斜外侧入路椎间融合术联合不同固定方式治疗腰椎滑脱症的早期疗效分析

【摘要】 目的：比较斜外侧入路椎间融合术（oblique lateral interbody fusion,OLIF）联合不同固定方式治疗腰椎滑脱症的早期临床疗效及并发症情况。方法：回顾性分析2020年1月~2022年1月于我院接受OLIF治疗的腰椎滑脱症患者53例,其中男性24例,女性29例,年龄62.17±9.72岁;OLIF联合侧方钢板（lateral plate,LP）固定组24例（LP组）,OLIF联合后方椎弓根螺钉（pedicle screw,PS）内固定组29例（PS组）。两组患者的年龄、性别及体质指数 （body mass index,BMI）等人群特征均无明显统计学差异。记录两组患者的手术时间、术中出血量、术后并发症情况。于术前、术后1周、3个月及12个月分别采用腰痛视觉模拟评分（visual analog scale,VAS）、Oswestry功能障碍指数（Oswestry disability index,ODI）及影像学指标如椎间隙高度（disc height,DH）、椎间孔高度（foraminal height,FH）、椎管横截面积（cross-sectional area,CSA）来综合评价临床疗效。末次随访时根据Bridwell评估方法对椎间融合率进行评估。结果：随访时间为13.2±6.5个月（12~16个月）。LP组手术时间及术中出血量均显著性低于PS组（75.41±11.53min vs 127.05±5.62min,P<0.05;39.55±5.32mL vs 89.81±9.62mL,P<0.05）。两组患者术前VAS评分、ODI指数均无统计学差异,术后1周LP组VAS评分及ODI均优于PS组[3.05±0.67 vs 4.55±0.39,P<0.01;（17.36±2.76）% vs （22.80±6.02）%,P<0.01],但这种差异在术后1年时消失。LP组术前DH、FH及CSA分别为8.96±1.23mm,16.18±3.49mm和88.95±14.79mm2,术后1年分别为12.53±3.47mm、20.14±3.12mm、124.83±7.56mm2,较前均明显改善;PS组术前DH、FH及CSA分别为8.66±2.21mm、16.35±5.19mm、89.23±12.18mm2,术后1年分别为12.32±4.67mm、20.86±3.44mm、125.75±7.76mm2,较前均明显改善,但各参数在同期随访时无组间差异。LP组22例实现椎间融合,融合率为 91.67%,略低于PS组（93.10%）,但无统计学差异。LP组融合器沉降2例,腰骶丛损伤2例;PS组融合器沉降2例,腰骶丛损伤1例,并发症发生率组间差异无统计学意义（P>0.05）。结论：OLIF+LP及OLIF+PS均可有效治疗腰椎滑脱症,相比于OLIF+PS,OLIF+LP的出血量更少、手术时间更短,而临床效果相当。     

强直性脊柱炎胸腰椎后凸畸形经椎弓根椎体截骨术后机械并发症与GAP评分的相关性及其危险因素分析

目的 ：探讨强直性脊柱炎(ankylosing spondylitis,AS)胸腰椎后凸畸形经椎弓根椎体截骨术(pedicle subtraction osteotomy,PSO)术后机械并发症与GAP(global alignment and proportion)评分的相关性,并分析其危险因素。方法：回顾性分析2010年1月～2019年6月在我院行单节段PSO且随访超过2年的AS胸腰椎后凸畸形患者。在术前、术后站立位全脊柱侧位X线片上测量矢状面平衡(sagittal vertical axis,SVA)、骨盆投射角(pelvic incidence,PI)、骶骨倾斜角(sacral slope,SS)、腰椎前凸角(lumbar lordosis,LL)、下腰椎前凸角(lower lumbar lordosis,LLL)、整体倾斜(global tilt,GT),计算GAP评分。根据患者GAP评分分为3组：矢状面协调组(GAP评分0～2分)、中等不协调组(GAP评分3～6分)、严重不协调组(GAP评分7～13分),记录随访过程中发生的机械并发症,包括近端交界性后凸/失败(proxim...     

Are the results of patient reported outcome measures after spine surgery influenced by recall of preoperative scores? A randomized controlled trial

BACKGROUND CONTEXTPatient reported outcome measures (PROMs) are of utmost importance to clinical practice as they permit a patient-focused evaluation of surgical outcomes. However, recall bias can limit an adequate interpretation of PROMs.PURPOSETo assess the impact of recall bias of preoperative status on postoperative PROMs of patients submitted to surgery due to degenerative spine disease.STUDY DESIGN / SETTINGRandomized controlled trial in a tertiary care neurosurgical unit in PortugalPATIENT SAMPLEAll patients submitted to surgery at our institution from January 2019 to April 2020 due to degenerative lumbar or cervical spine disease with valid PROMs questionnaires were enrolled, and 2 computer generated randomized groups were created.OUTCOME MEASURESThe study´s primary endpoint was the median postoperative Core Outcome Measure Index (COMI) score.METHODSThe intervention group was sent postoperative questionnaires including preoperative answers, while patients in the control group were sent the same PROMs without the preoperative answers.RESULTSRandomization was applied to 236 patients (118 for each group) and valid results were obtained for 147 patients (81 lumbar, 44 from the intervention group; and 66 cervical, 29 from the intervention group), from which 88 (60%) were females, with a median age of 58 years.Both groups shared similar baseline clinical characteristics and preoperative scores. Median postoperative COMI scores and interquartile ranges (IQR) were 4.20 (IQR: 2.30–6.00) and 5.45 (IQR: 3.75–7.40) for the intervention and control groups, respectively (Wilcoxon, p=.02). This difference was reached mainly due to cervical spine patients as median postoperative COMI score was 3.95 (IQR: 2.20–5.32) in the intervention group and 5.1 (IQR: 4.0–8.4) in the control group (Wilcoxon, p=.01). No significant difference was reached for lumbar patients.CONCLUSIONSBetter PROMs scores were obtained for degenerative cervical spine patients to whom the preoperative results were provided. Therefore, providing preoperative scores to patients upon postoperative PROMs fulfilment might influence postoperative results. Further research is necessary to increase the reliability of PROMs in clinical practice.     

Clinical outcomes and affecting factors of ipsilateral femoral neck and shaft fractures - Multination,multicenter analysis

BackgroundThis study aimed to evaluate the clinical outcomes of ipsilateral femoral neck and shaft fractures and identify the risk factors associated with missed diagnosis of femoral neck fractures and clinical outcomes of this fracture.MethodsThe ipsilateral femoral neck and shaft fractures from seven centers were retrospectively reviewed. Data on injury mechanism, fracture pattern, and fracture classification; surgical factors including fixation method; and timing of detection of femoral neck fracture were analyzed. The clinical outcomes, complications, and the incidence of avascular necrosis of the femoral head (AVNFH) were reviewed. Risk factors for missed femoral neck fracture and complications were analyzed.ResultsIn total, 74 patients with an average age of 43.6 years were included. Of the femoral shaft fractures, 56.8% were type A, 21.6% were type B, and 21.6% were type C. Sixteen patients had an open fracture of the femoral shaft. Femoral neck fracture was initially missed in 27% patients and the timing of delayed diagnosis was at an average of 11.1 days after injury. For detecting femoral neck fractures, minimal displacement of the femoral neck fracture was a risk factor, whereas computed tomography (CT) was a protective factor. The incidence of AVNFH was 6.8% at an average of 36.8 months after injury. The AVNFH group had more displaced femoral neck fractures at the time of surgery, but there was no difference in the timing of diagnosis compared to non-AVNFH group. The femoral shaft showed considerable healing problems, with an average union time of 29.7 weeks and a 20.2% nonunion rate.ConclusionIpsilateral femoral neck and shaft fractures had a high rate of missed diagnosis, especially in minimally displaced fractures; however, CT was a protective factor. AVNFH occurred in 6.8% and was related to femoral neck fracture displacement, but not delayed diagnosis. The femur nonunion rate was high, which warrants attention.     

The Effects of Adenosine Ligands R-PIA and CPT on Ethanol Withdrawal

The potential anxiogenic or anxiolytic effects of R(−)-N⁶-(2-phenylisopropyl)adenosine (R-PIA), an adenosine agonist, and 8-cyclopentyl-1,3,dimethylxanthine (CPT), an adenosine antagonist, were tested during chronic exposure to ethanol and to ethanol-induced withdrawal in rats. Effects on anxiety were measured by the elevated plus maze and dark–light box. Ethanol consumption and preference was tested in an additional experiment. In testing of elevated plus maze performance during withdrawal from ethanol, R-PIA produced no change in the anxiety-related behaviors of total arm entries and percent open arm entries, but produced a significant decrease in percent open arm time. CPT produced at least partial recovery from the anxiogenic effects of ethanol withdrawal on all three measures of elevated plus maze performance, although peak effects were seen at the intermediate dose of CPT (0.08 mg/kg) for total arm entries and percent open arm time. CPT also showed anxiolytic effects at low to intermediate doses (0.04, 0.08 mg/kg) in the dark–light box. CPT did not reduce the preference for ethanol over water or the total consumption of ethanol over a range of ethanol doses. In summary, the adenosine agonist, R-PIA, exacerbated the effects of ethanol withdrawal, whereas the adenosine antagonist, CPT, at least partially blocked the anxiogenic effects produced by ethanol withdrawal. These results suggest that adenosine antagonists, at least at some doses, may be useful for ameliorating the anxiogenic effects produced by ethanol withdrawal, although it does not appear useful for reducing consumption.     

Biomechanical effects of insertion location and bone cement augmentation on the anchoring strength of iliac screw

Background

Iliac screw loosening has been a clinical problem in the lumbo-pelvic reconstruction. Although iliac screws are commonly inserted into either upper or lower iliac column, the biomechanical effects of the two fixations and their revision techniques with bone cement remain undetermined. The purpose of this study was to compare the anchoring strengths of the upper and lower iliac screws with and without cement augmentation.

Methods

5 pairs of formalin fixed cadaveric ilia with the bone mineral density values ranged from 0.82 to 0.97 g/cm² were adopted in this study. Using screws with 70-mm length and 7.5-mm diameter, 2 conventional iliac screw fixations and their revision techniques with cement augmentation were sequentially established and tested on the same ilium as follows: upper screw, upper cement screw, lower screw, and lower cement screw. Following 2000 cyclic compressive loading of − 300 N to −100 N to the screw on a material testing machine, the maximum pull-out strengths were measured and analyzed.

Findings

The average pull-out strengths of upper, upper cement, lower, and lower cement screws were 964 N, 1462 N, 1537 N, and 1964 N, respectively. The lower screw showed significantly higher pull-out strength than the upper one (P = 0.008). The cement augmentation notably increased the pull-out strengths of both upper and lower screws. The positive correlation between pull-out strength and bone mineral density value was obtained for the 4 fixations.

Interpretation

The lower iliac screw technique should be the preferred choice in lumbo-pelvic stabilization surgery; cement augmentation may serve as a useful salvage technique for iliac screw loosening; preoperative evaluation of bone quality is crucial for predicting fixation strength of iliac screw.