共查询到20条相似文献，搜索用时 15 毫秒
1.
Omar A. Behery Sean M. Kearns Justin M. Rabinowitz Brett R. Levine 《The Journal of arthroplasty》2017,32(5):1510-1515
Background
The ideal fixation for modern tibial components in total knee arthroplasty (TKA) remains controversial with uncertainty on whether cementless implants can yield equivalent outcomes to cemented fixation in early follow-up.Methods
A series of 70 consecutive cases with reverse hybrid cementless fixation were matched to 70 cemented cases from 2008 to 2015 based on implant design and patient demographics.Results
Cementless TKA demonstrated greater aseptic loosening (7 vs 0, P = .013) and revision surgery (10 vs 0, P = .001) than cemented fixation within 5 years of follow-up, but with no clinically significant differences in outcome scores.Conclusion
It remains unclear whether early aseptic loosening in cementless TKA can be reduced with enhanced adjunct fixation and what proportion of early failure justifies the potential lifelong fixation through biologic ingrowth of cementless tibial components. 相似文献2.
Background
Pancreatic fistula (PF) is the major cause for morbidity and mortality following pancreaticoduodenectomy. The primary aim of this study was to compare the occurrence rate of postoperative PF between isolated Roux-en-Y reconstruction (RYR) and conventional reconstruction (CR) after pancreaticoduodenectomy.Methods
Data of 43 patients who underwent RYC were compared with those of a pair-matched equal number of patients undergoing CR. We also performed a meta-analysis of comparative studies of the two procedures.Results
The case-matched analysis showed no significant difference in PF occurrence between RYR and CR groups (23.3% versus 25.6%; P = 0.80). Meta-analysis of 1498 patients further confirmed this finding, showing a pooled odds ratio of 1.14 (95% confidence intervals, 0.82–1.58; P = 0.43).Conclusion
The use of RYR for pancreaticojejunostomy does not seem to decrease the occurrence rate of postoperative PF in patients undergoing pancreaticoduodenectomy. 相似文献3.
Richard J. Hanly Salman K. Marvi Sarah L. Whitehouse Ross W. Crawford 《The Journal of arthroplasty》2017,32(9):2712-2716
Background
It is increasingly apparent that the effect of obesity in arthroplasty is joint-specific. This study evaluates the effects of morbid obesity on primary total knee arthroplasty by comparing short-term outcomes between a morbidly obese (body mass index ≥40 kg/m2) and a normal weight (body mass index 18.5-<25 kg/m2) cohort at our institution between January 2003 and December 2010.Methods
One hundred seventeen morbidly obese patients were compared with 94 normal weight patients. Operative time, length of stay, complications, 30-day readmission, and readmission length were compared.Results
Morbid obesity conveyed no significant increase in 30-day readmission. Operative time was increased at 100 minutes in the morbidly obese group, compared with 90.5 minutes (P = .026).Conclusion
Morbid obesity conveyed no increased risk of length of stay or readmission in this cohort. 相似文献4.
Christopher V. Thompson David N. Naumann Jodie L. Fellows Douglas M. Bowley Nigel Suggett 《The surgeon》2017,15(3):123-130
Background
Experiences of actual/threatened death or serious injury to patients are commonplace in surgery. Pathological symptoms following stress may lead to Acute Stress Reaction (ASR) and Post-Traumatic Stress Disorder (PTSD). PTSD symptoms of insomnia, anger, poor concentration, hyper-vigilance and exaggerated startle have implications for patient safety. The current study investigates the prevalence of occult, untreated psychological morbidity amongst surgical trainees.Methods
A web-based survey of UK surgical trainees based upon the Impact of Events Scale-Revised (IES-R) was distributed using social media platforms and email. A score of ≥33 was indicative of ASR or PTSD (the former lasting <1 month, the latter >1 month). Additional questions concerned chronicity of symptoms, mentorship, team-working and access to support.Results
For 167 returned surveys the mean age was 32.7 (SD 3.6) years; 102/167 (61%) were male. Mean years in training were 6.1 (SD 3.6). Median IES-R score was 14 (IQR 7–23.5). Of 144 respondents who answered about stress symptoms, 23/144 (16%) had IES-R score ≥ 33; 6 of these had symptoms < 1 month (suggesting ASR); 17 had symptoms lasting >1 month (suggesting PTSD). Those with IES-R ≥ 33 group were more likely to have repeated years of training, and have witnessed severe pain, traumatic injury, and acute haemorrhage. Seven with score ≥ 33 had sought support.Conclusion
Occult psychological morbidity amongst surgical trainees may be higher than in the general population. Recognition and management of this risk is important for the mental health of trainees and the safety of patients. 相似文献5.
Masashi Uehara Jun Takahashi Shugo Kuraishi Masayuki Shimizu Shota Ikegami Toshimasa Futatsugi Hiroki Oba Hiroyuki Kato 《Journal of orthopaedic science》2017,22(2):218-223
Study design
A retrospective single-center and single-surgeon study.Objectives
This study investigated the clinical and radiological results of skip pedicle screw fixation for adolescent idiopathic scoliosis (AIS).Summary of background data
At present, the generally used technique for pedicle screw fixation for the surgical correction of AIS entails inserting a pedicle screw into every segment on the corrective side and into every or every other segment on the supportive side. To reduce operation time, blood loss, and cost, we developed skip pedicle screw fixation to achieve correction of AIS using fewer pedicle screws.Methods
We evaluated 62 consecutive patients who had undergone computer-assisted skip pedicle screw fixation from August 2005 to June 2014. All patients were followed up for at least two years. We investigated the clinical results of skip pedicle screw fixation for AIS.Results
The mean number of fused vertebrae was 10.3 ± 2.0, the mean surgical time was 242 ± 78 min, and the mean blood loss volume was 1060 ± 688 ml. The mean Cobb angle of main thoracic (MT) curve two years after surgery improved significantly compared with that before surgery (p < 0.01). The mean correction rate of MT curve immediately after surgery was 62.4 ± 12.4% and correction loss of MT curve at two years after surgery was 1.9 ± 5.8°. The SRS-22 subtotal score two years after surgery improved significantly compared to that before surgery (p < 0.01). Although no patients experienced major complications, eight (12.9%) encountered minor complications (two [3.2%] had massive blood loss [>3000 ml], three [4.8%] had a broken screw, one [1.6%] had a set-screw that dropped out, one [1.6%] experienced deep vein thrombosis, one [1.6%] experienced acute renal failure, and one [1.6%] experienced intercostal neuralgia). Revision surgery was not performed.Conclusions
Subjects with AIS who underwent skip pedicle screw fixation had significantly improved clinical and radiological parameters at two years after surgery, indicating that skip pedicle screw fixation could be used to successfully treat AIS.Level of evidence
Level 4 相似文献6.
W.M. Bennett E.L. Simonich A.M. Garre K.M. McEvoy M.A. Farinola T.D. Batiuk 《Transplantation proceedings》2017,49(8):1779-1782
Introduction
Between January 2013 and September 2015, 135 consecutive renal transplant patients were screened prospectively with ultrasound for renal cell carcinoma (RCC).Results
Eighteen ultrasound abnormalities were identified with 4 solid lesions detected. Fifty-six other patients were screened retrospectively by referring nephrology groups, with 6 additional malignancies found.Conclusion
As a result of our data, we recommend and have instituted annual ultrasound screening of native kidneys in all renal transplant patients. 相似文献7.
Jérôme Murgier J. Cailliez M. Wargny P. Chiron E. Cavaignac J.M. Laffosse 《The Journal of arthroplasty》2017,32(9):2788-2791
Background
The goal of this study was to assess the efficacy of cryotherapy with dynamic intermittent compression (CDIC) in relieving postoperative pain, decreasing blood loss, and improving functional scores after revision total knee arthroplasty (rTKA).Methods
We conducted a prospective case-control study (level of evidence: I) to evaluate the efficacy of CDIC on postoperative bleeding, pain, and functional outcomes after rTKA. Forty-three cases were included at a single institution and divided in 2 groups: a control group without CDIC (n = 19) and an experimental group with CDIC (n = 24). Bleeding was evaluated by calculating total blood loss, pain at rest was evaluated with a visual analog scale on postoperative day 3, and function was assessed using the Oxford score at 6 months postoperatively. The comparative analysis was performed using the Fisher exact test.Results
The CDIC group had significantly lower total blood loss (260 vs 465 mL; P < .05), significantly less pain on day 3 (1 vs 3; P < .05), and a significantly higher functional score (42 vs 40; P < .05) than the control group.Conclusion
This is the first report dealing with the use of CDIC after rTKA. According to our results, it improves the recovery of patients who underwent rTKA; thus, it should be integrated into our daily practice. 相似文献8.
Nasibeh Vatankhah Younes Jahangiri Gregory J. Landry Robert B. McLafferty Nabil J. Alkayed Gregory L. Moneta Amir F. Azarbal 《Journal of vascular surgery》2017,65(2):478-483
Objective
The neutrophil-to-lymphocyte ratio (NLR) has been used as a surrogate marker of systemic inflammation. We sought to investigate the association between NLR and wound healing in diabetic wounds.Methods
The outcomes of 120 diabetic foot ulcers in 101 patients referred from August 2011 to December 2014 were examined retrospectively. Demographic, patient-specific, and wound-specific variables as well as NLR at baseline visit were assessed. Outcomes were classified as ulcer healing, minor amputation, major amputation, and chronic ulcer.Results
The subjects' mean age was 59.4 ± 13.0 years, and 67 (66%) were male. Final outcome was complete healing in 24 ulcers (20%), minor amputation in 58 (48%) and major amputation in 16 (13%), and 22 chronic ulcers (18%) at the last follow-up (median follow-up time, 6.8 months). In multivariate analysis, higher NLR (odds ratio, 13.61; P = .01) was associated with higher odds of nonhealing.Conclusions
NLR can predict odds of complete healing in diabetic foot ulcers independent of wound infection and other factors. 相似文献9.
H.M. Ko S.H. Joo J.H. Jo W.S. Park W.Y. Jung J.H. Shin H.J. Ahn 《Transplantation proceedings》2017,49(5):1170-1174
Background
Hepatic ischemia-reperfusion injury (IRI) is an important determinant of the outcome of hepatic surgery, including re-section and transplantation. Previous studies have shown that nitric oxide (NO) has a protective effect against IRI. Therefore, many studies have examined methods for supplying NO. In this study, we investigated the effect of NO-releasing nanofibers on hepatic IRI in a rat model.Methods
Male Sprague-Dawley rats were divided into 4 groups: control, IRI only (n = 3); group 1, hepatic IRI and liver-wrapping with nanofiber lacking NO (n = 4); group 2, hepatic IRI and liver-wrapping with NO rapid-releasing nanofiber (n = 4); and group 3, hepatic IRI and liver-wrapping with NO slow-releasing nanofiber (n = 5).Results
The levels of aspartate aminotransferase and alanine aminotransferase were not significantly different between groups. On the basis of Western blots, Bax/β-actin levels were significantly lower in group 2 than in group 3 (P < .01). Cleaved Caspase-3/β-actin levels were significantly lower in group 2 than in the control, group 1, and group 3 (P < .05, .01, and .01, respectively). However, there were no significant differences in Bcl-2/β-actin between groups.Conclusions
The liver-wrapping NO rapid-releasing nanofiber downregulated cleaved Caspase-3 and Bax expression. It has a protective effect by reducing apoptosis in hepatic IRI in rats. 相似文献10.
Western Vascular Society guidelines for transfer of patients with ruptured abdominal aortic aneurysm
Matthew W. Mell Benjamin W. Starnes Larry W. Kraiss Peter A. Schneider William C. Pevec 《Journal of vascular surgery》2017,65(3):603-608
Introduction
When a patient with ruptured abdominal aortic aneurysm (rAAA) presents at a facility ill-equipped to provide care, transfer may provide the best chance for survival. Large distances and long travel times provide challenging barriers to prompt and appropriate care in the western United States.Methods
The Western Vascular Society (WVS) adopted a set of guidelines in considering transfer of a patient with an rAAA using published literature, membership survey and input, and existing recommendations. This article reports the guidelines and describes the process and rationale behind their development.Results
Fifteen guidelines for transfer and care of rAAAs were endorsed by the WVS.Conclusions
When local care cannot be provided, transfer guidelines may standardize care for rAAAs and may be applicable across may practice settings. 相似文献11.
Molly A. McGraw-Tatum Michael T. Groover Nicole E. George John S. Urse Victor Heh 《The Journal of arthroplasty》2017,32(7):2181-2185
Background
Increasing demand for total hip arthroplasty (THA) in a climate of increasing focus on clinical outcomes, patient satisfaction, and cost has created a need for better acute postoperative pain control for patients. An ideal pain control method would have few side effects, decreased opioid consumption, improved pain control, early ambulation, and decreased hospital length of stay (LOS).Methods
We performed a prospective randomized, controlled study involving 79 patients undergoing elective THA between June 2015 and February 2016. Forty patients received liposomal bupivacaine and 39 patients received a fascia iliaca compartment block (FICB). In addition, the medical records of 28 patients who underwent elective THA between May 2015 and December 2015 were retrospectively examined. The primary outcome was visual analog scale pain scores and the secondary outcomes were LOS and total opioid consumption. SPSS, version 22, was used to run 1-way analysis of variance with contrast and Mood's median test on the data.Results
There were statistically significant decreases in pain intensity (P = .019) and LOS (P = .041) in both the liposomal bupivacaine group and the FICB group compared with those in the retrospective control group. In addition, only the FICB group showed statistically significant decreased total opioid consumption compared with that in the retrospective group (P = .028).Conclusion
Patients undergoing elective THA have decreased overall pain intensity and a shorter LOS with multimodal pain management regimen that includes either liposomal bupivacaine or FICB. Patients who received FICB required less overall total opioids than the control group. 相似文献12.
Monther A. Gharaibeh Gandhi N. Solayar Ian A. Harris Darren B. Chen Samuel J. MacDessi 《The Journal of arthroplasty》2017,32(3):777-782
Background
Accelerometer-based, portable navigation devices have been introduced as a less invasive and simpler technique to perform navigated surgical implantation of knee prostheses. They have been postulated to have better accuracy than conventional instruments in restoration of alignment in total knee arthroplasty.Methods
A total of 190 patients were enrolled in this prospective, randomized controlled trial and underwent total knee arthroplasty using either the KneeAlign or conventional guides. Multiplanar alignment was evaluated with a CT imaging protocol.Results
A total of 86.5% of portable navigation device and 82.2% of conventional group had a postoperative hip–knee angle within 3° of neutral alignment (P = .54). There was no significant difference between the 2 groups for component coronal and sagittal plane alignment. Portable navigation device did not significantly increase the time to perform the surgery.Conclusion
Portable navigation device demonstrates accurate restoration of alignment; however, there was no statistically significant difference when compared with conventional guides. 相似文献13.
Matthew P. Abdel Brian P. Chalmers Robert T. Trousdale Arlen D. Hanssen Mark W. Pagnano 《The Journal of arthroplasty》2017,32(9):2744-2747
Background
A previous randomized clinical trial at our institution demonstrated slower recovery of 35 2-incision total hip arthroplasties (THAs) when compared with 36 mini-posterior THAs at 2 years. The primary aim of the present study was to report concise 10-year follow-up results.Methods
We retrospectively reviewed the 71 patients in the previous randomized clinical trial, comparing clinical outcomes, revisions, reoperations, and implant survivorship between the 2-incision and the mini-posterior THAs.Results
At the most recent follow-up, the mean Harris hip score was 85 in the 2-incision group and 87 in the mini-posterior group (P = .4). There were 4 revisions and 2 reoperations (16%) in the 2-incision group vs 1 revision and 3 reoperations (11%) in the mini-posterior group (P = .5). Ten-year survivorship free of aseptic revision or reoperation was 77% in the 2-incision group vs 90% in the mini-posterior group (P = .15).Conclusion
There were no improvements in early or midterm clinical outcomes with the 2-incision technique. However, there was a clinical trend toward a higher rate of aseptic revisions in the 2-incision THA group. 相似文献14.
Hong-Geun Jung Dong-Oh Lee Sang-Hun Lee Joon-Sang Eom 《Journal of orthopaedic science》2017,22(3):468-473
Background
Moderate to severe midfoot–forefoot varus deformities are commonly found in several conditions. However, few techniques are available to correct these deformities. So, we evaluated the clinical and radiological outcomes of patients who underwent midfoot derotational osteotomy to achieve plantigrade foot.Methods
From 2006 to 2014, 6 patients (7 feet) underwent midfoot derotational osteotomy. A visual analog scale (VAS) pain and the American Orthopedic Foot & Ankle Society (AOFAS) functional score were evaluated. Radiographic parameters, including tibiocalcaneal angle (TCA) and navicular height (NH), were assessed.Results
The mean patient age at surgery was 48.0 years (37–58). From before the operation to the final follow-up, the mean VAS score decreased from 6.5 (2–9) to 1.3 (0–4) and the mean AOFAS score improved from 42.7 (34–58) to 77 (68–87). All patients were satisfied with outcomes. The mean TCA significantly improved from 33.8° (9.9–66.7) to 12.7 (5.1–27.6) (p = 0.018)and the mean NH decreased from 46.7 mm (32.8–67) to42.6 (30.1–60.8) (p = 0.018).Conclusion
Severe midfoot–forefoot varus deformities can be efficiently corrected by midfoot derotational osteotomy resulting in favorable clinical and radiological outcomes and high patient satisfaction.Level of evidence
IV, case series. 相似文献15.
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16.
Pouya Alijanipour Timothy L. Tan Christopher N. Matthews Jessica R. Viola James J. Purtill Richard H. Rothman Javad Parvizi Matthew S. Austin 《The Journal of arthroplasty》2017,32(2):628-634
Background
Periarticular injection of liposomal bupivacaine has been adopted as part of multimodal pain management after total knee arthroplasty (TKA).Methods
In this prospective, randomized clinical trial, we enrolled 162 patients undergoing primary TKA in a single institution between January 2014 and May 2015. Eighty-seven patients were randomized to liposomal bupivacaine (experimental group), and 75 patients were randomized to free bupivacaine (control group). All patients received spinal anesthesia and otherwise identical surgical approaches, pain management, and rehabilitation protocols. Outcomes evaluated include the patient-reported visual analog pain scores, narcotic consumption, and narcotic-related side effects (Brief Pain Inventory) within 96 hours after surgery as well as functional outcomes using the Knee Society Score and the Short-Form 12 measured preoperatively and at 4-6 weeks after surgery.Results
There were no statistically significant differences between the groups in terms of postoperative daily pain scores, narcotic consumption (by-day and overall), or narcotic-related side effects. There were no statistically significant differences between the groups in terms of surgical (P = .76) and medical complications or length of hospital stay (P = .35). There were no statistically significant differences in satisfaction between the groups (P = .56) or between the groups in postoperative Knee Society Score (P = .53) and the Short-Form 12 at 4-6 weeks (P = .82, P = .66).Conclusion
As part of multimodal pain management protocol, periarticular injection of liposomal bupivacaine compared with bupivacaine HCl did not result in any clinically or statistically significant improvement of the measured outcomes following TKA. 相似文献17.
Christian Skovgaard Nielsen Kirill Gromov Øivind Jans Anders Troelsen Henrik Husted 《The Journal of arthroplasty》2017,32(1):177-182
Background
Postoperative anemia is frequent after revision of total knee arthroplasty (TKA) with reported transfusion rates up to 83%. Despite increased efforts of reducing blood loss and enhancing fast recovery within the fast-track setup, a considerable transfusion rate is still evident. The aim of this study was therefore to evaluate the effect of a bipolar sealer on blood loss and transfusion in revision TKA.Methods
In this single-center prospective cohort study with retrospective controls, 51 patients were enrolled in a fast-track setup for revision TKA without the use of a tourniquet. Twenty-five prospectively enrolled patients received treatment with both a bipolar sealer and electrocautery, whereas 26 patients had received treatment with a conventional electrocautery only in the retrospective group.Results
No significant differences were found neither for calculated blood loss, with 1397 (standard deviation, ± 452) mL in the bipolar sealer group vs 1452 (SD, ± 530) mL in the control group (P = .66), nor for blood transfusion rates of 53% and 46% (P = .89), respectively. Four controls were readmitted within 90 days follow-up.Conclusion
The use of a bipolar sealer in a TKA revision setting without the use of a tourniquet did not reduce blood loss or blood transfusion rates. 相似文献18.
Inari Laaksonen Gabrielle S. Donahue Rami Madanat Keijo T. Makela Henrik Malchau 《The Journal of arthroplasty》2017,32(1):341-346
Background
The aim of this review was to synthesize the main findings of clinical studies that have evaluated outcomes of the articular surface replacement (ASR) Hip System.Methods
We performed a systematic literature search to identify all articles published between January 2008 and June 2015 that included ASR hip resurfacing arthroplasty (ASR HRA) or ASR total hip arthroplasty (ASR XL THA) outcomes according to the PRISMA statement.Results
A total of 56 studies were assessed. The prevalence of adverse local tissue reactions (ALTRs) and revision rates were found to be high. ALTR prevalence varied from 12.5% to 69% (mean, 33.5%). Mean revision rate for any reason at 4-year to 7-year follow-up was 13.8% (range, 5.6%-31%) for ASR HRA and 14.5% (range, 0%-37%) for ASR XL THA. Femoral head size <53 mm was found to correlate with higher blood metal ion levels. Femoral head size >44 mm was not associated with higher ALTR prevalence or revision rates in ASR XL THA. High blood metal ion levels (>7 μg/L Co, >7 μg/L Cr) were associated with higher failure rates and bearing-related complications. The role of cup positioning was found to be controversial.Conclusion
ALTR prevalence and failure rates were high. High blood metal ion levels were a risk factor for ALTR and failure. Surprisingly, the role of cup positioning and large femoral head size in ASR XL THA were controversial. These findings should be considered in the clinical follow-up and risk stratification of patients with the ASR Hip System. 相似文献19.
Yohei Yukizawa Yutaka Inaba Naomi Kobayashi Hyonmin Choe So Kubota Tomoyuki Saito 《The Journal of arthroplasty》2017,32(7):2176-2180
Background
Bone mineral density (BMD) loss around femoral implants, particularly in the proximal femur, is a common outcome after total hip arthroplasty. Previous studies reported the prevention of postsurgical decrease in BMD with the use of osteoporosis drug therapy. This randomized study evaluated the efficacy of alendronate and alfacalcidol for preserving BMD over a long-term follow-up.Methods
Sixty consecutive patients with hip osteoarthritis who had undergone primary cementless total hip arthroplasty were randomly assigned to an alendronate (n = 20), alfacalcidol (n = 18), or control (n = 22) group. Periprosthetic BMD was measured using dual-energy X-ray absorptiometry at 1 week, 1 year, and the current follow-up (minimum 9 years after surgery). Changes in BMD are reported as mean percentages relative to the values at 1 week (baseline reference).Results
All groups showed a significant decrease in the BMD of the calcar at the current follow-up compared to the values at both 1 week and 1 year postoperatively (P < .001). The BMD values were significantly higher in the alendronate group than in the alfacalcidol and control groups (P < .05). The BMD values at the current follow-up were 76% ± 30% (alendronate group), 64% ± 22% (alfacalcidol group), and 59% ± 22% (control group) of the baseline values.Conclusion
Our findings demonstrate the efficacy of early administration of alendronate for the prevention of bone loss in the calcar region. 相似文献20.