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1.
Nevio Cimolai Geoffrey K. Blair James J. Murphy Graham G. Fraser 《Canadian journal of surgery》1997,40(1):28-32
Objectives
To determine the impact of Escherichia coli O157:H7 infection in children on the need for surgical assessment in a pediatric surgical practice and whether clinical and bacteriologic variables might contribute to that need.Design
Examination of a case series.Setting
A tertiary-care pediatric hospital.Patients
Between 1990 and 1994, E. coli O157:H7 gastrointestinal infections were documented among 85 children, 29 of whom suffered from hemolytic-uremic syndrome.Intervention
Surgical consultation for presumed or proven complications of the infection.Main Outcome Measures
The frequency of and reasons for surgical consultation, clinical and bacteriologic variables between patients who did or did not require surgical assessment.Results
Of the 85 children, 17 (20%) were assessed by the surgical service. The majority of these children were inpatients. Two required abdominal surgery. Female gender, older age and progression to hemolytic-uremic syndrome were factors associated in univariate analyses with a likelihood of need for surgical assessment; variation in bacterial genotype was not.Conclusion
There is the potential for verotoxigenic E. coli O157:H7 infection to have a considerable impact on the utilization of pediatric surgical services. 相似文献2.
Objective
To assess the long-term results of the PCA uncemented total hip replacement.Design
A prospective nonrandomized clinical trial. Follow-up ranged from 8 to 11 years (mean 10.3 years).Setting
A university hospital.Patients
One hundred consecutive PCA arthroplasties were performed on 89 patients. All operations were supervised by a single surgeon. The patients’ status was reviewed between September and November 1996 by an independent observer. Seventy-three total hip replacements were available for review.Intervention
PCA uncemented acetabular and femoral replacement through a lateral surgical approach.Main outcome measures
The need for revision, which was classified as failure, and definite 3-zone acetabular radiolucency, which was considered radiologic evidence of loosening.Results
The time to failure of the acetabulum averaged 8 years. Femoral failure occurred in 3 patients an average of 4 years postoperatively. The overall failure rate for the acetabulum was 13% and for the femur 7%.Conclusions
The acetabular failure rate is unacceptably high. Patients who have had hip replacement with the PCA prosthesis should be followed over the long term. 相似文献3.
Kevin Chan Forough Farrokhyar Sarah Burrow Marcin Kowalczuk Mohit Bhandari Olufemi R. Ayeni 《Canadian journal of surgery》2013,56(6):422-426
Background
The use of hip arthroscopy has been steadily rising as technology, experience and surgical education continue to advance. Previous reports of the complication rate associated with hip arthroscopy have varied. The purpose of this study was to report our experience with hip arthroscopy complications at a single Canadian institution (McMaster University).Methods
We performed a retrospective chart review of 2 hip arthroscopists at the same institution to identify patients who had undergone the index surgery and had been followed for a minimum of 6 months postoperatively. We used a standard data entry form to collect information on patient demographic and clinical characteristics, including age, sex, surgical indication and type of complication if any.Results
A total of 211 patients underwent 236 hip arthroscopies. The mean age at time of surgery was 37 ± 13 years and mean follow-up was 394 ± 216.5 days. The overall complication rate associated with hip arthroscopy was 4.2% (95% confidence interval 2.3%–7.6%). We identified 4 major and 6 minor complications.Conclusion
Overall, hip arthroscopy appears to be safe, with minor complications occurring more frequently than major ones. However, surgeons should recognize the possibility of serious complications associated with this procedure. Future research should focus on prospective designs looking for potential prognostic factors associated with hip arthroscopy complications. 相似文献4.
Gunnar Hägglund Henrik Lauge-Pedersen Måns Persson Bunke Elisabet Rodby-Bousquet 《Journal of children's orthopaedics》2016,10(4):275-279
Purpose
To analyze the development of windswept hip deformity (WS) in a total population of children with cerebral palsy (CP) up to 20 years of age, the association between WS and hip dislocation, and femoral varus osteotomy and scoliosis, and the impact of a hip surveillance program on the subsequent incidence of WS.Methods
This is a prospective study on children with CP in southern Sweden included in the Swedish follow-up programme and registry for CP (CPUP). All children born between 1990 and 1995 with CP were included; those born between 1990 and 1991 did not partake in the hip surveillance program until they were older (3–5 years of age) and served as a historic control group. Children born between 1992 and 1995 were included in the hip surveillance program from about 2 years of age and constituted the study group.Results
In the control group, 12 of 68 children (18 %) developed WS. In the study group of 139 children, 13 (9 %) developed WS (p = 0.071). Of all 25 children with WS, 21 also developed scoliosis and 5 developed a hip dislocation. The number of children with WS starting in the lower extremities was significantly lower in the study group (p = 0.028). No difference between the two groups was seen regarding WS that started in combination with scoliosis.Conclusion
With early inclusion in a hip surveillance program and early treatment of contractures, it appears possible to reduce the frequency of WS starting in the lower extremities.5.
K. Naresh K. Nayak Brian Mulliken Cecil H. Rorabeck Robert B. Bourne Michael R. Woolfrey 《Canadian journal of surgery》1997,40(5):368-374
Objective
To determine the prevalence of heterotopic bone formation in cemented versus noncemented total hip joint replacement.Design
A prospective randomized controlled trial. Follow-up ranged from 2 to 6 years (mean 4 years).Setting
A university hospital.Patients
Two hundred and twenty-six patients who had primary or secondary osteoarthrosis of the hip were stratified according to type of fixation, surgeon and age. Patients were randomized within strata: 112 received noncemented total hip prostheses and 114 received cemented prostheses. The 2 groups were similar with respect to age and sex.Intervention
Primary total hip arthroplasty. A cemented (methylmethacrylate) or noncemented prosthesis was inserted by a lateral surgical approach.Main outcome measure
The Brooker classification was used to grade heterotopic bone formation from postoperative radiographs.Results
Overall, 148 (66%) hips had no heterotopic ossification, 56 (25%) were Brooker class I, 14 (6%) were class II, 8 (3%) were class III and none were class IV. In the noncemented group of patients, 76 (68%) hips had no heterotopic ossification, 25 (22%) were Brooker class I, 7 (6%) were class II, 4 (4%) were class III and none were class IV. In the cemented group of patients, 72 (63%) hips had no heterotopic ossification, 31 (27%) hips were Brooker class I, 7 (6%) were class II, 4 (4%) were class III and none were class IV.Conclusion
There was no significant difference in the prevalence of heterotopic ossification between cemented and noncemented total hip replacements in patients with osteoarthrosis. 相似文献6.
Objectives
To assess the magnitude and the burden of hip fracture on the health care system, including time trends in hip fracture rates, in-hospital death rates, length of hospital stay (LHS) and discharge destination.Design
A retrospective study of discharge abstracts.Setting
The Province of Ontario.Patients
All patients (n = 93 660) over the age of 50 years and with a diagnosis of hip fracture discharged from hospital between 1981 and 1992 (excluding transfers).Main Outcome Measures
Age-sex standardized hip fracture rates per 1000 population, in-hospital death rates and age-adjusted mean LHS.Results
The overall hip fracture rate was 3.3 per 1000 persons (1.7 per 1000 men and 4.6 per 1000 women). There was no change in rates between 1981 and 1992 (p = 0.089), but there have been increases in the numbers of hip fractures. There was no change in the in-hospital death rate over time (p = 0.78). The age-adjusted mean LHS in 1981 was 28.6 days compared with 22.2 days in 1992. The numbers of hip fractures will increase from 8490 in 1990 to 16 963 in 2010.Conclusions
Despite stable age-adjusted rates of hip fractures, the doubling of the number of hip fractures by the year 2010 due to an aging population will become an increasing burden on the health care system. 相似文献7.
Clamp JA Baiju D Copas DP Hutchinson JW Rowles JM 《Annals of the Royal College of Surgeons of England》2008,90(6):492-496
INTRODUCTION
The introduction of Modernising Medical Careers (MMC) is likely to reduce specialist registrar (SpR) operative experience during higher surgical training (HST). A further negative impact on training by local Independent Sector Treatment Centres (ISTCs) could reduce experience, and thus competence, in primary joint arthroplasty at completion of higher surgical training.PATIENTS AND METHODS
Retrospective case note and radiograph analysis of patients receiving primary hip and knee arthroplasty in a teaching hospital, before and after the establishment of a local ISTC. Patients and operative details were recorded from the selected case notes. Corresponding radiographs were assessed and the severity of the disease process assessed.RESULTS
Fewer primary hip and knee replacements were performed by SpRs in the time period after the establishment of an ISTC.Conclusions
ISTCs may adversely affect SpR training in primary joint arthroplasty. 相似文献8.
Stephanie L. Gold BA Alissa J. Burge MD Hollis G. Potter MD 《Clinical orthopaedics and related research》2012,470(12):3321-3331
Background
Accurate, reproducible, and noninvasive assessment of hip cartilage is clinically relevant and provides a means by which to assess the suitability of candidates for arthroscopic or open surgical procedures and the response to such interventions over time. Given the relatively thin cartilage of the hip and the complex spherical anatomy, however, accurately assessing the cartilage poses a challenge for traditional MRI techniques.Questions/Purposes
We assessed the current status of imaging articular cartilage of the hip through a comprehensive review of recent literature.Methods
We performed a literature review using PubMed. Topics included quantitative MRI, imaging of the hip cartilage and labrum, femoroacetabular impingement syndrome, and osteoarthritis of the hip.Where Are We Now?
With the use of high in-plane and through-plane resolution, reproducible assessment of hip cartilage and labrum is clinically feasible. More recent quantitative MR techniques also allow for noninvasive assessment of collagen orientation and proteoglycan content in articular cartilage, thus providing insight into early matrix degeneration. These techniques can be applied to cohorts at risk for osteoarthritis, helping to predict cartilage degeneration before symptoms progress and osteoarthritic changes are visible on radiographs.Where Do We Need to Go?
Prospective longitudinal data registries are necessary for developing predictive models of osteoarthritis and subsequent joint failure to assess the results of surgical intervention and predict the timing of arthroplasty.How Do We Get There?
By establishing more hip cartilage registries, a correlation can be made between subjective measures and morphologic MRI to assess the cartilage, labrum, bone, and synovial lining of the hip. 相似文献9.
INTRODUCTION
Persistent sciatic artery (PSA) is a rare vascular anomaly associated with a higher rate of aneurysm formation or thromboembolic complications causing lower extremity ischemia.PRESENTATION Of Case
A 15-year-old female patient with bilateral PSA presented with lower extremity ischemia. Considering the age and symptoms of the patient, we did not perform any intervention, but continued surveillance with duplex ultrasonography in case of the high incidence of aneurysmal formation or thromboembolic event.DISCUSSION
Epidemiology, development, anatomical structure, diagnosis and treatments of PSAs are discussed.CONCLUSION
PSAs, are prone to early atheromatous degeneration and aneurysm formation. Treatment of a PSA mainly dependent on the symptoms is either by surgical procedures or by endovascular interventions. 相似文献10.
Westhoff B Zilkens C Reith A Jelinek E Martiny F Willers R Krauspe R 《International orthopaedics》2011,35(12):1833-1837
Purpose
The purpose of this study was to evaluate the functional impairments during gait after Legg-Calvé-Perthes Disease (LCPD) and to correlate these data with the clinical and radiographic outcome.Methods
In 13 individuals with LCPD in recovery or final stage (mean age 9.5 ± 3.5 years) with unilateral hip involvement the clinical result was graded according to Tönnis and the radiographic outcome according to Heyman and Herndon; the functional impairment during gait was compared to a group of healthy children (n = 30, mean age 8.1 ± 1.2 years). All children underwent computerised three-dimensional gait analysis.Results
The standard physical examination resulted in 69.2% normal range of movement according to Tönnis, but overall analysis of gait revealed that only 30.7% had a normal gait pattern. All children with an excellent or good radiographic (n = 6) outcome walked normally or showed minor deviations.Conclusions
The results of the standard clinical examination do not reflect the function of the hip joint during gait. Additional information is revealed from gait analysis and should be part of outcome studies in LCPD. 相似文献11.
Mohamed El-Sayed Tarek Ahmed Sameh Fathy Hosam Zyton 《Journal of children's orthopaedics》2012,6(6):471-477
Introduction
The surgical management of neglected developmental dysplasia of the hip (DDH) in walking children has always been a challenge to orthopedic surgeons. The aim of this study was to evaluate the short- to middle-term clinical and radiographic results of the management of DDH.Patients and methods
Patients less than 6 years old using two of the most commonly used osteotomies, namely, Salter innominate osteotomy and the Dega acetabuloplasty. Special attention was paid to acetabular remodeling after concentric reduction, which was monitored by the acetabular index, that, in turn, was measured preoperatively, immediately postoperatively, every 6 months, and at the final follow-up examination.Results
The final overall clinical end results were favorable (excellent or good) in 93 hips (85.3 %). There was a marked improvement of the acetabular coverage during the follow-up period, which proved the good remodeling potential of the acetabulum for this particular age group after concentric reduction was achieved and maintained.Conclusion
Both osteotomy types were found to be adequate for the management of neglected walking DDH patients under the age of 6 years. 相似文献12.
13.
V Manchev JL Bruce GV Oosthuizen GL Laing DL Clarke 《Annals of the Royal College of Surgeons of England》2015,97(4):274-278
Introduction
The Pietermaritzburg Metropolitan Trauma Service (PMTS) has run a systematic quality improvement programme since 2006. A key component included the development and implementation of an effective surveillance system in the form of an electronic surgical registry (ESR). This study used data from the ESR to review the incidence, spectrum and outcome of paediatric trauma in Pietermaritzburg, South Africa.Methods
The ESR was reviewed, and all cases of paediatric trauma managed between 1 January 2012 and 30 July 2014 were retrieved for analysis.Results
During the study period, 1,041 paediatric trauma patients (724 male, 69.5%) were managed by the PMTS, averaging a monthly admission of 36. The mean age was 10.9 years (standard deviation: 5.4 years). The mechanism of injury (MOI) was blunt trauma in 753 patients (72.3%) and penetrating trauma in 170 (16.3%). Pedestrian vehicle collisions accounted for 21% of cases and motor vehicle collisions for a further 11%. Intentional trauma accounted for 282 patients (27.1%) and self-inflicted trauma for 14 cases (1.3%). Ninety patients admitted to the intensive care unit and fifty-one required high dependency unit admission. There were 17 deaths, equating to an in-hospital mortality rate of 1.7%. A total of 172 children died on the scene of an incident. There were 35 road traffic related deaths, 26 suicides by hanging, 27 deaths from blunt assault and 23 deaths from penetrating assault. The overall mortality rate for paediatric trauma was 18.2%.Conclusions
The ESR has proved to be an effective surveillance system and has enabled the accurate quantification of the burden of paediatric trauma in Pietermaritzburg. This has improved our understanding of the mechanisms and patterns of injury, and has identified a high incidence of intentional and penetrating trauma as well as road traffic collisions. These data can be used to guide strategies to reduce the burden of paediatric trauma in our environment. 相似文献14.
David G. Chess R. Wayne Grainger Tom Phillips Zane D. Zarzour Bruce R. Sheppard 《Canadian journal of surgery》1996,39(5):389-392
Objective
To review the clinical performance of the anatomic medullary locking (AML) femoral stem in total hip arthroplasty.Design
A clinical and radiographic review.Setting
A tertiary lower limb joint replacement centre.Patients
Two hundred and twenty-one patients with noninflammatory gonarthrosis.Interventions
Two hundred and twenty-seven primary total hip arthroplasties with the noncemented AML component completed by two surgeons.Main Outcome Measures
Independent review by two experienced reviewers of the postoperative Harris hip score, radiographs of component fixation, size and degree of diaphyseal fill.Results
Harris hip score was 84 (range from 43 to 98); component fixation showed bone ingrowth in 41%, stable fixation with fibrous ingrowth in 56% and unstable fixation in 3%; severe thigh pain in 4% of cases correlated with unstable fixation, and there was mild thigh pain in 20% of cases.Conclusion
The AML femoral stem performs well in replacement arthroplasty compared with other noncemented stems. 相似文献15.
Patrick Sadoghi Christian Schr?der Andreas Fottner Arnd Steinbrück Oliver Betz Peter E. Müller Volkmar Jansson Andreas H?lzer 《International orthopaedics》2012,36(11):2197-2203
Purpose
The aim of the study was to compare primary total hip arthroplasty (THA) implantations between different countries in terms of THA number per inhabitant, age, and procedure type and to compare the survival curve including all THAs using hip arthroplasty registers.Methods
THA registers were compared between different countries with respect to the number of primary implantations per inhabitant and age, procedure type and survival curve. We performed a literature search for all national hip arthroplasty registers providing annual reports for 2009 or, if not available, a more recent period. The data from these reports were analysed in terms of number, age distribution and procedure type of primary THAs and survival curves.Results
We identified nine hip arthroplasty registers, which comprised sufficient data to be included. A large variation was found in the annual number of primary THA implantations per inhabitant. The procedure type varied greatly as well, e.g. in Sweden 67 % are cemented THAs whereas in Emilia-Romagna (Italy) 89 % are cementless THAs.Conclusions
This study revealed large differences in terms of the annual number of primary THAs per inhabitant and primary THA procedure type across countries. These data can be used to rank local primary THA implantations within an international context. 相似文献16.
Ravi Kumar Gupta Nipun Jindal Manish Pruthi 《Journal of Clinical Orthopaedics and Trauma》2015,6(2):94-100
Purpose
We report the surgical outcome in 52 patients with acetabular otherwise considered as poor surgical choices.Methods
43 male and 9 female patients were operated at a mean age of 43 years and followed up for a mean duration of 60.3 months. There were 22 elementary fractures and 31 associated ones according to Letournal and Judet classification. Osteosynthesis was attempted in 48 patients whereas a primary total hip arthroplasty was performed in 4 patients. Outcome was assessed radiologically and functionally employing Harris Hip Score (HHS).Results
Average HHS in osteosynthesis group was 82.56 ± 12.4 with excellent to good results in 59.6% of the cases. Symptomatic osteoarthritis occurred in 13.5% of cases, avascular necrosis and severe heterotopic ossification in 7.7% each, infection and nerve palsy in 11.5% each.Conclusion
Although the complication rates in this series is marginally more than that reported in literature, we recommend that the indications of surgical fixation in acetabular fractures need to be extended to those which were considered poor surgical choices. 相似文献17.
Background:
Spontaneous hip lateralization complicates the management of non-ambulatory children with cerebral palsy (CP). It can be diagnosed early using radiographs, but it involves standardization of positioning and exposure to radiation. Hence, the aim of this study was to assess the utility of Combined hip abduction angle (CHAA) in the clinical setting to identify those children with CP who were at greater risk to develop spontaneous progressive hip lateralization.Materials and Methods:
One hundred and three children (206 hips) with CP formed our study population. There were 48 boys and 55 girls aged 2–11 years (mean 5.03 years). 61 children were Gross Motor Function Classification System (GMFCS) level 5, while 42 were GMFCS level 4. Clinical measurements of CHAA were statistically correlated with radiographic measurements of Reimer''s migration percentage (MP) for bivariate associations using χ2 and t tests.Results:
CHAA is evaluated against MP which is considered as a reliable measure of hip subluxation. Thus, for CHAA, sensitivity was 74.07% and specificity was 67.35%. False-positive rate was 32.65% and false-negative rate was 25.93%.Conclusions:
Our study shows that correlation exists between CHAA and MP, which has been proved to be useful for hip screening in CP children at risk of hip dislocation. CHAA is an easy, rapid, cost-effective clinical test which can be performed by paraclinical health practitioners (physiotherapists) and orthopedic surgeons. 相似文献18.
Patrick M. Chiasson Peter D. Roy Michael J. Mitchell Ann M. Chiasson David I. Alexander 《Canadian journal of surgery》1997,40(5):383-389
Objective
To determine quality of hip fracture services provided by “generalist” general surgeons (generalists) in Nova Scotia.Design
Chart review and postoperative, blinded, random-ordered radiologic analysis.Setting
Three community hospitals and 1 tertiary care hospital in Nova Scotia.Participants
Seven generalists who performed 120 hip fracture repairs and 7 orthopedic surgeons (specialists) who performed 135 hip fracture repairs.Outcome measures
Patient demographics, preoperative, perioperative, postoperative and discharge information, technical quality of reduction as determined through postoperative radiologic assessment.Results
There were no differences between patients treated by generalists and those treated by specialists with respect to age, sex, American Society of Anesthesiologists’ class, level of function and fracture type. Intraoperatively, the patient groups were similar with respect to type of anesthesia, use of antibiotics, number of transfusions and surgical complications. Significant differences were noted in length of operation (54.4 v. 41.1 minutes), use of C-arm imaging (6.7% v. 85.9%) and management of Garden classes 1 and 2 subcapital fractures. Postoperatively, the 2 groups had similar numbers of medical complications, wound complications, reoperations, readmissions and deaths, and a similar level of function on discharge. Significant differences included the number of intensive care unit admissions (5.8% v. 15.6%) and length of stay there (5.7 v. 2.8 days) and of postoperative stay (14.5 v. 10.7 days). The assessment of radiographs did not demonstrate any significant difference in the quality of reduction.Conclusion
In Nova Scotia the outcomes of hip fracture surgery performed by generalists are comparable to those performed by specialists. 相似文献19.
Julien Girard Erwan Pansard Reda Ouahes Henri Migaud Cyril Delay Laurent Vasseur 《International orthopaedics》2014,38(5):923-928
Purpose
Cup design has been incriminated as the source of groin pain after hip resurfacing but has not been well described; thus, it was assessed in a prospective study looking at three implant types.Methods
A group-match was done between three groups of hip resurfacing devices according to age, sex, body mass index, activity level, osteoarthritis aetiology and pre-operative scores.Results
The global groin pain rate was 5.7 % at six months and 2.7 % at last follow-up. Groin pain rate was significantly different between the three groups (p = 0.004) and had a strong influence on the subjective results (p = 0.04). No groin pain emerged between six months and last follow-up. No clinical differences were noted in Harris hip score and Merle d’Aubigné-Postel score at last follow-up. However, the Oxford hip score and Devane activity score were significantly lower for cups with macrostructures.Conclusion
The low groin pain rate in this prospective cohort was probably secondary to the specific surgical technique used and seems to be correlated with cup design. Macrostructures on the external part of the cup could be significantly harmful. 相似文献20.
Thomas Crompton Claire Lloyd Michail Kokkinakis Fabian Norman-Taylor 《Journal of children's orthopaedics》2014,8(4):333-336