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1.

Objectives

There are not many chances to arthroscopically reassess how graft tunnel malpositions in primary anterior cruciate ligament reconstruction (ACLR) associate with intra-articular degeneration in revision ACLR. This study was aimed to evaluate whether radiographic tunnel position in primary ACLR affect cartilaginous changes and bucket-handle meniscus tears in revision ACLR.

Methods

Thirty-five patients who underwent revision ACLR were recruited; their primary surgeries were single-bundle reconstructions. Tunnel positions were evaluated using the plain radiographs after primary surgery. The sagittal tunnel positions of the femur (FP) and tibia (TP) were determined on the lateral view. The articular cartilage was evaluated arthroscopically at primary and revision surgery using the International Cartilage Repair Society (ICRS) score. A progression of two grades was considered as cartilaginous changes. Meniscal tears were evaluated with an arthroscopic probe. Logistic regression analysis was conducted using the prevalence of cartilaginous changes or bucket-handle meniscus tears as the dependent variable; tunnel parameters were used as the independent variables.

Results

Seven patients (20.0%) had cartilaginous changes and nine patients (25.7%) had bucket-handle tears in the medial meniscus. In logistic regression analysis, %FP [odds ratio (OR): 1.212; P = 0.007] and the cut-off of 60% in the FP (OR: 22.000; P = 0.008) were correlated with cartilaginous changes. %TP (OR: 1.126; P = 0.036) was correlated with the prevalence of bucket-handle meniscus tears.

Conclusions

Anterior femoral tunnel malposition in the femur was associated with the cartilaginous changes, and posterior tibial tunnel malposition with the development of bucket-handle meniscus tears.  相似文献   

2.

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   

3.

Background

In this study, we investigated the responsiveness of the Self-Administered Foot Evaluation Questionnaire (SAFE-Q) for patient's assessment before and after hallux valgus surgery.

Methods

Patient-reported answers on the SAFE-Q and Short Form-36 (SF-36) before and at a mean of 3–4 and 9–12 months after hallux valgus surgery were analyzed. Data of 100 patients (92 women, eight men) from 36 institutions throughout Japan were used for analysis.

Results

In all subscales of the SAFE-Q, the trend of increased scores after surgery was statistically significant (P < 0.001). Among the patients with available scores both before and at 9–12 months after surgery (n = 66), the largest effect sizes (ESs) were observed for shoe-related (1.60), pain and pain-related (1.05), and general health and well-being (0.84) scales. In the SF-36 (n = 64), the largest ES was observed for the bodily pain scale (0.86). Less notable changes were observed for the remaining SF-36 domains.

Conclusion

The SAFE-Q is the first patient-reported outcome measure which includes a quality of life assessment of shoes. In our cohort, the most remarkable responsiveness was observed for the shoe-related subscale. Based on its responsiveness, the SAFE-Q appears to be sufficient for evaluation of foot-related quality of life before and after surgery.  相似文献   

4.

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   

5.

Background

The purpose of this study was to evaluate the clinical results, survivorship and quick rehabilitation effects of modified surgery of percutaneously drilling and decompression through femoral head and neck fenestration combined with compacted autograft for early femoral head necrosis.

Methods

We conducted a retrospective cohort study with 83 hips performed percutaneous decompression through femoral head and neck fenestration (Modified group) combined with autogenous bone grafting for early ONFH. For comparison, another 90 hips treated with conventional core decompression with bone grafting (Control group).

Results

Median follow-up was 36 months (32–44 months). The length of incision, blood loss in operation, incision drainage, operation time and hospital stays in Modified group had better results than those in control group (P < 0.001). There were four cases in Modified group and five cases in control group had complications (P = 0.9). The VAS score and range of hip motion were better in Modified group during hospital stays summarily (P < 0.05). The average Harris score in modified group was higher than the control group at the first month (P = 0.005), while at other time of follow-up the two groups were with similar Harris scores (P > 0.05). There were 22 hips progressed to stage III in Modified group, while 23 hips progressed to stage III in control group (P = 0.89). The clinical success rate in Modified group were 86.7%, compared with that in control group (87.8%) ( P= 0.84).

Conclusion

Percutaneous drilling and decompression through femoral head and neck fenestration combined with compacted autograft we reported showed an good surgical effect with a quick rehabilitation and had similar short-term effects compared with the conventional core decompression in treatment of early ONFH.  相似文献   

6.

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   

7.

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   

8.

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   

9.

Background

Tranexamic acid (TXA) has been associated with decreased blood loss and transfusion after total hip arthroplasty (THA) and total knee arthroplasty (TKA). The purpose of this study was to examine both transfusion utilization and the economic impact of a Process Improvement Project implementing TXA for THA and TKA.

Methods

After standardization of TXA administration in THA and TKA patients, retrospective data were compared from 12 consecutive months before (group A, n = 336 procedures) and after (group B, n = 436 procedures) project initiation.

Results

TXA administration increased with project implementation (group A = 3.57%, group B = 86.01%) and was associated with reductions in perioperative hemoglobin decrement (20.2%), patients transfused (45%), and number of units transfused per patient (61.9%). Cost savings were notable per patient ($128) and annually program wide ($55,884) with the primary THA subgroup contributing the most to the savings. No increase in adverse effects was observed.

Conclusion

Standardized administration of TXA is an effective and economically favorable blood-reduction strategy for patients undergoing elective THA or TKA. Although reduction in transfusions with TXA may be greater after TKA, the economic and clinical impact of transfusion reduction is more substantial in THA patients.  相似文献   

10.

Introduction

Isolated microscopic hematuria (IMH) is not uncommon in potential kidney donors.

Aim

The aim was to study the kidney biopsy findings of potential kidney donors with IMH and the impact of the histopathologic diagnoses on the decision to accept or decline such donors from kidney donation.

Methods

In this retrospective study, all the potential kidney donors with IMH were identified from the medical records of patients who underwent kidney biopsies between January 2010 and December 2016.

Results

Forty-five such individuals were identified. The mean age of these potential donors was 32.6 years and 76% were male. All of them had normal blood pressure and no significant proteinuria. Seventeen (38%) biopsies showed histopathologic abnormalities; thin basement membrane disease (n = 13; 28%) was the most common cause followed by immunoglobulin (Ig)A nephropathy (n = 4; 9%). Donors with abnormal biopsy findings were excluded from donation. However, 62% of the potential donors had normal kidney biopsy findings and were accepted for kidney donation.

Conclusion

IMH justifies extensive work-up including kidney biopsy to identify donors who may have underlying significant glomerular pathology excluding them from kidney donation. On the other hand, kidney biopsy also helps in accepting the donors if it does not show significant abnormality.  相似文献   

11.

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   

12.

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   

13.

Background

Locomotive disorders are one of the main causative pathologies for the condition requiring assistance on activities of daily living (ADL). Although psychological concerns such as feeling of depression and anxiety are prevalent in elderly people, the causal relation among motor function, ADL disability, and psychological concerns is controversial.

Purpose

Purpose of this study was to investigate causal relationship among motor function, ADL disability, and psychological concerns in elderly people with locomotive disorders.

Methods

The data for this study were from a community-dwelling sample of 314 elderly persons with locomotive disorders aged 65 and older who visited orthopedic clinics and/or affiliated institutions. Motor function was assessed by one-leg standing time with eyes open, leg extension power and grip power. We assessed ADL disability using the 25-question Geriatric Locomotive Function Scale (GLFS-25), and psychological concerns by three self-reported questions. We constructed two models and tested fitness of the models to the data using a structural equation modeling (SEM). Model 1: motor function affects ADL disability and ADL disability affects psychological concerns, Model 2: motor function affects psychological concerns and psychological concerns affects ADL disability.

Results

The fit indices were chi-square = 23.152 (p = 0.081), RMSEA = 0.042, GFI = 0.981, AGFI = 0.955, CFI = 0.987 for Model 1, and chi-square = 84.583 (p < 0.001), RMSEA = 0.119, GFI = 0.935, AGFI = 0.854, CFI = 0.892 for Model 2. These fit indices indicated a good fit of the model 1 and inadequate fit of model 2 to the data.

Conclusion

Decline of motor function contributed toward psychological concerns via ADL disability in elderly people with locomotive disorders.  相似文献   

14.

Objective

As vascular procedures become more complex, patient understanding of their treatment(s) can become more difficult. We wished to evaluate the utility of multimedia presentations (MPs) to improve patient understanding of their vascular interventions.

Methods

Patients undergoing endovascular aneurysm repair (EVAR), peripheral angioplasty, Hickman catheter and peripherally inserted central catheter (PICC) insertion were randomized into a control group receiving traditional verbal consent, and a MP group that were shown a two minute simplified video of their procedure on an iPad? computer in addition to the traditional verbal consent. After obtaining consent, all patients completed a questionnaire assessing their comprehension of the procedure, and satisfaction with the consent process. Satisfaction was rated on a 5 point Likert scale with 5 being ‘very helpful’ in understanding the procedure.

Results

Ninety-three patients were recruited for this study, 62% of which were male. The intervention significantly increased total comprehension in all procedure types controlling for procedure type (multimedia vs. control; F = 9.14, P = .003). A second ANOVA showed there was a significant main effect by intervention (F = 44.06, p < .000) with those in the intervention group showing higher overall satisfaction scores after controlling for surgery type.

Conclusion

This study suggests that patients find the use of MP during the consent process to be helpful in patient understanding and that there is improved satisfaction. Given the rapid rate of innovation in vascular interventions, increased regular use of MPs to help patients understand their procedures would be beneficial in the care of patients undergoing vascular interventions.  相似文献   

15.

Backgrounds

There have been many reports describing that the capsular fibrosis of the shoulder joint is the main cause of frozen shoulder, whereas others reported the significance of subacromial impingement as an etiological factor. The purpose of this study was to investigate the contact pressure between the coracoacromial arch and the rotator cuff tendons to clarify the contact phenomenon in shoulders with joint contracture.

Methods

Fourteen fresh-frozen cadaveric shoulders were used. Specimens were divided into two groups: normal group (8 shoulders, definition: more than 61° of flexion and abduction and more than 21° of external rotation) and joint contracture group (6 shoulders, definition: less than 60° of flexion and abduction and less than 20° of external rotation). Contact pressure and area beneath the coracoacromial arch were measured by a flexible force sensor during flexion, abduction, internal and external rotation in adduction and abduction, extension and horizontal extension motions.

Results

The peak contact pressure under the acromion was observed at 90° in flexion and abduction in the normal group, whereas that in the contracture group was observed at 30° in flexion (P = 0.037) and at 30° in abduction (P = 0.041). Contact pressure in the contracture group was significantly higher than that in the normal group at 20° and 30° of abduction (P = 0.043, P = 0.041, respectively). There were no significant differences of contact pressure during other motions. Although no significant differences of contact pressure beneath the coracoacromial ligament were observed, contact area significantly increased in extension and horizontal extension motion.

Conclusion

The contact between the acromion and the rotator cuff was observed in lower angles of flexion and abduction in shoulders with contracture than in those without. When treating patients with shoulder contracture, we need to perform rehabilitation taking such an abnormal movement into consideration.  相似文献   

16.

Background

Proximal tibia arthroplasty is associated with high rates of infection. This study is the largest one that has compared the infection rates with titanium vs silver-coated megaprostheses in patients treated for sarcomas.

Methods

The infection rate in 98 patients with sarcoma or giant-cell tumor in the proximal tibia who underwent placement of a titanium (n = 42) or silver-coated (n = 56) megaprosthesis (MUTARS) was assessed, along with the treatments administered for any infection.

Results

As the primary end point of the study, the rates of infection were 16.7% in the titanium group and 8.9% in the silver group, resulting in 5-year prosthesis survival rates of 90% in the silver and 84% in the titanium group. Whereas in the titanium group 37.5% of patients ultimately had to undergo amputation in the present study, these mutilating surgical procedures were only necessary in the silver group in one patient (14.3%).

Conclusion

The use of silver-coated prosthesis reduced the infection rate in a relatively large and homogeneous group of patients. In addition, less-aggressive treatment of infection was possible in the group with silver-coated prosthesis.  相似文献   

17.

Objectives

Using a strategy of placing a surgical drain after kidney transplantation, the duration of a lymphatic fluid leakage and prevalence of a symptomatic lymphocele were retrospectively analyzed. The risk factors for persistent lymphatic fluid leakage or asymptomatic lymphocele were evaluated using multivariate analysis to estimate the origin of the lymphatic fluid leakage.

Materials and methods

Patients with persistent lymphatic fluid leakage and symptomatic lymphocele were defined as those with lymphatic fluid drainage >50 mL for more than 15 days and those who required a percutaneous drainage of the lymphocele, respectively.

Results

Persistent lymphatic fluid leakage and symptomatic lymphocele were observed in 40 (16.4%) and 10 (4.1%) of a total of 244 patients, respectively. The maximum durations of lymphatic fluid drainage from the initial drain tube and the second drainage of the symptomatic lymphocele were 48 and 28 days, respectively. Anastomosis of the graft artery to the external iliac artery was an independent risk factor to predict persistent lymphatic fluid leakage or symptomatic lymphocele after kidney transplantation (odds = 2.597, P = .008).

Conclusion

The findings of the study suggest that the lymphatic fluid originates from the recipient's iliac lymph trunk rather than from the graft kidney.  相似文献   

18.

Objective

Medial radial displacement (MRD) of the medial meniscus is a feature proving a dysfunction in the medial meniscus in osteoarthritis (OA) of the knee. MRD was measured in radiographic pre-OA knee and early osteoarthritis of the knee (early-OA) longitudinally using ultrasound (US) to investigate the characteristics involved in the onset and progression of OA.

Methods

Fifty-five patients with pain on the medial side of the knee participated in the present study. It was possible to follow-up 46 patients for 5 years, and, thus, they were divided into 32 pre-OA patients (female: 59%, mean age: 69.0 years) and 14 early-OA patients (female: 78%, mean age: 74.4 years) based on radiography at the baseline time-point. MRD was measured in standing and supine positions at baseline and after 1 and 5 years using US. MRD corrected with the skeletal size, i.e., the medial displacement index (MDI), was analyzed. The pre- and early-OA groups were divided into subgroups at 5 years: stable and OA progression groups, following the Kellgren/Lawrence classification, and ⊿MDI (gap of the MDI between the standing and supine positions) were retrospectively compared between the subgroups at baseline, 1 and 5 years.

Results

In the overall pre-OA group, MDI increased by 7% and 10% at 5 years in the supine and standing position, showing a significant increase (P = 0.044, 0.0147). ⊿MDI was significantly greater in the subgroup with OA progression in the pre- and early-OA groups (P = 0.02 and 0.03, respectively), and was continuously 6–7% in the pre-OA progression group, showing that the displacement rate was 2-fold or higher than in the stable group.

Conclusion

An increase in ⊿MDI on US may be an important risk factor for the disease stage progression of OA and useful as a feature predicting the onset of radiographic knee OA.  相似文献   

19.

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   

20.

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   

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