ABSTRACT
Purpose@#To evaluate the timing of the improvement in surgical skills of the direct anterior approach for hip arthroplasty through an analysis of the clinical features and learning curve in 58 cases. @*Materials and Methods@#From November 2016 to November 2018, 58 patients, who were divided into an early half and late half, and underwent hip arthroplasty by the direct anterior approach, were enrolled in this retrospective study. The operation time and complications (fracture, lateral femoral cutaneous nerve injury, heterotopic ossification, infection, and dislocation) were assessed using a chi-square test, paired t-test, and cumulative sum (CUSUM) test. @*Results@#The mean operation times in total hip arthroplasty (26 cases) and bipolar hemi-arthroplasty were 132.1 minutes and 79.7 minutes, respectively, demonstrating a significant difference between the two groups. CUSUM analysis based on the results revealed breakthrough points of the operation time, decreasing to less than the mean operation time because of the 16th case in total hip arthroplasty and 14th case in bipolar hemiarthroplasty. Complications were encountered in the early phase and late phase: five cases of fractures in the early phase, no case in the late phase; eight and two cases of lateral femoral cutaneous nerve injury, respectively; three and two cases of heterotopic ossification, respectively; and one case of dislocation, one case of infection and three cases of others in the early phase. The CUSUM chart for the fracture rate during operation in the early phase revealed the following: five cases fracture (17.2%) in the early phase and no case in the late phase (0%). This highlights the learning curve and the need for monitoring the inadequacy of operation based on the complications. @*Conclusion@#Hip arthroplasty performed by the direct anterior approach based on an anatomical understanding makes it difficult to observe the surgical field and requires a learning curve of at least 30 cases.
ABSTRACT
OBJECTIVE: The aim of this study was to identify the changes of pressure distribution on the foot after orthopaedic surgery for equinus deformity in spastic cerebral palsy using F-scan system. METHOD: Twenty-one children with spastic cerebral palsy were participated in this study. They had equinus deformity on foot and received soft tissue surgery. Pressure distribution on foot was measured before and after operation using F-scan system (Tekscan Inc., USA). Paired t-test was used in comparison of preoperative and postoperative measurements for statistical analysis. RESULTS: Total contact area, contact length, midfoot and hindfoot contact width were significantly increased after operation. Relative impulses of medial and lateral forefoot were significantly decreased and relative impulse of hindfoot significantly increased after operation (p<0.05). Anteroposterior distance of center of pressure (COP) and velocity of COP were significantly increased and mediolateral distance and slope of COP were significantly decreased after operation (p<0.05). CONCLUSION: This study revealed that patterns of foot pressure distribution during walking were significantly improved after operation. Therefore, these findings suggested that F- scan system might be useful for surgical outcome measurement for foot deformities in the children with spastic cerebral palsy.
Subject(s)
Child , Humans , Cerebral Palsy , Equinus Deformity , Foot Deformities , Foot , Muscle Spasticity , WalkingABSTRACT
OBJECTIVE: The aim of this study was to evaluate the bladder function in adults with cerebral palsy (CP). METHOD: Thirteen adults with CP were participated in this study. Nine of these thirteen subjects had urological symptoms. The urological history taking, urine analysis, urine culture, voiding cystourethrography (VCUG) and urodynamic study were done. RESULT: The urinary incontinence was the most common presenting symptom. All subjects without urological symptoms showed normal urodynamic findings. Eight of the subjects who had urological symptoms had abnormal findings on urodynamic study. All subjects showed normal findings on voiding cystourethrography. Based on urodynamic findings, six subjects were treated with anticholinergic drug and five (83.3%) of these subjects showed improvement of their urological symptoms. CONCLUSION: Many adults with CP might have the problems in urination. Our study showed that many symptomatic subjects had abnormal urodynamic findings and much of these urological symptoms was improved with proper treatment. These adults with CP would, therefore, benefit from proper assessment and treatment, expecially in the subjects who have urological symptoms.