ObjectiveTo review the definition and possible etiologies for C5 palsy. MethodsThe literature on C5 palsy at home and abroad in recent years was extensively reviewed, and the possible etiologies were analyzed based on clinical practice experience. ResultsThere are two main theories (nerve root tether and spinal cord injury) accounting for the occurrence of C5 palsy, but both have certain limitations. The former can not explain the occurrence of C5 palsy after anterior cervical spine surgery, and the latter can not explain that the clinical symptoms of C5 palsy is often the motor dysfunction of the upper limb muscles. Based on the previous reports, combining our clinical experience and research, we propose that the occurrence of C5 palsy is mainly due to the instrumental injury of anterior horn of cervical spinal cord during anterior cervical decompression. In addition, the C5 palsy following surgery via posterior approach may be related to the nerve root tether caused by the spinal cord drift after decompression. ConclusionIn view of the main cause of C5 palsy after cervical decompression, it is recommended to reduce the compression of the spinal cord by surgical instruments to reduce the risk of this complication.
Objective To evaluate the safety and effectiveness of anterior cervical discectomy and fusion (ACDF) by using zero-profile anchored cage (ZAC) in treatment of consecutive three-level cervical spondylosis, by comparing with plate-cage construct (PCC). Methods A clinical data of 65 patients with cervical spondylosis admitted between January 2020 and December 2022 and met the selection criteria was retrospectively analyzed. During consecutive three-level ACDF, 35 patients were fixed with ZAC (ZAC group) and 30 patients with PCC (PCC group). There was no significant difference in baseline data between the two groups (P>0.05), including gender, age, body mass index, surgical segment, preoperative Japanese Orthopaedic Association (JOA) score, Neck Disability Index (NDI), visual analogue scale (VAS) score, prevertebral soft tissue thickness (PSTT), cervical lordosis, and surgical segmental angle. The operation time, intraoperative blood loss, hospital stay, clinical indicators (JOA score, NDI, VAS score), and radiological indicators (cervical lordosis, surgical segmental angle, implant subsidence, surgical segment fusion, and adjacent segment degeneration), and the postoperative complications [swelling of the neck (PSTT), dysphagia] were recorded and compared between the two groups. Results Patients in both groups were followed up 24-39 months. There was no significant difference in follow-up duration between the two groups (P>0.05). The operation time and intraoperative blood loss were lower in ZAC group than in PCC group, and the length of hospital stay was longer, but there was no significant difference (P>0.05). At each time point after operation, both groups showed significant improvements in JOA score, VAS score, and NDI compared with preoperative scores (P<0.05), but there was no significant difference between the two groups at each time point after operation (P>0.05). Both groups showed an increase in PSTT at 3 days and 3, 6 months after operation compared to preoperative levels (P<0.05), but returned to preoperative levels at last follow-up (P>0.05). The PSTT at 3 days and 3 months after operation were significantly lower in ZAC group than in PCC group (P<0.05), and there was no significant difference between the two groups at 6 months and at last follow-up (P>0.05). The incidences of dysphagia at 3 days and 3 months were significantly lower in ZAC group than in PCC group (P<0.05), while no significant difference was observed at 6 months and last follow-up between the two groups (P>0.05). There was no postoperative complication in both groups including hoarseness, esophageal injury, cough, or hematoma. Both groups showed improvement in cervical lordosis and surgical segmental angle compared to preoperative levels, with a trend of loss during follow-up. The cervical lordosis loss and surgical segmental angle loss were significantly more in the ZAC group than in PCC group (P<0.05). The incidence of implante subsidence was significantly higher in ZAC group than in PCC group (P<0.05). There was no significant difference between the ZAC group and PCC group in the incidences of surgical segment fusion and adjacent segment degeneration (P>0.05). ConclusionIn consecutive three-level ACDF, both ZAC and PCC can achieve satisfactory effectiveness. The former can reduce the incidence of postoperative dysphagia, while the latter can better maintain cervical curvature and reduce the incidence of implant subsidence.
ObjectiveTo investigate the role of mindfulness-based stress reduction in improving anxiety and depression in elderly patients with chronic heart failure.MethodsFrom August 2016 to August 2018, a total of 196 elderly patients with chronic heart failure were randomly divided into the treatment group and the control group, with 98 cases in each group. The control group received routine care. The treatment group received routine care plus mindfulness-based stress reduction in two 60-minute sessions a week for 8 weeks. The level of serum N-terminal pro-brain natriuretic peptide (NT-proBNP) was detected by electrochemiluminescence immunoassay, and left ventricular ejection fraction (LVEF) was measured by echocardiography before intervention and at week 8 of intervention; the effective rate was calculated. Self-rating Anxiety Scale (SAS), Self-rating Depression Scale (SDS), and General Well-Being scale (GWB) were used to assess the degree of anxiety, depression, and well-being of patients before intervention and at week 8 of intervention.ResultsThe serum NT-proBNP levels at week 8 of intervention in the two groups were lower than those before intervention, and the LVEFs were higher than those before intervention (P<0.05). The treatment group showed significant changes when compared with the control group (P<0.05). The effective rate of the treatment group was higher than that of the control group (89.80% vs. 69.39%, P<0.05). Before intervention, the SAS scores in the treatment group and the control group were 56.61±8.25 and 55.98±6.32, respectively, the SDS scores were 59.98±7.21 and 58.86±6.17, respectively, and the GWB scores were 53.19±12.38 and 54.06±10.93, respectively; at week 8 of intervention, the SAS scores in the treatment group and the control group were 40.56±8.17 and 46.25±5.43, respectively, the SDS scores were 42.85±5.77 and 48.34±8.01, respectively, and the GWB scores were 76.17±9.63 and 68.58±13.30, respectively. At week 8 of intervention, the SAS and SDS scores of the two groups were both lower than those before intervention, and the GWB scores were higher than those before intervention (P<0.05). The treatment group showed significant changes when compared with the control group (P<0.05).ConclusionMindfulness-based stress reduction can improve the anxiety and depression of elderly patients with chronic heart failure, improve their well-being and promote the recovery of heart function.
目的:讨论侧后方减压融合术治疗胸腰椎骨折的优缺点及临床应用。方法:对12例胸腰椎骨折采用侧后方减压植骨融合术,经一个手术入路完成减压及脊椎的稳定重建。 结果:12例病例随访13～36个月,术后无一例神经症状加重;6例术后原有神经症状明显改善,2例2个月后神经症状开始恢复,3例无改善;12例均获得骨性融合。 结论:侧后方减压融合术是治疗胸腰椎骨折的较好方法。但其技术要求高,视野显露有限,操作范围较窄,易出血增加了手术难度。
Objective To evaluate the cl inical effects of anterior segmental decompression and autograft fusion in treating multi-level cervical spondylotic myelopathy (CSM). Methods Between January 2007 and May 2009, 23 patients with multi-level CSM were treated with anterior segmental decompression, autograft fusion, and internal fixation. There were 16 males and 7 females with an average age of 58 years (range, 49-70 years). Consecutive 3 segments of C3,4, C4, 5, and C5, 6 involvedin 15 cases and C4, 5, C5, 6, and C6, 7 in 8 cases. All patients suffered sensory dysfunction in l imbs and trunk, hyperactivity of tendon reflexes of both lower extremities, walking with l imp, and weakening of hand grip. Cervical MRI showed degeneration and protrusion of intervertebral disc and compression of cervical cord. The disease duration was 6 to 28 months (12.5 months on average). Japanese Orthopaedic Association (JOA) score system was adopted for therapeutic efficacy evaluation. JOA scores were recorded preoperatively, 1 week, 3 months, and 12 months postoperatively. Results Dura tear occurred in 1 case and was treated by fill ing with gelatinsponge during operation; no cerebrospinal fluid leakage was observed after operation. All the incisions healed by first intention. All cases were followed up 12 to 24 months (15.1 months on average), and no vertebral artery injury or recurrent laryngeal nerve injury occurred. The nervous symptoms in all cases were improved significantly within 1 week after operation. Lower l imb muscle strength increased, upper l imb abnormal sensation disappeared, and l imb moved more agile. A 2-mm collapses of titanium mesh into upper terminal plate were found in 1 case and did not aggravated during followup.The other internal fixator was in appropriate situation, and the fusion rate was 100%. The JOA score increased from 9.1 ±0.3 preoperatively to 14.3 ± 0.4 at 12 months postoperatively with an improvement rate of 65.8% ± 0.2%, showing significant difference (P lt; 0.01). According to Odom evaluation scale, the results were excellent in 10 cases, good in 8 cases, fair in 4 cases, and poor in 1 case. Conclusion Anterior segmental decompression and autograft fusion is a recommendable technique for multi-level CSM, which can make full decompression, conserve the stabil ity of cervical cord, and has high fusion rate.
Objective To investigate the cl inical appl ication and efficacy of lumbar vertebral canal expansion withpreservation of posterior l igaments complex, and to study its biomechanical properties. Methods Eight fresh lumbosacralcadaveric samples were divided into 3 groups. In group A, 8 intact lumbosacral cadaveric samples were used for biomechanical test. In group B, L3-5 laminectomy were, after the test in group A, performed and the posterior l igaments complex was preserved. In group C, the posterior l iagments complex was excised after the test in group B. In all 3 groups, the axial compression test, three-point bending test and torsional test were conducted. From June 2000 to June 2006, 309 patients (152 males and 157 females, aged 20-80 years with the average of 57.2 ) with lumbar canal stenosis received operation of the lumbar vertebral canal expansion with preservation of posterior l igaments complex. The course of disease was 3 months to 41 years. There were 55 patients suffering from pure lumbar canal stenosis, and 254 from lumbar canal stenosis combined with lumbar disc herniation, among which 105 were at L4, 5 level, 56 at L4-S1 level, 86 at L5, S1 level, and 7 at L2, 3 level. The therapeutic effect was assessed based on the JOA low back pain scoring system, the satisfaction degree of patient and radiographical observation. Results The axial compression test was performed. In the position of forward bending, stress, strain and axial displacement were smaller in groups A, B than those in group C, and axial stiffness in groups A, B was higher than those in group C, and the difference was significant(P lt; 0.01). In the position of backward extension, there was no significant difference among 3 groups (P gt; 0.05). Concerning the three-point bending test, under the same bending moment, there was a significant difference in deflection, dip and bending rigidity between group A and group C, and also between group B and group C (P lt; 0.01), but no significant difference between group A and group B (P gt; 0.05). In the torsional test, under the same torsional angle, the torque in group B was bigger than that in group C (P lt; 0.01). Under the same torque, the torsional angle in group B was smaller than that in group C (P lt; 0.01), and the torsional stiffness in group B was higher than that in group C (P lt; 0.01). The compl ications included 7 cases of distraction of nerve root, 5 leakage of cerebrospinal fluid and 4 wound infection. All compl ications were treated and restored completely. All patients were followed up for 1-7 years. According to the JOA low back pain scoring system, the improvement rate averaged 86.0%. Of all the 309 cases, 163 were excellent, 112 good, 34 fair, and the choiceness rate was 89%. The satisfaction rate of patient was 87%. There was no radiographic vertebral instabil ity postoperatively. Conclusion The lumbar vertebral canal expansion with preservation of posterior l igaments complex is conducive to maintaining the stabil ity of lumbar spine and have good cl inical outcomes.
目的:探讨原发性三叉神经痛微血管减压的手术效果及其影响因素。方法:选择正规药物治疗无效的三叉神经痛患者行核磁共振检查,排除继发性病因引起三叉神经痛的患者,对30例原发性三叉神经痛患者行微血管减压术。结果:28例患者术后疼痛立即消失,1例患者症状明显缓解,1例无效,无死亡患者,有效率为97％,随访1年有１例复发。结论:术前核磁共振检查能否发现责任血管,对手术和术后效果影响大;但同时与术者的经验和显微操作熟练程度密切相关。
Objective To explore an improved method of treating avascular necrosis of the femoral head in young adults by grafting the sartorius muscle iliac bone flap. Methods From September 1994 to August 2003, 68 patients (57 males, 11 females; age, 16-58 years) underwent of the transplant the sartorius muscle oliac bone flap into the femoral head after decompression of the femoral head medullary core and removal of the dead bone and the fibrous tissue in the femoral head. The transplantation was performed on 31 patients left-unilaterally, on 37 patients rightunilaterally, and on 7 patients bilaterally. The pathological causeswere as follows: alcoholism in 52 patients, prolonged use of hormones in 6, traumain the hip in 6, and undetermined cause in 4. Their illness course ranged from 8 months to 4 years. According the Ficat staging, 10 patients belonged to Stage I (11 sides), 27 patients to Stage Ⅱ (31 sides), and31 patients to Stage Ⅲ (33 sides). Results The follow-up of the 68 patientsfor 2.5-11 years averaged 5.2 years revealed that based on the Harris evaluation for the hip function, 23 patients had an excellent result, 33 had a good result, 10 had a fair result, and 2 had a poor result. The excellent and good resultsaccounted for 82.3%. There was no recurrence after operation. Conclusion Thismethod has the following advantages: the lesion focus can be eradicated; enoughdecompression can be achieved, and the blood circulation for the femoral head can be rebuilt. The grafting of the sartorius muscle iliac bone flap can bring the osteogenesis components to the femoral head, promoting the reconstruction of the bones. This method is suitable and effective for the patients with avascular necrosis of the femoral head (Ficat Grades Ⅰ, Ⅱ and Ⅲ) in young adults.
Objective To determine the feasibility, safety, and efficacy of common pedicle screw placement under direct vision combined with dome shaped decompression via small incision for double segment thoracolumbar fracture with nerve injury. Methods A retrospective analysis was performed on the clinical data of 32 patients with double segment thoracolumbar fracture with nerve injury undergoing common pedicle screw placement under direct vision combined with dome shaped decompression via small incision between November 2011 and November 2015 (combined surgery group), and another 32 patients undergoing traditional open pedicle screw fixation surgery (traditional surgery group). There was no significant difference in gender, age, cause of injury, time of injury-to-surgery, injury segments and Frankel classification of neurological function between two groups (P>0.05). The length of soft tissue dissection, the operative time, the blood loss during surgery, the postoperative drainage, the visual analogue scale (VAS) of incision after surgery, and recovery of neurological function after surgery were evaluated. Results All cases were followed up 9 to 12 months (mean, 10.5 months) in combined surgery group, and 8 to 12 months (mean, 9.8 months) in traditional surgery group. The length of soft tissue dissection, the operative time, the blood loss during surgery, the postoperative drainage, and the postoperative VAS score in the combined surgery group were significantly better than those in the traditional surgery group (P<0.05). Dural rupture during surgery and pedicle screw pulling-out at 6 months after surgery occurred in 2 cases and 1 case of the combined surgery group; dural rupture during surgery occurred in 1 case of the traditional surgery group. The X-ray films showed good decompression, and fracture healing; A certain degree of neurological function recovery was achieved in two groups. Conclusion Common pedicle screw placement under direct vision combined with dome shaped decompression via small incision can significantly reduce iatrogenic trauma and provide good nerve decompression. Therefore, it is a safe, effective, and minimally invasive treatment method for double segment thoracolumbar fracture with neurological injury.