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The Effect of Straight or Lordotic Rods on Cervical Subaxial Alignment While Fusing C1-C2.

直杆或前凸杆对颈椎轴下对线的影响,同时融合C1-C2。

  • 影响因子:1.52
  • DOI:10.1016/j.wneu.2019.09.118
  • 作者列表:"İştemen İ","Arslan A","Olguner SK","Gezercan Y","Ökten Aİ","Afşer KA
  • 发表时间:2020-01-01
Abstract

BACKGROUND:The C1 lateral mass and C2 pedicle screw with rod fixation system has been used commonly in recent years. Despite the numerous reports on this technique in the literature, there are no studies regarding the effect of the angle of the rod used. We investigated the effect of rod angle on subaxial lordosis, cervical sagittal balance, and pain scores. METHODS:Clinical records and radiologic images of 58 patients who underwent procedures between 2011 and 2016 at our clinic were assessed retrospectively. We recorded clinical findings, visual analog scale (VAS) scores, angles of cervical and segmental lordosis, and the distance between the C2 sagittal vertical axis (SVA) and the C7 posterior-superior corner. RESULTS:A total of 36 male and 22 female patients were enrolled. A negative correlation was found between the C1-C2 lordosis angle and the C2-C7 lordosis angle irrespective of surgical technique. In patients who were operated on using 30°-angled rods, there was a postoperative increase in C1-C2 lordosis degree and an improvement in C2 cervical SVA values. Postoperative month 6 VAS scores were significantly better in the patients who were operated on with angled rods compared with those who received straight rods. CONCLUSIONS:We believe this is because of the positive effect of the angled rod on sagittal balance. Nevertheless, prospective case-control studies should be conducted with larger groups of subjects. Furthermore, every patient should be evaluated considering the whole spinal sagittal balance.

摘要

背景: C1 侧块和C2 棒椎弓根螺钉固定系统近年来被广泛应用。尽管文献中有关于这种技术的大量报道,但没有关于所用棒角度影响的研究。我们研究了杆角对轴下前凸、颈椎矢状面平衡和疼痛评分的影响。 方法: 回顾性评估 2011 年至 2016 年间在我们诊所接受手术的 58 例患者的临床记录和放射学图像。我们记录了临床结果、视觉模拟评分 (VAS) 评分、颈椎和节段前凸角以及C2 矢状面垂直轴 (SVA) 与C7 后上角之间的距离。 结果: 共纳入 36 例男性和 22 例女性患者。无论手术技术如何,C1-C2 前凸角与C2-C7 前凸角均呈负相关。在使用 30 ° 角棒进行手术的患者中,术后C1-C2 前凸程度增加,C2 宫颈SVA值改善。与接受直杆手术的患者相比,接受有角度杆手术的患者术后 6 个月的VAS评分明显更好。 结论: 我们认为这是因为有角度的杆对矢状面平衡的积极作用。尽管如此,应该对更大的受试者群体进行前瞻性病例对照研究。此外,应考虑整个脊柱矢状面平衡对每位患者进行评估。

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作者列表:["Beltai A","Barnetche T","Daien C","Lukas C","Gaujoux-Viala C","Combe B","Morel J"]

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影响因子:4.13
发表时间:2020-01-01
DOI:10.1002/acr.23824
作者列表:["Chen SK","Liao KP","Liu J","Kim SC"]

METHODS:OBJECTIVE:We aimed to evaluate the comparative risk of hospitalized infection among patients with rheumatoid arthritis (RA) who initiated abatacept versus a tumor necrosis factor inhibitor (TNFi). METHODS:Using claims data from Truven MarketScan database (2006-2015), we identified patients with RA ages ≥18 years with ≥2 RA diagnoses who initiated treatment with abatacept or a TNFi. The primary outcome was a composite end point of any hospitalized infection. Secondary outcomes included bacterial infection, herpes zoster, and infections affecting different organ systems. We performed 1:1 propensity score (PS) matching between the groups in order to control for baseline confounders. We estimated incidence rates (IRs) and hazard ratios (HRs) with 95% confidence intervals (95% CIs) for hospitalized infection. RESULTS:We identified 11,248 PS-matched pairs of patients who initiated treatment with abatacept and TNFi with a median age of 56 years (83% were women). The IR per 1,000 person-years for any hospitalized infection was 37 among patients who initiated treatment with abatacept and 47 in those who initiated treatment with TNFi. The HR for the risk of any hospitalized infection associated with abatacept versus TNFi was 0.78 (95% CI 0.64-0.95) and remained lower when compared to infliximab (HR 0.63 [95% CI 0.47-0.85]), while no significant difference was seen when compared to adalimumab and etanercept. The risk of secondary outcomes was lower for abatacept for pulmonary infections, and similar to TNFi for the remaining outcomes. CONCLUSION:In this large cohort of patients with RA who initiated treatment with abatacept or TNFi as a first- or second-line biologic agent, we found a lower risk of hospitalized infection after initiating abatacept versus TNFi, which was driven mostly by infliximab.

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影响因子:4.13
发表时间:2020-01-01
DOI:10.1002/acr.23827
作者列表:["Lee RR","Rashid A","Thomson W","Cordingley L"]

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