颈椎前路术后吞咽困难的相关因素分析

目的:探讨颈椎前路手术后发生吞咽困难的相关因素。方法:随访2008年8月～2010年7月收治的颈椎前路手术患者135例,其中男82例,女53例;年龄32～80岁,平均58.2岁;诊断为脊髓型颈椎病58例,神经根型颈椎病32例,混合型颈椎病18例,后纵韧带骨化症27例。入院后均由同一组医师治疗,手术方式分为颈椎前路减压融合术(ACDF)、颈椎前路次全切减压融合术(ACCF)和人工颈椎间盘置换术(TDR)。观察患者手术后是否存在吞咽困难:对于存在吞咽困难的患者均静脉应用甲泼尼松龙及对症治疗。结果:术后共有36例(26.7%)患者出现吞咽困难,男11例,女25例,年龄42～80岁,平均59.6岁;其余99例,年龄32~76岁,平均52.3岁,发生吞咽困难者平均年龄显著高于未发生者(P<0.05)。发生吞咽困难患者中使用钛板内固定35例,其中单节段2例(9.1%),双节段13例(21.0%),多节段(包括三节段及三节段以上者)20例(52.6%);颈椎人工椎间盘置换者1例;术后吞咽困难发生率使用内固定者较人工椎间盘置换者高(P<0.05),多节段内固定者较单、双节段者明显升高(P<0.05)。手术最高节段累及C2或C3者23例,术后吞咽困难发生率26.1%;累及C4或C5者88例,发生率28.4%;累及C6或C7者24例,发生率20.1%,三组两两比较无统计学差异(P>0.05)。吞咽困难者的手术时间、失血量及住院天数与未发生吞咽困难者比较均无统计学差异(P>0.05)。35例(97.2%)患者的吞咽困难症状在术后6个月内减轻或消失,1例至随访1年时症状才消失。结论:女性、高龄、使用钛板内置物、手术节段多可能是颈椎前路手术后发生吞咽困难的相关因素,临床医生应给予相应重视和采取相应措施以减少其发生。     

Pharyngocutaneous fistula after anterior cervical spine surgery

Pharyngocutaneous fistulae are rare complications of anterior spine surgery occurring in less than 0.1% of all anterior surgery cases. We report a case of a 19 year old female who sustained a C6 burst fracture with complete quadriplegia. She was treated urgently with a C6 corpectomy with anterior cage and plating followed by posterior cervical stabilization at another institution. Post operatively she developed a pharyngocutaneous fistula that failed to heal despite several attempts of closure and esophageal exclusion with a Jpeg tube. The patient was eventually successfully treated with a three-stage procedure consisting of firstly a posterior approach to reinforce the posterior stabilization of the cervical spine that was felt to be inadequate, secondly an anterior approach with removal of all the anterior instrumentation followed by iliac crest bone graft and thirdly a superior based sternocleidomastoid flap that was interposed between the esophagus and the anterior cervical spine. The patient's fistula healed successfully. However, yet asymptomatic, the anterior iliac crest bone graft resorbed almost completely at 16 months follow up. In light of this complication, we discuss the surgical options for the treatment of pharyngocutaneous fistulae and the closure of this fistula using a superiorly based sternocleidomastoid muscle flap.     

Liver disease is an independent predictor of poor 30-day outcomes following surgery for degenerative disease of the cervical spine

BACKGROUND AND CONTEXT

The impact of underlying liver disease on surgical outcomes has been recognized in a wide variety of surgical disciplines. However, less empiric data are available about the importance of liver disease in spinal surgery.

颈椎病前路择期手术早期并发症危险因素分析

目的: 分析与颈椎病前路择期手术后的早期并发症发生率有关的危险因素。方法: 研究本院 1997年~2003年的 250例颈椎病前路择期 [1]手术病人的出院病历, 确定术后早期并发症; 用logistic回归分析评价早期并发症的危险因素。结果: 在所有病人中 24%的病人有一种或多种并发症,其中 17. 6%为非感染性手术并发症, 4. 0%为感染性并发症, 6. 8%为其它医疗并发症, 1. 2%在住院期间接受无计划的二次手术, 1例病人院内死亡。危险因素包括: 女性、高龄、全费、手术持续时间过长和既往有颈椎手术史者。结论: 对于高龄、女性、全费、手术持续时间过长和有既往颈椎手术史的患者, 应该充分做好术前准备, 手术应尽量采用简单实用手术时间少的术式, 以降低术后早期并发症发生率。     

Evolution of patient-reported outcome measures, 1, 2, and 5 years after surgery for subaxial cervical spine fractures,a nation-wide registry study

BACKGROUND CONTEXTA longer duration of patient follow up arguably provides more reliable data on the long-term effects of a treatment. However, the collection of long-term follow up data is resource demanding and often complicated by missing data and patients being lost to follow up. In surgical fixation for cervical spine fractures, data are lacking on the evolution of patient reported outcome measures (PROMs) beyond 1-year of follow up. We hypothesized that the PROMs would remain stable beyond the 1-year postoperative follow up mark, regardless of the surgical approach.PURPOSETo assess the trends in the evolution of patient-reported outcome measures (PROMs) at 1, 2-, and 5-years following surgery in patients with traumatic cervical spine injuries.STUDY DESIGNNation-wide observational study on prospectively collected data.PATIENT SAMPLEIndividuals treated for subaxial cervical spine fractures with anterior, posterior, or combined anteroposterior approaches, between 2006 and 2016 were identified in the Swedish Spine Registry (Swespine).OUTCOME MEASURESPROMs consisting of EQ-5D-3L_index and the Neck Disability Index (NDI) were considered.METHODSPROMs data were available for 292 patients at 1 and 2 years postoperatively. Five-years PROMs data were available for 142 of these patients. A simultaneous within-group (longitudinal) and between group (approach-dependent) analysis was performed using mixed ANOVA. The predictive ability of 1-year PROMs was subsequently assessed using linear regression.RESULTSMixed ANOVA revealed that PROMs remained stable from 1- to 2-years as well as from 2- to 5-years postoperatively and were not significantly affected by the surgical approach (p<0.05). A strong correlation was found between 1-year and both 2- and 5-years PROMs (R>0.7; p<0.001). Linear regression confirmed the accuracy of 1-year PROMs in predicting both 2- and 5-years PROMs (p<0.001).CONCLUSIONPROMs remained stable beyond 1-year of follow up in patients treated with anterior, posterior, or combined anteroposterior surgeries for subaxial cervical spine fractures. The 1-year PROMs were strong predictors of PROMs measured at 2, and 5 years. The 1-year PROMs were sufficient to assess the outcomes of subaxial cervical fixation irrespective of the surgical approach.     

The Rothman Index as a predictor of postdischarge adverse events after elective spine surgery

Background Context

The Rothman Index (RI) is a comprehensive rating of overall patient condition in the hospital setting. It is used at many medical centers and calculated based on vital signs, laboratory values, and nursing assessments in the electronic medical record. Previous research has demonstrated an association with adverse events, readmission, and mortality in other fields, but it has not been investigated in spine surgery.

Reciprocal changes in cervical spine alignment after corrective thoracolumbar deformity surgery

Purpose

To identify changes in cervical alignment parameters following surgical correction of thoracolumbar deformity and then assess the preoperative parameters which induce changes in cervical alignment following corrective thoracolumbar deformity surgery.

Methods

A retrospective study of 49 patients treated for thoracolumbar deformity with preoperative planning of an acceptably aligned coronal and sagittal plane in each case. We compared cervical spine parameters in two distinct low [preoperative C7 sagittal vertical axis (SVA) ≤6 cm] and high (preoperative C7 SVA ≥9 cm) C7 SVA groups. Multilinear regression analysis was performed and revealed the relationship between postoperative cervical lordosis and preoperative spinopelvic parameters and surgical plans.

Results

In the lower C7 SVA group, cervical lordosis was significantly increased after thoracic/lumbar deformity correction (p < 0.01). In contrast, the high C7 SVA group showed decreased cervical lordosis postoperatively (p < 0.01). Multilinear regression analysis demonstrated the preoperative parameters (preoperative C2–7 angle, T1 slope, surgical plan for PT and C7 SVA), which determine the postoperative cervical lordosis.

Conclusion

In spinal deformity procedures, preoperative spinal alignment parameters, and surgical plans could affect postoperative cervical spine alignment.     

脊椎退行性疾病患者生命质量量表的编制

目的编制适用于我国脊椎退行性疾病患者的生命质量量表（QLS-DSD）。方法采用议题小组和核心小组的程序化决策方式并借鉴国内外建立量表的经验制定量表,对296例脊椎退行性疾病患者进行调查,采用离散趋势法、相关系数法、反应度分析、逐步回归法和因子分析法等统计学方法对结果进行分析。结果采用上述5种方法删除3个条目,最终得到23个条目。结论 QLS-DSD准确反映脊椎退行性疾病患者的生命质量。     

Mid-term clinical results of minimally invasive decompression and posterolateral fusion with percutaneous pedicle screws versus conventional approach for degenerative spondylolisthesis with spinal stenosis

Introduction

In order to minimize perioperative invasiveness and improve the patients’ functional capacity of daily living, we have performed minimally invasive lumbar decompression and posterolateral fusion (MIS-PLF) with percutaneous pedicle screw fixation for degenerative spondylolisthesis with spinal stenosis. Although several minimally invasive fusion procedures have been reported, no study has yet demonstrated the efficacy of MIS-PLF in degenerative spondylolisthesis of the lumbar spine. This study prospectively compared the mid-term clinical outcome of MIS-PLF with those of conventional PLF (open-PLF) focusing on perioperative invasiveness and patients’ functional capacity of daily living.

Materials and methods

A total of 80 patients received single-level PLF for lumbar degenerative spondylolisthesis with spinal stenosis. There were 43 cases of MIS-PLF and 37 cases of open-PLF. The surgical technique of MIS-PLF included making a main incision (4 cm), and neural decompression followed by percutaneous pedicle screwing and rod insertion. The posterolateral gutter including the medial transverse process was decorticated and iliac bone graft was performed. The parameters analyzed up to a 2-year period included the operation time, intra and postoperative blood loss, Oswestry-Disability Index (ODI), Roland-Morris Questionnaire (RMQ), the Japanese Orthopaedic Association score, and the visual analogue scale of low back pain. The fusion rate and complications were also reviewed.

Results

The average operation time was statistically equivalent between the two groups. The intraoperative blood loss was significantly less in the MIS-PLF group (181 ml) when compared to the open-PLF group (453 ml). The postoperative bleeding on day 1 was also less in the MIS-PLF group (210 ml) when compared to the open-PLF group (406 ml). The ODI and RMQ scores rapidly decreased during the initial postoperative 2 weeks in the MIS-PLF group, and consistently maintained lower values than those in the open-PLF group at 3, 6, 12, and 24 months postoperatively. The fusion rate was statistically equivalent between the two groups (98 vs. 100%), and no major complications occurred.

Conclusion

The MIS-PLF utilizing a percutaneous pedicle screw system is less invasive compared to conventional open-PLF. The reduction in postoperative pain led to an increase in activity of daily living (ADL), demonstrating rapid improvement of several functional parameters. This superiority in the MIS-PLF group was maintained until 2 years postoperatively, suggesting that less invasive PLF offers better mid-term results in terms of reducing low back pain and improving patients’ functional capacity of daily living. The MIS-PLF utilizing percutaneous pedicle screw fixation serves as an alternative technique, eliminating the need for conventional open approach.     

Dialysis is an independent risk factor for perioperative adverse events,readmission, reoperation,and mortality for patients undergoing elective spine surgery

Background Context

The prevalence of dialysis-dependent patients in the United States is growing. Prior studies evaluating the risk of perioperative adverse events for dialysis-dependent patients are either institutional cohort studies limited by patient numbers or administrative database studies limited to inpatient data.

颈椎前路手术对脊髓型颈椎病患者椎间盘组织中炎性细胞因子的影响

目的 探讨颈椎前路手术对脊髓型颈椎病(CSM)患者椎间盘组织中炎性细胞因子的影响.方法 35例脊髓型颈椎病患者(CSM组)和30例颈椎外伤患者(对照组)均行颈椎前路手术治疗,观察治疗效果.采用固相分离放射免疫分析法(SPRIA)测定两组颈椎间盘组织中白细胞介素(IL)-6、IL-8、肿瘤坏死因子(TNF)－α水平.结果病程≤6个月组优良率为81.8％,病程＞6个月组优良率为38.5％,两组优良率比较差异有统计学意义(P＜0.05);CSM患者术前JOA评分为(9.73±2.12)分,术后JOA评分为(14.21±2.52)分,术后JOA评分显著高于术前(P＜0.05);CSM组颈椎间盘中IL-6、IL-8、TNF-α水平均显著高于对照组(P＜0.05).结论 颈椎前路手术是治疗CSM的一种较有效手术方法;IL-6、IL-8、TNF-α在颈椎间盘退变和CSM发病中起重要作用.     

Effect of patients' functional status on satisfaction with outcomes 12 months after elective spine surgery for lumbar degenerative disease

Background

Comprehensive assessment of quality of care includes patient-reported outcomes, safety of care delivered, and patient satisfaction. The impact of the patient-reported Oswestry Disability Index (ODI) scores at baseline and 12 months on satisfaction with outcomes following spine surgery is not well documented.

胸外科手术患者出院后90 d内非计划再次入院分析

目的总结分析北京协和医院胸外科手术患者再次入院的发生率、发生时间、主要原因以及再次入院需要承担的经济负担,以期为减少术后患者再次入院提供借鉴。 方法回顾性收集北京协和医院2011至2020年胸外科出院后90 d内非计划再入院患者的临床病历资料。根据手术部位、手术入路和再入院间隔时间进行亚组分析,并对组间差异进行比较。 结果共纳入111名患者。所有患者的90 d和30 d非计划再入院率分别为0.71%和0.55%。非计划再入院的最常见原因是大量胸腔积液（36.9%）、感染（31.5%）、漏气（19.8%）。该研究的总体再入院时间为14（19.3±19.4）d。非计划再入院患者的平均二次住院时间为13.1（12.0）d。住院费用为（19 533.6±18 918.7）元,总体的有创操作率为79.3%。 结论胸外科手术患者的非计划再入院是一个小概率事件。接受食管手术和非微创手术是非计划再入院的危险因素。大量胸腔积液、感染和漏气是所有患者非计划再入院的最常见原因。出院后的第2～3周是再入院风险最高的时间段。计划外的再入院会给患者带来额外的有创伤害、时间成本和经济负担。     

The influence of hand grip strength on surgical outcomes after surgery for degenerative lumbar spinal stenosis: a preliminary result

Background Context

Although a number of prognostic factors have been demonstrated to be associated with surgical outcome of degenerative lumbar spinal stenosis (DLSS), no study has investigated the relation between hand grip strength (HGS) and treatment outcome of DLSS.

Mini-open anterior spine surgery for anterior lumbar diseases

Minimally invasive surgeries including endoscopic surgery and mini-open surgery are current trend of spine surgery, and its main advantages are shorter recovery time and cosmetic benefits, etc. However, mini-open surgery is easier and less technique demanding than endoscopic surgery. Besides, anterior spinal fusion is better than posterior spinal fusion while considering the physiological loading, back muscle function, etc. Therefore, we aimed to introduce the modified “mini-open anterior spine surgery” (MOASS) and to evaluate the feasibility, effectiveness and safety in the treatment of various anterior lumbar diseases with this technique. A total of 61 consecutive patients (46 female, 15 male; mean age 58.2 years) from 1997 to 2004 were included in this study, with an average follow-up of 24–52 (mean 43) months. The disease entities included vertebral fracture (20), failed back surgery (13), segmental instability or spondylolisthesis (10), infection (8), herniated disc (5), undetermined lesion for biopsy (4), and hemivertebra (1). Lesions involved 13 cases at T12–L1, 18 at L1–L2, 18 at L2–L3, 22 at L3–L4 and 11 at L4–L5 levels. All patients received a single stage anterior-only procedure for their anterior lumbar disease. We used the subjective clinical results, Oswestry disability index, fusion rate, and complications to evaluate our clinical outcome. Most patients (91.8%) were subjectively satisfied with the surgery and had good-to-excellent outcomes. Mean operation time was 85 (62–124) minutes, and mean blood loss was 136 (minimal-250) ml in the past 6 years. Hospital stay ranged from 4–26 (mean 10.6) days. Nearly all cases had improved back pain (87%), physical function (90%) and life quality (85%). Most cases (95%) achieved solid or probable solid bony fusion. There were no major complications. Therefore, MOASS is feasible, effective and safe for patients with various anterior lumbar diseases.     

Fitness for work after surgery for lumbar disc herniation: a retrospective study

This report retrospectively evaluates fitness for work in 3956 cases of surgery for lumbar disc herniation between 1992 and 1994. Patient records were derived from a database including all interventions of the insured population of the largest Belgian sickness fund. The datafile consisted of 126 cases of percutaneous nucleotomy (nucleotomy group), 286 cases of lumbar disc surgery with fusion (fusion group) and 3544 cases of standard lumbar disc surgery (standard group). Fitness to resume work within 12 months after intervention was obtained in about 70% of the patients in the standard and nucleotomy groups but in only 45% of the patients in the fusion group. Ten medicosocial factors were related to fitness for work as outcome measure. Incapacity for work more than 12 months after intervention was defined as a bad outcome. Logistic regression was used to test the combined relative significance of the different variables. For the standard group a long duration of work incapacity before intervention, older age, lower benefit, employment as a blue-collar worker, a long duration of hospital stay and unemployment were significantly associated with a poor outcome. Related factors for the fusion group were a long duration of work incapacity before operation, a long duration of hospital stay and unemployment. For the nucleotomy group, no factor was significantly associated with a poor outcome. For the total group, discectomy combined with fusion was significantly related to a poor outcome whereas a standard discectomy and a percutaneous nucleotomy did not differ in their impact on fitness for work. Received: 12 February 1997 Revised: 26 July 1997 Accepted: 23 August 1997     

后路自体横突间植骨融合椎弓根内固定治疗退变性腰椎疾病

目的 总结后路自体横突间植骨融合椎弓根内固定治疗老年下腰椎退变性疾病的疗效.方法 对36例(52个腰椎节段)老年下腰椎退变性疾病患者行后路自体横突间植骨融合椎弓根内固定术,同时随访观察初期的临床疗效和融合率.结果 36例获随访,时间6～28个月,疗效评定按日本骨科学会(JOA)下腰痛15评分法评分,术前平均3.8分,术后平均13.7分,术后平均改善率88.9%,优良率91.8%,骨融合率97%.结论 后路自体横突间植骨融合椎弓根内固定治疗老年下腰椎退变性疾病融合率高,临床疗效满意,特别适宜在基层医院开展.     

颈椎前路术后吞咽困难危险因素的Meta分析

【摘要】 目的：系统评价颈椎前路术后发生吞咽困难的危险因素,明确独立危险因素,为颈椎前路手术围术期并发症的防治提供指导。方法：检索万方数据库（WanFang）、中国生物医学文献数据库（CBM）、中国知网（CNKI）、维普（VIP）、PubMed、Embase、 Cochrane Library、Web of Science共8个数据库,检索时限从建库至2023年7月15日,搜索关于颈椎前路术后吞咽困难的危险因素的病例对照研究和队列研究,采用纽卡斯尔-渥太华质量评定量表（Newcastle-Ottawa Scale,NOS）对纳入研究进行质量评价和数据提取（包括第一作者、发表年份、研究类型、样本量、评估方式、评估时间及危险因素）,通过Stata12软件进行Meta分析。结果：共纳入29篇文献,其中队列研究4篇,病例对照研究25篇,所有文献均为高质量研究,包括颈椎前路术后吞咽困难患者89571 例,对照组3092967例。年龄[优势比（odds ratio,OR）=1.093,95%置信区间（confidential interval,CI）：1.067~1.120]、女性（OR=2.419,95%CI：1.654~3.539）、糖尿病（OR=2.733,95%CI：2.240~3.333）、病程（OR=4.259,95%CI：2.458~7.381）、手术节段数量（OR=1.791,95%CI：1.718~1.868）、手术节段位置（OR=2.332,95%CI：1.812~3.003）、手术时间（OR=1.434,95%CI：1.110~1.852）、钢板内置物（OR=2.188,95%CI：1.413~3.175）及翻修手术（OR=2.687,95%CI：2.316-3.119）与颈椎前路术后发生吞咽困难相关,而吸烟（OR=1.323,95%CI：0.852~2.056）、高血压（OR=1.006,95%CI：0.591~1.713）、体重指数（body mass index,BMI）（OR=1.037,95%CI：0.929~1.159）、颈椎间盘置换（OR=0.577,95%CI：0.085~3.943）、C2-7角度变化（difference between postoperative and preoperative C2-C7 angle,dC2-7）＞5°（OR=1.716,95%CI：0.925~3.183）等因素与其不相关。结论：女性、高龄、术前病程长、合并糖尿病、双节段或多节段手术、高位颈椎手术、手术时间长、使用钢板及翻修手术的患者颈椎前路术后更易发生吞咽困难。     

加速康复外科在腰椎融合手术中的应用研究

目的 研究加速康复外科(enhanced recovery after surgery,ERAS)在脊柱外科腰椎融合手术中的应用效果.方法 对2015年1~8月于我科行腰椎融合手术且融合节段≤3个的236例病人进行前瞻性研究,根据病人意愿分为对照组(117例)及加速康复组(ERAS组,119例),分别对两组病人围手术期采取常规干预和ERAS干预.对比分析两组病人手术前后不同时间点的疼痛视觉模拟量表(visual ana-logue scale,VAS)评分、Oswestry功能障碍指数(Oswestry disfunction index,ODI)评分,以及阿片类药物使用情况、术后并发症、术后住院时间、术后1个月内再次住院率、病人治疗满意度等情况.结果 ERAS组在术后3 d内、出院时及术后1个月VAS评分均优于对照组(P<0.05),术后恶心呕吐的发生率显著小于对照组(P<0.05),阿片类药物在术后第1天和第2天使用量小于对照组(P<0.05),术后平均住院时间(4.9 d)与对照组(6.2 d)比较,差异有统计学意义(P<0.05).两组病例在术后1个月内再次住院率比较,差异无统计学意义(P=0.339).病人平均随访时间为(13.4±0.9)个月.两组末次随访的VAS评分(P=0.368)和ODI评分(P=0.251)比较,差异均无统计学意义.结论 实施ERAS可以在不影响腰椎融合手术病人再次住院率的情况下,缩短了病人术后住院时间、改善了病人术后疼痛、降低了术后并发症发生率及减少了阿片类药物的使用,值得在脊柱外科临床推广.