RESUMO
This study aimed to investigate the clinical efficacy and outcome of combined microscope-assisted anterior cervical discectomy and fusion (ACDF) with posterior minimally invasive surgery through tubular retractors for patients with multisegmental cervical spondylotic myelopathy (MCSM).This retrospective study included 28 patients (19 males and 9 females) with multisegmental cervical spondylotic myelopathy, who underwent combined microscope-assisted ACDF with posterior minimally invasive surgery through tubular retractors in our single center between January 2012 and December 2016. The evaluated postoperative clinical outcomes were operation time, length of hospitalization, blood loss, levels of creatine phosphokinase isoenzyme MM (CPK-MM), Japanese Orthopedic Association (JOA) scores, visual analogue scale (VAS) scores, Cobb angle of C2-C7, and radiological assessments (included X-rays, computed tomography scans, and magnetic resonanceimaging images).The mean surgery time was 198.42â±â17.53âminutes, the average hospitalization length of hospital was 7.59â±â1.38 days, and the mean follow-up time was 13â±â2.45 months. On average, about 36.42â±â10.15âmL of blood was lost and CPK-MM increased to 331.75â±â23.15âIU/mL postoperatively (Pâ<â.001). The mean modified JOA scores increased from 8.21â±â0.69 preoperatively to 13.96â±â1.57 postoperatively (Pâ<â.001), whereas the mean VAS scores decreased from 6.64â±â1.28 preoperatively to 0.39â±â0.50 postoperatively (Pâ<â.001). Cobb angle of C2-C7 increased from 13.86°â±â5.69° preoperatively to 14.10°â±â5.56° postoperatively (Pâ=â.16).In conclusion, combined microscope-assisted ACDF with posterior minimally invasive surgery through tubular retractors appears to be a safe and effective treatment for patients with MCSM.
Assuntos
Vértebras Cervicais/cirurgia , Discotomia/métodos , Procedimentos Cirúrgicos Minimamente Invasivos , Fusão Vertebral/métodos , Espondilose/cirurgia , Adulto , Idoso , Perda Sanguínea Cirúrgica , Vértebras Cervicais/diagnóstico por imagem , Creatina Quinase Forma MM/sangue , Discotomia/efeitos adversos , Feminino , Humanos , Imageamento Tridimensional , Tempo de Internação , Imageamento por Ressonância Magnética , Masculino , Microscopia , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Minimamente Invasivos/efeitos adversos , Duração da Cirurgia , Estudos Retrospectivos , Fusão Vertebral/efeitos adversos , Espondilose/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Escala Visual AnalógicaRESUMO
INTRODUCTION: We wished to explore the relationship between CYP3A5 polymorphisms and adverse events in patients undergoing clopidogrel therapy. METHODS: A Boolean search of the PubMed, EMbase, OVID and Cochrane Library databases was conducted in April 2016. The primary outcome was major adverse cardiovascular events (MACE). The secondary outcome was bleeding events and resistance to the effects of clopidogrel. The CYP3A5 polymorphism was classified into three types: wild-type (AA), heterozygote (AG) and homozygous mutant (GG). We estimated pooled odds ratios (ORs) and 95% confidence intervals (95% CIs) using the Mantel-Haenszel model. RESULTS: Twelve studies involving 8284 patients were eligible for our meta-analysis. CYP3A5 polymorphisms had no obvious influence on MACE (AA+AG vs. GG: OR=1.032, 95% CI=0.583-1.824, p=0.915; AA vs. AG+GG: 1.415, 0.393-5.094, 0.595). There was no significant relationship between CYP3A5 polymorphisms and bleeding (GG vs. AA+AG: OR=0.798, 95% CI=0.370-1.721, p=0.565) or clopidogrel resistance (AA+AG vs. GG: 1.009, 0.685-1.488, 0.963; AA vs. AG+GG, 0.618, 0.368-1.039, 0.069). CONCLUSION: No significant correlation was found between CYP3A5 polymorphisms and adverse events due to clopidogrel therapy.