Humerus başının yukarı kayması: rotator kılıf cerrahisinde prognostik bir araç olarak kullanılabilir mi?

Amaç:Rotator kılıf yırtığı bulunan hastalarda sağlam ve yırtık kılıf bulunan omuzda humerus başının glenoide göre superior’a kaymasının tamir sonrası prognostik kriter olarak kullanılabilirliği araştırıldı. Hastalar ve Yöntem:Tek taraflı tam kat rotator kılıf yırtığı tanısı konulan 27 hasta (14K, 13E) çalışmaya dahil edildi. Ortalama yaş 56 (Aralık: 32-71) idi. Ameliyat öncesi her iki omuz glenohumeral eklemin AP grafileri çekildi.Humerus başının yukarı kayma miktarı (∆e) ölçüldü. Kayma miktarı 0-3 mm olan hastalar Grup A, 4-5 mm olan hastalar Grup B olarak sınıflandı. Açık rotator kılıf tamiri yapıldı.Değerlendirmede Constant omuz skorlaması kullanıldı. Bulgular: Supraspinatus, infraspinatus ve subskapularis tendon yırtıkları sırasıyla 27 hastada (%100), 11 hastada (%40.7) ve 6 hastada (%22.2) saptandı.19 hasta A grubunda, 8 hasta B grubundaydı. İzole supraspinatus yırtığı bulunan hastaların hepsi (n=10) ve supraspinatus, infraspinatus yırtığı bulunan 11 hastanın 9'u A grubundaydı. Supraspinatus, infraspinatus ve subskapularis yırtığı bulunan hastaların hepsi (n=6) B grubundaydı. Ortalama preoperatif Constant skoru Grup A'da 48.6, Grup B'de 21.5 olarak tespit edildi. Aradaki fark istatistiksel olarak anlamlı bulundu (p<0.001). Ortalama postoperatif Constant skoru Grup A'da 75.3 grup B'de 69 idi. Her iki grup karşılaştırıldığında aradaki fark istatistiksel olarak anlamlı bulundu.(p<0.05) Ameliyat öncesi ve sonrası Constant skorlarıyla ∆e değeri arasında ters bir ilişki olduğu tespit edildi. Sonuç:Rotator kılıf yırtığından şüphelenilen hastalarda direk radyografide humerus başının yukarı kayması tamir sonrası prognozu göstermesi açısından önemlidir

Comparison of the Pullout Strength of Different Pedicle Screw Designs and Augmentation Techniques in an Osteoporotic Bone Model

Study DesignMechanical study.PurposeTo compare the pullout strength of different screw designs and augmentation techniques in an osteoporotic bone model.Overview of LiteratureAdequate bone screw pullout strength is a common problem among osteoporotic patients. Various screw designs and augmentation techniques have been developed to improve the biomechanical characteristics of the bone–screw interface.MethodsPolyurethane blocks were used to mimic human osteoporotic cancellous bone, and six different screw designs were tested. Five standard and expandable screws without augmentation, eight expandable screws with polymethylmethacrylate (PMMA) or calcium phosphate augmentation, and distal cannulated screws with PMMA and calcium phosphate augmentation were tested. Mechanical tests were performed on 10 unused new screws of each group. Screws with or without augmentation were inserted in a block that was held in a fixture frame, and a longitudinal extraction force was applied to the screw head at a loading rate of 5 mm/min. Maximum load was recorded in a load displacement curve.ResultsThe peak pullout force of all tested screws with or without augmentation was significantly greater than that of the standard pedicle screw. The greatest pullout force was observed with 40-mm expandable pedicle screws with four fins and PMMA augmentation. Augmented distal cannulated screws did not have a greater peak pullout force than nonaugmented expandable screws. PMMA augmentation provided a greater peak pullout force than calcium phosphate augmentation.ConclusionsExpandable pedicle screws had greater peak pullout forces than standard pedicle screws and had the advantage of augmentation with either PMMA or calcium phosphate cement. Although calcium phosphate cement is biodegradable, osteoconductive, and nonexothermic, PMMA provided a significantly greater peak pullout force. PMMA-augmented expandable 40-mm four-fin pedicle screws had the greatest peak pullout force

The influence of vertebral instability on peridural circulation and concomitant peridural fibrosis formation

An animal model of vertebral instability was used to analyze the effect of chronic lumbar instability on the peridural vasculature and fibrosis formation. Fifty mature male domestic rabbits were divided into five equal groups. The vertebral instability was performed by excision of supra and interspinous ligaments between L2-L3 and L3-L4, excision of transverse and spinous processes and making bilateral laminectomies and facetectomies in groups I, II, III and IV. In group V only para vertebral muscle dissection was performed without vertebral instability. The simulation of the long term effects of overuse model on unstable spines (chronic instability) were performed with the use of Electrical Neuromuscular Stimulator to simulate cyclic flexion-extension movement in groups I, II. The rabbits in group I and III were sacrified for the histological evaluation at postoperative fifth day. The rabbits in groups I II, IV and V were sacrified at postoperative 21st day. There was no peridural venous endothelial injury or stasis but there was an increased amount of polymorph nuclear leukocytes in both group I (unstable-overuse) and group III (unstable-no overuse) after sacrification at postoperative fifth day. Peridural fibrosis and also vascular changes with different grades were seen in group II, VI and V after sacrification at postoperative 21th day. The grade of the venous changes and the mean amount of peridural scar formation were prominently higher in group II (unstable-overuse) than in group IV (unstable-no overuse) and V (control group). There was no difference between group IV and V for peridural scar formation and vascular changes. In conclusion, the instability of the lumbar spine with overuse could be a cause of peridural venous circulatory impairment, resulting in fibrosis formation

Comparison of proximal junctional kyphosis rate according to fusion level

Introduction: There are two main accepted reasons of Proximal junctional kyphosis (PJK) after Scheuermann's kyphosis treatmentovercorrection of initial curve and fusion that is too short proximally. The purpose of this study was to evaluate the incidence of PJK in patients who have been previously treated for Schuermann's kyphosis with a curve exceeding 70 and corrected under 40 according to proximal fusion level T2 or T3. Methods: We retrospectively evaluated 30 patients treated for Schuermann's kyphosis with single stage posterior only procedure. We included patients that we achieved at least 50% correction of the initial curve. The surgeries were performed at the same institution by a single senior spinal surgeon. Patients were divided into two groups according to proximal fusion level T2 (16 patients) or T3 (14 patients) and evaluated for PJK, follow-ups ended three years after surgery. Results: Mean age was 22.7 in T2 and 21.6 years in T3 group. Mean preoperative Cobb angle was 78 in T2 and 78.7 in T3 group. The mean postoperative Cobb angle was 33.2 in T2 and 35 in T3 group. None of the patients showed neurologic complications. Four patients had PJK in T3 group and one needed revision. Conclusions: Selecting T2 as the proximal fusion level in Schuermann's kyphosis may decrease the incidence of PKJ. Studies with a larger number of patients needed to verify our results

Comparison of the Pullout Strength of Different Pedicle Screw Designs and Augmentation Techniques in an Osteoporotic Bone Model

Study Design: Mechanical study. Purpose: To compare the pullout strength of different screw designs and augmentation techniques in an osteoporotic bone model. Overview of Literature: Adequate bone screw pullout strength is a common problem among osteoporotic patients. Various screw designs and augmentation techniques have been developed to improve the biomechanical characteristics of the bone-screw interface. Methods: Polyurethane blocks were used to mimic human osteoporotic cancellous bone, and six different screw designs were tested. Five standard and expandable screws without augmentation, eight expandable screws with polymethylmethacrylate (PMMA) or calcium phosphate augmentation, and distal cannulated screws with PMMA and calcium phosphate augmentation were tested. Mechanical tests were performed on 10 unused new screws of each group. Screws with or without augmentation were inserted in a block that was held in a fixture frame, and a longitudinal extraction force was applied to the screw head at a loading rate of 5 mm/min. Maximum load was recorded in a load displacement curve. Results: The peak pullout force of all tested screws with or without augmentation was significantly greater than that of the standard pedicle screw. The greatest pullout force was observed with 40-mm expandable pedicle screws with four fins and PMMA augmentation. Augmented distal cannulated screws did not have a greater peak pullout force than nonaugmented expandable screws. PMMA augmentation provided a greater peak pullout force than calcium phosphate augmentation. Conclusions: Expandable pedicle screws had greater peak pullout forces than standard pedicle screws and had the advantage of augmentation with either PMMA or calcium phosphate cement. Although calcium phosphate cement is biodegradable, osteoconductive, and nonexothermic, PMMA provided a significantly greater peak pullout force. PMMA-augmented expandable 40-mm four-fin pedicle screws had the greatest peak pullout force

Do Magnetically Controlled Growing Rods Stimulate Longitudinal Vertebral Growth in Early-Onset Scoliosis Patients?

OBJECTIVE: Distraction-based systems are the most common systems used in the treatment of early-onset scoliosis. In addition to its corrective and deformity progression preventive properties, its vertebral growth stimulation effect has been proved. Recently popularized magnetically controlled growing rods (MCGRs) showed superior results in terms of outcomes and decreased complication rate. Its vertebral growth stimulation effect has not been studied. The aim of the study is to evaluate the vertebral growth stimulation effect in patients treated with MCGR. METHODS: Patients with progressive scoliosis treated by dual MCGR, who had no obvious lumbar vertebral deformity and had a regular 3-month interval spinal lengthening for at least 30 months, were subdivided into 2 groups according to the inclusion of L3 vertebra within instrumentation segments. The L3 vertebral vertical and horizontal lengths were measured postoperatively and at the last follow-up, and their differences were analyzed statistically in both groups. RESULTS: Twenty-four patients were included; 18 of them had an L3 vertebra outside instrumentation segments, while the other 6 had spanned by MCGR. Uninstrumented L3 were followed up for an average of 36 months. The height difference between initial postoperative examination and the last follow-up was 3.55 mm +/- 0.63 mm, and the width difference was 3.85 mm +/- 0.75 mm. Conversely, patients with instrumented L3 were followed up for a mean of 38.9 months. Their initial postoperative examination and last follow-up differences in height and width were 6.91 mm +/- 1.11 mm and 3.66 mm +/- 0.92 mm, respectively. CONCLUSIONS: Frequent distractions stimulate longitudinal vertebral growth in vertebrae spanned by MCGR

The results of Grice Green subtalar arthrodesis of valgus foot in spina bifida

Background: Valgus foot is a common foot deformity in spina bifida. The most popular operation for the valgus deformity has been the Grice talocalcaneal blocking. It has not been studied primarily in children with spina bifida. We report a prospective series, we present the results of hind foot valgus deformity of children with spina bifida, using Grice talocalcaneal arthrodesis with a tricortical iliac bone graft. Materials and Methods: Between May 2000 and December 2003, 21 patients with bilateral (42 feet) valgus deformity of feet underwent surgery. There were 7 males and 14 females. The mean age of patients was 67.7 months (range 50-108 months). Results: The total number of feet that had nonunion was 11, in 7 of them the grafts were completely reabsorbed and the outcome of all these feet was unsatisfactory. Four feet had partial union of which three had unsatisfactory and one had satisfactory outcome. Sixteen feet had residual valgus deformity at the last followup visit, 10 patients had nonunion, and 6 had inadequate correction. Mean preoperative talocalcaneal and calcaneal pitch angles were 48.5 and 31.9, respectively, which decreased to 38.5 and 29.1, respectively, postoperatively. The decrease in talocalcaneal angle and calcaneal pitch was significant between preoperative and postoperative measurements (P< 0.05). Conclusion: Grice subtalar arthrodesis technique is still a valuable option for valgus foot in patients with spina bifida. In this study, we found more encouraging results in older patients

Comparison of analgesic methods by using ropivacaine after arthroscopic shoulder surgery

Background: There is no clinical study which has evaluated real effectiveness of ropivacaine when it is used in a subacromial pump in addition to its bolus injection in a mixture of agents. The aim of the study is to evaluate pain relieving effect of ropivacaine infusion by a pain pump after arthroscopic shoulder surgery. Method: Thirty-six patients were randomly divided into three groups. Arthroscopic subacromial surgery was performed under general anesthesia. A subacromial catheter was placed in groups 1 and 2 patients. At the end of the operation, 15 ml of 0.5 % ropivacaine, 15 mg of ketolorac, and 4 mg morphine sulfate mixture was applied to all patients into the subacromial space. In addition to that, group 1 patients were applied with 0.5 % ropivacaine running through a pain pump at 4 cm3/h. Group 2 patients only received 100 cm3 saline (placebo) through the same pain pump, which was also running at 4 cm3/h. No additional intervention except subacromial mixture application was performed in group 3. Pain levels were evaluated by using the visual analogue scale. Results: Twelve male and 19 female patients were included in this study. During the first postoperative hour, there was no difference between the groups in terms of pain scores. During the ongoing 24-h period, group 2 patients suffered less pain and had less analgesic need compared with the other two groups (p &lt; 0.05). However, in the same day, there was no significant difference in pain scores and analgesic consumption between groups 1 and 3 (p &gt; 0.05). Conclusion: In terms of pain relief, the mixture of morphine, ropivacaine, and ketolorac was found to be as effective as the 24-h pump infusion of ropivacaine following arthroscopic rotator cuff repair. It was observed that placebo-given patients suffered less pain because saline increased the long-term effect of ropivacaine. So if an appropriate analgesic agent is applied to the subacromial space, there is no need for a pump infusion postoperatively. © 2013 EFORT