scholarly journals Comparison of One-Year Functional Outcomes and Quality of Life between Posterior Pelvic Ring Fixation and Combined Anterior-Posterior Pelvic Ring Fixation after Lateral Compression (B2 Type) Pelvic Fracture

Medicina ◽  
2021 ◽  
Vol 57 (3) ◽  
pp. 204
Author(s):  
Giedrius Petryla ◽  
Valentinas Uvarovas ◽  
Rokas Bobina ◽  
Jaunius Kurtinaitis ◽  
Roma Puronaitė ◽  
...  

Background and Objectives: The treatment algorithm of lateral compression B2 type pelvic fractures are still under debate. Some authors advocate conservative treatment, while others recommend surgical approach. The clear indications for isolated anterior or posterior ring fixation or combined anterior-posterior pelvic ring fixation of B2 type fractures remain unclear. The aim of this study was to compare the functional outcomes and quality of life after isolated posterior pelvic ring fixation and combined anterior-posterior pelvic ring fixation for the treatment of B2 pelvic fractures. Materials and Methods: Patients aged 18 to 65 years with B2 type pelvic fracture hospitalized in a single trauma centre over a period of 3 years were included in the research. Based on the attending surgeon’s preference, patients were treated with isolated posterior or combined anterior-posterior pelvic fixation. The quality of life and pelvic function were assessed using SF-36 and Majeed questionnaires, respectively. Patients filled in the questionnaires twice: during the first hospitalization (concerning their pre-trauma state—timepoint I) and one-year after the injury (timepoint II). Results: A cohort of 32 patients with B2 type pelvic fracture was enrolled in the analysis: 23 (72%) were female and 9 (28%) were male. The mean age was 35.3 ± 11.9 years. In this cohort 13 (41%) patients underwent isolated posterior pelvic ring fixation (group I) and 19 (59%) patients underwent combined anterior-posterior pelvic ring fixation (group II). No statistically significant differences were observed between the groups in both timepoints concerning Majeed, SF-36 PCS and MCS scores. However, in both groups Majeed and SF-36 PCS scores were statistically significantly lower one year after pelvic fracture compared with pre-trauma state, while SF-36 MCS scores did not differ. Conclusions: No differences were found in quality of life and functional outcomes between isolated posterior pelvic ring fixation and combined anterior-posterior fixation for the treatment of B2 type pelvic fractures.

Medicina ◽  
2021 ◽  
Vol 57 (6) ◽  
pp. 513
Author(s):  
Giedrius Petryla ◽  
Valentinas Uvarovas ◽  
Rokas Bobina ◽  
Jaunius Kurtinaitis ◽  
Tomas Sveikata ◽  
...  

Background and Objectives: Lateral compression injuries of the pelvic ring are most common among young and elderly patients. Of all pelvic ring fracture injuries, the B2.1 type—involving lateral compression of the pelvic ring—is the most common. Despite this, we still have no high-level evidence to consult when choosing between the surgical and non-operative approaches. The purpose of this research was to compare the short-term functional and quality of life outcomes between operatively and non-operatively treated young patients after a B2.1 type pelvic fracture. Materials and Methods: Patients aged 18 to 65 years with pelvic B2.1 type fractures—according to AO/Tile classification—that were hospitalized in a single trauma center between 2016 November and 2019 September were included in the research. Patients were retrospectively divided into two groups regarding their treatment: non-operative and operative. Functional outcomes were evaluated using Majeed score, and SF-36 was used for the evaluation of quality of life. Patients completed these questionnaires twice: first during hospitalization, regarding their pre-traumatic condition (timepoint I); and again 10 weeks after the injury, regarding their current condition (timepoint II). Results: A total of 55 patients (70.6% of whom were female) with type B2.1 pelvic fractures were included in the analysis, with an average age of 37.24 ± 13.78 years. There were 21 (38.18%) patients with high injury severity, and 37 (67.3%) patients were treated operatively versus 18 (32.7%) non-operatively. Between the two timepoints, Majeed score reduced by 34.08 ± 18.95 for operatively and 31.44 ± 14.41 for non-operatively treated patients. For operatively and non-operatively treated patients, the physical component summary (PCS) of the SF-36 questionnaire reduced by 19.45 ± 9.95 and 19.36 ± 7.88, respectively, while the mental component summary (MCS) reduced by 6.38 ± 11.04 and 7.23 ± 10.86, respectively. Conclusions: We observed that operative treatment of B2.1 type pelvic fractures for young patients is not superior to non-operative in the short-term, because the functional outcomes and quality of life are similar in both groups.


2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Giedrius Petryla ◽  
Rokas Bobina ◽  
Valentinas Uvarovas ◽  
Jaunius Kurtinaitis ◽  
Tomas Sveikata ◽  
...  

Abstract Background Spinopelvic dissociation is a transverse sacral fracture in conjunction with a vertical fracture of the sacrum on both sides, which causes the dissociation of the upper sacrum and spine from the pelvis. The most common causes of these fractures are high energy injuries such as falls from height or motor vehicle accidents. Spinopelvic dissociation is rare and heterogenous with severe associated injuries. The aim of this study was to assess the injury characteristics, changes in the quality of life and functional outcomes in the 1-year period after spinopelvic dissociation. Materials and methods During the period of 4 years (January 2016 and January 2020), 17 patients with spinopelvic dissociation were admitted to our centre and included in this single-centre prospective cohort study. One patient died during the admission; therefore 16 patients were enrolled in the analysis. Patients were followed-up for 12 months. The quality of life changes were evaluated via the SF-36 questionnaire, and the functional outcomes were evaluated using the Majeed pelvic score. Patients completed their questionnaires twice: firstly during hospitalization (regarding their pre-traumatic condition); and once again 1 year after their injury (regarding their current condition). Results The mean age of the patients was 40.2 ± 17.7 years. Mean Majeed, PCS and MCS scores of SF-36 before the injury were 95.81 ± 9.50, 55.87 ± 8.89, and 43.76 ± 12.45, respectively. Mean Majeed, PCS and MCS scores 1 year after the injury were 71.13 ± 20.98, 43.45 ± 9.64, and 43.41 ± 7.56. During the period of 1 year after the injury, Majeed and PCS results reduced statistically significantly (P = 0.001 and P = 0.003, respectively), while MCS results remained similar (P = 0.501). Conclusions According to the data of our study, for patients with spinopelvic dissociation functional outcomes are significantly reduced and only one-third of the patients achieved pre-traumatic functional outcomes 1 year after the injury.


2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Katharina Jäckle ◽  
Marc-Pascal Meier ◽  
Mark-Tilmann Seitz ◽  
Sebastian Höller ◽  
Christopher Spering ◽  
...  

Abstract Background Fragility fractures without significant trauma of the pelvic ring in older patients were often treated conservatively. An alternative treatment is surgery involving percutaneous screw fixation to stabilize the posterior pelvic ring. This surgical treatment enables patients to be mobilized quickly and complications associated with bedrest and temporary immobility are reduced. However, the functional outcome following surgery and quality of life of the patients have not yet been investigated. Here, we present a comprehensive study addressing the long-term well-being and the quality of life of patients with fragility pelvic ring fractures after surgical treatment. Methods Between 2011–2019, 215 geriatric patients with pelvic ring fractures were surgically treated at the university hospital in Göttingen (Germany). Of these, 94 patients had fragility fractures for which complete sets of computer tomography (CT) and radiological images were available. Fractures were classified according to Tile and according to the FFP classification of Rommens and Hofmann. The functional outcome of surgical treatment was evaluated using the Majeed pelvic score and the Short Form Health Survey-36 (SF-36). Results Thirty five tile type C and 48 type B classified patients were included in the study. After surgery eighty-three patients scored in average 85.92 points (± 23.39) of a maximum of 100 points using the Majeed score questionnaire and a mean of 1.60 points on the numerical rating scale ranging between 0 and 10 points where 0 points refers to “no pain” and 10 means “strongest pain”. Also, the SF-36 survey shows that surgical treatment positively effects patients with respect to their general health status and by restoring vitality, reducing bodily pain and an increase of their general mental health. Conclusions Patients who received a percutaneous screw fixation of fragility fractures of the posterior pelvic ring reported an overall positive outcome concerning their long-term well-being. In particular, older patients appear to benefit from surgical treatment. Trial registration Functional outcome and quality of life after surgical treatment of fragility fractures of the posterior pelvic ring, DRKS00024768. Registered 8th March 2021 - Retrospectively registered. Trial registration number DRKS00024768.


2021 ◽  
Vol 108 (Supplement_8) ◽  
Author(s):  
Anders Olsson ◽  
Katarina Woxnerud ◽  
Gabriel Sandblom ◽  
Otto Stackelberg

Abstract Aim Management of diastasis recti abdominis (DRA) differs regarding core training, surgical repair methods and post-operative rehabilitation. The purpose of this prospective cohort study was to evaluate the effect of a novel concept of treatment for DRA, the TOR-concept (Training, Operation and Rehabilitation). The concept includes preoperative evaluation of symptoms and instructed abdominal core training; tailored surgical repair of the DRA; and an individualized postoperative rehabilitation program. Material and Methods A cohort of seventy-five post-partum women with diagnosed DRA and training resistant core dysfunctions were evaluated and included to the study during 2018-2020. After surgery, all participants underwent an individualized supervised rehabilitation program with progressive increasing load for four months. Physical function was registered preoperatively and one year after surgery with the disability rating index (DRI) questionnaire. Quality of life (QoL) was assessed with the SF-36 questionnaire. The DRA and the surgical result were assessed with ultrasonography before and one year after surgery. Results Sixty-nine participants, 92%, completed the study. There were no DRA-recurrences at the 1-year follow-up. Early results shows that self-reported physical function, (DRI), improved in 88.8 % of patients, with a mean score improvement of 78.5 %. Quality of life, (SF-36), improved significantly compared with the preoperative scores, and reached a level similar to, or higher than, the normative Swedish female population. Conclusions In this cohort of post-partum women with DRA combined with core instability symptoms resistant to training, surgical reconstruction within the TOR-concept resulted in a significant improvement of physical function and QoL.


2020 ◽  
Vol 102-B (7) ◽  
pp. 845-851 ◽  
Author(s):  
Graham S. Goh ◽  
Ming Han Lincoln Liow ◽  
You Wei Adriel Tay ◽  
Jerry Yongqiang Chen ◽  
Sheng Xu ◽  
...  

Aims While patients with psychological distress have poorer short-term outcomes after total knee arthroplasty (TKA), their longer-term function is unknown. We aimed to 1) assess the influence of preoperative mental health status on long-term functional outcomes, quality of life, and patient satisfaction; and 2) analyze the change in mental health after TKA, in a cohort of patients with no history of mental health disorder, with a minimum of ten years’ follow-up. Methods Prospectively collected data of 122 patients undergoing primary unilateral TKA in 2006 were reviewed. Patients were assessed pre- and postoperatively at two and ten years using the Knee Society Knee Score (KSKS) and Function Score (KSFS); Oxford Knee Score (OKS); and the Mental (MCS) and Physical Component Summary (PCS) which were derived from the 36-Item Short-Form Health Survey questionnaire (SF-36). Patients were stratified into those with psychological distress (MCS < 50, n = 51) and those without (MCS ≥ 50, n = 71). Multiple regression was used to control for age, sex, BMI, Charlson Comorbidity Index (CCI), and baseline scores. The rate of expectation fulfilment and satisfaction was compared between patients with low and high MCS. Results There was no difference in the mean KSKS, KSFS, OKS, and SF-36 PCS at two years or ten years after TKA. Equal proportions of patients in each group attained the minimal clinically important difference for each score. Psychologically distressed patients had a comparable rate of satisfaction (91.8% (47/51) vs 97.1% (69/71); p = 0.193) and fulfilment of expectations (89.8% vs 97.1%; p = 0.094). The proportion of distressed patients declined from 41.8% preoperatively to 29.8% at final follow-up (p = 0.021), and their mean SF-36 MCS improved by 10.4 points (p < 0.001). Conclusion Patients with poor mental health undergoing TKA may experience long-term improvements in function and quality of life that are comparable to those experienced by their non-distressed counterparts. These patients also achieved a similar rate of satisfaction and expectation fulfilment. Undergoing TKA was associated with improvements in mental health in distressed patients, although this effect may be due to residual confounding. Cite this article: Bone Joint J 2020;102-B(7):845–851.


2018 ◽  
Vol 16 (1) ◽  
pp. 61-68
Author(s):  
Mariusz Trystuła

Although randomized trials have proven the benefit of revascularization with the use of carotid endarterectomy (CEA) or stenting (CAS) for appropriate patients, health care purchasers increasingly look beyond clinical outcome toward measures of health-related quality of life (HRQoL) in apportioning limited resources. 36 patients after TIA participated in this study. One group (n=18) had undergone CEA, whereas the second group (n=18) had undergone CAS. Both groups were matched according to age and sex. The Short Form 36 (SF-36) was used to assess the differences in patient-perceived HRQoL in two groups of patients who had suffered minor cerebral ischemic events. No significant difference in health profile between the CEA and CAS was detected for the eight SF-36 domains. However, the CEA group rated a significantly improved change in general health after one year compared with the CAS group (p<0.001). A greater proportion of the CEA group comparing to the CAS group thought their treatment had been successful and that their health had been improved (p<0.001). Both groups shared the same level of anxiety over potential future cerebral ischemic events (p=0.3). Patients' perception of HRQoL measured by the SF-36 domains was almost identical between the CEA and CAS apart from a small but significant improvement in self-reported overall health in the CEA group after one year follow up. HRQoL outcome measures may be of value in future clinical trials of cerebral revascularization to compare the effectiveness of carotid revascularization with the particular method of operation.


EP Europace ◽  
2021 ◽  
Vol 23 (Supplement_3) ◽  
Author(s):  
CAJ Van Der Heijden ◽  
E Bidar ◽  
R Vos ◽  
J Maessen ◽  
T Athanasiou ◽  
...  

Abstract Funding Acknowledgements Type of funding sources: None. Background Although one-year success of arrhythmia surgery for atrial fibrillation (AF) has long been defined as freedom from supraventricular tachyarrhythmia, patient-reported quality of life (QOL) has become increasingly important. Purpose We aimed to analyze current evidence of QOL following both concomitant and stand-alone arrhythmia surgery for AF. Methods Studies reporting on QOL of patients undergoing arrhythmia surgery for AF, stand-alone or concomitant, who provided essential data for the analysis, were included in this systematic review. A meta-analysis was performed on inter-study heterogeneity of changes in QOL in 9 of 12 included studies who used the Short-Form (SF) 36 tool. The metric standardized mean difference (SMD) was used to compare one year outcomes with baseline scores per variable of the SF-36 QOL questionnaire (total patients n = 545). Finally, meta-regression based on rhythm outcome after one year and add-on arrhythmia surgery as covariate were performed. Results QOL scores improved one year after surgical ablation for AF, evaluated by several questionnaires. In standalone arrhythmia procedures, meta-regression showed a significant improvement between the QOL and the procedural effectiveness after one year (Physical Functioning p = 0.015, Role Physical p = 0.006, General Health p = 0.002, Social Functioning p = 0.043. Forest plot Physical Functioning: SMD = 1.105; heterogeneity: I²=90.6%, p &lt; 0.001). While this association was also suggested in concomitant procedures, only the variable Physical Role demonstrated a significant improvement when comparing QOL of cardiac surgery with and without add-on surgical AF ablation (p = 0.037). Conclusion Arrhythmia surgery for AF improves QOL. Both in standalone and concomitant procedures, the improvement in QOL seems to be related to the procedural effectiveness to maintain sinus rhythm after 12 months. Abstract Figure. SF-36 variable Physical Functioning


Author(s):  
Babak Mirzashahi ◽  
Pejman Mansouri ◽  
Arvin Najafi ◽  
Saeed Besharati ◽  
Mohammad Taha Kouchakinejad ◽  
...  

Background: This study aimed to determine the outcome of surgical treatments in patients with degenerative cervical myelopathy (DCM). During one-year follow-up period, we evaluated patient-reported functional and quality of life (QOL) measures.   Methods: In a retrospective single-center study, we collected data of patients with DCM who underwent cervical fusion surgeries in Imam Khomeini Hospital, Tehran, Iran, from 2011 to 2015. Patients underwent single or multi-level anterior cervical discectomy and fusion (ACDF), anterior cervical corpectomy and fusion (ACCF), or posterior laminectomy and fusion. We utilized patient-reported assessments including Short Form 36 (SF-36), Visual Analogue Scale (VAS), Neck Disability Index (NDI), and Nurick grade. Follow-up was performed at 6 weeks, 3 months, 6 months, and 12 months post-operatively to assess the outcome of surgery.   Results: Ninety patients (56 men, 34 women) with a mean age of 54.1 (27-87) years were included. Comparison of pre- and post-operative scores showed significant improvement in SF-36 parameters, VAS, NDI, and Nurick grade (P < 0.001). Also, women’s VAS scores improved more than men's VAS scores during the follow-up period (P < 0.050). Age and type of surgery did not significantly affect the SF-36 parameters, VAS, NDI, and Nurick grade (P > 0.05).   Conclusions: Cervical surgeries in patients with different severity of DCM can improve different aspects of QOL during one-year after surgery


Nephron ◽  
2020 ◽  
Vol 145 (1) ◽  
pp. 44-54
Author(s):  
Rens J.R. Gadaen ◽  
Jeroen P. Kooman ◽  
Tom Cornelis ◽  
Frank M. van der Sande ◽  
Bjorn J. Winkens ◽  
...  

<b><i>Introduction:</i></b> It is widely known that dialysis patients have significantly impaired functional outcomes and arterial stiffness, but still few studies have investigated the effects of dialysis longitudinally by a multidimensional approach. We aimed to assess longitudinal patterns of physical activity (PA), physical functioning (PF), health-related quality of life (HrQoL), body composition (BC), and arterial stiffness in prevalent dialysis patients. <b><i>Materials and Methods:</i></b> Thirty-nine prevalent dialysis patients (23 conventional hemodialysis [CHD] and 16 peritoneal dialysis) with a mean vintage of 25.7 (±22.1) months were included in this observational prospective study with a 2-year follow-up, and at baseline 20 healthy controls were included. Measurements were performed every 6 months. HrQoL was assessed using the Short Form-36 (SF-36) questionnaire. PA was assessed using the SenseWear™ Pro3 accelerometer. PF was assessed by walking speed, the PF subscale of the SF-36, and handgrip strength (HGS). BC was assessed using the Body Composition Monitor® and arterial stiffness by measuring carotid-femoral pulse wave velocity (PWV). The longitudinal trend was assessed using linear mixed models, correcting for sex, age, and dialysis vintage. For PWV, the trend was additionally corrected for diabetes and systolic blood pressure. <b><i>Results:</i></b> After correction, no statistically significant changes over time were observed for the parameters of PA, PF, HrQoL, and BC. In the combined group and in the group of CHD patients only, a significant change was observed for PWV (overall trend: <i>p</i> = 0.007 and <i>p</i> = 0.008, respectively). A statistically significant difference at baseline was observed between dialysis patients and healthy controls in all parameters, except for HGS and PWV. <b><i>Discussion/Conclusion:</i></b> We observed no statistically significant changes in functional outcomes during a 2-year follow-up period, but a significant increase was observed for arterial stiffness. These results might suggest that after a certain period in time, a relatively stable course is present in functional outcomes, but an ongoing deterioration in arterial stiffness occurs, which might increase the risk of cardiovascular disease and all-cause mortality in these patients.


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