The role of the breast cancer surgeon in personalized cancer care: clinical utility of the 21-gene assay

BackgroundBreast cancer surgeons represent the first line of defense for many patients battling this disease. They often have the first contact to discuss treatment options with the patient after diagnosis. However, the potential impact of this consultation has evolved with the arrival of commercialized multigene prognostic and predictive tests that continue to reshape the landscape of breast cancer management, including modern surgical practice.MethodThis review was compiled from peer-reviewed literature indexed in PubMed.ConclusionsThe advent of genomic analysis has advanced the treatment and management of breast cancer toward the goal of personalized care. Therefore, the role of the surgeon now extends beyond extirpation of the tumor and includes an understanding of the biology of the disease as well as an appreciation of this new technology. Breast cancer surgeons should seize this opportunity to provide patients and colleagues with this information in an expeditious manner to optimize clinical outcomes.     

Patient information sources when facing repair of abdominal aortic aneurysm

ObjectiveShared medical decision making is most important when there are competing options for repair such as in treatment of abdominal aortic aneurysm (AAA). We sought to understand the sources of patients' pre-existing knowledge about AAA to better inform treating physicians about patients' needs for preoperative counseling.MethodsWe performed a multicenter survey of patients facing AAA repair at 20 Veterans Affairs hospitals across the United States as part of the Preferences for Open Versus Endovascular Repair of AAA study. A validated survey instrument was administered to examine the sources of information available and commonly used by patients to learn about their repair options. The survey was administered by study personnel before the patient had any interaction with the vascular surgeon because survey data were collected before the vascular clinic visit.ResultsPreliminary analysis of data from 99 patients showed that our cohort was primarily male (99%) and elderly (mean age 73 years). Patients commonly had a history of hypertension (86%), prior myocardial infarction (32%), diabetes (32%), and were overweight (58%). Patients arrived at their surgeon's office appointment with limited information. A majority of patients (52%) reported that they had not talked to their primary care physician at all about their options for AAA repair, and one-half (50%) reported that their view of the different surgical options had not been influenced by anyone. Slightly less than one-half of patients reported that they did not receive any information about open surgical aneurysm repair and endovascular aortic aneurysm repair (41% and 37%, respectively). Few patients indicated using the internet as their main source of information about open surgical aneurysm repair and endovascular aortic aneurysm repair (10% and 11%, respectively).ConclusionsPatients are commonly referred for AAA repair having little to no information regarding AAA pathology or repair options. Fewer than one in five patients searched the internet or had accessed other sources of information on their own. Most vascular surgeons should assume that patients will present to their first vascular surgery appointment with minimal understanding of the treatment options available to them.     

ED plaster-of-Paris jacket for infantile scoliosis

Background

There are various articles published in last few years which consider surgical methods like growing rod instrumentation and modulation of the growth as a “gold standard” for the treatment of early onset severe scoliosis. We emphasize orthopaedic correction with serial casting as another option for such progressive deformity. The key to the success of this treatment is to understand the strategy and the technique involved in the effective casting.

Methods

The conventional technique of elongation, derotation, flexion cast (named EDF by Cotrel) is described with some modifications like wedging the cast (gypsotomy) in order to produce the flexion component.

Results

Serial casting with ED casts for the treatment of progressive idiopathic infantile scoliosis is an effective tool for the benign types of curves (Mehta) and spinal fusion was not necessary in two-third of our cases.

Conclusion

Surgical option for treatment of early onset scoliosis is not a “gold standard”. Orthopaedic treatment with serial elongation, derotation casts remain the centerpiece of this treatment. Each detail to understand the technique must be known in order to obtain the best result.

     

Value of scoliosis care: Nonsurgical treatment versus surgery

Adult scoliosis is a complex issue, providing unique challenges to both the spine surgeon and the patient. Recently, there has been an interest in examining the quality of life of patients undergoing treatment for adult spinal deformity to compare the value of nonoperative versus operative management. This article reviews the current literature on the treatment of adult spinal deformity, in hopes of drawing conclusions for the best approach to these patients. Quality of life outcome measures and cost-effectiveness are reviewed to better understand the benefits, or lack thereof, of management options. It is crucial for spine surgeons to begin to use the same validated measures when studying this cohort of patients in order to compare treatments and draw appropriate conclusions. There is currently no literature reporting the quality-adjusted life years (QALY) or cost–utility of surgical treatment of adult scoliosis. Only one study analyzing the cost of nonoperative treatment for adult scoliosis was identified. Future prospective studies focusing on the cost-effectiveness of adult scoliosis treatment with an emphasis on improving the quality of life of these patients are needed to confirm the current retrospective literature's assertion that surgery provides better quality of life than nonoperative treatment.     

椎弓根螺钉固定在脊柱侧凸治疗中的应用

目的　探讨椎弓根螺钉固定在脊柱侧凸治疗中的应用效果。方法　采用连续或间断椎弓根螺钉固定技术治疗 93例脊柱侧凸患者 ,平均年龄 14 .3岁 ,特发性 5 1例 ,先天性 4 2例 ,术前Cobb角分别为 71.2°和 6 8.3° ,根据畸形程度和脊柱柔韧性 ,采用一次性矫形或分期矫形。结果　特发性侧凸术后Cobb角和矫正率分别为 2 8.7°和 6 1.5 % ,先天性侧凸为 32 .6°和 5 3.8% ,无严重并发症发生。结论　椎弓根螺钉固定对脊柱产生撑开、加压及旋转矫正作用 ,其矫正力大 ;且不占据椎管空间。尽管胸椎椎弓根螺钉固定难度较大 ,风险较高 ,但因其能对脊柱产生撑开、加压及旋转矫正作用 ,矫正力大 ,且不占据椎管空间 ,因此在具备一定技术条件时 ,该方法应被推广应用     

Unstaged versus staged posterior-only thoracolumbar fusions in deformity: a retrospective comparison of perioperative complications

Background contextImprovements in surgical techniques and medical support have made reconstruction of adult scoliosis more feasible. In an attempt to reduce the risk of complications, some surgeons have chosen to stage these procedures.PurposeWe sought to compare a staged group versus an unstaged group of patients undergoing posterior-only instrumentation and fusion from the thoracic spine to the pelvis by a single surgeon for degenerative kyphoscoliosis or residual, progressive adolescent idiopathic scoliosis to assess for a difference in complications.Study design/settingRetrospective chart review.Patient sampleWe included 143 consecutive patients treated between January 1, 2000, and December 31, 2010.Outcome measureThe primary outcome assessed was perioperative complications. Secondary outcomes included intraoperative blood loss, intraoperative transfusions, ICU stay, and disposition.MethodsAfter institutional review board approval, records were analyzed to identify comorbidities and determine whether the management of each patient was planned in an unstaged or staged fashion. “Failures” were identified in which the plan was for an unstaged procedure but were converted to a staged procedure. Complications were defined as unplanned additional procedures or unexpected medical outcomes within 90 days of surgery. We considered p<.005 to be significant.ResultsFifty-two patients underwent planned staged surgery and 90 underwent planned unstaged surgical procedures. Baseline demographics including American Society of Anesthesiologists (ASA) score, body mass index, and preoperative diabetic and cardiac status were not different between the two groups. Age was greater in the staged group (68 vs. 63 y; p=.001). Intraoperative transfusion and invasiveness index as defined by Mirza, were also higher in the staged group (p<.005). No difference was identified between the two intent-to-treat groups for complications including infection rate, death, myocardial infarction, stroke, pulmonary embolism, other pulmonary complication, or blindness. Eleven of the 90 unstaged patients were unable to have their surgical procedure completed at the time of the index procedure. The 11 “failures” demonstrated a higher ASA compared with the 79 successfully treated unstaged procedures (p<.005), although no differences in complications.ConclusionsThere were no differences in complications between the intent-to-treat groups of staged and unstaged procedures, nor was there a difference comparing the “failures” of unstaged care to successful unstaged patients. Although fraught with potential complications, both techniques may be reasonable approaches.     

Vision Loss After Spinal Fusion for Scoliosis in a Child With Spinal Cord Injury

Abstract

Background: Vision loss after spinal surgery is a rare and devastating complication. Risk factors include patient age, operative time, estimated blood loss, and intraoperative fluid management. Children with spinal cord injury often develop scoliosis that requires surgical correction.

Study Design: Case report.

Methods: Clinical and radiographic review was conducted of a 15-year-old boy who developed severe scoliosis after sustaining a C5 level injury at age 4 years from a motor vehicle crash.

Findings: The patient underwent a posterior spinal fusion from T2 to the pelvis, and good correction of the spinal deformity was attained. During the 8-hour procedure, blood loss was 4,000 mL (approximately 1.2 blood volumes) and 17,000 mL of fluids were administered. On postoperative day 5, it was determined that the patient had complete visual loss. Neuro-ophthalmology consultation confirmed the diagnosis of posterior ischemic optic neuropathy.

Conclusions: A significant number of children with spinal cord injury develop scoliosis requiring surgical correction. These procedures are often lengthy, with the potential for extensive blood loss and fluid shifts, factors that may increase the likelihood of postoperative vision loss. Patients should be counseled about this complication, and the surgical and anesthesiology teams should take all measures to minimize its occurrence.     

Randomized trials and registries: a computer simulation to study the impact of surgeon/patient factors on outcomes

Background contextPatient factors (diabetes, osteoporosis, cardiopulmonary problems, previous surgery, smoking, worker's compensation, litigation) and surgeon factors (operative experience, patient selection, technical skill, setting) are known to significantly impact outcomes of spinal surgery. The impact of these factors is difficult to assess clinically given the volume of patients required to obtain statistically significant information, the costs involved, and ethical/equipoise considerations. Computer simulation offers a viable and useful alternative.PurposeTo establish a computer simulation for randomized trials (randomized controlled clinical trials)/registries and to examine the impact of surgeon and patient factors on surgical outcomes.Study designComputer simulation of randomized controlled trials and nonrandomized trials (registries).MethodsOn the basis of an extensive review of the literature regarding surgical outcomes (lumbar disectomy and decompression) and patient/surgeon factors affecting such outcomes, hazard functions were developed to model the distribution of relative outcome as a function of the risk profile of individual patients and surgeons. An iterative algorithm was used to randomly or nonrandomly pair patients and surgeons to create simulated randomized controlled clinical trials/registries encompassing 10,000 performed procedures per run.ResultsWhen fully randomized, outcomes were as expected with 80% of patients obtaining a satisfactory result. When the best surgeons were paired with the best patients, success rates approached 98%; and when the worst surgeons were paired with the worst patients, success rates dropped to 53%. Other nonrandom combinations were also assessed.ConclusionsThe computer simulation obtains expected outcomes for randomized controlled clinical trials and closely mirrors the range of outcomes seen in available case-series/registry data—a very useful model allowing assessment of the impact of patient/surgeon factors on surgical outcomes. Multiple patient/surgeon combinations are assessed and the implications of findings discussed.     

Novel technique to accurately measure femoral diameter using a Thomas splint

IntroductionDuring surgical management of femoral shaft fractures, difficulties arise when treating patients with narrow femoral diaphyseal canals, such as young patients and those with dysplastic femurs secondary to underlying pathology. Accurate pre-operative assessment of the femoral diaphyseal canal diameter would allow the surgeon to plan surgical technique and ensure appropriate equipment was available, such as narrow, unreamed or paediatric sized nails.TechniqueWhen secured to the patient both longitudinal rods of the main Thomas Splint component lie parallel with the femoral shaft and horizontal to the radiographic x-ray plate. The diameter of these rods are 13 mm (Adult and paediatric). Using the calibration tool, we calibrate the diameter of the Thomas Splint to 13 mm, accurately measuring any further detail on that radiograph, such as the diaphyseal canal diameter.ConclusionAccurate knowledge pre-operatively of radiographic measurements is highly valuable to the operating surgeon. This technique can accurately measure femoral canal diameter using the Thomas splint, negates the requirement for a calibration marker, is reproducible, easy to perform, and is indispensible when faced with a patient with a narrow femoral canal in a diaphyseal femoral fracture. (181 words)     

Radical vaginal hysterectomy: classic and modified

RVH offers significant advantages to the corresponding abdominal procedure, including: the possibility for regional anesthesia, particularly in patients with poor medical conditions; reduced surgical trauma because of the absence of an abdominal incision; applicability in obese patients; shorter surgical time when performed by an experienced surgeon; decreased need for blood transfusions; lower risk for complications; faster postoperative recovery period; shorter hospitalization. The primary drawback to the use of RVH for early stage cervical cancer has always been the lack of lymph node dissection. This has now been modified by the widespread use of laparoscopic lymphadenectomy. The increasing reliability of noninvasive radiologic techniques has provided and will continue to provide greater possibilities for preoperative staging to best determine the needs of the patient. The authors believe that an oncologic surgeon familiar with advanced laparoscopic techniques and RVH is able to take advantage of the benefits of both routes. Furthermore, a surgeon skilled in these techniques and RAH has the tools to ideally care for the specific needs, of each patient. The authors encourage individualization of surgical management, with special emphasis on the revision of the role of RVH in gynecologic oncology.     

Papel da hemodiluição aguda na taxa de transfusão sanguínea em pacientes submetidos a tratamento cirúrgico de escoliose: estudo observacional retrospectivo

Background and objectivesThe study assessed the role of acute hemodilution in the blood transfusion rate in patients submitted to surgical treatment of scoliosis.MethodsRetrospective observational study performed at Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo (HC‐FMRP?USP). Medical charts of patients submitted to elective correction of scoliosis between January 1996 and December 2016 were analyzed. Variables assessed were: age, weight, sex, presence of comorbidities, data regarding anesthesia and surgery, lab data, adverse events and blood transfusion rate. The final sample consisted of 33 procedures performed by the same anesthesiologist and same surgeon, divided into two groups: Hemodilution Group (n = 16) and Control Group (n = 17). Indication of acute normovolemic hemodilution was determined by patient refusal of blood transfusion for religious reasons.ResultsThe sample was statistically homogeneous and the groups were compared in terms of the attributes analyzed. The volume of homologous blood used by the Hemodilution Group was significantly lower than the Control Group (p = 0.0016). The percentage of patients who required transfusion was 12.5% in the Hemodilution Group, while it was 70.69% (p = 0.0013) in the Control Group. Upon hospital discharge, mean values of hemoglobin and hematocrit between groups did not present significant differences (p = 0.0679; p = 0.1027, respectively).ConclusionsAcute normovolemic hemodilution, in scoliosis correction surgeries reduces blood transfusion rates, meeting patient needs without increasing adverse events or infection rates.     

Exploring breast surgeons’ reasons for women not undergoing immediate breast reconstruction

IntroductionFactors influencing breast reconstruction rates in Canada are complex and multi-factorial, ranging from patient-related to systemic considerations. For plastic surgeons, rates of immediate breast reconstruction (IBR) hinge on referral patterns from general surgeons performing breast cancer surgery and informed discussions with patients about their goals and risk tolerance. We seek to understand the reasons Alberta patients are not receiving IBR as reported by general surgeons.MethodsThe Synoptec™ database is a synoptic operative report designed by Cancer Surgery Alberta™ and utilized by 95% of Alberta breast cancer surgeons. Within this report are mandatory questions regarding if a patient is receiving IBR and, if not, why. A retrospective review of this database was performed for all patients undergoing surgical treatment of breast cancer over two years. All statistical comparisons were made using chi-squared test for categorical variables with a p-value of 0.05 considered significant.ResultsOf 6253 patients undergoing breast cancer surgery, 2649 underwent mastectomy and 615 mastectomy patients received IBR. The most commonly reported reasons patients did not undergo IBR were patient preference (55%), high likelihood of postoperative radiation therapy (20%), and high risk due to patient co-morbidities (12%). Resource limitations (2%) and a lack of an IBR discussion (3%) was rarely cited as reasons for no IBR.ConclusionsThere are many reconstructive options following mastectomy in breast cancer survivors. This study provides a unique look into general surgeon reported reasons patients are not receiving IBR and demonstrates the need for further probing into the thought-process behind these reported reasons from both a surgeon and patient perspective.     

Colorectal Emergencies: Review and Controversies in the Management of Large Bowel Obstruction

Introduction

Traditionally, large bowel obstruction (LBO) has been managed as an operative emergency. Its causes and treatments are an important part of general surgical and colon and rectal surgery practices.

Discussion

While management has traditionally been emergent laparotomy with resection or removal of underlying pathology, newer methodologies and treatments over the last decade have required treating physicians to consider a number of other options, including nonoperative options such as stenting, when treating these patients.

Conclusion

Given these changes, treating a patient with LBO requires a thoughtful assessment and comprehensive understanding of underlying pathology, assessment of the patient's comorbidities and up-to-date knowledge of modern options for treatment.     

Preferences for bariatric surgery: comparing surgeons and patients using a discrete choice experiment

BackgroundIncreased attention to shared decision-making is particularly important in bariatric surgery. It is unclear whether the large shift toward sleeve gastrectomy is evidence of good alignment between patient and surgeon preferences.ObjectiveTo identify surgeon preferences for risks, benefits, and other attributes of treatment options available for bariatric surgery and to compare results with patient preferences.SettingOnline survey.MethodsA discrete choice experiment of weight loss procedures. Each procedure was described by the following set of attributes: (1) treatment method, (2) recovery and reversibility, (3) years treatment has been available, (4) expected weight loss, (5) effect on other medical conditions, (6) risk of complication, (7) side effects, (8) changes to diet, (9) out-of-pocket costs. Participants chose between surgical profiles by comparing attributes. A convenience sample of providers for the online survey was recruited via LISTSERVs of professional associations.ResultsRespondents (n = 121) were most likely to select profiles of hypothetical procedures based on the resolution of existing medical conditions and higher expected weight loss. These results align with patient preferences. However, surgeons selected profiles based on lower risk of complications than did patients and surgeons were less sensitive to out-of-pocket costs than patients.ConclusionsResults show strong alignment between the preferences of patients and the preferences of surgeons when they are asked to stand in the place of their patients. Some differences, especially those related to sensitivity to risk of complications and out-of-pocket costs indicate that shared decision-making would benefit from providers explaining their concerns about surgical risk and from appreciating the concern many patients have about financial costs.     

A retrospective analysis of the definitive management of open talus fractures at a major trauma centre,comparing ORIF to FUSION: cohort study and audit of BOAST 4 guidelines

Purpose

Open talus fractures are notoriously difficult to manage, and they are commonly associated with a high level of complications including non-union, avascular necrosis and infection. Currently, the management of such injuries is based upon BOAST 4 guidelines although there is no suggested definitive management, and thus, definitive management is based upon surgeon preference. The key principles of open talus fracture management which do not vary between surgeons are early debridement, orthoplastic wound care, anatomic reduction and definitive fixation whenever possible. However, there is much debate over whether the talus should be preserved or removed after open talus fracture/dislocation and proceeded to tibiocalcaneal fusion.

Methods

A review of electronic hospital records for open talus fractures from 2014 to 2021 returned fourteen patients with fifteen open talus fractures. Seven cases were initially managed with ORIF, and five cases were definitively managed with FUSION, while the others were managed with alternative methods. We collected patient’s age, gender, surgical complications, surgical risk factors and post-treatment functional ability and pain and compliance with BOAST guidelines. The average follow-up of the cohort was 4 years and one month. EQ-5D-5L and FAAM-ADL/Sports score was used as a patient reported outcome measure. Data were analysed using the software PRISM.

Results

Comparison between FUSION and ORIF groups showed no statistically significant difference in EQ-5D-5L score (P = 0.13), FAAM-ADL (P = 0.20), FAAM-Sport (P = 0.34), infection rate (P = 0.55), surgical times (P = 0.91) and time to weight bearing (P = 0.39), despite a higher proportion of polytrauma and Hawkins III and IV fractures in the FUSION group.

Conclusion

FUSION is typically used as second line to ORIF or failed ORIF. However, there is a lack of studies that directly compared outcome in open talus fracture patients definitively managed with FUSION or ORIF. Our results demonstrate for the first time that FUSION may not be inferior to ORIF in terms of patient functional outcome, infection rate and quality of life, in the management of patients with open talus fracture patients. Of note, as open talus fractures have increased risks of complications such as osteonecrosis and non-union, FUSION should be considered as a viable option to mitigate these potential complications in these patients.

     

High pulmonary risk scoliosis surgery: role of noninvasive ventilation and related techniques

OBJECTIVE: There is little awareness among surgeons of the potential for noninvasive mechanical ventilation as an alternative to prolonged endotracheal intubation or tracheostomy for patients with neuromuscular scoliosis and ventilatory failure. These methods have not been reported for the perioperative management of scoliosis correction in patients with an inability to sustain their alveolar ventilation. METHODS: Five children with flaccid scoliosis secondary to muscular dystrophy or spinal muscular atrophy who had very high pulmonary risk were preoperatively trained in the use of noninvasive intermittent positive-pressure ventilation (IPPV) and mechanically assisted coughing prior to spinal fusion. RESULTS: All patients were extubated by the third postoperative day to noninvasive IPPV despite continuous ventilator dependence. No patient developed any postoperative pulmonary complications or required a tracheotomy. CONCLUSIONS: It is critical for the orthopedic surgeon to be aware of these noninvasive options to tracheotomy to decrease the tendency to avoid surgery for these otherwise high-risk surgical patients.     

Hanging up the surgical cap: Assessing the competence of aging surgeons

BACKGROUNDAs the average age of surgeons continues to rise, determining when a surgeon should retire is an important public safety concern.AIMTo investigate strategies used to determine competency in the industrial workplace that could be transferrable in the assessment of aging surgeons and to identify existing competency assessments of practicing surgeons.METHODSWe searched websites describing non-medical professions within the United States where cognitive and physical competency are necessary for public safety. The mandatory age and certification process, including cognitive and physical requirements, were reported for each profession. Methods for determining surgical competency currently in use, and those existing in the literature, were also identified.RESULTSFour non-medical professions requiring mental and physical aptitude that involve public safety and have mandatory testing and/or retirement were identified: Airline pilots, air traffic controllers, firefighters, and United States State Judges. Nine late career practitioner policies designed to evaluate the ageing physician, including surgeons, were described. Six of these policies included subjective performance testing, 4 using peer assessment and 2 using dexterity testing. Six objective testing methods for evaluation of surgeon technical skill were identified in the literature. All were validated for surgical trainees. Only Objective Structured Assessment of Technical Skills (OSATS) was capable of distinguishing between surgeons of different skill level and showing a relationship between skill level and post-operative outcomes.CONCLUSIONA surgeon should not be forced to hang up his/her surgical cap at a predetermined age, but should be able to practice for as long as his/her surgical skills are objectively maintained at the appropriate level of competency. The strategy of using skill-based simulations in evaluating non-medical professionals can be similarly used as part of the assessment of the ageing surgeons’ surgical competency, showing who may require remediation or retirement.     

Sacral and pelvic osteotomies for correction of spinal deformities

Aim

Rett syndrome is a progressive neurodevelopmental disorder that predominantly affects females and is associated with a high incidence of scoliosis and epilepsy. There is scant published work about intraoperative spinal cord monitoring in these patients and little more regarding the rate of perioperative complications. We investigated our institutions’ experience with both.

Methods

We retrospectively reviewed the records of 11 patients with Rett syndrome who underwent surgical correction of scoliosis at our institution between 2004 and 2010.

Results

Eleven patients underwent successful correction of their scoliosis at an average age of 12. Eight of the patients suffered one or more significant complications. The average curve was corrected from 71° to 27°. Successful spinal cord monitoring was achieved in eight of the nine patients where it was attempted. No patient suffered any neurological complications. Average inpatient stay was 18.2 days.

Conclusion

Scoliosis surgery in patients with Rett syndrome carries a very high rate of complications and an average hospital stay approaching 3 weeks. Both caregivers and surgeons should be aware of this when planning any intervention. These patients frequently have useful lower limb function and spinal cord monitoring is a valid tool to aid in its preservation. We would suggest aggressive optimisation of these patients prior to surgery, with an emphasis on nutrition.

     

退变性腰椎侧凸的手术治疗及疗效

目的探讨退变性腰椎侧凸的后路手术方法和手术疗效。方法回顾性分析2007~2012年本院手术治疗并获得随访的32例退变性腰椎侧凸患者的手术方法及疗效。患者均接受腰椎后路减压椎间融合器植骨融合内固定术,术后随访6个月~6年。采用下腰痛Oswestry功能障碍指数(Oswestry disability index,ODI)对患者手术前后的临床症状进行评分和疗效评价;通过手术前后冠状位和矢状位Cobb角度的比较,了解患者手术治疗的侧凸矫正率和腰椎前凸的恢复情况。结果患者ODI术前(52.30±13.65)%、术后(9.62±6.41)%,术前术后比较差异有统计学意义(P0.05),术后疼痛改善率为81.6%。32例患者中,24例疗效为优,6例疗效为良,2例疗效为可,术后疗效评价的优良率为93.8%。患者冠状位Cobb角术前21.99°±8.97°、术后6.84°±5.32°,术前术后比较差异有统计学意义(P0.05),侧凸矫正率为69.0%。患者腰椎前凸Cobb角术前13.80°±15.99°、术后24.95°±12.86°,术前术后比较差异有统计学意义(P0.05)。结论退变性腰椎侧凸采用腰椎后路减压椎间融合器植骨融合椎弓根螺钉内固定术治疗效果较理想,术后疗效满意。手术的关键是彻底减压、正确选择融合节段、重建退变节段椎间高度、矫正前凸减少和后凸畸形、纠正椎体侧方移位和侧凸畸形以稳定椎体。     

Olecranon fractures

Several options exist for the management olecranon fractures. These include tension band, plate and intramedullary fixation techniques as well as fragment excision with triceps advancement and non-operative management. No one technique is suitable for the management of all olecranon fractures. In deciding how to treat this common trauma presentation, the surgeon needs a good understanding of the anatomy, different fracture morphologies, surgical options and potential complications. With appropriate management and early mobilisation good functional results can be expected in the majority of patients.