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Arthroplasty Today Dec 2023Intraoperative pelvic motion during total hip arthroplasty (THA) in the supine position affects acetabular cup placement and occurs at each step of THA; however, there...
BACKGROUND
Intraoperative pelvic motion during total hip arthroplasty (THA) in the supine position affects acetabular cup placement and occurs at each step of THA; however, there are no reports of pelvic motion changes during each stage of THA via the direct anterior approach (DAA). This study aimed to evaluate pelvic motion at each step of THA through the DAA.
METHODS
From March to October 2022, 71 hips were prospectively measured for intraoperative pelvic tilt and axial rotation during THA through the DAA at a single center. These parameters were measured during each surgical step using the augmented reality-hip navigation system.
RESULTS
Both pelvic tilt and axial rotation were maximal during acetabular cup placement. The mean intraoperative pelvic tilt and axial rotation during cup placement were 4.8 ± 2.6° (95% confidence interval, 4.19-5.41°) and 4.2 ± 3.3° (95% confidence interval, 3.42-4.98°), respectively. The effects of the acetabular retractor and cup impactor on pelvic tilt and axial rotation were comparable. Spearman's correlation tests showed significant correlation between axial rotation and body mass index (r = -0.444, = .00011).
CONCLUSIONS
The pelvis tilts forward and rotates toward the surgical side during THA through the DAA. The effects of the acetabular retractor and cup impactor on pelvic motion are comparable. Cup implantation must take into account pelvic movement, and it must be recognized that the pelvis is moving at that time, even with only the acetabular retractor inserted, compared to before the skin incision.
PubMed: 38023653
DOI: 10.1016/j.artd.2023.101251 -
La Clinica Terapeutica 2023Splenosis is the presence of ectopic autotransplantation of splenic tissue in various compartments of the human body, occurring after rupture of the splenic parenchyma.
BACKGROUND
Splenosis is the presence of ectopic autotransplantation of splenic tissue in various compartments of the human body, occurring after rupture of the splenic parenchyma.
METHODS
A systematic PubMed and Scopus search was conducted.
RESULTS
The mean age of the patients was 51.7 years. The majority of patients were of female gender. An emergency presentation was noted in 30 out of 85 patients, having abdominal pain as main symptom. The principal reason for splenectomy were traffic accidents. The time span between splenectomy and the initial symptoms ranged between 1 and 57 years. The most frequent symptom at presentation of pelvic splenosis was abdominal pain. Almost a quarter of the included patients were without any symptom. Presence of extrapelvic splenosis was de-scripted in almost half of the included patients. With regards to the type of treatment provided, exploratory laparotomy, laparoscopic surgical exploration / laparoscopy, robotic removal of splenium and watchful waiting, were performed in 35 (41.2%), 32 (37.6%), 3 (3.5%) and 15 (16.3%) patients, respectively. No fatality was reported.
CONCLUSION
Pelvic splenosis is a rare clinical condition. It may mimic several clinical conditions and mislead diagnosis. The clinical history of splenectomy for trauma or different other reasons may es-tablish diagnosis and exclude other morbidities. Excision and complete removal of pelvic splenosis nodules is not always necessary and it depends on the clinical symptomatology. Careful imaging and precise assessment with the assistance of nuclear medicine may lead to correct diagnosis and avoid unnecessary surgical interventions.
Topics: Humans; Female; Middle Aged; Splenosis; Splenectomy; Abdominal Pain; Diagnosis, Differential; Laparotomy
PubMed: 37378510
DOI: 10.7417/CT.2023.2453 -
Frontiers in Bioengineering and... 2023Dogs () prefer the walk at lower speeds and the more economical trot at speeds ranging from 0.5 Fr up to 3 Fr. Important works have helped to understand these gaits at...
Dogs () prefer the walk at lower speeds and the more economical trot at speeds ranging from 0.5 Fr up to 3 Fr. Important works have helped to understand these gaits at the levels of the center of mass, joint mechanics, and muscular control. However, less is known about the global dynamics for limbs and if these are gait or breed-specific. For walk and trot, we analyzed dogs' global dynamics, based on motion capture and single leg kinetic data, recorded from treadmill locomotion of French Bulldog ( = 4), Whippet ( = 5), Malinois ( = 4), and Beagle ( = 5). Dogs' pelvic and thoracic axial leg functions combined compliance with leg lengthening. Thoracic limbs were stiffer than the pelvic limbs and absorbed energy in the scapulothoracic joint. Dogs' ground reaction forces (GRF) formed two virtual pivot points (VPP) during walk and trot each. One emerged for the thoracic (fore) limbs (VPP) and is roughly located above and caudally to the scapulothoracic joint. The second is located roughly above and cranially to the hip joint (VPP). The positions of VPPs and the patterns of the limbs' axial and tangential projections of the GRF were gaits but not always breeds-related. When they existed, breed-related changes were mainly exposed by the French Bulldog. During trot, positions of the VPPs tended to be closer to the hip joint or the scapulothoracic joint, and variability between and within breeds lessened compared to walk. In some dogs, VPP was located below the pelvis during trot. Further analyses revealed that leg length and not breed may better explain differences in the vertical position of VPP or the horizontal position of VPP. The vertical position of VPP was only influenced by gait, while the horizontal position of VPP was not breed or gait-related. Accordingly, torque profiles in the scapulothoracic joint were likely between breeds while hip torque profiles were size-related. In dogs, gait and leg length are likely the main VPPs positions' predictors. Thus, variations of VPP positions may follow a reduction of limb work. Stability issues need to be addressed in further studies.
PubMed: 37485325
DOI: 10.3389/fbioe.2023.1193177 -
Hip & Pelvis Mar 2022This study was conducted in order to assess changes in hip muscles by comparing results of preoperative and postoperative computed tomography (CT) in older patients who...
PURPOSE
This study was conducted in order to assess changes in hip muscles by comparing results of preoperative and postoperative computed tomography (CT) in older patients who underwent surgery for treatment of hip fracture.
MATERIALS AND METHODS
A total of 50 patients (aged ≥65 years) who underwent surgery for treatment of intertrochanteric fractures (25 patients) and femoral neck fractures (25 patients) between February 2013 and February 2019 and underwent preoperative and postoperative pelvic CT were enrolled in the study. The cross-sectional area, attenuation and estimates of muscle mass of the gluteus medius, gluteus minimus, iliopsoas, and rectus femoris on the uninjured side were measured. Basic patient data (sex, age, height, weight, body mass index [BMI], bone mineral density [BMD], Harris hip score [HHS], and length of follow-up) were collected from medical records.
RESULTS
No significant differences in sex, age, height, weight, BMI, BMD, HHS, and length of follow-up were observed between the two groups. No significant difference in the cross-sectional areas and attenuations of gluteus medius and gluteus minimus was observed after surgery; however, a statistically significant decrease was observed in those of iliopsoas and rectus femoris after surgery. Lower estimates with statistical significance of muscle mass of the iliopsoas and rectus femoris were observed on postoperative CT.
CONCLUSION
Muscle mass of the hip flexor (iliopsoas, rectus femoris) showed significant decreases on postoperative CT compared with preoperative CT. Based on these findings, selective strengthening exercise for hip flexor should be beneficial in rehabilitation of hip fractures.
PubMed: 35355628
DOI: 10.5371/hp.2022.34.1.10 -
Medicine May 2023To investigate the characteristics of pelvic floor surface electromyography parameters on the basis of Glazer assessment in women 42 days postpartum, and to analyze the... (Randomized Controlled Trial)
Randomized Controlled Trial
To investigate the characteristics of pelvic floor surface electromyography parameters on the basis of Glazer assessment in women 42 days postpartum, and to analyze the predictive value of surface electromyography (sEMG) in postpartum stress urinary incontinence. This is a retrospective study. Three thousand twenty-nine females in total who were screened 42 days postpartum in Jinniu District Maternal and Children's Health Hospital of Chengdu from January 2019 to December 2020 were selected, and were randomly allocated into stress urinary incontinence (SUI) (n = 509) and the non-SUI group (n = 2520). Pelvic floor surface electromyography was performed by the same physiotherapists. The evaluation parameters included the average EMG value in the pre-resting baseline, the maximum sEMG value, the rising time, the descent time in the fast-twitch phase, and the average sEMG value in the slow-twitch phase. Mean value and modifiability of EMG value in post-resting stage. The disparities of the mentioned parameters hereinabove in the SUI and non-SUI groups were made comparison, and the relationship between stress urinary incontinence and sEMG parameters was analyzed by multiple logistic regression analysis. The prevalence of SUI was 16.8% in women 42 days after delivery. Body mass index and vaginal delivery were risk factors for SUI. Among the sEMG parameters of the SUI group and the non-SUI group, the maximum EMG values in the fast-twitch phase (28.81 ± 14.41 vs 30.41 ± 15.15), the rising time in the fast-twitch phase (0.55 ± 0.36 vs 0.51 ± 0.30), and the Phase descent time (0.76 ± 0.76 vs 0.68 ± 0.65), mean slow-twitch phase EMG (17.82 ± 10.10 vs 19.69 ± 15.62), slow-twitch phase variability (0.28 ± 0.12 vs 0.26 ± 0.10), are statistically different (P < .05). In the SUI group, body mass index (estimated parameter = 0.029, P = .023), mean EMG during slow-twitch phase (estimated parameter = -0.013, P = .004) were relevant to stress urinary incontinence after delivery. The sEMG based on Glazer protocol indicates the activity of slow-twitch muscle fibers in SUI patients are decreased, and there is a correlation with the occurrence of stress urinary incontinence. sEMG can be applied as a quantitative evaluation tool of the pelvic floor analysis in postpartum SUI.
Topics: Child; Humans; Female; Electromyography; Urinary Incontinence, Stress; Cross-Sectional Studies; Pelvic Floor; Retrospective Studies; Postpartum Period; Muscular Diseases
PubMed: 37233412
DOI: 10.1097/MD.0000000000033851 -
JPMA. the Journal of the Pakistan... Apr 2023To determine the efficacy of whole-body vibration in the treatment of postnatal constipation. (Randomized Controlled Trial)
Randomized Controlled Trial
OBJECTIVES
To determine the efficacy of whole-body vibration in the treatment of postnatal constipation.
METHODS
The prospective, randomised, single-blind, pre-post, controlled trial was conducted from December 2020 to May 2021 at the outpatient clinic of the Obstetrics and Gynaecology Department, Kafrelsheikh University Hospital, Egypt, and comprised women with complaint of postnatal constipation. They were randomised into two groups. Group A was subjected to whole-body vibration in addition to diet instructions, pelvic floor exercises and static abdominal exercisesforsix weeks. Group B wassubjected to pelvic floor exercises,static abdominal exercises and diet instructions. Constipation symptom questionnaire and patient assessment of constipation quality of life questionnaire were used at baseline and post-intervention. Data was analysed using SPSS 25.
RESULTS
Of the 40 women, 20(50%) were in each of the 2 groups. Group A mean age was 24.88±2.22 years, while it was 24±2.25 years in Group B. Age, height and body mass index were not significantly different between the groups (p>0.05). There was significant improvement in Group A quality of life and constipation severity (p<0.05).
CONCLUSIONS
Whole-body vibration had positive impact on postpartum women's constipation symptoms and quality of life.
RCT REGISTRATION
NCT05286476, Link: https://clinicaltrials.gov/ct2/show/NCT05286476.
Topics: Pregnancy; Humans; Female; Young Adult; Adult; Quality of Life; Vibration; Single-Blind Method; Prospective Studies; Pelvic Floor; Constipation; Exercise Therapy
PubMed: 37482821
DOI: 10.47391/JPMA.EGY-S4-3 -
Ultrasound in Obstetrics & Gynecology :... Jun 2021Pelvic floor muscle contractility (PFMC) may contribute to anal continence. The aim of this study was to assess the association between clinical and sonographic measures... (Observational Study)
Observational Study
OBJECTIVE
Pelvic floor muscle contractility (PFMC) may contribute to anal continence. The aim of this study was to assess the association between clinical and sonographic measures of PFMC and anal incontinence (AI) symptoms, after controlling for anal sphincter and levator ani muscle (LAM) trauma.
METHODS
This was a retrospective study of 1383 women assessed at a tertiary center between 2013 and 2016. All patients underwent an interview, including the St Mark's incontinence score (SMIS) in those who reported AI symptoms, a clinical examination, including assessment of PFMC using the modified Oxford scale (MOS), and four-dimensional translabial ultrasound (TLUS). Sonographic measures of PFMC, i.e. cranioventral shift of the bladder neck (BN) and reduction of anteroposterior (AP) diameter of the levator hiatus, were measured offline using ultrasound volumes obtained at rest and on maximum pelvic floor contraction. The reviewer was blinded to all clinical data.
RESULTS
Of the 1383 patients assessed during the study period, seven were excluded due to missing imaging data, leaving 1376 for analysis. Mean age of the participating women was 55 years and mean body mass index was 29 kg/m . AI was reported by 221 (16.1%) women, with a mean SMIS of 11.8. Mean MOS grade was 2.3. On TLUS, mean BN cranioventral shift was 5.9 mm and mean AP diameter reduction was 8.1 mm. LAM avulsion and significant external anal sphincter (EAS) defect were diagnosed in 24.8% and 8.7% patients, respectively. On univariate analysis, sonographic measures of PFMC were not associated with AI. Lower MOS grade was associated with symptoms of AI; however, statistical significance was lost on multivariate analysis.
CONCLUSION
Clinical and sonographic measures of PFMC were not significantly associated with AI symptoms after controlling for EAS and LAM trauma. © 2020 International Society of Ultrasound in Obstetrics and Gynecology.
Topics: Fecal Incontinence; Female; Humans; Middle Aged; Muscle Contraction; Pelvic Floor; Retrospective Studies; Ultrasonography
PubMed: 32959435
DOI: 10.1002/uog.23128 -
European Journal of Sport Science Jul 2023In a running single-leg jump (RSLJ) for distance, the generation of vertical velocity without loss of horizontal velocity during the take-off phase is ideal, but...
In a running single-leg jump (RSLJ) for distance, the generation of vertical velocity without loss of horizontal velocity during the take-off phase is ideal, but difficult; however, we hypothesized that the pelvic rotation in the frontal plane achieved it. Here we show the effect of each segment rotation on the horizontal and vertical kinetic energies ( and ) of the centre of mass (CoM) during the take-off phase of an RSLJ for distance. We collected kinematic and ground-reaction-force data during RSLJs for distance by nine male long jumpers, involving an approximately 20-m approach in an outdoor field. We determined the components of the and changes due to each segment movement. Elevation of the pelvic free-leg side increased (0.53±0.16 J/kg, 9±3% of the total change). Pelvic axial rotation decreased , while pelvic elevation did not affect it (0.01±0.02 J/kg, no significant difference from zero). In contrast, forward rotations of the stance-leg shank and thigh decreased while simultaneously increasing . The results showed that pelvic elevation increased the vertical CoM velocity without causing a loss in horizontal velocity, although the lower-limb segments' effects on the vertical and horizontal velocities exhibited a trade-off, as previously speculated. RSLJs for distance have been frequently assumed as sagittal movements. However, our findings highlight the importance of three-dimensional pelvic movement, particularly in the frontal plane, for controlling both the vertical and horizontal velocities.l We show the effect of each segment rotation on the horizontal and vertical kinetic energies ( and ) of the centre of mass during the take-off phase of a running single-leg jump for distance.l Elevation of the pelvic free-leg side increased but did not decrease , while the forward rotations of the stance-leg thigh and shank decreased , while simultaneously increasing .l We highlight the importance of pelvic movement in the frontal plane for controlling both the vertical and horizontal velocities with single-leg stance.
Topics: Male; Humans; Leg; Lower Extremity; Running; Movement; Pelvis; Biomechanical Phenomena
PubMed: 35465845
DOI: 10.1080/17461391.2022.2070779 -
Journal of Experimental Orthopaedics May 2023Pelvic obliquity (PO) has not been extensively investigated, and there is no gold standard for measurement. The PO is essential for surgeons in planning hip...
PURPOSE
Pelvic obliquity (PO) has not been extensively investigated, and there is no gold standard for measurement. The PO is essential for surgeons in planning hip arthroplasty, which includes the restoration of leg length discrepancy (LLD). We aimed to establish a normative range of PO angles by measuring healthy individuals without musculoskeletal disorders.
METHODS
Our study included 134 consecutive cases (70 females) referred to our institution between April 2020 and September 2021 for non-orthopedic problems. Patients were screened for normal gait and posture using the visual observation method (VOM) and the Modified Gait Abnormality Rating Scale (GARS-M). In standing standard radiographs, the PO angle was measured as the angle between the horizontal plane and the inter-teardrop line.
RESULTS
Patients' mean age and Body Mass Index (BMI) were 39.7 ± 16.8 and 22.3 ± 3.1, respectively. PO angles did not follow a normal distribution, with a median (IQR) of 2.0° (0.9°-3.1°). According to the Wilcoxon one-sample test, the median PO angle differed significantly from zero (P < 0.001). The PO angle did not differ significantly between males and females (2° vs. 2°, P = 0.46), nor did it correlate significantly with age (P = 0.24). Considering the 95% percentile of PO angles was 5.6°, this range (0°-5.6°) was regarded as a normative value.
CONCLUSION
Normative values for PO in the normal healthy population range from 0° to 5.6°, with a median value of 2.0°. The PO angle was independent of age and sex and differed significantly from 0°. Slight pelvic obliquity may be normal, and physicians should not always assume that it is caused by pain, scoliosis, or weakness of the abductors.
LEVEL OF EVIDENCE
III.
PubMed: 37254005
DOI: 10.1186/s40634-023-00613-z -
Ginekologia Polska 2023The aim of this study is to examine the effects of delivery type and birth weight on pelvic floor structure using muscle defects, uterus-vagina angles and landmarks in...
OBJECTIVES
The aim of this study is to examine the effects of delivery type and birth weight on pelvic floor structure using muscle defects, uterus-vagina angles and landmarks in pelvic magnetic resonance imaging (MRI).
MATERIAL AND METHODS
This is a retrospective study. Pelvic MR images of 38 vaginal deliveries and 62 cesarean section patients who met the study criteria were analyzed. Pubococcygeal line, H line, M line were marked on MR images, uterus cervix, cervix upper vagina, upper and middle vagina, middle and lower vagina angles, urogenital hiatus width, levator hiatus width, obturator internus muscle area, levator ani defect was measured. The urinary incontinence and pelvic organ prolapse examination findings were recorded. The patients' age, body mass index (BMI), parity, delivery type, maximum birth weight questions were asked. The data of both groups were compared.
RESULTS
Uterocervical angle and levator ani muscle defect was significantly higher in the vaginal delivery group (p < 0.001). In the vaginal delivery group, a significant positive correlation was found between the parity and the levator ani muscle defect (r = 0.552), (p = 0.000). A significant negative correlation was found between the parity and the uterocervical angle (r = -0.337), (p = 0.039). A significant negative correlation was found between maximum birth weight and cervix upper vagina angle (r = -0.365) (p = 0.024). In the vaginal delivery group, a negative significant correlation was found between birth weight and obturator internus muscle area (r = -0.378), (p = 0.019).
CONCLUSIONS
These results show that cesarean section exposes the pelvic floor to less trauma and suggest that cesarean section may protect the pelvic floor.
Topics: Pregnancy; Humans; Female; Cesarean Section; Retrospective Studies; Pelvic Floor; Birth Weight; Magnetic Resonance Imaging
PubMed: 36477780
DOI: 10.5603/GP.a2022.0140