ABSTRACT
ABSTRACT Objective: The objective of this study was to analyze and compare the effectiveness of two types of abduction orthotics used for the feet, the Denis-Browne type (traditional) and the Dobbs type (dynamic), with regard to maintenance of deformity correction and prevention of recurrence . Method: In this comparative retrospective case study, information was collected from the medical records of children with idiopathic congenital clubfoot (CCF). We evaluated a total of 43 feet in 28 patients, which were divided into two groups. Group 1 was comprised of 16 patients with a total of 24 CCFs treated with the traditional orthotic device. Group 2 consisted of 12 patients with a total of 19 CCFs treated with the dynamic orthotic device. The statistical analysis used the ANOVA test to compare the categorical variables between the groups. A significance level of 5% was adopted (p-value≤0.05) . Results: In Group 1, recurrence was observed in 2 feet (8.33%), and in 1 foot in Group 2 (5.26%). No significant difference in effectiveness was seen between the two types of orthotic devices . Conclusion: Both abduction devices were seen to be effective in maintaining correction of congenital clubfoot deformities. There was no statistical significance between type of orthotic device and recurrence. Level of Evidence III, Retrospective Comparative Study.
RESUMO Objetivo: Analisar e comparar a eficácia entre dois tipos de órtese de abdução para o pé, tipo Denis-Browne (tradicional) e a proposta por Dobbs (dinâmica), quanto à manutenção da correção das deformidades e da prevenção das recidivas. Método: Estudo de casos, retrospectivo e comparativo, com levantamento de prontuários de crianças com PTCI. Foram avaliados 28 pacientes, totalizando 43 pés, divididos em dois grupos: Grupo 1 - tratados com aparelho tradicional, 16 pacientes, 24 PTCI. Grupo 2 - tratados com aparelho dinâmico, 12 pacientes, totalizando 19 PTCI. A análise estatística comparou as variáveis categóricas entre os grupos com o teste ANOVA. Foi adotado nível de significância de 5% (p ≤ 0,05). Resultados: No grupo 1, a recidiva ocorreu em dois pés (8,33%) e no grupo 2 em um pé (5,26%). Na comparação das duas órteses, a eficácia não apresentou diferença significante. Conclusão: Ambos os aparelhos de abdução mostraram-se eficazes na manutenção da correção das deformidades do pé torto congênito. Não ocorreu significância estatística em relação às órteses e a ocorrência de recidivas. Nível de Evidência III, Estudo Retrospectivo Comparativo.
ABSTRACT
OBJETIVO: Comprovar a viabilidade da técnica de herniorrafia inguinal com anestesia local, em regime ambulatorial, com segurança, eficácia e curta curva de aprendizado. MÉTODOS: Analisamos prospectivamente 454 pacientes submetidos à herniorrafias inguinais sob anestesia local em regime ambulatorial entre novembro de 2004 e agosto de 2008. Do total de hérnias tratadas cirurgicamente neste período, 285 foram operadas à direita, 163 à esquerda e seis bilaterais. Foram utilizados critérios clínicos, cirúrgicos e psicossociais para inclusão no procedimento. Os parâmetros para exclusão foram hérnia complexa ou irredutível, hérnia recidivada, obesidade (IMC maior que 30 Kg/m²), recusa do paciente e pacientes psiquiátricos. Todos os pacientes foram operados eletivamente e analisados quanto ao resultado cirúrgico, suas complicações e tempo de internação hospitalar. RESULTADOS: Todas as operações foram concluídas com êxito. Em nenhum dos casos foi necessário a mudança do método anestésico. O tempo cirúrgico foi semelhante ao realizado com outros métodos de anestesia, não havendo casos de efeitos adversos dos anestésicos locais. As complicações intra-operatórias totalizaram aproximadamente 2,64% (12/454) dos casos. Não houve necessidade de internações hospitalares superiores ao período de 24 horas. CONCLUSÃO: O procedimento é viável sem dor per - operatória significativa, com segurança, podendo ser realizada por residentes sob supervisão, com satisfatória aceitação pelos pacientes, com complicações semelhantes às observadas em uma herniorrafia convencional, possibilitando um tempo e custo de internação menor e acesso mais rápido dos pacientes ao tratamento.
OBJECTIVE: To demonstrate the feasibility of inguinal hernia repair with local anesthesia in an outpatient regime, with safety, efficacy and short learning curve. METHODS: We prospectively evaluated 454 patients undergoing inguinal hernia repair under local anesthesia on an outpatient basis between November 2004 and August 2008. Of the total number of hernias surgically treated in this period, 285 were operated on the right, 163 on the left and six bilateral. We used clinical, surgical and psychosocial criteria for inclusion in the procedure. The parameters for exclusion were complex, irreducible or recurrent hernia, obesity (BMI greater than 30 kg/m²), patient's refusal and psychiatric disorder. All patients underwent elective surgery and were analyzed regarding surgical outcome, complications and hospital stay. RESULTS: All operations were completed successfully. In no case there was need to change the anesthetic method. Surgical time was similar to that conducted with other methods of anesthesia and there were no cases of adverse effects of local anesthetics. Intra-operative complications amounted to approximately 2.64% (12/454). There was no need for hospital admissions greater than 24 hours. CONCLUSION: The procedure is feasible and causes no perioperative significant pain, is safe, can be performed by residents under supervision, has satisfactory patient acceptance and complications similar to those observed in a conventional herniorrhaphy, allowing lower time and cost of hospitalization and faster access to treatment.
Subject(s)
Female , Humans , Male , Ambulatory Surgical Procedures , Anesthesia, Local , Hernia, Inguinal/surgery , Ambulatory Surgical Procedures/methods , Feasibility Studies , Prospective StudiesABSTRACT
OBJECTIVE: To demonstrate the feasibility of inguinal hernia repair with local anesthesia in an outpatient regime, with safety, efficacy and short learning curve. METHODS: We prospectively evaluated 454 patients undergoing inguinal hernia repair under local anesthesia on an outpatient basis between November 2004 and August 2008. Of the total number of hernias surgically treated in this period, 285 were operated on the right, 163 on the left and six bilateral. We used clinical, surgical and psychosocial criteria for inclusion in the procedure. The parameters for exclusion were complex, irreducible or recurrent hernia, obesity (BMI greater than 30 kg/m²), patient's refusal and psychiatric disorder. All patients underwent elective surgery and were analyzed regarding surgical outcome, complications and hospital stay. RESULTS: All operations were completed successfully. In no case there was need to change the anesthetic method. Surgical time was similar to that conducted with other methods of anesthesia and there were no cases of adverse effects of local anesthetics. Intra-operative complications amounted to approximately 2.64% (12/454). There was no need for hospital admissions greater than 24 hours. CONCLUSION: The procedure is feasible and causes no perioperative significant pain, is safe, can be performed by residents under supervision, has satisfactory patient acceptance and complications similar to those observed in a conventional herniorrhaphy, allowing lower time and cost of hospitalization and faster access to treatment.