[A case control study of lumbar fusion surgery with the Wiltse approach and the traditional approach].

OBJECTIVE: To compare the clinical results between the Wiltse approach and traditional approach in lumbar fusion. METHODS: The clinical data of 70 patients with lumbar disc herniation or lumbar spondylolisthesis within Meyerding II degree who underwent lumbar fusion surgery from May 2016 to May 2017 were retrospectively analyzed. According to the surgical approach, the patients were divided into Wiltse approach group and traditional approach group. A total of 35 patients in Wiltse approach group, included 18 males and 17 females, with an average age of (52±11) years old;other 35 patients in traditional approach group, included 19 males and 16 females, with an average age of (51±14) years old. Included 38 patients with lumbar disc herniation and 32 patients with spondylolisthesis of Meyerding II degree. The operation time, intraoperative blood loss and postoperative drainage, the VAS score of low back pain and leg pain, the level of creatine phosphokinase (CK) and the cross-sectional area of multifidus muscl on MRI were recorded. RESULTS: The operation time, intraoperative blood loss and postoperative drainage in Wiltse approach group were less than in traditional approach group(P<0.05). There were significant differences in VAS score of low back pain at 7 days and 3 months after operation between two groups(P<0.05). VAS of back pain at both 7 days and 3 months showed better results (P<0.05); VAS of leg pain showed better results in 3 months but had no significant difference in 7 days. There was no significant difference in VAS score of leg pain at 7 days after operation between two groups(P>0.05), but at 3 months had significant difference(P<0.05). The peripheral blood CK levels at 1 day and 3 days after operation respectively were(400±103)U/L and (176±58)U/L in Wiltse approach group, while in traditional approach group were (598±57) U/L and (222±50) U/L, with statistical significance between the two groups(P<0.05). Preoperative cross-sectional area of multifidus muscl on MRI was (424±66) mm² in Wiltse approach group and (428±82) mm² in traditional approach group, there was no significant difference between two groups(P=0.8); at 3 months after operation, in Wiltse approach group was (347±73) mm² and in traditional approach group was(239±78)mm², there was significant difference between two groups(P<0.05). CONCLUSIONS: For lumbar spinal fusion surgery, compared with the traditional approach, Wiltse approach has advantages of shorter operation time, smaller paravertebral muscles injury, and obviously releasing postoperative low back and leg pain. However, in determining the surgery program, the surgical operater also should fully recognize that the anatomical differences of Wiltse approach may influence on operation.

[A study on the methodology regarding the prevalence survey of chronic obstructive pulmonary disease in China].

OBJECTIVE: To explore the methodology on prevalence study of chronic obstructive pulmonary disease (COPD) in line with the world, to obtain accurate epidemic data of COPD in China. METHODS: A national multi-center cross-sectional survey on prevalence, risk factors and burden of COPD was conducted in China. In each area, a population-based cluster sample of approximately 1450 individuals aged 40 years or older was interviewed, using standardized questionnaires that were revised on the methodology of burden of lung diseases (BOLD) study and according under the context of China. All participants were submitted to pre-bronchodilator spirometry. Those with airflow limitation received post-bronchodilator spirometry, physical examination, X-rays of chest and EKG (electrocardiogram) tests. The post-bronchodialators FEV1/FVC < 70% was identified as having COPD. RESULTS: Investigation has been completed with the same standardized procedures by all sites, up to the requirement of quality control. Over 85.0% of the spirometry tests and 95.0% of questionnaires had met the criteria of quality control in each area. Overall, 95.2% of the data was valid with acceptable spirometry and questionaire, and the valid response rate was 79.0%. CONCLUSION: The protocol was in line with the international standards, by which the prevalence of COPD in China was of adequate quality and valid.