Objective To evaluate the therapeutic effect of open-door cervical expansive laminoplasty (ELP) with anchor fixation on flurosis cervical stenosis (FCS). Methods From February 2005 to February 2006, 20 patients with FCS underwent ELP using anchor fixation (group A) and 24 patients with FCS received ELP using conventional silk thread fixation (group B). In group A, there were 11 males and 9 females aged (58.0 ± 11.2) years old, the course of disease ranged from 6 months to 5 years, and the stenosis involved 3 vertebral levels in 3 cases, 4 levels in 8 cases, and 5 levels in 9 cases, andthe sagittal diameter of the cervical spinal canal was (7.30 ± 5.23) mm. While in group B, there were 11 males and 13 females aged (61.0 ± 9.1) years old, the course of disease ranged from 5 months to 5 years, the stenosis involved 3 vertebral levels in 5 cases, 4 levels in 10 cases, and 5 levels in 9 cases, and the sagittal diameter of the cervical spinal canal was (7.11 ± 4.92) mm. No significant differences were evident between two groups in terms of the general information (P gt; 0.05). Before operation and at 24 months after operation, the nerve function was assessed by JOA score, the axial symptom (AS) was evaluated using Chiba 12-point method, and the changes of cervical lordosis index (CLI) and cervical range of motion (CRM) were detected by imaging examination. Results All wounds healed by first intention. All patients were followed up for 24 months. JOA score: in group A, it was improved from 7.4 ± 1.5 before operation to 14.6 ± 2.1 at 24 months after operation with an improvement rate of 61% ± 3%; in group B, the score was increased from 7.1 ± 2.2 to 12.6 ± 2.5 with an improvement rate of 52% ± 5%; significant differences were evident in two groups between before and after operation, and between two groups in terms of the improvement rate (P lt; 0.05). AS score: in group A, it was improved from 6.2 ± 2.1 before operation to 10.8 ± 0.3 at 24 months after operation with an improvement rate of 74% ± 4%; in group B, the score was increased from 6.3 ± 1.9 to 8.8 ± 0.5 with an improvement rate of 39% ± 3%; significant differences were evident in two groups between before and after operation, and between two groups in terms of improvement rate (P lt; 0.05). X-ray films and CT scan at 24 months after operation displayed that there was no occurrence of “breakage of door spindle” or “re-close of door” in two groups, there was no occurrence of anchor loosing in group A, and the molding of the spinal canal was satisfactory in two groups. Preoperatively, the CLI was 11.9 ± 1.9 in group A and 11.3 ± 2.2 in group B and the CRM was (39.5 ± 2.4)° in group A and (40.2 ± 1.8)° in group B. While at 24 months after operation, the CLI was 9.5 ± 2.2 in group A and 8.2 ± 2.8 in group B, and the CRM was (30.6 ± 2.0)° in group A and (28.7 ± 2.4)° in group B, suggesting there was a significant decrease when compared with the preoperative value and group A was superior to group B (P lt; 0.05). The saggital diameter of the cervical spinal canal 24 months after operation was (13.17 ± 2.12) mm in group A and (12.89 ± 3.21) mm in group B, indicating there was a significant difference when compared with the preoperative value (P lt; 0.01). Conclusion Compared with conventional silk thread fixation, ELP using anchor fixation brings more stabil ity to vertebral lamina, less invasion to the posterior muscular-skeletal structure of the cervical spine, sl ight postoperative neck AS, andsatisfactory cl inical outcomes.
【摘要】 目的 探讨脊柱外科手术患者术后发生谵妄的危险因素和有效防治措施。 方法 2007年1月-2009年10月应用ICU谵妄诊断的意识状态评估法观察1 835例脊柱外科术后患者。对于发生术后谵妄的患者随机分为治疗组和未治疗组，治疗组于谵妄诊断明确时即静脉注射氟哌利多5 mg。 结果 术后3 d，136例发生谵妄，谵妄发生率为7.41%。筛选出术后谵妄的可能高危因素包括高龄、术前合并高血压、术前合并糖尿病、术中出血量gt;600 mL、手术时间gt;4 h、术中应用激素、术后电解质紊乱和低氧血症、术后疼痛。发生谵妄的患者中，治疗组（68例）住院时间短于未治疗组（68例），差异有统计学意义（Plt;0.05）。 结论 高龄，术前合并高血压、糖尿病，术中出血量gt;600 mL，手术时间gt;4 h，术中应用激素，术后电解质紊乱、低氧血症及疼痛是脊柱外科手术患者术后发生谵妄的主要高危因素。氟哌利多治疗术后谵妄有效。【Abstract】 Objective To analyze the related factors influencing postoperative phrenitis in patients who have undergone spine surgery. Methods Postoperative phrenitis was evaluated with the confusion assessment method for the intensive care unit in 1 835 patients underwent spine surgery between January 2007 and October 2009. All the patients with postoperative phrenitis were randomly divided into two groups: treatment group and control group. The patients in treatment group underwent intravenous injection with droperidol (5 mg). Results Three days after the operation, 136 patients were diagnosed with postoperative phrenitis. The pre-operative complications of hypertension and diabetes, hemorrhage amount (gt;600 mL) during the operation, operative time (gt;4 hours), hormone usage during the operation, postoperative electrolyte disturbances, hyoxemia and pain were the factors influencing the morbidity of postoperative phrenitis. The length of hospital stay was shorter in the treatment group than that in the control group (Plt;0.05). Conclusions Senility, pre-operative complications of hypertension and diabetes, hemorrhage amount (gt;600 mL) during the operation, operative time (gt;4 hours), hormone usage during the operation, postoperative electrolyte disturbances, hyoxemia and pain were the factors influencing the morbidity of postoperative phrenitis. Droperidol is effective on postoperative phrenitis.
Objective To evaluate the effectiveness of combined posterior decompression with laminoplasty and anterior decompression with fusion for the treatment of cervical spinal canal stenosis with reverse arch. Methods Between May 2009 and February 2012, 13 cases of cervical spinal canal stenosis with reverse arch underwent posterior decompression with laminoplasty surgery in prone position and then anterior decompression with fusion surgery in supine position. There were 7 males and 6 females with an average age of 43.5 years (range, 38-62 years) and an average disease duration of 25 months (range, 18-60 months). All the patients had neck axial symptoms and spinal cord compressed symptoms, and lateral computer radiology (CR) of the neck showed reverse arch of cervical vertebrae. Segments of intervertebral disc protrusion included C3-6 in 4 cases, C4-7 in 4 cases, and C3-7 in 5 cases. After operation, anteroposterior and lateral CR was used to observe the cervical curvature change and fixation loosening, MRI to observe the change of the compression on spinal cord, visual analogue scale (VAS) score to evaluate the improvement of axial symptom, and Japanese Orthopaedic Association (JOA) score to assess the nerve function improvement. Results All incisions healed by first intention. All patients were followed up 9-32 months (mean, 15.4 months). Internal fixator had good position without loosening or breaking and the compression on spinal cord improved significantly after operation. All the patients obtained bony fusion at 6 months after operation. The axial symptoms and the nerve function at last follow-up were improved. VAS score at last follow-up (3.25 ± 1.54) was significantly lower than that at preoperation (6.55 ± 1.52) (P lt; 0.05); JOA score at last follow-up (10.45 ± 4.23) was significantly higher than that at preoperation (7.05 ± 1.32) (P lt; 0.05); and cervical curvature value at last follow-up [(6.53 ± 3.12) mm] was significantly higher than that at preoperation [(3.22 ± 5.15) mm] (P lt; 0.05). Conclusion Combined posterior decompression with laminoplasty and anterior decompression with fusion for the treatment of cervical spinal canal stenosis with reverse arch is a safe and effective surgical method.
Objective To summarize the characteristic imaging signs of ossification of the ligamentum flavum (OLF) associated with dural adhesions by analyzing retrospectively the imaging signs of OLF associated with dural adhesions. Methods A retrospective analysis was made on clinical data of 85 patients undergoing OLF surgery between January 2010 and September 2012. The patients were assigned into the study group and the control group according to the preoperative imaging signs. Of 85 patients, 34 had both “tram track sign” and “jagged line sign” as the study group and 51 had either “tram track sign” or “jagged line sign” and neither of them as the control group. Adherence between dura mater and ligamentum flavum was observed during operation as the “gold standard” for the diagnosis of dural adhesion. The imaging information of CT and MRI in sagittal and axial planes was analyzed. The typical characteristics of dural adhesions were found. Then the sensitivity, specificity, and positive likelihood ratio of the preoperative imaging examinations were calculated to estimate the reference value and diagnostic value (gt; 5 having reference value, and gt; 10 having diagnostic value). Results In the study group, dural adhesion was observed in 26 patients (10 males and 16 females), and the other 8 patients (6 males and 2 females) had no dural adhesion. In the control group, dural adhesion was found in 2 female patients who had “jagged line sign”, and 49 patients had no dural adhesion (14 males and 35 females). In patients having both “tram track sign” and “jagged line sign”, the sensitivity was 92.9%; the specificity was 86.0%; and the positive likelihood ratio was 6.6. In patients having “tram track sign”, the sensitivity was 92.9%; the specificity was 64.9%; and the positive likelihood ratio was 2.6. In patients having “jagged line sign”, the sensitivity was 100%; the specificity was 77.2%; and the positive likelihood ratio was 4.4. Conclusion For patients with OLF having both “tram track sign” and “jagged line sign”, preoperative CT and MRI have a reference value for diagnoses of the OLF associated with dural adhesions.
Objective To evaluate and compare the relation of the cl inical results of expansion of open-door cervical laminoplasty (EOLP), C5 nerve root palsy in hinge side, and reclose of the opened laminae with different angles in lamina opendoor.Methods Between July 2006 and January 2009, 198 patients with cervical myelopathy were treated by EOLP. Accordingto different opening angles which were measured by CT scan after operation, the patients were divided into group A (gt; 30°, 76 patients including 44 males and 32 females) and group B (15-30°, 122 patients including 71 males and 51 females). There was no significant difference in gender, age, disease duration, and segmental lesions between 2 groups (P gt; 0.05). The Japanese Orthopaedic Association (JOA) score before and after operation was used for neurological assessment and improvement rate, and the postoperative C5 nerve root palsy and reclose of the opened laminae were recorded. Results There was no significant difference in operation time, bleeding volume, and hospital ization days between 2 groups (P gt; 0.05). After 3 weeks of operation, C5 nerve root palsy in the hinge side occurred in 7 patients (9.2%) of group A, and in 2 patients (1.6%) of group B, were restored after symptomatic treatment, showing significant difference between 2 groups (χ2= 4.568, P= 0.033). All patients were followed up 24 to 48 months. Between group A and group B, no significant difference was found in JOA improvement rate at 24 months after operation (P gt; 0.05), and in JOA score at preoperation and at 24 months after operation (P gt; 0.05), but JOA score was significantly improved at 24 months after operation when compared with preoperative score in the same group (P lt; 0.05). The function of l imb l ifting restored in 9 cases of C5 nerve root palsy at 24 months after operation; CT examination revealed that no reclose occured in group A and reclose occurred in 4 cases (3.3%) of group B, but no persistent symptoms or worsen situationwere found during follow-up. Conclusion Different angles in lamina open-door have the same cl inical result; C5 nerve palsy has good prognosis. The opening angle between 15° and 30° will reduce the incidence of C5 nerve root palsy in the hinge side, but the open side should be firmly fixed to prevent further reclose of the opened laminae.
Objective To analyse the correlation between cervical sagittal parameters of cervical spondylotic myelopathy in different sagittal curvature so as to find out representative cervical sagittal alignment parameters by measuring on MRI. Methods A retrospective analysis was made on the clinical data of 88 patients with cervical spondylotic myelopathy between July 2015 and January 2016. The C2-C7 Cobb angle, T1 slope (T1S), and C2-C7 sagittal vertical axis (C2-C7 SVA) were measured on T2-weight MRI. According to C2-C7 Cobb angle, the patients were divided into lordosis group (≥10° Cobb angle, 48 cases) and straightened group (0-10° Cobb angle, 40 cases). Intraclass correlation coefficient (ICC) was used for the reliability of measured data, Pearson correlation analysis for correlation between cervical sagittal parameters. Results ICC was 0.858-0.946, indicating good consistency of measurement parameters. The C2-C7 Cobb angle, T1S, and C2-C7 SVA were (5.6±2.4)°, (22.2±6.7)°, and (10.2±5.4) mm in straightened group, and were (20.1±8.2)°, (23.4±8.9)°, and (8.2±4.6) mm in lordosis group respectively. There was no correlation between the 3 parameters in straighten group (r=0.100,P=0.510 for T1S and C2-C7 Cobb angle;r=–0.100,P=0.500 for T1S and C2-C7 SVA;r=0.080,P=0.610 for C2-C7 Cobb angle and C2-C7 SVA). There was positive correlation between T1S and C2-C7 Cobb angle (r=0.540,P=0.000), negative correlation between T1S and C2-C7 SVA (r=–0.450,P=0.001), and no correlation between C2-C7 Cobb angle and C2-C7 SVA (r=–0.003,P=0.980). Conclusion For cervical spondylotic myelopathy in patients with cervical lordosis, only T1S measurement on MRI can be used as the main parameter to judge the sagittal curvature, but in patients with straightened cervical Cobb angle, measurements of T1S, C2-C7 Cobb angle, and C2-C7 SVA should be taken for the comprehensive evaluation of cervical sagittal curvature.
Objective To summarize the clinical features, diagnosis, and treatment of acute deep venous thrombosis (DVT) at lower extremity of aged patients. Method Clinical data of 98 aged patients with acute DVT at lower extremity who got treatment in our hospital from Junuary 2012 to December 2014 were analyzed retrospectively. Results Of 98 aged patients with acute DVT at lower extremity, the time from disease developed to treatment was 1 day to 10 days with an average of 4 days. The main symptom was low limb swelling progressively. All the patients were treated by the comprehensive treatment based on individual anticoagulation. A total of 96 patients (98.0%) were followed up, and the follow-up period ranged from 12 months to 24 months (average of 18 months). Of 96 patients followed-up, we found a statistically significant difference between lower extremities before treatment and those at 3 months after treatment in venous clinical severity score (VCSS) and the change of lower extremity circumference (P<0.001). Of 96 patients, 9 patients were cured, 81 patients had markedly effective results, and 6 patients had effective results. None of the patients suffered from fatal pulmonary embolismin in duration of hospital day and follow-up period, and no one suffered form DVT recurrence. Conclusions The aged patients with acute DVT at lower extremity usually see a doctor lately. The comprehensive treatment based on individual anticoagulation is safe and effective in treatment of acute DVT at lower extremity of aged patients.
Objective To investigate whether preoperative T1 slope (T1S) in MRI can predict the changes of cervical curvature after expansive open-door laminoplasty (EOLP) in patients with cervical spondylotic myelopathy, so as to make up for the shortcomings of difficult measurement in X-ray film. Methods The clinical data of 36 patients with cervical spondylotic myelopathy who underwent EOLP were retrospectively analysed. There were 21 males and 15 females with an average age of 55.8 years (range, 37-73 years) and an average follow-up time of 14.3 months (range, 12-24 months). The preoperative X-ray films at dynamic position, CT, and MRI of cervical spine before operation, and the anteroposterior and lateral X-ray films at last follow-up were taken out to measure the following sagittal parameters. The parameters included C2-C7 Cobb angle and C2-C7 sagittal vertical axis (C2-C7 SVA) in all patients before operation and at last follow-up; preoperative T1S were measured in MRI, and the patients were divided into larger T1S group (T1S>19°, group A) and small T1S group (T1S≤19°, group B) according to the median of T1S, and the preoperative T1S, C2-C7 Cobb angle, C2-C7 SVA, and the C2-C7 Cobb angle and C2-C7 SVA at last follow-up, difference in axial distance (the difference of C2-C7 SVA before and after operation), postoperative curvature loss (the difference of C2-C7 Cobb angle before and after operation), the number of patients whose curvature loss was more than 5° after operation, and the number of patients whose kyphosis changed (C2-C7 Cobb angle was less than 0° after operation). Results The C2-C7 Cobb angle at last follow-up was significantly decreased when compared with preoperative value (t=8.000, P=0.000), but there was no significant difference in C2-C7 SVA between pre- and post-operation (t=–1.842, P=0.074). The preoperative T1S was (19.69±3.39)°; there were 17 cases in group A and 19 cases in group B with no significant difference in gender and age between 2 groups (P>0.05). The preoperative C2-C7 Cobb angle in group B was significantly lower than that in group A (t=–2.150, P=0.039), while there was no significant difference in preoperative C2-C7 SVA between 2 groups (t=0.206, P=0.838). At last follow-up, except for the curvature loss after operation in group B was significantly lower than that in group A (t=–2.723, P=0.010), there was no significant difference in the other indicators between 2 groups (P>0.05). Conclusion Preoperative larger T1S (T1S>19°) in MRI had a larger preoperative lordosis angle, but more postoperative physiological curvature was lost; preoperative T1S in MRI can not predict postoperative curvature loss, but preoperative larger T1S may be more prone to kyphosis.
Objective To elucidate the relationship between preoperative C7 slope (C7S) and sagittal parameters in anterior cervical discectomy with fusion (ACDF) by imaging. Methods A retrospective analysis of 54 patients (24 males and 30 females) with ACDF for cervical spondylosis between January 2012 and January 2017 was performed. The age ranged from 23 to 71 years (mean, 46.6 years). There were 29 cases of cervical spondylotic radiculopathy and 25 cases of cervical spondylotic myelopathy. The disease duration ranged from 3 to 48 months, with an average of 16.8 months. In the 55 patients, 44 were single-segment ACDF and 10 were double-segment ACDF. Sagittal parameters of cervical spine were measured on cervical X-ray films before operation and at last follow-up, including C2-7 Cobb angle, C2-7 sagittal vertical axis (C2-7 SVA), C7S, and segment Cobb angle (SCobb), and the changes of C2-7 Cobb angle (the difference between the last follow-up and the preoperative angle) were calculated. Pearson correlation was used to analyze the correlation between the parameters before operation and at last follow-up. According to the preoperative median value of C7S (15°), the patients were divided into group A (C7S<15°) and group B (C7S≥15°). The sagittal parameters before and after operation were compared between the two groups. Results All the 54 patients were followed up 6-45 months (mean, 15.5 months). At last follow-up, C7S, C2-7 Cobb angle, C2-7 SVA, and SCobb angle were significantly improved when compared with preoperative values (P<0.05). Correlation analysis showed that the preoperative C7S and SCobb angles were significantly correlated with C2-7 Cobb angle and C2-7 SVA (P<0.05), but there was no significant correlation between C7S and SCobb angle (r=0.049, P=0.724). There was a significant correlation between C7S, C2-7 Cobb angle, and SCobb angle at last follow-up (P<0.05), but there was no significant correlation between C7S and SCobb angles and C2-7 SVA (P>0.05). According to the median value of preoperative C7S, 28 patients in group A had C7S of (11.82±3.60)°, while 26 patients in group B had C7S of (20.77±4.09)°. There was no significant difference in gender and age between the two groups (P>0.05). The preoperative C2-7 Cobb angle and C2-7 SVA in group A were significantly lower than those in group B (P<0.05). There was no significant difference between preoperative SCobb angle and group B (t=0.234, P=0.816). There were no significant differences in C2-7 Cobb angle, C2-7 SVA, and SCobb angle between group A and group B at last follow-up (P>0.05). However, the change of C2-7 Cobb angle in group A was significantly higher than that in group B (t=2.321, P=0.024). Conclusion Preoperative C7S≥15° group has more physiological lordosis before operation, but its postoperative cervical curvature changes less, while ACDF is more conducive to correct the preoperative C7S<15 ° cervical curvature.