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1.
《Journal of Clinical Orthopaedics and Trauma》2021,12(6):976-982
ObjectiveMultiple treatment options for acetabular fractures in geriatric patients exist. However, no large-scale studies have reported the outcomes of acute total hip arthroplasty (THA) in this patient population. We systematically evaluated all available evidence to characterize clinical outcomes, complications, and revisions of acute THA for acetabular fractures in geriatric patients.MethodsMeta-analysis of 21 studies of 430 acetabular fractures with mean follow-up of 44 months (range, 17−97 months). Two independent researchers searched and evaluated the databases of Ovid, Embase, and United States National Library of Medicine using a Boolean search string up to December 2019. Population demographics and complications, including presence of heterotopic ossification (HO), dislocation, infection, revision rate, neurological deficits, and venous thromboembolic event (VTE), were recorded and analyzed.ResultsWeighted mean Harris Hip Score was 83.3 points, and 20% of the patients had reported complications. The most common complication was HO, with a rate of 19.5%. Brooker grade III and IV HO rates were lower at 6.8%. Hip dislocation occurred at a rate of 6.1%, 4.1% of patients developed VTE, deep infection occurred in 3.8%, and neurological complications occurred in 1.9%. Although the revision rate was described in most studies, we were unable to perform a survival analysis because the time to each revision was described in only a few studies. The revision rate was 4.3%.ConclusionsAcute THA is a viable option for treatment of acetabular fracture and can result in acceptable clinical outcomes and survivorship rates in older patients but with an associated complication rate of approximately 20%. Considering the limited treatment options, THA might be a viable alternative for appropriately selected patients. 相似文献
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Brambati B.; Tului L.; Baldi M.; Guercilena S. 《Human reproduction (Oxford, England)》1995,10(4):818-825
Multiple pregnancies resulting from ovarian stimulation areat a higher risk of carrying at least one fetus affected byMendelian or chromosomal anomalies, the incidence of which isdirectly related to the order of multiples. Genetic analysisbefore fetal reduction was offered to both high-and low-riskpregnant women carrying two or more fetuses after ovulationinduction. Chorionic villus sampling (CVS) and fetal reductionwere achieved by transabdominal needling. The use of short-termculture, the polymerase chain reaction and fresh tissue enzymaticanalyses have made it possible for genetic diagnosis to be availablein a few days. A total of 100 patients had multifetal pregnancyreduction performed by a single operator; all of them completedpregnancy and none was lost at follow-up. The total fetal lossbefore 24 weeks was 7% and no statistically significant relationshipwas found with the final number of fetuses and CVS. Perinatallosses (3.9%) were only present in the series with a final numberof two fetuses. Pregnancy duration and birthweight were significantlyhigher in singletons than in twins, but were not related toCVS. The rate of chromosomal disorders was higher (7.2%) inthe study series than in singleton pregnancies not undergoingfetal reduction. Diagnostic error due to incorrect samplingwas reported in 1.5% of cases. These data support fetal reductionas a valuable strategy to improve the outcome of multiple pregnancy.The outcome of pregnancies reduced to singletons was significantlybetter than of those reduced to twins, and was not related toCVS. Therefore, prenatal genetic diagnosis should become anintegral part of counselling on multiple pregnancy, and is stronglyrecommended when reduction to singleton pregnancy is requested. 相似文献
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目的 评价开放复位可塑形钛板内固定治疗跟骨骨折的疗效。方法 对33例(37足)以后关节突移位为主的跟骨骨折,行跟骨外侧入路、开放性复位可塑形钛板螺钉内固定,必要时行植骨术(18例)。结果 平均随访11.5个月,参照Mary—land food score评分,对患足是否疼痛、步态、距下关节及踝关节活动度、是否支架辅助、术后X线摄片等加以评估,19足疗效为优,17足为良,1足可。其中钛板断裂1例,手术切口皮缘坏死1例,换药后自愈。结论 跟骨外侧入路开放复位可塑形钛板螺钉内固定,必要时植骨术是治疗跟骨骨折的有效方法。 相似文献
7.
肱骨近端骨折手术与非手术治疗方法疗效分析 总被引:19,自引:0,他引:19
目的分析肱骨近端骨折手术及非手术治疗方法的疗效。方法2002~2003年对43例肱骨近端骨折分别采用切开复位解剖钢板、拉力螺钉、克氏针固定及手法复位夹板固定治疗。采用Constant-murley评分方法评定疗效。结果所有患者随访10~19个月,平均11.5个月。24例手术患者中优11例,良8例,可4例,差1例,优良率为79.2%;19例非手术患者中优6例,良7例,可6例,优良率为68.4%;手术疗效明显优于非手术疗效,差异有显著性意义(P<0.05)。X线片示无骨折不愈合及肱骨头坏死发生。结论对Neer分型中Ⅰ型和Ⅱ型中部分患者应采用非手术手法复位夹板固定治疗。而Ⅲ、Ⅳ型应采用手术方法治疗,主要采用解剖钢板固定。拉力螺钉、克氏针作为一种辅助手段,在手术中不宜过多使用。 相似文献
8.
C. Faldini M. Manca S. Pagkrati D. Leonetti M. Nanni G. Grandi M. Romagnoli M. Himmelmann 《Journal of orthopaedics and traumatology》2005,6(4):188-193
Abstract Complex tibial plateau fractures are a challenge in trauma surgery. In these fractures it is necessary to anatomically reduce
the articular part of the fracture and to obtain stable fixation. The aim of this study is to review the results of a surgical
technique consisting of fluoroscopic closed reduction and combined percutaneous internal and external fixation. Thirty-two
complex tibial plateau fractures in 32 patients were included. Twenty-one fractures were closed, 4 were open Gustilo grade
I, 3 were Gustilo grade II and 4 were Gustilo grade III. The mean age was 37.8 years (range 21–64 years). Surgery was performed
with patients in transcalcaneal traction and the knee flexed at 30° was used. Through a 1-cm incision centred over the tibial
metaphysis of the tibia, a 3.2-mm hole was drilled in the antero-medial tibial aspect. The tibial plateau fracture fragments
were elevated using either 1 or 2 curved Kirschner wires under fluoroscopy to control the reduction. Then the fragments were
fixed with 2 cannulated AO screws inserted through small incisions into the medial aspect of the tibial plateau. Knee rehabilitation
started postoperatively. Weight bearing started after 8–12 weeks depending upon the radiographic appearance. All external
fixators were removed in outpatient facilities. All patients were clinically and radiographically evaluated at a mean follow-up
of 48 months (range 38–57 months). Clinical results were evaluated according to the Knee Society clinical score. Average healing
time was 24 weeks (range 18–29 weeks). In 1 patient a non-union occurred. This patient was treated with open reduction and
plate fixation. In 2 patients a varus knee deformity occurred and a surgical correction was performed. There were no surgical
complications. Mean knee range of motion was 105° (range 75–125°) and mean Knee Society clinical score was 89. Twenty-five
results were scored as excellent, 4 good, 2 fair and 1 poor. Using this technique there is limited soft tissue damage and
virtually no periosteum damage to the fracture fragments. However anatomical reconstruction of the joint can be obtained.
Furthermore knee rehabilitation can be started immediately after surgery. We think that these factors were responsible for
the optimal clinical long-term results. 相似文献
9.
Eichi Itadera Yoshimasa Miyake Yoichi Nakatsuka Hirofumi Akazawa Shigeru Mitani Kiyoshi Aoki 《Journal of orthopaedic science》1996,1(4):252-258
We report satisfactory results with a new operative treatment, conducted via an extensive anterolateral approach, involving
360 degree circumferential capsulotomy, for residual subluxation in congenital dislocation of the hip (CDH). Long-term radiographic
results of this procedure (group A) were compared retrospectively with the results of partial capsulotomy (group B), which
preserved the posteroinferior joint capsule. The mean center edge angle in group A (22.5°) was greater than that in group
B (16.0°). Satisfactory results were achieved in 11 of 15 hips (73%) (Severin class I or II) in group A, and in 5 of 12 hips
(42%) in group B. These results suggest that whole circumferential capsulotomy can remove obstacles to complete reduction,
and that acetabular development can be expected in hips reduced by the procedure, without the performance of innominate osteotomy.
We believe that our technique is a useful alternative for the treatment of residual subluxation in CDH. 相似文献
10.
As part of a detailed study of limb defects and associated patterns of congenital malformations, cases with lower limb deficiencies were analysed separately. We identified a total of 130 cases with deficiencies of the lower limbs without defects of the upper limbs. This gives an incidence of 1.07/10,000 livebirths, or 1/9,337 for this group of limb defects. Most common were femur deficiencies and deficiencies of the foot. A preponderance of males was found in the group of transverse defects of the leg (fibula/tibia deficiencies) and central axis deficiencies, while females had significantly more often longitudinal tibia defects and preaxial ray defects. © 1993 Wiley-Liss, Inc. 相似文献