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1.
Ilana Sebbag Raymond Tang Vit Gunka JagPaul Sahota Himat Vaghadia Andrew Sawka 《Brazilian Journal of Anesthesiology》2018,68(3):280-284
Study objective
The purpose of this study was to assess whether application of dorsal table tilt and body rotation to a parturient seated for neuraxial anesthesia increased the size of the paramedian target area for neuraxial needle insertion.Setting
Labor and Delivery Room.Patients
Thirty term pregnant women, ASA I–II, scheduled for an elective C‐section delivery.Interventions
Lumbar ultrasonography was performed in four seated positions: (F) lumbar flexion; (FR) as in position F with right shoulder rotation; (FT) as in position F with dorsal table‐tilt; (FTR) as in position F with dorsal table‐tilt combined with right shoulder rotation.Measurements
For each position, the size of the ‘target area’, defined as the visible length of the posterior longitudinal ligament was measured at the L3‐L4 interspace.Main results
The mean posterior longitudinal ligament was 18.4 ± 4 mm in position F, 18.9 ± 5.5 mm in FR, 19 ± 5.3 mm in FT, and 18 ± 5.2 mm in FTR. Mean posterior longitudinal ligament length was not significantly different in the four positions.Conclusions
These data show that the positions studied did not increase the target area as defined by the length of the posterior longitudinal ligament for the purpose of neuraxial needle insertion in obstetric patients. The maneuvers studied will have limited use in improving spinal needle access in pregnant women. 相似文献2.
Armin Soave Roland Dahlem Hans O. Pinnschmidt Michael Rink Jessica Langetepe Oliver Engel Luis A. Kluth Birte Loechelt Philip Reiss Sascha A. Ahyai Margit Fisch 《European urology》2018,73(6):910-922
Background
Optimal surgical management of the buccal mucosa harvest site in patients with urethral stricture disease during buccal mucosa graft urethroplasty (BMGU) remains controversial.Objective
To analyze in detail intensity and quality of pain as well as oral morbidity following closure (C) versus nonclosure (NC) of the donor site.Design, setting, and participants
Randomized controlled trial on 135 patients treated with BMGU between October 15, 2014 and December 18, 2015.Intervention
Following computer-based randomization, 63 and 72 patients, respectively, received C and NC of the donor site at the inner cheek. Preoperatively, on days 1, 5, and 21 as well as at 3 and 6 mo postoperatively, patients completed standardized questionnaires, including validated questions on intensity and quality of pain as well as oral morbidity.Outcome measurements and statistical analysis
The coprimary end points were intensity and quality of oral pain. Secondary end points included oral morbidity and intensity of pain of the perineogenital region. Generalized linear mixed models evaluated the effect of various covariates on intensity and quality of oral pain, oral morbidity, as well as intensity of pain of the perineogenital region.Results and limitations
There was noninferiority for NC versus C in intensity and affective quality of oral pain at every time point following BMGU. Oral morbidity and complications included pain, bleeding, swelling, numbness, alteration of salivation and taste, as well as impairment of mouth opening, smiling, whistling, diet, and speech. Time from BMGU had significant effects on intensity (p < 0.001) and quality of oral pain (sensory pain: p < 0.001, affective pain: p < 0.001, total pain: p < 0.001). Length of buccal mucosa graft had significant effects on intensity (p = 0.001) and quality of oral pain (sensory pain: p = 0.020, total pain: p = 0.042).Conclusions
NC is noninferior to C of the donor site in intensity and quality of oral pain, and offers a treatment alternative. Time from BMGU and length of the buccal mucosa graft have effects on oral morbidity and complications.Patient summary
We investigated pain, morbidity, and complications following closure (C) versus nonclosure (NC) of the buccal mucosa harvest site in patients undergoing buccal mucosa graft urethroplasty (BMGU). We found that NC is not worse than C regarding oral pain. In addition, time from BMGU and length of the buccal mucosa graft have effects on oral morbidity and complications. 相似文献3.
Christopher Wei Guang Ho Yee Onn Kok Si Jack Chong 《Burns : journal of the International Society for Burn Injuries》2018,44(8):2018-2025
Background
Tumescent infiltration is a technique to reduce skin graft donor site bleeding, however there are no studies comparing tumescent solutions with different concentrations of adrenaline on donor site blood loss. We sought to evaluate the effect on skin donor site bleeding of different adrenaline concentrations in adrenaline-containing tumescent solutions in a prospective randomised trial.Methods
Donor sites were marked into thirds and each segment randomised to receive tumescent infiltration containing no adrenaline, adrenaline 1:500,000, or adrenaline 1:250,000. Donor sites were photographed 10 s after skin graft harvest. A laparotomy sponge was then placed onto the wound for a further 20 s and photographed. These photographs were divided into their corresponding thirds and each scored on a scale of 0 (no bleeding) to 5 (severe bleeding) by a blinded independent panel of plastic surgeons.Results
11 patients (15 donor sites) were recruited. Donor site segments infiltrated with adrenaline 1:250,000 had significantly lower wound bleeding and sponge staining mean rank scores compared with segments infiltrated with adrenaline 1:500,000 (9.47 vs 21.57; p = 0.035 and 9.63 vs 21.37; p < 0.043 respectively). Segments infiltrated with adrenaline 1:500,000 had significantly lower wound bleeding and sponge staining mean rank scores compared with segments that were not infiltrated with adrenaline (21.5 7 vs 37.97; p = 0.002 and 21.37 vs 38; p < 0.002 respectively). There were no local or systemic complications.Conclusions
We demonstrate that donor site infiltration with different adrenaline-containing tumescence solutions cause significantly different photographic bleeding scores. Adrenaline 1:250,000 tumescence resulted in significantly lower bleeding scores than lower concentrations of adrenaline without compromising safety or wound healing. These findings suggest that adrenaline tumescence reduces donor site blood loss in a dose-dependent manner. 相似文献4.
Overview of literature
Elderly patients sustaining a trivial fall may develop vertebral compression fractures if they are predisposed to any factor that leads to decreased bone mineral density. Such patients suffer with severe pain and disability during the early healing stages. Percutaneous Vertebroplasty is mainly done to provide immediate pain relief and also believed to offer stability to the compressed vertebra by preventing further collapse.Methods
Selected patients [n = 20; Age = 57.9 ± 7.9 years] with osteoporotic vertebral compression fracture of a single dorsolumbar vertebra were treated with percutaneous vertebroplasty after 2–3 weeks of conservative trail. Their Pain score was noted using numeric rating scale (NRS) before and after the procedure. Functional outcomes were analysed using Roland Morris Disability Questionnaire (RMDQ) score.Results
NRS pain score before procedure was 8.3 ± 0.6. RMDQ score before procedure was 21.6 ± 0.5. Third post procedural day NRS pain score was 4.7 ± 1.2 (p < 0.0001), denoting significant decrease in pain. Functional outcome analysis using RMDQ score showed an average of 87 ± 6.1 percent improvement (p < 0.0001), by 6 weeks following procedure. Considering pre-injury status all patients were in their best possible functional state by 6 weeks.Conclusions
Percutaneous Vertebroplasty serves its purpose adequately and economically. Under controlled circumstances, it offers immediate pain relief and stability, leading to early recovery in selective patients. Yet, underlying poor bone mineral density status needs to be treated.Study design
Observational Case Series (Level 4). 相似文献5.
J.P. Gawaziuk B. Peters S. Logsetty 《Burns : journal of the International Society for Burn Injuries》2018,44(1):183-187
Objective
Early ambulation of lower extremity burns that undergo a skin graft may help to avoid some of the complications associated with immobilization. Despite recent evidence supporting early ambulation, post-operative immobilization following lower extremity skin grafting is still a common practice. The purpose of this study was to retrospectively assess the outcomes of lower extremity skin graft cases dressed with a multi-layer compression bandage who were ambulated in the immediate post-operative period.Methods
This single centre observational study examined patients with a lower extremity burn that received a compressive dressing (Profore?) application immediately after surgical grafting and were ambulated no later than 1 day post-operatively.Results
Forty-two burn patients (47 limbs) met inclusion criteria for this study. Of these 42 patients, 25 were operated on as an inpatient. The remaining 17 patients were done on an outpatient basis and discharged the same day of surgery. Mean patient age was 48.2 years and 34 (81.0%) of patients were male. Mean TBSA affected was 5.3% (792 cm2). Mean number of procedures was 1 and mean graft take was 98.9%. Nearly all patients were ambulated within 1 day of surgery. The graft take rate across all cases was 98.9 ± 2.3%. No patients failed early ambulation with their compressive dressings, were readmitted or underwent repeated skin grafting.Conclusions
This study demonstrates the excellent graft take rates that can be achieved with immediate ambulation following lower extremity skin grafting and challenges the conventional teaching of post-operative bed rest following lower extremity skin grafting procedures. 相似文献6.
Lin Li Xiao-lei Wu Le Xu 《Burns : journal of the International Society for Burn Injuries》2018,44(8):2064-2073
Objective
This study aimed to evaluate self-perceived participation and autonomy in patients with burns in Fujian, China, and to identify key factors influencing these parameters.Methods
We investigated 212 patients admitted to the burns unit 1 and 3 months after discharge using the Impact on Participation and Autonomy (IPA), Acceptance of Disability Scale-Revised, Herth Hope Index, Modified Barthel Index Rating Scale, Visual Analogue Scale, and a self-designed demographic data and disease condition questionnaires. Influencing factors were identified using multivariable linear regression.Results
The general IPA questionnaire scores were 2.13 ± 0.74 and 2.03 ± 0.72 at 1 and 3 months post-discharge, respectively. Acceptance of disability, hope, and social participation were significantly correlated (P < 0.01). Financial situation, pain level, activities of daily living, acceptance of disability, and hope were major factors affecting self-perceived participation and autonomy 3 months post-discharge, accounting for a variance of 77.5%.Conclusion
Medium-to-low levels of self-perceived participation and autonomy were observed 1 and 3 months post-discharge. Clinicians should adopt specific measures to help patients (including those from poor economic backgrounds) successfully reintegrate into their families/societies. These include alleviating their pain, encouraging participation in daily activities while accepting their disabilities, and offering hope. 相似文献7.
Rosana C. Gomes Elaine C.O. Guirro Adriana C. Gonçalves Jayme A. Farina Junior Luiz O. Murta Junior Rinaldo R.J. Guirro 《Burns : journal of the International Society for Burn Injuries》2018,44(3):636-645
Introduction
Severe burns benefit from skin grafting, and grafting surgery is of great importance in the treatment of these injuries. As a result, there is formation of an additional wound at the donor site, which is painful and susceptible to infection. However, the therapeutic approach to these problems at donor sites for skin grafting is insufficiently explored in the literature.Aim
To evaluate electrical stimulation of the donor sites of burn patients treated by grafting surgery.Methods
This work evaluated 30 donor sites of cutaneous graft burn patients treated with high-voltage electrical stimulation. Subjects were randomized into two groups: electrical stimulation (GES), treated with electrostimulation (50 min, 100 Hz, twin pulses 15 us, monophasic), and the sham group (GS), treated by the same procedures but without current. Pain was assessed by visual analog scale daily before and after the electrical stimulation. The time elapsed until complete epithelization was evaluated (time of primary dressing detached spontaneously). Skin temperature was measured by thermography. The characteristics of donor sites were qualitatively evaluated using images and the plug-in CaPAS® (Carotid Plaque Analysis Software).Results
The results showed a significant decrease in pain, which was absent on the third day in the GES and the sixth day in the GS. The time the primary dressing detached spontaneously in days decreased (p < 0.05) (4.7 ± 0.2) compared to the GS group (7.0 ± 1.3). Donor site healing characteristics such as vascularization, pigmentation, height, the quantity of crust formed, irregularities, and the quality of healing was better in the GES; moreover, homogeneity and inertia of the images confirmed higher healing quality.Conclusion
As a result of the study, the technology shows promise and merits a larger study with objective assessments and different physical variables. 相似文献8.
9.
Joëlle Glémarec Stéphane Varin Céline Cozic Gilles Tanguy Christelle Volteau Philippe Montigny Benoît Le Goff Christelle Darrieutort Laffite Yves Maugars Grégoire Cormier 《Joint, bone, spine : revue du rhumatisme》2018,85(3):359-363
Objective
The primary objective of this study was to compare the efficacy of local injection of a local anesthetic with a glucocorticoid versus a local anesthetic with saline to treat low back pain due to lumbosacral transitional vertebras (LSTV) with a pseudoarticulation.Methods
A randomized placebo-controlled double-blind study was conducted in patients with unilateral low back pain ascribed clinically to LSTV. Patients were randomized to lidocaine plus saline (LS group) or lidocaine plus cortivazol (LC group) injected locally under computed tomography guidance. The primary outcome measure was the 24-hour mean visual analog scale (VAS) score for low back pain 4 weeks after the injection.Results
Of 16 randomized patients, 15 were included in the analysis, 8 in the LS group and 7 in the LC group. The mean VAS pain score at week 4 was not significantly different between the two groups. In the two groups pooled, the mean VAS pain score decreased significantly from baseline to week 4, from 5.52 ± 0.99 to 3.86 ± 2.55 (P ≤ 0.05). The difference remained significant at week 12. Significant improvements occurred in the EIFEL disability index and items of the Dallas Pain Questionnaire. No adverse events were recorded.Conclusion
In patients with chronic low back pain consistent with a symptomatic LSTV type II or IV in the Castellvi classification, a local injection of lidocaine with or without cortivazol may provide sustained improvements in pain and function. The underlying mechanism is unclear. 相似文献10.
Thomas Seisen Malte W. Vetterlein Patrick Karabon Tarun Jindal Akshay Sood Luigi Nocera Paul L. Nguyen Toni K. Choueiri Quoc-Dien Trinh Mani Menon Firas Abdollah 《European urology》2018,73(3):452-461
Background
There is limited evidence supporting the use of local treatment (LT) for prostate cancer (PCa) patients with clinically pelvic lymph node-positive (cN1) disease.Objective
To examine the efficacy of any form of LT ± androgen deprivation therapy (ADT) in treating these individuals.Design, setting, and participants
Using the National Cancer Database (2003–2011), we retrospectively identified 2967 individuals who received LT ± ADT versus ADT alone for cN1 PCa. Only radical prostatectomy (RP) and radiation therapy (RT) were considered as definitive LT.Intervention
LT ± ADT versus ADT alone.Outcome measurements and statistical analysis
Instrumental variable analyses (IVA) were performed using a two-stage residual inclusion approach to compare overall mortality (OM)-free survival between patients who received LT ± ADT versus ADT alone. The same methodology was used to further compare OM-free survival between patients who received RP ± ADT versus RT ± ADT.Results and limitations
Overall, 1987 (67%) and 980 (33%) patients received LT ± ADT and ADT alone, respectively. In the LT ± ADT group, 751 (37.8%) and 1236 (62.2%) patients received RP ± ADT and RT ± ADT, respectively. In IVA, LT ± ADT was associated with a significant OM-free survival benefit (hazard ratio = 0.31, 95% confidence interval [CI] = 0.13–0.74, p = 0.007), when compared with ADT alone. At 5 yr, OM-free survival was 78.8% (95% CI: 74.1–83.9%) versus 49.2% (95% CI: 33.9–71.4%) in the LT ± ADT versus ADT alone groups. When comparing RP ± ADT versus RT ± ADT, IVA showed no significant difference in OM-free survival between the two treatment modalities (hazard ratio = 0.54, 95% CI = 0.19–1.52, p = 0.2). Despite the use of an IVA, our study may be limited by residual unmeasured confounding.Conclusions
Our findings show that PCa patients with clinically pelvic lymph node-positive disease may benefit from any form of LT ± ADT over ADT alone. While not necessarily curative by itself, the use of RP or RT could be the first step in a multi-modality approach aiming at providing the best cancer control outcomes for these individuals.Patients summary
We examined the role of local treatment for clinically pelvic lymph node-positive prostate cancer. We found that the delivery of radical prostatectomy or radiation therapy may be associated with an overall mortality-free survival benefit compared with androgen deprivation therapy alone. 相似文献11.
Thomas Reygaerts Stéphane Mitrovic Bruno Fautrel Laure Gossec 《Joint, bone, spine : revue du rhumatisme》2018,85(4):405-410
Objectives
Fatigue is a significant issue in psoriatic arthritis. The objective was to assess the effect of biological disease modifying antirheumatic drugs and apremilast on fatigue in psoriatic arthritis randomised controlled trials and to compare this effect with the effect in the same trials, on pain, through a systematic literature review and meta-analysis.Methods
A systematic literature review was performed up to January 2017 in PubMed, Embase and Cochrane databases. All randomized controlled trials in psoriatic arthritis of biological disease modifying antirheumatic drugs or apremilast, assessing fatigue (whatever the score used), were included. Data were collected by 2 assessors regarding levels of fatigue and pain at baseline and at the time point closest to 24 weeks after the treatment introduction. Pooled standardized mean differences were calculated using RevMan.Results
After screening 295 publications, 7 randomised controlled trials were analysed: they pertained to adalimumab (n = 2), certolizumab pegol (n = 1), secukinumab (n = 2), ustekinumab (n = 1) and apremilast (n = 1), compared to placebo. The studies included 2341 patients: weighted mean ± standard deviation age: 48.6 ± 1.3 years, disease duration: 7.7 ± 1.6 years, 51.6% were females. Fatigue levels were high at baseline (Functional Assessment of Chronic Illness Therapy score: 28.7 ± 2.4). The pooled standardized mean difference was, for fatigue ?0.44 (95% confidence interval: ?0.54, ?0.35) and for pain, ?0.62 (?0.73, ?0.52).Conclusions
Biological disease modifying antirheumatic drugs and apremilast had a small effect on fatigue at 24 weeks in psoriatic arthritis randomized controlled trials and a higher effect on pain. These results are important to take into account in shared decision-making. 相似文献12.
R. Pagoti S. O’Brien J. Blaney E. Doran D. Beverland 《Journal of Clinical Orthopaedics and Trauma》2018,9(4):295-299
Background
Reduced flexion following knee arthroplasty (TKA) may compromise patient’s function and outcome. The timing of manipulation under anaesthesia (MUA) has been controversial. We present our experience in a high volume practice and analyse the impact of timing.Methods
All TKA patients requiring MUA from February 1996 to June 2015 under the care of a single surgeon were analysed. MUA was offered to patients who had ≤ 75° of flexion post-op, providing that they had 30° more flexion preoperatively. To address the impact of timing from primary surgery to MUA on flexion gain we looked at 3 groups: Group I ≤ 90 days, Group II 91-180 days and Group III > 180 days.Results
Sixty two out of 7,423 (0.84%) underwent MUA. The MUA patients were significantly younger than the overall TKA cohort 61.2 vs 70.5 years (p = < 0.01). The median duration between arthroplasty and MUA was 3.9 months (IQR 3.4, Range 1.6-72.5 months). Overall flexion gained at 6-12 Weeks and 1 year post MUA showed significant improvements of 20.9° (p = <0.01) and 25° respectively (p = < 0.01). The flexion gain in group I (≤ 90 days) was significantly better than group III ( > 180 days) both at 6 weeks and 1 year following MUA but not better than group II (90-180 days).Conclusions
MUA is an effective treatment for reduced flexion following TKA and should be the first line of management after failed physiotherapy. It can still have benefit beyond 6 months but the gains become less effective with time. 相似文献13.
Ji Shizhao Zheng Yongjun Zhang Lisen Luo pengfei Zheng Xiaopeng Wang Guangyi Zhu Shihui Hu Xiaoyan Xiao Shichu Xia Zhaofan 《Burns : journal of the International Society for Burn Injuries》2017,43(1):206-214
Background
The shortage of autologous skin sources not only adds difficulty to the repair of extremely large-area deep burn wounds but affects the healing quality. The aim of the present study is to explore an ideal method for repairing large-areas burn wounds with low scar formation.Methods
Between 2002 and 2014, we used grafting of small auto- and cryopreserved allo-skin to repair large-area residual burn wounds in wounds after 21 days 21 patients, and after early excision in 17 patients. The wound healing rate and quality were observed.Results
The skin expansion rate was 1:9–1:16, and the mean area of wounds repaired after three weeks was 64.8 ± 7.3%TBSA, the wound healing rate was 91.8 ± 3.7%. The mean area of the early excision group was 65.9 ± 9.8 TBSA, where the healing rate was 94.5 ± 5.6%. After small auto- and cryopreserved allograft skin grafting, the epidermis of the auto-skin gradually replaced the allo-epidermis, and the allo-dermis persisted for a prolonged period. The dermal collagen fibers at the allo-skin grafting sites were well arranged. At 1–2-year follow-up, observation showed that the Vancouver Scar Scale total score was 4·304 ± 2·363, and we did not discern significant contracture and dysfunction in the large joints of the four extremities.Conclusions
Small auto- and cryopreserved allograft skin grafting of small auto- and allo-skin not only raised the graft expansion rate but offers a stable wound healing rate. This new technique may provide an option for repair of large-area deep burn wounds. 相似文献14.
Sarah-Claude Provençal Suzie Bond Elie Rizkallah Ghassan El-Baalbaki 《Burns : journal of the International Society for Burn Injuries》2018,44(8):1870-1881
Background
Evidence from clinical trials suggests psychological interventions should be considered as an adjunct to medications.Objective
The purpose of this systematic review and meta-analysis was to evaluate the effectiveness of clinical hypnosis on pain, anxiety and medication needs during wound care in adults suffering from a burn injury.Data sources
Medline, PsychINFO, CINAHL, Embase, ISI, SCOPUS, Cochrane, and Proquest databases were searched for randomized controlled trials comparing hypnosis to other interventions during dressing change in adult patients.Data synthesis
Two independent reviewers extracted relevant articles and assessed their methodological quality. Only six studies met the inclusion criteria and were described in detail. Available data was pooled with Revman 5.3.Results
For the primary outcome, we found a statistically significant difference in pain intensity ratings favoring hypnosis (MD = ?8.90, 95% CI ?16.28, ?1.52). For the secondary outcomes, there was a statistically significant difference in anxiety ratings favoring hypnosis (MD = ?21.78, 95% CI ?35.64, ?7.93) and no difference in medication usage (MD = ?0.07, 95% CI ?0.32, 0.17).Conclusion
These results suggest that hypnosis reduces pain intensity and anxiety ratings in adults undergoing burn wound care. However, because of the limitations discussed, clinical recommendations are still premature. 相似文献15.
So Young Joo June-Bum Kim Yoon Soo Cho Yong Suk Cho Cheong Hoon Seo 《Burns : journal of the International Society for Burn Injuries》2018,44(4):1005-1010
Purpose
Pruritus, a common, chronically disabling condition is often refractory to treatment. The pruritus sensation is mediated in the spinal cord and post-burn pruritus is considered a form of neuropathic pain. We investigated cold pack therapy as a treatment modality for post-burn pruritus.Methods
We studied 23 patients with severe pruritus scoring at least 5 on the visual analogue scale (VAS) and refractory to antihistamine and gabapentin administration. Each cold pack therapy lasted more than 20 min. Patients participated in more than three sessions daily for 4 consecutive weeks. The numerical rating scale (NRS), 5-D Itch Scale, Leuven Itch Scale, and perfusion units were evaluated before, within 30 min after, 2, and 4 weeks cold pack therapy.Results
In all patients, the NRS was 9.37 ± 1.47 pre-therapy, 3.48 ± 2.19 at 2 weeks, and 2.78 ± 2.13 at 4 weeks following therapy, the pre-scores being significantly different (p < 0.001). Pruritus severity and consequences scores (Leuven Itch Scale) were improved after therapy compared to pre-therapy. Perfusion unit (PU) scores were statistically insignificant compared to PU scores measured before the application of cold pack therapy. Degree, direction, and disability scores (5-D Itch scale) significantly differed (p < .05).Conclusion
Cold pack therapy, a non-invasive, non-pharmacological treatment modality significantly reduces post-burn pruritus and could be useful in burn patients. 相似文献16.
Raju Vaishya Vipul Vijay Kapil Mani K.C. Amit Kumar Agarwal 《Journal of Clinical Orthopaedics and Trauma》2018,9(2):107-111
Introduction
Considering the old age, uncertain life expectancy, co-morbidities and fear of postoperative complications, elderly patients often hesitate to undergo simultaneous bilateral total knee arthroplasty (SBTKA).Materials & methods
A retrospective study of SBTKA in 46 patients (92 knees) of age >70 years done between 2003 and 2012. Mean age was 80.13 ± 5.24 years (range ?70–93 years).Results
74 percent had 1 or more major medical problems. There was a significant improvement of KSS at six months (p value = 0.00).Conclusion
With expected benefits of surgery, SBTKA seems a safe, efficient, and viable procedure for carefully selected elderly patients. 相似文献17.
Mark Glazebrook Alastair S.E. Younger Timothy R. Daniels Dishan Singh Chris Blundell Gwyneth de Vries Ian L.D. Le Dominic Nielsen M. Elizabeth Pedersen Anthony Sakellariou Matthew Solan Guy Wansbrough Judith F. Baumhauer 《Foot and Ankle Surgery》2018,24(5):440-447
Background
First metatarsophalangeal joint (MTPJ1) hemiarthroplasty using a novel synthetic cartilage implant was as effective and safe as MTPJ1 arthrodesis in a randomized clinical trial. We retrospectively evaluated operative time and recovery period for implant hemiarthroplasty (n = 152) and MTPJ1 arthrodesis (n = 50).Methods
Perioperative data were assessed for operative and anaesthesia times. Recovery and return to function were prospectively assessed with the Foot and Ankle Ability Measure (FAAM) Sports and Activities of Daily Living (ADL) subscales and SF-36 Physical Functioning (PF) subscore.Results
Mean operative time for hemiarthroplasty was 35 ± 12.3 min and 58 ± 21.5 min for arthrodesis (p < 0.001). Anaesthesia duration was 28 min shorter with hemiarthroplasty (p < 0.001). At weeks 2 and 6 postoperative, hemiarthroplasty patients demonstrated clinically and statistically significantly higher FAAM Sport, FAAM ADL, and SF-36 PF subscores versus arthrodesis patients.Conclusion
MTPJ1 hemiarthroplasty with a synthetic cartilage implant took less operative time and resulted in faster recovery than arthrodesis.Level of evidence
III, Retrospective case control study. 相似文献18.
Background
The operative management of failed first metatarso-phalangeal joint (MTPJ) surgery is often complicated by bone loss and shortening of the hallux. Restoration of first ray length and alignment often cannot be achieved with in situ fusion and reconstruction techniques with bone graft are therefore required. We present a novel technique of longitudinal (proximo-distal) bone dowel arthrodesis for first MTPJ arthrodesis with bone loss.Methods
Between August 2007 and February 2015, eight patients have been treated by the senior author with this technique. The mean age at surgery was 60.5 years (range 45–80) with seven females and one male. Index surgery was MTPJ arthrodesis (three patients), Keller excision arthroplasty (two patients), MTPJ hemiarthroplasty (two patients) and silastic arthroplasty (one patient). Clinical and radiological fusion was assessed and other radiological measurements included hallux valgus angle (HVA) and length of the hallux (LOH).Results
All patients achieved fusion at a mean of 9.3 weeks (range 6–12) from surgery and only one patient required removal of metalwork. There were no major complications. The HVA improved in all cases from 21.4 ± 2.8 pre-operatively to 11.6 ± 3.5 post-operatively (p > 0.05). The LOH also increased in all cases from 82.1 ± 8.3 mm to 86.7 ± 8.2 mm (p > 0.05). The subgroup of patients who were revised from an arthroplasty, where maintenance of length rather than increase in length was desirable (hemiarthroplasty, silastic) had significantly lower increase in LOH than those revised from a non-arthroplasty index surgery (arthrodesis, Keller) (p = 0.029).Conclusion
The dowel technique is successful for first MTPJ arthrodesis revision surgery with optimal union rates and satisfactory radiographic and clinical outcomes. It is an effective and versatile option for managing bone loss and deformity of the hallux. 相似文献19.