Pelvic floor muscle exercise (PFME) is the most common conservative management for urinary incontinence (UI) after radical prostatectomy (RP). However, whether the PFME guided by a therapist (G-PFME) can contribute to the recovery of urinary continence for patients after RP is still controversial. We performed this meta-analysis to investigate the effectiveness of G-PFME on UI after RP and to explore whether the additional preoperative G-PFME is superior to postoperative G-PFME alone. Literature search was conducted on Cochrane Library, Embase, Web of Science, and PubMed, to obtain all relevant randomized controlled trials published before March 1, 2018. Outcome data were pooled and analyzed with Review Manager 5.3 to compare the continence rates of G-PFME with control and to compare additional preoperative G-PFME with postoperative G-PFME. Twenty-two articles with 2647 patients were included. The continence rates of G-PFME were all superior to control at different follow-up time points, with the odds ratio (OR) (95% confidence interval [CI]) of 2.79 (1.53-5.07), 2.80 (1.87-4.19), 2.93 (1.19-7.22), 4.11 (2.24-7.55), and 2.41 (1.33-4.36) at 1 month, 3 months, 4 months, 6 months, and 12 months after surgery, respectively. However, there was no difference between additional preoperative G-PFME and postoperative G-PFME, with the OR (95% CI) of 1.70 (0.56-5.11) and 1.35 (0.41-4.40) at 1 month and 3 months after RP, respectively. G-PFME could improve the recovery of urinary continence at both early and long-term stages. Starting the PFME preoperatively might not produce extra benefits for patients at early stage, compared with postoperative PFME.
Humans ; Male ; Muscle, Skeletal/physiopathology* ; Pelvic Floor/physiopathology* ; Physical Therapy Modalities ; Prostatectomy/adverse effects* ; Prostatic Neoplasms/surgery* ; Treatment Outcome ; Urinary Incontinence/therapy*

PURPOSE: This study investigated the correlation between isometric muscle strength, gross motor function, and gait parameters in patients with spastic cerebral palsy and to find which muscle groups play an important role for gait pattern in a flexed knee gait. MATERIALS AND METHODS: Twenty-four ambulatory patients (mean age, 10.0 years) with spastic cerebral palsy who were scheduled for single event multilevel surgery, including distal hamstring lengthening, were included. Preoperatively, peak isometric muscle strength was measured for the hip flexor, hip extensor, knee flexor, and knee extensor muscle groups using a handheld dynamometer, and three-dimensional (3D) gait analysis and gross motor function measure (GMFM) scoring were also performed. Correlations between peak isometric strength and GMFM, gait kinematics, and gait kinetics were analyzed. RESULTS: Peak isometric muscle strength of all muscle groups was not related to the GMFM score and the gross motor function classification system level. Peak isometric strength of the hip extensor and knee extensor was significantly correlated with the mean pelvic tilt (r=-0.588, p=0.003 and r=-0.436, p=0.033) and maximum pelvic obliquity (r=-0.450, p=0.031 and r=-0.419, p=0.041). There were significant correlations between peak isometric strength of the knee extensor and peak knee extensor moment in early stance (r=0.467, p=0.021) and in terminal stance (r=0.416, p=0.043). CONCLUSION: There is no correlation between muscle strength and gross motor function. However, this study showed that muscle strength, especially of the extensor muscle group of the hip and knee joints, might play a critical role in gait by stabilizing pelvic motion and decreasing energy consumption in a flexed knee gait.
Biomechanical Phenomena ; Cerebral Palsy/*physiopathology/surgery ; Female ; Gait/*physiology ; Humans ; Isometric Contraction/physiology ; Knee/physiopathology ; Knee Joint/surgery ; Male ; Muscle Spasticity/etiology/physiopathology ; Muscle Strength/*physiology ; Muscle Strength Dynamometer ; Muscle, Skeletal/*physiopathology ; Pelvis ; Postural Balance/physiology ; Tenotomy

This article briefly summarizes the techniques for repair of skin and soft tissue defects around the knee joints as reported in 5 papers in this issue, including how to choose the skin flap, muscle flap, myocutaneous flap, and vascular anastomosis in recipient site. It is found that the anterolateral femoral flap, latissimus dorsi myocutaneous flap, and gastrocnemius flap are widely used in clinic with high survival rates, and they can be used for the repair of large soft tissue defects as well as the reconstruction of the knee joint function.
Humans ; Knee Injuries ; surgery ; Knee Joint ; physiopathology ; surgery ; Muscle, Skeletal ; Myocutaneous Flap ; Reconstructive Surgical Procedures ; methods ; Skin ; Skin Transplantation ; methods ; Soft Tissue Injuries ; surgery ; Surgical Flaps ; Treatment Outcome ; Wound Healing

OBJECTIVETo analyze the extent of postoperative hip abductor insufficiency in primary total hip arthroplasty (THA) patients undergoing anterolateral minimally invasive (ALMI) approach, and to investigate whether the clinical outcomes are more favorable in femoral neck fracture (FNF) patients than in non-femoral neck fracture (nFNF) patients.

METHODSA total of 48 patients were enrolled in this study. Each patient underwent a clinical examination preoperatively and 6, 12, 24 and 48 weeks postoperatively. The abductor torque, Trendelenburg's sign, gait velocity, Harris hip score, Oxford hip score, Westren Ontario and McMaster Universities (WOMAC) score and visual analog scale pain score were recorded. Statistical evaluation was performed with SPSS software version 18.0. The significance level was set at P<0.05.

RESULTSThe abductor torque of the operated hip and the recovery ratio showed a gradual improving tendency from 6 weeks postoperatively until the last follow-up. Gait velocity, Harris hip score, Oxford hip score and WOMAC score improved significantly after the operation until 24 weeks postoperatively. In the FNF group, the abductor torque of the operated side and the recovery ratio were significantly higher than in nFNF group at 6 weeks postoperatively, however, as time passed, this trend tended to disappear.

CONCLUSIONThis study demonstrates that patients can obtain good abductor strength and function in the early postoperative period and the hip abductor function of patients who suffer from hip osteoarthritis, rheumatoid arthritis, avascular necrosis of the femoral head could be significantly improved following ALMI THA.

Aged ; Arthroplasty, Replacement, Hip ; Femoral Neck Fractures ; physiopathology ; surgery ; Hip ; Humans ; Middle Aged ; Minimally Invasive Surgical Procedures ; Muscle Strength ; Muscle, Skeletal ; physiology ; Prospective Studies ; Recovery of Function ; Torque

BACKGROUND: It is not clear whether the pronator quadratus (PQ) muscle actually heals and provides a meaningful pronation force after volar plating for distal radius fractures (DRFs). We aimed to determine whether the length of the PQ muscle, which is dissected and then repaired during volar plating for a DRF, affects the forearm rotation strength and clinical outcomes. METHODS: We examined 41 patients who requested hardware removal after volar plating. We measured the isokinetic forearm rotation strength and clinical outcomes including grip strength, wrist range of motion, and disabilities of the arm, shoulder and hand (DASH) scores at 6 months after fracture fixation. During the hardware removal surgery, which was performed at an average of 9 months (range, 8.3 to 11.5 months) after fracture fixation, we measured the PQ muscle length. RESULTS: The average PQ muscle length was 68% of the normal muscle length, and no significant relationship was found between the PQ muscle length and the outcomes including isokinetic forearm rotation strength, grip strength, wrist range of motion, and DASH scores. CONCLUSIONS: This study demonstrates that the length of the healed PQ muscle does not affect isokinetic forearm rotation strength and clinical outcomes after volar plating for DRFs. The results of this study support our current practice of loose repair of the PQ that is performed by most of the surgeons to prevent tendon irritation over the plate, and suggest that tight repair of the PQ is not necessary for achieving improved forearm function.
Adult ; Aged ; Bone Plates ; Device Removal ; Female ; Forearm/physiopathology/surgery ; Fracture Fixation, Internal/*methods ; Hand Strength ; Humans ; Male ; Middle Aged ; Muscle Strength ; Muscle, Skeletal/physiopathology/*surgery ; Radius Fractures/radiography/*surgery ; Range of Motion, Articular ; Wound Healing ; Young Adult

OBJECTIVETo analyze the long-term effects of the quadratus femoris muscle pedicle bone graft with screw fixation for the treatment of femoral neck fractures in young adults.

METHODSFrom 2002 to 2008, 38 patients with femoral neck fractures were operated. There were 22 males and 16 females, with an average age of 40 years (ranged 25 to 60 years). Twenty-six patients injured from high velocity road traffic accident, among which 14 patients injured in automobile accident, 8 in two wheeler accident and 4 in fall from height. Twelve patients had serious associated injuries. Femoral neck fractures were classified by Garden classification: 25 patients were Graden II and 13 patients were Graden III. Thirty-six patients underwent emergency operation and 2 had delayed operation. Clinical scores were evaluated based on Sanders scores and the radiological criteria which was judged by the diminution of density in the necrotic portion of the femoral head.

RESULTSAll the patients were followed up for at least 2 years (ranged 2 to 5 years). There were significant differences between preoperation and postoperation in pain, function, muscle power and walk ability. All the patients with fractures were healed in an average of 5 months after operation and walked without aids and no complications occurred.

CONCLUSIONThis technique provides a high union rate with a low complication rate. In addition, the surgical procedure is relatively simple and has a nice long-term result.

Adult ; Aged ; Bone Screws ; Bone Transplantation ; Female ; Femoral Neck Fractures ; physiopathology ; surgery ; Follow-Up Studies ; Fracture Fixation, Intramedullary ; instrumentation ; Humans ; Male ; Middle Aged ; Muscle, Skeletal ; transplantation ; Time ; Treatment Outcome

OBJECTIVETo explore the improvement of the method for the treatment of supracondylar fractures of humerus in order to prevent and decrease the occurrence of cubitus varus.

METHODSOne hundred and ninety-seven patients with supracondylar fractures of humerus included 167 males and 30 females with an average age of 8.7 years old ranging from 3 to 12 years. There were 179 cases of extention and 18 cases of flexion. Six cases were open fractures. Thirty-four patients of fractures underwent fixation by only plaster slab, 53 underwent manipulative reduction and fixation by plaster slab, 23 underwent traction reduction and fixation by plaster slab, 87 underwent surgical operation. Among the cases of operation, 29 cases adopted anterior-lateral incision of elbow and 85 adopted posterior-interior incision of elbow.

RESULTSAmong the 197 cases, 191 cases were followed up for 1 to 5 years with an average of 3.7 years. According to the correlated curative effect evaluation of supracondylar fractures of humerus, the results were excellent in 142 cases, good in 27, fair in 13, poor in 9. Cubitus varus occurred in 8 cases.

CONCLUSIONThe objective factors for the occurrence of elbow varus do exist. However, during the treatment of these fracture, if strict correction of the ulnar deviation and stability are maintained during the reduction, the rate of occurrence of elbow varus could made to decreased a minimum.

Child ; Child, Preschool ; Elbow ; physiopathology ; Female ; Fracture Fixation ; methods ; Humans ; Humeral Fractures ; complications ; surgery ; Male ; Muscle, Skeletal ; physiopathology ; Postoperative Complications ; Treatment Outcome

BACKGROUND: The aim of this study was to evaluate the contribution of the proximal nerve stump, in end-to-side nerve repair, to functional recovery, by modifying the classic end-to-side neurorrhaphy and suturing the proximal nerve stump to a donor nerve in a rat model of a severed median nerve. METHODS: Three experimental groups were studied: a modified end-to-side neurorrhaphy with suturing of the proximal nerve stump (double end-to-side neurorrhaphy, Group I), a classic end-to-side neurorrhaphy (Group II) and a control group without neurorrhaphy (Group III). Twenty weeks after surgery, grasping testing, muscle contractility testing, and histological studies were performed. RESULTS: The grasping strength, muscle contraction force and nerve fiber count were significantly higher in group I than in group II, and there was no evidence of nerve recovery in group III. CONCLUSIONS: The contribution from the proximal nerve stump in double end-to-side nerve repair might improve axonal sprouting from the donor nerve and help achieve a better functional recovery in an end-to-side coaptation model.
Anastomosis, Surgical/methods ; Animals ; Axons/pathology ; Forelimb ; Hand Strength ; Male ; Median Nerve/pathology/*surgery ; Muscle Contraction ; Muscle, Skeletal/physiopathology ; Nerve Regeneration ; Nerve Transfer/*methods ; Rats ; Rats, Sprague-Dawley ; Recovery of Function ; Ulnar Nerve/pathology/*surgery

OBJECTIVETo investigate the clinical application of free forearm flap in the functional hemitongue reconstruction.

METHODSFrom July 2002 to November 2006, 40 patients with tongue cancer underwent hemiglossectomy and primary hemitongue reconstruction with free forearm flaps. In some cases, the lateral antebrachial cutaneous nerves of the flaps were anastomosed with the lingual nerve to restore the flap sensation.

RESULTSAll patients recovered uneventfully after surgery with no morbidity in the donor site. All free flaps survived. The average follow-up period was 2 years and 6 months. The aesthetic and functional results were both satisfactory. The swallowing and speech function were almost normal. The flap sensation was partially restored.

CONCLUSIONSGood functional hemitongue reconstruction can be achieved with free forearm flaps.

Adult ; Aged ; Female ; Forearm ; surgery ; Humans ; Male ; Middle Aged ; Muscle, Skeletal ; transplantation ; Oral Surgical Procedures ; Reconstructive Surgical Procedures ; methods ; Skin Transplantation ; Surgical Flaps ; Tongue Neoplasms ; physiopathology ; surgery

OBJECTIVE: To evaluate the clinical therapeutic effect of the release of gluteal muscle contracture by radiofrequency under arthroscopy. METHODS: From January 2004 to April 2005, 86 patients with gluteal muscle contracture were treated by radiofrequency release under arthroscopy.The patients were followed-up for 6-18 months(mean=12.6 months). RESULTS: Getting carriage, squatting down while keeping their knees contacting, crossing leg test, and impact on movement were served as evaluation criteria. Of the 86 patients, 79 had excellent results, 5 good, and the rest 2 were acceptable. There was no recurrence at the last follow-up, and all the patients were satisfied. CONCLUSION For gluteal muscle contracture, radiofrequency release under arthroscopy has minimally invasion, good results and quick recovery.
Adolescent ; Adult ; Arthroscopy ; Buttocks ; Catheter Ablation ; Child ; Contracture ; surgery ; Female ; Hip Contracture ; physiopathology ; surgery ; Humans ; Male ; Minimally Invasive Surgical Procedures ; Muscle, Skeletal ; physiopathology ; surgery ; Range of Motion, Articular