Average Visual Analog Scale Score Research Articles

Ultrasound-Guided Quadratus Lumborum Block Combined with General Anaesthesia or General Anaesthesia Alone for Laparoscopic Radical Gastrectomy for Gastric Adenocarcinoma: A Monocentric Retrospective Study.

PurposeTo investigate, in patients with gastric carcinoma undergoing laparoscopic radical gastrectomy, the effects of ultrasound-guided quadratus lumborum block (UG-QLB) combined with general anaesthesia (GA) on the postoperative recovery compared with GA alone.Patients and MethodsThe retrospective study enrolled 231 patients with gastric carcinoma undergoing laparoscopic radical gastrectomy, including 119 patients who received UG-QLB combined with GA (Group QG), and 112 patients undergoing GA alone (Group GA). The primary endpoint was the postoperative 3-year recurrence-free survival (RFS). The secondary endpoints were the average visual analogue scale (VAS) scores within 48 h after surgery, the first time of postoperative ambulation, the first time of flatus, postoperative hospitalization, perioperative opioid requirement and adverse effects after surgery.ResultsUG-QLB combined with GA did not affect the 3-year RFS in patients undergoing laparoscopic radical gastrectomy (HR 0.659, 95% CI 0.342–1.269, P=0.212). However, the VAS ranking analysis implicated that it could significantly alleviate the postoperative pain in laparoscopic radical gastrectomy patients (P<0.01). In addition, it dramatically facilitated the early recovery of postoperative ambulation and flatus, while shortening the duration of postoperative hospitalization (P<0.01). The most important was it could remarkably reduce the opioid consumption (P<0.01), which in the meanwhile, reduced the incidence of postoperative nausea and vomiting (PONV) (P=0.01).ConclusionAlthough UG-QLB combined with GA did not improve the 3-year RFS for patients with gastric carcinoma undergoing laparoscopic radical gastrectomy, it could provide satisfactory postoperative pain relief, reduce opioid consumption and adverse effects, which subsequently facilitates postoperative early rehabilitation.

Clinical Outcomes of Fifth Metatarsal Fractures using Jones Fracture-Specific Screw vs Intramedullary Fixation

Category: Midfoot/Forefoot Introduction/Purpose: Fractures of the proximal fifth metatarsal (Jones fractures) are common foot injuries in both athlete and nonathlete populations, given repetitive loading of the lateral column during gait. Intramedullary screw fixation is the current most common surgical management for Jones fractures, but high rates of nonunion and refracture as well as hardware prominence are reported with existing implant options for this fracture pattern. The Jones bolt is a novel surgical treatment for Jones fractures which aims for more anatomic fixation of this injury. The purpose of this study was to compare the Jones bolt to intramedullary screw fixation with regard to complication rates and patient reported outcomes. Methods: A retrospective single-surgeon case series was approved by our institutional review board. A sample of both athletes as well as nonathletes with proximal fifth metatarsal fractures treated with either intramedullary screw fixation or the Jones bolt was collected. Demographic data, patient reported outcomes, and complication rates were analyzed. Results: Patients reported significant improvements in both visual analog scale (VAS) and the American Orthopaedic Foot &amp; Ankle Society (AOFAS) scores following operative fixation of Jones fractures (Table 1). The average VAS score improved from 5.4+-2.6 preoperatively to 1.4+-1.7 postoperatively (p&lt;0.0001). The average AOFAS score improved from 59.0+-13.2 preoperatively to 186.0+-11.2 postoperatively (p&lt;0.0001). There was no difference in final postoperative VAS (1.4 vs. 1.4; p=0.9702) or AOFAS (87.7 vs 85.7; p=0.4262) or overall change of VAS (3.8 vs. 3.5; p=0.8219) or AOFAS (20.5 vs. 25.0; p=0.6613) for Jones bolt versus all other types of fixation. Conclusion: The Jones bolt is a novel treatment for proximal fifth metatarsal fractures, with noninferior outcome scores and complication rates when compared with intramedullary screw fixation. Long-term follow-up and larger sample sizes are indicated to assess for superiority of the Jones bolt.

Multicenter Retrospective Analysis of Intradiscal Condoliase Injection Therapy for Lumbar Disc Herniation.

Background and Objectives: Intradiscal injection of Condoliase (chondroitin sulfate ABC endolyase), a glycosaminoglycan-degrading enzyme, is employed as a minimally invasive treatment for lumbar disc herniation (LDH) and represents a promising option between conservative treatment and surgical intervention. Since its 2018 approval in Japan, multiple single-site trails have highlighted its effectiveness, however, the effect of LDH types, and influences of patient age, sex, etc., on treatment success remains unclear. Moreover, data on teenagers and elderly patients has not been reported. In this retrospective multi-center study, we sought to classify prognostic factors for successful condoliase treatment for LDH and assess its effect on patients < 20 and ≥70 years old. Materials and Methods: We reviewed the records of 137 LDH patients treated through condoliase at four Japanese institutions and assessed its effectiveness among different age categories on alleviation of visual analog scale (VAS) of leg pain, low back pain and numbness, as well as ODI and JOA scores. Moreover, we divided them into either a “group-A” category if a ≥50% improvement in baseline leg pain VAS was observed or “group-N” if VAS leg pain improved <50%. Next, we assessed the differences in clinical and demographic distribution between group-A and group-N. Results: Fifty-five patients were classified as group-A (77.5%) and 16 patients were allocated to group-N (22.5%). A significant difference in Pfirrmann classification was found between both cohorts, with grade IV suggested to be most receptive. A posterior disc angle > 5° was also found to approach statical significance. In all age groups, average VAS scores showed improvement. However, 75% of adolescent patients showed deterioration in Pfirrmann classification following treatment. Conclusions: Intradiscal condoliase injection is an effective treatment for LDH, even in patients with large vertebral translation and posterior disc angles, regardless of age. However, since condoliase imposes a risk of progressing disc degeneration, its indication for younger patients remains controversial.

Arthroscopic anterior talofibular ligament repair with Internal Brace and lasso-loop technique for chronic ankle lateral instability.

To introduce the surgical technique and clinical outcomes of arthroscopic anterior talofibular ligament (ATFL) repair using the Internal Brace and lasso-loop technique for chronic ankle lateral instability. A retrospective study was performed on 29 patients who underwent all-arthroscopic ATFL repair with the Internal Brace and lasso-loop technique from January to August 2020. The patients included 24 males and five females, with a mean age of 30.17years. Through the accessory anterolateral (AAL) portal, we drilled the bone tunnels and fixed the tape with 4.75mm and 3.5mm "SwiveLock" anchors and reattached the torn ligament by the lasso-loop technique. All 29 patients underwent all-arthroscopic procedures smoothly without serious complications, such as infection and important nerve or vessel injuries. There were eight cases of lateral malleolar avulsion fractures and ten cases of talus cartilage injury. The visual analog scale (VAS), Karlsson-Peterson, Tegner, and American Orthopedic Foot and Ankle Society (AOFAS) scores were used to evaluate the clinical consequences. All the patients were followed up for 18.66 ± 4.85months on average. The average pre-operative VAS score was 4.69 ± 1.04, which was significantly higher than the average post-operative VAS score of 1.14 ± 1.56. At the final follow-up appointments, the averages of Karlsson-Peterson, AOFAS, and Tenger scores were 75.83 ± 9.44, 88.31 ± 6.81, and 6.93 ± 1.79, respectively, which was significantly higher than that before the operation. This arthroscopic anterior talofibular ligament repair with the Internal Brace and lasso-loop technique achieves satisfactory clinical outcomes with the benefits of high safety and reliability for chronic ankle lateral instability.

A comparison of cemented and cementless intra-neck curved stem use during hip-preserving reconstruction following massive femoral malignant tumor removal.

BackgroundPatients who undergo massive femoral malignant tumor (MFMT) resection often exhibit shortened femoral metaphyseal juxta-articular segments. The use of a customized femoral endoprosthesis (CFE) with an intra-neck curved stem (INCS) has emerged as a viable reconstructive surgical strategy for these individuals. Relative to a cemented INCS, it remains unclear as to whether cementless INCS use is associated with improvements in functionality or reconstructive longevity. As such, the present study was conducted to compare functional outcomes, endoprosthetic survival, and endoprosthesis-related complication rates in patients undergoing cemented and cementless INCS implantation.MethodsA total of 24 patients undergoing lower limb salvage and reconstructive surgical procedures utilizing cemented or cementless INCS endoprostheses were retrospectively included. Patient-functional outcomes, endoprosthetic survival, and complication rates were compared as a function of age; diagnosis; the length of femoral resection; residual proximal femur length; Musculoskeletal Tumor Society (MSTS) scores; visual analog scale (VAS) scores; and the rates of implant breakage, periprosthetic infections, periprosthetic fractures, and aseptic loosening.ResultsThe mean follow-up was 56 months. Significant differences in the length of femoral resection (p<0.001) and residual proximal femur length were observed (p<0.001) between the cemented and cementless INCS groups. There were no differences in overall patient survival and aseptic loosening-associated endoprosthesis survival in the cemented and cementless groups. None of the included patients experienced periprosthetic fractures, infections, or implant breakage. Average respective MSTS and VAS scores did not differ between groups.ConclusionFor patients undergoing treatment for MFMTs, the use of a CFE with an INCS has emerged as a viable approach to hip-preserving reconstructive surgery. With appropriately designed individualized rehabilitative programs, good functional outcomes can be achieved for these endoprostheses, which are associated with low complication rates. Moreover, the selection between cemented or cementless INCS in the clinic should be made based on patient-specific factors, with cementless INCS implementation being preferable in younger patients with good-quality bone, the potential for long-term survival, and the osteotomy site near the lesser trochanter, whereas cemented INCS use should be favored for individuals who are older, have a shorter life expectancy, or have poor bone quality.

Outcomes of Posterior Monteggia Variant Fractures Repaired Through a Trans-Olecranon Approach

To evaluate the clinical and radiographic outcomes and complications following surgical treatment of adult posterior Monteggia fracture variants in which coexisting radial head and coronoid fractures were addressed through a single extensile posterior trans-olecranon approach. We performed a retrospective review from January 1, 2010, to January 1, 2021, of all adult patients who underwent fixation of posterior Monteggia variant fractures with coexisting radial head and/or coronoid fractures through a trans-olecranon approach by a single surgeon. Patient records were reviewed for postoperative complications and radiographic outcomes. All patients were contacted to participate in a repeat clinical examination and functional assessment. Thirteen patients met the inclusion criteria, of which 7 agreed to participate. Final follow-up was conducted at an average of 49 months postoperatively. Six patients had a coexisting radial head fracture, 1 had a radial neck fracture, and all 7 patients had a coronoid fracture. All 7 coronoid fractures were repaired, 2 patients had internal fixation of the radial head, and 5 had radial head replacement. Four patients underwent reoperation. There were no cases of infection or heterotopic ossification, and all patients achieved radiographic bony union. The average final range of motion was 13°-133° flexion-extension (range: 0°-30° extension to 125°-145° flexion), 76° pronation (range: 70°-90°) and 72° supination (range: 60°-90°). The average Mayo Elbow Performance Score was 86 (range: 70-100), average Visual Analog Scale score was 1.4 (range: 0-3), and average Disabilities of the Arm, Shoulder, and Hand score was 9.8 (range: 0.83-35.83). Use of a single extensile trans-olecranon exposure offers reliable visualization and access to all bony structures requiring repair while minimizing soft tissue disruption. Patients treated with this trans-olecranon surgical approach demonstrate satisfactory clinical and radiographic outcomes with low rates of heterotopic ossification, nonunion, and infection. Therapeutic IV.

Arthroscopy-assisted bone grafting for the treatment of SNAC stage I without radial styloidectomy.

To report the clinical and radiological outcomes of arthroscopic bone grafting and percutaneous K-wire fixation without radial styloidectomy in patients with scaphoid nonunion advanced collapse (SNAC).We retrospectively analyzed the records of 15 patients with SNAC who were treated with arthroscopic bone grafting and percutaneous K-wire fixation and subsequently followed up for a minimum of 1 year between November 2009 and March 2018. The clinical outcomes were evaluated by comparing the range of motion (ROM), grip strength, the modified Mayo Wrist Score, and visual analog scale (VAS) scores for pain, all of which were measured preoperatively and at the last follow-up. The radiologic outcomes were evaluated by comparing the scapholunate (SL) and radiolunate (RL) angles preoperatively and at the last follow-up.All 15 cases of nonunion were resolved. The average radiologic union time was 9.7 ± 1.2 weeks. The average VAS score increased from 5.7 ± 2.3 (range, 2 − 10) preoperatively to 1.3 ± 1.3 (range, 0 − 3) at the last follow-up (P < .05). The average modified Mayo wrist score increased from 58.3 ± 14.0 preoperatively to 80.0 ± 9.2 at the last follow-up (P < .05). The mean ROM of the wrist improved, but there was no statistical significance. At the last follow-up, the mean flexion and radial deviation on the affected side were significantly decreased, and the mean extension on the affected side was significantly improved compared to the normal side (P < .05). The mean preoperative SL and RL angles were 66 ± 11.9° and 7.2 ± 6.8°, respectively, and were decreased to 50.4 ± 7.5° and 6.4 ± 5.2°, respectively, at the last follow-up. The mean SL angle was significantly corrected (P = .01).Arthroscopic bone grafting and percutaneous Kerschner (K)-wire fixation without radial styloidectomy are considered to be very effective methods for correcting scaphoid deformities to treat SNAC stage I. However, caution may be needed during the surgery to prevent reductions in flexion and the radial deviation of the wrist.

The effectiveness of ARISCAT Risk Index, other scoring systems, and parameters in predicting pulmonary complications after thoracic surgery.

The Assess Respiratory Risk in Surgical Patients in Catalonia (ARISCAT) risk index, which is frequently used in nonthoracic surgery, may not be sufficient to predict postoperative pulmonary complications (PPCs). We aimed to evaluate the effectiveness of the ARISCAT risk index, ASA, preoperative albumin level, neutrophil/lymphocyte ratio (NLR), and other parameters in predicting PPCs after thoracic surgery.Patients undergoing elective thoracic surgery with 1-lung ventilation (OLV) were prospectively analyzed. Demographic data, ARISCAT score, ASA, Nutritional Risk Score-2002, NLR, white blood cell counts, albumin, hemoglobin levels, intraoperative complications, postoperative average visual analogue scale (VAS) score for pain at the 24th-hour, the length of stay in the postoperative intensive care unit, chest tube removal time, postoperative complications, and discharge time were recorded. Patients were assessed for morbidity and mortality on the 90th-day.120 patients’ data were analyzed. PPCs developed in 26 patients. The development of PPCs was statistically significant in patients with high ARISCAT scores (P = .002), high ARISCAT grades (P = .009), and ASA III (P = .002). The albumin level was statistically significantly lower in patients who had mortality within 3 months (P = .007). When scoring systems and laboratory parameters were evaluated together, patients with high ARISCAT grade, Albumin < 35g/L, and ASA III had significantly higher development of PPCs (P = .004).ARISCAT risk index and ASA were found to be significant in predicting PPCs after thoracic surgery. They were also valuable when evaluated in combination with preoperative albumin levels. Additionally; age, male gender, duration of surgery, and duration of OLV were also found to be associated with PPCs.

Clinical Analysis of Ear Congestion after Balloon Eustachian Tuboplasty (BET) with or without Tympanostomy Tube Insertion.

Objective To explore the clinical analysis of ear congestion after balloon Eustachian tuboplasty (BET) with or without tympanostomy tube insertion. Methods A total of 35patients (49 affected ears) with ear congestion following BET with or without tympanostomy tube insertion were recruited from the hospitalized patients from January 2015 to December 2017. The score of Eustachian Tube Dysfunction Questionnaire-7 (ETDQ-7) 15, visual analogue scale (VAS), and Valsalva scores were recorded before and after operation, and the influencing factors of prognosis were analyzed. The duration of follow-up was 1–4 years. Results All patients showed significantly decreased average preoperative ETDQ-7 score, VAS, and Valsalva score after operation (p < 0.05). The significance of the surgery types, course of disease, severity of tympanic membrane retraction, and tympanogram tracings classification as influencing factors of prognosis did not come up to the statistical standard (p > 0.05). Conclusion The patients showed relatively stable postoperative conditions after 3 years, and there were variations in the range of ETDQ-7 scores at 5 years postoperatively. Patients with levels I and II tympanic membrane retraction showed more favorable surgical effects. Surgical interventions are required for patients diagnosed with obstructive Eustachian tube dysfunction (ETD) after three months of conservative treatment without satisfactory results.

Results of Intrathecal Baclofen Treatment in Sixteen Spasticity Patients According to Four Different Measurement Scales:A Retrospective Analysis.

IntroductionSpasticity is a motor disorder characterized by a velocity-dependent increase in tonic stretch reflexes. It occurs as a result of overstimulation of the stretch reflex and is a component of the upper motor neuron syndrome. Intrathecal Baclofen (ITB) pump administration in patients with a diagnosis of spasticity may be a suitable option for reducing the complaints of the patients and increasing their quality of life. The aim of this study is to analyze clinically and statistically the diagnosis, treatment criteria, and post-treatment results of patients with spasticity who were treated in our clinic.Materials and MethodSixteen patients who were diagnosed with spasticity and placed on an intrathecal Baclofen pump between January 2015 and December 2020 were included in this study. An intrathecal Baclofen trial was first applied to patients who were candidates for the Baclofen pump. The spasticity levels of the patients who decided to have an intrathecal Baclofen pump were scored according to the modified Ashworth scale (MAS) and Penn spasm frequency scale (PSFS). In addition, the scaling of the patients' own conditions according to the visual analogue scale (VAS) and ambulation status according to the modified functional ambulation classification (MFAC) were recorded. All these evaluations were repeated in the preoperative, early postoperative, and follow-up periods.ResultsThe sex distribution of the patients included in the study was equal to eight women and eight men. The age distribution was between 18 and 76. The average age was 40.62 (standard deviation ±17.79). The average preoperative modified Ashworth scale score was 3.73, and the average Penn spasm frequency scale score of the patients was 3.67. The average preoperative modified functional ambulation classification score was 1.87, and the average visual analogue scale score was 6.67. At the end of the second postoperative week, the average modified Ashworth scale score was 1.80 and the average Penn spasm frequency scale score was 1.67. The modified functional ambulation classification score was 2.60 and the visual analogue scale score was 4.58. The average follow-up period of the patients was 64 months. At the end of the follow-up periods, the average late-period modified Ashworth scale score was 1.87, and the Penn spasm frequency scale score was 1.67. The average modified functional ambulation classification score was 3.00, and the average visual analogue scale score was 4.50. Statistically, there was a significant difference between preoperative and postoperative results in both modified Ashworth scale and Penn spasm frequency scale scores (P<0.05). Modified functional ambulation classification preoperative and postoperative comparison results (P<0.05) and visual analogue scale results (P<0.05) were also statistically significant. No significant difference was found between the early postoperative period and the late postoperative period in all measurements (P=1.00).ConclusionIntrathecal Baclofen administration is one of the many treatment options for spasticity. In this way, it has been shown that greater Baclofen efficacy is achieved and its side effects are reduced. It should always be remembered that the process of this treatment is teamwork that requires the participation of more than one specialty branch. Physical therapists, neurologists, pediatricians, and neurosurgeons should be included in this teamwork.

Impact of Timing of Targeted Muscle Reinnervation on Pain and Opioid Intake Following Major Limb Amputation.

Targeted muscle reinnervation (TMR) has been shown to play an important role in managing neuromas. However, the impact of the timing of TMR on pain visual analogue scale (VAS) scores or patient opioid use has not been thoroughly explored. We hypothesized that TMR performed acutely would lead to lower VAS scores and decreased opioid intake. Prospectively collected data from an amputation registry at a single institution were utilized to identify patients who underwent TMR. Acute TMR was defined as TMR performed within 1 month of the major limb amputation. Primary outcomes included VAS pain scores and patient-reported opioid consumption. In all, 25 patients (26 limbs) were identified in the acute group, and 18 patients (18 limbs) were identified in the delayed group. At intermediate follow-up (between 4 and 8 months postoperatively) and at final follow-up, the average pain VAS score in the delayed TMR group was significantly higher than that in the acute group (5.2 vs. 1.9 at intermediate P = .01 and 6.2 vs. 1.9 at final P = .002). In all, 84% of the amputees overall were not consuming opioid medications at the time of final follow-up (79% acute, 88% delayed, P = .72). There were no statistically significant differences in opioid consumption between the acute and delayed group at intermediate follow-up (P = .35) or at final follow-up (P = .68). TMR is an effective procedure to reduce pain following major limb amputation. Patients with TMR performed acutely had significantly lower VAS pain scores at both intermediate and final follow-up than patients with TMR performed in a delayed setting. Therapeutic II.

Immediate full weight bearing after pelvic percutaneous fixation by screw for simple acetabular and pelvic ring fractures in patients older than sixty fiveyears.

The aim of this study was to assess the walking and weight-bearing abilities of patients older than 65years with a simple acetabular or pelvic ring fracture treated with pelvic percutaneous screwing (PPS). This study included 27 patients. This was a retrospective, single-centre observational study conducted in a level 1 trauma centre from September 2019 to April 2021. All patients older than 65years who underwent PPS for an acetabular or pelvic ring fracture were included. All patients were able to walk and bear weight at oneday after PPS. The mean walking distance increased from 19.4m the day after the operation to 59.8m, 497.8m, and 1402m at discharge, three and sixweeks after the operation, respectively. The average pain visual analog scale scores before and after the operation were 4.1 (range, 3.6-5.1; standard deviation [SD], 0.63) and 0.9 (range, 0.5-1.2; SD, 0.25), respectively (p < .0001). The average daily dose of paracetamol used before and after the operation was 2.2 (range, 1.7-3.1; SD, 0.59) g/d and 1.3 (range, 0.6-1.7; SD, 0.40) g/d, respectively (p = .0232). The average daily dose of morphine used before and after the operation was 5.7 (range, 4.7-6.7; SD, 0.76) mg/d and 1.6 (range, 0.5-2.9; SD, 1.09) mg/d, respectively (p = .0001). All included patients were able to walk at one day after PPS. PPS was associated with reduced pain as well as a reduction in paracetamol and morphine use.

Histological changes and neural elements in the subacromial bursa on patients with rotator cuff tear: Pilot study.

Objective:This study aimed to investigate the neural elements of the subacromial bursa (SAB) in rotator cuff tears.Materials and methods:Twenty patients with rotator cuff tears were recruited, and their visual analog scale (VAS) score, duration of symptoms, and range of motion (ROM), including flexion, external rotation, and internal rotation were evaluated. Tear size was measured using magnetic resonance imaging (MRI). The SAB specimens obtained during arthroscopic rotator cuff repair were studied using routine hematoxylin and eosin staining and immunohistochemistry (S-100 protein and PGP 9.5 protein). The SAB specimen for the control group was obtained from 2 fresh cadavers and 2 patients with acute humeral shaft fracture. The Mann-Whitney U test was applied to assess the difference between histological findings of the rotator cuff tear group and control group. The correlation between the histological findings and clinical features was evaluated using the Spearman correlation coefficient.Results:The mean duration of symptom was 10.2 ± 6.4 months. The preoperative average VAS score was 2.9 ± 1.2. The degrees of preoperative ROM in forward flexion and external and internal rotations were 143.8 ± 19.5, 49.5 ± 23.1, and –4.3 ± 4.2, respectively. The tear was 2.0 ± 0.9 cm. For histological findings, the number of neural elements per low power field in the rotator cuff tear group was significantly less than the control group in both immunohistochemical stainings (S-100: 0.5 ± 0.7 vs 2.8 ± 0.5, p < .01; PGP 9.5: 0.4 ± 0.7 vs 3.5 ± 0.6, p < .01). During the correlation analysis, the number of neural elements in the PGP 9.5 staining was negatively correlated with the ROM in forward flexion and external rotation.Conclusion:This study revealed that chronic rotator cuff tears may induce degeneration of neural elements in SAB.

A comparative study of one-stage posterior unilateral limited laminectomy vs. bilateral laminectomy debridement and bone grafting fusion combined with internal fixation for the treatment of aged patients with single-segment spinal tuberculosis

Study designThis is a retrospective study.BackgroundTo assess and compare the clinical outcomes of posterior unilateral limited laminectomy (ULL) or bilateral laminectomy (BL) debridement and bone grafting fusion combined with internal fixation among aged patients with single-segment thoracic and lumbar tuberculosis (SST/LTB).Materials and methodsWe performed a retrospective study on aged patients (age > 65 years old) with SST/LTB from January 2010 to October 2018. We reviewed 36 aged patients who were treated with BL and 31 aged patients treated with ULL. All participants had undergone and finished a three-year follow-up. The outcomes were evaluated by the improvement of neurological function, correction Cobb angle, bone fusion time, and back pain, as well as operative time, blood loss, hospital stay, and postoperative complications.ResultsThe operative time, blood loss volume, and incidence of complications in group B were significantly less than those in group A (P < 0.01). The postoperative kyphotic angle in both groups was reduced significantly compared to the preoperative status (P < 0.01). The percentage of neurological improvement was 92.9% in group A and 90.9% in group B. All patients achieved solid bone fusion after surgery. At three-year follow-up, the angle loss in group B was significantly less than that in group A (P < 0.01); Furthermore, patients in group B had a lower average visual analog scale score of back pain and Oswestry Disability Index score than patients in group A (P < 0.05).ConclusionsFor aged patients with SST/LTB, ULL is a safer and more effective surgical treatment than BL.

Effectiveness of arthroscopic distal clavicle resection for symptomatic acromioclavicular joint arthritis

To investigate the effectiveness of arthroscopic distal clavicle resection for the symptomatic acromioclavicular joint arthritis. The clinical data of 14 patients with symptomatic acromioclavicular joint arthritis treated by arthroscopic indirect distal clavicle resection between January 2020 and March 2021 were retrospectively analyzed. There were 5 males and 9 females with an average age of 46.3 years (range, 18-57 years). The 4 cases of left shoulder and 10 cases of right shoulder were accompanied with acromial impingement, without the history of shoulder trauma. The average disease duration was 20.4 months (range, 9-48 months), and the average visual analogue scale (VAS) score was 7.6 (range, 5-9) preoperatively. The results were evaluated using the University of California Los Angeles (UCLA) shoulder rating score before and after operation, further, the patient satisfaction rate was also calculated. All 14 patients were followed up 5-18 months, with an average of 13 months. There was no postoperative pain of acromioclavicular joint in 12 patients; 1 case had occasional mild pain, which could be controlled by painkillers. Moreover, there was only 1 acromioclavicular joint subluxation due to early fitness training at 2 weeks postoperatively, and the symptoms gradually relieved after 1 month of conservative treatments. The UCLA score was 22.1±6.2 preoperatively, which improved to 30.2±3.4 at last follow-up, showing significant difference ( t=5.359, P<0.001). The patient satisfaction rate was 92.9%, with 12 excellent cases, 1 good case, and 1 fair case. Arthroscopic distal clavicle resection for symptomatic acromioclavicular arthritis is a safe, reliable, and repeatable procedure.

Comparative Analysis of ABM/P-15, Bone Morphogenic Protein and Demineralized Bone Matrix after Instrumented Lumbar Interbody Fusion.

ABM/P-15 (anorganic bone matrix/15-amino acid peptide fragment) is a commercially available synthetically manufactured P-15 collagen peptide fragment, that is adsorbed on ABM. This study was done to investigate the efficacy of ABM/ P-15 in achieving fusion in the lumbar spine and comparing it with that of recombinant bone morphogenic protein-2 (rhBMP-2) and demineralized bone matrix (DBM). A retrospective observational study of prospectively collected data of 140 patients who underwent lumbar spinal fusion surgeries in a single specialty spine hospital between 2016 and 2020, with a minimum 6-month follow-up was conducted. Based on the material used for the augmentation of the bone graft at the fusion site, the patients were divided into three categories namely ABM/P-15, rhBMP-2, and DBM group. ABM/P-15, rhBMP-2, and DBM were used in 46, 44, and 50 patients, respectively. Patient characteristics like age, gender, bone mineral density, smoking history, and presence of diabetes mellitus were comparable amongst the three groups. Average follow-up was 16.0±5.2, 17.9±9.8, and 26.2±14.9 months, respectively in ABM/P-15, rhBMP-2, and DBM groups. The fusion was achieved in 97.9%, 93.2%, and 98% patients while the average time-to-union was 4.05±2.01, 10±4.28, and 9.44±3.49 months (p<0.001), respectively for ABM/P-15, rhBMP-2, and DBM groups. The average pre-operative Visual analogue scale score was 6.93±2.42, 7.14±1.97, 7.01±2.14 (p=0.900) for ABM/P-15, rhBMP-2 and DBM groups, respectively, which reduced to 1.02±0.80, 1.21±0.96, and 0.54±0.70 (p=0.112), respectively at the last follow up. Pre-operative Oswestry disability index scores were 52.7±18.02, 55.4±16.8, and 53.56±19.6 (p=0.751) in ABM/P-15, rhBMP-2, and DBM groups, which post-operatively reduced to 33.77±15.52, 39.42±16.47, and 38.3±15.89 (p=0.412) and further to 15.74±8.3, 17.41±10.45, and 16.76±9.81 (p=0.603), respectively at the last follow-up. ABM/P-15 appears to achieve union significantly earlier than rhBMP-2 and DBM in lumbar spinal fusion cases while maintaining a comparable clinical and complication profile.

Application of cortical bone trajectory screw and sacral alar screw internal fixation for surgical treatment of lumbar adjacent segment degeneration

Objective: To explore the application of cortical bone trajectory screw (CBTS) and sacral alar screw (SAS) internal fixation in the treatment of lumbar adjacent segment degeneration (ASD) and evaluate its clinical effect. Methods: Data of 24 patients who were diagnosed with ASD and treated by CBTS or SAS in Beijing Chaoyang Hospital were retrospectively reviewed. There were 14 males and 10 females with a mean age of (67.9±8.2) years. The patients were followed-up for (2.6±0.4) years. Perioperative parameters including operation time, intraoperative blood loss and postoperative time on the ground were counted. All patients were followed-up for at least 2 years. Visual analogue scale (VAS) and the Oswestry disability index (ODI) were compared between pre-operation and at the last follow-up. The internal fixation-related complications, pseudarthrosis and adjacent re-degeneration were evaluated in the follow-up. Results: There were 14 proximal ASD patients, 8 distal ASD patients, 1 both ends ASD patient and 1 ASD patient in between the fusion surgeries. Bone mineral density (BMD) T score of the adjacent vertebrae was -1.98±0.91 on average. The ASD patients were re-operated with CBTS and SAS internal fixation technique. A small incision was made in the revision surgery and the original fixation was not completely cut open and removed. The mean operation time was (125±36) min, mean blood loss was (85±33) ml. The postoperative ambulation time was (3.1±1.9) days, and the hospitalization time was (9.0±2.6) days. Before the operation, the average VAS (back pain) score was 5.2±1.0, the average of VAS (leg pain) score was 6.8±1.9 and ODI was 56.6%±12.8%. VAS score was reduced to 1.4±0.6 (waist pain) and 0.9±0.4 (leg pain). ODI was improved to 13.8%±6.3%. All the difference between preoperative and the last follow-up was statically significant (all P<0.01). No internal fixation failure, pseudarthrosis and adjacent re-degeneration were observed in the final follow-up. Conclusion: The application of CBTS and SAS internal fixation techniques in the surgical treatment of lumbar ASD has the advantages of less trauma, faster postoperative recovery, reliable internal fixation, and fewer complications, especially in patients with low bone mineral density.

Evaluation of clinical and radiographic outcomes after total shoulder arthroplasty with inset Trabecular Metal-backed glenoid.

Trabecular Metal (TM)-backed glenoid implants were introduced for their theoretical ability to increase osseointegration while minimizing wear and the risk of loosening in total shoulder arthroplasty (TSA). Initial follow-up studies of TM-backed glenoids demonstrated high rates of metallic debris formation around the implant site, raising concerns about longevity. More recent data suggest that metallic debris formation may be less prevalent than previously reported and that the implants may have positive long-term outcomes regardless of debris. The goal of our study was to assess the clinical and radiographic outcomes at mid-term follow-up of TSA using a TM-backed glenoid implant placed with full backside support using an inset technique. We hypothesized that our clinical and radiographic outcomes would be good using this technique. We retrospectively reviewed the charts of 39 patients who underwent 41 TSA procedures with a Zimmer Biomet TM-backed glenoid component performed by a single surgeon between January 2010 and March 2016. After exclusions for death unrelated to surgery and loss to follow-up, 35 patients (37 shoulders) with minimum 2-year clinical follow-up were included in the study. The glenoids were all placed in an inset fashion with full backside support. Clinical, patient-reported, and radiographic outcomes were analyzed. The average follow-up period was 7.2 years (range, 2-11 years). At final follow-up, average shoulder elevation was 153° ± 22° and average external rotation was 53° ± 12°. The average American Shoulder and Elbow Surgeons score was 86.8 ± 19.0, and the average visual analog scale score was 1.3 ± 2.4. Metallic debris was found in 9 shoulders (27%), and radiolucency was observed around the glenoid components in 13 shoulders (39%) on the final postoperative radiographs. Metallic debris and radiolucency findings were low in severity, with average grades of 0.32 (standard deviation, 0.54) and 0.39 (standard deviation, 0.50), respectively. There were no reoperations. This study of 37 shoulders undergoing TSA with a TM-backed glenoid demonstrated 100% implant survivorship at an average follow-up of 7 years. Clinical outcomes were excellent despite the occurrence of some metallic debris formation. The findings suggest that a TM-backed glenoid component implanted in an inset fashion to achieve full backside support can provide good clinical and patient-reported outcomes in TSA patients at mid-term follow-up and suggest that continued consideration of the role of TM-backed glenoids and the optimal technique for implantation may be warranted.

Effectiveness of Ilizarov Ankle Arthrodesis in the Treatment of End-Stage Varus Ankle Osteoarthritis: A Retrospective Study.

ObjectiveTo evaluate the outcomes of Ilizarov ankle arthrodesis in the treatment of end‐stage varus ankle osteoarthritis (OA).MethodsThis was a retrospective study of 63 patients with varus ankle OA who underwent Ilizarov ankle arthrodesis between June 2013 and December 2018. There were 24 males and 39 females with an average age of 56.57 ± 4.45 years (range, 47–64 years). Thirty‐six cases were affected on the left side, and 27 were affected on the right side. The patients' mean body mass index (BMI) was 25.18 ± 2.93 kg/m2. According to the modified Takakura staging criteria, there were 18 cases of stage 3b (28.57%) and 45 cases of stage 4 (71.43%). Nine patients were primary (14.29%), 48 were traumatic (76.19%), and six were caused by rheumatoid OA (9.52%). Functional assessments were performed according to the American Orthopedic Foot and Ankle Society (AOFAS) ankle‐hindfoot score, Ankle Osteoarthritis Scale (AOS), and visual analogue scale (VAS). The tibial anterior surface angle (TAS), coronal plane tibial‐talar angle (CPT), talar tilt angle (TT), deformity angle (DA), and tibial lateral surface angle (TLS) were assessed on X‐ray films.ResultsThe average operation time was 147.84 ± 13.67 min (range, 135–168 min). The average follow‐up time was 34.24 ± 8.72 months (range, 24–61 months). Bony fusion was achieved in all ankles, and the fusion time was 12.43 ± 1.99 weeks on average. The average AOFAS score at the final follow‐up increased from 42.14 ± 8.66 to 80.90 ± 6.80. The average VAS score and AOS pain and disability scores at the final follow‐up decreased from 7.29 ± 1.27 to 2.24 ± 0.94, from 67.94 ± 7.68 to 27.92 ± 5.82, and from 71.64 ± 9.37 to 41.32 ± 8.99, respectively. The average TAS, CPT, and TLS at the final follow‐up increased from 77.76° ± 4.44° to 89.81° ± 1.25°, from 69.04° ± 3.73° to 90.43° ± 1.80°, and from 82.14° ± 3.77° to 88.67° ± 2.50°, respectively. The average TT and DA at the final follow‐up decreased from 8.76° ± 4.30° to 2.05° ± 1.28° and from 20.95° ± 3.73° to 1.57° ± 0.93°, respectively. Three patients developed superficial pin tract infections, all settled with local dressing and antibiotic treatment. Two patients were found to have subtalar arthritis and underwent conservative treatment.ConclusionAnkle arthrodesis using the Ilizarov technique is efficient in treating end‐stage varus ankle OA.

Estudio ECOSHOT: Capacitación en ecografía de hombro a médicos de atención primaria después de una formación específica

Introduction / ObjectiveThe effectiveness of shoulder ultrasound training programmes in primary care is unknown. This study aims to measure the diagnostic agreement between radiologists and general practitioners in shoulder ultrasound examination after a specific training programme. Materials and methodsWe designed a prospective study with patients who required a shoulder ultrasound examination. Ultrasound examination was performed by general practitioners after receiving specific training, consisting of 50hours of theoretical musculoskeletal ultrasound training online and 8hours of hands-on shoulder ultrasound practice. The findings were compared to those of radiologists using Cohen's Kappa coefficient. Sociodemographic and quantitative variables were also measured. ResultsWe included 153 patients. Finally, 121 radiologists’ reports were used for analyses. The average age was 61.8 years and 62.1% were women. Main occupations were domestic work/cleaning and administrative jobs. Average Visual Analogue Scale score was 5.25. Patients with previous treatment comprised 88.9% (mostly oral painkillers, rest, and physical measures). Complementary testing was performed in 28.8%, radiography was the most frequent. The most frequent motive for referral for ultrasound examination was unspecific shoulder pain. Our study reveals that the global agreement was moderate (kappa=.4346) overall, but when measured over time improved from weak (kappa=.3756) to good (kappa=.6423). There was a tendency to overdiagnose most lesions and underdiagnose partial tears. ConclusionsWe conclude that shoulder ultrasound examination training is feasible in primary care. The interobserver agreement improved with the number of ultrasound examinations performed over time, suggesting that specific programmes may be effective in training general practitioners in musculoskeletal shoulder ultrasound examination.