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Virtual preoperative planning and 3D printing are valuable for the management of complex orthopaedic trauma

Chinese Journal of Traumatology 2019年第6期22卷 350-355页

作者： Abhishek Mishra Tarun Verma Abhishek Vaish Riya Vaish Raju Vaishya Lalit Maini Department of Orthopaedics and Joint Replacement Surgery Maulana Azad Medical CollegeLok Nayak HospitalNew Delhi 110001India Department of Orthopaedics and Joint Replacement Surgery Indraprastha Apollo HospitalSaritaViharNew Delhi 110076India

Purpose:The technology of 3D printing(3DP)exists for quite some time,but it is still not utilized to its full potential in the field of orthopaedics and traumatology,such as underestimating its worth in virtual preoperative planning(VPP)and designing various models,templates,and jigs.It can be a significant tool in the reduction of surgical morbidity and better surgical outcome avoiding various associated complications.Methods:An observational study was done including 91 cases of complex trauma presented in our institution requiring operative fixation.Virtual preoperative planning and 3DP were used in the management of these fractures.Surgeons managing these cases were given a set of questionnaire and responses were recorded and assessed as a quantitative data.Results:In all the 91 cases,where VPP and 3DP were used,the surgeons were satisfied with the outcome which they got intraoperatively and postoperatively.Surgical time was reduced,with a better outcome.Three dimensional models of complex fracture were helpful in understanding the anatomy and sketching out the plans for optimum reduction and fixation.The average score of the questionnaire was 4.5,out of a maximum of 6,suggesting a positive role of 3DP in orthopaedics.Conclusion:3DP is useful in complex trauma management by accurate reduction and placement of implants,reduction of surgical time and with a better outcome.Although there is an initial learning curve to understand and execute the VPP and 3DP,these become easier with practice and experience.

关键词： Three-dimensional printing Bone fractures Fracture dislocation X-ray computed tomography

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Bilateral segmental pelvic and femoral fractures in a young female： A rare case report

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Chinese Journal of Traumatology 2016年第5期19卷 286-289页

作者： Raju Vaishya Amit Kumar Agarwal Nishint Gupta Vipul Vijay Department of Orthopaedics and Joint Replacement Surgery lndraprastha Apollo Hospitals New Delhi 110076 India

尽管有前进，多重复杂受伤病人的管理在现代医疗保健仍然是大挑战。我们在场与双边的部分大腿骨的柄联系的双边的不稳定的骨盆的破裂的一个稀罕案例断裂。我们建议了如此的复杂损害模式的机制并且讨论了管理的计划。在稳定病人的医学上... 详细信息

尽管有前进，多重复杂受伤病人的管理在现代医疗保健仍然是大挑战。我们在场与双边的部分大腿骨的柄联系的双边的不稳定的骨盆的破裂的一个稀罕案例断裂。我们建议了如此的复杂损害模式的机制并且讨论了管理的计划。在稳定病人的医学上帮助了我们的病人克服这些严重、致命的损害后不久，我们相信修理所有专业的及时、好攻击的外科的干预断裂。由进行为如此的复杂破裂的管理建立一个最佳的协议是必要的未来并且 multicentric 以后学习。

关键词：骨盆大腿骨的破裂肋骨破裂

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Spontaneous fracture of the femoral neck in preexisting avascular necrosis of femoral head in sickle cell dis-

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Chinese Journal of Traumatology 2012年第5期15卷 312-314页

作者： Raju Vaishya department of orthopaedics&joint replacement surgery Indraprastha Apollo HospitalsNew DelhiIndia

Avascular necrosis of the femoral head is a known complication of femoral neck fracture but on the contrary, femoral neck fracture in a case of preexisting avascular necrosis is a very rare phenomenon. We present a case study of a 47 year old Iraqi male who developed sponaneous ipsilateral subcapital femoral neck fracture under the condition of preexisting sickle cell disease and avascular necrosis of the femoral head. The fracture was unnoticed for a few months. The patient was managed successfully byuncemented total hip arthroplasty. Postoperative recovery was uneventful and he was discharged 4days after surgery. At 1 year's follow-up, the patient had normal gait and hip function, with no sign of loosening or any other complications on radiograph.

关键词：股骨头骨折坏死缺血细胞显示并发症髋关节

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Dual mobility cups in total hip arthroplasty

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World Journal of Orthopedics 2014年第3期5卷 180-187页

作者： Ivan De Martino Georgios Konstantinos Triantafyllopoulos Peter Keyes Sculco Thomas Peter Sculco department of Orthopaedic surgery Division of Adult Reconstruction and Joint ReplacementHospital for Special SurgeryNew YorkNY 10021United States

Total hip arthroplasty(THA)is considered one of the most successful surgical procedures in orthopaedics.With the increase in the number of THAs performed in the world in the next decades,reducing or preventing medical and mechanical complications such as post-operative THA instability will be of paramount importance,particularly in an emerging health care environment based on quality control and patient outcome.Dual mobility acetabular component(also known as unconstrained tripolar implant)was introduced in France at the end of the 1970s as an alternative to standard sockets,to reduce the risk of THA dislocation in patients undergoing primary THA in France.Dual mobility cups have recently gained wider attention in the United States as an alternative option in the prevention and treatment of instability in both primary and revision THA and offer the benefit of increased stability without compromising clinical outcomes and implant longevity.In this article,we review the use of dual mobility cup in total hip arthroplasty in terms of its history,biomechanics,outcomes and complications based on more than20 years of medical literature.

关键词： Dual mobility Total hip arthroplasty Dislocation Revision total hip arthroplasty Instability

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Computerized tomography based “patient specific blocks” improve postoperative mechanical alignment in primary total knee arthroplasty

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World Journal of Orthopedics 2016年第7期7卷 426-433页

作者： Raju Vaishya Vipul Vijay Vikas P Birla Amit K Agarwal department of orthopaedics Joint Replacement and ArthroscopyIndraprastha Apollo Hospital

AIM: To compare the postoperative mechanical alignment achieved after total knee arthroplasty(TKA) using computer tomography(CT) based patient specific blocks(PSB) to conventional instruments(CI).METHODS: Total 80 knees were included in the study, with 40 knees in both the groups operated using PSB and CI. All the knees were performed by a single surgeon using the same cruciate sacrificing implants. In our study we used CT based PSB to compare with CI. Postoperative mechanical femoro-tibial angle(MFT angle) was measured on long leg x-rays using picture archiving and communication system(PACS). We compared mechanical alignment achieved using PSB and CI in TKA using statistical analysis.RESULTS: The PSB group(group 1) included 17 females and seven males while in CI group(group 2) there were 15 females and eight males. The mean age of patients in group 1 was 60.5 years and in group 2 it was 60.2 years. The mean postoperative MFT angle measured on long-leg radiographs in group 1 was 178.23°(SD = 2.67°, range: 171.9° to 182.5°) while in group 2, the mean MFT angle was 175.73°(SD = 3.62°, range: 166.0° to 179.8°). There was significant improvement in postoperative mechanical alignment(P value = 0.001), in PSB group compared to CI. Number of outliers were also found to be less in group operated with PSB(7 Knee) compared to those operated with CI(17 Knee).CONCLUSION: PSB improve mechanical alignment after total knee arthroplasty, compared to CI. This may lead to lower rates of revision in the PSB based TKA as compared to the conventional instrumentation.

关键词： Knee replacement Arthroplasty Patient specific jigs Conventional jigs

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Subsequent total joint arthroplasty: Are we learning from the first stage?

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World Journal of Orthopedics 2024年第3期15卷 230-237页

作者： Christine Jiang Wu Colin Penrose Sean Patrick Ryan Michael Paul Bolognesi Thorsten Markus Seyler Samuel Secord Wellman department of Orthopaedic surgery Duke University HospitalDurhamNC 27710United States department of Orthopaedic surgery Midwest Center for Joint ReplacementIndianapolisIN 46241United States

BACKGROUND With the increasing incidence of total joint arthroplasty(TJA),there is a desire to reduce peri-operative complications and resource utilization.As degenerative conditions progress in multiple joints,many patients undergo multiple proce-dures.AIM To determine if both physicians and patients learn from the patient’s initial arth-roplasty,resulting in improved outcomes following the second procedure.METHODS The institutional database was retrospectively queried for primary total hip arth-roplasty(THA)and total knee arthroplasty(TKA).Patients with only unilateral THA or TKA,and patients undergoing same-day bilateral TJA,were excluded.Patient demographics,comorbidities,and implant sizes were collected at the time of each procedure and patients were stratified by first vs second surgery.Outcome metrics evaluated included operative time,length of stay(LOS),disposition,90-d readmissions and emergency department(ED)visits.RESULTS A total of 642 patients,including 364 undergoing staged bilateral TKA and 278 undergoing bilateral THA,were analyzed.There was no significant difference in demographics or comorbidities between the first and second procedure,which were separated by a mean of 285 d.For THA and TKA,LOS was significantly less for the second surgery,with 66%of patients having a shorter hospitalization(Psurgery.However,when a change in disposition was present from the first surgery,patients were significantly more likely to be discharged to home after the second procedure(P=0.033).There was no difference between procedures for post-operative readmissions(P=0.438)or ED visits(P=0.915).CONCLUSION After gaining valuable experience recovering from the initial surgery,a patient’s perioperative outcomes are improved for their second TJA.This may be the result of increased confidence and decrea

关键词： Staged total joint arthroplasty Asynchronous total joint arthroplasty Subsequent total joint arthroplasty Contralateral total joint arthroplasty Perioperative outcomes

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Acetabulum fractures in elderly patients:A review

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Chinese Journal of Traumatology 2022年第6期25卷 331-335页

作者： Ashwani Soni Ravi Gupta Ramesh Sen department of orthopaedics Goverrnment Medical College and HospitalSector-32Chandigarh160030India department of orthopaedics Max Super Speciality HospitalSahibzada Ajt Singh NagarMohali160062India

Fractures of the acetabulum in elderly patients were often caused by low energy trauma.Fractures involving anterior column are more common and often associated with impaction and comminution.Osteoporosis further complicates the management.Percutaneous fracture fixation has low morbidity but it is a technically demanding procedure.Open reduction and fracture fixation is done with or without simultaneous total hip replacement.Delayed total hip replacement is considered in posttraumatic arthritis patients.Patients with minimal displaced fractures,associated both-column fractures with secondary congruence of joint and patients who are medically unfit for surgery can be managed non-operatively.Whatever be the method of management,these elderly patients should be mobilised as early as possible.

关键词： Acetabulum Elderly Fracture Osteoporosis Hip Arthroplasty

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利用"Find-eat"策略通过受体功能化凋亡小体纳米囊泡靶向内皮细胞

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Science Bulletin 2023年第8期68卷 826-837,M0004页

作者：钱姝桐毛佳怡赵秋羽赵彬帆刘芷默卢博伦张柳成毛曦媛张余光王丹茹孙晓明崔文国 department of Plastic and Reconstructive surgery Shanghai Ninth People’s HospitalShanghai Jiao Tong University School of MedicineShanghai 200011China department of orthopaedics Shanghai Key Laboratory for Prevention and Treatment of Bone and Joint DiseasesShanghai Institute of Traumatology and OrthopaedicsRuijin HospitalShanghai Jiao Tong University School of MedicineShanghai 200025China

慢性创面的缺氧微环境导致血管化不足,进而使得伤口延迟愈合.内皮细胞作为组成新生血管的关键细胞,在血管化过程中发挥着核心作用.本研究构建了CX3CR1功能化凋亡小体纳米囊泡(nABs).“Find-eat”策略通过受体-配体组合,靶向低氧微环境... 详细信息

慢性创面的缺氧微环境导致血管化不足,进而使得伤口延迟愈合.内皮细胞作为组成新生血管的关键细胞,在血管化过程中发挥着核心作用.本研究构建了CX3CR1功能化凋亡小体纳米囊泡(nABs).“Find-eat”策略通过受体-配体组合,靶向低氧微环境中高表达CX3CR1的内皮细胞(ECs),从而放大“Find-eat”信号,促进血管生成.作者首先通过化学诱导脂肪干细胞(ADSCs)凋亡获得ABs,然后通过优化的低渗处理-温和超声-药物混合-挤压一系列处理步骤,获得载有去铁胺(DFO)的功能化凋亡小体纳米囊泡.体外实验显示ABs纳米囊泡生物相容性良好;可以通过CX3CL1/CX3CR1诱导缺氧微环境中的内皮细胞实现对其的“Find-eat”,进而促进内皮细胞的增殖、迁移、成管能力.体内实验中,ABs纳米囊泡可以促进伤口快速闭合,并可通过释放“Find-eat”信号靶向内皮细胞的同时实现促血管药物的缓释,促进糖尿病大鼠创面的新生血管形成.这种能够通过释放双重信号靶向内皮细胞并实现促血管药物缓释的ABs纳米囊泡为慢性糖尿病创面的愈合提供了一种新思路.

关键词： Endothelialcell-targeted Apoptotic body Nanovesicle Dual signal

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Wooden foreign body impalement through the right shoulder region–an unusual penetrating injury:A case report

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World Journal of Orthopedics 2022年第12期13卷 1064-1068页

作者： Abhay Harsh Kerketta Ritesh Kumar Seelora Sahu Jayanta Kumar Laik Manoj Kumar Rajak department of joint replacement and orthopaedics Tata Main HospitalSinghbhum 831001JharkhandIndia department of Anaesthesiology Tata Main HospitalJamshedpur 831001JharkhandIndia

BACKGROUND Impalement of the body is a rare injury and comes with varied presentation.There is no set classification or defined protocols for managing this injury.This case report aims to create awareness among trauma surgeons about unusual presentation and management of such case.CASE SUMMARY A 45-year-old man presented to the emergency department with a sharp penetrating wooden plank at right clavicular region between the neck and shoulder following a road traffic accident.The vehicle had crashed into a roadside wooden hut,thus causing an impalement injury.He was meticulously worked up and taken to emergency theatre.The wooden plank was removed and the wound healed uneventfully.Postoperatively,he had fairly good shoulder function and was able to return back to work successfully.CONCLUSION Each impalement injury brings in challenges in management as no two cases are the same.The varied presentation and risks involved should be known to medical professionals handling the emergency.Coordinated multidisciplinary team approach is needed for successful outcome.

关键词： Impaling Wooden Foreign body Sharp object Trunk Case report

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Multimodal prophylaxis for venous thromboembolic disease after total hip and knee arthroplasty： current perspectives

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Chinese Journal of Traumatology 2010年第6期13卷 362-369页

作者：鲁宁 Eduardo A. Salvati department of orthopaedics Second Affiliated Hospital of Kunming Medical University Kunming 650101 China department of orthopaedics Hospital for Special Surgery and Weill Medical College of Cornell University NewYork 10021 USA

Life-threatening in the short term and leading to a high level of morbidity in the long term, venous thromboembolism (VTE) is the most fearful complication following lower limb arthroplasty. With advances in surgical procedure, anesthetic management and postoperative convalescence have altered the risks of venous thromboembolism after total joint arthroplasty in the lower extremity.The pathogenesis of VTE is multifactorial and includes the well-known Virchow's triad of hypercoagulability, venous stasis and endothelial damage. Therefore, it is appropriate to use a multimodal approach to thromboprophylaxis. Despite extensive research, the ideal multimodal prophylaxis against venous thrombolism has not been identified. So this article reviews the recent developments in multimodal prophylaxis for thromboembolism after total joint arthroplasty.

关键词：静脉血栓多式联运膝关节栓塞置换预防疾病职业教育

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