Mathys 有限公司, 瑞士支持临床和放射多中心研究的资金。

所提交的研究是按照所有机构、国家和国际人类福利准则进行的。已获得机构审查委员会的批准。
<ol><li>将病人放置在一个标准的手术台上, 用两支独立的腿支撑。让同侧的腿保持移动。</li>
	<li>适用于仰卧位 antero 侧入路的标准不育覆盖率。</li>
	<li>用膝辊稍稍弯曲同侧一侧。此外, hyperextend 对侧边约为股骨准备。</li>
	<li>以触诊为导向, 定位大转子的尖端以及髂前上棘。</li>
	<li>使用手术刀 (6-12 厘米, 根据病人的解剖) 进行皮肤切口, 以大转子的尖端为中心, 瞄准在臀臀和张量之间的肌间隔上方的髂前上棘阔阔.</li>
	<li>皮下脂肪切开后, 使用两个皮肤拉钩前方和向后。打开筋膜, 不会对张量阔阔造成损伤。</li>
	<li>使用你的食指做一个钝的解剖, 推动臀部肌肉向后没有损伤。</li>
	<li>用三拉钩暴露关节囊。</li>
	<li>在股骨颈旁执行 capsulectomy。 注意: 没有任何肌肉的尖锐解剖, 特别是臀肌, 是需要的。</li>
	<li>切除前关节囊, 暴露股骨颈, 以执行截骨通过放置两个面对弯曲拉钩髋关节周围的股骨颈 (图 1)。 注意: 在股骨引导的短茎的植入中最重要的一步是选择截骨的个体水平。这样, 阀杆定位可以在很大的变化中单独进行, 从而产生大量的 CCD 角带宽 (图 2;图 3)。因此, 术前规划是强制性的, 以显示确切的水平 (图 4: 红线 (OL: 截骨水平))。</li>
	<li>对于外科医生的定位, 为了确定截骨的水平, 对较小的转子和窝梨进行触诊。如果根据先前存在的解剖学需要一个外翻位置, 则通过切除大部分股骨颈 (图 5a) 远端截骨。根据术前计划 (图 5c), 为了使茎在内翻的位置, 切除下部, 保留大部分股骨颈。因此, 可以精确地维持股骨偏移和腿部长度 (图 5)。</li>
	<li>根据术前规划使用长的硬刃摆动锯, 执行截骨 (图 1) 在同侧腿轻微的外部旋转。</li>
	<li>用股骨头提取器从髋臼中取出股骨头。为了保护臀臀, 放置一个 "Langenbeck"-牵引器内侧和拉下部。</li>
	<li>在髋臼准备过程中, 在髋臼的近端插入一个 "多根斯氏" 针, 以保护臀肌。</li>
	<li>用两个萃取器暴露髋臼。</li>
	<li>根据术前规划, 根据患者的个体解剖, 植入髋臼部分。</li>
	<li>为股骨准备, 首先取出膝部卷和 hyperextend 的对侧腿约。现在执行90°外部旋转和最大的90°屈膝关节。让助手把主题的腿放在最大的内收 (约 40°)。</li>
	<li>定位两个拉钩在股骨近端的内侧, 下部在股骨颈的后 (内侧) 皮质端。避免接触大转子, 以尽量减少可能损害骨骼和肌肉插入的风险。</li>
	<li>应用 "圆角" 技术打开股骨近端的股骨与弧形开口锥。 注意: 后结构如大转子或臀肌不受影响。</li>
	<li>在轻柔的特殊弯曲, 种植体形状的锉在提升大小使用锤子, 以准备股骨近端和股管, 直到皮质接触和稳定的适应和填充达到。请注意, 双偏移微创锉手柄可用。在 "圆角" 技术 (图 6) 中, 执行由股骨引导的插入。</li>
	<li>根据术前计划, 选择两个可用的不同偏移量版本 (标准和横向偏移) 的试验锥之一。</li>
	<li>使用数字图像增强器在插入试验头并进行试验复位后, 评估术中透视图, 将锉 (试用植入物) 的定位与术前规划 (图 7) 进行比较。进行前后牙片。要屏蔽第二个平面, 还要执行轴向视图射线照相。如有必要, 执行调整。 注意: 到达皮质接触对术后塌陷的危险性至关重要。避免 undersizing!(图 8)</li>
	<li>移除试用植入物, 并插入含有所选胶印版本的最终植入器, 使用特殊的植入式撞击器。请注意, 原始词干与试用锉 (图 9) 完全一致。</li>
	<li>在最终复位后, 应用轴向张力和腿部内旋转, 完成标准伤口闭合的程序。</li>
	<li>在大多数情况下, 在手术后使用2根拐杖在理疗监视下开始4小时后, 允许全负重。 注意: 在重症患者中, 初级稳定性可能受损, 因此, 必须相应调整负重协议。</li>
	<li>根据所记录的疼痛强度, 非甾体抗炎药 (NSAID), 预防异位骨化, 静脉血栓栓塞预防, 提供止痛药。</li>
</ol>

<ol>
	<li>Jerosch, J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=.">.</a> Kurzschaftendoprothesen an der H&#252;fte. , (2017).</li><li>Kutzner, K. P., Donner, S., Schneider, M., Pfeil, J., Rehbein, P. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=One-stage+bilateral+implantation+of+a+calcar-guided+short-stem+in+total+hip+arthroplasty.">One-stage bilateral implantation of a calcar-guided short-stem in total hip arthroplasty.</a> Oper Orthop Traumatol. , (2017).</li><li>Anderl, C. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=2-Jahres-Ergebnisse+mit+dem+Optimys-Kurzschaft+über+den+direkten+anterolateralen+Zugang.+JATROS.">2-Jahres-Ergebnisse mit dem Optimys-Kurzschaft über den direkten anterolateralen Zugang. JATROS.</a> Orthop&#228;die &amp; Rheumatologie 05/2015. 05, (2015).</li><li>Kutzner, K. P., Kovacevic, M. P., Roeder, C., Rehbein, P., Pfeil, J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Reconstruction+of+femoro-acetabular+offsets+using+a+short-stem.">Reconstruction of femoro-acetabular offsets using a short-stem.</a> Int Orthop. 39 (7), 1269-1275 (2015).</li><li>Matsushita, A., Nakashima, Y., Jingushi, S., Yamamoto, T., Kuraoka, A., Iwamoto, Y. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Effects+of+the+Femoral+Offset+and+the+Head+Size+on+the+Safe+Range+of+Motion+in+Total+Hip+Arthroplasty.">Effects of the Femoral Offset and the Head Size on the Safe Range of Motion in Total Hip Arthroplasty.</a> J Arthroplasty. 24, 646-651 (2009).</li><li>Asayama, I., Chamnongkich, S., Simpson, K. J., Kinsey, T. L., Mahoney, O. M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Reconstructed+hip+joint+position+and+abductor+muscle+strength+after+total+hip+arthroplasty.">Reconstructed hip joint position and abductor muscle strength after total hip arthroplasty.</a> J Arthroplasty. 20, 414-420 (2005).</li><li>Kutzner, K. P., Pfeil, J., Kovacevic, M. P. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Preoperative+digital+planning+versus+postoperative+outcomes+in+total+hip+arthroplasty+using+a+calcar-guided+short+stem:+frequent+valgization+can+be+avoided.">Preoperative digital planning versus postoperative outcomes in total hip arthroplasty using a calcar-guided short stem: frequent valgization can be avoided.</a> Eur J Orthop Surg Traumatol. 27 (5), 643-651 (2017).</li><li>H&#246;hle, P., Schr&#246;der, S. M., Pfeil, J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Comparison+between+preoperative+digital+planning+and+postoperative+outcomes+in+197+hip+endoprosthesis+cases+using+short+stem+prostheses.">Comparison between preoperative digital planning and postoperative outcomes in 197 hip endoprosthesis cases using short stem prostheses.</a> Clin Biomech. 30 (1), 46-52 (2015).</li><li>Kutzner, K. P., Freitag, T., Donner, S., Kovacevic, M. P., Bieger, R. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Outcome+of+extensive+varus+and+valgus+stem+alignment+in+short-stem+THA:+clinical+and+radiological+analysis+using+EBRA-FCA.">Outcome of extensive varus and valgus stem alignment in short-stem THA: clinical and radiological analysis using EBRA-FCA.</a> Arch Orthop Trauma Surg. (3), 431-439 (2016).</li><li>Kutzner, K. P., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Incidence+of+heterotopic+ossification+in+minimally+invasive+short-stem+THA+using+the+modified+anterolateral+approach.">Incidence of heterotopic ossification in minimally invasive short-stem THA using the modified anterolateral approach.</a> Hip Int. , (2017).</li><li>Kutzner, K. P., Kovacevic, M. P., Roeder, C., Rehbein, P., Pfeil, J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Reconstruction+of+femoro-acetabular+offsets+using+a+short-stem.">Reconstruction of femoro-acetabular offsets using a short-stem.</a> Int Orthop. , (2014).</li><li>Kutzner, K. P., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=One-stage+bilateral+versus+unilateral+short-stem+total+hip+arthroplasty:+comparison+of+migration+patterns+using+"Ein-Bild-Roentgen-Analysis+Femoral-Component-Analysis".">One-stage bilateral versus unilateral short-stem total hip arthroplasty: comparison of migration patterns using "Ein-Bild-Roentgen-Analysis Femoral-Component-Analysis".</a> Int Orthop. 41 (1), 61-66 (2017).</li><li>Kutzner, K. P., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Radiographic+alterations+in+short-stem+total+hip+arthroplasty:+a+2-year+follow-up+study+of+216+cases.">Radiographic alterations in short-stem total hip arthroplasty: a 2-year follow-up study of 216 cases.</a> Hip Int. 26 (3), 278-283 (2016).</li><li>Kutzner, K. P., Kovacevic, M. P., Freitag, T., Fuchs, A., Reichel, H., Bieger, R. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Influence+of+patient-related+characteristics+on+early+migration+in+calcar-guided+short-stem+total+hip+arthroplasty:+a+2-year+migration+analysis+using+EBRA-FCA.">Influence of patient-related characteristics on early migration in calcar-guided short-stem total hip arthroplasty: a 2-year migration analysis using EBRA-FCA.</a> J Orthop Surg Res. 11 (1), 29 (2016).</li><li>Kovacevic, M. P., Pfeil, J., Kutzner, K. P. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Implantation+of+a+new+short+stem+in+simultaneous+bilateral+hip+arthroplasty+-+a+prospective+study+on+clinical+and+radiographic+data+of+54+consecutive+patients.">Implantation of a new short stem in simultaneous bilateral hip arthroplasty - a prospective study on clinical and radiographic data of 54 consecutive patients.</a> OUP. 10, 456-461 (2014).</li><li>Hochreiter, J., Hejkrlik, W., Emmanuel, K., Hitzl, W., Ortmaier, R. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Blood+loss+and+transfusion+rate+in+short+stem+hip+arthroplasty.+A+comparative+study.">Blood loss and transfusion rate in short stem hip arthroplasty. A comparative study.</a> Int Orthop. , 1-7 (2016).</li><li>Bieger, R., Ignatius, A., Decking, R., Claes, L., Reichel, H., D&#252;rselen, L. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Primary+stability+and+strain+distribution+of+cementless+hip+stems+as+a+function+of+implant+design.">Primary stability and strain distribution of cementless hip stems as a function of implant design.</a> Clin Biomech. 27 (2), 158-164 (2012).</li><li>Loweg, L., Kutzner, K. P., Rehbein, P., Stephan, H., Pfeil, J., Schneider, M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Wertigkeit+der+intraoperativen+R&#246;ntgenkontrolle+in+der+prim&#228;ren+H&#252;ftendoprothetik.">Wertigkeit der intraoperativen R&#246;ntgenkontrolle in der prim&#228;ren H&#252;ftendoprothetik.</a> OUP. 5 (6), 334-338 (2016).</li></ol>

j. Pfeil 是瑞士 Mathys 有限公司的一名医疗顾问。

在现代临屋区, 与传统的直杆设计相比, 股骨引导短茎在短期随访中提供了许多优势。然而, 在中期和长期后续行动方面, 只发表了一些结果。
由于股骨短茎的短而弯曲的设计, 软组织备用植入似乎在技术上很容易。然而, 个性化植入技术需要对不同的内翻和外翻定位的特点有明确的认识。必须考虑到一个严重的学习曲线。
修改和疑难解答:
考虑到股骨引导短茎的个性化定位, 术前规划的准备是绝对强制性的8 (图 4)。除了检测正确的种植体大小, 特别是对齐的茎和所期望的水平截骨可以确定。术, 使用插入的试验锉, 在髋部复位后, 可以通过执行术中透视19 (图 7) 进行术前规划的比较。植入物的侧肩作为方向关于腿长度。
技术的局限性:
调查建议使用股骨引导的短茎5,8 (图 2) 充分重建不同髋关节剖析的宽带宽。图 3)。以前的研究调查了广泛的内翻和外翻茎对齐的结果10。2年后, 不需要进行翻修手术, 而放射学改变表明总的异常应力分布率较低。然而, 尤其对于外翻髋, 有明显的初始沉降被观察到10。
尤其对于年轻和小看的外科医生来说, 所提出的技术可能会带来意想不到的缺陷。
对于现有方法的意义:
股骨引导短茎的植入技术不同于常规的直茎和某些颈部切除和颈部保留短茎。常规的直茎提供骨干锚地和主要标准化水平的股骨颈截骨。现有的髋关节解剖只能通过使用不同的植入体5的胶印版本来重建。例如, 在广泛的内翻剖析中, 这通常无法正确实现 (图 10)。Valgization 已经被发现是成功重建髋几何的限制因素也在许多以前的短茎设计, 导致减少偏移和增加腿部长度9。
议定书内的关键步骤:
最关键的一步是选择正确的截骨水平。此外, 为了术正确地实现术前规划, 需要使用透视法进行验证。
由于在股骨引导的短茎的茎部长度缩短, 主要稳定性可能引起有关18。主要的固定类型是骺锚固, 基于合适的填充原理。然而, 由于这些阀杆设计的个性化定位选择, 锚固类型可能会有明显的差异。在内翻排列三点锚定是常见的皮质接触到侧皮质的部分切除颈部, 内侧股骨, 和侧皮质在顶端的茎。然而, 根据定位和大小, 特别是在广泛的外翻对准, 发音骨干锚地是可能的10。在这种情况下, 安全地实现皮质接触远端侧皮质, 以及远端内侧皮质是至关重要的。在外翻位置, 在早期集体中经常观察到尖端的缺失皮质接触, 包括学习曲线, 特别是在 undersizing 的情况下。因此, 外科医生应该考虑到, 特别是在外翻髋部, undersizing 伴有与侧皮质缺乏接触, 可能导致最初的不稳定和随后的植入 micromovement10。因此强烈建议使用术中透视来识别茎 undersizing 的19。
目前关于偏移重建技术的描述仅指二维分析。然而, 由于部分保留股骨颈, 短茎将自己的位置几乎自动沿颈前倾角和前倾的现存股骨近端骨。特别是在内翻-臀部, 这导致明显的前倾在轴向平面与茎尖被定位前方 (图 11)。因此, 前偏移也可以重建。进一步监测这一代短茎和植入技术在中长期随访是强制性的。

近年来, 现代股骨的短茎在临屋区已越来越多地使用1。新的股骨引导, 骺锚固短茎正在出现, 重点放在保留肌肉, 软组织和骨骼2,3, 从而允许微创 (MIS) 技术和方法成功应用4.
股骨导向的短茎的可能的好处可以通过特殊的植入技术来完成, 这与传统的直杆设计技术不同。最重要的方面, 在这方面, 是解剖曲率, 已经适应了从股骨。茎的定位跟随单独解剖学在股骨曲线旁边, 并且允许个体化植入5。应用所谓的 "圆角" 技术, 较大的大转子区域和最重要的臀部肌肉, 可以几乎完全幸免于2。
现代临屋区主要依赖于成功保存的髋关节几何。髋关节解剖的准确重建对临床预后至关重要。股-髋臼偏移量越来越多地聚焦5。减少的偏移可能导致臀部不稳定和髋关节不稳定性, 并增加了脱位的风险6,7。另一方面, 严重的偏移量增加会引起转子滑囊炎。鉴于这些发现, 似乎不希望的偏移变化有很大的临床相关性。
股骨偏移的重建高度依赖于复制不同 CCD 角度8的能力。然而, valgization 已被发现是在许多茎设计成功重建髋几何的限制因素, 导致减少偏移和增加腿部长度9。在这方面, 不同 CCD 角度的重建似乎是完成髋关节解剖 retainment 的关键。
在股骨引导的短茎, 茎对位可以个性化, 支持成功重建股骨偏移8。在股骨的指导下, 股骨近端的茎部定位取决于股骨颈的切除水平。鉴于先前存在的内翻解剖, 高切除也导致植入物的内翻位置, 保持较大的股骨偏移量。另一方面, 鉴于已存在的外翻解剖, 低切除导致外翻位置, 造成一个小的股骨偏移量10 (图 1;图 2)。
因此, 所提出的个性化植入技术允许对 CCD 角进行广泛的重建, 从而能够精确地保存髋关节几何。所提出的技术不同于传统的全髋关节置换术, 有可能包括一个严重的学习曲线。

<table border="0" cellpadding="0" cellspacing="0" width="677">
	<tbody>
		<tr height="40">
			<td height="40" style="height:30.0pt;width:149pt" width="198">optimys short stem</td>
			<td style="width:173pt" width="230">Mathys Ltd., Switzerland</td>
			<td style="width:90pt" width="120"></td>
			<td style="width:97pt" width="129">Implant</td>
		</tr>
	</tbody>
</table>

individualized stem-positioning in calcar-guided short-stem total hip arthroplasty

骨和软组织备用短茎越来越多地用于全髋关节置换术 (临区)。然而, 有大量的短茎的模型, 不同的设计和功能。股骨引导短茎提供一个解剖曲率在内侧股骨区域, 因此, 定位是单独完成股骨在 "圆角" 技术。根据颈部截骨的水平, 茎可以单独排列在一个大的内翻的带宽-和外翻剖析。这不同于传统的全髋关节置换术, 有可能包括一个严重的学习曲线。鉴于可保留大量的颈-骨干 (CCD) 角, 可以精确地实现股-髋臼偏移的重建。然而, 特别是广泛的内翻和外翻定位引起了关注的稳定性和骨重塑。本手稿的目的是展示植入技术在股骨指导的短茎, 并总结短期临床和放射结果。

研究的短茎的一些短期结果以前被出版了, 主要起因于一个持续的观察研究在作者的机关2,8,11,12, 13,14,15,16。利用所提出的技术, 可以精确地实现对不同股-髋臼偏移量的重构5。特别是保留现有 CCD 角度的能力允许生理髋关节几何 retainment8。两年后, 只有少量的放射学改变, 如应力屏蔽和皮质肥大是明显的14。微创技术导致异位血肿骨化相接的低发病率为11。因此, 与使用常规直茎17的植入技术相比, 失血和输血率保持在较低的速度。
优异的临床效果使该技术成功地应用于单级双侧短茎 (2)。对所提出的植入物的 "股骨成分分析" (EBRA) 的分析显示, 早期的轴向沉降增加, 特别是在重型和主动男性患者中, 由于术后完全负重, 但没有任何早期的临床后果13,15。特别是在外翻位置排列的茎导致早期下沉增加, 但 undersizing 和皮质接触不足的侧面, 可确定为主要原因18。
<img alt="Figure 1" class="xfigimg" src="/files/ftp_upload/56905/56905fig1.jpg"> 图 1: 股骨颈截骨.截骨是根据术前计划进行的。截骨的水平是由 palpating 小转子和大转子的尖端决定的, 作为参考。从2,4。
<img alt="Figure 2" class="xfigimg" src="/files/ftp_upload/56905/56905fig2.jpg"> 图 2: 外翻定位.在低位截骨术后, 茎部与外翻位置对齐。
<img alt="Figure 3" class="xfigimg" src="/files/ftp_upload/56905/56905fig3.jpg"> 图 3: 内翻定位.在高位截骨术后, 茎部与内翻位置对齐。
<img alt="Figure 4" class="xfigimg" src="/files/ftp_upload/56905/56905fig4.jpg"> 图 4: 术前规划.蓝色: 股骨导向短茎的模板;红色: 无水泥杯的模板。截骨水平是根据术前计划 (OL) 确定的。术, 并且种植体的侧肩的高度担当方向 (SH)。最重要的是茎必须升迁直到皮质接触侧向被到达 (CC)。
<img alt="Figure 5" class="xfigimg" src="/files/ftp_upload/56905/56905fig5.jpg"> 图 5: 对截骨和茎对齐的个性化水平.股骨近端的茎部定位取决于股骨颈的切除水平。由于内翻解剖, 高切除也导致植入物的内翻位置, 维持一个大的股骨偏移量 (c)。另一方面, 由于外翻解剖, 低切除导致外翻位置, 导致小股偏移 (a)。10,12从 Kutzner et 。2<a href="//cloudflare.jove.com/files/ftp_upload/56905/56905fig5large.jpg" target="_blank">请单击此处查看此图的较大版本.</a>
<img alt="Figure 6" class="xfigimg" src="/files/ftp_upload/56905/56905fig6.jpg"> 图 6: 圆角技术.插入是做与内侧股骨, 不影响侧向结构。尤其是大转子和臀部肌肉可以幸免。从 Kutzner et 。2<a href="//cloudflare.jove.com/files/ftp_upload/56905/56905fig6large.jpg" target="_blank">请单击此处查看此图的较大版本.</a>
<img alt="Figure 7" class="xfigimg" src="/files/ftp_upload/56905/56905fig7.jpg"> 图 7: 术中透视.在完成试验复位后, 使用数字图像增强器对两个平面中的术中造影进行评估, 应被认为是强制性的, 能够比较锉 (试验植入物) 的定位与术前规划。随后可以执行潜在的调整。从 Kutzner et 。2<a href="//cloudflare.jove.com/files/ftp_upload/56905/56905fig7large.jpg" target="_blank">请单击此处查看此图的较大版本.</a>
<img alt="Figure 8" class="xfigimg" src="/files/ftp_upload/56905/56905fig8v2.jpg"> 图 8: undersizing 的示例.皮质接触不足和 undersizing (a)导致随后2年后续行动(b)的下沉。<a href="//cloudflare.jove.com/files/ftp_upload/56905/56905fig8v2large.jpg" target="_blank">请单击此处查看此图的较大版本.</a>
<img alt="Figure 9" class="xfigimg" src="/files/ftp_upload/56905/56905fig9v2.jpg"> 图 9: 原始股骨引导的短茎的植入.最初的种植体位置本身完全一样的试验锉。从 Kutzner et 。2
<img alt="Figure 10" class="xfigimg" src="/files/ftp_upload/56905/56905fig10v2.jpg"> 图 10: 不同茎类型的内翻髋部的偏移重建示例.(a, b)由于骨干锚固和常规直茎的设计, 无法实现偏移重建。(c) 内翻-与股骨引导的短茎对齐, 完成偏移的精确重建。<a href="//cloudflare.jove.com/files/ftp_upload/56905/56905fig10v2large.jpg" target="_blank">请单击此处查看此图的较大版本.</a>
<img alt="Figure 11" class="xfigimg" src="/files/ftp_upload/56905/56905fig11.jpg"> 图 11: 两个平面中的术中透视示例.(a) "美联社"视图;(b) 轴向视图。短茎将自己的位置几乎自动沿颈前倾角和前倾的现有股骨近端骨。因此, 前偏移也可以恢复。<a href="//cloudflare.jove.com/files/ftp_upload/56905/56905fig11large.jpg" target="_blank">请单击此处查看此图的较大版本.</a>

Watch this Scientific Journal Video about Individualized Stem-positioning in Calcar-guided Short-stem Total Hip Arthroplasty at JoVE.com

Individualized Stem-positioning in Calcar-guided Short-stem Total Hip Arthroplasty

本协议描述了股骨引导短茎与内侧股骨的圆角技术和个体化茎定位, 这取决于截骨的水平。这不同于传统的全髋关节置换术, 包括学习曲线。

股骨引导下短茎全髋关节置换术的个体化茎定位

Bone- and soft-tissue sparing short stems are increasingly used in total hip arthroplasty (THA). However, there are a large variety of models of short ...

individualized-stem-positioning-calcar-guided-short-stem-total-hip

Research

JoVE Journal

Medicine

11.6K 次观看.  St. Josefs Hospital Wiesbaden. 本协议描述了股骨引导短茎与内侧股骨的圆角技术和个体化茎定位, 这取决于截骨的水平。这不同于传统的全髋关节置换术, 包括学习曲线。

视频: Individualized Stem-positioning in Calcar-guided Short-stem Total Hip Arthroplasty

Reverse Total Shoulder Arthroplasty

Reverse total shoulder arthroplasty was initially approved for use in rotator cuff arthropathy and well as chronic pseudoparalysis without arthritis in patients who were not appropriate for tendon transfer reconstructions. Traditional surgical options for these patients were limited and functional results were sub-optimal and at times catastrophic. The use of reverse shoulder arthroplasty has been found to effectively restore these patients function and relieve symptoms associated with their disease. The procedure can be done through two approaches, the deltopectoral or the superolateral. Complication rates associated with the use of the prosthesis have ranged from 8-60% with more recent reports trending lower as experienced is gained. Salvage options for a failed reverse shoulder prosthesis are limited and often have significant associated disability. Indications for the use of this prosthesis continue to be evaluated including its use for revision arthroplasty, proximal humeral fracture and tumor. Careful patient selection is essential because of the significant risks associated with the procedure.

Reverse total shoulder arthroplasty is indicated for the treatment of conditions that cannot be treated with conventional arthroplasty or other procedures. These primarily include degenerative and incapacitating conditions with irreparable rotator cuff and loss of the normal biomechanical coupling of the shoulder.

反向共肩关节置换术

Reverse total shoulder arthroplasty was initially approved for use in rotator cuff arthropathy and well as chronic pseudoparalysis without arthritis in ...

科研

医学

Implantation of the Syncardia Total Artificial Heart

With advances in technology, the use of mechanical circulatory support devices for end stage heart failure has rapidly increased. The vast majority of such patients are generally well served by left ventricular assist devices (LVADs). However, a subset of patients with late stage biventricular failure or other significant anatomic lesions are not adequately treated by isolated left ventricular mechanical support. Examples of concomitant cardiac pathology that may be better treated by resection and TAH replacement includes: post infarction ventricular septal defect,&#160;aortic root aneurysm / dissection, cardiac allograft failure, massive ventricular thrombus, refractory malignant arrhythmias (independent of filling pressures), hypertrophic / restrictive cardiomyopathy, and complex congenital heart disease. Patients often present with cardiogenic shock and multi system organ dysfunction. Excision of both ventricles and orthotopic replacement with a total artificial heart (TAH) is an effective, albeit extreme, therapy for rapid restoration of blood flow and resuscitation. Perioperative management is focused on end organ resuscitation and physical rehabilitation. In addition to the usual concerns of infection, bleeding, and thromboembolism common to all mechanically supported patients, TAH patients face unique risks with regard to renal failure and anemia. Supplementation of the abrupt decrease in brain natriuretic peptide following ventriculectomy appears to have protective renal effects. Anemia following TAH implantation can be profound and persistent. Nonetheless, the anemia is generally well tolerated and transfusion are limited to avoid HLA sensitization. Until recently, TAH patients were confined as inpatients tethered to a 500 lb pneumatic console driver. Recent introduction of a backpack sized portable driver (currently under clinical trial) has enabled patients to be discharged home and even return to work. Despite the profound presentation of these sick patients, there is a 79-87% success in bridge to transplantation.

The purpose of this manuscript is to briefly review indications, management, and outcomes for the total artificial heart. Video operative techniques for device implantation are presented.

SynCardia全人工心脏植入术

With advances in technology, the use of mechanical circulatory support devices for end stage heart failure has rapidly increased. The vast majority of ...

Using Continuous Data Tracking Technology to Study Exercise Adherence in Pulmonary Rehabilitation

Pulmonary rehabilitation (PR) is an important component in the management of respiratory diseases. The effectiveness of PR is dependent upon adherence to exercise training recommendations. The study of exercise adherence is thus a key step towards the optimization of PR programs. To date, mostly indirect measures, such as rates of participation, completion, and attendance, have been used to determine adherence to PR. The purpose of the present protocol is to describe how continuous data tracking technology can be used to measure adherence to a prescribed aerobic training intensity on a second-by-second basis.
In our investigations, adherence has been defined as the percent time spent within a specified target heart rate range. As such, using a combination of hardware and software, heart rate is measured, tracked, and recorded during cycling second-by-second for each participant, for each exercise session. Using statistical software, the data is subsequently extracted and analyzed. The same protocol can be applied to determine adherence to other measures of exercise intensity, such as time spent at a specified wattage, level, or speed on the cycle ergometer. Furthermore, the hardware and software is also available to measure adherence to other modes of training, such as the treadmill, elliptical, stepper, and arm ergometer. The present protocol, therefore, has a vast applicability to directly measure adherence to aerobic exercise.

Pulmonary rehabilitation is widely recognized in the management of respiratory diseases. A key component to successful pulmonary rehabilitation is adherence to the recommended exercise training. The purpose of the present protocol is to describe how continuous data tracking technology can be used to precisely measure adherence to a prescribed aerobic training intensity.

使用连续数据跟踪技术在肺康复研究锻炼坚持性

Pulmonary rehabilitation (PR) is an important component in the management of respiratory diseases. The effectiveness of PR is dependent upon adherence to ...

Implantation of Total Artificial Heart in Congenital Heart Disease

In patients with end-stage heart failure (HF), a total artificial heart (TAH) may be implanted as a bridge to cardiac transplant. However, in congenital heart disease (CHD), the malformed heart presents a challenge to TAH implantation. 
In the case presented here, a 17 year-old patient with congenital transposition of the great arteries (CCTGA) experienced progressively worsening HF due to his congenital condition. He was hospitalized multiple times and received an implantable cardioverter defibrillator (ICD). However, his condition soon deteriorated to end-stage HF with multisystem organ failure. 
Due to the patient's grave clinical condition and the presence of complex cardiac lesions, the decision was made to proceed with a TAH. The abnormal arrangement of the patient's ventricles and great arteries required modifications to the TAH during implantation.
With the TAH in place, the patient was able to return home and regain strength and physical well-being while awaiting a donor heart. He was successfully bridged to heart transplantation 5 months after receiving the device. This report highlights the TAH is feasible even in patients with structurally abnormal hearts, with technical modification.

This is a case report of a patient with congenitally corrected transposition of the great arteries (CCTGA) who received a total artificial heart (TAH) as a bridge to heart transplant. The TAH was successfully implanted with modifications to accommodate the patient's congenitally malformed heart.

的全人工心脏的先天性心脏病植入

In patients with end-stage heart failure (HF), a total artificial heart (TAH) may be implanted as a bridge to cardiac transplant. However, in congenital ...

Novel Diagnostics in Revision Arthroplasty: Implant Sonication and Multiplex Polymerase Chain Reaction

In orthopedic patients, foreign body-associated infections, especially periprosthetic joint infections (PJIs), are a devastating complication of arthroplasty. Infection requires complex treatment, may result in long hospitalization and causes considerable costs. Multiple surgical revisions can be necessary in these patients, with a loss in function as well as in quality of life.
The routine preoperative diagnostics include blood examination for C-reactive protein (CRP) and other biomarkers, as well as joint aspirate analysis for cell count, differentiation, and culture. Intraoperative specimens for histology and microbiology are also standard procedure. The microbiological examination of removed implants with sonication, in combination with the implementation of molecular biology techniques in microbiology, represent two novel techniques currently employed to enhance the differential diagnostics of PJI.
We present here the step-wise procedure of analyzing joint aspirate and sonication fluid, using a cartridge-based multiplex polymerase chain reaction (PCR) system. Results were matched against conventional cultures and consensus criteria for PJI. Conventional microbiological cultures from tissue biopsies, joint aspirate and sonication fluid showed a sensitivity of 66.7%, 66.7%, and 88.9%, respectively, and a specificity of 82.3%, 54.6%, and 61.5%, respectively. The PCR diagnostic of the sonication fluid and the joint fluid showed a sensitivity of 50.0% and 55.6%, respectively, and both a specificity of 100.0%. Both PCR diagnostics combined had a sensitivity of 66.7% and a specificity of 100.0%. The multiplex PCR therefore presents a rapid diagnostic tool with moderate sensitivity but high specificity in diagnosing PJI.

Differential diagnostics in painful arthroplasty is crucial for treatment success. Joint aspiration is routinely performed preoperatively. Multiplex polymerase chain reaction of the joint aspirate and the sonication fluid, a feasible tool for quick pathogen detection from these samples is described.

翻修术中的新诊断: 种植超声和多重聚合酶链反应

In orthopedic patients, foreign body-associated infections, especially periprosthetic joint infections (PJIs), are a devastating complication of ...

Use of Two Intracorporeal Ventricular Assist Devices As a Total Artificial Heart

Mechanical circulatory support (MCS) has been introduced as a viable alternative to heart transplantation primarily through the use of intracorporeal ventricular assist devices (VADs) for support of the left ventricle. However, certain clinical scenarios warrant biventricular mechanical support. One strategy for some patients is the excision of both ventricles and the implantation of two VAD pumps as a total artificial heart (TAH). This has recently been made possible by the improvements in device design and the small profile of centrifugal devices. This TAH approach remains experimental with many important challenges such as the device settings to balance the right and left circulation, the orientation of the devices and the outflow graft with their influence on hemolysis and stability, and the outcome of chronic support using such an orientation. This protocol aims to provide a reproducible approach for total artificial heart replacement with two intracorporeal centrifugal VADs in a cow model.

Here, we present a protocol using two centrifugal pumps as a total artificial heart replacement.

两体内心室辅助装置作为全人工心脏的应用

Mechanical circulatory support (MCS) has been introduced as a viable alternative to heart transplantation primarily through the use of intracorporeal ...

Generation of Human Nasal Epithelial Cell Spheroids for Individualized Cystic Fibrosis Transmembrane Conductance Regulator Study

While the introduction of Cystic Fibrosis Transmembrane Conductance Regulator (CFTR) modulator drugs has revolutionized care in Cystic Fibrosis (CF), the genotype-directed therapy model currently in use has several limitations. First, rare or understudied mutation groups are excluded from definitive clinical trials. Moreover, as additional modulator drugs enter the market, it will become difficult to optimize the modulator choices for an individual subject. Both of these issues are addressed with the use of patient-derived, individualized preclinical model systems of CFTR function and modulation. Human nasal epithelial cells (HNEs) are an easily accessible source of respiratory tissue for such a model. Herein, we describe the generation of a three-dimensional spheroid model of CFTR function and modulation using primary HNEs. HNEs are isolated from subjects in a minimally invasive fashion, expanded in conditional reprogramming conditions, and seeded into the spheroid culture. Within 2 weeks of seeding, spheroid cultures generate HNE spheroids that can be stimulated with 3',5'-cyclic adenosine monophosphate (cAMP)-generating agonists to activate CFTR function. Spheroid swelling is then quantified as a proxy of CFTR activity. HNE spheroids capitalize on the minimally invasive, yet respiratory origin of nasal cells to generate an accessible, personalized model relevant to an epithelium reflecting disease morbidity and mortality. Compared to the air-liquid interface HNE cultures, spheroids are relatively quick to mature, which reduces the overall contamination rate. In its current form, the model is limited by low throughput, though this is offset by the relative ease of tissue acquisition. HNE spheroids can be used to reliably quantify and characterize CFTR activity at the individual level. An ongoing study to tie this quantification to in vivo drug response will determine if HNE spheroids are a true preclinical predictor of patient response to CFTR modulation.

Here we describe a method to generate three-dimensional spheroid cultures of human nasal epithelial cells. Spheroids are then stimulated to drive Cystic Fibrosis Transmembrane Conductance Regulator (CFTR)-dependent ion and fluid secretion, quantifying the change in the spheroid luminal size as a proxy for CFTR function.

人鼻上皮细胞球体的生成与个体化囊性纤维膜电导调节的研究

While the introduction of Cystic Fibrosis Transmembrane Conductance Regulator (CFTR) modulator drugs has revolutionized care in Cystic Fibrosis (CF), the ...

An In Vivo Mouse Model of Total Intravenous Anesthesia During Cancer Resection Surgery

Anesthesia is a routine component of cancer care that is used for diagnostic and therapeutic procedures. The anesthetic technique has recently been implicated in impacting long-term cancer outcomes, possibly through modulation of adrenergic-inflammatory responses that impact cancer cell behavior and immune cell function. Emerging evidence suggests that propofol-based total intravenous anesthesia (TIVA) may be beneficial for long-term cancer outcomes when compared to inhaled volatile anesthesia. However, the available clinical findings are inconsistent. Preclinical studies that identify the underlying mechanisms involved are critically needed to guide the design of clinical studies that will expedite insight. Most preclinical models of anesthesia have been extrapolated from the use of anesthesia in in vivo research and are not optimally designed to study the impact of anesthesia itself as the primary endpoint. This paper describes a method for delivering propofol-TIVA anesthesia in a mouse model of breast cancer resection that replicates key aspects of clinical delivery in cancer patients. The model can be used to study mechanisms of action of anesthesia on cancer outcomes in diverse cancer types and can be extrapolated to other non-cancer areas of preclinical anesthesia research.

An In Vivo Mouse Model of Total Intravenous Anesthesia During Cancer Resection Surgery

This paper describes a method for modeling total intravenous anesthesia (TIVA) during cancer resection surgery in mice. The goal is to replicate key features of anesthesia delivery to patients with cancer. The method allows investigation of how anesthetic technique affects cancer recurrence after resection surgery.

癌症切除手术中全静脉麻醉的 体内 小鼠模型

Anesthesia is a routine component of cancer care that is used for diagnostic and therapeutic procedures. The anesthetic technique has recently been ...

In Vivo Quantification of Hip Arthrokinematics during Dynamic Weight-bearing Activities using Dual Fluoroscopy

Several hip pathologies have been attributed to abnormal morphology with an underlying assumption of aberrant biomechanics. However, structure-function relationships at the joint level remain challenging to quantify due to difficulties in accurately measuring dynamic joint motion. The soft tissue artifact errors inherent in optical skin marker motion capture are exacerbated by the depth of the hip joint within the body and the large mass of soft tissue surrounding the joint. Thus, the complex relationship between bone shape and hip joint kinematics is more difficult to study accurately than in other joints. Herein, a protocol incorporating computed tomography (CT) arthrography, three-dimensional (3D) reconstruction of volumetric images, dual fluoroscopy, and optical motion capture to accurately measure the dynamic motion of the hip joint is presented. The technical and clinical studies that have applied dual fluoroscopy to study form-function relationships of the hip using this protocol are summarized, and the specific steps and future considerations for data acquisition, processing, and analysis are described.

In Vivo Quantification of Hip Arthrokinematics during Dynamic Weight-bearing Activities using Dual Fluoroscopy

Dual fluoroscopy accurately captures in vivo dynamic motion of human joints, which can be visualized relative to reconstructed anatomy (e.g., arthrokinematics). Herein, a detailed protocol to quantify hip arthrokinematics during weight-bearing activities of daily living is presented, including the integration of dual fluoroscopy with traditional skin marker motion capture.

在维沃 使用双氟镜检查进行动态负重活动时臀部关节肌学的量化

Several hip pathologies have been attributed to abnormal morphology with an underlying assumption of aberrant biomechanics. However, structure-function ...

Robot-assisted Total Mesorectal Excision and Lateral Pelvic Lymph Node Dissection for Locally Advanced Middle-low Rectal Cancer

Since their approval for clinical use, da Vinci surgical robots have shown great advantages in gastrointestinal surgical operations, especially in complex procedures. The high-quality 3-D visual, multijoint arm and natural tremor filtration allow the surgeon to expose and dissect more accurately with minimal invasion. Total mesorectal excision is the standard surgical technique for the treatment of resectable rectal cancer. To reduce the lateral recurrence rate, lateral pelvic lymph node dissection can be performed, as it is a safe and feasible procedure for locally advanced middle-low rectal cancer with a high possibility of metastasis to the lateral lymph nodes. However, the complexity of the anatomic structures and the high postoperative complication rate limit its application. Recently, several surgeons have increasingly used robotic techniques for total mesorectal excision and lateral pelvic lymph node dissection. Compared with open and laparoscopic surgery, the robotic technique has several advantages, such as less blood loss, fewer blood transfusions, minimal trauma, shorter postoperative hospitalization, and quicker recovery. A robotic approach is generally regarded as a reasonable alternative for complicated procedures such as lateral pelvic lymph node dissection, although there are a limited number of high-quality prospective randomized controlled studies reporting direct evidence. Here, we provide the detailed steps of robot-assisted total mesorectal excision and lateral pelvic lymph node dissection performed at the First Affiliated Hospital of Xi&#39;an Jiaotong University.

The robotic technique described herein aims to detail a stepwise approach to robot-assisted total mesorectal excision and lateral pelvic lymph node dissection for locally advanced (T3/T4) rectal cancer located below the peritoneal reflection.

机器人辅助全直肠系膜切除术和盆腔外侧淋巴结清扫术治疗局部晚期中低直肠癌

Since their approval for clinical use, da Vinci surgical robots have shown great advantages in gastrointestinal surgical operations, especially in complex ...