فهرست مطالب farzam mokarami

Shoulder imbalance (SI) is among the most rated manifestations of adolescent idiopathic scoliosis (AIS)pointed to by patients and spine surgeons. It serves as a criterion to assess the outcome of scoliosis surgery and isalso a cause of dissatisfaction for the patients postoperatively. Despite the availability of multiple studies on this issue,a comprehensive survey of the risk factors and preventive measures has yet to be elucidated. The present study aimedto highlight the most recent approach to the evaluation and management of SI, as well as medical counseling about theexpectations and limitations of the surgery.

A systematic literature review using electric databases was conducted, including PubMed, Embase, theCochrane Library, and Google Scholar, with a well-defined search strategy on SI definition, risk factors, and preventiveand surgical recommendations.

A total of 69 articles were identified; SI > 2 cm was the most used cut-off, and its risk factors included the mainthoracic Cobb angle > 80˚, preoperative level shoulder, high left shoulder, and higher Risser grade. The most statedstrategies to preclude SI were the sufficient correction of the proximal thoracic curve, and moderate correction of themain thoracic and lumbar curve (LC).

Shoulder imbalance should be prevented not only for appearance or satisfaction but also for possiblecomplications such as distal adding-on, new LC progression, or trunk shift postoperatively in AIS patients.Level of evidence: V

A 30-year-old man presented to our clinic with progressive neck pain and dysphagia. He had been operated on for an atlantoaxial instability (os odontoideum) 7 years ago. Imaging studies revealed cervical spondyloptosis of C5-C6 and C7-T1; the neurologic examination was intact. It was decided to correct the deformity through a circumferential approach. Thus C5, C6, and C7 corpectomy, alongside anterior column reconstruction using titanium expandable cage, reinforced by posterior spinal instrumentation from occipital bone to T3 vertebra were performed; his symptoms resolved completely following an uneventful surgery.

A 45-year-old man presented to our facility with predominantly Sciatica-like leg pain and lower extremity motor weakness, who did not get relief despite undergoing two consecutive lumbar surgeries for suspected lumbar disc herniation. Medical history, physical findings, and a magnetic resonance imaging scan revealed thoracic cord tumor as the underlying disease. Our patient had complete resolution of his back and leg pain following surgical resection of the thoracic Schwannoma. Thoracic cord compression often results in diffuse pain and myelopathic symptoms caused by the irritation of ascending spinothalamic tract, which causes a vague and burning pain that should be differentiated from nerve root lesions and can be the first presentation of a thoracic cord lesion.

Carpal tunnel syndrome (CTS) is the most common compressive neuropathy. Diabetes mellitus is the most common disease that predisposes the patients to CTS. Diabetic neuropathy is a progressive disease and diabetics nerve is more susceptible to compression at known sites of anatomic constrains such as in the carpal tunnel; clinical results of carpal tunnel release has been questioned not to be as good as non-diabetic patients. This study was carried out to compare the clinical and electrodiagnostic outcomes of diabetic and non-diabetic carpal tunnel release (CTR) surgery. Patients and Twenty diabetic hands (14 patients) and 18 non-diabetic hands (14 patients) that underwent CTR between Octobers 2009 - 2012 were evaluated. They were operated by one hand surgeon and were evaluated at least six months after the operation. Clinical symptoms as numbness, pain, paresthesia and nocturnal symptoms were evaluated. Electrodiagnostic results were evaluated pre- and post-operatively. After surgical release, both groups showed significant improvements in clinical results, as 81.6% of patients had excellent and good outcomes, 18.4% had fair outcomes, and no one had poor outcome. Except for median sensory nerve conduction velocity (NCV) changes that had significant differences between diabetic and non-diabetic groups, other parameters had no significant differences between both groups. Furthermore, significant reverse correlation was found between the duration of CTS and the outcome. Clinical and electrodiagnostic results after CTR are approximately the same in patients with diabetes and without it. Diabetics with CTS as well as non-diabetic patients have satisfactory results after CTR surgery. Furthermore, the duration of CTS has a significant influence on the result of CTR; the shorter duration of diabetes, the better the result of CTR surgery.

Fingertip injuries are among the most prevalent hand injuries. The fingertip has important sensory and functional role. When the size of fingertip skin defect is large, full thickness skin grafting is necessary. There are several donor sites for obtaining skin graft; however, there is no study concerning the best region of harvesting skin graft compatible with the fingertip. This study was designed to compare the skin grafts harvested from wrist and groin for fingertip skin loss. Patients and A total of 72 patients in need of skin grafting were randomized to two group of 36 to receive skin graft harvested from the wrist or from the groin regions. The patients included 71 males and only one female patient who was in the wrist harvested group. All the patients were operated by one technique. The minimum follow-up period was 18 months. The grafted skin was evaluated clinically regarding two-point discrimination (TPD), light touch, ulcer, graft contracture, hair growth on the grafted skin, and color difference between the graft and recipient site, which was evaluated with photo analyzer in Photoshop software. The grafted skins were compared between groups. Clinically, TPD and light touch were better (lower thresholds) in the wrist group (P < 0.05). Moreover, The amount of skin contracture, color difference between grafted skin and recipient site, and hair follicle counts were less in the wrist group (P < 0.001). In both groups, there were no ulcer and fissuring. For fingertip injures, full thickness skin grafts harvested from the wrist have significantly better cosmetic and functional results including better TPD and light touch, less hair follicles, less color difference, and less contracture.

Pain is one of the major concerns of patients underwent Total Knee Arthroplasty (TKA); appropriate pain management is a key factor in patient''s early physical fitness to move, physiotherapy, and most importantly, patient satisfaction.. In this study the analgesic effect of single injection femoral nerve block (SFNB) was compared with local infiltration analgesia (LIA)..Patients and Forty patients who underwent TKA under spinal anesthesia were randomized to receive single femoral nerve block (group F) or intra-periarticular infiltration (group I). Group F received single injection 20cc ropivacaine (10mg/cc) and in group I, a combination of 300mg ropivacaine, 30mg ketorolac and 0.5mg epinephrine diluted to a volume of 150cc and locally injected in and around the knee joint in 3 stages. Postoperative pain intensity measured by Visual Analog Scale (VAS). Morphine consumption, mobilization time and patients’ satisfaction evaluated as well.. Group I had significantly lower morphine consumption in the first postoperative day (10 vs. 12.5mg, P-value < 0.05). Within 6 hours postoperatively, VAS score was statistically lower in group I compared to group F (3 vs. 4, P-value < 0.05). However, within 12 hours it was statistically higher in group I than group F (6 vs. 5, P-value < 0.05). Other parameters were not statistically different in two groups.. Both methods LIA and SFNB provided excellent pain relief and lower morphine consumption following TKA. LIA is a surgeon-controlled analgesic technique, which can be used to enhance patients’ satisfaction and reduce the pain in the very early postoperative period by surgeon independently..

The goal of this study was to evaluate، functional capacity of the knee in flexion and internal rotation after hamstring ligament harvest for Anterior Cruciate Ligament (ACL) reconstruction. Fifty patients (male and 18-45 years old) with isolated ACL injury، randomly allocated in two equal groups (in one group، ACL reconstruction was performed with Tibialis Posterior allograft and in another group with quadruple hamstring ligament auto graft) and before and 6 months after surgery in both groups isokinetic flexion strength and isometric internal rotation strength of knee evaluated with Biodex System 4 dynamometer and rotational torque recorder، in order. Isokinetic flexion strength evaluated in sitting and prone position; the later position was performed for deep flexion strength evaluation. Also subjective and objective assessment of all patients pre operatively and 6 months post operatively was documented with International Knee Documentation Committee (IKDC) questionnaire. In this study for first time، rotational torque strength of knee was recorded with new design measure، from isometric aspect and not isokinetic. Although significant improvements in IKDC scores، flexion and internal rotation capacity of the knee were observed in both groups، post operatively in respect to pre operatively; there was no significant difference between 2 groups. (P<0. 05 or more than 95% confidence Interval of the difference) This study demonstrates that ACL reconstruction surgery، improves knee performance in flexion and internal rotation، regardless of hamstring tendon harvesting. Considering potential complications of allograft (for example: transfer of harmful diseases from donor to recipient)، it is logical to use hamstring auto graft ligament for ACL reconstruction surgery. Because result of this study is not longstanding follow up and limited to male sex، for more worthfull conclusion، we suggest future study in both sex and with long duration of follow up.

Pain is one of the greatest concerns of patients undergoing total knee arthroplasty (TKA); which is severe and intolerable within 72 hours post-surgery. Appropriate pain management is a key factor in patient''s early mobilization، launching physiotherapy، less hospital length of stay and more importantly، patient''s satisfaction. New studies with the infiltration of combined analgesic agents peri and intra-articularly has shown encouraging results in pain reduction، good clinical outcome and patient''s satisfaction. The purpose of this study was to compare the analgesic effect of locally infiltrated analgesia (I) compared with single injection femoral nerve block (F) and its impact on pain relief، patient''s satisfaction، morphine consumption and clinical outcome. This research was a double-blind randomized clinical trial on 36 consecutive patients undergone TKA divided into group (F) in which the ipsilateral femoral nerve in the inguinal area was blocked by a single injection of 20 ml ropivacaine (10 mg/ml) and group (I) which a combination of ketorolac، ropivacaine and epinephrine was injected peri and intra-articularly on the knee during TKA. Pain intensity measured by visual analog scale (VAS)، clinical outcome (based on range of motion)، morphine consumption and patient''s satisfaction of pain management after TKA were compared between the two groups. Pain intensity score (VAS) and Morphine consumption were statistically less in group I than group F during the first 6 hours and 24 hours post surgery respectively (P< 0. 05); however، group F had 12-hour VAS score of 5 which was less than group (I) by 1 grade in pain scale (VAS) (P< 0. 05). Other parameters were not statistically different in the two groups and patients'' response to our pain management protocols proved to be satisfactory in both groups. Lower level of pain and morphine consumption in group (I) during the first 24 hours post-surgery in contrast to group (F) and its ease of use by a surgeon intra-operatively، introduce local infiltration analgesia as an effective method to decrease the patient''s pain and improve patient''s satisfaction in early post-surgery period after total knee arthroplasty.