Efficacy of intraoperative sedation combined with preemptive analgesia for single-level kyphoplasty under local anesthesia: A randomized clinical trial.

BACKGROUND: Kyphoplasty is widely used for Osteoporotic Vertebral Compression Fracture (OVCF) under general or local anesthesia, more attention was paid to its post-operative efficacy. Patients' pain and discomfort control strategies during surgery have not been taken seriously. OBJECTIVE: This study aimed at assessing the efficacy of preoperative preemptive analgesia combined with intraoperative sedation for pain and tension relief in OVCF patients undergoing kyphoplasty under local anesthesia. METHODS: We enrolled 128 patients with single-level OVCF who underwent kyphoplasty in our hospital from July 2013 to July 2016. The patients were randomly allocated into three groups: conventional group (i.e., local anesthesia with 0.5% lidocaine (1); n = 42), preemptive group (i.e, (1) + oral 200 mg Celecoxib on the night before surgery with intravenous 40 mg parecoxib sodium an hour before surgery (2); n = 43), and combined group (i.e., (1) + (2) + continuous intravenous 0.5 µg/kg/h dexmedetomidine intraoperatively; n = 43). Hemodynamic variations (heart rate, blood pressure, pulse oxygen saturation (SpO2)), Pain Visual Analogue Score (VAS), Ramsay score, and adverse events were recorded during perioperative period. RESULTS: Blood pressure and heart rate were more stable with significantly smaller values in the combined group than in the conventional and preemptive groups both intra- and postoperatively. In contrast, SpO2 showed no significant difference among the groups throughout the perioperative period. Intraoperative VAS scores revealed significant differences among the groups with the combined group having the smallest values followed by the preemptive group. Similarly, intraoperative Ramsay scores reflected significantly more favorable effects of sedation in the combined than in conventional group. Both VAS and Ramsay scores showed no significant differences among the groups postoperatively, and no differences in complication incidences were noted among the groups as well. CONCLUSIONS: For kyphoplasty under local anesthesia for single-level OVCF, intraoperative sedation combined with preemptive analgesia worked better in mitigating pain and tension intraoperatively and in preventing hemodynamic changes intra- and post-operatively, as compared to local anesthesia alone or additional preemptive analgesia.

Undercorrection: the undesired effect of compression on the osteotomy gap of the medial opening wedge high tibial osteotomy and its clinical significance.

INTRODUCTION: Undercorrection is a common problem in opening wedge high tibial osteotomy (OWHTO). We investigated the compression effect of cortex screw on the osteotomy gap and its clinical significance. MATERIALS AND METHODS: A standard OWHTO using the TomoFix plate was conducted on 20 bone models in two groups to get a 10-mm medial osteotomy gap. A cortex screw was used temporarily in a neutral (at the center) and an eccentric position (near the inclined plane) of the dynamic hole in group 1 and group 2, respectively. The mean of undercorrection observed in the two groups was compared using an independent t test. Also, the effect of compression on the gap between the plate and medial tibial cortex, and the osteotomy gap was evaluated using a Sine rule. Besides, the mean undercorrection observed was assessed for clinical significance based on the effect on the weight-bearing axis (WBA) using a Cosine Rule. RESULTS: The mean undercorrection was 1.3 ± 0.6 mm and 2.6 ± 0.6 mm in group 1 and group 2, respectively. A significantly greater undercorrection was observed in group 2 (p < 0.001). The correction loss in group 2 has resulted from combinations of the sliding effect of the dynamic hole and oblique compression effect over the gap between the plate and medial tibial cortex whereas in group 1 it has only resulted from the oblique compression effect. The observed undercorrection in group 2 has resulted in clinically significant WBA shift (10%) over the width of the tibial plateau. CONCLUSIONS: In OWHTO, compression is important for the stability and healing of osteotomy, but it can also cause loss of correction. In patients requiring large correction, the surgeon should control the amount of compression required and consider making extra osteotomy gap to avoid undercorrection. Furthermore, the placement of cortex screws in neutral is essential to lower the risk of undercorrection.

Preoperative Planning Using 3D Printing Technology in Orthopedic Surgery.

The applications of 3D printing technology in health care, particularly orthopedics, continue to broaden as the technology becomes more advanced, accessible, and affordable worldwide. 3D printed models of computed tomography (CT) and magnetic resonance image (MRI) scans can reproduce a replica of anatomical parts that enable surgeons to get a detailed understanding of the underlying anatomy that he/she experiences intraoperatively. The 3D printed anatomic models are particularly useful for preoperative planning, simulation of complex orthopedic procedures, development of patient-specific instruments, and implants that can be used intraoperatively. This paper reviews the role of 3D printing technology in orthopedic surgery, specifically focusing on the role it plays in assisting surgeons to have a better preoperative evaluation and surgical planning.