BACKGROUND Hip fractures account for 23.8%of all fractures in patients over the age of 75 years.More than half of these patients are older than 80 years.Bipolar hemiarthroplasty(BHA)was established as an effective man...BACKGROUND Hip fractures account for 23.8%of all fractures in patients over the age of 75 years.More than half of these patients are older than 80 years.Bipolar hemiarthroplasty(BHA)was established as an effective management option for these patients.Various approaches can be used for the BHA procedure.However,there is a high risk of postoperative dislocation.The conjoined tendon-preserving posterior(CPP)lateral approach was introduced to reduce postoperative dislocation rates.AIM To evaluate the effectiveness and safety of the CPP lateral approach for BHA in elderly patients.METHODS We retrospectively analyzed medical data from 80 patients with displaced femoral neck fractures who underwent BHA.The patients were followed up for at least 1 year.Among the 80 patients,57(71.3%)were female.The time to operation averaged 2.3 d(range:1-5 d).The mean age was 80.5 years(range:67-90 years),and the mean body mass index was 24.9 kg/m^(2)(range:17-36 kg/m^(2)).According to the Garden classification,42.5%of patients were typeⅢand 57.5%of patients were typeⅣ.Uncemented bipolar hip prostheses were used for all patients.Torn conjoined tendons,dislocations,and adverse complications during and after surgery were recorded.RESULTS The mean postoperative follow-up time was 15.3 months(range:12-18 months).The average surgery time was 52 min(range:40-70 min)with an average blood loss of 120 mL(range:80-320 mL).The transfusion rate was 10%(8 of 80 patients).The gemellus inferior was torn in 4 patients(5%),while it was difficult to identify in 2 patients(2.5%)during surgery.The posterior capsule was punctured by the fractured femoral neck in 3 patients,but the conjoined tendon and the piriformis tendon remained intact.No patients had stem varus greater than 3 degrees or femoral fracture.There were no patients with stem subsidence more than 5 mm at the last follow-up.No postoperative dislocations were observed throughout the follow-up period.No significance was found between preoperative and postoperative mean Health Service System scores(87.30±2.98 vs 86.10±6.10,t=1.89,P=0.063).CONCLUSION The CPP lateral approach can effectively reduce the incidence of postoperative dislocation without increasing perioperative complications.For surgeons familiar with the posterior lateral approach,there is no need for additional surgical instruments,and it does not increase surgical difficulty.展开更多
BACKGROUND Conjoined twins are a rare occurrence,and the majority of these malformations are detected during second trimester screening.CASE SUMMARY Herein we report a case of conjoined twins,which was diagnosed by ul...BACKGROUND Conjoined twins are a rare occurrence,and the majority of these malformations are detected during second trimester screening.CASE SUMMARY Herein we report a case of conjoined twins,which was diagnosed by ultrasound at 8 wk gestation and was normal at 7 wk gestation.The two fetuses shared one heart and were diagnosed as thoracopagus twins.This is the first report of conjoined twins diagnosed at 8 wk gestation.The pregnancy was terminated electively at 9 wk gestation.Because some congenital malformations can be diagnosed earlier,a prenatal ultrasound examination at an early gestational stage cannot be dismissed.CONCLUSION This case demonstrates that a 7-8 wk gestation might be the earliest period when conjoined twins can be diagnosed by ultrasound.展开更多
Objective:To observe the ultrasonographic characteristics of conjoined tendon repair in direct anterior approach for total hip arthroplasty(DAA-THA),and to evaluate the efficacy of musculoskeletal ultrasound in determ...Objective:To observe the ultrasonographic characteristics of conjoined tendon repair in direct anterior approach for total hip arthroplasty(DAA-THA),and to evaluate the efficacy of musculoskeletal ultrasound in determining the healing after joint tendon repair.Methods:A total of 60 patients who required primary total hip arthroplasty in Yulin Orthopedic Hospital of Chinese and Western Medicine from July 2020 to July 2021 were selected;the patients were divided into two groups,an observation group,group A(n=30),and a control group,group B(n=30),according to different intraoperative methods.There was no significant difference in gender,age,and diagnosis between the two groups.Direct anterior approach was used for both the groups.For group A,the joint capsule and conjoined tendon(superior gemellus,obturator internus,and inferior gemellus)were repaired in situ,whereas for group B,only the joint capsule was repaired in situ,while the conjoined tendon was not repaired.The healing of the tendon was observed.Results:(1)in terms of diagnosis,after conjoined tendon repair,26 cases in group A showed good tendon continuity,good tension,and a small amount of effusion echo around,three cases showed partial interruption of tendon echo,low echo,or no echo inside with insufficient structural clarity,and a case showed complete interruption;in group B,all 30 cases had continuous interruption,poor tension,tendon retraction,and thickening;the healing rate of group A’s conjoined tendon repair was 96.67%;(2)in terms of prognostic assessment,one month after the surgery,the Harris score of group A was significantly higher than that of group B(P<0.05);however,there was no significant difference in the terms of the Harris score between the two groups 3-6 months after surgery(P>0.05);the effective tension of conjoined tendon and the effective muscle strength of group A were significantly higher than those of group B(P<0.05).Conclusion:Musculoskeletal ultrasound has high diagnostic value in the healing of conjoined tendon and provides dynamic clinical observation after conjoined tendon repair in DAA-THA;it is proven that DAA-THA with conjoined tendon repair on the premise of reconstructing the joint capsule can well restore its tension,enhance its muscle strength,significantly improve early joint stability and joint function,as well as facilitate the rapid recovery of patients.展开更多
BACKGROUND Conjoined twins are a rare twin malformation commonly presenting as single amniotic sac twinning,with double amniotic sac twinning being extremely rare and poorly reported.Most conjoined twins are females.C...BACKGROUND Conjoined twins are a rare twin malformation commonly presenting as single amniotic sac twinning,with double amniotic sac twinning being extremely rare and poorly reported.Most conjoined twins are females.CASE SUMMARY A woman of childbearing age conceived naturally,and at 8 wk of gestation,transvaginal ultrasonography showed an embryo and cardiac tube pulsation in both amniotic sacs.On dynamic observation,the two embryos were connected in the lower abdomen,with restricted movement.A repeat transvaginal ultrasound at 11 wk showed that the intestinal tubes of both fetuses were connected in the lower abdomen.The pregnancy was terminated and labor was induced.CONCLUSION Transvaginal ultrasound may detect conjoined twin malformations in an early stage.Our case provides diagnostic insights for ultrasonographers and can help develop early therapeutic interventions.展开更多
文摘BACKGROUND Hip fractures account for 23.8%of all fractures in patients over the age of 75 years.More than half of these patients are older than 80 years.Bipolar hemiarthroplasty(BHA)was established as an effective management option for these patients.Various approaches can be used for the BHA procedure.However,there is a high risk of postoperative dislocation.The conjoined tendon-preserving posterior(CPP)lateral approach was introduced to reduce postoperative dislocation rates.AIM To evaluate the effectiveness and safety of the CPP lateral approach for BHA in elderly patients.METHODS We retrospectively analyzed medical data from 80 patients with displaced femoral neck fractures who underwent BHA.The patients were followed up for at least 1 year.Among the 80 patients,57(71.3%)were female.The time to operation averaged 2.3 d(range:1-5 d).The mean age was 80.5 years(range:67-90 years),and the mean body mass index was 24.9 kg/m^(2)(range:17-36 kg/m^(2)).According to the Garden classification,42.5%of patients were typeⅢand 57.5%of patients were typeⅣ.Uncemented bipolar hip prostheses were used for all patients.Torn conjoined tendons,dislocations,and adverse complications during and after surgery were recorded.RESULTS The mean postoperative follow-up time was 15.3 months(range:12-18 months).The average surgery time was 52 min(range:40-70 min)with an average blood loss of 120 mL(range:80-320 mL).The transfusion rate was 10%(8 of 80 patients).The gemellus inferior was torn in 4 patients(5%),while it was difficult to identify in 2 patients(2.5%)during surgery.The posterior capsule was punctured by the fractured femoral neck in 3 patients,but the conjoined tendon and the piriformis tendon remained intact.No patients had stem varus greater than 3 degrees or femoral fracture.There were no patients with stem subsidence more than 5 mm at the last follow-up.No postoperative dislocations were observed throughout the follow-up period.No significance was found between preoperative and postoperative mean Health Service System scores(87.30±2.98 vs 86.10±6.10,t=1.89,P=0.063).CONCLUSION The CPP lateral approach can effectively reduce the incidence of postoperative dislocation without increasing perioperative complications.For surgeons familiar with the posterior lateral approach,there is no need for additional surgical instruments,and it does not increase surgical difficulty.
基金Supported by Major Research Projects of Universities in Guangdong Province,No.2019KZDZX1032the Open Laboratory Project of Guangzhou Medical University in 2019,No.C195015026Youth Foundation of Scientific Research of the Third Affiliated Hospital of Guangzhou Medical University,No.2018Q18.
文摘BACKGROUND Conjoined twins are a rare occurrence,and the majority of these malformations are detected during second trimester screening.CASE SUMMARY Herein we report a case of conjoined twins,which was diagnosed by ultrasound at 8 wk gestation and was normal at 7 wk gestation.The two fetuses shared one heart and were diagnosed as thoracopagus twins.This is the first report of conjoined twins diagnosed at 8 wk gestation.The pregnancy was terminated electively at 9 wk gestation.Because some congenital malformations can be diagnosed earlier,a prenatal ultrasound examination at an early gestational stage cannot be dismissed.CONCLUSION This case demonstrates that a 7-8 wk gestation might be the earliest period when conjoined twins can be diagnosed by ultrasound.
文摘Objective:To observe the ultrasonographic characteristics of conjoined tendon repair in direct anterior approach for total hip arthroplasty(DAA-THA),and to evaluate the efficacy of musculoskeletal ultrasound in determining the healing after joint tendon repair.Methods:A total of 60 patients who required primary total hip arthroplasty in Yulin Orthopedic Hospital of Chinese and Western Medicine from July 2020 to July 2021 were selected;the patients were divided into two groups,an observation group,group A(n=30),and a control group,group B(n=30),according to different intraoperative methods.There was no significant difference in gender,age,and diagnosis between the two groups.Direct anterior approach was used for both the groups.For group A,the joint capsule and conjoined tendon(superior gemellus,obturator internus,and inferior gemellus)were repaired in situ,whereas for group B,only the joint capsule was repaired in situ,while the conjoined tendon was not repaired.The healing of the tendon was observed.Results:(1)in terms of diagnosis,after conjoined tendon repair,26 cases in group A showed good tendon continuity,good tension,and a small amount of effusion echo around,three cases showed partial interruption of tendon echo,low echo,or no echo inside with insufficient structural clarity,and a case showed complete interruption;in group B,all 30 cases had continuous interruption,poor tension,tendon retraction,and thickening;the healing rate of group A’s conjoined tendon repair was 96.67%;(2)in terms of prognostic assessment,one month after the surgery,the Harris score of group A was significantly higher than that of group B(P<0.05);however,there was no significant difference in the terms of the Harris score between the two groups 3-6 months after surgery(P>0.05);the effective tension of conjoined tendon and the effective muscle strength of group A were significantly higher than those of group B(P<0.05).Conclusion:Musculoskeletal ultrasound has high diagnostic value in the healing of conjoined tendon and provides dynamic clinical observation after conjoined tendon repair in DAA-THA;it is proven that DAA-THA with conjoined tendon repair on the premise of reconstructing the joint capsule can well restore its tension,enhance its muscle strength,significantly improve early joint stability and joint function,as well as facilitate the rapid recovery of patients.
文摘BACKGROUND Conjoined twins are a rare twin malformation commonly presenting as single amniotic sac twinning,with double amniotic sac twinning being extremely rare and poorly reported.Most conjoined twins are females.CASE SUMMARY A woman of childbearing age conceived naturally,and at 8 wk of gestation,transvaginal ultrasonography showed an embryo and cardiac tube pulsation in both amniotic sacs.On dynamic observation,the two embryos were connected in the lower abdomen,with restricted movement.A repeat transvaginal ultrasound at 11 wk showed that the intestinal tubes of both fetuses were connected in the lower abdomen.The pregnancy was terminated and labor was induced.CONCLUSION Transvaginal ultrasound may detect conjoined twin malformations in an early stage.Our case provides diagnostic insights for ultrasonographers and can help develop early therapeutic interventions.
