Transpedicular screw fixation is a widely used method in vertebral surgery, but it suffers from complications due to mismatches between the screw and pedicle. Therefore, information on the real minimal diameter of pedicle is needed for the development of instrumentation techniques and implantable devices. A total of 4,212 measurements from 1,404 pedicles of 702 human vertebrae were made from thoracic (T11, T12) to lumbar (Ll-L5). We found that there was a real minimal diameter which was different from the vertical and transverse diameters of pedicles. This is the smallest diameter which cannot be definitely determined by the imaging methods currently in use, such as anteroposterior and lateral radiographs, and computed tomography; direct measurements excepted. Based on these results, we suggest that neither vertical nor transverse diameter gives accurate measurements of minimal diameter. However, minimal diameter size may be estimated using the ratio of vertical or transverse diameter to minimal diameter reported in this study for each level.
ÖZETOdontojenik keratokist (OKK) dental lamina artıklarından oluştuğu düşünülen, asemptomatik, ilerleme eğilimli gelişimsel bir kisttir. Nüks oranı yüksektir. Uniloküler ve multiloküler olabilen, sınırlı belirgin radyolüsent lezyon olarak görüntü veren OKK, küçük lezyonlarda rutin radyografilerde fark edilirken, ilerlemiş olgularda ağrı, şişlik, enfeksiyon gibi bulgularla da fark edilir. En çok 2. ve 3. dekatlarda, erkeklerde ve mandibula posterior bölgede görülür. Gerçek tanı histopatolojik olarak konur. Tedavisi konservatif olabileceği gibi radikal cerrahi tedavilerde vardır. Şişlik, ağrı ve parestezi şikâyeti ile kliniğe başvuran 32 yaşında erkek hastanın yapılan muayenesinde ağız açmada kısıtlılık, palpasyonda ağrı, şişlik ve dudak ile yanakta hafif parestezi tespit edilmiştir. İnferior alveolar sinir hasarı ve olası mandibular fraktür riski gözetilerek marsupyalizasyon ve sonrasında enükleasyon yapılan hastanın takiplerinde parestezi ve diğer şikayetlerin düzeldiği görülmüştür.
Transpedicular spinal fixation is a widely used method in vertebral surgery, but it suffers from complications due to mismatches between the screw and pedicle. Therefore, information on minimal cancellous (MCD) and minimal external diameters (MED) of the pedicle is highly important for vertebral surgery. To determine these diameters and their ratios, 2,808 measurements of 1,404 pedicles of 702 human vertebrae were made from Th11 to L5. We found that the mean ratio of MCD to MED was 72.2%, MCD to vertical diameter (VD) was 41.7%, and MCD to transverse diameter (TD) was 62.2% in all levels. We recommend that these results be considered prior to pedicular fixation operations and design of new implantable devices.
Objectives: It is aimed to investigate the effect of tourniquet and tranexamic acid (TXA) on the amount of perioperative bleeding in patients undergoing total knee arthroplasty. Methods: One hundred and ninety-three patients included in the study. The patients included in the study were divided into 4 groups. Group 1 (n = 78) was determined as the patient group with long-term tourniquet application, but without additional application and was accepted as the control group. Group 2 (n = 40) was the long-term tourniquet and intravenous (IV) TXA applied group, Group 3 (n = 40) was the long-term tourniquet and intra-articular TXA applied group, and Group 4 (n = 35) was the short-term tourniquet (only in the cementing phase) and IV TXA applied group. The difference between groups according to use of a tourniquet during the operation, the method and dose of TXA, the amount of postoperative blood transfusion, the amount of drained blood, the length of hospital stay, and complications were investigated. Results: The largest Hemoglobin (Hb) and Hematocrit (Hct) decreases were found in Group 1 (3.39 ± 0.92 g/dl and 10.8%, respectively). Also the highest drainage (median 350 ml), transfusion (16.7%), length of hospital stay (mean 4.51 ± 1.07 days) and estimated blood loss (median 1559.8 ml) were in Group 1 (p < 0.05). The lowest Hb decrease (mean 2.95 ± 0.68 g/dl) and lowest drainage (median 150 ml) was seen in group 3 and the lowest length of hospital stay (mean 3.89 ± 0.8 days) in group 4 (p < 0.05). Conclusions: The use of TXA was shown to lead to a reduction in Hb and Hct, the amount of blood drained after surgery, and the length of hospital stay. The use of TXA may be a good option for bleeding control in patients undergoing total knee arthroplasty.
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