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1.
Diagnosis of Compressed Nerve Root in Lumbar Disc Herniation Patients by Surface Electromyography 下载免费PDF全文
Wei Li PhD Yan‐cheng Liu MD PhD Chen‐fan Zheng MS Jun Miao MD Hui Chen PhD Hai‐ying Quan PhD Song‐hua Yan PhD Kuan Zhang PhD 《Orthopaedic Surgery》2018,10(1):47-55
Objective
To establish a logistic regression model using surface electromyography (SEMG) parameters for diagnosing the compressed nerve root at L5 or S1 level in patients with lumbar disc herniation (LDH).Methods
This study recruited 24 patients with L5 nerve root compression and 23 patients with S1 nerve root compression caused by LDH from May 2014 to May 2016. SEMG signals from the bilateral tibialis anterior and lateral gastrocnemius were measured. The root mean square (RMS), the RMS peak time, the mean power frequency (MPF), and the median frequency (MF) were analyzed. The accuracy, sensitivity, and specificity values were calculated separately. The areas under the curve (AUC) of the receiver‐operating characteristic (ROC) curve and the kappa value were used to evaluate the accuracy of the SEMG diagnostic model.Results
The accuracy of the SEMG model ranged from 85.71% to 100%, with an average of 93.57%. The sensitivity, specificity, AUC, and kappa value of the logistic regression model were 0.98 ± 0.05, 0.92 ± 0.09, 0.95 ± 0.04 (P = 0.006), and 0.87 ± 0.11, respectively (P = 0.001). The final diagnostic model was: ; y = 10.76 ? (5.95 × TA_RMS Ratio) ? (0.38 × TA_RMS Peak Time Ratio) – (5.44 × 44 × LG_RMS Peak Time Ratio). L5 nerve root compression is diagnosed when P < 0.5 and S1 nerve root compression when P ≥ 0.5.Conclusions
The logistic regression model developed in this study showed high diagnostic accuracy in detecting the compressed nerve root (L5 and S1) in these patients with LDH.2.
Comparison of Plantar Pressure Distribution and Functional Outcome after Scarf and Austin Osteotomy 下载免费PDF全文
Stephan E Puchner MD Hans‐Jörg Trnka MD Madeleine Willegger MD Kevin Staats MD Johannes Holinka MD Reinhard Windhager MD Reinhard Schuh MD 《Orthopaedic Surgery》2018,10(3):255-263
Objective
To investigate the changes of plantar pressure distribution in patients who underwent either Austin or Scarf osteotomy and underwent a postoperative rehabilitation program.Methods
Between September 2006 and December 2007, 50 participants who suffered from mild to moderate hallux valgus deformity were prospectively included in this study. An Austin osteotomy (Austin group) was performed in 25 patients and a Scarf osteotomy (Scarf group) in 25 patients. Indication for the Scarf or Austin technique was made according to the consensus of the Austrian society of foot and ankle surgery. Plantar pressure analysis was performed at 4 weeks, 8 weeks, and 6 months postoperatively. Furthermore, range of motion and the American Orthopaedic Foot and Ankle Society (AOFAS) questionnaire were evaluated.Results
In the big toe and first metatarsal head region in groups, maximum force, peak pressure, and force‐time integral increased significantly from 4 weeks to 6 months postoperatively (P ≤ 0.001). The mean AOFAS score increased from 60.7 preoperatively to 93.1 6 months after Austin surgery and from 56.7 preoperatively to 94.4 6 months after Scarf surgery. The Austin group had a mean range of motion (ROM) of 68.5° that increased to a mean ROM of 75.5° 6 months postoperatively, while the Scarf group had a mean ROM of 67.8° that increased to a mean ROM of 68.2° 6 months postoperatively.Conclusion
Despite different surgical techniques and the degree of deformity, there were no differences in plantar pressure parameters and functional outcomes between both groups.3.
Kifayat Ullah PhD Man Zhang BS Yan‐sheng Dong MS Chao Xiong MD Zhi‐hui Zhao MD Jin‐feng Wang BS Ju‐wen Chen MD Yong‐qing Wang PhD 《Orthopaedic Surgery》2018,10(2):115-120
Objective
Angle stable interlocking intramedullary nail (ASIN), a novel technique, has rarely been used for treatment of tibial plateau fractures (TPF). This retrospective study was designed to introduce this novel technique, ASIN, as well as to describe the initial experience and verify the effectiveness when ASIN was used for the management for TPF.Methods
A cohort of 19 cases with closed TPF aged from 18–70 years with at least 23 months follow‐up from November 2008 to September 2013 was analyzed retrospectively. All patients underwent the ASIN procedure, which was performed by the same group of surgeons. Perioperative and postoperative parameters like the measurement of radiographic pictures, surgical data, and clinical function were recorded including the changes in treatment. A modified Hohl–Luck radiological and functional score combined with the Hospital for Special Surgery (HSS) score were applied to evaluate the final results and to provide reliable data through the whole procedure when applying the ASIN procedure.Results
The patients were followed up regularly for an average of 26.3 (range, 23–34) months. All patients achieved a bony union at an average of 15.1 weeks with no incidences of malunion, nonunion, or infection. Anatomical reduction of the articular surface was obtained in 16 patients. No secondary failure of fixation occurred. The mean postoperative knee flexion was 122.9°. The modified Hohl–Luck radiological and functional score was excellent and good, respectively, in 16 patients. The mean HSS score was 89.4.Conclusion
The angle stable interlocking intramedullary nail system turned out to be a viable alternative protocol in the treatment of tibia plateau fractures and provided satisfactory results, with good fracture reduction, biomechanical fixation, low rates of complications, and passable postoperative knee function.4.
Background
For patients with adolescent idiopathic scoliosis, shoulder balance influences their treatment satisfaction and psychological well-being. Several parameters are known to affect postoperative shoulder balance, but few prognostic models are as yet available.Purpose
This study aimed to identify independent predictive factors that can be used to assess preoperatively which patients are at risk of postoperative shoulder elevation, and to build a linear prediction model.Methods
N = 102 patients with all Lenke types were reviewed radiographically before surgery and 1 year afterward. The outcome measures were coracoid height difference (CHD), clavicular angle (CA), and clavicle–first rib intersection difference (CiRID). Predictive factors commonly used in the literature were investigated using correlation analysis and statistical testing. Significant contributing factors were included in three multiple linear regression models (for CHD, CA, and CiRID).Results
The mean shoulder level (CHD) significantly changed from a lower left shoulder value of ?8.5 mm before surgery to 3.3 mm at the follow-up examination. A high preoperative left shoulder level by CiRID, a large amount of Cobb angle correction of the distal thoracic curve, a low preoperative Cobb angle in the lumbar curve, and a structural proximal thoracic curve proved to be determinants and thus risk factors for left-sided shoulder elevation after surgery. The three models predicting CHD, CA, and CiRID at the follow-up examination included these four risk factors and were significant.Conclusions
Preoperative variables have the strongest influence on shoulder level after spinal instrumentation. Additionally, extensive correction of the distal thoracic curve can cause elevation of the left shoulder.5.
Surgical Infection after Posterolateral Lumbar Spine Arthrodesis: CT Analysis of Spinal Fusion 下载免费PDF全文
Pablo Andrés‐Cano MD PhD Ana Cerván MD PhD Miguel Rodríguez‐Solera MD Jose Antonio Ortega MD Natividad Rebollo MD Enrique Guerado MD PhD 《Orthopaedic Surgery》2018,10(2):89-97
Objective
To determine the incidence of infection after instrumented lumbar spine surgery, the demographic and surgical variables associated with acute infection, and the influence of infection and debridement on the consolidation of spinal fusion.Methods
After obtaining approval from the hospital ethics committee, an observational study was made on a prospective cohort of consecutive patients surgically treated by posterolateral lumbar spine arthrodesis (n = 139, 2005–2011). In all cases, the minimum follow‐up period was 18 months. The following bivariate analysis was conducted of demographic and surgical variables: non‐infection group (n = 123); infection group (n = 16). Fusion rates were determined by multislice CT. Logistic regression analysis was performed.Results
Incidence of deep infection requiring debridement: 11.51% (95% confidence interval, 5.85–17.18]). Bivariate analysis: differences were observed in hospital stay (7.0 days [range, 4–10] vs 14.50 days [range, 5.25–33.75]; P = 0.013), surgical time (3.15 h vs 4.09 h; P = 0.004), body mass index (25.11 kg/m2 [22.58–27.0] vs 26.02 kg/m2 [24.15 to 29.38]; P = 0.043), Charlson comorbidity index (median, 0 vs 1; P = 0.027), and rate of unsuccessful consolidation according to CT (18.4% vs 72.7%; P = 0.0001). In a model of multivariate logistic regression, taking as the dependent variable unsuccessful arthrodesis after 1 year, and adjusting for the other independent variables (infection, body mass index, Charlson comorbidity index, and surgical time), the only variable that was significantly associated with an outcome of unsuccessful spinal fusion after 1 year was infection, with OR = 12.44 (95% confidence interval, 2.50–61.76).Conclusion
Deep infection after instrumented lumbar spine arthrodesis is a common complication that compromises the radiographic outcome of surgery. Patients who develop a postoperative infection and require debridement surgery are 12 times less likely to achieve satisfactory radiological fusion.6.
En Bloc Resection of Primary Malignant Bone Tumor in the Cervical Spine Based on 3‐Dimensional Printing Technology 下载免费PDF全文
Wang‐jun Yan MD Dian‐wen Song MD Hai‐feng Wei MD Tie‐long Liu MD Zhi‐peng Wu MD Cheng Yang MD 《Orthopaedic Surgery》2016,8(2):171-178
Objective
To investigate the feasibility and safety of en bloc resection of cervical primary malignant bone tumors by a combined anterior and posterior approach based on a three‐dimensional (3‐D) printing model.Methods
Five patients with primary malignant bone tumors of the cervical spine underwent en bloc resection via a one‐stage combined anteroposterior approach in our hospital from March 2013 to June 2014. They comprised three men and two women of mean age 47.2 years (range, 26–67 years). Three of the tumors were chondrosarcomas and two chordomas. Preoperative 3‐D printing models were created by 3‐D printing technology. Sagittal en bloc resections were planned based on these models and successfully performed. A 360° reconstruction was performed by spinal instrumentation in all cases. Surgical margins, perioperative complications, local control rate and survival rate were assessed.Results
All patients underwent en bloc excision via a combined posterior and anterior approach in one stage. Mean operative time and estimated blood loss were 465 minutes and 1290 mL, respectively. Mean follow‐up was 21 months. Wide surgical margins were achieved in two patients and marginal resection in three; these three patients underwent postoperative adjuvant radiation therapy. One vertebral artery was ligated and sacrificed in each of three patients. Nerve root involved by tumor was sacrificed in three patients with preoperative upper extremity weakness. One patient (Case 3) had significant transient radiculopathy with paresis postoperatively. Another (Case 4) with C 4 and C 5 chordoma had respiratory difficulties and pneumonia after surgery postoperatively. He recovered completely after 2 weeks’ management with a tracheotomy tube and antibiotics in the intensive care unit. No cerebrovascular complications and wound infection were observed. No local recurrence or instrumentation failure were detected during follow‐up.Conclusion
Though technically challenging, it is feasible and safe to perform en bloc resection of cervical primary bone tumors. This is the most effective means of managing cervical spine tumors. Preoperative 3‐D printing modelling enables better anatomical understanding of the relationship between the tumor and cervical spine and can assist in planning the surgical procedure.7.
Objective
To compare characteristics and outcomes of benign prostatic hyperplasia patients undergoing prostate laser ablation with those undergoing laser enucleation using a nationwide cohort.Methods
Men who underwent prostate laser ablation (n=10054) or laser enucleation (n=1705) between 2011 and 2015 were identified by the common procedural terminology code as recorded in the National Surgical Quality Improvement Program database. Preoperative, intraoperative and postoperative parameters were compared between the groups using univariate and multivariate analysis.Results
Prostate laser ablation patients were older, had more comorbidities and were more likely to have abnormal laboratory values. Enucleations were significantly longer and more likely to result in a hospital stay >1day. Enucleation patients were also more likely to require a blood transfusion postoperatively, but less likely to experience urinary tract infection and sepsis on both univariate and multivariate analysis adjusted for preoperative and intraoperative factors.Conclusions
Although laser enucleation and prostate laser ablation are both considered minimally invasive techniques, significant differences in patient selection, intraoperative factors and postoperative complications are identified in this national cohort. The present study shows that despite similar outcomes in prospective single‐center studies, prostate laser ablation and laser enucleation have distinct practice patterns in a broader national context.8.
Yi‐zhong Li MD Hua‐feng Zhuang MD Si‐qing Cai MD Chang‐kun Lin MD Pei‐wen Wang MD Li‐sheng Yan MD Jin‐kuang Lin MD Hai‐ming Yu MD 《Orthopaedic Surgery》2018,10(1):17-22
Objective
To investigate the effect of grip strength on bone mineral density (BMD) in postmenopausal women. Low BMD is related to risk of fracture and falling is the strongest factor for fragility fractures. Handgrip strength is a reliable indicator of muscle strength and muscle strength is associated with falling.Methods
For the present study 120 women were divided into two groups: those ≤65 years and those >65 years. Serum 25 hydroxyvitamin D (25OHD), BMD, and handgrip strength were measured to observe the effect of age on 25OHD, grip strength, and BMD, as well as the effect of 25OHD on grip strength and BMD. The correlation between grip strength and BMD was investigated.Results
In the 120 patients, 25OHD was 24.31 ± 8.29 ng/mL. There were 37 cases with 25OHD <20 ng/mL and 83 cases with 25 OHD ≥20 ng/mL. The patients with 25OHD <20 ng/mL had significantly lower femoral neck BMD, most of them with a T score ≤?2.5 (P < 0.05). BMD measurement showed 66 patients with femoral neck T ≤?2.5, 30 cases with total hip T ≤?2.5 and 90 cases with lumbar BMD T ≤?2.5. The maximum grip strength in the group is 22.28 ± 6.17 kg. There were 38 cases with the maximum grip strength <20 kg and 82 cases with the maximum grip strength ≥20 kg. Patients >65 years had lower 25OHD, lower maximum grip strength, and lower BMD. The osteoporosis risk in postmenopausal women with a maximum grip strength <20 kg and who were >65 years was significantly elevated.Conclusion
Handgrip strength and 25OHD decrease with aging in postmenopausal women. The patients with lower 25OHD level had significantly lower BMD of femoral neck. The patients with lower handgrip strength had significantly lower BMD of lumbar spine, femoral neck, and total hip. Grip strength measurement is the simplest muscle strength measurement method. Our study confirmed that low grip strength was correlated with low BMD and was a strong risk factor for osteoporosis in postmenopausal women.9.
Transurethral seminal vesiculoscopy acts as a therapeutic investigation for intractable hemospermia: Step‐by‐step illustrations and single‐surgeon experience 下载免费PDF全文
Objective
To describe the methodology of transurethral seminal vesiculoscopy and the anatomy of the seminal tract, and to report a single‐surgeon experience with this procedure.Methods
A total of 38 consecutive patients with intractable macroscopic hemospermia were enrolled from January 2010 to July 2016. A 6/7.5‐Fr semirigid ureteroscope was used to enter the seminal tract by one of these two approaches: through either a trans‐ejaculatory duct opening or a trans‐utricle fenestration. Patient characteristics and their preoperative and postoperative measurements were analyzed retrospectively.Results
The success rate of transurethral seminal vesiculoscopy was 92.1%, whereas the approaching method in most patients was the trans‐utricle fenestration (88.89%). A total of 34 (94.4%) transurethral seminal vesiculoscopy inspections ended with complete remission, even though nearly half of them (47.2%) only disclosed negative perioperative findings. The median period to complete remission was 4 weeks (interquartile range 4–6 weeks) after the procedure. Four patients had recurrent hemospermia, and the median time to recurrence was 21.5 (range 13–48.5) months.Conclusions
Transurethral seminal vesiculoscopy is a valuable diagnostic tool for intractable hemospermia, and also plays a therapeutic role by blocking the vicious cycle of stasis, calculi and seminal vesiculitis. More familiarity of the anatomy and enough practice would make the learning curve less steep.10.
Delay in Diagnosis and Its Effect on Clinical Outcome in High‐grade Sarcoma of Bone: A Referral Oncological Centre Study 下载免费PDF全文
Louren M Goedhart MD Jasper G Gerbers MD PhD Joris J W Ploegmakers MD Paul C Jutte MD PhD 《Orthopaedic Surgery》2016,8(2):122-128