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Long-term clinical outcomes following total knee arthroplasty in patients with hemophilic arthropathy:a single-surgeon cohort after a 10-to 17-year follow-up

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Chinese Medical Journal 2023年第12期136卷 1478-1484页

作者： Bin Feng Yingjie Wang Xiying Dong Zeng Li Jin Lin Xisheng Weng Department of orthopedic Surgery State Key Laboratory of Complex Severe and Rare DiseasesPeking Union Medical College HospitalChinese Academy of Medical Science and Peking Union Medical CollegeBeijing 100730China Division of Joint Osteopathy and Traumatology Center of Orthopedics SurgeryGuangdong Provincial People’s HospitalGuangdong Academy of Medical SciencesSchool of MedicineSouth China University of TechnologyGuangzhouGuangdong 510000China

Background:Total knee arthroplasty(TKA)can reduce severe joint pain and improve functional disability in ***,the long-term outcomes have rarely been reported in ***,this study aimed to evaluate the long-term outcomes and complications of TKA in Chinese patients with hemophilic ***:We retrospectively reviewed patients with hemophilia who underwent TKA between 2003 and 2020,with at least 10 years of *** clinical results,patellar scores,patients’overall satisfaction ratings,and radiological findings were *** surgery for implants during the follow-up period was ***:Twenty-six patients with 36 TKAs were successfully followed up for an average of 12.4 *** Hospital for Special Surgery Knee Score improved from an average of 45.8 to *** average flexion contracture statistically significantly decreased from 18.1°to 4.2°.The range of motion(ROM)improved from 60.6°to 84.8°.All the patients accepted patelloplasty,and the patients’patellar score improved from 7.8 preoperatively to 24.9 at the last *** was no statistically significant difference in clinical outcomes between the unilateral and bilateral procedures,except for a better ROM at follow-up in the unilateral *** and enduring anterior knee pain was reported in seven knees(19%).The annual bleeding event was 2.7 times/year at the last follow-up.A total of 25 patients with 35 TKAs were satisfied with the procedure(97%).Revision surgery was performed in seven knees,with 10-and 15-year prosthesis survival rates of 85.8%and 75.7%,***:TKA is an effective procedure for patients with end-stage hemophilic arthropathy,which relieves pain,improves knee functions,decreases flexion contracture,and provides a high rate of satisfaction after more than ten years of follow-up.

关键词： Hemophilic arthropathy Total knee arthroplasty Patelloplasty Satisfaction Long-term outcome

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微创髋关节成形术后关节囊外持续输注0．3％罗哌卡因与安慰剂对患者吗啡自控镇痛的前瞻随机双盲对照研究

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麻醉与镇痛 2013年第5期9卷 54-59页

作者： Jose Aguirre, MD, MSc Barbara Baulig, MD Claudio Dora, MD Georgios Ekatodramis, MD Gina Votta-Velis, MD, PhD Philipp Ruland, MD Alain Borgeat, MD 赵燕君(译) 邓小明(校) Division of Anesthesiology Department of orthopedic Surgery Balgrist University Hospital Zurich Zurich Switzerland. Gina Votta-Velis is currently affiliated with the Department of Anesthesiology University of Illinois at Chicago 不详

背景本研究中，我们探讨了微创髋关节成形术后创口持续输注0．3％罗哌卡因对疼痛和吗啡用量的影响。方法在这项双盲研究中，前瞻性纳入连续67例在蛛网膜下隙麻醉下择期行微创髋关节成形术的患者。外科医师将15cm长的有孔导管放入关节囊... 详细信息

背景本研究中，我们探讨了微创髋关节成形术后创口持续输注0．3％罗哌卡因对疼痛和吗啡用量的影响。方法在这项双盲研究中，前瞻性纳入连续67例在蛛网膜下隙麻醉下择期行微创髋关节成形术的患者。外科医师将15cm长的有孔导管放入关节囊外。患者随机分为两组：在关闭切口前，创口内单次注入20ml的0．3％罗哌卡因（R-组）或0．9％生理盐水（P-组）。随后用弹性泵以8ml／h的速度分别持续泵入0．3％的罗哌卡因或者安慰剂至术后48小时。所有患者均给予静脉吗啡自控镇痛。记录48小时内患者吗啡用量、静息和运动时疼痛以及血浆罗哌卡因总浓度和游离浓度。术后随访3个月。结果两组-般资料和手术数据相似。术后第一个48小时期间，R-组平均吗啡用量显著低于P组：45．4±9．5VS69．7±9．6（P〈0．001）。R-组吗啡用量在术后第一个24小时期间平均减少14．4mg[95％可信区间（confidenceinterval，CI）12．6～16．1]，在术后第二个24小时期间平均减少20．8mg（95％CI为19．1～22．4）。R组患者静息和运动时疼痛评分均较低（P〈0．0001）。R-组患者平均满意度较基线增加了22．7％（95％CI为15．9～16．1）。R-组血浆罗哌卡因总浓度和游离浓度均低于中毒浓度。R-组在第24小时和第48小时时血浆罗哌卡因游离浓度分别是0．141μmol／ml和0．11μmol／ml。在术后3个月时，两组臀部疼痛和镇痛药用量相似，但是R．组患者创口接触（31．2；95％CI27．7～34．7）不适感和压迫不适感（24；95％CI为20．1-27．9）明显减轻（P〈0．0001）。结论微创髋关节置换术后关节囊外创口持续输注0．3％罗哌卡因是-种减少吗啡用量，改善术后镇痛质量的有效方法，术后3个月时该方法依然具有-定优势。

关键词：随机双盲对照研究髋关节成形术罗哌卡因静脉吗啡持续输注自控镇痛后关节安慰剂

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Hybrid External Fixation for Open Severe Comminuted Fractures of the Distal Femur

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Surgical Science 2013年第2期4卷 176-183页

作者： Ebrahim Ghayem Hassankhani Ali Birjandinejad Farzad Omidi Kashani Golnaz Ghayem Hassankhani Department of orthopedics and Spine Surgery Orthopedic Research Center Imam Reza Hospital Mashhad University of Medical Sciences Mashhad Iran Department of orthopedics Surgery Imam Reza Hospital Mashhad University of Medical Sciences Mashhad Iran Department of orthopedics Surgery Shahid Kamiab Hospital Mashhad University of Medical Sciences Mashhad Iran Mashhad University of Medical Sciences Mashhad Iran

Background: The treatment of distal femoral open comminuted fractures is a major problem for orthopedic surgeon. The basic and important aim in treatment of these fractures is to assemble the condylar fragments and then fix the condyles to the femoral shaft by minimum handling of the bone and soft tissues. Objectives: To evaluate the treatment of distal femoral open comminuted fractures (type C2 and C3) with hybrid external fixator. Methods: Thirty-four patients with distal femur open comminuted fracture (type C2 and C3) were treated by hybrid external fixator between January 2005 and December 2008. All of the fractures were opened with extension to joint surface. 30 patients were male and 4 were female. Their average age was 30.5 years (17 to 72 years). Average follow up period was 36 months. 12 patients had isolated fracture and 22 patients had multiple fractures. The bony and functional results were evaluated by the association for the study and application of the method of Ilizarov (ASAMI) protocol and knee society score. Results: 29 out of 34 fractures (85%) had union without bone grafts. Average time of union was 6.1 months (4 - 19 ms). The average knee range of motion was 87.5 degrees (30 - 115 degrees). The bony results were excellent in 24 patients (70.5%), good in 6 (17.7%), fair in 2 (5.9%), and poor in 2 (5.9%), and the functional results were excellent in 10 (29.4%) patients, good in 14 (41.2%), fair in 6 (17.6%), and poor in 4 (11.8%), and the functional results were excellent in 10 (29.4%) patients, good in 14 (41.2%), fair in 6 (17.6%), and poor in 4 (11.8%) according to ASAMI protocol. According to the knee society score the functional results were excellent in 9 (26.44%) patients, good in 13 (38.26%), fair in 7 (20.6%), and poor in 5 (14.7%). Conclusion: Hybrid external fixator is an effective method for treatment of distal femoral open comminuted fractures (type C2 and C3) and may be considered as an alternative surgical methods in the management

关键词： Hybrid External Fixator Open Fractures Distal Femoral Fracture Type C2 and C3

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orthopedic disorders of the knee in hemophilia:A current concept review

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World Journal of orthopedics 2016年第6期7卷 370-375页

作者： E Carlos Rodriguez-Merchan Leonard A Valentino Department of orthopedic Surgery La Paz University Hospital-Idi Paz Rush University Medical Center

The knee is frequently affected by severe orthopedic changes known as hemophilic arthropathy(HA) in patients with deficiency of coagulation factor Ⅷ or Ⅸ and thus this manuscript seeks to present a current perspective of the role of the orthopedic surgeon in the management of these *** factor replacement therapy(FRT) is optimal to prevent HA,however adherence to this regerous treatment is challenging leading to breakthrough *** patients with chronic hemophilic synovitis,the prelude to HA,radiosynovectomy(RS) is the optimal to ameliorate *** in people with hemophilia(PWH) is associated with a high risk of bleeding and infection,and must be performed with FRT.A coordinated effort including orthopedic surgeons,hematologists,physical medicine and rehabilitation physicians,physiotherapists and other team members is key to optimal ***,orthopedic procedures should be performed in specialized hospitals with experienced *** we are able to prevent orthopedic problems of the knee in PWH will have to continue performing orthopedic procedures(arthrocentesis,RS,arthroscopic synovectomy,hamstring release,arthroscopic debridement,alignment osteotomy,and total knee arthroplasty).By using the aforementioned procedures,the quality of life of PWH will be improved.

关键词： Hemophilia Knee orthopedic problems Prevention Surgical treatment

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Anterior muscle sparing approach for total hip arthroplasty

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World Journal of orthopedics 2013年第1期4卷 12-18页

作者： Joseph T Moskal Susan G Capps John A Scanelli Virginia Tech Carilion School of Medicine 3 Riverside Circle Roanoke WV 24016 United States Bensol-Biologic Engineering Solutions Warsaw IN 46582 United States Department of orthopedic Surgery University of Virginia School of Medicine Charlottesville VA 22908 United States

The purpose of this review is to examine the validity of positive claims regarding the direct anterior approach(DAA) with a fracture table for total hip arthroplasty. Recent literature regarding the DAA was searched and specific claims investigated including improved early outcomes, speed of recovery, component placement, dislocation rates, and complication rates. Recent literature is positive regarding the effects of total hip arthroplasty with the anterior approach. While the data is not definitive at present, patients receiving the anterior approach for total hip arthroplasty tend to recover more quickly and have improved early outcomes. Component placement with the anterior approach is more often in the "safe zone" than with other approaches. Dislocation rates tend to be less than 1% with the anterior approach. Complication rates vary widely in the published literature. A possible explanation is that the varianceis due to surgeon and institutional experience with the anterior approach procedure. Concerns remain regarding the "learning curve" for both surgeons and institutions. In conclusion, it is not a matter of should this approach be used, but how should it be implemented.

关键词： Total hip arthroplasty Anterior approach Hip Arthritis Joint replacement

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