Tratamiento del síndrome de Budd-Chiari agudo intraoperatorio mediante colocación de prótesis de silicona

Complete liver mobilization for major resections sometimes causes liver tilting due to the release of the suspensory elements of the liver. Rarely this may take to a liver abnormal position with acute obstruction to venous flow at the suprahepatic level (Budd-Chiari syndrome). To avoid this complication, techniques such as post-operative stent implantation have been described. The case of a patient who underwent a complete mobilization of the liver for resection of the inferiour venous cava and a right renal tumor, was reported. After that, an acute Budd-Chiari Syndrome was observed caused of the liver malposition, which was solved with the placement of two silicone prostheses in the liver cell.     

髋臼螺钉对非骨水泥全髋置换术中假体稳定性的影响

目的探讨髋臼螺钉在非骨水泥全髋置换术中对髋臼假体稳定性的影响。 方法回顾性分析2009年8月至2015年8月在深圳市龙岗区人民医院骨科行非骨水泥全髋置换术114例(117髋)病例资料，患者根据术中是否植入髋臼螺钉分成两组，其中A组无螺钉组59髋，B组螺钉固定组58髋。分别在术后3个月、12个月、24个月和末次随访时对病人进行随访，评估并比较影像学的改变及Harris评分。A组57髋B组56髋获得完整随访资料，平均随访(5.7±1.6)年。以Kaplan-Meier法分析两组假体生存率。 结果A组平均手术时间(t＝2.213, P<0.05)、术中出血量均小于B组(t＝2.342, P<0.05)；随访末期，A、B组术后平均Harris评分为(95.0±2.1)分及(93.0±5.5)分(P>0.05)；A、B组术后3个月、12个月、24个月分别有4髋(7.0%)、3髋(5.3%)、1髋(1.8%)和1髋(1.8%)、2髋(3.6%)及2髋(3.6%)出现髋臼周围透亮线；A组1髋术后4年出现骨溶解，B组2髋出现骨溶解。以影像学证明假体松动作为失败标准，计算两组假体平均随访(5.7±1.6)年生存率分别为97%和95%，两者差异无统计学意义(P >0.05)。 结论髋臼骨质条件良好时是否使用髋臼螺钉固定对臼杯的稳定性无明显影响，全髋关节置换术中植入髋臼螺钉不是必需的。     

Biomechanical factors affecting individuals with lower limb amputations running using running-specific prostheses: A systematic review

BackgroundRunning-specific prostheses (RSPs) are biomechanically designed to enable individuals with lower limb amputations to engage in high level sports.Research questionWhat is the influence of RSP use on the running biomechanics of individuals with lower limb amputations?MethodsAn article search was conducted in six databases since their inception to July 2021. Two independent reviewers assessed the title, abstract and full texts in the review process. The quality of the papers was appraised. The review included a total of 35 articles.ResultsMain findings indicate force production is a limitation of RSPs. Individuals with lower limb absence employ a variety of compensatory strategies such as adjusting their step frequency, contact length and joint kinetics to improve their running performance. Leg stiffness modulation and external factors relating to the RSP design and fitting play important roles in RSP biomechanics. For individuals with unilateral amputations, the increased loading of the intact limb could increase the risk of acute injury or chronic joint degradation.SignificanceTo improve their running performance, runners with lower limb amputations employ various compensatory strategies, such as altering the spatiotemporal and kinetic parameters. Factors relating to RSP height, stiffness, shape, and alignment also play an important role in terms of running biomechanics and should be considered in RSP design and fitting. Future studies should focus on the use of RSPs for recreation, in pediatric populations, with certain amputation levels, as well as the impact of training and running techniques.     

Role of pulsed electromagnetic fields after joint replacements

Although the rate of patients reporting satisfaction is generally high after joint replacement surgery, up to 23% after total hip replacement and 34% after total knee arthroplasty of treated subjects report discomfort or pain 1 year after surgery. Moreover, chronic or subacute inflammation is reported in some cases even a long time after surgery. Another open and debated issue in prosthetic surgery is implant survivorship, especially when related to good prosthesis bone ingrowth. Pulsed Electro Magnetic Fields(PEMFs) treatment, although initially recommended after total joint replacement to promote bone ingrowth and to reduce inflammation and pain, is not currently part of usual clinical practice. The purpose of this review was to analyze existing literature on PEMFs effects in joint replacement surgery and to report results of clinical studies and current indications. We selected all currently available prospective studies or RCT on the use of PEMFs in total joint replacement with the purpose of investigating effects of PEMFs on recovery, pain relief and patients' satisfaction following hip, knee or shoulder arthroplasty. All the studies analyzed reported no adverse effects, and good patient compliance to the treatment. The available literature shows that early control of joint inflammation process in the first days after surgery through the use of PEMFs should be considered an effective completion of the surgical procedure to improve the patient's functional recovery.     

Penile Prosthesis Implantation and Timing Disparities After Radical Prostatectomy: Results From a Statewide Claims Database

BackgroundMany patients with erectile dysfunction (ED) after radical prostatectomy (RP) improve with conservative therapy but some do not; penile prosthesis implantation rates have been sparsely reported, and have used nonrepresentative data sets.AimTo characterize rates and timing of penile prosthesis implantation after RP and to identify predictors of implantation using a more representative data set.MethodsThe Healthcare Cost and Utilization Project State Inpatient and State Ambulatory Surgery databases for Florida from 2006 to 2015 were used. Patients undergoing RP (2006–2012) were tracked longitudinally for penile prosthesis implantation. Patient and clinical data were analyzed using multivariable logistic regression.OutcomesThe primary outcome was risk-adjusted predictors of prosthesis implantation, and the secondary outcome was predictors of the highest quartile of time between RP and penile prosthesis.ResultsOf 29,288 men who had RP, 1,449 (4.9%) patients underwent subsequent prosthesis. The mean time from RP to prosthesis was 2.6 years (median: 2.1; interquartile range [IQR]: 1.2–3.5). Adjusted predictors of prosthesis implantation included open RP (odds ratio [OR]: 1.5, P < .01), African American race (OR: 1.7, P < .01) or Hispanic ethnicity (OR: 3.2, P < .01), and Medicare (OR: 1.4, P < .01) insurance. Oler patients (age >70 years; OR: 0.7, P < .01) and those from the highest income quartile relative to the lowest (OR: 0.8, P < .05) were less likely to be implanted. Adjusted predictors of longer RP-to-implantation time (highest quartile: median: 4.7 years; IQR: 3.9–6.0 years) included open RP (OR: 1.78, P < .01), laparoscopic RP (OR: 4.67, P < .01), Medicaid (OR: 3.03, P < .05), private insurance (OR: 2.57, P < .01), and being in the highest income quartile (OR: 2.52, P < .01).Clinical ImplicationsThese findings suggest ED treatment healthcare disparities meriting further investigation; upfront counseling on all ED treatment modalities and close monitoring for conservative treatment failure may reduce lost quality of life years.Strengths & LimitationsThis study is limited by its use of administrative data, which relies on accurate coding and lacks data on ED questionnaires/prior treatments, patient-level cost, and oncologic outcomes. Quartile-based analysis of income and time between RP and prosthesis limits the conclusions that can be drawn.ConclusionLess than 5% of post-RP patients undergo penile prosthesis implantation, with open RP, Medicare, African American race, and Hispanic ethnicity predicting post-RP implantation; living in the wealthiest residential areas predicts lower likelihood of implantation compared to the least wealthy areas. Patients with the longest time between RP and prosthesis are more likely to live in the wealthiest areas or have undergone open/laparoscopic RP relative to robotic RP.Bajic P, Patel PM, Nelson MH, et al. Penile Prosthesis Implantation and Timing Disparities After Radical Prostatectomy: Results From a Statewide Claims Database. J Sex Med 2020;17:1175–1181.     

Surgical treatment of radial head isolated Mason III fractures

Introduction

In this retrospective study we have analyzed a consecutive series of patients affected by isolated radial head Mason III fractures and treated with bone resection or prosthesis.

Cross-cultural adaptation and Rasch validation of the Slovene version of the Orthotics and Prosthetics Users’ Survey (OPUS) Client Satisfaction with Device (CSD) in upper-limb prosthesis users

ObjectiveTo validate the Slovene version of the Orthotics and Prosthetics Users’ Survey (OPUS) 8-item Client Satisfaction with Device (CSD) questionnaire in upper-limb prosthesis users and to further verify measurement properties of this tool with Rasch analysis.DesignParticipants consisted of a convenience sample of 76 adults (54 men) using a prosthesis after unilateral upper-limb amputation who consecutively attended a follow-up visit at our centre.MethodsAfter translation and cross-cultural adaptation of the CSD into the Slovene language, we evaluated functioning of the rating scale categories, item fit (internal construct validity), reliability indices and dimensionality, as well as convergent and discriminant construct validity of the questionnaire.ResultsRasch analysis indicated that: (1) functioning of the 4 response options was acceptable; (2) all items fitted the measured construct [information-weighted (infit) and outlier-sensitive (outfit) mean-square statistics 0.60 to 1.40]; (3) person separation reliability was 0.62 (and Cronbach α = 0.76), item separation reliability was 0.83; (4) on principal component analysis (PCA) on the standardised residuals, the CSD showed borderline but acceptable unidimensionality and no local item dependency. Moreover, as expected, the CSD score showed good correlation with the QUEST 2.0 score (r_s = 0.57) and little to fair correlation with the OPUS Upper Extremity Functional Status score (r_s = 0.21).ConclusionThe metric properties of the Slovene version of CSD agree with previous studies. The present study confirms the validity of CSD for measuring patient satisfaction with an upper-limb device, enhances the confidence in this tool for assessing upper-limb prosthesis users, and contributes to further refining the technical quality of this measure.     

偏心改向髋臼内衬的设计与模拟手术

目的：设计出偏心改向髋臼内衬,以解决臼杯位置不良时内衬补救或翻修,及小髋臼关节置换问题。方法在Solidworks2012软件平台上,利用三维实体建模技术,设计一套偏心改向髋臼内衬,并进行模拟手术,预测手术效果。结果成功设计出一套偏心改向髋臼内衬,改向规格有0°、10°、20°、30°;偏心规格有球心偏向非负重侧2 mm的外径／内径的比值分别为42 mm／28 mm、40 mm／28 mm和38 mm／24 mm、36 mm／24 mm四种。模拟手术显示髋关节置换或翻修术后防脱位效果和活动范围。结论偏心改向髋臼内衬设计合理,用于臼杯位置不良时内衬补救或翻修及小髋臼大球头置换,模拟手术提示有防脱位功能。