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1.
Masashi Takaso Toshiyuki Nakazawa Takayuki Imura Takamitsu Okada Masahiro Toyama Masaki Ueno Kensuke Fukushima Wataru Saito Atsushi Minatani Gennyo Miyajima Michinari Fukuda Naonobu Takahira Kazuhisa Takahashi Masashi Yamazaki Seiji Ohtori Hirotsugu Okamoto Toshiyuki Okutomi Makito Okamoto Takashi Masaki 《Journal of orthopaedic science》2010,15(2):171-177
Background
Instrumentation and fusion to the sacrum/pelvis has been a mainstay in the surgical treatment of scoliosis in patients with Duchenne muscular dystrophy since the development of the intrailiac post. It is recommended for correcting pelvic obliquity. However, caudal extent of instrumentation and fusion has remained a matter of considerable debate. This study was performed to determine the efficacy and safety of stopping segmental pedicle screw constructs at L5 during surgical treatment of scoliosis associated with Duchenne muscular dystrophy (DMD).Methods
From May 2005 to June 2007, a total of 20 consecutive patients underwent posterior spinal fusion and segmental pedicle screw instrumentation only to L5 for scoliosis secondary to DMD. All patients had progressive scoliosis, difficulty sitting, and back pain before surgery. A minimum 2-year follow-up was required for inclusion in this study. Assessment was performed clinically and with radiological measurements. The Cobb angles of the curves and spinal pelvic obliquity were measured on the coronal plane. Thoracic kyphosis and lumbar lordosis were measured on the sagittal plane. These radiographic assessments were performed before surgery, immediately after surgery, and at a 3-month interval thereafter. The operating time, blood loss, and complications were evaluated. Patients were questioned about whether they had difficulty sitting and felt back pain before surgery and at 6 weeks, 1 year, and 2 years after surgery.Results
A total of 20 patients, aged 11–17 years, were enrolled. The average follow-up period was 37 months. Preoperative coronal curves averaged 70° (range 51°–85°), with a postoperative mean of 15° (range 8°–25°) and a mean of 17° (range 9°–27°) at the last follow-up. Pelvic obliquity improved from 13° (range 7°–15°) preoperatively to 5° degrees (range 3°–8°) postoperatively and 6° (range 3°–9°) at the last follow-up. Good sagittal plane alignment was recreated and maintained. Only a small loss of correction of scoliosis and pelvic obliquity was noted. The mean operating time was 271 min (range 232–308 min). The mean intraoperative blood loss was 890 ml (range 660–1260 ml). The mean total blood loss was 2100 ml (range 1250–2880 ml). There was no major complication. All patients reported that difficulty sitting and back pain were alleviated after surgery.Conclusion
Segmental pedicle screw instrumentation and fusion only to L5 is safe and effective in patients with DMD scoliosis of <85° and pelvic obliquity of <15°. Good sagittal plane alignment was achieved and maintained. All patients benefited from surgery in terms of improved quality of life. There was no major complication. 相似文献2.
Akihiko Hiyama MD PhD Taku Ukai MD PhD Shota Ogasawara MD Tatsumi Tanaka MD Masahiko Watanabe MD PhD 《Orthopaedic Surgery》2023,15(5):1405-1413
Objective
Fluoroscopy is often used in the surgery of unstable pelvic ring fractures, and improved safety in implant placement is an issue. An anterior subcutaneous pelvic fixator (INFIX) combined with a percutaneous screw has been reported to be a minimally invasive and effective surgical technique for unstable pelvic ring injuries. However, although percutaneous screw fixation is minimally invasive, its indications for fracture fixation and fractures with large fragment displacements in the vertical plane remain controversial. Therefore, this technical note aims to describe a new technique for unstable pelvic ring fractures.Methods
We describe a 360° fusion of the pelvic ring to treat unstable pelvic ring fractures, including vertical shear pelvic ring fractures, using an intraoperative CT navigation system. Seven patients were treated with 360° fusion for type C pelvic ring fractures. In surgery, after reducing the fracture with external fixation, intraoperative CT navigation is used to perform a 360° fusion with INFIX and minimally invasive surgical spinopelvic fixation (MIS-SPF). We will introduce a typical case and explain the procedure.Results
A 360° fixation was performed, and no perioperative complications were noted. The mean blood loss was 253.2 ± 141.0 mL, and the mean operative time was 224.3 ± 67.4 min. In a typical case, bone union was obtained 1 year after surgery, and we removed all implants.Conclusions
MIS-SPF has a strong fixation force and helps reduce fractures' horizontal and vertical planes. In addition, 360° fusion with intraoperative CT navigation may help treat unstable pelvic ring fractures. 相似文献3.
Background
“Tilt” of surgical view was commonly shown on the monitor due to unintentional rotation of camera along its long axis by camera driver. Surgeons may be influenced on identification of anatomical structures by the tilt vision. We aimed to analyze the surgical records and videos of laparoscopic surgery, and to reveal the correlation between intraoperative complications and tilt view.Methods
A series of 425 consecutive patients who received laparoscopic low anterior resection and abdominoperineal resection were studied, and 398 surgery videos were reviewed. Still pictures showing intraoperative injury were selected. A method was established to measure tilt angle in the still pictures according to the reference line based on several anatomic landmarks. The patients were grouped with two methods according to different study purposes. Incidence of intraoperative complication and tilt angle were calculated, and statistical analysis was performed.Results
The incidence of intraoperative complications was 8.3 %. Tilt of the surgical field at different degrees (<15°, 15°–30° and >30°) was found in a relatively high rate in these surgery videos (31.4 %). Compared with controls, comparatively bigger tilt angles were found in all cases of complication group. It is interesting to note that intraoperative complications happened more often when the tilt angle was in the range of 15°–30° (72.7 %) than >30° (18.2 %). We also noted a high incidence of complication (72.7 %), while tilt angle was over 15° (26 %) in the first 100 cases; comparatively a steady declining low rate of complication occurrence (5–7 %) and also tilt angle over 15° (9–11 %) were noted in the later 298 cases.Conclusions
Rotation of camera is common during laparoscopic procedures. The tilt view increased the risk of laparoscopic procedures. Tilt angle at 15–30° is the most dangerous rotation for laparoscopic surgeries. Therefore, we propose the “Gravity Line Strategy” principle as one of the basic operating criteria to correct the tilt angle. 相似文献4.
Jinsong Yang MD Ming Xiang PhD Yiping Li MD Qing Zhang MD Fei Dai MD 《Orthopaedic Surgery》2023,15(8):1997-2006
Objectives
Rotator cuff injury caused by subacromial impingement presents different morphologies. This study aims to investigate the correlation between various shoulder anatomical indexes on X-ray with subacromial impingement and morphology of rotator cuff tears to facilitate surgical management.Method
This retrospective study was carried out between January 2020 and May 2022. Patients who were diagnosed as sub-acromial impingement associated with rotator cuff tears (without tendon retraction) and received arthroscopic surgery were enrolled in this study. The radiographic indexes of acromial slope (AS), acromial tilt (AT), lateral acromial angle (LAA), acromial Index (AI), and sub-acromial distance (SAD) were measured on preoperative true AP view and outlet view. The location of rotator cuff tear (anterior, middle, posterior, medial, and lateral) and morphology of tear (horizontal, longitudinal, L-shaped, and irregular shaped) were evaluated by arthroscopy. Groups were set up due to different tear location and tear morphologies, by comparing the various radiographic indices between each group (one-way analysis of variance and t-test), the correlation between radiographic indices and tear characteristics was investigated.Results
We analyzed 92 shoulders from 92 patients with a mean age of 57.23 ± 8.45 years. The AS in anterior tear group (29.32 ± 6.91°) was significantly larger than that in middle tear group (18.41 ± 6.13°) (p = 0.000) and posterior tear group (24.01 ± 7.69°) (p = 0.041). The AS in posterior tear group (24.01 ± 7.69°) was significantly larger than that in middle tear group (18.41 ± 6.13°) (p = 0.029). The LAA in middle tear group (67.41 ± 6.54°) was significantly smaller than that in posterior group (72.74 ± 8.78°) (p = 0.046). The AS in longitudinal tear group (26.86 ± 8.41°) was significantly larger than that in horizontal tear group (22.05 ± 9.47°) (p = 0.035) and L-shaped group (21.56 ± 6.62°) (p = 0.032). The LAA in horizontal group (70.60 ± 6.50°) was significantly larger than that in L-shaped group (66.39 ± 7.31°) (p = 0.033). The AI in L-shaped tear group (0.832 ± 0.074) was significantly larger than that in horizontal tear group (0.780 ± 0.084) (p = 0.019) and irregular tear group (0.781 ± 0.068) (p = 0.047).Conclusion
Acromion with a larger AS and a smaller LAA tend to cause anterior or posterior rotator cuff tears rather than middle tears in sub-acromial impingement. Meanwhile acromion with a larger AS tends to cause a longitudinal tear, a larger LAA tends to cause horizontal tears and a larger AI tends to cause L-shaped tears. 相似文献5.
Purpose
Recent high-tech innovations in digital surgical technology have led to advances in three-dimensional (3D) and high-definition (HD) operating scopes. We introduce a novel 3D–HD flexible surgical scope called “3D-Eye-Flex” and evaluate its utility as an alternative to the operating microscope.Methods
The 3D-Eye-Flex has a 15 mm long 3D–HD scope-head with a 15 mm outer diameter, a focus distance of 18–100 mm and 80° angle of view. Attached to a 615-mm-long flexible bellows, 3D-Eye-Flex can be easily fixed to the operating table. Microsurgical dissection of wet brain tissue and drilling a skull base model were performed under the scope while using the 3D–HD video monitor.Results
This scope system provided excellent illumination and image quality during the procedures. A large depth of field with stereoscopic vision had a greater advantage over using an operating microscope. 3D-Eye-Flex was easy to manipulate and provided an abundance of space above the operative field. Surgeons felt comfortable while working and could easily shift the position of the scope.Conclusion
This novel 3D–HD flexible scope is an effective alternative to the operating microscope as a new surgeon’s eye and will be suitable for digital image-based surgery with further refinement. 相似文献6.
Zhuang Zhang MD Liang Wang MD Jing-chi Li MD Li-min Liu MD Yue-ming Song MD Xi Yang MD 《Orthopaedic Surgery》2023,15(6):1607-1616
Objective
There has been increasing concern about the importance of sagittal alignment in the evaluation and treatment of spinal scoliosis. However, recent studies have only focused on patients with mild to moderate scoliosis. To date, little is known about the sagittal alignment in patients with severe and rigid scoliosis (SRS). This study was performed to evaluate the sagittal alignment in patients with SRS, and to analyze how it was altered after corrective surgery.Methods
In this retrospective cohort study, we included 58 patients with SRS who underwent surgery from January 2015 to April 2020. Preoperative and postoperative radiographs were reviewed, and the sagittal parameters mainly included thoracic kyphosis (TK), lumbar lordosis (LL), pelvic incidence (PI), pelvic tilt (PT), sacrum slope (SS), and sagittal vertical axis (SVA). The sagittal balance state was evaluated according to whether the PI minus the LL (PI-LL) was less than 9°, and the patients were divided into thoracic hyperkyphosis and normal groups based on whether the TK exceeded 40°. The Student's t test, Pearson's test, and Receiver operating characteristic (ROC) curve analysis were used to compare related parameters between the different groups.Results
The mean follow-up duration was 2.8 years. Preoperatively, the mean PI was 43.6 ± 9.4°, and the mean LL was 65.2 ± 13.9°. Sixty-nine percent of patients showed sagittal imbalance, and they showed larger TK and LL values and smaller PI and SVA values than those with sagittal balance. Additionally, most patients (44/58) presented with thoracic hyperkyphosis; this group had smaller PI and SVA values than the normal patients. Patients with syringomyelia-associated scoliosis were more likely to present with thoracic hyperkyphosis. The TK and LL values were significantly decreased, and 45% of patients with preoperative sagittal imbalance recovered after surgery. These patients had a larger PI (46.4 ± 9.0° vs 38.3 ± 8.8°, P = 0.003) and a smaller TK (25.5 ± 5.2° vs 36.3 ± 8.0°, P = 0.000) at the final follow-up.Conclusion
Preoperative sagittal imbalance appears in the majority of SRS patients, accounting for approximately 69% of our cohort. Patients with small PI values or syringomyelia-associated scoliosis were more likely to present with thoracic hyperkyphosis. Sagittal imbalance can generally be corrected by surgery, except in patients with a PI less than 39°. To achieve good postoperative sagittal alignment, we recommend controlling the TK to within 31°. 相似文献7.
Yi Long Huijun Hu Chuanhai Zhou Jingyi Hou Zhiling Wang Min Zhou Dedong Cui Xiaoding Xu Rui Yang 《Orthopaedic Surgery》2023,15(8):2052-2061
Objective
Anteroposterior (AP) radiographs do not necessarily offer the optimal approach to measuring the critical shoulder angle (CSA) due to the malposition of the scapula. Three-dimensional computed tomography (3D-CT) may offer some advantages, including the ability to rotate the scapula for position alignment and pre-operative planning for reducing CSA. This study aimed to investigate the accuracy and reliability of CSA measurement in 3D-CT and to determine whether there is an association between CSA and rotator cuff tears (RCTs).Methods
In this retrospective study we identified 200 patients who received shoulder arthroscopy from 2019 to 2021, including 142 patients (81 females, 61 males) with RCTs and 58 patients (14 females, 44 males) with non-RCTs. For each participant, CSA was measured from standard shoulder AP radiographs and anterior views of 3D-CT of the scapula by two independent assessors. Inter- and intra-observer agreements were assessed by the intraclass correlation coefficient (ICC). The relationship between the two measurement methodologies was determined by Spearman's correlation coefficient and Bland–Altman plots. Discriminative capacity was calculated by using receiver operating curve (ROC) analyses in the whole cohort and age sub-groups above and below 45 years.Results
We found perfect inter-observer (ICC >0.96) and intra-observer (ICC >0.97) reliabilities for CSA measurements obtained from the standard AP radiographs and the 3D-CT. There was a strong correlation between the two methods (r = 0.960, P < 0.001). The mean CSA was 31.7° ± 4.2° in the standard AP radiographs and 31.8° ± 4.4° in the 3D-CT (mean difference 0.02°, P = 0.940; bias 0.02°, limits of agreement −2.29° to +2.33°). ROC analysis of the whole cohort showed that the CSA measured in the standard AP radiographs (area under the ROC curve [AUC] = 0.812, P < 0.001) and the 3D-CT (AUC = 0.815, P < 0.001) predicted RCT with high confidence. ROC analysis of patients aged ≥45 years showed that the CSA measured from the standard AP radiographs (AUC = 0.869, P < 0.001) and the 3D-CT (AUC = 0.870, P < 0.001) were very good at predicting RCTs.Conclusion
CSA measured from standard AP radiographs and 3D-CT showed high consistency, and the CSA could be accurately and reliably measured using 3D-CT. CSAs measured from standard AP radiographs and 3D-CT could predict RCTs, especially in patients aged ≥45 years. 相似文献8.
Background
Remedial surgery for patients with persistent or recurrent primary hyperparathyroidism (1° HPT) remains a significant challenge. Cervical reexploration is technically difficult; reoperative neck anatomy is distorted by fibrosis and, as a result, remedial 1° HPT patients carry an increased risk of injury to the recurrent (RLN) and superior laryngeal nerve(s) as well as to normal residual parathyroid tissue. Causative hyperfunctioning parathyroid tissue is also more frequently ectopic in the remedial setting and can thus be difficult to localize. 相似文献9.
Purpose
It has been reported that recently developed circulating-water garments transfer more heat than a forced-air warming system. The authors evaluated the hypothesis that circulating-water leg wraps combined with a water mattress better maintain intraoperative core temperature ≥36°C than either forced-air warming or carbon-fiber resistive heating during major abdominal surgery. 相似文献10.
R. Gaulke F. Hildebrand M. Panzica T. Hüfner C. Krettek 《Clinical orthopaedics and related research》2010,468(4):1018-1024
Abstract
Recurrent dislocation of the peroneal tendons following operative treatment is relatively uncommon, but can be difficult to treat. We asked whether subligamental transposition of the peroneus brevis tendon, fibular grooving, and reattachment of the superior peroneal retinaculum for failed peroneal tendon dislocation surgery would achieve a stable fixation of the peroneal tendons and whether there would be restrictions of ROM or instability of the hindfoot. We reviewed six female patients (mean age, 24.5 years) with general laxity of joints preoperatively and at 6 weeks and 3, 6, and 12 months postoperatively. Within 1 year postoperatively no recurrence was found. In two ankles the extension was restricted 5° to 10°. In another pronation and supination was restricted 5° each. Stability of the ankle increased in four patients and stayed unchanged in two. AOFAS score increased from a mean value of 36 ± 20.6 preoperatively to 90 ± 7 postoperatively at 1 year. We conclude transposition of the peroneus brevis tendon is a reasonable treatment for failed peroneal tendon dislocation surgery. 相似文献11.
Hans-Georg Damert Silke Altmann Armin Kraus 《Archives of orthopaedic and trauma surgery》2013,133(5):713-719
Introduction
Treatment for giant cell tumors of the distal radius is challenging when motion is to be preserved. As standard wrist prostheses typically do not achieve favorable results, we treated a 36-year-old man with giant cell tumor of the distal radius with a new, custom-made implant.Methods
A custom-made wrist prosthesis with a long shaft was designed according to the patient’s X-ray findings. After complete tumor resection, the prosthesis was subsequently implanted into the distal radius without complications.Results
Two months after surgery, range of motion was 30°-0-25° for extension/flexion, 10°-0-5° for ulnar/radial abduction, 80°-0-0 for pronation/supination, complete range of motion for the fingers, and a grip strength of 6 kg. Two years after surgery, implant position was still correct and range of motion was 45°-0-10° for extension/flexion, 10°-0-20° for ulnar/radial abduction, and 80°-0-10° for pronation/supination. Grip strength was 16 kg, and DASH score was 25 compared to 39 before surgery. The patient returned to work as a craftsman.Conclusion
Custom-made wrist prostheses could become a practical option in patients with large defects of the distal radius who desire to preserve wrist motion. 相似文献12.
Takasuke Imai Tatsuya Shiga Nobuhiro Saruki Kouichi Nishikawa Tatsushi Fujita Yasuo Morishita 《Journal canadien d'anesthésie》1996,43(8):812-819
Purpose
To elucidate whether endotoxaemia detected during major surgery was a specific or non-specific reaction.Methods
Prospective clinical study in the operating theatre and multidisciplinary intensive care unit in a university hospital. A series of plasma samples was obtained from 21 patients, including eight after cardiopulmonary bypass (CPB), until 48 hr after surgery. The endotoxin titres in these samples were compared by the two chromogenic limulus amebocyte lysate (LAL) assays; one is factor C containing and the other factor G-free, endotoxin-specific test. The endotoxin neutralizing activity of the plasma was determined by adding the endotoxin to the plasma (1,000 pg · ml?1), and by assaying how much the potency of the endotoxin to activate LAL was lost during incubation for 120 min at 37°C.Results
Although endotoxin litres measured using the test including factor G showed a marked elevation during and after surgery, which were 3 ± 5 (4 ± 10), 14 ± 13 (20 ± 17**), 133 ± 13* (46 ± 29*), 89 ± 72* (48 ± 35*), 62 ± 40** (37 ± 29*), 50 ± 54 (39 ± 36) pg · ml?1 in patients with CPB (without CPB), mean ± SD, at 0, 3, 6, 9, 24, and 48 hr after start of surgery (*P < 0.01, **P < 0.05 compared with 0 hr), those measured by the endotoxin-specific test did not show any changes. Plasma neutralized 95% of endotoxin potency after five minutes incubation at 37°C.Conclusion
Using an endotoxin-specific assay, endotoxin could not be deleted in the blood stream during or after major surgery. 相似文献13.
William S. Murphy Greg Klingenstein MD Stephen B. Murphy MD Guoyan Zheng PhD 《Clinical orthopaedics and related research》2013,471(2):417-421
Background
While surgical navigation offers the opportunity to accurately place an acetabular component, questions remain as to the best goal for acetabular component positioning in individual patients. Overall functional orientation of the pelvis after surgery is one of the most important variables for the surgeon to consider when determining the proper goal for acetabular component orientation.Questions/Purposes
We measured the variation in pelvic tilt in 30 patients before THA and the effect of THA on pelvic tilt in the same patients more than a year after THA.Methods
Each patient had a CT study for CT-based surgical navigation and standing and supine radiographs before and after surgery. Pelvic tilt was calculated for each of the radiographs using a novel and validated two-dimensional/three-dimensional matching technique.Results
Mean supine pelvic tilt changed less than 2°, from 4.4° ± 6.4° (range, ?7.7° to 20.8°) before THA to 6.3° ± 6.6° (range, ?5.7° to 19.6°) after THA. Mean standing pelvic tilt changed less than 1°, from 1.5° ± 7.2° (range, ?13.1° to 12.8°) before THA to 2.0° ± 8.3° (range, ?12.3° to 16.8°) after THA. Preoperative pelvic tilt correlated with postoperative tilt in both the supine (r2 = 0.75) and standing (r2 = 0.87) positions.Conclusions
In this population, pelvic tilt had a small and predictable change after surgery. However, intersubject variability of pelvic tilt was high, suggesting preoperative pelvic tilt should be considered when determining desired acetabular component positioning on a patient-specific basis. 相似文献14.
Nilcshkumar Patcl Charles E. Smith Donald Knapke Alfred C. Pinchak Joan F. Hagen 《Journal canadien d'anesthésie》1997,44(6):669-673
Purpose
To determine the relative efficacy of heat conservation and convective warming in maintaining penoperative normothermia. (central temperature ≥36°C).Methods
Thirty-seven patients undergoing elective gynaecological, orthopaedic, or general surgery scheduled to last two hours were prospectjvely studied. Patients were randomized to one of two groups. Group I patients received heat conservation with reflective blankets (Thermadrape?, Vital Signs, Inc., Totowa, NJ) applied preoperatively and warmed iv fluids (Hotline? SIMS Level I Technologies, Inc, Rockland, MA). Group 2 patients received convective warming (BairHugger, Augustine Medical, Inc., Eden Prairie, MN) after induction of anaesthesia andiv fluids at room temperature. All patients received general anaesthesia with isoflurane. Tympanic membrane and forearm-fingertip skin temperature gradients were measured penoperatively at 15 min intervals.Results
Central temperature decreased after induction to a minimum level of 35.9 ± 0.1°C in group I and 36.0 ± 0.1°C in group 2 and then increased towards pre-induction values in group 2, and were higher (P < 0.05) than in group 1: 95% group 2 patients had central temperature ≥ 36.0°C at the end of surgery (vs 69% of group l.P < 0.05). During the first 30 mm in PACU, central temperatures were higher in group 1 than in group 2 (36.8 ± 0.1°C vs 36.2 ± 0.2°C. P< 0.05). After 60 mm, central temperatures were similar (36.8°C). The incidence of shivering and degree of penpheral cutaneous vasoconstnction were also similar.Conclusion
Patients receiving convective warming were more likely to leave the operating room normothermic. and had higher central temperatures dunng the first 30 mm in the recovery room. The intergroup temperature differences were small, and by 60 min, had disappeared. 相似文献15.
Junmo An Andrew G. Webb Dipan J. Shah Karen Chin Nikolaos V. Tsekos 《The international journal of medical robotics + computer assisted surgery : MRCAS》2018,14(1)
Background
A method for the identification of semi‐active fiducial magnetic resonance (MR) markers is presented based on selectively optically tuning and detuning them.Methods
Four inductively coupled solenoid coils with photoresistors were connected to light sources. A microcontroller timed the optical tuning/detuning of coils and image collection. The markers were tested on an MR manipulator linking the microcontroller to the manipulator control to visibly select the marker subset according to the actuated joint.Results
In closed‐loop control, the average and maximum were 0.76° ± 0.41° and 1.18° errors for a rotational joint, and 0.87 mm ± 0.26 mm and 1.13 mm for the prismatic joint.Conclusions
This technique is suitable for MR‐compatible actuated devices that use semi‐active MR‐compatible markers. 相似文献16.
Xu-chao Zhang MD Kang Liu MD Hua Ying MD Gai Yao MD Xia-wei Fu MD Bo-le Zhou MD Zhi-you Zhou MD Zi-min Wang MD PhD 《Orthopaedic Surgery》2023,15(8):2167-2173
Objective
Arthroscopic release is effective for patients with shoulder stiffness, but the traditional inside-out procedure cannot effectively alleviate the mobility of some severe stiff shoulder and even cause itrogenic injuries sometimes. The aim of this study is to evaluate the clinical efficacy and advantages of a modified outside-in shoulder release approach for severe shoulder stiffness.Methods
Included in this retrospective study were 15 patients (five male and 10 female) with severe shoulder stiffness who underwent modified outside-in shoulder release surgery at our hospital between June 2019 and March 2021. Of them, 10 patients had a primary frozen shoulder and five had secondary shoulder stiffness, involving the right shoulder in six cases and the left shoulder in nine cases. The mean age of the 15 patients was 56.7 (34–69) years. The patients were instructed to exercise passively from second-day post-operation and enhance the rehabilitation exercise gradually. All patients received a range of motion (ROM) examination before and after surgery. The American Shoulder and Elbow Surgeon's Score (ASES), Constant Score (CS), and Visual Analog Scale (VAS) score for pain were recorded. All data were tested by normal distribution first and then by paired T test, otherwise by Wilcoxon rank sum test.Results
The mean follow-up period was 18.2 (12–33) months. Compared with the preoperative value, the mean ASES score at the final follow-up improved from 38.4 ± 7.37 to 88.13 ± 6.33 points; the mean CS score from 43.27 ± 6.71 to 78.74 ± 6.93 points; the mean VAS score from 5.07 ± 1.03 to 0.81 ± 0.83 points; forward flexion from 81.93° ± 11.45° to 156.73° ± 9.12°; abduction from 65.93° ± 16.82° to 144.80° ± 8.83°; neutral external rotation from 13.53° ± 10.38° to 51.20° ± 4.77°; internal rotation from the buttock to waist (L3), all showing a significant difference (P < 0.0001). No serious complication was observed in any patient during the postoperative follow-up periods.Conclusion
The present study has demonstrated that the modified arthroscopic outside-in shoulder release approach can improve ROM of patients and alleviate pain effectively, proving it to be an appropriate surgical option for the treatment of severe shoulder stiffness. 相似文献17.
Ping Wu Chenke Luo Xiaoyang Pang Zhengquan Xu Hao Zeng Xiyang Wang 《Archives of orthopaedic and trauma surgery》2013,133(10):1341-1350
Purpose
To investigate the clinical efficacy and feasibility of one-stage surgical treatment for thoracic spinal tuberculosis with adjacent segments lesion by internal fixation, transpedicular debridement, and combined interbody and posterior fusion via a posterior-only approach.Materials and methods
Twenty-one patients (thirteen males, eight females) with thoracic tuberculosis whose lesions were confined to two adjacent segments were studied retrospectively. All patients were treated with one-stage surgical treatment by internal fixation, transpedicular debridement, and combined interbody and posterior fusion via a posterior-only approach. The American Spinal Injury Association (ASIA) impairment scale was used to assess neurological function. Thoracic Cobb angle was used to assess thoracic kyphosis. Operating time, blood loss, complications, neurological function, deformity correction and interbody fusion were investigated.Results
Average mean operating time was 231.4 ± 31.9 min, and evaluated blood loss during operation was 880.2 ± 112.7 ml. All patients were followed up for 22–41 months postoperatively (average 29.8 ± 5.4 months). All patients had significant postoperative improvement in ASIA classification scores. The thoracic kyphotic angles were significantly decreased to 9°–25° postoperatively (average 16.7° ± 4.4°), and at final follow-up were 10°–27°(average 17.7° ± 4.4°). No severe complications or spinal cord injury occurred. The erythrocyte sedimentation rate recovered to normal within 3 months postoperatively in all patients. All patients got bony fusion within 6–9 months after surgery.Conclusions
One-stage transpedicular debridement, posterior instrumentation and combined interbody and posterior fusion via a posterior-only approach can be an effective and feasible treatment method for thoracic spinal tuberculosis. 相似文献18.
Norifumi Tsutsumi Morimasa Tomikawa Munenori Uemura Tomohiko Akahoshi Yoshihiro Nagao Kozo Konishi Satoshi Ieiri Jaesung Hong Yoshihiko Maehara Makoto Hashizume 《Surgical endoscopy》2013,27(6):2178-2184
Background
The recent development of open magnetic resonance imaging (MRI) has provided an opportunity for the next stage of image-guided surgical and interventional procedures. The purpose of this study was to evaluate the feasibility of laparoscopic surgery under the pneumoperitoneum with the system of an open MRI operating theater.Methods
Five patients underwent laparoscopic surgery with a real-time augmented reality navigation system that we previously developed in a horizontal-type 0.4-T open MRI operating theater.Results
All procedures were performed in an open MRI operating theater. During the operations, the laparoscopic monitor clearly showed the augmented reality models of the intraperitoneal structures, such as the common bile ducts and the urinary bladder, as well as the proper positions of the prosthesis. The navigation frame rate was 8 frames per min. The mean fiducial registration error was 6.88 ± 6.18 mm in navigated cases. We were able to use magnetic resonance–incompatible surgical instruments out of the 5-Gs restriction area, as well as conventional laparoscopic surgery, and we developed a real-time augmented reality navigation system using open MRI.Conclusions
Laparoscopic surgery with our real-time augmented reality navigation system in the open MRI operating theater is a feasible option. 相似文献19.
Chunguang Zhou Limin Liu Yueming Song Hao Liu Tao Li Quan Gong Jiancheng Zeng Qingquan Kong 《European spine journal》2014,23(3):536-542
Purpose
To assess the correction effect of hemivertebra resection for unbalanced multiple hemivertebrae by measuring corresponding parameters in both coronal and sagittal planes on series posteroanterior and lateral radiographs and report the related complications.Methods
Twelve children with unbalanced multiple hemivertebrae were operated on by hemivertebra resection through a combined anterior and posterior approach or a posterior-only procedure. Mean age at time of surgery was 9.8 years (range 2–14 years). They were retrospectively studied with a mean follow-up of 48.7 months (range 30–60 months).Results
The mean Cobb angle of the main curve was 65.3° (range 45°–92°) before surgery and 13.8° (range 4°–30°) at the last follow-up. The correction rate was 80.0 % (range 65.5–92.4 %). The compensatory cranial curve was corrected from 25.8° (range 5°–53°) to 11.7° (range 0°–34°) with a correction rate of 65.9 % (range 33.3–100 %), and the compensatory caudal curve was corrected from 32.4° (range 17°–57°) to 7.1° (range 0°–20°) with a correction rate of 81.4 % (range 53.1–100 %). The angle of segmental kyphosis was 41.3° (range 12°–76°) before surgery and 17.0° (range ?12° to 45°) at the final follow-up. The coronal imbalance was ?1.0 cm (range ?3.5 to 3 cm) before surgery and 0.0 cm (range ?1.0 to 1.5 cm) at the most recent follow-up. The sagittal imbalance was 0.9 cm (range ?3.2 to 3 cm) before surgery and 0.6 cm (range ?3.0 to 3.5 cm) at the most recent follow-up. Complications including pedicle fractures, and pseudarthrosis were found in two patients (20 %).Conclusions
In the patients with unbalanced multiple hemivertebrae, hemivertebra resection allows for excellent correction in both the coronal and sagittal planes, and great care should be taken to reduce the rate of complications. 相似文献20.
Haku Iizuka Yoichi Iizuka Ryoichi Kobayashi Yasuhiko Takechi Masahiro Nishinome Tsuyoshi Ara Yasunori Sorimachi Takashi Nakajima Kenji Takagishi 《European spine journal》2013,22(5):1137-1141