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1.
Carlos Torrens Fernando Santana Raquel Marí Lluis Puig Albert Alier 《Journal of orthopaedic science》2017,22(5):858-861
Background
The objective of the study was to determine the normalization curve of the serum C-reactive protein (CRP) in elective shoulder arthroplasty.Methods
A prospective study including 58 consecutive patients who had undergone elective shoulder arthroplasty. Forty-one patients had received a Reverse Shoulder Arthroplasty, 13 a Total Shoulder Arthroplasty and 4 a Hemiarthroplasty. Based on a pilot study, blood samples to determine CRP values were obtained at baseline (1 h before surgery), on the 1st, 2nd, 6th, 8th and 14th postoperative days. All the patients included presented no postoperative complications during inpatient stay or any re-admission during the three months after surgery.Results
Mean CRP values showed a rapid increase on the 1st postoperative day (7-fold higher than the baseline in cuff tear arthropathy, 11-fold higher in primary osteoarthritis, 1-fold higher in acute fracture) and reached a peak on the 2nd postoperative day (14-fold higher than the baseline in cuff tear arthropathy, 24-fold higher in primary osteoarthritis and 2-fold higher in acute fracture). After the 2nd postoperative day CRP values began to slowly decrease reaching the normal range in the 14th postoperative day.Conclusions
Serum CRP levels after elective shoulder arthroplasty rapidly increase to reach a maximum peak after the 2nd surgery day and then slowly decrease to return to normality on the 14th day. Knowing the normalization curve of CRP can be a helpful tool to help in the diagnosis of acute infections in elective shoulder arthroplasty. 相似文献2.
Purpose
To identify factors influencing overall radiologic changes in the distal radioulnar joint after ulnar shortening osteotomy (USO) in patients with idiopathic ulnar impaction syndrome.Materials and methods
A total of 310 patients who had undergone USO between May 2007 and December 2013 were included in this retrospective case–control study. The patients were classified into two groups (with or without radiologic findings of new arthritic changes), after which the following factors were analyzed: 1) demographic factors; 2) radiologic aspects, including ulnar variance (UV), morphological DRUJ type (classified according to Tolat et al.), and union period after USO; and 3) operative aspects, including the triangular fibrocartilage complex degeneration type, use of a parallel double-blade saw, type of plate used for fixation, and plate position on the volar or dorsal ulnar surface.Results
Group 1 (no arthritic changes) consisted of 243 patients, whereas Group 2 (arthritic changes) consisted of 67 patients. Univariate and multivariate analyses showed that the presence of lunate cystic changes, amount of shortening, and the union period were significantly associated with newly developed arthritic changes in the distal radioulnar joint (DRUJ) after USO. The morphological DRUJ type was not a significant factor. Arthritic changes were significantly more prevalent in patients with a shortening amount >4.5 mm and a union period <3.25 months.Conclusions
Radiologic arthritic changes after USO, were associated with the presence of cystic changes in the lunate, a shortening amount (>4.5 mm), and early bony union (<3.25 months).Type of study/level of evidence
Therapeutic level III. 相似文献3.
4.
Dongmin Xu Hiroshi Koyama Hiroki Furuhashi Shoichi Nishikino Hironobu Hoshino Yukihiro Matsuyama 《Journal of orthopaedic science》2017,22(6):1102-1106
Background
In total hip arthroplasty (THA) surgery, hip muscle preservation is important in strengthening the stability of the hip and improving the activities of the patient. However, whether the type of femoral stem affects the recovery of the hip muscles remains unknown. The aim of this study was to compare the postoperative hip muscle recovery among femoral stem varieties after THA.Methods
The computed tomography (CT) images of 44 patients (44 hips) who underwent THA using an anterolateral approach were reviewed. Twenty-two patients received a fit-and-fill (FF) stem and 22 received the tapered-wedge (TW) stem. The volumes of the gluteus maximus (GMA), gluteus medius (GME), and obturator internus (OI) were measured on three-dimensional models reconstructed using preoperative and 6-month postoperative CT images. Relationships between muscle volume changes and factors including the femoral stem length were evaluated.Results
The GMA and GME volumes increased postoperatively by 8.2% and 8.3%, respectively, in the FF stem group and 7% and 6%, respectively, in the TW stem group, with no group differences. In contrast, the OI volume decreased postoperatively by 17.8% in the FF group and was preserved in TW group (p < 0.001). Moreover, OI volume was decreased in 19 patients (86%) in the FF group and in 11 patients (50%) in the TW group (p = 0.01). The normalized stem length was significantly associated with the postoperative change in OI volume (r = ?0.45, p = 0.002).Conclusions
The TW stem showed a significant advantage over the FF stem in terms of OI preservation. Surgeons should pay close attention during surgery to avoid OI injury when using different femoral stem types. We suggest that a short and reduced lateral shoulder femoral stem is a better choice for the preservation of external rotation muscles. 相似文献5.
Akira Kodama Toru Sunagawa Yuko Nakashima Rikuo Shinomiya Yuta Hayashi Mitsuo Ochi Nobuo Adachi 《Journal of orthopaedic science》2018,23(6):959-966
Background
Dynamic external fixation is a useful treatment option for unstable fracture-dislocations of the proximal interphalangeal (PIP) joint, because it simultaneously reduces axial pressure load on the joint surface, maintains congruent joint reduction, and permits early joint motion. However, most current devices are large, hindering finger movement, and unstable. To address these problems, we developed a dynamic external finger fixator, named the Micro Ortho Fixator®. The purpose of this study was to review the results of using the new external finger fixator to treat unstable fracture-dislocations of the PIP joint.Materials and methods
Nine patients who sustained unstable fracture-dislocation injuries of the PIP joint were treated with the Micro Ortho Fixator®. Seven fractures were accompanied by depressed bony fragments at the base of the middle phalanx. All patients were evaluated for pain and range of PIP motion at the final follow-up. Radiographs of the affected fingers were evaluated for PIP congruity and reduction. The mean follow-up duration was 11.1 months (range: 6–33 months).Results
At the final follow-up, pain averaged 0.3 (range: 0–2) on the Numeric Pain Rating Scale, and the total arc of motion at the PIP joint averaged 91.2° (range: 50–110°). All fractures had healed, and the intra-articular step-off improved from 1.9 mm (SD: 1.0) before surgery to 0.2 mm (SD: 0.4) at the final follow-up. The patients who sustained sports injuries returned to competition after an average of 3.5 months (range: 2.5–4 months).Conclusion
The external fixator is compact and facilitates range-of-motion (ROM) exercises, has high stability, and achieves good joint congruity and an ROM equivalent to the healthy joint of the patient.Study design/Level of evidence
Therapeutic/IV. 相似文献6.
Background
The objective of this study was to assess whether intravenous acetaminophen for patients undergoing knee or hip arthroplasty could reduce the opioid consumption and improve pain management.Method
Eligible studies were searched from electronic databases including PubMed, Web of Science, Embase (Ovid interface) and Cochrane Library (Ovid interface). The quality assessments were performed according to the Cochrane systematic review method. The assessed outcomes were including opioid consumption, pain scores, length of hospital stays and total occurrence of adverse events.Results
Among 832 records identified, six randomized controlled trials (RCTs) and five non-RCTs were eligible for data extraction and meta-analysis. According to the outcomes, the patients receive intravenous acetaminophen had less total opioid consumption after knee or hip artroplasty (SMD = ?0.66; 95%CI, ?1.13 to ?0.20), but they did not obtain statistical improvement of postoperative pain control at postoperative day 0 (POD0, SMD = ?0,15; 95%CI, ?0.36 to 0.07), POD1(SMD = 0,12; 95%CI, ?0.13 to 0.36), POD2 (SMD = ?0,29; 95%CI, ?0.70 to 0.12) and POD3 (SMD = ?0,04; 95%CI, ?0.49 to 0.41). Meanwhile, there were similar outcomes about the length of hospital stays in patients whether or not receiving intravenous acetaminophen (SMD = ?0,05; 95%CI, ?0.26 to 0.15). And, the total adverse effects occurrence also didn't show any significant difference between the acetaminophen group and control group (OR = 0.87; 95%CI, 0.57 to 1.33).Conclusions
Perioperative intravenous acetaminophen use in multimodal analgesia could significantly reduce of total opioid consumption, but it did not contribute to decrease the average pain scores and shorten the length of hospital stays in total hip or knee arthroplasty. 相似文献7.
Yeesuk Kim Jin Kyu Lee Kyu-Sung Chung Doo-Yeon Lee Choong Hyeok Choi 《Journal of orthopaedic science》2017,22(4):693-697
Background
The purpose of this study was to evaluate the joint gap kinematics in posterior-stabilized total knee arthroplasty (PS TKA).Methods
Between January 2010 and April 2011, 44 consecutive patients (55 knees) who underwent primary PS TKA using the navigation system were assessed. There were 37 women and 7 men with a mean age at operation of 63 years (range; 58–73 years). After fixation of all components with cement and insertion of polyethylene trial insert, medial and lateral joint gap measurements were carried out without distraction force and separately using a navigation system on each flexion angles. The joint gaps were measured before and after deflation of tourniquet, first with patella everted and then reduced.Results
Deflation of tourniquet did not effect on gap. In patellofemoral joint reduction situation, the medial gap relatively maintained throughout the range of knee motion, but the lateral gap is gradually decreasing with knee flexion from 30° to 120° flexion. However, in patellar eversion situation, the medial gap showed a significant increase and also statistically significantly increased compared with patellar reduced position over 90° knee flexion status, but the lateral gaps are decreased compared with patellofemoral reduction situation throughout the range of knee motion except full flexion status. In more physiologic status that is patella reduced and tourniquet deflated status, the average medial joint gap change was 2.30 ± 1.64 mm and the average lateral joint gap change was 2.90 ± 1.53 mm throughout the range of motion.Conclusions
Medial and lateral joint gaps showed different patterns with patellar eversion and patellofemoral joint reduction. However, such changes occurred within 3 mm in average throughout whole range of knee motion even with multi-radius femoral component. 相似文献8.
Norio Imai Ryota Takubo Hayato Suzuki Hayato Shimada Dai Miyasaka Kazuki Tsuchiya Naoto Endo 《Journal of orthopaedic science》2019,24(3):482-487
BackgroundIn obese patients, malpositioning of the acetabular cup increases the risk of dislocation in total hip arthroplasty (THA). The aim of this study was to determine whether obesity affects the accuracy of acetabular cup positioning using a computed tomography (CT)-based navigation system.MethodsWe retrospectively evaluated 226 consecutive patients who underwent cementless primary THAs assisted by the CT-based hip navigation system. We divided the patients into three groups according to body mass index (BMI) and examined the difference between preoperative planning and postoperative implantation angles from CT data.ResultsThere was no significant correlation between BMI and both inclination and anteversion differences (R = 0.028 and R = 0.045, respectively). There were no significant differences among the BMI < 25, 25 ≦ BMI < 30, and BMI ≧ 30 groups (p value: 0.725, 0.934, respectively); between the BMI < 25 and BMI ≧ 25 groups (p value: 0.542, 0.697, respectively); and between the BMI < 30 and BMI ≧ 30 groups with regard to inclination and anteversion (p value: 0.859, 0.456, respectively). Moreover, similar findings were observed with regard to the distance between the preoperative planning and postoperative cup positioning for the transverse, anteroposterior, and craniocaudal axes of the pelvis.ConclusionWe found that the accuracy of acetabular cup placement using CT based-navigation in THA was not affected in obese patients. Therefore, THAs with a CT-based navigation system are considered useful in obese patients. 相似文献
9.
Marc-Frederic Pastor Max Kieckbusch Melena Kaufmann Max Ettinger Mathias Wellmann Tomas Smith 《Journal of orthopaedic science》2019,24(2):237-242
Background
The reverse total shoulder arthroplasty (RTSA) is a common therapy for the fracture sequelae (FS) of the proximal humerus. The aim of this study was to show the short and midterm clinical outcome of the RTSA for FS and to identify prognostic factors.Methods
Data from 46 patients with chronic FS who underwent RTSA were analysed. The clinical follow-up included the Constant score and radiographic examination. Patients were divided into groups based on the Boileau classification of FS, and the degree of metaphyseal bone loss was measured (Boileau type I 9 patients; type II 3 patients; type III 8 patients and type IV 16 patients). Scapular notching was assessed according to the classification of Sirveaux.Results
The mean postoperative Constant score was 57. Clinical outcomes were similar among the various FS groups, as defined according to the Boileau classification, but patients who had undergone revision arthroplasty had a significantly inferior mean Constant score than patients with type IV FS. There were no significant differences between patients who were initially managed with conservative therapy and those treated surgically. Patients with metaphyseal bone loss >3 cm showed inferior clinical scores. Inferior scapular notching was seen in 25 patients, and had a negative effect on the clinical outcome. Complications included five infections and one dislocation.Conclusion
Metaphyseal bone loss was unfavourable prognostic factors in patients with FS treated with RTSA. However, the Boileau classification did not serve as a prognostic criterion. Previous operative or conservative treatment had no influence on the outcome and scapular notching was associated with inferior clinical results. 相似文献10.
Daisuke Tateiwa Kazuya Oshima Takaaki Nakai Yoshinori Imura Takaaki Tanaka Hidetatsu Outani Hironari Tamiya Nobuhito Araki Norifumi Naka 《Journal of orthopaedic science》2019,24(2):347-352
Background
The development of effective chemotherapy regimens and molecular targeting agents are improving the overall survival rates in patients with cancer. However, patients who are non-ambulatory due to metastatic epidural spinal cord compression (MESCC) may be assessed as unable to tolerate chemotherapy secondary to poor performance status. This means that the ambulatory status of patients with cancer might be significant for survival time.Methods
We investigated the functional outcomes and factors influencing overall survival in 31 patients who were non-ambulatory due to MESCC and underwent decompression surgery. The functional outcome was determined by the Frankel grading system.Result
Twenty-one patients (68%) improved by at least 1 Frankel grade; 17 patients (55%) became ambulatory postoperatively. Most of postoperatively ambulatory patients could undergo postoperative chemotherapy (14/17, 82%). On the other hand, only a few postoperatively non-ambulatory patients could undergo postoperative chemotherapy (2/15, 13%). We observed a complication rate of 35.5% with specific complications including wound infection, pneumonia, and deep vein thrombosis/pulmonary embolus. The median survival duration was 7.0 months. Factors that significantly affected the overall survival in univariate analyses were revised Tokuhashi score (RTS) ≥ 4, postoperative chemotherapy, ambulatory status, and complications (RTS ≥ 4, P < 0.05; postoperative chemotherapy, P < 0.001; ambulatory status, P < 0.001; complications, P < 0.01).Conclusions
Decompression surgery for patients who are non-ambulatory due to MESCC directly contributes to functional outcomes and may indirectly contribute to overall survival. If non-ambulatory patients who are assessed as unable to tolerate chemotherapy due to poor performance status regain the ability to walk by decompression surgery, they will have a chance to receive postoperative chemotherapy, thereby increasing their chances of prolonging survival. However, postoperative complications may shorten their survival; therefore, we should carefully consider the surgical indications. RTS is useful for judging the surgical indication. 相似文献11.
Seiya Miyamoto Takehiko Sugita Toshimi Aizawa Naohisa Miyatake Akira Sasaki Ikuo Maeda Masayuki Kamimura Atsushi Takahashi 《Journal of orthopaedic science》2018,23(5):801-806
Background
The efficacy of morphine added to periarticular multimodal drug injection (PMDI) for pain management after total knee arthroplasty (TKA) is controversial. Adding morphine to spinal anesthesia has reportedly improved pain relief for the first 24 h. We examined the effect of morphine added to PMDI or spinal anesthesia on pain management and functional recovery after TKA.Methods
A total of 97 patients were randomized into three groups: in Group A (34 patients), 10 mg morphine was added to PMDI; Group B (31 patients), 0.1 mg morphine was added to spinal anesthesia; and Group C (32 patients), morphine was added to neither the PMDI nor spinal anesthetic. To evaluate the efficacy of added morphine for pain management, we assessed rest pain, the number of times analgesics were used, and the time period until the first analgesic use. The adverse effects of morphine were assessed by counting the numbers of times vomiting occurred and antiemetics were used. Functional recovery was evaluated by recording the range of motion of the knee and the date of ability to walk.Results
Rest pain was the least in Group B at 6 and 12 h after operation. The number of times analgesics were used was the least in Group B. The time period until the first analgesic use was the longest in Group B. The number of vomiting episodes was the least in Group C. The number of times antiemetics were used was higher in Group A than in Group C. There were no significant differences in the range of motion and date of ability to walk among the three groups.Conclusions
The efficacy of morphine added to PMDI was limited, and that of morphine added to spinal anesthesia disappeared within 20 h postoperatively. Adding morphine to PMDI or spinal anesthesia did not improve functional recovery and caused some adverse effects. 相似文献12.
Jin-Woo Kim Dong-Hyun Kim Eui-Chan Jang Young-Kyun Lee Kyung-Hoi Koo Yong-Chan Ha 《Journal of orthopaedic science》2019,24(5):850-854
BackgroundThe purpose of this study was to assess mortality with a minimum of 2-year follow-up, related risk factors for mortality, and functional outcomes after surgical interventions in nonagenarian patients with hip fractures at the latest follow up.MethodsBetween June 2003 and November 2015, 260 nonagenarians (271 hips) with femoral neck and intertrochanteric fractures were included in this retrospective study. Cumulative mortality using the Kaplan-Meier method and risk factors for mortality using Cox proportional-hazards regression model were estimated. As functional outcome, ambulatory ability was assessed before injury and at the latest follow-up.ResultsSix-teen patients (16 hips) were lost to follow-up. The mean age at the time of surgery was 92.2 years (range 90–108 years). Mortality rates were 23.4% (57 of 244 patients) at 1 year and 40.6% (99 of 244 patients) at 2 years. Both genders had elevated standardized mortality ratio at 2-year post-fracture compared to that a 1-year post fracture. Multivariate analysis showed that American Society of Anesthesiologists (OR, 1.371; 95% CI, 1.021–1.843; P = 0.036) and time interval from trauma to operation (OR, 1.043; 95% CI, 1.002–1.086; P = 0.039) were significantly associated with risk of mortality. Of 58 patients alive, 13 patients (22.4%) had the same ambulatory ability before and after injury.ConclusionsThis study demonstrates that mortality is higher in nonagenarians with hip fracture. Risk factors for mortality in nonagenarians with hip fracture are American Society of Anesthesiologists and time interval from trauma to operation. And, nonagenarians with hip fractures have lower rate of maintaining pre-injury ambulatory ability. 相似文献
13.
14.
Tsuyoshi Tajika Atsushi Yamamoto Noboru Oya Chisa Okura Satoshi Shinagawa Takanori Kitagawa Hiroki Kobayashi Haku Iizuka Kenji Takagishi 《Journal of orthopaedic science》2017,22(1):144-148
Objective
This study investigated the relation between self-assessment of upper extremity function and locomotive syndrome in a general population.Methods
Using the 25-question Geriatric Locomotive Function (GLFS-25) test, 320 Japanese people (115 men, 205 women, mean age 67.6 years, 40–92 years) were evaluated for locomotive dysfunction. All had completed a self-administered questionnaire including items for sex, weight, height, dominant hand, and the degree of frequency of hand in ADL. We measured the bilateral hand grip and key pinch strength as indicators of hand muscle function. Study participants were assessed for upper extremity dysfunction using Hand 10, a self-administered questionnaire for upper extremity disorders, and using the Japanese Society for Surgery of the Hand Version of Disability of the Arm, Shoulder, and Hand. Statistical analyses were conducted to clarify the association between upper extremity dysfunction and screening results for locomotive dysfunction.Results
Participants reporting any upper extremity dysfunction were 137 (47 men, 90 women) out of 320 participants. The GLFS25 score was found to have significant positive correlation with age and Hand 10 scores. Significant negative correlation was found with the GLFS25 score and dominant grip strength, non-dominant grip strength, dominant key pinch strength, and non-dominant key pinch strength. Univariate analysis revealed a significant association with age, sex, bilateral hand grip, and key pinch, and with the Hand 10 score and Locomotive syndrome. Logistic regression analysis applied after adjustment for age, sex, height, and weight revealed a significant association between Locomotive syndrome and each of non-dominant hand grip (OR 0.73, 95%CI 0.61–0.87) and the Hand 10 questionnaire score (OR 1.10, 95%CI 1.06–1.14).Conclusion
Locomotive syndrome is associated with the decline of self-assessed and observed upper extremity function.Study design
Cross-sectional study. 相似文献15.
Tomoko Tetsunaga Tomonori Tetsunaga Keiichiro Nishida Masato Tanaka Yoshihisa Sugimoto Tomoyuki Takigawa Toshifumi Ozaki 《Journal of orthopaedic science》2017,22(3):554-559
Background
Although a multidisciplinary approach is often recommended to treat intractable pain, this approach does not completely prevent uncontrolled pain in some patients. The aim of this retrospective study was to investigate the exacerbating factors of prolonged, intractable pain among patients being treated at a pain liaison clinic.Methods
The participants of this study were 94 outpatients (32 men, 62 women) with chronic intractable pain who visited our hospital between April 2013 and February 2015. Demographic and clinical information was obtained from all patients at baseline. Experts in various fields, including anesthesia, orthopedic surgery, psychiatry, physical therapy, and nursing, were involved in the treatment procedures. All patients were assessed before and after a 6-month treatment period using the following measures: the Numeric Rating Scale (NRS); the Pain Catastrophizing Scale (PCS); the Hospital Anxiety and Depression Scale (HADS); the Pain Disability Assessment Scale (PDAS); and the Oswestry Disability Index (ODI). All participants were then divided into two groups based on their self-reported pain after treatment: a pain relief group (n = 70) and a prolonged pain group (n = 24). The exacerbating factors of prolonged pain after treatment in the pain liaison outpatient clinic were analyzed using univariate and multiple logistic regression analysis.Results
A significant improvement in NRS scores was observed after the 6-month follow-up period. After treatment, 24 (25.5%) of the 94 patients reported having prolonged pain. Significant improvements were seen in the PCS, PDAS, and ODI scores in the pain relief group, and in the HADS depression scores in the prolonged pain group. On univariate and multiple regression analysis, HADS depression scores were identified as a factor related to prolonged pain after treatment.Conclusions
The results of the present study suggest that severe depression at the initial visit to the liaison outpatient clinic was an exacerbating factor for prolonged pain after treatment. 相似文献16.
Yoshihiro Hagiwara Takuya Sekiguchi Yutaka Yabe Yumi Sugawara Takashi Watanabe Kenji Kanazawa Masashi Koide Nobuyuki Itaya Masahiro Tsuchiya Ichiro Tsuji Eiji Itoi 《Journal of orthopaedic science》2017,22(3):442-446
Background
The Great East Japan Earthquake and devastating Tsunami hit hard everything on the northeastern coast of Japan. This study aimed to determine socio-psychological factors for “subjective shoulder pain” of the survivors at 2 years evaluated by a self-report questionnaire.Methods
Between November 2012 to February 2013, survivors replied to the self-report questionnaire, and 2275 people consented to join this study. Living status was divided into 5 categories (1. same house as before the earthquake (reference group), 2. temporary small house, 3. apartment, 4. house of relatives or acquaintance, 5. new house) and economic hardship was divided into 4 categories (1. normal (reference group), 2. a little bit hard, 3. hard, 4. very hard). Gender, age, body mass index, living areas, smoking and drinking habits, complications of diabetes mellitus and cerebral stroke, working status, and walking time were considered as the confounding factors. Kessler Psychological Distress Scale of ≥10/24 and Athens Insomnia Scale of ≥6/24 points were defined as a presence of psychological distress and sleep disturbance, respectively. We used multiple logistic regression analysis to examine the association of shoulder pain with living environment, economic hardship, psychological distress, and sleep disturbance at 2 years after the earthquake.Results
There were significant differences in the risk of having shoulder pain in those with “apartment” (OR = 1.74, 95% CI = 1.03–2.96), “house of relatives or acquaintance” (OR = 2.98, 95% CI = 1.42–6.25), economic hardship of “hard” (OR = 1.71, 95% CI = 1.08–2.7) and “very hard” (OR = 2.51, 95% CI = 1.47–4.29), and sleep disturbance (OR = 2.96, 95% CI = 2.05–4.27).Conclusions
Living status of “apartment” and “house of relatives or acquaintance”, economic hardship of “hard” and “very hard”, and “sleep disturbance” were significantly associated with shoulder pain. 相似文献17.
Koji Yamasaki Masahiro Hoshino Keita Omori Hidetoshi Igarashi Takashi Tsuruta Hiroyuki Miyakata Yasuhiro Nemoto Hiromi Matsuzaki Takanori Iriuchishima 《Journal of orthopaedic science》2017,22(6):1021-1025
Background
Spinal surgery is classified as a moderate risk for DVT. The occurrence of DVT after various spinal surgical procedures was reviewed retrospectively, and the perioperative risk factors in the high-risk group were identified. In addition, the administration of the factor Xa inhibitor to DVT subjects with unstable thrombosis was evaluated to reveal its effectiveness in the prevention of PTE and postoperative complications.Methods
This study included 588 subjects who underwent lumbar spine surgery. The patient population consisted of the following four groups: the fracture group (F group), the laminectomy group (La group), the TLIF group (T group), and the long fusion group (Lo group). Bilateral lower limb venous ultrasonography was performed on the day before surgery, the day after surgery, and one week after surgery. The incidence of DVT was determined for each group and potential risk factors were evaluated in the group with the highest incidence of DVT. Subjects with DVT who had unstable thrombosis received anticoagulant therapy (factor Xa inhibitor) and their treatment results were assessed.Results
The overall incidence of DVT was 32.3% (190/588). A significantly high incidence of DVT was observed in the Lo group (54.3%; 75/138). Logistic regression and ROC analysis of potential risk factors in the Lo group identified a D-dimer value of 19.5 ug/ml at one week postoperatively as a risk factor of DVT (p = 0.02; odds ratio, 4.09; 95% CI, 2.82–7.88). Overall, 15.8% of subjects (30/190) received anticoagulant therapy. These subjects experienced neither PTE nor epidural hematoma. A follow-up ultrasonography performed at three weeks postoperatively detected the disappearance/resolution of DVT in 86.7% of these subjects (26/30).Conclusion
The incidence of DVT varied according to the invasiveness of the procedure. Successful management of DVT hinges on preoperative risk management involving prophylactic treatment and early diagnosis, in order to avoid PTE and other complications. 相似文献18.
Moon Jong Chang Sangyeon So Chan-Deok Park Jai Gon Seo Young-Wan Moon 《Journal of orthopaedic science》2018,23(1):92-96
Background
We sought to determine the 10-year survivorship of single-radius, posterior-stabilized total knee arthroplasty (TKA) in Asian patients. We also aimed to determine whether the long-term clinical and radiographic results differed between patients with and without patellar resurfacing.Methods
This retrospective study included 148 (115 patients) consecutive single-radius, posterior-stabilized TKAs. Ten-year survivorship analysis was performed using the Kaplan–Meier method with additional surgery for any reason as the end-point. Furthermore, long-term clinical and radiographic results of 109 knees (74%; 84 patients) with more than 10-year follow-up were analyzed. Ten-year survivorship and long-term outcomes after surgery were determined, and outcomes were compared between patients with and without patellar resurfacing.Results
The cumulative survival rate of the single-radius posterior-stabilized TKA of 148 knees was 97.7% (95% confidence interval, 93.1%–99.3%) at 10 years after surgery. Three knees required additional surgery during the 10-year follow-up because of one case of instability and two cases of periprosthetic infections. Mean postoperative Knee Society knee score and function score were 97 points and 75 points, respectively. There were no cases of aseptic loosening of the prosthesis, even though a non-progressive radiolucent line was found in 10 (9%) knees. There were no differences in postoperative scores and degree of patellar tilt and displacement between patients with and without patellar resurfacing.Conclusions
Single-radius, posterior-stabilized TKA showed satisfactory long-term clinical and radiographic outcomes in Asian patients regardless of patellar resurfacing, with comparable survivorship to that reported in westerners. 相似文献19.
Yu Sasaki Nobuyasu Ochiai Arata Nakajima Takahisa Sasho Tomonori Kenmoku Takeshi Yamaguchi Takehiro Kijima Eiko Hashimoto Yasuhito Sasaki Seiji Ohtori 《Journal of orthopaedic science》2018,23(5):834-841
Background
Rotator cuff tears are the most common shoulder injury, and little is known about the underlying etiology of fatty infiltration after rotator cuff tear. Previous studies speculated that rotator cuff tears lead to neural injury due to tethering of the suprascapular nerve at the notch. This study aimed to evaluate fatty infiltration after suprascapular nerve injury and rotator cuff tears.Methods
Ninety adult male Sprague–Dawley rats were used and were divided into four groups: sham, tendon transection only, suprascapular nerve ligation, and tendon transection plus suprascapular nerve ligation. The suprascapular nerve injury models were created by tying the suprascapular nerve. At 2, 4, and 8 weeks postoperatively, histological analysis and biomechanical testing were performed to evaluate fatty infiltration and elastic change in the supraspinatus muscles.Results
The amount of fatty infiltration in the supraspinatus muscle was significantly higher in both the suprascapular nerve ligation and tendon transection plus suprascapular nerve ligation groups than in the tendon transection only group at 2, 4, and 8 weeks. The ultimate failure load and tensile strength were significantly different among the tendon transection only, suprascapular nerve ligation, and tendon transection plus suprascapular nerve ligation groups at 8 weeks postoperatively. Furthermore, the mean Young's modulus of the muscle was significantly greater in the tendon transection plus suprascapular nerve ligation group than in both the tendon transection only and suprascapular nerve ligation groups at 8 weeks postoperatively.Conclusions
In this study, based on the results of histological and biomechanical examinations in our rat models, the etiology of fatty infiltration after massive rotator cuff tear might be different from the suprascapular nerve injury. 相似文献20.
Umito Kuwashima Ken Okazaki Kenyu Iwasaki Yukio Akasaki Hideya Kawamura Hideki Mizu-uchi Satoshi Hamai Yasuharu Nakashima 《Journal of orthopaedic science》2019,24(5):855-860
BackgroundFew studies have evaluated the impact of age on patient-reported outcomes in the long-term follow-up after high tibial valgus osteotomy (HTO). The purpose of this study is to assess the association between age at surgery and patient-reported clinical outcomes in the mid-term to long-term follow-up of HTO.Materials and methodsWe mailed the 2011 Knee Society score (KSS) questionnaires to 234 consecutive patients (295 knees) who had undergone closing-wedge HTO, and 158 patients (202 knees, 68.5%) returned a completed questionnaire. The cohort was divided into two groups depending on the age at the time of surgery, and pairs matched the follow-up period and sex was created. The mean follow-up period was approximately 12 years. KSS scores at the final follow-up were compared between two groups using the Student t test and chi-square test, and the survival rates were calculated using Kaplan–Meier survival curves.ResultsThe symptom, satisfaction, and expectation scores were not significantly different between the ≤64-year-old patients and ≥65-year-old patients. The functional activities score was significantly lower in older patients than in younger patients. The overall survival rates of HTO were 99.1 ± 0.4% at 5 years, 94.4 ± 1.2% at 10 years, and 84.6 ± 2.7% at 15 years. There was no significant difference in the survival rate after HTO between the two groups divided by the age (p = 0.602).ConclusionsPain relief and satisfaction after HTO in older patients were comparable to those in younger patients in the mid-term to long-term follow-up, although the functional activity was affected by age. 相似文献