RESUMEN
The purpose of this study was to further establish the efficacy of pedicle screw stimulation as a monitoring technique to avoid nerve root injury during screw placement. The study population consisted of 662 patients in whom 3,409 pedicle screws were placed and tested by electrical stimulation. If stimulation resulted in a myogenic response at a stimulation intensity of 10 mA or less, the placement of the screw was inspected. Inspection was necessary for 3.9% of the screw placements in 15.4% of the study population. None of the patients in the study experienced any new postoperative neurologic deficits. These findings provide guidelines for the interpretation of stimulation data and support the use of this technique as an easy, inexpensive, and quick method to reliably assess screw placements and protecting neurological function.
Asunto(s)
Tornillos Óseos , Monitoreo Intraoperatorio/métodos , Enfermedades del Sistema Nervioso Periférico/prevención & control , Complicaciones Posoperatorias/prevención & control , Raíces Nerviosas Espinales , Columna Vertebral/cirugía , Umbral Diferencial , Estimulación Eléctrica/métodos , Reacciones Falso Negativas , HumanosRESUMEN
A prospective, randomized, double-blind study of 437 patients undergoing arthroscopic diagnostic and operative procedures found that no deep infections occurred in any patient and only one superficial infection occurred in a patient who did not receive prophylactic antibiotics. One patient had a mild allergic reaction to the antibiotic that resolved after treatment with Benadryl. These results suggest that the routine use of prophylactic antibiotics is not indicated for patients undergoing arthroscopic surgery and that the slight risk of infection is outweighed by the cost of the antibiotics and the slight risk of allergic reaction.
Asunto(s)
Profilaxis Antibiótica , Artroscopía , Cefazolina/uso terapéutico , Cefalosporinas/uso terapéutico , Infección de la Herida Quirúrgica/prevención & control , Adolescente , Adulto , Anciano , Método Doble Ciego , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios ProspectivosRESUMEN
We studied the results of bone scans in 50 consecutive patients with symptomatic, unilateral, chronic anterior cruciate ligament (ACL) tears. All patients had failed conservative therapy and underwent radionuclide imaging of the knee prior to arthroscopic ACL reconstruction. The scintigraphic activity in each of the three knee compartments was quantitatively scaled from 1 (normal scintigraphic activity) to 4 (marked activity). Quantitative activity in each of the three compartments was correlated with plain radiographic, arthroscopic, and clinical findings. All but four of the scans (92%) showed abnormal scintigraphic activity. The quantitative activity was highest overall in the medial compartment (2.9), followed by the lateral (2.4) and patellofemoral compartments (1.9). In the subgroup of patients with normal menisci (10 patients), most of the abnormal activity was in the lateral compartment (2.9), implying that when the medial meniscus remains competent in the presence of a torn ACL, there is increased stress on the lateral compartment. There was little correlation with scintigraphy and roentgenographic changes, except in the presence of moderate or severe radiographic degenerative arthritis. Similarly, there was little correlation between increased scintigraphic activity and chondromalacia. These results provide a baseline for future studies that use scintigraphic imaging in monitoring restoration of bone homeostasis following ACL reconstruction.
Asunto(s)
Lesiones del Ligamento Cruzado Anterior , Medronato de Tecnecio Tc 99m , Adolescente , Adulto , Ligamento Cruzado Anterior/patología , Ligamento Cruzado Anterior/cirugía , Artroscopía , Enfermedades de los Cartílagos/complicaciones , Enfermedades de los Cartílagos/diagnóstico por imagen , Enfermedad Crónica , Estudios de Evaluación como Asunto , Femenino , Humanos , Puntaje de Gravedad del Traumatismo , Masculino , Osteoartritis/complicaciones , Osteoartritis/diagnóstico por imagen , Cuidados Preoperatorios , Radiografía , Cintigrafía , Sensibilidad y Especificidad , Heridas y Lesiones/clasificación , Heridas y Lesiones/complicaciones , Heridas y Lesiones/diagnóstico , Heridas y Lesiones/epidemiologíaRESUMEN
We studied all patients undergoing arthroscopic resection of symptomatic plica without other intraarticular abnormality at our institution from October 1981 to March 1987. To be considered abnormal, plicae had to be thickened and/or fibrotic when viewed arthroscopically. Seventy-six of nearly 2000 patients (4%) who underwent diagnostic arthroscopies met our inclusion criteria. Clinical response after arthroscopic resection was evaluated in 51 patients at an average of 47 months (range, 15 to 77). Excellent or good results were obtained in 57 (75%) of the patients. Eleven patients (14%) had an impingement lesion defined as a localized femoral condylar ridge or groove of the articular surface that impinged upon the plica with increasing flexion. All of these patients had an excellent or good result. Other factors associated with a favorable outcome included a specific preoperative diagnosis localizing symptoms to the medial compartment, onset of pain after a period of increased athletic activity or after a twisting injury, and younger age. Poor prognostic factors included associated chondromalacia and an unclear preoperative diagnosis.