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1.
Qiaojie Wang Karan Goswami Noam Shohat Arash Aalirezaie Jorge Manrique Javad Parvizi 《The Journal of arthroplasty》2019,34(5):947-953
Background
Whether prolonged operative time is an independent risk factor for subsequent surgical site infection (SSI) and periprosthetic joint infection (PJI) following total joint arthroplasty (TJA) remains a clinically significant and underexplored issue. The aim of this study is to investigate the association between operative time and the risk of subsequent SSI and PJI in patients undergoing primary TJA.Methods
We retrospectively reviewed 17,342 primary unilateral total knee arthroplasty and total hip arthroplasty performed at a single institution between 2005 and 2016, with a minimum follow-up of 1 year. A multivariate logistic regression model was conducted to identify the association between operative time and the development of SSI within 90 days and PJI within 1 year.Results
Overall, the incidence of 90-day SSI and 1-year PJI was 1.2% and 0.8%, respectively. Patients with an operative time of >90 minutes had a significantly higher incidence of SSI and PJI (2.1% and 1.4%, respectively) compared to cases lasting between 60 and 90 minutes (1.1% and 0.7%), and those lasting ≤60 minutes (0.9% and 0.7%, P < .01). In the multivariate model, the risk for infection increased by an odds ratio of 1.346 (95% confidential interval 1.114-1.627) for 90-day SSI and 1.253 (95% confidential interval 1.060-1.481) for 1-year PJI for each 20-minute increase in operative time.Conclusion
In patients undergoing primary TJA, each 20-minute increase in operative time was associated with nearly a 25% increased risk of subsequent PJI. We advocate that surgeons pay close attention to this underappreciated risk factor while maintaining safe operative practices, which minimize unnecessary steps and wasted time in the operating room. 相似文献2.
Accuracy and Precision of Acetabular Component Placement With Imageless Navigation in Obese Patients
Leonard T. Buller Alexander S. McLawhorn Jose A. Romero Peter K. Sculco David J. Mayman 《The Journal of arthroplasty》2019,34(4):693-699
Background
Obesity is a risk factor for acetabular component malposition when total hip arthroplasty is performed with manual techniques. The utility of imageless navigation in obese patients remains unknown. This study compared the accuracy and precision of imageless navigation for component orientation between obese and nonobese patients.Methods
A total of 459 total hip arthroplasties performed for osteoarthritis using imageless navigation were reviewed from a single surgeon’s institutional review board–approved database. Einzel-Bild-Roentgen Analyse determined component orientation on 6-week postoperative anteroposterior radiographs. Mean orientation error (accuracy) and precision were compared between obese (body mass index ≥ 30 kg/m2) and nonobese patients. Regression analysis evaluated the influence of obesity on component position.Results
The difference in mean inclination and anteversion between obese and nonobese groups was 1.1° (43.0° ± 3.5°; range, 35.8°-57.8° vs 41.9° ± 4.4°; range, 33.0°-57.1° and 24.9° ± 6.3°; range, 14.2°-44.3° vs 23.8° ± 6.6°; range, 7.0°-38.6°, respectively). Inclination precision was better for nonobese patients. No difference in inclination accuracy or anteversion accuracy or precision was detected between groups. And 83% of components were placed within the target range. There was no relationship between obesity (dichotomized) and component placement outside the target ranges for inclination, anteversion, or both. As a continuous variable, increased body mass index correlated with higher odds of inclination outside the target zone (odds ratio, 1.06; P = .001).Conclusion
Using imageless navigation, inclination orientation was less precise for obese patients, but the observed difference is likely not clinically relevant. Accurate superficial registration of landmarks in obese patients is achievable, and the use of imageless navigation similarly improves acetabular component positioning in obese and nonobese patients.Level of Evidence
Therapeutic Level IV. 相似文献3.
目的研究云南白药在围术期对全髋关节置换术术中出血量及术后引流量的影响。方法2006至2008年我科收治的股骨颈骨折行全髋关节置换术60例,随机分成两组,分别服用云南白药胶囊和空胶囊;术前术后测定凝血酶原时间(PT),记录全部病人术中出血量及术后24 h引流量。结果实验组和对照组病人的凝血酶原时间(PT)差异有统计学意义(P<0.01);试验组的术中出血量、术后24 h引流量分别为(380±78)ml(、336±77)ml,较对照组(481±77)ml(、418±68)ml明显减少,差异具有统计学意义(P<0.01)。结论云南白药胶囊能够明显减少全髋关节置换术围术期出血量。 相似文献
4.
C. Delaunay 《Interactive Surgery》2007,2(3-4):174-177
Assessment of possible low-wear with some former metal-on-metal (MoM) total hip arthroplasties (THA) led to the reintroduction
of metallic bearings in the late 80’s. The author reports on two studies of Metasul-28 mm cementless THA. In the first one
in a general population, impingement has been the main cause of osteolysis and Co level survey has been a good indicator of
Metasul bearing behaviour. In the second study, in a group of 83 less than 50-year-old and active patients, Metasul bearings
showed good wear resistance at 7.2 years mean follow-up. In both studies, no general toxic effect could have been detected
thus far. According to the current knowledge, it is always reasonable to expect low-wear and better THA longevity with use
of MoM bearings under the following conditions: 1) use of a CoCr alloy with high carbide concentration; 2) reduce impingement
risk (head without sleeve, slimmer as possible neck, perfectly adapted Morse cone from the same manufacturer, well — oriented
components); and 3) prefer cementless acetabular fixation. 相似文献
5.
应用自动化图象分析仪对131个胃粘膜肠型病灶(单纯性肠化27个;异型增生:轻度30,中度35个,重度20个;肠型胃癌19个)进行定量分析。以单个腺管内细胞核总面积与细胞面积之比(ING)作为反映细胞核大小、数量及覆层排列程度的客观定量指标。结果发现:单纯性肠化(对照组)0.165±0.025,轻度异型增生0.21±0.023,中度异型增生0.259±0.026,重度异型增生0.32±0.028,分化型胃癌0.371±0.052,各组ING值呈正态,各组间的均值有非常显著的差异(P<0001)。因而,ING可作为胃粘膜癌前病变诊断的指标。 相似文献
6.
人工髋关节置换术后脂肪栓塞综合征的观察与护理 总被引:3,自引:0,他引:3
笔者报道人工髋关节置换术后脂肪栓塞综合征的护理措施认为重视氧饱和度及动脉血氧分压监测,注意观察中枢神经系统症状和呼吸系统症状,及时发现并纠止低氧血症,对不同的病人制定不同护理方案,严密观察病情,及时掌握病情变化:是护理的关键。 相似文献
7.
P. Nikiforidis G. Ch. Babis N Papaioannou D. S. Korres T. Pantazopoulos 《European journal of orthopaedic surgery & traumatology : orthopedie traumatologie》1997,7(1):23-26
Summary The management of displaced intracapsular fractures of the hip is still controversial because of the high incidence of complications after internal fixation or hemiarthroplasty. To avoid some of these complications we have used primary total hip replacement for independently mobile patients over 65 years of age.Of 49 patients who were interviewed an average of 4.6 years after total hip replacement, 81.6% had excellent or good results as assessed by the Harris Hip Score. At that time two hips had been revised and another converted to Girdlestone due to deep infection. The survival of the prostheses was at 5 years 91.3%.It is concluded that total hip replacement is an established method of management for a selected group of patients with this injury, but further prospective studies are needed in order to define the groups of patients that benefit the most. 相似文献
8.
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
9.
J.S. WIGGLESWORTH 《Histopathology》1987,11(7):671-689
The major forms of lung pathology in the perinatal period are reviewed with emphasis on disturbances of growth and maturation. Lung hypoplasia results from impairment in the physiological control of lung growth during the fetal period. It is more common than organogenetic defects which are discussed only briefly. Hyaline membrane disease is now seldom seen in a pure form due to improvements in perinatal care. However, its complications and sequelae such as interstitial emphysema, pneumothorax and bronchopulmonary dysplasia are encountered more frequently. In addition, a wide variety of pathological processes may localize to, or be expressed in, the lung of the newborn, notably asphyxial changes, persistent pulmonary hypertension, haemorrhage and infection. 相似文献
10.
ABSTRACT. This study shows that children with late-diagnosed congenital dislocation of the hip (CDH) have close to normal height development during the initial 6.0 years of life. The treatment consisted of immobilization for 0.5 to 1.3 years starting between 0.2 and 0.7 years of age. The present work addresses one specific issue that is related to the age at onset of the childhood component of the ICP growth model. The onset normally appears between 0.5 and 1.0 year of age, and is recognized as an increase in length/height velocity. The onset is thus found during a period of increasing motor activity. The normal successive change from sitting to walking position may have some influence on the onset of this tempo change in early linear growth. The present documentation implies that there is no such influence. In all 14 children with CDH, the onset manifested during the period of immobilization, and the average age at onset was found to be Virtually equivalent with that of the controls. Our conclusion is that immobilization has no significant influence on the age at onset of the childhood phase of growth. The onset is accomplished independent of body position, be it lying down or normal for the age. 相似文献