【Abstract】 Objective To investigate the surgical management of dural injuries and postoperative cerebrospinal fluid(CSF) fistulas in spinal surgeries and to observe cl inical outcomes, since intraoperative injury of dura mater and postoperative CSF fistulas are common compl ications of spinal surgeries. Methods A retrospective research was designed and 405 patients with complete data who underwent spinal surgeries between June 2002 and March 2006 were acquired, including 298 cases of male and 107 cases of female, with the mean age of 46.2 years (ranging from 11 years to 78 years). The course of disease lasted from 3 months to 5 years. A total of 28 cases of intraoperative dural injuries and durotomies (28/405, 6.91%) were recorded, including 3 cases of cervical spinal surgery (3/152, 1.97%), 19 cases of thoracic and lumbar spinal surgery (19/239, 7.95%) and 6 cases of sacral surgery (6/14, 42.86%). CSF fistulas occurred in 6 cases of 28 patients. There were 2 cases in which no intraoperative dural injury was detected but CSF fistulas occurred after operation. The incidence of postoperative CSF fistula was 1.98% (8/405). Surgical management included closure of breach in the dura mater, oversewing every layer of the wound, bed rest and compression dressing and so on. Cl inical outcomes of surgical management were recorded. Results The average followup lasted for 1 year and 5 months (ranging from 3 months to 4 years). Preoperative symptoms remitted to different extents There were 8 cases of postoperative CSF fistula which were cured ultimately. A total of 6 cases of CSF fistulas from dorsal injuries of dura mater were treated mainly by bed rest, compression dressing and reoperations, while 2 cases of fistulas from ventral and lateral injuries of dura mater were treated by additional continuous cerebrospinal fluid drainage using a lumbar subarachnoid catheter. One case of central nervous system infection occurred and was treated successfully by multi-discipl inary disposal. Conclusion Timely and correct surgical intervention and postoperative management can help to heal dural injuries in spinal surgeries and can prevent occurrence of postoperative CSF fistulas.
Objective To evaluate the security and validity of the acute extreme hypervolemic hemodilution (AEHH) in spine surgery. Methods Thirteen patients(8 males, 5 females; age, 16-65 years; weight, 50-75 kg) who had undergone major spine operations were enrolled in this study. Eleven of them had undergone anterior decompression, who were given the grafting and the internal fixation for their thoracolumber spinal burst fractures; the other 2 patients were given the correction operation for their scoliosis. The baselines of the haematocrit (Hct）were 0.363-0.481 before operation. The patients had no cardiac, pulmonary, hepatic or renal dysfunction or coagulation abnormality. The hemodynamic status and the haematocrit were observed during operation. The parameters of thromboelastography (TEG)，arterial blood gas, and electrolytes were measured and observed at the following time points: before AEHH, after AEHH, 60 minutes after AEHH, 120 minutes after AEHH, and the end of the operation. The total fluid volume was recorded. Results The autologous blood volume was1 050-1 575 ml (average,1 419±198 ml), plasma substitute 2 100-3 150 ml (average,2 838±397 ml), blood loss1 000-3 130 ml (average, 1 747±743 ml), urine 450-1 270 ml (average, 871±374 ml), and the net blood transfusion 1 206-2 661 ml(1 863±598 ml). The homogenous blood of 400 ml was transfused in 1 patient for making upthe blood loss of 3 130 ml. There were no statistically significant differencesin the hemodynamic measurements, arterial blood gas, and electrolyte variables when compared with the baseline values before the hemodilution (Pgt;0.05). The reaction time of TEG was longer 60 minutes after AEHH than before AEHH (Plt;0.05); the other parameters of TEG had no differences when compared with the baseline values (Pgt;0.05). Conclusion The AEHH is safe and efficient in reduction of the perioperative homogenous blood transfusion in spine surgery.
Objective To explore the compliance improvement of rehabilitation exercise for patients after spine surgery. Methods Forty-nine in-patients who underwent spinal surgery between June 1st and July 14th 2016 were selected as the control group and 50 in-patients who underwent spinal surgery between July 15th and August 30th 2016 were selected as the trial group. The control group received conventional nursing for rehabilitation exercise, and the tiral group adopted a series of quality improvement measures for rehabilitation exercise. The compliance of functional exercise, the accuracy of patients’ exercise and the satisfaction with health education of the patients were compared between the two groups. Results The functional exercise compliance in the trial group (complete compliance in 45 cases, partial compliance in 4 cases, non-compliance in 1 case) was higher than that in the control group (complete compliance in 9 cases, partial compliance in 34 cases, non-compliance in 6 cases) with a statistical difference (Z=–6.910, P<0.001). The functional exercise accuracy rate of patients was higher in the trial group [84.00%(168/200)] than that in the control group [53.06% (104/196)] with a statistical difference (χ2=44.060, P<0.001). The patients’ satisfaction with health education in the trial group (4.64±0.49) was higher than that in the control group (4.20±0.89) with a statistical difference (t=3.084, P=0.003). Conclusion The implementation of nursing quality improvement intervention can improve the compliance and accuracy rate of rehabilitation functional exercise of patients undergoing spinal surgery, and improve the satisfaction of patients, which is worth promoting.
ObjectiveTo investigate the status of urination in post-spineoperative (cervical thoracic and lumber verteb) patients under the enhanced recovery after surgery (ERAS) mode.MethodsPatients who were admitted to the West China Hospital of Sichuan University from October 2018 to February 2019 were enrolled. The urination status of the patients was collected by using questionnaires. All patients were divided into normal urinating group, induced urinating group and catheterization group according to their urination status after returning to the ward.ResultsA total of 106 patients were included, including 78 (73.6%) who urinated smoothly [the first urinating time (72.18±36.33) min], 20 (18.9%) who urinated after induction [the first urinating time (81.50±41.68) min], and 8 (7.5%) who received catheters after induction failure [the first urinating time (162.50±84.52) min]. The different operation, operation time, position of urination, and postoperative pain degree affecting the placement of urethral catheter differed from each other significantly (P<0.05). Among the three groups, the differences were statistically significant in operation time, operation methods, position of urination (except for the induced urination group vs. catheterization group) and postoperative pain degree (except for the induced urination group vs. catheterization group) in pairs (P<0.05). There was no significant difference in other factors among three groups in pairs (P>0.05).ConclusionsMost post-spineoperative patients can autonomously urinate without catheter under the ERAS mode, which bases on operation methods, operation time, and the first urinating posture after the surgery. Early attention should be paid to patients with dysuresia to promote their early rehabilitation.