poor appetite,but these symptoms disappeared after symptomatic treatment. At last follow-up, X-ray examination indicated that the lumbosacral angle was 23.4-34.2° (mean, 28.6°). According to Bridwell criteria, 5 cases gained grade I bone fusion, and 2 cases gained grade II bone fusion, without migration of bone graft, or loosening or breakage of titanium plate or bolt. ConclusionStage I anterior approach debridement and autologous iliac crest graft with single self-locked titanium plate internal fixation is safe and effective in treating lumbosacral tuberculosis. It can achieve good bone fusion and stable lumbosacral stability, and maintain good deformity correction.
目的:探讨CCRS拉钩在颈椎前路手术中的应用方法及结果。方法:回顾分析2007~2008年在我院完成的97例颈椎前路手术中,应用CCRS拉钩来显露切口者的临床资料,并观察平均手术时间、术中出血量、周围软组织突入手术野的次数、术者术中调整撑开器的次数、患者术后咽部不适时间和医生满意度等指标。结果:该组病例平均手术时间103min,平均术中出血量110 mL,每台次软组织突入术野的次数为0~2次,术者术中调整CCRS 1~2次,患者术后咽部不适1~4 d,医生满意度为95.88%。结论:CCRS拉钩撑开切口后颈前方显露清晰,避免了周围软组织突入颈前操作区,从而提高了手术安全性和术者满意度。
Objective To investigate and compare the effects of restoring and maintaining the cervical curvature and height of the fused segment by using three different anterior cervical plate systems. Methods From January 2002 to June 2004, 122 patients underwent anterior cervical decompression,autogenous iliac bone graft and plate fixation. Of the 122 patients (85 males, 37 females, aged 14-70), 37 underwent surgery involving the fixation with the Orion plate system, 39 with the Zephir plate system, and 46 with the Codman platesystem. The cervical curvature and height of the fused segment were measured onthe lateral X-ray films so as to compare the changes of the conditions preoperatively,1 week after surgery, and during the follow-up, and also to compare the difference among the three groups. Results The follow-up of the patients for 6-35 months (average 17.3 months) showed that all the patients developed the bone fusion 6 months after operation. There was a significant improvement in the cervical curvature and height of the fused segment before operation versus 1 week after operation（Plt;0.05）; however, there were no significant changes 1 week after operation versus during the followup in each group（Pgt;0.05）; there was no significant difference among the three groups（Pgt;0.05）. Conclusion The three plate systems can effectively reconstruct and maintain the cervical curvature and height of the fused segment, with a satisfactory effect in a short term.
Objective To study the prevention and management of early compl ications associated with anterior cervical spinal surgery. Methods From November 1998 to December 2006, 363 cases were treated with anterior cervicalsurgery, including 268 males and 95 females aged 17-79 years．In these cases, 224 suffered from cervical spondylosis, 39 from cervical disc herniation, 87 from cervical trauma, 9 from cervical tumor and 4 from cervical tuberculosis. Forty-eight cases with anterior cervical surgery were fused by autogenous il iac bones, 132 cases with anterior cervical surgery were fused by autogenous il iac bones and anterior cervical spine locking plates, and 183 cases with anterior cervical surgery were fused by titanium mesh cage and anterior cervical spine locking plates. Results A total of 282 cases were followed up for 3 months to 5 years with the average of 1 year and 11 months. Twenty-three compl ications associated with surgery were found, with an incidence of 8.16%. Three cases of transient superior laryngeal nerve palsy recovered within 3-7 days after the restriction of l iquid diet and fluid replacement. Two cases of recurrent laryngeal nerve palsy recovered by 3-month pronunciation practice. One case of spinal cord injury was treated with medicine for dehydration and anti-inflammation, and was restored to preoperative muscle power of inferior extremity after 6 months. Two cases of CSF leakage were cured with moderate local compression and meticulous water-tight wound closure. Among the 10 patients with compl ications of internal fixation, one suffering mild dysphagia was reoperated, while the others were treated with cephal-cervico-thorax plaster external fixation and recovered with sol id fusion within 3-18 months. Among the 4 cases with cervical hematoma, 1 died of wrong rescue procedures and 1 was infected. Conclusion Adequate preoperative preparation, thorough understanding of anatomy related to the anterior approach and skilled surgical technique are essential for preventing the early postoperative compl ications of anterior cervical spinal surgery．
Objective To explore an improved surgical approach to the superior posterior partial resection of the fractured vertebral body followed by the single segmental fusion to treat lumbar burst fracture and to evaluate its preliminary clinical application. Methods From June to October 2006, 4 patients (2 males, 2 females; age, 17-39 years) with Denis B type lumbar burst fracture underwent the superior posterior partial resection of the fractured vertebral body followed by the single segmental fusion. The fracture occurred in 2 patients at L1 and 2 at L2. According to the Frankel scales assessment, before operation, 2patients were at Grade B and the other 2 at Grade C, and the visual analogue scale (VAS) was 7.00±0.82. Radiological evaluation was performed, which revealed the kyphosis Cobb angel of 22.94±11.21°, the adjacent superior and the inferiorintervertebal disc heights of 12.78±1.52 mm and 11.68±1.04 mm, espectively, and the vertebral canal sagittal diameter of 9.56±2.27 mm on the computer tomography (CT) scan. The neurological and the radiological evaluations were also made immediately and 3 months after operation. Results The anterior single segmental decompression and fusion operations were performed successfully in all the patients. The average operating time was 166±29 min and the average amount of blood loss was 395± 54 ml. The Frankel scales assessment showed that at the time immediately after operation, one of the 2 Grade B patients had an improvement to Grade C, but the other patient had no improvement. One of the 2 Grade C patientshad an improvement to Grade D, but the other patient had no improvement. Three months after operation, the 2 Grade B patients had an improvement to Grade C. The 2 grade C patients had an improvement to Grade D or E. The VAS score was significantly decreased to 3.50±1.29 after operation and to 1.25±0.50 3 months later （P＜0.05）. The vertebral canal sagittal diameter was significantly increased to 19.76±3.82 mm (Plt;0.01), but it was maintained to 19.27±3.41 mm3 months later, with no significant difference（Pgt;0.05）. The patients’ kyphosis Cobb angle was significantly improved to 8.71±5.41° (P＜0.05) , but it was maintained to 9.52±5.66° 3 months later, with no significant difference（Pgt;0.05）. The heights of the adjacent discs remained unchanged. No complication was observedduring and after operation, and the radiological and the CT scanning evaluations 3 months later showed no failure of the internal fixation. Conclusion The superior and posterior partial resection of the fractured vertebral body followedby the single segmental fusion can effectively decompress the vertebral canal and maintain the spine stability in treatment of the Denis B type fracture thoughthe longterm effectiveness requires a further follow-up.
目的:探讨早期护理干预对颈椎前路手术患者康复的影响。方法:选择颈椎前路手术患者66 例。分为实验组33例和对照组33例,实验组实施系统的早期护理干预活动指导,对照组进行常规护理,比较两组术后卧床时间、住院天数、术后并发症及术后生活质量。结果:实验组卧床时间及住院天数、术后并发症发生率均低于对照组 (Plt;0.05), 生活质量优于对照组 (Plt;0.05)。结论:早期护理干预有利于颈椎前路手术患者术后恢复