RESUMEN
A patient with trimalleolar ankle fracture was preoperatively diagnosed with deep vein thrombosis (DVT); after induction of general anesthesia, a temporary inferior vena cava filter (TIVCF) was intraoperatively placed by an anesthesiologist. This contributed to safe anesthesia management. A 65-year-old woman was scheduled to undergo surgery for a trimalleolar ankle fracture sustained in an accidental fall. Two days before surgery, leg venous ultrasonography showed DVT. On the day of surgery, after induction of general anesthesia, a TIVCF was inserted by the anesthesiologist. After surgery, the TIVCF was removed, and anesthetic management was completed. On the day after the surgery, anticoagulant treatment was administered. Approximately 3 weeks later, thrombus disappearance was confirmed, and treatment was terminated. DVT is a serious complication that may cause pulmonary thromboembolism. TIVCF is effective in the treatment of DVT, and insertion of the TIVCF used in the present study is relatively simple. TIVCF placement by anesthesiologists, who have reliable knowledge on the various approaches to veins, contributes greatly to securing perioperative patient safety. The collaboration and cooperation of several medical departments are essential for DVT treatment and enhancing perioperative patient safety.
Asunto(s)
Anestesia Intravenosa , Fracturas de Tobillo , Atención Perioperativa , Filtros de Vena Cava , Trombosis de la Vena/terapia , Anciano , Anestesia General , Anestesiología , Anticoagulantes/administración & dosificación , Competencia Clínica , Femenino , Humanos , Médicos , Periodo Preoperatorio , Ultrasonografía , Trombosis de la Vena/diagnóstico por imagen , Trombosis de la Vena/etiología , Trombosis de la Vena/prevención & control , Warfarina/administración & dosificaciónRESUMEN
Pedicle screw instrumentation has become increasingly popular for rigid internal stabilization of the thoracolumbar spine. However, when pedicle screws are used in elderly osteoporotic patients, the screw-bone interface is stripped easily. Therefore, the risk of screw loosening and backing-out after surgery has increased. The purpose of this study was to evaluate the efficacy of the novel-concept pedicle screw fixation augmented with calcium phosphate cement (CPC) in the osteoporotic spine. The novel-concept screw has the same shape as the ordinary screw, but it is hollow and fabricated with 20 small holes (1.3 mm in diameter) leading to the hollow part on the bottom of the thread. Fifteen embalmed cadaveric lumbar vertebrae were instrumented with two types of pedicle screw (the ordinary screw and the novel-concept screw) in each pedicle. Only the novel-concept screws were augmented with CPC after insertion. Seven days later, axial pull-out testing was performed at a crosshead speed of 10 mm/min. The mean maximal pull-out strength of the ordinary screws was 258 N, and that of the novel concept screws was 637 N. These results suggest that the novel-concept screw augmented with CPC can be useful for pedicle screw fixation of the osteoporotic spine.
Asunto(s)
Tornillos Óseos , Osteoporosis/cirugía , Enfermedades de la Columna Vertebral/cirugía , Anciano , Anciano de 80 o más Años , Fenómenos Biomecánicos , Cementos para Huesos , Cadáver , Fosfatos de Calcio , Humanos , Modelos Lineales , Vértebras Lumbares , Estadísticas no Paramétricas , Estrés MecánicoRESUMEN
Kyphoplasty and vertebroplasty with polymethylmethacrylate (PMMA) have been used for the treatment of osteoporotic vertebral compression fractures. We performed kyphoplasty and vertebroplasty with alpha-tricalcium phosphate cement (CPC) and PMMA to compare the biomechanical properties. Thirty osteoporotic vertebrae were harvested from nine embalmed cadavers. We randomized the vertebrae into four treatment groups: (1) kyphoplasty with CPC; (2) kyphoplasty with PMMA; (3) vertebroplasty with CPC; and (4) vertebroplasty with PMMA. Prior to injecting the cement, all vertebrae were compressed to determine their initial strength and stiffness. They were then recompressed to determine their augmented strength and stiffness. Although the augmented strength was greater than the initial strength in all groups, there was no significant difference between the two bone cements for either kyphoplasty or vertebroplasty. The augmented stiffness was significantly less than the initial stiffness in the kyphoplasty groups, but the difference between the two cements did not reach significance. In the vertebroplasty groups, the augmented stiffness was not significantly different from the initial stiffness. There was no significant difference between the two bone cements for either procedure when cement volume and restoration of anterior height were assessed. We concluded that kyphoplasty and vertebroplasty with CPC were viable treatment alternatives to PMMA for osteoporotic vertebral compression fractures.