Orthopaedic surgery
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Orthopaedic surgery · Nov 2016
Review Comparative StudyComparison of Anterior Cervical Discectomy and Fusion versus Posterior Cervical Foraminotomy in the Treatment of Cervical Radiculopathy: A Systematic Review.
Controversy remains over whether anterior cervical discectomy and fusion (ACDF) or posterior cervical foraminotomy (PCF) is superior for the treatment of cervical radiculopathy. We therefore performed a systematic review including three prospective randomized controlled trails (RCT) and seven retrospective comparative studies (RCoS) by searching PubMed and EMBASE. These studies were assessed on risk of bias according to the Cochrane Handbook for Systematic Reviews of Interventions, and the quality of evidence and level of recommendation were evaluated according to the GRADE approach. ⋯ In conclusion, the PCF was just as safe and effective as the ACDF in the treatment of cervical radiculopathy. Meanwhile, PCF might have lower medical cost than ACDF and decrease the incidence of adjacent segment disease. Based on the available evidence, PCF appears to be another good surgical approach in the treatment of cervical radiculopathy.
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Orthopaedic surgery · Nov 2016
Clinical TrialCorrelations of Japanese Orthopaedic Association Scoring Systems with Gait Parameters in Patients with Degenerative Spinal Diseases.
Japanese Orthopaedic Association (JOA) scoring systems were developed to evaluate the neurological function of patients with cervical or lumbar degeneration. As patient-based and multi-dimensional clinical evaluation tools, these systems should be capable of reflecting the walking disability of patients. The association between JOA scores and gait parameters, however, are not well characterized. The purpose of this study was to determine the correlations between JOA scores and gait parameters of patients with cervical spondylotic myelopathy (CSM) and lumbar intervertebral disc herniation (LDH). ⋯ There is a significant correlation between gait parameters and functional disability as measured by the JOA lumbar scoring system, which indicates that the JOA lumbar scoring system can reflect gait impairment. The JOA cervical scoring system, however, may need to be improved for efficiently evaluating the walking ability of CSM patients in the assessment of motor function of the lower extremity.
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Orthopaedic surgery · Aug 2016
Comparative Study Clinical TrialComparison of AO Titanium Locking Plate and Screw Fixation versus Anterograde Intramedullary Fixation for Isolated Unstable Metacarpal and Phalangeal Fractures.
This study aimed to compare the clinical and radiologic outcomes of AO titanium locking plate and screw (ATLPS) and anterograde intramedullary (AIM) fixation for treating unstable metacarpal and phalangeal fractures. ⋯ AIM outperforms ATLPS in the treatment of unstable metacarpal and phalangeal fractures in the early, but not the later, postoperative period; the latter is associated with significantly more complications. Patients treated by ATLPS require shorter sick leave, which is of particular benefit to workers with specialized manual skills.
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Orthopaedic surgery · Aug 2016
Review Meta AnalysisAnalgesic Efficacy of Adductor Canal Block in Total Knee Arthroplasty: A Meta-analysis and Systematic Review.
The aim of this meta-analysis and systematic review of randomized controlled trials (RCTs) was to evaluate the efficacy and safety of adductor canal block (ACB) for early postoperative pain management in patients undergoing total knee arthroplasty (TKA). Relevant manuscripts comparing ACB with saline or femoral nerve block (FNB) in TKA patients were searched for in the databases of PubMed, EMBASE, and Cochrane library. The outcomes assessed included cumulative analgesic consumption, pain at rest or during movement, ability to ambulate, quadriceps strength, and complications (nausea, vomiting or sedation). ⋯ Additionally, ACB did not increase the rate of complications. Our results suggest that, compared with saline, ACB decreases analgesic consumption and offers short-term advantages in terms of pain relief. Compared with FNB, ACB was associated with better ability to ambulate and quadriceps strength.
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Orthopaedic surgery · Aug 2016
Treatment of Distal Femur Nonunion Following Initial Fixation with a Lateral Locking Plate.
To report and evaluate the outcomes of patients undergoing definitive treatment for distal femur nonunion after initial treatment with a locking plate. ⋯ Definitive treatment of distal femur nonunion after initial treatment with a locking plate had a low rate of success in this study, suggesting that this procedure is ineffective as a definitive treatment for distal femur nonunion.