ABSTRACT
BACKGROUND AND AIM OF THE WORK: Since 2006, It has been developed the possibility to introduce a tibia nail through a suprapatellar access. However, the removal of device must be carried out using the classic infrapatellar approach. The aim of this study is to evaluate the clinical scores of a group of patients that removed a tibial nail by infrapatellar approach, previously introduced through a suprapatellar access. METHODS: Seven patients received removal, through infrapatellar access, of tibial nail previously introduced by suprapatellar approach. Despite being VAS <5, patients requested the device to be removed. The variables studied were the distance between the apex of the nail and the tibial plateau (TPD) and between the apex of the nail and the anterior tibia (ATD), oxford knee score (OKS), Kujala score (KJS), Visual Analog Scale (VAS) and SF 36 before surgery and 1 year. A1 year of follow up the Sidky-Buckley questionnaire was administered. The follow-up was 1 year. RESULTS: The mean VAS was 2.8 before surgery and 0.5 at 1 year after surgery, OKS average pre-surgery is 38 (good), while at 1 year it becomes 44 (excellent). The Sidky-Buckley questionnaire showed that all patients would have the intramedullary nail removed again. The widest improvement in all parameters is seen in the two patients with less distance from the tibial plateau. CONCLUSIONS: Although the patients had received initial suprapatellar access and a second infrapatellar for the removal of the device, no complications were reported regarding the use of the two accesses.
Subject(s)
Bone Nails , Device Removal/methods , Fracture Fixation, Intramedullary/methods , Tibial Fractures/surgery , Adult , Female , Fibula/injuries , Fibula/surgery , Fracture Fixation, Intramedullary/instrumentation , Fracture Healing , Fractures, Bone/surgery , Humans , Male , Middle Aged , Patella , Patient Satisfaction , Recovery of Function , Surveys and Questionnaires , Visual Analog ScaleABSTRACT
BACKGROUND CONTEXT: Cervical spondylotic myelopathy (CSM) is a common disorder, but its management and the role of surgery are still a matter of controversy. The assessment of surgical outcome is complicated by the lack of reliable and objective methods to assess the severity of the myelopathy and its evolution. Motor-evoked potentials (MEPs) are a useful and reliable tool to measure noninvasively the involvement of the corticospinal tract in patients with CSM. Recent evidence suggests that MEPs could also have a role in monitoring the effect of surgical therapy. PURPOSE: The aim of the present study is to use MEPs for the functional assessment of spinal cord before and after surgery and to correlate changes in MEPs with clinical findings. STUDY DESIGN/SETTING: This is a retrospective cohort study. PATIENT SAMPLE: Thirty-eight patients affected by CSM who underwent surgical intervention. OUTCOME MEASURES: We used the 18-point modified Japanese Orthopedic Association (mJOA) score for clinical evaluation and the central motor conduction time (CMCT) for the study of MEPs. METHODS: All patients were evaluated both clinically and neurophysiologically before (7-15 days) and after (6-12 months) surgery. MEPs were recorded from the biceps, abductor digiti minimi, and tibialis anterior muscles bilaterally. RESULTS: After surgery, the 18-point mJOA score increased significantly from 10.1 to 15.1, and the value of CMCT for tibialis anterior muscles showed a slight but significant reduction, more evident in patients with mild to moderate symptoms. CONCLUSIONS: Early surgical intervention for CSM could produce a beneficial effect on spinal cord functionality that can be detected by MEPs.
