Risk factors and care of early surgical site infection after primary posterior lumbar interbody fusion

Objectives:To explore the risk factors and nursing measures of early surgical site infection(SSI)after posterior lumbar interbody fusion(PLIF).Methods:A total of 468 patients who received PLIF in our hospital from January 2017 to June 2020 were enrolled into this study.According to the occurrence of early SSI,the patients were divided into two groups,and the general data were analyzed by univariate analysis.Multivariate logistic regression analysis was conducted with the dichotomous variable of whether early SSI occurred and other factors as independent variables to identify the risk factors of early SSI and put forward targeted prevention and nursing measures.Results:Among 468 patients with PLIF,18 patients developed early SSI(3.85%).The proportion of female,age,diabetes mellitus and urinary tract infection(UTI),operation segment,operation time,post-operative drainage volume,and drainage time were significantly higher than those in the uninfected group,with statistical significance(P<0.05),whereas the preoperative albumin and hemoglobin in the infected group were significantly lower than those in the uninfected group,with statistical significance(P<0.05).There was no significant difference between the two groups in the American Society of Anesthesiologists(ASA)grading,body mass index(BMI),complications including cardiovascular and cerebrovascular diseases or hypertension(P>0.05).Logistic regression analysis showed that preoperative diabetes mellitus(OR=2.109,P=0.012)/UTI(OR=1.526,P=0.035),prolonged drainage time(OR=1.639,P=0.029)were risk factors for early SSI.Men(OR=0.736,P=0.027)and albumin level(OR=0.526,P=0.004)were protective factors in reducing early SSI.Conclusions:Women,preoperative diabetes/UTI,hypoproteinemia,and prolonged drainage time are risk factors for early SSI after PLIF.Clinical effective preventive measures should be taken in combination with targeted nursing intervention to reduce the risk of early SSI.

Comparison of Clinical Outcomes of Cortical Bone Trajectory and Traditional Pedicle Screw Fixation in Posterior Lumbar Interbody Fusion

Posterior lumbar interbody fusion (PLIF) is a common surgical procedure and widely used in the treatment of lumbar degenerative disc disorders. Traditionally, posterior lumbar interbody fusion is done by using the traditional pedicle screw (PS) which offers great advantages, but at the same time it has some disadvantages which include the risk of superior facet joint violation and muscle damage. Recently, an alternative method of screw insertion via cortical bone trajectory (CBT) has been invented which has less invasive process and can be placed without the drawbacks associated with the traditional pedicle screw. However, it has to remain an interest whether CBT will provide similar or greater clinical outcomes compared to PS in PLIF. So the main aim of this review is to compare the clinical outcomes of cortical bone trajectory and traditional pedicle screw fixation in posterior lumbar interbody fusion based on the articles published on this topic. Compared to the traditional pedicle screw fixation, PLIF with CBT has similar clinical outcome based on pain intensity, ODI status and JOA score, as well as similar fusion rate and radiological evaluated complication such as loosening of screw. In addition PLIF with CBT has advantages of less facet joint violation, less blood loss, less intraoperative muscle damage and perioperative pain. On the basis of this study, we can suggest that PLIF with CBT can be considered as a reasonable alternative to PS in PLIF.

Biomechanical Effects of Implant Materials on Posterior Lumbar Interbody Fusion: Comparison of Polyetheretherketone and Titanium Spacers Using Finite Element Analysis and Considering Bone Density

Few biomechanical data exist regarding whether the polyetheretherketone (PEEK) spacer or titanium spacer is better for posterior lumbar interbody fusion (PLIF). This study evaluated the biomechanical influence that these types of spacers with different levels of hardness exert on the vertebra by using finite element analysis including bone strength distribution. To evaluate the risk of spacer subsidence for PLIF, we built a finite element model of the lumbar spine using computed tomography data of osteoporosis patients. Then, we simulated PLIF in L3/4 and built models with the hardness of the interbody spacer set as PEEK and titanium. Bones around the spacer were subjected to different load conditions. Then, fracture elements and some stress states of the two modalities were compared. In both models of PLIF simulation, fracture elements and stress were concentrated in the bones around the spacer. Fracture elements and stress values of the model simulating the PEEK spacer were significantly smaller compared to those of the titanium simulation model. For PLIF of osteoporotic vertebrae, this suggested that the PEEK spacer is in a mechanical environment less susceptible to subsidence caused by microfractures of bone tissue and bone remodeling-related fusion aspects. Therefore, PEEK spacers are bio-mechanically more useful.

Can bone mineral density affect intra-operative blood loss of mini-invasive posterior lumbar interbody fusion?

Objective:Many factors affect intraoperative blood loss(BL)in mini-invasive posterior lumbar interbody fusion(PLIF)procedures,but only few has examined.Specifically,the impact of bone mineral density(BMD)levels on intraoperative BL.This study aims to examine the correlation between these two factors.Methods:Retrospective review of 120 patients with low back disorders who were scheduled to undergo mini-invasive PLIF from October 2018 to October 2019 was performed.Patients were divided into two groups based on BMD of the lumbar spine:normal group and abnormal group(osteoporosis and osteopenia).Comparison of age,gender,BMD,BL,BMI,prothrombin time,activated partial thromboplastin time,haemoglobin concentration,intraoperative mean arterial pressure,platelet count,and operative time(OT)between the two groups,and correlation analysis of BMD and BL were conducted.Results:The mean BL of patients in the abnormal group was remarkably higher than that in the normal group:357.22±152.55 ml and 259.37±125.90 ml respectively(p<0.001).The partial correlation coefficient between BL and BMD was0.45(p<0.001).The results of univariate regression analysis demonstrated that only BMD,gender,and OT were related to BL(BMD,r=0.427,p<0.001;gender,r=0.211,p=0.024;OT,r=0.318,p=0.001).While multivariate linear regression analysis demonstrated that patients with lower BMD and longer OT had a higher amount of intraoperative BL(p<0.001).Conclusions:BMD is an important factor influencing intraoperative BL in mini-invasive PLIF.It should be assessed routinely as a part of the preoperative examination to improve preoperative assessment and ensure patient safety.

Use of Nonlinear Finite Element Analysis of Bone Density to Investigate the Biomechanical Effect in the Bone around Intervertebral Cages in Posterior Lumbar Interbody Fusion

Preventing subsidence of intervertebral cages in posterior lumbar interbody fusion (PLIF) requires understanding its mechanism, which is yet to be done. We aimed to describe the mechanism of intervertebral cage subsidence by using finite element analysis through simulation of the osteoporotic vertebral bodies of an elderly woman. The data from computed tomography scans of L2-L5 vertebrae in a 72-year-old woman with osteoporosis were used to create 2 FE models: one not simulating implant placement (LS-INT) and one simulating L3/4 PLIF using polyetheretherketone (PEEK) cages (LS-PEEK). Loads and moments simulating the living body were applied to these models, and the following analyses were performed: 1) Drucker-Prager equivalent stress distribution at the cage contact surfaces;2) the distribution of damage elements in L2-L5 during incremental loading;and 3) the distribution of equivalent plastic strain at the cage contact surfaces. In analysis 1, the Drucker-Prager equivalent stress on the L3 and L4 vertebral endplates was greater for LS-PEEK than for LS-INT under all loading conditions and tended to be particularly concentrated at the contact surfaces. In analysis 2, compared with LS-INT, LS-PEEK showed more damage elements along the bone around the cages in the L3 vertebral body posterior to the cage contact surfaces, followed by the area of the L4 vertebral body posterior to the cage contact surfaces. In analysis 3, in the L3 inferior surface in LS-PEEK the distribution of equivalent plastic strain was visualized as gradually expanding along the cages from the area posterior to the cages to the area anterior to them with increased loading. These analyses suggested that in PLIF for osteoporotic vertebral bodies, the localized stress concentration generated by the use of PEEK cages may cause accumulation of microscopic damage in the fragile osteoporotic vertebral bodies around the cages, which may result in cage subsidence.

Surgical Results of Posterior Lumbar Interbody Fusion with Transpedicular Fixation in Management of Spondylolisthesis

Objective: To evaluate the surgical results of posterior lumber interbody fusion with transpedicular fixation with rod screw system in management of spondylolisthesis. Study Design: Retrospective study reviewed all patient treated by lumber interbody fusion with transpedicular fixation with rod screw system. Patients and Methods: They were 40 patients operated for lumber and lumbosacral spondylolisthesis from Feb 2014 to April 2017 in Al-Azhar university hospital. These patients followed postoperatively clinically for improved neural function and for fusion stability and hardware fixation by radiological investigation. Data about pain intensity (by Visual Analogue Scale) was collected pre- and postoperatively;and outcome was assessed by Oswetry disability index (ODI). Outcome was graded as excellent, good, fair, or poor. Pre- and Post-operative data were statistically compared. Results: The mean age was 45 years (range between 30 - 60 years) with female sex predominance (male:female = 1:3). They had lytic (n = 30) or degenerative (n = 10) spondylolisthesis;and all underwent PLIF (posterior lumbar interbody fusion). In lytic group, the level was L4/L5 in 19 patients and L5/S1 in 11 patients, while in degenerative group the level was L4/L5 in 4 patients, L5/S1 in 3 patients, L2/L3 in 2 and L3/L4 in one patient. The spondylolisthesis grade was grade I among 25 subjects, grade two among 11 subjects and retrolisthesis among 4 subjects. Sensory deficits reported in 22 subjects (19 had lytic and 3 had degenerative spondylolisthesis);while motor deficits reported among 10 subjects and reduced reflexes among 8 subjects. The outcome was excellent, good, and fair among 30, 7, and 3 subjects respectively. The return to previous levels of activity was reported among 32 patients. VAS was 3.5 ± 2.94 at the end of follow up, while ODI was 28% and 36.0% and 3 and 6 months respectively. Conclusion: PLIF associated with transpedicular rod screw fixation system for management of spondylolisthesis is considered a safe and effective surgical intervention in both lytic and degenerative types.

Clinical observation of bone graft impaction on posterior intervertebral body fusion for lumbar spondylolisthesis

Objective To investigate the clinical effect of bone graft impaction on posterior intervertebral fusion for lumbar spondylolisthesis.Methods From January 2001 to July 2008,36 patients with lumbar spondylolisthesis were treated by

Application of the cortical bone trajectory technique in posterior lumbar fixation

The cortical bone trajectory(CBT) is a novel technique in lumbar fixation and fusion.The unique caudocephalad and medial-lateral screw trajectories endow it with excellent screw purchase for vertebral fixation via a minimally invasive method.The combined use of CBT screws with transforaminal or posterior lumbar interbody fusion can treat a variety of lumbar diseases,including spondylolisthesis or stenosis,and can also be used as a remedy for revision surgery when the pedicle screw fails.CBT has obvious advantages in terms of surgical trauma,postoperative recovery,prevention and treatment of adjacent vertebral disease,and the surgical treatment of obese and osteoporosis patients.However,the concept of CBT internal fixation technology appeared relatively recently;consequently,there are few relevant clinical studies,and the long-term clinical efficacy and related complications have not been reported.Therefore,large sample and prospective studies are needed to further reveal the long-term complications and fusion rate.As a supplement to the traditional pedicle trajectory fixation technique,the CBT technique is a good choice for the treatment of lumbar diseases with accurate screw placement and strict indications and is thus deserving of clinical recommendation.

Delayed arterial symptomatic epidural hematoma on the 14th day after posterior lumbar interbody fusion:A case report

BACKGROUND Delayed arterial symptomatic epidural hematoma(SEH)on the 14th day after posterior lumbar interbody fusion(PLIF)is rare but it may lead to severe complications if not identified and treated in a timely manner.After diagnosis of the current case,early surgical removal of the hematoma and strict hemostasis treatment was accomplished.This case report highlights the importance of swift diagnosis and treatment in SEH patients.CASE SUMMARY A 41-year-old male patient with a single-segment lumbar disc herniation underwent left-side PLIF.On the 14th post-operative day,the patient complained of lumbar incision pain with sudden onset accompanied by left limb radiation pain and aggravated cauda equina symptoms.Magnetic resonance imaging examination and a puncture blood draw at the incision site confirmed a delayed arterial SEH.Emergency surgical removal of the hematoma and hemostasis was performed.About 70 mL of hematoma was found in the left incision.Continuous bleeding was found in the anterior branch of the transverse process of the 4th lumbar artery in the muscle area about 2 cm below the transverse process of the 4th lumbar vertebra.A blood jet of about 10 cm in height was observed and bipolar electrocoagulation was used to stop the bleeding.Post-operative lumbar incision pain and left lower limb pain were relieved immediately and gradually disappeared.There was no recurrence during the 12-mo follow-up.CONCLUSION For delayed arterial SEH on the 14th day after PLIF,preventive measures including pre-,intra-and post-operative prevention should be implemented.

Mid-term follow-up of one-stage posterior debridement, intertransverse process bone grafting and screw-rod system fixation for Brucella spondylitis of the lumbar spine

Objective:To investigate the short-term and medium-term efficacy of one-stage posterior debridement,intertransverse process bone grafting and screw-rod system fixation in the treatment of Brucella spondylitis of the lumbar spine.Method:156 cases of Brucella spondylitis of lumbar spine were selected and divided into experimental group(n=80)and combined group(n=76)according to different surgical methods.The experimental group was treated with one-stage posterior debridement,intertransverse process bone grafting and screw-rod system fixation.The combined group was treated with one-stage anterior debridement and intertransverse process bone grafting combined with posterior internal fixation.The operative indexes and clinical effects were compared between the two groups.Result:The operation time,intraoperative bleeding volume and time of landing after operation in the experimental group were less than those in the combined group,with statistical significance(P<0.05).VAS score,ODI index,Cobb angle and Frankel grade of nervous function in the two groups were significantly improved after 3 months and 36 months of treatment(P<0.05),but there was no significant difference between the two groups at the same time(P>0.05).There was no significant difference in the excellent and good rate between the two groups after 3 and 36 months of treatment(P>0.05).There was no recurrence of the lesion in both groups.The intertransverse process bone graft healed and the screw-rod system was well fixed.Conclusion:One-stage posterior debridement,intertransverse process bone grafting and screw-rod system fixation for treatment of Brucella spondylitis of lumbar spine are effective,with short operation time and less trauma,which are worthy of clinical promotion.

Posterior Lumbar Interbody Fusion versus Posterolateral Fusion in Surgical Treatment of Lumbar Spondylolithesis

Background: The optimal surgical technique for lumbar spondylolithesis remains debated. Although posterior lumbar interbody fusion (PLIF) theoretically offers more advantages than posterolateral lumbar fusion (PLF), the evidence remains inconclusive. Aim: The aim of this study is to compare the clinical and functional outcomes of PLIF versus PLF in patients with lumbar spondylolithesis. Patients and Methods: We enrolled 38 patients with lumbar spondylolithesis (degenerative and isthmic) who underwent PLIF (N = 19) or PLF (N = 19). We collected operative data and performed follow-up for 12 months after the surgery. The collected data were analyzed using the SPSS software to detected significant differences between both groups. Results: The PLF and PLIF groups exhibited similar pre-operative characteristics between both groups in terms of age (p = 0.57), sex (p = 0.73), clinical presentation (p = 1), required levels of fixation (p = 1), pre-operative VAS score (p = 0.43) or muscle weakness (p = 1). However, the PLIF group had significantly more blood loss and longer operative time than the PLF group. Moreover, both groups had similar levels of postoperative pain (up to six months after surgery), and post-operative complications. The rates of arthrodesis were higher in PLIF group than PLF group within six months while no significant difference within 12 months of follow-up. Conclusion: In our comparative study, we achieved comparison between pedicle screw fixation with posterolateral fusion alone (PLF) in compare with pedicle screw fixation with posterior lumbar interbody fusion (PLIF). Results indicate better results of fusion rate in PLIF as regards arthrodesis with slightly more rate of complication than PLF. So we recommend PLIF in cases of lumbar spondylolithesis than PLF.

Two-Year Outcomes of Midline lumbar Fusion Versus Minimally Invasive Transforaminal Lumbar Interbody Fusion in the Treatment of L4-L5 Degenerative Disease

Objective We aimed to compare the clinical and radiological outcomes of midline lumbar fusion(MIDLF)versus minimally invasive transforaminal lumbar interbody fusion(MI-TLIF)in patients with degenerative spondylolisthesis and/or stenosis in L4-L5 two years after surgery.Methods Consecutively treated patients with lumbar pathology who underwent MIDLF(n=16)and a historical control group who underwent MI-TLIF(n=34)were included.Clinical symptoms were evaluated using Oswestry Disability Index(ODI),the 36-Item Short-Form Health Survey,and visual analog scale(VAS)scores before surgery and 3,6,12,and 24 months after surgery.Results The mean operative time and hematocrit(HCT,Day 1)were significantly shorter and lower in MIDLF cases(174 min vs.229 min,P<0.001;0.34 vs.0.36,P=0.037).The MI-TLIF group showed better improvement than the MIDLF group in ODI and VAS back and leg pain at 3 months postoperatively.VAS leg pain was higher in MIDLF than in MI-TLIF cases at 6 months.At 24 months follow-up,VAS back pain was higher in MI-TLIF than in MIDLF cases(P=0.018).Conclusion MIDLF is comparable to MI-TLIF at L4-5 in clinical outcomes and fusion rates,and the results verified the meaningful advantage of using MIDLF for the elderly with osteoporosis.

One Stage Anterior Reconstruction and Posterior Instrumentation in Surgical Management of Thoracolumbar Spine Fractures

Background: The different methods of anterior reconstruction and posterior instrumentation in surgical management of thoracolumbar spine fractures are PLIF, TLIF, lateral extracaviatary and transpedicular techniques which are increasingly used to perform partial or total corpectomies and anterior reconstructions from a posterior approach. These techniques were being alternative to the standard anterior approach with less morbidity and mortality. Patients and Methods: This study was performed between 2011 and 2014 on 100 patients with acute unstable thoracolumbar spine fractures which were divided into four groups: 30 patients underwent (TLIF), 28 patients underwent (PLIF), 28 patients underwent (PA) and 14 patients underwent (TPA). Neurological outcome, complications, operative times, kyphotic angle, vertebral height loss, spinal canal compromise, pulmonary functions, Denis pain and work scale, VAS score, ODI score, hospital stay, and estimated blood loss (EBL) were evaluated and compared in between the four groups. Results: There was a higher complication rate, increased EBL, and longer operative time with posteroanterior (PA) compared with PLIF, TLIF and (TPA). Patients undergoing PLIF, TLIF and TPA had a greater recovery of neurological function than those in whom PA were performed. Conclusion: TPA appeared to have more favorable results in improving the clinical and radiological outcome and no complications were reported apart from superficial wound infection which healed rapidly. The PLIF, TLIF and TPA appeared to have a comparable morbidity rate to PA. The different methods of anterior reconstruction from posterior approach are more favorable, applicable and convenient than PA approach.

Comparison of simple discectomy and instrumented posterior lumbar interbody fusion for treatment of lumbar disc herniation combined with Modic endplate changes

Background The purpose of this retrospective study was to compare the surgical outcomes of simple discectomy and instrumented posterior lumbar interbody fusion （iPLIF） in patients with lumbar disc herniation and Modic endplate changes.Our hypothesis was that iPLIF could provide better outcome for patients with refractory lumbar disc herniation and Modic changes （LDH-MC）.Methods Ninety-one patients with single-segment LDH-MC were recruited.All patients experienced low back pain as well as radicular leg pain,and low back pain was more severe than leg pain.Forty-seven patients were treated with discectomy and 44 were treated with iPLIE The outcomes of both low back pain and radicular leg pain using visual analogue scale （VAS） as well as the clinical outcome related to low back pain using Japanese Orthopaedic Association （JOA） score were assessed before and 18 months after surgery,respectively.Results Both low back and leg pain were significantly improved 18 months after simple discectomy and iPLIE Compared to patients undergoing simple discectomy,low back pain was significantly reduced in patients undergoing iPLIE but there was no significant difference in leg pain between two groups.Solid fusion was achieved in all patients who underwent iPLIF.Conclusions In patients with LDH-MC,iPLIF can yield significantly superior outcome on the relief of low back pain compared to simple discectomy.Simple discectomy can relieve radicular leg pain as efficient as iPLIE Accordingly,iPLIF seems to be a reliable treatment for patients with LDH-MC and predominant low back pain.

Complications associated with posterior lumbar interbody fusion using Bagby and Kuslich method for treatment of spondylolisthesis

Objective To analyze complications associated with posterior lumbar interbody fusion (PLIF) in which two Bagby and Kuslich (BAK) interbody fusion cages were implanted.Methods A total of 118 patients with spondylolytic spondylolisthesis underwent single-level PLIF using two BAK cages filled with morselized autogenous bone. The major clinical and radiographic complications were analyzed after a follow-up with an average time of 2 years and 9 months.Results Complications were divided into intraoperative and postoperative complications. Intraoperative complications mainly included dural tear (4 patients, 3.4%), nerve root injury (3 patients, 2.5%) and suboptimal cage position (9 patients, 7.5%). No death was caused by the operation. Postoperative complications chiefly consisted of cage retropulsion (3 patients, 2.5%), cage subsidence (4 patients, 3.4%), and postlaminectomy arachnoiditis (2 patients, 1.7%). Pseudarthrosis was noted radiographically with evidence of motion between adjacent vertebra on lateral flexion-extension films and luciencies around the cages (2 patient, 1.7%), continuous posterior cage migration (2 patients, 1.7%) or continuous cage subsidence (2 patients, 1.7%). Two patients died, one from a traffic accident and the other from metastatic cancer 1 year postoperatively.Conclusions The results of this study indicate that PLIF with BAK cages is an effective but also technically difficult procedure. The relatively high incidence of complications reminds us of the importance of surgical indications and proper manipulations.

UBE-LIF与后路病灶清除植骨融合内固定术治疗腰椎布氏杆菌性脊柱炎的临床疗效比较

目的对比UBE-LIF(unilateral biportal endoscopic technique with transforaminal lumbar interbody fusion)技术行病灶清除联合经皮椎弓根螺钉内固定术与经典后路病灶清除植骨融合内固定术治疗腰椎布氏杆菌性脊柱炎(LBS)的安全性及临床疗效。方法回顾性分析甘肃省中医院脊柱骨科2020年1月至2022年1月收治的32例LBS患者的临床资料,按术式分为UBE-LIF组(n=15)和开放组(n=17)。记录并分析两组的一般资料、手术相关指标及术后病理HE染色;根据术前、术后1周及术后1、3、6个月和1年的红细胞沉降率(ESR)和C反应蛋白(CRP)变化,腰痛疼痛视觉模拟评分(VAS)、日本骨科协会评分(JOA)、Oswestry功能障碍指数(ODI)评估患者临床恢复情况;影像学方法测量术前及末次随访时腰椎前凸角(LL)和椎间隙高度(DH),并采用Suk分级标准评估椎间植骨融合情况。结果两组患者均顺利完成手术,且均未发生严重术后并发症。两组患者的性别、年龄、手术节段、手术时间、术前ESR和CRP水平、术前VAS、JOA评分及ODI指数、术前LL和DH等资料比较差异均无统计学意义(P>0.05);UBE-LIF组术中出血量、术后引流量、术后下床时间、术后住院时间明显少于开放组(P<0.001);术中取病变组织行病理学检查,均符合布氏杆菌病改变。两组患者均获随访,随访时间12~18个月,平均14.8个月。两组患者的术后各时间点VAS、JOA评分和ODI指数均较术前明显改善(P<0.05);其中两组在术后1周差异较为明显:UBE-LIF组VAS评分低于开放组(P<0.01),两组CRP均较术前升高且UBE-LIF组升高水平明显低于开放组(P<0.001),两组ESR较术前无明显差异(P>0.05);术后其余各时间点两组间VAS、JOA评分和ODI指数、CRP及ESR比较差异无统计学意义(P>0.05)。末次随访时影像学检查示,UBE-LIF组椎间植骨总体融合率为93.3%,开放组为94.1%,差异无统计学意义(χ^(2)=0.246,P=0.884);两组LL和DH均较术前显著改善(P<0.01),两组手术前后差值比较差异无统计学意义(P>0.05)。结论两种术式治疗LBS均安全有效;与后路病灶清除植骨融合内固定术相比,UBE-LIF技术联合经皮椎弓根螺钉内固定术具有术中视野清晰、出血量少、术后早期恢复更快、术后住院时间更短等优势,是一种可行的微创治疗LBS的手术方式。

后路腰椎椎间融合术后伤口渗出的治疗转归

目的探讨后路腰椎椎间融合术(posterior lumbar interbody fusion,PLIF)后伤口渗出的治疗转归,为临床治疗提供理论支持。方法回顾性分析2018年9月至2021年4月收治的因腰椎退行性疾病导致神经或脊髓损伤且经历PLIF术后出现伤口渗出的23例患者资料,根据其临床资料分为感染组(n=10)和非感染组(n=13)。总结比较两组患者的临床表现及治疗过程。结果与非感染组相比,感染组患者术中出血较多(P<0.05),术后感染确诊时间及伤口愈合时间较长(P<0.05),术后第3天血红蛋白(hemoglobin,HB)较低(P<0.05),而血白细胞(white blood cell,WBC)计数、中性粒细胞计数(absolute neutrophil count,ANC)、红细胞沉降率(erythrocyte sedimentation rate,ESR)及C-反应蛋白(C-reactive protein,CRP)较高(P<0.05)。所有患者均治愈出院,且经过1年以上随访无复发。结论PLIF术后伤口渗出后早期正确的鉴别和干预,可取得较好的临床疗效。

伴或不伴马尾冗余征腰椎管狭窄症患者行斜外侧腰椎椎间融合术联合后路经皮内固定术的疗效分析

目的:探讨伴或不伴马尾冗余征(redundant nerve roots,RNRs)腰椎管狭窄症患者行斜外侧腰椎椎间融合术(oblique lumbar interbody fusion,OLIF)联合后路经皮内固定术的临床疗效。方法:回顾性分析2019年6月至2022年6月于本院采用斜外侧腰椎椎间融合术联合后路经皮内固定术治疗的92例腰椎管狭窄症患者,男32例,女60例,年龄44~82(63.67±9.93)岁。根据冗余与否将所有患者分为RNRs阳性组和RNRs阴性组。RNRs阳性组38例,男15例,女23例;年龄45~82(65.45±10.37)岁;病程24.00(12.00,72.00)个月。RNRs阴性组54例,男17例,女37例;年龄44~77(62.42±9.51)岁;病程13.50(9.00,36.00)个月。记录两组手术时间、术中出血量、并发症;手术前后影像学参数,包括狭窄节段数、椎间隙高度、腰椎前凸角、硬膜囊面积;采用视觉模拟评分(visual analogue scale,VAS)进行背部和腿部疼痛评价,采用Oswestry功能障碍指数(Oswestry disability index,ODI)评估日常生活活动障碍。结果:所有患者获得随访,时间8~18(11.04±3.61)个月,随访期未见并发症。RNRs阳性组狭窄节段数(1.71±0.46)个,多于阴性组(1.17±0.38)个(P<0.05)。RNRs阳性组术前椎间隙高度、硬膜囊面积、腰痛VAS、腿痛VAS、ODI分别为(1.11±0.19)cm、(0.46±0.17)cm^(2)、(5.39±1.00)分、(5.05±1.01)分、(55.74±4.05)%;RNRs阴性组分别为(0.97±0.23)cm、(0.69±0.26)cm^(2)、(4.50±0.77)分、(4.00±0.58)分、(47.33±3.43)%。RNRs阳性组术后椎间隙高度、硬膜囊面积、腰痛VAS、腿痛VAS、ODI评分分别为(1.60±0.19)cm、(0.74±0.36)cm^(2)、(3.39±0.72)分、(3.05±1.01)分、(46.74±4.82)%;RNRs阴性组分别为(1.48±0.25)cm、(1.12±0.35)cm^(2)、(3.00±0.82)分、(3.00±0.82)分、(37.67±3.58)%。两组术后椎间隙高度、硬膜囊面积、腰痛、腿痛VAS、ODI较术前明显改善(P<0.05)。两组术前椎间隙高度、硬膜囊面积、腰痛、腿痛VAS、ODI比较,差异均具有统计学意义(P<0.05)。但两组手术前后椎间隙高度差值、ODI差值比较,差异无统计学意义(P>0.05)。两组手术时间、术中出血量、术后硬膜囊面积、手术前后硬膜囊面积差值、术后腰痛VAS、手术前后腰痛VAS差值、手术前后腿痛VAS差值等比较,差异有统计学意义(P<0.05)。结论:OLIF联合后路经皮内固定术对于伴或不伴RNRs的患者均有较好疗效。多节段腰椎管狭窄、硬膜囊面积减小可能会导致RNRs的发生,伴RNRs的LSS患者症状更重。伴RNRs的LSS患者较不伴RNRs的患者手术疗效要差。

单纯后路病灶清除颗粒植骨内固定与后前路联合治疗腰椎结核的疗效比较

目的探讨单纯后路病灶清除颗粒植骨内固定术治疗腰椎结核的疗效及安全性。方法回顾性分析河北省胸科医院2020年5月—2022年8月接受腰椎结核后路及后前路手术的患者42例,根据手术方式分为单纯后路组24例和后前路组18例。比较2组患者手术时间、术中出血量及术后卧床时间;检测ESR、CRP等炎性指标的变化;使用疼痛视觉模拟评分(VAS)和Oswestry功能障碍指数(ODI)评估腰部疼痛及功能恢复情况;测量术后Cobb角矫正度数与随访1年丢失度数,记录术后融合时间;应用Bridwell植骨融合标准及CT骨融合标准评估植骨融合情况。结果与后前路组比较,单纯后路组手术时间缩短(t/P=5.995/<0.001),术中出血量减少(t/P=2.134/0.039),术后卧床时间缩短(t/P=5.835/<0.001)。与术前比较,2组患者术后6个月ESR、CRP降低,差异均有统计学意义(P<0.01);随访1年VAS、ODI评分均降低,差异有显著统计学意义(P<0.01),而2组之间比较差异无统计学意义(P>0.05)。2组患者术后Cobb角纠正度数、术后1年丢失度数及术后融合时间比较差异无统计学意义(P>0.05)。根据Bridwell融合标准和CT骨融合标准,2组随访1年的植骨融合比较,差异无明显统计学意义(P>0.05)。结论单纯后路与后前路联合手术治疗腰椎结核均可获得满意疗效。单纯后路病灶清除颗粒植骨内固定手术治疗腰椎结核取得了良好的临床疗效且安全可行,具有手术时间短、出血少、创伤小的优点。

围术期个体化营养干预对存在营养风险的高龄腰椎后路椎间融合术患者的影响

目的 探讨围术期个体化营养干预对存在营养风险的高龄腰椎后路椎间融合术患者的影响。方法 选取2018年1月-2019年12月于首都医科大学宣武医院行腰椎后路椎间融合术的181例年龄>75岁的老年患者作为研究对象,将NRS2002≥3分的85例患者纳入干预组,NRS2002<3分的96例患者纳入对照组。对照组予以常规饮食宣教,患者根据自己的饮食模式及喜好自行订餐;干预组予以进一步营养评估,制定个体化营养治疗方案。比较两组的营养指标(血清总蛋白、白蛋白、前白蛋白及血红蛋白)、可能致术后低蛋白血症的潜在高危因素(是否伴随糖尿病、衰弱状态、手术时间及术中出血量)及术后感染情况。结果 两组性别、病程、合并糖尿病比例及衰弱状态比较,差异均无统计学意义(P>0.05);干预组年龄高于对照组,体质量指数、术中出血量及术前血清总蛋白、白蛋白、前白蛋白、血红蛋白水平均低于对照组,手术时间短于对照组,差异均有统计学意义(P<0.05)。两组手术后血清总蛋白、白蛋白、前白蛋白及血红蛋白水平均较术前有所下降,干预组各指标的下降水平均低于对照组,差异均有统计学意义(P<0.05)。两组在住院时间及术后感染情况比较,差异均无统计学意义(P>0.05)。结论 对存在营养风险的行腰椎后路融合术的高龄患者进行术前营养干预,可减少术后营养指标的下降。