PurposeTo evaluate the hemostatic effect of intraarticular injection of a thrombin-based hemostatic agent in total knee arthroplasty (TKA).Materials and MethodsWe performed a prospective randomized controlled trial on the use of a thrombin-based hemostatic agent in patients undergoing unilateral TKA. A total of 100 TKA patients were enrolled, with 50 patients randomized into the study group and the other 50 patients into the controlled group. Drain output, hemoglobin level, total red blood cell loss for 24 hours after surgery, transfusion rates, and complications were assessed.ResultsPostoperative drain output was 525 mL in the study group and 667 mL in the control group (p=0.01). Nine patients in the study group and eighteen in the control group received blood transfusion (p=0.043). But, there was no significant difference between two groups in terms of hemoglobin level change and total red blood cell loss (p>0.05).ConclusionsThe thrombin-based hemostatic agent demonstrated efficacy in reducing drain output and blood transfusion rates. Thus, we believe the use of a thrombin-based hemostatic agent should be considered as an option in orthopedic surgery that involves massive bleeding.
Study Design. Retrospective study of data collected prospectively. Objective. To investigate changes in the degree of lower leg radiating pain (LLRP) after selective nerve root block (SNRB) and to evaluate associations of this change with postoperative improvements in symptom severity, functional outcomes, and quality of life. Summary of Background Data. SNRB is routinely performed as an initial treatment for lumbar foraminal or lateral recess stenosis with LLRP. The degree of improvement after SNRB has been suggested to predict the improvement in postoperative pain and functional outcomes. However, there have been no studies on the predictive value of this parameter.Methods. We enrolled 60 patients who underwent SNRB followed by decompressive surgery. They were divided into three groups. The degree of improvement was evaluated as a percentage of the pre-injection values. Functional outcomes of the spine were assessed using the Oswestry Disability Index (ODI) and Roland-Morris Disability Questionnaire (RMDQ). Quality of life was assessed using the 36-item Short Form Survey (SF-36) physical component score (PCS) and mental component score (MCS). The degree of LLRP was measured preoperatively and at 6, 12, and 24 months after surgery. These functional outcomes were evaluated preoperatively and at 12 and 24 months after surgery. Results. The improvement in LLRP in the short term (6 hours after SNRB) was found to be statistically significantly associated with the improvement in LLRP at 12 months after SNRB (P ¼ 0.044, correlation coefficient ¼ 0.261). No relationship between pain improvement after SNRB and functional outcome was identified. Conclusion.The degree of improvement in symptoms 6 hours after SNRB can predict the degree of improvement in LLRP at 12 months after surgery. However, symptomatic improvement after SNRB does not predict postoperative functional outcome or quality of life.
Purpose:The aims of this study were to assess sleep status and quality of life (QOL) in patients with frozen shoulder and to evaluate correlations between pain, disability, sleep disturbance and QOL. Materials and Methods: Thirty patients with idiopathic frozen shoulder and 60 healthy controls were enrolled into this study. Participants were evaluated using the following: visual analogue scale (VAS), American Shoulder and Elbow Surgeon's Score (ASES), Korean Shoulder Score (KSS), Pittsburg Sleep Quality Index (PSQI), and World Health Organization Quality of Life Scale Abbreviated Version (WHOQOL-BREF). Results: The mean VAS, ASES, and KSS scores in patient groups were 6.5, 40.3, and 45.1, respectively. The mean PSQI score was 8.6 in the patient group and 4.1 in the control group. Patient groups had signifi cantly higher scores than the control group for the PSQI score (p<0.05). The incidence of sleep disturbance was 86.7%. The mean WHOQOL-BLEF score was 77.6 in the patient group and 93.6 in the control group. The patient group was signifi cantly lower than the control group in the WHOQOL-BLEF score (p<0.05). There were no statistically signifi cant correlations with PSQI and WHOQOL-BLEF scores regarding duration of symptoms, VAS, ASES, and KSS scores (p>0.05). The ASES score had a positive correlation with physical health domain and KSS score had a positive correlation with overall QOL and physical health domain of the WHOQOL-BLEF (p<0.05). Conclusion: Patients with frozen shoulder had noticeable pain and functional disability. Furthermore, they had signifi cant incidence of sleep disturbance and had a signifi cantly lower QOL.
Lumbar epidural varices are a rare cause of radicular pain mimicking lumbar disc herniation or other cyst‐like masses including sequestrated disc herniation, facet joint synovial cyst, or perineural cyst. We report a case of a 36‐year‐old woman presenting with lumbar radicular pain caused by a lumbar epidural varix. Lumbar magnetic resonance imaging (MRI) revealed a cystic lesion in the ventral epidural space posterior to the right L4 body. Surgery was conducted and histopathology confirmed the diagnosis of an epidural varix. Lumbar epidural varices and other lumbar cystic lesions can commonly cause radicular pain. Physicians will benefit from increased awareness of epidural varices as a cause of lumbosacral radicular pain and the associated radiologic findings supporting differential diagnosis. In particular, careful interpretation of MRI scans may help ensure proper diagnosis of an epidural varix versus other cystic lesions.Level of EvidenceV
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