[Effects of short-segment pedicle screw internal fixation surgery combined with hyperbaric oxygen treatment for acute spinal injury on the morphology and function of the spine].

OBJECTIVE: To explore effect of short-segment pedicle screw internal fixation combined with hyperbaric oxygen in treating acute spinal fractures and its influence on recovery of spinal nerve function. METHODS: A total of 96 patients with acute spinal fracture admitted from February 2017 to March 2020 were divided into combined group and control group, with 48 cases in each group. Both groups were treated with short-segment pedicle screw internal fixation. The combined group was given hyperbaric oxygen after surgery. The operation time, surgical blood loss, incision length and other general operation conditions between two groups were recorded. The differences in spinal morphology and function, Ameraican Spinal Injury Assiciation(ASIA) neurological function grade, serum inflammatory factors and ability of daily living activities were observed before and after surgery. RESULTS: There was no significant difference in operation time, surgical blood loss, and incision length between combined group and control group(P>0.05). There were no significant differences in anterior height ratio and Cobb angle between two groups before surgery, 1 week and 6 months after surgery(P>0.05). The height ratio of anterior margin of the injured spine was significantly improved in both groups at 1 week and 6 months after surgery compared with preoperative period (P<0.05), and Cobb angle was significantly reduced in both groups compared with preoperative period (P<0.05). There was no statistically significant difference in serum interleukin-6(IL-6), interleukin-8(IL-8), and tumor necrosis factor-α(TNF-α) levels between two groups at 1 d after surgery(P>0.05);the serum IL-6, IL-8, and TNF-α levels of combined group were lower than those of control group at 1 week after surgery (P<0.05). At 6 months after surgery, ASIA neurological function grade of combined group was C grade in 2 cases, D grade in 23 cases, E grade in 22 cases. In control group, 7 cases was grade C, 26 cases was grade D, 13 cases was grade E, and the difference between two groups was statistically significant(P<0.05). The Barthel score of combined group was higher than that of control group at 1 month and 3 months after surgery, and the difference was statistically significant (P<0.05);at 6 months after surgery, there was no significant difference in Barthel score between two groups(P>0.05). CONCLUSION: Short-segment pedicle screw internal fixation combined with hyperbaric oxygen for the treatment of acute spinal fractures is beneficial to the recovery of spinal nerve function after surgery, and has a certain effect on the early improvement of the patients' activities of daily living.

[Comparision of surgical outcomes between percuteneous endoscopic interlaminar discectomy and fenestration discectomy for L5S1 lumbar disc herniation].

OBJECTIVE: To investigate the clinical effects of percuteneous endoscopic interlaminar discectomy(PEID)and fenestration discectomy(FD) for the treatment of L5S1 lumbar disc herniation(LDH). METHODS: A retrospective analysis was made on 86 patients with L5S1 LDH from January 2014 to March 2017 and followed up. According to the different surgical methods, the patients were divided into PEID group(43 cases) and FD group(43 cases). All operations were performed under general anesthesia. Forty-three patients in PEID group underwent percuteneous endoscopic interlaminar discectomy (PEID) and other 43 patients in FD group underwent classical fenestration discectomy (FD). Operative incision, operative time, intraoperative blood loss, duration of hospitalization, time of lying in bed after surgery, complication were compared between two groups. Pre- and postoperative visual analogue scale(VAS) of affected extremity pain and lumbar pain were recorded. Postoperative creatine kinase (CK) was observed in two groups. Modified Macnab criteria was used to evaluate the clinical effects. MRI was used to observe the survival rate of paraspinal muscle after operation. RESULTS: The length of skin incision, intraoperative blood loss, duration of hospitalization, time of lying in bed after surgery of PEID group and FD group were(0.7±0.1) cm, (8.0±3.0) ml, (3.0±1.5) d, (1.0±0.5) d and(5.0±1.8) cm, (62.0±50.5) ml, (11.0±2.5) d, (3.0±0.8) d, there was significant differences between two groups(P<0.05). VAS of affected extremity at 24 hours and 1 year after operation was obviously decreased in two groups(P<0.05), but there was no significant difference between groups(P>0.05). VAS of lumbar pain in PEID group and FD group were respectively (2.99±0.32), (5.44±1.31) scores at 24 hours after operation, and (1.56±0.60), ( 3.05±0.24) at 1 year after operation, there was significant differences between two groups(P<0.05). CK at 24, 48 hours after operation of FD group were obviously increased(P<0.05). According the modified Macnab criteria to evaluate the clinical effect, the rate of excellent and good of PEID group and FD group were 93% and 95%, respectively. The survival rate of paraspinal muscle by MRI in PEID group at 1 year after operation was higher than that in FD group(P<0.05). No complications such as spinal dura mater tearing, nerve root injury, vascular injury, intervertebral space infection were found in two groups. CONCLUSIONS: Both of the two methods are safe and can obtain satisfactory effect, but PEID is more in line with concept of minimally invasive and has more advantages in paraspinal muscle protection, operative incision, intraoperative blood loss, duration of hospitalization, time of lying in bed after operation.