Journal of orthopaedic science : official journal of the Japanese Orthopaedic Association
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Vertebral augmentation is an effective and minimally invasive procedure that is used extensively worldwide for the treatment of osteoporosis vertebral compression fractures (OVCFs). New pain from adjacent vertebra fracture (AVF) after initial cement augmentation has gradually been given attention, but the exact causes of AVF are still controversial. The purpose of this study was to analyze the associated incidence, risk factors, and possible causative mechanism of symptomatic AVF, and to evaluate the intrinsic relationship between cement leakage into the disk and AVF. ⋯ Older age, lower BMD, and intravertebral clefts are the main risk factors for symptomatic AVF after vertebral augmentation, but intradiscal cement leakage does not increase the risk of AVF. AVF occurs because of the natural progression of osteoporosis. Even distribution of bone cement in the vertebral body is important in OVCF patients with intravertebral clefts.
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Pregabalin is a well-accepted treatment option for patients with neuropathic pain. However, the therapeutic efficacy of pregabalin for reducing the incidence of spinal surgery to treat leg symptoms in patients with lumbar spinal stenosis remains unknown. The purpose of this study was to analyze the therapeutic efficacy of pregabalin for reducing the incidence of spinal surgery for leg symptoms in patients with lumbar spinal stenosis during the first year of treatment. ⋯ Nonsteroidal anti-inflammatory drug and pregabalin combination therapy may result in a lower incidence of spinal surgery during the first year of treatment or a delayed period before undergoing spinal surgery if necessary compared with nonsteroidal anti-inflammatory drug monotherapy in patients with leg symptoms caused by lumbar spinal stenosis.
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Most patients with recurrent patellar dislocation show cartilage damage in the patellofemoral joint. Medial patellofemoral ligament reconstruction has become one of the most important surgical techniques for treating recurrent patellar dislocation. However, patellofemoral chondral status after this reconstruction has not been elucidated. The purpose of this study was to investigate the effects of medial patellofemoral ligament reconstruction on articular cartilage in the patellofemoral joint by comparing the arthroscopic chondral status at the time of reconstruction with that at second-look arthroscopy. ⋯ According to short-term results, the patellofemoral chondral status after medial patellofemoral ligament reconstruction was not altered at second-look arthroscopy in most part of patellofemoral joint. At the central ridge of the patella, significant improvement of the International Cartilage Repair Society grading was observed.
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The vacuum phenomenon within an intervertebral disc is not an uncommon radiographic finding in the elderly. However, no reports in the English literature have focused on the effect of an anterior vacuum disc in relation to surgical outcome of same-segment spondylolisthesis. We hypothesized that instrumented posterolateral fusion is not adequate in this situation and that additional interbody fusion with cages would provide better radiographic and clinical outcomes. ⋯ The vacuum sign at the spondylolisthesis segment should be regarded as another sign of instability. We suggest that instrumented posterolateral fusion simultaneous with intervertebral fusion with a cage can overcome this situation.
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Pulmonary embolism (PE) is recognized as an important complication in patients undergoing hip fracture surgery. However, clinical evidence demonstrating the effectiveness of pharmacological thromboprophylaxis, including fondaparinux, is limited because the occurrence of postoperative PE after hemiarthroplasty is very low. The goal of this study was to analyze the effect of fondaparinux in reducing PE following hemiarthroplasty for femoral neck fracture using large-scale retrospective data. ⋯ Fondaparinux combined with mechanical prophylaxis is more effective in preventing postoperative PE following hemiarthroplasty for femoral neck fracture than mechanical prophylaxis alone.