spine雜志201701下半期摘要翻譯課件

TITLEDoestheTimingofPreoperativeEpiduralSteroidInjectionAffectInfectionRiskAfterACDForPosteriorCervicalFusion?術(shù)前硬膜外類固醇注射影響ACDF或PCF術(shù)后感染嗎？StudyDesign.Aretrospectivedatabaseanalysis.研究設(shè)計：回顧性數(shù)據(jù)庫分析。ABSTRACTObjective.Theaimofthisstudywastodeterminewhetheranyassociationexistsbetweenpreoperativecervicalepiduralsteroidinjections(CESIs)atvarioustimeintervalsbeforeanteriorcervicaldiscectomyandfusion(ACDF)orposteriorcervicalfusion(PCF)andtheincidenceofpostoperativeinfection.目的：本研究的目的是確定術(shù)前頸椎硬膜外類固醇注射(CESIs)的不同的時間間隔與頸前路椎間盤切除融合術(shù)（ACDF）或頸椎后路融合術(shù)（PCF）術(shù)后感染發(fā)生率的關(guān)系。ABSTRACTMethods.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),and

P

valueswerethencalculatedusingSPSS.AmultivariatebinomiallogisticregressionanalysiswasperformedtodeterminetheindependenteffectofpreoperativeinjectiononpostoperativeinfectionfollowingACDForPCFcontrollingforknownriskfactorsforinfection,includingage,gender,obesity,diabetes,andsmoking.方法：采用國家保險數(shù)據(jù)庫的數(shù)據(jù)比較在ACDF或PCF之前接受CESI的患者在90天內(nèi)的術(shù)后感染率。對于每個手術(shù)產(chǎn)生三個隊列：3個月內(nèi)的PCF（n=402）或ACDF（n=4354），3個月至6個月之間的PCF（n=586）或ACDF（n=5183）），在6和12個月之間的ACDF（3648）或PCF(n=629)。將這些隊列與在沒有預(yù)先CESI的情況下接受PCF（n=61,253）或ACDF（n=241,678）的對照組進行比較。使用國際疾病分類第9版（ICD-9）和手術(shù)術(shù)語（CPT）代碼評估術(shù)后90天內(nèi)的感染率。然后使用SPSS計算比值比（OR），95％置信區(qū)間（95％CI）和P值。進行多變量二項Logistic回歸分析以確定術(shù)前注射對ACDF或PCF控制感染的已知風險因素（包括年齡，性別，肥胖，糖尿病和吸煙）后術(shù)后感染的獨立影響。ABSTRACTResults.PatientswhounderwentCESIwithin3months(OR2.21,

P

<0.0001)andwithin3to6months(OR1.95,

P

=

0.0002)beforePCFhadsignificantlyincreasedoddsofdevelopingapostoperativeinfection.PatientswhounderwentCESIwithin3months(OR1.83,

P

<0.0001)beforeACDFhadsignificantlyincreasedoddsofdevelopingapostoperativeinfection.結(jié)果：在PCF手術(shù)之前3個月內(nèi)（OR2.21，P<0.0001）和3至6個月內(nèi)（OR1.95，P=0.0002）進行CESI的患者顯著增加術(shù)后感染的幾率。在ACDF之前3個月內(nèi)接受CESI（OR1.83，P<0.0001）的患者顯著增加術(shù)后感染的幾率。

ABSTRACTConclusion.ThepresentstudydemonstratesthatcervicalESIwithin6monthsofPCF,andwithin3monthsofACDF,isindependentlyassociatedwithsignificantlyincreasedratesofpostoperativeinfection.結(jié)論：本研究表明頸椎ESI在PCF手術(shù)的6個月內(nèi)，在ACDF手術(shù)3個月內(nèi)，與術(shù)后感染的顯著增加獨立相關(guān)。

TITLEReadmissionRates,Reasons,andRiskFactorsFollowingAnteriorCervicalFusionforCervicalSpondylosisinPatientsAbove65YearsofAge65歲以上患者頸椎病頸椎融合術(shù)后再入院率，原因和危險因素DepartmentofOrthopaedicSurgery,JohnsHopkinsHospital,Baltimore,MDStudyDesign.Aretrospectivedatabasereview.研究設(shè)計：回顧性數(shù)據(jù)庫審查。ABSTRACTObjective.Theaimofthisstudywastodeterminereadmissionreasonsandratesfollowingprimary,electiveanteriorcervicalspinalfusionsurgeryforcervicalspondylosisanddetermineriskfactorspredictingincreasedriskof30-dayreadmissioninanexclusivelyelderlypopulation.目的：本研究的目的是確定頸椎病前路頸椎融合手術(shù)后的再入院原因和發(fā)生率，并確定風險因素，預(yù)測在老年人群中30天再入院的風險增加的因素。ABSTRACTSummaryofBackgroundData.IntheUnitedStates,therewerealmost190,000cervicalspineproceduresin2009.Manycervicalspinesurgerypatientsareelderly,ademographicincreasinglyrequiringsurgeryfordegenerativecervicalspinepathology.Unfortunately,thispatientpopulationispoorlystudied,particularlyconcerningreadmissionrates.背景資料：在美國，2009年有大約190,000個頸椎手術(shù)。人口統(tǒng)計學發(fā)現(xiàn)越來越多的退行性頸椎病變進行手術(shù)治療，而許多頸椎手術(shù)患者是老年人。不幸的是，對這個患者人群研究不足，特別是關(guān)于再入院率。ABSTRACTResults.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.結(jié)果：在30天，90天和一年內(nèi)觀察到再入院率為1.0％至1.4％，2.7％至3.6％和13.2％至14.1％。在30天內(nèi)，來自兩個研究隊列的超過30％的患者由于手術(shù)原因而重新住院。30天再入院的手術(shù)原因：血腫是最常見的（占所有再入院的11.4％-15.4％）。男性，糖尿病，慢性肺部疾病，肥胖和吸煙史均時再入院的可預(yù)測因素。ABSTRACTConclusion.Unplanned30-dayreadmissionratesfollowingprimary,electiveACFinelderlypatientsislowandoftenduetomedicalreasons.Frequentsurgicalreasonsfor30-dayreadmissionincludehematoma/seromaformation.Malegenderandvariouscomorbiddiagnosesaresignificantpredictorsofall-causereadmissionswithin30days.結(jié)論：老年患者選擇性ACF后的計劃外30天再入院率低，往往是由于醫(yī)療原因。30天再入院的最常見原因時血腫形成。男性和各種合并癥診斷是30天內(nèi)所有原因的再住院的重要預(yù)測因素。*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年內(nèi)分別為1.0％至1.4％，2.7％至3.6％和13.2％至14.1％。*30天再入院的手術(shù)原因中，血腫是最常見的。*性別男性和幾種合并癥狀被發(fā)現(xiàn)可預(yù)測30天再入院。

ABSTRACTObjective.ToassesstheAmericanSocietyofAnesthesiologists(ASA)scoreasanindependentpredictorof30-readmissionsafteranteriorcervicaldiscectomyandfusion(ACDF).目的：評估美國麻醉師協(xié)會（ASA）評分作為ACDF30天再住院的獨立預(yù)測因子。美國麻醉醫(yī)師協(xié)會（ASA）于麻醉前根據(jù)病人體質(zhì)狀況和對手術(shù)危險性進行分類，共將病人分為六級。ASA分級標準是：第一級：體格健康，發(fā)育營養(yǎng)良好，各器官功能正常。圍手術(shù)期死亡率0.06%-0.08%；第二級：除外科疾病外，有輕度并存病，功能代償健全。圍手術(shù)期死亡率0.27%0.40%；第三級：并存病情嚴重，體力活動受限，但尚能應(yīng)付日?；顒印中g(shù)期死亡率1.82%-4.30%；第四級：并存病嚴重，喪失日?；顒幽芰?，經(jīng)常面臨生命威脅。圍手術(shù)期死亡率7.80%-23.0%；第五級：無論手術(shù)與否，生命難以維持24小時的瀕死病人。圍手術(shù)期死亡率9.40%-50.7%；第六級：確證為腦死亡，其器官擬用于器官移植手術(shù)。一、二級病人麻醉和手術(shù)耐受力良好，麻醉經(jīng)過平穩(wěn)。三級病人麻醉有一定危險，麻醉前準備要充分，對麻醉期間可能發(fā)生的并發(fā)癥要采取有效措施，積極預(yù)防。四級病人麻醉危險性極大，即使術(shù)前準備充分，圍手術(shù)期死亡率仍很高。五級為瀕死病人，麻醉和手術(shù)都異常危險，不宜行擇期手術(shù)。ABSTRACTSummaryofBackgroundData.TheASAclassificationschemewasintroducedin1941toestablishascoringsystemtoevaluatetheoverallhealthstatusandcomorbiditiesofpatientsbeforesurgery10–12.Althoughthescorewasdesignedtopredictpostoperativecomplications,itmayalsobeusedasapredictorofperioperativerisk.背景資料：ASA分類方案從1941年開始使用來評估手術(shù)前患者的總體健康狀況和合并癥。雖然評分設(shè)計用于預(yù)測術(shù)后并發(fā)癥，但也可用作圍手術(shù)期風險的預(yù)測因子。ABSTRACTResults.FromtheACS-NSQIPdatabase,1701electiveACDFcaseswereincludedforanalysis,including92(5.5%)ASAclass1,955(56.1%)ASAclass2,618(36.3%)ASAclass3and34(2.0%)ASAclass4patients.UsingASAclass1asareference,significantindependentpredictorsincludedbeinginASAclass4[oddsratio(OR)5.7;95%confidenceinterval(CI)0.58–56.7;P?=?0.039],havingcardiaccomorbidities(OR2.2;95%CI1.2–4.2;P?=?0.017),andpriorstrokes(OR3.8;95%CI1.4–10.1;P?=?0.0086).結(jié)果：從ACS-NSQIP數(shù)據(jù)庫中篩選出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類作為參考，顯著的獨立預(yù)測因子時ASA4[比值比（OR）5.7;95％置信區(qū)間（CI）0.58-56.7;P?=?0.039],具有心臟系統(tǒng)合并癥（OR2.2;95％CI1.2-4.2;P=0.017），和中風病史（OR3.8;95％CI1.4-10.1;P=0.0086）。ABSTRACTConclusion.Inconclusion,theunplannedreadmissionrateforpatientsundergoingACDFwas3.2%.TherewasasignificantandindependentassociationbetweenahighASAclass(class4),cardiaccomorbiditiesandpriorstrokeswith30-dayunplannedreadmissionsafterACDF.TheASAscoremaybeavaluabletoolforthepreoperativeassessmentofACDFpatientsforriskofunplannedreadmissions.結(jié)論：總之，接受ACDF的患者的計劃外再入院率為3.2％。在高ASA類（4類），心臟合并癥和中風病史與30天ACDF后的計劃外再入院之間存在顯著獨立的關(guān)聯(lián)。ASA評分可能是術(shù)前評估ACDF患者計劃外再入院風險的有價值工具。*ThepresentstudydemonstratesthatinpatientswhoundergoACDF,theoverall30-dayreadmissionratewas3.2%.*Aftermultivariateadjustment,therewasasignificantandindependentassociationbetweenahighASAclass(class4),andhospitalreadmissions.Otherindependentpredictorsincludedhavingcardiaccomorbiditiesandpriorstrokes.*TheASAscoremaybeavaluabletoolforthepreoperativeassessmentofACDFpatientsforriskofunplannedreadmissions.*本研究顯示，在接受ACDF的患者中，30天的再住院率為3.2％。*多變量調(diào)整后，高ASA分級（4）和再住院之間存在顯著和獨立的關(guān)聯(lián)。其他獨立預(yù)測因素包括心臟合并癥和卒中病史。*ASA評分可能是術(shù)前評估ACDF患者計劃外再入院風險的有價值工具。

ABSTRACTObjective.Thepurposeofthisstudywastodeterminetheincidenceandriskfactorsofadjacentsegmentdisease(ASD)aftertransforaminalinter-bodyfusion(TLIF)fordegenerativelumbardisease.目的：本研究的目的是確定經(jīng)椎間孔椎體間融合術(shù)（TLIF）后腰椎退行性疾病相鄰節(jié)段病變發(fā)病的危險因素（ASD）。ABSTRACTSummaryofBackgroundData.ASDisamajorcomplicationafterspinalfusion.ManyreportshavebeenpublishedconcerningtheriskfactorsforASDafterTLIF.Anumberofquantitativerelationshipstospino-pelvicparametershavebeenestablished.Aretrospectivecohortstudywascarriedouttoinvestigatespino-pelvicalignmentinpatientswithASDafterTLIF.背景資料：ASD是脊柱融合后的主要并發(fā)癥。許多報告已經(jīng)發(fā)表了關(guān)于TLIF后出現(xiàn)ASD危險因素后。一些文獻發(fā)現(xiàn)了脊柱-骨盆參數(shù)的相關(guān)關(guān)系。這項回顧性隊列研究探討TLIF后發(fā)生ASD患者的脊柱-骨盆參數(shù)。ABSTRACTConclusion.PatientswithpreoperativesagittalimbalancehaveastatisticallysignificantincreasedriskofASD.TheriskofASDincidencewas5.1timesgreaterinsubjectswithpreoperativePTofmorethan22.5°.結(jié)論：術(shù)前矢狀面失衡的患者有顯著更大的ASD風險。術(shù)前PT超過22.5°患者ASD發(fā)病風險增加了5.1倍。*RadiographicASDwasfoundin65cases(43.3%)intheFFgroup,and49cases(43.3%)intheLFgroup.*TheriskofASDwas5.1timesgreaterinsubjectswithpreoperativePTmorethan22.5°.*CareshouldbegiventopreventsagittalimbalanceaftersurgeryinsubjectswithalargepreoperativePTtolowertheriskofASD.*影像學ASD在FF組有65例（43.3%），在LF組有49例（43.3%）。*術(shù)前PT超過22.5°ASD的風險增加了5.1倍。*應(yīng)該避免大術(shù)前PT和術(shù)后矢狀面失衡以降低ASD風險。TITLEAcceleratedDischargeProtocolforPosteriorSpinalFusionPatientsWithAdolescentIdiopathicScoliosisDecreasesHospitalPostoperativeCharges22%青少年特發(fā)性脊柱側(cè)凸后路脊柱融合術(shù)的加速出院方案降低了術(shù)后費用22%Children'sOrthopedicCenter,Children'sHospitalLosAngeles,LosAngeles,CAStudyDesign.Aretrospectivestudyofconsecutivepatients.研究設(shè)計：連續(xù)患者的回顧性研究。ABSTRACTObjective.Thepurposeofthisstudywastodetermineimplementinganacceleratedprotocolcoulddecreaseouraveragehospitalstayandwhatimpactthishadonpostoperativepainmanagement.目的：本研究的目的是確定實施加速方案可以減少我們的平均住院時間和對術(shù)后疼痛管理有什么影響。ABSTRACTSummaryofBackgroundData.Toourknowledge,nopriorstudieshavereviewedtheeffectofanaccelerateddischargeprotocolonpostoperativepaincontrolforadolescentidiopathicscoliosis(AIS)followingposteriorspinalfusion.背景資料：據(jù)我們所知，先前沒有研究報道加速出院方案對青少年特發(fā)性脊柱側(cè)凸（AIS）后路脊柱融合術(shù)后疼痛控制的效果。ABSTRACTMethods.Thisisaretrospectivereviewofallconsecutivepatientsundergoingposteriorspinalfusion(PSF)forAISbefore(June1,2008–May31,2013=traditionalprotocol)andafter(June1,2013–October22,2014=acceleratedprotocol)protocolimplementation.SubjectiveresponsetotheFACESPainIntensityscalewascollectedforeachpostoperativedaywhileinthehospitalbythenursingstaff.方法：這是一個對所有接受后路脊柱融合（PSF）AIS患者的回顧，2008年6月1日至2013年5月31日使用傳統(tǒng)方案，2013年6月1日至2014年10月22日使用術(shù)后快速康復。主觀反應(yīng)是評估住院每一天的疼痛強度視覺模擬化量表。ABSTRACTResults.Therewere194patientsinthetraditionalpathwayand90patientsintheacceleratedpathway.Nosignificantdifferencesinageatsurgery,sex,ornumberoflevelsfusedwerepresentbetweenthegroups.Patientsmanagedundertheaccelerateddischargehadanaveragehospitalstayof3.7dayscomparedwith5.0daysforthetraditionaldischarge(P<0.001).Therewasnoincreasedincidenceofwoundcomplicationsbetweenthetwogroups[3.6%(7/194)vs.3.3%(3/90),P=0.91]orreadmission[1.5%(3/194)vs.4.4%(4/90),P=0.213].Hospitalchargesforpostoperativecareweresignificantlylessintheaccelerateddischargegroupthaninthetraditionalgroup($18,360vs.$23,640,P<0.0001).Thiscorrespondedtoa22%($5280/$23,640)decreaseinpostoperativehospitalcharges.Patientshadasmall(<1pointchangeonFACESpainscale)butstatisticallysignificantincreaseinpainonpostoperativedays2,3,and4(P=0.0001,P=0.0079,P=0.0076).結(jié)果：194例患者使用傳統(tǒng)方案和90例患者使用快速康復方案。兩組之間的年齡，性別，或融合的數(shù)量沒有顯著差異。與傳統(tǒng)5天出院相比在加速出院管理的患者平均住院天數(shù)為3.7天（P＜0.001）。兩組之間的沒有切口并發(fā)癥發(fā)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]的差異。快速康復組出院后護理費用明顯低于傳統(tǒng)組（18360美元vs23640美元，P＜0.0001）。這對應(yīng)于了22%術(shù)后住院費的減少（$5280/$23640）用?；颊咝g(shù)后第2、3、4天疼痛有統(tǒng)計學顯著的增加，但數(shù)值很?。?lt;1點的FACES疼痛量表變化的）。ABSTRACTConclusion.AccelerateddischargefollowingPSFforAISwasassociatedwitha22%decreaseinhospitalchargesinthepostoperativeperiod.結(jié)論：AISPSF術(shù)后加速康復術(shù)后住院費用下降了22%。*Anaccelerateddischargeprotocolfollowingposteriorspinalfusionforadolescentidiopathicscoliosiscanreducepostoperativehospitalstayfrom5to6to3.7days.*Inthisseries,therewasnoincreaseinpostoperativecomplicationsobservedinpatientswithadecreasedpostoperativestay.However,patientsintheacceleratedprotocolhadasmall(<1pointchangeonFACESpainscale)butsignificantincreaseinpostoperativepain.*Byadheringtoanaccelerateddischarge,postoperativechargescanbereducedby22%.*青少年特發(fā)性脊柱側(cè)凸后路脊柱融合術(shù)后的加速出院方案可減少術(shù)后住院時間從5到6天至3.7天。*在本系列中，術(shù)后患者術(shù)后并發(fā)癥的發(fā)生率并沒有增加。然而，加速方案的患者有一個小的術(shù)后疼痛加重。*加速康復術(shù)后費用可減少22%。TITLESurgicalManagementofCivilianGunshot-InducedSpinalCordInjury:IsItOverutilized?民用槍械導致脊髓損傷StudyDesign.Retrospectivechartreview.研究設(shè)計：回顧研究ABSTRACTObjective.Assessappropriateutilizationofsurgeryforciviliangunshot-inducedspinalcordinjuries(CGSWSCI)accordingtoliteraturestandardsinalargecohort.目的：在一個大的隊列中評估民用槍彈導致脊髓損傷（cgswsci）的手術(shù)。ABSTRACTSummaryofBackgroundData.CGSWSCIaremechanicallystableinjuriesthatrarelyrequiresurgery.Nonetheless,wecontinuetoseehighnumbersofthesepatientsundergosurgicaltreatment.ThisstudycomparesindicationsforsurgeriesperformedinalargecohortofCGSWSCIpatientstoestablishedindicationsforsurgicalmanagementofsuchinjuries.Therateofover-utilizationofsurgicalmanagementwascalculated.背景資料：cgswsci損傷機械性穩(wěn)定，很少需要手術(shù)。盡管如此，我們?nèi)匀话l(fā)現(xiàn)大量的患者接受手術(shù)治療。這項研究比較了大樣本量的cgswsci患者建立適應(yīng)這種損傷的外科治療的手術(shù)適應(yīng)證。分析目前的手術(shù)是否過度執(zhí)行。ABSTRACTMethods：Fourhundredeighty-nineCGSWSCIpatientstransferredforrehabilitationtoourinstitutionbetween2000and2014wereidentified.Retrospectivechartreviewwasperformedtoidentifypatientswhounderwentinitialsurgicaltreatment,thespecificsurgeriesperformed,andindicationsgiven.Weassessedappropriatenessofsurgeryaccordingtoliteraturestandards.Patientstreatedsurgicallywerefollowedtoassessforcomplicationsandtheneedforadditionalinterventionandcomparedtononsurgicalpatients.Secondarily,visualanalogscalepainscores(0–10)andpatientperceivedimprovementwerecomparedbetweensurgicalandnonsurgicalpatientsaftertelephonesurveyofbothgroups.方法：我們的機構(gòu)2000和2014之間進行治療的489例cgswsci患者納入?；仡櫺詫彶?，以確定患者進行了初步的手術(shù)治療，具體的手術(shù)方式，并給出了適應(yīng)癥。我們根據(jù)文獻標準評估手術(shù)的適應(yīng)癥。手術(shù)治療的患者與非手術(shù)患者比較隨訪并發(fā)癥。其次，電話調(diào)查兩組患者之間的疼痛視覺模擬評分（0–10）和患者主觀感受。ABSTRACTResults.Of489patients,91(18%)underwentinitialsurgery.Of91surgeries,69(75%)werenotindicatedbyliteraturestandards.Fiveof91(5.5%)ofinitiallyoperatedpatientsrequiredasecondarysurgerycomparedwithtwoof398(0.5%)ofthenonoperativegroup(P?=?0.003).Over-utilizationrateoftheentirecohortwas14.1%.Nodifferencewasseenforpainscoresorpatientperceivedimprovementbetweenoperativeandnonoperativepatients.結(jié)果：489例患者中，91例（18%）接受了手術(shù)。91個手術(shù)患者中，有69（75%）未按文獻標準表示。91中的5例（5.5%）需要再次手術(shù)而非手術(shù)的398中只有兩個需要后續(xù)手術(shù)（0.5%）（P=0.003??）。整個隊列的過度利用率為14.1%。手術(shù)與非手術(shù)患者之間疼痛評分或患者的主觀感受改善程度無顯著差異。ABSTRACTConclusion.Wereportahighoverutilizationrate(14%)ofsurgeryforCGSWSCIinourcohort.Surgicalmanagementwasassociatedwithhigherinfectionandsecondarysurgeryratescomparedtononsurgicalmanagement.Surgerydonewithoutaclear,demonstrablebenefitposesunnecessaryrisktopatientsandaccumulatesunwarrantedhealthcarecosts.結(jié)論：我們的報告發(fā)現(xiàn)在我們的cgswsci隊列中手術(shù)治療率很高（14%）。手術(shù)治療與非手術(shù)治療相比，有更高的感染率和再次手術(shù)率。手術(shù)沒有明確的益處，而且會對患者造成不必要的風險和不必要的醫(yī)療花費。*Prognosisofciviliangunshot-inducedspinalcordinjurycorrelatescloselywithinitialneurologicdeficit,nottreatment.*Civiliangunshot-inducedspinalcordinjuriesareneurologicallystaticandmechanicallystable,rarelyrequiringsurgicalintervention,withgreatercomplicationratesassociatedwithsurgicaltreatment.*Surgicaltreatmentofciviliangunshot-inducedspinalcordinjuriesmaybeoverutilizedinthecommunity.*民用火器傷脊髓損傷預(yù)后與初始神經(jīng)功障礙密切相關(guān)，而非治療。*民用槍彈致脊髓損傷神經(jīng)功能靜止和局部穩(wěn)定，很少需要手術(shù)干預(yù)，更大的并發(fā)癥發(fā)生率與手術(shù)治療相關(guān)。*民用槍彈脊髓損傷的外科治療可能被過度使用。

TITLESpinalEpiduralHematomaDueToTyre-BlastInjury:ACaseReport輪胎爆炸傷致硬膜外血腫1例StudyDesign.Aretrospectivecasereport.研究設(shè)計：回顧性病例報告。ABSTRACTObjective.Theobjectiveofthisarticleistoreportaspinalepiduralhematoma(SEH)duetoshockwave.目的：這篇文章的目的是報告一例由于沖擊波導致脊髓硬膜外血腫（SEH）的病例。ABSTRACTSummaryofBackgroundData.SEHisaninfrequentcondition.MostofSEH'sarespontaneous.WehavereportedanSEHtraumaticcasewithoutbonelesionsduetoexplodingtrucktire.Adifferentcategoryofblastinjuriesistheonerelatedwithexplodingtyres.Shockwavesarethemainmechanismthatisresponsibleforblastinjuries.WearepresentingthefirstreportofacuteSEHduetoshockwave.背景資料：SHE是一種罕見的情況。大部分SHE都是無意中造成的。我們報道了由于爆炸的卡車輪胎導致外傷性SHE，而且不合并骨折。爆炸的輪胎是爆炸傷的一個不同類別。沖擊波是主要的致傷機制。我們的這篇報道是對由于沖擊波造成急性SEH的首次報道。ABSTRACTMethods.A33-year-oldmanwasbroughttotheemergencydepartmentwithcomplaintsofweaknessandnumbnessoftheupperextremities.Therewasanepiduralhigh-signaldensitywithoutosseouslesionincomputerizedtomographyfromthelevelofC2toC5,andtherewasaT2-weightedhyperintenselesioninmagneticresonanceimagingfromthelevelofC2toC5withcompressionofthespinalcordtheanteriorandposteriorwhichprovedtobeanSEH.方法：一名33歲男子被帶到急診科，主訴上肢無力和麻木。在CT從C2到C5水平有一個不伴有骨病變的硬膜外高信號，和一個在T2加權(quán)從C2到C5脊髓前高信號病灶，后來發(fā)現(xiàn)這是一個SHE壓迫。ABSTRACTResults.Thepatientwasdischargedfromthehospitalwithcompleteneurologicrecovery.結(jié)果：患者出院，神經(jīng)功能完全恢復。ABSTRACTConclusion.SEHshouldbeconsideredpossibleintheblastinjury.SEHconditioncarriesasignificantriskofmorbidityandmortalitywithoutearlyrecognitionandrapidmanagement.結(jié)論：SEH可能在爆炸中受傷。SHE如果沒有早期發(fā)現(xiàn)并快速治療可能導致嚴重并發(fā)癥或死亡。Axialcomputerizedtomography(CT)showingepiduralhigh-signaldensitytoC4.Sagittal(A)andaxial(B)T2-weightedcervicalspinemagneticresonanceimaging(MRI)showingepiduralhigh-signalintensitylesionfromlevelC2toC5withcompressionofthespinalcord.PostoperativesagittalT2-weightedcervicalspinemagneticresonanceimaging(MRI).*MostSEHsarespontaneous,andprecipitatingfactorsincludecoagulopathy,neoplasm,vascularmalformation,andpregnancy.*Post-traumaticSEHisrelativelyuncommon.*Blastinjuriesoflargetyresaresimilartothoseresultingfromlandmineexplosionsbutwithoutthermalorchemicaleffects.Shockwavesarethemainmechanismthatisresponsibleforblastinjuries.*SEHshouldbesuspectedinblastinjuries.CTandMRIshouldbeusedforearlydiagnosis.Thesepatientsshouldundergoemergencysurgery.*ThisisthefirstreportofSEHduetoshockwave.*大多數(shù)SEHs是自發(fā)的，原因包括凝血功能障礙、腫瘤、血管畸形、妊娠。*創(chuàng)傷后SEH是比較少見的。*大輪胎爆炸傷類似地雷爆炸不造成熱或化學作用。沖擊波是主要的損傷機制。*懷疑爆炸傷SEH。CT和MRI應(yīng)用于早期診斷。這些病人應(yīng)該接受急診手術(shù)。這是由于沖擊波導致SEH的第一次報告。

TITLEMorbidObesityandLumbarFusioninPatientsOlderThan65Years:Complications,Readmissions,Costs,andLengthofStay大于65歲的病理性肥胖患者腰椎融合：并發(fā)癥，再住院，費用，住院天數(shù)StudyDesign.Retrospectivedatabasereview.研究設(shè)計：回顧性數(shù)據(jù)庫研究。ABSTRACTObjective.Theaimofthisstudywastodeterminehowbothmorbidobesity(bodymassindex[BMI]>=40)andobesity(BMI30–39.9)modify90-daycomplicationratesand30-dayreadmissionratesfollowing1-to2-level,primary,lumbarspinalfusionsurgeryfordegenerativepathologyinanelderlypopulation.目的：本研究的目的是確定1–2節(jié)段、首次、腰椎融合手術(shù)治療的老年退行性病變患者中病理性肥胖（體重指數(shù)[BMI]>=40）和肥胖（BMI30–39.9）對90天的并發(fā)癥發(fā)生率和30天再住院率。ABSTRACTSummaryofBackgroundData.IntheUnitedStates,bothobeseandelderlypatientsareknowntohaveincreasedriskofcomplication,yetbothdemographicsareincreasinglyundergoingelectivelumbarspinesurgery.背景資料：在美國，肥胖和老年患者都使并發(fā)癥的風險增加，但沒有對進行腰椎手術(shù)的這兩個人口進行統(tǒng)計。ABSTRACTMethods.Medicaredatafrom2005to2012werequeriedforpatientswhounderwentprimary1-to2-levelposterolaterallumbarfus