Objective To analyze the cause and treatment of the postoperative complications using one-stage posterior spinal osteotomy in the treatment of severe spinal deformity.Methods From September 2006 to May 2013,17 patients with severe spinal deformity (congenital scoliosis in 11 cases,congenital kyphosis in 4 cases,and congenital kyphoscoliosis in 2 cases) underwent one-stage posterior spinal osteotomy,including 5 males and 12 females with an average age of 22.6 (14-51) years.The preoperative mean coronal Cobb angle was 109° (85°-160°) while the mean sagittal Cobb angle was 104° (65°-152°).Two patients had neurological symptoms preoperatively whose spinal cord function was D,evaluated by ASIA classification.All patients were treated with pedicle subtration osteotomy and pedicle screw internal fixation,which SPO osteotomy 2 cases,PSO osteotomy 11 cases,VCR osteotomy 4 cases.Results There were 17 cases of complications in 147 patients,the complication rate was 11.6％(17/147).The causes were as followed,screw malposition in 2 cases,compromised by close of resected areas in 2 case,residual bone compression in 1 case,acute spinal cord injury in 2 cases,infection in 2 cases,broken stick or loosen hat in 3 cases,and superior mesenteric artery syndrome in 5 cases.Postoperative neurological complications occurred in 7 cases.Two cases with preoperative ASIA D became ASIA C,5 cases with normal nerve function became ASIA C in 2 cases and ASIA D in 3 cases.After surgical exploration,given Methylprednisolone and neurotrophic drugs,removal or changing of the internal fixation,anti-infection and symptomatic treatment,15 cases recovered completely and 2 cases improved partially.Conclusion One-stage posterior spinal osteotomy for severe spinal deformity is technical demanding and risky,and the postoperative complications are common.Appropriate operative procedure,close observation of sensation and motor function,timely surgical exploration and nerve decompression,and early brace wear are all required.

Objective:To investigate the efficacy and safety of tirofiban combined with dual antiplatelet therapy for progressive stroke, and obtain the effective time and speed of intravenous tirofiban.Methods:The patients with progressive stroke from June to December 2018 in the Second Hospital of Liaocheng Affiliated to Shandong First Medical University were divided into 2 groups: 28 patients were treated with dual antiplatelet (dual antiplatelet group) and 22 patients were treated with tirofiban combined with dual antiplatelet (tirofiban group). The demographic characteristics, risk factors of cerebral infarction, new infarct location and possible pathogenesis were recorded. The beginning of tirofiban, National Institutes of Health stroke scale (NIHSS) score at different time points, complications, and intravenous infusion effective time, maintenance dose and speed were recorded. NIHSS score was recorded for 14 d and modified Rankin scale (mRS) score was recorded for 90 d after discharge.Results:After 14 d of continuous treatment in the dual antiplatelet group, the NIHSS score decreased (2.92±1.13) scores. One case had gastrointestinal hemorrhage, and there were no intracranial hemorrhage complications. After 14 days of continuous treatment in the tirofiban group, the NIHSS score decreased (3.46±1.71) scored. One case had skin and mucosa hemorrhage, and there were no intracranial hemorrhage complications. In tirofiban group, the effective time of intravenous infusion was 42.2 to 135.7 (86.6 ± 42.3) h, and the infusion speed was 0.15 to 0.45 (0.31 ± 0.12) mg/h. Compared with the dual antiplatelet group, the NIHSS score and 90-day mRS score of tirofiban group decreased significantly: (3.36 ± 1.71) scores vs. (4.75 ± 2.30) scores and (2.93 ± 1.04) scores vs. (3.52 ± 1.83) scores, and there were statistical differences ( P<0.05). Conclusions:Intravenous tirofiban combined with dual antiplatelet therapy for progressive stroke may be a relatively effective method.