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1.
Shunichiro Kambara Hiroshi Nakayama Motoi Yamaguchi Akio Matsumoto Ken Sasaki Kaori Kashiwa Tomoya Iseki Shinichi Yoshiya 《Journal of orthopaedic science》2017,22(3):481-487
Purpose
To comparatively analyze the geometry of the posterolateral femoral (PL) tunnel in double-bundle ACL reconstruction between far anteromedial transportal (TP) and outside-in (OI) drilling techniques based on three-dimensional computed tomography (3DCT) image analysis.Methods
Forty patients who underwent anatomic double-bundle hamstring ACL reconstruction using the TP (n: 20) or OI (n: 20) method with postoperative CT data available were included in the study. The analyzed parameters were as follows: location of the intraarticular tunnel aperture, tunnel length, bending angle (angulation of the graft at the intraarticular tunnel aperture), and long axis of the tunnel aperture/drill diameter ratio as a parameter of ellipsoidal geometry.Results
Anatomical tunnel placement was achieved in both groups. Coalition of the AM and PL tunnel apertures was found in 3 knees in the TP group and 1 knee in the OI group, though no significant difference in the rate of this problem was demonstrated between the groups (P: 0.30). The tunnel length was not significantly different between the groups, while the graft bending angle at the tunnel aperture was significantly larger in the OI group than the TP group (99.4° vs. 63.6°). The long axis/drill diameter ratio averaged 1.23 in the TP group and 1.13 in the OI group with significant intergroup difference.Conclusion
When drilling the PL femoral tunnel in double-bundle ACL reconstruction, anatomic placement of the intraarticular tunnel aperture was feasible in both the TP and OI techniques. The tunnel aperture was rounder and the graft bending angle in knee extended position at the intraarticular aperture was more acute in the OI technique than the TP technique.Level of evidence
Level IV (retrospective comparison of the two patient groups treated at different hospitals). 相似文献2.
Ahmed El-Bakoury Hazem Hosny Mark Williams Jonathan Keenan Rathan Yarlagadda 《The Journal of arthroplasty》2017,32(2):541-545
Background
Periprosthetic fracture following total hip arthroplasty is a significant problem faced by hip surgeons, and its management in elderly patients remains a considerable challenge.Methods
We retrospectively reviewed 28 Vancouver B2 and B3 periprosthetic femoral fractures (PFF) treated with revision of the femoral stems by distally locked, hydroxyapatite-coated uncemented stems (Cannulok). Patients were aged 75 years or older at the time of surgery.Results
The mean follow-up was 44.6 months (range, 24-102). The mean postoperative Oxford hip score was 30.1 (range, 10-46). The rate of fracture union was 95.8%, and the survivorship of the stem was 100% at the end of follow-up.Conclusion
The management of PFF in elderly is associated with increased postoperative morbidity and mortality. The use of a distally locked, hydroxyapatite-coated femoral stem is a valid option for the treatment of PFF to achieve fracture union with a low rate of revision. 相似文献3.
M. Lejman K. Drabko B. Styka D. Winnicka M. Babicz I. Jaszczuk J.R. Kowalczyk 《Transplantation proceedings》2017,49(8):1903-1910
Background
In the light of an increasing number of hematopoietic stem cell transplantations and more frequent use of reduced-intensity conditioning as preparative regimens for hematopoietic stem cell transplantation, post-transplant cell chimera monitoring is considered a necessity.Methods
The quantitative fluorescence polymerase chain reaction method, along with the commercial AmpFSTR SGMPlus kit, was applied in research on hematopoietic chimeras.Results
The total of 102 patients who had undergone allogenic transplantations were investigated. Chimerism monitoring was commenced on the seventh day after transplantation and lasted up to 12 years in some cases, according to the instituted schedule.Conclusions
The kit has been shown to be fully sufficient for determining genetic profiles of recipients and donors and selecting informative markers. The method has been proven effective and satisfactory for assessing quantitative chimeras. 相似文献4.
Z. Wu S. Zhang L. Zhou J. Cai J. Tan X. Gao Z. Zeng D. Li 《Transplantation proceedings》2017,49(7):1656-1658
Objective
To investigate the thromboembolism induced by blood-mediated inflammatory reactions against infused cells during the clinical application of stem cells.Methods
Two patients with renal transplantation and chronic kidney disease, respectively, experienced thromboembolism after umbilical cord mesenchymal stem cell (UCMSC) infusion. The clinical manifestations and the laboratory test results were collected and analyzed.Results
The patients received stem cell infusion through the peripheral veins and presented with a swollen and painful forearm postinfusion. Doppler ultrasound showed venous clots at the proximal end of the puncture site. Urokinase and warfarin were used for thrombolytic therapy. The swelling and pain were relieved and cured.Conclusion
Safety concerns are still a primary hurdle for stem cell therapy, and thromboembolism as a critical complication should be prevented appropriately. 相似文献5.
E.C. Ataide S.R. Perales M.G. Silva F.C. Filho A.C. Sparapani P.F. Latuf Filho R.S.B. Stucchi J. Vassallo C.A.F. Escanhoela I.F.S.F. Boin 《Transplantation proceedings》2017,49(4):858-862
Background
Hepatocellular carcinoma (HCC) is the 6th leading cause of cancer worldwide. Its recurrence ranges from 6% to 26%. In the literature, many factors are associated with higher risk of recurrence, without a clear definition of the best method that could predict this highly lethal event.Objective
The aim of this study was to evaluate the immunoexpression of immunohistochemical markers: HSP70, glypican 3, glutamine synthetase, and beta-catenin, as well as studying their association with tumor characteristics and prognosis of patients undergoing liver transplantation for HCC.Methods
We studied 90 patients who underwent liver transplantation from 1998 to 2012. Afterwards we evaluated factors related to survival, tumor recurrence, and the correlation of expression of the immunohistochemical markers.Results
Immunohistochemical marker glutamine synthetase showed a positive trend toward better survival. HSP70-positive patients had a higher prevalence of histologic grade III. Patients with positive glypican 3 showed larger lesions and a higher number with AFP >200 ng/mL. Patients with positive beta-catenin showed larger nodules and more with histologic grade III. The association between beta-catenin and glypican 3 showed positive association with larger nodules.Conclusions
Most of the markers studied had a correlation with at least one of the variables studied, confirming our hypothesis that these markers can indeed assist in assessing the prognosis of patients undergoing liver transplantation for HCC. 相似文献6.
W.M. Bennett E.L. Simonich A.M. Garre K.M. McEvoy M.A. Farinola T.D. Batiuk 《Transplantation proceedings》2017,49(8):1779-1782
Introduction
Between January 2013 and September 2015, 135 consecutive renal transplant patients were screened prospectively with ultrasound for renal cell carcinoma (RCC).Results
Eighteen ultrasound abnormalities were identified with 4 solid lesions detected. Fifty-six other patients were screened retrospectively by referring nephrology groups, with 6 additional malignancies found.Conclusion
As a result of our data, we recommend and have instituted annual ultrasound screening of native kidneys in all renal transplant patients. 相似文献7.
Background
De novo gastric cancer is a rare complication of liver transplantation.Methods
Surgical treatments of 16 cases with different outcomes were reported in the English literature.Results
De novo gastric cancer (stage II) was diagnosed as the result of epi-gastric discomfort in a recipient 10 years after liver transplantation. The patient received chemotherapy alone and remained well for 26 months.Conclusions
De novo gastric cancer of liver transplantation recipients is a severe complication; early detection and relevant intervention will benefit these recipients. 相似文献8.
Vincent V.G. An Brahman S. Sivakumar Kevin Phan Yadin David Levy Warwick J.M. Bruce 《Journal of orthopaedic science》2017,22(1):116-120
Introduction
The technical objective of total knee arthroplasty (TKA) is to restore normal mechanical parameters to the knee. Patient-specific instrumentation (PSI) was developed to streamline the operative process and improve accuracy. PSI produces individualized cutting guides based on three-dimensional models of the patient's anatomy acquired from computed-tomography (CT) or magnetic-resonance imaging (MRI). However, the superiority of one modality over the other remains unclear. Therefore, we aimed to compare the accuracy of patient-specific cutting guides produced from MRI or CT imaging methods in TKA.Methods
Electronic databases were systematically searched using relevant keywords and MeSH terms for original-data English-language publications comparing the accuracy of CT and MRI-based PSI cutting guides in TKA. Data was extracted from the text, tables and figures of studies and meta-analysed.Results
MRI-based PSI cutting guides produced a lower proportion of coronal plane outliers (>3°) with regard to overall limb mechanical axis (OR 2.75, p = 0.01). There were no significant differences between the two in terms of sagittal femoral and tibial component placement, or coronal femoral and tibial placement, or femoral component axial rotation. Tibial rotation was not analysed in the literature.Conclusions
MRI-based patient-specific cutting guides produced a lower proportion of outliers in the overall coronal alignment of the limb compared to CT, with no significant difference between the two in terms of femoral or tibial component placement. Future studies should investigate the differences in resource usage and operative time between the two to inform surgeons' decision making when choosing an ideal imaging modality for PSI TKA.Study design
Meta-analysis.Level of evidence
III, systematic review of cohort and comparative studies. 相似文献9.
Teng Lijia Zeng Rui-Xi Gong Long Chen Lei Liu Yujie He Jin-Yun Wang Zhen-Hu 《Journal of orthopaedic science》2017,22(5):880-885
Background
The interaction between patients is rather important source of information about surgery and recovery. Patients always prefer particularly to compare themselves with others of relatively similar ability, opinion and situation. Exploration of patients' dyads, however, is rare and needs further elaboration as to the significance of fellow patients. This study was designed to determine in whether and how preoperative assignment affects TKA's results.Methods
We assessed early post-operative outcomes in a cohort of 520 TKA patients. Preoperative, and postoperative outcome measures at 6-months following TKA were analyzed and compared between patients who were hospitalized with a roommate whose surgical status was either similar (preoperative) or dissimilar (postoperative) and whose type of surgery was either similar (TKA) or dissimilar (THA). Mean scores, and postoperative change in scores were calculated. Outcome measures evaluated included WOMAC, SF-36, patient affiliation, preoperative anxiety, expectation and analgesic consumption, length of hospital stay.Results
patients were more willing to have serious conversations with roommates whose surgical status was dissimilar (postoperative) and whose type of surgery was similar (TKA). And their SF-36 and WOMAC scores to be significantly improved better. Besides, they were released from hospital more quickly and showed significantly less preoperative anxiety.Conclusions
We recommend implementation of an assignment policy that patients prior to TKA should be assigned into a postoperative roommate undergoing TKA as well. 相似文献10.
Hwa-Chang Liu Wen-Tien Wu Kai-Chiang Yang Kuang-Ting Yeh Shoichiro Sumi Chen-Chie Wang 《Journal of orthopaedic science》2017,22(3):506-511
Background
Rotational alignment of the distal femur is important in total knee arthroplasty. The purpose of this study is to use a roentgenographic technique to evaluate the accuracy of mini-incision total knee arthroplasty (MIS TKA) performed based on the transepicondylar line from the kneeling view.Methods
Totally 32 patients (aged from 64 to 80 years with an average of 70.9 years) with 46 cases of knee osteoarthritis received MIS TKA were registered. Before surgery, the condylar twist angle was measured from the kneeling view. The bone cut for the external rotation was completed, with regard to the condylar twist angle. The control group including 26 patients (aged from 50 to 89 years with an average of 69.7 years) with 42 cases of knee osteoarthritis underwent TKA with built-in cutting jig design 3 degrees of femoral external rotation. This study is a prospective continuous-time duration analysis study. The level of evidence is IIc.Results
The mean condylar twist angle was 5.1° in the experimental group and 5.4° in the control group. The mean postoperative angle between the clinical epicondylar axis and the posterior condylar line of the femoral component was 0.46°. The same postoperative angle of the built-in external rotation in the control group was 2.7°. The condylar twist angle was significantly more accurate than the built-in design.Conclusion
Our result substantiates that the kneeling view is practicable and reproducible as the cutting reference for femoral external rotation. The accuracy of the kneeling view shows that the epicondylar axis can be used in smaller wound surgery, such as MIS TKA.Level of evidence
Level IIc. 相似文献11.
Objective
The objectives of this study were to analyze the potential correlation between post–liver transplantation survival interval and CD4+ T-cell intracellular ATP (iATP) levels, and to describe the distribution of CD4+ T-cell iATP levels in liver transplant recipients.Methods
This was a retrospective analysis of clinical data of 273 patients who underwent liver transplantation from July 2010 to October 2012 in our center and achieved long-term stable survival. CD4+ T-cell iATP level was detected using Cylex ImmuKnow assay. Post–liver transplantation survival was analyzed.Results
CD4+ T-cell iATP level significantly differed among patients with different post–liver transplantation survival intervals. The peak CD4+ T-cell iATP levels typically occurred within the first 3 postoperative months.Conclusions
Post–liver transplantation survival interval is correlated with CD4+ T-cell iATP levels. 相似文献12.
Monther A. Gharaibeh Gandhi N. Solayar Ian A. Harris Darren B. Chen Samuel J. MacDessi 《The Journal of arthroplasty》2017,32(3):777-782
Background
Accelerometer-based, portable navigation devices have been introduced as a less invasive and simpler technique to perform navigated surgical implantation of knee prostheses. They have been postulated to have better accuracy than conventional instruments in restoration of alignment in total knee arthroplasty.Methods
A total of 190 patients were enrolled in this prospective, randomized controlled trial and underwent total knee arthroplasty using either the KneeAlign or conventional guides. Multiplanar alignment was evaluated with a CT imaging protocol.Results
A total of 86.5% of portable navigation device and 82.2% of conventional group had a postoperative hip–knee angle within 3° of neutral alignment (P = .54). There was no significant difference between the 2 groups for component coronal and sagittal plane alignment. Portable navigation device did not significantly increase the time to perform the surgery.Conclusion
Portable navigation device demonstrates accurate restoration of alignment; however, there was no statistically significant difference when compared with conventional guides. 相似文献13.
Eijiro Okada Takashi Tsuji Kentaro Shimizu Masanori Kato Kentaro Fukuda Shinjiro Kaneko Jun Ogawa Kota Watanabe Ken Ishii Masaya Nakamura Morio Matsumoto 《Journal of orthopaedic science》2017,22(1):3-9
Purpose
To clarify correlations between spinal fracture and delayed paralysis in patients with diffuse idiopathic skeletal hyperostosis (DISH) using computed tomography (CT) with multiplanar reformatting (CT-MPR). DISH increases susceptibility to unstable spinal fractures, leading to neurological deterioration. The pathomechanism of the neurological injury is unclear.Methods
This multicenter retrospective study included 42 DISH patients (32 male; 10 female) treated for 45 spinal fractures during a 5-year period. The mean age at the time of injury was 77.1 ± 10.1 years. The cause of injury, delay in diagnosis, fracture location, and neurological status were recorded, and anterior- and posterior-column fractures, a fracture displacement over 3 mm, and posterior-column ankylosis were assessed using CT-MPR.Results
Most fractures (73.8%) resulted from trivial trauma, such as falling from a standing or sitting position. Diagnosis was delayed in 47.6% of the patients, primarily due to delays in seeking medical attention (65.0%). Although 78.6% of the patients were neurologically intact at the time of injury, 54.8% developed paralysis, defined by a change in one or more Frankel-score levels during short-term follow-up. Of the fractures, 39.1% were in the vertebral body, and 60.9% were at the disc level. Fractures with posterior-column ankylosis were significantly associated with delayed paralysis.Conclusions
CT-MPR was useful for evaluating spinal fractures and determining treatment in patients with DISH. Fractures associated with posterior-column ankylosis resulted in unstable three-column injuries that led to delayed neurological deterioration. Early surgical stabilization of such fractures is recommended to avoid delayed paralysis. 相似文献14.
Carlos Torrens Fernando Santana Raquel Marí Lluis Puig Albert Alier 《Journal of orthopaedic science》2017,22(5):858-861
Background
The objective of the study was to determine the normalization curve of the serum C-reactive protein (CRP) in elective shoulder arthroplasty.Methods
A prospective study including 58 consecutive patients who had undergone elective shoulder arthroplasty. Forty-one patients had received a Reverse Shoulder Arthroplasty, 13 a Total Shoulder Arthroplasty and 4 a Hemiarthroplasty. Based on a pilot study, blood samples to determine CRP values were obtained at baseline (1 h before surgery), on the 1st, 2nd, 6th, 8th and 14th postoperative days. All the patients included presented no postoperative complications during inpatient stay or any re-admission during the three months after surgery.Results
Mean CRP values showed a rapid increase on the 1st postoperative day (7-fold higher than the baseline in cuff tear arthropathy, 11-fold higher in primary osteoarthritis, 1-fold higher in acute fracture) and reached a peak on the 2nd postoperative day (14-fold higher than the baseline in cuff tear arthropathy, 24-fold higher in primary osteoarthritis and 2-fold higher in acute fracture). After the 2nd postoperative day CRP values began to slowly decrease reaching the normal range in the 14th postoperative day.Conclusions
Serum CRP levels after elective shoulder arthroplasty rapidly increase to reach a maximum peak after the 2nd surgery day and then slowly decrease to return to normality on the 14th day. Knowing the normalization curve of CRP can be a helpful tool to help in the diagnosis of acute infections in elective shoulder arthroplasty. 相似文献15.
Background
The Meridional Hospital Liver transplant unit is the only one active in all Espírito Santo State, Brazil, since 2004.Objective
The aim is to analyze data of the first 250 transplants performed by the team.Methods
This retrospective study reviewed files from patients transplanted in the Meridional Hospital from January 2005 to December 2015.Results
There were 250 liver transplants in 236 patients and 14 retransplants. 72.4% were male recipients, with average age of 51.1 years (1–70 years), and the main etiology was alcoholic cirrhosis (33.6% of the cases). Surgical reintervention occurred in 58 patients (include retransplantations) during the same hospitalization, with revision of homeostasis and retransplant as main indications. In the retransplant group, 73.3% of patients died within 2 months. Thrombosis of the hepatic artery was responsible for 40% of the indications for retransplant. The average time between first and second transplant was 223 days (median 14 days). Currently 152 of 236 patients are living, with 1-year life expectancy of approximately 71%. The mortality peak occurred from the immediate postoperative period to 2 months post-transplant (63.8% of the deaths). 32% of subjects did not need intraoperative blood transfusion. The average time of intensive care unit stay was of 8.52 days, and overall hospital stay was 21.7 (median 15 days).Conclusion
Despite the logistic difficulties and lack of donors our unit, keep in advance with survival comparable to other national centers (68% to 74% in 1-year). 相似文献16.
Shigeo Fukunishi Shoji Nishio Yu Takeda Tomokazu Fukui Yuki Fujihara Shohei Okahisa Shinichi Yoshiya 《Journal of orthopaedic science》2017,22(5):898-904
Background
The number of hemodialysis patients has been progressively increasing in our country. On the other hand, chronic hip arthropathy associated with long-term hemodialysis is a devastating problems affecting patients' quality of life. In our previous study, we proposed a classification system for radiological abnormalities seen in hemodialysis-related hip lesions. The purpose of the study was to propose the surgical strategy for hip disorders caused by long-term hemodialysis.Methods
Patients with a history of hemodialysis for more than 10 years, 191 hip lesions in 165 consecutive patients who visited our institute due to hip symptoms. Various abnormalities were identified in 116 out of 191 hips. A retrospective assessment of the patient record and radiographs was performed for the included subjects examining the natural course of the disease process as well as the results of surgical treatment.Results
Seventy-six hip lesions (69.0%) were conservatively managed at the time of the initial visit. Surgeries were performed for 75 hips (64.7%) during the study period. Among those, surgical treatment was indicated for 40 hips at the time of the initial visit. On the other hand, surgeries were performed for 35 hips during the subsequent follow-up period due to progression of the disease process.Conclusions
Based on the analysis of our surgical experiences by the retrospective chart review, we have established a flowchart of the treatment strategy for chronic hip arthropathy in long-term hemodialysis patients.Study design
This study is retrospective clinical study. 相似文献17.
C. Karaca C. Yilmaz R. Ferecov Z. Iakobadze K. Kilic L. Caglayan S. Aydogdu M. Kilic 《Transplantation proceedings》2017,49(8):1841-1847
Background
Venous reconstruction in living-donor liver transplantation for Budd-Chiari syndrome (BCS) has challenges because the grafts from living donors lack vena cava, and hepatic venous anastomosis must be performed on an already-thrombosed and/or stenosed inferior vena cava. Several techniques are described to overcome this problem, and we represent our experience with 22 patients.Methods
Medical recordings of 22 patients were retrospectively collected, and disease-specific data as well as recordings about surgical technique were analyzed.Results
Creation of a wide, triangular de novo orifice was the main method used for venous drainage, which was used in 19 patients. The remaining 3 patients had totally thrombosed vena cava; thus, direct anastomosis to the supra-hepatic portion of the vena cava was used in 2 patients and an anastomosis to the right atrium was used in 1 patient.Conclusions
Venous reconstruction in BCS can be achieved without the use of patch-plasty, and the inferior vena cava can be safely resected in selected patients. Living-donor liver transplantation is a feasible option for the treatment of BCS, considering the scarcity of cavaderic donors. 相似文献18.
Akira Yoshiyama Takeshi Morii Michiro Susa Hideo Morioka Eisuke Kobayashi Naofumi Asano Tomoaki Mori Ukei Anazawa Itsuo Watanabe Katsuhito Takeuchi Yu Kushima Takayuki Aoyagi Shoichi Ichimura 《Journal of orthopaedic science》2017,22(5):924-930
Background
Surgical treatment for renal cell carcinoma metastases can be an effective modality for improving survival and patients' quality of life. However, it is often difficult to decide on the optimal surgical approach due to the lesion's high vascularity and uncertainty regarding postoperative performance status and survival.Patients and methods
Blood loss, postoperative performance status, overall survival, postoperative complication and related risk factors for surgical treatment were analysed in 61 renal cell carcinoma patients with bone metastases.Results
Pelvic location and impending/pathological fracture in the metastatic lesion were both significant risk factors for increased blood loss. An unresectable primary lesion and poor preoperative performance status were independent risk factors for poor postoperative performance status. A shorter duration from the discovery of primary lesion to bone metastasis, the number of metastases, and unresectable primary lesion were independent risk factors for shorter survival. Postoperative complications were identified in 15 cases (24.6%).Conclusion
The preoperative prediction of intraoperative blood loss, performance status and survival in renal cell carcinoma patients with bone metastases may be possible based on the risk factors identified in this study. 相似文献19.
Background
Percutaneous vertebroplasty has been widely applied in the treatment of osteoporotic vertebral compression fractures over the past two decades. However as one of the major complications, the rate of cement leakage seems not to be decreased significantly. In this study, the rate of cement leakage was compared between two groups using two different cement injection cannulas. The purpose was to determine the efficacy of side-opening cannula on preventing cement leakage in vertebroplasty for the treatment of osteoporotic vertebral compression fractures.Methods
A retrospective study was conducted from January 2013 to December 2015. Totally 225 patients who received bilateral vertebroplasty due to osteoporotic vertebral compression fractures were included in the study. The patients were divided into test group who received vertebroplasty with side-opening cannulas and control group who received vertebroplasty with front-opening cannulas. The patients' medical records were reviewed to determine the bone marrow density, preoperative vertebral compression ratio, preoperative and postoperative VAS, operation time, volume of injected bone cement, rate of cement leakage. Post-operative X-rays and CT scans were utilized to assess the degree of Cement leakage. Comparisons between groups and clinical results on VAS in each group were analyzed with appropriate test.Results
All the patients were performed successfully without symptomatic complications. The back pain was significantly relieved after operation in both groups (P < 0.05). At 6 days and 6 months follow-up, there was no significant difference in the mean VAS score between the two groups (P > 0.05). The rate of cement leakage in the test group was significantly lower than that in the control group (P < 0.05).Conclusion
Percutaneous vertebroplasty with side-opening cannula is a safe and effective minimally invasive method in the treatment of osteoporotic vertebral compression fractures, the rate of cement leakage can be significantly reduced by redirecting the cement flow. 相似文献20.