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CASE: We present a unique case of a 45-year-old man with his right middle finger embedded with rings. Limited finger flexion was noted because of flexor tendon injury caused by the dorsal migration of the embedded ring through joint. The rings were removed under anesthesia, resulting in the resolution of swelling and recover of osseous structure. Follow-up examinations revealed no residual edema or numbness, indicating preserved neurovascularization, despite the dorsal migration of the ring. CONCLUSION: Our unique case reveals continuous finger ring migration without compromising neurovascular bundles, with review of 30 cases emphasizing the importance of psychiatric consultation. Timely intervention yielded nearly half of patients achieving full recovery.
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Articulações dos Dedos , Humanos , Masculino , Pessoa de Meia-Idade , Traumatismos dos Dedos/cirurgia , Migração de Corpo Estranho/diagnóstico por imagemRESUMO
BACKGROUND: The inclusion of a connecting path in a porous implant can promote nutrient diffusion to cells and enhance bone ingrowth. Consequently, this study aimed to evaluate the biomechanical, radiographic, and histopathological performance of a novel 3D-printed porous suture anchor in a rabbit femur model. METHODS: Three test groups were formed based on the type of suture anchor (SA): Commercial SA (CSA, Group A, n = 20), custom solid SA (CSSA, Group B, n = 20), and custom porous SA (CPSA, Group C, n = 20). The SAs were implanted in the lateral femoral condyle of the right leg in each rabbit. The rabbits (New Zealand white rabbits, male, mean body weight of 2.8 ± 0.5 kg, age 8 months) underwent identical treatment and were randomized into experimental and control groups via computer-generated randomization. Five rabbits (10 femoral condyles) were euthanized at 0, 4, 8, and 12 weeks post-implantation for micro-CT, histological analysis, and biomechanical testing. RESULTS: At 12 weeks, the CPSA showed a higher BV/TV (median 0.7301, IQR 0.7276-0.7315) than the CSSA and CSA. The histological analysis showed mineralized osteocytes near the SA. At 4 weeks, new bone was observed around the CPSA and had penetrated its porous structure. By 12 weeks, there was no significant difference in ultimate failure load between the CSA and CPSA. CONCLUSIONS: We demonstrated that the innovative 3D-printed porous suture anchor exhibited comparable pullout strength to conventional threaded suture anchors at the 12-week postoperative time-point period. Furthermore, our porous anchor design enhanced new bone formation and facilitated bone growth into the implant structure, resulting in improved biomechanical stability.
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Fêmur , Impressão Tridimensional , Âncoras de Sutura , Titânio , Animais , Coelhos , Fêmur/cirurgia , Fêmur/diagnóstico por imagem , Fêmur/patologia , Porosidade , Masculino , Fenômenos Biomecânicos , Microtomografia por Raio-XRESUMO
BACKGROUND: Colorectal cancer is one of the most frequently diagnosed forms of cancer, and it is associated with several common symptoms and signs such as rectal bleeding, altered bowel habits, abdominal pain, anemia, and unintentional weight loss. Sciatica, a debilitating condition in which the patient experiences paresthesia and pain in the dermatome of associated lumbosacral nerve roots or sciatic nerve distribution, is not considered one of these. Here we present a case of colorectal cancer manifesting symptoms of sciatica alone. CASE PRESENTATION: A 68-year-old male presented with progressive lower back pain radiating to his left thigh and calf over L5/S1 dermatome. Sciatica was suspected and initially underwent conservative treatment with analgesics. However, the symptoms progressed and MRI revealed an epidural abscess surprisingly. Surgical debridement was performed and pus culture isolated Streptococcus gallolyticus. Based on the strong association of S. gallolyticus with colorectal cancer, the presence of this pathogen prompted further tumor evaluation, even in the absence of the typical symptoms and signs. This investigation ultimately leads to the diagnosis of sigmoid adenocarcinoma. CONCLUSIONS: Although rare, sciatica caused by S. gallolyticus infection of the spinal epidural space may serve as the initial presentation of colorectal cancer. Physicians should be aware of the strong association between S. gallolyticus and colorectal cancer. Based on what we currently know about the condition; a thorough systematic assessment of occult neoplasia for patients with S. gallolyticus infection is recommended.
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Neoplasias do Colo , Abscesso Epidural , Ciática , Masculino , Humanos , Idoso , Ciática/diagnóstico , Ciática/etiologia , Abscesso Epidural/diagnóstico , Abscesso Epidural/cirurgia , Neoplasias do Colo/complicações , Neoplasias do Colo/diagnóstico , Dor Abdominal , ConscientizaçãoRESUMO
BACKGROUND: Surgeons are routinely required to remove loose or failed pedicle screws and insert a new screw in their place. However, inserting a new screw into an existing hole may compromise the holding capacity of the pedicle screw. The purpose of this study is to evaluate the pullout strength of pedicle screws with different thread designs after the primary insertion and revision surgery in a synthetic bone model. METHODS: Four pedicle screws with different thread designs (single-lead-thread (SLT) screw, dual-lead-thread (DLT) screw, mixed-single-lead-thread (MSLT) screw, and proximal-unthreaded-dual-thread (PUDL) screw) were inserted into pre-drilled, untapped holes (ø 4.2 mm, length 35 mm) in Sawbone blocks of density 20 pcf. In the first sequence, a 6.0 mm screw was inserted into the predrilled foam block and the primary pullout strength of the screw was measured according to ASTM F543. In the second sequence, a 6.0 mm screw was inserted and removed, and then either a 6.5 mm screw of the same design or a different screw design was inserted into the same hole and the pullout strength recorded. RESULTS: In the first sequence, the mean pullout strength of the MSLT screw was significantly (p < 0.05) greater than all other screw designs. In the second sequence, when the MSLT screw was the primary screw, using a larger MSLT screw (6.5 mm) as the revision screw did not lead to a higher pullout strength than if a 6.0 mm diameter PUDL screw was used for the revision. Using a larger DLT screw (6.5 mm) as the revision screw resulted in a significantly (p < 0.05) greater pullout strength than a 6.0 mm STL, DLT, MSLT, or PUDL screw. CONCLUSIONS: Our results indicate that employing classic oversizing of the same screw design is a safe choice for maintaining screw purchase in the bone after revision. In cases where oversizing with the same screw design is not practical, opting for a PUDL screw with the same original diameter can provide enough purchase in the bone to maintain stability.
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Parafusos Pediculares , Humanos , Teste de Materiais , Poliuretanos , Osso e Ossos , Fenômenos BiomecânicosRESUMO
Pullout strength is an important indicator of the performance and longevity of pedicle screws and can be heavily influenced by the screw design, the insertion technique and the quality of surrounding bone. The purpose of this study was to investigate the pullout strength of three different pedicle screws inserted using three different strategies and with two different loading conditions. Three pedicle screws with different thread designs (single-lead-thread (SLT) screw, dual-lead-thread (DLT) screw and mixed-single-lead-thread (MSLT) screw) were inserted into a pre-drilled rigid polyurethane foam block using three strategies: (A) screw inserted to a depth of 33.5 mm; (B) screw inserted to a depth of 33.5 mm and then reversed by 3.5 mm to simulate an adjustment of the tulip height of the pedicle screw and (C) screw inserted to a depth of 30 mm. After insertion, each screw type was set up with and without a cyclic load being applied to the screw head prior to the pullout test. To ensure that the normality assumption is met, we applied the Shapiro-Wilk test to all datasets before conducting the non-parametric statistical test (Kruskal-Wallis test combined with pairwise Mann-Whitney-U tests). All screw types inserted using strategy A had a significantly greater pullout strength than those inserted using strategies B and C, regardless of if the screw was pre-loaded with a cyclic load prior to testing. Without the use of the cyclic pre-load, the MSLT screw had a greater pullout strength than the SLT and DLT screws for all three insertion strategies. However, the fixation strength of all screws was reduced when pre-loaded before testing, with the MSLT screw inserted using strategy B producing a significantly lower pullout strength than all other groups (p < 0.05). In contrast, the MSLT screw using insertion strategies A and C had a greater pullout strength than the SLT and DLT screws both with and without pre-loading. In conclusion, the MSLT pedicle screw exhibited the greatest pullout strength of the screws tested under all insertion strategies and loading conditions, except for insertion strategy B with a cyclic pre-load. While all screw types showed a reduced pullout strength when using insertion strategy B (screw-out depth adjustment), the MSLT screw had the largest reduction in pullout strength when using a pre-load before testing. Based on these findings, during the initial screw insertion, it is recommended to not fully insert the screw thread into the bone and to leave a retention length for depth adjustment to avoid the need for screw-out adjustment, as with insertion strategy B.
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The main causes for failure in implant surgery are prolonged exposure of implants or wound and tissue ischemia. Bacterial infection caused by the surrounding medical environment and equipment is also a major risk factor. The medical risk would be greatly reduced if we could develop an implant coating to guide tissue growth and promote antibacterial activity. Mesoporous bioactive glasses are mainly silicates with good osteoinductivity and have been used in medical dentistry and orthopedics for several decades. Strontium ions and silver ions could plausibly be incorporated into bioactive glass to achieve the required function. Strontium ions are trace elements in human bone that have been proposed to promote osseointegration and angiogenesis. Silver ions can cause bacterial apoptosis through surface charge imbalance after bonding to the cell membrane. In this study, functional polyelectrolyte multilayer (PEM) coatings were adhered to 316L stainless steel (SS) by spin coating. The multilayer film was composed of biocompatible and biodegradable collagen as a positively charged layer, γ-polyglutamic acid (γ-PGA) as a negatively charged layer. Chitosan was incorporated to the 11th positively charged layer as a stabilizing barrier. Spray pyrolysis prepared mesoporous bioactive glass incorporated with silver and strontium (AgSrMBG) was added to each negatively charged layer. The PEM/AgSrMBG coating was well hydrophilic with a contact angle of 37.09°, hardness of 0.29 ± 0.09 GPa, Young's modulus of 5.35 ± 1.55 GPa, and roughness of 374.78 ± 22.27 nm, as observed through nano-indention and white light interferometry. The coating's antibacterial activity was sustained for 1 month through the inhibition zone test, and was biocompatible with rat bone marrow mesenchymal stem cells (rBMSCs) and human umbilical vein endothelial cells (HUVECs), as observed in the MTT assay. There was more hydroxyapatite precipitation on the PEM/AgSrMBG surface after being soaked in simulated body fluid (SBF), as observed by scanning electron microscopy (SEM) and X-ray diffraction (XRD). In both in vitro and in vivo tests, the PEM/AgSrMBG coating promoted angiogenesis, osseointegration, and antibacterial activity due to the sustained release of silver and strontium ions.
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Background: Chronic kidney disease (CKD) is associated with bone and mineral metabolism. In this study we evaluated the comparative efficacies and safety of osteoporosis medications in patients with CKD or a history of kidney transplantation, and make recommendations for the best choice of osteoporosis treatment among patients with CKD or a history of kidney transplantation. Methods: We systemically searched for randomized controlled trials published in PubMed, Embase, and Cochrane databases up to June 2020. Network-meta analysis was used to compare the relative effectiveness of different treatments. A random-effects model was used when heterogeneity was expected. The safety of different treatments was also evaluated in terms of reported major adverse events. Results: A total of 17 studies with data from 10,214 patients who had stage 2-5 CKD, were receiving dialysis, or had a history of kidney transplantation were included in the network meta-analysis. Treatment with teriparatide, denosumab, alendronate, and raloxifene were all associated with a significantly reduced risk of fractures compared to treatment with placebos [teriparatide: odds ratio (OR) = 0.19, 95% confidence interval (CI): 0.10-0.35; denosumab: OR = 0.40, 95% CI: 0.27-0.58; alendronate: OR = 0.61, 95% CI: 0.40-0.92; raloxifene: OR = 0.52, 95% CI: 0.41-0.67]. The rank probability and the surface under the cumulative ranking (SUCRA) values suggested that teriparatide ranked the highest for improvement in vertebral bone mineral density (BMD) (SUCRA = 97.8%), whereas denosumab ranked the highest for improvement in femoral neck BMD (SUCRA = 88.3%). Conclusion: Teriparatide and denosumab seem to be the most effective treatments for preventing bone loss and reducing the risk of fracture in our network comparison. However, because of the limitations and potential biases in the reviewed studies, there is still some uncertainty about the best treatment options for osteoporosis in patients with CKD or a history of kidney transplantation. Systematic Review Registration: [PROSPERO], identifier [CRD42020209830].
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BACKGROUND: Among musculoskeletal disorders, lumbar degenerative disease (LDD) is the leading cause of total disability-adjusted life years globally. Clinical guidelines for LDD describe multiple treatment options in which shared decision making becomes appropriate. OBJECTIVES: To explore the relationships among measures of decision antecedents, process, and outcomes in patients with LDD. METHODS: Patients with LDD were recruited from outpatient clinics in a teaching hospital in Taiwan and administered surveys to collect measures of decision antecedents, processes, and outcomes. Multiple linear regression was conducted to assess the association between decision antecedents and the decision making process. Hierarchical linear regression was conducted to assess the relationships among decision antecedents, the decision making process, and decision outcomes. RESULTS: A total of 132 patients (mean age, 61 years) completed the survey. After adjustment for personal factors, 2 decision antecedents (namely, decision making self-efficacy and readiness) significantly predicted patients' experiences of engaging in shared decision making (SDM). Decision making readiness and process were associated with fewer decisional conflicts and greater decision satisfaction. LIMITATIONS: Models derived from cross-sectional surveys cannot establish causal relationships among decision antecedents, decision making processes, and decision outcomes. CONCLUSIONS: Our results support the SDM framework, which proposes relationships among decision antecedents, the decision making process, and decision outcomes.
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Tomada de Decisão Compartilhada , Participação do Paciente , Estudos Transversais , Tomada de Decisões , Humanos , Pessoa de Meia-Idade , Inquéritos e QuestionáriosRESUMO
OBJECTIVE: To evaluate the efficacy of shared decision-making (SDM) intervention among patients with lumbar degenerative diseases (LDDs) in terms of decision self-efficacy, control preferences, SDM process, decision satisfaction, and conflict. METHODS: A total of 130 outpatients with LDDs recruited from orthopedic or rehabilitation clinics were randomly assigned to the SDM intervention (n = 67) or comparison (n = 63) groups. Patients in the intervention group received decision aids (DAs) with decision coaching and those in controlled group received standard educational materials from a health educator. The primary outcome was decision self-efficacy, and secondary outcomes were control preference, SDM process, conflict, and satisfaction. RESULTS: The SDM intervention significantly improved decision self-efficacy (mean difference [MD] = 7.1, 95% confidence interval [CI]: 1.7-12.5, partial η2 = 0.05) and reduced conflict (MD = -7.0, 95% CI: -12.2 to -1.9, partial η2 = 0.06), especially in patients without family involvement, compared with the health education group. However, no significant between-group differences were observed in other outcomes. CONCLUSION: SDM intervention improved SDM self-efficacy and reduced conflict in patients with LDDs. PRACTICE IMPLICATIONS: Clinicians can integrate DAs and decision coaching in SDM conversations. SDM intervention seems to engage patients in decision-making, especially those without family involvement.
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Tomada de Decisão Compartilhada , Tutoria , Instituições de Assistência Ambulatorial , Comunicação , Tomada de Decisões , Humanos , Participação do PacienteRESUMO
An influenza vaccination might reduce the risk of incident peripheral arterial occlusive disease (PAOD) in patients with chronic kidney disease (CKD), but supporting evidence is limited. This case-crossover study analyzed data from Taiwan's real-world National Health Insurance Research Database. This study included elderly (≥ 67 years old) patients with CKD having incident PAOD from January 1, 2006, to June 30, 2015. We defined 1 year before PAOD onset as the index date for the self-control group. A conditional logistic regression model was used to investigate exposure to an influenza vaccination for estimating the risk for incident PAOD following vaccination. In total, this study included 46,782 elderly patients with CKD having incident PAOD. The odds ratios for incident PAOD were 0.85 (95% confidence interval 0.77-0.94), 0.85 (0.79-0.92), 0.84 (0.79-0.90), and 0.85 (0.81-0.90) at 1, 2, 3, and 4 months after an influenza vaccination, respectively. We observed consistent results for the subgroups of patients with CKD and concomitant diabetes. However, we did not observe any beneficial effects of influenza vaccination in patients with advanced CKD or end-stage renal disease. This study demonstrated that influenza vaccination may be associated with a reduced risk of incident PAOD among patients with early-stage CKD.
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Arteriopatias Oclusivas , Vacinas contra Influenza , Influenza Humana/prevenção & controle , Doença Arterial Periférica , Insuficiência Renal Crônica/epidemiologia , Vacinação , Idoso , Idoso de 80 Anos ou mais , Arteriopatias Oclusivas/induzido quimicamente , Arteriopatias Oclusivas/epidemiologia , Bases de Dados Factuais , Feminino , Humanos , Incidência , Vacinas contra Influenza/administração & dosagem , Vacinas contra Influenza/efeitos adversos , Masculino , Doença Arterial Periférica/induzido quimicamente , Doença Arterial Periférica/epidemiologia , Fatores de RiscoRESUMO
Hydrogen energy is a promising alternative for fossil fuels because of its high energy density and carbon-free emission. Si is an ideal light absorber used in solar water splitting to produce H2 gas because of its small band gap, appropriate conduction band position, and high theoretical photocurrent. However, the overpotential required to drive the photoelectrochemical (PEC) hydrogen evolution reaction (HER) on bare Si electrodes is severely high owing to its sluggish kinetics. Herein, a molybdenum tungsten disulfide (MoS2-WS2) composite decorated on a Si photoabsorber is used as a cocatalyst to accelerate HER kinetics and enhance PEC performance. This MoS2-WS2 hybrid showed superior catalytic activity compared with pristine MoS2 or WS2. The optimal MoS2-WS2/Si electrode delivered a photocurrent of -25.9 mA/cm2 at 0 V (vs reversible hydrogen electrode). X-ray absorption spectroscopy demonstrated that MoS2-WS2 possessed a high hole concentration of unoccupied electronic states in the MoS2 component, which could promote to accept large amounts of carriers from the Si photoabsorber. Moreover, a large number of sulfur vacancies are generated in the MoS2 constituent of this hybrid cocatalyst. These sulfur defects served as HER active sites to boost the catalytic efficiency. Besides, the TiO2-protective MoS2-WS2/Si photocathode maintained a current density of -15.0 mA/cm2 after 16 h of the photocatalytic stability measurement.
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Si is regarded as a promising photocathode material for solar hydrogen evolution reaction (HER) because of its small band gap and highly negative conduction band edge. However, bare Si electrodes have high overpotential because of sluggish HER kinetics on the surface. In this study, molybdenum tungsten sulfide (MoS2-WS2) was decorated on Si photocathodes as the co-catalyst to accelerate HER kinetics. The catalytic performance of MoS2-WS2 was further enhanced by introducing phosphate materials. Phosphate-modified molybdenum tungsten sulfide (PO-MoWS) was deposited on Si photoabsorbers to provide an optimal current of -15.0 mA cm-2 at 0 V. Joint characterizations of X-ray photoelectron and X-ray absorption spectroscopies demonstrated that the phosphate material dominantly coordinated with the WS2 component in PO-MoWS. Moreover, this phosphate material induced a large number of sulfur vacancies in the PO-MoWS/Si electrodes that contributed to the ideal catalytic activity. Herein, TiO2 thin films were prepared as the protective layer to improve the stability of photocathodes. The PO-MoWS/2 nm TiO2/Si electrode maintained 83.8% of the initial photocurrent after chronoamperometric measurement was performed for 8000 s.
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BACKGROUND: The TomoFix plate has been extensively used in high tibial osteotomy surgery to stabilize the distracted tibial bones. However, distal pain related to plate irritation was considered one of the most relevant complications for this fixation device. This study aimed to correlate reports of distal pain with the profiles of the distracted tibia and initial plate and plate contour. METHODS: This study used the finite-element method to investigate the profile-, distraction-, and contour-induced effects on stress distribution of the distal tibia-plate contact. The associations of two tibia profiles (normal and concave), distraction angles, and two plate profiles (contoured and non-contoured) were discussed in this study. The areas and stresses of the distal tibia-plate contact were chosen as comparison indices. FINDINGS: Before weight-bearing, the non-contoured plates of the normal and concave tibia profiles consistently showed less contact area at the distal tibia-plate region. Consequently, the physiological loads make the non-contoured plate subject to more concentrated bone stresses and thus may induce more pain at the distal tibia-plate region than a contoured plate. When the distraction angle decreases, the tibia-plate gap increases. Prior to fixation, the tibia-plate gap can be evaluated by the profiles of the distracted tibia and non-contoured plate by use of anteroposterior radiograph and computer-aided simulation. INTERPRETATION: In the situations of a lower distraction angle or a large tibia-plate gap, the use of a plate bender or a lag screw is recommended in order to contour the plate for reducing the concentrated stress at the distal tibia-plate region.
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Placas Ósseas , Análise de Elementos Finitos , Osteotomia , Estresse Mecânico , Tíbia/cirurgia , Parafusos Ósseos , Simulação por Computador , Feminino , Humanos , Tíbia/fisiologia , Suporte de CargaRESUMO
BACKGROUND: Lumbar spinal fusion with rigid spinal fixators as one of the high risk factors related to adjacent-segment failure. The purpose of this study is to investigate how the material properties of spinal fixation rods influence the biomechanical behavior at the instrumented and adjacent levels through the use of the finite element method. METHODS: Five finite element models were constructed in our study to simulate the human spine pre- and post-surgery. For the four post-surgical models, the spines were implanted with rods made of three different materials: (i) titanium rod, (ii) PEEK rod with interbody PEEK cage, (iii) Biodegradable rod with interbody PEEK cage, and (iv) PEEK cage without pedicle screw fixation (no rods). RESULTS: Fusion of the lumbar spine using PEEK or biodegradable rods allowed a similar ROM at both the fusion and adjacent levels under all conditions. The models with PEEK and biodegradable rods also showed a similar increase in contact forces at adjacent facet joints, but both were less than the model with a titanium rod. CONCLUSIONS: Flexible rods or cages with non-instrumented fusion can mitigate the increased contact forces on adjacent facet joints typically found following spinal fixation, and could also reduce the level of stress shielding at the bone graft.
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Transplante Ósseo/métodos , Análise de Elementos Finitos , Fixação Interna de Fraturas/métodos , Fixadores Internos , Modelos Anatômicos , Parafusos Pediculares , Fusão Vertebral/métodos , Implantes Absorvíveis , Fenômenos Biomecânicos , Humanos , Vértebras Lombares/cirurgia , Região Lombossacral/cirurgia , Amplitude de Movimento Articular , Titânio , Articulação Zigapofisária/cirurgiaRESUMO
Pedicle screws are commonly used for posterior stabilization of the spine. When used in deformed or degenerated segments, the pedicle screws are often not fully inserted into the bone, but instead the threaded portion is exposed by 1 or 2 threads to accommodate rod placement and ensure alignment between the tulip of the screw and the rod. However, broken pedicle screws have been reported with the use of this method. The aim of this study was to determine how the fatigue life of the screw is affected by not fully inserting the screw into the bone. Spinal constructs were evaluated in accordance with ASTM F1717. The following three screw positions were subjected to compression bending fatigue loading; (i) pedicle screw fully inserted in the test block with no threads exposed (EXP-T0), (ii) pedicle screw inserted with one thread exposed outside the test block (EXP-T1), (iii) pedicle screw inserted with two threads exposed outside the test block (EXP-T2). Corresponding finite element models FEM-T0, FEM-T1 and FEM-T2 were also constructed and subjected to the same axial loading as the experimental groups to analyze the stress distribution in the pedicle screws and rods. The results showed that under a 190 N axial load, the EXP-T0 group survived the full 5 million cycles, the EXP-T1 group failed at 3.7 million cycles on average and the EXP-T2 groups failed at 1.0 million cycles on average, while the fatigue strength of both the EXP-T1 and EXP-T2 groups was 170 N. The constructs failed through fracture of the pedicle screw. In comparison to the FEM-T0 model, the maximum von Mises stress on the pedicle screw in the FEM-T1 and FEM-T2 models increased by 39% and 58%, respectively. In conclusion, this study demonstrated a drastic decrease in the fatigue life of pedicle screws when they are not full inserted into the plastic block.
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Parafusos Pediculares/efeitos adversos , Falha de Prótese/etiologia , Fenômenos Biomecânicos , Força Compressiva , Análise de Falha de Equipamento , Humanos , Coluna Vertebral/cirurgia , Suporte de CargaRESUMO
BACKGROUND: Effective treatment of low back pain (LBP) originating in the lumbar and sacroiliac joints is difficult to achieve. The objective of the current study was to compare the clinical effectiveness of radiofrequency (RF) neurotomy versus conservative nonsurgical approaches for the management of chronic lumbar and sacroiliac joint pain. METHODS: The PICOS framework was adhered to (P [population]: patients with a history of chronic function-limiting lumbar and sacroiliac joint pain lasting at least 6 months; I [intervention]: RF neurotomy; C [comparator]: other nonsurgical treatments; O [outcomes]: the Oswestry Disability Index (ODI), measurement for pain, and a quality of life (QoL) questionnaire; S [study design]: meta-analysis). Two trained investigators systematically searched Medline, Cochrane, EMBASE, and ISI Web of Knowledge databases for relevant studies published in English through March 2019. RESULTS: Patients treated with RF neurotomy (nâ=â528) had significantly greater improvement in ODI scores, pain scores and QoL measured by EQ-5D compared with controls (nâ=â457); however, significant heterogeneity was observed when data were pooled from eligible studies. In subgroup analyses, patients who received RF neurotomy had a significantly greater improvement in ODI scores compared with those with sham treatment. Patients treated with RF achieved significantly greater improvement in pain scores compared with controls who received sham treatment or medical treatment. In a subgroup analysis of pain in the sacroiliac joint and in lumbar facet joints, the RF neurotomy group achieved a significantly greater improvement in ODI score and pain scores compared with the control group. The ODI score and pain score were improved after 2 months of follow up in the analyses stratified by follow-up duration. CONCLUSIONS: Use of RF neurotomy as an intervention for chronic lumbar and sacroiliac joint pain led to improved function; however, larger, more directly comparable studies are needed to confirm this study's findings.
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Artralgia/terapia , Dor Crônica/terapia , Tratamento Conservador , Denervação , Dor Lombar/terapia , Articulação Sacroilíaca , Humanos , Resultado do TratamentoRESUMO
The majority of compressive vertebral fractures in osteoporotic bone occur at the level of the thoracolumbar junction. Immediate decompression is often required in order to reduce the extent of neurological damage. This study evaluated four fixation methods for decompression in patients with thoracolumbar burst fractures, and presented the most suitable method for osteoporotic patients. A finite element model of a T7-L5 spinal segment was created and subjected to an L1 corpectomy to simulate a serious burst fracture. Five models were tested: a) intact spine; 2) two segment fixation (TSF), 3) up-three segment fixation (UTSF), below-three segment fixation (BTSF), and four segment fixation (FSF). The ROM, stiffness and compression ratio of the fractured vertebra were recorded under various loading conditions. The results of this study showed that the ROM of the FSF model was the lowest, and the ROMs of UTSF and BTSF models were similar but still greater than the TSF model. Decreasing the BMD to simulate osteoporotic bone resulted in a ROM for the four instrumented models that was higher than the normal bone model. Of all models, the FSF model had the highest stiffness at T12-L2 in extension and lateral bending. Similarly, the compression ratio of the FSF model at L1 was also higher than the other instrumented models. In conclusion, FSF fixation is suggested for patients with osteoporotic thoracolumbar burst fractures. For patients with normal bone quality, both UTSF and BTSF fixation provide an acceptable stiffness in extension and lateral bending, as well as a favorable compression ratio at L1.
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Vértebras Lombares/cirurgia , Osteoporose/cirurgia , Fraturas por Osteoporose/cirurgia , Fraturas da Coluna Vertebral/cirurgia , Vértebras Torácicas/cirurgia , Fenômenos Biomecânicos/fisiologia , Análise de Elementos Finitos , Fixação Interna de Fraturas/métodos , Fraturas por Compressão/cirurgia , HumanosRESUMO
BACKGROUND: Estrogen deficiency is associated with musculoskeletal disorders. Sintered dicalcium pyrophosphate (SDCP) is a novel antiosteoporotic agent. In this study, we examined its use for restoration of bone quality and attenuation of disc degeneration in ovariectomy rats. METHODS: Sixty female Sprague Dawley rats were randomly divided into 3 groups, namely sham group undergoing sham surgery, ovariectomy (OVX) group receiving an equivalent volume of isotonic sodium chloride solution, and OVX/SDCP group orally administered with 0.25 mg/mL SDCP. Animals were sacrificed at 3 and 6 months post ovariectomy and lumbar vertebrae and intervertebral discs were harvested. Bone mineral density, micro-computed tomography analysis, and biomechanical testing were performed to assess bone quality. Histological analysis with hematoxylin and eosin, Alcian blue, and Masson's trichrome stain were conducted to determine disc degeneration. Immunohistochemistry and real-time PCR were carried out to measure the expressions of aggrecan, type I collagen, type II collagen, and MMP-1, MMP-3, and MMP-13. RESULTS: SDCP improved bone quality as observed by the results of increased bone mineral density and stiffness in OVX rats. The improvement in disc degeneration induced by estrogen withdrawal was associated with reduced gene expressions of MMPs and increased production of collagen type II. CONCLUSION: SDCP prevents osteoporosis and ameliorates disc degeneration in OVX rats. It represents a favorable therapeutic agent for osteoporotic and osteoarthritic conditions in clinical practice.
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Pirofosfato de Cálcio/uso terapêutico , Estrogênios/deficiência , Degeneração do Disco Intervertebral/tratamento farmacológico , Degeneração do Disco Intervertebral/cirurgia , Ovariectomia , Administração Oral , Animais , Pirofosfato de Cálcio/administração & dosagem , Estrogênios/metabolismo , Feminino , Degeneração do Disco Intervertebral/metabolismo , Ratos , Ratos Sprague-Dawley , Microtomografia por Raio-XRESUMO
BACKGROUND AND OBJECTIVES: This study is a meta-analysis of randomized controlled trials comparing the efficacy of transcutaneous electrical nerve stimulation (TENS) to a control and to other nerve stimulation therapies (NSTs) for the treatment of chronic back pain. METHODS: Citations were identified in MEDLINE, the Cochrane Library, Google Scholar, and ClinicalTrials.gov through June 2014 using the following keywords: nerve stimulation therapy, transcutaneous electrical nerve stimulation, back pain, chronic pain. Control treatments included sham, placebo, or medication only. Other NSTs included electroacupuncture, percutaneous electrical nerve stimulation, and percutaneous neuromodulation therapy. RESULTS: Twelve randomized controlled trials including 700 patients were included in the analysis. The efficacy of TENS was similar to that of control treatment for providing pain relief (standardized difference in means [SDM] = -0.20; 95% confidence interval [CI], -0.58 to 0.18; P = 0.293). Other types of NSTs were more effective than TENS in providing pain relief (SDM = 0.86; 95% CI, 0.15-1.57; P = 0.017). Transcutaneous electrical nerve stimulation was more effective than control treatment in improving functional disability only in patients with follow-up of less than 6 weeks (SDM = -1.24; 95% CI, -1.83 to -0.65; P < 0.001). There was no difference in functional disability outcomes between TENS and other NSTs. CONCLUSIONS: These results suggest that TENS does not improve symptoms of lower back pain, but may offer short-term improvement of functional disability.
Assuntos
Dor Crônica/terapia , Dor Lombar/terapia , Medição da Dor/métodos , Estimulação Elétrica Nervosa Transcutânea/métodos , Dor Crônica/diagnóstico , Humanos , Dor Lombar/diagnóstico , Ensaios Clínicos Controlados Aleatórios como Assunto/métodosRESUMO
Blood pressure (BP) is a crucial indicator of cardiac health and vascular status. This study explores the relationship between radial artery BP and wrist skin strain. A BP estimation method based on the physical model of wrist skin tissues and pulse wave velocity (PWV) is proposed. A photoplethysmography (PPG) sensor and strain gauge are used in this method. The developed strain-based pulse wave sensor consists of a pressing force sensor, which ensures consistent pressing force, and a strain gauge, which measures the cardiac pulsation on the wrist skin. These features enable long-term BP monitoring without incurring the limb compression caused by a cuff. Thus, this method is useful for individuals requiring continuous BP monitoring. In this study, the BP of each participant was measured in three modes (before, during, and after exercise), and the data were compared using a clinically validated sphygmomanometer. The percentage errors of diastolic and systolic BP readings were, respectively, 4.74% and 4.49% before exercise, 6.38% and 6.10% during exercise, and 5.98% and 4.81% after a rest. The errors were compared with a clinically validated sphygmomanometer.