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Prognosis of Hardware-Related Problems in Anterior Cervical Discectomy and Fusion with Cage and Plate Constructs.

颈椎前路椎间盘切除术和Cage与钢板结构融合术中硬件相关问题的预后。

  • 影响因子:1.52
  • DOI:10.1016/j.wneu.2019.10.042
  • 作者列表:"Song KJ","Choi BW","Ham DH","Kim HJ
  • 发表时间:2020-02-01
Abstract

OBJECTIVE:To analyze hardware-related problems and their prognoses after anterior cervical discectomy and fusion (ACDF) using cages and plates for degenerative and traumatic cervical disc diseases. METHODS:The study included 808 patients who underwent anterior cervical discectomy and fusion for degenerative and traumatic disc diseases with >1 year of follow-up. We investigated time of onset and progression of problems associated with instrumentation and cage usage. The mean follow-up time was 3.4 years. Type of plate, range and level of fusion, patient factors (age, sex, body mass index, and bone mineral density), and local kyphosis were evaluated. RESULTS:Complications were found in 132 cases (16.5%), including subsidence in 69 cases, plate loosening in 8 cases, screw loosening in 8 cases, screw breakage in 1 case, and multiple complications in 36 cases. In 3 cases, additional posterior cervical surgery was performed. One case needed hardware revision. There were no esophageal, tracheal, or neurovascular structural injuries secondary to metal failure. There were no significant differences in type of plate, level of surgery, or patient factors. The greater the number of fusion segments, the greater the incidence of complications (P = 0.001). The clinical outcomes improved regardless of the complications (P = 0.083). CONCLUSIONS:Most hardware-related complications are not symptomatic and can be treated conservatively. Only a few cases need revision surgery. Precise surgical techniques are needed in multilevel anterior cervical discectomy and fusion (>3 levels) because of the increased complication rate.

摘要

目的: 分析颈椎前路椎间盘切除融合术 (ACDF) 治疗退行性和创伤性颈椎间盘疾病的硬件相关问题及其预后。 方法: 研究纳入 808 例因退行性和创伤性椎间盘疾病行颈椎前路椎间盘切除融合术的患者,随访时间> 1 年。我们调查了与器械和cage使用相关的问题的发生和进展时间。平均随访时间为 3.4 年。评估钢板类型、融合范围和水平、患者因素 (年龄、性别、体重指数和骨密度) 和局部后凸。 结果: 并发症 1 32 例 (1 6.5%),其中下陷 69 例,钢板松动 8 例,螺钉松动 8 例,螺钉断裂 1 例,和多种并发症 36 例。3 例额外行颈椎后路手术。一个案例需要硬件修订。没有继发于金属衰竭的食管、气管或神经血管结构损伤。在钢板类型、手术水平或患者因素方面无显著差异。融合节段数目越多,并发症发生率越大 (P = 0.001)。无论有无并发症,临床结局均有所改善 (P = 0.083)。 结论: 大多数硬件相关并发症无症状,可保守治疗。只有少数病例需要翻修手术。由于并发症发生率增加,多节段颈前路椎间盘切除融合术 (>3 级) 需要精确的手术技术。

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影响因子:2.15
发表时间:2020-02-01
DOI:10.1007/s40520-019-01202-w
作者列表:["Gan J","Tu Q","Miao S","Lei T","Cui X","Yan J","Zhang J"]

METHODS:BACKGROUND:Postoperative cognitive dysfunction (POCD) is a common complication after orthopedic surgery, which is not conducive to the prognosis of the elderly. AIMS:We performed this study to investigate the effects of oxycodone applied for patient-controlled intravenous analgesia (PCIA) on postoperative cognitive function in elderly patients after total hip arthroplasty (THA). METHODS:Ninety-nine participants were enrolled and allocated into two groups: oxycodone group (group O) and sufentanil group (group S). The primary outcome was the incidence of POCD, diagnosed according to the changes in the Mini-mental status examination (MMSE) and Montreal Cognitive Assessment (MoCA) scores. The secondary outcomes included the plasma levels of S-100B protein and neuron-specific enolase (NSE), the amount of postoperative analgesic consumption and the incidence of adverse reactions. RESULTS:The incidence of POCD was significantly lower in patients receiving oxycodone up to the 3rd postoperative day (POD, 1st POD 27.3% vs. 51.1%, P = 0.021; 3rd POD 20.5% vs. 40.0%, P = 0.045), as compared to patients receiving sufentanil. The MMSE and MoCA scores of both groups decreased to varying degrees. However, compared with group S, the MMSE scores at 1st POD, 3rd POD, 5th POD and 7st POD in group O were higher than that in group S, while MoCA scores at 1st POD, 3rd POD and 5th POD in group O were higher. Compared with group S, the plasma levels of S-100B protein in group O at 4 h, 8 h, 12 h post-surgery were lower. While the plasma levels of NSE in group O at 4 h, 8 h, 12 h, 24 h post-surgery were lower. Number of PCIA boluses and consumption of analgesic drug during the first two POD were similar between two groups. However, postoperative incidence of nausea, vomiting and pruritus was significantly lower in patients receiving oxycodone. CONCLUSION:Oxycodone applied for PCIA in elderly patients after THA could reduce the incidence of POCD, improve postoperative cognitive function and decrease the adverse reactions.

影响因子:1.69
发表时间:2020-02-01
DOI:10.1097/BPO.0000000000001393
作者列表:["Jain MJ","Inneh IA","Zhu H","Phillips WA"]

METHODS:BACKGROUND:Primary treatment for Blount disease has changed in the last decade from osteotomies or staples to tension band plate (TBP)-guided hemiepiphysiodesis. However, implant-related issues have been frequently reported with Blount cases. The purpose of our study is to evaluate the surgical failure rates of TBP in Blount disease and characterize predictors for failure. METHODS:We performed an Institutional Review Board-approved retrospective chart-review of pediatric patients with Blount disease to evaluate the results of TBP from 2008 to 2017 and a systematic literature review. Blount cases defined as pathologic tibia-vara with HKA (hip-knee-ankle) axis and MDA (metaphyseal-diaphyseal angle) deviations ≥11 degrees were included in the analysis. Surgical failure was categorized as mechanical and functional failure. We studied both patient and implant-related characteristics and compared our results with a systematic review. RESULTS:In 61 limbs of 40 patients with mean follow-up of 38 months, we found 41% (25/61) overall surgical failure rate and 11% (7/61) mechanical failure rate corresponding to 11% to 100% (range) and 0% to 50% (range) in 8 other studies. Statistical comparison between our surgical failure and nonfailure groups showed significant differences in deformity (P=0.001), plate material (P=0.042), and obesity (P=0.044) in univariate analysis. The odds of surgical failure increased by 1.2 times with severe deformity and 5.9 times with titanium TBP in the multivariate analysis after individual risk-factor adjustment. All 7 mechanical failures involved breakage of cannulated screws on the metaphyseal side. CONCLUSIONS:Most of the studies have reported high failure rates of TBP in Blount cases. Besides patient-related risk factors like obesity and deformity, titanium TBP seems to be an independent risk factor for failure. Solid screws were protective for mechanical failure, but not for functional failure. In conclusion, efficacy of TBP still needs to be proven in Blount disease and implant design may warrant reassessment. LEVEL OF EVIDENCE:Level III-retrospective comparative study with a systematic review.

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影响因子:2.43
发表时间:2020-01-15
DOI:10.5435/JAAOS-D-18-00777
作者列表:["Chen DQ","Montgomery SR Jr","Cancienne JM","Werner BC"]

METHODS:INTRODUCTION:As cancer treatments continue to improve the overall survival rates, more patients with a history of cancer will present for anatomic total shoulder arthroplasty (TSA). Therefore, it is essential for orthopaedic surgeons to understand the differences in care required by this growing subpopulation. Although the current research suggests that good outcomes can be predicted when appropriately optimized patients with cancer undergo lower extremity total joint arthroplasty, similar studies for TSA are lacking. The primary study question was to examine whether a history of cancer was associated with an increased rate of venous thromboembolism (VTE) after TSA. Secondarily, we sought to examine any association between a history of prostate and breast cancer and surgical or medical complications after TSA. METHODS:Using a national insurance database, male patients with a history of prostate cancer and female patients with a history of breast cancer undergoing anatomic TSA for primary osteoarthritis were identified and compared with control subjects matched 3:1 based on age, sex, diabetes mellitus, and tobacco use. Patients with a history of VTE and patients who underwent reverse TSA or hemiarthroplasty were excluded. RESULTS:Female patients with a history of breast cancer and male patients with a history of prostate cancer undergoing TSA had significantly higher incidences of acute VTE (including deep venous thrombosis and pulmonary embolism) compared with matched control subjects (female patients: odds ratio, 1.41; 95% confidence interval, 1.10 to 1.81; P = 0.024 and male patients: odds ratio, 1.37; 95% confidence interval, 1.05 to 1.79; P = 0.023). No significant differences were noted in the incidences of any other complications assessed. CONCLUSION:Although a personal history of these malignancies does represent a statistically significant risk factor for acute VTE after anatomic TSA, the overall VTE rate remains modest and acceptable. The rates of other surgical and medical complications are not significantly increased in patients with a history of these cancers after TSA compared with control subjects.

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