ObjectiveTo explore the value of modified subcutaneous lumbar spine index (MSLSI) as a predictor for short-term effectiveness of transforaminal lumbar interbody fusion (TLIF) in treatment of lumbar degenerative disease (LDD).MethodsBetween February 2014 and October 2019, 450 patients who were diagnosed as LDD and received single-segment TLIF were included in the study. Based on the MSLSI measured by preoperative lumbar MRI, the patients were sorted from small to large and divided into three groups (n=150). The MSLSI of group A was 0.11-0.49, group B was 0.49-0.73, and group C was 0.73-1.88. There was no significance in gender, age, disease duration, diagnosis, surgical segment, and improved Charlson comorbidity index between groups (P>0.05). There were significant differences in the subcutaneous adipose depth of the L4 vertebral body and body mass index (BMI) between groups (P<0.05). The operation time, intra-operative blood loss, length of incision, drainage tube placement time, drainage volume on the 1st day after operation, drainage volume on the 2nd day after operation, total drainage volume, antibiotic use time after operation, walking exercise time after operation, hospital stay, the incidences of surgical or non-surgical complications in the three groups were compared. Pearson correlation analysis was used to analyze the correlation between MSLSI and BMI, and partial correlation analysis was used to study the relationship between MSLSI, BMI, improved Charlson comorbidity index, subcutaneous adipose depth of the L4 vertebral body and complications. The Receiver Operating Characteristic (ROC) curve was used to evaluate the value of SLSI and MSLSI in predicting the occurrence of complications after TLIF in treatment of LDD.ResultsThere was no significant difference in operation time, length of incision, antibiotic use time after operation, walking exercise time after operation, drainage tube placement time, drainage volume on the 1st day after operation, drainage volume on the 2nd day after operation, and total drainage volume between groups (P>0.05). The amount of intra-operative blood loss in group C was higher than that in groups A and B, and the hospital stay was longer than that in group B, with significant differences (P<0.05). Surgical complications occurred in 22 cases (14.7%), 25 cases (16.7%), and 39 cases (26.0%) of groups A, B, and C, respectively. There was no significant difference in the incidence between groups (χ2=0.826, P=0.662). The incidences of nerve root injury and wound aseptic complications in group C were higher than those in groups A and B, and the incidence of nerve root injury in group B was higher than that in group A, with significant differences (P<0.05). There were 13 cases (8.7%), 7 cases (4.7%), and 11 cases (7.3%) of non-surgical complications in groups A, B, and C, respectively, with no significant difference (χ2=2.128, P=0.345). There was no significant difference in the incidences of cardiovascular complications, urinary system complications, central system complications, and respiratory system complications between groups (P>0.05). There was a correlation between MSLSI and BMI in 450 patients (r=0.619, P=0.047). Partial correlation analysis showed that MSLSI was related to wound aseptic complications (r=0.172, P=0.032), but not related to other surgical and non-surgical complications (P>0.05). There was no correlation between BMI, improved Charlson comorbidity index, subcutaneous adipose depth of the L4 vertebral body and surgical and non-surgical complications (P>0.05). ROC curve analysis showed that the area under ROC curve (AUC) of MSLSI was 0.673 (95%CI 0.546-0.761, P=0.025), and the AUC of SLSI was 0.582 (95%CI 0.472-0.693, P=0.191). ConclusionMSLSI can predict the short-term effectiveness of TLIF in treatment of LDD. Patients with high MSLSI suffer more intra-operative blood loss, longer hospital stay, and higher incidence of nerve root injury and postoperative incision complications.
Objective To investigate the therapeutic effectof the modified anterior approach in treatment of the patients with cervicothoracic junction spinal lesions. Methods From September 2000 to January 2005, 23 patients (15 males, 8 females) with spinal lesions in the cervicothoracic junction underwent a standard cervical approach, which was combined with apartial median steotomy and transverse steotomy through the synostosis between the manubrium and body of the sternum to expose the lesion adequately. Among thepatients, 3 had fracture, 7 had dislocation, 6 had tuberculosis, and 7 had tumor. The pathologic change regions was as follows: 2 in the C6-T1 segment, 2in the C6-T2 segment, 3 in the C7-T1 segment, 3 in the T3 segment, 8 in the T1 segment, and 5 in the T2egment. The classification of Frankel were as follows: 2 at grade A, 4 at grade B, 7 at grade C, 4 at grade D, and 6 at grade E. All the patients underwent a radical excision of the affected spinal bone, were given a proper tricortical iliac crest and anterior instrumentation to reconstruct the anterior spinal column, followed by immobilization in a brace for 3-6 months. Results The mean followup period was 30 months (range, 1042 months). Bony fusion was obtained in all the patients.One patient died of pulmonary cancer metastasis 10 months after operation. The nerve function of the spinal cord recovered at different degrees (1 at grade A, None at grade B, 2 at grade C, 10 at grade D, 10 at grade E). Conclusion Ourmodified anterior approach can provide a direct and safe access to the lesions in the region.
ObjectiveTo explore the clinical efficacy of modified polytetrafluoroethylene (PTFE) prosthesis rhinoplasty for correction of low nose and short columella.
MethodsBetween August 2012 and August 2015, modified PTFE prosthesis rhinoplasty was used to correct low nose and short columella in 52 patients. There were 4 males and 48 females, aged 19 to 45 years (mean, 27 years). Primary rhinoplasty was performed in 47 cases; secondary rhinoplasty was performed in 5 cases, and it was 12-18 months from the first operation (mean, 15 months). During operation, a scaly sag ventral side was made by carving and moving cap shaped nose prosthesis was prepared, and nasal dorsumnasal columella prosthesis covered by tension-free flap was designed. At pre-operation and last follow-up, Image ProPlus 6.0 software was used to measure the nose length, nose depth, nose tip width, nostril/nose tip, nasolabial angle, and nasal tip rotation for evaluation of external nose shape correction; and ultrasound was used to measure the alar cartilage angle, alar two vertex distance, and nose tip to vertex distance for evaluation of internal soft tissue changes; the prosthesis position was observed by CT scan at 12 months.
ResultsAll incisions healed by first intention, with no complications. All patients were followed up 7-36 months (mean, 20.4 months). At 12 months after operation, CT scans showed that prosthesis located in the middle of the nose and above nasal bone, septal cartilage and crus mediale cartilaginis alaris majoris in 45 patients; no prosthesis displacement was observed. At last follow-up, image measurement and ultrasound results showed external nose shape parameters (except nostril/nose tip) and internal soft tissue structures were significantly improved when compared with preoperative values (P < 0.05).
ConclusionModified PTFE prosthesis rhinoplasty can effectively correct low nose and short columella, with small surgical trauma and good appearance.
ObjectiveTo investigate the effectiveness of the modified Urbaniak operation to treat avascular necrosis of the femoral head (ANFH).
MethodsA retrospective analysis was made on the clinical data of 38 patients (41 hips) with ANFH treated between February 2010 and October 2012 with the modified Urbaniak operation (to add lateral femoral incision based on femoral greater trochanter incision, to preserve the original fibula flap drilling, decompression and filling through trochanteric outer cortex, and to select the descending branch of lateral circumflex femoral artery as the supply vessel). Of 38 cases, 25 were male (28 hips), 13 were female (13 hips), aged 16-52 years (mean, 34 years); there were 19 cases (21 hips) of alcoholic ANFH, 9 cases (9 hips) of traumatic ANFH, 5 cases (6 hips) of hormone ANFH, and 5 cases (5 hips) of idiopathic ANFH. The disease duration ranged from 10 months to 6 years (mean, 3.7 years). According to Ficat staging criteria, 24 hips were rated as stages II and 17 hips as stage III. The preoperative Harris hip scores were 80.63±5.02 and 77.06±6.77 in patients at stage II and III respectively. The related complications were recorded after operation. According to the findings of postoperative X-ray films, 4 grades were improvement, stabilization, deterioration, and failure; improvement or stabilization was determined to radiological success. According to the Harris score to evaluate the function of hips, more than 80 was determined to clinical success.
ResultsHealing by first intention was achieved in all patients after operation. Three cases had numbness and hypoaesthesia of the lateral femoral skin, 1 case had abnormal sensation of the dorsal foot, which had no effect on daily life. Thirty-eight cases (41 hips) were followed up 1 year to 3 years and 3 months (mean, 2 years and 3 months). There was no complication such as hip joint stiffness, hip or groin persistent pain, hip joint infection, or ankle instability. At last follow-up, the X-ray films showed improvement in 23 hips (56.1%), stabilization in 17 hips (41.5%), and deterioration in 1 hip (2.4%); 40 hips obtained the radiological success. According to the Harris score, the results were excellent in 17 hips, good in 20 hips, fair in 3 hips, and poor in 1 hip with an excellent and good rate of 90.2%; 37 hips achieved the clinical success. The Harris scores were 89.92±4.12 and 86.53±5.70 in patients at stage II and III respectively at last follow-up, showing significant differences when compared with preoperative ones (t=7.011, P=0.000;t=4.412, P=0.000).
ConclusionThe modified Urbaniak operation has the advantages of more convenient operation, less complications, higher safety, and better hip functional recovery. It is an effective method to treat ANFH.
ObjectiveTo analyze the cost and performance of five methods for detection of carbapenemase-producing Enterobacteriaceae (CPE), including PCR (method A), Carba NP test (method B), ultraviolet spectrophotometry (method C), modified carbapenem inactivation method (mCIM, method D), and loop-mediated isothermal amplification (LAMP, method E).MethodsPubMed, EMbase, The Cochrane Library, CNKI, WanFang Data and CBM databases were searched using the computer regarding literature on detection of CPE with the same or similar designs, same objectives, and independent results. The search was limited between May 2009 and May 2019. Data on the cost and detection performance of all five methods were extracted, and the four special indexes for laboratory tests, such as sensitivity, specificity, simplicity, and rapidity in the utility were quantified as specific values; subsequently, the cost-effective analysis (CEA), cost-utility analysis (CUA), and multi-attribute utility theory (MAUT) in the detection economic analysis were used to conduct health economics evaluation of five detection methods for CPE.ResultsThe cost of methods A, B, C, D and E were 210.00 yuan, 22.00 yuan, 10.50 yuan, 6.00 yuan, and 60.00 yuan, respectively. The C/E of CEA for the above five methods were 210.00, 22.96, 10.66, 6.14, and 60.00, respectively. The C/U of CUA for the above five methods were 302.16, 32.13, 19.30, 11.13, and 80.00, respectively. The MAUT value of the above five methods were 42.56, 5.00, 2.54, 1.63, and 12.56, respectively.ConclusionIn terms of CEA, CUA, and MAUT, the method D was the highest in economic value, which usually can be used as a routine method for detecting CPE, but it needs a long procedure time; thus, the method E can be used for rapid detection when clinical severe infection occurred, which is superior in both cost-effectiveness and rapidity.
Objective To investigate the clinical effects and the management of combined using of zerobalanced ultrafiltration(ZBUF) and modified ultrafiltration(MUF) in severe infant open heart surgery with cardiopulmonary bypass(CPB) , in order to evaluate the feasibility and clinical significance of combination of ZBUF and MUF. Methods 20 pediatric patients diagnosed as complicated congenital heart disease had been involved, which included 12 males and 8 females with 12.6±7.5months of age and 8.5±3.3 kg of weight. Gambro FH22 hemofilter was selected in all patients. The typical MUF method was chosen. ZBUF was done during CPB and MUF was performed after CPB. The variety of hemodynamics, blood gas, concentration of electrolytes, inflammatory media and change of the plasma colloid osmotic pressure(COP) were measured at several time points. Filtrate was salvaged to detect the level of tumor necrosis factor alpha (TNF-α) and interleukine-8 (IL-8). Results Mean arterial pressure(MAP) was significantly higher(P=0.001) after MUF finished in all patients. Lactate acid (LAC), TNF-α and IL-8 had no significant difference before and after ZBUF. COP was significantly higher after MUF than that after ZBUF(P=0.002). Concentration of TNF-α in MUF filtrate was significantly higher than that in ZBUF(p=0.036). Conclusion Combined using of ZBUF and MUF has the effective ability of removing the inflammatory mediators and ameliorating system immunoreaction in pediatric CPB. MUF can improve the respiratory and heart function through decreasing the body water and increasing COP and hematocrit.
ObjectiveTo compare the differences in preventing subcutaneous effusion, skin flap necrosis, and patient comfort between simple negative pressure drainage and negative pressure drainage combined with chest compression bandaging after radical mastectomy for breast cancer.
MethodsOne hundred and ninety-six patients underwent radical mastectomy for breast cancer from January 2010 to December 2012 in this hospital were collected.The simple negative pressure drainage (SNPD group, n=84) and negative pressure drainage combined with chest compression bandaging (NPD+CB group, n=112) after radical mastectomy for breast cancer were used to prevent postoperative subcutaneous effusion.The postoperative complications, postoperative 3 d drainage volume, and patient comfort were compared in two groups.
ResultsOne hundred and ninety-six patients with breast cancer were females.The differences of general clinical data were not statistically significant in two groups (P > 0.05).The differences of chest wall mean extubation time, axillary mean extubation time, postoperative 3 d mean drainage volume, and incidences of subcutaneous effusion and skin flap necrosis were not statistically significant in two groups (P > 0.05).The rate of comfort satisfactory in the SNPD group was significantly higher than that in the NPD+CB group [76.2%(16/84) versus 22.3%(25/112), P < 0.001].The chemotherapy was not affected after operation in two groups.
ConclusionsComparing with negative pressure drainage combined with chest compression bandaging, simple negative pressure drainage do not increase postoperative subcutaneous effusion and skin flap necrosis, but it greatly improves the patients satisfactory rate.
ObjectiveTo explore the clinical value of modified Soave procedure with stapler for the treatment of Hirschsprung disease. MethodsThe clinical data of 26 patients with Hirschsprung disease adimitted in No.477 hospital from January 2002 to December 2010 were analyzed retrospectively. All the patients underwent modified Soave operation with rectal mucosa and proximal intestine stapled end-to-end. ResultsAll operations were successful without anastomotic leakage, aponeurosis of investment infection, and colonitis. Increased stool frequency presented in two cases, which were cured with astringents on day 15 and 30 after operation, respectively. Mild fecal contamination was in one case. All cases were followed up between 3 months to 60 months, with an average 32 months, without incontinence and constiptation. ConclusionModified Soave procedure with stapler is safe and effective for the treatment of Hirschsprung disease in elder children and adult.
Objective To evaluate the cl inical outcomes of modified posterior-anterior operation in the treatment of serious lumbar fracture and dislocation. Methods From January 2002 to February 2006, 24 patients, 17 males and 7 females aged 22-69 years, underwent reduction of posterior spatium intermuscular approach combined with modified anterioroperation. Nine cases were caused by fall ing and 15 by traffic accident, involving: L1 in 5 cases, L2 in 10 cases, L3 in 4 cases, L4 in 2 case, L1,2 in 1 case and L3,4 in 2 cases. According to the Frankel grade, there were 5 cases for grade A, 11 for grade B, 7 for grade C and 1 for grade D. The recovery of neurological function was evaluated. The imageology examination was appl ied to evaluate the condition of internal fixation and bone union. The Cobb’s angle was measured by X-ray film before operation, 3 days after operation and at the final follow-up, and the difference was estimated. Results Nineteen patients were followed up for 8-52 months, 28.4 months on average. Among the 2 cases of grade A, one improved to C and the other had no improvement. Among the 9 cases of grade B, 5 improved to C, 2 improved to D, and other two had no improvement. Among the 7 cases of grade C, 5 improved to D and 2 improved to E. One case of grade D improved to E. The average Cobb’s angle was (—11.5 ± 4.6)° preoperatively, (4.2 ± 4.7)° 3 days after operation and (4.0 ± 4.8)° at the final follow-up, indicating there was a significant difference between preoperation, 3 days after operation and the final follow-up (P lt; 0.001), but no significant difference between 3 days after operation and the final follow-up (P gt; 0.05). The position of internal fixation was good during follow-up. The compl ications such as disruption, loosening and collapse were not observed. Conclusion Reduction of posterior spatium intermuscular approach combined with modified anterior operation in the treatment of serious lumbar fracture and dislocation could complete the reduction, decompression, grafting and internal fixation in one stage, and protect the paraspinal soft tissue and minimize the trauma caused by surgery. It has the merits of short time of operation, small amount of intraoperative hemorrhage, sol id union of internal fixation and satisfactory cl inical outcome.
Objective To study the cl inical effects of modified Galveston technology in the treatment of lumbosacral tuberculosis. Methods From January 2001 to May 2008, 19 patients with lumbosacral tuberculosis were treated, including13 males and 6 females aged 21-58 years old (average 38 years old). The course of disease was 8-22 months. The tuberculosis was at the L4-S1 level in 3 cases, the L5, S1 level in 10 cases, the L5-S2 level in 5 cases, and the S1, 2 level in 1 case. Seven cases were compl icated with neural symptom of the lower l imbs, 3 cases of them were grade C and 4 cases were grade D according to the Frankel scale of nerve function. The preoperative JOA score of lower back pain was 5-22 (average 19). Six cases were compl icated with il iac abscess, 3 cases with psoas abscess, 3 cases with sacroil iac joint tuberculosis, and 2 cases with pulmonary tuberculosis. For 12 patients, the operation of modified Galveston internal fixation via the posterior approach, focus debridement via vertebral canal, and interbody fusion with autogeneous il iac bone fragment grafting was performed; for 7 cases, the operation of modified Galveston internal fixation via the posterior approach, vertebral lamina fusion with autogeneous il iac bone fragment grafting, and anterior focus debridement was performed. Results The incision of 18 cases was healed by first intention, and 1 case had sinus 3 weeks after operation and healed 3 months after operation. Nineteen patients were followed up for 12-82 months (average 21 months). There was no recurrence of the local tuberculosis, and the common toxic symptom of tuberculosis disappeared 6-12 months after operation. All the patients achieved bony fusion 4-6 months postoperatively, and 3 patients with sacroil iac joint tuberculosis achieved sacroil iac joint fusion. For those 7 patients with combinations of the neural symptomof the lower l imbs, the symptoms disappeared and their Frankel scales were improved to grade E. The JOA score of low back pain at the final follow-up was 22-29 (average 26). There was a significant difference between preoperation and postoperation (P lt; 0.05). Conclusion The modified Galveston technology is helpful to reconstruct the stabil ity of lumbosacral vertebrae, improve bony fusion rate, reduce the postoperative in-bed time.
