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81.
Alessandra Motta Streva Ana Carla Raphaelli Nahás-Scocate Sérgio Lucio Pereira de Castro Lopes Andre Luiz Ferreira Costa 《Pediatric Dental Journal》2019,29(2):97-104
BackgroundCondylar cartilage acts as a centre of craniofacial complex growth and magnetic resonance imaging (MRI) is the most suitable examination to differentiate tissues and identify pathological conditions of TMJ. Condylar growth disturbance can alter the maxillofacial morphology, including occlusal relationship, and the affected children may not present symptoms. Although TMJ in children is similar to that in adults, the anterior condylar inclination is straight and increases with age, presenting slight condylar flattening and slight contrast enhancement.ObjectiveThe present work aimed to review the literature focussing to assess how MRI and the development of TMJ can contribute to orthopaedic/orthodontic diagnosis in growing patients.Main resultsMRI can also complement the predictive diagnosis of growth in which the image of a double contour of the condyle reveals proliferation of cartilage cells with immature ossification. Considering that orthodontic therapy usually begins after eruption of permanent teeth, the moment of alternation of the double contour-like structure is close or coincident with the eruption of upper second molars.ConclusionClinically, the advantage of diagnosis of double contour is not to use any ionizing radiation related to scan in these subjects. Therefore, MRI could be a choice for the follow-up of growing patients. 相似文献
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85.
《Orthopaedics and Trauma》2019,33(3):166-174
Infection is one of the most feared complications following knee arthroplasty and soft tissue arthroscopic procedures. This article summarizes the current understanding on the management of this rare but devastating problem. The healthcare and economic burden of periprosthetic joint infection (PJI) is highlighted, together with how the classification of infection and host staging can aid decision-making. Surgical treatment options will be described. These consist of ‘debridement, antibiotics and implant retention’ (DAIR), revision arthroplasty (single- or two-stage), as well as salvage procedures (arthrodesis, permanent resection, and amputation). In selected cases, chronic antibiotic suppression may be the only viable option. All implant-related orthopaedic infections must be managed using a multidisciplinary team (MDT) approach, ideally within dedicated bone infection units, in order to optimize clinical outcomes. 相似文献
86.
邱硕 《中华针灸电子杂志》2019,8(1):9-13
目的观察"邱氏"耳针夹治疗颞下颌关节紊乱病的临床疗效。
方法选取2012年8月至2017年8月扬州市中医院针灸科及口腔科门诊患者90例,按照随机数字表法分为耳针夹组和体针组,每组各30例。耳针夹组予"邱氏"耳针夹夹于相关耳穴治疗;体针组予毫针针刺听宫穴、下关穴等穴位进行治疗,2组患者均治疗10 d。采用χ2检验比较2组患者的视觉模拟评分(VAS)和关节活动度(ROM),比较2组患者疼痛程度及开口度方面的改善情况。
结果(1)治疗10 d后,耳针夹组VAS评分主要集中在0~1分占83.3%(25/30),其他评分段为≥7分者占3.3%(1/30),3~7分者占6.7%(2/30),1~3分者占6.7%(2/30);体针组VAS评分≥7分者占13.3%(4/30),3~7分 者占16.7%(5/30),1~3分者占10.0%(3/30),0~1分占60.0%(18/30),耳针夹组VAS评分0~1分段患者多于体针组,且差异有统计学意义(χ2=2.944,P<0.05)。(2)治疗10 d后,耳针夹组ROM主要集中在3.4~3.9 cm者共占83.4%(25/30),≤3.0 cm者占13.3%(4/30),≤2.0 cm者占3.3%(1/30);体针组ROM 3.4~3.9 cm者占60.0%(18/30),≤3.0 cm者占26.7%(8/30),≤2.0 cm者占13.3%(4/30),耳针夹组ROM 3.4~3.9 cm患者多于体针组,且差异有统计学意义(χ2=2.944,P<0.05)。(3)耳针夹组、体针组治疗10 d后治愈率分别为33.33%(10/30)、16.67%(5/30),耳夹针组高于体针组,且差异有统计学意义(χ2=2.844,P<0.05)。耳针夹组、体针组治疗10 d后总有效率分别为93.33%(28/30)、86.67%(26/30),耳针夹组高于体针组,且差异有统计学意义(χ2=4.444,P<0.05)。
结论"邱氏"耳针夹治疗颞下颌关节紊乱病,有即刻镇痛和改善开口度的效果,具有疗效显著、无创伤、安全性高、简便易行等优点,对惧针患者尤为适宜。 相似文献
87.
《The Journal of arthroplasty》2019,34(9):2022-2029
BackgroundCementless metaphyseal implant fixation of revision total knee arthroplasty has encouraging early results. We analyzed midterm results and implant survival of osteointegrative augments in Anderson Orthopedic Research Institute (AORI) type 2a, 2b, and 3 defects. Reasons for implant failure were explored and the potential for anatomic joint line reconstruction evaluated.MethodsSixty-seven consecutive patients (68 revision total knee arthroplasties) received cementless metaphyseal sleeves between 2011 and 2014. The mean follow-up was 5.0 years, mean age was 68.5 years, and mean body mass index was 31.4 kg/m2. The clinical and radiographic results were determined using established scoring systems. Additionally, the survival rate was calculated and reasons for failure were analyzed.ResultsIn 2 patients (4.3%), sleeves had to be removed early postoperatively for deep infection after second-stage reimplantation. With continuously functioning remaining implants, the aseptic survival rate was 93.6%. Cleared up for initial technical issues due to poor bone quality, it is as high as 98%. The scores remained to be significantly improved by 64.8 points (Western Ontario and McMaster Universities Osteoarthritis Index) and 25.8 points (Knee Society score) (P < .001). In 10 patients (29.4%), diaphyseal radiolucencies were observed without suspicion of loosening. The mean joint line was noted to be 0.36 mm lower to the anatomic level.ConclusionAt a mean follow-up of 5.0 years, cementless osteointegrative sleeves for metaphyseal fixation in AORI 2a, AORI 2b, and AORI 3 defects yielded continuous implant fixation even in cases with preceding revisions. The cleared up aseptic survival rate was 98% at 5 years. The modular sleeve design allowed joint line reconstruction near the anatomic level. 相似文献
88.
Daniel J. Snyder Thomas R. Kroshus Aakash Keswani Evan B. Garden Karl M. Koenig Kevin J. Bozic David S. Jevsevar Jashvant Poeran Calin S. Moucha 《The Journal of arthroplasty》2019,34(4):613-618
Background
Nursing Home Compare (NHC) ratings, created and maintained by Medicare, are used by both hospitals and consumers to aid in the skilled nursing facility (SNF) selection process. To date, no studies have linked NHC ratings to actual episode-based outcomes. The purpose of this study was to evaluate whether NHC ratings are valid predictors of 90-day complications, readmission, and bundle costs for patients discharged to an SNF after primary total joint arthroplasty (TJA).Methods
All SNF-discharged primary TJA cases in 2017 at a multihospital academic health system were queried. Demographic, psychosocial, and clinical variables were manually extracted from the health record. Medicare NHC ratings were then collected for each SNF. For patients in the Medicare bundle, postacute and total bundle cost was extracted from claims.Results
Four hundred eighty-eight patients were discharged to a total of 105 unique SNFs. In multivariate analysis, overall NHC rating was not predictive of 90-day readmission/major complications, >75th percentile postacute cost, or 90-day bundle cost exceeding the target price. SNF health inspection and quality measure ratings were also not predictive of 90-day readmission/major complications or bundle performance. A higher SNF staffing rating was independently associated with a decreased odds for >75th percentile 90-day postacute spend (odds ratio, 0.58; P = .01) and a 90-day bundle cost exceeding the target price (odds ratio = 0.69; P = .02) but was similarly not predictive of 90-day readmission/complications.Conclusion
Results of our study suggest that Medicare's NHC tool is not a useful predictor of 90-day costs, complications, or readmissions for SNFs within our health system. 相似文献89.
《Injury》2019,50(4):1000-1003
AimThe screw length is important to achieve a stable fixation for medial malleoli fractures. We aimed to evaluate the optimal screw length for different age groups in surgically treated medial malleoli fractures. The second aim was to identify the utility of the distance of epiphyseal scar to joint line or joint line to medullary space for assessment of screw length.Material method368 X-rays and computed tomography (CT) images of ankle joints were retrospectively evaluated for optimal screw length, epiphyseal scar to joint line distance, joint to medullary space distance. The mean screw length for each decade was calculated. The correlations of screw length with age, screw length with distance of epiphyseal scar to joint line, and screw length with distance of joint line to medullary space were evaluated.ResultsThe optimal screw length was obviously decreased in patients in 61–70 and >70 years old group (p = 0.002). As the distance of epiphyseal scar from joint line was increased, the optimal length of screw was also increased (p = 0.001). The distance of epiphyseal scar from joint line was decreased by age (p = 0.011).ConclusionThe optimal screw length was decreased by age and the epiphyseal scar to joint line distance could be a clue for optimal screw length in medial malleoli fractures. 相似文献
90.
《The Journal of arthroplasty》2019,34(6):1201-1206
BackgroundAntibiotic cement spacers are used during 2-stage revision total hip arthroplasty for prosthetic joint infection. Complications including dislocation and periprosthetic fracture have been reported but a large cohort comparing spacer design features is lacking. We aimed to determine if spacer design is associated with perioperative complications.MethodsWe performed a retrospective review of antibiotic cement spacers implanted between 2004 and 2014. Radiographic assessment included leg length, offset, and bone loss (Paprosky classification). Clinical outcomes included dislocation, periprosthetic fracture, spacer fracture, infection cure, and overall reoperation rate. Univariate analysis, Student’s t-test, chi-squared test, or Kruskal-Wallis test was employed (P < .05).ResultsOne hundred eighty-five patients were treated: 42% were female and mean age was 64 years (range 24-93, standard deviation 13.6). Spacer types were (1) molded (53%), (2) antibiotic-coated prosthesis (30%), (3) handmade (12%); and (4) prefabricated (4%). Cemented acetabular liners were used in 3% (6/185). There was no loss to follow-up during the interstage period. Spacer complications occurred in 26% (48/185). Dislocation occurred in 9% (17/185) and was associated with reduced femoral offset of >5 mm (P = .033) and increased bone loss (P = .01). Spacer fracture occurred in 8% (14/185); 12% (12/97) molded versus 8% (2/23) handmade (P = .02). Periprosthetic femur fracture was associated with increased offset >5 mm (P = .01) and extended trochanteric osteotomy (P = .001).ConclusionDuring 2-stage total hip arthroplasty, antibiotic-loaded cement spacers had an overall complication rate of 26%. Spacer design, acetabular and femoral bone loss, and offset restoration were significantly associated with perioperative complications. We recommend the optimization of antibiotic-loaded cement spacer placement to minimize potential complications by focusing on restoration of leg-length and offset, ensuring adequate femoral fixation and paying attention to selection of an appropriate head/neck ratio. 相似文献