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991.
The skeletal architecture of the DRUJ provides minimal inherent stability, as the sigmoid notch is shallow and its radius
of curvature is 50% greater than that of the ulnar head [Af Ekenstam F, Hagert CG. Anatomical studies on the geometry and
stability of the distal radio ulnar joint. Scand J Plast Reconstr Surg 1985;19(1):17–25]. Due to its incongruent articulation,
the DRUJ relies strongly on the surrounding soft tissues for stability. The triangular fibrocartilage complex (TFCC) is generally
accepted as the major soft tissue stabilizer of the DRUJ of which the volar and dorsal radioulnar ligaments are the primary
components. Restoration of the radioulnar ligaments offers the best possibility to restore the normal DRUJ primary constraints
and kinematics. This article presents an update of the procedure developed by the senior author that anatomically reconstructs
the palmar and dorsal radioulnar ligaments at their anatomic origins and insertions. 相似文献
992.
Isolated avulsion of the biceps femoris tendon is a relatively rare condition. We report a case of a 43 year-old soccer player
with a rupture of the biceps femoris tendon which occurred in a hyperextension of the knee. Based on this case, we discuss
the literature referring to injury pattern and treatment. 相似文献
993.
Hankemeier S van Griensven M Ezechieli M Barkhausen T Austin M Jagodzinski M Meller R Bosch U Krettek C Zeichen J 《Archives of orthopaedic and trauma surgery》2007,127(9):815-821
Introduction The original complex structure and mechanical properties are not fully restored after ligament and tendon injuries. Due to
their high proliferation rate and differentiation potential, Bone Marrow Stromal Cells (BMSC) are considered to be an ideal
cell source for tissue engineering to optimize the healing process. Ideal matrices for tissue engineering of ligaments and
tendons should allow for homogenous cell seeding and offer sufficient stability.
Material and methods A mixture of human BMSC and liquid fibrin glue was injected into a standardized full-thickness window defect of the patellar
tendon of immunodeficient rats (BMSC group). The histology of the tissue was analysed 10 and 20 days postoperatively and compared
to four control groups. These groups consisted of a cohort with a mixture of human fibroblasts and fibrin glue, fibrin glue
without cells, a defect group without treatment, and a group with uninjured patellar tendon tissue.
Results Tendon defects in the BMSC group revealed dense collagen fibres and spindle-shaped cells, which were mainly orientated along
the loading axis. Histologic sections of the control groups, especially of untreated defects and of defects filled with fibrin
glue only, showed irregular patterns of cell distribution, irregular formed cell nucleoli and less tissue maturation. Compared
to healthy tendon tissue, higher numbers of cells and less intense matrix staining was observed in the BMSC group. No ectopic
bone or cartilage formation was observed in any specimen.
Conclusions Injection of human BMSC in a fibrin glue matrix appears to lead to more mature tissue formation with more regular patterns
of cell distribution. Advantages of this “in-vivo” tissue engineering approach are a homogenous cell-matrix mixture in a well-known
and approved biological matrix, and simple, minimally-invasive application by injection. 相似文献
994.
A pilot study of factors associated with falls in individuals with incomplete spinal cord injury 下载免费PDF全文
BACKGROUND/OBJECTIVE: To determine factors associated with falls among a sample of ambulatory individuals with incomplete spinal cord injury (SCI). STUDY DESIGN: Cross-sectional mail survey. METHODS: A survey instrument of participant characteristics and fall-related variables was developed using relevant items from existing measures and was mailed to 221 individuals with incomplete SCI, who were identified from records of a large specialty hospital in the southeastern United States. Of the 221 prospective participants, 119 completed the questionnaire (54%). Multivariable logistic regression models were used to determine factors that were independently associated with having had a fall in the past year. RESULTS: After adjusting for covariates, having fallen in the past year was significantly (P < 0.05) associated with greater numbers of medical conditions (odds ratio [OR] = 1.3; 95% confidence interval [CI] = 1.0-1.7), having arthritis (OR = 3.4, 95% CI = 1.2-9.6), experiencing dizziness (OR = 5.6, 95% Cl = 1.1-27.7), greater numbers of days with poor physical health (OR = 1.1; 95% Cl = 1.0-1.3), and the restriction of community activities because of fear of falling (OR = 1.5, 95% CI = 1.1-2.1). The multivariable models also showed that the odds of having fallen were significantly lower among those with better current perceived physical health (OR = 0.5; 95% Cl = 0.3-0.9), those with better perceived health compared to a year ago (OR = 0.4; 95% Cl = 0.2-0.8), individuals who exercised more frequently (OR = 0.2; 95% CI = 0.1-0.7), and those who used a walker (OR = 0.3; 95% CI = 0.1-0.9). CONCLUSIONS: Results suggest that interventions that address exercise frequency, walker use, and dizziness have promise for reducing falls for individuals with incomplete SCI. 相似文献
995.
Chrysanthos Georgiou Kenji Inaba MD FRCSC FACS Joseph DuBose Pedro G. R. Teixeira Pantelis Hadjizacharia Ali Salim Carlos Brown Peter Rhee Demetrios Demetriades 《European journal of trauma and emergency surgery》2009,35(4):383-388
Abstract
Background:
The objective of this study was to describe the management of the Jehovah’s Witness (JW) in an intensely active level I trauma
center and review the modern therapeutic options available for the trauma care of these patients.
Study design:
A retrospective review of injured JWs admitted to a busy trauma center over a 13-year period was conducted.
Results:
Over the study period, 143 JWs were identified. Among these, 15.4% (22/143) overall and 32.3% (10/31) requiring surgical intensive
care unit (SICU) admission accepted transfusion. Overall, 56.6% of JWs (81/143) required operation and 21.7% (31/143) were
admitted to the SICU with a complication rate of 4.2% (6/143) and a mortality of 1.4% (2/143). One patient of the 31 patients
that were admitted to the SICU received 10 ml of blood with subsequent discontinuation of the transfusion and was excluded
from analysis. Of the 30 JWs admitted to the SICU, 20 (66.7%) did not receive transfusion and demonstrated mean admission
and nadir hemoglobin (Hb) levels of 12.7 (±2.5) and 9.1 (±3.0) mg/dl, respectively. Ten patients accepted transfusion. This
group had longer mean SICU stays (23.3 vs. 5.5 days) but similar mortality (10%, 1/10 vs. 5%, 1/20) compared to non-transfused
counterparts. Only one complication (1/20, 5%) was observed in the JWs who were not transfused, compared to a 40% (4/10) complication
rate in those accepting transfusion.
Conclusion:
Although our experience was limited, we found no significant difference in the mortality or morbidity between JW patients
who received or abstained from transfusion following major trauma. We should keep in mind that the population was small, in
order to extract safe conclusions regarding whether we should transfuse or not transfuse trauma patients. We can, however,
see interesting insights on the value of trauma resuscitation. 相似文献
996.
Stefan Danilla Jason Wasiak Susana Searle Cristian Arriagada Cesar Pedreros Heather Cleland Anneliese Spinks 《Burns : journal of the International Society for Burn Injuries》2009,35(7):956-961
Objective
To evaluate the methodological quality of published randomised controlled trials (RCTs) in burn care treatment and management.Methods
Using a predetermined search strategy we searched Ovid MEDLINE (1950 to January 2008) database to identify all English RCTs related to burn care. Full text studies identified were reviewed for key demographic and methodological characteristics. Methodological trial quality was assessed using the Jadad scale.Results
A total of 257 studies involving 14,535 patients met the inclusion criteria. The median Jadad score was 2 (out of a best possible score of 5). Information was given in the introduction and discussion sections of most RCTs, although insufficient detail was provided on randomisation, allocation concealment, and blinding. The number of RCTs increased between 1950 and 2008 (Spearman's rho = 0.6129, P < 0.001), although the reporting quality did not improve over the same time period (P = 0.1896) and was better in RCTs with larger sample sizes (median Jadad score, 4 vs. 2 points, P < 0.0001). Methodological quality did not correlate with journal impact factor (P = 0.2371).Conclusions
The reporting standards of RCTs are highly variable and less than optimal in most cases. The advent of evidence-based medicine heralds a new approach to burns care and systematic steps are needed to improve the quality of RCTs in this field. Identifying and reviewing the existing number of RCTs not only highlights the need for burn clinicians to conduct more trials, but may also encourage burn health clinicians to consider the importance of conducting trials that follow appropriate, evidence-based standards. 相似文献997.
Oberladstaetter J Kamelger FS Rosenberger R Dallapozza Ch Struve P Luger T Fink Ch Attal R 《Archives of orthopaedic and trauma surgery》2009,129(3):359-362
Introduction The 22nd Student World Winter Games took place in January 2005 in Innsbruck and Seefeld, Austria. Exactly 1,500 athletes of
50 nationalities competed in 69 events in ten winter sports. A total number of 750 functionaries, 800 volunteers and 85,000
spectators participated in the second largest winter sports event behind the Olympic winter games.
Aim The aim of this study was to evaluate the needed resources to ensure traumatological care for an event of that size.
Material At the medical “call-center” all consultations, as well as patient data, diagnosis, and medical treatment were recorded using
a preset protocol. Further, all patients treated in the University Hospital Innsbruck were registered with an emphasis on
trauma patients.
Results Forty-eight of 65 patients transported to the hospital as a result of the Universiade were trauma patients, 37 of whom were
athletes. The gender distribution was 34:14 (m:f). Ice hockey players had the highest rate of injury (25% of all injured athletes),
followed by alpine skiers (20.8% of injured athletes). The highest ISS was nine. Forty-three patients got ambulatory treatment,
five were admitted to the hospital and surgical treatment was conducted in three cases. Mean patient number was 4.8 per day.
No additional personnel, structural, or technical hospital resources were needed to accommodate a large winter sports event
like the Universiad. Thus, a level-B trauma center with an emergency room and independent traumatological department with
around the clock surgical capability seems to be sufficient to provide traumatological care for an event of this size if the
possibility of patient transport to a larger facility exists in the case of catastrophic events. 相似文献
998.
Yoshihiko Kato Tsukasa Kanchiku Yasuaki Imajo Kazuhiko Ichinara Syunichi Kawano Daiskue Hamanama Kentaro Yaji Toshihiko Taguchi 《The journal of spinal cord medicine》2009,32(5):555-559
Background/Objective:
It is suspected that the speed of the motion of the spinal cord under static compression may be the cause of spinal cord injury (SCI). However, little is known about the relationship between the speed of the motion of the spinal cord and its stress distributions. The objective was to carry out a biomechanical study of SCI in patients with ossification of the longitudinal ligament without radiologic evidence of injury.Methods:
A 3-dimensional finite element spinal cord model was established. After the application of static compression, the model underwent anterior flexion to simulate SCI in ossification of the longitudinal ligament patients without radiologic abnormality. Flexion of the spine was assumed to occur at 1 motor segment. Flexion angle was 5°, and flexion speeds were 0.5°/s, 5°/s, and 50°/s. Stress distributions inside of the spinal cord were evaluated.Results:
Stresses on the spinal cord increased slightly after the application of 5° of flexion at a speed of 0.5°/s. Stresses became much higher at a speed of 5°/s and increased further at 50°s.Conclusions:
The stress distribution of the spinal cord under static compression increased with faster flexion speed of the spinal cord. High-speed motion of the spinal cord under static compression may be one of the causes of SCI in the absence of radiologic abnormality. 相似文献999.
Regular exercise has been recommended for diabetes patients for many years; however, it is not widely used clinically. This
may be because of high costs, lack of reimbursement, low compliance and/or absence of proper infrastructure. Alternatively,
structured exercise therapy may be underutilised because current guidelines do not include detailed information on the preferred
type and intensity of exercise that should be applied to maximise the benefits of exercise for different subgroups of patients
with type 2 diabetes. Based on available evidence and our own clinical research experience this article proposes that exercise
therapy in type 2 diabetes might be more effective if (1) cardiac rehabilitation programmes served as a model for ‘pre-cardiac
diabetes rehabilitation’; (2) resistance exercise were prescribed for sarcopenic or severely deconditioned type 2 diabetes
patients; and (3) a multidisciplinary approach and continued exercise training under personal supervision became standard
therapy. Nevertheless, more clinical research is warranted to establish the efficacy of an approach that takes into account
type 2 diabetes subpopulations at different stages of the disease and with different levels of comorbidity. 相似文献
1000.
To present the findings in a 10-year-old male with a Chance fracture and associated aortic vascular injury and review of the literature on the subject. We reviewed the clinical and imaging findings in a patient who was in a serious motor vehicle accident, sustaining a Chance fracture of the lumbar spine and associated aortic and common iliac vessel injury. We also accomplished a literature review. Evidence of an associated aortic injury was available on the initial computed tomography (CT) study, but the findings were more exquisitely demonstrated on reconstructed studies of the lumbar spine. Our literature review indicated that aortic injury associated with Chance fracture is relatively rare and often overlooked. Abdominal aortic injury although rare, can occur with Chance fractures. With the now present sophisticated CT imaging in most Emergency Rooms it is possible to obtain exquisite reconstructed images of all organ systems including the vascular tree. The images may provide enough details so that further delineation of any given problem may not be necessary. 相似文献