技术

世界首例手腕置换手术成功 一名英国入日前经成为世界上第一个从半腕关节造形术中受益的患者，即一半腕关节被植人物取代，该技术可以保留天然腕关节的活动能力。

Hospital costs, length of stay and prevalence of hip and knee arthroplasty in patients with inflammatory bowel disease

AIM To examined the prevalence of hip and knee arthroplasty in patients with inflammatory bowel disease(IBD) by comparing the diagnostic codes for these procedures in patients with IBD and a control group of patients. METHODS The National Inpatient Sample database(NIS) is part of the Healthcare Cost and Utilization Project(HCUP), the largest publicly available inpatient healthcare database in the United States. The NIS samples about 20% of discharges from all community hospitals participating in HCUP, representative of more than 95% of the United States population, with approximately 7000000 hospitalizations reported annually. NIS contains data on diagnoses, procedures, demographics, length of stay(LOS), co-morbidities and outcomes. ICD-9-CM diagnostic codes for primary hospitalizations for arthroplasty of the hip or knee with a co-diagnosis of IBD [combining both Crohn's disease(CD) and ulcerative colitis(UC)] were used to identify study subjects for cost and LOS analysis for NIS from 1999-2012. Statistical analysis: 1: 2 propensity score matching between IBD vs a control group based on following factors: Patient age, gender, race, total co-morbidities, # of procedures, admission type, insurance, income quartiles, and hospital bed size, location and hospital teaching status. Categorical variables were reported as frequency and compared by χ2 tests or Fisher's exact tests. Individual 1:3 matching was also performed for patients carrying diagnostic codes for CD and for patients with the diagnostic code for UC. After matching, continuous variables were rcompared with Wilcoxon signed rank or Paired T-tests. Binary outcomes were compared with the Mc Nemar's test. This process was performed for the diagnosis of hip or knee arthroplasty and IBD(CD and UC combined). Prevalence of the primary or secondary diagnostic codes for these procedures in patients with IBD was determined from NIS 2007.RESULTS Costs and mortality were similar for patients with IBD and controls, but LOS was significantly longer for hip arthroplasties patients with IBD,(3.85 +/-2.59 d vs 3.68 +/-2.54 d, respectively, P = 0.009). Costs, LOS and survival from the procedures was similar in patients with CD and UC compared to matched controls. These results are shown in Tables 1-10. The prevalence of hip arthroplasty in patients with IBD was 0.5% in 2007,(170/33783 total patients with diagnostic codes for IBD) and was 0.66% in matched controls(P = 0.0012). The prevalence of knee arthroplasty in patients with IBD was 1.36,(292/21202 IBD patients) and was 2.22% in matched controls(P < 0.0001).CONCLUSION Costs and mortality rates for hip and knee arthroplasties are the same in patients with IBD and the general population, while a statistical but non-relevant increase in LOS is seen for hip arthroplasties in patients with IBD. Compared to the general population, arthroplasties of the hip and knee are less prevalent in hospitalized patients with IBD.

股骨近端关节内骨折——手术与非手术治疗的比较

总体而言,这些关于股骨近端关节内骨折治疗的报道,并没有提供充分的证据说明内固定或者关节置换术相比对方而言在死亡率上有优势。不过确实提示与关节置换术相比,内固定的再手术率更高。患者的不同特性使直接比较很困难。

Does mismatch of the femoral component aspect ratio influence the range of knee flexion after posterior-stabi- lized total knee arthroplasty？

ObjectiveTo 学习膝屈曲( ROF )的范围是否被大腿骨的部件和结果的变化的几何失配在高屈曲的以后稳定总数膝关节造形术( TKA )以后在以后的 condylar 偏移量( PCO )影响百个 osteoarthritic 病人( 50 男性和 50 女性)经历了的 .MethodsOne 大腿骨的截骨术由前面的引用技术。为每个病人的 PCO 以前从侧面的拍被测量，在期间并且在 TKA 以后的 2 年。联合软骨的厚度被磁性的回声成像在 TKA 前测量并且增加了到 X 光线照相术的测量上。在在 PCO 的变化和在 ROF 在前的改进之间的关系，在期间并且在 TKA 以后的 2 年是统计上有外科手术前的价值的 analyzed.ResultsCompared ， PCO 被减少由( 3.45 &plusmn;3.28 )在 TKA 以后的公里，比男病人在女病人与显著地更大的减小观察了( P > 0.05 )。当总体上检验题目人口时，在 TKA 期间在 PCO 和 ROF 改进之间有重要积极关联(P > 0.05 ) ，但是这改进没被维持在 TKA 以后的 2 年(P > 0.05 ) 。然而，当男、女的病人独立被分析时，为在两个时间点的两性在 PCO 变化和 ROF 改进之间有重要积极关联(所有 P > 0.05 ) PCO 的 .ConclusionsRestoration 甚至在以后稳定 TKA 以后在膝屈曲的优化起一个重要作用。大腿骨在白种人解剖特征上基于部件不能在中国人口匹配远侧的腿节的本国的解剖特别女汉语。有前面的引用技术的远侧的腿节的旋转切除术通常导致减少的 PCO 因此减少最大的可获得的屈曲。

Proximal humeral fractures treated with arthroplasty

Objective: To explore arthroplasty in treating 3- and 4-part fractures of the proximal humerus. Methods: A total of 132 patients with proximal humeral fractures were treated in our hospital from July 1997 to February 2003. According to Neer’s classification, the fractures of 45 patients (14 males and 31 females, aged 31-78 years, 56.1 years± 7.8 years on an average) belonged to 3- or 4-part fractures (10 patients with 4-part fracture and 35 with 3-part comminuted fracture) and they were treated with shoulder joint arthroplasty. Unipolar prosthesis replacement of the head of humerus was made in 28 cases, while bipolar prosthesis replacement in 2 cases and total shoulder joint replacement in 15 cases. Results: During the follow-up period (range: 12-72 months, mean: 37.3 months± 4.1 months), among the 45 patients who suffered from fractures of the proximal humerus and underwent arthroplasty surgery, 44 patients ( 97.8%) had no postoperative pain and were satisfied with the active range of motion and with the whole treatment results. And radiography showed that the prostheses were at their good position. One patient had postoperative pain because he had so narrow medullary cavity that the humeral prosthesis could not be put deeply enough and the prosthesis head was a little higher over the anatomic level. He did not have good postoperative active range of motion, either. Then he received a review surgery and got satisfied results. Temporary shoulder stiffness was observed in one patient. Manual release of these adhesions improved the shoulder function. No evidence of nonunion of the fracture segments around the humeral prosthesis stem was found. Conclusions: Shoulder arthroplasty is a dependable method to restore the comfort and function of the should joints of the patients with 3- or 4-part fractures of the proximal humerus.

Personalized image-based templates for precise acetabular prosthesis placement in total hip arthroplasty:a pilot study

Objective:In order to achieve accurate implantation of the acetabular prosthesis in total hip arthroplasty(THA),we designed individual templates based on a three-dimensional(3D) model generated from computed tomography(CT) scans.Methods:Individual templates were designed for 12 patients who underwent THA.A physical template was designed to conform to the contours of the patient's acetabulum and to confirm the rotation of the acetabular center.This guided the acetabular component orientation.Results:The preoperative and postoperative X-ray and CT scans were obtained to assess the location with respect to the accuracy of the acetabular component.For all patients,the abduction angle of the acetabular component was 46.7°o 54.3°and the anteversion angle was 11.3°to 18.5°.Conclusions:The assessment of postoperative CT scans demonstrated higher accuracy of the acetabular component bore when used with the individual template.Therefore,the individual template can be an alternative to the computer-assisted navigation systems,with a good cost-performance ratio.

Total hip arthroplasty with cementless cups and femoral head autografts for patients with hip dysplasia and osteoarthritis

Objective: To evaluate the outcome of total hip arthroplasty (THA) with cementless cups and femoral head autografts for patients with hip dysplasia and osteoarthritis. Methods: Between 1995 and 2002, we implanted 23 cementless cups and femoral head autografts in 20 patients with hip dysplasia and osteoarthritis. In this study, a retrospective study was made on 21 hips in 20 patients (18 females and 2 males, aged 50 years on an average) with developmental hip dysplasia treated by THA with a cementless cup and femoral head autograft. The acetabular cup was placed at the level of the true acetabulum and all the patients required autogenous femoral head grafts due to acetabular deficiency. The average rate of the acetabular cup covered by the femoral head autograft was 31% (ranging from 10% to 45%). Eight hips had less than 25% cup coverage and thirteen between 25% and 50%. The average follow-up period was (4.7) years (range, 1-8 years). The replacing outcome was evaluated by modified Harris hip score. Preoperative and follow-up radiographs were made. Results: All the autografts were united to the host bones. No autograft was collapsed or no component from the hip was loosed in all the patients. According to the modified Harris hip score, the average hip score increased from 46 before operation to 89 at the final review. Before operation, the leg-length discrepancy was greater than 2 cm in all the patients except one with bilateral hip dysplasia. After operation, only 2 out of 20 patients had a leg-length discrepancy greater than 1 cm. Three hips showed minor bone resorption in the lateral portion of the graft, which did not support the cup. Three hips developed Grade 1 Brooker heterotopic ossification and one developed Grade 2. Conclusions: THA with a cementless cup and a femoral head autograft for patients with osteoarthritis resulted from hip dysplasia can result in favorable outcomes. This method can provide reliable acetabular fixation and restore the acetabular bone stock in patients with developmental hip dysplasia when the cementless cup covered by the graft does not exceed 50%.

Radiographic and clinical analysis of cementless acetabular fixation in total hip arthroplasty

Objective: To investigate the factors affecting the fixation, loosening and therapeutic effect of cementless acetabular prosthesis through following up the patients with total hip arthroplasty clinically and radiographically. Methods: From February 1998 to May 1999, 139 patients (148 hips) underwent total hip arthroplasty with cementless acetabular prosthesis in our department. In this study, the clinical therapeutic effect and the anteroposterior radiographs of the pelvis and anteroposterior and lateral radiographs of the hips of 109 patients (116 hips) made before operation, at 1 week, 3, 6, and 12 months after operation and annually thereafter were analyzed retrospectively. The clinical therapeutic effects were evaluated with Harris hip score. Radiographs were used to observe the position of prostheses and the bone changes around the implant, and to measure the wearing speed and direction of the acetabular cup. All evaluations were made by an independent examiner who did not participate in the operation. The patients were followed up for 5-6 years. Results: The mean Harris score was 44 points (range, 10-70 points) before operation, but it increased to 92.4 points (range, 80-100 points) at the latest review after operation, which was significantly higher than that before operation (P< 0.05). No acetabular component was revised because of infection or aseptic loosening. And no acetabular component migrated. There was no revision of fixed acetabular component because of pelvic osteolysis secondary to polyethylene wear. The mean linear wear rate was 0.15 mm per year. All the acetabular prostheses were classified as stable on the radiographs. Conclusions: In terms of fixation, total hip arthroplasty with cementless acetabular components was successful. Although there is no aseptic loosening and a low incidence of osteolysis at the latest follow-up evaluation, polyethylene wear cannot be avoided and can lead to expansile osteolysis near the cups. This kind of osteolysis usually had no obvious clinical symptoms but it can be diagnosed early on radiographs. So radiographical follow-up for cementless acetabular components is very important.

Intracapsular fracture of the proximal femur Operative versus nonoperative management

Taken together, these reports do not provide strong evidence in favor of either internal fixation or arthroplasty over the other relative to mortality in the treatment of intracapsular fracture of the proximal femur. However, they do suggest a higher rate of reoperations in those receiving internal fixation compared with arthroplasty. Differing patient characteristics at baseline make direct comparisons difficult.

Comparative study on early period of recovery between minimally invasive surgery total knee arthroplasty and minimally invasive surgery-quadriceps sparing total knee arthroplasty in Chinese patients

Background Different kinds of minimally invasive surgery （MIS） procedures have now been used in total knee arthroplasty （TKA）. Compared with traditional TKA procedure with a long skin incision, clinical studies showed MIS procedures had some advantages. Quadriceps sparing （QS） procedures are the most minimally invasive MIS procedure until now. This study was aimed to find the insertion types for Chinese patients＇ vastus medialis and if the QS procedure had some advantages in patients＇ early recovery. Methods Between February 2006 and May 2007, 120 consecutive patients underwent unilateral primary TKA under general anesthesia, among whom 14 patients were lost to follow-up, the remaining 106 cases were enrolled in this study. Among the 106 cases there were 85 right knees, 21 left knees （15 men and 91 women, with a mean age of 65.1±7.4 years）; osteoarthritis in 97 patients （91.5%） and rheumatoid arthritis in 9 patients （8.5%）. MIS TKA was performed in 49 cases （MIS TKA group）, while MIS-QS TKA in 57 cases （MIS-QS TKA group）. During the operation, the type Ⅰ, Ⅱ and Ⅲ insertions of the vastus medialis for all patients were recorded. Each knee was rated post-operatively according to the Hospital of Special Surgery （HSS） scoring system. Clinical follow-up was undertaken at 1 week, 2, 6, 12 and 24 weeks. Operating time and complications were recorded. Results There was no statistically significant difference between the two groups for gender distribution, age, left or right knee incidence, pre-operative diagnosis, incidence of varus or valgus deformity. Of the 106 cases there was 1 （0.9%） case with a type Ⅰ insertion of the vastus medialis, 4 （3.8%） cases with type Ⅱ insertions, 101 （95.3%） cases with type Ⅲ insertions. The HSS scoring was significantly different between the MIS-QS TKA group and MIS TKA group within the first two weeks post operation. From 2 weeks later to 24 weeks, no significant difference was found. The average operating time was （53.3±12.4） minutes in the MIS TKA group and （64.1±15.1） minutes in the MIS-QS TKA group （P 〈0.001）. In the MIS-QS TKA group, 1 patient had delayed healing of the partial skin incision （1.8%）. No other complications were found in either group. Conclusions Although most of the Chinese patients had type Ⅲ insertions of the vastus medialis, the MIS-QS TKA procedure showed less injury to the quadriceps than the standard MIS TKA and this could contribute to the earlier recovery of of the patients. But a shorter-skin incision and more tension on the skin may also lead to more skin complications.