BACKGROUND Whether it’s better to adopt unilateral pedicle screw(UPS)fixation or to use bilateral pedicle screw(BPS)one for lumbar degenerative diseases is still controversially undetermined.AIM To make a comparison ...BACKGROUND Whether it’s better to adopt unilateral pedicle screw(UPS)fixation or to use bilateral pedicle screw(BPS)one for lumbar degenerative diseases is still controversially undetermined.AIM To make a comparison between UPS and BPS fixation as to how they work efficaciously and safely in patients suffering from lumbar degenerative diseases.METHODS We have searched a lot in the databases through 2020 with index terms such as“unilateral pedicle screw fixation”and“bilateral pedicle screw fixation.”Only randomized controlled trials and some prospective cohort studies could be found,yielding 15 studies.The intervention was unilateral pedicle screw fixation;Primarily We’ve got outcomes of complications and fusion rates.Secondarily,we’ve achieved outcomes regarding total blood loss,operative time,as well as length of stay.Softwares were installed and utilized for subgroup analysis,analyzing forest plots,sensitivity,heterogeneity,forest plots,publication bias,and risk of bias.RESULTS Fifteen previous cases of study including 992 participants have been involved in our meta-analysis.UPS had slightly lower effects on fusion rate[relative risk(RR)=0.949,95%CI:0.910 to 0.990,P=0.015],which contributed mostly to this metaanalysis,and similar complication rates(RR=1.140,95%CI:0.792 to 1.640,P=0.481),Δvisual analog scale[standard mean difference(SMD)=0.178,95%CI:-0.021 to 0.378,P=0.080],andΔOswestry disability index(SMD=-0.254,95%CI:-0.820 to 0.329,P=0.402).In contrast,an obvious difference has been observed inΔJapanese Orthopedic Association(JOA)score(SMD=0.305,95%CI:0.046 to 0.563,P=0.021),total blood loss(SMD=-1.586,95%CI:-2.182 to-0.990,P=0.000),operation time(SMD=-2.831,95%CI:-3.753 to-1.909,P=0.000),and length of hospital stay(SMD=-0.614,95%CI:-1.050 to-0.179,P=0.006).CONCLUSION Bilateral fixation is more effective than unilateral fixation regarding fusion rate after lumbar interbody fusion.However,JOA,operation time,total blood loss,as well as length of stay were improved for unilateral fixation.展开更多
Objective To explore the feasibility and efficiency of the treatment of lumbar degenerative diseases after transforaminal lumbar interbody fusion (TLIF) and posterolateral fusion (PLF) procedures in which unilateral p...Objective To explore the feasibility and efficiency of the treatment of lumbar degenerative diseases after transforaminal lumbar interbody fusion (TLIF) and posterolateral fusion (PLF) procedures in which unilateral pedicle screw fixation was used.展开更多
Background Genital prolapse affects 30% of middle-aged and older women and is becoming a major public health concern. Sacrospinous ligament fixation is an effective and safe procedure for vaginal vault prolaps with a ...Background Genital prolapse affects 30% of middle-aged and older women and is becoming a major public health concern. Sacrospinous ligament fixation is an effective and safe procedure for vaginal vault prolaps with a low recurrence and complication rate. This study aimed to investigate the efficacy and safety of unilateral sacrospinous ligament fixation （SSLF） for the management of pelvic organ prolapse （POP）.Methods Forty patients with severe prolapse of pelvic organ undergoing unilateral SSLF were retrospectively studied.In this study, all patients were staged by the value of POP-Q. All procedures were performed by a senior physician. The characteristics of these patients and their immediate and short-term post-operative outcome were recorded. All patients were seen six weeks and six months after the surgery. The evaluation included standardized questionnaire and site-specific vaginal examination by one physician.Results The average operation time was 65-92 minutes. The average blood loss was 83-188 ml. The average hospitalization time was 6.1 days. The average cost was 5885 yuan. The average day of urethral catheter removal after the operation was 2.1 days. The incidence of postoperative morbidity was 17.1%. One （2.4%） patient had hematoma in the right pelvic. The mean length of postoperative follow-up for 35 patients was 13.1 months. The rate of follow-up was 87.5%. One （2.9%） patient showed recurrent vaginal vault prolapse six months after the surgery. The objective success rate of pelvic organ prolapse was 85% （34/40）. There was significant difference between the POP-Q of Aa, Ba, Ap, Bp,and D before and after operation （P 〈0.001 ）. Five （14.3%） patients complained lower back pain, gluteal pain or right groin pain. Three （8.6%） patients developed de novo stress incontinence. Vaginal disabsorbable sutures were found in three （8.6%） patients. One （2.9%） patient had de novo urge incontinence.Conclusions Unilateral SSLF was both cost and treatment effective management for severe pelvic organ prolapse,especially for severe ovaginae anterior prolapse and uterus prolapse of POP Ⅰ, Ⅱ or Ⅲ. Main complications from this procedure included lower back pain, gluteal and groin pain and new onset of stress incontinence.展开更多
目的:比较大通道全内镜下椎间减压融合联合单侧椎弓根螺钉固定与双侧椎弓根螺钉固定治疗单节段腰椎退行性疾病的疗效。方法:回顾性分析2019年12月~2021年10月在我院行大通道全内镜下椎间减压融合内固定手术治疗的47例单节段腰椎退行性...目的:比较大通道全内镜下椎间减压融合联合单侧椎弓根螺钉固定与双侧椎弓根螺钉固定治疗单节段腰椎退行性疾病的疗效。方法:回顾性分析2019年12月~2021年10月在我院行大通道全内镜下椎间减压融合内固定手术治疗的47例单节段腰椎退行性疾病患者的临床资料,其中20例采用单侧椎弓根螺钉固定(单侧固定组),男5例,女15例,年龄39~69岁(54.1±9.6岁);27例采用双侧椎弓根螺钉固定(双侧固定组),男9例,女18例,年龄40~70岁(57.8±9.4岁)。两组患者的年龄、体重指数(body mass index,BMI)、性别、手术节段、疾病类型、随访时间等一般资料均无统计学差异(P>0.05)。比较两组患者手术时间、术中透视次数、住院费用、住院时间、手术前后的血红蛋白及变化值和并发症发生率;术前及术后3天、3个月、1年采用疼痛视觉模拟评分(visual analog scale,VAS)评价腰腿痛,术前及术后3个月、1年采用Oswestry功能障碍指数(Oswestry disability index,ODI)评价功能障碍情况;术后1年根据CT评价椎间融合情况,通过改良MacNab标准对临床疗效进行评价。结果:所有患者手术顺利,均获得1年及以上随访,双侧固定组手术时间、术中透视次数、住院费用、住院时间均显著性高于单侧固定组(P<0.05)。两组患者术前、术后血红蛋白值及血红蛋白变化值均无统计学差异(P>0.05)。两组患者术后3天、3个月、1年的VAS评分及术后3个月、1年的ODI均较术前明显下降(P<0.05);两组同时间点VAS评分及ODI比较均无统计学差异(P>0.05)。两组并发症发生率(单侧固定组10.0%vs双侧固定组11.1%)、术后1年融合率(单侧固定组90.0%vs双侧固定组92.6%)及改良MacNab优良率(单侧固定组90.0%vs双侧固定组88.9%)均无统计学差异(P>0.05)。结论:大通道全内镜下椎间减压融合联合单侧椎弓根螺钉固定与双侧椎弓根螺钉固定治疗单节段腰椎退行性疾病均安全有效,与双侧固定相比,单侧固定术中透视次数、手术时间、住院费用、住院时间更具有优势。展开更多
基金Supported by the Health Science and Technology of Tianjin Municipality,No.RC20204Tianjin Institute of Orthopedics,No.2019TJGYSKY03the National Natural Science Foundation of China,No.818717771177226。
文摘BACKGROUND Whether it’s better to adopt unilateral pedicle screw(UPS)fixation or to use bilateral pedicle screw(BPS)one for lumbar degenerative diseases is still controversially undetermined.AIM To make a comparison between UPS and BPS fixation as to how they work efficaciously and safely in patients suffering from lumbar degenerative diseases.METHODS We have searched a lot in the databases through 2020 with index terms such as“unilateral pedicle screw fixation”and“bilateral pedicle screw fixation.”Only randomized controlled trials and some prospective cohort studies could be found,yielding 15 studies.The intervention was unilateral pedicle screw fixation;Primarily We’ve got outcomes of complications and fusion rates.Secondarily,we’ve achieved outcomes regarding total blood loss,operative time,as well as length of stay.Softwares were installed and utilized for subgroup analysis,analyzing forest plots,sensitivity,heterogeneity,forest plots,publication bias,and risk of bias.RESULTS Fifteen previous cases of study including 992 participants have been involved in our meta-analysis.UPS had slightly lower effects on fusion rate[relative risk(RR)=0.949,95%CI:0.910 to 0.990,P=0.015],which contributed mostly to this metaanalysis,and similar complication rates(RR=1.140,95%CI:0.792 to 1.640,P=0.481),Δvisual analog scale[standard mean difference(SMD)=0.178,95%CI:-0.021 to 0.378,P=0.080],andΔOswestry disability index(SMD=-0.254,95%CI:-0.820 to 0.329,P=0.402).In contrast,an obvious difference has been observed inΔJapanese Orthopedic Association(JOA)score(SMD=0.305,95%CI:0.046 to 0.563,P=0.021),total blood loss(SMD=-1.586,95%CI:-2.182 to-0.990,P=0.000),operation time(SMD=-2.831,95%CI:-3.753 to-1.909,P=0.000),and length of hospital stay(SMD=-0.614,95%CI:-1.050 to-0.179,P=0.006).CONCLUSION Bilateral fixation is more effective than unilateral fixation regarding fusion rate after lumbar interbody fusion.However,JOA,operation time,total blood loss,as well as length of stay were improved for unilateral fixation.
文摘Objective To explore the feasibility and efficiency of the treatment of lumbar degenerative diseases after transforaminal lumbar interbody fusion (TLIF) and posterolateral fusion (PLF) procedures in which unilateral pedicle screw fixation was used.
文摘Background Genital prolapse affects 30% of middle-aged and older women and is becoming a major public health concern. Sacrospinous ligament fixation is an effective and safe procedure for vaginal vault prolaps with a low recurrence and complication rate. This study aimed to investigate the efficacy and safety of unilateral sacrospinous ligament fixation （SSLF） for the management of pelvic organ prolapse （POP）.Methods Forty patients with severe prolapse of pelvic organ undergoing unilateral SSLF were retrospectively studied.In this study, all patients were staged by the value of POP-Q. All procedures were performed by a senior physician. The characteristics of these patients and their immediate and short-term post-operative outcome were recorded. All patients were seen six weeks and six months after the surgery. The evaluation included standardized questionnaire and site-specific vaginal examination by one physician.Results The average operation time was 65-92 minutes. The average blood loss was 83-188 ml. The average hospitalization time was 6.1 days. The average cost was 5885 yuan. The average day of urethral catheter removal after the operation was 2.1 days. The incidence of postoperative morbidity was 17.1%. One （2.4%） patient had hematoma in the right pelvic. The mean length of postoperative follow-up for 35 patients was 13.1 months. The rate of follow-up was 87.5%. One （2.9%） patient showed recurrent vaginal vault prolapse six months after the surgery. The objective success rate of pelvic organ prolapse was 85% （34/40）. There was significant difference between the POP-Q of Aa, Ba, Ap, Bp,and D before and after operation （P 〈0.001 ）. Five （14.3%） patients complained lower back pain, gluteal pain or right groin pain. Three （8.6%） patients developed de novo stress incontinence. Vaginal disabsorbable sutures were found in three （8.6%） patients. One （2.9%） patient had de novo urge incontinence.Conclusions Unilateral SSLF was both cost and treatment effective management for severe pelvic organ prolapse,especially for severe ovaginae anterior prolapse and uterus prolapse of POP Ⅰ, Ⅱ or Ⅲ. Main complications from this procedure included lower back pain, gluteal and groin pain and new onset of stress incontinence.
文摘目的:比较大通道全内镜下椎间减压融合联合单侧椎弓根螺钉固定与双侧椎弓根螺钉固定治疗单节段腰椎退行性疾病的疗效。方法:回顾性分析2019年12月~2021年10月在我院行大通道全内镜下椎间减压融合内固定手术治疗的47例单节段腰椎退行性疾病患者的临床资料,其中20例采用单侧椎弓根螺钉固定(单侧固定组),男5例,女15例,年龄39~69岁(54.1±9.6岁);27例采用双侧椎弓根螺钉固定(双侧固定组),男9例,女18例,年龄40~70岁(57.8±9.4岁)。两组患者的年龄、体重指数(body mass index,BMI)、性别、手术节段、疾病类型、随访时间等一般资料均无统计学差异(P>0.05)。比较两组患者手术时间、术中透视次数、住院费用、住院时间、手术前后的血红蛋白及变化值和并发症发生率;术前及术后3天、3个月、1年采用疼痛视觉模拟评分(visual analog scale,VAS)评价腰腿痛,术前及术后3个月、1年采用Oswestry功能障碍指数(Oswestry disability index,ODI)评价功能障碍情况;术后1年根据CT评价椎间融合情况,通过改良MacNab标准对临床疗效进行评价。结果:所有患者手术顺利,均获得1年及以上随访,双侧固定组手术时间、术中透视次数、住院费用、住院时间均显著性高于单侧固定组(P<0.05)。两组患者术前、术后血红蛋白值及血红蛋白变化值均无统计学差异(P>0.05)。两组患者术后3天、3个月、1年的VAS评分及术后3个月、1年的ODI均较术前明显下降(P<0.05);两组同时间点VAS评分及ODI比较均无统计学差异(P>0.05)。两组并发症发生率(单侧固定组10.0%vs双侧固定组11.1%)、术后1年融合率(单侧固定组90.0%vs双侧固定组92.6%)及改良MacNab优良率(单侧固定组90.0%vs双侧固定组88.9%)均无统计学差异(P>0.05)。结论:大通道全内镜下椎间减压融合联合单侧椎弓根螺钉固定与双侧椎弓根螺钉固定治疗单节段腰椎退行性疾病均安全有效,与双侧固定相比,单侧固定术中透视次数、手术时间、住院费用、住院时间更具有优势。
