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1.
BackgroundRepairing crowns with defective margins is minimally invasive and cost-effective compared with replacement. The authors’ objectives were to examine the survival trajectory of crown margin repairs and to determine the factors associated with survival.MethodsRecords of adult patients from January 2008 through August 2019 were reviewed for crown margin repairs completed at University of Iowa College of Dentistry. A total of 1,002 crown margin repairs were found. Each repair was followed through the end of study in 2019 or until an event (for example, additional repair, endodontic treatment, crown replacement, or extraction). A Cox proportional hazards model was used to study the relationship between selected covariates and time to event.ResultsDuring the follow-up period, 32.8% of the repairs needed reintervention. In the final model, repair material was the only significant covariate. No difference was found between the survival of repairs done with resin-modified glass ionomer and amalgam. However, the repairs done with resin-based composite and conventional glass ionomer were more likely (1.5 times: 95% CI, 1.02 to 2.10 times; and 2 times: 95% CI, 1.40 to 2.73 times, respectively) to need reintervention than were those done with amalgam.ConclusionsMedian survival time of crown margin repairs was 5.1 years (95% CI, 4.48 to 5.72 years). Median survival times for amalgam, resin-modified glass ionomer, resin-based composite, and glass ionomer repair materials were 5.7 years (95% CI, 4.80 to 6.25 years), 5.3 years (95% CI, 4.73 to 6.34 years), 3.2 years (95% CI, 2.51 to 6.19 years), and 3.0 years (95% CI, 2.53 to 3.62 years), respectively.Practical ImplicationsWhen considering crown margin repairs, resin-modified glass ionomer or amalgam is preferable to resin-based composite or glass ionomer.  相似文献   
2.
《Orthopaedics and Trauma》2022,36(3):166-174
Shoulder replacement surgery has become the gold standard treatment for end-stage glenohumeral arthropathies in patients who are fit for surgical treatment. The options include anatomic total shoulder replacement, reverse total shoulder replacement and humeral hemiarthroplasty procedures. Whilst for some patients and some indications there is little debate, decision-making for older patients with osteoarthritis remains one of the hot topics in shoulder surgery. In this article we will explore the treatment options, outcomes, and controversies.  相似文献   
3.
ObjectiveTo evaluate the long-term incidence and outcome of aortic interventions for medically managed uncomplicated thoracic aortic dissections.MethodsBetween January 2012 and December 2018, 91 patients were discharged home with an uncomplicated, medically treated aortic dissection (involving the descending aorta with or without aortic arch involvement, no ascending involvement). After a median period of 4 (first quartile: 2, third quartile: 11) months, 30 patients (33%) required an aortic intervention. Patient characteristics, radiographic, treatment, and follow-up data were compared for patients with and without aortic interventions. A competing risk regression model was analyzed to identify independent predictors of aortic intervention and to predict the risk for intervention.ResultsPatients who underwent aortic interventions had significantly larger thoracic (P = .041) and abdominal (P = .015) aortic diameters, the dissection was significantly longer (P = .035), there were more communications between both lumina (P = .040), and the first communication was significantly closer to the left subclavian artery (P = .049). A descending thoracic aortic diameter exceeding 45 mm was predictive for an aortic intervention (P = .001; subdistribution hazard ratio: 3.51). The risk for aortic intervention was 27% ± 10% and 36% ± 11% after 1 and 3 years, respectively. Fourteen patients (47%) underwent thoracic endovascular aortic repair, 11 patients (37%) thoracic endovascular aortic repair and left carotid to subclavian bypass, 3 patients (10%) total arch replacement with the frozen elephant trunk technique, and 2 patients (7%) thoracoabdominal aortic replacement. We observed no in-hospital mortality.ConclusionsThe need for secondary aortic interventions in patients with initially medically managed, uncomplicated descending aortic dissections is substantial. The full spectrum of aortic treatment options (endovascular, hybrid, conventional open surgical) is required in these patients.  相似文献   
4.
BackgroundSelection of the transcatheter heart valve size for a mitral valve-in-valve procedure is based on the type and manufacturer’s labelled size. However, accurate information of surgical heart valve (SHV) size may not be available in the patient’s medical record. The purpose of this study is to establish reference data for computed tomography (CT) dimensions of commonly used mitral SHV in order to determine the manufacturer’s labelled size from a cardiac CT data set.MethodsCT datasets of 105 patients with surgical mitral bioprosthesis and available manufacturer labeled datasets were included in the analysis. CT derived valve dimensions were assessed by two observers using multiplanar reformats aligned with the basal sewing ring. A circular region of interest was used in a standardized fashion to minimize influence of image acquisition and reconstruction parameters. Interobserver variability was assessed by Bland-Altman analysis.ResultsThe CT-derived dimensions were stratified by valve size and type, and SHV properties were demonstrated for 5 common valve types. Variability of measurements was small and inter-observer limits of agreement were narrow. Stratified by SHV type, no overlap was noted for CT-derived dimensions among different SHV sizes . A reference table of CT characteristics of surgical mitral bioprosthesis types was created.ConclusionThe study provides reference CT data for determining the manufacturers’ labeled SHV size across a range of commonly used mitral SHVs. The findings will be important to help identify types of surgical mitral bioprosthesis utilizing CT characteristics for patients without SHV size documentation.  相似文献   
5.
ObjectivesGuidelines suggest aortic valve replacement (AVR) for low-risk asymptomatic patients. Indications for transcatheter AVR now include low-risk patients, making it imperative to understand state-of-the-art surgical AVR (SAVR) in this population. Therefore, we compared SAVR outcomes in low-risk patients with those expected from Society of Thoracic Surgeons (STS) models and assessed their intermediate-term survival.MethodsFrom January 2005 to January 2017, 3493 isolated SAVRs were performed in 3474 patients with STS predicted risk of mortality <4%. Observed operative mortality and composite major morbidity or mortality were compared with STS-expected outcomes according to calendar year of surgery. Logistic regression analysis was used to identify risk factors for these outcomes. Patients were followed for time-related mortality.ResultsWith 15 observed operative deaths (0.43%) compared with 55 expected (1.6%), the observed:expected ratio was 0.27 for mortality (95% confidence interval [CI], 0.14-0.42), stroke 0.65 (95% CI, 0.41-0.89), and reoperation 0.50 (95% CI, 0.42-0.60). Major morbidity or mortality steadily declined, with probabilities of 8.6%, 6.7%, and 5.2% in 2006, 2011, and 2016, respectively, while STS-expected risk remained at approximately 12%. Mitral valve regurgitation, ventricular hypertrophy, pulmonary, renal, and hepatic failure, coronary artery disease, and earlier surgery date were residual risk factors. Survival was 98%, 91%, and 82% at 1, 5, and 9 years, respectively, superior to that predicted for the US age-race-sex–matched population.ConclusionsSTS risk models overestimate contemporary SAVR risk at a high-volume center, supporting efforts to create a more agile quality assessment program. SAVR in low-risk patients provides durable survival benefit, supporting early surgery and providing a benchmark for transcatheter AVR.  相似文献   
6.
AimsThis review aims to provide an update of available methods for imaging calcification activity and potential therapeutic options.Data SynthesisAortic valve calcification represents the most common heart valve condition requiring treatment among adults in Western societies. No medical therapies are proven to be effective in treating symptoms or reducing disease progression. Therefore, surgical or transcatheter aortic valve replacement remains the only available treatment option. Elevated circulating concentrations of lipoprotein(a) is strongly associated with degenerative aortic stenosis. This relationship was first observed in prospective observational studies, and the causal relationship was confirmed in genetic studies.ConclusionsNew therapeutic targets have been identified and new imaging techniques could be used to test the effectiveness of new agents and further clarify the pathophysiology of AVS. No therapy that specifically lowers Lp (a) levels has been approved for clinical use.  相似文献   
7.
BackgroundThe treatment of complex 3- and 4-part proximal humerus fractures (PHFs) in the elderly poses significant challenges because of osteoporosis and fracture comminution. The wide range of surgical options available is evidence of the complex nature of the injury. At present, reverse shoulder replacement is gaining popularity among shoulder surgeons for treating these difficult fractures, and the literature has shown equivalent or superior outcomes with reverse shoulder arthroplasty (RSA). We aimed to analyze the long-term results of these complex PHF treated with reverse shoulder replacement.MethodsFor this study, fractures from 39 patients with a mean age of 63.18 years who were treated with RSA for acute complex fractures of the proximal humerus in our institution between 2013 and 2019 were analyzed (n = 31, acute 4-part fractures; n = 4, acute fracture–dislocation; n = 3, fracture with irreparable cuff tear; n = 1, osteoporotic 2-part fracture). All patients had a standard reverse shoulder replacement (cemented humeral stem n = 37 and uncemented stem n = 2) surgery in a level 1 trauma center. The mean follow-up duration was 60 months (24-111 months). The clinical outcomes (Oxford Shoulder Score and Constant Shoulder Score) and the complications at 6 months, 12 months, and 24 months were analyzed.ResultsOur study found a relatively younger population, with 21 patients (53.84%) aged <66 years. Spearman's correlation showed that younger patients had better signs of improvement in Oxford Shoulder Scores at 2 years (P = .008). The average Oxford Shoulder Score was 39.12 ± 4.327, and the average Constant Shoulder Score was 67.67 on the operated side. The mean active forward elevation was 142.56 ± 22.29º, abduction was 136.538 ± 24.31º, external rotation was 27 ± 9.011º, and internal rotation was 33 ± 20.41º. The overall complication rate of 17.94% (periprosthetic infection n = 2, periprosthetic humerus fracture n = 1, and hematoma evacuation n = 4) in our study was similar to those of recent studies in the literature.ConclusionRSA provides a reliable option for PHFs and offers good results in the form of pain relief and good functional outcomes at 2 years even in a younger age group. Thus, it is fast becoming an important option in treating complex PHF, but we must be wary of the steep learning curve and the complications pertinent to this procedure.  相似文献   
8.
目的 探讨维生素C注射液联合依托咪酯对膝关节置换术后病人氧化应激及炎症因子水平的影响。方法 纳入于我院行择期膝关节置换术的70例病人,按随机数字表法分为观察组和对照组。对照组给予丙泊酚辅助诱导麻醉及麻醉维持,观察组给予依托咪酯辅助麻醉诱导及麻醉维持,并在麻醉诱导前10 min、术中麻醉维持时、手术结束时及术后12 h分别予维生素C注射液0.5 g。于术前(T0)、术毕麻醉停止前(T1)、术后1 d(T2)、术后3 d(T3)、术后5 d(T4)这5个时间点分别抽取病人的外周静脉血,检测超氧化物歧化酶(SOD)、丙二醛(MDA)、肿瘤坏死因子-α(TNF-α)和白介素-6(IL-6)的水平。采用疼痛视觉模拟量表(VAS)对所有病人术后1、3、5 d的疼痛程度进行评分。结果 观察组中有1例退出研究,最终观察组纳入34例,对照组纳入35例。两组病人的年龄、性别、身体质量指数(BMI)、美国麻醉医师协会(ASA)分级、手术时间及止血带使用时间比较,差异均无统计学意义(P均>0.05)。两组病人T0和T1时间点的SOD和MDA水平比较,差异无统计学意义(P>0.05);在T2、T3、T4时间点,观察组的SOD水平显著高于对照组,而MDA水平显著低于对照组(P<0.05);从T0到T4,SOD水平变化趋势为先降低,然后在T4点升高,MDA水平变化趋势为先升高,然后在T4点降低。两组病人T0时的TNF-α和IL-6水平比较,差异无统计学意义(P>0.05);在T1、T2、T3、T4时间点,观察组的TNF-α和IL-6水平显著低于对照组(P<0.05);从T0到T4,TNF-α和IL-6水平变化趋势为先升高,然后在T3点逐渐降低。观察组术后1、3 d的VAS评分显著低于对照组(P<0.05)。结论 维生素C注射液联合依托咪酯可有效降低膝关节置换术病人的氧化应激水平和炎症反应,减小缺血再灌注损伤的影响,降低术后疼痛程度。  相似文献   
9.
BackgroundPost-operative elderly hip fracture patients require significant rehabilitation. Nandrolone is an anabolic steroid used to promote muscle growth. This study aims to examine the effect of nandrolone in improving rehabilitation and quality of life in elderly female patients with hip fractures undergoing hemiarthroplasty.MethodsThis is a double-blinded prospective randomized-controlled-trial consisting of female patients above the age of 65 with an isolated neck of femur fracture planned for a hip hemiarthroplasty. Participants were randomized into two arms of the study – 50 mg intramuscular nandrolone vs normal saline placebo administered on post-operative day 0, and weeks 2, 6 and 12. The participants were followed up across a 1-year period following the surgery. Clinical outcomes such as time taken to achieve rehabilitation milestones, distance of ambulation and thigh muscle girth, and functional scoring with SF-36 questionnaire were recorded at intervals of 2, 6 and 12 weeks, 6 months and 1 year following the surgery.ResultsThere were a total of 23 subjects with 11 in the steroid group and 12 in the placebo group. There was no significant difference in demographics and injury patterns between both groups. There was no significant difference for time taken to achieve various rehabilitation milestones and distance of ambulation. SF-36 scores on discharge and at 1-year follow-up mark were comparable. There was no difference in the complication rate between both groups.ConclusionIntra-muscular Nandrolone after hip surgery in elderly female patients does not result in short to mid-term improved rehabilitation or functional outcomes. Nandrolone did not result in increased short-term complications after hip surgery.Level of evidenceI.  相似文献   
10.
目的: 探讨采用大转子延长截骨钢丝固定加自体骨屑植骨进行全髋关节置换翻修的临床效果。方法: 自2010年12月至2018年12月,应用大转子延长截骨钢丝固定结合自体骨屑植骨,行全髋关节置换翻修术患者18例,其中男8例,女10例;年龄68~82(78.89±3.32)岁;初次置换术后至翻修时间9~22(16.33±2.93)年。术后定期随访记录患者截骨块愈合时间、完全负重活动时间、髋关节Harris评分及并发症等情况。结果: 纳入研究的18例患者均获得随访,时间16~38(25.78±6.65)个月。手术切口均Ⅰ期愈合。切口长度16~21(18.89±1.32) cm。手术时间105~128(115.44±6.59) min;出血量240~285(267.44±13.77) ml。截骨块愈合时间12~18(15.61±1.75)周;患者完全负重活动时间14~22(17.78±2.53)周。术前髋关节Harris评分(47.11±5.04)分,完全负重活动时髋关节Harris评分(76.39±3.85)分,末次随访时髋关节Harris评分(82.22±2.76)分,差异有统计学意义(P<0.05)。随访期间,患者均未发生患肢短缩、感染、切口愈合不良、假体松动及下沉、假体周围骨折等并发症。结论: 在全髋关节置换翻修术时,应用大转子延长截骨钢丝固定结合自体骨屑植骨,能够获得满意的临床治疗效果,但需要术者对翻修术前、术中及术后恢复等各个时期做好系统规划。  相似文献   
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