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1.
Phys Ther Sport ; 48: 196-200, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33508695

RESUMO

OBJECTIVE: To investigate the immediate effect of an adductor longus tenotomy on the results of the bent knee fall out test, and whether there was a correlation between pre-tenotomy measures and the magnitude of change. DESIGN: Observational study. METHODS: We included recreational to elite athletes with longstanding adductor-related groin pain (specifically adductor longus insertion pain) undergoing unilateral or bilateral full adductor longus tenotomy. The bent knee fall out test was performed immediately prior and immediately after the surgical procedure. We used Wilcoxon signed-rank test to compare test results pre- and post-tenotomy, and Spearman's rho (rs) to analyse correlation between pre-tenotomy values and the magnitude of change in the bent knee fall out test. RESULTS: We consecutively included 60 male adult athletes. There was a statistically significant difference (p < 0.001) in the bent knee fall out result from pre-surgery (median 11.5 cm [IQR 9-15], range 5-25 cm) to post-surgery (median 8 cm [IQR 6-10], range 3-15 cm). The mean difference was 3.9 ± 2 cm, range 0-11 cm, corresponding to a large effect size, d = 1.92. There was a moderate correlation between the bent knee fall out measurement pre-tenotomy and the difference from pre-to-post, rs = 0.75, p < 0.001. CONCLUSION: The bent knee fall out measurements changed considerably immediately after an adductor longus tenotomy, showing that the test is assessing adductor longus flexibility in male athletes with longstanding adductor-related groin pain. There was a moderate correlation between the bent knee fall out measure pre-tenotomy and the magnitude of change.


Assuntos
Traumatismos em Atletas/cirurgia , Virilha/lesões , Dor/cirurgia , Exame Físico/métodos , Tenotomia/métodos , Adolescente , Adulto , Traumatismos em Atletas/etiologia , Virilha/cirurgia , Quadril/fisiopatologia , Humanos , Articulação do Joelho , Masculino , Pessoa de Meia-Idade , Músculo Esquelético/cirurgia , Dor/etiologia , Amplitude de Movimento Articular , Tendinopatia/cirurgia , Adulto Jovem
2.
Plast Reconstr Surg ; 147(1): 66e-75e, 2021 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-33370055

RESUMO

BACKGROUND: Depression and pain catastrophizing are aspects of the patient's mindset that have been shown to be important in relation to the outcome of carpal tunnel release. However, other factors of the patient's mindset have been understudied, such as treatment expectations and illness perceptions. The aim of the present study was to investigate the influence of these mindset aspects on outcome of carpal tunnel release, in addition to psychological distress and pain catastrophizing. METHODS: A total of 307 patients with carpal tunnel syndrome who visited outpatient hand surgery clinics and who completed online questionnaires regarding demographic and psychosocial characteristics and carpal tunnel syndrome severity were included. The patient mindset was measured with the Patient Health Questionnaire-4, the Pain Catastrophizing Scale, the Credibility Expectancy Questionnaire, and the Brief Illness Perception Questionnaire. Hierarchical linear regression models were used to examine the relation between self-reported severity 6 months after carpal tunnel release, as measured with the Boston Carpal Tunnel Questionnaire, and psychosocial aspects of mindset, adjusting for preoperative Boston Carpal Tunnel Questionnaire score, patient characteristics, and comorbidities. RESULTS: Independent associations with better self-reported outcome were found for higher treatment expectations (ß = -0.202; p < 0.001) and illness comprehensibility (ß = -0.223; p < 0.001). The additional explained variance in Boston Carpal Tunnel Questionnaire scores by the patient's mindset was 13.2 percent (psychological distress and pain catastrophizing together, 2.1 percent; treatment expectations and illness perceptions together, 11.1 percent). CONCLUSION: Treatment outcome expectations and comprehensibility of illness are both independently associated with the outcome of carpal tunnel release, showing the importance of these aspects of the patient's mindset for the outcome of carpal tunnel release. CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, III.


Assuntos
Síndrome do Túnel Carpal/cirurgia , Catastrofização/epidemiologia , Descompressão Cirúrgica/estatística & dados numéricos , Depressão/epidemiologia , Dor/cirurgia , Adulto , Idoso , Síndrome do Túnel Carpal/complicações , Síndrome do Túnel Carpal/diagnóstico , Síndrome do Túnel Carpal/psicologia , Catastrofização/diagnóstico , Catastrofização/etiologia , Catastrofização/psicologia , Descompressão Cirúrgica/psicologia , Depressão/diagnóstico , Depressão/etiologia , Depressão/psicologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Dor/diagnóstico , Dor/etiologia , Dor/psicologia , Medição da Dor , Satisfação do Paciente/estatística & dados numéricos , Estudos Retrospectivos , Autorrelato/estatística & dados numéricos , Índice de Gravidade de Doença , Resultado do Tratamento
3.
Anticancer Res ; 40(10): 5701-5706, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32988895

RESUMO

BACKGROUND/AIM: The simultaneous increase of antioxidant CAT (catalase) enzyme and plasma MDA (malonidialdehyde) concentrations versus the numeric rating scale (NRS) pain score following surgery is unknown. Patients and Methods: The study included 114 patients with gallstone disease and 29 patients in the cancer group. RESULTS: Following surgery, the plasma CAT concentrations increased and plasma MDA concentrations decreased in all patients and especially in cancer patients. The linear mixed model time-effect was statistically significant in CAT and MDA (p<0.001 and p=0.02, respectively). In addition, a significant correlation between NRS pain score values and plasma MDA median concentrations in cancer patients was identified (r=0.430, p<0.001). CONCLUSION: The plasma MDA concentrations decreased and CAT concentrations increased significantly in all patients and especially in cancer patients following surgery. The simultaneous increase of antioxidant CAT enzyme with the decrease of plasma MDA may be an important ROS inhibiting mechanism to help patients return to normal antioxidant-oxidant status.


Assuntos
Catalase/sangue , Cálculos Biliares/sangue , Malondialdeído/sangue , Neoplasias/sangue , Dor/sangue , Antioxidantes/metabolismo , Feminino , Cálculos Biliares/patologia , Cálculos Biliares/cirurgia , Glutationa Peroxidase/sangue , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias/patologia , Neoplasias/cirurgia , Estresse Oxidativo/genética , Dor/patologia , Dor/cirurgia , Medição da Dor , Espécies Reativas de Oxigênio/metabolismo , Superóxido Dismutase/sangue
4.
N Z Med J ; 133(1519): 55-61, 2020 07 31.
Artigo em Inglês | MEDLINE | ID: mdl-32777795

RESUMO

AIMS: Hip abductor tendon tears are a common cause of chronic hip pain and a difficult problem to manage. The aim of this survey is to establish the level of recognition by New Zealand orthopaedic surgeons and identify the challenges in treating abductor tendon repairs. METHODS: An online survey was sent to 215 consultant orthopaedic surgeons in New Zealand with a registered interest in hip surgery. The survey consisted of five questions regarding the diagnosis, management and clinical challenges related to hip abductor tendon tears. RESULTS: Eighty-six of 204 eligible surgeons (42.2%) completed the survey. Almost all (90%) of respondents have diagnosed abductor tendon tears and over half (59%) have performed hip abductor tendon tears in their practice. The most common indication for repair was pain (35%), followed by functional weakness (29%), and the most common repair technique involved transosseous repair through the greater trochanter (41%), closely followed by suture anchors (37%). The majority of surgeons identified a need for novel biologics and tissue augments for improving repair. CONCLUSIONS: Hip abductor tendon tears were identified as a pertinent clinical problem in this survey. An improvement in the fundamental pathological understanding of disease and greater availability of proven biologics and tissue augments are required.


Assuntos
Quadril/cirurgia , Cirurgiões Ortopédicos/estatística & dados numéricos , Padrões de Prática Médica/estatística & dados numéricos , Traumatismos dos Tendões/cirurgia , Artroplastia/estatística & dados numéricos , Humanos , Nova Zelândia , Dor/etiologia , Dor/cirurgia , Inquéritos e Questionários , Traumatismos dos Tendões/complicações , Tendões/cirurgia
5.
J Vasc Interv Radiol ; 31(6): 912-916.e1, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32376178

RESUMO

Eight patients who underwent percutaneous cryoablation of mixed and/or motor nerves over a period of 5 years were identified. Distances from the ablation sites to origins of distal musculature were measured, and times to initial clinical recovery were collected. Strength progression over time following muscle activation was also collected and analyzed. All patients demonstrated activation of all muscles distal to the ablation, and the calculated mean rate of nerve regeneration based on distance to the origin of the assessed musculature and time to muscle activation for the group was 1.5 mm/day ± 1.1.


Assuntos
Criocirurgia , Denervação Muscular/métodos , Força Muscular , Músculo Esquelético/inervação , Regeneração Nervosa , Dor/cirurgia , Traumatismos dos Nervos Periféricos/fisiopatologia , Nervos Periféricos/cirurgia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Criocirurgia/efeitos adversos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neurônios Motores/patologia , Denervação Muscular/efeitos adversos , Dor/diagnóstico , Dor/fisiopatologia , Traumatismos dos Nervos Periféricos/diagnóstico , Traumatismos dos Nervos Periféricos/etiologia , Traumatismos dos Nervos Periféricos/patologia , Nervos Periféricos/patologia , Nervos Periféricos/fisiopatologia , Estudos Prospectivos , Recuperação de Função Fisiológica , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
6.
J Clin Neurosci ; 77: 25-30, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32451215

RESUMO

Spinal dural arteriovenous fistula (dAVF) is an extremely rare vascular entity that is usually misdiagnosed. We sought to determine the long-term clinical outcomes of patients undergoing microsurgical treatment for delayed diagnosis of spinal dAVF. This retrospective study identified patients with delayed diagnosed spinal dAVF at our institution from 2009 to 2018. Patients' data, including demographics, imaging, and follow-up data, were evaluated. This cohort included 65 consecutive patients with 68 dAVFs and a male-to-female ratio of 4:1 and a mean age of 53.5 ± 13.7 years. The presenting symptoms consisted of limb weakness (n = 42, 64.6%), paraparesis (n = 34, 52.3%), sphincter disturbances (n = 8, 12.3%), and pain (n = 13, 20.0%). The proportion of patients with each symptom significantly increased and patients experienced increased disability when the diagnosis was finalized. The mean length of delay of diagnosis was 20.7 ± 30.0 months. Surgery resulted in complete occlusion of the fistula on the first attempt in all patients. Three patients developed recurrent fistulas, and three died in the follow-up period. Improved motor function was achieved in 38 patients (59.5%). Other symptoms, such as sensory disorders, sphincter dysfunction, and pain, improved by 37.3%, 32.3%, and 66.7%, respectively. Patients with spinal dAVF usually exhibit progressive ascending myelopathy and often remain misdiagnosed for months to years. Some patients' increased disability cannot be reversed through surgery.


Assuntos
Malformações Vasculares do Sistema Nervoso Central/diagnóstico por imagem , Malformações Vasculares do Sistema Nervoso Central/cirurgia , Diagnóstico Tardio/tendências , Medula Espinal/diagnóstico por imagem , Medula Espinal/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Dor/diagnóstico por imagem , Dor/cirurgia , Paraparesia/diagnóstico por imagem , Paraparesia/cirurgia , Estudos Retrospectivos , Doenças da Medula Espinal/diagnóstico por imagem , Doenças da Medula Espinal/cirurgia , Resultado do Tratamento
7.
PLoS One ; 15(5): e0233347, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32463834

RESUMO

OBJECTIVES: One in five patients does not improve in pain with walking (non-responders) 12 months after total knee arthroplasty (TKA). This longitudinal study investigated a broad range of symptoms before and after TKA and evaluated possible differences in symptom distress between responders and non-responders with regards to pain with walking after TKA. METHODS: Prior to TKA surgery, 182 patients completed a demographic questionnaire and the Memorial Symptom Assessment Scale-Short Form (MSAS-SF). The MSAS-SF was repeated 12 months following TKA. Clinical data were extracted from medical records. Patients were categorized as responders or non-responders based on their trajectories of pain with walking assessed prior to surgery, on postoperative day 4, at 6 weeks, and at 3 and 12 months. RESULTS: Overall, the most distressful preoperative symptoms were pain, lack of energy, difficulty sleeping, feeling drowsy, worrying, feeling bloated, and problems with sexual interest or activity. However, compared with patients classified as responders to TKA, non-responders had higher total symptom distress scores both preoperatively and 12 months postoperatively. Preoperatively, non-responders scored higher than responders on five of the seven most distressing symptoms (i.e., all except difficulty sleeping and feeling bloated), and 12 months postoperatively, non-responders scored higher than responders on six of the seven most distressing symptoms (i.e., all but feeling bloated). In a multivariate analysis, higher preoperative distress scores for pain and problems with sexual interest or activity were significant predictors of non-response to TKA, controlling for other relevant factors. CONCLUSIONS: Patients' preoperative symptom burden may be a useful indicator of their risk for non-improvement following TKA surgery. Future studies need to evaluate the effect of reducing patients' preoperative symptom burden on TKA outcomes.


Assuntos
Artroplastia do Joelho , Idoso , Efeitos Psicossociais da Doença , Feminino , Seguimentos , Humanos , Estudos Longitudinais , Masculino , Dor/etiologia , Dor/cirurgia , Período Pós-Operatório , Período Pré-Operatório , Índice de Gravidade de Doença , Falha de Tratamento , Caminhada
8.
Am J Sports Med ; 48(6): 1450-1455, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32301621

RESUMO

BACKGROUND: Anterior shoulder instability can be successfully treated using Latarjet procedures, although a small proportion of patients report unexplained pain. PURPOSE/HYPOTHESIS: The purpose was to report the prevalence and characteristics of patients with unexplained pain without recurrent instability after open Latarjet procedures and to determine whether screw removal can alleviate pain. The hypothesis was that unexplained pain without recurrent instability might be due to soft tissue impingements against the screw heads and that the removal of screws would alleviate or reduce pain. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: We retrospectively reviewed the clinical and radiographic records of 461 consecutive shoulders treated by open Latarjet procedures for anterior instability between 2002 and 2014. Unexplained anterior pain was present in 21 shoulders (4.6%) and treated by screw removal at 29 ± 37 months (mean ± SD). Postoperative assessment at >12 months after screw removal included complications, visual analog scale for pain (pVAS), subjective shoulder value, Rowe score, Walch-Duplay score, and ranges of motion. The study cohort comprised the shoulders of 20 patients (9 women, 11 men) aged 25 ± 6 years (median, 25 years; range, 16-34 years) at screw removal and involved the dominant arm in 13 (62%) shoulders. RESULTS: Screw removal alleviated pain completely in 14 shoulders (67%; pVAS improvement, 6.4 ± 1.8; median, 6; range, 3-8) and reduced pain in the remaining 7 (33%; pVAS improvement, 2.4 ± 1.4; median, 2; range, 1-5). At 38 ± 23 months after screw removal, 2 recurrences of instability unrelated to screw removal occurred. The subjective shoulder value was 79% ± 22% (median, 90%; range, 0%-95%); Rowe score, 85 ± 20 (median, 95; range, 30-100); and Walch-Duplay score, 82 ± 19 (median, 85; range, 25-100). Mobility improved in active forward elevation (171°± 14°), external rotation with the elbow at the side (61°± 12°), and external rotation with the arm at 90° of abduction (67°± 13°) and especially in internal rotation, with only 2 shoulders (10%) limited to T12 spine segment. CONCLUSION: The present findings confirm that unexplained anterior pain after Latarjet procedures can be related to the screws used to fix bone blocks, which can safely be alleviated or reduced by screw removal.


Assuntos
Parafusos Ósseos , Remoção de Dispositivo , Instabilidade Articular , Dor/cirurgia , Articulação do Ombro/fisiopatologia , Adolescente , Adulto , Feminino , Humanos , Instabilidade Articular/cirurgia , Masculino , Amplitude de Movimento Articular , Recidiva , Estudos Retrospectivos , Ombro , Luxação do Ombro , Articulação do Ombro/cirurgia , Adulto Jovem
10.
Clin Plast Surg ; 47(2): 311-321, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32115057

RESUMO

Symptomatic neuromas are a common cause of postamputation pain that can lead to significant disability. Regenerative peripheral nerve interface surgery is performed to treat symptomatic neuromas and prevent the development of neuromas. This review delineates the clinical problem of postamputation pain, describes the limitations of the available treatment methods, and highlights the need for an effective treatment strategy that leverages the biologic processes of nerve regeneration and muscle reinnervation. The evidence supporting use of regenerative peripheral nerve interface surgery to mitigate neuroma formation is discussed and the rationale behind the efficacy of regenerative peripheral nerve interfaces is explored.


Assuntos
Regeneração Nervosa , Neuroma/cirurgia , Procedimentos Neurocirúrgicos/métodos , Manejo da Dor/métodos , Dor/cirurgia , Cotos de Amputação , Humanos , Neuroma/complicações , Neuroma/fisiopatologia , Dor/etiologia
11.
Arch Orthop Trauma Surg ; 140(5): 697-705, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32193673

RESUMO

Indications for surgical treatment of distal radius fractures (DRF) remain controversial in the literature, especially in elderly patients. Complication rates after operatively treated DRF are low and well documented. These include malunion, degenerative osteoarthritis in the radiocarpal joint and subsequently pain and impaired hand function. If conservative treatment fails then salvage procedures are necessary. This review summarizes the therapeutic options available to treat degenerative osteoarthritis after malunited distal radius fractures, regardless of the initial operative or conservative treatment.


Assuntos
Fraturas Mal-Unidas/cirurgia , Dor/etiologia , Fraturas do Rádio/cirurgia , Terapia de Salvação/métodos , Articulação do Punho/cirurgia , Fraturas Mal-Unidas/complicações , Fraturas Mal-Unidas/fisiopatologia , Humanos , Dor/cirurgia , Fraturas do Rádio/complicações , Fraturas do Rádio/fisiopatologia , Amplitude de Movimento Articular , Reoperação , Articulação do Punho/diagnóstico por imagem , Articulação do Punho/fisiopatologia
12.
Knee Surg Sports Traumatol Arthrosc ; 28(6): 2015-2022, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32221640

RESUMO

PURPOSE: To determine the component fit by radiography or computed tomography after total knee arthroplasty and the relation of imaging with clinical examination of residual knee pain. METHODS: The study was conducted in 172 patients with residual knee pain after total knee arthroplasty. The patients were examined to determine whether they experienced pain upon palpation at nine regions surrounding the tibial and femoral components, and the results were noted. The Knee Society Clinical Rating System and The Western Ontario and McMaster Universities Arthritis Index pain scale score forms were completed for all patients. Radiologic evaluation was performed using computed tomography and anteroposterior, lateral, and oblique radiographs to determine component overhang/underhang status at these nine regions. Overhang, underhang, and cortical fit groups were created based on the position of the component at the bone margin. A statistical relationship was sought between the clinical scores and the values measured to determine which imaging method showed the best correlation with clinical scores. Consistency of CT and Rx measurements was compared using the McNemar-Bowker test. Comparisons between groups were made using Student's t test for normally distributed data, and the Mann-Whitney U test. RESULTS: Computed tomography and radiographic measurements were similar in the medial, anterior, and lateral tibial regions. However, no similarities were observed in the anteromedial, anterolateral, posteromedial, and posterolateral tibial regions, and in the distal-medial and distal-lateral aspects of the femur. Statistical relationships among decreased clinical scores, pain with palpation, and the presence of overhang/underhang were only observed in the medial tibial region for imaging using radiography. A statistically significant relationship was observed in the medial, posteromedial, and posterolateral tibial regions, and in the distal-medial region of the femur for imaging based on computed tomography. CONCLUSIONS: Radiography could only aid in assessing the component fit in the anteromedial, medial, and lateral regions of the tibia in patients with residual knee pain following knee arthroplasty, but it was not sufficient in comparison with computed tomography in six other regions. LEVEL OF EVIDENCE: Prospective study, level of evidence II.


Assuntos
Artroplastia do Joelho/efeitos adversos , Articulação do Joelho/diagnóstico por imagem , Osteoartrite do Joelho/diagnóstico por imagem , Dor/diagnóstico por imagem , Idoso , Feminino , Fêmur/cirurgia , Humanos , Joelho/cirurgia , Articulação do Joelho/cirurgia , Prótese do Joelho , Masculino , Pessoa de Meia-Idade , Osteoartrite do Joelho/cirurgia , Dor/cirurgia , Complicações Pós-Operatórias/diagnóstico por imagem , Período Pós-Operatório , Estudos Prospectivos , Tíbia/cirurgia , Tomografia Computadorizada por Raios X
13.
Plast Reconstr Surg ; 145(3): 563e-573e, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-32097316

RESUMO

BACKGROUND: Many surgical techniques are used to treat symptomatic neuroma, but options are limited for digital neuromas because of a paucity of soft-tissue coverage and/or the absence of the terminal nerve end. The authors assessed factors that influence patient-reported outcomes after surgery for symptomatic digital neuroma. METHODS: The authors retrospectively identified 29 patients with 33 symptomatic digital neuromas that were treated surgically. Patients completed the Patient-Reported Outcomes Measurement Information System (PROMIS) Upper Extremity and Pain Interference scales, a numeric rating scale for pain, and the PROMIS Depression scale at a median follow-up of 7.6 years postoperatively (range, 3.2 to 16.8 years). Surgical treatment for neuroma included excision with nerve repair/reconstruction (n =13; 39 percent), neuroma excision alone (n =10; 30 percent), and excision and implantation (n =10; 30 percent). Multivariable linear regression was performed to identify the factors that independently influenced patient-reported outcomes. RESULTS: The mean postoperative PROMIS Upper Extremity score was 45.2 ± 11.2, the mean Pain Interference score was 54.3 ± 10.7, and the mean numeric rating scale pain score was 3 (interquartile range, 1 to 5). Compared with other treatment techniques, neuroma excision with nerve repair/reconstruction was associated with lower numeric rating scale pain scores; lower Pain Interference scores, corresponding to less daily impact of pain; and higher Upper Extremity scores, reflecting better upper extremity function. Older age and higher Depression scores were associated with lower Upper Extremity scores and higher Pain Interference scores. Smoking was associated with higher Pain Interference and numeric rating scale pain scores. CONCLUSIONS: Neuroma excision followed by nerve repair/reconstruction resulted in better outcomes compared with neuroma excision alone with or without implantation. Patient age and psychosocial factors influenced patient-reported outcomes. CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, III.


Assuntos
Depressão/diagnóstico , Neuroma/cirurgia , Procedimentos Neurocirúrgicos/métodos , Dor/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Neoplasias de Tecidos Moles/cirurgia , Adulto , Fatores Etários , Depressão/etiologia , Depressão/psicologia , Feminino , Dedos/inervação , Dedos/cirurgia , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Neuroma/complicações , Neuroma/psicologia , Dor/diagnóstico , Dor/etiologia , Dor/psicologia , Medição da Dor , Medidas de Resultados Relatados pelo Paciente , Período Pós-Operatório , Escalas de Graduação Psiquiátrica , Estudos Retrospectivos , Neoplasias de Tecidos Moles/complicações , Neoplasias de Tecidos Moles/psicologia , Resultado do Tratamento
14.
J Clin Neurosci ; 72: 124-129, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31948880

RESUMO

OBJECTIVE: Full-endoscopic lumbar discectomy (FELD) is a minimally invasive surgical option for recurrent lumbar disc herniation (LDH). Nonetheless, patients' clinical outcomes may be poorer after surgery for recurrent LDH than for primary LDH. Therefore, we compared patients' longitudinal clinical outcomes after FELD for recurrent LDH or primary LDH. METHODS: The medical records of patients who underwent FELD for primary LDH (group A) or recurrent LDH (group B) were retrospectively reviewed. The inclusion criteria were: 1) single-level LDH or recurrent LDH at L4-5 or L5-S1, 2) age ≤60 years, 3) previous open discectomy (group B), and 4) ≥6 months of follow-up. In total, 244 patients (group A, 211; group B, 33) were included. Clinical outcomes (Oswestry Disability Index [ODI]; visual analogue pain score for the back and leg [VAS-B] and [VAS-L]) over 24 months of follow-up were compared between groups with a linear mixed-effects model. RESULTS: All clinical outcomes significantly improved from pre-operation to 3 months postoperatively (p < 0.01), and the improvement was maintained for 24 months postoperatively in both groups. The clinical outcomes of groups A and B were not significantly different during 24 months follow-up (ODI, p = 0.94; VAS-B, p = 0.11; and VAS-L, p = 0.48). The reoperation rate was 3.3% in group A and 3.0% in group B, but the overall complication rate was higher in group B (9.8%) than in group A (6.6%). CONCLUSION: The longitudinal clinical outcomes after FELD for recurrent LDH may not be poor as feared. However, the higher complication rate in patients undergoing FELD for recurrent LDH should be noted.


Assuntos
Discotomia/tendências , Deslocamento do Disco Intervertebral/cirurgia , Vértebras Lombares/cirurgia , Reoperação/tendências , Adulto , Discotomia/efeitos adversos , Feminino , Humanos , Deslocamento do Disco Intervertebral/complicações , Deslocamento do Disco Intervertebral/diagnóstico por imagem , Estudos Longitudinais , Vértebras Lombares/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Dor/diagnóstico por imagem , Dor/etiologia , Dor/cirurgia , Medição da Dor/métodos , Medição da Dor/tendências , Complicações Pós-Operatórias/diagnóstico por imagem , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/cirurgia , Recidiva , Estudos Retrospectivos , Resultado do Tratamento
15.
Arthroscopy ; 36(3): 745-750, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31924382

RESUMO

PURPOSE: To determine if opioid use and health care costs in the year before and following hip arthroscopy for femoroacetabular impingement (FAI) differ between those with or without depression or anxiety. METHODS: Using the Truven Health Marketscan database, FAI patients who underwent hip arthroscopy between October 2010 and December 2015 were identified (Current Procedural Terminology codes 29914 [femoroplasty], 29915 [acetabuloplasty], and/or 29916 [labral repair]). Patients were excluded if they had incomplete coverage for 1 year either before or following surgery. The number of patients with 1 or more claims related to depression or anxiety during the year before surgery was quantified (International Statistical Classification Diseases and Related Health-9 codes 296, 298, 300, 309, 311). Health care costs in the year before and following hip arthroscopy were compared between those with or without depression or anxiety. We also compared the number of patients in each group who filled a narcotic pain prescription within 180 days before surgery as well as >60 or >90 days after hip arthroscopy. RESULTS: Depression or anxiety claims were seen in 5,208/14,830 patients (35.1%) before surgery. A significantly greater proportion of those with preoperative depression or anxiety filled opioid-related prescriptions in the 6 months before surgery (36.2% vs 25.6%, P < .0001) and both >60 days (31.3% vs 24.7%, P < .0001) and >90 days after surgery (29.5% vs 23.4%, P < .0001). The group with preoperative depression or anxiety had significantly greater health care costs both before ($8,775 vs $5,674, P < .0001) and following surgery ($5,287 vs $3,908, P < .0001). CONCLUSIONS: Both before and following hip arthroscopy, opioid use and health care costs were significantly greater for FAI patients with comorbid depression or anxiety. LEVEL OF EVIDENCE: Level III, retrospective comparative therapeutic study.


Assuntos
Analgésicos Opioides/uso terapêutico , Ansiedade/economia , Artroscopia/métodos , Bases de Dados Factuais , Depressão/economia , Impacto Femoroacetabular/cirurgia , Custos de Cuidados de Saúde , Acetabuloplastia , Adulto , Ansiedade/complicações , Artroscopia/economia , Comorbidade , Depressão/complicações , Feminino , Impacto Femoroacetabular/economia , Impacto Femoroacetabular/psicologia , Quadril/cirurgia , Articulação do Quadril/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Dor/cirurgia , Estudos Retrospectivos , Adulto Jovem
16.
Cryobiology ; 92: 203-207, 2020 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-31958427

RESUMO

This study aimed to evaluate the safety and effectiveness of CT-guided percutaneous cryoablation for treatment of painful osteolytic bone metastases. A total of 26 patients (36 bone metastases) treated with CT-guided percutaneous cryoablation between May 2012 and June 2016 were enrolled in this retrospective study. All procedures were performed under local anesthesia. A visual analog scale (VAS) was used to evaluate pain before the procedure and at 1 day, 1 month, 3 months, and 6 months after the procedure. Complications during and after the procedure were recorded and graded by the Clavien-Dindo classification. The mean VAS pain score was 7.1 ± 1.1 (range, 4-10) before cryoablation. It was significantly lower at all timepoints after treatment: 2.1 ± 1.7 (P < 0.0001) at 1 day after treatment, 1.3 ± 1.8 (P < 0.0001) at 1 month, 1.6 ± 1.7 (P < 0.0001) at 3 months, and 1.8 ± 1.3 (P < 0.0001) at 6 months. The response rates were 91.7%, 94.4%, 91.7%, and 94.4%, respectively, at 1 day, 1 month, 3 months, and 6 months after cryoablation; the complete response rates were 22.2%, 41.7%, 36.1%, and 22.2%, respectively. Adverse events (skin frostbite, nerve injury, pathologic fracture) occurred in 3 patients. CT-guided percutaneous cryoablation under local anesthesia appears to be a safe and effective treatment for painful osteolytic bone metastases. Prospective clinical trials on large samples needed to confirm this conclusion.


Assuntos
Neoplasias Ósseas/secundário , Neoplasias Ósseas/cirurgia , Criocirurgia/métodos , Osteólise/cirurgia , Dor/cirurgia , Idoso , Idoso de 80 Anos ou mais , Criocirurgia/efeitos adversos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Medição da Dor , Estudos Prospectivos , Estudos Retrospectivos , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento
17.
Spine (Phila Pa 1976) ; 45(11): 776-783, 2020 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-31923129

RESUMO

STUDY DESIGN: A prospective observational 10-year follow-up study. OBJECTIVE: This study aimed to examine preoperative predictors for better surgical outcomes in patients with lumbar spinal stenosis (LSS) 10 years after surgery. SUMMARY OF BACKGROUND DATA: LSS is a leading cause of low back surgery in patients older than 65 years. Limited data are available for predictors of long-term surgical outcomes in patients with LSS. METHODS: At the baseline, 102 patients with LSS underwent decompressive surgery, and 72 of the original study sample participated in a 10-year follow-up study. Study patients filled out a questionnaire preoperatively, and follow-up data were collected at 3 months, 6 months, 1 year, 2 years, 5 years, and 10 years postoperatively. Surgical outcomes were evaluated in terms of disability with the Oswestry Disability Index (ODI) and pain with the visual analog scale (VAS). Predictors in the models were nonsmoking status, absence of previous lumbar surgery, self-rated health, regular use of painkillers for symptom alleviation, and BMI. Statistical analyses included longitudinal associations, subgroup analyses, and cross-sectional analyses. RESULTS: Using multivariate analysis, statistically significant predictors for lower ODI and VAS scores at 10 years were nonsmoking status, absence of previous lumbar surgery, better self-rated health, and regular use of painkillers for <12 months. Patients who smoked preoperatively or had previous lumbar surgery experienced more pain and disability at the 10-year follow-up. CONCLUSION: These study results can enhance informed decision-making processes for patients considering surgical treatment for LSS by showing preoperative predictors for surgical outcomes up to 10 years after surgery. Smokers and patients with previous lumbar surgery showed a decline in surgical benefits after 5 years. LEVEL OF EVIDENCE: 3.


Assuntos
Vértebras Lombares/cirurgia , Medição da Dor/tendências , Dor/cirurgia , Cuidados Pré-Operatórios/tendências , Estenose Espinal/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Descompressão Cirúrgica/tendências , Feminino , Seguimentos , Humanos , Laminectomia/tendências , Vértebras Lombares/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Dor/diagnóstico por imagem , Dor/epidemiologia , Valor Preditivo dos Testes , Estudos Prospectivos , Estenose Espinal/diagnóstico por imagem , Estenose Espinal/epidemiologia , Inquéritos e Questionários , Fatores de Tempo
18.
Am J Sports Med ; 48(1): 167-172, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31765225

RESUMO

BACKGROUND: Patients with symptomatic femoroacetabular impingement (FAI) typically have anterior groin pain. However, a subset of these patients may have pain located laterally, posteriorly, or in a combination of locations around the hip. PURPOSE: To report and compare outcomes of hip arthroscopy for patients with FAI and atypical hip pain versus classic anterior groin pain. STUDY DESIGN: Cohort study; Level of evidence, 2. METHODS: Consecutive patients undergoing hip arthroscopy for FAI between August 2011 and March 2013 were identified. A total of 258 patients were identified as having symptomatic FAI based on clinical, radiographic, and advanced imaging diagnosis of FAI. Exclusion criteria included isolated thigh, knee, or low back pain. We also excluded patients with hip abductor pathology and trochanteric bursitis. Of the 226 patients ultimately included, 159 (70.4%) reported anterior groin pain, while 67 (29.6%) reported isolated lateral or posterior hip pain or a combination of locations. Patients were categorized into 4 groups: isolated anterior groin pain, lateral hip pain, posterior hip pain, and multiple primary hip pain locations (combined). These patients were followed prospectively with a minimum follow-up of 2 years. Patient characteristics, surgical characteristics, modified Harris Hip Score (mHHS), Non-arthritic Hip Score (NAHS), revision hip arthroscopy, and conversions to total hip arthroplasty (THA) were recorded. RESULTS: All 226 patients were included at final follow-up. Hip arthroscopy was performed by a single sports medicine fellowship-trained orthopaedic surgeon. Preoperative patient characteristics and baseline functional outcome scores did not significantly differ among groups. All 4 groups showed statistically significant improvements in mHHS and NAHS from baseline to final follow-up of a mean 2.63 years (range, 2.01-3.23 years). Functional outcome scores and rates of revision hip arthroscopy or conversion to THA did not significantly differ between groups. CONCLUSION: Hip arthroscopy can effectively improve patient outcomes in atypical hip pain. A careful history and physical examination should identify this clinically meaningful subset of patients with FAI who can benefit from surgical intervention while identifying patients with concomitant posterior extra-articular hip or spine pathology that should be addressed appropriately.


Assuntos
Artralgia/fisiopatologia , Artroscopia/métodos , Impacto Femoroacetabular/cirurgia , Articulação do Quadril/cirurgia , Adulto , Artroplastia de Quadril/estatística & dados numéricos , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Dor/cirurgia , Exame Físico , Resultado do Tratamento , Adulto Jovem
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