| Part One Efficacy analysis of O-arm navigation and traditional surgery in treatment of thoracic ossification of ligamentum flavumObjective: To explore the clinical efficacy of O-arm navigation in the treatment of TOLF by comparing the data of navigation and traditional surgical treatment of TOLF.Methods: From January 2010 to January 2018,73 patients who were diagnosed as TOLF and treated with laminectomy and internal fixation in the third Hospital of Hebei Medical University were divided into two groups.In the navigation group,35 patients underwent posterior thoracic laminectomy and internal fixation with the aid of O-arm navigation.And the images obtained by the O-arm were immediately uploaded to the navigation system and reconstructed,and the pedicle screws were placed under the guidance of three-dimensional navigation.38 patients were treated with conventional posterior thoracic laminectomy and internal fixation,which were non-navigation group.Antibiotics were routinely used in all patients within 24 hours after operation,and patients were encouraged to wear braces for activities 3-5 days after operation,and the braces were worn for about 1.5months.The general data,imaging data and operation-related data of the two groups were collected,and a retrospective cohort study was conducted to explore the clinical efficacy of O-arm navigation in the treatment of TOLF.Results: There was no significant difference between two groups in general data and Imaging data.The operation time of the non-navigation group was 162.11±26.16 minutes,while that of the navigation group was175.89±16.43 minutes and there was a significant statistical difference between the two groups(P = 0.009).The wound length of the non-navigation group was 14.93 ± 2.28 cm,which was significantly shorter than that of the navigation group(17.22 ± 1.93 cm)(P < 0.001).Although there was no significant difference in JOA score between the two groups at the last follow-up(P = 0.056),However,there was a significant difference in the recovery rate of JOA score(P = 0.031),and the accuracy score of screw placement(P = 0.024),the score of 9.14±0.91 in the navigation group was better than 8.53±1.31 in the non-navigation group.At the same time,we found that there was a significant difference in the operation time,exposure and screw placement time(P < 0.001),but there was no significant difference in the decompression and expose time.And in the non-avigation group,the number of cerebrospinal fluid leakage,postoperative neurological symptoms deterioration and intraoperative positioning segment errors in the non-navigation group was higher than that in the navigation group.Conclusions: The use of O-arm navigation-assisted technology can present the pedicle profile and accurately locate the shape,size and position of the ossified ligament during the operation.so that the operator can perform the operation more intuitively,thus improving the accuracy of nail placement and the prognosis of the operation.And it can reduce the occurrence of complications such as cerebrospinal fluid leakage and postoperative nerve deterioration.Part Two Risk factors for poor outcomes of thoracic ossification of liga- mentum flavum after laminectomyObjective: The purpose of the study was to identify the risk factors for poor outcomes of thoracic ligamentum flavum ossification after laminectomy.Methods: 64 patients with thoracic ossification of ligamentum flavum(TOLF)after laminectomy were reviewed from January 2010 to April 2018 in department of spine surgery of Third Hospital of Hebei Medical University.The Japanese Orthopaedic Association(JOA)scale was used to evaluate neurological function.According to the average JOA improvement rate,patients were divided into good outcomes group and poor outcomes group.Multivariate logistic regression analysis was used to identify risk factors for poor outcomes.Results: The average JOA improvement rate was 53.04%±24.29%.33 patients with improvement rate higher than the average was divided into good outcomes group,while 31 patients with improvement rate lower than the average was divided into poor outcomes group.Preoperative symptoms duration(P=0.005),high signal rate in thoracic pulp(P=0.001)and dural ossification rate(P=0.002)in the poor outcomes group were significantly higher than those in the good outcomes group.Multiple Logistic analysis showed that long preoperative symptoms duration(P=0.038),high signal in thoracic pulp(P=0.015),dural ossification(P=0.008)and beak like ossification(P=0.029)were risk factors for poor outcomes of thoracic ossification of ligamentum flavum after laminectomy and the OR and 95%CI were 1.078(1.011-1.151),16.016(1.949-131.586),13.999(2.067-94.825),and 4.722(1.168-19.088)respectively.The Cut-off value of preoperative symptom duration is 17.00(P=0.006),which means that more than 17 months is closely related to poor prognosis.Conclusions: Long preoperative symptoms duration,high signal in thoracic pulp,dural ossification and beak like ossification were the risk factors for poor outcomes of thoracic ossification of ligamentum flavum after laminectomy.Part Three Comparison of oblique lateral lumbar interbody fusion and transforaminal lumbar interbody fusion in the treatment of lumbar spondylolisthesisObjective: Our purpose was to compare the clinical efficacy of TLIF and OLIF in treatment of degenerative lumbar spondylolisthesis,and to provide a theoretical basis for the selection of surgical methods in clinical practice.Methods: 31 patients with single segment lumbar spondylolisthesis who underwent TLIF and OLIF from January 2018 to January 2021 were included.The age,gender,BMI,operative segment,operative time and bleeding volume,combined disease(including hypertension,diabetes,heart disease,cerebrovascular disease and osteoporosis)and Modic changes were recorded.JOA score and ODI score were used to evaluate the clinical efficacy of patients before operation and the last follow-up.Results: A total of 31 patients were included in TLIF group,including 23 males and 8 females.A total of 31 patients were included in OLIF group,including 27 males and 4 females.There was no significant difference in age(P = 0.770),sex(P = 0.199),BMI(P = 0.447),follow-up time(P = 0.096),surgical segment(P = 0.554),Modic change(P = 0.275)and combined diseases between the two groups.The average operation time in OLIF group was 126.13±40.24 minutes,which was significantly less than(P = 0.022)151.29 ± 43.66 minutes in TLIF group.The average amount of bleeding in OLIF group was 119.68 ± 57.24 ml,which was significantly lower than that in TLIF group(P < 0.001).In the last follow-up visit,compared with the preoperative X-ray of lumbar spine,25 patients in TLIF group achieved the reduction of spondylolisthesis(80.65%),while only 7 patients in OLIF group achieved the reduction of spondylolisthesis(22.58%).The reduction rate of spondylolisthesis in TLIF group was significantly higher than that in OLIF group(P < 0.001).There was no significant difference in JOA score between the two groups before operation(P = 0.068)and at the last follow-up visit(P =0.336).There was no significant difference in ODI score between the two groups before operation(P = 0.151),but after operation,ODI score in OLIF group was significantly lower than that in TLIF group(P = 0.039).Conclusions: Both TLIF and OLIF achieve good clinical efficacy.TLIF is superior to OLIF in the reduction of spondylolisthesis.The operation time and blood loss of OLIF operation are less than that of TLIF operation,and OLIF operation avoids the damage of lumbar muscles and soft tissue,and better retains the structure and function of the low back.Part Four Risk factors for surgical site infection after posterior thoraco-lumbar spinal surgeryObjective: The incidence of incision infection in posterior thoracolumbar surgery was studied retrospectively,and its risk factors were analyzed to provide theoretical basis for the prevention of postoperative infection.Methods: A total of 1,313 patients who underwent thoracolumbar posterior open surgery in the spinal surgery department of the third hospital of Hebei medical university from January 2017 to January 2019 were included.Basic clinical and surgical information was recorded.Postoperative infection was diagnosed according to CDC diagnostic criteria and the incidence was calculated.Multivariate logistic regression was used to analyze the risk factors for infection in posterior thoracolumbar surgery and to calculate the relative risk(OR)and 95% confidence interval(95%CI).Results: 33 patients were diagnosed with incision infection,with an incidence of 2.51%,and were included in the SSI group.Four patients were diagnosed with delayed infection,with an incidence of 0.03%,and were included in the DI group,while the remaining patients were included in the non-SSI group.The proportion of patients in the SSI group with BMI(P=0.001),preoperative diabetes(P=0.008),previous history of thoracolumbar posterior surgery(P=0.005)and mean operation time(P=0.003)were significantly higher than those in the non-SSI group.The number of patients with basic diseases in the SSI group was significantly higher than those in the non-SSI group(P=0.023).The proportion of patients in the DI group with age(P=0.015),preoperative diabetes(P<0.001),preoperative osteoporosis(P=0.003)and previous history of thoracolumbar posterior surgery(P<0.001)were significantly higher than those in the non-SSI group.Meanwhile,the proportion of previous surgical history in DI group was significantly higher than that in non-SSI group(P<0.001).Multivariate logistic regression analysis showed that high BMI(P<0.001),diabetes mellitus(P=0.028),previous history of posterior thoracolumbar surgery(P=0.039),and long operation time(P=0.002)were risk factors for posterior thoracolumbar surgery infection.Conclusions: the incidence of infection in posterior thoracolumbar surgery was 2.51%.High BMI,diabetes mellitus,previous history of posterior thoracolumbar surgery and long operation time are risk factors for postoperative infection.The incidence of delayed infection in posterior thoracolumbar surgery was 0.03%.High age,diabetes mellitus,osteoporosis and previous history of posterior thoracolumbar surgery are associated with delayed infection and all the delayed infection patients used internal fixation.Whether early infection or delayed infection,the number of patients’ underlying diseases before surgery was positively correlated with the risk of postoperative infection.The prevention of postoperative infection should be emphasized when the mentioned risk factors appear. |
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