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論文 |
論文
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Hayashi, Hiroyuki ; Murakami, Hideki ; Demura, Satoru ; Kato, Satoshi ; Yoshioka, Katsuhito ; Shinmura, Kazuya ; Yokogawa, Noriaki ; Ishii, Takayoshi ; Fang, Xiang ; Shirai, Toshiharu ; Tsuchiya, Hiroyuki
概要:
Background context Surgical site infection (SSI) associated with instruments remains a serious and common complication in patients who undergo total en bloc spondylectomy (TES). It is very important that the risk factors for SSI are
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known to prevent it.Purpose The purpose of the study was to identify independent risk factors for SSI after TES and evaluate the positive effect of iodine-supported spinal instruments in the prevention of SSI after TES.Study design This is a retrospective clinical study.Patient sample One hundred twenty-five patients who underwent TES for vertebral tumor were evaluated.Outcome measures Incidence rate of SSI, risk factors for SSI after TES, and safety of iodine-supported spinal instruments were the outcome measures.Methods Risk factors for SSI were analyzed using logistic regression. In recent 69 patients with iodine-supported spinal instruments, the thyroid hormone levels in the blood were examined to confirm if iodine from the implant influenced thyroid function. Postoperative radiological evaluations were performed regularly.Results The rate of SSI was 6.4% (8/125 patients). By multivariate logistic regression, combined anterior and posterior approach and nonuse of iodine-supported spinal instruments were associated with an increased risk of SSI. The rate of SSI without iodine-supported spinal instruments was 12.5%, whereas the rate with iodine-supported spinal instruments was 1.4%. This difference was statistically significant. There were no detected abnormalities of thyroid gland function with the use of iodine-supported instruments. Among the 69 patients with iodine-supported spinal instruments, 2 patients required additional surgery because of instrument failure. However, there were no obvious involvements with the use of iodine-supported spinal instruments.Conclusions This study identified combined anterior and posterior approach and nonuse of iodine-supported spinal instruments to be independent risk factors for SSI after TES. Iodine-supported spinal instrument was extremely effective for prevention of SSI in patients with compromised status, and it had no detection of cytotoxic or adverse effects on the patients.
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| 2.
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論文
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Sugita, Shurei ; Murakami, Hideki ; Demura, Satoru ; Kato, Satoshi ; Yoshioka, Katsuhito ; Yokogawa, Noriaki ; Tanaka, Sakae ; Tsuchiya, Hiroyuki
概要:
Purpose: Total en bloc spondylectomy (TES) is accompanied by preoperative embolization of segmental arteries, which is l
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imited to three consecutive levels to avoid the risk of spinal cord ischemia. We retrospectively examined the efficacy and safety of repeated TES with embolization of more than three levels of segmental arteries. Methods: Seven patients underwent TES twice for spinal metastases at different levels. Every patient underwent embolization of the bilateral segmental arteries before each surgery. We assessed the total number of segmental arteries embolized, the existence of Adamkiewicz arteries during the embolization procedure, intraoperative blood loss, and the motor function of the lower limbs, using the American Spinal Injury Association (ASIA) motor score. Results: No patient experienced any motor deficit after embolization. During the embolization procedure, an Adamkiewicz artery was depicted in five patients, which precluded embolization at that level. The median number of segmental arteries embolized in total was 9 (9–11). Intraoperative blood loss (median, IQR) was 480 (420–630) ml during the first surgery and 520 (280–600) ml during the second surgery. The ASIA motor scores (median, IQR) were as follows; 100 (98–100) (first admission), 100 (100–100) (first discharge), 100 (98–100) (second admission), and 97 (94–100) (second discharge). No patients had developed statistically significant neurological deterioration, and there had been no local recurrence after a median follow-up of 17.8 months (range 1–51 months). Conclusion: Repeated TES procedures can be performed safely even if more than three levels of segmental arteries are embolized. © 2015 Springer-Verlag Berlin Heidelberg<br />Embargo Period 12 months
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| 3.
論文 |
論文
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Sugita, Shurei ; Murakami, Hideki ; Demura, Satoru ; Kato, Satoshi ; Yoshioka, Katsuhito ; Yokogawa, Noriaki ; Tanaka, Sakae ; Tsuchiya, Hiroyuki
概要:
Purpose: Total en bloc spondylectomy (TES) is accompanied by preoperative embolization of segmental arteries, which is l
…
imited to three consecutive levels to avoid the risk of spinal cord ischemia. We retrospectively examined the efficacy and safety of repeated TES with embolization of more than three levels of segmental arteries. Methods: Seven patients underwent TES twice for spinal metastases at different levels. Every patient underwent embolization of the bilateral segmental arteries before each surgery. We assessed the total number of segmental arteries embolized, the existence of Adamkiewicz arteries during the embolization procedure, intraoperative blood loss, and the motor function of the lower limbs, using the American Spinal Injury Association (ASIA) motor score. Results: No patient experienced any motor deficit after embolization. During the embolization procedure, an Adamkiewicz artery was depicted in five patients, which precluded embolization at that level. The median number of segmental arteries embolized in total was 9 (9–11). Intraoperative blood loss (median, IQR) was 480 (420–630) ml during the first surgery and 520 (280–600) ml during the second surgery. The ASIA motor scores (median, IQR) were as follows; 100 (98–100) (first admission), 100 (100–100) (first discharge), 100 (98–100) (second admission), and 97 (94–100) (second discharge). No patients had developed statistically significant neurological deterioration, and there had been no local recurrence after a median follow-up of 17.8 months (range 1–51 months). Conclusion: Repeated TES procedures can be performed safely even if more than three levels of segmental arteries are embolized. © 2015, Springer-Verlag Berlin Heidelberg.<br />Embargo Period 12 months
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