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11.
Robert W. Mendicino DPM FACFAS Alan R. Catanzariti DPM FACFAS Karl R. Saltrick DPM FACFAS Michael F. Dombek DPM Brandon L. Tullis DPM Trenton K. Statler DPM Brandi M. Johnson DPM 《The Journal of foot and ankle surgery》2004,43(2):82-86
Nineteen patients (20 feet) with severe hindfoot and ankle deformity underwent tibiotalocalcaneal fusion with a retrograde locked intramedullary nail as a limb-salvage procedure. The purpose of this study was to compare the complication rates of this procedure in diabetic versus nondiabetic patients. There were 8 men and 11 women with preoperative diagnoses including Charcot neuroarthropathy, primary osteoarthritis, rheumatoid arthritis, equinocavovarus, posttraumatic osteoarthritis, gouty arthritis, and ankle malunion. Ten of 20 procedures were performed in patients with diabetes. The average patient age was 56 years, and the average postoperative follow-up was 19.8 months. Nineteen of 20 ankles (95%) achieved successful fusion with an average time of 4.1 months. Four patients (21%) required either a fracture brace or an ankle foot orthosis at final follow-up. Five patients (25%) had major complications and 11 patients had minor complications. Major complications included osteomyelitis (n = 2), Charcot arthropathy (n = 2), failure of fixation (n =1), soft-tissue necrosis (n = 1), cardiac arrest (n = 1), cerebral vascular accident (n = 1), and fatal pulmonary embolus (n = 1). All patients with major complications were diabetic, and 14 of 20 combined major and minor complications occurred in patients with diabetes. The complication rate was found to be high in diabetic patients with end-stage deformity undergoing a limb salvage 相似文献
12.
MDFrank A. Liporace MDKenneth Egol MDKenneth J. Koval 《Operative Techniques in Orthopaedics》2002,12(2)
Hip fractures have been one of the most studied injury pattern in adults. The number of hip fractures is increasing exponentially; furthermore, the cost of treatment places great economic strain on society. There have been recent developments in hip-fracture treatment, particularly involving the intertrochanteric region, with emphasis on deformity prevention to try to optimize patient functional outcomes. In this article, we outline some of these developments with an emphasis on changes in implant design. 相似文献
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Prof. Paul Bonnevialle Yves Bellumore Michel Mansat 《Operative Orthopadie und Traumatologie》1996,8(4):243-251
Summary
Goal of Surgery Stable internal fixation of extraarticular proximal humeral fractures.
Indications Extraarticular fractures angulated more than 30° which can be reduced closely or through a small incision.
Epiphysiolysis.
Fracture-dislocation of the humeral head.
Contraindications Pathological fractures.
Four part fractures.
Segmental fractures of the humerus.
Positioning and Anaesthesia Supine; the affected shoulder overhanging the edge of the table and supported by a radiolucent board.
General or regional anaesthesia.
Surgical Technique Closed pinning of two part and certain three part fractures of the proximal humerus being displaced, unstable, and mainly
at the metaphyseal level.
Introduction of Kirschner wires through a diaphyseal window and advancement into the proximal fragments after reduction which
is controlled by image intensification.
Postoperative Management Temporary immobilization in a sling.
Passive and active assisted movements after a few days.
Active movements after 2 weeks.
Removal of wires after 3 months.
Possible Complications Fracture of the humerus at the site of the cortical window. Injury to the radial nerve.
Results 32 patients, mean age 49 years, 30 two part fractures and 2 three part fractures. Number of Kirschner wires used: 3 to 6,
mean 4. Two out of 3 patients complained of pain at the site of wire insertion. All fractures consolidated. No avascular necrosis
nor infection.
Complications: Partial loss of internal fixation in 3 patients. One fracture of the humeral shaft. Sympathetic reflex dystrophy
in 3 patients. Half of the patients had a normal range of motion. Time of follow-up: 6 to 24 (mean 10) months.
Division of Orthopaedics and Traumatology, Purpan Hospital, Toulouse, France. 相似文献
15.
A comparative morphological and immunohistochemical study of testicular seminomas and intracranial germinomas 总被引:1,自引:0,他引:1
A series of 10 classical testicular seminomas and 10 intracranial germinomas were reviewed and examined using immunohistochemical techniques. In particular, the staining profiles of the tumour cells and the nature of the mononuclear cell infiltrate at the two sites were studied and compared. The tumour cells in eight of the 10 intracranial germinomas and nine of the 10 seminomas exhibited positive staining with placental alkaline phosphatase. Only one intracranial germinoma showed evidence of human chorionic gonadotrophin expression. Tumour cells in all cases at both sites were negative for cytokeratin and vimentin. The lymphocytic infiltrate in both the testicular and intracranial tumours was similar, comprising T-cells and B-cells, the former predominantly. The presence of macrophages and granulomas in tumours at both sites was noted. These findings confirm the high degree of similarity of germinomas of intracranial and testicular origin, and support the hypothesis of a common derivation. We could find no evidence of differentiation of tumour cells at either site. 相似文献
16.
Saito T Oda Y Tanaka K Matsuda S Sakamoto A Yamamoto H Iwamoto Y Tsuneyoshi M 《Pathology international》2003,53(2):115-120
We present the clinical, radiographical and pathological features of low-grade fibrosarcoma of the left proximal humerus in a 23-year-old man in whom it was necessary to distinguish the tumor from desmoplastic fibroma, malignant fibrous histiocytoma and intramedullary well-differentiated osteosarcoma. The patient presented with a 10-day history of pain in his left upper arm sustained when trying to break his fall with his left hand when slipping in the street. Plain radiography revealed an expanding multilobular osteolytic lesion from the proximal metaphysis to the diaphysis of his left humerus, accompanied by a pathological fracture at the distal portion of the lesion. Open biopsy of the lesion was performed twice; however, a conclusive diagnosis could not be obtained. The patient underwent wide excision and prosthetic replacement of the left proximal humerus. Histologically, the resected tumor was composed of both cellular areas and hypocellular areas. Cellular areas revealed a proliferation of bundles of uniform fibroblastic spindle-shaped cells with minimal cellular atypia, mixed with abundant intercellular collagenization. Mitotic figures were occasionally seen. Hypocellular areas showed myxoid features with loose bundles of collagen fibers. The patient demonstrates no evidence of disease 42 months after surgery. It is important to detect the scant atypical cells for the differential diagnosis of low-grade fibrosarcoma and desmoplastic fibroma of bone. 相似文献
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18.
目的 观察小切口骨折复位带锁髓内钉治疗股骨、胫腓骨骨折的临床疗效。方法 对 14例 (股骨干6例、胫骨干 5例、胫腓骨 3例 )采用带锁髓内钉固定。结果 随访 12例 ,平均 10 .5个月 ,骨折全部愈合 ,平均愈合时间胫腓骨为 11周、股骨为 18周。结论 小切口骨折复位带锁髓内钉治疗股骨、胫腓骨骨折是一种有效的内固定的方法。 相似文献
19.
肱骨髓腔的形态学参数测量及临床意义 总被引:4,自引:0,他引:4
目的 :为髓内钉的研制提供解剖学依据。方法 :分别以防腐湿肱骨 ,新鲜肱骨和干肱骨为材料 ,用牙托树脂灌铸成型后测量其内径 ;用螺旋CT测量活体肱骨髓腔内径 ,所有数据进行统计处理 ,观察各组数据的相关性关系。结果 :肱骨髓腔在中上 2 /3接近不规则圆柱体 ,自中下 1/3开始在矢状面上有一向前为 (8.8± 0 .3 )°的弧度。在桡神经沟部位的单侧骨密质最厚 (6.0± 1.5 )mm。髓腔最狭窄的部位在肱骨中下 1/3左右 ,其冠状径、矢状径在 7~ 8mm左右。分组统计结果证明 ,防腐湿肱骨的形态与新鲜肱骨无差别 ,干肱骨的形态与其他组差别显著 ,CT实测结果在大部分平面上与防腐湿肱骨及新鲜肱骨的结果无显著差别 ,与干肱骨组差别显著。结论 :肱骨髓内形状大体上接近于不规则圆柱体。 相似文献
20.
Femoralfracturesinthepresenceofotherintramedullaryimplantsareuncommon Thesefracturesaredifficulttomanageandthepresenceofotherintramedullaryimplantscreatesacomplexproblem Therateofthesefractureshasincreasedduetoanincreaseinthenumberofpatientshavingtota… 相似文献