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1.
Orthop Clin North Am ; 54(1): 23-35, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-36402508

RESUMO

With improved chemotherapeutic treatment, patients with primary or metastatic bone tumor have improved prognoses and longer life expectancies; therefore, durable limb-salvage constructs are critical. For tumors of the proximal femur, endoprosthetic replacement is an option for treatment in primary and metastatic disease, with the goals being tumor and pain control, earlier mobilization, shorter recovery period, and, in primary tumors, cure. This study provides a summary of current concepts in the treatment of oncologic lesions in the proximal femur with endoprostheses. Discussion of the inherent complications of these constructs is presented as well as the risks and treatment of reconstruction failure.


Assuntos
Neoplasias Ósseas , Fêmur , Humanos , Fêmur/cirurgia , Salvamento de Membro , Extremidade Inferior/cirurgia , Reimplante , Neoplasias Ósseas/cirurgia
3.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 36(11): 1381-1387, 2022 Nov 15.
Artigo em Chinês | MEDLINE | ID: mdl-36382456

RESUMO

Objective: To investigate the effectiveness and safety of low molecular weight heparin combined with aspirin for perioperative prophylactic anticoagulation in patients with lower extremity fracture after splenectomy. Methods: The clinical data of 50 patients with splenic rupture combined with lower extremity fracture between January 2009 and June 2022 were retrospectively analyzed. All patients were given enoxaparin sodium at 48 hours after splenectomy, and stopped at 24 hours before fracture surgery. After fracture surgery, the patients were divided into aspirin group (group A, 15 cases), low molecular weight heparin group (group B, 16 cases), and low molecular weight heparin combined with aspirin group (group C, 19 cases) according to different anticoagulation regimens. The treatment course was 28 days. There was no significant difference in gender, age, body mass index, cause of injury, fracture site, time from injury to operation, complications, and other general data between groups ( P>0.05). The occurrence of venous thromboembolism (VTE) was observed; hemoglobin (Hb), platelet (PLT), D-D dimer, and fibrinogen degradation product (FDP) were recorded before operation and at 1, 3, and 7 days after operation, and the effect of anticoagulation regimen on coagulation function was observed. The incidences of wound complications and bleeding related complications were recorded, and the total perioperative blood loss, hidden blood loss, and overt blood loss were calculated. Results: The incidences of VTE in groups A, B, and C were 13.33% (2/15), 12.50% (2/16), and 5.26% (1/19), respectively, and there was no significant difference between groups ( χ 2=0.770, P=0.680). There was no portal vein thrombosis and no VTE-related death in the 3 groups. There was no significant difference in the levels of Hb, PLT, D-D dimer, and FDP between groups before and after operation ( P>0.05); and there was no significant difference in total perioperative blood loss, hidden blood loss, and overt blood loss between groups ( P>0.05). No local skin necrosis was found in all patients. In group A, 1 case occurred redness and swelling of incision; in group B, 1 case had incision discharge, redness, and swelling, and 1 case had fat liquefaction; in group C, 1 case had repeated incision exudation accompanied by local tissue redness and swelling, and 1 case had local hematoma. The incidences of adverse incision in groups A, B, and C were 6.66% (1/15), 12.50% (2/16), and 11.76% (2/19), respectively, with no significant difference ( χ 2=0.302, P=0.860). There were 4 cases of bleeding related complications, including 1 case of incision ecchymosis in groups A and B respectively, with the incidence of 6.66% and 6.25%, respectively; there was 1 case of incision hematoma and 1 case of bleeding in group C, with the incidence of 11.76%; showing no significant difference in the incidence of bleeding related complications between groups ( χ 2=0.268, P=0.875). Conclusion: Perioperative combined use of low molecular weight heparin and aspirin for prevention of anticoagulation in patients with splenic rupture and lower extremity fracture can effectively prevent the occurrence of VTE without increasing the incidence of complications, which is an effective and safe treatment method. However, whether the incidence of VTE can be reduced needs to be further studied by expanding the sample size.


Assuntos
Fraturas Ósseas , Ruptura Esplênica , Tromboembolia Venosa , Humanos , Heparina de Baixo Peso Molecular/uso terapêutico , Tromboembolia Venosa/etiologia , Tromboembolia Venosa/prevenção & controle , Aspirina/uso terapêutico , Perda Sanguínea Cirúrgica , Estudos Retrospectivos , Fraturas Ósseas/cirurgia , Anticoagulantes/uso terapêutico , Ruptura Esplênica/induzido quimicamente , Ruptura Esplênica/complicações , Ruptura Esplênica/tratamento farmacológico , Hematoma , Extremidade Inferior/cirurgia , Heparina/efeitos adversos
4.
Artigo em Inglês | MEDLINE | ID: mdl-36361092

RESUMO

Lower limb amputation (LLA) is a common complication of diabetic foot ulcer (DFU), which can lead to a higher 5-year mortality rate compared to all cancers combined. This study aimed to determine the prognostic factors of LLA among DFU patients in Kelantan from 2014 to 2018. A population-based study was conducted using secondary data obtained from the National Diabetic Registry (NDR). There were 362 cases that fulfilled the study criteria and were further analysed. The prognostic factors were determined by Multiple Cox Proportional Hazards Regression. There were 66 (18.2%) DFU patients who underwent LLA in this study, while 296 (81.8%) were censored. The results revealed that the factor leading to a higher risk of LLA was abnormal HDL-cholesterol levels (Adj. HR 2.18; 95% CI: 1.21, 3.92). Factors that led to a lower risk of LLA include DFU in patients aged 60 or more (Adj. HR 0.48; 95% CI: 0.27, 0.89) and obesity (Adj. HR 0.45; 95% CI: 0.22, 0.89). In conclusion, our model showed that abnormal HDL cholesterol was associated with a 2 times higher risk of LLA when adjusted for age and BMI. Any paradoxical phenomena should be addressed carefully to avoid wrong clinical decision making that can harm the patient.


Assuntos
Diabetes Mellitus , Pé Diabético , Humanos , Pé Diabético/epidemiologia , Pé Diabético/cirurgia , Malásia/epidemiologia , Prognóstico , Fatores de Risco , Amputação , Extremidade Inferior/cirurgia , Estudos Retrospectivos
5.
Artigo em Inglês | MEDLINE | ID: mdl-36361140

RESUMO

INTRODUCTION: Acute respiratory infection (ARI) can significantly reduce postoperative quality of life and impair the recovery of older adult patients with lower-limb fractures, and its relationship with methods of anesthesia remains inconclusive. Using data from the National Health Insurance Research Database (NHIRD) of Taiwan, this study examined the data of patients who received surgical management for lower-limb fractures and compared those who underwent general anesthesia (GA) with those who underwent regional anesthesia (RA) in terms of their incidence of acute upper and lower respiratory infection during the one-month postoperative period. The study also identified related risk factors. MATERIAL AND METHODS: Approximately two million patients were randomly sampled from the NHIRD registry. We identified and enrolled patients with lower-limb fractures who were over 60 years old and underwent GA or RA during surgeries conducted between 2010 and 2017. We divided these patients into two groups for further analysis. The outcome of this study was the development of ARI during the one-month postoperative period. RESULTS: In total, 45,032 patients (GA group, 19,580 patients; RA group, 25,452 patients) with a mean age of 75.0 ± 8.9 years were included in our study. The incidence of postoperative ARI within one month of surgery was 8.0% (1562 patients) in the GA group and 9.5% (2412 patients) in the RA group, revealing a significant difference. The significant risk factors for the incidence of ARI were the application of RA for surgery, older age, hypertension, liver disease, and chronic obstructive pulmonary disease (COPD). A subgroup analysis revealed that the RA method was associated with a significantly higher ARI incidence relative to the GA method among patients aged between 60 and 80 years, among male patients, among the patients with or without any comorbidity and among the patients without COPD. CONCLUSION: The incidence of postoperative ARI within one month of surgery was higher among older patients with lower-limb fractures who received RA for surgery than among those who received GA for surgery. The other major risk factors for ARI were older age, hypertension, liver disease, and COPD. Therefore, we should focus on patients with a high risk of developing ARI, especially during the COVID-19 pandemic.


Assuntos
Raquianestesia , COVID-19 , Fraturas Ósseas , Hipertensão , Traumatismos da Perna , Doença Pulmonar Obstrutiva Crônica , Humanos , Masculino , Idoso , Pessoa de Meia-Idade , Idoso de 80 Anos ou mais , Raquianestesia/efeitos adversos , Incidência , Qualidade de Vida , Pandemias , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Anestesia Geral/efeitos adversos , Fraturas Ósseas/epidemiologia , Fraturas Ósseas/cirurgia , Extremidade Inferior/cirurgia , Doença Pulmonar Obstrutiva Crônica/etiologia , Hipertensão/complicações , Estudos Retrospectivos , Resultado do Tratamento
6.
Medicine (Baltimore) ; 101(45): e31661, 2022 Nov 11.
Artigo em Inglês | MEDLINE | ID: mdl-36397334

RESUMO

To observe the clinical efficacy of free inguinal flaps with retrograde blood supply anastomosis to repair skin and soft tissue defects in the limbs. A total of 25 patients with soft tissue defects of the limbs treated from January 2019 to December 2021 were selected and repaired with free inguinal flaps anastomotic with retrograde blood supply. All 25 skin flaps survived; 1 patient had skin flap infection and the wound healed gradually after symptomatic treatment, and 1 patient had venous embolism and the skin flap survived after re-anastomosis. The patients were followed up for 6 to 18 months after the operation. After healing, the patient recovered satisfactorily, and the flap had a good appearance, texture, and flexibility; a reoperation was not required. The patient was satisfied with the effect of the treatment. Retrograde vascular anastomosis with the anterolateral femoral perforator flap is safe and reliable for repairing the soft tissue defects of the limbs. It is convenient for micromanipulation and can achieve satisfactory clinical results, and thus is an ideal repair method.


Assuntos
Retalho Perfurante , Procedimentos Cirúrgicos Reconstrutivos , Lesões dos Tecidos Moles , Humanos , Lesões dos Tecidos Moles/etiologia , Lesões dos Tecidos Moles/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Retalho Perfurante/cirurgia , Anastomose Cirúrgica , Extremidade Inferior/cirurgia , Celulite (Flegmão)/cirurgia
7.
Anesth Analg ; 135(6): 1282-1292, 2022 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-36219577

RESUMO

BACKGROUND: Although neuraxial anesthesia may promote improved outcomes for patients undergoing lower limb revascularization surgery, its use is decreasing over time. Our objective was to estimate variation in neuraxial (versus general) anesthesia use for lower limb revascularization at the hospital, anesthesiologist, surgeon, and patient levels, which could inform strategies to increase uptake. METHODS: Following protocol registration, we conducted a historical cross-sectional analysis of population-based linked health administrative data in Ontario, Canada. All adults undergoing lower limb revascularization surgery between 2009 and 2018 were identified. Generalized linear models with binomial response distributions, logit links and random intercepts for hospitals, anesthesiologists, and surgeons were used to estimate the variation in neuraxial anesthesia use at the hospital, anesthesiologist, surgeon, and patient levels using variance partition coefficients and median odds ratios. Patient- and hospital-level predictors of neuraxial anesthesia use were identified. RESULTS: We identified 11,849 patients; 3489 (29.4%) received neuraxial anesthesia. The largest proportion of variation was attributable to the hospital level (50.3%), followed by the patient level (35.7%); anesthesiologists and surgeons had small attributable variation (11.3% and 2.8%, respectively). Mean odds ratio estimates suggested that 2 similar patients would experience a 5.7-fold difference in their odds of receiving a neuraxial anesthetic were they randomly sent to 2 different hospitals. Results were consistent in sensitivity analyses, including limiting analysis to patients with diagnosed peripheral artery disease and separately to those aged >66 years with complete prescription anticoagulant and antiplatelet usage data. CONCLUSIONS: Neuraxial anesthesia use primarily varies at the hospital level. Efforts to promote use of neuraxial anesthesia for lower limb revascularization should likely focus on the hospital context.


Assuntos
Anestesiologistas , Cirurgiões , Adulto , Humanos , Estudos Transversais , Anestesia Geral/efeitos adversos , Extremidade Inferior/cirurgia , Extremidade Inferior/irrigação sanguínea , Hospitais , Ontário , Estudos Retrospectivos
8.
Medicine (Baltimore) ; 101(38): e30412, 2022 Sep 23.
Artigo em Inglês | MEDLINE | ID: mdl-36197219

RESUMO

We focused on "returning to the horizontal position," one of the measures for preventing well leg compartment syndrome implemented at our hospital, and aimed to clarify the effect of intraoperative positional changes by operating table rotation on blood perfusion in the lower extremities during lithotomy in patients under general anesthesia. This prospective observational study examined 64 patients scheduled to undergo general anesthesia in the lithotomy position from March 2021 to May 2022. The primary endpoint was the perfusion index (PI) of the lower limb before and after operating table rotation. The baseline lower limb PI before the operating table rotation was 2.376 (1.591), and the lower limb PI after the change from Trendelenburg to the horizontal position was as follows: immediately after, 2.123 (1.405); 5 minutes, 1.894 (1.138); 10 minutes, 1.915 (1.167); and 15 minutes, 1.993 (1.218). Compared with the baseline, no significant difference was noted in the change in the lower limb PI due to the Trendelenburg to horizontal positional change. The baseline lower leg pressure before the operating table rotation was 51.4 (13.4) mm Hg, and the lower leg pressure after the change from the Trendelenburg to the horizontal position was as follows: immediately after, 36.6 (10.3) mm Hg; 5 minutes, 36.5 (10.2) mm Hg; 10 minutes, 36.4 (10.0) mm Hg; and 15 minutes, 36.5 (10.2) mm Hg. Compared with the baseline, the change in lower leg pressure due to the Trendelenburg to horizontal positional change showed a significant decrease immediately afterward (P < .001). After operating table rotation from the Trendelenburg to the horizontal position, the lower limb PI did not change significantly after 15 min. However, lower leg pressure showed a significant decrease immediately after returning to the horizontal position. This result provides evidence for operating table rotation as a preventive measure for well leg compartment syndrome.


Assuntos
Mesas Cirúrgicas , Humanos , Extremidade Inferior/cirurgia , Índice de Perfusão , Complicações Pós-Operatórias/prevenção & controle , Rotação
9.
Endocrinol Metab (Seoul) ; 37(5): 770-780, 2022 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-36222086

RESUMO

BACKGRUOUND: The present study investigates whether modifiable behavioral factors of current cigarette smoking, heavy alcohol consumption, and regular exercise are associated with risk of lower extremity amputation (LEA) in diabetic patients. METHODS: A total of 2,644,440 diabetic patients (aged ≥20 years) was analyzed using the database of the Korean National Health Insurance Service. Cox proportional hazard regression was used to assess adjusted hazard ratios (HRs) for the behavioral factors with risk of LEA under adjustment for potential confounders. RESULTS: The risk of LEA was significantly increased by current cigarette smoking and heavy alcohol consumption (HR, 1.436; 95% confidence interval [CI], 1.367 to 1.508 and HR, 1.082; 95% CI, 1.011 to 1.158) but significantly decreased with regular exercise (HR, 0.745; 95% CI, 0.706 to 0.786) after adjusting for age, sex, smoking, alcohol consumption, exercise, low income, hypertension, dyslipidemia, body mass index, using insulin or oral antidiabetic drugs, and diabetic duration. A synergistically increased risk of LEA was observed with larger number of risky behaviors. CONCLUSION: Modification of behaviors of current smoking, heavy alcohol intake, and exercise prevents LEA and can improve physical, emotional, and social quality of life in diabetic patients.


Assuntos
Diabetes Mellitus , Pé Diabético , Humanos , Pé Diabético/complicações , Qualidade de Vida , Fatores de Risco , Amputação , Exercício Físico , Extremidade Inferior/cirurgia , Consumo de Bebidas Alcoólicas/epidemiologia , Fumar/epidemiologia
10.
Zhongguo Gu Shang ; 35(10): 962-6, 2022 Oct 25.
Artigo em Chinês | MEDLINE | ID: mdl-36280413

RESUMO

The angle between the lower extremity force line and the position of the unicondylar prosthesis is an important factor affecting the long-term survival and rate clinical outcome of the unicondylar replacement prostheses. Insufficient lower limb alignment will accelerate the wear of prosthesis and reduce the survival rate of prosthesis. Excessive lower limb alignment will accelerate the progress of contralateral interventricular arthritis. It is generally believed that the lower limb force line should be corrected in mild varus after unicompartmental knee arthroplasty. However, some scholars believe that the lower limb alignment has no effect on the functional score and prosthesis survival rate after unicompartmental knee arthroplasty. The poor position of femoral and tibial prosthesis will cause unexplained pain and even prosthesis wear, but the optimal position of femoral and tibial prosthesis is controversial. It is generally believed that the posterior tibial slope should be corrected in the range of 3° to 7° in unicompartmental knee arthroplasty, but some scholars believe that excessive change of posterior tibial slope will also affect the balance of knee joint space and knee joint range of motion. This study shows that the correction of lower limb alignment to mild varus is still the best lower limb alignment for unicompartmental knee arthroplasty. The best position of femoral and tibial prosthesis needs to be confirmed by further biomechanical research. The correction of tposterior tibial slope should be changed according to the specific original dissection angle of patients before operation.


Assuntos
Artroplastia do Joelho , Prótese do Joelho , Osteoartrite do Joelho , Humanos , Articulação do Joelho/cirurgia , Tíbia/cirurgia , Osteoartrite do Joelho/cirurgia , Extremidade Inferior/cirurgia , Estudos Retrospectivos
11.
J Pak Med Assoc ; 72(9): 1788-1791, 2022 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-36280977

RESUMO

OBJECTIVE: To determine the relationship of muscular impairment and psychological health with lower extremity functions in patients with transtibial amputation. METHODS: The correlational study was conducted from March to September 2021 at the Fauji Foundation Hospital, Rawalpindi, Pakistan, and comprised male patients with transtibial amputation. Data was collected using the depression anxiety stress scale and the lower extremity functional scale. The correlation of muscular impairment and psychological health with lower extremity functions was determined. Data was analysed using SPSS 21. RESULTS: There were 85 male patients with a mean age of 53.74±11.30 years. There was weak iliopsoas muscle strength 4.64±0.50 and reduced muscle length of hamstrings 67.00±6.41 on the affected side. There was non-significant correlation in muscle atrophy of both amputated limb (p=0.82) and non-amputated limb (p=0.58) with lower extremity function. Significant inverse correlation was present between depression, anxiety and stress (p=0.001) with lower extremity function. CONCLUSIONS: Weak iliopsoas muscle strength and tight hamstrings were observed on the amputated side. Muscle atrophy was more in non-amputated limb than amputated limb. There was significant inverse correlation of depression, anxiety and stress with lower extremity function.


Assuntos
Amputação , Amputados , Humanos , Masculino , Adulto , Pessoa de Meia-Idade , Idoso , Extremidade Inferior/cirurgia , Atrofia Muscular , Músculo Esquelético
12.
Curr Oncol ; 29(10): 7598-7606, 2022 Oct 13.
Artigo em Inglês | MEDLINE | ID: mdl-36290877

RESUMO

BACKGROUND AND OBJECTIVES: Functional outcomes are important for oncology patients undergoing lower extremity reconstruction. The objective of the current study was to describe patient reported function after surgery and identify predictors of postoperative function in musculoskeletal oncology patients undergoing lower extremity endoprosthetic reconstruction. METHODS: We performed a cohort study with functional outcome data from the recently completed Prophylactic Antibiotic Regimens in Tumor Surgery (PARITY) trial. We utilized the 100-point Toronto Extremity Salvage Score (TESS), which was administered pre-operatively and at 3, 6 and 12 months post-operatively. Higher scores indicate better physical functioning, and the minimally important difference is 11 points. We calculated mean functional scores at each timepoint after surgery and developed a logistic regression model to explore predictors of failure to achieve excellent post-operative function (TESS ≥ 80) at 1 year after surgery. RESULTS: The 555 patients included in our cohort showed important functional improvement from pre-surgery to 1 year post-surgery (mean difference 14.9 points, 95%CI 12.2 to 17.6; p < 0.001) and 64% achieved excellent post-operative function. Our adjusted regression model found that poor (TESS 0-39) pre-operative function (odds ratio [OR] 3.3, 95%CI 1.6 to 6.6); absolute risk [AR] 24%, 95%CI 8% to 41.2%), older age (OR per 10-year increase from age 12, 1.32, 95%CI 1.17, 1.49; AR 4.5%, 95%CI 2.4% to 6.6%), and patients undergoing reconstruction for soft-tissue sarcomas (OR 2.3, 95%CI 1.03 to 5.01; AR 15.3%, 95%CI 0.4% to 34.4%), were associated with higher odds of failing to achieve an excellent functional outcome at 1-year follow-up. Patients undergoing reconstruction for giant cell tumors were more likely to achieve an excellent functional outcome post-operatively (OR 0.40, 95%CI 0.17 to 0.95; AR -9.9%, 95%CI -14.4% to -0.7%). CONCLUSIONS: The majority of patients with tumors of the lower extremity undergoing endoprosthetic reconstruction achieved excellent function at 1 year after surgery. Older age, poor pre-operative function, and endoprosthetic reconstruction for soft tissue sarcomas were associated with worse outcomes; reconstruction for giant cell tumors was associated with better post-operative function. LEVEL OF EVIDENCE: Therapeutic Level IV.


Assuntos
Tumores de Células Gigantes , Sarcoma , Neoplasias de Tecidos Moles , Humanos , Salvamento de Membro , Estudos de Coortes , Resultado do Tratamento , Sarcoma/cirurgia , Sarcoma/patologia , Extremidade Inferior/cirurgia , Extremidade Inferior/patologia , Tumores de Células Gigantes/cirurgia , Antibacterianos
16.
Afr J Prim Health Care Fam Med ; 14(1): e1-e10, 2022 Sep 30.
Artigo em Inglês | MEDLINE | ID: mdl-36226936

RESUMO

BACKGROUND: South Africa has a high prevalence of diabetes mellitus (DM), a leading risk factor for lower limb amputation (LLA). Lower limb amputation is associated with significant morbidity and mortality. Lower limb amputation incidence can be mitigated through prompt identification and treatment of individuals at risk and engagement in self-management practices. Also, when LLA is inevitable, outcomes or prognosis can be improved with timely surgery. AIM: This study explored the knowledge, attitude and perception of persons living with diabetes towards LLA and its prevention. SETTING: Nqamakwe, a rural community in the Eastern Cape province of South Africa. METHOD: This was a descriptive, qualitative study involving persons living with DM, with and without LLA, and community leaders. Fifteen participants were recruited purposively and conveniently from a rural community in the Eastern Cape, South Africa. Data collection took place through semistructured interviews, in English and a local language, Xhosa. Interviews were transcribed and translated, and an inductive approach was used for thematic analysis. RESULTS: A total of 15 individual interviews were conducted. Of those, 13 were persons with DM, five with LLA, including one with bilateral LLA. There was a gap in knowledge on foot self-examination as a measure of preventing LLA amongst persons with DM. The attitude of persons without LLA was mostly fearful and their fears centred around perioperative death, risk for contralateral amputation, loss of limb and independence. Consent to LLA procedure was a last resort and only when pain levels were unbearable. Family support and information on rehabilitation services and assistive devices also fostered consent to LLA surgery. CONCLUSION: There is a need for awareness creation and adequate health education for persons living with DM on LLA and its prevention measures, especially foot care practices. Also, health education programmes for persons living with DM in rural areas should address the various misperceptions of LLA to reduce delays.Contribution: The article revealed gaps in knowledge on LLA and its prevention among individuals living with diabetes as well as areas of concerns that may potentially delay acceptance when LLA is inevitable. Findings from our study may assist primary health care providers to determine important issues to be addressed during routine and pre-operative patient education.


Assuntos
Diabetes Mellitus , População Rural , Amputação/métodos , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Extremidade Inferior/cirurgia , Percepção , África do Sul
17.
Prosthet Orthot Int ; 46(5): 491-495, 2022 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-36215058

RESUMO

People with lower-limb loss (PLL) often have reduced mobility that translates into limited community access. The Life Space Questionnaire (LSQ) measures a person's real-world mobility within their home environment and community but has not been used among PLL. This study assessed preliminary LSQ test-retest reliability and discriminant validity from subjective and objective balance and walking measures in PLL. In addition, LSQ was hypothesized to have an inverse association with overall health status. Nine subjects were analyzed with mean age 48.2 ± 13.1 years and 4.8 ± 3.9 years' time since amputation. Six had transtibial and three had transfemoral amputations due to diabetes (4), vascular disease (3), and trauma (2). The primary outcome was the LSQ, a 9-level scale quantifying the extent to which people accessed their life space including home, yard, and community. Test-retest reliability for the LSQ was moderate (intraclass coefficient = 0.61 with 90% confidence interval: 0.19-0.87). Discriminant validity from balance and walking function was demonstrated by lack of correlation between LSQ score and the Activities-specific Balance Confidence and Berg Balance Scale and the Prosthetic Evaluation Questionnaire mobility subscale and walking speed (r < 0.50, P > .05). LSQ correlated with health status assessed with the Charlson Comorbidity Index (r = -0.84, P = .005). In this sample of PLL, the LSQ demonstrated moderate test-retest reliability as a measure of real-world mobility distinct as a construct from subjective and objective balance or walking measures. People may access their communities using various levels of assistance and methods of transportation. For this sample of PLL, health status was most strongly associated with LSQ score.


Assuntos
Membros Artificiais , Adulto , Humanos , Extremidade Inferior/cirurgia , Pessoa de Meia-Idade , Equilíbrio Postural , Reprodutibilidade dos Testes , Inquéritos e Questionários , Caminhada
18.
Sensors (Basel) ; 22(19)2022 Oct 02.
Artigo em Inglês | MEDLINE | ID: mdl-36236577

RESUMO

The increase of the aging population brings numerous challenges to health and aesthetic segments. Here, the use of laser therapy for dermatology is expected to increase since it allows for non-invasive and infection-free treatments. However, existing laser devices require doctors' manually handling and visually inspecting the skin. As such, the treatment outcome is dependent on the user's expertise, which frequently results in ineffective treatments and side effects. This study aims to determine the workspace and limits of operation of laser treatments for vascular lesions of the lower limbs. The results of this study can be used to develop a robotic-guided technology to help address the aforementioned problems. Specifically, workspace and limits of operation were studied in eight vascular laser treatments. For it, an electromagnetic tracking system was used to collect the real-time positioning of the laser during the treatments. The computed average workspace length, height, and width were 0.84 ± 0.15, 0.41 ± 0.06, and 0.78 ± 0.16 m, respectively. This corresponds to an average volume of treatment of 0.277 ± 0.093 m3. The average treatment time was 23.2 ± 10.2 min, with an average laser orientation of 40.6 ± 5.6 degrees. Additionally, the average velocities of 0.124 ± 0.103 m/s and 31.5 + 25.4 deg/s were measured. This knowledge characterizes the vascular laser treatment workspace and limits of operation, which may ease the understanding for future robotic system development.


Assuntos
Robótica , Extremidade Inferior/cirurgia , Robótica/métodos , Resultado do Tratamento
19.
JAMA Netw Open ; 5(10): e2235074, 2022 10 03.
Artigo em Inglês | MEDLINE | ID: mdl-36227599

RESUMO

Importance: Transcutaneous osseointegration post amputation (TOPA) creates a direct linkage between residual bone and an external prosthetic limb, providing superior mobility and quality of life compared with a socket prosthesis. The causes and potential risks of mortality after TOPA have not been investigated. Objective: To investigate the association between TOPA and mortality and assess the potential risk factors. Design, Setting, and Participants: This observational cohort study included all patients with amputation of a lower extremity who underwent TOPA between November 1, 2010, and October 31, 2021, at a specialty orthopedic practice and tertiary referral hospital in a major urban center. Patients lived on several continents and were followed up as long as 10 years. Exposures: Transcutaneous osseointegration post amputation, consisting of a permanent intramedullary implant passed transcutaneously through a stoma and connected to an external prosthetic limb. Main Outcomes and Measures: Death due to any cause. The hypotheses tested-that patient variables (sex, age, level of amputation, postosseointegration infection, and amputation etiology) may be associated with subsequent mortality-were formulated after initial data collection identifying which patients had died. Results: A total of 485 patients were included in the analysis (345 men [71.1%] and 140 women [28.9%]), with a mean (SD) age at osseointegration of 49.1 (14.6) years among living patients or 61.2 (12.4) years among patients who had died. Nineteen patients (3.9%) died a mean (SD) of 2.2 (1.7) years (range, 58 days to 5 years) after osseointegration, including 17 (3.5%) who died of causes unrelated to osseointegration (most commonly cardiac issues) and 2 (0.4%) who died of direct osseointegration-related complications (infectious complications), of which 1 (0.2%) was coclassified as a preexisting health problem exacerbated by osseointegration (myocardial infarction after subsequent surgery to manage infection). No deaths occurred intraoperatively or during inpatient recuperation or acute recovery after index osseointegration (eg, cardiopulmonary events). Kaplan-Meier survival analysis with log-rank comparison and Cox proportional hazards regression modeling identified increased age (hazard ratio, 1.06 [95% CI, 1.02-1.09]) and vascular (odds ratio [OR], 4.73 [95% CI, 1.35-16.56]) or infectious (OR, 3.87 [95% CI, 1.31-11.40]) amputation etiology as risk factors. Notable factors not associated with mortality risk included postosseointegration infection and male sex. Conclusions and Relevance: These findings suggest that patients who have undergone TOPA rarely die of problems associated with the procedure but instead usually die of unrelated causes.


Assuntos
Membros Artificiais , Osseointegração , Adulto , Amputação , Membros Artificiais/efeitos adversos , Feminino , Humanos , Extremidade Inferior/cirurgia , Masculino , Pessoa de Meia-Idade , Qualidade de Vida
20.
Pan Afr Med J ; 42: 154, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36187047

RESUMO

Introduction: for the treatment of varicose ulcer performed clinical and laboratory reasoning of the use of ultrasonic-assisted venous ulcer debridement and Platelet-rich plasma with radiofrequency ablation in an outpatient setting, was carried out. Methods: ultrasonic-assisted debridement of trophic ulcer were performed for 50 patients with lower extremity varicose veins at decompensation stage. The effectiveness of ultrasonic-assisted debridement was evaluated by indicators of bacteriological, morphological, cytological study and assessment of trophic ulcers according to the MEASURE system. After ultrasonic-assisted debridement, the patients were divided into two groups: 30 patients, who underwent combined Platelet-rich plasma to stimulate wound regeneration and 20 patients, for whom the Granuflex hydrocolloid bandage was applied for the same purpose. Results: a comparative analysis of ulcer regeneration in two groups of patients proved that in cases of platelet rich plasma the time of transition from inflammatory-regenerative type to regenerative one is much shorter than when using a hydrocolloid dressing. In 28 patients undergoing Platelet-rich plasma (PRP) and Platelet-rich fibrin (PRF), the radiofrequency ablation of the principal superficial and perforating veins was performed. Another 22 patients performed autodermoplasty of trophic ulcers after radiofrequency ablation. Conclusion: our experience has shown that in a one-day inpatient surgical clinic such a multidisciplinary approach to treatment of venous ulcers, including ultrasonic-assisted debridement that is stimulation of wounded process by Platelet-rich plasma with further surgeries to remove the causes of decompensated chronic insufficiency, is promising regarding low costs of treatment and rehabilitation of these patients.


Assuntos
Ablação por Cateter , Fibrina Rica em Plaquetas , Plasma Rico em Plaquetas , Úlcera Varicosa , Varizes , Desbridamento , Humanos , Extremidade Inferior/cirurgia , Úlcera , Ultrassom , Úlcera Varicosa/etiologia , Úlcera Varicosa/cirurgia , Varizes/complicações , Varizes/cirurgia , Cicatrização
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