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The exclusion criteria were: elevated surgical risk; high blood pressure that not respond to treatment; obstructed hernias; strangulated hernias; recurrent hernias; coagulation disorders Surgical randomization The patients entered to the study in a randomized way and the following techniques were applied: Bassini procedure without mesh and Lichtenstein procedure with mesh.
The surgical technique to be performed was contained in sequentially numbered opaque envelopes, using a table of random numbers to produce the series of interventions.
The envelopes were in an inviolable dispenser that could only be extracted per unit in a sequentially way, and its extraction was performed before the surgery, when the patient was in the pre-anesthesia room. All postoperative outpatient monitoring informations were collected in the corresponding tracking forms, which were sent to the external evaluation committee.
To evaluate the homogeneity of both study groups the following prognostic variables were taken into account: age, gender, unilateral or bilateral hernia, type of hernia direct, indirect or mixed , type of work forced, light and duration and time of evolution of surgery.
At the end of the fourth year a preliminary analysis of the results was performed by a Monitoring and Data analysis independent committee to re-evaluate the sample size necessary and decided that it wasn't necessary to continue with the inclusion of patients.
Statistical analysis To evaluate the quantitative variables age, disease evolution, duration of surgery in both groups arithmetic means and standard deviations were calculated, and were compared by the Student's t-test.
For the remaining prognostic variables, percentages were calculated which were compared by using the Chi-squared distribution or the Fisher's exact test according to the obtained frequencies.
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For the ordinal variables, the Chi-squared distribution of lineal association was applied. A survival analysis considering the time to return to work in days as the dependent variable of the type of surgery performed stratification variable was applied.
Median of these times were calculated according to the Kaplan Meier method and compared using the test of equality between strata: Log Rank Test. To perform the adjust for other intervening variables Cox's proportional hazards model was applied, the hazard ratios were calculated and their significance was tested by Likelihood Partial Test.
The adequacy of the adjustment was measured by the R 2 coefficient. The data analysis was done by intention to treatment, retaining subjects of study in their respective groups assigned at randomization.
The statistical package "STATA" was used to obtain the sample size and performing statistical analyzes.
After an intermediate analysis the sample size was recalculated and the power was significant not to continue including patients because of the benefits of the mesh placement. The patient's general characteristics are shown in the Table 1 , in which can be seen that no significant differences were found in the distribution by gender, age and type of work. Analyses per implant comparing locations between the upper and lower jaw also did not show statistical significance from planned locations in the coronal plane.
Figure 6 Open in figure viewer PowerPoint Regional analysis by implant. The overall average error was 0.
Schwartz - Principios de Cirugia Tomo 1optimizado
The average error and standard deviation per case was 0. Discussion With an increasing number of dental implant guides being used, it is important to analyze the accuracy of these systems in a controlled clinical environment.
To reduce experimental variability while still remaining biologically relevant, we assessed placement accuracy for implants that were planned and performed consistently by the same clinician. Our results show that when using this guided implant system, final implant locations are not statistically different from planned locations, corroborating our original hypothesis. Our novel cadaveric model provides a clinically relevant analysis of implant placement error resulting from the use of surgical guides, while upholding scientific rigor by reducing experimental variance.
In this study, average deviation was 0. It was also observed that the range of deviation was higher at the apex compared to the coronal plane.
Careful planning can help ensure an appropriate implant length to prevent damage to the maxillary sinus or mandibular nerve. It has been shown that error occurring during image acquisition and data processing ranges from 0. Error during surgical template production can be up to 0.
Error can also occur during template positioning and be increased if there is movement during drilling. Axial deviation could also occur from human error, such as setting the bur at the incorrect position. Because tolerance is dependent on bone mass and location to critical anatomic structures, among other patient factors, there are no universal tolerance values established for dental implant placement.
With the ability of errors to compound, it is important to still maintain safety margins when planning implant placement. In this study, experimental variability was reduced significantly by allowing only one clinician to plan and perform all surgeries in the same surgical environment.
The ex vivo use of entire cadaver heads allows a more clinical representation of surgical conditions while being able to ethically control for environmental variability.
However, due to preservation, cadaveric bone can be softer than live bone.Statistical analysis To evaluate the quantitative variables age, disease evolution, duration of surgery in both groups arithmetic means and standard deviations were calculated, and were compared by the Student's t-test.
Libro Principios de Cirugia SchwartzTomo 1
As an intern, Dr. Spencer, and Dr. Upperman, MD. Seymour Schwartz and Dr.
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