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71.
Michael G. Fehlings Branko Kopjar Ahmed Ibrahim Lindsay A. Tetreault Paul M. Arnold Helton Defino Shashank Sharad Kale S. Tim Yoon Giuseppe M. Barbagallo Ronald H.M. Bartels Qiang Zhou Alexander R. Vaccaro Mehmet Zileli Gamaliel Tan Yasutsugu Yukawa Darrel S. Brodke Christopher I. Shaffrey Osmar Santos de Moraes Mark B. Dekutoski 《The spine journal》2018,18(4):593-605
Background Context
Degenerative cervical myelopathy (DCM) is a progressive degenerative spine disease and the most common cause of spinal cord impairment in adults worldwide. Few studies have reported on regional variations in demographics, clinical presentation, disease causation, and surgical effectiveness.Purpose
The objective of this study was to evaluate differences in demographics, causative pathology, management strategies, surgical outcomes, length of hospital stay, and complications across four geographic regions.Study Design/Setting
This is a multicenter international prospective cohort study.Patient Sample
This study includes a total of 757 symptomatic patients with DCM undergoing surgical decompression of the cervical spine.Outcome Measures
The outcome measures are the Neck Disability Index (NDI), the Short Form 36 version 2 (SF-36v2), the modified Japanese Orthopaedic Association (mJOA) scale, and the Nurick grade.Materials and Methods
The baseline characteristics, disease causation, surgical approaches, and outcomes at 12 and 24 months were compared among four regions: Europe, Asia Pacific, Latin America, and North America.Results
Patients from Europe and North America were, on average, older than those from Latin America and Asia Pacific (p=.0055). Patients from Latin America had a significantly longer duration of symptoms than those from the other three regions (p<.0001). The most frequent causes of myelopathy were spondylosis and disc herniation. Ossification of the posterior longitudinal ligament was most prevalent in Asia Pacific (35.33%) and in Europe (31.75%), and hypertrophy of the ligamentum flavum was most prevalent in Latin America (61.25%). Surgical approaches varied by region; the majority of cases in Europe (71.43%), Asia Pacific (60.67%), and North America (59.10%) were managed anteriorly, whereas the posterior approach was more common in Latin America (66.25%). At the 24-month follow-up, patients from North America and Asia Pacific exhibited greater improvements in mJOA and Nurick scores than those from Europe and Latin America. Patients from Asia Pacific and Latin America demonstrated the most improvement on the NDI and SF-36v2 PCS. The longest duration of hospital stay was in Asia Pacific (14.16 days), and the highest rate of complications (34.9%) was reported in Europe.Conclusions
Regional differences in demographics, causation, and surgical approaches are significant for patients with DCM. Despite these variations, surgical decompression for DCM appears effective in all regions. Observed differences in the extent of postoperative improvements among the regions should encourage the standardization of care across centers and the development of international guidelines for the management of DCM. 相似文献72.
Background
Odontoid process fractures, of which type II constitute the majority, are an increasingly important cause of morbidity and mortality in the elderly population. The incidence of geriatric type II fractures is steadily increasing in line with the aging population. However, the decision between surgical and non-surgical intervention for type II fractures in the elderly remains controversial.Purpose
The present study aims to synthesize the current published literature comparing outcomes following surgical and non-surgical interventions for type II odontoid fractures in the elderly population (≥65 years old).Study design/setting
Systematic review and meta-analysis were performed.Methods
A systematic search of MEDLINE, MEDLINE In-Progress & Other Non-Indexed Citations, Embase, and Cochrane Central Register of Controlled Trials (CENTRAL) was performed to identify available evidence in English language. Studies with extractable data for all type II odontoid fractures in participants aged 65 years or older and which compared surgical and non-surgical intervention were included. Methodological quality was assessed using the Downs & Black checklist. Primary outcomes were mortality at short-term follow-up (≤3 months), mortality at long-term follow-up (predetermined study endpoint or mean follow-up length), and radiological union rate. Funding was provided by The University of Edinburgh for travel expenses to present this paper at the Society of British Neurological Sciences 2016 Conference ($170).Results
Twelve studies (n=1,098), all non-randomized, met eligibility criteria. Methodological quality was particularly poor in the confounding, bias, and power domains of assessment. Substantial methodological and statistical heterogeneity allowed only a narrative synthesis of the primary outcomes. Overall, data on mortality at short-term follow-up appeared to favor neither surgical nor non-surgical intervention. A small favorable outcome in surgically managed patients over non-surgically managed patients in terms of mortality at long-term follow-up was not proven conclusive because of considerable heterogeneity in study methodologies. Inadequate reporting of the time point of union assessment introduced the potential for significant intra- and interstudy heterogeneity and precluded assessment of union rates.Conclusions
Evidence on this controversial topic is sparse, markedly heterogeneous, and of poor quality. Well-designed prospective trials adhering to guidance published by the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) initiative are required to inform clinical practice on this contentious but growing issue. Future randomized controlled trials should include an assessment of frailty and medical comorbidities with suitable patients subsequently randomized to surgical or non-surgical treatment. 相似文献73.
Emma Rose McGlone Ajay K. Gupta Marcus Reddy Omar A. Khan 《Surgery for obesity and related diseases》2018,14(6):857-864
Although laparoscopic sleeve gastrectomy is an established operation for severe obesity, there is controversy regarding the extent to which the antrum is excised. The objective of this systematic review was to investigate the effect on perioperative complications and medium-term outcomes of antral resecting versus antral preserving sleeve gastrectomy. MEDLINE, EMBASE, and Cochrane databases were searched from 1946 to April 2017. Eligible studies compared antral resection (staple line commencing 2–3 cm from pylorus) with antral preservation (>5 cm from pylorus) in patients undergoing primary sleeve gastrectomy for obesity. Meta-analyses were performed with a random-effects model, and risk of bias within and across studies was assessed using validated scoring systems. Eight studies (619 participants) were included: 6 randomized controlled trials and 2 cohort studies. Overall follow-up was 94% for the specified outcomes of each study. Mean percentage excess weight loss was 62% at 12 months (7 studies; 574 patients) and 67% at 24 months (4 studies; 412 patients). Antral resection was associated with significant improvement in percentage excess weight loss at 24-month follow-up (mean 70% versus 61%; standardized mean difference .95; confidence interval .35–1.58, P<.005), an effect that remained significant when cohort studies were excluded. There was no difference in incidence of perioperative bleeding, leak, or de novo gastroesophageal reflux disease. According to the available evidence, antral resection is associated with better medium-term weight loss compared with antral preservation, without increased risk of surgical complications. Further randomized clinical trials are indicated to confirm this finding. 相似文献
74.
Alexander Dimitri Miras Anna Kamocka Darshan Patel Simon Dexter Ian Finlay James C. Hopkins Omar Khan Marcus Reddy Peter Sedman Peter Small Shaw Somers Suzie Cro Peter Walton Carel W. le Roux Richard Welbourn 《Surgery for obesity and related diseases》2018,14(7):1033-1040
Background
The National Bariatric Surgery Registry (NBSR) is the largest bespoke database in the field in the United Kingdom.Objectives
Our aim was to analyze the NBSR to determine whether the effects of obesity surgery on associated co-morbidities observed in small randomized controlled clinical trials could be replicated in a "real life" setting within U.K. healthcare.Setting
United Kingdom.Methods
All NBSR entries for operations between 2000 and 2015 with associated demographic and co-morbidity data were analyzed retrospectively.Results
A total of 50,782 entries were analyzed. The patients were predominantly female (78%) and white European with a mean age of 45 ± 11 years and a mean body mass index of 48 ± 8 kg/m2. Over 5 years of follow-up, statistically significant reductions in the prevalence of type 2 diabetes, hypertension, dyslipidemia, sleep apnea, asthma, functional impairment, arthritis, and gastroesophageal reflux disease were observed. The "remission" of these co-morbidities was evident 1 year postoperatively and reached a plateau 2 to 5 years after surgery. Obesity surgery was particularly effective on functional impairment and diabetes, almost doubling the proportion of patients able to climb 3 flights of stairs and halving the proportion of patients with diabetes related hyperglycemia compared with preoperatively. Surgery was safe with a morbidity of 3.1% and in-hospital mortality of .07% and a reduced median inpatient stay of 2 days, despite an increasingly sick patient population.Conclusions
Obesity surgery in the U.K. results not only in weight loss, but also in substantial improvements in obesity-related co-morbidities. Appropriate support and funding will help improve the quality of the NBSR data set even further, thus enabling its use to inform healthcare policy. 相似文献75.
Patawut Bovonratwet Vineet Tyagi Taylor D. Ottesen Nathaniel T. Ondeck Lee E. Rubin Jonathan N. Grauer 《The Journal of arthroplasty》2018,33(1):178-184
Background
The number of octogenarians undergoing revision total knee arthroplasty (TKA) is increasing. However, there has been a lack of studies investigating the perioperative course and safety of revision TKA performed in this potentially vulnerable population in a large patient population. The purpose of this study is to compare complications following revision TKA between octogenarians and 2 younger patient populations (<70 and 70-79 year olds).Methods
Patients who underwent revision TKA were identified in the 2005-2015 National Surgical Quality Improvement Program database and stratified into 3 age groups: <70, 70-79, and ≥80 years. Baseline preoperative and intraoperative characteristics were compared between the 3 groups. Propensity score matched comparisons were then performed for 30-day perioperative complications, length of hospital stay, and readmissions.Results
This study included 6523 (<70 years), 2509 (70-79 years), and 957 octogenarian patients who underwent revision TKA. After propensity matching, statistical analysis revealed only higher rates of blood transfusion and slightly longer length of stay in octogenarians compared to <70 year olds. Similarly, octogenarians had only higher rates of blood transfusion and slightly longer length of stay compared to 70-79 year olds. Notably, there were no differences in mortality or readmission between octogenarians compared to younger populations.Conclusion
These data suggest that revision TKA can safely be considered for octogenarians with the observation of higher rates of blood transfusion and slightly longer length of stay compared to younger populations. Octogenarian patients need not be discouraged from revision TKA solely based on their advanced age. 相似文献76.
目的 :通过Meta分析明确术前腰椎硬膜外激素注射(lumbar epidural steroid injection,LESI)是否增加后续腰椎手术术后手术部位感染(surgical site infection,SSI)风险。方法:检索Pubmed、Embase、Cochran Trail数据库,检索时间均是从建库到2018年7月。筛选出比较腰椎术前行LESI及未行LESI患者术后90d内SSI发生率的对照研究,各研究的观察(暴露)组为接受LESI并后续相同节段行首次腰椎手术,对照(非暴露)组为未行LESI而于相同节段行首次腰椎手术。各组病例数均大于100,随访时间至少90d。评价指标为术后90d内SSI发生率。依据LESI注射距后续腰椎手术时间分亚组(1个月内,1～3个月,3～6个月,6～12个月),合并SSI比值比(OR)。使用Newcastle-Ottawa Quality Scale(NOS)评分评价纳入研究质量。分别行亚组分析探讨异质性,敏感性分析测定合并结果稳定性,Egger′s回归检测发表偏倚。结果:共5篇文献纳入研究,其中4篇为回顾性病例对照研究,1篇为回顾性队列研究,研究质量NOS评分均在6分以上。共纳入225801例患者,其中暴露组38452例,对照组187349例。经Meta分析,术前1个月内行LESI,暴露组与对照组术后90d内SSI发生率比较OR=2.15(95%CI,1.30～3.55),P0.05;术前1～3个月行LESI,暴露组与对照组术后90d内SSI发生率比较OR=1.54(95%CI,1.36～1.74),P0.05;术前3～6个月行LESI,暴露组与对照组术后90d内SSI发生率比较OR=1.09(95%CI,0.94～1.26),P0.05;术前6～12个月行LESI,暴露组与对照组术后90d内SSI发生率比较OR=1.30(95%CI,0.88～1.93),P0.05。Meta分析亚组分析证实基线资料不匹配为显著异质性来源,敏感性分析证实Meta分析结果稳定,发表偏倚检测提示未见发表偏倚。结论:术前3个月内行LESI显著增加后续腰椎手术术后90d内SSI风险。 相似文献
77.
正寰枢椎是脊柱结构最复杂、运动方式最独特、治疗困难争议最多的部位。主要特点:(1)寰枢椎的运动是三维大幅度的弹性运动,其承担头颈部50%的旋转及12%的屈伸和侧曲运动,最灵活也最不稳定,最脆弱和最容易受伤,因其骨结构相对纤细,多依靠软组织稳定。(2)特殊的结构造就特殊的生物力学性能。寰枢椎间没有椎间盘,不适用三柱理论。寰枢关节以枢椎的2个侧块关节为支撑,将来自头部的两股力量传递到三柱的下颈椎,是力量转换中 相似文献
78.
The tracheocutaneous fistula after tracheostomy is a complex clinical problem. An ideal fistula closure is
still difficult at present though a variety of fistula-closing methods have been reported in the literature. We used a turnover skin flap to cover the fistula. All the procedures were completed at bedside under local anesthesia. The fistula was successfully closed and well healed without complications within 7-9 days. It has been proven that this operation is simple, effective, and safe. 相似文献
79.
80.
Hakan Koyuncu Faruk Yencilek Mehmet Kalkan Yavuz Bastug Esin Yencilek Ahmet Tunc Ozdemir 《International braz j urol : official journal of the Brazilian Society of Urology》2015,41(2):245-251