Computerised and technical navigation in total knee-arthroplasty

Abstract The objective of the study was to evaluate the precision, concordance, practicability and the early clinical outcome of the use of a computerised navigation system in a comparative study with a group of 100 patients. Two groups of 50 patients each underwent implantation of a bicondylar knee prosthesis either by means of the freehand navigation system or by means of technical instrumentation. We found that the computerised navigation system provided a higher precision than the technically instrumented implantation: 94% of the prostheses implanted with the navigation system have an alignment within a range of -3° to 3° on of the Mikulicz line. Only 46% of the patients operated by means of the technical instrumentation reached this aspired result. Furthermore, the navigation system showed smaller ranges in the deviation of the aspired alignment. The radiological and computer-modeled alignment values differed both pre- and postoperatively, but to a larger extent before surgery. The varus or valgus deviations of the axis were more distinct radiologically under the weight of the patient’s body than in the computer model. The clinical outcome examined by the use of the HSS score after a mean followup of 7 months is good in both groups, and without significant differences. On average, the duration of surgery was 13 minutes longer in the computerised navigation group. We conclude that the benefit of the computerised navigation system is represented by the high improvement of precision. Achieving early clinical results identical to those in the technical instrumentation group, we expect a reduction of aseptic loosening in the computerised navigation group.     

Diabetic control after total pancreatectomy

BACKGROUND: Diabetes after total pancreatectomy is commonly described as 'brittle' with most series reporting outcomes after resection for pancreatitis alone. The aim of this study was to determine glycaemic control in patients resected for benign and malignant disease. METHODS: A retrospective analysis of all patients undergoing total pancreatectomy (1989-2003) from a single institution was done. Data of diabetic control were obtained from case notes, general practitioners and telephonic consultation. Comparison was made against a matched type 1 diabetic population. RESULTS: Forty-seven patients with a median age of 59 years (range 17-85 years) and median follow-up of 50 months (range 5-136 months) were identified. Thirty-five underwent primary resection with 11 receiving completion procedures. Thirty were for malignancy (19 deceased) and 17 for benign/indeterminate histology (2 deceased). Thirty-three patients were available for detailed follow-up. There was no significant difference between median HbA(1c) of the study group and the control (8.2% versus 8.1%). The majority of patients reported diabetic control and daily performance as excellent or good. Resection for pancreatitis gave poorer subjective control (p < 0.05) than those resected for malignancy. Two patients required in-patient treatment for diabetic complications, with no deaths related to diabetes observed. CONCLUSION: Diabetes after total pancreatectomy is not necessarily associated with poor glycaemic control and in the majority results in equivalent biochemical control compared to a normal type 1 diabetic population.     

踝关节病的人工踝关节置换

[目的]探讨人工踝关节置换治疗踝关节病的疗效。[方法]对1999~2004年1月的18例患者包括骨性踝关节炎6例,创伤性踝关节炎9例,局限性距骨缺血坏死2例,踝关节融合后1例,均采用L ink STAR假体3构件套进行人工踝关节置换。18例中,男13例,女5例;平均年龄47.7岁(38~67)。[结果]随访平均3 a 9个月(1~5 a)。按Kofoed评价系统观察疗效,优(85~100)16例,良(75~84)2例,无可(70~74)和差(<70)。患足背屈平均8°(范围6°~12°),跖屈12°(范围8°~16°),背屈和跖屈平均16°(11°~23°)。并发症有切口皮缘坏死2例,无足内、外翻和影像学松动。[结论]人工踝关节置换是治疗和替代踝关节多种疾患疼痛和需要融合的良好方法。     

胃癌全胃切除术后消化道重建方式的选择

目的：探讨全胃切除术后较理想的消化道重建方式。方法：对近6年来122例施行全胃切除术患者的临床资料进行回顾性分析。全胃切除后消化道重建分别采用全胃切除术后消化道重建Orr式Roux-en-Y食管空肠吻合术、P型空肠袢食管空肠Roux-en-Y吻合术和远端空肠反口贮袋的Roux-en-Y食管空肠吻合术。结果：3种术式在食后烧灼感、进食量、进食次数、体重下降、倾倒综合征、血红蛋白、白蛋白等指标的比较，无明显差异（均P>0.05）。P型空肠袢食管空肠Roux-en-Y吻合术组所用手术时间显著多于Orr组及反口组（P<0.05）。反口组的贮袋大小及半排空时间显著优于Orr组及P袢组（P<0.05）。结论：远端空肠反口贮袋的Roux-en-Y吻合术是一种值得推荐的新型全胃切除术后消化道重建方法。     

保留假体清创治疗人工膝关节置换术后感染的作用

[目的]探讨保留假体清创在治疗人工膝关节置换术后感染中的可行性、适应证、成功和失败的相关因素以及注意事项.[方法]回顾分析本院自1990～2004年收治的人工膝关节置换术后感染病例,发现9例病人在治疗开始时曾尝试采用清创灌注冲洗的方法保留假体,对这9例病人进行总结,并对可能影响清创是否成功的因素进行统计学分析.[结果]本组9例病人中4例保留了假体,平均随访18个月（10～25个月）,感染均无复发.由于病例数较少,本研究针对可能影响清创成功的因素未能得出有意义的统计学结果,但从结果看：急性感染清创容易成功,而慢性感染则很难获得成功;表皮葡萄球菌成功率较高,金黄色葡萄球菌均失败;表面膝置换成功率较高,而铰链膝置换则难以获得成功;出现症状后应该抓紧时间进行清创,延误的时间越长,成功的可能性越低.[结论]保留假体清创在人工膝关节置换术后感染的治疗中有一定的应用价值,对于术后急性感染病人和术后晚期急性血源性感染病人应尝试进行保留假体清创治疗,但必须严格掌握手术时机及适应证才能获得成功.     

改良W形回肠代膀胱术的疗效观察(附36例报告)

目的 :探讨改良W形回肠代膀胱术的疗效。方法 :对 36例膀胱肿瘤患者行根治性膀胱切除、W形回肠代膀胱术 ,并对术式进行改进。结果 :36例手术时间平均 4 .2h。术后 31例随访 4～ 19个月 ,平均 10 .6个月 ,无严重并发症 ,均无瘤生存。患者一般于术后 3周自主可控性排尿 ,日间尿控率为 10 0 % ,术后 3、6、12个月夜间尿失禁发生率分别为 2 2 .5 %、11.1%及 6 .2 %。术后 6个月尿动力学检查膀胱容量 (36 0± 30 )ml,最大尿流率 (13.6± 2 .6 )ml/s,剩余尿量 (11.5± 5 .8)ml,充盈期膀胱压力明显低于尿道闭合压。新膀胱造影发现新膀胱呈球形 ,完全位于盆腔 ,未见输尿管反流。B超及IVU检查发现原上尿路积水 4例均明显减轻 ,其余未发现输尿管狭窄和上尿路积水征象。无高氯性酸中毒 ,肾功能正常。结论 :改良W形回肠代膀胱术手术时间短 ,操作简单 ,创伤轻 ,并发症少 ;新膀胱容量大 ,内压低 ,顺应性好 ,功能接近于正常膀胱 ,保持原位排尿 ,明显提高了患者术后生活质量 ,值得临床推广应用。     

改良Hardinge入路在非骨水泥全髋置换术中的应用

目的：对改良Hardinge入路行全髋置换进行评价。方法：对经改良Hardinge入路行非骨水泥全髋置换（THR－CL）术并获术后6个月以上随访的32例病人进行总结。结果：优良28例（88％），很好4例（12％），其中轻度跛行6例（19％），下肢不等长＞2cm1例（3％），改良Trendelenburg试验阳性3例（10％）。结论：此入路创伤小，暴露好，利于假体定位，易于控制下肢长度，术后外展肌功能恢复快。     

强直性脊柱炎股骨近段形态学改变对全髋关节置换术假体选择的意义

目的分析强直性脊柱炎股骨近段的形态学改变,及其改变对全髋关节置换术假体选择的意义。方法1999年1月~2004年6月,将13例(16髋)强直性脊柱炎患者设为选择组,患者均已出现关节强直,需行全髋关节置换术。另16例(19髋)为对照组,为非强直性脊柱炎患者而拟行全髋关节置换术。两组患者均摄髋关节正侧位X线片,测量Singh指数、髓腔张开指数、皮质形态指数及皮质骨指数,并进行统计学分析。结果选择组Singh指数、髓腔张开指数及皮质形态指数分别为3.81±0.54、2.63±0.41及2.02±0.38,对照组分别为4.63±0.62、3.03±0.27及2.76±0.28,两组比较差异均有统计学意义(P<0.05)。选择组皮质骨指数为1.69±0.69,对照组为2.12±0.24,两组比较差异无统计学意义(P>0.05)。选择组患者髓腔呈烟囱型10例13髋,普通型3例3髋;对照组烟囱型3例3髋,普通型13例16髋。结论强直性脊柱炎的全髋关节置换术应采用骨水泥型人工关节假体,并根据患者髓腔形态使用定制型骨水泥假体,以达到更好的近段固定效果。对于有严重骨质疏松者应按关节翻修术处理。     

胃癌10和11组淋巴结转移及其清扫

目的：研究胃癌脾门淋巴结(No．10)和脾动脉周围淋巴结(No．11)转移规律，进一步探讨No．10和11清扫的必要性和方法。方法：1991年-2000年132例行全胃切除，D2以上淋巴结清扫的胃癌患者，回顾性研究临床病理资料，包括性别、年龄、肿瘤部位、大小、浸润深度、病理类型、其他淋巴结转移等对No．10和11转移的影响，比较全胃切除和全胃联合脏器切除的并发症发生率。结果：胃癌具有较高的No．10或11淋巴结转移率(18．9％)，Logistic回归分析表明，胃癌部位、病理类型、浸润深度和大小弯淋巴结转移五项临床病理指标影响No．10和U转移率。联合脏器切除的并发症发生率(32％)明显高于单纯全胃切除(11．2％)，联合肢体尾切除增加肠下脓肿发生率，而脾切除并不增加全胃切除的危险性。结论：No．10和11在胃癌有较高的转移率和特定的转移规律，预防性和治疗性的清扫实属必要，联合左侧肢体尾加脾切除增加手术危险性，应严格掌握的适应证。而保留胰腺，切除脾血管和脾清扫No．10．和ll淋巴结合理可靠。     

The role of primary total hip replacement for the treatment of the displaced femoral neck fractures

Summary The management of displaced intracapsular fractures of the hip is still controversial because of the high incidence of complications after internal fixation or hemiarthroplasty. To avoid some of these complications we have used primary total hip replacement for independently mobile patients over 65 years of age.Of 49 patients who were interviewed an average of 4.6 years after total hip replacement, 81.6% had excellent or good results as assessed by the Harris Hip Score. At that time two hips had been revised and another converted to Girdlestone due to deep infection. The survival of the prostheses was at 5 years 91.3%.It is concluded that total hip replacement is an established method of management for a selected group of patients with this injury, but further prospective studies are needed in order to define the groups of patients that benefit the most.