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1.
Dolan RT Butler JS Murphy SM Cronin KJ 《Annals of the Royal College of Surgeons of England》2012,94(1):43-51
INTRODUCTION
Microvascular free flap reconstruction has revolutionised the reconstruction of complex defects of traumatic, oncological, congenital and infectious aetiologies. Complications of microvascular free flap procedures impact negatively on patient post-operative course and outcome.METHODS
We performed a retrospective analysis of 102 consecutive patients undergoing 108 free flap procedures at a tertiary referral centre over an 8-year period. Logistic regression analysis was used to identify factors pRedictive of free flap complications. Health-related quality of life (HRQoL) and aesthetic outcomes were assessed using the Short Form 36 questionnaire and a satisfaction visual analogue scale respectively.RESULTS
In total, 108 free tissue transfers were performed; 23% were fasciocutaneous free flaps, 69% musculocutaneous and 8% osteoseptocutaneous. The overall flap success rate was 92.6%. Over a third of patients (34.3%) had flap-related complications ranging from minor wound dehiscence to total flap loss. ASA (American Society of Anesthesiologists) grade ≥2 (OR: 16.9, 95% CI: 15.3–18.1, p<0.009), history of smoking (OR: 6.1, 95% CI: 5.5–7.2, p<0.049), body mass index ≥25kg/ m2 (OR: 21.3, 95% CI: 20.8–22.1, p<0.003), low albumin (odds ratio [OR]: 2.2, 95% confidence interval [CI]: 1.2–3.9, p<0.003) and peripheral vascular disease (OR: 6.9, 95% CI: 5.9–7.5, p<0.036) were identified as factors independently predictive of free flap complications.CONCLUSIONS
Patients undergoing uncomplicated free flap surgery and those reporting superior post-operative flap aesthesis have higher HRQoL scores. Microvascular free tissue transfer has revolutionised our approach to the reconstruction of complex defects, providing a safe, reliable procedure to restore functionality and quality of life for patients. 相似文献2.
Nefyn H. Williams Ruth Lewis Nafees Ud Din Hosam E. Matar Deborah Fitzsimmons Ceri J. Phillips Alex Sutton Kim Burton Maggie Hendry Sadia Nafees Clare Wilkinson 《European spine journal》2013,22(9):1921-1935
Purpose
Systematic review comparing biological agents, targeting tumour necrosis factor α, for sciatica with placebo and alternative interventions.Methods
We searched 21 electronic databases and bibliographies of included studies. We included randomised controlled trials (RCTs), non-RCTs and controlled observational studies of adults who had sciatica treated by biological agents compared with placebo or alternative interventions.Results
We pooled the results of six studies (five RCTs and one non-RCT) in meta-analyses. Compared with placebo biological agents had: better global effects in the short-term odds ratio (OR) 2.0 (95 % CI 0.7–6.0), medium-term OR 2.7 (95 % CI 1.0–7.1) and long-term OR 2.3 [95 % CI 0.5 to 9.7); improved leg pain intensity in the short-term weighted mean difference (WMD) −13.6 (95 % CI −26.8 to −0.4), medium-term WMD −7.0 (95 % CI −15.4 to 1.5), but not long-term WMD 0.2 (95 % CI −20.3 to 20.8); improved Oswestry Disability Index (ODI) in the short-term WMD −5.2 (95 % CI −14.1 to 3.7), medium-term WMD −8.2 (95 % CI −14.4 to −2.0), and long-term WMD −5.0 (95 % CI −11.8 to 1.8). There was heterogeneity in the leg pain intensity and ODI results and improvements were no longer statistically significant when studies were restricted to RCTs. There was a reduction in the need for discectomy, which was not statistically significant, and no difference in the number of adverse effects.Conclusions
There was insufficient evidence to recommend these agents when treating sciatica, but sufficient evidence to suggest that larger RCTs are needed.Electronic supplementary material
The online version of this article (doi:10.1007/s00586-013-2739-z) contains supplementary material, which is available to authorized users. 相似文献3.
4.
Purpose
To examine if pre-injury health-related factors are associated with the subsequent report of whiplash, and more specifically, both whiplash and neck pain.Methods
Longitudinal population study of 40,751 persons participating in two consecutive health surveys with 11 years interval. We used logistic regression to estimate odds ratio (OR) for reporting whiplash or whiplash with neck pain lasting at least 3 months last year, related to pre-injury health as indicated by subjective health, mental and physical impairment, use of health services, and use of medication. All associations were adjusted for socio-demographic factors.Results
The OR for reporting whiplash was increased in people reporting poor health at baseline. The ORs varied from 1.47 (95% CI 1.13–1.91) in people visiting a general practitioner (GP) last year to 3.07 (95% CI 2.00–4.73) in people who reported poor subjective health. The OR associated with physical impairment and mental impairment was 2.69 (95% CI 1.75–4.14) and 2.49 (95% CI 1.31–4.74), respectively. Analysis of reporting both whiplash and neck pain gave somewhat stronger association, with ORs varying from 1.50 (95% CI 1.07–2.09) in people visiting a GP last year to 5.70 (95% CI 3.18–10.23) in people reporting poor subjective health. Physical impairment was associated with an OR of 3.48 (95% CI 2.12–5.69) and mental impairment with an OR of 3.02 (95% CI 1.46–6.22).Conclusion
Impaired self-reported pre-injury health was strongly associated with the reporting of a whiplash trauma, especially in conjunction with neck pain. This may indicate that individuals have, already before the trauma, adopted an illness role or behaviour which is extended into and influence the report of a whiplash injury. The finding is in support of a functional somatic disorder model for whiplash. 相似文献5.
Purpose
To compare the clinical effectiveness of posterior lumbar interbody fusion (PLIF) and posterolateral fusion (PLF) for lumbar spondylolisthesis and to collect scientific evidence for determining which fusion method is better.Methods
After systematic search, comparative studies were selected according to eligibility criteria. Checklists by Furlan and by Cowley were used to evaluate the risk of bias of the included randomized controlled trials (RCTs) and nonrandomized controlled studies, respectively. Weighed mean differences (WMDs) and risk differences were calculated for common outcomes. The final strength of evidence was expressed as different levels recommended by the GRADE Working Group.Results
Four RCTs and five comparative observational studies were identified. Moderate-quality evidence indicated that PLIF was more effective than PLF for clinical satisfaction [odds ratios (OR) 0.49, 95 % confidence limits (95 % CI): (0.28, 0.88, P = 0.02)]. Moderate-quality evidence showed that no significant difference was found for the complication rate [OR 2.28, 95 % CI (0.97, 5.35), P = 0.06]. In secondary outcomes, moderate-quality evidence indicated that PLIF improved fusion rate [OR 0.32, 95 % CI (0.17, 0.61), P = 0.0006]. Low-quality evidence showed that PLIF resulted in a lower reoperation rate than PLF [OR 5.30, 95 % CI (1.47, 19.11), P = 0.01]. No statistical difference was found between the two groups with regard to blood loss [WMD = 76.52, 95 % CI (−310.68, 463.73), P = 0.70] and operating time [WMD = −1.20, 95 % CI (−40.36, 37.97), P = 0.95].Conclusions
Moderate-quality evidence indicates that PLIF can improve the clinical satisfaction and increase the fusion rate compared to PLF. No superiority was found between the two fusion methods in terms of complication rate, amount of blood loss, and operating time for the treatment of lumbar spondylolisthesis. 相似文献6.
Mackenzie C. Lees Shaheed Merani Keerit Tauh Rachel G. Khadaroo 《Canadian journal of surgery》2015,58(5):312-317
Background
Older adults (≥ 65 yr) are the fastest growing population and are presenting in increasing numbers for acute surgical care. Emergency surgery is frequently life threatening for older patients. Our objective was to identify predictors of mortality and poor outcome among elderly patients undergoing emergency general surgery.Methods
We conducted a retrospective cohort study of patients aged 65–80 years undergoing emergency general surgery between 2009 and 2010 at a tertiary care centre. Demographics, comorbidities, in-hospital complications, mortality and disposition characteristics of patients were collected. Logistic regression analysis was used to identify covariate-adjusted predictors of in-hospital mortality and discharge of patients home.Results
Our analysis included 257 patients with a mean age of 72 years; 52% were men. In-hospital mortality was 12%. Mortality was associated with patients who had higher American Society of Anesthesiologists (ASA) class (odds ratio [OR] 3.85, 95% confidence interval [CI] 1.43–10.33, p = 0.008) and in-hospital complications (OR 1.93, 95% CI 1.32–2.83, p = 0.001). Nearly two-thirds of patients discharged home were younger (OR 0.92, 95% CI 0.85–0.99, p = 0.036), had lower ASA class (OR 0.45, 95% CI 0.27–0.74, p = 0.002) and fewer in-hospital complications (OR 0.69, 95% CI 0.53–0.90, p = 0.007).Conclusion
American Society of Anesthesiologists class and in-hospital complications are perioperative predictors of mortality and disposition in the older surgical population. Understanding the predictors of poor outcome and the importance of preventing in-hospital complications in older patients will have important clinical utility in terms of preoperative counselling, improving health care and discharging patients home. 相似文献7.
T Ibrahim B Bloch CN Esler KR Abrams WM Harper 《Annals of the Royal College of Surgeons of England》2010,92(3):231-235
INTRODUCTION
The aim of this study was to evaluate temporal trends in the prevalence of primary total hip and knee replacements (THRs and TKRs) throughout the Trent region from 1991 to 2004.PATIENTS AND METHODS
The Trent Regional Arthroplasty Study records details of primary THR and TKR prospectively and data from the register were examined. Age and gender population data were provided by the Office for National Statistics.RESULTS
A total of 26,281 THRs and 23,606 TKRs were recorded during this period. Analysis showed that females had an increased incidence rate ratio (IRR) for both primary THR (IRR = 1.29; 95% CI 1.26–1.33; P < 0.001) and TKR (IRR = 1.17; 95% CI 1.14–1.20; P < 0.001). Patients aged 74–85 years had the largest IRR for both primary THR (IRR = 6.7; 95% CI 6.4–7.0; P < 0.001) and TKR (IRR = 15.3; 95% CI 14.4–16.3; P < 0.001).CONCLUSIONS
The prevalence of primary TKR increased significantly over time whereas THR remained steady in the Trent region between 1991 and 2004. 相似文献8.
Xian Chang Bin Chen Hai-yin Li Xiao-bo Han Yue Zhou Chang-qing Li 《International orthopaedics》2014,38(6):1225-1234
Purpose
The objective of this study was to compare the safety and efficacy of minimally invasive discectomy (MID) with standard discectomy (SD) and determine whether the use of the MID technique could decrease the recurrence of lumbar disc herniation (LDH) after the surgery.Methods
In February 2014, a comprehensive search was performed in PubMed, EMBASE, Web of Science, Cochrane Library and the Chinese Biological Medicine Database. Only randomised controlled trials (RCT) that compared MID with SD for the surgical management of LDH were included. These trials were carefully picked out following the inclusion and exclusion criteria. Using the Cochrane Collaboration guidelines, two authors independently extracted data and assessed these trials’ quality. The age of the patients, size of incision, surgical time, blood loss, visual analogue scale (VAS) score after the surgery, hospital stay, disc herniation recurrence, X-ray exposure and surgical costs in these studies were abstracted and synthesised by a meta-analysis with RevMan 5.2.0 software, and the main results (VAS score after the surgery and disc herniation recurrence) of publication bias were examined by Stata 12.0.Results
Overall, 16 trials involving 2,139 patients meeting our criteria were included and analysed. Comparing MID and SD, the former was more likely to increase disc herniation recurrence [relative risk (RR) = 1.95, 95 % confidence interval (CI) 1.19–3.19, p = 0.008], and it involved a smaller size of incision [mean difference (MD) = −1.91, 95 % CI −3.33 to −0.50, p = 0.008], shorter hospital stay, longer operating time (MD = 11.03, 95 %C I 6.62–15.44, p < 0.00001) and less blood loss (MD = −13.56, 95 % CI −22.26 to −4.87, p = 0.002), while no statistical difference appeared with regard to the age of the patients, VAS score after the surgery, X-ray exposure, hospital stay and surgical costs.Conclusions
Based on available evidence, MID results in less suffering for patients during the hospital course with a similar clinical efficacy compared to SD. This makes MID a promising procedure for patients with LDH; however, to popularise it greater effort is required to reduce disc herniation recurrence. 相似文献9.
Dror Ovadia Sharon Eylon Avraham Mashiah Shlomo Wientroub Eduard David Lebel 《Journal of children's orthopaedics》2012,6(4):327-331
Background
Adolescent idiopathic scoliosis (AIS) is the most prevalent spine deformity within the pediatric population. Orthosis is the mainstay of conservative treatment for mild to moderate AIS. The Rigo System Chêneau (RSC) brace is a custom-made thoracolumbar sacral orthosis (TLSO) based on a three-dimensional correction concept. The purpose of this study was to identify factors that could predict the therapeutic success/failure of the RSC brace.Materials and methods
A retrospective cohort study was performed on all consecutive patients according to the Scoliosis Research Society (SRS) criteria for the success of conservative treatment. Participants had a 2-year follow-up beyond the termination of brace treatment. All patients were treated with the RSC orthotic device.Results
Ninety-three patients met the inclusion criteria. At treatment onset, their average age was 12.9 years, average Cobb angle 31.97°, Risser score 1.07, and the mean angle of thoracic rotation (ATR) was 10.2°. The mean brace treatment period was 36 months. Treatment was successful in 83.8 % of these patients (n = 79). The average final Cobb angle was 28.97°, Risser score 4.88, and ATR 8.09°. The pre-treatment factors associated with the success of applying the RSC brace were a high Risser score [odds ratio (OR) = 2.97, 95 % confidence interval [CI] 1.18–7.44; p = 0.02), a low Cobb angle (OR = 0.92, 95 % CI 0.85–0.99; p = 0.02), and low ATR (OR = 0.86, 95 % CI 0.75–0.99; p = 0.04).Conclusions
The treatment of mild to moderate AIS with the RSC brace provides excellent clinical results. Its added benefit is enabling a three-dimensional correction of a three-dimensional deformity. Pre-treatment high Risser score, low Cobb angles, and low ATRs are associated with treatment success.Level of evidence
Retrospective analysis, Level III. 相似文献10.
11.
M Schweigert N Solymosi A Dubecz M Posada Gonzalez RJ Stadlhuber D Ofner HJ Stein 《Annals of the Royal College of Surgeons of England》2015,97(2):140-145
Introduction
Oesophageal perforation following chemoradiotherapy for oesophageal cancer is a devastating condition but there have been no studies investigating the role of emergency oesophagectomy for this life threatening situation.Methods
This retrospective study comprised all cases of emergency oesophagectomy for oesophageal perforation after chemoradiotherapy for oesophageal carcinoma at a major centre for oesophageal surgery in Germany between 2004 and 2013.Results
A total of 13 patients (mean age: 58.9 years) were identified. During the same time period, 356 elective oesophagectomies were performed. Tumour entities were squamous cell carcinoma (n=12) and adenocarcinoma of the oesophagus (n=1). Alcoholism (odds ratio [OR]: 25.79, 95% confidence interval [CI]: 6.70–121.70, p<0.0001) and chronic pulmonary disease (OR: 3.76, 95% CI: 1.06–14.96, p=0.027) were more common among the emergency cases.Oesophageal rupture was caused by perforation of an oesophageal stent (10 cases) or perforation during implantation of a percutaneous endoscopic gastrostomy tube (3 cases). Emergency oesophagectomy was carried out either as discontinuity resection (10/13) or oesophagectomy with immediate reconstruction (3/13).Compared with the elective cases, patients undergoing emergency oesophagectomy had significantly higher odds for sustaining perioperative sepsis (OR: 4.42, 95% CI: 1.23–16.45, p=0.01), acute renal failure (OR: 6.49, 95% CI: 1.57–24.15, p=0.005) and pneumonia (OR: 24.33, 95% CI: 3.52–1,046.65, p<0.0001). Furthermore, slow respiratory weaning was more common and there was a significantly higher tracheostomy rate (OR: 4.64, 95% CI: 1.14–16.98, p=0.02). Oesophageal discontinuity was eventually reversed in eight patients.Emergency oesophagectomy patients had odds that were three times higher for fatal outcome (OR: 3.59, 95% CI: 0.77–13.64, p=0.05). The overall mortality was 4/13. The remaining nine patients had a mean survival of 25.1 months (range: 5–46 months). The two-year-survival-rate was 38.5% (5/13).Conclusions
Despite the most unfavourable preconditions, the results of emergency oesophagectomy for oesophageal perforation after chemoradiotherapy are not desperate. The procedure is not only justified but life saving. 相似文献12.
Tao Li Qianyu Zhuang Xisheng Weng Lei Zhou Yanyan Bian 《International orthopaedics》2014,38(2):361-371
Purpose
So far, controversy still exists regarding the use of non-continuous or continuous wound drainage after total knee arthroplasty. The aim of this study was to assess the efficacy and safety of these two drainage techniques after total knee arthroplasty.Methods
We searched the established electronic literature databases of Pubmed, Embase, Cochrane Library, CNKI, VIP and WANFANG. Nine RCTs including a total of 761 patients involving 811 knees were eligible for this meta-analysis.Results
Our results showed that non-continuous drainage was associated with less haemoglobin loss (WMD, −0.43, 95 % CI −0.62 to −0.24; P < 0.00001) and postoperative visible blood loss (WMD, −305.09, 95 % CI −408.10 to −202.08; P < 0.00001) compared with continuous drainage. No significant difference was found between the two groups in terms of range of motion (WMD, 0.99, 95 % CI −1.01 to 2.98; P = 0.33), incidence of blood transfusion (OR, 0.63, 95 % CI 0.38 to 1.06; P = 0.80) or postoperative complications (OR, 1.09, 95 % CI 0.35 to 3.40; P = 0.89).Conclusion
The existing evidence indicates that non-continuous drainage can achieve less haemoglobin loss (especially the four- to six-hour drain clamping) and postoperative visible blood loss with no increased risk of postoperative complications compared with continuous drainage. 相似文献13.
14.
Marrigje F. Meijer Inge H. F. Reininga Alexander L. Boerboom Martin Stevens Sjoerd K. Bulstra 《International orthopaedics》2013,37(3):415-419
Purpose
Revision total knee arthroplasty (rTKA) is a complex procedure. Depending on the degree of ligament and bone damage, either primary or revision implants are used. The purpose of this study was to compare survival rates of primary implants with revision implants when used during rTKA.Methods
A retrospective comparative study was conducted between 1998 and 2009 during which 69 rTKAs were performed on 65 patients. Most common indications for revision were infection (30 %), aseptic loosening (25 %) and wear/osteolysis (25 %). During rTKA, a primary implant was used in nine knees and a revision implant in 60.Results
Survival of primary implants was 100 % at one year, 73 % [95 % confidence interval (CI) 41–100] at two years and 44 % (95 % CI 7–81) at five years. Survival of revision implants was 95 % (95 % CI 89–100) at one year, 92 % (95 % CI 84–99) at two years and 92 % (95 % CI 84–99) at five years. Primary implants had a significantly worse survival rate than revision implants when implanted during rTKA [P = 0.039 (hazard ratio = 4.56, 95 % CI 1.08–19.27)].Conclusions
Based on these results, it has to be considered whether primary implants are even an option during rTKA. 相似文献15.
May C. Tee Simon K. Chan Vy Nguyen Scott S. Strugnell Jonathan Yang Steven Jones Pari Tiwari Daniel S. Levine Sam M. Wiseman 《Canadian journal of surgery》2013,56(5):325-331
Background
Despite the different preoperative imaging modalities available for parathyroid adenoma localization, there is currently no uniform consensus on the most appropriate preoperative imaging algorithm that should be routinely followed prior to the surgical management of primary hyperparathyroidism (PHPT). We sought to determine the incremental value of adding neck ultrasonography to scintigraphy-based imaging tests.Methods
In a single institution, surgically naive patients with PHPT underwent the following localization studies before parathyroidectomy: 1) Tc-99m sestamibi imaging with single photon emission computed tomography/computed tomography (SPECT/CT) or Tc-99m sestamibi imaging with SPECT alone, or 2) ultrasonography in addition to those tests. We retrospectively collected data and performed a multivariate analysis comparing group I (single study) to group II (addition of ultrasonography) and risk of bilateral (BNE) compared with unilateral (UNE) neck exploration.Results
Our study included 208 patients. Group II had 0.45 times the odds of BNE versus UNE compared with group I (unadjusted odds ratio [OR] 0.45, 95% confidence interval [CI] 0.25–0.81, p = 0.008). When adjusting for patient age, sex, preoperative calcium level, use of intraoperative PTH monitoring, preoperative PTH level, adenoma size, and number of abnormal parathyroid glands, Group II had 0.48 times the odds of BNE versus UNE compared with group I (adjusted OR 0.48, 95% CI 0.23–1.03, p = 0.06). In a subgroup analysis, only the addition of ultrasonography to SPECT decreased the risk of undergoing BNE compared with SPECT alone (unadjusted OR 0.40, 95% CI 0.19–0.84, p = 0.015; adjusted OR 0.38, 95% CI 0.15–0.96, p = 0.043).Conclusion
The addition of ultrasonography to SPECT, but not to SPECT/CT, has incremental value in decreasing the extent of surgery during parathyroidectomy, even after adjusting for multiple confounding factors. 相似文献16.
Yang Liu Xueqiang Tao Pei Wang Zheng Zhang Wenlong Zhang Quan Qi 《International orthopaedics》2014,38(8):1691-1696
Purpose
Unipolar and bipolar hemiarthroplasty (HA) are used to treat displaced femoral-neck fractures. However, which type is best for treating displaced femoral-neck fractures in elderly patients remains a subject for debate. Our aim was to review randomised controlled trials to establish which type provides superior clinical outcome for this patient population.Methods
We searched PubMed, Embase and Cochrane Register of Controlled Trials databases and Web of Science for randomised controlled trials (RCTs) comparing unipolar with bipolar HA to treat femoral-neck fracture in the elderly. Risk ratios (RRs) and mean differences (MDs) from each trial were pooled using random-effects or fixed-effects models depending on study heterogeneity. Analysis was performed using RevMan5.2 from the Cochrane Collaboration.Results
A total of 1,100 patients from nine studies were assessed in this meta-analysis. Results showed no significant differences in function score [MD = −0.14, 95% confidence interval (CI) −2.42–2.13], mortality (RR = 0.97, 95% CI 0.65–1.46), dislocation (RR = 1.33, 95 % CI 0.53–3.34), deep infection (RR = 0.79, 95 % CI 0.35–1.79), acetabular erosion (RR = 1.99, 95 % CI 0.61–6.52), operating time (MD = 2.14, 95 % CI −9.85 to14.14), blood loss (MD = 13.40, 95 % CI −49.60 to 76.39) and length of hospital stay (MD = 0.12, 95 % CI −0.49to0.73) between unipolar and bipolar HA.Conclusions
Unipolar and bipolar HA achieved similar clinical outcomes in patients with displaced femoral-neck fractures. 相似文献17.
Raj Satkunasivam Melise Keays Kenneth T. Pace 《Canadian Urological Association journal》2011,5(5):324-327
Background:
We describe the practice variability of CUA (Canadian Urological Association) members and factors which predict these patterns for common stone scenarios.Methods:
We asked 308 English- and 52 French-speaking CUA members to complete online surveys in their respective languages. We collected demographic information on fellowship training, shock wave lithotripsy (SWL) access, academic setting and whether they are at a hospital with regionalized surgical services. Respondents indicated their actual as well as ideal treatment for scenarios of renal, proximal and distal ureteric calculi.Results:
In total, 131 urologists responded (36% response rate), all of whom treated urolithiasis. Of this number, 17% had endourology fellowship training, 76% had access to SWL, 42% were at an academic institution and 66% were at institutions with regionalized surgical services. Actual and ideal treatment modalities selected for symptomatic, distal and proximal ureteric stones (4, 8, 14 mm) were consistent with published guidelines. There were discrepancies between the use of ureteroscopy and SWL in actual versus ideal scenarios. Actual and ideal practices were congruent for proximal ureteric stones and asymptomatic renal calculi. In multivariate analysis, respondents were less likely to perform ureteroscopy on proximal 4- and 8-mm stones if they were at a hospital with regionalized surgical services (OR: 0.097; 95% CI: 0.01–0.76, p = 0.03 and OR: 0.330; 95% CI: 0.13–0.83, p = 0.02).Interpretation:
There is clinical variability in the management of urolithiasis in Canada; however, management approaches fall within published guidelines. Type of hospital and access to operating room resources may affect treatment modality selection. 相似文献18.
Dan Wu Ying-Ying Guo Nan-Nan Xu Shuai Zhao Lin-Xin Hou Ting Jiao Ning Zhang 《BMC musculoskeletal disorders》2015,16(1)
Background
We performed a meta-analysis to evaluate the effect of anti–tumor necrosis factor (TNF) therapy on the frequency of extra–articular manifestations (EAMs) in patients with ankylosing spondylitis (AS).Methods
We searched with the terms ‘ankylosing spondylitis’, ‘infliximab’, ‘etanercept’, ‘adalimumab’, ‘golimumab’, ‘certolizumab’, ‘TNF inhibitor/blocker/antagonists’ or ‘anti-TNF’ on MEDLINE, EMBASE and Cochrane Library for randomized controlled trials (RCTs) of ≥12 weeks with parallel or crossover design of TNF inhibitor versus placebo to treat uveitis, inflammatory bowel disease (IBD) and/or psoriasis of AS, published before February 2014.Results
We found 8 RCTs that fit our criteria. Anti–TNF therapy was associated with less uveitis than placebo in patients with AS (OR: 0.35, 95% CI: 0.15–0.81, P = 0.01). Subgroup analysis showed receptor fusion proteins were more efficacious for uveitis than placebo (OR: 0.30, 95% CI: 0.09–0.94, P = 0.04), but monoclonal antibodies were not (OR: 0.43, 95% CI: 0.12–1.49, P = 0.18). Anti–TNF therapy and placebo group did not significantly differ in treating IBD in AS patients (OR: 0.75, 95% CI: 0.25–2.29, P = 0.61). In subgroup analysis, neither monoclonal antibodies (OR: 0.45, 95% CI: 0.10–1.92, P = 0.28) nor receptor fusion proteins (OR: 1.52, 95% CI: 0.25–9.25, P = 0.65) significantly differed from placebo in treating IBD. We found no suitable reports on psoriasis.Conclusions
Anti–TNF therapy was preventive for flares or new onset of uveitis in AS patients, and might be an alternative for these patients. However, monoclonal anti–TNF antibodies and TNF receptor fusion proteins were not efficacious for IBD in AS patients. 相似文献19.
Purpose
The majority of patients experience a significant improvement in quality of life and function after total hip replacement (THR). It has recently been shown that age and good pre-operative function are the best predictors of postoperative function. When patients fail to achieve a satisfactory outcome, a cause is often identified. Where there is no identifiable cause, advice, follow-up and management is not clear. The aim of this study was to determine the long-term outcome of patients who had early poor function, but no identifiable cause.Methods
From a regional database, we identified 1,564 patients who underwent unilateral THR between 1998 and 2004 and who were without complication or subsequent bilateral procedure at six months. These patients were divided into two groups according to their Harris hip score (HHS) at this stage: group A consisted of 270 patients with a ‘poor’ result (HHS less than 70). Group B consisted of 1,294 patients with a ‘good’ or ‘excellent’ result (HHS 70 or above). The patients were reviewed at five years. One hundred and ten patients from group A and 980 from group B completed five-year follow-up without further identifiable complication.Results
Those with poor or fair function at six months were at an increased risk of developing an identified complication by five years including dislocation (OR 5.7, 95 % CI 1.8–18.2), deep infection (OR 9.8, 95%CI 2.9–37.7) and death (OR 1.6, 95 % CI 1.1–2.3). There was a greater rate of revision in group A versus group B (OR 5.7, 95 % CI 2.9–11). The overall function measured by the Harris hip score significantly improved in group A, but never reached that of those with good or excellent function at six months (HHS 76.2 versus 90.3, P < 0.001).Conclusions
Patients with poor function at six months, but no obvious cause, are at higher risk of developing complications by five years. This group may benefit from more regular arthroplasty review and intervention. 相似文献20.
Marko Simunovic Eddy Rempel Marc-Erick Thériault Nancy N. Baxter Beth A. Virnig Neal J. Meropol Mark N. Levine 《Canadian journal of surgery》2009,52(4):E79-E86