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Water treatment faces significant challenges due to the increasing complexity of pollutants and the need for more efficient, sustainable treatment methods. However, current adsorbent materials often struggle with issues such as low adsorption capacity, slow kinetics, and poor reusability, limiting their practical application. In this study, we developed a novel hierarchical porous hybrid gel (HPHG) for water treatment to address the limitations of conventional adsorbents. The HPHG features a multi-level porous structure (from 48 ± 28 nm to 4385 ± 823 nm) that significantly enhances its porosity and specific surface area. We systematically investigated the relationship between the material's structure and its adsorption performance. Kinetic studies revealed a tendency towards a pseudo-second-order adsorption model, attributed to the material's unique structural features that facilitate rapid mass exchange channels inside HPHG and provide abundant active sites for pollutant adsorption. Reusability tests demonstrated that the material retained 85.4% of its initial adsorption capacity after five adsorption-desorption cycles, highlighting its potential for practical applications. This study provides valuable insights into structure-performance relationships in advanced water treatment materials, offering a promising approach for designing next-generation adsorbents with superior efficiency and sustainability.
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OBJECTIVE: We investigated the advantages of robotic arm-assisted total knee arthroplasty (raTKA) over conventional manual TKA (cmTKA) by comprehensively comparing patients who received raTKA and cmTKA in terms of postoperative pain, function, imaging assessment, and trauma to the body. This study investigated the efficacy and safety of raTKA in patients using the YUANHUA-TKA system. METHODS: In a prospective, randomized single-blind trial, 60 patients undergoing primary unilateral TKA from October 2020 to December 2020 were randomly assigned to either raTKA or cmTKA. Clinical evaluation, including the time of osteotomy and prosthesis model testing, the total operation time, the visual analogue scale at rest, VAS in motion, opioid consumption, white blood cell count, neutrophil ratio, erythrocyte sedimentation rate, C-reactive protein (CRP), passive and active range of motion (pROM, aROM), Western Ontario and McMaster Universities Arthritis Index (WOMAC [stiffness, pain, and function]) score, gait analysis, keen society score (KSS), adverse events, and blood loss were collected by the project nurse, as well as the imaging evaluation, including the lateral tibia component angle (LTC), frontal femoral component angle, frontal tibia component angle (FTC), lateral femoral component angl, and hip-knee-ankle angle (HKA). The student t-test (or the Wilcoxon signed-rank test) and the χ2-test (or the Fisher exact test) were used to determine differences in categorical variables. RESULTS: No significant difference was found between the two groups in pain throughout the whole follow-up period. On the third day postoperatively, the erythrocyte sedimentation rate in the cmTKA group was significantly higher (p = 0.02), as well as the CRP (p = 0.04). No significant difference was found in the WOMAC stiffnes score or pROM. However, the aROM and the flexion range when walking (FRW) were significantly better in the raTKA group throughout the trial (p < 0.05). The KSS at the 1-month follow-up and the WOMAC function score at the 1-year follow-up were both significantly better in the raTKA group (p < 0.05). The HKA and the LTC in the raTKA group closer to the ideal angle, and the difference between the groups was significant (p < 0.05). The total operation time of the raTKA group was significantly longer (p = 0.001). The intraoperative blood loss had no significant difference in the two groups. CONCLUSION: Compared with cmTKA, raTKA with the YUANHUA robot not only avoids extra pain and trauma in patients but promises better functional recovery and improves the accuracy of the prosthesis position and axial alignment reconstruction.
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Artroplastia de Reemplazo de Rodilla , Prótesis de la Rodilla , Osteoartritis de la Rodilla , Procedimientos Quirúrgicos Robotizados , Humanos , Artroplastia de Reemplazo de Rodilla/métodos , Procedimientos Quirúrgicos Robotizados/efectos adversos , Estudios Prospectivos , Método Simple Ciego , Articulación de la Rodilla/cirugía , Osteoartritis de la Rodilla/cirugía , Dolor Postoperatorio/etiologíaRESUMEN
Hydrogel, recognized as a promising biomaterial for tissue engineering, possesses notable characteristics, including high water uptake, an interconnected porous structure, and excellent permeability. However, the intricate task of fabricating a hierarchically macro-micronanoporous structure, essential for providing adequate space for nutrient diffusion and cell growth within hydrogels, remains a formidable challenge. In response to these challenges, this study introduces a sustainable and straightforward three-dimensional (3D) foaming printing strategy to produce hierarchically macro-micronanoporous hydrogels (HPHs) without the utilization of porogens and post-etching process. This method entails the controlled generation of air bubbles within the hydrogels through the application of optimal mechanical stirring rates. Subsequent ultraviolet (UV) cross-linking serves to effectively stabilize the macropores within the HPHs. The resulting hierarchically macro-micronanoporous structures demonstrate a substantial improvement in the viability, adhesion, and proliferation of human umbilical vein endothelial cells (HUVECs) when incubated with the hydrogels. These findings present a significant advancement in the fabrication of hierarchically macro-micronanoporous hydrogels, with potential applications in the fields of tissue engineering and organoid development.
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Biomimética , Hidrogeles , Humanos , Hidrogeles/farmacología , Hidrogeles/química , Ingeniería de Tejidos/métodos , Células Endoteliales de la Vena Umbilical Humana , Proliferación Celular , Impresión Tridimensional , Andamios del Tejido/químicaRESUMEN
OBJECTIVES: The purpose of this study was to analyze mid- to long-term outcomes of total hip arthroplasty (THA) following failed internal fixation of femoral neck fracture. METHODS: This study retrospectively analyzed 345 patients with femoral neck fracture who underwent THA after failure of internal fixation at our hospital between January, 2003 and December, 2019. Patients older than 55 years (n = 175) and patients no older than 55 years (n = 170) were compared in terms of complications and survival rates during follow-up, which lasted a mean of 6 years. RESULTS: The two age groups showed similarly low incidence of complications and similarly long periods of survival without revision surgery. Only three younger patients and two older patients underwent revision surgery during follow-up. The two groups showed similarly high survival rates at the end of follow-up (> 93%). Younger patients showed significantly bettter Harris hip score at last follow-up (90.2 vs. 88.1 points, p < 0.001) without clinically significant difference, but they required THA significantly earlier after internal fixation (4.4 vs. 6.8 years, p < 0.001). CONCLUSIONS: THA after failed internal fixation of femoral neck fracture is a well tolerated and effective procedure in older and younger patients.
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Artroplastia de Reemplazo de Cadera , Fracturas del Cuello Femoral , Humanos , Anciano , Estudios Retrospectivos , Artroplastia de Reemplazo de Cadera/efectos adversos , Estudios de Seguimiento , Fracturas del Cuello Femoral/cirugía , Fijación Interna de FracturasRESUMEN
Immunomodulatory biomaterials have emerged as promising treatment agents for bone defects. However, it is unclear how such biomaterials control immune cell behaviors to facilitate large-segment bone defect repair. Herein, we fabricated biphasic calcium phosphate ceramics with nanowhisker structures to explore the immunoregulation features and influence on large-segment bone defect repair. We found that the nanowhisker structures markedly facilitated large-segment bone defect repair by promoting bone regeneration and scaffold resorption. Our in vitro experiment and transcriptomic analysis showed that mechanical stress derived from nanowhisker structures may activate the transcription of Egr-1 to induce early switch of macrophage phenotype to M2, which could not only facilitate osteogenic differentiation of BMSCs but also enhance the expression of osteoclast differentiation-regulating genes of M2 macrophage. In vivo study showed that the nanowhisker structures relieved local inflammatory responses by inducing early switch of macrophage phenotype from M1 to M2, which resulted in accelerated osteoclastogenesis for biomaterial resorption and osteogenesis for ectopic bone formation. Hence, we presume that nanowhisker structures may orchestrate bone formation and material resorption coupling to facilitate large-segment bone defect repair by controlling the switch of macrophage phenotype. This study provides new insight into the designing of immunomodulatory tissue engineering biomaterials for treating large-segment bone defects.
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BACKGROUND: Abductor mechanism deficiency is a clear indication for using constrained acetabular liners (CALs), and large acetabular bone defects are considered a relative contraindication to CALs. We report the results of using CALs in special cases in which abductor or greater trochanter deficiency was accompanied by large acetabular bone defects at second-stage re-implantation for chronic infected total hip arthroplasty (THA). METHODS: Between January 2010 and January 2018, 19 patients who used CALs at second-stage re-implantation and had abductor or greater trochanter deficiency and large acetabular bone defects were included in this study. We followed up with the clinical and radiological results of these patients. Complications and infection-related information were also recorded. RESULTS: Eight patients, 4 patients, and 7 patients had Paprosky type IIB, type IIC, and type IIIA acetabular bone defects at second-stage re-implantation, respectively. The indication for using CALs was abductor deficiency in 14 patients and greater trochanter deficiency in the other 5 patients. The mean follow-up was 74.4 months (range 50-96). The mean Harris Hip Score (HHS) was 76.3 points (range 62-86) at the last follow-up. Three patients presented acetabular radiolucent lines with no progress: zone 3, zone 3 and zone 2 and 3, respectively. One patient suffered transient sciatic nerve palsy. There was no dislocation, failure of the CALs, reoperation, or recurrence of infection. CONCLUSION: Our results suggested that for screened patients, CALs are a viable option in second-stage re-implantation for chronic infected THA with abductor or greater trochanter deficiency and large bone defects.
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Artroplastia de Reemplazo de Cadera , Prótesis de Cadera , Acetábulo/diagnóstico por imagen , Acetábulo/cirugía , Artroplastia de Reemplazo de Cadera/efectos adversos , Artroplastia de Reemplazo de Cadera/métodos , Fémur/diagnóstico por imagen , Fémur/cirugía , Estudios de Seguimiento , Prótesis de Cadera/efectos adversos , Humanos , Falla de Prótesis , Reoperación/métodos , Estudios RetrospectivosRESUMEN
PURPOSE: The use of porous tantalum augments and titanium-coated cups in primary total hip arthroplasty (THA) with acetabular defects has shown satisfactory outcomes in our centre. The aim of this study was to report the long-term radiological and clinical outcomes of using this combination for Paprosky type III acetabular bone defects in acetabular revision. PATIENTS AND METHODS: Between January 2007 and January 2015, 45 patients with Paprosky type III acetabular defects underwent acetabular revision using a combination of porous tantalum augments and titanium-coated cups. Among these, 41 patients (41 hips) had complete follow-up. Thirty-one patients had a Paprosky type IIIA defect, and ten patients had a Paprosky type IIIB defect. No patients had pelvic discontinuity. There were 20 males and 21 females with an average age of 63.2 years (range 35-80) at the time of revision surgery. RESULTS: The mean follow-up was 122.8 months (range 69-165). The Harris Hip Score (HHS) improved significantly from 32.1 points (range 17-58) pre-operatively to 85.3 points (63-98) at the last follow-up. The Short Form-12 (SF-12) and Hip Dysfunction and Osteoarthritis Outcome Score (HOOS) improved significantly for each item at the last follow-up. Two patients had a high hip centre post-operatively. One patient had recurrent dislocation but did not require re-revision. No further revision of the acetabular components was required, and all hips remained stable at the last follow-up with bony ingrowth of the acetabular components according to the criteria of Moore et al. CONCLUSION: The combination of tantalum augments and conventional titanium-coated cups achieved satisfactory long-term radiographic and clinical outcomes for Paprosky type III acetabular bone defects without pelvic discontinuity.
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Artroplastia de Reemplazo de Cadera , Prótesis de Cadera , Acetábulo/diagnóstico por imagen , Acetábulo/cirugía , Adulto , Anciano , Anciano de 80 o más Años , Artroplastia de Reemplazo de Cadera/efectos adversos , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Porosidad , Falla de Prótesis , Reoperación , Estudios Retrospectivos , Tantalio , TitanioRESUMEN
BACKGROUND: Total hip arthroplasty (THA) candidates frequently present pelvic malrotation. The aim of this study is to analyze how pelvic malrotation influence transverse acetabular ligament (TAL) guided cup orientation and investigate whether pelvic malrotation produce different clinical outcomes after THA. METHODS: We retrospectively reviewed a consecutive series of THA patients (144 hips) who use TAL as a guidance for cup positioning from March 2017 to January 2020. The patients were divided into normal pelvis (NP) group and backward pelvis (BP) group by sagittal pelvic malrotation assessed by APPA, the angle between the vertical and the APP on standing lateral pelvic radiographs preoperatively. Cup anteversion and inclination and that out of the safe zones were measured and compared in two groups. The demographic data, clinical results, and complications of patients were also compared. RESULTS: Backward pelvic malrotation were found in 60.6 % of this cohort of THA candidates. The mean angle of both inclination and anteversion in BP group were significantly larger than that in NP group. The rate of cup for anteversion and inclination above the safe zone in BP group was significantly larger than that in NP group. There were 4 patients in BP group recording anterior hip dislocation after surgery. Other complications were not observed at last follow-up. CONCLUSIONS: Backward pelvis malrotation may increase TAL guided cup inclination and anteversion, which were inclined to became outlier above the safe zone. This likely increase the rates of dislocation after THA. For the patients with pelvis malrotation, cup positioning should be performed individually instead of guided by TAL.
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Prótesis de Cadera , Acetábulo/diagnóstico por imagen , Acetábulo/cirugía , Articulación de la Cadera , Humanos , Pelvis/diagnóstico por imagen , Pelvis/cirugía , Estudios RetrospectivosRESUMEN
OBJECTIVE: The effect of patellar denervation with electrocautery (PD) on anterior knee pain (AKP) after total knee arthroplasty (TKA) is still debated. The aim of this meta-analysis was to evaluate the current evidence regarding the use of PD in TKA without patellar resurfacing. METHODS: A computerized search of published studies was performed in the PubMed, Embase and Cochrane Library databases in December 2019. Eligible studies were randomized controlled trials (RCTs) comparing clinical outcomes of the PD group and the non-PD group. Subgroup analyses were carried out according to the follow-up time (3, 12 months, and over 12 months) to evaluate whether the clinical effect of PD changed with time. RESULTS: Ten RCTs were included in this meta-analysis. Pooled results showed a lower rate of AKP (Risk Ratio [RR] = 0.70; 95% confidence interval [CI], 0.50 to 0.97; P = 0.03) and a reduction in visual analogue scale (VAS) for AKP (mean difference, -0.37; 95% CI, -0.69 to -0.05; P = 0.02) in the PD group when compared to the non-PD group. Subgroup analyses found the differences in AKP incidence and VAS for AKP were significant at 3- and 12-month follow-up but not after 12-month follow-up. No significant difference was observed in functional scores between the two groups. No specific complication directly or indirectly related to PD was found. CONCLUSION: PD can decrease the incidence and severity of AKP within 12 months after TKA, but the effect cannot be maintained after 12-month follow-up. Without significant associated complication and reoperation, the use of PD is still recommended in TKA without patellar resurfacing.
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Artralgia/cirugía , Artroplastia de Reemplazo de Rodilla , Desnervación/métodos , Electrocoagulación/métodos , Dolor Postoperatorio/cirugía , Rótula/inervación , Rótula/cirugía , Humanos , Manejo del Dolor/métodos , Dimensión del Dolor , Ensayos Clínicos Controlados Aleatorios como Asunto , Encuestas y CuestionariosRESUMEN
OBJECTIVE: To review the perioperative blood management (PBM) of total knee arthroplasty (TKA) and total hip arthroplasty (THA). METHODS: Recent researches on PBM for TKA and THA were comprehensively read and summarized. Then the advantages and disadvantages of various measures together with the clinical experience of West China Hospital of Sichuan University were evaluated from three aspects, including optimizing hematopoiesis, reducing blood loss and blood transfusion, which could provide a basis for clinical selection. RESULTS: There are many PBM methods in TKA and THA, among which the optimization of hematopoiesis mainly includes the application of perioperative iron and erythropoietin. Measures to reduce bleeding include the use of tourniquet, intraoperative controlled hypotension, and perioperative antifibrinolytic agents. Autologous blood transfusion includes preoperative autologous blood donation, hemodilution and cell salvage. Allogeneic blood transfusion is the ultimate treatment for anemia. The application of erythropoietin combined with iron therapy for blood mobilization before surgery together with intraoperative controlled hypotension for bleeding control and the multiple use of tranexamic acid can achieve satisfactory clinical results. CONCLUSION: In the perioperative period of TKA and THA, single or multiple use of different blood management measures should be considered carefully according to the physical and economic conditions of patients individually, so as to reduce the blood loss and allogeneic blood transfusion optimally, and finally accelerate the recovery of patients.
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Antifibrinolíticos , Artroplastia de Reemplazo de Cadera , Artroplastia de Reemplazo de Rodilla , Ácido Tranexámico , Pérdida de Sangre Quirúrgica , China , HumanosRESUMEN
OBJECTIVE: To evaluate the safety and effectiveness of total hip arthroplasty (THA) in patients with hypothyroidism. METHODS: Sixty-three patients with hypothyroidism (hypothyroidism group) and 63 euthyroid patients without history of thyroid disease (control group) who underwent primary unilateral THA between November 2009 and November 2018 were enrolled in this retrospective case control study. There was no significant difference between the two groups in gender, age, body mass index, hip side, reason for THA, American Society of Anesthesiology (ASA) classification, preoperative hemoglobin (Hb) level, and preoperative Harris score ( P>0.05). The perioperative thyroid stimulating hormone (TSH) and thyroxine (T 4) levels, the hypothyroidism-related and other complications during hospitalization, the decrease in Hb, perioperative total blood loss, blood transfusion rate, length of hospital stays, and 90 days readmissions rate in the two groups were recorded and evaluated. The periprosthetic joint infection, aseptic loosening of the prosthesis, and hip Harris score during follow-up were recorded. RESULTS: The differences in the TSH and T 4 of hypothyroidism group between pre- and 3 days post-operation were significant ( P>0.05) and no hypothyroidism-related complications occurred after THA. The decrease in Hb and perioperative total blood loss in the hypothyroidism group were significantly higher than those in the control group ( P<0.05), but there was no significant difference between the two groups in terms of transfusion rate, length of hospital stays, and 90 days readmission rates ( P>0.05). No significant difference in the rate of complications (liver dysfunction, heart failure, pulmonary infection, urinary infection, and wound complication) between the two groups was found ( P>0.05) except for the rate of intramuscular vein thrombosis which was significantly lower in the hypothyroidism group, and the rate of postoperative anemia which was significantly higher in the hypothyroidism group ( P<0.05). The two groups were followed up 1.0-9.9 years (mean, 6.5 years). At last follow-up, Harris score in both groups were significantly higher than those before operation ( P<0.05). An increase of 39.5±12.3 in hypothyroidism group and 41.3±9.3 in control group were recorded, but no significant difference was found between the two groups ( t=0.958, P=0.340). During the follow-up, 1 case of periprosthetic joint infection occurred in the hypothyroidism group, no loosening or revision was found in the control group. CONCLUSION: With the serum TSH controlled within 0.5-3.0 mU/L and T 4 at normal level preoperatively, as well as the application of multiple blood management, hypothyroid patients can safely go through THA perioperative period and effectively improve joint function, quality of life, and obtain good mid-term effectiveness.
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Artroplastia de Reemplazo de Cadera , Hipotiroidismo , Estudios de Casos y Controles , Articulación de la Cadera/cirugía , Humanos , Hipotiroidismo/etiología , Calidad de Vida , Estudios RetrospectivosRESUMEN
BACKGROUND: Stress shielding and bone loss of the femur are of great concern after revision total hip arthroplasty (THA) with extensively porous-coated stems, especially in a femur with already bone loss. The femoral bone remodeling patterns after revision THA with femoral bone defects using extensively porous-coated stems with cortical strut allografts remain unclear. METHODS: We retrospectively reviewed 47 patients who underwent revision THA using extensively porous-coated stems combined with cortical strut allografts and 75 patients without allografts. The minimum follow-up was 2 years. Femoral bone remodeling signs, including stress shielding, bone restoration in bone defect area, distal cortical hypertrophy, and femoral width, were compared between patients with and without cortical strut allografts. Clinical outcomes were also compared between two groups. RESULTS: Patients with cortical strut allografts showed less severe stress shielding (P = 0.01) than patients without allografts. Patients with allografts had more osseous restoration in bone defect area than patients without allografts (63.8% vs 30.7%, P < 0.001). Femoral width was significantly higher in femur with allografts than in femur without allografts at the immediate postoperative stage and latest follow-up (both P < 0.001). The hip function score, re-revision rate, and complications were comparable between two groups. CONCLUSION: The application of cortical strut allografts can decrease the severity of stress shielding, augment osseous restoration in bone defect area and improve femoral bone stock after revision THA using extensively porous-coated stems.
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Artroplastia de Reemplazo de Cadera/efectos adversos , Trasplante Óseo/métodos , Fémur/cirugía , Reoperación/métodos , Adulto , Anciano , Anciano de 80 o más Años , Artroplastia de Reemplazo de Cadera/métodos , Remodelación Ósea , Femenino , Fémur/patología , Humanos , Masculino , Persona de Mediana Edad , Estudios RetrospectivosRESUMEN
BACKGROUND: Revision total hip arthroplasty (THA) with severe femoral bone defects remains a major challenge. The purpose of this study is to report the minimum 8-year clinical and radiographic results of revision THA with severe femoral bone defects treated with extensively porous-coated stems and cortical strut allografts. METHODS: We retrospectively identified 44 patients diagnosed with Paprosky type III and IV femoral bone defects between January 2006 and July 2011. The exclusion criteria were patients not eligible for surgery, revised with extensively porous-coated stems alone, lost to follow-up and deceased. A total of 31 patients treated with extensively porous-coated stems and cortical strut allografts were finally included in this study. The degree of femoral bone defects was categorized as Paprosky type IIIA in 19 patients, type IIIB in 9 patients and type IV in 3 patients. The mean duration of follow-up was 11.0 ± 1.5 (range, 8.1-13.5) years. RESULTS: The mean Harris Hip Score improved significantly from 43.4 ± 10.5 points to 85.2 ± 6.6 points (P < 0.001). Similarly, WOMAC and SF-12 scores also significantly improved. Twenty-eight stems achieved stable bone ingrowth, two stems showed stable fibrous ingrowth, and one stem was radiologically unstable. Complete union and bridging between cortical strut allografts and host bone was achieved in all 31 patients. The femoral width was augmented with cortical strut allografts after revision surgery (an increase of 10.5 ± 0.5 mm) and showed a slight decrease of 2.5 ± 4.8 mm after the 10-year follow-up. Using re-revision for any reason as an endpoint, the Kaplan-Meier cumulative survival rate of the stem was 96.2% (95% confidence interval, 75.7-99.5%) at 10 years. CONCLUSION: Our data demonstrate that the use of extensively porous-coated stems combined with cortical strut allografts in revision THA with Paprosky type III and IV femoral bone defects can provide satisfactory clinical and radiographic outcomes with a minimum follow-up of 8 years.
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Artroplastia de Reemplazo de Cadera/instrumentación , Trasplante Óseo/métodos , Fémur/cirugía , Articulación de la Cadera/cirugía , Prótesis de Cadera , Reoperación , Adulto , Anciano , Anciano de 80 o más Años , Aloinjertos , Artroplastia de Reemplazo de Cadera/efectos adversos , Fenómenos Biomecánicos , Trasplante Óseo/efectos adversos , Femenino , Fémur/diagnóstico por imagen , Fémur/fisiopatología , Estudios de Seguimiento , Articulación de la Cadera/diagnóstico por imagen , Articulación de la Cadera/fisiopatología , Humanos , Estimación de Kaplan-Meier , Masculino , Persona de Mediana Edad , Oseointegración , Porosidad , Diseño de Prótesis , Falla de Prótesis , Radiografía , Rango del Movimiento Articular , Recuperación de la Función , Estudios RetrospectivosRESUMEN
PURPOSE: To investigate airway development and airway resistance by computed tomographic three-dimensional (3D) reconstruction of the bronchial tree in patients with adolescent idiopathic scoliosis (AIS). We evaluated factors predicting postoperative respiratory complications to provide timely treatment, prevent complications, and improve operative and anesthetic safety. METHODS: From August 2015 to August 2017, 53 AIS patients with a mean age of 15.4 years (range 10-20 years) were included in this study. Scoliotic parameters on radiographs were analyzed. Airway resistance was obtained by pulmonary function testing. All patients' pulmonary bronchial trees were 3D-reconstructed via chest thin layer computed tomography to explore the correlation between the spinal-thoracic deformity parameters and airway resistance. RESULTS: Correlations between scoliotic parameters and airway development parameters were not statistically significant (P > 0.05). The scoliotic parameters such as Cobb angle, apical vertebral translation, rotation angle to sagittal plane, rotation angle to middle line, and apical vertebral body-rib ratio (AVB-R) were positively correlated with tracheal bifurcation angle (R2: 0.429, 0.374, 0.430, 0.504, and 0.414, respectively; P < 0.05). Cobb angle, rib hump, and apical vertebral body-rib ratio (AVB-R) were positively correlated with left principal bronchus length to right principal bronchus length (PBL-R) (R2: 0.373, 0.503, and 0.377, respectively; P < 0.05). Superficial area of bronchial tree (SABT) and narrow cross section of trachea (NCT) were negatively correlated with plethysmography Pre-Ref resistance ratio (Pre/Ref) (R2: - 0.365 and - 0.452, respectively; P < 0.05). SABT and NCT were negatively correlated with respiratory impedance (Zrs) (R2: - 0.327 and - 0.436, respectively; P < 0.05). CONCLUSIONS: Pulmonary bronchial development in patients with AIS is affected by spinal-thoracic deformity. Comprehensive assessment of preoperative pulmonary function, especially airway resistance, is necessary in patients with AIS whether the thoracic scoliosis is severe or mild-to-moderate. These slides can be retrieved under Electronic Supplementary Material.
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Escoliosis , Fusión Vertebral , Adolescente , Adulto , Resistencia de las Vías Respiratorias , Niño , Humanos , Imagenología Tridimensional , Escoliosis/diagnóstico por imagen , Escoliosis/cirugía , Vértebras Torácicas , Tomografía Computarizada por Rayos X , Resultado del Tratamiento , Adulto JovenRESUMEN
BACKGROUND: Overt hypothyroidism is widely accepted as a risk factor for adverse events following total knee arthroplasty (TKA). However, no prior study has preoperatively reversed hypothyroidism and reevaluated its risk. This retrospective study aimed at investigating whether well-controlled overt hypothyroidism would still increase the risk of TKA. METHODS: Between November 2009 and November 2016, patients diagnosed with overt hypothyroidism but well controlled and underwent TKA were compared with euthyroid TKA patients. Data were extracted from our departmental database. Chi-squared test and t-tests were used for comparisons. RESULTS: Hypothyroid patients had more blood loss and lower postoperative haemoglobin (Hb) and haematocrit level than the control group (all P < 0.05). Although the postoperative anaemia rate was lower in the control group (P = 0.01), there was no significant difference in the transfusion rate between the two groups (2.99% versus 7.46%, P = 0.10) or in the rates of other complications (P > 0.05). Interestingly, intramuscular venous thrombosis rate in hypothyroid patients was significantly lower than that in the control group (1.49% versus 9.70%, P = 0.00). Clinical outcome scores were comparable between the two groups throughout the course. And only one case of infection occurred in the hypothyroid patients. CONCLUSION: Well-controlled overt hypothyroidism did not increase the risk of TKA, except for perioperative blood loss. Surgeons should be aware that even if hypothyroidism is reversed, the risk of more perioperative blood loss still exists and that, consequently, perioperative blood management is still essential in this population.
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Artroplastia de Reemplazo de Rodilla/efectos adversos , Hipotiroidismo/complicaciones , Complicaciones Posoperatorias , Anemia , Pérdida de Sangre Quirúrgica , Transfusión Sanguínea , Humanos , Hipotiroidismo/epidemiología , Estudios RetrospectivosRESUMEN
BACKGROUND: Severe acetabular bone defects is a complex problem in revision hip arthroplasty, cage is one of the reconstruction options. The purpose of this study is to report the mid-long term clinical and radiographic results of Paprosky type III acetabular bone defects revised with reconstructional cage and morselized allogeneic cancellous bone graft without impaction. METHODS: We retrospectively analyzed 28 patients who underwent revision hip arthroplasty with reconstructional cage and allogeneic cancellous bone graft between January 2007 and January 2016. There were 13 Paprosky type IIIA bone defect patients and 15 Paprosky type IIIB bone defect patients and 4 patients of the 15 were also with pelvic discontinuity. Clinical assessment included Harris Hip Score (HHS) and Short Form-12 (SF-12). Radiographic assessment included center of rotation, cage migration, and bone graft incorporation. RESULTS: All patients were followed up with a mean follow-up of 79.5 months (range 38-141), HHS improved from 31.4 (13-43) points preoperatively to 84.6 (55-94) points at last follow-up and SF-12 also improved significantly. There was 1 re-revision for the cage loosening and screw breakage at 61 months after surgery, and 2 patients had nonprogressive radiolucency in zone III and the junction of zone II and zone III at the bone implant interface. CONCLUSION: The reconstructional cage combining with morselized allografts without impaction achieves a good result with a high complete allograft incorporation rate in Paprosky type III acetabular bone defects.
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Acetabuloplastia/métodos , Acetábulo/patología , Artroplastia de Reemplazo de Cadera/métodos , Trasplante Óseo/métodos , Prótesis de Cadera/efectos adversos , Falla de Prótesis , Reoperación/métodos , Acetabuloplastia/instrumentación , Acetábulo/diagnóstico por imagen , Acetábulo/cirugía , Adulto , Anciano , Aloinjertos/trasplante , Artroplastia de Reemplazo de Cadera/instrumentación , Tornillos Óseos , Trasplante Óseo/instrumentación , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Osteoartritis de la Cadera/cirugía , Radiografía , Reoperación/instrumentación , Estudios Retrospectivos , Trasplante Homólogo , Resultado del TratamientoRESUMEN
Hydroxyapatite (HA), the traditional bone tissue replacement material was widely used in the clinical treatment of bone defects because of its excellent biocompatibility. However, the processing difficulty and poor osteoinductive ability greatly limit the application of HA. Although many strategies have been reported to improve the machinability and osteointegration ability, the performance including mechanical strength, porosity, cell adhesion, etc. of material still can not meet the requirements. In this work, a soft template method was developed and a porous scaffold with hierarchical pore structure, nano surface morphology, suitable porosity and pore size, and good biomechanical strength was successfully prepared. The hierarchical pore structure is beneficial for cell adhesion, fluid transfer, and cell ingrowth. Moreover, the loaded reduced graphene oxide (rGO) can improve the adhesion and promote the proliferation and spontaneous osteogenic differentiation bone marrow mesenchymal stem cells. The scaffold is then crushed, degraded and wrapped by the newly formed bone and the newly formed bone gradually replaces the scaffold. The degradation rate of the scaffold well matches the rate of the new bone formation. The hierarchical porous HA/rGO composite scaffolds can greatly accelerate the bone ingrowth in the scaffold and bone repair in critical bone defects, thus providing a clinical potential candidate for large segment bone tissue engineering.
Asunto(s)
Durapatita/farmacología , Grafito/química , Osteogénesis/efectos de los fármacos , Ingeniería de Tejidos , Animales , Regeneración Ósea/efectos de los fármacos , Huesos/efectos de los fármacos , Adhesión Celular/efectos de los fármacos , Diferenciación Celular/efectos de los fármacos , Supervivencia Celular/efectos de los fármacos , Durapatita/química , Grafito/farmacología , Humanos , Células Madre Mesenquimatosas/química , Células Madre Mesenquimatosas/metabolismo , Porosidad , Andamios del Tejido/químicaRESUMEN
PURPOSE: POEMS syndrome is a rare clonal plasma cell disease characterized by polyneuropathy, organomegaly, endocrinopathy, M protein, and skin changes. We report a rare case of neurological impairment in patients with concurrent cervical disc herniation and POEMS syndrome. METHODS: A patient presented to a local hospital with C3/4 and C4/5 disc herniation, apparent spinal cord compression concomitant with neurological signs, and concurrent POEMS syndrome. Anterior cervical discectomy and fusion was performed. RESULTS: The limb numbness was only slightly alleviated, and 10 days postoperatively the patient complained of muscle weakness of the extremities and was referred to our hospital. The patients exhibited non-typical neurological signs and an enlarged liver and spleen that could not be explained. Electroneuromyography and immunofixation electrophoresis produced abnormal results. We diagnosed concurrent POEMS syndrome, for which drug therapy was prescribed. The patient's symptoms receded. CONCLUSION: Patients presenting with cervical spondylopathy and non-typical neurological signs and symptoms or other systemic problems should be evaluated for the presence of concurrent disease and ruled out differential diagnoses.
Asunto(s)
Degeneración del Disco Intervertebral , Desplazamiento del Disco Intervertebral , Debilidad Muscular/etiología , Síndrome POEMS , Vértebras Cervicales/cirugía , Diagnóstico Diferencial , Discectomía , Humanos , Degeneración del Disco Intervertebral/complicaciones , Degeneración del Disco Intervertebral/cirugía , Desplazamiento del Disco Intervertebral/complicaciones , Desplazamiento del Disco Intervertebral/cirugía , Síndrome POEMS/complicaciones , Síndrome POEMS/diagnóstico , Fusión VertebralRESUMEN
OBJECTIVE: Structural changes of the spine and chest wall associated with SRS result in poor cardiopulmonary function. Comprehensive assessment of pulmonary function is extremely important for patients with SRS before a correction operation. We explore the changes of distribution of lung ventilation and perfusion function in patients with SRS using SPECT/CT and describe the relation between these changes with Cobb angle and FVC%. PATIENTS AND METHODS: From March 2015 to August 2016, 16 consecutive SRS patients with a mean age of 20.1 years(range 11-36 years) were included in the study. Scoliotic parameters on radiographs were analyzed. FVC% were obtained by spirometry test. Lungs ventilation/perfusion single photon emission computed tomography scans was performed preoperatively in all patients to explore pulmonary ventilation and perfusion function changes. These changes were measured as the deviation form the normal perfusion and ventilation function distribution in right and left lung and correlated with the Cobb angle of main curve and FVC%. RESULTS: The regional lung ventilation and perfusion function defects were not found in all SRS patients. Ventilation function deviation was a mean 5.7%(range, -3.6% to 10.1%), significantly less than perfusion function deviation of 8.2%(range, -0.3% to 22.2%) (P = 0.015, t = -2.732). Lung ventilation and/or perfusion function deviation did not correlated with Cobb angle and FVC%, respectively. There was significant correlation between lungs ventilation and perfusion function deviation(P = 0.001, r = 0.753). CONCLUSION: The ventilation and perfusion function distribution were favourable in convex and concave side lung of SRS. Deformity bring about greater lungs perfusion function changes than ventilation function. The measurement of lung ventilation and perfusion function changes may represents an additional functional feature to assess pulmonary function of SRS more comprehensively.