No Difference in Dislocation Rates Comparing Large Diameter Jumbo Femoral Heads and Dual-Mobility Bearings in Revision Total Hip Arthroplasty

BackgroundDual-mobility (DM) bearings reduce instability in revision total hip arthroplasty (THA); however, DM bearings are costly and reports of corrosion have recently emerged. Furthermore, no study has compared DM to standard bearings with large diameter femoral heads ≥40-mm. This study’s purpose was to compare postoperative dislocation rates of standard and DM bearings with large femoral heads after revision THA.MethodsA retrospective review of 301 consecutive revision THAs was performed. The mean follow-up was 37.1 months. To isolate the effect of the double articulation, standard and DM bearings with femoral heads ≥40-mm were compared. Outcomes were postoperative dislocation and reoperation within 90 days.ResultsThe cohort consisted of 182 standard bearings and 75 DM bearings. There were no differences in revision indication comparing standard and DM bearings (P = .258). Overall dislocation rate was 8.6% (22 of 257). The dislocation rate was 5.7% for standard bearings with ≥40-mm femoral heads compared with 6.9% in DM bearings with ≥40-mm femoral heads (P = 1.000). In multivariate analysis, lower body mass index (odds ratio 1.72), female sex (odds ratio 2.01), and decreased outer femoral head diameter–to–cup component size ratio (odds ratio 1.64) were predictors of postoperative dislocation regardless of bearing type.ConclusionThis study showed no difference in dislocation rates between standard and DM bearings when comparing similar femoral head diameters of ≥40-mm used in revision THAs. Considering the cost and potential deleterious issues associated with additional interfaces, DM bearings should be used judiciously considering similar results may be achieved with single-articulation bearings using large femoral heads.Level of EvidenceLevel III.     

胃肠道非计划性再次手术的原因及防治措施

目的 探讨胃肠道非计划性再次手术的原因及其防治措施。方法 回顾性分析2012年6月至2013年6月期间笔者所在医院胃肠外科因不同原因施行非计划性再次手术的21例患者的临床资料。结果 2 492例胃肠道手术患者中,行非计划性再次手术21例,再次手术率为0.8%。导致再次手术的原因为腹腔内出血10例,胃肠道瘘7例,炎性肠梗阻伴腹膜炎1例,切口裂开3例。施行缝扎止血术、结肠造瘘术、吻合口漏修补术、清创缝合术等处理后,20例治愈或好转,1例死亡。本组患者住院时间的中位数为25 d （16～49 d）,住院费用的中位数为76 000元（46 000～116 000元）。结论 胃肠道非计划性再次手术可对患者造成较严重的经济和精神负担,规范手术操作和加强围手术期监测可以降低非计划性再次手术的发生率,且合理掌握再次手术指征、实施及时有效的再次手术可避免疾病的进一步恶化。     

Greater Prevalence of Wound Complications Requiring Reoperation With Direct Anterior Approach Total Hip Arthroplasty

The purpose of this retrospective study was to compare wound complication rates between primary THAs performed via a posterior or direct anterior approach. From our prospective outcomes registry, we identified 1288 primary THAs performed via a posterior approach and 505 via a direct anterior approach. The direct anterior approach resulted in a significantly greater number of wound complications that required reoperation than the posterior approach (7/505 (1.4%) vs. 3/1,288 (0.2%), P = 0.007). As such, patients should be counseled on the potential increased risk of early wound complications with the direct anterior approach, and future research is needed to determine if alternative closure techniques can reduce the risk of wound complication.     

甲状腺癌再次手术的原因及对策

[目的] 探讨甲状腺癌再次手术治疗的原因及对策。[方法] 对过去10年间收治的甲状腺手术后病理证实为甲状腺癌，需要行再次手术治疗的69例临床病例资料进行回顾性分析。[结果] 47例再次手术的原因为将甲状腺癌误诊为甲状腺良性病变，手术切除范围不够；17例原因为首次术式选择不当，术后病理切片证实癌细胞残留；5例原因为甲状腺癌术后复发。其中随访42例，5年生存率95．2％(40／42)。[结论] 甲状腺癌的误诊是造成甲状腺癌再次手术治疗的主要原因，提高术者对甲状腺癌的认识水平，强调术中快速冰冻病检在甲状腺手术中的常规应用，选用恰当的手术方式，是避免甲状腺癌再次手术的关键。     

Limited root repair in acute type A aortic dissection is safe but results in increased risk of reoperation

Objective

Management of the aortic root is a challenge for surgeons treating acute type A aortic dissection.

Risk of major complications following thyroidectomy and parathyroidectomy: Utility of the NSQIP surgical risk calculator

Background

The primary objective of this study was to determine rates of reoperation, ED visits, and hospital readmission after thyroid and parathyroid surgery at a tertiary hospital. A secondary objective was to determine if scores from the American College of Surgeons Surgical Risk Calculator (ACS SRC) predicted these events.