A clinical study of shoulder arthroscopic rotator cuff repair on the psychological function of patients after operation.

BACKGROUND: Recently, psychological function in patients who underwent rotator cuff repair has been emphasized. However, the relationship of psychological function and clinical outcomes after rotator cuff repair is still poorly understood. This study aims to investigate the impact of arthroscopic rotator cuff repair on psychological status. METHODS: Clinical data were collected retrospectively from 60 patients with rotator cuff tears treated at the First Affiliated Hospital of Soochow University from January 2013 to June 2016. Preoperative and postoperative parameters were calculated and analyzed, including the Visual Analog Scale (VAS) pain score, the University of California, Los Angeles Scale (UCLA), the American Shoulder and Elbow Surgeons scale (ASES), the Simple Shoulder Test (SST), and the Short Form 36 Health Survey (SF-36) scores. RESULTS: Compared with preoperative scores, the VAS score decreased significantly 1 year postoperatively (P<0.05). In contrast, the UCLA, ASES and SST scores improved significantly (P<0.05). The results of the Short Form 36 Physical Component Summary score (SF-36 PCS) and the Short Form 36 Mental Component Summary score (SF-36 MCS) were also improved, which had significant differences before and after arthroscopy surgery (P<0.05). CONCLUSIONS: Arthroscopic rotator cuff repair can significantly improve the psychological function of patients, promote their rapid recovery, and achieve satisfactory results.

Early or delayed operation, which is more optimal for kyphoplasty? A retrospective study on cement leakage during kyphoplasty.

PURPOSE: To retrospectively assess the optimal operating time for kyphoplasty as far as the cement leakage during kyphoplasty is concerned. MATERIALS AND METHODS: One hundred and six patients with a total of 117 osteoporotic vertebral compression fractures (VCFs) were enrolled in our study. According to the time of kyphoplasty, they were divided into two groups: group 1 (early operation group, who received the operation within 14 days after fracture, n=46) and group 2 (delayed operation group, who received the operation between 15 and 28 days after fracture, n=71). Preoperative and postoperative visual analogue scale (VAS) and Oswestry Disability Index (ODI) scores were compared 3 days after surgery within each group and between the two groups. The radiographic outcomes were evaluated by the restoration rate (RR) of the treated vertebrae. The outcome of cement leakage was assessed after surgery using X-ray and computed tomography (CT) scans. Leaks of cement were classified into three types: those via the basivertebral vein (type B), via the segmental vein (type S) and through a cortical defect (type C). RESULTS: The mean VAS and ODI scores decreased significantly from pre-surgery to post-surgery in each group, as did the RR (p>0.05). There was no significant difference postoperatively on VAS and ODI scores (p>0.05) between the two groups. However, significant differences were observed postoperatively on RR (p=0.045) and vertebrae with leakage (p=0.038). In addition, there was a significant difference on leakage site of type C between the two groups (p=0.032). CONCLUSION: Both early and delayed operations of kyphoplasty can achieve satisfactory clinical and radiographic outcomes for osteoporotic VCFs. The risk of cement leakage during kyphoplasty will decrease obviously in delayed operation; so delayed operation, perhaps 2 weeks after fracture, is more safe and optimal than early operation as far as cement leakage is concerned, especially for vertebrae with cortical defects. But early operation of kyphoplasty is more effective in vertebral height restoration.

Standard fluoroscopic views in cadavers for determining the entry point and depth of a guide needle for use in transpedicular procedures of the thoracolumbar spine.

The purpose of this study was to determine the entry point and the depth of a guide needle in a transpedicular procedure of the lower thoracic and lumbar spine on standard fluoroscopic views. Ten human cadaveric thoracolumbar spines (T9-L5) were anatomized into single vertebrae. The transpedicular puncturing needle was inserted and placed under the anterior cortex of the vertebrae along the center axis of the pedicle. The projection of the pedicle was divided into 12 sectors ("clock measurement") on the standard posterior-anterior (PA) view. We found that the ratio of the needle depth to the width of the vertebrae on the standard lateral view varied from 71.53%+/-5.72% to 93.28%+/-3.72% (mean+/-standard deviation). The entry point was located at the 9 o'clock to 11 o'clock position on the left pedicle projection and at the 1 o'clock to 3 o'clock position on the right pedicle projection on the PA view.

Classification and management of the tandem ossification of the posterior longitudinal ligament and flaval ligament.

OBJECTIVE: To provide appropriate guidelines for treatment of tandem ossification of the posterior longitudinal ligament (OPLL) and flaval ligament (OFL). Data sources Published articles about OPLL and OFL were selected using Medline and Embase electronic databases. Study selection An English literature search from January 1980 to December 2006 was conducted. Because many reported cases were incorporated in OFL studies, the key words for search were OFL or OFL and OPLL. The first step revealed 93 studies of which 13 reports of tandem OPLL and OFL (tandem ossification) were selected. RESULTS: All studies were case series or case report and advocated that the primary therapy for tandem ossification should be operative. The clinical outcomes of surgery were evaluated in most reports, predominantly using the JOA scores. Gender is the only factor which has prognostic value. A higher proportion of women was found in the failure group. A two-stage classification of tandem ossification was developed to relate diagnosis to outcome. CONCLUSIONS: All patients with suspected ossification of the spinal ligaments should undergo routine MRI screening of the whole spine. The correlation of the classification with surgical treatments needs further studies to validate its usefulness.

[Long-term outcomes of the revision open lumbar discectomy by fenestration: a follow-up study of more than 10 years].

OBJECTIVE: To evaluate the long-term clinical results and the factors that influences the outcomes of the revision open lumbar discectomy by fenestration. METHODS: Fifty-one patients, who underwent the second open discectomy by fenestration from January 1 1988 to December 31 1994, were followed for an average of 146.8 months (range, 120 to 203 months). The long-term follow-up results were evaluated by using the MacNab classification and the Japanese Orthopaedic Association (JOA) scoring system through direct examinations and questionnaires. Radiography was also used in patients who agreed to visit the hospital, and findings were compared with those on preoperative radiographs. RESULTS: At the final follow-up, with the MacNab classification an excellent and good outcome was achieved in 70.6% of the cases, 78.4% were satisfied with their results. The failure rate was 15.7% (8 patients). Excluding those 8 failed cases who needed another reoperation, the average improvement calculated by JOA scores was (64.6 +/- 18.2)%. The disc height of the operation site significantly decreased after surgery, nevertheless, this did not affect the long-term clinical outcome. Factors that were associated with a fair and bad outcome included smoking, isolated trauma or injury, fibrosis and the length of the remaining or recurrent primary postoperative symptoms history. Psychosociological signs were probably known as negative predictors of lumbar disc surgery outcome. CONCLUSION: The long-term outcome of the revision open lumbar discectomy by fenestration in this series was favorable. Because the revision operation is typically associated with a higher complexity, selection of suitable surgical candidates and determination of valid indications for operative treatment are very important. JOA scores have proved to be easy to perform for patients and clinicians and standardize subjective data.