Objective To investigate the drainage volume and nursing method of lifted tube drainage and continuous negative pressure drainage after lower lumbar surgery.Methods A total of 248 consecutive patients undergoing the first or second lumbar spine surgery from January 2008 to July 2013 were prospectively randomly divided into two groups.116 patients in the experimental group (group A) took the lifted tube drainage and 132 patients in the control group (group B) took the normal continuous negative pressure drainage protocol after surgery.The total drainage volume,pre-and post-operative hemoglobin,post-operative temperature,complications and JOA score in the two groups were compared.Results The average drainage volume after single or two segment surgery were (97.0 ± 34.2)ml and (108.5 ± 32.7)ml in group A.The average drainage volume after single or two segment lower lumbar surgery were (393.4 ± 143.5) ml and (448.2 ± 169.6) ml in group B,the difference was statistically significant (t =14.43,17.55,respectively;P ＜ 0.01).There was no significant difference in drainage volume in single or two segment in group A and B (P ＞ 0.05).The post-operative hemoglobin level was (121.7 ± 13.4) and (117.8 ± 12.5) g/L in group A and B respectively,the difference was statistically significant (t =2.38,P ＜ 0.05).Conclusions Based on the findings in this study,lifting the drainage tube to an appropriate height is a simple and safe way to reduce postoperative drainage volume in lower lumbar spine surgery which is worthy of further investigations.

Objective:To investigate the mid-term efficacy of Dynesys internal fixation and posterior lumbar interbody fusion (PLIF) in the treatment of grade I degenerative lumbar spondylolisthesis.Methods:From June 2014 to June 2016, 68 cases, in which 35 males and 33 females aged from 44-74 (55.3±7.5), of grade I degenerative lumbar spondylolisthesis treated using Dynesys internal fixation were retrospectively analyzed. There were 8 cases of L 3, 52 cases of L 4 and 8 cases of L 5 with an average visual analogue scale (VAS) of 4.5±2.1. At the same time, 72 patients were treated with posterior lumbar interbody fusion (PLIF). There were 37 males and 35 females aged from 46-76 (56.8±7.2), with 9 cases of L 3, 53 cases of L 4 and 10 cases of L 5. The VAS of this group was 4.4±2.3. The operative time, intraoperative blood loss, postoperative drainage volume and complications were compared between the two groups. Range of motion (ROM), disc height of stable segment and upper adjacent segment, adjacent segment degeneration between the two groups were evaluated. ASD, Oswestry disability index (ODI) score and Japanese Orthopaedic Association (JOA) score were also compared between the two groups. Results:The patients in both groups were followed up. The follow-up time of Dynesys group was 50-74 months, average 64.2±18.3 months, and the follow-up time of PLIF group was 55-79 months, average 65.2±15.5 months. The operation time [(120.5±21.0) min vs. (132.5±27.0) min, t=2.924, P=0.004], intraoperative bleeding [(312.5±80.7) ml vs. (352.5±84.5) ml, t=2.861, P=0.005] and postoperative drainage [(120.3±45.8) ml vs. (140.2±50.2) ml; t=2.446, P=0.016] in Dynesys group were significantly better than those in PLIF group. The differences were statistically significant. There was no significant difference in postoperative ROM of stable segment, ROM of upper segment, disc height of stable segment and adjacent segment between the two groups before operation. At 5 years postoperatively, there was statistically significant difference between the stable segment ROM (4.3°±1.6° vs. 0; t=22.809; P<0.001) and the upper segment ROM (10.5°±2.1° vs. 12.8°±2.2°; t=6.329, P<0.001). At 5 years postoperatively, ODI scores of the two groups were (11.25%±8.12%, 16.53%±9.23%), and JOA scores were (22.60±2.20, 19.01±2.34), which were significantly improved compared with those before surgery, with statistically significant differences (ODI: t=3.585, P<0.001; JOA: t=9.340, P<0.001). There was no significant difference in the incidence of symptomatic ASD between the two groups (8.8% vs. 16.7%, χ2=1.284, P=0.257) , but there was significant difference in the incidence of X-ray ASD between the two groups (2.9% vs. 13.9%, χ2=4.043, P=0.044) . Conclusion:Compared with PLIF, Dynesys internal fixation for degenerative lumbar spondylolisthesis is a minimally invasive, safe and effective surgical method to retard ASD; Compared with PLIF, adjacent segment degeneration can be reduced using Dynesys internal fixation.

Objective To discuss the clinical efficacy of surgical treatment of pathologic vertebral surgery for thoracic and lumbar tuberculosis. Methods All of 322 cases of thoracic and lumbar spinal tuberculosis patients from December 2003 to June 2014 were retrospectively analyzed in our department. All patients were underwent debridement, fusion and nerve decompres?sion surgery. According to different fixed methods, patients were divided into pathologic vertebral surgery group (fixation complet?ed within lesions invaded motion unit) including 91 males and 100 females, with an average age of 41.53 years, and non?pathologic vertebral surgery group (long segments or short segment fixation) including 61 males and 70 females, with an average age of 42.72 years. We observed the tuberculosis cure rate, degrees of deformity, pain and neurological recovery, operative time, blood loss and complications by follow?up. Results The average follow?up time was 75.52 months in pathologic vertebral surgery group and 76.21 months in non?pathologic vertebral surgery group. The total number of pathologic vertebras in pathologic vertebral surgery group and non?pathologic vertebral surgery group were 277 and 218 respectively, and the average was 1.45 and 1.66. The total number of fixed segments was 277 in pathologic vertebral surgery group and 485 in non?pathologic vertebral surgery group, and the average fixed segments was 1.45 and 3.70. The cure rate was 85.86%in pathologic vertebral surgery group and 85.49%in non?pathologic vertebral surgery group at 6 months postoperatively, and 98.95%and 98.47%at the last follow?up time, with no signifi?cant difference between groups. Graft fusion rate was 89.00%in pathologic vertebral surgery group and 89.31%in non?pathologic vertebral surgery group 6 months postoperatively, 98.38%and 98.47%at the last follow?up time, without significant difference. In lumbar spine, the average correction of Cobb's angle was 12.4° in pathologic vertebral surgery group and 13.1° in non?pathologic vertebral surgery group, and the average angle loss was 1.3 and 1.4°, with no significant difference. In thoracolumbar, the average correction of Cobb’s angle was 10.9°in pathologic vertebral surgery group and 11.1°in non?pathologic vertebral surgery group, and the average angle loss was 1.7°and 1.5° respectively, without significant difference. However, in thoracic, the average correction of Cobb's angle was 10.2° in pathologic vertebral surgery group and 12.7° in non?pathologic vertebral surgery group, and the average angle loss was 3.6° and 2.5°respectively, with significant difference. The mean operation time was 210.45 min in pathologic verte?bral surgery group and 210.45 min in non?pathologic vertebral surgery group, with significant difference. The average blood loss was 726.12 ml in pathologic vertebral surgery group and 726.12 ml in non?pathologic vertebral surgery group, with significant dif?ference. The complication rate was 11.51%in pathologic vertebral surgery group and 11.45%in non?pathologic vertebral surgery group, with no significant difference. Conclusion Pathologic vertebral surgery surgery is a safe, effective and feasible method of operation for treatment of thoracic and lumbar tuberculosis, which can effectively preserve adjacent normal vertebral motion unit features. The thoracic surgery was less satisfactory than the lumbar and thoracolumbar surgery.