Outcomes of Thoracolumbar Burst Fracture in Patients With Osteoporosis Without Neurologic Symptoms: Analysis of Three Different Surgical Approaches

2019 ◽  
Vol 9 (8) ◽  
pp. 1052-1057
Author(s):  
Tao Li ◽  
Yonghong Zheng ◽  
Zhengwei Xu ◽  
Dingjun Hao ◽  
Lixiong Qian
Keyword(s):  
Blood Loss ◽  
Internal Fixation ◽  
Hospital Stay ◽  
Burst Fracture ◽  
Surgical Approaches ◽  
Intraoperative Blood Loss ◽  
Thoracolumbar Burst Fracture ◽  
Neurologic Symptoms ◽  
Group A ◽  
Group B

This study aimed to compare the outcomes of thoracolumbar burst fractures in patients with osteoporosis without neurologic symptoms according to the surgical approach. The patients in group A underwent percutaneous balloon kyphoplasty, those in group B underwent minimally invasive percutaneous reduction and internal fixation, and those in group C underwent open reduction with bone graft fusion and internal fixation. Fracture reduction was assessed by X-ray. The operative time in group A was shorter than that in groups B and C, with less intraoperative blood loss and shorter hospital stay. The intraoperative blood loss was less in group B than in group C, with shorter hospital stay. The postoperative visual analog scale scores were lower than the preoperative scores in each group. Cobb's angle of the injured vertebra in the last follow-up was larger in group A than in groups B and C. Regarding complications, in group A, nine patients developed postoperative bone cement leakage that required no specific treatment. In group B, one patient developed subcutaneous hematoma that healed well after treatment. The screw channel was loosened in two patients without symptoms; the screws were removed 1 year later. In group C, delayed incision healing was found in five patients. All three surgical approaches safely and effectively relieved the lower back pain in patients with thoracolumbar burst fracture with osteoporosis but without neurologic symptoms.

scholarly journals Comparison of Conventional Fenestration Discectomy Versus Percutaneous Transforaminal Endoscopic Discectomy for Treating Lumbar Disc Herniation

2020 ◽  
Author(s):  
Quanyi Li ◽  
yongchun zhou
Keyword(s):  
Blood Loss ◽  
Hospital Stay ◽  
Lumbar Disc Herniation ◽  
Disc Herniation ◽  
Lumbar Disc ◽  
Intraoperative Blood Loss ◽  
Endoscopic Discectomy ◽  
Percutaneous Transforaminal Endoscopic Discectomy ◽  
Group A ◽  
Group B

Abstract Purpose: To compare the efficacy of conventional interlaminar fenestration discectomy (IFD) versus percutaneous transforaminal endoscopic discectomy (PTED) for treating lumbar disc herniation (LDH). Methods: The clinical data of 1,100 patients who had been diagnosed with LDH from January 2012 to December 2017 were retrospectively analysed. IFD was performed on the 605 patients in Group A, while PTED was performed on the 505 patients in Group B. The Oswestry Disability Index (ODI), Visual Analogue Scale (VAS) for pain, and modified Macnab criteria were adopted to evaluate the outcomes. Moreover, the surgery durations, intraoperative blood loss, postoperative off-bed activities, and postoperative lengths of hospital stay for the two groups were observed. Results: The follow-up period ranged from 24 months to 60 months, with an average duration of 43 months. As the excellent and good outcome rate was 93.5% in Group A and 92.6% in Group B, there were no significant differences in efficacy between the two groups (P > 0.05). However, Group B had significantly less intraoperative blood loss and shorter bed rest durations and postoperative lengths of hospital stay than did Group A (P < 0.05). There were two cases of postoperative recurrence in Group A and three in Group B. Conclusions: Although conventional IFD and PTED had similar levels of efficacy in treating LDH, transforaminal endoscopic discectomy exhibited several advantages, such as less trauma, less bleeding, and a shorter length of hospital stay, and it can be considered an ideal surgical option for treating LDH.Save and Continue

scholarly journals Comparison of conventional fenestration discectomy with Transforaminal endoscopic lumbar discectomy for treating lumbar disc herniation:minimum 2-year long-term follow-up in 1100 patients

2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Quanyi Li ◽  
Yongchun Zhou
Keyword(s):  
Hospital Stay ◽  
Lumbar Disc ◽  
Length Of Hospital Stay ◽  
Bed Rest ◽  
Intraoperative Blood Loss ◽  
Postoperative Length ◽  
Group A ◽  
Group B ◽  
Endoscopic Lumbar Discectomy

Abstract Purpose To compare the efficacy of conventional interlaminar fenestration discectomy (IFD) with transforaminal endoscopic lumbar discectomy (TELD) for treating lumbar disc herniation (LDH). Methods The clinical data of 1100 patients who had been diagnosed with LDH between January 2012 and December 2017 were retrospectively analysed. IFD was performed on 605 patients in Group A, whereas TELD was performed on 505 patients in Group B. The Oswestry Disability Index, Visual Analogue Scale for pain and modified MacNab criteria were used to evaluate the outcomes. The surgery duration, intraoperative blood loss, postoperative off-bed activity and postoperative length of hospital stay were recorded. Results The follow-up period ranged from 24 to 60 months, with an average of 43 months. The excellent and good outcome rates were 93.5% in Group A and 92.6% in Group B. There was no significant difference in efficacy between the groups (P > 0.05). However, Group B had significantly less intraoperative blood loss and shorter bed rest duration and postoperative length of hospital stay than Group A (P < 0.05). There were two cases of postoperative recurrence in Group A and three in Group B. Conclusions Although conventional IFD and TELD had similar levels of efficacy in treating LDH, TELD had several advantages. There was less intraoperative bleeding, shorter length of hospital stay and shorter bed rest duration. It can be considered a safe and effective surgical option for treating LDH.

scholarly journals Effect of Intraoperative Blood Loss on Perioperative Complications and Neurological Outcome in Adult Patients Undergoing Elective Brain Tumor Surgery

2019 ◽  
Vol 10 (04) ◽  
pp. 631-640 ◽  
Author(s):  
Vanitha Rajagopalan ◽  
Rajendra Singh Chouhan ◽  
Mihir Prakash Pandia ◽  
Ritesh Lamsal ◽  
Girija Prasad Rath
Keyword(s):  
Brain Tumor ◽  
Blood Loss ◽  
Blood Volume ◽  
Perioperative Complications ◽  
Tumor Surgery ◽  
Intraoperative Blood Loss ◽  
Brain Tumor Surgery ◽  
Group A ◽  
Group B ◽  
Group D

Abstract Background Major blood loss during neurosurgery can lead to several complications, including life-threatening hemodynamic instabilities. Studies addressing these complications in patients undergoing intracranial tumor surgery are limited. Materials and Methods During the study period, 456 patients who underwent elective craniotomy for brain tumor excision were categorized into four groups on the basis of estimated intraoperative blood volume loss: Group A (<20%), Group B (20–50%), Group C (>50–100%), and Group D (more than estimated blood volume). The occurrence of various perioperative complications was correlated with these groups to identify if there was any association with the amount of intraoperative blood loss. Results The average blood volume loss was 11% ± 5.3% in Group A, 29.8% ± 7.9% in Group B, 68.3% ± 13.5% in Group C, and 129.1% ± 23.9% in Group D. Variables identified as risk factors for intraoperative bleeding were female gender (p < 0.001), hypertension (p = 0.008), tumor size >5 cm (p < 0.001), high-grade glioma (p = 0.004), meningioma (p < 0.001), mass effect (p = 0.002), midline shift (p = 0.014), highly vascular tumors documented on preoperative imaging (p < 0.001), extended craniotomy approach (p = 0.002), intraoperative colloids use >1,000 mL (p < 0.001), intraoperative brain bulge (p = 0.03), intraoperative appearance as highly vascular tumor (p < 0.001), and duration of surgery >300 minutes (p < 0.001). Conclusions Knowledge of these predictors may help anesthesiologists anticipate major blood loss during brain tumor surgery and be prepared to mitigate these complications to improve patient outcome.

scholarly journals Comparison of Clinical and Radiologic Outcome of Adolescent Idiopathic Scoliosis Treated with Hybrid Hook-Screw Instrumentation versus Universal Clamp System

2016 ◽  
Vol 2016 ◽  
pp. 1-5 ◽  
Author(s):  
Ebrahim Ghayem Hassankhani ◽  
Farzad Omidi-Kashani ◽  
Shahram Moradkhani ◽  
Golnaz Ghayem Hassankhani ◽  
Mohammad Taghi Shakeri
Keyword(s):  
Adolescent Idiopathic Scoliosis ◽  
Blood Loss ◽  
Idiopathic Scoliosis ◽  
Operative Time ◽  
Intraoperative Blood Loss ◽  
Curve Correction ◽  
Universal Clamp ◽  
Outcome Scores ◽  
Group A ◽  
Group B

Background. In surgical treatment of adolescent idiopathic scoliosis (AIS), hybrid universal clamp system has been used by some authors. We aimed to compare the clinical and radiologic outcome of hybrid universal clamp with hybrid thoracic hook lumbar screw. Methods. A prospective study was performed on 56 consecutive patients with AIS, who had alternatively undergone a posterior spinal fusion and instrumentation with hybrid thoracic hook lumbar screw system (28 patients: group A) and hybrid universal clamp system (28 patients: group B) between June 2006 and January 2014 at Imam Reza University Hospital and had been followed up for more than two years. The comparison was according to radiographic changes, operative time, intraoperative blood loss, complications, and Scoliosis Research Society (SRS-22) outcome scores. Results. The preoperative mean curve Cobb angle was 58°±7° (42°–74°) in group A and 60°±9° (46°–75°) in group B. The mean final coronal curve correction was 60.4% and 75.5% in groups A and B, respectively (P=0.001). Postoperative SRS outcome scores were also comparable. Conclusion. Universal clamp instrumentation had a significantly better curve correction and lower complication rate compared with hybrid thoracic hook lumbar screw. Both instrumentation methods had similar operative time, intraoperative blood loss, and postoperative SRS outcome scores.

Single Intravenous Bolus versus Continuous Infusion of Tranexamic Acid to Reduce Blood Loss in Transurethral Resection of Prostate: a Prospective Randomized Double-Blind Study

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Safaa I Ghaly ◽  
Marwa A Khairy ◽  
Mohamed M Kamal ◽  
Eman A Mohammed
Keyword(s):  
Blood Loss ◽  
Tranexamic Acid ◽  
Transurethral Resection ◽  
Bolus Dose ◽  
Transurethral Resection Of Prostate ◽  
Intraoperative Blood Loss ◽  
Operative Blood Loss ◽  
Single Bolus Dose ◽  
Group A ◽  
Group B

Abstract Background and aim Intraoperative use of a single bolus dose of tranexamic acid may not be sufficient to prevent bleeding in the early postoperative period. The present study was carried out to compare the effect of two dose regimens of tranexamic acid in reducing perioperative blood loss and the amount of allogeneic blood transfusion in transurethral resection of prostate. Design prospective, double-blinded and controlled study. Setting Ain Shams University Hospital, Patients and Methods 50 patients electively posted for transurethral resection of prostate were randomly assigned to receive a single bolus dose of tranexamic acid (10 mg/kg) (Group A), a bolus dose of tranexamic acid (10 mg/kg) followed by infusion (1 mg/kg/h) till 4 h postoperatively (Group B). Measurements Total intraoperative blood loss, amount of allogeneic blood transfusion, postoperative drain collections, and hemoglobin and hematocrit levels were recorded at different time intervals. Data obtained after comparing two groups were analyzed using the statistical package for social sciences. Results There was no statistically significant difference among patients in both groups regarding intraoperative blood loss and postoperative blood loss at 6 hrs and 48 hrs postoperatively. However the post-operative blood loss at 24 hrs was significantly higher among patients in group A than patients in group B (P-value= 0.014) . Conclusion Tranexamic acid causes more effective reduction in post-operative blood loss when used as a bolus followed by an infusion continued in the postoperative period in comparison to its use as a single intravenous bolus in transurethral resection of prostate.

scholarly journals Intramedullary nailing for pertrochanteric fractures of proximal femur: a consecutive series of 323 patients treated with two devices

2019 ◽  
Vol 14 (1) ◽  
Author(s):  
Pompeo Catania ◽  
Daniele Passaretti ◽  
Giorgio Montemurro ◽  
Simone Ripanti ◽  
Stefano Carbone ◽  
...  
Keyword(s):  
Blood Loss ◽  
Age Distribution ◽  
Harris Hip Score ◽  
Consecutive Series ◽  
Intraoperative Blood Loss ◽  
Pertrochanteric Fractures ◽  
Functional Scores ◽  
Group A ◽  
Group B

Abstract Introduction Pertrochanteric fractures (PFs) frequently affect the lower limb of osteoporotic patients and represent an important cause of morbidity and mortality in the elderly. In this prospective randomized controlled trial, we have compared functional and radiological results and complications of patients affected by PFs treated with two intramedullary proximal femoral nails. Materials We enrolled 323 subjects with PFs, classified according to AO/OTA system as 31.A1 (pertrochanteric simple) and 31.A2 (pertrochanteric multifragmentary). Patients were divided into two groups according to the osteosynthesis devices: group A, Elos-Intrauma® nail (155 cases) and group B, Gamma 3-Stryker® nail (168 cases). Pre-operatively, the baseline characteristics of each patient (gender, age, weight and BMI) were collected. Intraoperative blood loss, subjective pain by visual analogue scale (VAS), esthetic satisfaction, functional scores of the hip by Harris Hip Score (HHS), and Western Ontario and McMaster Universities Arthritis Index (WOMAC) were noted. The post-operative degree of fracture reduction was assessed. Each patient had a minimum follow-up of 12 months. Results The study group was composed of 106 male and 217 female with an average age of 85.4 (range, 65–90, standard deviation (SD) 5.95) years. No statistical differences about sex and age distribution were noted between the two groups. Group A reported lower intraoperative blood loss, 45 ml vs 51 ml, respectively (p < 0.001). There was not any statistical difference about operative time. Group A had a better reduction of fracture (p = 0.0347). The greatest difference was detectable comparing subgroups 31.A2 (p = 0.032). There were no statistical differences about complication frequency and the overall rate was 25% (80 cases). Finally, there was no difference in terms of VAS, HHS, and WOMAC score between the two groups on each follow-up. Patients of group A showed a higher subjective satisfaction index at 1 post-operative year, 7.42 (SD 1.19) vs 6.45 (SD 1.35) of group B (p < 0.001). Conclusion Elos® nail is a reliable device on a short-term follow-up and represents an alternative choice to the Gamma 3® nail, a well-known and appreciated system for over 25 years.

scholarly journals Comparison of three surgical approaches for thoracolumbar junction (T12-L1) tuberculosis: a multicentre, retrospective study

2019 ◽  
Vol 20 (1) ◽  
Author(s):  
Yanping Zeng ◽  
Peng Cheng ◽  
Jiulin Tan ◽  
Zhilin Li ◽  
Yuan Chen ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Blood Loss ◽  
Operation Time ◽  
Neurological Deficits ◽  
Thoracolumbar Junction ◽  
Surgical Approaches ◽  
Instrumented Fusion ◽  
Group A ◽  
Group B ◽  
Multicentre Retrospective Study

Abstract Background The surgical approaches to thoracolumbar junction (T12-L1) tuberculosis were controversial. We aimed to compare the safety and efficacy of three different procedures through a multicentre retrospective study. Methods The medical records of thoracolumbar junction tuberculosis patients (n = 177) from January 2005 to January 2015 were collected and reviewed. Forty-five patients underwent anterior debridement and instrumented fusion (Group A), 52 underwent anterior combined with posterior debridement and instrumented fusion (Group B) and 80 underwent posterior-only debridement and instrumented fusion (Group C). Patients with neurological deficit were 10 in Group A, 23 in Group B, 36 in Group C. All patients had a standard preoperative and postoperative anti - tuberculous therapy regimen. Clinical outcomes, laboratory indexes and radiological evaluation of the three groups were compared. Operations at each centre were performed by the respective senior medical teams of the six different hospitals. Results All three surgical approaches achieved bone fusion and pain relief. Cases with neurological deficits had different degrees of improvement after surgery. The operative time was 330.2 ± 45.4 min, 408.0 ± 54.3 min, 227.9 ± 58.5 min, and the blood loss was 744.0 ± 193.8 ml, 1134.6 ± 328.2 ml, 349.8 ± 289.4 ml in groups A, B and C respectively. The average loss of correction was 5.5 ± 3.7° in group A, 1.6 ± 1.9° in group B, 1.7 ± 2.2° in group C, and the difference between groups except B vs C were of statistically significant (P < 0.05). Conclusions For patients with thoracolumbar junction (T12-L1) tuberculosis, the posterior-only procedure is the better than the anterior-only procedure in the correction of kyphosis and maintenance of spinal stability. The posterior-only procedure is recommended because it achieves the same efficacy as combined procedure with shorter operation time, less blood loss and trauma.

Endoscopic Left Central Lymph Node Dissection of Thyroid Cancer: Safe, Feasible, and Relatively Easy

2021 ◽  
pp. 155335062098364
Author(s):  
Peng Sun ◽  
Tsz Kin Mak ◽  
Jinyi Li ◽  
Cunchuan Wang
Keyword(s):  
Lymph Node ◽  
Blood Loss ◽  
Intraoperative Blood Loss ◽  
Node Dissection ◽  
Central Lymph Node ◽  
Central Lymph Node Dissection ◽  
Group A ◽  
Metastasis Rate ◽  
Central Lymph ◽  
Group B

Purpose. The purpose of this study was to explore the feasibility of left central lymph node dissection (CLND) in endoscopic thyroidectomy via chest-breast approach (ETCB). Methods. Retrospective analysis of 57 cases of left CLND (group A) via ETCB, 35 cases of open left CLND (group B), and 90 cases of right CLND via ETCB (Group C) were performed from October 2014 to October 2019. Surgical data, complications, and follow-up data were compared among group A and group B, group A and group C, respectively. Results. There were no significant differences between group A and group B in intraoperative blood loss, tumor size, lymph node (LN) metastasis rate, dissected LN number, metastatic LN number, serum thyroglobulin (sTg), radioactive iodine uptake (RAIU), radioactive technetium uptake (RATU), radionuclide imaging of the residual area (RITRA), and radionuclide imaging of suspicious lymph node metastasis (RISLNM). There were no significant differences between group A and group C in age, operation time, intraoperative blood loss, postoperative hospital stay, tumor size, LN metastasis rate, dissected LN number, metastatic LN number, hypoparathyroidism, sTg, RAIU, RATU, RITRA, and RISLNM. There were 5 cases of temporary recurrent laryngeal nerve (RLN) palsy and 1 case of recurrence in group C. Besides, 1 case of lymphatic leakage was in group A. Conclusion. For selected cases, endoscopic left CLND is safe, feasible, efficient, and more easier than endoscopic right CLND.

scholarly journals Clinical effect of individualized 3D printing guide assisted placement of upper cervical pedicle screw

2021 ◽  
Author(s):  
Guoqi Niu ◽  
Chao Li ◽  
Jianzhong Bai ◽  
Gong Zhou ◽  
Lutan Liu ◽  
...  
Keyword(s):  
3D Printing ◽  
Blood Loss ◽  
Pedicle Screw ◽  
Operation Time ◽  
Intraoperative Blood Loss ◽  
Cervical Pedicle Screw ◽  
Upper Cervical ◽  
Group A ◽  
Cervical Pedicle ◽  
Group B

Abstract Objective To investigate the clinical effect of individualized 3D printing guide assisted upper cervical pedicle screw placement. Methods Eighteen patients with upper cervical spine injury requiring surgical treatment were included in our hospital from May 2010 to May 2019. These patients were divided into guide plate assisted screw implantation group (Group A, N = 10) and traditional operation group (Group B, N = 8). All patients were followed up for more than 6 months. Screw implant accuracy, cervical spine JOA score, ASIA score, VAS score, operation time, intraoperative blood loss were compared between the two groups. Result A total of 72 atlantoaxial pedicle screws were implanted, 40 in group A and 32 in group B. The accuracy rate of nail implantation was 97.50% in group A and 81.25% in group B (P < 0.05). The operation time in group A (189.7 ± 16.1 mins) and group B (242.1 ± 23.2 mins), P < 0.05. The intraoperative blood loss in group A (216.0 ± 49.7 ml) and group B (385.0 ± 23.5 ml), P < 0.05. The intraoperative fluoroscopic times was 8.7 ± 1.1 in group A and 30.0 ± 3.3 in group B (P < 0.05). Besides, the JOA, Asia and VAS scores of the two groups at one week after operation and the last follow-up were significantly different from those before operation. One week after operation, the JOA, Asia and VAS scores of group A were significantly better than those of group B, but there was no significant difference between the two groups at the last follow-up. Conclusions individualized 3D printing guide assisted placement of upper cervical pedicle screw can significantly improve the accuracy of screw implantation and postoperative function of patients, reduce the times of X-ray fluoroscopy, operation time, and intraoperative blood loss, which is a safe and effective approach and worthy of clinical promotion.

scholarly journals The Improved TBW Versus the Standard TBW for Olecranon Fractures in the Aged: a Retrospectively Comparative Study

2021 ◽  
Author(s):  
Xiaoyong Lin ◽  
Hai Liao
Keyword(s):  
Postoperative Pain ◽  
Soft Tissue ◽  
Internal Fixation ◽  
Intraoperative Blood Loss ◽  
Fracture Union ◽  
Duration Of Surgery ◽  
Group A ◽  
Elbow Function ◽  
Group B ◽  
Olecranon Fractures

Abstract Objectivession: Olecranon fractures of the aged are traditionally managed operatively with Tension Band Wire (TBW). We compared clinical outcomes of treatment of the improved TBW versus the standard TBW for the treatment of the senile Olecranon fractures patients. Methods: A retrospective study was conducted on senile olecranon fractures patients in our hospital from June 2016 to January 2019. After appropriate exclusion, 62 olecranon fractures patients (29 patients in group A of the improved TBW, 33 patients in group B of the standard TBW) were reviewed in this study. All reviewed patients underwent preoperative immobilization and detumescence, open reduction and internal fixation, and postoperative function exercise. Duration of surgery, intraoperative blood loss, times of fluoroscopy intraoperatively, postoperative pain score, fracture union time, soft tissue irritation, failure of fixation and Broberg Morrey score of elbow function were recorded and compared.Results: The duration of surgery, intraoperative blood loss, postoperative pain score, Broberg Morrey score of elbow function had no significant difference between the two groups. The improved TBW (group A) was better than the standard (group B) in terms of the fixation loosening, fracture union time, the skin irritation, and the difference was significant ( all p< 0.05) .Conclusions: On the basis of no additional surgical trauma, the improved TBW was not only benefit for the fracture union, but also benefit for reducing the incidence of internal fixation loosening and soft tissue irritation. This improved internal fixation is not an unattractive option for senile olecranon fractures patients.

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