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1.
Harvey Mathews Addie Middleton Lindsey Boan Madison Jacks Lindsey Riddick Jessica Shepherd Jay Patel Antonia McNeal Stacy Fritz 《Journal of hand therapy》2018,31(4):554-561
Study Design
Clinical measurement.Introduction
Individuals with carpal tunnel syndrome (CTS) sometimes exhibit weakness of palmar abduction strength (TAS). Reliable assessment of this strength in both subjects with and without CTS with the commonly available Microfet 2 is not known.Purpose of the Study
The purpose of this study was to determine the intrarater and interrater reliabilities of a handheld dynamometric (HHD) method to assess TAS in individuals with and without CTS using the commercially available MicroFET2 and to examine the association between TAS in individuals with CTS and the Carpal Tunnel Symptom Questionnaire (CTSQ) scores.Methods
In 2 different study phases, individuals with and without CTS were assessed for TAS by 2 different examiners. The CTSQ was administered to the individuals with CTS.Results
Intrarater and interrater reliability coefficients (0.89-0.93 and 0.82-0.90, respectively) were excellent in individuals with and without CTS. Weak negative correlations were found between TAS and overall CTSQ and symptom severity subscale scores, and a moderate negative correlation was found between TAS and functional Status Subscale score.Discussion
This HHD method of reliably assessing TAS better quantifies deficits and progress than traditional manual muscle testing for muscle grades greater than 3/5.Conclusion
This method of HHD reliably quantifies TAS but is more reliable with the same than different raters. 相似文献2.
M.H. Kuizenga P.J. Colin K.M.E.M. Reyntjens D.J. Touw H. Nalbat F.H. Knotnerus H.E.M. Vereecke M.M.R.F. Struys 《British journal of anaesthesia》2018,120(3):525-536
Background
Neural inertia is defined as the tendency of the central nervous system to resist transitions between arousal states. This phenomenon has been observed in mice and Drosophila anaesthetized with volatile anaesthetics: the effect-site concentration required to induce anaesthesia in 50% of the population (C50) was significantly higher than the effect-site concentration for 50% of the population to recover from anaesthesia. We evaluated this phenomenon in humans using propofol or sevoflurane (both with or without remifentanil) as anaesthetic agents.Methods
Thirty-six healthy volunteers received four sessions of anaesthesia with different drug combinations in a step-up/step-down design. Propofol or sevoflurane was administered with or without remifentanil. Serum concentrations of propofol and remifentanil were measured from arterial blood samples. Loss and return of responsiveness (LOR-ROR), response to pain (PAIN), Patient State Index (PSI) and spectral edge frequency (SEF) were modeled with NONMEM®.Results
For propofol, the C50 for induction and recovery of anaesthesia was not significantly different across the different endpoints. For sevoflurane, for all endpoints except SEF, significant differences were found. For some endpoints (LOR and PAIN) the difference was significant only when sevoflurane was combined with remifentanil.Conclusions
Our results nuance earlier findings with volatile anaesthetics in mice and Drosophila. Methodological aspects of the study, such as the measured endpoint, influence the detection of neural inertia. A more thorough definition of neural inertia, with a robust methodological framework for clinical studies is required to advance our knowledge of this phenomenon.Clinical trial registration
NCT 02043938. 相似文献3.
M.S. Schaefer T.A. Treschan J. Gauch M. Neukirchen P. Kienbaum 《British journal of anaesthesia》2018,120(6):1394-1400
Background
The anaesthetic xenon shows potent organ-protective properties. Due to high density and dynamic viscosity, peak inspiratory pressure (Pmax) increases during xenon application. Thus, barotrauma may counteract organ protection. Accordingly, we investigated the influence of xenon on lung mechanics and lung aeration in patients with normal and reduced thoracic wall compliance.Methods
After registration and ethical approval, 20 patients free of pulmonary disease undergoing routine xenon-based anaesthesia were mechanically ventilated. The primary outcome variable transpulmonary pressure (Ptp) was determined from plateau pressure and intraoesophageal pressure before and after xenon wash-in. We recorded Pmax, and calculated airway resistance (RAW), and static (Cstat) and dynamic (Cdyn) respiratory compliances. Finally, lung aeration was quantified by electrical impedance tomography-derived centre of ventilation index (CVI) and global inhomogeneity index (GI) in the awake state, before and during xenon.Results
Xenon increased Pmax [20.8 (SD 3) vs 22.6 (3) cm H2O, P<0.001] and RAW [0.9 (0.2) vs 1.4 (0.3) cm H2O litre?1 s, P<0.001], without affecting Ptp [1.5 (4) vs 2.0 (4) cm H2O, P=0.15]. While Cstat remained unchanged, Cdyn was reduced [33.9 (7) vs 31.2 (6) ml (cm H2O)?1, P<0.001). A ventral tidal volume shift after anaesthesia induction [CVI 0.53 (0.03) vs 0.59 (0.04), P<0.001] was unaltered during xenon [CVI 0.59 (0.04), P=0.29]. Homogeneity of lung aeration was also unchanged during xenon [GI 0.37 (0.03) vs 0.37 (0.03), P=0.99]. There were no clinically meaningful differential BMI-related effects.Conclusions
Xenon increases calculated airway resistance and peak inspiratory pressure without affecting transpulmonary pressure, independent of BMI.Clinical trial registration
NCT02682758. 相似文献4.
J. Miller S.B. Clough R.C. Pollard S.A. Misbah 《British journal of anaesthesia》2018,120(6):1195-1201
Background
Perioperative anaphylaxis (POA) is infrequent, but remains an important and potentially life-threatening complication of general anaesthesia. The diagnostic uncertainty surrounding the investigation of anaesthetic allergy poses numerous challenges. We aimed to inform practice by auditing the outcomes of repeat anaesthesia, after an investigation for previous POA.Methods
One-hundred and seventy-four subjects were investigated after suspected POA between December 2002 and August 2015. Outcome data were obtained for a total of 70 patients who underwent repeat anaesthesia after investigation in the drug-allergy clinic.Results
Sixty-seven out of the 70 patients studied underwent repeat anaesthesia without further complications. Three individuals experienced a further episode of anaphylaxis. In two cases, incomplete referral information led to the offending drugs being omitted from initial testing. The third was found to have underlying systemic mastocytosis (SM).Conclusions
In our cohort, the incidence of repeat anaphylaxis after a comprehensive assessment in the drug-allergy clinic for suspected POA was 4%. Important risk factors include the completeness of referral information provided to the assessor and the role of exacerbating disorders, particularly SM. 相似文献5.
J.-L. Hanouz F. Le Gall J.-L. Gérard N. Terzi H. Normand 《British journal of anaesthesia》2018,120(4):868-873
Background
During preoxygenation, the lack of tight fit between the mask and the patient's face results in inward air leak preventing effective preoxygenation. We hypothesized that non-invasive positive-pressure ventilation and positive end-expiratory pressure (PEEP) could counteract inward air leak.Methods
Healthy volunteers were randomly assigned to preoxygenated through spontaneous breathing without leak (SB), spontaneous breathing with a calibrated air leak (T-shaped piece between the mouth and the breathing system; SB-leak), or non-invasive positive inspiratory pressure ventilation (inspiratory support +6 cm H2O; PEEP +5 cm H2O) with calibrated leak (PPV-leak). The volunteers breathed through a mouthpiece connected to an anaesthesia ventilator. The expired oxygen fraction (FeO2) and air-leak flow (ml s?1) were measured. The primary end point was the proportion of volunteers with FeO2 >90% at 3 min. The secondary end points were FeO2 at 3 min, time to reach FeO2 of 90%, and the inspiratory air-leak flow.Results
Twenty healthy volunteers were included. The proportion of volunteers with FeO2 >90% at 3 min was 0% in the SB-leak group, 95% in the SB group, and 100% in the PPV-leak group (P<0.001). At 3 min, the mean [standard deviation (sd)] FeO2 was 89 (1)%, 76 (1)%, and 90 (0)% in the SB, SB-leak, and PPV-leak groups, respectively (P<0.001). The mean (sd) inward air leak was 59 (12) ml s?1 in the SB-leak group, but 0 (0) ml s?1 in the PPV-leak group (P<0.001).Conclusions
Preoxygenation through non-invasive positive-pressure ventilation and PEEP provided effective preoxygenation despite an inward air leak.6.
P.M. Spieth A. Güldner C. Uhlig T. Bluth T. Kiss C. Conrad K. Bischlager A. Braune R. Huhle A. Insorsi F. Tarantino L. Ball M.J. Schultz N. Abolmaali T. Koch P. Pelosi M. Gama de Abreu 《British journal of anaesthesia》2018,120(3):581-591
Background
Experimental studies showed that controlled variable ventilation (CVV) yielded better pulmonary function compared to non-variable ventilation (CNV) in injured lungs. We hypothesized that CVV improves intraoperative and postoperative respiratory function in patients undergoing open abdominal surgery.Methods
Fifty patients planned for open abdominal surgery lasting >3 h were randomly assigned to receive either CVV or CNV. Mean tidal volumes and PEEP were set at 8 ml kg?1 (predicted body weight) and 5 cm H2O, respectively. In CVV, tidal volumes varied randomly, following a normal distribution, on a breath-by-breath basis. The primary endpoint was the forced vital capacity (FVC) on postoperative Day 1. Secondary endpoints were oxygenation, non-aerated lung volume, distribution of ventilation, and pulmonary and extrapulmonary complications until postoperative Day 5.Results
FVC did not differ significantly between CVV and CNV on postoperative Day 1, 61.5 (standard deviation 22.1) % vs 61.9 (23.6) %, respectively; mean [95% confidence interval (CI)] difference, ?0.4 (?13.2–14.0), P=0.95. Intraoperatively, CVV did not result in improved respiratory function, haemodynamics, or redistribution of ventilation compared to CNV. Postoperatively, FVC, forced expiratory volume at the first second (FEV1), and FEV1/FVC deteriorated, while atelectasis volume and plasma levels of interleukin-6 and interleukin-8 increased, but values did not differ between groups. The incidence of postoperative pulmonary and extrapulmonary complications was comparable in CVV and CNV.Conclusions
In patients undergoing open abdominal surgery, CVV did not improve intraoperative and postoperative respiratory function compared with CNV.Clinical trial registration
NCT 01683578. 相似文献7.
Yoshinobu Saitoh Takao Setoguchi Takako Yoshioka Junichiro Nishi Akihide Tanimoto Setsuro Komiya 《Acta orthopaedica et traumatologica turcica》2018,52(3):191-195
Objective
The aim of this study was to evaluate whether intraoperative histopathological examination could predict the risk of relapse of infection in periprosthetic joint infections (PJI).Methods
The study included 25 patients (14 women and 11 men, with a mean age of 67.0 years (range, 37–83 years)), who had two-staged revision surgery for a PJI. Following prosthetic removal in the first stage, all patient underwent an intraoperative histopathological examination during the second stage. The patients were divided into PMNs-positive group (≥five PMNs per high-powered field) or -negative group (<five PMNs). A relapse was defined as the occurrence of PJI. Median follow-up was 51 months (range, 32–80 months) following second-stage revision surgery.Results
Intraoperative histopathological revealed that 8.0% of cases were PMNs-positive. Postoperative histopathological examination revealed that 28.0% of cases were PMNs-positive. 28.0% of cases showed discrepancy between the PMNs-positivity. Intraclass correlation coefficient indicates poor reproducibility. Infection relapse after revision surgery occurred in two cases (8.0%); both relapse cases were from the PMNs-negative group. There was no statistical relationship between the presence of PMNs in periprosthetic tissue by intraoperative or postoperative histopathological examination and relapse of infection.Conclusions
Our findings showed that intraoperative histopathological examination could not predict the relapse of infection. Intraoperative histopathological examination promotes overdiagnosis of the requirement for re-implantation of antibiotic-impregnated cement and prolonged treatment periods.Level of evidence
Level III, diagnostic study 相似文献8.
9.
H. Abe M. Sumitani K. Uchida T. Ikeda H. Matsui K. Fushimi H. Yasunaga Y. Yamada 《British journal of anaesthesia》2018,120(4):779-789
Background
Although the incidence of maternal mortality during Caesarean delivery remains very low, the rate of severe maternal morbidity is increasing. Improvements in obstetric anaesthetic practice have resulted in a dramatic reduction in the risk of maternal death from general anaesthesia. Less clear is whether the risk of severe maternal morbidity differs according to mode of anaesthesia for women undergoing Caesarean delivery. We analysed the association between the mode of anaesthesia and severe maternal morbidity during Caesarean delivery using a nationally representative inpatient database.Methods
We identified 89 225 women undergoing scheduled Caesarean delivery from the Diagnosis Procedure Combination database in Japan, 2010–2013. We defined severe maternal morbidity as the presence of any life-threatening complications and identified women with severe maternal morbidity from the database. Propensity score-matched analysis was carried out to compare the odds of severe maternal morbidity between women who underwent general vs neuraxial anaesthesia.Results
Of 89 225 women, 10 058 received general anaesthesia and 79 167 received neuraxial anaesthesia. In the propensity score-matched analysis with 10 046 pairs, a higher incidence of severe maternal morbidity was observed among patients receiving general (2.00%) rather than neuraxial anaesthesia (0.76%). The odds ratio of severe maternal morbidity was 2.68 (95% CI, 1.97–3.64) among women receiving general compared with neuraxial anaesthesia.Conclusions
For scheduled Caesarean delivery, general anaesthesia compared with neuraxial anaesthesia is associated with greater odds for severe maternal morbidity. However, we should be cautious with interpretation of these findings because they may be explained by confounding indications. 相似文献10.
Béatrice de la Grandville Ferenc Petak Gergely Albu Sam Bayat Isabelle Pichon Walid Habre 《British journal of anaesthesia》2019,122(5):682-691
Background
Although a high inspired oxygen fraction (FiO2) is commonly used in paediatric anaesthesia, the impact on postoperative lung function is unclear. We compared lung volume, ventilation heterogeneity, and respiratory mechanics in anaesthetised children randomised to receive low or high FiO2 intraoperatively.Methods
In a double-blind randomised controlled trial, children scheduled for elective surgery were randomly assigned FiO2 100% (n=29) or FiO2 80% (n=29) during anaesthesia induction and emergence. During maintenance of anaesthesia, participants assigned FiO2=100% at induction/emergence received FiO2=80% (FiO2>0.8 group); those randomised to FiO2=80% at induction/emergence received FiO2=35% intraoperatively (FiO2 [0.8→0.35 group]). During spontaneous breathing, we measured the (i) functional residual capacity (FRC) and lung clearance index (ventilation inhomogeneity) by multiple-breath nitrogen washout; and (ii) airway resistance and respiratory tissue elastance by forced oscillations, before operation, after discharge from the recovery room, and 24 h after operation. Mean (95% confidence intervals) are reported.Results
Fifty eight children (12.9 [12.3–13.5] yr) were randomised; 22/29 (high group) and 21/29 (low group) children completed serial multiple-breath nitrogen washout measurements. FRC decreased in the FiO2>0.8 group after discharge from recovery (–12.0 [–18.5 to –5.5]%; P=0.01), but normalised 24 h later. Ventilation inhomogeneity increased in both groups after discharge from recovery, but persisted in the FiO2>0.8 group 24 h after surgery (6.1 [2.5–9.8%]%; P=0.02). Airway resistance and respiratory elastance did not differ between the groups at any time point.Conclusions
FiO2>0.8 decreases lung volume in the immediate postoperative period, accompanied by persistent ventilation inhomogeneity. These data suggest that FiO2>0.8 should be avoided in anaesthetised children with normal lungs.Clinical trial registration
NCT02384616. 相似文献11.
Raquel Cantero-Téllez Jorge Hugo Villafañe Kristin Valdes Pedro Berjano 《Journal of hand therapy》2018,31(1):68-73
Study Design
A quasi-experimental trial.Introduction
Orthoses are effective to decrease pain and improve function in patients with carpometacarpal osteoarthritis (CMC OA). However, current research does not support one design of an orthosis as more effective and/or more favorable than another.Purpose of the Study
The aim of this study was to compare the effectiveness of 2 different static orthosis on pain and functional abilities on CMC OA.Methods
Eighty-four patients, 91.7% females (mean ± standard deviation age, 60.1 ± 9.6 years), with thumb CMC OA were randomized into 1 of 2 groups. For group A, a Ballena orthotic was constructed, and for group B, a Colditz orthotic was constructed. Both static orthoses were worn for 3 months. The outcome measures included pain with activity measured with the visual analog scale and functional abilities assessed with the Disabilities of the Arm, Shoulder and Hand.Results
Both orthoses improved pain level and functional abilities (F[1.0] = 413.327 and F[1.0] = 211.742; both P < .001). There was no statistically significant difference between 2 groups regarding to pain recovery and functional improvement (F[1.0] = 0.075 and F[1.0] = 7.248; both P > .05).Discussion
The main purpose was to compare the effect of 2 different thermoplastic thumb orthoses. Previous studies support the use of CMC orthoses to decrease hand pain and improve hand function, but different orthoses have been described and in most cases, orthotic interventions were accompanied by other medical treatments.Conclusions
A clinically significant reduction in pain intensity and improvement in functional abilities was achieved with both orthoses in patients with thumb CMC OA.Level of Evidence
2.12.
R.P. Duarte A.M.O. da Silva R.M. Tonella L.S.R. Ratti I.F.S.F. Boin 《Transplantation proceedings》2018,50(3):776-778
Introduction
The liver transplantation procedure, in addition to its prolonged surgical time, also predisposes to complications such as changes in respiratory mechanics, lung volumes, and gas exchange.Objective
This study aims to verify if clinical factors related to the recipient, namely immediate pretransplant Model for End-Stage Liver Disease (MELD) score, surgical time, and root square metric (RMS) of the diaphragmatic domes, affect the extubation time after liver transplantation.Method
A prospective study, with a sample collected for convenience, gathered age (years), sex (male or female), MELD score immediately prior to transplantation (without the addition of special situation scores), and surgical time and time for extubation (in minutes). The latter were obtained from the physiotherapy team records, and surface electromyography was performed within 30 minutes after elective extubation, by a single researcher, with supplemental oxygen support, maintaining SpO2 ≥ 95% and following protocol of positioning and acquisition of electromyographic signals based on the study of Oliveira et al (2012).Results
For the 21 patients studied, the RMS of the left dome showed a moderate-intensity correlation (?0.56) with the time of extubation, and linear multiple regression model the left dome (P = .013) and preoperative MELD score (P = .048) showed significant correlation with extubation time.Conclusion
The preoperative MELD score and the RMS values of the left dome significantly correlate with the time for patient extubation after liver transplantation, showing the effect of previously acquired muscle weakness and preoperative MELD score on postoperative outcome. 相似文献13.
14.
S. Ceruti L. Anselmi B. Minotti D. Franceschini J. Aguirre A. Borgeat A. Saporito 《British journal of anaesthesia》2018,120(1):101-108
Background
Significant hypotension is frequent after spinal anaesthesia and fluid administration as therapy is usually empirical. Inferior vena cava (IVC) ultrasound (US) is effective to assess fluid responsiveness in critical care patients. The aim of this study was to evaluate the IVCUS-guided volume optimization to prevent post-spinal hypotension.Methods
In this prospective, randomized, cohort study, 160 patients scheduled for surgery under spinal anaesthesia were randomized into a study group (IVCUS-group), consisting of an IVCUS analysis before spinal anaesthesia with IVCUS-guided volume management and a control group (group C) with no IVCUS assessment. The primary outcome was a relative risk reduction in the incidence of hypotension between the groups; secondary outcomes were the need for vasoactive drugs and the amounts of fluids required after spinal anaesthesia. We also tested the hypothesis of a correlation between IVC collapsibility index and hypotension after spinal anaesthesia.Results
The relative risk reduction of hypotension between the groups was 35% (IVCUS-group 27.5%, Group C 42.5%, P=0.044, CI=95%). The need for vasoactive drugs in the IVCUS-group was significantly lower compared to the C-group (P=0.015), while the total amount of fluids was significantly superior higher in the IVCUS group (P<0.0001) compared to Group C. IVC collapsibility index was correlated with the amount of fluid administered (r2=0.32), but could not be used to predict postspinal anaesthesia hypotension.Conclusions
IVCUS is an effective method to prevent postspinal anaesthesia hypotension by IVCUS-guided fluid administration before spinal anaesthesia.15.
Study Design
Case series.Introduction
Hand injuries are the most common injury observed in hurling although compliance in wearing protective gloves is reportedly low.Purpose of the Study
To devise a glove that offers comfort, protection and freedom of movement, using the bespoke capabilities of 3-dimensional (3D) printing.Methods
Each player's “catching” hand was imaged using a 3D scanner to produce a bespoke glove that they later trialed and provided feedback.Results
Nine players provided feedback. On average, the players favorably rated the glove for the protection offered. The average response on comfort was poor, and no players reported that glove aided performance during play.Discussion
This feasibility study explores the versatility of 3D printing as a potential avenue to improve player compliance in wearing protective sportswear. Feedback will help refine glove design for future prototypes.Conclusions
Hurling is the primary focus in this study, but knowledge gains should be transferable to other sports that have a high incidence of hand injury.Level of Evidence
4. 相似文献16.
Background
Heart-lung transplantation is a well-established therapeutic modality for concomitant end-stage heart and lung failure. With growing organ scarcity, the rates of these transplants are declining, and center experience is waning.Methods
With over 35 years of experience performing heart-lung transplantation, we describe our procurement protocol herein, as well as offer suggestions to avoid potential pitfalls in order to ensure technical excellence in harvesting these valuable grafts.Results
Procurement issues most commonly arise with organ preservation and inadvertent damage to structures that are difficult to fully visualize.Conclusions
En-bloc heart-lung procurement can be taught effectively and safely to trainees with an emphasis on avoiding common pitfalls that may compromise graft function. 相似文献17.
Pilar Alvial Gabriela Bravo María Paz Bustos Gabriel Moreno Roberto Alfaro Renata Cancino Juan Cristóbal Zagal 《Journal of hand therapy》2018,31(1):129-136
Study Design
A male patient with partial hand amputation of his nondominant hand, with only stumps of the proximal phalanx of the first and fifth finger, was evaluated. The performance of using two alternative 3D printed silicone-embedded personalized prostheses was evaluated using the quantitative Jebsen Hand Function Test.Introduction
Custom design and fabrication of 3D printed prostheses appears to be a good technique for improving the clinical treatment of patients with partial hand amputations. Despite its importance the literature shows an absence of studies reporting on quantitative functional evaluations of 3D printed hand prostheses.Purpose of the Study
We aim at producing the first quantitative assessment of the impact of using 3D printed silicone-embedded prostheses that can be fabricated and customized within the clinical environment.Methods
Alginate molds and computed tomographic scans were taken from the patient's hand. Each candidate prosthesis was modeled in Computer Aided Design software and then fabricated using a combination of 3D printed parts and silicone-embedded components.Discussion
Incorporating the patient’s feedback during the design loop was very important for obtaining a good aid on his work activities. Although the explored patient-centered design process still requires a multidisciplinary team, functional benefits are large.Conclusion(s)
Quantitative data demonstrates better hand performance when using 3D printed silicone-embedded prosthesis vs not using any aid. The patient accomplished complex tasks such as driving a nail and opening plastic bags. This was impossible without the aid of produced prosthesis. 相似文献18.
Alberto M. Leopaldi Krzysztof Wrobel Giovanni Speziali Sjoerd van Tuijl Agne Drasutiene W. Randolph Chitwood 《The Journal of thoracic and cardiovascular surgery》2018,155(1):147-155
Objective
Previously, cardiac surgeons and cardiologists learned to operate new clinical devices for the first time in the operating room or catheterization laboratory. We describe a biosimulator that recapitulates normal heart valve physiology with associated real-time hemodynamic performance.Methods
To highlight the advantages of this simulation platform, transventricular extruded polytetrafluoroethylene artificial chordae were attached to repair flail or prolapsing mitral valve leaflets. Guidance for key repair steps was by 2-dimensional/3-dimensional echocardiography and simultaneous intracardiac videoscopy.Results
Multiple surgeons have assessed the use of this biosimulator during artificial chordae implantations. This simulation platform recapitulates normal and pathologic mitral valve function with associated hemodynamic changes. Clinical situations were replicated in the simulator and echocardiography was used for navigation, followed by videoscopic confirmation.Conclusions
This beating heart biosimulator reproduces prolapsing mitral leaflet pathology. It may be the ideal platform for surgeon and cardiologist training on many transcatheter and beating heart procedures. 相似文献19.
Pavel P. Morozov Munib Sana Brian J. McGrory Steven W. Farraher Tod G. Abrahams 《The Journal of arthroplasty》2017,32(8):2535-2545
Background
Failed total hip arthroplasty (THA) caused by mechanically assisted crevice corrosion (MACC) has serious consequences—notably, adverse local tissue reactions. Metal artifact reduction sequence (MARS) magnetic resonance imaging (MRI) has been used to evaluate failed THA for other reasons but has not been assessed for the analysis of cases of MACC in the setting of metal-on-polyethylene arthroplasties.Methods
We examined the correlation between preoperative MARS MRI and surgical findings in a cohort of 20 consecutive patients undergoing revision THA for symptomatic MACC without other associated orthopedic diagnoses. Surgical findings included soft tissue and bone evaluation, presence and location of fluid, abductor disruption, composite tissue damage grade, and prosthesis trunnion damage at the time of revision.Results
MARS MRI complex synovitis, thickened pseudocapsule, and extra-articular fluid extension each strongly correlated with both the soft-tissue damage grade and trunnion damage noted at surgery. Bone marrow edema was also found to strongly correlate with bone necrosis intraoperatively.Conclusion
MARS MRI is an excellent diagnostic tool for evaluation of patients with elevated serum Co after metal-on-polyethylene THA. Patients with complex synovitis, a thick pseudocapsule, bone marrow edema, and extra-articular fluid should strongly consider revision surgery. 相似文献20.
Daryl K.A. Chia Zachery Yeo Stanley E.K. Loh Shridhar Ganpathi Iyer Glenn Kunnath Bonney Krishnakumar Madhavan Alfred W.C. Kow 《American journal of surgery》2018,215(1):131-137