Pelvic fractures are often caused by high-energy injuries and accompanied by hemodynamic instability.Traditional open surgery has a large amount of bleeding,which is not suitable for patients with acute pelvic fractur...Pelvic fractures are often caused by high-energy injuries and accompanied by hemodynamic instability.Traditional open surgery has a large amount of bleeding,which is not suitable for patients with acute pelvic fracture.Navigationguided,percutaneous puncture-screw implantation has gradually become a preferred procedure due to its advantages,which include less trauma,faster recovery times,and less bleeding.However,due to the complexity of pelvic anatomy,doctors often encounter some problems when using navigation to treat pelvic fractures.This article reviews the indications,contraindications,surgical procedures,and related complications of this procedure for the treatment of sacral fractures,sacroiliac joint injuries,pelvic ring injuries,and acetabular fractures.We also analyze the causes of inaccurate screw placement.Percutaneous screw placement under navigational guidance has the advantages of high accuracy,low incidence of complications and small soft-tissue damage,minimal blood loss,short hospital stays,and quick recovery.There is no difference in the incidence of complications between surgeries performed by new doctors and experienced ones.However,computer navigation technology requires extensive training,and attention should be given to avoid complications such as screw misplacement,intestinal injury,and serious blood vessel and nerve injuries caused by navigational drift.展开更多
Fecal incontinence is not a diagnosis but a frequent and debilitating common final pathway symptom resulting from numerous different causes. Incontinence not only impacts the patient’s self-esteem and qual...Fecal incontinence is not a diagnosis but a frequent and debilitating common final pathway symptom resulting from numerous different causes. Incontinence not only impacts the patient’s self-esteem and quality of life but may result in significant secondary morbidity, disability, and cost. Treatment is difficult without any panacea and an individualized approach should be chosen that frequently combines different modalities. Several new technologies have been developed and their specific roles will have to be defined. The scope of this review is outline the evaluation and treatment of patients with fecal incontinence.展开更多
U-shaped sacral fractures are rare and often difficult to diagnose primarily due to the difficulty in obtaining adequate imaging and the severe associated injuries. These fractures are highly unstable and frequently c...U-shaped sacral fractures are rare and often difficult to diagnose primarily due to the difficulty in obtaining adequate imaging and the severe associated injuries. These fractures are highly unstable and frequently cause neurological deficits. The majority of surgeons have limited experience in management of U-shaped sacral fractures. No standard treatment protocol for U-shaped sacral fractures has been available till now. This study aimed to examine the management of U-shaped sacral fractures and the early outcomes. Clinical data of 15 consecutive patients with U-shaped sacral fracture who were admitted to our trauma center between 2009 and 2014 were retrospectively analyzed. Demographics, fracture classification, mechanism of injury and operative treatment and deformity angle were assessed. All the patients were treated with lumbopelvic fixation or （and） sacral decompression. EQ-5d score was applied to evaluate the patients＇ quality of life. Of the 15 consecutive patients with U-shaped sacral fracture, the mean age was 28.8 years （range： 15-55 years） at the time of injury. There were 6 females and 9 males. The mean follow- up time was 22.7 months （range： 9-47 months） and mean full weight-bearing time was 9.9 weeks （range： 8-14 weeks）. Ten patients received lumbopelvic fixation and sacral decompression, one lombosacral fixation, and 4 merely sacral decompression due to delayed diagnosis or surgery. The post-operation deformity angle （mean 27.87°, and range： 8°-90°） of the sacrum was smaller than that pre-operation （mean 35.67; range： 15-90） with no significance difference noted. At the latest follow-up, all patients obtained neurological recovery with different extents. Visual analogue score （VAS） was reduced from preoperative 7.07 （range： 5-9） to postoperetive 1.93 （range： 1-3）. All patients could walk without any aid after treatment. Eight patients were able to care for themselves and undertook some daily activities. Five patients had returned to work ful展开更多
BACKGROUND Fecal incontinence(FI)is an involuntary passage of fecal matter which can have a significant impact on a patient’s quality of life.Many modalities of treatment exist for FI.Sacral nerve stimulation is a we...BACKGROUND Fecal incontinence(FI)is an involuntary passage of fecal matter which can have a significant impact on a patient’s quality of life.Many modalities of treatment exist for FI.Sacral nerve stimulation is a well-established treatment for FI.Given the increased need of magnetic resonance imaging(MRI)for diagnostics,the In-terStim which was previously used in sacral nerve stimulation was limited by MRI incompatibility.Medtronic MRI-compatible InterStim was approved by the United States Food and Drug Administration in August 2020 and has been widely used.AIM To evaluate the efficacy,outcomes and complications of the MRI-compatible InterStim.METHODS Data of patients who underwent MRI-compatible Medtronic InterStim placement at UPMC Williamsport,University of Minnesota,Advocate Lutheran General Hospital,and University of Wisconsin-Madison was pooled and analyzed.Patient demographics,clinical features,surgical techniques,complications,and outcomes were analyzed.Strengthening the Reporting of Observational studies in Epidemiology(STROBE)cross-sectional reporting guidelines were used.RESULTS Seventy-three patients had the InterStim implanted.The mean age was 63.29±12.2 years.Fifty-seven(78.1%)patients were females and forty-two(57.5%)patients had diabetes.In addition to incontinence,overlapping symptoms included diarrhea(23.3%),fecal urgency(58.9%),and urinary incontinence(28.8%).Fifteen(20.5%)patients underwent Peripheral Nerve Evaluation before proceeding to definite implant placement.Thirty-two(43.8%)patients underwent rechargeable InterStim placement.Three(4.1%)patients needed removal of the implant.Migration of the external lead connection was observed in 7(9.6%)patients after the stage I procedure.The explanation for one patient was due to infection.Seven(9.6%)patients had other complications like nerve pain,hematoma,infection,lead fracture,and bleeding.The mean follow-up was 6.62±3.5 mo.Sixty-eight(93.2%)patients reported significant improvement of symptoms on follow-up evaluation.CONCLUSION This study 展开更多
Objective： To provide a new method in the fixation of sacral fracture by means of three-dimensional reconstruction and reverse engineering technique. Methods： Pelvis image data were obtained from threedimensional C...Objective： To provide a new method in the fixation of sacral fracture by means of three-dimensional reconstruction and reverse engineering technique. Methods： Pelvis image data were obtained from threedimensional CT scan in patients with sacral fracture. The data were transferred into a computer workstation. The threedimensional models of pelvis were reconstructed using Amira 3.1 software and saved in STL format. Then the threedimensional fracture models were imported into Imageware 9.0 software. Different situations of reduction （total reduction, half reduction and non-reduction） were simulated using Imageware 9.0 software. The best direction and location of extract iliosacral lag screws were defined using reverse engineering according to these three situations and navigation templates were designed according to the anatomic features of the postero-iliac part and the channel. The exact navigational template was made by rapid prototyping. Drill guides were sterilized and used intraoperatively to assist in surgical navigation and the placement of iliosacral lag screws. Results： Accurate screw placement was confirmed with postoperative X-ray and CT scanning. The navigation template was found to be highly accurate. Conclusion： The navigation template may be a useful method in minimal-invasive fixation of sacroiliac joint fracture.展开更多
The sacral nerve anterior root consists of parasympathetic nerves（dominating urinary bladder detrusor）and somatic motor nerves（dominating urethral sphincter）,and electrical stimulation to the sacral nerve anterior...The sacral nerve anterior root consists of parasympathetic nerves（dominating urinary bladder detrusor）and somatic motor nerves（dominating urethral sphincter）,and electrical stimulation to the sacral nerve anterior root induces simultaneous contraction of the bladder detrusor and urethral sphincter.Accordingly,urethral pressure exceeds intravesical pressure,resulting in little or no urination,kidney damage,and trembling of lower limbs due to high intravesical pressure.In the present study,sacral nerve posterior roots were transected in a spastic bladder rabbit model,followed by three-pole electrode and long-pulse electrical stimulation to the sacral anterior root.Intravesical and urethral pressures were simultaneously measured to verify the feasibility of anode inhibition to the sacral anterior root following induced detrusor contraction.As stimulus intensity increased,somatic motor nerves were increasingly inhibited; with a stimulus pulse width of 300 μs and stimulus current of 1.05 mA,urethral pressure was zero and average intravesical pressure was 3.84 kPa.In addition,detrusor contraction was displayed,and lower extremity trembling was significantly reduced.Three-pole electrode and long-pulse electrical stimulation to the sacral nerve anterior root induced detrusor contraction and inhibited low extremity trembling under electrical stimulation.展开更多
We report a 27-year-old female who presented with abdominal distension, saddle anesthesia, and lower back pain. CT and MRI of the abdomen/spine were performed which showed a large anterior sacral meningocele occupying...We report a 27-year-old female who presented with abdominal distension, saddle anesthesia, and lower back pain. CT and MRI of the abdomen/spine were performed which showed a large anterior sacral meningocele occupying most of the pelvic and abdominal cavity and displacement of their respective contents. Anterior approach was chosen, uterine didelphys was identified and mobilized, meningocele identified and gentle drainage with subsequent resection of the cyst wall and watertight closure was achieved. Subsequent MRI demonstrated resolution of most the sacral meningocele. Patient symptoms improved and are doing well.展开更多
This study analyzed the clinical characteristics and outcomes of sacral extradural spinal meningeal cysts with spinal nerve root fibers treated by reconstruction of the nerve root sheaths.The relationships between the...This study analyzed the clinical characteristics and outcomes of sacral extradural spinal meningeal cysts with spinal nerve root fibers treated by reconstruction of the nerve root sheaths.The relationships between the cysts and spinal nerve root fibers were examined microscopically,the cysts were partially excised,and the defects were oversewn to reconstruct the nerve root sheaths.The Improved Japanese Orthopedic Association(IJOA)scoring system was used to evaluate preoperative and postoperative neurological function.Thirty-eight patients were included in this study,with a mean age of 41.4±15.57 years.The mean IJOA score was 18.8±1.32 preoperatively and 19.6±0.65 postoperatively,which was a significant difference(t=–3.77,P=0.001).These results indicate a significant improvement in neurological function after surgery.The most significant improvement in neurological function was sensation(z=–2.86,P=0.004),followed by bowel/bladder function(z=–2.31,P=0.02).展开更多
Background： Resection of sacral chordomas is challenging. The anatomy is complex, and there are often no bony landmarks to guide the resection. Achieving adequate surgical margins is, therefore, difficult, and the re...Background： Resection of sacral chordomas is challenging. The anatomy is complex, and there are often no bony landmarks to guide the resection. Achieving adequate surgical margins is, therefore, difficult, and the recurrence rate is high. Use of computer navigation may allow optimal preoperative planning and improve precision in tumor resection. The purpose of this study was to evaluate the safety and feasibility of computer navigation-aided resection of sacral chordomas. Methods： Between 2007 and 2013, a total of 26 patients with sacral chordoma underwent computer navigation-aided surgery were included and followed for a minimum of 18 months. There were 21 primary cases and 5 recurrent cases, with a mean age of 55.8 years old （range： 35 84 years old）. Tumors were located above the level of the $3 neural foramen in 23 patients and below the level of the $3 neural foramen in 3 patients. Three-dimensional images were reconstructed with a computed tomography-based navigation system combined with the magnetic resonance images using the navigation software. Tumors were resected via a posterior approach assisted by the computer navigation. Mean follow-up was 38.6 months （range： 18-84 months）. Results： Mean operative time was 307 min. Mean intraoperative blood loss was 3065 ml. For computer navigation, the mean registration deviation during surgery was 1.7 ram. There were 18 wide resections, 4 marginal resections, and 4 intralesional resections. All patients were alive at the final follow-up, with 2 （7.7%） exhibiting tumor recurrence. The other 24 patients were tumor-free. The mean Musculoskeletal Tumor Society Score was 27.3 （range： 19-30）. Conclusions： Computer-assisted navigation can be safely applied to the resection of the sacral chordomas, allowing execution of preoperative plans, and achieving good oncological outcomes. Nevertheless, this needs to be accomplished by surgeons with adequate experience and skill.展开更多
<b>Background:</b> Peripheral block techniques for total hip arthroplasty have been used as an analgesic strategy, only a few studies described it as an anesthetic technique, so the perioperative performan...<b>Background:</b> Peripheral block techniques for total hip arthroplasty have been used as an analgesic strategy, only a few studies described it as an anesthetic technique, so the perioperative performance and safety are poorly studied. <b>Methods:</b> 78 total hip arthroplasties were prospectively observed in our hospital. Divided into 2 groups: 1) General anesthesia;and 2) Lumbar sacral plexus block anesthesia. Variables measured in both groups were: demographics, conversion to general anesthesia, total opioid doses, surgical time, blood loss, postoperative pain, use and total dose of vasopressors drugs, transfusion and ICU transfer needs, postoperative ambulation time, and length of hospital stay. T student and chi-square tests were used upon the case. A significant difference was considered when a value of p < 0.05 was obtained. Descriptive statistics were performed in frequency, percentages, variance and standard deviation. <b>Results:</b> 3 patients (7.3%) anesthetized with combined lumbar sacral plexus block were converted to general anesthesia. When comparing peripheral nerve block and general anesthesia, less intraoperative (p = 0.000) and postoperative (p = 0.002) opioid consumption were noted, less postoperative pain in PACU (p = 0.002) and in the first 24 hours (p = 0.005), as well as earlier onset of ambulation (p = 0.008) and shorter hospital stay (p = 0.031). <b>Conclusions:</b> In our study, the lumbar and sacral plexus block anesthesia technique provided anesthetic conditions to perform hip joint arthroplasty and it was proved to be advantageous in comparison to general anesthesia.展开更多
To analyze the anatomy of sacral venous plexus flow, the causes of injuries and the methods for controlling presacral hemorrhage during surgery for rectal cancer.METHODSA review of the databases MEDLINE<sup>...To analyze the anatomy of sacral venous plexus flow, the causes of injuries and the methods for controlling presacral hemorrhage during surgery for rectal cancer.METHODSA review of the databases MEDLINE<sup>®</sup> and Embase™ was conducted, and relevant scientific articles published between January 1960 and June 2016 were examined. The anatomy of the sacrum and its venous plexus, as well as the factors that influence bleeding, the causes of this complication, and its surgical management were defined.RESULTSThis is a review of 58 published articles on presacral venous plexus injury during the mobilization of the rectum and on techniques used to treat presacral venous bleeding. Due to the lack of cases published in the literature, there is no consensus on which is the best technique to use if there is presacral bleeding during mobilization in surgery for rectal cancer. This review may provide a tool to help surgeons make decisions regarding how to resolve this serious complication.CONCLUSIONA series of alternative treatments are described; however, a conventional systematic review in which optimal treatment is identified could not be performed because few cases were analyzed in most publications.展开更多
Background： Sacral neuromodulation （SNM） has become an effective method for treating lower urinary tract voiding dysfunction during the past 20 years. Because of the expensive cost, the number of implantable pulse ...Background： Sacral neuromodulation （SNM） has become an effective method for treating lower urinary tract voiding dysfunction during the past 20 years. Because of the expensive cost, the number of implantable pulse generator （IPG） implantations per year in China is far lower than that in Western developed countries since 2012. This study was to summarize the effects of the appropriate prolonged SNM testing time in improving the implantation rate of a permanent IPG in patients with refractory lower urinary tract symptoms （LUTS） in China's Mainland. Methods： From January 2013 to June 2016, 51 patients with refractory LUTS received SNM therapy, in this study, we compared the conversion rate 2 weeks after the Stage I test and final actual conversion rate. We also observed the complications （such as pain, infection, and electrode displacement） and effectiveness. We tried to improve an appropriate prolonged test time which was favorable for improving the SNM conversion rate while ensuring safety and effectiveness. Results： Among 51 patients receiving SNM therapy, 19 patients （mean age 45.0 ±16.9 years） had poor Stage I test results, and on an average, the electrode was removed 27.4 ± 9.6 days after the surgery. In one patient, the electrode was removed within 2 weeks; when the remaining 18 patients were questioned 2 weeks after testing, none of the patients wanted to terminate the test, and all the 18 patients desired to prolong the testing time to further observe the treatment effect. The remaining 32 patients （mean age 46.7 ± 15.3 years） received Stage If permanent implantation at 19.6 ± 10.4 days after the surgery. The overall Stage Ⅰ-Ⅱ conversion was 62.7% （32/51） in this study. Within 2 weeks after the surgery, only eight patients received Stage II permanent implantation, and the conversion rate was only 15.7% （8/51 ）, which was much lower than the overall conversion rate of 62.7%. Nearly 84.4% （27/32） of the patients received Stage 11 implantation within 4 weeks. N展开更多
Background Sacral nerve injury is a common complication of pelvic or sacral fractures. As the sacral nerve courser within the sacrum and has a complex relationship with the surrounding tissues, different parts of the ...Background Sacral nerve injury is a common complication of pelvic or sacral fractures. As the sacral nerve courser within the sacrum and has a complex relationship with the surrounding tissues, different parts of the sacral plexus injury have similar clinical symptoms and signs. Since lack of specific imaging technique in the diagnosis of sacral nerve injury,especially on multi-segment, multi-site, how to determine the preoperative location and extent of the sacral nerve injury accurately becomes a concem of the general orthopaedic and images practitioners. This study was conducted to gain an insight into the overall anatomical features of the sacral nerve （SN） on the same slice in high resolution computed tomography （HRCT） reconstruction and to determine the value of this information for the clinical diagnosis of related diseases.Methods Fifty healthy volunteers and 30 patients （40 sides） with SN lesions confirmed by surgery were scanned using a 16-slice helical CT scanner （Light Speed, GE, USA）. Among the patients, 6 with intervertebral disk hernia （6 sides）, 8with spinal stenosis （12 sides）, 11 with pelvic trauma （14 sides）, 4 with pelvic malignancies （6 sides）, and 1 with sacral vertebral tuberculosis （2 sides）. The SN multiplanar reconstruction was performed using a UNIX-based SCD4.1workstation where the image was set on the same slice. All images were stored in the Digital Imaging and Communications in Medicine format. The display of nerves in different sections was analyzed using a five-graded scale with coordinate curves of each individual score. The overall anatomic features visible on the slice were analyzed and the abnormalities of the lesions were studied.Results The image of the same slice clearly revealed the shape, running direction, thickness, tension and adjacent anatomy of the S1-S4 nerves. The rank of display rates in different sections was： outward-rotated oblique sagittal 〉outward-rotated oblique coronal 〉 oblique coronal plane 〉 coronal 〉 sagitta展开更多
Sacral fractures following posterior lumbosacral fusion are an uncommon complication. Only a few case series and case reports have been published so far. This article presents a case of totally displaced sacral fractu...Sacral fractures following posterior lumbosacral fusion are an uncommon complication. Only a few case series and case reports have been published so far. This article presents a case of totally displaced sacral fracture following posterior L4-S1 fusion in a 65-yearold patient with a 15-year history of corticosteroid use who underwent open reduction and internal fixation using iliac screws. The patient was followed for 2 years. A thorough review of the literature was conducted using the Medline database between 1994 and 2014. Immediately after the revision surgery, the patient's pain in the buttock and left leg resolved significantly. The patient was followed for 2 years. The weakness in the left lower extremity improved gradually from 3/5 to 5/5. In conclusion, the incidence of postoperative sacral fractures could have been underestimated, because most of these fractures are not visible on a plain radiograph. Computed tomography has been proved to be able to detect most such fractures and should probably be performed routinely when patients complain of renewed buttock pain within 3 mo after lumbosacral fusion. The majority of the patients responded well to conservative treatments, and extending the fusion construct to the iliac wings using iliac screws may be needed when there is concurrent fracture displacement, sagittal imbalance, neurologic symptoms, or painful nonunion.展开更多
Acupoints on the different parts of the body surface vary in regulating the autonomic nervous system(ANS),exhibiting differences in the acupoint specificity in terms of the distributing directions of sympathetic and p...Acupoints on the different parts of the body surface vary in regulating the autonomic nervous system(ANS),exhibiting differences in the acupoint specificity in terms of the distributing directions of sympathetic and parasympathetic branches.The paper introduces the rules of acupoints on the corresponding body surfaces in modulating ANS based on their location at four limbs,abdomen,sacrum,head and face,suboccipital and lateral cervical region and auricle(concha).The fundamental rule of acupoint heterogeneity in ANS regulation is that:all acupoints can induce somatic-sympathetic reflex.The regional heterogeneity of acupoints in ANS is shown:by the fact that stimulation beyond a certain intensity can induce systemic autonomic effects.The acupoints on the abdomen act on the sympathetic nervous system,those at concha on the vagal system and those on the sacral region on the sacral parasymathetic system.The heterogeneity of acupoints in regulating ANS refers to co-effects of acupoints specific effect(within segments) and its systemic effect(whole body),which embodies the specificity of acupoints structure.The acupoints on the same body surface regions display the homogeneity of modulation.Mastering the heterogeneous characteristics of acupoints in modulating ANS is particularly conductive to constructing the theoretical basis of acupoints in clinical acupuncture treatment for systemic diseases.展开更多
Previous studies have shown that, anode block electrical stimulation of the sacral nerve root can produce physiological urination and reconstruct urinary bladder function in rabbits. However, whether long-term anode b...Previous studies have shown that, anode block electrical stimulation of the sacral nerve root can produce physiological urination and reconstruct urinary bladder function in rabbits. However, whether long-term anode block electrical stimulation causes damage to the sacral nerve root re- mains unclear, and needs further investigation. In this study, a complete spinal cord injury model was established in New Zealand white rabbits through T9_10 segment transection. Rabbits were given continuous electrical stimulation for a short period and then chronic stimulation for a longer period. Results showed that compared with normal rabbits, the structure of nerve cells in the anterior sacral nerve roots was unchanged in spinal cord injury rabbits after electrical stimu- lation. There was no significant difference in the expression of apoptosis-related proteins such as Bax, Caspase-3, and Bcl-2. Experimental findings indicate that neurons in the rabbit sacral nerve roots tolerate electrical stimulation, even after long-term anode block electrical stimulation.展开更多
文摘Pelvic fractures are often caused by high-energy injuries and accompanied by hemodynamic instability.Traditional open surgery has a large amount of bleeding,which is not suitable for patients with acute pelvic fracture.Navigationguided,percutaneous puncture-screw implantation has gradually become a preferred procedure due to its advantages,which include less trauma,faster recovery times,and less bleeding.However,due to the complexity of pelvic anatomy,doctors often encounter some problems when using navigation to treat pelvic fractures.This article reviews the indications,contraindications,surgical procedures,and related complications of this procedure for the treatment of sacral fractures,sacroiliac joint injuries,pelvic ring injuries,and acetabular fractures.We also analyze the causes of inaccurate screw placement.Percutaneous screw placement under navigational guidance has the advantages of high accuracy,low incidence of complications and small soft-tissue damage,minimal blood loss,short hospital stays,and quick recovery.There is no difference in the incidence of complications between surgeries performed by new doctors and experienced ones.However,computer navigation technology requires extensive training,and attention should be given to avoid complications such as screw misplacement,intestinal injury,and serious blood vessel and nerve injuries caused by navigational drift.
文摘Fecal incontinence is not a diagnosis but a frequent and debilitating common final pathway symptom resulting from numerous different causes. Incontinence not only impacts the patient’s self-esteem and quality of life but may result in significant secondary morbidity, disability, and cost. Treatment is difficult without any panacea and an individualized approach should be chosen that frequently combines different modalities. Several new technologies have been developed and their specific roles will have to be defined. The scope of this review is outline the evaluation and treatment of patients with fecal incontinence.
文摘U-shaped sacral fractures are rare and often difficult to diagnose primarily due to the difficulty in obtaining adequate imaging and the severe associated injuries. These fractures are highly unstable and frequently cause neurological deficits. The majority of surgeons have limited experience in management of U-shaped sacral fractures. No standard treatment protocol for U-shaped sacral fractures has been available till now. This study aimed to examine the management of U-shaped sacral fractures and the early outcomes. Clinical data of 15 consecutive patients with U-shaped sacral fracture who were admitted to our trauma center between 2009 and 2014 were retrospectively analyzed. Demographics, fracture classification, mechanism of injury and operative treatment and deformity angle were assessed. All the patients were treated with lumbopelvic fixation or （and） sacral decompression. EQ-5d score was applied to evaluate the patients＇ quality of life. Of the 15 consecutive patients with U-shaped sacral fracture, the mean age was 28.8 years （range： 15-55 years） at the time of injury. There were 6 females and 9 males. The mean follow- up time was 22.7 months （range： 9-47 months） and mean full weight-bearing time was 9.9 weeks （range： 8-14 weeks）. Ten patients received lumbopelvic fixation and sacral decompression, one lombosacral fixation, and 4 merely sacral decompression due to delayed diagnosis or surgery. The post-operation deformity angle （mean 27.87°, and range： 8°-90°） of the sacrum was smaller than that pre-operation （mean 35.67; range： 15-90） with no significance difference noted. At the latest follow-up, all patients obtained neurological recovery with different extents. Visual analogue score （VAS） was reduced from preoperative 7.07 （range： 5-9） to postoperetive 1.93 （range： 1-3）. All patients could walk without any aid after treatment. Eight patients were able to care for themselves and undertook some daily activities. Five patients had returned to work ful
文摘BACKGROUND Fecal incontinence(FI)is an involuntary passage of fecal matter which can have a significant impact on a patient’s quality of life.Many modalities of treatment exist for FI.Sacral nerve stimulation is a well-established treatment for FI.Given the increased need of magnetic resonance imaging(MRI)for diagnostics,the In-terStim which was previously used in sacral nerve stimulation was limited by MRI incompatibility.Medtronic MRI-compatible InterStim was approved by the United States Food and Drug Administration in August 2020 and has been widely used.AIM To evaluate the efficacy,outcomes and complications of the MRI-compatible InterStim.METHODS Data of patients who underwent MRI-compatible Medtronic InterStim placement at UPMC Williamsport,University of Minnesota,Advocate Lutheran General Hospital,and University of Wisconsin-Madison was pooled and analyzed.Patient demographics,clinical features,surgical techniques,complications,and outcomes were analyzed.Strengthening the Reporting of Observational studies in Epidemiology(STROBE)cross-sectional reporting guidelines were used.RESULTS Seventy-three patients had the InterStim implanted.The mean age was 63.29±12.2 years.Fifty-seven(78.1%)patients were females and forty-two(57.5%)patients had diabetes.In addition to incontinence,overlapping symptoms included diarrhea(23.3%),fecal urgency(58.9%),and urinary incontinence(28.8%).Fifteen(20.5%)patients underwent Peripheral Nerve Evaluation before proceeding to definite implant placement.Thirty-two(43.8%)patients underwent rechargeable InterStim placement.Three(4.1%)patients needed removal of the implant.Migration of the external lead connection was observed in 7(9.6%)patients after the stage I procedure.The explanation for one patient was due to infection.Seven(9.6%)patients had other complications like nerve pain,hematoma,infection,lead fracture,and bleeding.The mean follow-up was 6.62±3.5 mo.Sixty-eight(93.2%)patients reported significant improvement of symptoms on follow-up evaluation.CONCLUSION This study
文摘Objective： To provide a new method in the fixation of sacral fracture by means of three-dimensional reconstruction and reverse engineering technique. Methods： Pelvis image data were obtained from threedimensional CT scan in patients with sacral fracture. The data were transferred into a computer workstation. The threedimensional models of pelvis were reconstructed using Amira 3.1 software and saved in STL format. Then the threedimensional fracture models were imported into Imageware 9.0 software. Different situations of reduction （total reduction, half reduction and non-reduction） were simulated using Imageware 9.0 software. The best direction and location of extract iliosacral lag screws were defined using reverse engineering according to these three situations and navigation templates were designed according to the anatomic features of the postero-iliac part and the channel. The exact navigational template was made by rapid prototyping. Drill guides were sterilized and used intraoperatively to assist in surgical navigation and the placement of iliosacral lag screws. Results： Accurate screw placement was confirmed with postoperative X-ray and CT scanning. The navigation template was found to be highly accurate. Conclusion： The navigation template may be a useful method in minimal-invasive fixation of sacroiliac joint fracture.
基金a grant for International Cooperation Project by Jilin Provincial Science and Technology Commission,No.20100735
文摘The sacral nerve anterior root consists of parasympathetic nerves（dominating urinary bladder detrusor）and somatic motor nerves（dominating urethral sphincter）,and electrical stimulation to the sacral nerve anterior root induces simultaneous contraction of the bladder detrusor and urethral sphincter.Accordingly,urethral pressure exceeds intravesical pressure,resulting in little or no urination,kidney damage,and trembling of lower limbs due to high intravesical pressure.In the present study,sacral nerve posterior roots were transected in a spastic bladder rabbit model,followed by three-pole electrode and long-pulse electrical stimulation to the sacral anterior root.Intravesical and urethral pressures were simultaneously measured to verify the feasibility of anode inhibition to the sacral anterior root following induced detrusor contraction.As stimulus intensity increased,somatic motor nerves were increasingly inhibited; with a stimulus pulse width of 300 μs and stimulus current of 1.05 mA,urethral pressure was zero and average intravesical pressure was 3.84 kPa.In addition,detrusor contraction was displayed,and lower extremity trembling was significantly reduced.Three-pole electrode and long-pulse electrical stimulation to the sacral nerve anterior root induced detrusor contraction and inhibited low extremity trembling under electrical stimulation.
文摘We report a 27-year-old female who presented with abdominal distension, saddle anesthesia, and lower back pain. CT and MRI of the abdomen/spine were performed which showed a large anterior sacral meningocele occupying most of the pelvic and abdominal cavity and displacement of their respective contents. Anterior approach was chosen, uterine didelphys was identified and mobilized, meningocele identified and gentle drainage with subsequent resection of the cyst wall and watertight closure was achieved. Subsequent MRI demonstrated resolution of most the sacral meningocele. Patient symptoms improved and are doing well.
基金supported by grants from the Science Foundation for the Excellent Youth Scholars of Ministry of Education of China(200800011035)the National Natural Science Foundation of China(81200969/H0912)
文摘This study analyzed the clinical characteristics and outcomes of sacral extradural spinal meningeal cysts with spinal nerve root fibers treated by reconstruction of the nerve root sheaths.The relationships between the cysts and spinal nerve root fibers were examined microscopically,the cysts were partially excised,and the defects were oversewn to reconstruct the nerve root sheaths.The Improved Japanese Orthopedic Association(IJOA)scoring system was used to evaluate preoperative and postoperative neurological function.Thirty-eight patients were included in this study,with a mean age of 41.4±15.57 years.The mean IJOA score was 18.8±1.32 preoperatively and 19.6±0.65 postoperatively,which was a significant difference(t=–3.77,P=0.001).These results indicate a significant improvement in neurological function after surgery.The most significant improvement in neurological function was sensation(z=–2.86,P=0.004),followed by bowel/bladder function(z=–2.31,P=0.02).
文摘Background： Resection of sacral chordomas is challenging. The anatomy is complex, and there are often no bony landmarks to guide the resection. Achieving adequate surgical margins is, therefore, difficult, and the recurrence rate is high. Use of computer navigation may allow optimal preoperative planning and improve precision in tumor resection. The purpose of this study was to evaluate the safety and feasibility of computer navigation-aided resection of sacral chordomas. Methods： Between 2007 and 2013, a total of 26 patients with sacral chordoma underwent computer navigation-aided surgery were included and followed for a minimum of 18 months. There were 21 primary cases and 5 recurrent cases, with a mean age of 55.8 years old （range： 35 84 years old）. Tumors were located above the level of the $3 neural foramen in 23 patients and below the level of the $3 neural foramen in 3 patients. Three-dimensional images were reconstructed with a computed tomography-based navigation system combined with the magnetic resonance images using the navigation software. Tumors were resected via a posterior approach assisted by the computer navigation. Mean follow-up was 38.6 months （range： 18-84 months）. Results： Mean operative time was 307 min. Mean intraoperative blood loss was 3065 ml. For computer navigation, the mean registration deviation during surgery was 1.7 ram. There were 18 wide resections, 4 marginal resections, and 4 intralesional resections. All patients were alive at the final follow-up, with 2 （7.7%） exhibiting tumor recurrence. The other 24 patients were tumor-free. The mean Musculoskeletal Tumor Society Score was 27.3 （range： 19-30）. Conclusions： Computer-assisted navigation can be safely applied to the resection of the sacral chordomas, allowing execution of preoperative plans, and achieving good oncological outcomes. Nevertheless, this needs to be accomplished by surgeons with adequate experience and skill.
文摘<b>Background:</b> Peripheral block techniques for total hip arthroplasty have been used as an analgesic strategy, only a few studies described it as an anesthetic technique, so the perioperative performance and safety are poorly studied. <b>Methods:</b> 78 total hip arthroplasties were prospectively observed in our hospital. Divided into 2 groups: 1) General anesthesia;and 2) Lumbar sacral plexus block anesthesia. Variables measured in both groups were: demographics, conversion to general anesthesia, total opioid doses, surgical time, blood loss, postoperative pain, use and total dose of vasopressors drugs, transfusion and ICU transfer needs, postoperative ambulation time, and length of hospital stay. T student and chi-square tests were used upon the case. A significant difference was considered when a value of p < 0.05 was obtained. Descriptive statistics were performed in frequency, percentages, variance and standard deviation. <b>Results:</b> 3 patients (7.3%) anesthetized with combined lumbar sacral plexus block were converted to general anesthesia. When comparing peripheral nerve block and general anesthesia, less intraoperative (p = 0.000) and postoperative (p = 0.002) opioid consumption were noted, less postoperative pain in PACU (p = 0.002) and in the first 24 hours (p = 0.005), as well as earlier onset of ambulation (p = 0.008) and shorter hospital stay (p = 0.031). <b>Conclusions:</b> In our study, the lumbar and sacral plexus block anesthesia technique provided anesthetic conditions to perform hip joint arthroplasty and it was proved to be advantageous in comparison to general anesthesia.
文摘To analyze the anatomy of sacral venous plexus flow, the causes of injuries and the methods for controlling presacral hemorrhage during surgery for rectal cancer.METHODSA review of the databases MEDLINE<sup>®</sup> and Embase™ was conducted, and relevant scientific articles published between January 1960 and June 2016 were examined. The anatomy of the sacrum and its venous plexus, as well as the factors that influence bleeding, the causes of this complication, and its surgical management were defined.RESULTSThis is a review of 58 published articles on presacral venous plexus injury during the mobilization of the rectum and on techniques used to treat presacral venous bleeding. Due to the lack of cases published in the literature, there is no consensus on which is the best technique to use if there is presacral bleeding during mobilization in surgery for rectal cancer. This review may provide a tool to help surgeons make decisions regarding how to resolve this serious complication.CONCLUSIONA series of alternative treatments are described; however, a conventional systematic review in which optimal treatment is identified could not be performed because few cases were analyzed in most publications.
文摘Background： Sacral neuromodulation （SNM） has become an effective method for treating lower urinary tract voiding dysfunction during the past 20 years. Because of the expensive cost, the number of implantable pulse generator （IPG） implantations per year in China is far lower than that in Western developed countries since 2012. This study was to summarize the effects of the appropriate prolonged SNM testing time in improving the implantation rate of a permanent IPG in patients with refractory lower urinary tract symptoms （LUTS） in China's Mainland. Methods： From January 2013 to June 2016, 51 patients with refractory LUTS received SNM therapy, in this study, we compared the conversion rate 2 weeks after the Stage I test and final actual conversion rate. We also observed the complications （such as pain, infection, and electrode displacement） and effectiveness. We tried to improve an appropriate prolonged test time which was favorable for improving the SNM conversion rate while ensuring safety and effectiveness. Results： Among 51 patients receiving SNM therapy, 19 patients （mean age 45.0 ±16.9 years） had poor Stage I test results, and on an average, the electrode was removed 27.4 ± 9.6 days after the surgery. In one patient, the electrode was removed within 2 weeks; when the remaining 18 patients were questioned 2 weeks after testing, none of the patients wanted to terminate the test, and all the 18 patients desired to prolong the testing time to further observe the treatment effect. The remaining 32 patients （mean age 46.7 ± 15.3 years） received Stage If permanent implantation at 19.6 ± 10.4 days after the surgery. The overall Stage Ⅰ-Ⅱ conversion was 62.7% （32/51） in this study. Within 2 weeks after the surgery, only eight patients received Stage II permanent implantation, and the conversion rate was only 15.7% （8/51 ）, which was much lower than the overall conversion rate of 62.7%. Nearly 84.4% （27/32） of the patients received Stage 11 implantation within 4 weeks. N
基金This study was supported by the National Natural Science Foundation of China （No. 30973066）.
文摘Background Sacral nerve injury is a common complication of pelvic or sacral fractures. As the sacral nerve courser within the sacrum and has a complex relationship with the surrounding tissues, different parts of the sacral plexus injury have similar clinical symptoms and signs. Since lack of specific imaging technique in the diagnosis of sacral nerve injury,especially on multi-segment, multi-site, how to determine the preoperative location and extent of the sacral nerve injury accurately becomes a concem of the general orthopaedic and images practitioners. This study was conducted to gain an insight into the overall anatomical features of the sacral nerve （SN） on the same slice in high resolution computed tomography （HRCT） reconstruction and to determine the value of this information for the clinical diagnosis of related diseases.Methods Fifty healthy volunteers and 30 patients （40 sides） with SN lesions confirmed by surgery were scanned using a 16-slice helical CT scanner （Light Speed, GE, USA）. Among the patients, 6 with intervertebral disk hernia （6 sides）, 8with spinal stenosis （12 sides）, 11 with pelvic trauma （14 sides）, 4 with pelvic malignancies （6 sides）, and 1 with sacral vertebral tuberculosis （2 sides）. The SN multiplanar reconstruction was performed using a UNIX-based SCD4.1workstation where the image was set on the same slice. All images were stored in the Digital Imaging and Communications in Medicine format. The display of nerves in different sections was analyzed using a five-graded scale with coordinate curves of each individual score. The overall anatomic features visible on the slice were analyzed and the abnormalities of the lesions were studied.Results The image of the same slice clearly revealed the shape, running direction, thickness, tension and adjacent anatomy of the S1-S4 nerves. The rank of display rates in different sections was： outward-rotated oblique sagittal 〉outward-rotated oblique coronal 〉 oblique coronal plane 〉 coronal 〉 sagitta
文摘Sacral fractures following posterior lumbosacral fusion are an uncommon complication. Only a few case series and case reports have been published so far. This article presents a case of totally displaced sacral fracture following posterior L4-S1 fusion in a 65-yearold patient with a 15-year history of corticosteroid use who underwent open reduction and internal fixation using iliac screws. The patient was followed for 2 years. A thorough review of the literature was conducted using the Medline database between 1994 and 2014. Immediately after the revision surgery, the patient's pain in the buttock and left leg resolved significantly. The patient was followed for 2 years. The weakness in the left lower extremity improved gradually from 3/5 to 5/5. In conclusion, the incidence of postoperative sacral fractures could have been underestimated, because most of these fractures are not visible on a plain radiograph. Computed tomography has been proved to be able to detect most such fractures and should probably be performed routinely when patients complain of renewed buttock pain within 3 mo after lumbosacral fusion. The majority of the patients responded well to conservative treatments, and extending the fusion construct to the iliac wings using iliac screws may be needed when there is concurrent fracture displacement, sagittal imbalance, neurologic symptoms, or painful nonunion.
基金Supported by National Natural Science Foundation of China:No.82374284Jiangsu Natural Science Foundation:No.BK20221350。
文摘Acupoints on the different parts of the body surface vary in regulating the autonomic nervous system(ANS),exhibiting differences in the acupoint specificity in terms of the distributing directions of sympathetic and parasympathetic branches.The paper introduces the rules of acupoints on the corresponding body surfaces in modulating ANS based on their location at four limbs,abdomen,sacrum,head and face,suboccipital and lateral cervical region and auricle(concha).The fundamental rule of acupoint heterogeneity in ANS regulation is that:all acupoints can induce somatic-sympathetic reflex.The regional heterogeneity of acupoints in ANS is shown:by the fact that stimulation beyond a certain intensity can induce systemic autonomic effects.The acupoints on the abdomen act on the sympathetic nervous system,those at concha on the vagal system and those on the sacral region on the sacral parasymathetic system.The heterogeneity of acupoints in regulating ANS refers to co-effects of acupoints specific effect(within segments) and its systemic effect(whole body),which embodies the specificity of acupoints structure.The acupoints on the same body surface regions display the homogeneity of modulation.Mastering the heterogeneous characteristics of acupoints in modulating ANS is particularly conductive to constructing the theoretical basis of acupoints in clinical acupuncture treatment for systemic diseases.
基金supported by the International Cooperation Projects of Jilin Province Science and Technology Commission,No.20100735
文摘Previous studies have shown that, anode block electrical stimulation of the sacral nerve root can produce physiological urination and reconstruct urinary bladder function in rabbits. However, whether long-term anode block electrical stimulation causes damage to the sacral nerve root re- mains unclear, and needs further investigation. In this study, a complete spinal cord injury model was established in New Zealand white rabbits through T9_10 segment transection. Rabbits were given continuous electrical stimulation for a short period and then chronic stimulation for a longer period. Results showed that compared with normal rabbits, the structure of nerve cells in the anterior sacral nerve roots was unchanged in spinal cord injury rabbits after electrical stimu- lation. There was no significant difference in the expression of apoptosis-related proteins such as Bax, Caspase-3, and Bcl-2. Experimental findings indicate that neurons in the rabbit sacral nerve roots tolerate electrical stimulation, even after long-term anode block electrical stimulation.
