Percutaneous pedicle screw fixation combined with limited-open decompression technique for thoracolumbar fractures with neurologic deficit / 中国骨伤

<p><b>OBJECTIVE</b>To evaluate the clinical effects of percutaneous pedicle screw fixation combined with limited open decompression technique for the treatment of thoracolumbar fractures with neurologic deficit.</p><p><b>METHODS</b>The clinical data of 76 patients with thoracolumbar fractures with neurologic deficit underwent percutaneous pedicle screw fixation combined with limited open decompression technique from June 2010 to June 2014 were retrospectively analyzed. There were 45 males and 31 femals, aged from 17 to 56 years with an average of 32.5 years old. According to the classification of Denis, 33 cases were type A, 26 cases were type B, 17 cases were type C. According to the criterion of American Spinal Injury Association(ASIA), 13 cases were grade A, 9 cases were grade B, 21 cases were grade C, 33 cases were grade D. The operative time, intraoperative blood loss, postoperative internal fixation lossening and breakage were recorded. The informations of the Cobb angle, the anterior height of injured vertebra, canal stenosis were observed before operation, 3 days after operation, and the final follow-up. The improvement of neurologic function were analyzed at final follow-up.</p><p><b>RESULTS</b>All the patients were followed up from 13 to 47 months with an average of 32.1 months. The mean operative time was 159 min (136 to 218 min) and the intraoperative blood loss was 225 ml(150 to 360 ml). The anterior height of injured vertebra was increased from (52.0±5.9)% before operation to (87.2±1.8)% at 3 days after operation, and (86.1±1.5)% at final follow-up (=45.27,=0.000); the Cobb angle was decreased from (29.7±8.2)° before operation to (5.7±2.9)° at 3 days after operation, and (5.9±3.6)° at final follow-up (=34.62,=0.000); the canal stenosis was decreased from (37.5±7.2)% before operation to (12.3±3.3)% at 3 days after operation, and (11.9±3.1)% at final follow-up(=37.02,=0.000); there was no significant differences between postoperative 3 days and the final follow-up about the above parametres(>0.05). According to ASIA criterion, the spinal cord function was classified as grade A in 13 cases, grade B in 0 cases, grade C in 10 cases, grade D in 21 cases and grade E in 32 cases at final follow-up. Internal fixation lossening and breakage occurred in 2 cases.</p><p><b>CONCLUSIONS</b>Percutaneous pedicle screw fixation combined with limited open decompression technique can obtain satisfactory clinical effect for patients with thoracolumbar fractures with neurologic deficit, and have a good recovery of nerve function can be observed.</p>

Neurologic Injury within Pelvic Ring Injuries

PURPOSE: To evaluate the incidence of neurologic injury in pelvic ring injuries and to assess the risk factors for neurologic injury related to pelvic fractures. MATERIALS AND METHODS: Sixty-two patients with the pelvic ring injury were enrolled in the study from March 2010 to May 2013. When the neurologic injury was suspected clinically, the electro-diagnostic tests were performed. Combined injuries, fracture types, and longitudinal displacements were examined for correlations with the neurologic injury. RESULTS: There were 7 cases of AO/OTA type A, 37 cases of type B, and 18 cases of type C. Among them, 25 patients (40%) had combined spine fractures, and the average of longitudinal displacement was 7 mm (1-50 mm). Of the 62 patients, 13 (21%) had neurologic injury related with pelvic fractures; 5 with lumbosacral plexus injury, 5 with L5 or S1 nerve injury, 2 with obturator nerve injury, and 1 case of lateral femoral cutaneous nerve injury. There were no relationships between the neurologic injuries and fracture types (p=0.192), but the longitudinal displacements of posterior ring and combined spine fractures were related to the neurologic injury within pelvic ring injury (p=0.006, p=0.048). CONCLUSION: The incidence of neurologic injury in pelvis fracture was 21%. In this study, the longitudinal displacements of posterior ring and combined spine fractures were risk factors for neurological injury in pelvic ring injury.

The Effect of Distal Aortic Pressure on Spinal Cord Perfusion in Rats

BACKGROUND: Aortic cross clamping is associated with spinal cord ischemia. This study used a rat spinal cord ischemia model to investigate the effect of distal aortic pressure on spinal cord perfusion. MATERIALS AND METHODS: Male Sprague-Dawley rats (n=12) were divided into three groups. In group A (n=4), the aorta was not occluded. In groups B (n=4) and C (n=4), the aorta was occluded. In group B the distal aortic pressures dropped to around 20 mmHg. In group C, the distal aortic pressure was decreased to near zero. The carotid artery and tail artery were cannulated to monitor the proximal aortic pressure and the distal aortic pressure. Fluorescent microspheres were used to measure the regional blood flow in the spinal cord. RESULTS: After aortic occlusion, blood flow to the cervical spinal cord showed no significant difference among the three groups. In groups B and C, the thoracic and lumbar spinal cord and renal blood flow decreased. No microspheres were detected in the thoracic and lumbar spinal cord of group C. CONCLUSION: The spinal cord blood flow is dependent on the distal aortic pressure after thoracic aortic occlusion.

Neurologic injury after off-pump coronary artery bypass grafting in elder patients with a history of cerebral infarction / 中华内科杂志

Objective To study neurologic injury after off-pump coronary artery bypass grafting (OPCABG) in elder patients with a history of stroke. Methods 108 patients (age≥60years) undergoing elective OPCABG with a history of stroke were studied. Each study patient was matched with 1 control patient who had no stroke history and was undergoing elective OPCABG either immediately before or immediately after the study patients by the same surgeon. Preoperative characteristics, ICU stay, hospital stay, hospital mortality, postoperative neurologic injury were compared in the two groups. Results The incidence of neurologic injury after operation among the study group was higher than those in control group (P＜0.01)(27.8% vs 4.6%). The incidence of delirium and stroke after operation among the study group was higher than those in control group(P＜0.05) (20.4% vs 3.7% ,7.4% vs 0.9%) ;The study group took longer to stay in ICU and hospital than the control group [(26.5±16.4)h vs (21.6±8.8)h ,(23.6±9.2)d vs(19.4±5.7)d, P＜0.01]. Logistic regression analysis showed that the risk factors of neurologic injury after OPCABG included previous stroke (OR 6. 269, 95% CI 2. 218-17. 717), age (OR 1.131,95% CI 1.032-1.239), hypertension (OR 5.072,95% CI 1. 420-18. 114) and diabetes (OR 2. 652,95% CI 1. 123-6. 260). Stroke after the operations was found in 8 of 108 study patients and included cerebral infarction in 6 and transient ischemic attack in 2. 8 patients had late stroke (＞ 24 hours).Conclusion The eldely patients with previous stroke undergoing OPCABG are more likely to have neurologic injury after operations, these patients had longer stays in ICU and hospital.

Risk Factor Analysis for Spinal Cord and Brain Damage after Surgery of Descending Thoracic and Thoracoabdominal Aorta / 대한흉부외과학회지

BACKGROUND: Surgery of descending thoracic or thoracoabdominal aorta has the potential risk of causing neurological injury including spinal cord damage. This study was designed to find out the risk factors leading to spinal cord and brain damage after surgery of descending thoracic and thoracoabdominal aorta. MATERIAL AND METHOD: Between October 1995 and July 2005, thirty three patients with descending thoracic or thoracoabdominal aortic disease underwent resection and graft replacement of the involved aortic segments. We reviewed these patients retrospectively. There were 23 descending thoracic aortic diseases and 10 thoracoabdominal aortic diseases. As an etiology, there were 23 aortic dissections and 10 aortic aneurysms. Preoperative and perioperative variables were analyzed univariately and multivariately to identify risk factors of neurological injury. RESULT: Paraplegia occurred in 2 (6.1%) patients and permanent in one. There were 7 brain damages (21%), among them, 4 were permanent damages. As risk factors of spinal cord damage, Crawford type II.III (p=0.011) and intercostal artery anastomosis (p=0.040) were statistically significant. Cardiopulmonary bypass time more than 200 minutes (p=0.023), left atrial vent catheter insertion (p=0.005) were statistically significant as risk factors of brain damage. Left heart partial bypass (LHPB) was statistically significant as a protecting factor of brain (p=0.032). CONCLUSION: The incidence of brain damage was higher than that of spinal cord damage after surgery of descending thoracic and thoracoabdominal aorta. There was no brain damage in LHPB group. LHPB was advantageous in protecting brain from postoperative brain injury. Adjunctive procedures to protect spinal cord is needed and vigilant attention should be paid in patients with Crawford type II.III and patients who have patent intercostal arteries.

Risk Factor Analysis for Operative Death and Brain Injury after Surgery of Stanford Type A Aortic Dissection / 대한흉부외과학회지

BACKGROUND: Surgery for Stanford type A aortic dissection shows a high operative mortality rate and frequent postoperative brain injury. This study was designed to find out the risk factors leading to operative mortality and brain injury after surgical repair in patients with type A aortic dissection. MATERIAL AND METHOD: One hundred and eleven patients with type A aortic dissection who underwent surgical repair between February, 1995 and January, 2005 were reviewed retrospectively. There were 99 acute dissections and 12 chronic dissections. Univariate and multivariate analysis were performed to identify risk factors of operative mortality and brain injury. RESULT: Hospital mortality occurred in 6 patients (5.4%). Permanent neurologic deficit occurred in 8 patients (7.2%) and transient neurologic deficit in 4 (3.6%). Overall 1, 5, 7 year survival rate was 94.4, 86.3, and 81.5%, respectively. Univariate analysis revealed 4 risk factors to be statistically significant as predictors of mortality: previous chronic type III dissection, emergency operation, intimal tear in aortic arch, and deep hypothemic circulatory arrest (DHCA) for more than 45 minutes. Multivariate analysis revealed previous chronic type III aortic dissection (odds ratio (OR) 52.2), and DHCA for more than 45 minutes (OR 12.6) as risk factors of operative mortality. Pathological obesity (OR 12.9) and total arch replacement (OR 8.5) were statistically significant risk factors of brain injury in multivariate analysis. CONCLUSION: The result of surgical repair for Stanford type A aortic dissection was good when we took into account the mortality rate, the incidence of neurologic injury, and the long-term survival rate. Surgery of type A aortic dissection in patients with a history of chronic type III dissection may increase the risk of operative mortality. Special care should be taken and efforts to reduce the hypothermic circulatory arrest time should always be kept in mind. Surgeons who are planning to operate on patients with pathological obesity, or total arch replacement should be seriously consider for there is a higher risk of brain injury.

Invasive Pulmonary Aspergillosis Invaded to Thoracic Vertebra in a Immunocompetent Host: A case report / 대한흉부외과학회지

Pulmonary aspergillosis is the most common disease of fungal infection and has lower infectivity. Pulmonary aspergillosis is classified by aspergilloma, bronchopulmonary aspergillosis, necrotic and invasive aspergillosis. Invasive aspergillosis is found in immune compromised host, immunosuppressive treatment after organ transplantation, anticancerous chemotherapy, blood abnormality, AIDS patients etc. We reported a case of invasive aspergillosis in an immunocompetent host, with review of literatures.