文献抄读(2012-03-09)1

CannulatedScrewandCableareSuperiortoModifiedTensionBandintheTreatmentofTransversePatellaFractures101patientswithameanageof56,wereselectedforthestudy.AllofthepatientsweresufferedpatellarfractureswithAOclassificationof34-C1andC2.Amongthosepatients,49wereperformedcable-cannulatedscrewfixation,and52wereperformedmodifiedk-wirefixation.Titaniumcable-cannulatedscrewtensionbandfixationThefigureareshowingthemethodofcable-cannulatedscrewfixtion.Firstly,twok-wireswereintroducedpassthroughthepatellarfractures.Then,thecannulatedscrewwerescrewedalongwiththek-wire.Andtwocableswerethreadedthroughthescrewsandtightenedthefracture.Fracturefragmentgaps,kneefunctionalrehabilitations,fracturehealingtimes,andcomplicationswereevaluatedandcomparedbetweentwotypesoffixations.Conclusion:•Thecable-cannulatedscrewtensionbandtechniqueshowedsuperiorresultsandcouldbeconsideredasanalternativemethodfortreatmentoftransversepatellarfractures.CanComputerAssistanceImprovetheClinicalandFunctionalScoresinTotalKneeArthroplasty?•73patientswereselectedforanalysiswithafollow-upatlest8years.36patientswereoperatedwiththeaidofcomputednavigation,and37patientswereperformedstandardarthroplastysurgery.•wirelessimage-freenavigationsystem(StrykerImageFreeComputerNavigationSystem,versions1.2and1.3;Stryker-Leibinger,Freiburg,Germany).•Thepatientsinthenavigatedgrouphadmoreideallypositionedimplants(p\0.001)thanthoseinthestandardgroup1.KSS(kneeandfunctionalscores);2.Implantsurvivalratesat8years;Thereisnodifferencesinclinicalandfunctionalevaluationorinsurvivalratesat8years•Majorcomplications(thoserequiringrevisionsurgery)weresimilarbetweengroupsSeveralstudiesreportedpreviouslywerealsoreviewed.Theauthersalsoreviewedseveralstudiesreportedpreviously.Andonlyonestudydeclaimedthatthenavigationsystemcouldachievedbetterfunctionalresultcomparingtothestandardoperation.Butrest4studiesconsiderthereisnodifferencebetweenbothofthemethods.•Conclusions:Inthemidterm,thereisnodifferenceinfunctionalandclinicalscoresorimplantsurvivalbetweenTKAsperformedwithandwithouttheassistanceofanavigationsystem.TreatmentofEarlyPostoperativeInfectionsafterTHA:ADecisionAnalysisSeveralstudieswerereviewedandselectedasmaterialsforsensitivityanalysis.Mostofthestudieswerereportedpreviously,andmainlyfocusontheinfectionandfunctionalrehabilitationsaftertotalhiparthroplasty.•Includingcritieria:Thepatientwhopresents3weeksafteracementlessprimaryTHAwithadeepperiprostheticjointinfection.•Infectionfreecritieria:aperiodgreaterthan2yearswithoutadditionalsurgeryfortreatingtheinfection,withorwithoutlong-termsuppressiveantibiotics.•Hereisaproceduretreesdescribingtheinfectiontherapeuticstrategies.Threemethodscouldbeusedforinfectioncontrol,includingopenirrigation/debridement,singlestageexchange,andtwostageexchange.Atechniquetermedsensitivityanalysisusesforanumericalcalculationtoevaluatetheeffectofinfectioncontrolmethod.Infectioncontrol------Health-relatedqualityoflifeaone-stageexchangeledtothehighestchanceofobtainingthemaximumfinalhealth-relatedqualityoflife,ofwhichthesuccessrateofinfectioncontrolandrecoveryofqualityoflifeisover65%.•Bytheone-waysensitivityanalysis,aone-stageexchangewasthetreatmentforearlyTHAinfectionthatmaximizedqualityof-lifeoutcomesiftheprobabilityofcontrollingtheinfectionexceeded66%withthisprocedure.•Iftheprobabilityofinfectioncontrolofaone-stageexchangewaslessthan66%orthatofirrigationandde´bridementwasgreaterthan60%,thenirrigationandde´bridementappearedtoresultinthegreatestquality-of-lifeoutcome.•Whenthesuccessrateoftwo-stageexchangewasvariedfrom0%to99%success,therewasnothresholdabovewhichatwo-stageexchangewouldleadtothegreatestqualityoflife.•Bythetwo-waysensitivityanalysis,WhentheprobabilitysuccessofIrrigationwaslessthan38%,andtheprobabilitysuccessofonestageexchangewaslessthan69%,themodelpredictedatwo-stageexchangemightresultinthegreatesthealth-relatedqualityoflife.