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Abstrak :
ABSTRAK
Latar Belakang: Stenosis kanal lumbal SKL merupakan suatu kondisi yang potensial menimbulkan disabilitas dan seringkali ditemukan seiring meningkatnya usia populasi. Studi bertujuan menganalisa hubungan antara luaran klinis pasien SKL dan klasifikasi stenosis berdasarkan MRIMetode: Studi kohort prospektif ini dilakukan di Rumah Sakit Cipto Mangunkusumo RSCM pada januari hingga juli 2016 melalui metode consecutive sampling. Tiga puluh delapan sampel didapat dan kesemuanya dilakukan tatalaksana pembedahan yang sama yaitu dekompresi dan stabilisasi posterior. Subjek dikategorikan ke dalam 4 kategori berdasarakan pemeriksaan MRI menggunakan klasifikasi Schizas. Pemeriksaan pra dan pasca operasi 3 bulan dan 6 bulan dilakukan menggunakan Visual Analogue Scale VAS , Oswestry Disability Index ODI , Japanese Orthopaedic Association Score JOA and Roland Morris Disability Questionnaire RMDQ . Analisis statistic dilakukan dengan menggunakan program SPSS v19Hasil: Rata ndash; rata usia dari 38 sampel yang didapatkan adalah 58.92 tahun rentang 50-70 tahun . Terdapat 16 orang laki ndash; laki dan 22 orang perempuan. Sebagian besar pasien diklasifikasikan pada grade C berdasarkan klasifikasi Schizas. Perbaikan skor klinis pada subjek laki ndash; laki didapatkan lebih tinggi dibanding perempuan dan hasilnya didapatkan bermakna pada pengukuran VAS pascaoperasi 6 bulan p=0.003 dan JOA pascaoperasi 3 bulan p=0.029 . Tidak ditemukan perbedaan bermakna antara derajat klasifikasi berdasarkan MRI dengan skor perbaikan klinis preoperasi, 3 bulan dan 6 bulan pasca operasi menurut VAS p=0.451, p=0.738, p=0.448 , ODI p=0.143, p=0.929, p=0.796 , JOA p=0.157, p=0.876, p=0.961 dan RMDQ p=0.065, p=0.057, p=0.094 Simpulan: Terdapat perbaikan klinis setelah dilakukan operasi dekompresi dan stabilisai posterior yang ditandai dengan perbaikan skor VAS, ODI, JOA dan RMDQ pasca operasi 3 dan 6 bulan . Tidak terdapat hubungan antara derajat SKL dengan skor VAS, ODI, JOA dan RMDQ.

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ABSTRACT
Background Lumbar canal stenosis LCS is a condition which can potentially cause disability and often discovered within the increasing age of population. The aim of this study was to analyze the correlation between clinical outcome of postoperative patients and classifications that are based from MRI assesments.Method This prospective cohort study was carried out a Cipto Mangunkusumo General Hospital from January till july 2016 obtained using consecutive sampling. Thirty eight samples were obtained and all of them were managed with same surgical technique that was decompression and posterior stabilization. Patients were categorized in 4 types based on MRI examination using Schizas Classification. Pre and post treatment 3 month and 6 month assessment of the patients was done according to Visual Analogue Scale VAS , Oswestry Disability Index ODI , Japanese Orthopaedic Association Score JOA and Roland Morris Disability Questionnaire RMDQ . Statistical analysis was performed using statitiscal program for social science SPSS v.19.Result From 38 samples that were obtained average age was 58.92 years old range 50 70 years old . There were 16 males and 22 females. Most of patients are classified in type C 21 subjects based on MRI examination. The improvement of clinical score in male subjects were better dan female subjects and significantly different in 6 month postoperative VAS p 0.003 and 3 month postoperative JOA score p0.029 . In this study was found that generally VAS, ODI, JOA and RMDQ score improved along follow up time. There was no statistical differences between MRI based classification and clinical outcome in preoperative, 3 and 6 month postoperative according to VAS p 0.451, p 0.738, p 0.448 , ODI p 0.143, p 0.929, p 0.796 , JOA p 0.157, p 0.876, p 0.961 dan RMDQ p 0.065, p 0.057, p 0.094 Conclusion There was clinical improvement after decompression and posterior stabilization in lumbar canal stenosis which were manifested in 3 and 6 months post operation of VAS ODI, JOA and RMDQ score. There was no association between degree of LCS and VAS, ODI, JOA and RMDQ score.

Abstrak :
Pendahuluan: Enhanced Recovery After Surgery (ERAS) bertujuan untuk menstandardisasi manajemen perioperatif dan meningkatkan luaran klinis. Implementasi ERAS pada total knee replacement (TKR) mengurangi mortalitas, transfusi, komplikasi, dan length of stay (LOS) tanpa mempengaruhi readmisi. Studi ini bertujuan mengevaluasi ERAS pada pasien TKR unilateral di Indonesia. Metode: Penelitian ini menggunakan desain klinis acak tersamar tunggal di RSUPN Dr. Cipto Mangunkusumo dan RS Fatmawati, Jakarta, dengan 55 pasien TKR unilateral berusia 60-70 tahun dengan OA grade III-IV sebagai subjek. Metode analisis data melibatkan SPSS dengan uji normalitas, Chi-square, T tidak berpasangan, dan Mann Whitney untuk menilai efektivitas ERAS dibandingkan dengan protokol konvensional. Hasil: Hasil menunjukkan bahwa protokol ERAS meningkatkan skor Knee Special Score (KSS) (p=0,001, mean difference=4,09) dan Oxford Knee Score (OKS) (p<0,001, mean difference=4,98), serta mengurangi durasi rawat inap (p<0,001, mean difference=-2,15 hari) dan nyeri pascaoperasi (p<0,001, mean difference=-2,01) dibandingkan protokol konvensional. Faktor pre-operatif dan post-operatif seperti usia, komorbiditas, dan mobilisasi dini memberikan pengaruh terhadap durasi lama rawat inap. ERAS efektif menurunkan nyeri pascaoperasi dan meningkatkan skor KSS serta OKS. Integrasi edukasi praoperatif, manajemen nyeri, mobilisasi dini, dan perawatan perioperatif komprehensif meningkatkan hasil fungsional. Kesimpulan: Program ERAS secara signifikan memperbaiki skor KSS, OKS, mengurangi durasi rawat inap, dan menurunkan nyeri pascaoperasi pada pasien TKR unilateral dibandingkan protokol konvensional. ......Introduction: Enhanced Recovery After Surgery (ERAS) aims to standardize perioperative management and improve clinical outcomes. ERAS implementation in total knee replacement (TKR) reduces mortality, transfusions, complications, and length of stay (LOS) without affecting readmissions. This study aims to evaluate ERAS in unilateral TKR patients in Indonesia. Methods: This study utilized a single-blind randomized clinical trial design at RSUPN Dr. Cipto Mangunkusumo and RS Fatmawati, Jakarta, involving 55 unilateral TKR patients aged 60-70 years with grade III-IV OA. Data analysis methods included SPSS, normality tests, Chi-square, independent T-tests, and Mann Whitney tests to evaluate the effectiveness of ERAS compared to conventional protocols. Result: The results show that the ERAS protocol improves Knee Society Score (KSS) (p=0.001, mean difference=4.09) and Oxford Knee Score (OKS) (p<0.001, mean difference=4.98) scores, reduces length of stay (p<0.001, mean difference=-2.15 days), and decreases postoperative pain (p<0.001, mean difference=-2.01) compared to conventional protocols. Discussion: Pre-operative and post-operative factors such as age, comorbidities, and early mobilization influence the length of stay. ERAS effectively reduces postoperative pain and improves KSS and OKS scores. Integrating preoperative education, pain management, early mobilization, and comprehensive perioperative care enhances functional outcomes. Conclusion: The ERAS program significantly improves KSS, OKS scores, reduces length of stay, and decreases postoperative pain in unilateral TKR patients compared to conventional protocols.