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Background
Degenerative spondylolisthesis (DS) and lumbar spinal stenosis (LSS) are the most common degenerative spinal diseases. The evaluating of spinopelvic sagittal alignment of the two diseases using pelvic radius (PR) technique have not been reported. The purpose of this study was to use PR measurement technique to compare the differences in spinopelvic sagittal alignment between DS and LSS.Methods
A total of 145 patients with DS or LSS were retrospectively reviewed. Seventy patients with DS (DS group) and 75 age-matched patients with LSS (LSS group) were enrolled. Spinopelvic parameters including pelvic angle (PA), regional lumbopelvic lordosis (PR–L1, PR–L2, PR–L3, PR–L4 and PR–L5), total lumbopelvic lordosis (PR–T12), pelvic morphology (PR–S1), sagittal vertical axis from the C7 plumb line (SVA), lumbar lordosis (LL), thoracic kyphosis (TK), L4 slope and L5 slope were assessed in the two groups. Several parameters of DS and LSS group were compared with the normal population (NP).Results
The PR–L4, PR–L5 and PR-S1 in the DS group were significantly smaller than those in the LSS group. There was no difference in PR–T12 between the DS group and NP (p > 0.05), while PR–T12 of the LSS group were significantly lower (p < 0.01). Degree of correlations among spinopelvic parameters differed between the two groups. PR–T12 of the DS group was more strongly correlated with PA (r = ?0.829, p < 0.001) than with LL (r = 0.664, p < 0.001), TK (r = 0.582, p < 0.001). PR-T12 of the LSS group was more strongly correlated with LL (r = 0.854, p < 0.001), TK (r = 0.616, p < 0.001) than with PA (r = ?0.582, p < 0.001).Conclusions
PR–L4 and PR–L5 may be the predisposing factors for DS development. Spinopelvic morphology differed in patients with DS and LSS compared to NP. The compensatory mechanisms to maintain spinopelvic sagittal alignment in DS and LSS patients may be different. 相似文献2.
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Background and importanceCauda equina syndrome is a common acute medical condition, usually caused by large degenerative disc herniation or metastatic lumbar disease. We describe a patient who presented with a lesion featuring both discal and tumoral characteristics.Clinical presentationA 41-year-old woman presented with ongoing back pain, progressive lower-limb weakness and sphincter disorder. Magnetic resonance imaging showed a very odd-looking large anterior epidural lesion originating from the L3-L4 space and severely compressing the roots of the cauda equina. Partial surgical decompression was performed in emergency. At a later time, redo surgery was performed to maximize resection, and was unfortunately followed by several complications. After 6 surgical procedures including a ventriculo-peritoneal shunt insertion and intensive rehabilitation, the patient could walk independently with the aid of one crutch. Following collegial review, the diagnosis of low-grade chondrosarcoma of the intervertebral disc was suggested.ConclusionWe report on a very unusual and therapeutically challenging spinal tumor diagnosed as low-grade chondrosarcoma of discal origin, an entity never previously described. 相似文献
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Romain Champagne Julie Bodin Natacha Fouquet Yves Roquelaure Audrey Petit 《Journal of hand therapy》2019,32(3):322-327
Study DesignSurvey.IntroductionRotator cuff syndrome (RCS) is one of the most common musculoskeletal disorders reported in workers. The functional incapacity related to RCS may vary according to the sociodemographic context and to the medical management.Purpose of the StudyThe purpose of this is to analyze the RCS-related functional incapacity assessed by the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaires in workers according to their sociodemographic characteristics and the use of care.MethodsA cross-sectional study was carried out on a French sample of workers diagnosed with RCS. The DASH and DASH-work scores were studied according to the sociodemographic factors, musculoskeletal symptoms, and RCS medical management during the preceding 12 months.ResultsTwo hundred seven workers who suffered from RCS filled out the questionnaire of which 80% were still working. The DASH score was significantly higher in women (24.0 vs 17.4; P < .01; effect size (d) = 0.39), in patients over the age of 50 years (23.6 vs 11.3; P < .005) and in case of another upper limb musculoskeletal disorder (P < .0001; d ≥ 0.4). The DASH and DASH-work scores were significantly higher in case of use of care for RCS (P < .005; d > 0.6).DiscussionThe demographic factors and the RCS medical management influenced the overall incapacity assessed by the DASH questionnaire. Work incapacity was more especially related to the use of care for RCS.ConclusionThe sociodemographic and medical parameters added to other established predictors could help guide clinicians in managing their patients. 相似文献
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F.H. Cornelis E. Monard M.-A. Moulin E. Vignaud F. Laveissiere M. Ben Ammar M. Nouri-Neuville M. Barral B. Lombart 《Diagnostic and interventional imaging》2019,100(12):753-762
The aims of this review were to describe the rationale and the techniques of sedation in interventional radiology, and to compile the safety and efficacy results available so far in the literature. A systematic MEDLINE/PubMed literature search was performed. Preliminary results from several studies demonstrated the feasibility, the efficacy and the safety of using sedative techniques in interventional radiology. Beyond pharmacological sedation and clinical hypnosis, digital sedation could reduce the anxiety and pain associated with interventional radiology procedures. 相似文献
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Masatoshi Morimoto Kosaku Higashino Hiroaki Manabe Fumitake Tezuka Kazuta Yamashita Yoichiro Takata Shoichiro Takao Toshinori Sakai Takashi Chikawa Akihiro Nagamachi Koichi Sairyo 《Journal of orthopaedic science》2019,24(1):50-56
Background
Despite facet joints being three-dimensional structures, previous computed tomography and magnetic resonance imaging studies have evaluated facet joint orientation in only the axial plane. Facet joint orientation in the sagittal plane has rarely been studied using these imaging techniques. The aim of this study was to elucidate facet joint orientation in both the axial and sagittal planes on computed tomography.Methods
A total of 568 patients (343 men, 225 women) (excluding orthopedic outpatients) for whom abdominal and pelvic computed tomography scans were obtained at our hospital between September 2010 and October 2012 were included. Mean age was 63 (range 21–90) years. Patients were divided into a degenerative spondylolisthesis group (67 patients; 30 men, 37 women) and a control group (313 patients; 313 men, 188 women). Facet joint orientation was evaluated in the control group according to patient age (≤50, 51–60, 61–70, or ≥71 years). The findings in the control group were then compared with those in the degenerative spondylolisthesis group. The orientation of the lumbar facet joints at each level was measured in the axial and sagittal planes on computed tomography images.Results
Facet joint angles decreased with age at L4/5 and L5/S1 in women in the axial plane and at L4/5 in men and L3/4 and L4/5 in women in the sagittal plane. The variation in facet joint angle was greatest at L4/5 in women. Patients with degenerative spondylolisthesis showed more sagittally and horizontally oriented facet joints in the axial and sagittal planes; facet tropism showed an association with degenerative spondylolisthesis in the axial plane.Conclusions
The axial and sagittal orientation of facet joints in the lower lumbar vertebra, especially L4/5, was negatively correlated with age. This finding could help to explain why older people are more prone to degenerative spondylolisthesis. 相似文献12.
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C. Damade G. Tesson V. Gilard S. Vigny E. Foulongne R. Gauthé M. Ould-Slimane 《Neuro-Chirurgie》2019,65(6):377-381
IntroductionTranexamic acid (TXA) has been shown to reduce bleeding. Patients with spinal tumors are fragile and acute anemia may be harmful. Tumor excision surgery is reputed to be hemorrhagic and treatment may increase thromboembolic complications. The aim of this study was to compare blood loss with or without perioperative TXA injection. The transfusion-related and postoperative complications were documents.MethodThis retrospective analysis of prospectively collected data involved 83 patients with spinal tumors who underwent decompressive surgery associated with bone fixation. Tranexamic acid was used arbitrarily in 36 of them, while the other 47 did not receive TXA. The overall, intraoperative and postoperative blood loss was recorded. Blood loss was reported relative to the number of fixed levels and the number of levels decompressed by laminectomy. Transfusions were quantified in number of red blood cell packets and erythrocyte volume. Postoperative complications were documented.ResultsEpidemiological and morphological data were similar between groups. There were no significant differences between the two groups in the overall, intraoperative, and postoperative blood loss. A significant reduction in postoperative bleeding was found in the TXA group when the volume was related to the number of decompressed levels. A significant reduction (P < 0.05) in the volume of transfused blood was identified in the treated group. No predictor of blood loss was identified, and no additional complications occurred.ConclusionThe efficacy of TXA appears to be moderate during spinal tumor surgery since it does not lead to a reduction in perioperative bleeding. However, a significant reduction in transfusion volume was found without an increase in complications. 相似文献
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Purpose
To identify factors influencing overall radiologic changes in the distal radioulnar joint after ulnar shortening osteotomy (USO) in patients with idiopathic ulnar impaction syndrome.Materials and methods
A total of 310 patients who had undergone USO between May 2007 and December 2013 were included in this retrospective case–control study. The patients were classified into two groups (with or without radiologic findings of new arthritic changes), after which the following factors were analyzed: 1) demographic factors; 2) radiologic aspects, including ulnar variance (UV), morphological DRUJ type (classified according to Tolat et al.), and union period after USO; and 3) operative aspects, including the triangular fibrocartilage complex degeneration type, use of a parallel double-blade saw, type of plate used for fixation, and plate position on the volar or dorsal ulnar surface.Results
Group 1 (no arthritic changes) consisted of 243 patients, whereas Group 2 (arthritic changes) consisted of 67 patients. Univariate and multivariate analyses showed that the presence of lunate cystic changes, amount of shortening, and the union period were significantly associated with newly developed arthritic changes in the distal radioulnar joint (DRUJ) after USO. The morphological DRUJ type was not a significant factor. Arthritic changes were significantly more prevalent in patients with a shortening amount >4.5 mm and a union period <3.25 months.Conclusions
Radiologic arthritic changes after USO, were associated with the presence of cystic changes in the lunate, a shortening amount (>4.5 mm), and early bony union (<3.25 months).Type of study/level of evidence
Therapeutic level III. 相似文献15.
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Nikolaos A. Chatzizacharias Susan Tsai Michael Griffin Parag Tolat Paul Ritch Ben George Chad Barnes Mohammed Aldakkak Abdul H. Khan William Hall Beth Erickson Douglas B. Evans Kathleen K. Christians 《Surgery》2018,163(5):1053-1062
Background
Patients with locally advanced pancreatic cancer have historically been considered inoperable. The purpose of this report was to determine resectability rates for patients with locally advanced pancreatic cancer based on our recently described definitions of type A and type B locally advanced pancreatic cancer.Methods
An institutional prospective pancreas cancer database was queried for consecutive patients with locally advanced pancreatic cancer treated between January 2009 and June 2017. All pretreatment imaging was re-reviewed and patients were categorized as locally advanced pancreatic cancer type A or type B. Demographics, induction therapy, resection type, and outcomes were reviewed.Results
We identified 108 consecutive patients; 12 were excluded from analysis due to the absence of available pretreatment imaging or they had not yet completed all intended neoadjuvant therapy. Of the remaining 96 patients (45 type A, 51 type B), disease progression occurred in 19 (20%) during induction therapy and 30 (31%) were deemed inoperable at final preoperative restaging. Therefore, 47 (49%) of 96 patients were taken to surgery and 40 (42%) underwent successful resection (28 [62%] of 45 type A and 12 [24%] of 51 type B); an RO resection was achieved in 32 (80%). Metastatic disease was found intraoperatively (6 at laparoscopy, 1 at laparotomy) in 7 (15%) of 47 patients. There were no mortalities; 6 (15%) patients experienced major postoperative complications. Resected patients had a median overall survival of 38.9 months.Conclusion
Locally advanced pancreatic cancer can be dichotomized into type A and B with distinctly different probabilities of completing all therapy to include surgery; thereby allowing goals of therapy to be established at the time of diagnosis. Multimodality therapy that includes surgery can be accomplished in selected patients with locally advanced pancreatic cancer and is associated with a median overall survival that approximates earlier stages of disease. (Surgery 2017;160:XXX-XXX.) 相似文献17.
Yasmin Hassen Pritam Singh Philip H. Pucher Maximilian J. Johnston Ara Darzi 《Surgery》2018,163(6):1226-1233
Background
Postoperative care quality is variable. Risk-adjusted mortality rates differ between institutions despite comparable complication rates. This indicates that there are underlying factors rooted in how care is delivered that determines patient safety. This study aims to evaluate systematically the surgical ward environment with respect to process-driven and structural factors to identify quality markers for safe care, from which new safety metrics may be derived.Methods
Semistructured interviews of clinicians, nurses, patients and administrators were undertaken for the study.Results
In the study, 97% of staff members recognized the existence of variation in patient safety between surgical wards. Four main error-prone processes were identified: ward rounds (57%), medication prescribing and administration (49%), the presence of outliers (43%), and deficiencies in communication between clinical staff (43%). Structural factors were categorized as organizational or environmental; organizational included shortage in staffing (39%) and use of temporary staff (27%). Environmental factors considered layout and patient visibility to nurses (49%) as well as cleanliness (29%). Safety indicators identified included staff experience level (31%), overall layout of the ward, cleanliness and leadership (all 27% each). The majority of patients (87%) identified staff attentiveness as a safety indicator.Conclusion
This study demonstrates that there are a number of factors that may contribute to safety on the surgical ward spanning multiple processes, organizational, and environmental factors. Safety indicators identified across all these categories presents an opportunity to develop broader and more effectual safety improvement measures focusing on multiple areas simultaneously. 相似文献18.
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Yusuke Hori Akira Matsumura Takashi Namikawa Minori Kato Shinji Takahashi Shoichiro Ohyama Tomonori Ozaki Akito Yabu Hiroaki Nakamura 《Journal of orthopaedic science》2019,24(2):224-229