ABSTRACT
INTRODUCTION: Knee joint decompression is one of the promising methods for the treatment of osteoarthritis. Yet, the most appropriate decompression force is not conclusive. OBJECTIVES: To compare the effect of different distraction force magnitudes on knee joint space, active range of motion (ROM), hamstring flexibility, and self-reported discomfort in asymptomatic subjects. METHODS AND MATERIALS: Twenty-five asymptomatic participants were recruited in this study. The dominant knee was distracted for 30 minutes in a 30° flexion position using three force magnitudes (10%, 20%, and 30% body weight (BW)). The traction forces were randomized with one week in between knee distractions. Joint space, range of motion (ROM), and hamstring flexibility were assessed before, immediately after, and 30 minutes after the distraction. The self-reported discomfort was assessed immediately after the distraction only. RESULTS: Medial joint space, ROM, and discomfort showed a significant difference between different force magnitudes post-distraction. The 20% and 30% BW force magnitudes significantly, but equally, increased joint space and ROM post distraction. The discomfort level was directly related to distraction force magnitude and the least comforting was the 30% BW force. Follow-up data was not significantly different than that for post-distraction. Hamstring muscle flexibility showed a significant. Yet, small increase after the 30% BW distraction force. CONCLUSION: Continued mechanical distraction of the knee joint using force magnitudes of 20% and 30% of body weight was effective in increasing medial joint space, active knee ROM, and hamstring flexibility in asymptomatic individuals. 20% force magnitude was more comfortable than the 30% percent.
INTRODUÇÃO: A descompressão da articulação do joelho é um dos métodos promissores para o tratamento da osteoartrite. No entanto, a força de descompressão mais apropriada não é conclusiva. OBJETIVOS: O objetivo deste estudo foi comparar o efeito de diferentes magnitudes de força de distração espaço articular do joelho, amplitude de movimento ativa (ADM), flexibilidade dos isquiotibiais e desconforto autorreferido em indivíduos assintomáticos. MÉTODOS: Vinte e cinco participantes assintomáticos foram recrutados. O joelho dominante foi distraído por 30 minutos em uma posição de flexão de 30° usando três magnitudes de força (10%, 20% e 30% do peso corporal (PC)). As forças de tração foram randomizadas com uma semana de intervalo entre as distrações do joelho. Espaço articular, ADM e flexibilidade dos isquiotibiais foram avaliados antes, imediatamente após e 30 minutos após a distração. O desconforto autorreferido foi avaliado imediatamente após a distração apenas. RESULTADOS: O espaço articular medial do joelho, ADM e desconforto mostraram uma diferença significativa entre as diferentes magnitudes de força após a distração. As magnitudes de força de 20% e 30% de PC aumentaram significativamente, mas igualmente, o espaço articular e a ADM após a distração. O nível de desconforto estava diretamente relacionado à magnitude da força de distração e o menos reconfortante foi a força de 30% do PC. Os dados de acompanhamento não foram significativamente diferentes dos da pós-distração. A flexibilidade muscular dos isquiotibiais mostrou um aumento significativo, mas pequeno, após a força de distração de 30% do PC. CONCLUSÃO: A distração mecânica contínua da articulação do joelho utilizando magnitudes de força de 20% e 30% do peso corporal foi eficaz no aumento do espaço articular medial, ADM ativa do joelho e flexibilidade dos isquiotibiais em indivíduos assintomáticos. A magnitude de força de 20% era mais confortável do que a de 30%.
Subject(s)
Knee , Decompression , JointsABSTRACT
Background: Odontogenic keratocyst is a challenging odontogenic lesion, originating from the epithelial remnants of the dental lamina, ranging from small cysts to extensive lesions with a high recurrence rate and morbidity for patients. The sometimes aggressive nature of these pathological entities explains the controversy among researchers regarding the best classification for these lesions, justifying the fact that these odontogenic cysts were once defined as benign odontogenic tumors for some years. However, there is consensus among scholars that it is a disease that requires careful follow-up of affected patients due to the high recurrence rates, especially in the first two decades after treatment completion. Objectives: The present study aims to elucidate the case of a patient with a mandibular odontogenic keratocyst who prematurely discontinued follow-ups and had a significant recurrence of the lesion after 7 years. Description: the second treatment was performed using Carnoy's solution. Conclusion: Carnoy's solution is an absolutely essential therapeutic resource in the treatment of odontogenic keratocysts, as its use significantly reduces the potential recurrence of the disease (AU)
Contexto: Ceratocisto odontogênico é uma lesão odontogênica desafiadora, originada a partir dos restos epiteliais da lâmina dentária, que permeia desde pequenos cistos até extensas lesões com alta taxa de recorrência e morbidade para os pacientes. O caráter por vezes agressivo destas entidades patológicas, explica as controvérsias entre os pesquisadores com relação à qual seria a melhor classificação destas lesões, justificando o fato de que estes cistos odontogênicos já foram por alguns anos definidos como tumores odontogênicos benignos. Entretanto, é consensual entre os estudiosos que se trata de uma enfermidade que carece de criteriosa proservação dos pacientes acometidos dado as elevadas taxas de recidiva, especialmente nas duas primeiras décadas após o tratamento finalizado. Objetivos: O presente estudo objetiva elucidar o caso de um paciente portador de ceratocisto odontogênico mandibular que abandonou os acompanhamentos precocemente e teve importante recidiva da lesão após 7 anos. Descrição: Descrição: o segundo tratamento foi realizado empregando-se a solução de Carnoy. Conclusão: A solução de Carnoy mostrou ser um recurso essencial no tratamento do queratocisto odontogênico por ter reduzido significativamente o potencial de recorrência da doença(AU)
Subject(s)
Humans , Recurrence , Odontogenic Cysts , Odontogenic Tumors , Decompression , MandibleABSTRACT
Introducción: La malformación de Chiari tipo 1 incluye un grupo heterogéneo de malformaciones congénitas, caracterizadas por el descenso caudal del cerebelo a través del foramen magno. En un 30-70 por ciento de los casos tiene siringomielia asociada. Existen controversias en torno a la técnica quirúrgica ideal. Objetivo: Presentar un caso de MC-1 asociada a siringomielia en el que no se aplica una duroplastia expansiva. Presentación de caso: Paciente femenina de 43 años, con antecedentes de hipertensión arterial. Acudió a consulta neuroquirúrgica por dolor cervical irradiado al miembro superior derecho. Al examen neurológico mostró signos de afectación de primera y segunda motoneurona. La resonancia magnética confirmó el diagnóstico de MC-1. Se intervino quirúrgicamente mediante descompresión de fosa posterior sin duroplastia expansiva. La paciente evolucionó sin complicaciones y egresó a las 48 horas. Durante el seguimiento mejoraron las manifestaciones parestésicas; sin embargo, el examen neurológico se mantuvo igual. A los seis meses, la resonancia magnética indicó una marcada disminución de la siringomielia y la reconformación de la cisterna magna. Hasta los 18 meses del tratamiento, los síntomas no habían empeorado y la capacidad funcional resultaba aceptable (Karnofsky 90/100). Conclusiones: La descompresión de fosa posterior sin duroplastia expansiva, seguida de re-permeabilización microquirúrgica del foramen de Magendie, tuvo resultados favorables en este caso(AU)
Introduction: Chiari malformation type 1 includes a heterogeneous group of congenital malformations, characterized by caudal descent of the cerebellum through the foramen magnum. It has associated syringomyelia in 30-70 percent of cases. Controversies exist regarding the ideal surgical technique. Objective: To present a case of MC-1 associated with syringomyelia in which an expansive duroplasty is not applied. Case report: Female patient, 43 years old, with history of arterial hypertension. She went to the neurosurgical consultation for cervical pain radiating to the right upper limb. On neurological examination, she showed signs of first and second motor neuron involvement. MRI confirmed the diagnosis of MC-1. She underwent surgery by decompression of the posterior fossa without expansive duroplasty. The patient evolved without complications and she was discharged after 48 hours. During the follow-up, the paresthetic manifestations improved; however, the neurological examination remained the same. At six months, MRI indicated a marked decrease in syringomyelia and reshaping of the cisterna magna. Until 18 months after treatment, symptoms had not worsened and functional capacity was acceptable (Karnofsky 90/100). Conclusions: Posterior fossa decompression without expansive duroplasty, followed by microsurgical re-permeabilization of Magendie's foramen, had favorable results in our case(AU)
Subject(s)
Humans , Female , Adult , Arnold-Chiari Malformation/diagnosis , Syringomyelia/diagnosis , Magnetic Resonance Spectroscopy , Decompression/methods , Foramen Magnum , HypertensionABSTRACT
Introducción: la fusión intersomática lumbar oblicua (OLIF) es una alternativa mínimamente invasiva a la fusión intersomática abierta tradicional. Permite al cirujano acceder al espacio discal mediante un abordaje retroperitoneal anterior al músculo psoas. Tiene la ventaja teórica de preservar los ligamentos longitudinales, aumentar la altura del disco con descompresión indirecta de los elementos neurales e inserción de cajas de mayor tamaño. Objetivo: evaluar los resultados clínicos de una serie consecutiva de 32 pacientes sometidos a fusión intersomática lumbar oblicua por enfermedad degenerativa de la columna lumbar. Material y métodos: treinta y dos pacientes con hallazgos radiológicos de enfermedad degenerativa de la columna lumbar fueron tratados mediante OLIF entre enero de 2017 y junio de 2019. Los resultados clínicos se evaluaron mediante el índice de discapacidad de Oswestry (ODI), la escala analógica visual (EVA) para el dolor de espalda y EVA para el dolor de extremidades inferiores, antes de la cirugía y en el primer año de seguimiento. Además, se revisaron retrospectivamente los siguientes parámetros: edad, sexo, tipo de enfermedad degenerativa, número de niveles de fusión, tiempo operatorio, duración de la estancia hospitalaria y complicaciones quirúrgicas. Resultados: se implantaron 42 cajas intersomáticas en 32 pacientes. El 56,25% de los pacientes eran mujeres, con una edad media de 56 (30-79) años. El número de niveles fusionados fue 1 en 21 pacientes (65,6%), 2 en 7 pacientes (21,9%) y 3 en 4 pacientes (12,5%). El nivel de fusión fue L1-L2 en 2 pacientes (4,76%), L2-L3 en 7 pacientes (16,67%), L3-L4 en 12 pacientes (28,57%) y L4-L5 en 21 pacientes (50%). El tiempo operatorio medio fue de 153,13 (88-210) minutos y el tiempo medio de estancia hospitalaria fue de 2,53 días (1-5). El análisis estadístico mostró significancia para los resultados en ODI, EVA para el dolor de espalda y EVA para el dolor de extremidades inferiores. Un toral de 4 pacientes presentaron paresia transitoria del psoas por tracción del músculo. Tres pacientes presentaban entumecimiento transitorio de la ingle y el muslo, y un paciente tuvo una lesión del plexo simpático. Conclusión: la fusión intersomática lumbar oblicua ofrece a los pacientes una opción de tratamiento quirúrgico seguro y eficaz para tratar la enfermedad degenerativa de la columna lumbar(AU)
Background: oblique lumbar interbody fusion (OLIF) is a minimally invasive alternative to traditional open interbody fusion. It allows the surgeon to access the disc space via a retroperitoneal approach anterior to the psoas muscle. It has the theoretical advantage of preservation of the longitudinal ligaments, augmentation of the disc height with indirect decompression of neural elements and insertion of large footprint cages. Objective: the purpose of this study was to asses the clinical outcomes of a consecutive series of 32 patients who underwent oblique lumbar interbody fusion for degenerative lumbar spine disease. Methods: thirty-two patients with radiological findings of degenerative lumbar spine disease had undergone OLIF between January 2017 and June 2019. Clinical outcomes were assessed by means of Oswestry Disability Index (ODI), Visual Analog Scale (VAS) for back pain and VAS for leg pain, before surgery and at first year follow-up. Furthermore, the following parameters were retrospectively reviewed: age, gender, type of degenerative disease, number of levels of fusion, operative time, length of hospital stay and surgical complications. Results: 42 interbody cages were implanted in 32 patients. 56,25% of the patients were female, with a mean age of 56 years. The number of fused levels was 1 in 21 patients (65,6%), 2 in 7 patients (21,9%) and 3 in 4 patients (12,5%). The fused level was L1-L2 in 2 patients (4,76%%), L2-L3 in 7 patients (16,67%%), L3-L4 in 12 patients (28,57%) and L4-L5 in 21 patients (50%). The mean operative time was 153,13 (88-210) minutes and the mean length of hospital stay was 2,53 days (1-5). Statistical analysis showed significance for the results in ODI, VAS for back pain and VAS for leg pain. 4 patients presented transient psoas paresis from traction of the muscle. Transient groin and thigh numbness was present on three patients and one patient had a sympathetic plexus injury. Conclusion: OLIF offers patients a safe and effective surgical treatment option to treat degenerative lumbar spine disease(AU)
Subject(s)
Spine , Arthrodesis , General Surgery , Back Pain , Decompression , Intervertebral Disc , MusclesABSTRACT
Antecedentes y objetivos: Los trabajadores expuestos a condiciones hiperbáricas, como el buceo y el trabajo en caissons o cámaras, enfrentan riesgos de salud específicos como enfermedad por descompresión y barotrauma. El Departamento de Salud Ocupacional solicita esta síntesis para conocer experiencias internacionales sobre la regulación y vigilancia de estas exposiciones laborales, con fines de actualización normativa en Chile. Metodología: El equipo metodológico, junto con la División de Políticas Públicas Saludables y Promoción (DIPOL) y la Unidad de Políticas de Salud Informadas por Evidencia (UPSIE), definió que era de interés explorar las experiencias de Australia, Canadá, España, Noruega, Países Bajos y China, específicamente sobre las regulaciones contenidas en los protocolos de vigilancia para trabajadores expuestos a condiciones hiperbáricas. Se buscaron documentos en páginas gubernamentales, incluyendo los siguientes conceptos: "work [or] dive in hyperbaric environment", "hyperbaric occupational activities" "hyperbaric exposure" "work in hyperbaric atmospheres", segun el idioma nativo de cada país. Resultados: - Se encontró información en los siguientes países priorizados: Australia, Canadá, España, Noruega y Países Bajos. - Las principales enfermedades reportadas producto del trabajo en condiciones hiperbáricas fueron: enfermedad por descompresión; barotrauma; narcosis nitrogenada; intoxicación por contaminación del gas respirable. - Entre las patologías crónicas o de salud común que pueden agravarse, se señalan: las condiciones cardíacas (ej., enfermedad cardíaca o presión arterial alta); enfermedades respiratorias (ej., asma, neumotórax, infecciones) y condiciones que puedan resultar en pérdida de conciencia (ej., epilepsia y diabetes). Se reportan, además en este informe, otras condiciones médicas específicas establecidas como contraindicaciones para el buceo ocupacional (ej. trastornos de la circulación periférica). - Los exámenes requeridos para el trabajo en condiciones hiperbáricas incluyeron: análisis de orina, espirometrías dinámicas, radiografías de tórax y electrocardiogramas. - En general, la periodicidad establecida para el examen médico de las personas que se desempeñan laboralmente como buzo, fue de 12 meses, a excepción de Canadá que establece un periodo de 24 meses.
Subject(s)
Barotrauma , Environmental Salubrity , Working Conditions , Chile , DecompressionABSTRACT
Introducción. El espasmo hemifacial (EHF) es una condición infrecuente que se caracteriza por la contracción unilateral, paroxística e involuntaria de los músculos de la cara inervados por el nervio facial, causado en la mayoría de los casos por un conflicto vascular en el trayecto cisternal del nervio. Objetivos. Presentar los resultados de una serie de pacientes a los que se les realizó descompresiva microvascular por EHF. Pacientes y métodos. Desde junio de 2005 a septiembre de 2022, 42 pacientes con EHF fueron operados; se evaluó edad, género, tiempo de evolución, lado de la afección, realización de toxina botulínica, hallazgos intraoperatorios, resultados postquirúrgicos y complicaciones. Técnica quirúrgica. Se utilizó la posición semisentada y un abordaje suboccipital lateral. En la cisterna, se disecó el flóculo para permitir reclinarlo de abajo hacia arriba y exponer el sitio de origen real del nervio facial. Se colocó teflón interpuesto y el uso de cola de fibrina se ajustó según el caso. Resultados. El promedio de edad fue 49,6 años, con 61,9% de mujeres. El lado derecho se vio afectado en 20 casos. El vaso mayoritariamente identificado en la cirugía fue la arteria cerebelosa anteroinferior (20 casos). La respuesta fue total en 37 casos, parcial en 3 casos y nula en 2 casos. Déficits transitorios ocurrieron en 9 casos y permanentes en 2 casos. Conclusión. La mayoría de los pacientes de nuestra serie obtuvieron una mejoría total del espasmo. La descompresiva debe ser considerada como primera línea de tratamiento del EHF primario(AU)
Background. Hemifacial spasm is a rare condition characterized by unilateral, paroxysmal, and involuntary contraction of the facial muscles innervated by the facial nerve, caused in most cases by a vascular conflict in the cisternal course of the nerve. Objectives. To present the results of a series of patients who underwent microvascular decompression by hemifacial spasm. Methods. From June 2005 to September 2022, 42 patients underwent surgery; age, gender, time of evolution, side of the condition, the performance of botulinum toxin, intraoperative findings, post-surgical results, and complications were evaluated. Surgical technique. The semi-sitting position and a retrosigmoid approach were used. In the cistern, arachnoid dissection of the flocculus was performed to allow reclining it from the bottom to up and expose the exit zone of the facial nerve. Teflon felt was interposed, and the use of fibrin glue was adjusted according to the case. Results. The average age was 49.6 years, with 61.9% women. The right side was affected in 20 cases. The vessel most frequently identified in surgery was the anterior inferior cerebellar artery (20 cases). The response was total in 37 cases, partial in 3 cases, and null in 2 cases. Transitory deficits occurred in 9 cases and permanent deficits in 2 cases. Conclusion. Most of the patients in our series obtained a total improvement in the spasm. Decompression should be considered the first line of treatment for primary hemifacial spasms(AU)
Subject(s)
Hemifacial Spasm , Spasm , Flocculus , Decompression , Microvascular Decompression SurgeryABSTRACT
Objective: To compare the volumetric changes of cervical disc herniation (CDH) after cervical microendoscopic laminoplasty(CMEL),expansive open-door laminoplasty (EOLP) and conservative treatment. Methods: A retrospective study was conducted involving 101 patients with cervical spondylotic myelopathy(CSM),at the Department of Orthopaedic Surgery,the First Affiliated Hospital of Zhengzhou University from April 2012 to April 2021. The patients included 52 males and 49 females with an age of (54.7±11.8) years(range:25 to 86 years). Among them, 35 patients accepted CMEL treatment,33 patients accepted EOLP treatment,while 33 patients accepted conservative treatment. Volume data of CDH were measured by three-dimensional analysis of the initial and follow-up MRI images. The absorption rate and reprotrusion rate of CDH were calculated. The happening of resorption or reprotrusion was defined when the ratio was greater than 5%. The clinical outcomes and quality of life were evaluated by the Japanese Orthopaedic Association (JOA) score and the neck disability index (NDI).Quantitative data was analyzed by one-way ANOVA with post LSD-t test (multiple comparison) or Kruskal-Wallis test. Categorical data was analyzed by χ2 test. Results: The follow-up time of the CMEL group,EOLP group and the conservative treatment group were (27.6±18.8)months,(21.6±6.9)months and(24.9±16.3)months respectively with no significant difference(P>0.05). Changes of CDH volume in patients:(1) There were 96 CDH of 35 patients in the CMEL group,among which 78 showed absorption. The absorption frequency was 81.3%(78/96) and the absorption rate was ranged 5.9% to 90.9%;9 CDH showed reprotrusion,the reprotrusion frequency was 9.4% (9/96) and the reprotrusion rate was 5.9% to 13.3%;(2) There were 94 CDH of 33 patients in the EOLP group,of which 45 showed absorption. The absorption prevalence was 47.9% (45/94) and the absorption rate was 5.0% to 26.7%;20 CDH showed reprotruded,with the reprotrusion frequency of 21.3% (20/94) and the reprotrusion rate was 5.8% to 28.3%;(3) There were 102 CDH in 33 patients of the conservative group. Among them, 5 showed absorption. The absorption frequency was 4.9% (5/102),and the absorption rate was 7.2% to 14.3%;58 CDH showed reprotruded with the re-protrusion ratio of 56.9% (58/102) and the re-protrusion rate was 5.4% to 174.1%. The absorption ratio and reprotrusion ratio of the CMEL group were statistically different from EOLP group or the conservative group (P<0.01).The absorption ratio and reprotrusion ratio of the EOLP group was different from conservative group (all P<0.01). In terms of clinical outcomes, the excellent/good rate of the JOA score and NDI scores in the CMEL group were different from that of conservative group (all P<0.01) but not from that of the EOLP group(P>0.05). Conclusions: CMEL is an effective method for the treatment of CSM,making CDH easier to resorption compared to the EOLP or conservative treatment,thus making a better decompression effect on the nerves. This study enlightened on a new strategy for the clinical treatment of CSM.
Subject(s)
Male , Female , Humans , Adult , Middle Aged , Aged , Aged, 80 and over , Retrospective Studies , Intervertebral Disc Displacement/surgery , Conservative Treatment , Quality of Life , Treatment Outcome , Spondylosis/surgery , Cervical Vertebrae/surgery , Spinal Cord Diseases , Laminoplasty/methods , DecompressionABSTRACT
OBJECTIVE@#To investigate the effectiveness of distal radius core decompression in the treatment of chronic wrist pain caused by various etiologies.@*METHODS@#A retrospective analysis was performed for the clinical data of 10 patients with chronic wrist pain treated with distal radial core decompression between January 2018 and December 2021. There were 6 males and 4 females with an average age of 37.4 years (range, 21-55 years). The disease duration ranged from 7 to 72 months, with an average of 26.5 months. Preoperative MRI examination showed that 10 cases had bone marrow edema at the distal radius on the affected side, and 8 cases had bone marrow edema in the carpal bones such as scaphoid and lunate bone. Among them, 3 patients had a history of wrist fracture, and 2 patients had Kienböck diseases (1 case each in stage ⅡB and stage ⅢA). Three cases were combined with triangular fibrocartilage complex (TFCC) type 1A injury. Two cases were combined with osteoarthritis, 1 of them was complicated with severe traumatic arthritis, the wrist arthroscopy showed that the TFCC was completely lost and could not be repaired, and the cartilage of the lunate bone and the ulnar head were severely worn.Visual analogue scale (VAS) score was used to evaluate the relief of wrist pain before operation, at 6 months after operation, and at last follow-up, and the range of motion of the affected wrist in dorsiflexion, palmar flexion, ulnar deviation, and radial deviation was measured. The degree of bone marrow edema was evaluated according to T1WI, T2WI, and STIR sequences of MRI.@*RESULTS@#All the patients were followed up 12-22 months, with an average of 16.4 months. Except for 1 patient who experienced persistent wrist joint pain and limited mobility after operation, the remaining 9 patients showed significant improvement in pain symptoms and wrist joint mobility. The VAS score and range of motion of wrist dorsiflexion, palmar flexion, ulnar deviation, and radial deviation at 6 months after operation and at last follow-up were significantly improved when compared with those before operation, the VAS score and the range of motion of wrist ulnar deviation and radial deviation at last follow-up were further improved when compared with those at 6 months after operation, all showing significant differences ( P<0.05). There was no significant difference in wrist dorsiflexion and palmar flexion between at 6 months after operation and at last follow-up ( P>0.05). Bone marrow edema was improved in 6 patients on MRI at 6 months after operation, and was also improved in other patients at last follow-up.@*CONCLUSION@#For chronic wrist pain caused by a variety of causes, distal radius core decompression can directly reduce the pressure of the medullary cavity of the distal radius, improve the blood supply of the corresponding distal structure, significantly alleviate chronic wrist pain, and provide an option for clinical treatment.
Subject(s)
Male , Female , Humans , Adult , Radius/surgery , Wrist , Retrospective Studies , Radius Fractures/surgery , Wrist Joint/surgery , Scaphoid Bone/surgery , Pain , Arthralgia/complications , Arthroscopy , Decompression , Range of Motion, Articular , Treatment OutcomeABSTRACT
As a new respiratory support technique, high-flow nasal cannula oxygen therapy (HFNC) has been widely used in clinical practice in recent years. During HFNC treatment, due to the long time and continuous wearing of nasal stopper and fasteners on the patient face, it is easy to cause medical device-related pressure injury on multiple facial skin. Moreover, when the patient's position changes greatly, because there is no good fixed design at the HFNC nasal stopper, it is easy to shift or turn the nasal stopper outward, causing abnormal ventilation and failure to achieve the purpose of clinical oxygen therapy. To overcome above problems, medical staff in the intensive care unit of department of infectious diseases, Tongji Hospital Tongji Medical College of HUST designed a new type of decompression fixator to prevent HFNC face pressure injury, and obtained national utility model patent (ZL 2022 2 0754626.1). The integrated design structure of the device has the functions of decompression of facial skin and fixation of nasal stopper, which can ensure the effect of oxygen therapy and improve the oxygen therapy experience and patient comfort, which is suitable for clinical promotion.
Subject(s)
Humans , Cannula , Pressure Ulcer/prevention & control , Oxygen Inhalation Therapy/methods , Oxygen , Decompression , Respiratory Insufficiency/therapy , Noninvasive VentilationABSTRACT
OBJECTIVE@#To evaluate the effectiveness of robot-guided percutaneous fixation and decompression via small incision in treatment of advanced thoracolumbar metastases.@*METHODS@#A clinical data of 57 patients with advanced thoracolumbar metastases admitted between June 2017 and January 2021 and met the selection criteria was retrospectively analyzed. Among them, 26 cases were treated with robot-guided percutaneous fixation and decompression via small incision (robot-guided group) and 31 cases with traditional open surgery (traditional group). There was no significant difference in gender, age, body mass index, lesion segment, primary tumor site, and preoperative Tokuhashi score, Tomita score, Spinal Instability Neoplastic Score (SINS), visual analogue scale (VAS) score, Oswestry disability index (ODI), Karnofsky score, and Frankel grading between groups ( P>0.05). The operation time, hospital stays, hospital expenses, intraoperative blood loss, postoperative drainage volume, duration of intensive care unit (ICU) stay, blood transfusion, complications, and survival time were compared. The pedicle screw placement accuracy was evaluated according to the Gertzbein-Robbins grading by CT within 4 days after operation. The pain, function, and quality of life were evaluated by VAS score, ODI, Karnofsky score, and Frankel grading.@*RESULTS@#During operation, 257 and 316 screws were implanted in the robot-guided group and the traditional group, respectively; and there was no significant difference in pedicle screw placement accuracy between groups ( P>0.05). Compared with the traditional group, the operation time, hospital stays, duration of ICU stay were significantly shorter, and intraoperative blood loss and postoperative drainage volume were significantly lesser in the robot-guided group ( P<0.05). There was no significant difference in hospital expenses, blood transfusion rate, and complications between groups ( P>0.05). All patients were followed up 8-32 months (mean, 14 months). There was no significant difference in VAS scores between groups at 7 days after operation ( P>0.05), but the robot-guided group was superior to the traditional group at 1 and 3 months after operation ( P<0.05). The postoperative ODI change was significantly better in the robot-guided group than in the traditional group ( P<0.05), and there was no significant difference in the postoperative Karnofsky score change and Frankel grading change when compared to the traditional group ( P>0.05). Median overall survival time was 13 months [95% CI (10.858, 15.142) months] in the robot-guided group and 15 months [95% CI (13.349, 16.651) months] in the traditional group, with no significant difference between groups ( χ 2=0.561, P=0.454) .@*CONCLUSION@#Compared with traditional open surgery, the robot-guided percutaneous fixation and decompression via small incision can reduce operation time, hospital stays, intraoperative blood loss, blood transfusion, and complications in treatment of advanced thoracolumbar metastases.
Subject(s)
Humans , Blood Loss, Surgical , Quality of Life , Retrospective Studies , Robotics , Surgical Wound , DecompressionABSTRACT
OBJECTIVE@#To explore the clinical efficacy and safety of manual therapy combined with posterior percutaneous endoscopic cervical decompression(PECD) in the treatment of intractable cervical spondylotic radiculopathy.@*METHODS@#From May 2016 to May 2018, 23 CSR patients who responded poorly to conservative treatment for at least 6 weeks underwent the combination management. Firstly, the patients received the posterior percutaneous endoscopic cervical decompression routine care for the following 4 weeks and manual therapy for another 4 weeks. A total of 23 patients were followed up, including 14 males and 9 females, the age ranged from 29 to 78 years old with an average of (50.30±12.28) years, the course of disease was 3 to 24 months with an average of (9.74±5.76) months. The lesion segment involved C4,5 in 4 cases, C5,6 in 13 cases, C6,7 in 6 cases. The visual analogue scale (VAS), neck disability index (NDI), changes of cervical physiological curvature and interbody stability, adverse events were observed before and after operation. The follow-up time points were before operation, 1 day after operation and 1, 3 and 6 months after operation.@*RESULTS@#All patients successfully completed the operation and manual treatment for 4 to 8 times. Among the 29 cases, 23 patients were followed up for more than 6 months. There was no spinal cord and nerve root injury during the treatment and follow-up. Operation time was from 80 to 120 min with a median of 90 min;intraoperative blood loss was from 35 to 80 ml with a median of 50 ml. NDI, VAS of neck, shoulder and arm each period after operation were significantly lower than those before PECD(P<0.05), while there were no significant improvement in cervical physiological curvature and target segment intervertebral space height(P>0.05);there was no significant change in interbody stability (P>0.05). After received the manual therapy, NDI significantly decreased (P<0.05), however, there was no significant difference in VAS of neck, shoulder and arm, physiological curvature of cervical spine and intervertebral space height of target segment compared with that before manual treatment (P>0.05);there was no significant change in interbody stability (P>0.05).@*CONCLUSION@#Manual therapy combined with PECD in the treatment of intractable cervical spondylotic radiculopathy can not only quickly improve the symptoms, but also alleviate the residual symptoms after PECD safely and effectively, and can not cause obvious signs of accelerated instability of cervical adjacent segments in the short term.
Subject(s)
Child , Child, Preschool , Female , Humans , Male , Cervical Vertebrae/surgery , Decompression/adverse effects , Musculoskeletal Manipulations , Radiculopathy/surgery , Retrospective Studies , Spondylosis/surgery , Treatment OutcomeABSTRACT
Introducción: el quiste dentígero, también conocido como quiste folicular, es la segunda forma más habitual de los quistes de la región maxilar después del quiste radicular. Tiene una incidencia del 20% con respecto a todos los quistes odontogénicos y se encuentra más en el género masculino entre los 20-40 años. El manejo conservador en lesiones quísticas de gran tamaño es indispensable para evitar defectos óseos o daño a estructuras vecinas. Sin embargo, en lesiones de menor tamaño, la enucleación continúa siendo el tratamiento de elección. Objetivo: presentar un caso clínico de un quiste dentígero y hacer una revisión de la literatura actualizada. Caso clínico: paciente masculino de 23 años que presentó aumento de volumen en zona geniana derecha y, además, en su ortopantomografía se observó una lesión en el sector de los incisivos superiores. Se realizó enucleación de la lesión, cuyo diagnóstico histológico previo fue quiste dentígero y posteriormente se obtiene una correcta regeneración ósea tras un año de seguimiento Conclusión: el manejo del quiste dentígero es variado: puede ir desde la enucleación quirúrgica hasta la descompresión y marsupialización del mismo. No obstante, todos los tratamientos actuales se basan en contrarrestar los factores de expansión quística que permiten a esta lesión alcanzar grandes tamaños intraóseos y poder causar desde rizolisis de dientes adyacentes hasta una asimetría facial como sucedió en este caso clínico.
Introduction: The dentigerous cyst, also known as a follicular cyst, is the second most common form of cysts of the maxillary region after the radicular cyst. It has an incidence of 20% with respect to all odontogenic cysts, it is found more in the male gender between 20-40 years of age. Conservative management of large cystic lesions is essential to avoid bone defects or damage to neighboring structures. However, in smaller lesions, enucleation continues to be the treatment of choice. Objective: To present a clinical case of a dentigerous cyst and to review the updated literature. Clinical case: A 23-year-old male patient who presented increased volume in the right genital area and his orthopantomography showed a lesion in the upper incisor sector. Enucleation of the lesion was performed, whose previous histological diagnosis was dentigerous cyst and later a correct bone regeneration was obtained after one year of follow-up. Conclusion: The management of the dentigerous cyst is varied, it can range from surgical enucleation to decompression and marsupialization. However, all current treatments are based on counteracting cystic expansion factors that allow this lesion to reach large intraosseous sizes and can cause from rhizolysis of adjacent teeth to facial asymmetry, as happened in this clinical case.
Subject(s)
Humans , Male , Adult , Dentigerous Cyst , Odontogenic Cysts , DecompressionABSTRACT
Introducción: La periodontitis apical asintomática es de los diagnósticos endodónticos más comunes que se presentan en la población mundial. Consiste en la afectación del tejido periapical como resultado de la activación de mecanismos de inflamación, los que incluyen lisis y reabsorción de tejidos de soporte como cemento, ligamento y hueso alveolar. El signo patognomónico de la periodontitis apical es la presencia de radiolucidez periapical, resultado de la destrucción de los tejidos periapicales. Su principal tratamiento abarca el manejo endodóntico convencional cuyo objetivo es la eliminación de los irritantes locales dentro del conducto radicular. Sin embargo, cuando se desarrollan lesiones de gran tamaño es necesario complementar con terapias que aceleren la reparación, una de ellas la descompresión, la cual a partir de la reducción de la presión intralesión e intraósea con lo que favorece la formación de tejido fibroso, conectivo y óseo. Objetivo: Describir la técnica de descompresión intraconducto en el manejo de lesiones periapicales de gran tamaño. Presentación del caso: Paciente de 33 años de edad, con diagnóstico de periodontitis apical asintomática y evaluación tomográfica de lesión periapical de gran tamaño (67,5 UH) manejado con terapia endodóntica convencional y descomprensión intraconducto como terapia coadyuvante. Posterior a la restauración se realizaron controles clínicos y radiográficos. A los 24 meses se evidenció reparación de los tejidos involucrados con restauración del espacio del ligamento periodontal. Conclusiones: En este caso, la terapia descomprensiva fue una alternativa en el manejo de una lesión periapical de gran tamaño, que permitió regular la presión intraósea y facilitar la regeneración del tejido óseo, evitando la intervención quirúrgica siendo así más confortante para el paciente(AU)
Introduction: Asymptomatic apical periodontitis is one of the most common endodontic disorders diagnosed in the world population. It consists in damage to the periapical tissue due to activation of inflammation mechanisms, including lysis and resorption of support tissues like cementum, ligament and alveolar bone. The pathognomonic sign of apical periodontitis is the presence of periapical radiolucency due to the destruction of periapical tissue. Its main treatment includes conventional endodontic management aimed at removing local irritants from the root canal. However, when large lesions develop, it is necessary to complement the conventional treatment with therapies speeding up the repair process, such as decompression, which reduces intralesion and intraosseous pressure, fostering the formation of fibrous, connective and bone tissue. Objective: Describe the use of intracanal decompression technique in the management of large periapical lesions. Case presentation: A case is presented of a 33-year-old patient diagnosed with asymptomatic apical periodontitis and a tomographic evaluation of a large periapical lesion (67.5 UH) treated with conventional endodontic therapy and intracanal decompression as adjuvant therapy. Restoration was followed by clinical and radiographic controls. At 24 months it was observed that the tissues involved had been repaired and the periodontal ligament space restored. Conclusions: The use of decompressive therapy as an alternative in the management of a large periapical lesion, made it possible to regulate intraosseous pressure and facilitate bone tissue regeneration, relieving the patient from the discomforts of a surgical intervention(AU)
Subject(s)
Humans , Male , Adult , Periapical Periodontitis/diagnosis , Decompression/methods , Periapical Tissue , Surgical Procedures, OperativeABSTRACT
Introdução: os cistos radiculares são as lesões císticas mais comuns nos maxilares. Eles surgem dos Restos Epiteliais de Malassez, presos no ligamento periodontal e podem ser ativados por um processo inflamatório na região pulpar. Geralmente são descobertos em exames radiográficos de rotina, apresentando-se como uma imagem radiolúcida, bem delimitada, envolvendo o periápice de um ou mais dentes. Objetivo: apresentar o tratamento de um extenso cisto radicular, em região de maxila, com acompanhamento de 18 meses. Relato do caso: Paciente do sexo feminino, 49 anos, foi encaminhada para avaliação e tratamento na Clínica Odontológica da Faculdade Sete Lagoas (FACSETE), apresentando lesão extensa em região maxilar anterior direita ao exame radiográfico. Ao exame clínico, observou-se leve assimetria facial e ausência de sintomas dolorosos. Tomografia computadorizada, punção aspirativa e biópsia incisional foram utilizadas para se chegar ao diagnóstico compatível com cisto radicular. Optou-se por uma técnica conservadora, em que foi realizada a descompressão da lesão. Após 05 meses de tratamento, um novo procedimento cirúrgico foi realizado para enuclear o restante da patologia. Conclusão: a descompressão, com utilização de cânula, é um tratamento auxiliar fácil, conservador, eficaz e reduz a morbidade causada por diferentes cistos odontogênicos(AU)
Introduction: root cysts are the most common cystic lesions in the jaw. They arise from the Epithelial Remains of Malassez, trapped in the periodontal ligament and can be activated by an inflammatory process in the pulp region. They are usually discovered in routine radiographic examinations, presenting as a well-defined radiolucent image involving the periapex of one or more teeth. Objective: to present the treatment of an extensive root cyst, in the maxillary region, with a follow-up of 18 months. Case report: A 49-year-old female patient was referred for evaluation and treatment at the Dental Clinic of Faculdade Sete Lagoas (FACSETE), with an extensive lesion in the right anterior maxillary region on radiographic examination. On clinical examination, mild facial asymmetry and absence of painful symptoms were observed. Computed tomography, aspiration puncture and incisional biopsy were used to reach a diagnosis compatible with radicular cyst. We opted for a conservative technique, in which the lesion was decompressed. After 05 months of treatment, a new surgical procedure was performed to enucleate the rest of the pathology. Conclusion: decompression, using a cannula, is an easy, conservative, effective auxiliary treatment and reduces the morbidity caused by different odontogenic cysts.
Subject(s)
Humans , Female , Middle Aged , Radicular Cyst , Decompression , Periodontal Ligament , Odontogenic Cysts , Radicular Cyst/surgery , Radicular Cyst/diagnosis , Radicular Cyst/therapy , Radicular Cyst/diagnostic imagingABSTRACT
Abstract Objective To compare pain, function, quality of life and adverse events of lumbar decompression and spinal fusion in patients with degenerative spinal pathologies who participated in a second opinion program for spinal surgeries with a 36-month followup. Methods The data for this retrospective cohort were withdrawn from a private healthcare system between June 2011 and January 2014. The study sample consisted of 71 patients with a lumbar spine surgical referral. The outcomes for the comparisons between lumbar decompression and spinal fusion were quality of life (evaluated through the EuroQoL 5D), pain (measured by the Numerical Rating Scale) and function (assessed through the Roland Morris Disability Questionnaire) measured at baseline, and at 12 and 36 months after the surgical procedures. The definitions of recovery were established by the minimal clinically important difference (MCID). The baseline differences between the groups were analyzed by non-paired t-test, and the differences in instrument scores between time points, by generalized mixed models. The results were presented as mean values adjusted by the models and 95% confidence intervals. Results Concerning the surgical techniques, 22 patients were submitted to spinal fusion and 49 patients, to lumbar decompression. As for the comparisons of the findings before and after the surgical interventions, the MCID was achieved in all outcomes regarding quality of life, pain and function at both time points when compared to baseline scores Moreover, concerning the complication rates, only lumbar decompression presented a surgical rate of 4% (n = 3) for recurrence of lumbar disc hernia. Conclusion Patients with degenerative spinal pathologies present improvements in long-term outcomes of pain, function and quality of life which are clinically significant, no matter the surgical intervention.
Resumo Objetivo Comparar a dor, a função, a qualidade de vida e os eventos adversos da descompressão lombar e da fusão espinhal em pacientes com patologias degenerativas da coluna vertebral que participaram de um programa de segunda opinião para cirurgias de coluna com acompanhamento de 36 meses. Métodos Os dados desta coorte retrospectiva foram obtidos de um sistema de saúde privado entre junho de 2011 e janeiro de 2014. A amostra do estudo foi composta por 71 pacientes encaminhados para cirurgia de coluna lombar. Os desfechos para comparações entre a descompressão lombar e a fusão espinhal foram qualidade de vida (avaliada pelo questionário EuroQoL 5D), dor (medida pela Escala Numérica de Classificação de Dor) e função (avaliada pelo Questionário de Incapacidade de Roland Morris) no início do estudo e aos 12 e 36 meses de acompanhamento pós-cirúrgico. As definições de recuperação foram estabelecidas pela diferença mínima clinicamente importante (DMCI). As diferenças basais entre os grupos foram analisadas por teste t não pareado, e as diferenças nas pontuações dos instrumentos entre os momentos, por modelos mistos generalizados. Os resultados foram apresentados como valores médios ajustados pelos modelos e intervalos de confiança de 95%. Resultados No total, 22 pacientes foram submetidos à artrodese, e 49 pacientes, à descompressão lombar. Quanto às comparações de achados antes e depois das intervenções cirúrgicas, a DMCI foi alcançada em todos os desfechos de qualidade de vida, dor e função nos dois pontos de acompanhamento em relação aos escores basais Em relação às complicações, apenas a descompressão lombar apresentou 4% (n = 3) de taxa cirúrgica de recidiva da hérnia de disco lombar. Conclusão Pacientes com patologias espinhais degenerativas apresentam melhoras nos desfechos de dor, função e qualidade de vida em longo prazo que são clinicamente significativas e independentes da intervenção cirúrgica.
Subject(s)
Humans , Outcome and Process Assessment, Health Care , Arthrodesis , Quality of Life , Spinal Fusion , Spine , Surgical Procedures, Operative , Retrospective Studies , Musculoskeletal Diseases , Back Pain , Decompression , Delivery of Health CareABSTRACT
ABSTRACT Background: Peripheral neural surgical decompression (PNSD) is used as a complementary therapy to the clinical treatment of neuritis to preserve neural function. Objective: To evaluate the long-term (≥ 1 year) clinical and functional results for PNSD in leprosy neuritis. Methods: This cross-sectional study included leprosy patients who were in late postoperative period (LPO) of surgical decompression of ulnar, median, tibial, and fibular nerves. Socioeconomic, epidemiological, and clinical data were collected. The following instruments were used in this evaluation: visual analogue pain scale (VAS), Douleur Neuropathique en 4 Questions (DN4), SALSA scale, and simplified neurological assessment protocol. The preoperative (PrO) and 180-day postoperative (PO180) results were compared. Results: We evaluated 246 nerves from 90 patients: 56.6% were on multidrug therapy (MDT) and 43.3% discharged from MDT. Motor scores and pain intensity showed statistically significant improvement (p<0.01). There was an increase in sensory scores only for bilateral ulnar nerves (p<0.05). Of the operated cases, 26.0% of patients were referred for surgery of ulnar neuritis and 23.6% of tibial neuritis. Neuropathic pain was reported in 41% of cases. Daily dose of prednisone reduced from 39.6 mg (±3.0) in PrO, 16.3 mg (±5.2) in PO180, to 1.7 mg (±0.8) in LPO. The SALSA scale results showed mild activity limitation in 51% and moderate in 34% of patients. Eighty percent of individuals reported that the results reached their expectations. Conclusions: PNSD in leprosy was effective in the long term to decrease the prevalence and intensity of pain, improve motor function, and reduce the dose of corticosteroids, which is reflected in the patients' satisfaction.
RESUMO Antecedentes: A descompressão cirúrgica neural periférica (DCNP) é usada como uma terapia complementar ao tratamento clínico da neurite hansênica para preservar a função neural. Objetivo: Avaliar a longo prazo (≥ 1 ano) os resultados clínicos e funcionais da DCNP na neurite hansênica. Métodos: Este estudo transversal incluiu pacientes que estavam no pós-operatório tardio (POT) de cirurgia de descompressão dos nervos ulnares, medianos, tibiais e fibulares. Foram coletados dados socioeconômicos, epidemiológicos e clínicos. Os instrumentos utilizados foram: escala visual analógica de dor (EVA), questionário de dor neuropática 4 (DN4), escala SALSA e protocolo de avaliação neurológica simplificada. Os resultados obtidos foram comparados com os do pré-operatório (PrO) e pós-operatório de 180 dias (PO180). Resultados: Foram avaliados 246 nervos de 90 pacientes: 56,6% estavam em poliquimioterapia (PQT) e 43,3% em alta da PQT. Escores motores e intensidade da dor apresentaram melhora significante (p<0,01). Houve aumento nos escores sensitivos nos nervos ulnares bilaterais (p<0,05). Neurite ulnar foi indicação cirúrgica em 26,0% dos casos operados, seguida pela neurite tibial (23,6%). Dor neuropática foi relatada em 41% dos casos. Dose diária de prednisona reduziu de 39,6 mg (±3,0) na PrO, 16,3 mg (±5,2) na PO180, para 1,7 mg (±0,8) na POT. Escala SALSA mostrou limitação leve da atividade em 51% e moderada em 34% dos pacientes. 80% dos indivíduos relataram que os resultados atingiram suas expectativas. Conclusão: DCNP na hanseníase foi eficaz a longo prazo na redução da prevalência e intensidade da dor, na melhora da função motora e redução da dose de corticosteroides, refletindo na satisfação do paciente.
Subject(s)
Humans , Leprostatic Agents/therapeutic use , Leprosy/complications , Leprosy/drug therapy , Cross-Sectional Studies , Follow-Up Studies , Decompression , Drug Therapy, CombinationABSTRACT
La neuralgia del trigémino es un trastorno neuropático paroxístico que afecta a una o varias de las ramas sensoriales del nervio trigémino cuya etiología es variada, la más aceptada es por compresiones vasculares a nivel del ángulo ponto cerebeloso que generan conflicto de espacio. Dentro de las posibilidades de tratamiento, la descompresión microvascular permite la cura fisiopatológica de la neuralgia del trigémino, teniendo resultados satisfactorios a corto/largo plazo, y bastantes ventajas en comparación a otras técnicas de mínima invasión. Se presenta el caso de una paciente con tratamiento médico máximo no efectivo, a la cual se realizó descompresión microvascular evidenciando conflicto arterial y venoso con el nervio.
Trigeminal neuralgia is a paroxysmal neuropathic disorder that affects one or more of the sensory branches of the trigeminal nerve, the etiology of which is varied, the most accepted being due to vascular compressions at the level of the brainstem that generate conflict of space. Within the treatment possibilities, microvascular decompression allows the pathophysiological cure of trigeminal neuralgia, having satisfactory results in the short / long term, and many advantages compared to other minimally invasive techniques. We present the case of a patient with maximum ineffective medical treatment, who underwent microvascular decompression, showing arterial and venous conflict with the nerve.
Subject(s)
Decompression , Microvascular Decompression Surgery , Trigeminal Nerve , Trigeminal NeuralgiaABSTRACT
ABSTRACT Objective: To verify the effectiveness of indirect decompression after lateral access fusion in patients with high pelvic incidence. Methods: A retrospective, non-comparative, non-randomized analysis of 22 patients with high pelvic incidence who underwent lateral access fusion, 11 of whom were male and 11 female, with a mean age of 63 years (52-74), was conducted. Magnetic resonance exams were performed within one year after surgery. The cross-sectional area of the thecal sac, anterior and posterior disc heights, and bilateral foramen heights, measured pre- and postoperatively in axial and sagittal magnetic resonance images, were analyzed. The sagittal alignment parameters were measured using simple radiographs. The clinical results were evaluated using the ODI and VAS (back and lower limbs) questionnaires. Results: In all cases, the technique was performed successfully without neural complications. The mean cross-sectional area increased from 126.5 mm preoperatively to 174.3 mm postoperatively. The mean anterior disc height increased from 9.4 mm preoperatively to 12.8 mm postoperatively, while the posterior disc height increased from 6.3 mm preoperatively to 8.1 mm postoperatively. The mean height of the right foramen increased from 157.3 mm in the preoperative period to 171.2 mm in the postoperative period and that of the left foramen increased from 139.3 mm in the preoperative to 158.9 mm in the postoperative. Conclusions: This technique is capable of correcting misalignment in spinal deformity, achieving fusion and promoting the decompression of neural elements. Level of evidence III; Retrospective study.
RESUMO Objetivo: Verificar a eficácia da descompressão indireta depois de fusão por acesso lateral em pacientes com alta incidência pélvica. Métodos: Análise retrospectiva, não comparativa, não randomizada de 22 pacientes com alta incidência pélvica submetidos à fusão por acesso lateral; 11 do sexo masculino e 11 do sexo feminino, com média de idade de 63 anos (52 a 74). Os exames de ressonância magnética foram realizados até um ano depois da cirurgia. Foram analisadas: área da seção transversal do saco tecal, altura discal anterior e posterior, altura dos forames bilaterais, medidas no pré e pós-operatório em imagens de ressonância magnética axial e sagital. Os parâmetros do alinhamento sagital foram medidos a partir de radiografia simples. Os resultados clínicos foram avaliados com os questionários ODI e EVA (costas e membros inferiores). Resultados: Em todos os casos, a técnica foi realizada com sucesso, sem complicações neurais. A área da secção transversal média aumentou de 126,5 mm no pré-operatório para 174,3 mm no pós-operatório. A média da altura anterior do disco aumentou de 9,4 mm no pré-operatório para 12,8 mm no pós-operatório, enquanto a altura posterior do disco aumentou de 6,3 mm no pré-operatório para 8,1 mm no pós-operatório. A média da altura do forame direito aumentou de 157,3 mm no pré-operatório para 171,2 mm no pós-operatório e a do forame esquerdo aumentou de 139,3 mm no pré-operatório para 158,9 mm no pós-operatório. Conclusões: Essa técnica é capaz de corrigir o desalinhamento na deformidade da coluna vertebral, alcançando a fusão e promovendo a descompressão dos elementos neurais. Nível de evidência III; Estudo Retrospectivo.
RESUMEN Objetivo: Verificar la eficacia de la descompresión indirecta después de fusión por acceso lateral en pacientes con alta incidencia pélvica. Métodos: Análisis retrospectivo, no comparativo, no aleatorizado de 22 pacientes con alta incidencia pélvica sometidos a fusión por acceso lateral; 11 del sexo masculino y 11 del sexo femenino, con promedio de edad de 63 años (52 a 74). Los exámenes de resonancia magnética fueron realizados hasta un año después de la cirugía. Fueron analizadas: área de la sección transversal del saco dural, altura discal anterior y posterior, altura de los for ámenes bilaterales, medidas en el pre y posoperatorio en imágenes de resonancia magnética axial y sagital. Los parámetros de la alineación sagital fueron medidos a partir de una radiografía simple. Los resultados clínicos fueron evaluados con los cuestionarios ODI y EVA (espalda y miembros inferiores). Resultados: En todos los casos, la técnica fue realizada con éxito, sin complicaciones neurales. El área de la sección transversal promedio aumentó de 126,5 mm en el preoperatorio para 174,3 mm en el postoperatorio. El promedio de altura anterior del disco aumentó de 9,4 mm en el preoperatorio para 12,8 mm en el postoperatorio, mientras que la altura posterior del disco aumentó de 6,3 mm en el preoperatorio para 8,1 mm en el postoperatorio. El promedio de altura del foramen derecho aumentó de 157,3 mm en el preoperatorio para 171,2 mm en el postoperatorio y la del foramen izquierdo aumentó de 139,3 mm en el preoperatorio para 158,9 mm en el postoperatorio. Conclusiones: Esta técnica es capaz de corregir la desalineación en la deformidad de la columna vertebral, alcanzando la fusión y promoviendo la descompresión de los elementos neurales. Nivel de evidencia III; Estudio retrospectivo.
Subject(s)
Humans , Arthrodesis , Spinal Stenosis , DecompressionABSTRACT
Abstract Degenerative lumbar spinal stenosis is the most frequent cause of low back pain and/or sciatica in the elderly patient. Epidemiology, pathophysiology, clinical manifestations and testing are reviewed in a wide current bibliographic investigation. The importance of the relationship between clinical presentation and imaging study, especially magnetic resonance imaging (MRI), is emphasized. Prior to treatment indication, it is necessary to identify the precise location of pain, as well as the differential diagnosis between neurological and vascular lameness. Conservative treatment combining medications with various physical therapy techniques solves the problem in most cases, while therapeutic testing with injections, whether epidural, foraminal or facetary, is performed when pain does not subside with conservative treatment and before surgery is indicated. Injections usually perform better results in relieving sciatica symptoms and less in neurological lameness. Equine tail and/or root decompression associated or not with fusion is the gold standard when surgical intervention is required. Fusion after decompression is necessary in cases with segmental instability, such as degenerative spondylolisthesis. When canal stenosis occurs at multiple levels and is accompanied by axis deviation, whether coronal and/or sagittal, correction of axis deviations should be performed in addition to decompression and fusion, especially of the sagittal axis, in which a lumbar lordosis correction is required with techniques that correct the rectified lordosis to values close to the pelvic incidence.
Resumo A estenose degenerativa do canal vertebral lombar é a causa mais frequente de dor lombar e/ou ciática no paciente idoso; sua epidemiologia, fisiopatogenia, manifestações e testes clínicos são revistos em ampla investigação bibliográfica atual. A importância da relação entre a clínica e o estudo por imagens, principalmente a ressonância magnética (RM), é ressaltada. Antes da indicação do tratamento, é necessário identificar a localização precisa da dor, bem como o diagnóstico diferencial entre a claudicação neurogênica e a vascular. O tratamento conservador associando medicações com as diversas técnicas fisioterápicas resolve o problema na maioria dos casos, já o teste terapêutico com os bloqueios, seja epidural, foraminal ou facetário, é realizado quando as dores não cedem com o tratamento conservador e antes da indicação da cirurgia. Os bloqueios costumam dar melhores resultados no alívio dos sintomas de ciatalgia e menos no quadro de claudicação neurogênica. A descompressão da cauda equina e/ou radicular associada ou não à artrodese é o padrão ouro quando a intervenção cirúrgica é necessária. A artrodese após a descompressão é necessária nos casos com instabilidade segmentar, como na espondilolistese degenerativa. Quando a estenose de canal acontece em múltiplos níveis e vem acompanhada de desvio de eixo, seja coronal e/ou sagital, deve ser realizada, além das descompressões e artrodese, a correção dos desvios de eixo, principalmente o eixo sagital, quando a correção da lordose lombar se impõe com técnicas que corrigem a lordose retificada para valores próximos à incidência pélvica.
Subject(s)
Humans , Pain , Arthrodesis , Spinal Stenosis , Magnetic Resonance Spectroscopy , Low Back Pain , Constriction, Pathologic , Decompression , Diagnosis, Differential , Intermittent ClaudicationABSTRACT
OBJECTIVE@#To investigate the short-term clinical effect of double channel decompression and bone grafting through the greater trochanter combined with allograft fibula propping in the treatment of osteonecrosis of femoral head (ONFH).@*METHODS@#Twenty two patients (23 hips) with osteonecrosis of the femoral head were included from November 2017 to February 2019. According to Association Research Cirulation Osseous(ARCO) staging, there were 13 hips at stageⅡgroup, aged from 20 to 48 years old with an average of(32.5±8.5)years old;10 hips at stageⅢgroup, aged from 18 to 45 years old with an average of(32.7±8.6) years old. A single approach through the greater trochanterwas used for decompression, bone grafting and fibula support. Harris scoring system was used to evaluate the function of hip joint before and after implantation, and the anteroposterior and lateral X-ray films of hip joint were taken at 3, 6, 12 and 18 months after implantation to observe and analyze the progress of femoral head necrosis and regeneration.@*RESULTS@#All patients were followed up, and the duration ranged from 12 to 18 months with an average of (14.6±2.1) months. Harris score of stageⅡand stageⅢpatients increased from 73.2± 5.5 and 66.5±3.4 to 87.6±8.7(@*CONCLUSION@#The effect of double trochanteric decompression and bone grafting combined with fibular allograft propping in the treatment of early and middle stage avascular necrosis of the femoral head is good, especially suitable for young and middle aged patients with ARCOⅡstage avascular necrosis of the femoral head.