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1.
Background
The purpose of this study was to characterize anterolateral bowing of the femur using X-rays and muscular atrophy in the mid-thigh using computed tomography (CT) in patients with atypical femoral fractures (AFFs). We then compared the results with those of an intertrochanteric fracture to understand whether these measures act as causative factors of AFFs.Methods
From January 2009 to December 2015, 37 patients with complete AFF and 12 patients with incomplete AFF were enrolled in this study. Lateral femoral bowing, anterior femoral bowing, cross-sectional area (CSA), and attenuation coefficient of thigh muscles in the AFF group are measured and compare with those in the intertrochanteric fracture group.Results
Lateral and anterior femoral bowing in the AFF group were significantly higher than those in the intertrochanteric fracture group. The level of fracture was found to be significantly associated with lateral and anterior femoral bowing (r = 0.569, r2 = 0.324, p < 0.001; r = ?0.530, r2 = 0.281, p < 0.001, respectively). Total CSA and CSA of anterior and medial compartments were significantly lower in the AFF group (p < 0.05). The attenuation coefficient of the total thigh muscle and all three compartments in the AFF group were significantly lower than those in the intertrochanteric fracture group (p < 0.05).Conclusions
This study demonstrated that anterolateral femoral bowing and loss of thigh muscle were highly associated with the occurrence of AFFs. 相似文献2.
Hiroshi Hagino Naoto Endo Atsushi Harada Jun Iwamoto Tasuku Mashiba Satoshi Mori Seiji Ohtori Akinori Sakai Junichi Takada Tetsuji Yamamoto 《Journal of orthopaedic science》2017,22(5):909-914
Background
A nationwide survey of hip fractures by the Japanese Orthopaedic Association (JOA) from 1998 to 2008 found a drastic increase in incidence. The aims of this study were to elucidate the status of hip fractures from 2009 to 2014 and to survey the causes for delayed surgery.Methods
A tally of all hip fractures that occurred in patients from 2009 to 2014 was conducted in hospitals authorized by the JOA or in clinics with inpatient facilities of the Japanese Clinical Orthopaedic Association (JCOA). A survey of the causes for delay in surgery was conducted at 849 sites and 526 sites participated.Results
A total of 488,759 hip fractures were registered. Increases in incidence from 2009 to 2014 were prominent in the 90–94-year-old age group among women and the 85–89-year-old age group among men. More trochanteric fractures than neck fractures occurred; however, the neck/trochanter ratio increased over time. The mean duration of preoperative hospital stay was 4.8 and 4.5 days, and the mean duration of hospitalization was 40.5 and 36.8 days in 2009 and 2014, respectively. There were significant differences between patients who waited for surgery up to 3 days and those who waited longer than 3 days in date of hospitalization, fracture type, comorbidities, anticoagulant use, surgical procedure, type of physician who administered anesthesia, type of anesthesia, and operating room schedule. Physicians in charge of each patient who waited for surgery for more than 3 days most frequently cited difficulties in securing operating rooms as the cause for delayed surgery.Conclusion
A drastic increase occurred in the number of patients with hip fractures with time in Japan. One problem in the treatment of hip fractures is the long waiting time from hospitalization to surgery resulting from difficulties in securing operating rooms. 相似文献3.
Eiji Nakata Shinsuke Sugihara Natsumi Yamashita Shozo Osumi 《Journal of orthopaedic science》2017,22(5):946-950
Background
Atypical femoral fractures (AFFs) have been reported to occur in patients with bone metastases who received long-term bisphosphonate treatment. However, the incidence of AFFs in breast cancer patients with bone metastases who received intravenous bisphosphonate is unclear. The purpose of this study is to examine the incidence of AFFs in breast cancer patients with bone metastases who received intravenous bisphosphonate. In addition, we estimated the number of dose and duration of intravenous bisphosphonate at the time of occurrence of AFFs.Methods
We identified 356 female breast cancer patients with bone metastases who received intravenous bisphosphonate between November 2004 and October 2013 in our institution. The median number of doses of intravenous bisphosphonate was 18 (range, 1–103). The median duration of intravenous bisphosphonate treatment was 16 months (range, 1–102 months).We estimated the incidence of AFFs in patients who received intravenous bisphosphonate and used Poisson regression model to obtain the incidence rates of AFFs.Results
Three AFFs in two patients were identified and the estimated incidence of AFFs was 2.99 per 1000 person-years. At the time of occurrence of AFFs, the patients had received 41 and 83 doses of intravenous bisphosphonate, for 37 and 79 months, respectively. The patients underwent open reduction and internal fixation with intramedullary nail. The frequency and incidence of AFFs in patients who received intravenous bisphosphonate for at least 41 or 83 doses or for more than 37 or 79 months were 2/60 (3.3%), 1/7 (14.3%), 2/70 (2.9%), and 1/9 (11.1%), respectively.Conclusions
The incidence of AFFs is low in breast cancer patients with bone metastases who received intravenous bisphosphonate. Careful observation is warranted and radiography should be performed to investigate AFFs when clinical signs such as thigh pain appear.Study design
Clinical study. 相似文献4.
Purpose of Review
To summarize reports published since the 2013 American Society of Bone and Mineral Research Task Force Report on atypical femoral fractures (AFF).Recent Findings
The absolute incidence of AFFs remains low. AFFs are primarily associated with prolonged bisphosphonate (BP) exposure, but have also been reported in unexposed patients and those receiving denosumab for osteoporosis and metastatic bone disease. Asians may be more susceptible to AFFs. Lateral femoral bowing and varus hip geometry, which increase loading forces on the lateral femoral cortex, may increase AFF risk. Altered bone material properties associated with BP therapy may predispose to AFFs by permitting initiation and increasing propagation of micro-cracks. Relevant genetic mutations have been reported in patients with AFFs. Single X-ray absorptiometry femur scans permit early detection of incomplete and/or asymptomatic AFFs. Orthopedists recommend intramedullary rods for complete AFFs and for incomplete, radiologically advanced AFFs associated with pain and/or marrow edema on MRI. Teriparatide may advance AFF healing but few data support its efficacy.Summary
Greater understanding of biological and genetic predisposition to AFF may allow characterization of individual risk prior to initiating osteoporosis therapy and help allay fear in those at low risk for this complication, which remains rare in comparison to the osteoporotic fractures prevented by antiresorptive therapy.5.
Noboru Hosono Shota Takenaka Yoshihiro Mukai Kosuke Tateishi Yasushi Fujiwara Yuichiro Morishita Hiroaki Konishi 《Journal of orthopaedic science》2018,23(3):477-482
Background
The JOA (Japan Orthopaedic Association) score has been a standard outcome measure to evaluate cervical myelopathy in Japan. Despite its reliability and convenience, there can be a rating bias in the JOA score. The current study was conducted to delineate the rater's bias of the JOA score by comparing it with a new objective outcome measure.Methods
Two hundred and thirty four operative candidates with cervical myelopathy were included in the study. The patients were divided into four groups according to the surgeon (92 patients in group A, 60 patients in group B, 38 patients in group C and 44 patients in group D). Each patient's preoperative JOA score was exclusively recorded by the surgeon himself, while JOACMEQ (Japanese Orthopaedic Association Cervical Myelopathy Evaluation Questionnaire) was recorded by each patient. Disease severity, the most important prognostic factor, was equalized between patient groups by a special statistical method called inverse-probability weighting (IPW). To define similarity of the two groups, Cohen's d was used.Results
After the adjustment, the differences of the JOA score were only 0.1 between groups A and D and 0 between groups B and C. The values of Cohen's d were also very small both between groups A and D (3%), and between groups B and C (0.3%). The averaged JOA scores of groups A and D were higher by 0.4–0.8 than those of groups B and C, while the averaged JOA scores were almost the same both between groups A and D, and between groups B and C. Surgeons A and D had the same tendency to give higher JOA scores than surgeons B and C did.Conclusions
The current study confirmed there is a definite rater's bias in the JOA score. JOACMEQ is to be applied as a more reliable outcome measure to evaluate myelopathy patients. 相似文献6.
Hiroaki Onuma Takashi Hirai Toshitaka Yoshii Hiroyuki Inose Masato Yuasa Shigenori Kawabata Atsushi Okawa 《Journal of orthopaedic science》2018,23(6):923-928
Purpose
To clarify whether there is any difference in mid-term clinical and radiologic outcomes between bone-grafted laminoplasty (BG LAMP) and non-bone-grafted laminoplasty (non-BG LAMP) when used to treat cervical spondylotic myelopathy.Background
Conventional BG LAMP includes bone grafting at the lamina hinge site to prevent closure of the lamina postoperatively, but it often results in segmental fusion and sometimes causes loss of cervical mobility and lordotic alignment. Non-BG LAMP can now be performed to address this problem and preserve mobility postoperatively. However, there have been no studies comparing BG LAMP and non-BG LAMP to date.Methods
Forty-one patients who underwent BG LAMP (n = 24) or non-BG LAMP (n = 17) and had 5 years of follow-up were enrolled in the study. Neurological status was assessed preoperatively and postoperatively using the Japanese Orthopedic Association (JOA) scoring system. The Numeric Rating Scale (NRS) was used to assess neck pain after surgery at the final visit. Radiographic parameters were evaluated at 1, 3, and 5 years after surgery. Postoperative segmental fusion was defined as the level at which the segmental flexion–extension range of motion was <1°.Results
There was no significant difference in JOA score or recovery rate between the groups. NRS score was significantly lower in the BG group, indicating less neck pain (P < .01). The lordotic angle and range of motion at C2-C7 were significantly decreased in the BG group (P < .05). The segmental fusion was evident from 1 year postoperatively in both groups, but the fusion rate was significantly higher in the BG group (P < .05).Conclusions
Neurologic outcomes were similar between the two groups, whereas axial symptom was lower in the BG group than in the non-BG group.Level of evidence
Ⅳ 相似文献7.
Eijiro Okada Takashi Tsuji Kentaro Shimizu Masanori Kato Kentaro Fukuda Shinjiro Kaneko Jun Ogawa Kota Watanabe Ken Ishii Masaya Nakamura Morio Matsumoto 《Journal of orthopaedic science》2017,22(1):3-9
Purpose
To clarify correlations between spinal fracture and delayed paralysis in patients with diffuse idiopathic skeletal hyperostosis (DISH) using computed tomography (CT) with multiplanar reformatting (CT-MPR). DISH increases susceptibility to unstable spinal fractures, leading to neurological deterioration. The pathomechanism of the neurological injury is unclear.Methods
This multicenter retrospective study included 42 DISH patients (32 male; 10 female) treated for 45 spinal fractures during a 5-year period. The mean age at the time of injury was 77.1 ± 10.1 years. The cause of injury, delay in diagnosis, fracture location, and neurological status were recorded, and anterior- and posterior-column fractures, a fracture displacement over 3 mm, and posterior-column ankylosis were assessed using CT-MPR.Results
Most fractures (73.8%) resulted from trivial trauma, such as falling from a standing or sitting position. Diagnosis was delayed in 47.6% of the patients, primarily due to delays in seeking medical attention (65.0%). Although 78.6% of the patients were neurologically intact at the time of injury, 54.8% developed paralysis, defined by a change in one or more Frankel-score levels during short-term follow-up. Of the fractures, 39.1% were in the vertebral body, and 60.9% were at the disc level. Fractures with posterior-column ankylosis were significantly associated with delayed paralysis.Conclusions
CT-MPR was useful for evaluating spinal fractures and determining treatment in patients with DISH. Fractures associated with posterior-column ankylosis resulted in unstable three-column injuries that led to delayed neurological deterioration. Early surgical stabilization of such fractures is recommended to avoid delayed paralysis. 相似文献8.
Introduction
Rib fractures after blunt trauma contribute substantially to morbidity and mortality in the elderly.Methods
Retrospective review of 255 patients ≥65 years old at a level 2 trauma center over 6 years, who sustained blunt trauma resulting in rib fractures. Outcomes measured include mortality, hospital length of stay(LOS), intensive care unit(ICU) admission, ICU LOS, need for MV, and MV days.Results
There were 24 deaths (9.4%), of which 7 were early (<24?h). 130 patients (51%) were admitted to ICU, and 49 (19.2%) required MV. Mean ICU and MV days were 5.9 and 6.3, respectively. ICU admission was predicted by a base deficit <-2.0, ISS>15, bilateral rib fractures, pneumothorax or hemothorax on chest x-ray (All p?<?0.001), as well as hypotension, GCS<15, and 1st rib fractures (All p?<?0.05). Mortality was predicted by a base deficit?<?-5.0, GCS score of 3(Both p?<?0.001), as well as hypotension, ISS≥25, RTS <7.0, bilateral pneumothoraces, 1st rib fractures, and >5 rib fractures (All p?<?0.05).Conclusion
Rib fractures in elderly blunt trauma patients are associated with significant mortality and morbidity, but outcomes can be predicted to improve care. 相似文献9.
Kousuke Iba Takayuki Dohke Junichi Takada Koichi Sasaki Tomoko Sonoda Megumi Hanaka Suichi Miyano Toshihiko Yamashita 《Journal of orthopaedic science》2018,23(1):127-131
Background
We have previously reported that the low rate of osteoporosis patients treated with anti-osteoporotic drugs following surgical treatment for the first fragility fractures by orthopaedic surgeons during 3 years from 2000 to 2003 was only 13.1%. Ten years have now passed our previous study, and we hypothesized that the rate of appropriate pharmacologic treatment for the prevention of secondary fractures has improved.Methods
We studied 730 osteoporosis patients (102 men and 628 women; average age of 78 years, range 33–102 years) who underwent surgical treatment for fragility fractures, during 3-year period from 2010 to 2012. The 730 cases consisted of 489 hip fractures and 241 distal radius fractures. All patients were admitted and underwent surgical intervention in hospitals. Variables were examined to ascertain whether pharmaceutical treatment was performed after discharge. Based on these data, we compared results for patients in the present study with those from our previous study.Results
The rate of treatment with anti-osteoporosis medication in the present (16.2%) was slightly but significantly improved from that in our previous study (13.1%). The rate of pharmaceutical treatment following hip fractures increased significantly, while that following distal radius fractures showed no significant change. Regarding the categories of anti-osteoporotic drugs prescribed to the patients, the rate of treatment with bisphosphonate as a higher evidenced drug for the prevention of fractures in the present study was significantly higher than that in our previous study.Conclusion
We demonstrated that the rate of pharmacologic treatment by orthopaedic surgeons and the rate of more effective anti-osteoporotic drugs prescribed to the patients following surgical intervention for the first fragility fracture in the present study were improved in comparison with those of 10 years ago. 相似文献10.
Michael G. Jakubietz Laura Mages Robert K. Zahn Werner Kenn Rafael G. Jakubietz Rainer H. Meffert 《Journal of orthopaedic science》2017,22(3):434-437
Background
Intraarticular fractures of the distal radius present a challenging problem for surgeons. While preoperative CT scans are considered helpful to understand the type of fracture and to choose an adequate approach, the role of postoperative CT scans is not yet clearly defined. The aim of this study was to analyze indications for postoperative CT scans and to evaluate its potential therapeutic consequence in regard to detection of complications and its influence on revision rates in intraarticular fractures. These findings were used to establish an algorithm to help identifying patients that benefit from a postoperative CT scan.Patients and methods
Ninety-two patients with intraarticular fractures were included. AO type C fractures were seen in about 90% of patients, with type C3 being present in 55% of the patients. According to Frykman's classification type 7 and 8 fractures were found in 93%. Data was analyzed in regard to radiographic results, complications and indication for a postoperative CT scan.Results
Six patients underwent revision surgery. When analyzing data in regard to correlation of radiographs and CT Scans a statistically significant correlation was found.Conclusions
A high correlation between both imaging techniques can be shown. In inconclusive radiographs, CT scans are recommended to rule out intraarticular screw placement or step offs. Due to the number of patients and the retrospective design, further studies are needed. 相似文献11.
Eliza E. Moskowitz Clay Cothren Burlew Ernest E. Moore Fredric M. Pieracci Charles J. Fox Eric M. Campion Ryan A. Lawless Mitchell J. Cohen 《American journal of surgery》2018,215(4):675-677
Background
Open pelvic fractures are life-threatening injuries. Preperitoneal pelvic packing (PPP) has been suggested to be ineffective for hemorrhage control in open pelvic fractures. We hypothesize that PPP is effective at hemorrhage control in patients with open pelvic fractures and reduces mortality.Methods
Patients undergoing PPP from 2005 to 2015 were analyzed. Patients with open pelvic fractures were defined as direct communication of the bony injury with overlying soft tissue, vagina, or rectum.Results
During the 10-year study, 126 patients underwent PPP; 14 (11%) sustained an open pelvic fracture. After PPP, 1 patient (7%) underwent angioembolization with a documented arterial blush. PPP controlled pelvic hemorrhage in all patients. Overall mortality rate was 7% with one death due to traumatic brain injury.Conclusions
PPP is effective for hemorrhage control in patients with open pelvic fractures. PPP should be used in a standard protocol for hemodynamically unstable patients with pelvic fractures regardless of associated perineal injuries. 相似文献12.
Atsushi Kimura Katsushi Takeshita Hirokazu Inoue Atsushi Seichi Yosuke Kawasaki Toshitaka Yoshii Hiroyuki Inose Takeo Furuya Kazuhiro Takeuchi Shunji Matsunaga Shoji Seki Mikito Tsushima Shiro Imagama Masao Koda Masashi Yamazaki Kanji Mori Hirosuke Nishimura Kenji Endo Atsushi Okawa 《Journal of orthopaedic science》2018,23(1):185-189
Background
Fall-induced injuries represent a major public health concern for older individuals. The relationship between risk of falling and the severity of locomotive syndrome (LS) remains largely unknown.Methods
We conducted a retrospective analysis of patients who had undergone surgery from January 2012 to December 2013 and completed at least 1 year of follow-up at 12 participating institutes. Patients completed a questionnaire survey regarding their fall experience during a routine postoperative follow-up. Questionnaire items included the number of falls during the prior postoperative year and the 25-question Geriatric Locomotive Function Scale (GLFS-25). The severity of cervical myelopathy was assessed using the Japanese Orthopaedic Association (JOA) score. We analyzed the association between the incidence of falling and the severity of LS measured by the GLFS-25.Results
Of 360 patients, 61 (16.9%) experienced 1 fall; 31 (8.6%), 2–3 falls; 4 (1.1%), 4–5 falls; and 6 (1.7%), ≥6 falls during the first postoperative year. Thus, 102 (28%) patients experienced at least 1 fall, and 41 (11%) experienced recurrent falls (2 or more falls) during the time period. The mean GLFS-25 score was 30.2 ± 22.7, and 242 (62%) patients had GLFS-25 scores of 16 or higher, which fulfilled the diagnostic criteria for LS. When subjects were categorized into recurrent fallers and non-recurrent fallers, recurrent fallers had a significantly higher GLFS-25 score and a significantly lower extremity motor function score of the JOA score than non-recurrent fallers. The GLFS-25 and lower extremity motor function score of the JOA score yielded the areas under the receiver operating characteristic curves of 0.674 and 0.607, respectively, to differentiate recurrent fallers from non-recurrent fallers.Conclusion
Postoperative patients with cervical myelopathy had a 62% prevalence of LS. The GLFS-25 may be useful to predict the risk of recurrent falls in patients with cervical myelopathy. 相似文献13.
Joachim Gülke Barbara Leopold Daniel Grözinger Björn Drews Stephan Paschke Nikolaus J. Wachter 《Journal of hand therapy》2018,31(1):20-28
Study Design
Prospective cohort randomized controlled trial.Purpose of the Study
Is either a home exercise (HE) program or traditional physical therapy (PT) more effective in the postoperative management of metacarpal fractures?Methods
Sixty patients suffering from nonthumb metacarpal fractures who received mobilization-stable open reduction and internal fixation were included. All patients were prospectively randomized into either the PT group or the HE group. Follow-up examinations at 2, 6 and 12 weeks postoperatively.Results
After 2 weeks, the range of motion (ROM) in both groups was still severely reduced. Twelve weeks after surgery the ROM improved to 245° (PT) and 256° (HE). Grip strength after 6 weeks was 68% (PT) and 71% (HE) when compared to the non-injured hand, improving to 91% (PT) and 93% (HE) after 12 weeks.Conclusion
Study results show that both HE program and traditional PT are effective in the postoperative management of metacarpal fractures.Level of Evidence
II. 相似文献14.
Takayoshi Suzuki Hirohisa Katagiri Tatsuya Noda Shusuke Ota Hideki Murata Junji Wasa Seiichi Hosaka Tetsuo Shimoyama Mitsuru Takahashi 《Journal of orthopaedic science》2017,22(3):405-410
Objective
The purpose of this study was to investigate the differences between spinal metastasis and osteoporotic compression fractures on plain X-ray images, focusing on asymmetrical vertebral collapse and fracture level.Materials and methods
This study included 180 patients with pathological collapse from spinal metastasis (188 vertebrae) who were treated at our institution and 70 patients (92 vertebrae) with osteoporotic compression fractures. Anteroposterior X-ray images of the lower thoracic and lumbar spine were evaluated for asymmetrical collapse deformity.Results
Asymmetrical collapse was found in 134 vertebrae (71.3%) with metastasis, and in 20 osteoporotic vertebrae (21.7%); this difference was significant (p < 0.0001). The asymmetrical collapse angle in spinal metastasis patients ranged from 0 to 18°, with a mean of 7.0 and a standard deviation (SD) of 4.5. In contrast, the asymmetrical collapse angle in patients with osteoporotic fractures ranged from 0 to 13°, with a mean of 3.1 and a SD of 2.8. The difference in collapse angle between the two groups was statistically significant (p < 0.001). The cutoff value to suspect spinal metastasis was determined to be 5° or more (sensitivity 0.67, specificity 0.74). Fracture at Th10 or below L3 was found in 20.2% of spinal metastasis patients; only 3% of osteoporotic fractures occurred at these levels.Conclusion
Asymmetrical collapse with an angle of 5° or more and fractures at atypical levels on plain radiographs can be useful clues to spinal metastasis. 相似文献15.
Shinya Hayashi Shingo Hashimoto Koji Takayama Tomoyuki Matsumoto Kotaro Nishida Ryosuke Kuroda 《The Journal of arthroplasty》2017,32(5):1606-1611
Background
We identified preoperative predictors and size of acetabular bone defects for poor return to daily activity after revision total hip arthroplasty.Methods
Our analysis was based on outcomes of 140 cases of revision total hip arthroplasty, performed for any reason between May 2001 and March 2013. The Japanese Orthopaedic Association (JOA) score and body mass index (BMI) measured preoperatively, and the University of California Los Angeles (UCLA) activity score and JOA score measured at the 2-year follow-up were evaluated. Acetabular bone defects were classified according to the American Academy of Orthopaedic Surgeons grading system, with further classification of the location and severity of each acetabular bone defect. We compared preoperative clinical factors and postoperative clinical outcomes statistically.Results
We found a significant association between the number of revision surgeries and worse postoperative JOA scores and UCLA activity scores. There were significant differences in postoperative JOA scores and UCLA activity scores between patients with partial and global acetabular bone defects.Conclusion
Multiple revision surgeries and the size of the acetabular bone defect were predictors of both poorer clinical outcome and greater restriction in postoperative daily activities. Closer attention to the postoperative management of patients with a lower preoperative status is warranted. 相似文献16.
Takashi Hirai Toshitaka Yoshii Kenichiro Sakai Hiroyuki Inose Tsuyoshi Yamada Tsuyoshi Kato Shigenori Kawabata Yoshiyasu Arai Kenichi Shinomiya Atsushi Okawa 《Journal of orthopaedic science》2018,23(1):32-38
Background
There have been no prospective studies comparing anterior surgery and posterior method in terms of long-term outcomes. The purposes of this study is to clarify whether there is any difference in long-term clinical and radiologic outcomes of anterior decompression with fusion (ADF) and laminoplasty (LAMP) for the treatment of cervical spondylotic myelopathy (CSM).Methods
Ninety-five patients were prospectively treated with ADF or LAMP for CSM in our hospital from 1996 through 2003. On alternate years, patients were enrolled to receive ADF (1997, 1999, 2001, and 2003: ADF group, n = 45) or LAMP (1996, 1998, 2000, and 2002: LAMP group, n = 50). We excluded 19 patients who died during follow-up, and 25 who were lost to follow-up. Clinical outcomes were evaluated by the recovery rate of the Japanese Orthopaedic Association (JOA) score between the two groups. Sagittal alignment of the C2–7 lordotic angle and range of motion (ROM) in flexion and extension on plain X-ray were measured.Results
Mean age at the time of surgery was 58.3 years in the ADF group and 57.9 years in the LAMP group. Mean preoperative JOA score was 10.0 and 10.5, respectively. Mean recovery rate of the JOA score at 3–5 years postoperatively was significantly higher in the ADF group (p < 0.05). Reoperation was required in 1 patient for pseudarthrosis and in 1 patient for recurrence of myelopathy in the ADF group; no patient in the LAMP group underwent a second surgery. There was a significant difference in maintenance of the lordotic angle in the ADF group compared with the LAMP group (p < 0.05), but not in ROM.Conclusions
Both ADF and LAMP provided similar good outcomes at 10-year time-point whereas ADF could achieve more satisfactory outcomes and better sagittal alignment at the middle-term. However, the incidence of reoperation and complication in the ADF group were higher than those in the LAMP group.Study design
A prospective comparative study (not randomized). 相似文献17.
Keishi Maruo Tokuhide Moriyama Toshiya Tachibana Shinichi Inoue Fumihiro Arizumi Kazuki Kusuyama Shinichi Yoshiya 《Journal of orthopaedic science》2017,22(2):248-253
Background
Lumbar destructive spondyloarthropathy (DSA) is a serious complication in long-term hemodialysis patients. There have not been many reports regarding the surgical management for lumbar DSA. In addition, the adjacent segment pathology after lumbar fusion surgery for DSA is unclear. The objective of this study was to assess the clinical outcome and occurrence of adjacent segmental disease (ASD) after lumbar instrumented fusion surgery for DSA in long-term hemodialysis patients.Materials and methods
A consecutive series of 36 long-term hemodialysis patients who underwent lumbar instrumented fusion surgery for DSA were included in this study. The mean age at surgery was 65 years. The mean follow-up period was 4 years. Symptomatic ASD was defined as symptomatic spinal stenosis or back pain with radiographic ASD. The Japanese Orthopedic Association score (JOA score), recovery rate (Hirabayashi method), complications, and reoperation were reviewed.Results
The mean JOA score significantly increased from 13.5 before surgery to 21.3 at the final follow-up. The mean recovery rate was 51.4%. Six of the 36 patients died within 1 year after index surgery. One patient died due to perioperative complication. Symptomatic ASD occurred in 43% (13 of 30) of the cases. Of these 13 cases, 5 had adjacent segment disc degeneration and 8 had adjacent segment spinal stenosis. Three cases (10%) required reoperation due to proximal ASD. Multi-level fusion surgery increased the risk of ASD compared with single-level fusion surgery (59% vs. 23%). The recovery rate was significantly lower in the ASD group than the non-ASD group (38% vs. 61%).Discussion.
This study demonstrated that symptomatic ASD occurred in 43% of patients after surgery for lumbar DSA. A high mortality rate and complication rate were observed in long-term hemodialysis patients. Therefore, care should be taken for preoperative planning for surgical management of DSA. 相似文献18.
19.
Ji Wan Kim Yongkoo Lee Joonho Seo Jai Hyung Park Yong Min Seo Sung Soo Kim Hyun Chul Shon 《Journal of orthopaedic science》2018,23(2):383-388
Background
To report our experiences with the use of three-dimensional (3D) printing in the field of orthopedic trauma.Methods
This retrospective study enrolled 24 patients from three university teaching hospitals in whom 3D printing technique was applied: 14 patients with acetabular fractures and 10 patients with clavicular shaft fractures. We summarized our experiences with 3D printed bone models.Results
Three-dimensional printed acetabular models improved understanding of complex acetabular anatomy and fracture pattern to plan the optimal positioning of a reduction clamp and the trajectory of screws. Pre-bending of a reconstruction plate could reduce operative time. We also recorded fluoroscopic images of a simulated surgery for percutaneous screw fixation of the acetabular posterior column, with the optimal positioning of the guide wire determined during the simulation used as a reference during the actual operation. This surgical simulation was performed by a resident and served as a helpful training method. For fractures of the clavicle, we identified the optimal position of anatomical plates using 3D printed clavicle models.Conclusion
In our experience, 3D printing technique provided surgeons with improved understanding of the fracture pattern and anatomy and was effectively used for preoperative planning, education of surgical trainees, and performing simulations to improve intra-operative technical outcomes. 相似文献20.
Tomoko Tetsunaga Tomonori Tetsunaga Keiichiro Nishida Masato Tanaka Yoshihisa Sugimoto Tomoyuki Takigawa Yoshitaka Takei Toshifumi Ozaki 《Journal of orthopaedic science》2017,22(2):230-236