Comparative Outcomes of Different Surgical Approaches for Non‐Lactational Mastitis With Posterior and Non‐Posterior Space Abscesses: A Retrospective Cohort Study

Postoperative data indicate that 15-30% of patients undergoing unicompartmental knee arthroplasty (UKA) experience moderate-to-severe pain during the early recovery period, impeding rehabilitation. Due to the complex innervation in the knee, continuous femoral nerve block (FNB) is often administered but provides incomplete analgesia. Although the analgesic effects of nerve blocks are well studied, less is understood about their effects on postoperative rehabilitation and gait kinematics. Thus, in this study, we aimed to investigate the impact of ultrasound-guided obturator nerve block (ONB) combined with FNB on gait kinematics in patients undergoing UKA. This is the first study to quantify the biomechanical benefits of ONB combined with FNB in patients undergoing UKA by gait analysis. Patients undergoing UKA and admitted to the Department of Orthopedics, People's Hospital of Ningxia Hui Autonomous Region between March 2024 and December 2024 were retrospectively enrolled. The patients were allocated based on their postoperative nerve block procedure into the FNB or FNB + ONB group, with 30 cases in each group. The FNB group underwent ultrasound-guided, single-shot FNB with catheterization, whereas the FNB + ONB group underwent additional ipsilateral ONB. Patient demographics, preoperative and postoperative visual analog scale (VAS) scores (at rest and during 30° knee flexion), adverse events, kinematic gait parameters, Knee Society Score, and range of motion were recorded. No intergroup differences were observed in the preoperative VAS scores (P > 0.05). Both groups showed improved postoperative VAS scores (P < 0.05) with comparable resting VAS scores (P > 0.05). The FNB + ONB group demonstrated significantly lower activity-associated VAS scores than did the FNB group (P < 0.05). Analgesic rescue needs and adverse event rates showed no intergroup differences (P > 0.05). The FNB + ONB group exhibited superior postoperative Knee Society Scores, greater range of motion, and reduced kinematic gait abnormalities compared with the FNB group (all, P < 0.05). ONB combined with FNB provides superior postoperative analgesia compared with FNB alone in patients undergoing UKA, particularly during activity, thereby facilitating early rehabilitation and mitigating postoperative gait disturbances.

To determine the relationship between the serum urate (SU) level, neutrophil / lymphocyte ratio (NLR), and pain severity using preoperative and postoperative visual analogue scale (VAS) scores in patients with lumbar disc herniation (LDH). This single-center, cross-sectional study included 20 consecutive patients who were operated for LDH by the same surgeon. The patients'pre- and postoperative UA levels, NLRs, and intensity severity VAS scores were investigated. Preoperative magnetic resonance imaging (MRI) findings, serum UA levels, and neutrophil and lymphocyte counts were recorded. Pain severity was recorded preoperatively and at 6 months postoperatively. Effects of the preoperative SU levels and NLRs on the pre- and postoperative VAS scores were statistically assessed. Statistically significant positive correlation coefficients were determined between NLR and the preoperative and postoperative VAS scores. Negative correlation coefficients were found between the SU levels and preoperative VAS scores; in contrast, positive correlation coefficients were found between the SU levels and the postoperative VAS scores. Our results demonstrate the importance of not ignoring the serum UA level and NLR in pre- and postoperative pain in patients with LDH. Nevertheless, further extensive studies are warranted.

Intertrochanteric fracture of the femur is a common fracture in older people. Due to the poor systemic condition and prognosis of elderly patients, it is prone to more complications. We introduce the bone-setting concept in the design of the robots, which are used for intertrochanteric fracture of the femur reduction. The purpose of this study is to compare the effect of bone-setting robots and conventional reduction in the treatment of intertrochanteric fracture of the femur (IFF). From June 2021 to January 2023, 60 patients with IFF who were treated surgically were assigned to bone-setting robots group and conventional reduction methods group in this retrospective study. The reduction time, operation time, total time, intraoperative blood loss, incision length, fluoroscopy time, and the follow-up time were reviewed. The visual analogue scale (VAS) and Harris scores were used for functional assessment. For continuous variables, independent t-tests were applied; for categorical data, the chi-square test was applied. The significance level as p < 0.05. Among the 60 patients with IFF, 31 were assigned to the bone-setting robots group, and 29 were assigned to the conventional reduction methods group. Both groups with a similar baseline in the number, gender, age, and classification (p > 0.05). The reduction time, operation time, total time, intraoperative blood loss, and fluoroscopy time were less than those in the bone-setting robots reduction group compared to the conventional reduction group. In the bone-setting robots reduction group, the preoperative VAS score was 6.2 ± 1.3, the Harris score was 35.3 ± 3.1, 1 week after surgery VAS score was 3.3 ± 1.2, the Harris score was 57.3 ± 3.7, and at the last follow-up VAS score was 2.4 ± 0.8, and the Harris score was 88.7 ± 3.4. While in the conventional reduction group, the preoperative VAS score was 6.3 ± 1.3, the Harris score was 35.9 ± 2.9, 1 week after surgery VAS score was 4.8 ± 1.4, the Harris score was 46.8 ± 2.8, and at the last follow-up VAS score was 2.6 ± 0.8, and the Harris score was 87.3 ± 3.3. There were no significant differences between the two groups at the preoperative and 6-month postoperative follow-ups in VAS score and Harris score (p > 0.05, p > 0.05, respectively). But the difference was statistically significant at the one-week postoperative follow-up in VAS and Harris scores (p < 0.001). The bone-setting robots can better protect the "fracture environment" and have the advantages of being precise, minimally invasive, simple, short time, low radiation, and rapid fracture recovery. The clinical effect of closed repair of IFF is ideal.

ObjectiveTo explore the clinical efficacy and advantages of Arthroscopic-assisted Uni-portal Spinal Surgery (AUSS)-Transforaminal Lumbar Interbody Fusion (TLIF) in the treatment of degenerative lumbar spinal stenosis (LSS).MethodsThis study included 71 patients with lumbar spinal stenosis who underwent surgical treatment at the Department of Spine Surgery, Second Affiliated Hospital of Xi’an Medical University, between January 2022 and December 2023. Among these, 34 patients underwent AUSS-TLIF surgery, and 37 patients underwent minimally invasive TLIF (MIS-TLIF) surgery. Preoperative and postoperative Visual Analog Scale (VAS) scores for low back and leg pain, Oswestry Disability Index (ODI) scores, intervertebral disc height, anterior-posterior diameter of the canal (APDC), surgical-related parameters (such as operative time, intraoperative blood loss, postoperative drainage, postoperative C-reactive protein levels, and length of hospital stay), and surgical outcomes were compared and analyzed between the AUSS-TLIF and MIS-TLIF groups.ResultsAll 71 patients were followed up. There were no significant differences in preoperative VAS scores or ODI index between the AUSS-TLIF and MIS-TLIF groups (P > 0.05). Three days postoperatively, both groups showed significant reductions in back and leg symptoms, with VAS scores significantly lower than preoperatively (P < 0.05). However, the AUSS-TLIF group had lower VAS scores at 3 days and 3 months postoperatively compared to the MIS-TLIF group, with a statistically significant difference (P < 0.05). At 12 months postoperatively, there was no significant difference in VAS scores between the two groups (P > 0.05). Both groups showed significant improvement in lumbar function at 3 and 12 months postoperatively, with ODI scores significantly lower than preoperatively (P < 0.05). However, the AUSS-TLIF group had a significantly lower ODI score at 3 months postoperatively compared to the MIS-TLIF group (P < 0.05), with no significant difference at 12 months (P > 0.05). There were no significant differences in preoperative intervertebral disc height or APDC between the two groups (P > 0.05). CT scans at 12 months postoperatively showed a significant increase in intervertebral disc height and APDC in both groups compared to preoperative values (P < 0.05), with no significant difference between the groups (P > 0.05). The AUSS-TLIF group had lower surgical blood loss, postoperative drainage, and postoperative inflammatory markers compared to the MIS-TLIF group (P < 0.05), but the AUSS-TLIF group had a significantly longer operative time compared to the MIS-TLIF group (P < 0.05).ConclusionBoth AUSS-TLIF and MIS-TLIF achieve good clinical outcomes, but AUSS-TLIF, as an endoscopic surgery with an open surgical concept, offers advantages including greater flexibility, smaller trauma, less blood loss, shorter operative time, and shorter hospital stay. It provides a better perioperative experience for patients.

Objective: This study aims to evaluate the results of disc restoration hydrogel implanted (GelstixTM) lumber disc hernia patients. Materials and Method: Patients suffering from chronic back pain diagnosed with lumber disc hernia who were admitted to Firat University Algology Clinic and treated with disc restoration hydrogel between January 2013 and January 2014 were evaluated. Cases were evaluated for demographic characteristics, magnetic resistance imaging findings, preoperative and postoperative visual analog scale (VAS) scores, complications, side effects, and patient satisfaction after the procedure. Results: Of the operated 62 patients were 25 male (40.3%) and 37 female (59.7%). The mean age of all patients was 49.18±14.18 years, the mean age of female patients was 50.81±13.37 years and the mean age of male patients was 46.76±15.27 years. The mean duration of pain in female and male patients was 37.81±37.92 months and 25.36±33.58 months, respectively. Preoperative and postoperative VAS scores of female patients were 8.24±1.09 and 3.56±2.11; male patients were 7.88±1.01 and 3.76±2.17, respectively. Of the 62 patients suffered from 16 right leg pain (25.8%), 20 left leg pain (32. 3%), and 26 bilateral lower limb pain (41.9%). Of 62 patients 31 had no additional disorders (50%), 12 had cardiac disorders (19.4%), 3 had (4.8%) respiratory disorders, 7 had endocrine disorders (11.3%), 4 had both endocrine and cardiac disorders (6.5%), 2 had both cardiac and respiratory disorders (3.2%), 1 had both endocrine and respiratory disorders (1.6%), and 2 had both endocrine, cardiac and respiratory disorders (3.2%). Of the 62 patients 25 had bulging (40.3%), 5 had protrusion (8.1%), 4 had narrowed neural foramen (6.5%), 18 had bulging+narrowed neural foramen (29%), 3 had narrowed neural foramen + protrusion (4.8%) and 7 had bulging + protrusion (11.3%). Thirteen patients hadn’t had previous therapy (20.97%), transforaminal steroid injection was applied to 29 patients (46.77%), and medical therapy (such as NSAID, miyorelactants) was applied to 20 (32.26%). Levels of complaints were 2 at L2-L3 (3. 2%), 17 at L3-L4 (27.4%), 28 at L4-L5 (45.2%), and 15 at L5-S1 (24.2%). Without L2-L3 level other operated levels had significant differences between preoperative VAS scores and postoperative VAS scores. The number of unsatisfied patients was 9 (14.5%), moderated satisfied patients number 16(25.8%), good satisfied patients number was 16 (25. 8%), and perfectly satisfied patients number was 21 (33.9%). Conclusion: Disc restoration hydrogel is a safe minimal invasive technique with satisfactory results, low complication rates, and low side effect risk especially in young and middle-aged patients.

To study the clinical characteristics of the patients with tiny lumbar disc herniation and severe symptoms(tLDHSS) and the therapeutic effects of percutaneous endoscopic lumbar discectomy(PELD). From January 2014 to February 2019, 34 patients with tLDHSS were reviewed retrospectively, including 20 males and 14 females, aged from 31 to 73 (48.8±10.1) years, with a follow up duration ranged from 8 to 48 (21.8±10.3) months. The clinical manifestations, imaging and surgical data were analyzed. The visual analogue scale (VAS) and Oswestry Disability Index (ODI) scores were analyzed before operation, 1 month after operation and at the latest follow-up. The preoperative and postoperativescores were compared. At the latest follow up, the Macnab system was used to evaluate the effects of the operation. The main symptom of 34 cases was severe radiation pain on one side of lower limbs. The duration of preoperative symptoms ranged from 0.33 to 84 months. The disc herniation was found in 7 cases of L4, 5 and 27 cases of L5S1. According to the MSU division of lumbar disc herniation, 31 cases were located in area B. In all cases, it was confirmed that the protruding nucleus compressed the nerve root, and in 26 cases, the nerve root was obviously inflamed. The operation time ranged from 30 to 80 min, with a mean time of (43.5±9.5) min. The preoperative VAS score was 8.1±1.3 and ODI score was 31.8±6.7. And the VAS score was 1.1± 0.3, 0.7±0.4 on the first month after operation and the latest follow up, respectively. The ODI score was 5.3±2.1 and 0 to 10 (with a median score of 2) on the first month after operation and the latest follow-up respectively. The postoperative VAS and ODI scores were improved compared with preoperative scores.At the latest follow up, 28 cases got an excellent result and 6 cases good according to Macnab evaluation system. During the follow-up period, only one patient had recurrent disc herniation. The main symptom of patients with tLDHSS is severe radiation pain on one side of lower limb. It manifests as sudden onset and shorter course of disease. Severe local inflammation was induced by local compression of the protruding nucleus pulposus on the nerve root out of the dura. For this kind of patients, thin layer CT scan has an important diagnostic value. In the treatment of this kind of patients, the symptoms are relieved rapidly, the curative effect is definite and the recurrence rate is low.

The aim of this study was to examine whether severity of preoperative pain intensity is related to postoperative pain and morphine consumption. Sixty consecutive patients scheduled for total hip surgery during intrathecal anesthesia were studied. Preoperative visual analog scale (VAS) scores and analgesic intake was assessed 1 day before surgery. Three groups of patients were identified: those with mild pain (n = 12, VAS score 0-4), moderate pain (n = 18, VAS score 4-7), and severe pain (n = 28, VAS score 7-10). Postoperative pain scores were recorded in the first 24 h, as was the amount of morphine delivered by the patient-controlled analgesia pump. There were no differences among the groups in VAS scores at any time. Severe preoperative pain levels correlated with significantly greater postoperative morphine intake. The mean morphine intake during the first 24 h postoperatively was 19.2 mg in the mild pain group, 21.2 mg in the moderate pain group, and 29.5 mg in the severe pain group (P < 0.05 compared with both other groups). We conclude that patients with severe preoperative pain self-medicate to achieve postoperative pain scores equivalent to those of patients with mild and moderate pain and require a greater postoperative morphine intake for adequate analgesia than patients with mild or moderate preoperative pain. In this study, we showed that severity of preoperative pain intensity relates to postoperative pain levels and morphine consumption. Patients scheduled for total hip surgery with severe preoperative pain require more postoperative morphine in the first 24 h.

Introduction/Objective Arthroscopic mechanical hand tools, motorized shavers, and bipolar radiofrequency are used in arthroscopic partial meniscectomy. The aim of this study is to evaluate efficacy of radiofrequency on early clinical outcomes in patients who underwent arthroscopic partial meniscectomy with horizontal cleavage tear and without additional intraarticular knee pathology. Methods A total of 37 patients complied with the study criteria. Patients were divided into two groups according to usage of bipolar radiofrequency. Patients were evaluated by using visual analog scale (VAS) and Tegner Lysholm knee scores at the end of the first year follow-up. Results Twenty-two patients comprised the shaver-using group. Preoperative mean VAS score was 7.9 ? 0.8, and the Tegner Lysholm knee score was 49.6 ? 9.6. Fifteen patients comprised the bipolar radiofrequency-using group. Preoperative VAS score was 7.8 ? 0.9, and the Tegner Lysholm knee score was 52.2 ? 10.7. The mean VAS score was 1.2 ? 0.9, and the mean Tegner Lysholm knee score was 89.5 ? 8.1 in shaver used group at last follow-up. At the last postoperative follow-up, the mean VAS score was 1.1 ? 1, and the Tegner Lysholm knee score was 88.8 ? 7.3 in the bipolar radiofrequency-using group. No statistically significant differences between the VAS and Tegner Lysholm knee scores of the preoperative and postoperative controls of the two groups were observed (p?0.05). Conclusion Radiofrequency use has no effect on early clinical outcomes in the arthroscopic treatment of isolated medial meniscus posterior horn horizontal cleavage tears; we do not recommend its use.

The primary aim was to identify potential risk factors for early conversion to total knee arthroplasty (TKA) in patients with high tibial osteotomy (HTO) surgery. A retrospective study was conducted and 240 patients received HTO surgery between January 2008 and January 2014 were included in this study. The associations between different clinical factors and HTO survivorship were analyzed. A logistic regression analysis was performed to detect independent risk factors for HTO survivorship. The cut-off value, sensitivity and specificity of these independent factors were calculated by receiver operating characteristic (ROC) curve. In this study, thirty-five (14.6%) patients were early conversion to TKA within a 5-year follow-up. These results indicated that age, body mass index (BMI), preoperative Kellgren-Lawrence (K-L) grade and preoperative visual analogue scale (VAS) score were potential risk factors for HTO survivorship. The cut-off values of those factors were 60 years, 25.35 kg/m2, 2 and 5, respectively. The combination of age, BMI, preoperative K-L grade and preoperative VAS score has the highest predictive value for HTO survivorship (AUC = 0.896, P < 0.001). Based on the present study, the five-year HTO survivorship for the treatment of medial compartment osteoarthritis of the knee was approximately 85.4%. We identified age >60 years, BMI >25.35 kg/m2, preoperative K-L grade >2 and preoperative VAS score >5 as independent risk factors for early conversion to TKA in patients with HTO surgery, and those factors combined had the highest predictive value for predicting early conversion to TKA.

Statistical Analysis of Total Labor Pain Using the Visual Analog Scale and Application to Studies of Analgesic Effectiveness During Childbirth

Preoperative pain sensitivity predicts postoperative pain severity and analgesics requirement in lumbar fusion surgery – a prospective observational study

Is Presurgical Pain Intensity Related to Postoperative Recurrence of Post-Traumatic Trigeminal Neuropathic Pain?

OBJECTIVE Prior studies have correlated preoperative depression and poor mental health status with inferior patient-reported outcomes following lumbar spinal procedures. However, literature regarding the effect of mental health on outcomes following cervical spinal surgery is limited. As such, the purpose of this study is to test for the association of preoperative SF-12 Mental Component Summary (MCS) scores with improvements in Neck Disability Index (NDI), SF-12 Physical Component Summary (PCS), and neck and arm pain following anterior cervical discectomy and fusion (ACDF). METHODS A prospectively maintained surgical database of patients who underwent a primary 1- or 2-level ACDF during 2014-2015 was reviewed. Patients were excluded if they did not have complete patient-reported outcome data for the preoperative or 6-week, 12-week, or 6-month postoperative visits. At baseline, preoperative SF-12 MCS score was assessed for association with preoperative NDI, neck visual analog scale (VAS) score, arm VAS score, and SF-12 PCS score. The preoperative MCS score was then tested for association with changes in NDI, neck VAS, arm VAS, and SF-12 PCS scores from the preoperative visit to postoperative visits. These tests were conducted using multivariate regression controlling for baseline characteristics as well as for the preoperative score for the patient-reported outcome being assessed. RESULTS A total of 52 patients were included in the analysis. At baseline, a higher preoperative MCS score was negatively associated with a lower preoperative NDI (coefficient: -0.74, p < 0.001) and preoperative arm VAS score (-0.06, p = 0.026), but not preoperative neck VAS score (-0.03, p = 0.325) or SF-12 PCS score (0.04, p = 0.664). Additionally, there was no association between preoperative MCS score and improvement in NDI, neck VAS, arm VAS, or SF-12 PCS score at any of the postoperative time points (6 weeks, 12 weeks, and 6 months, p > 0.05 for each). The percentage of patients achieving a minimum clinically important difference at 6 months did not differ between the bottom and top MCS score halves (p > 0.05 for each). CONCLUSIONS The results of this study suggest that better preoperative mental health status is associated with lower perceived preoperative disability but is not associated with severity of preoperative neck or arm pain. In contrast to other studies, the present study was unable to demonstrate that preoperative mental health is predictive of improvement in patient-reported outcomes at any postoperative time point following an ACDF.

The Reliability of Remembered Pretreatment Visual Analog Scale Scores among Hand-Surgery Patients

Thymectomy is indicated in the presence of primary thymic diseases such as thymoma. However, there is no clear conclusion which is the best surgical approach for thymectomy. We performed this network meta-analysis (NMA) to compare the outcomes of different surgical approaches for thymectomy. An exhaustive search of PubMed, Excerpt Medica Database (EMBASE), Web of Science and the Cochrane Central Register of Controlled Trials (CENTRAL) was conducted to identify relevant studies from inception to May 1, 2024. Direct and indirect evidence was combined to calculate the odds ratios (ORs) or standardized mean differences (SMDs), along with their 95% confidence intervals (CIs). Cluster analyses were adopted to compare the outcomes of different surgical approaches according to the similarity of two variables. Publication bias was detected by comparison-adjusted funnel plots. Fifty-eight studies were enrolled in this NMA, involving four surgical approaches: thoracotomy (TORA), robot-assisted thoracoscopic surgery (RATS), video-assisted thoracoscopic surgery (VATS) and subxiphoid video-assisted thoracoscopic surgery (SPT). The results indicated that in terms of blood loss, RATS was the least, and TORA had more blood loss than VATS and SPT. As for pleural drainage volume, TORA had more pleural drainage volume than VATS and SPT. In terms of visual analogue scale (VAS) score, VATS and TORA had higher VAS scores than SPT. The complete stable remission (CSR) of RATS was superior to that of VATS and TORA. SPT has faster postoperative recovery and less postoperative pain, and other perioperative outcomes are not inferior to other surgical approaches. RATS is safer and has certain clinical advantages in CSR. We look forward to more large-sample, high-quality randomized controlled studies published in the future.