Five-year outcome of surgical decompression of the lumbar spine without fusion

As the average life expectancy of the population increases, surgical decompression of the lumbar spine is being performed with increasing frequency. It now constitutes the most common type of lumbar spinal surgery in older patients. The present prospective study examined the 5-year outcome of lumbar decompression surgery without fusion. The group comprised 159 patients undergoing decompression for degenerative spinal disorders who had been participants in a randomised controlled trial of post-operative rehabilitation that had shown no between-group differences at 2 years. Leg pain and back pain intensity (0–10 graphic rating scale), self-rated disability (Roland Morris), global outcome of surgery (5-point Likert scale) and re-operation rates were assessed 5 years post-operatively. Ten patients had died before the 5-year follow-up. Of the remaining 149 patients, 143 returned a 5-year follow-up (FU) questionnaire (effective return rate excluding deaths, 96%). Their mean age was 64 (SD 11) years and 92/143 (64%) were men. In the 5-year follow-up period, 34/143 patients (24%) underwent re-operation (17 further decompressions, 17 fusions and 1 intradural drainage/debridement). In patients who were not re-operated, leg pain decreased significantly (p < 0.05) from before surgery to 2 months FU, after which there was no significant change up to 5 years. Low back pain also decreased significantly by 2 months FU, but then showed a slight, but significant (p < 0.05), gradual increase of <1 point by 5-year FU. Disability decreased significantly from pre-operative to 2 months FU and showed a further significant decrease at 5 months FU. Thereafter, it remained stable up to the 5-year FU. Pain and disability scores recorded after 5 years showed a significant correlation with those at earlier follow-ups (r = 0.53–0.82; p < 0.05). Patients who were re-operated at some stage over the 5-year period showed significantly worse final outcomes for leg pain and disability (p < 0.05). In conclusion, pain and disability showed minimal change in the 5-year period after surgery, but the re-operation rate was relatively high. Re-operation resulted in worse final outcomes in terms of leg pain and disability. At the 5-year follow-up, the “average” patient experienced frequent, but relatively low levels of, pain and moderate disability. This knowledge on the long-term outcome should be incorporated into the pre-operative patient information process.     

Accidental falls involving medical implant re-operation

Implantation of medical devices is becoming more prevalent, and as a result, a greater number of patients who fall accidentally are expected to have a medical implant. The Nationwide Inpatient Sample (NIS) was used to evaluate hospital admissions following accidental falls involving re-operation of existing medical implants (hip, knee, spine, and fracture fixation) from 1990 to 2005. From 1990 to 2005, hospitalisations due to accidental falls on level surfaces increased by 306%, and hospitalisations due to falls from stairs increased by 310%. Falls involving orthopaedic revision surgery (re-operation) are relatively rare, but the incidence has increased by approximately 35%. Hospital stays after falls on level surfaces involving re-operation were 1.0 day (median) longer and cost 50% (median) more than those that did not involve re-operation in 2005. After staircase falls, hospital stays for patients undergoing re-operations were 2.0 days (median) longer and cost 108% (median) more. The greater hospital costs and hospital stay for patients needing re-operations indicate that additional medical treatment was required.     

复发性大肠癌51例再手术治疗分析

目的探讨提高复发性大肠癌生存率的治疗方法。方法回顾性分析我院1999年以来复发性大肠癌再手术病例51例的临床资料,其中单纯肝转移14例,单纯吻合口复发9例,腹腔广泛转移12例,单纯腹膜后淋巴结转移6例,盆腔转移10例;再次手术共切除25例,行肠造口术、肠吻合短路手术10例,单纯置化疗泵共7例,行单纯剖腹探查术9例。结果术后42例获随访,5例已存活5年,6例已存活3年,4例手术距今不足3年仍存活,7例2年内死亡,20例1年内死亡。结论大肠癌复发再次手术仍有较高切除率,再次手术治疗能提高生存率。     

泪囊鼻腔吻合失败的再手术治疗

目的：探讨泪囊鼻腔吻合术失败再次手术的效果。方法：1997年3月－2001年5月对16例（16眼）泪囊鼻腔吻合术失败者进行再次手术，治疗泪囊炎，结果：术后随访6月－3年，16例中14例治愈，1例有效，1例无效，治愈率87．5％，结论：再次手术的治率高，解除了患者的痛苦，适合基层应用。     

腰椎间盘镜术后再手术的原因分析及对策

目的:探讨腰椎间盘镜术后再手术的原因及对策,明确椎间盘镜术的减压原则。方法:经首次腰椎间盘镜手术后需再次手术的患者11例,男4例,女7例;年龄28~52岁,平均34.5岁。再手术方式:腰椎间盘镜手术2例,开窗减压术4例,环形减压术4例,半椎板切除术1例,术后对再手术原因进行回顾性分析。结果:再手术原因:定位错误2例,游离髓核遗漏1例,同侧髓核再脱出1例,对侧再突出2例,仅摘除髓核而未解除侧隐窝狭窄5例。术后随访8~20个月,平均13个月,按Nakai标准评定,优7例,良3例,可1例。结论:腰椎间盘镜手术应遵循"以神经根为中心减压"的原则,术后复发的原因与适应证选择不当、定位错误及手术技巧有关,再次手术可获得满意的疗效。     

Reconstruction of the knee extensor mechanism after chronic buttonhole deformity

Chronic buttonhole deformity of the knee after patellectomy is an unusual and rare complication. Reconstruction of the extensor mechanism is difficult as the tissues are thinned and friable. The technique of repair was reinforced using semitendinosus and gracilis. The post-operative care initially concentrated on range of motion and then power. This allowed MRC grade four power with a range of movement of 0°–125° at 1 year.     

心脏瓣膜置换术后机械瓣功能不全再次手术

目的对心脏瓣膜机械瓣发生功能不全的原因进行分析,讨论再次手术方法的选择。方法选择心脏瓣膜置换术后发生机械瓣膜功能不全的病人16例,对其手术资料及临床资料进行回顾性分析,手术种类包括二尖瓣置换术及主动脉瓣置换术．均为择期手术,对其发生功能不全的原因及再次手术方法进行汇总分析,并统计不同方法的救治成功率。结果本组患者再次手术的原因均为瓣环组织增生和血栓形成,其中包括机械瓣置换术9例,生物瓣置换术7例,机械瓣组死亡4例（44.44％）,生物瓣组死亡1例（14．28％）,两组比较差异具有显著性意义。结论对于瓣环组织增生和血栓形成引起的术后机械瓣功能不全,应用生物瓣进行再次手术的成功率较高。     

关于心脏瓣膜置换术后再次瓣膜手术的探讨

目的 分析心脏瓣膜置换术后再次瓣膜手术的原因,探讨手术时机的选择、手术方法及对结果的影响因素.方法 对2008年10月至2010年2月心脏瓣膜置换术后再次瓣膜手术的13例患者进行回顾性分析,术前NYHA心功能Ⅲ级4例,Ⅳ级9例.单纯二尖瓣置换术7例,单纯主动脉瓣置换术3例,二尖瓣并主动脉瓣置换术3例.结果 术后早期死亡1例,病死率7.7%(1/13),死亡原因为术后低心排血量综合征.术后因出血二次开胸止血和再次气管插管各1例,经抢救治疗后均好转,12例患者均于3～6周出院.随访6～15个月,无死亡病例发生,所有患者心功能恢复良好.结论 合理选择手术时机,术中尽早建立体外循环,加强心肌保护,术中、术后防止出血是提高心脏瓣膜置换术后再次瓣膜手术疗效的关键.

Abstract：

Objective To summarize the results of valve re-operative cases after cardiac valve replacement, to find the better re-operative time, and to estimate the re-operative methods and influencing factors of the operation. Methods Thirteen valve re-operative cases after cardiac valve replacement from October 2008 to February 2010 were retrospectively studied. According to NYHA classification, 9 cases belonged to class Ⅳ, and only 4 cases belonged to class Ⅲ preoperatively. Mitral valve replacement (MVR)was performed in 7 cases, aortic valve replacement (AVR) in 3 cases, MVR + AVR in 3 cases. Results The early-stage postoperative mortality was 7.7%( 1/13),and the reason was low cardiac output syndrome. Two cases who underwent re-operation and re-intubation respectively after operation for hemorrhage were improved after treatment. Twelve cases were discharged in 3-6 weeks after heart valve surgery and all were followed up for 6-15 months. The cardiac function of all the discharged patients recovered well and no death occurred during follow-up. Conclusion The key factors to reduce the death of re-operation are improving preoperative heart function,setting up extracorporeal circulation as soon as possible,consummating myocardial preservation,perfecting operating skills,correcting low cardiac output syndrome in time and preventing complications.     

97 HINTEGRA ankle prostheses: Results and survival at more than 5 years’ follow-up

BackgroundIn Europe, fixed-bearing implants predominate again in total ankle replacement (TAR). The present single-center single-surgeon study assesses the Hintegra® mobile-bearing implant (NEWDEAL).MethodsBetween November 2008 and November 2015, 97 Hintegra® were implanted in 94 patients: mean age, 62.4±10.9 years (26?83); 59% (57/97) male; normal mean body-mass index (BMI), 27.5 ± 4.3 kg/m². Indications mainly comprised posttraumatic (40.2%), instability (29.9%) and primary osteoarthritis (16.5%). 17.5% of patients had prior surgery during the previous 6 months (9 fusions, 8 ligament reconstructions, and 4 osteotomies); in 59.8%, other procedures were associated to TAR. Functional, clinical and radiological follow-up was conducted at 1 year, 2 years and last follow-up (>5 years).ResultsNinety-four TARs were analyzed at a mean 81 ± 21.6 months (19?124). Revision-free survival was 76% (95% confidence interval (95%CI): 0.66–0.8), and explantation-free survival 92% (95%CI: 0.85–1) with 10 cases of curettage and 5 explantations.Mean AOFAS score improved from 41.8 ± 12.5 (21?69) to 77.5 ± 16.5 (24?100) up (p < 0.001); 75% of patients had no or only mild pain (p < 0.001). Clinical ranges of motion were 8.0 ± 7.1° dorsiflexion (p < 0.001) and 35.1 ± 9.4° plantar flexion (preoperatively, 34.1 ± 7.9°) (p = 0.71).Radiologically, tibial components were well-positioned; 87% of talar components were well-centered. Global ankle range of motion was 23.5 ± 10.2° (5?48) (p = 0.17). 54.6% of TARs showed posterior tibial calcification at follow-up. Risk of severe cyst (>1 cm) on CT was 36% (95%CI: 23–47) at a mean 77 ± 21.9 months (18?123).ConclusionHintegra® TAR incurred a low risk of revision, and is a reliable option for ankle osteoarthritis.Level of evidenceIV     

腹腔镜成人疝修补术后复发的原因分析

目的：探究腹腔镜成人疝修补术后复发的原因。方法回顾性分析整群选取的该院2011年3月-2014年3月收治的299例腹腔镜成人疝修补术患者临床资料,统计复发情况,并分析疝修补术复发原因。结果经研究分析发现,患者手术复发率为3.68%(12/299﹚,复发原因包括2例补片固定不佳导致移位,1例补片固定时留有空隙较大,1例由于手术后感染,2例由于疝囊颈缝扎位置欠佳,使得存在漏洞,进而复发,2例内环口水肿,1例内环口缝线断裂,1例直疝误诊为斜疝,1例复发由于补片的材料及形状的影响,1例补片位置不合理;经在手术治疗后,患者病情均得以控制,逐渐好转,1年内未见复发。结论腹腔镜成人疝修补术后存在一定复发几率,术后复发对患者病情影响较大,复发原因较多,应加强对复发原因的分析,明确复发原因后再次手术治疗控制患者病情,以确保患者健康安全。