Spine杂志201701下半期摘要翻译

,TITLE,DoestheTimingofPreoperativeEpiduralSteroidInjectionAffectInfectionRiskAfterACDForPosteriorCervicalFusion?术前硬膜外类固醇注射影响ACDF或PCF术后感染吗？StudyDesign.Aretrospectivedatabaseanalysis.研究设计：回顾性数据库分析。,ABSTRACT,Objective.Theaimofthisstudywastodeterminewhetheranyassociationexistsbetweenpreoperativecervicalepiduralsteroidinjections(CESIs)atvarioustimeintervalsbeforeanteriorcervicaldiscectomyandfusion(ACDF)orposteriorcervicalfusion(PCF)andtheincidenceofpostoperativeinfection.目的：本研究的目的是确定术前颈椎硬膜外类固醇注射(CESIs)的不同的时间间隔与颈前路椎间盘切除融合术（ACDF）或颈椎后路融合术（PCF）术后感染发生率的关系。,ABSTRACT,SummaryofBackgroundData.AlthoughinfectiouscomplicationsfollowingCESIareuncommon,theassociationbetweenpreoperativeCESIandpostoperativeinfectionfollowingACDForPCFhasyettobeevaluatedinthecurrentliterature.背景资料：虽然CESI后感染的并发症少见，但PCF或ACDF术前CESI与术后感染之间的关联尚未在文献中进行报道。,ABSTRACT,Methods.Anationalinsurancedatabasewasutilizedtocomparepostoperativeinfectionrateswithin90daysinpatientswhoreceivedaCESIbeforeACDForPCF.Threecohortswerecreatedforeachprocedure:PCF(n=402)orACDF(n=4354)within3months,PCF(n=586)orACDF(n=5183)between3and6months,andPCF(n=629)orACDF(3648)between6and12monthsfollowingaCESI.ThesecohortswerecomparedwithcontrolcohortswhounderwentPCF(n=61,253)orACDF(n=241,678)withoutpriorCESI.Postoperativeinfectionrateswithin90dayswereassessedusingInternationalClassificationofDisease,9thRevision(ICD-9)andCurrentProceduralTerminology(CPT)codes.Oddsratios(ORs),95%confidenceintervals(95%CIs),andPvalueswerethencalculatedusingSPSS.AmultivariatebinomiallogisticregressionanalysiswasperformedtodeterminetheindependenteffectofpreoperativeinjectiononpostoperativeinfectionfollowingACDForPCFcontrollingforknownriskfactorsforinfection,includingage,gender,obesity,diabetes,andsmoking.方法：采用国家保险数据库的数据比较在ACDF或PCF之前接受CESI的患者在90天内的术后感染率。对于每个手术产生三个队列：3个月内的PCF（n=402）或ACDF（n=4354），3个月至6个月之间的PCF（n=586）或ACDF（n=5183），在6和12个月之间的ACDF（3648）或PCF(n=629)。将这些队列与在没有预先CESI的情况下接受PCF（n=61,253）或ACDF（n=241,678）的对照组进行比较。使用国际疾病分类第9版（ICD-9）和手术术语（CPT）代码评估术后90天内的感染率。然后使用SPSS计算比值比（OR），95置信区间（95CI）和P值。进行多变量二项Logistic回归分析以确定术前注射对ACDF或PCF控制感染的已知风险因素（包括年龄，性别，肥胖，糖尿病和吸烟）后术后感染的独立影响。,ABSTRACT,Results.PatientswhounderwentCESIwithin3months(OR2.21,P0.0001)andwithin3to6months(OR1.95,P=0.0002)beforePCFhadsignificantlyincreasedoddsofdevelopingapostoperativeinfection.PatientswhounderwentCESIwithin3months(OR1.83,P0.0001)beforeACDFhadsignificantlyincreasedoddsofdevelopingapostoperativeinfection.结果：在PCF手术之前3个月内（OR2.21，P=three-levelanteriorcervicalfusion(ACF)wereidentifiedandincludedintwostudycohorts.Reasonsforandratesofreadmissionweredeterminedwithin30days,90days,andone-yearpostoperatively.Riskfactorsformedical,surgical,andall30-dayreadmissionswerealsodetermined,selectingfromvariouscomorbidities,demographics,andsurgicalvariables.方法：在2005年到2012年的医疗保险数据查找接受1、2和3节段的前路颈椎融合手术的颈椎病老年患者（65-84岁），确定了45254名接受一至两节段治疗的患者和12103名节段的前路颈部融合（ACF）的患者，并分别纳入两个研究队列中。再入院的原因和发生率在术后30天，90天和1年内确定。从各种合并症，人口统计学和手术变量中选择确定手术和所有30天再入院的危险因素。,ABSTRACT,Results.Readmissionratesof1.0%to1.4%,2.7%to3.6%,and13.2%to14.1%wereobservedwithin30days,90days,andoneyear.Within30days,over30%ofpatientsfrombothstudycohortswerereadmittedforsurgicalreasons.Ofsurgicalreasonsfor30-dayreadmission,hematoma/seromadiagnoseswerethemostfrequent(11.4%15.4%ofallreadmissions).Malegender,diabetesmellitus,chronicpulmonarydisease,obesity,andsmokinghistorywereallfoundtobepredictiveofall-causereadmissions.结果：在30天，90天和一年内观察到再入院率为1.0至1.4，2.7至3.6和13.2至14.1。在30天内，来自两个研究队列的超过30的患者由于手术原因而重新住院。30天再入院的手术原因：血肿是最常见的（占所有再入院的11.4-15.4）。男性，糖尿病，慢性肺部疾病，肥胖和吸烟史均时再入院的可预测因素。,ABSTRACT,Conclusion.Unplanned30-dayreadmissionratesfollowingprimary,electiveACFinelderlypatientsislowandoftenduetomedicalreasons.Frequentsurgicalreasonsfor30-dayreadmissionincludehematoma/seromaformation.Malegenderandvariouscomorbiddiagnosesaresignificantpredictorsofall-causereadmissionswithin30days.结论：老年患者选择性ACF后的计划外30天再入院率低，往往是由于医疗原因。30天再入院的最常见原因时血肿形成。男性和各种合并症诊断是30天内所有原因的再住院的重要预测因素。,*ReadmissionratesfollowingACFinelderlypatientsare1.0%to1.4%,2.7%to3.6%,and13.2%to14.1%within30days,90days,andoneyear.*Ofsurgicalreasonsfor30-dayreadmission,hematoma/seromadiagnoseswerethemostfrequent.*Malegenderandseveralcomorbidconditionswerefoundtobepredictiveof30-dayreadmissions.*老年患者ACF后的再入院率在30天，90天和1年内分别为1.0至1.4，2.7至3.6和13.2至14.1。*30天再入院的手术原因中，血肿是最常见的。*性别男性和几种合并症状被发现可预测30天再入院。,TITLE,RelationshipBetweenASAScoresand30-DayReadmissionsinPatientsUndergoingAnteriorCervicalDiscectomyandFusionACDF患者ASA分数和30天再入院之间的关系StudyDesign.Retrospectivestudyofprospectivelycollecteddata.研究设计：前瞻性收集数据的回顾性研究。,ABSTRACT,Objective.ToassesstheAmericanSocietyofAnesthesiologists(ASA)scoreasanindependentpredictorof30-readmissionsafteranteriorcervicaldiscectomyandfusion(ACDF).目的：评估美国麻醉师协会（ASA）评分作为ACDF30天再住院的独立预测因子。,美国麻醉医师协会（ASA）于麻醉前根据病人体质状况和对手术危险性进行分类，共将病人分为六级。ASA分级标准是：第一级：体格健康，发育营养良好，各器官功能正常。围手术期死亡率0.06%-0.08%；第二级：除外科疾病外，有轻度并存病，功能代偿健全。围手术期死亡率0.27%0.40%；第三级：并存病情严重，体力活动受限，但尚能应付日常活动。围手术期死亡率1.82%-4.30%；第四级：并存病严重，丧失日常活动能力，经常面临生命威胁。围手术期死亡率7.80%-23.0%；第五级：无论手术与否，生命难以维持24小时的濒死病人。围手术期死亡率9.40%-50.7%；第六级：确证为脑死亡，其器官拟用于器官移植手术。一、二级病人麻醉和手术耐受力良好，麻醉经过平稳。三级病人麻醉有一定危险，麻醉前准备要充分，对麻醉期间可能发生的并发症要采取有效措施，积极预防。四级病人麻醉危险性极大，即使术前准备充分，围手术期死亡率仍很高。五级为濒死病人，麻醉和手术都异常危险，不宜行择期手术。,ABSTRACT,SummaryofBackgroundData.TheASAclassificationschemewasintroducedin1941toestablishascoringsystemtoevaluatetheoverallhealthstatusandcomorbiditiesofpatientsbeforesurgery1012.Althoughthescorewasdesignedtopredictpostoperativecomplications,itmayalsobeusedasapredictorofperioperativerisk.背景资料：ASA分类方案从1941年开始使用来评估手术前患者的总体健康状况和合并症。虽然评分设计用于预测术后并发症，但也可用作围手术期风险的预测因子。,ABSTRACT,Methods.DatacollectedfortheAmericanCollegeofSurgeonsNationalSurgicalQualityImprovementProgram(ACS-NSQIP)databaseintheperiod2005to2012wereusedinthepresentanalysis.CurrentProceduralTerminologycodeswereusedtoidentifyelectiveACDFcases(CPTcodes:22551,22554,and63075).Theprimarystudyoutcomewas30-dayreadmissionratesafterelectiveACDFinadults.Univariateandmultivariateanalysiswasusedtodeterminewhetheranyofage,sex,race,bodymassindex,comorbidities,operativevariables,orASAclasswerepredictorsof30-dayreadmissionratesafterACDF.方法：采用美国外科医师国家外科质量改进计划（ACS-NSQIP）数据库收集的2005-2012年期间的数据进行分析。手术术语代码用于识别ACDF病例（CPT代码：22551,22554和63075）。主要研究结果是成人ACDF后30天的再住院率。单变量和多变量分析用于确定年龄，性别，种族，体重指数，合并症，手术变量或ASA类别是否是ACDF后30天再住院率的预测因素。,ABSTRACT,Results.FromtheACS-NSQIPdatabase,1701electiveACDFcaseswereincludedforanalysis,including92(5.5%)ASAclass1,955(56.1%)ASAclass2,618(36.3%)ASAclass3and34(2.0%)ASAclass4patients.UsingASAclass1asareference,significantindependentpredictorsincludedbeinginASAclass4oddsratio(OR)5.7;95%confidenceinterval(CI)0.5856.7;P=0.039,havingcardiaccomorbidities(OR2.2;95%CI1.24.2;P=0.017),andpriorstrokes(OR3.8;95%CI1.410.1;P=0.0086).结果：从ACS-NSQIP数据库中筛选出1701例ACDF，包括921（5.5）ASA1，955（56.1）ASA2，618（36.3）ASA3和34（2.0）ASA4。使用ASA1类作为参考，显着的独立预测因子时ASA4比值比（OR）5.7;95置信区间（CI）0.58-56.7;P=0.039,具有心脏系统合并症（OR2.2;95CI1.2-4.2;P=0.017），和中风病史（OR3.8;95CI1.4-10.1;P=0.0086）。,ABSTRACT,Conclusion.Inconclusion,theunplannedreadmissionrateforpatientsundergoingACDFwas3.2%.TherewasasignificantandindependentassociationbetweenahighASAclass(class4),cardiaccomorbiditiesandpriorstrokeswith30-dayunplannedreadmissionsafterACDF.TheASAscoremaybeavaluabletoolforthepreoperativeassessmentofACDFpatientsforriskofunplannedreadmissions.结论：总之，接受ACDF的患者的计划外再入院率为3.2。在高ASA类（4类），心脏合并症和中风病史与30天ACDF后的计划外再入院之间存在显着独立的关联。ASA评分可能是术前评估ACDF患者计划外再入院风险的有价值工具。,*ThepresentstudydemonstratesthatinpatientswhoundergoACDF,theoverall30-dayreadmissionratewas3.2%.*Aftermultivariateadjustment,therewasasignificantandindependentassociationbetweenahighASAclass(class4),andhospitalreadmissions.Otherindependentpredictorsincludedhavingcardiaccomorbiditiesandpriorstrokes.*TheASAscoremaybeavaluabletoolforthepreoperativeassessmentofACDFpatientsforriskofunplannedreadmissions.*本研究显示，在接受ACDF的患者中，30天的再住院率为3.2。*多变量调整后，高ASA分级（4）和再住院之间存在显着和独立的关联。其他独立预测因素包括心脏合并症和卒中病史。*ASA评分可能是术前评估ACDF患者计划外再入院风险的有价值工具。,TITLE,RiskFactorsofAdjacentSegmentDiseaseAfterTransforaminalInter-BodyFusionforDegenerativeLumbarDisease经椎间孔椎体间融合术治疗退行性腰椎疾病后相邻节段病变的危险因素DepartmentofOrthopaedicSurgery,SonodaMedicalInstituteTokyoSpineCenter,Adachi-ku,Tokyo,JapanStudyDesign.Aretrospectivestudy.研究设计：回顾性研究。,ABSTRACT,Objective.Thepurposeofthisstudywastodeterminetheincidenceandriskfactorsofadjacentsegmentdisease(ASD)aftertransforaminalinter-bodyfusion(TLIF)fordegenerativelumbardisease.目的：本研究的目的是确定经椎间孔椎体间融合术（TLIF）后腰椎退行性疾病相邻节段病变发病的危险因素（ASD）。,ABSTRACT,SummaryofBackgroundData.ASDisamajorcomplicationafterspinalfusion.ManyreportshavebeenpublishedconcerningtheriskfactorsforASDafterTLIF.Anumberofquantitativerelationshipstospino-pelvicparametershavebeenestablished.Aretrospectivecohortstudywascarriedouttoinvestigatespino-pelvicalignmentinpatientswithASDafterTLIF.背景资料：ASD是脊柱融合后的主要并发症。许多报告已经发表了关于TLIF后出现ASD危险因素后。一些文献发现了脊柱-骨盆参数的相关关系。这项回顾性队列研究探讨TLIF后发生ASD患者的脊柱-骨盆参数。,ABSTRACT,Methods.Thisstudyevaluated263subjects(150subjectsundergoingfloatingfusion(FFgroup),and113patientsundergoinglumbosacralfusion(LFgroup)whounderwentTLIFfrom2009to2012.Themeanfollow-upperiodwas37.6months.Severalparametersweremeasuredusingpre-andpostoperativefull-lengthfree-standingradiographs,includinglumbarlordosis(LL),sacralslope(SS),pelvicincidence(PI),pelvictilt(PT),andPI-LL.MultivariatelogisticregressionanalysiswasperformedtoevaluatetheseparametersaspotentialriskfactorsofearlyonsetradiographicASD.方法.这项研究评估了263名2009到2012接受TLIF手术的受试者。平均随访时间为37.6个月。使用术前和术后X线片测量脊柱全长的几个参数，包括腰椎前凸（LL）、骶骨倾斜角（SS）、骨盆入射角（PI）、骨盆倾斜（PT），和pi-ll。多因素logistic回归分析来评估这些参数作为潜在的风险因素。,ABSTRACT,Results.RadiographicASDwasfoundin65cases(43.3%)intheFFgroup,and49cases(43.3%)intheLFgroup.LLimprovedby7.5and3.9ineachgrouprespectivelyafterTLIF.However,PTworsenedby6.4intheLFgroup.WhencomparingwithASDpositivecasesandASDnegativecases,asignificantdifferenceinpreoperativePTwasobservedinbothFF(P=0.001)andLFgroups(P=0.0001).LogisticregressionanalysisandreceiveroperatingcharacteristicanalysisrevealedthatpreoperativePTofmorethan22.5wasasignificantriskfactoroftheincidenceofASDafterTLIF(P=0.02;oddsratio:5.1,95%CI:1.629.03).结果：发现影像学ASDFF组65例（43.3%），LF组49例（43.3%在。LLTLIF术后分别提高7.5和3.9。然而，LF组PT减少6.4。当比较ASD阳性病例和ASD阴性的病例时，观察到术前PT有显著性差异。Logistic回归分析及ROC分析显示术前PT超过22.5是一个重要的危险因素（P=0.02；比值比：5.1，95%可信区间：1.629.03）。,ABSTRACT,Conclusion.PatientswithpreoperativesagittalimbalancehaveastatisticallysignificantincreasedriskofASD.TheriskofASDincidencewas5.1timesgreaterinsubjectswithpreoperativePTofmorethan22.5.结论：术前矢状面失衡的患者有显著更大的ASD风险。术前PT超过22.5患者ASD发病风险增加了5.1倍。,*RadiographicASDwasfoundin65cases(43.3%)intheFFgroup,and49cases(43.3%)intheLFgroup.*TheriskofASDwas5.1timesgreaterinsubjectswithpreoperativePTmorethan22.5.*CareshouldbegiventopreventsagittalimbalanceaftersurgeryinsubjectswithalargepreoperativePTtolowertheriskofASD.*影像学ASD在FF组有65例（43.3%），在LF组有49例（43.3%）。*术前PT超过22.5ASD的风险增加了5.1倍。*应该避免大术前PT和术后矢状面失衡以降低ASD风险。,TITLE,AcceleratedDischargeProtocolforPosteriorSpinalFusionPatientsWithAdolescentIdiopathicScoliosisDecreasesHospitalPostoperativeCharges22%青少年特发性脊柱侧凸后路脊柱融合术的加速出院方案降低了术后费用22%ChildrensOrthopedicCenter,ChildrensHospitalLosAngeles,LosAngeles,CAStudyDesign.Aretrospectivestudyofconsecutivepatients.研究设计：连续患者的回顾性研究。,ABSTRACT,Objective.Thepurposeofthisstudywastodetermineimplementinganacceleratedprotocolcoulddecreaseouraveragehospitalstayandwhatimpactthishadonpostoperativepainmanagement.目的：本研究的目的是确定实施加速方案可以减少我们的平均住院时间和对术后疼痛管理有什么影响。,ABSTRACT,SummaryofBackgroundData.Toourknowledge,nopriorstudieshavereviewedtheeffectofanaccelerateddischargeprotocolonpostoperativepaincontrolforadolescentidiopathicscoliosis(AIS)followingposteriorspinalfusion.背景资料：据我们所知，先前没有研究报道加速出院方案对青少年特发性脊柱侧凸（AIS）后路脊柱融合术后疼痛控制的效果。,ABSTRACT,Methods.Thisisaretrospectivereviewofallconsecutivepatientsundergoingposteriorspinalfusion(PSF)forAISbefore(June1,2008May31,2013=traditionalprotocol)andafter(June1,2013October22,2014=acceleratedprotocol)protocolimplementation.SubjectiveresponsetotheFACESPainIntensityscalewascollectedforeachpostoperativedaywhileinthehospitalbythenursingstaff.方法：这是一个对所有接受后路脊柱融合（PSF）AIS患者的回顾，2008年6月1日至2013年5月31日使用传统方案，2013年6月1日至2014年10月22日使用术后快速康复。主观反应是评估住院每一天的疼痛强度视觉模拟化量表。,ABSTRACT,Results.Therewere194patientsinthetraditionalpathwayand90patientsintheacceleratedpathway.Nosignificantdifferencesinageatsurgery,sex,ornumberoflevelsfusedwerepresentbetweenthegroups.Patientsmanagedundertheaccelerateddischargehadanaveragehospitalstayof3.7dayscomparedwith5.0daysforthetraditionaldischarge(P0.001).Therewasnoincreasedincidenceofwoundcomplicationsbetweenthetwogroups3.6%(7/194)vs.3.3%(3/90),P=0.91orreadmission1.5%(3/194)vs.4.4%(4/90),P=0.213.Hospitalchargesforpostoperativecareweresignificantlylessintheaccelerateddischargegroupthaninthetraditionalgroup($18,360vs.$23,640,P0.0001).Thiscorrespondedtoa22%($5280/$23,640)decreaseinpostoperativehospitalcharges.Patientshadasmall(1pointchangeonFACESpainscale)butstatisticallysignificantincreaseinpainonpostoperativedays2,3,and4(P=0.0001,P=0.0079,P=0.0076).结果：194例患者使用传统方案和90例患者使用快速康复方案。两组之间的年龄，性别，或融合的数量没有显着差异。与传统5天出院相比在加速出院管理的患者平均住院天数为3.7天（P0.001）。两组之间的没有切口并发症发生率3.6%（7/194）和3.3%（3/90），P=0.91或再入院1.5%（3/194）和4.4%（4/90），P=0.213的差异。快速康复组出院后护理费用明显低于传统组（18360美元vs23640美元，P0.0001）。这对应于了22%术后住院费的减少（$5280/$23640）用。患者术后第2、3、4天疼痛有统计学显着的增加，但数值很小（=40）和肥胖（BMI3039.9）对90天的并发症发生率和30天再住院率。,ABSTRACT,SummaryofBackgroundData.IntheUnitedStates,bothobeseandelderlypatientsareknowntohaveincreasedriskofcomplication,yetbothdemographicsareincreasinglyundergoingelectivelumbarspinesurgery.背景资料：在美国，肥胖和老年患者都使并发症的风险增加，但没有对进行腰椎手术的这两个人口进行统计。,ABSTRACT,Methods.Medicaredatafrom2005to2012werequeriedforpatientswhounderwentprimary1-to2-levelposterolaterallumbarfusionfordegenerativepathology.Elderlypatientsundergoingelectivesurgerywereselectedandseparatedintothreecohorts:morbidlyobese(BMI=40;n=2594),obese(BMI=30,=40；n=2594），肥胖（B