共查询到20条相似文献，搜索用时 15 毫秒
1.
Jie Wang Yandong Lu Yujie Cui Xuelei Wei Jie Sun 《Acta orthopaedica et traumatologica turcica》2018,52(5):334-342
Objective
The aim of this meta-analysis of randomized controlled trials (RCT) and retrospective cohort studies (CS) regarding the use of volar locking plate (VLP) and external fixation (EF) in distal radius fractures was to determine whether there was any evidence that one treatment was superior to the other.Methods
The meta-analysis followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Electrical databases (PubMed, EMBASE and the Cochrane library) were retrieved to find RCTs and CSs met the eligibility criteria. Two reviewers screened the studies, extracted the data and evaluated the methodological quality, and performed data analysis with RevMan 5.1. The publication bias was test by Stata 14.0. The Begg's and Egger's test were performed by Stata 14.0. The quality of evidence was graded according to the criteria of GRADE. We ultimately included ten RCTs and eleven CSs.Results
A total of 1590 subjects were reported. Publication bias was detected by funnel plot in RCTs. VLP could provide better results such as DASH scores (RCT: MD = ?6.12, 95%CI = ?12.07–0.17; CS: MD = ?6.43, 95%CI = ?12.53–0.3), ulnar variance (RCT: MD = ?0.81, 95%CI = ?1.25–0.37) and infection rate (RCT: RR = 0.25, 95%CI = 0.10–0.65; CS: RR = 0.15, 95%CI = 0.06–0.40). There were no significant differences for G-W scores, VAS and grip strength between the VLP group and EF group. There was significantly greater loss of volar tilt (P = 0.01) and radial inclination (P = 0.02) in patients receiving EF, basing on the CSs.Conclusions
VLP could provide better results, such as DASH scores, ulnar variance, volar tilt, radial inclination and infection rate. The use of VLP appear to be associated with better results of ROM (flexion, pronation, supination and radial deviation), radiographic parameters (volar tilt and radial inclination) and lower total complication rate and CRPS rate in CSs.Level of evidence
Level 1, Therapeutic study. 相似文献2.
Chia-Chi Tsai Po-Sheng Yang Chien-Liang Liu Chih-Jen Wu Yi-Chiung Hsu Shih-Ping Cheng 《American journal of surgery》2018,215(1):179-185
Background
Topical antibiotics have been shown to reduce exit-site infection and peritonitis. The aim of this study was to compare infection rates between mupirocin and gentamicin.Methods
Multiple comprehensive databases were searched systematically to include relevant randomized controlled trials and observational studies. Pooled risk ratios (RRs) and 95% confidence intervals were calculated for the incidences of exit-site infection and peritonitis.Results
Seven studies (mupirocin group n = 458, gentamicin group n = 448) were analyzed for exit-site infection. The risk of gram-positive exit-site infection was similar between the groups. Gram-negative exit-site infection rate was higher in the mupirocin group (RR = 2.125, P = 0.037). Six studies were assessed the peritonitis risk. There was no difference in the gram-positive and -negative peritonitis rate.Conclusions
Topical use of gentamicin is associated with fewer exit-site infections caused by gram-negative organisms. Gentamicin has comparable efficacy to mupirocin for peritonitis and gram-positive exit-site infection. 相似文献3.
D.P. Joyce D. Murphy A.J. Lowery C. Curran K. Barry C. Malone R. McLaughlin M.J. Kerin 《The surgeon》2017,15(5):272-277
Introduction
Triple-negative breast cancers (TNBC) are associated with a poor prognosis owing to an aggressive phenotype. We aimed to carry out a prospective study comparing management strategies and response to therapy in TNBC and non-TNBC patients.Methods
Data were obtained from a prospectively maintained database of patients treated for breast cancer.Results
A total of 142 TNBC and 142 age-, stage- and NPI-matched non-TNBC patients were treated. The difference in overall survival between the 2 groups was statistically significant (77% of TNBC patients alive at a mean follow-up of 32 months, versus 92% of non-TNBC patients at a mean follow-up of 38 months, P = 0.0 Log rank test). This survival difference was found to be independent of NPI (P = 0.0 Log rank test). Locoregional recurrence rates were similar between TNBC patients who were treated with wide local excision versus mastectomy (P = 0.449 Log rank test). A significant difference in survival was noted between TNBC patients who responded differentially to neoadjuvant chemotherapy (P = 0.035 Log rank test).Conclusion
Patients with TNBC have adverse outcomes despite aggressive treatment. The development of effective targeted therapies is essential for this breast cancer subtype. 相似文献4.
Dong-Yeong Lee Young-Jin Park Hyun-Jung Kim Hyeong-Sik Ahn Sun-Chul Hwang Dong-Hee Kim 《Acta orthopaedica et traumatologica turcica》2018,52(2):101-108
Introduction
The aim of this study is to evaluate whether early (<8 h) surgical decompression is better in improving neurologic outcomes than late (≥8 h) surgical decompression for traumatic spinal cord injury (tSCI).Methods
The various electronic databases were used to detect relevant articles published up until May 2016 that compared the outcomes of early versus late surgery for tSCI. Data searching, extraction, analysis, and quality assessment were performed according to Cochrane Collaboration guidelines. The results are presented as relative ratio (RR) for binary outcomes and mean difference (MD) for continuous outcomes with 95% confidence intervals (CIs).Results
Seven studies were finally included in this meta-analysis. There were significant differences between the 2 groups in neurologic improvement (MD = 0.54, 95% CI = ?18.52 to ?7.02, P < 0.0001) and length of hospital stay (MD = ?12.77, 95% CI = 0.34–0.74, P < 0.00001). However, no significant differences were found between the 2 groups in perioperative complications (OR = 0.95, 95% CI = 0.35–2.61, P = 0.92).Conclusions
Early surgical decompression within 8 h after tSCI was beneficial in terms of neurologic improvement compared with late surgery. Early surgical decompression (within 8 h) is recommended for patients with tSCI.Level of evidence
Level III, therapeutic study. 相似文献5.
N.R. Bhatt G. Sheridan M. Connolly S. Kelly A. Gillis K.C. Conlon S. Lane E. Shanahan P.F. Ridgway 《The surgeon》2017,15(3):139-146
Introduction
Pulmonary complications are a significant cause of morbidity, mortality and increased hospital stay following complex abdominal surgery. We investigated whether postoperative early aerobic activity with a pedal exerciser reduced respiratory morbidity and length of stay and improved pulmonary function.Methods
A prospective case-control study on 30 cases and 30 case matched controls aged 18 years or more who underwent major surgery was conducted. Controls were case-mix matched prospectively from a similar general surgical service not utilising postoperative exercising. Thirty consecutive cases were started on a twice-daily aerobic exercise program with pedal exerciser post-operatively day 2 or from when sitting independently. Primary outcome measures were respiratory tract infection (RTI), deep vein thrombosis (DVT) or pulmonary embolus (PE). Secondary outcome measure was subjective breathlessness and Length of Stay (LOS) postoperatively.Results
The rate of RTI was only 16.6% in the exercise group and 43.3% in the control group (P = 0.024). None of the cases or controls suffered from a DVT or PE. Median postoperative length of stay in the control group was 11 ± 7.5 days whereas in the cases it was 8.5 ± 5.00 days (P = 0.049). The Borg subjective breathlessness score in the cases group showed a decline in the subjective breathlessness on postoperative day 4 (P = 0.002).Conclusions
Early aerobic activity with a pedal exerciser halves the rate of postoperative RTI and postoperative hospital stay after complex abdominal surgery. Subjective breathlessness was also reduced with the use of pedal exerciser, signifying potential to improve exercise endurance in the postoperative patient. 相似文献6.
Background
Limited data describe risks and perioperative resource needs of total joint arthroplasty (TJA) in dialysis-dependent patients.Methods
Retrospective multiple cohort analysis of dialysis-dependent American College of Surgeons National Surgical Quality Improvement Program patients undergoing primary elective total hip and knee arthroplasty compared to non–dialysis-dependent controls from 2005 to 2015. Relative risks (RRs) of 30-day adverse events were determined by multivariate regression adjusting for baseline differences.Results
Six hundred forty-five (0.2%) dialysis-dependent patients of 342,730 TJA patients were dialysis-dependent and more likely to be dependent, under weight, anemic, hypoalbuminemic, and have cardiopulmonary disease. In total hip arthroplasty patients, dialysis was associated with greater risk of any adverse event (RR = 1.1, P < .001), mortality (RR = 2.8, P = .012), intensive care unit (ICU) care (RR = 9.8, P < .001), discharge to facility (RR = 1.3, P < .001), and longer admission (1.5×, P < .001). In total knee arthroplasty patients, dialysis conferred greater risk of any adverse event (RR = 1.1, P < .001), ICU care (RR = 6.0, P < .001), stroke (RR = 7.6, P < .001), cardiac arrest (RR = 4.8, P = .014), discharge to facility (RR = 1.5, P < .001), readmission (RR = 1.8, P = .002), and longer admission (1.3×, P < .001).Conclusion
Dialysis-dependence is an independent risk factor for 30-day adverse events, ICU care, longer admission, and rehabilitation needs in TJA patients. Thirty days is not sufficient to detect infectious complications among these patients. These findings inform shared decision-making, perioperative resource planning, and risk adjustment under alternative reimbursement models. 相似文献7.
Barrett A. Kielhorn Anthony J. Senagore Theodor Asgeirsson 《American journal of surgery》2018,215(3):373-376
Background
Perioperative insulin resistance is associated with significant hyperglycemia-related morbidity in patients undergoing major surgery. We sought to assess the effect of preoperative loading with a low-dose maltodextrin/citrulline solution compared to a commercially available sports drink on glycemic levels in an established colorectal enhanced recovery program.Methods
Retrospective analysis was undertaken of elective non-diabetic colectomies and enterectomies from January 2016–March 2017. Cohorts included simple (SIM) and complex carbohydrate (COM) groups. Statistical analysis was performed with linear and logarithmic regression.Results
83 patients were included (42 SIM, 41 COM). SIM group was older (61.7 vs 52.7 p = 0.012) Glycemic variability was less in the COM group (7.6% vs 21.4% P = 0.034). The frequency of hyperglycemia, postoperative complications, and length of stay trended higher in the SIM group.Conclusions
This retrospective analysis identifies significant improvement in the perioperative glycemic variability with preoperative low dose complex carbohydrate loading compared to simple carbohydrate loading in colorectal surgery patients. 相似文献8.
Jichao Yin Hongmou Zhao Guihua Zhuang Xiaojun Liang Xinglv Hu Yi Zhu Rongqiang Zhang Xiaochen Fan Yi Cao 《Journal of orthopaedic science》2018,23(3):552-556
Background
This cross-sectional study aims to investigate the flexible flatfoot (FFF) prevalence and related factors in school-aged children.Methods
A total of 1059 children aged 6–13 years were included. Dynamic footprints according to the FootScan system were collected from both feet. The relationship of FFF with age, gender, side, and body mass index (BMI) was investigated.Results
FFF percentage decreased from 39.5% at 6 years to 11.8% at 12 years and reached a plateau at 12–13 years. Overweight (OR 1.35, 95%CI 1.03–1.77, P = 0.03) and obese (OR 2.43, 95%CI 1.81–3.26, P＜0.01) showed a positive correlation with percentage of FFF children. No correlation was found between FFF prevalence and gender or side.Conclusions
FFF prevalence decreases with age and reaches a plateau at 12–13 years. Moreover, FFF prevalence is positively correlated with increased BMI and body height. 相似文献9.
Hakan Çiçek Ümit Tuhanioğlu Hasan Ulaş Oğur Fırat Seyfettinoğlu Murat Bozkurt 《Acta orthopaedica et traumatologica turcica》2018,52(2):92-96
Introduction
Patients with Su Type III fractures based on total knee arthroplasty (TKA) constitute a patient group with problematic treatment and management. Although it has difficulties, open reduction and internal fixation is one of the treatment options.Method
A retrospective evaluation was made of 22 patients surgically treated in our clinic with double locking, low contact titanium plate and screw for a Su Type III periprosthetic fracture based on TKA. The patients were evaluated with bone mineral densitometry, postoperative Knee Society Score (KSS), WOMAC and radiological evaluations.Results
The mean follow-up period of the patients was 68.6 ± 15.5 months, with pain-free weight-bearing determined at 4.9 ± 1.1 months and mean radiological union at 18.5 ± 4.3 weeks. Revision was required because of non-union in 2 (9.09%) cases. The postoperative KSS value was 81.8 ± 7.8, the WOMAC value was 78.1 ± 5.3 and the T-score was ?3.3 ± 0.3. At the final follow-up examination, a correction loss (4.9° ± 1.5°) was determined in the mean knee valgus angle according to the mechanical axis, which was statistically significant but remained within the physiological limits (p = 0.21).Conclusion
In addition to providing the advantages of rigid fixation together with early and effective rehabilitation, satisfactory clinical and radiological results were obtained with the application of double locking plate and screw in the treatment of periprosthetic femoral fractures based on TKA, with osteoporosis.Level of evidence
Level IV, Therapeutic study. 相似文献10.
Eric J. Finnesgard T.K. Pandian Michael L. Kendrick David R. Farley 《American journal of surgery》2018,215(3):447-449
Background
The effects of replacing a surgeon's familiar, experienced certified surgical assistant (CSA) on perioperative outcomes in complex surgery were investigated.Methods
An interrupted time series of totally laparoscopic pancreatoduodenectomies performed by a single surgeon was retrospectively studied. Segmented regression analysis estimated replacement effects on estimated blood loss (EBL) and operative time.Results
The cohort was composed of the last 100 cases with the familiar CSA and the first 100 cases with the replacement CSA. Study groups were similar. Unadjusted segmented regression of operative time and EBL predicted replacement effects of 70 min (95%CI, 18–122; p = 0.008) and 114 cc (95%CI, -93-320; p = 0.3), respectively. Adjusted regression predicted replacement effects of 40 min (95%CI, 0.9–78; p = 0.04) and 27 cc (95%CI, -156-210; p = 0.3).Conclusions
The replacement of a familiar, experienced CSA was associated with longer operative times. Despite confinement to a single surgeon and procedure, these results suggest what all surgeons know: excellent help is priceless. 相似文献11.
Masanori Izeki Koutatsu Nagai Masato Ota Yasutaka Matsuda Shuichi Matsuda 《Journal of orthopaedic science》2018,23(6):857-864
Background
Only a few reports have described symptomatic patients with postoperative spinal subdural hematoma (SSH) for which further surgery may have been required. No report has focused on the detailed clinical characteristics of postoperative SSH, including asymptomatic cases, in a case series. The reasons for this may be that SSH is an implicitly recognized rare entity, and there is no established consensus regarding the significance of performing postoperative magnetic resonance imaging (MRI) for all cases and the time at which to perform it. In this case-controlled retrospective analysis, we attempted to identify a detailed clinical presentation of SSH after open lumbar decompression surgery using MRI taken uniformly at 14 days before hospital discharge.Methods
We retrospectively studied 196 patients who underwent routine MRI following open lumbar spinous process-splitting decompression surgery between 2012 and 2016. We assessed the frequency, clinical presentation, and radiological findings of SSH that developed postoperatively. Furthermore, we used a multivariate analysis to identify factors that were postulated to increase the risk of SSH postoperatively.Results
None of the patients developed serious neurologic deficits, such as paresis or bladder and bowel dysfunction that required emergency evacuation. However, our results showed that postoperative SSHs, including asymptomatic SSHs, developed considerably frequently (43/182 patients, 23.6%). Furthermore, of the 43 patients with SSH, three presented with new postoperative neurologic findings that were strongly suspected to be associated with SSH. Multivariate analysis identified that preoperative hypertension (adjusted odds ratio [aOR]: 2.501, P = 0.018), anticoagulant therapy (aOR: 2.716, P = 0.021), and multilevel procedures (aOR: 2.327, P = 0.034) were significant risk factors of postoperative SSH.Conclusions
Spine surgeons should be aware that postoperative SSH is not rare and is a potential cause of recurrent pain or neurologic deterioration perioperatively. 相似文献12.
Background
The objective of this study was to assess whether intravenous acetaminophen for patients undergoing knee or hip arthroplasty could reduce the opioid consumption and improve pain management.Method
Eligible studies were searched from electronic databases including PubMed, Web of Science, Embase (Ovid interface) and Cochrane Library (Ovid interface). The quality assessments were performed according to the Cochrane systematic review method. The assessed outcomes were including opioid consumption, pain scores, length of hospital stays and total occurrence of adverse events.Results
Among 832 records identified, six randomized controlled trials (RCTs) and five non-RCTs were eligible for data extraction and meta-analysis. According to the outcomes, the patients receive intravenous acetaminophen had less total opioid consumption after knee or hip artroplasty (SMD = ?0.66; 95%CI, ?1.13 to ?0.20), but they did not obtain statistical improvement of postoperative pain control at postoperative day 0 (POD0, SMD = ?0,15; 95%CI, ?0.36 to 0.07), POD1(SMD = 0,12; 95%CI, ?0.13 to 0.36), POD2 (SMD = ?0,29; 95%CI, ?0.70 to 0.12) and POD3 (SMD = ?0,04; 95%CI, ?0.49 to 0.41). Meanwhile, there were similar outcomes about the length of hospital stays in patients whether or not receiving intravenous acetaminophen (SMD = ?0,05; 95%CI, ?0.26 to 0.15). And, the total adverse effects occurrence also didn't show any significant difference between the acetaminophen group and control group (OR = 0.87; 95%CI, 0.57 to 1.33).Conclusions
Perioperative intravenous acetaminophen use in multimodal analgesia could significantly reduce of total opioid consumption, but it did not contribute to decrease the average pain scores and shorten the length of hospital stays in total hip or knee arthroplasty. 相似文献13.
Francesco Muratori Filippo Frenos Leonardo Bettini Davide Matera Nicola Mondanelli Maurizio Scorianz Pierluigi Cuomo Guido Scoccianti Giovanni Beltrami Daniela Greto Lorenzo Livi Giacomo Baldi Giuliana Roselli Rodolfo Capanna Domenico Andrea Campanacci 《Journal of orthopaedic science》2018,23(6):1038-1044
Background and objectives
Liposarcoma (LPS) is a malignant mesenchymal tumor and the most common soft tissue sarcoma. Four different subtypes are described: well differentiated (WD) LPS or atypical lipomatous tumor (ALT), dedifferentiated (DD) LPS, myxoid LPS, and pleomorphic LPS (PLS). The objective of the study was to investigate prognostic factors and clinical outcome of liposarcoma.Methods
We retrospectively examined the clinico-pathological features of a series of 307 patients affected by Liposarcoma at a mean follow-up of 69 months (range 6–257). ALT/WD LPS were analyzed separately. The influence of site, size, type of presentation, grading, histotype and local recurrence on local and systemic control and survival was assessed.Results
The statistical analysis indicated that only surgical margins represented a significant prognostic factor for local recurrence in ALT/WD LPS (P = 0.0007) and other subtypes of LPS (P = 0.0055). In myxoid, PLS and DD LPS, significant prognostic factors for metastasis free survival (MFS) were surgical margins (P = 0.0009), size of the tumor (P = 0.0358), histology (P = 0.0117) and local recurrence (P = 0.0015). In multivariate analysis, surgical margins (0.0180), size (0.0432) and local recurrence (0.0288) correlated independently with MFS. Margins (P = 0.0315), local recurrence (P = 0.0482) and metastases (P < 0.0001) were prognostic factors for overall survival (OS).Conclusion
Marginal surgery can be an accepted treatment for ALT/WD LPS. In other liposarcoma subtypes (Myxoid, DD, PLS) wide or radical surgery is recommended as the margins significantly influence local recurrence-free survival (LRFS), metastasis-free survival (MFS) and overall survival (OS). Local recurrence and metastases were significant prognostic factors for OS. 相似文献14.
Momotaro Kawai Atsushi Tanji Takayuki Nishijima Koichi Tateyama Yuhei Yoda Ai Iizuka Yusaku Kamata Tadahisa Urabe 《Journal of orthopaedic science》2018,23(6):987-991
Background
It remains unclear whether early surgical intervention can reduce mortality after surgery in hip fracture patients. The aim of this study was to investigate the association between time from injury to surgery and mortality rate within 90 days after hip fracture surgery.Methods
We retrospectively identified 1827 patients who underwent hip fracture surgery in a tertiary care center in Japan between April 2007 and March 2017. After applying exclusion criteria (patients with spontaneous fracture, multiple fractures, revision surgery, total hip arthroplasty, or a refusal to participate), 1734 patients were included. We extracted data concerning patients’ age, race, sex, operative procedure, American Society of Anesthesiologists (ASA) score, days from injury to surgery (injury-surgery days), and days from admission to surgery (admission-surgery days), which could affect 90-day mortality after surgery. Variables associated with 90-day mortality were determined using multivariate logistic regression analysis.Results
The 90-day postoperative mortality rate was 3.5% (60 of 1734). Multivariable analysis showed that injury-surgery days were not associated with 90-day mortality (odds ratio [OR], 0.91; 95% confidence interval [CI], 0.80 to 1.05; P = 0.19), and that older age (OR, 1.06; 95% CI, 1.02 to 1.10; P = 0.005), male sex (OR, 3.62; 95% CI, 1.86 to 7.03; P < 0.001) and high ASA score (OR, 2.10; 95% CI, 1.06 to 4.18; P = 0.034) significantly increased 90-day mortality. In addition, admission-surgery days were not associated with 90-day mortality (OR, 0.95; 95% CI, 0.83 to 1.09; P = 0.45).Conclusion
Our results demonstrated that time from injury to surgery was not associated with mortality within 90 days after surgery after adjusting for age, sex, operative procedure, and ASA score. 相似文献15.
Background
The purpose of this study was to characterize anterolateral bowing of the femur using X-rays and muscular atrophy in the mid-thigh using computed tomography (CT) in patients with atypical femoral fractures (AFFs). We then compared the results with those of an intertrochanteric fracture to understand whether these measures act as causative factors of AFFs.Methods
From January 2009 to December 2015, 37 patients with complete AFF and 12 patients with incomplete AFF were enrolled in this study. Lateral femoral bowing, anterior femoral bowing, cross-sectional area (CSA), and attenuation coefficient of thigh muscles in the AFF group are measured and compare with those in the intertrochanteric fracture group.Results
Lateral and anterior femoral bowing in the AFF group were significantly higher than those in the intertrochanteric fracture group. The level of fracture was found to be significantly associated with lateral and anterior femoral bowing (r = 0.569, r2 = 0.324, p < 0.001; r = ?0.530, r2 = 0.281, p < 0.001, respectively). Total CSA and CSA of anterior and medial compartments were significantly lower in the AFF group (p < 0.05). The attenuation coefficient of the total thigh muscle and all three compartments in the AFF group were significantly lower than those in the intertrochanteric fracture group (p < 0.05).Conclusions
This study demonstrated that anterolateral femoral bowing and loss of thigh muscle were highly associated with the occurrence of AFFs. 相似文献16.
Susan M. Nedza Donald E. Fry Michael Pine Agnes M. Reband Pan Chen Gregory Pine 《American journal of surgery》2018,215(3):367-370
Background
Preoperative emergency department (ED) visits may reflect the patient's biliary disease, or may signal unstable comorbid conditions that have relevance following inpatient laparoscopic cholecystectomy (ILC) and outpatient laparoscopic cholecystectomy (OLC) in Medicare patients.Methods
We used the Medicare inpatient and outpatient Limited Datasets to identify elective laparoscopic cholecystectomy patients from 2011 to 2014. ED visits for 30-days before the surgical event were identified and correlated with the probability of patients returning to the ED in the 30-days following the procedure.Results
A total of 129,377 inpatient and 235,339 outpatient LCs were identified. A total of 20,021 (15.5%) of ILCs and 52,025 (22.1%) of OLCs had 30-day preoperative ED visits. ILCs with any 30-day ED visit preoperatively had an Odds Ratio (OR) that predicted a post-discharge ED visit of 1.85 (95% CI = 1.78–1.92; P < 0.0001). OLCs with any 30-day ED visit preoperatively had an OR for post-discharge ED visit of 1.50 (95% CI = 1.46–1.54; P < 0.0001).Conclusion
Preoperative ED visits predict postdischarge ED visits for laparoscopic cholecystectomy in Medicare patients. 相似文献17.
Jian Zhao Mingyuan Yang Yiling Yang Ziqiang Chen Ming Li 《Journal of orthopaedic science》2018,23(5):744-749
Background
To investigate the risk factors of proximal junctional kyphosis (PJK) in Lenke 5 AIS patients after all-pedicle instrumentation and correction, and to compare the difference of radiographic and clinical outcome between PJK and Non-PJK populations.Method
Medical records of Lenke 5 AIS patients were reviewed from January 2008 to January 2013, included posteroanterior and lateral full spine X-ray films preoperatively, postoperatively (4–7 days after surgery), and at final follow-up. Demographic data and radiologic parameters were evaluated. Based on the proximal junctional angle (PJA) at final follow-up, those patients were divided into 2 groups: PJK group (n = 35, PJA≧10°), and Non-PJK group (n = 52, PJA<10°). Comparisons analyses between PJK and Non-PJK groups were carried out. Binary logistic Regression analysis was performed to detect the risk factors of PJK at follow-up.Results
The current study recruited 87 Lenke 5 AIS patients with average follow-up of 4.67 ± 1.17 years. Significant differences between PJK and Non-PJK groups were observed as follows: UIV(P = 0.010), the disruption of junctional ligaments (P < 0.001); preoperative variables [MTC (P = 0.001), TK(P < 0.001), LL (P = 0.017), SVA (P = 0.036), and PJA (P = 0.014)], postoperative variables [TLK(P = 0.004), and PJA (P < 0.001)], and follow-up [SVA (P = 0.014), C-SVA (P < 0.001), and PJA (P0.001). Binary logistic regression showed that the disruption of junctional ligaments, postoperative PJA and UIV (upper instrumented vertebra) at proximal or lower thoracic levels were the main risk factors of PJK [Odds Ratio (OR) = 5.114, 2.345, and 6.212, respectively]. However, the SRS-22 scores did not change significantly in PJK and Non-PJK groups.Conclusion
Greater postoperative PJA, disruption of junctional ligaments, UIV at lower thoracic levels were the main risk factors for PJK in Lenke 5 AIS patients. Recommedation: Preserve junctional ligaments in those individuals with UIV located in the lower thoracic region. 相似文献18.
Young-Kyun Lee Jung Taek Kim Awad Abdalla Alkitaini Ki-Choul Kim Yong-Chan Ha Kyung-Hoi Koo 《The Journal of arthroplasty》2017,32(5):1593-1598
Background
Conversion hip arthroplasty is a salvage procedure for failed internal fixation of intertrochanteric fractures. However, the technical difficulties and perioperative morbidity of conversion arthroplasty are uncertain.Methods
We compared the type of arthroplasty (total hip arthroplasty or hemiarthroplasty), operative parameters, perioperative morbidity, 1-year mortality, implant stability, and clinical results of 33 conversion hip arthroplasties due to a failed internal fixation of intertrochanteric fracture with those of a matched control group of 33 primary hip arthroplasties due to the same fracture. Propensity score was used for the control matching of gender, age, and body mass index.Results
Total hip arthroplasty was more frequently performed in the conversion group (10/33) compared to the primary group (3/33) (P = .016). The operation time, perioperative blood loss, amount of transfusion, and risk of femoral fracture during the operation were increased in the conversion group. The overall 1-year mortality was 3% (1 patient) in the conversion group and 9% (3 patients) in the primary group (P = .307). At a mean of 3-year follow-up, there was no significant difference in clinical results and none of the implants were loose in both groups.Conclusion
In patients with failed internal fixation of intertrochanteric fracture, conversion hip arthroplasty should be planned and executed, bearing in mind the increased operative morbidities corresponding to operation time, perioperative blood loss, requirement of transfusion, and intraoperative femoral fracture. 相似文献19.
Objective
In this study we analyzed the outcome of tibial and peroneal venous and heparin-bonded expanded polytetrafluoroethylene (HePTFE) bypasses in diabetics with critical limb ischemia (CLI). We aimed to verify our hypothesis that HePTFE grafts will achieve acceptable 1-year patency and limb salvage results in patients who lack an adequate vein.Methods
We conducted a retrospective analysis for all diabetics who underwent tibial bypass surgery in our department between October 2007 and October 2012. The study includes 97 grafts. All these patients were not suited for an endovascular therapy. We used autologous veins in 56 cases (Vein-Group) and HePTFE grafts in 41 cases (HePTFE-Group). Study endpoints were primary and secondary patency, limb salvage, and survival at 2 years postoperatively.Results
Risk factors and indications were similar in both groups.The comparison between HePTFE- and Vein-Group showed significantly different patency rates. At 2 years, primary patency was 39.3% in HePTFE-Group vs. 78.5% in Vein-Group (P = .003) and secondary patency was 47.4% vs. 81.9% (P = .002). Limb salvage at 2 years was 79.3% vs. 87.4% (P = .073) and survival was 64.6% vs. 62.9% (P = .593) at the 2-year mark, with no significant differences. 30-days mortality, graft occlusion and major amputation rate showed no significant differences, either.Conclusions
This study shows that HePTFE bypasses are a viable option for diabetics undergoing tibial bypass surgery when no adequate vein is available. 相似文献20.
C.A.L. de Raaff U.K. Coblijn E.S.M. de Klerk M.J.L. Ravesloot N. de Vries B.A. van Wagensveld 《The surgeon》2018,16(3):151-155