ABSTRACT
Objective:To explore the value of nursing checklist in posterior surgery for thoracolumbar fracture with general anesthesia under prone position.Methods:A retrospective case series study was conducted to analyze the clinical data of 106 patients with thoracolumbar fracture admitted to Sir Run Run Shaw Hospital，Zhejiang University School of Medicine from June 2018 to May 2020. There were 80 males and 26 females，with age range of 25-57 years［（48.6 ± 11.9）years］. Segments of injury were located at T 11 in 18 patients，at T 12 in 26，at L 1 in 21，at L 2 in 25 and at L 3 in 16. All patients were treated with thoracolumbar posterior screw fixation under general anesthesia. Of all，51 patients received conventional postural nursing from June 2018 to May 2019（control group），and 55 patients received prone position nursing scheme for general anesthesia on the basis of conventional postural nursing from June 2019 to May 2020（verification group）. The incidence of postoperative complications including stress injury，brachial plexus injury，ulnar nerve injury and ocular discomfort as well as length of hospital stay and patients’ satisfaction were compared between the two groups. Visual analogue scale（VAS）and Oswestry disability index（ODI）were also used to measures outcome at postoperative 3 months. Results:All patients were followed up for 8-12 months［（10.5±0.9）months］. Verification group and control group showed significant differences in the incidence of stress injury（4%∶29%），brachial plexus injury（4%∶16%）and ocular discomfort consisiting of tears（2%∶12%），foreign body sensation（0%∶4%）and dryness（4%∶16%）（ P < 0.05），not in ulnar nerve injury and blurred vision. Length of hospitalization in verification group was（7.0±1.3）days，significantly shorter than that in control group［（9.9±1.9）days］（ P < 0.05）. Satisfaction of patients in verification group and control group was 85%（47/55）and 69%（35/51），respectively（ P < 0.05）. At 3 months postoperatively，VAS in verification group［（1.9 ± 0.8）points］was significantly lower than that in control group［（3.5±1.1）points］（ P < 0.05），and ODI was similar between the two groups（ P > 0.05）. Conclusions For patients with thoracolumbar fracture treated by posterior surgery with general anaesthesia under prone position，nursing checklist helps reduce occurrence of the related complication，shorten length of hospital stay，improve patient satisfaction，reduce postoperative pain and promote rehabilitation.
ABSTRACT
Objective To investigate the effect of anterior artificial vertebral body reconstruction and internal fixation after the failed posterior thoracolumbar fracture surgery.Methods A retrospective case series study was conducted to analyze the clinical data of 14 patients whose posterior thoracolumbar fracture surgery failed admitted to Sir Run Run Shaw Hospital School of Medicine affiliated to Zhejiang University from January 2014 to June 2017,There were eight males and six females,aged 29-69 years[(43.6±11 .9)years].The involved segments included T11 in one patient,T12 in two patients,L1 in five patients,L2 in four patients and L3 in two patients.According to AO classification,there were four patients with type A2,six with type A3,two with type B1 and two with type B2.The thoracolumbar injury severity scores(TLICS)ranged from 4 to 8 points[(5.3±1.1)points].There were six patients with nonunion,three with nonunion following screw loosening,three with nonunion following breakage,and two with neurological dysfunction.Revision plan:for patients with internal fixation loosening or rupture or long nail placement,the posterior internal fixation would be removed first,and then the stage I anterior revision would be performed after changing the position;for patients with complete internal fixation,only anterior revision would be performed.The operation time,intraoperative blood loss,intraoperative and postoperative complications,pain visual analogue score(VAS),Oswestry dysfunction index(ODI)score and kyphosis angle changes before and after operation were recorded.Results All patients were followed up for 12-54 months[(25.9±13.0)months].The anterior operation time ranged from 100 to 180 minutes[(137.9±23.6)minutes].The intraoperative blood loss ranged from 280 to 750 ml[(452.9±145.4)ml].There were no intraoperative or postoperative complications such as spinal nerve injury,cerebrospinal fluid leakage,vascular injury,abdominal organ injury,incision infection and hemorrhage.VAS decreased from preoperative(6.1±0.9)points to(1.9±0.7)points 3 months after operation and to(1.4±0.5)points at the last follow-up;ODI increased from preoperative(30.4±7.1)points to(7.9±6.4)points 3 months after operation and to(8.1±4.3)points at the last follow-up;kyphosis degree decreased from preoperative(-20.1±6.5)° to(5.6±6.4)° 3 months after operation and to(5.4±6.8)0 at the last follow-up.The VAS,ODI score and kyphosis degree were significantly improved at the last follow-up compared with those before operation(P＜ 0.01).Conclusions For patients with failed thoracolumbar fracture posterior surgery,anterior artificial vertebral body reconstruction and internal fixation can significantly relieve back pain,improve function and kyphosis deformity,with satisfactory clinical effect,which can be an ideal treatment option for the revision of thoracolumbar fracture.
ABSTRACT
Objective To identify the risk factors for postoperative reintubation in patients undergoing general anesthesia.Methods Forty-six thousand five hundred and seven patients,aged 18-83 yr,requiring reintubation after planned extubation in the postanesthesia care unit (PACU) of our hospital from January 2010 to December 2012,served as reintubation group.Patients in a 1∶5 ratio,aged 18-83 yr,admitted to the PACU of our hospital from January 2010 to December 2012,with successful extubation,served as control group.The general data of patients and operation-related factors including type of operation (emergency operation/elective operation),operative sites (head and neck,airway,within the chest,upper abdomen,lower abdomen,other sites) and operation time and anesthesia-related factors including requirement for opioids and muscle relaxants within 30 min before operation,and for neostigmine at the end of operation were recorded.The risk factors of which P values were less than 0.05 would enter the logistic regression analysis to stratify reintubation-related risk factors.Results Thirty-two patients were reintubated after operation and the incidence was 0.069％.There was significant difference in age,gender,body mass index,ASA physical status,preoperative SpO2,complication with upper respiratory infections within 2 weeks before operation,chronic obstructive pulmonary disease (COPD),or systemic inflammatory response syndrome (SIRS) and hypoproteinemia,operative sites and operation time between the two groups (P ＜ 0.05 or 0.01).The logistic regression analysis showed that ASA physical status ≥ Ⅲ,complication with COPD or SIRS,and thoracic surgery were closely correlated with postoperative reintubation in patients undergoing general anesthesia.Conclusion ASA physical status ≥ Ⅲ,complication with COPD or SIRS,and thoracic surgery are risk factors for postoperative reintubation in patients undergoing general anesthesia.