Objective：To investigate a novel surgical method for multilevel cervical spondylotic myelopathy （CSM）. Methods： Totally 21 patients with multilevel CSM undergoing a novel surgical procedure from April 2001 to Janu...Objective：To investigate a novel surgical method for multilevel cervical spondylotic myelopathy （CSM）. Methods： Totally 21 patients with multilevel CSM undergoing a novel surgical procedure from April 2001 to January 2004 were analyzed retrospectively. All patients experienced anterior cervical decompression surgery in subsection, autograft fusion and internal fixation. Preoperative, immediate postoperative and follow-up image data, X-rays and semi-quantitative Japanese orthopaedics association （JOA） scores were used to evaluate the restoration of lordosis （Cobb＇s angle）, intervertebral heights, the stability of the cervical spine and the improvement of neurological impairment. Results： Preoperative symptoms were markedly alleviated or disappeared in most of the patients. According to the JOA scores, the ratio of improvement in neurological function was 72. 2%, including excellent in 9 cases （42.9%）, good in 7 cases （33.3%）, fair in 3 cases （14.3%） and poor in 2 cases （9.5%）. Immediate postoperative X-rays showed obvious improvements in lordosis and in the intervertebral height of the cervical spine （P〈0. 01）. There is no evidence of instrument failure during the mean follow-up period of 14. 2 months （9-24 months, P〉0. 01）. Conclusion：Anterior cervical decompression in subsection, autograft fusion and internal fixation is a rational effective method for the surgical treatment of multilevel CSM.展开更多
BACKGROUND Whether it’s better to adopt unilateral pedicle screw(UPS)fixation or to use bilateral pedicle screw(BPS)one for lumbar degenerative diseases is still controversially undetermined.AIM To make a comparison ...BACKGROUND Whether it’s better to adopt unilateral pedicle screw(UPS)fixation or to use bilateral pedicle screw(BPS)one for lumbar degenerative diseases is still controversially undetermined.AIM To make a comparison between UPS and BPS fixation as to how they work efficaciously and safely in patients suffering from lumbar degenerative diseases.METHODS We have searched a lot in the databases through 2020 with index terms such as“unilateral pedicle screw fixation”and“bilateral pedicle screw fixation.”Only randomized controlled trials and some prospective cohort studies could be found,yielding 15 studies.The intervention was unilateral pedicle screw fixation;Primarily We’ve got outcomes of complications and fusion rates.Secondarily,we’ve achieved outcomes regarding total blood loss,operative time,as well as length of stay.Softwares were installed and utilized for subgroup analysis,analyzing forest plots,sensitivity,heterogeneity,forest plots,publication bias,and risk of bias.RESULTS Fifteen previous cases of study including 992 participants have been involved in our meta-analysis.UPS had slightly lower effects on fusion rate[relative risk(RR)=0.949,95%CI:0.910 to 0.990,P=0.015],which contributed mostly to this metaanalysis,and similar complication rates(RR=1.140,95%CI:0.792 to 1.640,P=0.481),Δvisual analog scale[standard mean difference(SMD)=0.178,95%CI:-0.021 to 0.378,P=0.080],andΔOswestry disability index(SMD=-0.254,95%CI:-0.820 to 0.329,P=0.402).In contrast,an obvious difference has been observed inΔJapanese Orthopedic Association(JOA)score(SMD=0.305,95%CI:0.046 to 0.563,P=0.021),total blood loss(SMD=-1.586,95%CI:-2.182 to-0.990,P=0.000),operation time(SMD=-2.831,95%CI:-3.753 to-1.909,P=0.000),and length of hospital stay(SMD=-0.614,95%CI:-1.050 to-0.179,P=0.006).CONCLUSION Bilateral fixation is more effective than unilateral fixation regarding fusion rate after lumbar interbody fusion.However,JOA,operation time,total blood loss,as well as length of stay were improved for unilateral fixation.展开更多
背景:腰椎退行性疾病是一种中老年人常见疾病,临床表现主要为腰背部疼痛和下肢功能障碍。传统上使用腰椎融合联合双侧椎弓根螺钉固定进行外科干预,但存在创伤大、并发症多等问题。而腰椎融合联合单侧椎弓根螺钉固定是一种新兴的微创治...背景:腰椎退行性疾病是一种中老年人常见疾病,临床表现主要为腰背部疼痛和下肢功能障碍。传统上使用腰椎融合联合双侧椎弓根螺钉固定进行外科干预,但存在创伤大、并发症多等问题。而腰椎融合联合单侧椎弓根螺钉固定是一种新兴的微创治疗方式,具有较小的创伤和较低的并发症风险,已逐渐成为腰椎退行性疾病治疗的新选择。目的:探讨腰椎融合联合单侧椎弓根螺钉固定治疗腰椎退行性疾病的效果及优势。方法:通过检索中国知网和PubMed数据库2010年1月至2025年1月发表的相关文献,总结腰椎融合联合单侧椎弓根螺钉固定的临床研究及生物力学特点,以“腰椎融合术,单侧固定,双侧固定,生物力学,腰椎退行性疾病”为中文检索词,以“lumbar fusion,unilateral fixation,bilateral fixation,biomechanics,degenerative disease of the lumbar spine”为英文检索词,最终纳入70篇文献进行综述。结果与结论:①腰椎融合联合单侧椎弓根螺钉固定能有效减少手术创伤和术中失血量,提供与双侧椎弓根螺钉固定相似的生物力学稳定性,并降低邻近节段退变的风险;②单侧椎弓根螺钉固定在单节段及双节段腰椎退行性疾病治疗中已获得广泛认可,但在多节段腰椎退行性疾病中的应用效果仍需进一步研究;③腰椎融合联合单侧椎弓根螺钉固定为腰椎退行性疾病治疗提供了微创、安全的选择,未来需要更多高质量的研究验证其在复杂病例中的应用和长期疗效,进一步优化临床应用。展开更多
目的:评估在腰椎减压融合内固定术中静脉应用氨甲环酸(tranexamic acid,TXA)的疗效和安全性。方法:回顾性分析2020年12月~2024年10月在南京鼓楼医院行腰椎减压融合内固定术治疗的957例患者的临床资料。根据患者是否静脉应用TXA分为TXA组...目的:评估在腰椎减压融合内固定术中静脉应用氨甲环酸(tranexamic acid,TXA)的疗效和安全性。方法:回顾性分析2020年12月~2024年10月在南京鼓楼医院行腰椎减压融合内固定术治疗的957例患者的临床资料。根据患者是否静脉应用TXA分为TXA组(507例,男229例,女278例,年龄57.9±12.7岁)与对照组(450例,男184例,女266例,年龄59.0±12.0岁)。TXA组与对照组在性别、年龄、身体质量指数(body mass index,BMI)、融合节段等基线指标上无显著差异(P>0.05)。统计并比较对照组与TXA组患者术前和术后1d的生化检查指标数据(血红蛋白、红细胞压积、血小板计数、凝血功能与肝肾功能)、血液管理资料(术后引流时间、血容量、估计总失血量、术中失血量、术中输血量、术后1d引流量、总引流量与拔管时间)以及手术相关并发症发生情况。在TXA组内按用药剂量进行亚组分析,其中316例患者在术前或者术中小剂量使用TXA(1g)纳入低剂量组;191例患者术前使用TXA后术中补用一定剂量TXA纳入高剂量组。亚组间比较分析上述指标和并发症。结果:TXA组相较于对照组,术中失血量(462.9±297.9mL vs 520.0±370.2mL)、估计总失血量(619.6±377.0mL vs 685.9±448.9mL)、术后总引流量(362.6±237.1mL vs 477.1±282.8mL)及术后1d引流量(162.7±84.1mL vs 242.1±133.8mL)均显著更低。术后生化分析表明,TXA组D-二聚体含量显著低于对照组(1.9±2.1mg/L vs 2.4±2.6mg/L,P<0.05),而血红蛋白、凝血功能(PT、APTT、TT)、肝肾功能指标(ALT、AST、BUN、Scr)两组相比无显著差异(P>0.05)。两组术后并发症发生率无统计学差异。在亚组分析中,高剂量组失血量(432.9±272.3mL vs 493.0±312.5mL)、术后1d引流量(152.5±65.6mL vs 174.0±97.0mL)均显著低于低剂量组,其余指标无显著性差异(P>0.05)。结论:静脉应用TXA能够有效减少腰椎减压融合内固定手术的术中失血量和术后引流量,且不会增加相关并发症发生率;其中较高剂量使用TXA在控制围手术期总失血量方面较低剂量更具优势,同时不会导致血栓风险升高。展开更多
文摘Objective：To investigate a novel surgical method for multilevel cervical spondylotic myelopathy （CSM）. Methods： Totally 21 patients with multilevel CSM undergoing a novel surgical procedure from April 2001 to January 2004 were analyzed retrospectively. All patients experienced anterior cervical decompression surgery in subsection, autograft fusion and internal fixation. Preoperative, immediate postoperative and follow-up image data, X-rays and semi-quantitative Japanese orthopaedics association （JOA） scores were used to evaluate the restoration of lordosis （Cobb＇s angle）, intervertebral heights, the stability of the cervical spine and the improvement of neurological impairment. Results： Preoperative symptoms were markedly alleviated or disappeared in most of the patients. According to the JOA scores, the ratio of improvement in neurological function was 72. 2%, including excellent in 9 cases （42.9%）, good in 7 cases （33.3%）, fair in 3 cases （14.3%） and poor in 2 cases （9.5%）. Immediate postoperative X-rays showed obvious improvements in lordosis and in the intervertebral height of the cervical spine （P〈0. 01）. There is no evidence of instrument failure during the mean follow-up period of 14. 2 months （9-24 months, P〉0. 01）. Conclusion：Anterior cervical decompression in subsection, autograft fusion and internal fixation is a rational effective method for the surgical treatment of multilevel CSM.
基金Supported by the Health Science and Technology of Tianjin Municipality,No.RC20204Tianjin Institute of Orthopedics,No.2019TJGYSKY03the National Natural Science Foundation of China,No.818717771177226。
文摘BACKGROUND Whether it’s better to adopt unilateral pedicle screw(UPS)fixation or to use bilateral pedicle screw(BPS)one for lumbar degenerative diseases is still controversially undetermined.AIM To make a comparison between UPS and BPS fixation as to how they work efficaciously and safely in patients suffering from lumbar degenerative diseases.METHODS We have searched a lot in the databases through 2020 with index terms such as“unilateral pedicle screw fixation”and“bilateral pedicle screw fixation.”Only randomized controlled trials and some prospective cohort studies could be found,yielding 15 studies.The intervention was unilateral pedicle screw fixation;Primarily We’ve got outcomes of complications and fusion rates.Secondarily,we’ve achieved outcomes regarding total blood loss,operative time,as well as length of stay.Softwares were installed and utilized for subgroup analysis,analyzing forest plots,sensitivity,heterogeneity,forest plots,publication bias,and risk of bias.RESULTS Fifteen previous cases of study including 992 participants have been involved in our meta-analysis.UPS had slightly lower effects on fusion rate[relative risk(RR)=0.949,95%CI:0.910 to 0.990,P=0.015],which contributed mostly to this metaanalysis,and similar complication rates(RR=1.140,95%CI:0.792 to 1.640,P=0.481),Δvisual analog scale[standard mean difference(SMD)=0.178,95%CI:-0.021 to 0.378,P=0.080],andΔOswestry disability index(SMD=-0.254,95%CI:-0.820 to 0.329,P=0.402).In contrast,an obvious difference has been observed inΔJapanese Orthopedic Association(JOA)score(SMD=0.305,95%CI:0.046 to 0.563,P=0.021),total blood loss(SMD=-1.586,95%CI:-2.182 to-0.990,P=0.000),operation time(SMD=-2.831,95%CI:-3.753 to-1.909,P=0.000),and length of hospital stay(SMD=-0.614,95%CI:-1.050 to-0.179,P=0.006).CONCLUSION Bilateral fixation is more effective than unilateral fixation regarding fusion rate after lumbar interbody fusion.However,JOA,operation time,total blood loss,as well as length of stay were improved for unilateral fixation.
文摘背景:腰椎退行性疾病是一种中老年人常见疾病,临床表现主要为腰背部疼痛和下肢功能障碍。传统上使用腰椎融合联合双侧椎弓根螺钉固定进行外科干预,但存在创伤大、并发症多等问题。而腰椎融合联合单侧椎弓根螺钉固定是一种新兴的微创治疗方式,具有较小的创伤和较低的并发症风险,已逐渐成为腰椎退行性疾病治疗的新选择。目的:探讨腰椎融合联合单侧椎弓根螺钉固定治疗腰椎退行性疾病的效果及优势。方法:通过检索中国知网和PubMed数据库2010年1月至2025年1月发表的相关文献,总结腰椎融合联合单侧椎弓根螺钉固定的临床研究及生物力学特点,以“腰椎融合术,单侧固定,双侧固定,生物力学,腰椎退行性疾病”为中文检索词,以“lumbar fusion,unilateral fixation,bilateral fixation,biomechanics,degenerative disease of the lumbar spine”为英文检索词,最终纳入70篇文献进行综述。结果与结论:①腰椎融合联合单侧椎弓根螺钉固定能有效减少手术创伤和术中失血量,提供与双侧椎弓根螺钉固定相似的生物力学稳定性,并降低邻近节段退变的风险;②单侧椎弓根螺钉固定在单节段及双节段腰椎退行性疾病治疗中已获得广泛认可,但在多节段腰椎退行性疾病中的应用效果仍需进一步研究;③腰椎融合联合单侧椎弓根螺钉固定为腰椎退行性疾病治疗提供了微创、安全的选择,未来需要更多高质量的研究验证其在复杂病例中的应用和长期疗效,进一步优化临床应用。
文摘目的:评估在腰椎减压融合内固定术中静脉应用氨甲环酸(tranexamic acid,TXA)的疗效和安全性。方法:回顾性分析2020年12月~2024年10月在南京鼓楼医院行腰椎减压融合内固定术治疗的957例患者的临床资料。根据患者是否静脉应用TXA分为TXA组(507例,男229例,女278例,年龄57.9±12.7岁)与对照组(450例,男184例,女266例,年龄59.0±12.0岁)。TXA组与对照组在性别、年龄、身体质量指数(body mass index,BMI)、融合节段等基线指标上无显著差异(P>0.05)。统计并比较对照组与TXA组患者术前和术后1d的生化检查指标数据(血红蛋白、红细胞压积、血小板计数、凝血功能与肝肾功能)、血液管理资料(术后引流时间、血容量、估计总失血量、术中失血量、术中输血量、术后1d引流量、总引流量与拔管时间)以及手术相关并发症发生情况。在TXA组内按用药剂量进行亚组分析,其中316例患者在术前或者术中小剂量使用TXA(1g)纳入低剂量组;191例患者术前使用TXA后术中补用一定剂量TXA纳入高剂量组。亚组间比较分析上述指标和并发症。结果:TXA组相较于对照组,术中失血量(462.9±297.9mL vs 520.0±370.2mL)、估计总失血量(619.6±377.0mL vs 685.9±448.9mL)、术后总引流量(362.6±237.1mL vs 477.1±282.8mL)及术后1d引流量(162.7±84.1mL vs 242.1±133.8mL)均显著更低。术后生化分析表明,TXA组D-二聚体含量显著低于对照组(1.9±2.1mg/L vs 2.4±2.6mg/L,P<0.05),而血红蛋白、凝血功能(PT、APTT、TT)、肝肾功能指标(ALT、AST、BUN、Scr)两组相比无显著差异(P>0.05)。两组术后并发症发生率无统计学差异。在亚组分析中,高剂量组失血量(432.9±272.3mL vs 493.0±312.5mL)、术后1d引流量(152.5±65.6mL vs 174.0±97.0mL)均显著低于低剂量组,其余指标无显著性差异(P>0.05)。结论:静脉应用TXA能够有效减少腰椎减压融合内固定手术的术中失血量和术后引流量,且不会增加相关并发症发生率;其中较高剂量使用TXA在控制围手术期总失血量方面较低剂量更具优势,同时不会导致血栓风险升高。
