Significant Difference In Visual Analogue Scale Score Research Articles

Travmatik korneal abrazyon hastalarında Dekspantenol kullanımının hasta konforuna olan etkisi

Objective: The aim in this study was to investigate if the use of Dexpanthenol could play a role in the relief of pain in the treatment of corneal abrasions (CA). Methods: Patients presenting to the BLINDED with a diagnosis of CA were conducted in this retrospective, case-control study. A detailed ocular examination was done and pain severity was assessed using a visual analogue scale (VAS) score. In group 1, subjects were treated with only topical ofloxacin %0.3 while subjects in group 2 were treated with topical ofloxacin %0.3 and dexpanthenol. Foreign body sensation, photophobia, excessive lacrimation and VAS were documented at follow up examinations. Results: 70 patients were allocated into group 1 and 68 patients were allocated into group 2. At each visit, there were significant differences in VAS scores between the groups (p<0.005). VAS scores were lower in group-2. There were no statistically significant differences between two groups in terms of photophobia, foreign body sensation, excessive lacrimation (p>0.05). All patients were free of any complications. Conclusion: Although it was shown that adding topical dexpanthenol to the treatment regimen could permit faster pain relief in treating CAs, the prospective studies should be done. Key words: Traumatic corneal abrasion, Dexpanthenol, Visual analogue scale.

Comparison of Relative Benefits of Mirror Therapy and Mental Imagery in Phantom Limb Pain in Amputee Patients at a Tertiary Care Center

ObjectiveTo determine the relative benefit of mirror therapy and mental imagery in phantom limb pain. DesignProspective randomized controlled trial. SettingPhysical Medicine and Rehabilitation Department, All India Institute of Medical Sciences, Patna. ParticipantsAmputees (N=92) with no significant difference in baseline characteristics. There was a male predominance in both groups (mirror therapy: 36 men, 10 women; mental imagery: 37 men, 9 women). InterventionPatients of both groups underwent a conventional amputee rehabilitation program and daily treatment of either mirror therapy or mental imagery on a regular basis, first in a rehabilitation care unit and later at home. Main Outcome MeasuresPhantom limb pain (PLP) was measured by visual analog scale (VAS) score at baseline (0) and at 4, 8, and 12 months. ResultsThis study included 92 patients ranging in age from 12 to 75 years (average, 34.79y). There was no significant difference in VAS score between the groups at baseline, but we found a significant reduction of pain in both groups at follow-up. However, upon comparing the improvement in both groups, we determined that the mirror therapy group had better improvement (from 7.07±1.74 to 2.74±0.77) compared with the mental imagery group (from 7.85±0.76 to 5.87±1.41). ConclusionsMirror therapy and mental imagery are both good and cost-effective rehabilitation aids for amputee patients to reduce PLP, but mirror therapy appears to be more effective than mental imagery.

Influence of preoperative weight on the early and middle outcome of fixed platform medial unicompartmental knee arthroplasty

Introduction:Obesity is an important independent risk factor for the development of knee osteoarthritis .According to the data of the world Health Organization, there were more than 1.9 billion overweight adults in the world in 2014, among which at least 600 million were clinically obese .Therefore, among the patients undergoing knee replacement, the number of obese patients is increasing .The use of single condyle replacement for medial compartment arthritis of the knee began in the 1970s.With the continuous development of new implants, the continuous improvement of surgical techniques and the strict control of indications by surgeons, the 15-year survival rate of single condyle replacement is over 90%, and the 20-year survival rate is 84%, achieving good results.In the indications of knee monocepicondylar replacement, the maximum weight standard has been increased from 82kg in 1989 [8] to 90kg in 2002 [9].However, there is still controversy over the body weight cut-off point in the indications, especially the observation on the postoperative effect of single condyle replacement in obese patients, which has been rarely reported in China.Hypotheses:To evaluate the near and middle term efficacy of unicompartmental knee arthroplasty(UKA) in patients with medial knee osteoarthritis with different body mass index, and to determine the effect of body weight on the efficacy and complications of UKA.Methods:A total of 128 patients who underwent UKA in department I of arthropathy, zhengzhou orthopaedic hospital from December 2016 to December 2018 due to medial knee osteoarthritis were included as study subjects, and the clinical data of the study subjects were retrospectively analyzed. There were 29 males and 99 females, with an average age of 65.13± 7.37 years (range: 51˜87 years).According to the preoperative body mass index (BMI), the subjects were divided into three groups, namely the underweight or normal weight group (BMI < 24kg /㎡), the overweight group (24kg /㎡≤BMI < 28kg /㎡) and the obese group (BMI≥ 28kg /㎡).Visual analogue scale (VAS), knee range of motion(ROM), American hospital for special surgery (HSS) score of knee joint, complications and other relevant indicators were recorded before and at the last follow-up for each group. According to the data types of preoperative and postoperative efficacy evaluation indexes of the same group, paired sample T test, c² test or Wilcoxon sign rank sum test were used for difference analysis. One-way anova, c² test or K-W rank sum test were used to evaluate the difference between groups.Results:All subjects were followed up for 13-37 months (22.34± 7.22).Compared with before surgery, VAS scores of patients in the last follow-up were significantly lower in the underweight or normal weight group, the overweight group and the obese group (6.91±6.34 vs. 0.44±0.67, 6.90 ±0.77 vs. 0.63±0.68, 6.78±0.71 vs. 0.59±0.61) (t= 46.488-42.654,P values <0.01), knee ROM significantly increased (97.67±10.87 vs. 114.77±8.01, 98.96±10.67 vs. 116.03±6.96, 95.31±11.50 vs. 110.93±11.46) (t= -20.83 - -11.039,All P values were <0.01), and knee HSS score was significantly improved (51.63±0.61 vs 88.00±4.06, 50.68±6.46 vs 87.87±5.73, 48.25±6.70 vs 87.03±5.17) (t= -48.920- -34.010, all P values <0.01).There were no statistically significant differences in VAS score, knee ROM and knee HSS score between the overweight group and the obese group compared with the underweight or normal group. None of the patients had serious complications such as periprosthesis infection, simple prosthesis loosening and periprosthesis fracture. The incidence of venous thrombosis in lower extremities was 14.06% (18/128), with no significant difference between groups. There were 7 cases of poor incision healing (overweight group is 3 and obese group is 4), and the risk of poor incision healing was higher in the obese group than in the underweight or normal weight group, with statistical significance (P=0.03).Conclusion:UKA can achieve satisfactory clinical effect in patients with different body mass index, but patients in obesity group are prone to complications such as poor incision healing.

The effect of bone cement distribution on the outcome of percutaneous Vertebroplasty: a case cohort study

BackgroundTo analyze the effect of different types of bone cement distribution after percutaneous vertebroplasty (PVP) in patients with osteoporotic vertebral compression fracture (OVCF).MethodsOne hundred thirty seven patients with single level OVCF who underwent PVP were retrospectively analyzed. The patients were divided into two groups according to bone cement distribution. Group A: bone cement contacted both upper and lower endplates; Group B: bone cement missed at least one endplate. Group B was divided into 3 subgroups. Group B1: bone cement only contacted the upper endplates; Group B2: bone cement only contacted the lower endplates; Group B3: bone cement only located in the middle of vertebral body. The visual analogue scale (VAS) score at 24 h post operation and last follow-up, anterior vertebral height restoration ratio (AVHRR), anterior vertebral height loss ratio (AVHLR), local kyphotic angle change and vertebral body recompression rate were compared.Results24 h post operation, the pain of all groups were significantly improved. The average follow-up time was 15.3 ± 6.3 (6–24) months. At last follow-up, the VAS score of group A was lower than that of group B. There were 14 cases (10.2%) of adjacent vertebral fracture, 5 cases (8.6%) in group A and 9 cases (11.4%) in group B. There were 9 cases (6.6%) of cement leakage, 4 cases (6.9%) in group A and 5 cases (6.3%) in group B. At last follow-up, there were 16 cases (11.7%) of vertebral body recompression, including 3 cases (5.2%) in group A and 13 cases (16.5%) in group B. There was no significant difference in AVHRR between two groups. Local kyphotic angle change was significant larger in group B. At last follow-up, AVHLR in group B was higher than that in group A. Analysis in subgroup B revealed no significant difference in VAS score, local kyphotic angle change, vertebral recompression rate, AVHRR or AVHLR.ConclusionsIf the bone cement fully contacted both the upper and lower endplates, it can better restore the strength of the vertebral body and maintain the height of the vertebral body, reduce the risk of the vertebral body recompression and long-term pain.

Clinical study of Youngswick versus distal oblique osteotomy in the treatment of grade Ⅲ and Ⅳ hallux rigidus

Objective: To investigate the clinical outcomes and effects of distal oblique osteotomy and the Youngswick osteotomy in the treatment of grade Ⅲ and Ⅳ hallux rigidus. Methods: Totally 29 patients (33 feet) suffered from grade Ⅲ and Ⅳ hallux rigidus who received the distal first metatarsal osteotomy in Ningbo NO.6 Hospital from May 2013 to December 2018 were analyzed retrospectively. Among them, there were 10 males and 19 females. The average age was (56±6) years. Seventeen cases (18 feet) underwent distal oblique osteotomy of the first metatarsal, 12 cases (15 feet) underwent the Youngswick osteotomy. The overall clinical evaluations were investigated before the operation and at the final follow-up, included the visual analogue scale (VAS) of the pain, American Orthopedic Foot & Ankle Society (AOFAS) scores, the motionrange of the first metatarsophalangeal joint and the first metatarsophalangeal joint space. The data before and after operation were compared by paired t test and non-parametric rank sum test. Results: The operation time were (1.1±0.2) hours and (1.3±0.1) hours, and the intraoperative bleeding was 35 (25, 36) ml and 35 (30, 40) ml in the distal oblique osteotomy and Youngswick osteotomy respectively. All patients were followed up for 12 to 46 months. No nonunion or delayed union occurred in all patients. All patients did not need to be operated again, and no complications such as transferring metatarsalgia, infection and osteonecrosis occurred. In the two groups, the pain VAS score decreased significantly (Z=-3.8, -3.5, both P<0.01), the first metatarsophalangeal joint dorsal extension activity increased (Z=-3.7, -3.4, both P<0.01), the AOFAS score increased (t=28.0, 15.4, both P<0.05) and the first metatarsophalangeal joint space also improved significantly (t=17.7, 14.6, P<0.05) after the operation. There was no significant difference in VAS score, the first metatarsophalangeal joint activity and Horton index between the two groups(Z=-1.3, -0.3, -0.4, all P>0.05), and there was no statistical difference inAOFAS score (t=0.1, P>0.05). But compared with it in the first distal oblique metatarsal osteotomy, the joint space with the Youngswick osteotomy after the operation was larger ((2.4±0.3) mm vs (2.1±0.4) mm, t=2.2, P=0.04). Conclusions: The oblique metatarsal osteotomy and Youngswick osteotomy can effectively relieve the pain of the hallux rigidus, increase the dorsal extension activity and joint space of the first metatarsophalangeal joint, sink the first metatarsal head, and improve the living conditions of the patients. The results of the distal metatarsal osteotomy and the Youngswick osteotomy in the treatment of stage Ⅲ and Ⅳ patients with rigid are similar, which can delay the progress of the disease.

The analgesic effect of tramadol combined with butorphanol on uterine cramping pain after repeat caesarean section: a randomized, controlled, double-blind study.

This study aimed to explore the effect of patient-controlled intravenous analgesia (PCIA) using tramadol combined with butorphanol on uterine cramping pain in women undergoing repeat caesarean section. A total of 126 patients, who were scheduled to undergo repeat caesarean section under spinal anesthesia, were included. PCIA using tramadol combined with butorphanol or sufentanil was randomly performed for postoperative pain control. Postoperative uterine cramping pain and wound pain within 48h after surgery were evaluated. Postoperative analgesic consumption, early activity time, and length of hospital stay were also recorded and analyzed. Uterine cramping pain intensity in women undergoing repeat caesarean section was significantly higher compared with their wound pain (P < 0.05). The mean visual analog scale (VAS) score for uterine cramping pain in the tramadol-butorphanol group was significantly lower than that in the sufentanil group at rest, and at 6h and 12h after surgery. VAS scores for uterine cramping pain during movement at 6h, 12h, and 24h after surgery in the tramadol-butorphanol group were also significantly lower than that in sufentanil group (P < 0.05). There was no significant difference in VAS score for wound pain at the different time points between the tramadol-butorphanol and sufentanil groups (P > 0.05). Patient-controlled intravenous analgesia with tramadol accelerated early rehabilitation and decreased the length of hospital stay (P < 0.05). PCIA using tramadol combined with butorphanol provided a better analgesic effect and accelerated postoperative rehabilitation compared with sufentanil, and may be an optimal analgesic strategy for women undergoing repeat caesarean section. The trial was registered at Chinese Clinical Trial Registry ( www.chictr.org.cn ) with ID: ChiCTR-1800014986.

Dexamethasone added to levobupivacaine prolongs the duration of interscalene brachial plexus block and decreases rebound pain after arthroscopic rotator cuff repair

It has been reported that the addition of dexamethasone to interscalene brachial plexus block (ISBPB) prolongs the duration of the block effect. However, there have been no studies focusing on the effects of dexamethasone on rebound pain after the block effect has worn off. The aim of this study was to investigate the effect on postoperative pain when dexamethasone was added to ISBPB for arthroscopic rotator cuff repair (ARCR). In this multicenter, single-blinded, and randomized controlled study, 54 patients (33 males, 21 females) who received ARCR were randomly assigned to group L (ISBPB with 20 cc of 0.25% levobupivacaine; 21 patients) or group LD (ISBPB with 20 cc of 0.25% levobupivacaine + 3.3 mg dexamethasone; 33 patients). The primary outcome was the visual analog scale (VAS) for pain after the block effect had worn off. Secondary outcomes were the duration of analgesia, the time to the first request for additional analgesic, the number of additional doses of analgesic, and complications. The VAS scores on postoperative days 0 and 1 were significantly lower in group LD than group L (P = .005, .035). This indicated that the rebound pain was relieved in group LD. After postoperative day 1, there was no significant difference in VAS score (P = .43 and .19 for days 2 and 3, respectively). The duration of analgesia was significantly longer in group LD than group L (P < .001). The time to the first request for additional analgesic was significantly longer in group LD than group L (P < .001). The number of additional doses of analgesic was significantly lower in group LD (P < .001). In ARCR, the addition of dexamethasone to levobupivacaine not only prolongs the duration of ISBPB but also relieves rebound pain after the block effect wears off.

Comparison of Clinical Outcomes between Idiopathic Frozen Shoulder and Diabetic Frozen Shoulder After a Single Ultrasound-Guided Intra-Articular Corticosteroid Injection.

There is no consensus on the use of intra-articular corticosteroid injections in diabetic frozen shoulder (FS). Thus, we aimed to compare clinical outcomes after intra-articular corticosteroid injections in patients with diabetic FS and idiopathic FS. Data collected from 142 FS patients who received glenohumeral joint intra-articular corticosteroid injections were retrospectively reviewed. Thirty-two patients were diagnosed with diabetic FS and 110 patients with idiopathic FS. Data including visual analog scale (VAS) for pain, American Shoulder and Elbow Surgeons (ASES) score, subjective shoulder value (SSV), and passive range of motion (ROM) were compared before the injection and at 3, 6, and 12 weeks after the injection. There were significant improvements in all outcomes (p < 0.001 for all parameters) through 12 weeks in both groups. There were no significant differences in all outcomes, except for ASES scores, between both groups at 3 weeks. However, there were significant differences in VAS score, SSVs, ASES scores, and passive ROMs, except for angle of abduction, between the two groups at 6 weeks and 12 weeks after injection. A single intra-articular steroid injection can be used as a conservative treatment for diabetic FS, but less effective than for idiopathic FS.

Ultrasound guided bilateral rectus sheath block for post operative analgesia in patients undergoing umbilical surgeries under GA. A comparative study between bupivacaine, levobupivacaine and Ropivacaine

: Ultrasound guided (US) rectus sheath block, blocks ventral rami of 7 to 12 thoracic nerves by injection of local anaesthetics (LA) into the space between the rectus muscle and posterior sheath. The aim of the study was to evaluate the analgesic efficacy of Bupivacaine, Levobupivacaine and Ropivacaine in ultrasound guided bilateral rectus sheath block in patients undergoing umbilical surgeries.: Patients received bilateral US-guided injection of total 30 mL of levobupivacaine (GpL) 0.25 % (or 0.375% of Ropivacaine (GpR) or 0.25%of Bupivacaine (GpB) respectively, behind the rectus muscle to detach it from its sheath. Analgesic efficacy of LA was evaluated using duration of analgesia, pain score at extubation and 1-16 hrs postoperatively and mean VAS (visual analogue scale) score to assess the quality of analgesia.: There were statistically significant differences in VAS scores between the groups L, R and B at all postoperative time points - 1hr, 2 hr, and 3hr till 16hrs. (P &amp;#60; 0.00001). The mean duration of analgesia in three groups was 9.30±0.92 hrs in Gp L, 13.02±1.17 hrs in Gp R and 6.2± 0.83hrs in Gp B respectively. This difference was statistically significant (p =&amp;#60; 0.0001). Single shot of different local Anaesthetics in Ultrasound guided bilateral rectus sheath block provides postoperative analgesia up till 16hrs in patients with BMI 25-40kg/m2 undergoing umbilical surgeries with excellent VAS scores with Ropivacaine.

Evaluation of multimodal analgesia in treatment of avascular necrosis of femoral head with free vascularized fibular grafting

To prospective study the effectiveness and safety of multimodal analgesia (MA) in treatment of avascular necrosis of the femoral head with free vascularized fibular grafting (FVFG). Sixty patients with avascular necrosis of the femoral head, who were scheduled to unilateral primary FVFG between February 2016 and December 2016 and met the selection criteria, were included in the study. All patients were allocated to two groups according to the method of random number table: MA group ( n=30) and control group ( n=30). There was no significant difference in gender, age, body mass index, side, duration and stage of avascular necrosis of the femoral head, preoperative visual analogue scale (VAS) scores under quiescent and active states, and range of motion (ROM) of hip flexion and abduction before operation ( P>0.05). The patients in the MA group were treated with MA therapy, including oral administration of celecoxib before operation, local anesthetic wound infiltration during operation, and ice compression and oral administration of celecoxib after operation. The patients in control group were only treated with patient-controlled intravenous analgesia pump. The postoperative VAS scores under quiescent and active states, ROM of hip flexion and abduction, prescription of Tramadol and adverse reaction were recorded and compared. The operations were completed successfully in both groups without obvious complications and adverse reaction. The Tramadol was used in 4 cases (13.3%) of MA group and in 11 cases (36.7%) of control group, but no significant difference was found between the two groups ( χ 2=4.356, P=0.072). The VAS scores under quiescent state at 6 and 24 hours postoperatively were significantly lower in MA group than in control group ( P<0.05), while VAS scores under active state at 48 hours postoperatively and on the day of discharge were significantly lower in MA group than in control group ( P<0.05). There was no significant difference in VAS score between two groups at other time points ( P>0.05). The ROM of hip flexion in MA group was better than that in control group at 1 day postoperatively and the day of discharge ( P<0.05), while no significant difference was found at 2 and 3 days postoperatively ( P>0.05). The ROM of hip abduction in MA group was superior to the control group at 1, 2, and 3 days postoperatively and the day of discharge ( P<0.05). The MA can effectively relieve the pain following FVFG and facilitate early functional exercises of the hip. The usage of opioids was also relatively fewer for MA protocol.

Is Facet Joint Distraction Associated with Functional Outcome in Patients with Cervical Spondylotic Radiculopathy Treated with Single-Segment Anterior Cervical Discectomy and Fusion?

To explore 1) whether the degree of facet joint distraction during single-segment anterior cervical discectomy and fusion for cervical spondylotic radiculopathy affects functional outcome and 2) whether the degree of facet joint distraction is related to cervical sagittal parameters. This study retrospectively analyzed data from 72 patients with single-segment cervical spondylotic radiculopathy from January 2013 to December 2018. Lateral cervical radiographs were performed preoperatively and 12months postoperatively. Disc height, interfacet distance, and segmental angle were measured from the lateral cervical radiographs to evaluate facet joint distraction, and cervical sagittal parameters were measured. The outcome measures included visual analog scale (VAS) and Neck Disability Index scores. Sixty-eight patients were included. ΔInterfacet distance was statistically significant in relation to ΔVAS score (P < 0.01). In a receiver operating characteristic curve analysis, less than the mean ΔVAS score for all patients was set as a positive result, and the critical value of Δinterfacet distance was 0.7 mm (P= 0.024, area under the curve= 0.659, sensitivity= 46.8%, specificity= 78.8%). According to the critical value determined by the receiver operating characteristic curve, all patients were divided into the appropriate distraction group or the excessive distraction group. There was a significant difference in VAS scores between the 2 groups (P < 0.05). After undergoing single-segment ACDF for the treatment of cervical spondylotic radiculopathy, patients with an interfacet distance of 0.7 mm or more had worse VAS pain scores. However, this was not related to the improvement in postoperative Neck Disability Index scores; changes in the interfacet distance were not associated with changes in the cervical sagittal parameters.

Effectiveness comparison of low-temperature bone cement perfusion before and after improvement in percutaneous vertebroplasty

To discuss the safety and effectiveness of the improved technique by comparing the effects of low temperature bone cement infusion before and after the improvement in the percutaneous vertebroplasty (PVP). The clinical data of 170 patients (184 vertebrae) with osteoporotic vertebral compression fracture who met the selection criteria between January 2016 and January 2018 were retrospectively analyzed. All patients were treated with PVP by low-temperature bone cement perfusion technology. According to the technical improvement or not, the patients were divided into two groups: the group before the technical improvement (group A, 95 cases) and the group after the technical improvement (group B, 75 cases). In group A, the patients were treated by keeping the temperature of bone cement at 0℃ and parallel puncture; in group B, the patients were treated by increasing the temperature of bone cement or reducing the time of bone cement in ice salt water and cross puncture. There was no significant difference in gender, age, disease duration, T value of bone mineral density, operative segment, and preoperative vertebral compression rate, visual analogue scale (VAS) score between the two groups ( P>0.05). CT examination was performed immediately after operation, and the leakage rate of bone cement was calculated. The amount of bone cement perfusion and the proportion of bone cement in contact with the upper and lower endplates at the same time were compared between the two groups. The vertebral compression rate was calculated and the VAS score was used to evaluate the pain before operation, at immediate after operation, and last follow-up. There was no complication such as incision infection, spinal nerve injury, or pulmonary embolism in both groups. There was no significant difference in the amount of bone cement perfusion between groups A and B ( t=0.175, P=0.861). There were 38 vertebral bodies (36.89%) in group A and 49 vertebral bodies (60.49%) in group B exposed to bone cement contacting with the upper and lower endplates at the same time, showing significant difference ( χ 2=10.132, P=0.001). Bone cement leakage occurred in 19 vertebral bodies (18.45%) in group A and 6 vertebral bodies (7.41%) in group B, also showing significant difference ( χ 2=4.706, P=0.030). The patients in group A and group B were followed up (13.3±1.2) months and (11.5±1.1) months, respectively. The vertebral compression rates of the two groups at immediate after operation were significantly lower than those before operation ( P<0.05), but the vertebral compression rate of group A at last follow-up was significantly higher than that at immediate after operation ( P<0.05), and there was no significant difference in group B between at immediate after operation and at last follow-up ( P>0.05). The VAS scores of the two groups at immediate after operation were significantly lower than those before operation ( P<0.05); but the VAS scores of group A at last follow-up were significantly higher than those at immediate after operation ( P<0.05) and there was no siginificant difference in group B ( P>0.05). There was no significant difference in VAS scores between the two groups at immediate after operation ( t=0.380, P=0.705); but at last follow-up, VAS score in group B was significantly lower than that in group A ( t=3.627, P=0.000). The improved advanced low-temperature bone cement perfusion technology during PVP by increasing the viscosity of bone cement combined with cross-puncture technology, can reduce bone cement leakage, improve the distribution of bone cement in the vertebral body, and reduce the risk of vertebral collapse, and achieve better effectiveness.

Platelet-Rich Plasma Versus Corticosteroids for Plantar Fasciitis: A Systematic Review of Randomized Controlled Trials.

Background:Plantar fasciitis is the most common cause of plantar heel pain. Several recent randomized control trials (RCTs) have been published comparing the use of platelet-rich plasma (PRP) and corticosteroids (CSs) for the treatment of plantar fasciitis.Purpose:To perform a systematic review of RCTs to compare whether PRP or CS injections result in decreased pain levels and improved patient outcomes in the treatment of plantar fasciitis.Study Design:Systematic review; Level of evidence, 1.Methods:Medline, EMBASE, and the Cochrane Library were screened according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines to identify RCTs comparing PRP and CS injections for plantar fasciitis. The visual analog scale (VAS) pain scores and the American Orthopaedic Foot and Ankle Society (AOFAS) scores were compared between groups at 1, 1.5, 3, 6, and 12 months, where possible. Statistical analysis was performed using RevMan, and P < .05 was considered to be statistically significant.Results:A total of 9 RCTs were identified comparing 239 patients with PRP with 240 patients with CS injections. At the follow-up time points, including 1-1.5, 3, 6, and 12 months, there were statistically significant differences in VAS scores in favor of PRP (P = .004, P < .00001, P < .00001, and P < .00001, respectively). At 1 and 3 months, there was no difference in AOFAS scores (P = .76 and P = .35, respectively). However, at 6 and 12 months, there was a difference in AOFAS scores in favor of PRP (P < .00001 and P < .00001, respectively).Conclusion:In patients with chronic plantar fasciitis, the current clinical evidence suggests that PRP may lead to a greater improvement in pain and functional outcome over CS injections.

A comparative study of clinical effect of total knee arthroplasty in the treatment of primary osteoarthritis and osteoarthritis of Kashin-Beck disease.

To evaluate the clinical efficacy of total knee arthroplasty (TKA) in the treatment of primary osteoarthritis (OA) and osteoarthritis of Kashin-Beck disease (KBD). This study enrolled 77 KBD patients (77 knees, KBD-TKA) and 75 OA patients (75 knees, OA-TKA) who underwent TKA from September 2008 to June 2018. Clinical assessments for each patient were performed pre-operatively and last follow-up. The efficacy measures included the visual analogue scale (VAS) pain score, range of motion (ROM), Hospital for Special Surgery (HSS) score, and short form 36 Health Survey (SF-36) as well as related influencing factors between the two groups. All patients were followed up; the follow-up time of KBD-TKA was 14-132months, with an average of 72.68 ± 37.55months; OA-TKA was 15-120months, with an average of 49.2 ± 28.91months. There was no difference in pre-operative VAS score (7.29 vs. 7.24) and SF-36 (PCS) score (4.87 vs. 5.49) between KBD-TKA and OA-TKA (P > 0.05), while compared with OA, KBD-TKA had significantly worse pre-operative ROM (75.48° vs. 82.87°), HSS score (36.40 vs. 41.84), and SF-36 (MCS) score (26.28 vs. 28.73) (P < 0.05). At the final follow-up, there was no significant difference in VAS score (1.13 vs. 1.16), ROM (105.79 vs. 105.79), and HSS score (92.06 vs. 92.25) between KBD-TKA and OA-TKA (P > 0.05), while compared with OA, KBD-TKA had significantly worse SF-36 (PCS) score (36.90 vs. 42.00) and SF-36 (MCS) score (55.16 vs. 59.70) (P < 0.05). In a multivariate regression, controlling for multiple potential confounders, diagnosis of KBD was associated with poor quality of life after surgery, whereas pre-operative pain was specifically associated with post-operative pain. However, preoperative gender, age, BMI, and the angles of knee prosthesis (before and after surgery) were not associated with post-operative outcome. Patients with KBD undergoing primary TKA have excellent outcomes, comparable with OA at the final follow-up, in spite of worse pre-operative ROM, HSS score, and SF-36(MCS) score. However, KBD patients are worse than OA in terms of general health. Pre-operative age, gender, BMI, and the angles of knee prosthesis were not the factors influencing the clinical efficacy of TKA. The diagnosis of KBD was an independent risk factor for poor quality of life after TKA. Pre-operative pain was a clinically important predictor of outcome.

Relationship Between Pubic Symphysis Separation and Postpartum Pelvic Girdle Pain: A Retrospective Study of 32 Cases.

Pain severity of postpartum pelvic girdle pain (PGP) does not seem closely related to the symphysis gap. To determine the relationship between the pubic symphysis gap and postpartum PGP in women treated with the squeeze-and-clap maneuver. Retrospective study. Hospital Clinic PATIENTS: 32 patients with postpartum PGP. The patients were grouped by the pubic symphysis gap as: group A (6-11 mm), group B (12-20 mm), and group C (21-30 mm). GP severity was measured by visual analogue scale (VAS). The symphysis gap was measured on radiographs. All patients were treated with the squeeze-and-clap maneuver. The VAS scores and the symphysis gaps at the first clinic visit and the second clinic visit 4-8 weeks later were analyzed. There was no significant difference in VAS scores between the three groups at the first clinic visit and the second clinic visit. VAS scores of the three groups were all significantly decreased at the second clinic visit compared with the first clinic visit (all P < .001). The symphysis gap was significantly decreased in group C at the second clinic visit (P = 0.004), but not in group A and group B. Pubic symphysis separation was not associated with pain severity of postpartum PGP.

Sarcopenia and Back Muscle Degeneration as Risk Factors for Back Pain: A Comparative Study.

Study DesignCase-control study.PurposeTo investigate the independent associations of back pain with sarcopenia and with back muscle degeneration, and to introduce a new risk index for back muscle degeneration.Overview of LiteratureThe Asian Working Group for Sarcopenia recommends diagnosis using handgrip strength, gait speed, and skeletal muscle mass. However, these criteria do not strongly reflect back muscle degeneration.MethodsPatients who completed a questionnaire on back-pain between October 2016 and October 2017 were enrolled in this study. Appendicular skeletal muscle index (ASMI), cross-sectional area (CSA) index, fatty infiltration (FI) rate of the paraspinal muscles, and lumbar extensor strength index (LESI) were measured and compared between no back-pain and back-pain group. Correlations between LESI and ASMI, CSA index, and FI rate were analyzed. The back-pain group was further divided according to ASMI into sarcopenia and non-sarcopenia subgroups and by our newly developed back muscle degeneration risk index based on correlation coefficients between LESI and CSA index, FI rate. Differences in ASMI, CSA index, FI rate, LESI, and Visual Analog Scale (VAS) score between subgroups were analyzed.ResultsThe ASMI, CSA index, FI rate, and LESI differed significantly between back-pain and pain-free groups. The LESI demonstrated the strongest correlation with FI rate. There were no significant differences in VAS score and back muscle degeneration index in the back-pain group when divided according to the presence of sarcopenia. However, there was a significant difference in VAS score between back-pain patients when classified according to high and low back muscle degeneration risk index.ConclusionsWe suggest that the degree of back pain is more strongly associated with back muscle degeneration than with sarcopenia. This back muscle degeneration risk index, reflecting both back muscle morphology and function, could be a useful parameter for evaluation of back pain and muscle degeneration.

Effect of moxibustion combined with five-element music therapy on postoperative pain relief after mixed hemorrhoid operation

Objective: To investigate the effect of moxibustion combined with five-element music therapy on the postoperative pain relief of patients undergoing surgical operation for mixed hemorrhoid with damp-heat syndrome. Methods: Totally, 159 patients meeting the inclusion criteria were assigned to the control group, study group 1, and study group 2, with 53 cases in each group. All patients received routine care after surgical treatment, including acupoint application and Chinese herbal fumigation. In addition, patients in the study group 1 received moxibustion, and those in the study group 2 were given moxibustion combined with five-element music therapy. The degree of postoperative pain was evaluated using visual analog scale (VAS). Results: There was no significant difference in VAS score on pain during dressing changes among three groups (P > 0.05). After 3, 5, and 7 days of intervention, there was a significant difference in VAS score on pain at rest among three groups (P < 0.001), and VAS score in the study group 2 was lower than that in the study group 1 and the control group after 3 and 5 days of intervention, respectively (P < 0.05). Conclusion: Moxibustion combined with five-element music therapy is effective to relieve the postoperative pain of patients undergoing a surgical operation for mixed hemorrhoids with damp-heat syndrome.

Efficacy of coblation versus radiofrequency thermocoagulation for the clinical treatment of trigeminal neuralgia.

IntroductionPostoperative facial numbness is the main complication of radiofrequency thermocoagulation in treating trigeminal neuralgia, which could seriously affect the surgical efficacy. This problem is expected to be resolved by coblation technique.AimTo compare the long-term efficacy and safety of coblation and percutaneous trigeminal radiofrequency thermocoagulation (PT-RFT) under fluoroscopic guidance in the treatment of trigeminal neuralgia (TN).Material and methodsA case-control prospective study was carried out. Patients with TN were randomly scheduled to receive coblation or PT-RFT. Both surgical procedures were performed under fluoroscopic guidance. The data, including the degree of pain, pain relief and complications, were recorded during follow-up evaluation, which was performed on the first day and at the end of the first month, third month, sixth month and first year after surgery.ResultsA total of 50 patients were enrolled in this study, with 25 patients in each group. The visual analog scale (VAS) scores in both groups at each time point after surgery were significantly lower compared with before surgery (p < 0.05). There were no significant differences in VAS scores or pain relief between the two groups at any time point after surgery (p > 0.05). However, patients in the PT-RFT group exhibited greater facial numbness after surgery (p < 0.05). For other complications, there were no significant differences between the two groups (p > 0.05).ConclusionsCoblation and PT-RFT showed similar effectiveness in reducing pain; however, coblation was associated with a lower rate of postoperative facial numbness. Therefore, coblation may be a better treatment option for TN.

Hyaluronic acid treatment outcome on the post-extraction wound healing in patients with poorly controlled type 2 diabetes: A randomized controlled split-mouth study

Background Hyaluronic acid is widely used in the medical field. However, there is a lack of research about its effect on patients with certain risks, such as compromised wound healing commonly found in patients with poorly controlled type 2 diabetes. The aim of this study is to investigate the efficacy of hyaluronic acid on the post-extraction wound healing and pain in patients with poorly controlled type 2 diabetes. Material and Methods The randomized controlled split-mouth study was designed, which included 30 patients with poorly controlled type 2 diabetes with a bilaterally same teeth in the lower jaw for extraction. The sockets treated with 0.8% hyaluronic acid represented the study group, while the sockets where hyaluronic acid was not applied represented the control group. Wound closure rate (WCR), clinical scores in wound healing scale (WHS) and pain intensity in Visual analogue scale (VAS) were recorded. Patients were followed up on 5th, 10th, 15th, 20th, 25th day after tooth extraction. Results The results showed a higher WCR at the extraction site where hyaluronic acid was applied. Also, statistically significant difference was found (p< 0.001). In regards to WHS, the sockets treated with hyaluronic acid showed better healing, especially on day 10 (p=0.006) and day 15 (p=0.021). However, there were no statistically significant differences in VAS scores between groups. Conclusions Hyaluronic acid placed in post-extraction socket in patients with poorly controlled diabetes may improve wound healing, especially in the first days after application. Key words:Hyaluronic acid, type 2 diabetes mellitus, post-extraction wound healing, wound closure measurement.

Prospective clinical study on extracorporeal shock wave therapy combined with platelet-rich plasma injection for knee osteoarthritis

To investigate the effectiveness of extracorporeal shock wave therapy combined with platelet-rich plasma (PRP) injection in treatment of knee osteoarthritis (KOA) by prospective clinical study. Between June 2015 and June 2018, 180 patients with KOA met the inclusion criteria were included in study and randomly allocated to group A (n=60), group B (n=60), and group C (n=60). The patients were treated with autologous PRP intra-articular injection in group A, extracorporeal shock wave therapy in group B, and extracorporeal shock wave therapy combined with autologous PRP intra-articular injection in group C, once a week and 5 times a duration of treatment. There was no significant difference in age, gender, disease duration, side of KOA, and Kellgren-Lawrence grading between groups (P>0.05). The pain and function of knee joint were assessed by visual analogue scale (VAS) score, Lequesne Index score, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score, and knee joint activity before treatment and at 1, 3, and 5 weeks after the first treatment. There were significant differences in VAS score, Lequesne Index score, WOMAC score, and knee joint activity between pre- and post-treatment in all groups (P<0.05). VAS score, Lequesne Index score, and WOMAC score gradually decreased with the prolongation of treatment time (P<0.05); but there was no significant difference in knee joint activity between different time points (P>0.05). There was no significant difference in VAS score, Lequesne Index score, WOMAC score, and knee joint activity between groups before treatment (P>0.05); the scores of group C were superior to groups A and B (P< 0.05) at different time points after treatment; while the knee joint activities of 3 groups were similar (P>0.05). The extracorporeal shock wave therapy combined with PRP injection can relieve the pain synergistically for KOA.