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1.
Erica Kholinne Hyun Joo Lee Sung Jung Kim So Hyun Park In-Ho Jeon 《Acta orthopaedica et traumatologica turcica》2018,52(1):22-26
Objective
The aim of this study was to compare the microarchitecture of the greater tuberosity with or without rotator cuff tear and to obtain optimum location for anchor screw insertion for rotator cuff repair.Methods
Twenty-five humeral heads were harvested from 13 male cadavers of mean age 58.4 years, including 6 humeri with rotator cuff tear and 19 intact humeri. Six regions of interest (proximal, intermediate, and distal zones of the superficial and deep regions) were divided into the anterior (G1), middle (G2), and posterior (G3) areas of the greater tuberosity. Trabecular bone volume and cortical thickness were evaluated.Results
Total trabecular bone volume was greater in subjects <50 years old than in subjects >50 years old but did not differ significantly in subjects with and without rotator cuff tear. Cortical thickness in both intact and torn rotator cuff groups was significantly greater in the proximal and intermediate zones than in the distal zone. Cortical thickness was related to anatomic location rather than age or cuff tear.Conclusion
The optimal location for anchor screw insertion during rotator cuff repair is either the proximal or intermediate region of the greater tuberosity. Age has more influence in terms of trabecular bone volume loss than rotator cuff integrity. 相似文献2.
Tatsuo Mae Konsei Shino Ryo Iuchi Kazutaka Kinugasa Ryohei Uchida Shigeto Nakagawa Hideki Yoshikawa Ken Nakata 《Journal of orthopaedic science》2017,22(5):886-891
Purpose
To clarify 1) the force sharing between two portions of BTB graft in anatomic rectangular tunnel (ART) reconstruction and 2) the knee stability in ART technique under anterior tibial load.Methods
Eleven fresh cadaveric knees were used. First, anterior-posterior (A-P) laxity was measured with Knee Laxity Tester® in response to 134 N of A-P tibial load at 20° on the normal knees. Then ART ACL reconstruction was performed with a BTB graft. For graft, the patellar bone plug and tendon portion was longitudinally cut into half as AM and PL portions. After the tibial bone plug was fixed at femoral aperture, AM/PL portions were connected to the tension-adjustable force gauges at tibial tubercle, and were fixed with 10 N to each portion at 20°. Then the tension was measured 1) under anterior tibial load of 134 N at 0, 30, 60, and 90°, and 2) during passive knee extension from 120 to 0°. Next the graft tension was set at 0, 10, 20, 30, or 40 N at 20°, and the A-P laxity was measured by applying A-P load of 134 N. By comparing the laxity for the normal knee, the tension to restore the normal A-P laxity (LMP) was estimated.Results
The AM force was significantly smaller at 0° and larger at 90° than the PL force under anterior load, while the force sharing showed a reciprocal pattern. During knee extension motion, the tension of both portions gradually increased from around 5 N to 20–30 N with knee extended. And the LMP was 1.6 ± 1.0 N with a range from 0.3 to 3.5 N.Conclusion
The pattern of force sharing was similar to that in the normal ACL in response to anterior tibial load and during passive knee extension motion. LMP in this procedure was close to the tension in the normal ACL.Level of evidence
Level IV, a controlled-laboratory study. 相似文献3.
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4.
Udit Kumar Biswal Gopisankar Balaji Sandeep Nem Jagdish Menon Dilip Kumar Patro 《中华创伤杂志(英文版)》2018,21(1):50-53
Purpose
We conducted this study to correlate the short term clinical outcomes after anterior cruciate ligament (ACL) reconstruction with patients' age, time since injury and associated meniscal injury.Methods
A total of 43 patients who underwent ACL reconstruction between October 2013 and February 2015 were taken for the study. Preoperative demographic data, clinical scores (Lysholm, IKDC) were recorded for each patient. Time since injury and associated meniscal injuries were recorded. Then a standardized surgical technique was used for each graft type. They were followed up for 6 months and the Lysholm and IKDC scores were evaluated.Results
Only 33 patients completed 6 months follow-up at the end of this study. Twenty-four patients (72.7%) were in the age group of 18–30 years. Nine patients belonged to age group 30–50 years (27.3%). The p value for differences in Lysholm scores between the two age groups was not significant (0.339). The p value for differences in IKDC scores between the two age groups was not significant either (0.138). The mean Lysholm scores were 93.86 ± 3.024 for the group who presented <6 months post-injury, 92 ± 5.494 for the group who presented between 6 months and 1 year and 94.64 ± 3.104 for the group who presented after 1 year; whereas the mean IKDC scores were 92.43 ± 0.793, 90.64 ± 6.598 and 90.89 ± 2.113 respectively. The correlation of outcomes with meniscal injury had no statistical significance.Conclusion
Based on our study, we conclude that age, time since injury and associated meniscal injury does not affect short term functional outcome in ACL reconstruction. 相似文献5.
Z. Wu S. Zhang L. Zhou J. Cai J. Tan X. Gao Z. Zeng D. Li 《Transplantation proceedings》2017,49(7):1656-1658
Objective
To investigate the thromboembolism induced by blood-mediated inflammatory reactions against infused cells during the clinical application of stem cells.Methods
Two patients with renal transplantation and chronic kidney disease, respectively, experienced thromboembolism after umbilical cord mesenchymal stem cell (UCMSC) infusion. The clinical manifestations and the laboratory test results were collected and analyzed.Results
The patients received stem cell infusion through the peripheral veins and presented with a swollen and painful forearm postinfusion. Doppler ultrasound showed venous clots at the proximal end of the puncture site. Urokinase and warfarin were used for thrombolytic therapy. The swelling and pain were relieved and cured.Conclusion
Safety concerns are still a primary hurdle for stem cell therapy, and thromboembolism as a critical complication should be prevented appropriately. 相似文献6.
Background
De novo gastric cancer is a rare complication of liver transplantation.Methods
Surgical treatments of 16 cases with different outcomes were reported in the English literature.Results
De novo gastric cancer (stage II) was diagnosed as the result of epi-gastric discomfort in a recipient 10 years after liver transplantation. The patient received chemotherapy alone and remained well for 26 months.Conclusions
De novo gastric cancer of liver transplantation recipients is a severe complication; early detection and relevant intervention will benefit these recipients. 相似文献7.
Kazuhisa Hatayama Masanori Terauchi Kenichi Saito Hiroshi Higuchi 《The Journal of arthroplasty》2017,32(6):1808-1813
Background
The purpose of this study is to investigate whether varus-valgus laxity of cruciate-retaining (CR) total knee arthroplasty (TKA) changes between 1 year and >5 years after surgery based on postoperative limb alignment.Methods
One hundred twenty-one varus osteoarthritic knees that underwent CR TKA were included. The minimum follow-up was 5 years. Weight-bearing full-leg radiographs were obtained postoperatively and the hip-knee-ankle (HKA) angle was measured. Knees were grouped in varus (HKA angle ≤ ?3°, 47 knees) and neutral groups (?3° < HKA angle < 3°, 70 knees). The range of motion was measured and a Hospital for Special Surgery score was obtained at the last follow-up. Varus-valgus laxity at 15° of knee flexion was measured with stress radiographs after 1 year and at the last follow-up.Results
No knees required revision surgery. The mean knee flexion angle (121.0° vs 117.1°) and Hospital for Special Surgery score (90.3 vs 90.4) at the last follow-up were not significantly different between the varus and neutral groups. In both groups, there was no significant change in varus or valgus laxity between 1 year and at the last follow-up.Conclusion
Postoperative residual varus limb alignment did not lead to increasing varus laxity after CR TKA in the mid-term. 相似文献8.
Alejandro Lizaur-Utrilla Daniel Martinez-Mendez Santiago Gonzalez-Parreño Luis Marco-Gomez Francisco A. Miralles Muñoz Fernando A. Lopez-Prats 《The Journal of arthroplasty》2018,33(7):2141-2145
Background
Few studies have analyzed the outcomes of total knee arthroplasty (TKA) in patients with prior anterior cruciate ligament (ACL) reconstruction, and the reported outcomes are controversial. The purpose of this study is to assess if prior ACL reconstruction had any impact on the outcome of subsequent TKA.Methods
A matched case-control study was conducted in patients who underwent TKA, including 37 with prior ACL reconstruction and 37 patients without ACL reconstruction. Preoperative and postoperative clinical and radiological data were collected from a prospective arthroplasty database with a minimum follow-up of 5 years. The mean age was 69.6 years, and 59.4% were men. The Knee Society scores, Short Form-12, and Western Ontario and McMaster Universities questionnaires were used for functional evaluations. Visual analogue scale 0-10 was used for patient satisfaction.Results
The mean follow-up after TKA was 6.1 (range 5-7.3) years. Two patients in the ACL group developed knee stiffness requiring manipulation under anesthesia, while 1 patient in the control group suffered superficial wound infection. At last follow-up, no significant differences in functional or radiologic outcomes were found between both groups. The performance of TKA in ACL patients had increased technical difficulty and significantly longer time of surgery, but this had no influence on the outcomes. In the ACL group, 24 knees had technical difficulty in surgery. The main difficulty in most ACL patients was due to varus deformity and increased retraction of the medial soft structures which required progressive medial release. Other 2 knees had difficult knee exposure. One was an unexpected partial patellar tendon avulsion and the other required planned quadriceps snip.Conclusion
TKA was an effective procedure for patients with prior ACL reconstruction. The surgeon should be warned of the possible difficulties in the knee exposure and possible need of medial release to obtain an appropriate ligament balance. However, these additional procedures had no negative effect on the outcomes of TKA. 相似文献9.
Background
Conventional tests of shoulder laxity have been shown to have poor reliability due to the difficulty in palpating the subtle movements of the shoulder joint beneath the musculature. Modified drawer test that is performed while the soft tissues surrounding the shoulder are loosened has been proposed to facilitate glenohumeral joint movement and improve reliability. We hypothesised that the modified drawer test would have an improved intra- and inter-observer reproducibility in comparison to the drawer and load and shift tests. Correlation of shoulder laxity measured by these tests with generalized joint laxity was also assessed.Methods
Forty healthy volunteers underwent bilateral shoulder examination in the clinic using the three tests for anterior and posterior laxity assessment by a consultant shoulder surgeon and a resident. The examination was repeated three months later by the same examiners in the same cohort. Intra- and inter- observer reproducibility was calculated using Kappa values. The correlation of shoulder with generalized joint laxity was also investigated.Results
The modified drawer test showed significantly improved intra-observer reproducibility compared to the drawer test, but not to the load and shift (κ = 0.173, ?0.042, and 0.009, respectively). There were no significant differences in the inter-observer reproducibility between the three tests (κ = 0.054, 0.055, and 0.056, respectively). Moderate correlation was noted between shoulder and generalized joint laxity when modified drawer test was used (r = 0.417).Conclusions
The modified drawer test improves intra- but not inter- observer reproducibility compared to the drawer test. Shoulder laxity assessed by the modified test correlated to generalized joint laxity. The modified drawer test has an improved reproducibility and correlation to generalized joint laxity over the conventional tests. 相似文献10.
Background
The global rise in infectious disease has led the Center for Disease Control and Prevention and the World Health Organization to release new guidelines for the prevention of surgical site infection.Methods
In this article, we summarize current recommendations based on level of evidence, review unresolved and unaddressed issues, and supplement them with new literature.Results
Although the guidelines discuss major issues in reducing surgical site infection, many questions remain unanswered.Conclusion
These guidelines will hopefully help in setting a standard of care based on best evidence available and focus investigators on areas where evidence is lacking. 相似文献11.
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13.
Emrah Kovalak Tolga Atay Cem Çetin İ. Meltem Atay Mustafa Onur Serbest 《Acta orthopaedica et traumatologica turcica》2018,52(1):37-43
Objective
Whether surgical or conservative treatment is more effective in allowing patients to return to physical activity after anterior cruciate ligament (ACL) injury is controversial. We sought to compare mid-term outcome measures between isolated ACL tear patients who underwent reconstruction followed by closed kinetic chain exercises and those who underwent neuromuscular training only.Methods
We retrospectively evaluated patients with ACL tears who underwent post-surgery CKC strength training after ACL reconstruction (Group A), and patients who only underwent neuromuscular training (Group B) with a minimum follow-up time of 5 years. Surgical techniques, rehabilitation, assessment of subjective knee function, one-leg hop test, assessment of joint position sense, muscle strength, and the health profile of the patient were evaluated.Results
Overall, 43 patients were included in Group A (mean age, 32.56 ± 4.89; Tegner activity scale, 5) and 39 patients in Group B (31.67 ± 7.27; 5). Patients in both groups returned to their regular physical activity level after a similar time frame (Group A: average, 12 months; Group B, average, 13.4 months). The mean Lysholm knee score was 88.52 ± 7.65 in Group A and 86.21 ± 13.72 in Group B. Mean distances for the one-leg hop test for Group A were 135.21 ± 31.66 and 145.36 ± 42.10 mm in the reconstructed and uninjured knees, respectively. In Group B, the mean hop distances were 132.47 ± 28.13 and 147.89 ± 21.45 mm in the rehabilitated and uninjured knees, respectively. No statistical difference was observed between the groups for any of the parameters evaluated, including assessment of subjective knee function, one-leg hop test, assessment of joint position sense, muscle strength, and the health profile.Conclusion
Our data suggest that early surgical reconstruction may not be a prerequisite to returning to recreational physical activities after injury in patients with ACL tears.Level of evidence
Level IV, therapeutic study. 相似文献14.
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15.
16.
Evan S. Nielsen Albert Hsu Shantanu Patil Clifford W. Colwell Darryl D. D&#x;Lima 《The Journal of arthroplasty》2018,33(7):2293-2300
Background
Knee instability is emerging as a major complication after total knee arthroplasty (TKA), with ligament laxity and component alignment listed as important contributory factors. Knee balancing remains an art and is largely dependent on the surgeon's subjective “feel.” The objectives were to measure the accuracy of an electronic balancing device to document the magnitude of correction in knee balance after soft-tissue releases and measure change in knee laxity after medial release.Methods
The accuracy of a second-generation electronic ligament-balancing device was compared with that of 2 mechanical balancing instruments. TKA was performed in 12 cadaver knees. Soft-tissue balance was measured sequentially before TKA, after mounting a trial femoral component, after medial release, and after resecting the posterior cruciate ligament. Coronal laxity of the knee under a 10 Nm valgus moment was measured before and after medial release.Results
The electronic balancing instrument was more accurate than mechanical instruments in measuring distracted gap and distraction force. On average, before TKA, the flexion gap was wider than the extension gap, and the medial gap was tighter than the lateral gap. Medial release increased the medial gap in flexion and increased passive knee valgus laxity. Posterior cruciate ligament release increased the tibiofemoral gap in both flexion and extension with a greater increase in the lateral gap.Conclusion
The second-generation electronic balancing device was significantly more accurate than mechanical instruments and could record knee balance over the entire range of flexion. More accurate soft-tissue balance may enhance outcomes after TKA. 相似文献17.
John Kuckelman Riyad Karmy-Jones Elizabeth Windell Seth Izenberg Jean-Stephane David William Long Matthew J. Martin 《American journal of surgery》2018,215(5):794-800
Background
Traumatic Rib Cage Hernias (TRCH) requiring operative repair are rare and there is currently no literature to guiding surgical management.Methods
Perioperative review of TRCH over 32 years. Five operative grades were developed based on extent of tissue/bone damage, size, and location.Results
Twenty-four patients (20 blunt, 4 penetrating) underwent operative repair. Lung was the herniated organ in 88% with a median of 4 rib fractures and average size of 60.25?cm. Types of operation were well clustered by assigned TRCH grade. The majority required mesh (75%) and/or rib plating (79%). Complex tissue flap reconstruction was required in 10%. Full range-of-motion was maintained in 88% with79% returning to pre-injury activity levels. Five patients had continued pain at final follow up (mean?=?7months).Conclusion
The size and degree of injury has important implications in the optimal surgical management of TRCHs. These operative grades effectively direct surgical care for these rare and complex injuries. 相似文献18.
Colin G. DeLong Justin A. Doble Amber L. Schilling Eric M. Pauli David I. Soybel 《American journal of surgery》2018,215(4):610-617
Background
After open complex ventral hernia repair (cVHR), chronic pain has a significant impact on quality of life and processes of care.Methods
Records of 177 patients undergoing cVHR were reviewed in order to characterize the burden of managing postoperative pain in the first post-operative year following open cVHR.Results
In this cohort, 91 patients initiated at least one unsolicited complaint of pain, though phone call (37), unscheduled clinic visit (45) or evaluation in the emergency room (9); among these an actionable diagnosis was found in 38 (41.8%). Among 41 patients who initiated additional unsolicited complaints of pain, an actionable diagnosis was found in only 3 patients. Risk factors for such complaints included pre-operative pain and the use of synthetic mesh.Conclusions
Even in the absence of an actionable diagnosis, significant resources are utilized in evaluation and management of unsolicited complaints of pain in the first year after cVHR. 相似文献19.
Monti Khatod 《The Journal of arthroplasty》2018,33(6):1649-1651
Background
Total joint arthroplasty is a successful operation with increasing prevalence in the United States. Kaiser Permanente has been using multiple tools to optimize patient outcomes while keeping health-care expenditures in check.Methods
We describe the patient, surgeon, and hospital perspective toward the delivery of sustainable arthroplasty care for a growing elderly population. Quality metrics for each stakeholder are presented.Results
Kaiser Permanente optimizes value for the patient, surgeon, and hospital with the use of evidence-based integrated care pathways and a national joint arthroplasty registry.Conclusion
A continued focus on value-driven care will provide continued efficiency in a time of growth with maintenance of excellent outcomes. 相似文献20.