Visual Analogue Score Score Research Articles

Effect of Ultrasound-Guided Injection of Local Ozone or Platelet Rich Plasma Versus Corticosteroid in Plantar Fasciitis

ABSTRAC. Background : Plantar fasciitis or recently called plantar fasciopathy, generally observed with heel spurs because of the deposition of calcium, although the definite pathology is still unknown. Ultrasound-guided injection of conventional corticosteroids was the primary treatment modality, with other emerging substances (e.g. Ozone or Platelet Rich Plasma PRP). Aim of the study: This study was conducted to evaluate the effect of ultrasound-guided injection of local Ozone or Platelet Rich Plasma (PRP) versus conventional corticosteroid in the management of plantar fasciitis. Patient and methods: this a randomized Prospective comparative study has done Al-Azhar university hospitals (Al-Hussein and Sayed Galal), where fifty-one patients have been diagnosed to have plantar fasciitis were included and allocated into one of three groups (17 patients in each group) to receive an ultrasound-guided injection of corticosteroid (control group), platelet-rich plasma (PRP) or Ozone O2-O3. Clinical evaluation and ultrasonographic measurement of the plantar fascia thickness was done before, at one, three and six months next to the injection. Primary outcome included: pain score using the visual analogue score (VAS). While secondary outcomes were plantar fascia thickness and foot quality health status. Results: There was a highly significant decrease in VAS score and plantar fascia thickness, and an increase in foot pain domain of the foot health status (FHSQ) score in corticosteroid and Ozone groups (p < 0.01 respectively) in one month. Regarding 3-month results, there was a highly significant decrease in VAS score plantar fascia thickness, and an increase in FHSQ score in the corticosteroid group (p < 0.01 respectively). Regarding long-term 6-month results, there was a highly significant decrease in VAS score, plantar fascia thickness, and an increase in FHSQ score in the PRP group (p < 0.01 respectively). Conclusion: Corticosteroid and Ozone injections were effective at short-term assessment, but PRP was more valuable at long-term assessment regarding pain management in plantar fasciitis patients.

Correlation of Patient-Reported Outcomes With Physical Function After Total Ankle Arthroplasty.

Total ankle arthroplasty (TAA) is successful by both subjective patient-reported outcome measures (PROMs) and objective functional improvements of gait. Each is reproducible and valid, but they are entirely distinct methods. This study investigated the correlation between subjective and objective outcomes of TAA. Seventy patients underwent gait analysis preoperatively and 1 year after TAA. The 36-Item Short-Form Health Survey (SF-36) and visual analog score (VAS) for pain and American Orthopaedic Foot & Ankle Society (AOFAS) Ankle-Hindfoot Scores were recorded at each interval. A Student t test, a multivariate regression, and a Pearson correlation coefficient were used to measure the correlation between parameters of gait and PROMs. Patients had statistically significant improvements in gait velocity, total range of motion (ROM), maximum plantarflexion, ankle power, and SF-36 Physical, VAS, and AOFAS scores. The SF-36 Physical score had a moderate positive correlation with preoperative walking speed, step length, and ankle power and postoperative walking speed and ankle power. No correlation between VAS score and function was detected. The AOFAS score had a moderate positive correlation with postoperative walking speed, step length, and ankle power, and improvement in walking speed, cadence, and ankle power. Statistically significant correlations were found between numerous preoperative and postoperative comparisons of PROMs and the AOFAS score with the objective biomechanical outcomes of gait. Walking speed and ankle push-off power correlated most with patient perceptions of function and improvement, while pain and ROM did not. Subjective PROMs and objective biomechanical outcomes were complementary in the assessment of surgical outcomes and, combined, helped to address the dilemma of the confounding effect of other lower extremity pathologies on PROMs. Level III, comparative series.

USG guided platelet rich plasma therapy for chronic resistant tendinopathies – Is it the next gold standard?

Background: One of the most common and under-treated problems faced by orthopedic surgeons is tendinopathy. Contradictory to the initial belief that tendinopathies are an inflammatory pathology, the histopathological analysis suggested that it is a disease of degeneration with characteristic hypercellularity, vascular hyperplasia, and collagen disorganization. Platelet-rich plasma (PRP) is a treatment modality attempting to modulate chronic inflammation and stimulate tissue regeneration. Materials and Methods: This is a prospective study conducted on patients having tendinopathies on an outpatient basis. PRP infiltration was done at the tendinopathy site for 95 patients between the ages of 18 to 65 years. The patients with tendinopathies resistant to conservative management were included. Preinjection Disabilities of the Arm, Shoulder, and Hand (DASH) scores and Visual Analogue Score (VAS) were recorded. The patients were then injected with PRP at the site of the tendinopathy under ultrasound guidance and post-injection DASH and VAS scores were recorded. Results: We had a total of 95 cases included in the study. The gender-wise distribution showed a male predominance with M:F ratio of 2:1. The age-wise analysis showed a predominant number of cases in the age group of 36-45 years (n=41). The mean pre-intervention DASH score and VAS score of the included patients were 56.32 (SD=12.4) and 7.5 (SD=1.4) respectively which significantly reduced to 26.67 (SD=9.6) and 3.1 (SD=0.9) respectively at 6 months follow-up (p Conclusion: PRP injections are a safe and effective treatment for patients presenting with tendinopathies irrespective of their etiologies and location. All the included patients had a consistent improvement in their clinical symptoms with just a single dose thereby reducing the adverse effects due to chronic use of non-steroidal anti-inflammatory drugs and also minimize the risk of surgeries. Keywords: Ultrasound, Plateletrich plasma, Tend

Effects of Continuous Epidural Injection of Dexamethasone on Blood Glucose, Blood Lipids, Plasma Cortisol and ACTH in Patients With Neuropathic Pain.

Objective: To study the effects of continuous epidural injection of dexamethasone on blood glucose, blood lipids, plasma cortisol, and adrenocorticotropic hormone (ACTH) in patients with neuropathic pain.Methods: Thirty patients with cervical spondylotic radiculopathy, lumbar disc herniation, herpes pain or postherpetic neuralgia were randomly divided into three groups and were treated with different doses of epidural injection of dexamethasone (Group S with a concentration of 25 μg/mL; Group M with a concentration of 50 μg/mL; Group L with a concentration of 100 μg/mL). Epidural catheterization placement was guided by computed tomography (CT), and was connected to the analgesic pump for 10 days. Visual Analog Score (VAS), fasting blood glucose (FBG), total cholesterol (CHOL), triglyceride (TG), 2 h postprandial blood glucose (2hPG) and the concentrations of cortisol, ACTH were measured before injection (T0), 2, 4, 6, 8, and 10 days during injection (D2, D4, D6, D8, D10), and 7, 14, 21, 28 days (W1, W2, W3, W4) after injection.Results: During and after the treatment, VAS score was significantly decreased, and group M and L had the lowest VAS score. The concentrations of cortisol and ACTH were significantly lower during the treatment, but all of them recovered to the normal level after stopping the injection. The treatment did not affect the CHOL and TG concentrations.Discussion: Epidural injection of dexamethasone at the concentration of 50 μg/mL is recommended for patients with neuropathic pain because of its good analgesic effect and less adverse effect on blood glucose, plasma cortisol, and ACTH.

Radiographic evaluation of low back pain after lumbar fusion using Technetium-99 single-photon emission computed tomography: Impact on clinical decision-making and outcome

Accurate identification of spinal pain generators is critical to selecting the optimal treatment strategy for patients with persistent low back pain following instrumented lumbar fusion. Conventional diagnostic imaging modalities such as CT and MRI often yield equivocal results in this patient population. The purpose of this study is to assess the utility of Tc-99 SPECT/CT as an adjunct to conventional imaging modalities in the identification of spinal pain generators in patients with persistent low back pain after a lumbar fusion. A retrospective cohort review of 18 patients with a history of at least 1-year of persistent low back pain following a lumbar fusion surgery was conducted. All patients had MRI and/or CT scans that did not definitively identify a spinal pain generator. Tc-99 SPECT/CT imaging was subsequently performed in this cohort and treatment was determined according to imaging results. For patients undergoing revision fusion, pre- and post-operative visual analogue scores (VAS) at last follow-up were analyzed. All pain sites not clearly visualized on CT or MRI were identified by increased uptake of Tc-99 on SPECT/CT. According to anatomic location of uptake, six patients in this cohort underwent revision lumbar fusion. For patients undergoing revision lumbar fusion, preoperative VAS score averaged 8.5 ± 0.29 and declined after surgery to 4.75 ± 0.95. Patients in our series who suffered from failed lumbar spinal surgery syndrome, and subsequently underwent SPECT/CT imaging leading to the identification of pain generators amenable to surgical treatment experienced significant reduction in VAS scores after revision surgery.

Surgical options for symptomatic old osteoporotic vertebral compression fractures: a retrospective study of 238 cases

BackgroundSymptomatic osteoporotic vertebral compression fractures (OVCF) are increasing, as are acute and chronic pain episodes and progressive spinal deformities. However, there are no clear surgical treatment criteria for patients with these different symptoms. Therefore, this study aims to explore the surgical approaches for the treatment of OVCF with different symptoms and evaluate the feasibility of these surgical approaches.MethodsWe retrospectively analyzed 238 symptomatic OVCF patients who entered our hospital from June 2013 to 2016. According to clinical characteristics and imaging examinations, these patients were divided into I-V grades and their corresponding surgical methods were developed. I, old vertebral fracture with no apparent instability, vertebral augmentation; II, old vertebral fracture with local instability, posterior reduction fusion internal fixation; III, old fractures with spinal stenosis, posterior decompression and reduction fusion and internal fixation; IV, old vertebral fracture with kyphosis, posterior osteotomy with internal fixation and fusion; V, a mixture of the above types, posterior osteotomy (decompression) with internal fixation and fusion. Postoperative visual analog score (VAS), oswestry disability index (ODI) scores, sagittal index (SI) and ASIA grades of neurological function were observed.ResultsAll 238 patients were followed up for 12–38 months, with an average follow-up of 18.5 months. After graded surgery, the VAS score, ODI score, and vertebral sagittal index SI of 238 patients were significantly improved, and the difference between the last follow-up results and the preoperative comparison was statistically significant (P ˂ 0.05). Besides, the postoperative ASIA grades of 16 patients with nerve injury were improved from 14 patients with preoperative grade C, 2 patients with grade D to 4 patients with postoperative grade D and 12 patients with postoperative grade E.ConclusionIn this study, we concluded that graded surgery could better treat symptomatic old OVCF and restore spinal stability. This provides clinical reference and guidance for the treatment of symptomatic old OVCF in the future.

Treatment of Popliteal Cyst through Radiofrequency Thermocoagulation under Ultrasound Guidance

Objective: The purpose of this study was to explore the clinical efficacy and security of the treatment of popliteal cyst through radiofrequency thermocoagulation (RFT) under ultrasound guidance. Methods: The clinical data of 35 patients with popliteal cyst, who were treated by RFT under ultrasound guidance from June 2019 to June 2020, were retrospectively analyzed. The Visual Analogue Scores (VAS) and the size of cyst before and after treatment were recorded at the first month, the third month, the sixth month. After six months, the recovery rate of Rauschning and Lindgren classification (R-L classification) level 0, 0 - I were counted. All the complications of the patients were observed. Results: 32 patients were followed up for six months. The scores and cyst sizes of each patient before and after the treatment were on a normal distribution curve. There was no significant difference in VAS scores before and after the treatment (P > 0.05). However, there was a significant difference in cyst sizes before and after the treatment (P 0.05). According to the R-L classification in 6 months after treatment: the recovery rate of class 0 was 62.5% and class 0 - I level was 87.5%. There were no serious complications in the process. Conclusion: Treatment of popliteal cyst through RFT under ultrasound guidance is a simple, easy, reliable method that is worthy of clinical promotion.

Comparison of dexmedetomidine and clonidine as the adjuvants with hyperbaric bupivacaine in subarachnoid block for lower limb orthopaedic surgeries

Aim: To compare dexmedetomidine versus clonidine as the adjuvants with hyperbaric bupivacaine in subarachnoid block for lower limb orthopedic surgeries. Material and method: The present study included 160 patients undergoing lower limb orthopedic surgery under subarachnoid block at Department of anaesthesia, Mahatma Gandhi Missions Institute of Health Sciences, Navi Mumbai, Maharashtra. Randomization was a statistical procedure by which the participants have been allocated into 2 different groups i.e. Group C (Clonidine group) and Group D (Dexmedetomidine group). Time of onset of motor block was assessed using Bromage scale. Analgesia duration was observed and recorded following pain scoring system- Visual analogue score (VAS). Results: It was observed that there was statistically significant difference between the total duration of sensory and motor block of the patient in the both groups. The difference in VAS scores were found to be statistically significant among two groups (p

Effect of oral gabapentin premedication on hemodynamic parameters and postoperative pain in patients of laparoscopic cholecystectomy: A randomized double-blind controlled study.

Background and Aims:Carbon dioxide (CO2) pneumoperitoneum created during laparoscopic cholecystectomy causes adverse hemodynamic changes such as rise in arterial pressure. The aim of this study was to assess the effect of oral gabapentin premedication on hemodynamic parameters in addition to postoperative nausea and vomiting (PONV) and pain in patients of laparoscopic cholecystectomy conducted under general anesthesia.Material and Methods:Randomly selected 60 American Society of Anesthesiologists (ASA) class I patients scheduled for laparoscopic cholecystectomy were premedicated with either gabapentin 1200 mg (Group GB) or placebo (Group PL) 2 h prior to induction of anesthesia. Anesthesia was induced with fentanyl, propofol, and vecuronium; and maintained with oxygen (33%), nitrous oxide (66%), and isoflurane (1%) with controlled ventilation. Hemodynamic parameters were recorded at various time intervals intraoperatively and during pneumoperitoneum every 10 min till 50 min. Postoperatively visual analog score (VAS) for pain, incidence of PONV, and sedation score were recorded for 6 h. The collected data were analyzed statistically by using repeated measures analysis of variance (ANOVA), Student's t test, Chi-square test, and Mann–Whitney U test.Results:Changes in mean BP, systolic BP, and diastolic BP from prepneumoperitoneum values were significantly less in group GB during pneumoperitoneum (P < 0.05) with no significant change in HR in both groups (>0.05). VAS score was significantly lower in group GB. The duration of analgesia and PONV free period were significantly higher in group GB (P < 0.01).Conclusion:Oral gabapentin premedication may be used to control hemodynamic parameters during pneumoperitoneum in patients undergoing laparoscopic cholecystectomy.

Ventilation strategies and postoperative pain in laparoscopic cholecystectomy: pulmonary recruitment maneuver versus extended hyperventilation: a prospective randomized study

Objectives: Acidic milieu created by carbon dioxide is associated with post laparoscopic surgical pain. Gas washing techniques were used to reduce such effects. This trial compared pulmonary recruitment maneuver (PRM) versus extended hyperventilation technique (EHV) regarding postoperative pain profile in laparoscopic cholecystectomy patients. Methods: In a prospective, randomized controlled study, 90 patients, underwent laparoscopic cholecystectomy were divided into two equal groups; (PRM group) and (EHV group). Collected data included heart rate (HR), mean arterial blood pressure (MAP), visual analog score (VAS), the incidence of shoulder and sub-diaphragmatic pain, postoperative nausea, and vomiting (PONV). Results: The overall incidence of shoulder and sub-diaphragmatic pain, late VAS score (at 12, 24 hours) were lower in the EHV group, while hemodynamics, early VAS scores, rescue analgesic consumption, and PONV were comparable in both groups. Conclusion: Gas washing techniques improved safety and efficacy in improving pain profile following laparoscopic surgery. EHV provides less pain and more patients comfort than PRM, especially at delayed times.

Epidural Ropivacaine and Dexmedetomidine with that of Epidural Ropivacaine and Fentanyl for Postoperative Analgesia in Lumbar Spine Surgeries- A Randomised Double-Blinded Study

Introduction: Epidural with opioids as adjuvants are the most common agents of choice for postoperative analgesia in spine surgeries which promote early ambulation, increased patient satisfaction and improved outcome. Recently, epidural administration of α2 agonists in combination with local anaesthetics in low doses offers new dimensions in the management of postoperative pain. Aim: To compare the analgesic efficacy, sedation score and haemodynamic stability of Epidural Ropivacaine and Fentanyl (RF) with that of Ropivacaine and Dexmedetomidine (RD) in the postoperative period in lumbar spine surgeries. Materials and Methods: This was a randomised, double-blinded study conducted on 120 patients at IMS and SUM Hospital, Bhubaneswar, Khordha, India. Haemodynamic parameters, Visual Analogue Score (VAS), sedation score, time to 1st dose of rescue analgesics requirement and complications were observed. The study consisted of group RF that received ropivacaine and fentanyl and group RD that received ropivacaine and dexmedetomidine, with 60 patients in each group. Continuous variables were analysed with the unpaired t-test and categorical variables were analysed with Chi-square Test and Fisher-Exact test. Statistical significance was taken as p &lt;0.05 Results:ThemeanageofparticipantsingroupRDwas39.73±7.192 years and in group RF was 40.67±7.434 years (p-value 0.872). Heart rate was in lower range in RD group throughout the study and was statistically significant with a p-value &lt;0.05. VAS score was lower, sedation score was higher and time to 1st dose of rescue analgesia were longer in RD group compared to group RF (p&lt;0.005). Complications like hypotension (33.3%), bradycardia (20%) were more common in group RD while nausea, vomiting (16.67%) and pruritis (10%) were noted in group RF. Conclusion: Dexmedetomidine seems to be a better neuraxial adjuvant with good postoperative analgesic efficacy, better patient comfort and hemodynamic stability compared with that of fentanyl.

Efficacy and opioid-sparing effect of interpleural bupivacaine in patients undergoing laparoscopic cholecystectomy: Prospective observational study (Running title: Efficacy of inter-pleural bupivacaine in laparoscopy)

Introduction: Laparoscopic cholecystectomy is considered minimally invasive, but pain following laparoscopy is moderate to severe, leading to increased morbidity and length of hospital stay. Various medications, including opioids, NSAIDs, and techniques like intraperitoneal local anesthetic infiltration, are used. In this study, we investigated interpleural block with bupivacaine for pain relief following laparoscopic cholecystectomy. Methods: A total of 60 patients were included in the study. 30 patients received 20 ml of 0.5% interpleural bupivacaine (group 1), and 30 patients recieved 20 ml of 0.9% normal saline (group 2). We recorded visual analog score (VAS), vital signs, and postoperative opioid requirements. Tramadol (2 mg/kg) was rescue medication if VAS ≥ 5. Results: Significant difference between study groups was recorded among VAS scores measured at 30 minutes, 1, 2, 6, 10, and 12 hours (p value &lt; 0.05). The difference in VAS scores at 15 minutes and 14 hours between study groups was insignificant (p value &gt; 0.05). The number of patients who received tramadol was 9 (30%) patients in group 1 and 29 (96.7%) patients in group 2. The difference in proportion for tramadol intake at 6 hours was significant among study groups (p-value &lt; 0.05). Conclusion: Interpleural bupivacaine 20 ml of 0.5% used as analgesia reduces post-operative opioid requirement following laparoscopic cholecystectomy. Hence interpleural block can be safely used as a regional technique for pain relief following laparoscopic cholecystectomy.

Comparison of Peripheral Neurectomy vs. Medical Treatment for Migraine: A Randomized Controlled Trial.

Migraine is a common form of primary neurologic headache. Many patients are chronic migraineurs and suffer from a significant disability and adverse effects of drugs. There are various surgical options available to treat migraines, including peripheral neurectomies. To study the surgical and functional outcomes of migraine surgeries using peripheral neurectomies and compare them with conservatively treated patients. Migraine patients who had a unilateral onset pain were given local bupivacaine block at the suspected trigger site, and those who were relieved were given the option for surgery. In the operative group, the peripheral nerve of the trigger site was lysed under local anesthesia. The conservative group was continued with the standard treatment. Evaluations with a baseline and 6 months visual analog score (VAS), migraine headache index (MHI), migraine disability assessment test (MIDAS), and pain self-efficacy questionnaire (PSEQ) scores were done. A total of 26 patients got benefitted with the local bupivacaine block, out of which 13 underwent surgery. At baseline, the VAS, MHI, MIDAS, and PSEQ scores were similar in both the groups. The operative group had significant (P < 0.001) improvement in all these parameters 6 months after the surgery. All patients of the operative group got free from prophylactic migraine treatment; however, 11 out of 13 patients still needed occasional use of analgesics. There was one complication of transient temporal numbness. Migraine surgery using peripheral neurectomies was more effective than chronic drug treatment in appropriately selected patients.

Repair of spondylolysis using a pedicle screw U-shaped rod construct: A preliminary study of 25 young patients with a mean follow-up of 24 months.

Study Design:Prospective case series, therapeutic Level IV.Objectives:Functional and radiographic outcome evaluation of patients with spondylolysis treated with pars interarticularis defect repair with iliac bone grafting and application of a construct consisting of a pair of polyaxial pedicle screws connected by a U-shaped rod passing beneath the spinous process.Methods:Twenty-five patients (27 operated lumbar levels) with an average of 20 months of follow-up (range 12–24 m) with spondylolysis who met our inclusion criteria were treated with the above-mentioned technique. Functional assessment was by the Visual Analog Score (VAS) for low back pain (LBP) and Oswestry Disability Index (ODI). Fusion was confirmed with plain x-rays and when indicated with computed tomography scan. Return to activities of daily living (ADL) was also assessed.Results:There were 16 males (64%) and 9 females (36%), with a mean age of 18 ± 3 years at surgery, with a mean operating time of 79 ± 13 min and a mean blood loss of 186 ± 57 ml. ODI significantly improved from a mean of 63 ± 7 preoperatively to 10 ± 4 at 12 months postoperatively (P < 0.001). The mean preoperative LBP VAS score 8 ± 1 showed also a statistically significant decrease of values to 1 ± 1 at 12 months, (P < 0.001). At 12 m, all patients returned to unrestricted ADL. Pars healing was present in 19 patients (76%) at 6 months and in all patients at 12 months.Conclusions:Polyaxial pedicular screws with a U-shaped rod offer an effective and reproducible treatment for spondylolysis with an appropriate fusion rate, predictable return to daily activities, and good pain relief in young adults.

Predictors of Outcome in Hallux Valgus Surgery

Introduction: Hallux valgus (HV) is the most common forefoot deformity, and is known to be a debilitating disease, causing pain and reduced social function. There are various established surgical treatments for HV, with patient satisfaction up to 85% after surgery. In this paper, we aim to identify the pre-operative factors that may serve as predictors to patient outcome after surgery, to help surgeons select suitable candidates for surgery in the clinic. Methods: A prospective study was done on patients who underwent scarf and akin osteotomy for symptomatic HV between October 2015 and March 2018. Five patient factors were collected pre-operatively, including osteoarthritis grade of first metatarsophalangeal joint, severity of HV, presence of osteoarthritic or sesamoid pain, and presence of flat foot. Patient’s self-reported outcomes was assessed pre- and post-surgery, using the Manchester-Oxford Foot Questionnaire (MOXFQ) and Visual Analogue Score (VAS). Pre- and post-surgery outcome scores were compared, and changes in scores analysed with numerous patient factors to identify any significant association. Results: 41 feet of 36 patients were included after implementation of exclusion criteria. Both MOXFQ and VAS showed a significant reduction in scores (improvement in outcomes) after surgery. None of the pre-operative patient factors examined was found to be significantly associated with the reduction in MOXFQ score. However, the results suggested that high pre-surgery MOXFQ score was associated with a greater MOXFQ score reduction post-surgery, with p-value of &lt;0.001. Conclusion: Our study found that none of the factors looked at significantly correlated with reductions in MOXFQ and VAS scores post-surgery, other than high presurgery MOXFQ scores. This suggests that surgeons should counsel as such in clinic. Nonetheless, as this study had a small study size, further studies should be done to support the findings of this research.

Study on pain control of continuous adductor block analgesia after primary knee replacement

To investigate the effect of continuous adductor block on pain control after bilateral knee joint Ⅰ stage replacement. A retrospective analysis was made of the data of 24 patients with bilateral knee joint I stage replacement who were treated in our hospital from January 2018 to January 2019, and who underwent continuous adductor block analgesia. There were 6 males and 18 females, aged 60 to 72 (65.05±5.82) years old. The patients underwent continuous block of adductor canal with patient-controlled analgesia system. At 4, 6, 12, 24, 36 and 48 hours after operation, visual analogue score(VAS) of resting state and passive motion state was performed;the knee joint activity was followed up for 1 week, 1, 3 and 6 months after operation;the knee joint function was scored at 6 months after operation, using the knee joint scoring standard of American Special Surgery Hospital(HSS);adverse reactions and complications were recorded. The VAS scores under resting state and passive motion state at each time point were less than 3 points in patients with continuous adductor block. The patients had better postoperative exercise of knee joint activity. The score of HSS was excellent in 20 cases, good in 2 cases, fair in 1 case and poor in 1 case. There were only 4 cases of nausea and vomiting, none of them had serious adverse reactions and complications such as bradycardia and deep vein thrombosis. Continuous adductor block has a significant effect on pain control and less adverse reactions after bilateral knee jointⅠ -stage replacement.

Extracorporeal shockwave therapy versus musculoskeletal mesotherapy for Achilles tendinopathy in athlete

BackgroundAchilles tendinopathy (AT) is considered the commonest tendon pathology, occurring mainly in athletes. Different conservative treatment options have been introduced but with short-term effects; however, extracorporeal shockwave therapy (ESWT) and mesotherapy (MT) injections were claimed to provide longer effects and could be used in cases failure of response to conservative treatments.The objective of our prospective 12-week study was to compare the effect of ESWT and MT on chronic Achilles tendinopathy in athletes by both clinical and ultrasonographical assessment.ResultsForty patients with chronic AT diagnosed clinically and with high-resolution ultrasound (US) randomly allocated in two groups first received weekly ESWT session, and the other group underwent weekly MT sessions for 4 consecutive weeks. Both groups improved during the treatment and follow-up period. The mean visual analogue score (VAS) decreased in both the ESWT group and the MT group. Mean American Orthopedic Foot and Ankle Society (AOFAS) hindfoot score and VAS scores were not significantly different between ESWT and MT groups at the 4th and the 12th week of follow-up. However, US assessment significantly improved after 12 weeks in the ESWT group (as regards tendon thickness, calcifications, and Doppler signal), and for the mesotherapy group, there was the only improvement of tendon thickness.ConclusionESWT showed improvement of pain and inflammation and calcifications of AT than MT injections, which was documented by US improved findings at week 12 follow up.

Comparison of 127° small and 135° large stem angle prostheses in total hip arthroplasty

To investigate the effect of total hip arthroplasty(THA) with the prosthesis of 127° small neck stem angle and 135° large neck stem angle. From January 2014 to June 2016, 84 patients with THA were selected, including 44 males and 40 females, aged 45 to 72(53.4±8.1) years old, 68 patients with necrosis of the femoral head(32 on the left and 36 on the right), 16 patients with serious osteoarthritis of the hip caused by other reasons, and the course of disease was 9 to 36 (24.0±5.5) months. Forty-two patients in each group were evaluated by Harris score, visual analog score(VAS), length measurement of lower limbs, biomechanical evaluation of different angles of the neck stem. The complications and quality of life 24 months after operation were compared. Two patients in each group were lost, the rest were followed up for 30 to 36 (33.0±1.6)months. The Harris score and the length of both lower limbs were measured before and 1, 6, 12, 24 months after operation. The difference of Harris score and the length of both lower limbs in the two groups was significantly improved compared with that before operation(P<0.05), but there was no significant difference between the two groups(P>0.05). There was no significant difference between the two groups in VAS score before operation (P>0.05), but the VAS score of the group with large neck stem angle was significantly lower than that of the group with small neck stem angle(P<0.05). There was no significant difference in the incidence of postoperative complications between the two groups (P>0.05). The quality of life of the patients in the two groups after 24 months was significantly higher than that before operation (P<0.05). THA with large and small neck stem angle prosthesis can better recover the function of hip joint, but large neck stem angle can reduce the degree of postoperative pain and improve the quality of life of patients.

Early results with a bicruciate-retaining total knee arthroplasty: a match-paired study.

The aim of this study is to compare 2 groups of total knee arthroplasties (TKAs): the bicruciate-retaining (BCR-group) and cruciate-retaining total knee arthroplasty (CR-group), evaluating the functional results in the short-term follow-up. 24 BCR were included in the study and were compared with a group of 24 TKAs performed with the same implant, but with sacrifice of the ACL and retention of the posterior cruciate ligament. For preoperative and postoperative clinical evaluation, the visual analogue score (VAS) and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) were used. Radiological evaluation included weight-bearing long-leg view, a Rosemberg view, lateral view of the knee and tangential view of the patella. Hip-knee-ankle angle (HKA) was recorded pre and postoperatively. Radiolucent lines (RLLs) were evaluated according the Knee Society Roentgenographic Evaluation System (KSRES). At last follow-up the mean VAS score was 1.81 for BCR group and 1.43 for CR group (p = 0.61). The mean WOMAC score was 8.68 for BCR group and 12.81 for CR group (p = 0.33). As for the radiological evaluation, preoperative HKA angle was 0.53° varus for BCR group and 3.14° varus for CR group (p = 0.24); postoperative HKA was 0.72° valgus for BCR group and 0.38° valgus for CR group (p = 0.75). The percentage of RLLs was similar between the two groups (12% versus 15%). BCR-TKA has showed to give similar functional and radiographic outcomes compared to conventional CR-TKA in a similar cohort of patients. An higher operative times and higher number of complications respect were found in BCR group. These results can be explained by the early learning curve experiences. Future randomized controlled trials should be performed to support new implant designs such as BCR. Level of evidence Case-control study, level III.

Autologous adipose-derived stem cells for the treatment of complex cryptoglandular perianal fistula: a prospective case-control study

BackgroundComplex cryptoglandular perianal fistula (CPAF) is a kind of anal fistula that may cause anal incontinence after surgery. Minimally invasive surgery of anal fistula is constantly emerging. Over the past 20 years, there are several sphincter-sparing surgeries, one of which is autologous adipose-derived stem cell (ADSC) transplantation. However, to date, there is no study regarding the treatment of complex CPAF with ADSC in China. This is the first study in China on the treatment of complex CPAF with ADSC to evaluate its safety and efficacy.MethodsTotally, 24 patients with complex CPAF were enrolled in this prospective case-control study from January 2018 to December 2019 in the National Colorectal Disease Center of Nanjing Hospital of Chinese Medicine Affiliated to Nanjing University of Chinese Medicine. Patients were divided into ADSC group and endorectal advancement flap (ERAF) group according to their desire. The healing of fistulas (healing of all treated fistulas at baseline, confirmed by doctor’s clinical assessment and magnetic resonance imaging or transrectal ultrasonography) was evaluated at week 12 after treatment. In addition to their safety evaluation based on adverse events monitored at each follow-up, the patients were also asked to complete some scoring scales at each follow-up including pain score with visual analog score (VAS) and anal incontinence score with Wexner score.ResultsThe closure rates within ADSC group and ERAF group at week 12 were 54.55% (6/11) and 53.85% (7/13), respectively, without significant difference between them. VAS score in ADSC group was significantly lower than that in ERAF group at the 5th day postoperatively [1(0,2) VS 2(2,4), p = 0.011], but no differences were observed at the other time. Wexner score of all patients was not increased with no significant differences between the two groups. Adverse events were observed fewer in ADSC group (27.27%) than that in ERAF group (53.85%), but there was no significant difference between them.ConclusionThis study indicated safety and efficiency of ADSC for the treatment of complex CPAF in the short term, which is not inferior to that of ERAF. ADSC may provide a promised and potential treatment for complex CPAF conforming to the future of the treatment, which is reconstruction and regeneration.Trail registrationChiCTR, ChiCTR1800014599. Registered 23 January 2018—retrospectively registered, http://www.chictr.org.cn/showproj.aspx?proj=24548