BACKGROUND Total cervical artificial disc replacement(TDR)has been considered a safe and effective alternative surgical treatment for cervical spondylosis and degenerative disc disease that have failed to improve with...BACKGROUND Total cervical artificial disc replacement(TDR)has been considered a safe and effective alternative surgical treatment for cervical spondylosis and degenerative disc disease that have failed to improve with conservative methods.Positioning the surgical patient is a critical part of the procedure.Appropriate patient positioning is crucial not only for the safety of the patient but also for optimizing surgical exposure,ensuring adequate and safe anesthesia,and allowing the surgeon to operate comfortably during lengthy procedures.The surgical posture is the traditional position used in anterior cervical approach;in general,patients are in a supine position with a pad under their shoulders and a ring-shaped pillow under their head.AIM To investigate the clinical outcomes of the use of a modified surgical position versus the traditional surgical position in anterior approach for TDR.METHODS In the modified position group,the patients had a soft pillow under their neck,and their jaw and both shoulders were fixed with wide tape.The analyzed data included intraoperative blood loss,position setting time,total operation time,and perioperative blood pressure and heart rate.RESULTS Blood pressure and heart rate were not significantly different before and after body positioning in both groups(P>0.05).Compared with the traditional position group,the modified position group showed a statistically significantly longer position setting time(P<0.05).However,the total operation time and intraoperative blood loss were significantly reduced in the modified position group compared with the traditional position group(P<0.05).CONCLUSION The clinical outcomes indicated that total operation time and intraoperative blood loss were relatively lower in the modified position group than in the traditional position group,thus reducing the risks of surgery while increasing the position setting time.The modified surgical position is a safe and effective method to be used in anterior approach for TDR surgery.展开更多
Objective To investigate the operation key points,instrument improvement and shortterm effects in total en bloc spondylectomy (TES) via a single posterior approach for thoracic and lumbar tumors.Methods A series of mo...Objective To investigate the operation key points,instrument improvement and shortterm effects in total en bloc spondylectomy (TES) via a single posterior approach for thoracic and lumbar tumors.Methods A series of modified展开更多
Direct anterior total hip arthroplasty has become increasingly more popular among arthroplasty surgeons,in large part due to the use of an intramuscular interval and desire to reduce soft tissue damage.Several studies...Direct anterior total hip arthroplasty has become increasingly more popular among arthroplasty surgeons,in large part due to the use of an intramuscular interval and desire to reduce soft tissue damage.Several studies have now been published comparing the anterior intramuscular to other commonly used approaches,and many studies have published complication rates on large series of patients.Review of comparative studies indicates direct anterior hips tend towards shorter hospital stays and high rates of patients discharged to home.Although some studies show evidence of early benefit in functional outcomes,there is no strong evidence that the anterior approach provides any long term functional improvements compared to other approaches.Additionally,evidence to support reduced damage to soft tissue may not translate to certain clinical significance.Rates of intra-operative femur fracture,operative time and blood loss rates are notably higher for those developing familiarity with this approach.However,when surgeons have performed a modest number of procedures,the complication rates tend to markedly decrease in most studies to levels comparable to other approaches.Accuracy of component positioning also favors the anterior approach in some studies.This review summarizes the available literature comparing the direct anterior to other approaches for total hip arthroplasty and provides a comprehensive summary of common complications.展开更多
背景:经直接前入路(DAA)行全髋关节置换术(THA)的疗效及安全性尚不明确。目的:应用系统评价及meta分析的方法评价度过学习曲线后DAA和后方入路(PA)对THA疗效及安全性的影响。方法:计算机检索各数据库内关于DAA与PA对THA疗效及安全性影...背景:经直接前入路(DAA)行全髋关节置换术(THA)的疗效及安全性尚不明确。目的:应用系统评价及meta分析的方法评价度过学习曲线后DAA和后方入路(PA)对THA疗效及安全性的影响。方法:计算机检索各数据库内关于DAA与PA对THA疗效及安全性影响的对照试验,按照既定的纳入、排除标准检出文献,严格评价纳入研究的方法学质量并提取数据,采用Rev Man 5.2软件对可以合并分析的指标进行meta分析,对不能合并的指标采用描述性分析。结果:纳入文献11篇,共入选患者1612例,其中DAA组817例,PA组795例。DAA组患者术后需使用助行设备的时间明显短于PA组(WMD=-11.05,95%CI:-17.79^-4.31,P=0.001)。描述性分析发现DAA在术后早期功能恢复以及活动能力上优于PA。两组术中及术后1年的并发症发生率(OR=1.48,95%CI:0.69~3.20,P=0.32)、术中骨折发生率(OR=1.31,95%CI:0.50~3.45,P=0.58)、术后脱位发生率(OR=0.34,95%CI:0.09~1.28],P=0.11)、异位骨化发生率(OR=1.01,95%CI:0.26~3.94,P=0.99)、腹股沟区疼痛发生率(OR=2.73,95%CI:0.62~12.06],P=0.19)均无统计学差异。而且两组的手术时间(WMD=10.25,95%CI:-6.33~26.83],P=0.23)、住院时间(WMD=-0.34,95%CI:-0.76~0.07],P=0.10)、Lewinnek安全区内髋臼假体的数量(OR=2.08,95%CI:0.65~6.72,P=0.22)也无统计学差异。同时,DAA具有预防术后脱位的潜在优势,DAA术中使用X线透视会避免出现明显异常的髋臼假体位置。结论:在熟练掌握DAA THA技术的前提下,DAA是具有一定优势的手术入路。展开更多
文摘BACKGROUND Total cervical artificial disc replacement(TDR)has been considered a safe and effective alternative surgical treatment for cervical spondylosis and degenerative disc disease that have failed to improve with conservative methods.Positioning the surgical patient is a critical part of the procedure.Appropriate patient positioning is crucial not only for the safety of the patient but also for optimizing surgical exposure,ensuring adequate and safe anesthesia,and allowing the surgeon to operate comfortably during lengthy procedures.The surgical posture is the traditional position used in anterior cervical approach;in general,patients are in a supine position with a pad under their shoulders and a ring-shaped pillow under their head.AIM To investigate the clinical outcomes of the use of a modified surgical position versus the traditional surgical position in anterior approach for TDR.METHODS In the modified position group,the patients had a soft pillow under their neck,and their jaw and both shoulders were fixed with wide tape.The analyzed data included intraoperative blood loss,position setting time,total operation time,and perioperative blood pressure and heart rate.RESULTS Blood pressure and heart rate were not significantly different before and after body positioning in both groups(P>0.05).Compared with the traditional position group,the modified position group showed a statistically significantly longer position setting time(P<0.05).However,the total operation time and intraoperative blood loss were significantly reduced in the modified position group compared with the traditional position group(P<0.05).CONCLUSION The clinical outcomes indicated that total operation time and intraoperative blood loss were relatively lower in the modified position group than in the traditional position group,thus reducing the risks of surgery while increasing the position setting time.The modified surgical position is a safe and effective method to be used in anterior approach for TDR surgery.
文摘Objective To investigate the operation key points,instrument improvement and shortterm effects in total en bloc spondylectomy (TES) via a single posterior approach for thoracic and lumbar tumors.Methods A series of modified
文摘Direct anterior total hip arthroplasty has become increasingly more popular among arthroplasty surgeons,in large part due to the use of an intramuscular interval and desire to reduce soft tissue damage.Several studies have now been published comparing the anterior intramuscular to other commonly used approaches,and many studies have published complication rates on large series of patients.Review of comparative studies indicates direct anterior hips tend towards shorter hospital stays and high rates of patients discharged to home.Although some studies show evidence of early benefit in functional outcomes,there is no strong evidence that the anterior approach provides any long term functional improvements compared to other approaches.Additionally,evidence to support reduced damage to soft tissue may not translate to certain clinical significance.Rates of intra-operative femur fracture,operative time and blood loss rates are notably higher for those developing familiarity with this approach.However,when surgeons have performed a modest number of procedures,the complication rates tend to markedly decrease in most studies to levels comparable to other approaches.Accuracy of component positioning also favors the anterior approach in some studies.This review summarizes the available literature comparing the direct anterior to other approaches for total hip arthroplasty and provides a comprehensive summary of common complications.
文摘背景:经直接前入路(DAA)行全髋关节置换术(THA)的疗效及安全性尚不明确。目的:应用系统评价及meta分析的方法评价度过学习曲线后DAA和后方入路(PA)对THA疗效及安全性的影响。方法:计算机检索各数据库内关于DAA与PA对THA疗效及安全性影响的对照试验,按照既定的纳入、排除标准检出文献,严格评价纳入研究的方法学质量并提取数据,采用Rev Man 5.2软件对可以合并分析的指标进行meta分析,对不能合并的指标采用描述性分析。结果:纳入文献11篇,共入选患者1612例,其中DAA组817例,PA组795例。DAA组患者术后需使用助行设备的时间明显短于PA组(WMD=-11.05,95%CI:-17.79^-4.31,P=0.001)。描述性分析发现DAA在术后早期功能恢复以及活动能力上优于PA。两组术中及术后1年的并发症发生率(OR=1.48,95%CI:0.69~3.20,P=0.32)、术中骨折发生率(OR=1.31,95%CI:0.50~3.45,P=0.58)、术后脱位发生率(OR=0.34,95%CI:0.09~1.28],P=0.11)、异位骨化发生率(OR=1.01,95%CI:0.26~3.94,P=0.99)、腹股沟区疼痛发生率(OR=2.73,95%CI:0.62~12.06],P=0.19)均无统计学差异。而且两组的手术时间(WMD=10.25,95%CI:-6.33~26.83],P=0.23)、住院时间(WMD=-0.34,95%CI:-0.76~0.07],P=0.10)、Lewinnek安全区内髋臼假体的数量(OR=2.08,95%CI:0.65~6.72,P=0.22)也无统计学差异。同时,DAA具有预防术后脱位的潜在优势,DAA术中使用X线透视会避免出现明显异常的髋臼假体位置。结论:在熟练掌握DAA THA技术的前提下,DAA是具有一定优势的手术入路。
