Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 7 de 7
Filtrar
1.
Anaesthesia ; 73(9): 1110-1117, 2018 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-29858510

RESUMEN

Animal data have demonstrated increased block duration after local anaesthetic injections in diabetic rat models. Whether the same is true in humans is currently undefined. We, therefore, undertook this prospective cohort study to test the hypothesis that type-2 diabetic patients suffering from diabetic peripheral neuropathy would have increased block duration after ultrasound-guided popliteal sciatic nerve block when compared with patients without neuropathy. Thirty-three type-2 diabetic patients with neuropathy and 23 non-diabetic control patients, scheduled for fore-foot surgery, were included prospectively. All patients received an ultrasound-guided popliteal sciatic nerve block with a 30 ml 1:1 mixture of lidocaine 1% and bupivacaine 0.5%. The primary outcome was time to first opioid request after block procedure. Secondary outcomes included the time to onset of sensory blockade, and pain score at rest on postoperative day 1 (numeric rating scale 0-10). These outcomes were analysed using an accelerated failure time regression model. Patients in the diabetic peripheral neuropathy group had significantly prolonged median (IQR [range]) time to first opioid request (diabetic peripheral neuropathy group 1440 (IQR 1140-1440 [180-1440]) min vs. control group 710 (IQR 420-1200 [150-1440] min, p = 0.0004). Diabetic peripheral neuropathy patients had a time ratio of 1.57 (95%CI 1.10-2.23, p < 0.01), experienced a 59% shorter time to onset of sensory blockade (median time ratio 0.41 (95%CI 0.28-0.59), p < 0.0001) and had lower median (IQR [range]) pain scores at rest on postoperative day 1 (diabetic peripheral neuropathy group 0 (IQR 0-1 [0-5]) vs. control group 3 (IQR 0-5 [0-9]), p = 0.001). In conclusion, after an ultrasound-guided popliteal sciatic nerve block, patients with diabetic peripheral neuropathy demonstrated reduced time to onset of sensory blockade, with increased time to first opioid request when compared with patients without neuropathy.


Asunto(s)
Diabetes Mellitus Tipo 2/fisiopatología , Pie Diabético/fisiopatología , Pie Diabético/cirugía , Bloqueo Nervioso/métodos , Adulto , Anciano , Anciano de 80 o más Años , Analgésicos Opioides/administración & dosificación , Anestésicos Locales/administración & dosificación , Anestésicos Locales/farmacología , Estudios de Casos y Controles , Diabetes Mellitus Tipo 2/complicaciones , Pie Diabético/etiología , Esquema de Medicación , Femenino , Pie/cirugía , Humanos , Masculino , Persona de Mediana Edad , Dimensión del Dolor/métodos , Dolor Postoperatorio/prevención & control , Estudios Prospectivos , Nervio Ciático/diagnóstico por imagen , Nervio Ciático/efectos de los fármacos , Nervio Ciático/fisiopatología , Sensación/efectos de los fármacos , Factores de Tiempo , Ultrasonografía Intervencional , Adulto Joven
3.
Shoulder Elbow ; 11(1): 9-16, 2019 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-30719093

RESUMEN

INTRODUCTION: The hypothesis of this study was that patient selection for midshaft clavicle fracture (open reduction internal fixation with plate versus conservative) would give better functional outcome than random treatment allocation. METHODS: We performed a systematic literature search for primary studies providing functional score and non-union rate after conservative or surgical management of midshaft clavicle fractures. Six randomized controlled trial and 19 non-randomized controlled trial studies encompassing a total of 1348 patients were included. RESULTS: Patients treated with surgical management were found to have statistically superior Constant scores in non-randomized controlled trials than in randomized controlled trials (94.76 ± 6.4 versus 92.49 ± 6.2; p < 0.0001). For conservative treatment, randomized controlled trials were found to have significantly better functional outcome. The prevalence of non-union (6.1%) did not show significant statistical difference between non-randomized controlled trial and randomized controlled trial studies. The functional outcome after surgical management was significantly higher than after conservative management in both randomized controlled trial and non-randomized controlled trial groups. The non-union rate after surgery (1.1% for both non-randomized controlled trial and randomized controlled trial) was significantly lower than following conservative treatment (9.9% non-randomized controlled trial versus 15.1% randomized controlled trial). DISCUSSION: This review shows that patient selection for surgery may influence functional outcome after midshaft clavicle fracture. Our results also confirm that plate fixation provides better functional outcome and lower non-union rate.

4.
J Plast Reconstr Aesthet Surg ; 72(3): 467-476, 2019 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-30579912

RESUMEN

INTRODUCTION: Composite anterolateral thigh (ALT) flap with vascularized fascia lata can reconstitute patellar tendon integrity and knee soft tissue coverage in one stage. However, long-term evidence of outcomes is lacking. This work analyzes long-term functional results, compares subtotal and total reconstruction of patellar tendon, and assesses the respective function of the extensor apparatus. PATIENTS AND METHODS: Outcomes of reconstruction using 10 ALT flaps in 9 patients (age range 21-87 years) were analyzed (mean follow-up 30 ±â€¯6 months). Knee Society Scores, isometric knee extensor strength (M1-M5), and sensory recovery were evaluated, together with active range of motion and extensor lag of the reconstructed limb, compared to contralateral. RESULTS: Ten flaps were used for tendon replacement in 9 patients. Eight (80%) free flaps and 2 (20%) propeller distally based flaps were used. Complications requiring the harvest of a second flap were seen in 2 patients. All patients could return to their daily activities without the use of walking supports. Mean active ROM was 94.4° with an extensor lag of 9.4°, without a significant difference between partial and total patellar tendon reconstruction. The mean knee and functional scores of the Knee Society were 81/100 and 77/100, respectively. CONCLUSION: Composite ALT flap with fascia lata can satisfy the twofold needs of functional restoration and soft tissue coverage, thus ensuring stable results in total and subtotal knee extensor mechanism reconstruction. Distally based flaps should be carefully considered, as they lead to higher complication rates.


Asunto(s)
Fascia Lata/trasplante , Colgajos Tisulares Libres/trasplante , Rótula/cirugía , Procedimientos de Cirugía Plástica/métodos , Tendones/cirugía , Muslo/cirugía , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Procedimientos de Cirugía Plástica/efectos adversos , Adulto Joven
5.
Orthop Traumatol Surg Res ; 101(3): 277-82, 2015 May.
Artículo en Inglés | MEDLINE | ID: mdl-25817903

RESUMEN

INTRODUCTION: Periprosthetic femur fracture (PFF) is a serious complication after total hip arthroplasty that can be treated using different internal fixation devices. However, the outcomes with curved non-locking plates with eccentric holes in this indication have not been reported previously. The objectives of this study were to determine: (1) the union rate; (2) the complication rate; (3) autonomy in a group of patients with a Vancouver type B PFF who were treated with this plate. HYPOTHESIS: Use of this plate results in a high union rate with minimal mechanical complications. MATERIALS AND METHODS: Forty-three patients with a mean age of 79 years ± 13 (41-98) who had undergone fixation of Vancouver type B PFF with this plate between 2002 and 2007 were included in the study. The time to union and Parker Mobility Score were evaluated. The revision-free survival (all causes) was calculated using Kaplan-Meier analysis. The average follow-up was 42 months ± 20 (16-90). RESULTS: Union was obtained in all patients in a mean of 2.4 months ± 0.6 (2-4). One patient had varus malunion of the femur. The Parker Mobility Score decreased from 5.93 ± 1.94 (2-9) to 4.93 ± 1.8 (1-9) (P = 0.01). Two patients required a surgical revision: one for an infection after 4.5 years and one for stem loosening. The survival of the femoral stem 5 years after fracture fixation was 83.3% ± 12.6%. CONCLUSION: Use of a curved plate with eccentric holes for treating type B PFF led to a high union rate and a low number of fixation-related complications. However, PFF remains a serious complication of hip arthroplasty that is accompanied by high morbidity and mortality rates.


Asunto(s)
Placas Óseas , Fracturas del Fémur/cirugía , Fijación Interna de Fracturas/instrumentación , Curación de Fractura , Fracturas Periprotésicas/cirugía , Adulto , Anciano , Anciano de 80 o más Años , Artroplastia de Reemplazo de Cadera/efectos adversos , Placas Óseas/efectos adversos , Supervivencia sin Enfermedad , Femenino , Estudios de Seguimiento , Fijación Interna de Fracturas/efectos adversos , Fijación Interna de Fracturas/métodos , Humanos , Estimación de Kaplan-Meier , Masculino , Persona de Mediana Edad , Reoperación , Estudios Retrospectivos
7.
Rev Med Suisse Romande ; 121(10): 725-8, 2001 Oct.
Artículo en Francés | MEDLINE | ID: mdl-11715289

RESUMEN

Hallux valgus arises from static and dynamic unbalance of the forefoot. Possibilities of conservative treatment are limited. This paper recalls the essentials of physiopathology and exposes briefly to the non-operators the most current amongst 150 operative techniques described. While becoming more complex, the surgery of hallux valgus has proven to gain efficiency. Surgical indication, based on biomechanics, should be very careful, which gives a greater interest to this discipline.


Asunto(s)
Hallux Valgus , Fenómenos Biomecánicos , Hallux Valgus/etiología , Hallux Valgus/fisiopatología , Hallux Valgus/terapia , Humanos
SELECCIÓN DE REFERENCIAS
DETALLE DE LA BÚSQUEDA