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61.
《Journal of Clinical Orthopaedics and Trauma》2021,12(6):983-988
PurposeInjuries of both pelvic ring and acetabulum as rare very few articles are available in literature. There are no set protocols in defining the injury let alone defining early and definitive management strategies. This article is an attempt to encompass all available data to give us guidelines in managing these injuries.MethodsAn extensive literature review was carried out on PubMed/Medline, google scholar and Embase databases was done with the eligibility criteria of 1) Case series with a minimum of 20 cases. 2) The patient’s outcome reported. 3) Full article available. 4) Article in English. 5) Minimum Jadad score of 3. As per PRISMA guidelines the search was done and gradually filtered down to relevant articles which were 8 in number.ResultsThe incidence of these injuries range from 5 to 16%. The transverse acetabular fracture pattern is the commonest followed by associated both column fractures. There is equal propensity of Anteroposterior compression and lateral compression injuries. The injury mechanism appears to transmitted lateral force from the greater trochanter inwards with an implosion injury causing acetabular and pelvic injury as a continuum. The initial management is similar to managing pelvic ring injuries with focus on patient resuscitation, hemodynamic stabilization and temporary stabilization. The injury severity score and the mortality rates are comparable to isolated unstable pelvic ring injuries. Definitive management focuses on fixing the posterior pelvic ring first followed by the acetabular fracture and then the anterior pelvic ring. The displacement rates and outcome is worse than isolated acetabular injuries or pelvic injuries.ConclusionCombined Pelvic and acetabular injuries are complex injuries which need to be managed initially as we manage pelvic injury and later as we fix as an acetabular fracture meticulously. 相似文献
62.
63.
《中国现代医生》2020,58(31):130-133+141
目的 研究产褥感染的危险因素及常见致病微生物耐药情况,为临床治疗提供参考。方法 回顾性分析我院2017 年1 月~2019 年12 月发生的84 例产褥感染病例的临床资料,与同时期未发生产褥感染的200 例产妇进行对照研究,分析产褥感染的影响因素,并对分离获得的致病微生物进行耐药性分析。结果 感染组妊娠糖尿病、产钳助产、宫口开全后中转剖宫产患者的分布率高于对照组,差异有统计学意义(P<0.05);经多因素Logistic 回归分析,妊娠糖尿病是产褥感染的独立影响因素(P<0.05)。本研究中共检出致病微生物40 株,其中革兰阴性菌13 株(占32.50%),革兰阳性菌10 株(占25.00%),支原体16 株(占40.00%),衣原体1 株(占2.50%),革兰阴性菌中以大肠埃希菌最常见,对二代头孢菌素类抗生素耐药率20%。革兰阳性菌以金黄色葡萄球菌最常见,对青霉素及头孢菌素耐药率高,未发现对亚胺培南及万古霉素耐药。结论 产钳助产、妊娠糖尿病、宫口开全后中转剖宫产是产褥感染可能的危险因素,其中,妊娠糖尿病是产褥感染的独立危险因素。目前临床常见致病微生物谱及耐药率未发生明显变化。 相似文献
64.
65.
Subdental synchondrosis and anatomy of the axis in aging: a histomorphometric study on 30 autopsy cases 总被引:4,自引:4,他引:0
Matthias Gebauer Christian Lohse Florian Barvencik Pia Pogoda Johannes M. Rueger Klaus Püschel Michael Amling 《European spine journal》2006,15(3):292-298
During skeletal development the two ossification centers of the odontoid process are separated from the corpus of the axis by a subdental synchondrosis. This synchondrosis is thought to close and disappear spontaneously in adolescence although this has never been studied in detail. The basis of the dens is of clinical relevance as type II dens fractures are located here. To characterize the morphological architecture of the axis with particular attention to the subdental synchondrosis, the complete axis was harvested from thirty age-matched and gender-matched patients of the three different age groups at autopsy. The subdental synchondrosis and the bone structure of the dens, the basis of the dens and the body of C2 were analyzed by radiography, histology and quantitative histomorphometry. At the macroscopic level the persistency of the subdental synchondrosis in the adult cervical spine was detected in 87% (26 of 30) of the specimens. Histomorphometry revealed a residual disc blastema with an average size of 25.8% of the sagittal depth of the basis of the dens at this level. Bony integration of the synchondrosis was poor throughout all ages. Histologically a cartilaginous matrix composition of the subdental synchondrosis persisted throughout all groups. The trabecular microarchitecture demonstrated a significant reduction of bone volume and trabecular number as well as an increased trabecular separation within the basis of the dens as compared to the corpus or the dens of C2. This histomorphometric data regarding a poor integration of the synchondrosis into the trabecular network and the reduced bone mass within the basis of the dens might offer a previously underestimated explanation for the occurrence of type II dens fractures and their association with pseudoarthrosis, respectively.Matthias Gebauer and Christian Lohse contributed equally to this study and therefore share first authorship. 相似文献
66.
Salvage of a failed valgus osteotomy for nonunion
of an unstable pertrochanteric fracture is reported.
A valgus intertrochanteric osteotomy was performed for a
failed sliding hip screw fixation of an unstable
pertrochanteric fracture at another institution. Four months
following osteotomy, the fracture was still un-united with
two distal screws of the hip plate broken and a coxa vara
deformity. Reconstruction was performed with a nine-hole
95° angle blade plate and cancellous bone graft, because the
insufficient fixation of the distal fragment was considered to
be the main reason for failure. The osteotomy was healed at
six months post-surgery and the patient reported complete
resolution of symptoms. Intertrochanteric valgus osteotomy
is an effective procedure for mal-union and non-union of
pertrochanteric fracture but stable fixation is required for a
good result. The blade of the angle plate offers good purchase
of the proximal fragment and secures it under rotational
and bending stresses. We recommend that distal fragments
should be fixed with at least seven cortices for this
type of osteotomy. 相似文献
67.
Bone stock preservation is crucial when performing total hip replacement in young patients. The aim is to save good bone stock
for a possible revision procedure. Furthermore, there is an increasing demand from young and active patients to receive a
new joint which allows a normal or nearly normal life style. With this in mind, we began, in 1993, to develop a new femoral
implant. The purpose of this ultra-short stem was a physiologic strain distribution on the proximal femur with a proximal
load transfer from the implant to the femoral bone. Main features were an almost complete absence of the diaphyseal portion
of the stem, a well defined lateral flare with load transfer on the lateral column of the femur, and a very high femoral neck
cut. These innovations resulted in a conservative implant on both the bone stock and the soft tissues. This implant, in the
first years, was recommended only for young and active patients. Over the last thirteen years, this project has undergone
several modifications but the basic principles of the implant have remained the same. In the present review, we present the
rationale, the surgical technique and the clinical and experimental results so far obtained with this implant. 相似文献
68.
经皮椎弓根技术治疗胸腰椎骨折的临床探讨 总被引:2,自引:0,他引:2
目的:探讨微创经皮椎弓根螺钉内固定手术治疗胸腰椎骨折的可行性及其疗效。方法:20例胸腰椎骨折病例,男13例,女7例;年龄28~65岁,平均48·2岁。其中16例损伤平面以下无神经功能损害、无双下肢和大小便障碍;4例有不同程度的脊髓损伤,按Frankel分级:C级1例,D级3例。在C形臂X线的定位下确定需要固定的椎弓根根部,做4个1·5cm长的切口,固定与复位均在4个小切口内完成。结果:所有病例均获随访,时间9~18个月,平均15个月。术后患者椎体高度均有不同程度恢复,椎体后凸畸形获得不同程度矫正。手术时间约1·5h,出血量约80ml。结论:微创经皮椎弓根螺钉内固定手术操作简便、安全可靠,具有创伤小、出血少、疼痛轻、恢复快、住院时间短等优点。 相似文献
69.
70.
肱骨骨不连的手术治疗 总被引:4,自引:0,他引:4
目的探讨肱骨骨不连的手术治疗方法及疗效。方法1998年12月~2005年5月共收治肱骨骨不连患者25例,均为肱骨骨折内固定术后发生骨不连,其中3例并发骨髓炎,6例合并不同程度肱骨骨缺损,骨缺损长度为3~6cm。骨不连病程8个月~5年。15例行吻合血管游离腓骨移植,10例采用加压交锁髓内针进行肱骨固定并辅以自体骨植骨。结果术后25例均得到随访,时间6个月~6年2个月。吻合血管游离腓骨移植组中移植的腓骨段均与肱骨干形成骨性愈合,平均骨性愈合时间为3.1个月;交锁髓内针组平均骨愈合时间为3.8个月。按Crates和Whittle肩肘关节功能评价标准,腓骨移植组:优9例,良4例,差2例;交锁髓内针组:优5例,良3例,差2例。结论应用加压交锁髓内针辅以自体骨移植对硬化性肱骨骨不连是一种有效的外科治疗方法;对合并骨髓炎、大段骨缺损及严重骨质疏松的肱骨骨不连,采用吻合血管游离腓骨移植可一期进行修复与重建。 相似文献