Objective To explore the short-term therapeutic effect of mini-incision common vertebral pedicle screw internal fixation on thoracoclumbar fractures without neurological injury. Methods The data of 61 patients with thoracolumbar fractures without neurological injury treated with mini-incision common vertebral pedicle screw internal fixation (the mini-incision group, n=32) or percutaneous pedicle screw fixation (the percutaneous group, n=29) from February 2014 to January 2016 was retrospectively collected and analyzed. Total incision length, operation time, blood loss, fluoroscopy times, postoperative bed rest time, hospitalization costs, Visual Analogue Scale (VAS) score, Oswestry Disability Index (ODI), vertebral Cobb angle of correction, and accuracy rate of screw placement were compared between the two groups. Results All the patients were followed up for 6 to 24 months with a mean of 13.4 months. There were no complications such as incision infection and neurovascular injury except for 2 screws breakage in one patient in the percutaneous group. In the mini-incision group, the average total incision length was longer than that in the percutaneous group [(7.33±0.53) vs. (6.38±0.44) cm], while the average operation time was shorter than that in the percutaneous group [(62.66±4.75) vs. (72.93±5.09) minutes]; the differences were statistically significant (P<0.001). In the mini-incision group, the average frequency of fluoroscopy was fewer [(5.63±0.61)vs. (19.07±1.60) times] and the average hospitalization costs was lower [(23.3±1.5) thousand yuan vs. (39.5±1.6) thousand yuan] than those in the than that in the percutaneous group; the differences were statistically significant (P<0.001). No significant difference was found in blood loss, postoperative bed rest time, VAS score, ODI, vertebral Cobb angle of correction, and accuracy rate of screw placement between the two groups (P>0.05). Conclusions Mini-incision common vertebral pedicle screw internal fixation for thoracoclumbar fractures without neurological injury has the advantages of short operation time, less fluoroscopy times, low hospitalization costs and high fixation strength. It may obtain a good short-term effectiveness.
Objective To observe the relationship between the suturing patterns to close the scleral incision and postoperative intraocular pressure (IOP) in 23G minimally invasive vitrectomy. Methods Eighty eyes of 80 patients with vitreoretinal diseases, who were treated with primary 23G minimally invasive vitrectomy, were enrolled in this prospective clinical study. Patients with poor closed scleral incision which need suturing were excluded from this study. The corrected visual acuity ranged from hand movement to 0.2. The IOP ranged from 7.9 to 19.8 mm Hg (1 mm Hg=0.133 kPa), with the mean of (13.9plusmn;1.8) mm Hg. The eyes were randomly divided into three groups: group A (20 eyes), suturing all three scleral puncture after vitrectomy; group B (20 eyes), suturing only two upper scleral puncture, but not the lower infusion puncture after vitrectomy; group C (40 eyes), no suturing for all 3 scleral puncture after vitrectomy. All patients underwent 23G vitrectomy only. The corrected visual acuity and IOP were observed after surgery. Results The corrected visual acuity were 0.1 -0.3, 0.2- 0.5, 0.3 -0.8 in one, seven and 14 days after surgery, respectively. No one in group A, B experienced hypotony in one, three, seven and 14 days after surgery. Thirteen (32.5%), five (12.5 %), two eyes (5.0%) in group C experienced hypotony in one, three and seven days after surgery. Seven eyes (17.5%) experienced severe hypotony (＜5 mm Hg) in 14 day after surgery in group C. The difference was statistically significant compared the incidence of hypotony in group C with group A, B respectively at different time points after surgery (chi;2= 16.82,P=0.007). The difference was statistically significant compared the incidence of hypotony in group C at different time points after surgery (chi;2=11.64,P=0.003). The difference was no significant compared the IOP between group A and B at different time points after surgery (F=1.618,P=0.205). Compared the IOP of group C to group A and B, the difference was statistically significant in one and three days after vitrectomy (F=9.351,P=0.000); but not statistically significant in seven and 14 days after vitrectomy(F=0.460,P=0.633). Conclusions Whether or not suturing the scleral punctures is closely related to postoperative hypotony in 23G vitrectomy. Suturing only the two upper scleral punctures can reduce the occurrence of postoperative hypotony.
【摘要】 目的 探讨早期微创腹腔置管灌洗在重症急性胰腺炎（severe acute pancreatitis，SAP）治疗中，对减轻炎性反应的作用。 方法 选择2007年1月-2009年6月收治的SAP患者56例，随机分为早期微创腹腔置管灌洗组（灌洗组，n=28）和常规治疗组（对照组，n=28）；两组同时给予生长抑素，抑酸，抗感染，保持水、电解质及酸碱平衡等综合治疗，灌洗组在常规治疗基础上早期予以微创腹腔置管灌洗。检测两组治疗前及治疗后2、5、7 d C反应蛋白（C-reactrve protein，CRP）、血清肿瘤坏死因子α（tumor necrosis factor α，TNF-α）、 白细胞介素6（interleukin，IL-6）、IL-8水平。 结果 两组治疗前CRP、TNF-α、IL-6、IL-8水平差异无统计学意义（Pgt;0.05），治疗后2、5、7 d比较差异有统计学意义（Plt;0.05）。 结论 早期微创腹腔置管灌洗操作简便易行、创伤小、疗效佳，对减轻SAP所致的全身炎性反应具有较好效果，是治疗SAP有效方法之一。【Abstract】 Objective To explore the effect of the early minimally invasive peritoneal lavage in severe acute pancreatitis (SAP) from Januany 2007 to June 2009. Methods A total of 56 cases of SAP were randomly divided into early minimally invasive peritoneal lavage group (lavage group, n=28) and conventional treatment group (control group, n=28). The patients were given comprehensive treatment, including somatostatin, acid suppression, anti-infection, and maintaining water, electrolyte, and acid alkali balance.In lavage group, the patients were treated with early minimally invasive peritoneal lavage in addition.The levels of C reactive protein(CRP), serum tumor necrosis factor α (TNF-α), interleukin 6 (IL-6), and interleukin 8(IL-8)were detected before and 2, 5, 7 days after tretment. Results There was no significant difference in CRP, TNF-α, IL-6, or IL-8 before treament between the two groups (Pgt;0.05). There were significant differences in CRP, TNF-α, IL-6, and IL-8 after treatment between the two groups (Plt;0.05). Conclusion Early minimally invasive peritoneal lavage is a simple, minially invasive, and effective techinique in treating SAP.
At present, tamponade agent which being used in retinal surgery is mainly sterile air, gas and silicone oil. Sterile air is mostly used in the treatment of simple retinal detachment. Gas or silicone oil as tamponade is greatly applied for complicated retinal detachment. In recent years, with the application of micro-invasive vitrectomy under a wide-angle viewing system and perioperative anti-vascular endothelial growth factor drugs, application of intraocular filling materials also has changed. The application of silicone oil is significantly reduced. Percentage rate of gas as tamponade for retinal detachment is reduced. The application of sterile air as tamponade is rising. With selecting indication carefully and picking up the suitable air or gas, doctor will reduce the workload. It will also reduce the social burden and benefit patients.
ObjectiveTo compare the safety and efficacy of a modified 23G with suturing incision and traditional 23G vitrectomy for silicone oil removal. MethodsA total of 177 patients (180 eyes) who underwent silicon oil removal (the average tamponade period was 4.5 months) were enrolled in this prospective study. The patients included 112 males (113) and 65 female (67). The mean age was (43.8±10.3) years. The corrected vision, indirect ophthalmoscopy, intraocular pressure, B-ultrasound and optical coherence tomography were measured for all patients. All patients had no complete retinal detachment. The patients were randomly divided into modified 23G with suturing incision group (group A, 88 eyes) and traditional 23G vitrectomy (group B, 92 eyes). The differences of sex (χ2=1.596), age, corrected vision (t=0.785), intraocular pressure (t=0.352), primary disease (χ2=1.982) and lens condition (χ2=2.605) were not significant (P>0.05). The operation time, intraocular pressure, silicon oil retention, choroidal detachment, retinal redetachment and endoophthalmitis were recorded at the end of the operation. ResultsThe difference of mean operation time was not significant between group A and B (t=1.950,P>0.05). The differences of mean visual acuity 1 day, 1 week and 3 months after operation were not significant between group A and B (t=0.873, 1.115, 0.141; P>0.05). There was difference of mean intraocular pressure at 1 day after operation (t=2.550,P<0.05), but not at 1 week and 3 months after operation (t=1.451,1.062; P>0.05) between group A and B. There were 25 eyes (28.4%) with intraocular hypotension, 8 eyes (9.1%) with choroidal detachment, 5 eyes (5.7%) with vitreous hemorrhage, 9 eyes (10.2%) with retinal redetachment, and 7 eyes (8.0%) with silicon oil retention in group A. There were 5 eyes (5.4%) with intraocular hypotension, 2 eyes (2.2%) with choroidal detachment, 2 eyes (2.2%) with vitreous hemorrhage, 8 eyes (8.7%) with retinal redetachment, and 1 eye (1.1%) with silicon oil retention in group B. The differences of incidence of intraocular hypotension, choroidal detachment and silicon oil retention were significant (P<0.05). No endoophthalmitis occurred. ConclusionThe safety of modified 23G with suturing incision is better than traditional 23G vitrectomy for silicone oil removal, with decreased incidence of intraocular hypotension, choroidal detachment and silicon oil retention.