Difference In VAS Score Research Articles

A Comparison of Two Methods of Regional Anesthesia

Category: Other Introduction/Purpose: Poorly controlled post-operative pain is a common cause of patient dissatisfaction. With future emphasis on value-based medicine, optimization of cost-effectiveness and patient satisfaction is critical. Popliteal and saphenous nerve blocks are routinely use in foot and ankle orthopaedic surgery and have become the gold standard for immediate post-operative analgesia. Traditionally a single long-acting local anesthetic agent is utilized which achieves analgesia for 6-24 hours. Recent evidence has shown that multimodal anesthesia with combined anesthetic agents remains effective for a longer duration compared to single-medication nerve blocks. The purpose of this study is to determine if patients undergoing foot and ankle surgery safely benefit from multi-modal compared with traditional single-medication nerve blocks. Methods: This was a two-armed, prospective, randomized, double-blinded study. The study population consisted of 70 patients from a single institution undergoing foot and ankle surgery by two fellowship-trained orthopaedic foot and ankle surgeons. 34 patients received a local anesthetic only popliteal and saphenous nerve block (Bupivacaine) and the other 36 patients received a triple additive nerve block (Dexamethasone, Clonidine, and Buprenorphine) in addition to Bupivacaine. Pre- and Post-operative assessments were performed to determine VAS pain scores, numbness, duration of anesthesia, patient satisfaction with analgesia, and oral pain medication use. Results: Triple additive (TA) nerve block mean duration to onset of pain was longer than for single agent (LA) nerve blocks (40.2 hrs vs 24.3 hrs respectively). Time to complete block resolution was also longer for the TA nerve blocks (82.3 hours) compared to LA blocks (38.7 hrs). 17/34 TA block patients had residual numbness at 1 week compared to 5/36 LA block patients. However, by 3 months there was no difference (8/34 TA and 7/36 LA). There was no significant difference in VAS scores or patient satisfaction rates at 1 week or 3 months. 7/34 TA block patients required narcotic refills compared to 6/36 LA block patients. There was no significant difference in complications between the groups. Conclusion: Triple agent nerve blocks give a longer duration of effective postoperative analgesia compared to single agent blocks. There was a higher rate of lingering numbness in the triple agent blocks at one week but not at 3 months. Patient satisfaction was very high for both groups regardless of their VAS pain scores. Triple agent nerve blocks demonstrate equivalent safety compared with single agent nerve blocks.

Comparison of three flap designs on postoperative complication after third molar surgery

Introduction: Third molar surgery can cause post-operative complications to the patient due to the presence of wound from the incision. The study aimed to compare modified triangular (triangular reverse) flap with triangular and envelope flap on postoperative complications by the measurements on post-surgical swelling, trismus, pain scale, wound dehiscence and the occurrence of alveolar osteitis.Methods: Study design using a single-blind randomized clinical trial. Each treatment group consisted of 10 patients. An assessment was performed on day 1, 7 and 14 after surgery. The swelling was measured using different anatomical points, and trismus was measured using the distance of inter-incisal opening. The occurrence of dehiscence was measured from the width of the incision line. Alveolar osteitis and pain scale was observed.Results: The results of one way ANOVA (p>0.05) shows there was no difference between treatment groups both for swelling and mouth opening, but there was a difference between treatment groups for dehiscence on days 7 and 14. The results of the Post Hoc test show that flap envelope differs from the other flap design, whereas triangular and triangular reverse flap showed no difference. Friedman test results (p>0.05) showed no difference in VAS score. There was no alveolar osteitis occurred in each treatment group during postoperative control. Kruskal Wallis test (p>0.05) showed that there was no difference of VAS score between treatment group during post-operative control.Conclusion: The triangular reverse flap design may decrease the occurrence of postoperative complication after mandibular third molar surgery.Â

Application of drilling columnar autogenous iliac bone graft and clinical analysis of postoperative complications in the donor bone region

To investigate the clinical effect of drilling columnar autogenous iliac bone graft and analyze the effect of bone grafting on postoperative complications in donor site. From March 2014 to October 2016, 68 patients with autogenous iliac bone graft were retrospectively analyzed, and divided into drilling group and osteotomy group, 34 patients in each group. In drilling group, there were 24 males and 10 females with an average age of (40.06±5.60) years old ranging from 23 to 53 years old;in osteotomy group, there were 26 males and 18 females with an average age of (39.32±6.44) ranging from 22 to 56 years old. The operative time of bone extraction, blood loss in donor area, healing time of donor site and postoperative donor site complications were observed and compared between the two groups. VAS score was used to evaluate the pain of donor site in different periods after operation. All patients were followed up for 12 to 24 months, with an average of 16.9 months in drilling group and 17.1 months in osteotomy groups. The bone healing structure was displayed in the recipient area in two groups, the effect of autogenous iliac bone grafting was good. There was no significant difference in operative time between two groups (P>0.05). There was significant difference between two groups in the amount of donor site bleeding and the time of donor site wound healing(P<0.05). Postoperative complications(iliac depression and numbness) were significantly different between two groups (P<0.05). There was no significant difference in VAS score between two groups at 2 weeks after operation(P>0.05). VAS scores of drilling group at 6 months and 1 year after operation were lower than those of osteotomy group (1.85±0.61 vs 2.97±0.67, P=0.000; 1.15±0.56 vs 2.41±0.61, P=0.000). When bone graft is no need to have large pieces of special shape or more cortical bone iliac, it is simple to operate and less complications postoperative by drilling type columnar autogenous iliac bone graft. What's more, it has the obvious advantages of promote healing, improve patient quality of life compared with traditional osteotomy.

Case-control study on polymer polylactic acid absorbable medical film for preventing acromion adhesion after arthroscopic rotator cuff repair

To study effect of shoulder joint function after rotator cuff repair of polylactic acid absorbable membrane. From September 2015 to December 2016, 50 patients diagnosed with rotator cuff tear were selected and divided into treatment group and control group. There were 25 patients in control group, including 12 males and 13 females, with an average age of (48.7±3.5) years old, who received simple arthroscopic rotator cuff repair. There were 25 patients in treatment group, including 11 males and 14 females, with an average age of(49.2±4.1) years old, who performed arthroscopic rotator cuff repair with implanting polylactic acid absorbable membraneon shoulder of rotator cuff. Preoperative and postoperative VAS score, ASES score and UCLA score were recorded and compared between two groups. At 6 months after operation, preoperative VAS score in control group was 5.48±1.12, and decreased as 1.28±0.84 after operation; ASES score before operation was 52.24±4.64, and improved to 86.92±3.20 after operation;preoperative UCLA score improved from 14.36±1.89 before operation to 30.72±1.28 after operation. In treatment group, VAS score decreased from 5.36±1.32 before operation to 1.40±0.71 after operation;preoperative ASES score was 51.04±4.09, and improved to 88.96±2.79 after operation; UCLA score improved from 15.12±1.81 before operation to 32.12±1.33 after operation. There was no significant difference in VAS score between two groups, and ASES score, UCLA score in treatment group was obviously better than control group. Application of polylactic acid absorbable medical membrane could obviously improve shoulder function, and effectively prevent acromion adhesion after arthroscopic rotator cuff repair.

Application of three-dimensional printing technology to design individual angle section on Chevron of hallux valgus osteotomy

To explore clinical application of three-dimensional printing technology to design individual angle section on Chevron of hallux valgus osteotomy. From May 2013 to May 2016, 47 patients(66 feet) with mild to moderate hallux valgus treated by Chevron osteotomy according to different preoperative design were divided into computer osteotomy group(group A) and traditional osteotomy group(group B). In group A, there were 25 patients (33 feet), including 4 males(5 feet) and 21 females(28 feet) with an average age of (47.88±6.08) years old, average weight IMA was (13.58±1.15) degree, AOFAS score was 59.00±5.86, and treated individual 3D printing technology to design operation scheme. While in group B, there were 22 patients (33 feet), including 3 males (3 feet) and 19 females (28 feet) with an average age of (48.16±6.16) years old, average weight IMA was(13.51±1.14) degree, AOFAS score was 60.67±5.85, and treated with osteotomy according to surgical experience. Operation time, blood loss, hospital stays, VAS score at 1 week after operation, wound healing and improvement of postoperative weight-bearing intermetatarsal angle(IMA) were compared between two groups, AOFAS score system was used to evaluate ankle function after surgery. There was no significant difference in following-up between group A 12.41±2.32 and group B 11.73±2.76. There was 1 patient in group B were excluded. Others perform good wounds healing on the first stage after operation. There were no significant differences in operation time, blood loss, hospital stays and VAS score at 1 week after operation(P<0.05); IMA in group A was (5.21±0.88)°, (6.42±0.85)° in group B, and had significant differences between two groups (t=5.68, P<0.05). There was obvious meaning in AOFAS score between group A 88.15±5.19 and group B 82.90±5.01(t=4.14, P<0.05). Fourteen feet in group A obtained excellent results and 19 feet good, while 5 feet in group B obtained excellent results and 27 feet good. Compared with traditional osteotomy group, three-dimensional printing technology to design individual angle section on Chevron of hallux valgus osteotomy could better correct IMA, improve postoperative foot function, and it is a kind of individualized and digital method to design operation.

Effect of Full-Length Carbon Fiber Insoles on Lower Limb Kinetics in Patients With Midfoot Osteoarthritis: A Pilot Study.

We investigated the effects of full-length carbon fiber (FCF) insoles on gait, muscle activity, kinetics, and pain in patients with midfoot osteoarthritis (OA). We enrolled 13 patients with unilateral midfoot OA (mild: Visual Analog Scale [VAS] range, 1-3; moderate, VAS range, 4-7) and healthy controls. All participants were asked to walk under two conditions: with and without FCF insole. The outcome measures were ground reaction force, quantitative gait parameters, electromyography activities and pain severity (VAS). In the patients with moderate midfoot OA, significantly longer gait cycle and higher muscle activity of lower limb during loading-response phase were observed while walking without FCF insoles. In the mild midfoot OA group, there was no significant difference in VAS score (without, 2.0 ± 1.0 vs. with, 2.0 ± 0.5) with FCF insole use. However, significantly reduced VAS score (without, 5.5 ± 1.4 vs. with, 2.0 ± 0.5) and muscle activity of the tibialis anterior and increased muscle activity of gastrocnemius were observed in the moderate midfoot OA group by using an FCF insole (P < 0.05). Full-length carbon fiber insoles can improve pain in individuals with moderate midfoot OA, which might be associated with changes in the kinetics and muscle activities of the lower limb. Taken together, the results of the present study suggest that FCF insoles may be used as a helpful option for midfoot OA.

Mepivacaine Spinal Anesthesia Facilitates Rapid Recovery in Total Knee Arthroplasty Compared to Bupivacaine

BackgroundMepivacaine as a spinal anesthetic for rapid recovery in total knee arthroplasty (TKA) has not been assessed. The purpose of this study is to compare spinal mepivacaine vs bupivacaine for postoperative measures in patients undergoing primary TKA. MethodsRetrospective review of a prospectively collected single-institution database was performed on 156 consecutive patients who underwent primary TKA. Fifty-three patients were administered mepivacaine and 103 patients were administered bupivacaine. Primary outcomes were urinary retention, length of stay, pain control, opioid consumption, and distance associated with physical therapy. Statistical analysis with univariate logistic regression was performed to evaluate the effect of anesthetic with primary outcomes. ResultsPatients undergoing TKA with mepivacaine had a shorter length of stay (28.1 ± 11.2 vs 33.6 ± 14.4 hours, P = .002) and fewer episodes of straight catheterization (3.8% vs 16.5%, P = .021) compared to bupivacaine. Patients administered mepivacaine exhibited slightly higher VAS pain scores and morphine consumption in the postanesthesia care unit (1.3 ± 1.9 vs 0.5 ± 1.3, P = .002; 2.2 ± 3.3 vs 0.8 ± 2.1 equivalents/h, P = .002), but otherwise exhibited no difference in VAS scores or morphine consumption afterwards. There was no need to convert to general anesthesia or transient neurologic symptom complication in either group. ConclusionMepivacaine for spinal anesthesia with TKA had adequate duration to complete the surgery and facilitated a more rapid recovery with less urinary complications and a shorter length of stay. Patients administered mepivacaine did not display worse pain control or transient neurologic symptoms afterwards.

Epidural and wound infiltration analgesia in patients: A comparative study

Background: The present study was conducted to compare epidural and wound infiltration analgesia in study group. Materials & Methods: The present study was conducted in the department of Anesthesia. It comprised of 64 patients aged 30–70 years belonging to the American society of Anesthesiologists physical status 1 and 2. Patients were divided into 2 groups of 32 each. Group I were those in which epidural infiltration was given and group II were those in which wound infiltration was done. Patients were evaluated for visual analogue score at rest (VASR) and at deep breathing (VASDB) post‑operatively. Results: There was non- significant difference (P> 0.05) in VAS score recorded in both groups at 10 minutes, 20 minutes, 60 minutes, 90 minutes, 120 minutes and 180 minutes at rest whereas it was significant at deep breadth (P

Clinical effects and safety comparison of two kinds of sufentanil doses combined with ropivacaine for analgesia on painless childbirth

Objective To investigate clinical effects and safety differences of conventional and low doses of sufentanil combined with ropivacaine for analgesia on painless childbirth. Methods 130 lying-in women with painless childbirth were chosen and randomly divided into two groups including control group (65 cases) with sufentanil for 7.5μg and observation group (65 cases) with sufentanil for 5.0μg combined with ropivacaine; the block onset time, the arrival time at the maximum block level, modified Bromage score, the Apgar score in 5min after childbirth, the VAS score before and after analgesia and adverse reaction incidence of both groups were compared. Results The sense and motion block onset time and the arrival time at the maximum block level of control group were separately (4.33±1.91)min, (7.50±1.70)min, (14.26±1.50)min.The sense and motion block onset time and the arrival time at the maximum block level of observation group were separately (3.68±1.54)min, (5.73±1.21)min, (9.71±1.15)min.The block onset time and the arrival time at the maximum block level of observation group were significant shorter than control group (t=2.78, 3.07, 3.47, all P 0.05). There was no significant difference in VAS score before and after analgesia between the two groups(t=1.15, 1.02, 0.95, 0.63, 0.87, all P>0.05). The adverse reaction incidence of observation group were significant lower than control group (χ2=9.24, 8.66, 12.07, 10.45, all P<0.05). Conclusion Compared with conventional doses of sufentanil, low doses of sufentanil combined with ropivacaine for analgesia on painless childbirth can efficiently accelerate the block onset process and reduce the risk of adverse reactions. Key words: Analgesia, obstetrical; Dose-response relationship, drug; Sufentanil; Ropivacaine

The Effect of Rectus Sheath Block as a Supplement of General Anesthesia on Postoperative Analgesia in Adult Patient Undergoing Umbilical Hernia Repair.

Ultrasound guided rectus sheath block can block the ventral rami of the 7th to 12th thoracolumbar nerves by injection of local anesthetic into the space between the rectus muscle and posterior rectus sheath. The aim of this randomized double-blind study was to evaluate the analgesic effect of the bilateral ultrasound guided rectus sheath block as supplement of general anesthesia on patents undergoing elective umbilical hernia repair. After the hospital ethics committee approval, 60 (ASA I-II) adult patients scheduled for umbilical hernia repair were included in this study. The group I (n=30) patents received only general anesthesia. In the group II (n = 30) patents after induction of general anesthesia received a bilateral ultrasound guided rectus sheath block with 40 ml of 0.25% bupivacaine. In this study we assessed demographic and clinical characteristics, pain score - VAS at rest at 2, 4, 6, 12 and 24 hours after operation and total analgesic consumption of morphine dose over 24-hours. There were statistically significant differences in VAS scores between the groups I and II at all postoperative time points - 2hr, 4 hr, 6 hr, 12 hr and 24 hr. (P < 0.00001). The cumulative 24 hours morphine consumption after the operation was significantly lower in the group II (mean = 3.73 ± 1. 41) than the group I (mean = 8.76 ± 2.41). This difference was statistically significant (p = 0.00076). The ultrasound guided rectus sheath block used for umbilical hernia repair could reduce postoperative pain scores and the amount of morphine consumption in 24 hours postoperative period.

Effect of SLC6A4 gene polymorphism on pain sensitivity in patients with lung cancer

Objective To evaluate the effect of SLC6A4 gene polymorphism on pain sensitivity in the patients with lung cancer. Methods A total of 248 patients with pulmonary malignant tumor served as lung cancer group and 104 healthy subjects in the Physical Examination Center of our hospital served as control group.Patients with malignant pulmonary tumor in lung cancer group were further divided into 3 subgroups according to pain score and the three step analgesic ladder recommended by WHO(opioids was used when visual analogue scale [VAS] score≥4 points): painless subgroup, mild pain subgroup and moderate-severe pain subgroup.The consumption of opioids(based on requirement for morphine)within 24 h after pain relief(VAS score≤3 points)after treatment and VAS score before treatment were recorded.Venous blood samples were collected, and the genotypes were analyzed by polymerase chain reaction-restriction fragment length polymorphism. Results There was no significant difference in genotype frequency or allele frequency at rs4795541 and rs3813034 sites between lung cancer group and control group and among the three subgroups(P>0.05). There was no significant difference in VAS score before treatment or requirement for morphine between patients of different genotypes and alleles(P>0.05). There was no significant difference in VAS score before treatment or requirement for morphine between lung cancer patients with medium and low expression of serotonin transporter in 5-HTT-linked polymorphic region. Conclusion SLC6A4 gene polymorphism exerts no effect on pain sensitivity in the patients with lung cancer. Key words: Serotonin plasma membrane transport proteins; Polymorphism, single nucleotide; Neoplasms; Pain threshold

Locking plates versus intramedullary nails in the management of displaced proximal humeral fractures: a systematic review and meta-analysis

To compare the clinical outcome and complications of locking plates versus intramedullary nails in patients with displaced proximal humeral fractures. Our hypothesis was that there would be no difference between these two implants with regard to clinical outcome and complications. We performed a systemic review of PubMed, EMBASE, Clinical Trials Registry, Cochrane Central Register of Controlled Trials and Google Scholar to identify all relevant randomized controlled trials, prospective and retrospective comparative studies on April 26, 2017. The studies of locking plates compared to intramedullary nails in patients with displaced proximal humeral fractures were included. We conducted a meta-analysis of shoulder functional scores, range of motion, pain scores, and complications. This meta-analysis included 13 comparative studies with 958 patients (529 in the locking plate group and 429 in the intramedullary nail group). A significantly greater external rotation (MD =9.67; 95% CI, 4.22-15.12; P=0.0005) and a significantly higher penetration rate (RR =1.75; 95% CI, 1.11-2.77; P=0.02) were observed in the locking plate group compared with the intramedullary nail group. Constant-Murley scores, DASH scores and total complication rate were comparable between the two groups. Moreover, there were no significant differences in forward elevation, VAS scores, and other complications. Current evidence indicates that locking plates and intramedullary nails have similar performance in terms of the functional scores and total complication rate. No superior treatment was suggested between locking plates and intramedullary nails for displaced proximal humeral fractures.

Comparison between conservative and surgical management in postpartum pubic symphysis diastasis: a randomized controlled trial

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Pubic symphysis diastasis is a postpartum complication with an incidence of 1:385 to 1:500 births. Typically conservative treatment is performed, operative treatment is also successful alternative method. This study was conducted to assess whether surgery (ORIF) provide early pain relief and improve mobility and quality of life than conservative management does in same patients&lt;span lang="EN-IN"&gt;.&lt;/span&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; This study is a randomized controlled trial conducted at MKCG Medical College, Berhampur from December 2014 to April 2017. Total eligible 16 postpartum pubic diastasis patients coming to MKCG hospital were randomly assigned to two groups in 1:1 ratio. Group A received surgical and group B conservative management. All were followed up at 3 weeks, 6 weeks, 3 months and upto 6 months in which EQ-5D-3L score and Visual analogue scale were measured for assessing pain and general health outcome in participants. All data were analyzed with SPSS.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; The mean EQ-5D descriptive index was almost similar in both groups at the time of admission, but declined more rapidly in group A as compared to that in group B. 75% of group A has this index 5 (lowest score) at 6 months whereas none of the group B patients attained it. lower EQ-5D index indicates patients had good mobility and early ambulation, less discomfort, able to do usual activity. There was a significant difference in mean EQ-5D descriptive index and pain VAS score between two groups&lt;span lang="EN-IN"&gt;. &lt;/span&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; This study showed surgical management is more effective than conservative management in postpartum pubic symphysis patients by rapidly improving general health, ameliorating pain and bringing ambulation&lt;span lang="EN-IN"&gt;.&lt;/span&gt;&lt;/p&gt;

Comparison of Nerve Transfer and Nerve Grafting for Restoration of External Rotation of Shoulder Function in Traumatic Brachial Plexus Injuries

There is no financial information to disclose. We aimed to critically evaluate our results of patients with traumatic brachial plexus injury who underwent either C5 or C6 root grafting or spinal accessory nerve transfer to suprascapular nerve transfer. A review was performed on all patients who underwent suprascapular nerve reconstructions for traumatic brachial plexus injury between 2001 to 2011. Exclusion criteria were any patients below the age of 18 and follow-up less than one year. Eighty-seven patients were identified and made the cohort of the study (36 grafting, 51 transfers). Mean age was 32 (range: 18-65) with 74 males and 13 females. There were 12 upper trunk (UT), 38 upper trunk with C7 (UT+7), and 37 complete brachial plexus injuries in our study population with mean time to surgery of 5.2 months (range: 0.8-11 months) and mean follow-up of 2.8 years (range 1-9.9 years). Eighteen percent were smokers, and mean BMI was 28 (range: 19-46). Nerve transfers were found to be statistically superior to nerve grafting for recovering MRC > 3 for external rotation. External rotation ROM was 10.9 degrees for transfers versus 2 degrees for grafting (P = 003). No significant difference in VAS or DASH scores was found favoring a particular method of reconstruction but EMG recovery favored the nerve transfer group. Additionally, age, BMI, smoking, time to surgery, length of graft, and type of graft were not found to affect strength or motor recovery for either groups. •Best clinical results for improved shoulder muscle grade (MRC > 3), shoulder range of motion, and EMG signs of recovery were obtained in patients who underwent spinal accessory nerve to suprascapular nerve transfer.•No significance found for DASH or VAS scores, age, BMI, smoking, time to surgery, length of graft, and type of graft for either transfers or grafting.

Midterm results of surface replacement of the shoulder

PurposeThis study was undertaken to determine the midterm results of resurfacing hemiarthroplasty of the shoulder, evaluate the inclination of prosthesis and correlate the effect of valgus or varus positioning on clinical outcomes. MethodsBetween 2007 and 2014, fifty-seven humeral head surface replacements were performed in our hospital for the osteoarthritis of shoulder. One patient expired and 6 shoulders were lost to follow-up. Forty-seven patients with 3 patients having bilateral humeral head replacements, were assessed thoroughly at the mean period of 4.4+2.3years (Range 2–9 years). All fifty shoulders were evaluated using the VAS, ASES and Constant and Murley score. ResultsHumeral head surface replacement produced satisfactory results in 96% of the patients at a mean follow-up of 4.4 years. We found that the difference in mean postoperative ASES, Constant and VAS score in normal and valgus inclination angle shoulders was not significant whereas the difference in normal and varus inclination angle shoulders was significant. Three patients had severe pain with VAS score (range 0 to 10) of 7, 5 and 4 postoperatively though in all 3 patient’s inclination angle was normal. No revision surgery was performed till recent follow-up. ConclusionsIn conclusion mid-term outcomes of the uncemented Global C.A.P. resurfacing prosthesis are promising. Inclination of the implant has effect on functional outcome of patients.

Effect of functional exercise at different time and different immobilization positions on functional recovery of elbow joint with type C distal humeral fractures

To investigate the effect of functional exercises at different time and different immobilization positions on the functional recovery of elbow joint with type C distal humeral fractures. A total of 120 patients with type C distal humeral fractures admitted to the hospital between June 2013 and July 2015 were included in the study. They were randomly allocated to 3 groups, 40 patients in each group. Group A: functional exercises began immediately after the operation; Group B: the affected elbow was fixed at 90° flexion for 1 week and then began functional exercises after 1 week of immobilization; Group C: the affected elbow was fixed at 30° extension for 1 week and then began functional exercises after 1 week of immobilization. There was no significant difference in gender, age, fracture pattern, fracture side, injury time, and surgical approach between groups ( P>0.05). In groups A and B, 1 case had incision redness and swelling respectively, and the other incisions healed by first intention. Five patients occurred myositis ossificans in group A, 4 cases in group B, and 5 cases in group C. The incidence of complications in groups A, B, and C was 15.0% (6/40), 12.5% (5/40), and 12.5% (5/40), respectively. There was no significant difference between groups ( χ2=0.144, P=0.930). All patients were followed up 6-25 months, with an average of 9.8 months. At 2 weeks after operation, the Mayo elbow joint function score of group A was significantly higher than those of groups B and C ( P<0.05), and the visual analogue scale (VAS) of group A was significantly lower than those of groups B and C ( P<0.05). There was no significant difference between groups B and C ( P>0.05). At 6 months after operation, there was no significant difference in Mayo elbow joint function score and VAS score between groups ( P>0.05). At 2 weeks and 6 months after operation, the flexion and extension activities of elbow joint in groups A and C were better than that in group B ( P<0.05), and there was no significant difference between groups A and C ( P>0.05). There was no significant difference in forearm rotation between groups ( P>0.05). All fractures of 3 groups achieved clinical healing, and there was no significant difference in healing time between groups ( P>0.05). Early functional exercises can relieve pain and obtain better elbow flexion and extesion activities after operation. The elbow joint fixed at 30° extension is better than at 90° flexion in elbow flexion and extension activitis.

Randomized controlled pilot trial of supportive text messages for patients with depression

BackgroundDepression is projected to be the primary cause of disability worldwide by 2030. In a recent survey, the most commonly cited unmet need among 42.4% of depressed Albertans was the lack of sufficient, accessible, and affordable counselling. Our aim was to test the efficacy of a supportive text messaging mobile health intervention in improving treatment outcomes in depressed patients.MethodsWe performed a single-rater-blinded randomized trial involving 73 patients with Major Depressive Disorder. Patients in the intervention group (n = 35) received twice-daily supportive text messages for 3 months while those in the control group (n = 38) received a single text message every fortnight thanking them for participating in the study. The primary outcome of this study was: “Mean changes in the BDI scores from baseline“.ResultsAfter adjusting for baseline BDI scores, a significant difference remained in the 3 month mean BDI scores between the intervention and control groups: (20.8 (SD = 11.7) vs. 24.9 (SD = 11.5), F (1, 60) = 4.83, p = 0.03, ηp2 = 0.07). The mean difference in the BDI scores change was significant with an effect size (Cohen’s d) of 0.67. Furthermore, after adjusting for baseline scores, a significant difference remained in the 3 month mean self-rated VAS scores (EQ-5D-5 L scale) between the intervention and control groups, 65.7 (SD = 15.3) vs. 57.4 (SD = 22.9), F (1, 60) =4.16, p = 0.05, ηp2 = 0.065. The mean difference in change mean self-rated VAS scores was also statistically significant with an effect size (Cohen’s d) of 0.51.ConclusionsOur findings suggest that supportive text messages are a potentially useful psychological intervention for depression, especially in underserved populations. Further studies are needed to explore the implications of our findings in larger clinical samples.Trial registrationClinicalTrials.gov NCT02327858. Registered 24 December 2014.

Retrograde interlocked intramedullary nailing with tibia bone graft fusion for the treatment of end-stage ankle arthritis

To explore clinical outcomes of retrograde interlocked intramedullary nailing with tibia bone graft fusion in treating end-stage ankle arthritis. From November 2014 to April 2016, 22 patients with end-stage ankle arthritis were treated with retrograde interlocked intramedullary nailing with tibia bone graft fusion, including 9 males and 13 females aged from 30 to 65 years old with an average of 48.5 years old. Seven patients had obvious varus deformity, and other 15 patients' appearance were normal. Operative time, blood loss, fracture healing time and complications were observed and compared, AOFAS and VAS score were applied for evaluate ankle joint function and pain degree before operation and 9 months after operation. All patients were followed up from 12 to 24 months with an average of 18.6 months. The incision were healed at stage I , and no complications occurred. Operative time ranged from 80 to 120 min with an average of 90 min;blood loss ranged from 15 to 50 ml with an average of 30 ml;fracture healing time was from 10 to 18 weeks with an average of 14 weeks. AOFAS score at 9 months after operation was 88.00±3.45, while 54.82±2.98 before operation, and there was statistical significance; 8 cases obtained excellent results, 12 good and 2 moderate. There was significant difference in VAS score between preoperative(3.96±1.27) and 9 months after operation(9.37±0.55). Retrograde interlocked intramedullary nailing with tibia bone graft fusion for the treatment of end-stage ankle arthritis has advantages of stable fixation, less trauma, less blood loss, bone union and rapid recovery of function, and could relieve pain obviously.

Comparative study of pain in women submitted to conventional laparoscopic cholecystectomy versus single-port laparoscopic cholecystectomy

To evaluate postoperative pain in patients submitted to conventional laparoscopic cholecystectomy with four ports versus single-port laparoscopic cholecystectomy with only one port. Twenty-one patients were included in the conventional laparoscopic cholecystectomy group and 19 other patients in the single-port laparoscopic cholecystectomy group. A VAS was used for the assessment of postoperative pain at three time points. Differences were considered statistically significant when p<0.05. Intergroup analysis showed no significant difference in VAS scores between the conventional laparoscopic cholecystectomy and single-port laparoscopic cholecystectomy groups at any of the time points studied. This study found no significant difference in postoperative pain between the two groups.

Effect of different bone cement dispersion types in the treatment of osteoporotic vertebral compression fracture

To observe different bone cement dispersion types of PVP, PKP and manipulative reduction PVP and their effects in the treatment of senile osteoporotic vertebral compression fractures and the bone cement leakage rate. The clinical data of patients with osteoporotic vertebral compression fractures who underwent unilateral vertebroplasty from January 2012 to January 2015 was retrospectively analyzed. Of them, 56 cases including 22 males and 34 females aged from 60 to 78 years old were treated by PVP operation; Fouty-eight cases including 17 males and 31 females aged from 61 to 79 years old were treated by PKP operation; Forty-three cases including 15 males and 28 females aged from 60 to 76 years old were treated by manipulative reduction PVP operation. AP and lateral DR films were taken after the operation; the vertebral bone cement diffusion district area and mass district area were calculated with AutoCAD graphics processing software by AP and lateral DR picture, then ratio(K) of average diffusion area and mass area were calculated, defining K<50% as mass type, 50%<=K<=100% as mixed type and K>100% as diffusion type. Different bone cement dispersion types of PVP, PKP and manipulative reduction PVP operation were analyzed. According to bone cement dispersion types, patients were divided into diffusion type, mixed type and mass type groups.Visual analogue scale (VAS), vertebral body compression rate, JOA score and bone cement leakage rate were observed. All patients were followed up for 12-24 months with an average of 17.2 months. There was significant difference in bone cement dispersion type among three groups (P<0.05). The constituent ratio of diffusion type, mixed type and mass type in PVP operation was 46.43%, 35.71%, 17.86%, in PKP was 16.67%, 37.50% , 45.83%, and in manipulative reduction PVP was 37.21%, 44.19% and 18.60%, respectively. PVP operation and manipulative reduction PVP were mainly composed of diffusion type and mixed type, while PKP was mainly composed of mass type and mixed type. There was no significant difference in VAS score, JOA score and bone cement leakage rate among three groups. There was statistically significant difference in postoperative vertebral body compression rate among three bone cement dispersion types(P<0.05), postoperative vertebral body compression rate in diffusion type group at 24 h postoperatively and final follow-up was (17.31±5.06)% and(18.58±4.91)%, respectively. In mixed type group, it was(14.21±5.15)% and(14.59±5.07)%, respectively. In mass type group, it was(13.89±5.02)% and(14.28±4.94)%, respectively. Bone cement dispersion type is different in PVP, PKP and manipulative reduction PVP operation. The bone cement dispersion of mass type and mixed type to recovery of compressed vertebral body is better than diffusion type, and there is no obvious difference in clinical effect in different bone cement dispersion type early and middle term.