Intraoperative halo-femoral traction during posterior spinal arthrodesis for adolescent idiopathic scoliosis curves between 70° and 100°: a randomized controlled trial

OBJECTIVE Surgical management of scoliosis curves between 70° and 100° remains controversial. The authors designed this randomized controlled trial to validate the efficacy of intraoperative halo-femoral traction (IOHFT) in patients with adolescent idiopathic scoliosis (AIS), Cobb angles between 70° and 100°, and flexibility < 35%. METHODS The authors prospectively recruited and randomized 29 patients with severe AIS scheduled for posterior surgery into a traction group or control (nontraction) group. The primary outcome measures were operative time, blood loss, and length of hospital stay. Secondary outcomes included degree of spine deformity correction, traction-related complications, and health-related quality of life. RESULTS In the traction group, the average preoperative Cobb angle was 83.2°, with an average 20.6% flexibility. The average postoperative Cobb angle was 16.1° and the major curve was 18.3° at the final follow-up. In the control group, the average preoperative major curve was 80.3° with 22.8% flexibility. The average postoperative Cobb angle was 16.1° and the major curve was 18.1° at the final follow-up. The operative duration was 325.7 minutes for the traction group and 385.4 minutes for the control group (p = 0.018). Compared with the control group, the traction group had a 29.5% reduction in intraoperative blood loss and a significantly lower rate of blood transfusion (13.3% vs 50.0%, p = 0.033). There were no neurological complications in either group. One patient in the traction group had a superficial infection at the traction site. CONCLUSIONS Use of IOHFT contributed to significant reductions in operative time and blood transfusion requirements, with no added morbidity. It is an effective and safe method to assist correction of AIS curves between 70° and 100° and flexibility < 35%.

EFFECTS OF LUMBAR SNAG AND MECHANICAL TRACTION IN PATIENTS WITH DISCOGENIC LUMBOSACRAL RADICULOPATHY

Objective: To compare the effects of lumbar sustained natural apophyseal glide and Mechanical Traction in patients with discogenic lumbosacral radiculopathy. Study Design: Quasi experimental study. Place and Duration of Study: Kanaan Physiotherapy and Spine Clinic, from Mar to Sep 2020. Methodology: A total of 44 patients were included in study in 2 groups of 22 each. Patients between ages 30-60 years having chronic radiating pain in one or both legs, patients with minimum of 25 score out of 100, on low back pain index and patients having radiculopathy were included. Exclusion criteria were history of low back pain treatment in last 90. Complications such as cancer, spine pathology and joint disease. Dice roll method was used for group allocation. Group classification was as group 1, sustained natural apophyseal glide group, and group 2, mechanical traction group. NPRS and oswestry disability index were used. Data analysis was done with SPSS version 21. Results: There is statistically significant improvement in pain as mean post treatment value for sustained natural apophyseal glide group is 2.55 ± 1.503 and for mechanical traction group is 4.05 ± 1.864, oswestry disability index and shober test results in sustained natural apophyseal glide group were also significant as compared to mechanical traction with p-value <0.05. Although pain was also decreased in mechanical traction group patients but overall sustained natural apophyseal glides were more effective. Conclusion: Sustained natural apophyseal glide are more effective in the treatment of lumber radiculopathy patients as compared to mechanical traction. Further studies.............

Safety and effectiveness of mucosal traction using a snare combined with endoclips to assist the resection of esophageal intraepithelial neoplasia: a propensity score matching analysis

Summary Currently, the reports on esophageal endoscopic submucosal dissection (ESD) assisted by traction with a snare are rare. Because a snare is a commonly used endoscopic accessory and is easily available, its application in mucosal traction is worth exploring. The present study aims to evaluate the safety and effectiveness of snare-endoclip traction-assisted ESD for esophageal intraepithelial neoplasia. Cases of esophageal intraepithelial neoplasia resected using ESD in the Digestive Endoscopy Center of Guangzhou Nanfang Hospital, China from June 2013 to March 2019 were retrospectively analyzed. The procedure of snare-endoclip traction-assisted ESD was compared with nontraction-assisted ESD by using a propensity score matching analysis. Operation time, en bloc and R0 resection, intra- and postoperative complications, and surgery-related costs were mainly evaluated. Overall, 99 cases of esophageal intraepithelial neoplasia under tissue biopsy were included in the present study. Further, 22 exact matched pairs were obtained. There were no differences in en bloc and R0 resection rates, intra- and postoperative complications, and costs of disposable surgical accessories between the traction group and the nontraction group. However, median operation time showed a significant difference: traction group, 50.0 min (range, 20–100 min); nontraction group, 70.0 min (range, 35–133 min), P=0.012. In conclusion, snare-endoclip traction-assisted ESD for esophageal intraepithelial neoplasia was safe and shortened operation time in the study, thereby improving the efficiency of ESD. Despite the additional use of a snare and endoclips for traction, the total costs of endoscopic accessories seemed not to be increased.

Induction of labour after 37 weeks of pregnancy using foley’s catheter: traction versus non-traction method

Background: Cervical Foley’s catheter used now a days for induction of labour alone as well as a combined with cerviprim gel. The objective of the study was to assess the effectiveness of 750 cc traction on Foley catheter with no traction for labour induction in >37 weeks pregnancy.Methods: A randomized controlled trial performed on pregnant women at >37 weeks who were admitted for induction of labour with unfavourable cervix. They were randomly assigned into two groups, Foley’s with 750 cc traction and without traction. The primary outcomes were improvement in Bishop Score, number of favourable cervix following induction and the mode of delivery. The secondary outcomes were neonatal outcome, and maternal infection.Results: A total of 80 pregnant women were randomized into traction group (n=46) and non-traction group (n=34). Traction group had significantly (p=0.0462) higher number of vaginal delivery compared to non-traction group. Participants were comfortable using both methods. There was no difference in neonatal outcomes and risk of maternal infections in both groups.Conclusions: Application of traction did result in more vaginal delivery.

A comparative evaluation of the efficacy between skeletal traction and skin traction in pre-operative management of femur shaft fractures in Korle Bu Teaching Hospital

Objectives: This study is to compare the outcomes of pre-operative skeletal and skin traction in adult femoral shaft fractures awaiting surgical fixation within two weeks of presentation to the Accident Center of Korle Bu Teaching Hospital.Methods: This study was a clinical trial on 86 recruited patients with closed femoral shaft fractures sustained within 24 hours of presentation grouped into 2 groups. Descriptive and inferential statistics comprising frequency, percentage, Chi-square, independent sample t-test and Mann-Whitney U test were used in analysing the data.Results: Of the total number of patients involved in the study, 74% (n=64) were males and 26% (n=22) were females with a mean age of 39.49 (SD ±15). There was no statistically significant difference in the mean visual analogue scale (VAS) pain assessment between the Skin traction group and Trans-tibia skeletal traction group after traction. With regards to complications, the difference between the Skin traction group and the Skeletal traction group was statistically significant (P=0.001). Moreover, the mean blood loss compared with the open type of reduction in the Transtibia skeletal traction group was significantly less than the Skin traction group (p=0.000).Conclusion: This study has shown that both Skeletal traction and Skin traction were equally effective in controlling pre-operative pain in adult patients with femoral shaft fractures and does not affect intra-operative blood loss and postoperative management. Therefore, pre-operative Skin traction can be considered a useful and cost-effective method of maintaining alignment and pain relief in adult femoral shaft fractures.Keywords: Skin traction, Trans-tibia skeletal, reamed Intramedullary nailing, Intra-operative blood loss, Visual Analogue ScaleFunding: Personal Funding

Correlation between hematological evaluation and the type of physical activity performed by horses in the state of São Paulo-Brazil

The veterinarian has to frequently assess blood tests in equine medicine. The reference values are adapted from international literature, based on examinations of healthy horses, under a standardized climate and physical activity. This study aimed to compare the blood values obtained from sports horses and traction horses, taking into account the type of activity performed. Anamnesis and hematology data from 76 animals were used: 32 members belonged to the Traction Group (TG), corresponding to equines from traction activity (cart horses) and 44 members belonged to the Sport Group (SG), corresponding to equines used in obstacle jumping, both groups were from the Pirassununga region, State of São Paulo. Complete blood counts and plasmatic fibrinogen dosage were evaluated. The animals from the TG had lower erythrocyte count and hematocrit values. The animals from the TG had greater leukocyte values in the leukogram compared to the animals from the SG. Cart horses were found to have lower means of hematological values compared to the jumping horses. Moreover, these values were below the normal physiological range for the species.

HISTOLOGICAL EXAMINATION OF THE ELONGATED ESOPHAGUS IN EXPERIMENT

Introduction. Traction and convergence of atreseal ends of the esophagus with subsequent anastomosis is the most common technique for treating newborns with the fistulous form of esophagus atresia. The performed literature analysis did not reveal any researches aiming to study the correlation between a postoperative histological picture and diastasis length between atresial esophageal ends. Purpose. To assess the potential for modeling esophageal surgeries with biological models; to study and analyze the histological picture of operated esophagus and its correlation with the diastasis distance between atresial ends. Material and methods. Rats were randomly divided into three groups (n = 5 in each group). Rats from Group 1 had a standard surgery with the end-to-end esophageal anastomosis and artificially created diastasis of 1.0 cm by esophageal segment resection. Rats from Group 2 had a similar surgery but without any esophageal segment resection; so, the anastomosis in them was put without diastasis and significant tension of esophageal ends. Rats from Group 3 did not have any surgery; they were controls. The experimental rats were monitored daily for seven postoperative days. Results. There was no any significant macroscopic difference in the esophagus length in traction, nontraction and control groups. However, microscopic examination revealed that mucous and muscular membranes thickness in the esophagus, as a rule, was slightly thinner in the traction group. Despite the muscle layer thinning, hypertrophy of muscle fibers, lymphoplasmacytic infiltration with some eosinophilic leukocytes as well as signs of perifocal epitheliotropism were noted.

DOZ047.124: Thoracoscopic anatomy of long-gap esophageal atresia. What can we predict?

Since the very beginning in 1999, thoracoscopic repair of esophageal atresia has become a gold standard in many pediatric surgery centers worldwide. Despite the advances in surgical technique, treatment of long-gap esophageal atresia still remains a challenge. The aim of this study is to assess whether the localization of esophageal stumps can predict number of stages needed to perform anastomosis. We analyzed video records of 21 patients who underwent staged thoracoscopic repair of long-gap esophageal atresia using internal traction technique. All procedures were performed by the same surgeon. We divided patients into two groups: first requiring single internal traction procedure, second who underwent multiple procedures. We assessed esophageal stump position in relation to thoracic vertebrae. The distance between stumps was measured in vertebral bodies. Mean distance between esophageal ends was 5.8 in single traction group. The distance between the stumps was significantly greater in multiple procedures group: 7.33 (P = 0.003). Patients who required multiple procedures had significantly lower localization of distal stump. Localization of proximal stump did not affect the possibility for anastomosis after single traction. Distance between both ends after internal traction was also significantly longer in multiple procedures group. Patients with lower localization of distal esophageal stump assessed during primary thoracoscopy are at higher risk for requiring multiple surgical procedures.

Comparative Effects of Portable and Stationary Traction in the Management of Mechanical Neck Disorders

Objective The purpose of this study was to compare the therapeutic effects of portable and stationary tractions on treatment outcomes in patients with mechanical neck disorders (MNDs). Methods Forty-one participants with MNDs were randomly assigned to either portable traction or stationary traction. Participants' pain level, activity limitation, disability, and neck range of motion were measured before and after 6 weeks of intervention. Inferential statistics for comparing the treatment outcome involved paired t-test and two-way analysis of variance at P < 0.05. Results The mean age of participants was 47.3 ± 10.5 years. After intervention, there were significant improvements in both groups. However, the portable traction group had significantly higher score on neck flexion than the stationary traction group at baseline (portable: 27.1 ± 6.0, stationary: 22.1 ± 6.8; P = 0.009) and after intervention ( F-ratio = 15.0; P = 0.001). Conclusion Inclusion of both portable and stationary tractions to usual physiotherapy provided comparable treatment outcomes in patients with MNDs.