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1.
Shigeru Ono Shigehisa Fumino Shinichi Shimadera Naomi Iwai 《Journal of pediatric surgery》2010,45(2):376-378
Introduction
Choledochal cyst (CC) is closely associated with anomalous arrangement of the pancreaticobiliary duct, which is considered a high-risk factor for biliary tract malignancy. Early diagnosis and early treatment for CC could lead to a good prognosis. This study investigated late complications and long-term outcomes after surgery for CC.Patients and Methods
Fifty-six patients with CC and over 10 years of postoperative follow-up were analyzed retrospectively. All patients had undergone total resection of the extrahepatic bile duct and hepaticojejunostomy.Results
Six patients showed liver dysfunction manifested in the first 10 years after surgery, but all returned to normal thereafter. Dilatation of intrahepatic bile ducts persisted in 6 postoperatively, and in 3, this was still apparent more than 10 years after. Recurrent abdominal pain was encountered in 3, 1 had pancreas divisum with a pancreatic stone, and 1 had adhesive small bowel obstruction. Two patients developed biliary tract malignancy. A 14-year-old girl died of recurrent common bile duct cancer 2 years after the initial resection of CC with adenocarcinoma. A 26-year-old man with repeated cholangitis owing to multiple intrahepatic bile stones developed cholangiocarcinoma 26 years after the initial resection of CC. Event-free survival rate and overall survival rate were 89% (50/56) and 96% (54/56), respectively.Conclusions
Choledochal cyst generally has an excellent prognosis with early total resection and reconstruction. Long-term surveillance for the development of malignancy is still essential, especially if there is ongoing dilatation of the intrahepatic bile duct or biliary stones. 相似文献2.
Sauli A Palmu Sampo Auro Martina Lohman Reijo T Paukku Jari I Peltonen Yrj?n? Nietosvaara 《Acta orthopaedica》2014,85(5):513-517
Background
Tibial fracture is the third most common long-bone fracture in children. Traditionally, most tibial fractures in children have been treated non-operatively, but there are no long-term results.Methods
94 children (64 boys) were treated for a tibial fracture in Aurora City Hospital during the period 1980–89 but 20 could not be included in the study. 58 of the remaining 74 patients returned a written questionnaire and 45 attended a follow-up examination at mean 27 (23–32) years after the fracture.Results
89 children had been treated by manipulation under anesthesia and cast-immobilization, 4 by skeletal traction, and 1 with pin fixation. 41 fractures had been re-manipulated. The mean length of hospital stay was 5 (1–26) days. Primary complications were recorded in 5 children. The childrens’ memories of treatment were positive in two-thirds of cases. The mean subjective VAS score (range 0–10) for function appearance was 9. Leg-length discrepancy (5–10 mm) was found clinically in 10 of 45 subjects and rotational deformities exceeding 20° in 4. None of the subjects walked with a limp. None had axial malalignment exceeding 10°. Osteoarthritis of the hip and/or knee was seen in radiographs from 2 subjects.Interpretation
The long-term outcome of tibial fractures in children treated non-operatively is generally good.Tibial fractures are among the most common long-bone fractures in children (Shannak 1988, Landin 1997, Mäyränpää et al. 2010). Primary complications such as vascular or nerve injuries or compartment syndrome are rare. Secondary complications include malunion and premature physeal closure in fractures extending to physis.Operative treatment has recently gained popularity, although most uncomplicated tibial fractures can be safely treated with closed reduction and cast-immobilization (Setter and Palomino 2006, Heinrich and Mooney 2010). There have been very few reports on the long-term results of tibial fracture treatment in children.Here we present long-term outcomes in children (< 15 years of age) who were treated for a tibial fracture in Aurora City Hospital, Helsinki during the period 1980–89. Aurora City Hospital was the primary treatment center for fractures in children in Helsinki during the study period. 相似文献3.
Long-term prognosis of post-infectious renal scarring in relation to radiological findings in childhood — a 27-year follow-up 总被引:2,自引:2,他引:0
Stefan H. Jacobson Ole Eklöf Lars-Eric Lins Ingrid Wikstad Jan Winberg 《Pediatric nephrology (Berlin, Germany)》1992,6(1):19-24
In a previous report the long-term prognosis of 30 patients with renal scarring after pyelonephritis in childhood was described. In this study, we have related the extent of renal scarring present in childhood to the conditions in early adulthood. A radiological progression of searring from childhood to adulthood was seen in one-third of the kidneys. The 7 patients with bilateral scarring in childhood had a smaller renal area, lower glomerular filtration rate and higher plasma vasopressin at follow-up than 13 healthy controls. The 20 patients who had unilateral searring in childhood had a smaller renal area, lower glomerular filtration rate, higher diastolic blood pressure and higher plasma renin at follow-up than controls; 4 had hypertension. The most important finding was that children with unilateral disease are at risk of serious long-term complications. Filtration fraction at follow-up was higher in patients with extensive renal scarring in childhood compared with those with a normal renal area or small scars in childhood (r=–0.43,P<0.05). This may indicate glomerular hyperfiltration by remnant glomeruli. This paper emphasizes the potential seriousness of childhood urinary tract infections especially when early infantile infections are overlooked. A follow-up of more than 4 decades may be necessary before the ultimate prognosis can be established, especially in patients with unilateral renal disease. It is advised that most patients with post-infectious renal scars are followed as high-risk patients, and that treatment continuity is established between paediatricians, nephrologists and, when required, obstetricians.to Author for further revision and received in revised form May 28, 1991 相似文献
4.
Anders Moller MD Ralph Hasserius PhD Inga Redlund-Johnell PhD Acke Ohlin PhD Magnus K. Karlsson PhD 《The spine journal》2007,7(6):701-707
BACKGROUND CONTEXT: Several studies report a favorable short-term outcome after nonoperatively treated two-column thoracic or lumbar burst fractures in patients without neurological deficits. Few reports have described the long-term clinical and radiological outcome after these fractures, and none have, to our knowledge, specifically evaluated the long-term outcome of the discs adjacent to the fractured vertebra, often damaged at injury and possibly at an increased risk of height reduction and degeneration with subsequent chronic back pain. PURPOSE: To evaluate the long-term clinical and radiological outcome after nonoperatively treated thoracic or lumbar burst fractures in adults, with special attention to posttraumatic radiological disc height reduction. STUDY DESIGN: Case series. PATIENT SAMPLE: Sixteen men with a mean age of 31 years (range, 19-44) and 11 women with a mean age of 40 years (range, 23-61) had sustained a thoracic or lumbar burst fracture during the years 1965 to 1973. Four had sustained a burst fracture Denis type A, 18 a Denis type B, 1 a Denis type C, and 4 a Denis type E. Seven of these patients had neurological deficits at injury, all retrospectively classified as Frankel D. OUTCOME MEASURES: The clinical outcome was evaluated subjectively with Oswestry score and questions regarding work capacity and objectively with the Frankel scale. The radiological outcome was evaluated with measurements of local kyphosis over the fractured segment, ratios of anterior and posterior vertebral body heights, adjacent disc heights, pedicle widths, sagittal width of the spinal canal, and lateral and anteroposterior displacement. METHODS: From the radiographical archives of an emergency hospital, all patients with a nonoperatively treated thoracic or lumbar burst fracture during the years 1965 to 1973 were registered. The fracture type, localization, primary treatment, and outcome were evaluated from the old radiographs, referrals, and reports. Twenty-seven individuals were clinically and radiologically evaluated a mean of 27 years (range, 23-41) after the injury. RESULTS: At follow-up, 21 former patients reported no or minimal back pain or disability (Oswestry Score mean 4; range, 0-16), whereas 6 former patients (of whom 3 were classified as Frankel D at baseline) reported moderate or severe disability (Oswestry Score mean 39; range, 26-54). Six former patients were classified as Frankel D, and the rest as Frankel E. Local kyphosis had increased by a mean of 3 degrees (p<.05), whereas the discs adjacent to the fractured vertebrae remained unchanged in height during the follow-up. CONCLUSIONS: Nonoperatively treated burst fractures of the thoracic or lumbar spine in adults with or without minor neurological deficits have a predominantly favorable long-term outcome, and there seems to be no increased risk for subsequent disc height reduction in the adjacent discs. 相似文献
5.
Operative treatment of 109 tibial plateau fractures: five- to 27-year follow-up results 总被引:4,自引:0,他引:4
Rademakers MV Kerkhoffs GM Sierevelt IN Raaymakers EL Marti RK 《Journal of orthopaedic trauma》2007,21(1):5-10
OBJECTIVE: To analyze the long-term (5-27 years) functional and radiologic results of surgically treated fractures of the tibial plateau. DESIGN: Retrospective study. SETTING: University hospital. PATIENTS AND METHODS: Two hundred two consecutive tibial plateau fractures were included in this study. All fractures were classified according to both the AO and the Schatzker classification. There were 112 men and 90 women. The mean age at injury was 46 years (16 to 88). One hundred sixty-three patients had isolated fractures and 39 had multiple fractures. A 1 year follow-up was done in all 202 patients. One hundred nine of these patients also had an additional long-term follow-up visit. Functional results of these 109 patients were graded with the Neer- and HSS-knee scores. Radiologic results were graded with the Ahlb?ck score. Statistical analysis was performed by means of the SPSS data analysis program. RESULTS: An uneventful union was present at the 1 year follow-up in 95% of the patients, along with a mean knee ROM of 130 degrees (range, 10-145 degrees). One hundred nine patients had a long-term follow-up visit after a mean period of 14 years (range, 5-27 years). The mean ROM at this time was 135 degrees (range, 0-145 degrees). Functional results showed a mean Neer score of 88.6 points (range, 56-100 points) and a mean HSS score of 84.8 points (range, 19-100 points). Monocondylar fractures showed statistically significant better functional results compared to bicondylar fractures. In 31% of the patients, secondary osteoarthritis had developed but was well tolerated in most (64% of the patients). Patients with a malalignment of more then 5 degrees developed a moderate to severe grade of osteoarthritis statistically significant more often (27% of the patients) compared to patients with an anatomic knee axis (9.2%; MWU, P = 0.02). Age did not appear to have any influence on the results. CONCLUSION: Long-term results after open reduction and internal fixation for tibial plateau fractures are excellent, independent of the patient's age. 相似文献
6.
Displaced intra-articular calcaneal fractures: 15-year follow-up of a randomised controlled trial of conservative versus operative treatment 总被引:2,自引:0,他引:2
AIM: To report the 15-year follow-up of displaced intra-articular calcaneal fractures from a randomised controlled trial of conservative versus operative treatment published in 1993. PATIENTS AND METHODS: Of the initial study, 46 patients (82%) were still alive at a mean of 15 years post injury and 26 patients (57%) agreed to review. The patients had been randomly allocated to either conservative or operative treatment in the original study. Clinical [American orthopaedic foot and ankle society hindfoot scale (AOFAS), foot function index (FFI) and calcaneal fracture score] and radiological (B?hler's angle and calcaneum height) outcome measures were used. The grade of osteoarthritis was also assessed at long-term follow-up. RESULTS: At long-term follow-up, the clinical outcomes were not different between conservative versus operative treatment. AOFAS hindfoot scale: conservative=78.5 and operative=70, p=0.11; FFI: conservative=24.4 and operative=26.9, p=0.66; calcaneal fracture score: conservative=70.1 and operative=63.5, p=0.41. The radiological outcomes were also not different between both groups. B?hler's angle: conservative=10.4 degrees and operative 16.9 degrees , p=0.07; height of calcaneum: conservative=37.2mm and operative=38.2mm, p=0.57; grade of osteoarthritis of the sub-talar joint: p=0.54. There was no correlation between B?hler's angle and the outcome measures in either group. CONCLUSION: The results of this 15-year follow-up of displaced intra-articular calcaneal fracture randomised controlled trial were equivalent between conservative and operative treatment and demonstrate similar findings to those at one year follow-up. 相似文献
7.
Background contextMany studies have focused on either the intervertebral disc as a culprit in back pain problems, or the vertebral body, but very few studies have examined both structures and their relationship.PurposeTo measure the concordant changes in morphology of the discs and vertebrae during 5-, 10-, and 15-year follow-ups.Study designLongitudinal study.Patient sampleAmong a general population sample of 232 men that had been scanned in 1992–1993, 105 men were reexamined in 1997–1998 and 2007–2008. Mean age at the 15-year follow-up was 63 years. A confirmatory sample with 10 years follow-up was also included.MethodsScanners (1.5 Tesla) with surface coils were used at baseline and follow-up. Image analyzing software was used to measure distances and areas of interest of midsagittal and midaxial spine images.ResultsThe disc heights decreased at 5 years by 3.4% (0.4 mm) and 3.3% (0.4 mm) and at 15 years by 8.7% (1.0 mm) and 11.3% (1.3 mm) in the upper and lower discs, respectively (p<.001). Although not clear after 5 years, vertebra heights increased in mean by 3.1% (0.8 mm) in the upper lumbar levels and by 4.7% (1.1 mm) in the lower vertebrae after 15 years (p<.001). Vertebra height increases were associated with disc narrowing (p=.001). The mean annual shortening of the lumbar spine L1–S1 block was 0.13 mm/y, which was in line with the mean standing height that decreased little (174.7 cm at baseline and 174.4 cm at the follow-up).ConclusionsDiscs and vertebrae degenerate or remodel in concert: decreases in disc height appear to be compensated, in part, by accompanying increases in adjacent vertebra heights. The mechanism behind this novel finding and its implications require further study. 相似文献
8.
Ho-Rim Choi Yukiharu Hasegawa Seiji Kondo Takuya Shimizu Kunio Ida Hisashi Iwata 《Journal of orthopaedic science》2001,6(6):493-497
From January 1976 to December 1990, 66 high tibial osteotomies for medial gonarthrosis were performed in 59 patients. Thirty
knees of 26 patients (18 women and 8 men) were reviewed after a mean follow-up period of 15.3 years (range, 10–24 years).
The mean age of these 26 patients was 59 years at the time of operation and 75.5 years at the latest follow-up. The average
femoro-tibial angle changed, from 187° before surgery to 170° after surgery, and to 174° at the latest follow-up. Progression
of osteoarthritic changes was observed in 87% for the medial and in 90% for the lateral compartment of the knee. Clinical
results, assessed according to the Japanese Orthopaedic Association (JOA) knee score, showed improvement with a score of 65
points before surgery, and a score of 81 points at the latest follow-up. The overall clinical results were satisfactory for
60% of the knees. The results of this long-term follow-up study show that high tibial osteotomy for medial compartment osteoarthritis
can be effective for as long as 15 years.
Received: January 24, 2001 / Accepted: July 7, 2001 相似文献
9.
Simon Barr Fiona M. Reid Carolyn E. North Gordon Hosker Anthony R. B. Smith 《International urogynecology journal》2009,20(4):443-445
Introduction and hypothesis The aim of this study is to provide long-term outcome data, at least 10 years, following laparoscopic colposuspension.
Methods The study includes a control group who underwent open colposuspension. A consecutive series of 139 women who had undergone
laparoscopic colposuspension were reviewed and compared to 52 women who had an open colposuspension in the same unit. Subjects
were contacted by telephone, at least 10 years post-operatively, at which time a structured interview was performed which
included the short-form Bristol Female Lower Urinary Tract Symptom questionnaire.
Results There was deterioration in subjective cure rates from 71% and 67% at 6 months to 52% and 36% at 10 years for the laparoscopic
and open procedures, respectively.
Conclusion This study provides evidence that laparoscopic colposuspension is probably as durable as open colposuspension. However, cure
rates for both procedures appear to deteriorate over time, emphasising the importance of long-term follow-up. 相似文献
10.
G. Leidig-Bruckner H. K. Genant H. W. Minne T. Storm G. Thamsborg T. Bruckner P. Sauer T. Schilling O. H. Soerensen R. Ziegler 《Osteoporosis international》1994,4(3):154-161
There is no agreed definition for the assessment of vertebral fractures and deformities in patients with osteoporosis. Radiographs of 66 patients randomized for therapy with etidronate or placebo were analyzed at baseline and during follow-up (60/120/150 weeks) independently using two procedures. The first method of spinal deformity index (SDIG) and vertebral deformity score (VDSG) is based on a semiquantitative visual reading of each vertebra between T4 and L4. The second method of spine deformity index (SDIM) and vertebral deformity index (VDIM) is based on vertebral height measurements of T4 through L5 and each measurement from T5 to L5 (anterior, middle and posterior height) is related to T4 and compared with the respective T4-related normal range. There was good agreement between the mean vertebral deformation from T5 to L4 graded by VDSG and VDIM, with correlation coefficients betweenR=0.52 (p<0.0001) andR=0.9 (p<0.0001) respectively. Spinal deformation at baseline as measured by SDIM and SDIG was correlated withR=0.76 (p<0.0001). For diagnosing a vertebra as fractured or not, VDIM reached a sensitivity of 82% and a specificity of 85% using VDSG as a standard, and on the other hand VDSG reached a sensitivity of 78% and a specificity of 88% in relation to VDIM. The changes in spinal deformation from week 0 to 150 were correlated withR=0.58 (p<0.0002) between SDIM and SDIG. To detect vertebral fracture progression the sensitivity of VDIM was 74% and the specificity 86%, when changes in VDSG were used as a standard. On the other hand sensitivity for VDSG was 56% and specificity 95% to detect vertebral fracture progression, when changes in VDIM were used as a standard. The comparison of changes in spinal deformation in the etidronate and placebo group during the 3-year study demonstrated that changes in SDIM during follow-up confirmed the results found by the changes in SDIG. As an independent standard for vertebral deformity and fracture definition is not available, the present study does not allow a decision as to whether semiquantitative reading (SDIG) or vertebral height measurements (SDIM) are closer to the biological truth. We conclude that in clinical studies the assessment of vertebral fractures or deformations should be validated by the comparison between two different established techniques, performed independently. 相似文献
11.
Tsuyoshi Sato Takui Ito Toru Hirano Osamu Morita Ren Kikuchi Naoto Endo Naohito Tanabe 《European spine journal》2011,20(1):94-99
A cross-sectional study that targeted a total of 43,630 pupils in Niigata City, Japan was performed. The objective of the
study was to evaluate the association between sports activities and low back pain (LBP) in childhood and adolescence in Japan.
Regarding risk factors of LBP, a large number of studies have been conducted that have examined gender differences, height
and weight, body mass index, sports time, differences in lifestyle, family history, and mental factors; however, no definitive
conclusion has yet been made. A questionnaire survey was conducted using 43,630 pupils, including all elementary school pupils
from the fourth to sixth grade (21,893 pupils) and all junior high pupils from the first to third year (21,737 pupils) in
Niigata City (population of 785,067). 26,766 pupils who were determined to have valid responses (valid response rate 61.3%)
were analyzed. Among the 26,766 pupils with valid responses, 2,591 (9.7%) had LBP at the time of the survey, and 8,588 (32.1%)
had a history of LBP. The pupils were divided between those who did not participate in sports activities except the physical
education in school (No sports group: 5,486, 20.5%) and those who participated in sports activities (Sports group: 21,280, 79.5%), and the difference in lifetime prevalence between No sports group and Sports group was examined. The odds ratio for LBP according to sports activity was calculated by multiple logistic regression analysis
adjusted for gender, age, and body mass index. In addition, the severity of LBP was divided into three levels (Level 1: no
limitation in any activity, Level 2: necessary to refrain from participating in sports and physical activities, and Level
3: necessary to be absent from school), and Levels 2 and 3 were defined as severe LBP; the severity was compared between No sports group and Sports group and in each sport’s items. Moreover, in Sports group, the amount of time spent participating in sports activities were divided into three groups (Group 1: less than 6 h per week,
Group 2: 6–12 h per week, and Group 3: 12.1 h per week or more), and the dose–response between the amount of time spent participating
in sports activities and the occurrence of LBP were compared. In No sports group, 21.3% experienced a history of LBP; in Sports group, 34.9% experienced LBP (P < 0.001). In comparison to No sports group, the odds ratio was significantly higher for Sports group (1.57), and also significantly higher for most of the sports items. The severity of LBP was significantly higher in Sports group (20.1 vs. 3.2%, P < 0.001). The amount of time spent participating in sports activities averaged 9.8 h per week, and a history of LBP significantly
increased in the group which spent a longer time participating in sports activities (odds ratio 1.43 in Group 3). These findings
suggest that sports activity is possible risk factors for the occurrence of LBP, and it might increase the risk for LBP in
childhood and adolescence. 相似文献
12.
《Injury》2018,49(6):1137-1140
IntroductionThe (modified) Stoppa approach for acetabular fracture surgery has gained significant popularity and early results have been encouraging but clinical outcome at extensive follow-up is scarce. The purpose of this study is to provide an update on our experience with this approach for operative treatment of acetabular fractures and to assess clinical outcome at mid-term follow-up.MethodsIn this retrospective study, all patients treated operatively for an acetabular fracture using the Stoppa approach over a 10-year period were included. Surgery details were reviewed and patients were contacted and requested to return for follow-up. Primary outcome was native hip survivorship, secondary outcome measures included; functional outcome (Merle d’Aubiginé, Harris hip) scores, health-related quality of life (short-form 36) and radiographic outcome (heterotopic ossification, hip osteoarthritis).ResultsForty-five patients received operative fixation for 47 acetabular fractures using the Stoppa approach. Complications requiring surgical intervention were found in one patient (with a vascular lesion) intra-operatively and 3 patients (with wound infections (2) and diffuse bleeding (1)) post-operatively. Follow-up was 83% and 29/39 (74%) native hips survived at mean 59 months (SD 49) postoperatively. Excellent-good functional scores were found in 88% (Merle d’Aubiginé) and 76% (Harris hip) of patients who had retained their native hip. Most (6/8) short-form 36 indices in these patients were comparable to population norms. Of 29 native hips with radiographic follow-up (mean 59 months (SD 49), 4 (86%) had no-minimal radiographic abnormalities.ConclusionThis study confirms that the Stoppa approach is a safe and effective technique for acetabular fracture fixation. Moreover, at mid-term follow-up, this approach is associated with satisfactory results in terms of hip survivorship as well as functional and radiographic outcome. As such, our findings reinforce the notion that this less invasive technique presents a valuable alternative to the ilioinguinal approach for the surgical treatment of acetabular fractures. 相似文献
13.
Gabra HO Jesudason EC McDowell HP Pizer BL Losty PD 《Journal of pediatric surgery》2006,41(9):1513-1516
Background
Sacrococcygeal teratoma (SCT) is uncommon (1:35,000-1:40,000 newborns). We report a 25-year single-center experience with a focus on late effects.Methods
Surgical and tumor registries identified patients with SCT between 1977 and 2001. Perinatal data, associated anomalies, operative findings, histology, and survival were recorded. Continence was assessed clinically. Urodynamics and anorectal manometry were performed as indicated.Results
Thirty-three patients (28 females) were treated for SCT. Before 1988, 2 of 18 were diagnosed antenatally compared with 8 of 15 between 1988 and 2001. Ten babies were delivered by cesarean birth. Seven children presented after the neonatal period. Surgery comprised tumor excision with coccygectomy. Histology was benign in 26 (79%), malignant in 6 (18%), and immature in a single patient. Presentation beyond the newborn period was associated with malignant disease and poorer outcome. Overall survival was 94%. Neuropathic bladder or bowel disturbance was identified in 7 of 20 patients on long-term follow-up.Conclusions
Antenatal diagnosis of SCT appears to be increasing. Parental counseling should include the continence problems that may follow removal of even benign tumors. Resection by surgical oncologists and reconstruction by colorectal specialists may improve function. Follow-up by oncologists, surgeons, and urologists remains an important part of SCT management. 相似文献14.
Lidia Castagneto Gissey James R. Casella Mariolo Alfredo Genco Alfonso Troisi Nicola Basso Giovanni Casella 《Surgery for obesity and related diseases》2018,14(10):1480-1487
Background
Sleeve gastrectomy (SG) has grown into the most popular bariatric operation. Nevertheless, a scarcity of long-term outcomes are available.Objectives
This study aims at evaluating the long-term percent weight loss (%WL), excess weight loss (%EWL), weight regain (WR), and co-morbidity resolution rates in a single-center cohort undergoing SG as a primary procedure, with a minimum 10-year follow-up.Setting
University hospital, Italy.Methods
One hundred eighty-two morbidly obese patients with body mass index (BMI) 46.6 ± 7.3 kg/m2 underwent SG. Obesity-related co-morbidities (type 2 diabetes, hypertension, sleep apnea, gastroesophageal reflux disease) were investigated. Predictors of dichotomous dependent-variable diabetes remission were computed using a binomial logistic regression.Results
Patient retention rate was 77%. Mean %WL was 30.9, %EWL was 52.5%, and WR (≥25% maximum WL) occurred in 10.4%. Baseline BMI significantly (P?=?.001) and linearly predicted %EWL (10 yr %EWL?=?18.951?+?initial BMI × .74); the super-obese subgroup generated substantially greater WL compared with those with BMI <50 kg/m2 (%EWL 48.0 ± 18.5 versus 61.5 ± 23.2; P < .001). Type 2 diabetes remission occurred in 64.7%; 42.9% patients developed de novo gastroesophageal reflux disease symptoms postoperatively (P < .0001).Conclusions
SG generates sustained WL and co-morbidity resolution up to 10 years postoperatively. Although a notable portion of patients experience WR, mean %WL persists to exceed 30%, translating in adequate WL also in the long term. Additionally, WR does not seem to impact negatively on co-morbidity resolution. SG represents a safe and effective bariatric operation, which easily grants the possibility to proceed to revisional bariatric surgery in patients with WR or failure to WL. 相似文献15.
Jin Kyu Lee Hae-won Jeong Il-Han Joo Young-Il Ko Chang-Nam Kang 《The spine journal》2018,18(6):962-969
Background Context
Controversy exists regarding percutaneous balloon kyphoplasty (PBK) in patients with a very severe osteoporotic vertebral compression fracture (vsOVCF).Purpose
The study was conducted to investigate the clinical and radiological outcomes of PBK for the treatment of vsOVCF compared with those of non-vsOVCF.Study Design/Setting
This is a retrospective, case-control study.Patient Sample
A total of 167 consecutive patients (210 vertebral bodies) who underwent PBK for OVCF between March 2010 and January 2015 were assessed.Outcome Measures
Visual analog scale (VAS) scores for back pain, Korean Oswestry disability index (K-ODI) scores, vertebral body height variations, and kyphotic angles were evaluated preoperatively, postoperatively, and 1 year after treatment.Materials and Methods
Patients in the non-vsOVCF group (anterior vertebral compression of more than two-thirds on plain radiograph) who had undergone PBK where compared with those in the non-vsOVCF group (compression between 30% and two-thirds). Clinical and radiological outcomes were compared. In addition, complications were evaluated.Results
In total, 31 patients (33 vertebrae) in the vsOVCF group and 136 patients (177 vertebrae) in the non-vsOVCF group were treated with PBK. Both groups had significant postoperative improvements in the clinical and radiological outcomes (VAS score, K-ODI score, vertebral body height variation, and kyphotic angle). There was no difference regarding the VAS score and the K-ODI score between the two groups at the final follow-up (p>.05). The cement leakage occurred frequently in the vsOVCF group (26 vertebrae, 78.8%) than in the non-vsOVCF group (92 vertebrae, 52.0%), the difference was statistically significant (p<.05). But there was no case that showed neurologic complication or pulmonary embolism caused by cement leakage. The incidence of recollapse was significantly higher in the vsOVCF group (five vertebrae, 15.2%) than in the non-vsOVCF group (seven vertebrae, 4.0%) (p<.05). The incidence of an adjacent segment fracture (vsOVCF group, 6 vertebrae, 18.2%; non-vsOVCF group, 21 vertebrae, 11.9%) was not significantly different (p=.320).Conclusions
Percutaneous balloon kyphoplasty is a safe and effective procedure for the treatment of vsOVCF. 相似文献16.
17.
Gutiérrez Del Alamo J Garcia-Cimbrelo E Castellanos V Gil-Garay E 《The Journal of arthroplasty》2007,22(4):515-524
We used 79 Wagner SL stems (Sulzer Orthopedics, Baar, Switzerland) in femoral revisions with a minimum 5-year follow-up. There were 11 dislocations. A limb length discrepancy and limp were frequent. One loosened stem was rerevised. The cumulative probability of not having a stem revision for any reason was 92.3% in the best case scenario. Stem subsidence was associated with poor femoral canal filling. Definite proximal new bone regeneration (50 hips) was associated with an absence of major bone defects (P = .01). Lateral and medial femoral cortex and the outside femoral diameter had increased at the end of follow-up (P < .001). Wagner SL femoral revision stems can solve difficult cases with major proximal bone defects or periprosthetic fractures. Radiographic bone fixation and bone regeneration were frequent. Dislocations and stem subsidence were also frequent. 相似文献
18.
Prakash L. V. Prabhu V. V. Saralaya M. M. Pai A. V. Ranade G. Singh S. Madhyastha 《Osteoporosis international》2007,18(7):891-903
Summary The body of the vertebra can be affected in the majority of the conditions involving the lumbar spine. Multiple references,
both books and periodicals, have been reviewed, and the anatomical factors responsible for the vertebral body integrity in
the lumbar spine have been included under the following important areas, namely, morphology, development, genetics, microscopic
examination using histology, structural architecture, blood supply, neuromuscular control, and biomechanics.
Introduction The anatomy provides a three-dimensional frame work to support the interaction between the physiological and pathological
alterations. The body of the vertebra can be affected in a majority of acute or chronic conditions involving the lumbar spine.
The etiology of these conditions is multifactorial, which has been dealt with in previous studies sporadically. This study
aims to review and incorporate the important anatomical factors which can influence the integrity of vertebral bodies in the
lumbar region and manifest as low back pain.
Methods Multiple references, both books and periodicals, have been reviewed for the literature. Electronic databases, including Medline
and PubMed, were used to collect the latest information. They were finally arranged in an anatomical framework for the article.
An attempt has been made to cover these relevant issues in an integrated way in the article and have been structured into
introduction, morphology, development, genetics, microscopic examination using histology, structural architecture, blood supply,
neuromuscular control, biomechanics, and conclusion. The aforementioned anatomical aspects, some of which have received less
attention in the literature, may be helpful to clinicians for restoring the mobility, stability, and load bearing capacity
of the lumbar spine as well as planning better management strategies, especially for the chronic low back pain.
Results In our article all the anatomical factors affecting the integrity of vertebral body, including the morphology, development,
genetics, growth and ossification, blood supply, specifically in the lumbar region, have been described, which were not covered
earlier. The limitations of this review is its wide dimensions; hence, there are fair scopes of missing many relevant facts,
as all of them cannot be compiled in a single article. We have attempted to confine our views to different anatomical domains
only, this is our second limitation. Additional studies are required to incorporate and discuss the uncovered relevant scientific
details.
Conclusions The integrity of the body of the lumbar vertebra is multifactorial (Fig. 8). The vast spectrum of the anatomical domain influencing it has been summarized. The evolution of erect posture is a landmark
in the morphology of human beings and the lumbar lordosis, which has also contributed to the gross design of the vertebral
body, is one of the most important adaptations for axial loading and bipedal movements. The role of metamerism in the evolution
of vertebrate morphology is repeated in the development of spine. The body of the vertebra is intersegmental in origin, which
results in dual vascular and nerve supply, both from superior and inferior aspects of the body of the lumbar vertebrae. The
vertebral body ossifies from three primary centers, one for centrum, which will form the major portion of body, and the other
two for neural arches. The cartilaginous growth plate is mainly responsible for the longitudinal vertebral growth. Regional
differentiation of the vertebral column, and the definite pattern of the structure of the different vertebra, is regulated
by a large number of genetic factors, including the Hox genes. The vertebral body design therefore provides the requirements
for optimal load transfer by maximal strength with minimal weight. Bone mineral density (BMD), bone quality, microarchitecture,
and material properties are the important factors that contribute to bone strength. BMD is highly heritable; bone mineral
distribution and architecture are also shown to be under strong genetic influence. All the aforementioned factors finally
integrate to ensure mainly the mobility, stability, and load bearing capacity of the lumbar spine. 相似文献
19.
Sadri H Pfander G Siebenrock KA Tannast M Koch P Fujita H Ballmer P Ganz R 《Archives of orthopaedic and trauma surgery》2008,128(8):869-877
INTRODUCTION: We report the results of a titanium acetabular reinforcement ring with a hook (ARRH) in primary total hip arthroplasty (THA), which was introduced in 1987 and continues to be used routinely in our center. The favorable results of this device in arthroplasty for developmental dysplasia and difficult revisions motivated its use in primary THA. With this implant only minimal acetabular reaming is necessary, anatomic positioning is achieved by placing the hook around the teardrop and a homogenous base for cementing the polyethylene cup is provided. MATERIALS AND METHODS: Between April 1987 and December 1991, 241 THAs with insertion of an ARRH were performed in 178 unselected, consecutive patients (average age 58 years; range 30-84 years) with a secondary osteoarthrosis in 41% of the cases. RESULTS: At the time of the latest follow-up, 33 patients (39 hips) had died and 17 cases had been lost to follow-up. The median follow-up was 122 months with a minimum of 10 years. Eight hips had been revised, leaving 177 hips in 120 living patients without revision. Six cups were revised because of aseptic loosening. Two hips were revised for sepsis. The mean Merle d'Aubigné score for the remaining hips was 16 (range 7-18) at the latest follow-up. For aseptic loosening, the probability of survival of the cup was 0.97 (95% confidence interval, 0.94-0.99). However, analysis of radiographs implied loosening in seven other cups without clinical symptoms. CONCLUSIONS: The results of primary THA using an acetabular reinforcement ring parallel the excellent results of these implants often observed in difficult primary and revision arthroplasty at a minimum of 10 years. Survivorship is comparable to modern cementless implants. Medial migration that occurs with loosening of the acetabular component seems to be prevented with this implant. Radiographic loosening signs can exist without clinical symptoms. 相似文献
20.
Philip D. Ross James W. Davis Robert S. Epstein Richard D. Wasnich 《Calcified tissue international》1992,51(2):95-99
Summary It has been proposed that vertebral dimensions be used to objectively identify vertebral fractures, permitting standardization of methodology for comparisons between studies. In this report, we evaluate the ability of various vertebral dimensions and ratios to identify abnormal vertebrae. As no gold standard exists for prevalent vertebral fractures, we examined the ability of cross-sectional dimensions (at a single point in time) to detect fractured vertebrae that had been identified from changes in dimensions compared with previous radiographs. Theoretically, a cutoff of 3 SD below the mean will rarely misclassify normal vertebrae as fractured (specificity=99.9%). However, we found that this cutoff correctly identified only about 70% of the incident fractures. A less stringent criterion (2 SD below the mean; theoretical specificity=97.7%) identified about 85–90% of true fractures. Dividing by stature or other vertebral heights sometimes yielded marginal improvements in the ability of the anterior or posterior height dimensions to diagnose fractures. The results suggest that the true fracture prevalence may sometimes be substantially higher than suggested by cross-sectional vertebral measurements. 相似文献