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1.
Yusuke Hori Akira Matsumura Takashi Namikawa Minori Kato Shinji Takahashi Shoichiro Ohyama Tomonori Ozaki Akito Yabu Hiroaki Nakamura 《Journal of orthopaedic science》2019,24(2):224-229
Background
The degenerative lumbar scoliosis (DLS) patients who mainly complained about neurogenic claudication due to spinal canal stenosis are well-indicated for short segment fusion (SSF) at the affecting levels. However, it is unclear whether we should consider global sagittal balance or not. The aim of this study was to evaluate the impact of sagittal balance on the surgical outcomes of degenerative lumbar scoliosis (DLS) patients who underwent SSF.Methods
We retrospectively reviewed 70 DLS patients who underwent SSF (less than 3 levels) and could be followed for at least 2 years. The PI-LL, PT, SVA, and T1 pelvic angle (TPA) were measured using standing whole spine X-rays preoperatively (PreO) and at final follow-up (FFU). Surgical outcomes were assessed with the improvement in Japanese Orthopaedic Association score (JOAs) for low back pain (LBP), and the level of LBP was measured using the visual analogue scale (LBP-VAS). We analysed the relationships between the radiographic parameters and the surgical outcomes.Results
We divided the patients into the three groups (poor/fair/good) based on the JOAs. The analysis with the Jonckheere-Terpstra trend test indicated that the following radiographic parameters had a significant trend with surgical outcomes in each group: (poor/fair/good; p value); PreO PI-LL (26/20/17°; P = 0.04), SVA (46/75/35.5 mm; P = 0.02), TPA (28/27/23°; p = 0.04), FFU PI-LL (33/25/8.5°; P = 0.004), SVA (93/90.5/32.5 mm; P = 0.001), and TPA (33/29/25°; P = 0.007). Additionally, LBP-VAS had a significant correlation between the three groups at final follow-up (P = 0.004). There were significant correlations between improvement in JOAs and PI-LL, SVA, and TPA both PreO and at FFU (P < 0.05).Conclusions
Sagittal spinal imbalance and spinopelvic malalignment significantly impact the surgical outcomes of SSF for DLS. Preoperative evaluation of spinopelvic alignment and sagittal balance is of critical importance when SSF are performed for DLS patients. 相似文献2.
Yoshihiro Hagiwara Takuya Sekiguchi Yutaka Yabe Haruki Momma Masahiro Tsuchiya Kenji Kanazawa Masashi Koide Nobuyuki Itaya Shinichiro Yoshida Yasuhito Sogi Toshihisa Yano Eiji Itoi Ryoichi Nagatomi 《Journal of orthopaedic science》2019,24(2):361-367
Background
Because the relationship between coaches and athletes is unequal, verbal and physical abuse remains a common problem among sports coaches. We aimed to elucidate the characteristics of baseball coaches who verbally/physically abuse young baseball players.Methods
A cross-sectional study was conducted on youth sports team coaches in Miyagi prefecture, Japan (n = 380), using a self-reported questionnaire. Multivariate logistic regression models were used for the analyses, evaluating the following variables: sex, age, educational level, smoking habits, years of coaching, level of baseball-playing experience, personal experience with verbal/physical abuse by former coaches, satisfaction with athletes’ attitudes, number of athletes on the team, team competition level, awareness of the recommendations of the Japanese Society of Clinical Sports Medicine, limitations in the total pitch count, difficulty in coaching in other positions, number of games per year, and acceptance of former verbal/physical abuse.Results
The prevalence of verbal/physical abuse toward young athletes was 74.5% (n = 283) and 6.6% (n = 25), respectively. Verbal abuse was significantly associated with personal experience of verbal abuse by former coaches (odds ratio [OR]: 2.00, 95% confidence interval [95% CI]: 1.04–3.85), and acceptance of verbal/physical abuse (OR: 2.61, 95% CI: 1.34–5.10). Physical abuse was significantly associated with greater than 10 years of coaching experience (OR: 7.16, 95% CI: 1.36–37.78), personal experience with physical abuse by former coaches (OR: 4.25, 95% CI: 1.23–14.70), and acceptance of verbal/physical abuse (OR: 3.85, 95% CI: 1.51–9.84).Conclusions
Coaches’ experiences with verbal/physical abuse by former coaches negatively affected young athletes. Breaking this cycle is necessary to keep athletes active and interested in playing baseball.Level of evidence
Level III. 相似文献3.
Victor Kong Ross Weale Joanna Blodgett Johan Buitendag George Oosthuizen John Bruce Grant Laing Damian Clarke 《American journal of surgery》2019,217(4):653-657
Introduction
The spectrum of injury associated with anterior abdominal stab wounds (SWs) is well established. The literature in the specific setting of isolated omental evisceration is limited.Materials and methods
We reviewed our experience of 244 consecutive patients with established indications for laparotomy over an eight year period at a major trauma centre in South Africa.Results
Of the 244 patients (93% male, mean age: 27 years), 224 (92) underwent immediate laparotomy (IL). Twenty were initially observed and eventually required a laparotomy (delayed laparotomy, DL). The mean time from injury to decision for laparotomy was <3?h in 92% (224/244), <6?h in 6% (14/244), <12?h 2% (4/244) and <18?h in 1% (2/244). Ninety-eight per cent (238/244) of laparotomies were positive and 96% of the positive laparotomies (229/238) were considered therapeutic. The mostly commonly injured organ encountered on laparotomy were small bowel, stomach and colon.Conclusions
The most commonly injures encountered are intestinal and gastric. Clinicians must remain vigilant as injuries may be subtle. 相似文献4.
5.
Kiyoshi Yoshida Ichiro Kajiura Tsunehiko Suzuki Hidehiko Kawabata 《Journal of orthopaedic science》2018,23(4):649-652
Background
Scoliosis in cerebral palsy (CP) often occurs and causes a disturbance in daily life. The purpose of this study was to investigate the natural history of scoliosis in cerebral palsy and determine risk factors for the progression of scoliosis using multivariate analyses.Methods
We revised 113 patients with CP (47 males and 66 females) who had scoliosis with a curve of at least 10° were reviewed and retrospectively investigated these cases of scoliosis and analyzed the risk factors for the progression of this condition.Results
The mean follow-up period was 16.5 years and the mean age at onset of scoliosis was 6.6 years (range: 1–16 years). In 59 patients (52%), the age at onset of scoliosis was under 6 years. On the final radiographs, the mean Cobb angle was 55.1° (range: 10° to 169°). After the age of 20 years, 13 of 40 patients (32.5%) had a progression of over 10° in scoliosis. Multivariate analyses showed the risk factors for the progression of scoliosis to be hip displacement (p = 0.0038), the onset of scoliosis before the age of 6 years (p = 0.0024), and 30° of the Cobb angle before the age of 10 years (p < 0.001). A subtype of CP (spastic quadriplegia) was identified as a potential risk factor.Conclusions
After the age of 20 years, 32.5% patients had a progression of over 10° in scoliosis. Risk factors for the progression of scoliosis in CP included hip displacement, early-onset scoliosis, and Cobb angle of 30° before the age of 10 years.Level of evidence
Prognostic level IV - case series. 相似文献6.
Huan Yan Natalie Calcatera Tricia A. Moo-Young Richard A. Prinz David J. Winchester 《American journal of surgery》2019,217(3):437-440
Background
Primary hyperparathyroidism (HPT) is an undertreated disease. This study's purpose is to determine if the calcium levels correlate with prevalence of symptoms and surgical treatment in patients with primary HPT.Method
Patients treated in 2006–2015 with serum calcium≥10.0?mg/dL and PTH>65?pg/mL were identified and stratified based on calcium level: 10.0–10.3 (normocalcemia), 10.4–11.2 (moderate), and ≥11.3 (severe) mg/dL. Clinical variables and rates of surgery were compared between the three groups.Results
A total of 2266 patients were identified: 303 with normocalcemia, 1513 with moderate hypercalcemia, and 450 with severe hypercalcemia. All three groups had similar rates of nephrolithiasis (p?=?0.10), osteoporosis (p?=?0.82), and reduced GFR (p?=?0.06). Most patients (85%) had at least one surgical indication, but only 29% underwent parathyroidectomy. Higher calcium levels were correlated with higher surgical rates: 12% for Ca 10.0–10.3, 27% for Ca 10.4–11.2, and 46% for Ca≥11.3 (p?<?0.01).Conclusion
Prevalence of symptoms does not correlate with calcium levels. Patients with normocalcemia and moderate hypercalcemia were equally likely to have a surgical indication, but normocalcemic patients are less likely to receive surgery. 相似文献7.
A. Ríos A. López-Navas P.R. Gutiérrez F.J. Gómez J. Iriarte R. Herruzo G. Blanco F.J. Llorca A. Asunsolo P. Sánchez A. Fernández M.T. de Jesús L. Martínez Alarcón A. Lana L. Fuentes J.R. Hernández J. Virseda J. Yelamos P. Parrilla 《Transplantation proceedings》2019,51(2):250-252
Introduction
Religious factors have conditioned the attitude toward organ donation and transplantation (ODT) since the beginning of transplantation, despite the fact that most religions are in favor of transplantation.Objective
To assess the impact of religious beliefs of medical students on their attitude toward ODT.Method
Population under study: Medical students in Spanish universities. Study sample: Stratified by geographical area and academic course. Assessment instrument: Attitude ODT questionnaire PCID-DTO-Ríos, anonymous and self-administered.Results
Of all students, 42% (n = 3907) declare themselves atheists or agnostics. The remaining 58% (n = 5368) declare themselves to be religious, the majority being Catholic (55%, n = 5102). Of the rest, 0.2% are Muslims (n = 8), 0.1% Protestants (n = 1), and the remaining 2.7% (n = 257) indicate other religious doctrines but do not want to specify it. Regarding their attitude toward ODT, those who consider themselves atheists or agnostics have a more favorable attitude than those who consider themselves religious (84% versus 76%; P < .001). Among those who follow some kind of religion, Catholics are more in favor of ODT than non-Catholics (77% vs 64%, P < .001). Note that among the religious, only 57% (n = 3050) know which religion is in favor of transplantation, while 22% (n = 1,152) consider that it has not been pronounced on the matter, 13% (n = 723) think the religion is against donation, and the remaining 8% (n = 443) do not know.Conclusion
The religion professed by medical students conditions their attitude toward donation, with the atheists and agnostics being more in favor of donation. 相似文献8.
M. Aloufi G. Alzahrany N. Abdulmajeed S. Alzahrani S. Alghwery R. Zahid A. Alghamdi 《Transplantation proceedings》2019,51(2):522-525
Background
Viral infections are known to be common complications after kidney transplant (KTx), causing significant numbers of mortality and morbidity.Objectives
We aimed to highlight the pattern of viral infections after KTx in children and its impact on allograft function.Methods
We included children who underwent KTx between 2012 and 2017. Baseline demographics, immunosuppressive agents, episodes of viral infections with cytomegalovirus (CMV), BK virus, and Epstein-Barr virus (EBV), and serum creatinine were collected. All children received induction agent followed by maintenance immunosuppression. Oral valganciclovir was given to all high-risk patients for CMV for 180 days as prophylaxis. CMV and EBV polymerase chain reactions were monitored every 2 weeks initially until the ninth month, then monthly until the end of the second year, and then every 3 months. Urine BKV polymerase chain reactions were monitored monthly in the first year and then every 3 months.Results
A total of 18 children received transplants. There was 1 episode of CMV infection (5.6%), 2 episodes (11.1%) of isolated BK viruria (1 of the 2 with an episode of BK viremia [5.6%] with no associated BK nephropathy [0%]), and no episodes of EBV or lymphoproliferative disease (0%). Allograft functions continued to be stable with mean serum creatinine of 52.2 μmol/L during the study period with 2 episodes (11.1%) of acute cellular rejection and 1 episode (5.6%) of early antibody-mediated rejection.Conclusion
Prolonged prophylaxis and strict viral monitoring protocol can be effective ways of controlling viral infections after KTx. 相似文献9.
Nobuyuki Fujita Aiko Sakurai Azusa Miyamoto Takehiro Michikawa Osahiko Tsuji Narihito Nagoshi Eijiro Okada Mitsuru Yagi Yohei Otaka Takashi Tsuji Hitoshi Kono Ken Ishii Masaya Nakamura Morio Matsumoto Kota Watanabe 《Journal of orthopaedic science》2019,24(1):19-23
Background
Locomotive syndrome is a condition in which the ability to lead a normal life is restricted owing to a dysfunction in one or more of the parts of the musculoskeletal system. Although lumbar spinal canal stenosis (LSS) is considered to cause locomotive syndrome, a detailed assessment of the association between two pathologies has not yet been reported.Methods
The clinical data of patients aged > 65 years old who planned to undergo surgery for LSS at multiple institutions were prospectively collected from April 2016 to August 2017. A total of 200 participants comprising 120 men and 80 women were enrolled in this study. Association of severity of LSS evaluated by Zurich Claudication Questionnaire scores with three locomotive syndrome risk tests (Stand-up Test, the Two-step Test, and a 25-question risk assessment) and Timed Up-and-Go Test were evaluated.Results
In the total assessment of locomotive syndrome, 96.5% of the participants were diagnosed as grade 2, and the remaining 3.5% were diagnosed as grade 1. When the participants were divided into 3 groups according to the LSS severity, the scores of all locomotive syndrome risk tests were significantly worse with increasing LSS severity. Logistic regression analysis revealed that LSS severity was positively correlated with the risk level of locomotive syndrome evaluated by the Two-step Test (OR = 3.45, CI = 1.33–8.96).Conclusions
All LSS patients with surgical indications were diagnosed as having locomotive syndrome. In addition, our results indicated that LSS severity is potentially associated with the progression of locomotive syndrome. The treatment of LSS may be beneficial in alleviating the risk for locomotive syndrome. 相似文献10.
Hyeon Jang Jeong Bong Young Kong Sung Min Rhee Joo Han Oh 《Journal of orthopaedic science》2019,24(1):95-102
Background
This retrospective study was designed to compare the hemodynamics among the types of shoulder arthroplasty and to evaluate predictors of transfusion in the Asian population.Methods
A total of 212 shoulder arthroplasties (26 fracture hemiarthroplasty (fHA), 49 anatomical total shoulder arthroplasty (aTSA), 132 reverse total shoulder arthroplasty (rTSA), and 5 revision surgery) from August 2004 to January 2016 were retrospectively reviewed. Demographics, surgical factors, and perioperative hemodynamic factors among the types of arthroplasty were compared. Multivariate analysis was conducted to determine predictors of transfusion.Results
Preoperative hemoglobin and hematocrit levels were lower in the fracture hemiarthroplasty group (p < 0.001, 0.001). The overall transfusion rate of shoulder arthroplasties in Asian population was 11.3%, and transfusion rate was significantly different among the types of arthroplasty (fHA 30.8%, aTSA 10.2%, rTSA 7.6%, revision 20.0%; p = 0.010). The predictors of transfusion were preoperative hemoglobin levels <12.15 g/dL (OR = 7.404, 95% C.I. 2.420–22.653, p < 0.001) and <10.0 g/dL at postoperative day 1 (OR = 5.499, 95% C.I. 1.929–15.671, p = 0.001).Conclusion
The best predictors of transfusion were hemoglobin levels of perioperative periods, furthermore, total amount of drainage could not represent the quantity of perioperative hemorrhage. Therefore, careful monitoring of hemoglobin level is more crucial than monitoring the amount of drainage. Hemodynamics according to the type of arthroplasty should be considered in shoulder arthroplasty.Level of evidence
Level IV, retrospective case series. 相似文献11.
Seung Bo Shim Jeung Yeol Jeong Dong Ho Keum Jae Chul Yoo 《Journal of orthopaedic science》2019,24(2):250-257
Purpose
Creating a trough on the anterior glenoid rim is one of the methods used for arthroscopic Bankart repair with suture anchors. The purpose of this study was to analyze clinical and radiological outcomes of arthroscopic Bankart repair with suture anchors; to compare between the outcomes of surgical procedures with and without trough.Methods
Clinical and radiological outcomes were evaluated for 116 patients who underwent arthroscopic Bankart repair at our institute from 2005 to 2011. The mean follow-up was 5.2 years (range, 2–8.8 years). All data were divided into trough group (n = 62) and non-trough group (n = 71). Clinical and functional outcomes were assessed pre- and postoperatively as range of motion (ROM), pain on the visual analog scale (p-VAS), function on the visual analog scale (f-VAS), and Rowe score. Radiological outcomes were also evaluated.Results
The overall postoperative clinical and functional outcomes improved significantly (P < .001). A total of 8 patients (6.8%) showed recurrent instability. Radiologic findings showed mild arthritis in 27 cases (23.1%), moderate arthritis in 6 cases (5.1%), and no severe arthritis. 32 patients showed anterior apprehension after surgery, and 22 out of those 32 patients were from non-trough group. However, no significant difference between the trough and non-trough groups was found with respect to clinical and functional outcomes (P > .05).Conclusion
The additional procedure of creating a trough did not improve clinical outcomes in terms of frank dislocation; however, at the final follow-up, patients with the trough showed less anterior apprehension. Overall, arthroscopic Bankart repair using suture anchors had relatively good clinical outcome, with a redislocation rate of 6.8%.Level of evidence
Level III, Case series. 相似文献12.
B. Febrero P. Ramírez L. Martínez-Alarcón C. Abete M. Galera A. Ríos R. Robles-Martínez P.M. Ramírez-Pino J. Almela G. Ramis J.A. Pons P. Parrilla 《Transplantation proceedings》2019,51(1):28-32
Background
It is well-known that there is a high incidence of depression in patients on the liver transplant (LT) waiting list. However, there have been few studies of psychological intervention on these patients.Objectives
To determine symptoms of depression in patients on the LT waiting list and the impact of group psychotherapy.Methods
Study population: patients on the LT waiting list who received group psychotherapy (n = 15). Control group: patients who did not receive psychotherapy (n = 10). Measurement instrument: Beck's depression test, which was provided before psychotherapy was initiated and after it was completed (after 6 months). The control group was given the questionnaire at the same 2 points in time as the study group. The psychotherapeutic method consisted of discussing patients' feelings, which dealt with several matters related to transplantation. Different coping strategies were considered.Results
More than half of those surveyed initially had depressive symptoms. When the second survey was administered to the study population, all the patients improved in their psychopathological assessment. When the survey was administered to the control group, a worse psychopathological assessment was obtained in all cases.Conclusions
Our data suggest an improvement in depressive symptoms in patients on the LT waiting list after receiving group psychotherapy. 相似文献13.
14.
A. Hawasli L. Camero T. Williams G. Ambrosi M. Sahly D. Demos S. Harrington 《American journal of surgery》2019,217(3):454-457
Background
Esophagectomy has high cardiac and pulmonary complication rates that can reach 43% and 58% respectively. The original Ivor Lewis esophagectomy was a two-stage procedure. We revisited this procedure using a hybrid minimally-invasive approach.Methods
Thirty-five consecutive patients with esophageal cancer were operated on over an eight-year period. The first stage used laparoscopic mobilization of the stomach, while the second stage used open thoracotomy. Six patients were aborted due to unresectable disease.Results
Twenty-nine patients were studied. The mean operative times for stage-one and stage-two were 108?±?18 and 226?±?63?min respectively. All patients were extubated in the operating room. One (3.4%) patients had cardiac complication and one (3.4%) patient had pulmonary complication.Conclusion
Metachronous hybrid two-stage esophagectomy was associated with a low rate of cardio-pulmonary complications. It may be considered as an alternative to the one-stage esophagectomy, especially in low-volume centers, to decrease these high-risk cardio-pulmonary complications. 相似文献15.
Kanji Mori Takafumi Yayama Kazuya Nishizawa Akira Nakamura Tomohiro Mimura Shinji Imai 《Journal of orthopaedic science》2019,24(1):30-34
Background
The development and etiology of diffuse idiopathic skeletal hyperostosis (DISH) were far from complete understanding. Even the precise mechanism of the development of its typical right-sided ossification of the anterior longitudinal ligament (OALL) frequently compared to ‘flowing candle wax’, a hallmark of DISH, remains unknown.Methods
The participants of this study were 261 individuals (31 females and 230 males) diagnosed as DISH according to the criteria established by Resnick and Niwayama extracted from a consecutive 3013 patients who have undergone chest CT for the examination of pulmonary diseases in our institute. The patients with previous thoracic spine surgery and younger than 15 years old were excluded. Chest CT data were converted to the condition suitable for bone evaluation by the software application. The positional relationship between thoracic aorta and OALL, the morphology of the OALL adjacent to the aorta and the presence of calcification of the aortic wall adjacent to the OALL were studied.Results
Of 261 individuals with DISH, we found that thoracic aorta was localized adjacent to the OALL (AD-group) in 123 cases (47%), whereas 138 cases (53%) were not (NAD-group). All OALL in AD-group was localized between T6 and T12. The shape of the OALL adjacent to the aorta was either flat or concave except for one. No case showed obvious calcification of the aortic wall adjacent to the OALL in AD-group.Conclusions
The aortic pulsation might play an important role in inhibit the development of the OALL toward the aorta in DISH. It is likely that establishment of the optimal condition of the pulsation stress simulating aortic pulsation and its delivery system can achieve arresting, slowing the progression and/or changing the morphology of the ossified lesions. 相似文献16.
Angelena Crown Lauren G. Scovel Flavio G. Rocha Elliot J. Scott Debra G. Wechter Janie W. Grumley 《American journal of surgery》2019,217(1):138-141
Background
Oncoplastic breast conserving surgery (OBCS) integrates plastic surgery techniques in the resection of breast cancer and lowers the rate of re-excision while improving breast cosmesis. The goal of this study is to compare the surgical site complication rate of OBCS with that of standard BCS.Methods
A single institution chart review evaluated all patients undergoing BCS for treatment of breast cancer. Patients treated from January 2009 to December 2010, prior to adoption of oncoplastic techniques, were identified as the standard surgery (SS) group. Patients treated with OBCS from January 2013 to July 2015 were identified as the oncoplastic surgery (OS) group. All surgical site complications were recorded.Results
Overall, 561 patients were evaluated. The SS group comprised 273 patients compared with 288 patients in the OS group. Surgical site complications occurred in 49 patients (17.9%) in the SS group compared with 23 patients (8.0%) in the OS group (p?<?0.001).Discussion
Overall, BCS has a low rate of significant surgical site complications. OBCS has a lower rate of surgical site complications compared to standard BCS. 相似文献17.
18.
Leonard R. Henry Michael J. Minarich Rhonda Griffin Urs W. von Holzen Ashley N. Hardy Hubert Fornalik Roderich E. Schwarz 《American journal of surgery》2019,217(3):447-451
Background
Administrative data are widely used as determinants of surgical quality. We compared surgical complications identified in a structured surgical review to coding and billing data of over a 19-month period.Methods
A retrospective review of monthly morbidity and mortality conference reports was compared to a report over the same time period generated from hospital coding and billing data.Results
807 sequential operative procedures were included. Physician derived data compared to administrative data identified a complication of any severity in 205 (25.4%) versus 111 (13.8%) cases (r?=?0.39), and major complications in 68 (8.4%) versus 46 (5.7%) cases (r?=?0.36). Review of the administrative data regarding major complications identified 80 false negatives, 52 false positives, and 38 true positive designations. Overall sensitivity, specificity, positive and negative predictive values, and accuracy for administrative data in identifying major complications was 0.32, 0.99, 0.42, 0.99, and 0.99.Conclusions
The correlation between physician determined and administrative data with regard to identifying surgical complications is poor. Administrative data are insensitive and lack positive predictive value. 相似文献19.
Masashi Uehara Jun Takahashi Yohei Akazawa Shugo Kuraishi Shota Ikegami Toshimasa Futatsugi Hiroki Oba Hiroyuki Kato 《Journal of orthopaedic science》2018,23(2):294-298