ABSTRACT
Heterotopic ossification (HO) is one of the complications of a cervical cord injury that results in limited range of motion, which can interfere with basic movements and activities of daily living. We encountered a case of a cervical cord injury patient with limited range of motion and mobility due to HO of the hip joint who experienced improvement in both as a result of early surgery and rehabilitation. A 17-year-old boy was diagnosed with a cervical cord injury due to an anterior fracture of the sixth cervical vertebrae following a fall into a pool. It was classified as bilateral C6BII according to the Zancolli's classification for cervical cord injury. The patient presented with limited range of motion in his left hip and was diagnosed with HO four months after the injury. Eight months after the injury, his hip range of motion deteriorated further；consequently, he required continuous transfer assistance. Therefore, surgical HO removal was performed during this period of convalescent rehabilitation. The patient underwent constant post-operative rehabilitation, and the range of motion in his left hip joint improved；thus, he became independent in transfer activities. A concomitant HO after a cervical cord injury can lead to functional impairment in convalescent rehabilitation. In addition, no practice guidelines have been developed that include recommendations on when to perform surgical procedures for HO. Treatment of HO with a combination of immediate surgery and aggressive rehabilitation can be expected to restore function and maximize activity and participation in patients with cervical cord injury with concomitant HO.
ABSTRACT
Heterotopic ossification (HO) is one of the complications of a cervical cord injury that results in limited range of motion, which can interfere with basic movements and activities of daily living. We encountered a case of a cervical cord injury patient with limited range of motion and mobility due to HO of the hip joint who experienced improvement in both as a result of early surgery and rehabilitation. A 17-year-old boy was diagnosed with a cervical cord injury due to an anterior fracture of the sixth cervical vertebrae following a fall into a pool. It was classified as bilateral C6BII according to the Zancolli's classification for cervical cord injury. The patient presented with limited range of motion in his left hip and was diagnosed with HO four months after the injury. Eight months after the injury, his hip range of motion deteriorated further；consequently, he required continuous transfer assistance. Therefore, surgical HO removal was performed during this period of convalescent rehabilitation. The patient underwent constant post-operative rehabilitation, and the range of motion in his left hip joint improved；thus, he became independent in transfer activities. A concomitant HO after a cervical cord injury can lead to functional impairment in convalescent rehabilitation. In addition, no practice guidelines have been developed that include recommendations on when to perform surgical procedures for HO. Treatment of HO with a combination of immediate surgery and aggressive rehabilitation can be expected to restore function and maximize activity and participation in patients with cervical cord injury with concomitant HO.
ABSTRACT
Background@#Individuals with axillary osmidrosis suffer detrimental effects to their psychosocial functioning. In Asian nations, major operations for axillary osmidrosis include subdermal excision (open surgery) and suction-curettage (closed surgery). @*Objective@#The aim of this meta-analysis was to determine which of these two procedures is most favorable in terms of safety and efficacy. @*Methods@#According to the Preferred Reporting Items for Systematic Reviews and Metaanalyses (PRISMA) guideline, we searched electronic databases for articles published in English, Japanese, Korean, and Chinese languages. Fixed-effects model meta-analyses of odds ratios (OR) and 95% confidence intervals (CI) were conducted, and the I2 was used to assess heterogeneity. Complication rates, recurrence/ineffectiveness rates, and patient satisfaction data were extracted and compared between open and closed surgeries. @*Results@#Our search yielded 8 articles that include 1,179 patients; 560 underwent open surgery, and 619 underwent closed surgery. Our meta-analysis revealed that suction-curettage had a significantly lower risk of acute adverse events than open excision (OR, 0.15; 95% CI, 0.07~0.32), whereas open excision was significantly superior to suction-curettage for recurrence/ineffectiveness rate (OR, 2.90; 95% CI, 1.37~6.15). Patient satisfaction was equally high with both treatments (OR, 1.58; 95% CI, 0.69~3.60). @*Conclusion@#Since surgical treatments for axillary osmidrosis have been performed mostly in East Asian nations, it was meaningful to review articles published in four languages. This meta-analysis revealed that closed surgery was safer but less effective than open surgery. However, both patient groups expressed high satisfaction with the outcomes. Our results may be helpful for deciding surgical treatment options.