spine杂志201701下半期摘要翻译课件

TITLEDoestheTimingofPreoperativeEpiduralSteroidInjectionAffectInfectionRiskAfterACDForPosteriorCervicalFusion?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。ABSTRACTObjective.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。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（95％CI）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。ABSTRACTResults.PatientswhounderwentCESIwithin3months(OR2.21,

P

<0.0001)andwithin3to6months(OR1.95,

P

=

0.0002)beforePCFhadsignificantlyincreasedoddsofdevelopingapostoperativeinfection.PatientswhounderwentCESIwithin3months(OR1.83,

P

<0.0001)beforeACDFhadsignificantlyincreasedoddsofdevelopingapostoperativeinfection.结果：在PCF手术之前3个月内（OR2.21，P<0.0001）和3至6个月内（OR1.95，P=0.0002）进行CESI的患者显着增加术后感染的几率。在ACDF之前3个月内接受CESI（OR1.83，P<0.0001）的患者显着增加术后感染的几率。

ABSTRACTConclusion.ThepresentstudydemonstratesthatcervicalESIwithin6monthsofPCF,andwithin3monthsofACDF,isindependentlyassociatedwithsignificantlyincreasedratesofpostoperativeinfection.结论：本研究表明颈椎ESI在PCF手术的6个月内，在ACDF手术3个月内，与术后感染的显着增加独立相关。

TITLEReadmissionRates,Reasons,andRiskFactorsFollowingAnteriorCervicalFusionforCervicalSpondylosisinPatientsAbove65YearsofAge65岁以上患者颈椎病颈椎融合术后再入院率，原因和危险因素DepartmentofOrthopaedicSurgery,JohnsHopkinsHospital,Baltimore,MDStudyDesign.Aretrospectivedatabasereview.研究设计：回顾性数据库审查。ABSTRACTObjective.Theaimofthisstudywastodeterminereadmissionreasonsandratesfollowingprimary,electiveanteriorcervicalspinalfusionsurgeryforcervicalspondylosisanddetermineriskfactorspredictingincreasedriskof30-dayreadmissioninanexclusivelyelderlypopulation.目的：本研究的目的是确定颈椎病前路颈椎融合手术后的再入院原因和发生率，并确定风险因素，预测在老年人群中30天再入院的风险增加的因素。ABSTRACTSummaryofBackgroundData.IntheUnitedStates,therewerealmost190,000cervicalspineproceduresin2009.Manycervicalspinesurgerypatientsareelderly,ademographicincreasinglyrequiringsurgeryfordegenerativecervicalspinepathology.Unfortunately,thispatientpopulationispoorlystudied,particularlyconcerningreadmissionrates.背景资料：在美国，2009年有大约190,000个颈椎手术。人口统计学发现越来越多的退行性颈椎病变进行手术治疗，而许多颈椎手术患者是老年人。不幸的是，对这个患者人群研究不足，特别是关于再入院率。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.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。ABSTRACTConclusion.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。

ABSTRACTObjective.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。ABSTRACTSummaryofBackgroundData.TheASAclassificationschemewasintroducedin1941toestablishascoringsystemtoevaluatetheoverallhealthstatusandcomorbiditiesofpatientsbeforesurgery10–12.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。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).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;95％CI1.2-4.2;P=0.017），和中风病史（OR3.8;95％CI1.4-10.1;P=0.0086）。ABSTRACTConclusion.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。

ABSTRACTObjective.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）。ABSTRACTSummaryofBackgroundData.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。ABSTRACTConclusion.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22.5°ASD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。TITLEAcceleratedDischargeProtocolforPosteriorSpinalFusionPatientsWithAdolescentIdiopathicScoliosisDecreasesHospitalPostoperativeCharges22%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%Children'sOrthopedicCenter,Children'sHospitalLosAngeles,LosAngeles,CAStudyDesign.Aretrospectivestudyofconsecutivepatients.研究设计：连续患者的回顾性研究。ABSTRACTObjective.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。ABSTRACTSummaryofBackgroundData.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。ABSTRACTMethods.Thisisaretrospectivereviewofallconsecutivepatientsundergoingposteriorspinalfusion(PSF)forAISbefore(June1,2008–May31,2013=traditionalprotocol)andafter(June1,2013–October22,2014=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。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).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（P＜0.001）。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，P＜0.0001）。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（<1点的FACES疼痛量表变化的）。ABSTRACTConclusion.AccelerateddischargefollowingPSFforAISwasassociatedwitha22%decreaseinhospitalchargesinthepostoperativeperiod.结论：AISPSF术后加速康复术后住院费用下降了22%。*Anaccelerateddischargeprotocolfollowingposteriorspinalfusionforadolescentidiopathicscoliosiscanreducepostoperativehospitalstayfrom5to6to3.7days.*Inthisseries,therewasnoincreaseinpostoperativecomplicationsobservedinpatientswithadecreasedpostoperativestay.However,patientsintheacceleratedprotocolhadasmall(<1pointchangeonFACESpainscale)butsignificantincreaseinpostoperativepain.*Byadheringtoanaccelerateddischarge,postoperativechargescanbereducedby22%.*青少年特发性脊柱侧凸后路脊柱融合术后的加速出院方案可减少术后住院时间从5到6天至3.7天。*在本系列中，术后患者术后并发症的发生率并没有增加。然而，加速方案的患者有一个小的术后疼痛加重。*加速康复术后费用可减少22%。TITLESurgicalManagementofCivilianGunshot-InducedSpinalCordInjury:IsItOverutilized?民用枪械导致脊髓损伤StudyDesign.Retrospectivechartreview.研究设计：回顾研究ABSTRACTObjective.Assessappropriateutilizationofsurgeryforciviliangunshot-inducedspinalcordinjuries(CGSWSCI)accordingtoliteraturestandardsinalargecohort.目的：在一个大的队列中评估民用枪弹导致脊髓损伤（cgswsci）的手术。ABSTRACTSummaryofBackgroundData.CGSWSCIaremechanicallystableinjuriesthatrarelyrequiresurgery.Nonetheless,wecontinuetoseehighnumbersofthesepatientsundergosurgicaltreatment.ThisstudycomparesindicationsforsurgeriesperformedinalargecohortofCGSWSCIpatientstoestablishedindicationsforsurgicalmanagementofsuchinjuries.Therateofover-utilizationofsurgicalmanagementwascalculated.背景资料：cgswsci损伤机械性稳定，很少需要手术。尽管如此，我们仍然发现大量的患者接受手术治疗。这项研究比较了大样本量的cgswsci患者建立适应这种损伤的外科治疗的手术适应证。分析目前的手术是否过度执行。ABSTRACTMethods：Fourhundredeighty-nineCGSWSCIpatientstransferredforrehabilitationtoourinstitutionbetween2000and2014wereidentified.Retrospectivechartreviewwasperformedtoidentifypatientswhounderwentinitialsurgicaltreatment,thespecificsurgeriesperformed,andindicationsgiven.Weassessedappropriatenessofsurgeryaccordingtoliteraturestandards.Patientstreatedsurgicallywerefollowedtoassessforcomplicationsandtheneedforadditionalinterventionandcomparedtononsurgicalpatients.Secondarily,visualanalogscalepainscores(0–10)andpatientperceivedimprovementwerecomparedbetweensurgicalandnonsurgicalpatientsaftertelephonesurveyofbothgroups.方法：我们的机构2000和2014之间进行治疗的489例cgswsci患者纳入。回顾性审查，以确定患者进行了初步的手术治疗，具体的手术方式，并给出了适应症。我们根据文献标准评估手术的适应症。手术治疗的患者与非手术患者比较随访并发症。其次，电话调查两组患者之间的疼痛视觉模拟评分（0–10）和患者主观感受。ABSTRACTResults.Of489patients,91(18%)underwentinitialsurgery.Of91surgeries,69(75%)werenotindicatedbyliteraturestandards.Fiveof91(5.5%)ofinitiallyoperatedpatientsrequiredasecondarysurgerycomparedwithtwoof398(0.5%)ofthenonoperativegroup(P = 0.003).Over-utilizationrateoftheentirecohortwas14.1%.Nodifferencewasseenforpainscoresorpatientperceivedimprovementbetweenoperativeandnonoperativepatients.结果：489例患者中，91例（18%）接受了手术。91个手术患者中，有69（75%）未按文献标准表示。91中的5例（5.5%）需要再次手术而非手术的398中只有两个需要后续手术（0.5%）（P=0.003  ）。整个队列的过度利用率为14.1%。手术与非手术患者之间疼痛评分或患者的主观感受改善程度无显著差异。ABSTRACTConclusion.Wereportahighoverutilizationrate(14%)ofsurgeryforCGSWSCIinourcohort.Surgicalmanagementwasassociatedwithhigherinfectionandsecondarysurgeryratescomparedtononsurgicalmanagement.Surgerydonewithoutaclear,demonstrablebenefitposesunnecessaryrisktopatientsandaccumulatesunwarrantedhealthcarecosts.结论：我们的报告发现在我们的cgswsci队列中手术治疗率很高（14%）。手术治疗与非手术治疗相比，有更高的感染率和再次手术率。手术没有明确的益处，而且会对患者造成不必要的风险和不必要的医疗花费。*Prognosisofciviliangunshot-inducedspinalcordinjurycorrelatescloselywithinitialneurologicdeficit,nottreatment.*Civiliangunshot-inducedspinalcordinjuriesareneurologicallystaticandmechanicallystable,rarelyrequiringsurgicalintervention,withgreatercomplicationratesassociatedwithsurgicaltreatment.*Surgicaltreatmentofciviliangunshot-inducedspinalcordinjuriesmaybeoverutilizedinthecommunity.*民用火器伤脊髓损伤预后与初始神经功障碍密切相关，而非治疗。*民用枪弹致脊髓损伤神经功能静止和局部稳定，很少需要手术干预，更大的并发症发生率与手术治疗相关。*民用枪弹脊髓损伤的外科治疗可能被过度使用。

TITLESpinalEpiduralHematomaDueToTyre-BlastInjury:ACaseReport轮胎爆炸伤致硬膜外血肿1例StudyDesign.Aretrospectivecasereport.研究设计：回顾性病例报告。ABSTRACTObjective.Theobjectiveofthisarticleistoreportaspinalepiduralhematoma(SEH)duetoshockwave.目的：这篇文章的目的是报告一例由于冲击波导致脊髓硬膜外血肿（SEH）的病例。ABSTRACTSummaryofBackgroundData.SEHisaninfrequentcondition.MostofSEH'sarespontaneous.WehavereportedanSEHtraumaticcasewithoutbonelesionsduetoexplodingtrucktire.Adifferentcategoryofblastinjuriesistheonerelatedwithexplodingtyres.Shockwavesarethemainmechanismthatisresponsibleforblastinjuries.WearepresentingthefirstreportofacuteSEHduetoshockwave.背景资料：SHE是一种罕见的情况。大部分SHE都是无意中造成的。我们报道了由于爆炸的卡车轮胎导致外伤性SHE，而且不合并骨折。爆炸的轮胎是爆炸伤的一个不同类别。冲击波是主要的致伤机制。我们的这篇报道是对由于冲击波造成急性SEH的首次报道。ABSTRACTMethods.A33-year-oldmanwasbroughttotheemergencydepartmentwithcomplaintsofweaknessandnumbnessoftheupperextremities.Therewasanepiduralhigh-signaldensitywithoutosseouslesionincomputerizedtomographyfromthelevelofC2toC5,andtherewasaT2-weightedhyperintenselesioninmagneticresonanceimagingfromthelevelofC2toC5withcompressionofthespinalcordtheanteriorandposteriorwhichprovedtobeanSEH.方法：一名33岁男子被带到急诊科，主诉上肢无力和麻木。在CT从C2到C5水平有一个不伴有骨病变的硬膜外高信号，和一个在T2加权从C2到C5脊髓前高信号病灶，后来发现这是一个SHE压迫。ABSTRACTResults.Thepatientwasdischargedfromthehospitalwithcompleteneurologicrecovery.结果：患者出院，神经功能完全恢复。ABSTRACTConclusion.SEHshouldbeconsideredpossibleintheblastinjury.SEHconditioncarriesasignificantriskofmorbidityandmortalitywithoutearlyrecognitionandrapidmanagement.结论：SEH可能在爆炸中受伤。SHE如果没有早期发现并快速治疗可能导致严重并发症或死亡。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.*大多数SEHs是自发的，原因包括凝血功能障碍、肿瘤、血管畸形、妊娠。*创伤后SEH是比较少见的。*大轮胎爆炸伤类似地雷爆炸不造成热或化学作用。冲击波是主要的损伤机制。*怀疑爆炸伤SEH。CT和MRI应用于早期诊断。这些病人应该接受急诊手术。这是由于冲击波导致SEH的第一次报告。

TITLEMorbidObesityandLumbarFusioninPatientsOlderThan65Years:Complications,Readmissions,Costs,andLengthofStay大于65岁的病理性肥胖患者腰椎融合：并发症，再住院，费用，住院天数StudyDesign.Retrospectivedatabasereview.研究设计：回顾性数据库研究。ABSTRACTObjective.Theaimofthisstudywastodeterminehowbothmorbidobesity(bodymassindex[BMI]>=40)andobesity(BMI30–39.9)modify90-daycomplicationratesand30-dayreadmissionratesfollowing1-to2-level,primary,lumbarspinalfusionsurgeryfordegenerativepathologyinanelderlypopulation.目的：本研究的目的是确定1–2节段、首次、腰椎融合手术治疗的老年退行性病变患者中病理性肥胖（体重指数[BMI]>=40）和肥胖（BMI30–39.9）对90天的并发症发生率和30天再住院率。ABSTRACTSummaryofBackgroundData.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。ABSTRACTMethods.Medicaredatafrom2005to2012werequeriedforpatientswhounderwentprimary1-to2-levelposterolaterallumbarfus