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Alternative Therapies in Health and... Jun 2024Degenerative spondylolisthesis (DS) is a prevalent degenerative condition affecting the lumbar spine. Local spinal parameters play a pivotal role in surgical...
CONTEXT
Degenerative spondylolisthesis (DS) is a prevalent degenerative condition affecting the lumbar spine. Local spinal parameters play a pivotal role in surgical complications and in the QoL that adults with spinal deformities experience. Treatment can effectively alleviate radicular symptoms, but it doesn't significantly mitigate postoperative axial symptoms (AS).
OBJECTIVE
The study intended to investigate the correlation between postoperative axial symptoms (AS) and spinal-pelvic parameters for patients with DS of the lumbar spine.
DESIGN
The research team conducted a prospective cohort study.
SETTING
The study took place at the Huai'an Hospital of Huai'an City in the Huai'an District of Huai'an City in JiangSu Province, China.
PARTICIPANTS
Participants were 120 patients with DS who had been admitted to the department of orthopedics at the hospital between January 2016 and December 2022 and 120 healthy volunteers during the same period.
INTERVENTION
The research team created two groups, each with 120 participants: (1) the intervention group with DS who received posterior laminar decompression + pedicle-screw internal fixation + intervertebral-space bone grafting and fusion, and (2) the control group, the healthy volunteers.
OUTCOME MEASURES
The research team: (1) measured both group's spinal-pelvic parameters at baseline and at 6 months postintervention, (2) evaluated both group's motor functions at baseline and at 6 months postintervention, using the Japanese Orthopedic Association (OAS) scale and the Oswestry Disability Index (ODI), (3) examined the intervention group's postoperative AS, and (4) analyzed the correlation between the intervention group's spinal-pelvic parameters and its postoperative AS and motor function.
RESULTS
At 6 months postintervention, the intervention group's spinal-pelvic parameters-lumbar lordosis (LL) and sacral slope (SS) were significantly lower-and-pelvic incidence (PI), pelvic tilt (PT), thoracic kyphosis (TK), segmental lumbar lordosis (SLL), and sagittal vertical axis (SVA) were significantly higher than those of the control group (all P = .000). The intervention group's JOA and ODI scores were significantly lower than those of the control group postintervention (both P = .000). Postintervention compared to the non-AS group, the AS group's LL (P = .000), PI (P = .000), and SS (P = .020) were significantly lower and PT (P = .002), TK (P = .000), SLL (P = .002), and SVA (P = .000) were significantly higher. Postoperative AS was negatively correlated with LL, PI, SS, and positively correlated with PT, TK, SLL, and SVA (all P = .000). The JOA and ODI scores were positively correlated with LL, PI, and SS, and negatively correlated with PT, TK, SLL, and SVA (all P = .000).
CONCLUSIONS
Postoperative AS in patients with DS is significantly correlated with spinal-pelvic parameters, providing convincing evidence for the evaluation of postoperative dysfunction. However, generalizing to other patients is limited due to the small sample size, which might have resulted in bias in spinal-pelvic parameters. Hence, ongoing trials with large samples are warranted.
PubMed: 38870498
DOI: No ID Found -
JBJS Case Connector Apr 2024We present a 64-year-old woman with loss of lumbar lordosis with a preoperative computed tomography scan demonstrating the presence of an intrapelvic kidney with...
CASE
We present a 64-year-old woman with loss of lumbar lordosis with a preoperative computed tomography scan demonstrating the presence of an intrapelvic kidney with aberrant vasculature. A 2-level anterior lumbar interbody fusion with a 2-level oblique interbody fusion was planned. An anterior approach was successfully used to access the anterior spine without damaging the pelvic kidney.
CONCLUSION
Anatomic variations, both congenital and acquired, can pose significant challenges to surgeons during their dissection. We present a case where multilevel anterior interbody cage placement can be safely performed, even in a patient whose anatomy is complicated by an intrapelvic kidney.
Topics: Humans; Spinal Fusion; Female; Middle Aged; Lumbar Vertebrae; Kidney; Tomography, X-Ray Computed
PubMed: 38870326
DOI: 10.2106/JBJS.CC.23.00637 -
Sports Health Jun 2024There is little evidence to guide elite athletes who desire returning to competition after giving birth to a child. Ultimately, this can result in decreased performance... (Review)
Review
CONTEXT
There is little evidence to guide elite athletes who desire returning to competition after giving birth to a child. Ultimately, this can result in decreased performance and increased risk of injury. This paper addresses aspects that must be considered when building and monitoring a return to running program for a postpartum elite or subelite athlete, including pelvic floor and core stability, progressive reloading of the musculoskeletal system, monitoring of nutritional parameters, and considerations for lactation.
EVIDENCE ACQUISITION
PubMed and CINAHL (Cumulative Index for Nursing and Allied Health Literature) were searched with the following search strategy: (extreme sports OR elite athletes OR running OR exercise) AND (breastfeeding OR lactation OR bone density OR fetal weight OR gestational weight gain OR postpartum or post-partum OR postnatal OR post-natal OR pregnancy OR childbirth). The following information is based on best available evidence and clinical experience.
STUDY DESIGN
Clinical review.
LEVEL OF EVIDENCE
Level 4.
RESULTS
Due to the interplay between cardiovascular fitness, postpartum nutrition, lactation, and progressive reloading of the muscular and skeletal system, we propose a multimodal, multidisciplinary approach to safely and successfully allow an athlete to return to an elite level of competition.
CONCLUSION
Return to running in the postpartum period is a highly individualized process that benefits from multidisciplinary, individualized care. This includes monitoring of nutrition, core and pelvic floor function, bone reloading, muscle and tendon reloading, and breastfeeding care when applicable.
STRENGH OF RECOMMENDATION TAXONOMY (SORT)
C.
PubMed: 38864285
DOI: 10.1177/19417381241256973 -
Zhongguo Yi Liao Qi Xie Za Zhi =... May 2024The treatment of bone defects caused by fractures or bone tissue lesions has always been a difficult problem in the field of orthopedics. Implantation of...
The treatment of bone defects caused by fractures or bone tissue lesions has always been a difficult problem in the field of orthopedics. Implantation of high-performance titanium alloy prosthesis is an effective method to treat bone defects. 3D printing technology can produce low-modulus titanium alloy implants with porous structures, providing a better solution to the above problems. This technology is convenient to design and has a huge advantage in making orthopedic implants. The article used electron beam melting in 3D printing technology to create two samples of Ti-6Al-4V prosthesis, including solid structural pelvic prosthesis and porous structural pelvic prosthesis. The mechanical properties of the prosthesis showed that the yield and tensile strengths of the rod tensile specimen were 894 MPa and 956 MPa, respectively, and the compressive modulus and compressive strength of the porous pelvic prosthesis were 55 GPa and 65.2 MPa, respectively. The results of the L929 cytotoxicity assay and the MC3T3-E1 cell adhesion assay demonstrated good biocompatibility of the prosthetic samples. New Zealand white rabbits were used to prepare the femoral joint cavity defect models and two pelvic prostheses were implanted. A microscopic CT scan 4 weeks after implantation showed that the bone defect caused by the drill had healed and that the porous structure of the pelvic prosthesis formed a new trabecular structure within the hole. In conclusion, the 3D printed Ti-6Al-4V pelvic prosthesis has excellent mechanical properties, biocompatibility, and the ability to promote new bone growth.
Topics: Printing, Three-Dimensional; Titanium; Animals; Rabbits; Alloys; Biocompatible Materials; Materials Testing; Prostheses and Implants; Mice; Prosthesis Design; Porosity; Pelvic Bones; Pelvis
PubMed: 38863090
DOI: 10.12455/j.issn.1671-7104.230611 -
International Journal of Legal Medicine Jun 2024In the field of forensic anthropology, researchers aim to identify anonymous human remains and determine the cause and circumstances of death from skeletonized human...
In the field of forensic anthropology, researchers aim to identify anonymous human remains and determine the cause and circumstances of death from skeletonized human remains. Sex determination is a fundamental step of this procedure because it influences the estimation of other traits, such as age and stature. Pelvic bones are especially dimorphic, and are thus the most useful bones for sex identification. Sex estimation methods are usually based on morphologic traits, measurements, or landmarks on the bones. However, these methods are time-consuming and can be subject to inter- or intra-observer bias. Sex determination can be done using dry bones or CT scans. Recently, artificial neural networks (ANN) have attracted attention in forensic anthropology. Here we tested a fully automated and data-driven machine learning method for sex estimation using CT-scan reconstructions of coxal bones. We studied 580 CT scans of living individuals. Sex was predicted by two networks trained on an independent sample: a disentangled variational auto-encoder (DVAE) alone, and the same DVAE associated with another classifier (C). The DVAE alone exhibited an accuracy of 97.9%, and the DVAE + C showed an accuracy of 99.8%. Sensibility and precision were also high for both sexes. These results are better than those reported from previous studies. These data-driven algorithms are easy to implement, since the pre-processing step is also entirely automatic. Fully automated methods save time, as it only takes a few minutes to pre-process the images and predict sex, and does not require strong experience in forensic anthropology.
PubMed: 38862820
DOI: 10.1007/s00414-024-03268-2 -
Acta Ortopedica Mexicana 2024pelvic fracture in children is considered one of the most important injuries due to its high mortality. They are rare, but have a major impact on patients' functional...
INTRODUCTION
pelvic fracture in children is considered one of the most important injuries due to its high mortality. They are rare, but have a major impact on patients' functional outcomes.
OBJECTIVE
to evaluate the clinical evolution and functional grade in pediatric patients with pelvic fractures who have already been treated, either conservatively or surgically.
MATERIAL AND METHODS
descriptive-cross-sectional-retrospective study. Sample of 24 patients, aged five to 16 years with pelvic fracture, treated from 2016 to 2021. Clinical and functional outcome was assessed using the Barthel index and hip range of motion, as well as surgical or conservative treatment, accompanying lesions and injury mechanism.
RESULTS
to find out if there is an association between the Torode and Zieg classifications with the Barthel index and hip range of motion, an association analysis was performed with the 2 statistic, obtaining a 2 value = 19.213. with p = 0.004 for the Barthel index and a 2= 14.253 with p = 0.0026 for hip ranges of motion; these results indicate that there is statistically significant association.
CONCLUSION
the most frequent type of pelvic fracture in pediatric patients treated is type III on the Torode and Zieg scale, which according to the Barthel index is associated with a degree of independence and complete hip mobility arches, so the clinical and functional outcome in these patients is high in severe injuries.
Topics: Humans; Child; Pelvic Bones; Adolescent; Male; Female; Fractures, Bone; Cross-Sectional Studies; Child, Preschool; Retrospective Studies; Tertiary Care Centers; Range of Motion, Articular; Conservative Treatment; Treatment Outcome
PubMed: 38862142
DOI: 10.35366/115807 -
Frontiers in Physiology 2024To evaluate the effectiveness of 3D NerveVIEW sequence with gadolinium contrast on the visualization of pelvic nerves and their branches compared to that without...
OBJECTIVE
To evaluate the effectiveness of 3D NerveVIEW sequence with gadolinium contrast on the visualization of pelvic nerves and their branches compared to that without contrast.
METHODS
Participants were scanned twice using 3D NerveVIEW sequence with and without gadolinium contrast to acquire pelvic nerve images. The signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR) and contrast ratio of the nerves were calculated and compared to determine the quality of images. To subjectively assess, using a 3-point scale, branch nerves critical to therapeutic decision-making, including the pelvic splanchnic nerve and pelvic plexus, the superior gluteal nerve, and the pudendal nerve.
RESULTS
In the 32 eligible participants after using contrast, the CNRs of the images of nerve-to-bone and nerve-to-vessel significantly increased ( < 0.05). The CR of the images with contrast of all nerve-to-surrounding tissues (i.e., bone, muscle, blood vessels, and fat) were also found significantly higher ( < 0.05). The assessment of observers also shows higher scores for images with contrast compared to images without contrast.
CONCLUSION
The 3D NerveVIEW sequence combined with gadolinium contrast improved vascular suppression, increased the contrast between pelvic nerves and surrounding tissue, and enhanced the visualization of nerves and their branches. This study may be helpful for the technically challenging preoperative planning of pelvic diseases surgery.
PubMed: 38854630
DOI: 10.3389/fphys.2024.1394431 -
Open Forum Infectious Diseases Jun 2024The optimal duration and choice of antibiotic for fracture-related infection (FRI) is not well defined. This study aimed to determine whether antibiotic duration (≤6...
BACKGROUND
The optimal duration and choice of antibiotic for fracture-related infection (FRI) is not well defined. This study aimed to determine whether antibiotic duration (≤6 vs >6 weeks) is associated with infection- and surgery-free survival. The secondary aim was to ascertain risk factors associated with surgery- and infection-free survival.
METHODS
We performed a multicenter retrospective study of patients diagnosed with FRI between 2013 and 2022. The association between antibiotic duration and surgery- and infection-free survival was assessed by Cox proportional hazard models. Models were weighted by the inverse of the propensity score, calculated with a priori variables of hardware removal; infection due to , , or species; and flap coverage. Multivariable Cox proportional hazard models were run with additional covariates including initial pathogen, need for flap, and hardware removal.
RESULTS
Of 96 patients, 54 (56.3%) received ≤6 weeks of antibiotics and 42 (43.7%) received >6 weeks. There was no association between longer antibiotic duration and surgery-free survival (hazard ratio [HR], 0.95; 95% CI, .65-1.38; = .78) or infection-free survival (HR, 0.77; 95% CI, .30-1.96; = .58). Negative culture was associated with increased hazard of reoperation or death (HR, 3.52; 95% CI, 1.99-6.20; < .001) and reinfection or death (HR, 3.71; 95% CI, 1.24-11.09; < .001). Need for flap coverage had an increased hazard of reoperation or death (HR, 3.24; 95% CI, 1.61-6.54; = .001).
CONCLUSIONS
The ideal duration of antibiotics to treat FRI is unclear. In this multicenter study, there was no association between antibiotic treatment duration and surgery- or infection-free survival.
PubMed: 38854390
DOI: 10.1093/ofid/ofae262 -
Nihon Hoshasen Gijutsu Gakkai Zasshi Jun 2024Osteosclerotic images are known as an image appearance of occult femoral neck fractures in X-ray images. The aim of this study is to investigate frequency enhancement...
PURPOSE
Osteosclerotic images are known as an image appearance of occult femoral neck fractures in X-ray images. The aim of this study is to investigate frequency enhancement processing that improves the visibility of the osteosclerotic image.
METHODS
We acquired three sclerotic bone images with different thicknesses, and self-made bone equivalent phantoms were set up on a pelvic phantom. The frequency processing type and high-density enhancement coefficients were applied to the X-ray images taken at RF-A(1.0, 2.0), C(2.0, 4.0), D(1.0), and H(2.0, 4.0). For the physical index, we compared the difference in signal values between the sclerotic and background normal bone. We evaluated the preference using Scheffé's paired comparison methods for the visual index.
RESULTS
For the physical index, RF-C(4.0) had the most significant signal value difference for all 3 bone stiffness images. For the visual index, RF-C(4.0) showed the highest preference.
CONCLUSION
Using frequency-enhanced processing, RF-C(4.0) was suggested to improve the visibility of the osteosclerosis image.
PubMed: 38853003
DOI: 10.6009/jjrt.2024-1447 -
Journal of Orthopaedic Surgery and... Jun 2024Continuous peripheral nerve blocks are widely used for anesthesia and postoperative analgesia in lower limb surgeries. The authors aimed to develop a novel continuous...
BACKGROUND
Continuous peripheral nerve blocks are widely used for anesthesia and postoperative analgesia in lower limb surgeries. The authors aimed to develop a novel continuous sacral plexus block procedure for analgesia during total knee arthroplasty.
METHODS
The study comprised two stages. In Stage I, the authors built upon previous theories and technological innovations to develop a novel continuous sacral plexus block method, ultrasound-guided continuous parasacral ischial plane block (UGCPIPB) and subsequently conducted a proof-of-concept study to assess its effectiveness and feasibility. Stage II involved a historical control study to compare clinical outcomes between patients undergoing this new procedure and those receiving the conventional procedure.
RESULTS
The study observed a 90% success rate in catheter placement. On postoperative day (POD) 1, POD2, and POD3, the median visual analog scale (VAS) scores were 3 (range, 1.5-3.5), 2.5 (1.6-3.2), and 2.7 (1.3-3.4), respectively. Furthermore, 96.3% of the catheters remained in place until POD3, as confirmed by ultrasound. The study revealed a significant increase in skin temperature and peak systolic velocity of the anterior tibial artery on the blocked side compared with those on the non-blocked side. Complications included catheter clogging in one patient and leakage at the insertion site in two patients. In Stage II, the novel technique was found to be more successful than conventional techniques, with a lower catheter displacement rate than the conventional procedure for continuous sciatic nerve block.
CONCLUSION
UGCPIPB proved to be an effective procedure and safe for analgesia in total knee arthroplasty.
CHINESE CLINICAL TRIAL REGISTRY NUMBER
ChiCTR2300068902.
Topics: Humans; Pain, Postoperative; Arthroplasty, Replacement, Knee; Nerve Block; Male; Female; Aged; Ultrasonography, Interventional; Middle Aged; Proof of Concept Study; Lumbosacral Plexus; Feasibility Studies; Pain Management; Aged, 80 and over; Ischium; Pain Measurement
PubMed: 38849964
DOI: 10.1186/s13018-024-04822-9