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1.
Abd R. Muhamad Joana M. Freitas James D. Bomar Jerry Dwek Harish S. Hosalkar 《Journal of children's orthopaedics》2012,6(5):391-396
Background
Assessment of lower extremity (LE) torsional profile using computed tomography (CT) imaging is a well-recognized imaging method that supplements the clinical examination. Magnetic resonance imaging (MRI) is another advanced imaging modality that can be used as an alternative, since there are many growing concerns of radiation exposure with traditional CT studies, particularly in the skeletally immature population.Methods
Sixty-two patients between the ages of 7 and 19 years were included. Thirty-four had CT and 28 had MRI for assessment of LE torsional profile. All patients had clinical evidence of torsional malalignment. CT and MR images were randomized and de-identified. Two observers measured femoral anteversion and tibial torsion based on previously published methodologies. This exercise was repeated 2 weeks later and the data were tabulated and statistical analysis was performed. Radiation exposure for the patients studied by CT was estimated.Results
The mean age of the patients was 14.4 years (range 9.5–18.9 years) and 13.8 years (range 7.3–18.9 years) for the CT and MRI groups, respectively. Inter-observer reliability for both CT and MRI studies were excellent. The intra-class correlation coefficient (ICC) for femoral anteversion and tibial torsion studied by CT and MRI for both observers at both times were excellent. The radiation exposure for CT examination averaged 0.3–0.5 mSv, compared to none with the MRI method.Conclusions
MRI provides a reproducible method for assessing the torsional profile in children and adolescents using similar anatomic landmarks for measurements as those used on CT torsional profile. In circumstances where MRI methods are readily available (and affordable), the CT torsional profile can be replaced with MRI methods, in the current era of growing concerns of radiation hazards and increasing awareness about radiation safety.Level of evidence
Diagnostic Level III. 相似文献2.
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Norbert Kastner Simon Sternbauer Jörg Friesenbichler Ines Vielgut Matthias Wolf Mathias Glehr Andreas Leithner Patrick Sadoghi 《International orthopaedics》2014,38(2):291-295
Purpose
The aim of this study was to analyse a possible correlation between the tibial slope and range of motion (ROM) after implantation of the low-contact-stress (LCS), mobile-bearing, total knee arthroplasty (TKA) after a minimum follow-up of ten years.Methods
Eighty-three TKAs in 66 patients were investigated in this retrospective correlation analysis at a minimum follow up of ten years. Out of these 66 patients, 50 were women (76 %) and 16 (24 %) were men. The average age of these patients at the time of the examination was 76 years [standard deviation (SD) 11 years, range 37–95 years]. A lateral X-ray was taken at follow-up in order to analyse the tibial slope with respect to inter- and intra-observer agreement. ROM was measured and correlated with the tibial slope.Results
The mean active ROM was 96.1° (SD 18.8) and the mean tibial slope after four measurements was 7.65° (SD 4.23), with substantial inter- and intra-observer agreement. We found no significant correlation between tibial slope and ROM in patients with a minimum follow-up of ten years [correlation 0.196 (p > 0.05) and 0.152, (p > 0.05), respectively].Conclusions
Alteration of the tibial slope does not significantly influence ROM after implantation of the LCS TKA at a minimum follow-up of ten years. We conclude that the tibial slope is not the primary influencing factor for ROM in patients ten years after primary TKA and believe that it should not substantially be altered during surgery. 相似文献4.
5.
David Metcalfe Craig J. Hickson Lesley McKee Xavier L. Griffin 《Journal of orthopaedics and traumatology》2015,16(4):275-285
Background
It is uncertain whether external fixation or open reduction internal fixation (ORIF) is optimal for patients with bicondylar tibial plateau fractures.Materials and methods
A systematic review using Ovid MEDLINE, Embase Classic, Embase, AMED, the Cochrane Library, Open Grey, Orthopaedic Proceedings, WHO International Clinical Trials Registry Platform, Current Controlled Trials, US National Institute for Health Trials Registry, and the Cochrane Central Register of Controlled Trials. The search was conducted on 3rd October 2014 and no language limits were applied. Inclusion criteria were all clinical study designs comparing external fixation with open reduction internal fixation of bicondylar tibial plateau fractures. Studies of only one treatment modality were excluded, as were those that included unicondylar tibial plateau fractures. Treatment effects from studies reporting dichotomous outcomes were summarised using odds ratios. Continuous outcomes were converted to standardized mean differences to assess the treatment effect, and inverse variance methods used to combine data. A fixed effect model was used for meta-analyses.Results
Patients undergoing external fixation were more likely to have returned to preinjury activities by six and twelve months (P = 0.030) but not at 24 months follow-up. However, external fixation was complicated by a greater number of infections (OR 2.59, 95 % CI 1.25–5.36, P = 0.01). There were no statistically significant differences in the rates of deep infection, venous thromboembolism, compartment syndrome, or need for re-operation between the two groups.Conclusion
Although external fixation and ORIF are associated with different complication profiles, both are acceptable strategies for managing bicondylar tibial plateau fractures.Level of evidence
II. 相似文献6.
Colin P White Michael J Cooper James R Bain Carolyn M Levis 《CANADIAN JOURNAL OF PLASTIC SURGERY》2012,20(1):24-27
BACKGROUND:
The common peroneal nerve is the most commonly injured nerve in the lower limb. Nerve transfer using expendable donor nerves is emerging in the literature as an alternative surgical procedure to traditional treatments.OBJECTIVE:
To identify potential donors of motor axons from the tibial nerve that can be transferred to the common peroneal nerve branches.METHODS:
Using 10 human cadaveric lower extremities, all motor nerve branches of the tibial nerve were identified and biopsied. These were compared with the motor branches to tibialis anterior and extensor hallucis longus (branches of the deep peroneal nerve).RESULTS:
The most suitable donor nerves with respect to cross-sectional area to tibialis anterior (cross sectional area [mean ± SD] 0.255±0.111 mm) was the motor branch to lateral gastrocnemius (0.256±0.105 mm). When comparing the total number of axons, the branch to the tibialis anterior had a mean of 3363±1997 axons. The branch to the popliteus was most similar, with 3317±1467 axons. The most suitable donor nerves for the motor branch to extensor hallucis longus (cross sectional area 0.197±0.302 mm) with respect to cross-sectional area was the motor branch to flexor hallucis longus (0.234±0.147 mm). When comparing the total number of axons, the branch to the extensor hallucis longus had an average of 2062±2314 axons. The branch to the lateral gastrocnemius was most similar with 2352±1249 axons and was a suitable donor.CONCLUSION:
Nerve transfers should be included in the armamentarium for lower extremity reinnervation, as it is in the upper limb. 相似文献7.
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Cristiano Hossri Ribeiro Nilson Roberto Severino Patricia Maria Moraes de Barros Fucs 《International orthopaedics》2014,38(8):1627-1631
Purpose
This study aimed to verify if the navigation system used in high tibial osteotomy (HTO) adds precision to the procedure regarding mechanical axis correction and prevention of tibial slope increases.Methods
In this historically controlled study, patients with medial osteoarthrosis and genuvarum underwent HTO between 2004 and 2012; the first 20 were operated with the conventional technique, using pre-planning correction by the Dugdale method and 18 further patients were operated with the navigation system introduced in our hospital.Results
The two groups were similar for pre-operative mechanical axis (mean 8.10 ± 3.14 for the control and 6.60 ± 2.50 for the navigated group), pre-operative tibial slope (mean 8.95 ± 3.47 versus 8.17 ± 3.11, respectively) and Lyshom score (40.85 ± 15.46 and 44.83 ± 16.86). After surgery, the control group presented mean mechanical axis of 3.35 ± 3.27, tibial slope of 13.75 ± 3.75 and Lyshom score of 87.60 ± 11.12. The navigated group showed a postoperative mechanical axis mean of 3.06 ± 1.70, tibial slope of 10.11 ± 0.18 and Lyshom score of 91.94 ± 11.61.Conclusions
The navigation system allowed a significantly better control of tibial slope. Patients operated with the navigation system had significantly better Lysholm scores. 相似文献10.
Thomas J. Heyse MD PhD Joseph D. Lipman MS Carl W. Imhauser PhD Scott M. Tucker MS Yogesh Rajak Geoffrey H. Westrich MD 《HSS journal》2014,10(3):260-265
Background
Component malposition is one of the major reasons for early failure of unicompartmental knee arthroplasty (UKA).Questions/Purposes
It was investigated how reproducibly patient-specific instrumentation (PSI) achieved preoperatively planned placement of the tibial component in UKA specifically assessing coronal alignment, slope and flexion of the components and axial rotation.Patients and Methods
Based on computer tomography models of ten cadaver legs, PSI jigs were generated to guide cuts perpendicular to the tibial axis in the coronal and sagittal planes and in neutral axial rotation. Deviation ≥3° from the designed orientation in a postoperative CT was defined as outside the range of acceptable alignment.Results
Mean coronal alignment was 0.4 ± 3.2° varus with two outliers. Mean slope was 2.8 ± 3.9° with six components in excessive flexion. It was noted that the implants were put in a mean of 1.7 ± 8.0° of external rotation with seven outliersConclusions
PSI helped achieve the planned coronal orientation of the component. The guides were less accurate in setting optimal tray rotation and slope.Electronic supplementary material
The online version of this article (doi:10.1007/s11420-014-9410-z) contains supplementary material, which is available to authorized users. 相似文献11.
Soenke Percy Frey MD Hendrik Jansen MD Michael J. Raschke MD Rainer H. Meffert MD Sabine Ochman MD 《Clinical orthopaedics and related research》2012,470(12):3607-3614
Background
Complicated tibial fractures with severe soft tissue trauma are challenging to treat. Frequently associated acute compartment syndrome can result in scarring of muscles with impaired function. Several studies have shown a relationship between angiogenesis and more effective muscle regeneration. Vascular endothelial growth factor (VEGF) is associated with angiogenesis but it is not clear whether it would restore muscle force, reduce scarring, and aid in muscle regeneration after acute musculoskeletal trauma.Questions/purposes
Therefore, we asked whether local application of VEGF (1) restores muscle force, (2) reduces scar tissue formation, and (3) regenerates muscle tissue.Methods
We generated acute soft tissue trauma with increased compartment pressure in 22 rabbits and shortened the limbs to simulate fracture débridement. In the test group (n = 11), a VEGF-coated collagen matrix was applied locally around the osteotomy site. After 10 days of limb shortening, gradual distraction of 0.5 mm per 12 hours was performed to restore the original length. Muscle force was measured before trauma and on every fifth day after trauma. Forty days after shortening we euthanized the animals and histologically determined the percentage of connective and muscle tissue.Results
Recovery of preinjury muscle strength was greater in the VEGF group (2.4 N; 73%) when compared with the control (1.8 N; 53%) with less connective and more muscle tissue in the VEGF group. The recovery of force was related to the percentage of connective tissue versus muscle fibers.Conclusions
Local application of VEGF may improve restoration of muscle force by reducing connective tissue and increasing the relative amount of muscle fibers.Clinical Relevance
VEGF may be useful to improve skeletal muscle repair by modulating muscle tissue regeneration and fibrosis reduction after acute trauma. 相似文献12.
Hausselle J Moreau PE Wessely L de Thomasson E Assi A Parratte S Essig J Skalli W 《International orthopaedics》2012,36(8):1567-1573
Purpose
Acetabular component malalignment in total hip arthroplasty can lead to potential complications such as dislocation, component impingement and excessive wear. Computer-assisted orthopaedic surgery systems generally use the anterior pelvic plane (APP). Our aim was to investigate the reliability of anatomical landmarks accessible during surgery and to define new potential planes of reference.Methods
Three types of palpations were performed: virtual, on dry bones and on two cadaveric specimens. Four landmarks were selected, the reproducibility of their positioning ranging from 0.9 to 2.3 mm. We then defined five planes and tested them during palpations on two cadaveric specimens.Results
Two planes produced a mean orientation error of 5.0° [standard deviation (SD 3.3°)] and 5.6° (SD 2.7°).Conclusions
Even if further studies are needed to test the reliability of such planes on a larger scale in vivo during surgery, these results demonstrated the feasibility of defining a new plane of reference as an alternative to the APP. 相似文献13.
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Purpose
The purpose of this study was to present a retrospective comparative overview of the Ilizarov non-free bone plasty techniques of one-stage multilevel fragment lengthening and gradual tibilisation of the fibula used for extensive tibial defect management.Methods
Extensive tibial defects in 83 patients were managed either by multilevel fragment lengthening (group I, n = 41, mean defect size 13.1 ± 0.9 cm) or gradual tibilisation of the fibula (group II, n = 42, mean defect size 12.5 ± 1.2 cm) using the Ilizarov apparatus. The initial findings, treatment protocols and outcomes of those patients treated within the period 1972–2011 were studied retrospectively by medical records and radiographs, and statistically assessed with Microsoft Excel and Attestat software.Results
Group I had multilevel fragment lengthening over one stage that averaged 288.0 ± 14.4 days. The mean total period of gradual tibilisation of the fibula in group II was 316.0 ± 29.7 days. The patient’s age in the latter group had an effect on the completeness of leg-length equalisation.Conclusions
The techniques can be used to manage extensive tibial defects as all the defects bridged, leg-length discrepancy and deformity were corrected and patients were able to load their limbs. 相似文献15.
16.
Tracked Ultrasound Snapshots in Percutaneous Pedicle Screw Placement Navigation: A Feasibility Study
Tamas Ungi MD PhD Eric Moult BSc Joseph H. Schwab MD Gabor Fichtinger PhD 《Clinical orthopaedics and related research》2013,471(12):4047-4055
Background
Computerized navigation improves the accuracy of minimally invasive pedicle screw placement during spine surgery. Such navigation, however, exposes both the patient and the staff to radiation during surgery. To avoid intraoperative exposure to radiation, tracked ultrasound snapshots—ultrasound image frames coupled with corresponding spatial positions—could be used to map preoperatively defined screw plans into the intraoperative coordinate frame. The feasibility of such an approach, however, has not yet been investigated.Questions/purposes
Are there vertebral landmarks that can be identified using tracked ultrasound snapshots? Can tracked ultrasound snapshots allow preoperative pedicle screw plans to be accurately mapped—compared with CT-derived pedicle screw plans—into the intraoperative coordinate frame in a simulated setting?Methods
Ultrasound visibility of registration landmarks was checked on volunteers and phantoms. An ultrasound machine with integrated electromagnetic tracking was used for tracked ultrasound acquisition. Registration was performed using 3D Slicer open-source software (www.slicer.org). Two artificial lumbar spine phantoms were used to evaluate registration accuracy of pedicle screw plans using tracked ultrasound snapshots. Registration accuracy was determined by comparing the ultrasound-derived plans with the CT-derived plans.Results
The four articular processes proved to be identifiable using tracked ultrasound snapshots. Pedicle screw plans were registered to the intraoperative coordinate system using landmarks. The registrations were sufficiently accurate in that none of the registered screw plans intersected the pedicle walls. Registered screw plan positions had an error less than 1.28 ± 1.37 mm (average ± SD) in each direction and an angle difference less than 1.92° ± 1.95° around each axis relative to the CT-derived positions.Conclusions
Registration landmarks could be located using tracked ultrasound snapshots and permitted accurate mapping of pedicle screw plans to the intraoperative coordinate frame in a simulated setting.Clinical Relevance
Tracked ultrasound may allow accurate computer-navigated pedicle screw placement while avoiding ionizing radiation in the operating room; however, further studies that compare this approach with other navigation techniques are needed to confirm the practical use of this new approach. 相似文献17.
Shigeshi Mori MD Masao Akagi MD PhD Shigeki Asada MD Tetsunao Matsushita MD Kazuhiko Hashimoto MD 《Clinical orthopaedics and related research》2013,471(5):1465-1471
Background
Tibia vara seen in Japanese patients reportedly influences the tibial component alignment when performing TKA. However, it is unclear whether tibia vara affects the component position and size selection.Questions/purposes
We therefore determined (1) the amount of medial tibial bow, (2) whether the tibia vara influences the aspect ratio of the tibial resected surface in aligning the tibial component with the tibial shaft axis, and (3) whether currently available tibial components fit the shapes of resected proximal tibias in terms of aspect ratio.Methods
We measured the tibia vara angle (TVA), proximal varus angle (PVA), and the mediolateral and middle AP dimensions of the resected surface using three-dimensional preoperative planning software in 90 knees of 74 female patients with varus osteoarthritis. We determined the correlations of the aspect ratio with TVA or PVA and compared the aspect ratios to those of five prosthesis designs.Results
The mean TVA and PVA were 0.6° and 2.0°, respectively. The aspect ratio negatively correlated with both TVA and PVA (r = −0.53 and −0.55, respectively). The mean aspect ratio of the resected surface was 1.48 but gradually decreased with increasing AP dimension, whereas four of the five prostheses had a constant aspect ratio.Conclusions
The aspect ratio of resected tibial surface was inversely correlated to the degree of tibia vara, and currently available prosthesis designs do not fit well to the resected surface in terms of aspect ratio.Clinical Relevance
The design of a tibial component with a smaller aspect ratio could be developed to obtain better bone coverage in Japanese patients. 相似文献18.
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Conteduca F Iorio R Mazza D Caperna L Bolle G Argento G Ferretti A 《International orthopaedics》2012,36(8):1589-1593