Comparison of Surgical Outcomes of the Posterior and Combined Approaches for Repair of Cervical Fractures in Ankylosing Spondylitis.

STUDY DESIGN: Retrospective cohort study. PURPOSE: To evaluate surgical outcomes and complications of cervical spine fractures in ankylosing spondylitis (CAS) patients who were treated using either the posterior (P) or combined approach (C). OVERVIEW OF LITERATURE: Ankylosing spondylitis typically causes progressive spinal stiffness that makes patients susceptible to spinal fractures. CAS is a highly unstable condition. There is contradictory evidence regarding which treatment option, the posterior or the combined approach, yields superior clinical results. METHODS: A single institution database was reviewed for data in the period 1999 to 2015. All CAS patients who underwent posterior or combined instrumented fusion were enrolled. We analyzed demographic data, radiographic results, perioperative complications, and postoperative results. RESULTS: Thirty-three patients were enrolled (23 in the P group, 10 in the C group). All patients presented with neck pain after a fall. In the P group, mean operative time was 161.1 minutes (100-327 minutes), and mean estimated blood loss (EBL) was 306.4 mL (50-750 mL). In the C group, 90% of patients underwent a staged procedure, typically with posterior surgery first. Mean EBL was 124 mL (25-337 mL). For posterior surgery, mean EBL was 458.3 mL (400-550 mL). EBL of posterior surgery in the C group was higher but this difference was not significant (p=0.16). Postoperative complication rate was higher in the C group but this difference was not significant (50% vs. 17.4%, p=0.09). In the follow-up period, no late reoperations were performed. Patients who underwent C surgery had a higher rate of neurological improvement but this difference was not significant (p=0.57). CONCLUSIONS: Both P and C provided good clinical results. P surgery had lower EBL, lower postoperative complication rate, and shorter length of stay than C surgery; none of these differences were statistically significant

Stone ingestion causing obstructed inguinal hernia with perforation

We report a rare case of obstructed right inguinal hernia caused by ingested stones. A 2 year-old boy from Northern Thailand was transferred to our hospital with low-grade fever, vomiting, and acute painful swelling at his right hemiscrotum for one day. The physical examination revealed marked enlargement with inflammation in his right hemiscrotum. The radiological findings showed huge number of stones in the right  hemiscrotum. At surgery, the content of hernia sac was ascending colon, which was full of hard masses. With the help of additional lower transverse abdominal incision, the obstructed segment was successfully reduced and revealed a perforation. Most of the stones were removed through the  perforation. The colonic wound was  primarily repaired and both incisions were primarily closed. Although he developed post-operative wound  infection, the boy had uneventfully  recovered. The psychological exploration in this “stone pica” revealed no other psychological disorders.Key words: Inguinal hernia, pica, stone ingestio

Модель прогнозирования вывиха контралатерального бедра у пациентов с церебральным параличом и односторонним вывихом бедра: система оценки для принятия решений

BACKGROUND: Cerebral palsy (CP) patients commonly present with unilateral hip dislocation. However, the decision for concurrent prophylaxis surgery on the contralateral hip in this condition is still controversial. AIM: This study aims to explore the prognostic factors for contralateral hip dislocation and develop a scoring system. MATERIALS AND METHODS: Data on CP patients with unilateral hip dislocation between January 2005 to January 2019 were reviewed. We explored the difference of preoperative parameters between the group in which the contralateral hip is eventually dislocated or remains stable. A multivariable logistic regression analysis was performed to develop a model for predicting contralateral hip dislocation. RESULTS: Seven of included 30 patients (23.3%) developed contralateral hip dislocation. Pre-operative contralateral hips Reimers Migration Index (RMI), Acetabular Index (AI), Lateral Center Edge Angle of Wiberg (CEA), and Pelvic obliquity (PO) were significantly different (p = 0.049, 0.019, 0.030 and 0.038 respectively). The multivariable logistic regression analysis reveals that RMI 25% (mOR 36.66, 95% CI 1.131185.50, p = 0.042) and age 9 years old (mOR = 22.55, 95% CI 0.76665.37, p = 0.071) are significant predictors. Both parameters were included in the model, which revealed an AuROC of 0.84 (95% CI 0.690.99). Each factor was assigned a score of 1. There was no contralateral hip displacement in patients with a score of 0. Two out of 15 patients (28.6%) with a score of one developed contralateral hip displacement. Five out of eight (71.4%) patients with a score of 2 developed contralateral hip dislocation. CONCLUSIONS. Significant predictors for contralateral hip dislocation in CP patients are RMI 25% and age 9 years old. The proposed scoring system might help guide the surgeons decision to perform contralateral prophylactic surgery.Актуальность. В комплексе проблем, выявляемых у пациентов с церебральным параличом, часто встречается односторонний вывих бедра. Однако вопрос необходимости одновременного превентивного оперативного вмешательства на контралатеральном бедре при центральном параличе по-прежнему вызывает дискуссии. Цель определение прогностических факторов развития вывиха контралатерального бедра и разработка системы оценки для принятия решения об оперативном лечении. Материалы и методы. За период с января 2005 г. по январь 2019 г. проведен обзор пациентов с церебральным параличом и односторонним вывихом бедра. Обнаружено различие показателей до операции в группе пациентов, у которых впоследствии развился вывих контралатерального бедра или у которых контралатеральный тазобедренный сустав остался стабильным. Для разработки модели прогнозирования вывиха контралатерального бедра мы провели многофакторный анализ методом логистической регрессии. Результаты. Из 30 пациентов, включенных в исследование, вывих контралатерального бедра развился у 7 человек (23,3 %). У этих пациентов наблюдались значимые различия показателей миграционного индекса Реймерса (RMI), ацетабулярного индекса, латерального центрально-краевого угла Виберга и перекоса таза до операции (p = 0,049, 0,019, 0,030 и 0,038 соответственно). В ходе многофакторного анализа с применением логистической регрессии мы обнаружили, что значимыми прогностическими факторами являются RMI 25 % (медиана отношения шансов 36,66, 95 % ДИ 1,131185, 50, p = 0,042) и возраст 9 лет (медиана отношения шансов 22,55, 95 % ДИ 0,76665,37, p = 0,071). Оба параметра были включены в модель, в результате площадь под ROC-кривой составила 0,84 (95 % ДИ 0,690,99). Каждому фактору присваивали 1 балл. У пациентов с баллом 0 смещение головки контралатеральной бедренной кости отсутствовало. Среди 15 пациентов с баллом 1 смещение головки контралатеральной бедренной кости произошло у двух человек (28,6 %). Из 8 пациентов с баллом 2 вывих контралатерального бедра развился у 5 человек (71,4 %). Выводы. Значимыми прогностическими факторами развития вывиха контралатерального бедра у пациентов с церебральным параличом являются RMI 25 % и возраст 9 лет. Предлагаемая система балльной оценки может помочь хирургам принять решение о проведении превентивного оперативного вмешательства на контралатеральном бедре