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1.
Ubee S Kumar M Athmanathan N Singh G Vesey S 《Annals of the Royal College of Surgeons of England》2011,93(2):157-161
INTRODUCTION
Open radical retropubic prostatectomy (RRP) has an average blood loss of over 1,000ml. This has been reported even from high volume centres of excellence.1–4 We have looked at the clinical and financial benefits of using intraoperative cell salvage (ICS) as a method of reducing the autologous blood transfusion requirements for our RRP patients.MATERIALS AND METHODS
Group A comprised 25 consecutive patients who underwent RRP immediately prior to the acquisition of a cell saver machine. Group B consisted of the next 25 consecutive patients undergoing surgery using the Dideco Electa (Sorin Group, Italy) cell saver machine. Blood transfusion costs for both groups were calculated and compared.RESULTS
The mean postoperative haemoglobin was similar in both groups (11.1gm/dl in Group A and 11.4gm/dl in Group B). All Group B patients received autologous blood (average 506ml, range: 103–1,023ml). In addition, 5 patients (20%) in Group B received a group total of 16 units (average 0.6 units) of homologous blood. For Group A the total cost of transfusing the 69 units of homologous blood was estimated as £9,315, based on a per blood unit cost of £135. This cost did not include consumables or nursing costs.CONCLUSIONS
We found no evidence that autologous transfusions increased the risk of early biochemical relapse or of disease dissemination. ICS reduced our dependence on donated homologous blood. 相似文献2.
Objectives
To compare the incidence and severity of acetabular fractures and associated injuries before and after seatbelt legislation.Design
A retrospective study.Setting
Two major trauma centres, which are teaching hospitals.Patients
Three hundred and ninety-three patients who sustained acetabular fractures during the 5 years before and 5 years after seatbelt legislation was enacted. Of these, the fractures in 198 patients (50.4%) resulted from a motor vehicle accident.Main Outcome Measures
The number and severity of acetabular fractures and associated injuries.Results
There has been a significant reduction in the number of acetabular fractures (p = 0.005) since seatbelt use became mandatory, and the complexity of the fractures has decreased. There has also been a marked reduction in associated injuries, such as fractures of other bones, and head, chest and abdominal injuries (p < 0.001).Conclusion
The seatbelt law has been a useful preventive measure, resulting in a reduction in the incidence of acetabular fractures and associated injuries. 相似文献3.
Mason L Fitzgerald C Powell-Tuck J Rice R 《Annals of the Royal College of Surgeons of England》2011,93(5):398-400
INTRODUCTION
A number of ways of reducing blood loss in arthroplasty have been explored, including preoperative autologous transfusion, intraoperative cell salvage and postoperative autologous transfusions. Both intraoperative blood salvage and postoperative retransfusion drains have been shown to be effective in reducing blood loss in total hip arthroplasty. In our department there was a change in practice from using postoperative retransfusion drains to intraoperative cell salvage. To our knowledge no study has directly compared using intraoperative blood salvage and postoperative retransfusion drains alone in total hip arthroplasty.METHODS
This was a retrospective service evaluation including all primary hip arthroplasty performed under our care between January 2006 and December 2008. Patients were divided into two groups: Group A used a postoperative autologous blood transfusion (ABT) drain and Group B used intraoperative cell salvage.RESULTS
A total of 144 patients were included in this study: 84 in Group A and 60 in Group B. The mean haemoglobin difference for Group A was 3.96g/dl (standard deviation [SD]: 1.52) and for Group B it was 3.46g/dl (SD: 1.42). The mean haematocrit difference for Group A was 0.12% (SD: 0.05) and for Group B it was 0.10% (SD: 0.04). Using an independent t-test for the comparison of means, a significant difference was found between Group A and B both in regards to haemoglobin difference (p=0.009) and haematocrit difference (p=0.046).CONCLUSIONS
We feel that intraoperative cell salvage provides a more efficient method of reducing blood loss than postoperative retransfusion in primary total hip replacement. A prospective randomised study would be useful to ascertain any clinical difference between the two methods. 相似文献4.
Carl C. Berasi IV Keith R. Berend Joanne B. Adams Erin L. Ruh Adolph V. Lombardi Jr 《Clinical orthopaedics and related research》2015,473(2):528-535
Background
Although the introduction of ultraporous metals in the forms of acetabular components and augments has increased the orthopaedic surgeon’s ability to reconstruct severely compromised acetabuli, there remain some that cannot be managed readily using cups, augments, or cages. In such situations, allograft-prosthetic composites or custom acetabular components may be called for. However, few studies have reported on the results of these components.Questions/purposes
The purposes of this study were to determine the (1) frequency of repeat revision, (2) complications and radiographic findings, and (3) Harris hip scores in patients who underwent complex acetabular revision surgery with custom acetabular components.Methods
Between August 2003 and February 2012, 26 patients (28 hips) have undergone acetabular reconstruction with custom triflange components. During this time, the general indications for using these implants included (1) failed prior salvage reconstruction with cage or porous metal construct augments, (2) large contained defects with possible discontinuity, (3) known pelvic discontinuity, and (4) complex multiply surgically treated hips with insufficient bone stock to reconstruct using other means. This approach was used in a cohort of patients with Paprosky Type 3B acetabular defects, which represented 3% (30 of 955) of the acetabular revisions we performed during the study period. Minimum followup was 2 years (mean, 57 months; range, 28–108 months). Seven patients (eight hips) died during the study period, and three (11%) of these patients (four hips; 14%) were lost to followup before 2 years, leaving 23 patients (24 hips) with minimum 2-year followup. Sixteen patients were women. The mean age of the patients was 67 years (range, 47–85 years) and mean BMI was 28 kg/m2 (range, 23–39 kg/m2). Revisions and complications were identified by chart review; hip scores were registered in our institution’s longitudinal database. Pre- and postoperative radiographs were analyzed by the patient’s surgeon to determine whether migration, fracture of fixation screws, or continued bone loss had occurred.Results
There have been four subsequent surgical interventions: two failures secondary to sepsis, and one stem revision and one open reduction internal fixation for periprosthetic femoral fracture. There were two minor complications managed nonoperatively, but all of the components were noted to be well-fixed with no obvious migration or loosening observed on the most recent radiographs. Harris hip scores improved from a mean of 42 (SD, ± 16) before surgery to 65 (SD, ± 18) at latest followup (p < 0.001).Conclusions
Custom acetabular triflange components represent yet another tool in the reconstructive surgeon’s armamentarium. These devices can be helpful in situations of catastrophic bone loss.Level of Evidence
Level IV, therapeutic study. 相似文献5.
Masanori Fujii Tetsuro Nakamura Toshihiko Hara Yasuharu Nakashima Yukihide Iwamoto 《Clinical orthopaedics and related research》2015,473(6):2056-2066
Background
Although radiographic coxa profunda has been considered an indicator of acetabular overcoverage, recent studies suggest that radiographic coxa profunda is a nonspecific finding seen even in hip dysplasia. The morphologic features of coxa profunda in hip dysplasia and the frequency with which the two overlap are not well defined.Questions/purposes
We determined (1) the prevalence of radiographic coxa profunda in patients with hip dysplasia; (2) the morphologic differences of the acetabulum and pelvis between patients with hip dysplasia and control subjects; and (3) the morphologic differences between hip dysplasia with and without coxa profunda.Methods
We retrospectively reviewed the pelvic radiographs and CT scans of 70 patients (70 hips) with hip dysplasia. Forty normal hips were used as controls. Normal hips were defined as those with a lateral center-edge angle between 25° and 40°. Coxa profunda was defined as present when the acetabular fossa was observed to touch or was medial to the ilioischial line on an AP pelvic radiograph. CT measurements included acetabular version, acetabular coverage, acetabular depth, and rotational alignment of the innominate bone.Results
The prevalence of coxa profunda was 44% (31 of 70 hips) in dysplastic hips and 73% (29 of 40 hips) in the control hips (odds ratio, 3.32; 95% CI, 1.43–7.68). Dysplastic hips had a more anteverted and globally shallow acetabulum with inwardly rotated innominate bone compared with the control hips (p < 0.001). Dysplastic hips with coxa profunda had a more anteverted acetabulum (p < 0.001) and inwardly rotated innominate bone (p < 0.002) compared with those without coxa profunda, whereas the acetabular coverage and depth did not differ between the two groups, with the numbers available.Conclusions
Radiographic coxa profunda was not a sign of increased acetabular coverage and depth in patients with hip dysplasia, but rather indicates classic acetabular dysplasia, defined by an anteverted acetabulum with anterolateral acetabular deficiency and an inwardly rotated pelvis. Thus, the presence of coxa profunda does not indicate a disease in addition to hip dysplasia, and the conventional maneuvers during periacetabular osteotomy are adequate for these patients.Level of Evidence
Level IV, diagnostic study. 相似文献6.
Alexandre Pompeo Wilson R. Molina David Sehrt Marcos Tobias-Machado Renato M. Mariano Costa Jr Antonio Carlos Lima Pompeo Fernando J. Kim 《JSLS, Journal of the Society of Laparoendoscopic Surgeons》2013,17(1):121-125
Objectives:
To examine the feasibility of early laparoscopic ureteroneocystostomy for ureteral obstruction due to hysterectomy injury.Methods:
We retrospectively reviewed a 10-y experience from 2 institutions in patients who underwent early (<30 d) or late (>30 d) laparoscopic ureteroneocystostomy for ureteral injury after hysterectomy. Evaluation of the surgery included the cause of the stricture and intraoperative and postoperative outcomes.Results:
A total of 9 patients with distal ureteral injury after hysterectomy were identified. All injuries were identified and treated as early as 21 d after hysterectomy. Seven of 9 patients underwent open hysterectomy, and the remaining patients had vaginal and laparoscopic radical hysterectomy. All ureteroneocystostomy cases were managed laparoscopically without conversion to open surgery and without any intraoperative complications. The Lich-Gregoir reimplantation technique was applied in all patients, and 2 patients required a psoas hitch. The mean operative time was 206.6 min (range, 120–280 min), the mean estimated blood loss was 122.2 cc (range, 25–350 cc), and the mean admission time was 3.3 d (range, 1–7 d). Cystography showed no urine leak when the ureteral stent was removed at 4 to 6 wk after the procedure. Ureteroneocystostomy patency was followed up with cystography at 6 mo and at least 10 y after ureteroneocystostomy.Conclusion:
Early laparoscopic ureteral reimplantation may offer an alternative surgical approach to open surgery for the management of distal ureteral injuries, with favorable cosmetic results and recovery time from ureteral obstruction due to hysterectomy injury. 相似文献7.
8.
Mariah Steinbach Mauricio H. Z. Centenaro Rui M. S. Almeida 《Brazilian Journal Of Cardiovascular Surgery》2014,29(3):374-378
Objective
To show if blood salvage is indicated in all patients submitted to cardiovascular surgery with cardiopulmonary bypass.Methods
We studied 77 consecutive patients submitted to cardiac surgery with use of blood salvage and cardiopulmonary bypass from November 2010 to June 2012. The sample was divided in three groups, depending on the time of cardiopulmonary bypass. In group A, the time of cardiopulmonary bypass was smaller than 45, in group B from 45 to 90 and in group C greater than 90 minutes. We analyzed the volume of red cells recovered and infused, the pre, intra and post-operative hemoglobin, the number of packed red cells units which were transfused and hematocrit and hemoglobin blood infused.Results
The average group age was 60.44±12.09 years old, of whom 71.43% were males. The group A was formed by 5.19% of the patients, B by 81.82% and C by 12.99%. The volume of erythrocytes recovered and infused was respectively 1,360.50±511.37 ml and 339.75±87.71 ml in group A, 1,436.63±516.06 ml and 518.83±183.0 ml in B and 2,137.00±925.04 ml and 526.20±227.15 ml in C. About packed red cells transfusions, in group A 1,00±2,00 packed red cells were transfused, in B 1.27±1.85 packed red cells and in C 2.56±2.01 packed red cells. The infused blood had a hematocrit of 50.97±12.06% and hemoglobin of 19.57±8.35 g/dl.Conclusion
That blood salvage can be used in patients submitted to cardiovascular surgery with cardiopulmonary bypass. However, it is only cost-effective in surgeries in which the time of cardiopulmonary bypass is greater than 45 minutes. 相似文献9.
Scott A. Wingerter Angela D. Keith Perry L. Schoenecker Geneva R. Baca John C. Clohisy 《Clinical orthopaedics and related research》2015,473(8):2639-2643
Background
Tranexamic acid (TXA) has shown safety and efficacy in reducing blood loss associated with various surgical procedures. However, to our knowledge there are no studies evaluating the effect of TXA on blood loss and transfusion requirements associated with periacetabular osteotomy (PAO).Questions/purposes
The main purpose of this study is to determine whether TXA reduces blood loss and transfusion use in patients undergoing PAO for symptomatic acetabular dysplasia. Our secondary purpose was to compare the frequency of symptomatic thromboembolic events between patients undergoing surgery with and without TXA.Methods
A consecutive series of 100 periacetabular osteotomies performed by one surgeon was reviewed to compare the groups immediately before and after implementation of routine use of tranexamic acid (two retrospective cohorts). TXA dosing followed an established protocol with a standard dose of 1 g infused intravenously during 10 minutes before skin incision and an additional 1 g intravenously at wound closure. Outcome measures include total estimated blood loss perioperatively and transfusion requirements. Total estimated blood loss was calculated using a formula built from the National Surgical Quality Improvement Program data regarding surgical blood loss.Results
The mean perioperative total estimated blood loss was less in the patients receiving TXA compared with blood loss in patients who did not receive TXA (706 mL versus 1021 mL; p < 0.001; 95% CI, −495 to −134). Twenty-six (52%) of the 50 patients who did not receive TXA had postoperative blood transfusions compared with 15 (30%) of 50 who received TXA (odds ratio, 0.395; 95% CI, 0.174–0.899; p = 0.0414). No symptomatic deep vein thromboses or symptomatic pulmonary emboli were identified in either group.Conclusions
TXA reduces estimated blood loss and the frequency of transfusions in patients undergoing PAO for treatment of symptomatic acetabular dysplasia. Future prospective studies should confirm our findings to determine whether patients undergoing PAO should receive routine perioperative TXA.Level of Evidence
Level III, therapeutic study. 相似文献10.
Pascal André Vendittoli David Alexander Young David J. Stitson Rory Wolfe Angelo Del Buono Nicola Maffulli 《International orthopaedics》2012,36(11):2235-2241
Purpose
The purpose of this study was to investigate whether acetabular morphology may influence both pathogenesis and prognosis of the acetabular rim lesions and to propose a new system to classify labral tears.Methods
We assessed radiographic and arthroscopic findings in 81 patients (40 male and 41 female patients, 86 hips) aged from 16 to 74 years (median, 31 years) who underwent hip arthroscopy.Results
Acetabular rim lesions were associated with four different hip morphologies. Eleven (32 %) of 34 patients with severe rim lesions underwent hip arthroplasty for progressive symptoms, whereas no patient with early rim lesion reported significant progression of symptoms. The strategy of treatment was changed in 33 % of the patients undergoing arthroscopy before undertaking peri-acetabular osteotomy.Conclusions
Hip arthroscopy avoids more invasive procedures in patients with early acetabular rim lesions. 相似文献11.
Clément M. L. Werner Carol E. Copeland Thomas Ruckstuhl Jeff Stromberg Clifford H. Turen Samy Bouaicha 《International orthopaedics》2012,36(12):2559-2563
Purpose
Acetabular fractures typically occur in high energy trauma. Understanding of the various contributing biomechanical factors and trauma mechanisms is still limited. While several investigations figured out what role femoral position during impact plays in distinct fracture patterns, no data exists on the influence of acetabular version on the fracture type. Our study was carried out to clarify this issue.Methods
Radiological data sets of 192 patients (145 male, 47 female, age 14–90 years) sustaining acetabular fractures were assessed retrospectively. The crossover ratio of the crossover sign and presence or absence of the posterior wall sign and ischial spine sign were used to determine acetabular retroversion on conventional radiographs. Acetabular version in the axial plane was measured on a computed tomography (CT) scan. Statistics were then performed to analyse the relationship between the acetabular fracture type according to the Letournel classification and acetabular version.Results
A significant difference (p = 0.029) in acetabular version was found between fractures of the anterior [mean equatorial edge (EE) angle 19.93°] and posterior (mean EE angle 17.53°) acetabulum in the CT scan. No difference was shown on the measurements on conventional radiographs.Conclusions
Acetabular version in the axial plane has an influence on the acetabular fracture pattern. While more anteverted acetabula were frequently associated with anterior fracture types according to the Letournel classification, retroversion of the acetabulum was associated with posterior fracture types. 相似文献12.
Background
The orientation of the acetabular cup component of a total hip arthroplasty can be evaluated in a number of ways, utilizing a myriad of imaging techniques and measurement parameters, including intraoperative surgical estimates, postoperative radiographs, and cross-sectional imaging such as computed tomography (CT) and magnetic resonance imaging (MRI).Questions/Purposes
How do traditional versus corrected measurements of acetabular version vary from one another based on the inclination of the cup? What is the reliability of the corrected acetabular version measurements based on interobserver and intraobserver consistency?Patients and Methods
Two fellowship-trained musculoskeletal radiologists reviewed CT scans on 60 total hip arthroplasties. Acetabular inclination, traditional CT acetabular version, and CT acetabular version corrected for inclination (by utilizing multi-planar reformations to measure in the plane of the cup face) were each measured. The difference was then calculated between the “traditional” axial CT and “corrected” acetabular version measurements, and the association between this difference and the acetabular inclination was assessed.Results
The “traditional” axial CT and “corrected” acetabular version measurements differed from one another in every case, with the traditional method yielding a version measurement that was on average 9.5° higher than the corrected technique. However, as the acetabular cup inclination angle decreased, the “traditional” measurement became more variable and increasingly discordant with the “corrected” version measurement.Conclusions
There is inherent variability between the many methods utilized for defining and measuring acetabular version, with axial CT measurements often used as an accepted proxy for true cup anteversion. However, the variability between different measurement techniques is correlated with acetabular inclination, and this variability is most pronounced when acetabular inclination is low, ultimately leading to potential confusion in measurement terminology. The increasingly widespread availability of multi-planar CT reformations provides an opportunity to standardize methodology, eliminate the impact of inclination on acetabular version measurements, and potentially provide a more reliable comparison of the impact of cup orientation on surgical outcomes.Electronic supplementary material
The online version of this article (doi:10.1007/s11420-014-9416-6) contains supplementary material, which is available to authorized users. 相似文献13.
Belen Carsi Sariyah Al-Hallao Karim Wahed Jonathan Page Nicholas M P Clarke 《Acta orthopaedica》2014,85(1):66-70
Background
Residual acetabular dysplasia is one of the most common complications after treatment for developmental dysplasia of the hip. The acetabular growth response after reduction of a dislocated hip varies. The options are to wait and add a redirectional osteotomy as a secondary procedure at an older age, or to perform a primary acetabuloplasty at the time of the open reduction to stimulate acetabular development. We present the early results of such a procedure—open reduction and an incomplete periacetabular acetabuloplasty—as a one-stop procedure for developmental dysplasia of the hip.Patients and methods
We retrospectively reviewed the results obtained with 55 hips (in 48 patients, 43 of them girls) treated between September 2004 and February 2011. This cohort included late presentations and failures of nonoperative treatment and excluded unsuccessful previous surgical treatment (including closed reductions), neuromuscular disease, and other teratological conditions. Patients were treated once the ossific nucleus was present or when they reached one year of age. 31 cases were late presentations while 17 represented failures of nonoperative treatment. The mean age of the patients at surgery was 1.3 (0.6–2.6) years. The mean follow-up period was 4 (2–8) years. According to the IHDI classification, 1 was grade I, 9 were grade II, 13 were grade III, and 32 were grade IV.Results
The mean acetabular index fell from 38 (23–49) preoperatively to 21 (10–27) at the last follow-up. There were no infections, nerve palsies, or graft extrusions. None of the cases required secondary surgery for residual acetabular dysplasia. 8 patients developed avascular necrosis (AVN) of grade II or more. The incidence of AVN was significantly associated with previous, failed nonoperative treatment. 1 patient developed coxa magna requiring shelf arthroplasty 4 years after the index procedure and 1 patient with lateral growth arrest required medial screw epiphysiodesis.Interpretation
This incomplete periacetabular acetabuloplasty is a reliable adjunct to open reductions, and it is followed by a rapid acetabular growth response that avoids secondary pelvic procedures. It is a one-stop surgery with predictable outcome that can be performed in 0.5- to 2.5-year-old children.The treatment of children with developmental dysplasia of the hip (DDH) between 6–24 months of age is controversial. Many authors have advocated closed reduction, provided arthrographic concentricity is achieved. However, the prevalence of residual acetabular dysplasia in this age group ranges from 38% to over 80% (Roose et al. 1979, Luhmann et al. 2003, Albinana et al. 2003). Many of these children will need secondary procedures at a later date, mainly a pelvic osteotomy, to prevent degenerative disease (Wedge and Wasylenko 1979). Some surgeons favor open reduction, which provides an opportunity to address acetabular dysplasia at the same time. Intentional late open reduction (delayed until the appearance of the ossific nucleus or by 1 year of age) is considered to be safe, as it is associated with a lower rate of subsequent pelvic osteotomy and a reduced incidence of avascular necrosis (Bolland et al. 2010).We present the early results of a novel but possibly reinvented acetabular intervention. The incomplete periacetabular acetabuloplasty (IPA) is performed simultaneously with open reduction and capsulorrhaphy. The aim of the procedure is to “ignite” acetabular growth following concentric reduction of the femoral head rather than to completely correct acetabular deficiency or to perform a redirectional procedure. We believe that the addition of less aggressive acetabular growth stimulation surgery may restore a more normal femoral head/acetabular development in a shorter period by precipitating a remodeling cascade. Such a process would obviate the need for further and more interventional secondary reconstructive pelvic surgery to address residual acetabular dysplasia. 相似文献14.
Javad Parvizi Mohammad R. Rasouli Mehrad Jaberi Guillaume Chevrollier Scott Vizzi Peter F. Sharkey William J. Hozack 《International orthopaedics》2013,37(12):2357-2362
Purpose
It is not clear whether type of surgical approach affects the amount of blood loss in one-stage bilateral total hip arthroplasty (THA). This study therefore aims to examine if type of surgical approach can affect peri-operative blood loss and allogeneic blood transfusion in patients undergoing one-stage bilateral THA.Methods
Records of 319 patients who underwent one-stage bilateral THA from January 2004 to June 2011 were retrospectively reviewed. Patients were divided into two groups: direct anterior (DA) approach (75 patients) and direct lateral (DL) approach (244 patients). Blood loss was calculated using a previously validated formula. Blood loss and need for allogeneic blood transfusion were compared between the two groups. Additionally, the effects of using cell saver and surgical approach were evaluated in a multivariate analysis.Results
Compared to the DL approach, calculated blood loss was significantly lower in the DA group (2,813.90 ± 804.13 ml vs 3,617.03 ± 1,148.47 ml) and a significantly lower per cent of patients needed allogeneic blood transfusion in the DA group (26.6 vs 52.4 %). Intra-operative cell saver was used in 36 patients. Compared to the non-cell saver group, mean blood loss was significantly higher in the cell saver group (4,061.0 ± 1,285.55 ml vs 3,347.71 ± 1,083.85 ml), whereas the difference between the two groups regarding allogeneic blood transfusion was not statistically significant. The DA approach was an independent predictor of lower peri-operative blood loss and allogeneic blood transfusion while using cell saver was not.Conclusions
Our results may be explained by the lower extent of muscular dissection performed in the DA approach. Our findings also indicate that intra-operative cell salvage might not be justified in bilateral THA performed expeditiously. 相似文献15.
Bryan G. Garber Jean-Denis Yelle Robin Fairfull-Smith John W. Lorimer Cathy Carson 《Canadian journal of surgery》1996,39(6):474-480
Objectives
To document the current practice pattern for the treatment of splenic injuries in one Canadian trauma centre and to identify factors that determined which method was employed.Design
A cohort study.Setting
A Canadian lead trauma centre.Patients
A cohort of 100 patients with splenic injury treated at one trauma hospital over 5 years was identified from a prospective trauma database.Main Outcome Measures
The success rate and failure rate for splenic salvage by splenectomy, splenorrhaphy or observation. Volume of blood transfused, injury severity score (ISS) and method of diagnosis.Results
The median ISS for the cohort was 34 (36 for splenectomy, 38 for splenorrhaphy and 35 for observation). A blunt mechanism of injury was present in 96%. The diagnosis was made by computed tomography (CT) in 55%. Splenic salvage was accomplished in 51 patients; of these, 44 (86%) were in the observation group, and the success rate was 90% (within the range reported in the literature). Only seven patients underwent splenorrhaphy. CT was performed more frequently in the observation group than in the splenectomy group (82% v. 25%, p < 0.0001). The splenectomy group had more blood tranfused than the successful observation group (mean units 15 v. 3, p = 0.0001) and had a higher median ISS (36 v. 29, p = 0.02). Multivariate analysis revealed that the method of diagnosis (CT v. diagnostic peritoneal lavage) was the strongest factor associated with how the splenic injury was treated.Conclusions
The finding in this report of an increase in observational treatment of splenic injuries represents a shift in practice from a previous Canadian report and is in keeping with recent published trends from the United States. Future studies are needed to assess whether any strong regional practice pattern variations in the management of blunt splenic injuries exists in other trauma centres across Canada. 相似文献16.
17.
N Papadakos R Pearce MD Bircher 《Annals of the Royal College of Surgeons of England》2014,96(4):297-301
Introduction
Acetabular fractures due to high energy injuries are common and well documented; those secondary to low energy mechanisms are less well described. We undertook a retrospective study of the acetabular fracture referrals to our unit to evaluate the proportion of injuries resulting from a low energy mechanism.Methods
A total of 573 acetabular fractures were evaluated from 1 January 2005 to 31 December 2008. The plain radiography and computed tomography of those sustaining a low energy fracture were assessed and the fracture patterns classified.Results
Of the 573 acetabular fractures, 71 (12.4%) were recorded as being a result of a low energy mechanism. The male-to-female ratio was 2.4:1 and the mean patient age was 67.0 years (standard deviation: 19.1 years). There was a significantly higher number of fractures (p<0.001) involving the anterior column (with or without a posterior hemitransverse component) than in a number of previously conducted large acetabular fracture studies.Conclusions
Our results demonstrate that low energy fractures make up a considerable proportion of acetabular fractures with a distinctly different fracture pattern distribution. With the continued predicted rise in the incidence of osteoporosis, life expectancy and an aging population, it is likely that this type of fracture will become increasingly more common, posing difficult management decisions and leading to procedures that are technically more challenging. 相似文献18.
Anders Troelsen Lone R?mer Steffen Jacobsen Steen Ladelund Kjeld S?balle 《Acta orthopaedica》2010,81(4):436-441
Background and purpose
The appearance of acetabular version differs between the supine and weight bearing positions in developmental dysplasia of the hip. Weight bearing radiographic evaluation has been recommended to ensure the best coherence between symptoms, functional appearance, and hip deformities. Previous prevalence estimates of acetabular retroversion in dysplastic hips have been established in radiographs recorded with the patient supine and with inclusion only if pelvic tilt met standardized criteria. We assessed the prevalence and the extent of acetabular retroversion in dysplastic hip joints in weight bearing pelvic radiographs.Patients and methods
We assessed 95 dysplastic hip joints (54 patients) in weight bearing anteroposterior pelvic radiographs, measuring the acetabular height and the distance from the acetabular roof to the point of crossing of the acetabular rims, if present.Results
Acetabular retroversion was found in 31 of 95 dysplastic hip joints. In 28 of 31 hip joints with retroversion, crossover of the acetabular rims was positioned within the cranial 30% sector. The degree of pelvic tilt differed between retroverted and non-retroverted dysplastic hip joints, though only reaching a statistically significant level in male dysplastic hip joints.Interpretation
We identified cranial acetabular retroversion in one-third of dysplastic hip joints when assessed on weight bearing pelvic radiographs. If assessed on pelvic radiographs obtained with the patient supine, and with inclusion only if the degree of pelvic tilt meets standardized criteria, the prevalence of acetabular retroversion may be underestimated. 相似文献19.
Fernando G. Abarzua-Cabezas Einar Sverrisson Robert De La Cruz Philippe E. Spiess Peter Haddock Wade J. Sexton 《International braz j urol : official journal of the Brazilian Society of Urology》2015,41(1):147-154
Purpose
To assess the oncologic and functional outcomes of salvage renal surgery following failed primary intervention for RCC.Materials and Methods
We performed a retrospective review of patients who underwent surgery for suspected RCC during 2004-2012. We identified 839 patients, 13 of whom required salvage renal surgery. Demographic data was collected for all patients. Intraoperative and postoperative data included ischemic duration, blood loss and perioperative complications. Preoperative and postoperative assessments included abdominal CT or magnetic resonance imaging, chest CT and routine laboratory work. Estimated glomerular filtration rate (eGFR) was calculated according to the Modification of Diet in Renal Disease equation.Results
The majority (85%) of the patients were male, with an average age of 64 years. Ten patients underwent salvage partial nephrectomy while 3 underwent salvage radical nephrectomy. Cryotherapy was the predominant primary failed treatment modality, with 31% of patients undergoing primary open surgery. Pre-operatively, three patients were projected to require permanent post-operative dialysis. In the remaining 10 patients, mean pre- and postoperative serum creatinine and eGFR levels were 1.35 mg/dL and 53.8 mL/min/1.73 m2 compared to 1.43 mg/dL and 46.6 mL/min/1.73 m2, respectively. Mean warm ischemia time in 10 patients was 17.4 min and for all patients, the mean blood loss was 647 mL. The predominant pathological stage was pT1a (8/13; 62%). Negative surgical margins were achieved in all cases. The mean follow-up was 32.9 months (3.5-88 months).Conclusion
While salvage renal surgery can be challenging, it is feasible and has adequate surgical, functional and oncological outcomes. 相似文献20.
William J. Cundy Annika R. Mascarenhas Georgia Antoniou Brian J. C. Freeman Peter J. Cundy 《Journal of children's orthopaedics》2015,9(1):39-43