14 research outputs found
NOUSEVAN AORTAN KIRURGIA; BENTALL-DEBONO LEIKKAUKSEEN LIITTYVÄT RISKIT JA VÄLITTÖMIIN LEIKKAUSTULOKSIIN VAIKUTTAVAT TEKIJÄT
No full textBentall-DeBono operaatio on yleisesti käytetty menetelmä nousevan aortan kirurgiassa. Tässä retrospektiivisessä tutkimuksessa kartoitettiin Tampereen yliopistollisen sairaalan Sydänkeskuksessa vuosina 2004–2009 Bentall-DeBono operaatiolla elektiivisesti leikatut potilaat. Leikattuja potilaita oli yhteensä 86. Poissulkukriteereinä olivat päivystysleikkaus ja aneurysma, joka ulottui aortankaareen.
Tutkimuksen leikkauskuolleisuus oli 3,49 %. Leikkauskuolleisuus oli yhteneväinen aikaisempien tutkimuksien kanssa. Postoperatiivisista komplikaatioista merkittävin oli eteisvärinä. Eteisvärinä ilmaantui 46,5 prosentille leikatuista. Iäkkäillä havaittiin enemmän postoperatiivista eteisvärinää ja sydänlihasiskemiaa kuin nuoremmilla potilailla. Diureettilääkityksellä oli eteisvärinää ehkäisevä vaikutus. Potilailla, joilla ei ollut preoperatiivisesti liitännäissairauksia, ei esiintynyt eteisvärinää ja johtumishäiriöitä oli muita vähemmän. Tämän tutkimuksen heikkoutena oli retrospektiivinen tutkimusasetelma ja tutkittavien potilaiden seurantaa ei luotettavasti pystytty analysoimaan.
Tutkimus osoittaa, että TAYS:n sydänkeskuksessa elektiivisesti Bentall-DeBono leikatut potilaat hyötyvät leikkauksesta. Tulevaisuudessa tarvitaan prospektiivisia tutkimuksia, jotta seuranta olisi mahdollista tehdä kontrolloidusti.
Asiasanat:Nousevan aortan kirurgia, Aneurysma, leikkaustulokse
Trends in Foot and Ankle Surgery : Hardware Removal and the Use of Bioabsorbable Implants
No full textTämän väitöskirjan tavoitteena oli selvittää vaivaisenluun leikkausmäärät ja mahdolliset muutokset edellisten vuosien aikana, tutkia metallisten implanttien poistomääriä nilkkamurtumaleikkauksien jälkeen sekä arvioida biomekaanisten testauksien avulla biomateriaaleja, jotka soveltuisivat jalkateräkirurgiaan.
Tutkimuksen yhtenä tärkeimmistä löydöksistä oli, että vaivaisenluuleikkauksien ilmaantuvuus väheni merkittävästi 1997-2014 välisenä aikana. Samaan aikaan isovarpaan tyvinivelen ja ensimmäisen jalkapöytänivelen luudutusleikkaukset kasvattivat suosiotaan ja ensimmäisen jalkapöytäluun osteotomia leikkaus pysyi suosituimpana toimenpiteenä.
Toiseksi todettiin, että metalli-implanttien poistomäärä oli jopa 27% nilkkamurtumaleikkauksen jälkeen. Huomionarvoista oli myös havaita ensimmäisen kerran, että poistomäärät olivat merkittäviä myös 3-vuoden jälkeen leikkauksesta. Metalli- implanttien poistoleikkaukset aiheuttivat merkittävää kustannusta yhteiskunnalle.
Kliinisessä seurantatutkimuksessa todettiin, että biohajoavalla piennivelimplantilla saavutettiin hyviä pitkäaikaisia tuloksia nivelrikkoisessa vaivaisenluu tai jäykkäisovarvas leikkauksissa. Tosin seurantatutkimuksen potilasmäärä oli vähäinen, mutta tutkimuksessa selkeästi nähtiin suurella osalla potilaista merkittävä hyöty kahdella eri potilasmittarilla.
Lisäksi väitöskirjassa todettiin kahdessa kokeellisessa työssä, että biohajoava ruuvi voi mahdollisesti toimia yhtä hyvin isovarpaan tyvinivelen ja ensimmäisen jalkapöytänivelen luudutusleikkauksissa. Tutkimuksilla haluttiin varmistaa, että on turvallista aloittaa kliininen tutkimuskokonaisuus, jolla asia voidaan todella todentaa.
Tässä väitöskirjassa on kuvattu erilaisia kirurgisia menetelmiä isovarpaan tyvinivelen ja ensimmäisen jalkapöytänivelen luudutusleikkauksissa. Ensimmäisessä osa- työssä todettiinkin juuri näiden leikkaustekniikoiden kasvattaneen viimeaikana suosiota. Väitöskirjassa selvitettiin, että nykyisin käytettyihin implanttimateriaaleihin liittyy ongelmia sekä niiden poisto-operaatioiden määrä on merkittävä myös taloudellisesti yhteiskunnalle. Vaikka nämä biohajoavat implanttimateriaalit ovat vielä kehityksen alaisia ja tarvitsevat vielä lisätutkimusta, on mahdollista, että ne voisivat korvata osittain nykyiset implanttimateriaalit.In Finland, first ray surgical indications and techniques have varied over time. Be- cause foot surgery is still a relatively new and narrow subspecialty within orthopedic surgery, there is very little systematic follow up or knowledge in foot surgery. The aim of this dissertation was to establish the number of first ray surgeries performed in recent years and to find out whether there have been any changes in surgical procedures during this time. A further aim is to ascertain the removal rate for metallic implants after ankle fracture surgery.
Bioabsorbable materials first came into use in the 1980s and became a keen focus of research thereafter. One part of this dissertation deals with bioabsorbable mate- rials in foot and ankle surgery. In this part of the study, the long-term results of a bioabsorbable interpositional implant were investigated and bioabsorbable screws were compared with titanium alloy screws in two biomechanical specimens.
Two of the main findings of the study were that the incidence of HV surgery reduced significantly between 1997 and 2014 and that the rate of implant removal was as high as 27% after ankle fracture surgery. A clinical follow-up study found that the bioabsorbable interpositional implant achieved good long-term results in MTP- 1 surgery. Furthermore, in this dissertation, it is demonstrated that a bioabsorbable screw may work equally well in TMT-1 and MTP-1 arthrodesis, although a clinical study is still required to verify this finding.
This dissertation describes a surgical technique in TMT-1 and MTP-1 surgeries that could lead to the future replacement of titanium alloy and steel implants. In the first part of the study, it was found that these surgical techniques have recently gained popularity. The finding of this dissertation demonstrate that the implant materials currently in use have drawbacks, such as stress-shielding and associated soft tissue irritation in addition to the significant economic cost to society of the large number of hardware removal operations. These bioabsorbable implant materials are, of course, still under development and still require more development and further research before they are ready to completely replace existing implant materials
Yksilölliset jalkineet ja pohjalliset jalkaongelmien hoidossa diabetesta sairastavilla
No full textNon peer reviewe
Diabeetikon turvonnut jalka vaatii heti huomiota
No full textKun diabeetikon jalka on turvonnut, tulee ensisijaisesti epäillä Charcot’n jalkaa. Raaja asetetaan välittömään varauskieltoon ja immobilisaatioon ortoosilla tai kipsillä. Tarkempi diagnostiikka tehdään diabetesjalkapoliklinikalla ja magneettikuvauksella. Kuvaamme kaksi tyypin 1 diabetesta sairastavaa potilasta, joille Charcot’n jalka kehittyi murtuman jälkeen. Diagnoosi viivästyi, koska kliininen kuva ei kivun vuoksi ollut tyypillinen tai epäiltiin rasitusmurtumaa. Alkuvaiheen röntgenkuva olisi voinut helpottaa diagnoosiin pääsyä ja hoidon valintaa.Peer reviewe
Reduced incidence and economic cost of hardware removal after ankle fracture surgery : a 20-year nationwide registry study
No full textIncidence and Timing of Foot Injury Diagnosis in Polytrauma Patients: A Retrospective Registry-Based Study
No full textBackground: Foot injuries are often missed in polytrauma patients, as more severe injuries may overshadow them, leading to delayed diagnosis and treatment. The aim of this study was to assess the incidence of foot injuries in polytrauma patients, evaluate the timing of their diagnosis, and identify risk factors associated with delayed diagnosis. Methods: In this retrospective registry-based study, all polytrauma patients with a New Injury Severity Score of ≥16 treated at Tampere University Hospital (TAUH) from 2016 to 2023 were screened for foot fractures as well as Lisfranc and Chopart injuries. Patient demographics, injury characteristics, and timing of diagnosis were extracted from TAUH’s trauma registry and analyzed. Results: Out of 1327 polytrauma patients, 54 (4.1%) sustained foot injuries, totalling 215 foot injuries (195 fractures). Delayed diagnosis, defined as >24 hours between trauma and diagnosis, occurred in 23 patients (43%), involving 80 injuries (37%). Fractures of the midfoot and metatarsus were most commonly diagnosed with delay. Delayed diagnosis was significantly more common in patients with a higher number of foot fractures and injuries (P < .001). Logistic regression analysis identified number of foot injuries (OR 1.658 [95% CI 1.098-2.504]), lower Glasgow Coma Scale (GCS) scores (OR 0.582 [95% CI 0.340-0.998]), and presence of concomitant facial injuries (OR 18.227 [95% CI 1.643-202.211]) as independent risk factors for delay in diagnosis. Conclusion: A substantial portion of polytrauma patients had foot injuries that were diagnosed >24 hours after the time of trauma. Despite these delays, most injuries were minor and without notable clinical consequences. Current tertiary survey protocols effectively detect most major foot injuries requiring immediate attention. Level of Evidence: Level III, retrospective registry.Peer reviewe
Evaluation of the changes in incidence and patient age of knee arthroscopy along with changes in time between knee arthroscopy and arthroplasty between 1998 and 2018: a nationwide register study
No full textBackground: Recent evidence has led to guidelines to refrain from recommending knee arthroscopy for patients with an osteoarthritis diagnosis. The aim of this study was to evaluate the latest changes in the incidence of arthroscopic surgery for degenerative knee disease, changes in the ages of those patients and the delay between knee arthroscopy and arthroplasty, in Finland between 1998 and 2018. Method: The data for were collected from the Finnish National Hospital Discharge Register (NHDR). All knee arthroplasties and arthroscopies performed due to osteoarthritis, degenerative meniscal tears, and traumatic meniscal tears were included. Incidence rates (per 100,000 person-years) as well as the median age of patients were calculated. Results: The incidence of arthroscopy decreased 74% (413 to 106 per 100,000 person-years) and knee arthroplasty increased 179% (94 to 262 per 100,000 person-years) between 1998 and 2018. The incidence of all arthroscopies increased until 2006. Subsequently, the incidence of arthroscopy due to OA decreased by 91% and arthroscopic partial meniscectomy (APM) for degenerative meniscal tears decreased by 77% until 2018. The decrease of traumatic meniscal tears begun later, leading to decrease of 57% between 2011 and 2018. Conversely, the incidence of patients undergoing APM of traumatic meniscal tear increased 375%. The median age of patients who underwent knee arthroscopy decreased from 51 to 46 and from 71 to 69 in knee arthroplasty patients. Conclusions: Increasing evidence that recommends refraining from knee arthroscopy in OA and degenerative meniscal tears has led to a dramatic decrease in the incidence of arthroscopies. Simultaneously, the median age of the patients who undergo these operations has continued to decrease.Peer reviewe
Inter- and intraobserver reliability of non-weight-bearing foot radiographs compared with CT in Lisfranc injuries
No full textEpidemiology of talus fractures in Finland: a nationwide register study from 1997 to 2020
No full textAbstract Background The aim of this study was to estimate the nationwide incidence of talus fractures (per 100 000 person-years) and to determine the incidence of operative treatment in the Finnish population. Methods Based on Finnish Care Register for Health Care data, all patients 18 years and older admitted to hospital with talar fractures between 1997 and 2020 were included. Results During the 24-year study period, 5247 patients with primary or secondary diagnoses of talar fracture were identified. The mean incidence during the whole study period was 50.4 per 100 000 person-years. There was a clear increase starting from the year 2009 (61.4 per 100 000 person-years), that continued and the incidence in 2018 raised up to 106.8 person-years. The total incidence of operations performed on talar fractures remained almost the same during the study period (9.1 per 100 000 person-years from 1997 to 2020). Conclusions While the incidence of performed operations had remained stable, the incidence of talar fractures in Finland has increased during the last decades. The increase was more prominent in men. The observed change is possibly due to the progress and availability of computer tomography. Level of Evidence II
Operative versus non-operative treatment for non-displaced Lisfranc injuries: A two-center randomized clinical trial
No full textBackground and aims: There is no consensus on which Lisfranc injuries can be treated non-operatively. The aim of the study was to compare non-operative treatment and open reduction and internal fixation (ORIF) in the treatment of non-displaced Lisfranc injuries. Materials and methods: This study was a multicenter randomized controlled trial (RCT) conducted at two hospitals in Finland between 19 March 2012, and 20 December 2022, with a target sample size of 60 patients. The primary outcome was Visual Analogue Scale Foot and Ankle (VAS-FA) at 2 years. The secondary outcomes included VAS-FA pain, function, and other complaints subscales and the American Orthopedic Foot & Ankle Society (AOFAS) Midfoot Scale. All outcomes were measured at 6 months, 1 and 2 years. Results: Altogether 27 patients with computed tomography (CT)-confirmed non-displaced Lisfranc injuries were enrolled in this trial resulting in an underpowered trial. In patients with non-displaced Lisfranc injuries, the mean VAS-FA overall score in the non-operative group was 96.1 [confidence interval (CI): 91.5–100] and 91.8 [86.9–96.7] in the ORIF group at 2 years with no statistically significant difference between the groups (mean between-group difference (MD) 4.3 [CI, −2.4 to 11], Cohen’s d = 0.706) in this underpowered RCT. Conclusion: There was no difference in VAS-FA between non-operative and ORIF in patients with non-displaced Lisfranc injuries, but the trial is underpowered to draw robust conclusions.Peer reviewe
