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1.
Bestami Yalvaç Nilgün Mesci Duygu Geler Külcü Ozan Volkan Yurdakul 《Acta orthopaedica et traumatologica turcica》2018,52(5):357-362
Objective
The aim of this study was to compare the efficacy of extracorporeal shock wave therapy (ESWT) and therapeutic ultrasound (US) in the treatment of lateral epicondylosis (LE).Methods
Our study enrolled 50 patients with LE. Patients were randomized into two groups. Group 1 underwent therapeutic US (n = 24; 5 males and 15 females; mean age: 43.75 ± 4.52) Group 2 underwent ESWT (n = 20; 8 males and 16 females; mean age: 46.04 ± 9.24). Patients were evaluated at baseline, after treatment,and 1 month following treatment. The outcome measures were the visual analog scale (VAS), algometer, grip dynamometer, quick-disability of the arm,shoulder,and hand (QDASH), patient-rated tennis elbow evaluation (PRTEE), and Short Form-36 (SF-36) health survey questionnairre.Results
Both groups showed significant improvements in terms of VAS (all p values < 0.0001), dynamometer (p = 0.001 vs p = 0.015), algometer (all p values < 0.0001), PRTEE (all p values < 0.0001), QDASH (all p values < 0.0001), and SF-36 scores (p = 0.001 vs p = 0.005) within time. There was no significant difference between the two groups, except algometer scores in favor of ESWT (p = 0.029).Conclusion
ESWT and therapeutic US are equally effective in treating LE. ESWT is an alternative therapeutic intervention and as effective as US.Level of evidence
Level III, Therapeutic study. 相似文献2.
Cenk Ermutlu Murat Aksakal Ayşem Gümüştaş Güven Özkaya Emrah Kovalak Yüksel Özkan 《Acta orthopaedica et traumatologica turcica》2018,52(6):442-446
Objective
The aim of this study was to define a quantitative parameter to indicate which cases of plantar fasciitis will benefit from local corticosteroid injection or ESWT and to compare the efficacy of two different treatment modalities.Methods
Seventy patients (mean age: 49.10; range: 41–58) with chronic plantar fasciitis unresponsive to conservative treatment for 3 months were treated with either betamethasone injection or extracorporeal shock wave therapy (ESWT). Correlation between AOFAS scores, fascia thickness, duration of symptoms, age and calcaneal spur length were assessed.Results
Degree of fascial thickening (mean 4.6 mm for all patients) did not influence baseline AOFAS scores (r = ?0.054). Plantar fascia thickness significantly decreased in both groups after treatment (1.2 mm for steroid, 1.2 mm for ESWT) (p < 0.01 for both groups). Percentage of change in AOFAS scores (68% for steroid and 79% for ESWT, p = 0.069) and fascial thickness (24% for steroid and 26% for ESWT, p = 0.344) were similar between two groups. Functional recovery was not correlated with baseline fascial thickness (r = 0.047) or degree of fascial thinning after treatment (r = ?0.099). Percentage of change in AOFAS scores was correlated only with baseline AOFAS scores (r = ?0.943).Conclusions
Plantar fascia thickness increases significantly in plantar fasciitis and responds to treatment. Both ESWT and betamethasone injection are effective in alleviating symptoms and reducing plantar fascia thickness in chronic plantar fasciitis. However, the only predictive factor for functional recovery in terms of AOFAS scores is patients' functional status prior to treatment. Measuring of plantar fascia is not helpful as a diagnostic or prognostic tool and MRI imaging should be reserved for differential diagnosis.Level of evidence
Level III, Therapeutic study. 相似文献3.
Toru Morihara Yoshikazu Kida Ryuhei Furukawa Tsuyoshi Sukenari Yukichi Kabuto Masao Kurokawa Hiroyoshi Fujiwara Toshikazu Kubo 《Journal of orthopaedic science》2018,23(3):495-503
Background
In cases of the large or massive rotator cuff tears, retear rates after rotator cuff repairs remain high. We introduced an arthroscopic-assisted modified Debeyre-Patte procedure which enables to decrease the tension of torn rotator cuff by sliding supraspinatus and infraspinatus laterally keeping fascia connection to the rhomboids.Purpose
The objective of this study was to examine the clinical outcomes and retear rates after an arthroscopic-assisted modified Debeyre-Patte procedure for irreparable large and massive rotator cuff tears.Methods
Thirty-three rotator cuff tear patients (34 shoulders) were selected. These patients underwent arthroscopic-assisted modified Debeyre-Patte procedures and were observed postoperatively for at least 24 months. Magnetic resonance imaging (MRI) was used to evaluate the preoperative location of the torn rotator cuff stump and fatty infiltration of the muscles composing the rotator cuff, as well as the repaired rotator cuffs. Shoulder functional evaluations through the use of the Constant and Murley scores and the University of California Los Angeles (UCLA) shoulder score were compared before and after surgery, and the preoperative global fatty degeneration index (GFDI) was compared between retear and healed shoulders.Results
MRI showed that 77% of shoulders were healed and 23% exhibited retear postoperatively. The mean preoperative GFDI was 1.99 among the 26 healed shoulders and 2.54 among the 8 retear shoulders (p < .05). When the Goutallier's classification was grade 3 or lower for all 3 cuff muscles for fatty infiltration, the retear rate was 14.3%. The mean Constant and Murley scores in healed and retear groups respectively improved from 34.7 ± 15.8, 30.0 ± 15.1 points (p = 0.47) preoperatively to 70.8 ± 8.3, 53.9 ± 14.0 points (p < .001), and UCLA scores in healed and retear groups from 13.8 ± 3.9, 12.4 ± 5.0 points (p = 0.46) preoperatively to 32.8 ± 2.7, 28.4 ± 3.6 points (p < .001).Conclusion
The clinical outcomes of healed shoulders after the arthroscopic-assisted modified Debeyre-Patte procedure were favorable. If the torn rotator cuff stump is retracted near the glenoid fossa, and the rotator cuff muscle scored Goutallier grade 3 or lower, this modified Debeyre-Patte procedure would be a viable option. 相似文献4.
Fatih Yildiz Abdulkadir Sari Anil Pulatkan Vahdet Ucan Alauddin Kochai Kerem Bilsel 《Acta orthopaedica et traumatologica turcica》2018,52(4):245-248
Objective
The aim of this study was to investigate whether coexistent intraarticular lesions are negative prognostic factors for the results of arthroscopic capsular release in frozen shoulder patients.Methods
Seventy-two patients who met inclusion criteria and underwent arthroscopic capsular release between March 2011 and August 2015 for the frozen shoulder were retrospectively evaluated. The patients were divided into two groups according to existence of concomitant intraarticular pathologies detected during arthroscopy. Preoperative and postoperative functional results were assessed with Constant score and shoulder ranges of motion; and the amount of pain was evaluated using visual analog scale (VAS).Results
Group I consisted of 46 patients (mean age 47.2 years and mean follow-up 26 months) without concomitant shoulder pathologies and group II consisted of 26 patients (mean age 48.6 years and mean follow-up 15 months) with coexistent lesions (SLAP lesions, n = 8; SLAP and partial rupture of the RC, n = 4; SLAP, partial rupture of RC and impingement, n = 10; SLAP and impingement, n = 2; and AC arthritis and impingement, n = 2). Preoperatively, the mean ranges of forward flexion (p = 0.221), abduction (p = 0.065), internal rotation (p = 0.564), Constant (p = 0.148) and VAS (p = 0.365) scores were similar between the groups. After a minimum 12 months of follow-up, all patients significantly improved but no statistically significant difference was detected in the mean ranges of forward flexion (152 vs 150; p = 0.902), abduction (137 vs 129; p = 0.095), external rotation (45 vs 40; p = 0.866), internal rotation (5 vs 5 point; p = 0.474), Constant (82 vs 82.3; p = 0.685) and VAS (1.2 vs 1.2; p = 0.634) scores between the groups.Conclusion
The presence of concomitant shoulder pathologies does not appear to affect the clinical outcomes in patients undergoing arthroscopic capsular release for frozen shoulder.Level of evidence
Level III, Therapeutic study. 相似文献5.
Introduction
The purpose of this study was to determine if there are clinical features that raise suspicion for parathyroid hyperplasia.Materials & methods
We retrospectively reviewed patients with primary hyperparathyroidism who underwent parathyroidectomy from 1991 to 2017, analyzing demographics, calcium and PTH, and localizing studies for patients with hyperplasia and single adenoma.Results
549 patients underwent parathyroidectomy: 464 (85%) with adenoma, 44 (8%) with double adenoma, 38 (7%) with hyperplasia, and 3 (1%) with cancer. Compared to patients with a single adenoma, patients with hyperplasia were more likely to have negative sestamibi, ultrasound or both exams (92% vs 6%, p < 0.001; 96% vs 4%, p < 0.001; and 91% vs 2%, p < 0.001) and lower gland weights (619 ± 1067 mg vs. 1466 ± 1899 mg, p < 0.001).Conclusion
Parathyroid hyperplasia should be suspected in patients with lower gland weights and negative imaging. 相似文献6.
Sevtap Gunay Ucurum Derya Ozer Kaya Yasemin Kayali Ayhan Askin Mustafa Agah Tekindal 《Acta orthopaedica et traumatologica turcica》2018,52(4):249-255
Objective
The aim of this study was to assess and compare the effects of different electrotherapy methods and exercise therapy on pain, function and quality of life in shoulder impingement syndrome.Methods
Eighty-three patients (66 females, 17 males; mean age: 48.2 ± 7.33 years) with shoulder impingement syndrome were selected and 79 of them were randomly allocated into four groups. Group 1 (n = 19, mean age: 47.89 ± 7.12 years) was given hot pack and exercises, Group 2 (n = 20, mean age: 47.70 ± 6.51 years) was given hot packs, exercises and interferential current, Group 3 (n = 20, mean age: 48.50 ± 8.34 years) was given hot packs, exercises and TENS and Group 4 (n = 20, mean age: 48.55 ± 7.89 years) was given hot packs, exercises and ultrasound three times a week for four weeks. Assessments were made before treatment, right after it and three months after that using the visual analog scale (VAS), Short Form-36 (SF-36) and the Disabilities of the Arm, Shoulder and Hand (DASH) outcome measures.Results
At the fourth week and third month assessments, all groups showed significant improvements in terms of pain, DASH and SF-36 physical component scores (p < 0.05). In intragroup comparisons, a significant difference between pre- and post-treatment results was found only in SF-36 mental component scores of Group 2. No significant difference was observed between the groups in any stage of the study period (p > 0.05).Conclusion
Application of ultrasound, interferential current and TENS in addition to exercise therapy in shoulder impingement syndrome treatment had similar improvements in terms of pain, function and physical component of quality of life. However, interferential current treatment showed significantly better outcomes for the mental component of quality of life.Level of evidence
Level I, Therapeutic study. 相似文献7.
Yuki Shiota Nobuyuki Yamamoto Jun Kawakami Hideaki Nagamoto Takayuki Muraki Kazuo Kaneko Eiji Itoi 《Journal of orthopaedic science》2017,22(6):1031-1041
Backgrounds
There have been many reports describing that the capsular fibrosis of the shoulder joint is the main cause of frozen shoulder, whereas others reported the significance of subacromial impingement as an etiological factor. The purpose of this study was to investigate the contact pressure between the coracoacromial arch and the rotator cuff tendons to clarify the contact phenomenon in shoulders with joint contracture.Methods
Fourteen fresh-frozen cadaveric shoulders were used. Specimens were divided into two groups: normal group (8 shoulders, definition: more than 61° of flexion and abduction and more than 21° of external rotation) and joint contracture group (6 shoulders, definition: less than 60° of flexion and abduction and less than 20° of external rotation). Contact pressure and area beneath the coracoacromial arch were measured by a flexible force sensor during flexion, abduction, internal and external rotation in adduction and abduction, extension and horizontal extension motions.Results
The peak contact pressure under the acromion was observed at 90° in flexion and abduction in the normal group, whereas that in the contracture group was observed at 30° in flexion (P = 0.037) and at 30° in abduction (P = 0.041). Contact pressure in the contracture group was significantly higher than that in the normal group at 20° and 30° of abduction (P = 0.043, P = 0.041, respectively). There were no significant differences of contact pressure during other motions. Although no significant differences of contact pressure beneath the coracoacromial ligament were observed, contact area significantly increased in extension and horizontal extension motion.Conclusion
The contact between the acromion and the rotator cuff was observed in lower angles of flexion and abduction in shoulders with contracture than in those without. When treating patients with shoulder contracture, we need to perform rehabilitation taking such an abnormal movement into consideration. 相似文献8.
Daryl K.A. Chia Zachery Yeo Stanley E.K. Loh Shridhar Ganpathi Iyer Glenn Kunnath Bonney Krishnakumar Madhavan Alfred W.C. Kow 《American journal of surgery》2018,215(1):131-137
Background
Associating liver partition with portal vein ligation for staged hepatectomy (ALPPS) and conventional staged hepatectomy (CSH) are options for patients with unresectable liver tumors due to insufficient future liver remnant (FLR).Methods
A retrospective comparison of clinical data, liver volumetry and surgical outcomes between 10 ALPPS and 29 CSH patients was performed.Results
Patient demographics and disease characteristics were similar between both groups. ALPPS induced superior FLR growth (ALPPS vs. CSH, 48.1% (IQR 39.4–96.9%) vs. 11.8% (IQR 4.3–41.9%), p = 0.013). However, post-operative day 5 international normalized ratio (INR) (ALPPS vs. CSH, 1.6 (IQR 1.5–1.8) vs. 1.4 (IQR 1.3–1.6), p = 0.015) and rate of post-hepatectomy liver failure (ALPPS vs. CSH, 25 vs. 0%, p = 0.032) was higher in the ALPPS group. 90-day mortality (ALPPS vs. CSH, 12.5% vs. 0%, p = 0.320) was similar in both groups.Conclusion
ALPPS was superior in inducing FLR growth but associated with increased post-hepatectomy liver failure compared to CSH. 相似文献9.
Tamer M. Shaker Joseph T. Carroll Mathew H. Chung Tracy J. Koehler Brian R. Lane Andrea M. Wolf G. Paul Wright 《American journal of surgery》2018,215(3):498-501
Background
The purpose of this study was to compare patient outcomes for thoracic epidural anesthesia (TEA) with transversus abdominis plane (TAP) blocks.Methods
A prospective, randomized trial was performed for patients undergoing abdominal oncologic surgeries.Results
There were 32 TAP and 35 TEA subjects. The TEA group demonstrated increased episodes of hypotension in the first 24 h (3 v 0.6, p = 0.02). There was no difference in 24–48 h fluid balance between the groups. Overall parenteral morphine equivalents of opioids administered for the TEA group were higher for each postoperative day (p < 0.05). The post-operative survey did not demonstrate any difference in subjective pain between the TAP and TEA groups (6 v 6 p = 0.35). There was no attributable morbidity associated with either technique.Conclusions
TAP block use was associated with lower parenteral morphine equivalent usage and decreased incidence of hypotension in the early post-operative period compared to TEA. 相似文献10.
Huijun Kang Kunpeng Fu Conglei Dong Fei Wang 《Acta orthopaedica et traumatologica turcica》2018,52(5):372-375
Objective
The purpose of this study was to evaluate the diagnostic value of the patellar tendon wavy (PTW) sign for an anterior cruciate ligament (ACL) tear on MRI.Methods
One hundred MRI scans were prospectively analyzed, with 50 patients with an ACL tear underwent an ACL reconstruction (group 1) and 50 patients with knee complaints other than ACL tear (group 2). The PTW sign was confirmed on the sagittal MRI. In addition, the patellar tendon length, tibial-femoral angle and tibial anterior translation (TAT) were compared between the groups.Results
The PTW sign was present in 41/50 (82%) MRI scans in group 1 and 10/50 (20%) in group 2, with significant difference between two groups (p = 0.000). Significant differences were also found, in medial TAT (6.29 ± 3.25 mm versus 3.12 ± 2.85 mm) and in lateral TAT (7.62 ± 3.85 mm versus 1.58 ± 3.93 mm) between two groups (both p = 0.000). Comparison of MRI with and without PTW sign, ACL injury was found to be of significant difference with 41/51 (80.4%) versus 9/49 (18.4%) (p = 0.000), and both medial and lateral TAT were with significant differences, 5.39 ± 3.90 mm versus 3.99 ± 2.71 mm (p = 0.039) and 7.67 ± 3.77 mm versus 1.40 ± 3.81 mm (p = 0.000), respectively. The sensitivity and specificity of PTW sign were 82% and 80%. The positive and negative predictive value were 80.4% and 81.6%. The diagnosis accuracy was 81%.Conclusion
The PTW sign is a useful secondary MRI sign to establish the diagnosis of an ACL tear. It may be associated with the TAT secondary to an ACL tear.Level of evidence
Level III, diagnostic study. 相似文献11.
Morteza Nakhaei Amroodi Mostafa Salariyeh 《Acta orthopaedica et traumatologica turcica》2018,52(2):115-119
Objective
The aim of this study was to evaluate the outcome of single-incision Eden-Lange procedure in trapezius muscle paralysis.Methods
The medical records of 11 patients (3 females and 8 males); mean age: 41 (25–59) years with trapezius muscle paralysis who underwent Eden-Lange procedure in our Center, between February 2009 and April 2013, were retrospectively analyzed. The clinical outcomes were evaluated with the American Shoulder and Elbow Surgeons Shoulder (ASES) score and visual analogue scale (VAS).Results
The mean duration of symptoms before surgery was 10.18 months. The average duration of follow-up was 33.5 (24–48) months. The mean VAS score improved from 7.8 to 1.6 points (p < 0.05). The total ASES improved from 32.8 to 82.1 points (p < 0.05). The mean range of motion in forward elevation and abduction increased significantly from 121.80 to 154.40 (p < 0.05) and 80.00 to 148.18° (p < 0.05), respectively.Conclusion
Single incision Eden-Lange procedure appears to be a safe and effective treatment option for the patients with trapezius muscle paralysis.Level of evidence
Level IV, therapeutic study. 相似文献12.
Jérémie Ménard Benjamin Léger-St-Jean Frédéric Balg Yvan Petit Marc Beauchamp Dominique M. Rouleau 《Journal of orthopaedic science》2017,22(6):1120-1125
Background
This study biomechanically compares two methods of supraspinatus repair: single row transosseous braided-tape (BT) and suture bridge transosseous equivalent (SBTE) with 2 medial anchors and 2 lateral anchors. The purpose is to test the hypothesis that BT provides superior or equal biomechanical strength compared to SBTE.Methods
Nine pairs of frozen cadaveric shoulders were selected and both repair techniques were tested on each pair, using a biomechanical testing unit to measure cyclic loading and ultimate load to failure. Moreover, tendon displacement was measured using the percentage of footprint exposed during the cyclic loading phase.Results
Mean specimen age was 71 years (6 males, 3 females), and mean volumetric bone mineral density was 134 mg/cm3. BT mean ultimate load was 266 ± 81 Newton (N) compared to 398 ± 69 N for SBTE and this difference of 131 N was statistically significant p = 0.025. There was a strong positive correlation between bone mineral density and SBTE construct ultimate load. The difference between the percentage of footprint exposed after cyclic loading of the two repairs was statistically significant with the exception of the 10–80 N load (p < 0.05). The failure mode was suture cutout through the tendon in 88% (7/8) of specimens for both techniques.Conclusion
SBTE repair with bone anchors provides superior biomechanical strength compared to BT repair in terms of ultimate load and cyclic loading. The tendon-suture junction is the weakness of both methods. These models simulate a complete tear with total loss of contact with rotator interval and infraspinatus. Future studies could focus on a more isolated physiologic supraspinatus tear pattern.Level of Evidence
Basic science study (Level II). 相似文献13.
Vernissia Tam Waseem Lutfi Stephanie Novak Ahmad Hamad Kenneth K. Lee Amer H. Zureikat Herbert J. Zeh Melissa E. Hogg 《American journal of surgery》2018,215(2):282-287
Background
Adoption of robotics in general surgery has expanded but there is no mandatory national standardized curriculum for general surgery residents (GSR).Methods
A survey was administered to all GSRs in 2014 addressing future practice and robotic experience. A non-mandatory robotic curriculum was available for residents to train. Compliance was assessed. In 2016, the same survey was re-administered. Barriers to completing the curriculum were identified.Results
Interest in improving robotic skills remained high (2014 = 97.8% vs 2016 = 95.9%, p = 0.608), and the majority planned to incorporate robotics into future practice (77.8% vs 69.4%; p = 0.358). Only 11 residents (18%) voluntarily completed the curriculum while 36 (60%) started but did not complete. A trend toward increased procedure participation was seen (60.0%–77.6%, p = 0.066). The perceived barriers to completion of the curriculum were length of time required (80%) and lack of access to a simulator (60%).Conclusions
A structured robotic training curriculum that is non-mandatory is insufficient in helping residents gain fundamental robotic skills. 相似文献14.
Kazutake Okada Sotaro Sadahiro Takashi Ogimi Hiroshi Miyakita Gota Saito Akira Tanaka Toshiyuki Suzuki 《American journal of surgery》2018,215(4):563-569
Background
In rectal cancer who received chemoradiotherapy, the number of Lymph nodes (LNs) required remains unclear. We conducted a randomized controlled trial to determine whether preoperative tattooing increases the number of LNs and enhances the detection rate of metastatic LNs.Methods
Eighty patients with rectal cancer who received chemoradiotherapy were randomly assigned to receive no tattooing (C group) or to receive tattooing (T group).Results
The number of LNs was significantly higher in the T group (13.3 ± 7.4, mean ± SD) than in the C group (8.8 ± 5.9, p < 0.001), however, the number of positive LNs did not differ (0.5 ± 1.3 vs. 0.5 ± 1.1, p = 0.882). The long-axis diameter of LNs was significantly smaller in the T group than in the C group (3.4 ± 1.8 vs. 3.9 ± 2.3 mm, p < 0.001), however, the long-axis diameter of positive LNs did not differ.Conclusions
Tattooing increased the number of retrieved LNs by 51%, however, there was no increase in the number of positive LNs. 相似文献15.
Xiao Yu Difeng Zhang Xianjun Chen Ji Yang Lin Shi Qingjiang Pang 《Journal of orthopaedic science》2018,23(2):356-364
Background
Non-traumatic osteonecrosis of the femoral head (ONFH) is a refractory osteonecrosis disease caused by an abnormal blood supply to bone tissue. However, therapeutic hip preservation strategies are diverse, and the therapeutic outcomes are not ideal.Objective
A network meta-analysis was performed to assess the effect of hip preservation treatments on non-traumatic ONFH.Methods
We searched public electronic databases through May 15, 2017 using the following keywords: “femoral head necrosis osteonecrosis”; “femoral head osteonecrosis”; “osteonecrosis of femoral head”; “avascular necrosis of femoral head”; “necrosis of femoral”; and “random*”. The primary outcome in the present analysis was the treatment failure rate. Secondary outcomes included the Harris hip and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores.Results
We included 21 articles assessing a total of 1415 hips in our analysis. In the network meta-analysis, the treatments were ranked by the surface under the cumulative ranking curve (SUCRA). Core decompression (CD) plus cytotherapy was most likely to reduce the treatment failure rate (SUCRA score = 18.9%), followed by alendronate treatment (SUCRA score = 17.8%), cocktail treatments (SUCRA score = 15.6%), extracorporeal shock wave therapy (ESWT) plus alendronate (SUCRA score = 15.4%), and avascular biomaterials plus cytotherapy (SUCRA score = 13.8%) in a frequentist framework; similar results were obtained in a Bayesian framework. For the secondary outcomes, ESWT was most likely to improve the Harris hip score (SUCRA score = 33.7%), followed by ESWT plus alendronate (SUCRA score = 33.1%) and cocktail (SUCRA score = 19.6%) treatments in a frequentist framework. A traditional analysis showed that the effect of CD plus cytotherapy was significantly better than the effect of CD alone in improving the WOMAC score (SMD, ?6.01; 95% CI, ?7.81 to ?4.22; p < 0.001).Conclusion
CD plus cytotherapy is a relatively superior treatment for reducing treatment failure rates in early and intermediate ONFH patients, and ESWT is the most effective treatment for improving Harris hip scores. 相似文献16.
Ali Cagdas Yorukoglu Ahmet Fahir Demirkan Nihal Buker 《Acta orthopaedica et traumatologica turcica》2018,52(4):294-298
Objective
The aim of this study was to describe an alternative fixation method for distal humeral extra-articular fractures through posterior approach using distal tibia anatomic locking plate; and to evaluate the patient's functional outcome and union condition.Methods
Eighteen patients (11 men and 7 women; average age of 37.0 ± 17.3 years (range: 18–73 years)) with a distal humeral extra-articular fracture who were treated with distal tibial medial locking plate were included into the study. The mean follow up time was 36.2 ± 16.7 (12–57) months. Functional results were evaluated with perception of pain, range of joint motion, grasp and pinch strengths.Results
Union was achieved in 17 of 18 patients. Only one patient had non-union due to infection and underwent debridement. The mean time for union was 7.8 ± 5.9 months (2–20). Patient perception of pain was X = 1.88 ± 2.50 and X = 4.55 ± 2.68, respectively, at rest and activity. The active ranges of joint motion were adequate for functional use. General functional state of affected extremity (DASH-T) was perfect (X = 27.14 ± 25.66), the performance of elbow joint was good (X = 84.44 ± 11.57). There were no differences in the comparison of grasp and pinch grip of patients with uninvolved extremity (p > 0.05).Conclusions
In distal humeral extra-articular fractures, use of distal medial tibia plate has advantages such as providing high rates for union, low rates for complication, and early return to work with early rehabilitation, therefore it may be considered a fixation choice that can be used for distal humeral extra-articular fractures.Level of evidence
Level IV, therapeutic study. 相似文献17.
Cigdem Benlice Conor P. Delaney David Liska Jennifer Hrabe Scott Steele Emre Gorgun 《American journal of surgery》2018,215(3):442-445
Background
To identify factors associated with diverting ileostomy creation (DLI) in patients undergoing sigmoid colectomy for diverticular disease in a high volume colorectal unit and to obtain information for better preoperative patient counseling.Methods
Patients who underwent sigmoid colectomy with colorectal anastomosis with or without DLI for diverticulitis between 01/1994-12/2014 were identified. Preoperative characteristics, surgeon practice year, individual surgeon and postoperative outcomes were compared between patients with DLI or not.Results
1320 patients were identified and DLI was created in 204 (15.4%) patients. DLI creation was associated with older age (p < 0.001), female gender (p = 0.01), higher ASA-class (p < 0.001), hypertension (p = 0.01), DM(p < 0.001), renal comorbidities (p < 0.001), preoperative steroid use (p = 0.03), preoperative anemia (p = 0.004), and open surgery (p < 0.001). While ileostomy creation rates did not vary over the years during the study period or with increased surgeons' experience, surgeon identity had significant impact on ileostomy creation (Rate range 6.8–60.7%, p < 0.001). Multivariate logistic regression analysis revealed that individual surgeon, open approach, preoperative steroid use, and disease-related factors remained independently associated with DLI creation.Conclusion
Individual surgeon's practice affects the rate of diverting ileostomy creation in patients undergoing sigmoid colectomy for diverticular disease. 相似文献18.
Hirokazu Shoji Toru Hirano Kei Watanabe Masayuki Ohashi Tatsuki Mizouchi Naoto Endo 《Journal of orthopaedic science》2018,23(3):449-454
Background
In spinal instrumentation surgeries, surgical site infection (SSI) is one of the complications to be avoided. However, spinal instrumentation surgeries have a higher rate of SSI than other clean orthopedic surgeries. The purpose of this study was to investigate the risk factors for SSI following spinal instrumentation surgeries and contribute to the prevention of SSIs by identifying high-risk patients.Methods
Records of 431 patients who underwent spinal instrumentation surgeries from 2011 to 2014 with a minimum follow-up period of 90 days were retrospectively reviewed. Associations of SSI with various preoperative, operative, and postoperative factors were statistically analyzed with univariate and stepwise multivariate logistic regression analysis.Results
Deep or superficial SSIs were observed in 15 patients (3.5%). Univariate analysis revealed significant association of SSI with diabetes mellitus (odds ratio [OR] 4.7, 95% confidence interval [CI] 1.5–14.4; p = 0.012) and serum albumin ≤3.5 g/dl (OR 3.35, 95% CI 1.1–10.38, p = 0.012). The number of regular medications prescribed in patients with SSI (8.2 ± 5.4) was significantly more than that in patients without SSI (3.8 ± 4.4) (p = 0.001), and the cut-off value of the number of medications was 7, as derived from receiver operating characteristics analysis. Multivariate analysis revealed that the number of regular medications ≥7 was an independent risk factor significantly associated with SSIs (OR 7.3, 95% CI 2.3–24.0, p = 0.001).Conclusions
Our study demonstrated that an important risk factor for SSI after spinal instrumentation surgery was number of regular medications ≥7. Number of regular medications is a simple and valuable risk index for SSI, which reflects the influence of medications and comorbidities. 相似文献19.
C.A.L. de Raaff U.K. Coblijn E.S.M. de Klerk M.J.L. Ravesloot N. de Vries B.A. van Wagensveld 《The surgeon》2018,16(3):151-155
Background
To examine the influence of obstructive sleep apnea (OSA) on the quality of life (QoL) in bariatric surgery.Methods
All patients who underwent a laparoscopic Roux-and-Y gastric bypass (LRYGB), preoperative poly(somno)graphy and completed an Impact of Weight on QoL-Lite questionnaire before and after surgery were included.Results
A total of 276 patients were included. OSA was diagnosed in 150 (53.3%) patients. All subscale scores improved 15 months post-surgery (p < 0.01). Total score improved from 51.2 (SD 19.1) to 89.7 (SD 13.9). Lower postoperative scores were seen in OSA patients on subscales Public Distress (90.4 SD 18.8 versus 95.7 SD 10.2; p = 0.003) and Work (92.9 SD 15 versus 96.1 SD 9.7; p = 0.031). All postoperative subscale scores were negatively correlated with OSA severity (p < 0.01).Conclusions
After LRYGB, QoL improved in both OSA and non-OSA patients. OSA patients, especially patients with severe OSA, have lower postoperative scores on subscales Public Distress and Work after LRYGB. 相似文献20.
Dhriti Mukhopadhyay Katie C. Wiggins-Dohlvik Mary M. MrDutt Jeffrey S. Hamaker Graham L. Machen Matthew L. Davis Justin L. Regner Randall W. Smith David P. Ciceri Jay G. Shake 《American journal of surgery》2018,215(1):28-36