Der Orthopäde
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Meta Analysis
Anterior versus posterior instrumentation for treatment of thoracolumbar tuberculosis : A meta-analysis.
To compare clinical and functional outcomes of anterior versus posterior debridement and spinal fixation for surgical treatment of thoracolumbar tuberculosis. ⋯ The anterior and posterior approaches are equally good methods for treatment of thoracolumbar tuberculosis. The anterior approach results in less blood loss, whereas posterior instrumentation is better suited for correction of kyphotic angle.
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The aim of this study was to systematically review the efficacy of percutaneous transforaminal endoscopic discectomy (PTED) and fenestration discectomy (FD) in the treatment of lumbar disc herniation (LDH). ⋯ The Percutaneous transforaminal endoscopic discectomy is associated with better postoperative ODI score, better results in length of incision, lower blood loss, shorter operation time, postoperative bed time and hospitalization time. The complications did not differ significantly between PTED and FD in the treatment of lumbar disc herniation. These findings provide evidence to support PTED is efficacious for LDH; however, scar repair of a ruptured anulus fibrosus needs a long time and the patients undergoing PTED should be advised to stay in bed for a long time even if the symptoms are markedly relieved. These results are not limited to randomized controlled trials and lack data about the long-term outcome.
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Review Meta Analysis
[Characteristics of elective hip replacement in the elderly].
Due to demographic changes the number of elderly patients undergoing hip replacement surgery is increasing. In order to ensure safe treatment of elderly patients, age-specific medical factors must be taken into consideration. ⋯ Out of 3166 patients a total of 439 were over 80 years old (average age 84 years). It can be concluded from the scientific literature and from own data that elective hip replacement surgery in elderly patients is a technically safe procedure; however, the risk profile of each patient must be thoroughly analyzed so that in the event of even minor signs of potential complications countermeasures can be taken in good time.
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Review Meta Analysis Comparative Study
[Hip fractures in the elderly : Osteosynthesis versus joint replacement].
Osteoporotic fractures of the femoral neck and trochanteric region pose an ever-expanding existential problem both for the individual and for society. Despite numerous innovations and advances regarding implant design, mortality and the systemic and mechanical complication rates remain high. ⋯ In summary, there are many parameters affecting the outcome in the treatment of fragility and hip fractures. Technical features as well as surgeon characteristics play an important role and the ultimate solution has yet to be developed. Even though fracture morphology may indicate a specific treatment option, patient characteristics play an important role in decision-making. The development of centers of fragility fracture care in Germany could help to lower the complication rate and increase quality of life in hip fracture patients in the future.
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Review Meta Analysis Comparative Study
[Subgroup-specific therapy of low back pain: description and validity of two classification systems].
In spite of profound advances in the diagnosis and therapy, low back pain (LBP) remains one of the main challenges for health systems in western industrialized countries. Clinical trials and meta-analyses typically show heterogeneous evidence and small effect sizes. One explanation for this phenomenon is the heterogeneous nature of the population of patients with LBP, not adequately considered in clinical practice and research. Recent studies and one meta-analysis show that therapy which is specifically directed at well defined subgroups leads to improved effectiveness of interventions, especially for non-surgical interventions such as manual therapy or physiotherapy. ⋯ The reliability of the described classification systems is moderate to good, aspects of validity have been shown. Their implementation in clinical practice seems recommendable.