ABSTRACT
Objective: To investigate the efficacy and safety of a new cervical artificial disc prosthesis in the treatment of cervical degenerative diseases. Methods: The clinical data of 18 patients with single-level cervical degenerative diseases who underwent three dimensional printed anatomical bionic cervical disc replacement at Department of Spinal Surgery,Honghui Hospital,Xi'an Jiaotong University from May 2019 to July 2020 were analyzed retrospectively. There were 7 males and 11 females,aged (45±8) years old(range:28 to 58 years).The surgical segment was located at C3－4 level in 2 cases, C4－5 level in 5 cases, C5－6 level in 9 cases, and C6－7 level in 2 cases.The clinical and radiographic outcomes were recorded and compared at preoperative,postoperative times of one month and twelve months.The clinical assessments contained Japanese orthopedic association (JOA) score,neck disability index (NDI) and visual analogue scale (VAS).Imaging assessments included range of motion (ROM) of cervical spine, prosthesis subsidence and prosthesis anteroposterior migration.Repeated measurement variance analysis was used for comparison between groups,and paired t test was used for pairwise comparison. Results: All patients underwent the operation successfully and were followed up for more than 12 months.Compared with preoperative score,the JOA score,NDI and VAS were significantly improved after surgery (all P<0.01).There was no significant difference in postoperative ROM compared with 1-and 12-month preoperative ROM (t=1.570,P=0.135;t=1.744,P=0.099). The prosthesis subsidence was (0.29±0.13) mm (range: 0.18 to 0.50 mm) at 12-month postoperatively.The migration of prosthesis at 12-months postoperatively were (0.71±0.20) mm (range: 0.44 to 1.08 mm).There was no prosthesis subsidence or migration>2 mm at 12-month postoperatively. Conclusion: Three dimensional printed anatomical biomimetic cervical artificial disc replacement has a good early clinical effect in the treatment of cervical degenerative diseases, good mobility can be obtained while maintaining stability.
Subject(s)
Adult , Female , Humans , Male , Middle Aged , Biomimetics , Cervical Vertebrae/surgery , Follow-Up Studies , Intervertebral Disc/surgery , Intervertebral Disc Degeneration/surgery , Range of Motion, Articular , Retrospective Studies , Total Disc Replacement/methods , Treatment OutcomeABSTRACT
ABSTRACT We retrospectively evaluated the records of 49 grade 4 and 5 patients with 42 intracranial aneurysms treated within 72 h of subarachnoid hemorrhage (SAH). In total, 35 patients (71%) were grade 4, and 14 (29%) were grade 5. A total of 42 (85%) patients had one aneurysm, 6 (12%) had two aneurysms, and 1 (3%) had three aneurysms. Out of 49 patients, one technical (2%) and one clinical (2%) complication occurred at surgery. Twenty-one (43%) patients recovered well, including 7 with postoperative hematoma requiring an immediate evacuation of a clot. Fourteen (29%) patients had hydrocephalus and required a ventriculo-peritoneal shunt; 12 patients underwent tracheotomy postoperatively due to coma and pulmonary infection. We found that patients with Hunt and Hess grade 4 and 5 aneurysms can undergo successful neurosurgical clipping of the aneurysms after SAH. However, the morbidity and mortality rates remain high because of their poor clinical condition and a high incidence of vasospasm during treatment.
RESUMO Avaliamos retrospectivamente os registros de 49 pacientes com 42 aneurismas intracranianos de graus 4 e 5, tratados nas primeiras 72 horas após uma hemorragia subaracnóidea (HSA). Trinta e cinco pacientes (71%) apresentavam grau 4 e catorze (29%) grau 5. Quarenta e dois pacientes (85%) tinham um único aneurisma, seis (12%) tinham dois aneurismas, e um paciente (3%) tinha três aneurismas. Dos 49 pacientes, uma complicação técnica (2%) e uma complicação clínica (2%) ocorreram durante a cirurgia. Vinte e um pacientes (43%) recuperaram-se bem, incluindo sete que tiveram hematomas pós-operatórios que requereram a imediata evacuação do coágulo. Catorze pacientes (29%) tiveram hidrocefalia e submeteram-se à derivação ventrículo-peritoneal; doze pacientes submeteram-se à traqueostomia no pós-operatório, devido a coma e infecção pulmonar. Pacientes com aneurismas de graus 4 e 5, segundo a escala de Hunt & Hess podem submeter-se com sucesso à clipagem dos aneurismas após HSA. Entretanto, as taxas de morbidade e mortalidade ainda são altas, devido à condição clínica precária e à alta incidência de vasoespasmo durante o tratamento.