Postoperative Visual Analog Scale Research Articles

Clinical efficacy and safety study of vNOTES for benign ovarian tumors in obese patients

To evaluate the clinical efficacy and safety of transvaginal natural orifice transluminal endoscopic surgery (vNOTES) for treating benign ovarian tumors in obese patients. A retrospective analysis was conducted on the clinical data of 35 obese patients who underwent vNOTES for benign ovarian tumor resection and 41 obese patients who underwent multi-port laparoscopic surgery (MPLS) during the same period from January 2021 to June 2024 at Qinghai Red Cross Hospital. Key parameters such as operative time, intraoperative blood loss, intraoperative and postoperative complications, hospitalization duration, postoperative anal exhaust time, postoperative visual analog scale (VAS) score, and SF-36 score were analyzed. No statistical differences were observed between the two groups regarding baseline characteristics such as age, body mass index (BMI), tumor diameter, parity, and history of pelvic surgery. The vNOTES group exhibited shorter operative times compared to the MPLS group, with no significant differences in tumor pathology, intraoperative blood loss, or tumor rupture rates. Postoperatively, the vNOTES group had shorter hospital stays, fewer postoperative complications, lower 24-hour postoperative VAS scores, and higher three-month postoperative SF-36 scores compared to the MPLS group. No differences were found between the groups concerning anal exhaust time, sexual satisfaction rate, or 24-hour postoperative VAS scores. vNOTES is a safe and feasible surgical method for treating benign ovarian tumors in obese patients, offering advantages such as no abdominal incisions and quicker postoperative recovery.

Anatomical measurements of the Thoracic splanchnic nerve and clinical applications.

To describe in detail the characteristics of the travels and relationship of splanchnic nerves, and to provide an anatomical basis for splanchnic nerve block. 1. For 20 thoracic splanchnic nerve anatomies, the relationship between the intersection of the greater splanchnic nerve (GSN) and lesser splanchnic nerve (LSN) and the T12 vertebrae was examined. 2. 6 patients with cancer pain in the epigram, unresponsive to conservative treatment, underwent splanchnic nerve radiofrequency ablation. The procedure was performed with CT guidance, and the patients were evaluated for postoperative visual analogue scale (VAS), quality of sleep (QS), and any adverse effects. Anatomy: 90% of the GSN and LSN intersect. The point was (18.69±3.52) mm from the median sagittal plane, (7.99±4.43) mm from the anterior aspect of the vertebral body, (8.2±7.9) mm from the cranial aspect of the superior endplate of the T12 vertebral body, and (7.03±12.41) mm from the caudal aspect of the inferior endplate of the T12 vertebral body. Clinical validation: All patients exhibited a decrease in VAS and an increase in QS compared to preoperative levels (P < 0.0001) CONCLUSIONS: The intersection of the GSN and LSN exists in the downward course, and its position is relatively fixed, located on the anterior side of the T11-L1 vertebral body, and the point where the GSN crosses the diaphragm is searched for anteriorly and upwardly, and the block is performed according to the position of the intersection of the GSN and LSN in the clinic, which is safe and effective.

Comparison of Clinical Efficacy between Vesselplasty and Percutaneous Vertebroplasty in Genant Grade 3 Osteoporotic Vertebral Compression Fracture.

In recent years, a modified percutaneous vertebroplasty procedure, known as Vesselplasty, has demonstrated favorable clinical outcomes in the treatment of osteoporotic vertebral compression fractures (OVCFs). However, there have been no reports on the application of Vesselplasty for Genant grade 3 OVCFs. This study aims to evaluate the efficacy and clinical outcomes of Vesselplasty in treating Genant grade 3 OVCFs, thereby providing evidence-based guidance for clinical decision-making. A retrospective study was conducted on 41 patients with Genant grade 3 OVCFs who underwent traditional percutaneous vertebroplasty (PVP) and 54 patients who underwent Vesselplasty at our hospital between February 2019 and January 2023. Clinical data from both groups were compared, including visual analog scale (VAS) scores, relative anterior vertebral height (RFVH), and local kyphosis angle (LKA) before surgery, as well as related complications. Postoperative VAS scores in both groups were significantly lower than preoperative scores, with no significant difference in VAS scores between the two groups after surgery. The Vesselplasty group exhibited a significant increase in RFVH (Preoperative: 55.93±9.61, 2 weeks: 82.11±8.32, 1 year: 81.02±7.43) and a significant decrease in LKA postoperatively (Preoperative: 27.17±5.37, 2 weeks: 11.15±4.84, 1 year: 12.01±5.45), whereas the PVP group showed no significant changes in RFVH(Preoperative: 56.01±3.54, 2 weeks: 56.29±9.85, 1 year: 56.13±9.15) or LKA(Preoperative: 26.99±6.65, 2 weeks: 26.52±5.77, 1 year: 26.63±6.27). Multivariate logistic regression analysis revealed that vertebral height (OR: 3.247, 95%CI: [2.749, 12.531], P = 0.000), LKA (OR: 2.116, 95% CI: [1.302, 4.785], P = 0.000), had shown significant improvement at 1 year. No cases of neurological injury, spinal canal compression, infection, continuous bleeding, cement allergy, or pulmonary embolism were observed in either group. The incidence of cement leakage was significantly lower in the Vesselplasty group compared to the PVP group (1.85%/14.63%, χ2=12.214, P=0.000). Both Vesselplasty and PVP techniques effectively alleviate pain symptoms in patients with Genant grade 3 OVCFs. However, Vesselplasty demonstrates superior efficacy in restoring vertebral height, correcting kyphotic deformity, and reducing the risk of cement leakage.

Restoring coronal pre-arthritic alignment in mobile-bearing unicompartmental knee arthroplasty: mid- to long-term outcomes

BackgroundPrevious research suggests that restoring pre-arthritic alignment in fixed-bearing unicompartmental knee arthroplasty (UKA) can improve postoperative knee function. However, its applicability to mobile-bearing UKA remains unclear. This study evaluated whether patients who achieve pre-arthritic alignment following mobile-bearing UKA with the kinematic alignment technique experience superior postoperative knee function compared with those who do not.MethodsA retrospective analysis was conducted on 236 knee joints that underwent UKA using kinematic alignment techniques between May 2015 and November 2017. Of these, 222 knee joints met the inclusion criteria for the study. Postoperative outcomes were assessed, with pre-arthritic alignment determined using the arithmetic hip-knee-ankle angle (aHKAA). Postoperative alignment within ± 3° of the aHKAA was classified as pre-arthritic alignment. Patients were categorized into two groups: pre-aligned and non-pre-aligned. Final follow-up occurred in September 2024, and outcome measures included the visual analogue scale (VAS) score, Hospital for Special Surgery (HSS) score, and Knee Injury and Osteoarthritis Outcome Score (KOOS) subscales for daily living, sports, and survivorship. Additionally, the percentage of patients meeting the patient-acceptable symptom state (PASS) criteria for KOOS-related subscales was recorded. Failure was defined as conversion to total knee arthroplasty.ResultsAmong the 222 knee joints analyzed, the average follow-up time was 8.65 years (range: 7–9 years), with an average implant survival time of 8.48 years and a total knee arthroplasty conversion rate of 2.7%. The 5-year survival rate was significantly higher in the pre-arthritically aligned group (99.4%) than in the non-pre-arthritically aligned group (92.5%) (p = 0.012). In total, 169 knees (76.13%) were classified as pre-arthritically aligned, while 53 knees (23.87%) were non-pre-arthritically aligned. postoperative VAS scores significantly improved from 6.90 ± 0.82 to 0.58 ± 0.56 (p < 0.001), and HSS scores increased from 56.3 ± 8.36 to 92.39 ± 4.54 (p < 0.001). Although no significant differences in postoperative VAS scores were observed between groups (p = 0.147), the pre-arthritically aligned group demonstrated significantly higher HSS scores and better KOOS subscale scores for daily living activities, sports, and quality of life than the non-pre-arthritically aligned group (all p < 0.01). The PASS ratio for KOOS subscales also indicated superior outcomes in the pre-arthritically aligned group.ConclusionUsing the kinematic alignment technique for mobile-bearing UKA, knees that achieved pre-arthritic alignment demonstrated superior survivorship and subjective postoperative knee function compared with those that did not.

Assessment of Clinical and Radiologic Outcomes of Biportal Endoscopic Posterior Cervical Inclinatory Foraminotomy : A Retrospective Cohort Study.

To evaluate clinical and radiological outcomes of biportal endoscopic posterior cervical inclinatory foraminotomy (BE-PCIF) to treat cervical spondylotic radiculopathy (CSR). This retrospective study included patients with CSR who underwent BE-PCIF between April 2020 and April 2023. Patient demographic data were collected and clinical outcomes were assessed using the visual analog scale (VAS) and MacNab criteria. Various radiological parameters, including inclinatory angles, were collected and correlations with demographic or radiological factors were evaluated. We included 101 patients (46 men and 55 women) with a mean age of 56.99 years, encompassing 162 surgical levels primarily affecting the C5-6 and C6-7 vertebrae. The postoperative VAS scores decreased to <1, with 90.1% of patients reporting excellence according to the MacNab criteria. None of the patients experienced any major postoperative complications, including instability. The isthmic distance (ID) expansion ratio, representing the degree of distal decompression, was 2.4, with a minor facet resection rate of 0.4. Right-sided surgeries or surgeries at lower cervical levels correlated with higher inclinatory angles, with a p-value of 0.003 each. Significant correlations were noted between the inclinatory angle and both the facet resection rate and ID expansion ratio, with coefficients of 0.45 and 0.3, respectively, both having a p-value of <0.001, indicating strong statistical significance. BE-PCIF effectively relieves pain and enhances clinical outcomes in CSR patients. The use of the inclinatory angle approach facilitates cervical foraminal expansion and sufficient neural decompression, with higher angles required for adequate decompression at lower cervical levels.

Role of bilevel erector spinae with high thoracic block vs conventional unilevel block in analgesia and reduction of pain in axilla in breast cancer surgeries: a randomized controlled trial.

Management of pain associated with breast cancer surgeries is crucial in reducing incidence of postmastectomy pain syndrome. The pain distribution involves the anterior chest wall, axillary area and ipsilateral upper limb. This study was designed to investigate the effect of bilevel erector spinae plane block (ESPB) with high thoracic block vs the conventional unilevel ESPB vs opioids in patients with cancer undergoing modified radical mastectomy regarding pain control and reducing pain in axilla. One hundred twenty-six female patients with cancer and American Society of Anesthesiology II, III were randomized into 3 groups: bilevel ESPB, unilevel ESPB, and control group. The primary outcome was total postoperative morphine consumption. Total postoperative morphine consumption was higher for the control group compared with the bilevel and unilevel groups (5.5 ± 1.8 vs 3.0 ± 0.0 and 4.3 ± 1.6 mg, P = 0.038). First time to receive morphine was longer for bilevel and unilevel groups compared with the control group (20.7 ± 3.1 and 17.7 ± 4.1 vs 8.2 ± 5 hours, P < 0.001). There was 96.1% and 90.3% reduction in morphine intake with odds ratio 25.6 (95% confidence interval [CI]: 6.6-100) and 10.3 (95% CI: 3.7-28.6) for the bilevel and unilevel groups compared with the control group. There was 98.5% and 65.4% reduction in the incidence of pain in axilla with odds ratio 66.6 (95% CI: 16.9-250) and 21.7 (95% CI: 6.75-66.6) for the bilevel and unilevel groups compared with the control group. Postoperative visual analog scale was lower for the bilevel group after 2, 4, and 24 hours compared with both the control group and the unilevel groups, P < 0.005. Both conventional unilevel and high thoracic bilevel ESPB had better analgesic profile when compared with opioids. Although the bilevel ESPB had additional merits to the unilevel ESPB in analgesic effects, both can be used effectively.

Enhancing the technical pearls for L5-S1 anterior lumbar interbody fusion in patients with body mass index greater than 30: clinical and radiographic outcomes at 1-year follow-up

Performing anterior lumbar interbody fusion (ALIF) in patients with a body mass index (BMI) >30 presents surgical challenges. To overcome those challenges, a modified procedure is described. This study retrospectively reviewed patients with a BMI >30 who underwent the modified L5-S1 ALIF procedure from August 2017 to September 2023. Patient demographic and operative characteristics were collected. Clinical and radiographic outcomes were analyzed before surgery and at 1-year follow-up. An analysis was performed comparing patients with a BMI >30 who underwent the modified ALIF procedure versus the standard ALIF procedure. A total of 26 patients with BMI >30 were evaluated. Thirteen received treatment with the modified ALIF technique, and 13 received treatment with the standard ALIF technique. Operative time was significantly shorter in the modified ALIF technique cohort (P= 0.006). Preoperative and postoperative radiographic findings indicated significant differences in anterior disc height (P < 0.001), posterior disc height (P= 0.02), and L5-S1 segmental lordosis (P < 0.001) in patients undergoing the modified ALIF technique. There were no intraoperative complications. Postoperative visual analog scale for back pain, visual analog scale for leg pain, and Oswestry Disability Index scores significantly improved after surgery (P < 0.05) in both cohorts after 1 year. Complete interbody fusion was achieved according to computed tomography evaluation 1 year after surgery in more than 80% of cases. ALIF surgery is a safe technique to address lumbar pathologies. This operative technique provides complimentary abdominal exposure data for access surgeons while performing ALIFs in patients with BMI >30. This technique could reduce operative time in such patients.

Impact of Dexamethasone on Blood Glucose After Total Knee Arthroplasty in Patients With Type 2 Diabetes.

With the global aging population, the incidence of OA is rising annually, and the number of TKA surgeries is rapidly increasing, placing a heavy economic and healthcare burden on society. As one of the key medications in the ERAS protocol, DXM can significantly reduce postoperative pain, suppress nausea and vomiting, and accelerate patient recovery. However, the safety of perioperative DXM use in patients with diabetes remains unclear. This study aims to clarify the safety of perioperative DXM application in diabetic patients. This retrospective analysis involved 285 patients with type 2 diabetes and late-stage knee osteoarthritis who underwent unilateral TKA at the Joint Surgery Center of Peking University Third Hospital from January 2019 to November 2022. After application of the inclusion and exclusion criteria, 161 patients were included in the study. The patients were divided into two groups according to whether they had received continuous intravenous administration of DXM for 3 days postoperatively: the DXM group (n = 66) and the non-DXM group (n = 95). All other treatments and medications were the same in both groups. The patients' PBG, incidence of PONV, length of hospital stay, pain scores, and clinical data were collected and compared between the two groups. There were no significant differences in the general preoperative data between the DXM and non-DXM groups. The average PBG and the proportion of patients with levels exceeding 200 mg/dL were not significantly different between the two groups (10.84 mg/dL vs. 11.05 mg/dL and 43.2% vs. 43.9%). The postoperative visual analog scale scores (3.67 vs. 2.48) and the incidence of PONV were significantly lower in the DXM than non-DXM group (40% vs. 16%). The preoperative level of glycated hemoglobin accurately predicted PBG. Furthermore, there were no statistically significant differences in the incidence of early postoperative complications between the groups. The administration of DXM after unilateral TKA can effectively reduce postoperative pain and suppress the occurrence of PONV without affecting PBG in patients with type 2 diabetes. In addition, the preoperative level of glycated hemoglobin can accurately predict PBG.

Effect and safety of percutaneous endoscopic interlaminar discectomy for L5-S1 disc herniation: direct inferior endplate approach versus indirect approach.

To explore the efficacy and safety of the direct inferior endplate approach in percutaneous endoscopic interlaminar discectomy (PEID) for the treatment of L5-S1 disc herniation. This was a retrospective analysis of 116 patients with L5-S1 disc herniation treated with PEID; 74 patients underwent surgery via the direct inferior endplate approach (group A), and 42 patients underwent surgery via the indirect approach (group B). The number of intraoperative fluoroscopy exposures, establishment channel time, operation time, postoperative visual analogue scale (VAS) score, and Oswestry Disability Index (ODI) were compared between the 2 groups. Compared with those in Group B, the channel establishment time, number of fluoroscopy exposures, and operation time in Group A were significantly lower (P < 0.05). There was no significant difference in the VAS score or ODI between the two groups (P > 0.05). Compared with the indirect approach, the direct inferior endplate approach can allow the exposed target to be reached more quickly, shorten the operation time, and reduce the degree of radiation exposure of doctors and patients, resulting in a high safety profile.

The impact of preexisting psychiatric disorders on patient outcomes following primary total shoulder arthroplasty: A systematic review and quantitative synthesis.

To summarize complication rates, reoperation rates, length-of-stay (LOS), patient-reported outcome measures (PROMs), and range of motion following total shoulder arthroplasty (TSA) in patients with preexisting psychiatric disorders (PDs) compared to controls. Three databases (MEDLINE, PubMed, and EMBASE) were searched from inception to 4 March 2024 to identify studies comparing outcomes between patients undergoing anatomic (aTSA) or reverse TSA (rTSA) with or without a preexisting psychiatric condition. The authors adhered to the preferred reporting items for systematic reviews and meta-analyses and revised assessment of multiple systematic review guidelines. Data on demographics, as well as postoperative complication rates, reoperation rates, LOS, PROMs, and range of motion were extracted from included studies. PROMs included the American Shoulder and Elbow Surgeons (ASESs) score, and visual analogue scale (VAS) pain score. Meta-analyses were conducted for outcomes reported by multiple studies, with odds ratios (ORs) and mean differences (MDs) as effect measures for continuous and dichotomous outcomes, respectively. Thirteen studies were included in this review, comprising a total of 820,831 TSA patients. The PD group (71.0% female) consisted of 150,432 patients (mean age: 67.6 ± 9.9) with a mean follow-up time of 34.1 ± 30.1 months. The control group (58.1% female) consisted of 670,399 patients (mean age: 69.4 ± 10.7) with a mean follow-up time of 39.1 ± 36.0 months. The PD group had significantly higher rates of complications and reoperation. The PD group also reported significantly lower postoperative ASES scores, higher postoperative VAS scores, and inferior postoperative abduction. There were no significant differences in postoperative LOS, forward flexion, internal rotation, or external rotation. Patients with preexisting PDs may have a one-and-a-half times higher odds of postoperative complication or reoperation, as well as significantly worse postoperative pain and PROMs. Identification of at-risk individuals with preexisting psychiatric conditions and preoperative referral to a mental health specialist to optimize psychiatric conditions may benefit this patient cohort ahead of their shoulder arthroplasty procedure. IV.

A relevant investigation of the degree of cement diffusion after robot-assisted percutaneous vertebroplasty

The aim of this research was to conduct randomized trials assessing the extent of cement diffusion following robot-assisted percutaneous vertebroplasty (R-PVP) for osteoporotic vertebral compression fractures (OVCF). A total of 96 OVCF patients meeting the inclusion criteria and admitted between January 2023 and November 2023 were included in the study. Among them, 48 patients were assigned to the robotic-assisted PVP group (R-PVP group) and 48 patients were assigned to the traditional PVP group (PVP group). The study examined the differences in age, sex, BMD T-value, fracture segment, preoperative, postoperative, and 3-month postoperative visual analogue scale (VAS) and Oswestry disability index (ODI) pain scores, fluoroscopic dose, frequency of fluoroscopy, volume of bone cement injected, angle of puncture abduction, degree of cement diffusion, and bone cement spillage among the two patient groups. A logistic regression model was employed to analyze the factors influencing the extent of postoperative bone cement diffusion. The findings indicated that the R-PVP group exhibited a significantly larger puncture abduction angle, improved postoperative cement dispersion, increased cement injection volume, and decreased incidence of cement spillage compared to the PVP group. Furthermore, the R-PVP group demonstrated superior outcomes in these aspects, as well as lower intraoperative fluoroscopic frequency and radiation exposure. Additionally, bone density, puncture abduction angle, cement injection volume, and surgical approach were identified as independent factors associated with the extent of postoperative cement dispersion.

The efficacy and safety of patient-controlled intravenous analgesia with esketamine after total hip arthroplasty: a randomized controlled trial

PurposeTo evaluate the efficacy and safety of esketamine-based patient-controlled intravenous analgesia following total hip arthroplasty.MethodsA total of 135 total hip arthroplasty patients were randomly assigned to one of the three treatment groups: esketamine, sufentanil or continuous fascia iliaca compartment block (FICB) group. The primary endpoint was the postoperative visual analogue scale (VAS) pain scores at rest and on movement. Secondary endpoints included preoperative 1-day and postoperative 7-day Self-Rating Anxiety Scale (SAS) and Self-Rating Depression Scale (SDS) scores, the satisfaction of patients and surgeons, postoperative 1-month and 3-month Harris function scores, the incidence of adverse reactions.ResultsAt 48 h post-surgery, the VAS pain scores in the esketamine and FICB groups at rest and on movement were significantly lower than those in the sufentanil group (P < 0.05). The satisfaction of patients in the esketamine group was higher than that in the sufentanil and FICB groups (P = 0.014). The satisfaction of surgeons in the esketamine and FICB groups was higher than that in the sufentanil group (P = 0.002). At postoperative day 7, the SAS scores and SDS scores in the esketamine group were significantly lower than those in the sufentanil and FICB groups (P < 0.05). Compared with the sufentanil group, the postoperative nausea and vomiting, dizziness and total adverse reactions in the esketamine group and FICB group were lower (P < 0.05).ConclusionPatient-controlled intravenous analgesia with esketamine has the potential to provide good postoperative analgesia for total hip arthroplasty patients, reduce the incidence of adverse reactions after the operation, improve the satisfaction of patients and surgeons, and significantly improve patients’ postoperative mood.Trial registration: ChiCTR2300069632 (https://www.chictr.org.cn/) (March 22th, 2023).

Compare the Effects of Infiltration of Bupivacaine in Liver Bed with Preperitoneal Nerve Block in Laparoscopic Cholecystectomy

Background: Laparoscopic cholecystectomy is now considered the preferred treatment for symptomatic gallstone diseases, establishing itself as the gold standard method. Nevertheless, pain remains the sole grievance responsible for delaying discharge. Objective: To compare the effectiveness of bupivacaine infiltration into the liver bed and peritoneal cavity in reducing pain after laparoscopic cholecystectomy. Material and Methods: This prospective comparative study was done at the Department of General Surgery of Akbar Niazi Teaching Hospital, Islamabad. The study included 100 patients who were admitted for elective laparoscopic cholecystectomy between June and November 2023.Patients were consecutively assigned to received either bupivacaine preperitoneal nerve block. After gallbladder was removed, 20 ml bupivacaine 0.5% was administered in liver bed. For preperitoneal nerve block bupivacaine 0.5% was infiltrated into port sites to block the preperitoneal nerves. Postoperative pain assessment was conducted at 1, 6, 12, and 24 hours utilizing the Visual Analog Scale (VAS). Results: The mean patients ages were43.88±7.8 years. Postoperative mean VAS at 1, 6 and 12 hours were decreased in Bupivacaine compare to preperitoneal nerve block (p ≤ 0.05). Postoperatively no difference was observed in VAS at 24 hours between the patients (p ≥ 0.05). The total doses mean of SAID utilized in first 24 hours postoperatively were lower in Bupivacaine patients than in preperitoneal nerve block patients (p ≤ 0.05). Conclusion: The infiltration of bupivacaine in the liver bed following laparoscopic cholecystectomy effectively reduces pain as compare to preperitoneal nerve block. This straightforward, cost-effective technique should be adopted to diminish early postoperative pain in all elective cases.

Endoscopic Treatment of Chronic Plantar Fasciitis with Plantar Heel Spur Pain: A Combined Suprafascial and Infrafascial Approach.

To determine whether a combined endoscopic suprafascial and infrafascial approach with medial and lateral portals is a safe and effective technique for the endoscopic treatment of chronic plantar fasciitis with plantar heel spur pain. An interventional, prospective study was conducted. A total of 61 patients with plantar fasciitis with plantar heel spur pain underwent an endoscopic plantar fasciotomy with plantar heel spur resection, using a combined suprafascial and infrafascial approach between January 2018 and August 2022. Preoperative Foot and Ankle Ability Measure (FAAM), 36-Item Short Form Health Survey (SF-36), and visual analog scale (VAS) scores were measured. The measurements were repeated at 6 weeks, 3, 6, and 12 months postoperatively and at the final follow up. Preoperative and 1-year postoperative film parameters (Meary angle, calcaneal pitch angle, medial cuneiform-fifth metatarsal height) were compared.Complications were recorded at each encounter. The mean follow up time was 2.6 ± 1.1 years. At the 6-week postoperative visit, the mean change in FAAM-ADL, FAAM-Sport, SF-36 physical component summary, SF-36 mental component summary, and VAS were 26.0,19.0, 44.8, 61.2, and -5.8, respectively. These changes were statistically significant (P < .001). These findings were sustained and generally improved at all other follow-up points: 3, 6, and 12 months postoperatively and final follow-up. The average period until the recovery of activities of daily living and sport activities were 2.6 and 8.6 weeks, respectively. There were no significant differences between the pre- and 1-year postoperative radiographic values (P > .05). No cases resulted in medial arch collapse. Five cases (8%) had an injury to the first branch of lateral plantar nerve. Endoscopic plantar fascia release and plantar heel spur resection using a combined suprafascial and infrafascial approach resulted in the improvement of postoperative FAAM, SF-36, and VAS scores and involved a low incidence of postoperative complications.

The influence of high doses of vitamin C on functional recovery and postoperative pain in patients with trochanteric fracture after intramedullary nailing during a three-month follow-up: a pilot study

&amp;lt;p&amp;gt;&amp;lt;strong&amp;gt;Aim&amp;lt;/strong&amp;gt; To determine the effects of high peri- and postoperative doses of vitamin C administration on severity of pain in postoperative period and functional outcome of the patients with trochanteric fracture treated with intramedullary nailing during a three-month follow-up.&amp;lt;br /&amp;gt;&amp;lt;strong&amp;gt;Methods&amp;lt;/strong&amp;gt; A prospective, randomized, pilot study included 56 patients who were randomly divided into vitamin C (intervention) and control groups. In the intervention group, patients received vitamin C perioperatively by an intravenous route for 2 days, and oral vitamin C for 38 days postoperatively. Baseline characteristics, postoperative metamizole consumption, Visual Analogue Scale (VAS) score, Harris Hip Score (HHS) value, and the prevalence of complications were evaluated in both groups.&amp;amp;nbsp;&amp;lt;br /&amp;gt;&amp;lt;strong&amp;gt;Results&amp;lt;/strong&amp;gt; No significant differences were noted between the groups regarding age, gender, length of hospitalization, and distribution in fracture type. Postoperative metamizole consumption was notably higher in the control group compared to the vitamin C group (p=0.006). Postoperative VAS score was higher in the control group (p&amp;amp;lt;0.05). No significant differences in HHS values were detected between the groups at 6 and 12 weeks postoperatively (p=0.655 and p=0.755, respectively). The group variable significantly contributed to VAS score, and age and gender variables significantly contributed to HHS value.&amp;lt;br /&amp;gt;&amp;lt;strong&amp;gt;Conclusion&amp;lt;/strong&amp;gt; A significant reduction of subjective pain levels and lower analgesic consumption was found in patients who received vitamin C, suggesting that it should be considered as an adjuvant agent for analgesia in patients with hip fracture.&amp;lt;/p&amp;gt;

Comparison of anterior and posterior approaches for the treatment of cervical ossification of the posterior longitudinal ligament: a meta-analysis of 28 cohort studies.

At present, the choice of approach for the surgical treatment of cervical ossification of the posterior longitudinal ligament (OPLL) remains controversial. We performed this meta-analysis to compare the efficacy of the anterior and posterior approaches in the treatment of cervical OPLL. PubMed, EMBASE and the Cochrane Library were systematically searched for all eligible articles as of August 3, 2023, without any publication date restrictions. We used the random effects model to pool standardized mean differences (SMDs) or odds ratios (ORs) with 95% confidence intervals (CIs). We conducted subgroup analyses to explore the potential sources of heterogeneity, and sensitivity analyses were used to evaluate the robustness of the findings via the leave-one-out procedure. In addition, we evaluated publication bias by observing the symmetry of the funnel plot and using Egger's test, and the trim-and-fill method was employed to A total of 28 studies including 6,324 participants met the inclusion criteria. The meta-analysis revealed that, compared with the posterior approach, the anterior approach was significantly associated with a superior recovery rate (SMD, 0.83; 95% CI, 0.41 to 1.25), a greater number of patients with a recovery rate ≥ 50% (OR, 2.13; 95% CI, 1.16 to 3.92), higher Japanese Orthopaedic Association (JOA) scores (SMD, 0.62; 95% CI, 0.31 to 0.94), and better recovery of cervical lordosis (SMD, 1.83; 95% CI, 0.95 to 2.72). Furthermore, the results revealed that the complication rate (OR, 1.45; 95% CI, 1.01 to 2.09) with the anterior approach was significantly greater than that with the posterior approach. However, our study revealed no significant differences between the two surgical groups in terms of the postoperative visual analogue scale (VAS) score, postoperative space available for the spinal cord, postoperative range of motion of the cervical spine, duration of symptoms, operation time, blood loss, or length of stay. The anterior approach is superior to the posterior approach in terms of the postoperative recovery rate, the number of patients with a recovery rate ≥ 50%, JOA scores, and recovery of cervical lordosis. Combined with the results of the above outcome and subgroup analysis, we advocate for the anterior approach in patients with a canal-occupying ratio exceeding 50% or 60%.

Robot-Assisted Positioning for Percutaneous Endoscopic Interlaminar Discectomy.

During percutaneous endoscopic interlaminar discectomy (PEID), a range of technologies including medical robotics, visual navigation, and spatial registration have been proposed to expand the application scope and success rate of minimally invasive surgery. The use of robotic technology in surgery is conducive to improving accuracy and reducing risk. This study aims to introduce a precise and efficient targeting method tailored for robot-assisted positioning under C-arm fluoroscopy inPEID. This study conducted a retrospective analysis of 107 patients with lumbar disc herniation (LDH) who underwent surgical treatment at our hospital from February 2023 to February 2024 (average age: 43.3 ± 13.3 years; 61 males and 43 females). The method entails constructing a specialized end-effector capable of simultaneous fluoroscopy calibration and robot-to-image-space registration. The average time of the surgical procedure and the average number of fluoroscopy exposures were collected. Preoperative and postoperative follow-up data were collected, including assessment scores from the Japanese Orthopedic Association (JOA) and Visual Analog Scale (VAS). Paired t-tests were employed to compare differences in each clinical outcome between the preoperative and follow-up time. These techniques effectively reduce both radiation exposure and operation time. Clinical data reveals that the average time for robot-assisted positioning stands at 2.5 ± 0.7 min, with anteroposterior and lateral radiographs demonstrating accuracies of 2.4 ± 2.8 mm and 3.1 ± 3.7 mm, respectively, during robot-assisted positioning. Postoperative VAS scores for back pain and leg pain were significantly lower than preoperative scores (1.2 ± 1.8 vs. 4.1 ± 2.3, 0.9 ± 2.0 vs. 5.9 ± 1.8; p < 0.05, p < 0.05, respectively). Postoperative JOA scores were significantly higher than preoperative scores (26.1 ± 3.5 vs. 14.5 ± 4.9; p < 0.05). Through the evaluation of the system in robot-assisted positioning during PEID, this study substantiates the accuracy and reliability of the proposed method in clinical applications.

Percutaneous hallux fusion with calcaneus bone autograft: a retrospective cohort study of clinical and radiographic outcomes.

In the case of end-stage hallux rigidus, first metatarsophalangeal (MTP) joint arthrodesis is the gold-standard and is traditionally performed via an open approach. However, complications such as nonunion have been reported to be as high as 30%. Recently, there have been reports demonstrating a percutaneous approach to be effective and safe. Forty-nine patients with end-stage hallux rigidus underwent percutaneous first MTP joint arthrodesis with calcaneus autograft performed by a single surgeon. Each patient underwent a minimum of 24 month clinical and radiographic follow up, including 3 month post operative computed tomography scans. Clinical outcomes were assessed using the Visual Analog Scale (VAS) and Foot Function Index (FFI) preoperatively and at final follow-up. Mean follow-up was 27.3 months. Bone union was observed in 46 patients (93.9%). Mean time to union was 3.1 months. Nonunion rate was 6.1%. Overall complication rate was 12.2%. Mean pre- and postoperative VAS scores were 7.5 and 0.2, respectively (P < .0001). Mean pre- and postoperative total FFI values were 56.3 and 15.7 (P < .0001), respectively. Patient satisfaction after the procedure was 93.9%. Observed union rate is comparable to the average fusion rate previously reported for open and minimally invasive procedure union rates. Mean time to union was observed to be comparable to open procedures union time. Observed overall complication rate is similar to those reported for open techniques as well. Patient reported outcomes demonstrated a significant reduction in postoperative VAS and FFI for the percutaneous metatarsophalangeal arthrodesis with calcaneus bone autograft. Patient satisfaction rates compared favorably to those reported following open surgery.

Impact of Nasal Anatomical Variation Subtype on Surgical Outcomes for Rhinogenic Contact Point Headache.

Background/Objectives: Rhinogenic contact point headache (RCPH) is a controversial secondary headache disorder involving mucosal contact points in the nasal sinuses. The efficacy of surgical versus medical management has been debated, with some studies showing excellent long-term outcomes but others citing placebo effects. This study aimed to clarify the correlation with nasal anatomical variation detected by CT and RCPH treatment outcomes. Methods: A prospective cohort study was conducted on 90 RCPH patients undergoing surgery or medical therapy. Patients were diagnosed using CT scans, endoscopy, and lidocaine testing. The surgery group had endoscopic procedures to remove contact points. The medical group received intranasal steroids. Outcomes were measured by visual analog scale (VAS) for pain and headache frequency. Predictors like age, gender, and nasal anatomical variations were analyzed. Results: The surgery group showed significant reductions in VAS scores (6.02 to 2.51, p < 0.001) and headache frequency (9.11 to 3.04, p < 0.001). The medical group did not improve significantly. All nasal subtypes improved with surgery but concha bullosa had worse VAS outcomes (4.0) than septal deviation (1.8, p < 0.001) or spur (1.73, p < 0.001). Multivariate analysis found nasal anomalies predicted postoperative VAS scores (p < 0.001) but not headache frequency (p = 0.255). Conclusions: Surgery demonstrated superiority over medications for RCPH. This study provides new evidence that preoperative CT scans should be considered a non-invasive gold standard for analyzing nasal subtypes as they significantly influence surgical success, with concha bullosa associated with worse pain relief. Larger studies should validate these findings to optimize RCPH management.

Evaluating efficacy and outcomes: comparison of laser treatment and crystallized phenol in pilonidal sinus disease.

The aim of this study is to comprehensively evaluate the efficacy of laser ablation and crystallized phenol application in the treatment of pilonidal sinus disease, focusing on treatment success, recurrence rates, complications, and the patients' return to normal life. Data from patients treated for pilonidal sinus disease with laser ablation and crystallized phenol application at our clinic between January 2020 and September 2023 were retrospectively reviewed. Preoperative data including pit counts, disease stage, preoperative pilonidal abscess history, disease duration (week), treatment success, recurrence/persistent disease, postoperative complications, healing time (days), and visual analogue scale (VAS) scores on postoperative days 1 and 7, as well as return to normal life (days), were analyzed. A total of 121 patients were included in the study, with 51 receiving laser ablation and 70 receiving crystallized phenol application. The postoperative outcomes revealed that the wound healing period and postoperative VAS values were statistically significantly better in the laser ablation group. Wound healing was faster and postoperative pain was less in the laser group compared to the phenol group. According to this study, both methods can successfully treat the disease in selected cases.