RESUMO
INTRODUCTION: To determine whether immobilization after arthroscopic rotator cuff repair improved tendon healing compared with early passive motion. MATERIALS AND METHODS: A systematic electronic literature search was conducted to identify randomized controlled trials (RCTs) comparing early passive motion with immobilization after arthroscopic rotator cuff repair. The primary outcome assessed was tendon healing in the repaired cuff. Secondary outcome measures were range of motion (ROM) and American Shoulder and Elbow Surgeons (ASES) shoulder scale, Simple Shoulder Test (SST), Constant, and visual analog scale (VAS) for pain scores. Pooled analyses were performed using a random effects model to obtain summary estimates of treatment effect with 95% confidence intervals. Heterogeneity among included studies was quantified. RESULTS: Three RCTs examining 265 patients were included. Meta-analysis revealed no significant difference in tendon healing in the repaired cuff between the early-motion and immobilization groups. A significant difference in external rotation at 6 months postoperatively favored early motion over immobilization, but no significant difference was observed at 1 year postoperatively. In one study, Constant scores were slightly higher in the early-motion group than in the immobilization group. Two studies found no significant difference in ASES, SST, or VAS score between groups. CONCLUSION: We found no evidence that immobilization after arthroscopic rotator cuff repair was superior to early-motion rehabilitation in terms of tendon healing or clinical outcome. Patients in the early-motion group may recover ROM more rapidly. LEVEL OF EVIDENCE: Level II; systematic review of levels I and II studies.
Assuntos
Artroscopia/reabilitação , Terapia por Exercício/métodos , Imobilização , Cuidados Pós-Operatórios/métodos , Lesões do Manguito Rotador , Lesões do Ombro , Traumatismos dos Tendões/cirurgia , Humanos , Modelos Estatísticos , Medição da Dor , Amplitude de Movimento Articular , Manguito Rotador/cirurgia , Articulação do Ombro/fisiologia , Articulação do Ombro/cirurgia , Traumatismos dos Tendões/reabilitação , Resultado do Tratamento , CicatrizaçãoRESUMO
OBJECTIVE: To investigate the clinical effect of the nervus cutaneus femoris posterior pedicle flap on repairing large soft tissue defects at the heel or inferior segment of the shank. METHODS: Totally 14 cases were followed up for 8-22 months (mean 15.5 months) to observe the clinical effects of nervus cutaneus femoris posterior pedicle flap on repairing large soft tissue defects of the heel or inferior segment of the shank. Among them, there were 3 patients afflicted with infection and cutaneous defects in the middle and inferior segment of the shank after internal fixation of open fracture, 4 patients with soft tissue defects of the ankle and uncovered tendo calcaneus, and 7 patients with soft tissue defects of the heel and exposed calcaneus. RESULTS: The flaps survived well in 13 cases and partial necrosis occurred in 1 case that was thereafter cured with changing dressing. Various extents of pain and stiffness of the knee joints were present in all cases and disappeared through 1-8 weeks' (mean 3.2 weeks) functional exercises. The last follow-up showed that all the flaps kept good texture and satisfactory appearance. CONCLUSIONS: The nervus cutaneus femoris posterior pedicle flap, having the advantages of simple surgical procedures, anastomosing the nerves and restoring the sensation of recipient site, can be used for recovering large soft tissue defects of the shank and ankle.
Assuntos
Calcanhar/cirurgia , Perna (Membro)/cirurgia , Lesões dos Tecidos Moles/cirurgia , Retalhos Cirúrgicos , Adolescente , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
Percutaneous vertebroplasty is a minimally invasive technique for treating vertebral compression fractures and tumors. Although percutaneous vertebroplasty is considered a relatively safe and technically simple procedure, it is also associated with life-threatening complications as a result of cement leakage, including cardiac perforation and pulmonary embolism. A 63-year-old woman underwent percutaneous vertebroplasty for an L3 vertebral fracture and had cement leaks into the inferior vena cava, pulmonary arteries, and right heart chambers, with a free wall perforation. Surgical removal of the cement emboli was recommended as a result of apparent penetration of the ventricle and the fragile nature of polymethyl methacrylate. A cardiopulmonary bypass was immediately performed via a right atriotomy. A foreign body 10 cm in length was removed from the right atrium and ventricle. Arteriotomies were then performed, and 4 cement filaments were retrieved from the pulmonary arteries. The inferior vena cava was also surgically opened, allowing extraction of a cement fragment that was 12 cm long. The postoperative course was uneventful, and the patient fully recovered. This is the first report of the migration of a cement fragment larger than 10 cm that had migrated and embedded in the heart chamber. This report showed that imaging analysis is valuable when cement leakage is detected during percutaneous vertebroplasty and can be used to avoid serious complications and improve patient outcomes.
Assuntos
Cimentos Ósseos , Migração de Corpo Estranho/cirurgia , Traumatismos Cardíacos/cirurgia , Polimetil Metacrilato , Complicações Pós-Operatórias/cirurgia , Embolia Pulmonar/cirurgia , Veia Cava Inferior/cirurgia , Vertebroplastia , Feminino , Fraturas por Compressão/cirurgia , Átrios do Coração/cirurgia , Ventrículos do Coração/cirurgia , Humanos , Vértebras Lombares/lesões , Vértebras Lombares/cirurgia , Pessoa de Meia-Idade , Fraturas da Coluna Vertebral/cirurgiaRESUMO
Patient-specific instrumentation (PSI) has been introduced as a tool to increase the accuracy of total knee arthroplasty (TKA) compared with conventional instrumentation (CLI). However, previous studies have shown inconsistent results. The authors conducted a meta-analysis to compare the performance of PSI to CLI in TKA. PubMed, EMBASE, and Cochrane Central Register of Controlled Trials electronic databases were systematically searched to identify eligible trials published between 2000 and March 2014. Two reviewers independently assessed methodological quality according to the Cochrane Handbook. Subgroup analyses were performed based on the different study designs (randomized, controlled trial [RCT] vs non-randomized, controlled trial [non-RCT]), preoperative magnetic resonance imaging vs computed tomography, and systems of PSI to explore the source of heterogeneity. Fourteen studies (7 RCTs and 7 non-RCTs) involving 1906 patients were included. There were no statistical differences with respect to the outliers of mechanical axis, coronal femoral component, sagittal femoral component, femoral component rotation, operative time, blood loss, and length of hospital stay between PSI and CLI groups. The number of outliers in coronal tibial components (odds ratio, 2.29; 95% confidence interval, 1.20 to 4.35; P=.01) and sagittal tibial components (odds ratio, 1.67; 95% confidence interval, 1.16 to 2.42; P<.01) was significantly lower in the CLI group than in the PSI group. Based on the numbers available, the use of PSI compared with CLI was not likely to improve the accuracy of component alignment and treatment effects of TKA. Further high-quality RCTs are warranted to confirm the authors' results.
Assuntos
Artroplastia do Joelho/instrumentação , Humanos , Prótese do Joelho , Reprodutibilidade dos Testes , Cirurgia Assistida por ComputadorAssuntos
Placas Ósseas/efeitos adversos , Clavícula/lesões , Fixação Interna de Fraturas/efeitos adversos , Fraturas Ósseas/cirurgia , Dor Pós-Operatória/diagnóstico , Adulto , Clavícula/cirurgia , Feminino , Seguimentos , Fixação Interna de Fraturas/instrumentação , Humanos , Masculino , Pessoa de Meia-Idade , Medição da Dor , Dor Pós-Operatória/etiologia , Dor Pós-Operatória/prevenção & controle , Resultado do TratamentoRESUMO
Rotator cuff tears have a high recurrence rate, even after arthroscopic rotator cuff repair. Although some biomechanical evidence suggests the superiority of the double-row vs the single-row technique, clinical findings regarding these methods have been controversial. The purpose of this study was to determine whether the double-row repair method results in a lower incidence of recurrent tearing compared with the single-row method. Electronic databases were systematically searched to identify reports of randomized, controlled trials (RCTs) comparing single-row with double-row rotator cuff repair. The primary outcome assessed was retear of the repaired cuff. Secondary outcome measures were the American Shoulder and Elbow Surgeons (ASES) shoulder score, the Constant shoulder score, and the University of California, Los Angeles (UCLA) score. Heterogeneity between the included studies was assessed. Six studies involving 428 patients were included in the review. Compared with single-row repair, double-row repair demonstrated a lower retear incidence (risk ratio [RR]=1.71 [95% confidence interval (CI), 1.18-2.49]; P=.005; I(2)=0%) and a reduced incidence of partial-thickness retears (RR=2.16 [95% CI, 1.26-3.71]; P=.005; I(2)=26%). Functional ASES, Constant, and UCLA scores showed no difference between single- and double-row cuff repairs. Use of the double-row technique decreased the incidence of retears, especially partial-thickness retears, compared with the single-row technique. The functional outcome was not significantly different between the 2 techniques. To improve the structural outcome of the repaired rotator cuff, surgeons should use the double-row technique. However, further long-term RCTs on this topic are needed.
Assuntos
Artroscopia/métodos , Lesões do Manguito Rotador , Humanos , Incidência , Complicações Pós-Operatórias , Recidiva , Manguito Rotador/cirurgia , Resultado do TratamentoRESUMO
OBJECTIVE: To explore the solution of choosing the minimally invasive incision site for gluteal muscle contracture patient based on standard injection point of gluteal muscle. METHODS: from September 2008 to August 2010, 25 patients (14 males and 11 females with an average of 16.5 years, ranging from 12 to 26 years) with injected gluteal muscle contracture were prospectively studied. The course of disease was from 6 to 12 years. Firstly, the connective skin Surface line from anterior superior iliac spine to coccyx (line AD) was delineated and the point (point O) was marked out as the standard gluteal muscle injection site which was on the one-third of the distance from the anterior superior iliac spine(point A) to the coccyx (point D). Secondly, the anterior and posterior edge lines of surface projection of the gluteal muscle contracture banding (line a, line p) were delineated. Thirdly, the distance from B to O and C to O (B is the point of intersection of line a and line AD,C is the point of intersection of line P and line AD)were measured which was the intersection of line a,p and line AD to point O. Lastly, the minimally invasive surgery was operformed via the skin entry of point C. RESULTS: OB = (0 +/- 0.76) cm, OC = (2.86 +/- 0.78) cm, BC = (2.86 +/- 1.01) cm,the mean postoperative drainage was less than 10 ml,there was no nerve damage,hematoma and other complications. All patients achieved the function of squatting in 4 to 6 days. CONCLUSION: The solution of choosing the minimally invasive incision site based on standard injection point of gluteal muscle has advantages of positioning precisely,handling easily, recoverying quickly, less trauma and safety, etc.
Assuntos
Nádegas , Contratura/cirurgia , Músculo Esquelético/cirurgia , Adolescente , Adulto , Criança , Feminino , Humanos , Injeções Intramusculares , Masculino , Procedimentos Cirúrgicos Minimamente InvasivosRESUMO
OBJECTIVE: To study the strategy of the treatment for dislocation of cervical vertebra. METHODS: The clinical data of 39 cases with dislocation of cervical vertebra were analyzed. Among them,29 were male and 10 were female. The average age was 40 years old (range from 6 to 74 years old). Segment of dislocation: 15 cases in C(1,2), 1 case in C(3,4), 9 cases in C(4,5), 9 cases in C(5,6), 5 cases in C(6,7). Spinal injury according to Frankel grade, 9 cases were A grade,8 were B, 5 were C, 8 were D, 8 were E, 1 case had radicular symptom. Thirty-two cases were early and rapidly treated with traction (progressive weight). Seventeen cases were treated with operation. RESULTS: Traction-reduction was successful in 90% of patients. According to Frankel grade, 32 cases averagely improved 0.63 grades. Six cases of severe spinal injury accompany with interlocking of zygopophysis died. CONCLUSION: Inspecting weight of traction is important in rapid traction-reduction for dislocation of cervical vertebra. The choice of surgical treatment depends on the degree of reduction, the result of MRI,the grade of spinal trauma and the status of patients.