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1.
We present the case of a 50-year-old woman, who is a bilateral Syme's amputee and subsequently underwent patellofemoral arthroplasty (PFA) for osteoarthritis primarily involving the patellofemoral (PF) joint. History and physical examination were suggestive of severe PF arthritis without patellar instability of the right knee. The diagnosis was confirmed by roentgenogram and a PFA was performed. A slightly modified rehabilitation program was implemented and the patient was followed until 6 years after surgery. In comparison to the preoperative scores, the Oxford, the Western Ontario and McMaster Universities (WOMAC), the Knee Society, and the Hospital for Special Surgery Knee Scores improved significantly (p < 0.05) at the time of final follow-up. PF problems specific to below-knee amputees, factors to be considered before performing PFA, and the drawbacks of other treatment modalities in these patients have been discussed.  相似文献   

2.
PurposeBCCT.core (Breast Cancer Conservative Treatment. cosmetic results) is a software created for the objective evaluation of aesthetic result of breast cancer conservative treatment using a single patient frontal photography. The lack of volume information has been one criticism, as the use of 3D information might improve accuracy in aesthetic evaluation. In this study, we have evaluated the added value of 3D information to two methods of aesthetic evaluation: a panel of experts; and an augmented version of the computational model - BCCT.core3d.Material and methodsWithin the scope of EU Seventh Framework Programme Project PICTURE, 2D and 3D images from 106 patients from three clinical centres were evaluated by a panel of 17 experts and the BCCT.core. Agreement between all methods was calculated using the kappa (K) and weighted kappa (wK) statistics.ResultsSubjective agreement between 2D and 3D individual evaluation was fair to moderate. The agreement between the expert classification and the BCCT.core software with both 2D and 3D features was also fair to moderate.ConclusionsThe inclusion of 3D images did not add significant information to the aesthetic evaluation either by the panel or the software. Evaluation of aesthetic outcome can be performed using of the BCCT.core software, with a single frontal image.  相似文献   

3.
Background and Objectives: Successful performance of lower-extremity regional anesthesia includes sensory and/or motor block assessment of up to 4 major peripheral nerves. This brief report describes a methodology for the rapid evaluation of lower-extremity anesthesia before surgical incision. Methods: Illustrations highlight the techniques for evaluation of sciatic, obturator, lateral femoral cutaneous, and femoral nerve anesthesia. This methodology is based on a Four P's acronym: push, pull, pinch, punt. Conclusions: Accurate assessment of lower-extremity regional anesthesia can be achieved rapidly using The Four Ps evaluation tool. Reg Anesth Pain Med 2002;27:618-620.  相似文献   

4.
Purpose: The re-establishment of distal radius alignment and articular congruency after fracture has been approached by a variety of methods in order to limit injury sequelae such as degenerative osteoarthritis. Although arthroscopy has been beneficial for other articular fractures, it is unclear to what degree arthroscopy should be used for treatment of distal radius articular fractures, especially when avoiding full-open procedures that can promote arthrofibrosis. The purpose of this study was to determine the utility of adjuvant wrist arthroscopy and whether a diagnostic benefit is observed during treatment. Type of Study: A modified protocol for treatment of intra-articular distal radius fractures was developed in a crossover trial fashion for the purposes of this study. Materials and Methods: Thirty-three consecutive subjects treated over a 2-year period were included for study. Fractures were classified according to Melone, treated by indirect reduction techniques under fluoroscopic visualization, stabilized by static external fixation, and supplemented with percutaneous pins or bone graft as needed. The adequacy of reduction under fluoroscopic visualization was assessed by arthroscopic visualization after this initial treatment. Results: 14.3% of type I fractures, 37.5% of type II fractures, 33.3% of type III fractures, and 71.4% of type IV fractures were modified due to arthroscopic visualization after initial treatment by indirect reduction techniques. No subject required a full-open procedure for subsequent reduction. Conclusions: Based on these data, surgical treatment of intra-articular distal radius fractures solely under fluoroscopic visualization appears inadequate to re-establish articular congruency. Adjuvant wrist arthroscopy provides a diagnostic benefit in determining whether distal radius articular fracture reduction is adequate and may also translate to direct improvement in patient satisfaction and outcome by limiting injury sequelae. When considering indirect reduction techniques for distal radius articular injury, we recommend routine arthroscopic evaluation to verify and assist in re-establishment of articular congruency.  相似文献   

5.
Patellofemoral instability (PFI) is one of the most disabling conditions in the knee, often affecting young individuals. Despite its not uncommon presentation, the underlying biomechanical features leading to this entity are not entirely understood. The suitability of classic physical examination manoeuvres and imaging tests is a matter of discussion among treating surgeons, and so are the findings provided by these means. A potential cause for this lack of consensus is the fact that, classically, the diagnostic approach for PFI has relied on statically obtained data. Many authors advocate for the study of this entity in a dynamic scenario, closer to the actual situation in which the instability episodes occur. In this literature review, we have compiled the available data from the last decades regarding dynamic evaluation methods for PFI and related conditions. Several categories are presented, grouping the related techniques and devices: physical examination, imaging modalities (ultrasound (US), magnetic resonance imaging (MRI), computed tomography (CT) and combined methods), arthroscopic evaluation, and others. In conclusion, although a vast number of quality studies are presented, in which comprehensive data about the biomechanics of the patellofemoral joint (PFJ) are described, this evidence has not yet reached clinical practice universally. Most of the data still stays in the research field and is seldom employed to assist a better understanding of the PFI cases and their ideal treatment targets.  相似文献   

6.
Objective. This is a study concerning ureteroceles associated with a single collecting system of the involved kidney.Methods. Over an eight-year period 9 children (5 boys, 4 girls) had a ureterocele subtending a single collecting system, whereas 63 children had duplex ureteroceles. Malformations of other organ systems were present in only I patient.Results. Three patients have undergone surgical interventions: a transureteral incision of bilateral obstructive ureteroceles in I and nephroureterectomy in 2. In 4 cases cystic/dysplastic kidneys involuted and were reabsorbed with collapse of the ureteroceles. The last 2 patients have received antibiotic treatment for single episodes of a urinary tract infection.Conclusions. Earlier reports of a high incidence of concomitant anomalies and male predominance in patients with single-system ectopic ureteroceles could not be verified by our experience. Our current policy for a patient is careful evaluation, individualized therapy, and long-term surveillance.  相似文献   

7.
目的 :探讨关节镜下髌骨去神经化联合微骨折术治疗髌股关节炎的临床疗效。方法 :自2015年5月至2018年5月治疗60例膝关节退行性髌股关节炎患者,男28例,女32例;年龄24~56(40.5±3.35)岁。其中30例行单纯关节镜检查清理术(对照组),30例行关节镜下清理、髌骨周围去神经化联合软骨锥髌股关节面微骨折处理(治疗组)。术后采用VAS、Lysholm、Kujala评分评价治疗效果。结果:所有患者术后未出现切口感染、血管神经损伤、下肢深静脉血栓等并发症。60例患者均获随访,时间7~36个月,平均12.5个月。两组患者术后4周VAS评分均改善,而且治疗组改善明显优于对照组,差异有统计学意义(P0.05)。两组患者术后末次随访时行Lysholm、Kujala评分比较,治疗组改善明显优于对照组。结论:髌骨去神经化处理联合微骨折术治疗髌股关节炎能更好地缓解疼痛,改善膝关节功能。  相似文献   

8.
Background: Blunt traumatic aortic injury (TAI) is clinically difficult to diagnose, as signs and symptoms are unreliable and variable. The identification of TAI may be obscured by other injuries that are more apparent. Furthermore, radiologic evaluation of the mediastinum for this injury is not well defined. Most patients with TAI die immediately. Survivors have a contained rupture which requires crucial early diagnosis and treatment. Material and Methods: A Medline search was conducted using the terms “traumatic aortic injury”, “aortic injury”, “aortic trauma”, and “thoracic trauma” from 1966 until December 2002. Investigations used in the diagnostic evaluation of blunt TAI were reviewed and an initial investigative approach to this condition formulated. Results: The choice of investigation for TAI depends on clinical suspicion, hemodynamic stability, availability, and rapidity of access to tests. These include chest radiography, helical computed tomography angiography (CT-A), transesophageal echocardiography (TEE), aortography, and intraarterial digital subtraction angiography (IA-DSA). CT-A is considered an excellent test in hemodynamically stable blunt thoracic trauma patients. TEE is preferred in unstable patients. Conclusion: Investigations must confirm or exclude TAI with great precision. CT-A is a reliable screening and now primary diagnostic test in the hemodynamically stable patient. A negative CT-A excludes aortic injury, with a positive or equivocal CT-A leading to treatment or further diagnostic evaluation. TEE is appropriate for the hemodynamically unstable patient but is operatordependent and not widely available. Aortography is still considered the reference test for blunt TAI and is used when the results from other modalities are inconclusive.  相似文献   

9.
Objective: To investigate the diagnosis and surgical treatment of excessive lateral pressure syndrome of the patellofemoral joint caused by military training. Methods: Fifteen patients (patient group) and 18 healthy volunteers (control group) were involved in this retrospective study. Radiographs of the knee joints of all patients and volunteers were taken. The bone architecture was assessed, the trochlear angle, coincidence angle and patellofemoral joint index measured in both groups, and the resulting data compared. All 15 patients (17 knees) were treated by lateral collateral retinaculum release. Pre‐ and post‐operative pain was evaluated with a visual analog scale (VAS). Results: The differences between the two groups in coincidence angle (patient group: 7.67°± 5.81°; control group: ?2.2°±?2.71°) and patellofemoral joint index (patient group: 2.49 ± 1.40; control group: 1.25 ± 0.15) were statistically significant. Subchondral bone sclerosis and osteophytosis in the patellofemoral joint were more pronounced in the patient group than in the control group. The VAS was higher preoperatively (7.06 ± 0.85) than postoperatively (6 months postoperatively: 3.87 ± 0.24; 1 year postoperatively: 3.01 ± 0.17), and the differences between preoperative and postoperative were statistically significant. Conclusions: Apart from the case history, typical symptoms and physical signs, X‐ray examination is the most basic way to diagnose excessive lateral pressure syndrome of the patellofemoral joint, and the patellofemoral joint index is the most reliable for diagnosis. Lateral collateral retinaculum release with a small‐incision is an effective treatment for this disease.  相似文献   

10.
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